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?QUIZ COMPKNDS? No. 13 
 
 A COMPEND OF 
 
 DENTAL PATHOLOGY AND 
 DENTAL MEDICINE 
 
 CONTAINING THE MOST NOTEWORTHY POINTS UPON 
 
 THE SUBJECTS OF INTEREST TO THE DENTAL 
 
 STUDENT AND A SECTION ON 
 
 EMERGENCIES 
 
 BY 
 
 GEO. W. WARREN, A.M., D.D.S. 
 
 PROFESSOR OF PRINCIPLES AND PRACTICE OF OPERATIVE DENTISTRY, PENNSYLVANIA 
 COLLEGE OF DENTAL SURGERY, PHILADELPHIA 
 
 FOURTH EDITION. ILLUSTRATED 
 
 PHILADELPHIA 
 
 P. BLAKISTON'S SON & CO 
 
 No. 1012 Walnut Street 
 1903 
 

 FEB^ 8 1947 
 
 ut^'^^fL/'CuG^G^ 
 
 Copyright, 1903, by P. Bi^akiston's Son & Co. 
 
 Prkss of 
 
 Rkpokt Publishing CoMPAiSv 
 
 Lebanon, Pa. 
 
iil 
 
 'St 
 
 cr> 
 
 TO MV FRIEND 
 
 PROFESSOR C. N. PEIRCE, D.D.S. 
 
NOTE. 
 
 One of the first, and sometimes most difficult, les- 
 sons the student has to learn is how to study, and 
 many of our text-books are so voluminous that they 
 prove a source of embarrassment to one just begin- 
 ning his professional studies. Compends are de- 
 signed to facilitate these labors, and if properly 
 used as aids to more elaborate works, they have a 
 special value. 
 
 The author hopes that it will be found useful to 
 students as a guide and help in giving a systematic 
 view of the subject to be studied in larger works and 
 as a book for review giving a thorough outline of 
 work which has been done. 
 
CONTENTS. 
 
 PAGE 
 
 Anatomical and Physiological iNTuoDrcTiox ^ 
 
 Development of the Teeth, ^ 
 
 Structure of the Teeth 14 
 
 Anatomy of the Teeth !•' 
 
 Decalcification of the Temporarj^ Teeth '^^ 
 
 Dental Pathology and Therapeutics ^'-^ 
 
 Inflammation, ; ^^ 
 
 Diseases of the Dental Pulp and Membrane, ^^ 
 
 Diseases of the Hard Dental Structure, 4*.> 
 
 Injuries and Diseases of the :Maxillary P.ones 57 
 
 Defects of the Palatine Organs ^5 
 
 Extraction of Teeth, ^'^^ 
 
 Deposits upon the Teeth, "^ 
 
 Dental Medicine, ^4 
 
 Narcotics and Hypnotics ^4 
 
 Analgesics or Anodynes, *^ 
 
 Anesthetics, '•' 
 
 Stimulants, -^^ 
 
 Tonics, 1^^ 
 
 Sedatives, H-^ 
 
 Antipyretics, H**^ 
 
 Irritants 120 
 
 Astringents, 123 
 
 Styptics and Hemostatics, 126 
 
 Escharotics or Caustics, 12'i' 
 
 Antizymotics (Antiseptics and Disinfectants), 131 
 
 Cathartics, 143 
 
 Emergencies, . 14^ 
 
 Weights and Measures, ' l'if^2 
 
 Index, l'*^^ 
 
 vii 
 
ABBREVIATIONS. 
 
 ABBREVIATION. LATIN. 
 
 aa Ana (G.), 
 
 Ad saturand., . . .Ad saturandum, . 
 Ad lib., .... Ad libitum, 
 Aq., . . . . ^ Aqua, .... 
 
 Aq. dest., .... Aqua destillata, . 
 
 Comp., Compositus, 
 
 Ext., Extractum, . 
 
 F. or Ft., . . . .Fiat vel flant, 
 
 Garg., Gargarysma, . 
 
 Gr., Granum, vel giana, 
 
 Gtt Gutta, vel gutt^, . 
 
 Infus., Infusum, . 
 
 M., Misce 
 
 Mist Mistura, . . . 
 
 0-. Octarius, 
 
 Pil Pilula, vel pilulae, 
 
 Pulv., Pulvis, vel pulveres, 
 
 Q- s., Quantum sufficit, 
 
 IJv Recipe, 
 
 S., Signa, .... 
 
 Spts., Spiritus, 
 
 ss., Semis, .... 
 
 Syi., Syrupus. 
 
 Tinct., Tinctura, . 
 
 It) Libra 
 
 *. Uncia, .... 
 
 3» Drachma, . 
 
 9. Scrupulus, 
 
 iE Fluid uncia, 
 
 f3, Fluid drachma, 
 
 T(\^, , , . , . . Minim, 
 
 ENGLISH. 
 
 . Of each. 
 
 . Until saturated. 
 
 . At pleasure. 
 
 . Water. 
 
 . Distilled water. 
 
 . Compound. 
 . An extract. 
 
 . Let there be made. 
 
 . A gargle. 
 
 . A grain, or grains. 
 
 . A drop, or drops. 
 
 An infusion. 
 
 . Mix. 
 
 . A Mixture. 
 
 . A pint. 
 
 . A pill, or pills. 
 
 A powder, or powders. 
 
 . A sufficient quantity. 
 
 . Take. 
 
 . Write directions. 
 
 . Spirits. 
 
 . The half. 
 
 . Syrup. 
 
 . A tincture. 
 
 . A pound. 
 
 . An ounce. 
 
 . A drachm. 
 
 . A scruple. 
 
 . A fluid ounce. 
 
 . A fluid drachm. 
 
 . A drop. 
 
 Vlll 
 
DENTAL PATHOLOGY AND 
 DENTAL MEDICINE. 
 
 ANATOMICAL AND PHYSIOLOGICAL 
 INTRODUCTION. 
 
 DEVELOPMENT OE THE TEETH. 
 
 A Tooth. — It is sometimes difficult to give in a few words 
 a satisfactory definition to a term. This it seems has been the 
 case with the word tooth. Some writers say "a tooth is a hard 
 substance situated in the anterior portion of the alimentary 
 canal;" others define it as "a papilla of the raucous membrane of 
 the gum, which has undergone a characteristic development." 
 Again it is described "a bony structure implanted in the alveoli 
 along the margins of the jaw." Broomell, in his excellent work 
 on Dental Anatomy and Histology, says "a tooth is a specialized 
 organ for the seizure and mastication of food, placed at the 
 entrance of the alimentary canal." But as a little fuller and 
 more satisfactory explanation of the term we might accept the 
 following : "A tooth is a small organ, bony in character, which 
 normally occupies an alveolar cavity of the upper or lower 
 jew. Collectively the teeth are the hardest portion of the body 
 and are the principal organs of mastication." The developmen^" 
 of these organs is a most curious and interesting process, com- 
 mencing very early in fetal life. 
 
 The Enamel Organ. — During the seventh week of fetal 
 life there appears on the border of the jaw a ridge of epithe- 
 
 9 
 
10 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 lium, known as the dental ridge; from this the epithelial folli- 
 cles are deflected inward, and later on form what is known as 
 the Enamel Organ. Each follicle represents an individual 
 
 .a 
 
 Fig. 1. 
 
 Fig. 2. 
 
 Figs. 1 and 2. — Theee Stages in Developing Enamel Organs. 
 a. Dental ridge, c. Infant layer of cells, d. Epithelial cord. e. Stellate 
 reticulum, f. Dentinal papilla, g. Inner tunic, h. Outer tunic, i. 
 Transverse section of vessel. 7c. Forming bone. 
 
 tooth. The cells active in the formation of the enamel are 
 known as enamelblasts or amelloblasts.. 
 
 The Dentine Organ. — A papilla arises in the dermal tissue, 
 
DEVELOPMENT OF THE TEETH. 
 
 11 
 
 at a point immediately in contact with the rounded portion of 
 the enamel organ — ^that is, from below in the lower jaw, and 
 from above in the upper Jaw. Simultaneously, the bottom of 
 the enamel organ is rendered concave, in correspondence to the 
 form and size of the dentine papilla, covering it like an in- 
 verted cup : this dentine bulb begins to assume the form of the 
 tooth from the ninth to the tenth week. (See Figs. 1 and 2.) 
 
 By the end of the twelfth week the follicles of the first, 
 or deciduous, set of teeth are completed. 
 
 Fig. 3. 
 
 a. Outer layer of mucous membrane. 6^ 6. Calcifying bone. c. Epithelial 
 cord. d. Dentinal papilla, e. Calcifying enamel, f. Enamel germ. 
 h. Permanent tooth germ. 
 
 When the follicle is completed, it is developed by vascu- 
 lar tissue, forming the dental sac; this is about the fourteenth 
 week. During this process of dentification there appears in the 
 jawbone a groove within which the dentinal follicles rest. 
 
 Follicular Development of the Permanent Teeth. 
 
 The follicles of the permanent teeth begin to develop 
 about the seventeenth week of embryo life; of these, the first 
 to become completed are those of the four first molars, at ahout 
 the twentieth weeh; these are followed by the follicles of the 
 teeth anterior to them, which are completed before birth. 
 
12 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The ten anterior teeth originate from the necks of the 
 primitive follicles, while the hud of the follicle of the first per- 
 manent molar originates from the epithelial lamina, as do the 
 deciduous teeth, and back of all the follicles of the temporary- 
 set. 
 
 The follicle of the second permanent molar originates 
 from the neck of the follicle of the first molar, and begins to 
 
 Tooth sac of Per- 
 manent Tooth. 
 
 Periosteum and 
 Mucous Mem- 
 brane from 
 Hard Palate. 
 
 Gubernaculum. 
 
 Tooth sac for Per- 
 manent First 
 Molar. 
 
 Fig. 4. — Tooth-sacs of Deciduous Teeth. 
 
 form about the twelfth week after birth. This budding process 
 is illustrated in Fig. 3. It is also very clearly shown in Fig. 
 4 which represents a dissection made by Prof. Broomell. 
 
 The follicle of the third permanent molar begins to 
 develop about the third year after birth, budding from the neck 
 of the follicle of the second molar, and is in its follicular evo- 
 lution about three years, thus loosening its connection with 
 the epithelial band at about the sixth year. It is then from 
 
DEVELOPMENT OF THE TEETH. 13 
 
 twelve to fifteen yeai's coiuing- to such maturity as to emerge 
 from the giim. 
 
 Calcification. 
 
 The Calcification of the Enamel. — The deposition of lime 
 salts., which gives the teeth their characteristic hardness and is 
 termed calcification, commences at the surface of the dentine 
 and proceeds outward, each enamel rod taking the form of the 
 cell, which in their compactness take on various shapes, usually, 
 however, hexagonal, and the lime salts from each are depos- 
 ited in close contact with each contiguous cell; there being but 
 a very small amount of animal matter, the cement material be- 
 tween them. When it is completed the enamel organ disappears 
 and nourishment to the enamel can only be had through the 
 surface lying nearest to the dentine, which is accomplished 
 through osmotic action. 
 
 The calcification of the dentine commences on the surface 
 next to the enamel organ, and progresses from without inward, 
 this being the point where mineralization begins in the tooth 
 structure. The working cells of the dentine, the odontoblasts. 
 throw out processes around which the lime salts are deposited, 
 the processes leng-thening with the thickening of the cap of 
 dentine; thus forming the tubular structure of dentine. The 
 processes occupying the tubules of the dentine are simply pro- 
 toplasmic prolongations. As age advances, both the tubuli and 
 fibrilli decrease in size, and in old age the extremities are 
 nearly or wholly obliterated. 
 
 The Cementum. — The cells active in the formation of the 
 Cementum are termed Cementohlasts. This structure is formed 
 from the pericemental membrane, remaining as the residue of 
 the dental sac, and becomes adherent to the previously calcified 
 dentine. 
 
 Calcification commences about the seventeenth week of fetal 
 life, in the temporary incisors, and in the remaining temporary 
 teeth during the seventh month; in the first permanent molars 
 
14 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 during the eighth month; during the first year in the perma- 
 nent incisors and cuspids; the third year in the bicuspids, the 
 fifth year in the second molars, and during the eighth year in 
 the third molars. 
 
 It requires about two years for calcification to become com- 
 pleted in a deciduous tooth, and about ten years in a perma- 
 ment tooth. The progress of calcification is shown in Fig. 5. 
 
 STRUCTUEE OF THE TEETH. 
 
 Physiologically, the teeth are divided into the enamel, den- 
 tine, cementum, pulp, and pericemental membrane. 
 
 The enamel covers the crown portion of the dentine. It 
 is the hardest and most dense of all organic substances, hence 
 it serves as a protection to the dentine from abrasion, and 
 forms a greater resistance to mechanical force and the action 
 of acids as well as to beautify the teeth. 
 
 The dentine gives the typical form of the teeth. The chief 
 characteristics which adapt it to constitute the main body of 
 the tooth structure are its density and vitality. While it en- 
 closes within it the pulp, it is itself enclosed on the crown by 
 the enamel and on the root by the cementum. Frequently im- 
 perfect dentine formations occur, known as interglobular 
 spaces; these are found near the surface of the enamel and are 
 due to malnutrition during the period of calcification. Pits 
 in the enamel will very often be found accompanying these 
 interglobular spaces, and are due to the same causes. 
 
 The cementum, a somewhat dense substance, covers the 
 root portion of the dentine. Its special use is, by being inter- 
 mediate in the density of its structure, to form a union of the 
 soft tissue of the root membrane with the dentine, thus aiding 
 the pulp in nourishing the tooth, and preserving, in a measure, 
 the vitality of the tooth after the pulp may have been de- 
 vitalized. 
 
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 CO 
 
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 c3 
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16 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The pulp is enclosed by the dentine, and like the dentine 
 represents the shape of the tooth only in a more diminished 
 size. It is composed of nerve, vein, artery and formative tissue. 
 This body is the mere shrunken condition to which the tooth 
 germ, or dental papilla, is reduced, after it has normally accom- 
 plished the work of dentification. 
 
 Fig. 6. — Repkesents Vektical, Sections of the Uppek Cuspid and 
 
 MOLAE TeETH^ showing THE RELATION AND RELATIVE THICKNESS 
 
 OF THE Hard Dental Tissues ; also Size^ Shape and Location 
 op the Pulp Chamber. 
 
 E. Enamel. C. Cement. D. Dentine. P. Pulp cavity. 
 
 The pulp is exquisitely sensitive and highly vascular; it is 
 of a reddish gray color and is enveloped in an exceedingly deli- 
 cate membrane, which is continuous with the peridental mem- 
 brane and is adherent to the wall of the pulp cavity. 
 
 The pulp is divided into two portions — the crown or body, 
 which occupies the crown cavity, and the extremities, which 
 occupy the root canal. 
 
 In advanced age this body often undergoes considerable 
 
STRUCTURE OF THE TEETH. 
 
 17 
 
 change; the size is sometimes much diminished or is entirely 
 replaced by calcic matter, while again it is found as a shriveled 
 and nearly insensitive mass. 
 
 This degeneration is due to the mild but almost constant 
 irritation and shock to which the teeth are liable at this time 
 of life, owing to their w^orn and abraded condition. If then. 
 
 Main Nerve- 
 trunk. 
 
 Main Blood- 
 vessels. 
 
 Branch ing 
 of Main 
 Nerve- 
 trunk into 
 Single Fi- 
 bers. 
 
 Bra n ehi ng 
 of Main 
 Blood-vt'S- 
 sels into 
 Capilla- 
 ries. 
 
 Fig. 7. — Distribution of Blood-vessels and Nerves to the Pulp of 
 Human Molar. — (Broomell, after Gysi.) x 20. 
 
 the irritation is mild, and the patient of a calcic diathesis, this 
 further deposit of lime salts is made, and the pulp diminished 
 in size in consequence. But where the irritation is more severe 
 it will result in congestion and death of the pulp. 
 
 The pericemental membrane is, as the name implies, the 
 membrane which surrounds or invests the roots of the teeth. Ifc 
 is a richly vascular, fibrous structure, and is the nutrient organ 
 of the cementum. It is also the organ of touch in the tooth, a8 
 
18 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 through the nerves of this membrane every impression upon the 
 tooth is reported to the brain. It serves, too, to unite the tooth 
 to the alveolus by its continuation throughout the alveolar 
 cavities or sockets, and is connected at the dental foramen with 
 the pulp, as previously stated. 
 
 The peridental membrane also serves as a cushion, permit- 
 ting a certain passive motion by v^hich the teeth are protected 
 from injury by blows and concussions which they are apt to 
 receive during the performance of their peculiar function of 
 tearing and grinding during the process of mastication. 
 
 Nutrition of the Teeth. — As has been indicated, the pulp 
 owing to its very intimate relation to the dentine, is the prin- 
 ciple source of blood and nerve supply to that structure. His- 
 tologists show us that the dental tubules or tubuli open freely 
 upon the walls of the pulp cavity, and are therefore brought 
 into direct communication with the pulp. These tubuli as they 
 radiate towards the enamel and cementum, gradually diminisli 
 in size and give off numerous branches which anastomose with 
 those of neighboring tubuli, or they may gradually disappear; 
 or, as they sometimes do, enter the enamel or cementum layers 
 and through them, these tissues are nourished by osmotic action. 
 Jt is through this plasmic material which invades the tubular 
 substance, that the tooth receives its nourishment. 
 
 The cementum may be largely excluded from tlie above as 
 this structure is principally nourished by the pericemental 
 membrane. The cementum is but a slight modification of bone 
 structure; it has the little lakes or lacunae, filled with protoplas- 
 mic material, and small radiating canals or canaliculi, which 
 comtmunicate with the neighboring lacunae. These little lakes 
 are supplied with nutrient material principally from the arterial 
 circulation of the pericemental membrane. As previously 
 stated, however, the dentinal tubuli do sometimes enter the ce- 
 mentum and then unite with the nearby canalicidi and thus 
 become involved in a measure in the nourishment of this 
 structure. 
 
ANATOMY OF THE TEETH. 19 
 
 ANATOMY OF THE TEETH. 
 
 Primary and Permanent Dentures. 
 
 Anatomically, tlie teeth are divided into three parts, the 
 crown, neck, and root, the crown being that portion which pro- 
 jects freely into the mouth; the neck is surrounded by the 
 gums, and the root is that portion covered by the alveolar pro- 
 cess of the jaw and by which the whole tooth is held securely in 
 position. In old age it is not unusual for the gums to recede, 
 exposing the neck, and sometimes a part of the root is exposed 
 in consequence of atrophy of the alveolar process. The teeth 
 are classified into two general groups, the simple, those having 
 but one root and cusp, and the complex, or those having two or 
 more roots and cusps. Collectively as dentures there are also 
 two divisions — the first is called the deciduous or temporary 
 denture, designed to serve the needs of early childhood. The 
 second is termed the permanent set or denture. 
 
 The temporary denture consists of twenty teeth, divided 
 into three groups — the incisors, cuspids, and molars. The rela- 
 tive position and number these groups bear to one another is 
 expressed in the following formula: — 
 
 M^ M, CI2 1, I I, lo C M, M^. 
 
 In the temporary teeth the proportion of the length to the 
 width is marked, they being somewhat shorter than their suc- 
 cessors, the permanent teeth. The color of the temporary 
 teeth is of a milky or bluish white, while that of the perma- 
 nent presents a yellowish appearance. In determining be- 
 tween the temporary and permanent teeth the observer will 
 be aided by the relative size and color, and by remembering 
 that the former are somewhat loose, and have a marked depres- 
 sion at the neck, just at the union of the enamel and cementum. 
 
 The permanent denture consists of thirty-two teeth, which 
 
20 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 are divided into four groups, namely: incisors (cutting), cus- 
 pids (tearing), bicuspids (crushing), and molars (grinding), 
 according to the following formula: — 
 
 M3 M2 M, BC, BC, C I, I, 
 JVIgM^M^BC^BC^CI,!, 
 
 I, I, C BC, BC2 M, M, M3 
 I.LCBC.BaM^M^Mg 
 
 The relation between the permanent and temporary teeth is 
 shown in the accompanying diagram. Fig. 8. 
 
 The anterior twenty teeth, namely, the incisors, cuspids, 
 and bicuspids, each have one root, except the first upper bicus- 
 
 3 3 
 
 ' 4- 2 2 At '7 
 
 Fig. 8.* — The Figures 1, 2, 3, etc.^ Indicate the Groups of Teeth 
 AND THE Order of their Appearance. 
 
 pid, which in about eighty per cent, has two roots, one labial 
 and one palatine. The roots of the upper incisors are rounded; 
 those of the bicuspids are flattened laterally. The roots of the 
 lower incisors are the most flattened, while the root of the cus- 
 pid combines partially the roundness of the incisor and the flat- 
 ness of the bicuspid. The upper molars have three roots each, 
 two buccal and one palatine, which are usually of a round 
 
 *Taken from "Diseases of the Digestive Organs in Infancy and Child- 
 hood," by Dr. Louis Starr. 
 
ANATOMY OF THE TEETH. 
 
 21 
 
 shape. While the lower molars have but two roots, one an- 
 terior and one posterior, these are laterally flattened, and extend 
 from the buccal to the lingual surface of the tooth. The roots 
 of the third molar or wisdom tooth are subject lo the same 
 rules as those of other molars, but they are subject to a great 
 number of exceptions. 
 
 The crowns of the teeth present several surfaces for ex- 
 amination, which are named according to their position and 
 use. Those of the incisors and cuspids presenting toward the 
 lips are called labial surfaces; while the same outer surfaces of 
 
 Fig. 9. — The medium line is shown at M, labial surface at L, cutting edge 
 at C, palatal surface at P, and approximal surfaces at A, of typical 
 superior central incisors. 
 
 the bicuspids and molars are called huccal, being next to the 
 cheeks, and the opposite or inner surfaces of all the teeth, that 
 portion presenting toward the tongue, are called the lingual 
 surfaces. Some, however, use the term "palatine surfaces" for 
 those of the upper jaw and "lingual" for those of the lower. 
 While this is not necessary, it seems perfectly proper. 
 
 Those surfaces of the teeth that lie adjacent or next to the 
 adjoining teeth are called proximate or proximal; these are 
 more closely defined or divided by the terms mesial and distal. 
 They are so named hj their relative position to the central or 
 median line of the face. Those proximate surfaces which face 
 toward the median line are called mesial surfaces; and the op- 
 posite, or those most distant from this line, are called the distal 
 
22 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 surfaces. These several surfaces are clearly shown in Figs. 9, 
 10 and 11. 
 
 Fig, 10. — The SevebaIj Surfaces 
 OF A Superior Cuspid Tooth. 
 
 L indicates the labial, P, the pal- 
 atal, and A, the approximal sur- 
 faces. 
 
 Fig. 11. — The Three Roots, Neck 
 AND Crown of a Superior 
 Molar Tooth, Presenting 
 Both the Buccal and Ap- 
 proximal Aspect. 
 The masticating surface is indi- 
 cated at M. 
 The cutting edges of the anterior teeth and the grinding sur- 
 faces of the bicuspids and molars are called the occluding sur- 
 faces. 
 
 J 
 
 ^ 
 
 Fig. 12. 
 
 The arrangement of the teeth in the dental arch is repre- 
 sented in Fig. 12. 
 
ANATOMY OF THE TEETH. 
 
 23 
 
 The Normal Articulation. — In the upper jaw the arch is 
 larger than in the lower, especially in the anterior portion of 
 it. The upper and lower teeth, therefore, do not meet perpen- 
 dicularly in articulating; the lower incisors and cuspids articu- 
 late on the palatine surfaces of the corresponding teeth in the 
 upper jaw. The cusps of the lower bicuspids and molars articu- 
 late in the grooves and furrows of the upper, and the teeth are 
 so arranged in size and position that each tooth in the upper 
 
 Fig. 13. 
 
 jaw when articulating occludes with two of the lower teeth. 
 This is illustrated in Fig. 13. 
 
 Primary Dentition. 
 First dentition takes place, normally, in the order given in 
 the following formula : — 
 
 Central incisors, 5th to 7th month. 
 
 Lateral " 7th to 10th 
 
 First molars, 12th to 14th 
 
 Cuspids, 14th to 18th 
 
 Second molars, . . . , , . 18th to 25th " 
 
 Marked Exceptions.— Some children are born with a few 
 teeth erupted, and there are cases reported where the entire 
 
24 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 temporary set have been erupted at birth; there are also cases 
 on record of adults who have been edentulous from birth. But 
 these are rare exceptions. 
 
 The force which causes the teeth to emerge is called vital 
 force, and operates by growth, developing first the neck, then 
 proceeding gradually to the apical end of the root. 
 
 Lesions Incident to First Dentition. 
 
 The eruptive process of dentition is normally a physiological 
 action, and should be accomplished without serious constitu- 
 tional disturbance. In order that the teeth may emerge it is not 
 only necessary that the overlying gum tissue be absorbed, but 
 a portion of the bony crypt must be removed in order to allow 
 tlie crown to pass through. This, with the pressure against a 
 sometimes thick and swollen gum, and the backward pressure 
 upon the formative organ, does however, in many cases cause 
 serious irritation. 
 
 During early childhood the tissues are all softer, more vas- 
 cular and sensitive, the nervous system predominating. Hence 
 it is that the system at the period of first dentition is so sus- 
 ceptible to nervous impressions. In infancy, too, the system is 
 less capable of combating diseases, and a large portion of the 
 alarmingly great mortality of this period may be traceable to 
 the irritation caused by dental evolution. 
 
 The indications of the eruption of the teeth are, first, an 
 increased flow of saliva — a healthy manifestation, as it tends to 
 keep the mouth moist and cool. This "drooling" is due to the 
 irritation of the trifacial or fifth pair of nerves, which is sen- 
 sory to the teeth and nutrient to the salivary glands. When the 
 irritation becomes more pronounced, the secretions are some- 
 what checked and the month becomes hot and dry, the cheeks 
 unusually red, eruptions appear upon the face, and, indeed, 
 sometimes over the whole body; with ulcerations upon the 
 tongue and mucous membrane of the mouth and inflanunation 
 
ANATOMY OF THE TEETH. 
 
 25 
 
 of the glim over the advancing tooth or teeth. A condition quite 
 opposite to the above in appearance is a white and hardened 
 glim overlying the advancing tooth or teeth. This offers a 
 gTeater resistance than the inflamed condition and is often neg- 
 lected, especially by physicians, owing to the absence of any 
 appearance of congestion. 
 
 The child becomes wakeful, peevish, and cross, loses his appe- 
 tite, and if relief is not then given this may be followed by 
 persistent nausea, diarrhoea, and spasms or con\ailsions. 
 
 Treatment. — The first thing is to remove the irritation by 
 
 Fig. 14. 
 
 freely lancing the gums over the advancing teeth. The manner 
 of doing this is admirably and fully shown in the accompany- 
 ing illustration (Fig. 14), which is taken from a paper by the 
 late Dr. James W. White, in the "American System of Dent- 
 istry.'' If the convulsive stage is reached, the patient's feet 
 should be placed in hot mustard water, and cold cloths applied 
 to the head, or the entire body put in a warm bath; such meas- 
 ures cause muscular relaxation and have a soothing effect upon 
 the nervous system. 
 
 Decalcification of the Temporary Teeth. 
 
 The temporary teeth must be removed before the per- 
 manent can erupt in their normal position; this, too, is a physi- 
 
26 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 ological action though a somewhat obscure one, and takes place 
 normally, by the resorption or decalcification of the roots. 
 
 This process usually commences at the apex of the root, on 
 the side nearest to the successional tooth; this, however, is not 
 invariably the case. Absorption may commence at several and 
 distinct points, sometimes on the labial side — ^that most distant 
 from the succeeding tooth. 
 
 The cause and manner in which the roots of the temporary 
 teeth are absorbed has been the subject of much and careful 
 study by such advanced investigators as Tomes, Peirce, 
 Bodeker, Abbot, and others. 
 
 It was thought for a long while that the pressure caused by 
 the advance of the permanent teeth was the sole cause for the 
 decalcification of the primary teeth; but it is now generally 
 conceded that it is simply the result of a physiological action 
 and not a mechanical force. The fact that the decalcification 
 of the deciduous teeth is frequently successfully accomplished 
 in the absence of the corresponding permanent teeth adds much 
 to the evidence that their presence and pressure is not essential. 
 
 Prof. Peirce, in the "Transactions of the American Dental 
 Association," says : "The several conditions which are always 
 present and essential are readily recognized, but the part each 
 plays is not easily ascertained. The place of its conmience- 
 ment, at the end of the root, the retention of. pulp vitality, and 
 the presence of a vascular papilla in close proximity to the 
 absorbing surface, with the fact that the surface of this papilla 
 is rich in giant-cells, termed '^osteoclasts/ are evidently essen- 
 tial accompaniments, and the absence of any one of them would 
 certainly militate against the completion of the process." 
 
 And in another place the same writer says: "That the organ 
 has served its purpose, and that the nourishment which had 
 previously been appropriated by it is diverted or relegated to 
 its successors, is probably the most plausible explanation we 
 can give of this interesting physiological process." 
 
ANATOMY OF THE TEETH. 
 
 27 
 
 Decalcification of the deciduous teeth commences in 
 the central incisors at about the fourth year; in the lateral 
 incisors in the fifth year; in the first molars the seventh year, 
 the second molars the eighth year, and the cuspids the ninth 
 year. After decalcification commences in a tooth, it takes about 
 three years for it to accomplish its work. (See Fig. 15.) 
 
 Second Dentition. 
 
 In a harmonious development of the teeth and jaws, the indi- 
 cations of the time approaching for the development of the per- 
 
 II 
 
 I'll 
 
 II 
 
 »!)■!» 
 
 Fig. 15. — Decalcification of the Deciduous Teeth. 
 (From a diagram prepared by Prof. C. N. Teirce, 1884.) 
 
 manent teeth are the expanding of the alveolar ridge and the 
 spreading apart of the deciduous teeth. 
 
 The emergence of the permanent teeth takes place, nor- 
 mally, in the order given below: — 
 
 First molars, 6 to 7 years. 
 
 Central incisors, 7 to 9 " 
 
 Lateral " 8 to 10 " 
 
 First bicuspids, 10 to 11 
 
 Second " 11 to 12 
 
 Cuspids 12 to 13 
 
 Second molars, 12 to 13 
 
 Third " 16 to 25 
 
 Exceptions. — Deviations from the order of appearance and 
 the respective ages as given above occur ; it is usually in strong 
 
28 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 cHildren that the teeth appear at a later period, a scrofulous 
 diathesis being indicated in premature dentition. 
 
 Third Dentition. 
 
 Cases of third dentition are reported by a number of writers, 
 but undoubtedly the majority of these reports refer to teeth 
 that in reality were part of the second set, which failed to 
 emerge at the normal time, and had only appeared in old age 
 when there was sufficient room for them, or the jaws had atro- 
 phied. 
 
 The writer has extracted two well-developed third molar teeth 
 (which had never emerged from the gums) for a patient sixty 
 years of age; this was after the extraction of the second molar 
 roots. It was known that the patient had never had any "wis- 
 dom teeth." 
 
 Anomalies of Number. — Supernumerary teeth are espe- 
 cially frequent in the anterior portion of the superior maxil- 
 lary. When sufficient room is wanted for them, they may 
 stand within or without the arch. Usually the shape of both 
 the crown and root of these teeth is conical, while the shape 
 of the crown of those found in the posterior part of the mouth 
 is cuboidal — resembling the molars. 
 
 Dentures from which normal teeth are missing are more 
 frequent than those containing supernumerary teeth. Occa- 
 sionally the space from which the permanent tooth is missing 
 may be occupied by a temporary tooth. Sometimes temporary 
 teeth may be seen in the mouth of persons twenty-five and 
 thirty years of age; in these cases the permanent ones are gen- 
 erally retained in the jaw, and may erupt later. 
 
INFLAMMATION. 29 
 
 DENTAL PATHOLOGY AND THERAPEUTICS. 
 
 Dental pathology treats of the origin and progress of the 
 varous diseases to which the teeth and the surrounding oral 
 tissues are liable. 
 
 Dental therapeutics considers the medicines and remedies 
 used in the treatment of such diseases. 
 
 Disease, pathologically considered, is any abnormal condi- 
 tion in those processes which constitute perfect health. It is 
 but the normal physiological force perverted, tearing down 
 what it had before built up. Its chief manifestations are ex- 
 pressed by the word inflammation. 
 
 In studying inflammation there are several terms which the 
 student should have clearly defined in order to have a proper 
 appreciation of the subject. We may refer to Hyperemia, Ple- 
 thora, Anemia, etc. 
 
 Hyperemia is a local congestion of blood, or a local plethora 
 of the capillaries. 
 
 Plethora then is an abnormal fulness of the blood-vessels; 
 generally speaking it is an increase in the entire mass of blood in 
 the system. The converse of anemia. 
 
 Anemia indicates a deficiency in the volume of blood in the 
 system, but particularly a deficiency in the red corpuscles. An 
 anemic condition therefore indicates an enfeebled condition of 
 system as a whole. 
 
 Ischemia (is-ke'me-ah) is the term used to indicate a local 
 anemia. It implies a deficiency of the supply of blood to a part. 
 
 Inflammation. 
 
 Inflammation may be defined as a disturbance of nutrition 
 in a tissue accompanied by heat, redness, swelling, pain, and 
 impaired function, modified only by peculiarities of the struc- 
 ture and intensity of action. It is a series of changing condi- 
 tions, each the result of the preceding one. It is essentially a 
 
30 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 destructive process and is the basis of many degenerative 
 changes. 
 
 The usually accepted view of modern pathologists is that 
 until the disturbed aria is invaded by septic organisms there 
 can be no deteriorative action, and that the earlier stages there- 
 fore, is simply a condition of hyperemia. That is to say, until 
 we have infection we are simply confronted with hyperemia or 
 local congestion. 
 
 This is essentially the same in the pulp of a tooth, as in the 
 peridental membrane, mucous membrane or elsewhere, slightly 
 varying symptoms being induced, as already indicated, by struc- 
 tural peculiarities. 
 
 The first cause of any inflammatory condition is irritation; 
 that is, the slightest foreign influence disturbing the harmony 
 of the functions of the tissues. This is most readily traced in 
 the vascular system. 
 
 The first stage may be accepted as congestion, in which 
 the capillary vessels are excited into active contraction and re- 
 laxation, quickening the circulation of the blood, inducing 
 warmth, and causing some discomfort. 
 
 Acute inflammation, or the second stage, is characterized 
 by warmth, a sense of fulness, slight swelling, and increasing 
 pain; the abnormal volume of blood in the parts presses upon 
 the nerve filaments supplying the inflamed tissue, causing pain 
 in accordance with the expansion of the vessels. 
 
 Chronic inflammation. — In prolonged inflammation, the 
 functions of the parts become somewhat changed, adapting 
 themselves to the surrounding conditions; thus, the tissues in- 
 volved become less susceptible to the impression of an irritant, 
 and comparatively little pain follows, this being one of the 
 most noticeable characteristics of chronic disease. 
 
 Treatment. — In treating inflammation, after removing the 
 cause, that is, the irritant, effort is made to effect resolution, or 
 to hasten suppuration. 
 
HYPERTROPHY. 31 
 
 Resolution is the subsidence of inflammation and a return 
 of the tissues to normality. 
 
 Suppuration, or pus formation, being the breaking down of 
 the parts, the debris of which, with white blood corpuscles, 
 forms pus. 
 
 The remedies used are, first, to remove the cause, to ad- 
 minister laxatives, and apply sedatives and stimulants. 
 
 The chronic stage of the inflammatory process, if not 
 checked, may result in one of several degenerative changes; 
 among these are hypertrophy, induration, tumefaction, or con- 
 gestion of the tissues. 
 
 Hypertrophy. 
 Hypertrophy is an excessive growth of normal tissue by the 
 multiplication of cell elements. Of the oral tissues, the gum 
 
 Fig. 16. 
 
 and mucous membrane are the most liable to this disease. The 
 usual form recognized is in a growth of the free border of the 
 gum, lying loosely against the teeth, in some cases extending 
 to the cutting edges. Another form consists in the thickening 
 of the entire gums, covering the teeth to such an extent that 
 only the masticating surfaces are visible; the hypertrophied 
 portion being firm and dense, protruding the lip to such an 
 extent as to cause deformity; this latter form of hypertrophy of 
 the gum, however, is rare. 
 
 The cause of hypertrophy of the gum tissue is usually lack 
 of care on the part of the patient. Calcic matter is deposited 
 about the cervical portion of the teeth, and this irritates the 
 surrounding gum tissue sufficiently to stimulate it to abnormal 
 activity. The consequence is a multiplication of the cell ele- 
 
32 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 raents resulting in a local overgrowth or hypertrophy. This 
 condition is illustrated in Fig. 16. 
 
 Treatment consists in cutting away the long points and 
 borders of the gum down to the necks of the teeth, and then 
 the abnormal growth being out of our way, the treatment obvi- 
 ously is the careful and thorough removal of the irritating de- 
 posits. The small particles of calcific matter lying deepest 
 under the loosened gums, that is the spicules nearest the point 
 of actual attachment are the most irritating. It is essential, 
 therefore, that delicately formed instruments be employed to 
 reach the point of attachment and dislodge all foreign sub- 
 stance. 
 
 Where the deposits are very difficult to dislodge, the work 
 may be facilitated by applying a few drops of trichloricetic acid, 
 20 per cent., upon a small twist of cotton and allowed to remain 
 a few minutes. Following the removal of the calcic matter the 
 pockets should be thoroughly irrigated with warm water and 
 peroxid of hydrogen, followed by the application of stimulants 
 and astringents. 
 
 Other forms of hypertrophy are encountered by the dentist, 
 however, and may be here referred to. Occasionally we find 
 large hypertrophied areas of alveolae process, induced by irrita- 
 tion in consequence of lack of occlusion. Another form is 
 found in excementosis, hypercementosis or exostosis, as one may 
 choose to term it. This will be treated in another place. We 
 also find hj'pertrophy of the pulp tissue, resulting sometimes 
 from dental caries, which will be taken up under diseases of 
 the dental pulp. 
 
 Induration. 
 
 Induration is a circumscribed, hardened swelling; it is an 
 enlargement of individual cells, and not a multiplication as in 
 hypertrophy. In this condition the functions of the tissue in- 
 volved are inactive, the circulation being very much retarded. 
 
