V 3«e «£, sr- *Y OF MEDICINE NATIONAL LIBRARY OF MEDICINI 3NOia3w do Aavaan tvnoiivn 3nidiq3w do Aavaan tvnoiivn snidiosw do Aavaan tvnoiivi^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MED*CINf 3NiDia3w do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn 3NiDia3w do Aavaan tvnoiivn NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINI 3NIDIQ3W dO AHVaaiT TVNOIIVN 3NIDIQ3W dO AaVaaiT TVNOUVN 3NIDI03W dO AavaaiT TVNOIIVN NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE aNiDiasw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINI snidicisw jo Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn snioiqsw do Aavaan tvnoiivn /Vl NATIOMAl iJBKAST Of MKIU RARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE ARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION jo Aavaan tvnoiivn SNmasw do Aavaan tvnoiivn snidiosw do Aavaan tvnoiivn snidio /v-n x LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION I / I P jo Aavaan tvnoiivn 3nidiq3w do Aavaan tvnoiivn 3nidio3w do Aavaan tvnoiivn 3nidi< LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION I \ UION / jo Aavaan tvnoiivn 3nioio3w do Aavaan tvnoiivn snioiqsw do Aavaan tvnoiivn snidic o LIBRARY OF MEDICINE ' NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIOf do Aavaan tvnoiivn 3NOia3w do Aavaan tvnoiivn 3nidio3w do Aavaan tvnoiivn snidk IBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIOC I / T TVNOIIVN 3NIDia3W dO AavaaiT TVNOIIVN 3NIDH DENTAL MEDICINE. GORGAS. Standard Works on Dentistry. HARRIS' PRINCIPLES AND PRACTICE OF DENTISTRY. Eleventh Edition. 744 Illustrations and Two Full-page Plates. By Chapin A. Harris, m.d., d.d.s., late President of the Baltimore Dental College, Author of " Dictionary of Medical Terminology and Dental Surgery." Eleventh Edition. Revised and Edited by Ferdi- nand J. S. Gokgas, a.m., m.d., d.d.s., Author of " Dental Medicine," Professor of the Principles of Dental Science, Dental Surgery and Dental Mechanism, in the University of Maryland. With Two Full-page Plates and 744 other Illustrations. 994 pages. 8vo. Cloth, $6.00; Leather, #7.50 HARRIS' DICTIONARY OF MEDICINE AND DENTAL SUR- GERY. Fourth Edition. By the same Author and Editor as the above. A Dictionary of Medical Terminology, Dental Surgery, and the Collateral Sciences. Carefully Revised and Enlarged. Octavo. Cloth, $6.50; Leather, #7.50 TAFT'S OPERATIVE DENTISTRY. Fourth Edition. A Prac- tical Treatise. By Jonathan Taft, d.d.s., Professor of Operative Dentistry in the Ohio College of Dental Surgery. Fourth Revised Edi- tion. With 136 Illustrations. 8vo. Cloth, $4.25 ; Leather, $5.00 RICHARDSON'S MECHANICAL DENTISTRY. Fourth Edi- tion. A Practical Treatise. By Joseph Richardson, m.d., d.d.s., Professor of the Principles of Prosthetic Dentistry in Indiana Dental College, etc. Fourth Edition. Revised and Improved. 8vo. In Press. TOMES' DENTAL ANATOMY. Human and Comparative. By C. S. Tomes, d.d.s. Second Edition. 191 Illustrations. 12010. Cloth, $4.25 TOMES' SYSTEM OF DENTAL SURGERY. Third Edition. By John Tomes, f.r.s. Third Revised Edition. With 263 Illustrations. Jn Press. BARRETT'S HANDBOOK OF DENTAL SURGERY. For Prac- titioners and Students. By Ashley W. Barrett, m.d. Illustrated. i2mo. Cloth, $1.00 GORGAS' DENTAL MEDICINE. Second Edition. A Manual of Dental Materia Medica and Therapeutics. By Ferdinand J. S. Gorgas, a.m., m.d., d.d s. Second Edition. Thoroughly Revised and Enlarged, by about 70 new pages. 8vo. Cloth, $3.25 FLAGG'S PLASTICS AND PLASTIC FILLINGS. By J. Foster Flagg, d.d.s., Professor of Dental Pathology and Therapeutics in the Philadelphia Dental College. Second Edition. Octavo. Cloth, $4.00 LEBER AND ROTTENSTEIN. DENTAL CARIES AND ITS CAUSES. Translated from the German by Thomas H. Chandler, d.d.s., m.d., Professsor of Mechanical Dentistry in the Dental School of Harvard College. Illustrated. 8vo. Paper covers, 75 cts.; Cloth, $1.25 HUNTER'S MECHANICAL DENTISTRY. A Practical Treatise on the Construction of the various kinds of Artificial Dentures, with use- ful Formulae, Tables, Receipts, etc. By Charles Hunter, d d.s. 100 Illustrations. i2mo. Cloth, $1.50 WHITE. THE MOUTH AND THE TEETH. By J. W. White, m.d., d.d.s., Editor of the Dental Cosmos. 121710. Cloth, .50 /6S*" These books may be obtained through any Bookseller or Dental Depot, or, upon receipt of the price we will send, prepaid, to any address. Complete Catalogues of Dental, Medical and Chemical Books, free, upon application. P. BLAKISTON, SON & CO., Medical and Dental Publishers, Philadelphia DENTAL MEDICINE. A MANUAL DENTAL MATERIA MEDICA AND THERAPEUTICS, PRACTITIONERS AND STUDENTS, wxj* FERDINAND J. S. GORGAS, A.M., M.D., D.D.S., »11 Editor of " Harris' Principles and Practice of Dentistry," and " Harris' Diction- ary of Medical Terminology and Dental Surgery," Professor of the Principles of Dental Science, Dental Surgery, etc., in the University of Maryland, Baltimore. SECOND EDITION. REVISED AND ENLARGED. PHILADELPHIA: P. BLAKISTON, SON & CO., No. 1012 Walnut Street. 1885. Y* U Entered according to Act of Congress, in the year 1885, by P. BLAKISTON, SON & CO., In the Office of the Librarian of Congress, at Washington, D. C. PREFACE TO SECOND EDITION. In introducing a second edition of his Dental Medicine, which the rapid sale of the first has necessitated, the author desires to acknowledge, with grateful thanks, the universal favor with which the first edition was received by the dental profession of this and other countries, and also the kind notices, in the form of reviews, from the different dental periodicals. The work has been entirely revised, and many additions and some corrections made, which the author trusts may increase its usefulness, and merit the favor of all interested. Among the additions are, a chapter on Inflammation, with special ref- erence to the Mucous Membrane of the Mouth; a Synopsis of the Treatment, with additions, of Affections of the Oral Cavity; the results of recent investigations into the properties of Anaes- thetic Agents; the Methods of prominent practitioners for the employment of medicinal agents in the treatment of affections for which such agents are specially applicable. To the Dental Materia Medica, such agents as Cocaine, Peroxide of Hydrogen, Iodide of Zinc, Chlorides of certain Metals, Boracic and other Acids, Duquesnel's Aconitine, Papain, Resorcin, Syrup of Lacto-phosphate of Lime, Eugenol, Jamaica Dogwood, Gly- ceroborates of Calcium and Sodium, Napthalin, the Medicinal Oleates, Boroglyceride, Sulphate of Cadmium, Chinoline, Oil of Sanitas, Sulphites of Calcium and Sodium, etc., etc., etc., have been added; also a number of formulae, and an Index to Dental Diseases. FERDINAND J. S. GORGAS. Hamilton Terrace, Baltimore, Md., December ist, /88j. V PREFACE TO THE FIRST EDITION. This work has been prepared by the author in deference to many requests from former pupils, and has been compiled from lectures delivered by him in dental institutions during the past twenty-five years, and notes obtained from the standard works on Materia Medica and Therapeutics, and also from personal experience as a dental practitioner and teacher. While the author claims the credit of the compilation, he does not claim originality in the sources, derivations, medical properties and action of the various articles of dental materia medica which are given in this work. His intention has been to present not alone his own ideas as to the particular application of remedies, but also those of well known and acknowledged authorities, and in such a man- ner as may be of service to the dental student in acquiring a knowledge of this important branch of his profession; hence nothing has been presented in this work that, in the author's opinion, is not applicable to dental practice, and that will not be of benefit to the dental student. The dental formulary comprises many valuable combina- tions, and credit has been given, in every case where it was possible, to the authors of the different preparations. The necessity for an American work of this kind has long been apparent, and after years of delay and promises the author gratefully dedicates this work to his former pupils in the dental institutions with which he has been and is now connected, in the capacity of a teacher. Hamilton Terrace, Baltimore, January, 1884. vi CONTENTS. PAGE Prefaces .......................... v)vi Definition of Subjects....................... 9 Action of Medicinal Substances.................. 9 Inflammation, with Special Reference to Oral Mucous Membrane .... 10 General Remarks......................... 35 Important Points in Diagnosing Affections of the Mouth, with a Synopsis of Treatment........................ 37 Characteristic Indications of the Tongue.......t....... 57 Abbreviations, with Latin and English Terms............. 58 Approximate Measurements.................... 59 Fineness of Powder........................ 60 Weights and Measures...................... 60 Metric or French Decimal System of Weights and Measures...... 61 Rules for Regulating Doses.................... 64 Table of Doses of all Officinal Medicines, Expressed in Terms of Both the Apothecaries' and the Decimal Metric System of Weights and Measures, 67 Poisons—Symptoms and Antidotes................ 78 The Pulse............................ 85 Pulsation per Minute at Various Ages................ 86 Respiration at Various Ages.................... 88 Thermometers.......................... 88 Table of Elementary Substances.................. 90 Table of the Solubility of Chemicals in Water and Alcohol....... 91 Classification of Medicinal Substances................ 94 Definitions of the Various Classes of Medicinal Agents......... 94 Forms in which Medicinal Substances are Employed..........102 vii Viii CONTENTS. PAGE Source, Derivation, Medical Properties and Action, and Therapeutic Uses of Medicinal Substances Employed in Dental Practice; Together with their Dental Uses and Application...............123 Administration of General Anaesthetic Agents.............169 The Dangers of Anaesthesia....................174 Preventive Measures Against the Dangers of Anaesthesia........174 Treatment of Dangerous Symptoms of Anaesthesia...........175 Methods of Resuscitation—Sylvester's Method—Hall's Ready Method . . 176 Local Anaesthesia.........................178 Topical Remedies........................352 The Endermic Method......................353 The Hypodermic Method.....................353 Setons and Issues.........................354 General Bloodletting.......................354 Local Bloodletting by Leeching, Cupping and Scarifications.......354 Periods for the Eruption of the Teeth................356 Electricity as a Therapeutic Means in the Treatment of Disease.....356 Authorities Consulted......................363 Index to Dental Formulary and Dental Diseases...........365 General Index...................... • 371 DENTAL MEDICINE. INTRODUCTION. DEFINITION OF SUBJECTS. Materia Medica is that branch of medical science which refers to and describes the substances known as " medicinal agents," which are employed in the prevention and treatment of disease. Therapeutics is that branch of medical science which com- prises the doctrine of the management of disease. Generally, however, the term is restricted to a description of the modus operandi of medicines, or, in other words, their use and effects when applied in the treatment of various morbid conditions. An accurate knowledge of the principles and rules which govern the administration and action of medicinal substances enables the practitioner to restore disordered functions, and to so impress the organism as to maintain harmonious conditions, by means of which the various functions, in a state of health, are intimately connected by relation and sympathy. Some medicinal agents exert their influence on primary nourishment, converting food, by digestion, into the substance of organic beings, while other remedies, without interfering with digestion, by a modification of the process of assimilation, exert a destructive influence upon the tissues. Some medi- cinal agents affect the nervous system, and others are so irri- tant in their effects as to cause their speedy expulsion ; while others, again, have a particular affinity for certain organs, and are eliminated by them, the effects ceasing as soon as the evacuation is completed. What are known as topical or external remedies act directly upon the parts to which they are applied, and their general effects are produced through the nervous system. 2 9 10 DENTAL MEDICINE. INFLAMMATION : WITH SPECIAL REFERENCE TO ORAL MUCOUS MEMBRANE. Definition of Conditions Associated with Disturbances of Nutrition.—Hyperezmia signifies superabundance of blood in the blood vessels, but this term is restricted to such a condition existing in a definite organ or portion of an organ; hence, hyperaemia and dilatation of blood vessels are so intimately connected that the one cannot exist without the other. It is also necessary that the capillaries as well as the arteries and veins should be injected, in order that the color of the region so affected should be increased, as the former constitute a dense network, which traverses the entire organ, while the latter only form single branches, which occupy limited spaces. The term Plethora, as distinguished from hyperaemia, signifies a superabundance of blood in the entire circulatory system. Active hyperaemia in the skin and mucous membranes is char- acterized by a diffuse bright-red coloration, the parts so affected having a higher temperature than those around them. The diffuse coloration is caused by the bright-red arterial blood which fills the capillaries; and the elevation of the tempera- ture is due to the presence of the blood which heats the skin or mucous membranes, and the more quickly the blood circu- lates the warmer the tissue becomes, until at length the highest degree of blood heat is accomplished. Passive hyperaemia denotes a condition of the tissues char- acterized by a diffuse venous, not arterial, coloration and a relatively low temperature. In passive hyperaemia the capil- laries are also dilated, but the blood current through them is retarded; hence the tissues so affected are of a venous color instead of the bright-red or arterial of active hyperaemia. The term Anezmia signifies a condition in which there is an abnormal diminution in the amount of blood, and is the opposite of that of Plethora, being characterized by a pale face, lips, gums and mucous membranes. But the normal amount of blood may be present, and yet the characteristic paleness denote an anaemic condition, for the reason that the number of INFLAMMATION. 11 red blood corpuscles are decreased and replaced by white blood corpuscles, or by blood plasma. Again, the paleness of an anaemic condition may be due to a deficiency of the red coloring matter of the red blood cor- puscles. A permanent contraction of the blood vessels may also cause a paleness of the face, lips, gums and mucous membranes. The term ischcemia is also employed to denote local poverty of the blood, a deficiency of the coloring matter (haemoglobine). The direct cause of hyperaemia, and also of ischaemia, is a change of calibre of the blood vessels, namely, dilatation and contraction. This dilatation and contraction of the blood vessels is due to the elastic and contractile elements of the sheaths and walls of the arteries and veins, and both the dila- tation and contraction are regulated by the spinal cord, through the medium of the vaso-motor nerves. It is a common opinion that hyperaemia cannot exist without the influence of the vaso- motor nerves. Irritation indicates the condition of a tissue in which there exists an excess of vital action, on account of the disordered state of the nerves of the affected part or organ. It is com- monly manifested by such symptoms as increased circulation, warmth and sensibility, and functional disturbance of a greater or less degree. What inflammation is to the vascular system, irritation is to the nervous system, and the difference between these two con- ditions is defined by the explanation that the latter terminates when the former begins. Irritation is generally excited by the action of certain stimuli upon organic tissues, by which the sensibility of such tissues is perverted and the circulation deranged ; such pathological conditions, when they are not the precursor of inflammation, soon passing off, and the affected tissue regaining its normal state, when the exciting cause ceases to operate. Irritation may be direct and indirect— direct when the irritation manifests itself at the point where the impression to which it owes its origin is received; indirect when the irritation, through sympathy and reflex action, is 12 DENTAL MEDICINE. transmitted to more or less remote parts or organs. An example of direct irritation may be adduced by friction upon the skin or mucous membrane of the mouth sufficient to cause redness in the first tissue, and increased coloration in the second; of indirect irritation, in the convulsions attending difficult dentition, the irritation being communicated to the brain by the fifth pair of nerves, and from thence to the nerves of the voluntary muscles, the seat of the spasmodic action. Dental caries also affords another example of indirect irritation, in the form of neuralgic pains of the temple, face, ear, eye, and of even more remote parts, such as the uterus. The effect of irritation upon the vascular system is mani- fested by dilatation of the blood vessels; but the immediate effect, however, of a slight chemical or mechanical irritant is not at once apparent in the capillaries, but first causes contrac- tion of the smaller arteries, and sometimes of the veins, such contraction being followed by dilatation, the immediate cause of which is yet obscure. It is, however, supposed to be the result of a relaxation or a temporary paralysis of the walls of the vessels, a condition following contraction, and which, as a con- sequence, causes a decrease of their resistance to the pressure of the blood within them. The irritation either perverts the func- tion of the nerves of the vessels, or of the lining cell substance of the capillary walls; or the disturbance is due to reflex action. Inflammation denotes an abnormal process or condition characterized by certain changes of texture, which, although uniform in type, differ widely in appearance, and terminate in different results, according to the nature and permanency of the causes upon which such a condition depends, or which have given rise to it. The symptoms of inflammation consist of the phenomena which accompany the textural changes characteristic of this condition, and its pathology the textural changes which occur during the continuance of this condition. The essential features of inflammation are an increased afflux of blood to the affected part, with a greatly increased tendency to cell proliferation and tissue formation. inflammation. 13 The causes of inflammation determine in a great degree its treatment, on account of the influence they exert upon its destructive tendency, and they may be classified as those arising—1st, from mechanical violence ; 2d, from irritating and destructive chemical action; 3d, from poisonous infection, and the effect of injurious micro-organisms—the latter being regarded as " immediate determining causes of the more de- structive phases of the inflammatory process." When inflam- mation owes its origin to an evident injury, or the reverse, it is termed traumatic, or idiopathic, and when no apparent cause can be discovered it is termed spontaneous. The causes of inflammation are divided into predisposing and exciting. Among the more important predisposing causes are im- poverished blood—defective in quality—such as may result from a want of proper food and of fresh air, the effects of such deprivations being manifested in the case of a neglected child where a hard swelling occurs in the cheek, which, after a few days, presents a gangrenous condition, constituting the disease known as cancrum oris or gangrcznopsis. On the other hand, an habitual excess of food and drink is also a predisposing cause of inflammation, the blood, as a consequence, being im- paired, and also the tissue which it supplies. Blood poisoning is also another predisposing cause, resulting, it may be, from the presence of certain diseases, such as syphilis, diabetes mel- litus, eczema, etc. A local hyperaemia, constituting the first stage in the development of inflammation, may result from certain poisons in the blood, which cause it to stagnate in limited areas, through an inability to stimulate the heart and blood vessels. Syphilitic ulceration of the mucous membrane of the mouth is an example of such a predisposing cause. Weakened vitality of parts is also a predisposing cause of in- flammation, and may result from habitual ill feeding, protracted illness, over work, long exposure to extreme cold. Parts such as the mucous membrane of the mouth, which have already been the seat of inflammation, are prone to such a condition subse- quently, from slight provocation. 14 DENTAL MEDICINE. Defective or perverted nervous supply may also be regarded as a predisposing cause of inflammation. Certain forms of skin disease, and inflammatory conditions of the mucous membrane of the mouth, furnish examples ; also, of the peri- osteum of the teeth, resulting in severe dental periostitis and alveolar abscess. The influence of climate is also regarded as a predisposing cause, for, in tropical regions, inflammations of certain organs, often terminating in abscesses, are very prevalent. The mid- summer and fall months are considered to be more favorable for surgical operations, on account of the comparative absence of inflammatory complications at such times. Age has also some influence as a predisposing cause of inflammation. In childhood, acute hyperaemia is induced by comparatively slight exciting causes, as then the process of nutrition is at its greatest period of activity, and any interrup- tion of this process is followed by derangement of health. The effects of the irritation of first dentition may be adduced as an example. Old age induces weakness in the tissues, and decrease of power of resistance to the exciting causes of inflam- mation. Exciting Causes of Inflammation.—These causes may all be included in the condition known as irritation of the tissues, resulting from irritants of various kinds, the action of which is immediate in producing the inflammatory condition. Ex- citing causes may be divided into external, which are easily recognized, and internal, which are more obscure, and are assisted by some predisposition of the organism. Cold is a frequent cause of inflammation, and its effects are due to sudden changes in the constitution of the blood from an arrest of the function of the tissues, temporary in its nature, which interferes with the emunctory action, whereby effete and irritant materials which should be eliminated are retained, and poison the blood. Heat is also a cause of inflammation, its effects varying from a slight redness, denoting transient hy- peraemia, to vesication, either superficial or deep. When death of tissue results from such a cause, suppuration ensues on the INFLAMMATION. 15 separation of the eschar ; and when there is a loss of cicatricial power, repair by granulation and suppuration (second intention) is prevented. The inflammation resulting from simple burns and scalds, provided no eschar is formed, and air is excluded, soon subsides. Mechanical violence excites inflammation, yet, under favor- able circumstances, this condition resulting from an incised wound, is soon arrested, owing to its benign form, by the par- ticles of lacerated tissue being carried away by the blood and the subsequent liquid exudation, while those that remain undergo liquefaction and absorption by the lymphatics ; hence, when the cut surfaces are brought and retained in proper apposition, speedy union, " by the first intention" results. Union by " first intention " is induced by such changes as cell- proliferation, the formation of new capillaries, and the genera- tion of cicatricial tissue. It is only when the vitality of the tissue is destroyed and foreign matters left in the wound, especially a punctured one, caused by a rough or rusty instru- ment, that there are complications. The tissues themselves, when they lose their vitality, become irritants, even when the dead matter is very minute. A boil furnishes an example, the core of which is composed mainly of yellow, elastic fibres with some leucocytes or pus cells in the meshes. This mass becomes dead, and while the white fibrous element liquefies and mingles with the pus, the yellow fibres remain unchanged and constitute the irritant body, to the presence of which is due the suppurative inflammation. The presence of a clot of blood in a wound may prevent union, and cause pus formation. Chemical irritants excite inflammation by first causing in- creased redness, which steadily extends and becomes more intense until a considerable diameter is attained. There is also increased heat and fullness of the part affected, and an eschar forms as the result of the action of the chemical agent upon the epidermis in the case of the skin, or the corium in the case of mucous membrane, the depth of the action depend- ing upon the nature of the chemical irritant. After one or two days the narrow circle of redness disappears, and, after 16 DENTAL MEDICINE. one or two weeks, the eschar separates, disclosing an area of smooth cicatricial tissue. When the action of such irritants is slight, repair soon follows, without the formation of an eschar ; but when their action is severe enough to devitalize the-tissue, the sloughs are thrown off without suppuration, if the parts have been protected from the air, or antiseptic applications have been made. Mineral irritants, such as mercury and arsenic, for example, cause inflammation by a process different from that of chemi- cal irritants. The inflammatory action of mercury and arse- nious acid is developed only after the poison has entered the circulation, and a certain amount has been received by the stomach, when active inflammation of the mouth with saliva- tion (mercurial stomatitis) supervenes, if the agent is mercury, or active gastric hyperaemia with vomiting, if the agent is arsenic. There is a specific poisonous action brought about by such irritants, on account of the tissues of the mouth and stomach being more sensitive to the influence of these mineral poisons. The cause of this peculiar susceptibility is as yet obscure. Micro-organisms are capable of exciting inflammation by direct contact with tissues, when the latter are exposed by injury. Many of these low forms of life are indestructible by the most extreme heat and cold, and also by the strongest chemi- cal agents. And whenever the oxygen is prevented from entering a wound these micro-organisms generate with great rapidity, and are nourished by the fluids and granulating sur- faces which surround them. The chemical and vital changes which these animal materials undergo bring about putrefac- tion through the agency of fermentation, and certain poison- ous combinations are thus formed. These micro-organisms, therefore, acting as a poison, decompose the materials gener- ated for repair, and thus prevent the constructive process ; they also act as a putrefactive ferment, producing septic poisons destructive in their action. It has been definitely determined that these organisms, although present in every destructive INFLAMMATION. 17 inflammation, " do not occur in the blood nor in the tissues of the healthy living body of man or of the lower animals." Diminished vitality, whatever may be the cause, favors the invasion and development of micro-organisms in the form of parasites. Symptoms of Inflammation.—The coexistence of the phe- nomena, redness and heat, with swelling and pain, the ordinary symptoms of inflammation, may, therefore, be considered as sufficient evidence of the presence of the inflammatory condi- tion. The absence, however, of one or more of these phe- nomena is not incompatible with the existence of inflammation, for the increased redness and heat may disappear before the inflammatory process ceases, and pain be sometimes absent. The redness of an inflamed part is usually the first observ- able phenomenon, and one of the most characteristic symptoms of inflammation, and one also that is rarely absent. It varies in intensity, according to the degree of the inflammatory process, the nature of the part affected, the condition of the system, and the cause of the inflammation. Of a light tint in the early stage, it becomes deeper as the inflammatory process increases in degree, until every grade, almost, of redness is observable, ending in a deep crimson or even purple. It may appear in points, streaks, in minute ramifications, or be quite uniform over the entire surface affected. Usually it is more intense in one spot, gradually fading as it recedes, until lost in the surrounding healthy tissue ; in other cases the redness has an abrupt boundary, and is of equal intensity over its entire area. The brighter hue usually attends ordinary active in- flammation ; the darker hue that form of inflammation pro- ceeding from some specific cause, or associated with a gangre- nous tendency. The redness of inflammation is caused by the increased amount of blood entering the vessels of the part, and remaining there for a longer time than is natural under other conditions. The Heat of an inflamed part is caused by the unusual quantity of red blood present, and also by an increase of that vital action upon which the evolution of heat depends, namely, 18 dental medicine. superoxidation of the affected tissues, resulting in their de- composition. The increase of temperature is generally more sensible to the sufferer than to the observer, though it may often be detected by the hand, and is very evident by the clinical use of the thermometer; it is also verified by compari- son with other unaffected parts. The Swelling of an inflamed tissue is caused in part by the unusual quantity of blood present in the dilated vessels, and also by the matters, both liquid and solid, which exude into the affected tissue through the walls of the dilated vessels, and also to extravasation resulting from rupture of these walls ; for as the vessels are distended their walls become thinner, and permit the blood plasma to escape through them in greater quantity than is required for mere nourishment; hence the inflamed tissue becomes infiltrated with this plasma, the con- sequence of which is an increase of thickness or swelling. The swelling of a part, however, without other symptoms, is not an evidence of inflammation, as this phenomenon may occur from other causes. Swelling may also be absent when the other symptoms of inflammation are present, an example of which is afforded in inflammation of mucous membranes, before exudation has occurred in the connective tissue beneath. The Pain of inflammation is due to the local irritation of the nerves of the part, caused by the irritant which has excited the condition; also by the tension which results, together with the injury inflicted upon the nervous filaments.- Every tissue is supplied with sensory nerves, and the pain resulting from irritation and injury varies considerably, in accordance with the nature of the part and its supply of nervous filaments. Parts having little sensibility in a normal condition, often become extremely painful when inflamed; the gums afford a well marked example. When the parts are unyielding, as in dental periostitis, the pain becomes very severe; and a pulsa- tile or throbbing pain is caused by the increased force of the smaller vessels conveying the blood to the focus of inflamma- tion, and also the obstruction of the circulation produced by the swelling and increased by the stasis at the focus of the inflammation. 19 affected area. When the veins of an inflamed part become obstructed by the swelling, bringing about pressure to such a degree as to prevent the blood from passing through them, the quantity being constantly increased by the supply from the arteries, a condition of strangulation results, in which the pain is very severe. We find an example of this condition of strangulation in pul- pitis, or inflammation of the pulps of the teeth. Pain is also generally present, even in the case of soft tissues affected with inflammation, and where every advantage is afforded for their swelling; the oral mucous membrane is an example. There is also pain of an itching character in certain forms of inflammation of mucous membranes; also boring pain in the neighborhood of joints. The pain of alveolar abscesses, when they slowly form, is often of a tensive character, and generally becomes lanci- nating when they are about to point; and in all such cases is useful in determining the seat of the suppurative process. Fever of Inflammation, also known as " traumatic," is very generally present when the inflammation is severe, or the injury occasioning it is extensive and complicated. This inflammatory fever generally makes its appearance in from twelve to twenty-four hours after the injury is received, or when the inflammatory process is at its height; and when the parts have previously been healthy, and the inflammation limited, it is moderate in its character and soon terminates spontaneously. The symptoms of inflammatory fever are a feeling of fatigue, restlessness, thirst, hot and dry mouth, coated tongue, urine scanty but deeper in color, frequent pulse, temperature about ioo° F.; and the fever usually reaches its climax in about thirty-six hours, when it begins to decline, and by the sixth or seventh day has disappeared. In the case of an abscess, it frequently happens that when suppuration occurs the fever begins to decline. Should the fever continue longer than the time referred to, the cause may generally be due to deeper suppuration and other complications of the local affection. During the inflammatory process, when putres- cent matter has been absorbed by the blood in greater quantity 20 DENTAL MEDICINE. than can be resisted or gotten rid of by the organism, and there is no escape for it by drainage, the symptoms of inflam- matory fever become more intense, and a condition of septic poisoning takes place, known as septicesmia. When some time has elapsed after the inception of the inflammatory process, and the characteristic fever has almost disappeared, a chill suddenlyoccurs, followed by profuse perspiration, the condition known as pyaemia is present—pus globules in the blood. Exudation.—The exudation of materials, such as a phos- phatic, saline fluid, and white blood corpuscles and fibrin, through the capillary vessels, is due to inflammation, and such exudations are derived from the blood. The symptom of swelling is in great part due to exudation. The exudation in what is termed " healthy inflammation," and known as plastic or coagulable lymph, seen on the surface of a recent wound or in the form of swelling around a centre of inflammation, is a mild and unirritating product, the function of which is to form new tissue for repair, called at first granulations. Inflam- matory exudations from free surfaces of mucous membranes contain mucus, and a substance known as mucin, in the form of filaments, insoluble in acetic acid. The inflammatory effu- sion known as plastic or coagulable lymph, the true indicator of a healthy constructive process, is soon converted from a jelly- like substance, by the germinal power, into a mass of living cells, through which other minute cells, which are to form the capillaries, make their way like a small stream, the primitive living cells flattening out and making walls, apparently, for the forming vessels. These new capillaries penetrate the mass of germinal cells in large numbers, like delicate connecting threads, and furnish the blood supply to the organizing mass, which becomes converted into new or young connective tissue. This tissue drawing and binding together the opposite sides of the wound, then becomes the cicatricial tissue, which originates from the cement-like material furnished by the inflammatory exudation. The cicatricial tissue becomes invested, in the case of oral mucous membrane, with epithelium, by a similar process of cell growth and development; and this is the pro- INFLAMMATION. 21 cess of union by the first intention. The cicatrix or scar is redder than natural, owing to the large number of vessels; but when the supply of blood is no longer needed in such quantity as is at first necessary, the capillaries diminish and disappear, so that the cicatrix grows paler and of smaller bulk. In the case of an abrasion of the skin, the exuding plastic lymph dries upon the denuded surface when not disturbed, and forms a protecting crust, which at length falls off, exposing a reddish surface covered with epidermis. In the case of the oral mucous membrane, a like result is produced under the protec- tion of the mucous secretions peculiar to such a tissue. Suppuration.—The formation of pus is a result of destructive inflammation, as the presence of such a fluid denotes a loss of substance, which does not occur when a wound heals by the first intention. Under favorable circumstances an inflamed surface heals by the process of the second intention, as follows: A soft, red surface of coagulable lymph becomes organized into embryonic tissue, which is known as granulation tissue, and the yellowish fluid, bland in nature, which is present is pus; these materials or "products of inflammation" being generated for reparative processes. The granulation tissue is composed of embryonic cells and a network of capillary loops, by which the tissue receives its supply of nutritive matter from the blood, so that it may become what is recognized later as the cicatricial tissue, or one of a higher organism than the granulation tissue. The granulation tissue is of a variable pinkish color, the tint depending upon the quality of the blood which its vessels contain, and is of a jelly-like consistence, and somewhat smooth and firm. Its surface, when in a normal condition, is studded over with small conical prominences called granulations, in which are very minute vessels situated so superficially as to bleed on the slightest touch. Pus of a yellow color is found between the granulations, which vary in size, form and color, a moderately bright-red color being indicative of a healthy healing process. When there is a want of power in the process of forming the cicatricial or repair tissue, the granulations become large 22 DENTAL MEDICINE. and translucent, and the pus which surrounds them is pale and thin. If'the affected surface is exposed to friction, or irritation from other causes, the granulations become extremely small and of a deeper red color than is normal, and at length may disappear at points, leaving grayish spots or smooth patches. If the process of cicatrization is prevented in its first stage, the granulations become large and coalesce, protruding and over- hanging the edges of the wound, and forming what is com- monly known as "proud flesh." During the entire healing process, a flow of pus is going on from the affected surface as a normal act, and the first appearance of it is indicative of repair. Its appearance is also coincident with the organization of plastic lymph. When the suppuration is well established, the heat, tension and swelling of the inflamed part become less in degree, and the frequency of the pulse and the temperature of the body diminish. Whenever the granulating surface is formed, union by the second intention, or second adhesion, as it is termed, will take place, if separated surfaces are brought into apposition. Origin and Characteristics of Pus.—Pus is a secretion fur- nished by the blood at the expense of the tissues, an exuberant quantity of plastic material, for which excess there is no demand in the reparative process. The leucocytes which are brought to the surface of a granulating wound are discharged from it in the form of pus, while those that remain behind develop into tissue. This effect, by which the excess of leu- cocytes is gotten rid of, is accomplished by liquid exudation, the supply of which comes from the newly formed and the old capillaries, and is the same force that carries the nutritive material to the tissues. Healthy pus is of a yellowish-white color, sometimes assuming a pale greenish tint, of cream-like consistence; a slightly saltish taste, but somewhat sweet; a faint animal odor, with an alkaline reaction. The presence of bile may give to pus a deep orange color, while all of the other shades are due to the coloring matter of the blood, known as haematoidine. As long as the air has access to it, there is little tendency to putrefaction; and even when it is INFLAMMATION. 23 removed from the body and exposed to ordinary temperature, change in it occurs very slowly. Pus consists of two portions —a solid portion known as pus corpuscles, and which consists almost entirely of young pus cells or leucocytes, and a liquid portion known as liquor puris, which is a serous fluid, and con- stitutes about three-fourths of its bulk. When pus is subjected to pressure, as sometimes occurs in abscess of the antrum, and about bones, it may become a yellowish, cheesy mass, owing to the compression of the pus cells. The solid portion of'pus consists of more than nine- tenths of leucocytes or young pus cells, which, in freshly formed pus, presents under the microscope a granular appear- ance, and also the peculiar movements of active, young and healthy leucocytes; but pus which has collected in an abscess for several days shows no such movements, thereby indicating that the leucocytes have died. Living and dead pus cells may be found in ordinary pus, mingled together. Pus also contains such micro-organisms as vibrios and bacteria. Varieties of Pus.—The constitution of pus, which is subject to constant change, depends upon the form of the disease, the locality, and the condition of the patient. When it is of a yellowish-white color, of the consistence of cream, and com- posed of a great number of pus globules, it is called " healthy," " pure," or " laudable." ",Sanious," " serous," and " ichorous " pus is almost transparent, of a yellowish, oily, or reddish color, and very acrid, being the product of unhealthy inflam- mation, and is common to caries of the bones, irritable ulcers, etc., and is frequently mixed with blood, particles of fibrin, and dead tissue. In chronic and cold abscesses the pus corpuscles become pale and watery, showing that they are undergoing solution ; the pus from epithelial tumors, indolent ulcers, and phagedenic ulcers, is thin and sanious, and contains more or less dead tissue, which prevents the repair. The term abscess denotes a collection of pus in the substance of the tissues, and the formation of the acute form is as follows : The exciting cause, acting as an irritant, causes an afflux of blood to the centre of the affection, and the distended capilla- 24 DENTAL MEDICINE. ries pour out liquid exudation, which coagulates at this centre into plastic lymph, expanding the meshes of the neighboring surrounding tissues with a more serous fluid. Leucocytes are formed from cell proliferation in the plastic lymph, but, on account of their not being in a proper place for their growth and development into tissue, they become changed into pus, which collects in a cavity formed by it, and the result is an abscess. As these phenomena occur in rather quick succession, pain, heat, redness and swelling are present, and also constitutional disturbance in the form of hectic fever. The increase of an abscess in size is attended with a certain amount of redness on the surface over it and to which it is approaching, this increasing redness being preceded by more or less cedema of the tissue beneath, which is owing to the protruding of the serous exudation surrounding the central collection of pus. The centre of the surface redness then presents a more prominent and elevated point, where the outer tissue becomes thinner, purplish, or livid, and soon the yellow pus within is visible through it—a condition to which the term pointing is applied. Soon after the " pointing," the integument gives way and the pus exudes through the opening thus made. This thinning and weakening of the surface is caused by the stretching and obstruction of the blood vessels, which con- vey the nutritive supply from beneath, by the pressure of the enlarging abscess to such a degree that the surface integument is deprived of its blood and slowly dies by minute particles, the dead material being added to the contents' of the abscess. An abscess unattended with such symptoms as pain, heat, and redness, is termed a cold abscess, and its presence depends upon a low degree of vitality. A cold abscess presents the same phenomena of pus forma- tion as the acute form, but resembles more the growth of a tumor, as all the symptoms may be absent except the swelling. The formation of pus on the surface of a tissue, such as mu- cous membrane, is not so serious as that in an abscess, as the conversion of the leucocytes into pus requires but little more increased activity than in cell germination. The exudation INFLAMMATION. 25 takes place from the network of capillaries which exist beneath every mucous membrane, and which furnishes nourishment for the constant renewal of the epithelium, and any injury re- ceived causes a fluxion of blood to the capillaries, which increases the cell proliferation. The effect is, then, to promote an increased discharge from the surface of the membrane, in the form of pus. Suppuration from mucous membranes usu- ally causes pain, heat, increased redness, and swelling of the inflamed surface, owing to the exudation into the meshes of the connective tissue beneath, and recovery is characterized by diminished fluxion of blood to the affected part, and conse- quent lessening of cell production ; the cells resume their func- tion of producing epithelial tissue, the pus becomes thin and more fluid, and finally ceases when the normal conditions again appear. Hectic fever is a symptom of destructive inflammation, and is a persistent, low form of continued fever, characterized by remission and exacerbation morning and night. This form of fever is caused by absorption into the blood of some of the products of inflammation, in such quantities and so gradually as not to produce an immediate fatal result, and inducing a regular succession of chill, fever, and perspiration during the space of every twenty-four hours. Its effect is progressive emaci- ation and a tendency to fatal termination, if the cause is not removed, through combustion of tissue material to supply the fever heat. The regularity of the night sweats, and the pulse retaining its frequency during the apyrexia, even in the morn- ing, when the temperature is normal, are the diagnostic signs of hectic from typhoid and malarial fevers. The most unfavorable symptoms of hectic fever are the higher fever in the evening, the increase in the frequency of the pulse, the more exhausting night sweats, with the occur- rence of aphthae in the mouth, and diarrhoea. Chronic Inflammation.—Chronic or asthenic inflamma- tion is a process in which all the cardinal symptoms of inflam- mation may be present, but in less degree than in the acute form. In chronic inflammation there is present a permanent 3 26 DENTAL MEDICINE. local hyperaemia, attended with an exudation into the inter- stices of the inflamed part, or from its surface. The pain in this form is "usually slight, or may be intermittent, or even absent, or be no more than an itching sensation; heat is present, but is not a prominent symptom ; the redness is of a light hue, sometimes livid, from passive hyperaemia and the stretching of the vessels by the over distention to which they had before been subjected, and the diminished force of the circulation ; the swelling is in the form of induration, owing to the exudation having become organized into tissue. This latter accounts for the hardness around an indolent ulcer, and an old sinus. Inflammatory induration consists of the new tissue growth in the state of more imperfect organization than 'the normal cicatricial tissue. In mucous membranes indura- tion is indicative of chronic inflammation, and is caused by exudative infiltration into the substance of the submucous con- nective tissue, and a considerable change of structure in these membranes often occurs. Although the symptoms of chronic inflammation are present in a limited degree, yet they are more persistent, on account of the object for which the increased nutritive effort was made proving unsuccessful. Ulceration is a passive process, and results from the molecular death caused by insufficient blood supply, insuffi- cient nervous influence, impure quality of blood, or the presence of blood poison. Ulceration is very closely associ- ated with inflammation, although the former may be independ- ent of the latter, and consists of a progressive softening and disintegration of successive layers of the affected tissue. Ulceration generally begins in a process of chronic inflamma- tion, and in such a manner that the death of the tissues only occurs when the tissues themselves have undergone cellular infiltration in consequence of the inflammatory changes. The loss of the integument leaves a red, raw surface, which bleeds easily, and which is covered with a tenacious, slimy matter. Very soon irregular cavities are formed in this surface, sepa- rated by red elevations with ragged edges. A thin, serous, bloody discharge exudes, with severe pain of a gnawing char- INFLAMMATION. 27 acter. The ulcer thus formed, and which has been defined as " a wound surface having no tendency to heal," spreads more or less rapidly, and the surrounding integument is hot and swollen, and the disintegrated tissue is thrown off as extraneous matter. Ulcers also originate from pustules that fail to heal after the pus escapes, but spread and maintain an acute inflam- matory character. An ulcer may be circular, crescentic, irregular, in the form of a shallow or deep ring, or it may be tubular, forming a fistula. The edges of an ulcer are either low or raised, hard (callous), soft, jagged, vertical, everted, or undermined, etc. Ulcers arising from persistent local irritation, as those of the oral mucous membrane, usually heal as soon as the affected parts are placed under favorable external circumstances. As long as the epithelium is preserved, the superficial inflammatory process in mucous membrane may be called catarrh. When suppuration of mucous membrane proceeds so far as to expose the substantia propria or corium, the diseased surface is known as an ulcer. Effects of Micro-Organisms.—While some of the common parasites cause injurious effects by inciting inflammation in tissues and organs, they only act as foreign bodies, while the microscopic fungi and their germs, acting as invisible particles of organized matter, cause the greatest injury. If they are protected from the influence of oxygen, these micro-organisms germinate very rapidly, and derive their sustenance from the fluids of the inflamed tissue and the granulating surface. The form known as vibrio septica generate putrefaction in animal matter by bringing about a process of fermentation—dental caries affords an example. The chemico-vital changes accom- panying the process of putrefactive fermentation give rise to septic poisons, which, being absorbed into the circulation, result in septicezmia and pycemia. Dr. Koch affirms that "bacteria do not occur in the blood nor in the tissues of the healthy living body, either of man or of the lower animals," and the same investigator also says: " When introduced by inoculation into animal tissues, they multiply and excrete 28 DENTAL MEDICINE. soluble substances, which get into the surrounding tissues by diffusion." The tissues, by the contact of the micrococci, lose their vitality, and the parasitic growth multiplies and spreads rapidly in the dead tissues, advancing directly toward the parts in which vitality yet remains. Terminations of Inflammation.—According to the present knowledge of this subject, inflammation terminates—ist, By Resolution ; 2d, By Formation of New Tissue; 3d, By Gangrene, or Local Death—Necrosis. When the inflammatory process terminates by resolution, all of the symptoms gradually dimin- ish and disappear, and the affected tissues resume their normal condition. Such a result is generally due to the mild character of the injury, and the progress of the inflammation. When the inflammatory process terminates by the formation of new tissue, the new growth is produced by inflammation— either by the union by first intention, or by the development of granulations, which become organized into a cicatrix. When the inflammatory process terminates in gangrene, or local death, the effort of the inflammation toward repair has failed, either on account of the functions of the capillaries and the connective tissue becoming impeded to such a degree as to render inoperative the resources of the organisms, or because of certain conditions arising at a later period which have obstructed the reparative effort and caused the parts to lose their vitality. The termination of the inflammatory process by gangrene depends upon the degree and nature of the lesion, and the inability of the capillaries and arteries to maintain the local circulation. The impairment of the vitality of the blood vessels causes stasis and thrombosis to occur, and as soon as actual death takes place, the dead tissue presents a further: obstacle to the local circulation, and also adds to the difficulty of elimination, which favors the spread of the gangrene. The earliest symptoms of gangrene are hard swelling, burning and tensive pain, and livid color. The pain then subsides, vesica- tions appear, the part takes on a marbled, purplish-yellow INFLAMMATION. 29 color, afterward becoming brown or grayish, and finally cold and insensible, exhaling a putrid odor. Treatment of Inflammation.—It has already been stated that the causes of inflammation determine in a great measure its treatment, and this is especially true of inflammation of the oral mucous membrane. The indications of treatment are as follows:— Prevention and Removal of Cause.—Prevention may include the removal of a predisposing cause when local, or the lessen- ing of its effects when it is general or constitutional. If malaria is present, quinine is indicated; if syphilis, iodide of potassium, or minute doses of bichloride of mercury. Irritation, the precursor of inflammation, may often be arrested by the removal of a local cause, such as salivary calcu- lus, for example. The restoration of the secretion of the different organs is also indicated in the treatment of certain forms of inflammation, and also the use of such palliative remedies as will allay the excitement of the nervous system. When the cause is apparent, its removal is, as a general rule, easily accomplished; but when the cause is obscure, the con- dition of the secretions of the bowels and the diet should receive careful attention. To correct the secretions, purgatives are indispensable; also such other depletory measures as bleeding, abstinence from food, use of emetics or nauseants to lessen the general circulation and reduce the vascular tension. To allay the nervous excitement and irritability, narcotics or opiates are indicated, their direct effect being relief of pain and spasm, and inducement to rest and tranquillity. The advantages of rest and immobility cannot be over esti- mated, for a simple lesion, if subjected to constant mobility, may become one of a much graver character, destructive inflammation often being provoked by friction and undue motion. An example is furnished in the case of dental peri- ostitis, where a cap or partial interdental splint made of model- ing composition or gutta percha, or vulcanized rubber, will protect the affected tooth from irritation, and materially assist the remedial measures; also strips of adhesive plaster, collo- 30 DENTAL MEDICINE. dion, etc., will insure immobility in certain cases where such appliances are indicated, as undue motion retards and prevents the process of healing. Position is also to be considered as a measure for relieving the irritation and pain, so that no provocation may exist for subsequent inflammation. The best position should be selected for the affected part, which will favor the return of venous blood and retard the arterial current; hence, an elevated position will tend to prevent passive hyperaemia. A favorable position will also secure muscular relaxation, and prevent the involuntary spasmodic action, which may result from muscular tension. The administration of an anaesthetic to secure mus- cular relaxation, in the case of certain injuries, as in fracture or dislocation of the jaw, is often resorted to as a measure against spasmodic contraction, and also to reduce the excessive vascular reaction. Cold, when outwardly applied as a depressor to the inflamed part, reduces the excitement and irritability. The application of the spray of absolute ether, or of rhigolene, will often prove serviceable in the early stage of dental periostitis. Cold, whenever moderately applied, is tonic and invigorating, and, besides evaporating applications, ice may be employed; but such local measures to maintain a low temperature must be re- newed at short intervals. Cold, when locally applied, causes the capillaries to contract, thus diminishing the afflux of blood to the affected tissue. The persistent application of cold, how- ever, may cause gangrene; but the employment of the ether or rhigolene spray is attended with less danger in this respect than that of ice applications. A granulating surface, on the other hand, develops better in a warm temperature. Heat and Moisture.—Heat is also, under certain circum- stances, a valuable antiphlogistic. Dry heat will mitigate pain, and heat with moisture, in the form of a poultice, is very com- monly used to relieve the pain and tensive heat of local in- flammation by its soothing and relaxing effect. While cold has an astringent, sedative effect, and constringes the capilla- ries of the inflamed tissue, thus promoting healing by resolu- INFLAMMATION. 31 tion, moist heat is relaxing and promotes exudation, if not suppuration, leading to repair by " the second intention." The use of cold is dispensed with in inflammatory conditions as soon as it is apparent that the termination of the inflammation by resolution is impossible, when resort is had to poultices or warm fomentations, such as flaxseed and slippery-elm bark, to which vaseline, or boracic acid, or a weak solution of carbolic acid may be added, to prevent fermentation in the poultice, and putrefaction in the wound. To relieve pain, tincture of opium may be applied to the surface of the poultice, a water dressing, composed of cloth saturated with warm water or a medicated solution, such as boracic acid or biborate of sodium. The local warm bath is also another method of applying heat and moisture, as the granulations of a surface immersed in tepid water develop favorably; and an ulcerated surface which has been subjected to a prolonged warm bath, made antiseptic by carbolic acid, or the application of an eight per cent, solution of chloride of zinc, is greatly benefited. Warmth and moisture are especially indicated for parts having a feeble circulation. Warm, moist applications, such as poul- tices, promote the tendency to suppuration ; hence, care should be observed in applying such applications to the surface of the face, in the case of an alveolar abscess, as pointing and the escape of pus may be induced in a position where permanent disfigurement would be very apparent. Compression is also of service in the treatment of certain forms of inflammation, especially during the late stages, but it must be uniformly, moderately, and continuously applied. Even in the acute form, compression may prevent the over dis- tention of the capillaries and limit the exudation; in the chronic form, compression promotes absorption. It is accomplished by means of bandages, either alone or in conjunction with cotton batting, as the latter prevents irregular constriction and main- tains a uniform temperature. A fine compressed sponge, moistened, after it is applied, with tepid water, is a painless and effective means for obtaining compression in the treatment of indolent ulcers. Compression by means of sheet lead or tin, 32 DENTAL MEDICINE. and pads of bibulous paper, will often prevent an alveolar abscess from discharging on the surface of the cheek or neck, when such an event is imminent. Bloodletting.—General bloodletting is now rarely employed in the treatment of inflammation ; but the local abstraction of blood by means of leeches, cups, scarification, incisions, and other means, is of great service in reducing vascular action, and lessening inflammatory symptoms. The efficiency of local depletion in relieving hyperaemia is very evident by the cessa- tion of pain caused by strangulation and tension. Dental periostitis and acute gingivitis furnish examples. Leeches should never be applied to a part where it would be difficult to arrest the hemorrhage which may follow their use; their application is also contraindicated in the case of children, who cannot bear the loss of considerable blood with impunity. Incisions are made for the purpose of relieving tension and pain, evacuating pus, or the escape of dead material, for tension aggravates the inflammation, and the retention of pus in an ab- scess prolongs the pain, and also adds to the destruction of parts by the formation of gangrenous patches. Superficial incisions will relieve the tension of the skin and mucous membrane, and also evacuate the pus of an abscess when it is near the surface. Deeper incisions are necessary when the pus is at a greater distance from the surface, and there is considerable tension. Incisions are also often judicious as a prevention of suppura- tion and ulceration; also in cases where the presence of pus is suspected, but there is no apparent fluctuation. In making deep incisions, care is necessary to avoid wounding arteries and nerves ; hence the director should precede the use of the knife. In acute abscesses the incisions should be made at an early stage, and of such a size as will permit of the free evacu- ation of the pus, and in the most depending position, to insure its easy discharge. Hence, as soon as fluctuation is detected in an acute abscess, the incision for the escape of the pus should be made ; while in the case of a chronic or cold abscess, the incision may be delayed, or a puncture with a trocar substi- tuted for it, which may at once be closed. INFLAMMATION. 33 Drainage is employed for the purpose of giving outlet for any matters liable to collect in a wound or abscess which may act as obstacles to the process of repair. Teeth affected with abscess are often relieved and retained by an opening made into the pulp canal or into the abscess sac, sufficiently free to relieve the tension and drain off the accumulated pus; also in the case of abscess of the antrum, where an opening made through the alveolar cavity of one of the roots of a posterior tooth is kept open by means of a canula, to relieve the tension and permit the pus to escape as it accumulates, and also to afford an easy entrance for the injection of antiseptic and stimulating agents in the treatment of such cases. Drainage can also be made through soft tissues, such as the gum, etc., by strands of floss silk, hemp thread, and horse hair, dipped in a carbolic acid solution before they are inserted into the opening connected with the sac; also by means of caoutchouc tubing. Counter-irritants, or " derivatives," are also employed in the treatment of inflammation, for the purpose of inducing an afflux of blood from the locality of the inflammation to another point in close proximity, thus relieving the vessels of the affected part. Such counter-excitement in the case of the oral mucous membrane, is induced by blistering applications, stimu- lants, escharotics, etc., which excite a new action in a part more or less remote from the focus of inflammation. Cantharidal collodion, tincture of iodine, either alone or in combination with aconite, or with creasote, or with carbolic acid, nitrate of silver, nitric acid, and the actual cautery, may be named as the most common counter-irritants for application to the oral mucous membrane in the case of deep-seated inflammation and pulpitis; and are mainly useful in the early stage of the acute form, and in the chronic form. Mouth Washes and Lotions, such as tincture of myrrh, chlorate of potassa, solutions of carbolic acid, listerine, per- manganate of potash, nitrate of silver, sulphate of copper, sulphate of zinc, oxide of zinc, lead water, tincture of opium, etc., are employed with benefit in superficial inflammations and ulcerations of the oral mucous membrane. 34 DENTAL MEDICINE When putrefaction is present in an inflamed part, chlorinous washes are serviceable for deodorizing purposes, and also to prevent the entrance of putrid matter into the circulation. The object of cauterizing an inflamed part is to break the continuity of the morbid process. Anaesthetics, such as chloroform, ether, etc., when employed in the treatment of inflammation, exercise an influence as preventives, and also render lax tissues which become very rigid, and enable reductions to be made, as well as temporarily mitigating the pain ; fracture and dislocation of the jaw are examples. When inflammation has devitalized parts, the treatment varies in respect to the nature of such parts. Dead, soft tissues are to be so treated that the putrid matter is prevented from entering the circulation, by the application of antiseptic agents, which have in a great measure replaced antiphlogistics ; hence, antiseptics which possess the power of destroying micro- organisms without the danger of destroying the vitality of the tissues, are considered to be the most active agents of this class. When the hard tissues are devitalized, such as bone, for example, although the living bone becomes sepa- rated from the dead portion as effectually as a living soft part from its slough, yet it is necessary to liberate the bony seques- trum from the overlying texture which may confine it; hence the removal of dead bone is necessary as soon as the line of demarcation is formed, the time for which may vary from a period of less than three weeks in the case of small sequestra, to more than two months, where the entire bone is involved. Also in cases where the extremity of a part consisting of soft and hard tissues, for example, the alveolar process and tissues over it, become gangrenous, it is best, in most instances, to remove the dead tissues by amputation; and such an operation may also become necessary in cases of long continued ex- haustive suppuration. Many forms of inflammation have their special remedies, such as mercurial inflammation of the mouth, when chlorate of potash is indicated ; dental periostitis, when tincture of iodine and tincture of aconite, or creasote, or INFLAMMATION. 35 carbolic acid, in combination with the iodine, are indicated; gingivitis, where stimulating and antiseptic washes and lotions of tincture of myrrh, biborate of soda, carbolic acid solutions and combinations, etc., are indicated. General Remarks.—In every case, the first object should be to ascertain and, if possible, remove the cause of a disease. It should be remembered that medicinal substances are always more certain in their action when applied directly to the affected tissue; also, that chemical, physical and vital changes result from the topical action of such substances; and that age modifies the effects, and also determines the dose ; also sex, owing to the greater susceptibility of the nervous system in females than in males ; also the temperament, as the sanguine, for example, is more susceptible to the influence of medicinal agents than the phlegmatic ; also habit and mode of life, as the habitual use of such agents as stimulants lessens their influ- ence, and the occupation affects the susceptibility to external influence; also the condition of the body, as different diseases exercise considerable influence on the effects of medicinal sub- stances ; also the mind, as a hopeful mind conduces to the beneficial action of medicines ; also idiosyncrasy, as some indi- viduals are more susceptible to the action or effects of medi- cinal substances than others; also the nature of the tissue or organ to which application is made, as some are more suscep- tible to the effect of medicinal agents than others, owing to rapidity of absorption and the degree of decomposition of the substance employed; also climate, from the recognized influ- ence of climate in modifying the structure and functions of the animal economy, and increasing or diminishing morbid conditions, and by such means influencing the effects of medi- cinal agents. In most acute diseases there is a tendency to recovery after a certain time has elapsed, in case there is no failure in the functions of any of the essential organs ; hence, in all acute diseases, the state of the nervous system should be carefully watched. When the affection is not of a serious character, such symp- 36 DENTAL MEDICINE. toms as are especially troublesome may be relieved ; but when the nervous and vascular systems are affected, both locally and generally, then it is necessary that the proper measures for their relief be promptly taken. Where mucous membrane is the seat of the affection, it is often possible to remove the exciting cause. There are also many inflammatory affections met with, where, from the be- ginning, there is a diminished action of the heart, and a depressed state of the nervous centres. In the treatment of such cases, the depressed condition of the general system chiefly requires attention, as the progress and termination of the local affection depend upon the cause from which it has originated. There are also morbid states not necessarily dependent on organic disease. Various acids are produced by the ferment- ation of substances containing starch or sugar, and there is reason for believing that an increased secretion of acid may take place from the mucous membrane of the stomach and produce symptoms of acidity independently of fermentation, although one of the properties of the gastric fluid is to prevent fermentation. The symptoms of acidity are a sour taste, and the occurrence of acid eructations, often accompanied with heartburn, and sometimes with diarrhoea, and a feeling of sinking at the epigastrium. In these cases the cause must be sought for, and such treat- ment instituted as will neutralize the acidity and stimulate the peptic glands to an increased secretion of the digestive fluid; also such as will regulate the bowels. Due attention must also be given to the diet, which should consist of such sub- stances as will not readily ferment, and all food containing starch should be avoided. Although topical remedies are more generally employed in the treatment of dental affections, yet there are many diseases of the oral cavity which are due to remote causes, and require constitutional as well as local treatment. The appearances presented by the mucous membrane of the mouth are valuable, as indicating the state of other parts more DIAGNOSIS OF MOUTH AFFECTIONS. 37 remote; and it is frequently the case that, when the constitu- tional affection is overcome, the local symptoms disappear as a consequence, or become very amenable to local remedies. IMPORTANT POINTS IN DIAGNOSING AFFECTIONS OF THE MOUTH, WITH A SYNOPSIS OF TREATMENT. The Irritation of Teething is indicated by a hot, swollen and tender condition of the gums, fretfulness, irritable temper, refusal of nourishment, fever and thirst, and, if not relieved, diarrhoea with offensive motions, sometimes a troublesome cough, convulsions, and other serious results. An Abnormal Dentition is indicated by a hot, dry mouth, swollen gums, tense, tender and shining, fever, disordered bowels, fretfulness, eruption on skin, diarrhoea, convulsions. Convulsions of Dentition are indicated by such premonitory symptoms as irritable temper, unusual brightness of eyes, indisposition to eat or sleep, slight involuntary movements of muscles of face or extremities, grinding of teeth. The par- oxysm is indicated by rigidity of body, utterance of a cry, face turning red or purple, veins of neck turgid, suspension of respiration, loss of consciousness, irregular and intermittent contractions of muscles, protrusion of tongue, frothing at lips, distortion of face, rolling of eyeballs, contracted and rapid pulse. Treatment.—For the relief of the premonitory symptoms of dentition, bromide of potassium in doses of gr. iij to v, accord- ing to age, every ten minutes. Demulcent and soothing lotions to the gums. An aperient if no diarrhoea is present. For more decided symptoms, scarification or lancing of the gums. An enema of soap and water to relieve the digestive canal of irritating substances, or the use of the following combination to abate the fever and allay the irritability of stomach and bowels :— &. Potass, bromidi pulv..............,.................... gr.xv Potass, nit. pulv......................................... gr.xij Zinci oxidi................................................ gr.ij. M. Divide in chart. No. vi. Sig.—One powder every four hours, until bedtime. 38 DENTAL MEDICINE. For the diarrhoea: change the diet, adopt hygienic measures; mild purgatives in small doses. For acid dejections, calcined magnesia; or small doses of sulphate of magnesia and tincture of rhubarb; or of pulv. ipecac, pulv. rhubarb and bicarbonate of soda; or castor oil in doses of 5ss. For convulsions : the administration of an anaesthetic to abort or control the spas- modic movements; hydrate of chloral, gr. v to x, according to age, dissolved in two or three drachms of water, and injected into the rectum ; or the administration of bromide of potas- sium ; use of hot foot bath, to which is added a small quantity of mustard; the warm bath ; and when cerebral congestion is threatened, cold applications to the head. Inflammation of the Dental Periosteum is indicated by a sense of uneasiness and fullness, which is at first relieved by pressure, but after active inflammation is established, pressure on the affected tooth causes intense pain, of a dull, heavy, annoying character. The tooth is also protruded, to a slight degree, from the alveolus, and also somewhat loosened, owing to the thickening of the investing membrane ; and the inflammation, which is at first manifested by a red line near the margin of the gum, becomes general over the entire root, sometimes involving the neighboring gum, and even the palate and cheek, and symptoms of febrile disturbance. If not arrested, a sup- purative condition, alveolar abscess, ensues. A modification of the symptoms just enumerated, the tooth being tender to pressure, more or less raised in its cavity, and surrounded by a reddened and swollen gum, with a varying amount of pain, and the discharge of pus from around the neck, or from a fistulous opening in the gum, and such symptoms continuing for a long time, indicate the chronic form of an advanced stage of dental periostitis, which often results from systemic in- fluences. Treatment.—Remove all irritants; apply counter-irritants, such as equal parts of tinct. iodine and tinct. aconite ; or can- tharidal collodion ; or iodine and creasote, or carbolic acid ; or capsicum in form of tincture, or in small bags of the powder to surface of gum over root of affected tooth. Depletion by DIAGNOSIS OF MOUTH AFFECTIONS. 39 the lancet, leeches or cups. Hypodermic injection of morphine, or tinct. of opium. Application of spray of rhigolene or absolute ether until gum is blanched. To relieve pain, a solu- tion of equal parts of tinct. aconite, tinct. opium, and chloro- form ; or lead water and tinct. opium. Constitutional treat- ment : Saline cathartics; bromide of potassium, gr. xxv, combined with gtt. v of tinct. veratrum, every four hours; or bromide of potassium alone, in doses of gr. xxv or xxx. The tooth protected from irritation during treatment, by a cap over adjoining teeth. Alveolar Abscess is first indicated by pain of a constant char- acter, which is afterward aggravated at each pulsation ; then swelling about the root of the affected tooth, which at length becomes defined and prominent, and afterward points and dis- charges pus, when the active symptoms subside. The devel- opment of alveolar abscess is indicated by such constitutional symptoms as foul tongue, offensive breath, hot skin, thirst and headache, and when the suppuration is considerable, symp- tomatic fever and rigors. The characteristic pain of an alveolar abscess is deep-seated and throbbing, and, with the swelling, denotes the formation of pus. A chronic form of alveolar abscess is indicated by a subsidence of the active symptoms, and a continuance of the discharge of small quantities of pus through a fistulous open- ing opposite the root of the affected tooth, or about its neck. An elastic fluctuating swelling in any part of the face, or for some distance down the neck, may result from abscessed teeth. Treatment.—Remove all irritants. Give free vent for the escape of the pus. Destroy sac of abscess by therapeutic treat- ment, or by a surgical operation. Therapeutic treatment: First cleanse the root canal by injections of chloride of sodium; then apply escharotics to destroy the sac, such as creasote, carbolic acid, salicylic acid, nitrate of silver, iodine, dilute aromatic sulphuric acid, to which, in chronic cases, add tinct. of capsicum. The surgical method consists in gaining access to the sac, by means of a bistoury or small trephine, through the fistulous opening, where such exists, and detaching and 40 DENTAL MEDICINE. breaking up the sac by means of suitable nerve instruments, and the application of escharotic agents. Alveolar Abscess about to point Externally is indicated by the skin, for some distance around a central point, becoming red and distended, with a throbbing sensation, succeeded by a change in the appearance of the skin to a thin and scaly surface, from which the epidermis scales off. The integument becomes glued down to the bone around the spot where the pus will ultimately appear; the latter following a fistulous track between the diseased tooth and the surface of the cheek, the fistula remaining open and discharging as long as the inflammatory action continues. Treatment.—Make a free incision in the gum opposite and near the apex of the root of the affected tooth. Apply to the surface at the threatened point of exit of the pus alcohol or spirits of camphor, or paint with collodion, and make gentle pressure by means of a compress of sheet lead or sheet tin, or pads and bandage, to change the direction of the pus. Abscess of the Antrum is indicated by a discharge of pus into the nose, sometimes producing scarcely any discomfort; at other times the severest local and constitutional suffering; an aching pain in the cheek, which is hot, flushed and somewhat swollen ; and as the symptoms increase, greater pain, of a throbbing character, with the rigors and fever peculiar to suppuration ; an expansion of the bone of the upper jaw; an elevation of the malar bone, with a very apparent depression beneath it; the molar teeth on the affected side depressed so as to appear elongated, and to prevent the proper closure of the mouth; an increase of pus; the palate losing its concavity and becoming convex; the nostril of the affected side being encroached upon, and, in protracted cases, the floor of the orbit of the eye so pushed up as to force the eye partly from its socket; the sight affected by the stretching of the optic nerve; the walls of the antrum becoming so thin as to afford evidence of fluid fluctuation on pressure; at length the pus escaping through the cheek, or into the nose, or burrowing along the side of a root of a tooth and discharging into the mouth ; the DIAGNOSIS OF MOUTH AFFECTIONS. 41 floor of the orbit giving way and the pus discharging along the lower eyelid. Treatment.—Make an opening into the antrum, either through the alveolar cavity of one of the roots of a superior first or second molar, or through the process above the roots, with a suitable trephine, and thoroughly wash out the cavity with a warm injection of salt 5j to water Oss, and if there is an offensive odor, syringe with a solution of permanganate of potash ; then dress daily with a solution composed of carbolic acid one part, and oil of sweet almonds fifteen parts, applied on cotton secured in the cavity. If no improvement, then syringe the antrum with a solution consisting of carbolic acid 5j, tinct. iodine 5j, water Sviij. Where a more powerful stimu- lant is required, use an injection of chloride of zinc, gr. x to the ounce of water. For systemic treatment, administer sulphide of calcium in the form of one-tenth of a grain pill three times a day, after meals, doubling the dose if necessary. {Abbott?) Necrosis of the Alveolar Process is indicated by a dark purple and swollen condition of gum, with offensive purulent dis- charge from one or more fistulous openings, or from between the gums and the teeth. The gum becomes soft and spongy, very sensitive, bleeds readily, and loses its connection with the necrosed bone beneath. Treatment.—(See Necrosis of the Jaws.) Phosphor-Necrosis is indicated by pain in jaw, similar to odontalgia, at first not constant, but soon becoming severe, and extending along side of the head, and to the shoulder, with swelling and great tenderness near the seat of the affection, the integument becoming red and tense, the teeth elongated and extremely painful when closed together, and also becoming loose; the gums and mucous membrane of the cheeks swollen and livid; at length, suppuration ensues, with fever, rigors, etc.; gums become spongy, with escape of pus around necks of necrosed teeth, and the pus fetid, and the swelling very great, especially when the lower jaw is affected ; a dense plastic exudation encases the under and external surface of the 4 42 DENTAL MEDICINE. bone; intense glistening redness of the skin, as the pus approaches the surface; at length, intense fever, with delirium and great suffering; the throwing out of a bony deposit of a peculiar appearance, like pumice-stone. Treatment.—Removal of patient from exposure to fumes of phosphorus, and the excision of diseased portion of bone. Fracture of the Alveolar Process is indicated by a swollen, red and painful state of gum and tissues covering maxillary bone, occurring some days after the receipt of the injury, and, if neglected, may result in necrosis of the bone. Treatment.—Antiphlogistic lotions, to reduce the inflamma- tion, such as— R . Plumbi acetatis............................................. gj Tinct opii.................................................... ^ss Aquae........................................................ Jx. M. Sig.—Apply on lint. Remove any detached portions of process, and secure loose teeth. Mercurial Poisoning, or Salivation, when of a mild form, is indicated by a red margin of the gum, which eventually becomes somewhat spongy and tender, with a slight fetor of the breath and a metallic taste. An increased degree of salivation, or mercurial stomatitis, is indicated by a profuse flow of saliva, intense fetor, strong metallic taste, tenderness of the gums, stiffness of the jaws, followed by ulceration and sloughing, if the injudicious use of the mercury is persisted in. Treatment.—Discontinue use of mercury. Chlorate of pot- ash, internally, gr.x, in water Sss ; as a gargle, 5j, to water 5j ; or iodide of potassium in doses of gr.iij, three times a day. To correct fetor of breath, permanganate of potash solution, gr.ij to x, to the ounce of water; or washes of chlorinated soda; astringent washes during convalescence. Loose teeth should not be removed, as they will again become firm. Lead Poisoning is indicated by a blue line upon the edge of the gums, and such constitutional symptoms as paralysis and colic attend severe cases. DIAGNOSIS OF MOUTH AFFECTIONS. 43 Treatment.—Administration of iodide of potassium in gr.iij doses, four times a day, after meals, to eliminate the lead; saline cathartics, electricity, strychnine, etc., for the paralysis, and tonics, such as quinine, to promote the strength, Scurvy is indicated by a general spongy condition of the. gums, and, in severe cases, intense fetor, ulceration and slough- ing, together with constitutional symptoms of an aggravated character. The premonitory symptoms in the mouth are, gums paler than usual, with a slight tumid or everted line on free margins, and slight tenderness on pressure ; breath offen- sive, and a disagreeable taste ; tongue flabby and larger, though clean and pale. Later, the gums become darkened in color, inflamed, swollen, spongy, bleed readily, and finally separate from the teeth. The gums of edentulous jaws do not present these symptoms. At length, the gums present great, fungous, lacerable excrescences, which are prone to suppurate and be- come a brown, fetid mass, with a very offensive odor. The salivary glands become enlarged and swollen; tongue indented by the teeth, which latter become coated with a salivary de- posit, and finally drop out. Necrosis and extensive exfolia- tion of the bones of the jaws may occur. Some varieties of salivary calculus will produce similar local symptoms, especi- ally when the general condition of the system is unfavorable. Treatment.—Change of diet, substituting fresh meats, soups, nitrogenous food, and recent vegetable acids, as citric, tartaric and acetic, and these combined with potassium, either alone or mixed with vinegar, as an antiscorbutic. A Simple Form of Stomatitis is indicated by slightly elevated, reddish, glistening patches on the mucous membrane, which may coalesce, so that the whole surface is involved. Treatment.—Emollient and detergent lotions, such as slip- pery-elm bark, pith of sassafras, or borax, 5j, glycerine, §j, or, borax, 5j, honey, 5iij, or a weak solution of alum, or acetate of lead, gr.iij to the ounce of water. A few doses of bromide of potassium will relieve the nervous excitement. Chlorate of potash lotion, gr.v to the ounce of water, is also efficacious as a local remedy. 44 DENTAL MEDICINE. Ulcerous Stomatitis, common to childhood, is indicated by ulceration commencing on or near the gums, more frequently in the lower than in the upper jaw, and usually on one side only, and spreading over the entire mouth. The gum first becomes thickened and congested, and of a deep purple color, and bleeds readily; ulceration speedily occurs, and exposes the necks of the teeth, and extends to the mucous membrane of the mouth generally, the ulcerated surface being covered with a dirty-white or yellow exudation, leaving exposed numer- ous bright red points on a yellowish ground. The edges of the ulcers are sharp and ragged, and the ulcer, at first super- ficial, becomes gradually deeper. Ulcers of the mouth are often due to syphilis and dyspepsia, and are aggravated by the irritation resulting from the irregular edges of fractured and decayed teeth. When neglected, such ulcers may assume the appearance of epithelioma, especially when induration of the glands beneath the jaw is present. Treatment.—Remove all apparent causes of irritation. Change diet and residence, if at fault, observe cleanliness, administer tonics, as liquor ferri nitratis with tincture of calumba. Local applications of nitrate of silver, gr.j to iij to the ounce of water, or diluted muriatic acid, alternating with a lotion of equal parts of borax and honey, or chloride of lime, 5j, honey, gj. Chlorate of potash internally, in doses of 5ij or iij, and also as a lotion, is efficacious ; also a strong solution of borax, in obstinate cases, gr. xv to the ounce of water; also a solution of sulphate of copper. Ulcers of the Mouth due to Syphilis are indicated when such ulceration is obstinate under any but specific treatment, and when accompanied by symptoms peculiar to syphilis. Treatment.—Constitutional treatment with mercury or iodide of potassium, and such local remedies as are employed in ulcerous stomatitis. Syphilitic Inflammation of the Mucous Membrane of the Mouth is indicated by a general swelling of the gums, with everted and ulcerated margins, exposing the necks of the teeth, although not affecting, to any great degree, their stability, with DIAGNOSIS OF MOUTH AFFECTIONS. 45 a viscid discharge, mixed with blood, from about their necks ; soreness, rendering mastication painful; the affection slowly spreading, until the bone is exposed and a portion exfoliated ; greater degree of congestion; formation of mucous patches on sides of cheeks ; superficial ulcers inside of cheeks and beneath the tongue; erosions of the soft palate and tonsils; fissures at corner of the mouth, and eruptions on skin and scalp. Treatment.—(See Ulcers of the Mouth due to Syphilis.) Gangrenous Stomatitis, common to children during the shed- ding of the temporary teeth, is indicated by a thick swelling of the face; skin tense and shining; swelling becoming hard and circumscribed, but devoid of tenderness, with a central spot, red and variegated in appearance ; the formation of an ulcer, corresponding to the red spot outside, on the inside of the cheek; profuse salivation, the ulcerated part becoming gangrenous, with an opening through the cheek; absence of pain and destruction of parts. Treatment.—Preventive: Pure air, cleanliness, nourishing diet. Sulphate of quinine, internally, in doses of gr. ij to iij ; and as a lotion, sulphate of zinc, 5j to the ounce of water. When the disease is established, the local use of escharotics, as acetic, sulphuric, nitric, hydrochloric acids, nitrate of silver, acid nitrate of mercury, or chloride of antimony, each applied by means of a camel-hair brush to gangrenous part, and at once followed by the application of dry chloride of lime. The mouth to be washed out with tepid water, by means of a syringe. After the separation of the slough, the dry chloride of lime alone may be used. The muriated tincture of iron is also employed ; and after the gangrene is arrested, astringent lotions are efficacious. A Tumor of the Upper Jaw is indicated by a gradually increasing prominence of the cheek, which more or less in- volves the mouth, obstructing the nostril, causing double vision by displacing the eyeball. Treatment.