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GORGAS. STANDARD WORKS FOR DENTAL STUDENTS AND PRACTITIONERS. Published by P. BLAKISTON, SON & CO. Harris.—The Principles and Practice of Dentistry. I2th Edition. Tho- roughly Revised and Enlarged. By Prof. F. J. S.' Gorgas. 1086 Illustrations. 1225 Pages..........Cloth, $7.00; Leather, #8.00 Harris.—Dictionary of Medicine, Dentistry, and Collateral Sciences. 4th Edition. By Prof. F. J. S. Gorgas.......Cloth, #6.50; Sh., 7.50 Richardson.—Mechanical Dentistry. 4th Edition. . . Cloth, $4.50; Sh., 5.50 Potter.—Compend of Anatomy. New 4th Edition. " Illustrated. . . Cloth, 1.00 Talbot.—Irregularities of the Teeth and their Treatment. 'Illus. . . Cloth, 2.00 Blodgett.—Dental Pathology. Illustrated............Cloth, 1.75 Buxton.—Anaesthetics. Illustrated...............Cloth, 1.25 Fillebrown.—Text-book of Operative Dentistry. Illustrated. . . . Cloth, 2.50 Taft.—Operative Dentistry. 4th Ed. 136 Illustrations. 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Cloth, 1.00 Brubaker.—Compend of Physiology. Illustrated. 4th Edition. . Cloth, 1.00 Holden.—Anatomy. 5th Edition. 208 Illus. Oil-Cl.,#4.50; CI.,$5.00; Sh., 6.00 g@~ Catalogues of Medical and Dental Books sent upon application. DENTAL MEDICINE A MANUAL DENTAL MATERIA MEDICA AND THERAPEUTICS. FERDINAND J. S. GORGAS, A.M., M. D., D.D.S., ♦*» 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. THIRD EDITION REVISED AND ENLARGED. PHILADELPHIA: y/&p P. BLAKISTON, SON & CO.T No. 1012 Walnut Street. 1889. r 1883 -fllmro. \OlotJtLJc.i< s. Entered according to Act of Congress, in the year 1889, by P. BLAKISTON, SON & CO., In the Office of the Librarian of Congress, at Washington, D. C. PRESS OF THE JAS. B. ROOQERS PRINTING CO. 52 & 64 N. SIXTH STREET PHILADELPHIA. PREFACE TO THIRD EDITION. In presenting a third edition of the " Dental Medicine," the author trusts that the new matter it contains, comprising nearly one hundred pages, will add to its value as a text- book, and increase its usefulness to the dental practitioner. The universal favor with which the preceding editions have been received, is gratefully appreciated, and the fact that, like the " Principles and Practice of Dentistry," the second edition of the " Dental Medicine " was exhausted for several months before the present one could be prepared for publi- cation, is an evidence of its favorable reception. What the author deems an improvement, has been made in the arrange- ment of a portion of the subject matter of the present edition, and considerable additions have been made to a number of subjects, among them being the following: Diagnosis of the Affections of the Mouth, General and Local Anaesthesia, the Action of Arsenious Acid as a Devitalizing Agent, etc., etc. In the new matter will be found : The Action of Antisep- tic Agents, The Proper Use of Antiseptics in Dental Practice, The Value of Germicides and Disinfectants, The Digestibility of Foods, Incompatibility, etc., etc. To the Dental Materia Medica and Therapeutics have been added such agents as Iodol, Hydronaphthol, Bromides of Ammonium, Calcium, Lithium, Sodium, Benzoates, Lithium and its Preparations, Phosphates and Phosphites, Creolin, Cresylic Acid, Hydrate iii IV PREFACE TO THIRD EDITION. of Amylene, Herbst's Obtundent, Lanolin, Kandol, Methyl Chloride, Nux Vomica, Turpentine, Rhubarb, Paraldehyde, Sodium and its Preparations, Sulfanol, Stenocarpine, Sali- cylates, Serpentaria, Prunus Virginiana, Naphthalene, Guiacol, Cod-liver Oil, Colchicum, Sulphite of Aluminium, Anthemis, Antifebrin, Antipyrene, Aloes, Acetanilide, Sulphurous Acid, Ammonia and its Preparations, Cresylicum, Aromatic Bitters, etc., etc., etc. A number of new formulae have also been added, and the Index to " Dental Diseases and Remedies '' has been correspondingly increased. Ferdinand J. S. Gorgas. Hamilton Terrace, Baltimore. May j, 1889. 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 manner 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, V CONTENTS. PAGE Prefaces........................... iii. v. Definition of Subjects........................ 9 Action of Medicinal Substances.................... 9 Inflammation, with Special Reference to Oral Mucous Membrane..... 10 Important Points in Diagnosing Affections of the Mouth, with a Synopsis of Treatment........................ 37 Characteristic Indications of the Tongue.................59 Digestibility of Foods....................... 60 Abbreviations, with Latin and English Terms.............. 62 Approximate Measurements......................63 Fineness of Powder..........................64 Weights and Measures....................... 64 Metric or French Decimal System of Weights and Measures....... 65 Rules for Regulating Doses......................68 Topical Remedies..........................70 The Endermic Method........................71 The Hypodermic Method.......................71 Setons and Issues......................... 72 General Bloodletting........• •...............72 Local Bloodletting by Leeching, Cupping and Scarifications........73 Electricity as a Therapeutic Means in the Treatment of Disease....... 74 Incompatibility.......................... 79 Table of Doses of all Officinal Medicines, Expressed in Terras of Both the Apothecaries' and the Decimal Metric System of Weights and Measures 81 Poisons—Symptoms and Antidotes.................. 92 The Pulse............................ 99 Pulsation per Minute at Various Ages.................100 Respiration at Various Ages......................102 Thermometers...........................102 vii viii CONTENTS. PAG E Table of Elementary Substances..................104 Table of the Solubility of Chemicals in Water and Alcohol.......105 Classification of Medicinal Substances................108 Definitions of the Various Classes of Medicinal Agents.........108 Forms in which Medicinal Substances are employed ..........136 Source, Derivation, Medical Properties and Action, and Therapeutic Uses of Medicinal Substances Employed in Dental Practice; Together with their Dental Uses and Application...............140 Administration of General Anaesthetic Agents.............191 The Dangers of Anaesthesia . . ,.................198 Preventive Measures Against the Dangers of Anaesthesia........199 Treatment of Dangerous Symptoms of Anaesthesia...........199 Methods of Resuscitation—Sylvester's Method—Hall's Ready Method . . 200 " " Howard's Method, etc............202 Local Anaesthesia.........................203 Rapid Breathing as a Pain Obtunder....... .........206 Appendix............................4!4 Periods for the Eruption of the Teeth . . ........•. . . . 429 Authorities Consulted.......................a?0 Index to Dental Formulary and Dental Diseases............43! General Index ................. A~n DENTAL MEDICINE. DEFINITION OF SUBJECTS. Materia Medica is that branch of medical science which re- fers to and describes the methods and 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 management of disease. Generally, however, the term is restricted to a description of the modus operandi of medicines, or, in other words, their use, application 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 func- tions, and to so impress the organism as to maintain harmoni- ous 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. Other medicinal agents prevent septic decomposition and the growth of micro-organisms. 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. 9 10 DENTAL MEDICINE. INFLAMMATION: WITH SPECIAL REFERENCE TO ORAL MUCOUS MEMBRANE. Definition of Conditions Associated with Disturbances of Nutrition.—Hypercemia 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 consti- tute 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, signi- fies 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 temperature is due to the presence of the blood which heats the skin or mucous membranes, and the more quickly the blood circulates 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 Anosmia 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 INFLAMMATION. 11 denote an anaemic condition, for the reason that the number of 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 deficency 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 12 DENTAL MEDICINE. the impression to which it owes its origin is received; indirect when the irritation, through sympathy and reflex action, is 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 irrita- tion, 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 consequence, causes a decrease of their resistance to the pres- sure of the blood within them. The irritation either perverts the function 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 INFLAMMATION. 13 features of inflammation are an increased afflux of blood to the affected part, with a greatly increased tendency to cell proliferation and tissue formation. 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—ist, 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 14 DENTAL MEDICINE. as the mucous membrane of the mouth, which have already been the seat of inflammation, are prone to such a condition subsequently, from slight provocation. 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 in- flammation. 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 INFLAMMATION. 15 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 separation of the eschar; and when there is a loss of cicatri- cial power, repair by granulation and suppuration (second intention) is prevented. The inflammation resulting from sim- ple 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 un- dergo 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 16 DENTAL MEDICINE. 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 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 chem- ical 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 • INFLAMMATION. 17 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, " 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 a'nd 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 failing 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. 2 18 DENTAL MEDICINE. 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, 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 be- neath. 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- INFLAMMATION. 19 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 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 pulpitis, 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 20 DENTAL MEDICINE. 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 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 septicaemia. When some time has elapsed after the inception of the inflammatory.process, and the characteristic fever has almost disappeared, a chill suddenly occurs, 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 tissues 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 INFLAMMATION. 21 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- 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 protection 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, 22 DENTAL MEDICINE. 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 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 INFLAMMATION. 23 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 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 liquorpuris, 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 yel- lowish, 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. 24 DENTAL MEDICINE. 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- 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 oedema 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 in- tegument 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 convey the nutritive supply from beneath, by the pressure of the enlarging abscess to such a degree that the surface integu- ment is deprived of its blood and slowly dies by minute par- ticles, 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- INFLAMMATION. 25 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 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 received 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 membrane 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 emaciation 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 morning, 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 26 DENTAL MEDICINE. 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 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 INFLAMMATION. 27 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- 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 28 DENTAL MEDICINE. to septic poisons, which, being absorbed into the circulation, result in septiccemia and pyoemia. 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 soluble substances, which get into the surrounding tissues by diffusion." The tissues, by the contact of the micrococci, lose their vitality, and the parasite 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—1st, By Resolution; 2d, By Formation of New Tissue; 3d, By gan- grene, or Local Death—Necrosis. When the inflammatory process terminates by resolution, all of the symptoms gradually diminish 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 INFLAMMATION. 29 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 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 advantage 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 30 DENTAL MEDICINE. 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- 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 means 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- INFLAMMATION. 31 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- 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 b) iron and hypophosphites to increase the quantity of nutritious constituents of the blood. 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 to invade surrounding structures, and to fungate like a mush- room. Treatment.— Removal by a surgical operation, and the ap- plication of escharotics, as chromic acid, or chlorate 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 48 DENTAL MEDICINE. 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 unerupted tooth by destroying the front wall of the cyst, and the cavity filled with lint, so as to induce granulation and gradual oblit- eration. 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. Necrosis of the Jaw is indicated by inflammation like that of periodontitis 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, listerine and ethereal DIAGNOSIS OF MOUTH AFFECTIONS. 49 solution of iodoform, are also used as applications. Sup- port 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, may be diagnosed by grasping the 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, 4 50 DENTAL MEDICINE. 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, maybe 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 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 repro- duction, 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, DIAGNOSIS OF MOUTH AFFECTIONS. 51 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. Sodii borat...................gj Glycerine...................£ij Aquae....................sjiv. M. Sig.—Apply with a camel's-hair brush four or five times a day. Or— R. Zinc sulph..................gr.ij-iv Aquae rosae...................Sjij. M. Or a weak solution of nitrate of silver. Aphthoe 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 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 oidium 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- 52 DENTAL MEDICINE. olar cavity of a tooth and has 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 glandsj 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 a healthy cicatrization. If the disease has involved 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 Pyorrhoea, or Riggs' Disease, is indicated at first by an uneasy sensation; then inflammation of margins of gums; DIAGNOSIS OF MOUTH AFFECTIONS. 53 looseness of the gums about the teeth, which form pockets; and necrosis of edges of alveolar processes ; a tendency to hemorrhage ; inflammation extending deeper into gums ; small sulci filled with pus; looseness of the teeth and change of posi- tions ; disagreeable taste; peculiar fetor of breath; dark livid color of gums, with thick margins, and often extreme sensitive- ness to touch ; in some cases the gums are denuded of their epithelium, 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, 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, also strong tincture of myrrh, aromatic sulphuric acid. 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. 54 DENTAL MEDICINE. Another method : After thorough removal of deposits, syringe with aromatic sulphuric acid, diluted with one-half water, and apply night and morning a powder composed of creta prepar- atae, ^j; acidum boricum 3j- The use of " Robinson's Remedy " is also recommended. Irritation of the Dental Pulp is indicated by an uneasy sen- sation, which develops into pain of a gnawing or boring char- acter, the affected tooth being sensitive to changes of temper- ature, painful in mastication, but exhibiting no symptoms of inflammation of the gum or peridental membrane. 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 ammonia. 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. 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. DIAGNOSIS OF MOUTH AFFECTIONS. 55 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, 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 56 DENTAL MEDICINE. 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. Ottolengui's method : Apply the rubber-dam, dry cavity with bibulous paper, then insert a pledget of cotton saturated with absolute alcohol, then apply intermittingly a series of blasts of hot air to produce evaporation, until parts become whitened or thoroughly dry, then throw on a con- tinuous spray of ether. 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. 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. Hypercementosis or 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 appar- ent on the side of the alveolar ridge. DIAGNOSIS OF MOUTH AFFECTIONS. 57 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. Organic Defects of Structure, indicated by defects in the enamel, in the form of opaque spots, grooves or pits, congenital in origin, and due to altered functions from impaired nutrition. Treatment.—Preventive by mitigating severity of diseases producing the condition, by the administration of proper remedies. For the pitting variety, properly inserted fillings. 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. Erosion of the Teeth is indicated by the gradual destruction of the enamel of the labial surfaces of the incisors, 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 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 the affected tooth. 58 DENTAL MEDICINE. 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 mouth, 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 disinfectants, antiseptics, 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, oxalic acid, chloride of soda, sulphite of soda combined with boracic acid, cyanide of potassium, tartaric aid 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, also use of nitrous oxide in combination with chloride of sodium, also peroxide of hydrogen. Dental Caries is indicated by a process of gradual softening and disintegration of the tooth tissues by deleterious agents CHARACTERISTIC INDICATIONS OF THE TONGUE. 59 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 cleanli- ness. Deep-seated caries should be removed, and its further progress arrested by well inserted fillings of a durable ma- terial. 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 ex- haustive discharges. A Red Dry Tongue indicates inflammatory fever or pyrexia. A Red Glazed Tongue indicates debility and inability to di- gest 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. 60 DENTAL MEDICINE. DIGESTIBILITY OF FOODS. Giving the time required for the digestion in the stomach of various alimentary substances, derived from actual experi- ments. Article. Mode ok Prep. Hrs. Min. Aponeurosis (gristle)............Boiled.......3 00 Apples, sour, mellow............Raw........2 00 Apples, sour, hard.............Raw........2 50 Apples, sweet, mellow...........Raw........I 30 Bass, Striped...............Broiled.......3 00 Beans, Pod................Boiled.......2 30 Beans and green corn............Boiled.......3 45 Beef....................Fried........4 00 Beefsteak.................Broiled.......3 00 Beef, fresh, lean, dry............Roasted.......3 30 Beef, fresh, lean, rare............Roasted.......3 00 Beef, with mustard, &c............Boiled.......3 10 Beef, with salt only.............Boiled.......3 36 Beets...................Boiled.......3 45 Brains, animal...............Boiled.......1 45 Bread, corn................Baked . .'.....3 15 Bread, wheat, fresh.............Baked.......3 30 Cabbage.................Raw........2 30 Cabbage with vinegar...........Raw........2 00 4 3° Cabbage.................Boiled..... Carrot, orange...............Boiled.......3 13 Cartilage.................Boiled.......4 15 Catfish..................Fried........3 30 Cheese, old and strong...........Raw........-i -jo Chicken, full-grown............Fricasseed.....2 45 Codfish, cured, dry.............Boiled .......2 00 Custard..................Baked.......2 45 Duck, tame................Roasted ......4 00 Duck, wild................Roasted......4 30 Eggs, fresh................Raw........2 ^ Eggs, fresh................Whipped......1 30 Eggs, fresh................Roasted......2 15 Eggs, fresh...............Soft boiled.....3 ^ Eggs, fresh................Hard boiled.....3 30 Eggs, fresh................Fried.......^ 3Q Fowls, domestic..............Roasted ......4 00 Fowls, domestic..............Boiled.......4 00 Gelatine.................Boiled..... Goose, wild................Roasted .... Hashed meat and vegetables.........Warmed 2 30 2 30 2 30 < < a n 3 P . K---' -- 3*" ?r ?r e c - — — — —J-~'—'~Jr\r\r\r, OOOP c c c c &*& ^ "< B3? Jc « a o tr n-1 p. 3 trq er ft w hrt p o y p o o 3 ft h-1 P ft C/l 3- hdh3'-d*d>-d>TjhdHtf>TjHdlTJOOO (7Q CTq EJ g s ?v 5T ■."•»- ■» w a - ?f> = hH n> Q rt en »■ £. £. £ 3 ft ft ft g S £ B P O tn 5' " -h Sf -h -r ft ft w . 3" 3" 3" 3* 3" P* * * p ft 3 p "S. « ^3 B c 5. > p B 2. g b ~ 2. 2. 2. 2. ° ° a. n> » n s p pu ft ft ft ft p: B B u^ p. p. p. p. p. p. p. p. p. ft ft ft •-— ft ft p. p. p. ft p. p. y. + (^ to to to ii <-> « 4i ^ U OJ W W m u ^ Oj to N + ■(> W W (n W m to to U> U> tOWOJOJ to to to to to -l* 62 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. aa, Ana (G.), Ad saturand., Ad saturandum, Ad lib., Ad libitum, Aq., Aqua, Aq. tepid, Aqua tepida, Aq. ferv., Aqua fervens, Aq. dest., Aqua destillata, C. or Cong., Congius, Chart., Chartula, Coch., Cochlear, Coch. mag., Cochlear magnum, Coch. parv., Cochlear parvum, Colent, Colentur, Collyr., Collyrium, Comp., Compositus, Contus., Contusus, Cort., Cortex, Ext., Extractum, F. or Ft., Fiat vel fiant, Fol., Folium vel folia, Garg., Gargarysma, Gr., Granum vel grana, Gtt., Gutta vel guttae, Haust., Haustus, Infus., Infusum, M., Misce, Mass., Massa, Mist, Mistura, o., Octarius, Pil., Pilula vel pilulse, Pulv., Pulvis vel pulveres, q. s., Quantum sufficit, R., Recipe, Rad., Radix, S., Signa, Spts., Spiritus, ss., Semis, Syr., Syrupus, Tinct., Tinctura, ENGLISH WORD. Of each. Until saturated. At pleasure. Water. Warm water. Hot water. Distilled water. A gallon. A small paper. A spoonful. A tablespoonful. A teaspoonful. Let them be strained. An eye-water. Compound. Bruised or broken. Bark. An extract. Let there be made. A leaf or leaves. A gargle. A grain or grains. A drop or drops. A draught. An infusion. Mix. A mass. A mixture. A pint. A pill or pills. A powder or powders. A sufficient quantity. Take. A root. Write or give directions. Spirits. The half. Syrup. A tincture. ABBREVIATIONS FOR PRESCRIPTIONS. 63 ABBREVIATION. LATIN WORD. ENGLISH WORD. ft)., Libra, A pound. 3, Uncia, An ounce. 3. Drachma, A drachm. 9, Scrupulus, A scruple. '3. Fluiduncia, A fluid ounce. f3. Fluidrachma, A fluid drachm. 1TI, Minim, A drop. Although the symbol (TTL) 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 hun- dred 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 (TTL). A wine glass (approximate measurement) contains two fluid- ounces. A teacup (approximate measurement) contains four fluid- ounces. A tablespoon of powder (approximate measurement) con- tains two drachms. A teaspoon of powder (approximate measurement) contains one-half drachm. One drop of water (small drop, approximate measurement) contains one minim. 64 DENTAL MEDICINE. 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 and 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, polish- ing powders, etc.:— . „ . ("Should pass through a') A very fine powder . . \ sieve having 80 or more w=No. 80 Powder. (^meshes to linear inch. J . _ , (Should pass through a") A fine powder .... -{sieve having 60 meshes y—No. 60 Powder. (_ to the linear inch. ) . . . _ , (Should pass through a") A moderately fine powder < sieve having 5o meshes ^—No. KO Powder (_ to the linear inch. J J ... (Should pass through a") A moderately coarse powder-< sieve having 4o meshes I—No. 40 Powder. ( to trie linear inch. J " A . (Should pass through a") A coarse powder . . . < sieve having 20 meshes y=No. 20 Powder. (_ to the linear inch. J WEIGHTS AND MEASURES. APOTHECARIES' WEIGHT. 20 grains (gr.) make I scruple..............sc. or Q 3 scruples make i drachm.............dr. or z . S drachms make I ounce..............oz. or 5 12 ounces make i pound..............lb. or lb SCALE OF COMPARISON. ft> oz. dr. sc. gr. I = " = 96 = 288 = 5760 1 = 8 = 24 = 480 1 = 3 = 60 1 = 20 TROY WEIGHT. 24 grains (gr.) make 1 pennyweight............dwt. 20 pennyweights make 1 ounce............ # oz 12 ounces make 1 pound............ ^b y/i, grains make 1 carat (diamond weight)........k. WEIGHTS AND MEASURES. 65 SCALE OF COMPARISON. ft- oz- dwt. gr. 12 — 240 — 576o 1 = 20 _ 48q ' = 24 I k. = y/ , , , AVOIRDUPOIS WEIGHT 16 drachms (dr.) make 1 ounce........ 16 ounces make 1 pound......... fb 25 pounds make 1 quarter......... ' Qr 4 quarters make 1 hundredweight...........cwt 20 hundredweight make I ton......... T 100 pounds make 1 cental......... q SCALE OF COMPARISON. T- cwt- qr. lb. OZ. dr. 1 = 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 oifiuid measure is the liter—the cube of T'0 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 den- sity. 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 15 TROY GRAINS, AND TO CONSIDER I CUBIC-CENTIMETER AS EQUAL TO I 5 MINIMS. We accordingly have— 1 gram equal r troy grains. 1 troy grain equal to rV gram. 1 cubic-centimeter equal to i fluid drachm. 1 fluid drachm equal to f cubic-centimeter. 5 66 DENTAL MEDICINE. 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 75 / and 2. To CONVERT APOTHECARIES' DRACHMS INTO GRAMS, OR FLUIDRACHMS INTO CUBIC-CENTIMETERS, multiply by 4. In writing, prescriptions, the " gram " (abbreviated " Gm.") and "cubic-centimeter" (abbreviated " C.C.," which maybe called " fluigram," and written "f Gm") 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. R. Hydrarg. chloridi. corros.......... o 1 25 Gm. Potassi iodidi..............10 00 Gm. A grain- 15 to 45 minims. Extr. podophylii .... 3 to 10 centigrams . y to iy grains. 30 to 60 minims. 0.10 to 0.30 C. c. . . 2 to 5 minims. 6 to 30 centigrams . 1 to 5 grains. 30 to 60 minims. 30 to 60 minims. 5 to 15 grains. 15 to 45 minims. y to 2 fl. drachms. 15 to 60 minims. 15 to 30 minims. 30 to 60 minims. 5 to 15 minims. y to 2 fl. drachms. y to 2 fl. drachms. y to 1 fl. drachm. Extr. Scutellariae fl. . . . 2 to 8 C. c..... y to 2 fl. drachms. 8 to 15 minims. 1 to 4 fl. drachms. 30 to 60 minims. 15 to 60 minims. Extr. spigeliae et sennas fl. y to 2 fl. drachms. y to 2 fl. drachms. Extr. stillingias comp. fl. . y to 2 fl. drachms. Extr. stramonii (Engl.) . 3 to 6 centigrams . y to 1 grain. Extr. stramonii fol. ale. . 2 to 4 centigrams . Y to y grain. Extr. stramonii sem.. . . 1 to 3 centigrams . yi to y grain. 15 to 60 minims. 5 to 15 grains. y to 2 fl. drachms. Extr. ustilag. maid. fl. . . 15 to 60 minims. 30 to 60 minims. 5 to 15 grains. 30 to 60 minims. Extr. veratr. vir. fl. . . . 0.6 to 0.30 C. c. . . . 1 to 5 minims. Extr. viburni opuli fl. . . 1 1 to 2 fl. drachms. 86 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Extr. viburni [prunifol.] fl Extr. zingiberis fl. . . Fel bovis purif. . . . Ferri arsen. .... Ferri carb. sacch. . . Ferri chlorid..... Ferri citr...... Ferri et amnion, 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 brayeras . . Infusum catechu comp Infusum columbas . . Infusum digitalis . . Infusum eupatoris. . Infusum gentiana comp Infusum pruni virginianae Infusum quassias . . Infusum sennas comp. Ingluvin...... Iodoformum .... Iodum....... , , | expect. Ipecacuanha [em^et> Jalapa Dose in metric weights or measures. 4 to 8 C. c. . . . 0.50 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 6o* 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 i 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. y to 2 ounces. 1 to 5 grains. 1 to 5 grains. 5 to 30 grains. 1 to 3 grains. y to iy grains. 1 to 3 grains. 10 to 60 minims. 1 to 5 grains. 10 to 30 grains. h to fa grain. yi to 8 grains. fa to fa grain. tV to y grain. Ye to 1 grain. y to 1 grain. 3 to 8 grains. 2 to 8 fl. ounces. 1 to 2 fl. ounces. y to 2 fl. ounces. 2 to 4 fl. drachms. 1 to 2 fl. ounces. 1 to 8 fl. drachms. Y to 2 fl. ounces. y to 2 fl. ounces. 1 to 2 fl. ounces. 5 to 20 grains. 1 to 3 grains. ye to y grain. Ye to 1 grain. 15 to 30 grains. 15 to 30 grains. POSOLOGICAL TABLES. DOSE TABLE CONTINUED. Remedies. Kamala......... Kino.......... Lactucarium....... Liq. ammon. acet..... Liq. arsen. et hydr. iod. . Liq. ferri nitrat...... Liq. iodi. comp...... Liq. magnes. citratis . . Liq. pepsina....... Liq. potassas....... Liq. potassii arsenit . . . Liq. potassii citrat .... Liq. sodas........ Liq. sodii arseniatis . . . 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 copaibas..... Massa ferri carb..... Massa hydrarg...... Mist, ammoniaci..... Mist, asafostidas..... Mist, camphora (Hopis) . Mist, chloroformi . . . . Mist, cretae....... Mist, ferri comp..... Mist, ferri et ammon. acet Mist, glycrrh. comp. . . . Mist, magnes. et asafost. . Mist, potassii citr..... Mist, rhei et sodas . . . . Morphina and its salts . . Moschus........ Mucil. acacias...... Narceina........ Nitroglycerinum..... Nux vomica...... Oleoresina aspidii .... Oleoresinacapsici . . . . Oleoresina cubebae . . . 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..... 60 to 250 C. c..... to 15 C. c..... 0.30 to 1 C. c..... 0.15 to 0.50 C. c. . . 8 to 15 C. c..... o 30 to 1 C. c.. . . . 0.15 to 0.50 C. c.. . . 10 to 30 centigrams . 6 to 30 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 I to 4 C. c. . . . 0.06 to 0.30 C. c. . 0.30 to 2 C. c. . . Dose in apothecaries' weights or measures. 1 to 2 drachms. 8 to 30 grains. 8 to 15 grains. 2 to 8 fl. drachms. 2 to 7 minims. 8 to 15 minims. 5 to 20 minims. 2 to 8 fl. ounces. 2 to 4 fl. drachms. 5 to 15 minims. 3 to 7 minims. 2 to 4 fl. drachms. 5 to 15 minims. 3 to 7 minims. 2 to 5 grains. 1 to 3 grains. 2 to 6 grains. 2 to 5 grains. 2 to 8 grains. 5 to 10 grains. 15 to 60 grains. 15 to 60 grains. 2 to 8 drachms. 2 to 8 drachms. 8 to 30 grains. 2 to 10 grains. 1 to 2 ounces. 5 to 30 grains. 5 to 15 grains. 1 to 15 grains. 4 to 8 fl. drachms. 4 to 8 fl. drachms. 1 to 8 fl. drachms. 4 to 8 fl. drachms. 1 to 2 fl. ounces. yz to 2 fl. ounces. yz to 1 fl. ounce. 1 to 4 fl. drachms. 1 to 4 fl. drachms. y to 2 fl. ounces. y to 1 ft. ounce. fa to }i grain. 2 to 15 grains. 1 to 8 fl. drachms. yi to 2 grains. fa to ts1 grain 1 to 5 grains. 15 to 60 minims. 1 to 3 minims. 5 to 30 minims. 88 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Oleoresina lupulini . . Oleoresina piperis . . . Oleoresina zingiberis . . Oleum copaibas .... Oleum cubebae .... Oleum eucalypti .... Oleum morrhua .... Oleum phosphoratum . Oleum ricini..... Oleum sabinas .... 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 myrrhas . . , Pil. antimon. comp. . . . Pil. asafcetidas...... 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 1 C. c.. . . 0.06 to 0.20 C. c. . 0.06 to 0.20 C. c. . 0.50 to 1 C. c.. . . 0.30 to 1 C. c.. . . 0.60 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. . 0.30 to 2 C. c.. . . 0.03 to 0.10 C. c. . 1 to 10 centigrams 0.30 to 1 Gm. . . . 1 to i5*Gm. . . . 0.60 to 1 Gm. . . . 0.50 to 3 milligrams I to 30 milligrams 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 .... 3 to 20 centigrams 3 to 20 centigrams 1 to 4 Gm..... 0.50 to 4 Gm. . . . 1 to 8 Gm..... 0.50 to 4Gm. . . . 0.50 to 2 Gm. . . . 0.50 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. I to 3 minims. 1 to 8 fl. drachms. 1 to 3 minims. 5 to 30 minims. y to 2 minims. Ye to 1 y grains. 5 to 20 grains. 15 grains to y ounce. 10 to 20 grains. T-h-t0 fa grain- fa to y 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. y to 3 grains. y 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. fa t0 lA grain. y to 1 ounce. 5 to 15 grains. 2 to 15 grains. 8 to 15 grains. 1 to 4 drachms. 1 to 10 grains. 15 to 30 grains. POSOLOGICAL TABLES. 89 DOSE TABLE CONTINUED. Remedies. Potassii tartras..... Prunus Virginianum . . . Pulv. aromat...... Pulv. cretae comp..... Pulv. effervescent aperient (seidlitz powder) Pulv. glycyrrh. comp. . . Pulv. ipecac, et opii . . . Pulv. jalapas comp. . . . Pulv. rhei comp..... Quassia........ Quinidina (and salts) . . Quinina (and salts) . . . Resina jalapas..... Resina podophylli . . . 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. ammonias ..... Spir. ammonias arom. . . Spir. camphorae..... Spir. chloroformi .... Spir. frumentis ..... Spir. vini gallici..... Spir. juniper...... 5 to 30 Gm. 2 to 4 Gm. 0.50 to 2 Gm. 0.50 to 2 Gm. Dose in metric weights or measures. 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 centigrams 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. . . . 0.30 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. . . . 0.50 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. . . . 0.50 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. o 8 drachms. o 1 drachm. o 30 grains, o 30 grains. Chart No. 1. 60 grains. 15 grains. 60 grains. 60 grains. 60 grains. 30 grains. 30 grains. 5 grains. Yt. grain. 10 grains. 30 grains. 30 grains. 60 grains. 5 grains. 30 grains. 15 grains. 60 grains. 60 grains. fa grain. 15 grains. 30 grains. 30 grains. 30 grains. 30 grains. 30 grains. 15 grains. 30 grains. 15 grains. 30 grains. 15 grains. 15 grains. 30 grains. 10 grains. 8 drachms. 30 grains. 60 minims. 2 fl. drachms. 30 minims. 60 minims. 30 minims. 60 minims. 4 fl. drachms. 4 fl. drachms. 4 fl. drachms. 90 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Spir. lavend. comp. . . Spir. menth. pip. . . , Strychnina (and salts) . Succus conii...... Succus limonis .... Sulphur....... Syrupus calcii lactophos Syrupus calcis .... Syrupus ferri bromidi . Syrupus ferri iodidi . . Syr, fer. manganese iodidi Syrupus ferri oxidi. . . . Syrupus ferri hypophosph. Syr. fer. quin. et str. phos. Syrupus hypophosphit. . Syrupus hypophos. c. fer. Syrupus ipecac...... Syrupus lactucarii .... Syrupus pruni virginiani Syrupus rhei...... Syrupus rhei arom. . . . Syrupus rosas...... Syrupus rubi...... Syrupus sarsap. comp.. . Syrupus scillas..... Syrupus scillae comp. . . Syrupus senegas .... Syrupus sennas..... Syrupus tolutan..... Tmct. aconiti fol..... Tinct. aconiti rad..... Tinct. aeon. rad. Fleming's Tinct. aloes (1880) . . . Tinct. aloes et myrrhae . Tinct. arnicas flor. . . . Tinct. arnicas rad. . . . Tinct. asafostidas .... Tinct. belladonnas . . . Tinct. calumbae .... Tinct. cannabis ind. . . . Tinct. cantharid..... Tinct. capsici...... Tinct. catechu..... Tinct. cimicifugae .... Tinct. cinchonas .... Tinct. cinchonas comp. . Tinct. colchici sem. . . . Tinct. conii...... Tinct. cubebas..... Tinct. digitalis..... Dose in metric weights or measures. 2 to 4 C. C. . . , 2 tO 4 C. C. . . , 1 to 5 milligrams 2 to 16 C. c. . . . 4 to 8 C. c. . . . 2 to 15 Gm. . . . 5 to 10 C. c. . . . 1 to 2 C. c. . . . 1 to 4 C. c. . . . 1 to 4 C. c. . . . 0.60 to 4 C. c. . . 5 C.c...... 5 C. c...... 5 C. c...... 5 C. c...... 5 C. c...... 2 to 15 C. c. . . . 5 to 10 C. c. . . . 4 to 16 C. c. . . . 4 to 15 C. c.. . . 4 to 15 C. c. . . . 4 to 8 C. c. . . . 4 to 8 C. c. . . . 4 to 15 C. c. . . . 2 to 4 C. c. . . . 1 to 4 C. c. . . . 4 to 8 C. c. . . . 5 to 15 C. c. . . . 4 to 32 C. c. . . . 0.50 to 1 C. c. . . 0.06 to 0.30 C. c. . 0.04 to 0.15 C. c. . 2 to 8 C. c. . . . 4 to 8 C. c. . . . 0.50 to 2 C. c.. . . 1 to 2 C. c. . . . 2 to 4 C. c. . . . 0.20 to 1 C. c. . . 3 to 15 C. c. . . . 0.30 to 2 C. c. . . 0.06 to 0.60 C. c. . 0.30 to 2 C. c. . . . 2 to 8 C. c. . . . 2 to 4 C. c. . . . 2 to 8 C. c. . . . 2 to 8 C. c. . . . 0.30 to 1 C. c. . . 0.30 to 2 C. c. . . 4 to 8 C. c. . . . 0.30 to 1 C. c. . . Dose in apothecaries' weights or measures. 30 to 60 minims. 30 to 60 minims. fa to fa grain. y to 4 fl, drachms. 1 to 2 fl. drachms. y to 4 drachms. I to 2 fl. drachms. 15 to 30 minims. 15 to 60 minims. 15 to 60 minims. 10 to 60 minims. 1 fl. drachm. 1 fl. drachm. 1 fl. drachm. 1 fl. drachm. 1 fl. drachm. y to 4 fl. drachms. 1 to 3 fl. drachms. 1 to 4 fl. drachms. 1 to 4 fl. drachms. 1 to 4 fl. drachms. 1 to 2 fl. drachms. I to 2 fl. drachms. 1 to 4 fl. drachms. y to 1 fl, drachm. 15 to 60 minims. 1 to 2 fl. drachms. 1 to 4 fl. drachms. 1 to 8 fl. drachms. 8 to 16 minims. 1 to 5 minims. y to 2y minims. Y to 2 fl. drachms. 1 to 2 fl. drachms. 8 to 30 minims. 15 to 30 minims. 30 to 60 minims. 3 to 15 minims. 1 to 4 fl. drachms. 5 to 30 minims. 1 to 10 minims. 5 to 30 minims. y to 2 fl. drachms. 30 to 60 minims. y to 2 fl. drachms. y to 2 fl. drachms. 5 to 15 minims. 5 to 30 minims. 1 to 2 fl. drachms. 6 to 15 minims. POSOLOGICAL TABLES. 91 DOSE TABLE CONTINUED. Remedies. eucalypti .... ferri chloridi . . . ferri chloridi aether. gentian comp. . . gelsemii..... guaiaci..... guaiaci ammon. . . humuli..... hydrastis . . . . hyoscyami fol. . . hyoscyami sem. . iodi....... ipecac, et opii. . . jalapas...... kino ...... kramerias .... lavend comp. . . lobelias..... lupulini . . . . . matico...... nuc. vomicae . . . opii deodorat . . . opii camph. . . . physostigmatis . . pyrethri..... quassias..... rhei........ sanguinanae . . . . scillias...... , serpentarias . . . stramon. fol. . . . stramon. sem. . . sumbul...... tolutan...... valer....... valer. am on. . . . veratr. vir..... zingiberis .... . elaterini..... Uva ursi........ Veratrina....... Vin, aloes ....*•• ,7. .. f expect, et. alt Vin. antim|emPet ^ _ Vin. colch. rad...... Vin. colch. sem..... Vin. ergotas...... Vin. ferri amar...... Vin. ferri citrat...... Vin. xericum...... 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 4C. 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..... 5Cc....... 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 2y fl. 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 y 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. 92 DENTAL MEDICINE. DOSE TABLE CONTINUED. Remedies. Vin. ipecac. |exPefct r {emet. Vin. opii . . Vin. portense Vin. rhei. . Zinci acet. . Zinci oxid. . Zinci sulphas emet. Zinci valerianas Dose in metric weights or measures. 0.30 to 1 C. c. ... 10 to 25 C. c..... 0.30 to 1 C. c..... 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. Dose in apothecaries' weights or measures. 5 to 15 minims. 3 to 6 fl. drachms. 5 to 15 minims. 1 to 8 fl. drachms. 1 to 2 fl. drachms. I to 2 grains. 1 to 10 grains. 15 to 30 grains. y to 2 grains. The Best Twenty-five Drugs.—It is claimed that the medi- cal art could be carried on with the following drugs, twenty- five in number, and which represent the soul of the Pharmaco- poeia : 1, opium; 2, mercury; 3, iodides; 4, quinine; 5, chloroform; 6, ether ; 7, sulphate of magnesia ; 8, salicylic acid; 9, aloes; 10, alcohol; 11, bromides; 12, iron; 13, chloral; 14, castor-oil; 15, digitalis; 16, arsenic; 17, colchi- cum ; 18, ipecac; 19, aconite : 20, strychnia ; 21, cocaine ; 22, ergot; 23, bicarbonate of potash; 24, mineral acids; 25, nitrites. 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 suffi- cient, 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 POISONS. 93 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 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 impreg- nated with mucus and blood. Death occurs from inflamma- tion, 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. 94 DENTAL MEDICINE. ARSENIC. Symptoms.—Faintness and nausea, with burning pain in the epigastrium; vomiting; purging, or diarrhoea; thirst; con- striction 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 convulsions. Antidotes.—Moist peroxide of iron (obtained from perchlo- ride of iron and calcined magnesia); animal charcoal; ammo- 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 di- lated 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 atropine. Antidotes.—Same as for atropine. CANNABIS INDICA (Indian Hemp.) 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 poisons. 95 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 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, picro- tine, 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 96 DENTAL MEDICINE. (one pole may be applied to nape of neck and the other to th£ pit of the stomach); brandy and ammonia enemata; hypoder- mic injection of fa gr. of digitaline, followed in four hours after by fa gr- °f atropine, or hypodermic injection of I 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. 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. POISONS. 97 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. 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 purg- ing; 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 exces- sive 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. 7 98 DENTAL MEDICINE. 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. Antidotes.—Enema of tobacco, % oz. to 20 oz. of boiling water, to be administered until spasms abate; nicotine, 1 drop, in warm sherry wine and water. OPIUM. Symptoms.—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 stom- ach ; 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 aceticacid; citric acid; lemon juice; fixed oils; demulcents. THE PULSE. 99 SILVER (Nitrate of Silver). Symptoms.—Corrosion of tissues; nausea; vomiting; con- vulsions ; paralysis. Antidotes.—Chloride of sodium (common salt); albumen; white of egg. STRAMONIUM (See Belladonna). STRYCHNINE. Symptoms.—Spasmodic action of muscles (twitching); jerk- ing of limbs ; tetanic spasms; dyspnoea; death. Antidotes.—Chloroform ; belladonna; tincture of aconite ; morphine; tobacco; chloral, in drachm doses; 8 grs. morphine 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; vomiting; 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 some- 100 DENTAL MEDICINE. times 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. 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........................120 Child under 5 years of age................100 Youth 90 Male adults......................72-80 Female adults.....................80-85 Old age........................70 THE PULSE. 101 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 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 102 DENTAL MEDICINE. abnormal frequency in an adult. There are exceptions to this, 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 STAGES 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 at 32 degrees below the freezing point, while in the others zero marks the freezing point. 35 25 20 18 THERMOMETERS. 103 77 122 167 212 25 5o 75 100 20 40 60 80 The boiling point in Fahrenheit's is placed at 212 degrees ; in Centigrade at IOO, and in Reaumer's at 80. , The degrees between the freezing and boiling points in the instruments are, therefore, respectively 180, IOO and 80. The following diagram will explain the variance:— Fahrenheit......o. 32 Centigrade......17-77 o Reaumer......14.22 o 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, 9&}4°, 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 temper-ature 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 temperature of the body is usually proportionate to the fre- quency 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. « " ioo° " " 80. « « 1010 " " 90. «< « 1020 " " 100. » " 1030 " " no. « " 1040 " " 120. 104 DENTAL MEDICINE. TABLE OF ELEMENTARY SUBSTANCES. Elements. "3 J3 Atomic Equiva- £ t/3 Weight. lent. Aluminum . . Al 27 13-5 Antimony . . Sb 120 120 Arsenic . . . As 74-9 74-9 Barium . . . Ba 136.8 68.4 Berylium . . Be 9 9 (Glucinum) Bismuth . . . Bi 210 210 Boron .... B 11 n Bromine . . . Br 79.8 79.8 Cadmium . . Cd 111.8 55-9 Caesium . . . Cs 132.6 132.6 Calcium . . . Ca 40 20 Carbon1 . . . C 12 6 Cerium . . . Ce 141 70.5 Chlorine2 . . CI 35-4 35-4 Chromium . . Cr 52.4 26.2 Cobalt . . . Co 58.9 29.45 Copper . ... Cu 63.2 31.6 Didymium . . Di 144.6 72.3 Erbium . . . E 165.9 82.95 Fluorine . . . Fl 19 '9 Gallium . . . G 68.8 34-4 Gold .... Au 196.2 196.2. Hydrogen . . H 1 1 Indium . . . In "3-4 56.7 Iodine . . . I 126.6 126.6 Iridium . . . Ir 192.7 96-35 Iron .... Fe 55-9 27.95 Lanthanum . . La 138.5 138.5 Lead .... Pb 206.5 103.25 Lithium . . . Li 7 7 Magnesium . . Mg 24 12 Manganese . . Mn 54 27 Mercury . . . Hg 199.7 99.85 Elements. "3 Atomic Equiva- s c« Mo Weight. lent. Molybdenum . 