TUMEFACTION. 33 
 
 It may manifest itself in the gum, in the muscles of mastica- 
 tion, or in the muscles of the neck. 
 
 Treatment. — In induration of cheek or neck, apply hot 
 cloths and an active stimulant, such as capsicum. When the 
 disease is in the gum, apply capsicum plaster and lance freely. 
 
 Tumefaction. 
 
 Timiefaction is a condition of chronic inflammation, by 
 which is produced an abnormal amount of tissue, of a different 
 kind from the surrounding tissue, exhibiting a difference in 
 color and texture. Tumefaction as found in the mouth . is 
 divided into epulis, cystic, and vascular. 
 
 Epulis tumors originate in the periosteum, and are usually 
 found in the interspaces of the anterior teeth. They are fibrous 
 in structure, and usually of a dark red color. 
 
 Treatment consits of excision, care being taken to remove 
 all the abnormal tissue; the bistoury should be passed well 
 around and under the tumor, as deep as the periosteum; after 
 removing the growth as entire as possible with the knife, car- 
 bolic acid or trichloracetic acid should be applied, to destroy 
 the vitality of any fibers that should remain. 
 
 Cystic tumors originate in the mucous membrane; they are 
 membraneous in structure, of a lighter color than the normal 
 mucous membrane, and are filled with a viscid fluid. 
 
 Treatment consists in lancing at the lowest points, and 
 emptying the contents by pressure, after which applications of 
 stimulants and astringents should be made. 
 
 Vascular tumors arise from some blood-vessel supplying 
 the oral tissues. They are usually of a dark red color, and 
 highly vascular ; they have a smooth and shiny surface, and are 
 more or less fibrous. 
 
 Treatment same as in epulis tumors. 
 
 Congestion is also often the result of inflammatory pro- 
 cesses. 
 
34 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The prominent feature of congestion is blood stasis, caus- 
 ing severe pain with each pulsation of the heart. The capillary 
 vessels in the inflamed parts being engorged, the blood rebounds 
 at each pulsation of the heart, thus causing the throbbing pain. 
 The pain, however, is sometimes intermittent, by the capillaries 
 being broken through, relieving the pressure temporarily. 
 
 Treatment is to apply stimulants and sedatives. 
 
 Alveolar Abscess. 
 
 An abscess is a circumscribed collection of pus — circum- 
 scribed by the development of a soft membrane, forming a sac. 
 
 Fig. 17. — Result op an Abscess at the Root of an Incisob 
 Tooth ; a indicates abscess cavity ; b, mouth of fistula on gum 
 
 ABOVE LABIAL SURFACE OF THE TOOTH ; C, MOUTH OF FISTULA OPENING 
 ON THE PALATAL SURFACE, 
 
 restraining the pus from passing into the surrounding tissues, 
 causing it to seek the surface at the point of the least resist- 
 ance. The pus works its way through the tissue at this point, 
 forming an escape called a fistula. 
 
 An alveolar abscess is, as the name indicates, an abscess 
 originating within the alveolar walls. It is the result of inflam- 
 mation of the pericemental membrane, consequent, usually, 
 upon the death and septic decomposition of the tooth pulp. 
 
 Symptoms of alveolar abscess are congestion and inflam- 
 mation of the gums about the affected tooth; severe pain which 
 is often accompanied by considerable fever. There is also 
 
ALVEOLAR ABSCESS. 35 
 
 apparent elongation of the tooth, caused by inflammation of 
 the pericemental membrane and accumulation of pus in its 
 socket; the pus formed, being confined about the apical end of 
 the root, and between bony walls, causes considerable pressure 
 as it accumulates. The bone in this neighborhood is not of a 
 very hard nature, and in consequence is readily destroyed by the 
 pus in its efforts to seek the surface. During the time the pus 
 is penetrating the bone the patient suffers most ; the pain at this 
 stage being very severe and of a throbbing character. 
 
 The features become swollen and disfigured on the affected 
 side; the eye is sometimes entirely closed, and the jaws so stiff 
 that the mouth can not be opened to any considerable distance. 
 
 Treatment. — The surgical and local treatment consists in 
 gaining free access to the diseased parts, and removing the 
 cause, and breaking up the sac of the abscess. In securing 
 ready access to the point of accumulation it is best to first open 
 up the canals of the affected tooth. In doing this it is better 
 to sacrifice good tooth structure than to attempt to work around 
 corners and through too small a canal, being careful to follow 
 the line of the canal, and not perforate the side of the root; 
 after which the canal should be thoroughly irrigated with per- 
 oxide of hydrogen followed by a dressing of an effective anti- 
 septic and germicide before filling. 
 
 Where the abscess has advanced to any considerable extent, 
 it will sometimes be found necessary to more freely open or 
 enlarge the fistulous canal by driling in through the gum and 
 alveolar process over the affected tooth with a medium-sized 
 rose-head burr revolved by the dental engine. In so doing the 
 parts may be more thoroughly drained and treated, and the sac, 
 when attached to the end of the root, can be more readily 
 reached and broken up. 
 
 If the patient is in an otherwise healthy condition, nature 
 will finish the work by throwing off the broken-down tissue and 
 developing new granulations, without further treatment. It 
 
36 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 would be advisable, however, to assist in throwing off the foreign 
 matter by injecting peroxide of hydrogen and warm water freely 
 into the enlarged fistulous opening and socket. 
 
 Where the patient is of low vitality, or the abscess of long 
 standing, other therapeutic treatraent must follow the surgical 
 before a cure can be accomplished. After cleansing the canals 
 thoroughly with peroxide of hydrogen, as before stated, some 
 one of the more efficient antiseptic and disinfectant remedies, 
 such as carbolic acid and iodine, or oil of cinnamon, should 
 be applied on a strand of floss silk, or a few fibers of cotton, or 
 asbestos, which should be carried to the apex of the root by 
 means of a nerve canal-plugger, and the crown cavity closed 
 with a temporary stopping. The gum tissue about the affected 
 tooth should then be painted with tincture of iodine and aconite, 
 which will aid in the reduction of the inflammation by counter- 
 irritation. This treatment should be repeated in from two to 
 three days, and continued according to the character and symp- 
 toms of the case in hand. 
 
 Other causes than that of the death and decomposition of 
 the pulp may give rise to alveolar abscess; any foreign ma,tter, 
 such as filling material, being forced through the apex of the 
 root, calcic deposits within the walls of the alveolus, necrosed 
 root or hone, impacted teeth, etc., may cause sufficient inflam- 
 mation of the periosteum to produce an abscess, all the suc- 
 cessive stages of inflammation being involved in the formation 
 of an abscess, from irritation to suppuration. This is quite as 
 true in connection with vital teeth when calcic deposits are 
 made upon the pericemental membrane in sufficient quantity 
 to cause inflammation of that structure. 
 
 Ulceration. 
 The terms ulcer and abscess are frequently confounded by 
 students, and a general comparison may therefore be advan- 
 tageous. 
 
STOMATITIS. 37 
 
 An nicer forms upon the surface, that is, has its inception on 
 a cutaneous surface. An abscess forms in some cavity within 
 the body. An ulcer is never induced by pyogenic bacteria, 
 while infection from these organisms is the primary cause of 
 an abscess. 
 
 An ulcer is an open suppurating surface; an abscess is m 
 circumscribed collection of pus. 
 
 An ulcer usually has its inception in some morbid structural 
 change or old wound; an abscess is the result of some recent 
 degenerative condition. 
 
 Treatment for ulceration consists in applying astringents 
 and antiseptics, and administering a tonic. 
 
 Stomatitis. 
 
 The term stomatitis implies an inflammatory condition of the 
 tissues of the mouth. It is sometimes employed to cover diverse 
 conditions, though its usual application is to the tongue and 
 mucous membrane. It is usually due to a lack of oral hygiene. 
 and is more frequent in the mouths of infants, especially among 
 the children of the very poor where nourishing foods and sani- 
 tary surroundings are not much in evidence. 
 
 It may be said then to be due to improper food, infected milk 
 from lack of care in cleansing and scalding the nursing bottle, 
 irritating fungi harbored by rubber nipples, and from other 
 unsanitary conditions. 
 
 In adults a general neglect of the teeth and mouth may re- 
 sult in stomatitis. If food particles and mucous accumulations 
 are allowed to remain between the teeth and about the free 
 margins of the giims indefinitely the fermentation and putre- 
 faction resulting will cause gingivitis, which by continuity of 
 structure will spread over the entire mouth. Anemic persons 
 are specially liable to inflammatory conditions of the mucous 
 membrane, and where it continues for a considerable length of 
 time may result in an ulcerative stomatitis. 
 
38 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 L#ocal inflammation of the gums, which can not be classed 
 as general stomatitis — though it would contribute to a general 
 inflammatory condition of the mucous membrane of the mouth 
 where other unsanitary conditions are present — may result in 
 a loosening and thickening of the gingivae, a form of pyorrhea, 
 or a serious hypertrophy of the gums. These several conditions 
 will be treated under their proper classification. 
 
 DISEASES OF THE DENTAL PULP AND 
 MEMBEANE. 
 
 Inflammation of the Pulp or Pulpitis. 
 
 As in other tissues, inflammation is induced in tfie pulp by 
 irritation, and is similar to inflammatory conditions in other 
 tissues except slight modifications owing to the surrounding 
 conditions. The most raarked of these conditions is the fact 
 that the pulp is enclosed within close and unyielding walls. In 
 addition to this the blood-vessels of the pulp are modified in 
 structure in that they lack the muscular coats of other blood- 
 vessels; while the nerves of the pulp lack the general structure 
 of those of the general nervous system and have not the usual 
 sheaths. 
 
 The most frequent cause is the encroachment of dental caries ; 
 this removes the normal covering of the pulp, allowing thermal, 
 chemical and mechanical irritation to readily reach that soft 
 and sensitive tissue. 
 
 Treatment. — If irritation has been mild and only for a few 
 days, immediate filling will give relief. By mild we mean re- 
 sponsiveness to thermal changes, but passing away where the 
 irritation is removed; paroxysmal and returning only upon 
 provocation. If the irritation had continued for several days, 
 and has been severe enough to cause actual pain, which condi- 
 tion may be designated as hyperemia of the pulp, treatment 
 
DISEASES OF THE DENTAL PULP AND MEMBRANE. 39 
 
 consists in applying some stimulating antiseptic and filling with 
 a good temporary stopping. If no further pain is felt within 
 ten days, fill permanently. When the irritation has continued 
 for a considerable length of time, the pulp being seriously in- 
 volved though it may not be exposed, or in cases where the pulp 
 is exposed from the disintegration of the dentine covering, we 
 have a very different condition to cope with. Instead of having 
 the quick, sharp flashes of pain, disappearing in a short time, 
 the pain becomes almost continuous, accompanied with a bor- 
 ing sensation, indicating tl.at the inflammation had passed to 
 effusion, in which there is an extravasation or working out of 
 the blood into the body of the pulp. Up to this time there is 
 strong probability of the pulp returning to its normal condition 
 if treated as indicated, but this point having been reached the 
 probabilities are against its conservation, and it is generally 
 preferred to devitalize and extirpate the pulp and fill the canals 
 before attempting to fill the crown cavity. 
 
 In teeth that are not carious, inflammation of the pulp 
 may arise from violent thermal changes, to which they are some- 
 times very sensative, and if repeatedly exposed to such changes 
 death of the entire pulp may be the result. Or some slight 
 mechanical injury, resulting from a fall or blow, may cause 
 sufficient congestion to cause death of the pulp. Hence, we not 
 infrequently find teeth with devitalized pulps that are other- 
 wise sound. 
 
 Treatment in such cases is very simple. If the irritation 
 is from thermal changes and has not been of long standing, the 
 pulp will return to its normal condition by simply removing the 
 irritant; that is, protecting the teeth from such marked ther- 
 mal changes and applying a good stimulant, such as tincture of 
 iodine, to the gum over the root of the tooth affected. If the 
 pulp has been devitalized or the irritation has continued for 
 such a length of time as to make devitalization necessary, — that 
 is, where it will not respond to the treatment just described, — it 
 
40 DENTAL PATHOLOGY AND DENTAL MEDICESTE. 
 
 should be removed by opening the tooth at a point making the 
 pnlp chamber and canal of most easy access; and after the de- 
 vitalized organ is removed the canals should be thoroughly filled. 
 
 Inflammation of Pulp Following Filling. — Occasionally 
 inflammation of the pulp follows the filling of carious teeth. 
 This may arise from mechanical irritation, that is, undue pres- 
 sure upon the pulp by the capping or filling material; chemical, 
 by the action of acids used in the capping or filling material ; or 
 thermal, by the conductibility of the filling material, readily 
 carrying every impression to the pulp. 
 
 Treatment. — This can be readily diagnosed, and when the 
 inflammation is only superflcial the pulp may be restored to 
 health by removing the irritant and treating as directed above. 
 But when inflammation is more general (and every precaution 
 has been taken in filling the tooth), a general engorgement of 
 the blood-vessels and possibly effusion is indicated, there is no 
 reasonable probability that it can be saved; the filling, there- 
 fore, should be taken out, the pulp destroyed and removed, the 
 canals thoroughly closed and the tooth refilled. 
 
 Hypertrophy of the pulp is preceded by chronic inflam.- 
 mation, and is indirectly the result of caries. In hypertrophy of 
 this organ the nerves do not retain the same degree of growth as 
 the connective tissue ; the pulp polypus is, therefore, not so pain- 
 ful as the normal or acutely inflamed portion; for this reason 
 such growths are permitted to remain in the cavity for months 
 before the patient calls for treatment. 
 
 Treatment consists in the extirpation of the polypus, then 
 the devitalization and removal of the remainder of the pulp, 
 before filling. 
 
 Secondary Dentine. 
 
 There are several manifestations of secondary dentine, which 
 are classed as: — 
 
 (i) Dentine of repair, a physiologic process, wherein na- 
 ture through the odontoblasts interposes a secondary deposition 
 
DISEASES OF THE DENTAL PULP AND MEMBRANE. 41 
 
 of calcic matter. This is physiologic inasmuch as it is an at- 
 tempt to repair a loss of covering through caries, or to protect 
 the pulp from the encroachment of erosion or abrasion. 
 
 (2) Osteodentine or calcic degeneration of the pulp. This 
 is where the process last referred to — the deposit upon the 
 periphery of the pulp usually for self -protection, — is continued 
 until the entire body of this organ is calcified. This secondary 
 dentine differs somewhat from the primary dentine; it has fewer 
 tubules, and is calcified from several centers which are finally 
 fused together, making it quite irregular in form. 
 
 (3) Nodular Dentine, erratic growths or calcic exudations 
 into the pulp tissue. In other words it is a formation of small 
 nodules of calcified matter within the pulp cavity; they are gen- 
 erally confined to the body of the pulp, but at times nodules are 
 found within the root canals. Since nodular calcifications 
 sometimes occur in the pulps of teeth the crowns of which are 
 perfect, there being neither abrasion nor decay, though decay 
 may be and often is, found in connection with such formations, 
 the presence of these bodies is evidently due to some other cause 
 that is as yet unknown. These bodies give much trouble when 
 connected with other diseases affecting the tooth pulp, and 
 sometimes give serious trouble in themselves. This form of 
 secondary dentine should therefore be classed as pathologic. 
 When the bodies do occasion trouble, it is generally in the 
 form of infra-orbital neuralgia, with paroxysms of pain in one 
 or more of certain teeth. Patients with these symptoms some- 
 times present themselves. In "these instances, where no carous 
 
 
 
 or otherwise visibly diseased teeth are found, it may be pre- 
 sumed that the pain is caused by an odontinoid formation in 
 the pulp of one of these teeth. To ascertain the affected tooth, 
 the usual tests of cold water and percussion should be em- 
 ployed, when the patient will usually express some abnormal 
 feeling in the tooth or teeth containing these formations. 
 
 Treatment.— When pulp stones are diagnosed, the tooth 
 
42 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 should be drilled into, in the best position and direction for 
 reaching the pulp; this done, arsenious acid should be applied 
 for the devitalization of the pulp, which, of course, should be 
 thoroughly removed and the root canals and tooth filled. 
 
 Gangrene of the pulp (death in a body without loss of 
 substance, as in suppuration). — Gangrene of the pulp not infre- 
 quently is the result of acute inflammation; the over-supply of 
 blood in the arteries compresses the veins at the dental foramen, 
 interrupting the circulation so as to cut off all nutrition from 
 this territory, causing death to the pulp in a hody. Gangrene 
 occurs in two forms, dry and moist. Dry gangrene is where 
 the pulp becomes a dry and shriveled mass, or mummified. 
 Moist gangrene is where, after death en masse, we have putre- 
 factive decomposition of the pulp. Treatment consists in the 
 removal of all remnants of pulp and in perfect disinfection of 
 the root canals before filling. 
 
 Pericementitis. 
 
 Pericementitis (inflammation of the pericemental niem- 
 brane) may arise from some one or more of the following irri- 
 tants: inflammation of the pulp, putrescent pulp, excess of fill- 
 ing material, looseness of the tooth or root, salivary or sanguin- 
 ary calculus, dental manipulation, mal-occlusion, want of occlu- 
 sion, mercurial poisons, previous pericementitis, etc. 
 
 The pericementum serves as a cushion, breaking the force 
 directed upon the tooth in masticating or other external vio- 
 lence, hence we find it subject to occasional irritation from this 
 source. This tissue, too, is very vascular and not infrequently 
 is it infected from a decomposing pulp ; this is in fact the most 
 fruitful source of pericementitis. 
 
 Symptoms. — There is sometimes confusion as to the 
 symptoms which distinguish pulpitis from pericementitis. 
 Therefore, that the student may have a clear conception of the 
 differentiating symptoms they are compared in detail : 
 
DISEASES OF THE DENTAL PULP AND MEMBRANE. 43 
 
 PERICEMENTITIS. PULPITIS. 
 
 A kuowledge of the presence of the Sometimes difficult at first to de- 
 tooth, there being no trouble to locate termine just which tooth is at fault, 
 the one affected. the paiu being more or less fleeting. 
 
 There is apparent elongation, the ^, . i ^- 
 
 effected to.,th being the first to strike There is no elongation, nor incon- 
 
 iu closing the mouth. vemence in closing the teeth. 
 
 There is pain following the slight- There is no pain upon tapping, and 
 
 est pressure from occlusion of the tootle can be used in masticating if 
 
 jaws, or from the tongue or finders. thermal extremes are avoided, 
 
 or from tapping the tooth. The pain is sharp, and darting in 
 
 The pain is dull and constant, not character, and in earlier stages par- 
 paroxysmal in character. oxysmal. 
 
 There is no material sensation from Tooth is extremely sensitive to 
 
 thermal changes. thermal extremes. 
 
 Treatment. — First remove the irritants, vital or mechanical, 
 then apply a good stimulant and sedative to the gnni over the 
 affected tooth, to hasten resolution. A hot foot-bath is also 
 beneficial in relieving the blood pressure in the diseased parts. 
 When gangrenous or putrescent pulp is diagnosed, the teeth 
 should be thoroughly opened up, every vestige of the pulp re- 
 moved, the canal roots thoroughly cleansed and disinfected as 
 soon as the soreness will permit. 
 
 Pyorrhoea Alyeolaris. 
 
 Pyorrhoea alveolaris is a term applied to a condition char- 
 acterized by a breaking-down of the alveolar walls; forma- 
 tion of pus about the roots of the teeth; a deposit of calculi, 
 either salivary, sanguinary, or both, upon the teeth; a destruc- 
 tion of the pericementum, inflammation of the surrounding 
 tissues, and accompanied by a general calcic diathesis. This 
 condition has been known by numerous names; for many years 
 it was called "Rigg^'s Disease," expressing nothing. It was so 
 called because Dr. J. M. Riggs, of Hartford, Connecticut, 
 was first to give it much concern and to call public attention to 
 it as a distinct pathologic condition. 
 
 Pyrrhoea alveolaris has been divided by Professor Peirce into 
 two classes : (1) Those of local origin, and (2) those having 
 their origin in a constitutional derangement. In writing upon 
 this subject* Dr. Peirce stated that in the effort to reduce the 
 
 *For the Odontological Society of New York, November, 1893. 
 
44 DENTAL PATHOLOGY AjSJD DENTAL MEDICINE. 
 
 disease to tlie simplest factors and determine the primary ori- 
 gin of each, he should coin two terms, expressive as to the na- 
 ture of the disease. 
 
 The first form, where the salt is deposited from the saliva, 
 he has designated as ptyalogenic calcic pericementitis, express- 
 ing the idea that in its origin it is local, peripheral, and 
 salivary. This is characterized by a loosening and driving back 
 of the gum tissue, by the accumulation of calcic deposits; the 
 gums becoming turgid and inflamed. A viscid, degenerate 
 mucous may be forced from beneath the loosened gum, and it 
 may be found, in more advanced cases, that the irritation has 
 reached and involved the alveolar process and pericemental 
 membrane. When this condition is reached it is usually fol- 
 lowed by a more or less discharge of pus and loosening of the 
 teeth. This form of pyorrhoea alveolaris may, therefore, be at- 
 tributed to a general lack of oral hygiene. The irritation in 
 some instances is contributed to by mal-occlusion or non-occlu- 
 sion of aifected teeth. 
 
 The second is designated as hematogenic pericementitis, ex- 
 pressive of the idea that in its origin it is constitutional, cen- 
 tral, and associated with some modification of the normal com- 
 position of the blood plasma. This is the condition which may 
 be termed true pyorrhoea alveolaris. This latter form of the 
 disease has been demonstrated by Professor Peirce to usually 
 accompany the gouty diathesis, and he has been misquoted by 
 many in that it was the result of gout. His researches, however, 
 show that it is not the result of this disease, as it may exist 
 where there are no marked symptoms of gout, but that the pre- 
 disposing cause, uric acid, or other waste products, are aniver- 
 sally present. In other words it is another expression of the 
 uric acid condition. 
 
 One of the conditions usually present in this form of the 
 disease, is the accumulations of sanguinary calculi, very hard 
 and dark colored nodules upon the roots of the teeth affected. 
 
DISEASES OF THE DENTAL PULP AND MEMBRANE. 45 
 
 which concretions have repeatedly been found to contain uremic 
 salts, indicating a constitutional derangement. 
 
 Clinical History. — The clinical history of pyorrhoea alveo- 
 laris is, as has been previously indicated, a deposition of calcic 
 matter upon the necks or roots of the teeth; a loosening, swell- 
 ing, and more or less inflammatory condition of the gums; an 
 oozing of pus from beneath the gum margins; a resorption of 
 the alveolar borders; and a progressive loosening and mal- 
 position of the affected teeth. The true form of pyorrhoea alveo- 
 laris being coincident with some of the familiar expressions of 
 the uric acid diathesis, such as rheumatism and gout. 
 
 Treatment. — In this, as in all diseased conditions, the first 
 effort should be to remove the cause — that is, the source of irri- 
 tation. Where the exciting cause is purely local, that is, where 
 lack of cleanliness and the irritation from foreign substances 
 impinging on the gingival margin establishes a local gingivitis, 
 the treatment is of a simple nature. It may be simply the re- 
 moval, by suitable scaling instruments, of all calculary deposits 
 from the necks and roots of the teeth, a very simple line of 
 surgical procedure and should be most thoroughly and care- 
 fully carried out. This should be followed with local astrin- 
 gent and stimulating treatment for the gums, and enforced 
 hygienic treatment of the mouth. If mal-occlusion or lack of 
 occlusion play any part, this, too, should be corrected, if need 
 be, by the insertion of a sufficient number of artificial teeth to 
 overcome the difficulty ; or, if any of the teeth become very loose, 
 as we more frequently find the lower incisors, they should be 
 securely bound together by some light mechanical appliance. 
 
 When the origin is in a systemic derangement which 
 is usually found to be a uric acid diathesis, the general treat- 
 ment is directed toward the elimination of waste products; a 
 plain, wholesome diet and open-air exercise should be pre- 
 scribed. In such cases the medicinal treatment should, as has 
 been indicated, be directed toward the elimination of uric acid 
 
46 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 and its compounds. For this purpose some of the various lith- 
 ium preparations are indicated. And the free use of alkaline 
 waters — Vichy, Carlsbad, Apollinaris, etc. 
 
 In these cases we find deep pockets about the affected teeth, 
 formed by the breaking down of the surrounding alveolar wall; 
 the pockets contain pus to a greater or less extent, a quantity of 
 which can be forced out by a gentle manipulation of the gums. 
 There is accompanying this condition a heavy, metallic-like 
 odor to the breath, which is increased or diminished with the 
 quantity of pus present. 
 
 By a careful exploration of these. pockets we will detect well 
 up toward the apex of the root, and closely attached to its side, 
 hard and gritty nodules — the sanguinary deposits previously 
 referred to. 
 
 In addition then to the above anti-gout regime, careful local 
 treatment should be given these roots and pockets. The roots 
 should be cleansed as thoroughly as possible from all calcic 
 deposits, the pockets formed about the roots should be freely 
 irrigated with peroxide of hydrogen in warm water, followed by 
 the introduction of a few drops of pyrozone, 25 per cent., or tri- 
 chloracetic acid, 50 per cent., or lactic acid, or zinc chloride, as 
 some operators prefer, in each pocket. These drugs are best 
 applied upon a thin, wedge-shaped piece of orange wood, or upon 
 a small twist of cotton which may be forced to the extremities 
 of the pocket, and allowed to remain for a few minutes, when 
 the cotton should be withdrawn. This will "burn out" the 
 pockets, stimulating the formation of new granulations; then 
 the application of local stimulants, such aF the tincture of 
 iodine, should be made to the surface of the gums, and repeated 
 at frequent intervals. 
 
 Dental Erosion. 
 Dental erosion is a chemical solution of the faces of teeth, 
 and should not be confounded with dental caries or mechanical 
 
DISEASES OF TliE DENTAL PULP AND MEl^IBRANK, 47 
 
 abrasion. The labial surfaces of the teeth are usually attacked, 
 resulting in the formation of cup-shaped excavations. The ero- 
 sion, in some cases, progresses until the pulp area is encroached 
 upon; in these cases, however, it is usually found that nature 
 has caused a deposit of calcic matter to be made at the per- 
 iphery of this organ in advance of the progress of the erosion, 
 so that when the pulp is reached it is found to be entirely ob- 
 literated through calcification. 
 
 Cause. — Dental erosion is the result of the action of acid 
 secretions from the labial glands, caused, probably, by the pa- 
 tient being of the uric acid diathesis. 
 
 Fig. 18. — A TypiCAii Case of Erosion, showing the cup-shaped 
 
 CAVITIES on the FACE OF EACH OF THE ANTERIOE TEETH. 
 
 Treatment. — ^When the solution has proceeded to any depth, 
 the cavities may be filled. At the same time an alkaline mouth- 
 wash should be persistently used to counteract the acidity of the 
 oral secretions; counter-irritants may be applied to the tissues 
 surrounding the glands, and in extreme cises the destruction of 
 the glands by the electric needle has been suggested by Profes- 
 sor Brubaker. 
 
 Exostosis. 
 Exostosis, or hypercementosis, is a disease common to all 
 bones, but owing to the vascularity of the cementum of the 
 tooth, it is of tener found there to a greaater or less degree than 
 in any other part of the osseous structure. It consists of out- 
 growth of new tissue from the cemental layer covering the 
 roots of the teeth. It sometimes takes the form of prominent 
 nodules, and again will be found in regular layers or masses 
 covering a large portion of the cementum. 
 
48 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The specimens of hypercementosis shown in Fig. 19 are from 
 the practice of Dr. William Jarvie, and are teeth successively 
 lost by one patient. 
 
 The cause of exostosis is inflammation of the pericemental 
 membrane (pericementitis), which may be induced by mal- 
 occlusion, want of occlusion, shock from severe dental opera- 
 tions, or other violence, such as biting thread — a habit formed 
 by many seamstresses. Where any of the above conditions are 
 continued for any length of time it causes an abnormal energy 
 in the odontoblastic layer of the cementum, producing increase 
 
 Fig. 19. 
 
 in the growth of the structure. The alveolus is in many cases 
 enlarged or absorbed in proportion to the growth of cementum, 
 and the patient experiences little or no inconvenience, but there 
 are often instances where the enlargement of the cementum 
 causes such pressure on nerve filaments as to give more or less 
 discomfort, and sometimes excruciating pain; at times, too, it 
 causes severe facial neuralgia quite remote from the seat of the 
 trouble. It also happens in rare cases that the roots of adja- 
 cent teeth in this way become firmly united. 
 
 Treatment. — ^Where it is possible to discover this disease at 
 an early stage, the frequent application of a good counter-irri- 
 tant, such as tincture of iodine, over the affected root may in- 
 terfere with its progress. But where the disease has established 
 
DISEASES OF THE HARD DENTAL STRUCTURE. 
 
 49 
 
 itself, the extraction' of the affected tooth or teeth is the only 
 available treatment. 
 
 DISEASES OF THE HAED DENTAL STRUCTURE. 
 
 Dental Caries. 
 Dental caries is the gradual softening and molecular disin- 
 tegration of the tooth substance, proceeding from the periphery 
 toward the pulp. It first appears as a chalky, opaque spot in 
 
 Fig. 20.- 
 
 -PENETEATION OF THE TUBULI BY MiCRO-OKGANISMS. 
 
 (Barrett after Mummery.) 
 
 the enamel in which the structure is loosened and gradually 
 broken down. 
 
 In studying the causes of any disease they are divided into 
 two general groups, predisposing and exciting. By "predispos- 
 ing" we mean such causes as render the system or organ liable 
 to attack, yet in themselves are not sufficient to cause the dis- 
 ease. By "exciting" we mean such causes as are actually re- 
 sponsible for the establishment of the disease. The etiology 
 of dental caries will, therefore, be considered both from the pre- 
 disposing and exciting standpoint. 
 
)0 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The exciting cause of dental caries is (1) the action of 
 lactic acid, resulting from fermentation of food debris, which 
 attacks and breaks down the inorganic substance. (2) The 
 destruction of the organic matrix through the solvent action 
 of certain forms of micro-organisms. That is, after the enamel 
 rods have been broken down (decalcified), the tubuli of the 
 exposed area of dentine is invaded by, and forms a habitat for, 
 many varieties of micro-organisms. 
 
 The micro-organisms active in the destruction or decalci- 
 fication of tooth structure are: (1) Those of fermentation — ^the 
 
 Fig. 21. — Ceoss Section Showing a Beeaking ok Melting Down of 
 Intektubulae Substance. (Bax-rett after Mummery.) 
 
 yeast-plant, a vegetable fungus; (2) those responsible for de- 
 struction of the dentine — the bacilli (a cylindrical or rod-like 
 form of bacteria). These micro-organisms do not act" directly 
 upon the dentine, but in the act of their multiplication — and 
 they multiply in a cavity of decay by the millions, — ^their pro- 
 duct is an acid, which, in its turn, attacks and decalcifies and 
 disorganizes the dentine. 
 
 Dental caries then may be accepted as a germ disease, re- 
 sulting from infection. The germs are propagated and com- 
 
DISEASES OF THE HARD DENTAL STRUCTURE. 51 
 
 niunicated to the interior of the tooth first by fermentation of 
 food particles which, lodging between the teeth or in some 
 irregularity of the surface of the enamel. This ferment com- 
 bined with the moisture and temperature of the mouth, forms 
 an excellent media for the proliferation of low forms of life, 
 and at once becomes infested with certain acid producing fungi. 
 These germs form lodgment wherever they are not frequently 
 disturbed, it may be in fissures or pits, under clasps of partial 
 plates or ill-fitting crowns, or between the teeth. They form 
 glutinous or felt-like masses, quite adhesive to the enamel, 
 which excrete lactic acid and owing to the thick plaque or mass 
 of fungi this acid is prevented from being washed away and has 
 an opportunity to exert its full solvent action upon the enamel 
 rods. 
 
 After decalcification once starts so as to give a depressed and 
 softened area the destructive work progresses more rapidly, 
 proceeding along the line of the enamel rods. The bacteria 
 grow into the spaces formed by the destruction of the interpris- 
 matic cement, or the animal portion of the enamel, causing a 
 breaking down and dislodgment of masses of partially decalci- 
 fied enamel, thus hastening the cavity formation. The organ- 
 isms, it will be noted, do not in themselves attack the tooth, but 
 their product, lactic acid, being the solvent; they are therefore 
 only indirectly responsible. 
 
 When the dentine becomes exposed through the process of 
 caries the tubules at the exposed surface become infested with 
 the bacilli referred to above, which in their multiplication pro- 
 duce or excrete lactic acid resulting in the decalcification, and 
 in time the disorganization of the dentine. This process is 
 shown in Figs. 20 and 21. 
 
 The predisposing causes of dental caries are numerous, 
 and are in nearly all cases due to constitutional or systemic 
 disturbances. The character of the structure of the teeth re- 
 
52 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 garding both the quality and quantity of the several tissues is 
 an important factor; this is well illustrated by the interglobular 
 spaces frequently met with both in the enamel and dentine. 
 These spaces are the result of some systemic disturbance during 
 the period of calcification of the teeth, and later form weak 
 points, or are predisposing causes of caries. The position of the 
 teeth, too, is often a factor in the frequency of caries in these 
 organs; that is, whether they stand so that all surfaces may be 
 readily cleansed, or very irregularly, presenting numerous sur- 
 faces for the lodgment of fermentable substances. The general 
 tone of the system, whether giving to these organs their needed 
 nourishment, or a nerve or blood supply of a sluggish nature, 
 the effects of illness, and the relation of sex also presents certain 
 predisposing characteristics. 
 
 Dental Caries During Illness. — In severe illness, several 
 conditions favor dental caries: 1st, the lack of nutrition causes 
 the teeth to be less able to resist destructive influences; 2d, the 
 abnormal acid secretion aids in the destruction of the tooth 
 substance; 3d, fermentation often progresses about the tooth 
 without hindrance, on account of the patient's inability to keep 
 the surface properly cleansed. 
 
 During childhood, when the nervous system is in an ex- 
 alted state, owing to the developmental changes of this period, 
 and frequently from excessive mental strain following too close 
 confinement and over study, we have a disturbance of the nutri- 
 tive functions and a lowering of the general tone of the system, 
 which must be recognized a predisposing cause of caries. 
 
 Dental Caries in Its Relation to Sex. — In the male adult 
 the conditions are more favorable than in the female. The 
 male usually uses his teeth more in mastication, and partakes 
 of sweets less frequently between meals, there being a less de- 
 sire for saccharine and farinaceous foods. Particles of food 
 collecting about the teeth are readily converted into lactic acid, 
 thus becoming injurious to the tooth substance.. 
 
DISEASES OF THE HARD DENTAL STRUCTURE. 53 
 
 M. Parreidt, in writing upon this subject, says: — 
 "The female is also at a disadvantage during pregnancy, at 
 which time a large quantity of lime phosphates are essential to 
 the growth of the fetus, and this supply is diverted from the 
 teeth. It is well known that during pregnancy fractures heal 
 less readily, because the lime phosphates are needed for the 
 fetus. If, in a similar manner, the nourishment of the teeth 
 is affected, as during the healing of fractures, one may readily 
 conceive that their power of resistance against unhealthy influ- 
 ences must be materially diminished, and the reactions of the 
 
 Fig. 22. 
 
 oral fluids during pregnancy are not infrequently acid. Finally, 
 in these cases, the reflex disturbances of digestion should be 
 considered also, for the acid eructations are also injurious to 
 the teeth." 
 
 Poorly organized or "soft teeth" offer a strong predispo- 
 sition to dental decay. Careful analyses may show one tooth to 
 contain the same amount of the calcium salts as another, yet 
 owing to the structural organization we may find in applying 
 the burr or chisel, great differences in resistance, similar to 
 that shown in chalk and marble. A tooth poorly organized, 
 therefore, will succumb sooner than the one with a more com- 
 pletely organized structure. 
 
 Structural defects in the enamel, without reference to cause, 
 is a predisposing factor in the decay of the tooth. These de- 
 fects may be too small to be noticed by the operator, yet are of 
 sufficient size to give lodgment to colonies of micro-organisms. 
 
54 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 There are, however, other and more apparent defects fre- 
 quently met with. Nutritive disturbance during the calcifica- 
 tion of the teeth has been referred to ; if this is the result of a 
 prolonged illness it is apt to produce a line of pits or a groove 
 
 Fig. 23. 
 
 across the face of the tooth indicating the point where calcifi- 
 cation was progressing when nutrition was disturbed. (Fig. 22.) 
 Cases are also met with where there may be several rows of pits, 
 or a completely roughened surface, indicating repeated Reasons 
 of nutritive disturbances during early childhood. (Fig. 23.) 
 
 Quite a different malformation of the face and edges of the 
 teeth is that resulting from inherited syphilis. Teeth of this 
 character are, owing to their very irregular surfaces, prone to 
 caries. This effect of inherited syphilis was first called atten- 
 
 FlG. 24. 
 
 tion to by Jonathan Hutchinson, and today the condition is 
 frequently referred to as Hutchinson's teeth. 
 
 This condition is illustrated in Fig. 24, which will aid the 
 student in more readily distinguishing between these structural 
 defects. 
 
DISEASES OF THE HARD DENTAL STRUCTURE. 
 
 55 
 
 The proximal surfaces are convenient positions for the 
 lodgment of fermentable substances; in consequence, fully 65 
 per cent, of the first appearances of caries occur on these sur- 
 faces of the teeth. From statistical examinations made 
 by the writer of one hundred thousand permanent teeth, dental 
 caries may be classified in the folowing groups: — 
 
 Per cent. 
 
 Superior central incisors, caiious 
 
 Inferior " " 
 
 Superior lateral " 
 
 Inferior " " 
 
 Superior cuspids, 
 
 Inferior " 
 
 Superior flrst bicuspids, 
 
 Inferior " " 
 
 Superior second bicuspids 
 
 Inferior " " 
 
 Superior first molar, 
 
 Inferior " " 
 
 Superior second molar 
 
 Inferior " " 
 
 Superior third " 
 
 Inferior " " . 
 
 .144 
 
 .006 
 
 .14 
 
 .008 
 
 .07 
 
 .009 
 
 .10 
 
 .05 
 
 .08 
 
 .05 
 
 .16 
 
 .145 
 
 .11 
 
 .12 
 
 .025 
 
 .03 
 
 Relative Location of Dental Caries. 
 