—Removal by a surgical operation. A Malignant Form of Tumor of the Jaws is indicated by a- solid prominence, rapid in growth, and having a tendency 46 DENTAL MEDICINE. to invade surrounding structures, and to fungate like a mush- room. Treatment.—Removal by a surgical operation, and the appli- cation of escharotics, as chromic acid, or chloride of zinc, etc., to prevent its reproduction. A Dentigerous Cyst.—Cysts of the teeth are of two kinds— those connected with the roots of developed or erupted teeth, and those connected with imperfectly developed or unerupted teeth, and both varieties are common to either jaw; the latter, however, are known as " dentigerous cysts." A dentigerous cyst is indicated by the expansion of the bone of the jaw at some particular spot, with disfigurement of the adjacent parts ; a sense of weight and tension in the affected part; in some cases, constitutional irritation from pressure; pressure pro- ducing a parchment-like crackle or crepitation; absence of a tooth, which has never been erupted nor extracted. Heath remarks that " the clinical history of cysts connected with the teeth is that of painless expansion of the alveolus of either jaw, but more frequently of the upper, with crackling of the bone on pressure, and ultimate absorption of the bony wall. The cyst then presents a bluish appearance through the dis- tended mucous membrane, and if large, gives distinct evidence of fluctuation." Treatment.—A free incision, and the removal of the un- erupted tooth by destroying the front wall of the cyst, and the cavity filled with lint, so as to induce granulation and gradual obliteration. In the case of a cyst of the lower jaw, after the removal of the contents and a portion of the wall, the plates of bone should be pressed together as much as is possible. An Unerupted Impacted Tooth is indicated by a hard, bony tumor on the alveolar ridge, sometimes extending along the surface of the palate bone, or the body of the maxilla, and in form corresponding to a tooth, the absence of which is noted. Treatment.—Extraction, by first making an incision through the mucous membrane, and then exposing the tooth by the removal of its bony capsule. DIAGNOSIS OF MOUTH AFFECTIONS. 47 Necrosis of the Jaw is indicated by inflammation like that of dental periostitis in the early stage, but differing as the disease progresses; gum over affected part thickened, tumid and of a red color; pus oozing from the edge of gum, which soon separates from the alveolus, the margins of which become exposed ; loosening and loss of the teeth; the detachment of the dead alveoli from the living bone, and remaining loose in the substance of the thickened gum, surrounded by pus; the escape of the pus into the mouth, or pointing below the chin, or beneath the fascia of the neck, as low, at times, as the clavicle. Treatment.—Remove the dead portions from the living bone. Syringe with tepid water to cleanse the part, and use chlo- rinated washes, such as chloride of soda, or permanganate of potash, to correct the offensive odor and disagreeable taste. Make daily applications of dilute aromatic sulphuric acid, adding to the acid a few drops of the tincture of capsicum for its stimulating effect; diluted carbolic acid, tincture of iodine and chloride of zinc, sulphate of copper and ethereal solution of iodoform, are also used as applications. Support the strength by stimulants, tonics and nourishing diet. Dislocation of the Lower Jaw, when double, is indicated by inability to close the mouth ; the mouth widely open ; the chin prominent, with a distinct hollow in front of each ear. A single dislocation is indicated by the mouth being only par- tially open, the chin displaced to one side, the distinct hollow below the ear being on the opposite side. Treatment.—Reduction is made by placing the thumbs, protected by napkins, as far back upon the molars as possible, and then depressing the back part of the jaw, and at the same time raising the chin. The jaws should afterward be secured by a bandage extending under the chin and over top of head. Fracture of the Lower Jaw is indicated by inability to close the mouth, and to speak articulately; laceration of the gums and hemorrhage; irregularity of the teeth from displacement of the fragments of bone ; crepitation. Fracture of the maxilla may, however, show no displacement, or the fracture extending through the angle or ramus, maybe diagnosed by grasping the 48 DENTAL MEDICINE. two sides of the jaw and moving them forcibly. Crepitus, increased flow of saliva, mobility of fragments, and irregularity of the teeth, if the fracture is through the body of the bone, are all signs of fracture. A swollen, red and painful condition of the tissues covering the lower jaw, occurring some days after the accident, denote the possibility of fracture, neglect causing a high degree of inflammation, and in some cases even necrosis of the bone. Treatment.—Reduce by bringing the displaced portions into apposition, being guided by the arch of the teeth, and then securing them by wire or silk ligatures around the teeth, and introducing an interdental splint. Cleft Palate is indicated by a fissure extending through the soft palate alone, or through both soft and hard palates, and which may be combined with single or double hare-lip, in which case the intermaxillary bones are frequently displaced. Treatment.—When the cleft is confined to the soft palate, the operation of staphylorraphy may be performed ; when, however, the cleft is through both soft and hard palates, the construction of an artificial obturator and palate combined will often prove successful in correcting the voice and prevent- ing much inconvenience in partaking of food and drink. Hare-Lip is indicated by a congenital fissure of the upper lip, and may be single or double, and may also be combined with fissure of the hard and soft palates. Treatment.—Pare the surfaces of the edges of the fissure in such a manner as will allow a flap on one to cover the edge of the other when they are brought in apposition, when they are secured by the aid of pins and the figure-of-eight suture, which, in the case of infants, may be preserved from injury by passing a silver wire through the cheeks, having on each pro- truding end a button, to prevent the breaking up of the suture during the act of crying. Cocaine is a useful local anaesthetic for such operations. Facial Paralysis is indicated by distortion of the face, in which the mouth is drawn to one side, being due to paralysis of the facial nerve. The eye may also remain permanently DIAGNOSIS OF MOUTH AFFECTIONS. 49 open on the affected side, the saliva escape from the corner of the mouth, and the food collect under the cheek, on account of the paralysis of the buccinator muscle. Treatment.—Electricity, and systemic treatment with strych- nine, phosphorus, iron, quinine, ergot, etc. A Nasal Polypus is indicated by more or less obstruction of one or both nostrils, with occasional watery discharge ; a gray or yellowish mass, like jelly in consistence, can be detected by the finger, if it is passed behind the soft palate, hanging down into the pharynx, and which greatly increases in damp weather; the nose bulged out on one side by the growth within. Treatment.—Remove either by the snare or by torsion, or by repeated applications of chromic acid. To prevent reproduc- tion, apply to the surface chromic acid or chloride of zinc. Thrush, common to infants and children under eighteen months of age, is indicated by small, white spots, the size of a pin's head, upon the dorsal surface of the tongue, palate, velum, inside of cheek and lips, which increase in size and coalesce, with a tendency to form false membrane, the crusts falling off and reappearing; the mucous membrane beneath redder than natural. Treatment.—Change of diet and residence, if these are at fault; the administration of saccharate of lime in milk. Local treatment, mel-boracis, or borax solution, or— R. Sodiiborat................................................... ^j Glycerinse.................................................. gij Aquae ........................................................ .^iv. M. SiG.—Apply with a camel's-hair brush four or five times a day. Or— R. Zinc sulph.................................................. gr.ij-iv Aquae rosa?................................................. ^ij. M. Or a weak solution of nitrate of silver. Aphthce or Follicular Ulceration, common to childhood, is indicated by the mucous membrane becoming inflamed, and the formation of small, round, transparent vesicles on the fraenum, in the sulcus between the lips and gums, and lower 50 DENTAL MEDICINE. surface of tongue. On the bursting of the vesicles, small, spreading ulcers, with red and swollen margins, appear, which become coated with a layer of o'idium albicans. Treatment.—Demulcent applications, such as mucilage of gum acacia, or flaxseed. Mel-boracis applied with a camel's- hair brush. For constitutional symptoms, administer laxatives and the bromides, with warm foot bath. Epulis is indicated by a growth on the gums, either small and pedunculated, or large and sessile. If it is firm in texture and slow of growth, the epulis is generally fibrous; but if rapid in growth and dark in color it is myeloid; if prone to ulcerate and very painful, it may be an epithelioma. Treatment.—Removal of the growth, and its reproduction prevented by the application of nitrate of silver, or chromic acid, or a fire cautery. Generally, it is necessary to remove the periosteum and a thin scale of the bone beneath, as this growth is connected with the periosteum. Extract all roots of carious teeth, and when the epulis is connected with the alve- olar cavity of a tooth and has a tendency to the interior of the jaw, it is generally myeloid, and several teeth will have to be sacrificed, so that the alveolus can be thoroughly excavated. When very extensive, a considerable portion of the alveolus and bone of the jaw must be removed. Epithelioma is indicated by a ragged ulcer on the lower lip, commencing as a wart, the skin around being hard and infil- trated, with enlargement of the submaxillary lymphatic glands, which become tender, or even ulcerated. Epithelioma of the gum is in the form of a ragged ulcera- tion, often the result of irritation from diseased teeth ; the pain and inconvenience at first slight; a tending of the ulceration to spread toward the tongue and cheek, with induration of the base of the ulcer. Treatment.—Removal as soon as its nature is manifest. In slight or doubtful cases the application of the strongest nitric acid, the acid nitrate of mercury, or the actual cautery, to bring about healthy cicatrization. If the disease has involved DIAGNOSIS OF MOUTH AFFECTIONS. 51 the alveolus, as is evident by the swelling of the gum and the looseness of the teeth, a free removal of the bone is necessary. Hypertrophy of the Gums is indicated by an increase of their substance to such a degree as to cause them to overhang and cover the greater portion of the crowns of the teeth ; tendency to hemorrhage; gums dark and livid; fetor of breath ; increased flow of saliva. Treatment.—Remove all dead teeth and salivary calculus. Remove the morbid growth by a horizontal incision through the diseased structure to the crowns of the teeth, and freely scarify the gums by passing a lancet between the teeth to the process, and repeat this operation at intervals of four or five days, if necessary. Use detergent and astringent lotions, and occasionally a weak solution of nitrate of silver. Phenate of soda is efficacious as a lotion. Diet non-irritating, and all ex- cess and intemperance avoided. The teeth should be kept perfectly clean. Alveolar Pyorrhosa, or Rigg's Disease, is indicated at first by an uneasy sensation; then inflammation of margins of gums ; looseness of the gums about the teeth, which form pockets; and necrosis of edges of alveolar processes ; a tendency to hemor- rhage ; inflammation extending deeper into gums ; small sulci filled with pus ; looseness of the teeth and change of positions ; disagreeable taste ; peculiar fetor of breath; dark livid color of gums, with thick margins, and often extreme sensitiveness to touch ; in some cases the gums are denuded of their epithe- lium, with a polished appearance, in others, with a pimpled surface; the teeth, at length, held in their cavities by a tough, ligamentous attachment, due to the change occurring in the periosteum. A simple form of this disease may manifest itself at the margin of the gum, indicating its presence by a congested appearance, beneath which may be found a granule of calcified material. While in many cases there is general congestion of the affected gum, and a proneness to hemorrhage, in other cases the gum may present an anaemic appearance—pale and bloodless. This disease may also be associated with syphilis, 52 DENTAL MEDICINE. mercurial salivation and scurvy. The deposit of salivary cal- culus and calcified substance is supposed to be secondary to the disease, as a deep-red and denuded gum tissue about the necks of the teeth may be present without any deposit. Treatment.—The first and most important matter is to remove all deposits from the roots of the teeth, and all necrosed bone from the margins of the alveolar processes. This can be accomplished with what are known as Riggs' instruments. An acquired and acute sense of touch is necessary to determine the thoroughness of the cleansing operation. The pockets formed in the gum may then be treated with iodoform and eucalyptus, iodoform and oil of cinnamon, or with injections of chloride of alumina, gr. iij to the ounce of water. Peroxide of hydrogen, and also a solution of iodide of zinc, gr. xii-xiv to the ounce of water, are also recommended by Dr. Harlan, in the form of injections; and for chronic cases the latter in a solution composed of gr. xxiv to the ounce of water, after the parts are cleansed by injections of the peroxide of hydrogen. Irritation of the Dental Pulp is indicated by an uneasy sensa- tion, which develops into pain of a gnawing or boring character, the affected tooth being sensitive to changes of temperature, painful in mastication, but exhibiting no symptoms of inflam- mation of the gum or periosteum. Treatment.—The treatment must vary with the condition producing the affection. First remove all irritants. If the cause is systemic, constitutional treatment for the condition present is indicated. Saline cathartics, as the sulphate or carbonate of magnesia; diaphoretics, as spts. mindererus, or Dover's powder; diuretics, as preparations of nitre, often prove efficacious; also bromide of potassium. If the fluids of the mouth are irritative, they must be corrected. If a carious cavity exists, all foreign substances and the softer parts of carious dentine should be removed, and the cavity syringed with a tepid solution of bicarbonate of soda, potash or am- monia. Dilute carbolic acid, or wood creasote, may then be applied, and a non-conducting filling of a solution of gutta percha and chloroform be introduced. DIAGNOSIS OF MOUTH AFFECTIONS. 53 Acute Inflammation of the Dental Pulp is indicated by acute pain in the affected tooth, which frequently extends to neigh- boring teeth and to the side of the face, but is more intense in the tooth itself; pain may subside after a few hours' duration, to return again on the slightest provocation, or on patient assuming a horizontal position; the pain may also assume a throbbing character. Treatment.—The treatment of this condition of pulp is indi- cated in that of " irritation of the pulp." For soothing appli- cations, solution of gutta percha and chloroform, tincture of hamamelis applied warm, oil of cloves, dilute creasote, equal parts of chloroform, aconite and tincture of opium, may be employed. Chronic Inflammation of the Dental Pulp is indicated by pain, less severe than in the acute form, and of less duration ; coming on at irregular intervals, and wandering, like neuralgic pains, and incited by changes of temperature, and the application of irritants. (See Irritation of Dental Pulp.) Fungous Growth of Pulp is indicated by the organ, as a result of continued irritation, assuming the form of a small vascular tumor, or granular mass, attached by means of a pedicle, which, in some cases, completely fills the cavity of decay in the crown of the tooth, and is often extremely sensitive and prone to hemorrhage. Treatment.—When a tendency to fungous growth is dis- covered, the free application of carbolic acid or tincture of aconite, followed by the use of chromic acid, will obtund the sensibility, when the entire tumor should be excised, and its reproduction prevented by application of nitric acid on a disc of card board. Ossification of the Dental Pulp is indicated by pain of a neuralgic character, which commences in an uneasy feeling, and changes to what has been described as a gnawing sensa- tion, similar to that which attends the knitting together of the fractured parts of a bone. It may be continuous, but not constantly severe, and frequently amounts to no more than an uneasy sensation; at other times it may be sharp and darting, 54 DENTAL MEDICINE. affecting the side of the head, and all the branches of the supe- rior maxillary division of the fifth pair of nerves. The affected tooth is free from soreness and discoloration. Treatment.—Apply anodynes, such as lead water, and those indicated in "acute inflammation of pulp, to relieve the pain. Open the pulp chamber, and completely extirpate the pulp. Abnormal Sensibility of Dentine is indicated by pain resulting from irritation of dentinal structure, being of shorter duration and less acute in character than that from an inflamed dental pulp; the pain of sensitive dentine soon subsides on the removal of the irritating cause. Treatment.—Apply obtunding agents, as chloride of zinc, chloroform and aconite equal parts, carvacrol, oil of cloves, oil of cedar, oil of eucalyptus, tannin combined with glycerine or camphor, chloral, camphorized ether, oxide of calcium, car- bonate of sodium, menthol, thymol, sesquichloride of chro- mium, sulphate of morphine and gum camphor equal parts, ethylate of sodium, carbonate of potash and glycerine, carbol- ized potash. Atrophy of the Teeth is indicated by certain structural defects in the enamel, in the form of opaque spots or pits. Treatment.—For the pitting variety, properly inserted fillings of a durable material. Abrasion of the Teeth is indicated by a loss of structure, due to friction, to such an extent at times as to destroy the entire crowns. Treatment.—Gold caps or partial crowns, either in the form of ferrules or contour fillings, or fillings of other metals, will often arrest the process of abrasion, and render much worn teeth useful organs. Also the insertion of artificial posterior teeth will often prevent natural front teeth from being abraded from unnatural use. Hypertrophy of the Alveolar Processes is indicated by an osseous deposit, either at the apex of the alveolar cavity, in which case the affected tooth is protruded from its cavity, or by a deposit of osseous matter on the wall of the alveolar cavity, in which case the tooth is forced to one side. DIAGNOSIS OF MOUTH AFFECTIONS. 55 Treatment.—When the osseous deposit is in the bottom of the alveolar cavity, the length of the tooth may be reduced from time to time until a certain degree is reached, when the loss of the tooth is inevitable. When the deposit is upon the side of the cavity, the effect is irregularity or malposition, for which there is often no remedy but the removal of the devi- ating tooth. Dental Exostosis is indicated by an uneasy sensation in the affected tooth, followed by a gnawing pain, which, in some cases, assumes a severe neuralgic character, especially when the deposit of cementum on the root is of considerable size, in which case there is a prominence apparent on the side of the alveolar ridge. Treatment.—During the early stage of this affection, the administration of large doses of iodide of potassium, and the application of counter-irritants, such as a saturated tincture of iodine or cantharidal collodion, have been suggested, to arrest the deposit and cause absorption. When the deposit is large and productive of pain and inconvenience, the removal of the affected tooth is inevitable. Odontomes are indicated by irregular masses of dental tissues, which result from morbid conditions of the formative pulp, such as nodules of enamel and dentine, hypertrophy of cementum, 'etc., some being congenital, others induced. Treatment.—Extraction, when they are a source of irritation, or an injury to the normal teeth. Syphilitic Teeth are indicated by notches, generally crescentic, in the cutting edges of the incisors, and peg-like shaped cus- pids ; also, a dark color and soft consistence are characteristic of such teeth. Treatment.—The most skillful treatment is necessary for their preservation. Denuding of the Teeth is indicated by the gradual de- struction of the enamel of the labial surfaces of the in- cisors, canines, and sometimes of the bicuspids, generally in the form of a continuous horizontal groove, smooth and regular; in some cases it may extend over nearly the whole 56 DENTAL MEDICINE. of the labial surface, the color of the enamel being rarely changed. Treatment.—In advanced stages, arrest its progress by fill- ings of a durable material. Absorption of Process and Recession of Gum is indicated by a slight increase of redness, some congestion and a shrinkage of the margins of the gums, and may be accompanied with a slight purulent discharge about the neck of affected tooth. The symptoms resemble those of chronic inflammation of the gums. The progress of the affection is generally slow, and is often first observed about the necks of the canine teeth. Teeth so affected become more susceptible to impressions of heat, cold, acids, etc., and eventually loose. Treatment.—To arrest the progress of this affection, first remove all irritants, and cleanse thoroughly, polishing the exposed surfaces. Correct the nature of the fluids of the motu:h, if at fault, by constitutional treatment, the use of alkaline lotions, such as lime water, and detergent dentifrices. Such agents as a weak solution of chloride of zinc, to produce healthy granulation, carbolic acid, nitrate of silver, and judi- cious pressure, may be employed with advantage. A moder- ately stiff brush and floss silk are useful adjuncts to the treatment. Necrosed Teeth.—The term " necrosed " is applied to a tooth . when the vitality of its pulp and lining membrane.is destroyed, the peridental membrane, however, maintaining a degree of vitality which prevents the tooth from becoming an irritant, so as to ensure its loss as an effete organ. Treatment.—When a necrosed tooth is not productive of injury to the adjacent structures, and there is a probability of rendering it a useful organ, the pulp canal should be thoroughly exposed, cleansed, and treated, if necessary, with deodorizers, disinfectants, etc., and then filled, together with the crown cavity, with a suitable material. As necrosed teeth are fre- quently considerably discolored, on account of the tubuli of the dentine absorbing coloring matter from the dead pulp, such bleaching agents as chloride of lime, chloride of alumina, CHARACTERISTIC INDICATIONS OF THE TONGUE. 57 oxalic acid, chloride of soda, sulphite of soda combined with boracic acid, cyanide of potassium, tartaric acid in combination with chloride of lime, chloride of zinc, also alum in combina- tion with liq. sodae chlorinatae, may be employed, to improve their appearance. Dental Caries is indicated by a process of gradual softening and disintegration of the tooth tissues by deleterious agents, the progress being hastened, primarily, by certain structural defects in the enamel and dentine, and secondarily, by certain diseases of the mucous membrane, and some derangement of the general health. Incipient dental caries is indicated by an opaque, whitish or gray appearance of the enamel. A pale brown varying to a nearly black color indicates the existence and progress of dental caries in the tooth tissues; the deeper the color the slower the progress of the caries, and the paler the color the more rapid the progress. Treatment.—Incipient caries should be removed with great care, and the exposed surface of tooth structure prepared to resist further attacks by giving to it as high a polish as is pos- sible, and the patient warned in regard to its future cleanliness. Deep-seated caries should be removed, and its further progress arrested by well inserted fillings of a durable material. CHARACTERISTIC INDICATIONS OF THE TONGUE. A White Coated Tongue indicates febrile disturbance. A Brown Moist Tongue indicates digestive disorder and an overloaded stomach. A Brown Dry Tongue indicates depressed vital power. A Red Moist Tongue indicates feebleness, especially from exhaustive discharges. A Red Dry Tongue indicates inflammatory fever or pyrexia. A Red Glazed Tongue indicates debility and inability to digest food and stimulants. A Tremulous, Moist and Flabby Tongue indicates feebleness and nervousness. A Glazed Bluish Tongue, with loss of epithelium in patches, and in severe cases, cracks and scars, indicates tertiary syphilis. 5 58 DENTAL MEDICINE. ABBREVIATIONS. In medical prescriptions, letters, parts of words, or certain symbols, are employed as abbreviations, to designate the sub- stance, quantity, etc., as follows :— ABBREVIATION. LATIN WORD. ENGLISH WORD. aa, Ana (G.), Of each. Ad saturand., Ad saturandum, Until saturated. Ad lib., Ad libitum, At pleasure. Aq., Aqua, Water. Aq. tepid, Aqua tepida, Warm water. Aq. ferv., Aqua fervens, Hot water. Aq. dest., Aqua destillata, Distilled water. C. or Cong., Congius, A gallon. Chart., Chartula, A small paper. Coch., Cochlear, A spoonful. Coch. mag., Cochlear magnum, A tablespoonful. Coch. parv., Cochlear parvum, A teaspoonful. Colent., Colentur, Let them be strained. Collyr., Collyrium, An eye-water. Comp., Compositus, Compound. Contus., Contusus, Bruised or broken. Cort., Cortex, Bark. Ext., Extractum, An extract. F. or Ft., Fiat vel fiant, Let there be made. Fol., Folium vel folia, A leaf or leaves. Garg., Gargarysma, A gargle. Gr., Granum vel grana, A grain or grains. Gtt., Gutta vel guttae, A drop or drops. Haust., Haustus, A draught. Infus., Infusum, An infusion. M., Misce, Mix. Mass., Massa, A mass. Mist., Mistura, A mixture. o., Octarius, A pint. Pil., Pilula vel pilulae, A pill or pills. Pulv., Pulvis vel pulveres, A powder or powders. q. s., Quantum sufficit, A sufficient quantity. R., Recipe, Take. Rad., Radix, A root. s., Signa, Write or give directions. Spts., Spiritus, Spirits. ss., Semis, The half. ABBREVIATIONS FOR PRESCRIPTIONS. 59 ABBREVIATION. LATIN WORD. ENGLISH WORD. Syr., Syrupus, Syrup. Tinct., Tinctura, A tincture. ft), Libra, A pound. 3. Uncia, An ounce. 3> Drachma, A drachm. 9. Scrupulus, A scruple. fS. Fluiduncia, A fluid ounce. (3, Fluidrachma, A fluid drachm. *l. Minim, A drop. Although the symbol (ti\,) is adopted in the United States Pharmacopoeia to designate a drop, it should be remembered that the size of a drop varies according to the greater or less fluidity and gravity of the liquid, and the shape of the mouth of the bottle from which it is dropped. It is best to use a small vial with a thin edge of mouth, when great precision is necessary, and to dilute the active medicine and administer it in the form of a mixture; for in some preparations, one hundred and fifty drops would measure but a fluidrachm, while in others the same number of drops would be somewhat more than three fluidrachms. A tablespoonful of any liquid is regarded as equal to half an ounce by measure; and a teaspoonful equal to a fluidrachm; and such measures are sufficiently accurate where no great precision is requisite. A gallon contains eight pints. A pint contains sixteen fluidounces. A fluidounce contains eight fluidrachms. A fluidrachm contains sixty minims (n\). A wine glass (approximate measurement) contains two fluid- ounces. A teacup (approximate measurement) contains four fluid- ounces. A tablespoon of powder (approximate measurement) contains two drachms. A teaspoon of powder (approximate measurement) contains one-half drachm. 60 DENTAL MEDICINE. One drop of water (small drop, approximate measurement) contains one minim. One drop of essential oils (approximate measurement) con- tains one-half minim. A graduated measure glass is the most accurate measure, as spoons, glasses, etc., vary greatly in size. FINENESS OF POWDER. The fineness of powder is denoted either by descriptive words (as in the case of brittle or easily pulverizable sub- stances), or in terms expressing the number of meshes to a linear inch in the sieve. The following degrees of fineness will prove serviceable in the preparation of dentifrices, polishing powders, etc.:— (Should pass through a"| A very fine powder . . \ sieve having 80 or more y=No. 80 Powder. ■^ (_ meshes to linear inch. J ( Should pass through a~| . A fine powder .... \ sieve having 60 meshes V=No. oo Powder. J r C t0 tne linear inch. ) f Should pass through a"] A moderately fine powder ^ sieve having50 meshes v=No. 50 Powder. •* J x (_ to the linear inch. ) J f Should pass through sC\ A moderately coarse powders sieve having 40 meshes y=No. 40 Powder. (.to the linear inch. ) ("Should pass through a~| A coarse powder . . . \ sieve having 20 meshes ^=No. 20 Powder. C to the linear inch. ) WEIGHTS AND MEASURES. APOTHECARIES' WEIGHT. 20 grains (gr.) make I scruple........................................ sc. or ^ 3 scruples make I drachm........................................ dr. or z 8 drachms make I ounce.......................................... oz. or 2 12 ounces make i pound......................................... lb. or lb SCALE OF COMPARISON. ft). oz. dr. sc. gr- I = = 12 96 = 288 = 5760 I = 8 — 24 = 480 1 = 3 1 = 60 20 WEIGHTS AND MEASURES. 61 TROY WEIGHT. 24 grains (gr.) make 1 pennyweight.................................... dwt. 20 pennyweights make 1 ounce................ ........................... oz. 12 ounces make 1 pound............................................ lb. 3)4. grains make I carat (diamond weight)..................... k. SCALE OF COMPARISON. lb. oz. dwt. gr. I = 12 = 24O = 5760 I = 20 = 480 I = 24 1 k. = 3y2 AVOIRDUPOIS WEIGHT. 16 drachms (dr.) make 1 ounce..........................•................ oz. 16 ounces make 1 pound......................................... lb. 25 pounds make 1 quarter....................................... qr. 4 quarters make 1 hundredweight ............................. cwt. 20 hundredweight make I ton............................................. T. 100 pounds make 1 cental.......................................... C. SCALE OF COMPARISON. T. cwt. qr. lb. oz. dr. I = 20 =. 80 = 2000 = 32000 = 512000 1=4= 100 = 4000 = 25600 1 = 25 — 400 = 6400 1 = 16 = 256 1 = 16 THE METRIC OR FRENCH DECIMAL SYSTEM OF WEIGHTS AND MEASURES. The metric system is based upon the meter, which is the standard unit of length of that system, and equal to 39.370432 inches, or about 10 per cent, longer than the yard. The metric unit of fluid measure is the* liter—the cube of tV meter, or 1000 cubic-centimeters—equal to about 34 fluid ounces. The metric unit of weight is the gram, which represents the weight of one cubic-centimeter of water as its maximum density. It is equal to 15(43234874) troy grains. One cubic-centimeter is equal to 16.231 minims. In writing prescriptions it is sufficiently accurate and safe to. consider i gram as exactly equal to i 5 troy 62 DENTAL MEDICINE. GRAINS, AND TO CONSIDER I CUBIC-CENTIMETER AS EQUAL TO 15 MINIMS. We accordingly have— I gram equal to " tr°y grains. I troy grain equal to -fV gram. I cubic-centimeter equal to \ fluid drachm. i fluid drachm equal to f cubic-centimeter. Hence— I. TO CONVERT TROY GRAINS INTO GRAMS, OR MINIMS INTO CUBIC-CENTIMETERS— a. Divide by 10, and from the quotient subtract one-third; or, b. Divide by 15 ; .and 2. To CONVERT APOTHECARIES' DRACHMS INTO GRAMS, OR FLUIDRACHMS INTO CUBIC-CENTIMETERS, multiply by /J.. In writing prescriptions, the " gram " (abbreviated " Gm.") and "cubic-centimeter," (abbreviated "C.C.," which may be called " fluigram," and written "fGm") only, should be used. The centigram, which is a very convenient unit to refer to in medicine and pharmacy, is used in books and in speaking, but not in writing prescriptions. All other terms, and units, and prefixes, used in the metric system, may be wholly ignored by the physician and the phar- macist.* EXAMPLE OF A METRIC PRESCRIPTION. J&. Hydrarg. chloridi. corros.........'.............. o 1 25 Gm. Potassi iodidi....................................... 10 00 Gm. Aquae................................................ 100 00 C.C. Tinct. cinch, comp.................................. 100 00 C.C. Mix. The use of a decimal line prevents possible errors. To write a prescription for fifteen doses of any medicine, write it first for one dose in grains and minims, and then * The prefixes are simply numerals, as follows :— myria, which means 10,000. kilo, " " 1,000. hecto, " " 100. deka, " " 10. and are quite unnecessary in the writing of prescriptions (if not in all cases), English numerals being more convenient, and at least equally explicit. deci, which means 0.1. centi, " " 0.01. tnilli, " " 0.001. WEIGHTS AND MEASURES. 63 substitute the same number of " grams " and " cube-cents," thus :— R- Opii............................................................... gr.j Camphorse...................................................... gr.ij Make one pill. and to get fifteen such doses in metric terms, write— R. Opii.............................................................. I Gm. Camphorse....................................................... 2 Gm. Make fifteen pills. The gram and the cubic-centimeter (fluigram), when referring to liquids, may be considered as equal quantities, except the liquids be very heavy (as in the case of chloroform), or very light (as in the case of ether). Measures may be discarded and weights exclusively em- ployed, if preferred. All quantities in a prescription would then be expressed in grams.* The average "drop" (water) may be considered equal to 0.05 C.C, or 0.05 Gm. An average teaspoon holds 5 C.C, and an average tablespoon 20 C.C. Decimal numbers should be used as far as practicable without sacrifice of accuracy as to strength and dose of the preparation. It is safe to prescribe 30 Gm. for one troy ounce, and 250 C.C. for eight fluidounces. The above contains all that it is necessary to know or learn of the metric system, in order to write metric pre- scriptions, without a metric posological table, or with one. To become familiar with the system, the rules given above for the conversion of apothecaries' weights and measures into the corresponding metric quantities, may be profitably used, the results to be verified by comparison with the following— * As any liquid medicine must necessarily be administered to the patient in measured, and not in weighed, doses, it will, of course, be more convenient to the physician to continue to make use of fluid measures in writing prescriptions, especially as he is already accustomed to this, and would not then have to bear in mind the specific gravity of any liquid ingredient in the prescription. To the pharmacist it makes but little difference, as he will have both weights and meas- ures, and can use one or the other, as may be directed. If the physician discards measures, he must, of necessity, so adjust the proportion in his formula as to produce a mixture of which, after all, the dose must be a " teaspoonful," or some other convenient measure, and this is as unnecessary as it is difficult.— Oscar Oldberg, Phar. D., in Blakiston's Phys. Visiting List. 64 DENTAL MEDICINE. TABLE OF EQUIVALENTS. apothecaries' weights METRIC WEIGHTS (and measures). (and measukbs). Troy grains (or minims). Grams (or cubic-centimeters). l Si °°°i (T7V,j) l °-°02 (twos) l °-°°4 (tAt) 1 J 0.008 (T^5TT) 1 0.016 (^) 1 2 °°33 (A) I 0.066 (TV) 2 °-!33 (A) 5 0-3-33 (7) IO 0.666 (|) 15 1.000 (1) 20 1-333 m) 30 2.000 (2) Drachms (or fluidrachms). Grams (or cubic-centimeters). I 4 2 8 4 16 6 24 7V grain. 0 45 minims. 0 iX grains. o 60 minims. :o 5 minims. 5 grains. ;o 60 minims. o 60 minims. o 15 grains. o 45 minims. :o 2 fl. drachms. o 60 minims. o 30 minims. o 60 minims. 015 minims. o 2 fl. drachms. o 2 fl. drachms. o 1 fl. drachm. q 2 fl. drachms. 0 15 minims. o 4 fl. drachms. 0 60 minims. o 60 minims. o 2 fl. drachms. 0 2 fl. drachms. 0 2 fl. drachms. 0 1 grain. 0 % grain. o X grain. o 60 minims. o 15 grains. 0 2 fl. drachms. 0 60 minims. :o 60 minims. o 15 grains. :o 60 minims. o 5 minims. :o 2 fl. drachms. 72 Remedies. DENTAL MEDICINE. DOSE TABLE CONTINUED 4 tO 8 C. C . . O.50 tO 2 C. C. . . 20 to 40 centigrams 6 to 12 milligrams 0.25 to 1 Gm. . . 5 to 20 centigrams 30 to 60 centigrams 30 to 60 centigrams 30 to 60 centigrams 0.30 to 1 Gm. . . 30 to 60 centigrams 1 to 4 Gm. . . 30 to 60 centigrams 5 to 30 centigrams 20 to 30 centigrams 30 to 60 centigrams 5 to 20 centigrams 5 to 20 centigrams 15 to 60 Gm. . . 5 to 30 centigrams 5 to 30 centigrams 0.30 to 2 Gm. . . 5 to 20 centigrams 3 to 10 centigrams 5 to 20 centigrams 0.60 to 4 C. c. . . 6 to 30 centigrams 0.60 to 2 Gm. . . 1 to 6 milligrams 1 to 50 centigrams 3 to 6 milligrams 4 to 30 milligrams 1 to 6 centigrams 15 to 60 milligrams 15 to 50 centigrams 60 to 250 C. c. . . 30 to 60 C. c. . . 15 to 60 C. c. . 8 to 15 C. c. . . 30 to 60 C. c. . . 4 to 30 C. c. . . 15 to 60 C. c. . . 8 to 60 C. c. . . 30 to 60 C. c. . . 0.30 to 1 Gm. . . 5 to 20 centigrams 1 to 3 centigrams 1 to 6 centigrams 1 to 2 Gm. . . 1 to 2 Gm. . . Dose in apothecaries' weights or measures. 1 to 2 fl. drachms. 8 to 30 minims. 3 to 6 grains. fa to \ grain. 4 to 15 grains. 1 to 3 grains. 5 to 10 grains. 5 to 10 grains. 5 to 10 grains. 5 to 15 grains. 5 to 10 grains. 15 to 60 grains. 5 to 10 grains. 1 to 5 grains. 3 to 5 grains. 5 to 10 grains. 1 to 3 grains. 1 to 3 grains. X to 2 ounces. 1 to 5 grains. 1 to 5 grains. 5 to 30 grains. 1 to 3 grains. X to iX grains. 1 to 3 grains. 10 to 60 minims. 1 to 5 grains. 10 to 30 grains. fa to fa grain. ye to 8 grains. 2V to fa grain. tV to X grain. Ye to 1 grain. X to 1 grain. 3 to 8 grains. 2 to 8 fl. ounces. 1 to 2 fl. ounces. X to 2 fl. ounces. 2 to 4 fl. drachms. 1 to 2 fl. ounces. 1 to 8 fl. drachms. Y to 2 fl. ounces. X to 2 fl. ounces. 1 to 2 fl. ounces. 5 to 20 grains. 1 to 3 grains. Y to Y grain. Ye to 1 grain. 15 to 30 grains. 15 to 30 grains. Extr. viburni [prunifol.] fl Extr. zingiberis fl. . Fel bovis purif. . . Ferri arsen. . . . Ferri carb. sacch. Ferri chlorid. . . . Ferri citr..... Ferri et ammon. citr. Ferri et ammon. sulph. Ferri et ammon tartr. Ferri et cinchonid. citr. Ferri et pot. tartr. Ferri et quin. citr. Ferri et strychn. citr. Ferri ferrocyanid Ferri hypophosphis . Ferri lactas . . . Ferri oxalas . . . Ferri oxid. hydrat. . Ferri phosphas • . Ferri pyrophosphas . Ferri subcarb. . . Ferri sulphas . . . Ferri sulphas exsiccat. Ferri valer. . . . Ferrum dialys . . Ferrum reduct. . . Gentiana .... Hydrarg. chlorid. corros. Hydrarg. chlorid. mite. Hydrarg. cyanid . . Hydrarg. iodid. rubr. Hydrarg. iodid. vir. . Hydrarg. subsulphas flav Hydrarg. c. creta Infusum brayerae . Infusum catechu comp. Infusum columbae . Infusum digitalis . . Infusum eupatoris . Infusum gentiana comp. Infusum pruni virginianae Infusum quassiae . . Infusum sennae comp. Ingluvin .... Iodoformum . . . Iodum..... Ipecacuanha I exPect- r j emet. Jalapa . . • . . . POSOLOGICAL TABLES. 73 DOSE TABLE CONTINUED. Remedies. Kamala . . Kino..... Lactucarium . . Liq. ammon. acet. Liq. arsen. et hydr Liq. ferri nitrat. . Liq. iodi. comp. . Liq. magnes. citratis Liq. pepsini . . Liq. potassae . . Liq. potassii arsen it Liq. potassii citrat Liq. soda? . . . iod Liq. sodii arseniat Lithii benzoas . Lithii bromid. . Lithii carb. . . Lithii citr. . . Lithii salicylas Lupulinum . . Magnesia . . Magnesii carb. Magnesii citr. gran. Magnesii sulphas Magnesii sulphis . Mangani sulphas Manna .... Massa copaibae . Massa ferri carb. . Massa hydrarg. . Mist, ammoniaci . Mist, asafcetidae . Mist, camphora (Hopis) Mist, chloroformi Mist, cretae . . Mist, ferri comp. Mist, ferri et ammon Mist, glycrrh. comp Mist, magnes. et asafcet Mist, potassii citr. Mist, rhei et sodae Morphina and its salts Moschus . . . Mucil. acaciae . . Narceina . . . Nitroglycerinum . Nux vomica . . Oleoresina aspidii Oleoresina capsici Oleoresina cubebae acet Dose in metric weights or measures. 4 to 8 Gm. . 0.50 to 2 Gm. . 0.50 to 1 Gm. . 8 to 30 C. c . 0.10 to 0.50 C. c. 0.50 to 1 C. c. . 0.30 to 1 C. c. 66 to 250 C. c.. to 15 C. c. . 0.30 to 1 C. c . 0.15 to 0.50 C. c. . to 15 C. c. . 0.30 to 1 C. c. . 0.15 to 0.50 C. c. 10 to 30 centigrams 6 to 20 centigrams 10 to 40 centigrams 10 to 30 centigrams 10 to 50 centigrams 30 to 60 centigrams 1 to 4 Gm. . . 1 to 4 Gm. . . 8 to 30 Gm. . . 8 to 30 Gm. . . 0.50 to 2 Gm. . . 10 to 60 centigrams 30 to 60 Gm. . . 0.30 to 2 Gm. . . 0.30 to 1 Gm. . . 0.06 to 1 Gm. . . 15 to 30 C. c. . . 15 to 30 C. c. . . 4 to 32 C. c. . . 15 to 30 C. c. . . 30 to 60 C. c. . . 15 to 60 C. c . . 15 to 30 C. c. . . 4 to 15 C. c . . 4 to 15 C. c. . . 15 to 60 C. c. . . 15 to 30 C. c. . . 4 to 30 milligrams 0.10 to 1 Gm. . . 4 to 32 C. c. . . 1 to 10 centigrams 1 to 4 milligrams. 5 to 30 centigrams 1 to 4 C. c. . . 0.06 to 0.30 C. c. . 0.30 to 2 C. c. . . Dose in apothecaries' weights or measures. o 2 drachms. o 30 grains. o 15 grains. 0 8 fl. drachms. o 7 minims. 015 minims. o 20 minims. o 8 fl. ounces. o 4 fl. drachms. o 15 minims. o 7 minims. o 4 fl. drachms. 015 minims. o 7 minims. o 5 grains. o 3 grains. o 6 grains. o 5 grains. 0 8 grains.- o 10 grains. o 60 grains. 0 60 grains. o 8 drachms. 0 8 drachms. o 30 grains. o 10 grains. o 2 ounces. o 30 grains. o 15 grains. 015 5rains. 0 8 fl. drachms. o 8 fl. drachms. o 8 fl. drachms. o 8 fl. drachms. o 2 fl. ounces. o 2 fl. ounces. 0 1 fl. ounce. o 4 fl. drachms. 0 4 fl. drachms. 0 2 fl. ounces. o 1 fl. ounce. 0 X grain. o 15 grains. o 8 fl. drachms. o 2 grains. o fa grain. 0 5 grains. o 60 minims. 0 3 minims. 0 30 minims. 6 74 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Oleoresina lupulini . Oleoresina piperis . Oleoresina zingiberis Oleum copaibae . . Oleum cubebae . . Oleum eucalypti . . Oleum morrhua . . Oleum phosphoratum Oleum ricini . . . Oleum sabinae . . Oleum terebinth . . Oleum tiglii . . . Opium (14% morphine Pancreatine . . . Pepsinum purum. . Pepsinum saccharatum Phosphorus . . . Pilocarpina (and salts) Pil. aloes .... Pil. aloes et asafcet. Pil. aloes et ferri . Pil. aloes et mast Pil. aloes et myrrhae Pil. antimon. comp. Pil. asafoetidae . . Pil. cathart. comp Pil. ferri comp. Pil. ferri iodidi Pil. galbani comp Pil. opii . . . Pil. phosphori . Pil. rhei . . . Pil. rhei comp. Plumbi acetas Plumbi iodidum Potassii acetas Potassii bicarb. Potassii bitartr. Potassii bromid. Potassii carb. . Potassii chloras Potassii citras . Potassii cyanid. Potassii et sodii tartr Potassii hypophosphis Potassii iodid. . . . Potassii nitras . . . Potassii sulphas . . Potassii sulphidum . Potassii sulphis . . Dose in metric weights or measures. 0.30 tO I C. C . . 0.06 to 0.20 C.C. . 0.06 to 0.20 C.C. . 0.50 tO I C. C. . . 0.30 tO I C. C. . . O.60 tO 2 C. C. . . 4 to 16 C. c. . . 0.05 to 0.20 C.c. . 4 to 32 C. c. . . 0.06 to 0.20 C. c . O.30 to 2 C. C 0.03 too. 10 C.c. . 1 to 10 centigrams 0.30 to 1 Gm. . . 1 to 15 Gm. . . 0.60 to 1 Gm. . . 0.50 to 3 milligrams 1 to 30 milligrams 1 to 3 pills . 2 to 5 pills . 1 to 3 pills . 1 to 3 pills . 2 to 5 pills . I to 3 pills . 1 to 6 pills . I to 4 pills . 2 to 5 pills . 1 to 4 pills . 1 to 5 pills . 1 to 2 pills . 1 to 4 pills . 2 to 5 pills . 2 to 5 pills . 3 to 20 centigrams 3 to 20 centigrams 1 to 4 Gm. 0.50 to 4 Gm. 1 to 8 Gm. 0.50 to 4 Gm. 0.50 to 2 Gm. o 50 to 2 Gm. 1 to 4 Gm.. 4 to 8 milligrams 15 to 30 Gm. 0.30 to 1 Gm. 0.10 to 1 Gm. 0.50 to 1 Gm. 4 to 15 Gm. 5 to 60 centigrams 1 to 2 Gm. . . Dose in apothecaries' weights or measures. 5 to 20 minims. 1 to 3 minims. 1 to 3 minims. 8 to 15 minims. 5 to 15 minims. 10 to 30 minims. 1 to 4 fl. drachms. 1 to 3 minims. 1 to 8 fl. drachms. 1 to 3 minims. 5 to 30 minims. Y to 2 minims. Ye to 1X grains. 5 to 20 grains. 15 grains to X ounce. 10 to 20 grains. tIt to fa grain. fa to X grain. 1 to 3 pills. 2 to 5 pills. 1 to 3 pills. 1 to 3 pills. 2 to 5 pills. 1 to 3 pills. 1 to 6 pills. 1 to 4 pills. 2 to 5 pills. 1 to 4 pills. 1 to 5 pills. 1 to 2 pills. 1 to 4 pills. 2 to 5 pills. 2 to 5 pills. X to 3 grains. X to 3 grains. 15 to 60 grains. 8 to 60 grains. 15 to 120 grains. 8 to 60 grains. 8 to 30 grains. 8 to 30 grains. 15 to 60 grains. tV to X grain. X to 1 ounce. 5 to 15 grains. 2 to 15 grains. 8 to 15 grains. 1 to 4 drachms. I to 10 grains. 15 to 30 grains. POSOLOGICAL TABLES. 75 DOSE TABLE CONTINUED. Remedies. Dose in metric weights or measures. 5 to 30 Gm. 2 to 4 Gm. Potassii tartras . . Prunus Virginianum Pulv. aromat......o.joto 2Gm. Pulv. cretae comp. . . .[0.50 to 2 Gm. Pulv. effervescent aperient (seidlitz powder Pulv. glycyrrh. comp Pulv. ipecac, et opii Pulv. jalapae comp. Pulv. rhei comp. . Quassia .... Quinidina (and salts Quinina (and salts) Resina jalapae. Resina podophyll Resina scammonii Rheum . . Salicinum . Santonica . Santoninum Sapo . . . Scammonium Senna . . Sodii acetas Sodii arsenias Sodii benzoas Sodii bicarb. Sodii bisulphis Sodii boras . Sodii bromid Sodii carb. . Sodii carb. exsicc Sodii chloras . Sodii hypophosphis Sodii hyposulphis Sodii iodidum Sodii phosphas . Sodii salicylas Sodii santoninas . Sodii sulphas . . Sodii sulphis . . Spir. aether, comp. Spir. aether, nitrosi Spir. ammoniae . Spir. ammoniae arom Spir. camphorae . Spir. chloroformi. Spir. frumentis Spir. vini gallici . Spir. juniper . . 2 to 4 Gm.. 0.30 to 1 Gm. 2 to 4 Gm.. 2 to 4 Gm.. 0.60 to 4 Gm. 0.05 to 2 Gm. 0.05 to 2 Gm. 10 to 30 centigrams 8 to 30 milligrams 10 to 60 centigrams 0.10 to 2 Gm. . . 0.50 to 2 Gm. . . 0.50 to 4 Gm. . . 6 to 30 centigrams 0.30 to 2 Gm. . . 0.20 to 1 Gm. . . 0,50 to 4 Gm. . . 1 to 4 Gm. . . . 1 to 6 milligrams 0.30 to 1 Gm. . . 0.50 to 2 Gm. . . 0.50 to 2 Gm. . . 0.50 to 2 Gm. . . 0.50 to 2 Gm. . . o 50 to 2 Gm. . . 0.30 to 1 Gm. . . 0.30 to 2 Gm. . . 0.50 to 1 Gm. . . 0.50 to 2 Gm. . . 0.30 to 1 Gm. . . 0.10 to 1 Gm. . . 0.30 to 2 Gm. . . 15 to 60 centigrams 4 to 30 Gm. . . 0.50 to 2 Gm. . . 2 to 4 C. c. . . 2 to 8 C. c. . . 0.50 to 2 C. c. . . 1 to 4 C. c. . . o 50 to 2 C. c. . . 1 to 4 C. c. . . 4 to 16 C. c. . . 4 to 16 C. c. . . 4 to 16 C. c. . . Dose in apothecaries' weights or measures. 1 to 8 drachms, X to 1 drachm. 8 to 30 grains. 8 to 30 grains. Chart No. 1. 30 to 60 grains. 5 to 15 grains. 30 to 60 grains. 30 to 60 grains. 10 to 60 grains. 1 to 30 grains. 1 to 30 grains. 2 to 5 grains. X to X grain. 2 to 10 grains. 2 to 30 grains. 8 to 30 grains. 8 to 60 grains. 1 to 5 grains. 5 to 30 grains. 3 to 15 grains. 8 to 60 grains. 15 to 60 grains. fa to fa grain. 5 to 15 grains. S to 30 grains. 8 to 30 grains. 8 to 30 grains. 8 to 30 grains. 8 to 30 grains. 5 to 15 grains. 5 to 30 grains. 8 to 15 grains. 8 to 30 grains. 5 to 15 grains. 2 to 15 grains. 5 to 30 grains. 2 to 10 grains. 1 to 8 drachms. 8 to 30 grains. 30 to 60 minims. 4 to 2 fl. drachms. 8 to 30 minims. 15 to 60 minims. 8 to 30 minims. 15 to 60 minims. 1 to 4 fl. drachms. 1 to 4 fl. drachms. 1 to 4 fl. drachms. 76 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Dose in metric weights Dose in apothecaries' or measures. weights or measures. Spir. lavend. comp. . . . 2 tO 4 C. C . . . 30 to 60 minims. Spir. menth. pip. . . 30 to 60 minims. Strychnina (and salts) . . 1 to 5 milligrams fa to fa grain. X to 4 fl. drachms. Succus limonis . . . . 4 to 8 C. c. . . . 1 to 2 fl. drachms. 2 to 15 Gm. . . . X to 4 drachms. Syrupus calcii lactophos . 1 to 2 fl. drachms. Syrupus calcis . . . . 15 to 30 minims. Syrupus ferri bromidi . . 1 to 4 C. c. . . . 15 to 60 minims. Syrupus ferri iodidi . . . 1 to 4 C. c. . . . 15 to 60 minims. Syr. fer. manganese iodidi. 0.60 to 4 C. c. . . . 10 to 60 minims. Syrupus ferri oxidi. . . . 5 C. c...... 1 fl. drachm. Syrupus ferri hypophosph. 5 C. C...... 1 fl. drachm. Syr. fer. quin. et str. phos. 5 C. c...... 1 fl. drachm. Syrupus hypophosphit. 5 C. c...... 1 fl. drachm. Syrupus hypophos. c. fer. . 5 C. c...... 1 fl. drachm. X to 4 fl. drachms. Syrupus lactucarii . . . 1 to 3 fl. drachms. Syrupus pruni virginiani . 1 to 4 fl. drachms. Syrupus rhei . . • . . 4 to 15 C. c. . . 1 to 4 fl. drachms. Syrupus rhei arom. . . . 1 to 4 fl. drachms. 4 to 8 C. c. . . . 1 to 2 fl. drachms. 4 to 8 C. c. . . . 1 to 2 fl. drachms. Syrupus sarsap. comp. . . 4 to 15 C. c. . . . 1 to 4 fl. drachms. Syrupus scillae . . . . X to 1 fl. drachm. Syrupus scillae comp. . . 1 to 4 C. c. . . . 15 to 60 minims. Syrupus senegae .... 4 to 8 C. c. . . . 1 to 2 fl. drachms. Syrupus sennae .... 5 to 15 C. c. . . . 1 to 4 fl. drachms. Syrupus tolutan .... 1 to 8 fl. drachms. 0.50 to 1 C. c. . . . 8 to 16 minims. Tinct. aconiti rad. . . . 0.06 to 0.30 C c 1 to 5 minims. X to 2X minims. Tinct. aeon. rad. Fleming's 0.04 to 0.15 C. c. . . Tinct. aloes (1880) . . . 2 to 8 C. c. . . . X to 2 fl. drachms. Tinct. aloes et myrrhae . . 4 to 8 C. c . . . 1 to 2 fl. drachms. Tinct. arnicae flor. . 8 to 30 minims. 15 to 30 minims. Tinct. arnicae rad. . . . 1 to 2 C. c. . . . Tinct. asafcetidae . . . 2 to 4 C. c. . . . 30 to 60 minims. Tinct. belladonnae . . . 0.20 to 1 C. c. . . . 3 to 15 minims. Tinct. calumbae .... 1 to 4 fl. drachms. Tinct. cannabis ind. . . 0.30 to 2 C. c. . . . 5 to 30 minims. Tinct. cantharid..... 0.06 to 0.60 C. c. . . 1 to 10 minims. 0.30 to 2 C. c. . . . 5 to 30 minims. Tinct. catechu .... 2 to 8 C. c. . . . X to 2 fl. drachms. Tinct. cimicifugae . . . 30 to 60 minims. Tinct. cinchonae .... 2 to 8 C. c. . . . X to 2 fl. drachms. Tinct. cinchonae comp. 2 to 8 C. c. . . . X to 2 fl. drachms. Tinct. colchici sem. . . . 0.30 to 1 C. c. . . . 5 to 15 minims. 5 to 30 minims. 1 to 2 fl. drachms. Tinct. cubebae .... 4 to 8 C. c. . . Tinct. digitalis . . 3.30 to 1 C. c. . . . 6 to 15 minims. POSOLOGICAL TABLES. 77 DOSE TABLE CONTINUED. Remedies. Tinct. eucalypti . . . . Tinct. ferri chloridi . . . Tinct. ferri chloridi aether. Tinct. gentian comp. . . Tinct. gelsemii . . . . Tinct. guaiaci..... Tinct. guaiaci ammon. . . Tinct. humuli..... Tinct. hydrastis . . . . Tinct. hyoscyami fol. . . Tinct. hyoscyami sem. Tinct. iodi...... Tinct. ipecac, et opii. . . Tinct. jalapae..... Tinct. kino...... Tinct. krameriae . . . . Tinct. lavend comp. . . Tinct. lobeliae..... Tinct. lupulini . . . . Tinct. matico..... Tine. nuc. vomicae . . . Tine, opii deodorat . . . Tinct. opii camph. . . . Tinct. physostigmatis . . Tinct. pyrethri . . . . Tinct. quassiae . . . . Tinct. rhei...... Tinct. sanguinariae . . . Tinct. scillae..... Tinct. serpentariae . . . Tinct. stramon. fol. . . . Tinct. stramon. sem. . . Tinct. sumbul..... Tinct. tolutan..... Tinct. valer...... Tinct. valer. amon. . . . Tinct. veratr. vir. . . . Tinct. zingiberis . . . . Tritur. elaterini . . . . Uva ursi...... Vin. antim Veratrina ... Vin. aloes , . . expect. emet Vin. colch. rad. . , Vin. colch. sem. . , Vin. ergotae . . . Vin. ferri amar. . . Vin. ferri citrat. . . Vin. xericum. . . . et alt Dose in metric weights or measures. 3 to 8 C. c. . . I tO 2 C. C. . . I tO 2 C. C. . . 3 to 8 C. c. . . 0.50 to 1 C. c. . . 2 to 4 C. c. . . 2 to 4 C. c. . . 4 to 10 C. c. . . 2 to 6 C. c . . 1 to 4 C. c. . . 1 to 2 C. c. . . 0.30 to 1 C. c. 0.30 to 1 C. c. 2 to 8 C. c. . . 2 to 8 C. c. . . 2 to 8 C. c . . 2 to 8 C. c . . 1 to 3 C. c. . . 2 to 8 C. c. . . 2 to 8 C. c . . 0.06 to 0.60 C. C.. 0.30 to 2 C. c . . 0.50 to 5 C. c. . . 0.30 to 1 C. c. . . 0.50 to 2 C. c. . . 2 to 8 C. c. . . 4 to 30 C. c. . . 1 to 4 C. c. . . 0.50 to 4 C. c. . . 2 to 8 C. c. . . 0.50 to 1 C.c. . . 0.30 to 1 C.c. . . 0.50 to 2 C.c. . . 4 to 8 C. c. . . 2 to 8 C. c. . . 2 to 8 C. c. . . 0.20 to 0.60 C. c. . 1 to 4 C. c. . . 8 to 30 milligrams 2 to 4 Gm. . . 1 to 6 milligrams 4 to 8 C. c. . . 0.06 to 0.50 C. c. . 2 to 5 C. c. . . 0.30 to 2 C. c . . 0.30 to 2 C. c . . 4 to 12 C. c. . . 5 C. c..... 5 C. c..... 4 to 32 C. c. . . Dose in apothecaries' weights or measures. to 2 fl. drachms. to 30 minims. to 30 minims. to 3 fl. drachms. to 15 minims. to 60 minims. to 60 minims. to 2X A- drachms. to 90 minims. to 60 minims. to 30 minims. to 15 minims. to 15 minims. to 2 fl. drachms. to 2. fl drachms. to 2 fl. drachms. to 2 fl. drachms. to 45 minims. to 2 fl. drachms. to 2 fl. drachms. to 10 minims. to 30 minims. to 75 minims. to 15 minims, to 30 minims. to 2 fl. drachms. to 8 fl. drachms. to 60 minims. to 60 minims. to 2 fl. drachms. to 15 minims. to 15 minims. to 30 minims. to 2 fl. drachms. to 2 fl. drachms. to 2 fl. drachms. to 10 minims. to 60 minims. to X grain. to 1 drachm. to fa grain. to 2 fl. drachms. to 8 minims. to 75 minims. to 30 minims. to 30 minims. to 3 fl. drachms. fl. drachm. fl. drachm. to 8 fl. drachms. 78 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Dose in metric weights or measures. Dose in apothecaries' weights or measures. Vin. ipecac. {^ Vin. portense . . Vin. rhei. . . . :t. 4 to 32 C. C. . . . 4 to 8 C. c. . . . 5 to 12 centigrams . 6 to 60 centigrams , 1 to 2 Gm..... 30 to 120 milligrams. 5 to 15 minims. 3 to 6 fl. drachms. 5 to 15 minims. 1 to 8 fl. drachms. 1 to 2 fl. drachms. 1 to 2 grains. 1 to 10 grains. 15 to 30 grains. X to 2 grains. Zinci oxid. . Zinci sulphas emet. Zinci. valerianas . POISONS. SYMPTOMS AND ANTIDOTES. Cases of poisoning require the prompt administration of remedies, and hence, a knowledge of the usual antidotes is requisite, in order that they may be employed with effect. For the majority of such cases, the chief reliance must be upon emetics, so that free vomiting may be induced by such articles of this class which are most speedy in their effect. Sulphate of zinc is preferable to many, and, if vomiting is present, it may be aided by diluents or a vegetable emetic. When the poisonous substance has remained for any length of time in the stomach, the use of emetics will not prove sufficient, but resort must be had to the stomach-tube and syringe. Milk, lime water, soap, or solutions of sugar or honey will protect the stomach and intestines, while oil and other fatty matters may prove injurious. Carbonate of magnesia with tincture of opium, suspended in water, freely administered, will prove very serviceable after the vomiting has ceased, and the patient is suffering from retching and pain. When the nature of the poison is unknown, a general anti- dote, consisting of equal parts of calcined magnesia, pulverized charcoal, and hydrated peroxide of iron, which are to be diffused in water, may be freely administered, and will, in the majority of cases, prove efficient, as one or another of them is an antidote to most of the mineral poisons. The albumen of eggs and tannic acid are also considered POISONS. 79 to be valuable antidotes. The albumen neutralizes corrosive sublimate and like salts, and the tannic acid precipitates all of the vegetable alkaloids as tannates. ACIDS (Mineral). Symptoms.—Corrosion of parts with which the acid comes in contact, with an immediate burning pain in the mouth, throat, oesophagus and stomach ; vomiting of liquid impregnated with mucus and blood. Death occurs from inflammation, or from asphyxia. Antidotes.—Chalk ; magnesia; solution of carbonate of soda ; emollient drinks ; fixed oil and fatty matter; plaster off wall, in emergency. ACONITE. Symptoms.—Numbness and tingling of the mouth and throat, followed by vomiting and purging ; giddiness ; feeble pulse ; dilated pupil; oppressive breathing ; paralysis. Death occurs from syncope or apncea. Antidotes.—Emetics ; stimulants, external and internal, such as sulphate of zinc, tannic acid, animal charcoal, atropine, belladonna. ALKALIES (See Potash). ANTIMONY (Tartar Emetic, Butter of Antimony). Symptoms.—A burning pain in stomach and bowels ; vomit- ing ; purging; cold perspiration ; great thirst; cramps ; great debility, and death. Antidotes.—Vegetable acids, such as tannic acid, catechu, nutgalls, white oak bark, kino, cinchona. ARSENIC. Symptoms.—Faintness and nausea, with burning pain in the epigastrium ; vomiting ; purging, or diarrhoea ; thirst; constric- tion in the throat; feeble action of the heart, with a quick and weak pulse ; painful and hurried respiration ; cold and clammy skin. Death occurs from collapse, and sometimes with con- vulsions. Antidotes.—Moist peroxide of iron (obtained from perchlo- ride of iron and calcined magnesia) ; animal charcoal; ammo- 80 DENTAL MEDICINE. nia; lime water ; stomach-pump ; artificial respiration ; cold affusion ; emetics ; milk ; raw eggs. ARGENTI NITRAS (Nitrate of Silver). Symptoms.—Corrosion of parts; sometimes nausea and vomiting and convulsions ; paralysis. Antidotes.—Solution of common salt in demulcent drinks; albumen. ATROPINE. Symptoms.—Insatiable thirst, with dryness of mouth and throat; nausea ; giddiness ; palpitation of heart; intensely dilated pupil; coma and death. Antidotes.—Emetics ; sulphate of copper (gr.x) ; cold to head; ammonia, externally and internally; opium; animal charcoal; calabar bean; stimulants; subcutaneous injection of morphia. BELLADONNA. Symptoms.—Same as those of atropia. Antidotes.—Same as for atropia. CANNABIS INDICA (Indian Hemf). Symptoms.—Temporary insanity, as shown by a singular gait, a constant rubbing of hands, and other strange actions; a peculiar and cunning appearance of the eyes, great hunger. Antidotes.—Hot brandy and water ; vegetable acids, such as lemon-juice, vinegar, etc ; blisters to nape of neck ; indulgence in sleep. CANTHARIDES. Symptoms.—A burning pain in stomach; vomiting and purging ; blood-stained urine ; pain in loins; strangury ; pria- pism ; convulsions; death. Antidotes.—Emetics; emollient or mucilaginous drinks ; opiates by mouth and rectum; venesection, if necessary. CARBOLIC ACID. Symptoms.—When taken internally, it causes pain in the stomach; a whitened and shriveled appearance of the mucous membrane of the lips, mouth and throat; sometimes vomiting; contracted pupils; stertorous breathing; coma, and death POISONS. 81 within a period of from five to ten minutes to eight or ten hours, according to the quantity of the acid swallowed. Antidotes.—Olive oil; castor oil; lime water; saccharate of lime ; precipitated carbonate of lime; albuminous and mucila- ginous substances. CHLORINE WATER. Symptoms.—Irritation of air passages ; burning pain in the throat and stomach ; vomiting of bloody mucus. Antidotes—Albumen; white of egg; milk; flour. CHLORAL. Symptoms.—Excitement; delirium; flushed face ; cramps in limbs; eyes closed; profound unconsciousness; stertorous breathing; increasing feebleness ; lividity of countenance ; loss of pulse ; pallor ; coldness of extremities; muscular relaxation ; death from cardiac syncope. Antidotes.—Nitrite of amyl, when the poison has been taken in large quantity ; strychnia, when the action of the poison is slow and culminative. According to some authorities, picrotine, fa gr., sufficient for 30 grs. of chloral; coffee. CHLOROFORM. Symptoms. — Drowsiness ; insensibility; stertorous, rapid breathing; weak pulse; dilatation of pupils ; relaxation of muscles; coldness of surface; increasing feebleness of pulse ; heart ceasing its action. Antidotes.—Fresh air; artificial respiration (inclining head down, tongue pulled forward), cold water dashed over face and chest; galvanism to pneumogastric and through diaphragm (one pole may be applied to nape of neck and the other to the pit of the stomach) ; brandy and ammonia enemata; hypoder- mic injection of T^ gr of digitaline, followed in four hours after by T^ gr. of atropia, or hypodermic injection of 1 drachm of ether; inhalation of nitrite of amyl; tracheotomy. CONIUM (Hemlock). Symptoms.—Thirst; dryness of throat; delirium ; convul- sions; coma and death, resulting from paralysis of the respi- ratory muscles. 82 DENTAL MEDICINE. Antidotes.—Emetics, followed by demulcent drinks, internal and external stimulants, as brandy; ammonia; coffee, if coma is present; tannic acid; animal charcoal. CORROSIVE SUBLIMATE. Symptoms.—Heat and pain of a burning nature in mouth, and throat, and stomach ; nausea ; vomiting of bloody mucus; diarrhoea; dysentery; cramps; convulsions; coma and death. Antidotes.—Albumen; milk; white of egg (white of I egg to 4 grs. corrosive sublimate); flour ; perchloride of tin ; iron and zinc (iron filings 2 parts and zinc I part). CREASOTE (See Carbolic Acid). CROTON OIL. Symptoms.—Irritation of mucous membrane; burning pain along course of alimentary tract; excessive purging; inflam- mation of stomach and intestines. Antidotes.—Emetic of sulphate of copper, io grs., followed by mucilaginous fluids containing opium, to allay the pain; olive oil; opium. SULPHATE OF COPPER. Symptoms.—Metallic taste; eructations ; violent emesis and purging; cramps in limbs; griping pains; headache; giddi- ness ; convulsions; coma and death, with symptoms of a dis- ordered condition of the nervous system. Antidotes.—Albumen or white of egg. DIGITALIS. Symptoms.—Nausea; vomiting; purging; feeble or slow and irregular pulse; dilated pupils; excessive debility; stupor; convulsions; coma and death. Antidotes.—Recumbent posture after the use of such emetics as sulphate of zinc; stimulants internally and externally; tannic acid; animal charcoal. HYDROCYANIC ACID. Symptoms.—Dilated pupils; spasmodic breathing; convul- sions ; insensibility; fixed eyes; spasmodic closure of jaws ; very feeble pulse and speedy death. POISONS. 83 Antidotes.—Fresh air and artificial respiration, with cold affusion upon head and neck; freshly precipitated oxide of iron, with an alkaline carbonate, such as carbonate of ammonia; chlorine. HYOSCYAMUS. Symptoms.—A feeling of giddiness, followed by delirium; dilated pupils; fullness about the head; drowsiness ; cold per- spiration ; paralysis ; exhaustion ; death. Antidotes.—Stomach pump; emetics; stimulants, external and internal; lemon juice; strong coffee. IODINE. Symptoms.—In extreme cases, violent vomiting and purging; fever and excessive thirst; palpitation of heart; cramps ; small and frequent pulse; occasional dry cough; and when death ensues, it is probably due to gastro-enteritis. In excessive doses, it acts as an irritant poison, giving rise to such symptoms as restlessness; burning sensation; palpitation; violent priapism; frequent pulse ; excessive thirst; extreme diarrhoea; trembling; extreme emaciation, and sometimes syncope. Antidotes.—Emetics and demulcent drinks ; starch or flour diffused in water; albumen ; milk. LEAD SALTS. Symptoms.—A dry and constricted throat; pain in stomach and bowels; colic ; paralysis of extensor muscles ; apoplectic symptoms. Antidotes.—Sulphate or phosphate of soda; Epsom salts, followed by emetics, and afterwards opium and milk; iodide of potassium. MORPHINE (See Opium). MERCURY. When in the form of the perchloride (corrosive sublimate), or nitrate of mercury, see corrosive sublimate. NUX VOMICA. Symptoms.—Spasmodic twitching of muscles ; violent move- ments of limbs ; tetanic spasms ; dyspnoea ; death. 84 DENTAL MEDICINE. Antidotes.—Enema of tobacco, yi oz. to 20 oz. of boiling water, to be administered until spasms abate ; nicotine, 1 drop, in warm sherry wine and water. OPIUM. Syjnptoms.—Increasing drowsiness ; giddiness; stupor ; in- sensibility ; stertorous breathing; feeble pulse; contracted pupil; coma; convulsions ; death. Antidotes.—Emetic of 10 grs. of sulphate of copper; stomach pump; stimulants, external and internal; brandy and coffee; artificial respiration; cold affusion; ammonia to nostrils ; en- forced exertion ; galvanic shocks ; belladonna ; tannic acid ; animal charcoal; atropine. OXALIC ACID. Symptoms.—Burning pain in throat, oesophagus and stomach; vomiting of a dark green or black fluid, composed of altered mucus and blood. Antidotes.—Chalk ; magnesia; plaster from wall in emer- gency; solution of carbonate of soda; emetics; stomach pump. PHOSPHORUS. Symptoms.—Burning pain along alimentary tract; corrosion of tissues; vomiting of mucus and blood; diarrhoea. Antidotes.—Magnesia; turpentine ; emetics and purgatives. POTASH AND SODA SALTS. Symptoms.—Sharp, burning pain of the mouth, throat, oesophagus and stomach; corrosion ; vomiting of blood and mucus. Antidotes.—Dilute acetic acid; citric acid; lemon juice; fixed oils; demulcents. SILVER (Nitrate of Silver). Symptoms.—Corrosion of tissues; nausea; vomiting; con- vulsions ; paralysis. Antidotes.—Chloride of sodium (common salt); albumen; white of egg. THE PULSE. 85 STRAMONIUM (See Belladonna). STRYCHNINE. Symptoms.—Spasmodic action of muscles (twitching) ; jerk- ing of limbs ; tetanic spasms; dyspnoea; death. Antidotes.—Chloroform ; belladonna; tincture of aconite; morphia; tobacco ; chloral, in drachm doses ; 8 grs. morphia antidote to I gr. strychnia; extract of conium. TOBACCO. Symptoms.—Nausea ; vomiting; violent retching. Antidotes.—Emetic ; stimulants, both external and internal; strychnia. ZINC SALTS. Symptoms.—A burning sensation in stomach ; nausea; vomit- ing ; anxious countenance; difficult breathing; small, quick pulse ; cold perspiration ; syncope; convulsions ; death. Antidotes.—Carbonate of soda; emetics; warm demulcent drinks. THE PULSE. The word " pulse " is derived from the Latin word pulso, " I strike," and denotes the striking or lifting of the finger by the distending vessel, as with each contraction of the heart blood is forced into the vessels. The word pulse has also been applied to the appearance of a lifting up of the coverings over a distending vessel, so that this word " pulse " is applied not only to that which is felt, but to that which is seen. There are two kinds of pulse, the arterial and the venous. The arterial is appreciated mainly by palpitation, the venous by inspection. It is the " arterial pulse " that it is necessary to study. The " radial pulse " is the one usually selected, although the " temporal pulse " is also noted in the administration of anaes- thetic agents. The pulse in other vessels must also sometimes be observed, as in the brachial, the facial in front of the masseter muscle, the posterior tibial, the dorsalis pedis, the carotid and femoral arteries. 86 DENTAL MEDICINE. The " radial pulse," the one usually selected, and which, in most cases, answers all the requirements, is of moderate size, superficial, and can be readily compressed against the radius. When the pulse is to be observed, the patient should be either sitting or lying down. The observer should place his index, middle, or ring finger lightly upon the pulse, and should then appreciate the state of the coats of the artery, and should next note the frequency, the rhythm, the tension, volume and force of the pulse; and, lastly, any peculiarities, if present. Moreover, the pulse of one side of the body should always be compared with the other. It should also be remembered that forcible extension or flexion of the forearm will sometimes arrest the radial pulse. In noting the pulse of children and infants, it is well to count the pulse, if possible, while they are asleep. This can be conveniently done in the temporal artery. In noting the pulse at the wrist, asleep or awake, there are often involuntary movements of the arm and twitching of the muscles, which render it difficult to keep the finger of the observer on the pulse. This difficulty may be overcome in a great degree by grasping the entire hand of the child, and then extending the index finger upon the pulse. It is also advisable not to take the pulse of the patient until some little time has elapsed after the appearance of the observer. In health, changes in the frequency and rhythm of the pulse are often met with. The following is a table of the variations in the frequency of the pulse in health :— Infant asleep, at birth.............. . . . 140 Infancy.........................I20 Child under 5 years of age,.......... 100 Youth,........................ 90 Male adults,............... 72-80 Female adults,.............. 8o-8q Old age,........................ 7o It is only in rare cases that great frequency of the pulse in health is met with. Sex has some influence. Up to the 7th THE PULSE. 87 year of age the frequency is about the same in both sexes, but later the female is from 6 to 14 beats—average 9—greater than in the male. Posture also affects the pulse. It is most frequent in the standing, and least in the recumbent position. The pulse of a man is twice as much affected by change of position as that of a woman. When the pulse is much increased in frequency, change in position has but little effect, and, for the higher numbers, entirely disappears. When the head is lower than the body, the pulse falls. The general law as to the degree of frequency of the pulse, as affected by position, is as follows :— The frequency is directly proportioned to the amount of muscular effort required to support the body in different posi- tions. The pulse falls in sleep, as much as ten beats. Sleep- lessness increases its frequency. On awaking from sleep, there is usually a decided increase in frequency. Food in- creases the rate of the pulse. Mental excitement and activity of the emotions increases the frequency; mental depression is often accompanied by a decrease. Cold lowers and heat raises the rate of the pulse. Among other causes producing an increase in the frequency of the pulse in health, are spirituous and warm drinks, tobacco, diminished atmospheric pressure. Among other causes producing diminished frequency of the pulse, besides those before mentioned, are fatigue, long con- tinued rest, debility without disease, and increased atmospheric pressure. Occasionally the pulse is irregular in health, but when it is so, it is usually congenital. Intermittency is not infrequent in health, and it is then either congenital or may be due to terror, anxiety, grief, mental or physical fatigue, and old age. The intermittency may be only temporary, or it may become permanent; and if it becomes very frequent, may be patho- logical. A pulse of 90 or more may be regarded as a pulse of abnormal frequency in an adult. There are exceptions to this, 88 DENTAL MEDICINE. but they are rare. If the pulse is quicker than the temperature will explain, it indicates cardiac weakness. A pulse that day by day progressively increases, the temper- ature remaining the same, shows increasing cardiac weakness. In all febrile diseases, a pulse, in adults, over 120 is serious, and indicates cardiac weakness. A pulse of 130 or 140 indi- cates great danger ; and with a pulse at 160, the patient almost always dies. Under the age of fifteen, any disease of the lungs is almost invariably accompanied by great frequency of the pulse, so that a pulse of 120 to 140 would not be con- sidered as so serious in significance as if it occurred in an older person. A pulse of 120 in a strong, robust patient affected with pneumonia, indicates some form of heart disease. When pneu- monia occurs in the cachectic or debilitated, the pulse is usually very frequent, often 120 to 160, and such cases usually die. In pericarditis and myocarditis, there is great frequency of the pulse, especially on any movement of the patient—130 to 160— and the change may be very sudden. In acute articular rheu- matism, unaccompanied by any heart disease, a pulse of 120 or more indicates great danger. In pleuritic effusions, the pulse may be very frequent, especially when there is displace- ment of the heart. RESPIRATION AT VARIOUS AGES. At one year of age, per minute,........... " two years of age, " " " puberty, " " .....• • " adult age, " " THERMOMETERS. There are three different thermometers in use—Fahrenheit's, Centigrade and Reaumer's—each differing from the other with reference to the number of degrees between the freezing and boiling points of water. In Fahrenheit's, zero is placed 35 25 20 18 THERMOMETERS. 89 at 32 degrees below the freezing point, while in the others zero marks the freezing point. The boiling point in Fahrenheit's is placed at 212 degrees ; in Centigrade at 100, and in Reaumer's at 80. The degrees between the freezing and boiling points in the instruments are, therefore, respectively 180, 100 and 80. The following diagram will explain the variance:— Fahrenheit, . . . o. 32 yy 122 167 212 Centigrade, . . . 17.77 ° 25 5° 75 100 Reaumer, . . . 14.22 o 20 40 60 80 The Clinical Thermometer is employed as a valuable means of diagnosis and prognosis. It is valued because the vital processes can only be normally and perfectly performed at the temperature of 98^°, and just in proportion as it varies from this, either above or below, they are changed or entirely arrested. This standard of temperature, 98^°, of the healthy body, is subject to slight variations during the day. Although observations show that the normal heat, which is the most essential condition of life, may be considerably altered by a number of circumstances, yet the variations in health are generally temporary and within narrow limits, whereas those which arise from disease are persistent during the continuance of the abnormal condition. Both increase and decrease of temperature have to be considered, for while an increase of four to six degrees may be maintained for a month, and not endanger life, a decrease of but one degree, if maintained for a considerable time, will result in death. The increase in tem- perature of the body is usually proportionate to the frequency of the pulse, one degree corresponding to an increase of ten beats per minute. Thus— With a temperature of 980, we have a pulsation of 60. 990 " " 70. 100° " " 80. " " 1010 " " 90. " 1020 " '' 100. 1030 " " no. 1040 " " 120. 7 90 DENTAL MEDICINE. TABLE OF ELEMENTARY SUBSTANCES. Elements. ^ -Q Atomic Equiva- s in Weight. lent. Al 27 i3-5 Sb 120 120 As 74-9 74-9 Ba 136.8 68.4 Be 9 9 Bi 210 210 B 11 n Br 79.8 79.8 Cd 111.8 55-9 Cs 132.6 132.6 Ca 40 20 C 12 6 Ce 141 70.5 CI 354 354 Cr 52.4 26.2 Co 58.9 29.45 Cu 63.2 31.6 Di 144.6 72.3 E 165-9 82.95 Fl l9 19 G 68.8 344 Au 196.2 196.2 H 1 1 In 1134 56.7 I 126.6 126.6 Ir 192.7 96-35 1-e 55-9 27.95 La 1.38.5 138.5 Pb 206.5 103.25 Li 7 7 Mg 24 12 Mn 54 27 Hg 199.7 99.85 Elements. Molybdenum Nickel . Niobium Nitrogen3 Osmium Oxygen4 Palladium Phosphorus Platinum Potassium Rhodium Rubidium Ruthenium Scandium Selenium Silicon . Silver . Sodium. Strontium Sulphur5 Tantalum Tellurium Thallium Thorium Tin . . Titanium Tungsten Uranium Vanadium Ytterbium Yttrium Zinc . . Zirconium Atomic 6 Weight. in Mo 95-5 Ni 58 Nb 94 N H Os 198.5 O 16 Pd 105.7 P 3i Pt 194.4 K 39 Rh 104.1 Rb 85-3 Ru 104.2 Sc 44 Se 78.8 Si 28 Ag 107.7 Na 23 Sr 87.4 S 32 Ta 182 Te 128 Tl 203.7 Th 233 Sn 117.7 Ti 48 Tr 183.6 U 238.5 V 51-3 Yb 172.7 Y 89.8 Zn 64.9 Zr 90 Equiva- lent. Carbon: ix.9736. 2 Chlorine : 35.370. 3 Nitrogen : 14.021. * Oxygen : 15.9633. 6 Sulphur: 31.984. CHEMICALS SOLVABLE BY WATER AND ALCOHOL. 91 TABLE OF THE SOLUBILITY OF CHEMICALS IN WATER AND ALCOHOL. Abbreviations : s. = soluble; ins. = insoluble ; sp. = sparingly ; v. = very; aim. = almost; dec. = decomposed. CHEMICALS. One part is soluble in: Acidum arseniosum . . . Acidum benzoicum . . . Acidum boricum .... Acidum carbolicum . . . Acidum chromicum . . . Acidum citricum .... Acidum gallicum .... Acidum salicylicum . . . Acidum tannicum . . . Acidum tartaricum . . Alumen....... Alumen exsiccatum . . . Ammonii carbonas . . . Ammonii nitras .... Ammonii valerianas. . . Antimonii et potassii tartras Argenti cyanidum . . . Argenti iodium .... Argenti nitras..... Argenti nitras fusus . . . Argenti oxidum . . Atropina...... Atropinae sulphas .... Bismuthi subnitras . . . Bromum....... Calcii bromidum .... Calcii carbonas praecipitatus Calcii chloridum .... Calcii hypophosphis . . Calcii phosphas praecipitatus Calx........ Camphora monobromata . Chloral....... Cinchonidinae sulphas . . Cinchonina ..... Cinchoninae sulphas . . . Codeina....... Creta praeparata .... Cupri acetas..... Cupri sulphas..... Ferri chloridum .... Ferri citras .... WATER. ALCOHOL. At I5° C. (5°u r\) Boiling. At 150 C. (5o° F.) Boiling. Parts. Parts. Parts. Parts. 30.80 15 sp. sp. 500 15 3 I 25 3 15 5 20 V. s. v. s. v. s. v. s. dec. dec. 0.75 0.5 1 0.5 IOO 3 4-5 1 450 14 2.2 V. s. 6 V. s. 0.6 V. s. 0.7 0.5 2.5 0.2 10.5 ins. o.3 ins. 20 ins. 0.7 ins. 4 dec. dec. dec. 0.5 v. s. 20 3 v. s. V. s. v. s. v. s. 17 3 ins. ins. ins. ins. ins. ins. ins. ins. ins. ins. 0.8 O.I 26 5 0.6 . 0.5 25 5 v. sp. v. sp. ins. ins. 600 35 v. s. v. s. 0.4 V. s. • 6.5 v. s. ins. ins. ins. ins. 33 . . . dec. dec. 0.7 V. s. 1 V. s. ins. ins. ins. ins. 1-5 v. s. 8 1-5 6.8 6 ins. ins. ins. ins. ins. ins. 750 1300 ins. ins. aim. ins. aim. ins. v. s. v. s. v. s. v. s. V. s. 100 4 71 12 aim. ins. aim. ins. no 28 70 H 6 1-5 80 17 V. s. V. s. ins. ins. ins. ins. 15 5 135 H 2.6 0.5 ins. ins. v. s. v. s. v. s. v. s. s. v. s. ins. ins. 92 DENTAL MEDICINE. TABLE OF THE SOLUBILITY OF CHEMICALS IN WATER AND ALCOHOL. (Continued.) CHEMICALS. One part is soluble in: Ferri lactas........ Ferri sulphas....... Ferri valerianas ...... Hydrargyri chloridum corrosivum Hydrargyri chloridum mite . . Hydrargyri cyanidum .... Hydrargyri iodidum rubrum . . Hydrargyri iodidum viride . . Hydrargyri oxidum flavum . . Hydrargyri oxidum rubrum . . Hydrargyrum ammoniatum . . Hyoscyaminae sulphas .... Iodoformum....... Iodum......... Magnesia........ Magnesii carbonas..... Magnesii sulphas...... Magnesii sulphis...... Mangani oxidum nigrum . . . Mangani sulphas...... Morphina...... Morphinee acetas...... Morphinae hydrochloras . •. . Morphinae sulphas..... Phosphorus........ Piperina......... Plumbi acetas....... Plumbi carbonas...... Plumbi iodidum...... Plumbi nitras....... Plumbi oxidum...... Potassa......... Potassii acetas....... Potassii bicarbonas . ' . . . . Potassii bichromas..... Potassii bitartras...... Potassii bromidum..... Potassii carbonas...... Potassii chloras.....; Potassii citras....... Potassii cyanidum..... Potassii ferrocyanidum .... Potassii hypophosphis . . . Potassii iodidum...... Potassii nitras . . . At 150 C. (5°° F.) Parts. 40 1.8 ins. 16 ins. 12.8 aim. ins. aim. ins. ins. ins. ins. v. s. ins. sp. aim. in . aim. ins. 0.8 20 ins 0.7 v. sp. 12 24 24 ins. aim. ins. 1.8 ins. 2000 2 ins. 0.5 0.4 ■ 3-2 10 210 1.6 1 16.5 0.6 2 4 0.6 0.8 4 Boiling. Parts. 12 °-3 dec. 2 ins. 3 . aim. ins. aim. ins. ins. ins. ins. v. s. ins. aim. ins. ins. aim. ins. ins. 0.15 ins. 19 ins, ins. ins. 0.8 ins. 500 100 i-5 68 0.5 63 0.75 702 ins. v. sp. aim. ins. 3° 0.5 8 ins. ins. 200 v. sp. 0.8 aim. ins ins. ins. v. s. 2 v. s. 2.5 dec. aim. ins 1-5 ins. 15 v. sp. 1 200 0.7 ins. 2 v. sp. v. s. v. sp. 1 sp. 2 ins. 0-3 7-3 0.5 18 0.4 aim. ins At 150 C. (5°° F.) Parts. aim. ins. ins. v. s. .3 ins. 15 130 ins. ins. ins. ins. v. s. 80 11 CHEMICALS SOLVABLE BY WATER AND ALCOHOL. 93 TABLE OF THE SOLUBILITY OF CHEMICALS IN WATER AND ALCOHOL. (Continued.) CHEMICALS. One part is soluble in : Potassii permanganas . Potassii sulphas .... Potassii tartras .... Quinidinae sulphas . . . Quinina....... Quininae bisulphas . . . Quininae hydrochloras . Quininae sulphas .... Quininae valerianas . Saccharum...... Saccharum lactis .... Salicinum...... .Soda ........ Sodii acetas..... Sodii bicarbonas .... Sodii boras...... Sodii carbonas .... Sodii chloras..... Sodii chloridum .... Sodii hypophosphis . . . Sodii hyposulphis.... Sodii iodidum..... Sodii nitras...... Sodii sulphas..... Sodii sulphis..... Strychnina...... Strychninae sulphas . . . Sulphur lotum..... Sulphur praecipitatum . . Sulphur sublimatum . . . Thymol....... Veratrina...... Zinci acetas..... Zinci carbonas praecipitatus Zinci chloridum .... Zinci iodidum..... Zinci oxidum..... Zinci phosphidum . . . Zinci sulphas..... Zinci valerianas .... At 150 C. (5°° F.) Parts. 20 9 o.7 ioo 1600 IO 34 740 100 0.5 7 28 L7 3 12 16 1.6 1.1 2.8 1 L5 0.6 i-3 2.8 4 6700 10 ins. ins. ins. 1200 v. sp. 3 ins. v. s. v. s. ins. ins. 0.6 100 Boiling. Parts. 3 4 O.5 7 700 V. s. I 30 40 0.2 I 0.7 0.8 I dec. 0.5 0.25 0.5 2.5 0.12 0.5 0.3 0.6 0.4 0.9 25000 2 ins. ins. ins. 900 v. sp. ins. v. s. v. s. ins. ins. °-3 ALCOHOL. At 150 C. (5°° F.) Parts. dec. ins. aim. ins 8 6 32 3 65 5 175 ins. 3° v. s. 30 ins. ins. ins. 40 aim. ins, 30 ins. 1.8 sp. ins. sp. no 60 ins. ins. ins. 1 3 30 ins. v. s. v. s. ins. ins. ins. 40 94 DENTAL MEDICINE. CLASSIFICATION OF MEDICINAL SUBSTANCES. In order to impress the memory and facilitate investigation, it is necessary that medicinal substances should be classified according to their similarity of action on the animal economy, as follows:— r Narcotics, Anaesthetics, i. Neurotics, or those which have a special Antispasmodics, r • r U J Tonics, action on and modify the functions ot the < Astringents, nervous system. To this group belong : ^v«?' ^ Spinants. r Emetics, 2. Eccritics, or those which have a special | Cathartics, _ . . i Diaphoretics, action on the secretions. 1 o this group < DiureuCS( belong : I blennorrheas, ° ^ Emmenagogues, Hemetics, or those which modify the blood. / H-matinic., < Alteratives, To this group belong : I Antacids. {Irritants, Demulcents, Coloring Agents, Anthelmintics. DEFINITIONS OF THE VARIOUS CLASSES OF REMEDIAL AGENTS. NARCOTICS. Narcotics are medicinal substances which affect the cerebral and spinal functions by impairing or destroying nervous action, having first a stimulant effect, to which their therapeutic efficacy is in a great degree due. Narcotics allay cerebral or spinal irritability, relieve muscular spasm, and also pain, and induce sleep. When administered to relieve pain, they are termed anodynes; to induce sleep, they are termed hypnotics or soporifics. Narcotics fulfill two indications, namely : Exciting and de- pressing the nervous energy. For the first, it is necessary to begin with small doses and repeat them frequently; for the second, a full dose must be given and not repeated for a con- siderable time. On account of the system becoming very soon habituated to the action of narcotics, when it is necessary to REMEDIAL AGENTS. 95 resort to their use for any length of time the amount must be constantly increased, in order to maintain the same impression. The difference between the susceptibility to their action when the body is in a morbid or a healthy condition should not be overlooked. Under narcotics are classed such agents as opium and its different preparations, chloral, lactucarium, belladonna, stramo- nium, hyoscyamus, tobacco, lobelia, conium, aconite, cannabis indica, humulus, camphor, hydrocyanic acid, etc., etc. ANAESTHETICS. Anaesthetics are medicinal agents which diminish sensibility and relieve pain. They are generally in the form of vapors or gases, applied by inhalation, and possess the power of tempor- arily suspending the general sensibility, being commonly employed for the prevention of pain during surgical operations. They are divided into general and local anaesthetics. General anaesthetics are agents capable of producing com- plete insensibility throughout the entire system. Included in this class are such agents as ether, chloroform, nitrous oxide gas, bromide of ethyl, bichloride of methylene, tetrachloride of carbon, dichloride of ethidene, etc., etc. Local anaesthetics are agents whose action is limited to a certain part or organ, when topically applied, paralyzing the nerves of the part, and temporarily destroying the sensibility. Included in this class are such agents as absolute ether, rhigo- lene, aconite, pyrethrum, atropine, cocaine, etc., etc. ANTISPASMODICS. Antispasmodics are medicinal agents which allay irregular muscular contraction or spasm, and compose the irregular actions of the nervous system, without any special or decided effect on the brain. They are employed in many varieties of mental disturbance, insanity, wakefulness, hypochondriasis, convulsions from teething, spasm from general debility, in which latter case an aromatic stimulant of the circulation and a permanent tonic prove beneficial. In hysteria, dependent upon idiopathic or primary nervous irritation, the use of anti- 96 DENTAL MEDICINE. spasmodics is indicated. Included in this class are such agents as asafcetida, musk, camphor, valerian, galbanum, ammoniac, castor, compound spirit of ether (Hoffman's anodyne), etc., etc. TONICS. Tonics are medicinal agents which impart strength to the system, producing a gradual and permanent increase of nervous vigor, without preternatural excitement. They stimulate also in a secondary manner, by gradually increasing the force of the circulation, and restoring the digestive and secretory func- tions to a more healthy state, differing, however, from stimu- lants, in the more permanent character of their effects. Certain agents of this class, when administered in large doses, act as antiperiodics in intermittent diseases. Benefit also results in the use of tonics by alternating them. They are divided into vegetable and mineral tonics, the former pos- sessing a bitter extractive principle, and the latter uniting astringent with tonic properties, and, in the case of prepara- tions of iron, increasing the red coloring matter of the blood. Such agents as gentian, quassia, col umbo, wild cherry, serpen- taria, cinchona and its alkaloid quinine, salix, pepsin, are examples of vegetable tonics; and the preparations of iron, preparations of copper, preparations of zinc, and such agents as subnitrate of bismuth, sulphuric, nitric, muriatic and oxalic acids, are examples of the mineral tonics. ASTRINGENTS. Astringents are medicinal agents which produce contraction of the tissues, having a corrugating power, either directly exerted on a part, or extended by sympathetic action, and thus removing morbid affections arising from a state of relaxation, such as inflammation of superficial parts, hemorrhage and excessive discharges from mucous membranes. This class of remedies is important in dental practice, owing to their great efficacy as antiphlogistics. Astringents are divided into vege- table and mineral, the former owing their peculiar property of astringency to the presence of tannic acid, while the latter possess a more decided astringency, and exert a sedative action REMEDIAL AGENTS. 97 on the vascular system. In the treatment of affections of the mucous membrane, such as stomatitis, the object is to arrest the inflammatory action, which is accomplished by the power of the astringent remedies employed locally to increase the to- nicity of the tissue, and to diminish the calibre of the vessels supplying the part with blood, thus diminishing the quantity required for the production of the morbid action. Besides diminishing the current of the blood to the inflamed part, astringents also exert an influence on the pores or ducts through which the discharge is poured out, by diminishing their calibre also. Astringents also exert an influence on morbidly relaxed tissues, when such a condition results as the sequelae of disease, especially in lymphatic temperaments, where flabbiness of the soft tissues is characteristic. Care, however, is necessary in the use of astringents, for when long or immoderately used they may act as direct irri- tants, including inflammation followed by ulceration and slough- ing. They are contra-indicated for the arrest of evacuations that are designated by nature to relieve a plethoric state of the system, unless such evacuations exist to an alarming extent. This class of remedies can be readily detected by the taste, as they convey a sense of roughness to the palate which cannot be mistaken, and which is more marked in some substances than in others. Such agents as tannic acid, gallic acid, nut- gall, matico, kino, catechu, rhatany, white oak bark, creasote, salicylic acid, are examples of the vegetable astringents; while the preparations of iron and lead, alum, sulphuric and nitric acids are examples of the mineral astringents. (See Styptics') STIMULANTS. Stimulants, also known as excitants and hypersthenics, are medicinal substances capable of exciting a temporary and rapid exaltation of the organic actions, the excitation thus pro- duced being extended or not to the rest of the system. Al- though the stomach is the organ generally selected in medical practice to be the first impressed by stimulants, on account of the extensive sympathy which exists between it and the rest 98 DENTAL MEDICINE. of the system, in dental practice these agents are topically applied to the mucous membrane of the mouth as counter-irri- tants and vesicants. The influence of stimulants is most appar- ent in conditions of morbid depression, whereas in health they soon induce depression. They possess the power of arousing the energies of the nervous system, and hence are beneficial in many nervous disorders, especially those of a spasmodic nature. When applied to the gastro-intestinal canal they pro- mote digestion as stomachics, and when administered to dispel flatulence they are known as carminatives. When internally administered, it is for the most part advisable to begin with small doses, and increase them as circumstances may require. In some cases, however, it is necessary to give them freely from the first. It is often requisite to change the stimulating substance and also the part of the body to which it is applied ; when the stomach fails the rectum and skin maybe acted upon beneficially. Topically applied, stimulants irritate and inflame the parts with which they come in contact, and are then known as irritants. The most powerful and rapid stimulants are known as dif- fusible, while others of a vegetable nature, containing a volatile oil, are termed aromatic. Among the class of diffusible stimu- lants are such agents as alcohol, preparations of ammonia, arnica, phosphorus, etc., etc. Among the class of aromatic stimulants are capsicum, cinnamon, black pepper, mace, cloves, pimento, oil of turpentine, ginger, cardamom, calamus, gaul- theria, peppermint, origanum, etc., etc. SEDATIVES. Sedatives are medicinal substances employed to diminish the frequency of the action of the circulation, their therapeutic influence being due, it is thought, to a stimulant character. They reduce vascular excitement, and while relieving irrita- bility and irregularity of the heart's action, their first effect is to restore its tone and force when it is in a morbidly depressed condition. Substances known as refrigerants, which possess the power of diminishing febrile heat, allaying thirst, restoring REMEDIAL AGENTS. 