95-5 4275 Nickel . . . Ni 58 29 Niobium . . Nb 94 94 Nitrogen3 . . N H H Osmium . . Os 198.5 99.25 Oxygen * . . 0 16 8 Palladium . . Pd 105.7 52.85 Phosphorus . P 31 3i Platinum . . Pt 194.4 97.2 Potassium . . K 39 39 Rhodium . . Rh 104.1 52.05 Rubidium . . Rb 85-3 85-3 Ruthenium Ru 104.2 52.1 Scandium . . Sc 44 22 Selenium . . Se 78.8 39-4 Silicon . . . Si 28 14 Silver . . . Ag 107.7 107.7 Sodium . . . Na 23 23 Strontium . . Sr 874 43-7 Sulphur5 . . S 32 16 Tantalum . . Ta 182 182 Tellurium . . Te 128 64 Thallium . . Tl 203.7 203.7 Thorium . . Th 233 116.5 Tin ... . Sn 117.7 58.85 Titanium . . Ti 48 24 Tungsten . . Tr 183.6 91.8 Uranium . . U 238.5 119.25 Vanadium . . V 51-3 5r-3 Ytterbium . . Yb 172.7 172.7 Yttrium . . . Y 89.8 89.8 Zinc .... Zn 64.9 32.45 Zirconium . . Zr 90 45 1 Carbon: 11.9736. ^Chlorine: 35.370. 8Nitrogen: 14.021. «Oxygen: 15.9633. *Sulphi 31-984. CHEMICALS SOLVABLE BY WATER AND ALCOHOL. 105 TABLE OF THE SOLUBILITY OF CHEMICALS IN WATER AND ALCOHOL. Abbreviations ; s. = soluble; ins. = insoluble; sp. = sparingly ; v. dec. = decomposed. very ; aim. = almost; 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 15° C. (5o° F.) Boiling. At 150 C. (5°° F.) Boiling. Parts. Parts. Parts. Parts. 30.80 15 sp. sp. 50O 15 3 I 25 3 15 5 20 V. s. V. s. V. S. V. s. dec. dec. O.75 0.5 1 0.5 IOO 3 4-5 1 450 H 2.2 V. s. 6 V. s. 0.6 V. s. 0.7 0.5 2-5 0.2 10.5 ins. "°-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. 07 V. s. 1 V. s. ins. ins. ins. ins. i-5 v. s. 8 i-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. v. s. IOO 4 71 12 aim. ins. aim. ins. no 28 70 14 6 i-5 80 17 V. s. v. s. ins. ins. ins. ins. *5 e 5 135 H 2.6 0.5 ins. ins. v. s. v. s. v. s. v. s. s. V. s. ins. ins. 106 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 . . . Iodoforum....... Iodum......... Magnesia........ Magnesii carbonas .... Magnesii sulphas..... Magnesii sulphis..... Mangani oxidum nigrum . . Mangani sulphas..... Morphina........ Morphinae 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...... WATER. ALCOHOL. At I5° C (50° F.) Boiling. At 15° C. (50° F.) Boiling. Parts. Parts. Parts. Parts. 40 12 aim. ins. aim. ins. 1.8 °-3 ins. ins. ins. dec. v. s. v. s. 16 . 2 3 1.2 ins. ins. ins. ins. 12.8 3 15 6 aim. ins. aim. ins. 130 15 aim. ins. aim. ins. ins. ins. ins. ins. ms. ins. ins. ins. ins. ins. ins. ins. ins. ins. v. s. v. s. v. s. v. s. ins. ins. 80 15 sp. n aim. ins. aim. ins. ins. ins. aim. ins. aim. ins. ins. ins. 0.8 0.15 ins. ins. 20 19 ins. ins. ins. ins. ins. ins. 0.7 0.8 ins. ins. 500 IOO 36 12 i-5 68 H 24 0.5 63 3i 24 0.75 702 144 ins. ins. v. sp. v. sp. aim. ins. aim. ins. 3° 1 1.8 0.5 8 1 ins. ins. ins. ins. 2000 200 v. sp. v. sp. 2 0.8 aim. ins. aim. ins. ins. ins. ins. ins. 0.5 v. s. 2 v. s. 0.4 v. s. 2-5 v. s. 3-2 dec. aim. ins. aim. ins. 10 i-5 ins. ins. 210 15 v. sp. v. sp. 1.6 1 200 16 1 0.7 ins. ins. 16.5 2 v. sp. v. sp. 0.6 v. s. v. sp. v. sp. 2 I sp. sp. 4 2 ins. ins. 0.6 °-3 7-3 3.6 0.8 0.5 18 6 4 0.4 aim. ins. aim. ins. CHEMICALS SOLVABLE BY WATER AND ALCOHOL. 107 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 . . . . Ati5°C. (5°° F.) Parts. 20 9 0.7 IOO 1600 10 34 .74o IOO 0.5 7 28 U7 3 12 16 1.6 1.1 2.8 1 i-5 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 IOO Boiling. ALCOHOL. Parts. 3 4 0.5 7 70Q v. s. 1 3° 40 0.2 1 0.7 0.8 1 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. i-5 ins. v. s. v. s. ins. ins. o-3 At150 C. (5°° F.) Parts. dec. ins. aim. ins. 8 6 32 3 65 5 i75 ins. 30 v. s. .3° ins. ins. ins. 40 aim. ins 3° ins. 1.8 sp. ins. sp. no 60 ins. ins. ins. 1 3 .3° ins. v. s. v. s. ins. ins. ins. 40 Boiling. Parts. dec: ins. aim. ins. v. s. 2 v. s. y. s. 3 1 28 ins. 2 v. s. 2 ins. ins. ins. 43 aim. ins. 1 ins. 1.4 40 ins. sp. 12 2 ins. ins. ins. v. s. V. s. 3 ins. v. s. v. s. ins. ins. ins. 108 DENTAL MEDICINE. I. Neurotics, or those which have a special action on and modify the functions of the nervous system. To this group belong: 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: Narcotics, Anaesthetics, Antispasmodics, Tonics, Astringents, Stimulants, Sedatives, Spinants. (" Emetics, 2. Eccritics, or those which have a special j Cathartics, _ . . I Diaphoretics, action on the secretions. To this group < Diuretics, L„1~„,~. ■ Blennorrhetics, belong: „ ° V. Emmenagogues. 3. H^emetics, or those which modify the blood, f Haematites, < Alteratives, To this group belong: . ( Antacids. C Irritants, _, , . 11! Demulcents, 4. Topical remedies. To this group belong: i coloring Agents, [_ Anthelmintics. DEFINITIONS OF THE VARIOUS CLASSES OF REMEDIAL AGEN TS. 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 effi- cacy 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. 109 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- niuitf, hyoscyamus, tobacco, lobelia, conium, aconite, cannabis indica, humulus, camphor, hydrocyanic acid, etc., etc. ANESTHETICS. 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- 110 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, calumba, 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. Ill 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 112 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 may be 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. 113 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 8 114 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 admin- ister 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; arid 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. 115 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); Yz drop of diluted hydrocyanic acid in syrup and water, or in syrup of wild cherry bark (given every 15 minutes); or in- fusion 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 min- eral 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 indications: 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 116 DENTAL MEDICINE. administered immediately after a full meal, they arrest the digestive 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 continued till the requisite action is induced, yet not sufficient to prove an irritant. But in the treatment of many diseases, it is prefer- able 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 ipecacuanha, 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. 117 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 resino-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 manganese, 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 com- bination 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. (See Purgatives.) 118 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, ammonia, 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 diaphor- etics, 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. 119 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 120 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 amennorrhcea; for example, when anaemia 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 debil ity 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. HEMATINICS. 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. 121 ALTERATIVES. Alteratives are medicinal substances which are capable, when administered in small, doses, of removing morbid struc- tures and conditions, without any sensible evacuation; in other words, changing, in some inexplicable and insensible manner, certain morbid actions of the system. Alterative remedies re-establish the healthy functions of the animal economy in a slow but decided manner, acting on the various secreting organs, sometimes without any sensible in- crease of the secretions themselves. The effect of minute doses of mercury, iodine and other substances, upon the glandular 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 ex- halations 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 inflammation is arrested, and visceral and glandular enlarge- ments are dispelled. But if administered too freely, the blood may become so impoverished as to interfere with the func- tions 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 inflammation, and the preparations of iodine and bromine in chronic inflamma- tions. 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. 122 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 un- usual 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 anaplastics and resolvents in inflam- mation, and as diuretics. As a general rule, the administra- tion 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. 123 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- 124 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. 125 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, w?here 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 126 ' 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 Lenitives, 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. 127 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, marshmallow, benne, quince seed, liquorice root, Iceland moss, Irish moss, starch, arrow root, tapioca, sago, barley, glycerin, pyroxylon, 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 influence 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 they are used for coloring dentifrices, such as 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 :— 128 DENTAL MEDICINE. Absorbents, Detergents, Hypersthenics, Anodynes, Deodorizers, Hypnotics, Antemetics, Diluents, Laxatives, Anthridrotics, Discutients, Nervines, Antiperiodics, Disinfectants, Nutritives, Antipyretics, Emollients, Purgatives, Antiseptics, Errhines, Refrigerants, Aromatic Bitters, Escharotics, Resolvents, Carminatives, Expectorants, Restoratives, Caustics, Evacuants, Sialogogues, Cauterants, Excitants, Stimulants, Constringents, Febrifuges, Styptics, Counter-irritants, Germicides, Vesicants. Desiccatives, Haemostatics, ABSORBENTS. 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 capa- ble 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, hsema- toxylon, etc. REMEDIAL AGENTS. 129 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. ANTIPYRETICS. Antipyretics are medicinal agents having a decided power to depress the temperature of the body. Included in this class are antifebrin, antipyrine, quinoline or chinoline, thalline, kairine, etc. ANTISEPTICS. Antiseptics are medicinal agents capable of arresting fer- mentative 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, iodol, hydronapthol, peroxide of hydrogen, bichloride of mer- cury, essential oils, etc. Forms of Antiseptics for Use: Dr. Black on this subject, says: " In regard to the use of antiseptics in different cases and for different purposes, I should divide them into three forms, each of which has especial advantages. " These forms are: the solution in water, the oil, and the powder. " The solution in water is especially useful for cleaning in- fected surfaces of wounds, washing abscesses and, indeed, in any case where there is something that can be removed by washing. In the performance of this act the antiseptic is dif- fused to all parts of the wound or abscess mechanically to the best advantage. It is more likely to reach every part in this form than in any other; and this is an advantage that can hardly be over-estimated; for it is very difficult to reach all parts of an abscess by any mode of procedure now known to us on account of the very tardy diffusion of liquids. And in case the liquid containing the antiseptic in solution does dif- 9 130 DENTAL MEDICINE. fuse, its very diffusion and mixture with the surrounding fluids soon dilutes it below its range of antiseptic value. It is there- fore necessary that the washing be continuous to obtain the continuous effect of the drug. This is generally impracticable, and for this reason the watery form of antiseptics is very much limited in usefulness. The continuous drip, or the application as often as every fifteen or twenty minutes, gives effective re- sults in some favored localities; but it is very difficult to carry out and occasions much trouble. The continuous bath is still more limited in its range of application. Neither of these can be used in dental practice. With us the watery form of antiseptics should be limited to the cleaning of infected parts. They cannot be trusted to prevent septic action for any length of time, for the reason that they so soon become diluted be- low their range of antiseptic value by mixture with the secre- tions, or the juices of the flesh. Since studying the powers of antiseptics and disinfectants more closely, my feeling is that it will not do for us to expect to do much disinfectant work in connection with the soft tissues except in cases in which some tissue destruction can be borne; and that antiseptics only re- tard the growth of microbes during their presence in effective proportion; hence the necessity for continuous and oft-re- peated application. In using these for the purpose of clean- ing, much aid may be had by making use of the solution in peroxide of hydrogen instead of water, so as to obtain the mechanical effect of the ebullition of the oxygen evolved in mix- ing the antiseptic with the secretions. There is possibly some antiseptic virtue in oxygen itself as well, but I am apt to think that its principal use is the mechanical one. And that is a very important use. Thorough cleaning is excellent antiseptic work, and the peroxide of hydrogen will do this in many positions where nothing else will, and at the same time carry the antiseptic proper to the more remote parts of the wound or abscess." AROMATIC BITTERS. Aromatic bitters differ from simple bitters in the aromatic constituents they contain. They possess tonic properties and REMEDIAL AGENTS. 131 invigorate digestion and promote constructive metamor- phosis. They are employed in the same cases as simple bitters, but appear to possess some specific properties due to the aromatic constituents. Included in this class are serpen- taria, prunus virginiana, canella, anthemis, etc. CARMINATIVES. Carminatives are medicinal agents capable of dispelling flatulence, and allaying pain in the stomach and bowels. In- cluded in this class are such agents as cinnamon, cardamom, cloves, coriander, lavender, ginger, juniper, caraway, pepper- mint, 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, aconite 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)) 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 132 DENTAL MEDICINE. 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?) 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. REMEDIAL AGENTS. 133 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 Irritants.) 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, ben- zoic acid, preparations of ammonia, tartar emetic, balsam of tolu, myrrh, nitrate of potash, seneca, wild-cherry bark, lobe- lia, etc., etc. (See Blennorrhetics) EVACUANTS. Evacuants Delong 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- nized as Refrigerants. Included in this class are nitrate of potassa, chlorate of potassa, the mineral acids, spirits of nitrous ether, etc., etc. GERMICIDES. Germicides include all substances which destroy any form of microbe or disease germ. Included in this class are bichloride of mercury, peroxide of hydrogen, iodoform, iodol, iodine, salicylic acid, eucalyptus, carbolic acid, chlorine, chloride of zinc, permangate of potash, naphthol, etc.; also heat. 134 DENTAL MEDICINE. HEMOSTATICS. Haemostatics are medicinal agents capable of arresting hemorrhage, and belong to the class of Astringents. (See Astringents and Styptics)) HYPERSTHENICS. Hypersthenics belong to the class of stimulants. (See Stim- ulants)) 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 as- similation 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, and are divided into sev- eral classes, according to the nature of their action, such as: Laxatives, which incite intestinal movements without much increase of the intestinal secretions. Included in this class are manna, sulphur, magnesia, castor-oil, etc. Saline Purga- tives, which produce increased secretion, and at the same time hasten the peristaltic action, the stools being loose and watery. Included in this class are sulphate of magnesia, phosphate of soda, tartrate of potassium and sodium, Seidlitz powder, bitartrate of potassium, etc. Mercurial Purgatives, principally calomel and blue mass, which are supposed to produce cholagogue effects and also an influence peculiar to themselves. Tonic-astringent and resin-bearing purgatives, REMEDIAL AGENTS. 135 which have an influence over the liver and the glandular ap- pendages, and promote the tonicity of the muscular layer of the intestines. Included in this class are senna, rhubarb, aloes, jalap, scammony, colocynth, podophyllum, etc. Hydra- gogue purgatives, which are very energetic in their action, in- crease the glandular secretions and cause an abundant out- ward diffusion to such a degree as to produce very watery stools; and also excite rapid and severe peristaltic move- ments. Included in this class are cambogia, croton-oil, elater- ium, etc. (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- tion and dispersing morbid swellings. (See Alteratives and Emollients)) RESTORATIVES. Restoratives belong to the classis 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 136 DENTAL MEDICINE. useful in cases of paralysis of the tongue, etc., by their directly excitant properties ; also in 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- 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 THERAPEUTIC FORMS. 137 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. 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 are 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 fre- quently applied and persevered in for some time. They are employed in cases of inflammation and ulceration of the mu- cous membrane of the mouth and fauces. Glycerites are solutions of medicinal substances in gly- cerine. Infusions are preparations obtained by pouring a hot or 138 DENTAL MEDICINE. cold fluid upon vegetable substances, for the purpose of ex- tracting 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 prep- arations 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 medici- nal 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. (See Medicinal Oleates). 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. 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. Poultices are preparations for applying continuous heat and moisture and softening the tissues. Their effects are to cause an afflux of blood to the part, dilate the vessels and soften the tissues by the influence of both heat and moisture, and render the diffusion of the fluids easy. In inflammatory conditions, the stasis of the vessels implicated is relieved, the tension of the parts lessened and resolution brought about: Where the stage of exudation is present, these preparations pro- mote the increase and migration of the white corpuscle, and facil- itate the escape of purulent matter. Poultices also relieve the pain of inflamed parts by relaxing the tissues, and thereby removing pressure from the sensory nerve filaments; they re- lieve pain in parts distant from the points where their applica THERAPEUTIC FORMS. 139 tions are made, and have both a local and systemic effect. Poultices are generally composed of such substances as flax- seed-meal, powdered slippery-elm bark and corn meal; also bread and milk are sometimes employed. The substance dissolved in hot water is spread upon soft muslin of such a size as to allow one free end to fold over the mass and intervene between it and the surface of the skin ; or it may be inclosed in a small bag of muslin. Glycerine spread over the surface of a poultice will prevent its drying. Laud- anum is often added to mitigate the pain, if necessary; also charcoal in the form of powder. A yeast poultice is made of brewer's yeast with enough of flaxseed to give it a proper con- sistence. They should not be allowed to remain too long, as their effect will cause the skin to become white, wrinkled and pulpy, and lead to the formation of small boils or abscesses ; also, in case of wounded or ulcerated surfaces their too long use will cause the granulations to become pale and flabby and prevent healing; besides, if the granulations are large, they lower the tone and vigor of the system, depress the circulation, and exhaust the irritability of the vaso-motor nerves, and thus prevent healing, Poultices are employed in boils, car- buncles, irritable ulcers, gangrenous sloughs. The charcoal and yeast poultices are used in foul wounds. Poultices are also applied with benefit in pneumonia, pleuritis, pericarditis, hepatitis, peritonitis, faucial inflammations, etc. Suppositories are solid preparations, of a round, cylindri- cal, or conical form, to be introduced into the anus ; and are composed of sedative, astringent, or purgative medicines, com- bined 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 (H2C12H18O10H2O), 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, Sj ad libitum. Of the mucilage (giv, water Syj) £ij 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. 140 ACETIC ACID. 141 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 acaciae.................gij Sodii boratis..................3 ij 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, 3j 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 142 DENTAL MEDICINE. vapor, when applied to the nostrils, acts as aa excitant in syncope, headache, etc. Dental Uses.—Acetic Acid is externally employed in indo- lent ulcers of the mouth, cancrum oris, and scurvy, both locally and internally. It is also applied to fungous growths of gums and dental pulps, the stronger acid being used. In the form of glacial acetic acid—Acidum Aceticum Glaciate (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 pain, and pro- motes a healthier condition. DENTAL FORMULA. For Indolent Ulcers of the Mouth, For Inflamed Fauces. Cancrum Oris, Scurvy. R-. Acidi acetici......f5 ij R. Acidi acetici......f^ iij Ammonii chloridi . ... £j Aquae.........f £ v. Mellis.........f ^ iss Fiat solution Aquse.........f g xij Sig.—Apply with a camel's-hair brush. Fiat gargarysma. ACIDUM ARSENIOSUM—ARSENIOUS ACID. WHITE OXIDE OF ARSENIC-ARSENIOSUM OXIDUM. Formula.—As2Os. 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 arseni- cal 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 transparent internally. It has no odor, and is there- fore liable to be mistaken for more innocent substances, and scarcely any taste, or merely a faint, sweetish impression. ARSENIOUS ACID. 143 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, 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 addding 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 conditions. 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 recommended 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 excavated by a purgative, 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 regu- larity, 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, 144 DENTAL MEDICINE. 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, and fatal effects have followed the administra- tion of two grains, although much larger quantities have been taken with impunity; very large quantities often cause 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, symp- toms resembling those of poisonous doses make their appearance. ARSENIOUS ACID. 145 Arsenious acid acts locally as an escharotic, but while a true escharotic acts chemically, producing decomposition of the 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. 10 146 DENTAL MEDICINE. Dose.—Of arsenious acid, gr. fa to gr. fa, in pills with bread crumb three times a day. Of liquor potassii arsenitis (Fow- ler's Solution), mij to 1Ux, 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 and pulmonary affections. Therapeutic Uses.—In intermittent and periodic diseases, such as malaria, neuralgic and spasmodic diseases, being of great value 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 (Sodcs 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 ARSENIOUS ACID. 147 acid, when employed for the devitalization of dental pulps, has been combined with pulverized charcoal, under the impression 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 arsenjous 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 atropine, 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 t£t, fa, 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 148 DENTAL MEDICINE. required to enable the arsenious acid to properly devitalize the pulp of a tooth; the difference in time depending upon the 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 exposed surface of the organ. Accuracy as to«the quantity of the arsenious acid to be employed may be arrived at by hav- ing a grain divided into forty to sixty 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 or, what may be more painless, oil of cloves, and the de- sired quantity of the powder, being taken up on the pellet, can be placed directly in contact with the exposed surface of the pulp, and secured in the carious cavity by means of a second pellet of cotton, saturated with either sandarach or shellac var- nish, a solution of gutta percha and chloroform, wax or sof- tened gutta percha. To properly secure the arsenical prepa- ration in the cavity of a tooth, a concave disk of thin platinum may be placed over it, and a temporary filling of soft gutta percha introduced into the carious cavity. Dr. Chas. Truman suggests a mixture of iodoform and ar- senious acid as a painless devitalizer under all conditions. It is applied as follows: After placing the rubber dam in position, drying cavity, &c, the amount of the arsenious acid it is pro- posed to employ is placed upon a glass slide and an equal quantity of iodoform, or an excess is added and a paste made with a five per cent, solution of carbolic acid, and the whole carried to the pulp on a piece of cotton, the size of a pin's head. This is then covered with a gutta percha cap, or one of platinum, and a temporary filling introduced; the latter may consist of cotton saturated with sandarach varnish. Pres- sure upon the pulp must be avoided. 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 ARSENIOUS ACID. 149 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, or gutta percha may be softened and packed against the margin of the gum in such a quantity as will fill the interspace. Failure to observe such precautions may re- sult in violent inflammation involving the alveoli and causing necrosis of the bone. 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 per- mitting the agent to remain in the tooth for a longer time than is necessary for the devitalization of the pulp only, is periosteal inflammation. Where several applications of the arsenical preparation fail to produce the desired devitalization, the resistance 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, ex- traordinary vital power in the pulp, which may be due to the peculiar constitution of the patient, who probably would not be as susceptible 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. The action of arsenic depends upon both local and systemic conditions. When the capillaries of the pulp are congested as a result of the inflammation, the absorption of the agent is pre- vented or retarded, and it acts chemically upon the superficial tissue of the exposed portion of the pulp and causes pain, ren- dering it necessary to relieve the congestion before the nerve- tissue can be primarily affected. In case of a lymphatic tern- 150 DENTAL MEDICINE. perament, characterized by low vital power and excess of fluids in the tissues, the arsenic is readily absorbed and devitalization speedily results; whereas in cases where there is great nerve- power or excessive nervous irritability, the susceptibility of the tissues to its influence is very feeble, and the devitalization of the pulp is difficult and sometimes impossible, unless re- peated applications are made. When arsenious acid is applied to the surface of an exposed pulp, its first effect is stimulating, followed by paralysis of the sensory nerves, a degree of inflammation being excited which depends upon the quantity of arsenious acid employed. After the stimulating effect passes off the arsenic is gradually ab- sorbed and the pulp slowly dies. Too large a quantity of the arsenic will cause violent inflammatory action, increase the congestion and prevent the pulp from absorbing the agent; and experience has shown that recently exposed pulps are more readily devitalized by .arsenious acid than those which have been exposed for a considerable time. It is therefore advisable to employ minute quantities of arsenic as a devitalizing agent, and to avoid pressure on the pulp when applying it, so that the pain occasioned by its action may be limited to the space of one hour on an average. The danger of an excess of arsenic passing through the apical foramen of the root to the peri- dental membrane must always be guarded against by carefully regulating the quantity of the agent; on the other hand, all ex- traneous matters that will interfere with the action and appli- cation of the arsenic to the exposed surface of the pulp must be removed or irritation and pain and not devitalization will result. For the application of arsenious acid to the surface of a fractured tooth, where it is difficult to retain it, the filling may be ligatured in place, after being covered with a thin layer of gutta percha. Dr. E. C. Kirk uses for such a purpose surgeon's rubber plaster, carrying it around the tooth. 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 ARSENIOUS ACID. 151 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 ob- tunder of hyper-sensitive dentine. DENTAL For Devitalizing Pulps of Teeth, Flagg. R. Acidi arseniosi . . . gr.j Morphinae acetatis. . gr.ij Acidi carbolici . . . gtt.iij. M. Fiat massa. Signa.—The property quantity to re- main 12 to 24 hours. Pierce. R. Acidi arseniosi . . . gr.x Morphinae sulphatis . gr.xx Creasoti......q.s. To make a thick paste. Signa.—To remain 24 hours for adults; 10 hours for children. Garrettson. R. Acidi arseniosi, Morphinae acetatis aa gr.x Creasoti...... q.s. To make a thick paste. Signa.—To remain 24 hours for adults; lo hours for children. If a very irritable condition is pres- ent, sulphate of atropia may be sub- stituted for the morphia. Hollander. R. Acidi arseniosi . . gr.xij Morphine acetatis . gr.ij Olei caryophylli . . gtt.iv Creasoti ...'.. q.s. Ut fiat pasta. FORMULA. R. Acidi arseniosi . . gr.v Acidi tannici . . . gr.x Tincturae aconiti . q.s. To make a thick paste. Signa.—To remain 24 hours. J. D. White. R. AciTli arseniosi . . gr.ij Morphinae sulphatis gr.j Creasoti.....q.s. M. Fiat massa. Signa.—To remain from 12 to 24 hours. R. Acidi arseniosi . . gr.xx Morphinae acetatis . gr.x Creasoti.....q.s. To make a thick paste. Signa.—To remain 12 to 24 hours for adults; 8 to 10 hours for children. R. Acidi arseniosi.....gr.x Morphinae acetatis .... gr.xl Creasoti, vel acidi carbolici . q.s. To make a thick paste. Signa.—To remain 12 to 24 hours. For Malignant Ulcerations of a Cancer- ous Character. B f#. Liquoris hydrargyri nitratis A powerful caustic. Signa.—Applied by means of a camel hair brush, and the parts then cov ered with lint. 152 DENTAL MEDICINE. R. Absorbent cotton . . (cross cut fine). Arsenious acid . . gr.v. Tannic acid . . . gr.ij. R . Acidi arseniosi ... I part. saturated with the oil of cloves Cocaini hydrochloras 4 parts. and the arsenious acid taken Lanolin.....5 parts. M. up on this and applied to the Signa.—To remain 24 hours. pulp. E. C. KlRK. Devitalizing Fibre. R. Acidi arseniosi . . Cocaini hydrochloratis aa gr.xx. Menthol cryst . . . gr.v. Glycerini . . enough to make a stiff paste. M. c- ,. ,, , . , , Acetate of morphine gr.x. Signa.—Use the desired quantity, and ,. *" , .,.,,,, , Oily carbolic acid . q.s. for a secure it with a lead cap covered J ^ . , , thin paste. with gutta percha. r , . , Reduce the cotton by cutting and For Painless Devitalization. cross-cutting to a soft fine fuzz, R. Acidi arseniosi . . gr. £■$. then incorporate it with the above 01 ei caryophilli . . enough to mixture; dry and separate into make a paste. M. small pieces for convenient appli- Or a pledget of cotton may be cation. 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 de- posited 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 me- tallic arsenic. When heated in a glass tube with charcoal or black flux, it sublimes, and condenses in the form of a bril- liant 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 addi- tion 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 subject- ing the arsenic to the action of nascent hydrogen (evolved by the action of diluted sulphuric acid on pure zinc); it is de- oxidized, and unites with the hydrogen to form arseniuretted hydrogen gas, which has the odor of garlic, and burns with a BENZOIC ACID. 153 bluish-white 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 ar- senic. The late Dr. Robert Arthur preferred cobalt as a de- vitalizing 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, solutions of po- tassa, 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, by the assumption of the elements of glycocoll, and in this 154 DENTAL MEDICINE. 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 cystitis, 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 in- gredients 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, 3ij of pow- dered 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 disin- fectant, 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, necrosis and caries of maxillary bones, in the form of injections and lotions; 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. BORACIC ACID. 155 For such diseases as diphtheria, catarrh, dysentery, scarla- tina, erysipelas, smallpox, different forms of fevers, etc., the dose is one teaspoonful three or more times a day (as indi- cated). For Stomatitis of Dentition. R Listerine.....gj R Listerine......gj Glycerine.....-fss Syr. simplicis . . . . ^vij. M. Water . . . qs. ad. gij. M. Sjg.—A teaspoonful every two to four hours, after nursing or feeding. or— For Sore Mouth of Nursing Women. R Listerne........ Glycerine.....aa ^yj Rose water......2j ijss. M. Sig.—Use as a mouth-wash. ACIDUM BORICUM—BORIC ACID—BORACIC ACID. Formula.—H B02. Derivation.—Boric Acid, formerly called Boracic Acid, is obtained artificially by decomposing a hot saturated solution of borax with sulphuric acid, which unites with the soda to form sulphate of soda, and liberates 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.—Boric acid is antiseptic and deodorant. It destroys minute organisms, and arrests fer- mentation 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 decomposi- tion. Boracic acid is employed in all the forms and combina- tions in which carbolic and salicylic acids are used by the anti- septic method, in the form of a saturated solution. Boric Lint is made by steeping lint in a saturated solution at the boiling point. 156 DENTAL MEDICINE. Dose.—Oi boric 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 boric acid 62 parts, and glycerine 92 parts, each gently heated over a water bath and the boric 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 boric acid powder. (See Glycerine for Glyceroborates of Sodium and Calcium.) Boric Ointment is composed of boric acid 1 part; paraffin 2 parts ; almond oil 2 parts. When used it should be mixed with a little glycerine. Mel Sodii Boratis—Honey of Borax—is composed of borax, 60 grains ; honey, 1 troy ounce. Dental Uses.—Boric acid may be employed as an antiseptic 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.J Boric acid, in ten per cent, solution, may be used with benefit in the form of an injection into suppurating cavities. As a mouth-wash and gargle it is employed in a solution composed of twenty grains to the ounce of water. Combined with glycerine in the form of boro-glyceride, a valuable appli- cation is secured for antiseptic dressings and injections. One part of boric acid in 130 of water is used as a germicide. For Alveolar Pyorrhoea. For Aphthous Ulcrations of Mouth, Fis- sured Tongue, Abrasions by Artificial R. Creta preparatae . . Jj Dentures, etc. Acidum boricum . . ^j. M. SlG.—Apply this powder to gums about C. N. Peirce. necks of teeth, after all deposits have R. Acidum boricum . grs. lxiv been thoroughly removed, and aromatic Olei gaultheriae . . . ^fss sulphuric acid injected. Glycerini......f3lv Alcoholis......fgj Aquae enough to make four ounces. M. CARBOLIC ACID. 157 ACIDUM CARBOLICUM—CARBOLIC ACID. PHENIC ACID ; PHENYLIC ALCOHOL ; PHENOL. Formula.—C6H5HO. 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, interlac- ing 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 differ- ent substance. Much of what is called creasote is nothing but impure carbolic acid {Acidum Carbolicum Impurum), com- bined with two other substances, similar in constitution, and known as creasole andphosole. 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 yo° ¥., 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, 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. Water dissolves six per cent, of carbolic acid, and five parts dissolve in one part of alcohol; four in one part of ether; three in one part of chloroform; seven in two parts of glycerine, and four in seven parts of olive oil. It is also solu- ble in carbon disulphide, benzol and fixed and volatile oils. The best quality of carbolic acid contains two per cent, of water, and should be hard and dry, with no odor of creasote nor of volatile sulphur compounds. 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 158 DENTAL MEDICINE. 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. Medicinal 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. Its powers as an antiseptic and germicide are not now con- sidered to be equal to those of some other substances, such as bichloride of mercury, iodine, iodoform, etc., although it is yet regarded as a useful and important agent. It is irritant to the skin and other tissues, and capable of being absorbed to a dan- gerous amount. Eisentein regards carbolic acid as an anti- pyretic as inferior to salicylic acid, and others regard boracic acid as possessing equal antiseptic properties. As a local anaesthetic, carbolic acid exerts a very soothing influence upon painful tissues ; hence it is beneficial in odontalgia, and for pulp dressing. On account of its solubility, a variety of solu- tions of special value can be formed with it, which are especially serviceable as antiseptic applications. 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. CARBOLIC ACID. 159 Its nauseous oder 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 ophthalmia and itching of the skin. Dose.—Of crystallized carbolic acid, gr. ^ to gr. j, 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 Acidi Carbolici), made by rubbing together ^ij of carbolic acid with Oss of glycerine, is TTUv. The dose of carbolic acid water {Aqua Acidi Carbolici), f"5x ; of the glycerite, dissolved in distilled water, enough to make the mixture measure a pint, the dose is f"5ss to f"3j. Impure carbolic acid is employed for disinfectant purposes. Ointment of carbolic acid {Unguentum Acidi Carbolici)— carbolic acid, 5j '•> lard, ^j- Sulpho-carbolic acid (HC6H5S04) is considered to be a very 160 DENTAL MEDICINE. efficient antiseptic and disinfectant. The addition of acids, particularly sulphuric, to crude carbolic acid of different strengths increases its antiseptic and disinfectant properties, and considerably increases its solubility. Twenty-five per cent, of crude carbolic acid, mixed with an equal quantity of concentrated crude sulphuric acid, gives the best results, and renders it a cheap and effective disinfectant and sterilizer. 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 and other agents. Applied to exposed pulps, it forms, by escharotic action, an eschar, which some regard as conducive to the recovery of the organ, while others regard the quiescent CARBOLIC ACID. 161 state it produces as an indication of the degeneration of the pulp, and hence 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). Car- bolic 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. Com- bined with glycerine (1 part to 12 of glycerine), it will stimu- late 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. For use as a disinfectant, the form of carbolic acid which contains about ninety-four per cent, of the pure acid and 11 162 DENTAL MEDICINE. known as " carbolic acid No. 4," is the best, and it may be used as an antiseptic in the following strength: for lotions or sponges, 2^ per cent, in water; for spray or vapor, 5 per cent, in water; for a dressing, 5 per cent, in olive oil. Car- bolate of potash (unofficial—Robinson's remedy) is composed of equal parts of carbolic acid and caustic potassa rubbed to- gether ; it is employed in pyorrhoea alveolaris and hyper-sensi- tive dentine. Phenol Sodique (unofficial) is a solution of sodium carbo- late and is extensively employed in dental practice (See Phe- nate of Soda). It is composed of pure melted carbolic acid, 5 parts; solution of caustic soda (of a specific gravity of 1.332), 1 part; distilled water, 5 parts. Mix. DENTAL A Lotion for Soft and Spongy Gums. R. Acidi carbolici . . . gr.xx Spiriti rectificati (al- cohol) .......gij Aquas destillatae . .. gvj. M. It renders the gums less tender and firmer. An Antiseptic Lotion or Injection. R. Acidi carbolici . . . 3 ss Glycerini.....^xv. 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 . . . ^j Glycerini.....sjiy Aquae.......J 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. ITlxxv gr.v gr.xxv TTtxxv m* Ttlv. FORMULAE. 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 Dis- ease). R. Acidi carbolici . Potassii iodidi . Zinci chloridi . Alcohol absolut . Aq. destillatae . 01. menthse pip Misce et filtra. Signa.—As an injection in pockets of gum. A Disinfectant Mouth Wash. Dr. J. B. Patrick. R. Acidi carbolici (cryst.), Glycerini, Aquae rosse......aa..... gij. M. Signa.—Five to eight drops in a wine- glass of water. A Stimulant and Antiseptic Mouth Wash. R. Acidi carbolici . . . gtt.xx Glycerini.....ziy Aquae.......jj x. M. Signa.—To be used as a gargle. CARBOLIC ACID. 163 For Fetid Perspiration. R. Acidi carbolici ... 2 parts Glycerini.....3 parts M. For Parasitic Skin Diseases. R. Acidi carbolici . . . 5jj Glycerini ..... ^j. M. Antiseptic Solution for Washing and Spraying Wounds, etc. R. Acidi carbolic (cryst.) partem j Aquae........part.xxiv. Signa.—Dilute the above solution with equal parts of water, which will make it equal to 1 part of the acid to 40 parts ofjwater; for use in disinfecting instruments and sponges. For Dry Mouth. H. J. Fish. R. Acidi carbolici . . . gtt.x Glycerini.....^j. ^. Signa.—Apply on palate or mouth with a soft brush three times a day. For Inhalation in Syphilitic Ulcera- tions. R. Acidi carbolici . . . 3 xxj Aquae destillatae . . 3 iij. M. Signa.—Inhale the vapor. Antiseptic. A Stimulant and Antiseptic Injection. R. Acidi carbolici ... I part. Glycerini.....30 parts. M. Useful as an injection in chronic forms of alveolar abscess. For Odontalgia. R. Acidi carbolici, Chloroform, liquid opii Vel morphinae hydro- chloratis . . aa . . ^ij Tincturaebenzoini . . %). M. Apply to exposed surface of pulp, on cotton. A Stimulant and Antiseptic Lotion or Injection. Percy Boulton. R. Acidi carbolici . . . V(\y) Tincture iodi .... TTLxlv 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 . . . gij Glycerini.....Jj Aquae rosae.....^vuj« 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." For Alveolar Pyorrhoea {Rigg's Disease). R. Acidi carbolici . . Tflv Spts. vini rectif. . £vj Aq. menthae pip . £ij 01. anisi . . - . TTU 01. cinnamon. . . TTtss. M. Signa.—Apply to gum with camel's- hair brush. 164 DENTAL MEDICINE. An Antiseptic and Disinfectant Dentifrice. J. Stocken. Acidi carbolici . . Iftxxx Pulveris ossis sepiae . 3»j Pulveris radicis iridis. SU Cretae preparatae. . . S"j Olei caryophylli . . gtt. iij. For Chilblains. R. Acidi carbolici . . . ^j Tincture iodi. . . . 5pj Acidi tannici.. . . . ^ij R. Acidi carbolici . . Tilxxx „ ,• • ^> •»«■ Cereat simphcis. . . giv M. Fiat unguentum. For Odontalgia. M. B- Collodii (flexile) . . jj Acidi carbolici . . . gij. M. .for a Carbolized Styptic. Signa.—Apply to surface of exposed R. Acidi carbolici . . . x parts and painful pulp. Collodii......c parts For Odontalgia. Acidi tannici . . . . v parts R. Acidi carbolici . . . gij Acidi benzoici . . . v parts. M. Morphinae acetatis. . gr. xx. It coagulates blood and albumen, Solve.—Applied to surface of exposed and cicatrizes the tissues. pulp, on cotton. 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 GALLIC ACID. 165 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 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 some- times 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...................Sjj. 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 166 DENTAL MEDICINE. 