 Superior central incisors, 
 lateral " 
 cuspids, 
 " flrst bicuspids, 
 second " 
 first molars, 
 second " 
 third " 
 
 Inferior central incisors, 
 lateral " 
 cuspids, 
 " first bicuspids, 
 
 " second " 
 
 " first molars, 
 
 " second " 
 
 third " 
 
 Approx. La. Pal. Mas. 
 
 .95 
 
 .94 
 .98 
 .93 
 .92 
 .35 
 .20 
 .04 
 
 .99 
 .98 
 .95 
 .91 
 .91 
 .30 
 .16 
 .02 
 
 .01 
 
 .01 
 
 .015 
 
 .005 
 
 .005 
 
 Approx. La. 
 
 .01 
 
 .02 
 
 .045 
 
 .01 
 
 .005 
 
 .04 
 .05 
 .005 
 
 Lin. 
 
 .005 
 
 .065 
 
 .075 
 
 .61 
 
 .75 
 
 .95 
 
 .08 
 
 .085 
 
 .64 
 
 .78 
 
 .95 
 
 Bug. 
 
 .04 
 .05 
 .01 
 
 Mas. Bug. 
 
 .06 
 .06 
 .03 
 
 Note.— The above tables are made without respect to age or sex. 
 
56 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Therapeutics of Dental Caries. — The most effective treat- 
 ment of caries consists in the removal of the diseased portions 
 and the proper preparations of the cavity, followed by a well- 
 inserted filling of the least destructible substance compatible 
 to the case in hand. There .are exceptional cases, however, 
 where decay does not extend into the dentine — where the tooth 
 may be preserved by removing the diseased parts with a fine 
 stone, diamond disk, or diamond point, and leaving the surface 
 thus treated well polished. 
 
 Prophylaxis. — From the time of the eruption of the decid- 
 uous teeth the mouth should be kept scrupulously clean. A 
 soft or medium brush and water should be employed daily after 
 each meal, and with a good powder upon rising in the morning 
 and just before retiring at night. Where the teeth are so closely 
 situated that the brush cannot be worked between them, so as to 
 cleanse the proximal surfaces, floss silk or quill toothpicks should 
 be used to remove any particles of food that become lodged be- 
 tween the teeth. 
 
 Mouth-washes. — AU^aline mouth-washes, such as milk of 
 magnesia, lime-water, or bicarbonate of soda in solution, are 
 sometimes used; not, however, as a substitute for the tooth 
 brush and dentifrice, but as an adjunct. They temporarily 
 neutralize the oral fluids when of an acid reaction. 
 
 Dental Abrasion. 
 Odontalgia (tooth pain) is not infrequently caused by 
 sensitive dentine on the abraded or worn-down masticating 
 surfaces of the teeth; the enamel covering being removed, irri- 
 tation is more readily carried to the pulp. If the irritation is 
 very severe, and is continued for a considerable length of time, 
 it may cause acute inftammation and lead to the death of the 
 pulp. This condition, however, usually shows itself when there 
 is a strong calcic diathesis. That is, where there is superabund- 
 ance of lime in the system, making the teeth hard, and some- 
 
INJURIES AND DISEASES OF THE MAXILLARY BONES. 57 
 
 times more or less brittle. Owing to this excess of lime, the 
 pulp, in these cases, generally responds to the irritation by 
 throwing out a deposit of secondary dentine proportionate to 
 the advance of the abrasion. Abrasion, as has been indicated, 
 is a mechanical action, and should not be confounded with 
 erosion, which is the result of a chemical action. 
 
 Treatment. — Apply to the abraded surface chloride of zinc 
 crystals, or rub the sensitive points with nitrate of silver, and 
 follow, when practicable, by building up the surface with gold ; 
 also make application of a counter-irritant and stimulant to the 
 gums about the abraded teeth. 
 
 INJTIKIES AND DISEASES OF THE MAXILLAEY 
 
 BONES. 
 
 Fractures of the Lower Jaw. 
 
 Fractures of the lower jaw are usually the result of di- 
 rect violence, such as a kick from a horse, fall from a height 
 upon the face, the unskillful application of the dental "key" 
 and forceps, etc. Professor Pancoast, however, met with a 
 case in which the neck of the bone was fractured by a violent 
 fit of coughing."^ 
 
 The Most Frequent Location. — ^Fractures occur most fre- 
 quently in the neighborhood of the cuspid tooth, this position 
 being determined by the weakness of the bone at this point, in 
 consequence of the depth of the alveoli. 
 
 Fractures of the alveolus are frequently unavoidable dur- 
 ing the extraction of teeth. The displacement of portions of 
 this bone,, however, gives little inconvenience, and hastens the 
 resorptive process; but, should the fracture affect the alveoli of 
 the adjoining teeth, a troublesome exfoliation may follow. 
 Since accidents of this kind are due to the natural eonforma- 
 
 ♦Gross' "Surgery." 
 
58 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 tion of the parts, legal proceedings against the operator for 
 this mishap are most unjust. 
 
 Diagnosis. — fractures of the lower jaw are readily recog- 
 nized; the regularity of the dental arch is altered, and the 
 mobility of the fractured portions is shown when pressure is 
 applied to the teeth or alveolar process at the site of pain. 
 
 Crepitation is discernible during the first week after frac- 
 ture. Its absence, after this time, is due to formations of gran- 
 ulations and of the partial union of the fractured ends. 
 
 The gums, also, are usually lacerated at the point of frac- 
 ture, accompanied by considerable inflammation and swelling. 
 
 Fracture of the ramus of the jaw is less frequent than 
 in the body, and is not so readily diagnosed, as the upper por- 
 tion cannot be grasped with the fingers, and crepitation is 
 difficult to make out. 
 
 Treatment. — The appliances used for the maintenance of 
 the fractured portions in position may be divided into two 
 classes : — 
 
 External and internal to the mouth, though it may be, in 
 a few instances, necessary to combine the two methods. The 
 simplest form of apparatus for external use is the ordinary 
 four-tailed bandage or sling, with a split for the chin to rest 
 in. It is made from a piece of muslin, about a yard in length 
 and two or three inches broad; this should have "a slit four 
 inches long cut in the center of it, parallel to, and an inch from, 
 the edge. The end of the bandage should then be split to within 
 a couple of inches of the slit, thus forming a four-tailed band- 
 age, with a hole in the middle. The central slit can be readily 
 adapted to the chin, the narrow portion going in front of the 
 lower lip, and the broader beneath the jaw, and the two tails 
 corresponding to the lower part of the bandage are then to be 
 carried over the top of the head, while the others are crossed 
 over them and tied round the nape of the neck. The ends of 
 the two bandages may then be knotted together" (Heath). 
 
INJURIES AND DISEASES OF THE MAXILLARY BONES. 59 
 
 Hamilton has devised a sling for which he claims superi- 
 ority; we give it in his own words: "The advantage of this 
 dressing over any which I have yet seen consists in its capability 
 to lift the anterior fragment vertically, and at the same time it 
 is in no danger of falling forward and downward upon the fore- 
 head. If, as in the case of most other dressings, the occipital 
 stay had its attachment opposite the chin, its effect would be to 
 draw the central fragment backward. By using a firm piece of 
 leather as a maxillary band, and attaching the occipital stay 
 above the ears, this difficulty is completely obviated." 
 
 The interdental splint is an apparatus used in common 
 among dentists for an internal appliance in the treatment of 
 fractured maxillae. It is usually made of vulcanite rubber, and 
 gives very satisfactory results. In 1866, Mr. Gunning, of New 
 York, gave a description of this contrivance as then used by 
 him.* 
 
 Method of Making Single Interdental Splint.— Take 
 impression in wax or modeling compound, using as small an 
 amount as will insure a good impression of the teeth and gums. 
 An assistant should stand behind the patient and hold the broken 
 bone as near in place as can be done with any degree of com- 
 fort to the patient, while the operator stands directly in front 
 and takes impression. After the casts of both jaws have been 
 secured, they should be carefully articulated. This is done by 
 cutting with a small saw the lower cast at the point or points of 
 fracture, and rearranging the sections thus made, so as to bring 
 the teeth into correct articulation. The pieces should then be 
 secured in this position with plaster-of-Paris, and the two 
 models placed in an articulator. The casts are then covered 
 with No. 60 tinfoil; this makes the cavities in the splint a little 
 larger than the corresponding teeth, making it easily adjusted, 
 and leaves it with a smooth surface. Use two thicknesses of 
 base-plate wax over the tinfoil, allowing it to pass down a trifle 
 
 ♦New York Medical Journal and British Journal of Dental Science. 
 
60 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 below the necks of the teeth. Flask and vulcanize in usual 
 manner for rubber work. 
 
 When the fracture is of an obstinate vertical nature, a splint 
 that will enclose the teeth and gnms of the upper jaw at well 
 as the lower should be used. When the proper treatment is 
 employed, a cure is effected in from six to eight weeks, accord- 
 ing to the age and physical condition of the patient. 
 
 Fractures of the upper jaw are less frequent and less diffi- 
 cult of treatment than those of the lower jaw. In recent cases 
 a simple replacement of the parts is all that is necessary, and 
 occasionally the application of a simple retention splint is em- 
 ployed. 
 
 Angle's Method of Fixation. — A more recent method for 
 treatment of fractures of the maxillae is that devised by Dr. 
 E. H. Angle. For a detailed description of this method, to- 
 gether with that of the interdental splint, the student is re- 
 ferred to Richardson's "Mechanical Dentistry," seventh edition. 
 
 Necrosis of the Jaws. 
 
 Necrosis of the jaw is indicated by inflammation, similar 
 to that of dental periostitis. The gum about the affected part 
 is swollen and of a dark-red or purple color, pus oozing from 
 the edge of the gum between the teeth, or through one or more 
 fistulous openings; this discharge is not always confined to 
 the mouth; we find the pus escaping sometimes through an 
 opening on the cheek or neck, as low do^vn at times as the 
 clavicle. 
 
 The effect of necrosis of the jaw upon the teeth is 
 obvious, since great pain is produced by the least pressure, and 
 in cases of entire necrosis they become loose and discolored; 
 in the majority of such cases the teeth prove such an annoy- 
 ance to the patient that they are extracted, if they do not drop 
 out of their own accord. 
 
 Treatment. — Remove the dead portions from around the 
 living bone, — here the dental engine and burrs are useful, — 
 
INJURIES AND DISEASES OF THE MAXILLARY BONES. 61 
 
 syringe with tepid water and peroxide of hydrogen to cleanse 
 the parts, followed by stimulants, tonics, and nourishing diet. 
 
 New bone is produced in the lower jaw if the periosteum 
 is preserved, this with the surrounding tissue being active in 
 producing new bone to take the place of the lost portion. 
 
 In the superior maxillary there is a development of fibrous 
 tissue in the young subject. In the adult, nature does not do 
 this much. When a part of the superior maxillary is necrosed, 
 the periosteum ordinarily makes no effort to renew the lost 
 bone. (Eor an elaboration upon this subject see Heath's "Dis- 
 eases of the Jaw.") 
 
 Dislocation of the Lower Jaw. 
 
 The causes of dislocation of the lower jaw are yawning, 
 shouting, vomiting, the introduction of the stomach pumpj etc. 
 Sometimes it occurs during operations upon the teeth; in all 
 cases the patient's mouth is opened to its fullest extent. The 
 capsular ligament, being very large and tenacious, is not 
 ruptured. 
 
 The manner in which dislocation takes place is as fol- 
 lows : When the mouth is opened to its fullest extent, each con- 
 dyle of the jaw leaves the true articular eminence of the inter- 
 articular fibro-cartilage, which is drawn forward of the external 
 pterygoid muscle. A cavity is thus left behind the condyle; 
 when the jaw is in this position, but very slight force is needed 
 to carry the condyle over the articular eminence, producing a 
 dislocation. 
 
 Symptoms of Dislocation. — The mouth is open and the 
 jaw fixed, mastication being impossible, as the lower teeth pro- 
 ject beyond those of the upper jaw. Saliva dribbles from the 
 mouth, and speech is indistinct. A careful examination reveals 
 a concavity immediately in front of the ear, and the condyle 
 may be both seen and felt in front of this. The masseter muscle 
 is firmly contracted and very prominent (see Fig. 25). 
 
62 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Treatment. — Reduction is made by placing the thumbs 
 (protected by napkins) as far back upon the molars as possible 
 (see Fig. 26), depressing the back part of the jaw, followed at 
 once by the raising of the chin, which results in sliding the 
 the dislocation the jaws should be secured by a bandage extend- 
 ing under the chin and over the top of the head. The patient 
 capitulum backward into the condyle fossa. After correcting 
 
 Fig. 25. — Dislocation of 
 Lower Jaw. — (Bryant.) 
 
 Fig. 26.- — Reduction of Dis- 
 liOCATiON of Lower Jaw. — 
 (Bryant.) 
 
 should be recommended to take care, for some weeks, not to 
 open the mouth too far, as a disposition to a recurrence is great. 
 
 Inflammation of the Temporo-maxillary Articulation. 
 
 Serious inflammation of the temporo-maxillary articulation 
 is infrequent; when such complaint arises, it is usually found 
 that some derangement of the teeth is the seat of the trouble; 
 however, when by a close examination we find the teeth and 
 their surrounding tissues in an apparently good condition, in- 
 flammation of this articulation may be surmised. 
 
 Symptoms. — The parts in the vicinity of the joint are sensi- 
 tive to pressure; they present a swollen appearance and cause 
 considerable pain when the mouth is opened and closed. 
 
INJURIES A2s'D DISEASES OF THE MAXILLARY BONES. 63 
 
 Treatment. — First, comparative rest must be given the joint, 
 the patient partaking only of liquid or soft food. An applica- 
 tion of some good stimulant, such as tincture of iodine, followed 
 by ice-water compresses, to decrease the heat of the inflamed 
 parts. 
 
 Abscess of the Antrum of Hjghmore. 
 
 The Maxillary Sinus or so-called Antrum of Highmore 
 is separated from the apices of the superior molars by a very 
 thin lamella of bone, which is sometimes penetrated by the 
 roots of a tooth; usually the lii'st molar. This sinus or cavity, 
 situated in the body of the superior maxilla is connected with 
 the air passages of the nose through small openings in the sides 
 of this organ. By this portion of the bone being hollow contour 
 is given to the face without adding to the weight of the bone. 
 Its principle value, however, is in giving resonance to the voice ; 
 in fact it is sometimes referred to as the sounding chamber of 
 the human voice. 
 
 The mucous membrane lining this cavity is continuous 
 with that lining the nose — the Scluieiderian membrane. Hence 
 very serious nasal inflammation may through this continuity 
 of tissue, induce antral disorders. Then we may have quite the 
 reverse, nasal inflammation and discharges caused by suppura- 
 tion in the antrum. 
 
 At times, inflammation from alveolar periostitis extends to 
 the mucous membrane of the antrum. Again, abscesses are 
 formed in the antrum by the septic decomposition of the pulp 
 of a tooth the roots of which extend into the cavity, or the ac- 
 cumulation of pus about the apical i^ortion of the root has caused 
 resorption of the floor of the antrum sufficiently to allow the pus 
 to enter this chamber. Fig. 27 shows an alveolar abscess at the 
 root of an upper molar discharging into the Antrum of High- 
 more. 
 
 When this takes place, the natural opening between the an- 
 trum and the nose becomes diminished by the swelling of the 
 
64 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 lining mucous membrane. Inflammation becomes excessive, 
 and a large collection of pus takes place, which at length escapes 
 into the nose, or burrows -alongside of the root of a tooth and 
 discharges into the mouth. Or a fistula may be established 
 upon the cheek; and in protracted cases the floor of the orbit 
 may give way, and pus discharge along the lower eyelid. 
 
 Symptoms. — Whatever the source of the antral disease, the 
 phenomena presented are about the same, and are distinctive. 
 The patient complains of a feeling of fullness or pressure, dull. 
 
 Fig. 27. — a, Abscess Cavity in the bone ; b, Nostrum ; c, Pus in the 
 
 ANTRAl, CAVITY. 
 
 heavy pains on the affected side of the face, and if the trouble 
 has continued for a considerable length of time, there will be 
 a discharge of pus into the nose, especially while in a recumbent 
 position. This pus is usually accompanied by a bad odor, and 
 at times causes severe local and constitutional suffering. The 
 cheek is hot, flushed, and somewhat swollen; and when the an- 
 trum becomes filled with pus, the malar bone is elevated, with 
 an apparent depression beneath it; the palate in severe cases 
 loses its concavity and becomes convex, and the floor of the 
 orbit is pushed up, forcing the eye partly from its normal 
 position. 
 
 Treatment. — If it is found that a devitalized pulp is the 
 exciting cause, the tooth being in an otherwise good condition, 
 effort should be made to preserve it. The pulp should be re- 
 
INJURIES AND DISEASES OF THE MAXILLARY BONES. 05 
 
 moved, roots cleaned and temporarily filled with some antiseptic 
 dressing. 
 
 The antrum should then be opened by penetrating the walls 
 with a suitable drill revolved by the dental engine. After de- 
 termining the lowest point the parts should be anesthetized with 
 chloride of ethel spray, or the patient may be given nitrous 
 oxide of gas. The drill then being revolved rapidly will enter 
 in a few seconds. In selecting the drill for this purpose one 
 giving an entrance large enough to admit the nozzle of a good- 
 sized rubber syringe should be employed. 
 
 Good drainage having been secured, the cavity should be 
 washed with warm water to which a little salt has been added. 
 The nozzle of the syringe is carefully placed in the opening 
 until it reaches the antrum when firm and steady pressure will 
 throw the contents into the cavity. The syringe should be 
 quickly withdrawn so that the operator's hands will not inter- 
 fere with free drainage through the nose. This may be repeated 
 until the cavity is quite clean, when it may be followed with 
 water containing a little peroxide of hydrogen. Full strength 
 peroxide of hydrogen, or even 50 per cent., would cause severe 
 pain owing to the violent foaming in a pent-up cavity. 
 
 The opening may be maintained for treatment by the in- 
 sertion of a platinum drainage tube or a plug of some nature. 
 This treatment should be renewed every second day for a short 
 time, then gradually decreased as the case demands. 
 
 In instances where the condition of the tooth at fault is 
 such as not to warrant an effort to save it, the tooth should be 
 extracted and the antrum entered through one of the root 
 sockets. Where there are complications, such as serious necrosis 
 the case had best go to the general or oral surgeon. 
 
 DEFECTS OF THE PALATINE OEGANS. 
 Cleft Palate. — One of the most distressing deformities to 
 which the human frame is liable is that defective condition of 
 the palatine organs known as Cleft Palate. 
 
66 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 It is indicated by a fissure extending through the soft, or 
 both the soft and hard, palate, causing an impairment of mas- 
 tication, of deglutition, and of speech. They are divided into 
 two classes — Acquired (by accident or disease), and Congenital 
 (dating from birth). 
 
 Congenital cleft palate is the result of a lack of develop- 
 ment of the maxillary bones, which may be caused by hereditary 
 disease, or malformation from lack of nourishment of the 
 tissues involved during embryonic life.* 
 
 These defects are sometimes accompanied by more or less 
 deformity of the alveolar arch and of the teeth, which are 
 usually of a soft texture, with imperfectly developed roots. The 
 cleft is not always confined to the palate bones and the soft 
 palate, but may be complicated with complete fissure of the 
 alveolar process and with harelip. 
 
 Acquired cleft palate includes all losses of tissue in either 
 soft or hard palate that are not congenital, whether occasioned 
 by disease or accident. The faculty of distinct articulate speech 
 is impaired, and deglutition is performed with much incon- 
 venience; acquired lesions coming generally in adult life, the 
 individual has not the advantage of the training of the parts 
 during infancy, as in cases of congenital defects. 
 
 The infant resorts to a very curious expedient to secure the 
 nourishment necessary for subsistence and growth. The nip- 
 ple, instead of being taken between the tongue, upper lip, and 
 gum, is taken between the lower surface of the tongue, and the 
 lower lip and gum. This habit being acquired, it is applied 
 later in the mastication of solid food. The food being conveyed 
 between the tongue and movable floor, is brought back between 
 the teeth for deglutition, which is usually performed in this 
 way without any food entering the nose through the cleft palate. 
 
 Treatment. — The remedy for these deformities must be the 
 closing of the passage in such a way as to restore, as far as 
 
 *See article on "Physiology of Voice and Speech," "American System 
 of Dentistry," Vol. III. 
 
DEFECTS OF THE PALATINE ORGANS. 6'7 
 
 possible, to the organs, their functions. This may be done by a 
 surgical operation or by the insertion of an artificial palate. 
 
 Staphylorrhaphy. 
 
 The surgical operation sometimes resorted to is an ex- 
 ceedingly painful one for the patient and difficult for the oper- 
 ator, and which, after all, often proves a failure. Indeed, it is 
 claimed by some writers that failures of closure in these opera- 
 tions are in the majority. However this may be, there are many 
 cases on record where such operations have been performed with 
 a marked degree of success. 
 
 Staphylorrhaphy is derived from a Greek word signifying 
 suture of the uvula. It consists in freshening or paring the 
 edges of the palate and passing ligatures or sutures through, 
 drawing the edges together, and closing the gap by tying the 
 sutures.* 
 
 It is claimed that the idea of this operation was first con- 
 ceived by one Le Monnier, an ingenious French dentist, and 
 was successfully performed by him as early as 1764. It does 
 not seem to have been recognized by the medical profession, 
 however, for more than half a century afterward; it was then, 
 in 1820, practiced by M. Eoux, in France, and in America by 
 Dr. J. C. Warren, of Boston. 
 
 Dr. Warren's methods were considered simpler, and his opera- 
 tions are generally regarded as the basis of the various modi- 
 fications that have since aided in perfecting the procedure, and 
 it is now classed among the regular operations of surgery. 
 
 Artificial Palates. 
 Artificial palates, according to some writers, were em- 
 ployed by the Greek physicians, but the first description was 
 given by the celebrated French surgeon, Ambrose Pare, in the 
 early part of the sixteenth century. Many improvements upon 
 
 *For full treatment of this operation see "American System of Den- 
 tistry," Vol. III. 
 
63 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 these primitive forms have been made. They are divided into 
 two distinct classes — obturators and artificial velum.* 
 
 An obturator is a non-elastic and stationary cover or stopper 
 for those defects in the hard or soft palate which have a com- 
 plete and well defined boundary. 
 
 An artificial velumf is a movable valve, made to supply the 
 loss of the posterior soft palate; being under the control of the 
 surrounding muscles, opening or closing the passage at will. 
 
 EXTKACTION OF TEETH. 
 
 The extraction of teeth is an operation that need seldom 
 be resorted to. It is, in nearly all cases, from negligence of the 
 patients or their fear of dental operations that the teeth are 
 permitted to remain in diseased conditions until they reach such 
 a state that extraction is necessary. It is not surprising that 
 the operation is usually approached with apprehension, since 
 frequent accidents occur in its performance; this, however, is 
 generally due to the neglect, awkwardness, or unskilfulness of 
 the operator. It very often occurs in the hands of medical prac- 
 titioners, and is a subject that should receive more attention 
 from physicians, by whom, though not belonging to their pro- 
 vince, it is frequently performed. 
 
 Indications Justifying the Operation. — First, with the 
 teeth of first dentition, it is sufficient to state that when a tooth 
 of replacement is about to be erupted, or has actually made its 
 appearance, either in front or behind the corresponding decidu- 
 ous tooth, the latter should at once be extracted ; and when these 
 teeth have been so neglected that they, together with the sur- 
 rounding tissue, have become seriously diseased, it is best that 
 they should be removed. It is desirable, however, whenever they 
 can be retained in a fair state of health, to do so, retaining the 
 shape of the arch until it is time for their successors to replace 
 
 *See Richai'dson's "Mechanical Dentistry," seventh edition. 
 tVelum : a veil, a cover ; hence, "a pendulous veil of the palate." 
 
EXTRACTION OF TEETH. 69 
 
 them, as well as gisdng the child their service in mastication. 
 
 Second. In regard to the propriety of extracting the perma- 
 nent teeth, it should first be stated that none of these should be 
 sacrificed unless called for by some urgent necessity. Uncon- 
 trollable pain and incurable disease surrounding the tooth are 
 instances. 
 
 Third. Extensive loss of surrounding tissue, leaving the tooth 
 or root very much loosened, acting as in irritant and becoming 
 a source of disease to the rdjacent parts. 
 
 Fourth. Where a tooth is the cause of an incurable alveolar 
 abscess, the offending member should not be allowed to remain ; 
 such cases, however, are rare. 
 
 Fifth. To prevent or correct irregularity in the arrangement 
 of the teeth. 
 
 Sixth. In preparing the mouth for an artificial denture it is 
 sometimes found that the loss of one or more remaining teeth 
 may be advantageous. 
 
 There are other cases presented at times, to which fixed rules 
 would not be applicable, where experienced judgment must de- 
 termine the practice to pursue. 
 
 In conclusion, it is scarcely necessary to say that whenever 
 a tooth can be restored to a healthy condition it should always 
 be done, and that we should not for any reason be too hasty in 
 extracting the first tooth from an unbroken arch. As all teeth, 
 except the central incisors and upper third molars, have nor- 
 mally two antagonists in articulation, the loss of one tooth 
 would place two others partially without function, and the ad- 
 joining teeth would soon become irregular by gradually leaning 
 into the spaces. 
 
 Hemorrhage after Extraction. — In cases where extraction 
 is folloived hy excessive hemorrhage, or where the tendency to 
 hemorrhage exists, the application of some reliable styptic 
 should be made, the following being the most powerful of these 
 agents : tannic acid, solution of persulphate of iron, and the 
 powdered sulphate of iron (Monsel's powder), or adrenalin. 
 
70 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Some of the simple local remedies are spider web or a pledget of 
 cotton or sponge saturated with sandarach varnish as mechani- 
 cal obstructors ; this packing should be allowed to remain Tintil 
 all danger of a return is past. 
 
 DEPOSITS UPON THE TEETH. 
 
 The simplest form of deposit upon the teeth is the white, 
 soft accumulations which are frequently found just at the gum 
 margins. It is composed of partially fermented food debris, 
 mucous and micro-organisms. These organisms are without 
 doubt acid producers, though slower in action than those in- 
 volved in caries, as when this deposit is allowed to remain for 
 a considerable length of time, the enamel surface immediately 
 beneath it will be found to be decalcified. 
 
 Green stain, more frequently found in the moutljs of chil- 
 dren, is another form of soft deposit, composed of certain forms 
 of chromogenic (color producing) bacteria, intermixed more or 
 less with a growth of leptothrix buccalis. 
 
 This fungus, as it grows, attaches itself to roughened sur- 
 faces of the enamel, or to surfaces not kept scrupulously clean 
 and polished. Some claim that its attachment and action 
 simply involves the so-called Nasmyth's membrane, but clinical 
 experience would indicate that where it is allowed to remain 
 for a long while it has a solvent action upon the tooth, as the 
 enamel directly beneath it will be more or less roughened from 
 decalcification. 
 
 While these deposits are called green stain, there are several 
 gradations of color, which is caused by the color forming bac- 
 teria. In older persons it is more nearly black or bronze in 
 color. These deposits are readily removed with disks, and a re- 
 volving brush and pumice. After its removal any eroded sur- 
 face of enamel should be dressed down and polished. 
 
 There are two varieties of calculus, or tartar, as it is 
 most commonly called, found upon the teeth; namely, salivary 
 and sermnal or sanguinary. 
 
DEPOSITS UPON THE TEETH. Tl 
 
 Salivary calculus is deposited from the saliva upon the 
 crowns or any exposed surfaces of the teeth. It varies in color 
 from a light cream to a dark brown or black, depending upon 
 its age and the habits and general health of the patient. The 
 characteristics of the substance, therefore, furnish diagnoses of 
 importance to the physician and dentist. 
 
 Composition. — Salivary calculus is composed of mineral and 
 animal matter; about 75 and 25 per cent, respectively. Phos- 
 phate of lime, and in some cases a little magnesia, carbonate 
 of lime, mucus, and a small quantity of animal fat, are its 
 principal ingredients. The relative proportions of its constitu- 
 ents very according to its density. A fair average is expressed 
 in the following table: 
 
 Calcium phosphate, 65 
 
 Calcium carbonate, ........ 8 
 
 Ferric phosphate, 2 
 
 Organic matter, leptothrix, mucus, etc., . . 25 
 
 All persons are subject to salivary calculus to a greater or 
 less extent, but its physicial characteristics are exceedingly 
 variable. Hence it is that analyses made of it by different 
 chemists differ. 
 
 Origin and Deposition. — It is generally conceded that this 
 concretion is a deposit, chiefly from the saliva, with an admix- 
 ture of mucus. 
 
 Saliva is the mixed fluid from the different salivary glands 
 and mucous follicles, and in its normal state is either allvaline 
 or neutral. On exposure to the atmosphere, and the decomposi- 
 tion liable to occur in the mouth, it may be found strongly acid 
 or strongly alkaline, holding salts of lime in solution. On the 
 formation of acids in the mouth, and by the action of the 
 carbonic acid exhaled,* decomposition takes place, and the salts 
 
 * Carbonic acid having a strong affinity for lime, unites with it in the 
 salivary solution, forming carbonate of lime. 
 
72 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 of lime are deposited upon the teeth. Naturally, it is precipi- 
 tated in great quantities upon the surfaces of the teeth opposite 
 the ducts from which the saliva is emptied, upon the lingual 
 surfaces of the inferior incisors and cuspids (opposite Whar- 
 ton's duct), and the buccal surfaces of the superior molars, in 
 the region of the mouth of the duct of Steno. The necks of the 
 teeth about the free margins of the gum afford favorable points 
 for its collection. A nucleus once being formed, it deposits 
 particle by particle, rapidly encroaching upon the crown, where 
 it is deposited more abundantly. In the mouths of uncleanly 
 persons it sometimes accumulates in such quantities that nearly 
 all the teeth are encrusted; and sometimes several of the teeth 
 become bound together in one mass. 
 
 Salivary calculus is not deposited upon the soft tissues, but 
 upon some substance that forms nuclei, such as the natural and 
 artificial teeth, plates, etc. ; though it is found sometimes in the 
 ducts of the salivary glands, owing, no doubt, to a sluggish 
 condition of the saliva. It has no special pathological signifi- 
 cance further than its being a mechanical irritant to the gum 
 tissue and alveolar process and interferes with the hygienic 
 care of the mouth. 
 
 Treatment. — The removal of salivary calculus is an opera- 
 tion of importance to the health of the gums and alveolar pro- 
 cess, and the preservation of the teeth. For its removal, instru- 
 ments (scalers) that may be readily applied to every part of the 
 tooth should be employed. Considerable tact and practice are 
 necessary to perform the operation skillfully. The scaler should 
 be passed well down beneath the margin of the gums — that is, 
 below the edge of the deposit — until it is brought in contact 
 with the surface of the tooth, and the mass scaled off in the 
 direction of the cutting or masticating surface. Every particle 
 of the deposit should be removed, care being necessary that the 
 tooth substance is not roughened by the edge of the instruments, 
 and the surface polished, lest nuclei for immediate reaccumu- 
 lation be left. 
 
DEPOSITS UPON THE TEETH. 73 
 
 Chemical agents are employed by some for the removal of 
 salivary calculus. This should be scrupulously avoided, as any 
 acid capable of dissolving this accumulation is more or less 
 injurious to the teeth. "Their careless administration by physi- 
 cians is a fruitful source of injury to the teeth, and they cer- 
 tainly should form no part of any dentifrice, or be in any way 
 used for the removal of stains of any kind from the teeth." 
 (Harris.) 
 
 Salivary calculi are concretions sometimes found in the 
 ducts above referred to. These deposits are formed in concen- 
 tric layers, are more or less irregular in shape and vary in 
 color from a light yellow to brown. These calculi do not con- 
 tain the mucus and leptothrix found in the ordinary calculus 
 of the mouth, having about the following composition : 
 
 Calcium phosphate, 75.0 
 
 Calcium carbonate 12.5 
 
 Organic matter, 12.5 
 
 Sanguinary calculus is deposited upon the roots of the 
 teeth, and not upon their cro\\ms, as with salivary calculus. It 
 is precipitated from the liquor sanguinis of the blood, following 
 hyperemia, which may be caused by any local irritation. It is 
 in the form of dark granulations, approaching crystallization. 
 It is much harder than salivary calculus, and adheres more 
 firmly. The attachment is so close sometimes, as to practically 
 make it necessary to chisel it away. 
 
 Composition. — Sanguinary calculus is composed chiefly of 
 lime salts, colored with the haematin of the blood, which in- 
 creases its tendency to take crystalline form. 
 
 It should be remembered that while salivary calculus causes 
 inflammation, sanguinary calculus is a result of the inflamma- 
 tory action. 
 
 It is, however, in itself distinctly irritating to surrounding 
 tissues, and local inflammatory troubles cannot be controlled 
 until this deposit is thoroughly removed. 
 
 6 
 
DENTAL MEDICINE. 
 
 Dental materia medica is an embodiment of the nature, 
 medicinal properties, and therapeutical action, of all substances 
 used as medicine in dental practice. 
 
 The classification of medicines is made according to their 
 action upon the animal economy. 
 
 The different classes in common use by dentists are as 
 
 follows : Narcotics and hypnotics, analgesics or anodynes, 
 anesthetics, stimulants, tonics, sedatives, antipyretics, irritants, 
 astringents, styptics, and haemostatics, caustics, escharotics, 
 antizymotics, or antiseptics, and disinfectants and laxatives. 
 
 NAECOTICS AND HYPNOTICS. 
 
 Narcotics (stupor) are medicinal substances which, by im- 
 pairing or destroying nervous action, lessen the relationship of 
 the individual to the external world. They at first, however, 
 have a stimulating effect, to which their therapeutic efficacy is 
 largely due, which is followed by profound sleep and stupor. 
 If the dose be sufficient, death will ensue by paralysis of the 
 centres of the medulla, which govern respiration and the other 
 functions of organic life. 
 
 Hypnotics (sleep) belong to the class of narcotics, but are 
 capable of causing sleep without any preliminary cerebral ex- 
 citement, by bringing the brain into a favorable condition for it. 
 
 The principal narcotics are opium (see Anodynes), alcohol 
 (see Stimulants), belladonna (see Anodynes), chloroform, ether 
 (see Anesthetics), etc. 
 
 The hypnotics are opium, the bromides, chloral, etc. When 
 administered to relieve pain, they are termed anodynes. 
 
 74 
 
NARCOTICS AND HYPNOTICS. 75 
 
 Bromine, Br. — Bromides. 
 
 Derivation. — Bromine is obtained from sea- water and cer- 
 tain saline springs. 
 
 Properties. — Bromine is a dark brownish-red, liquid, non- 
 metallic element. It has an offensive, suffocating odor, some- 
 what resembling chlorine and iodine. In its pure state it is an 
 active escharotic and internally a violent poison. The salts of 
 bromine are cerebral and cardiac depressants and are highly 
 valued as hypnotics. 
 
 The Principal Preparations: 
 
 Ammonium Bromide, NH^Br. — Colorless, prismatic crys- 
 tal. Dose, gr. v-xx. 
 
 Calcium Bromide, CaBr^. — A white, granular, deliques- 
 cent salt. Dose, gr. v-3j. 
 
 Lithium Bromide, LiBr. — A white, granular, deliques- 
 cent salt. Dose, gr. v-xx. 
 
 Potassium Bromide, KBr. — Colorless, cubical crystals. 
 Dose, gr. v-3j. 
 
 Sodium Bromide, NaBr. — Colorless, monoclinic crystals. 
 Dose, gr. v-3j. 
 
 Zinc Bromide, ZnBr^. — A white, granular, deliquescent 
 powder. Dose, gr. ss-ij. 
 
 Syrup of Bromide of Iron. — Contains 10 per cent, of fer- 
 rous bromide, FeBr^. Dose, ^ss-j. 
 
 Therapeutic Uses. — The bromides are used as sedatives to 
 the nervous system to produce sleep, and in affections of the 
 heart or cerebrum, when shown by increased action, in neural- 
 gia, spasmodic cough, etc. 
 
 Dental Uses. — Bromide of potassium is a useful remedy in 
 convulsions from the irritation of dentition, in neuralgia, also 
 in cases of extreme sensitiveness of the soft palate. Dose, gr. 
 10-20 every hour for several hours before taking impression. 
 
7b dental pathology akd dental medicine. 
 
 Chloral, 02110130. 
 
 Derivation. — Ohloral is obtained by the action of chlorine 
 gas on absolute alcohol. It is a colorless, unstable, oily fluid, 
 which readily combines with water and forms chloral hydrate, 
 the official "chloral" having the formula O2HOI3OH2O. 
 
 Properties and Actions. — The official body, chloral hydrate, 
 is in the form of a white, crystalline substance, having a pung- 
 ent odor and taste, and is soluble in water, alcohol, and 
 glycerine. 
 
 It is hypnotic, antispasmodic, and to a limited degree 
 anesthetic. It is serviceable in fevers, accompanied by cere- 
 bral excitement, convulsions, deliriiim tremens, etc. Dose, from 
 gr. V to gr. XXX. Liebreich claims to have produced profound 
 sleep, lasting from five to fifteen hours, with twenty-five to 
 thirty grains. 
 
 The hypnotic action is preceded by a stage of excitement of 
 short duration, which is followed by sudden calm and refresh- 
 ing sleep, from which the patient can be easily aroused to par- 
 take of nourishment and will readily fall asleep again — differing 
 in this respect from narcotism, which is marked by profound 
 stupor. 
 
 Dental Use. — Hydrate of chloral is sometimes used in den- 
 tal practice for the relief of odontalgia from pulpitis, from one- 
 half to one grain being applied to the inflamed body. It has 
 also been thought a serviceable agent by some in the treatment 
 of putrescent pulp-canals, and as a stimulant and antiseptic 
 injection in chronic alveolar abscesses. 
 
 ANALGESIOS OK ANODYNES. 
 
 Anodynes are agents which are capable of relieving pain. 
 They are divided into two classes, general and local. 
 
 General anodynes, when taken internally, affect the whole 
 organism, by depressing the cerebral centers of perception and 
 sensation. 
 
ANALGESICS OR ANODYNES. 77 
 
 Local anodynes, when applied, affect the parts either by 
 impairing: the conductivity of the sensory nerve-fibres, or by 
 reducing the local circulation. Some of the most efficient ano- 
 dynes act either general or local. The principal agents of this 
 class are as follows : — 
 
 General Anodynes. — Opium, morphia, belladonna, aconite, 
 ether, and chloroform (see Anaesthetics). 
 