99 the secretions, and which comprise almost all of the neutral alkaline salts, are also included with sedatives. Among the class known as sedatives are digitalis, American hellebore (veratrum viride), white hellebore (veratrum album), yellow jasmine (gelsemium), tartar emetic, nitrate of potassium, etc., etc. Among the class known as refrigerants are borate of soda, citrate of potassium, acetate of ammonia, spirit nitrous ether, and vegetable acids. SPINANTS. Spinants or spastics are medicinal substances employed to excite muscular contraction. Vegetable spinants containing the alkaloids strychnia and brucia and employed therapeuti- cally in cases of torpid and paralytic conditions of the mus- cular system, are the most important of this class; also ergot, which is employed to excite muscular contraction of the uterus. Among the class of spinants are such agents as nux vomica, and its alkaloid strychnine, ignatia, cotton-root bark, ergot. EMETICS. Emetics are medicinal substances which excite vomiting, their action being independent of any effect arising from the quantity of the agent introduced into the stomach. While the action of an emetic is local as regards the stomach, it extends to almost every organ of the body, and in order that a substance of this kind shall produce its effect upon the stomach, it must first make an impression upon the cerebro- spinal axis. Within fifteen or twenty minutes after an emetic is administered there is experienced a feeling of distress, re- laxation and faintness, with a cool, moist skin and small, feeble and irregular pulse, such symptoms increasing until emesis occurs; during which the face becomes flushed, the pulse full and frequent, with an increase in the temperature of the body. When the action of vomiting is over, the skin again becomes moist, the pulse soft and feeble, and a languid and drowsy feeling is experienced. Whatever may be the apparent necessity for evacuating the stomach, all the circum- stances of the case must be considered, and, especially if there 100 DENTAL MEDICINE. be much arterial excitement, with determination to the head, blood-letting should sometimes be premised. When the full dose of an emetic is requisite, as in cases of poisoning, the object is to evacuate the contents of the stomach as speedily as possible ; but in other cases it is better to adminis- ter the emetic substance in divided doses, frequently repeated, until the desired effect is produced. In cases of torpor or congestion, it is sometimes necessary to arouse the system by retching or vomiting, which may be done by administering the emetic with only a small quantity of fluid; but when the object is to empty the stomach and duodenum merely, free draughts of tepid water or weak chamo- mile tea may be given as soon as nausea occurs. When the excitability of the stomach is greatly diminished by a narcotic, as in cases of poisoning, it is necessary to assist the emetic by the addition of some excitant. Vinegar, mustard, or ammonia answer as excitants, when such an effect is caused by opium ; but the stomach tube is the best resource. There are some few cases where emetics cannot be employed with safety, as in congestion of the brain, a great determina- tion of blood to the head dependent upon constitutional causes, pregnancy, hernia, active hemorrhage from the lungs and uterus, acute gastritis, etc., etc.; and if emetics are allowable in such diseases or conditions, it is in nauseating doses only. When they are used merely to excite nausea, they are termed nauseants. Emetics, by frequent use, are prone to cause an increased susceptibility of the stomach to their action; hence, persons of delicate habits should use them cautiously. Therapeutically, emetics are employed to evacuate the stomach in cases of poisoning, undigested food, etc., to expel foreign substances from the throat or oesophagus ; to excite nausea, in order to depress the vascular and muscular systems ; to relieve spasm ; to promote secretion and excretion; and to make decided impressions in the forming stages of certain fevers and delirium tremens. To relieve excessive vomiting, resulting from the use of REMEDIAL AGENTS. 101 emetics, ice broken in small pieces and swallowed; lime water and milk (a teaspoonful of each, mixed cold, and given at intervals of 15 or 20 minutes); a drop of creasote in a wine- glass of water (a tablespoonful given every 15 or 20 minutes); Y2 drop of diluted hydrocyanic acid in syrup and water, or in syrup of wild cherry bark (given every 15 minutes) ; or infusion of camphor (made with boiling water and given cold, a teaspoonful frequently repeated); brandy and water; clove or green tea; an anodyne injection; counter irritant to the stomach (as a mustard plaster, or hot fomentation of brandy and clove or spice plaster). Among the class of vegetable emetics are ipecacuanha, sanguinaria, mustard, lobelia, tobacco, squill; and such mineral emetics as sulphate of zinc, sulphate of copper, tartar emetic, alum, common salt, turpeth mineral. CATHARTICS. Cathartics or purgatives are medicinal agents which evacu- ate the bowels, and are capable of fulfilling three different in- dications : 1. Simply to evacuate the bowels. 2. To excite an increased discharge from the mucous coat of the intestines, and 3. To stimulate the neighboring viscera and cause them to secrete a greater quantity of their peculiar fluids. When they produce watery discharges by stimulating the mucous follicles and exhalants, they are termed hydragogues. When given in overdoses they are so powerful as to produce violent vomiting and purging, pain in the abdomen, cold extremities and a sinking pulse. Several different cathartics are usually combined in one formula, when it is desired to produce all of the indications above referred to. Some agents of this class produce their effect by absorbing the acid generated in the alimentary canal, thus becoming converted into a purgative salt, as magnesia, for example. Others expend their principal force upon the rectum and large intestines, and for this reason are advantageously employed in affections of the lower bowels, and the uterus and its appendages, such as aloes, for example. Cathartics should always be given on an empty stomach. If 102 DENTAL MEDICINE. administered immediately after a full meal, they arrest the di- gestive process, are liable to cause nausea, if not vomiting, and do not evacuate the bowels with the same certainty or effect. When simple costiveness is to be removed, the cathartic may be administered in the evening, and, if not sufficient, the dose can be repeated in the morning and at regular intervals through the day, until the effect is produced. In administering cathartics, the excitement is to be repeated till the requisite action is induced, yet not sufficient to prove an irritant. But in the treatment of many diseases, it is preferable to purge through the day, in order that the sleep may not be disturbed at night. The operation of cathartics may be very much accelerated by the free use of diluent drinks, such as gruel, barley water, etc., etc. By combining these remedies, the action of many of them is modified and controlled ; and some of the more powerful may be made to operate mildly and certainly by uniting small quantities of several of them in the same dose. The addition of an emetic substance, such as ipecachuana, or tartar emetic, gives activity to the combination, while it modifies the harshness of the powerful cathartics. The operation of a cathartic may often be promoted by judicious venesection, and if there is spasm of the intestines, opium may be advantageously added to the cathartic. Cathartics act not only upon the bowels, but upon distant parts, as every portion of the organism is capable of being impressed by them. Cathartics are divided, according to the intensity of their operation, into laxatives, purgatives and drastics, to which may also be added enemata. Laxatives gently stimulate the mucous coat of the intestines, and hence they are well adapted for cases in which the sole indication is to unload the bowels of their contents. Purgatives are more powerful in their operation ; they excite a copious exhalation from the mucous lining of the intestines, and augment the peristaltic action to a great degree. Drastics are the more powerful and violent cathartics, and produce a greater degree REMEDIAL AGENTS. 103 of irritation in the lining membrane of the intestines, and occasionally act upon the nerves of the stomach, so as to cause nausea and sometimes vomiting. Drastics generally belong to the resmo-extractive substances, and act violently, on account of being sparingly soluble and adhering to the mucous coat of the intestines. Enemata are agents of this class which act on the lower part of the intestinal tube by direct application; they irritate the lining membrane of the rectum, and by sympathy of continuity, their influence is extended to the intestinal canal. Hence enemata may be employed with advantage when cathartics cannot be given by the mouth, as when deglutition is im- practicable. What are known as saline cathartics are employed in the treatment of febrile and inflammatory affections, as they do not produce any excitant action on the general system. There are also acrid cathartics, which are not violent enough to cause inflammation. Others are known as mercurial cathar- tics. The class known as laxatives comprise such substances as certain articles of diet, as ripe and dried fruits, such as tama- rinds, peaches, raisins, figs, prunes, also molasses, honey, cracked wheat, Indian meal and oat meal, etc., etc. Other laxatives are castor oil, manna, sulphur, purging cassia, etc., etc. Saline cathartics comprise such substances as magnesia, carbonate and sulphate of magnesia (Epsom Salts), solution of citrate of magnesia, sulphate of sodium (Glauber's salt), sulphate of man- ganese, phosphate of sodium, sulphate of potassium, cream of tartar, soluble tartar, Rochelle salts. Mild, acrid cathartics comprise such substances as rhubarb, aloes, senna, leptandra, elder. Drastic cathartics comprise such substances as jalap, may apple, scammony, colocynth, gamboge, elaterium, croton oil. Mercurial cathartics consist of calomel, blue mass, mercury with chalk. Enemata consist of tepid water, flaxseed tea or other demulcent infusion; a combination of a tablespoonful each of common salt, molasses and lard or olive oil, in two- thirds of a pint of warm water, to which castor oil or Epsom salt may be added to augment the cathartic effect, is a formula for the common laxative enema. 104 DENTAL MEDICINE. DIAPHORETICS. Diaphoretics, known also as sudorifics, are medicinal sub- stances capable of producing perspiration, or an increase of the cutaneous discharge, which may be occasioned by the mere drinking of a large quantity of fluid, provided the temperature of the system be kept up. The determination of blood to the cutaneous vessels by a warm temperature or exercise will pro- duce diaphoresis, and the action of nauseating agents, by re- laxing the orifices of the cutaneous vessels, and also stimulants, by exciting such vessels to increased secretion, will have the same effect. The external application of heat, friction, etc., stimulates the cutaneous capillaries and causes an increased secretion. Diaphoresis may also be excited by medicines which enter the circulation and stimulate the cutaneous vessels by contact, such as the mercurials and sulphur; also by medicines which act on the surface sympathetically, through the medium of the stomach, as cold drinks, etc. Diaphoresis may also be produced by increasing the general action of the vascular system, by such means as violent exer- cise, the warm bath, and by the use of alcohol, ammoniaj guaiacum, etc.; it may also be produced by the use of agents capable of relaxing the morbidly constricted mouths of the perspiratory vessels, such as the antimonials, saline diaphoretics, and by the operation of venesection. Nauseating diaphoretics are employed to produce a powerful relaxing action in inflammatory cases not complicated with gastric irritability, and for such effects the emetics ipecacuanha and the preparations of antimony are administered. Refrigerant diaphoretics are employed to produce a gentle relaxing effect in allaying febrile excitement and reducing the temperature of the body. Stimulating diaphoretics are employed in rheumatic and pulmonary affections, after vascular excitement has been reduced, and where the surface is cool, being contra-indicated in a high degree of inflammation. For such effects, the diffus- ible stimulants, aromatic substances, and such narcotics as REMEDIAL AGENTS. 105 opium and camphor are administered. During the adminis- tration of diaphoretics, the patient should be confined to bed, and when diaphoresis is excited, it should not be suddenly checked. Venesection is generally resorted to when there is great arterial excitement with undue heat of skin, before the attempt is made to administer diaphoretics. Belonging to the class of diaphoretics are such agents as Dover's powder, guaiac, spirits of mindererus, nitrate of po- tassa, sweet spirit of nitre, etc., etc. DIURETICS. Diuretics are medicinal substances which act upon the kidneys, and produce an increased flow of urine. Remedies of this class act immediately and specially upon the kidneys, some reaching these organs by first passing through the blood, without being decomposed, while others, on the contrary, undergo changes in the first passages, the result of such changes exciting diuresis. The principal use of diuretics is to promote the absorption of dropsical effusions. They are also employed to correct nephritic disorders, ac- companied with obstructed secretion in calculi of the kidneys, ureters and bladder, and, as evacuants, to reduce inflam- mation. Where there is great arterial excitement, a judicious use of a lancet is recommended, prior to the administration of diu- retics, the patient being kept cool, to avoid perspiration. To insure the full effect of diuretics, diluent drinks should be freely given, and especially such as contain some diuretic substance. Included in the class of diuretics are such agents as squill, nitre, cubebs, juniper, colchicum, erigeron, cream of tartar, copaiba, podophyllum, etc., etc. BLENNORRHETICS. Blennorrhetics are medicinal substances which increase the secretion of the mucous membranes, and are employed in morbid conditions of such membranes, in order to restore them to healthy action, in cases where their secretion is deficient, excessive or abnormal in quality. They are termed expectorants 8 106 DENTAL MEDICINE. when used to stimulate the secretion of mucus from the bron- chial or laryngeal membranes, as in bronchitis and laryngitis, and during convalescence, in pneumonia. The oleo-resinous agents of this class are employed in chronic diarrhoea, and the diarrhoea of typhoid fever, such as oil of turpentine, for example; also in diseases of the urino-genital mucous membranes, such as gonorrhoea, gleet, leucorrhcea, incontinence of urine, cystitis, etc., etc. Included in the class of blennorrhetics are such agents as senna, cimicifuga, garlic, turpentine, squill, copaiba, cubebs, matico, buchu, myrrh, benzoin, storax, balsam of Peru, balsam of tolu, etc., etc. EMMENAGOGUES. Emmenagogues are medicinal substances which promote the menstrual discharge, or restore it when entirely suppressed. The particular emmenagogue required depends upon the cause of the amenorrhcea; for example, when anemia is the cause, the preparations of iron prove most effectual; when from plethora, blood-letting and cathartics or evacuants are resorted to. Certain medicinal substances excite the pelvic circula- tion, and stimulate the parts in direct connection with the uterus, and thereby increase or promote the menstrual dis- charge. General debility being the cause of the local affection, an active administration of tonics, in connection with the emmen- agogue required, is advisable. The most prominent of this class of emmenagogues are savine, cantharides, ergot, cotton root, Seneca snake root, guaiacum, etc., etc. H^EMATINICS. Haematinics are medicinal substances which increase the number of blood corpuscles, or the amount of haematin in the blood, and hence, are administered in such diseases as are dependent on a deficiency of these elements. This class of remedies includes the preparations of iron or chalybeates, which are capable of causing changes in the condition of the blood, and also general and local tonic effects. REMEDIAL AGENTS. 107 ALTERATIVES. Alteratives are medicinal substances which are capable, when administered in small doses, of removing morbid structures and conditions, without any sensible evacuation; in other words, changing, in some inexplicable and insensible manner, certain morbid actions of the system. Alterative remedies reestablish the healthy functions of the animal economy in a slow but decided manner, acting on the various secreting organs, sometimes without any sensible increase of the secretions themselves. The effect of minute doses of mercury, iodine and other substances, upon the gland- ular apparatus, afford examples. Medicinal remedies of almost every class become alteratives by being administered in very small doses, at intervals of a few hours; and they are generally classed with stimulants and tonics, and some of them with narcotics. By their action the secretions and exhalations are increased; the exudation of plastic or coagulable lymph is diminished ; the formation of false membranes checked; the textures softened; inflammatory action arrested; and morbid growths and deposits are absorbed. Phlegmonous inflamma- tion is arrested, and visceral and glandular enlargements are dispelled. But if administered too freely, the blood may become so impoverished as to interfere with the functions of nutrition, and a marasmatic or cachectic condition be produced, the textures being softened, or even destroyed. Hence, this class of remedies should be carefully adminis- tered, and their effects be closely observed. The chief use of alteratives is antiphlogistic or resolvent; for example, the mercurials are generally employed in acute inflamma- tion, and the preparations of iodine and bromine in chronic inflammations. Included in this class are the preparations of mercury, iodine, iodide of potassium, iodoform, bromine, preparations of arsenic, phosphate and hypophosphite of lime, chlorate of potassium, permanganate of potassium, chlorine water, chlo- rinated lime, etc., etc. 108 DENTAL MEDICINE. ANTACIDS. Antacids are medicinal substances, capable of neutralizing acidity of the blood, the secretions, etc., by combining with the acid and counteracting it. The alkalies, alkaline earths and their carbonates are the substances included in this class, and the former are more energetic in their action than the alkaline earths, such as magnesia. The carbonates of these earths have little or no chemical influence upon the tissues. This class of remedies, in the form of alkaline preparations, are administered internally as antacids in cases where an unusual quantity of acid is generated in the stomach—a com- mon symptom of dyspepsia, which is indicated by acid eruc- tations, violent heartburn and marked effervescence when a carbonated alkali is taken; the acid in the stomach laying hold of the alkaline base, and resulting in a large quantity of carbonic acid being driven off Alkalies are also employed to relieve irritability of the stomach and check vomiting; also as antidotes in cases of poisoning from acids; also as antilithics, to neutralize lithic acid when it is separated in unusual quantity by the urinary secretion; also as lithontriptics, or solvents of calculi, more particularly lithates; also employed in cases of acute rheuma- tism and gout, to neutralize the excess of acid in the blood; also in diabetes mellitus, and to relieve irritability of the urinary organs, cutaneous irritation, itching of the anus, especially when such conditions are dependent on an excess of acid in the system; and also as antiplastics and resolvents in inflam- mation, and as diuretics. As a general rule, the administration of antacids should be preceded by an emetic or cathartic, and in some cases both. When a permanent effect is desired, antacids are usually combined with tonics and aromatics, and occasionally with narcotics; for when given alone the relief afforded is but transient. To prevent an irritant and purgative action on the bowels, and also to facilitate their absorption, antacid prepara- tions are administered in a state of large dilution. REMEDIAL AGENTS. 109 In dental practice antacids are also employed for correcting acidity of the fluids of the mouth, often a result of acid eructa- tions from the stomach. The class of antacids comprise the preparations of potassium, sodium, lithium, ammonium, mag- nesium and calcium. The antacids employed in dental prac- tice are principally precipitated chalk, lime water, carbonate of soda, etc. IRRITANTS. The medicinal substances recognized as irritants are sub- divided into rubefacients, epispastics, suppurants and escharotics. Rubefacients are agents employed to redden the surface by exciting the action of the capillaries, and occasioning an afflux of vascular and nervous power to the part with which they come in contact; hence pain is a usual consequence of their employment. They are used for the same purposes as blisters, and are often a good substitute for them; for example, in low degrees of inflammation, as local anodynes, as general stimulants; their efficacy as such depending upon their action on the capillary circulation, and also on the pain they occasion. They are especially serviceable in the coma and asphyxia resulting from poisons and drowning, but in cases of cerebral oppres- sion are inferior to blisters. Rubefacients are used until red- ness and pain occur, and their persistent application will cause vesication, and even gangrene. In the class of rubefacients are included mustard, capsicum, oil of turpentine, ammonia liniment, Burgundy pitch, Canada pitch, ginger, black pepper, garlic, and spice plaster. Epispastics, also called vesicants and blisters, are medicinal agents capable of producing, when applied to the skin, inflam- mation followed by an effusion of serum beneath the cuticle. As a general rule, blisters should remain on the surface of the skin six or eight hours, in order to insure their full effect. When the skin is very delicate, a shorter application will answer every purpose ; and in the case of children it is seldom necessary for them to remain longer than three or four hours. When applied to the scalp, twelve hours are generally re- 110 DENTAL MEDICINE. quired. After removing a blister, the usual dressing is some non-irritating ointment, such as simple cerate. In acute dis- eases, blistering ought never to precede such means as have a tendency to reduce inflammatory action, and the application should be as near the affected part as possible. Covering blisters with fine gauze renders them much less irritating, and does not retard their operation. If a blister is applied long enough to redden the skin, a simple poultice will complete the vesication ; and in the case of children this method should always be pursued. When it is necessary to keep the blister open, weak epispastic or savin ointment will prove sufficient. When the circulation is lan- guid in the extremities, they seldom act efficiently, and may cause gangrene by exhausting what vitality remains. When strangury is produced, the blister must be removed after three or four hours, and the part bathed with olive oil, or a poultice applied, and diluent drinks used; an opium suppository or injection will prove serviceable. Epispastics are employed as local stimulants in the treatment of inflammation ; to create a healthy inflammatory action, as in various cutaneous eruptions; to relieve pain; to destroy morbid associations by causing a powerful impression ; to stimulate the absorbing or secreting vessels of parts in the neighborhood of the affected part; to stimulate generally; to relieve threatened gangrene and pa- ralysis ; to produce local depletion as evacuants, and to prepare a surface for the endermic application of medicines. The class of epispastics include such agents as cantharides, cantharidal collodion, water of ammonia, etc., etc. Suppurants are medicinal agents, which, when rubbed on the skin, cause rubefaction, accompanied by a pustular erup- tion ; their beneficial effects being due to the counter-irritation set up. The agents of this class are generally employed in subacute, chronic laryngeal and bronchial affections, diseases of the joints, etc., etc. Included as suppurants are croton oil, antimonial ointments, etc. Escharotics, called also Cauterants or Caustics, are medi- REMEDIAL AGENTS. Ill cinal agents capable of destroying the structure and vitality of the parts with which they come in contact, producing an eschar or slough, which is followed by inflammation and suppuration of the neighboring tissues to such a degree that the slough separates from the living parts. The mode of action of an escharotic is as follows : After being applied to the skin, so as to chemically disorganize it, or destroy its vitality, a new action is set up in the vessels beneath the slough, so as to cause it to be thrown off The excavation resulting is then kept open by inserting some irritant, which maintains a copious secretion of pus from the ulcerated surface. Escharotics are divided into Actual and Potential; the actual being fire itself, while the potential are substances which destroy the living solids, either by excessive stimulation, or by producing a chemical decom- position. Iron heated to a white heat and the moxa (cones or cylin- ders of inflammable substance) represent the actual cautery; and caustic potash, nitrate of silver, burnt alum, chloride of zinc, chromic, sulphuric and nitric acids, and the nerve or arsenical paste employed in dental practice, represent the potential cautery. A sub-class is composed of what are known as Issues and Setons : the blister-issue, where the skin is re- moved by a blister, and the discharge promoted by means of stimulating applications, as the cantharidal ointment, for ex- ample; also, the pea-issue, where an incision made by the lancet is kept open by means of a pea, bean or piece of orris root. The Seton is prepared as follows : A seton needle, to which is attached a skein of silk, is passed completely through the part chosen for the operation, after which it is removed, and the ends of the silk left hanging from the wound. It is dressed once or several times a day with some mild ointment; or, if this is not sufficient to keep up the discharge, a more stimulating ointment is used. Escharotics are employed to destroy morbid growths, warts, polypi, condylomata, fungous granulations, etc.; also to relieve violent inflammation by their substitutive action ; to stimulate indolent ulcers, sinuses, etc.; to open abscesses of the liver and other internal viscera, the 112 DENTAL MEDICINE. method of " aspiration " being preferred ; to remove cancer, lupus and other morbid growths; to decompose the virus of rabid and venomous animals, and of chancres and malignant pustules, and prevent their absorption. Escharotics include such agents as caustic potassa, fused nitrate of silver, caustic soda, solution of nitrate of mercury, corrosive chloride of mercury, bichromate of potassium, the mineral acids, sulphate of copper, and the substances before referred to. DEMULCENTS. Demulcents, also called Lentitives, are medicinal substances which soften and relax the tissues. When applied to irritated or inflamed surfaces these agents diminish the heat, tension and pain. They consist principally of gum or mucilage, often combined with saccharine or farinaceous substances, and, di- luted with water, form viscid solutions. By modifying the acridity of the secretions, they are capable, to some degree at least, of relieving irritation in remote organs, although their constitutional effects are chiefly nutritive. Demulcents are employed internally to protect the gastro-enteric surface from irritating substances, especially poisons of an acrid nature; also to relieve irritation and inflammation of the alimentary canal in such affections as diarrhoea, dysentery, enteritis, gas- tritis, etc.; also in catarrhal affections, for their soothing and lubricating effects from direct contact, and also by reflex action ; and they also exert some influence in modifying the acridity of expectorated matters; also in such affections of the urinary passages as cystitis, ardor urinae, as they tend to diminish the acridity of the secretions ; also as drinks, to promote the action of the secreting and exhaling organs, and to allay the thirst in fevers; also as light diet, and to suspend substances in- soluble in water. Demulcents are employed externally in the form known as Emollients, to relieve the heat, swelling and pain of inflam- mation, wounds and burns; to hasten suppuration, as deter- gents to cleanse foul ulcers, and to promote suppuration from granulating surfaces. Mixed with water in the form of soft REMEDIAL AGENTS. 113 masses, they are commonly termed cataplasms or poultices, and have the effect of softening the parts to which they are applied as vehicles of heat and moisture. Included in the class of demulcents are such substances as gum arabic, flax- seed, tragacanth, slippery-elm bark, sassafras pith, marshmal- low, benne, quince seed, liquorice root, Iceland moss, Irish moss, starch, arrow root, tapioca, sago, barley, glycerin, py- roxylon, collodion, solution of gutta percha, honey, animal fats, such as lard, in the form of cerate (lard, 2 parts, and white wax, i part), and suet, both containing stearine. ANTHELMINTICS. Anthelmintics, or Vermifuges, are medicinal substances em- ployed to destroy and expel worms (entozoa) from the alimen- tary canal. Their action differs according to the nature of the substance used, either to destroy by a direct poisonous influ- ence or by mechanical means. The most powerful of the cathartics (drastic) also act as anthelmintics by the copious secretion and exhalation which they produce from the alimen- tary canal. When anthelmintics are employed, they must be persevered in for several days, with the occasional intervention of an active cathartic. Belonging to this class are such agents as wormseed, spi- gelia, santonica, cowhage, male fern, oil of turpentine, kameela, pumpkin seed, kousso, calomel with gamboge, calomel with pink root, iron preparations, etc., etc. COLORING AGENTS. Coloring agents are substances employed to communicate their peculiar color to pharmaceutical preparations. They include saffron, cochineal, red saunders, etc., etc.; and in dental practice, for coloring dentifrices, rose pink. In addition to the general classes mentioned, there are cer- tain sub-classes recognized, which have not been specially referred to in the preceding definitions, as follows:— 114 DENTAL MEDICINE. Absorbents, Deodorizers, Hypersthenics, Anodynes, Diluents, Hypnotics, Antemetics, Discutients, Laxatives, Anthridrotics, Disinfectants, Nervines, Antiperiodics, Emollients, Nutritives, Antiseptics, Errhines, Purgatives, Carminatives, Escharotics, Refrigerants, Caustics, Expectorants, Resolvents, Cauterants, Evacuants, Restoratives, Constringents, Excitants, Sialagogues, Counter-irritants, Febrifuges, Stimulants, Desiccatives, Haemostatics, Styptics, Detergents, ABSORBENTS. Vesicants. Absorbents, known also as Desiccatives, are medicinal agents capable of checking secretions, and drying up secretions or discharges from ulcers and suppurating wounds. Included in this class are tannic acid, oxide of zinc, charcoal, subnitrate of bismuth, starch, powdered galls, magnesia, powdered myrrh, carbonate of lime, etc., etc. ANODYNES. Anodynes, which, with sedatives, hypnotics or soporifics, are included in the group of narcotics, are medicinal agents capable of alleviating pain. Included in this class are opium, morphia, chloroform, sulphuric ether, aconite, croton-chloral, belladonna, camphor, gelsemium, cannabis indica, stramonium, hyoscyamus, carbolic acid, atropine, creasote, etc., etc. ANTEMETICS. Antemetics are medicinal agents capable of arresting vomit- ing. Included in this class are creasote, dilute hydrocyanic acid, lime water, chloral, chloroform, magnesia, dilute nitric acid, dilute phosphoric acid, belladonna, oxalate of cerium, etc. ANTHRIDROTICS. Anthridrotics are medicinal agents capable of checking perspiration. Included in this class are oxide of zinc, sul- phuric acid, acetic acid, tannic acid, sulphate of iron, haema- toxylon, etc. REMEDIAL AGENTS. 115 ANTIPERIODICS. Antiperiodics are medicinal agents capable of relieving periodical diseases, such as intermittent fevers, neuralgia, etc. Included in this class are cinchona, quinia, arsenic (in form of Fowler's solution), chloroform, chloride of soda, salicin, etc. ANTISEPTICS. Antiseptics are medicinal agents capable of arresting fermen- tative processes, thereby preventing the decomposition of organic substances. When these agents are brought in contact with disease germs they destroy their vitality. Included in this class are carbolic acid, creasote, salicylic acid, eucalyptus oil, iodoform, benzoic acid, boracic acid, pepsin, bromine, etc. CARMINATIVES. Carminatives are medicinal agents capable of dispelling flatu- lence, and allaying pain in the stomach and bowels. Included in this class are such agents as cinnamon, cardamon, cloves, coriander, lavender, ginger, juniper, carraway, peppermint, etc. CAUSTICS. Caustics are medicinal substances capable of destroying vitalized tissue. (See Irritants) CAUTERANTS (See Irritants). CONSTRINGENTS (See Astringents). COUNTER-IRRITANTS. Counter-irritants are medicinal agents which are employed to produce external irritation for the purpose of relieving or curing diseased action in another part, as in periodontitis, for example, when such agents as iodine, cantharidal collodion, creasote and iodine, ammonia, etc., etc., are applied to the gum over the root of the affected tooth. (See Irritants) DESICCATIVES. Desiccatives are medicinal agents capable of checking secre- tions, and arresting mucous discharges from ulcers, wounds, etc. (See Absorbents) 116 DENTAL MEDICINE. DETERGENTS. Detergents are medicinal agents capable of cleansing ulcers, suppurating wounds, etc., by acting as either stimu- lants or emollients. Included in this class are such agents as borax, burnt alum, slippery-elm bark, acacia, flax seed, tragacanth, etc. DEODORIZERS. Deodorizers are medicinal agents capable of destroying infectious and fetid odors. Included in this class are carbolic acid, salicylic acid, creasote, chloride of lime, charcoal, per- manganate of potash, thymol, chloride of zinc, solution of chloride of soda, oil of eucalyptus, iodoform, menthol, hydro- chloric acid, nitric acid, sulphuric acid, etc., etc. (See Anti- septics) DILUENTS. Diluents are medicinal agents capable of diluting the blood, and thus increasing its fluidity; at the same time exercising a solvent action, and eliminating a portion of the solid con- stituents. Included in this class are such agents as water, aerated water, mineral waters, rice water, beef tea, whey, barley water, gruel, etc., etc. DISCUTIENTS. Discutients are medicinal agents capable of reducing and depressing morbid growths, swellings, etc. Included in this class are iodine, mercury, bromide of potassium, iodide of potassium, chlorate of potassium, arsenic, colchi- cum, etc., etc. DISINFECTANTS. Disinfectants are medicinal agents capable of depriving effluvia of their morbific properties by chemically combining with them. Included in this class are such agents as chlorine, carbolic acid, carbolate of lime, chloride of lime, salicylic acid, solution of chlorinated soda, charcoal, creasote, hydrochloric acid, sulphuric acid, nitric acid and chloride of zinc. (See Antiseptics and Deodorizers) REMEDIAL AGENTS. 117 EMOLLIENTS. Emollients, or Protectives, are medicinal agents capable of relaxing soft tissues, allaying irritation, protecting sensitive surfaces, relieving pain in ulceration of mucous membrane. Included in this class are glycerine, collodion, solution of gutta percha, acacia, tragacanth, Irish moss, sassafras pith, flax seed, slippery-elm bark, liquorice root, wax, in the form of cerate ointment, poultices of bread and milk, yeast and flax seed, and charcoal and yeast with flax seed, lard, etc., etc. ERRHINES. Errhines are medicinal agents capable of inducing a secre- tion from the nose. Included in this class are ammonia, ipe- cacuanha, chlorine, acetic acid, orris root, etc., etc. ESCHAROTICS. Escharotics are medicinal agents capable of producing an eschar or slough, and are included among Irritants. (See Irri- tants) EXPECTORANTS. Expectorants are medicinal agents capable of promoting the excretion of mucus and other fluids from the air passages and lungs. Included in this class are squill, ipecacuanha, benzoic acid, preparations of ammonia, tartar emetic, balsam of tolu, myrrh, nitrate of potash, seneca, wild-cherry bark, lobelia, etc., etc. (See Blennorrhetics) EVACUANTS. Evacuants belong to the class of cathartics which promote alvine evacuations. (See Cathartics) EXCITANTS. Excitants belong to the class of stimulants which excite the vital powers, causing an increase of the circulation. (See Stimulants) FEBRIFUGES. Febrifuges are medicinal agents capable of diminishing the heat and allaying the thirst of fevers, and are generally recog- 118 DENTAL MEDICINE. nized as Refrigerants. Included in this class are nitrate of potassa, chlorate of potassa, the mineral acids, spirits of nitrous ether, etc., etc. HAEMOSTATICS. Haemostatics are medicinal agents capable of arresting hem- orrhage, and belong to the class of Astringents. (See Astrin- gents and Styptics) HYPERSTHENICS. Hypersthenics belong the class of Stimulants. (See Stimulants) HYPNOTICS. Hypnotics belong to the class of Narcotics, and are capable of causing sleep. (See Narcotics) LAXATIVES. Laxatives are mild cathartics. (See Cathartics) NERVINES. Nervines belong to the class of Neurotics, and are capable of relieving and curing disorders of the nerves. (See Neu- rotics) NUTRITIVES. Nutritives are medicinal agents capable of quickening assimi- lation and building up the organic tissues. Included in this class are cod-liver oil, gum arabic, glycerin, beef extracts, milk, manna, etc., etc. PURGATIVES. Purgatives are active cathartics. (See Cathartics) REFRIGERANTS. Refrigerants are medicinal agents which are capable of diminishing heat and allaying thirst. They are also called Febrifuges. Included in this class are nitrate of potassa, chlorate of potassa, solution of acetate of ammonia, acetic acid, citric acid, hydrochloric acid, nitric acid, tartaric acid, spirits nitrous ether, etc., etc. RESOLVENTS. Resolvents belong to the classes of Alteratives and Emol- lients, being medicinal agents capable of reducing inflamma- REMEDIAL AGENTS. 119 tion and dispersing morbid swellings. (See Alteratives and Emollients) RESTORATIVES. Restoratives belong to the classes of Stimulants and Tonics. (See Stimulants and Tonics) SIALAGOGUES. Sialagogues are medicinal substances capable of increasing the salivary secretion by a stimulant or irritant effect. By the excitant properties of these agents the lining membrane of the mouth is irritated, the effect extending along the ducts to the salivary glands, so that not only is the quantity of fluid exhaled from the mucous membrane increased, but salivation results. In this way depletion follows their employment, and more or less revulsive effect ensues, which may prove beneficial to distant parts affected by disease. Sialagogues may also prove useful in cases of paralysis of the tongue, etc., by their directly excitant properties ; in such cases as local palsy of the tongue. They are occasionally employed as masticatories in odontalgia, and in such affections of the head as may indicate the use of substances which excite irritation in and increased discharge from the lining membrane of the nasal cavities. Included in this class are pyrethrum, horse radish, calamus, ginger, to- bacco, calomel, corrosive sublimate, blue mass, iodide of mer- cury, etc. STYPTICS. Styptics, which belong to the class of Astringents, are medi- cinal agents capable of arresting hemorrhage when employed externally. They are divided, according to their action, into chemical and mechanical, the chemical styptics coagulating the blood exuding from the part, and at the same time stimulating the tissues to contraction ; whilst the mechanical, as lint, felt, spider's web, plaster of Paris, etc., detain the blood in their meshes, or absorb it until it coagulates, and thus arrest the hemorrhage. Among the Astringents which may be classed as Styptics, are tannic acid, persulphate of iron solution, powdered subsulphate of iron, alum, nitrate of silver, pow- 120 DENTAL MEDICINE. dered galls, sulphuric acid, matico, gallic acid, perchloride of iron. VESICANTS. Vesicants, which belong to the class of Epispastics, are medicinal agents capable of producing a serous exudation beneath the cuticle. Included in this class are cantharides, cantharidal collodion, glacial acetic acid, strong solution of ammonia, mustard, etc., etc. (See Epispastics) FORMS IN WHICH MEDICINAL SUBSTANCES ARE EMPLOYED. Alkaloids are bases capable of combining with acids to form salts, and which exist as proximate principles in certain vegetables, and possess the properties of an alkali in a greater or less degree. Alkaloids are, therefore, the active principles of medicines. Baths. Medicinal Baths are composed of tepid water, with the addition of saline, emollient, narcotic or stimulant sub- stances, such as salt, mustard, etc., etc. Cataplasms are poultices or plasters composed of soft, macerated preparations, to be applied externally. Collyria are preparations applied to the eyes. They are sometimes dry, but generally liquid, consisting of infusions, decoctions or distilled waters, with the addition of various medicinal substances. Confections, or Electuaries, are preparations made into a pulpy mass, with sugar or honey, mucilage or glycerin. Decoctions are solutions made by boiling certain vegetable ingredients in a fluid, for the purpose of extracting the parts soluble at that temperature. Emulsions are preparations composed of oils, resins, etc., suspended by means of mucilage, yolk of egg, sugar, etc. Enemata, or Clysters, are liquid preparations injected into the rectum by means of a syringe, as auxiliaries to or substi- tutes for cathartics. Extracts are preparations obtained by the evaporation of a vegetable solution, in the form of juices, infusions or decoc- tions, to a more or less fluid consistence. THERAPEUTIC forms. 121 Fomentations are fluid preparations applied to the surface of the body by means of a sponge, flannel or soft cloth. Fumigations are the vapors of medicinal substances em- ployed to purify infected air by absorbing or otherwise coun- teracting deleterious gases. They are also employed in dis- eases of the skin, and may be sometimes substituted for a local bath. Gargles ate washes for the mouth and throat, and are gen- erally astringent and stimulating, sedative, refrigerant, etc. To be of any service, gargles or mouth washes must be frequently applied and persevered in for some time. They are employed in cases of inflammation and ulceration of the mucous mem- brane of the mouth and fauces. Glycerites are solutions of medicinal substances in gly- cerine. Infusions are preparations obtained by pouring a hot or cold fluid upon vegetable substances, for the purpose of extracting their medicinal properties. Inhalants are remedies in the form of steam, for inhalation directly to the lungs. Injections are medicated fluids thrown into a natural or preternatural cavity of the body by means of a syringe. Liniments, or Embrocations, are unctuous medicinal prepa- rations to be applied externally by means of friction. Lotions are liquid preparations, or washes, to be applied to the body externally. Mixtures are fluid preparations containing several medicinal ingredients, to be administered by the mouth. Ointments, or Cerates, are preparations of the consistence of lard, composed of wax, lard, or resin, with solid or liquid ingredients, for topical application. Cerates are somewhat harder than ointments, especially where wax is substituted for the lard. Oleates are medicinal ointments. Pills are simple or compound medicinal agents, of a firm consistence, spherical or globular in shape, and generally not exceeding five or six grains in weight. 9 122 dental medicine. Plasters are preparations of a solid glutinous composition, which, at the ordinary temperature of the body, adheres to the part on which it is placed. Suppositories are solid preparations, of a round, cylindrical. or conical form, to be introduced into the anus ; and are com- posed of sedative, astringent, or purgative medicines, combined with suet, cocoa-butter, honey, or soap. Syrups are liquid conserves, made by dissolving sugar with some plant, or in water, either with or without medicinal impregnation. Tinctures are preparations in the form of solutions of the active portions of medicinal substances, in rectified or proof spirits. A tincture is called simple when it holds only one substance in solution, and compound, when two or more ingre- dients are submitted to the solvent. DENTAL MATERIA MEDICA AND THERAPEUTICS. ACACIA—GUM ARABIC. Source.—A thorny tree or shrub, of Arabia and Africa. Description.—The concrete juice which exudes spontaneously from the stem of the Acacia vera, in the form of a gum, which hardens, on exposure, in small, irregular or roundish or oval pieces, of various sizes, more or less transparent, hard, brittle and pulverizable. It is generally either white or yellowish white, but sometimes of a deep orange or brownish color; the powder, however, being pure white. It is inodorous, with a feeble, slightly sweetish taste, and when pure dissolves wholly away in the mouth. In water it forms a viscid solution, known as mucilage. It is insoluble in alcohol, ether and the oils. When kept dry, it undergoes no change. Chemical Constituents.—It consists of a peculiar proximate principle known as Gum or Arabin, composed chiefly of a soluble acid substance, Gummic Acid (H2Ci2H18Oi0H2O), com- bined with 3 per cent, of lime, forming a soluble salt, gum- mate of calcium. Medicinal Properties and Action.—Demulcent and emollient. It forms an excellent adjunct to other medicinal substances of the same class, and an ingredient in all the officinal lozenges. Dose.—Of the gum, 5j ad libitum. Of the mucilage (5iv, water Svj) 51J to Svj daily, or ad libitum. Therapeutic Uses.—Coughs and hoarseness, gastro-intestinal irritation, infantile diarrhoea, epistaxis and superficial hemor- rhages ; applied in the form of fine powder. Dental Uses.—As an emollient, in the form of mucilage, to cover and protect inflamed surfaces of mucous membrane. 123 124 DENTAL MEDICINE. As a mechanical styptic, in a finely-powdered form, in super- ficial hemorrhages, such as from leech bites, etc. Combined with borax, it is a useful application for inflamed mucous membrane. Prof. Bonafoux of the Academy of Medicine, Paris, recom- mends a powder composed of equal parts of gum arabic, colo- phony and carbon, as possessing great haemostatic powers, and capable of arresting the bleeding of large arteries. DENTAL FORMULA. For Inflamed Mucous Surfaces R. Pulveris acacise.................................... Sodii boratis....................................... Fiat pulvis. SiG.—Apply to inflamed part. ACIDUM ACETICUM—ACETIC ACID. Formula.—H C2H302. Derivation.—Purified Pyroligneous Acid. Prepared from wood by destructive distillation ; contains 28 per cent, of anhy- drous acetic acid. Specific gravity 1.047. Dilute Acetic Acid—Acidum Aceticum Dilutum, the only form in which it is employed internally, is prepared by mixing one pint of acetic acid with seven pints of distilled water. Specific gravity 1.006. Medical Properties and Action.—Refrigerant, diaphoretic, astringent, diuretic, stimulant, tonic. It allays restlessness by allaying thirst, and acts upon the skin and kidneys ; also acts as an antiscorbutic. The strong acid applied to the skin causes intense redness and pain, followed by rapid vesication. Dose.—Of acetic acid, gtt. iij to x. Of dilute acetic acid, 5j to ij. Therapeutic Uses.—Fevers, night sweats, diarrhoea, scurvy, hemorrhage of the lungs, stomach and nose. Externally, the strong acetic acid is applied in tinea capitis, psoriasis, cancer, corns, and warts; the dilute form is applied externally to gangrene, ulcerated throat, in the form of gargle, ulcers, sprains, and bruises. Owing to its volatility and pungency, its 3»j 3»J- ARSENIOUS ACID. 125 vapor, when applied to the nostrils, acts as an excitant in syncope, headache, etc. Dental Uses.—Acetic Acid is externally employed in indo- lent ulcers of the mouth, cancrum oris, and scurvy. In the form of glacial acetic acid—Acidum Aceticum Glaciale (concentrated acetic acid), it is applied externally, as a caustic, in fungous growths of gum, dental pulp, etc. In cancerous ulcerations of mucous membrane, it relieves the pain, and promotes a healthier condition. DENTAL FORMULAE. For Indolent Ulcers of the Mouth, For Inflamed Fauces. Cancrum Oris, Scurvy. R. Acidi acetici................. f"3ij R. Acidi acetici.................. f^nj Ammonii chloridi.......... 55 j Aquae............................ f^v- Mellis........................ f^iss Fiat solution. Aquae......................... f3xU- SlG.—Apply with a camel's-hair brush. Fiat gargarysma. ACIDUM ARSENIOSUM—ARSENIOUS ACID. WHITE OXIDE OF ARSENIC—ARSENIOSUM OXIDUM. Formula.—As203. Arsenic-arsenicum, the metal from which arsenious acid is obtained, is not employed as a medicine in its native state. It is combined with sulphur and certain metals, and is hard, brittle, crystalline, of a steel-gray color. When heated to a dull redness, it volatilizes in the form of a colorless vapor, with an odor like that of garlic—alliaceous. It is generally found in cobalt ore. It is a powerful poison. Derivation.—Arsenious Acid is obtained by roasting arsenical ores, and purifying by sublimation. It is in the form of a fine white powder, which is often adulterated with chalk, lime, etc.; hence it is better to procure it in the solid form or lump, which is of a milk-white color externally, and often perfectly trans- parent internally. It has no odor, and is therefore liable to be mistaken for more innocent substances, and scarcely any taste, or merely a faint, sweetish impression. Medical Properties and Action.—Arsenious acid in large doses is a virulent irritant poison, but in doses of one-sixtieth to one-twelfth of a grain, properly administered, is a tonic, 126 DENTAL MEDICINE. increasing the appetite and improving the secretions, both in quality and quantity. In large doses, in the form of Fowler's Solution—Liquor Potassii Arsenitis (prepared by boiling 64 grains of arsenious acid and bicarbonate of potassium, each in half a fluid ounce of distilled water, then adding 12 fluid ounces more of distilled water, half a fluid ounce of compound spirit of lavender, and afterward water enough to make the solution measure a pint)—it is a powerful antiperiodic. In small doses, administered for a considerable time, it modifies the blood, and through it nutrition, so as to remove various morbid condi- tions. When continuously used, a sensation of heat in the throat, oesophagus and stomach is sometimes experienced, with nausea, pain in the stomach and occasional vomiting; also, great languor or depression of spirits, with redness of the eyes, swelling of the eyelids and oedema of the face ; hence, at the first evidence of such symptoms, the remedy should be discontinued until they have passed away. When continually increasing doses are administered, the arsenic accumulates, and poisonous symptoms quickly appear; hence, it is recom- mended to begin a course of arsenic with large doses, and the quantity given regularly reduced. When arsenious acid is administered, the bowels should be well evacuated by a purga- tive, given previously, and the arsenic taken directly after a meal, but never upon an empty stomach, on account of gastric irritation. Its use should be omitted for a day or two every two or three weeks, and a mild aperient employed, in order to prevent the accumulation of the arsenic in the system. A few drops of laudanum added to the arsenical preparation will prevent nausea and vomiting. All arsenical preparations should be administered with the greatest regularity, at stated times. During the employment of arsenic, the eyes of the patient should be examined daily, and if the eyelids and conjunctiva become inflamed, the remedy should be discontinued; also, when the urine, from being pale and copious, becomes scanty, acid and high-colored, the arsenic should be suspended. Poisonous symptoms have been caused by half a grain of ARSENIOUS ACID. 127 arsenious acid, and fatal effects have followed the administra- tion of two grains, although much larger quantities have been taken with impunity; very large quantities often causing emesis, which removes the substance from the stomach, and thus prevents fatal effects. When the idiosyncrasies of the patient are unknown, it is better to use small doses before beginning with large doses. The quantity of arsenic required to produce a fatal effect varies according to the susceptibilities of the patient and the state of the stomach. Much, however, depends on the idiosyncrasies of the individual, which differ greatly in different persons. When large quantities are taken, the effects are sometimes manifested on the cerebro-spinal system, death following, from narcotism, in a short time. When arsenious acid is swallowed or applied to a denuded surface, it is rapidly absorbed into the system ; hence it is a dangerous agent, and in every case should be carefully used, and its effects closely watched. It possesses a very powerful antiseptic property, arresting the process of putrefaction. The stomach and alimentary canal of persons who have died from its effects have been found in a perfect state of preservation for a long time after interment. Poisonous doses produce great intestinal inflammation, with ulceration in some cases, and rarely, gangrene. It has also been detected after death, in the blood, in the urine, and also in the liver, spleen, kidneys, muscles and stomach. A certain degree of tolerance in the use of arsenic may be established, where poisonous doses can be taken with impunity. Such a state may be produced by the constant legitimate use of the agent, or in the case of those who begin the habit of arsenic eating at an early age, and who find this practice of service in increased breathing power, strength, and improved bodily condition. As long as such a habit is continued, no ill effects are apparent, but as soon as the arsenic is discontinued, symptoms resembling those of poisonous doses make their appearance. Arsenious acid acts locally as an escharotic, but while a true escharotic acts chemically, producing decomposition of the 128 DENTAL MEDICINE. part to which it is applied, a state incompatible with life, arsenic destroys the vitality of the organized structure, and its decomposition is the consequence. This distinction should be remembered in the use of arsenious acid in dental practice. Arsenic is eliminated by the liver, kidneys, intestinal canal and bronchial tubes ; and it is thought that some of the symp- toms produced by it have their origin in the local effects of the poison on the channels of excretion. The symptoms of gastro-intestinal arsenical poisoning—the more common form—are described by Bartholow as follows : Burning sensation at the epigastrium, and extending over the abdomen ; violent and uncontrollable vomiting; excessive dry- ness of the mouth and fauces, intense thirst, intestinal irrita- tion, bloody and offensive stools, retracted abdomen, strangury, suppression of urine, or bloody urine, and in females menor- rhagia; rapid and feeble action of the heart, oppressed breath- ing, great agitation and restlessness, shrunken features, cold breath, involuntary evacuations, collapse ; consciousness being retained to the end. The symptoms of the cerebral form of arsenical poisoning are profound insensibility and coma, similar to extreme opium narcosis. The effects of arsenical poisoning, when not fatal, are felt for a long time in the form of gastro-enteric irritability, an irritable condition of the skin, stiffness of the joints, neural- gic pains, numbness, formication, paralysis, etc. After death from arsenical poisoning, the gastro-intestinal mucous membrane exhibits deep redness, erosions, ecchymosis and softening. Death generally occurs in the midst of con- vulsions, followed by rigid spasm of the whole body. When arsenic has been injudiciously administered for too long a period, in addition to the irritation of the conjunctiva, swelling of the face, desquamation of the skin, etc., salivation has been observed in some instances, and at times a peculiar silvery whiteness of the tongue. Dose.—Of arsenious acid, gr. fa to gr. fa, in pills with bread crumb three times a day. Of liquor potassii arsenitis (Fow- ARSENIOUS ACID. 129 ler's Solution), n\,ij to nix, three times a day; each fluid drachm contains half a grain of arsenious acid. Arsenic is contraindicated in infancy and childhood; in all sthenic diseases accompanied by strong arterial action ; in all irritable conditions of the stomach and alimentary canal; and in all inflammatory pulmonary affections. Therapeutic Uses.—In intermittent and periodic diseases, such as malaria, neuralgic and spasmodic diseases, being of great vatue in neuralgia, especially when of a malarial type, hemicrania, chronic rheumatism, asthma, whooping-cough, chorea, diseases of the skin, vomiting of pregnancy, hay fever, irritative dyspepsia, uterine affections, bites of venomous snakes, etc. Externally it is applied to cancerous growths ; hypodermically, in cases of local chorea. Arsenic is also employed medicinally in the forms of arseni- ate of iron {Ferri Arsenias) and arseniate of soda (Soda? Arsenias). Dental Uses.—The devitalizing power of arsenious acid being far more powerful than its escharotic power, it has been em- ployed for many years to destroy the vitality of the pulps of teeth, for which purpose it is generally combined with either the acetate or sulphate of morphia and sufficient creasote to form a paste, to prevent, or at least mitigate, the extremely painful action of the arsenic when topically applied to living tissue. It was formerly supposed that creasote was a solvent for the arsenic, but this is now denied. Carbolic acid may be substituted for the creasote. As the danger of absorption is great, there is considerable risk in applying arsenious acid to the teeth of young persons, or those very susceptible to the influence of this agent; hence other escharotics, such as repeated applications of carbolic acid, or pepsina porci, with dilute hydrochloric acid, or nitric acid, chromic acid, or chloride of zinc, or the galvanic cautery, or the surgical method of introducing into the body of the pulp a barbed wire, are employed in such cases. The arsenious acid, when employed for the devitalization of dental pulps, has been combined with pulverized charcoal, under the impression 130 DENTAL MEDICINE. that the latter prevents the rapid absorption of the arsenic, and thus limits its action mechanically rather than therapeuti- cally. The creasote (or carbolic acid), employed in combination with the arsenious acid as a nerve paste, obtunds sensibility, acting as a styptic, antiseptic and escharotic; hence some depend upon this agent alone to modify the action of the arsenic, and dispense with the morphine. Tannic acid and tincture of aconite are sometimes substi- tuted for the morphine and creasote, or carbolic acid, in the preparation of a nerve paste. Arsenious acid is also employed alone, in the form of the dry powder, to devitalize pulps of teeth; but it is not only more painful, but less prompt in its action than when it is combined with other agents. Previous to the application of the arsenical preparation, chloroform, tincture of aconite, or sulphate of atropia, may be applied to the exposed portion of the pulp, and the painful effect of the arsenic be thus modified. The spray of rhigolene, or absolute ether, has been employed for this purpose. The quantity of arsenious acid to be employed for devitali- zation will depend upon the structure and class of the tooth, varying from the fa to the fa of a grain; also the length of time the arsenical preparation should remain in the tooth, as the condition of the pulp and tooth, the age of the patient, the quality of the tooth structure and the susceptibility of the patient, should all be considered. While in most cases pulps are readily devitalized by the application of a moderate quantity of the agent, in other cases, it appears to be impossible to accomplish this object without extra measures are resorted to. In teeth of a soft, frail structure, owing to an excess of organic matter, the arsenic is rapidly absorbed; but if, on the other hand, the tooth is of a dense structure, the retention of the arsenical preparation for a much longer time may not be attended with any injurious effects, such as periosteal inflam- mation. From twelve to twenty-four hours are generally required to enable the arsenious acid to properly devitalize the pulp of a tooth; the difference in time depending upon the ARSENIOUS ACID. 131 quantity of the acid employed, as well as upon other circum- stances already enumerated. To produce a speedy effect, the pulp should be freely exposed by the careful application of the excavator, and the devitalizing agent applied directly to the surface of the organ. Accuracy as to the quantity of the arsenious acid to be employed may be arrived at by having a grain divided into twenty or twenty-five parts, by weight, in the form of the dry powder. A pellet of cotton, on the end of an excavator, may then be saturated with creasote or carbolic acid ; and the desired quantity of the powder, being taken up on the pellet, can be placed directly in contact with the ex- posed surface of the pulp, and secured in the carious cavity by means of a second pellet of cotton, saturated with either san- darach or shellac varnish, a solution of gutta percha and chlo- roform, wax, or softened gutta percha. Some prefer to wound the pulp, so as to draw blood, before the application of the arsenical preparation is made, and thus insure its speedy action. Care is necessary that the arsenic should be completely secured in the carious cavity, and no portion of it come in contact with the parts outside of the tooth. In the case of proximal cavities, a roll of bibulous paper, saturated with sandarach varnish, may be pressed be- tween the teeth, beyond the cavity, and thus prevent the arsenical preparation from coming in contact with the gum and cheek. After the devitalization of the pulp has been accomplished, it is necessary that every particle of the arsenic should be removed from the tooth. The effect of permitting the agent to remain in the tooth for a longer time than is ne- cessary for the devitalization of the pulp only, is periosteal inflammation. Where several applications of the arsenical preparation fail to produce the desired devitalization, the resist- ance thus offered to the influence of the agent may be owing to several causes : a granulated, protective covering, which is formed over the surface of the exposed portion of the pulp, which defends it from the action of the arsenic; or, extraordi- nary vital power in the pulp, which may be due to the peculiar constitution of the patient, who probably would not be as sus- 132 DENTAL MEDICINE. ceptible to the action of arsenic as the majority of persons are, even if it were administered by the mouth. Such resistance to the action of the devitalizing agent may be overcome, either by the removal of the granulated surface where it exists, or, in cases of non-susceptibility, by puncturing the pulp with a pointed instrument, charged with the arsenical preparation; first taking the precaution to obtund the sensi- bility of the organ by the application of a benumbing agent. ' Arsenious acid is also employed in dental practice to obtund the undue sensitiveness of dentine, but less frequently now than in past years, as its action is due more to a devitalizing energy than to a chemical action, such as a true escharotic produces. As it is capable of being absorbed through a con- siderable thickness of dentine, the result of which would be the death of the pulp, arsenious acid, if it is employed for obtunding the sensibility of the dentine, should be suffered to remain in the tooth but a very short time—from one to three hours—and every particle of it carefully removed. As there are many agents which prove effective for such a purpose, it is much better to refrain from the use of arsenious acid as an obtunder of dentinal sensibility. DENTAL FORMULaE. For Devitalizing Pulps of Teeth. Flagg. Pierce. R. Acidi arseniosi........ gr.j R. Acidi arseniosi........ gr.x Morphinae acetatis... gr.ij Morphinae sulphatis.. gr.xx Acidi carbolici......... gtt.iij. M. Creasoti................. q.s. Fiat massa. To make a thick paste. SlGNA.—The proper quantity to remain Signa.—To remain 24 hours for adults; 12 to 24 hours. 10 hours for children. Garrettson. To Destroy Cancerous Tumors. R. Acidi arseniosi, R. Acidi arseniosi........ 3J Morphinae acetatis aa gr.x Adipis, Creasoti................. q.s. Cerati cetacei...aa... ^vj. To make a thick paste. Signa.—Melt the cerate and lard over Signa.—To remain 24 hours for adults; a slow fire, and then stir in the ar- 10 hours for children. senic, and triturate carefully in a If a very irritable condition is pres- glass mortar. ent, sulphate of atropia may be sub- stituted for the morphia. ARSENIOUS ACID. 133 Hollander. R. Acidi arseniosi........ g?xx R. Acidi arseniosi........ gr-xrj Morphinae acetatis... gr.x Morphinae acetatis... gr.ij Creasoti................. q.s. Olei caryophylli...... gtt.iv To make a thick paste. Creasoti................. q.s. SlGNA.—To remain 12 to 24 hours for Ut fiat pasta. adults; 8 to 10 hours for children. R. Acidi arseniosi......... gr.v R. Acidi arseniosi.................. gr.x Acidi tannici.......... gr.x Morphinae acetatis............ gr.xl Tincturae aconiti...... q.s. Creasoti, vel acidi carbolici... q.s. To make a thick paste. To make a thick paste. SlGNA.—To remain 24 hours. SlGNA.—To remain 12 to 24 hours. J. D. White. For Malignant Ulcerations of a Can- R. Acidi arseniosi........ gr.ij cerous Character. Morphinae sulphatis.. gr.j R. Liquoris hydrargyri nitratis.. f^j. Creasoti................. q.s. M. A powerful caustic. Fiat massa. Signa.—Applied by means of a camel- SlGNA.—To remain from 12 to 24 hair brush, and the parts then cov- hours. ered with lint. Tests for Arsenic.—Arsenic, in the solid state, may be de- tected by its volatility; heated over a spirit-lamp, it passes off in the form of a white vapor, devoid of smell, and is deposited on a cool surface, as an amorphous powder, or in octahedral crystals. When arsenic is thrown on burning charcoal, it is deoxidized, and gives out the garlic odor of metallic arsenic. When heated in a glass tube with charcoal or black flux, it sublimes, and condenses in the form of a brilliant steel-gray ring or mirror. The following reagents will detect it when it is in aqueous solution: Sulphuretted hydrogen, or sulphide of ammonium, produces a lemon or yellow sulphide of arsenic; the addition first of ammonia, and then of nitrate of silver, produces a light- yellow arsenite of silver; the addition of potassa, and then of sulphate of copper, produces a light-green arsenite of copper. The most delicate test, however, is that of nascent hydrogen, known as Marsh's Test, which consists of subjecting the arsenic to the action of nascent hydrogen (evolved by the action of diluted sulphuric acid on pure zinc); it is deoxidized, and unites with the hydrogen to form arseniuretted hydrogen gas, which has the odor of garlic, and burns with a bluish-white 134 DENTAL MEDICINE. flame, depositing a black spot of metallic arsenic on the surface of a cold plate held directly in the jet. Reinsch's Test consists in boiling the suspected material with hydrochloric acid and clean copper foil, when, if any arsenic is present, the copper foil becomes coated with gray metallic arsenic. Cobalt.—Cobaltum {Formula, Co)—is a metal chiefly found in combination with arsenic, either in the form of the arsenide {tin-white cobalt), or as gray cobalt ore, with sulphur and arsenic. The late Dr. Robert Arthur preferred cobalt as a devitalizing agent to arsenious acid, being of the opinion that less irritation followed its action, and consequently greater immunity from periosteal inflammation. Others, however, do not regard cobalt as being any safer, but, on the other hand, less prompt in its action as a devitalizing agent. ACIDUM BENZOICUM—BENZOIC ACID. Formula.—H C7H502. Derivation.—Benzoic Acid is obtained from benzoin (a bal- samic resin, which exudes from the incised stem of a tree of Sumatra, Java, Borneo and Siam), either by sublimation or by the action of alkalies ; it is also made from hippuric acid. It is in the form of white, feathery crystals, of a silky lustre, a peculiar, agreeable odor, and warm, acidulous taste. While it is sparingly soluble in cold water, it is more soluble in warm or boiling water, and very soluble in alcohol, solu- tions of potassa, soda, ammonia, lime, and concentrated sulphuric and nitric acids. The fixed oils also dissolve it. From solution it crystallizes in transparent prisms. It is also inflammable. Medical Properties and Action.—Benzoic acid is stimulant, particularly of mucous surfaces, and its vapor causes great irritation of the air passages. It is also antiseptic and expec- torant, and some claim that it is a more powerful antiseptic than carbolic acid. Like salicylic and boracic acids, it pre- vents fermentation and putrefaction and destroys minute organisms. In the system, it is converted into hippuric acid, BENZOIC ACID. 135 by the assumption of the elements of glycocoll, and in this form is excreted in the urine ; a large part is excreted by the kidneys, as benzoic acid. Therapeutic Uses.—Benzoic acid is employed in chronic cys- titis, gout, calculous diseases, jaundice, incontinence of urine in children, etc. Dose.—gr. x. Dental Uses.—Benzoic acid may be employed as an anti- septic in suppurating and gangrenous conditions of the pulps of teeth and mucous membrane ; also as a local haemostatic in combination with powdered alum. It forms one of the ingre- dients of Dr. Chapin A. Harris' Gum Wash. The tinctures of benzoin are employed in the treatment of unhealthy and sloughing wounds, flabby granulations, foul ulcers, as they destroy the fetor and stimulate to a more healthy growth. In the antiseptic employment of benzoic acid, it may be used as a substitute for boracic and salicylic acids. The addition of borax will increase its solubility in water. Benzoate of Ammonium—Ammonii Benzoas—will dissolve phosphatic calculi, if its use is long continued. Benzoated Lard, when employed in the preparation of oint- ments, prevents chemical change, such as rancidity or acridity. It is prepared by digesting, at a moderate heat, 5ij of powdered benzoin with a pound of lard. Listerine, the formula of which is thyme, eucalyptus, bap- tisia, gaultheria, and mentha arvensis, in combination, each fluid drachm also containing two grains of benzo-boracic acid, is largely employed as an antiseptic, deodorizer, and disinfectant, in surgical practice, in the form of a lotion, a gargle, a dressing, or an injection. In dental practice, listerine is reliable in carious teeth, ulcerations of mucous membrane, and wounds of the mouth, in the form of a lotion or dressing; for alveolar abscesses, in the form of an injection; after the extraction of teeth, as a mouth wash ; and for offensive breath, as a gargle. It may be employed in its full strength, or in various degrees of dilution with water. 136 DENTAL MEDICINE. For such diseases as diphtheria, catarrh, dysentery, scarlatina, erysipelas, smallpox, different forms of fevers, etc., the dose is one teaspoonful three or more times a day (as indicated). ACIDUM BORICUM—BORIC ACID—BORACIC ACID. Formula.—H B02. Derivation.—Boracic Acid is obtained artificially by decom- posing a hot saturated solution of borax with sulphuric acid, which unites with the soda to form sulphate of soda, and liber- ates the acid. It is in the form of white, shining crystals, of a scaly nature. It is soluble in 26 parts of cold water, in three parts of warm water, and feebly soluble in alcohol. Medical Properties and Action.—Boracic acid is antiseptic and deodorant. It destroys minute organisms, and arrests fermentation and putrefactive decomposition, and is said to be as effective, as an antiseptic, as carbolic acid, and less irritating than salicylic acid. Therapeutic Uses.—It is locally employed as a dressing for wounds, ulcers, burns, scalds, skin-grafting, etc., as it is non- irritating, and lessens suppuration, and prevents decomposition. Boracic acid is employed in all the forms and combinations in which carbolic and salicylic acids are used by the antiseptic method, in the form of a saturated solution. Boracic Lint is made by steeping lint in a saturated solution at the boiling point. Dose.—Of boracic acid, gr. viij to xvj. It does not cause any disturbance of the stomach, and is eliminated in the urine. Boro-glyceride is composed of boracic acid 62 parts, and glycerine 92 parts, each gently heated over a water bath and the boracic acid gradually added to the glycerine, and the heat continued until 54 parts, or three molecules of water are driven off. It is amber-colored and very friable, and proves to be a valuable antiseptic. Boro-glyceride has an acid, pungent taste, and an astringent effect on mucous membranes, and is free from some of the objections to the use of the boracic acid powder. (See Glycer- ine for Glyceroborates of Sodium and Calcium.) CARBOLIC ACID. 137 Boracic Ointment is composed of boracic acid I part; par- affin 2 parts; almond oil 2 parts. When used it should be mixed with a little glycerine. Dental Uses.—Boracic acid may be employed as an antisep- tic in all the forms and combinations in which carbolic and salicylic acids are used, and when it is combined with sulphite of soda, the compound forms a valuable preparation for bleach- ing discolored teeth. (See Sulphite of Soda.) Boracic acid, in ten per cent, solution, may be used with benefit, in the form of an injection into suppurating cavities. Combined with glycerine in the form of boro-glyceride, a valuable application is secured for antiseptic dressings and injections. ACIDUM CARBOLICUM—CARBOLIC ACID. PHENIC.ACID; PHENYL ALCOHOL; PHENYLIC ACID. Formula.—C6HsO H. Derivation.—Carbolic Acid is obtained from coal tar by frac- tional distillation and subsequent purification, being extracted from that part of the heavy coal-tar oils which distill over between 1500 and 2000 Centigrade. Specific gravity 1.065. When pure, it is in the form of colorless acicular crystals, which at 95 ° F. become an oily liquid, possessing a strong odor and taste, closely resembling creasote, which it resembles in characters and properties, although it is a different substance. Much of what is called creasote is nothing but impure carbolic acid {Acidum Carbolicum Impuruni), combined with two other substances, similar in constitution, and known as creasole and phosole. Chemically considered, carbolic acid is an alcohol rather than an acid, and its crystals readily absorb moisture on ex- posure to the air, and are thus liquefied. It crystallizes at 700 F., and becomes liquid at from 900 to 950 F., and fuses at 930 to 1060. It is freely soluble in alcohol, ether, chloroform, glycerine and the essential oils. When carbolic acid is liquefied and discolored by exposure, it is diffi- cult to detect it from creasote, as it possesses the same odor, 10 138 DENTAL MEDICINE. taste, caustic properties, and a like affinity for albumen. Car- bolic acid is soluble in from twenty to twenty-three parts of water, the purest being the most soluble. A small quantity of water will convert it into the liquid state, but will not dis- solve it. Crystallized carbolic acid may be dissolved by a small quantity of cologne water; and to prevent recrystallization and prepare it for use in the form of injections, for example, the bottle containing it should be warmed by immersion in hot water, until it becomes fluid, and about five per cent, of rectified alcohol, or a few drops of glycerine, be added. The red color which it assumes on exposure is thought to be caused by the ammonia in the air, and also by the presence of copper in the acid, which is affected by the ammonia of the atmosphere. Medical Properties and Action.—Carbolic acid resembles creasote so closely, in many of its characters and medicinal properties, that the therapeutic applications are the same in the case of both of these substances. Many, however, con- sider carbolic acid to be more efficacious in obstinate dis- charges than creasote ; and also less irritating in its crystalline form when applied to very sensitive organs, such as the pulp of a tooth. In its pure state it is escharotic; when diluted, it is rube- facient, anaesthetic and antiseptic. Internally administered, it is sedative and carminative, possessing the power of allaying vomiting and gastric irritability. As an antiseptic, Prof. Lister regards carbolic acid to be superior to all other agents, as it is a most potent poison to all the low forms of life which determine putrefaction, as it retains this power, even when diluted to such a degree as to be almost entirely unirritating to the tissues of the human body. One per cent, in strength is sufficient to destroy bacteria, vibrios, etc. On account of its volatility, the vapor of carbolic acid is also efficacious as an antiseptic. Eisentein, however, regards carbolic acid as an antipyretic as inferior to salicylic acid, and others regard boracic acid as possessing equal antiseptic properties. As a local anaesthetic, carbolic acid exerts a very CARBOLIC ACID. 139 soothing influence upon painful tissues; hence it is beneficial in odontalgia, and for pulp dressing. On account of its solu- bility, a variety of solutions of special value can be formed with it, which are especially serviceable as antiseptic appli- cations. The application of large quantities of carbolic acid to an extensive surface is, however, dangerous, as cases of fatal poi- soning have resulted by the absorption of this acid; hence, care is necessary in its use as an external application. Its nauseous odor and taste and its caustic action render it objectionable, unless greatly diluted, for internal administration. To obviate such objections, it is recommended to use it in the form of sulpho-carbolates. When applied to the skin or to mucous membrane, it pro- duces a burning sensation, of short duration, and the eschar is at first whitish', afterward becoming brown or black, and surrounded by a zone of inflammatory redness; and, notwith- standing its power to coagulate albumen, is rapidly diffused into the blood. Carbolic acid exists in the blood as a carbo- late; and the blood itself does not appear to undergo any change in its corpuscular elements. It is in part consumed in the body, and the products of its combustion are excreted in the urine. Solutions of carbolic acid of adequate strength will check suppuration, and correct the fetor of ulcers, etc. Therapeutic Uses.—Internally, it is employed for nausea and vomiting due to an irritable state of the stomach, in scarlatina, measles and smallpox, pyrosis, etc.; as a gargle in diphtheria ; as an inhalation in chronic nasal catarrh, hay asthma, whoop- ing-cough, phthisis, etc.; as an injection in chronic cystitis, primary syphilis, erysipelas, pleuro-pneumonia and uterine diseases; as a lotion in gangrenous and other ill-conditioned ulcers, carbuncle, poisoned wounds, burns, skin diseases, scrofu- lous ophtKalmia and itching of the skin. Dose.—Of crystallized carbolic acid, gr. j to gr. ij, largely diluted. A better form, however, is one drop of the crystallized acid, liquefied by heat, in one ounce of mucilage, three times a day. The dose of glycerite of carbolic acid {Glyceritum 140 DENTAL MEDICINE. Acidi Carbolici), made by rubbing together Sij of carbolic acid with Oss of glycerine, is rojv. The dose of carbolic acid water (Aqua Acidi Carbolici), f5x ; of the glycerite, dissolved in distilled water, enough to make the mixture measure a pint, the dose is f5ss to f5j. Impure carbolic acid is employed for disinfectant purposes. Ointment of carbolic acid (Unguentum Acidi Carbolici)— carbolic acid, 5j ; lard, Sj- Sulpho-carbolic acid (HC6H5S04) is considered to be a very efficient antiseptic and disinfectant. Sulpho-carbolate of zinc (Zn (C6H5S04)2H20), combines the virtues of zinc salts and carbolic acid, and is used internally, in diarrhoea, and externally, in aqueous solution of from three to six grains to the ounce, as a dressing for wounds and ulcers and an injection in gonorrhoea. Sulpho-carbolates of sodium, potassium, magnesium, calcium, and quinia are employed as antiseptics in cholera and zymotic diseases generally. Dental Uses.—Carbolic acid being antiseptic, styptic, eschar- otic, stimulant and sedative, or narcotic, is a valuable agent in dental therapeutics. When applied to carious dentine, it not only obtunds sensibility, but arrests putrefactive changes in the devitalized structure, and coagulates the albuminous ele- ments at the ends of the dentinal tubuli. It relieves odontalgia when applied to the surface of an exposed and painful pulp. It is also invaluable in the treatment of alveolar abscess ; and, in combination with iodine or other agents it is often employed with beneficial effects in the treatment of dental periostitis. When employed in the treatment of alveolar abscess, as an antiseptic, although the discharge of pus may be increased for a short time after its application, there is soon manifested a decided diminution in the quantity secreted. When applied to a suppurating pulp it arrests putrefaction, and induces a healthy action without irritation. It is also a valuable antiseptic application in ulcerations of the mucous membrane of the mouth, gangrenous conditions and mercurial stomatitis; for such purposes being combined with glycerine CARBOLIC ACID. 141 and other agents. Applied to exposed pulps, it forms, by escharotic action, an eschar, which some regard as con- ducive to the recovery of the organ, while others prefer to use it in a diluted form, for the same object, objecting to its employment in its pure state, on account of its escharotic or caustic effect. It is also useful as a styptic in cases of superficial hemor- rhage from the gums after the extraction of teeth, especially in combination with other agents. A preparation known as phenol sodique is often employed for such a purpose. Oil of cloves, when added to an equal quantity of carbolic acid, will disguise, to some extent, its taste and odor. It can also be perfumed by adding to I part of carbolic acid 3 parts of oil of lemon and 100 parts of alcohol (36 degrees). Carbolic acid is also employed to check the hemorrhage resulting from the application of leeches to the mucous membrane of the mouth. When applied to an ulcerated surface, it should be repeated, as pus is formed or fungous growths appear; and, having formed an eschar when applied to an exposed pulp, it should not be repeated until the eschar is detached from the surface. It has also been employed in the form of hypodermic injections, for the relief of neuralgia. Carbolic acid is also useful as a local anaesthetic. 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 upper dentures. When properly diluted with alcohol, it renders soft and spongy gums firmer and less tender. It will also correct fetor of the breath arising from carious teeth, smoking, etc., acting as a deodorizer. In all fetid discharges from the mouth, throat, etc., carbolic acid, combined with glycerine or an aqueous solution, may be used with advantage. The pure acid is employed for bathing cavities in teeth, preparatory to the introduction of the filling material, for its effect on sensitive or softened dentine and low organisms. 142 DENTAL MEDICINE. A Lotion for Soft and Spongy Gums. R. Acidi carbolici......... gr.xx Spiriti rectificati (al- cohol) ............... gij Aquae destillatae...... ^vj. M. It renders the gums less tender and firmer. DENTAL FORMULAE. A Disinfectant Mouth Wash. Dr. J. B. Patrick. R. Acidi carbolici (cryst.), Glycerini, Aquae rosae.....5a..... .^ij. M. Signa.—Five to eight drops in a wine- glass of water. An Antiseptic Lotion or Injection. R. Acidi carbolici......... £ss Glycerini .............. 3XV- M. For alveolar abscess and ulcers of mouth. The glycerine modifies the caustic action of the acid. A Stimulant and Antiseptic Lotion. Dr. J. Stocken. R. Acidi carbolici........ 3] Glycerini............... c^iv Aquae................... ^x. M. Useful in ulceration of the gums and mucous membrane. For Sensitive Dentine and Alveolar Pyorrhoea. Dr. J. A. Robinson. R. Acidi carbolici (cryst.), Potassae caustic.aa... partes equal. Misce, by triturating in a mortar until a crystalline paste is formed. Signa.—Apply on a loosely rolled twist of cotton about neck of tooth, for alveolar pyorrhoea. It is known as the "Robinson Remedy." For Alveolar Pyorrhoea (Rigg's Disease). R. Acidi carbolici........ ttlxxv Potassii iodidi......... gr.v Zinci chloridi......... gr.xxv Alcohol absolut....... ttlxxv Aq. destillatae......... rt^x 01. menthae pip....... m^v. Misce et filtra. Signa.—As an injection in pockets of gum. A Stimulant and Antiseptic Mouth Wash. R. Acidi carbolici........ gtt.xx Glycerini............... %iv Aquae................... ^x. M. Signa.—To be used as a gargle. R. R. For Fetid Perspiration. Acidi carbolici........ 2 parts Glycerini............... 3 parts. M. For Parasitic Skin Diseases. Acidi carbolici........ ^j Glycerini............... ^j. M. For Wounds and Ulcers, to Produce an Antiseptic Scab. R. Melt together, with a gentle heat, stearine, 15 parts; rosin, 60 parts; and when the mass has somewhat cooled, but is still liquid, add 25 parts of carbolic acid. This mixture is then incorporated with from 700 to 800 parts of precipitated carbonate of calcium, and carefully reduced to a uniform powder. For Inhalation in Syphilitic Ulcera- tions. R. Acidi carbolici........ 3XX] Aquae destillatae...... 3 iij. M. Signa.—Inhale the vapor. Antiseptic. A Stimulant and Antiseptic Injection. R. Acidi carbolici......... 1 part. Glycerini............... 30 parts. M. Useful as an injection in chronic forms of alveolar abscess. CARBOLIC ACID. 143 For Odontalgia. R. Acidi carbolici, Chloroformi, Liquidi opii, Vel morphinae hydro- chloratis.....aa..... gij Tincturaebenzoini.... !|j. M. Apply to exposed surface of pulp, on cotton. For Alveolar Pyorrhea (Rigg's Disease). R. Acidi carbolici........ n^v Spts. vini rectif....... gvj Aq. menthae pip...... 3 ij . 01. anisi................ rnj 01. cinnamon......... TTlss. M. Signa.—Apply to gum with camel's- hair brush. A Stimulant and Antiseptic Lotion or Injection. Percy Boulton. R. Acidi carbolici........ TTlvj Tincturae iodi......... TT\xlv Glycerini............... ^j Aquae destillatae..... ^v. M. For inflamed mucous membrane, and an injection for chronic alveolar ab- scess ; also useful in acute abscess after the use of more powerful escharotic and antiseptic agents. For Itching of the Skin. R. Acidi carbolici........ 15 ij Glycerini................ !|j Aquae rosae............ ^v'ij- M. Signa.—To be applied by means of a sponge. The following preparation is recom- mended for the relief of odontalgia, by Dr. K. W. Millican: — " Melt white wax or spermaceti, two parts, and when melted add carbolic acid crystals, one part, and chloral hy- drate crystals, two parts; stir well till dissolved. While still liquid, immerse thin layers of carbolized absorbent cotton-wool, and allow them to dry. When required for use, a small piece may be cut off and slightly warmed, when it can be inserted into the carious cavity of the tooth, where it will solidify." An Antiseptic and Disinfectant Denti- frice. J. Stocken. R. Acidi carbolici......... TTlxxx Pulveris ossis sepiae.. ^ij Pulveris radicis iridis 3 ij Cretae preparatae...... ^ iij Olei caryophylli...... gtt.iij. M. For a Carbolized Styptic. R. Acidi carbolici........ x parts Collodii................. c parts Acidi tannici.......... v parts Acidi benzoici......... v parts. M. It coagulates blood and albumen, and cicatrizes the tissues. For Chilblains. R: Acidi carbolici........ srj Tincturae iodi......... £ij Acidi tannici.......... t^ij Cerat simplicis......... ^iv. M. Fiat unguentum. For Odontalgia. R. Collodii (flexile)...... %] Acidi carbolici........ 3 ij. M. Signa.—Apply to surface of exposed and painful pulp. For Odontalgia. R. Acidi carbolici......... ^ij Morphinae acetatis... gr.xx. Solve. Applied to surface of exposed pulp, on cotton. 144 DENTAL MEDICINE. ACIDUM CHROMICUM—CHROMIC ACID. Formula.—Cr03. Derivation.—Chromic Acid is obtained in the form of bril- liant, deep red, acicular crystals, by the reaction of strong sul- phuric acid upon a solution of bichromate of potash. It is deliquescent, and very soluble in water and alcohol, forming an orange-yellow solution. Medical Properties and Action.