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 hy- menopterous insect on the twigs of the gall oak {Quercus Infectorid). 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. 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, leucorrhoea, 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, ^j. It is combined with opium in the proportion of ointment of galls, ^j; 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 GALLIC ACID. 167 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 ex- ternal use, is composed of gallic acid, ^j; glycerine, ^iv. Ointment of galls {Unguentum Gallce) is composed of galls in fine powder, 3j; lard, 420 grains. 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 of Mucous Membrane of the Mouth. R. Acidi gallici .... gr.xl Liq. sodae chlorinatae ^ij Glycerini.....3 ij Aquae destillatae . . ^ viij. M. Signa.—To be used as an antiseptic and astringent gargle. For Relaxation of Uvula and Hyper- trophy of Tonsils. R. Infusi gallae . . . . ^ vj Aluminis.....gr.xl. M. Signa.—Use as a gargle. An Internal Astringent in Hemor- rhagic Affections. R. Acidi gallici . . . . %] Glycerini.....^iv Aquae destillatae . . £ vj. M. Signa.—Take ^j as a dose. An Internal Astringent for Dental Hemorrhage. Otto Arnold. R. Acidi gallici . . . . gj Aquae cinnamon . . ^ij. M. Signa.—A teaspoonful every hour un- til bleeding is arrested. 168 DENTAL MEDICINE. For an Astringent, Gargle or Lotion. R. Pulveris gallae...............^ ss Aquae..................Oj. M. SiGNA.—As a gargle or lotion in inflamed or ulcerated condition of mucous membrane and gums. ACIDUM HYDROBROMICUM—HYDROBROMIC ACID. Formula.—H B r. Derivation.—Diluted Hydrobromic Acid is prepared by add- ing ten per cent, of absolute hydrobromic acid to ninety per cent, of water. It is a clear, colorless liquid, having no odor, but a decidedly acid taste and an acid reaction. Medical Properties and Therapeutic Uses.—Hydrobromic acid is often substituted for the bromides on account of its pos- sessing many of their properties. It is employed in cerebral disorders from over-exertion, epilepsy, spasmodic cough, angina pectoris, affections of the heart, as it diminishes its action, to relieve the symptoms of quinine, and also of morphine, mi- graine or sick headache, neuralgia, spasmodic asthma, etc. Dose.—Tflxx to 5ij. Dental Uses.—Diluted Hydrobromic Acid may be employed in facial neuralgia, infantile convulsions due to teething, and to lessen the irritability of the fauces when impressions for obturators and artificial palates are being taken. 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 HYDROCHLORIC ACID. 169 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 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 constituent. 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, TTLx to ITLxxx, 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 ulcer- 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 FORMULA. For Aphthce. 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.....3 iv cjL 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......gss dilut......ITlx Mellis, Infusi cinchonae . . fjjiv Aquae rosae . aa . fgj. M. Mellis......f3J. M. Signa.—Apply with a camel-hair pen- Fiat gargarysma. cil three or four times a day. 170 DENTAL MEDICINE. 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 atonic 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 PHOSPHORIC ACID. 171 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 III- Conditioned Ulcers. R. Acidi nitrici................TTU-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 meirfbrane. 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 172 DENTAL MEDICINE. ounces of distilled water, afterwards 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 to 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 dilute 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 FORMULA. For Caries of the Maxillary Bones and For Ulcers over Carious Bones. for Osseous Tumors of the Jaw. R. Acidi phosphorici gla- R. Acidi phosphor, dilut . I part cialis......gj Aquae destillatae . 8 to Io parts. M. Aquae destillatae . . f^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 (POs), 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 powder, 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- PHOSPHORIC ACID. 173 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 it 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 " " 174 DENTAL MEDICINE. ACIDUM SALICYLICUM—SALICYLIC ACID. Formula.—HC7H503 or C6H4|c3qH]- 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-crystalization, 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 ul- mariae (meadow sweet). Medical Properties and Action.—Salicylic acid is a power- ful antiseptic, and is said to be as effective in small quan- tities as 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 v/ill arrest vinous fermentation and prevent the de- composition of animal fluids. Although free from any pois- onous 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 SALICYLIC ACID. 175 dissolve -^ of 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 em- ployed 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 rec- ommended 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 ef- fect 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. Spiriti vini rectificati 3 x. M. Signa.—Use as a gargle. Signa.—Use as a gargle. 176 DENTAL MEDICINE. For Perspiration of Hands and Feet. For Warts. R. Acidi salicylici . . 3 parts UNNA. Magnesii silicat . . 87 parts. M. R. Acidi salicylici . . 3 iij Signa.—Use in the form of a powder. Cerae, An Emollient and Antiseptic Gargle. Adipis . aa . q.s. to make a firm R. Acidi salicylici . . 3 ij ointment that will adhere to the skin. Sodii boratis . . . 3 iij For Burns. Aquae destillatae . . ^iij. M. R. Acidi salicylici . . gj Signa.—Add one or two drachms to Olei olivae . . . . ^ viij half a pint of warm water. SlGNA.—Apply as a lotion. 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 fgvij with distilled water fSlxxvij, and when the mixture has cooled to 6o°, add more water glxxxiiiss. 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 SULPHURIC ACID. 177 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 in 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, Tflv to Tflxx, three times a day, in water. AromaticSulphuric 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 oij, 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, in the treatment of pyorrhoea alveolaris, especially where there is necrosis of the alveolar walls, when it is applied on cotton packed in the pockets; also in chronic alveolar abscesses. For such pur- poses it must be kept in the pockets, sinuses and abscesses for several hours in order to insure its full effects. It is also employed locally in cancrum oris and gangrene of the mouth, and largely diluted, it forms an efficient astringent mouth- wash in simple stomatitis, etc. Dose.—Of aromatic sulphuric acid, Tflv to TTLxxx, three times a day, in water. Dental Uses of the Different Forms of Sulphuric Acid.—The 12 178 DENTAL MEDICINE. 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 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 FORMULA. For Mercurial and Ulcerative Stomatitis. For Aphtha and other Ulcers of Mucous Thomas. Membrane and Gums. R. Acidi sulphurici . . . . TTtx R- Acidi sulphurici . . fgss Decocti hordei.....fgiv Mellis.......ft^j M. Mellis........fSjss M. Signa.—To be applied with a camel- Signa.—Use as a gargle. hair brush. SULPHUROUS ACID. 179 For Carious Bone, Rigg's Disease, etc. R. Acidi sulphurici aromat...........f ^ iii Tinctura capsici..............gtt.x Aquae..................f^ti. M. Signa.—To be used as an injection or lotion. ACIDUM SULPHUROSUM—SULPHUROUS ACID. Formula.—H2S03. Derivation.—Sulphurous Acid is made by dissolving sul- phurous anhydride (S02) in water. The latter is made by burning sulphur. It is a colorless liquid, having the suffo- cating odor of burning sulphur, and a sour, astringent taste. Medical Properties and Action.—It is a deodorizer and dis- infectant, and destructive to micro-organisms, such as bacteria, fungi, etc. Owing to its affinity for oxygen it acts upon organic matter with great energy. Therapeutic Uses.—The diluted acid is locally applied to ulcers of the tonsils in diphtheria, syphilitic and tuberculous laryngitis, chilblains, parasitic skin diseases, ill-conditioned, sloughing or gangrenous wounds; also used in pyrosis, indi- gestion, etc. Also, in the form of inhalations of the sulphurous-acid gas, in cases of chronic bronchitis, etc. In the form of spray, as a local application in diseases of air passages. Dose.—Of sulphurous acid, tit v to 5j. Dental Uses.—Dilute sulphurous acid is efficacious in mer- curial stomatitis, aphthae, and mucous patches, gangrene of the mouth, cancrum oris, ulcers of mucous membrane, and sloughing wounds. It is an efficient and convenient disin- fectant. For Chilblains. For Destroying Parasites in Skin Diseases. Bartholow. Startin. R. Acid sulphurosi ... 3 iij R • Acidi sulphurosi, dil. . g ss Elycecint......3J Sodii hyposulphitis . . giij Aquae.......£iss M. Aquae, q. s. ad. . . . |xvj M. Signa.—Apply as a lotion. Signa.—Apply as a lotion. 180 DENTAL MEDICINE. ACIDUM TANNICUM—TANNIC ACID. TANNIN. Formula.—C^H^Or;. 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 -fa 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 yellow- ish, inodorous, astringent to the taste, but without bitterness, and with an acid reaction. It is obtained in the form of vesic- ular 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. 181 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 9j, 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. 182 DENTAL MEDICINE. An English preparation known as Styptic Colloid, 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, jij; glycerine, 3viij. Ointment of tannic acid—Unguentum Acidi Tannici, is made of tannin, 3j; lard, |j. Useful for a local application to ulcers. DENTAL FORMULAE. For Inflamed and Ulcerated Mucous Membrane. R. Acidi tannici .... gss Spiriti vini rectificati. gss Aquae camphorae . . f^v. M. Signa.—To be used as a gargle. For Inflamed and Ulcerated Gums. R. Acidi tannici .... giv Glycerini.....^ij. M. Signa.—To be used as a gargle or mouth-wash. For an Astringent Dentifrice. R. Acidi tannici .... gr. xxx Cretae preparatae . . ^ij Pulveris ossis sepiae . 3 ij Olei caryophylli . . gtt.iij. M. For same as above. R. Acidi tannici . ■ • • 3>j Tinct. iodinii . . . ^iv Potassii iodidi . . gr.xx Tinct. myrrhae . . 9iv Aqua rosae . . . . . f^viij. M. Signa.—A dessert-spoonful in a wine- glass of water as a mouth-wash or gargle. For Inflamed Mucous Membrane, Abra- sions, Ulcers and Sensitive Dentine. R. Acidi tannici . . . 5j ij Tincturae arnica? . . sjij Tincturae myrrhae . . ^j. M. Signa.—To be used as a lotion. For Same as Above. R. Acidi tannici . ... gjto^ij Spiriti rectificati . . 3J Aquae destillatae ... ^x. M. Signa.—To be used as a gargle. TARTARIC ACID. 183 For Inflamed Mucous Membrane of Mouth, R. Acidi tannici .... ^ ij Pulveris aluminis . . gr.xxx Aquae destillatae ... ^ v. M. Signa.—To be used as a gargle. For Sensitiveness following the Removal of Salivary Calculus. Coleman. R. Acidi tannici .... 3 ss Eau de Cologne . . f^iv. M. Signa.—Add 10 or 12 gtts. of above solution to a teaspoonful of tepid water, and use as a gargle 3 or 4 times a day. For Loose Teeth and Spongy Gums. R. Acidi tannici .... 3; jss Potassii iodidi . . . gr xii Tinct. iodi.....^j Tinct. myrrhae ... ^j Aquae rosoe.....^vj. M. Dissolve the tannic acid and iodide of potassium in the rose water and add the tinctures and strain. Signa.—A teaspoonful in a wine-glass of warm water, used every morning as a mouth wash. For an Astringent Mouth Wash in In- flamed and Ulcerative Conditions of Gum and Mucous Membrane. R. Acidi tannici . . . . gr. xx Tincturae pyrethri . . 3 iij Aquae rosae . . . . ^ vj. M. Signa.—To be used as a gargle. For Ulcerations and Abrasions. R. Acidi tannici . . . gr. xv Glycerini.....f gj. M- Signa.—To be used as a lotion. For Inflamed Mucous Membrane of Mouth. R. Acidi tannici . . . 3 ss Sodii boratis . . . . 3 iij Glycerini.....^ ij Aquae destillatae . . 3j iv. M. Signa.—Use as a gargle. For R. Inflamed Mucous Membrane Mouth and Fauces. of Acidi tannici . . Tinctura myrrhae Pulv. acaciae . . Glycerini . . . Aq. destil. q.s. ad Signa.—Use as a 3J 3iJ Iij 3vj. M. For Odontalgia. Druitt. R. Acidi tannici . . . . gr. xx. Gum mastich . . . gr. x Spt. aether sulph . . f ^ ss. M. Signa.—To be applied to carious cavity, on a pellet of cotton. For Alveolar Hemorrhage. R. Acidi tannici . . . . gr. xl Liq. plumb, subacet. dilut...... f|jiss Vin. opii.....f^ss- M. Signa.—Apply on cotton or lint, or as an injection. For Chronic Ulcers and Abscesses. Berel. R. Acidi tannici . . . . gr. xxxij Aquae destillatae . . f^viij. M. Signa.—To be used as a lotion. ACIDUM TARTARICUM—TARTARIC ACID. Formula.—H2C4H406. Derivation.—Tartaric Acid is obtained from " tartar " (a peculiar substance which concentrates on the inside of wine casks, being deposited during the process of fermentation), or from crude cream of tartar. 184 DENTAL MEDICINE. 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 discontinued. 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, 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 internal administratation of Duquesnel's Aconitia, in neuralgia of the fifth pair of nerves. Another principle of aconite, suggested by Duquesnel, is known as Napelline, which is less powerful than aconitia, but possesses important hypnotic properties, 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 ACONITE. 185 circulation. In large doses it is an active poison, lessening the heart's action, affecting its ganglia and muscle, and paralyzing the muscles of respiration. In moderate doses it produces warmth in the stomach, general warmth of the body, and some- times 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 poisonous doses, by its powerfully sedative impression on the nervous system, by suspension of the respiratory function and by syncope. 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, amenorrhoea, tonsillitis, acute congestion of liver, peritonitis, eruptive fevers, etc., etc. It is contra-indi- cated in inflammatory conditions of the gastro-intestinal mu- cous 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—extractum aconiti—gr. j to gr. ij. The tincture of the root is composed of twelve troy-ounces to alcohol Oij. Dose of aconitia, gr. -^. 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 ab- scess where pus is already formed. Combined with an equal part of the tincture of iodine, it is a valuable application in the incipient stages of dental periodontitis, as it relieves the in- flammation by retarding the circulation and stimulating lym- phatic action. For such a purpose the gum or root of the af- fected tooth should be painted with this combination until it assumes a dark brown color, taking the precaution to first re- move all moisture from the surface to which it is to be ap- 186 DENTAL MEDICINE. plied, 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 peridental membrane. 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 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 forma- tion of inflammatory products. The alkaloid, aconitia, is a useful remedy in neuralgia 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 constitutional effects may result. Fifteen drops of the tincture, taken internally, have caused death. The symptoms of poisoning by aconite are as fol- lows: Overpowering sense of fatigue in the lower extremi- ties, great muscular weakness, dimness of vision, with dilated pupils; great dyspnoea, the respirations being short and la- bored ; the pulse at first slow and small, and afterward imper- ceptible ; 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 ammonia. DENTAL FORMULA. For Neuralgia. R. Pulveris radicis aconiti gx For Odontalgia. Camphorae......|ss R. Tincturae aconiti, Spiriti rectificati . . . q.s. Chloroformi . aa . fgiij. Moisten the aconite with some of the Tinct. capsici . fzj alcohol and macerate in a close Tinct. pyrethri. vessel for 3 days, then percolate 01. caryophylli . aa fgss slowly into a receiver containing Gum camph ... 5 ss. M. the camphdr until the product Signa.—To be applied on a pellet of measures half a pint. cotton. Signa.—Apply with a camel-hair brush. ETHER. 187 A Local Anxsthetic for the Extraction of Teeth. R . Tincturae aconiti . . §iss 3»J Veratrinae . . . gr.x Morphinae sulphas gr.iv Spiriti rectificati . • l» Chloral hydratis . . gr.iv. M. Let stand 4 days and then filter. Signa.—Apply to the gum over root of tooth to be removed, for 60 seconds, by means of an applicator. For a Local Anxsthetic for Extraction of Teeth. R. Tinctura aconiti . . f^j. Menthol.....gr.x. Chloroformi .... f zj. M. Signa.—Apply freely to gum about tooth for several minutes. For Neuralgia and Rheumatic Pains, Bruises, etc. R. Tincturae aconiti, Chloroformi venalis, Spiriti ammoniac . aa . f z. ij Olei ricini.....3 ^ Linimenti saponis . . f^j. M. Signa.—To be rubbed on the affected part. ^THER—ETHER. AETHER 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—jEiher Fortior. Sp. gr. 0.728. Sulphuric ether is a For Neuralgia of Fifth Pair of Nerves. (For Internal Use.) R. Aconitinae.....%?-fa Glycerini, Alcohol . . aa . . . zj Aquae menthae pip . . ^ ij. M. Dose.—A teaspoonful. For Neuralgia. R. Linimenti aconiti, Lin. belladonnae . aa . ^vij Chloroformi.....3 ij. M. Signa.—Apply, on lint, to the part affected, and cover with a fine piece of sponge saturated with warm water. For Trigeminal Neuralgia. R. Aconitinae (Duques- nel's)......gr.^ Glycerini, Alcohol. . aa . . . zj Aquae menthae pip . . ^ij. M. Dose.—A teaspoonful, slowly and cautiously increased to y%. For Dental Periodontitis. R. Tincturae iodi, Tincturae aconiti . aa . ^ss. M. Signa.—Apply to gum over root of affected tooth with a camel-hair brush. 188 DENTAL MEDICINE. 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, 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, fjvj, 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 ETHER—ANESTHESIA. 189 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, and diuretic, and is employed in febrile affections, dropsies, etc., etc. Dose.—Of ether, f5ss to f5j; of Hoffman's Anodyne, f5ss 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 Anaesthetic Agent.—Sulphuric ether is generally considered to be a safer anaesthetic agent than chlorform, 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 mucous 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, V 190 DENTAL MEDICINE. 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 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- ETHER—ANAESTHESIA. 191 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. 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, and many 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 Anaesthetics.—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 aneesthetic agent—half an ounce of ether or a drachm of 192 DENTAL MEDICINE. 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 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 ETHER—ANESTHESIA. 193 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 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 cumulative action of these general anaesthetics should also be remembered, for a state of narcosis frequently intensifies for half a minute or more after the suspension of the administra- tion, which is due to the vapor of the anaesthetic which was in the lungs entering the blood after the administration ceases. Dr. Buxton points out that even admitting greater danger from chloroform, its use is indicated in the following circum- stances : a. In protracted operations about the mouth, jaws, nose, or pharynx, which necessitate the mouth and nose being un- covered. b. All operations needing the employment of the actual . cautery, or lighted candles, lamps, etc., in the vicinity of the mouth; ether being highly inflammable, and when mixed with air, detonating, so that the incautious bringing of the appara- tus near a light may lead to grave consequences. c. Persons who are suffering from bronchitis, and those 13 194 DENTAL MEDICINE. liable to that complaint; the emphysematous (if the condition be very pionounced) and, as a rule, asthmatics bear ether badly, since it creates cough, and may clog the bronchial tubes with a quantity of excessive secretion. d. In renal disease, when extensive, ether is said to induce suppression of urine; so that if given at all in these cases, it should be with the utmost caution. e. The vascular excitement to which ether gives rise, con- tra-indicates its use for persons whose arteries are presumably brittle, etc. /. In infants and very young children. g. As ether always provokes coughing and rapid breath- ing, it should not be used when these are prejudicial to the patient or to the success of the operation. h. The presence of brain tumors, intestinal obstruction, and cancerous tumors is by some considered contra-indicatory of ether. To these the Chronicle adds two other large groups of conditions, viz.: 1st, all cases of brain surgery; 2d, where the circumstances of the patient or the requirements of the operation are such as to demand the securing of perfect rest by the free use of opiates, ether must be avoided on account of its action on the kidneys. Prof. J. J. Chisholm, of the University of Maryland, gives the following five simple rules for the administration of chlo- roform, 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 ETHER—ANESTHESIA. 195 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 the 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 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." Dr. H. A. Hare states that if during anaesthesia, respiration stops, he has found that in a large number of instances, both in man and in the lower animals, the free use of ether poured upon the belly causes so great a shock, by the cold produced by its evaporation, as to cause a very deep inspiration, which is often followed by the normal respiratory movements. Dr. H. I. Neilson gives the following conclusions concern- ing the pupil as a guide in the administration of chloroform : I. The first effect of chloroform narcosis on the pupils consists in a dilatation which varies in intensity and duration in different individuals. As the anaesthesia becomes more profound the pupils begin to contract and finally become very small and immovable. If now the chloroform is pushed still further, a sudden dilatation occurs, which is the result of asphyxia, from which the patient seldom recovers. 2. As long as the pupil is observed to dilate in response to sensory stimuli, such as pinching the skin, the anaesthesia is not yet sufficient to allow the commencement of the operation. 3. As soon as the pupil becomes strongly contracted and immovable, the administration of the anaesthetic must be sus- 196 DENTAL MEDICINE. pended until a commencing dilatation is observed, and the pa- tient must be held at just this point as long as the operation continues. 4. Vomiting causes a dilatation similar to that occurring as the patient emerges from the narcotic condition, but it is usually more sudden in the former case. The contraction of the pupils does not appear to begin until the blood-pressure is somewhat reduced, and the dilatation proceeds pari passu with the increase in the blood-pressure. He therefore regards the appearance of the pupil as a very reliable guide for the ad- ministration of chloroform, as he is enabled to judge accu- rately concerning the condition of the patient. 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 completed 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 position 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 ether, 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- ETHER—ANESTHESIA. 197 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 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. 198 DENTAL MEDICINE. 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 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 principal 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 Anaesthesia.—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. ETHER—ANESTHESIA. 199 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 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 forcing up of the chin, or the forcible drawing out of the tongue to lift the epiglottis ; the practice of artificial respiration by the Sylvester method, and by faradiza- tion 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, 200 DENTAL MEDICINE. and artificial respiration, according to Sylvester's method or Marshall Hall's ready method, or Howard's 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 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 should- ers 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. ETHER—ANESTHESIA. 201 "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- 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 per- ceived. 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 ^piration takes place. When 202 DENTAL MEDICINE. 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 aug- ments 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 forc- ing instrument; also, the warm bath, and all rough treatment)' DR. HOWARD'S METHOD OF RESUSCITATION. One of the most efficient, as well as the most recent method, is that of Dr. Howard for performing artificial re- spiration. Position of Patient.—Face upward, a hard roll of clothing beneath the thorax, with shoulders slightly declining over it. LOCAL ANESTHESIA. 203 (One twist of handkerchief around the crossed wrists will keep them there.) Rip or strip clothing from waist and neck. Position of Operator.—Kneel astride the patient's hips; place your hands upon his chest, so that the ball of each thumb and little finger rests upon the inner margin of the free border of the costal cartilages, the tip of each thumb near or upon the xiphoid cartilage, the fingers fitting in the corresponding intercostal spaces. Fix your elbows firmly, making them even with your sides and hips; then— Action of Operator.—Pressing upward and inward toward the diaphragm, use your knees as a pivot, and throw your weight slowly forward two or three seconds until your face almost touches that of the patient, ending with a sharp push, which helps to jerk you back to your erect kneeling posi- tion. Rest three seconds, then repeat this bellows-blowing movement as before, continuing it at the rate of seven to ten times a minute, taking the utmost care on the occurrence of a natural gasp, gently to aid and deepen it into a longer breath until respiration becomes natural. When practicable, have the tongue held firmly out of one corner of the mouth with thumb and finger armed with a dry cotton rag. Very frequently during the early stages of the administra- tion of an anaesthetic the patient may " forget to breathe," even before the ability to perceive peripheral irritation is lost. Even later in the anaesthesia, when the breathing suddenly ceases, instead of using cold water externally and slapping the patient with wet towels, Dr. H. A. Hare recommends pour- ing a quantity of ether upon the belly, the shock caused by the cold produced by its evaporation bringing on a very deep in- spiration, followed often by the normal respiratory movements. Local Anesthesia.—The fatality attending the use of general anaesthetics led to the introduction of what are termed " local anaesthetics," some 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 lim- ited to small parts of the body, and its utility depends upon 204 DENTAL MEDICINE. the ease and rapidity with which a desired spot of living flesh can be frozen, in other words, temporarily deprived of its vi- tality, 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 the equivalent loss. The part consequently dies for the mo- ment, 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 restoration rapidly occurs. The fluids used are ether, of a specific gravity not exceed- ing 0.723, highly rectified, and as free as is possible from either alcohol or water—what is known as " absolute ether "—and 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.) LOCAL ANESTHESIA. 205 Liquefied chloride of methyl dissolved in ether and care- fully applied by means of a hair pencil, is recommended for the painless extraction of teeth, the opening of alveolar ab- cesses, etc., etc. (See Cocaine as a local anaesthetic.) A plan of local anaesthesia, known as Voltaic Narcotism, has been suggested by Dr. Richardson, of London. It con- sists in passing a galvanic current through a narcotic solution held in contact with the part to be operated upon. This plan appears to be successful only where the cavity of the tooth to be extracted is exposed. 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. Dr. Scott describes his method of applying electricity for the extraction of teeth as follows : " Use a Kidder electro-mag- netic machine, or any other giving very rapid vibrations of armature. Place the positive electrode on the gum of the tooth to be extracted, and the negative in the patient's hand, or at the back of the neck. Start with a light current and gradually increase the strength as much as can be borne without producing pain. The electrode applied to the tooth should em- brace each side, the better to convey the current. For this pur- pose it should be bifurcated at the end of the handle, the arms of sufficient length for convenience in operating. At the end of these solder small disks about the size of a dime. The han- dle and arms must be insulated to prevent the current passing off at any other point than the disks. Cover the disks with thin pads of fine sponge. A cylinder electrode, also covered with fine sponge or cloth is the proper one for the hand. Moisten each with saline water. Another method is to attach one pole of the batttery to the extracting forceps, the handles of which are well insulated, the other pole being held in the hands of the patient. As soon as the forceps come in contact with the tissues about the tooth the circuit is completed, and the electrical effect produced, which is often painful. A Commit- 206 DENTAL MEDICINE. tee of the College of Dentists, England, in a recent report upon the anaesthetic value of electricity, were unanimous that in no case was local anaesthesia produced by such currents, but that the effects were due to " diversion of sensation, less difficulty of extraction as compared with other extractions, syncope more or less marked, and differences in methods of operating." (See Electricity as a Therapeutic Means, etc.) Obtunding mixtures, consisting of a combination of cocaine, pyrethrum, aconite, chloral, veratria and alcohol, or chloro- form, aconite, belladonna and opium, etc., have been employed to produce local anaesthesia, and in many cases with satisfac- tory results. (See recipes for obtunding mixtures and local anaesthetics.) For, although entire insensibility to pain cannot in all cases be brought about, yet some diminution of it may be effected by the use of such agents. They have the merit, at least, of being less dangerous than the general anaesthetics. Such pain obtunding mixtures are best applied to the parts about the neck and over the root of a tooth by means of a simple apparatus, devised by Von Bonhorst. It consists of two small metallic cups, attached to the free ends of a spring some seven inches long, and which contain sponges to hold the liquid. When used, the sponges in the cup are saturated with the obtunding mixture and applied by pressing them on the gum on each side of the tooth to be removed, where they are retained from one-half to two minutes. Previous to the application the patient should be cautioned against swallowing any portion of the mixture. (See Cocaine, hyperdermic use of.) Rapid Breathing as a Pain Obtunder.—A method first sug- gested by Dr. W. G. A. Bonwell, and from which he claims a similar effect to that of ether, chloroform and nitrous-oxide gas in their primary stages, and to render the patient suffi- ciently unconscious to any acute pain from any operation, where the time consumed is not over from twenty to thirty seconds. " While the special senses are in partial action, the sense of pain is obliterated and, in many cases, completely annulled, consciousness and general sensibility being pre- served." " To accomplish this, each patient must be instructed LOCAL ANESTHESIA. 207 how to act and what to expect. As simple as it may seem, there is a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is informed of the fact that while he will be unconscious of pain, he will know full or partially well any touch upon his person; that the inhalation must be vigorously kept up during the whole operation, without for an instant stopping; that the more energetically and steadily he breathes, the more perfect the effect. It is obligatory to do so, on account of its evanes- cent effects, which demand that the patient be pushed by the operator over energetic appeals to 'go on.' It is very difficult for any one to respire over one hundred times to the minute, as he will become by that time so exhausted as not to be able to breathe at all. For the next minute following the comple- tion of the operation, the subject will not breathe more than once or twice. Very few have force enough left to raise hand or foot. The voluntary muscles have nearly all been subju- gated and overcome by the undue effort at forced inhalation of one hundred and seventeen, the normal standard. " The heart's action is not increased more than from seventy (the average) to eighty and sometimes ninety, but is much enfeebled, or throwing a lesser quantity of blood. The face becomes suffused, as in blowing a fire or in stooping, which continues until the breathing is suspended, when the face becomes paler. (Have not noticed any purple, as from asphyxia by a deprivation of oxygen.) The vision becomes darkened, and a giddiness soon appears. The voluntary mus- cles farthest from the heart seem first to be affected, and the feet and hands, particularly the latter, have a numbness at their extremities, which increases until, in many cases, there is partial paralysis as far as the elbow, while the limbs become fixed. The hands are so thoroughly affected, that when open the patient is powerless to close them and vice versa. There is a vacant gaze from the eyes, and a looking into space with- out blinking of the eyelids for a minute or more. The head seems incapable of being held erect, and there is no move- ment of the arms or legs, as is usual when in great pain. 208 DENTAL MEDICINE. There is no disposition on the part of the patient to take hold of the operator's hand or interfere with the operation." Dr. Bonwell bases his method on the following theory:— I. Diversion of the will-force in the act of forced respira- tion at a moment when the heart and lungs have been in nor- mal reciprocal action (twenty respirations to eighty pulsations); which act could not be made and carried up to one hundred respirations per minute without such concentrated effort that ordinary pain could make no impression upon the brain while this abstraction was kept up. 2. There is a specific effect resulting from enforced respira- tion of one hundred to the minute, due to the excess of car- bonic acid gas set free from the tissues, generated by this enforced normal act of throwing into the lungs five times the normal amount of oxygen demanded in one minute, when the heart has not been aroused to exalted action, which comes from violent action in running, or where one is suddenly star- tled ; which excess of carbonic acid cannot escape in the same ratio from the lungs, since the heart does not respond to the proportionate overaction of the lungs. 3. " Hyperaemia is the last in the chain of effects; which is due to the excessive amount of air passing into the lungs, preventing but little more than the normal quantity of blood from passing from the heart into the arterial circulation, but damming it up in the brain, as well as throughout the capil- lary and venous systems as well as upon the heart, the same as if it were suspended in that gas outside the body." Dr. A. Hewson agrees with Dr. Bonwell as to the efficacy of rapid breathing as a pain obtunder, yet he differs with him as to the theory or nature of the changes in the different symptoms brought about during its progress. Says Dr. Hew- son : " Every circumstance would therefore seem to indicate that this process of inducing insensibility to pain is one essen- tially of diminished oxidation and decarbonization of the blood, and recognizing such a state as belonging to the initia- tive stage of all anaesthetics, when insensibility to pain is positively marked, we have no necessity for begging any spe- ALCOHOL. 209 cial theory for this process, as in its action it readily comes under the category of such agents, and is thus not either an absurdity or an impossibility from a scientific point of view." ALCOHOL. Formula.—C2H5HO. Sp. Gr. of officinal alcohol, 0.820; of 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), 0.928. Derivation.—Alcohol is obtained from vinous or fermented liquors by repeated distillations, and, in its officinal form, con- tains about fifteen per cent, of water. It is colorless, inflam- mable, wholly vaporizable by heat, and unites in all propor- tions with water and ether. It frequently contains such impurities as fusel oil or amylic alcohol (obtained from fer- mented 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. Sp. Gr. 0.794, when containing no water. 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 45 to 55 per cent., by volume, of absolute alcohol); whiskey— Spiritus Frumenti (the spirit obtained from fermented grain by distillation, and containing from 50 to 58 per cent, by volume, of absolute alcohol); wine—Vinum (the fermented juice of the grape, and containing alcohol in varying proportions), are pow- erful diffusible stimulants, increasing the action of theheart and arteries, exciting the nervous and vascular systems, and caus- ing a general exhilaration of spirits. Excessive quantities pro- duce 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 14 210 DENTAL MEDICINE. 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 latter 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 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, its antiseptic properties rendering it useful as a mouth-wash when the secretions are vitiated and the surfaces of the mucous mem- brane soft and spongy. It is also useful for cleaning pulp- canals as a preparatory treatment to the use of the more active antiseptic agents, such as the bichloride of mercury. For suppurating 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 imperme- ble covering. 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- ALOES. 211 hoi 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 FORMULE. For Obtunding Sensitive Dentine. For Obtunding Sensitive Dentine. R. Alcohol (absolute) . . gss R. Alcohol (absolute) . . gss Acidi tannici . . . . z. ss Zinci chloridi . . . . 3 ss Glycerini......gss. M. Glycerini......gss. M. For Superficial Inflammations. For Mercurial Stomatitis. R. Alcohol, R. Spts. vini gallici ... I part Aquae . . . aa . . . g ss. M. Aquae.....4 to 6 parts. M. Signa.—To be applied as a lotion. Signa.—To be used as a gargle. ALOE—ALOES. Source.—Aloes is the inspissated juice of the leaves of the Aloe Socotrina, and contains a bitter precipitate known as aloin, and also a volatile oil, to which its odor is due. Its preparations are purified aloes—aloe purificata ; watery Extract of Aloes—Extractum Aloes Aquosum ; Tincture of Aloes— Tinctura Aloes ; also a number of pilular forms, and a tincture combined with myrrh—Tinctura Aloes et Myrrhae, and wine of aloes—Vinum Aloes. Purified Aloes is in the form of pieces of a dull or reddish-brown color, very brittle and soluble in alcohol, and a very bitter and disagreeable taste. Medical Properties and Action.—Aloes is a stomachic tonic and purgative, being principally employed for the latter effect. In large doses its action is that of a powerful purgative, and hence it is contraindicated in irritable or inflammatory condi- tions of the stomach. It stimulates the functions of the liver, and increases the flow of bile as well as the intestinal secre- 212 DENTAL MEDICINE. tions generally. Its chief effects are on the large intestine, increasing its peristaltic movement, and causing tormina and tenesmus with heat and irritation of the rectum. It also in- creases the menstrual flow and the blood supply of the pelvic organs. It requires some ten or twelve hours to produce its cathartic effects. A purgative action may be induced by ap- plying it to an exposed surface. In moderate laxative doses the stools are not liquid and but slightly altered in character. It is commonly administered in small doses in combination with nux vomica. Therapeutic Uses.—Aloes is very efficient in constipation dependent on weakness of the muscular layer of the large intestine. It is also employed in jaundice, atonic dyspepsia, hemorrhoids without active pelvic congestion, amenorrhoea dependent upon anaemia, menorrhagia in debilitated conditions, gonorrhoea, catarrh of uterus, etc. Dose.—Of Aloe purificata, gr. to v; extractum aloes aquosum, gr. ss to iij ; Tinctura Aloes, f5ss to ij; Tinctura Aloes Myrrhae, 5ss to 5ij; Vinum Aloes, 5j to Sss. ALUMEN—ALUM. Formula.—A1(N H4)2(S04) 12 H20. 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- ALUM. 213 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. Dose.—Of alum, gr. x to 9j or 3ij, 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. Potassi alum—Aluminii et Potassii Sulphas—the alum of 214 DENTAL MEDICINE. 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 FORMULE. For Odontalgia. For Inflamed and Ulcerated Mucous Rt, . . , . . .. Membrane and Gums. . Pulveris aluminis . . Z11 „ „..... , „. . ... .. ., R. Pulveris aluminis . . gr. lxxx. .Etheris nitrici . . . Zvy. M. ** °_ _ _ , ,. , „ . , Aquae destillatae . . fix. M. Signa.—To be applied on a pellet of „ , , .,, . Signa.—To be used as a mild, astnn- cotton. gent gargle. For Ulceration of the Gums and Mucous For Ulcerated and Spongy Gums. Membrane of the Mouth. R. Aluminis.....zj R. Aluminis.....zj Vini.......Oj Zinci sulphatis . . . 3 ss Tinct. cinchonae . . % ss Sodii borat .... gr.iv. Tinct. myrrhae . . . 3 ij Aquae rosae .... Jjviij. M. Mel. rosae '. . . . . %i). M. Signa.—To be applied as a lotion. Signa.—To be used as a gargle. For Inflammation and Ulceration of the Mouth and Throat. R. Infus. lini...................^ xv Tinct. kino..................^j Aluminis...................3 ij- M. Signa.—To be applied as a gargle. ALUMINA ACETAS—ACETATE OF ALUMINA. Formula.—Al2032 C4H303+4H O. 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 AMMONIA. 215 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 moderate 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 on scrofulous ulcerations, aphthae, caries of the teeth, or the wearing of artificial teeth. AMMONIUM—AMMONIA. Formula.—N H3. Ammonia, often called ammoniacal, or ammonia gas, is colorless and readily soluble in water, and forms a number of volatile stimulants, such as Aqua ammonice—ammonia water, which is the stronger water of ammonia diluted with two parts of water; Aqua ammonia fortior—stronger water of ammonia, is made by passing ammonia gas into water to make its specific gravity, 0.900 at 590 F; Spiritus ammonice—which is a ten per cent, solution of ammonia gas in alcohol; Spiritus ammonice aromaticus, which is an alcoholic solution of carbon- ate of ammonium, to which are added oils of lemon, nutmeg and lavender. (See also muriate of ammonia, sal ammoniac, carbonate of ammonium, solution of acetate of ammonia, spirit of mindererus, chloride of ammonium, and valerianate of ammonium.) Medical Properties and Action.—Ammonia gas is very al- kaline, and an irritant to mucous surfaces. Inhaled, it causes an overpowering sense of suffocation and spasm of the glottis, 216 DENTAL MEDICINE. and when prolonged, violent inflammation of the air-passages. Solution of ammonia when swallowed causes destructive in- flammation of the mucous membrane, extending to the stomach. The long-continued use of ammonia interferes with digestion by neutralizing the gastric juice, and by in- creased waste of tissue causes pallor, emaciation and feeble- ness. In the blood it injures the red blood-globules, and thus affects the nutrition of the body, being largely converted into urea. The preparations of ammonia are stimulant expec- torants. Therapeutic Uses.—Aqua ammonia is administered by in- halation in syncope and shock, and as a counter-irritant; for which purpose ammonia liniment is also employed. The in- cautious inhalation of ammonia may cause inflammation of the fauces and glottis, but when cautiously employed some- times gives relief to acute catarrh and hay asthma. The dil- uted aqua ammonia will relieve the pain of stings of insects, and the strong aqua ammonia is an antidote, when at once applied, to the bite of venomous snakes, and of rabid animals. The aromatic spirits of ammonia is useful in acidity of stomach, gaseous eructations and abdominal distension ; also in sick headache, and migraine; but the bromides are more effective in the latter affection. Ammonia salts stimulate the liver and increase the secretions of the kidneys and intestinal mucous glands and the action of the heart, hence are frequently used in adynamic states, constipation, coated tongue and scanty urine. The preparations of ammonia for internal use correct obsti- nate vomiting when the irritating substances are removed, and the matters vomited are acid. Dose.