 Local Anodynes. — Opium, belladonna, carbolic acid (see 
 Escharotics), cocaine (see Anaesthetics), aconite, etc. 
 
 Opium. 
 
 Source. — Opium is obtained from the white poppy, an annual 
 herb gTown in Asia Minor. 
 
 Nature. — It is a gummy exudation which follows the incis- 
 ing of the unripe capsules. It should yield not less than nine 
 per cent, of morphine when in its normal moist condition. 
 
 Opium contains seventeen alkaloids, the most important of 
 these being morphine — dose, gr. y.,o--!/2 — ^hypnotic, narcotic, and 
 anodyne. 
 
 Principal Preparations of Opium: — 
 
 Pulvis opii, powdered opium. Dose, gr. Yg-ij. 
 
 Tinctura opii, (laudanum), composed of powdered opium, 
 oz. iiss; and diluted alcohol, oj (pint). Dose, TTLxij, or 25 drops, 
 equivalent to 1 gr. of opium. 
 
 Tincture opii camphor at a (camphorated tincture of opium, 
 paregoric) is prepared by macerating "sixty grains of opium in 
 two pints of diluted alcohol, with sixty grains of benzoic acid, 
 a fluidrachm of oil of anise, two ounces of clarified honey, and 
 forty grains of camphor." Dose, f3j-fBj. Dose for infant, v 
 to XX drops (gtt.)-Bss. contains about gr. j. It therefore con- 
 tains ^/^Q the strength of the tincture. 
 
 Pulvis ipecacuanhas et opii (Dover's powder), composed of 
 ipecac 1 part, opium 1 part, sugar of milli 8 parts, triturated to 
 a fine powder. Dose, gr. v to gr. xv. 
 
<0 dextal pathology axd dextal medicine. 
 
 Belladonna. 
 (Deadly Nightshade.) 
 
 Source and Composition. — It is an European plant, the 
 leaves and root being the medicinal portions. It contains two 
 alkaloids — atropine, the active principle, and belladonnine. 
 
 Preparations of Belladonna. From the leaves: — 
 
 Tincture of Belladonna. — Dose, TTtj-3ss. 
 
 Extract of Belladonna. — Dose, gr. 14-I/2. 
 
 From the root : — 
 
 Abstract of Belladonna (powdered). — Dose, gr. ys-V2- 
 
 Fluid Extract of Belladonna. — Dose, nij-v. 
 
 Sulphate of Atropine.— Dose, gr. Vioo'Veo- 
 
 Therapeutics. — Belladonna is especially useful in the pain 
 of inflammation, particularly that of rheumatism, neuralgia, 
 etc., and is used locally in connection with morphine to relieve 
 the pain of abscesses, boils, etc. 
 
 Atropine is used by ophthalmologists to lessen pain, dilate 
 the pupils, paralyze the accommodation, etc. ^ 
 
 Aconite. 
 
 Source and Composition. — It is obtained from the tuberoas 
 root of Aconitum napellus, a perennial plant, -found in the 
 mountainous regions of Europe and Asia. The leaves are 
 sometimes used, but the root makes the most powerful drug. 
 
 The active principle is the alkaloid aconitine, a sedative 
 poison. 
 
 Principal preparations : — 
 
 Extract of Aconite. — Dose, gr. ^2-3- 
 
 Fluid Extract of Aconite. — Dose, Tn.%=-ij. 
 
 Tincture Aconite. — Dose, T^lss-iv. 
 
 Medical Properties and Action. — Aconite is a powerful 
 sedative to the nervous system. In large doses it acts as a 
 cardiac, respiratory, and spinal depressant. 
 
ANESTHETICS. 79 
 
 It proves fatal in poisonous doses by paralyzing the heart 
 and respiration. It is also diaphoretic and antipyretic. 
 
 Dental Therapeutics. — Aconite, in the form of a tincture, 
 is administered in inflammatory affections and in chronic cases 
 of neuralgia. It is an active antagonizer of the fever process, 
 and has been termed the "therapeutic lancet." 
 
 When applied locally, it checks inflammation in its first 
 stages, by paralyzing the peripheral ends of the nerves in the 
 parts, and favoring rcvsolution; also limits the extent of an 
 abscess where pus has already formed. 
 
 In combination with the tincture of iodine, in equal parts, 
 it acts very promptly in the incipient stages of dental perios- 
 titis, relieving the inflammation, retarding the circulation, and 
 stimulating lymphatic action. 
 
 In such cases the gum over the affected tooth should be 
 thoroughly dried and then painted with this combination, pro- 
 tecting the lip or cheek until the remedy is absorbed. It is also 
 considered useful by many in the dressing of pulp canals, pre- 
 venting the formation of inflammatory products. When applied 
 to a large surface, or where the skin is abraded, care should be 
 exercised, or dangerous constitutional effects may result. 
 
 The physiological antagonists are atropine, morphine, 
 digitalis, and ammonia. In aconite 'poisoning the stomach 
 should be evacuated, stimulants administered, warmth applied 
 to the extremities, and the recumbent position maintained. 
 
 ANESTHETICS. 
 
 Anesthetics are agents which temporarily destroy sensation 
 and relieve pain. They are employed for this purpose during 
 surgical operations, to relieve severe neuralgia and other pain, 
 and are sometimes used to relax the muscular system in case 
 of spasms. They are divided into two groups : general and local. 
 
 General anesthetics are volatile substances, capable of pro- 
 ducing (when inhaled) complete unconsciousness, loss of sensi- 
 
80 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 bility, and lessened motor power. When complete, general anes- 
 thesia includes muscular relaxation. 
 
 Partial Anesthesia is sometimes employed where only the 
 loss of conscious sensation is desired. Here only the cerebrum 
 is controlled; the reflex centers of the spinal cord are still sen- 
 sible. This is easily demonstrated by the muscular activity 
 whenever a sensory nerve is irritated. 
 
 'Full anesthesia, or surgical anesthesia, is where both the 
 cerebral cortex and the reflex centers of the spinal cord are para- 
 lyzed. Happily the centers of consciousness are first affected, 
 and those of respiration and circulation, which are so essential 
 to life, last. 
 
 The accompanying diagram from Long's Materia Medica and 
 Therapeutics, shows very clearly a division of the central nerv- 
 ous system, numbered in the order as paralyzed by anesthetics. 
 It is now accepted that anesthetics produce their essential effects 
 by a direct action upon these nerve centers. 
 
 Stages of anesthesia may be divided into the following four 
 distinct divisions: 
 
 (1) Stimulation. 
 
 (2) Primary anesthesia. 
 
 (3) Full anesthesia. 
 
 (4) Paralysis. 
 
 The phenomena of each stage follow each other in apparent 
 sequence and are readily distinguished. The most significant 
 associated with the first stage is general functional excitation. 
 The early action upon the cerebrum producing disturbed nerve 
 function, such as laughing or crying, incoherent talking, un- 
 controlled muscular movements, holding the breath, etc. 
 
 The second stage or primary anesthesia is manifest by the 
 abolition of conscious sensation of pain, though there may be 
 marked reflex irritability, and respiration may be interrupted 
 by spasms or rigidity of the respiratory muscles. Surgical 
 operations should not be undertaken during this stage owing to 
 the dangers of reflex impressions upon the vital ganglia. 
 
AKESTHETICS. 
 
 81 
 
 Danger area 
 
 Anaesthesia area 
 
 1. Conseiouanesa aboliahed 
 
 8. Reapiration paralyzed 
 
 4. Circulation paralyzed 
 
 The several sections are numbered in the 
 order in which they are paralyzed by anes^ 
 thetics. The paralysis of 1 and 2 constitutes 
 surgical anesthesia, paralysis of 3 introduces 
 an element of great danger, and that of 4 is 
 usually fatal. 
 
 [The heart is included in this diagram of 
 the several parts of the central nervous sys- 
 tem, for the reason that it contains nerve- 
 ganglia, which, with their highly irritable 
 muscular structure, provides for its auto- 
 matic, rhythmic action. This provision is' 
 quite independent of the cerebrospinal sys- 
 tem.] 
 
 2. Be flex activity aboliahed 
 
 Fig, 2><. 
 
82 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Full anesthesia, profound, or surgical anesthesia as one 
 may choose to term it, is marked by complete relaxation of the 
 muscular system, and an absence of reflex irritability which is 
 usually tested by touching the cornea or conjunctiva of the 
 eye. With muscular relaxation full and regular respiration fol- 
 lows, accompanied by stertor or snoring largely due to vibra- 
 tions of the relaxed soft palate. 
 
 The fourth or paralytic stage should always be guarded 
 against. It is the danger ground and may result in paralysis 
 of the heart or respiration. 
 
 The principal general anesthetics are ether, chloroform, 
 nitrous oxide gas, and bromide of ethyl. 
 
 Local anesthetics are agents whose action is limited to the 
 circumscribed parts to which they ar^ applied. They paralyze 
 the nerves of the part, thus temporarily destroying sensation. 
 They act similarly to the local anodynes, except that while the 
 anodynes diminish the sensibility of the parts, the local anes- 
 thetic destroys sensation entirely for a time. 
 
 The principal agents of this class are cocaine, eucaine, 
 ethyl chloride, and absolute ether. 
 
 Ether^ C^HjqO. 
 
 Derivation. — Sulphuric ether (improperly so called) is 
 ethylic ether, or oxide of ethyl. It is obtained "by the distilla- 
 tion of ethylic alcohol and sulphuric acid, the acid dehydrating 
 the alcohol and remaining in the retort. (C^IIgO)^ — 11,0= 
 C,H,„0. 
 
 Medicinal Properties and Actions. — Ether is a colorless, 
 volatile, and inflammable liquid. It is an anesthetic and ano- 
 dyne, a diffusible stimulant, and a narcotic poison. Adminis- 
 tered internally, it is one of the most powerful secretion stimu- 
 lants known. The action of the heart, and hence the circulation 
 is increased, flushing and warmth of the surface soon follow. 
 The senses are tnore keen, and the phenomenon of alcoholic in- 
 
ANESTHETICS. 83 
 
 toxication results, which is less protracted, however, ether being 
 quickly eliminated, chiefly by the lungs. 
 
 The first effect of ether, that is the increase in arterial pres- 
 sure due to heart and vaso-motor stimulation, is soon followed 
 by a fall in blood pressure and lowering in force and frequency 
 of the heart movements. 
 
 Principal Preparations: — 
 
 Ether Fortior, stronger ether, ethyl oxide, "C^H^^O," con- 
 tains about six per cent, of alcohol. 
 
 Sulphuric Ether, ethyl sulphate, C^H^^SO^. 
 
 Nitrous Ether, ethyl nitrite (sweet spirit of nitre), 
 C.,E[.!IsrO,. The well-known antipyretic and diaphoretic. Dose, 
 TUv-3ij. 
 
 Dental Use.— Ether is employed as a general and local 
 anesthetic, as a local anodyne in neuralgia and odontalgia, and 
 as a counter-irritant, evaporation being prevented. 
 
 Ether as an Anesthetic Agent. — The practicability of 
 producing anesthesia by the inhalation of ether was first 
 demonstrated by Dr. Horace Wells, of Hartford, Conn., and 
 Dr. W. G. S. Morton, of Boston, Mass., during the years 
 1844-'46. 
 
 Ether, though less prompt in its action, is much safer than 
 chloroform. It has its necrology, however ; a number of fatal 
 cases (about thirty) have been reported. 
 
 The Administration of Ether. — The operator should be 
 well assured, before administering an anesthetic, that the pa- 
 tient is not laboring under any serious disease of the heart, 
 brain, or lungs, as ignorance in this direction might lead to 
 fatal results. The clothing about the neck and chest should 
 always be loose, lest it act as an impediment to respiration, and 
 if artificial teeth be worn, they should be removed before the 
 administration of the anesthetic. 
 
 For the inhalation of ether and chloroform a number 
 of instruments have been devised, but the simplest and probably 
 
84 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 the best method is from a sponge, napkin, or handkerchief, 
 placed within a cone, formed of a towel or stiff paper, with a 
 small opening at the apex for the admission of air; or a small 
 piece of lint can be held in the palm of the hand and on these 
 pour the anesthetic agent. 
 
 The inhalation should be commenced cantionsly, the pa- 
 tient should be directed to breathe quite naturally, and to obey 
 any instructions given, as the rasing of the hand, etc. The 
 towel or napkin should be held six inches from the patient's 
 face, aproaching it gradually, thus overcoming the irritating 
 effect and a sense of strangulation, which follow when the agent 
 is placed at once to the mouth and nostrils. 
 
 Action of Ether. — The first stage of anesthesia is stimulant, 
 the second is tetanic or convulsive, the third, complete relax- 
 ation. 
 
 During complete anesthesia the face is cool, there being 
 a profuse perspiration; the eyes are closed, insensible to the 
 touch, and the pupils are somewhat contracted. The respiration 
 and pulse are somewhat slower than normal, as shown in the 
 following table : — 
 
 Normal pulse, 72 a minute. 
 
 Pulse on administration of ether: — 
 
 1st min. 2d min. 3d min. 4th min. 5th min. 
 92 109 110 94 69 
 
 Normal respiratory movements average about 20 a 
 minute. 
 Respiration on administration of ether: — 
 
 1st min. 2d min. 3d min. 4th min. 5th min. 
 23 24 26 18 15 
 
 Order in Which Nerve Centers Are Acted Upon.— 
 
 First, the cerebrum; second, cerebellum; third, the spinal cord, 
 fourth, the medulla oblongata. 
 
ANESTHETICS. 85 
 
 The Quantity o£ Ether Required. — Largest quantity, 9 
 ozs. ; minimum, 2^2 ozs. ; average quantity to produce 
 anesthesia, 5 ozs. 
 
 The Time Required for Full Anesthesia. — Longest time 
 required, 24 minutes; shortest time, S^/^ minutes; average 
 time, 8 minutes. 
 
 The Dangers of Anesthesia. — There are conditions ren- 
 dering general anesthesia dangerous, and the practitioner, 
 whether medical or dental, should be well assured, before ad- 
 ministering ether or chloroform, that none of these are present. 
 They are fatty degeneration of the heart, valvular lesions, kid- 
 ney disease, brain tumors, respiratory obstructions from en- 
 larged tonsils, thoracic tumors or aneurism, and chronic alco- 
 holism. It should be born in mind that ether is irritant to the 
 air passages and kidneys, lessening the elimination power of 
 the latter. An anesthetic should never be administered on a 
 full stomach, as sickness would likely follow that would inter- 
 fere with the operation, and anesthesia of the glottis prevents 
 the expulsion of vomited matter in case it enters the larynx by 
 regurgitation; neither should it be given after long fasting, as 
 an absence of nutrition would tend toward cardiac paralysis; 
 excitement should be avoided, instruments should be kept out 
 of sight, and too many spectators should not be present. A 
 painful operation should not be commenced before the stage of 
 complete anesthesia is reached, or it may cause death from 
 shock, as the result of peripheral irritation. 
 
 Treatment of Dangerous Symptoms. — In case of the sus- 
 pension of the heart's action, the agent should be withdrawn, 
 the body placed in a reclining position, and, if need be, inverted, 
 and air freely admitted. The failure of respiration requires the 
 drawing forward of the tongue, by a finger being thrust deeply 
 into the mouth; the inhalation of a good stimulant, nitrite of 
 amyl, gtt. ij to gtt. v; but care is necessary in its use, and not 
 jnore than two or three drops should be administered to patients 
 
86 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 who have never inhaled it. The inhalation of ammonia is pos- 
 sibly as efficient, and can be used with more freedom than nitrite 
 of amyl. Galvanism, too, has been successfully employed as a 
 cardiac and respiratory stimulant, "the positive pole being; 
 placed to the nostril and the negative pole over the diaphragm, 
 to excite a reflex action between the fifth pair and the pneumo- 
 gastric, or the poles may be applied directly over both phrenic 
 nerves, or on a line with the fourth cervical vertebra, in order 
 to stimulate respirations; or one pole may be placed over the 
 upper dorsal spinous process and the other pole over the apex 
 of the heart, to induce cardiac contraction."* And if necessary, 
 artificial respiration should be employed (see Appendix) and 
 warmth applied. The extremities should also be rubbed briskly, 
 rubbing upward. 
 
 Note. — It should be remembered that ether vapor is heavier 
 than air, and forms therewith a highly explosive mixture. 
 Therefore, if a light must be in the room, it should be high 
 above the patient. A grate fire, gas stove, etc., in the vicinity 
 are very dangerous. 
 
 CHLOROFORM;, CHCI3. 
 
 Derivation. — Chloroform (Ter-chloride of Methyl, or Meth- 
 ylic Ether) is obtained by distilling alcohol with chlorinated 
 lime. It was discovered in 1831, by Samuel Guthrie, of Sack- 
 ett's Harbor, N. Y. 
 
 The form for medicinal use is Chloroformum Purificatum, 
 or Purified Chloroform. 
 
 Medicinal Properties and Action. — When inhaled, chloro- 
 form is an anesthetic, and when administered internally, it is 
 an anodyne and antispasmodic. If swallowed undiluted, it 
 excites great inflammation of the mucous membrane and causes 
 violent gastritis. 
 
 *Gorgas' "Dental Medicine." 
 
ANESTHETICS. 87 
 
 Its effects are similar to those of ether, but more rapidly 
 produced, and it is more powerful in its action; hence requiring 
 more care in its administration. 
 
 When first administered (internally) it causes a feeling of 
 warmth in the stomach, which is soon followed by a sense of 
 coldness. It increases the action of the heart, producing excite- 
 ment of the brain, followed by depression and deep, heavy sleep. 
 In large doses it causes stupor and insensibility, and has caused 
 death. 
 
 Therapeutic Uses. — Chloroform is used for the same pur- 
 poses as is ether, and is much employed locally in liniments. 
 Administered by inhalation, it is a general anesthetic, and 
 when administered internally, in substance, it is an anodyne 
 and antispasmodic, and is used as such in cases of nausea, sea 
 sickness, sick headache, and in cases of cholera. In the last 
 named it has probably proven more efficacious than any other 
 single remedy. Dose, nij-^ss, diluted, internally. 
 
 Spirit of chloroform (chloroform, Bj; diluted alcohol, Sij), 
 3ss-3j. 
 
 For inhalation, ^j-Bj. Average, 3iij. 
 
 Dental Use. — Chloroform is employed by some in dental 
 practice as a general anesthetic; its use, however, is growing 
 less every year, in favor of ether and nitrous oxide gas. It is 
 also used as a local anesthetic; in this case it is generally com- 
 bined with other substances, as aconite, alcohol, ether, 
 opium, etc. 
 
 For administration as an anesthetic, treatment of dan- 
 gerous symptoms, etc., see Ether. ® 
 
 Chloroform Narcosis. — 
 
 Shortest time, 2 minutes 30 seconds. 
 
 Longest time, 14 " 30 " 
 
 Average time, 6 "24 " 
 
 Chloroform mortality is 1 in 3,000; over 500 fatal cases 
 are reported, none of which, however, were in obstetrical prac- 
 tice. The apparent safety of chloroform in obstetrics has been 
 
88 
 
 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 explained by the theory that death from chloroforra is due to 
 vasomotor paralysis, and as pregnancy increases the vasomotor 
 tension, pregnant women are in consequence less liable to fatal 
 results. 
 
 Compared with ether mortality, 1 in 16,000. 
 
 The physiologic action of ether and chloroform compared 
 is as follows : 
 
 Organs, Tissues, 
 etc., affected. 
 
 Arterial tension ( 
 and blood-pres- < 
 sure, ( 
 
 Heart, 
 
 Lung-s, 
 
 Mouth, ncse and 
 pharynx, 
 
 Stomach and in- r 
 testines, I 
 
 Liver, 
 
 i 
 
 Kidneys, 
 
 Temperature, 
 
 Pupils and corneal f 
 reflex, ' 
 
 Ether. 
 
 Greatly increases both. 
 Followed by fall. 
 
 Stimulates and large 
 
 doses paralyze. Zone 
 
 between these quite 
 large. 
 
 Has slightl.v direct ir- 
 ritating effect, caus- 
 ing increased tracheo- 
 bronchial secretion. 
 Stimulates respiratory 
 center and large doses 
 paralyze. Zone very 
 large. 
 
 Greatl.T increases all se- 
 cretions, f^arge doses 
 paralyze muscles of 
 tongue, epiglottis and 
 palate. Both above 
 favor aspiration. 
 
 Considerable nausea and ^ 
 vomiting. I 
 
 No effect. 
 
 In normal kidneys ] 
 
 transitory effect | 
 (casts and traces of 
 
 albumin). decreased | 
 
 amount of bio d and ) 
 
 secretion. In diseased i 
 
 kidneys has a bad ef- I 
 
 feet, may cause anu- ! 
 
 ria and uremia. J 
 
 Lowers it. 
 
 Pupils contracted some "] 
 and respond. Corneal 
 reflex of some value. 
 
 Chloroform. 
 Gradually decreases both. 
 
 Depresses and large doses 
 paralyze ; zone between 
 these two, small. 
 
 Slows respiration and 
 large doses paralyze. 
 Zone small. 
 
 Scarcely any effect on se- 
 cretions. Large doses 
 also paralyze tongue, 
 etc. 
 
 Less nausea than ether; in 
 large doses causes some 
 fatty degeneration of 
 muscles. 
 
 Prolonged administration 
 causes fatty degenera- 
 tion with decreased gly- 
 cogen, icterus, and in 
 fatty liver may cause 
 acute yellow atrophy. 
 
 In ordinary administra- 
 tion and normal kidneys 
 but slight transitory ef- 
 fect. In prolonged ad- 
 ministration causes con- 
 siderable fatt.v degen- 
 eraiion. 
 
 Lowers it less than ether. 
 
 Pupils somewhat con- 
 tracted but respond. Sec- 
 ondary dilation of pupil, 
 bad sign. Corneal re- 
 flex of li**!* vnlnp. 
 
ANESTHETICS. 89 
 
 Nitrous Oxide Gas, NgO. 
 
 History. — Nitrous Oxide, or "Laughing" Gas, was discovered 
 by Dr. Priestly in 1776, and its respirability demonstrated by 
 Sir Humphry Davy, though the results v^ere not published until 
 some twenty years afterward. In 1844 Dr. Horace Wells prac- 
 tically demonstrated the value of its anesthetic property for the 
 relief of pain during surgical or dental operations. 
 
 Nitrous oxide gas is manufactured by slowly melting and 
 boiling the salt nitrate of ammonia in a glass retort, dissolving 
 it into a vapor of water and a permanent gas (NH^NOg+Heat 
 =N20+2H20). The gas should pass through three wash 
 bottles, the first containing a solution of the sulphate of iron or 
 caustic potash, and the other two pure water, for the purpose of 
 purifying it before it enters the receiver, from which it is 
 administered to the patient through an inhaling tube. A 
 pound of the salt will generate about thirty gallons of the gas. 
 It is perfectly fused at 226° F., white fumes are emitted at 
 302° F., and gas begins to evolve at 460° F. If the temperature 
 is raised to 500° F., a dangerous impurity, nitric oxide, is given 
 off; this need not be generated, however, if the proper care is 
 observed, not allowing the temperature to rise above 480° F. 
 
 Liquefied Nitrous Oxide. — The most convenient form for 
 use is the liquefied gas, it being liquefied and solidified under 
 intense cold and great pressure. It is then secured in strong 
 iron cylinders, from which it is allowed to escape into an in- 
 haling bag when needed for use. 
 
 The advantages of this form of gas are its purity, con- 
 venience for use, the large supply which can be kept on hand, 
 and its comparative freedom from deterioration, notwithstand- 
 ing its age. 
 
 Properties and Actions. — ^Nitrous oxide gas is an elastic, 
 
 colorless gas, with a very slight and agreeable odor. It will 
 
 freeze into a beautiful, clear, crystalline solid, at about 15° F. 
 
 below zero. 
 7 
 
90 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 "By the evaporation of this solid, a degree of cold may be 
 produced far below that of carbonic acid bath in vacuo, or 
 lower than 17° F."'^" 
 
 Nitrous oxide gas supports combustion with nearly the same 
 promptness as oxygen. 
 
 As an Anesthetic. — Nitrous oxide gas is the most pleasant 
 and the safest general anesthetic known. The shortness of the 
 anesthetic stage is the greatest objection to its administration 
 for surgical operations, though its rapid action, comparative 
 safety, and the transient nature of its effects on the system 
 render it the most useful anesthetic agent for all minor opera- 
 tions, such as the extracting of teeth, removal of nerves from 
 the teeth, where the tooth substance is lost to such an extent 
 that a devitalizing agent could not be retained, for the lancing 
 of abscesses, etc. 
 
 The administration of nitrous oxide gas for dental oper- 
 ations, should be conducted with the same care that is given 
 to ether and chloroform, though it is a comparatively safe 
 anesthetic. The patient should be seated in an operating chair 
 which will admit of the back being lowered to such a degree 
 that the patient could at once be placed in a horizontal position. 
 The dress about the throat and waist, if tight, should be previ- 
 ously loosened, and the patient should not have partaken of food 
 for at least two hours previous to the inlialation of the gas. 
 
 A mouth prop, of which there are several patterns manu- 
 factured, should he placed between the teeth, to prevent the 
 closure of the jaws, as the muscles become rigidly contracted 
 during the administration of this gas. The most suitable prop 
 is one made of India rubber — the ordinary lead-pencil eraser, 
 cut in proper lengths, answers the purpose very nicely — or a 
 firm cork, as it prevents injury to the teeth or fillings, which 
 sometimes occurs when a mouth prop of a hard substance is 
 
 *Gorgas' "Dental Medicine." 
 
AXESTHETICS. 91 
 
 used. The patient is then directed to take full, regular, and 
 deep inspirations of the gas, the nose being held or covered, 
 to prevent the admixture of atmospheric air. Its anesthetic 
 effects are soon made manifest by strong, involuntary respira- 
 tions, accompanied by snoring, this being caused by the relax- 
 ation of the nuiscles of the pharynx, and paralysis of the tongue, 
 causing it to fall back toward the throat, interfering with 
 breathing, and a livid appearance of the lips, cheeks, and finger 
 nails, due to the discolored blood in the capillaries. Bu1 the 
 most delicate test for complete anesthesia is, as in ether and 
 chloroform, the loss of sensibility to the touch in the conjunctiva 
 of the eye. 
 
 The amount of gas required to produce complete anesthesia 
 varies, from five to fifteen gallons being the usual amount. Out 
 of several administrations the writer has had one case where 65 
 gallons were required, and another where SO gallons were in- 
 haled before the anesthetic stage was reached. 
 
 The first stage under nitrous oxide gas is muscular activity. 
 
 The second stage is muscular rigidity. It can not be con- 
 tinued until complete muscular relaxation, lest the patient die 
 of- asphyxia. 
 
 Nitrous Oxide Gas Mortality. — There is about one death 
 to each 125,000 administrations. 
 
 Dangerous Symptoms, with Treatment, etc. — See Ether. 
 
 Bromide of Ethyl^ C^H^Br. 
 
 Derivation. — Bromide of ethyl, or hydrobromic ether, is 
 obtained by distilling bromide of potassium and sulphuric ether, 
 and redistilling with chloride of lime. 
 
 Properties. — It is a colorless, volatile fluid, possessing an 
 agreeable ethereal odor and a pungent taste. It is not inflam- 
 mable, caustic, nor irritant; in this respect it is preferable to 
 chloroform or ether as an anesthetic agent. 
 
 The Administration. — Bromide of ethyl is administered as 
 is ether or chloroform, or in a folded starched napkin, so as to 
 
92 DENTAL PATHOLOGY AXD DENTAL MEDICINE. 
 
 cover the face, as directed by Prof. Gorgas. A soft linen hand- 
 kerchief is placed inside the napkin, and upon this the agent is 
 poured; one drachm should be used at first, directing the pa- 
 tient to take deep, full inspirations. At the end of two minutes 
 the second drachm should be added; this should be repeated at 
 intervals of two minutes, until complete anesthesia is produced. 
 The quantity differs according to the susceptibility of the 
 patient. 
 
 Action. — The administration of bromide of ethyl is attended 
 with some danger, and clinical experience has not demonstrated 
 to careful operators that it is as safe as some other and older 
 agents of this class. It has a toxic action on the centers of 
 respiration. The heart force is decreased and its action is more 
 frequent, which contributes to the paralysis of the respiratory 
 centers. Several deaths occurred in a very limited number of 
 administrations of this agent. 
 
 Precautionary measures in administering anesthetics: 
 That respiration may in no way be hampered, the operator 
 should see to it that the respiratory tract is not encroached 
 upon either by a collar at the throat, or by corset stays about the 
 chest. It is quite as important to test the freedom of respira- 
 tion before administering an anesthetic as it is to take the 
 pulse or listen to the heart's action. Where enlarged tonsils are 
 noted and post-nasal growths indicated or enlargement of the 
 glands of the neck, goitre, severe bronchitis or any other local 
 trouble which might interfere with respiration, or where there 
 is apparent existence of serious disease of the vital organs, as 
 indicated under the dangers of anesthesia, a general anesthetic 
 should not be administered without consulting the family physi- 
 cian, and possibly securing his co-operation. 
 
 The neurotic patient may be at first misleading. Mental dis- 
 quietude frequently causes an accelerated action of the heart, 
 or such a patient may at first hold the breath or breathe ap- 
 parently with much effort. These should be noted and not ac- 
 cepted as normal conditions. 
 
ANESTHETICS. 93 
 
 Some operators prefer the admixture of ether and chloroform, 
 or alcohol, ether and chloroform, while others adhere strictly to 
 the separate drug; and claim that the various mixtures are to 
 be depreciated owing to the uncertainty as to the exact propor- 
 tion of the separate ingredients the patient would appropriate. 
 
 Cocaine. 
 
 Source. — Cocaine is the active crystalline alkaloid of Ery- 
 throxylon coca, a small Peruvian shrub. The leaves resemble 
 those of Chinese tea, and in South America thy are used by 
 eight millions of people much as we use tea or coffee. 
 
 In the preparation of the alkaloid, it is necessary that the 
 leaves be carefully gathered, as the best quality only should be 
 used. They should be dried, and not injured by age or exposure 
 to the air, as moisture deprives them of value. 
 
 Preparations of Erythroxylon : — 
 
 Extractum Erythroxyli Fluidum, fluid extract of ery- 
 throxylon. Dose, 3ss-ij. 
 
 Salts of cocaine. 
 
 Cocaine Hydrochlorate, C^_H2iN0^. — Dose internally, gr. 
 Vg-ij ; most commonly used as a local anesthetic in aqueous so- 
 lutions, 2-5 per cent. 
 
 Cocaine Oleate, cocaine and oleic acid, 5-20 per cent, solu- 
 tions for external use. 
 
 Cocaine Hydrobromate, cocaine and hydrobromic acid, 
 2-10 per cent, as a local anesthetic. 
 
 Cocaine Wines, Pastes, Lozenges, etc., are made in great 
 varieties. 
 
 Medicinal Properties and Action. — Cocaine, when applied 
 locally, acts as an anesthetic ; when taken internally in small 
 doses, it is a general stimulant, improving digestion, stimulating 
 the respiration, circulation, etc. It produces wakefulness and a 
 marked diminution of the sense of fatigue and hunger., ^ov 
 
94 DENTAL PATHOLOGY AND DEKTAL MEDICINE. 
 
 this reason the leaves are chewed by the Peruvian Indians to 
 sustain them during long journeys or arduous labor. 
 
 A toxic dose, or long-continued use (cocaine habit) pro- 
 duces insomnia, decay of the moral and intellectual powers, 
 hallucinations, insanity, and death. 
 
 Dental Use. — The salts of cocaine have proven very efficient 
 for their local anesthetic and anodyne effects; their power as a 
 local anesthetic is very great over a limited area, and hence it 
 is of special value to the dentist, for operations upon the sub- 
 mucous tissues and the extraction of teeth, where it should be 
 used by hypodermic injection, or applied to the gum on either 
 side of the tooth to be extracted^ the latter method being the 
 safer; two or three applications should be made at intervals of 
 about two minutes each, when a painless operation is generally 
 secured. It has been found to act very happily, also, in connec- 
 tion with arsenious acid, for the devitalization of dental pulps, 
 the pulp dying without giving the patient any discomfort. But 
 as for its use as a pain obtundent in hypersensitive dentine, its 
 practical benefits are questionable. 
 
 A warning, however, should be given, that a potency for 
 evil lurks in this most valuable drug. In many cases where it 
 has been injected into the gum tissue for extraction of teeth, 
 toxic results of an alarming nature have occurred and patients 
 have been rendered ill for several weeks. This, however, is not 
 apt to follow when the patient is of a sanguine temperament and 
 in good health. The writer has made a record of many cases 
 where toxic results have followed the use of this drug, and finds 
 them all to be of a nervous or hysterical temperament, or preg- 
 nant women. The lesson is that we should use judgment and 
 discrimination in its application. 
 
 Dangerous Symptoms. — The extremities usually become 
 cold and rigid, the eyes staring and glassy, and the face pallid, 
 while the pulse is weak, the heart beats faint, and respiration 
 slow and weak — the symptoms of an impending collapse. 
 
ANESTHETICS. 95 
 
 Treatment of Dangerous Symptoms. — Fresh air should 
 be admitted and some good stimulant administered, such as 
 brandy, or aromatic ammonia and nitrate of amyl — ^by inhala- 
 tion, or ether in case of convulsions, and if need be the battery. 
 As soon as the patient is able, assist him to stand up and 
 promenade. 
 
 Chloride of Ethyl, C^HgCl. 
 
 Properties. — Chloride of ethyl is a colorless liquid possessing 
 a strong ethereal odor, and is very volatile and inflammable in 
 ordinary temperature. Its boiling point is about 50° F. It is 
 due to this low boiling or vaporizing point that it is so exactly 
 adapted to the special requirements of a local anesthetic. It is 
 put up in convenient glass tubes, drawn out to a fine point, and 
 hermetically sealed. 
 
 The point of the tube is marked by a file scratch at its 
 smallest part. Hero the point is broken off when ready for use, 
 either by the fingers or the forceps. Immediately the chloride 
 in a gaseous state escapes from the small opening, and if the 
 tube is partially inverted, a small jet of the liquid is projected; 
 this is further accelerated by allowing a good portion of the 
 tube to come in contact with the hand, the warmth of which 
 hastens the vaporization of the liquid. 
 
 The preparation of chloride of ethyl, as spoken of above (in 
 glass tubes), is a patented process. As the chloride evaporates 
 in ordinary temperature and is very inflammable, the point has 
 to be drawn out and sealed while the tube and its contents are 
 immersed in ice water. 
 
 The Application and Action. — ^When about to apply, the 
 parts to be anesthetized should be thoroughly dried, by means 
 of absorbent cotton or napkin, then the point of the tube should 
 be broken, or the screw-cap removed as the case may be, as pre- 
 viously directed, and the fine jet of chloride directed upon the 
 surface. 
 
96 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 If teeth are to be extracted, a napkin should be placed in the 
 mouth back of the teeth to be operated upon, and the patient 
 directed to breathe entirely through the nose; the liquid should 
 then be projected upon the mucous membrane around the tooth 
 or root and upon the cheek over the track of the inferior maxil- 
 lary nerve for the lower, and on the temple over the emergence 
 of the fifth nerve for the upper teeth. This application upon 
 the face, however, need not be made unless the teeth are very 
 difficult to extract, and prolonged anesthesia is desired. 
 
 It is seldom necessary to use the entire contents of a tube 
 for a single operation; one-quarter of it will usually produce 
 complete anesthesia of the parts. The opening in the tube can 
 then be closed and the contents preserved for a subsequent 
 operation. 
 
 The writer has employed chloride of ethyl in over three hun- 
 dred minor surgical operations with uniform success. It is 
 a most satisfactory local anesthetic in the extraction of teeth, 
 lancing of abscesses, removal of small tumors, opening the 
 maxillary sinus, extraction of the tooth pulp, and in the prepa- 
 ration of roots of teeth and the fitting of bands and caps in 
 crown- and bridge-work. 
 
 EucAiNE Hydroohlorate^ "A." 
 
 Derivation. — Eucaine hydrochlorate "A" is obtained by the 
 action of one molecule of ammonia upon three molecules of 
 aceton which forms triacetonamin. This is then transformed 
 into dry triacetonamincyanhydrin by hydrocyanic acid. 
 
 This compound when saponified becomes triacetonall?;amin- 
 carbonic acid, ammonia being given off in the process. 
 
 When benzylated and methylated we get n-methyl-benzoyl- 
 tetramethyly-oxjrpiperidincarbonic acid-methylester, or eucaine. 
 
 As will be apparent from this synthesis, eucaine is not a 
 coal-tar product. 
 
ANESTHETICS. 97 
 
 Properties and Actions. — Eucaine (A) is a white, neutral, 
 crystalline powder, soluble in ten parts cold water, making 
 about nine per cent, solution. This solution is stable and may 
 be boiled without suffering deterioration. It may be employed 
 in all cases where cocaine is used and in similar strength or 
 stronger, since the two drugs are quite similar as regaras the 
 rapidity, intensity, and duration of anesthesia; eucaine, how- 
 ever, being much less toxic. 
 
 Therapeutics. — Eucaine is employed as a local anesthetic 
 for minor surgical operations, and, as has been indicated, the 
 only important difference of this drug and cocaine, physiologi- 
 cally or therapeutically, is the difference in their toxic effects. 
 It is claimed, after many careful experiments, that the pulse is 
 not materially affected by the use of eucaine, either in rate or 
 character. Some writers have stated that unpleasant disturb- 
 ances of sensation follow the use of this drug, particularly when 
 used upon the pharynx. These disturbances, however, are less 
 unpleasant and less marked than those produced by cocaine, 
 and are more transient, and, speaking generally, after the lapse 
 of an hour from the time of application, the subjective sensa- 
 tions may be described as normal. 
 
 Dental Uses. — In dental practice, eucaine, from two to five 
 per cent, solution, is employed as a local anesthetic in the ex- 
 traction of teeth; it is applied locally, by freely bathing the 
 parts, for lancing painful abscesses; is injected hypodermatically 
 in minor surgical operations in the mouth, such as the removal 
 of small tumors, necrosed bone, and in operations upon the 
 antrum of Highmore. Eucaine may also be employed, cata- 
 phorically, for the obtunding of sensitive dentine, the removal 
 of the dental pulp, etc. The writer has secured very satisfactory 
 results with a ten per cent, solution of the drug, both as a local 
 anesthetic in operations upon the antrum, and in conjunction 
 with cataphoric instruments in the usual dental operations. 
 