—It is a powerful caustic, de- composing the tissues by rapid oxidation; and although it is very slow and gradual in its action, yet it is deeply penetrating, and when action ceases, sesquioxide of chromium remains. So destructive is its effect, that small animals are dissolved entirely, bones and all, by it, in fifteen or twenty minutes. On account of its penetrating deeply, without much pain, care is necessary in its use; and when used as a caustic, the sur- rounding tissues should be well protected. The part on which it acts first becomes yellow, then brown, and ultimately black, and the eschar is detached in from twenty-four to forty- eight hours. It is a powerful oxidizer, and gives up its oxygen readily to organic matter, which it thus dissolves. When in solution, more or less diluted, its action can be modified, according to the effect desired. Therapeutic Uses.—Chromic acid is not given internally. In the form of paste, or solution with water, it is a valuable caustic in cancerous and other ulcerations, malignant growths, hemor- rhoids, warts, etc. Chromic acid has been employed with good effect in syphilitic sores, cases of secondary syphilitic deep and jagged ulcers of the tongue, and ulceration of inside of the cheek, mucous tubercles and condylomata. It has also been employed in the treatment of granular ophthalmia, uterine hemorrhage, uterine catarrh, etc. It causes less pain than nitric acid and other caustics, and should never be applied to a surface to be cauterized in a layer deeper than a line in thick- ness. For removal of warts, etc., it is employed in a solution of 100 grains to the ounce of distilled water. Dental Uses.—In dental practice chromic acid has been em- ployed for obtunding sensitive dentine; but its most valuable GALLIC ACID. 145 application is for the removal of tumors and morbid growths upon the gums, fungous growths of tooth pulp, etc. When applied to any part of the mouth, the surrounding parts should be carefully protected by folds of lint or strips of adhesive plaster. A glass rod, or a gold or platinum wire should be used for its application. It is also useful in ulceration and recession of the gums, beginning the treatment with a weak solution, and gradually increasing the strength. It is sometimes combined with glycerine, in which case the latter must be added to the acid, drop by drop, in order to avoid explosion. DENTAL FORMULA. For Secondary Syphilitic Ulcers, and Ulceration of Mucous Membrane of Mouth and Tongue. R. Acidi chromici............................................... gr.x Aquae ......................................................... gj. Misce solut. Sig.—Paint the diseased parts three or four times a day, with a camel's-hair brush dipped in the solution. ACIDUM GALLICUM—GALLIC ACID. Formula.—C7H605. Derivation.—Gallic Acid is obtained from galls by exposing the powder, in water, to the action of the air, at a temperature of between 6o° and yo° F., when the acid is deposited in the form of small, silky, almost colorless crystals, possessing a slightly acid and astringent taste. Gallic acid is slightly sol- uble in cold water, and freely soluble in hot water, glycerine or alcohol. Galls, from which gallic acid is prepared, are the excres- cences caused by the punctures and deposited ova of a hymen- opterous insect on the twigs of the gall oak (Quercus Infectoria). Source.—Galls are obtained from Asia Minor and Persia. Medical Properties and Actions of Galls.—Powerfully astrin- gent, this property depending upon the presence of tannic and gallic acids, as they contain 35 per cent, of tannic and 5 per cent, of gallic acids. The powder, which is obtained from the small, round, dark-blue or lead-colored excrescences, is of a light yellowish-gray color, inodorous and of a bitter taste. 146 DENTAL MEDICINE. Galls are used in various forms, such as powder, tincture, infusion, ointment, etc. Therapeutic Uses.—Galls are employed in the treatment of chronic diarrhoea, dysentery, leucorrhcea, chronic gonorrhoea and gleet, diseases of the uterus and intermittent fevers, and externally in hemorrhagic disorders, hemorrhoids, relaxation of uvula, hypertrophy of the tonsils, etc. Gallic acid is given directly for internal hemorrhage. Dose.—Of powdered galls, gr. x to gr. xx. The ointment is composed of: powdered galls, gr. lxxx; benzoated lard, Sj. It is combined with opium in the proportion of ointment of galls, Sj; powdered opium, gr. xxxij. Medical Properties and Actions.—Gallic acid is a powerful astringent for arresting hemorrhage in which the bleeding vessels must be reached through the circulation. It is also a valuable styptic in cases of hemorrhage depending on a hemor- rhagic diathesis, and in the form of a gargle it is very service- able in acute inflammations of mucous membranes. It is also a strongly deodorizing agent; and, like tannic acid, it is cap- able of taking oxygen from the globules. Internally employed it produces constipation, which may be prevented by an occa- sional aperient. Although it is weaker than tannic acid, yet its properties are very similar. It is supposed to be converted into tannic acid in the blood. Therapeutic Uses.—Gallic acid is employed in the treatment of hemorrhagic diseases, in their chronic stages especially, such as haemoptysis, hemorrhage from ulcer of the stomach, haematemesis and haematuria, atonic menorrhagia; also, for the profuse perspirations and excessive expectoration of phthisis, for albuminuria, dyspepsia, chronic diarrhoea and gastric irritation in children, gonorrhoea, gleet, etc. Dose.—Of gallic acid, gr. ij to gr. v, in pill, every two or three hours. Glycerite of gallic acid (Glyceritum Acidi Gallici), for external use, is composed of gallic acid, Sj; glycerine, Siv. Ointment of galls (Unguentum Galla) is composed of galls in fine powder, 5j ; lard, 420 grains. HYDROCHLORIC ACID. 147 Dental Uses.—Powdered galls is useful as a styptic in super- ficial hemorrhages from the gums and mucous membrane ; also in inflamed and ulcerated conditions of mucous membrane, and in relaxation of the uvula. Gallic acid, in the form of a gargle, is employed in acute inflammations of mucous mem- brane, as astringent and antiseptic, and in hemorrhages from mucous surfaces depending upon a hemorrhagic diathesis. DENTAL FORMULAE. For Acute Tonsillitis and Inflammation An Internal Astringent in Hemor- of Mucous Membrane of the Mouth. rhagic Affections. R. Acidigallici............. gr.xl R. Acidi gallici............ £) Liq. sodae chlorinatae.. ^ij Glycerini.............. Siv Glycerini................. ^ij Aquae destillatae........ j§vj. M. Aquae destillatae........ ^ viij. M. Signa.—Take J j as a dose. Signa.—To be used as an antiseptic and astringent gargle. For an Astringent, Gargle or Lotion. R. Pulveris gallae......... Sjss For Relaxation of Uvula and Hyper- Aquae..................... Oj. M. trophy of Tonsils. Signa.—As a gargle or lotion in in- R. Infusi gallae............ ^vj flamed or ulcerated conditions of mu- Aluminis................. gr.xl. M. cous membrane and gums. Signa.—Use as a gargle. ACIDUM HYDROCHLORICUM—HYDROCHLORIC ACID. MURIATIC ACID—ACIDUM MURIATICUM. Formula.—HC1. Sp. gr. 1.16. Derivation.—Hydrochloric or Muriatic Acid is obtained by the action of sulphuric acid on a solution of chloride of sodium or common salt. When pure, it is a transparent, color- less liquid, but when contaminated with chlorine, iron and other substances, it has a yellow color. It emits a dense, white vapor, with a pungent odor and a corrosive taste, being an active poison. The antidote is magnesia or soap. Medical Properties and Actions.—The strong acid is a power- ful caustic and escharotic ; also disinfectant and fumigant, but inferior in its disinfectant properties to those of chlorine. For internal use the dilute acid, which is tonic, refrigerant and astringent, is employed, acidum hydrochloricum dilutum— diluted hydrochloric acid, which is prepared by diluting the 148 DENTAL MEDICINE. strong acid so that four ounces of the acid are contained in a pint of diluted acid. It is of a deep yellow color, and emits the odor of chlorine, which is its principal con- stituent. Therapeutic Uses.—The dilute hydrochloric acid is internally employed in the treatment of calculous affections, gout, atonic dyspepsia, typhus and typhoid fevers, continued fevers of childhood, syphilis, chronic whooping cough, phthisis, etc., and externally in diphtheria, ulcerated sore throat, cynanche maligna, etc. Dose.—Of dilute hydrochloric acid, fllx to npcxx, freely diluted; otherwise, when swallowed, it is highly irritant and corrosive. Dental Uses.—The strong acid is employed in the dental laboratory for dissolving zinc, in the preparation of a flux for soldering certain metals. The strong acid is also employed as a local application in gangrenous stomatitis or cancrum oris, for arresting the ulcera- tive process; but care is necessary in its use, on account of its powerful action, in order to limit its application to the parts on which it is to act. In mild cases it should be diluted with an equal weight of honey. In aphthous ulcerations of the mouth, in children, it is often a useful application. DENTAL FORMULAE. For Aphtha. For Ulceration of Mucous Membrane. R. Acidi hydrochlorici I part R. Acidi hydrochlorici Mellis.................. 8 parts. M. diluti................. ^ij Signa.—Apply with a camel-hair pen- Glycerini.............. ziv cib Aquae destillatae...... gx. M. Signa.—To be used as a gargle. For Chronic Inflammation of Mucous For Scorbutic Gums. Membrane and Gums. R . Acidi hydrochlorici R. Acidi hydrochlorici dilut................ zss dibit.................. tt\x Mellis, Infusi cinchonae...... f^iv Aquae rosae.....aa..... f|j. M. Mellis.................. f3j- M- Signa.—Apply with a camel-hair pen- Fiat gargarysma. cil three or four times a day. NITRIC ACID. 149 ACIDUM NITRICUM—NITRIC ACID. AQUA FORTIS. Formula.—HN03. Sp. gr. 1.420. Derivation.—Nitric Acid is obtained by the action of sul- phuric acid upon nitrate of potash or soda. When strong and pure it is colorless, but on account of the presence of nitric peroxide it is generally of a yellow color, and emits acrid, corrosive fumes. Medical Properties and Action.—Pure nitric acid is a power- ful caustic and escharotic, and leaves a permanent stain on the cuticle. It is not employed in its concentrated form internally, but externally, as an escharotic to destroy warts and stimulate sluggish sinuses ; in a diluted form it is employed as an astrin- gent wash or gargle. The antidotes in cases of poisoning are magnesia or soap, and mucilaginous drinks. Therapeutic Uses.—The strong acid is employed externally in hospital gangrene and phagedenic ulcerations; hemor- rhoids and painful hemorrhoidal tumors, syphilitic condylo- mata, syphilitic sore throat, malignant ulcers, obstinate skin diseases, etc. Diluted Nitric Acid—Acidum Nitricum Dilutum, contains three ounces of acid in a pint of the diluted acid. Medical Properties and Action.—It is an antalkaline, altera- tive, tonic and refrigerant, and has a very direct action on the liver, and if its use is continued for a long time it causes sali- vation. Like all mineral acids, it injures the teeth; hence, proper care should be taken to prevent such action—such as the use of alkaline gargles before and after taking the acid into the mouth, which should be done through a glass tube or quill. As a tonic it is advantageously employed during convalescence after inflammation, and in cachexia following acute disease or habits of intemperance. It is also employed as an alterative after a long use of mercury, as it increases the strength and improves the tone of the system. It is also valuable as a dis- infectant, but inferior to chlorine. It is not as agreeable to the stomach as diluted sulphuric acid. Therapeutic Uses.—Dilute nitric acid is employed in the 150 DENTAL MEDICINE. treatment of calculous disease, syphilis, chronic hepatitis, chronic diarrhoea, constipation, chronic affections of the spleen, chronic rheumatism, cardialgia, whooping cough, intermittent fevers, etc. Dose.—Of diluted nitric acid, gtt. ij-xv, three times a day, diluted with water. Dental Uses.—The strong acid when mixed with two parts of hydrochloric acid, is a solvent for gold, and is known as aqua regia. It is also employed as one of the most effectual caustics in cancrum oris, the constitution being supported and quinine given at the same time; also for malignant ulcers of the mouth, and for devitalizing pulps of teeth when nearly ex- posed by mechanical abrasion, care being observed that the part of the surface immediately over the pulp is touched with the acid, and the neighboring parts protected. DENTAL FORMULA. For Sloughing and 111- Conditioned Ulcers. R. Acidi nitrici................................................ Ttll-lx Aquae......................................................... Oj. M. Signa.—Apply with a camel-hair brush. ACIDUM PHOSPHORICUM—PHOSPHORIC ACID. Acidum Phosphoricum Dilutum—Diluted Phosphoric Acid, is the principal form in which phosphoric acid is employed in medicine. Formula.—H3P04. Sp. gr. 1.056. Derivation.—Phosphorus, a non-metallic element, obtained from bones, is a translucent, nearly colorless, wax-like solid, without taste, and emitting white vapors when exposed to the air. Sp. gr. 1.8. It is insoluble in water, but soluble in ether and in hot oil of turpentine, and has a peculiar smell. It is nervine, tonic and stimulant, and, in over-doses, poisonous. The vapor is irritating to the conjunctiva and bronchial mucous membrane. Derivation.—Diluted Phosphoric Acid is prepared by boiling phosphorus with nitric acid and distilled water until it is dis- solved, evaporating and re-diluting it. It may also be obtained by dissolving an ounce of glacial phosphoric acid in three PHOSPHORIC ACID. 151 ounces of distilled water, afterward adding forty grains of nitric acid, boiling to a syrup, and diluting with water until the solution measures twelve and a half ounces. Medical Properties and Action.—It is tonic and refrigerant, and, in large doses, is a powerful stimulant of the nervous and vascular systems. It can be detected in the blood, owing to its absorption, and, in large doses, is an irritant poison. Therapeutic Uses.—Diluted phosphoric acid is employed in scrofula, dropsy, haemoptysis, calculous disease, diabetes and cardialgia. Externally, it has been employed as a local appli- cation in the treatment of caries of the bones and osseous tumors. Dose.—Of diluted phosphoric acid, gtt. ij-xv, diluted in sugar and water. Dental Uses.—As a local application in the treatment of caries of the maxillary bones and osseous tumors of the jaws. Internally, it has been administered with a view of supplying a deficiency of phosphoric acid in the teeth. (See Hypophos- phites of Lime) DENTAL FORMULAE. For Caries of the Maxillary Bones and For Ulcers Over Carious Bones. for Osseous Tumors of the Jaw. R. Acidi phosphori'i gla- R. Acidi phosphor, dilut... I part cialis.................... 3j Aquae destillatae...8 to IO parts. M. Aquae destillatae......... f Sj viij. Signa.—Apply as a lotion or injection. Fiat solutio Signa.—To be applied on compresses to ulcers situated over carious bones. Phosphoric Acid in the anhydrous state consists of one equivalent of phosphorus to five equivalents of oxygen (P05), and is obtained by the direct union of its constituents, which takes place when phosphorus is burned in perfectly dry oxygen gas. Thus procured, it is in the form of a white amorphous pow- der, extremely deliquescent, volatilizable at a red heat, and assumes, when it cools, after fusion, a vitreous appearance. Glacial Phosphoric Acid, or monohydrated phosphoric acid, is readily obtained from calcined bones, by first treating them with sulphuric acid, which produces an insoluble superphos- 152 dental medicine. phate 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 to 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, the formula of which is HO,P05, and contains 11.2 per cent, of water. It is a white, transparent, fusible solid, generally in the form of sticks, inodor- ous and sour to the taste. It slowly deliquesces, and is spar- ingly soluble in water, but freely soluble in alcohol. Dental Uses.—Glacial phosphoric acid and white oxide of zinc formed into an anhydrate, give the plastic material for filling teeth, known as oxy-phosphate of zinc. The powder or solid portion of this preparation is prepared by packing pure oxide of zinc in a clay crucible and subjecting it to almost a white heat for two hours, when it will have been reduced in bulk fifty per cent. It is then pulverized in a mortar, to an almost impalpable powder. The burning of the oxide of zinc colors it to a light yellow, and it is now in a condition for use, and may be kept in a covered vessel for any length of time. The liquid portion of this filling material being glacial phos- phoric acid, it is dissolved in pure water until a saturated solu- tion is obtained, when it is reduced by boiling in a glass vessel until it is of the consistency of glycerine, in which operation it loses one-third in bulk. It is now ready for use, and must be kept in a close glass-stoppered bottle. Formula for Fletcher's and Weston's preparations of oxy- phosphate of zinc filling materials :— FLETCHER'S. Fluid. Solid. Phosphoric acid. Basic oxide of zinc. Phosphate of alumina. WESTON'S. Fluid. Solid. Phosphoric acid. Basic oxide of zinc—80 per cent. (See Oxide of Zinc) Silicate of alumina—20 " " SALICYLIC acid. 153 ACIDUM SALICYLICUM—SALICYLIC ACID. Formula.—HC7H503 or C6H4{ Cooh }• Derivation.—Salicylic Acid is obtained by combining car- bolic acid with caustic soda, and subjecting this compound to dry carbonic acid under the influence of heat, the portion of salicylate of sodium remaining behind after the carbolic acid distills over being saturated, in the form of a hot, aqueous solution, with muriatic acid, which liberates the salicylic acid in small crystals. The crystals are washed, dissolved in hot water, and by re-crystallization, obtained in the form of a powder of a light brown color, which is then bleached until it is quite white ; but most of that sold is of a light cream color, with a reddish tinge. The coloring matter, however, which is present, does not interfere with its efficacy. It has no smell, a slight taste, and is soluble in alcohol and ether and in hot water and glycerine. It can also be obtained from salicin, the vegetable principle existing in willow, poplar, etc., and from oil of gaultheria (winter green) and from spiraea ulmariae (meadow sweet). Medical Properties and Action.—Salicylic acid is a powerful antiseptic, and is said to be far more effective in smaller quan- tities than any other antiseptic, in arresting the putrefactive and fermentative processes. When properly reduced in strength, it causes no pain or irritation in the parts to which it is applied. It will destroy minute organisms, and a small quantity will arrest vinous fermentation and prevent the decomposition of animal fluids. Although free from any poisonous action when administered in a reasonable quantity, yet in large doses it will cause nausea and vomiting. It is thought to combine with the soda of the blood, where it is present as a salicylate. It has little or no affinity for cold water, but the addition of certain alkaline salts, such as sodium phosphate, increases its solubility. Combined with sulphite of sodium, which is also antiseptic, and water, a solution is formed which is free from irritating properties, and especially applicable to the treatment of zymotic diseases. Glycerine warmed will dissolve fa of n 154 DENTAL medicine. its weight of salicylic acid, and the solution may then be diluted with water to any desirable extent. Therapeutic Uses.—It is employed in fevers as an antipyretic or febrifuge ; also for the same purpose in acute rheumatism, pneumonia, phthisis, diphtheria, etc. Externally it is employed as a disinfectant and deodorizer, many preferring it, on account of its freedom from odor, to carbolic acid. It is also employed as a local application in eczema of the head and face, syphilitic ulcers, and to cancer, gangrenous and sloughing wounds, in the form of powder, and as an ointment for burns. Dose.—Of salicylic acid, gr. x to gr. xx or xxx. Dental Uses:—Salicylic acid is employed in the treatment of suppurating and gangrenous pulps of teeth, in the form of the dry powder introduced into the pulp canals and permitted to remain for several days. An ethereal solution of salicylic acid, introduced on a small piece of spunk, has also been em- ployed for the same purpose, where it is difficult to introduce the dry powder; the ether volatilizes in a few minutes. Sali- cylic acid is also employed with advantage in inflamed con- ditions of the mucous membrane of the mouth and gums, and in the treatment of aphthae, thrush and other ulcers, in the form of a solution. For such purposes its combination with powdered cassia or cinnamon, equal parts, is recommended, to be applied with a soft brush. Salicylic acid has also been found efficacious in all inflammatory conditions resulting from decayed and dead teeth and roots. It has also been recom- mended as a dentifrice, in the form of an alcoholic solution of the acid perfumed with oil of gaultheria, but its use for such a purpose is questioned, on account of its softening effect upon the tooth structure. As tannic acid interferes with the action of salicylic acid, these agents should not be used in combination. DENTAL FORMULAE. A Disinfectant Mouth Wash. A Disinfectant and Stimulant Mouth R. Acidi salicylici......... i part Wash. Sodii phosphate........ 3 parts R. Acidi salicylici........ gij Aquae destillatae........30 parts. M. Spirit! vini rectificati ^x. M. Signa.—Use as a gargle. Signa.—Use as a gargle. SULPHURIC ACID. 155 For Perspiration of Hands and Feet. For Burns. R. Acidi salicylici......... 3 parts R. Acidi salicylici......... s;j Magnesii silicat.........87 parts. M. Olei olivae............... ^ viij. M. Signa.—Use in the form of a powder. Signa.—Apply as a lotion. An Emollient and Antiseptic Gargle. R. Acidi salicylici................................................ ^ij Sodii boratis................................................... 3 iij Glycerini...................... ................................ ^"ss Aquae destillatae.............................................. giij. M. Signa.—Add one or two drachms to half a pint of warm water. ACIDUM SULPHURICUM—SULPHURIC ACID. OIL OF VITRIOL. Formula, H2S04. Sp. gr. 1.843. Derivation.—Sulphuric Acid is obtained by burning sulphur, mixed with one-eighth of its weight of nitre, over a stratum of water contained in a chamber lined with lead. It is a dense, colorless liquid, inodorous, with an acrid taste, oily consistence and very corrosive. On the addition of water, with which it unites in all proportions, there is an evolution of heat. In the concentrated form it is only used externally as a caustic. Being an acid, corrosive poison, it causes death from asphyxia. The antidote is magnesia or chalk, or solution of soap, and mucilaginous drinks freely administered. Medical Properties and Action.—It is a powerful escharotic, and when applied to living tissue, the parts first become white, and subsequently a brownish-black color. It is not used in- ternally, on account of its corrosive action. It is considered to be one of the most effective caustics in the bites of rabid animals. Diluted Sulphuric Acid—Acidum Sulphuricum Dilutum. Derivation.—It is prepared by diluting sulphuric acid fSvij with distilled water fSlxxvij, and when the mixture has cooled to 6o°, add more water Slxxxiiiss. Sp. gr. 1.094. Medical Properties and Action.—It is refrigerant, astringent and tonic. It is employed as a refrigerant in fevers; as an astringent for arresting hemorrhage and passive mucous dis- charges ; and as a tonic to improve digestion. As it is very 156 DENTAL MEDICINE. injurious to the teeth, the proper precautions should be ob- served, as in the case of all acids administered as medicines— such as alkaline gargles used before as well as after their intro- duction into the mouth, and the use of a glass tube or quill. Therapeutic Uses.—Diluted sulphuric acid is employed as an internal remedy in hemorrhage from the lungs, bowels and uterus, in calculous affections, certain skin diseases, diarrhoea, profuse perspiration of phthisis, in the advanced stages of • typhus and typhoid fevers, scarlatina, lead poisoning, etc. Externally as a gargle and wash to ulcers. Dose.—Of diluted sulphuric acid, ttiv to "Xxx, three times a day, in water. Aromatic Sulphuric Acid—Acidum Sulphuricum Aromati- cum—Elixir of Vitriol. Derivation.—Aromatic sulphuric acid is prepared by mixing sulphuric acid fSiij, with rectified spirit Oij, and adding cin- namon Sij, and ginger &%. It is a reddish-brown liquid, with an aromatic odor and a pleasant taste. Medical Properties and Action.—It is tonic and astringent, and is the most agreeable form of sulphuric acid for internal use. Therapeutic Uses.—Aromatic sulphuric acid is employed as a substitute for the diluted form in debility with night sweats, loss of appetite during convalescence from fevers, haemoptysis and other hemorrhages, and epidemic dysentery. Externally it is applied to carious bone, ulcers, etc. Dose.—Of aromatic sulphuricacid, n\,v to nixxx, three times a day, in water. Dental Uses of the Different Forms of Sulphuric Acid.—The concentrated sulphuric acid is employed as a caustic in malig- nant ulcers, cancrum oris, gangrene, etc., in the form of a paste, made by mixing it with powdered sulphate of zinc. The con- centrated sulphuric acid is also used in the dental laboratory, to cleanse metal plates, preparatory to and after soldering, for which purpose it is generally diluted with one-third of water, its action being greater when it is in a warm state. The con- centrated acid is also used in combination with nitric acid, sulphuric acid. 157 to reduce hemp paper to pyroxylin, in the preparation of the celluloid base. The aromatic sulphuric acid is similar in its action to the diluted form, and is more agreeable for use about the mouth. It is a valuable application in pyorrhoea alveolaris (Riggs' disease), and in caries and necrosis of the maxillary bones, as an injection or lotion, as it stimulates the parts to healthy action by favoring granulation. It may be applied to parts about the teeth, in cases of recession of the gums and absorp- tion of the processes, on a properly-shaped piece of orange wood. It is also valuable in alveolar abscesses as an injection, especially in sluggish cases, when the addition of a few drops of tincture of capsicum will prove serviceable. It has the power of dissolving the thin, carious portions of the bones, such as the margins of the alveolar cavities, and can be applied on cotton saturated with it and permitted to remain for several hours, when the parts should be perfectly cleansed with warm water. It is also employed as a gargle, properly diluted, in mercurial inflammation of the mouth and other forms of sto- matitis, which do not yield to the influence of milder astringent washes. It is also employed in the treatment of aphthae and other ulcers of the mouth. DENTAL FORMULAE. For Mercurial and Ulcerative Stomatitis. For Aphthce and other Ulcers of Mucous Thomas. Membrane and Gums. R. Acidi sulphurici....... rtlx R. Acidi sulphurici......^Sss Decocti hordei.........fjf iv Mellis................... f^j. M. Mellis...................f^ ss. M. Signa.—To be applied with a camel- SlGNA.—Use as a gargle. hair brush. For Carious Bone, Rigg's Disease, etc. R. Acidi sulphurici aromat.................................... f"^iij Tinctura capsici.............................................. gtt.x Aquae.......................................................... f 3 ij. M. Signa.—To be used as an injection or lotion. 158 DENTAL MEDICINE. ACIDUM TANNICUM—TANNIC ACID. TANNIN. Formula.—C^H^O^. Derivation.—Tannic Acid is obtained by exposing powdered galls to a damp atmosphere for several days, when sufficient ether is added to form a soft paste, which is allowed to stand for twenty-four hours. It is then subjected to pressure as quickly as possible, and the mass again treated with ether, to which tV of its bulk of water has been added; this is allowed to stand as before, and is again subjected to pressure. The expressed liquids are now combined and allowed to evaporate spontaneously; then, by the aid of a little heat, brought to a syrupy consistence, when it is dried on plates in a hot air chamber, at a temperature not exceeding 212° F. Pure tannic acid is solid, uncrystallizable, either white or slightly yellowish, inodorous, astringent to the taste, but without bitterness, and with an acid reaction. It is obtained in the form of vesicular masses, or thin, glistening scales, or in the shape of fine threads of a pseudo-crystalline appearance. Tannic acid exists also in rhatany, catechu, and other vegetable astringents, as it is their chief principle. Medical Properties and Actions.—-Tannic acid is considered to be the most active of all vegetable astringents and styptics, and especially powerful on albumen, gelatin and fibrin. It is very soluble in water, and less so in alcohol and ether. Taken internally, it produces no nausea, is perfectly safe, and its use may be continued for a long time without any ill effects. It may also be administered before and after meals, at all times, and be combined with many other remedies, such as iron, cod- liver oil, bitters, etc. Like gallic acid, it is capable of taking oxygen even from the blood globules, when in contact with alkalies. Tannic acid is converted into gallic acid in the blood, by absorbing oxygen from the red corpuscles; this absorption does not occur in the stomach. Tannic acid unites with albumen, fibrin and gelatin, forming TANNIC ACID. 159 insoluble tannates, thus preserving the parts beneath from the influence of irritating agents until resolution occurs. Its solution reddens litmus paper, and it is decomposed and entirely dissipated when thrown upon red-hot iron. Therapeutic Uses.—Internally it is administered in hemor- rhages of the lungs, stomach, kidneys or uterus, chronic bronchial catarrh, phthisis, after softening has taken place, intermittent fever, whooping cough, chronic diarrhoea, diseases of the genito-urinary organs, dyspepsia, diphtheria, nervous diseases, etc. Externally it is applied to hemorrhages and profuse secretions, mercurial salivation, diseases of the eye, nasal polypus, gonorrhoea and gleet, bed sores, relaxation of uvula, skin diseases, ulcers, etc. Dose.—Of tannic acid, gr. j to 3j, in pill. Dental Uses.—In dental practice tannic acid is a valuable agent for local use in the treatment of such diseases as mer- curial stomatitis, ulceration of the gums and mucous mem- brane of the mouth, hypertrophy of the gums, hemorrhage following the extraction of teeth and wounds of mucous mem- brane, fungous growth of pulp, sensitive dentine, sponginess of the gums, for the temporary relief of odontalgia, disease of the antrum. In mercurial salivation tannic acid, in the form of powder, moistened with water, will render the spongy gums firmer and more comfortable, causing contraction of the vessels and checking a tendency to absorption and the consequent loosening of the teeth. A strong solution of tannin in alcohol is beneficial in obtunding the sensitiveness of dentine, or the tannin may be, in the form of a powder, combined with mor- phine and creasote. Tannic acid, in the form of a paste or ointment, made by rubbing two scruples of tannin with twenty drops of glycerine, and then with an ounce of lard, makes a good astringent application. A gargle composed of tannic acid and glycerine, is a useful application for abrasions caused by artificial teeth and other irritants. A preparation known as Elixir of Vitriol and Tannin, saturated solution, is a power- ful astringent and haemostatic when applied to bleeding sur- faces, fungous growths, etc. 160 DENTAL MEDICINE. An English preparation known as Styptic Qolloid, is a satu- rated solution of tannin and gun cotton, and is highly recom- mended for its styptic and deodorizing properties, as it solidifies blood and albumen by mere contact, and can be applied directly by means of a camel-hair brush, or, mixed with an equal quan- tity of ether, in the form of spray. No irritation follows its use, and for hemorrhage from the extraction of teeth, or in the treatment of necrosed or carious maxillary bones, it is very efficient. Cold or warm water will not dissolve it, but an ether and alcohol solution may be used to remove the dressing. A styptic and antiseptic cotton can be prepared by saturating purified cotton with tannic acid 5 parts ; carbolic acid 4 parts ; alcohol 50 parts. The cotton should be dried and preserved air-tight. Glycerite of tannic acid—Glyceritum Acidi Tannici, for ex- ternal use, is made of tannin, Sij; glycerine, Sviij. Ointment of tannic acid—Unguentum Acidi Tannici, is made of tannin, 5j ; lard, Sj. Useful for a local application to ulcers. DENTAL FORMULAE. For Inflamed and Ulcerated Mucous Membrane. R. Acidi tannici......... gss Spiriti vini rectificati ^ss Aquae camphorae .... f^v. M. Signa.—To be used as a gargle. For Inflamed and Ulcerated Gums. R. Acidi tannici......... ^iv Glycerini............... ^ij. M. Signa.—To be used as a gargle or mouth-wash. For an Astringent Dentifrice. R. Acidi tannici.......... gr.xxx Cretae preparatas...... ^ ij Pulveris ossis sepiae... 3 ij Olei caryophylli....... gtt.iij. M. For Inflamed Mucous Membrane, Abra- sions, Ulcers and Sensitive Dentine. R. Acidi tannici........... ^ij Tincturae arnicae...... ^ij Tincturae myrrhae...... ^j. M. SlGNA.—To be used as a lotion. For Same as Above. R. Acidi tannici........... gj to £ij Spiriti rectificati...... sjj Aquae destillatae ...... gx. M. Signa.—To be used as a gargle. For Same as Above. R. Acidi tannici........... ^ ij Pulveris aluminis..... gr.xxx Aquae destillatae....... gv. M- Signa.—To be used as a gargle. TARTARIC ACID. 161 For an Astringent Mouth Wash in In- flamed and Ulcerative Conditions of Gum and Mucous Membrane. R. Acidi tannici......... grxx Tincturae pyrethri... 3 iij Aquae rosae............ Sjvj. M. Signa.—To be used as a gargle. For Inflamed Mucous Membrane of Mouth. R. Acidi tannici........... s;ss Sodii boratis............ 5 iij Glycerini............... ^ij Aquae destillatae........ £ iv. M. Signa.—Use as a gargle. For Inflamed Mucous Membrane of Mouth and Fauces. R. Acidi tannici......... gj Tincturae myrrhae__ 3 iij Pulv. acaciae.......... 31J Glycerini............... ^ij Aq. destil. q.s ad..... ^vj. M. Signa.—Use as a gargle. For Odontalgia. Druitt. R. Acidi tannici......... gr-xx Gummastich.......... gr.x Spt. aether sulph ..... f ^ ss. Signa.—To be applied to cavity, on a pellet of cotton M. carious For Alveolar Hemorrhage. R. Acidi tannici........... gr-xl Liq. plumb, subacet dilut................... f ^iss Vin. opii............... ^3SS- M. Signa.—Apply on cotton or lint, or as an injection. For Chronic Ulcers and Abscesses. Beral. R. Acidi tannici........... gr.xxxij Aquae destillatae....... f^vnj. M. Signa.—To be used as a lotion. For Ulcerations and Abrasions. R. Acidi tannici........... gr.xv Glycerini............... f^j. M. Signa.—To be used as a lotion. ACIDUM TARTARICUM—TARTARIC ACID. Formula.—H2C4H406. Derivation.—Tartaric Acid is obtained from " tartar" (a pecu- liar substance which concentrates on the inside of wine casks, being deposited during the process of fermentation), or from crude cream of tartar. It is in the form of white or colorless crystals, irregular, six- sided prisms, and is soluble in water and alcohol, and wholly dissipated by heat. Medical Properties and Action.—It is refrigerant, and dissolved in water and sweetened, is a good substitute for lemonade. In large doses it is an irritant poison, and when its internal use is followed by a red and dry tongue, it should be discon- tinued. It is often administered in the form of effervescing powders. Therapeutic Uses.—Internally it is employed as a refrigerant, in inflammatory and febrile diseases, irritability of the stomach, 162 DENTAL MEDICINE. nausea and vomiting, dyspepsia, and diseases attended with copious secretion of mucus, dysentery, etc., etc. Dose.—Of tartaric acid, gr. x to gr. xx, dissolved in water and sweetened. Dental Uses.—In combination with an equal quantity of chloride of lime, it is employed for bleaching discolored teeth. ACONITUM—ACONITE. WOLFSBANE, MONKSHOOD. Source.—Aconite is obtained from the dried, tuberous root of Aconitum Napellus, a perennial plant abounding in the mountains of Europe and Asia. The leaves and root are both used, but the latter is the most powerful. The alkaloid Aconitia or Aconitine, a sedative poison, is obtained from the root, and is externally employed for neuralgic affections, producing a sensation of heat and pricking, succeeded by a feeling of numbness and constriction in the part on which it is rubbed; and very satisfactory results have been obtained from the in- ternal administration of Duquesnel's Aconitia, in neuralgia of the fifth pair of nerves. Another principle of aconite, sug- gested by Duquesnel, is known as Napelline, which is less powerful than aconitia, but possesses important hypnotic pro- perties, and is substituted for opium and chloral, especially in cases of wakefulness and mental excitement during neuralgic attacks. Medical Properties and Action.—Aconite is a powerful seda- tive to the nervous system, and reduces the force of the circulation. In large doses it is an active poison, lessening the heart's action, affecting its ganglia and muscle, and para- lyzing the muscles of respiration. In moderate doses it produces warmth in the stomach, general warmth of the body, and sometimes nausea, numbness and tingling in the limbs and fingers, muscular weakness, diminished force and frequency of the pulse, and diminished respiration. It proves fatal, in poison- ous doses, by its powerfully sedative impression on the nervous system, by suspension of the respiratory function, and by syncope. ACONITE. 163 Therapeutic Uses.—Aconite, in the form of an extract pre- pared from the leaves, and a tincture prepared from the root, is administered in all inflammatory and febrile affections, acute rheumatism, neuralgia, especially in chronic cases of neuralgia, where all the signs of active disease are absent, or have been relieved by other remedies; tetanus, sciatica, diseases of the heart, erysipelas, amenorrhcea, tonsillitis, acute congestion of liver, peritonitis, eruptive fevers, etc., etc. It is contra indicated in inflammatory conditions of the gastro-intestinal mucous membrane. It is locally applied to painful sprains and bruises, and chronic arthritic swellings. Dose.—Of the tincture of aconite—tinctura aconiti—gtt. j to gtt. v; of the extract of aconite—extr actum aconiti— gr. j to gr. ij. The tincture of the root is composed of twelve troy-ounces to alcohol Oij. Dose of aconitia, gr. vis. Dental Uses.—Aconite, in the form of the tincture, is a valu- able agent in dental practice. When locally applied it checks inflammation in its early stages, by paralyzing the nerves of the part and lessening the excitement to the local afflux of blood, favoring resolution and limiting the extent of an abscess where pus is already formed. Combined with an equal part of the tincture of iodine, it is a valuable application in the in- cipient stages of dental periostitis, as it relieves the inflammation by retarding the circulation and stimulating lymphatic action. For such a purpose the gum or root of the affected tooth should be painted with this combination until it assumes a dark brown color, taking the precaution to first remove all moisture from the surface to which it is to be applied, and after its application, protecting the adjoining parts, such as the lips or cheeks, until the remedy is absorbed. A drop or two of the tincture, introduced into the cavity of an aching tooth, will relieve odontalgia; and the same quantity will subdue the pain which follows the extraction of a tooth, especially when the cause has been the inflammation of the dental periosteum. Tincture of aconite is also serviceable in the conservative treatment of irritated or inflamed pulps of teeth. Combined with an equal quantity of chloroform, it is applied as a local 164 DENTAL MEDICINE. anaesthetic for the extraction of teeth. For the same purpose it is combined with chloral, pyrethrum, morphia, etc. (See Dental Formula.) It is also a useful dressing for the pulp canals of teeth, preventing the formation of inflammatory products. The alkaloid, aconitia, is a useful remedy in neural- gia of the fifth pair of nerves. (See Dental Formula.) Care is necessary in the application of the tincture of aconite to large surfaces, or where the skin is abraded, as dangerous con- stitutional effects may result. Fifteen drops of the tincture, taken internally have caused death. The symptoms of poison- ing by aconite are as follows: Overpowering sense of fatigue in the lower extremities, great muscular weakness, dimness of vision, with dilated pupils ; great dyspnoea, the respirations being short and labored ; the pulse at first slow and small, and afterward imperceptible ; surface of body, tongue and breath cold ; a profuse perspiration ; muscles of respiration paralyzed; ceasing of the heart's action. The antidotes are heat, brandy and ammoniae. DENTAL FORMULAE. For Neuralgia. A Local Anaesthetic for the Extraction R. Pulveris radicis aconiti ^ x °f Teeth. Camphorae................ ^ss R. Tincturae aconiti...... 3j iss Spiriti rectificati......... q.s. Pyrethri................. ghj Moisten the aconite with some of the Veratrinae............... gr.x alcohol and macerate in a close Morphinae sulphas.... gr iv vessel for 3 days, then percolate Spiriti rectificati....... t^iv slowly into a receiver containing Chloral hydratis....... gr.iv. M. the camphor until the product Let stand 4 days and then filter. measures half a pint. Signa.—Apply to the gum over root of Signa.—Apply with a camel-hair brush. tooth to be removed, for 60 seconds, by means of an applicator. For Odontalgia. For Neuralgia and Rheumatic Pains, R. Tincturae aconiti, Bruises, etc. Chloroformi....aa... f^iij R. Tincturae aconiti, Tinct. capsici......... f^j Chloroformi venalis, Tinct. pyrethri., Spiriti ammoniae..aa... f 3 ij 01. caryophylli...aa.. f^ss Olei ricini................ ^ij Gum camph........... | ss. M. Linimenti saponis...... f|j. M. Signa.—To be applied on a pellet of Signa.—To be rubbed on affected cotton. part. ETHER. 165 For Neuralgia of Fifth Pair of Nerves. For Trigeminal Neuralgia. (For Internal Use.) R. Aconitinae (Duques- R. Aconitinae.............. £?fa nel's)................. g^To Glycerini, Glycerini, Alcohol......aa........ £j Alcohol........aa...... %\ Aquae menthae pip.... ^ ij. M. Aquae menthae pip.... ^ij. M. Dose.—A teaspoonful. Dose.—A teaspoonful, slowly and cautiously increased to Y- For Neuralgia. R. Linimenti aconiti, For Dental Periostitis. Lin. belladonnae..aa... sjvij R. Tincturae iodi., Chloroformi.............. ^ij. M. Tincturae aconiti.. aa... ^ss. M. Signa.—Apply, on lint, to the part Signa.—Apply to gum over root of affected, and cover with a fine piece affected tooth with a camel-hair of sponge saturated with warm water. brush. AETHER—ETHER. yETHER SULPHURICUS—SULPHURIC ETHER. Formula.—C4H10O. Sp. gr. — Of pure ether, 0.713 ; of stronger ether, 0.728 ; of ordinary officinal ether, 0.750. Derivation.—Sulphuric Ether is obtained by the distillation of alcohol and sulphuric acid, and is rectified by re-distillation with solution of potassa. The form of sulphuric ether em- ployed for inhalation is still further purified by agitation with water, and it is freed from this and from an excess of alcohol and deleterious acid substances by the action of chloride of lime and freshly calcined lime, when it is known as stronger ether—sEther Fortior. Sp. gr. 0.728. Sulphuric ether is a colorless, limpid, volatile and inflammable fluid, with a sweet odor and a hot, pungent taste; on account of its great vola- tility, it should be kept securely in ground-glass-stoppered bottles. It usually reddens litmus paper slightly; when it does so strongly, the ether is impure. The impurities, besides acids and fixed substances, are heavy oil of wine, an excess of alco- hol and water. Acids being detected by litmus paper, may be removed by agitation with potassa; fixed substances may be removed by evaporating the ether. Some alcohol is always found in ether, and it is only when it is present in too great a quantity that the density of the ether is rendered too high. The quantity of alcohol any preparation of ether may contain, 166 DENTAL MEDICINE. can be determined by agitating it in a minim measure with half its volume of a concentrated solution of chloride of cal- cium. This will remove the alcohol, and the reduction of the volume of ether when it rises to the surface will indicate the amount of alcohol which has been present. Heavy oil of wine can be detected by the ether becoming milky when mixed with water. Ether boils at 980 F., and a cold of 1660 below zero will not freeze it. When kept too long it undergoes decom- position, and is converted in part into acetic acid. It evaporates so readily and completely in the air as to cause a great degree of cold, hence it has been employed in the form of spray, as a local anaesthetic. It combines with alcohol and chloroform in all proportions, and dissolves in ten times its volume of water. Medical Properties and Actions.—Ether is a diffusible stimu- lant, antispasmodic, anodyne and anaesthetic. It is administered internally in the form of ether or of Hoffmann's Anodyne, compound spirit of ether—Spiritus Etheris Compositus (com- posed of ether, Oss, ethereal oil, f5yj, and alcohol, Oj); also, in the form of spirit of nitrous ether, Spiritus Etheris Nitrosi, and known as sweet spirit of nitre (a solution of nitrous ether in alcohol). When ether is taken into the stomach, it causes a cooling sensation, after the subsidence of the burning, which is quickly diffused over the body; increased action of the heart, flushing of face and warmth of surface follow in a few minutes; the senses are quickly excited; the mind becomes more active, and the phenomena of alcoholic intoxication result, which soon pass away, leaving a feeling of calmness and sleep. Therapeutic Uses.—Ether is employed internally as an anti- spasmodic and anodyne, for angina pectoris, hysteria, asthma, flatulence, cramp of stomach and bowels, syncope, epilepsy, hiccough, nervous or hysterical headache. Hoffmann's Ano- dyne possesses the antispasmodic and stimulating effects of ether, and the anodyne effects of ethereal oil, or oil of wine, and is also carminative. The Spirit of Nitrous Ether is antispasmodic, diaphoretic, ETHER—ANAESTHESIA. 167 and diuretic, and is employed in febrile affections, dropsies, etc., etc. Dose.—Of ether, f5ss to f5j ; of Hoffmann's Anodyne, foss to 5ij, in sweetened water; of spirit of nitrous ether, f5ss to fSss. Dental Uses.—Ether is employed as a general and local anaesthetic; as a topical anodyne in neuralgia and odontalgia, for which purpose it is generally combined with other agents ; in aphthae and stomatitis; as a counter-irritant, evaporation being prevented. Sulphuric Ether as an Anesthetic Agent.—Sulphuric ether is generally considered to be a safer anaesthetic agent than chloroform, as but comparatively few deaths have resulted from its inhalation. The discovery of its anaesthetic properties was first made in 1844, by Dr. Horace Wells, a practicing dentist, of Hartford, Conn.; and Dr. Morton, of Boston, also a dentist, first demonstrated the application of its anaesthetic properties in dentistry and surgery, in 1846. As the physiological actions of both ether and chloroform are similar, they may be considered as follows : When the vapor of ether or chloroform is inhaled, the first effect is faucial irritation, to a greater or less degree, according to the strength of the agent employed, a feeling of suffocation, with cough, a flow of mucus and the reflex act of swallowing. The desire for air may cause more or less struggling, especially in the case of children. The sensibility of the glottis, however, is soon relieved, the cough ceases, and the inhalation of the agent proceeds without further resistance. The primary effect is a general exhilaration ; and, in the case of ether especially, it is often one of excitement, which, in the majority of cases, may continue for a short time only, while in other cases, it may, from its duration and violence, give rise to considerable trouble. But, if the inhalation can be con- tinued and this stage of excitement passed over, insensibility soon occurs. The pulse increases in frequency, the respira- tions become more rapid, and may assume a convulsive char- acter. There is flushing of the face, cerebral intoxication, to a greater or less degree, according to the temperament, such 168 DENTAL MEDICINE. as talking, laughing, singing, crying, etc. In those of a mer- curial or hysterical disposition this stage of excitement is more pronounced and persistent, and during its continuance sensi- bility to pain is considerably diminished, although the sense of touch is still preserved, while those of taste and smell are lost, and complete insensibility soon follows. When the patient is of a full habit, and in robust health, and the inhalation of the anaesthetic agent has been rapid, the stage of complete insensibility is preceded by a convulsive stage, during which there is rigidity of the voluntary muscles, stertorous breathing and lividity of the face. If the inhalation of the agent be still further continued, the tetanic rigidity of the muscles subsides, the lividity of the face disappears, the breathing becomes quiet, complete muscular relaxation ensues, power of movement is lost, as shown by the arm, when raised, dropping without resistance, and the conjunctiva of the eye, under mechanical irritation, being perfectly insensible to pain. During complete anaesthesia the surface of the face is cool and bathed in abundant perspiration; the countenance is calm, the eyes closed and the pupils somewhat contracted, the respiration easy and the pulse slower. The functions of respiration and circulation continue, all others being suspended. From such a condition the patient will soon emerge, provided the further inhalation of the agent be stopped ; on the other hand, if the inhalation be continued, the functions of respiration and circu- lation will be suspended, and life will end with the cessation of the action of the heart and the respiratory organs. Sudden death from the inhalation of anaesthetic agents is due to paralysis of the cardiac ganglia. When death occurs during the stage of rigidity and stertorous breathing, it is due to tetanic fixation of the respiratory muscles and obstruction of the pulmonary circulation, accumulation of venous blood in the heart and the arrest of the heart's action. Death may also ensue by paralysis of the respiratory mus- cles during the stage of complete muscular relaxation ; also by paralysis of the heart during complete insensibility, the motor ganglia being paralyzed. ETHER—ANESTHESIA. 169 Death may also occur from depression of the functions and the shock of the accident, or of the surgical operation. Mr. Woodhouse Braine divides anaesthetics into two classes: (i) Those which produce death through the lungs as well as through the heart; this class includes chloroform, bichloride of methylene, dichloride of ethidene, andrnany others of the chlorine series ; (2) those which produce death through the lungs alone, the heart's action continuing for some time after respiration has quite ceased; this class includes ether and nitrous oxide; and he says, that in choosing an anaesthetic three factors are to be considered: (1) The nature of the operation; (2) the amount of insensibility necessary; (3) the length of time during which insensibility has to be kept up; and he sums up as follows : (1) It is well to avoid all anaes- thetics which tend to depress the heart's action ; (2) for short operations nitrous oxide is the best agent; (3) for long opera- tions, except where it is desirable to avoid hemorrhage, or where the cautery is used, ether answers perfectly; (4) the best time for operating is the early morning; (5) nitrite of amyl is the best cardiac stimulant. The Administration of Anesthetics.—To administer ether or chloroform, take a folded piece of lint, of three or four thicknesses, and of a size that can be held conveniently in the hollow of the fingers and palm of the hand, and on it pour the anaesthetic agent—half an ounce of ether or a drachm of chloroform. Some prefer a large napkin or towel, folded in the form of a cone, with an opening of an inch or an inch and a half at the apex, for the admission of air. The advantage, however, of the lint over the folded napkin is, that by holding the lint in the hand but little evaporation occurs. Before commencing the inhalation, the condition of the pulse should be ascertained, by placing the middle finger of the left hand on the left temporal artery, and at the same time endeavor to reassure the patient and allay fear by cheerful words. The clothes should be loose, and artificial teeth, if any are worn, as well as pins, if the habit of keeping them in the mouth is indulged in, should be removed before the administration of 12 170 DENTAL MEDICINE. the anaesthetic is commenced. The inhalation should be com- menced by holding the moistened lint or towel three or four inches from the patient's face, directing him to breathe quite naturally, always remembering that a strong atmosphere in the early stages of the inhalation is dangerous, and carefully watching for coughing or acts of swallowing, when, if any such occur, the lint or towel should be moved further away, and approached again more gradually. If the patient shows no signs of the anaesthetic vapor being too strong, the lint or towel may be gradually brought to within an inch and a half of the patient's mouth and nostrils; and to still more concen- trate the atmosphere, if lint is used, the hand holding it may be covered with one fold of an ordinary large napkin, which may hang loose over the mouth and chin, but should be so arranged above that the patient's eyes and forehead may remain uncovered and visible. The inhalation should be com- menced cautiously, by instructing the patient to breathe quite naturally, and to obey any direction given to raise the hand or open the eyes. When the inhalation has fairly commenced, it should be continued until there is no winking when the margins of the eyelids are touched or the hand cannot be raised, and the limbs are perfectly relaxed, when the patient is ready for the opera- tion ; what is termed the " surgical period " having arrived. An inhalation with chloroform generally takes about four minutes; often more; seldom less. With ether, the time re- quired is longer and the quantity of the agent greater. It should also be remembered that, in summer, chloroform and ether evaporate more readily than in the colder seasons. The operator should devote his undivided attention to the patient, during the inhalation of anaesthetics. One finger should be kept on the pulse, and the respiration should be carefully noted ; for the latter is of more importance than the former, although the pulse is by no means to be neglected. When the patient becomes excited, he should be watched very closely, and if the respiration becomes proportionately quick- ened, so must the vapor of the anaesthetic be proportionately ETHER--ANESTHESIA. 171 weakened, by withdrawing the lint or towel slightly from the face. When the muscles become rigid, and the patient holds his breath and becomes livid, the anaesthetic should be given very weak indeed, as such a state of semi-asphyxiation, due to the suspension of respiration, is often followed by extreme rapidity and depth of respiration, and a dangerous condition is apt to supervene, because anaesthesia is added to asphyxia. The cumu- lative action of these general anaesthetics should also be re- membered, for a state of narcosis frequently intensifies for half a minute or more after the suspension of the administration, which is due to the vapor of the anaesthetic which was in the lungs entering the blood after the administration ceases. Prof. J. J. Chisholm, of the University of Maryland, gives the following five simple rules for the administration of chloroform, and which will apply to ether also :— " i. I always, without a single exception, give a strong drink of whiskey, from one to two ounces, to every adult to whom I intend to administer chloroform. This is done a few minutes before the operation. " 2. Always loose the neck and chest clothing, so as to have no impediment to respiration. " 3. Only administer chloroform in the recumbent posture, with body perfectly horizontal and head on a low pillow, this pillow to be removed as the anaesthesia progresses. "4. Give chloroform on a thin towel, folded in conical form, with open apex, so that the vapor, before inhalation, will be freely diluted with atmospheric air. In holding this cone over the face of the patient, at some little distance from the nose, place the fingers under the borders of the cone, for the double purpose of allowing air to enter freely, and also to prevent the chloroform liquid on the towel from coming in contact with the skin of the patient's face, and thereby avoid its blistering effects. "5. Should loud snoring occur, force up the chin. This manipulation, by straightening the air passages from the nose to the larynx, makes easy breathing. The forcible elevation of 172 DENTAL MEDICINE. the chin is far better in every respect than pulling out the tongue. It is easier of application, more quickly done, re- quires no instruments, and is much more efficient in removing the impediment to respiration. " While operating, I have constantly in view both the color of the face and the respiration of the patient, which I consider even more important for the surgeon to observe than to feel the pulse." When ether or chloroform is administered for the extraction of teeth, the operation should be performed in a dental chair so constructed as to admit of the patient being placed in as horizontal a position as is possible, to operate successfully, and every instrument it is necessary to use should be within reach of the hand of the operator. As soon as the operation is com- pleted the head of the patient should be gently inclined to the side, so as to permit the blood to run from the mouth and not pass down the throat. Any considerable change in the posi- tion of the patient should be avoided until recovery has taken place. Fresh air should be admitted by lowering the window, and the patient freely supplied with it by means of a fan. M. Paul Bert instituted experiments with mixtures of either, chloroform and air, or nitrous oxide and air, or nitrous oxide and oxygen, under pressure, which he claimed diminished the danger without lessening the advantages of the anaesthetic. A proportion of eight per cent, after six or seven minutes, sufficed to induce and to maintain a state of surgical coma for fifteen to thirty minutes, and the symptoms of the stage of exhilaration were much less marked than usual. He also claimed that there is an absence of the feeling of suffocation common to the old method; that the face retains its natural color; that respiration is regular, but somewhat quickened and sometimes snoring; that the pulse shows no marked disturb- ance; that the buccal secretion is scanty; that the patient is spared violent coughing, which often seems to initiate the after vomiting ; that the return to consciousness from complete anaesthesia takes from eight to ten minutes ; that the quantity of chloroform used is small—in one case, where the anaesthesia ETH ER—ANESTH ESI A. 173 lasted half an hour, it was only five grammes ; that by means of the apparatus used the patient escapes any local irritation of the skin, and the operator does not receive the fumes of the drug in his face. The appliance used in Bert's method is the invention of Dr. H. Martin for analyzing the gases of respira- tion, and consists of a pair of reservoirs connected with a caoutchouc mouth piece, and containing the required mixture of air and chloroform. By a special contrivance a constant supply of the anaesthetic is maintained, to make up for the loss by inhalation, and the pressure within the reservoirs remains, under all circumstances, equal to that of the surrounding air; and the respiratory movements, can be accurately watched by means of a water manometer and scale affixed to the instru- ment. In operations on the mouth, anaesthesia is first produced by the aid of the mouth piece, and afterward kept up by an occasional jet of the mixed vapor sent into the back of the mouth. Some eminent surgeons, however, among the number Messrs. Gosselin and Richet, consider Bert's method a danger- ous one, and the latter states of the cases at the Saint Louis Hospital, Paris, which he witnessed, one in three was accom- panied with vomiting, discomfort, and, on one occasion, with great excitement. What has been styled " vitalized air," is the vapor from a mixture composed of equal parts of chloroform and alcohol combined with the nitrous oxide gas. The vapor from two or three drops of the chloroform and alcohol mixture is used with each gallon of gas, the anaesthetic effect of which, it is claimed, is more lasting, and at the same time less dangerous, than from either of the two agents alone. An apparatus for combining these two agents is in use, which is attached to the gas cylin- der, in place of the ordinary connection. The administration of anaesthetics through the nose has been suggested by Dr. B. C. A. Windle, of England, a pecu- liar instrument being employed for pumping the vapor of the anaesthetic through a tube which passes into one nostril; wings, to close the outer surface of the nostril containing the tube 174 DENTAL MEDICINE. and the opposite surface of the septum nasi, are attached to the tube, so that air may pass through the passage unoccluded by the tube. The inventor of this method claims that by its use perfect anaesthesia can be maintained throughout an opera- tion about the face, of any length, without interfering with the operator's actions; also, that in operations about the mouth and palate the patient can be maintained at that point of anaes- thesia which may be considered desirable, and that the supply can be regulated. Dr. Axel Yversen, of Copenhagen, suggested etherization by the rectum, the vapor being conducted to the rectum by a rubber tube (attached to a bottle containing the ether, in a water bath of 1200), terminating in a recurrent catheter, the free or recurrent end being closed by pressure of the thumb during the inflation of the bowel; the expiratory act being performed by removing this pressure and the water bath. The principle advantage this method appears to possess is that it permits operations on the face without the ordinary obstacles of the common method. The Dangers of Anesthesia.—The conditions rendering general anaesthetics dangerous are fatty degeneration of the heart (a prominent contra-indication) ; previous alcoholic habits; brain tumors and degenerations ; respiratory obstruction from swollen epiglottis, enlarged tonsils, oedema glottidis, laryngeal paralysis, thoracic tumors or aneurism ; emphysema and ob- structed pulse circulation from engorgement of right heart and deficient heart power ; valvular lesions ; incomplete anaes- thesia during painful surgical operations, causing death from shock, as the result of peripheral irritation. Muscular debility and weakness from exhaustion, if otherwise uncomplicated, are considered to be rather aids to anaesthesia than contra- indications. Preventive Measures Against the Dangers of Anes- thesia.—A thorough examination for sources of danger should always be made previous to the administration of the anaes- thetic. An anaesthetic should never be administered on a full stomach, as an anaesthesia of the glottis prevents the expulsion ether—anesthesia. 175 of vomited matter from the larynx, in case it enters by regur- gitation. An anaesthetic should never be administered after long fasting, as absence of nutrition may tend toward cardiac paralysis. One or two ounces of whiskey should be adminis- tered immediately before the operation. All excitement should be avoided, to the patient, from fear, sight of instruments, too many spectators, etc., all of which tend to induce shock. All appliances for resuscitation should be at hand, and plenty of fresh air be available during the inhalation. In using chloro- form mix only three and a half per cent, of the vapor with air, to ensure safety. In the administration of ether the respira- tions, according to some authorities, alone need be watched ; in chloroform, however, both the respirations and the pulse should be carefully noted. Treatment of Dangerous Symptoms of Anesthesia.— The suspension of the heart's action necessitates the immediate withdrawal of the vapor and the immediate inversion of the patient, according to Nelaton's method. The failure of respi- ration necessitates the forcible drawing out of the tongue to lift the epiglottis ; the practice of artificial respiration by the Sylvester method, and by faradization of the respiratory muscles ; the inhalation of gtt. iij to gtt. v of nitrite of amyl; ammonia to the nostrils; galvanism (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 placed directly over both phrenic nerves, 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). Artificial warmth should be applied, but no cold applications. The inversion of the body, according to Nelaton's method, and artificial respiration, according to Sylvester's method and Marshall Hall's ready method, are safe and are the most promising expedients. A simple method of producing artificial respiration is as follows:— " With outspread palms, press the front of the chest forcibly 176 DENTAL medicine. down, whilst an assistant at the same time presses the abdo- men. Make these movements not oftener than fifteen times in the minute." DR. H. R. SYLVESTER'S METHOD OF RESUSCITATION. " To Adjust the Patient's Position.—Place the patient on his back, on a flat surface; raise and support the head and shoul- ders on a small, firm cushion, or folded article of dress, placed under the shoulder-blades ; remove all tight clothing about the neck and chest. " To Maintain a Free Entrance of Air into the Windpipe.— Cleanse the mouth and nostrils; open the mouth; draw forward the patient's tongue, and keep it forward; an elastic band over the tongue and under the chin will answer the purpose. " To Imitate the Movements of Breathing:— " First, Induce Inspiration. Place yourself at the head of the patient; grasp his arms; raise them upward by the sides of his head; stretch them steadily but gently, upward and back- ETHER--ANESTHESIA. 177 ward, for two seconds. By this means fresh air is drawn into the lungs, by raising the ribs. " Secondly, Induce Expiration. Immediately turn down the patient's arms, and press them firmly, but gently, downward against the sides of his chest, for two seconds. By this means foul air is expelled from the lungs, by depressing the ribs. " Thirdly, Continue these Movements. Repeat these move- ments alternately, deliberately and perseveringly, fifteen times in a minute, until a spontaneous effort to respire be perceived. By these means an exchange of air is produced in the lungs, similar to that effected by natural respiration." MARSHALL HALL'S READY METHOD IN ASPHYXIA. " i st. Treat the patient instantly, on the spot, in the open air, freely exposing the face, neck and chest to the breeze, except in severe weather. " 2d. In order to clear the throat, place the patient gently on the face, with one wrist under the forehead, that all fluid, and the tongue itself, may fall forward, and leave the entrance into the windpipe free. " 3d. To excite respiration, turn the patient slightly on his side, and apply some irritating or stimulating agent to the nostrils, as Veratrine, dilute Ammonia, etc. "4th. Make the face warm by brisk friction; then dash cold water upon it. " 5th, If not successful, lose no time; but, to imitate respira- tion, place the patient on his face, and turn the body gently, but completely, on the side and a little beyond; then again on the face, and so on, alternately. Repeat these movements deliberately and perseveringly, fifteen times only in a minute. (When the patient lies on the thorax, this cavity is compressed by the weight of the body, and ^rpiration takes place. When he is turned on the side, this pressure is removed, and Aspira- tion occurs.) " 6th. When the prone position is resumed, make a uniform and efficient pressure along the spine, removing the pressure immediately before rotation on the side. (The pressure 178 DENTAL MEDICINE. augments the ^piration ; the rotation commences Aspiration.) Continue these measures. " 7th. Rub the limbs upward, with firm pressure and with energy. (The object being to aid the return of venous blood to the heart.) " 8th. Substitute for the patient's wet clothing, if possible, such other covering as can be instantly procured, each by- stander supplying a coat or cloak, etc. Meantime, and from time to time, to excite inspiration, let the surface of the body be slapped briskly with the hand. " 9th. Rub the body briskly till it is dry and warm, then dash cold water upon it, and repeat the rubbing. "Avoid the immediate removal of the patient, as it involves a dangerous loss of time ; also the use of bellows, or any forcing instrument; also, the warm bath, and all rough treatment." Local Anesthesia.—The fatality attending the use of general anaesthetics, led to the introduction of what are termed " local anaesthetics," the most important of which depend upon the therapeutic property of cold, which is properly an anaes- thetic only when it freezes the part to which it is applied. The use of cold for such a purpose must necessarily be limited to small parts of the body, and its utility depends upon the ease and rapidity with which a desired spot of living flesh can be frozen, in other words, temporarily deprived of its vitality, without inflicting mechanical injury on the delicate structure of the part. According to Dr. Richardson, the proposer of the method, the principle consists in directing on a part of the body a volatile liquid, having a boiling point at or below blood heat, in a state of fine subdivision or spray, such subdivision being produced by the action of air or other gaseous substance on the volatile liquid to be dispersed. When it falls on a part of the body, it comes with force into the most minute contact with the surface upon which it strikes. As a result, there is rapid evaporation of the volatile fluid, and so great an evolution of heat force from the surface of the part to which the spray is applied, that the blood cannot supply ALCOHOL. 179 the equivalent loss. The part consequently dies for the moment, and is insensible; but as the power of the body is unaffected, the blood, as soon as the external reducing agency is withdrawn, quickly makes its way again through the dead parts, and resto- ration rapidly occurs. The fluids used are ether, of a specific gravity not exceeding 0.723, rhigolene, a product of petroleum, and the lightest liquid known, and bromide of ethyl. When a current of the volatile liquid, either atomized ether or rhigolene, comes in contact with the skin, by the use of the spray apparatus, an intense degree of cold is produced, which deprives the nerves of the part of their power to transmit impressions to the sensorium. For the extraction of teeth, destruction of the pulps of teeth, opening abscesses, and other minor surgical operations, and neuralgia of superficial nerves, success has attended the use of such local anaesthetics. The greatest objections to such a method of inducing local anaes- thesia, are the great pain which attends the first application, and the unpleasant burning sensation of the part when it is recovering from the freezing process. (See Rhigolene.) (See Aconite, for obtunding mixture.) Electro-magnetism has also been employed as a local anaes- thetic, and it is a mooted question whether it relieves pain or complicates the sensations. It is well, however, to remember that some persons are so peculiarly constituted as to render them very susceptible to the influence of electricity. (See Elec- tricity as a Therapeutic Means, etc.) ALCOHOL. Formula.—C2H5HO. Sp. gr. of officinal alcohol, 0.835 j °f rectified spirit—Spiritus Rectificatus, 0.838; of stronger alcohol, —Alcohol Fortius, 0.817; of diluted alcohol—Alcohol Dilutum (equal parts of alcohol and distilled water), 0.941. Derivation.—Alcohol is obtained from vinous or fermented liquors by repeated distillations, and, in its officinal form, contains about fifteen per cent, of water. It is colorless, inflam- mable, wholly vaporizable by heat, and unites in all propor- 180 DENTAL MEDICINE. ____________________^_______________________________ tions with water and ether. It frequently contains such im- purities as fusel oil or amylic alcohol (obtained from fermented grain or potatoes), the presence of which can be detected by agitating the alcohol with sulphuric acid, when the former becomes colored. Stronger Alcohol.—Alcohol Fortius—Absolute Alcohol—is obtained by agitating the officinal alcohol with heated carbonate of potassium. Medical Properties and Action.—All the different forms of alcohol, including brandy—Spiritus Vini Gallici (the spirit obtained from fermented grapes by distillation, and containing 48 to 56 per cent, by volume, of absolute alcohol); whiskey— Spiritus Frumenti (the spirit obtained from fermented grain by distillation, and containing from 48 to 56 percent, by volume, of absolute alcohol); wine—Vinum (the fermented juice of the grape, and containing alcohol in varying proportions), are powerful diffusible stimulants, increasing the action of the heart and arteries, exciting the nervous and vascular systems, and causing a general exhilaration of spirits. Excessive quan- tities produce the effect of narcotic poisons, ending in coma and death. The habitual use of alcoholic drinks causes most injurious effects upon the system generally, and directly upon the mucous coats of the stomach, deranging and destroying its functions and structure, resulting in dyspepsia, followed by cirrhosis of the liver and kidneys, loss of mental and physical strength, derangement of the nervous system, and, at last, delirium tremens. When properly administered in diseased conditions, however, alcoholic preparations are valuable agents. Therapeutic Uses.—The different forms of alcohol are em- ployed as stimulants in acute inflammations, such as pneumonia, pleurisy, bronchitis, pulmonary affections of children, etc., etc., and in rheumatic pericarditis, in the later stages of typhus and typhoid fevers, diphtheria, acute neuralgia, convulsions of dentition, tetanus, asphyxia from cold, pyaemia, etc., etc. Externally in superficial inflammation, bruises, sprains, ptyal- ism, gout, cerebral affections, bed sores, etc., etc. According ALCOHOL. 181 to Bartholow, alcohol is an excellent haemostatic for restrain- ing oozing from a large surface, and an efficient antiseptic dressing, as it destroys germs, removes fetor, and stimulates the tissues to more healthy growth. Dental Uses.—Alcohol, as a narcotic, is employed to relieve pain. In combination with tannic acid or chloride of zinc, it obtunds the sensibility of dentine ; as a styptic, it arrests hem- orrhage from relaxed tissues, coagulating the blood by its effect on albumen, and causing contraction of the mouths of the vessels by its astringent property. Equal parts of alcohol and water make an excellent application as an evaporating lotion, for the relief of superficial inflammations. For suppu- rating wounds, it is a useful antiseptic dressing, as it destroys germs, removes fetor, and stimulates the tissues to a more healthy action. It also favors the cicatrization of open wounds, coagulating the albumen, and forming an impermeable cover- ing. In mercurial salivation (mercurial stomatitis), it forms an excellent gargle. For softened and sensitive dentine, and for drying cavities preparatory to filling them, the stronger or absolute alcohol is employed. A simple method of preparing this form of alco- hol is to add one part of carbonate of potassa to four parts of the ordinary or officinal alcohol. Owing to the great affinity carbonate of potassa has for water, it abstracts the latter from the alcohol to a sufficient degree to answer all practical pur- poses. The cavity of a tooth is first dried with cotton and bibulous paper, and then bathed with the absolute alcohol, which at once evaporates, and causes the almost perfect absorption of moisture. Brandy and water form, in combination, an excellent lotion for mercurial and other forms of stomatitis. DENTAL FORMULAE. For Obtunding Sensitive Dentine. For Obtunding Sensitive Dentine. R. Alcohol (absolute)...... 3*ss R. Alcohol (absolute)...... gss Acidi tannici.............. £ss Zinci chloridi............ £ss Glycerini.................. 35s. M. Glycerini................... gss. M. 182 DENTAL MEDICINE. For Superficial Inflammations. For Mercurial Stomatitis. R. Alcohol, R. Spts. vini gallici......... I part Aquae...........aa......... 3*ss. M. Aquae............... 4 to 6 parts.M. Signa.—To be applied as a lotion. Signa.—To be used as a gargle. ALUMEN—ALUM. Formula.—A1(NH4)2(S04) 12H20. Source.—It is found native in Italy, in the neighborhood of volcanoes, and is the mineral from which the metal aluminium is obtained. Derivation.—Alum is also obtained from aluminous slate, shale or schist, from which it is obtained by the process of roasting and exposure to the air. Alum is a white, slightly efflorescent salt, which crystallizes in regular octahedrons. It possesses an astringent, acid, and sweetish taste. It is insoluble in alcohol, but dissolves in from fourteen to fifteen times its weight in cold, and three-fourths of its weight of boiling water. Medical Properties and Action.—Alum is astringent and styptic, and is employed both externally and internally. When taken internally, it is absorbed into the system, and has been detected in the liver, spleen and urine. Excessive doses cause vomiting, griping, purging, and inflammation of the gastro- enteric mucous membrane. Powdered alum, in doses of a teaspoonful, is an efficient emetic. It coagulates albumen, and causes an abundant flow of saliva, coagulating the albumen of the saliva and buccal mucus in whitish, membranous, flakes. Its astringent influence is chiefly upon mucous surfaces. Applied locally to relaxed or bleeding parts, it corrugates the surrounding tissues and causes contraction of the capillaries, and, in this manner, acts as an astringent. Therapeutic Uses.—Alum is internally administered in diar- rhoea, chronic dysentery, colica pictonum, catarrh of the stom- ach, etc. Externally it is applied in ulcerated and relaxed throat affections, ptyalism, gonorrhoea and gleet, uterine hem- orrhage, morbid growths, haematuria, ophthalmia, chronic whooping cough, chronic skin diseases, chilblains, ulcers, hospital gangrene, etc., etc. ALUM. 183 Dose.—Of alum, gr. x to 3j or 9ij, in powder, or solution in water, or in some simple infusion. Ammonia Alum—Sulphate of alumina and ammonia— Alumina et Ammonia? Sulphas—is prepared by adding sulphate of ammonia to a solution of sulphate of alumina. Dried Alum—Alumen Exsiccatum (alum deprived of its water of crystallization by heat)—is employed externally as a mild escharotic, to destroy exuberant granulations, etc. Dental Uses.—Alum is employed in dental practice as a styptic in alveolar hemorrhage; as a gargle in stomatitis, ulceration, and sponginess of the gums, morbid or fungous growth of gums, dental pulp, etc., superficial hemorrhage from the mucous membrane of the mouth, ulcers of the mouth, cancrum oris, odontalgia, etc., etc. In congested conditions of the mucous membrane of the mouth and throat, alum gargles afford great relief. Powdered alum added to liquor sodae chlorinatae (Labarraque's Solution), is an excellent bleaching application for discolored necrosed teeth. The habitual use of alum as an ingredient of a dentifrice is injurious to the teeth, on account of the sulphuric acid it contains. Potassa alum—Aluminii et Potassii Sulphas—the alum of commerce (which has been superseded by ammonia alum), will render plaster casts hard, when they are boiled in a strong solution for half an hour. dental formulae. For Odontalgia. For Inflamed and Ulcerated Mucous R. Pulveris aluminis....... sjij Membrane and Gums. Etheris nitrici............ 3v'j- M. R. Pulveris aluminis...... gr.lxxx Signa.—To be applied on a pellet of Aquae destillatae........ f^x. M. cotton. Signa.—To be used as a mild, astrin- gent gargle. For Ulceration of the Gums and Mucous For Ulcerated and Spongy Gums. Membrane of the Mouth. R. Aluminis.................. gj R. Aluminis................. £j Vini........................ Oj Zinci sulphatis.......... £ss Tinct. cinchonae......... 3 ss Sodii borat............... gr.iv Tinct. myrrhae........... gij Aquae rosae............... 3" viij. M. Mel. rosae................. 3*ij. M. Signa.—To be applied as a lotion. Signa.—To be used as a gargle. 184 DENTAL medicine. For Inflammation and Ulceration of the Mouth and Throat. R. Infus. lini...................................................... 3*xv Tinct kino..................................................... |j Aluminis........................................................ ^ij. M. Signa.—To be used as a gargle. ALUMINA ACETAS—ACETATE OF ALUMINA. Formula.—Al2032C4H303+4HO. Derivation.—The salt, Acetate of Alumina, is obtained by the direct combination of hydrated alumina with acetic acid, or by reaction between sulphate of alumina and acetate of lead. The solution, when properly prepared, is a clear fluid, of a sharp, sweetish, astringent taste, and a distinct odor of acetic acid. When it is evaporated, there is deposited light, fragile, glossy scales, which are perfectly soluble in water, and not readily affected by the atmosphere. Medical Properties and Action.—It is disinfectant and anti- septic. In maximum doses it produces an unpleasant sensation of warmth and fullness in the stomach, and, at the same time, vertigo and confusion of the senses, which may continue for several hours. Therapeutic Uses.—Acetate of alumina is rarely employed internally, and only for zymotic and contagious diseases. It is generally used externally, and is a very effectual remedy in the treatment of wounds, preventing pyaemia in suppurating wounds and ulcers. It is also applied in parasitic skin affec- tions, as an injection in gonorrhoea, and for the destruction of animalculae in putrescent fluids. As a surgical dressing, it is used by keeping the wound saturated with a solution of moder- ate strength, or by irrigation. A concentrated solution will preserve anatomical subjects for a considerable time. Dose.—Of acetate of alumina, gtt. xx to gtt. 60 of the solution. Dental Uses.—Acetate of alumina is useful in dental practice, as an antiseptic and disinfectant in cancrum oris, ulcers of the mouth, suppurating wounds of mucous membrane, pyorrhoea alveolaris, alveolar abscess, etc. A very weak solution has been employed as a mouth wash for offensive breath depending carbonate of ammonium. 185 on scrofulous ulcerations, aphthae, caries of the teeth, or the wearing of artificial teeth. LIQUOR AMMONII ACETATIS—SOLUTION OF ACETATE OF AMMONIA. spirit of mindererus. Formula.—NH4C2H302. Derivation.—Spirit of Mindererus is obtained by saturating diluted acetic acid with carbonate of ammonia, being a solution of the acetate of ammonia. It is a colorless liquid, with a saline taste, and requires to be freshly made when about to be used. Medical Properties and Action.—It is refrigerant, diaphoretic, and diuretic, and its action can be greatly increased by combi- nation with other remedies. Few medicines are in more general use. Therapeutic Uses.—Spirit of mindererus is employed in the treatment of febrile and inflammatory affections, and exanthe- mata, sick headache, catarrh and influenza, etc., etc. Externally it is used as a lotion to sprains, bruises, glandular enlarge- ments, etc. Dose.—Of spirit^of mindererus, f5j to fSj. Dental Uses.—A lotion composed of one part to ten of water is a serviceable application in inflamed conditions of mucous membrane. Internally administered as a refrigerant, it is useful in acute periosteal inflammation, inflammation of the dental pulp—pulpitis, etc. AMMONII CARBONAS—CARBONATE OF AMMONIUM. Formula.—N4H18C309. Derivation.—Carbonate of Ammonium is a sesquicarbonate, and is obtained by subliming a mixture of chloride of ammo- nium and chalk. It is in the form of white, translucent masses, with a pungent, ammoniacal odor, and an acrid, alkaline taste. It is soluble in water, and on exposure to the air it becomes opaque and falls into powder, losing its ammonia. Medical Properties and Action.—It is antacid, stimulant, di- 13 186 DENTAL MEDICINE. aphoretic and expectorant, and is considered to be especially useful in cases where the vital powers are greatly depressed. In large doses it causes colic, convulsions and great dis- turbance of the nervous system, and when long continued, an annoying itching of the scalp, and skin over the surface of the body. It has a tendency to fluidify the blood. Inter- nally, as a diffusible stimulant, it is preferred to solution of ammonia. Therapeutic Uses.—It is internally administered in diabetes, scrofula with languid circulation, asthma, pneumonia, croup, chorea, diseases of the skin, puerperal insanity, mercurial erethism, drunkenness, etc., etc. Externally it is employed as a volatile or smelling salts, in syncope, hysteria, and asphyxia. Dose.—Of carbonate of ammonium, gr. v to gr. x, in pill, or in solution with gum and sugar. Dental Uses.—It is a useful internal remedy in cancrum oris, in doses of gr. v, gradually increased to gr. x, every two or three hours, using strong nitric acid as a local application. It is also a very useful remedy in mercurial erethism, in con- junction with camphor and other stimulants. AMMONII VALERIANAS—VALERIAN ATE* OF AMMONIUM. Formula.—NH4C5H902. Derivation.—Valerianate of ammonium is obtained by com- bining valerianic acid with a strong solution of ammonia and evaporating to a syrupy consistence; it is also obtained by subjecting the monohydrated acid to the action of dry, gaseous ammonia. It is in the form of a white salt, in quadrangular plates, with the odor of valerianic acid, and a sharp, sweetish taste. It is soluble in water and alcohol. Medical Properties and Action.—It is stimulant, nervine, and antispasmodic. Therapeutic Uses.—It is employed in neuralgia, nervous headache, hysteria, epilepsy, chorea, etc., etc. Dose.—Of valerianate of ammonium, gr. ij to gr. viij, in pill, or in elixir, with aromatics (valerianate of ammonium 5j, fluid CHLORIDE OF AMMONIUM. 187 extract of vanilla fSss, tincture of cardamom f5yj, curacoa, foij, water fSiv—Misce. Dose, a teaspoonful three times a day). Dental Use.—It is internally administered for neuralgia. AMMONII CHLORIDUM—CHLORIDE OF AMMONIUM. MURIATE OF AMMONIA—HYDROCHLORATE OF AMMONIA—SAL AMMONIAC. Formula.—NH4C1. Derivation.—Chloride of Ammonium is obtained by neutral- izing hydrochloric acid with ammonia, and evaporating to dryness. It is in the form of a snow-white, crystalline powder, soluble in two and a half parts of cold water, and sparingly soluble in alcohol. It has a pungent, saline taste. Medical Properties and Action.—In large doses it is an irritant poison, with a purging action ; but in small doses it is a power- ful resolvent alterative; it is also refrigerant and anodyne. Its action upon the system closely resembles that of mercury as an alterative. Externally it is used as a discutient application, and as a cold lotion in fevers, hernia, etc. Therapeutic Uses.—It is employed internally in amenorrhcea, rheumatic affections, chronic bronchitis, pneumonia, dropsical affections, hemorrhages, whooping cough and myalgia. Ex- ternally in abscesses of the mamma, skin diseases, ecchy- mosis of the eye, hydrocele, senile gangrene, gonorrhoea, leucorrhcea, etc. Dose.—Of chloride of ammonium, gr. v-xxx, every two or three hours, in powder or mucilage. Dental Uses.—It is employed in facial neuralgia, in doses of 5ss, repeated four times daily. Externally it is used as an application to indolent ulcers, for its stimulating effect. As a gargle, it is employed in the strength of Sss to Sxij of water. It is also applied to cancerous tumors, and has been used to restore zinc which has become deteriorated from long use in laboratory work. Chloride of ammonium (sal ammoniac) is also used as a flux, in refining gold for laboratory use. 188 DENTAL MEDICINE. AMYLENE. Formula.—QH10. Derivation.—Amylene is obtained by distilling amylic alcohol with chloride of zinc. It is a colorless, very mobile liquid, with a boiling point of 1020, and the density of its vapor 2.45. It has a very peculiar and disagreeable smell. Medical Properties and Action.—Amylene was introduced as an anaesthetic in 1856, by the late Dr. Snow, who regarded it as possessing the following advantages : the safety of ether, absence of pungency and irritating property, readiness with which the absence of pain is obtained, with less coma than with chloroform or ether, the speedy recovery from its effects, less nauseating, and less headache and rigidity and struggling than in the case of ether or chloroform. Others, however, have not been so much impressed with this anaesthetic agent as was Dr. Snow; hence, it has not been regarded with the same favor as other agents of this class. An extreme quantity being required to produce complete insensibility to pain, its operation is considered to be dangerous. Therapeutic Use.—As an anaesthetic. AMYL NITRIS—NITRITE OF AMYL. Formula.—C5HuN02. Sp. gr. 0.877. Derivation.