—Of Aqua Ammoniae, TTlv to 3ss, much diluted ; of Spiritus Ammoniae, m,x to f3J, greatly diluted; of Spiritus Ammoniae Aromaticus, f5ss to foij. Dental Uses.—Ammonia is used as a stimulant in danger- ous narcosis ; to prevent syncope or severe shock; in facial neuralgia, especially the chloride, and in periodontitis when it is combined with aconite and opium. Aqua ammonia is locally applied as a counter-irritant to the gums in acute in- CARBONATE OF AMMONIUM. 217 flammation of the peridental membrane. (See Acetate, Carbonate, Valerianate and Chloride of Ammonium). 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 f§j. 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, and as a diaphoretic and refrigerant in periodontitis, when it may be combined with either aconite or opium, or both. 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 218 DENTAL MEDICINE. the air it becomes opaque and falls into powder, losing its ammonia. Medical Properties and Action.—It is antacid, stimulant, di- 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 ; also as a stimu- lant in dangerous narcosis from anaesthetic agents. AMMONII VALERIANAS—VALERIANATE 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. CHLORIDE OF AMMONIUM. 219 Therapeutic Uses.—It is employed in neuralgia, nervous headache, hysteria, epilepsy, chorea, etc., etc., especially for females. Dose.—Of valerianate of ammonium, gr. ij to gr. viij, in pill, or in elixir, with aromatics (valerianate of ammonium 3J, fluid extract of vanilla fsss, tincture of cardamom f5yj, curacoa f5ij, 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 amenorrhoea. 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, leucorrhoea, 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 220 DENTAL MEDICINE. gargle, it is employed in the strength of §ss 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. AMYLENE. Formula.—C5H10. 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. Hydrate of Amylene is a tertiary alcohol first prepared by Wurtz. It is a colorless, watery-looking fluid, with a sharp taste and smell, and is soluble in eight times its volume of al- cohol. It is generally regarded as a safe and reliable narcotic and hypnotic, sleep being produced in from fifteen to forty- five minutes, and sometimes almost instantly. Where large doses are given, sleep may be induced in five or eight minutes, and as a rule its actions are prompt and safe. Contra-indi- cations of the drug have not yet been observed, but in cases of severe gastric troubles and ulcerations of the pharynx, it should be given per anus. Its actions may be briefly summed up as follows: NITRITE OF AMYL. 221 I. Hydrate of amylene is a hypnotic whose action can be confidently relied upon when sufficiently large doses are given. Experiments have shown that it is not so strong as chloral, yet stronger than paraldehyde. 2. Hydrate of amylene also acts upon persons who are accustomed to the use of hypnotics, although the dose employed in such cases must be comparatively large. 3. Sleep occurs soon after the administration of the drug, and is not preceded by any period of excitement. The sleep produced is light or heavy, according to the dose given; yet it is always easy to awaken the patient. Upon waking, the patient is perfectly sensible and bright, but if not disturbed further will at once fall asleep again. 4. Sleep lasts from two to three hours if small doses have been given, or from six to eight hours under the influence of larger doses. 5. The awaking is similar to that from natural sleep. The patients feel rested and strengthened. No headache or weak- ness was ever observed. 6. The respiration remains unchanged. 7. The change in the pulse's frequency and in the pressure of blood is no more than that which accompanies natural sleep. 8. The patients were never observed to wake up with a bad taste in their mouths and complaining of a disagreeable smell, symptoms which nearly always follow the use of paraldehyde. 9. Whether or not a habit and tolerance for the drug may be formed remains yet to be seen. As yet, even when the drug has been used continually, an increase of dose was never found necessary. Dose.—Of hydrate of amylene grs. xii to grs. xxxvii. It may be administered in gelatin capsules containing 15^ grains each, or in the fluid form mixed with claret and water, or raspberry syrup. 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, 222 DENTAL MEDICINE. until reaction commences, when the heat is withdrawn, and afterward re-applied. The distilled portion obtained below 212° 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, and belongs to the class of compound ethers. 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, paralysis of the action of the smaller arteries, a sense of great fullness of the brain, a lowering of the blood pressure and temperature, and com- plete 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. It affects respiration and the composition of the blood, producing headache, which is often prolonged. 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. As a rem- edy for chloroform narcosis, it is supposed to antagonize cerebral anaemia by causing capillary dilatation and thus pro- moting the inflow of blood to the brain. By inhalation, for relieving the pain of angina pectoris, and preventing epileptic seizures; also used in asthma, ANTIFEBRIN. 223 strychnia poisoning, hydrophobia, tetanus, epileptic attacks, and in many other convulsive or spasmodic diseases. Dose.—Of nitrite of amyl, 1ftij to 1ft v, by inhalation; not more than 1ft. 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 patientsi especially the weak and nervous, are very susceptible to its influence. ANTHEMIS—CHAMOMILE. Source.—The flowers of the Anthemis nobilis. A German variety is known as Matricaria, which is similar to Anthemis in its effects. The herb chamomile has a fragrant odor and a bitter aromatic taste. A votatile acid is obtained from the flowers, which is similar, if not identical, with valerianic acid. Medical Properties and Therapeutic Uses.—Chamomile is a mild tonic in small doses, but in large doses may act as an emetic. It is used in the form of a cold infusion in enfeebled digestion, flatulent colic and infantile disorders connected with digestive derangement. It is also employed in the form of infusions prepared with hot water and vinegar, for the re- lief of pain of boils, abscesses, etc. When employed for the relief of odontalgia in the form of fomentations to the face, there is danger of the abscess pointing externally; it is also applied to flabby, ill-conditioned ulcers as a gentle incitant. The tepid infusion will promote the operation of emetics. Dose.—Of the powder as a tonic, 5ss to 5j. It is generally employed in the form of infusion. ANTIFEBRIN—ACETANILIDE. Formula.—C2H3NO. Antifebrin, as Acetanilide is commonly called, is a white crystalline powder composed of colorless scales or plates sim- 224 DENTAL MEDICINE. ilar to boric acid. It is slightly soluble in water, but readily soluble in alcohol, and has a burning but not disagreeable taste. Chemically it is aniline. Medical Properties and Therapeutic Uses.—In regard to its properties as an antipyretic opinions differ, but it is generally regarded as being more powerful than antipyrine. It in- creases the intra-vascular blood pressure, and the action of the central nervous apparatus, but a quantitative decline ensues in the functions of motility and sensibility until they are alto- gether suspended. The quantity required to produce antipy- retic effects varies from four to eight grains, the latter dose lessening fever heat effectively, as it reduces the temperature and pulse-rate. It is employed in fevers, neuritis, neuralgia, myalgia, locomotor ataxis, herpes zoster, migraine, sciatica, epilepsy, etc. Three to five grain doses ter die will relieve the pains of inflammations, such as neuralgia, myalgia, migraine, etc. Dose.—Grs. v to grs. viij. ANTIPYRINE—DIMETHYLOXYQUINIZINE. Formula.—C20 H18N402. Antipyrine is in the form of whitish or grayish-white crys- talline powder, slightly bitter sweetish taste, and soluble in water. It combines with acids to form salts. Medical Properties and Therapeutic Uses.—Antipyrine is an antipyretic and stomachic tonic, and acts as an antiseptic in preventing fermentative changes in the intestines. It stimu- lates the secretions and readily diffuses into the blood. It first stimulates and then paralyzes the nerve-centres, dilates the cutaneous vessels, and increases the loss of heat by radia- tion, reducing the temperature rapidly. Sometimes it may cause dangerous symptoms, such as a feeble pulse, profuse diaphoresis and collapse. It is employed in typhoid and malarial fevers, pneumonia, phthisis, neuritis, sciatica, locomo- tor ataxis, neuralgia of the fifth pair of nerves associated with neuritis and sciatica, migrain, acute rheumatism, epilepsy, cho- rea, etc., and as a substitute for morphine, and in the morphine habit. DISTILLED WATER. 225 Dose.—Grs. v to grs. lx, being determined by its uses. Sub- cutaneously injected, it is very effective in painful affections originating in the nerves. The hypodermic use of antipyrine has given very satisfac- tory results in the treatment of nervous articular and muscular pains, gastric affections, bronchial asthma, articular rheuma- tism, chronic lumbago. A painless injection may be made by half-filling a hypodermic syringe with a fifty per cent, solution of antipyrine, which will amount to about five and a half grains; then immerse the syringe into a ten per cent, solu- tion of cocaine, drawing up enough of the cocaine into the syringe to make it about three-fourths full; this will amount to one-third grain of cocaine. The two solutions readily mix and do not decompose, and may be used as a local anaesthetic. Dental Uses.—Antipyrine is used hypodermically with great success in cases of severe neuralgia of the fifth pair of nerves. It also has a marked effect in controlling hemor- rhage from the gums and alveolar cavities when used as a haemostatic after the extraction of teeth. Antipyrine has also been administered internally with satisfactory results in the treatment of periodontitis: and in cases where, owing to the severity of the symptoms in the same affection, the internal administration has proven unsuccessful, the hypodermic in- jection of fifteen grains has afforded relief. 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. 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.—\t 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, i5 226 DENTAL MEDICINE. 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.—AgNOa. 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, and finally, black color, on account of the partial reduction of the silver by the sulphuretted hydrogen. Small doses, ad- ministered 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 power- ful tonic to the nervous system, and has been chiefly em- ployed as an antispasmodic tonic. It is chiefly used ex- ternally, as a stimulant, vesicant, and escharotic. If applied, NITRATE OF SILVER. 227 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 occa- sional purgatives should be given, to promote its elimination. The persistent use of iodide of potassium and the hyposul- phite of soda will cause the absorption and excretion of the silver deposits, in cases of skin discoloration 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 ad- ministered, and during a course, it should be occasionally in- termitted 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 discon- tinued. Exposure to the sun should be avoided. Therapeutic Uses.—Nitrate of silver is internally employed in dyspepsia, chronic gastritis, chronic diarrhoea and dysen- tery, 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, en- largement 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. *^ 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 valu- 228 DENTAL MEDICINE. able application, in the form of injections or solutions of va- rious 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 tannic acid, gallic acid, etc., on account of the coagulum or clot formed by it, being soluble in an ex- cess of albumen. It is also'employed to obtund the sensi- tiveness of dentine, especially where the cause is mechanical abrasion; also in aphthae, mercurial stomatitis, ulceration of the gums, salivary fistula, alveolar abscess. For obtund- ing 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 im- mersed in nitric acid, and applied 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 gelat- inous portion of the tooth, destroying its vitality to the ex- tent of the combination which takes place. The objection to its use in such cases is the discoloration 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 application of a solution of ammonia. Old stains may be re- moved 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 chloride of silver, to be followed by emetics, and the proper antiphlogistic treatment. DENTAL FORMULE. For Inflamed and Ulcerated Mucous For Ulcers and Aphtha. Membrane. R. Argenti nitratis . . . . Z ss R. Argenti nitratis . gr. ij to z ss Aquae destillatae . . . . ^j. M. Aquae destillatae. . . . f|j. M. Signa.—To be applied with a camel- SlGNA.—To be used as a lotion. hair brush. For Disease of the Antrum. For Mercurial Stomatitis. R. Argenti nitratis .gr.j to gr.v R. Argenti nitratis . . . . gr.ss Aquse destillatae . . . fgj. M. Aquae destillatae .... fgj. M. Signa.—To be used as an injection. Signa.—To be used as a mouth wash. ARNICA. 229 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 1ftx to f^ss. Dental Uses.—In dental practice, the tincture of arnica is applied to irritable pulps of teeth, in periodontitis to prevent 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. The tincture of arnica, when largely diluted with water, forms an efficient mouth wash during operations upon the teeth. Equal parts of tincture of arnica and glycerine diluted with water forms an effective mouth wash in inflammations of the mucous membrane of the mouth. DENTAL FORMULE. For Abraded Surfaces of the Mucous For Ecchymosis. Membrane of the Mouth. R. Tincturae arnicae. . . . 3j ss R . Tincturae arnicae, Liquor ammonii muriat. 25 ss Glycerini. . aa . . . ^j. M- Aquae........3 v. M- Signa.__To be used as a lotion. Signa.—To be applied as a lotion. 230 DENTAL MEDICINE. For Inflamed and Ulcerated Mucous Membrane. R. Tincturae arnicae...............3 'J Glycerini..................gij Aquae rosae..................^ ij Aquae destillatae................^ x. M. Signa.—To be used as a gargle. ATROPINE SULPHAS—SULPHATE OF ATROPINE. ATROPINE. Formula.—QyH^NO^ 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, of which it is the alkaloid, but is far more energetic in its action. It is an active poison, and should only be administered in- ternally with the greatest care. Hypodermically 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 discon- tinued. Without being a direct hypnotic, it induces sleep by relieving pain. Although it is not so well tolerated, as a general rule, as is morphine, yet patients who cannot bear morphine will bear atropine. Therapeutic Uses.—See Belladonna. Dose.—Of sulphate of atropine, gr. tU to gr. ih. For an anodyne and antispasmodic, hypodermically injected, the dose is 1ft ij = gr. rhs, as a commencement. An ointment is made of atropine gr. viij, rectified spirit f3ss, lard ?j. 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 SULPHATE OF ATROPINE. 231 pulps of teeth, preparatory to their treatment, and to their devitalization; it is also applied to acute inflammation, de- pending 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 morphine, but there is doubt as to its being so effective as the morphine salts; in facial neuralgia, in the form of an ointment; in neuralgia and in profuse salivation. As an anodyne for internal use, it proves efficacious 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 ; for such a purpose lis of a grain of the atropine sulphate is often combined with morphine sulphate. DENTAL FORMULE. For Facial Neuralgia. R . Atropinae sulphat . . . gr.j Adipis.......zj. M. Signa.—To be applied in the form of an ointment, over seat of pain. For Neuralgia. J. L. Ludlow. R . Atropinae sulphatis . . gr.ss Aconitinae.....gr.iss Olei tiglii.....gtt.ij Ung. petrolei . . . . z ij. M. Signa.—Apply externally. For Facial Neuralgia. R. Pulveris belladonae . . ^ x. Camphorae.....^ss , Spiritus rectificati . . q.s. M. Signa. To be applied with a camel- hair brush. For Neuralgia of Superficial Nerves. AlTKEN. R. Atropinae sulphat . . . gr.v Aquce destillat . . . . f g iii. 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. R. Ext. belladonnae . . . gr.ss Quininae sulphat . . . gr.ij. Ft. pil. No. I. Signa.—Use three times daily. M. For Facial Neuralgia. R. Linimenti belladonnae, Linimenti aconiti . aa . z vij Chloroformi.....f ^ij. M. SlGNA.—To be applied as a lotion, on lint saturated with it, and covered with oiled silk. For Neuralgia in Superficial Nerves. R. Chloroformi, Spts. vini rect . aa . ^ss Atropinae sulphat . . . gr.v. M. Signa.—To be applied on lint to pain- ful part, and covered with oiled silk. 232 DENTAL MEDICINE. For Neuralgia. R. Ext. belladonnae...............gr.iv Ext. stramonii................gr-v Ext. hyoscyami........•......gr.v Quininae sulphat...............Qij- M. Ft. pil. No. xx. Signa.—One pill two or three times a day. AURUM TERCHLORIDUM—TERCHLORIDE OF GOLD. Formula.—AuCl3. Derivation.—The Terchloride of Gold is obtained by dis- solving gold in aqua regia (three parts, by measure, of hydro- chloric acid, and one of nitric acid), using gentle heat to has- ten the solution, the acids employed being chemically pure. The solution is then evaporated to dryness, when ruby-red, prismatic crystals of the terchloride of gold result. 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 re- moved 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- ployee! 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 BELLADONNA. 233 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 irritant poison, care should be observed in its use. If not protected in a glass-stoppered bottle, the gold is precipitated in a metallic form. BELLADONNE FOLIA—BELLADONNA LEAVES. BELLADONNE 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, difficult 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 mor- phine. 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, epi- lepsy, 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 234 DENTAL MEDICINE. the extract, gr. % to gr. j; of the tincture, gtt. v to gtt. xx. (See Atropine.) 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 and America, and generally in combination with sul- phur and oxygen. It fuses at 4760 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 the 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 gen- erally contains. Subnitrate of bismuth is in the form of a heavy, white powder, with a faint acid odor and slightly metallic taste, and is insoluble 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 somewhat 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 gj to lard g j), chronic skin diseases, chlorosis, when iron is not tolerated, etc., etc. If not well borne by the stomach, BROMIDES. 235 it may be combined with aromatic powder, or if alkalies are indicated, with chalk and magnesia. Bismuthi subnitras is also employed as an antiseptic dress- ing 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- muth paste, and the subsequent dressings made in the same manner. Dose.—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 FORMULE. For Vomiting and Painful Digestion of For Diarrhma of Dentition. Teething Children, Acidity and Pyro- R. Bismuthi subnitrat . gr.lx sis. Extract rhei fluid . . gtt.viij Bartholow. Syrup rubus. . . . fjss R. Bismuthi subnitrat . ziij Elixir aurantii . . . fgss. M. Acid carbol .... gr.ij-gr.iv . _. Signa.—A teaspoonful four or six times Mucil. acaciae . • • .5J jt> r j- u 1 .. ~ ... „, a day. Proper feeding—barley water, Aquae menthae pip . . g iy. M. J f ° J H . ,, . f 1 r j 1* j rnilk and lime water. Starchy food Signa.—A tablespoonful for adults, and \,-\- a proportionate quantity for children, " three or four times a day. por Internal Administration to Support For Gangrene of Mouth ( Cancrum Oris). the Strength. R . Bismuthi subnitras (powd.). R. Quininae sulphat . . gr.iij to v Signa.__Applied to ulcerated surface, Tinct. ferri chloridi . gtt.v. M. and covered with absorbent cotton. Signa.—Three times daily. BROMIDES. Bromides are diffusible agents which rapidly pass into the blood, and in large doses can be detected in the faeces and 236 DENTAL MEDICINE. intestinal mucus, owing to a portion of the agent not being absorbed. They depress the heart's and also respiration and animal temperature, and in some cases large doses may cause transient excitement, giddiness, and intoxication. Moderate doses have a tranquillizing effect and refreshing sleep, and lower the sensibility to pain and irritation. Their immoderate use will cause paralysis of the muscles, and a condition known as bromism, the symptoms of which may be extreme pallor and anaemia, dilated pupils, slow and feeble action of the heart, breathlessness and quickened pulse on slight exertion, acne skin eruption, cool extremities, tremulous and uncertain movements, want of tactile feeling, relaxation of the genitals, dry fauces, difficult deglutitions, and weak mind. Ammonii Bromidum—Bromide of Ammonium. Formula. —NH4Br. In the form of colorless, transparent crystals, or a white granular salt, with a pungent, saline taste, neutral reaction, and no odor. Ammonii Bromidum is soluble in 1.5 parts of water, in 150 parts of alcohol at 6o° F., and in 0.7 part of boiling water. Dose.—Gr. x to 5ss, considerably diluted. Calcii Bromidum—Bromide of Calcium. Formula.— CaBr2. In the form of a white granular, deliquescent salt, with a pungent, saline, bitter taste, and no odor. It has a neutral reaction, and is soluble in 0.7 part of water, and in 1 part of alcohol. Dose.—3j to 5ij. Lithii Bromidum—Bromide of Lithium. Formula.— LBr. In the form of white, granular, deliquescent salt, with a pungent, bitter taste, and a neutral reaction. Quite soluble in water and alcohol. Dose.—Gr. v to 3ij. Sodii Bromidum—Bromide of Sodium. Formula.—NaBr. In the form of small, colorless crystals, or a white crystalline powder, with a saline taste, neutral reaction, and no odor. It is soluble in 1.6 parts of water, and in 200 parts of water at 6o° F. Dose.—3j to 5ii. (See Bromides of Potassium, Camphor and Ethyl.) SULPHATE OF CADMIUM. 237 Medical Properties and Therapeutic Uses.— The bromides have the same general action and are employed for the same purposes. The bromide of lithium is considered to have a more hypnotic influence than the others; and the bromide of sodium is generally given in full doses; the others in rather smaller doses. Prof. Bartholow considers the bromide of potassium to possess more toxic power, and the bromide of sodium the least. As regards their influence on the pulse, body-heat, and respiration, the same author places the bromides in the following order: bromide of sodium, bromide of lithium, bromide of potassium, bromide of ammonium. The bromides are eliminated through the kidneys chiefly; also through the mucous membrane of fauces, bronchi, intestinal canal and the skin ; several days being required for their diffusion outwardly from the blood. The bromides are administered in delirium tremens, insanity, increased action of the heart, tetanus, neu- ralgia, epilepsy, vaso-motor disturbances, spasmodic asthma, abnormal sexual excitement, nocturnal seminal emissions, vomiting of cerebral congestion, pregnancy and sea-sickness, cholera infantum, migraine, strychnine-poisoning, etc., etc. Locally in pruritus, prurigo, eczema, epithelioma, old ulcers, etc. (For Dental Uses, see Bromide of Potassium.) CADMII SULPHAS—SULPHATE OF CADMIUM. Formula.—i (CdO.S03) -f SHO. Derivation.—Sulphate of Cadmium is obtained by the action of nitric acid, diluted with distilled water, on the metal cadmium, the solution filtered and mixed with carbonate of soda, and again dissolved in sulphuric acid diluted with dis- tilled 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- toms of coma and convulsions; it is not administered inter- nally, as the preparations of zinc are preferable for such use. 238 DENTAL MEDICINE. 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 boiling water, until phosphoretted hydrogen escapes, and phosphate 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 absorbed, and are partially changed in the system into sul- phates. 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, typhus fever, smallpox, and other exanthematous diseases, pyaemia, dyspepsia, neuralgia with nervous depression, anaemia, CALENDULA. 239 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 eli- gible 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 hypo- phosphites prove serviceable. In the case of delicate children, where there is reason for believing 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, amenorrhoea, 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 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. 240 DENTAL MEDICINE. Dose.—Of the tincture of calendula, f3j 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. 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, CALCIUM. 241 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 small-pox. 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 ammonia and water, each, a sufficient quantity. Dose.—f.5j to f.5j. This syrup is especially useful in rickets, mollities ossium, delayed union of fractures, caries and necrosis in bone, anaemia 16 242 DENTAL MEDICINE. of nursing mothers, mammary abscesses or boils, carbuncles, chronic bronchitis, leucorrhoea, 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 IOO 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 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 CAMPHOR. 243 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 maybe 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 FORMULE. For Gangrene of the Mouth—Cancrum For Fetor of the Breath. Oris. Bartholow. Bartholow. R. Calc. chlorat . . . . z iij; R. Calc. chlorat . . . . z ss Aquae destil . . . . g ij Mucilaginis. . . . . ^ss Alcoholis.....^ij Aquae destil . . . . % Hiss. 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. CAMPHORA—CAMPHOR. Formula.—Ci0H16O. Source.—Camphor is a concrete substance obtained from the 244 DENTAL MEDICINE. 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 TTtxl, carbonate of magnesia Sss, distilled water Oij). Soap Liniment—Linimentum Saponis—(camphor Siv, oil of rosemary fgss, alcohol Oij, water Svj) 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, TTlv to ITLxx. 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, CAMPHOR. 245 and that following the extraction of teeth affected with peri- odontitis ; 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 combined 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 vermilion 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 formule. For a Local Anaesthetic. R. Pulv. camphorae . . . 3 viij Ether, sulph .... fgj. M. Signa.—Applied to the gum over the tooth to be removed, until it turns white or becomes blanched. For a Local Anaesthetic. R. Chloral, Camphorae . . aa . . zjj Morphiae sulph ... z ss Chloroformi .... £j. M. Signa.—Apply with camel's-hair brush, allow to dry and reapply as freely as is necessary to render part insensible to pain. For a Stimulant and Anodyne Lotion. R. Spiritus rosmarini . . ^ j Camphorae.....3J Saponis albae .... 5pv. M. Signa.—To be applied as a lotion. For a Local Anaesthetic. R. Camphorae.....Zj Ether vel chloroformi 3 ij. M. Signa.—Apply with a camel's-hair brush. For Neuralgia. R. Camphorae, Chlor. hydratis aa equal parts. M. Signa.—Apply as a lotion. For Neuralgia and Exposed Pulps. R. Camphorae.....5 parts. Chlor. hydratis ... 2 parts. Cocaine hydrochlor . I part. M. Signa.—Heat to boiling point of water, when it liquefies; use as a local ap- plication. For Pain of Tooth Extraction. R. Camphor .....zj. Chloroform .... f 3^ ij. M. Signa.—Apply on cotton. 246 DENTAL MEDICINE. CAMPHORA MONOBROMATA—MONOBROMATED CAMPHOR. Formula.—C10H15BrO2.' 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 sys- tem, and where camphor is indicated, as in asthma, neuralgia, hysteria, 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, neural- gia, etc. For children suffering from the convulsions of den- tition, gr. j of the bromide of camphor in acacia mucilage, and administered every hour, has been very serviceable in ar- resting 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- CAPSICUM. 247 tion, and also the genito-urinary organs. In excessive doses, capsicum is an irritant poison. 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 inflammation of the fauces, hoarseness due to a relaxed con- dition of the vocal cords, relaxed uvula, and in poisoning by opium, 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 TTlx to f3j. 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 the early stages of acute periodontitis; and also 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 periodontitis, 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 loose- ness of the teeth as a result of salivation; also in cases of turgidity and pufflness of the gums. It is often serviceable in chronic alveolar abscess, as an injection, after the sac has been destroyed ; 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. Dr. Kirk recommends capsicum as a local stimulant and counter- irritant in the initial stages of pericemental inflammation before 248 DENTAL MEDICINE. the formation of pus has taken place; in cases of soreness about roots of pulpless teeth, due to external violence, cold, etc., and not to septic irritation ; for relief of severe neuralgias following the extraction of lower molar teeth, in the form of a cataplasm applied to the affected side of the face, or by moist- ening a piece of heavy blotting paper and applying this to the side of face. Dr. J. F. Flagg recommends the use of capsicum for pericemental inflammation in the form of the powder sewed in small linen bags to be placed in the mouth over root of affected tooth. Dr. Leffman recommends sm all oval disks cut from capsicum plaster (Seabury & Johnson's), the surface of which has been lightly anointed with the ethereal extract, or oleoresin of capsicum, which can be nicely adapted to the gum. 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. 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, CARVACROL. 249 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. 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 250 DENTAL MEDICINE. 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 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. Formula.—C6H5N. 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, CHLORAL. 251 although they are soluble in water. Chinoline is very soluble in alcohol and sparingly 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, prevent- ing 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. CHLORAL HYDRAS—HYDRATE OF CHLORAL. Formula.—C2H ClsO 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 252 DENTAL MEDICINE. 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 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 morphine, 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. Great care is necessary in its use where symptoms of pulmonary disease, fatty heart or degenerated blood-vessels are apparent. 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 CHLORAL. 253 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 morphine, when it is very effective. Dose.—Of hydrate of chloral, gr. v to 9j ; 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 are required, from gr. xx 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 periodontitis; and as an injection, for alveolar abscesses. It is also used as a lotion (when diluted with water) for in- flammations of the oral mucous membrane, and as an anti- septic (chloral, 5j; aqua, f5ij) for injecting putrid pulp- 254 DENTAL MEDICINE. canals and chronic alveolar abscesses. Although it is em- ployed hypodermically, yet painful phlegmons have re- sulted from its repeated application. DENTAL For Foul and Fetid Indolent Ulcers. R. Chloral hydratis . . . gr.x Aquae destillatae . . . f 25 j. M. Signa.—To be applied as a lotion. For a Local Anaesthetic. R. Chloral hydratis ... ^ ij Pulveris camphorae . ^ ij. M. Signa.—To be applied as an obtund- ing mixture, by means of an applica- tor. For Odontalgia—Pulpitis. Flagg. R. Chloral hydratis ... z iij Aquae destill .... f zj. Signa.—Apply on cotton. M. FORMULE. For a Hypnotic. R , Chloral hydratis ... z ij Syrupi aurantii flores . z. iv Syrupi tolutani ... zjv Aquae destillatae . . . ^ vj. M. Signa.—Dose, y^ part, largely diluted. For Neuralgia. R. Chloral hydratis . partes 3 Camphorae . . . partem I. M. Signa,—To be applied over seat of pain. For a Local Anaesthetic. R. Chloral hydratis, Pulveris camphorae. aa . 5 ij Morphinae sulph. ... z. ss Chloroformi.....zj. M. Signa.—Apply with camel's-hair brush; dry rapidly, and reapply. For Neuralgia and Exposed Pulps. R. Chloral hydratis . . 2 parts. Camphorae .... 5 parts. Cocaini hydrochloratis 1 part. M. Heat to about boiling point of water till liquefied. Signa.—Apply locally. 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 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 For Foul and Fetid Indolent Ulcers. R. Chloral hydratis ... g ss Adipis ...... ^j M. Signa.—To be used as an ointment. CHLOROFORM. 255 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 suffocating odor of chlorine gas. It should be kept in glass- stoppered 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. 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 prac- tice, 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 undergoing such treatment, which may be ac- complished by the application of a large rubber dam, such as is used in the operation of filling teeth. DENTAL F0RMULE. For Aphthae and Gangrene of the Mouth. For Aphthae, Stomatitis, and Cancrum R. Aquae chlori.....£ ss Oris. Aquae destillatae . . . ^ iiiss R. Liquoris chlori, Syrupi simp.....gss. M. Mellis . . aa . . . H;ij. M. Signa—To be used as a gargle or lo- Signa.—To be applied as a lotion, tion. For Fetor of the Breath and an Antisep. For Mercurial Stomatitis. tic. R . Liquoris chlori . . . part j R. Liquoris chlori ... ^iv Aquae destillatae . . part viij, M. Mellis.......3 iv Signa.—To be used as a gargle for cor- Aquae destillatae ... J x. M. recting the fetor, and diminishing Signa.—To be used as a gargle. slightly the discharge. CHLOROFORMUM—CHLOROFORM, Formula.—CHC13. Sp. gr. 1.480. Derivation.—Chloroform is obtained by the distillation of 256 DENTAL MEDICINE. 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 col- orless, volatile liquid, of an agreeable ethereal odor, and a hot, aromatic, sweet taste. It is slightly soluble in water, and dissolves 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 chlo- roform for internal use is obtained from the hydrate of chloral. The purity of chloroform may be ascertained by agitating it with the bfriitro-sulphuret of iron, which shows the pres- ence of alcohol by the production of a brown tint; chlorinated pyrogenous oil may be detected and removed by strong sul- phuric 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 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, inducing violent gastritis. It is diffused into the blood, and affects remote parts. It increases the action of the circula- tory system, producing excitement of the brain, followed by a deep, heavy sleep; and in poisonous doses, stupor and insen- CHLOROFORM. 257 sibility. The first effect of the inhalation of the vapor of chloroform is a feeling of warmth and excitement extending to the extremities, which is succeeded by noises in the ears and a vibratory thrilling and benumbing sensation throughout the body, followed by a loss of feeling, motion and conscious- ness, with general paralysis of the respiratory muscles, ster- torous breathing, quick pulse, which may become irregular and weak, owing to the sedative action on the heart. The pupils, at first contracted, become dilated, and there is com- plete 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 affec- tions, such as nausea and vomiting, sea-sickness, sick head- ache, flatulent colic, intermittent fevers, and in .cholera, for which it is very efficient. The vapor is employed for the re- lief 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 pre- vented. 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 em- ployed as a stimulating application to foul and indolent ulcers. Dr. Spark recommends highly, as a haemostatic agent, a solu- 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, Tttj to v, in sweetened water or mu- cilage. Dose of chloroform for inhalation, 5j to 5ij. Spirit of Chloroform—Spiritus Chloroformi—is com- posed of chloroform §j; diluted alcohol Sij. Dose of spirit of chloroform, 5ss to 5j. 17 258 DENTAL MEDICINE. Mixed Chloroform-Morphia Narcosis. — A method practiced by Prof. Thiersch, of Leipsic, succeeds often in in- ducing a perfect analgesia without unconsciousness. Mor- phine is first hypodermically injected, and in from five to seven minutes afterwards the patient is very lightly chloro- formed till near the stage of excitement; the operation is per- formed ; as soon as pain is felt, if the operation is a prolonged one, a little chloroform 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 of 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. Cocaine-Chloroform Narcosis.—This consists essen- tially in the combined use of cocaine and chloroform, and is strongly favored by Prof. Obolinski, of Cracow, who injects either before or after the anaesthesia is obtained, from one to three centigrammes of cocaine; or he injects in the neighbor- hood of the seat of the operation, and during its progress, from three to seven centigrammes. Cocaine is used on the ground that it is a complete antagonist of chloroform and chloral; but it is not so regarded by others, who represent it to be a general exciter of the central nervous gray matter, rather than a direct and powerful stimulator of the heart, while its stimulant effect upon respiration is not to be depended upon. Prof. Obolinski claims that this mixed narcosis secures anaesthesia with the use of less chloroform, and that vomiting is prevented, and there are fewer disagreeable after-effects. 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. CINCHONA. 259 DENTAL FORMULE. For Neuralgic Affections. R. Chloroformi, Spiriti ammoniae, Tincturae aconiti aa f z ij Olei ricini . . . . 3 ij 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 3;j Morphinae sulphat . gr.vj. M. Signa.—To be applied to gum over root of tooth to be extracted. For a Local Anaesthetic. Von Bonhorst. R. Chloroformi, Etheris sulph., Spiriti lavandulae, Pyrethri (fluid ext.) . aa f^j. M. SiGNA.—Apply for one or two minutes to gum over root of tooth to be ex- tracted. For Odontalgia—Pulpitis. R. Chloroformi . . . Alcoholis .... Ether..... Camphorae (pulv.) Tinct. opii . . . Oleum caryophylli SiGNA.—Apply on cotton wool, to ex- posed pulp. §ij M. f^iij fgss For Neuralgic Affections of the Teeth. R. Chloroformi . . . . f zj or ij Aquae......Oj. M. SiGNA.—To be used as a wash or a gargle. For Neuralgic Affections. R. Chloroformi . . . . z ij Camphorae . . . . ^ iss Olei olivae . . . . ^ij. M. Signa.—To be applied as a liniment over seat of pain. For Odontalgia—Pulpitis. R. Chloroformi, Tinct. aconiti . Tinct. capsici Tinct. pyrethri Oleum caryoph Camphorae (pulv.) . 35 ss. M. SiGNA.—Apply on cotton wool. For an Anodyne Application in Neu- ralgia. R. Chloroformi . . . . fzj Linimenti camphorae f ^ ij. M. Signa.—To be applied over seat of pain, and covered with oiled silk, to prevent evaporation. For Earache of Dentition. R. Chloroformi . . . . z j Oleum olivae . . . . §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. 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, espec- ially of Bolivia and Southern Peru. Different varieties are 260 DENTAL MEDICINE. named, according to their color, as Cinchona Flava, yellow cinchona; Cinchona Pallida, pale cinchona; Cinchona Rubra, red cinchona. The medical properties of these barks depend upon the alkaloids they contain in varying proportions, Quin- ina 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. 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 QUININE. 261 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 internally employed in the treatment of intermittent fevers, and also other fevers, such as remittent, typhus, puerperal and scarlet; also 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 3iij, 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 formule. Dentifrice R. Pulv. cinchonae flav . . z. iv Pulv. saponis cas. albi . z iv Cretse prep......^ ij Magnesiae calc.....^ iij Otto rosae......gtt. viij Olei caryophylli . . . gtt.vj. M- Dentifrice. R. Pulv. cinchonae flav. . z iij Cretae prep......^ iij Sacchari albi.....3jj Pulv. cinnamom . • • 3J Pulv. saponis cas. albi. z ij Pulv. myrrhae .... £j. M. 262 ■ DENTAL MEDICINE. For Mercural Stomatitis. Garrettson. R. Tinct. cinchonae . . . ^ ij Potassas chloratis . . . ^ss Sodas bibor.....z ij Aluminis pulv.....zij Potassae permanganatis. gr.xxv Aquae coloniae ....£} Tinct. myrrhae . . . . £] Tinct. capsici.....zj Tinct. krameriae . . . £] Aquae........gviij.M. Signa.—Use as a gargle. Dentifrice. R. Pulv. cinchonae flav . . flb.ss Cretae prep.....Ib.ss Pulv. myrrhae . . . . ^ iv Pulv. radicis iridis . . |j iv. M. For Ulceration of Gums. R. Pulv. cinchonae . . . . z. ij Cupri sulph......gr.x Acaciae (pulv.) . . . . zj Mellis.......zij Aquae purae.....^iij. M- SlG.—Apply with a camel's-hair brush to ulcerated surface of mucous mem- brane. For a Wash after the Extraction of Teeth. R. Cinchonae (decoct.) . . f^ij Aluminae......zij Infus. rosae.....f ^ ij. M. Signa.—Use as a gargle. 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 f5j to f5iij. Oil of Cinnamon—Oleum Cinnamomi—is obtained by dis- COCAINE. 263 filiation, 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. 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; it is, also, combined 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 264 DENTAL MEDICINE. strained off, continue the exhaustion of the leaves by pouring on them eight parts of alcohol, at 850; 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 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 disagree- able smell. This is impure cocaine. The coloring matter is removed 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 in- fluence 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 inflammable, 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, trans- parent prisms, without odor, but with a slight bitter taste. The chemical composition of the alkaloid is C17H21N04; its reaction is strongly alkaline. 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 COCAINE. 265 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 con- taining % 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, 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 hydrobrornate, has been produced 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. Roller, 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 anaesthetized, and lose all reflex excitability, 266 DENTAL MEDICINE. 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 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 in some forms of insanity, melancholia, neurasthenia, gastralgia; and in wasting diseases, pruritic skin affections and hoarseness. The leaves in cigarettes have relieved hay fever and throat affections. Co- caine is employed as a local anaesthetic and local anodyne in all painful affections of the eye, the operation for cataract, al- though the evidence as to its reliability in such deep opera- tions as iridectomy, cataract, squint, etc., is conflicting. (There are, however, cases reported by Dr. Konigstein 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 injections of the hydrochlorate of co- caine. Dr. Wagner, of Vienna, basing a theory upon the es- tablished principle that fluids move from the positive to the negative pole in a galvanic current, saturated the positive elec- trode with a strong cocaine solution, applied it to the skin, and applied the negative pole a short distance from the positive, and found that incisions could be made without producing any pain. COCAINE. 267 Dental Uses.