98 DENTAL PATHOLOGY AKD DENTAL MEDICINE. 
 
 STIMULAE^TS. 
 
 Stimulants are medicinal agents whicli increase organic 
 activity. The most powerful and rapid in action, though tran- 
 sient in effect, are termed diffusible stimulants, while the local 
 stimulants, which are of a vegetable nature, containing a vola- 
 tile oil, are termed aromatic. 
 
 Among the first class are such agents as the alcoholic prep- 
 arations, ammonia, camphor, ether, nitrite of amyl, myrrh, nor- 
 mal saline solution, coca, caffbae, etc. 
 
 The principal members of the class of aromatic stimu- 
 lants are capsicum, oil of cloves, peppermint, etc. Heat and 
 cold also act as local stimulants. 
 
 Alcohol, C2HgO. 
 
 Derivation. — Alcohol is obtained by repeated distillations 
 from the product of fermented grain or starchy substances, 
 easily converted into grape sugar, which in the presence of and 
 by the growth of low vegetable organisms (the yeast plant, etc.) 
 splits up into alcohol and CO^. Commercial alcohol contains 
 about 90 per cent, of absolute alcohol with 10 per cent of water. 
 
 Properties and Action. — Alcohol is a colorless, inflammable 
 fluid, wholly vaporizable by heat, and unites in any proportion 
 with water and ether. It possesses a pungent odor and burning 
 taste. All of the alcoholic preparations are powerful diffusible 
 stimulants, causing general exhilaration of spirits. 
 
 In large doses, however, it is a depressant, producing mus- 
 cular inco-ordination and the effects of narcotic poisons, ending 
 in delirium, coma, and death. 
 
 The Most Important Alcohols are: — 
 
 Methylic Alcohol, C^Ufi, methyl hydrate, wood spirit. 
 
 Ethylic Alcohol, C2HgO, ethyl hydrate, grain spirit. 
 
 Amylic Alcohol, C-H^oO, amyl hydrate, potato spirit, also 
 occurs with the ethylic alcohol, in excessive distillations of fer- 
 mented grain. 
 
STIMULAA'TS. 99 
 
 Principal Preparations of Alcohol: — 
 
 Absolute Alcohol, rarely obtainable in the shops, however, 
 stronger than 98 per cent. 
 
 Alcohol contains about 91 per cent, of absolute alcohol. 
 
 Alcoholis Dilutum contains equal parts of alcohol and 
 water. 
 
 Spiritus Frumenti, whisky from rye, corn, barley, and 
 potatoes, contains from 45 to 50 per cent, of alcohol. 
 
 Rum, obtained by the distillation of fermented molasses. 
 
 Wines — ^port wine, sherry white wine (made by fermenting 
 the juice of the grape without the seeds, stems, or skins) ; red 
 wine (from the juice of grapes with their skins) ; champagne, 
 claret, Hhine, etc. These contain from 5 to 40 per cent of 
 alcohol. 
 
 Beer by slow fermentation, contains 2 to 3 per cent, alcoliol. 
 Ale, by rapid " •' 2 to 6 " " 
 
 Porter and stout '• 4 to G " " 
 
 Therapeutic Uses. — The alcoholic preparations are most val- 
 uable agents in disease, for appropriate cases; they are em- 
 ployed as stimulants in acute inflammations, such as pneu- 
 monia, pleurisy, bronchitis, phthisis, and in the last stages of 
 typhoid fever, diphtheria, acute neuralgia, etc. In insomnia 
 from cerebral anaemia, small doses of some alcoholic stimulant 
 at bedtime are found beneficial. In poisoning by cardiac de- 
 pressants and snake venom, alcohol, freely sustains the heart. 
 In chloroform anesthesia, an ounce of whisky beforehand will 
 sustain the heart and prolong narcosis. 
 
 Dental Uses.- — In the administration of nitrous oxide gas, 
 a small quantity of wine taken beforehand will often be found 
 beneficial, increasing the heart's action at about the time the 
 effects of the anesthetic are passing off. In painful operations 
 upon the teeth, I have found small doses of sherry or brandy 
 to be verv beneficial. 
 
100 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 As a styptic, it arrests hemorrliags by coagulating the blood 
 by its effects "upon albumin, and contracts the mouth of the 
 vessels by its astringent properties. 
 
 For suppurating wounds it is a useful antiseptic dressing. 
 
 For the treatment of soft and sensitive dentine, and 
 for drying cavities preparatory to filling, absolute alcohol is 
 generally an efficient agent; after drying the cavity with cotton 
 or bibulous paper, it should be bathed v^ith alcohol, which evap- 
 orates rapidly and causes the almost perfect absorption of 
 moisture from the dentine. 
 
 Treatment of Acute Alcoholism. — ^Evacuate the stomach, 
 administer ammonia cautiously by inhalation, apply warmth to 
 the extremities and cold affusion to the head, and, if need be, 
 artificial respiration. * . 
 
 Ammonia. • 
 
 Medicinal Properties and Action. — It exists most com- 
 monly in the form of ammonia gas, NHg; which, dissolved in 
 water, is the aqua ammonise of conunerce. It is intensely alki- 
 line, and is an irritant to the mucous membrane. When inhaled 
 it. acts as a stimulant, especially as an antagonist of cardiac de- 
 pressants. Prolonged inhalation induces spasmodic coughing, 
 a sense of suffocation, and inflammation and oedema of the 
 glottis; when swallowed, the aqua sets up violent inflammation 
 of the passages and stomach. 
 
 The salts of ammonia, in medicinal doses, are stimulating 
 expectorants, and stimulate the heart's action; while in large 
 doses or continued use they produce rapid emaciation, by im- 
 pairing digestion and increasing tissue waste. In large doses 
 they also injure the red blood corpuscles. 
 
 Principal Preparations: — 
 
 Aqua ammoniae, water of ammonia, containing 10 per cent, 
 of the gas in water. Dose, "niv-xxx, diluted. 
 
STIMULANTS. 101 
 
 Aqua ammoniae fortior, containing 28 per cent, of the gas 
 in solution. 
 
 Ammonium carbonate. Dose gr. ij-x. 
 
 Ammonium chloride, sal ammoniac. Dose, gr. j-xx. 
 
 Ammonia spirits (a 10 per cent, solution of aqua ammoniae 
 in alcohol). Dose, "nix-Sj, diluted. 
 
 Aromatic spirits of ammonia, the carbonate with aro- 
 matics (oil of lemon, lavender, etc., and alcohol and water). 
 Dose, TTLx-^ij. 
 
 Ammonia liniment, aqua ammonias, 30 per cent., and cot- 
 ton-seed oil, 70 per cent. 
 
 Ammonium nitrate, used in preparing nitrous oxide gas. 
 
 Ammonium sulphate, used in preparing other ammonium 
 salts, etc. 
 
 Camphor^ CjoH^gO. 
 
 Source. — Camphor is a white, concrete, and translucent gum, 
 obtained from the volatile oil of the camphor laurel, an ever- 
 green tree indiginous in China, Japan, Formosa, etc. Refined 
 camphor is prepared in large circular cakes, one to two inches 
 thick. 
 
 Properties and Action. — Camphor is slightly soluble in 
 water (about 1 to 1300), but freely in alcohol, ether, chloroform, 
 oils, and mill^. Alcohol forms a 75 per cent, solution. It has 
 a penetrating, fragrant odor, a bitter, pungent taste, leaving a 
 slight sense of coolness. It is a stimulant, anodyne, diaphoretic, 
 antiseptic, and irritant. 
 
 In medicinal doses it temporarily increases the heart's 
 action, stimulates respiration and mental activity, promotes 
 perspiration, and allays pain and spasm. 
 
 Large doses depress the heart and excite narcotic symptoms, 
 and have proved fatal. 
 
102 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Principal Preparations: — 
 
 Aqua camphorae, camphor water (8 parts of camphor to 
 1000 of distilled water, with 16 parts of alcohol to aid in the 
 suspension of camphor). Dose, 3j-iv. 
 
 Spiritus camphorae, spirit of camphor (camphor, Siv, alco- 
 hol, Oj). Dose, TTLv-xx. 
 
 Linimentum camphorae, camphor liniment (camphor 1 
 part to olive oil 4 parts). 
 
 Linimentum saponis, soap liniment (soap 10 parts, cam- 
 phor 5, oil rosemary 1, alcohol 70, water 15). Is an anodyne 
 and mild irritant for sprains, rheumatic pains, etc. 
 
 Dental Use. — In dental practice the spirit of camphor is 
 sometimes employed by local application to allay the pain of 
 sensitive dentine, and that which sometimes follows the ex- 
 traction of teeth, and the wounding of pulps of teeth. Cam- 
 phor is also employed in the treatment of putrescent root canals 
 of teeth. It is also one of the ingredients of the celluloid base 
 for artificial teeth. 
 
 Nitrite of Amyl, C.H^^NOg. 
 
 Derivation. — Nitrite of amyl is produced by the action of 
 nitric or nitrous acid upon amylic alcohol. 
 
 Properties and Action.— Nitrite of amyl is a clear, yellow- 
 ish, oily liquid. It has an ethereal odor, and is very volatile 
 and inflammable; it is insoluble in water, but soluble in alcohol, 
 ether and chloroform. It is used by inhalation, causing great 
 cardiac activity, vascular dilatation, flushing of the face, a 
 sense of fullness of the brain, and complete resolution of the 
 muscular system. It is a muscle poison, and when the vapor 
 is applied directly to the muscular or nervous tissues it arrests 
 their functional activity. 
 
 Dental Use. — Nitrite of amyl, being a powerful stimulant 
 to the heart, is employed in syncope and chloroform narcosis. 
 It is also used in epileptic attacks and other convulsive or spas- 
 
STIMULANTS. 103 
 
 modic diseases. Cases are reported where nitrite of amyl has 
 restored the patient after artificial respiration had failed. Care, 
 however, must be observed in its use, as it is a powerful and 
 dangerous agent. 
 
 Dose of nitrite of amyl by inhalation is from TTLij to TTLv. 
 JSTot more than two or three drops should be administered to 
 weak and nervous patients who are susceptible to its influence. 
 
 Myrrh. 
 
 Source. — Myrrh is a resinous exudation from a small tree 
 grown in Arabia and the northeastern coast of Africa, known 
 as the Balsamodendron myrrha. It is a spontaneous exuda- 
 tion from the stems of the tree, which collects in small masses 
 upon the bark. 
 
 Properties and Action. — Myrrh is brittle and is easily pul- 
 verized. It is of a reddish-yellow color, translucent, with an 
 aromatic taste and a peculiar fragrant odor. When pulverized 
 the powder is of a light yellow color, if pure. In medicinal 
 doses, myrrh is a stimulant and astringent. It stimulates the 
 digestive organs and improves the appetite, but in larger doses 
 it acts as an irritant to the gastro-intestinal membrane. It is 
 employed externally as a local application to inflamed, iilcerated, 
 and relaxed tissues, for stimulating and astringent effect. 
 
 Dose — Powdered myrrh, gr. x to ^ss, in pill form or sus- 
 pended in water. Tincture of myrrh, ^ss to j (myrrh Biij, 
 alcohol Oij). 
 
 Dental Use. — The tincture of myrrh, diluted, forms an ex- 
 cellent gargle and mouth-wash, and a stimulating lotion for 
 spongy and inflamed gums. The powder is employed as an 
 ingredient of many dentifrices for its astringent properties. 
 
 Capsicum. 
 Source. — Capsicum, or Cayenne Pepper, is the fruit of Cap- 
 sicum fastigiatunfhj a plant of tropical Africa and America. Its 
 
104 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 pungent odor and hot taste are due to its very acrid and volatile 
 principle, called capsicine. 
 
 Medicinal Properties and Actions. — Capsicum in medic- 
 inal doses is a powerful stimulant. It produces a sensation of 
 warmth in the stomach, and a general glow over the body; it 
 stimulates the circulation and digestive process, but in ex- 
 cessive doses it acts as an irritant poison. 
 
 Preparations : — 
 
 Tincture Capsicum. Dose, "niv-Sj. 
 
 Powdered Capsicum. Dose, gr. v-x in pills. 
 
 Emplastrum Capsicum. A most excellent plaster. 
 
 Dental Use. — Capsicum in tincture or plaster form, pre- 
 ferably the latter, is very serviceable in dental periostitis, as it 
 aids in establishing resolution or hastens suppuration. It is 
 also an excellent stimulating gargle, tin«t. capsicum, 5ss to 
 rose water, Sviij. 
 
 Oil of Clo\^s. 
 
 Source. — The oil of cloves is obtained from the dried, unex- 
 panded flowers of the Eugenia caryophyllata, an evergreen tree 
 of the myrtle order, a native of the Indies. 
 
 Properties and Actions. — The oil of cloves, when fresh, is 
 a clear and colorless preparation; it has a pungent, spicy taste, 
 and a fragrant odor. Is an aromatic stimulant, irritant and 
 antiseptic. It is sometimes administered to relieve nausea, and 
 prevent griping when combined with purgatives, also to modify 
 the action of other medicines. Dose, TTtj-v. 
 
 Dental Use. — The oil of cloves is employed in dental prac- 
 tice to relieve odontalgia, by introducing two or three drops 
 into the carious cavity of the aching tooth, relieving the pain 
 by its stimulating effect upon the pulp. It is sometimes used 
 for the same purpose in combination with other agents, and has 
 the effect of rendering carbolic acid more pleasant, without in- 
 terfering with its action. It is used also by microscopists to 
 clarify preparations for mounting. 
 
STIMULANTS. 105 
 
 Eugenol (C^qHj^oO.O is an active principle of oil of cloves. 
 It is sometimes called an acid, as it possesses some acid quali- 
 ties. It is a clear, colorless oil, and its odor and taste resemble 
 those of the oil of cloves. It is an excellent antiseptic for 
 dental uses. 
 
 Peppermint. 
 
 Source. — ^Mentha piperita, or peppermint, is grown every- 
 Vfhere, and as a plant is familiar to every one. The leaves and 
 tops are used for medicinal purposes. 
 
 Properties and Actions. — The properties of peppermint are 
 due to a volatile oil, in which form it is generally used. It is 
 an aromatic stimulant, carminative and antispasm.odic, and local 
 anodyne and anesthetic when evaporation is prevented after 
 being applied to the surface. 
 
 Preparations : — 
 
 Oil of Peppermint (consisting largely of menthol). Dose, 
 
 mj-v. 
 
 Peppermint Water (2 parts of the oil to 1000 of distilled 
 water). Dose indefinite. 
 
 Essence of Peppermint (10 per cent, of oil with 1 per cent, 
 of the powdered herb in alcohol. Dose, trtx-xxx. 
 
 Dental Use. — Local anodyne and anesthetic. 
 
 Sodium Chloride. 
 
 Normal saline solution (0.6 per cent, sodium chloride). In 
 emergency cases it is sometimes necessary to inject a stimulant 
 directly into the vein, and as this saline solution correspends 
 so closely in salinity to the blood serum it is regarded today one 
 of the most important means of stimulation. Serious loss of 
 blood, and extreme depression or collapse would indicate its use. 
 
 Normal saline solution is prepared by dissolving 6 parts so- 
 dium chloride in 1000 parts of sterile water, and as has been 
 indicated is injected intravenously. 
 
106 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 TONICS. 
 
 Tonics are agents which give healthful activity and vigor to 
 the functions, gradually imparting strength and tone to the 
 system, that is, without preternatural excitement. They are 
 divided into vegetable and mineral tonics. 
 
 Principal among the vegetable tonics are cinchona, nux 
 vomica, digitalis, cimicifuga, and eucalyptus. 
 
 While the principal mineral tonics are the preparations 
 of iron, arsenic, zinc, sulphuric acid, nitric acid, muriatic 
 acid, etc. 
 
 Cinchona (Peruvian Bark). 
 
 Source. — Cinchona is the bark of any variety of cinchona. 
 The different species of this tree are natives of the mountains 
 of western South America, especially in Peru and Bolivia, 
 though they have been planted and are grown in Indi% Ceylon 
 and Burmah. 
 
 The medicinal properties of these barks depend upon the 
 alkaloids they contain, which are in varying proportions, usu- 
 ally from 3 to 4 per cent., at least 2 per cent, of which is 
 quinine, this being the most important. 
 
 Principal preparations of cinchona and its alkaloids are 
 as follows : 
 
 Powdered cinchona. Dose, gr. x-3iij. 
 
 Tincture cinchona (strength 20 per cent.). Dose, 3j-,^ss. 
 
 Extract cinchona (in pill). Dose, gr. j-x. 
 
 Sulphate of Quinine. Dose, gr. j-xx. 
 
 Sulphate of cinchonidine (one-half the strength of qui- 
 nine). Dose, gr. ij-xxx. Much used in hospital and dispensary 
 work. 
 
 Properties and Actons. — The different varieties of cin- 
 chona are named according to their color. Yellow cinchona — 
 cinchona flava; pale cinchona — cinchona pallida; red cinchona 
 • — cinchona rubra. The powder from the yellow bark is of an 
 
TONICS. 107 
 
 orange color; has a more bitter taste than the other barks, con- 
 taining more of the alkaloid quinine. Cinchona is a bitter 
 tonic, astringent, antipj'^retic, and antiseptic. The alkaloid 
 quinine is preferable for ordinary use, as a much larger quan- 
 tity of the powdered bark is necessary to obtain the full effects, 
 often causing derangement of the stomach, headache, and con- 
 stipation. 
 
 Dental Uses. — In dental practice quinine is employed in 
 from five to ten grain doses as a tonic, and in the treatment of 
 neuralgia when due to malaria. Cinchona is also used as an 
 antiseptic. "The powder dusted over unhealthy wounds will 
 arrest putrefaction and promote healthy cicatrization. Quinine 
 will destroy minute organisms, and preserve substances from 
 decomposition."* Cinchona is also employed for its antiseptic 
 and tonic properties as an ingredient in certain dentifrices. 
 
 Nux Vomica. 
 
 Source. — Nux vomica is the seeds of the Stryclmos nucis 
 vomica, a tree of the family Strychnoides, which grows in 
 India. These seeds have been long sold in the shops under the 
 names of nux vomica, bachelor's buttons, poison nuts, etc., and 
 for a long time were used only for such purposes as poisoning 
 rats. 
 
 Medicinal Properties and Actons. — Nux vomica contains 
 two all'^ialoids, strychnine and brucine, to which its medicinal 
 properties are chiefly due. Brucine has only y^,, the strength 
 of strychnine, but they are otherwise identical, physiologically 
 and therapeutically. 
 
 In small doses nux vomica is a bitter tonic, exciting the 
 secretions and stimulating the functions of the body. 
 
 In full doses (strychnine gr. Y^q) the function of the spinal 
 cord is exalted, causing tetanic spasms of the extensor muscle, 
 
 *Gorgas' ''Dental Medicine." 
 
108 . DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 the lower jaw is stiff, the pupils dilated, and the face wears an 
 unmeaning smile. 
 
 In toxic doses (strychnine gr. ^^2) the function of the spinal 
 cord is paralyzed, respiration is arrested, death following from 
 asphyxia; consciousness is preserved, however, until CO2 nar- 
 cosis takes place. 
 
 Treatment of Strychnine Poisoning. — The antidote is 
 tannic acid, which forms an insoluble tannate ; then the stomach 
 pump should be employed or emetics administered, after which 
 the patient should be kept perfectly quiet. 
 
 The antagonists are chloral, chloroform, and potassium 
 bromide; the last named, though, is rarely used, on account of 
 its being so slow of action. 
 
 The bladeer must be evacuated frequently, lest a reabsorp- 
 tion of the poison take place. 
 
 Preparations : — ^ 
 
 Abstract of Nux Vomica. — Dose, gr. V2 gradually in- 
 creased to gr. j. 
 
 Tincture of Nux Vomica (20 per cent, of the drug). 
 Dose, TUJ-x. 
 
 Extract of Nux Vomica. Dose, gr. i/g-j. 
 
 Fluid Extract of Nux Vomica. Dose, nij-v. 
 
 Sulphate of Strychnine. Dose, gr. yioo"V2o- 
 
 Dental Uses. — Where a cardiac or nerve tonic is required, 
 nux vomica and its chief alkaloid hold the first rank. 
 
 Digitalis. 
 Source. — Digitalis, or foxglove, is the leaves of Digitalis 
 purpurea, or purple foxglove; the leaves of the second year's 
 growth are considered the best. The plant grows wild in 
 Europe, and is cultivated in this country, where it is sometimes 
 seen in private gardens, grown for its beautiful spike of purple 
 flowers. The Shakers cultivate it quite extensively for the 
 drug market. 
 
TONICS. 109 
 
 Medicinal Properties and Actions. — Digitalis is chiefly 
 used in disease for its tonic and diuretic properties, its tonic 
 effect upon the heart, principally; though the heart is slowed 
 by its action, its force is at the same time increased. For the 
 full cardiac effects the recumbent posture should be maintained. 
 When the doses are large, severe gastric disturbance is caused. 
 In toxic doses, the muscles and peripheral nerves are paralyzed; 
 respiration is first slowed and then becomes rapid and feeble; 
 coma and convulsions followed by death from the sudden 
 paralysis of the heart. 
 
 Preparations and Doses: — 
 
 Digitalis (the leaves). Dose, gr. ss-iij. 
 
 Abstract of Digitalis. Dose, gr. %^-j (strength 200 per 
 cent.). 
 
 Extract of Digitalis. Dose, gr. ^ / ^.-]. 
 
 Fluid Extract of Digitalis. Dose, Tixj-iij. 
 
 Tincture of Digitalis (15 per cent.). Dose, iilv-xx. 
 
 CiMICIFUGA. 
 
 Source. — Cimicifuga, or the black snakeroot, is the root of 
 the Cimicifuga racemosa, a common plant in the United States. 
 
 Medicinal Properties and Actions. — Cimicifuga has a 
 bitter and nauseous taste, somewhat resembling that of opium. 
 It is an efficient cardiac tonic, antispasmodic, diaphoretic, and 
 diuretic. It is feebler in its action than digitalis, and should 
 be used more frequently when the latter drug is indicated. 
 
 Preparations and Doses: — 
 
 Fluid Extract of Cimicifuga. Dose, tiiv-xxx. 
 
 Tincture of Cimicifuga (20 per cent, in strength). Dose, 
 TUxx-lx (3j). 
 
 Eucalyptus. 
 Source. — Eucalyptus is obtained from the leaves of the 
 Eucalyptus globulus, or "blue gum tree," a native of Australia, 
 but is now grown in Northern Africa, Southern Europe and in 
 the United States. 
 
110 DENTAL PATHOLOGY AXD DEKTAL MEDICINE. 
 
 Properties and Actions. — The leaves are the only portion 
 of the tree which possesses medicinal qualities, the fresh being 
 more active than the dried leaves. Their medicinal properties 
 are due to a volatile oil, called oleum eucaljTpti, which contains 
 three oils, eucalyptene, turpene, and cymol, which distilled over 
 at different temperatures, the first product being the most im- 
 portant. Eucalyptus promotes appetite and digestion, and in- 
 creases the heart's action. 
 
 In large doses it causes indigestion, nausea, diarrhoea, and 
 great muscular weakness, and if continued will cause irritation 
 and congestion of the kidneys. It is eliminated by the skin, 
 bronchial mucous m.embrane, and kidneys, the secretions of 
 which become strongly odorous, owing to the presence of the 
 oil. Eucalyptus is also an antiseptic, disinfectant, sedative, 
 and diaphoretic, "and has anti-malarial properties, absorbing 
 noxious germs, as well as enormous quantities of water from 
 the soil, and by its emanations purifying the atmosphere in 
 the vicinity. It is largely cultivated in malarial districts for 
 these properties, and has rendered habitable a portion of the 
 deadly Koman Campagna."* 
 
 Preparations of Eucalyptus: — 
 
 Extract. Dose, gr. j-xv. 
 
 Fluid Extract. Dose, ttLxx-3j. 
 
 Tincture. Dose, f^ss-ij. 
 
 Oil. Dose, niv-xx in emulsion or capsules. 
 
 Dental Use. — In dental practice the oil of eucaljiptus is 
 employed either alone or combined with iodoform, for its 
 antiseptic properties, in the treatment of putrescent pulps of 
 teeth and chronic alveolar abscesses. This combination has 
 also proven very efficient in the treatment of necrosis and caries 
 of the bone of the jaws. 
 
 ♦Potter's "Materia Medica." 
 
TONICS. Ill 
 
 By taking- advantage of tlie solvent effects of eucalyptol 
 upon the giitta-percha, it will be found of great benefit in the 
 insertion of fillings of this material. 
 
 Iron. 
 
 Ferrum, or ironj, is a metal of a bluish-gray color, fibrous in 
 texture, is hard, ductile, malleable, and magnetic. Chemical 
 analysis demonstrates the presence of iron in the blood, 1 part 
 to 230 of red corpuscles, also in the gastric juice, chyle, bile, 
 lymph, urine, milk, and pigment of the eye. 
 
 Properties and Actions. — Iron taken into the stomach in 
 the metallic state, meeting with the acids of that cavity, is 
 dissolved, which causes an evolution of hydrogen gas, and gives 
 to the iron molecular activity. Given tnedicinally in small 
 doses, the salts of iron act through and upon the blood, improv- 
 ing its quality and increasing the number of red corpuscles; 
 they also promote the appetite and improve digestion, and hence 
 it is recognized as one of the most efficient tonics. 
 
 In large doses these salts cause nausea and vomiting and 
 act as irritants. Or the prolonged administration of small 
 doses exhausts the gastric glands by over-stimulation. 
 
 Monsel's preparations of iron are principally used exter- 
 nally, for hemorrhage, and are considered to be among the very 
 best styptics in use. When internally employed it is for their 
 hemostatic effect in hemorrhage from remote organs. In admin- 
 istering iron care should be exercised, as nearly all the prepara- 
 tions are more or less astringent, and act injuriously on the 
 teeth. 
 
 Contra-indications. — Iron should never be given when 
 plethora (a superabundance of blood) exists, especially when 
 accompanied with a hemorrhagic tendency. 
 
 Principal Preparations : — 
 
 Tincture of the Chloride of Iron. Dose, niv-xx. 
 
112 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Powdered Sulphate of Iron, Monsel's Powder. Dose, gr. 
 ss-iij, in pill; used also as a styptic. 
 
 Solution of Subsulphate of Iron, or Persulphate, Monsel's 
 Solution. Possesses powerful astringent properties; used only 
 as a styptic. 
 
 Dental Uses. — ^In dental practice the chief indications for 
 iron are where hemorrhage follows the extraction of teeth, or 
 from any other cause, such as wounds of the gums and mucous 
 membrane. IVTonseFs solution or powder is employed for this 
 purpose. See chapter on Extraction of Teeth. 
 
 AeseniC;, As. 
 
 Properties. — Arsenic is a brittle, granular metal, of steel- 
 gray color, is very combustible, and volatilizes before melting, 
 the vapor having an odor like that of garlic. It is a powerful 
 poison, not of itself, however, but by virtue of the facility with 
 which it absorbs oxygen. It is generally found in cobalt ore. 
 It is not employed as medicine in its native state. 
 
 Preparations : — 
 
 Arsenious Acid (?), White Arsenic, "Ratsbane." Dose, gr 
 
 Veo to Vio- 
 
 Solution of Arsenious Acid, 1 per cent, solution (strength, 
 Vioo) with hydrochloric acid and distilled water. Dose, TTLij-x, 
 after meals. 
 
 Solution of Potassium Arsenite, Fowler's solution (strength 
 y^oo). Dose, TTlij-x, after meals. 
 
 White Oxide of Arsenic (AsgOg), Arsenious Acid, is in 
 the form of irregnilar solid lumps, having a chalky appearance 
 externally, though it is often perfectly transparent internally. 
 It is usually furnished in the shops, however, in the form of a 
 fine white powder, and is often adulterated with chalk or lime. 
 It is odorless and has a faint sweetish taste. 
 
 Physiological Actions. — In small doses, arsenic is a gen- 
 eral tonic, promoting the appetite, digestion, and cardiac action, 
 
TONICS. 113 
 
 stimulates mental activity, and causes rotundity of form and 
 ■ clear skin. In large doses it becomes a violent corrosive poison, 
 creates skin eruptions and itching of the eyelids, nausea, 
 dysentery, and an irritable and feeble heart, death following 
 from narcotism. Externally, it is a powerful escharotic. 
 
 Toxicology. — The antidote to arsenic is the hydrated oxide 
 of iron. After the prompt evacuation of the stomach this should 
 be administered, the dose being eight times the quantity of 
 the poison taken. This should be followed by mucilaginous or 
 oily drinks, to protect the mucous membrane, and iodide of 
 potassium or alkaline mineral waters, to promote elimination. 
 
 Tests for Arsenic. — There are a number of tests for arsenic, 
 the following being considered the best : If in a solid state, place 
 the suspected material on burning charcoal, when the arsenic, if 
 present, will become deoxidized and emit the garlic odor spoken 
 of above. When in an aqueous solution, it may be detected by 
 adding sulphide of ammonium, which produces a yellow sul- 
 phide of arsenic, or the addition first of ammonia, then a small 
 quantity of nitrate of silver, will produce a light yellow arsenite 
 of silver. Again, the addition of potassa and sulphate of copper 
 produces a light gTeen arsenite of copper. 
 
 Marsh's Test. — The most delicate test for arsenic consists 
 in subjecting the material to the action of nascent hydrogen.* 
 The arsenic is deoxidized and forms with the hydrogen arseni- 
 uretted hydrogen gas; this also has the peculiar odor of garlic, 
 burning with a bluish-white flame, which deposits metallic 
 arsenic in the form of a black spot on the surface of a cold 
 plate if held directly in the flame. 
 
 Reinsch's test consists of boiling the material suspected of 
 containing arsenic with hydrochloric acid and copper foil, when, 
 if arsenic is present, it will manifest itself in the form of a 
 coating of gray metallic arsenic upon the foil. 
 
 ♦Nascent hydrogen is evolved by the action of diluted sulphuric acid 
 on zinc. 
 
114 DENTAL PATHOLOGY AJSD DENTAL MEDICINE. 
 
 Dental Uses. — Arsenic is employed in dental practice for 
 its devitalizing power in destroying the vitality of the pulps of 
 teeth. It is generally combined with other agents, in the form 
 of paste or fibre, for this purpose. But I have found the white 
 arsenic alone to act very happily when applied to the pulp and 
 retained by a small pledget of cotton which had been 'previously 
 saturated with cocaine. The cavity should be completely se- 
 cured, that none of the arsenic come in contact with the part 
 outside of the tooth. 
 
 The quantity to be used for this purpose is about the ^ /^^ 
 of a grain, and the time required is usually about 24 hours, 
 though there are instances where 48 hours or more are required 
 to thoroughly destroy the vitality. 
 
 ZiNC^ Zn. 
 
 Properties. — Zinc is one of the metallic elements — it is 
 very hard, has a bluish-white color, and the fresh surface has 
 considerable lustre, but is soon dulled, from the facility with 
 which it oxidizes. 
 
 Principal Preparations: — 
 
 Zinci Oxidum. Dose, gr. j-x, insoluble in water. 
 
 Zinci Acetas. Dose, gr. i/4-ij; as a lotion, gr. ij to Sj of 
 water, in which it is very soluble. 
 
 Zinci Sulphas. Dose as a tonic and astringent, gr. Yio-j. 
 As an emetic, gr. vj in §iv of water, in tablespoonful doses, re- 
 peated every few minutes until emesis takes place. 
 
 Zinci Carbonas Praecipitatus. As ointment, or dusted 
 over wounds as a protection. 
 
 Zinci lodidi. Dose, gr. ss-v, in the form of a syrup. 
 
 Zinci Chloridum, tonic and escharotic. Dose, gr. ss-ij, well 
 diluted. 
 
 Zinci Chloridum Liquor, solution of chloride of zinc, 1/2 to 
 1 per cent, in strength. 
 
TONICS. 115 
 
 Physiological Actions. — The salts of zinc are more or less 
 poisonous, the soluble salts, the acetate, sulphide, and chloride 
 being" corrosive poisons. In small doses they are tonic and 
 astringent, while in larger quantities they are strong emetics. 
 
 The sulphate is a specific emetic, acting without much 
 depression. 
 
 The chloride is a powerful and penetrating escharotic. It 
 is also a useful deodorizer and disinfectant. "When applied 
 to malignant and indolent ulcers, it promotes healthy granula- 
 tions, and when topically applied it not only destroys the dis- 
 eased structure, but excites a new and healthy action of sur- 
 rounding parts." 
 
 The antidotes for zinc poisoning are, the white of an egg, 
 carbonate of soda, magnesia, etc. 
 
 Dental Uses. — In dental practice the chloride of zinc 
 (ZnCl.J is a valuable agent. It is employed as an obtunding 
 agent for sensitive dentine — the sensitive surface being pre- 
 viously bathed with chloroform, which will modify the painful 
 action of the chloride. It has also been employed as a styptic 
 to arrest superficial hemorrhage from a wound of the gum 
 during the filling of the teeth. It induces union of the wounded 
 parts by first intention, by its effect upon the glutinous matter, 
 also as an injection for chronic alveolar abscess, and in diseases 
 of the antrum of Highmore. It is also used in the recession of 
 the gum and the absorption of the alveolar process from the 
 necks of the teeth. The application can be conveniently made 
 by means of a piece of orange wood, so shaped as to permit of 
 its being introduced beneath the gums. 
 
 The chloride of zinc, in solution, is also used as one of 
 the ingredients of the filling material known as the oxychloride 
 of zinc, the other ingredient being the oxide of zinc. 
 
 The combination of these two forms of zinc makes an ex- 
 cellent capping material, and is probably one of the best mate- 
 rials for root filling. 
 
116 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 The oxide of zinc, ZnO, is sometimes employed, combined 
 with carbolic acid, in the form of a paste, for capping exposed 
 pnlps; it is also one of the ingredients of the zinc filling 
 materials, and of the celluloid base of artificial teeth. 
 
 The sulphate of zinc, ZnSO^THgO, is sometimes employed 
 in disease of the antrum of Highmore, and ulcerations of the 
 mucous membrane, for its stimulant and astringent properties. 
 
 Sulphuric Acid^ HgSO^. 
 
 Properties. — Sulphuric acid, or oil of vitriol, is a dense, 
 inodorous, colorless, oily, and corrosive liquid. It consists of 
 not less than 96 per cent, sulphuric anhydride and about 10 
 per cent, of water. 
 
 Preparations: — 
 
 Sulphuric Acid. Used as an escharotic or caustic. 
 
 Diluted Sulphuric Acid (10 per cent, of the acid to 90 
 per cent, of water). Dose, niv-xv, well diluted. 
 
 Aromatic Sulphuric Acid (Elixir of Vitriol). Sulphuric 
 acid diluted with alcohol and flavored with ginger and cinna- 
 mon (strength 20 per cent.). Dose, Tltv-xxv, well diluted. 
 
 Action. — The action of sulphuric acid in its different forms 
 is as follows: Aromatic sulphuric acid, tonic and astringent; 
 diluted sulphuric acid, tonic, astringent, and refrigerant (in 
 fevers) ; sulphuric acid, escharotic. 
 
 Treatment of Sulphuric Acid Poisoning. — Being a cor- 
 rosive poison, sulphuric acid causes death from asphyxia (the 
 suspension of vital phenomena, from the non-oxygenation of 
 the blood — an excess of carbon dioxide). Administer alkalies, 
 as washing soda, magnesia, lime water, soapsuds, etc., to neu- 
 tralize the acid, and mucilaginous drinks freely, to protect the 
 mucous membrane. Stimulants, opium, aramonia intraven- 
 ously, to combat the depressed condition of the vital powers. 
 
 Dental Uses. — The concentrated sulphuric acid is employed 
 in dental practice as a caustic; in the laboratory, in a diluted 
 
TONICS. 117 
 
 state, for the cleansing of metals before and after soldering 
 ("the acid bath"). It is also used in the manufacture of 
 pyroxylin — gun cotton. 
 
 Aromatic sulphuric acid is more agreeable for use in the 
 mouth, while its action resembles that of diluted sulphuric acid. 
 It is a valuable agent in the treatment of pyorrhoea alveolaris 
 and necrosis of the maxillary bones, stimulating the parts to 
 healthy action. It is also employed in the treatment of chronic 
 alveolar abscesses, in combination with a few drops of tincture 
 of capsicum. 
 
 Nitric Acid, HN0„. 
 
 Properties. — Nitric acid, or aqua fortis, is a highly caustic 
 liquid, very volatile, its fumes being corrosive and suffocating, 
 and in the pure state is colorless and transparent, but that 
 usually found in shops is of a yellow color, owing to the pres- 
 ence of nitric peroxide. Strong nitric acid is never given in- 
 ternally; it is used in the form of the diluted nitric acid, 10 
 per cent, absolute acid. Dose lUiij-x, well diluted. 
 
 Action. — Pure nitric acid is a powerful caustic and escha- 
 rotic, and is rarely used except as an application to foul, indo- 
 lent ulcers, or to warts. The diluted acid is a tonic, alterative, 
 and refrigerant, used as a drink in fevers. It is, as are most 
 mineral acids, injurious to the teeth; hence, care should be 
 taken in its use. It should be taken through a glass tube or 
 quill, and followed by an alkaline mouth wash. It is not as 
 agreeable to the stomach as diluted sulphuric acid. 
 
 The antidotes for nitric acid poisoning are magnesia or 
 soap and mucilaginous drinks. 
 
 Dental Uses. — ^Nitric acid is employed in dental practice 
 as a caustic for malignant ulcers of the mouth, and has been 
 used for devitalizing pulps of teeth when nearly exposed by 
 mechanical abrasion. It is also used in combination with 
 hydrochloric acid (aqua regia) as a solvent for gold. 
 
118 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Phosphoric Acid, HgPO^. 
 
 Properties. — Phosphoric acid is a solid, colorless compound, 
 soluble in water and vitrifiable by heat (converted into glass). 
 It is obtained from bones, where it exists in combination with 
 lime. Diluted phosphoric acid is the form in which phosphoric 
 acid is usually employed in medicine. It contains 10 per cent, 
 of the absolute acid. Dose, "niv-xx. 
 
 Action. — Phosphoric acid is tonic and refrigerant, and in 
 large doses an irritant poison. It has been employed externally 
 in the treatment of osseous tumors and caries of the bones. 
 