—Nitrite of Amyl is obtained by heating one part of strong nitric acid with two parts of rectified fusel oil, until reaction commences, when the heat is withdrawn, and afterward re-applied. The distilled portion obtained below 2120 F. is rectified by means of carbonate of potassium, and that portion only distilling between 2000 and 2060 F. is re- served, being a nitrite of the oxide of amyl. It is a yellowish or amber-colored liquid, somewhat oily, very volatile and in- flammable, and boils at 1820 F. It has an odor like that of ripe pears. Medical Properties and Action.—It is used by inhalation, causing an accelerated action of the heart, sudden flushing of the face, dilatation of the arteries, a sense of great fullness of the brain, a lowering of the blood pressure and temperature, NITRITE OF AMYL. 189 and complete resolution of the muscular system. The vapor of nitrite of amyl, when applied directly to the muscular or nervous tissues, arrests their functional activity, and, circulating in the blood, appears to act most on the vaso-motor system and unstriped muscular fibre. Therapeutic Uses.—Being a powerful stimulant to the heart, it is an antidote to chloroform. A case is mentioned in the British Medical Journal, where, during chloroform narcosis, respiration ceased, and artificial respiration failed to restore the patient. Some nitrite of amyl was then poured on lint, and held to the patient's nostrils. In ten seconds there was a flushing of the face, the pulse was again felt, and respiration was restored. When from two to five minims are poured on lint and applied to the nostrils, the heart's action will be accelerated, a sudden flushing of the face takes place, dilatation of the arteries results, also a fall in the blood pressure and a lowering of the temperature, and complete muscular relaxation. By inhalation, for relieving the pain of angina pectoris ; also used in asthma, strychnia poisoning, hydrophobia, tetanus, epileptic attacks, and in many other convulsive or spasmodic diseases. Dose.—Of nitrite of amyl, n\,ij to nvv, by inhalation; not more than gtt. iij should be administered, unless the patient has been accustomed to its use. Dental Uses.—As an antidote for chloroform narcosis, for the relief of epileptic attacks during the extraction of teeth, for relieving the pain of neuralgia of the fifth pair of nerves, and for restoration from syncope. As nitrite of amyl is a powerful and dangerous agent, care must be observed in its use, and but small doses applied at first, as some patients, especially the weak and nervous, are very susceptible to its influence. AQUA DESTILLATA—DISTILLED WATER. Derivation.—" Take of water 80 pints. Distill two pints, using a tin or glass condenser, and throw them away ; then distill 64 pints, and keep them in glass bottles."—U.S. D. 190 DENTAL MEDICINE. Properties.—Distilled water has a vapid, and by no means pleasant taste, and is only perfectly pure when the vessel used in the distillation is of silver. It should evaporate without residue. Therapeutic Uses.—It is very essential in the preparation of some formulae, and of no use whatever in others, as the com- mon pure water will answer. Such agents as tartar emetic, nitrate of silver, corrosive sublimate, chlorides of calcium, barium, acetate and subacetate of lead, permanganate of potassa, the sulphates of iron and zinc, sulphate of quinia, the salts of morphia, and all the alkaloids and their salts, require, when given in solution, distilled water. Dental Uses.—Distilled water is required in the preparation of many formulae for use in dental practice. ARGENTI NITRAS—NITRATE OF SILVER. LUNAR CAUSTIC. Formula.—AgNOs. Derivation.—Nitrate of Silver is obtained by dissolving silver in nitric acid and distilled water, and evaporating the solution. It is in the form of a heavy, colorless, anhydrous salt, and crystallizes in shining, rhombic plates. The action of light and organic matters causes it to turn black. It is wholly soluble in distilled water, the only preparation of water that should be employed in forming solutions of this salt. It has a strong, metallic, styptic taste. In the preparation of the solid form of sticks, it is first melted and poured into moulds, ex- posure to the light causing the sticks to become gray, and more or less dark, owing to the reduction of the silver by the sulphuretted hydrogen contained in the atmosphere ; hence, on account of the decomposition of this salt, it should be care- fully excluded from the light. Medical Properties and Action.—Nitrate of silver is tonic, antispasmodic, sedative, and astringent. When applied to the skin, mucous membrane, or ulcers, it produces, at first, a white appearance, owing to its union with the coagulated albumen of the cuticle, but this gradually changes to a bluish-gray, purple, NITRATE OF SILVER. 191 and finally, black color, on account of the partial reduction of the silver by the sulphuretted hydrogen. Small doses, admin- istered for a long time, give a peculiar blue appearance to the skin. When internally administered, it has an astringent action on the mucous coats of the intestines. It is a powerful tonic to the nervous system, and has been chiefly employed as an antispasmodic tonic. It is chiefly used externally, as a stimu- lant, vesicant, and escharotic. If applied, even lightly, three or four times, to the moistened skin, it will cause vesication in a few hours. The blue appearance on the skin, when small doses are long continued, is said to be preceded by a peculiar blue line on the gums, like that from lead poisoning. A very minute quantity of this salt, when internally administered, is eliminated by the kidneys, as most of it escapes by the liver and the intestinal glands, a portion remaining permanently deposited in the tissues, when its use has been long continued. Six weeks is the length of time it is safe to continue its internal use,and during that time occasional purgatives should be given, to promote its elimination. The persistent use of iodide of potassium and the hyposulphite of soda will cause the absorp- tion and excretion of the silver deposits, in cases of skin dis- coloration from its long continued use, aided by baths of the hyposulphites, and the very careful use of lotions containing cyanide of potassium, which possesses a solvent power over silver deposits. As long as inflammation is present, it should not be internally administered, and during a course, it should be occasionally intermitted for a few days, and a purgative used. The gums and fauces should be frequently examined, and if the slightest blue discoloration is observed, the remedy should be discontinued. Exposure to the sun should be avoided. Therapeutic Uses.—Nitrate of silver is internally employed in dyspepsia,'chronic gastritis, chronic diarrhoea and dysentery, cholera, diseases of the eye, chorea, epilepsy, asthma, and whooping cough. Externally in ophthalmia and other diseases of the eyes, cutaneous diseases, diphtheria, erysipelas, hydrophobia, enlarge- 192 DENTAL MEDICINE. ment of glands, diseases of the genito-urinary organs, diseases of the ear, burns, ulcers, etc., etc. Dose.—Of nitrate of silver, gr. }&, gradually increased to gr. x/2 three times a day, in pill made of some vegetable pow- der, or in solution. The fused nitrate of silver—Argenti Nitras Fusa—or solid form, is used externally. Dental Uses.—For inflamed and ulcerated conditions of the mucous membrane of the mouth, nitrate of silver is a valuable application, in the form of injections or solutions of various strengths, from gr. ij to 5ss of distilled water; also in diseases of the antrum and fistula, as an injection. It is also used as a styptic, for the arrest of alveolar hemorrhage, but is not so reliable as the preparations of iron, tannic acid, etc., on account of the coagulum or clot formed by it, being soluble in an excess of albumen. It is also employed to obtund the sensitiveness of dentine, especially where the cause is mechanical abrasion; also in aphthae, mercurial stomatitis, ulceration of the gums, salivary fistula, alveolar abscess. For obtunding sensitive dentine, the stick form (one end of a stick inserted into a quill, or fused on the end of a platinum wire) is employed; or the end of a silver wire may be immersed in nitric acid, and ap- plied to the sensitive surface, taking care to limit its action to the part on which it is to act. When applied to sensitive dentine, it acts on the gelatinous portion of the tooth, destroy- ing its vitality to the extent of the combination which takes place. The objection to its use in such cases is the discolora- tion it causes. As salt decomposes the nitrate of silver, a solution of the chloride of sodium will relieve the excessive pain following its application to sensitive dentine, or to ulcers of the mouth; such a solution will also remove recent stains, if followed by the ap- plication of a solution of ammonia. Old stains may be removed with tincture of iodine, followed by cyanide of potassium. The antidote in cases of poisoning by nitrate of silver is chloride of sodium (common salt), which converts it into chlo- ride of silver, to be followed by emetics, and the proper anti- phlogistic treatment. ARNICA. 193 DENTAL FORMULAE. For Inflamed and Ulcerated Mucous For Ulcers and Aphthce. Membrane. R. Argenti nitratis........... £ss R. Argenti nitratis.. gr.ij to gss Aquae destillatae.......... 3J. M. Aquae destillatae........... f^j. M. Signa.—To be applied with a camel- Signa.—To be used as a lotion. hair brush. For Disease of the Antrum. For Mercurial Stomatitis. R. Argenti nitratitis.. gr.j to gr.v R. Argenti nitratis......... gr.ss Aquae destillatae........... f^j M. Aquae destillatae........ f^j. M. Signa.—To be used as an injection. Signa.—To be used as a mouth wash. ARNICA. LEOPARD'S BANE. Source.—Arnica Montana is a perennial, herbaceous plant, of which the dried flowers and root—Arnica Flores and Arnica Radix—are the medicinal portions, and is found in the moun- tains of Northern Europe and the Northwestern portions of America, Medical Properties and Action.—Arnica is nervine, stimulant, and diaphoretic. In over doses, it is an acro-narcotic poison, causing vomiting, purging, vertigo, tetanic twitchings of the muscles, and convulsions. Moderate doses, when long con- tinued, are liable to cause a very troublesome eruption. Its activity depends upon an alkaloid—Arnicina, which is a bitter and acrid extractive. Therapeutic Uses.—Arnica is administered internally in typhus and typhoid fevers, chronic dysentery, rheumatic gout, etc., etc. Externally to bruises, sprains, lacerations, chilblains, etc., in the form of tincture—Tinctura Arnica. The antidote for poisoning by arnica is common vinegar. Dose.—Of the extract of arnica, gr. v to gr. x. Of the tincture of arnica (arnica root Sj, rectified spirit Oj), the dose is lr^x to foss. Dental Uses.—In dental practice, the tincture of arnica is applied to irritable pulps of teeth, in dental periostitis, to pre- vent suppuration, to wounds of the mucous membrane of the mouth, combined with glycerine, to abraded surfaces caused by artificial teeth, and with tannic acid or glycerine of tannin, for ulcers of the mouth. 194 DENTAL MEDICINE. The tincture of arnica, when largely diluted with water, forms an efficient mouth wash during operations upon the teeth. DENTAL FORMULAE. For Abraded Surfaces of the Mucous For Ecchymosis. Membrane of the Mouth. R. Tincturae arnicae......... Jss R. Tincturae arnicae, Liquor ammonii muriat. 3* ss Glycerini......aa........ £]■ M. Aquae...................... 3* v. M. Signa.—To be used as a lotion. Signa.—To be applied as a lotion. For Inflamed and Ulcerated Mucous Membrane. R. Tincturae arnicae............................................. ^ij Glycerini...................................................... gij Aquae rosae...............................................__ ^ ij Aquae destillatae............................................. ^ x. M. Signa.—To be used as a gargle. ATROPINE SULPHAS—SULPHATE OF ATROPINE. ATROPINE. Formula.—C17H23N03. Derivation.—Sulphate of Atropine is obtained by adding a mixture of sulphuric acid to an ethereal solution of atropine. It is in the form of a white, slightly crystalline powder, very soluble in water and alcohol, but insoluble in ether. It is inodorous, and of a bitter taste. Medical Properties and Action.—Sulphate of atropine has the same medical properties and action as belladonna, but is far more energetic in its action. It is an active poison, and should only be administered internally with the greatest care. Hypo- dermically employed, it is a useful anodyne and antispasmodic, and the quantity should be cautiously increased from a very small dose in the beginning. Such symptoms as dryness of the throat, vertigo, and diplopia, are indications that its use should be discontinued. Without being a direct hypnotic, it induces sleep by relieving pain. Although it is not so well tolerated, as a general rule, as is morphia, yet patients who cannot bear morphia will bear atropia. Therapeutic Uses.—See Belladonna. Dose.—Of sulphate of atropine, gr. T^ to gr. fa. For an anodyne and antispasmodic, hypodermically injected, the dose is til ij = gr. Th, as a commencement. An ointment is made of atropine gr. viij, rectified spirit f5ss, lard Sj. SULPHATE OF ATROPINE. 195 The antidote in cases of poisoning by belladonna and its alkaloid is an infusion of galls and lime water, first evacuating the stomach as speedily as possible. Dental Uses.—In dental practice, sulphate of atropine is applied externally, to obtund the sensitiveness of inflamed pulps of teeth, preparatory to their treatment, and to their devitalization; it is also applied to acute inflammation, depend- ing upon alveolar periostitis and abscess. It forms one of the ingredients of a nerve paste, for devitalizing pulps of teeth, being substituted for the acetate of morphia; in facial neural- gia, in the form of an ointment; in neuralgia and in profuse salivation. As an anodyne for internal use, it proves effica- cious in relieving intense pain, such as may result from an inflamed pulp or periosteum ; also internally, or in the form of hypodermic injections, for the relief of facial neuralgia. DENTAL FORMULAE. For Facial Neuralgia. For Facial Neuralgia. R. Atropinae sulphat........ gr.j R. Ext. belladonnae......... gr.ss Adipis..................... 3J. M. Quininae sulphat......... gr.ij. M. Signa.—To be applied in the form of Ft. pil. No. i. an ointment, over seat of pain. SlGNA.—Use three times daily. For Neuralgia. For Facial Neuralgia. J. L. ludlow. R. Linimenti belladonnae, R. Atropinae sulphatis...... gr.ss Linimenti aconitLaa.. gvij Aconitinae................. gr.iss Chloroformi.............f3ij. M. Olei tiglii.................. gtt.ij SlGNA.—To be applied as a lotion, on Ung. petrolei............. £ij. M. lint saturated with it, and covered Signa.—Apply externally. with oiled silk. For Facial Neuralgia. For Neuralgia in Superficial Nerves. R. Pulveris belladonnae.... 5;x R. Chloroformi, Camphorae................. 3*ss Spts. vini rect.....aa..... 3*ss Spiritus rectificati........ q.s. M. Atropinae sulphat........ gr-v. M. Signa.—To be applied with a camel- Signa.—To be applied on lint to painful hair brush. part, and covered with oiled silk. For Neuralgia. R. Ext. belladonnae............................................ gr.iv Ext. stramonii............................. ................. gr.v Ext. hyoscyami.............................................. gr.v Quininae sulphat............................................ 3 ij. M. Ft. pil. No. xx. Signa.—One pill two or three times a day. 196 DENTAL MEDICINE. AURUM TERCHLORIDUM—TERCHLORIDE OF GOLD. Formula.—Au Cl3. Derivation.—The Terchloride of Gold is obtained by dissolv- ing gold in aqua regia (three parts, by measure, of hydrochloric acid, and one of nitric acid), using gentle heat to hasten the solution, the acids employed being chemically pure. The solution is then evaporated to dryness, when ruby-red, pris- matic crystals of the terchloride of gold results. Properties and Action.—Terchloride of gold is very deli- quescent, and is soluble in water, alcohol and ether. It pos- sesses a disagreeable, styptic taste, reddens blue litmus paper, and will impart a purple stain to the skin, which may be removed by a solution of cyanide of potassium. It is readily decomposed by many metallic and non-metallic elements, and also by saline and organic compounds, on account of its ele- ments being held together by a feeble affinity. It is escharotic and disinfectant, and its physiological effects are similar to those of corrosive sublimate. It is not used internally. Dental Uses.—In dental practice, the terchloride of gold, in the form of an aqueous, alcoholic, or ethereal solution, is em- ployed for the purpose of obtunding the sensitiveness of dentine, for which it is a valuable application ; and the ethereal solu- tion possesses some advantages over the aqueous or alcoholic solutions, for such a purpose. To prepare an obtunding solu- tion : " Dissolve the crystals of the gold in pure water ; fill a test tube half full of the solution; then add an equal quantity of sulphuric ether, and agitate the mixture. Let it then rest for a few minutes, when the ethereal solution will rise to the surface, and may be poured off into another tube or phial, and securely stopped. It should be kept, as much as practicable, from the action of light and air. Applied to dentine, on pledgets of cotton, it acts like chloride of zinc, but more promptly and with less pain. Chlorine is more abundantly liberated during its action than from chloride of zinc, hence it is a better disinfectant than the latter." It has a fine yellow tint, and it is not absorbed by the dentine, but forms an in- soluble compound with the gelatinous elements. As it is an BELLADONNA ROOT. 197 irritant poison, care should be observed in its use. If not pro- tected in a glass-stoppered bottle, the gold is precipitated in a metallic form. BELLADONNA FOLIA—BELLADONNA LEAVES. BELLADONNA RADIX—BELLADONNA ROOT. DEADLY NIGHTSHADE. Source.—Belladonna is a perennial, herbaceous plant, found in Europe, the leaves and root being the medicinal portions. Medical Properties and Action.—Belladonna is anodyne and antispasmodic, its activity depending upon an alkaloid, Atro- pine. Belladonna, in small doses, is a valuable narcotic and anodyne stimulant It causes a peculiar dryness of the mouth, fauces, stomach and intestines, but increased secretion follows, especially in the case of the latter organs, when atropine is administered or subcutaneously injected. In larger doses, it causes dilatation of the pupils, giddiness, loss of vision, diffi- cult deglutition, constriction of the throat, difficult articulation, increased action of the heart, quickened respiration, nausea, vomiting, diuresis, purging, and sometimes a red eruption. It is eliminated chiefly by the urine. Opium is the antidote, or hypodermic injections of morphine. When applied to the eyebrows, belladonna causes dilatation of the pupils. Therapeutic Uses.—Belladonna is extensively employed, either alone or in combination with sulphate of quinia, in the treatment of neuralgia ; also in mania, Bright's disease, epilepsy, lead colic, spasmodic affections, diseases of the cerebro-spinal system, as a preventive of scarlatina, night sweats of phthisis, etc. Dose.—Of powdered belladonna, gr. ss to gr. j, daily ; of the extract, gr. % to gr. j; of the tincture, gtt. v to gtt. xx. BISMUTHI SUBNITRAS—SUBNITRATE OF BISMUTH. Formula.—BiON03H20. Derivation.—The metal Bismuth—Bismuthum, Formula Bi, from which the subnitrate is obtained, is found native in Europe 198 DENTAL MEDICINE. and America, and generally in combination with sulphur and oxygen. It fuses at 476 F., and is brittle and pulverizable. It is employed in the dental laboratory for making fusible metal alloys for dies and counter-dies. The Subnitrate of Bismuth is obtained by dissolving the metal bismuth in dilute nitric acid, and converting the nitrate thus formed into carbonate, by adding a solution of carbonate of sodium, which is then dissolved in nitric acid, and trie nitrate of bismuth again formed, which is washed in water, and the nitric acid removed by ammonia. Such a process frees it from the arsenious acid which metallic bismuth generally contains. Subnitrate of bismuth is in the form of a heavy, white powder, with a faint acid odor and slightly metallic taste, and is insol- uble in water. Large quantities are poisonous, with symptoms of arsenical poisoning. Medical Properties and Action.—Subnitrate of bismuth is sedative, astringent and alterative. Owing to the formation of a sulphide, it coats the tongue black, and its continued use may give rise to the formation of a bluish-red line on the gums, similar to that resulting from the use of lead, except that the line is wider and deeper in color. In proper doses, it promotes the appetite and increases the digestive power. Being some- what astringent, it affects the intestinal movements, and can be detected in the blood, urine, and other secretions. Therapeutic Uses.—Subnitrate of bismuth is employed' in atonic dyspepsia, gastric irritations (milder forms), pyrosis, gastrodynia, ulcer of the stomach, diarrhoea from debility, etc., chronic laryngitis, epilepsy, ringworm (in form of an oint- ment Sj to lard Sj), chronic skin diseases, chlorosis, when iron is not tolerated, etc., etc. If not well borne by the stomach, it may be combined with aromatic powder, or if alkalies are indi- cated, with chalk and magnesia. Bismuthi subnitras is also employed as an antiseptic dressing for wounds, to promote primary union. The subnitrate is held in suspension in water, in the proportion of 10 per cent., and during the operation the wound is, from time to time, sprinkled with the solution, and afterward sealed with a bis- SULPHATE OF CADMIUM. 199 muth paste, and the subsequent dressings made in the same manner. f)ose.—Of subnitrate of bismuth, gr. v-x to 5j, in powder or emulsion. Dental Uses.—Subnitrate of bismuth is a valuable internal remedy in aphthae, mercurial salivation, painful ulcers of the mucous membrane of the mouth, vomiting, cholera infantum, and diarrhoea of children during painful dentition. It is best given in milk, and before meals. For cancrum oris, after using a disinfecting solution to cleanse the gangrenous part, the topical application of sub- nitrate of bismuth, every three hours, corrects the fetor, arrests the progress of the gangrene, and hastens cicatrization. DENTAL FORMULAE. For Vomiting and Painful Digestion of For Diarrhaa of Dentition. Teething Children, Acidity andPyro- R. Bismuthi subnitrat...... gr.lx sjSi Extract rhei fluid....... gtt.viij bartiiolow. Syrup rubus.............f^ss R. Bismuthi subnitrat...... 3iij Elixir aurantii.......... f3ss- M- Acid, carbol.............. gr-ij-gr-iv Signa.—A teaspoonful four to six times Mucil. acaciae............ 3*j a day. Proper feeding—barley water, Aquae menthae pip....... 3*iij. M. milk and lime water. Starchy food Signa—A tablespoonful for adults, and prohibited. a proportionate quantity for children, three or four times a day. CADMII SULPHAS—SULPHATE OF CADMIUM. Formula.—3 (CdO.S03) + SHO. Derivation.—Sulphate of Cadmium is obtained by the action of nitric acid, diluted with distilled water, on the metal cad- mium, the solution filtered and mixed with carbonate of soda, and again dissolved in sulphuric acid diluted with distilled water. It is in the form of transparent, colorless crystals, like those of sulphate of zinc. Medical Properties and Action.—Sulphate of cadmium is emetic and astringent, and closely resembles sulphate of zinc in its action, but is stronger, with a caustic and astringent taste. It is very nauseant and depresses greatly. Locally it is an irritant poison, and produces the cerebro-spinal symp- 200 DENTAL MEDICINE. toms of coma and convulsions ; it is not administered internally, as the preparations of zinc are preferable for such use. Therapeutic Uses.—Sulphate of cadmium is employed locally in affections of the eye, being valuable as a collyrium; it has the power of causing absorption of opacities of the cornea to a remarkable degree. It is also used as an injection in gonor- rhoea, in the strength of one grain to four ounces of water. It is also used in the form of ointment, two grains with four scruples of lard, Dental Uses.—Sulphate of cadmium has been employed in ulcerations of mucous membrane, gangrene of the mouth, or cancrum oris, indolent ulcers, purulent diseases of the antrum, in the form of injections and lotions, of a strength of about one grain of the sulphate to four ounces of water. CALCII HYPOPHOSPHIS—HYPOPHOSPHITE OF LIME Formula.—Ca2PH202. Derivation.—The salt, Hypophosphite of Lime, is obtained by boiling phosphorus in a mixture of hydrate of lime in boil- ing water, until phosphoretted hydrogen escapes, and phos- phate and hypophosphite of lime are formed in the solution, which is then filtered and evaporated over sulphuric acid, when the salt is crystallized out in the form of white, pearly crystals, with a nauseous, bitter taste. It is soluble in six parts of water, but is insoluble in alcohol. Medical Properties and Action.—The hyposulphite of lime, with those of soda and potassa, are all included under the term " alkaline sulphites." Taken internally, they are readily ab- sorbed, and are partially changed in the system into sulphates. They combine with acids to form salts, and they dissolve albumen, and increase the formation of saliva. Being regarded as tonic, alterative, stimulant and nervine, they are employed in cases of debility, more especially where the phosphates are deficient, as they possess the therapeutic properties of phosphorus. Therapeutic Uses.—The different sulphites of lime, soda, and potassa, are employed in intermittent and malarious fevers, CALENDULA. 201 typhus fever, smallpox, and other exanthematous diseases, pyaemia, dyspepsia, neuralgia with nervous depression, anaemia, for which affections they are combined with iron and quinine; diphtheria, cystitis, phthisis, etc., etc. Externally, the sulphites are efficient as local applications (especially the sulphites of soda), in gangrenous and other ulcerations, diseases of the skin, etc. One or two ounces to the pint of water form a stimulant and deodorizing lotion, which is promotive of healthy action. Dose.—Of the hypophosphites, gr. iij to gr. xv, three times a day, in syrup. Dental Uses.—The hypophosphite of lime is the most eligible salt, but the different sulphites are often administered together, in the form of a syrup. Where there is nervous depression, as a result of trigeminal neuralgia, the hypophosphites prove serviceable. The hypophosphite of lime is recommended in the case of delicate children, where there is reason for believ- ing the phosphate of lime, or the lime salts generally of the teeth, are deficient in quantity. CALENDULA. MARIGOLD. Source.—Calendula is a well known garden plant, sometimes growing wild, with a peculiar and rather disagreeable odor, and a bitter, rough, saline taste. Both the leaves and the flowers are employed. Medical Properties and Action.—It is slightly stimulant, diaphoretic, antispasmodic, sudorific, and emmenagogue, but is seldom used internally. It contains a bitter principle, known as calendulin. Therapeutic Uses.—Calendula has been employed in low forms of fevers, scrofula, jaundice, amenorrhcea, etc. Externally it is used in the form of tincture—Tinctura Calendula—in its full strength or diluted, and is very serviceable in exercising a curative influence in the treatment of incised wounds and contusions, preventing inflammation and suppuration. Some writers consider it to be unequaled as a local application after 202 DENTAL MEDICINE. surgical operations, as it promotes union by first intention. It is applied as a lotion, on lint. It is also thought to be a pre- ventive against gangrene and tetanus. Dose.—Of the tincture of calendula, f5j to f5ij. Dental Uses.—Calendula, in the form of tincture, is employed in dental practice as an application to wounded or irritated pulps of teeth, when partially exposed; also after the extrac- tion of teeth ; wounds about the mouth ; and for such uses it proves a very useful remedy. A few drops added to a wine- glass of water, forms a soothing and efficient mouth wash for the soreness resulting from the removal of salivary calculus ; superficial inflammations of the mucous membrane of the mouth, etc. CALX—CALCIUM. LIME. Formula.—CaO. Derivation.—Lime is obtained by calcining limestone or chalk, until the carbonic acid is driven off. Lime is more soluble in cold than in hot water, and a compound of lime and sugar is more soluble in water than pure lime alone. Calcium is the metallic base of lime. Medical Properties and Action.—Quicklime is a powerful escharotic and irritant. Liquor Calcis—Lime Water.—It is prepared by adding cold water to freshly slacked lime, and the clear fluid poured off The officinal preparation consists of four troy ounces of saturated solution of lime in eight pints of distilled water. It is a colorless, inodorous liquid, possessing a disagreeable alkaline taste. Exposure to the air causes it to gradually absorb carbonic acid, with the formation of insoluble carbonate of lime, and it should therefore be preserved in glass-stoppered bottles. The addition of liquorice or coriander seed will disguise its taste. Medical Properties and Action.—-Lime water is antacid, astrin- gent, antiseptic and detergent. It is applicable to all cases where antacids are indicated, and where an astringent effect is not objectionable. CALCIUM. 203 Therapeutic Uses.—Lime water is an excellent remedy in gastric irritation, accompanied with nausea and vomiting; also in dyspepsia, attended with vomiting of food ; also in diarrhoea, after the inflammatory action has been relieved; also in gland- ular affections, as an alterative resolvent. Externally, as a wash for foul ulcers, diseases of the skin, and as an injection in gleet and leucorrhcea. Atomized inhalations have been found useful in diphtheria and membranous croup. Dose.—Of lime water, fSss to fSiij or iv, several times a day. It may be mixed with an equal quantity of milk for internal use. Lime liniment—Linimentum Calcis (lime water fSviij, flax- seed oil Svij)—is a valuable application to burns, scalds, and in smallpox. Dental Uses.—In dental practice, lime water is a useful agent in the form of a gargle, where the secretions of the mouth are viscid and fetid, and especially where the teeth are soft in structure and exceedingly sensitive, owing to the condition of the oral fluids, and especially in mucous secretions, which act readily on teeth deficient in earthy constituents. For young patients, the use of lime water is very beneficial to the teeth, owing to an acid condition of the oral fluids, common to an early period of life. It is also useful where the teeth are very sensitive, on account of the recession of the gum and absorp- tion of the process. When lime water is applied to inflamed mucous membrane, or to suppurating surfaces, it arrests secretion. It is also useful in sickness and irritability of the stomach during dentition; also to relieve the superficial ulceration of the mucous mem- brane of the mouth, caused by the acid eructations attending dyspepsia, in the proportion of one part of lime water to two or three of milk. Syrup of the lacto-phosphate of lime — Syrupus Calcii Lacto-phosphatis—is composed of precipitated phosphate of calcium 22 parts; lactic acid 33 parts; orange flower water 80 parts ; sugar 600 parts ; hydrochloric acid, water of am- monia and water, each, a sufficient quantity. . 204 DENTAL MEDICINE. Dose.—fl. 5j to fl. Sj- This syrup is especially useful in rickets, mollities ossium, delayed union of fractures, caries and necrosis in bone, anaemia of nursing mothers, mammary abscesses or boils, carbuncles, chronic bronchitis, leucorrhcea, early decay of the teeth in children, etc. . CALX CHLORATA—CHLORINATED LIME. CHLORIDE OF LIME. Formula.—CaCl202CaCl2. Derivation.—Chloride of Lime is obtained by passing, chlor- ine over hydrate of lime till saturation is effected. It is in the form of a grayish-white substance, either in powder or friable masses, dry or but slightly moist It is readily soluble in water, and will absorb moisture when exposed to the air. It has a bitter, caustic taste, and a slight odor of chlorine. Medical Properties and Action.—Chloride of lime is a stimu- lant, deodorizer, disinfectant, antiseptic and bleaching agent. In small doses it increases the action of the secreting organs, and if long continued it acts specifically upon the lymphatic glandular system, causing the reduction or absorption of glan- dular and other tumors. In large doses it acts as an acro- narcotic poison, and its use should always be commenced in small doses, carefully increased, and discontinued when such symptoms as nausea, vomiting or giddiness appear. It is chiefly used as a disinfectant. Therapeutic Uses.—Solutions of chlorinated lime are em- ployed locally in scarlet fever, diphtheria, aphthae, gangrene ; and it has been administered internally in scrofula, typhus, malignant scarlet fever, syphilis, etc. Dose.—Of chloride of lime, gr. j to gr. v, in solution, sev eral times a day. As a wash, I part dissolved in 100 parts of water. Dental Uses.—Chloride of lime is employed in dental prac- tice in the treatment of cancrum oris ; one method of applica- tion being the introduction of the dry powder, with the point of the finger, to the ulcerated surface, and the mouth well CHLORINATED LIME. 205 washed out immediately afterward; also, in the form of a gargle composed of I part of powdered chloride of lime to 30 parts of mucilage and 15 parts of syrup. Solutions of chloride of lime are also efficient in scorbutic and other ulcerations of the mouth. It is also employed to correct the fetor of the breath, in the form of a mouth wash, prepared as a weak solution. One of the most important uses in dental practice is as a bleaching agent, either alone or in combination with other substances, to restore the color of devitalized teeth. When chlorinated lime is employed for bleaching discolored teeth, a good quality should be obtained, and no steel instrument used for its introduction; wood or gold instruments are to be pre- ferred, and the chloride should be perfectly dry, and have been kept so from the time it was made. An efficient bleaching preparation is composed of equal parts of dry chlorinated lime and tartaric acid, mixing them together dry, and adding a little of the acid at a time. When prepared, the mixture should be kept in a glass-stoppered bottle. For bleaching purposes, chlorinated lime is also combined with chloroform, in the form of a thin paste. When chlorinated lime, or its combinations, is introduced into the cavity of a tooth, it should be secured by a temporary filling of gutta percha, Hill's Stopping, or one of the zinc preparations, and be secured from passing beyond the foramen of the root, by a filling introduced near the apex of the root. More than one application may be required, after which the cavity should be thoroughly cleansed, and a tempor- ary filling of the whitest shade of the oxychloride of zinc filling material be introduced and worn for some time, after which a more durable gold filling can be inserted. dental formulae. For Gangrene of the Mouth—Cancrum For Fetor of the Breath. Oris. BARTHOLOW. bartholow. R. Calc. chlorat............ 3iij R. Calc. chlorat........... .. £ss Aquae destil............ 31J Mucilaginis............... 3*ss Alcoholis................ 3*ij Aquae destil............... f, iiiss. M. 01. rosae................. gtt.iv. M. Signa.--To be used as a lotion. Signa—A teaspoonful in a tumblerful of water; used as a gargle. 206 DENTAL MEDICINE. CAMPHORA—CAMPHOR. Formula.—Ci0H16O. Source.—Camphor is a concrete substance obtained from the camphor laurel, an evergreen tree of China, Japan and For- mosa, by sublimation, the crude gum being purified by resubli- mation with quicklime. Refined camphor is in the form of large, circular cakes, one or two inches thick, and has a strong, penetrating, fragrant odor, and a bitter, pungent taste, attended with a slight sense of coolness. It is white, pellucid, and somewhat unctuous to the touch. Medical Properties and Action.—Camphor is anodyne, stimu- lant, refrigerant, diuretic, and diaphoretic. It increases the action of the heart and arteries, and renders the pulse softer and fuller ; but such effects are very transitory, and are followed by depression. In large, but not over doses, it allays pain and spasm, and induces sleep. In over doses, it excites narcotic symptoms, with those of an irritant poison, and has proved fatal. It acts chiefly on the nervous system. Therapeutic Uses.—Camphor is administered in fevers of an asthenic type, acute inflammations, inflammation of the brain, delirium tremens, asthma, rheumatic and nervous headaches, diseases of the heart, hysteria, dysentery, diarrhoea, cholera, etc., etc. Externally as an anodyne in rheumatism, and as a discutient in chronic inflammatory affections ; also, the powder as a snuff in coryza and influenza, and in the form of Camphor Liniment—Linimentum Camphora—(camphor I part, olive oil 4 parts). Camphor Water—Aqua Camphora—(camphor gr. cxx, alcohol in, xl, carbonate of magnesia Sss, distilled water Oij). Soap Liniment—Linimentum Saponis—(camphor Siv, oil of rosemary fSss, alcohol Oij, water Syj) is an anodyne and gentle rubefacient for sprains, rheumatic and gouty pains. Spirit of Camphor—Spiritus Camphora—(camphor Siv, alcohol Oij). Dose.—Of camphor in substance, gr. ij to gr. x, in form of an emulsion, made of sugar, gum arabic, myrrh, and water. Of camphor water 5j to Sj ; of spirit of camphor, m„v to nixx. CAMPHOR. 207 Dental Uses.—In dental practice, the spirit of camphor is locally employed to allay the pain arising from the near expo- sure of the pulps of teeth ; also the pain of sensitive dentine, and that following the extraction of teeth affected with peri- ostitis ; also to arrest the hemorrhage and allay the pain of wounded pulps of teeth. It forms an efficient anodyne when in the form of a strong solution of camphor in chloroform. Camphor has also been employed in the treatment of putres- cent pulps of teeth. Combined with creasote or carbolic acid, camphor is thought to have the power of modifying the escharotic action of these agents. For such a purpose, 20 grains of camphor are com- bined with 1 ounce of the creasote or carbolic acid. The Oil of Camphor—Oleum Camphora—is preferred by some to answer such indications. Camphor also forms one of the ingredients of the celluloid base of artificial teeth, which is composed of pyroxylin 100 parts, camphor 40 parts, oxide of zinc 2 parts, and vermillion 0.6 part. With ether, camphor is also used as a local anaesthetic. A cataplasm of camphor, morphia and flaxseed, applied to the cheek, has been used for the relief of odontalgia. dental formulae. For a Local Ancesthetic. For a Stimulant and Anodyne Lotion. R. Pulv. camphorae........ gxj R. Spiritus rosmarini......... ^j y£ther. sulph............ f^ j. M. Camphorae............... gj Signa.—Applied to the gum over the Saponis albae............. jiv. M. tooth to be removed, until it turns Signa.—To be applied as a lotion. white or becomes blanched. For a Local Ancesthetic. For a Local Ancesthetic. R. Camphorae............... :^j R. Chloral, ^Ether vel chloroformi. ^ij. M. Camphorae......aa........ ^ij Signa.—Apply with a camel's-hair Morphiae sulph.......... ,"ss brush. Chloroformi............... £j. M. Signa.—Apply with camel's-hair brush, For Neuralgia. allow to dry and reapply as freely as R. Camphorae, is necessary to render part insensible Chlor. hydratis aa equal parts. M. to pain Signa,.—Apply as a lotion. 208 DENTAL MEDICINE. CAMPHORA MONOBROMATA—MONOBROMATED CAMPHOR. Formula.—Ci0H15BrO2. Derivation.—Monobromated Camphor is obtained by the action of bromine on camphor, and subsequent purification with animal charcoal and repeated crystallization. It is a colorless, crystalline substance, with the odor of camphor and turpentine, and a slightly bitter taste. It is insoluble in water, but soluble in alcohol and ether. Medical Properties and Action.—It produces a sedative effect upon the circulatory system, and especially upon the cerebro- spinal nervous system, and is also an antispasmodic. Therapeutic Uses.—Bromide of camphor is employed as a sedative and antispasmodic, in affections of the nervous system, and where camphor is indicated, as in asthma, neuralgia, hys- teria, delirium tremens, etc. Dose.—Of bromide of camphor, gr. ij to gr. x, for an adult. Dental Uses.—In dental practice, the bromide of camphor is employed as a sedative in convulsions of dentition, neuralgia, etc. For children suffering from the convulsions of dentition, gr. j of the bromide of camphor in acacia mucilage, and ad- ministered every hour, has been very serviceable in arresting the paroxysms. CAPSICUM. CAYENNE PEPPER. Source.—Capsicum is obtained from the tropics of both hemispheres, being the fruit of capsicum annuum, and of other species of capsicum. The crimson or yellow pods are dried and ground to powder, which has a bright red color, and an aromatic smell, with a bitter, acrid, burning taste. Its acrid, pungent qualities are due to a peculiar substance in the form of a thick, yellowish-red fluid, called capsicine. Medical Properties and Action.—Capsicum is a powerful stimulant, producing, when small doses are taken, a sensation of warmth in the stomach, and a general glow over the body. It promotes the digestive process, and stimulates the circula- tion, and also the genito-urinary organs. In excessive doses, capsicum is an irritant poison. PURIFIED ANIMAL CHARCOAL. 209 Therapeutic Uses.—It is employed in certain forms of dys- pepsia, flatulent colic, scarlet fever, yellow fever, delirium tremens, opium habit, etc., etc. Externally or locally as a gargle, in putrid and other forms of sore throat, chronic inflam- mation of the fauces, hoarseness due to a relaxed condition of the vocal cords, relaxed uvula, and in poisoning by opiun, belladonna and aconite, it has proved useful as a stimulant. Dose.—Of powdered capsicum, gr. v to gr. x, in pill. Of the tincture of capsicum—Tinctura Capsici (capsicum Sj, to diluted alcohol Oij)—the dose is tibx to f5j. Of the infusion —Infusum Capsici (capsicum Sss ; boiling water Oj)—the dose is fSss. The infusion is also used as a gargle. Dental Uses.—In dental practice the tincture of capsicum is serviceable in acute dental periostitis, where it is necessary to hasten suppuration as quickly as possible, on account of the increasing severity of the attack— a solution composed of gtt. xxv, in a glass of warm water, of which a mouthful is to be retained for some minutes. The tincture of capsicum is also useful in chronic dental peri- ostitis, to resolve the inflammatory products. It is also used to stimulate the gums and mucous membrane of the mouth in chronic inflammation and ulceration, and for looseness of the teeth as a result of salivation ; also in cases of turgidity and puffiness of the gums. It is often serviceable in chronic alveolar abscess, as an injection, after the sac has been de- stroyed ; also in recession of the gums from the necks of the teeth, for the purpose of stimulating them. A few drops added to a solution of aromatic sulphuric acid will prove serviceable in caries of the maxillary bones and in disease of the antrum. An efficacious stimulant gargle may be made of the tincture of capsicum Sss, to rose water Sviij. CARBO ANIMALIS PURIFICATUS—PURIFIED ANIMAL CHARCOAL. Source.—Animal Charcoal, called " bone black " is obtained by exposing bones to a red heat, protected from the air. It consists of charcoal, phosphate and carbonate of lime. 210 DENTAL MEDICINE. Purified Animal Charcoal—Carbo Animalis Purificatus— is obtained by digesting bone black in hydrochloric acid and water to a moderate heat, when it is dried and heated to red- ness in a covered crucible. Properties and Action.—Animal charcoal is an absorbent, and is used to counteract the effects of poisonous agents, such as the alkaloids and acids. Dose.—Of animal charcoal as an absorbent, Sss, to neutralize the effects of each grain of such agents and strychnia and morphia. CARBO-LIGNI—WOOD CHARCOAL. Source.—Wood Charcoal is obtained by subjecting soft wood to a red heat with but a limited supply of air, by which the water, etc., are removed, allowing the carbon to remain. Properties and Action---Wood charcoal is antiseptic and dis- infectant and detergent, and is very serviceable in correcting the fetor of discharges and arresting the process of ulceration, especially when in the form of the dry powder, or mixed with linseed as a poultice. Therapeutic Uses.—For foul and gangrenous ulcers, gan- grene, phagedaena, suppurating surfaces, cancerous tumors, etc., etc. Dental Uses.—The powdered charcoal added to water, in the proportion of one or two drachms to a glass of water, forms an efficient disinfectant gargle for the offensive fetor of mercu- rial stomatitis ; also useful in foul and gangrenous ulcers of the mouth, diseased gums, offensive ulcerations, offensive fetor of cancrum oris, etc., etc. Notwithstanding its detergent prop- erties, injury results from its use as a dentifrice, on account of its tendency to cause recession of the gums from the necks of the teeth. CARVACROL. Source—The caraway plant, a native of Europe. Derivation.—Carvacrol is a product of the essential oil of caraway, which is obtained from the seeds of the plant. Caraway—carum—seeds are of a light yellow color, with a pleasant aromatic smell, and a sweetish, warm, spicy taste. CARVACROL. 211 They are stomachic and carminative, and are occasionally used in flatulent colic, as a corrective of other medicines. The volatile oil of caraway is most employed in doses of gtt. j to gtt. x. Carvacrol is obtained by treating the oil of caraway with iodine, and washing the product with potassa, when it is mixed with carvene, which is one of the liquid oils of caraway. Carvacrol is also found among the products of the action of iodine on camphor. When pure, it is a colorless, viscid oil, lighter than water, in which it is nearly insoluble. Its odor is like that of creasote, and its taste is persistent, strong and acrid. Medical Properties and Action.—Carvacrol is antiseptic, car- minative, disinfectant and escharotic. Combined, it forms an efficient gargle in inflammatory conditions. It is not employed internally. Dental Uses.—In dental practice, carvacrol has been em- ployed as a substitute for creasote, carbolic acid, and glycerole of thymol, in the treatment of odontalgia, sensitive dentine, alveolar abscess, and as an antiseptic in the pulp canals of teeth ; also as a gargle in inflamed and ulcerated conditions of the mucous membrane of the mouth, tonsillitis, etc. Com- bined with water, in the proportion of 3 drops to the ounce, it forms an efficient gargle in stomatitis, tonsillitis, etc,; the strength of the solution may be increased, when a more pow- erful action is required. It is also employed with advantage in sensitive cavities of the teeth, in operating with the dental engine, to lessen the pain from friction of the instrument. As an application in odontalgia, from an exposed and irritable pulp, it affords almost instantaneous relief. It is claimed for carvacrol, that it is not so liable to cause inflammation as crea- sote ; especially when it is applied through the pulp canals. When employed to obtund the sensitiveness of dentine, it is necessary to confine it in the cavity of the tooth for a few days, by means of a temporary filling of zinc preparation, as it readily dissolves Hill's Stopping and gutta percha. When it is used in the form of an injection in alveolar abscess, a sharp, burning sensation is experienced as soon as it reaches the seat 212 DENTAL MEDICINE. of the affection, when the crown cavity of the tooth should be immediately closed. In patients of a scrofulous diathesis, it is necessary to exer- cise care in the use of carvacrol. When applied to cavities before the introduction of the filling, and to exposed pulps, it is introduced on a pellet of cotton. CHINOLINE OR QUINOLINE. Derivation.—Chinoline was first obtained from coal tar, but afterward from the cinchona alkaloids. More recently it has been produced by the action of glycerin on aniline, or nitro- benzol. It is an oily liquid, with a highly refracting property, and it combines with acids to form salts. The salt, Tartrate of Chinoline, is not so deliquescent as the other salts formed by its combination with acids, and is in the form of lustrous crystals, which preserve their form even in a damp atmosphere, although they are soluble in water. Medical Properties and Action.—Chinoline, like other phenol derivatives, such as resorcin, hydroquinone, etc., possesses the power to lower fever heat, but does not affect the normal temp- erature. Therapeutic Uses.—Like resorcin, chinoline has been used in intermittent and remittent fevers with great success; also in septic disorders. Topically, chinoline is a valuable anti- septic, and successfully acts upon minute organisms, pre- venting their increase and septic decomposition. A five per cent, solution of the tartrate of chinoline, the salt generally employed, has been applied locally in diphtheria, with marked effect. Dose.—Of chinoline, gr. v to xv. Dental Uses.—Chinoline is used in dental practice as an antiseptic, belonging to the same class as resorcin, the salt tartrate of chinoline, in the form of a five per cent, solution, being preferable for local application. It is also used in com- bination with carbolic acid, for application on cotton to an aching cavity from which a tooth has been extracted. chloral. 213 CHLORAL. CHLORAL HYDRAS—HYDRATE OF CHLORAL. Formula.—C2H C130 H20. Derivation.—Chloral is obtained by the action of dry chlorine gas on absolute alcohol, and is purified by sulphuric acid and a small quantity of lime; a small quantity of water converts it into solid crystalline hydrate of chloral. It is in the form of a snow-white, crystalline mass, with a pungent odor and taste, soluble in its own weight of distilled water, and very soluble in alcohol. When heated, it fuses and evaporates, leaving no residue, and in the air without combustion. Medical Properties and Action.—Hydrate of chloral is hyp- notic and anaesthetic, possessing more of the former and less of the latter property than chloroform, and, unlike chloroform, after its administration there is no elimination by the breath or urine. It diffuses into the blood rapidly, causing an abundant flow of saliva, and a cooling sensation in the stomach, followed by warmth. Very large quantities cause a high degree of gastric irritation, nausea and vomiting. Taken in moderate quantity it stimulates the appetite, and produces muscular relaxation. It is uniformly certain in its action as a hypnotic, has no depressing influence, and does not cause constipation. Administered in doses of gr. x to gr. xxx, it causes uncon- sciousness to pain, and a profound sleep, lasting over several hours. The sleep it produces is quiet and gentle, and induced without distress. Liebreich claims to have produced sleep which lasted from five to fifteen hours, with from 25 to 30 grains of hydrate of chloral. The habitual use of chloral leads to a disorder which is somewhat similar to the " opium habit," although it may not be as persistent. When there is present no susceptibility to its hypnotic action, it is liable to cause headache, and in some cases, a delirious excitement. Its hypnotic action is immedi- ately preceded by a stage of excitement, generally of short duration, which is followed by sudden and complete sleep, very much like natural sleep, calm, dreamless and refreshing. It differs from a condition of narcotism from the fact that the 214 DENTAL MEDICINE. patient can be easily roused to partake of nourishment, and will readily fall asleep again. There are no unpleasant after-effects resulting from a moder- ate dose of chloral, differing in this respect from morphia, which often causes headache, faintness, giddiness, nausea and constipation. Chloral is not capable of producing insensibility to pain, unless the quantity administered is sufficient to suspend the functions of the cerebrum. When a proper dose is administered, the pupil contracts slightly, but the pulse may remain unaltered or become slower, and the respiration unaffected. When an improper or danger- ous dose is taken, profound narcotism ensues, the respiration becomes slower, the pulse weak, rapid and irregular, sensibility is lost, all reflex movements are impossible, and complete mus- cular relaxation follows. It destroys life by the suspension of the functions of the cerebrum, and by paralysis of the respira- tory centre, and of the cardiac ganglia ; also death may suddenly follow by paralysis of the heart, in cases of fatty degeneration, and the lower lobes of the brain remain unaffected. The para- lytic phenomena caused by chloral are due to its direct action on the nervous centres. The congestion of the meninges of the brain and cord, and distention of the right cavities of the heart, have been observed after poisoning by chloral. The antidote in cases of poisoning is strychnia, and the same treat- ment as in opium poisoning. Therapeutic Uses.—The most important uses of chloral are in diseases of the nervous system, such as delirium tremens, insanity, tetanus, acute mania, neuralgia, chorea, whooping cough, and in rheumatism, cholera morbus, sea sickness, etc., etc. Having no direct pain-relieving power, except by suspend- ing the functions of the cerebrum and in dangerous doses, sleep can be procured and pain relieved by combining the chloral with morphia, when it is very effective. Dose.—Of hydrate of chloral, gr. v to 3j; but it must be remembered that one-half drachm has produced poisonous symptoms. Thirty grains of hydrate of chloral are equal in effect to gr. j of opium. For adults, if short intervals of sleep CHLORINE. 215 are required, from gr. xxv to xxx will answer; for young children, gr. vij is the dose recommended. Moderate and frequently repeated doses are better than a single large one. Dental Uses.—In dental practice, the hydrate of chloral, in the form of from gr. ss to gr. j, is applied to inflamed pulps for the relief of odontalgia, and is an efficient remedy ; it is also employed for the relief of neuralgia of the fifth pair of nerves ; as a stimulant and deodorizing application to foul and fetid indolent ulcers ; also as a local anaesthetic, for this purpose being combined with camphor and other agents (see Aconite), (see Camphor); also as an anodyne, for the relief of the pain of dental periostitis ; and as an injection, for alveolar abscesses. Although it is employed hypodermically, yet painful phlegmons have resulted from its repeated application. DENTAL FORMULAE. For Foul and Fetid Indolent Ulcers. For Foul and Fetid Indolent Ulcers. R. Chloral hydratis......... gr.x R. Chloral hydratis...... gss Aquae destillatae......... fSjj. M. Adipis.................. 3*j. M. Signa.—To be applied as a lotion. Signa.—To be used as an ointment For a Local Anesthetic. For a Hypnotic. R. Chloral hydratis......... 3*ij R. Chloral hydratis...... 3ij Pulveris camphorae..... 3*ij. M. Syrupi aurantii flores 3"iv Signa.—To be applied as an obtunding Syrupi tolutani........ 3 iv mixture, by means of an applicator. Aquae destillatae...... 3*vj. M. Signa.—Dose,^ part, largely diluted. For Odontalgia—Pulpitis. FLAGG. For Neuralgia. R. Chloral hydratis.......... 3"iij R. Chloral hydratis...... partes 3 Aquae destill............. f^j. M. Camphorae............. partem i.M. Signa.—Apply on cotton. Signa.—To be applied over seat of pain. For a Local Anczsthetic. R. Chloral hydratis, Pulveris camphorae ..............aa........................ 3 ij Morphinae sulph.............................................. 3 ss Chloroformi................................................... 3-j. M. Signa.—Apply with camel's-hair brush ; dry rapidly, and reapply. CHLORINIUM—CHLORINE. Derivation.—Chlorine is a greenish-colored gas, of a pene- trating and suffocating odor, very persistent and characteristic. It is soluble in water, in the proportion of two volumes of the 216 DENTAL MEDICINE. gas to one of water, and is a supporter of combustion. It is generated from black oxide of manganese, hydrochloric acid and water, is an active irritant, and, when breathed, excites cough, a sense of suffocation and irritation of the mucous membrane of the nostrils and bronchial tubes, and, when con- siderable quantities are inhaled, it induces spitting of blood, violent pains, and sometimes death. It is a deodorizer and disinfectant, and has been used to destroy disease germs and offensive effluvia. Chlorine Water—Aqua Chlori—is an aqueous solution of chlorine, formed by passing the gas through water. It is a greenish-yellow liquid, with an astringent taste, and the suffo- cating odor of chlorine gas. It should be kept in glass-stop- pered bottles, in a cool place, and protected from the light. Therapeutic Uses.—Chlorine water is used internally in malignant fevers, such as scarlet fever, typhus, and in diph- theria, aphthae, gangrene, syphilis, diseases of the liver/skin diseases, etc.; and as an antidote for hydrocyanic acid. The poisonous effects of chlorine gas may be prevented by am- moniacal gas, and albumen is the antidote for chlorine water, given freely, in the form of milk, flour, eggs, etc. Dose.—Of chlorine water, f5j to f5iv, diluted. Dental Uses.—Chlorine water is employed in dental practice, as a local application in gangrene of the mouth and fauces, aphthae, cancrum oris, and fetor of the breath. Chlorine gas has been employed to bleach discolored teeth, care being taken that it reaches no other part than the cavity of the tooth under- going such treatment, which may be accomplished by the application of a large rubber dam, such as is used in the operation of filling teeth. DENTAL FORMULAE. For Aphthcz and Gangrene of the Mouth. For Fetor of the Breath and an Anti- R. Aquae chlori............... ^ss septic. Aquae destillatae........... ^iiiss R. Liquoris chlori............ giv Syrupi simp!................ |ss. M. Mellis...................... sjiv Signa.—To be used as a gargle or Aquae destillatae......... ^ x. M. lotion. Signa.—To be used as a gargle. CHLOROFORM. 217 For Aphtha", Stomatitis, and Cancrum For Mercurial Stomatitis. Oris. R. Liquoris chlori...... part j R. Liquoris chlori, Aquae destillatae..... part viij. M. Mellis........aa............ 3*ij. M. Signa.—To be used as a gargle for cor- Signa.—To be applied as a lotion. recting the fetor, and diminishing slightly the discharge. CHLOROFORMUM—CHLOROFORM. Formula.—CHC13. Sp. gr. 1.480. Derivation.—Chloroform is obtained by the distillation of alcohol with chlorinated lime. The form for medicinal use (Chloroformum Purificatum) is purified by agitation with sul- phuric acid, which frees the crude chloroform from such dele- terious agents as chlorinated pyrogenous oil; the lighter liquid is then separated, and carbonate of sodium, previously dis- solved in water, is added to it. The mixture is then agitated, the chloroform separated from the supernatant layer, alcohol mixed with it, and lime in coarse powder added. It is a color- less, volatile liquid, of an agreeable ethereal odor, and a hot, aromatic, sweet taste. It is slightly soluble in water, and dis- solves very readily in alcohol and ether in all proportions. The boiling point is 1420 F. The purest form of chloroform has a specific gravity of 1.5022, while the officinal contains a little alcohol; it is a terchloride of formyl. The purest chloroform for internal use is obtained from the hydrate of chloral. The purity of chloroform may be ascertained by agitating it with the binitro-sulphuret of iron, which shows the presence of alcohol by the production of a brown tint; chlorinated pyro- genous oil may be detected and removed by strong sulphuric acid, which gives the solution a yellowish or reddish-brown color, if such an impurity is present. Medical Properties and Action.—Chloroform, when inhaled, is an anaesthetic; and when administered internally, is ano- dyne and antispasmodic. Its effects on the system are similar to those of ether, but more powerful and more rapidly pro- duced, and it requires more care in its administration, both in- ternally and by inhalation of the vapor. Undiluted, it excites great irritation and inflammation of the mucous membrane, and 15 218 DENTAL MEDICINE. the vapor, passing through the fauces in quantity, may enter the larynx and cause great heat, inflammation and even oedema. When taken internally it causes a feeling of warmth in the stomach, followed by coldness, similar to ether, and if taken in large quantity, undiluted, it acts as an irritant poison, in- ducing violent gastritis. It is diffused into the blood, and affects remote parts. It increases the action of the circulatory system, producing excitement of the brain, followed by a deep, heavy sleep; and in poisonous doses, stupor and insensibility. The first effect of the inhalation of the vapor of chloroform, is a feeling of warmth and excitement extending to the extremi- ties, which is succeeded by noises in the ears and a vibratory thrilling and benumbing sensation throughout the body, fol- lowed by a loss of feeling, motion and consciousness, with general paralysis of the respiratory muscles, stertorous breath- ing, quick pulse, which may become irregular and weak, owing to the sedative action on the heart. The pupils, at first con- tracted, become dilated, and there is complete relaxation of the muscular system. [As the physiological actions and mode of administration of chloroform and ether are similar, the reader is referred to the article on Sulphuric Ether.] Therapeutic Uses.—Besides its use as a general anaesthetic agent, chloroform is internally administered in substance, as an anodyne and antispasmodic, for non-inflammatory affections, such as nausea and vomiting, sea-sickness, sick headache, flatulent colic, intermittent fevers, and in cholera, for which it is very efficient. The vapor is employed for the relief of hay asthma, whooping cough, spasmodic asthma, and as a hypnotic in delirium tremens, and as an injection and lotion in neuralgia, and as a counter-irritant or vesicant, for which purposes it is applied to the skin, and evaporation prevented. Great care is necessary in the administration of chloroform in substance, as fatal effects have followed such use ; 15 drops have destroyed life. Externally, chloroform is employed as a stimulating application to foul and indolent ulcers. Dr. Spark recommends highly, as a haemostatic agent, a solu- CHLOROFORM. 219 tion composed of chloroform 2 parts, water 100 parts. He claims that it acts with a rapidity that is truly marvelous, and it has not the slightest disagreeable taste. It is useful in all operations upon the mouth and throat Dose.—Of chloroform, mj to v, in sweetened water or mu- cilage. Dose of chloroform for inhalation, 5j to 5ij. Spirit of Chloroform—Spiritus Chloroformi—is composed of chloroform Sj; diluted alcohol Sij. Dose of spirit of chloroform, 5ss to 5j. Mixed Chloroform—Morphia Narcosis.—A method prac- ticed by Prof. Thiersch, of Leipsic, succeeds often in inducing a perfect analgesia without unconsciousness. Morphine is first hypodermically injected, and in from five to seven minutes afterwards the patient is very lightly chloroformed till near the stage of excitement; the operation is performed; as soon as pain is felt, if the operation is a prolonged one, a little chloro- form is added. In this manner not the tenth part of chloroform is needed, and it is claimed that the operation is as painless as under full chloroform narcosis, and there is no risk or danger incurred. Men receive one-half a grain of morphine, women one-quarter of a grain, children one-twelfth to one-eighth of a grain. Dental Uses.—Chloroform is employed in dental practice as a general anaesthetic; also as a local anaesthetic, for which purpose it is generally combined with other agents ; as an anodyne and antispasmodic, either locally applied or the vapor inhaled, as in the treatment of convulsions of dentition, for which it is a very efficient remedy. DENTAL FORMULAE For a Local Anasthetic. For Odontalgia—Pulpitis. Von Bonhorst. R. Chloroformi............ gij R. Chloroformi, Alcoholis............... ^j ./Etheris sulph., ./Ether.................... ^ss Spiriti lavandulae, Camphorae (pulv.)..... J^ss Pyrethri (fluid ext.)...aa.. f^j- M. Tinct. opii............... !| ss SlGNA—Apply for one or two minutes Oleum caryophylli..... ^j. M. to gum over root of tooth to be ex- Signa.—Apply, on cotton wool, to ex- tracted, posed pulp. 220 DENTAL MEDICINE. For Neuralgic Affections. R. Chloroformi, Spiriti ammoniae, Tincturae aconiti....aa... fijij Olei ricini................ sjij Linimenti saponis...... f^j. M. Signa.—To be applied as a liniment over seat of pain. For a Local Anaesthetic. R. Chloroformi purificati, Tincturae aconiti, Alcoholis........aa........ f^j Morphinae sulphat........ gr-vj- M. Signa.—To be applied to gum over root of tooth to be extracted. For Odontalgia—Pulpitis. R. Chloroformi, Tinct. aconiti....aa...... f.5iij Tinct. capsici.............f^j Tinct. pyrethri, Oleum caryoph...aa... f^ss Camphorae (pulv.)...... 3*ss. M. Signa.—Apply on cotton wool. For an Anodyne Application in Neu- ralgia. R. Chloroformi............... f^j Linimenti camphorae... f^ij. M. Signa—To be applied over seat of pain, and covered with oiled silk, to pre- vent evaporation. For Earache of Dentition, R. Chloroformi.............. 3J Oleum olivae............. 3*j M. Signa.—Pour from gtt. x to xx in ear, and close orifice with cotton. For a Local Anaesthetic. R. Chloroformi............ part, xx Acidi acetici (cryst.).. part. j. M. Signa.—Apply with camel's-hair brush, or by applicator. For Neuralgic Affections of the Teeth. R. Chloroformi............. f 3 j or ij Aquae.................... Oj. M. Signa—To be used as a wash or a gargle. For Neuralgic Affections. R. Chloroformi............ 31J Camphorae.............. J iss Olei olivae............... 3*ij. M. Signa.—To be applied as a liniment over seat of pain. CINCHONA FLAVA—YELLOW CINCHONA. CALISAYA BARK, PERUVIAN BARK. Source.—Cinchona is the bark of the tree cinchona calisaya, which grows on the western coast of South America, especially of Bolivia and Southern Peru. Different varieties are named, according to their color, as Cinchona Flava, yellow cinchona; Cinchona Pallida, pale cinchona; Cinchona Rubra, red cin- chona. The medicinal properties of these barks depend upon the alkaloids they contain in varying proportions, Quinina being the most important. Medical Properties and Action.—The yellow bark has a much more bitter taste than the others, but is comparatively free from acidity. It is brownish yellow, the powder being of an orange color, and it contains more of the alkaloid quinine than the other barks. YELLOW CINCHONA. 221 Cinchona is tonic, astringent and antiperiodic, and the different varieties owe their tonic and antiperiodic properties to the alkaloids quinina, cinchonina, and cinchonidina. On account of the large quantity of the powdered barks it is necessary to take in order to obtain the full effects, and which cause, in some cases, derangement of the stomach, vomiting, headache and constipation, the alkaloid quinine, in the form of sulphate of quinina, is preferable, Sulphate of Quinina—Quinina Sulphas, is prepared by boiling the yellow bark in water acidulated with hydrochloric acid, by which the alkaloid is separated from its combination with kinic and other acids, to form a soluble hydrochlorate. This salt is decomposed, and the quinine is precipitated by the addition of lime, and afterwards washed in boiling alcohol. Sulphate of quinine is in the form of colorless, very light and silky crystals, and is readily soluble in alcohol, and in water acidulated with sulphuric acid. It is insoluble in ether, and requires 740 parts of cold, or 30 parts of boiling, water to entirely dissolve it. Cinchona ,is also antiseptic, as the powder dusted over unhealthy wounds will arrest putrefaction, and promote healthy cicatrization. Quinina will destroy minute organisms, and preserve substances from decomposition. The cinchona alka- loids are readily diffused into the blood, and when hypodermi- cally injected, are absorbed by the blood. Cinchona and its alkaloids increase the action of the heart slightly, but in large doses quinine depresses the heart's action and enfeebles the pulse. As quinine accumulates in the brain, a sense of fullness in the head, a tightness and constriction about the forehead, a ringing in the ears (tinnitus aurium), giddiness and vertigo, are experienced. Deafness also occurs, as the effect of consider- able doses, and, if continued, permanent injury may result. Poisonous doses cause intense headache, dilated pupils, de- lirium, coma, and convulsions. Peruvian bark and its alkaloids are the most reliable tonics and antiperiodics. Therapeutic Uses.—Cinchona, and its alkaloid quinine, are 222 DENTAL MEDICINE. internally employed in the treatment of intermittent fevers, and also other fevers, such as remittent, typhus, puerperal and scarlet; in influenza, neuralgias of a malarial origin, acute rheumatism, phthisis, advanced stages of pneumonia and pleu- risy, erysipelas, urticaria, diseases of the eye, epilepsy, gangrene and mortification, scurvy, pyaemia, malarial dysentery, passive hemorrhages, and as an anthelmintic, etc., etc. Dose.—Of powdered cinchona, 3j to 5iij, given in infusion of liquorice; of the extract of cinchona, gr. j to gr. x, in pill; of sulphate of quinine, gr. j to 3j. Dental Uses.—Cinchona and its alkaloid, quinine, are em- ployed in dental practice, in the treatment of neuralgia of the fifth pair of nerves, when due to malaria, in from five to ten grain doses of quinine; in aphthous ulcerations, in one or two grain doses every two or three hours, especially when there is great debility; and in cancrum oris ; also in the form of gargles and lotions, in gangrenous ulcerations of the mouth. Cinchona is also employed in the form of powder, as an ingredient of certain dentifrices, for its tonic and antiseptic properties. DENTAL FORMULAE. For Mercurial Stomatitis. Garrettson. ■ 3ii Potassae chloratis........ ■ 3ss Sodae bibor................ ■ 3U ■ S»j Potassae permanganatis.. . gr.xxv Aquae coloniae ............ Si , !j • 3\ Tinct. krameriae.........., ■ Si Aquae..................... ■ SvnJ--' Signa.—Use as a gargle. Dentifrice. R. Pulv. cinchonae flav...... £iv Pulv. saponis cas. albi... giv Cretae prep.................. ^ ij Magnesiae calc........... ^iij Otto rosae.................... gtt.viij Olei caryophylli.......... gtt.vj.M. For Ulceration of Gums. R. Pulv. cinchonae............ srij Cupri sulph................. gr.x Acaciae (pulv.)............ 3J Mellis....................... 3-ij Aquaepurae............... ^iij. M. Signa.—Apply with camel's hair brush to ulcerated surface of mucous mem- brane. Dentifrice. R. Pulv. cinchonae flav..... Ib.ss Cretae prep................. Ib.ss Pulv. myrrhae............. ?iv Pulv. radicis iridis....... giv. M. For a Wash after the Extraction of Teeth. R. Cinchonae (decoct.)...... f^ij Aluminae................... ?ij Infus. rosae................. f^ij. M. Signa.—Use as a gargle. CINNAMON. 223 Dentifrice. R. Pulv. cinchonae flav.......................................... 3"iij Cretae prep.................................................... ^iij Sacchari albi.................................................. ^j Pulv. cinnamom............................................ 3*j Pulv. saponis cas. albi...................................... 31J Pulv. myrrhae................................................. 3J. M. CINNAMOMUM—CINNAMON. CASSIA BARK. Source.—The best variety of cinnamon is obtained from Ceylon, and is the prepared bark of a tree of the natural order Lauracea. It is in the form of long, cylindrical pieces, thin, smooth, and of a yellow-brown color, with a fragrant odor, and a warm, sweetish, aromatic, and slightly astringent taste. It contains a volatile oil, a slight amount of tannic acid, an acid peculiar to itself, cinnamic acid, mucilage, lignin, etc. Medical Properties and Action.—Cinnamon is an aromatic stimulant and astringent, being more powerful as a local than as a general stimulant. Its medicinal virtues principally reside in a volatile oil, oleum cinnamomi. Therapeutic Uses.—Cinnamon is chiefly used as an adjunct to other medicines, being seldom prescribed alone, though it is capable of allaying nausea and vomiting, and also relieving flatulence. Combined with chalk and with other astringents, it is well adapted for the treatment of diarrhoea. Dose.—Of cinnamon, gr. x to 5ss of the powder; of the tincture, the dose is f3j to foiij. Oil of Cinnamon—Oleum Cinnamomi—is obtained by distil- lation, and when fresh, is of a light yellow color, which becomes deeper by age, and ultimately red. It has an exces- sively hot, pungent taste. It is often employed to conceal the taste of other medicines, and is a powerful local stimulant. Large doses of the oil of cinnamon are poisonous, producing an inflamed and corroded condition of the gastric and intestinal mucous membrane. Dose.—Of the oil of cinnamon, gtt, j or gtt. ij, administered in the form of an emulsion. 224 DENTAL MEDICINE. Cinnamon water—Aqua Cinnamomi—(cinnamon, carbonate of magnesia, and distilled water), is used as a vehicle for other medicines. Spirit of cinnamon—Spiritus Cinnamomi—(oil of cinnamon, i part, stronger alcohol 15 parts). Dose, gtt. x to gtt. xx. Dental Uses.—Cinnamon, in the form of powder, is employed as an ingredient of dentifrices, for its stimulant, astringent and aromatic properties. Oil of cinnamon is employed in dental practice for the relief of odontalgia. One drop applied to an inflamed dental pulp will afford temporary relief; also, com- bined with iodoform, in the treatment of alveolar pyorrhoea. COCAINE. Source.—Cocaine is the alkaloid obtained from the leaves of the Erythroxylon Coca, a shrub indigenous to certain parts of South America, as Peru and Chili. The leaves resemble those of Chinese tea, and in the preparation of the alkaloid it is neces- sary that they should be of the best quality, which depends upon their being gathered at a proper time, carefully dried, and not injured by age or by exposure to the air, as moisture de- prives them of all value. Cocaine being extremely suscep- tible to the influence of acids, A. Castaing, ph.g., devised a method by which one grain of cocaine can be extracted from four hundred and eighty grains of the leaves without using acidulated fluids, which is as follows : " On one part by weight of coca leaves pour eight parts of boiling water, and let them steep for half an hour in a closed vessel, in a water bath ; pour the whole into a percolator, and when all the liquid part is strained off, continue the exhaustion of the leaves by pouring on them eight parts of alcohol, at 85° ; mix the two liquids and precipitate them by means of acetate of lead, draw off with a siphon, and then add sulphate of sodium to remove the salts of lead; filter and evaporate, at a gentle heat, until the liquid has attained the consistence of syrup; treat the whole with water, to separate the resinous part, and then precipitate with carbonate of sodium; the precipitate is then to be exhausted by sulphuric ether, and the ethereal solution, after the ether is COCAINE. 225 distilled, is exposed to the air until every trace of ether has completely disappeared ; by this means is obtained a crystal- lized residue, of a brownish-yellow color, and of a disagreeable smell. This is impure cocaine. The coloring matter is re- moved by washing once or twice with cold alcohol. The cocaine thus purified, appears in the form of transparent prisms, without smell, bitter to the taste, soluble in seven hun- dred'parts of cold water, more soluble in alcohol, and entirely soluble in ether. The solution has an alkaline reaction, and, when applied to the tongue, it imparts a bitter taste, and a certain insensibility, followed by a slight sensation of cold, recalling the effect of ether spray upon the epidermis. Heated to 2080 F., the cocaine becomes liquid, and, under the influence of cold, it becomes a transparent mass, which gradually assumes a crystalline form. If it be exposed to a higher heat than 2080 F., cocaine changes its.color and decomposes. It is in- flammable, and burns with a brilliant flame, leaving an ash. It forms soluble salts with acids (its hydrochlorate is one of the best), and all these salts are more bitter than the alkaloid. It is a compound of carbon, hydrogen, nitrogen and oxygen. Pure cocaine is in the form of colorless, transparent prisms, without odor, but with a slight bitter taste. The two forms in which cocaine is most generally used are the hydrochlorate or muriate and the oleate. The hydrochlorate of cocaine is generally employed in surgery, and is in the form of a white crystalline powder, which is sparingly soluble in water, but readily soluble in alcohol, ether, oil and vaseline. At first a 2 per cent, solution was used, but subsequently it was increased to four, five, ten, and twenty per cent. Merck has, however, introduced a new preparation, known as the Citrate of Cocaine, in the form of pills, made by incorporating it with gum tragacanth dissolved in glycerine, each pill containing y& grain of the citrate, in which form it retains its strength. The citrate of cocaine, however, in solution, will decompose in three or four days. Dr. John S. Marshall, from experiments made with the citrate of cocaine, is of the opinion that it is more reliable, 226 DENTAL MEDICINE. when applied to hypersensitive dentine or to the dental pulp, than the first two forms, but appears to possess no special ad- vantages over them for operations on submucous tissues, or in the extraction of teeth. Another new salt of cocaine, the hydrobromate, has been pro- duced by Dr. Lyons, by a combination of hydrobromic acid with cocaine, in the form of slender, translucent prisms, of snowy whiteness. It is claimed that the local anaesthetic effect of this preparation is greater, for the same amount of solution, than that of any of the other salts employed. Medical Properties and Action.—Dr. Niemann, of Goslar, as early as i860, noted the fact that cocaine, when applied to the tongue, produced local anaesthesia, but his investigations, as well as those of others at a later period, appear to have been forgotten, until 1884, when Dr. Koller, of Vienna, demonstrated the action of cocaine, in solution, on the eye. Apparently very little is known concerning the physiological action of cocaine, but that it is a valuable local anaesthetic and local anodyne is beyond question. It appears to paralyze the nerves of the vessels, causing, at the same time, a constriction, as is evident from the blanching of the part acted on. Many are of the opinion that its effects are mainly due to its influence upon the sympathetic. When one drop of a 2 or 4 per cent. solution of cocaine is applied to the eye, a slight burning sensation is felt, and a minute or two later the cornea and con- junctiva become anaesthetic, and lose all reflex excitability. The finger can be passed over the cornea and conjunctiva, and the latter can be taken up with the forceps, without pain. At the same time there is a feeling of tension in the lids, and the eye seems protruding. These effects last about ten minutes and gradually disappear. Dr. Konigstein reports having re- moved the eyeball of a dog cocainized, without the animal feeling any pain. A ten or twenty per cent, solution is used, according to the sensitiveness of the parts and the nature of the operation, when less sensitive organs than the eye have to be obtunded. For the larynx, it should be applied three or four times, at intervals of ninety seconds ; for the eye, a drop COCAINE. 227 of the two per cent, solution, at intervals of two minutes, the maximum effect being reached in fifteen minutes. Dr. Jelinek recommends a dilute alcoholic solution of ten or twenty per cent. For the former strength the proportion of alcohol to water should be one to four; for the latter, two to three. Therapeutic Uses.—Cocaine is employed as a local anaesthetic and local anodyne in all painful affections of the eye, the operation for cataract, although the evidence as to its reliability in such deep operations as iridectomy, cataract, squint, etc., is conflicting. (There are, however, cases reported by Dr. Ko- nigstein of even the surfaces of the eyelids entirely losing their sensitiveness when hydrochlorate of cocaine was applied in solid form). It is also employed in painful affections of the pharynx and larynx, or of any other excitable mucous membrane, or of nerve tissue. Prof. Engle reports a case of trigeminal neuralgia successfully treated by hypodermic injec- tions of the hydrochlorate of cocaine. Dental Uses.—In operations in the mouth, affecting the mucous membrane and the immediately subjacent tissues, the salts of cocaine have proven very efficient for their local anaes- thetic and anodyne effects. But for operations on deep-seated tissues, such as are involved in the extraction of teeth, the action of cocaine has been, as Dr. W. W. Allport remarks, " so uncertain as to render its practicable benefits questionable." Cocaine has, however, proven very efficient in relieving the pain of the surgical treatment of alveolar pyorrhoea, the extir- pation of the pulps of teeth, and that of hypersensitive dentine. Exposed pulps are rendered less painful after being treated with a five per cent, solution of cocaine, to which, in some cases, morphine has been added. In some cases also, it is claimed, highly inflamed pulps have been successfully capped, as an experiment, with a paste of cocaine and glycerine, although, as was foreseen, the anaesthetic did not arrest the course of the pulpitis. In treating hypersensitive dentine, the more sensitive the structure the stronger the solution of cocaine to be employed. The pure cocaine in the form of crystals, or the hydrochlorate or other salts, in the form of powder, have 228 DENTAL MEDICINE. proven efficient when applied to hypersensitive dentine ; while the twenty per cent, solution of the salts have relieved the acute pain which is common to such a condition. It is also claimed that the crystals of cocaine, applied to the gum, close to a tooth to be extracted, three times, at intervals of two minutes each, has secured a painless operation. It has been suggested that immediately after the application of the cocaine crystals to the gum, three or four minims of a four per cent. solution be injected with a hypodermic syringe, between the gum and the neck of the tooth to be extracted. For the extir- pation of pulps of teeth, it is recommended first to anaesthetize the pulps superficially, with a paste of cocaine and glycerine, and then to introduce, by means of a syringe, a twenty per cent, solution of cocaine directly on the exposed portion of the pulp, when it can be removed with a nerve extractor without causing any pain. Dr. John S. Marshall, from his experiments with the pills of citrate of cocaine, found that under favorable circumstances, the citrate, in such a form, produces anaesthesia, when applied to sensitive dentine, in from five to ten minutes, and that the obtunding effect is of a duration sufficient for the preparation of the cavity. He was also able to extirpate the pulp of a tooth, after the citrate had been applied, in from three to twelve minutes. In using the citrate in the form of pills, one pill is introduced into the sensitive cavity, and, after being secured with a pledget of cotton, moistened in tepid water, is permitted to remain from five to twelve minutes. Dr. Mar- shall suggests the use of granules, containing one-sixteenth of a grain of pure citrate of cocaine, instead of pills containing glycerine and saccharine matters. A solution of the salts of cocaine has also been subcutaneously injected, with favorable results, for the relief of the pain resulting from periodontitis and dental exostosis; and Dr. Hillischer recommends the rub- bing in of cocaine, either in substance or in concentrated solution, after the epithelium has been macerated with tincture of iodine, to promote absorption, to relieve the pain of chronic periodontitis ; also the repeated application of the concentrated solution to relieve the ulcers of thrush, aphthae, etc. In the COCAINE. 229 surgical treatment of alveolar pyorrhoea, the pain may be re- lieved by first applying dilute alcohol to the gums, by means of a camel's-hair brush, and then, in the same manner, a ten per cent, solution of cocaine, repeating the application of the cocaine once or twice during a space of five minutes. Cocaine has also been used by hypodermic injection, for the extraction of teeth. Owing to the necessity for introduc- ing the agent deeply into the tissues, Dr. Walb's method is to inject a two per cent, solution of the hydrochlorate of cocaine hypodermically over the root of the tooth to be extracted, the injections being usually made on each side of the gum, above the root of the tooth, and as many as the number of teeth to be extracted may indicate ; the same method is employed for obtunding hypersensitive dentine, and in removing pulps. The full anaesthetic effect is developed in from five to ten minutes, and continues ten or fifteen minutes. It has also been suggested to hypodermically inject the solutions of cocaine upon both the lingual branch and the inferior dental branch of the inferior maxillary nerve, the former being preferred by some, on ac- count of its supplying the alveoli and gums; but greater success appears to result from injecting the gum on each side of the tooth. DENTAL FORMULAE. To Make a Solution of Hydrochlorate For Neuralgia and Odontalgia. of Cocaine (Four per cent). R . Cocaini hydrochloratis R. Cocaini hydrochloratis (cryst.) ................. gr.vj (cryst.).................. gr.x Menthol.................. gr.xxx Aquae destillatae......... f3j. M. Alcoholis...q.s....ad..... f^j. M. Signa.—Apply as a lotion, or on a For Exposed Pulps. pledget of cotton. R. Cocaini hydrochloratis Chloroform or bromide of ethyl may (cryst.) ................. gr.vj be substituted for the alcohol. Spiritus menthae pip... f^j. M. Signa.—Apply on a pledget of cotton. To Make Oleate of Cocaine, (Five per cent.) For Local Anceslhesia. R. Cocaine (alkaloid)..... g^-^Y (H. J. McKellops.) Acidi oleic (pure)...... rr\xx R. Mur. cocaini............. gr.iss Olei amygdalae......... rrbxl. Spts. alcoholis........... 3 j Dissolve the alkaloid in the. oleic acid Chloroformi.............. 3J. M. and add the almond oil. 230 DENTAL MEDICINE. For Hypersensitive Dentine. For Neuralgia and Odontalgia. R. Cocaini hydrochloratis R. Cocaini hydrochloratis (cryst.)................. gr.x (cryst.) ................. gr.xv Tragacanth. glyceritum q.s. Olei caryophylli....... f^j. M. Form a mass. Signa.—Apply as a lotion, or on a Signa.—Insert a minute portion in pledget of cotton. cavity half an hour before operating. COLLODIUM—COLLODION. Derivation.—Collodion is a solution of 4 parts of pyroxylin in 70 parts of stronger ether, and 26 parts of alcohol. Pyroxy- lin or gun cotton, is prepared by adding a mixture of nitric and sulphuric acids to cotton freed from impurities. Collodion is a colorless, syrupy, and very inflammable liquid, with a strong ethereal odor. By long standing and exposure, or when applied to a surface, it deposits a thin, transparent and strongly contractile film, which is insoluble in water or alco- hol. It should be kept in glass-stoppered bottles. It is applied by means of a camel-hair brush. When it becomes too thick, it may be diluted by a solution constituted of ether, 3 parts, alcohol, 1 part. Medical Properties and Action.—It is serviceable as an emol- lient, and its action is mechanical, as it draws together and holds in apposition divided parts, and protects such, as well as abraded or denuded surfaces, from contact with the air. As the ether it contains evaporates, the surface of the part to which it is applied is constringed, and a degree of pressure is thus established, which is very useful in moderating vascular action, promoting absorption, and changing the course of pus which may already be formed into a direction more desirable. On account of the liability of collodion to crack and peel off, these objections have been obviated by the use of what is known as Flexible Collodion—Collodium Flexile—(collodion, 92 parts, Canada turpentine, 5 parts, castor oil 3 parts), which is softer and more pliable and elastic. Therapeutic Uses.—Collodion is very useful in ulcers, fissures, incised wounds, abraded surfaces, erysipelas, skin diseases, etc. Dental Uses.—Collodion is a very useful application in dental practice, to prevent alveolar abscesses from discharging exter- COLLODION. 231 nally on the face ; for such a purpose, it is applied in successive layers, so as to act as a compress, and, by moderating the vascular action, cause absorption, or such a change in the direction of the discharge as will induce it to open in the mouth. It is also employed in combination with carbolic acid, as an application for odontalgia ; when introduced on cotton, it acts as a temporary filling; it has also been employed for arresting the mucous secretion during the operation of filling cavities near to or under the margin of the gum, but the rubber dam has superseded it in this respect. Combined with iron and other agents, it forms a styptic preparation. In the dental laboratory, collodion, in the form of a colored preparation, is employed to coat the surfaces of the plaster models of plastic work, and when not applied too thick, it protects the plaster surface, and also prevents an unsightly rubber surface on the part of the plate which is adapted to the mucous surface of the mouth. When this preparation becomes too thick for use, it may be diluted with a solution of 3 parts of ether to I part of alcohol. Collodion is precipitated by carbolic acid. Cantharidal Collodion.