—In operations in the mouth, affecting the mucous membrane and the immediately subjacent tissues, the salts of cocaine have proven 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, in some cases, that of hyper- sensitive 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 cap- ped, 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 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 268 DENTAL MEDICINE. 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 surgical treatment of alveolar pyorrhoea, the pain may be relieved 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 the space of five minutes. The slowness of the action of coacine is a great objection to its use as an anaesthetic. The four per cent, or five per cent, solution applied to a tooth unprotected by a rubber dam (as the rubber prevents the anaesthetic action of the agent), for the space of twenty minutes, repeating the application if necessary, is recom- mended by Dr. Thompson. Dr. A. W. Harlan recommends a solution composed of cocaine hydrochlorate, ten grains, in sulphuric ether, ninety minims, which is to be applied for four or five minutes, for the painless extirpation of an exposed pulp. Herbst's Obtundent consists of a saturated solution of cocaine COCAINE. 269 hydrochlorate in chemically pure sulphuric acid, to which sulphuric ether is added to the point of saturation, the excess of the ether floating upon the surface and evaporating. Several applications are necessary to produce anaesthetic effects, and seventy grains of cocaine hydrochlorate are required to saturate two drachms of the sulphuric acid. Cocaine, owing to the unsatisfactory results which have attended its use as a local application, is used by hypodermic injection, for the extraction of teeth. Owing to the necessity for introducing the agent deeply into the tissues, Dr. Walb's method is to inject a two per cent, solution of the hydrochlo- rate 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 account of its supplying the alveoli and gums; but greater success appears to result from injecting the gum on each side of the tooth. Dr. Ray- mond recommends charging the syringe with thirteen minims of a four per cent, solution of cocaine, and to direct the needle- point on a line extending about midway between the angle and the coronoid process of the inferior maxillary, passing through the internal pterygoid muscle, and, using the finger on the internal oblique line as a guide, to cany the needle- point along inner surface of ramus until the nerve is reached, where it enters the inferior dental foramen, for operation on the inferior molar teeth. Dr. Raymond also suggests the following method of pre- paring and applying cocaine: Obtain a quantity of the soluble alkaloid, and mix it at the time of using it (as it de- teriorates when long kept). The requisites are a minim glass, 270 DENTAL MEDICINE. pair of scales, some filtering paper, and a little water that has been boiled. It is necessary to have an easy-working syringe, with a perfectly smooth, sharp needle. Care must be taken to exhaust the air from the syringe when charged ready for use. This can be done by drawing in more of the solution than is needed, and pressing it out to the required number of minims. Hold the needle-point up, so as to allow the air to get above the solution, then press the piston. The combined use of cocaine and chloroform is advocated by Obolinski, who injects, either before or after the anaesthesia is obtained, from one to three centigrammes of cocaine; or he injects in the neighborhood of the seat of operation, and dur- ing its progress, from three to seven centigrammes. Cocaine is thus used on the ground that it is a complete antagonist to chloroform, of which, however, there is some doubt, as cocaine is rather a general exciter of the central nervous gray matter than a direct and powerful stimulator of the heart, while its stimulant effect upon respiration is not to be depended upon. Obolinski claims that this mixed narcosis requires the use of less chloroform, that vomiting is prevented, and that there are few disagreeable after-effects. Dr. Gordon White recommends a saturated solution of cocaine hydrochlorate in ether as an excellent preparation for sensitive dentine and pulp-extirpation. The dangers from the use of cocaine are enumerated as follows: Certain persons possess an idiosyncrasy to cocaine, which cannot be foreseen or entirely guarded against; it exerts its toxic effects upon the nervous centres and, secondarily, the heart; its evil effects are most liable in neurotic subjects; the danger in cocaine poisoning is mainly from paralysis of the heart, syncope; special care is necessary in " weak heart" and organic heart disease; many regard its subcutaneous adminis- tration as dangerous, and that it should be avoided; the use of the strongest solutions is dangerous and unnecessary; that it may be well to precede its use by the administration of alcohol or other cardiac stimulant, as is done with chloroform. The treatment of cocaine poisoning consists of measures to rouse the heart, especially inhalations of the nitrite of amyl. COLCHICUM. 271 Cocaine is also employed in combination with arsenious acid for a devitalizing mixture. (See Arsenious Acid). DENTAL To Make a Solution of Hydrochlorate of Cocaine (four per cent.). R. Cocaini hydrochloratis (cyst-)......gr. 2% Aquae destillatae . . . f zj. M. For Exposed Pulps. R. Cocaini hydrochloratis (cryst.)......gr.vj Spiritus menthae pip. . f zj. M. SiGNA.—Apply on a pledget of cotton. For Local Anaesthesia. H. J. McKellops. R, Mur. cocaini .... gr.iss Spts. alcoholis . . . . Zj Chloroformi.....zj. M. For Neuralgia and Odontalgia. R. Cocaini hydrochloratis (cryst.)......gr.vj Menthol......gr.xxx Alcoholis . q.s . ad . . f zj. M. Signa.—Apply as a lotion, or on a pledget of cotton. Chloroform or bromide of ethyl may be substituted for the alcohol. To Make Oleate of Cocaine. (Five per cent.) R. Cocaine (alkaloid) . . gr.2^ Acidi oleic (pure) . . 1T1XX Olei amygdalae .... Tfyxl. Dissolve the alkaloid in the oleic acid and add the almond oil. FORMULE. ForPain of Difficult Dentition. M. VlQUIER. R. Cocaini hydrochloratis . gr.ij Syrup simp.....3 ijss Tinct. saffron .... gtt.x. M. Signa.—Rub the painful gums fre- quently during the day. For Local Anesthesia. J. M. Lewis. R. Cocaini hydrochloras . grs.viii Chloralis hydrat . . . gr.v Acidi carbolici .... gtt.iij Aquae destil.....f 3iij. M. Signa.—Inject two or three drops into the gum. For Hypersensitive Dentine. R, Cocaini hydrochloratis (cryst.)......gr.x Tragacanth. glyceritum q.s. Form a mass. Signa.—Insert a minute portion in cavity half an hour before operating. For Neuralgia and Odontalgia. R, Cocaini hydrochloratis (cryst.)......gr.xv Olei caryophylli . . . fgj. M. Signa.—Apply as a lotion, or on a pledget of cotton. COLCHICUM—MEADOW SAFFRON. Source.—Colchicum root—Colchici radix; Colchicum seed— Colchici semen, the bulb and seed of the Colchicum Autumnali. Containing tannic and gallic acids and an alkaloid known as colchic&ie, which is the active principle; colchicum also contains starch, sugar and gum. Colchicum has a bitter 272 DENTAL MEDICINE. taste, and imparts its medicinal \yrtues to water, alcohol and ether; wine and vinegar extracting all its properties. Medical Properties and Therapeutic Uses.—Colchicum, in the forms of fluid extract, wine and tincture, increases the mucous and glandular secretions of the stomach, intestines, liver, kidneys and skin, and causes an increased flow of saliva, and also of urine. A large dose may produce heat in the epigastrium, nausea, vomiting, depression of the circulation, muscular feebleness and pain in the head, large, watery stools and an increased secretion of biliary matters. In poisonous doses it produces all the symptoms of an irritant poison, such as acute pain in abdomen, profuse watery and mucous dis- charges, suppression of urine, cold extremities and feeble pulse; also muscular cramps, in some cases. Colchicum is principally employed in gout, when a quantity sufficient to shorten the duration of an acute attack and reduce the swelling by an increased secretion from the skin, intestines and kidneys, is only required. It is often combined with an alkali, such as aromatic spirits of ammonia, bicarbonate of potassium, or carbonate of magnesia, to increase its effect. The active principle, colchicine, is generally more efficacious than the crude colchicum. It is very serviceable in rheumatic gout when combined with alkalies, and also in all affections dependent upon a gouty diathesis, such as constipation, congestion of the liver, and headache from torpor of the portal circulation. It is now rarely used in acute rheumatism, but in chronic rheumatism it often proves serviceable. Its use is indicated in plethora, constipation and deficient action of the liver, kidneys and skin. Dose.—Of fluid extract of colchicum root—Extractum Colchici Radicis Fluidum, ITtij to Til v. Of wine of colchicum root—Vinum Colchici Radicis, TTtv to Trfxxx. Of acetous extract of colchicum root—Extractum Colchici Radicis, gr. ss to gr. ij. Of tincture of colchicum (seed)—Tinctura Colchici, 1Ux to 3j. COLLODIUM—COLLODION. Derivation.—Collodion is a solution of 4 parts of pyroxylin COLLODION. 273 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 alcohol. 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 consisting 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- 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 18 274 DENTAL MEDICINE. 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 that 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 periodontitis, applied to the gum over the root of the 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, 5j, HEMLOCK. 275 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......ziij Collodii . . aa . . . ^j. M. Tinct. ferri perchloridi. z j 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 ioo cavity. Acidi carbolici . . partes lo 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. CONIUM—HEMLOCK. Derivation.—Hemlock is the fruit of the Conium maculatum, or spotted (not the common) hemlock, which is an umbellif- erous plant. The principal one of its three alkaloids is conine, C8Hj5N, which is very powerful. Medical Properties and Action.—Conium is a depressing agent producing motor paralysis, first causing, as the effects of a large dose, nausea and vomiting with a general weakness of the voluntary muscles, but with no direct action on the heart. In fatal cases of poisoning death follows from paralysis of the respiratory muscles causing asphyxia. The antidotes are nux vomica, picrotoxin, and active muscular exercise. It is quickly decomposed by heat. Therapeutic Uses.—Conium is employed in mania, chorea, tetanus, hydrophobia, whooping-cough, asthma, laryngismus stridulus, diseases of the eye and strychnine poison. For nerve-pain with muscular spasm, the best results may be ex- pected from the combined administration of morphine and conine, subcutaneously applied, as the effects of conine are greatly heightened by morphine. Conium is also used in dislocations to relax muscles. Dose.—Of Abstractum conii, gr. ss to gr. ij; Extractum 276 DENTAL MEDICINE. conii alcoholicum, gr. ij to gr iv; Extractum conii fluidum, mij to Tllv; Tinctura conii, TTlx to f5j ; Conine, nLny to TrUj. Dental Uses.—Conium is employed in neuralgias, locally applied; inflamed dental pulps; also in cases of artificial teeth lodging in the oesophagus, to produce relaxation of the muscles. 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 xp'aC "flesh," and oour-yc, " 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 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 geaerally 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 , CREASOTE. 277 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, irri- table stomach, nausea, vertigo, but has no effect, such as dila- tation 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. 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 f5iv. 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 278 DENTAL MEDICINE. similar in their action, with some advantages in the case o carbolic acid. Creasote is employed for the relief of odontal- gia, obtunding the sensitiveness of dentine, alveolar abscess, periodontitis, 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, ^j, 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 as glycerine, iodine, etc.; also in devitalized teeth, and as an antiseptic application in ulceration of the mouth, and reces- sion of gums from the neck of the teeth. When used as a styptic after the extraction of teeth it is applied on lint or cot- ton, with pressure; 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. Cre- asote 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. PREPARED CHALK. 279 DENTAL FORMULAE. For Pulpitis. Garretson. R. Creasoti......gtt.vj Tinct. iodinii . . . zj Sig. plumb, subacet . zj Chloroformi Tinct. opii . . aa . . ^ ss. M. Signa.—Apply on cotton to exposed surface of pulp. For Alveolar Abscesses. R. Creasoti, Linimenti iodi, partes aequales. M, Signa.—To be used as an injection. For Odontalgia. R . Creasoti......^ ss Camphorae . . . . gr. x. M. Signa.—To be applied, on a pellet of cotton, to carious cavity, Guiacol is a derivation of wood creasote, in the form of an oily liquid with an odor of cassia and resorcin. It possess the active principle of creasote, and the power to destroy microbes in the human mouth. It is claimed to pos- sess the same therapeutic value as creasote and to be a better disinfectant, especially in cases of decomposed pulps. " Gui- acol may be sealed up in a pulp cavity from one to three months or more, and the contents be found perfectly disin- fected." CRETA PR^EPARATA—PREPARED CHALK. PRECIPITATED CHALK, CARBONATE OF LIME, Formula.—CaC 03. Derivation.—Prepared chalk is obtained by freeing chalk from such impurities as gritty and flinty subtances and solu- ble saline matter, by elutriation, and afterward drying it. It is the only form in which chalk is used medicinally. Medical Properties and Action.—Prepared chalk is antacid, absorbent and astringent. It diminishes the secretion of the R. Creasoti......z. ij Morphinae acetatis .gr.xx. M. Signa.—To be applied, on cotton, to carious cavity. For Odontalgia. R. Creasoti, Chloroformi, Liquidi opii . aa . . ziij Tinctura benzoini . . ^j. M. Signa.—To be applied on a pellet of cotton, to carious cavity. For Odontalgia. R. Creasoti, Chloroformi, Morphinae hydrochlo- ratis . . aa . . . z. iij Tinctura benzoini . ^j, M. Signa.—To be applied, on a pellet of cotton, to carious cavity, (See for- mulae of Carbolic Acid.) 280 DENTAL MEDICINE. mucous membrane, and at the same time acts as antacid in correcting any acidity present. W'hen internally administered for a considerable time, like magnesia, it accumulates in the bowels and forms intestinal concretions; 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, f Siv) is often combined with opiates and astringents, such as laudanum and tincture of kino, or of catechu, in the treatment of diarrhoea. Dose, 3j to Sss. 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. 281 DENTAL FORMULAE. Dentifrice in the Form of Troches. R. Cretae preparatae . . . . tb.iv Sodii boratis (pulv.) . . . ^ x Saponis Castil " . . . ^ x Sacch. albae " ... rb.iss Ossis sepiae " . . . fb.i^ Olei rosae.......gtt. xxx Millefleurs.......%} Essentia? jasmin.....^ ^ Mix with a solution of gum syrup. 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 01. gaultheriae Cretae praep. . 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 . . . tbj Pulv. radicis iridis . . Ibj Pulv. sacchari albi. . Ibiss Pulv, saponis cas. . . 3jj Sodii carb.....^j Olei sassafras . . . gtt.lxxx. Dentifrice, (Am. Dent. Association.) R. Cretae praep.....tbiij Pulv. cinchonae . . . ibj Pulv. radicis iridis. . Ibj Pulv. sacchari albi. . fbjss Pulv. saponis cas . . 3;j Sodii carb.....%) Glycerini.....f J iij Mellis.......q. s. M. And form into a paste. Ibss I" zss zjv 3J gtt.iv Dentifrice. R. Pulv. radicis iridis . Cretae praeparatae . Sodii carb. . . . Pulv. cinchonae . . Pulv. sacchari albi. Pulv. myrrhae. . . Pulv. ossis sepiae . Otto rosae .... With rose pink, q. s. to co 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.....§ iij Pulv. radicis iridis. . § ij Pulv. sacchari albi . ^j Pulv. cinnamon. . . z iij Pulv. saponis cas. . . z ij Pulv. myrrhae. . . . zj 01. gaultheriae . . . gtt. x. M. Dentifrice. (A. W. Harlan.) R. Cretae praeparatae, Pulv. radicis iridis aa ^ ij Pulv. saponis cas., Pulv. sodii bibora- tis . . . aa . . . ^ss Pulv. myrrhae. . . . z ij Mellis et glycerini . . q. s. To make a soft paste. Color rose pink. Perfume to suit. 282 DENTAL MEDICINE. Dentifrice. (Chapin A. Harris.) R. Cretae praeparatae . Pulv. radicis iridis Pulv. cinnamon Sodii carbonatis e siccatae .... Pulv. sacchari albi Olei limonis . . . Olei Rosae.....gtt. ij Signa.—Ingredients to be thoroughly pulverized and well mixed. 3* l» ziv zss gtt. XV Dentifrice in the form of a Paste for Compressible Tubes, (Keller Medicine Co.) PTS. BY WT. R. Magnes. carbonat. . 2 Sodii bicarb.....3 •5 .20 . 6 . 1 R. Dentifrice. Cretae praeparatae . . flbiss Pulv. sodii boratis, Pulv. radicis iridis. aa Ibss Semen cardamom . !|j Pulv. sacchari albi . Ibss Otto rosae.....q. s. Potas. chlorat. . . Calcii carbonat. Sapo. cas. pulv. Glycerini .... Olei gaultheriae Olei limonis. . aa Syr. simplic.....q. s. Signa.—To make a paste. q. s. Dentifrice, Antacid, Tonic and Anti- R. M. To flavor. septic. Cretae praeparatae Quininae disulph. Pulv. ossis sepiae Otto rosae ... 5* gr.iv ziv gtt. iv. M. R. Dentifrice, (W. D. Miller.) Precipitated carbonate For Fetor of Breath. (MlLLIRON.) R, Sulphur powd., ^ iii^ Creta prep, pulv. aa . ^ j 3 xv Spts. rectificatus . . ^jss Zxv Aquae destill. . . . ^ iij Z™% Peppermint .... q.s. M. 3 iij^ Signa.—After removal of all calcic de- gtt. x to xv posits, use with a tooth-brush morn- Mix well. ing and evening. Dentifrices may be pleasantly flavored with wintergreen, cassia, sassafras, lemon, peppermint, anise, lavender, penny- royal, cloves, calamus, attar of roses, oil of neroli, etc. of calcium . . . , Cinchona bark . . , Prepared oyster shell Powd. myrrh. . . , " cloves . . . Oil of cinnamon . . 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 SULPHATE OF COPPER. 283 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. 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 neural- gia, 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 periodontitis, pul- pitis, etc., etc. DENTAL FORMULA. For Neuralgic Odontalgia. Von Kirchbauer. R. Croton chloral................zj Glycerini..................£vj Aquae destill.................% iiss Syr. aurantii.................5 iv Oleum fceniculae...............gtt.yj. 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, 5H20. 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 284 DENTAL MEDICINE. to the air, effloresce to a slight degree, and become cov- ered 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 adminis- tration 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 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 oc- curs. For internal use other than emetic the dose is gr.^ 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. Culpri sulph.....z ij Mellis........g ss. M. Pulv. cinchonae . . . . \ ss Signa.—Apply as a lotion, or by means Aquae........^ iv. M. of a camel's hair brush. Signa.—Brush over ulcerated surface twice daily. DICHLORIDE OF ETHIDENE. 285 For Ulcerative Stomatitis. For Caries of the Maxillary Bones. R. Cupri sulph......gr.x (Bartholow.) Pulv. cinchonae . . . . z ij R. Culpri sulph, Pulv. gum acaciae . . . zj Zinci chloridi . . aa . partes xv Mellis........zij Liquor plumbi . ... " xxx Aquae........^iij. M. Aquae destillatae . . . " cc. Signa.—Apply, by means of a camel's- Signa.—To be applied for 30 minutes hair brush, to the ulcerated surface. at a time. ERGOTA—ERGOT. Derivation.—Ergot is a fungous growth which replaces the grain of the common rye. It is bitter, and excites heat and dryness, followed by pain in stomach, thirst, vomiting and intestinal pain and sometimes purging. Small doses, long continued, cause spasms and death by coma and asphyxia; gangrene of the lower extremities may follow its pro- longed use. Medical Properties aud Action.—Ergot causes contraction of the involuntary muscular fibre, the uterus, and smaller blood vessels, and dilates the pupils. It is employed to pro- duce contraction of the uterus in child-birth. It is also ad- ministered in chronic diarrhoea and dysentery, enlarged heart without valvular lesion, gonorrhoea, acne rosacea, etc., etc. It is very serviceable in the hemorrhagic diathesis where there is a want of tonicity of the vessels; also used in epistaxis, uterine, renal, and intestinal hemorrage, and in haemoptysis; bleeding of hemorrhoids, etc. Dose.—Of the fluid extract for internal use, f5ss to ij; of the wine of ergot: 5j to Sss; of the aqueous extract dissolved in water the hypodermic dose is gr.% to gr. iij. Dental Uses.—Ergot is useful in the treatment of hemor- rhage of the gums, and that following the extraction of teeth when it is excessive and persistent. ETHIDENE DICHLORIDUM—DICHLORIDE OF ETHIDENE. Formula.—C2H4C12. Sp. gr. 1.225. Derivation.—Dichloride of Ethidene is obtained in the preparation of chloral, from the waste products, and is very much like chloroform in appearance, odor and taste. It 286 DENTAL MEDICINE. has a variable boiling point of about 1150 F., and is readily soluble in alcohol, sparingly soluble in water, and but slight- ly 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 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 recom- mended to combine the vapor of ethidene with that of nitrous oxide, by loosely inserting a sponge containing half an ounce of ethidene 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 anaes- thetic, 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. BROMIDE OF ETHYL. 287 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 is 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, strong and sweetish, with a somewhat burning after-taste. It is readily soluble in alcohol and ether, and but sparingly solu- ble 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) Chlo- roform increases,and then decreases, respiration; nitrous oxide 288 DENTAL MEDICINE. 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, towards 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 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 BROMIDE OF ETHYL. 289 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 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 19 290 DENTAL MEDICINE. 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 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 bro- mide of ethyl is atomized with the " spray apparatus," which should furnish enough of the liquid to moisten the skin. The extremity 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, anaes- thesia of the part occurs, which is shown by the appearance of a white spot. The formation of this spot may be has- tened by superficially puncturing or scratching the skin. The sensation of cold thus produced is sometimes disagree- able, 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 recom- mended for whooping cough, in the form of a solution of 1 part of bromide of ethyl in 200 parts of water; also in angina pectoris, the dose being one-half to two ounces. EUCALYPTUS. 291 Given internally, it is also said to relieve gastric pain, with- out affecting the appetite. Inhalations readily relieve con- vulsive cough ; and, introduced on cotton wool into the ex- ternal meatus, it relieves the pain of otalgia, without causing any irritation. EUCALYPTUS. Source.—Eucalyptus is obtained from the eucalyptus globu- lus, a tree of large size, and of the natural order Myrtaceae, found originally in Australia, and known as the " Blue Gum Tree." 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 me- dicinal 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 im- portant 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 pro- duce offensive eructations, a feeling of weight and tension at the epigastrium, and indigestion, followed by diarrhoea, and irritation and congestion of the kidneys. It increases the ac- tion 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 292 DENTAL MEDICINE. 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 essential 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 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-5j; of the tincture of eucalyptus—Tinctura Eucalypti—f3ss to f5ij; of the extract—Extractum Eucalypti—gr. j to 3j ; of eucalyptol, the dose is TfiVv 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, or fluid extract, are used as dis- infectant applications in indolent offensive ulcers of the mucous membrane of the mouth, stomatitis, pharyngitis, etc. 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, pyorrhoea alveolaris, 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, putrescent pulp- canals, necrosis, and caries of the bones of the jaws, etc. The oil can be introduced as an injection, with an abscess syringe, IRON. 293 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 may also be applied by dipping a pledget of cotton in the oil and then in finely pulverized iodoform (Truman), and carried to the tooth, as in cases of putrescent pulps. It is also employed as a local anaesthetic for odontalgia, and as an astringent or styptic in superficial hemorrhages, 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. DENTAL FORMULAE. For Abscess of Antrum. Geo. L. Parmele. R. Eucalypti......zj Iodoformi.....gr.x Aquae.......gj. M. Signa.—To be used as an injection in connection with a tent of floss silk saturated with glycerine and euca- lyptus. For Alveolar Pyorrhoea. (Riggs' Disease). G. V. Black. R. Olei eucalypti .... TIlxc Acidi carbolici. . . . Trfxc Olei gaultheriae . . . TTLXXX.M. Signa.—Apply by means of an abscess syringe. For Suppurating Pulps, Ulcers, etc. R . Olei eucalypti .... z j 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 For Abscess of Antrum. R. Olei eucalypti .... z ij Acidi carbolici . . . gtt.x Glycerini......zij Olei gaultheriae ... 5^ss. M. Signa.—Use as an injection. For Root-Canals as an Antiseptic. R. D. Pedley. 01. eucalypti . . 2 parts 01. caryoph ... 3 parts Creasoti .... 10 parts, M. Into this dissolve gum mastich to saturation, filter through cotton- wool and thoroughly incorporate with iodoform in a mortar until it becomes a solid mass. Signa.—Introduce on floss silk or wisps of cotton, and cap it with a disk of metal and insert temporary filling. 294 DENTAL MEDICINE. 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- 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 IRON. 295 . upon the teeth. While the carbonate of iron in the form of pill, nor the reduced iron, are injurious to the teeth by direct action, yet eructations of hydrogen compounds produced by their ingestion may injure the teeth. The use of a tube carried well back in the mouth and the iron preparation well diluted, should be preceded and followed by the alkaline solution. 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 constipation, and hence it is the best form in which to admin- ister iron. The dose of dialysed iron is TTLv to 5j. Therapeutic Uses of Iron.—Iron is an efficient tonic, and prornotes the appetite and the digestion; hence it is em- ployed in anaemia, chlorosis, combined with quinine, in chronic malarial affections ; syphilitic cachexia, acute rheumatism, ery- sipelas, diphtheria, scrofula, rickets, neuralgia depending on anaemia, epilepsy in weak, anaemic subjects, fatty degenera- tion 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 extraction of teeth, hem- orrhage resulting from wounds and surgical operations, etc., etc. [For doses of the various preparations of iron, see " Table of Doses."] 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, TTIy-xx. Externally the chloride of iron is employed as a styptic and - 296 DENTAL MEDICINE. 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 proportion 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 styp- tic. Chloride of iron is also useful as an application to fungous tumors. Reduced Iron—Ferrum Rcductum—is metallic iron in the form of a fine powder, obtained by the reduction of ferric oxide by hydrogen. Dose.—Gr. j to gr. v. Solution of Subsulphate of Iron—Liquor Ferri Subsul- phatis—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. When employed for the arrest of alveolar hemor- rhage from tooth-extraction, it is liable to cause sloughing of the bleeding tissues, and if used it should be in weak solution, and carefully watched. Powdered Subsulphate of Iron—Pulvis Ferri Subsul- phatis—Monsel's Powder—is in the form of a yellow powder, and possesses the same astringent and other properties as the so- lution, and is applied as a styptic in alveolar hemorrhage with much greater convenience. Medical Properties and Action.—Monsel's solution and powder 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 IRON. 297 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 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, or soft modeling composition, should be applied over the cotton filling the cavity, and held in place by the opposing teeth, when the mouth is closed. 298 DENTAL MEDICINE. DENTAL FORMULAE. 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 thickness, 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. When poisonous doses are taken, all of the symptoms de- scribed 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 GLYCERIN. 299 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, TTLv to Tftxv. 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. ix> to gr. uV. Dental Uses.—Gelsemium is greatly extolled as a remedy for neuralgia of the fifth nerve, often affording permanent re- lief, 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-hour, 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 moder- ate one, and the symptoms carefully observed. DENTAL FORMULA. For Neuralgia from Devitalized Teeth. R. Tinct. gelsemii.............. gtt.x Tinct. aconiti................gtt.v Aquae...................^ iv. M. Signa.—One teaspoonful every hour. GLYCERINUM—GLYCERIN. Formula.—C3H63HO. Sp. gr. 1.25. Source.—Glycerin is obtained from the saponification of fats and fixed oils, and contains a small percentage of water. 300 DENTAL MEDICINE. 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 tV 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 solu- tions of medicinal agents in glycerin are known as glycerites {glyceritd). 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- ment or embrocation. Five parts of glycerin rubbed up in a mortar with four parts of yolk of egg, forms a compound GLYCERIN. 301 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 applied 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 the 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 dis- eases 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 asrents. 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 the R. Glycerini......§ j Mucous Membrane. Tinct. iodi. comp . . . TTLxlv R • Glycerini......£ j Acidi carbolici cryst . TTlvj Sodii boratis.....zjj M. Aquae destillatae . . . g v. M. Signa.—Apply as a lotion. Signa.—Apply as a lotion or injection. 302 DENTAL MEDICINE. For Aphthous Ulceration of the Mouth. For a Sedative Application in Inflamed R. Glycerini......5j Mucous Membrane. Sodii sulphitis . . . . zj. M. R. Glycerini Signa.—Apply as a lotion. Chloroformi . . aa . . g ss M. Signa.—Apply as a lotion. For Chronic Alveolar Abscess, Ulcera- *■ tion of Mucous Membrane, etc. For Aphthous Sore Mouth of Infants. R. Glycerini ...... partem I R. Glycerini, Acidi tannici .... partes 2. Aquae . . . aa . . . § 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......f z; ij Acidi tannici . . . . gr. j Acidi tannici .... z ij 01. menth. pip., Morphiae acetatis . . . 3 j 01. caryophylli . aa . gtt. xxv. M. Iodoformi......J) 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 somewhat 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 hemorahages from nose, uterus, and from hemorrhoids. Dose.—Of the fluid extract of hamamelis, 5ss to 5ij; of the decoction, Sss to Sj. MERCURY. 303 Dental Uses.—Hamamelis is employed in dental practice as a sedative or anodyne application, in incipient periodon- titis, 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 40°. 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, metal- lic mercury does not readily tarnish in the air, and it can be purified by re-distillation, or by adding to it a small quantity 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- times with gold and platinum, in addition to the other metals named. 304 DENTAL MEDICINE. 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, and it is now regarded as one of the most powerful germicides in use and very extensively employed in antiseptic surgery. Dr. F. Abbott regards the bichloride of mercury as being the symplest antiseptic in use. Dr. W. D. Miller, of Berlin, also testifies to the power of the bichloride as an antiseptic in the treatment of the oral cavity as follows: " The experiments show that bichloride of mercury is about two hundred times as powerful as carbolic acid, and demonstrate very clearly the mistake of substituting weak solutions of this antiseptic (1-1000, as I have seen recommended) for concentrated car- bolic acid. One one-thousandth is only one-fifth as powerful as pure carbolic acid, which in many cases may be used with impunity. It is consequently useless to attempt to introduce the sublimate solution for the purpose of sterilizing root-canals, MERCURY. 305 cavities before filling, etc., unless we may use at least a y2 per cent., if not a I per cent, solution. I see no reason why this may not be done. In a few cases I have used a I per cent. solution for treating root-canals, and do not hesitate, partic- ularly with the rubber dam adjusted, to wipe out cavities be- fore filling with a 2 per cent, solution, and see no possible evil which could result from it." "As a mouth wash I have fre- quently used a t Iodol.......1 part. R. Iodol.......gr.x. Alcoholis.....16 parts. Zinci oxidi .... gr.xx. Glycerini.....34 parts. Vaseline carbol . q.s. to form a Signa.—Apply with a camel's-hair thick paste. M. brush or in the form of spray. Signa.—Place in canal and seal with Dental Varnish. an oxyphosphate filling. R. Saturated solution of iodol in al- For a Topical Application. coho1......x part. Evaporating quickly. Hubbard's negative varnish R. Iodol.......1 part. 6 Parts- M- JEthet sulph .... 8 parts. M. A good, quick drying varnish. IODUM—IODINE. Formula.—I. Derivation.—Iodine is a non-metallic, metalloid element, obtained principally from kelp (made by burning seaweed, and in the form of impure soda), which is subjected to distillation in iron retorts, after which it is mixed with sulphuric acid and IODINE. 317 black oxide of manganese. It is evolved in the form of vapor, which is condensed. The vapor is readily recognized by its beautiful violet color. Iodine is usually in the form of bluish-black crystalline scales, with a metallic lustre, a strong, peculiar odor and a hot, acrid taste. It is slightly soluble in water and soluble in alcohol, ether, solution of chloride of so- dium and a solution of iodide of potassium. Medical Properties and Action.—Iodine in small doses is alterative, stimulant and tonic, and acts locally as an irritant, causing redness, itching and desquamation; exhaled in the form of vapor, it excites cough and warmth in the air pas- sages. Taken internally it excites a sensation of heat or burning in the stomach, and in large doses is an irritant poison, inflaming the mucous membrane of the stomach and causing superficial eschars. The internal use of the iodides gives rise to an eruption of acne, especially on the face, thighs and shoulders ; they have also anaphrodisiac powers when long continued. The influence of the iodides in pro- ducing iodism may be prevented by large draughts of water being used during their administration. The odor of iodine can be detected in the blood, brain and muscles. When combined with potassium its local irritant effect is di- minished ; hence, the preparation known as Iodide of Potas- sium, Potassii Iodidum (obtained by treating an aqueous solution of potassa with iodine), is employed whenever the constitutional effects of iodine are desired, as the iodide of potassium pos- sesses many advantages over iodine for internal use, such as being less irritant, and for this reason may be administered in larger doses and for a greater length of time; it is also more soluble than iodine alone, and when taken into the stomach is absorbed much more rapidly. The formula is KI, and it is in the form of white crystals, of an acrid, saline taste. Some persons are peculiarly susceptible to the influence of iodine, even small doses causing unpleasant effects, such as headache, vertigo, derangement of the digestive organs, etc. Iodide of potassium, like iodine, produces a very decided 318 DENTAL MEDICINE. effect on the secretions, increasing them, and occasionally to the degree of ptyalism. The antidote for poisoning by iodine is starch. Therapeutic Uses.—Iodine and its preparations are valuable resolvents in the treatment of glandular enlargements, in- durations, tumors, thickening of membranes, etc., etc.; also in scrofula, scrofulous ophthalmia, tubercular meningitis, ad- vanced stage of pleurisy, chronic affections of the liver, etc., etc. Iodide of potassium is much employed in mercurial poison- ing and in syphilis, especially in the secondary and tertiary forms, and after the employment of mercury has proved use- less ; also in affections of the nervous system of a syphilitic origin, together with the other affections already referred to as indicating iodine. Externally iodine is used in the form of tincture in the treatment of enlarged scrofulous glands, cuta- neous affections, erysipelas, rheumatism, gout, phlegmons, syphilitic gummatae and nodes, phagedaenic ulcerations, car- buncles, diseases of the joints, wounds and parts poisoned; and as a counter-irritant in pneumonia, phthisis and pleurisy; and as injections in hydrocele and bronchocele. The vapor is inhaled with benefit in chronic bronchitis and phthisis. Io- dine also ranks highly as a disinfectant. Dose.—Of iodine alone, gr. % to gr. j two or three times a day, in the form of a pill, directly after eating, on account of its irritant effect; the best form for administration, however, is iodide of potassium. Dose of the iodide of potassium, gr. iij to gr. x. Tincture of Iodine—Tinctura Iodi (iodine, Sj; alcohol, Oj). Dose, mj to TTlv. Compound Tincture of Iodine—Tinctura Iodi Composita (iodine, Sss; iodide of potassium, Sj; alcohol, Oj). Dose, 1TLij to TTlx. Colorless Iodine.—Iodine is bleached by carbolic acid, and the colorless carbolate combines all the advantages of both base and acid. One of the easiest methods to decolorize iodine is to add forty minims of a saturated solution of hypo- IODINE. 319 sulphite of soda to each fluid ounce of the tincture of iodine. Forty minims of the saturated solution contain about thirty- two grains of sodic hyposulphite. Another method of decol- orizing iodine is to put into an open vessel a drachm of the tincture of iodine and six ounces of hot water; add twelve grains of phenol and stir with a glass rod, when the solution will be at once bleached. Dental Uses.—In dental practice iodine and its preparations are valuable agents, the officinal and compound tinctures being employed in the treatment of periodontitis, alveolar ab- scess, mercurial stomatitis and other forms of stomatitis, inflammation and ulceration of the gums, fungous growths of gum and tooth pulp, necrosed teeth and suppurating pulps of teeth, diseases of the antrum, caries of maxillary bones, den- tigerous cysts, recession of gums and absorption of alveolar processes. For the different forms of stomatitis, and especially mercu- rial stomatitis, the tincture of iodine is used in the form of a gargle; for an injection in alveolar abscess it is diluted or com- bined with carbolic acid, glycerine and other agents; for fun- gous growths it may be used alone, or combined with rectified alcohol; for ulcerations of gum and mucous membrane it is generally combined with carbolic acid; for periodontitis it is combined with the tincture of aconite root, and is regarded as being almost a specific for the incipient stages of this affec- tion, as it relieves the inflammation by retarding the circulation and stimulating lymphatic action. Either the officinal or com- pound tincture is employed with an equal quantity of the tincture of aconite, the preparation being applied to the gum over root of affected tooth, which should be previously dried of moisture, by means of a camel's-hair brush or cotton on the point of an excavator. The mouth should be kept open and the part protected until a metallic pellicle is formed. Iodine is also a valuable disinfectant and germicide in the treatment of alveolar abscess (in the form of the compound tincture), used as injections throughout the pus tract, and for root canals and the pus-pockets of alveolar pyorrhoea. 320 DENTAL MEDICINE. A valuable combination of iodine, carbolic acid, glycerin and water is known as " Boulton's Preparation," and is a useful application in the form of injections, gargles and lotions. For the chronic form of alveolar abscess, and also for the acute form, after more powerful agents have been employed, it is a useful remedy, possessing antiseptic and stimulant properties in a marked degree; it also possesses the property of modify- ing mucous membrane and diminishing sensibility; hence it is useful in ulcerations, &c. Tincture of iodine combined with creasote or carbolic acid is a powerful application in peri- odontitis, suppuration of necrosed teeth, ulceration of margins of the gums and for fungous growth, as it stimulates debili- tated parts and destroys such as are too weak to be restored. A colorless tincture of iodine is composed of glycerin and aqua ammonia in combination with the iodine, but the presence of the ammonia restricts its use. Another colorless tincture, in which sulphate of soda is substituted for the ammonia, is less irritating in its effects. The addition of water and honey to the officinal tincture of iodine will render it suitable for a gargle for inflamed and ulcerated parts. The iodide of potassium is employed inter- nally in mercurial stomatitis, dental exostosis, facial neuralgia, convulsions of dentition, periodontitis, looseness of the teeth, tumefaction and sponginess of the gums, syphilitic and scrof- ulous ulcerations of the mouth, caries and necrosis of the maxillary bones. DENTAL FORMULA. For Chronic Alveolar Abscess, Ulcera- For Fungous Growths and Suppurating tions, Inflammations, etc., etc. Surfaces. Boulton. R • Tinct. iodi......z. ij R. Tinct. iodi. comp . . . fTlxlv Spiriti rectificati. . . . \}. M. Acidi carbolici (cryst) . TTXVJ Signa.—To be applied with a camel's- Glycerinae.....5j j hair brush. Aquae destillatae . . . ^ v. M. It becomes colorless in from 8 to io For Mercurial Stomatitis. hours- R. Tinct. iodi. . . . ziij vel vj Signa.—To be used as an injection, Potassii iodidi . . gr.xv vel xxx gargle or lotion. Aquae......Oss. M. Signa.—To be used as a gargle. ORRIS ROOT. 321 For Ulceration of Gums. For Periodontitis. R. Tinct. iodi.....TTlxlv R . Tinct. iodi., Acidi carbolici .... TT\vj Tinct. aconiti . . aa . . ^ ss. M. Glycerini......5J Signa.—To be applied by means of a Aquae destillatae . . . ^ v. M. camel's-hair brush until a metallic Signa.—Apply as a lotion. pellicle is formed, three times daily. For Excessive Sweating of the Hands. For Periodontitis. R _ Xinct. iodi......zj R. Tinct. iodi......§j Lin. camphorae comp., Creasoti vel., Glycerinae . . aa . . . ziss Acidi carbolici . . zss. M. Lin. belladonna comp . gj Signa.—To be applied to gum about Eau de cologne . . . . zj. M. neck of tooth, as a counter-irritant. Signa.—Apply as an embrocation twice a day, having previously well bathed For Ulcerated Gums and Mucous the hands in warm water, in which Membrane. is dissolved two drachms or half an R. Tinct. iodi.....partem j ounce of chloride of ammonia and Mellis......partes ij four drachms of carbonate of soda Aquae......partesvij.M. crystals, enough water being used to Signa.—To be used as a gargle. well cover the hands. For Putrescent Pulps and Chronic For Periodontitis. ., , ., Alveolar Abscess. R- Tinct. iodi.....zx R Iod.......... .. Potassii iodidi . . . . gss Alcoholis.......f zij. M. Camphorae......gij Spiriti rectificati . . . f^x. M. For Same andPyorrhasa Alveolaris. Signa.—Apply with a camel's-hair R. Iodi, brush to gum over root of affected Acidi carbolici (crystals)aazj tooth. Alcoholis.......fzJj.M. IRIDIS RHIZOME—ORRIS RHIZOME—ORRIS ROOT. Source.—The plant from which Orris Root is obtained is a native of Italy and the south of Europe. It belongs to the natural order Iridaceae, of which there are three varieties of the species of Iris—Iris Rhizoma, Iris Florentina and Iris Ger- vianica. The root, which is the officinal portion of the plant, is of various forms and sizes, often branched, usually knotty and flattened, white, heavy, and of the thickness of the finger. It has a pleasant odor, like that of violet, and a bitter, acrid taste. Medical Properties and Action.