 Glacial phosphoric acid, HOPO-, is obtained from calcined 
 bones. They are first treated with sulphuric acid, "which pro- 
 duces an insoluble superphosphate of lime, then dissolving out 
 the latter salt and saturating it with carbonate of ammonia, 
 which generates phosphate of ammonia in solution, and, finally, 
 obtaining the phosphate of ammonia by evaporating t^ dryness, 
 and then igniting it in a platinum crucible. The ammonia and 
 all of the water, except one equivalent for each equivalent of 
 the acid, are driven off, and the glacial phosphoric acid remains. 
 It is a white, transparent, fusible solid, generally in the form 
 of sticks, inodorous, and sour to the taste. It slowly deliquesces, 
 and is sparingly soluble in water, but freely soluble in alcohol."* 
 
 Dental Uses. — Phosphoric acid has been employed in dental 
 practice as a local treatment of osseous tumors and caries of 
 the maxillary bones. 
 
 Glacial phosphoric acid is employed as one of the ingre- 
 dients of the plastic filling material, known as oxyphosphate of 
 zinc, the other ingredient being the white oxide of zinc. 
 
 Hydrochloric Acid, HCl. 
 Properties. — Hydrochloric or muriatic acid is nearly color- 
 less when pure, but that usually found in the shops is of a pale 
 yellow color, being contaminated with chlorine, iron, and other 
 
 *Gorgas' "Dental Medicine." 
 
ANTIPYRETICS. 119 
 
 substances. It is volatile, emitting a dense white and suffocat- 
 ing vapor; taste very acid and caustic. 
 
 Actions. — Hydrochloric acid is caustic, escharotic, and dis- 
 infectant. The diluted acid administered internally is tonic, 
 refrigerant, and astringent. 
 
 Diluted Hydrochloric Acid (ten per cent, solution of 
 absolute acid and water). Dose, TTLv-xx. 
 
 Dental Uses. — It is sometimes a useful application for 
 treatment of ulceration and inflammation of the mucous mem- 
 brane and gums. "The strong acid is employed in the labora- 
 tory for dissolving zinc, in the preparation of a flux for solder- 
 ing certain metals." 
 
 SEDATIVES. 
 
 Sedatives are agents which exert a soothing influence — -that 
 is, diminish pain — by lessening the functional activity of 
 organs. 
 
 The principal agents of this class are opium and aconite 
 (see Anodynes), digitalis (see Tonics), alcohol (see Stimu- 
 lants), chloroform (see Anesthetics), etc. 
 
 ANTIPYRETICS. 
 
 Antipyretics are agents which reduce the temperature of 
 fever. They act either by lessening heat production or by 
 radiation of heat. 
 
 The most prominent of this class are antipyrine, quinine 
 (see Tonics), aconite, alcohol (by increasing heat radiation), 
 also cold bath, ice to the body, etc. 
 
 Antipyrine, C2oIIj^gN402. 
 
 Derivation. — Antipyrine is an alkaliodal product of the 
 destructive distillation of coal-tar oil. 
 
 Properties.— It is a whitish, crystalline powder, soluble in 
 water (one-half its weight of hot and its own weight of cold 
 
120 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 water) ; less soluble in alcohol, chloroform, and ether ; is slight- 
 ly bitter and odorless. It may be administered hypodermically ; 
 IS non-irritant to the stomach or the tissues. When combined 
 with ferric chloride it gives a bright-red' color, and with nitric 
 acid a beautiful green color. 
 
 Actions. — Antipyrine is a powerful and popular antipyretic, 
 a general anodyne, haemostatic, and also possesses mild anes- 
 thetic and hypnotic powers. A full medicinal dose (gr. xxx) 
 produces a stimulant stage of short duration, which is soon 
 followed by profuse sweating, coolness of the surface, slowed 
 pulse, and more or less depression. The temperature in fevers 
 is reduced from 2 to 10 degrees in from 1 to 5 hours, according 
 to the size and continuance of the dose. In health the reduction 
 of the temperature is very slight, and it gives rise to slight 
 nausea and depression. It is eliminated by the kidneys, appear- 
 ing in the urine a few hours after taking. ♦ 
 
 "In toxic doses its principal influence is exerted upon the 
 blood, altering the shape of the red blood corpuscles, separating 
 the hsematin, and causing decomposition of that fluid."* 
 
 Dose, for adult, gr. v-xxx; children, gr. j-x. 
 
 Dental Uses. — Antipyrine may be employed in dental prac- 
 tice for its haemostatic, anesthetic, and anodyne powers. 
 
 lEEITANTS. 
 
 Irritants are agents which produce more or less vascular ex- 
 citement or inflammation. They may be either chemical, me- 
 chanical, or nervous. 
 
 Chemical irritants are those which act by virtue of their 
 atfinity for organic tissue, exciting the action of the capillaries, 
 and causing an afflux of vascular and nervous power to the 
 part to which they are applied. Included in this class are 
 
 ♦Potter's "Materia Medica." 
 
IRRITANTS. 121 
 
 iodine, capsicum, (see Stimulants), turpentine, ammonia (see 
 Stimulants), etc. 
 
 Mechanical irritants are agents or means that cause lesions 
 or inflammation by mechanical operation. Filling material or 
 other foreign substances being forced through the apical fora- 
 men of the root of a tooth will cause sufficient irritation to 
 produce an abscess; and cuts, contusions, etc., are included 
 in this class. 
 
 Nervous irritants act through the medium of the nerves, 
 as nervous shock, depression, or sympathetic inflammation. 
 
 Iodine. 
 
 Derivation. — Iodine is obtained principally from marine 
 plants, though it occurs in cod-liver oil and shell-fish to a 
 limited extent. 
 
 Properties. — ^Iodine is -a non-metallic element, is usually in 
 the form of bluish-black crystalline plates or scales, having a 
 metallic lustre, a peculiar odor, hot, acrid taste, and is of 
 neutral reaction. It volatilizes at a low temperature, giving off 
 a beautiful purple vapor, is slightly soluble in water (1 in 
 TOGO), readily soluble in alcohol and ether (1 in 12), also in a 
 solution. of chloride of sodium and iodide of potassium. 
 
 Principal Preparations : — 
 
 Tincture of Iodine, 8 per cent, in alcohol. Dose, lUj-v. 
 
 Compound Tincture of Iodine (iodine, 5 per cent., potas- 
 sium iodide, KI, 10 per cent., and water 85 per cent.). Dose, 
 nij-x diluted. 
 
 Potassium Iodide. Dose, gr. v-xxx. 
 
 Iodoform, CHI3. Dose, gr. j-v, in pill form. 
 
 Actions. — Iodine in its elementary state is an irritant to 
 the skin, and is much used in the form of tincture to produce 
 counter-irritation. 
 
 Internally in small doses it is a stimulant and tonic; it 
 excites a sensation of heat or burning in the stomach, and in 
 
122 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 large doses acts as an irritant poison. If continued for any 
 length of time, iodine induces great waste and rapid elimina- 
 tion of waste products, causing anaemia and depression. 
 
 The local irritant effect is diminished when combined with 
 potassium; hence, potassium iodide (aqueous solution of potassa 
 and iodine) is usually employed for internal use, which allows 
 the administration of larger doses and for a greater length of 
 time. 
 
 Toxicology. — The antidote for iodine is starch, forming an 
 iodized starch, which should then be evacuated from the 
 stomach. 
 
 Colorless Iodine. — There are a number of methods for 
 bleaching iodine; among them are the following: 1st. Add to 
 a drachm of tincture of iodine six ounces of hot water and 
 twelve grains of phenol; stir with a glass rod. 2d. Iodine is 
 bleached by mixing with carbolic acid; this, carbolate of iodine, 
 combines all the advantages of both agents. 
 
 Dental Uses. — Iodine is a very valuable agent in dental 
 practice, the tincture being employed locally in the treatment 
 of periostitis, inflarmnation and ulceration of the gums, fun- 
 gous growths, suppurating pulps of teeth, alveolar abscess, and 
 for ulcerations of the mucous membrane; it is often combined 
 with carbolic acid, and for dental periostitis it is generally 
 combined with tincture of aconite; this combination forms an 
 excellent treatment for the incipient stages of this affection, as 
 well as those of alveolar abscesses. 
 
 Turpentine. 
 
 Derivation. — Turpentine is a concrete, oleo-resinous exuda- 
 tion from various species of pine, but principally from the 
 "yellow pine." 
 
 Properties. — Turpentine is in the form of tough, yellowish 
 masses, more or less transparent, inflammable, having a strong, 
 unpleasant odor, and warm, pungent taste. 
 
ASTRINGENTS. 123 
 
 It is composed entirely of resin and the essential oil known 
 as oil of turpentine, Cj^H^gO. It is soluble in alcohol. The 
 oil is the form mainly used. 
 
 Actions. — Turpentine is a stimulant, diuretic, antispas- 
 modic, and rubefacient (counter-irritant), and antiseptic ex- 
 ternally. 
 
 Principal Preparations : — 
 
 Oil of Turpentine, Spirits of Turpentine, a volatile oil dis- 
 tilled from turpentine. Dose, TTtv-xv in emulsion as a stimulant. 
 
 Turpentine Liniment. — Resin cerate (a composition of 
 wax, oil, or lard), 65 per cent., oil of turpentine, 35 per cent. 
 
 Pitch is a resinous exudation from the stem of certain pine, 
 fir, and spruce trees. It melts at the boiling point of water, and 
 softens by the heat of the human body. It is of a dark-brown 
 color, and possesses a well-known odor and taste. It is used 
 principally as the base of plasters. 
 
 Dental Uses. — Turpentine may be used in dental practice 
 for its rubefacient and antiseptic properties. 
 
 ASTRINGENTS. 
 
 Astringents are agents which produce contraction and con- 
 densation of organic tissues, with a tendency to remove morbid 
 affections, arrest hemorrhage and excessive secretions from the 
 mucous membrane. They are divided into two classes, known 
 as vegetable and mineral. 
 
 The principal vegetable astringents are tannic acid and 
 gallic acid, the chief elements of these being tannin, while the 
 mineral astringents are persalts of iron (see Tonics), alum, 
 sulphuric acid, nitric acid, etc. 
 
 Tannic Acid, 02^11220^^. 
 
 Derivation. — Tannic acid is obtained from nut galls. Galls 
 are the excrescence on the twigs of the Dyer's oak, grown in 
 
124 DEXTAL PATHOLOGY AND DEKTAL MEDICINE. 
 
 Asia Minor and Persia, caused by the punctures and deposited 
 ova (egg) of an insect. 
 
 Properties. — Tannic acid is obtained in the form of thin, 
 yellowish crystals, inodorous, very soluble in water, less so in 
 alcohol and ether. 
 
 Actions. — Tannic acid is the most powerful of all vegetable 
 astringents and styptics. It is especially active upon albumin, 
 gelatin, and fibrin, forming therewith insoluble tannates, thus 
 protecting the parts beneath until resolution occurs. Dose, 
 gr. j-xx, in pill. 
 
 Dental Uses. — Tannic acid is a very valuable agent to the 
 dental practitioner. It is used locally in the treatment of 
 hemorrhage following the extraction of teeth, wounds of the 
 mucous membrane, fungous growths of the tooth pulp, hyper- 
 trophy of the -gums, and to many it has proven beneficial in the 
 treatment of sensitive dentine, a strong solution of tannin being 
 mixed with alcohol. In mercurial salivation, the powdered tan- 
 nic acid, moistened with water, will check the tendency to 
 absorption and the consequent loosening of the teeth, and will 
 render the gums firmer and more comfortable. 
 
 Glycerite of Tannic Acid (tannin, Sij; glycerin, Sviij), 
 for external use. 
 
 Ointment of Tannic Acid (tannin, 3j; lard, Sj), for appli- 
 cation to ulcers, etc. 
 
 Gallic Acid, C^HgOg. 
 
 Derivation. — Gallic acid is prepared from nutgalls. The 
 powdered galls, in water, are left to the action of the atmos- 
 phere, when the acid, in the form of fine, almost colorless, crys- 
 tals are deposited. 
 
 Properties. — Gallic acid is obtained in the form of very 
 fine, silky, and almost colorless crystals. It is slightly soluble 
 in cold water (100 parts), and rapidly so in hot water, glycerine, 
 or alcohol. It has a slightly acid and astringent taste. 
 
ASTRINGENTS. 125 
 
 Action. — Gallic acid is a powerful astringent, styptic, and 
 disinfectant. It is given directly for internal hemorrhage pro- 
 fuse perspiration (night sweats), and excessive expectorations 
 of phthisis and chronic diarrhoea. Dose, gr. v-xx, in pill form. 
 
 Dental Uses. — in dental practice gallic acid may be used 
 as a styptic in superficial hemorrhages; it is not so efficient, 
 however, as tannic acid. It is employed in the form of a gargle, 
 in acute inflammation of the mucous membrane, etc. For 
 hemorrhage following extraction of teeth. Dr. Bartholomew 
 claims that a tea spoonful of gallic acid in a glass of water, in- 
 ternally administered, is very efficacious. 
 
 Alum. 
 
 Source. — Alum is found native in Italy, in the neighbor- 
 hood of volcanoes. It is also obtained from aluminous slate or 
 shale by roasting and exposure to the air. 
 
 Formula. — The official alum (potassic-aluminic-sulphate) 
 has the formula K2AL24SO4+24H2O. Dried or "burnt alum" 
 has the water of crystallization, 24II2O, driven off by gentle 
 heating, which leaves it in the form of a soft, white powder. 
 
 Properties. — Alum is a white, transparent salt, crystallizing 
 easily in octahedrons (having eight equal and equalateral tri- 
 angles). It dissolves easily in hot water, and by about fifteen 
 times its weight in cold water; is insoluble in alcohol. It pos- 
 sesses an astringent and sweetish taste. 
 
 Actions. — When taken internally in large doses, it causes 
 vomiting, purging, and inflammation of the gastro-mucous 
 membrane. As an emetic, powdered alum, in teaspoonful doses 
 is very efficient. Applied locally, it is an excellent astringent to 
 relaxed or bleeding parts. Dose, in powder or solution, gr. 
 x-xl (2®). 
 
 Dental Uses. — In dental practice, alum is employed as a 
 styptic in alveolar hemorrhage, superficial hemorrhage of the 
 mucous membrane, ulcers of the mouth, etc. It also serves an 
 
126 DENTAL PATHOLOGY AND DEXTAL MEDICINE. 
 
 excellent purpose as a gargle in ulceration and sponginess of 
 the gums. 
 
 STYPTICS AND HEMOSTATICS. 
 
 Styptics are agents which arrest hemorrhage by local appli- 
 cation. They are divided into chemical and mechanical, ac- 
 cording to their action. 
 
 Chemical styptics coagulate the exuding blood, and at the 
 same time stimulate the tissues to contraction. 
 
 The principal members of this class are, tannic and gallic 
 acids (see Astringents), persulphate of iron — solution, subsul- 
 phate of iron — powdered (see Tonics), alum (see Astringents), 
 and adrenalin. 
 
 Mechanical styptics are agents which promote clot forma- 
 tions in the mouths of bleeding vessels. They retard the flow 
 by detaining the blood in their meshes, or absorb it^ until it 
 coagulates. 
 
 The principal mechanical styptics are spider's web, plas- 
 ter-of -Paris, sandarach varnish, cotton, etc. 
 
 Adrenalin. 
 
 Derivation. — Adrenalin is the active principle of the 
 adrenal or suprarenal gland. Adrenalin chloride, 1 : 1000, is a 
 definite product, composed of 1 part adrenalin with 999 parts 
 normal saline solution, and may be diluted to any degree desired 
 by the adding of this solution. This preparation is practically 
 permanent if kept in well stoppered bottles. Under continued 
 exposure to air the liquid becomes brown in color and a sedi- 
 ment is thrown down, when it should be discarded. The raanu- 
 facturers say that adrenalin is about a thousand times as pow- 
 erful as adrenal or suprarenal gland, making the 1 : 1000 solu- 
 tion of the chloride approximately the same strength of the 
 original gland, but freed from all inert matter. 
 
 Dental Uses. — The adrenalin chloride solution, applied 
 locally is an excellent styptic, and astringent. Its action is 
 
ESCilAROTlGS OR CAUSTICS. 127 
 
 local upon the muscular tissue of the small blood vessels. It 
 does not coagulate albumen. Its use is indicated in the treat- 
 ment of persistent hemorrhage following the extraction of a 
 tooth, or the removal of a pulp; and in the fitting and setting 
 of crowns, etc., to render the field bloodless. Adrenalin has 
 more recently been recommended for the extirpation of pulps, 
 but extended clinical experience must determine just what value 
 it has in this direction. 
 
 Hemostatics are agents capable of arresting hemorrhage 
 by internal administration, such as ergot, antipyrine (see As- 
 tringents), the diluted m.ineral acids (see Tonics), etc. 
 
 Ergot. 
 
 Source. — Ergot is obtained from a parasitic fungi replacing 
 the grain of rye. It is a diseased state of the grain, occasioned 
 probably by a hot summer succeeding a rainy spring. Corn 
 ergot is obtained from a similar growth upon the Indian corn. 
 
 Principal Preparations : — 
 
 Fluid Extract of Ergot. Dose, 3ss-ij. 
 
 Extract of Ergot. Dose, gr. j-xx. 
 
 Medical Properties and Actions. — Ergot is a hemo- 
 static, aiding coagulation by slowing the blood current. It is 
 also used to stimulate the contraction of unstriped muscular 
 fibre, particularly those of the uterus, causing continuous labor 
 pains. It has been much used for this purpose in obstetrics, 
 and very often injuriously, causing laceration of the perineum 
 and paralysis of the foetal heart, the natural intermitting con- 
 traction being the most desirable. 
 
 Dental Uses. — Ergot may be used in dental practice for its 
 hemostatic properties in alveolar or other hemorrhages. 
 
 ESCHAROTICS OR CAUSTICS. 
 
 Escharotics or caustics are agents which are capable of de- 
 stroying the life of the tissue with which they come in contact, 
 producing an eschar or sloughing of the tissue. Fire itself is 
 
128 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 the actual cautery, while the potential cautery (caustic sub- 
 stances) is reijresented by silver nitrate, arsenious acid (see 
 Tonics), carbolic acid, zinc chloride (see Tonics), and the 
 mineral acids (see Tonics), etc. 
 
 Nitrate of Silver^ AgNOg. 
 
 Derivation. — ^Nitrate of silver, or "lunar caustic," is made 
 by dissolving silver in nitric acid, and evaporating the solution. 
 The reation being Ag3+4H]Sr03=3AgN03+2H20+NO. 
 
 Properties. — Nitrate of silver is in the form of colorless, 
 shining crystals, but is readily blackened by mixing with or- 
 ganic matter or by exposure to the light, is very soluble in 
 water, and has a strong metallic and styptic taste. It is often 
 cast in sticks, by first being melted (fusing at 426' F.) and 
 then poured into suitable moulds. 
 
 Actions. — Nitrate of silver is a powerful caustic and astrin- 
 gent, a heart and nerve stimulant, antispasmodic and sedative. 
 When applied locally to the mucous membrane, ulcers, etc., it 
 first turns the surface white, owing to its union with the coagu- 
 lated albumin, but finally turns to a black color, which is due 
 to the partial reduction of the silver by the sulphuretted hydro- 
 gen contained in the atmosphere. Continued use of nitrate of 
 silver will cause a peculiar blue line in the gums, similar to 
 that from lead poisoning; this is followed by a blue appearance 
 of the skin. The remedy should be discontinued at once when 
 this discoloration is observed. 
 
 Dose of nitrate of silver, gr. y^ gradually increased to 
 gr. 3, in pill form. Never should be given with tannin or a 
 vegetable extract ; an explosive compound may result. . The 
 fused or solid form is used externally. 
 
 The antidote for nitrate of silver is chloride of sodium 
 (common salt) freely; it precipitates it in the insoluble chlo- 
 ride of silver; also acts as an emetic. 
 
ESCI-IAROTICS OR CAUSTICS. 129 
 
 Dental Uses. — Nitrate of silver is employed in dental prac- 
 tice for obtunding sensitive dentine, especially where the cause 
 is mechanical abrasion, or from the fracture of a tooth, expos- 
 ing the healthy and sensitive dentine, the stick form being em- 
 ployed, or the end of a silver wire may be immersed in nitric 
 acid and carefully applied. It is also a valuable application for 
 ulcerated conditions of the mucous membrane of the mouth, 
 also as a treatment for caries in deciduous teeth. 
 
 Carbolic Acid^ CgH^O. 
 
 Derivation. — Carbolic acid, phenylic alcohol or phenol, is 
 obtained as an alcoholic product of the distillation of coal tar, 
 between the temperatures of 338° and 370° F. Carbolic acid, 
 though the universal name, is inappropriate. It does not be- 
 long to the acid series (it will not turn blue litmus paper red), 
 being neutral in its reaction. 
 
 Properties. — Carbolic acid, when pure, is in the form of 
 colorless or pinkish acicular (needle-like) crystals. It becomes 
 an oily liquid at 95° F., or, if exposed to the air, the crystals 
 readily absorb moisture and are thus liquefied. Five per cent, 
 of water liquefies it; any further addition simply forms a 
 mechanical mixture. It is freely soluble in alcohol, ether, chlo- 
 roform, glycerine, and the essential oils. It has a strong aro- 
 matic odor and taste, resembling creasote somewhat. 
 
 Actions. — Carbolic acid in its pure state is escharotic; when 
 diluted, it is a powerful antiseptic, germacide, rubefacient, and 
 is a violent poison; internally, it is a sedative and carminative, 
 allaying vomiting and gastric irritability. 
 
 It resembles creasote closely in many of its medicinal prop- 
 erties, but is probably more efficacious, and its odor is surely 
 less objectionable. 
 
 Dose, gr. y^, for relief of nausea, etc. 
 
 Dental Uses. — Carbolic acid is a valuable agent in dental 
 therapeutics, it being one of the best escharotics, styptics, anti- 
 
130 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 septics, sedatives, etc. It is used to obtund sensitive dentine, 
 to relieve odontalgia, when caused by the exposure of the tooth 
 pulp, by applying it to the exposed surface; it arrests putrefac- 
 tive changes, is a valuable agent in the treatment of alveolar 
 abscess; is also used to bathe cavities in the teeth, both for its 
 obtunding effect upon the sensitive dentine and to destroy any 
 low organisms that may be in the softened dentine. 
 
 In a form known as phenol sodique, carbolic acid is 
 very useful as a styptic for the treatment of superficial hemor- 
 rhage after the extraction of teeth, and forms an excellent anti- 
 septic mouth-wash. 
 
 "Combined with glycerine (1 part to 12 of glycerine) it will 
 
 stimulate the mucous secretion, and hence has been applied to 
 
 the palate, in cases of deficiency of this secretion, to promote 
 
 the suction of the upper dentures."* 
 
 • 
 Acetic Acid^ C^Kfi^. 
 
 Derivation. — Acetic acid is produced from wood by de- 
 structive distillation. 
 
 Properties and Actions. — The purified acid contains about 
 28 per cent, of anhydrous acetic acid. The dikited acid, the 
 only form employed internally, is composed of one part acetic 
 acid to seven parts distilled water. 
 
 It is a stimulant, astringent, diaphoretic, escharotic, etc. 
 The strong acid, when applied to the skin, causes considerable 
 redness and pain, which rapidly results in a blister (vesication). 
 
 Dose. — Acetic acid, dilute, 3j-ij. 
 
 Therapeutic Uses. — Acetic acid is sometimes employed in 
 fevers, night sweats, hemorrhage of the lungs or stomach. Ex- 
 ternally, the strong acid is used in the treatment of cancer, 
 corns, warts, or fungous growths. The dilute acid is sometimes 
 employed externally to gangrene, ulcers, and sprains or bruises. 
 
 *Pi-of. Gorgas. 
 
ANTIZYMOTICS. 131 
 
 Dental Uses. — Acetic acid is sometimes applied to indolent 
 ulcers of the month, and to fungus growths of gum or dental 
 pulp ; for the latter the concentrated form is employed. Gorgas 
 gives the following formula for indolent ulcers, cancrum oris, 
 etc. : Acetic acid three fluid ounces to distilled water five fluid 
 ounces; apply with camel's-hair brush. 
 
 Trichloracetic Acid. 
 
 Derivation. — Trichloracetic acid is formed from acetic acid, 
 three atoms of the hydrogen of which is, in the new acid, re- 
 placed by chlorine. It is one of a group of three acids, having 
 similar properties; the difference in their composition is due 
 to the proportion of chlorine they contain. The others referred 
 to are monochloracetic and dichloracetic acids. 
 
 Properties and Actions. — Trichloracetic acid is in the 
 form of colorless, deliquescent crystals, having an agreeable 
 odor, and is readily soluble in water and alcohol. Its concen- 
 trated solutions are powerful caustics, while the weaker solu- 
 tions make a good antiseptic. 
 
 Therapeutic Uses. — As an antiseptic it is used in putrid 
 and indolent wounds and erysipelas. Diluted with water to a 
 3 per cent, strength it is an effective stimulant and astringent. 
 
 Dental Uses. — It is used in dental practice as an escha- 
 rotic; 10 per cent, solution is often employed in the treatment 
 of pyorrhoea alveolar is, acting, it is claimed, as a solvent on 
 calculi upon the roots of teeth. A one per cent, solution is 
 reconunened as a mouth-wash, owing to its astringent and 
 stimulating qualities. 
 
 ANTIZYMOTICS. 
 
 Antizymotics are agents which arrest or prevent fermenta- 
 tive processes; they are divided into antiseptics and disin- 
 fectants. 
 
132 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Antiseptics are those agents whicli prevent or retard septic 
 decomposition, either by destroying the bacteria upon which 
 putrefaction depends, or by arresting their development. 
 
 The most important of this group are bichloride of mer- 
 cury, peroxide of hydrogen, carbolic acid, (see Escharotics),. 
 potassium permanganate, iodoform, phenal sodique, alcohol, 
 eucalyptol, etc. 
 
 Disinfectants are those agents which destroy the germs of 
 infectious diseases. 
 
 The principal members of this group are carbolic acid (see 
 Escharotics), zinc chloride (see Tonics, Zinc), potassium per- 
 manganate, iodine (see Irritants), aromatic sulphuric acid (see 
 Tonics, Sulphuric Acid). 
 
 Bichloride of Mercury^ HgCl2. 
 Derivation. — Bichloride of mercury, mercuric chloride, or 
 "corrosive sublimate," is obtained by distilling* a mixture of 
 sodium chloride and mercuric sulphate; a double decomposition 
 takes place, forming mercuric chloride and sodium sulphate. 
 
 Properties. — Bichloride of mercury is in the form of col- 
 orless crystalline masses. It is inodorous, fusible, soluble in 
 16 parts of water, 7 parts of alcohol and ether, and has an acrid, 
 styptic taste. 
 
 Actions. — Bichloride of mercury is one of the most active 
 salts of mercury. It is one of the most efficient of all the anti- 
 zymotics in the strfength of 1 part to 2000 parts of water. It is 
 internally employed in chronic diarrhoea, dysentery, and 
 syphilis. 
 
 Dose, gr. Vsq-Vio i^ piU form. 
 
 Antidotes to bichloride of mercury are albumin, wheat 
 flour, milk, etc. 
 
 ♦The double process of vaporization and condensation of the vapor. 
 
ANTIZYMOTICS. 133 
 
 Dental Uses. — For prophylactic treatment of the oral 
 cavity, particularly of the teeth, bichloride of mercury, 1 to 
 10,000, is most effective. It should be carefully used, however, 
 on account of its poisonous character. 
 
 It is also used extensively in dental practice, in treatment 
 of alveolar abscesses, and in diseases of the antrum of High- 
 more, in a solution of 1 to 2000, to 1 to 5000. 
 
 Peroxide of Hydrogen^ 112^^2- 
 Derivation. — Peroxide of hydrogen is obtained by combin- 
 ing an extra molecule of oxygen with hydrogen monoxide, 
 H^O (water), the result being a water-like liquid, H2O2. "As 
 when barium dioxide is dissolved in dilute hydrochloric acid : — 
 
 BaO^+SHCl+H^O-BaCl^+H^O-fH^O^."* 
 
 Properties. — Peroxide of hydrogen is in the form of a col- 
 orless, transparent liquid, is inodorous, and almost tasteless. 
 
 Actions. — Peroxide of hydrogen is one of the most efficient 
 and at the same time the least harmful of all antiseptics and 
 disinfectants. The second molecule of oxygen, spoken of above, 
 is very loosely combined, and the mixture is always on a strain 
 to break up into water and oxygen; for this reason it should 
 be kept in a cool and dark place, and it is owing to this 
 fact (that peroxide of hydrogen generates "ozone," O3) that pus 
 and the bacteria of diseased surfaces, when treated with this 
 agent, are at once destroyed. "As soon as ozone has accom- 
 plished its cleansing effects upon the infected surface, it is 
 readily transformed into ordinary oxygen, owing to its insta- 
 bility." It is employed as an internal remedy in fevers, whoop- 
 ing cough, bronchitis, consumption or phthisis, diphtheria, dys- 
 pepsia, catarrh of the stomach, etc. 
 
 LfOcally Employed. — Peroxide of hydrogen may be em- 
 ployed for its antiseptic and pus-destroying properties in the 
 
 *Leffmann's "Chemistry." 
 
134 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 treatment of abscesses, ulcers, carbuncles, wounds, both fresh 
 and putrid, catarrh of the nose, hay fever, diphtheria, etc. It 
 is also the base of most hair-bleaching solutions. 
 
 Dose of peroxide of hydrogen, 3ss-ij. 
 
 Dental Uses. — It is one of the most valuable remedies in 
 dental therapeutics, being especially valuable as a cleansing 
 agent, and is employed also in the treatment of alveolar 
 abscesses, pyorrhoea alveolaris, inflammation and ulceration of 
 the oral mucous membrane, fungous growths, etc. 
 
 Pyrozone. 
 
 Derivation. — ^Pyrozone solutions are aqueous or ethereal 
 fluids, containing exact percentages of hydrogen peroxide. The 
 solutions are prepared in two strengths, aqueous 3 per cent, 
 solution, and ethereal 25 per cent, solution. 
 
 Properties and Actions. — Pyrozone 3 per cent, solution is 
 a rapidly acting, harmless antiseptic, which can be employed 
 externally or internally without danger of toxic effects. It 
 may be used in all cases where carbolic acid or other disinfect- 
 ant is indicated. The 25 per cent, solution is a bleaching agent, 
 and when applied to diseased parts acts as a powerful caustic, 
 bringing about resolution in a short time. 
 
 Therapeutic Uses. — The 3 per cent, solution is used in cer- 
 tain forms of indigestion or dyspepsia, ulcers of the stomach, 
 and gastritis; 25 per cent, solution is applied to ulcers, syphil- 
 itic patches, pus-generating surfaces, and for chronic eczema. 
 
 Dental Uses. — Pyrozone is used in the 3 per cent, solution 
 as a mouth-wash; it is non-poisonous, and in cases where the 
 micro-organisms of the mouth threaten septic invasion of the 
 stomach, it forms a perfect gargle or spray. It completely de- 
 stroys pus and mucous secretions, and renders the mouth 
 aseptic. The 25 per cent, solution is, as has been indicated, 
 employed principally as a bleaching agent, and is proving a 
 most valuable drug for that purpose. 
 
antizymotics. 135 
 
 Peroxide of Sodium. 
 
 Derivation. — Sodium peroxide is obtained by adding hydro- 
 gen peroxide to an excess of caustic soda, 20 per cent, solution, 
 which is then poured into alcohol. 
 
 Properties and Actions. — Sodium peroxide is the chemical 
 analogue of hydrogen peroxide, and is dispensed as a yellowish 
 white powder, which is soluble in water, which action produces 
 an increase in temperature and evolves a certain arflount of 
 oxygen. It is a strong caustic alkaline, which properties it re- 
 tains after the loss of part of its oxygen, becoming Na20, which 
 in combination with water, is ordinary caustic soda. 
 
 Dental Uses. — It is used in dental practice as a bleaching 
 and sterilizing agent. It is claimed that sodium peroxide re- 
 moves more completely than any other drug, the dental tubular 
 contents; and it is further claimed that the normal translucency 
 of the tooth is more fully restored. 
 
 Permanganate of Potassium, KgMn^Og. 
 
 Derivation. — Permanganate of potassium is prepared by 
 fusing the black oxide of manganese with chlorate of potassium 
 and caustic potassa. 
 
 Properties. — It is in the form of dark purple crystals; it is 
 very soluble in water, forming a beautiful lilac-colored solution ; 
 inodorless, and has a sweetish, astringent taste. 
 
 Actions. — Permanganate of potassium taken internally is 
 a stimulant, and is given with benefit in dyspepsia; is a mild 
 escharotic, and a powerful disinfectant and deodorizer. The 
 solution is decomposed by organic matters, sulphides and sul- 
 phites, yielding up its oxygen readily (on which property its use 
 depends), and is coilverted into a colorless solution. . 
 
 The most important uses for this agent are external, where 
 it is employed as a deodorizer and disinfectant in abscesses, 
 ulcers, cancers, caries of the bone, etc., in the form of a lotion 
 and spray, while the powder may be sprinkled on gangrenous 
 
136 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 surfaces, acting as a local stimiilaiit as well as a deodorizer. 
 
 Dose, for internal use, gr. ^-j. For external use, i^ to 
 water, fSv-x. 
 
 Dental Uses. — It is employed in dental practice in the treat- 
 ment of foul abscess, in diseases of the antrum, necrisis of the 
 maxillary bones, ulcers of the mouth attended with fetid dis- 
 charges, offensive breath, etc. 
 
 Iodoform^ CHI3. 
 
 Derivation. — Iodoform is a preparation of iodine. It is 
 "obtained by the action of chlorinated lime upon an alcoholic 
 solution of iodide of potassium, heated at 104° F., the product 
 being iodoform and iodate of lime, the iodoform being separated 
 by boiling alcohol." 
 
 Properties. — Iodoform is in the form of small yellow crys- 
 tals, which are soft to the touch, of a sweetish taste; is volatile, 
 and has a very unpleasant odor (which may be covered with oil 
 of rose, etc.) ; is insoluble in water, but is soluble in alcohol, 
 ether, chloroform, and the essential oils. 
 
 Actions. — Iodoform is an efficient antiseptic, inhibiting and 
 destroying the microbes of putrefaction and suppuration; it has 
 also slight local anesthetic properties. 
 
 Internally in small doses it is a tonic, alterative, anodyne, 
 and antiseptic. 
 
 In large doses it causes a form of intoxication, followed by 
 convulsions, collapse, and death. 
 
 Dose, gr. j-v, in pill form. 
 . Dental Uses. — In dental practice iodoform is a valuable 
 agent; it is an excellent antiseptic for the treatment of alveolar 
 abscesses, putrescent pulps, especially when combined with oil 
 of eucalyptus. Prof Peirce recommends iodoform ground with 
 equal parts of oil of cloves and oil of eucalyptus, a portion of 
 which may be introduced to the inflamed part on the point of a 
 small broach. 
 
ANTIZV3L0T1CS. ±0 i 
 
 Iodoform is also serviceable as a packing for the pockets of 
 pyorrhoea alveolaris, and as a dressing or packing for wounds, 
 where it may be used in the powdered form or in the form of 
 a gauze wliich is prepared for the purpose. 
 
 Aristol. 
 
 Derivations. — Aristol is a preparation of iodine, and has 
 gained a position in recent therapeutics as a perfect substitute 
 for iodoform. It is a thymol iodide, and is ''produced by 
 treating an aqueous solution of iodine in iodide of potassium 
 with an aqueous solution of thymol in the presence of caustic 
 potash." 
 
 Properties. — Aristol is in the form of a reddish brown pow- 
 der; is volatile, and has a slight aromatic odor, though when 
 compared with iodoform we may say it is practically inodorous. 
 The quantity of iodine contained in it is from 45 to 50 per 
 cent. 
 
 Aristol is insoluble in water and glycerine, slightly soluble 
 in alcohol, but is readily soluble in ether, chloroform, collodion, 
 and the fixed and ethereal oils. 
 
 Actions. — Aristol is an efficient antiseptic; it is particularly 
 applicable as a dressing for wounds, ulcerations, and abrasions 
 of the skin and mucous membrane. 
 
 It may be dusted over the wound, or applied in the form of 
 aristol ointments (compounds of vaseline or cold cream) or in 
 combination with collodion. All of these are excellent and easy 
 of application. Its efficiency as an antiseptic and alterative is 
 largely due to the fact that it slowly gives off its iodine, and it 
 is also due to this fact that it does so decompose, when exposed 
 to the light or undue heat, that it should be kept in a colored 
 bottle or a closed box and in not too warm a place. If this is 
 not done, the loss of iodine will be readily noticed by its grad- 
 ually becoming paler in color. 
 
 Dental Uses. — Aristol is a welcome addition to our cata- 
 logue of therapeutic agents. I have found it an excellent agent 
 
 10 
 
138 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 for treating root-canals from which putrescent pulps have been 
 removed and for alveolar abscesses. It can also be used advan- 
 tageously in combination with root-filling materials; it may be 
 used by mixing the powder with chloro-percha, or, where gutta- 
 percha cones are to be used, the cone may be dipped in a solu- 
 tion of aristol and chloroform and immediately carried to 
 position. Dr. Kirk says of it in this connection: "I have made 
 use of aristol in connection with root-filling materials by an- 
 other method. A strong solution of aristol is made in the oil 
 known to house-painters as 'Japan dryer,' sufiicient of the drug 
 being added to make the liquid somewhat thinner than glycer- 
 ine; into this is worked with a spatula freshly calcined oxide of 
 zinc until the mass is like putty, in which condition it is to be 
 worked into the root-canals. The mass becomes quite hard, and 
 seems to fulfill admirably the requirements of a root-filling." 
 
 Formalin. • 
 
 Derivation. — The name formalin has been given to a 40 
 per cent, solution of chemically pure formaldehyde in water. 
 Formaldehyde (CH2O), as is well known, is a gaseous body 
 which is prepared by subjecting methyl-alcohol to oxidation. 
 It is readily absorbed by water; for this reason it is put on 
 the market in the form of an aqueous solution termed "forma- 
 lin." It mixes with water in all proportions, making it easy, 
 therefore, to prepare any dilution required. 
 