—Collodium cum Cantharide—is composed of cantharides (Spanish flies), in powder, 60 parts, flexible collodion, 85 parts, commercial chloroform, q. s. The addition of one per cent, of Venice turpentine to cantharidal collodion will prevent the disagreeable, and, at times, painful contraction of the preparation on drying. Like cantharides, cantharidal collodion, when locally applied, excites inflammation of the skin and mucous membrane, which terminates in a copious secretion of serum under the cuticle. It produces a blister in the same time as the ordinary blister- ing plaster, and is applied with greater facility, and is better adapted to cover uneven surfaces, and retains its place more certainly. It acts much more readily if the evaporation of the ether is retained by a piece of oiled silk placed over the surface immediately after the application of the collodion. Dental Uses.—Cantharidal collodion is a valuable application in dental periostitis, applied to the gum over the root of the 232 DENTAL MEDICINE. affected tooth, by means of a camel-hair brush, previously removing all moisture from the surface, and protecting the lips and cheeks, until the ether it contains has evaporated, and an artificial cuticle is formed. The blister which rises on the gum should be punctured with a needle. The counter irritation thus produced relieves the periosteal inflammation. Iodized Collodion—Collodium Iodidum—(collodion, Sj, iodine, gr. xx), forms a good solution of iodine for external use. DENTAL FORMULA. For Odontalgia. For a Styptic. R. Acidi carbolici cryst., R. Collodii .................... 3 iij Collodii........aa........ SI- ^. Tinct. ferri perchloridi... 3J Signa.—To be applied on cotton. Olei ricini................. gtt.ij. M. Signa.—To be applied to the bleeding For a Styptic. surface, or, on cotton, to the alveolar R. Collodii.............. partes 100 cavity. Acidi carbolici...... partes 10 Acidi tannici........ partes 5 For a Styptic. Acidi benzoici...... partes 5. M. R. Acidi tannici, Signa.—To be applied to the bleeding Alcoholis, surface by means of a camel-hair ^Etheris......aa...... partes aeq. M brush. Then add as much pyroxylin as the solution will dissolve. CREASOTUM—CREASOTE. Formula.—C8H10O2. Sp. gr. 1.071. Derivation.—Creasote is a product of the distillation of wood tar, its name being derived from the Greek xpsaZ, " flesh," and ocarrjq, " preserver," as animal substances, when saturated with it, are preserved from putrefaction. It is also obtained from crude pyroligneous acid. Creasote, when fresh and pure, is a colorless, oleaginous fluid, with a strong, empyreumatic odor, resembling closely carbolic acid, and a caustic, burning taste. After exposure, it has a yellowish or brownish tinge. Its purity may be tested by strong acetic acid, which dissolves the creasote, and leaves behind the impurities floating above the creasote solution. It may also be tested by dropping it on paper, when, if pure, it will, after being volatilized by heat, leave no stain. Creasote CREASOTE. 233 may be distinguished from carbolic acid, which it closely resembles in many respects, by not coagulating collodion when mixed with it, and by not imparting a blue color to a piece of pine wood dipped first into an alkaline solution of creasote, and then, after drying, into muriatic acid. Medical Properties and Action.—Creasote is stimulant, sedative, rubefacient, escharotic, styptic and antiseptic. It possesses the property of immediately coagulating albumen, and to this property is ascribed many of its effects on the living system. In large doses it is an acro-narcotic poison; but in small doses, it is styptic and astringent, and for the latter property it is more generally administered than for any other. When creasote comes in contact with the blood, the latter changes from a bright red to a reddish-brown color, with small spots of coagulated albumen, and also becomes thicker. Applied to the tongue, it causes severe pain, but without redness or tumefaction; it also causes a strong taste of smoke, and a copious flow of saliva. When administered internally in small doses, it causes a sensation of warmth in the stomach, and exercises a decided sedative action. In large and poisonous doses, it produces profound stupor, flushed countenance, fixed eyes, slow and labored pulse, irrit- able stomach, nausea, vertigo, but has no effect, such as dila- tion or contraction, on the pupils. The treatment in cases of poisoning by creasote consists in administering albumen, such as white of eggs, milk, or wheat flour; also the administration of ammonia and other stimulants, mustard, emetics, etc. Death from creasote is caused by its coagulating the albumen of the blood, and preventing its circulation through the arterial system. Therapeutic Uses.—Creasote is administered internally for gastric irritability and vomiting, flatulence, diarrhoea, diabetes, haemoptysis, pulmonary consumption, chronic bronchitis, epi- lepsy, neuralgia, etc. Externally, it is applied to ulcers, eruptions, diseases of the skin, wounds, hemorrhage from wounds or leech bites, warts; also in putrid sore throat, as a gargle. 16 234 DENTAL MEDICINE. Dose.—Of creasote, gtt. j or gtt. ij, several times a day, either in mucilage, in the proportion of half a fluid ounce to a drop of the creasote; or it may be given in pill form. For external use, from gtt. ij to gtt. vj, or more, may be added to a fluid ounce of water. Creasote Water—Aqua Creasoti—(creasote, 5j, distilled water, Oj). Dose of creasote water, f5j to foiv. Solidified Creasote.—For the purpose of making the application of creasote to the teeth more convenient, and pre- venting the effects upon the mucous membrane of the mouth when applying it to carious cavities in teeth, a gelatinous solid- ity may be given to it by adding 10 parts of collodion to 15 parts of creasote. Dental Uses.—Creasote, like carbolic acid, is a valuable agent in dental practice, although the use of the latter has, in some respects, superseded that of the former, the two being very similar in their action, with some advantages in the case of carbolic acid. Creasote is employed for the relief of odontal- gia, obtunding the sensitiveness of dentine, alveolar abscess, dental periostitis, suppurating pulps of teeth, devitalizing pulps of teeth, treatment of exposed pulps of teeth, mercurial and other forms of stomatitis, ulcers of the mouth, diseases of the gums; as a styptic for hemorrhage from the gums, mucous membrane and leech bites, and after the extraction of teeth. Creasote, like carbolic acid, has a peculiar power as an anti- septic, hence it is a valuable application in cases attended with offensive purulent discharges. It promotes the growth of healthy granulations, and hastens the healing of wounds, and arrests the process of suppuration. When applied to ulcerated surfaces, it should be repeated as pus is formed or fungous growths appear. It is a painful escharotic upon mucous mem- brane, with, however, a soothing reaction. An ointment— Unguentum Creasoti—-is composed of creasote, f5ss, lard, Sj, and is useful in cutaneous affections. For the treatment of exposed pulps it is employed either diluted or in its full strength ; for dental periostitis and alveolar abscess, in its full strength, or in combination with such agents PREPARED CHALK. 235 as glycerine, iodine, etc.; also in devitalized teeth, and as an anti- septic application in ulceration of the mouth, and recession of gums from the necks of the teeth. When used as a styptic after the extraction of teeth it is applied on lint or cotton, with pres- sure ; and diluted with water, it is employed in the treatment of caries and necrosis of the maxillary bones. To dilute it for injections it is often mixed with alcohol, and the strength reduced by adding water. Mixed with an equal quantity of oil of cloves its odor and taste are modified. Creasote is also employed to neutralize any acid remaining in the cavity of a tooth about to be filled, and to harden and render imperishable the contents of the dentinal tubuli, for which purpose it is applied to the walls of the cavity on a pellet of cotton. DENTAL FORMULAE. For Alveolar Abscesses. For Odontalgia. R. Creasoti, R. Creasoti, Linimenti iodi, partes aequales. M. Chloroformi, Signa.—To be used as an injection. Liquidi opii......aa......3 iij Tinctura benzoini........!|j. M. For Odontalgia. Signa.—To be applied, on a pellet of R. Creasoti................. 3*ss cotton, to carious cavity. Camphorae...............gr.x. M. Signa.—To be applied, on a pellet of For Odontalgia. cotton, to carious cavity. R. Creasoti, Chloroformi, For Odontalgia. Morphinae hydrochlo- R. Creasoti..................31J ratis..........aa........3HJ Morphinae acetatis......gr.xx. M. Tinctura benzoini.......Jj. M. Signa.—To be applied, on cotton, to Signa.—To be applied, on a pellet of carious cavity. cotton, to carious cavity. (See Formu- lae of Carbolic Acid. CRETA PR^PARATA—PREPARED CHALK. PRECIPITATED CHALK, CARBONATE OF LIME. Formula.—CaCOa. Derivation.—Prepared chalk is obtained by freeing chalk from such impurities as gritty and flinty substances and soluble saline matter, by elutriation, and afterward drying it. It is the only form in which chalk is used medicinally. 236 DENTAL MEDICINE. Medical Properties and Action.—Prepared chalk is antacid, absorbent and astringent. It diminishes the secretion of the mucous membrane, and at the same time acts as antacid in correcting any acidity present. When internally administered for a considerable time, like magnesia, it accumulates in the bowels and forms intestinal secretions; hence an occasional aperient is necessary. Therapeutic Uses.—Prepared chalk is an excellent antacid in diarrhoea from acidity, in acidity attending dyspepsia and gout, chronic bronchitis in advanced stages, rachitis, etc. Externally, it is employed in the treatment of ulcers, burns, excoriations and skin diseases. It moderately stimulates ulcers and absorbs the discharge, thus preventing them from spreading. It is an antidote for poisoning by oxalic and most of the vegetable and mineral acids. Dose.—Of prepared chalk, gr. v to 3j, in powder or sus- pended in water by the aid of mucilage and sugar. Chalk Mixture—Mistura Creta—(prepared chalk, Sss ; acacia, gr. cxx; water, fSiv,) is often combined with opiates and astringents, such as laudanum and tincture of kino, or of catechu, in the treatment of diarrhoea. Dose, 5j to 5ss. Dental Uses.—Prepared chalk is used in dental practice chiefly for its antacid property, and generally as an ingredient of dentifrices; it is also employed in the form of powder as an antacid in acidity of the oral fluids, for which purpose it is rubbed between the teeth and permitted to remain during the night; it is also employed to obtund the sensitiveness of dentine, on account of its absorbent and antacid properties; for such a purpose it should be applied repeatedly, for several days, to the sensitive surface. In the dental laboratory it is used as a polishing powder for metal and plastic work; also for polishing the surfaces of gold fillings. The precipitated chalk of the Pharmacopoeia is the preparation to be preferred, on account of its freedom from gritty particles. PREPARED CHALK. 237 DENTAL FORMULAE. Dentifrice in the form of a Camphorated Paste. (Keller Medicine Co.) PTS. BY WT. R. Magnes. carb.......... 2 Glycerini .............. I Potas. chlorat.......... 3 Tr. camphora......... I 01. gaultheriae......... q. s. Cretae praep............ q. s. To make desired number of parts. Syr. simplic............ q. s. M. To make a thick paste. Dentifrice. (Am. Dent. Association.) R. Cretae praeparatae...... ibiij Pulv. cinchonae....... Ibj Pulv. radicis iridis... Ibj Pulv. sacchari albi... Ibiss Pulv. saponis cas...... 3*j Sodii carb............. Jj Olei sassafras........... gtt. lxxx. Dentifrice. (Am. Dent. Association.) R. Cretae praep............ Ibiij Pulv. cinchonae........ Ibj Pulv. radicis iridis... Ibj Pulv. sacchari albi... Ibjss Pulv. saponis cas...... ^j Sodii carb.............. ^j Glycerini............... fj iij Mellis................... q. s. M. And form into a paste. Dentifrice. R. Pulv. radicis iridis... ibss Cretae praeparatae...... 3*iv Sodii carb.............. 3SS Pulv. cinchona?....... 31V Pulv. sacchari albi... Jjij Pulv. myrrhae.......... 3J Pulv. ossis sepiae...... 3" ij Otto rosae............... gtt. iv. With rose pink, q. s. to color. Dentifrice in the form of Glycerine Tablets. (Keller Medicine Co.) PTS. BY WT. R. Solut. magnes. carb.. 2 " sodii bicarb... I " potas. chlorat.. 3 " sapo. cas. albi. 6 Glycerini............... 1 Cal. carb...............10 01. gaultheria, Cassiae........aa........ q. s. M. To flavor. Dentifrice. R. Cretae praep............. 3 iij Pulv. radicis iridis___ 3*ij Pulv. sacchari albi___ £ j Pulv. cinnamon........ 3HJ Pulv. saponis cas...... 31J Pulv. myrrhae.......... 3J 01. gaultheriae......... gtt. x. M. Dentifrice. (A. W. Harlan.) R. Cretae praeparatae, Pulv. radicis iridis.aa. 3" ij Pulv. saponis cas., Pulv. sodii bibora- tis.........aa......... 3*ss Pulv. myrrhae.......... 31J Mellis et glycerini.... q. s. To make a soft paste. Color rose pink. Perfume to suit. Dentifrice. (Chapin A. Harris.) R. Cretae praeparatae...... £iv Pulv. radicis iridis.... 3*iv Pulv. cinnamon....... 3iv Sodii carbonatis ex- v siccatae.............. 3SS Pulv. sacchari albi... 3*j Olei limonis............ gtt. xv Olei rosae............... gtt. ij. Signa.—Ingredients to be thoroughly. pulverized and well mixed. 238 DENTAL MEDICINE. Dentifrice in the form of a Paste for Dentifrice. Compressible Tubes. R. Cretae praeparatae...... Ibiss (Keller Medicine Co.) Pulv. sodii boratis, pts. by wt. Pulv. radicis iridis.aa. Ihss R. Magnes. carbonat..... 2 Semen cardamom.... 3*j Sodii bicarb........... 3 Pulv. sacchari albi... Ibss Potas. chlorat.......... 5 Otto rosae............... q.s. M. Calcii carbonat........20 To flavor. Sapo. cas. pulv........ 6 Dentifrice, Antacid, Tonic and Anti- Glycerini............... 1 septic. Olei gaultheriae, R. Cretae praeparatae...... 3*iv Oleilimonis.....aa..... q.s. Quininae disulph...... gr. iv Syr. simplic............ q.s. Pulv. ossis sepiae...... 3iv SlGNA.—To make a paste. Otto rosae............... gtt. iv. M. Dentifrices may be pleasantly flavored with wintergreen, cassia, sassafras, lemon, peppermint, anise, lavender, penny- royal, cloves, calamus, attar of roses, oil of neroli, etc. CROTON-CHLORAL HYDRATE. BUTYL-CHLORAL HYDRATE. Formula.—C4H5C130H20. Derivation.—Croton-chloral Hydrate is obtained by the action of chlorine upon aldehyde. It is in the form of small, brilliant, white, silvery crystals, of a sweetish taste, like that of melons. It is slightly soluble in water, and resembles hydrate of chloral in its hypnotic effects; but its action in this respect is not so powerful, nor so certain. It differs from hydrate of chloral in the singular property of causing anaesthesia of the head. To relieve pain and induce sleep, the best effects are obtained from a combination of the two agents. Medical Properties and Action.—It is a sedative, hypnotic and anaesthetic. It resembles chloral hydrate, but is not so certain in its effects as a hypnotic. Its action commences in the head and face. Therapeutic Uses.—Croton-chloral hydrate is highly recom- mended in dysmenorrhcea, sciatica, chronic cough, and in neuralgia as an anodyne. One or two grains will relieve severe neuralgia of the fifth pair of nerves; it is frequently necessary, however, to administer from five to fifteen grains, but it is not safe to exceed this amount at one time. SULPHATE OF COPPER. 239 Dose.—Of croton-chloral hydrate, gr. j to gr. x; as an anaes- thetic, gr. xv, dissolved in warm water. Dental Uses.—It is employed with effect in facial neuralgia, in doses of from two to five grains every hour or two, until fifteen grains have been taken ; also as a sedative, in doses of from three to five grains, in dental periostitis, pulpitis, etc., etc. DENTAL FORMULA. For Neuralgic Odontalgia. Von Kirchbauer. R. Croton chloral............................................... 3J Glycerini..................................................... 3 vj Aquae destill................................................ 5uss Syr. aurantii................................................. 3iv Oleum foeniculae............................................ gtt-vj- M. Signa.—A tablespoonful, and, if pain continues severe, repeat the dose in an hour. CUPRI SULPHAS—SULPHATE OF COPPER. BLUE VITRIOL, BLUE STONE. Formula.—CuS04, 5H2O. Derivation.—Sulphate of Copper is obtained by roasting the native sulphuret, or by the combination of oxide of copper and sulphuric acid, filtering and crystallizing. It is in the form of blue prismatic crystals which, after exposure to the air, effloresce to a slight degree, and become covered with a greenish-white powder. It has an astringent, metallic taste. Medical Properties and Action.—Sulphate of copper is emetic, tonic, nervine, stimulant and astringent, and is quite soluble in water, but insoluble in alcohol. It is a prompt and efficient emetic, the emesis commencing a few minutes after it reaches the stomach, and the copper comes up with the vomited matter. Little or no depression follows its administration as an emetic, and it is especially adapted to cases of narcotic poisoning. Therapeutic Uses.—Sulphate of copper is employed as a prompt and efficient emetic in cases of poisoning; it is also administered in intermittent fever, neuralgia, diarrhoea, dysen- tery, croup, epilepsy, hysteria, etc., etc. Externally it is applied in ulcerative and gangrenous affections, superficial hemorrhage, leucorrhcea, gonorrhoea, ringworm, purulent 240 DENTAL MEDICINE. ophthalmia, mucous discharges, diseases of the skin, indolent ulcers, fungous granulations, warts, etc. Dose.—Of sulphate of copper as an emetic, gr. iij to gr. v; or dissolve 20 grains in two ounces of distilled water and give a tablespoonful every 15 minutes until vomiting occurs. For internal use other than emetic the dose is gr.yi to gr. ss, in pill. Dental Uses.—Sulphate of copper is employed in dental practice, in the form of the ammoniacal solution, for long standing cases of neuralgia; and externally it is applied to ulcers of the mouth, cancrum oris, aphthous ulceration, ulceration of the gums and mucous membrane of the mouth, hemorrhage from leech bites, fungous growths of the gums, etc., etc. DENTAL FORMULAE. For Cancrum Oris, Aphtha and Gan- For Gangrenous Ulcers of the Mouth grenous Affections of the Mouth. and Cancrum Oris. R. Cupri sulph. (powdered) gr.v R. Cupri sulph............... 3-ij Mellis...................... 5;ss. M. Pulv. cinchonae........... ^ss Signa.—Apply as a lotion, or by means Aquae....................... ?iv. M. of a camel's-hair brush. SlGNA.—Brush over ulcerated surface twice daily. For Ulcerative Stomatitis. R. Cupri sulph................. gr.x For Caries of the Maxillary Bones. Pulv. cinchonae............ 3ij (Bartholow.) Pulv. gum acaciae........ 3J R. Cupri sulph, Mellis....................... Sij Zinci chloridi.....aa.... partes xv Aqua;....................... .^ iij. M. Liquorplumbi............ " xxx Signa.—Apply, by means of a camel's- Aquae destillatae........ " cc. hair brush, to the ulcerated surface. Signa.—To be applied for 30 minutes at a time. ETHIDENE DICHLORIDUM—DICHLORIDE OF ETHIDENE. Formula.—C2H4C12. Sp.gr. 1.225. Derivation.—Dichloride of Ethidene is obtained in the prepa- ration of chloral, from the waste products, and is very much like chloroform in appearance, odor and taste. It has a variable boiling point of about 1150 F., and is readily soluble in alcohol, sparingly soluble in water, and but slightly soluble in chloroform. It is inflammable, but less so than alcohol. Medical Properties and Action.—Dichloride of ethidene is a general anaesthetic, and is said to occupy an intermediate rank BROMIDE OF ETHYL. 241 between chloroform and ether. It reduces the action of the heart to a less degree than chloroform, with, however, con- siderable depression of the pulse. It has been somewhat employed in England, where it is regarded as being safer than chloroform for inhalation, and requiring less quantity to produce anaesthesia than ether. Methods of Administration.—It is recommended to admin- ister nitrous oxide until the patient is nearly unconscious, and then to add the vapor of ethidene. The effects of this agent are described as follows : The pupils dilate, and at the same time stertorous breathing commences ; the pulse falls, and should be carefully watched, and insensibility to pain con- tinues for some time after the patient becomes conscious. It is also claimed for this agent that there are no unpleasant after- effects, the patient recovering as if from a natural sleep, with a clear mind and distinct utterance. It is also recommended to combine the vapor of ethidene with that of nitrous oxide, by loosely inserting a sponge containing half an ounce of ethi- dene in the nitrous oxide gas-inhaling tube, or in the rubber supply bag, when the effect is said to be more profound and agreeable than when nitrous oxide alone is administered, with no nausea and but little lividity of the lips. It is also said to produce relaxation of the muscles rather than rigidity, differing in this respect from nitrous oxide gas. Dichloride of ethidene is also employed as a local anaesthetic, in the same manner as chloroform, aconite, etc., for the relief of facial neuralgia, etc. It has not been introduced to any extent into this country. ETHYL BROMIDUM—BROMIDE OF ETHYL. HYDROBROMIC ETHER. Formula.—C2H5Br. Sp. gr. 1.420. Derivation.—Bromide of Ethyl is obtained from bromide of potassium, sulphuric acid, alcohol and water, by distillation, and re-distilled by chloride of calcium. It is a colorless and very volatile liquid, boiling at 400 C, heavier than water, and possesses an agreeable ethereal odor, and a pungent taste, 242 DENTAL MEDICINE. strong and sweetish, with a somewhat burning after-taste. It is readily soluble in alcohol and ether, and but sparingly soluble in water. Medical Properties and Action.—Bromide of ethyl is con- sidered to be a very effective and pleasant general anaesthetic, but like all other agents of this class, it must be administered with great care, and a pure article employed. There is no doubt but that it is pleasanter to inhale than chloroform, ex- ceedingly rapid in producing complete unconsciousness, and very evanescent in its action. That it is any safer than some other and older agents of this class, clinical experience has not demonstrated, as several deaths occurred in a very limited number of the administrations attending its introduction. Bromide of ethyl is not inflammable, nor caustic, nor even irritant, in this respect being preferable to chloroform, which is very caustic, and to sulphuric ether, of which the ingestion is nearly impossible. Dr. Isaac Ott, comparing bromide of ethyl with other anaesthetics, says : " (a) Chloroform increases the pulse, then slows it by a cardiac inhibitory stimulation; ether increases the pulse; nitrous oxide also increases it by paralysis of cardiac inhibitory apparatus ; whilst bromide of ethyl increases the pulse by an action on the heart itself, (b) Chloroform reduces the blood pressure by paralysis of the main vaso-motor centre, and cardiac debility; ether greatly increases it and keeps it increased; and nitrous oxide also increases it; bromide of ethyl increases it either by a stimula- tion of the spinal or peripheral vaso-motor system, (c) Chloro- form increases, and then decreases, respiration ; nitrous oxide reduces it; bromide of ethyl decreases it by a central action." He also draws the following conclusions: " i. Bromide of ethyl, either by inhalation or subcutaneous use, kills, by a toxic action on the centres of respiration. 2. That the decrease of force and frequency of the heart contributes to the paralysis of the respiratory centres. 3. That injections of ethyl into the jugular, toward the heart, kill, by cardiac arrest, probably due to an action on the cardiac muscle. 4. Bromide of ethyl, in toxic doses, depresses momentarily the frequency of the BROMIDE OF ETHYL. 243 heart, which is followed by a subsequent rise to a normal rate. 5. Bromide of ethyl, in toxic doses, depresses the arterial tension, due, in major part, to the depressant action of the drug upon the heart, and in a minor part, to a partial loss of tone of either the spinal vaso-motor centres or the peripheral vaso-motor system. 6. The inhibitory power of the pneumo- gastric is not paralyzed." Introduced into the stomach, bromide of ethyl does not produce anaesthesia, as when absorbed by the respiratory organs, and does not increase the pulse over its normal beat; and in the second stage, causes an intermission of the pulse every second beat. Administration.—Bromide of ethyl is best administered in a folded starched napkin, so as to cover the face, and having inside of it a soft linen handkerchief. On the linen handker- chief one measured drachm of the agent should be poured, and the patient directed to take long, deep inspirations, or what is better, to make prolonged and forced expirations. In two minutes from the time of administration of the first drachm, a second should be given, and this should be repeated at intervals of two minutes. Like all general anaesthetics, how- ever, the quantity for inhalation differs according to the suscep- tibility of the patient. One drachm (or in some cases two drachms may be required, according to the susceptibility of the patient) of the bromide of ethyl will generally, in from one to three minutes, produce an anaesthesia as profound as that pro- duced by an ounce of sulphuric ether. As it produces an anaesthetic effect on the muscles of the throat and upper parts of the pharynx, it is useful for operations on the mouth and throat. The effect of an anaesthetic, however, is to be more regarded than the mere quantity of the agent poured upon a napkin or sponge, as the*degree of anaesthesia should be governed, in most cases, by the nature of the operation to be performed under its influence. Prof. Chisholm says : " I have found the action of bromide of ethyl so very evanescent that it can never take the place of 244 DENTAL MEDICINE. either chloroform or of sulphuric ether for any surgical opera- tion which requires some time for its performance; but for all quick work, which can be done in one or two minutes, the use of this anaesthetic agent leaves nothing to be desired. These really magical effects must be obtained from the first inhalation, what I call the primary anaesthesia. If the operation be pro- tracted, and a second, or even third dose of the bromide of ethyl be inhaled, and I find nausea, vomiting, and heaviness, in all respects as if chloroform or ether had been used—under this repetition, bromide of ethyl loses all its advantages." The odor of bromide of ethyl is more rapidly removed, and is more agreeable than that of sulphuric ether, and its effects more rapid than even those of chloroform, as it is eliminated by respiration, and by the kidneys, more speedily than any other general anaesthetic agent. It requires excessive quanti- ties to affect the heart and respiration to any great degree. Having no caustic action, it can be safely applied subcuta- neously, and also to the external auditory meatus and to the mucous membrane. It evaporates upon the skin very rapidly, producing a very sensible feeling of cold. As a rule, its general effects are as follows : Moderate acceleration of the pulse and respiration ; slight excitement or talking, and seldom any struggling; flushing of face ; dilatation, sometimes pre- ceded by contraction of pupil; diaphoresis, generally profuse ; complete anaesthesia in two or three minutes; recovery of consciousness in from one to two minutes after the withdrawal of the anaesthetic agent; no after-vomiting. Any specimen of bromide of ethyl which has a disagreeable odor, or which, on standing, becomes brown, or any that will explode and burn, is impure, and should not be employed for inhalation. A common impurity is bromoform, produced by the action of bromine and caustic potassa on alcohol, or wood spirit. Bromide of ethyl possesses properties, intermediate between those of chloroform and ether. As a local anaesthetic it is highly spoken of, and, owing to its non-inflammability, is the only anaesthetic which can be used in connection with the actual cautery. Dr. Byrd strongly recommends an anaesthetic EUCALYPTUS. 245 mixture of bromide of ethyl I part, chloroform 3 parts, and alcohol 4 parts, a drachm of which is poured upon the sponge of the inhaler, which the patient is allowed to inhale with the stopper out, after which the stopper is replaced and the full strength of the mixture inhaled. Generally in five minutes the patient is fully anaesthetized, when the stopper may be taken out to permit a greater admixture of air, and replaced as the judgment of the operator may dictate. This mixture, it is claimed, is safer and less disagreeable in its effects than the bromide alone. For use as a local anaesthetic, the bromide of ethyl is atomized with the " spray apparatus," which should furnish enough of the liquid to moisten the skin. The ex- tremity of the tube should be held some two or three inches from the surface on which the spray is to be thrown. Within two or three minutes after its first application, anaesthesia of the part occurs, which is shown by the appearance of a white spot. The formation of this spot may be hastened by superficially puncturing or scratching the skin. The sensation of cold thus produced is sometimes disagreeable, but is rarely painful. The skin, and even a thin layer of the subjacent tissue, may be painlessly incised while the white spot lasts. This anaesthetic appears to be very well adapted for short operations, requiring simple anaesthesia and not complete muscular resolution, hence it is now preferred by some, for the extraction of teeth, to either chloroform or ether. Internally, bromide of ethyl has lately been recommended for whooping cough, in the form of a solution of I part of bromide of ethyl in 200 parts of water; also in angina pectoris, the dose being one-half to two ounces. Given internally, it is also said to relieve gastric pain, without affecting the appetite. Inhalations readily relieve convulsive cough; and, introduced on cotton wool into the external meatus, it relieves the pain of otalgia, without causing any irritation. EUCALYPTUS. Source.—Eucalyptus is obtained from the eucalyptus globulus, a tree of large size, and of the natural order Myrtaceas, found originally in Australia, and known as the " Blue Gum Tree." 246 DENTAL MEDICINE. These trees are now growing in the southern parts of Europe and the United States, and northern Africa, and their presence is thought to be preventive of malaria. The leaves, which are ensiform, of a grayish-green color, and parchment-like, are the only part which possesses medicinal qualities. They have a pleasant, aromatic odor, with a warm, bitter, and somewhat pungent taste, like that of cubebs, the fresh being more active than the dried leaves. Their medicinal virtue is owing to a volatile oil—Oleum Eucalypti—which contains three principles, called eucalyptene, turpene and cymol. Tannic acid, and a peculiar crystalline fatty acid, are also found in eucalyptus; but eucalyptene is the most important constituent. Medical Properties and Action.—Eucalyptus is antiseptic, disinfectant, sedative, tonic, diaphoretic, and somewhat astrin- gent. When taken into the mouth, it excites a flow of saliva, and leaves a hot, pungent, persistent and disagreeable odor. When introduced into the stomach, it causes a sensation of warmth, and promotes the secretion of the gastric juice. Being stomachic, it increases the appetite and the digestive action, with increased intestinal secretion. Large doses produce offensive eructations, a feeling of weight and tension at the epigastrium, and indigestion, followed by diarrhoea, and irrita- tion and congestion of the kidneys. It increases the action of the heart, lessening the arterial tension, and causes a feverish condition. It accelerates the respiratory movements, and although it induces sleep in the weak and anaemic, it has the opposite effect on the strong and healthy. The secretions of the skin, mucous membrane and kidneys are increased by it, and become strongly odorous, owing to the presence of eucalyptol, a name given to the oil. The inhalation of large quantities of the vapor produces effects analogous to those of the agent when taken in substance, and the essen- tial oil is readily diffusible and readily impregnates the blood. Therapeutic Uses.—While the internal use of eucalyptus is contra-indicated in inflammatory conditions, it is a very efficient remedy in atonic dyspepsia; chronic, gastric, and intestinal EUCALYPTUS. 247 catarrh, cachectic conditions, flatulence, palpitation of the heart, hysteria, chorea, asthma, catarrhal broncho-pulmonary affec- tions, chronic diseases of the liver and bladder, etc. It is also employed in intermittent fever, and during convalescence from remittent fever. Externally, it is an efficient application to chronic forms of angina and tonsillitis, to foul ulcers and wounds, etc. Dose.—Of the fluid extract of eucalyptus, 5ss-oj ; of the tincture of eucalyptus—Tinctura Eucalypti—foss to f5ij ; of the extract—Extraction Eucalypti—gr. j to 3j ; of eucalyptol, the dose is x<\y to 5ss, in capsules or emulsion. Dental Uses.—In dental practice, the decoction of the leaves is an efficient local application in the different forms of stoma- titis, after the acute stage has subsided. The tincture and the distilled water of eucalyptus are used as disinfectant applica- tions in indolent offensive ulcers of the mucous membrane of the mouth. The tincture of eucalyptus has been employed with advantage to obtund the sensibility of dentine. The oil of eucalyptus, either alone or combined with iodoform, forms one of the most effective antiseptics in use, for the treatment of putrescent pulps of teeth, alveolar abscess, of the chronic form, foul ulcers of the mouth, etc. No other preparation appears to prove more efficient as an antiseptic than the combination of eucalyptus oil and iodoform, in the treatment of suppurating conditions, necrosis, and caries of the bones of the jaws, etc. The oil can be introduced as an injection, with an abscess syringe, or by means of a fine broach, armed with cotton, taking care that the agent is carried to the seat of the disease, and the application repeated as often as necessary. It is also employed as a local anaesthetic for odontalgia, and as an astringent or styptic in superficial hem- orrhages, mucous discharges, ulcerating mucous membrane of the mouth, and for spongy, ulcerating gums. Eucalyptus has a solvent effect upon gutta percha, a fact which should be remembered when using it in connection with temporary fillings of the former material, or of Hill's Stopping. 248 DENTAL MEDICINE. DENTAL FORMULAE. For Abscess of Antrum. For Alveolar Pyorrhoea Geo. L. Parmele. (Rigg's Disease). R. Eucalypti.................... 3J G. V. Black. Iodoformi .................. gr.x R. Olei eucalypti............ TTlxc Aquae........................ 3*j. M. Acidi carbolici........... rrixe Signa.—To be used as an injection in Olei gaultheriae.......... TTlxxx M. connection with a tent of floss silk Signa.—Apply by means of an abscess saturated with glycerine and euca- syringe. lyptus. For Suppurating Pulps, Ulcers, etc. R. Olei eucalypti............................................... 3J Iodoformi................................................... gr.xv. M. Signa.—Apply as an injection, by means of a syringe; or on cotton wrapped on the end of a fine broach ; or on a strand of floss-silk. FERRUM—IRON. Chemical analysis demonstrates the presence of iron in the blood, the gastric juice, chyle, lymph, bile, milk, urine and the pigment of the eye ; and, although metallic iron is inert, yet, when it reaches the stomach, it is dissolved by the acids, and thus acquires molecular activity. By its oxidation in the stomach hydrogen is set free, which in its nascent state unites with sulphur, forming sulphuretted hydrogen. Medical Properties and Action.—The salts of iron act through and upon the blood, improving its quality and increasing its quantity,and hence they are termed "haematinic." These salts of iron are absorbed into the system, and are detected in the blood, urine, etc, and under their use the appetite increases, the digestion is improved, the pulse increases in frequency and fullness, the health becomes better, and there is an increase in flesh and an improvement in color ; hence they are " restora- tives." As these salts of iron in large doses cause nausea and vomiting, being irritant poisons, and even small doses, when administered for a long period, exhaust the gastric glands by over-stimulation, their use is contra-indicated in a plethoric condition, especially when accompanied with a hemorrhagic tendency, or when there is an atheromatous state of the cere- bral vessels. Certain of these salts, such as the sulphates, the chlorides, and the nitrates, possess a high degree of astrin- IRON. 249 gency, and when taken internally produce constipation. Brought in contact with the blood, they coagulate it, and solidify the albuminous elements of the tissues, being powerful " haemostatics." Without great care is exercised in the internal administra- tion of iron, owing to the acidity and astringent property of many of these preparations, injury results to the teeth, upon which they act with great energy. The tincture of the chlo- ride and the sulphate, as shown by the experiments of Dr Smith, of Edinburg, Scotland, are more corrosive than the wine of iron, and even more injurious than the compounds of iron with the vegetable acids. The use of an alkaline gargle of carbonate of soda, or prepared chalk, or solution of am- monia, before and after the taking of the iron preparation into the mouth, and the subsequent employment of an antacid dentifrice, will obviate the injurious effects of these salts of iron upon the teeth. The preparation known as dialysed iron— Ferrum Dialysatum—which is iron in the colloid state, made by the process of diffusion, is odorless, without the styptic taste of the other preparations, and does not discolor the teeth, being free from irritant action ; neither does it cause constipa- tion, and hence it is the best form in which to administer iron. The dose of dialysed iron is rn„v to 5j. Therapeutic Uses of Iron.—Iron is an efficient tonic, and promotes the appetite and the digestion; hence it is employed in anaemia, chlorosis, combined with quinine, in chronic malarial affections; syphilitic cachexia, acute rheumatism, erysipelas, diphtheria, scrofula, rickets, neuralgia depending on anaemia, epilepsy in weak, anaemic subjects, fatty de- generation of the heart, passive forms of hemorrhage due to anaemia, albuminuria, etc., etc. Externally, the styptic preparations of iron are employed to arrest hemorrhage— hemorrhage from leech bites, hemorrhage following the ex- traction of teeth, hemorrhage resulting from wounds and surgical operations, etc., etc. [F"or doses of the various preparations of iron, see" Table of Doses."] 17 250 DENTAL MEDICINE. Chloride of Iron—Ferri Chloridum—Perchloride of Iron. Formula, Fe2Cl6,i2H20. Is obtained by heating iron wire with hydrochloric acid, and afterwards converting the ferrous chloride thus formed into ferric chloride by heating it with hydrochloric and nitric acids. It is in the form of crystalline masses of an orange yellow color, inodorous and of a strong styptic taste. It is deliquescent and readily soluble in water, alcohol and ether. It is used internally in the form of a tincture —Tinctura Ferri Chloridi. Dose, nLv-xx. Externally the chloride of iron is employed as a styptic and for an astringent, for the latter purpose being in solution of various strength. Dental Uses.—In dental practice the chloride of iron is used internally for the treatment of neuralgia when it is attended with anaemia; also externally, for the arrest of alveolar hem- orrhage, although the preference is given to the solution or powder of the subsulphate. The chloride of iron may be used in the semi-deliquesced or crystallized form, or in solu- tion—Liquor Ferri Perchloridi—which is preferred by some to the crystallized. To bleeding surfaces it is applied in the pro- portion of 5ss to 5yj to the ounce of water. One part of the chloride gradually added to six parts of collodion, in the form of a yellowish-red, limpid liquid, makes a valuable styptic. Chloride of iron is also useful as an application to fungous tumors. Solution of Subsulphate of Iron—Liquor Ferri Sub- sulphatis—Monsel's Solution—is composed of sulphate of iron, Sxij; sulphuric acid, Sj and gr. xxx ; nitric acid, gr. ccclx. It is of a syrupy consistence and a ruby red or dark brown color, no odor or acrid taste, but possesses powerful astringent properties. Powdered Subsulphate of Iron—Pulvis Ferri Subsulphatis —Monsel's Powder—is in the form of a yellow powder, and possesses the same astringent and other properties as the solu- tion, and is applied as a styptic in alveolar hemorrhage with much greater convenience. Medical Properties and Action.—Monsel's solution and powder IRON. 251 act topically as powerful astringents and mild caustics, and are considered to be among the best styptics in use. These styp- tics combine with albumen and form a pale yellow compound, and on this property depends their chemical action on the tissues of the body. Internally administered they act like the sulphate of iron, their remote effect being tonic and haemo- static. In small doses they exert an astringent effect on the gastro-intestinal mucous membrane, diminishing the quantity of fluids secreted or exhaled ; hence their constant use will cause constipation. Monsel's preparations of iron are principally used exter- nally for hemorrhage from bleeding vessels. When employed internally it is for the arrest of hemorrhage from remote organs. Therapeutic Uses.—The solution and powder of the sub- sulphate of iron are used internally for hemorrhage from the stomach and bowels. Externally, for hemorrhage, varicose ulcers, etc., etc. Dose.—Of the solution of subsulphate of iron, gtt. v to gtt. x, twice a day, in some bitter infusion. Of the powdered sub- sulphate of iron the dose is gr. v to gr. xv. The solution is also given in small doses with the sulphate of magnesia, and as an artificial chalybeate purging water. Dental Uses.—In dental practice Monsel's solution and powder are principally employed for arresting hemorrhage following the extraction of teeth, hemorrhage from leech bites, and also from other causes, such as wounds of the gums and mucous membrane, in the treatment of ulcers of the mouth; and the solution, diluted with water, forms a serviceable appli- cation for abraded and inflamed mucous surfaces. For Hemorrhage Following the Extraction of Teeth. —After carefully cleansing the bleeding cavity as thoroughly as possible, the styptic should be applied on a pellet of cotton, or, in case the powdered subsulphate of iron is employed, on a pellet of cotton previously dipped in sandarach varnish, to which the powder will adhere, and inserted over the mouth of the bleeding vessel at the apex of the alveolar cavity. Cotton 252 DENTAL MEDICINE. should then be inserted over the styptic preparation, and the alveolar cavity be thoroughly filled up. If necessary, a com- press, made from a cork, should be applied over the cotton filling the cavity, and held in place by the opposing teeth when the mouth is closed. DENTAL FORMULA. For Hemorrhage from Extraction of Teeth. Steere. R . Liq. ferri persulph., Sodium chlor..................aa............... partes aequales. M. Signa.—Apply on cotton to bleeding cavity and secure by covering with a roll of cotton cloth. GELSEMIUM—YELLOW JASMINE. Source.—Gelsemium is obtained from the root of the gel- semium sempervirens—yellow jasmine—woodbine, belonging to the natural order Apocynaceae, which grows plentifully in the southern United States. The root is of a brownish color exter- nally, and a grayish color within, and is sold in small pieces, from one-half to two inches in length, and a quarter of an inch in thick- ness, being hard and slightly cracked longitudinally. It has a bitter taste and an aromatic odor, somewhat like that of green tea. Medical Properties and Action.—Gelsemium has a depressing and sedative influence upon the nervous centres, and dimin- ishes the force and frequency of the heart's action. It contains a very powerful alkaloid, gelsemia or gelsemina, which is color- less, odorless, with an intensely bitter taste. Gelsemium, in moderate doses, causes a languid feeling, attended with mental calmness, slow action of the heart, droop- ing eyelids, dilatation of the pupil, and some feebleness of muscular movements. In larger doses it causes vertigo, double vision, amblyopia, paralysis of the muscle that elevates the upper eyelid, so that it cannot be raised, dilated pupil, labored respiration, on account of its effect upon the respiratory mus- cles, slow and feeble movement of the heart, great muscular weakness, and a reduced sensibility to pain and touch. Such effects occur about half an hour after the gelsemium is taken, and continue for two or three hours, when they disappear. GELSEMIUM. 253 When poisonous doses are taken, all of the symptoms des- cribed above occur in a more intense degree, and there is first an unsteady gait, until all muscular power is lost, the lower jaw drops, the muscles of the tongue are paralyzed, speech being impossible, the respirations are very labored, slight and irregular, and the action of the heart weak, feeble and intermit- tent, and generally the skin is covered with a profuse perspira- tion. Death occurs from asphyxia, but consciousness is preserved until near the end, which is generally calm, and not disturbed by convulsions. Therapeutic Uses.—Gelsemium is internally administered in tetanus, mania, convulsive or spasmodic cough, such as whoop- ing cough ; pneumonia, remittent and typho-malarial fevers, ovarian and other forms of neuralgia, cerebro-spinal meningitis, pleuritis, etc., etc. Dose.—Of the fluid extract of gelsemium—Extractum Gel- semii Fluidum—the only officinal preparation, n\,v to ttlxv. Of the tincture of gelsemium—Tinctura Gelsemii—(gelsemium Siv, alcohol, Oj), the dose is gtt. x to gtt. xx. The fluid extract is preferable for administration, but one fluidrachm of this has caused death. Dose of the alkaloid gelsemia, gr. -fa to gr. -fa. Dental Uses.—Gelsemium is greatly extolled as a remedy for neuralgia of the fifth nerve, often affording permanent relief, especially when the affection is associated with diseased teeth. The dose may be repeated at any time after an hour and a half, if the pain is not relieved; a third dose is seldom required. In neuralgia of the face or head, three-minim doses of the tincture of gelsemium every half hoifr, will often act very beneficially, and leave no ill effects. Owing to the toxic effects of this drug, care is necessary that the dose is a moderate one, and the symptoms carefully observed. DENTAL FORMULA. For Neuralgia from Devitalized Teeth. R. Tinct. gelsemii............................................ gtt.x Tinct. aconiti.........:................................... gtt.v Aquae................ ...................................... 3*iv. M. Signa.—One teaspoonful every hour. 254 DENTAL MEDICINE. GLYCERINUM—GLYCERIN. Formula.—C3H53HO. Sp. gr. 1.25. Source.—Glycerin is obtained from the saponification of fats and fixed oils, and contains a small percentage of water. It is a colorless, inodorous, syrupy liquid, of a sweet taste, and freely soluble in water and alcohol, but not in ether or chloroform. Medical Properties and Action.—Glycerin is nutrient and emollient, possessing considerable power as a solvent and pre- servative. The addition of %, yi, or even -fa part of glycerin to a lotion or poultice, or an external application, renders it particularly emollient and soothing. It keeps the parts moist- ened and soft, and corrects or prevents the disagreeable odor of discharges, and it does not evaporate or dry at any ordinary temperature. Glycerin dissolves carbolic acid, creasote, tannic acid, borax, iodine, quinine, iodide of potassium, gallic acid, etc., and its uses as a solvent and a vehicle for other remedies are very numerous. It has been prescribed as a substitute for cod-liver oil, where the latter nauseates. Officinal solutions of medicinal agents in glycerin are known as glycerites (glycerita). Therapeutic Uses.—Glycerin is rarely used alone as an internal remedy, its chief use being external, or in combination with other medicinal substances. It has been prescribed in phthisis, diabetes, acne; externally, as an emollient in acute coryza, chronic follicular pharyngitis, chapped hands and face. fissures, skin diseases, dressing for wounds and ulcerated sur- faces, and as a vehicle for the application of astringents to the eye; also to soften cerumen and for the removal of insects from the ear, and for diminishing the secretion of pus ; also in burns, abraded surfaces, erysipelas, etc. It has also been employed in smallpox as an emollient and to prevent pitting, a mixture of one part of glycerin and two parts of rose water being ap- plied, after the pustules have broken and the discharge has commenced to dry. It is applied for a few days, until the scabs begin to loosen. Glycerin is also used in croup, locally applied to the glottis; also in deafness, where the auditory canal is dry and inelastic. For an emollient application it is frequently combined with other agents, and used in the form of an oint- GLYCERIN. 255 ment or embrocation. Five parts of glycerin rubbed up in a mortar with four parts of yolk of egg, forms a compound which prevents the action of the air from irritating broken or abraded surfaces, and is soothing in erysipelas, cutaneous affections, etc. Although glycerin is so bland in its general character, yet it produces a smarting sensation when first ap- plied to an abraded surface of the skin; such an effect is thought to be due to the affinity of glycerin for moisture, which it abstracts from the skin so rapidly as to cause the smarting sensation; mixing the glycerin with a little water will obviate this. Pure glycerin, when mixed with water, will raise the temperature eight or ten degrees, and hence the two should be combined previous to its application. Dose.—Of glycerin, 5j to 5ij. Dental Uses.—Glycerin is a useful agent in dental practice as a solvent and emollient, as a solvent alone, and as both solvent and emollient, when combined with other substances. It is employed with great benefit in such affections as diseases of the mucous membrane of the mouth, such as the different forms of stomatitis, for ulcers of the mouth, aphthae, alveolar abscess, abraded surfaces from the irritation of acrid substances, artificial teeth, etc. In the treatment of inflamed and ulcerated conditions of the mucous membrane, it is frequently combined with borax, and for chronic alveolar abscess, or after the use of more active agents, and diseases of mucous membrane, it is combined with carbolic acid, iodine, sulphite of soda, etc. As an anodyne and emollient application, glycerin is combined with morphine, atropine, acetate of lead, etc., etc. To form ointments and embrocations, it is combined with gum tragacanth, lime water, oil of almonds, rose water, etc., etc. DENTAL FORMULAE. For Chronic Abscess, Ulcerations, etc. For Inflammation and Ulceration of R. Glycerini.................. ^j the Mucous Membrane. Tinct. iodi. comp...... mjdv R. Glycerini.................... %} Acidi carbolici cryst... TTlvj Sodii boratis............... 3ij. M. Aquae destillatae......... ^v. M. Signa.—Apply as a lotion. Signa.—Apply as a lotion or injection. 256 , DENTAL MEDICINE. For Aphthous Ulceration of the Mouth. For a Sedative Application in Inflamed R. Glycerini.................. 3*j Mucous Membrane. Sodii sulphitis............ 3J. M. R. Glycerini, SlGNA.—Apply as a lotion. Chloroformi......aa...... 3" ss. M- Signa.—Apply as a lotion. For Chronic Alveolar Abscess, Ulcera- tions of Mucous Membrane, etc. For Aphthous Sore Mouth of Infants. R. Glycerini................ partem 1 R. Glycerini, Aciditannici............. partes 2. Aquae.........aa......... 3*ss Sodium sulph............ gr.xxx. M- For Pulpitis. Signa.—Use on swab, every 2 hours. R. Glycerini.................. gtt.ij Acidi carbolici........... gr.v For Pulp Canals of Abscessed Teeth. Tr. aconit. rad., Faught. Aq. menth. pip...aa.... gtt.ij R. Glycerini.................. f3ij Aciditannici.............. gr.j Aciditannici.............. 31J 01. menth. pip., Morphiae acetatis......... 3J 01. caryophylli...aa.... gtt.xxv.M. Iodoformi................... ^j- M. Signa.—Apply on cotton. Signa.—Apply on floss silk or cotton. HAMAMELIS. witch hazel. Source.—Hamamelis Virginica is an indigenous shrub, com- mon to all parts of the United States and Canada, and usually found in stony places and on the banks of streams. The bark and leaves are the medicinal portions. Medical Properties and Action.—It is tonic, astringent, seda- tive, and anodyne. The bark has a bitter, astringent, and some- what sweetish and pungent taste, and was first employed by the Indians as a sedative and discutient application, in painful tumors and other cases of superficial inflammation. The bark contains from eight to ten per cent, of tannic acid, and also a bitter principle. Therapeutic Uses.—Hamamelis Virginica, although not until recently officinal, has for some time been employed in hemor- rhage of the lungs, haematemesis, and in phthisis. Externally, it is applied to tumors, inflamed and painful parts, etc., etc., in the form of a fluid extract, decoction and tincture. Two minims of the tincture of hamamelis every half hour, will often control hemorrhages from nose, uterus and from hemor- rhoids. MERCURY. 257 Dose.—Of the fluid extract of hamamelis, 5ss to 5ij; of the decoction, Sss to Sj. Dental Uses.—Hamamelis is employed in dental practice as a sedative or anodyne application, in incipient dental peri- ostitis, in the form of the fluid extract, applied warm on lint or cotton, as a lotion; also as an anodyne, to irritated and painful exposed pulps of teeth; also for passive hemorrhage from the mucous membrane of the mouth ; also for the soreness arising from the removal and effects of salivary calculus. The tincture may be applied as a sedative lotion, in the proportion of one part to ten of water. HYDRARGYRUM—MERCURY. QUICKSILVER. Formula.—Hg. Sp. gr. 13.5. Sources.—Mercury is a metal of a nearly silver-white color, and a very high degree of lustre. It is liquid at all ordinary temperatures, and only solidifies when cooled to 400. It fuses at 390 F., and readily volatilizes at 6620 F.; it boils and yields a transparent, colorless vapor, of great density. It also volatil- izes somewhat at ordinary temperatures, and especially above 68° F. The ordinary ore from which metallic mercury is obtained is the mercuric sulphide, although it is occasionally met with in globules disseminated through this native sulphide, and which is noted as cinnabar. There is also a form known as horn silver or native calomel, and a native amalgam of silver and mercury. California furnishes metallic mercury of a pecu- liar purity^ in large quantities. The metal is obtained from the sulphide by the process of " roasting." When pure, metallic mercury does not readily tarnish in the air, and it can be purified by re-distillation, or by adding to it a small quan- tity of a strong solution of nitrate of mercury. The impurities are generally dirt, dust, lead, tin, bismuth or zinc. Dental Uses.—Metallic mercury is employed in dental prac- tice, as an ingredient of amalgam filling material, being com- bined for such a purpose with silver, tin and zinc, and some- 258 DENTAL MEDICINE. times with gold and platinum, in addition to the other metals named. Hydrargyri Chloridum Corrosivum—Corrosive Chloride of Mercury—Corrosive Sublimate. Mercuric Chloride. Bichlo- ride of Mercury. Formula, HgCl2. Derivation.—Corrosive sublimate is obtained by subliming a mixture of chloride of sodium and mercuric sulphate, the latter made by boiling together sulphuric acid and mercury; double decomposition takes place, forming mercuric chloride and sulphate of sodium. Corrosive sublimate is in the form of colorless crystals, or crystalline masses, which are inodorous, fusible, and sublime without residue, and of an acrid, styptic taste. It is readily soluble in 15 parts of water, 7 parts of alcohol and ether. Medical Properties and Action.—It is one of the most active salts of mercury, and is a corrosive poison, but the therapeutic dose now used is less liable to cause the disagreeable and dangerous effects of mercury than almost any other preparation used for the same purposes. It is in the form of colorless crystals, and is entirely soluble in water. Corrosive sublimate is an effective germicide in the strength of one part to 2500 parts of water, being 250 times more powerful than carbolic acid. An aqueous solution of 1 in 20,000 destroys the spores of bacilli in ten minutes, and a solution of 1-5000 is a certain disinfectant, when the exposure is very short. Dr. F. Abbott regards the bichloride of mercury as being the simplest antiseptic in use. In twenty-one ounces of water use one-half a grain—1 to 20,000. Dr. W. D. Miller, of Berlin, also testifies to the power of the bichloride as an antiseptic in the treatment of the oral cavity. Referring to the bichloride of mercury, benzoic and salicylic acids, and listerine, he says : of these four, which are available for the prophylactic treat- ment of the oral cavity, particularly of the teeth, the bichloride is, without doubt, the most effective, because its action con- tinues longer; and he further says: "Unfortunately the bichloride of mercury possesses one great disadvantage in its highly poisonous character. It seems, however, scarcely MERCURY. 259 possible that any harm could result from its use in so dilute a form." (See Hydrargyri Chloridum Mite.) Therapeutic Uses.—Corrosive sublimate is alterative in small doses, and in large quantities it is a powerful irritant poison, corroding the stomach and causing death in a very few hours. Its continued use has caused salivation, but it has a less ten- dency to produce such an effect than the other preparations of mercury. Internally it is employed in secondary syphilis, chronic diarrhoea and dysentery. Externally in diseases of the eye, diseases of the skin, ulcers, gonorrhoea and gleet, etc., etc. The external application to large surfaces is dangerous. Its use is contraindicated in patients affected with pulmonary disease. For cases of poisoning the antidotes are albumen, white of egg, wheat flour, milk, etc. Dose.—Of corrosive sublimate gr. fa to gr. fa, in pill or solution. Dental Uses.—It is employed as a lotion, injection or gargle, in chronic diseases of the mucous membrane, ulcers, ulitis, etc. Dr. C. T. Stockwell reports a case of acute ulitis in which bichloride of mercury, in solution i-iooo, was used to bathe the parts, and the pockets about the teeth injected with it, the result being very satisfactory. Hydrargyri Chloridum Mite—Mild Chloride of Mercury. Calomel. Mercurous Chloride. Formula, HgCl. Derivation.—Calomel is obtained by subliming a mixture of mercurous sulphate and chloride of sodium, a double decom- position taking place, by which mercurous chloride and sul- phate of sodium are formed. The mercurous sulphate thus employed is obtained by boiling mercury in sulphuric acid and triturating the resulting mercuric sulphate with mercury. To remove any corrosive sublimate which the calomel may contain it is washed with hot distilled water until the absence of a white precipitate with ammonia shows that the poisonous ingredient has been removed. Calomel is in the form of a white, inodorous, tasteless powder, insoluble in water, alcohol and ether, and wholly volatilized by heat. Calomel is in- 260 dental medicine. compatible with the alkalies, and alkaline earths and alkaline carbonates, with lead, copper and iron. When nitro-muriatic acid is combined with it, corrosive sublimate is formed; neither should it be given in combination with iodine. Medical Properties and Action.—Calomel and the other mercurials are employed as alteratives, sialagogues, purgatives, diuretics, etc., and moderate doses increases the action of the secreting glands and organs, stimulating the salivary glands in a very decided manner. When large doses are administered the effects are manifested on the gums, which become tender and swollen, the salivary glands take no increased action, the saliva and buccal mucus flow profusely, the mucous mem- brane of the mouth becomes inflamed and ulcerated, the tongue swollen and the breath fetid, with a metallic, copper taste, and the teeth become loose; such symptoms constitute the condi- tion known as salivation. When the use of the drug is dis- continued these symptoms disappear, but the mucous mem- brane and gums are ever after more susceptible to irritation, and the stability of the teeth is more or less impaired, as is shown by the recession of the gums and the absorption of the alveolar processes. In many cases the gums, especially about the necks of the teeth, remain somewhat tumefied, with a tendency to ulceration. If the use of the mercury is continued beyond the stage which the symptoms just described indicate, or even as the effects of small doses in persons very susceptible to the influence of mercury, an excessive salivation ensues, with serious ulceration of the gums and mucous membrane of the mouth, loss of the teeth, and even necrosis of the bones of the jaws. Mercury has also the effect of causing considerable emaciation, from the absorption of fat, and sometimes a peculiar febrile state known as mercurial fever; and also diarrhoea, skin diseases, rheumatism, neuralgia and disorder of nervous system. Mercury, after it is absorbed, has a decided effect upon the blood, which it impoverishes, destroying the red blood globules (hematine and globuline); the blood contains more water, is more prone to putrefaction, and the unnatural MERCURY. 261 fluidity predisposes to hemorrhage, which may become dangerous. Therapeutic Uses.—Mercury in the form of calomel, blue mass (Pilula Hydrargyri—pills of mercury—mercury Sij ; confection of rose Siij, and powdered liquorice root Sj,) are employed as sialagogues, indirect tonics and cholagogues, and purgatives in syphilis, diseases of the skin, bilious derange- ments, dyspepsia, acute glandular affections, diarrhoea and dysentery of infants, hepatic disorders, croup and membranous laryngitis, cholera, etc., etc. Dose.—Of calomel, gr. -fa to gr. x ; of blue pills, or mass, gr. ss to gr. xv. Mercurials are administered by the mouth, by inunction, by fumigation, and by the hypodermic method. Mercurial Ointment—Unguentum Hydrargyri. Blue oint- ment is made by rubbing two parts of mercury with one part of suet and lard each, until the globules disappear. When rubbed into the skin, it produces the constitutional effects of mercury, and is applied to tumors, syphilitic sores, blistered surfaces, and is used to destroy pediculi, and also to prevent pitting in smallpox. Mercury with Chalk—Hydrargyrum cum Creta, a gray powder, consists of mercury, three parts, prepared chalk, five parts. It is a gentle laxative, when given in full doses, and is antacid, and employed chiefly as an alterative in infantile diarrhoea, etc. • Dose.—Of mercury with chalk, for adults, gr. v to xx; for children, gr. ss to ij, iij or x. The effect of mercurial preparations upon children is some- times very serious, as a profuse, or even gentle salivation will, at times, cause mortification and destruction of the bones of the jaw, the teeth, the cheek, and lip ; and although such cases may not be common, yet, to avoid such a powerful action, the gums should be frequently and carefully examined, when a course of such remedies is being pursued. Protiodide of Mercury—Hydrargyrum Iodidum Viride, known also as Green Iodide of Mercury—is prepared by rubbing mercury and iodine together, with the addition of a 262 DENTAL MEDICINE. little alcohol. The formula is Hgl, and it is in the form of a greenish-yellow powder, insoluble in water and alcohol, but soluble in ether. Exposure to the light partially decomposes it, when it becomes of a dark olive color. Protiodide of mercury is internally administered in scrofula and scrofulous syphilis. It exercises a specific influence over the lymphatic and glandular systems. It should never be given at the same time as iodide of potassium, as it converts it into biniodide and metallic mercury. Dose.—gr. yi to j. Externally, protiodide of mercury is applied, in the form of ointment, to syphilitic ulcers, acne, pityriasis, etc., etc. DENTAL FORMULAE. For Diarrhxa of Dentition. For Venereal Sore Mouth and Throat. R. Calomel.................... gr.ij advj R. Hydrar. chlor. corrosi... gr.j Cretaeppt.................. gr.xviij Mellis despumati......... fgss Ipecacuanhaepulv........ gr.ij Aquae destillatae.......... f^iv. M. Extract hyoscyami...... gr.iijadvj. SlGNA.—To be used as a gargle. F. chart. No. vj. Signa.—One every two or three hours, For Warts, Condylomata, etc. according to circumstances. R. Hydrar. chlor. corrosi. 3J Collodii................... gj. Solve. For Febrile Excitement of Dentition. SlGNA.—To be applied as a caustic, R. Calomel................... gr.ij ad iij with a camel's-hair brush. Magnes. calc............. gr.xxiv Ipecacuanhae pulv...... gr.ij to iij. For Diarrhceaof Teething Children. F. ch. No. x^j. R. Hydrargyri cum. cretae., Signa.—One to be given every three Pulv. ipecac. et or, the nitrate of ammonia may be tested by a solution of nitrate of silver, which will also give a precipitate, if chlorine is present. The test with nitrate of silver may be made by dissolving a drachm of the nitrate of ammonia in half a glass of distilled water and adding a few crystals of the nitrate of silver. If the nitrate of ammonia is pure, the solution will remain perfectly clear, but should chlorine be present, it will show a clouded appearance, and should be discarded, as it is not fit to generate the gas from. The salt nitrate of ammonia is a white, crystalline, sub- stance, formed by neutralizing dilute nitric acid by means of carbonate of ammonia, and is so constituted as to be resolved into nitrous oxide and water. A pound of the salt will gen- erate about thirty gallons of the gas. In generating nitrous oxide gas, care must be taken to preserve its purity; conse- quently it becomes important to maintain, as nearly as possible, an equal temperature during its manufacture, and should any 290 DENTAL MEDICINE. nitric oxide—binoxide of nitrogen—be formed, which may be done by too high a heat under the retort, it is necessary to remove it and other impurities, by the aid of solutions of caustic potash and copperas; the caustic potash neutralizing any free nitric acid present, and the copperas removing either chlorine or nitric oxide. The salt nitrate of ammonia is perfectly fused at 2260 F., emits white fumes at 3020 F., and begins to evolve gas at 4600 F. At 5000 F. the impurity. nitric oxide, is given off; hence the temperature during the process should not be permitted to rise above 4820 F., which can be determined by thermometers prepared for the purpose. No red fumes should pass from the retort. Nitrous oxide gas, as principally used at the present time, is in the form of condensed gas, being liquefied and solidified under great pressure, and secured in iron cylinders, from which it escapes into an inhaling bag when needed for use, by turning a stop-cock. The advantages of the condensed form of the gas are its purity, convenience for use whenever needed, the large supply which can be kept for use, and the freedom from deterioration notwithstanding its age. Nitrous oxide is an elastic, colorless gas, with a faint but agreeable odor, and a sweetish taste, which it imparts to water. Under a pressure of 50 atmospheres at about 45 ° F. it be- comes a clear, colorless liquid, and at about 1500 F. below zero it freezes into a beautiful, clear, crystalline solid. 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 1700 F. The washing of nitrous oxide gas, and the retention of it over water for any length of time, is attended with con- siderable loss, as much of it is absorbed, especially if the water is cold; such loss may be avoided to a great extent by using water of an elevated temperature or a strong solution of com- mon salt. The impurities Qf nitrous oxide gas are air, water, nitric oxide or binoxide of nitrogen, chlorine and hyponitric acid. The mixture with air, which may occur in the receiver or when the patient is inhaling the gas, merely dilutes it, as does also the vapor of water. Nitric oxide, however, is a NITROUS OXIDE. 291 dangerous impurity, and with others may be generated even when pure nitrate of ammonia is used in preparing the gas ; this impurity is also one of the most difficult to separate from the gas. Like nitrous oxide, nitric oxide is a colorless gas, lighter and less soluble in water, and if it is generated, is liable to pass through the washing solutions into the gasometer or receiver; nitric oxide, however, need not be generated if the proper care is observed with regard to the degree of heat under the retort which contains the nitrate of ammonia. Chlorine is also a dangerous impurity, and may be set free if the salt nitrate of ammonia contains muriate of ammonia (sal-ammoniac), and chloride of ammonium. To prevent such contamination the tests of the salt before referred to may be made. Nitrous oxide gas supports combustion with almost the same promptness as pure oxygen; and although nearly identical in constitution with atmospheric air, it differs from it both in the proportion of its constitutional elements and in the manner of their association. Nitrous oxide contains about one-third of oxygen to two-thirds of nitrogen, while atmos- pheric air has only about one-fifth of oxygen to four-fifths of nitrogen. Again, in nitrous oxide, the elements nitrogen and oxygen are in chemical combination with each other, while in atmo- spheric air there is no apparent chemical union whatever. Medical Properties and Action.—Nitrous oxide gas is not only the most pleasant, but is the safest general anaesthetic in use, and the greatest objection to its administration is the very short anaesthetic stage which it induces, unless the inhalation of the gas be continued, which is impossible in operations upon the mouth. When inhaled, the first effect is dizziness, with ringing noises in the ears, a tingling sensation, extending to the extremities, an uplifting of the whole system, followed by fullness or expansion of the chest, and a loss of sensation throughout the entire body. According to the temperament, the stage of excitement is transient or prolonged ; in some cases there are strange illusions, with a form of intoxication, which may be manifested by declamation, singing, laughing or crying, 292 DENTAL MEDICINE. or melancholy, with a disposition at times to assault all near Such effects, if the administration is interrupted, soon pass off For surgical operations, the gas is given with less admixture of air, and the inhalation persisted in until the stage of excite- ment is overcome and insensibility produced, when the face becomes extremely pale, the respirations, at first shallow, be- come deep and stertorous, the jaw fixed, 'the eyes protruding, and a bluish and purplish color about the lips and face, the patient presenting a very alarming and death-like appearance a condition of which Bartholow says: " So far as the exterior phenomena can afford any indication of the nature of the action, is an asphyxiated state. The blood ceases to be oxy- genated, carbonic acid accumulates, and the centres of conscious impressions are rendered inactive in consequence of the defi- cient supply of oxygen and the excess of carbonic acid. The rational indications of the nature of the narcosis produced by nitrous oxide are confirmed by physiological experiment. It has been found that the exhalation of carbonic acid is de- cidedly diminished by the inhalation of nitrous oxide, and that animals live no longer in an atmosphere of "this gas than in an atmosphere of hydrogen." The same author speaks of the fatal cases that have occurred, as being with propriety attribut- able to the lethal action of this gas, and refers to various cases under his own observation in which nervousness, vague mental symptoms and headache, have been experienced after the inhalations ; at the same time he pronounces nitrous oxide to be almost free from danger. There is no doubt but that the prompt action of nitrous oxide gas, and the rapid subsidence of the narcosis, have much to do with its safety, and account for the impunity with which it is used. Nitrous oxide gas has the advantages of safety; also rapid anaesthesia, which is gen- erally induced in from thirty seconds to a minute and a half, insensibility often occurring before complete unconsciousness ; also the pleasant odor and taste, thereby preventing repugnance and nausea; and the complete recovery from its influence without unpleasant after-effects. It generally requires six gallons or less to produce anaesthesia with nitrous oxide gas; NITROUS OXIDE. 293 hence the rubber bag from which it is inhaled should have a capacity of about eight gallons. Mode of Administration.—The most improved apparatus consists of an iron cylinder containing 100 gallons or more of the condensed or liquefied nitrous oxide, to which is at- tached a rubber gas bag and inhaling tube with a double valve and mouth-piece. The patient, for dental operations, is seated in a suitable chair which will admit of the back being lowered to such a degree as will bring the patient to an almost hori- zontal posture, and the head well supported. A piece of India rubber or a firm cork to which a thin, strong cord is attached, to prevent its slipping down the throat, is placed between the teeth, so as to prevent the closure of the jaws, for, unlike chlo- roform and ether, the muscles become rigidly contracted under the influence of this gas; such a prop also prevents injury to the front teeth by the patient biting too hard on the mouth- piece of the inhaling tube. The patient is then directed to breathe deeply and regularly, the nose being held, to prevent the admixture of atmospheric air, and the same precautions observed as are necessary when administering ether or chloro- form. (See Ether.) The anaesthetic state, or " surgical period," as it is termed, is generally manifested by snoring, although this symptom does not invariably occur; when it does, how- ever, it indicates a state of profound anaesthesia, to which it is not necessary to carry the patient when performing many minor surgical operations. As more or less excitement follows the inhalation of this gas, when it is largely mixed with atmospheric air, such a condition is either prevented or abbreviated by holding the nose of the patient during the inhalation. The patient should not partake of food for at least two hours before the adminis- tration of the gas, but at the same time should not be in a weakened condition for want of it; and the dress, if tight, should be previously loosened, and as soon as the operation is completed the head should be gently moved to one side, to allow the blood to escape from the mouth. Fresh air should then be admitted into the room, and the patient 294 DENTAL MEDICINE. supplied with it by means of a fan. (See Administration of Anaesthetics.) Therapeutic and Dental Uses.—According to the investiga- tions of Dr. Ziegler, nitrous oxide is an efficient restorative when administered either in its gaseous state by the lungs, or in conjunction with liquids by the alimentary canal. He recommends the use of this gas in moderate quantities, so as not to generate too much carbonic acid. Regarding nitrous oxide and oxygen as of primary importance in asphyxia, and the natural antidotes to narcotizing agents and asphyxiated conditions, he advocates their use whenever practicable, either alone or in combination with heat, and claims that they will often save life in apparently hopeless cases. The rapid action of nitrous oxide and the transient nature of its effects on the system, render it a very useful anaesthetic agent for all minor surgical operations—such as extracting teeth, lancing abscesses, devitalizing nerves of teeth, etc., etc It has also been successfully employed in the performance of some capital surgical operations, where the anaesthesia has been kept up from fifteen minutes to half an hour. It has recently been recommended to use, during the first part of an inhalation, the pure nitrous oxide gas, and for the purpose of prolonging the anaesthesia with less danger, to dispense with the pure gas and administer a mixture of oxygen and nitrous oxide in pro- portions very similar to the air we breathe. OLEUM AMYGDALAE DULCIS—OIL OF SWEET ALMONDS. Derivation.—The Oil of Sweet Almonds is obtained by first depriving the almonds of the brown powder adhering to their surface, and rubbing them together in a piece of coarse linen, grinding them in a mill or mortar, and then submitting them to pressure in canvas sacks between slightly heated plates of iron. The oil, which is at first turbid, is clarified by rest and filtration. It is clear, colorless, or of a slight greenish-yellow tinge, nearly inodorous, with a bland, sweetish taste. It will remain liquid at temperatures below the freezing point of water. OIL OF CAJUPUT. 295 Medical Properties and Action.—The oil of sweet almonds is demulcent. Therapeutic Uses.—It is employed as an emulsion in pul- monary affections with cough, and as a vehicle for other medi- cines. Dental Uses.—The oil of sweet almonds forms a pleasant and soothing application for excoriations of the lips and in- flamed mucous membranes ; also for a soothing application to the small, simple, but painful ulcers which sometimes appear upon the gums, mucous membrane of the cheeks, and the tongue. Almond mixture—-Mistura Amygdala—is made by dissolving a mixture of half an ounce of blanched sweet al- monds, 30 grains of gum arabic and 120 grains of sugar, in half a pint of distilled water. It forms a pleasant demulcent. OLEUM CAJUPUTI—OIL OF CAJUPUT. Source.—The volatile oil of the leaves of melaleuca cajuputi a tree indigenous in Batavia and Singapore. It is transparent, of a green color, with an odor like camphor, and a warm, pungent taste. Medical Properties and Action.—Cajuput Oil is a diffusible stimulant, antispasmodic and diaphoretic. Internally adminis- tered it causes a sensation of warmth in the stomach, and excites the action of the heart and arteries, afterward producing copious diaphoresis. Externally, either alone or in combina- tion with equal parts of soap liniment or olive oil, it is an efficient rubefacient and stimulant embrocation. Its use is becoming more common. Therapeutic Uses.—It is employed internally as an antispas- modic stimulant in typhus and other low fevers, spasmodic cholera, gout and rheumatism, neuralgic affections, hysteria, flatulence and flatulent colic, headache, nausea, etc. Externally, in neuralgia, headache, gout, rheumatism, lumbago, sprains, contusions, paralysis, etc., etc. Dose.—Of cajuput oil, gtt. j to gtt v., in emulsion, or on sugar. Dental Uses.—Cajuput oil is an efficacious remedy for the 296 DENTAL MEDICINE. relief of odontalgia, applied on lint or cotton to the carious cavity of the tooth; also in neuralgic affections, if they are not connected with inflammatory action. OLEUM CARYOPHYLLI—OIL OF CLOVES. Source.—Oil of Cloves is obtained from the dried flower buds of the caryophyllus aromaticus, an evergreen tree, of the natural order Myrtacea—myrtle order—a native of the Indies. The unexpanded buds are of a dark brown color, with a yellow- ish red tint. The oil is prepared by distilling cloves with water, to which common salt is added, in order to raise the temperature to the boiling point. It has a fragrant odor, and a hot, acrid taste. Medical Properties and Action.—Oil of cloves contains tannic acid, a pungent, volatile oil, resin, etc., and two substances—a hydro-carbon caryophyllin, and an oxygenated oil, eugenol, called an acid on account of its possessing acid properties. Oil of cloves is an aromatic and powerful stimulant. Although it is a very fluid, clear and colorless preparation when fresh, it becomes yellow by exposure, and ultimately reddish brown, with the odor of cloves, and a hot, aromatic taste. Like cloves, the oil acts less upon the system at large than on the part to which it is immediately applied. Therapeutic Uses.—Oil of cloves is sometimes administered to relieve nausea and vomiting, to correct flatulence, and excite digestion when languid; but its chief use is to modify the action of other medicines. Dose.—Of oil of cloves, gtt. ij to gtt. vj. Dental Uses.—In dental practice, oil of cloves is employed to relieve odontalgia, either alone, as in the form of a drop or two upon cotton, introduced into the carious cavity of a tooth, and obtunds the pain by an over-stimulating effect upon the irritable pulp. It is also employed for the same purpose in combination with other agents, such as morphia, sweet spirits of nitre, etc. When the use of creasote or carbolic acid is prohibited, owing to the patient's idiosyncracy, the oil of cloves may be substituted. opium. 297 The oil of cloves has also the effect of rendering creasote and carbolic acid more pleasant, without interfering with their action, being added in equal admixture. It is also employed in the treatment of alveolar abscess, being applied like creasote or carbolic acid. Eugenol, C10H12O2, also called eugenic acid, is an active prin- ciple of oil of cloves, and is prepared by decomposing eugenate of potassium with sulphuric acid. It is in the form of a color- less oil, of the specific gravity of 1.076. Its odor resembles that of oil of cloves, and it has a sharp, penetrating taste. It does not decompose at ordinary temperatures, and is not affected by exposure to the air. It is soluble in water and alcohol, but the aqueous solution is the more potent as a germicide. It is not poisonous, and when pure will coagulate albumen. For dental uses eugenol is of considerable value. When applied to exposed or partially exposed pulps of teeth it usually relieves the pain in from one to two minutes. For inflamed and congested pulps, it has been suggested to first apply a solution of borax and then eugenol. It also answers well as a dressing for root canals, especially after the removal of a recently devitalized pulp. In alveolar pyorrhoea, it is used in solution, 1 part of eugenol to 1000 of water, for the purpose of cleansing the pus pockets. In alveolar abscesses it has been suggested as an injection, after the use of peroxide of hydrogen, taking the precaution, in cases of abscesses with a fistulous tract, to seal the root at the apex. It has also been successfully employed in the treatment of benign tumors of the mouth, in the form of an injection of two drops. OPIUM. Source.—Opium is obtained from the unripe capsules of the papaver somniferum, of the natural order Papaveracea—poppy order, in the form of a concrete juice, which exudes from inci- sions, and which is permitted to evaporate spontaneously. Commercial opium is in the form of irregular masses, of from a few ounces to several pounds in weight, with a moist, brown or chestnut surface, and a peculiar odor and nauseous taste. 20 298 DENTAL MEDICINE. The purest form should have a chestnut color, a strong aro- matic flavor, and a dense consistence, and break with a deeply notched fracture, and when drawn across white paper leave an interrupted line. The alkaloid morphine is the most important of the chemical constituents of opium. (See Morphine.) Medical Properties and Uses.—As an anodyne and hypnotic opium possesses the power of relieving pain and inducing sleep; it relaxes muscular spasm, and hence is a very efficient remedy in tetanus, spasms, nervous irritability, and discharges of a morbid nature. It excites the circulation as a first action, and increases the temperature of the skin, and causes an agree- able exhilaration of the intellectual faculties, so much so as to be used by some as an habitual narcotic, which is finally de- structive to both the physical and mental functions. But the stage of excitement is very transient, and is succeeded by a falling of the pulse, a diminished susceptibility to external impressions, confusion of mind and the loss of consciousness in deep sleep. Other effects are also manifested, such as dry- ness of the throat, thirst, and, in some cases, nausea and vomit- ing, with an itching miliary eruption on the skin. Taken in large or poisonous doses, opium does not cause any excitement, but giddiness and stupor rapidly supervene, with a lessening in the frequency of the pulse, but not in fullness, a tendency to sleep which is irresistible, and finally coma, in which the breathing is heavy and stertorous, the pulse slow, and the pupils contracted, with a sinking of the pulse and relaxation of the muscles immediately preceding death; in the case of children death is often preceded by vio- lent convulsions. The antidotes in poisoning by opium are the stomach pump, emetics in double doses, such as sulphate of zinc, in doses of gr. xx to gr. xxx, or sulphate of copper, gr. v to gr. x; also mustard in powder, Sss, or powdered alum, answer as emetics, strong coffee, keeping the patient in motion, counter-irritation to nape of neck, flagellation to the palms of the hands and soles of the feet, and the electro-magnetic battery, which is often efficient when other measures fail, artificial respiration, OPIUM. 299 and belladonna, in hypodermic injections of its alkaloid atro- pine, in solution. No local lesions are found after death. Therapeutic Uses.—Opium as an anodyne and hypnotic is employed in almost all diseases where the necessity of assuaging pain and inducing sleep is required. (See Morphine.) Opium is contra-indicated where there is a tendency to apoplexy or coma, or where an unusual susceptibility to its influence exists, and it should be administered to the very young and very old with great caution. When long administered it is necessary to increase the dose. Externally, in the form of powder, it is applied to irritable ulcers, etc., and to the rectum, as suppositories. Dose.—Of opium, in powder or pill, as an anodyne and hypnotic, gr. j. Dental Uses.—Opium is employed as an anodyne in con- vulsions of teething, but must be administered with great care and in small doses ; also as an anodyne preparatory to lancing the gums of children; also in mercurial salivation, to arrest the excessive secretion, in doses of gr. j every four hours; also in neuralgia; but it is inferior to aconite. A small lump of opium in contact with an aching tooth pulp will relieve the pain, or the powder may be used for the same purpose. In the form of wine and tincture, opium is serviceable in odontalgia, dental periostitis, inflamed gums and mucous membrane of the mouth; in injections, for alveolar abscess, when it is often used in combination with tincture of iodine. The wine of opium is a more soothing and pleasant application than the tincture of opium. Vinum Opii—Wine of Opium, is obtained by macerating two ounces of powdered opium, together with cinnamon and cloves, in one pint of white wine. Dose, n\,v to 5j. Dental Uses.—Employed as a soothing and anodyne appli- cation to inflamed and tender gums and mucous membrane, odontalgia, ulcerations of mouth, alveolar abscess, dental peri- ostitis, pulpitis, etc. Tinctura Opii—Tincture of Opium—laudanum, is com- posed of powdered opium, Siiss; diluted alcohol, Oj. Dose, 300 DENTAL MEDICINE. nixiij, or 25 drops, equivalent to one grain of opium. Its strength increases with age. One drachm of the tincture contains 120 drops. The dental uses are the same as for wine of opium, but the latter is the most pleasant application for the mouth. Tinctura Opii Camphor at a—Camphorated Tincture of Opium—paregoric elixir, 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, f5j to fSj or a tablespoonful, containing a little less than one grain of opium. Dose for an infant, gtt. v to xx. This is an agreeable preparation for children. Tinctura Opii Deodorata—Deodorized Tincture of Opium, is composed of the watery extract of opium, washed with ether, which is afterward separated, and the residue dissolved in water and mixed with enough alcohol to preserve it. This preparation of opium is free from the narcotina and many other injurious ingredients of opium, and is a valuable preparation. Dose, n\,v to f5j, or 25 drops. DENTAL FORMULA. A Stimulating Injection for Abscess of Antrum. J. S. Smith. R . Glycerinae................................................... f 3;j Tinct. opii camph......................................... f^ij Eau de cologne............................................ 3iv. M. Signa.—Inject daily. PAPAIN OR PAPAIVA. Source.—Papain is a ferment obtained from the Carica papaya, from which exudes, on incision, a white, slightly astringent and milky juice, which contains the papain. Medical Properties and Action.—Papain is a digestive ferment like pepsin, its active digestive power causing the solution of albuminous substances. Catillon denies that it is a true ferment, with power to convert albuminoids into peptones; hence it cannot be substituted for pepsin in affections of the stomach. pepsin. 301 Therapeutic Uses.—It is an active solvent of false membranes, intestinal worms, ascarides and taenias, hence it is employed in diphtheria, ascarides, vermiculares, tapeworm. Locally, like pepsin, it is employed in the form of injections made with the hypodermic syringe, in the treatment of fatty tumors and other benign growths, and to retard the growth of cancerous and other malignant tumors, the solution being injected well into the substance of the tumor. Dental Uses.—Papain is employed in the treatment of tumors of the mouth, both benign and malignant, the solution being injected into the substance of the growth by means of a hypo- dermic syringe. PEPSINUM—PEPSIN. Source.