—Orris root is cathartic and diuretic, and in large doses emetic. It has been employed with some benefit in dropsies, but is not often administered as 21 322 DENTAL MEDICINE. a general remedy at the present time. It is valued for its pleasant, violet odor. Dental Uses.—In dental practice it is employed as a very common ingredient of dentifrices, and also to correct an offensive breath. DENTAL FORMULA. Dentifrice. Dr. Sewell. R. Pulv. radicis iridis..............5 ss Pulv. saponis cas...............3 ij Pulv. sodii boratis..............z ij Cretae preparatae...............§ij. M. Flavor with a few drops of oil of cloves and lavender. Or, add a few drops of carbolic acid to each ounce of the powder, and flavor the whole with eucalyptus oil. ISONANDRA GUTTA—GUTTA PERCHA. Source.—Gutta Percha is the inspissated juice of the tree Isonandra Gutta, extensive forests of which are found in the East Indies. It belongs to the natural order Sapotacea. It is in the form of tough, flexible pieces, which have been freed from impurities by cutting it into thin slices, and then washing and tearing it into shreds by heavy machinery while it is soft- ened in boiling water. It maybe more thoroughly purified by dissolving it in either chloroform, benzol or hot turpentine, thus causing the impurities to separate, when it is evaporated to dryness. Crude gutta percha is of a chocolate or reddish- brown color; commercial gutta percha is of a grayish-white color, and the variety which has been purified by dissolving it in chloroform, etc., is almost white, greasy to the touch, and of a leathery smell, like that of India rubber. It is insoluble in water at any temperature, and is a bad conductor of heat and electricity. At ordinary temperatures it is tough, hard and inelastic, but toward 1200 F. it softens, and at 1500 it becomes soft and plastic, and may be moulded into any form, which it will retain on cooling, having, however, a perceptible shrinkage. Gutta percha is dissolved cold by chloroform and sulphide of carbon; benzol requires the aid of heat and oil of turpentine requires to be quite hot. The alkalies have no action upon it; GUTTA PERCHA. 323 but concentrated nitric acid attacks it rapidly, with efferves- cence and the escape of nitrous fumes. Dental Uses.—Combined with mineral substances it forms a plastic material for temporary fillings of teeth, and, colored with vermilion, is used for taking impressions of the mouth and for the base plates of plastic work. It is often employed as a filling material, on account of its non-conducting property, protecting a partially exposed pulp or sensitive dentinal sur- face from irritation when metallic fillings would not be tolerated. The preparation known as "Hill's Stopping" is composed of gutta percha, quicklime and feldspar, the mineral ingredi- ents being incorporated with the gutta percha while the latter is in a plastic condition from the effects of heat. Gutta percha has been used for interdental splints. Solution of Gutta Percha—Liquor Gutta Percha, is com- posed of gutta percha, ^iss; chloroform, ^xvij ; or a thick solution may be made by dissolving as much gutta percha in chloroform as will give the desired consistence (like that of * thick cream). Solution of gutta percha is a useful application for the relief of odontalgia arising from an exposed and inflamed pulp; also for capping an exposed pulp, a more durable material being inserted over it. The chloroform of the solution quickly evaporates, leaving an impermeable covering of the gutta percha, which is non-irritable, non-conducting and protective. It is also a useful application for inflamed or abraded surfaces, chaps, skin affections, etc. Gutta percha dissolved in chloro- form is a popular and efficient material for root fillings, as are also cones of gutta percha softened in chloroform. KRAMERIA. RHATANY. Source.—Krameria is obtained from the root of the shrub krameria triandra, of the natural order Poly galea, native of Peru. It is in the form of cylindrical pieces, of the thickness of a quill, with many branches of a light red color within and 324 DENTAL MEDICINE. crossed by a reddish-brown bark. The root is without odor, and of an astringent, and somewhat bitter-sweetish taste. Medical Properties and Action.—Krameria is a powerful astringent, its medicinal property being due to tannic acid, of which it contains about forty per cent. There is also present an odorous principle, wax gum, and a peculiar acid known as krameric acid. When chewed it imparts a red tinge to the saliva. It imparts its properties very readily to alcohol, but less so to both cold and boiling water. Therapeutic Uses.—Krameria is employed internally for its astringent and a slightly tonic effect in the treatment of diar- rhoea, dysentery, passive hemorrhages, menorrhagia, leucor- rhoea, etc. Externally, in the form of powder, tincture and infusion, in the treatment of ozaena, ophthalmia, etc., and as an enema in hemorrhoids, fissures of the anus, sore nipples, leucorrhcea, etc., etc. Dose.—Of powdered krameria, gr. xx to gr. xxx; of the extract—extractum krameria, the dose is gr. v to gr. x; of the infusion—infusum krameria—(krameriae Sj; water, Oj), the dose is §ss to Sj'» of the tincture—tinctura krameria— (krameriae, 5vj ; diluted alcohol, Oij), the dose is 5j to 3ij. Of the fluid extract—extractum krameria fluidum, the dose is TTlvto 5ss; of the syrup—syrupus krameria, the dose is 5j to 5iv. Dental Uses.—Krameria is a valuable astringent in dental practice, being employed in the form of the tincture, in ulcer- ated and spongy gums ; in the form of the infusion, as a gargle in inflammation of the gums and mucous membrane; in the form of the powder and also tincture, in spongy and bleeding gums, as an astringent; and also in the form of the powder as an ingredient of dentifrices, for its astringent property. DENTAL FORMULA For Inflamed Gums and Mucous Membrane. Thomas. R. Pulv. krameriae, Pulv. cinnamomi.......aa....... zj Aquae bullientis................f 3 vii Macerate for two hours, strain, and add sacchari ^ ij Signa.—To be used as a gargle. SOLUTION OF CHLORINATED SODA. 325 LIQUOR SOD.E CHLORATE —SOLUTION OF CHLORINATED SODA. LABARRAQUE'S SOLUTION. Formula.—NaCl, NaClO. Derivation.—Solution of Chlorinated Soda is obtained by decomposing a solution of carbonate of sodium by one of chlorinated lime. It is a transparent liquid, of a greenish- yellow color, having a faint odor of chlorine and a sharp saline taste. Medical Properties and Action.—Solution of chlorinated soda internally is stimulant, tonic and antiseptic. Externally, it is a stimulant, astringent and deodorizer, and is generally ap- plied in the form of a lotion. Therapeutic Uses.—Solution of chlorinated soda is employed internally in typhus and typhoid and malignant scarlet fevers, mesenteric affections of children, etc. Externally it is used as an application to all forms of foul and indolent ulcers, ulcerations of membranes, ozaena, coryza, otorrhoea, syphilitic eruptions of scalp and other skin diseases, burns, etc., etc. It is used diluted, and has an alkaline reaction. It is a powerful disinfectant, and is useful in all affections attendant with fetor. The concentrated solution is an irritant poison and caustic; largely diluted it is tonic and stimulant. Dose.—A solution of chlorinated soda, gtt. xxx to 5j, di- luted, several times a day; it fulfills the same indications as chlorinated lime. Dental Uses.—Solution of chlorinated soda is a valuable agent in dental practice as a disinfectant, deodorizer and anti- septic. It is employed in mercurial stomatitis, ulcerated gums fetid discharges from carious teeth, and all affections of the mouth attended with fetid discharge, and is useful for its stim- ulating property, thus inducing healthy action ; also in aphthae cancrum oris, diseases of the antrum, necrosis of the bones of the jaws, scurvy, offensive breath, and as a bleaching agent for discolored teeth, especially in combination with powdered alum. • It should be kept in glass-stoppered bottles and pro- tected from the light and heat. 326 DENTAL MEDICINE. DENTAL FORMULA. For Aphtha- and Ulceration of the For Mercurial Stomatitis, Fetid Dis- Mouths of Children. charges from Carious Teeth, Ulcerated R. Liquor sodae chlor., Gums, etc. Myrrhae . . . aa . . fgss R- Liquor sodae chlor . . fzyj Aquae rosae.....fjj Aquae.......f^xij. M. Aquae.......f3vj. M. Signa.—To be used as a lotion. Signa.—To be used as a lotion. For Offensive Breath and Deodorizer For Mercurial Stomatitis. Generally. R. Liquor sodae chlor . . gss R Liquor sodae chlor. Mellis.......3ss (concent.) .... gtt.vj to x Aquae destillatae . . . gx M. Aquse purae . . . . gij. M. Signa.—To be used as a mouth wash. Signa.—To be used as a gargle. For Phagedenic and Sloughing Ulcers. For Offensive Breath. R. Liquor sodae chlor . . fgj R. Liquor sodae chlor . . zj Aquae.......f^v"j. M. Aquae.......£iv. M. Signa.—To be applied as a lotion. Signa.—To be used as a gargle. KINO—KINO. Source.—The inspissated juice of the Pterocarfus Marsupium, and of other plants. Medical Properties and Therapeutic Uses.—With Krameria, Galla, and Catechu, Kino is one of the substances containing forms of tannic acid, and has the same physiological action and uses, being powerfully astringent. The tincture, " Tinc- tura Kino" compound of ten parts of kino to one hundred parts of alcohol, is the only preparation employed. Dose.—Of Tinctura Kino, TTlx to gij. (See Tannic and Gallic Acids, Krameria.) LITHIUM—LITHIUM. Source.—From the alkali Lithium, which is rare in nature. Preparations.—Lithii Carbonas—carbonate of lithium, a white powder but slightly soluble in water, and having a feeble alka- line reaction. Dose.—Grs. ij to grs. x. Lithii Citras—Citrate of Lithium, a deliquescent white pow- der, soluble in twenty-five parts of water. Dose.—Grs. v to grs. xxx. Lithii Salieylas.—Salicylate of Lithium, a deliquescent white LACMUS. 327 powder with a sweetish taste, feeble acid reaction and very soluble in alcohol and water. Dose.—Gr. v to 3j. Lithii Benzoas.—Benzoate of Lithium, either in the form of a white powder or small, shining scales, not deliquescent in the air, and having a sweetish, cooling taste and a feeble acid reaction. It is soluble in twelve parts of alcohol at 6o° F., and in four parts of water. Dose.—Gr. ij to gr. xv. Medical Properties and Therapeutic Uses.—These lithium salts have strong alkaline properties, and produce effects sim- ilar to those of the potassium and sodium compounds; and hence are very effective antacid agents. The salts of lithium are employed with great benefit in rheumatic gout, uric acid diathesis, rheumatism, uric acid calculi of kidneys and blad- der, irritable bladder from an excess of acid in the urine, etc. Dental Uses.—The lithium salts are effective in preventing and correcting the effects of a gouty diathesis upon the teeth, and in periodontitis dependent upon gout. The carbonate of lithium is employed to arrest the abrasion or erosion of the teeth, when due to an excess of uric acid in the saliva; for such a purpose the agent can be dissolved in carbonic acid water. LITMUS—LACMUS. Source.—Litmus is a peculiar coloring matter obtained from various species of rocella, of the natural order Lichenes—the Lichen order, which grow on Alpine or maritime rocks in various parts of the world. The varieties used for chemical purposes are obtained from the European and African coasts and Northern Europe. They yield coloring substances by the reaction of water, air, and ammonia. Litmus is prepared chiefly in Holland; the lichens being coarsely powdered and macerated for several weeks, with occasional agitation in a mixture of urine, lime and potassa or soda, fermentation en- suing ; the mass becomes first red and ultimately blue, and is then mixed with calcareous or siliceous matter, to give it con- 328 DENTAL MEDICINE. sistence. A tincture is formed from this product (litmus I part to distilled water 20 parts), and blue litmus paper is made by steeping unsized paper in the liquid and afterwards drying it. The blue tincture is rendered deeper in color by indigo. Red litmus paper is prepared in the same manner, except that the tincture, into which the unsized paper is steeped, is reddened by the addition of sulphuric acid. Use.—The chief use of litmus in medicine and dentistry is as a test of acids and alkalies; blue litmus paper being turned red by acids, while red litmus paper is turned blue by alkalies. In dental practice litmus paper is employed to determine the nature of the oral fluids—whether acid or alkaline. A single color, viz., purple, has recently been substituted for the ordinary blue and red litmus paper. This purple litmus paper turns red with acids, blue with alkalies. It is claimed to be much more delicate and convenient. MAGNESIA—CALCINED MAGNESIA. Foi'mula.—MgO. Derivation.—Magnesia is obtained by exposing carbonate of magnesium to a red heat, and thus expelling all of the car- bonic acid, which is shown by a want of effervescence on the addition of dilute sulphuric acid. It is very light, and of white color and odorless, and in the form of powder, with an earthy taste, and slightly soluble in water, more so in cold than in hot water. Medical Properties and Action.—Magnesia is antacid and laxative, its laxative effect being the result of the combination it forms with the free acids of the stomach and intestines. After its effects are exerted in the intestinal canal, it becomes absorbed and renders the urine alkaline. Large doses, when administered for a considerable time, may accumulate in the bowels; such an effect may be avoided by administering it with lemonade, which renders it more soluble. Being mild and unirritating, it is well adapted for children, and is an ex- cellent remedy for great acidity in the stomach. It is the antidote in poisoning by the mineral acids. SULPHATE OF MAGNESIUM. 329 Therapeutic Uses.—Magnesia is administered in acidity of the stomach, heartburn, sick headache and kidney affections, as an antacid, and in combination with other agents in the diarrhoea of children. It is also an efficient aperient, alone or in a little milk. Dose.—Of magnesia, as a laxative, gr. x to 5j ; as an ant- acid, 3j. Of a preparation known as " Henry's," the dose is half the quantity just given. Dental Uses.—Magnesia is employed in dental practice, chiefly for its antacid properties, as an ingredient of dentifrices; in solution in the form of a gargle, to counteract the effect of acid medicines upon the teeth ; also as an ingredient of remedies for infantile diarrhoea during the period of dentition ; and also to change an acid condition of the oral fluids, by being rub- bed between the teeth and permitted to remain for a short time. DENTAL FORMULAE. For Infantile Bilious Diarrhaa. For Infantile Mucous Diarrhoea. CoNDIE. Eherle. R. Magnesiae calc . . . gr.xxiv R. Magnesiae calc . . gr.x Calomel.....gr.ij—iij Bals. copaibae . . . zj Ipecacuanha . . . gr.ij—iij Spir. aether nit . . . ziij Ext. hyoscyami . . gr.iv-vj. M. Sacch. alb.....3 ij F. ch. No. xij. Aq. cinnamon . . . % iij. M. Signa.—One to be given every two or Signa.—A teaspoonful every two or three hours. three hours; each dose to be followed in the course of an hour by the fifth of a grain of Dover's Powder. MAGNESII SULPHAS—SULPHATE OF MAGNESIUM. (EPSOM salt). Formula.—MgSOjHJD. Derivation.—Epsom Salt is obtained by the action of sul- phuric acid on magnesite, the siliceous hydrate of magnesium. It is in the form of small, colorless crystals, which effloresce on exposure to the air, and are very soluble in water. It is odorless, but has a very bitter taste. Medical Properties and Action.—Sulphate of magnesia is a refrigerant purgative, safe and mild in its action, and is per- 330 DENTAL MEDICINE. haps more commonly employed as a cathartic than any other. It is at times combined with other agents. Therapeutic Uses.—Sulphate of magnesia is administered as a saline purgative in acute inflammatory and febrile affections, to depress the arterial tension, and also to relieve the kidneys where they are hyperaemic; hence it is a valuable remedy in renal and cardiac dropsy, constipation of lead colic, acute dysentery, dyspepsia with constipation, etc., etc. Dose.—Of sulphate of magnesia, 5j to ^j, in water or car- bonic acid water. Dental Uses.—Sulphate of magnesia is employed internally in dental practice, to reduce the arterial tension in acute in- flammations of the dental organs, such as acute pulpitis, acute periodontitis, etc. To diguise the bitter taste of Epsom salts, the following formula may be employed :— R. Magnesii sulphatis..............Z v Essentiae menthae..............gtt.iij. M. DENTAL FORMULA. For Dysuria of Difficult Dentition. R. Sulph. magnes............3 ij to 5 iij Aquae purae............-\) dein adde Spir. aether, nitrici...........zij Tinct. opii..............-fllvij to xv. M. Signa.—A teaspoonful, to be repeated according to circumstances. MATICO. Source.—Matico—matica folia, are the dried leaves of the shrub artanthe elongata, of the natural order Piperacea—pep- per order, and is a native of Peru. They are from two to eight inches long by an inch in breadth, strongly reticulated, and of a bright green on the upper surface and lighter in color beneath when fresh, with an agreeable aromatic odor and a strong astringent taste. They contain a trace of tannic acid, a peculiar acid, artanthic, a volatile oil, resin, and a very bitter principle—maticin. Medical Properties and Action.—Matico is an aromatic tonic, an alterative stimulant, an internal haemostatic and local styp- JAPANESE CAMPHOR. 331 tic. It has a special determination to the mucous membranes, and although as an internal remedy its astringent properties are not so well marked, it acts externally as a reliable haemostatic and styptic. The powder made from the under side of the leaf is more powerfully styptic than that from the upper side. Therapeutic Uses.—Matico in the form of powder, infusion and fluid extract, is employed in internal hemorrhages, epis- taxis, atonic diarrhoea and diseases of the urinary passages, etc. ; externally as a haemostatic in superficial hemorrhages, and also in leucorrhoea, in the form of an injection. Dose.—Of powdered matico, 5ss to 5j, three times a day ; of the infusion the dose is fSij; of the fluid extract the dose is f5ss to f5j. Dental Uses.—The powder and tincture are valuable styp- tics in hemorrhage following the extraction of teeth, hemor- rhage from leech bites and superficial wounds of mucous membrane. MENTHOL—JAPANESE CAMPHOR. (PEPPERMINT CAMPHOR). Formula.—QoH^O. Derivation.—Menthol is the stearoptene of peppermin toil, and is obtained from this oil either by long keeping or by being cooled at a low temperature. Chemically, menthol occupies the position of an alcohol, having in its composition four atoms more of hydrogen than the ordinary camphor, and containing the radical menthyl. It is in the form of a crystal- line solid, composed of small white crystals of a peppermint odor and resembling sulphate of magnesia. It is imported as Japanese camphor, its chief source being the Japanese and Chinese peppermint oils. In a liquid state it has a specific gravity less than that of water. It is rendered liquid and volatile at a temperature one or two degrees below that of the body. It is sparingly soluble in cold water, liquefying slowrly in water at 82° F., quickly at 1200 F., but remains mostly as a separate body. It is freely soluble in alcohol, ether, glycerine, and in the fixed and volatile oils. 332 DENTAL MEDICINE. Medical Properties and Action.—Menthol is anodyne, anti- spasmodic, and antiseptic. In doses of gr. tV to \ it steadies the contractions of an excited heart, and causes tranquillity, and at the same time slight cerebral drowsiness. Jk Half a grain may cause vomiting from gastric irritaff, hence care should be observed in its administration, either internally or externally, about the mouth. Its internal use is not advocated, unless well diluted, but its principal use is as an external application. Therapeutic Uses.—Menthol is said to prove as effectual as aconite, veratria and atropine for such diseases as neuralgia, brachalgia and gout; more so, it is claimed by some. It is also used in chronic rheumatism and in headache. It is also applied to putrefactive wounds, as an antiseptic. Dental Uses.—In dental practice, menthol has given satis- faction as an external remedy in facial neuralgia, odontalgia, as an obtunder of sensitive dentine, and as a local anaesthetic. For relieving the pain of sensitive dentine, a small portion of the crystals is applied to the sensitive surface, and in a few minutes the local anaesthetic effect is produced. As an anti- septic it has been employed in the treatment of decomposing pulps of teeth, necrosed teeth, etc. When applied to mucous surfaces for its anaesthetic effect, a twenty to thirty per cent. solution is used, but it is more evanescent than cocaine. Menthol also forms an ingredient of a devitalizing mixture. The oil of the ordinary peppermint is considered to be a germicide and antiseptic of considerable power and rapidity. It is readily diffusible, does not evaporate quickly, and is non- poisonous. It is useful in root canals and fistulous tracts after removal of pulps, and for hypersensitive dentine. DENTAL FORMULA. For Facial Neuralgia and Odontalgia. For Neuralgia and Odontalgia. R. Menthol.......gr.j R, Menthol........gr.v Spts. vini rectificati . . Tflj Olei caryophylli (or oil of caje- Olei caryophylli .... Ifffx. M. put)........fgj. M. SiGNA.—For facial neuralgia, painted SiGNA.—To be painted on affected part, on the affected part. For odontalgia, or, for odontalgia, applied on cotton. applied on cotton to carious cavity. MORPHINE. 333 METHYLIC ETHER—METHYL-ETHYLIC ETHER. Formula.—(C H 2)20. Derivation.—Methylic Ether is obtained by digesting methy- lic alcohol with strong sulphuric acid. It is a gaseous sub- stance, of an ethereal odor, and under the name of methyl- ethylic ether, it has been used as a general anaesthetic. The methylic ether is prepared for use as methyl-ethylic ether by frequent washings in a strong solution of potassa, and is after- wards dissolved in absolute ethylic ether. In order that it may be fit for use it is necessary to keep it for some time securely stopped. Dental Uses.—According to Dr. B. W. Richardson, of Eng- land, it is a superior anaesthetic for dental operations—better, he says, than nitrous oxide gas, because it allows air to be given with it, and does not asphyxiate nor produce muscular spasms and syncope. Under its influence the patient is in a state of semi-consciousness, but is not conscious of pain from an operation. MORPHINA—MORPHINE. Formula.—Ci7H19N03, H20. Derivation.—Morphine is the alkaloid which constitutes the chief narcotic principle of opium, the proportion varying from 10 to 15 per cent. It is present in opium in combination with meconic acid, and the meconate of morphia is separated by repeated macerations with water, after which the salt is de- composed by alcohol and water of ammonia, the latter precipi- tating the morphine and the former taking up the coloring matter as soon as it is freed from the alkali. The crystals of morphine are then boiled in alcohol and the solution filtered through animal charcoal. Morphine is in the form of white, or colorless crystals, which are inflammable and freely soluble in boiling alcohol, scarcely soluble in cold water, and some- what so in boiling water. The salts of morphine, however, are freely soluble in water. It is without odor, and has a very bitter taste. Morphine differs somewhat in its mode of action from opium, which may arise from the peculiar state of com- bination in which it exists in opium. Morphine is more 334 DENTAL MEDICINE. insoluble than its salts, and for this reason the latter are pre- ferred for administration. Medical Properties and Action.—Morphine is more powerful than opium ; but it causes less vascular and arterial excite- ment, less headache and vertigo, less subsequent depression, less constipation, and often it will be retained on an irritable stomach, when opium or its tincture (laudanum) would be rejected. Morphine is indicated when the object is to relieve nervous irritability and induce tranquillity. The effects of morphine differ according to the peculiarities of nervous constitution. The hypnotic effect may be produced and the stimulant action be confined to the heart; in some cases the excitant effect pre- vails, or the two effects may be equal. The excitant effect may counteract the hypnotic effect to a greater or less degree, resulting in insomnia, with restlessness, or even delirium. Females appear to be more liable to its excitant effects than males; and if there is present a highly emotional, excitable and energetic temperament, it causes great distress, and dangerous effects when hypodermically administered. Therapeutic Uses.—Morphine, in the form of salts, is em- ployed as an anodyne and hypnotic in neuralgic affections, diseases of the heart, painful uterine affections, and in all cases of painful affections. (See Opium.) The principal salts of morphine are the acetate, the hydro- chlorate and the sulphate. MORPHINE ACETAS—ACETATE OF MORPHINE. Formula.—C17H19N03, HC2H302. Derivation.—Acetate of Morphine is obtained by precipi- tating morphine from the hydrochlorate of morphine, by the aid of ammonia, the precipitate resulting being washed in dis- tilled water and dissolved and neutralized by acetic acid, after which it is evaporated and dried by heat. It is in the form of a white or yellowish-v/hite, amorphous or crystalline powder, altogether soluble in water and alcohol, and of a bitter taste. MORPHINE. 335 MORPHINAE HYDROCHLORAS OR MURIAS--HYDROCHLORATE OR MURIATE OF MORPHINE. Formula.—C17H19N02, HC1 3H20. Derivation.—Hydrochlorate or Muriate of Morphine is ob- tained by macerating opium in distilled water, evaporating to a small quantity, and adding chloride of lime, and concen- trating the solution until it becomes solid when cool, after which it is pressed, washed with distilled water, again evapor- ated, cooled and pressed, and again dissolved in distilled water, when it is subjected to animal charcoal, to remove the coloring matter, filtered, and precipitated by ammonia, the codeia of the opium remaining in solution. The crystals resulting are then dissolved in muriatic acid, and the morphine allowed to crys- tallize into hydrochlorate or muriate of morphine. It is in the form of snow-white, feathery, flexible and acicular crystals, of a bitter taste and silky lustre, and altogether soluble in water and alcohol. MORPHINE SULPHAS--SULPHATE OF MORPHINE. Formula.—C17H19N03, 2H0SO4, 5H20. Derivation.—Sulphate of Morphine is obtained by dissolving morphine in boiling alcohol, and saturating it while hot with sulphuric acid, the coloring matter being removed by animal charcoal; it is then boiled and filtered while at the boiling temperature. Upon cooling the sulphate is deposited in the form of white, feathery, acicular crystals, of a silky lustre, odor- less, with a bitter taste and a neutral reaction. It is soluble in water and alcohol. Medical Properties and Action of the Salts of Morphine.—The salts of morphine possess anodyne, hypnotic and antispas- modic properties, and are less stimulating, less convulsant, and more hypnotic and anodyne than opium, and they also produce less constipation, and less diaphoretic action than opium. After the administration or insertion of the ordinary dosej which is one-sixth to one-fourth of a grain, there is experi- enced a sense of heat and flushing of the face, which may be preceded by some pallor, a fullness of the head, giddiness, 336 DENTAL MEDICINE. noise in the ears, and frequently nausea, sometimes epigastric pain. The vertigo may cause a staggering walk and inability to maintain an upright position. Injection of the conjunctiva and contraction of the pupils occur at the same time that the cerebral effects are felt. The lips have a bluish appearance, the mouth and tongue dry, deglutition is painful and the voice becomes husky. During these symptoms the anodyne effects are manifested by the relief of pain and spasm, with perfect calmness of mind and tranquillity. While the effect is generally hypnotic, yet in some cases there is extreme wakefulness, with great mental activity, and when sleep occurs, instead of its being calm, the respirations are slow, noisy and labored, the patient being disturbed by dreams and visions. While the action of the heart is diminished in frequency, there is a considerable rise in the arterial tension. When a hypodermic injection of morphine has been made, there is experienced an itching of the nose, which may extend to the entire cutaneous surface. The skin, which is at first dry, becomes moist, from diaphoresis, which is sometimes profuse. The secretions of the mucous surface are also arrested as a primary effect. If morphine is administered after a full meal, its effect is to suspend digestion for some time, and also to temporarily arrest the intestinal movements and diminish the urinal discharge, and make its emission difficult on account of the temporary loss of contractile power of the bladder and of the ejaculatory muscles. When the narcotic effects of morphine decline, there is generally experienced headache, confusion of mind, anorexia and nausea. When a poisonous dose is administered, a pro- found state of narcotism quickly ensues, the pulse becomes slow and feeble, the respiration slow and indistinct, the skin cold and covered with perspiration, the face pale, blue and ghastly, the conjunctiva deeply injected, the pupils greatly con- tracted, the reflex movements entirely destroyed. Half a grain of morphia is the smallest dose which has proved fatal to an adult, but other cases are recorded where one grain destroyed life. It chiefly affects the cerebro-spinal functions, and causes death by paralyzing the respiratory muscles. MORPHINE. 337 The antidotes in cases of poisoning are the stomach pump, emetics, cold effusions, counter-irritation, strong coffee, active stimulants, atropine by hypodermic injection, electro-magnet- ism, and artificial respiration. Therapeutic Uses.—The salts of morphine are employed in all neuralgic affections, for the relief of pain from whatever cause, and to induce sleep; also in diseases of the heart, chronic gastritis, delirium tremens, tetanus, colic, spasms, dysentery, cholera, cough of pulmonary affections, cerebro-spinal menin- gitis, puerperal fever, convulsive diseases, vomiting, colica pictonum, diarrhoea, diabetes, gangrene, etc., etc. For hypo- dermic injection, the acetate of morphine is supposed to possess some advantages over the other salts, such as the sulphate and muriate, one of which is its greater solubility. Morphine is contra-indicated where there is a tendency to apoplexy or coma. Dose.—Of the salts of morphine, gr. y^ to gr. y£. One sixth of a grain of either of the salts of morphine is equiva- lent to a grain of opium, or twenty-five drops of the tincture of opium (laudanum). For hypodermic injections the dose of salts of morphine is gr. yi to y&. The use of morphine hypodermically fre- quently leads to the morphine habit, which, once formed, is rarely abandoned ; and which, independent of its fatal systemic effects, has very injurious effects upon the teeth—the enamel and dentine becoming thoroughly disintegrated, owing to the presence of erosive acids. For endermic application, gr. y£ to j of morphine may be sprinkled on a surface (which has been blistered to remove the cuticle) over the seat of pain ; but the hypodermic method is the most effectual. Dental Uses.—For dental use the acetate of morphine and the muriate of morphine are preferable to the sulphate, on account of their greater solubility and greater chemical affinity with the tissues on which they are to act. The acetate of morphine is also preferred to the other salts as an ingredient of nerve paste for destroying the vitality of the pulps of teeth, 22 338 DENTAL MEDICINE. on account of its chemical and mechanical compatibility with the pulp tissue, giving relief as an anodyne when the sulphate would irritate. Concerning the action of morphine when com- bined with arsenious acid, its effect is anodyne, modifying the irritant action of the arsenic, and preventing to a considerable degree the intense pain which follows its application to vitalized structures. Besides its use in devitalizing mixtures and as an obtunder of sensitive dentine, morphine is employed for the temporary relief of odontalgia, for such a purpose being com- bined with carbolic acid, sweet spirits of nitre, oil of cloves and other anodyne agents. A paste made of acetate of morphine and creasote (or car- bolic acid) is much used for obtunding the sensitiveness of dentine. A thin paste, made of acetate of morphine rubbed up with oil .of cloves is an excellent application for exposed pulps; also a mixture of acetate of morphine, grs. v; oil of cajeput, £5j; applied on a pledget of cotton. The latter is also effective for the pain following tooth extraction; it is ap- plied on cotton in the alveolar cavity. For internal administration in facial and other neuralgias, morphine is combined with atropine in the proportion of atro- pine, gr. xh to tU; morphine, gr. \ to J; hypodermically in- jected. Morphine in combination with carbolic acid is also employed to relieve the pain of an exposed and painful pulp. DENTAL FORMULAE. For Odontalgia. For Itching of Inflamed Surfaces. White. R, Morphinae sulph . .gr.vj R. Morphinae acetatis . .gr.xx Sodii boratis . . . . ^ss Olei caryophylli, Aquae rosae . . . . f ■§ viij. M. Spiritus aetheris nitro- Signa.—To be used as a lotion. si ... aa ... zij. M. Signa.—Apply on a pellet of cotton. For Devitalizing Pulps of Teeth. For Odontalgia. R. Morphinae acetatis . . gr.j R. Morphinae acetatis . .gr.xx Acidi arseniosi . . .gr.ij Creasoti (vel acidi car- Creasoti......q.s. M. bolici).....3 ij- M. Fiat massa. Signa.—Apply to carious cavity on a Signa.—Apply a sufficient quantity to pellet of cotton. exposed surface of pulp, on cotton. MYRRH. 339 To Relieve the Pain following the Extraction of Teeth, and a Local Anasthetic. R. Morphinae.................gr.vj Tincturae aconiti, Chloroformi, Alcoholis........aa.......fgj. M. Signa.—Apply on cotton, or with an applicator, as a local anaes- thetic. (See Formulae under Arsenious Acid.) MYRRHA—MYRRH. Source.—Myrrh is a gum-resinous exudation from a small, shrubby tree—Balsamodendron Myrrha, of the natural order Amyridacea, growing in Arabia and the northeastern coast of Africa. It is obtained in the form of small, irregular frag- ments or tears, or in larger masses, composed of agglutinated portions. The juice exudes spontaneously from the stem of the tree, and concretes upon the bark. When pure, myrrh is of a reddish-yellow or reddish-brown color, translucent, with a strong, peculiar fragrant odor and a bitter aromatic taste, brittle and pulverizable. Its powder is of a light yellow color; when of a dark color it is impure. When powdered myrrh is rubbed up for fifteen minutes with an equal weight of muriate of ammonia and fifteen times its weight of water gradu- ally added, and it dissolves quickly and entirely, it may be considered pure. Medical Properties and Action.—Myrrh is stimulant, astrin- gent, expectorant and emmenagogue. It stimulates the digest- ive organs and improves the appetite. In large doses of a half ounce, it causes a burning sensation in the stomach, increased arterial excitement, and profuse diaphoresis, with a great influ- ence on the urinary passages. It diminishes discharges from mucous membrane when internally administered, and is a useful external application for relaxed tissues. Therapeutic Uses.—Myrrh is internally administered in chronic catarrh, humoral asthma, amenorrhoea, chlorosis, leucorrhcea, chronic bronchitis, etc., etc.; and in combination with cha- lybeates and aloes in uterine affections. Locally, myrrh is applied to inflamed, ulcerated and aphthous surfaces. 340 DENTAL MEDICINE. Dose.—Of powdered myrrh, gr. x to 5ss, in pill or suspended in water. Tincture of Myrrh—Tinctura Myrrha (myrrh, Siij; alco- hol, Oij). Dose.—f5ss to f3j. Is used internally and exter- nally. Dental Uses.—Myrrh, in the form of the powder and tincture, is employed as a local application to inflamed, ulcerated and spongy gums, ulcerations of mucous membrane of the mouth and throat, in the form of a gargle; also in mercurial stomatitis, indolent ulcers, aphthous sore mouth of children. The diluted tincture forms a stimulating gargle or mouth-wash, and the powder is employed as an ingredient of dentifrices, for its stimulating and astringent properties. NAPHTHALENE—NAPTHALENE. Formula.—Ci0H8. Derivation.—Naphthalene may be obtained by subjecting coal-tar to distillation, 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 expec- torant 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 nature. Naphthalin is a powerful antiseptic, and can be used as a substitute for iodoform, with the advantage of not pro- ducing any constitutional action. Its application causes a slight pain of short duration. As an antiseptic and disinfec- tant 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 car- bolic acid, and as an odorless preparation, it will no doubt become a desirable substitute, as it has no corrosive action and will not injure textile fabrics. NAPHTHOL. 341 NAPHTHOL—NAPHTHOL. Formula.—C10H7HO. Derivation.—Naphthol is an alcohol derived from Naphtha- lene (C10H8), which is obtained from coal-tar in the form of white shining crystals of a strong, disagreeable odor, soluble in alcohol, but insoluble in water and employed locally in indolent ulcers and as a disinfectant in pus-pockets and wounds and skin diseases. (See Naphthalene.) Medical Properties and Therapeutic Uses.—There are two forms of Naphthol, known as a and b Naphthol, the latter being employed medicinally on account of its less irritating and injurious action. It is in the form of light-brown crys- tals, soluble in hot water, and possesses antiseptic properties. and employed internally and locally in the form of ointment with vaselin dissolved in alcohol, ether or olive oil, in the proportion of two per cent. It is employed in parasitic dis- eases of the skin, and as a general antiseptic. Hydronaphthol.—The chemistry of this agent, which is sup- posed to be a form of B naphthol, is not well known. It is in the form of light fawn-colored crystalline flakes, having a feeble odor and taste. As a germicide it apparently possesses the power of preventing the development of germs and their spores. It resembles capsicum in possessing slight stimu- lating and counter-irritant properties, but is not so powerful. Dental Uses.—Hydronaphthol is employed for treating the canals of pulpless teeth, pericemental inflammation of septic origin, especially in the early stages before pus has formed. Dr. Jas. Truman recommends a solution of I : 1000 of water for injection into pulp-canals; and Dr. E. C. Kirk recom- mends a paste of hydronaphthol and glycerine, pumped into a thoroughly cleansed pulp-canal in pericemental inflamma- tion from septic causes, to remove the soreness and inflam- mation in a few hours : it should be retained by a temporary fillino- of gutta percha. It is also recommended as an in- gredient for a mouth-wash for diseased gums and mucous membrane. Alpha-oxynaphthoic acid (or alpha-naphthol-carbonic acid) is 342 DENTAL MEDICINE. prepared in a similar manner to salicylic acid, naphthol being substituted for phenol. Its formula is C10H6, COOH. It is obtained by bringing together under strong pressure, and at an elevated temperature, alpha-naphthol, sodium and carbonic acid gas. It is nearly insoluble in water, but soluble in the alkalies and alkaline carbonates, forming salts, which are color- less and of neutral reaction, and more soluble in hot and cold water than the acid itself. It is antiseptic and germicide, experiments upon bacteria giving favorable results. NITROUS OXIDE—PROTOXIDE OF NITROGEN. LAUGHING GAS, Formula.—N20. Sp. gr. compared with air is about 1.6. Derivation.—The discovery of Nitrous Oxide Gas was made by Dr. Priestly in 1776, and scientific investigations demon- strating its respirability, by Sir Humphrey Davy, the results of which were published some twenty years afterward. To Dr. Horace Wells, a dentist of Hartford, Connecticut, is due the credit of having demonstrated its property as an anaes- thetic agent for the relief of pain during surgical operations, in the year 1844. Nitrous oxide is obtained by heating the salt nitrate of ammonia in a glass retort until it melts, and then boils, dissolving into a vapor of water and into a perma- nent gas. The salt nitrate of ammonia is obtained in three forms—the crystallized, the granulated and the fused. The fused form is prepared by melting the crystallized nitrate of ammonia, and allowing it to solidify on cooling ; the granulated is prepared by evaporating the solution to a density sufficient to solidify on cooling, and agitating the mass until it becomes cool. As it is very important to use a pure form of the nitrate of ammonia in the generation of nitrous oxide gas, the salt, either in the fused or granulated state, may be tested by heat- ing it on platinum, when the nitrate, if pure, should volatilize perfectly. It may also be tested by a few drops of chloride of barium, which should not give a precipitate when added to the nitrate of ammonia; should it do so, then sulphuric acid NITROUS OXIDE. 343 is present; or, the nitrate of ammonia may be tested by a so- lution 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 solu- tion will remain perfectly clear, but should chlorine be pres- ent, it will show a clouded appearance, and should be dis- carded, 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 possi- ble, an equal temperature during its manufacture, and should any nitric oxide—binoxide of nitrogen—be formed, which may be done by too high a heat under the retort, it is neces- sary to remove it and other impurities, by the aid of solu- tions of caustic potash and copperas; the caustic potash neu- tralizing any free nitric acid present, and the copperas remov- ing either chlorine or nitric oxide. The salt nitrate of am- monia is perfectly fused at 2260 F., emits white fumes at 3020 F. and begins to evolve gas at 4600 F. At 5000 F. the im- purity, nitric oxide, is given off; hence the temperature dur- ing 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. Liquefied Nitrous Oxide—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 se- cured in iron cylinders, from which it escapes into an-inhal- ing bag when needed for use, by turning a stop-cock. Lique- fied nitrous oxide is a colorless fluid, having a specific gravity of 0.908, and at a very low temperature (1480 F.) it congeals into a transparent crystalline solid. It is prepared by con- 344 DENTAL MEDICINE. densing the gas by a pressure of fifty atmospheres at a tem- perature of 400 F., and may be kept in the iron cylinders for an indefinite period. 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 400 F. it becomes a clear, colorless liquid, and at about 1480 F. be- low zero it freezes into a beautiful, clear, crystalline solid. By the evaporation of this solid, a degree of cold may be pro- duced 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 of 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 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 NITROUS OXIDE. 345 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 atmos- pheric 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, 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- 346 DENTAL MEDICINE. 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; 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 ioo 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 NITROUS OXIDE. 347 _%____________________________ 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 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 348 DENTAL MEDICINE. 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. NUX VOMICA. Source.—The seed of the Strychnos nux vomica, which con- tains two alkaloids, strychnine and brucine, the amount of strychnine being one-fourth to one-half per cent, and of bru- cine from one-eighth to one per cent. Strychnine—Strychnina (C21H2iN202)—is a white or gray- ish white powder of a very bitter taste, almost insoluble in water, and very soluble in boiling alcohol. Sulphate of Strychnine—Strychnina Sulphas—is a white salt in the form of colorless prismatic crystals, which are very bitter and odorless, soluble in ten parts of water, somewhat so in alcohol, but insoluble in ether. Medical Properties and Therapeutic Uses.—Nux vomica and strychnine are bitter stomachic and muscular tonics. In small doses strychnine increases the gastro-intestinal secre- tions, hasten intestinal movements, and elevate arterial ten- sion. In larger doses the pupils are dilated and the muscles spasmodically contracted. Poisonous doses cause muscular tremors, intermittent tetanic spasms, and death from rigidity of the respiratory muscles, without any impairment 6f the mind. Poisonous quantities of strychnine accumulate in the sys- tem, on account of the agent being slowly excreted, from very small doses frequently administered. The antidotes are free evacuation of the stomach, vegetable astringents to precipi- OIL OF SWEET ALMONDS. 