 Properties and Actions. — Formalin can be used either in 
 a gaseous or liquid form ; it is non-poisonous, of a peculiar, 
 penetrating odor. When brought into contact with the animal 
 skin, undiluted formalin exerts a kind of tanning effect, mak- 
 ing the skin impermeable and finally brings about necrosis. The 
 tissue is destroyed with suppuration or formation of a wound. 
 Therapeutic Uses. — Formalin is an ideal germicide, disin- 
 fectant, deodorant, and antizymotic, possessing the same germ- 
 icidal power as corrosive sublimate, without its toxicity. It is 
 
ANTIZYMOTICS. 139 
 
 used in aseptic and antiseptic surgery, for inhalations, in oph- 
 thalmic practice, in bacteriology, as a hardening and preserving 
 medium, and in the recognization of the typhoid bacillus. 
 
 Dental Uses. — It may be used in dentistry for destroying 
 the nerves of teeth, and as an antiseptic agent. 
 
 Gaultheria. 
 
 Derivation. — Gaultheria is obtained from the leaves of the 
 gaultherise procumbens (Ericaceae), a small plant common to 
 North American woods. These leaves contain tannic acid, 
 urson, arbutin, ericolin, a volatile oil, etc. 
 
 Properties and Actions. — Gaultheria has an aromatic, bit- 
 ter, and astringent taste. The volatile oil is composed princi- 
 pally of methyl salicylate and gaultherilene, which produce 
 pure salycilic acid. 
 
 Therapeutic Uses. — The oil of gaultheria is antipyretic and 
 antiseptic, and is used in wounds, and administered internally 
 for auricular rheumatism. The spirit of gaultheria is used as 
 a flavoring extract. 
 
 Dental Uses. — Gaultheria, being one of the essential oils, 
 is useful to the dentist for its antiseptic properties, either alone 
 or combined with other medicines for the treatment of alveolar 
 abscess and putrid root canals; it is also an ingredient of local 
 anesthetic mixtures. 
 
 Creasote. 
 
 Derivation. — Creasote is one of the products of the distilla- 
 tion of wood-tar, and consists principally of such phenols as 
 phloral, creasol, methyl-creasol, and guaiacol. It can also be 
 obtained from crude pyroligneous acid. That made from beech- 
 wood, however, is the better form for medicinal use. 
 
 Properties and Actions. — Creasote is a colorless, oily fluid, 
 with an odor somewhat resembling carbolic acid, and has a 
 burning taste. It is a stimulant, antiseptic, styptic, sedative. 
 
140 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 and rubefacient. In large closes it is a narcotic poison, causing 
 death by coagulating the albumen of the blood, preventing its 
 circulation through the arteries. It is used in small doses, gen- 
 erally, for its astringent qualities. 
 
 Therapeutic Uses. — Internally, creasote is administered for 
 pulmonary consumption, chronic bronchitis, vomiting and gas- 
 tric troubles, diarrhoea, diabetes, etc. Externally, applied to 
 hemorrhages from wounds, etc., diseases of the skin, eruptions, 
 ulcers, etc. 
 
 Dental Uses. — Creasote has for many years been employed 
 in dental practice for relieving odontalgia, as an obtundant, for 
 alveolar abscess, ulcers of the mouth, etc. Its antiseptic powers 
 render it valuable for offensive purulent discharges; and its 
 styptic properties are sometimes taken advantage of in the 
 treatment of hemorrhage after extraction of teeth. 
 
 Naphtiiol. 
 
 Derivation. — Naphthol is derived from naphthalene (C^qH^) 
 which is a coal-tar product and in the form of white crystals, 
 having a strong, unpleasant odor; soluble in alcohol, but not in 
 water. This alcoholic solution is known as naphthol. 
 
 Properties and Action. — There are two forms of .naphthol, 
 a-naphthol and /S -naphthol; the latter, owing to its less irri- 
 tating effects, is generally employed medicinally. It is a light- 
 brown crystal, soluble in hot water. 
 
 Therapeutic Uses. — Owing to its antiseptic properties it is 
 used in parasitic diseases of the skin ; it is given internally, 
 and applied externally as an ointment. 
 
 Dental Uses. — ITydronaphthol, supposed to be a form of 
 ,'3-naphthol, is most generally used in detal practice for treating 
 canals and pulpless teeth, pericemental inflammation of septic 
 jrigin, especially in early stages before pus has formed. Pro- 
 fessor James Truman recommends a solution of 1 : 1000 of water 
 for injection into pulp canals. It is also recommended as an 
 
AXTJZYMOTICS. 141 
 
 ingredient for a mouth- wash for diseased gums and mucous 
 membrane. 
 
 Campho-phenique, C^Hj^O. 
 
 Derivation. — Campho-phenique is obtained from the chemi- 
 cal union of carbolic acid and camjihor. It is prepared as fol- 
 lows : Nine parts of carbolic acid to one part of alcohol are 
 mixed with twenty-five parts camphor. The clear oily solution 
 is the result. 
 
 Properties and Actions. — Campho-phenique is a limpid, 
 volatile fluid, having an aromatic taste and the odor of camphor. 
 It is an antiseptic, a mild local anesthetic, and germicide; is 
 non-irritant, non-poisonous; insoluble in water or glycerine, 
 but will mix in all proportions with alcohol, ether or chloroform. 
 
 Dental Uses. — As a dressing in the treatment of putrescent 
 pulp-canals it has given quite satisfactory results. It has been 
 employed hypodermically as a local anesthetic, causing no con- 
 stitutional disturbance. It is also recommended for the relief 
 of pain following the extraction of teeth, in which case it is 
 introduced into the sockets upon pledgets of cotton. 
 
 Cinnamon (Cassia Bark). 
 
 Source. — The commercial cinnamon is the prepared bark of 
 a tree of the natural order Lauraceae. The best varieties of 
 this bark are obtained from Ceylon. It contains a volatile oil, 
 an acid peculiar to itself — cinnamic acid — a trace of tannic 
 acid, mucilage, etc. 
 
 Properties and Actions. — Cinnamon is placed upon the 
 market in the form of long, thin, cylindrical pieces, having a 
 yellow-brown color, a fragrant odor, and a sweetish, aromatic, 
 and mildly-astringent taste. It is more powerful as a local 
 than as a general stimulant. Its medicinal virtues, however, 
 reside in a volatile oil, oleum cinnamomi, or oil of cinnamon. 
 
142 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Therapeutics. — Cinnamon is sometimes employed to allay 
 nausea and vomiting, and in combination with chalk and with 
 other astringents it is used for the treatment of diarrhoea. The 
 oil of cinnamon is often employed to conceal the taste of other 
 medicines, and is a strong local stimulant. 
 
 Oil of Cassia. — Oil of cassia is prepared from the bud of 
 the same order of tree, and the oil of cinnamon from the bark. 
 The oil of cassia is preferred by many as an antiseptic for local 
 treatment. 
 
 Dental Uses. — Oil of cinnamon and oil of cassia are em- 
 ployed by many as antiseptics in dental practice. In the treat- 
 ment of putrescent root-canals the writer has secured very sat- 
 isfactory results from both these drugs. Applied to exposed 
 and inflamed dental pulps, they will give temporary relief, and 
 have been recommended for the treatment of pyorrhoea alveo- 
 laris, combined with iodoform. Dr. Black's "1, 2, 3 mixture" 
 is composed of oil of cinnamon, 1 part; carbolic acid (crystals), 
 2 parts; oil of gaultheria, 3 parts. This is employed in the 
 local treatment of pyorrhoea alveolaris, and for alveolar ab- 
 scesses, etc. 
 
 Electrozone. 
 
 Derivation. — Electrozone is the product of sea- water speci- 
 ally treated by electrolysis. It has been so named from the fact 
 that it is manufactured with the aid of the electric current, 
 and the oxidizing agent being ozone. The result of electrolysis 
 thus performed is the formation of new compounds, consisting 
 of the hypochlorites, hypobromites, etc., and, it is claimed, the 
 substitution of free oxygen and peroxide of hydrogen for the 
 air between the molecules of water. 
 
 Properties and Actions. — It is a clear, colorless liquid, hav- 
 ing an unpleasant, salty taste, and an odor resembling chlorine. 
 It is a non-poisonous and efficient antiseptic, germicide, and 
 disinfectant. 
 
CATHARTICS. 143 
 
 Therapeutic Uses. — It is much used for diphtheria, catarrh^ 
 and fevers, and is applied to burns, scalds, and wounds of any 
 nature. 
 
 Dental Uses. — It is valuable to the dentist for its antiseptic 
 and germicidal qualities, and is very efficacious in the treat- 
 ment of acute pulpitis, giving almost instant relief. The 
 writer has also found it very valuable in the treatment of root- 
 canals, as a mouth- wash, and wherever a harmless germicide 
 and deodorizer is desirable. 
 
 CATHAETICS. 
 
 Cathartics, or purgatives, are agents which hasten the intes- 
 tinal evacuations; they comprise such substances as magnesia 
 preparations (Epsom salts), senna, rlnibarb, fruits of various 
 kinds, etc. 
 
 Magnesia^ MgO. 
 
 Derivation. — Magnesia, or magnesium oxide, is obtained by 
 subjecting magnesium to a red heat in the open air, when it 
 will burn with a bright light and produce MgO. 
 
 Properties. — Magnesia is a very light, white powder, odor- 
 less, has an earthy taste, is freely soluble in water — more so in 
 cold water — and neutralizes acids. 
 
 Actions. — Magnesia is an efficient aperient (mild purga- 
 tive), is antacid — whence an excellent remedy for great acidity, 
 of the stomach — and is the antidote for poisoning by mineral 
 acids. When it is desirable to administer magnesia in large 
 doses and for a considerable length of time, it may be given 
 in connection with lemonade, which will render it more soluble, 
 avoiding its accumulation in the bowels. 
 
 Chief Preparations: — 
 
 Sulphate of Magnesia, "Epsom salts," "salts." Dose, 3j-§j, 
 in water, a popular purgative. 
 
144 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 Liq. Citrate of Magnesia (magnesium carbonate), citric 
 acid, potassium bicarbonate, and water. Dose, 5iv-vj. 
 
 Dose of Magnesia as an aperient, gr. x-3j. As an antacid, 
 gr. 20(9j). 
 
 Dental Uses. — The form of magnesia usually employed in 
 dental practice is known as magnesium hydrate, or milJc of 
 magnesia, and consists of precipitated magnesium hydrate held 
 in suspension in water, and is employed for counteracting the 
 injurious action of acid secretions, especially in cases of erosion. 
 It is applied in the same way that lime-water or precipitated 
 chalk is used for the purpose of bringing about an alkaline 
 condition of the oral fluids, by neutralizing the excess of acids 
 present. A teaspoonful of the preparation taken into the 
 mouth and allowed to float about the teeth coats them 
 with a slight alkaline film, which protects the tooth surface 
 from the acid action for several hours. 
 
 MISCELLANEOUS DEUGS. 
 
 GLYCERm. 
 
 Derivation. — Glycerin is a production of the saponification 
 of fijied oils and fats; it also contains a small percentage of 
 water. 
 
 Properties and Actions. — It is a colorless, syrupy liquid, 
 having a sweet taste but no odor; soluble in water or alcohol. 
 It is a solvent, preservative, emollient, and nutrient. 
 
 Therapeutic Uses. — It is used to dissolve iodine, iodide of 
 potassium, borax, tannic acid, creasote, carbolic acid, etc. It is 
 much used in poultices and for roughness of the skin, as one of 
 the ingredients for dressings for wounds and ulcers, erysipelas, 
 and small-pox (to prevent pitting). Glycerin is used in cases 
 of earache and deafness. It should be mixed with a little water 
 before applying to abraded or cut surfaces to prevent smarting. 
 
 Dental Uses. — Glycerin is much used in dotal practice as 
 a solvent and emollient. It is used in the treatment of diseases 
 
M ISCMLI.AM^ors DKl'CiS. 145 
 
 of the mucous membrane of the mouth, such as ulcers, stoma- 
 titis, alveolar abscess, etc. Combined with lime-water, rose- 
 water, gum tragacanth, etc., it forms ointments and emollients. 
 Combined with atropine, acetate of lead, morphine, etc., it is 
 used as an anodyne and emollient. 
 
 Collodion. 
 
 Derivations. — Collodion is a solution of pyroxylin, stronger 
 ether, and alcohol, in the proportion of 4, 70, and 26 respec- 
 tively. Pyroxylin, or common gun-cotton, is a mixture of 
 nitric and sulphuric acids added to cotton freed from im- 
 purities. 
 
 Properties and Actions. — Collodion is a colorless, inflam- 
 mable liquid, of the consistency of syrup, with an ethereal odor. 
 It is used to protect abraded or cut surfaces from the air, by 
 means of the film which it forms. Owing to its astringent ten- 
 dencies it draws together and holds in apposition divided parts. 
 
 Therapeutic Uses. — It is applied to ulcers, abraded surfaces, 
 fissures, and is also used in skin diseases and erysipelas. 
 
 Dental Uses. — Combined with carbolic acid it is applied for 
 odontalgia. With iron, etc., it forms a styptic preparation. 
 When a number of layers are applied, it will sometimes prevent 
 an alveolar abscess from discharging on the face, causing it to 
 open in the mouth. It is useful in the dental laboratory for 
 coating plaster models, protecting the surface. Should it be- 
 come too thick, dilute with a solution of ether and alcohol, 
 3 to 1. 
 
 Sandaraoh. 
 
 Derivation. — Sandarach is derived from an evergreen tree 
 common to Northern Africa. 
 
 Properties and Actions. — Sandarach gum is in the form 
 of small, irregular drops, of a light yellow color, occasionally 
 brown; brittle, and slightly transparent. It has an agreeable 
 
146 DENTAL PATHOLOGY AND DENTAL MEDICINE. 
 
 odor and a resinous, acrid taste. It is inflammable, and when 
 melted by heat throws out a strong balsam odor. It dissolves 
 readily in alcohol or ether. 
 
 Dental Uses. — The alcoholic solution of sandarach is much 
 used in dental practice as a varnish for coating plastic fillings, 
 etc.; and applied on cotton as a temporary stopping, and for a 
 coating for cotton used for separating purposes. 
 
 ANTACIDS. 
 
 Bicarbonate of Soda, 2NaIIC03. 
 
 Sodium bicarbonate is a white powder, having a mildly aUva- 
 line, cooling taste. It is soluble in water, insoluble in alcohol. 
 Alkaline in reaction. 
 
 Dental Uses. — Sodium bicarbonate is used in dental prac- 
 tice to counteract the actions of acids, and is sometimes em- 
 ployed as an antacid ingredient of dentifrices, etc. 
 
 Borax, Na22B202. 
 
 Borax, or sodium borate, is a white powder having an alka- 
 line taste and reaction. It is both alkaline and antiseptic and 
 may be used in a saturated solution where these qualities are 
 desired. 
 
 Dental Uses. — It is sometimes employed in mouth-washes, 
 particularly in the treatment of stomatitis or thrush. The 
 latter trouble occurring usually in the mouths of infants, a 
 saturated solution of glycerin has been suggested for the treat- 
 ment of same. Borax is also useful in blow-pipe analysis, as a 
 flux in soldering metals, in solution for hardening plaster 
 casts, etc. 
 
 Lime Water. 
 A saturated solution of calcium hydrate in water. It is a 
 colorless, nearly odorless liquid, alkaline in reaction. Lime 
 
ANTACIDS. 147 
 
 water is readily prepared by treating freshly slaked lime with 
 distilled water. 
 
 Dental Uses. — ^Lime water may be used freely as an antacid 
 mouth-wash and gargle. It may also be used to correct acidity 
 of the stomach, and is frequently added to the food of infants 
 for this purpose. 
 
 Magnesia (see Cathartics). 
 
 Prepared Chalk^ CaCOg. 
 
 This substance is a form of calcium carbonate. It is a 
 white powder, sometimes moulded into small blocks or cones, 
 almost tasteless, very slightly soluble in water and insoluble in 
 alcohol; it is antacid, absorbent and astringent. It is prepared 
 by freeing chalk from impurities and gritty substances by 
 elutriation (e-lu-tre-a'shun) . 
 
 Dental Uses. — The insolubility and antacid property of 
 prepared chalk gives it special value as a basis for tooth powders 
 and as a packing between teeth over night where there is a 
 strong tendency to acidity. It is employed by some dentists to 
 Telieve sensative dentine in cavities of decay or erosion. In 
 such cases it is employed for several days before operating. It 
 is used in the laboratory for polishing purposes. 
 
APPENDIX. 
 
 EMERGENCIES. 
 
 Preliminary Remarks. 
 
 Nothing, of course, can take the place of the advice and 
 service of an experienced physician in time of emergencies; 
 but the physician is not always at hand, and accidents of 
 various kinds may occur in the dental office, or patients in 
 distress present themselves to the dental practitioner for im- 
 mediate relief; or some one may be burned, cut, poisoned, or 
 suffocated, where, if we possess presence of mind and sufficint 
 knowledge, it may be our privilege to save an endangered life. 
 It is, therefore, expedient that the dental student should have a 
 more thorough knowledge of what to do in case of such emer- 
 gencies; it is for that purpose that this chapter of practical 
 suggestions is prepared. 
 
 Apoplexy is the rupturing of a blood-vessel in the brain. 
 The symptoms are stupor, heavy snoring breathing, slow pulse, 
 flushed face, followed by paralysis usually of one side, this 
 being marked by the drawing up of one side of the face. 
 
 Treatment. — Loosen clothing about the neck, make cold ap- 
 plications to the head, and keep the patient in a sitting posture 
 until the physician arrives. 
 
 Burns or Scalds. — Not infrequently does some one's cloth- 
 ing take fire, usually that of women, on account of the charac- 
 ter of their clothing. The first thing to do in time of such an 
 accident is to have the patient lie down, but if she loses her 
 presence of mind and will not obey instructions, she must be 
 quickly placed upon the floor or ground and then covered or 
 enveloped at once with the first article you seize that will ex- 
 
 148 
 
APPEADJX. 149 
 
 elude the air and smother the flame — a breadth of carpet, rug, 
 blaiilvet, or coat will serve the purpose. 
 
 After the fire is extinguished, or after an extensive scald, if 
 there is m.uch of a burn or blister, the clothing-, as much as 
 need be removed, should be carefidly clipped away, so as not to 
 break the blisters that may have formed. These may be punc- 
 tured at one edge and their contents discharged, when the outer 
 skin will fall back in place. Then a dressing of pure sweet oil 
 or castor oil should be carefully applied on strips of soft linen. 
 When the skin is destroyed, the air may be excluded by apply- 
 ing at once any of the following : sweet oil, linseed oil, collodion, 
 vaseline, etc. Dr. Charles Dulles, in his manual on accidents 
 and emergencies, says : "In case of a person severely and ex- 
 tensively burned, the entire body may be immersed in a bath, 
 which shall be kept, as long as necessary, at a temperature of 
 100°. Where the shock of a burn is great some stimulant should 
 be given, and laudanum, in twenty-droi:) doses to an adult, and 
 half as much to a child, to allay the suffering." 
 
 For Slight Burns or Scalds, an excellent dressing is to 
 quickly sprinkle the parts with bicarbonate of soda and cover 
 same with wet cloth, or they may be painted with white lead, 
 or covered with the white of an egg or carron oil (equal parts 
 of linseed oil and lime water) — in fact, anything that will ex- 
 clude the air and prevent friction, and will not prevent after- 
 examination, may be used. Aristol ointment (aristol in cold 
 cream or vaseline) is also being used with good results, while 
 for small burns on the hand, arm, leg, etc., immerse instantly 
 in cold water, and let it remain for some length of time. 
 
 Burns with Acids or Caustic Alkalies, such as soap lye, 
 should be deluged with water, and followed by an application of 
 bicarbonate of soda for the former and vinegar for the latter, 
 to be followed by an application of oil. 
 
 Catalepsy in appearance somewhat resembles death. The 
 patient becomes unconscious, the muscles rigid, and the skin 
 
150 APPENDIX. 
 
 pallid. In itself it is by no means dangerous, and it affords time 
 enough to summon a doctor, which is the only sensible thing to 
 do under these circumstances. 
 
 Choking is usually caused by the lodgment of some foreign 
 substance in the trachea or oesophagus. When the body is 
 lodged in the trachea, there is great irritation and coughing, 
 though it does not materially interfere with deglutition. While, 
 on the other hand, when the oesophagus is closed, it is usually 
 impossible to swallow, and there is little or no coughing. 
 
 Treatment. — Hold the head low and slap the back quite forc- 
 ibly. Blow into the ear, which will excite a reflex action that 
 will aid the patient in expelling the foreign body. The re- 
 moval of pins, needles, splinters, fish bones, etc., from the 
 throat is usually an extremely delicate operation. They should 
 be grasped with a small pair of forceps or tweezers, or a blunt 
 pair of scissors may be used for the same purpose. 
 
 Convulsions are usually caused by some irritation of the 
 digestive apparatus, or hy some interference in the eruption of 
 the teeth. 
 
 Treatment. — When the physician's coming is delayed, the 
 child should be placed in a hot bath; the head at the same time 
 should be kept cool by cold applications. This should be con- 
 tinued for about ten minutes, when the child should be wrapped 
 in warm blankets and put to bed. If there should he one or 
 more teeth endeavoring to erupt at this time, the gums should, 
 he freely lanced. 
 
 Dislocations can be easily detected. There is always de- 
 formity, pain, and stiffness of the joint affected. 
 
 Dislocation of the lowerjaw, with treatment for same, is 
 fully treated upon pages 62 and 63. 
 
 Dislocation of the fingers can easily be corrected by strong 
 pulling and at the same time pressing the parts into place, where 
 they should be retained for several days by a splint and bandage. 
 
 Dislocations of other joints had better be left for the sur- 
 geon's hands. "The risk of doing injury by injudicious efforts 
 
APPENDIX. 151 
 
 to set a joint is greater than that of waiting until a surgeon 
 can be summoned." The patient, however, should be placed in 
 the most comfortable position and hot fomentations should 
 be applied. 
 
 Drowning. — It is important to remember that the body as 
 a whole, is a very little lighter than water; therefore, a person 
 who is in danger of drowning should lie flat on the back and 
 keep the entire body, with the exception of the mouth and 
 nose, under water. The arms should be stretched at full length 
 above the head, and the lungs should be kept filled with air as 
 much of the time as possible. This would very materially aid 
 both the one in danger and the rescuing party. 
 
 Resuscitation. — Avoid delay. Do not wait to carry the 
 patient to a house or hospital, but treat him on the spot. "Re- 
 member that the patient is suffering from two things, want of 
 air, or oxygen, and loss of heat from the body." The first thing 
 to do, then, is to free the body from any clothing that may in- 
 terfere with respiration — that is, about the neck, chest, and 
 waist. If natural breathing has ceased, artificial respiration 
 should be commenced as soon as possible. First, hastily make 
 a roll from clothing, blanlvets, or anything that may be at hand, 
 place the patient over this, face doivnward, allowing his fore- 
 head to rest upon one hand to keep the mouth and nose clear 
 of the ground. Place the hands, well spread, upon the patient's 
 back, over the stomach and base of thorax. Then, with a for- 
 ward motion, throw all the weight upon them that the age and 
 sex of the patient will justify. Repeat this three or four times, 
 which will cause the water and mucous to run out of the mouth, 
 throat and trachea. (See Fig. 29.) Wrap a handkerchief 
 around the forefinger and pass it into the mouth and remove 
 any mucus that may remain. Turn the patient on his back, 
 grasp the tongue and draw it forward and down onto the chin; 
 lay a strip of the handkerchief or other material across the 
 tongn.e and pass the ends behind the neck and tie, or have some 
 
152 
 
 APPENDIX. 
 
APPENDIX. 153 
 
 one to hold the tongrie to keep it from falling back and closing 
 the throat. Then begin artificial respiration. 
 
 Howard's Method. — The patient is placed upon his back, 
 his arms extended backward and outward, where they should be 
 held by an assistant. A roll of something (clothing, a folded 
 blanket, coat, or stick of wood, if nothing better is at hand) is 
 then placed under the false ribs so as to throw them prominently 
 forward. The operator should then kneel astride the patient's 
 abdomen, placing both hands so that the fingers will press into 
 the intercostal spaces on each side, and the base of the thumb 
 rest upon the anterior margin of the false ribs. The operator 
 should then place his elbows firmly against his sides, and throw 
 himself forward, bringing his weight to bear upon the patient's 
 false ribs, forcing them inward and upward toward the dia- 
 phragm, then suddenly let go and return to the erect position. 
 Repeat these movements ten to twelve times a minute until 
 natural breathing begins, which may gradually take the place 
 of the artificial. Fig. 30 illustrates this method. 
 
 Sylvester's Method. — After the patient has been placed 
 upon his back, with folded clothing under his shoulders, the 
 operator should kneel behind his head and go through the 
 following manipulations : — 
 
 First, to induce inspiration : Grasp both arms just below the 
 elbows and swing them around horizontally until they nearly 
 meet above the head, with the back of the hands or elbows 
 touching the ground; hold them there for three or four seconds. 
 This draws the ribs up so as to expand the chest and allows the 
 air to enter the lungs. (See Fig. 31.) 
 
 The second movement is to induce expiration. Bend the arms 
 at the elbows, and carry them down so that they rest upon 
 either side of the chest. Bring the weight of your body upon 
 them, pressing forcibly and steadily, which pressure, if con- 
 tinued for a few seconds, will force the air out of the lungs. 
 
 11 
 
154 
 
 APPENDIX. 
 
APPENDIX. 155 
 
 (See Fig. 32.) These movements should be continued alter- 
 nately twelve to fifteen times a minute. 
 
 When natural hreathing is attempted, it may be stimulated 
 by applying smelling salts or anmaonia to the nose, or by slap- 
 ping the chest. When the patient is able to swallow, some 
 stimulant should be given every few minutes until the danger- 
 point is passed — such as a teaspoonful of whisky or brandy, or 
 double the quantity of hot water. After the patient is resus- 
 citated he should be wrapped in warm blankets and carefully 
 carried, with the head low, to a warm bed. 
 
 Epileptic Fits are characterized by sudden loss of conscious- 
 ness and power of co-ordination of motion; there is a rigidity 
 of motion which is followed by violent convulsions of short 
 duration, usually accompanied by more or less foaming at the 
 mouth. There is also a peculiar cry that accompanies these 
 attacks, caused by laryngeal spasms. 
 
 Treatment. — There should be no struggling with the patient, 
 but an effort should be made to regulate the movements so 
 that the patient will not do himself any harm. A folded napkin 
 or towel or a soft piece of wood should be placed between the 
 teeth to prevent biting the tongue. As soon as the convulsions 
 are passed, the patient should be allowed to rest quietly in bed 
 for some time. Dr. Dulles says: "It would be a good plan if 
 every one who is subject to epileptic attacks had his or her 
 name and address placed inside the coat or in some place where 
 it could be seen at once when the clothing is loosened to give 
 relief, as is almost invariably done when such attacks occur. 
 Epileptics should not, except where it is absolutely unavoidable, 
 go about alone, or go into crowded places. They have no right, 
 on their own account and for the sake of others, to incur risks 
 involved in such conduct, except under stress of necessity." 
 
 Exhaustion, Heat. — This is not a serious illness. It is 
 usually caused by physical overwork in hot and badly ventilated 
 rooms or in the heat of summer, — the latter is apt to be con- 
 founded with heat or sunstroke. In heat exhaustion, however, 
 
156 
 
 APPENDIX. 
 
APPENDIX. 
 
 0* 
 
 Hi 
 
 > 
 «2 
 
158 APPENDIX. 
 
 there is a cool, moist skin, while in sunstroke the bodily tem- 
 perature is raised and the skin is quite dry. 
 
 Treatment of heat stroke is very simple. The patient should 
 have complete rest, plenty of fresh air, and a mild stimulant — 
 hot soup, milk, tea, or coffee, or a small dose (one or two tea- 
 spoonfuls) of wine or brandy. 
 
 Fainting is caused by the cutting off of the supply of blood 
 to the brain, which is due to a temporary weakening of the 
 heart's action. 
 
 Treatment. — If, for any reason, the patient does not fall to 
 the floor or couch so as to bring the head low, the body should 
 be placed in such a position. This is to aid the heart in sending 
 the blood to the brain, and if the head is placed a little lower 
 than the body, the force if gravity will aid very much in sending 
 the blood where it is needed. At the same time the clothing 
 should be lossened and plenty of fresh air admitted. Cold 
 water may be sprinkled upon the face, and ammonia or smelling 
 salts applied to the nose tend to excite the nerves of sensation 
 and rouse the heart to renewed activity. 
 
 Fractures. — Fractured bones may be recognized by the de- 
 formity and abnormal mobility of the parts affected. It is 
 also usually accompanied by crepitus, — a clicking or grating 
 sensation at the point of fracture. 
 
 The treatment of fractures should not be attempted by any 
 one who has not surgical training, and as there is no great haste 
 necessary, an effort should be made to simply place the patient 
 in as comfortable a position as possible until the physician ar- 
 rives. The following notes and illustration (Fig. 33) are taken, 
 with permission of the author, from Dr. G. R. Butler's "Emer- 
 gency Notes" : — 
 
 "If patient must he moved^ or travel some distance, apply 
 temporary splints or dressings to prevent further injury from 
 movement. 
 
APPENDIX. 
 
 159 
 
 Ed 
 O 
 
 P5 
 
 C3 . 
 
 H O 
 
 a H 
 
 
 
 CO 
 CO 
 
160 APPENDIX. 
 
 "In city or country one of the following list of materials may 
 usually be found, and, by the aid of a little ingenuity, utilized 
 for temporary dressings : — 
 
 ''^For splints — Cigar boxes, pasteboard (boxes, book-covers), 
 folded newspapers, shingles, barrel-staves, umbrellas, walking- 
 sticks, rulers, paper-cutters, branches, twigs, straw, fence-pal- 
 ings, spoons, tongs. 
 
 "For padding — Cotton, flannel, towels, flax, jute, oakum, hay, 
 moss, pieces of blanket, coat-sleeves or stockings stuffed with 
 grass, hay, straw, or leaves. 
 
 "For bandages — Handkerchiefs, stockings, garters, suspend- 
 ers, sheets, blankets, and patient's clothing torn into strips. 
 
 "The temporary treatment of the following special fractures 
 should be studied and personally practised. Some of these im- 
 provised splints and their application are shown in Fig. 33. 
 
 ''Jaiv-hone — Four-tailed bandage. 
 
 "Collar-hone — Broad bandage around chest and a^jm of in- 
 jured side. Broad arm-sling. 
 
 "Upper arm-hone — Two splints. ^Narrow arm-sling. 
 
 "Foreariyi and wrist hone — One splint reaching to base of 
 fingers. Broad arm-sling. 
 
 "Rihs — Broad bandage around chest, applied during expira- 
 tion — i. e., chest emptied of air. 
 
 "Thigh-hone — Preferably a long posterior (back) splint 
 reaching from waist to heel. If this can not be secured, simply 
 tie limbs together. 
 
 "Leg and anJde-hones — Internal (inside) splint, or tie limbs 
 together." (See Fig. 33 for illustrations.) 
 
 Freezing of the ears, nose, hands, or feet sometimes takes 
 place in such a deceptive manner that much damage is done 
 before it is recognized, for one may go sometimes with a part 
 of the body frozen and not be aware of it, on account of the 
 absence of sensation in the part, which is due to the freezing 
 of the nerves. 
 
APPENDIX. 161 
 
 Treatment. — Warmth and circulation is the first demand, 
 and this should be restored gradually until normal (98° Fahren- 
 heit). This is best accomplished by applying snow or cold 
 water to the part, to which gradually add warm water; gentle 
 friction, too, is found beneficial. The after efi^ects, if serious, 
 should have similar treatment to that of a burn. If the whole 
 body or a large part of it is frozen, after tiie normal tempera- 
 ture is restored the patient should be wrapped in warm blankets 
 and given some internal stimulant, as tea or coffee, until the 
 physician arrives. 
 
 Hemorrhage. — There is no accident where a little accurate 
 knowledge and a level head is of more value than in case of 
 hemorrhage, whether it be from some external wound or from 
 the rupture of a blood-vessel internally. Hemorrhage may 
 occur from three sources, the arteries, veins, or capillaries; and 
 its source can usually be determined by the color and manner 
 in which the blood flows. 
 
 Arterial : Hemorrhage from an artery is very dangerous, and 
 life is often quickly lost; here it is that knowledge, judgment, 
 and coolness is called for. The blood from an artery is bright 
 red and flows' in jets, each jet or spurt corresponding to the 
 beating of the heart. 
 
 Venous or Capillary Hemorrhage is marked by the slow, 
 steady flow of blood, it being darker than the arterial blood. 
 
 Treatment. — The first thing to do in all cases of hemorrhage 
 is to elevate the bleeding part, whenever possible, above the 
 level of the heart. If in the hand or arm, raise above the head. 
 In this position the blood has to travel up hill, and therefore 
 reaches the wound with less force, which means slower escape 
 of blood, and a greater likelihood of forming a clot at the mouth 
 of the wound. Cold water or ice applied to the parts assists, 
 especially in wounds of small arteries, by contracting the ves- 
 sels. Styptics should be applied to contract the bleeding sur- 
 
162 APPENDIX. 
 
 face* and to aid in forming a clot. Probably the best remedies 
 for this purpose are tannic acid, subsulphate of iron, or a mix- 
 ture of vinegar and water, about one part of the former to four 
 of the latter. Pressure on the artery at the wounded point or 
 above the wound is a very simple expedient and will, in nearly 
 all cases, prove of very great value in controlling the flow of 
 blood until more permanent means can be employed. Several 
 methods follow: 
 
 Pressure with the fingers is made by placing one finger just 
 above and one below the wound, and crowding the edges to- 
 gether firmly. 
 
 Pressure by compress and bandage consists of making a com- 
 press of some soft material, such as muslin, linen, cheese cloth, 
 etc., folded into suitable shape and bound securely upon the 
 wound with a bandage. 
 
 Pressure above the wound may be made by the finger, or 
 when the wound is in a limb a tourniquet may be 'employed, 
 which is readily made by tying a handkerchief around the 
 limb loosely, with secure knots, then pass a pencil or knife 
 through the handkerchief and twist in such a manner as to 
 tighthen it sufficiently to stop the bleeding. This may be con- 
 tinued until a surgeon has ligated the artery, which, if neces- 
 sary, should be as soon as possible. 
 
 Hemorrhage from the Nose is not infrequent and is usually 
 not dangerous. It is generally due to the rupture of some of 
 the capillaries of the lining membrane of the nose. But there 
 are times when the bleeding is due to the rupture of a small 
 artery, possibly from ulceration, when it is so profuse as to 
 threaten life. In some cases, which are very rare, medical aid 
 should be summoned at once. 
 
 Treatment. — Have the patient to sit upright, and to hold the 
 hands above the head, at least the one on the bleeding side. 
 
 *See page 126. 
 
APPENDIX. 163 
 
 Take a towel and wring out of ice water or place in it finely 
 cracked ice, and wrap it around the neck. If bleeding con- 
 tinues, have patient snuff up from the hand or inject into the 
 nostrils, with a small syringe, ice water and alum, a teaspoon- 
 ful of alum to a half -glass of water. Vinegar, too, used in the 
 same manner, will usually stop the flow of blood. But if these 
 means should fail. Dr. Butler's plan will be found very good. 
 He says: "Take a piece of cotton wool as large as the first joint 
 of the thumb, tie a thread around its middle, soak it in alum 
 water, or, if that is not at hand, oil it with sweet oil or vaseline 
 and plug the nostril. This is best done by pushing the cotton 
 with a screwing or twisting motion until firmly lodged. The 
 thread serves to draw it out when required." 
 
 Hemorrhage from the Gums can usually be controlled by 
 syringing the mouth or sockets (if teeth have been extracted) 
 with warm water to remove clots, then rinse the mouth freely 
 with ice water and alum. If this should fail, some good styptic 
 should be applied. (See page 69, "Hemorrhage after Extrac- 
 tion.") 
 
 Hemorrhage from the Stomach may be caused by inflam- 
 mation, cancers, corrosive poisons, etc., or may occur without 
 any apparent cause. It is, however, not a very frequent occur- 
 rence. The blood in such cases, when vomited, is usually of a 
 dark brown color, resembling coffee grounds, unless it has very 
 recently and suddenly escaped into the stomach, when it is of 
 a bright red color. Bleeding from the stomach should not be 
 mistaken for bleeding from the lungs. It is therefore impor- 
 tant to remember these facts : that blood from the stomach is 
 usually of a dark brown color and is vomited and not frothy, 
 while blood from the lungs is of a 'bright red color and is frothy, 
 also that it is coughed up, not vomited. 
 
 Treatment. — Hest in bed should be insisted upon. Keep the 
 patient calm, as excitement increases the heart's action and the 
 amount of blood; for the same reason stimulants should not be 
 administered. The patient should be given small pieces of ice 
 
164 APPENDIX. 
 
 to swallow, and teaspoonful doses of vinegar may be given every 
 ten minutes. Also ice-cold cloths may be placed over the 
 stomach. 
 
 PIemorrhage from the Lungs is usually caused by consump- 
 tion and is rarely if ever fatal, except sometimes in the last 
 stages of the disease. It is, therefore, not necessary to appre- 
 hend immediate death, as is so often done. 
 
 Treatment. — The best treatment to pursue until a physician 
 arrives is to place the patient in a reclining position, but not 
 with the head low, give small lumps of ice to be swallowed, and 
 let him eat a teaspoonful of salt with the same quantity of 
 vinegar. Salt absorbs water from the blood, and thus tends to 
 relieve hemorrhage by thickening the blood. Also, if patient is 
 not too weak, cloths wrung out of ice water may be applied to 
 the chest and neck. 
 
 Intoxication is usually caused by an excessive use of alco- 
 holic beverages. It sometimes resembles apoplexy? and great 
 care should be taken in determining the disease, as this mistake 
 has been made with very embarrassing results. It should be 
 remembered that in drunkenness there is a helplessness on both 
 sides alike, but no paralysis; that there is usually some sensa- 
 tion displayed by touching the eyeball, and that the patient 
 can be aroused from the stupor; also, that the odor of liquor 
 can be detected upon the breath, though this might be the 
 case in apoplexy. 
 
 Treatment. — A teaspoonful of aromatic spirits of ammonia 
 in a half or two-thirds of a glass of water is a useful corrective 
 and stimulant. If this is not at hand, a large draught of vine- 
 gar often does much toward sobering an intoxicated person. In 
 an extreme case, where respiration has ceased, or where there is 
 evidence of collapse, artificial respiration should be resorted to, 
 heat should be applied to the body, and copious draughts of hot 
 coffee should be administered. 
 