—Pepsin is obtained by digesting the mucous mem- brane of the stomach of the pig, calf or sheep, which has been scraped off, chopped finely, and macerated for several days in water, in a solution of muriatic acid, from which the pepsin is precipitated with chloride of sodium. The medicinal prepara- tion is in the form of a nitrogenized, light, amorphous, grayish- white or fawn-colored powder, soluble in water and alcohol, and of a peculiar odor and bitter, nauseous taste. When quite pure, it is both tasteless and inodorous. When decomposed by heat it no longer possesses digestive properties, and much of what is sold is almost or wholly inert. Pure pepsin is an artificial digestive. Medical Properties and Action.—Pepsin is an essential con- stituent of the gastric juice, and digests the nitrogenous con- stituents of the food, converting them into peptones. Taken internally, as a medicinal preparation, pepsin increases the appetite and allays irritability of the stomach. It should be administered immediately before meals, and no hot food taken for some time afterward. Therapeutic Uses.—Pepsin is employed in dyspepsia, gastral- gia, obstinate vomiting, infantile diarrhoea, apepsia of infants, vomiting of pregnancy, cancer and chronic ulcer of the stom- ach, anaemia, chlorosis, atrophy, etc. Externally, it is injected 302 dental medicine. into cancerous tumors and morbid growths with the hypoder- mic syringe, to retard their progress. Dose.—Of pepsin suspended in syrup, saccharated pepsin— Pepsinum saccharatum—gr. v to gr. x. Syrup of orange peel will disguise its odor. Vinum Pepsini. Dose, 5ss to oj. Glycerinum Pepsini. Dose, 5ss to 5j. Both the saccharated pepsin and the glycerole are un- changeable. Pepsin appears to be especially efficient in cases of children; and when pepsin and a small quantity of hydrochloric acid are added to animal broths given by the rectum, in cases where food is rejected by the stomach, such nourishment is very beneficial. Dental Uses.—In dental practice, pepsin is successfully em- ployed in the treatment of putrid pulps of teeth, as an anti- septic and deodorizer. In the form of a thin paste made by mixing pepsin with water containing some two per cent, of hydrochloric acid, it is introduced into the pulp canal after the removal of the decomposed matter, and confined by a tempo- rary filling in the crown cavity, being permitted to remain for twenty-four hours, when it is removed and the canal syringed with tepid water, and, if necessary, the application of the pepsin paste repeated until the odor of decomposition can no longer be detected. Pepsin, in the form of the paste, is also applied to partially decomposed dentine, which may, for good reasons, be permitted to remain immediately over the pulp of the tooth, and the action of the pepsin is confined to dead matter alone. DENTAL FORMULAE. For Suppurating Dental Pulps. For Indigestion. (Oakley Coles.) (Mialhe.) R. Acidi hydrochlorici.... mj R. Pepsini................... 3iss Aquae destillatae......... rajd Aquae...................... f3viss Pepsini porci............ q.s. Vini xerici............... f3xiiss To make a paste. Alcoholis.................f ^ iij Signa.—To be applied to suppurating Sacchari.................. ij. pulps. Solve et cola. Signa.—A tablespoonful immediately after each meal. PEROXIDE OF HYDROGEN. 303 PEROXIDE OF HYDROGEN—HYDROGEN PEROXIDE. Formula.—H202. Derivation.—Peroxide of Hydrogen is obtained by rubbing up peroxide of barium with distilled water, so as to form a liquid paste, which is added gradually, with constant stirring, to distilled water acidulated with one-third of its weight of hydrochloric acid, contained in a vessel immersed in a freezing mixture. When the muriatic acid is saturated, a fresh quantity of the acid in a concentrated state is added, and then more of the peroxide of barium, and the operation repeated till the solution will hold no more chloride of barium, which is deposited by a mixture of ice and salt, except a small portion which is gotten rid of by adding sulphate of silver to precipitate the sulphate of baryta and chloride of silver. The filtered liquid is then concentrated by sulphuric acid, and the water rising in vapor is absorbed and protoxide of hydrogen is obtained nearly pure, in the form of a colorless liquid of a fluid consistence. Medical Properties and Action.—Dr. B. W. Richardson, of London, found that peroxide of hydrogen imparts oxygen to venous blood deprived of its fibrin, with an increase of heat and a change of the color to red. Fibrin and cellular tissue cause it to evolve oxygen, while albumen, gelatin, urea, and cutaneous tissue have no effect upon it. Topically, it acts by imparting oxygen to the diseased tissues, and thus destroying them. It arrests, immediately and definitely, all fermentation due to an organized ferment, and Bert and Reynard found, on the other hand, that soluble ferments do not seem to be affected by it; saliva, diastase, the gastric and pancreatic fluids, continue to act in solutions con- taining peroxide of hydrogen. The conclusions, therefore, that these, as well as Peau and Baldy, have arrived at are that peroxide of hydrogen, even when very dilute, arrests fermenta- tions due to the development of living organisms, and the putrefaction of all substances which do not decompose it; that, containing, according to circumstances, from two to six times its volume of oxygen, it is capable of advantageously replacing 304 DENTAL MEDICINE. alcohol and carbolic acid ; that it can be employed externally for dressing wounds and ulcerations of all natures, in injections and in vaporizations, and internally; that the results obtained in the case of the largest operations, up to the present, are in the highest degree satisfactory; that not only fresh wounds, but old ones, proceed rapidly to cicatrization, and reunion by first intention appears to be encouraged by its use as a dressing; that the general as well as the local state appears to be favor- ably influenced ; that the advantages over carbolized water are its not having any poisonous effect nor unpleasant odor, while its application is entirely painless. It is an effective application in a large class of diseases in which mucous membrane tissue is chiefly affected, and for cleansing purposes is considered to be unequaled. Dr. Prince remarks that a drop of pus will decompose peroxide of hydrogen and liberate nascent oxygen, which adheres to and attacks all the adjacent tissues for which it has an affinity, and it thus becomes a powerful bacterial destroyer. Peroxide of hydrogen for surgical use must be entirely neutral, as that obtained generally often contains sulphuric acid, so that its use would not be without danger. Therapeutic Uses.—Peroxide of hydrogen is employed as an internal remedy in low forms of fevers, chronic and subacute rheumatism, whooping cough, chronic bronchitis, dyspepsia, as it improves digestion, diabetes, etc., etc. Locally employed, peroxide of hydrogen is an effective antiseptic, and, according to Dr. Prince, owes its importance as a therapeutic agent to its instability, being decomposed, in the presence of a variety of agents, into water and oxygen. He considers peroxide of hydrogen to be inferior to iodoform as an antiseptic, but it resembles it in producing little or no irritation when used about tender organs, and can be successfully applied in an unirritating form, so that it comes in contact with and destroys diseased germs, hence its applicability to dental uses, and in ocular and oral therapeutics, as in gonorrhceal ophthalmia and mastoid abscess, for examples. Peroxide of hydrogen acts very promptly and beneficially in feeble, flabby, or ill-condi- PEROXIDE OF HYDROGEN. 305 tioned ulcers, chancre, and diphtheritic sores, ozaena, wounds, both fresh and putrid, etc., etc. Dose.—Of peroxide of hydrogen, gr. iij to gr. v, containing six times its volume of oxygen, or two per cent. In operations on mucous membrane, a strong solution of peroxide of hydro- gen—twelve per cent., greatly facilitates by decolorizing the blood and by its cleansing, styptic action. Dental Uses.—Peroxide of hydrogen is a valuable remedy in dental therapeutics, especially in the treatment of alveolar abscess, alveolar pyorrhoea, ulcerations of oral mucous mem- brane, gangrene or cancrum oris, fungous growths, etc., etc. Dr. A. H. Prince's method of treatment, in the case of alveolar abscess, illustrates the properties of peroxide of hydro- gen. " The septic abscess is caused to heal by one application made in the following manner : After removing the pulp and passing a broach through the canal of the root into the abscess cavity, a drop of the liquid is injected by means of Farrar's syringe. The cavity of the crown is then immediately closed with softened gutta percha, before which, under pressure of the finger, the liquid is driven into the abscess cavity. Upon coming into contact with the pus in the fetid cavity, the liberated gas permeates it throughout, and by the continued evolution of the gas the cavity is emptied of its contents, which boil out at the fistulous opening so thoroughly mixed that the appearance is that of foam or froth ; while the remnant thus removed is rendered so thoroughly antiseptic that the healing process proceeds uninterruptedly." Dr. A. W. Harlan has successfully employed the peroxide of hydrogen, in con- nection with iodide of zinc solution and other agents, in the treatment of alveolar pyorrhoea. Dr. Harlan's treatment is as follows : First pack the pus pockets with iodoform and eucalyptus, iodoform and oil of cinnamon, or thoroughly syringe with a one to three grain solution to the ounce of water, of chloride of alumina, a method which will relieve the suffering and reduce the swollen gums to their normal size. In three or four days the san- guinary deposits may be removed, and the edges of the alveoli 306 DENTAL MEDICINE. scraped or burred off. The pockets are then syringed with peroxide of hydrogen, and after drying the gums, injected with one, two or three drops of a solution of iodide of zinc, grs. xii to the ounce of water. On the fourth day the gums are care- fully dried, and a fine cone of cotton or bibulous paper moistened with peroxide of hydrogen, gently pressed into each pocket. If any effervescence occurs, it denotes the presence of pus, when each pocket should again be injected with the iodide of zinc solution. In chronic cases, after syringing with the peroxide of hydrogen, a stronger injection of the iodide of zftic (grs. xxiv to the ounce of water) is made, and in very bad or hopeless cases even a stronger solution of the zinc (grs. xlviii to the ounce of water); and when the gingival margins present a ragged border or cone-shaped slit, pure granular iodide of zinc is applied to such edges. The injection into the pocket is repeated every fourth day. In some cases constitu- tional treatment is also required. PISCIDIA ERYTHRINA—JAMAICA DOGWOOD. Source.—Jamaica Dogwood is a plant indigenous to the West Indies, where it has been used as an intoxicant in taking fish. The bark is the officinal portion, and is smooth and bright-colored. Medical Properties and Action.—Jamaica dogwood is a pow- erful narcotic, and, in a measure, tonic and diuretic. Its narcotic properties are supposed to be superior to opium, as it does not cause the disagreeable after-effects common to that drug. When chewed, Jamaica dogwood has an unpleasant, acrimonious taste. It yields its virtues to alcohol, but not to water. Its internal use is generally followed by a sensation of heat gradually extending to the surface, and succeeded by profuse perspiration, with profound sleep. In large doses it produces general paralysis, and death from asphyxia. It has been used as a substitute for morphine, which it resembles in many respects. Therapeutic Uses.—The principal use of Jamaica dogwood is in neuralgia, in the form of a tincture composed of Jamaica ACETATE OF LEAD. 307 dogwood Sj, rectified spirits fSiv. It is effectual in acute pains usually, and is said to be efficacious in lunacy, and cough of phthisis. Dose.—Of the tincture of Jamaica dogwood, f5j. Dental Uses.—Jamaica dogwood, in the form of the tincture, is efficacious in trigeminal neuralgia, and in odontalgia result- ing from an irritable pulp, for which purposes a fluid drachm in cold water may be taken internally, and externally in the case of odontalgia, introduced on a dossil of cotton into the carious tooth. PLUMBI ACETAS—ACETATE OF LEAD. SUGAR OF LEAD. Formula.—Pb2C2H302, 3H20. Derivation.—Acetate of Lead is obtained by immersing lead in distilled vinegar, or litharge in pyroligneous or crude acetic acid ; when the acid has become saturated, the solution is per- mitted to cool and crystallize. Acetate of lead is a white salt, in the form of beautiful, bril- liant, needle-shaped crystals, like long prisms, which effloresce on exposure to the air. It has a sweet, astringent taste, and an odor of acetic acid, and is soluble in water and alcohol. Medical Properties and Action.—Acetate of lead is sedative and astringent, checking the secretions and reducing the activ- ity of the capillary system, and diminishing the force and fre- quency of the pulse. Like all the salts of lead, it is an irritant and corrosive poison, causing gastro-enteric inflammation. It requires, however, a large quantity (not less than half an ounce) of the acetate of lead to destroy life, as much of it is rejected by vomiting. The symptoms of lead poisoning, when the lead is slowly introduced into the system, are loss of appetite and strength, wasting of flesh, paleness of the face, constipation, pain in the joints, dry colic, which is relieved by pressure, neu- ralgia of the abdominal muscles, contraction of the intestines, belly drawn toward the spinal column, contraction of the liver, jaundiced skin, yellow conjunctiva, urine colored with biliary coloring matter, a blue line along the margin of the gum, about the incisor teeth; also at times a bluish discoloration of 308 DENTAL MEDICINE the mucous membrane of the lips and mouth, dimness of vision, paralysis of the extensor muscles of the fingers and arms, death resulting from the gradual failure of nutrition and the paralysis of the muscles of respiration. When the poisonous dose is large, there is intense gastric irritation, numbness, paralysis, coma, and collapse. Iodide of potassium in large doses, also Epsom salts and sulphur baths, are the antidotes in chronic cases of lead poisoning, and for the lead colic, alum in doses of one or two drachms every three or four hours, dissolved in some demulcent liquid, is considered to be the best remedy. For the treatment of lead paralysis, strychnia and electricity are employed. The blue or slate- colored line on the gums is supposed to be due to a deposition of the sulphide of lead. Therapeutic Uses.—Acetate of lead is internally administered in dysentery, diarrhoea, cholera, cholera morbus, phthisis, chronic bronchitis, pneumonia, diseases of the heart, hemor- rhage from the lungs, stomach, kidneys, nose, etc.; diseases of the eye, erysipelas, skin diseases, chronic gastric catarrh, gas- tralgia, pyrosis, summer diarrhoea of children, humid asthma, whooping cough, etc.; but the danger of producing toxic effects must be remembered in its internal use. Externally, solutions of lead are employed to relieve super- ficial inflammations, arrest morbid discharges, and allay the pain of acute inflammations. Lead should not be given with natural waters containing lime, carbonic acid, mineral acids and salts, vegetable acids, or vegetable astringents, iodide of potas- sium, and preparations of opium. Dose.—Of plumbi acetas, gr. ss or j to gr. v, two or three times a day. Liquor Plumbi Subacetatis Dilutus—Diluted Solution of Subacetate of Lead.—Lead water is composed of subacetate of lead solution, f5ij; distilled water, Oj; and is a mild astringent and sedative when applied externally; it is never prescribed internally. It arrests discharges from suppurating and ulcer- ated mucous surfaces, and promotes the resolution of acute superficial inflammations. CAUSTIC POTASH. 309 Dental Uses.—Lead water is employed in dental practice, to relieve inflamed gums and mucous membrane of the mouth ; as an application to indolent and foul ulcers ; also in the treat- ment of teeth after the devitalization and removal of the pulps, to prevent periosteal trouble. It proves serviceable when applied to chapped hands and lips. A good ointment for such a purpose is composed of a combi- nation of lead water, camphor, white wax and oil of almonds. DENTAL FORMULAE For Acute Inflammation of the Mucous For Chapped Hands and Lips. Membrane of the Mouth and the R. Liq. plumbi subacetatis Gums. dilutus................. 3*vj R. Plumbi acetatis......... 3J Camphorae............... gr.xl Tinct. opii............... ^ss Cerae albae............... 3*viij Aquae..................... 3*x. M. Olei amygdalae dulcis. Oj. M. SlGNA.—Apply as a lotion, on lint. Fiat cerat. Signa.—Apply as an ointment. POTASSA CAUSTICA—CAUSTIC POTASH. HYDRATE OF POTASH—FUSED POTASH—OXIDE OF POTASSIUM. Formula.—H KO. Derivation.—Caustic Potash is prepared by boiling a solution of potash until ebullition ceases, and the potassa melts or as- sumes a solidified consistence, when it is poured into suitable moulds and kept in well-stopped bottles, as it rapidly deli- quesces when exposed to the air. It dissolves in water and alcohol, and attracts moisture. Its officinal form is that of sticks of a white and somewhat transparent color, but upon exposure to the air, or if it is impure, it becomes a dingy gray, greenish or bluish color, and has the odor of slaking lime. When it is digested in alcohol, so as to free it from such impurities as are insoluble in alcohol, it is called alcoholic potassa. Medical Properties and Action.—Caustic potash is the most powerful caustic and escharotic in use, and, when taken inter- nally, is a corrosive poison. It is only employed externally. When applied to a part, it rapidly destroys its vitality to a considerable depth, differing in this respect from nitrate of 310 DENTAL MEDICINE. silver (lunar caustic), as the latter is more limited in its action, and does not liquefy when it comes in contact with the tissues. From the penetrating action of caustic potash, it is necessary to use it with great care. It is very deliquescent, which is a great objection to its use in some cases, but when mixed with an equal quantity of lime, the deliquescent action is in a measure prevented; it is then known as potassa cum cake— potassa with lime, and is in the form of a grayish-white powder, which is sometimes made into a paste, under the name of Vienna Paste, which is milder and less deliquescent. Therapeutic Uses.—Caustic potassa is chiefly employed to open abscesses, and in the treatment of chancres, hospital gan- grene, eczema, malignant growths, to arrest the sloughing of carbuncles; in tetanus, applied to the spine; bites of rabid animals and venomous reptiles; phlegmons and incipient car- buncles, to arrest their progress; to form issues, etc. To prevent its coming in contact with neighboring parts a piece of adhesive plaster is used, with an opening corresponding in size to the surface on which the caustic is to act. When mixed with water, in the proportion of caustic potash, 5iss to water, fSij, it forms a rubefacient solution. Dental Uses.—In dental practice, caustic potassa is employed in gangrene of the mouth (cancrum oris), malignant growths, fungous growths of gum, ulcers, etc.; for opening abscesses, when it is not prudent to use the lancet. POTASSII BICARBONAS—BICARBONATE OF POTASSIUM. Formula.—K H C 03. Derivation.—Bicarbonate of Potassium is obtained by pass- ing carbonic acid through an aqueous solution of carbonate of potassium, until it is completely saturated. The solution is then filtered and evaporated, the product being bicarbonate of potassium, in the form of transparent, colorless crystals, of the shape of irregular eight-sided prisms. It is inodorous, with a saline and somewhat alkaline taste, and is soluble in water, but insoluble in alcohol. Its incompatibles are acids and acidulous salts, etc. BROMIDE OF POTASSIUM. 311 Medical Properties and Action.—Bicarbonate of potassium is antacid, diuretic and antilithic. In large quantities it is a corrosive poison. Therapeutic Uses.—It is employed internally in acute rheu- matism, gout, and uric acid lithiasis, diseases of the skin, calculous affections, etc., etc. Dose.—Of bicarbonate of potassium, gr. v to &]. Dental Uses.—Bicarbonate of potassium is employed in dental practice, as an antacid, a solution being serviceable as a mouth-wash, to prevent injury to the teeth from acid medicines. DENTAL FORMULA. For Neuralgia. (J. E. Garretson.) R. Ferri sulphatis exsic, Potassii carbonatis.....................aa..................... gr.ccl Syrup acaciae.................................................. q.s. M. Ft. pil. No. ioo. Signa.—Begin with three a day and increase to six; take several hundred. POTASSII BROMIDUM—BROMIDE OF POTASSIUM. Formula.—KBr. Derivation.—Bromide of Potassium is obtained by adding a solution of pure carbonate of potassium to a solution of bro- mide of iron. The iron being precipitated, the bromide of potassium is obtained from the solution by evaporation. It is in the form of white crystals, without odor, wholly soluble in water, and but sparingly soluble in alcohol, and having a pun- gent, saline taste. Medical Properties and Action.—Bromide of potassium is stimulant, sedative, narcotic and antispasmodic, and, being ab- sorbed into the system, can be detected in the blood, urine, faeces and mucus. If administered in considerable quantity, the action of the heart, respiration, and the temperature are depressed, and although in some cases a transient excitement may be caused by large doses, the effect of this agent is to induce a sound and refreshing sleep, and if its use is long con- tinued, a constant drowsiness is experienced. Bromide of 312 DENTAL MEDICINE. potassium has also the power of lessening the sensibility to pain, especially causing a loss of sensibility of touch in the case of the mucous membrane and skin, which is due to the local action of the salt as it is eliminated. The long continued use of this agent also causes a loss of motion, and if it is in- jected into the tissues of a limb, it will cause paralysis of motion and sensibility. It also diminishes the sexual feeling, and the condition which a long course of the bromides develop is known as bromism, which is characterized by weakness of mind, confusion, headache, pallor and anaemia, uncertain gait, etc. Therapeutic Uses.—Bromide of potassium is employed as an internal remedy in cerebral affections, acute rheumatism, chol- era infantum, sea sickness, vomiting of pregnancy; affections of the heart, as shown by increased action; neuralgia, maniacal excitement, tetanus, strychnia poisoning, epilepsy, spasmodic asthma, spasmodic cough, etc., etc. Dose.—Of bromide of potassium, gr. v to 5j. Dental Uses.—Bromide of potassium is a useful remedy in infantile convulsions from the irritation of dentition, and is also efficacious in preventing such conditions by relieving the irritation; also in neuralgia, due to diseased teeth. As its local effect is to diminish sensibility, it has been ap- plied to the pharynx and velum palati, in order to prepare such parts for the taking of impressions for artificial palates. POTASSII CHLORAS—CHLORATE OF POTASSIUM. Formula.—KCL03. Derivation.—Chlorate of Potassium is obtained by passing an excess of chlorine through a solution of carbonate of potassa and slaked lime; the chlorine being converted into chloric acid by the hydrogen of the lime and the acid com- bining with the potassa, forming chlorate of potassium. It is in the form of colorless or white crystals, of a pearly lustre, altogether soluble in distilled water, and in twelve parts of cold and two parts of boiling water. It is inodorous, with a cool, saline taste, and when applied to animal fluids does not CHLORATE OF POTASSIUM. 313 decompose them nor undergo any change, although perfectly soluble in such fluids. It is absorbed by the blood, and is eliminated by the kidneys. Medical Properties and Action.—Chlorate of potassium is detergent, refrigerant, diuretic, and stimulant, and its action as a refrigerant and diuretic is similar to that of nitrate of potassa. It improves the appetite, and on account of the large quantity of oxygen it contains has been employed in contaminated conditions of the blood as an oxidizing agent. Although it may be administered with impunity in very large doses, yet excessive quantities have given rise to gastro-enteric inflamma- tion, with fatal effects. Therapeutic Uses.—Chlorate of potassium is employed in continued and typhoid fevers, neuralgia, croup, diphtheria, sore throat, chronic bronchitis, phthisis, scrofula, erysipelas, scurvy, mercurial salivation, etc., etc. Externally, it is em- ployed in the treatment of ozaena, sore throat of scarlatina, pharyngitis, cancerous sores, ulcerated surfaces, fetid and scrofulous ulcers, etc., etc. Dose.—Of chlorate of potassium, gr. v to 3j, every three or four hours ; for children, gr. iij in sweetened water every four hours for a child three years of age; gr. v for one of eight or nine years, with due attention to the bowels and constitution, regulating the former and supporting the latter. In the case of teething children, gr. ij may be administered to a child of one year of age. Troches of Chlorate of Potassium are prepared by a combina- tion of chlorate of potassium, Sv; sugar, Sxviij; tragacanth, Sij ; vanilla, gr. xxx; mixed together with water into a mass and divided into 480 troches, each of which contains gr. v of chlorate of potassium ; useful for sore throat, etc. Dental Uses.—Chlorate of potassium is a valuable agent in dental practice as an internal and external resolvent and deter- gent remedy in the various forms of stomatitis—inflammation of the gums, aphthae and other ulcerative affections, gangren- ous stomatitis, mercurial stomatitis, erysipelatous inflammation 21 314 DENTAL MEDICINE. of the mouth, scurvy, ulcers of the gums, cheeks and tongue, abraded surfaces of mucous membrane, secondary syphilitic ulcerations of the mouth, indolent and scrofulous ulcers, etc., for such purposes being used alone in the form of mouth- washes or gargles, or in combination with tannic acid, alum, borax, glycerine, etc. In the treatment of mercurial stomatitis, great benefit is derived from both its internal and external use. For the inflamed gums of teething children, it is employed as a lotion, with beneficial effects. In the form of powder, it is a useful application to ulcerated and abraded surfaces. A simple gargle or mouth wash may be made by dissolving one drachm of chlorate of potassium in four ounces of water, or half an ounce may be dissolved in a pint of water. DENTAL FORMULAE. For Inflamed Gums After the Extrac- tion of Teeth. R. Potassii chloratis........ 3 ij Tincturae krameriae, Glycerini......aa........ foss Aquae rosae............... gviij. M. Signa.—To be used as a gargle 6 or 8 times daily, to harden the gums. For Ulceration and Inflammation of the Gums and Mucous Membrane. (Stocken.) R. Potassii chloratis....... 3 ij Sodii biboratis........... 3»j Potassii nitratis......... 3SS Aquae destillatae........ 3VUJ- M. Signa.—To be used as a gargle. For Inflammation of Gums and Mucous Membrane. (Stocken.) Potassii chloratis....... 31J Sodii biboratis..., R. •• 3) Potassii nitratis......... 3SS Tinct. arnicae............ 3 ij Aquae rosae............ ^vij. Signa.—To be used as a gargle. M. For Ulcers and Suppurating Wounds. R. Potassii chloratis........ pt.j Glycerini................ pts.x. M. Signa.—To be applied as a lotion. For Aphthous and Secondary Syphilitic Ulcerations of the Mouth and Fauces. R. Potassii chlorat......... 3iv Aquae destillatae........ 3*x. M. Signa.—To be used as an antiseptic mouth wash. For Ulceration of the Mouth. (Bartholow.) R. Potassii chloratis....... 3J Acidii carbolici......... 3SS Aquae destillatae........ 3*iv. M. Signa.—To be used as a lotion. For Inflamed Gums, Mucous Mem- brane, etc. R. Potassii chlorat......... 3J Sodii biboratis........... 3J Aquae destillatae......... 3*ij. M. Signa.—To be used as a mouth wash or gargle. NITRATE OF POTASSIUM. 315 For Inflamed Gums and Mouth. For Inflamed Mucous Membrane. R. Potassii chlorat... .... 31J R. Potassii chlorat........ 3J Pulv. aluminis........... 31J Aluminae sulph......... 3J Aquae destillatae........ 3"x. M. Aquae destillatae........ ^ iv. M. Signa.—To be used as a gargle. Signa.—To be applied as a mouth wash. POTASSII NITRAS—NITRATE OF POTASSIUM. SALTPETRE—NITRE. Formula.—KN02. Derivation.—Nitrate of Potassium is obtained in the native state in various portions of the world, but the variety employed for medicinal purposes is prepared by purifying the native production of India. It can also be artificially made by com- bining decayed organic animal and vegetable matters, or by the double decomposition of nitrate of sodium and chloride of potassium. The crude nitre is refined by re-solution and crys- tallization. It is in the form of white, crystalline, six-sided prisms, odorless, with a sharp, saline, cooling and slightly bitter taste, wholly soluble in water, but insoluble in alcohol. Medical Properties and Action.—Nitrate of potassium is re- frigerant, sedative, antiseptic, diuretic and diaphoretic. It pro- motes the secretions, lessens the heat of the body and the frequency of the pulse. For allaying febrile excitement, it is frequently employed in the form of nitrous powders (nitre, gr. x; tartar emetic, gr. y&; calomel, gr. % to %). In overdoses, nitrate of potassium causes pain and heat in the stomach, vomiting and purging of blood, inflammation of the bowels, great prostration, convulsions, and sometimes death. The antidotes are emetics, mucilaginous and demulcent drinks, and stimulants to sustain the sinking powers of the system. Therapeutic Uses.—Nitrate of potassium is employed inter- nally as a refrigerant in febrile affections ; in inflammatory dis- eases, acute rheumatism, scurvy, purpura, haemoptysis, passive hemorrhages, asthma, etc. In fevers it is frequently combined with other remedies. The vapor is used in spasmodic asthma. Dose.—Of nitrate of potassium, gr. ij to gr. x. 316 DENTAL MEDICINE. Dental Uses.—In dental practice, nitrate of potassium has been recommended in the incipient stages of alveolar abscess, being introduced into the pulp canal and secured by a tempo- rary filling in the crown cavity of the tooth. It is also em- ployed in inflammatory conditions of the mucous membrane of the mouth and throat, in the form of gargles. DENTAL FORMULAE. For Inflammation of the Mouth and For Inflamed Mucous Membrane and Throat. Gums. (J.W.White.) R. Potassii nitratis......... 3SS R. Potassii nitratis.......... 3ijto3iv Potassii chloratis....... 31J Aquae destillatae........ Oj. M. Sodii biboratis.......... 3J Signa.—To be used as a gargle. Aquae destillatae........ 3* viij. M. Signa.—To be used as an antiseptic and refrigerant mouth wash. POTASSII PERMANGANAS—PERMANGANATE OF POTASSIUM. Formula.—K2Mn208. Derivation.—Permanganate of Potassium is obtained by the mixture of equal parts of black oxide of manganese and chlorate of potassium, with a slight excess of caustic potassa, dissolving in water, and evaporating to dryness, when it is exposed to a nearly red heat; the chlorate of potassium yields oxygen, which changes the black oxide of manganese into permanganic acid, and this acid, combining with the potassa, gives as a product the permanganate of potassium. It is in the form of dark purple, slender, prismatic crystals, inodorous, very soluble in water, forming a solution of a beautiful lilac color, even in very minute proportion, and with a sweet astrin- gent taste. Medical Properties and Action.—Permanganate of potassium, when taken internally, is supposed to oxidize the blood. It is a stimulant, mild escharotic, and is a powerful disinfectant, as it has a remarkable power of destroying fetid odors from organic sources, and proves useful in preventing the spread of infectious disease. It yields up its oxygen readily, in the form of ozone, and its use depends upon this property. It is in- stantly decomposed on reaching the stomach. PERMANGANATE OF POTASSIUM. 317 Therapeutic Uses.—Permanganate of potassium is employed with advantage in dyspepsia, flatulence, excessive deposition of fat, uric acid diathesis, acute rheumatism, diabetes, scar- latina, petechial fever, spinal meningitis. Condy's Fluid is a favorite preparation with some, for both internal and external use. The most important uses for permanganate of potassium are externally, as a deodorizer and disinfectant, to correct the fetor of cancer, abscesses, ulcers, caries of bone, ozaena otor- rhcea, gonorrhoea, leucorrhcea, ulcerated sore throat, etc., in the form of injections, lotions and spray. It is also used externally in the treatment of diphtheria, in the proportion of a drachm of Condy's Fluid to the ounce of water. In solu- tion, permanganate of potassium is applied in varying strength, according to the effect desired. As a local stimulant, as well as deodorizer, it is useful in chronic and indolent ulcers, carbuncles, hospital gangrene, etc. The powder may be sprinkled on gangrenous surfaces. In concentrated solution permanganate of potassium acts as a caustic. A strong solution is composed of 10 parts dissolved in 90 parts of water, and is employed in its full strength in cancerous, phagedenic and atomic ulcers. For dressing simple wounds, or as an injection in abscesses, ozaena, leucorrhcea, etc., half a fluid ounce of the solution may be added to a pint of water; in gangrenous and diphtheritic wounds and scrofulous ulcers, a fluid ounce of the solution to a pint of water. Dose.—Of permanganate of potassium for internal use, gr. % to gr. j, three times a day. Condy's Fluid is composed of 32 grains of permanganate of potassium in one pint of distilled water; half a fluid ounce contains 1 grain. Dose of Condy's Fluid, nvv. For external application, f5j, to water, fSv to x. Solution of permanganate of potassium—Liquor Potassii Per- manganatis, is composed of 64 grains of permanganate of potassium to one pint of distilled water. M. de Lacerda has recently discovered that permanganate of potassium is one of the most energetic antidotes to the venom of snakes. Dental Uses.—In dental practice the permanganate of potas- sium is employed in the treatment of fetid and gangrenous 318 DENTAL MEDICINE. ulcerations of the mouth, such as cancrum oris, foul abscesses, ulcerations of mucous membrane attended with fetid discharges; as an antiseptic for decomposing pulps of teeth ; in diseases of the antrum and caries and necrosis of the maxillary bones, Riggs' disease, ulcers of the mouth, offensive breath, etc. The powdered crystals introduced into a carious cavity will relieve odontalgia. The stains of permanganate of potassium can be removed by dilute muriatic acid. DENTAL FORMULAE. For Unhealthy Ulcers of the Mouth, For Ulcers, Abscesses, Decomposing and Offensive Breath. Pulps of Teeth, etc. (J. W. White.) R. Liquoris potassii per- R. Potas. permanganatis.. Qj to iv manganatis.......... 3J Aquae destillatae........ Oj. M. Aquae destillatae....... ^vjtox. M. Signa.—To be used as a gargle. Signa.—To be used as a gargle or as an injection. For Gangrenous Ulceration of the Mouth—Cancrum Oris. For Fetid Perspiration and Foul Breath. R. Potassii permanganatis gr.xxx R. Potassii permanganatis gr.j Aquae destillatae........ 3*j. M. Aquae destillatae........fjj. M. Signa.—Apply as a lotion. Signa.—To be used as a lotion and gargle. PYRETHRUM—PELLITORY. Source.—Pyrethrum is a native of the Mediterranean coast, the root of which is the medicinal portion—pyrethri radix, in the form of cylindrical, wrinkled pieces, of the size of the little finger, hard and brittle, and when dried, has little or no odor. Externally it is of an ash-brown color, within white, and possesses an extremely acrid taste, with a burning and tingling sensation over the whole mouth and throat, which continues for some time, and excites a copious flow of saliva. Medical Properties and Action.—Pyrethrum root is an irritant and sialagogue, and when it is rubbed on the skin it causes much irritation, and may even excite inflammation. Its activity depends upon an acrid oil and a compound resin called pyrethrin.—It is rarely used internally, and only as a masticatory. Therapeutic Uses.—Pyrethrum has been employed as an WHITE OAK BARK. 319 excitant in paralysis of the tongue and muscles of the throat, relaxed sore throat, spontaneous salivation, certain forms of headache, for such purposes being chewed, or employed in the form of a gargle, in tincture or decoction. Dose.—Of pyrethrum as a masticatory, gr. xx to 5j. Tinc- tura Pyrethri, Tincture of Pyrethrum, is composed of py- rethrum Siv, rectified spirit Oj. Dental Uses.—Pyrethrum is employed in dental practice, for neuralgic affections of the face, for which it is chewed; for the relief of odontalgia, in the form of the tincture applied to the irritable pulp on a pellet of cotton ; as a stimulant to the gums and mucous membrane of the mouth in relaxed conditions; for obtunding sensitive dentine, in the form of a strong alco- holic extract. The ethereal oil of pyrethrum is recommended as a pleasant and efficacious remedy in odontalgia, applied in the same manner as the tincture; the fluid extract is also employed as an ingredient for local anaesthetic preparations, combined with chloroform, ether and lavender. (See Chlo- roform.) DENTAL FORMULA. For Relaxed Conditions of Mucous Membrane of Mouth and Gums. R. Tinctura pyrethri.......................................f^iij Aquae...................................................... §v"j. M- Signa.—To be used as a stimulant gargle. QUERCUS ALBA—WHITE OAK. Source.—White oak, the dried inner bark of which is the medicinal portion, is a common tree of the natural order Amentacea. The bark has a light-brown color, fibrous texture and an astringent, bitter taste. Its medicinal virtues depend upon the presence of tannic and gallic acids, and a bitter principle known as quercin. Water and alcohol form with it decoctions and tinctures. Medical Properties aJid Action.—White oak bark is tonic, astringent, and antiperiodic. It is principally used as an external application. Therapeutic Uses.—White oak bark is employed internally in the treatment of diarrhoea, dysentery and hemorrhoids. 320 DENTAL MEDICINE. Externally in relaxation of the uvula, tonsils, etc.; gangrene, indolent ulcers, leucorrhcea, atonic menorrhagia, fissure of the anus, etc., etc., in the form of tincture, and decoction as gargles, lotions and injections. Decoction of White Oak Bark, Decoctum Quercus Alba, is composed of oak bark, Sj ; water, Oj. Dose.—Of powdered white oak bark, gr. xxx to gr. xl. Of the decoction the dose is fSss to fSj. Dental Uses.—In dental practice the decoction and tincture are employed externally in the various forms of stomatitis, sponginess of the gums, relaxed condition of the mucous membrane of the mouth and fauces. QUILLAYA SAPONARIA—QUILLAIA BARK. SOUTH AMERICAN SOAP TREE BARK. Source.—Quillaia Bark is obtained from an evergreen tree of the natural order Rosacea—rose order, growing in Chili and Peru, the inner bark being employed. Medical Properties and Action.—Quillaia bark when bruised and macerated in water, imparts to that liquid the property of frothing like soap solution when agitated, which is owing to the saponaria in the bark, the same principle which imparts a similar property to soap wort—saponaria officinalis. Quillaia contains no tannic acid or other bitter principle, and is an article of commerce, being imported in large quantities for cleansing grease from cloth, as it does not change the color of silken or woolen goods ; it is also used for cleansing the hair, which it is supposed to preserve and beautify. When the powder is snuffed up the nostrils, it causes sneezing and a profuse nasal discharge. Therapeutic Uses.—Quillaia bark has been employed as a febrifuge, to arrest excessive secretion, as an application to ulcers, as a remedy for colds in the head, when it is used as a sternutatory, in the form of powder. The tincture is composed of quillaia bark I part, alcohol 5 parts; it is also used in the form of infusion and fluid extract. Dental Uses.—Quillaia bark, in the form of powder, tincture SULPHATE OF QUININE. 321 and fluid extract, is employed as an ingredient of mouth- washes, for its frothy and detergent properties ; it is also used as an application to chronic ulcers of the mouth, and to arrest excessive secretion of the mucous membrane of the mouth. DENTAL FORMULAE. Detergent Mouth Wash. For a Mouth Wash. (Am. Journ. Pharm.) R. Pulv. quillaiae sapona- R. Pulv. potassii bicar- riae..................... 3*iv bonatis................. 3*ss Glycerini................. 3" iij Mellis .................... 3*iv Alcoholis dialutus suf- Alcoholis................. 3*ij ficient for 2 pints. Olei caryophylli........ q.s Olei gaultheriae......... gtt.xx Olei gaultheriae, Olei menthae............ gtt.xx. M. Quillaiae saponariae Macerate the soap bark in the mix- (fluidext.).....aa..... ^j ture of glycerine and alcohol for three Aquae destillatae........ 5; ix. M. days, and filter through a little mag- To be used after the removal of. sali- nesia previously triturated with the vary calculus. volatile oils. For Inflamed Gums and Mucous Membrane. (Chapin A. Harris.) R. Quillaiae saponariae....................................... ^v"j Pyrethri, Radicis iridis, Acidi benzoici, Cinnamon........................Sa........................ 3*j Acidi tannici............................................... 3iv Sodii boratis................................................ 9 iv Olei gaultheriae............................................f sjij Olei menthae................................................f£lv Cochineal................................................... 3 iij Sacchari albi.............................................. Ibj Alcoholis.................................................... Oiij Aquae purae.................................................. Ov. M. Digest for six days and filter. Signa.—To be used as a gargle. QUININAE SULPHAS—SULPHATE OF QUININE. Formula.—C20H24N2O2, 3HzO. Derivation.—The two important alkaloid principles of cin- chona are quinia and cinchonia, which exist in combination with kinic acid. (See Cinchona.) Sulphate of Quinine is obtained by boiling the powdered 322 DENTAL MEDICINE. yellow cinchona bark in water acidulated with hydrochloric acid, by which the alkaloid quinine is separated from kinic and other acids, and forms a soluble hydrochlorate or muriate, the salt being decomposed and the quinine precipitated by the addition of lime; sulphuric acid is added, after digestion in boiling alcohol, which dissolves the quinine, and the solution is boiled with animal charcoal, filtered and allowed to crystal- lize. Sulphate of quinine is in the form of colorless, very light and silky crystals, which are readily soluble in alcohol and in water acidulated with sulphuric acid, but insoluble in ether. It has an intensely bitter taste, and is inodorous. Medical Properties and Action.—Sulphate of quinine is a very valuable tonic and antiperiodic, also antiseptic and stimulant. In small doses it increases the fullness of the pulse and action of the heart, and improves the tonicity of the capillary vessels, and is diffused into various parts of the system with great rapidity. In large doses it depresses the action of the heart, lowers the blood pressure, and enfeebles as well as diminishes the beats of the pulse. As it accumulates in the brain, it causes a fullness in the head, a constricted feeling about the forehead, a buzzing or ringing in the ears—tinnitus aurium, giddiness, vertigo, and deafness, which may be permanent if the agent is taken in excessive quantity; also amaurosis and amblyopia may be caused by full doses. Poisonous doses cause intense headache, dilated pupils, delirium, coma and convulsions. Some five hours are required to bring about the greatest effect of quinine, although it can be detected in the urine in about half an hour after it is taken into the stomach, and elimination, chiefly by the kidneys, is not completed in a less time than 48 hours, although the principal portion is excreted in 12 hours. Therapeutic Uses.—Quinine is extensively employed in periodical diseases of a malarial origin, such as intermittent fever, neuralgia of various forms, as enteralgia, hepatalgia, nephralgia, gastralgia, sciatica, angina pectoris, and in cases of debility, pneumonia, pleurisy, endocarditis, pyaemia, erysipe- las, puerperal fever, cerebro-spinal meningitis, eruptive fevers, HYPOPHOSPHITE OF QUININE. 323 etc., etc.; but the most important uses of quinia are for the treatment of malarial diseases. Dose.—Of sulphate of quinine, gr. j to 3j, in aromatic water, by the aid of aromatic sulphuric acid, and also as an enema, or hypodermically. Pills may be made by combining 24 grains of sulphate of quinine with 14 grains of clarified honey, and dividing into 24 pills. Pills can also be made with glycerine. Dental Uses.—Sulphate of quinine is internally employed in dental practice in the treatment of facial and other neuralgic affections, in cancrum oris, for its tonic and stimulant effects, in aphthous ulcerations of the mouth and in scurvy, where the system is much debilitated, and externally as an ingredient of dentifrices, for its tonic and stimulant properties. QUININAE HYPOPHOSPHIS—HYPOPHOSPHITE OF QUININE. Formula.—C22H24N04PH202. Derivation.—Hypophosphite of Quinine is obtained by dis- solving quinine with hypophosphorous acid, or by decomposing sulphate of quinine with hypophosphite of baryta, filtering and evaporating the solution. Medical Properties and Action:-—Same as those of sulphate of quinine, but not so powerful in its action. Therapeutic Uses.—Hypophosphite of quinine is used in all cases where hypophosphites are indicated, and its action is milder, on account of its containing less acid. It is employed as an antiperiodic, and is especially adapted for the treatment of children during the period of dentition when it is accom- panied with emaciation, loss of appetite and strength, and when convulsions are threatened. Dose.—Of hypophosphite of quinine, gr. j to gr. iij. DENTAL FORMULAE. For Facial Neuralgia from Dental For Neuralgia from Dental Dis- Disturbance. turbance. (Barrett.) (L. De L. Gorgas.) R. Ferri et quin. (cit.)..... 3ij R. Quininae sulphatis...... gr.x Syrup aurantii........... 3*j Ferri sulphat. exsic... gr.v Aqua dest................ f,\ Acidi arseniosi......... gr.ss Elixir calisayae......... 3*ij. M. Ext. nucis vomicae..... gr.v. M Signa.—Coch. parv. ter in die. Ft. pil. No. xx. SlGNA.—One pill every four hours. 324 DENTAL MEDICINE. For Neuralgia Associated with Ancemia. (Garretson.) R. Tinct. ferri chloridi....................................... 3J Quininae sulphatis........................................ 3J- M. Signa.—Teaspoonful four times daily. RESORCIN. Derivation.—Resorcin is a chemical compound of the phenol group and aromatic series, to which carbolic acid belongs. It is obtained from certain resins by the action of fusing alkalies, and is of the form of tabular, prismatic, shining crystals, some- what sweetish to the taste, followed by a slight pungency. Resorcin is very soluble in water, 95 parts in 100, and to a less degree in alcohol, ether, glycerine and vaseline ; chloro- form and carbon sulphide will not dissolve it. It darkens on exposure to the air, and is phosphorescent when rubbed in the dark. Its odor is somewhat similar to that of phenol, but not so strong. Medical Properties and Uses.—Resorcin acts somewhat simi- lar to quinine, although it differs from the latter in its lethal effects. Quinine, carbolic acid and salicylic acid promote its effects; atropine antagonizes it. Through its action on the ner- vous system, it greatly increases in frequency the respiration, which becomes convulsive and spasmodic, and afterward weak but rapid. It also increases the action of the heart, causes the pulse to become weak and irregular. It is eliminated by the urine quite rapidly. It has no irritating action on mucous membranes. Therapeutic Uses.—Resorcin, on account of its less irritating property, is considered preferable to carbolic acid for internal use and subcutaneous injection. It is .employed internally in catarrh of the stomach, ulceration, gastralgia, fermentative in- digestion, fevers, for its antiseptic and antipyretic actions, and ulcerative endocarditis, etc., etc. Locally, on account of its antiseptic properties, in diphtheria, in syphilitic and other sloughing sores, and anthrax, in the form of crystals or powder, and in the form of spray in catarrhal and ulcerating affections of the nose and throat; in solution, on account of RHIGOLENE. 325 its antiseptic action, it is used for dressing putrid and atonic wounds, and is combined with water, glycerine and alcohol; also in pomades. A compound composed of resorcin and salicylic acid heated together, is known as " Salicyl Resorcin-Ketone," is antiseptic to a degree, as it limits the development of, rather than destroys, septic germs. It is soluble in glycerine and alcohol, and is neither poisonous nor disagreeable to the taste. Dose.—Of resorcin, gr. v-xv. Five grains every two hours in an ordinary case. Dental Uses.—Resorcin is a valuable antiseptic in dental practice, and may be applied with advantage in all cases where antiseptics are indicated. (See Antiseptic Uses of Carbolic Acid.) RHIGOLENE. Derivation.—Rhigolene is a product of the distillation of petroleum. In its composition it is a hydrocarbon, and is destitute of oxygen, being extremely volatile and inflammable, and is the lightest of all liquids, with a specific gravity of 0.625. It is a petroleum naphtha, and boils at yo° F., and when perfectly pure should be almost odorless; but it is difficult to procure any specimen that does not have the un- pleasant odor of petroleum. It is colorless, and on account of its great volatility and inflammability requires to be kept tightly stopped, in a cool place. The storage of large quanti- ties, except in very secure places, is attended with considerable risk, and on this account it is somewhat difficult to procure it outside of the manufactories. It is dangerous to use it at night, or near a light. Dental Uses.—Rhigolene is employed, like absolute ether, to produce local anaesthesia, by dispersing it in the form of spray, with the spray apparatus, being the most rapid in its congealing effects, and also the most easily controlled and con- venient of all of the freezing mixtures. As a local anaesthetic it is employed in the operation of extracting teeth, by apply- ing it, in the form of spray, to the parts about the tooth to be removed until a blanched surface of gum is produced. The 326 DENTAL MEDICINE. spray of rhigolene is also applied to the gum over the root of a tooth affected with incipient periostitis. SANDARACA—SANDARACH. Source.—Sandarach is a resinous substance obtained from an evergreen tree—Thuya Articulata—which grows in the northern part of Africa. The gum is in the form of small, irregular, round and oblong tears, of a pale yellow color, some- times brown, and more or less transparent, dry and brittle. It has a faint, agreeable odor, which is increased by warmth, and a resinous, somewhat acrid taste. It melts with heat, diffusing a strong balsam odor, and is inflammable. It is soluble in alcohol and ether, and slowly dissolves in warm oil of turpentine. It consists of three resins, varying in their re- lations to alcohol, ether, and oil of turpentine. The sanda- racin which remains after sandarach has been exposed to the action of ordinary alcohol is a mixture of two of these resins. Uses.—Sandarach was formerly employed as a medicinal agent, and entered into the composition of various ointments and plasters, but its use is now restricted to such purposes as the composition of a varnish, ingredient of incense, etc. After the erasion of ink marks, its powder, if rubbed on such a sur- face, will prevent fresh ink marks from spreading. Dental Uses.—In dental practice, sandarach dissolved in alcohol forms a varnish for coating the surface of plaster models, etc.; it is also used for checking secretions from the gums during the operation of filling teeth, either applied as a coating to the surface, or on bibulous paper saturated with it It is also employed to saturate cotton to be used as a tempo- rary filling in cavities of the teeth, for the protection of medi- cinal applications. DENTAL FORMULA. Transparent Sandarach Varnish, R. Gum sandarach..........................................t zv Alcohol.................................................. % qt i Mix and digest over a moderate heat until the sandarach is dissolved. PHENATE OF SODA. 327 SHELL-LAC—SHELLAC. Source.—Lac is a resinous substance, obtained from several varieties of trees which grow in the East Indies, and particu- larly from the Croton Lacciferum, and two species of the Ficus. It is supposed to be an exudation from the bark, owing to the puncture of an insect belonging to the genus Coccus ; it is also said to be the exudation from the bodies of the insects them- selves. Several varieties are known in commerce, the most common being the stick-lac, the seed-lac and the shell-lac. Lac, in its crude state, consists of resin, coloring matter, and a peculiar principle, insoluble in water, alcohol or ether, and known as lacin, a little wax, and various saline matters in small proportion. Uses.—It is slightly astringent, and has been recommended as an adhesive substance for dressing ulcers, wounds, etc., being used by simply spreading it on the bandages after it is dis- solved in alcohol by a gentle heat. Shellac is prepared by melting the crude lac, straining it, and pouring it upon a flat, smooth surface, to harden. It is in the form of thin fragments of various sizes, from half a line to a line in thickness, and of a light and also dark brown color, shining, hard, brittle and inodorous. It is insoluble in water, but freely soluble in alco- hol, especially with the aid of heat. It is employed as a varnish. In dental practice its uses are the same as those of sandarach, but, owing to the dark brown color of the solution, it is not so sightly, and does not make a transparent varnish. DENTAL FORMULAE. For a Colored Varnish. For an Aqueous Varnish. R. Gum shellac............. 3*v R. Pulv. shellac......... partes j Alcohol.................. qt.j. Sat. solut. boracis... partes ij. Mix and digest over a moderate heat Mix by shaking together; it will give until thoroughly dissolved. a starch gloss. SODyE PHENAS—PHENATE OF SODIUM. CARBOLATE OF SODIUM. Formula.—NaC6H50. Derivation.—Phenate or Carbolate of Soda is obtained by mixing caustic soda with carbolic acid and a small quantity of water, and evaporating the solution, the result being a % 328 DENTAL MEDICINE. saponaceous mass of acicular crystals of a light pinkish color, which are converted by heat into a fluid of an oily consistence. It is freely soluble in creasote, carbolic acid and water. Medical Properties and Action.—Phenate of soda is haemo- static, antiseptic and disinfectant. Therapeutic Uses.—It is internally administered in the form known by the French name of Phenol Sodique, in doses of gtt. viij or gtt. x in a glass of water, in typhus and typhoid fevers, as a preventive of cholera, in plagues, cholera infantum, etc.; externally, it is a valuable styptic in local hemorrhage, and as a dressing for wounds, burns, chilblains, excoriations, vari- cose veins, venomous stings and bites, and as a disinfectant in throat affections, leucorrhcea, diphtheria, scarlatina, small- pox, ozaena, etc. Dental Uses.—Phenate of soda is useful in dental practice, as an astringent and styptic in hemorrhage following the extraction of teeth, and to relieve the soreness of such an operation, as it promotes the rapid absorption of the extravasated blood, and the healing and hardening of the gums. It is applied on a pellet of cotton, or in solution with water, and acts as a seda- tive and antiphlogistic as well as a haemostatic, and has little or no escharotic action. For soft and spongy gums it forms an efficient gargle or mouth wash, and can be employed for this purpose in its full strength, in the form of phenol sodique, or diluted with from one to twelve parts of water. When applied on cotton, to an exposed and inflamed pulp, it relieves odontal- gia. It is also employed in aphthous ulcerations of the mouth, and as a disinfectant in offensive breath, in the proportion of a teaspoonful to a glass of water. DENTAL FORMULA. A Phenol Sodique Preparation. R. Acidi carbolici.................................... gr. clxxxviij Sodae caustic....................................... gr. xxxj Aqu«................................................ 3"iv. M. Signa.—To be applied on a pellet of cotton, or, as a mouth wash, diluted to meet requirements of case. BICARBONATE OF SODIUM. 329 SODII BICARBONAS—BICARBONATE OF SODIUM. (SESQUICARBONATE OF SODIUM.) Formula.—NaHC03. Derivation.—Bicarbonate of Sodium is obtained by saturat- ing the carbonate of sodium with carbolic acid. It is in the form of a white, opaque powder, freely soluble in water, with a mild, slightly alkaline taste. Medical Properties and Action.—Bicarbonate of sodium is antacid, alterative, lithontriptic, and from its mildness and non-irritating qualities is more pleasant to the taste and to the stomach than the carbonate. It is extensively used in the preparation of soda and seidlitz powders. Therapeutic Uses.—Bicarbonate of sodium is internally ad- ministered in neuralgia connected with acidity of the stomach, cardialgia, flatulence and vomiting, dyspepsia, diarrhoea, dis- eases of the skin, albuminuria, calculous disease, etc. Ex- ternally in diseases of the skin of a scaly and papular nature, ecthyma, ringworm, and sprinkled over burns and scalds, and combined with an equal part of common salt, for stings of venomous insects. Dose.—Of bicarbonate of sodium, gr. v. to 5j, in carbonic acid water, or with sugar and mucilage. Effervescing Powders,—Pulveris Effervescentes, are com- posed of tartaric acid, gr. xxv, in one paper, and bicarbonate of sodium, gr. xxx, in another paper. Dental Uses.—Bicarbonate of sodium is employed in dental practice, to relieve neuralgia of an acid origin, in which a full dose often proves very serviceable; in aphthae of children it is often combined with a little rhubarb and proves very efficacious. Externally it relieves odontalgia when a small portion of the powder is applied to the irritable pulp. It is also useful for neutralizing the acidity of the oral fluids, especially when such a condition is the result of pregnancy. It also forms an antacid ingredient in dentifrices. 22 330 DENTAL MEDICINE. SODII BORAS—BORATE OF SODIUM. (BORAX.) Formula.—2NaB02, 2HB02, 9H20. Source.—Borax is a native salt, but can be obtained artifi- cially by boiling together native boracic acid (found in Italy), and carbonate of soda. California furnishes the borax used in this country. It is in the form of colorless crystals, which effloresce somewhat in dry air, and are freely soluble in water and glycerine, but insoluble in alcohol, with an alkaline reac- tion, and a sweetish, alkaline taste. It dissolves fibrine, albu- men, casein and uric acid. Medical Properties and Action.—Borax is refrigerant, diuretic, detergent, antacid and emmenagogue, and has been employed as a solvent for calculi. It resembles in its action carbonate of soda, and by its mild alkaline qualities it improves the condi- dition of the skin and mucous membranes. In excessive or large repeated doses it is injurious, causing nausea and vomit- ing, and a scorbutic condition of the body. Therapeutic Uses.—Borax is internally administered in infan- tile diarrhoea, in the form of an enema; also as a solvent for calculi, and in dropsy, etc., but its chief use is as an external application. Externally it is applied as a detergent in cutane- ous affections, ulcerations, pityriasis, to remove freckles, to allay itching, etc., etc. Dose.—Of borate of sodium, gr. ij to 3j. Glycerite of Borate of Sodium—Glyceritum Sodii Boratis —Glycerinum Boracis—is composed of borax, Sij; glycerine, Oss, and is a useful application to the mouth and throat. Honey of Borate of Sodium—Mel Sodii Boratis—Mel Boracis—is composed of borax, 5j; clarified honey, Sj, and is also useful as a detergent application to the mouth and throat. Dental Uses.—Borax, mixed with sugar or honey, is a very useful application for aphthae and other ulcerations of the mouth, for which it may be mixed with sugar in the propor- tion of one part to seven, or in the form of mel boracis. In mercurial stomatitis, an aqueous solution of borax, or the mel SULPHITE OF SODA. 331 boracis, forms an efficient gargle. Borax is also a useful appli- cation in fissured or cracked tongue. Borax is also added to sage and balm teas, to form gargles. In the dental laboratory, borax is employed as a flux in melting metals, such as gold and silver, and in the process of soldering metals. It is also employed to harden plaster casts or models, the model being well dried and then immersed for a few minutes in a solution of borax in boiling water, which renders it, when cool, hard and durable. (Solutions of carbon- ate of soda and alum are used for the same purpose.) DENTAL FORMULAE. A Mild Detergent Gargle. For Fissured Tongue. R. Sodii biboratis........... ^j (J.W.White.) Glycerini................ ^vj. M. R. Sodii biboratis........... gr xl Glycerini................. ^j For Fissured or Cracked Tongue. Aquae destillatae......... 3*iv. M. R. Sodii biboratis........... ^j To be used as a gargle. Glycerini................. 3*j. M. To be used as a lotion or gargle. A Detergent Alkaline Gargle. R. Sodii biboratis........... 3iv For Aphthous Ulcerations, Parasitic Glycerini, Formations, and Diphtheritic Condi- Tincturae myrrhae..aa.. J ss tions. Aquae destillatae........ ^x. M. R. Sodii hyposulphitis..... ^ ij Syrupi aurantii......... 3iv For Aphthous Ulcerations, etc., etc. Aquae destillatae........ 3*iv. M. R. Sodii sulphitis........... 3J SlGNA.—To be applied as a lotion or Glycerini................. 3*j. M. mouth wash, stimulant and antiseptic. Signa.—To be used as a lotion or mouth wash. SODII SULPH IS—SULPHITE OF SODA. Formula.—Na2S03. Derivation.—Sulphite of Soda is prepared by passing sul- phurous acid into a solution of carbonate of soda, and evapo- rating free from air. The sulphurous acid unites with the soda of the carbonate, to form the sulphite of soda, and the carbonic acid escapes. On cooling, the salt crystallizes in white prismatic crystals, and should be kept well stopped, as it changes on exposure into sulphate of soda. Medical Properties and Action.—Sulphite of soda is a disin- 332 DENTAL MEDICINE. fectant and deodorizer, and its action and uses are similar to those of the other sulphites, hyposulphites and sulphurous acid. Dose.—Of sulphite of soda, gr. xv to 5j, three times a day. Dental Uses.—Sulphite of soda is sometimes employed in the form of a lotion for aphthous sore mouth due to a parasitic vegetable; also in ulcerous stomatitis, gangrenous stomatitis, and all suppurative affections of mucous membrane, especially when they are sustained by zymotic influences or invisible organisms. Dr. E. C. Kirk has successfully employed sulphite of soda in combination with boracic acid, for bleaching dis- colored teeth. (See Formula.) His method is as follows :— Having adjusted the rubber dam to the tooth to be treated, and one adjoining it on each side, the cavity of decay is cleansed of all debris and the root filled with gold or gutta percha for one-half its length. The powder, composed of sul- phite of soda and boracic acid, is packed into the remaining portion of the pulp canal and cavity of decay, leaving just sufficient space to insert a temporary filling of gutta percha or Hill's Stopping. After the powder has been properly packed, a drop of water is permitted to fall upon it from a drop-tube or a pellet of cotton wrapped around a broach, the object being to dampen the powder, not to wash it out. The cavity of decay is then filled with gutta percha, and the patient dis- missed until the next sitting, when a second application can be made, which is usually sufficient, except in cases where the walls of the tooth are very thick and much discolored, when a third application may be necessary. When the water is added to the powder a chemical reaction takes place, the boracic acid unites with the sodium of the sulphite to form sodium borate, at the same time liberating the sulphurous acid, upon which the bleaching power depends. DENTAL FORMULAE. For Aphthous Sore Mouth. For Same. R. Sodii sulphitis.......... 3J (Wallace.) Aquae.....................fgj. M. R. Sodii sulphitis...........gr.xxx Signa.—Apply as a lotion. Glycerinae, Aquae.........aa......... gss. Signa.—To be used on a swab every two hours. TERCHLORIDE OF PHENOL. 333 For Bleaching Discolored Teeth. (E. C. Kirk.) R. Sodii sulphitis..........................................♦.. gr.ioo Acidi boracis............................................ gr-7° Mix by grinding together in a warm, dry mortar, to a fine powder, which is preserved in an air-tight stoppered bottle, and kept in a dry place. Signa.—(See Dental Uses of Sulphite of Soda.) TERCHLORIDE OF PHENOL. Derivation.—Terchloride of Phenol has recently been intro- duced as a disinfectant and antiseptic. It is prepared by passing a stream of chlorine gas through chemically pure car- bolic acid, previously melted, until it acquires a violet hue. Medical Properties and Action.—It is not an irritant and has no acid reaction. When carbolic acid is acted upon by chlor- ine gas a number of compounds are produced; such as a mono-chloride, a bichloride, and a tri- or ter-chloride of car- bolic acid (phenol). Therapeutic and Dental Uses.—Terchloride of phenol is claimed to be a valuable antiseptic and disinfectant in the treatment of gangrenous ulcers, etc. In dental practice it has been very recently recommended in combination with iodoform, as a material for capping exposed pulps and as a filling for root canals of teeth, and the advantages claimed for it are, that it will be resorbed when in contact with living tissues; it is easily introduced into pulp canals; it absorbs exudations; it becomes hard when mixed with certain chemical substances, but is destroyed by pus ; it is a very bad conductor of heat; and it is absolutely a non-irritant. The method recom- mended for its use as a capping and filling material is, to incorporate the iodoform and terchloride of phenol with de- calcified dead bone, as follows: dead bone or ivory shavings are decalcified in a ten per cent, solution of chemically pure hydrochloric acid, and after all the lime salts are extracted, the residue is collected upon a filter, washed, dried and rubbed to a fine powder in a porcelain or glass mortar. Upon this powder ten times its weight of a ten per cent, solution of iodoform in sulphuric ether is gradually poured and constantly 334 DENTAL MEDICINE. rubbed until a fine yellow powder is obtained, which contains about fifty per cent, of iodoform. When used as a capping for pulps, or a filling material for root canals of teeth, this powder is made into a paste by the addition of carbolic acid or terchloride of phenol, being worked or rubbed together like ordinary cement. For hyperaemic conditions of the dental pulp success has attended the application of a cap of the iodoform and decalcified bone paste mixed with terchloride of phenol. For inflamed pulps the application of terchloride of phenol is to be repeated every third or fifth day, until no more pain is felt, and the pulp is then to be capped with the de- calcified bone, iodoform and terchloride of phenol material, and a temporary filling introduced into the crown cavity. The treatment of ulcerated and gangrenous pulps of teeth consists in treating with the terchloride of phenol, and after the second or third application, if no trouble occurs from a temporary closure of the root canals, to fill with the decalcified bone, iodoform and terchloride material, using whalebone in- struments for its introduction, until congelation is occasioned, and the congested condition of the capillaries of the part re- lieved, acting as a counter-irritant and antiphlogistic. THYMOL. Formula.—C10H14O. Derivation.—Thymol, or thymic acid, is obtained from the herb thymus vulgaris, or common thyme, which is cultivated in this country for the same purpose as sage, lavender, etc. Thyme yields a volatile oil, oleum thymi, from which thymol or thymic acid is obtained by treating the oil with an aqueous solution of potassa or soda, which separates it from a principle called thymene, with which it is mixed in the oil, and which is not affected by the alkalies. The thymate thus formed is de- composed by an acid, and the liberated thymol or thymic acid is purified by repeated washings, dessication and distillation. Thymol is in the form of aromatic white crystals, soluble in one thousand parts of hot water. Medical Properties and Action.—In a concentrated state, THYMOL. 335 thymol has an acrid and caustic taste, but when very much diluted, the only taste experienced is that of thyme. Thymol has acrid properties, and is similar in its action to carbolic acid. It imparts a sense of coolness to the mouth, like that of oil of peppermint, and when once melted it remains indefinitely in the liquid state. While it is only slightly soluble in water, it is freely soluble in alcohol, and is dissolved by ether and the fixed oils. The alkalies unite with it to form soluble salts. Like creasote, it has the property of combining with animal tissues, and thus prevents putrefaction. While it has the important practical properties of carbolic acid, it is free from disagreeable odor, and it is claimed to be as efficient an antiseptic as that agent. Therapeutic Uses.—Thymol is almost exclusively employed as an external application, and is often substituted for the oil of origanum, which is obtained from the common majoram. It is considered to be a valuable antiseptic and antifermentative agent Dental Uses.—Thymol, when combined with glycerine, in a form known as Glycerole of Thymol, is a valuable antiseptic in the treatment of suppurating pulps of teeth, as a dressing for ulcers of the mouth, wounds, etc.; also in the treatment of teeth after the devitalization of the pulp, chronic inflamma- tion of the pulp, and alveolar abscess, as it arrests the putre- factive process; also in stomatitis and abrasion of mucous membrane. DENTAL FORMULAE. Glycerole of Thymol. For Stomatitis. R. Thymolis (cryst.)....... gr.xx (Alvin.) Glycerini, R. Thymolis (cryst.) ..... ptm.j Alcoholis,......aa.......f^j Glycerini................. pts.ioo. Aquae destillatae......... Oj. M. Signa.—To be used as a lotion and gargle. Fot Alveolar Abscess, Suppurating Pulps, etc. For an Antiseptic in Suppurating (Alvin.) Pulps, Alveolar Abscess, etc. R. Thymolis (cryst.)....... ptm.j R. Thymolis (cryst.)...... ptm.i Iodi....................... ptm.j Glycerini................. pts.ij to iv. Potassii iodidi.......... ptm .j SlGNA.—Applied in the same manner as Glycerini................. pts.vtoxv. carbolic acid. Apply as in use of carbolic acid. 336 DENTAL MEDICINE. VASELIN—VASELINE. PETROLEUM OINTMENT. Derivation.—Vaseline is obtained from crude petroleum, in the form of a petroleum jelly. In the distillation of crude petroleum there remains in the apparatus, after the separation of the light oils, a semi-liquid tar, which constitutes crude vaseline, which, in such a state, has a disagreeable odor like petroleum, of a strong taste and black color. This compound is heated in the open air, and decolorized by animal charcoal, the product being the petroleum jelly known as vaseline, which is a mixture of several hydrocarbons. When pure, vaseline is white, inodorous and insipid, and of the consistence of jelly, or very unctuous fat. It melts at 35° C, boils at 1500 C, and distills at 2000 C, and burns without residue. Exposed for a considerable time to light, it acquires a slight odor of petroleum. It is insoluble in water, sparingly soluble in alcohol, and very soluble in warm ether, chloroform, fats, volatile oils, and sulphide of carbon. It sensibly dissolves iodine, bromine, sulphur, phosphorus, carbolic acid, benzoic acid, atropine and strychnine. Medical Properties and Action.—By its composition, vaseline is not capable of becoming rancid, nor of being saponified; hence it is a very useful agent or excipient for caustic alkalies, oxides, metallic salts, and even acids in the cold, without action by them, and without modifying their therapeutic prop- erties. Incorporated in ointments, a certain quantity of vase- line will preserve them and obviate rancidity, being preferable to lard, butter, glycerine and glyceroles. The addition of par- affin will give it any consistency desired. Therapeutic Uses.—Vaseline is used externally as a dressing for wounds, cuts, bruises, sprains, piles, rheumatism, skin dis- eases, eczema, inflamed surfaces, diseases of the eye, etc., etc. Combined with carbolic acid, it forms a very useful ointment for affections of the skin, etc., etc. Dental Uses.—Vaseline is an efficacious application to in- flamed and excoriated surfaces of the gums and mucous mem- brane of the mouth ; also as a dressing introduced into the VERATRINE. 337 canals of teeth affected with periostitis, and as an emollient application after the devitalization and removal of dental pulps. In the form of Vaseline Camphor Ice, it is a pleasant and efficacious application to chapped lips and hands, being bland and non-irritating in its action. An ointment made by dissolving and incorporating thor- oughly by the aid of heat, equal parts of vaseline and lead plaster, to which a little bergamot may be added for perfume, is very serviceable for the treatment of excoriated surfaces, and dry desquamating surfaces of certain skin diseases, and especially to the form of skin affection which may result from the constant use of scented soaps on the hands. VERATRINA—VERATRINE. Source.—Veratrine is an alkaloid, or a mixture of alkaloids, obtained from the seeds of asagraa officinalis, of the natural order Melanthacea. It is in the form of a white, or grayish- white amorphous powder, of an acrid taste, imparting a sensa- tion of tingling and numbness to the tongue, and causing con- striction of the fauces and violent sneezing. It is but slightly soluble in cold or hot water, to which it imparts an acrid taste and a somewhat alkaline reaction. It is soluble in three parts of alcohol at 590 F., and very soluble in boiling alcohol; also soluble in 6 parts of ether, in 2 parts of chloroform, and in 96 parts of glycerin; it melts when heated. Veratrine Ointment—Unguentum Veratrina—is composed of veratrine, 4 parts; alcohol, 6 parts; benzoinated lard, 96 parts. The veratrine is rubbed with the alcohol in a warm mortar until dissolved, and the benzoinated lard gradually added and thoroughly mixed. Therapeutic Uses.—Veratrine is used only externally in neu- ralgia, myalgia, headache, rheumatism, paralysis, etc., in the form of the ointment, or dissolved in alcohol. Dental Use.—Veratrine, in the form of the ointment, is used for facial and other forms of neuralgia, a small quantity being rubbed over the seat of pain. 338 dental medicine. VERATRUM VIRIDE—AMERICAN HELLEBORE. (POKE ROOT.) Source.—Veratrum Viride, of the natural order Melanthacea, the officinal portion of which is the root, is indigenous to the swampy portions of the United States, and is prepared in the form of slices or fragments, of a dark or blackish-gray color externally, and of a grayish-white color internally. Its odor is peculiar, especially when it is moistened, and its taste is bitter and acrid. It is inodorous, but in the form of powder is sternutatory. It is similar in chemical composition to vera- trum album—white hellebore and veratrum sabadillae. Like veratrum album, it contains a quantity of soft resin, and two alkaloids—-jervia and veratroidia. Medical Properties and Action.—Veratrum viride is acrid and sedative, causing redness and heat when applied to the skin, and has a violent sternutatory effect on the Schneiderian mem- brane. Small doses stimulate the secretions and depress the pulse. Although a prompt emetic, its operation is attended with intense nausea and depression, and violent, persistent vomiting. Large doses occasion great depression, with a weak action of the heart and pulse, vomiting, retching, cold surface of body, a cold perspiration, faintness, dimness of sight, dilata- tion of the pupils, great muscular weakness, slow respiration, and sometimes coma, insensibility and stertorous breathing, but notwithstanding such symptoms, fatal results are rare. The antidotes are free stimulants. The tincture—Tinctura Veratri Viridis, is the best preparation for internal administra- tion. Therapeutic Uses.—Veratrum viride is not employed for its emetic effect, on account of its violent action. Internally it is administered in diseases of the heart, active hemorrhage in the plethoric, to reduce the temperature and pulse in " typhoid and other fevers," in acute mania and delirium, in puerperal convulsions, neuralgia, neuralgic headache, etc. Externally it is employed for neuralgia, myalgia, headache, rheumatism, paralysis, etc. Dose.—Of the tincture of veratrum viride, nyj to ni,v, of the XANTHOXYLUM. 339 fluid extract of veratrum viride—Extractum Veratri Viridis Fluidum, mjj to n\,v. Dental Uses.—In dental practice, the tincture of veratrum viride has been employed internally for neuralgia of the fifth nerve; also in dental periostitis, as a sedative; also in severe hemorrhage from the extraction of teeth, to depress the heart's action. DENTAL FORMULA. For Facial Neuralgia. Da Costa. R. Veratriae............................................ gr.xv Aconitiae........................................... gr.ij Glycerinae.......................................... f3 ij Cerati adipis....................................... f 5 vj. M. Sig.—To be rubbed over painful part, care being taken to see that there is no abrasion of the skin. XANTHOXYLUM—PRICKLY ASH. Source.—Xanthoxylum is a shrub growing in the northern, middle and western States of North America. The bark is the officinal portion, and is obtained in the form of pieces, more or less quilled, of one or two lines in thickness and of a whitish color, with an ash-colored epidermis. It is quite inodorous and has a taste at first sweetish and slightly aro- matic and afterwards bitter and acrid. Medical Properties and Action.—Xanthoxylum is aromatic, stimulant and sialagogue, and when swallowed occasions a sense of heat in the stomach, more or less general arterial excitement, and a tendency to diaphoresis. Therapeutic Uses.—Xanthoxylum has been administered with considerable benefit in the chronic form of rheumatism. Dose.—Of powdered xanthoxylum, gr. x to 5ss, three or four times a day. Dental Uses.—Xanthoxylum, in the form of the powder, has been applied with success to an aching pulp for the relief of odontalgia, and a decoction of the bark is employed as a wash for foul ulcers; in the form of a tincture it is efficacious in relieving the soreness which remains after the extirpation of the dental pulp; it is applied on floss silk or cotton. In 340 DENTAL MEDICINE. the southern States the Angelica Tree—Aralia Spinosa, some- times called "Toothache Tree," is often called prickly-ash, but it differs from xanthoxylum, although its tincture answers for the relief of odontalgia. ZINCI CHLORIDUM—CHLORIDE OF ZINC. Formula.—ZnCl2. Derivation.—Chloride of Zinc is obtained by the action of hydrochloric acid on granulated zinc, the solution thus made being purified by a solution of chlorine and carbonate of zinc, when it is evaporated till it assumes a solid form. It is in the form of a white deliquescent salt, freely soluble in water, alcohol and ether, as soft as wax, and capable of being melted and sublimed by heat. As it rapidly deliquesces when exposed to the air, it should be kept in glass-stoppered bottles. It has a styptic, metallic taste, which is very disagreeable. Medical Properties and Action.—Chloride of zinc is the most active of the zinc preparations, being a powerful and pene- trating escharotic. Its local action as a caustic depends upon its affinity for albumen and gelatin, and when in contact with living parts it destroys their vitality, and uniting with the albuminous and gelatinous matters present, forms an eschar. It is also a useful deodorizer and disinfectant, and largely diluted has been employed as a nervine tonic; but as the milder preparations of zinc answer the same purpose, it is rarely employed internally. On account of the great affinity for water and its power of combination with albumen, chloride of zinc penetrates and spreads deeply, and produces an eschar which is white, thick and hard. When applied to malignant and indolent ulcers, it promotes healthy granulations, and when topically applied it not only destroys the diseased structure, but excites a new and healthy action in the surrounding parts. When employed as a caustic, it does not give rise to con- stitutional disorder from absorption, an effect which is some- times caused by arsenical preparations. In over doses it causes a burning pain in the throat and stomach, nausea, vomiting, cold sweats, decrease of pulse, cramps of the limbs, etc., CHLORIDE OF ZINC. 341 being a powerful irritant poison. The antidotes in poisoning by zinc salts are albumen, carbonate of soda, magnesia and soap. Therapeutic Uses.—Chloride of zinc has been employed internally in chorea, epilepsy, neuralgia, scrofula, and com- bined with hydrocyanic acid in facial neuralgia. Externally it is applied to malignant growths, gonorrhoea, indolent ulcers, etc. A solution of the chloride of zinc is used as an antiseptic and disinfectant. Liquor Zinci Chloridi—Solution of Chloride of Zinc, known as "Burnett's Disinfecting Fluid," is composed of chloride of zinc, gr. cc, water, Sj. Dose.—Of chloride of zinc, gr. ss, or gr. j, or gr. ij, largely diluted. Dental Uses.—Chloride of zinc is a valuable agent in dental practice, being employed as an external application to sensitive dentine. As an obtunding agent a drop of the deliquescent chloride is placed in contact with the sensitive dentinal surface (which has previously been dried and is protected from all moisture), and allowed to remain from two to four minutes. Considerable pain follows the application of the chloride, which is of a steady, continuous character, without the throbbing nature which characterizes the pain of an irritated dental pulp. Its painful action may be modified by bathing the sensitive surface, prior to the application of the chloride, with chloro- form, tincture of aconite or atropine solution, or a combination made. When the pain has subsided the excavation of the cavity can be proceeded with until the layer of dentine affected by the chloride has been removed, when another application may be necessary. As it is not absorbed by the dentine to any great degree, its action being superficial, it is not so dangerous an agent as is arsenious acid when employed for the same purpose. In no case should the chloride of zinc be used as an obtunding agent, when there is danger of irritating the pulp of the tooth. Chloride of zinc applied to dentine as an obtunder of sensi- 342 DENTAL MEDICINE. bility, is superficial in its action. It is also employed to arrest superficial hemorrhage from a wound of the gum during the filling of teeth ; it will also temporarily arrest the secretion of mucous from the surface of the mucous membrane of the mouth. When applied to a cut surface it induces union by first intention, by its effect upon the glutinous matter. It has also been successfully employed as an injection for chronic alveolar abscesses, and in the treatment of ulceration of the gums attended with recession of gum and absorption of process from the necks of teeth; also as an injection in disease of the antrum. It has been claimed that its application in a diluted form will promote the formation of secondary dentine over a nearly exposed pulp, but its escharotic action must be considered in using the agent for such a purpose. When applied to the sulcus which often forms during ulceration and recession of the gum from the neck of a tooth, the application can be safely and conveniently made by means of a camel's- hair brush, or by a piece of orange wood so shaped as to permit of its being introduced to the bottom of such a sulcus. Chloride of zinc in a properly diluted form is an efficient disinfectant, and has been employed for such a purpose in gangrenous conditions of the mouth. Chloride of zinc is one of the ingredients of the temporary filling material composed of the chloride of zinc in solution and the oxide of zinc, which has been employed to cap the exposed pulps of teeth. But owing to the escharotic action of the chloride this method has not been uniformly successful. The zinc preparations, however, answer good purposes as tem- porary filling materials, especially in sensitive cavities where the presence of metallic fillings would not be tolerated. (See Appendix to Dental Formulary.) ZINCI IODIDUM—IODIDE OF ZINC. Formula.—Znl2. Derivation.—Iodide of Zinc is obtained by digesting an excess of zinc with iodine diffused in water. It is in the form of fine, white, deliquescent needles, very soluble in water, and OXIDE OF ZINC. 343 of a metallic, styptic taste, resembling that of sulphate of zinc, and is very liable to spontaneous combustion. Medical Properties and Action.—Iodide of zinc is tonic, astringent and antispasmodic. Therapeutic Uses.—Iodide of zinc has been favorably em- ployed in chorea, cachexia, scrofula and hysteria. It has been used for strumous inflammations and enlargements, both externally and internally. Externally it is an efficient local stimulant and escharotic, and is considered to be equal, if not superior, to chloride of zinc. In enlarged tonsils it has been advantageously employed in a solution of 10 to 30 grains to the ounce of water. In the form of an ointment, composed of a drachm of the iodide to the ounce of lard, it has been used in the treatment of tumors. Dose.—Of iodide of zinc, gr. j gradually increased to gr. vj, given in the form of syrup. Dental Uses.—Iodide of zinc is a valuable local application in alveolar pyorrhoea, tumors of the mouth, enlargement of the tonsils, etc. In alveolar pyorrhoea it is used in connection with peroxide of hydrogen, which see. DENTAL FORMULA. For Alveolar Pyorrhoea. (A. W. Harlan.) R. Zinci iodi............................................ gr. xij to xxiv. Aquae................................................. f^j. M. Signa.—After drying the gums, inject each pus-pocket with one, two, or three drops of this solution. ZINCI OXIDUM—OXIDE OF ZINC. Formula.—ZnO. Derivation.—Oxide of Zinc is obtained by subjecting precipi- tated carbonate of zinc to a red heat, till the whole of the carbonic acid and water are expelled. It is in the form of a yellowish-white powder, insoluble in water, but soluble in dilute sulphuric and hydrochloric acids, without effervescence. It is inodorous and tasteless. Medical Properties and Action.—Oxide of zinc is tonic and antispasmodic, but in large doses causes vomiting and purg- 344 DENTAL MEDICINE. ing; by gradually increasing the dose, large quantities can be taken without injurious effects. It should never be given on an empty stomach, as it may cause nausea. Therapeutic Uses.—It is employed in spasmodic asthma, con- vulsions of children, epilepsy, chorea, whooping cough, hys- teria, and is an excellent remedy for gastralgia; also in chronic diarrhoea and chronic dysentery. Dose.—Of oxide of zinc, gr. ss to gr. x. Dental Uses.—Oxide of zinc may be employed in the treat- ment of convulsions of children during dentition, given in doses of gr. ss to gr. v, gradually increased to gr. viij, in pow- der, with a little sugar. It is also combined with carbolic acid, in a fluid form, for capping exposed pulps, being applied in the form of a paste to the exposed surface of the dental pulp. It also forms an ingredient of the zinc-filling materials, and of the celluloid base for artificial teeth. (See Appendix to Dental Formulary.) ZINCI SULPHAS—SULPHATE OF ZINC. Formula.—ZnS04 7H20. Derivation.—Sulphate of Zinc is obtained by the action of sulphuric acid on granulated zinc, the solution being purified by means of chlorine and carbonate of zinc, and afterwards evaporated, the product being crystals of sulphate of zinc. It is in the form of colorless crystals, which effloresce on expos- ure to air, and are soluble in water and insoluble in alcohol, resembling in appearance Epsom salts. It has a disagreeable, metallic, styptic taste. Medical Properties and Action.—Sulphate of zinc is tonic, astringent, antispasmodic, and, in large doses, emetic. Exter- nally, it is stimulant and astringent. When its use is long continued, it produces symptoms like those of lead. When administered in proper doses, it exerts an antispasmodic in- fluence on the nervous system, and where there is spasm and convulsion, it is very serviceable. Therapeutic Uses.—It is internally administered in epilepsy, chorea, hysteria, angina pectoris, chronic dysentery, flatulence, APPENDIX TO DENTAL MATERIA MEDICA. 345 night sweats of phthisis, etc., and is a prompt emetic in cases of narcotic poisoning. Externally, it is employed in the treat- ment of gonorrhoea, diseases of the eye, chronic skin diseases, epithelioma, ulcers, gangrene, etc. Dose.—Of sulphate of zinc, gr. % to gr. vj. For an emetic in cases of poisoning six grains will prove sufficient, well diluted with water, and repeated every fifteen minutes until emesis occurs. Dental Uses.—Sulphate of zinc is employed externally in dental practice, in gangrene of the mouth, disease of the antrum, ulcerations of mucous membrane, and indolent ulcers, acting as a stimulant and astringent. DENTAL FORMULAE. For Gangrene of the Mouth, [Cancrum For Ulceration of Mucous Membrane Oris). of the Mouth. R. Zincisulphat.............. gr.xx R. Zinci sulphat........ gr. j to v Mellis..................:... gj. M. Aquae destillatae..... ^j. M Signa.—To be applied with a camel's Signa.—To be used as a gargle or. hair brush. lotion. For Chronic Alveolar Abscesses, Abscess of Antrum, etc. G. L. Parmele. R. Zinci sulphat................................................. gr. iij Plumbi acetatis............................................ gr. v Tinct. catechu.............................................. gtt. x Aquae.........................................................f|j. M. Signa.—Use as a stimulating injection. APPENDIX TO DENTAL MATERIA MEDICA AND THERAPEUTICS. Antiseptic and Styptic Cotton- Wool.—First free the ordinary cotton-wool from grease, by macerating it in benzine for ten minutes, press and dry in the air. Then steep the purified cotton, for ten minutes, in a solution of tannin 5, carbolic acid 4, alcohol 50, and castor oil 8 parts. Styptic Cotton- Wool.—Purify, as before, with benzine, dry in air, and then steep it in a solution of alum 2, water 12, chloride of iron solution 2 parts; dry at 6o° C. 23 346 DENTAL MEDICINE. Chloride of Aluminium—Aluminii Chloridum.—The chloride of aluminium, also known as Chloralum, is prepared by pass- ing chlorine, at high temperatures, over a mixture of aluminium and charcoal. By placing the anhydrous chloride of alumi- nium in water, it is converted into hydrated chloride. It is said to be quite as potent as chloride of zinc or carbolic acid, and devoid of poisonous properties and unpleasant odor, and is unirritating, rendering it a useful antiseptic and disinfectant. As it does not cauterize, it is especially convenient for applica- tions to the mouth. The taste is sharply saline, like that of alum, and its action closely approximates that of chloride of zinc. In dental practice it has been used in the treatment of peri- odontitis, alveolar abscess, caries of bones, putrid pulps, alve- olar pyorrhoea, and other diseases of mucous membrane. Chloride of Magnesia—Magnesii Chloridum, is prepared by evaporating to dryness a concentrated solution of muriate of magnesia, the chloride being obtained in the state of a fused hydrate. It is a bitter, very deliquescent salt, which acts mildly and favorably as a purgative, causing a flow of bile, and an increase of appetite. On account of its extreme deliquescence the liquid form, prepared by dissolving the salt in its weight of water, is preferred. The dose, diluted, is Sss to Sj. In dental practice the hypochlorite of magnesia has been employed for bleaching teeth. Chloride of Tin—Stannum Chloridum, is prepared by heating tin and hydrochloric acid together, and has been recommended for local application in purulent discharges. According to M. Mallez, chloride of tin has a direct action upon purulent secretions from mucous surfaces, without any substitutive action, like nitrate of silver, for instance. Placed in contact with pus globules, under the microscope, these are seen to immediately disappear. In purulent diseases of the eye, also, it was successful. A solution consisting of 5ss of the salt in fSiij of distilled water, is used for injections. Glyceroborate of Calcium is a powerful antiseptic, and is pre- pared by mixing equal parts of borate of calcium and glycer- APPENDIX TO DENTAL MATERIA MEDICA. 347 ine, and heating the mixture to about 1600, with constant stirring, which is kept up until a drop of the mixture falling from the end of a stirring rod upon a glass plate solidifies, on cooling, to a clear, colorless, brittle bead; the mass is then poured out, and after cooling, is broken up and the fragments at once put into a well-stoppered and dry bottle. It is soluble in all proportions of water, and on exposure to the air will rapidly become liquid, taking up its weight of water. Even when in a very dilute solution it is a powerful antiseptic, with no odor and no poisonous properties. Glyceroborate of Sodium is prepared in the same manner as the glyceroborate of calcium, simply substituting the borate of sodium. It possesses the same properties as the glyceroborate of calcium, and is somewhat preferable to the latter, as even concentrated solutions of the glyceroborate of sodium can be applied to the eye without inconvenience. Both preparations will preserve meat for a long time. Naphthalin may be obtained by subjecting coal tar to distil- lation, when it passes over the coal naphtha. It is purified by subliming it with charcoal, and is then in the form of a white, crystalline body. It has a slightly aromatic taste and the odor of coal tar. While it has no poisonous effect on man and the higher animals, it is destructive to fungi, spores, small insects, etc. It is soluble in alcohol, ether, naphtha and the oils, but insoluble in water. As an expectorant it has been used in humoral asthma and in chronic pulmonary catarrh, in doses of from gr. viii to xxx, in syrup or emulsions, and as an ointment in skin diseases of a scaly natur*. Naphthalin is a powerful antiseptic, and can be used as a substitute for iodo- form, with the advantage of not producing any constitutional action. Its application causes a slight pain of short duration. As an antiseptic and disinfectant it is applied to indolent ulcers, septic and unhealthy wounds, ulcerating cancerous growths, phagedenic ulcers, etc. It is said that its antiseptic property is superior to that of carbolic acid, and as an odorless preparation, it will do doubt become a desirable substitute, as it has no corrosive action and will not injure textile fabrics. 348 DENTAL MEDICINE. Oleates.—Medicinal oleates are, according to Dr. J. D. Shoe- maker, definite chemical compounds or salts, having no excess of either their acid or basic radicals, and Dr. Lawrence Wolff finds that the best and readiest method of preparing oleates is by the double decomposition of sodium oleates with solutions of neutral salts. The sodium oleate is made by the saponifi- cation of oleic acid with sodium hydrate. -Dr. Squibb, how- ever, is of the opinion that in the preparation of oleates, none are so good as those made by the direct union of the acid with the dry base, without heating, and that the preparation should always be either a liquid or semi-solid which is easily and completely liquefied by the natural temperature of the surface to which it is applied; and he further says, that in the rare cases where the excess of acid as a solvent of the oleates proves an irritant to the skin, dilution with a bland oil becomes admissible. The most common oleates in use are those of mercury, zinc, lead, copper, aluminium, bismuth, iron, arsenic, silver, aconite, atropine, morphine, veratria and strychnine. Oleates of the more active alkaloids, namely, aconitia, atropia, strychnia and veratria, are usually made of the strength of two per cent, of the alkaloid; the oleate of morphia usually con- tains five per cent, of the alkaloid; the oleate of quinine usually contains twenty per cent, of the alkaloid. Dr. Squibb says that all of these are very simply and easily made by put- ting the weighed quantity of the alkaloid into a mortar, adding a small quantity of the oleic acid, little by little, and triturating until the alkaloid is completely dissolved. The strong solu- tion thus made is »then poured into a tared bottle, and the mortar and pestle rinsed twice into the bottle with small quan- tities of oleic acid. The proper weight is then made up by the addition of oleic acid. According to the preparation of oleates as recommended by Dr. Shoemaker— Oleate of Mercury is prepared by precipitating a solution of sodium oleate with mercuric chloride, and is the best local stimulant and alterative application of all the mercurials. It may be diluted with either the parafnnates, or, better still, with APPENDIX TO DENTAL MATERIA MEDICA. 349 lard or lard oils. When applied to the unbroken skin it causes marked stimulation, bordering on congestion. It has great penetrating power, is readily absorbed by the skin, and does not become rancid nor stain the linen. It is a valuable remedy in syphilis, the treatment of indurations after abscesses, skin diseases of a scaly nature, obstinate ulcers, parasitic affections, etc., and may be employed advantageously with other oleates. As it is capable of producing the constitutional effects, it must be employed carefully. A mixture of oleate of mercury gr. x to xx, with the oint- ment of oleate of zinc 5j, is very effective in chronic acne and eczema, especially in the fissured variety of the latter common to the palmar and plantar surfaces. For syphilitic skin erup- tions and in superficial ulcers, oleate of mercury 5j, with oleate of bismuth 5iij, or the same quantity of the ointment of the oleate of lead, acts promptly and efficiently. For one of the best and most efficacious oily applications for loss of hair, especially when the scalp is harsh and dry, and the hairs dull and without lustre, a preparation composed of oleate of mercury 5j to ij, with oil of ergot Sj, is highly recommended. Oleate of Zinc is prepared by decomposing a sodium oleate with a saturated solution of zinc sulphate, boiling out and drying the precipitate and then reducing it to an impalpable powder. One part of oleate of zinc melted with three parts of lard or oil gives a most useful ointment, but the best results are obtained from the oleate of zinc alone. It is in the form of a fine, pearl-colored powder, having a soft, soapy feel, much like powdered French chalk. It is valuable in all forms of sweating. Oleate of Lead is prepared by precipitating a sodium oleate with a solution of lead subacetate. To form the ointment of lead oleate, the washed and dried precipitate is melted with equal parts of lard. Oleate of lead exerts a combined seda- tive and astringent action when applied to denuded skin, and also arrests morbid discharges, protects the surface, and allays irritation. It is useful in eczema, acne and other skin diseases. For skin diseases, oleate of lead 5ij, with oleate of bismuth 350 DENTAL MEDICINE. 5j, is very effectual, especially in the fissured form of palmar and plantar eczema; and when the cracking is very deep, to cause stimulation, oil of cade gtt. xx to xxx may be added. In scabies, oleate of lead 5iv with sulphur 5ss is an excellent application. Oleate of Aluminium is prepared by decomposing sodium oleate with aluminium sulphate. The washed precipitate, mixed with equal parts of lard, forms an ointment of a semi- solid, dark-brown color, which is very astringent in its action. It rapidly arrests all muco-purulent discharges, and is an efficient dressing for foul ulcers, sinuses, burns and scabs. Oleate of Bismuth is prepared by first obtaining crystallized bismuth nitrate, and dissolving it in glycerine and decomposing with this the sodium oleate. It is of the consistence of oint- ment, and of a pearly-gray color and a soft, bland substance. It has an emollient and somewhat astringent action, and is an excellent application for relieving cutaneous irritation. In pustular eruptions, especially sycosis, it is a useful application; also in superficial erysipelas, sunburn and chronic inflamma- tion of a portion of the face. Oleate of Copper is prepared in a similar way to the oleate of lead, by double decomposition with a saturated solution of copper sulphate. A ten or twenty per cent, ointment can be made with either cosmoline, fat or lard. When applied to the unbroken skin, it penetrates deeply, and causes a slight stimu- lation ; and when applied to broken skin, it coats it with an insoluble albuminate. It is very efficient for ringworm, and in the most obstinate cases usually effects a cure. It is also used with advantage on indolent ulcerated surfaces, and with effect on hard, horny warts and corns. Oleate of Arsenic is obtained from arsenious chloride, made by the careful saturation of hydrochloric acid with arsenic. This solution is mixed with sodium oleate, when the arsenic oleate is precipitated. In the proportion of gr. xx to an ounce of fatty base, it forms oleate of arsenic ointment, which is soft and yellow, having no action on the skin. When applied to wounds, or ulcerating surfaces, it destroys the tissue to some APPENDIX TO DENTAL MATERIA MEDICA. 351 depth. It is used in lupus, the ulcerating variety of epithelioma, and, after scraping the surface, to destroy warts, corns, old granulations, etc. It may be combined with arnica, opium, belladonna or hyoscyamus. A number of other oleates are in use, among them Nickel oleate, which is a greenish, waxy mass, which is used in the form of an ointment, containing from five -to fifteen grains to the ounce of lard, is astringent and somewhat escharotic, and useful for hard, horny, granulating surfaces; Silver oleate, a brownish pulverent substance, and, in the form of ointment, valuable for application to ulcers, erysipelas, etc.; Cadmium oleate, a yellowish-white mass, and in the form of ointment (five to fifteen grains to the ounce), has an astringent and escharotic action, and is useful in glandular enlargements and thickening of the integument. Oil of Sanilas—Oleum Sanitas, is obtained by the oxidation of oil of turpentine floating on water, by directing a stream of heated air on its surface. Sanitas oil is an antiseptic and dis- infectant, possessing considerable oxidizing power. It is non- irritant and non-poisonous, and its odor is similar to fresh pine. The oils of cinnamon, gaultheria and sassafras will disguise its odor. In dental practice, the oil of sanitas has been very successfully employed in alveolar pyorrhoea, alveolar abscess, diseases of mucous membrane, exposed pulps, abscess of the antrum, foul ulcers, wounds, and ulcerated sore throat. Pinus Canadensis—Abies Canadensis, hemlock, hemlock spruce of the United States and Canada. The medicinal portions are the juice and bark. The concrete juice, which is known as Pix Canadensis—Canada pitch, is a yellowish or faintly greenish, transparent, viscid liquid, when fresh, but afterward becomes an opaque, reddish-brown, hard and brittle mass, which contains resin and a volatile oil. It is used to make rubefacient plasters. The bark is rough and deeply furrowed, and is very astringent, possessing properties similar to those of the white-oak bark. An extract prepared from the bark is used as a topical astringent, but it is not considered to have any advantages over other common vegetable astringents. 352 DENTAL MEDICINE. For Inflamed Mucous Membrane, and for Use after the Removal of Salivary Calculus. (A. W. Harlan.) R. Pinus canadensis (white).............................. % ss Aquae rosae................................................ ifiijss Eugenol.................................................... Tllxxx. M. Signa.—Use as a lotion or on a tooth-brush, three times daily. Trichloroacetic Acid—Acidum Trichloroaceticum—Formula, CCl3Co2H, is a crystalline body, readily soluble in water and alcohol, with an agreeable odor. It coagulates albumen, and its concentrated solutions are caustic. Diluted solutions cause an increased secretion of saliva, and destroy its power to convert starch into sugar; it also arrests the digestive action of pepsine. As an antiseptic it has been employed in putrid and indolent wounds, in the form of weak solutions, which are unirritating, and promotes healthy granulations and cicatriza- tion ; it has also been employed externally in erysipelas and venereal sores. Internally it has been recommended by Dr. Filippowitch as a preventive of cholera, in doses of gr. ij to iij, three or four times daily. Externally, it is employed in one or two per cent, solutions. The common dose is gr. ij to v, in very dilute solution, three times a day. It has also been used internally for gastric catarrh, and the summer com- plaint of children; for the latter, in doses of gr. y2 to I, three times daily. In a two per cent, solution it destroys all forms of organic life ; in five per cent solution it arrests the growth of bacteria and micrococci. TOPICAL REMEDIES. Medicinal substances are applied to the mucous membrane of the mouth and to the dental structures, almost exclusively for local effects. In dental practice antiseptic remedies are extensively employed to arrest fermentative and putrefactive processes, as every kind of fermentation depends upon the growth and increase of a living organism. Various diseases of the dental structures have a close relationship with low organisms, in the morbid processes which result during their TOPICAL REMEDIES. 353 progress, and which are maintained and developed by the presence of living matter. The remedies recognized as be- longing to the group of antiseptics, when brought into con- tact with the disease germs, which are constituted of these organized forms of life, have the power of destroying their vitality and of arresting the fermentative or putrefactive pro- cess which they either develop or promote. The effect of escharotics when applied to a part of which the structure and vitality are to be destroyed, is to produce an eschar and incite inflammation and suppuration of the adjacent tissues, by which the slough is separated from the living parts. Medicinal substances are applied to the mucous membrane of the mouth in the form of gargles or mouth washes, lotions and injections, and generally for a local effect. Medicinal substances are applied to the skin for both a local and general effect, either by friction, by the endermic, or by the hypodermic methods. In the endermic method, the cuticle is Usually removed by the action of a blister, and the medicinal agent is applied to the denuded surface in the form of a powder or ointment, and is a useful method when the irritability of the stomach or difficult deglutition prevents medicines from being taken through the mouth. The hypodermic method consists in injecting medicines by means of a graduated syringe with a sharp-pointed nozzle, and constructed for the purpose, into the subcutaneous cellular tissue, thus producing both a local and general effect, and an impression is made much more rapidly than when the medicine is taken into the stomach. The medicinal agents used for hypo- dermic injections-are so prepared as to be perfectly soluble, and of considerable strength in small bulk. Anodynes thus used are more rapid in their effect, and the general rule as regards the quantity is, that in first injections the dose should be, for males, two-thirds of the ordinary dose by the stomach, and for females, about one-half. It is very necessary that a vein should not be punctured when introducing the point of the syringe. The insertion of the deltoid muscle in the arm is generally selected as the place of injection, and the needle- 354 DENTAL MEDICINE. point of the syringe should not be inserted very deep, nor at the same point in subsequent injections. Medicinal substances of the classes of rubefacients and epispastics are employed as counter-irritants, their effect being to establish external or artificial irritation for the relief or cure of internal inflammation existing in a part or in the body. The extent and character of the counter-irritation thus es- tablished should be, in a great measure, regulated by the character of the disease which it is intended to relieve; a rubefacient being indicated in irritation of mucous membrane, a seton or issue when the disease is of a suppurative character, and a vesicant in inflammation of serous membranes. Setons and Issues are employed to produce permanent counter-irritant effects. A seton consists of a skein of silk or a piece of tape or other substance passed through the in- tegument by means of a seton-needle, and allowed to remain, so that a discharge is maintained. A simple seton in the case of an incision into an alveolar abscess, is composed of a single or double strand of floss silk introduced into a wound made by the lancet, or into the orifice of a fistulous opening, after the pus of the abscess has been evacuated, to maintain a free exit for the pus which may be secreted after the first operation; fine silver wire is also employed for the same purpose. An issue is generally some irritating substance, such as caustic potassa, or a small pea, or piece of orris root, introduced to maintain a discharge. Bloodletting is performed for the purpose of lessening vascu- lar excitement, reducing inflammatory action, relieving con- gestive pain and spasm, promoting absorption, relaxing the muscles and arresting hemorrhage. It is divided into general and local, general bloodletting consisting of venesection or phlebotomy, the median cephalic or basilic veins of the arm, and occasionally the external jugular and other veins, being the ones selected from which to draw the blood. But it should be resorted to with caution, as it is a powerful and exhausting agent* Local Bloodletting is chiefly employed for the relief of local TOPICAL REMEDIES. 355 inflammations and congestions, and is accomplished by means of leeches, cups, and scarifications. The leech—hirudo—is commonly employed as an agent for local bloodletting, and is preferable to "cupping" in many local and chronic forms of inflammation; also in infantile affections which require such an operation, when the American leech is used, as it makes a smaller incision than the European leech, and draws less blood. A leech is supposed to draw, on an average, about a drachm and a half to two drachms of blood before it is removed, and the quantity which subsequently flows will generally equal that drawn by the leech. Leeches are often applied to the gum over the root of a tooth affected with acute periostitis, to relieve the inflammation and congestion. To make the leech bite readily, the surface to which it is to be applied may be smeared with cream or sweet milk, or a puncture may be made in it, so as to draw blood, and, to isolate the part of the surface on which it is desired to apply the leech, a small hole may be made in a piece of bibulous paper, which will adhere to a dry surface of the gum, and afford an opening for the mouth of the leech to ap- proach the surface. To remove a leech, if it does not drop off of its own accord, which they will generally do in from fifteen to twenty minutes, it may be sprinkled with a little cold water or diluted vinegar, or powdered sugar. To promote bleeding from leech bites, fomen- tations or warm dry cloths, or a cupping glass, may be used. To check the hemorrhage from leech bites, which is sometimes ex- cessive, firm pressure may be made with the finger, or exposure to cold air, or the application of such styptics as alum or matico. Cupping is employed when it is desired to draw blood rap- idly, or to ascertain the exact quantity of blood drawn, or when it is desirable to make an impression on the system. Cupping is performed by means of cupping glasses and a scarificator. The glasses are applied after being partially exhausted of air, when the removal of the atmospheric pressure produces a de- termination of blood to the capillaries of the part, and it is afterwards easily drawn by scarification. 356 DENTAL MEDICINE. Scarifications consist of small incisions made in inflamed and congested parts, to relieve the engorged condition of the capillary vessels, and are sometimes employed to relieve acute inflammation of the gums and mucous membrane of the mouth. ERUPTION OF THE TEETH. TEMPORARY TEETH. (The inferior generally precede the superior by two or three months.) Central incisors, . . . 5 to 8 months. Lateral " . . . 7 to 10 1st molars, . . . . 12 to 16 " Canines, . . . . 14 to 20 " 2d molars, . . . . 50 to 36 " PERMANENT TEETH. 1 st molars, . . . . 5 to 6 years. Central incisors, . . . 6 to 8 " Lateral " . . . . 7 to 9 " 1st bicuspids,.....9 to 10 " 2d .... 10 to 12 " Canines,.....11 to 13 " 2d molars, . . . . 12 to 14 " 3d .....17 to 21 " ELECTRICITY AS A THERAPEUTIC MEANS IN THE TREAT- MENT OF DISEASE. Electricity is a powerful agent in many forms of nervous disease, especially in the treatment of paralysis and neuralgia. Three forms of electricity are employed, viz.: The induced current, the galvanic current, both of which are dynamical, and the static current, which is frictional. Galvanic electricity—galvanism, and induced electricity— faradism, are the two forms generally employed, frictional electricity being but seldom applied. What is known as electro- magnetism is a form of induced current, generated by the rotary instrument, and is not reliable. Faradism, so called from its discoverer, is generated by an instrument which is capable of applying slow or rapid shocks, and giving what is THERAPEUTICS OF ELECTRICITY. 357 denominated a fine, strong, induced current. It consists of coils of wire; a small hammer of soft iron, attached to a spring; a pole, containing a platinum-pointed screw; the ham- mer breaking the current in the coil of wire, and by rapid vibration producing shocks. " The galvanic current is generated by a series of cells, suffi- cient in number to cause a current of tension, which is the resistance offered to the passage of a current. " One cell supplies a current, the poles of other cells being alternately joined, and there are finally but two terminal poles." As the current from the first cell passes through the remaining cells, its power is increased and the effect is governed by the number of cells belonging to the circuit. There is also what is denominated a current of " quantity," which is generated by a large metallic surface in the battery cell, the tension current being generated by a number of small metal plates. The " tension current" serves the best purpose for medical use, while the " quantity current " furnishes heat, and is, therefore, adapted to purposes of electro-surgery. The modified Bunsen galvanic cell is the best for medical purposes, although what is known as -the Siemens and Halske cell is extensively used ; " it consists of an outer cell of glass, with elements of zinc and copper, a diaphragm of porous earthenware, and a dia- phragm of papier mache, between the solutions." The Holtz electric instrument furnishes the best static current. The Ruhmkorff coil is also employed, in the use of which but one wire is brought in contact with the patient, the other conductor being formed by the air, and a spark, similar to the ordinary spark from the friction machine, being produced. When electricity is applied to the body, sponges of differ- ent sizes, or polished metallic surfaces, known as " electrodes," the metallic being the best, are employed, the effect upon the skin being similar to what is caused by puncturing with many small needles. The theory of electro-therapeutics is dependent upon the following effects :— " If a portion of a motor nerve is included between the poles of a galvanic battery, it is said to be polarized, and in a state 358 DENTAL MEDICINE. of electrotonus. At the positive pole, the irritability of the nerve is diminished, while at the negative it is excited and more susceptible to stimulation. The condition at the positive pole is called anelectrotonus, and that at the negative catelectro- tonus. The positive pole is known as the anode; the negative, the cathode, and these give the name to the states described. A nerve is said to be tetanized when the muscle supplied is thrown into a state of permanent tetanic contraction by a rap- idly intermitting current. The passage of a number of these shocks for some time will diminish the irritability of the nerve to such an extent that, finally, there will be no further response; An ascending current causes a greater irritability in a nerve than a descending one; a descending one depresses excitability. The stimulus is felt at the negative pole when the current com- mences, and when it is broken it is felt at the positive pole. A shock is felt at the opening of the weak currents ; with mod- erately strong ones it is felt both at the opening and the closure. With very strong currents, it is impossible to tell the points of sensation, as the power of the nerve is impaired." The action upon involuntary muscles is less than upon the voluntary, and, as regards the latter, it is the same, or nearly so, as long as the integrity of their immediate nerve supply is concerned. Degenerations and atrophies of muscles interfere to a con- siderable extent with their susceptibility to electric currents; hence it is better, in diseased conditions, to pass the current through the nerve trunk which supplies them. The faradic current has but a local effect, the deeper muscles and nerves escaping. When a metallic or sponge electrode is applied to the moistened skin, a prickling sensation follows, attended with redness and tingling, and this impression on the cutaneous nerves and muscles is known as electro-muscular sensibility. The galvanic current occasions a sensation of warmth, like that produced by a local stimulant, such as a mustard plaster, and when the faradic current is applied to the dry skin, or when the electrodes are but lightly applied, there is produced THERAPEUTICS OF ELECTRICITY. 359 a sensation of pain, and the pain is the greater when caused by rapidly succeeding shocks than by slow ones. The galvanic current causes deeper impressions than the faradic, and also electrolytic changes different from the faradic, producing absorption and changing the structure of the dif- ferent tissues, and beneficial results have resulted from its application in diseases of the brain. The physical effects of the galvanic current upon the sympathetic nerve are dilatation followed by contraction of the pupil, diminished frequency of the pulse, and a lowering of the tension of the carotid arteries. When electricity is used for the purpose of diagnosis, the existence of local tenderness, exalted sensibility, anaesthesia, paralysis, diseases of the brain, spinal cord, etc., may be as- certained. It has also been used to determine the question of doubtful death, whether certain affections are recent or of long standing, and to detect malingering. As various nervous dis- eases are associated with the loss of such functions of muscles as contraction and sensation, or the reverse, electricity deter- mines the extent of such changes. When applying the electric current, the anatomy of the part affected should be well understood, for example, for neuralgia of the fifth pair of nerves one pole should be applied as near as possible to the point of exit of the nerve from the cranium, and the other pole to the remote parts of distribution. Galvanism and faradism are employed for the relief of pain and spasm, to improve the nutritive processes, and to restore deficient muscular power, to stimulate sensation in nerves, to stimulate secretion, to influence circulation, to cause absorption of fluids, to bring about the absorption of morbid growths and deposits, to induce sleep, and in surgery, in the form of the galvanic cautery. The galvanic current is con- sidered to be the most useful for the mediate, and the faradic current for the immediate application, the former proving serviceable in all forms of neuralgia, and especially in facial neuralgia, and the latter in headaches, especially those of a rheumatic nature. 360 DENTAL MEDICINE. Galvanism is also employed with advantage in sciatica, spinal irritation and hysteria, also tumors, such as aneurisms and goitre, these morbid products being dispersed by con- necting the two poles of a galvanic battery with needles, which are thrust into the morbid growth and generate a process known as electrolysis. In such operations bubbles of hydrogen gas are disengaged at the negative pole, which sparate mechanically the adjacent tissues, breaking them up in such a manner that the disintegrated particles may be taken up by the circulation. Oxygen is disengaged at the positive pole, which forms an acid with certain elements of the tissue, and the albumen is coagulated, forming a clot if this occurs in a cavity filled with blood. For surgical operations, as a substitute for the knife or ecraseur, a platinum wire is placed between the poles of a powerful battery, the wire being adjusted in a handle, which in a few minutes becomes white hot, and is especially ser- viceable for operations in deep cavities where it would be impossible to use the knife, the application of such a galvanic cautery being unattended by pain or hemorrhage. Strong currents of electricity should not be applied to the head, nor its use be persevered in for more than fifteen minutes at a time. Electro-magnetism has been employed for relieving pain during the extraction of teeth, one pole of an ordinary battery being attached to the forceps and the other to a handle which is grasped by the patient. The susceptibility to the current is first ascertained by the patient holding both the forceps and the handle in his hands, and a feeble shock applied, which is gradually increased until the sensation is felt at or just beyond the elbows, when the current is somewhat reduced in power. After the gum has been lanced, the connection is made as before described, by the patient holding the handle and the operator the forceps in contact with the tooth to be removed, the handles of the instrument being isolated, when the operation is at once completed. Great diversity of opinion, however, exists as to the efficiency of this method, which has its advocates and opponents. APPENDIX TO DENTAL FORMULARY. 361 APPENDIX TO DENTAL FORMULARY. Dentifrice in the For??i of Troches. R. Cretae preparatae........ ib.iv Sodii boratis (pulv.)... 3X Saponis Castil " ... 3X Sacch. albae " ... Ib.iss Ossis sepiae " ... Ib.i^f Olei rosae................ gtt.xxx Millfleurs................. 3*j Essentiae jasmin........ B/4- Mix with a solution of gum syrup. Antiseptic Solution for Washing and Spraying Wounds, etc. R . Acidi carbolici (cryst.) partem j Aquae...................... part.xxiv, SlGNA.—Dilute the above solution with equal parts of water, which will make it equal to 1 part of the acid to 40 parts of water ; for use in disinfecting instruments and sponges. For a Disinfectant in Mercurial Salivation. R. Potassii permanganat.. gr.xv Aquae...................... f^ viij. Signa.—Use as a gargle. For Ulceration of Gums and Mucous Membrane of Mouth. R. Potassii chloras......... Jjij Aquae..................... 3*v. M. Signa.—A tablespoonful 3 times a day; also as a gargle 4 or 5 times a day. For Neuralgia of the Head. (von niemever.) R. Ext. hyoscyami, Zinci oxidi......aa...... 9 ij. M. Signa.—Fiat pill. xj. Begin with one pill morning and evening, and increase to xx or xxx daily. For Sensitiveness Following the Re- moval of Salivary Calculus. (COLEMAN.) R. Aciditannici............ 3*ss Eau de Cologne.........f 3" iv. M. Signa.—Add 10 or 12 gtts. of above so- lution to a teaspoonful of tepid water, and use as a gargle 3 or 4 times a day. Oxyphosphate of Zinc Preparation for Filling Teeth. POWDER. R. Zinci oxidi............... partes 200 Silicii (fine powd.)..... partes viij Sodii boratis............. partes iv Pulv. glass............... partes v. Levigate under water, to ensure com- plete admixture, and dry by evapora- tion ; then calcine at a white heat; then reduce to powder. LIQUID. R. Acidi phosphorici, Aquae................. q.s. to dissolve, and evaporate the solution by aid of heat, until it is of the consistence of glycerin. Another Formula for the Oxyphos- phate Preparation, in which simply the calcined oxide of zinc and glacial phos- phoric acid are employed, is prepared as follows:— Calcine the oxide of zinc for two hours, at a white heat, or until it becomes a hard, yellowish mass; then pulverize in a mortar, and sieve through fine bolting cloth. For the liquid, take 3*j of glacial phosphoric acid (German), in crystals, and dissolve in f 3*j of water, and then evaporate to one-third, on a sand bath. 24 362 DENTAL MEDICINE. For Pulpitis. (garretson.) R. Creasoti................... gtt.yj Tinct. iodinii............ 3J Liq. plumb, subacet... 3J Chloroformi, Tinct. opii......aa,...... 3*ss. M. SlGNA.—Apply, on cotton, to exposed surface of pulp. For Neuralgia of Superficial Nerves. (aitken.) R. Atropinae sulphat...... gr.v Aquae destillat..........f^iij- M. Signa.—Use on a compress and renew several times in 24 hours, and con- tinue for at least one hour at a time, covering with oilskin, to prevent evaporation. For Facial Neuralgia. (wales.) R. Potassii bicarb.......... 3SS Ext. ergotae fluidi......f 5 j Infusi ergotae............f^ vj. M. Signa.—Two tablespoonfuls every four hours. For Neuralgia. R. Zinci valerian........... 5 ij Ext. gentianae........... Qj Ext. nucis vom......... gr.v. M. Fiat pill. No. xx. Signa.—One pill three or four times a day. Oxychloride of Zinc Preparation for Filling Teeth. powder. R. Zinci oxidi............... gr.xxx Sodii boratis............ gr.ij Silicii (fine powd.)..... gr.j. Mix thoroughly and subject to a bright red heat, in a crucible. Then grind this frit to a powder, and mix it with three times its weight of calcined oxide of zinc. liquid. R. Zinci chloridi (deliq.) f^j Aquae...................... f|j v to vj. For Gangrene of Mouth (Cancrum Oris.) R. Bismuthi subnitratis (powd.) Applied to ulcerated surface and covered with absorbent cotton. For internal administration, to support the strength :— R. Quininae sulphat............................................ gr.iij to v Tinct. ferri chloridi....................................... gtt.v. M. Signa.—Three times daily. AUTHORITIES CONSULTED. Pharmacopoeia of the United States, 1882. Bartholow's Materia Medica and Therapeutics. United States Dispensatory. Braithwaite's Retrospect. National Dispensatory. Waring's Practical Therapeutics. Blakiston's Physician's Visiting List. Biddle's Materia Medica. British Pharmacopoeia. American Journal of Medical Sciences. London Lancet. British Medical Journal. Medical and Surgical Reporter. Stille's Therapeutics and Materia Medica. Taylor on Poisons. Tanner on Poisons. Wood's Therapeutics, Materia Medica and Toxicology. Medical Record. New York Medical Journal. Medico-Chirurgical Transactions. Ure's Dictionary. Therapeutic Handbook of the United States Pharmacopoeia. Universal Cyclopaedia—A. McLane Hamilton. Ellis' Medical Formulary. Compendium of Medical Science. American Journal of Dental Science. Dental Cosmos. Independent Practitioner. Ohio State Journal of Dental Science. London Dental Record. British Journal of Dental Science. Garretson's Oral Surgery. Tanner's Index to Diseases. Pereira's Materia Medica and Therapeutics. 363 « INDEX TO DISEASES AND DENTAL FORMULARY. i, 305. ABNORMAL Dentition, .... Abraded Surface of Mucous Membrane of Mouth, Abrasion of Teeth, ........ Abscess, of Antrum.......4°. J93> Absorption of Process and Recession of Gum, Acidity and Pyrosis,..... Alkaline Gargle, Alveolar Abscess, Hemorrhage, Pyorrhoea, Anaemia, Anaesthetics, General, Local, . Anodyne Lotion, Antiseptic Dentifrice, Gargle, Lotion or Injection, Aphthae, . . 49 Aphthous Ulcerations, . Astringent Dentifrice, Gargle, ..... Lotion, Gargle or Mouth Wash, Atrophy of Teeth, .... 39, 40, 235, 256, 27 . 51, 142, 143, 157, . 95, 165, 213, 217, 238, 57, 193, 216, 217, 240, 256, BLEACHING Discolored Teeth, Kirk's Method of, Bruises,..... Burns, ..... Burnett's Disinfecting Fluid, . CANCEROUS Tumors, . Ulceration, Carbolized Potash, . Styptic..... Caries of Maxillary Bones, Chapped Hands and Lips, Chilblains, .... Chronic Abscesses and Ulcers, . Alveolar Abscesses, Ulcerations, etc Inflammation of Gums and Mucous Membrane, PAGE . 37 160, 161, 194 54 • 23 248, 300, 314 • 56, 157 • 199 • 33i 318, 335. 342 161, 232, 252 248, 305, 343 . 10 240, 241, 288 . . 178 220 • H3. l6° • 155 . 142, 361 276, 313. 3J4 3H, 331. 332 . 160 . 147 147, 161 54 56, 205, 313, 332, 333 • 332 164, 194 • 155 • 341 45, 50, 132, 133, 187 . 26 142 • H3 151, 157, 240 • 3°9 • H3 . 161, 255, 271 • 255, 271 124, 148, 160, 183, Inflammation, 365 193, 255, 256, 275, 288, 309, 314 . 25 366 INDEX TO DISEASES AND DENTAL FORMULARY. Cleft Palate,..... Cocaine, To make Preparations of, Convulsions of Dentition,- DANGERS of Anaesthesia, . Dental Caries, Dental Exostosis, Periostitis, Dentifrices, .... 143, 160, Dentigerous Cysts, . Denudation, .... Deodorizer of Iodoform, . Detergent Mouth Wash or Gargle, Devitalizing Pulps of Teeth, . Diarrhoea of Dentition, Diphtheritic Conditions, . Discolored Teeth, Disease of Antrum, Diseases of Dental Pulp, . Disinfectant Mouth Wash or Gargle, Dislocation of Jaw, Dysuria of Difficult Dentition, EARACHE of Dentition, . Ecchymosis, . . Effervescing Powders, Emollient and Antiseptic Gargle, Enlarged Glands, . Epithelioma, .... Epulis,...... Excessive Sweating of the Hands, Exostosis, Dental, . Exposed Pulps, .... 222, 37, 165 223, 237 13 1, 132 40 164, 195, 207, 229, 28 TTIACIA'L Neuralgia, . JO Facial Paralysis, Febrile Excitement of Dentition, . Fetid Perspiration...... Fetor of Breath,..... ■ Fissured Tongue, ..... Foul and Fetid Indolent Ulcers, Fracture of Alveolar Process, of Jaw, ...... Fungous Growths and Suppurating Surfaces, f^ ANGRENE of Mouth (Cancrum Oris), 125, 199, 205 Gingivitis, .... Glycerite of Borate of Sodium, Glyceritum Sodii Boratis, . Glycerole of Thymol, Gutta Percha Solution, HARE Lip, Hectic Fever, . . 48 . 229 37 • 174. 189 57 • 55 231, 269, 271 238, 272, 361 . . 46 • 55 266, 321 • 321, 331 133, 266, 287 . 199, 262 • 131 . 56, 205 193, 248, 300 • 52, 53 143, 154, 361 • 47 279 194 329 155 267 50 5o 271 55 267, 228 53 323 216 339- 362 . 48 262 142, 318 205, 216 • 33i • 215 . 42 47 . 271 240, 318, 345. 362 • 43 ■ 330 • 330 • 335 • 273 25 INDEX TO DISEASES AND DENTAL FORMULARY. 367 Hemorrhage from Extraction of Teeth, Hyperaemia,..... Hypertrophy of Gums, . of Processes, .... of Tonsils, .... Hypnotic,...... IMPACTED Tooth, . Indigestion, Indolent Ulcers of Mouth, Infantile Bilious Diarrhoea, Mucous Diarrhoea, PAGE 147, l6l, 232, 251, 252 . IO 51 • 54 147 . 118 . 46 . 302 125, 215 . 278 . 278 Inflamed and Ulcerated Gums, 124, 142, 147, 161, 255, 314, 315, 316, 321 Fauces and Throat,........125 Mucous Membrane and Gums, 124, 160, 183, 193, 194, 255, 256, 275, 288, 309, 314, 315, 316, 321, 352 Inflammation of Mouth, Syphilitic,.......44 with special reference to the Mucous Membrane of the Mouth, 10 Inflammatory Fever,..........19 Internal Astringent in Hemorrhagic Affections, .... 147 Irritation, ......... . . .11 of Teething, .......... 37 Ischaemia, ............11 Itching of Inflamed Surfaces,......143, 287 of the Skin,...........143 LEAD Poisoning, Local Anaesthetics, Lotion for Soft and Spongy Gums, MALIGNANT Ulcerations, Mercurial Stomatitis, Micro-organisms, Effects of, Mild Detergent Gargle, Mouth Wash, C. A. Harris, .......42 164, 207, 215, 219, 220, 229, 287, 245 142, 160, 183 45, 5o, 133, 187 42, 157, 182, 193, 217, 222, 271, 276 ......16, 27 ..... 321, 33i ........321 ""VTASAL Polypus,.........49 _Li Necrosis of Alveolar Process,.......41 Necrosis of the Jaws..........47 Neuralgia, . . 164, 165,187, 195, 207, 215, 220, 229, 230, 253, 266, 311, 323, 324, 361, 362 from Dental Disturbance,.......253, 362 in Superficial Nerves,........195 Neuralgic Affections, of the Teeth,......220, 239 Odontalgia,..........239 OBTUNDING Mixture, . . 164,181,215,219,220,229,287,325 Odontalgia, 143, 161,164, 182, 219, 220, 229, 230, 232, 235, 239, 256, 265, 266, 281, 287, 296, 307, 319, 328 Odontomes,...........55 Offensive Breath,........205, 216, 276 Ointment of Iodoform and Eucalyptus,.....267 Osseous Tumors of the Jaws,........151 Oxychloride of Zinc Preparations,......362 Oxyphosphate of Zinc Preparations,......152, 361 368 INDEX TO DISEASES AND DENTAL FORMULARY. 37, 165, PAIN following Extraction of Teeth, Parasitic Skin Diseases, . Periostitis, Dental,..... Perspiration of Hands, etc., Phagedenic and Sloughing Ulcers,. Phenol Sodique Preparation, Phosphor Necrosis,..... Plethora, . . . . . . Poisoning,...... Pulpitis, 142., 143, 160, 161, 183, 215,219,220,229,230,232; as a Capping in, . Pulpless Teeth, Pulveris Effervescentes, Putrescent Pulps, . Pyorrhoea Alveolaris, . 247, 248, 256, 263, 264, 266, 302, 51, 142, 143, PAGE I63, 264, 287 . 142, 131 231, 269, 271 • 155 276 . 328 41 . IO . . 78 235, 256, 265, 266, 362 . 267 266, 302 • 329 305- 318, 335 157. 248, 305 EELAXATION of Uvula,........147 Relaxed Condition of Mucous Membrane of Mouth and Gums,.........147, 319 Rheumatic Pains, Bruises, etc.,.......164 Rigg's Disease (See Alveolar Pyorrhoea). Robinson Remedy...........142 SALIVARY Calculus, after Removal of, Salivation, ...... Sandarach Solution, .... Scorbutic Gums, ..... Scurvy, 181, 203, 227, Calculus, Sensitive Dentine, . . 54, 142, Sensitiveness after Removal of Salivary Shellac Solution, .... Skin Diseases, ..... Sloughing and 111 Conditioned Ulcers, Soft and Spongy Gums, Sore Throat,..... Stimulant and Antiseptic Mouth Wash or Lotion, and Antiseptic Injection, and Anodyne Lotion . Stomatitis, ..... Styptic,..... Superficial Inflammation, Suppurating Pulps of Teeth, Wounds,..... Suppuration, .... Syphilitic Teeth, .... Ulceration of Mucous Membrane of Mouth, TEETH deficient in Lime Salts, Thrush, .... Tonsillitis,..... Trigeminal Neuralgia, Tumors of Gums, . . . . of Jaws, .... 142, . 161, 247, 248, 256, 352 42 326 43, 125, 148 229, 230, 281, 341 . 361 • 327 • 142, 143 . 150 60, 183, 320, 328 161, 184 ■ 142, H3, 154 • 142, 143 . 207 43, 44, 45, 217 232, 252, 328, 335 182, 328, 361 263, 266, 302, 318 142, 265 . 21, 271 55 142, 145, 3H 201, 203 • 49 • H7 253, 3°7 266, 267 • 45 INDEX TO DISEASES AND DENTAL FORMULARY. 369 PAGE I TLCERATED Gums, 183, 184, 222, 240, 248, 255, 271, 314, 318, 361 V_J Ulceration..........26, 271 Ulceration and Abrasion of Mouth......161, 194, 255 Ulcerative Stomatitis, 145, 148, 157, 183, 184, 193, 194, 215, 222, 240, 248, 255, 271, 361 Ulcers of Mouth.....145, 157, 193, 215, 240, 248, 314, 318 over Carious Bone,.........151 syphilitic,...........44 Ulitis,............43 VARNISHES, shellac,........327 sandarach,.........326 Venereal Sore Mouth and Throat,.......262 Vomiting and Painful Digestion of Children, . . . .199 "TTTARTS, Condylomata, etc.,.......262 W Wash after Extraction of Teeth, . . 222,314,315,328 Wounds and Ulcers,........142, 265, 328 GENERAL INDEX. PAGE PAGE A BBREVIATIONS, J\ Abies Canadensis, . 58 Aluminas Acetas, . . I84 351 et Ammonias Sulphas, . 183 Abnormal Dentition, 37 Aluminii et Potassii Sulphas, 183 Sensibility of Dentine, . 54 Chloridum, . 346 Abrasion of Teeth, 54 Alveolar Abscess, . • 39 Abscess..... 23 about to Point Externally, 40 of Antrum, 40 Pyorrhoea, 51 Absolute Alcohol, 180 American Hellebore, ■ 338 Absorbents..... 114 Ammonia Alum, 183 Absorption of Alveolar Process , 56 Ammonii Carbonas, . 185 Acacia, .... 123 Chloridum, . 187 Acetate of Alumina, 184 Valerianas, . 186 of Ammonia Solution, . 185 Amyl Nitris, 188 of Lead..... 3°7 Amylene, . 188 of Morphine, 283 Anaesthetics, 95 Acetic Acid..... 124 Administration of, etc., . 169 Acidum Aceticum, 124 Anodynes, .... 114 Arseniosum, 125 Antacids, . 108 Benzoicum, . 134 Antemetics, 114 Boricum, . . . . 136 Anthelmintics, • H3 Carbolicum, . 137 Anthridrotics, 114 Chromicum, 144 Antilithics, . 108 Gallicum, H5 Antiperiodics, "5 H y drochloricum, 147 Antiseptic and Styptic Cotton Muriaticum, . H7 Wool, 345 Nitricum, 149 Antiseptics, ■ H5 Nitricum Dilutum, 149 Antispasmodics, . 95 Phosphoricum, 150 Aphthae, .... . 49 Salicylicum, . 153 Apothecaries' Weight, 60 Sulphuricum, . 155 Appendix to Dental Formulary, 361 Sulphuricum Aromaticum 156 Appendix to Dental Materia Tannicum, . 158 Medica and Therapeu- Tartaricum, 161 tics, • 345 Trichloroaceticum, 352 Aqua Acidi Carbolici, . 140 Aconite..... 162 Camphora, . 206 Aconitine, Duquesnel's, 162 Chlori, . 216 Aconitum, 162 Cinnamomi, . 224 Action of Medicines, . 9 Creasoti, 234 Acute Inflammation of Denta [ Destillata, . 189 Pulp, . 53 Fortis, . 149 .Ether, .... 165 Aralia Spinosa, • 34o Alcohol, .... 179 Argenti Nitras, . 190 Alkaloids, . . . ■ 120 Aromatic Sulphuric Acid, . 156 Alteratives, . 107 Arnica, J93 Alum...... 182 Arsenic, Tests for, . • 133 Alumen..... . 182 Arsenious Acid, . 125 Exsiccatum, . 183 Astringents, . 96 371 372 GENERAL INDEX. Atrophy of Teeth, . . 54 Atropinae Sulphas, . . . 194 Atropine, . . . .194 Aurum Terchloridum, . .196 Avoirdupois Weight, . . 61 BATHS, . . . .120 Belladonnae Folia, . 197 Belladonnae Radix, . -197 Benzoated Lard, . . . 135 Benzoic Acid, . . . .134 Bert's Method of Administer- ing Anaesthetics, . .172 Bicarbonate of Potassium, . 310 of Sodium, . . . 329 Bichloride of Mercury, . 258 Bismuthi Subnitras, . .197 Bleaching Discolored Teeth, 56, 205, 332 Blenorrhetics, .... 105 Bloodletting.General and Local,354 Blue Stone, .... 239 Vitriol, • 239 Boracic Acid, 136 Lint, Ointment, • 136 137 Borate of Sodium, . • 33° Borax, ..... Boro-glyceride, Bromide of Camphor, . of Ethyl, . of Potassium, 330 ■ 136 208 . 241 311 Burnett's Disinfecting Fluid, Butyl-Chloral Hydrate, ■ 34i 238 C ADM 11 Sulphas, . .199 Calcii Hypophosphis, 200 Calcined Magnesia, . . 277 Calcium, .... 202 Calendula, .... 201 Calisaya Bark, . . . 220 Calomel, . . . -259 Calx,.....202 Chlorata, .... 204 Camphor, .... 206 Liniment, . . . 206 Water, .... 206 Camphora, .... 206 Monobromata, . . 208 Camphorated Tincture of Opi- um, .... 300 Cantharidal Collodion, . 231 Cajeput Oil, .... 295 Capsicum, .... 208 Carbo Animalis Purificatus, Ligni, Carbolate of Soda, Carbolate of Sodium, . Carbolic Acid, Water, . Carbonate of Ammonium, of Lime, Caries, Dental, Carminatives, Carvacrol, Cassia Bark, Cataplasms, Cathartics, . Causes of Inflammation, Caustic Potassa, . Caustics, . Cauterants, PAGE 209 210 327 327 137 140 185 235 57 H5 210 223 120 101 309 H5 H5 Cautery, Actual and Potential, 111 Cayenne Pepper, Cerates, .... Chalk Mixture, Characteristic Indications of the Tongue, . Chinoline, .... Chloral, ..... Hydras, Chlorate of Potassa Troches, . of Potassium, Chloride of Aluminium, of Ammonium, of Iron, of Magnesium, of Zinc, of Zinc Solution, of Tin, .... Chlorinated Lime—Chloride of Lime, .... Chlorine, Water, .... Chlorinium, Chloroform..... Chloroformum, . Chromic Acid, Chronic Inflammation, Chronic Inflammation of Den- tal Pulp, Cinchona Flava, Cinnamomum, Cinnamon, Oil, . Water, .... Classification of Medicinal Substances, . 208 121 236 57 212 213 213 313 312 346 187 250 346 34o 34i 346 204 215 216 215 217 217 144 25 53 220 223 223 223 224 94 GENERAL INDEX. 373 Cleft Palate, PAGE • 48 Clinical Thermometer, . . 89 Clysters, 120 Cobalt, . . . • • 134 Cocaine, 224 Hydrochlorate, . 225 Oleate, . 225, 229 Citrate, . 225 Hydrobromate, 226 Collodion, • 230 Collodium, . 230 cum Cantharide, • 231 Flexile, 230 Iodidum, . • 232 Collyria, 120 Compound Tincture of I odine, 269 Coloring Agents, . H3 Colorless Tincture of Ioc line, . 269 Condy's Fluid, • 317 Confections, . . 120 Constringents, • H5 Convulsions of Dentitioi 1, • 37 Corrosive Chloride of M< ;rcury, 258 Corrosive Sublimate, . 258 Counter-irritants, H5.354 Creasote, . 232 Ointment, • 234 Water, • 234 Solidified, • 234 Creasotum, . 232 Creta Praeparata, • 235 Croton-Chloral Hydrate • 238 Cupping, • 355 Cupri Sulphas, • 239 DANGERS of Anaesthesia, 174 Deadly Nightshade, . 197 Decimal System of Weights and Measures, . • 61 Decoction of White Oak Bark, 320 Decoctions, . . • .120 Decoctum Quercus Albae, . 320 Definition of Subjects—Mate- ria Medica and Thera- peutics, 9 of Various Classes of Remedial Agents, . 94 Demulcents.....II2 Dental Caries, 57 Periostitis, . • -38 Dental Exostosis, . . 55 Dentigerous Cyst, . . .4" Denudation, . • • 55 Deodorized Tincture of Opium, 300 PAGE Deodorizers, . . • .116 Desiccatives, . . • 115 Detergents, . . • .116 Dialysed Iron, . . . 249 Diaphoretics.....J°4 Dichloride of Ethidene, . 240 Diluents, . . • • "6 Diluted Solution of Subacetate of Lead, . . .308 Discutients.....II^> Disinfectants, . . • 116 Dislocation of Lower Jaw, . 47 Distilled Water, . . .189 Diuretics, .... 105 Doses of Medicines, Table of, 67 Drastics......io3 Dried Alum, . . .183 EFFERVESCING Powders, 329 Electricity for Relieving pain of Extraction of Teeth.....36° Electricity as a Therapeutic Means in the Treatment of Disease, . • 356 Electuaries,. 120 Elementary Substances, Table of, . 9° Elixir of Vitriol and Tannic Acid, • 159 Emetics, . . . 99 Emmenagogues, . 100 Emollients, . 117 Emulsions, . 120 Enemata, . 120 Endermic Method, • 353 Epispastics, . 109 Epithelioma, 5° Epsom Salt, . . 278 Exudation, . 20 Epulis, . • 5° Errhines . 117 Eruption of the Tee sth, . . 356 Escharotics, no Ether, . . 165 Ethidene Dichlorid um, . 240 Ethyl Bromidum, . 241 Eucalyptol, . 246 Eucalyptus, • 245 Eugenic Acid, • 297 Eugenol, • 297 Evacuants, . . 117 Excitants, . U7 Exostosis, Dental 55 374 GENERAL INDEX. PAGE PAGE Expectorants, 117 Hare Lip..... 48 Extracts, .... 120 Harlan's method of treating Extractum Gelsemii Fluidum, 253 Alveolar Pyorrhoea, 3°5 Extractum Krameriae, 274 Hall's (Marshall) Ready Me- Exudation, 20 thod in Asphyxia, 177 Hectic Fever, 25 TJ7ACIAL Paralysis, Jj Febrifuges, . 48 117 Hemorrhage Following the Ex-traction of Teeth, 251 Ferri Chloridum, 250 Hoffman's Anodyne, . 166 Ferrum, .... 248 Honey of Borate of Sodium, . 330 Dialysatum, 249 Hirudo..... 355 Fever of Inflammation, . l9 Hydrargyri Chloridum Corro- Fineness of Powder, . 60 sivum, . . . . 258 Fomentations, 121 Chloridum Mite, . 259 Forms of Medicinal Substances , 120 Hydrargyrum, 257 Fracture of Alveolar Process, 42 cum Creta, . 261 of Lower Jaw, 47 Iodidum Viride, 261 French Decimal System of Hydragogues, 101 Weights and Measures, 61 Hydrate of Chloral, 213 Fused Potassa, 3°9 of Potash, 3°9 Fungous Growth of Pulp, . 53 Hydrochlorate of Ammonia, 187 Fumigations, .... 121 of Morphine, . 283 Hydrochloric Acid, H7 /H ALLIC Acid, VJT Galls, • 145 Hydrobromic Ether, 241 H5 Hydrogen Peroxide, . 3°3 Gargles, .... 121 Hypersthenics, 118 Gelsemium, .... 252 Hypertrophy of Alveolar Pro- General Remarks, 35 cesses, 54 Glacial Phosphoric Acid, 151 of Gums, . . . . 5i Glycerin, .... 2 54 Hypnotics, .... 118 Glycerinum, .... 254 Hypodermic Method, 353 Boracis, 33o Hypophosphite of Lime, 200 Pepsini, .... 302 of Quinine, 323 Glycerite of Borate of Sodium, 33° of Carbolic Acid, 139 "TMPACTED TOOTH, JL Important Points in Diag- 46 of Gallic Acid, 146 of Tannic Acid, 160 nosing Affections of the Glycerites, .... 121 Mouth, 37 Glyceritum Acidi Carbolici, . r39 Inflammation with Special Ref- Acidi Gallici, 146 erence to the Mucous Acidi Tannici, 160 Membrane of the Mouth 10 Sodii Boratis, 33o of Dental Periosteum, 37 Gingivitis, .... 43 of Dental Pulp, 53 Glacial Acetic Acid, 125 of Mucous Membrane of Glyceroborate of Calcium, 346 the Mouth, Syphilitic, 44 of Sodium, . 347 Inhalants, . . . . 121 Glycerole of Thymol, 334 Injections, .... 121 Green Iodide of Mercury, . 261 Infusions, . . . . 121 Gum Arabic, .... 123 Infusum Capsici, 121 Gutta Percha, 272 Iodide of Potassium, 268 of Zinc, 342 TTT^EMATINICS. . 1 J Haemostatics, . 106 Iodine,..... 267 118 Iodized Collodion, 232 Hamamelis, .... 256 Iodoform, . . . . 262 GENERAL INDEX. 375 Iodoformum, 262 Iodum, .... 267 Iridis Rhizome, . 271 Iron and Preparations, . 248 Irritants, .... 109 Irritation, n of Dental Pulp, 52 of Teething, 37 Isonandra Gutta, 272 TAMAICA Dogwood,. <*J Japanese Camphor, . 306 280 TT^RAMERIA, . 274 T ABARRAQUE'S Solution, 275 1 J Lacmus, . 276 Laudanum, • 299 Laughing Gas, 288 Laxatives, . 118 Lead Poisoning, . 42 Water, 308 Leeches, .... 355 Lentitives, . 112 Leopard's Bane, . 193 Lime, .... 202 Liniment, 203 Water, . 202 Liniments, .... 121 Linimentum Calcis, ■ 203 Camphorae, . 206 Saponis, . . 206 Liquefied Nitrous Oxide, 290 Liquor Ammonii Acetatis, 185 Calcis, .... 202 Ferri - Perchloridi, . 250 Ferri Subsulphatis, 250 Gutta Percha, . 272 Plumbi Subacetatis Dilutus, 308 Potassii Arsenitis, 126 Sodae Chloratis, 275 Potassii Permanganatis, 317 Zinci Chlorodi, 34i Listerine, .... 135 Lithontriptics, 108 Litmus, .... 276 Local Anaesthesia, . 178 Bloodletting, 354 Lotions, .... 121 Lunar Caustic, 190 MAGNESIA, . . .277 Magnesii Chloridum, 346 Magnesii Sulphas, . . . 278 Marigold, . . . 201 Matico......279 Measurement of Medicinal Substances, . . 59 Menthol, .... 280 Mel Boracis, . . . 330 Sodii Boracis. . . . 330 Mercury, . . . .257 with Chalk, . . .261 Mercurial Ointment, . . 261 Poisoning, . . .42 Mercuric Chloride, . . 258 Mercurous Chloride, . -259 Methyl Ether, . . .281 Methyl-Ethylic Ether, . .281 Metric System of Weights and Measures, . . 61 Micro-Organisms, . . .27 Mild Chloride of Mercury, . 259 Mistura Cretae, . . . 236 Mixed Chloroform, . . 219 Mixtures, . . . .121 Monobromated Camphor, . 208 Monsel's Solution and Powder, 250 Morphina.....282 Morphinae Acetas, . . . 283 Hydrochloras or Murias, 283 Sulphas, . . . 284 Morphine, .... 282 Narcosis, . . . 219 Muriate of Ammonia, . .187 of Morphine,. . . 283 Muriatic Acid, . . .147 Myrrh, .... 287 Myrrha......287 "VTAPHTHALIN, . . 347 JL\| Napelline, . . . 162 Narcotics, .... 94 Nasal Polypus, . . .49 Nauseants.....100 Necrosed Teeth, . . .56 Necrosis of Alveolar Process, 41 of Jaw, . . . -47 Nelaton's Method of Resusci- tation, . . . 175 Nervines, . . . .118 Nitrate of Silver, . . 190 of Potassium, . . .315 Nitre......315 Nitric Acid.....149 Nitrite of Amyl, . . .188 Nitrous Oxide, . . . 288 Action and Administration of 291-293 376 GENERAL INDEX. Nitrous Powders, . PAGE ' ■ 315 Phosphoric Acid, PAGE . 150 Nutritives, . . Il8 in the Anhydrous State, 151 Pills, . . 121 /^vDONTOMES, \_J Oil of Cajuput, 55 Pinus Canadensis, 351 • 295 Piscidia Erythrina, . ■ 3°6 of Camphor, 207 Pix Canadensis, . 35i of Cinnamon, . ■ 223 Plasters..... . 122 of Cloves, 296 Plumbi Acetas, . 3°7 of Pyrethrum, . ■ 319 Poisons, .... 78 of Sanitas, . • 35i Symptoms and Antidotes of Sweet Almonds, . • 294 for, Acids, Mineral, 79 of Vitriol, 155 Aconite, 79 Ointment of Carbolic Acid 140 Alkalies, . 79 of Galls, . . 146 Antimony, . 79 of Tannic Acid, . 161 Arsenious Acid, 79 Ointments, . 121 Atropine, 80 Oleate of Aluminum, . • 35° Belladonna, 80 of Arsenic, • 35° Cannabis Indica, . 80 of Bismuth, . • 35o Cantharides, . 80 of Cadmium, . ■ 35i Carbolic Acid, 80 of Copper, • 35° Chloral, . . . . 81 of Lead, . ■ 349 Chlorine Water. . 81 of Mercury, . ■ 348 Chloroform, 81 of Nickel, • 35i Conium, 81 of Silver, • 35i Copper, Sulphate of 82 of Zinc, ■ 349 Corrosive Sublimate, . 82 Oleates, Medicinal, . 348 Creasote, . . . . 82 Oleum Amygdalae Dulcis, 294 Croton Oil, . 82 Cajuputi, . • 295 Digitalis, . . . . 82 Camphorae, . 207 Hydrocyanic Acid, 82 Caryophilli, . 296 Hyoscyamus, . 83 Cinnamomi, . • 223 Iodine, 83 Eucalypti, . 246 Lead Salts, 83 Opium, • 297 Mercury, 83 Orris Rhizome, . 271 Morphine, 83 Root, . 271 Nux Vomica, 83 Ossification of Dental Pulp > • 53 Opium, . 84 of Zinc, ■ 342 Oxalic Acid, 84 Oxide of Potassium, ■ 3°9 Phosphorus, 84 Potash and Soda Salts, 84 "OAPAIN or Papaiva, . XT Pellitory, . • 3°° Silver, Nitrate of 80 ■ 318 Stramonium, 85 Peppermint Camphor, . . 280 Strychnine, 85 Pepsin, • 301 Tobacco, 85 Pepsinum, ■ 301 Zinc Salts, 85 Saccharatum, • 3°i Poke Root, .... 338 Perchloride of Iron, . 250 Posological Tables, 67 Permanganate of Potassiun \ 3l6 Potassa Alum, 183 Peroxide of Hydrogen, . ■ 3°3 Caustica, 3°9 Peruvian Bark, . 220 Cum Calce, . 310 Petroleum Ointment, ■ 336 Potassii Bicarbonas, 310 Phenate of Sodium, • 327 Potassii Bromidum, 311 Phenol Sodique, • 328 Chloras, 312 Phosphor Necrosis, 41 Iodidum, 268 GENERAL INDEX. 377 Potassii Nitras, PAGE 315 Sandaraca, . . . . PAGE 326 Permanganas, 3l6 Sandarach..... 326 Powdered Subsulphate of iron, 250 Scarifications, .... 356 Precipitated Chalk, 235 Scurvy..... 43 Prepared Chalk, . 235 Sedatives, . . . . 98 Preventive Measures against Sensitive Dentine, 54 dangers of Anaesthesia, 174 Sesquicarbonate of Soda, 329 Prickly Ash, .... 339 Setons and Issues, . m 354 Prince's Method of Treating Shellac,..... 327 Alveolar Abscess, 3°5 Sialagogues, . no Protectives, .... 117 Soap Liniment, . 206 Protiodide of Mercury, . 261 Sodae Phenas, 327 Protoxide of Nitrogen, 288 Sodii Bicarbonas, 329 Pulse, the .... 85 Boras, . 330 Variations in, Frequency Sulphis, , 33i of ... . 86 Solubility of Chemicals in Pulvis Ferri Subsulphatis, 250 Water and Alcohol, . 91 Purgatives. .... 118 Solution of Acetate of Ammo- Purified Animal Charcoal, 209 nia, .... 185 Pus,..... 22 of Chlorinated Soda, 275 Pyorrhoea, Alveolar, . 51 of Chloride of Zinc, 34i Pyrethrum..... 3i8 of Gutta Percha, of Permanganate of Potas- 273 /~\UERCUS Alba, . \cJ. Quicksilver, . ^ Quillaia Bark, . 3^9 sium, 317 257 of Subsulphate of Iron, 250 320 Soporifics, 94 Quillaya Saponaria, 320 S. Am. Soap Tree Bark, 320 Quininae, . . . 221,321 Spastics, . . . 99 Hypophosphis, 323 Spirit of Chloroform, . 219 Sulphas, . . 221,321 of Cinnamon, . 224 Quinine, . . . .221,321 of Nitrous Ether, . 166 Quinoline, .... 212 of Mindererus,. . 185 Spiritus Athens Compositus, 166 "DEFRIGERANTS, . JL\ Recession of Gums, . 118 .(Etheris Nitrosi, . 166 56 Camphorae, . 206 Resolvents, . 118 Chloroformi, . 219 Resorcin, .... 324 Cinnamomi, . 224 Respiration at Various Ages, 88 Spinants, • 99 Restoratives, 119 Stannum Chloridum, . 336 Resuscitation, Methods of 175 Stimulants, .... 97 Rhatany, • 274 Stomachics, . 98 Rhigolene, .... 325 Stomatitis, • 43 Riggs' Disease, • 5i Gangrenous, 45 Rubefacients, 109 Ulcerous,. • 44 Rules for Administering Anass Mercurial, . 42 thetics, 171 Syphilitic, ■ 44 for Regulating Doses, 64 Styptic Colloid, 160 Cotton, • 345 QACCHARATED Pepsin, O Sal Ammoniac, 302 Styptics..... 119 . 187 Subnitrate of Bismuth, . • 197 Salicylic Acid, 153 Subsulphate of Iron, . 250 Salicyl Resorcin Ketone, • 325 Sugar of Lead, ■ 3°7 Salivation, . 42 Sudorifics, .... 104 Saltpetre, .... 315 Sulphate of Atropirie, • 194 25 378 GENERAL INDEX. Sulphate of Cadmium, . 199 of Copper, . . . 239 of Magnesium, . . 278 of Morphine, . . . 284 of Quinine, . . 221,321 of Zinc, . . . 344 Sulphite of Lime, . . 200 Sulphite of Soda, . . .331 Sulpho-Carbolates of Zinc, So- dium, Potassium, Mag- nesium, Calcium, and Quinine, . . .140 Sulpho-Carbolic Acid, . 140 Sulphuric Acid, . . . 155 Ether, .... 165 Suppositories, . . , .122 Suppurants,. . . .109 Suppuration, . . . .21 Sylvester's Method of Resusci- tation, . . .176 Symptoms of Inflammation, 17 Synopsis of Treatment of Af- fections of the Mouth, 37 Syphilitic Inflammation of Mouth.....44 Teeth, .... 55 Syrup of Lacto-Phosphate of Lime.....203 Syrups, . . . .122 Syrupus Calcii Lacto-phospha- tis, .... 203 TABLE of Doses of Medi cines, of Equivalents, Tannic Acid, . Tartaric Acid, Tartrate of Chinoline, Terchloride of Gold, . of Phenol, Teriodide of Formyl. . Terminations of Inflammation Tests for Arsenic, Thermometers, Thiersch's Method of Morphia Narcosis, Thrush, Thymol, .... Tinctura Aconiti, Arnica, Calendula, . Capsici, . Eucalypti, Gelsemii, .' 67 64 158 161 212 196 333 262 28 133 219 49 334 163 193 201 209 247 253 Tinctura Iodi, . . . 269 Iodi Composita, . . 269 Krameriae, . . . 274 Myrrhae, . . . .288 Opii.....299 Opii Camphorata, . . 300 Opii Deodorata, . . 300 Pyrethri, . . . -319 Tinctures, . . . . 122 Tonics,.....96 Topical Remedies, . . 352 Treatment of Dangerous Symp- toms of Anaesthesia, . 175 of Inflammation, . . 29 Trichloroacetic Acid, . . 352 Troches of Chlorate of Potas- sium, . . . 313 Troy Weight.....61 Tumorof Jaws, Malignantform of . . . . 45 of Upper Jaws,. . .45 ULCERS of Mouth, Syphi- litic, .... 44 Ulitis,.....43 Unerupted Impacted Tooth, 46 Unguentum Acidi Carbolici, . 140 Unguentum Acidi Tannici. 160 Boracicum, . . .137 Creasoti, . . . 234 Gallae, .... 146 Hydrargyri, . . .261 VALERIANATE of Am- monium, . . . 186 Varnish, Colored . . 327 Aqueous,.... 327 Transparent, . . 326 Vaselin,.....336 Vaseline, .... 336 Veratrina, .... 337 Veratrine, .... 337 Veratrum Viride, . . . 338 Vesicants, .... 20 Vinum Opii.....299 Pepsini, . . . 302 Vitalized Air, .... 294 WALB'S Method of Using Cocaine, . . 229 Weights and Measures, . . 60 White Oak Bark, . . 319 Witch Hazel, . . . .256 GENERAL INDEX. 379 Windle's Method of Admin- istering Anaesthetics, 173 Wine of Opium. . . , 299 Wood Charcoal, . . . 210 "TT^ANTHOXYLUM, . . 339 ELLOW Cinchona, . 220 Jasmine, . . 252 T Yversen's Method of Ad- ministering Anaesthetics, z INCI Chloridum, Iodidum, Oxidum, . Sulphas, 174 34o 342 343 344 j£lB?&> RECOMMENDATIONS OF THE FIRST EDITION OF Gorgas' Dental Medicine. From The Dental Cosmos, Philadelphia, March, 1884. " The author of the volume before us, a distinguished teacher and writer, is well and favorably known to his profession. * * * The work may be said to be the first elaborate attempt to supply a want which every practitioner of Dentistry has experienced. It contains a large amount of useful information which is not to be found in any other volume." From Prof. Frank Abbott, m.d., d.d.s., N. Y. College of Dentistry. " I am so pleased with the work that I shall, with pleasure, recommend it to the students of our College (as well as to the profession generally), and will add it to the list of text-books." From Prof. J. S. B. Alleyne, Missouri Dental College, St. Louis. " Thoroughly correct, and admirably adapted to the wants of the dental student." From The Independent Practitioner, Buffalo, N. Y., March, 1884. " We most heartily commend it to every one who is desirous of a complete text-book upon dental therapeutics. Prof. Jonathan Taft, in the Dental Register, February, 1884. " Perhaps no one in this country is better able to prepare such a manual than Prof. Gorgas. He has large experience in various directions, that has, in an eminent degree, qualified him for such a task." C. T. Stockwell, d.d.s., Editor of the New England Journal of Dentistry. " I have no criticisms to make of the work. It appears to me to be most admirable for the purpose for which it is evidently intended." From the Dental Jairus, San Francisco, February, 1884. " No man in the dental profession is better qualified to prepare such a book. * * * The great number of Tables and Dental Formulae which it contains make it truly valuable." From the Dental Practitioner, Philadelphia, March, 1884. " The best book of the kind with which the dental profession has been favored. * * * We have not attempted to enumerate all the good things in this book, but sufficient to indicate its general character. The need of such a work has long been felt by the profession, and we make no doubt its rapid sale will express their approval of it." From the Dental News, Indiana, February, 1884. " We have never examined a work pertaining to dental science that we can more heartily en- dorse for real practical merit than this." From Dr. J. S. Cassidy, Ohio College of Dental Surgery, May, 1884. " I consider the work a decided improvement over all others of the kind. From New England Journal of Dentistry, April, 1884. " More than two hundred and fifty dental formulae are given under the head of the principa 1 ingredients composing them, thus making reference easy. We will not attempt to give all its good points. It is both an educator and assistant in daily practice. No dentist can afford to be without it. It is a duty he owes to himself and his patrons to own and consult it." From The Dental Advertiser, Buffalo, April, 1884. " This is by far the largest and most elaborate work published, and is unquestionably of genuine merit." From Professor I. J. Wetherbee, President Boston Dental College, March, 1884. " In its present form it will be a valuable aid to all in pursuit of technical knowledge, and will have my approval as a text-book in the Boston Dental College." From A. L. Lengfeld, d.d.s., Professor of Medical Chemistry and Materia Medica, University of California, January, 1884. " I have carefully examined Gorgas' Dental Medicine, and consider it one of the best works of the kind I have ever seen and shall take pleasure in recommending it to my students." **# The above are extracted from Press notices and Personal Letters of recom- mendation of the first edition of Gorgas' Dental Medicine. 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Nervous Diseases. 6.00 NURSING. Cullingworth. Manual of. 1.00 -----Monthly Nursing. .50 Domville's Manual. - .75 Record for the Sick Room. .25 Temperature Charts. - .50 OBSTETRICS. Cazeaux and Tarnier. New Ed. Colored Plates. - 8.00 Gallabin's Manual of. - --- Glisan's Text-book. - 4.00 ' Landis. Compend. - 1.00 Meadows. Manual. - 2.00 Rigby and Meadow's. - .50 Savage. Female Pelvic Org. 12.00 Schultze. Diagrams. - 25.00 Swayne's Aphorisms - 1.25 OSTEOLOGY. Holden's Text-book. 1 Vol. 6.00 PATHOLOGY & HISTOLOGY. Gibbes. Practical - - 1.50 Gilliam. Essentials of. - 2.00 Jones and Sieveking. - 5.50 Paget's Surgical Path. - 7.00 Piersol. Histology, 40 Pits. 6.50 Rindfleisch. General. 2.0s Virchow. Post-mortems. --- Wilkes and Moxon. - 6.00 PHARMACY. Beasley's Druggists' Rec'ts. 2.25 -----Formulary. - - 2.25 Fliickiger. Cinchona Barks. 1.50 Genois. Compend of. - 1.00 Mackenzie. Phar. of Throat. 1.25 Merrell's Digest. - - 4.00 Oldberg. Unofficial Pharm. 3.50 Piesse. 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Syphilis. - - 1.25 VISITING LISTS AND AC- COUNT BOOKS. Lindsay and Blakiston's Regular Edition. - - 1.00 ----- Perpetual Edition. 1.25 Watson's Led. and Cash Bk. 4.00 VETERINARY PRACTICE. Armatage's Pocket-book of. 1.25 Tuson's Vet. Pharmacopoeia. 2.50 WATER. Fox. Water, Air, Food. 4.00 Frankland. Analysis of. 1.00 MacDonald. " " 2.75 WOMEN, DISEASES OF. Byford's Text-book. - 5.00 ------ Uterus. - - - I-25 Courty. Uterus, Ovaries, etc. 6.00 Dillnberger. and Children. 1.50 Duncan. Sterility. - 2.00 Gallabin. Diseases of. - ---- Savage. Surgery ot Female Pelvic Organs. - - 12.00 Tilt% Change of Life. - 1.25 THE LATEST AND Most Important Books. THE PRINCIPLES AND PRACTICE OF MEDICINE. By Charles Hilton Fagge, m.d., f.r.c.p., Examiner in Medicine in the University of London; Physician to, and Lecturer on Pathology at, Guy's Hospital; Senior Physician to Evelina Hospital for Sick Children, etc. Edited by P. H. Pve-Smith, m.d., f.r.c.p., Physician to, and Lecturer on Medicine at, Guy's Hospital; Examiner in Physiology, University of London. Two Volumes. Royal Octavo. About iooo Pages each. Nearly Ready. This work on the Principles and Practice of Medicine, which occupied the late Dr. Hilton Fagge for the last twelve years of his valuable life, is now in the press, and will soon be published. It is based on laborious researches into the pathological and clinical records of Guy's Hospital during the twenty years in which the author held office there as Medical Registrar, as Pathologist, and as Physician. Familiar, beyond most, if not all, of his contemporaries, with modern medical literature, a diligent reader of French and German periodicals, Dr. Fagge, with his remarkably retentive memory and methodical habits, was able to bring to his work of collection and criticism almost unequaled opportunities of extensive experience in the wards and in the dead house. The result is that which will probably be admitted to be a fuller, more original, and more elaborate text-book on medicine than has yet appeared. The work will appear in two handsome octavo volumes of about iooo pages each. Great care has been^aken in the arrangement of the sections and paragraphs, in the contents of the chapters, the head lines, and the index, to render it easy of reference. BARTLEY'S MEDICAL CHEMISTRY. A Text-book for Medical Students. By E. H. Bartley, m.d., Associate Professor of Chemistry at the Long Island College Hospital, President of the American Society of Public Analysts, Chief Chemist Board of Health, of Brooklyn, N. Y. With Illustrations, Glossary and Complete Index. 121x10. Cloth, $2.50 GOODHART AND STARR. A MANUAL OF THE DIS- EASES OF CHILDREN. By J. F. Goodhart, m.d., Physician to the Evelina Hospital for Children; Assistant Physician to Guy's Hospital, London. 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Cloth, $1.75 *** This is a complete epitome of skin diseases, arranged in alphabetical order, giving the diagnosis and treatment in a concise, practical way. Many prescriptions are given that have never been published in any text-book, and an article incorporated on Diet. The plates do not represent one or two cases, but are composed of a num- ber of figures, accurately colored, showing the appearance of various lesions, and will be found to give great aid in diagnosing. " This new handbook is essentially a small encyclopaedia. * * * Contains a very complete summary of the present state of Dermatology. * * * We heartily commend it for its brevity, clearness and evidently careful preparation."—Philadelphia Medical Times. " The author shows a proper appreciation of the wants of the general practitioner."—New York Medical Record. " It is concisely and intelligently written, and contains many of the best formulas in use for the various forms of Skin Disease."—New York Medical Times. " This is an excellent little book, in which, for ease of reference, the more common diseases of the skin are arranged in alphabetical order, while many good prescriptions are given, together with clear and sensible direc- tions as to their proper application."—Boston Medical and Surgical Journal. " It is just the kind of book that the general practitioner will find most convenient for reference, and we feel confident that it will be appreciated."—Southern Practitioner. RINDPLEISCH'S PATHOLOGY. The Elements of Pathology. By Prof. Edward Rindfleisch, University of Wurzburg. Authorized translation from the first German edition, by Wm. H. Mercur, m.d. (Univ. of Pa.) Revised by James Tyson, m.d., Professor of Pathology and Morbid Anatomy in the Univer- sity of Pennsylvania. i2mo. Cloth, $2.00 Prof Tyson, in his Preface to the American edition, says :—" A high appreciation of Prof. Rindfleisch's work on Pathological Histology, caused me to make careful examination of these ' Elements' immediately after their publication in the original. From such an examination I became satisfied that the book would fill a niche in the wants of the student, as well as of others who may desire to familiarize themselves with general patho- logical processes, viewed from the most modern standpoint." BRUEN'S PHYSICAL DIAGNOSIS. Second Edition. A Pocket-book of Physical Diagnosis of the Heart and Lungs; for the Student and Physician. By Edward T. Bruen, Demonstrator of Clinical Medicine in the University of Pennsylvania; Lecturer on Pathology in the Women's Medical College of Phila- delphia ; 2d Edition, revised, with new original illustrations. i2mo. Cloth, $1.50 " We consider the description of the manner and rules governing the art of percussion well given. The sub- ject is always a difficult one for beginners, and requires to be well handled in order to be properly understood." ■—American Journal of Medical Sciences. WOAKES ON CATARRH AND DISEASES OP THE NOSE CAUS- ING DEAFNESS. By Edward Woakes, m.d., Senior Aural Surgeon to the London Hospital for Diseases of the Throat and Chest. 29 Illustrations. I2mo- Cloth, $1.50 " Out of the large number of special works on catarrh, there is none for which we have such an unqualified good opinion. * * * The subject is clearly presented. * * * The line of treatment suggested is rational." —North Carolina Medical Journal. P. BLAKISTON, SON & CO., 1012 Walnut St., Philadelphia. PRACTICAL HANDBOOKS—Continued. VON ARLT. DISEASES OF THE EYE. Including those of the Con- junctiva, Cornea, Sclerotic, and of the Iris and Ciliary Body. By Dr. Ferdi- nand Ritter von Arlt, Professor of Ophthalmology in Vienna. Translated by Lyman Ware, m.d., Surgeon to the Illinois Charitable Eye and Ear Infirmary ; Ophthalmic Surgeon to the Presbyterian Hospital, and to the Protestant Orphan Asylum, Chicago. Illustrated. 8vo. 325 pages. Cloth, $2.50 " His style is condensed but clear, and his pages contain a vast amount of information, couched in such lan- guage that it will be equally instructive to the general practitioner and the specialist."— Philadelphia Medical and Surgical Reporter, May 30th, 1885. TYSON ON THE URINE. A Practical Guide to the Examination of Urine. For the Use of Physicians and Students. With Colored Lithographic Plates and Numerous Illustrations Engraved on Wood. Fourth Edition. i2mo. Cloth, $1.50 ■i-Thr P1"^1'0?1 man wil1 ""d in this little book all that is absolutely necessary for him to know, in order to utilize fully the data supplied by the urine."—Chicago Medical Journal. GILLIAM'S ESSENTIALS OF PATHOLOGY. The Essentials of Path- ology. By D. Tod Gilliam, m.d., Professor of Physiology, Starling Medical College, Columbus, Ohio. With 47 wood engravings. i2mo.' Cloth, $2.00 "The general practitioner will find in this little i2mo a convenient compendium of the current pathology of the day. '—Chicago Medical Journal and Examiner. THE PRACTICAL SERIES. A NEW VOLUME JUST READY. *** The volumes of this series written by well known physicians and surgeons, of large private and hospital experience, recognized authorities on the subjects of which they treat, will embrace the various branches of medicine and surgery. They are of a thoroughly practical character, calculated to meet the requirements of the practi- tioner, and will present the most recent methods and information in a compact shape and at a low price. Bound uniformly, in a handsome and distinctive cloth binding. DISEASES OF THE KIDNEYS, AND URINARY DERANGE- MENTS. By C. H. Ralfe, m.a., m.d., f.r.c.p., Assistant Physician to the London Hospital; late Senior Physician to the Seamen's Hospital, Greenwich. i2mo. With Illustrations. 572 pages, fust Ready. Cloth, $2.75 BODILY DEFORMITIES AND THEIR TREATMENT. A Handbook of Practical Orthopaedics. By H. A. Reeves, f.r.c.s., Senior Assistant Surgeon and Teacher of Practical Surgery at the London Hospital; Surgeon to the Royal Orthopaedic Hospital, etc. i2mo. 228 Illustrations. 460 pages. Cloth, $2.25 " From what we have already said, it will be seen that Mr. Reeves has given us a trustworthy guide for the treatment of a very extended class of cases. * * * If the other volumes of the Practical Series are as good as this, we shall be agreeably disappointed "—American Journal of Medical Sciences, April, 1885. " The utility of the work now before us cannot be better recommended to the appreciation of the professional reading public, than by recalling that it is the first of its kind, dealing with orthopaedics from a modern stand- point."—Hospital Gazette and Students' Journal. DENTAL SURGERY FOR GENERAL PRACTITIONERS AND STUDENTS IN MEDICINE. By Ashley W. Barrett, m.d., m.r.c.s. Eng., Surgeon-Dentist to, and Lecturer on Dental Surgery and Pathology in the Medical School of, London Hospital, nmo. Illustrated. Cloth, $1.00 " Replete with an abundance of practical information of unquestionable utility."—Hospital Gazette and Students' Journal. " The object of this volume is to present the student and practitioner with a clear, concise and systematic account of urinary pathology and therapeutics, based upon the latest ascertained facts, and supported by the best authorities. Throughout, the author has endeavored to put prominently forward ihe characters upon which the diagnosis of the various renal and urinary diseases is founded, and their treatment indicated."—Extract from The Preface. P. BLAKISTON, SON & CO., 1012 Walnut St., Philadelphia. MEDICAL JOURNALS Published by P. BLAKISTON, SON & CO. THE LONDON MEDICAL TIMES AND GAZETTE. 38 Pages Weelfly for $5.00 per Annum, Post-Free. Commencing with the number for January 5th, 1884, the London," Medical Times and Gazette " underwent an alteration in the size of page, that makes it much more con- venient for handling and binding. A clearer type, better accommodated to the eye, has been employed, and an increase in the number of pages made, thus increasing the amount of reading matter. The contents will be printed on the first page of reading matter, enabling them to be bound up with the volume, and a reduction in the price, of one-half, makes it at once one of the cheapest and best Weekly Medical Papers now published. CONTENTS.—The contents of each number consist of several original Lectures or Contributions, Reports of Cases from the large London or British Government Hospitals, Editorial Notes on current topics, New Methods of Treatment and Research, New Discoveries, Remedies, Etc. Leading Articles, Reviews and Book Notices, Abstracts and Selections, Reports of the London and Foreign Medical Societies, Medical Notes and News, Etc. As A representative London Journal the " Medical Times " is among the first, and its low price, compared^ with other foreign journals of the same size, brings it within the reach of every physician who wishes to keep acquainted with the progress of Medical Science abroad as well as at home. THE POLYCLINIC. A monthly Journal of Medicine and Surgery, conducted by the Faculty of the Philadel- phia Polyclinic and College for Graduates in Medicine. HENRY LEFFMANN, M. D., Editor in Chief. Published on the 15th day of each month. Now in its second volume. Subscription, per annum, $1.00. Partial List of Contributors to Vol. i.— Dr. J. Solis-Cohen, on the Throat, Etc.; G. C. Harlan, M. D., Ophthalmology; Prof. Roberts Bartholow, Nervous Prostration; S. Weir Mitchell and C. K. Mills, M. D., Nervous Diseases; Dr. Arthur Van Harlingen, Vice-Presi- dent of the American Dermatological Society, on Skin Diseases; Prof. Jas. Tyson, The Albu- min Test Etc.; Jas. C. Wilson, M. D.; Prof. Theophilus Parvin, Obstetrical Reports; Drs. John B. Roberts and Thos. G. Morton, General Surgery and Hospital Reports; Dr. J. Henry C. Simes, Syphilis, Chancre, Urethritis, Etc.; Prof. Henry Leffmann, Alcoholism, Chemical Notes, Poisoning, Tests, Hypnotism, Etc.; Charles H. Burnett, M. D., Otology; Dr. E. O. Shakespeare, and others. CONTENTS.—Original Clinical Lectures, or Articles, Editorials, Book Reviews, Medical Notes, Selec- tions, Translations, Hospital and Society Reports. THE OPHTHALMIC REVIEW. A monthly record of Ophthalmic Science, now in its third volume. Subscription, per annum, $3.00. The Ophthalmic Review is the only journal devoted to this special branch of medicine that is published in England, and therefore represents the advances made in that country, as no other periodical can. CONTENTS.—The principal contents of each number are original articles with some illustrations, transla- tions of German or French articles, Bibliography, Etc. ANNALES DES MALADIES DE L'OREILLE DU LARYNX ET DES ORGANES CONNEXES. Bi-Monthly. Subscription $3.00. The publishers beg to announce that Dr. J. 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They form a most complete set of Compends, containing information nowhere else collected in such a condensed, practical shape. The authors have had large experience as quiz masters and attaches of colleges, with exceptional opportunities for noting the most recent advances in therapeutics, methods of treatment, etc. The arrangement of the subjects, illustrations and types, are all of the most improved form, and the size of the books is such that they may be easily carried in the pocket. Bound in Cloth, each $1.00. Interleaved, for the Addition of Notes, $1.25. No. 1. Human Anatomy. Third Edi- tion. Illustrated. By Samuel O. L. Potter, m.a., m.d., late A. A. Surgeon U. S. Army. With 63 Illus. 3d Revised Ed, " To those desiring to post themselves hurriedly for examination, this little book will be useful in refreshing the memory."—New Orleans Med. and Surg. Jl. Nos. 2 and 3. Practice of Medicine. Especially adapted to the use of Students and Physicians. By Daniel E. Hughes, m.d., Demonstrator of Clinical Medicine in Jefferson Med. College, Phila. In two parts. Part I.—Continued, Eruptive and Periodical Fev- ers, Diseases of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kidneys, etc. (includingTests for Urine), General Diseases, etc. Part II.—Diseases of the Respiratory System (in- cluding Physical Diagnosis), Circulatory System and Nervous System ; Diseases of the Blood, etc. *** These little books can be regarded as a full set of notes upon the Practice of Medicine, containing the Synonyms, Definitions, Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each disease, and includ- ing a number of prescriptions hitherto unpublished. No. 4. Physiology, including Embry- ology. Second Edition. By Albert P. Brubaker,m.d., Prof, of Physiology, Penn'a College of Dental Surgery; Demonstrator of Physiology in Jefferson Med. College, Phila. Revised and Enlarged. " This is a well written little book."—London Lancet. No. 5. Obstetrics. Illustrated. Second Edition. For Physicians and Students. By Henry G. Landis, m.d., Prof, of Ob- stetrics and Diseases of Women, in Starling Medical College, Columbus. Revised Ed. New Illustrations. " We have no doubt that many students will find in it a most valuable aid."—The Amer.Jl. of Obstetrics. No. 6. Materia Medica and Therapeu- tics. Second Revised Edition. With especial Reference to the Physiological Ac- tions of Drugs. For the use of Medical, Dental and Pharmaceutical Students, and Practitioners. Based on the New Revision (Sixth) of the U. S. Pharmacopoeia, and including many unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., late A. A. Surg. U. S. Army. Revised Edition, with Index. " One of the very best we have ever seen."—Southern Clinic. No. 7. Inorganic Chemistry. New Edi- tion. By G. Mason Ward, m.d., Demon- strator of Chemistry in Jefferson Med. Col- lege, Phila. Including Table of Elements and various Analytical Tables. New Ed. " This neat pocket volume is a brief but excellent compend of inorganic chemistry and simple analysis of the metals."—Pharmaceutical Record, N Y. No. 8. Visceral Anatomy. Illustrated. By Samuel O. L. Potter, m.a., m.d., late A. A. Surg. U. S. Army. With 40 Illus. " Worthy our recommendation to students, and a ready reference to the busy practitioner."—Chicago IKed. Times. No.g. Surgery. Second Edition. Illus- trated. Including Fractures, Wounds, Dislocations, Sprains, Amputations and other operations; Inflammation, Suppuration, Ul- cers, Syphilis, Tumors, Shock, etc. Dis- eases of the Spine, Ear, Eye, Bladder, Tes- ticles, Anus, and other Surgical Diseases. By Orville Horwitz, a.m., m.d., Resident Physician Pennsylvania Hospital, Phil'a. Second Edition, Revised and Enlarged. With 62 Illustrations. " Will prove very useful, both to the student and practitioner."—Valentine Mott, m.d., Ass't to the Prof, of Surgery, Bellevue Hospital, New York. No. 10. Organic Chemistry. Including Medical Chemistry, Urine Analysis, and the Analysis of Water and Food, etc. By Henry Leffmann, m.d., Demonstrator of Chemis- try in Jefferson Med. College; Prof, of Chemistry in Penn'a College of Dental Surgery, Philadelphia. " It is a useful and valuable addition to the series of Quiz-Compends."—College and Clinical Record. No. 11. Pharmacy. By Louis Genois, ph.g., Member of the Amer. Pharmaceutical Association. In Preparation. Bound in Cloth, each $1.00. Interleaved, for the Addition of Notes, $1.25. These books are constantly revised to keep up with the latest teachings and discoveries. P. BLAKISTON, SON & CO., 1012 Walnut St., Philadelphia. NOW READY FOR 1886. The Physician's Visiting List. (LINDSAY & BLAKISTON'S.) PUBLISHED ANNUALLY; NOW IN ITS THIRTY-FIFTH YEAR. Containing Calendar, List of Poisons and Antidotes, Dose Tables rewritten in accord- ance with the Sixth Revision of the U. S. Pharmacopoeia, Marshall Hall's Ready Method in Asphyxia, Lists of New Remedies, Sylvester's Method for Producing Artificial Respiration, with Illustrations; Diagram for Diagnosing Diseases of Heart and Lungs; a new Table for Calculating the Period of Utero-Gestation, etc. B@~ The Quality of the Leather used in Binding this List has been again Improved, and a Superior Pencil, with Nickel Tip, manufactured especially for it, has been added. SIZES AND PRICES. For 25 Patients weekly. Tucks, pockets, etc., $1.00 50 " " " " 1-25 75 " " " " 1.50 100 " " " " 2.00 a n -IT 1 {Jan- to June 1 „ ,.„ 5° 2Vols- \July to Dec. { 2-5° n cc 17 1 l Jan. to Tune | 100 " " 2Vols- j July to Dec.} ^°° interleaved edition. For 25 Patients weekly. Interleaved, tucks, etc., 1.25 50 " " ' " " f.50 it it vi f Jan- to June ) 5° 2Vols- {July to Dec.} 3-°° Perpetual Edition, without Dates, can be commenced at any time and used until full, similar in style, contents and arrangements to the above. For 25 Patients, Interleaved, #1.25 » 50 " " 1.50 " For completeness, compactness, and simplicity of arrangement it is excelled by none in the market."—N. Y. Medical Record. " The book is convenient in form, not too bulky, and in every respect the very best Visiting List published."— Canada Medical and Surgical Journal. " After all the trials made, there are none superior to it."—Gaillard's Medical Journal. "It has become Standard.'"—Southern Clinic. " Regular as the seasons comes this old favorite."—Michigan Medical News. " It is quite convenient for the pocket, and possesses every desirable quality."—Medical Herald. "The most popular Visiting List extant."—Buffalo Medical and Surgical Journal. " We have used it for years, and do not hesitate to pronounce it equal, if not superior, to any."—Southern Clinic. "This Visiting List is too well known to require either description or commendation from us."—Cincinnati Medical News. WATSON'S Physician's Ledger and Cash Book Combined. WEEKLY AND MONTHLY. This Ledger is based upon, and designed to be used in connection with, Lindsay & Blakiston's Physician's Visiting List. PRICES. Ledger for 1000 accounts, Leather, $6.50 " 500 " " 5.00 500 " Cloth, 4.00 *** Sample pages of both books sent upon application. Books sent, postage pre- paid, upon receipt of full price, or can be obtained through any bookseller. P. BLAKISTON, SON & CO., 1012 Walnut St., Philadelphia. n tvnoiivn aNioiaaw jo xavaan tvnoiivn n ivmomvn jKinm^w jo axvxsit tvnoiivn LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE l&L 1 i Df)tf an tvnoiivn SNiDiasw jo Aavaan tvnoiivn snidiosw jo Aavaan tvnoiivn 3noi NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIC la ^ LIBRARY OF MEDICINE 1 \ jo Aavaan tvnoiivn 3nidiq3w jo Aavaan tvnoiivn ^nidiosw jo Aavaan tvnoiivn ^ snid LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIC i jo Aavaan tvnoiivn snidiqsw jo Aavaan tvnoiivn snidiqsw jo Aavaan tvnoiivn sno LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATK v jo Aavaan tvnoiivn snidkosw jo Aavaan tvnoiivn snidiosw jo Aavaan tvnoiivn 3ni: i / y i ^ LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATI n jo Aavaan tvnoiivn snidicisw jo Aavaan tvnoiivn 3nidio3w jo Aavaan tvnoiivn 3ni: c 0 1 s i.rmu.i iiodadv rm ucniriMP NATIONAI MRRARY OF MEDICINE NA NATIONAL LIBRARY OF MEDICINE NLM DSEETSm fl NLM052295148