349 tate the strychnine, and the inhalation of ether or chloroform, and the hypodermic injection of chloral. Strychnine is em- ployed in anaemia, atonic dyspepsia, constipation, vomiting of pregnancy, gastralgia, gastric catarrh, etc., of drunkards, chlorosis, purpura, hemorrhagic diathesis, local paralysis, poi- soning by lead, spasmodic asthma, etc., etc. It is an antidote to chloral, and nux vomica is used in intermittent fever as an adjunct to quinine. Brucine is much weaker than strychnine, but similar in its action, and the pure agent is analogous to cocaine, possessing local anaesthetic properties. For hypo- dermic injection it is resorted to in paraplegia, infantile paralysis, facial paralysis, etc., and also in diseases of the eye, and infra- orbital paralysis. A half-grain of strychnine has produced a fatal result, and one-twelfth of a grain will produce muscu- lar twitchings, and one-sixteenth of a grain has proved fatal in the case of a child. Dose.—Of Abstractum nucis vomica, gr. I; of Extractum nucis vomica, gr. £ to gr. \; of Extractum nucis vomica jlu- idum, TTfj to v; of Tinctura nucis vomica, ITlv to x; of Strychnina, gr. is to h; of Strychnina Sulphas, gr. is to -is ; of Brucine, gr. js to 1. DENTAL FORMULA. For Neuralgia. R. Ext. nucis vom...............gr. v Zinci valerian...............9 ij Ext. gentianae...............9j M, Fiat pill No. XX. Signa.—One pill three or four times a day. OLEUM AMYGDALA 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 then 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. 350 DENTAL MEDICINE. 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 caju- puti, a tree indigenous in Batavia and Singapore. It is trans- parent, 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 ex- cites 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 ef- ficient rubefacient and stimulant embrocation. Its use is be- coming more common. Therapeutic Uses.—It is employed internally as an anti- spasmodic stimulant in typhus and other low fevers, spasmodic cholera, gout and rheumatism, neuralgic affections, hysteria, flatulence and flatulent colic, headache, nausea, etc. Exter- nally, 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 OIL OF CLOVES. 351 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 yel- lowish 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 tan- nic 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 adminis- tered 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 Use.—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 car- bolic acid is prohibited, owing to the patient's idiosyncrasy, he oil of cloves may be substituted. 352 DENTAL MEDICINE. 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. OLEUM MORRHU.E—COD-LIVER OIL. Source.—Cod-liver oil is obtained from the liver of the cod, Gadus morrhua, and is in the form of a fixed oil, containing biliary principles, traces of iodine, bromine, phosphorus, lime, magnesia, iron,soda and sulphuric and phosphoric acids; also a principle known as gaduin. By distillation with ammonia, it yields propylamin. The pale oil is considered to be the best for internal use, and is the official preparation. Iodine, phospho- OPIUM. 353 rus, bromine and iron are often combined with cod-liver oil, but are considered to add nothing to its therapeutical powers. The special medicinal value of this oil depends upon the gaduin and propylamin, which are constituents of bile, iodine, phosphorus, bromine, etc., as well as upon the common in- gredients of animal fat. The phosphates, hypo-phosphites, or the lacto-phosphate of lime are often combined with cod liver oil, with excellent effects. Medical Properties and Therapeutic Uses.—Cod-liver oil is considered to be a valuable remedy in certain forms of phthisis, such as the chronic forms,—chronic tuberculosis and fibroid lung; but not in acute phthisis and caseous pneumonia; also in chronic affections of the brain and nervous system, and such skin diseases as lupus, ecthyma, psoriasis, etc. It is also employed in sequelae of scarlet fever, chronic bronchitis, emphy- sema, chronic rheumatism and rheumatic arthritis, strumous synovitis, scrofula, caries and necrosis of bone, scrofulous, rickety infants and chlorotic girls derive benefit from warm baths and inunctions of the oil; also lean persons. Inunction with cod-liver oil is also useful in rubeola, scarlatina, erysipe- las, high fevers, catarrhal attacks, scrofula, phthisis, chronic dysentery, etc. It builds up the tissues, repairs waste and supplies nervous, muscular and digestive power. It may be administered in ale, beer, coffee, lemon juice, hot whiskey punch, compound spirits of lavender and brandy, or washing out the mouth with whiskey or brandy, or as an emulsion made with glycerine and yolks of eggs, and flavored. It is also used in the preparation of bread in form of rolls; ether added to it promotes its digestion ; fifteen minims of ether to every half-ounce of the oil. Dose.—Of cod-liver oil, f5j to 5iv. 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. 23 354 DENTAL MEDICINE. 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. 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 o^ gr. xx to gr. xxx, or sulphate of copper, gr. v to gr. x; also mustard in powder, 5ss, or powdered alum, answer as emetics, strong coffee, keeping the patient in motion, counter-irritation OPIUM. 355 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, 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, TTtv 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. 356 DENTAL MEDICINE. Dover's Powder—Pulvis ipecacuanha et opii. Dose, gr. x. Ten grains contain one grain each of ipecac and of opium, and eight grains of sugar of milk. For influenza or " com- mon cold," a dose of Dover's powder taken at bed-time, with such adjuncts as warm clothing, hot drinks, foot-baths, etc., to promote profuse diaphoresis, proves very effective. Ten grains at bed-time is also a very serviceable remedy for inflammations of the peridental membrane. Tinctura Opii—Tincture of Opium—laudanum, is com- posed of powdered opium, Siiss; diluted alcohol, Oj. Dose, TTLv to Tit xxx; 25 drops, are equivalent to one grain of opium. Its strength increases with age. Tincture of opium in hot water (f5ij, to aquae ferv. f§x), held for some minutes in the mouth, is useful in peridental inflammation. 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 Camphorata—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 f5j 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, TTLv to TTlxxx. paraldehyde. 357 dental formula. A Stimulating Injection for Abscess of Antrum, J. S. Smith. R . Glycerinae................f ^j Tinct. opii camph............f^ij Eau de cologne.............giv. 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. 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. paraldehyde—paraldehyde. Formula.—C6H 12Oa. Derivation.—Paraldehyde is a polymeric modification of al- dehyde (C2H40). It is a colorless liquid of an ethereal odor, pungent taste and insoluble in eight parts of water, which is a proper menstruum. It is frequently combined with chloro- form, oil of almonds and syrup of orange peel, or cinnamon. Medical Properties and Therapeutic Uses.—Paraldehyde is 358 DENTAL MEDICINE. an efficient hypnotic, similar in its effects to chloral, although the sleep caused by it is not so deep nor so prolonged. As it does not weaken or paralyze the heart or lungs, it is consid- ered to be safer than chloral. It is employed as a hypnotic in fevers, rheumatism, gout, prurigo, insomnia, hysterics, delir- ium tremens, some cases of neuralgia, and all mental and nervous disorders. It is also used as an expectorant. Poison- ous doses cause respiratory paralysis. Dose.—Of Paraldehyde, TTlxv to f5j, repeated if necessary. 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 prepa- ration is in the form of a nitrogenized, light, amorphous, gray- ish-white or fawn-colored powder, soluble in water and alco- hol, and of a peculiar odor and bitter, nauseous taste. When quite pure, it is both tasteless and inodorous. When decom- posed 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 into cancerous tumors and morbid growths with the hypoder- mic syringe, to retard their progress. Dose.—Of pepsin suspended in syrup, saccharated pepsin— PEPSIN. 359 Pepsinum saccharatum—gr. v to gr. x. Syrup of orange peel will disguise its odor. Vinum Pepsini. Dose, 5ss to 5j. 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. The hydrochloric acid and pepsin paste has also been recommended for devitalizing the pulps of teeth where rapid action is not desired, the quantity employed being about one-fifteenth of a grain. DENTAL FORMULAE. For Suppurating Dental Pulps. For Indigestion, Oakley Coles. Mialhe. R. Acidi hydrochlorici . . Tflj R • Pepsini...... z iss Aquae destillatae . . . . TfLxl Aquae......fzviss Pepsini porci . . . .q.s. Vini xerici .... fzxiiss To make a paste. Alcoholis.....f z iij Signa.—To be applied to suppurating Sacchari..... 3J. pulps. Solve et cola. Signa.—A tablespoonful immediately after each meal. 360 DENTAL MEDICINE. Ingluvin is a ferment prepared from the gizzard of the chicken, and its effects are analogous to those of pepsin. It is employed internally for indigestion, etc., and to prevent nausea and vomiting. Dose.—Of Ingluvin, grs. v to 3j. PEROXIDE OF HYDROGEN—HYDROGEN PEROXIDE. HYDROGEN DIOXIDE. 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- PEROXIDE OF HYDROGEN. 361 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 alcohol and carbolic acid; that it can be employed exterrtally 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 con- tains 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 362 DENTAL MEDICINE. 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 gonorrhoeal ophthalmia and mastoid abscess, for example. Peroxide of hydrogen acts very promptly and beneficially in feeble, flabby, or ill-condi- 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 opera- tions on mucous membrane, a strong solution of peroxide of hydrogen—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, bleaching discolored teeth, etc., etc. Dr. A. H. Prince's method of treatment, in the case of alve- olar abscess, illustrates the properties of peroxide of hydrogen. " The septic abscess is caused to heal by one application made in the f6llowing manner: After removing the pulp and pass- ing 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 liber- ated gas permeates it throughout, and by the continued evolu- tion 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 connection with iodide of zinc solution and other agents, in the treatment of alveolar pyorrhoea. PHOSPHATES AND PHOSPHITES. 363 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 sanguinary deposits may be removed, and the edges of the alveoli 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 carefully 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 per- oxide of hydrogen, a stronger injection of the iodide of zinc (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 pre- sent 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 constitutional treatment is also required. Peroxide of hydrogen has also been successfully used for bleaching discolored teeth, first adjusting the rubber dam and repeatedly washing out the cavity with the peroxide of hydrogen, and then carefully dry- ing with the hot-blast syringe. A small quantity of chloride of alumina is then placed in the cavity and moistened with peroxide of hydrogen and allowed to remain for five minutes, and then washed out with a clear solution of sodae biboras. PHOSPHATES AND PHOSPHITES. The Phosphates are ingredients of most of the animal and vegetable foods, and a sufficient amount of phosphorus is, under normal conditions, appropriated by digestive action for the supply of the system. Every part of the body contains 364 DENTAL MEDICINE. phosphate of lime, and rickets and softening of the bones and defective teeth result when too little is supplied during the formative period. The blood, saliva, gastric juice, urine, milk and the entire intercellular fluid contain phosphate of lime in solution. When this agent is administered by the stomach, diffusion into the blood results as a consequence of its being to some extent soluble in lactic and hydrochloric acids; hence it is very essential to the nutrition of the body, and small doses are as effective as large ones, as all in excess of the quantity soluble in the acids of the stomach is not appro- priated, but passes off or forms concretions in the intestines. Phosphate of sodium is also a constituent of the blood, and by removing morbid states of the mucous membrane it pro- motes digestion and improves nutrition and the tone of the nervous system. Large doses, on the other hand, when ad- ministered in health, will impair digestion. Phosphorus exists generally as a phosphate, and has a strong affinity for oxygen, compounds being rapidly formed in the stomach ; but some of it may enter the blood uncombined. It is a powerful irritant poison, the dose being no larger than to? to is of a grain. The preparations of the Phosphates and Phosphites are : Syrupus Calcii Lacto-phosphatis.—Syrup of the lacto-phos- phate of lime. Dose.—{^} to fgj. (See Syrup of Lacto-phos- phate of Lime.) Compound Syrup of the Phosphates.—Each drachm contains two and a half grains of phosphate of iron and one grain of phosphate of lime. Sodii Phosphas—Phosphate of Sodium. In the form of large, colorless, transparent prisms, with a cooling saline taste, feebly alkaline and no odor, and a slightly alkaline reaction. Soluble in six parts of water at 6o° F. and in two parts of boiling water. Dose.—f5j to f§j. Calcii Phosphas Pracipitatus.—Precipitated Phosphate of Lime. In the form of a white powder, with no taste or odor and insoluble in water or alcohol. Dose.—Gr. ij to gr. v. Syrupus Hypophosphitum.—Syrup of Hypophosphites. Com- JABORANDI. 365 posed of hypophosphites of calcium, sodium and potassium. Dose.—l5j. Sodii Pyrophosphas.—Pyrophosphate of Sodium. In the form of colorless, translucent prisms, with a cooling saline taste and a feeble alkaline reaction, but no odor, soluble in water, but insoluble in alcohol. Dose.—f5ss to fSss. Calcii Hypophosphis.—(See Hypophosphite of Lime.) Sodii Hypophosphis—Hypophosphite of Sodium. In the form of small, colorless or white prisms, or a white granular powder with a sweetish saline taste, and a neutral reaction, and solu- ble in water. Dose.—Gr. v. to gr. x. Therapeutic Uses.—The phosphates are useful in rickets, mollifies ossium, non-union of fractures, soft teeth of children, caries and necrosis of bone, anaemia of nursing mothers, chronic bronchitis, leucorrhcea. The phosphate of soda in bilious sick headache, hepatic colic, jaundice, carbuncles, boils, etc., etc. The hypophosphites in phthisis, emphysema, fibroid lung, chronic tuberculosis, dilated bronchi, skin dis- eases, and all diseases characterized by mal-nutrition. Phos- phoric and hypophosphoric acids are frequently combined with many vegetable and mineral tonics. The hypophosphites fulfill nearly all the indications of phosphorus itself. PILOCARPUS—JABORANDI. Source.—From the leaflets of the Pilocarpus pennatifolius, a Brazilian plant. The alkaloid on which the properties of the substance depends is pilocarpine, which combines with acids to form salts. Another alkaloid is jaborine, both having the same chemical composition, CnH16N202, and pilocarpine " by heat, merely by concentration of an acid solution," is con- verted into jaborine; washing with absolute alcohol will sepa- rate them when united. The principal preparations are : Hy- drochlorate of pilocarpine—pilocarpina hydrochloras,—which is in the form of white crystals, deliquescent, with a slightly bitter taste, a neutral reaction, and no odor. It is very soluble in alcohol, but not soluble in ether or chloroform; and the 366 DENTAL MEDICINE. fluid extract of pilocarpus—extractum pilocarpi fluidum. Bella- donna and its alkaloid atropine are antagonistic to pilocarpine. Medical Properties and Therapeutic Uses.—Large doses of crude jaborandi cause nausea and vomiting on an empty stomach, and the use of the alkaloid appears to have the same effect under similar circumstances. It increases the perspira- tion and saliva, Ringer stating that the secretion of the sali- vary glands is augmented as much as twenty-seven fluid ounces as the result of a full dose. The nauseating effects of the alkaloid pilocarpus appear to depend upon its action on the muscular layers of the stomach and intestines; and the increased secretion of the mucous membrane doubtless results from the stimulation of the pancreas and the glands of the mucous membrane. Children do not appear to experience its influence to the same degree, in regard to salivation, perspiration and tempera- ture, as do adults. As a general rule, drowsiness follows the profuse perspiration, and pallor the flushings caused by this drug: and the languor and debility it occasions continue for some hours. The pupil of the eye is contracted, but this organ generally recovers from its diminished vision after the space of one hour and a half. Jaborandi is employed in drop- sies of the heart and kidneys, mumps, diseases of the eye, to increase the secretion of milk, diabetes insipidus, diphtheria, skin diseases, etc. It is also employed in ptyalism with ad- vantage, in the form of the hydrochlorate of pilocarpine, one- third of a grain three or four times daily. Dose.—Of Infusion—Infusum Pilocarpi, Sss to Sij. Of Fluid Extract—Extractum Pilocarpi Fluidum, 5ss to 5ij. Of Tinc- ture—Tinctura Pilocarpi, 5ss to 5ij. Of Hydrochlorate—Pi- locarpina Hydrochloras, gr. tz to gr. ss. 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. ACETATE OF LEAD. 367 Medical Properties and Action.—Jamaica dogwood is a pow- erful narcotic, and, in a measure, tonic and diuretic. Its nar- cotic 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 dogwood Sj, rectified spirits fgiv. 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, brilliant, 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. 368 DENTAL MEDICINE. 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, neuralgia of the abdominal muscles, contraction of the intestines, belly drawn toward the spinal column, contrac- tion 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 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, gastralgia, pyrosis, summer diarrhoea of children, humid ACETATE OF LEAD. 369 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 potassium, 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. 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 FORMULA. For Acute Inflammation of the Mucous For Chapped Hands and Lips. Membrane of the Mouth and the R. Liq. plumbi subacetatis Gums. dilutus......^ vj R. Plumbi acetatis . . . £J Camphorae.....gr. xl Tinct. opii.....^ ss Cerae albae.....£ viij Aquae.......3*. ^. Olei amygdalae dulcis. Oj. M. Signa.—Apply as a lotion, on lint. Fiat cerat. Signa.—Apply as an ointment. ' For Inflamed Gums and After Tooth McQuiLLEN. Extraction. R. Liq. plumbi subacetatis ^ j R. Plumbi acetatis . . . gr. xv Tinct. opii.....3 ij. M. Tinct. opii.....f z ij Signa.—Apply to cavity on cotton and Aquae.......f^»j. M. to gum externally. Signa.—Use as lotion and mouth-wash. 24 370 DENTAL MEDICINE. PODOPHYLLUM—MAY APPLE. Source.—The rhizoma and rootlets of Podophyllum peltatum, or May Apple. It contains the alkaloid berberine, which is also peculiar to other plants, and two resinous substances soluble, one in alcohol and ether and the other in alcohol only, and on which its medicinal properties depend. Both are purgatives. It has a bitter taste, with a sense of acidity. Medical Properties and Therapeutic Uses.—Podophyllum is a useful cathartic and cholagogue. In cases of constipation, due to deficient secretions of the intestinal canal and liver, it is a useful cathartic, and for habitual constipation small doses combined with belladonna are very effective. It is also em- ployed in catarrhal and malarial jaundice, ascites, hemorrhoids, bleeding from stasis of the portal circulation, and torpidity of liver, as a substitute for calomel and blue mass. It is slow in its action and is therefore often combined with other cathartics. Podophyllin is the resina podophylli. Dose.—Of Resina Podophylli—Resin of podophyllum, gr. \ to gr.j. Of Extractum Podophylli Fluidum—Fluid extract of podophyllum, Ttlj to 5ss. Of Abstractum Podophylli—Ab- stract of podophyllum, gr. \ to gr.j. 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-stoppered 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. BICARBONATE OF POTASSIUM. 371 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 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 calce— 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. POTASSIUM BICARBONAS—BICARBONATE OF POTASSIUM. Formula.—K H C03. 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 372 DENTAL MEDICINE. 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. 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 3j. 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 FORMULAE. For Facial Neuralgia. For Neuralgia. Wales. J. E. Garretson. R. Potassii bicarb . . . . z ss R. Ferri sulphatis exsic. Ext. ergotae fluidi . . . f 3 j Potassii carbonatis. aa . gr.ccl Infusi ergotae . . • . f ^ vj. M. Syrup acaciae .... q.s. M. Signa.—Two tablespoonfuls every four Ft. pil. No. 100. hours. Signa.—Begin with three a day and increase to six; take several hun- dred. 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, BROMIDE OF POTASSIUM. 373 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 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, and in facial neuralgia when congestive in character. 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, and to overcome extreme susceptibility of the mucous membrane of the roof of the mouth in first wearing artificial dentures. For such purposes the agent is administered in one-half drachm doses 3 times daily for two or three weeks previously ; or doses of grs. xx to xxx may be given, repeated two or three times. 374 DENTAL MEDICINE. POTASSII CHLORAS—CHLORATE OF POTASSIUM. Formula.—KC103. 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 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 inflam- mation, 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. Poisonous symptoms have re- sulted from the habitual use of chlorate of potassium, and several cases of death have been recorded. 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 CHLORATE OF POTASSIUM. 375 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 combi- nation of chlorate of potassium, Sv; sugar, Sxviij ; tragacanth, 5ij ; 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 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 Extraction of Teeth. R. Potassii chloratis ... z ij Tincturae krameriae, Glycerini . . aa . . . f J ss Aquae rosae.....gviij.M. Signa.—To be used as a gargle 6 or 8 times daily, to harden the gums. For Ulcers and Suppurating Wounds. R . Potassii chloratis . . . pt.j Glycerini......pts.x. M. Signa.—To be applied as a lotion. For A phthous and Secondary Syphilitic Ulcerations of the Mouth and Fauces. R. Potassii chlorat . . . z iv Aquae destillatae . . . §x. M. Signa.—To be used as an antiseptic mouth wash. For Ulceration of the Mouth. Bartholow. R. Potassii chloratis . . . zj Acidi carbolici . . . £ss Aquae destillatae . . . 5 iv. M. Signa.—To be used as a lotion. 376 DENTAL MEDICINE. For Ulceration and Inflammation of the Gums and Mucous Membrane. STOCKEN. R. Potassii chloratis ... z. ij Sodii biboratis . . . . Zj Potassii nitratis ... zss Aquae destillatae . . . 3jviij. M. SiGNA.—To be used as a gargle. For Inflammation of Gums and Mucous Membrane. Stocken. Potassii chloratis Sodii biboratis . Potassii nitratis Tinct. arnicae Aquae rosae . . R. 3»J zss §vij. M. Signa.—To be used as a gargle. For Inflamed Gums, Mucous Membrane, etc. R. Potassii chlorat . . . zj Sodii biboratis . . . . Zj Aquae destillatae . . . ^ ij. M. Signa.—To be used as a mouth wash or gargle. For Inflamed Gums and Mouth. R. Potassii chlorat . . . . z. ij Pulv. aluminis . . . . zij Aquae destillatae . . . . ^ x. M. Signa.—To be used as a gargle. For Inflamed Mucous Membrane. R. Potassii chlorat . . . . zj Aluminae Sulph . . . . zj Aquae destillatae . . . . Sjiv. M. Signa.—To be applied as a mouth wash. For Periodontitis. R. Potassii chlorat . . . . zj Plumbi acetas . . . . gj Aquae font......3 ij. M. Signa.—To be used as a mouth wash. For Ulceration of Gums and Mucous Membrane of Mouth. R. Potassii chloras . . . . z ij Aquae........gv. M. Signa.—A tablespoonful three times a day; also as a gargle four or five times a day. POTASSII NITRAS—NITRATE OF POTASSIUM. SALTPETRE-NITRE. Formula.—KNO„ 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 crystallization. It is in the form of white, crystalline, six-sided prisms, odorless, with a sharp, saline, cooling and slightly bit- ter 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 promotes the secretions, lessens the heat of the body and the PERMANGANATE OF POTASSIUM. 377 frequency of the pulse. For allaying febrile excitement, it is frequently employed in the form of nitrous powders (nitre, gr. x ; tartar emetic, gr. j4 ', calomel, gr. j£ to y2). 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. 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 imflammatory 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 . . . zss R. Potassii nitratis . . . Zjj togiv Potassii chloratis . . . zij Aquae destillatae . . . Oj. M. Sodii biboratis . . . zj Signa.—To be used as a gargle. Aquae destillatae ... § 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 378 DENTAL MEDICINE. 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. Therapeutic Uses.—Permanganate of potassium is employed with advantage in dyspepsia, flatulence, excessive deposition of fat, uric acid diathesis, acute rheumatism, diabetes, scarla- tina, 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, leucorrhoea, 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 solution, 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, car- buncles, hospital gangrene, etc. The powder may be sprinkled on gangrenous surfaces. In concentrated solution permanga- nate 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, leucorrhoea, etc., half a fluid ounce of the PERMANGANATE OF POTASSIUM. 379 solution may be added to a pint of water ; in gangrenous and dipththeritic wounds and scrofulous ulcers, a fluid ounce of the solution to a pint of water. Dose.—Of permanganate of potassium for internal use, gr. Y± to gr. j, three times a day. Condy's Fluid is composed of 32 grains of permanganate of potassium in one pint of dis- tilled water; half a fluid ounce contains one grain. Dose of Condy's Fluid, TTLv. For external application, f5j, to water, fSvto x. Solution of permanganate of potassium—Liquor Potassii Permanganatis, is composed of 64 grains of perman- ganate of potassium to one pint of distilled water. M. de Lacerdahas 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 po- tassium is employed in the treatment of fetid and gangrenous ulcerations of the mouth, such as cancrum oris, foul ab- scesses, ulcerations of mucous membrane attended with fetid discharges, offensive breath ; as an antiseptic for decomposing pulps of teeth (grs. ij to water Sj); in diseases of the antrum, such as abscess, and caries and necrosis of the maxillary bones, Riggs' disease, ulcers of the mouth, pyorrhoea areo- laris, etc. (grs. x to water Sj). The powdered crystals intro- duced into a carious cavity will relieve odontalgia. The stains of permanganate of potassium can be removed by dilute hydrochloric acid. DENTAL FORMULAE. For Unhealthy Ulcers of the Mouth, and For Gangrenous Ulceration of the Offensive Breath. Mouth—Cancrum Oris. J. W. White. R. Potassi permanganatis . gr. xxx R. Potas. permanganatis . 9J to iv Aquae destillatae . . . |j. M. Aquae destillatae . . . Oj. M. SiGNA.—Apply as a lotion. SiGNA.—To be used as a gargle. For Fetid Perspiration and Foul Breath. r. . . R. Potassi permanganatis .gr.j For Ulcers, Abscesses, Decomposing ** .,, A • », r, ,*. s t- 41. .** Aquae destillatae . . . f 5j. M Pulps of Teeth, etc. ^ °J R. Liquoris potassii perman- ganatis .....3J Signa.—To be used as a lotion and gargle. Aquae destillatae . . | vj to x. M. For a Disinfectant in Mercurial Saliva- Signa.—To be used as a gargle or as an injection. tion. R. Potassii permanganatis gr. xv Aquae.......f 3 viij. Signa.—Use as a gargle. 380 DENTAL MEDICINE. PRUNUS VIRGINIANA—WILD CHERRY. Source.—Prunus Virginiana is obtained from the bark of the Prunus Serotina, and is composed of amygdalin and emul- sion, from which, by their reaction, tannic, gallic and hydro- cyanic acids are produced. The preparations of wild cherry are: Infusum Pruni Virginiana—Infusion of wild cherry; Extractum Pruni Virginiana Fluidum — Fluid extract of wild cherry; Syrupus Pruni Virginiana — Syrup of wild cherry. Medical Properties and Therapeutic Uses.—Wild cherry is an aromatic bitter stomachic tonic and expectorant. It is em- ployed as a stomachic tonic and in catarrhal conditions of the bronchial mucous membrane, phthisis, etc. The syrup forms one of the ingredients of many cough mixtures. Dose.—Of tincture of wild cherry, 5ss to 5ij; fluid extract, 5 ss to 5 ij; infusion, S ss to 5 j. 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 irri- tant 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 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. WHITE OAK BARK. 381 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..............fziij Aquae..................3v"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 and 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. Externally in relaxation of the uvula, tonsils, etc.; gangrene, indolent ulcers, leucorrhoea, atonic menorrhagia, fissure of the anus, etc., etc., in the form of tincture, and decoction as gargles, lotions and injections. 382 DENTAL MEDICINE. 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 soapwort—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 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 ar- rest excessive secretion of the mucous membrane of the mouth. SULPHATE OF QUININE. 383 DENTAL FORMULAE. Detergent Mouth Wash. For a Mouth Wash. Am. Journ. Pharm. R. Pulv. quillaiae sapona- R. Pulv. potassii bicar- riae.......? iv bonatis.....|ss Glycerini.....J iij Mellis.......g iv ' Alcoholis dilutus suf- Alcoholis.....| 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- (fluid ext.) . aa . . g j ture of giycerine and aicohol for three Aquae destillatae . . § 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.............. 5 viij Pyrethri, Radicis iridis, Acidi benzoici, Cinnamon........aa........ 2 j Acidi tannici ziv Sodii boratis...............g i^ Olei gaultheriae . ,............f z ij Olei menthae...............f z iv Cochineal 3»J Sacchari albi...............Ibj Alcoholis.................Oiij Aquae purae................Ov. M. Digest for six days and filter. Signa.—To be used as a gargle. QUININE SULPHAS—SULPHATE OF QUININE. Formula.—C2oH24N202, 3H20. 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 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 muri- ate, the salt being decomposed and the quinine precipitated 384 DENTAL MEDICINE. by the addition of lime; sulphuric acid is added, after diges- tion in boiling alcohol, which dissolves the quinine, and the solution is boiled with animal charcoal, filtered and allowed to crystallize. Sulphate of quinine is in the form of color- less, very light and silky crystals, which are readily soluble in alcohol and in water acidulated with sulphuric acid, but in- soluble in ether. It has an intensely bitter taste, and is in- odorous. 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 cap- illary vessels, and is diffused into various parts of the sys- tem with great rapidity. In large doses it depresses the ac- tion 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, de- lirium, 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, 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 HYPOPHOSPHITE OF QUININE. 385 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 reducing inflammation of the peridental membrane when resorted to in the early stages of the disease, and before effusion of inflammatory products, cell-proliferation and escape of the white blood corpuscles have occurred; also in hypersensitiveness of dentine—three or four grain doses every four hours until thirty grains have been taken (Klump). The treatment of facial and other neuralgic affections, especi- ally when of malarial origin, 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.—QaH^NO^PH^. Derivation.—Hypophosphite of Quinine is obtained by dis- solving quinine with hypophosphorous acid, or by decompos- ing 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. 25 386 DENTAL MEDICINE. DENTAL FORMULiE. For Facial Neuralgia from Dental For Neuralgia from Dental Disturb- Disturbance. ance. Barrett. L. De L. Gorgas. R. Ferri et quin (cit.) . . tzij R. Quininae sulphatis . . .gr.x Syrup aurantii ... . \) Ferri sulphat. exsic . . gr.v Aqua dest......^ j Acidi arseniosi .... gr.ss Elixir calisayae . . . . ^ ij. M. Ext. nucis vomicae . . . gr.v. M. SiGNA.—Coch. parv. ter in die. Ft. pil. No. xx. Signa.—One pill every four hours. For Neuralgia Associated with Anamia. For Acute Periodontitis. Garretson. R- Quininae sulph.....zss R. Tinct. ferri chloridi . . gj Acidi sulph. aromat.. . zij Quininae sulphatis. . . zj. M. Elix. calisaya bark . . zxiv. M. Signa.—Teaspoonful four times daily. Signa.—A teaspoonful every two or three hours. 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 nervous system, it greatly increases in frequency the respira- tion, 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 RHUBARB. 387 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 its antiseptic action, it is used for dressing putrid and atonic wounds, and is combined with water, glycerine and alcohol; it is also used in pomades. A compound composed of resorcin and salicylic acid heated together, is known as " Salicyl Resorcin-Ketone," and is anti- septic 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. A ten per cent, solution of resorcin is recommended in cases of chronic alveolar pyorrhoea (after cleansing the pockets with peroxide of hydrogen) where there is impaired circulation of the tissues. (See Antiseptic Uses of Carbolic Acid.) RHEUM—RHUBARB. Source.—The root of Rheum officinale. It contains two acids, rheo-tannic and rheumic, a resin, phaoretin and an acid, chrysophan or chrysophani. Medical Properties and Therapeutic Uses.—Rhubarb possesses tonic and astringent as well as purgative properties. In small doses, as a tonic, it promotes the appetite and digestive power, and by virtue of the tannic acid it contains, is astringent. The purgative principle it possesses enables sufficient doses of rhubarb to act as a cathartic, producing stools which are of a 388 DENTAL MEDICINE. yellowish-brown color, and soft but not watery. It has no tendency to cause gastro-enteric inflammation. It is now classed among the cholagogues, as it increases the flow of bile and the intestinal secretions, being due to phaeoretin—rhu- barb resin. Its coloring matter not only stains the stools, but also the perspiration, milk of nursing women, to which it gives a bitter taste and purgative principles, and the urine. It is employed with benefit in diarrhoea caused by the accumu- lation of undigested food in the intestines, hemorrhoids ac- companied by constipation, dyspepsia with deficient biliary and intestinal secretions, the summer diarrhoea of children in the form of the aromatic syrup and in catarrh of biliary ducts with jaundice; and the chewing of rhubarb-root is beneficial in habitual constipation; its frequent use, however, is object- ionable on account of the astringent after-effect, which in the rhubarb pill is remedied by the soap. Dose.—Of Extractum Rhei—Extract of Rhubarb, grs. x to grs. xv. Of Extractum Rhei Fluidum—Fluid extract of rhu- barb, 5ss to 5ij. Of Pilula Rhei—Rhubarb pills, each pill consists of grs. iij of rhubarb and gr. j of soap. Of Pilula Rhei Composita—Compound pills of rhubarb, consisting of rhubarb, aloes and myrrh. Dose, 2 to 4 pills. Of Syrupus Rhei—Syrup of rhubarb, 5ss to 5ij. Of Tinctura Rhei Aro~ maticus—Aromatic tincture of rhubarb, 5ss to oij. Of Tinc- tura Rhei Dulcis—Sweet tincture of rhubarb, Sss to Sij. Of Vinum Rhei—Wine of rhubarb, 5j to Sss. Of Pulvis Rhei Compositus—Compound powder of rhubarb, a teaspoonful. 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 SANDARACH. 389 of its great volatility and inflammability requires to be kept tightly stoppered, 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 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. 390 DENTAL MEDICINE. Dental Uses.—\n. 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 medic- inal applications. DENTAL FORMULA. Transparent Sandarach Varnish. R. Gum sandarach...............^ v. Alcohol..................qt.j. Mix and digest over a moderate heat until the sandarach is dissolved. SERPENTARIA—VIRGINIA SNAKEROOT. Source.—Serpentaria is prepared from the rhizoma and rootlets of the Aristolochia serpentaria and of the Aristolochia reticulata, and is composed of a volatile oil, resin and bitter principle. Its preparations are: Infusum Serpentaria—Infu- sion of Serpentaria; Tinctura Serpentaria—Tincture of Ser- pentaria; Extractum Serpentariae Fluidum—Fluid extract of serpentaria. Medical Properties and Therapeutic Uses.— Serpentaria is a bitter, aromatic, stimulating tonic, employed in typhoid and typho-malarial fevers, and as a stimulant expectorant in capil- lary bronchitis; also combined with the carbonate of ammo- nia in a low form of pneumonia, chlorosis, anaemia, and diph- theria. Large doses cause diarrhoea, nausea, vertigo and headache. Dose.—Of Infusion, Sss to Sj; Tincture, 5ss to 5ij; Fluid extract, 5ss to 5ij. 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 PHENATE OF SODIUM. 391 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, m its crude state, consists of resin, coloring matter, and a pe- culiar 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 dissolved 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 frag- ments of various sizes, from half a line to a line in thickness, and of a light and also dark brown color, shining, hard, brit- tle and inodorous. It is insoluble in water, but freely soluble in alcohol, 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 FORMULA. For a Colored Varnish. For an Aqueous Varnish. R. Gum shellac.....§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. SOD.E PH EN AS—PHENATE OF SODIUM. CARBOLATE OF SODIUM--PHENOL SODIQUE. 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 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. 392 DENTAL MEDICINE. 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, leucorrhoea, 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 extrac- tion 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 sed- ative 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 ap- plied on cotton, to an exposed and inflamed pulp, it relieves odontalgia. 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. Phenol Sodique. Pure melted carbolic acid.............e parts Solution of caustic soda, specific gravity, 1.332 . . . . 1 part Distilled water.................c partg Mix. A Phenol Sodique Preparation. R. Acidi carbolici...............gr. clxxxviij Sodae caustic...............~ xxx: A R. Thymol..... 1 part For an Antiseptic in Suppurating Pulps, Alcohol.....IO parts Alveolar Abscess, etc. Glycerin". \ '. . . 20 parts R. Thymolis (cryst.) . . ptm.l Watef......100 parts. M. Glycerini.....pts.ij to iv. c. .. . 1 • j • »i. Signa.—Apply as a lotion. SiGNA.—Applied in the same manner • rr / as carbolic acid. VASELINE. 403 VALERIANA—VALERIAN. Source.—Rhizoma and rootlets of Valeriana officinalis. Va- lerian contains a volatile oil, and from it are several prepara- tions, among them valeric acid, HC5H902, to which the virtues of the agent are principally due. This acid is now prepared from fusel oil, and is not the same as that from valerian, although it is largely used as a substitute. Valerianates are made from the acid prepared from fusel oil, but are not as good as the preparations from valerian. The official valerianates are Ammonii valerianas (N.H4)C5H902; dose, gr. ij to x. Ferri valerianas, Fe(C5H902)6; dose, gr. j to iij. Quininae valerianas ; dose, gr. j to iij. Zinci valerianas (QH902)H20; dose, gr. % to ij. Medical Properties and Uses.—Valerian and its preparations have a peculiar, disagreeable odor and a hot, pungent taste, with a sensation of warmth at the epigastrium, being a gentle stimulant and antispasmodic. In moderate doses the action of the heart is increased, with a rise of temperature and dia- phoresis. Large doses cause nausea, hiccough, eructations, vomiting and diarrhoea. Small doses have no apparent physio- logical effects. It antagonizes strychnine. Valerianic acid is apparent in the breath, perspiration and urine. Valerian is frequently employed in hysteria and general nervousness, as are also the valerianates; also in flatulence, whooping-cough, neuroses of the respiratory organs, epilepsy, chorea, paralysis agitans, diabetes, etc. Valerianate of ammonia is used in ner- vous headache and in dental and other neuralgias. (See Va- lerianate of Ammonia.) Dose.—Of Abstractum Valeriana—Abstract of valerian, gr. v to 3j. Of Extractum Valeriana Fluidum—Fluid extract of valerian, 5ss to Sss. Of Tinctura Valeriana—Tincture of valerian, 5ss to 5ij. Of Oleum Valeriana—Oil of valerian, TTlij to TTliv. VASELIN—VASELINE. PETROLEUM OINTMENT. Derivation.—Vaseline is obtained from crude petroleum, in the form of a petroleum jelly. In the distillation of crude petro- 404 DENTAL MEDICINE. leum 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 pro- duct 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 3$° C, boils at 1500 C, and distills at 200° 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 sen- sibly 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 ac- tion by them, and without modifying their therapeutic proper- ties. Incorporated in ointments, a certain quantity of vaseline 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 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. VERATRINE. 405 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. It is also used as an obtundent of sensitive dentine. 406 DENTAL MEDICINE. DENTAL formula. For Sensitive Dentine. For Facial Neuralgia. Bogue. GARRETSON. R . Veratrina.....gr.iv R. Veratrinae.....gr.iv Acidum tannicum . . gr.j Aconitinae.....gr.ij Alcoholis.....gtt.xx Olei tiglii.....gtt.ij Glycerini.....fzj Olei olivae.....zij. M. Acidi carbolici ... zij. M. SiGNA.—Rub over affected spot thrice Signa.—Dry the tooth thoroughly and daily. apply to sensitive surface. 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 administration. Therapeutic Uses.—Veratrum viride is not employed for its PRICKLY ASH. 407 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, tTLij to TTly; of the fluid extract of veratrum viride—Extractum Veratri Viridis Fluidum, TTLij to TTLv; veratrina, gr. is to gr. TV. 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...............fzij Cerati adipis.............. f^yj. M. SlG.—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. 408 DENTAL MEDICINE. 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 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. — Chlorijde 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 CHLORIDE OF ZINC. 409 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., 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 410 DENTAL MEDICINE. 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- 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 mucus 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.) OXIDE OF ZINC. 411 ZINCI IODIDUM—IODIDE OF ZINC. Formula.—Zn I2. Derivation.—Iodide of Zinc is obtained by digesting an excess of zinc with iodide diffused in water. It is in the form of fine, white, deliquescent needles, very soluble in water, and 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 ex- ternally 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 pre- cipitated carbonate of zinc to a red heat, till the whole of the carbonic acid and water are expelled. 412 DENTAL MEDICINE. 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- 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, convulsions of children, epilepsy, chorea, whooping-cough, hysteria, 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 powder, 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. DENTAL FORMULAE. 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 be- comes a hard, yellowish mass; then pulverize in a mortar, and sieve through fine bolting cloth. For the liquid, take !