 Nausea, if caused by slight indigestion, can usually be cor- 
 rected by taking a teaspoonful of baking soda and the juice of 
 
APPENDIX. 165 
 
 one lemon in a half of a glass of water; stir and drink while 
 foaming-. Or take a teaspoonfnl of aromatic spirits of ammonia 
 in a third of a glass of water. If the nausea is due to some- 
 thing objectionable to the stomach, the soda and water will 
 usually give relief by causing vomiting. 
 
 Poisons. — The old maxim, ''an ounce of prevention is better 
 than a pound of cure." is surely applicable to the subject of 
 poisons. In the first place, all dangerous articles should be 
 kept out of the way of chiA-ven; then, all bottles, etc., contain- 
 ing anything of a toxic nature should be distinctly marked 
 "poison." A very good plan is to have such bottles marked by 
 a ball and chain, which may be procured at the drug store; this 
 will give warning in the dark as well as in the light. When it 
 is discovered that a poison has been swallowed, some one should 
 be dispatched for a physician at once; meanwhile, treatment 
 must be directed toward getting rid of the poison before it 
 takes effect. 
 
 First admi)uster a, prompt emetic. Some poisons, by their 
 irritating effect, naturally produce vomiting, so that with a 
 little encouragement the stomach will be thoroughly evacuated. 
 Where this is not the case, the emetic will provoke expulsion of 
 the matter. A very good emetic for such an emergency is luke- 
 warm water in quantity, or a tablespoonful of mustard or salt to 
 a pint of warm water. As this is no occasion for fastidiousness, 
 any water that is at hand may be used ; if soapy, and the hands 
 have been washed in it, use it, as by its very repulsiveness it 
 may act more quickly than anything else; the patient should be 
 urged to drink freely until he can contain no more, and be 
 made to vomit over and over again. 
 
 This sometimes leaves the patient much depressed in body, 
 and mind, showing signs of collapse. In such a case, some mild 
 stimulant may be given; hot tea is probably one of the best, as 
 it is also a chemical antidote to many poisons. Strong, hot 
 coffee is also good. To either of these a teaspoonful of brandy 
 may be added. The patient will, of course, be in bed, and it 
 
166 
 
 APPENDIX. 
 
 should not be forgotten that warm coverings are indispensable. 
 Hot bricks and hot-water bags or bottles, may be brought into 
 requisition. Again, where it is known that poison has been 
 taken, and especially if it is one of the more active and corro- 
 sive, an antidote to counteract the action of the poison should be 
 administered before or after the emetic. The following list of 
 the more common poisons, with their antidotes, etc, will be 
 useful for ready reference. 
 
 SPECIAL POISONS AND READY ANTIDOTES. 
 
 Poison. 
 
 Acids — Sulphuric, Nitric, Aco- 
 tic. Oxalic, Muriatic, or Hy- 
 drochloric, 
 
 Alkalies — Potash, Lye, Soft 
 Soap, Strong Ammonia or 
 Hartshorn, 
 
 Arsenic, 
 
 Carbolic Acid, -■ 
 
 Chloral, 
 
 Chloroform, Ether, etc., 
 
 Iodine, 
 
 Lead — Sugar of Lead { 
 
 Mercury — Bichloride of Mer- 
 cury or "Corrosive Subli- 
 mate," 
 
 Opium — MorpDine, Laudanum, 
 Paregoric, 
 
 Phosphorus, 
 
 Prussic Acid, C 
 
 I 
 
 Silver — Nitrate of Silver, j- 
 
 "Lunar Caustic," | 
 
 Strychnine | 
 
 Treatment. 
 
 Give an alkali, such as powdered chalk, 
 plaster, lime-water, as much as patient 
 can swallow; or lime scraped from the 
 plaster or white-washed wall, stirred in 
 a cup of water. A tablespoonful of 
 strong soapsuds, etc. 
 
 Give an acid — vinegar, lemon-juice, sour 
 Cider, etc. Acids and alkalies neutralize 
 each other — that is, combine to form 
 harmless salts. 
 
 Milk or raw eggs, or flour and water, or 
 lime-water and oil, and after patient has 
 vomited freely, follow with a dose of 
 castor oil. 
 
 There is no chemical antidote, but the 
 stomich should be protected and vomiting 
 encouraged by giving mucilaginous drinks, 
 flour and water, and oil freely — olive, lin- 
 seed, or castor. 
 
 Treatment same as opium. 
 
 Loosen clothing; sprinkle cold water on the 
 face; suspend the patient by the legs; 
 artificial respiration, as for drowning. 
 
 Starch and water; boiled or baked potatoes. 
 
 Epsom salts; after vomiting freely, give 
 dose of oil. 
 
 Albumen, uncooked white of eggs, wheat 
 flour, milk, etc. 
 
 Induce vomiting first. There is no chemi- 
 cal antidote, but strong coffee, pain, mo- 
 tion, counteract its effect. In extreme 
 cases, in addition to above treatment, 
 cold water should be dashed on the face 
 and chest, and artificial respiration and 
 the battery resorted to. 
 
 Provoke vomiting. Teaspoonful doses of 
 turpentine, mixed with magnesia; but no 
 oil, it favors the action of phosphorus. 
 
 Induce vomiting first, and give teaspoonful 
 of ammonia in water. 
 
 Large teaspoonful or salt in a glass of 
 water ; vomiting. 
 
 Induce vomiting first; give a purgative; 
 secure absolute quiet in a dark room. 
 
APPENDIX. 167 
 
 There are other poisons, such as Alcohol, Aconite, Bella- 
 donna, etc., which need not be classified here, as vomiting 
 thoroughly, followed by a mild stimulant and rest, is all that is 
 needed. 
 
 Poisonous Bites. — By this we mean bites of rabid or ven- 
 omous animals and the stings of insects. 
 
 Snake Bites. — Tie a cord, or a handkerchief twisted into 
 a cord, tightly around the part just above the wound. Enlarge 
 the wound by making a cross cut through the center of the bite 
 with a pen knife. This will encourage bleeding, and will ex- 
 pose the wound more thoroughly for the later steps in treat- 
 ment, which are as follows: Draw the poison from the wound 
 by means of suction with the mouth, unless the mouth be sore, 
 or by taking a wide-mouthed bottle, and after saturating a 
 piece of cotton or paper with alcohol or benzine, set it on fire 
 and dip it into the bottle. As soon as the flames begin to die 
 out, quickly invert the bottle over the wound and press tightly 
 against the skin to prevent the admission of air. This will ex- 
 tract the venom and blood from the exposed vessels. Then heat 
 a knitting needle, a piece of wire, or small blade of a knife to a 
 white heat, and thrust it into the wound. At the same time 
 large doses of whisky or brandy should be given and the patient 
 kept under the influence of the stimulant until medical aid 
 can be secured. Some, however, prefer to use aromatic spirits 
 of ammonia instead of whisky, one drachm to a wineglassful 
 of water. 
 
 Mad Dog Bites. — There are some physicians who claim that 
 there is no such disease as hydrophobia; one author puts it in 
 this way: "So-called hydrophobia exists exactly in proportion 
 to the common belief in it," that is to say, the trouble is alto- 
 gether mental. There is no doubt but that a great many deaths 
 have been caused by fright and anxiety, but that all cases are 
 spurious we are not prepared to believe, and think that prompt 
 and heroic treatment should always be given. 
 
168 APPENDIX. 
 
 As dogs are, with many i^ersons, daily companions, it is im- 
 portant to know the various symptoms of madness. The fol- 
 lowing is a resume of the instructions issued by the Council of 
 Hygiene, of Bordeaux. 
 
 Signs of Madness ix Dogs. — "1. A short time after the dis- 
 ease has been contracted, the dog becomes agitated and restless, 
 and turns continually in his kennel. If unchained, he roams 
 about aimlessly; he seems to be seeking something; then stands 
 motionless, as if waiting; he starts, snaps at the air, as if 
 catching a fly, and dashes himself, barking and howling, against 
 the wall. The voice of his master recalls him and he obeys, but 
 slowly, with hesitation and seeming regret. 
 
 "2. He does not try to bite, is gentle, even affectionate, and 
 eats and drinks ; but gnaws his litter, the ends of the curtains, 
 the padding of cushions, bed-coverlids, carpets, and anything 
 which happens to be in his reach. 
 
 "3. From the movement of his paws along the ^des of his 
 open mouth, one might suppose him trying to free his throat of 
 a bone. 
 
 "4. His voice is changed so markedly that it is impossible 
 to overlook it. 
 
 "5. He becomes surly, and begins to fight with other dogs." 
 
 The symptoms, however, vary in different cases, and a change 
 in the habits or manner of a pet dog should always be looked on 
 with suspicion, and the animal should be chained for a while. 
 
 The probability of hydrophobia being communicated to per- 
 sons bitten by a mad dog varies with the location of the bite. 
 If it be in a part unprotected by clothing, inoculation is almost 
 certain ;• in other parts, the chances depend on the thickness of 
 the clothing, which wipes the virus from the teeth. 
 
 Treatment. — The treatment in case of mad dog bite must be 
 altogether preventive, as after the specific symptoms manifest 
 themselves the only thing to do is to keep the patient quiet by 
 the administration of hypnotics, until death ensues. But this, 
 
APPENDIX. 160 
 
 of course, belongs to the physician. When one is bitten by a 
 rabid dog, the same course should be pursued as directed for 
 snake bite, excepting the stimulants. Then start at once for a 
 hospital, where the patient can receive Pasteur's treatment 'by 
 inoculation. 
 
 Bites and Stings of Insects. — Despite the current belief 
 that the bite of a tarantula, centipede, and other insects are 
 dangerous to life, experience proves that they are in nearly all 
 cases comparatively harmless, causing only temporary pain 
 and annoyance. 
 
 Treatment. — They may be treated with cold, wet applications; 
 if nothing better is at hand, wet earth is good. The application 
 of a few drops of hartshorn at the point where the sting entered 
 will also give relief. It sometimes happens that a wasp or bee 
 is swallowed in taking a drink of water hurriedly in the dark. 
 In such cases the fauces swell rapidly from the moment the 
 sting enters the throat, which places the patient in danger of 
 suffocation. This should be treated by the free use of a gargle 
 of hot water and salt, pending the physician's arrival. 
 
 Sea-Sickness. — Sickness occasioned by the motion of a 
 vessel at sea is often most distressing. The most efficient pre- 
 ventive or treatment is to take a seat near the center of the 
 vessel (if inclined to keep up) and, as the ship descends, take a 
 full breath; wear a wide firm belt around the stomach, eat 
 lightly, plainly and often; if the stomach is much disturbed, 
 take the juice of one lemon in half a glass of water, with one 
 tea spoonful of baking soda; stir and drink while foaming. 
 
 Sprains. — A sprain is a sudden overstretching and tearing 
 of the ligaments which enter into the formation of a joint, as 
 w^ell as the tendons and muscles about the joint. 
 
 Treatment. — The joint should be soaked in water as hot as 
 the patient can bear for twenty minutes or more, then rub 
 gently with cosmoline, and apply a snugly fitting, but not tight, 
 flannel bandage, and give the part as near perfect rest as 
 possible. 
 
 13 
 
170 APPENDIX. 
 
 ' Starvation. — When a person is found exhausted from starv- 
 ation, he should be placed in a comfortable position and given 
 stimulating, fluid food. Warm milk, soup, and hot coffee are 
 among the best, given a little at a time, but often. 
 
 Strangulation. — In cases of strangulation — ^that is, com- 
 pression of the windpipe from the outside, as in hanging, etc.— 
 the treatment to be pursued is to remove the pressure at once, 
 and re-establish the respiration, as in drowning. 
 
 Suffocation. — Suffocation from foul air, noxious gases, etc., 
 is caused by a poisonous gas known as carbonic acid. When it 
 is desirable to enter a cellar, well, mine, etc., where there is a 
 suspicion of foul air, a thorough examination should be made. 
 Man can not live in an atmosphere where a candle will not burn, 
 animal life and flame being both supported by oxygen. The 
 best test, therefore, is to lower an unprotected light where foul 
 air is suspected; if the flame flickers and goes out, by no means 
 enter. # 
 
 Carbonic acid gas, being heavier than air, can readily be re- 
 moved by the use of a pump, but if this is not at hand, quick 
 lime (lime freshly burned), scattered about in large quantities, 
 will accomplish the purpose. 
 
 Treatment. — In case of asphyxiation from noxious vapors the 
 patient should be removed as soon as possible to fresh air, and 
 natural respiration re-established, as directed for drowning. 
 
 Sun Stroke does not necessarily arise from undue exposure 
 to the direct rays of the sun, but may proceed from a prolonged 
 elevation of the bodily temperature, or from excessive heat en- 
 countered when the vital forces are near the point of exhaustion. 
 It is generally preceded for some time, usually from one to 
 three days, by pain in the head, a feeling of weakness, disturb- 
 ance of the sight and nausea. This attack, however, culminates, 
 usually after the third day, in a loss of consciousness. The skin 
 is intensely hot and dry, the temperature rising as high is 112. 
 In fevers, if the temperature rises to 105 or 106, it is considered 
 
APPENDIX. 1 7 ] 
 
 a severe case. It is, therefore, apparent that the patient is suf- 
 fering from an excess of heat in the body. The thing to be 
 done, then, is to lower the temperature as soon as possible. 
 Every minute being valuable, the following treatment should 
 be pursued: — 
 
 Treatment. — Send some one for a physician. Remove as 
 much of the clothing as possible, and place the patient in a 
 cool and airy place, indoors or out. Cold must then be applied 
 to the head and body, not dashed or sprinl^led, as that would 
 only cause a needless shock; but towels wrung out of ice-water, 
 and frequently renewed, should be placed upon the head, cracked 
 ice placed in the arm-pits, and the body may be wrapped in 
 cold, wet blankets. Continue this treatment until the physician 
 arrives or the patient shows signs of consciousness, then discon- 
 tinue, unless consciousness should again be lost or the surface 
 of the body becomes very hot. Never in such cases administer 
 a stimulant. 
 
 Wounds. — In surgery, wounds are divided into three classes 
 according to their cause, namely, incised^ lacerated and con- 
 tused. There is a subdivision of this classification, of course, 
 but this is all that is necessary for our present purpose. 
 
 Incised Wounds are those made by sharp-cutting instru- 
 ments, making what are called clean cuts; that is, there is no 
 tearing or bruising, but the -edges are clean cut and the surface 
 smooth. 
 
 Treatment. — If the wound is simple and small, the only 
 treatment that is required is to cleanse the edges and apply ad- 
 hesive plaster and perhaps a bandage. But where the wound is 
 more extensive and serious, the edges should be brought firmly 
 together,- if possible, and held in that position by adhesive plas- 
 ter and bandages. But when this will not answer, hold the parts 
 together with the hands until the physician arrives. Dr. Dulles 
 says : "In case an entire part be cut off, as an ear, or a nose, or 
 a toe, or a finger, it should be cleansed with lukewarm water 
 
172 APPENDIX. 
 
 and put in its place, leaving to the surgeon the decision whether 
 or not it would be worth while to try to save it. Some very 
 remarkable cases of reunion of such parts are in record, and an 
 attempt to save them is not to be lightly rejected." 
 
 Lacerated Wounds are made by blunt tearing instruments, 
 such as dull tools, pieces of machinery, nails, hooks, etc. These 
 wounds are rough and ragged and usually bleed but little. They 
 should be given surgical skill, but until this can be secured the 
 torn parts should be cleansed by a stream of lukewarm water, 
 then brought as near to their natural position as possible and 
 covered with a cloth soaked in lohenol sodique, tincture of mari- 
 gold, or laudanum, and wrapped lightly. If no good remedy is 
 at hand, wrap in cloth wrung out of cold water. If the patient 
 seems much depressed, administer a little brandy or wine. 
 
 Contusions are what are commonly known as bruises; they 
 are usually caused by some blunt instrument or a fall; the skin 
 is not torn through, but is often discolored, which is dfue to the 
 rupture of the capillaries, allowing the blood to escape into the 
 surrounding tissues — the familiar black and blue appearance 
 of a bruise. 
 
 Treatment. — Such wounds are best treated by directing upon 
 the wounded part a stream of water, as hot as the patient can 
 bear it, for several minutes. This will favor the carrying off 
 of the escaped blood. Then, after bathing the part freely with 
 phenol sodique or laudanum, wrap in hot, wet cloths. 
 
 WEIGHTS AND MEASUKES. 
 
 APOTHECARIES' WEIGHT. 
 
 20 grains (gr.) make 1 scruple, sc. or 9 
 
 3 scruples make 1 drachm, dr. or 3 
 
 8 drachms make 1 ounce, oz. or § 
 
 12 ounces make 1 pound, lb. or It) 
 
 SCALE OF COMPARISON. 
 
 Xb oz. dr. sc. gr. 
 
 1 = 12 =: 96 = 288 = 5760 
 
 1 = 8 = 24 = 480 
 
 1 = 3 = 60 
 
 1 = 20 
 
APPENDIX. 
 
 173 
 
 APOTHECARIES' OR WINE MEASURE. 
 
 60 minims ci]-^) make 1 fl. draclim fl. dr. or tc 
 
 8 Jl. drachms make 1 fl. ounce, fl. oz. or fg 
 
 16 fl. ounces make 1 pint. O. 
 
 S pints make 1 gallon, C. 
 
 SCALE OF COMPABISON. 
 
 Gallon. 
 
 Pints. 
 
 Fl. ounces. 
 
 
 Fl 
 
 . drach 
 
 ms. 
 
 
 Minims. 
 
 C. 
 
 1 
 
 0. 
 
 8 
 
 = 128 
 
 _ 
 
 
 1024 
 
 
 _ 
 
 61440 
 
 
 1 
 
 = 16 
 
 =r 
 
 
 128 
 
 
 — 
 
 7680- 
 
 
 
 1 
 
 = 
 
 
 8 
 
 1 
 
 
 =^ 
 
 480 
 60 
 
 TROY WEIGHT. 
 
 24 grains (gr.) make 1 pennyweight, dwt. 
 
 20 pennyweights make 1 ounce, oz. 
 
 12 ounces make 1 pound, lb 
 
 3% grains make 1 carat (diamond weight), k. 
 
 m- 
 
 1 
 
 SCALE 
 
 OF 
 
 COMPARISON. 
 
 OZ. 
 
 
 dwt. 
 
 12 
 
 z= 
 
 240 
 
 1 
 
 
 
 20 
 
 1 
 Ik. 
 
 gl". 
 
 5760 
 
 480 
 24 
 3% 
 
 AVOIRDUPOIS WEIGHT. 
 
 16 drachms idr.) make 1 ounce, oz. 
 
 16 ounces make 1 pound, lb. 
 
 25 pounds make 1 quarter qr. 
 
 4 quarters make 1 hiindredweight, cwt. 
 
 20 hundredweight make 1 ton, T. 
 
 100 pounds make 1 cental, C. 
 
 
 
 
 
 SCALE 
 
 OF 
 
 COMPARISON. 
 
 
 
 
 T. 
 
 cwt. 
 
 
 qr. 
 
 
 
 lb. 
 
 
 oz 
 
 
 dr. 
 
 1 = 
 
 = 20 
 
 =: 
 
 SO 
 
 = 
 
 
 2000 
 
 = 
 
 32000 
 
 — 
 
 512000 
 
 
 1 
 
 = 
 
 4 
 
 = 
 
 
 100 
 
 = 
 
 4000 
 
 ■ — 
 
 25600 
 
 
 
 
 1 
 
 ^ 
 
 
 25 
 
 1 
 
 = 
 
 400 
 
 16 
 
 ] 
 
 — 
 
 6400 
 
 256 
 
 16 
 
 A gallon contains eight pints. 
 
 A pint contains sixteen fluid ounces. 
 
 A fluid ounce contains eight fluid drachms. 
 
 A fluid drachm contains sixty minims (Tn)- 
 
174 
 
 APPENDIX. 
 
 APPROXIMATE MEASUEEMENT, 
 
 A wineglass contains two fluid ounces. 
 
 A teacup contains four fluid ounces. 
 
 A teaspoon of powder contains one-half drachm. 
 
 A tablespoon of powder contains two drachms. 
 
 One drop of essential oils contains one-half minim. 
 
 One drop of water contains one minim. 
 
 From Oould's Medical Dictionary. 
 
 The following table of approximate and exact equivalents of 
 the metric and common weights and measures may prove 
 serviceable : 
 
 Unit of Measurement. 
 
 1 inch, 
 
 1 centimeter 
 
 1 yard, 
 
 1 meter (3D. 37 
 
 1 foot, 
 
 1 kilometer (1000 meters), 
 1 mile, 
 
 (Vioo meter), 
 inches). 
 
 Approximate Equivalent. 
 
 2 ^2 cubic centimeters, 
 
 0.4 inch, 
 
 1 meter, 
 
 1 yard, 
 
 30 centimeters, 
 
 % mile, 
 
 1% kilometer. 
 
 Accurate 
 Equivalent. 
 2.539 
 0.393 
 0.914 
 1.093 
 30.479 
 0.621 
 1.609 
 
 SUEFACE. 
 
 Unit of Measurement. 
 
 1 hectare 
 1 acre. 
 
 (10,000 sq. meters). 
 
 Approximate Equivalent. 
 2% acres, 
 Yg hectare. 
 
 Accurate 
 
 Equivalent. 
 . . 2.471 
 . . 0.404 
 
 WEIGHT, 
 
 Accurate 
 
 Approximate Equivalent. Equivalent. 
 
 . 151/2 grains, 15.432 
 
 . 0.064 gramme, .... 0.064 
 . 2y. lbs. avoirdupois, . . 2.204 
 % kilogramme, .... 0.453 
 ounce, Troy or apothecary (480 28^/3 grammes, .... 28.349 
 grains), 31 grammes, 31.103 
 
 Unit of Measurement. 
 
 gramme, 
 
 grain, 
 
 kilogramme (1000 grammes), 
 pound avoirdupois, . . . . 
 ounce avoirdupois (437% grains) 
 
 BULK. 
 
 Unit of Measurement. 
 
 Approximate Equivalent. 
 
 1 cubic centimeter 0.06 cubic inch, . 
 
 1 cubic inch, l^y^ cubic centimeters, 
 
 1 liter (1000 cubic centimeters), . 1 IT. S. Standard quart, 
 1 United States quart, ... 1 liter, .... 
 1 fluid ounce 29% cubic centimeters, 
 
 Accurate 
 
 Equivalent. 
 
 0.061 
 
 16.386 
 
 0.946 
 
 1.057 
 
 29.570 
 
INDEX. 
 
 Abbreviations, 8. 
 Abrasion of the teeth, 50. 
 Abscesses, 34. 
 
 Alveolar, 34, 63. 
 of the antrum of Highmore, 62. 
 Absorption of roots, 27. 
 Acetic acid, 130. 
 Acids, antidotes for. 166. 
 burns from, 148. 
 their effect upon the teeth, TA. 
 Aconite, 78. 
 
 Acute inflammation, 30. 
 Adrenalin, 126. 
 Alcohol, 98. 
 Alkalies, 166. 
 
 antidotes for, 106. 
 Alum, 125. 
 
 xVlveolar abscesses, 34. 
 Alveolaris pyorrhoea, 43. 
 Amelloblasts 10. 
 Ammonia, 100. 
 Amyl nitrite, 102. 
 
 Anesthesia, treatment of dangerous 
 dangers of, 85. 
 symptoms in, 95. 
 stages of, 80. 
 Anesthetics, general, 79. 
 
 local, 82, 93. 
 Analgesics, 76. 
 Anatomy of the teeth, 19. 
 Anemia, 29. 
 
 Angel's method of fixation, 59. 
 Anodynes, 76. 
 Anomalies of the teeth, 28. 
 Antacids, 146. 
 Antidotes, 166. 
 Antipyretics, 119. 
 Antipyrine, 119. 
 Antiseptic mouth-washes, 45. 
 Antiseptics, 131. 
 Antizymotics, 131. 
 
 Antrum of Highmore, diseases of, 
 
 62. 
 Apoplexy, 148. 
 Aristol, 137. 
 Arsenic, 112. 
 
 Articulation of the teeth, 23. 
 Artificial palates, 67. 
 respiration, 153. 
 Astringents, 123. 
 Atropine, 78. 
 
 B. 
 
 Bandages, 158. 
 Belladonna, 78. 
 Bicarbonate of soda, 146. 
 Bichloride of mercury, 132. 
 Bites, dog, 167. 
 
 serpent and insect, 169. 
 Bleeding, 161. 
 Blood stasis, 34. 
 Borax, 146. 
 Bromide of ethyl, 91. 
 Bromine, bromides, 75. 
 Bruises, 172. 
 Burns, 148. 
 
 c. 
 
 Calcareous deposits, 69. 
 Calcification of the pulp, 16. 
 
 of the teeth, 13, 15. 
 Campho-phenique, 141. 
 Camphor, 101. 
 Capsicum, 103. 
 Carbolic Acid, 129. 
 Caries in relation to sex, 52. 
 
 of the teeth, 49-55. 
 Caries, relative location of, 55. 
 
 therapeutics of, 56. 
 Catalepsy, 149. 
 Cathartics, 143. 
 
 175 
 
176 
 
 INDEX. 
 
 Caustics, 127. 
 Cementoblasts. 13. 
 Cementum, 13, 14. 
 Chemical irritants, 120. 
 Chloral, 76. 
 Chloride of ethyl, 95. 
 
 of zinc, 114. 
 Chloroform, 86. 
 
 mortality, 87, 88. 
 
 physiological action, S8. 
 
 therapeutic uses of, 87. 
 Choking, 150. 
 Chronic inflammation, 30. 
 Cimicifuga, 109. 
 Cinchona, 106. 
 Cinnamon, 141. 
 Citrate of magnesia, 143. 
 Classification of tue teeth, 19. 20. 
 Cleaning teeth, 72. 
 Cleft palate, 65. 
 Cloves, oil of, 104. 
 Cocaine, 93. 
 Collodion, 145. 
 Congestion, 33. 
 Contusions, 172. 
 Convulsions. 150. 
 
 in teething, 25. 
 Corn ergot, 127. 
 Corrosive sublimate, l'o2. 
 Creasote, 139. 
 Crowns of teeth, 21. 
 Cuts, 171. 
 Cystic tumors, 38. 
 
 D. 
 
 Dangers of anesthesia, 85. 
 Deaths from teething, 25. 
 Deciduous teeth, decalcification of. 
 25. 
 
 germination of, 10, 11. 
 Defects of the palatine organs, 65. 
 Dental Abrasion, 56. 
 
 caries, 49-55. 
 
 relative location of, 55. 
 Dental caries, therapeutics of, 56. 
 
 erosion, 46. 
 
 medicine, 74. 
 
 pathology, 29. 
 
 periostitis, 42. 
 
 pulp, 16, 17. 
 
 therapeutics, 29. 
 
 Dentinal fibrils, 13. 
 Dentine, 14. 
 
 calcification of, 13, 14. 
 
 formations, 40. 
 
 organ, 10. 
 Dentition, 23. 
 
 lesions incident to, 24. 
 
 second, 27. 
 
 third, 28. 
 Denture, permanent, 17. 
 
 temporary, 17. 
 Deposits upon the teeth, 69. 
 Development of teeth, 9, 10. 
 Devitalization of pulp, 39. 
 Digitalis, 108. 
 Disease. 29. 
 
 Diseases of dental pulp and meip- 
 brane, 38. 
 
 of hard dental structure, 49. 
 
 of maxillary bones, 57. 
 Disinfectants, 131. 
 Dislocation of the inferior maxil- 
 lary, 61. 
 
 treatment of, 62. 
 Dislocations, 150. 
 Dover's powders, 77. 
 Drowning, treatment of. 151. 
 Drugs, miscellaneous. 144. 
 
 E. 
 
 Electrozone, 142. 
 Emergencies, 148. 
 Enamel, 9, 14. 
 
 calcification oi, 12. 
 
 formation of. 9, 11. 
 
 organ, 9. 
 Enamelblasts. 10. 
 Epilepsy, treatment of, 155. 
 Epithelium, 9. 
 Epsom salts, 143. 
 Epulis tumors, 33. 
 Ergot. 127. 
 
 Erosion, dental, 46, 4 4'. 
 Eruption of the teeth, 23, 27. 
 Escharotics, 127. 
 Ether, 82. 
 
 action of, 82, 84. 
 
 administration of, 83. 
 
 mortality, 88. 
 
 physiological action, 88. 
 
INDEX. 
 
 177 
 
 Ethyl bromide, 91. 
 
 chloride, 95. 
 Etiology of dental caries, 50. 
 Bucaine hydrochlorate, '"A," Uil 
 Eucalyptus, 109. 
 Eugenol, 104. 
 
 Exhaustion from heat, 155. 
 Exostosis, 47, 48. 
 Exposed pulp, 39. 
 Extraction of teeth, 07. 
 
 hemorrhage following, GO. 
 
 indications justifying, 07, OV. 
 
 F. 
 
 Fainting, 158. 
 
 Ferrum, 111. 
 
 Fistula, 34. 
 
 Follicles of the teeth, 11, 12. 
 
 Foreign bodies in the throat, 150. 
 
 Formalin, 138. 
 
 Formula of permanent teeth, 20. 
 
 of temporary teeth, 19. 
 Fowler's solution, 112, 
 Fractures, 158. 
 
 of alveolar process, 57. 
 
 of maxillae, 57. 
 
 treatment of, 58. 
 Freezing, 160. 
 
 gum before extracting, 95. 
 
 G. 
 
 Gallic acid, 124. 
 Gangrene of the pulp, 42. 
 Gas, administration of, 89. 
 
 liquefied, 90. 
 Gas, mortality of, 91. 
 
 nitrous oxide, 89. 
 Gases, noxious, 170. 
 Gaultheria, 139. 
 Germination of the teeeth, 9. 
 Glacial phosphoric acid, 118. 
 Glycerin, 144. 
 Green stain, 09. 
 
 H. 
 
 Hard dental structure, diseases of, 
 
 49. 
 Heat-stroke, 155. 
 14 
 
 Hemorrhage, IGl. 
 
 after extraction, 09, 103. 
 
 from lungs, 1G4. 
 
 from nose, 162. 
 
 from stomach, 1G3. 
 Hemostatics, 12G. 
 Hutchison teeth, 54. 
 Hydrochloric acid, 118. 
 Hydrogen peroxide, 133. 
 Hydrophobia, 1G7. 
 
 treatment of, x^6. 
 Hypercementosis. 47, 48. 
 Hyperemia, 29. 
 Hypertrophy, 31. 
 
 of the pulp, 40. 
 Hypnotics, 74. 
 
 Incised wounds, 171. 
 Induration, 32. 
 Inflammation, 29. 
 
 acute, 30. 
 
 chronic, 30. 
 
 of the pericemental membrane, 
 42, 43. 
 
 of the pulp, 38. 
 
 of the temporo-maxillary artic- 
 ulation, 61. 
 Injuries and diseases of maxillary- 
 bones, 56. 
 Interdental splints, 58, 59. 
 Interglobular spaces, 14. 
 Intoxication, 164. 
 Iodine, 121. 
 Iodoform, 130. 
 Iron, 111. 
 Irritants, 120. 
 Irritation of pulp, 17. 
 Ischemia, 29. 
 
 L. 
 
 Lacerated wounds, 172. 
 Lancing of gums, 25. 
 Laxatives, 142. 
 Lime Water, 146. 
 Lunar caustic, 128. 
 
 M. 
 
 Magnesia, 143. 
 
 Materials used for splints, 160, 
 
178 
 
 INDEX. 
 
 Maxillary bones, diseases and inju- 
 ries of, 56. 
 Mechanical irritants, 120. 
 Medicine, dental, 74. 
 Membrane, pericemental, 17. 
 Miscellaneous drugs, 144. 
 Monsel's solution, 111. 
 Morphine, 77. 
 Mouth-washes, 56. 
 Mucous deposits, 70. 
 
 effects of, upon the teeth, 70. 
 Myrrh, 103. 
 
 N. 
 
 Naphthol, 140. 
 
 Narcotics, 74. 
 
 Nausea treatment of, 164. 
 
 Necrosis of the jaws, 59. 
 
 Nervous irritants, 121. 
 
 Nitrate of Amyl, 102. 
 
 Nitrate of silver, 128. 
 
 Nitric acid, 117. 
 
 Nitrite of amyl, 102. 
 
 Nitrous oxide as an anesthetic, 89. 
 
 manner of preparation of, 89. 
 
 mode of administering, 70. 
 
 mortality of, 91. 
 Nodular dentine, 41. 
 Nut-galls, 123. 
 Nutrition of the teeth, 18. 
 Nux vomica, 107. 
 
 0. 
 
 Obturators, 68. 
 Occlusion of the teeth, 23. 
 Odontalgia, 56. 
 Odontoblasts, 13. 
 Oil of cloves, 104. 
 
 of eucalyptus, 109. 
 Opium, 77. 
 Organ, dentine, 10. 
 
 enamel, 9. 
 Osteodentine, 41. 
 Oxychloride of zinc, 115. 
 Oxyphosphate of zinc, 115. 
 
 Pain after filling, 40. 
 Palates, artificial, 67. 
 
 I'alatine organs, defects of, 65. 
 Pajiilla, dentinal, 10. 
 Paralysis, 148. 
 Pathology, dental, 29. 
 Peppermint, 105. 
 Pericementitis, 42, 43. 
 Peridental membrane, 17. 
 Permanent denture, 19. 
 
 tooth follicles, 12. 
 Permanganate of potassa, 135. 
 Peroxide of hydrogen, 133. 
 
 of sodium, 135. 
 Persulphate of iron, 11. 
 Peruvian bark, 106. 
 Phenol sodique, 130. 
 Phosphoric acid, 113. 
 Physical effects of anesthesia, 
 
 84, 88. 
 Physiology of the teeth, 14. 
 Pitted teeth, 53. 
 Plethora, 29. 
 Poisons and their antidotes, 165, 
 
 166. 
 Polypus, 40. 
 Prepared chalk, 147. 
 Primary dentition, 23. - 
 Prophylaxis, 56. 
 Proximal surfaces, 5o. 
 Pulp, calcification of, 16. 
 
 devitalization of, 39. 
 
 diseases of, 38. 
 
 exposure of, 39. 
 
 gangrene of, 42. 
 
 hypertrophy of, 40. 
 
 inflammation of, 38. 
 
 irritation of, 17. 
 
 nodules, 41. 
 
 structure of, 16, 17. 
 Pulpitis, 43. 
 Purgatives, 137. 
 Pus and pus formation, 31. 
 Pyorrhoea alveolaris, 43. 
 Pyrozene, 134. 
 
 Quinine, 116. 
 
 R. 
 
 Removal of temporary teeth, 25. 
 Resolution, 31. 
 
INDEX. 
 
 179 
 
 Kespiration, artificial, 153. 
 Resuscitation from drowning, 151. 
 Rhubarb, 143. 
 
 S. 
 
 JSaliva, 70. 
 
 ISalivary calculus, 69, 70. 
 
 composition of, 70. 
 Sandarach, 145. 
 Sanguinary calculus, 72. 
 Scalds, treatment of, 148. 
 Sea-sickness, 169. 
 Second dentition, 27. 
 Secondary dentine, 40. 
 Sedatives, 119. 
 Senna, 143. 
 
 Shedding of temporary teeth, 215. 
 Silver nitrate, 128. 
 Snake bites, 167. 
 Sodium chloride, 105. 
 Sodium peroxide, 135. 
 Splints, 59, 160. 
 Sprains, 169. 
 Staphylorrhaphy, 66. 
 Starvation, 170. 
 Stimulants, 98. 
 Stomalitis, 37. 
 Strangulation, 170. 
 Structure of the pulp, 16. 
 
 of the tfeth, 14. 
 Strychnine, 107. 
 Styptics, 126. 
 Suffocation from gas, 170. 
 Sulphate of iron, 112. 
 
 of magnesia, 143. 
 Sulphuric acid, 116. 
 
 aromatic, 116. 
 Sun-stroke, treatment of, 170. 
 Supernumerary teeth, 28. 
 Suppuration, 31. 
 Surface of teeth, 21, 22. 
 
 T. 
 
 Tannic acid. 123. 
 
 Tartar of salivarj' calculus, 69. 
 Teeth, anatomy of, 19. 
 
 articulation of, 23. 
 
 calcification of, 13, 15. 
 
 cementum of, 14. 
 
 classification of, 19, 20. 
 
 crowns of, 21. 
 
 decalcification of, 25. 
 
 dentine of, 14. 
 
 development of, 9. 
 
 enamel of, 9, 13. 
 
 eruption of, 23, 27. 
 
 extraction of, 67. 
 
 follicles of, 12. 
 
 germination of, 9. 
 
 occlusion of, 23. 
 
 permanent, eruption of, 27. 
 
 primary, eruption of, 23. 
 
 pulp of, 16. 
 
 relative proportion of roots 
 and crowns of, 21. 
 
 structure of, 14. 
 
 supernumerary, 28. 
 
 surfaces of, 21. 
 
 temporary, 23. 
 
 absorption of, 25. 
 Teething, 24. 
 
 convulsions in, 25. 
 
 deaths from, 25. 
 
 treatment during, 25. 
 Temporary denture, 19. 
 Therapeutics, 29. 
 
 of caries, 56. 
 Third dentition. 28. 
 Tonics, 106. 
 Tooth powder, 56. 
 
 pulp, 16. 
 Trichloracetic acid, 131. 
 Tumefaction, 33. 
 Turpentine, 122. 
 
 U. 
 
 Ulceration, 34. 
 
 I'se of tooth-brushes, 56. 
 
180 
 
 IMjEX. 
 
 Vascular tumors, 33. 
 Velum, artificial, 67. 
 Vomiting, to allay, 164. 
 to produce, 165. 
 
 W. 
 
 Weights and measures, 172, 173. 
 
 Wounds, contused, 171. 
 incised, 171. 
 lacerated, 172. 
 
 Z. 
 
 Zinc, 114. 
 
 chloride, 114. 
 oxychloride of, 115. 
 oxyphosphate of, 115. 
 
FOR MEDICAL STUDENTS 
 
 WEBSTER'S DIAGNOSTIC 
 
 M¥J^ np U 1^ -pi Q CHEMICAL. BACTERIOLOGICAL, 
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 the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
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 2002341247 
 
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