|j of glacial phosphoric acid (German), in crystals, and dissolve in f ^ j of water, and then evaporate to one-third, on a sand bath. SULPHATE OF ZINC. 413 Oxychloride of Zinc Preparation for FOR THE LIQUID. Filling Teeth. R, Zinci chloridi (deliq.) . f. ^ j for the powder. Aquae.......f^v to vj. R. Zinci oxidi.....gr.xxx. Sodii boratis . . . .gr.ij. For Neuralgia of the Head. Silicii (fine powd.) . gr.j. Von Niemeyer. Mix thoroughly and subject to a R • Ext. hyoscyami, bright-red heat in a crucible. Then Zinci oxidi . . aa . . £) ij. M. grind this frit to a powder, and mix it SiGNA.—Fiat pill. xj. with three times its weight of calcined Begin with one Pm morning and oxide of zinc evening, and increase to xx or xxx daily. ZINCI SULPHAS—SULPHATE OF ZINC. Formula.—ZnS047H20. 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, 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. 414 DENTAL MEDICINE. Dental Uses.—Sulphate of zinc is employed externally in dental practice, in gangrene of the mouth, disease of the an- trum, 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. Zinci sulphat.....gr.xx R. Zinci sulphat.....gr.jtov Mellis........j|j. 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. Sulphite of Aluminium—Aluminii Sulphis.—The sulphite of aluminium is a new antiseptic, being a sulphurous salt of aluminium; that metal uniting with acids to form salts in the proportion of two molecular equivalents of the base and three of the acid. The persulphite may be made by adding sul- phurous acid to the undried sesquisulphite to solution and crystallizing without heat; or by precipitating the persulphite from solution with alcohol, filtering or decanting, washing the precipitate with alcohol and drying on bibulous paper. The sulphurous salts of aluminium are the best representatives of its antiseptic, therapeutic properties, two being produced—the sesquisulphite and the persulphite; the former being insolu- ble in water, while the sulphite is soluble. Three hundred times as much of the sesquisulphite of aluminium can be administered with safety as of the bichloride of mercury, and while the latter is two and a half times as active as the alum- inium salt in equal quantity, the difference in dose permissi- ble favors the relative efficiency of the latter; and the same APPENDIX. 415 relations exist in the topical use of these two agents. The insoluble sesquisulphite may be made by taking the theoret- ical quantities of potassic alum and sulphite of sodium and mixing their solutions in water; the precipitate to be washed and carefully dried. The proportion is ten parts of alum and eight of sodium sulphite. These aluminium salts are applica- ble to almost every conceivable condition where an antifer- ment is indicated. Benzoic Sulphide of Sodium is obtained by dissolving a large quantity of benzoic acid in a concentrated solution of sulphide of sodium. It is a valuable antiseptic for dressing wounds, and may be used as a wash, lotion or injection, its antiseptic properties being very active and healing. Thirty to forty-five grains are used to the quart of water. Heckel con- siders it to be equal to carbolic acid, and superior both to sublimate and iodoform, as it is not poisonous like corrosive sublimate, and is free from the disagreeable effects of iodo- form. It is very soluble in water and contains the antiseptic properties of its two principal ingredients—benzoic acid and sulphite of sodium. It is harmless, even when given in large doses. 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, chlor- ide of iron solution 2 parts ; dry at 60 ° C. 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 alumi- nium and charcoal. By placing the anhydrous chloride of aluminium 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 disin- 416 DENTAL MEDICINE. fectant. As it does not cauterize, it is especially convenient for applications 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 Chlotidum,'\s 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 deli- quescence the liquid form, prepared by dissolving the salt in its weight of water, is preferred. The dose, diluted, is 5ss 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 f§iij of distilled water, is used for injections. Cresylic Acid—Acidum Cresylicum, is an antiseptic and germi- cide upon the different kinds of pathogenic organisms. It is a colorless liquid having the odor of creasote. It boils at 2030 and is slightly caustic. It is soluble in water, quite soluble in alcohol, glycerine, and water of ammonia and very soluble in ether. When injected in rabbits it produces toxic symptoms, but to cause death a dose four times greater than that of carbolic acid is required. It has a marked effect in retarding the fermentation of urine and milk. Experiments on cultures of the various pathogenic micro-organisms demon- APPENDIX. 417 strated that cresylic acid is a powerful antiseptic and quicker in its action than carbolic acid or its congeners. Creolin—Creoline is a product of the decomposition of coal tar. It is obtained in the form of a brownish liquid, complex and very impure, with an odor like tar; and in its impure state is slightly irritating, slightly caustic and strongly acid, and resembles in its properties the phenols. A purified preparation of creolin is, however, as neutral as vaseline, and quite as in- offensive to man and animals. Creolin is both antiseptic, germicide and haemostatic, being employed for the latter pur- pose in obstetrical practice. It is employed with great benefit in ulcers of the cornea. Its germicidal powers are said to be ten times superior to those of carbolic acid, and its action on the spores is even more pronounced than corrosive sublimate. The addition of from eight to ten drops of a three per cent. aqueous solution is sufficient to completely sterilize and pre- vent the development of the comma-bacillus, and from one to three drops of a one per cent, solution will retard the develop- ment of the micro-organisms, and four drops will prevent it completely. Its antiseptic properties are said to be superior to all other drugs at our command. It is soluble in water, alcohol and glycerine, and it does not affect the skin nor cor- rode instruments, and the odor of the purified preparation is not disagreeable. It appears to have an anodyne effect, and is curative when applied to open wounds. An aqueous solu- tion of creolin is made of: ~2f. Creolin, gr. iss; aquae destil., TTtcl, which may be applied with a brush or in the form of spray. For dental use it may be injected, or applied on floss- silk or cotton-wool. Glyceroborate of Calcium is a powerful antiseptic, and is pre- pared by mixing equal parts of borate of calcium and glycer- 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 27 418 DENTAL MEDICINE. 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. Lanolin is the natural fat of wool, and is used as a substitute for ordinary fat for local use. On account of its being analo- gous to the natural fat of the skin, it is supposed to be more freely absorbed by the tissues than the ordinary fats; hence it is employed as a vehicle for remedies which are to be absorbed, and for such a purpose has been combined with arsenious acid and hydrochlorate of cocaine in a devitalizing mixture. Chloride of Methyl—Methyl Chloride. Formula.—CH3C1. The chloride of a hydrocarbon in the form of methyl chloride, is employed as a local anaesthetic in the form of spray, and being very volatile and ether-like, rapid evaporation occurs when it is applied over an affected area. To avoid producing inflammation of the skin, or an erythema in persons having an irritable skin, caution is necessary; and it should be applied over as many nerve-filaments as possible. The special advan- tage of chloride of methyl is its external application, which may never cause more than a temporary irritation of the skin. In order to produce local anaesthesia with this agent, M. Bardet proposes before spraying a surface with it, to paint it with glycerine, the revulsive action being less severe, and the glycerine forming a surface on which the drops of the refrig- erant mixture collect, and which may be readily removed after the desired effect has been produced; the use of glycerine is also said to prevent the dangers of sloughing. Dr. Ch. Bailly recommends the following method of applying this agent as a local anaesthetic: A tampon of dry cotton covered APPENDIX. 419 with dry silk is sprayed with the anaesthetic until its tempera- ture is reduced to 23°-55°C. below zero. The tampon is then grasped with ebony pincers and applied for a few seconds to the parts to be anaesthetized, and perfect abolition of pain at once secured. 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 tarred 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— 420 DENTAL MEDICINE. 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 paraffinates, or, better still, with 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 APPENDIX. 421 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 oij, with oleate of bismuth 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. 422 DENTAL MEDICINE. 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 depth. It is used in lupus, the ulcerating variety of epithe- lioma, 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, erysipel as, 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. Kandol is a product formed by the distillation of naphtha, and is a perfectly clear, colorless fluid, extremely volatile, burns easily, and has a slight odor of benzine. It can be mixed with a small quantity of water or alcohol, and its preparation is cheap and simple. Dr. Njuschkon advocates the use of kandol in the place of ether or cocaine as a local anaesthetic in the form of spray. In one minute kandol will reduce the temperature to io° C, and keep it nearly uniform at that temperature for some time, while ether reduces the temperature to I7°C. As an effect of the spray of kandol, the skin becomes very hard and is completely anaesthetized, and there is no bleeding, or else the blood coagulates as soon as it makes its appearance, so that all operations may be per- formed with ease and rapidity. 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 APPENDIX. 423 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 consid- ered to have any advantages over other common vegetable astringents. For Inflamed Mucous Membrane, and for Use after the Removal of Salivary Calculus. A. W. Harlan. R. Pinus canadensis (white)............^ ss Aquae rosae..................5? iijss Eugenol...................TTlxxx. M. SiGNA.—Use as a lotion or on a tooth-brush, three times daily. Sulfonal— Sulphonal. Formula, (CH3)2= C=(C2H5S02)2. Sulfonal is in the form of colorless prisms, odorless and taste- less. It is easily soluble in hot water and in alcohol, and but slightly soluble in cold water, and melts at 2580 F. It appears to possess hypnotic properties of considerable power, and is regarded as prompt and reliable, producing a quiet, natural sleep, lasting a number of hours. It appears to have no un- favorable effects on the heart or the circulation, nor on the temperature, the pulse or the respiration, and to produce no disagreeable secondary symptoms, nor to interfere with the process of digestion. It is best administered in hot liquids, such as a bowl of soup or broth, a cup of milk, tea, coffee, cocoa, etc. The conclusions drawn by Mathes are as follows: 1. Sul- fonal is a useful hypnotic agent, though it is not always effica- cious. 2. It has the advantage over other agents of having no odor or taste, and no influence on the essential organs of life. 3. The worst of its disagreeable effects are insignificant. 4. The dose depends upon the individual susceptibility, and is therefore variable. Generally a gramme is sufficient to cause 424 DENTAL MEDICINE. sleep without accessory manifestations. When these are pro- duced the dose should be diminished. On account of its slow action, it should be given at least an hour before the time for sleep. 5. When the insomnia is due to irritating cough or to pains not clearly neuralgic, the use of sulfonal is contra-indicated. In most true neuralgias, on the contrary, it may be used with benefit. Dose.—Grs. xv to grs. xxx ; but variable, depending upon the individual susceptibility. Stenocarpine, or Gleditschine, is an alkaloid obtained from the tree Gleditschia triacanthus. As a local anaesthetic, Dr. Herman Knapp, in his experiments as to its physiological ac- tion, found it to be fully as energetic as a cocaine solution of equal strength in producing anaesthesia of the cornea and conjunctiva. Dr. Jackson found that the instillation of one drop of a two per cent, solution of stenocarpine caused a slight smarting, followed by dryness of the conjunctiva, dilata- tion of the pupil, and within two and a half minutes complete anaesthesia of the conjunctiva and cornea, lasting for about twenty minutes. These results were obtained in sixteen dif- ferent individuals, in all complete anaesthesia being attained in one or two minutes, and passing off mostly within half an hour. Stenocarpine also appears to produce a wider dilata- tion of the pupil than other local anaesthetics used upon the eye. Applied to mucous membrane of the nose, throat, etc., anaesthesia can be readily produced to an equal, if not more marked, degree than can be obtained by the employment of a solution of cocaine of equal strength; and when applied to the throat or nose the senses of taste and smell are respect- ively suspended. Applied to the skin externally, it causes complete anaesthesia, the method of application being to sim- ply moisten the surface, and keep it continually moist with the solution, when, after ten minutes, a needle may be plunged into the skin without the slightest sensation. To produce painless operations on the healthy skin, the incisions must pass but gradually through the skin, and as each layer is di- vided, the wound must be freely moistened with the solution. APPENDIX. 425 As regards the toxicological action of stenocarpine when given in large doses, the nature of the symptoms of poison- ing which it produces does not appear to be as yet clearly established. Dr. Knapp states that its action is analogous to strychnine, while Dr. Jackson describes stenocarpine as a de- pressor motor poison, and in no case in his experiments does he refer to the production of convulsions. As far as has yet been determined, the physiological action of stenocarpine ap- pears to be closely similar to that of cocaine. 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. ^ 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. Essential Oils.—The volatile or essential oils are compounds of carbon and hydrogen, and differ from the fixed oils, which are compounds of carbon, hydrogen and oxygen, the molecu- lar arrangements of which are similar to the metallic salts and compound ethers—possessing the radicals of certain acids united with hydro-carbons. The essential oils are generally absorbers of oxygen, and such of them as the oils of pepper- mint, cloves, caraway, cajeput, mustard and turpentine are 426 DENTAL MEDICINE. useful obtunders of hypersensitive dentine ; and some are also efficient germicides and antiseptics. From experiments no- ticed by Dr. Harlan, the essential oils are not miscible with water; hence when they are used as a root-dressing they are not contaminated or dissipated by the saliva or the mixed fluids of the mouth. They are capable of depositing vaporiz- able camphors that are powerful disinfectants, and are soluble at a temperature below body heat. They are good menstrua for iodine compounds, and oily dressings, when not too tightly confined in a pulp-chamber, are not vitiated like sub- stances which are soluble in water. They may be allowed to remain for longer periods in the roots of teeth, when it is not possible to fill such roots at once. When an oily dressing (such as oil of peppermint or oil of cassia) is applied in a root canal, after the removal of a pulp by extirpation or its devital- ization by arsenic, it acts as an anodyne and also as an anti- septic, preventing the formation of mephitic gases. The oily dressings may be pumped through roots and fistulous tracts with impunity, and will not clog delicate canals. The solu- tions of the essential oils are all made as follows (Dr. Black): " An excess of the oil is mixed with water by violent shaking continued for some minutes. It is then placed in the incu- bating oven, where the temperature is 990 F., for twelve hours. It is then again violently shaken and returned to the oven for another twelve hours, twenty-four hours in all. It is then carefully filtered, and if not perfectly clear and free from all appearance of oil, it is refiltered until it is clear. The fil- trate is then used as the solution of the oil. The same plan is used in making saturated solutions of the crystalline sub- stances." The prominent essential oils are those of cajeput, cassia, cinnamon, cloves, eugenol, eucalyptol, fennel, mustard, cara- way, peppermint, sassafras, turpentine, thyme, pennyroyal, valerian, wintergreen. In dental practice the oil of cassia di- luted with a bland oil like that of wintergreen is a valuable dressing for putrid root canals and abscesses. Dr. Black recommends the following mixture: APPENDIX. 427 fy. Carbolic acid (melted crystals), I part; oil of cassia, 2 parts; oil of wintergreen, 3 parts. Mix the oils and add the melted crystals of carbolic acid. This is known as the 1, 2, 3 mixture. Dr. Black also says: " After thorough cleaning with the watery form of the antiseptic we need something that will be more enduring in its effects, and according to conditions should choose between the oils and the powders. If it is an abscess with which we have to deal, an oil which is in itself an antiseptic, or an oil holding the antiseptic drug in solution in effective proportions, may be introduced into the cavity and so agitated as best to bring it in contact with all of its parts. This will, on account of its sparing solubility, remain in posi- tion very much longer than the watery forms, and the essen- tial oils are very much more diffusible than the fixed oils, or, indeed any other of the simple forms of the antiseptics with which I am yet acquainted. At the same time a sufficient amount for very extended work is contained in small compass. These are of especial value in such positions as the roots of teeth. In this position any but the most irritating of the an- tiseptic essential oils may be used to good advantage, and may be relied upon for many days together. In the choice of the essential oils it is by no means necessary that the most powerful of them be selected. It should be remembered in making the choice that the more powerful antiseptics are the more irritating, as a rule. It is therefore often best to choose antiseptics of very moderate range, especially where it is only required to preserve a condition of asepsis. For instance, when a very foul root canal is opened such an antiseptic as the oil of cassia is indicated. After appropriate cleaning, and especially in case cleaning is to be deferred for fear of forcing poisonous material through the apical foramen, it may be used in full strength; in which form it may be relied upon as a disinfectant as well. But afterward, when it is only a mat- ter of holding an aseptic condition during the healing of the parts, an antiseptic of shorter range, that is not so liable to injure the tissues, is to be preferred. For this purpose the 428 DENTAL MEDICINE. eucalypti extract in substance is a very useful agent. Its range of actual inhibition is very short, but its injurious ef- fects on the tissues are also very slight, so that the healing process may go on in its presence without hindrance. Fur- thermore, this oil has a very extended range of restraining influence beyond its range of actual inhibition that is un- doubtedly of much use. This oil may be exchanged for ter- pinol where a little more stimulating effect is regarded as beneficial. The oil of cloves and the oil of cinnamon seem to occupy a middle ground and may be made useful in a large class of cases if the others are in any wise distasteful to the dentist or his patient. The oil of mustard, though a good antiseptic of short range, has an irritant action that limits its use. Yet in cases where it is desirable to arouse the tissues from a state of inactivity this action, in a high degree, is com- bined with the antiseptic property. It is also one of the most diffusible of the antiseptic oils thus far studied. " Any of these oils may be used in the emulsion, if, for any reason, it is not thought well to use the oil in substance. This form is especially recommended for surfaces of suppurating wounds and the washing of abscesses. In this way small quantities of the oil may be widely diffused and left in a mul- titude of minute globules to gradually dissolve where it is most wanted, forming a kind of connecting link. between the true solutions and the oils in substance. For this purpose a little of the oil selected may be diffused through water by severe shaking, or better, by repeatedly filling and violently emptying the syringe. The milky emulsion thus formed may be used in the same manner as the solution. " I have said that all antiseptics are poisons. I wish to em- phasize this statement. They are antiseptic by virtue of their power of restraining life forces ; and their use as antiseptics is permitted only by shades of difference in the action of certain poisons toward the different forms of life, by which they affect the fungi more prominently than the animal tis- sues." APPENDIX. 429 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 io " First molars...............12 to 16 " Canines................14 to 20 " Second molars.............20 to 36 " The following diagram, by Dr. Louis Starr,* shows the grouping, the date of eruption and the duration of the pauses between the appearance of each group of temporary teeth. The numbers I to 5 indicate the groups to which the in- dividual teeth belong and their order of appearance, and the letters a and b the precedence of eruption in the different groups. - a a f 2 2 2 2 f WV Is EXPLANATION OF DIAGRAM. I. 1. Between the fourth and seventh months. Pause of 3 to 9 weeks. 2. 2. 2. 2. Between the eighth and tenth months. Pause of 6 to 12 weeks. 3- 3- 3« 3- 3- 3- Between the twelfth and fifteenth months. Pause until the eighteenth month. 4. 4. 4. 4. Between the eighteenth and twenty-fourth months. Pause of 2 to 3 months. 5. 5. 5. 5. Between the twentieth and thirtieth months. PERMANENT TEETH. First molars ... 5 to 6 years Second bicuspids . 10 to 12 years. Central incisors . . 6 to 8 " Canines.....11 to 13 " Lateral.....7 to 9 " Second molars . . 12 to 14 " First bicuspids . . 9 to 10 " Third molars . . . 17 to 21 " * Diseases of the Digestive Organs in Children, Philadelphia, 1886. AUTHORITIES CONSULTED. Pharmacopoeia of the United States. 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. Dental Register. 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. American System of Dentistry. The Epitome. Western Dental Journal. Items of Interest. Dental Advertiser. Odontographic Journal. Dental Review. International Dental Journal. 430 INDEX. TO DISEASES AND DENTAL FORMULARY. A BNORMAL.Dentition ...................37 ■^-~^- Abnormal Sensitiveness of Dentine............55 Abraded Surface of Mucous Membrane of Mouth, 156, 165, 169 182, 183, 229 Abrasion of Teeth........................56 Abrasions by Artificial Dentures.................156 Abscess.......................24, 301, 302, 379 of Antrum..................40, 293, 357, 362, 414 Absorption of Process and Recession of Gum.........57, 178 Acidity and Pyrosis.......................235 Alkaline Gargle.........................396 Alveolar Abscess.....................39, 279, 402 Hemorrhage...................183, 297, 298 Pyorrhoea.....52, 156, 162, 163, 179, 293, 306, 362, 363, 387, 411 Ulceration..........................41 Anaemia.............................10 Anaesthetics, General......109, 187, 251, 255, 282, 287, 333, 342 Local .......................203, 263, 285 Anodyne Lotion.........................245 Antiseptic Dentifrice.....................164, 182 Gargle...........................402 Lotion or Injection.............162, 163, 259, 306, 402 Oils.............................427 Solution for Washing or Spraying Wounds..........163 Aphthae................51, 169, 178, 228, 255, 284, 326 Aphthous Ulcerations...........156, 301, 302, 375, 396, 397 Astringent Dentifrice ......................182 Gargle.....................168, 182, 183 Lotion, Gargle or Mouth Wash..............168, 182 BLEACHING Discolored Teeth......... . 58, 243, 397, 398 Kirk's Method of....................398 Boulton's Preparation...................320 Bruises......................... • 187, 229 Burns..............................176 Burnett's Disinfecting Fluid..................409 CANCEROUS Tumors............47, 51, 142, 151, 220 Ulceration........................26 Cancrum Oris..............142, 235, 284, 379, 414 431 432 INDEX TO DISEASES AND DENTAL FORMULARY. PAGE Carbolized Potash........................162 Styptic...........................164 Caries of Maxillary Bones...............I72» *79» 285 Chapped Hands and Lips.....................369 Chilblains.........................164, 179 Chronic Abscesses and Ulcers............183, 301, 302, 320 Alveolar Abscesses-, Ulcerations, etc. . 39, 183, 301, 302, 320, 321, 414 Inflammation of Gums and Mucous Membrane . . 169, 183, 214, 320 Inflammation of Dental Pulp.................55 Inflammation........................26 Cleft Palate...........................49 Cocaine, To make Preparations of.................271 Convulsions of Dentition...................37, 245 DANGERS of Anaesthesia................ 198, 221 Dental Caries.......................58 Exostosis, or Hypercementosis.............56 Dental Periodontitis.................38, 187, 247, 248 Dentifrices................182, 261, 262, 281, 282, 322 Dentigerous Cysts........................ 47 Denudation, or Erosion.....................57 Deodorizers of Iodoform.....................314 Detergent Mouth Wash or Gargle..............395, 396 Devitalizing Pulps of Teeth.........147,148,151,152,314,338 Diarrhoea of Dentition................38, 235, 310, 329 Diphtheritic Conditions.....................396 Discolored Teeth...................58, 243, 397, 398 Disease of Antrum........................228 Diseases of Dental Pulp...................54, 55 Disinfectant Mouth Wash or Gargle . ... . . .......162, 175 Dislocation of Jaw........................49 Dry Mouth...........................163 Dysuria of Difficult Dentition..................330 EARACHE of Dentition...................259 Ecchymosis........................229 Effervescing Powders...................393 Electro-Magnetism........................78 Emollient and Antiseptic Gargle.................176 Enlarged Glands.........................315 Epithelioma...........................52 Epulis.............................51 Erosion of Teeth........................57 Excessive Sweating of the Hands.................321 Exostosis, Dental........................56 Exposed Pulps.....................245, 254, 271 FACIAL Neuralgia.........186,231,245/372,386,406,407 Paralysis........................50 Febrile Excitement of Dentition..............310 Fetid Perspiration.......................321 Fetor of Breath....................243, 255, 282 Fissured Tongue....................I56, 395, 396 Foul and Fetid Indolent Ulcers..................254 Fracture of Alveolar Process...................43 of Jaw........................." ! 49 Fungous Growths and Suppurating Surfaces..........55, 320 INDEX TO DISEASES AND DENTAL FORMULARY. 433 PAGE r> ALVANO-CAUTERY....................78 ^~* Gangrene of Mouth (Cancrum Oris), 46, 142, 235, 243, 255, 284, 379 . . 4M Gingivitis............................162 Glycerite of Borate of Sodium..................395 Glyceritum Sodii Boratis.....................395 Glycerole of Thymol Preparation.................402 Gutta Percha Solution......................323 HARE-LIP.........................50 Hectic Fever.......................25 Hemorrhage from Extraction of Teeth . . 167, 183, 275, 297, 298 Hyperaemia...........................10 Hypercementosis........................56 Hypersensitive Dentine............55, 182, 211, 271, 406 Hypertrophy of Gums......................52 of Processes.........................56 of Tonsils............................167 Hypnotic............................254 TMPACTED Tooth . ......................48 -*- Incompatibility.......................79 Indigestion .........................359 Indolent Ulcers of Mouth.................. 142, 254 Infantile Bilious Diarrhoea....................329 Mucous Diarrhoea......................329 Inflamed and Ulcerated Gums, 141, 182, 183, 211, 214, 230, 301, 302, 324 369, 376, 377 Fauces and Throat...............142, 214, 217, 377 Mucous Membrane and Gums, 167, 182, 183, 211, 214, 228, 230, 301 302, 324, 369, 376, 377, 414 Inflammation..........................10 of Gums after Extraction of Teeth............369, 375 of Mouth, Syphilitic.....................45 with Special Reference to the Mucous Membrane of the Mouth . 10 Inflammatory Fever.......................19 Inhalation in Syphilitic Ulcerations...........• .... 163 Injections, Stimulant and Antiseptic...............163 Internal Astringent in Hemorrhagic Affections and Dental Hemor- rhage...........................167 Iodoform, Deodorizing of.....................3*4 Topical Application.....................3l6 Irritation............................J 1 of Teething........................37 of Pulp of Tooth.......-.-..•.............54 Ischaemia............................IX Itching of Inflamed Surfaces..................338 of the Skin......................• • 163 LEAD Poisoning.......................43 Local Anaesthetics . . ... .... . . . 187, 203, 245, 254, 259, 271 Lotion for Soft and Spongy Gums, and Loose Teeth ... .183 Loose Teeth and Inflamed Gums.................183 MALIGNANT Ulcerations............45, 52, 151, 2I9 Mercurial Stomatitis .... 43, 178, 211, 228, 255, 262, 320, 326 Micro-organisms, Effects of.............16, 27 Mild Detergent Gargle . . ....................383 28 434 INDEX TO DISEASES AND DENTAL FORMULARY. PAGE Mouth Wash, Chapin A. Harris..................3§3 Washes....................157, 162, x75, 4°2 NASAL Polypus.......................5° Necrosed Teeth .....................58 Necrosis of Alveolar Process................42 Necrosis of the Jaws.......................48 Neuralgia, 186, 187, 231, 232, 245, 254, 259, 271, 283, 299, 314, 349, 372, 386 from Dental Disturbance..............231, 299, 413 in Superficial Nerves.....................231 Neuralgic Affections of the Teeth,.......186, 187, 259, 299, 413 Odontalgia.........................283 C_)bTUNDING Mixtures, Local Anaesthetics, 187, 203, 245, 254, 259, 271 Odontalgia, 163, 164, 183, 186, 214, 254, 259, 271, 275, 279, 302, 314 332, 338 Odontomes..........................57 Offensive Breath......................326, 379 Ointment of Iodoform and Eucalyptus..............315 Organic Defects of Structure...................57 Osseous Tumors of the Jaws...................172 Ossification of Pulp.......................55 Oxychloride of Zinc Preparations...............410, 413 Oxyphosphate of Zinc Preparations..............173, 412 PAIN following Extraction of Teeth.....245, 262, 339, 383, 392 of Difficult Dentition..................271 Parasitic Skin Diseases................163, 179 Periodontitis.........38, 187, 247, 248, 321, 369, 376, 386, 394 Perspiration of Hands, etc.....................176 Phagedenic and Sloughing Ulcers................326 Phenol Sodique Preparations...................392 Phosphor Necrosis........................42 Plethora.............................10 Poisoning . „...........................92 Pulpitis .... 54, 163, 164, 183, 186, 214, 254, 259, 271, 279, 302, 314, 315 as a Capping in.......................315 Pulpless Teeth...............302, 314, 315, 316, 341, 426 Pulveris Effervescentes......................393 Putrescent Pulps ...... 52, 293, 302, 314, 321, 341, 359, 379, 402, 426 Pyorrhoea Alveolaris......................52 RECESSION of Gums...............» .... 57 Relaxation of Uvula....................167 Relaxed Condition of Mucous Membrane of Mouth and Gums, 381 Rheumatic Pains, Bruises, etc...................187 Riggs' Disease (See Alveolar Pyorrhoea). Robinson Remedy........................162 Root Canals of Abscessed Teeth.................316 SALIVARY Calculus, after Removal of.......... 183, 414 Salivation.......................43! 370 Sandarach Solution....................[ 390 Scrofula.............................46 Scorbutic Gums....................142, 169, 183 Scurvy.............................44 INDEX TO DISEASES AND DENTAL FORMULARY. 435 PAGE Sensitive Dentine.............55, 162, 182, 211, 271, 406 Sensitiveness after Removal of Salivary Calculus......183, 414 Shellac Solution..... .................391 Skin Diseases........................163, 164 Sloughing and Ill-Conditioned Ulcers....... .......171 Soft and Spongy Gums.............162, 182, 214, 383, 392 Sore Throat........................ 182, 214 Sore Mouth of Nursing Women................. 155 Stimulant and Antiseptic Mouth Wash and Lotion.........162 and Antiseptic Injection.................162, 163 and Anodyne Lotion.....................245 Stomatitis...........44, 155, 178, 211, 228, 255, 262, 320, 402 Stomatitis of Dentition......................155 Styptic.............................275 Superficial Inflammation ....................211 Suppurating Pulps of Teeth, 52, 293, 302, 314, 321, 341, 359, 379, 402, 426 Wounds.........................163, 311 Suppuration.........................21, 321 Syphilitic Teeth.......................57 Ulceration of Mucous Membrane of Mouth......45, 165, 375 TEETH deficient in Lime Salts............. 239, 241 Thrush........................50 Tonic to Support Strength.................235 Tonsillitis...........................167 Trigeminal Neuralgia................... 299, 367 Tumors of Gums.........'.'............314, 315 of Jaws.........................47, 3J5 ULCERATED Gums.....178, 182, 183, 214, 262, 320, 321, 324 Ulceration...................151, 301, 320 Ulceration and Abrasion of Mouth . . 156, 165, 169, 183, 214. 414 Ulcerous Stomatitis, 45, 178, 214, 228, 285, 301, 302, 320, 321, 324, 375, 376 Ulcers of Mouth ... 45, 142, 178, 183, 165, 228, 254, 285, 293, 375, 379 over Carious Bone......................172 syphilitic..........................45 Ulitis..............................44 VARNISHES, Dental.....................316 Shellac........................391 Sandarach.......................390 Venereal Sore Mouth and Throat.................310 Vomiting and Painful Digestion of Children............235 "\lt TARTS, Condylomata, etc................176, 310 V V Wash after Extraction of Teeth .... 245, 262, 339, 383, 392 Wounds and Ulcers..............163, 311, 392 GENERAL INDEX. PAGE A BBREVIATIONS .... 62 ■**■ Abies Canadensis . . . 422 Abnormal Dentition.....37 Sensibility of Dentine . . 55 Abrasion of Teeth......56 Abscess ..........24 of Antrum.......40 Absolute Alcohol......209 Absorbents.........128 Absorption of Alveolar Process 57 Acacia...........140 Acetate of Alumina.....214 of Ammonia Solution . .215 of Lead.........296 of Morphine.......335 Acetanilide.........223 Acetic Acid.........141 Acidum Aceticum......141 Arseniosum.......142 Benzoicum.......153 Boricum........155 Carbolicum.......157 Chromicum.......164 Cresylicum.......416 Gallicum........165 Acidum Hydrobromicum . . . 168 Hydrochloricum.....168 Muriaticum.......168 Nitricum........170 Nitricum Dilutum .... 170 Phosphoricum......171 Salicylicum.......174 Sulphuricum......176 Sulphuricum Aromaticum 177 Sulphurosum......179 Tannicum.......180 Tartaricum.......183 Trichloroaceticum .... 425 Aconite...........184 Aconitine, Duquesnel's .... 184 Aconitum..........184 Action of Medicines.....10 Acute Inflammation of Dental Pulp . . .......54 PAGB Administration of Anaesthtics . 191 ^Ether...........187 Alcohol...........209 Alkaloids..........136 Aloe—Aloes........211 Alteratives.........121 Alpha-oxynaphthoic Acid . . . 341 Alum............212 Alumen...........212 Exsiccatum.......213 Aluminae Acetas.......214 et Ammoniae Sulphas . .213 Aluminii et Potassii Sulphas .213 Chloridum.......415 Sulphis.........414 Alveolar Abscess......39 about to Point Externally . 40 Pyorrhoea........52 Alveolar Ulceration.....41 American Hellebore.....406 Ammonia..........215 Ammonium.........215 Ammonia Alum.......213 Ammonii Bromidum .... 236 Water........ .215 Spirit of.........215 Aromatic Spirit of......215 Ammonii Carbonas.....217 Chloridum.......219 Valerianas.......218 Amyl Nitris.........221 Amylene..........220 Amylene Hydrate......220 Anaemia..........10 Anaesthetics.........109 Administration of, etc. . . 191 Animal Charcoal......248 Anodynes..........128 Antacids..........122 Antemetics.........128 Anthelmintics........127 Anthemis..........223 Anthridrotics........128 Antifebrin.........223 437 438 GENERAL INDEX. PAGE Antilithics.........122 Antiperiodics........129 Antipyretics.........129 Antipyrine.........224 Antiseptic and Styptic Cotton Wool.........415 Antiseptics.......129, 427 Antispasmodics.......109 Aphthae..........51 Apothecaries' Weight.....64 Appendix..........414 Approximate Measurements . 63 Aqua Acidi Carbolici .... 162 Aqua Ammonia.......216 Camphora.......244 Chlori.........255 Cinnamomi.......263 Creasoti........277 Destillata........225 Fortis.........170 Aralia Spinosa.......408 Argenti Nitras........226 Aromatic Bitters.......130 Prunus Virginiana .... 380 Serpentaria.......390 Aromatic Sulphuric Acid . . .177 Arnica...........229 Arsenic, Tests for......152 Arsenious Acid.......142 Astringents.........no Artificial Respiration.....199 Atropinae Sulphas......230 Atropine..........230 Aurum Terchloridum .... 232 Avoirdupois Weight.....65 BATHS..........136 Belladonnae Folia . . . 233 Belladonnae Radix......233 Benzoate of Lithium.....327 Benzoated Lard.......154 Benzoic Acid........153 Benzoic Sulphide of Sodium .415 Bert's Method of Administer- ing Anaesthetics .... 196 Best Twenty-five Drugs ... 92 Bicarbonate of Potassium . . .371 of Sodium.......393 Bichloride of Mercury .... 304 Bismuthi Subnitras.....234 Bleaching Discolored Teeth, 58 397, 398 Blenorrhetics........119 Bloodletting, General and Local 72 PAGE Blue Stone.........283 Mass..........3°8 Vitriol.........283 Boric Acid.........155 Lint..........155 Ointment........156 Borate of Sodium......394 Borax...........394 Boro-glyceride.......156 Bromides..........235 Bromide of Ammonium . . . 236 of Calcium.......236 of Lithium.......236 of Sodium........236 of Camphor.......246 of Ethyl........287 of Potassium......372 Brucine...........348 Burnett's Disinfecting Fluid . 409 Butyl-Chloral Hydrate .... 282 pADMII Sulphas.....237 ^ Calcii Hypophosphis . . 238 Calcii Lithium........326 Calcined Magnesia......328 Calcium..........240 Calendula.........239 Calisaya Bark........259 Calomel..........307 Calx............240 Chlorata . •.......242 Camphor..........243 Liniment........244 Water.........244 Camphora.........243 Monobromata......246 Camphorated Tincture of Opi- um ..........356 Cantharidal Collodion .... 274 Cajuput Oil.........350 Capsicum..........246 Carbo Animalis Purificatus . . 248 Ligni..........248 Carbolate of Soda......391 Carbolate of Sodium.....391 Carbolic Acid........157 Ointment........159 Water.........159 Carbonate of Ammonium . . .217 of Lime.........279 of Lithium.......326 Caries, Dental........58 Carminatives........131 Carvacrol..........249 GENERAL INDEX. 439 PAGE Cassia Bark.........262 Cataplasms.........137 Cathartics..........115 Causes of Inflammation ... 13 Caustic Potassa.......370 Caustics........124, 131 Cauterants.......124, 131 Cautery, Actual and Potential .125 Cayenne Pepper.......246 Cerates...........138 Chalk*Mixture.......280 Chamomile.....• ... 223 Characteristic Indications of the Tongue......59 Chinoline..........250 Chloral........251 Hydras.......251 Chlorate of Potassa Troches . 375 of Potassium.....374 Chloride of Aluminium . . .415 of Ammonium .... 219 of Iron.......295 of Methyl......418 of Magnesium . . . .416 of Zinc.......408 of Zinc Solution .... 409 of Tin.......416 Chlorinated Lime—Chloride of Lime.......242 Chlorine........254 Water.......255 Chlorinium.......254 Chloroform.......255 Chloroform-Cocaine Narcosis . 258 Chloroformum......255 Purificatum......256 Chromic Acid . . . . . . 164 Chronic Inflammation ... 26 Chronic Inflammation of Den- tal Pulp......55 Cinchona Flava, Pallida and Rubra.......259 Cinnamomum......262 Cinnamon........262 Oil.........262 Water.......263 Citrate of Lithium.....326 Classification of Medicinal Substances.....108 Cleft Palate.........49 Clinical Thermometer.....103 Clysters...........137 Cobalt............153 Cocaine...........263 PAGE Cocaine Hydrochlorate .... 264 Oleate..........264 Citrate. . . * •.....265 Hydrobromate......265 -Chloroform Mixture . . . 270 -Chloroform Narcosis . . 258 Cod-liver Oil.........352 Colchicum..........271 Collodion..........272 Collodium..........272 cum Cantharide.....274 Flexile.........273 Iodidum.........274 Collyria...........137 Compound Syrup of the Phos- phates .........364 Compound Tincture of Iodine . 317 Coloring Agents.......127 Colorless Tincture of Iodine . .318 Condy's Fluid........379 Confections.........137 Conium...........275 Constringents........no Convulsions of Dentition ... 37 Corrosive Chloride of Mercury 304 Sublimate........304 Counter-irritants.......131 Creasote...........276 Ointment........278 Water..........277 Solidified.......277 Creasotum..........276 Creolin...........417 Cresylic Acid........416 Creta Praeparata.......279 Croton-Chloral Hydrate .... 282 Cupping...........74 Cupri Sulphas........283 DANGERS of Anaesthesia . . 198 Deadly Nightshade . . . 233 Decimal System of Weights and Measures.......65 Decoction of White Oak Bark 382 Decoctions..........137 Decoctum Quercus Albae . . . 382 Definition of Subjects—Materia Medica and Therapeutics 9 of various Classes of Reme- dial Agents......108 Demulcents.........126 Dental Caries........58 Exostosis........ Periodontitis.......56 440 GENERAL INDEX. PAGE Dentifrices . . . 182, 261, 281, 322 Dentigerous Cyst.......47 Deodorized Tincture of Opium 356 Deodorizers.........131 Desiccatives.........131 Detergents..........131 Devitalizing Pulps of Teeth . . 147 Dialysed Iron........295 Diaphoretics.........118 Dichloride of Ethidene .... 285 Digestibility of Foods.....60 Diluents...........132 Diluted Solution of Subacetate of Lead........369 Discutients..........132 Disinfectants.........132 Dislocation of Lower Jaw ... 49 Distilled Water........225 Diuretics...........119 Doses of Medicines, Table of . 81 Dover's Powder.......355 Drastics . ,.........116 Dried Alum.........213 pCCRITICS........108 -*-' Effervescing Powders . . 393 Electricity for Relieving Pain of Extraction of Teeth . 78, 205 Methods of Applying . . . 205 as a Therapeutic Means in the Treatment of Disease 74 Electrolysis.........yj Electro-Magnetism for Extrac- tion of Teeth .... 78, 205 Elementary Substance*, Table of...........104 Elixir of Vitriol........177 of Vitriol and Tannin . . . 181 Emetics...........113 Emmenagogues.......120 Emollients........ 126, 132 Emulsions..........137 Enemata...........137 Endermic Method......71 Epispastics..........123 Epithelioma.........52 Epsom Salt.........329 Exudation........• . 20 Epulis........... -. 51 Ergot............285 Erosion...........57 Errhines...........133 Eruption of the Teeth.....429 Escharotics.......124, 133 PAGE Essential Oils........425 Ether............165 Ethidene Dichloridum .... 285 Ethyl Bromidum.......287 Eucalyptol..........292 Eucalyptus..........291 Eugenic Acid........352 Eugenol...........352 Evacuants..........133 Excitants..........133 Exostosis, Dental.......56 Expectorants.........133 Extracts...........137 Extractum Gelsemii Fluidum . 299 Krameriae........324 Exudation..........20 "RACIAL Paralysis.....50 -^ Febrifuges.......133 Ferri Chloridum.......295 Ferrum...........293 Dialysatum.......295 Reductum.......296 Fever of Inflammation .... 19 Fineness of Powder......64 Fomentations........137 Forms of Antiseptics for Use . 425 Forms of Medicinal Substances 136 Fracture of Alveolar Process . 43 of Lower Jaw.....49 French Decimal System . 43 Weights and Measures . 65 Fused Potassa........370 Fungous Growth of Pulp ... 55 Fumigations.........137 GALLIC Acid.......165 Galls..........166 Galvano-Cautery.......78 Gargles...........137 Galvanism..........76 Gelsemium.........298 Germicides.........133 Glacial Phosphoric Acid . . . . 172 Gleditschine........• . 424 Glycerin...........299 Glycerinum . ........299 Boracis.........395 Pepsini.........359 Glycerite of Borate of Sodium . 395 of Carbolic Acid.....159 of Gallic Acid......167 of Tannic Acid......182 GENERAL INDEX. 441 PAGE Glycerites..........137 Glyceritum Acidi Carbolici . . 159 Acidi Gallici.......167 Acidi Tannici......182 Sodii Boratis.......395 Gingivitis..........44 Glacial Acetic Acid......142 Glyceroborate of Calcium . . .417 of Sodium........418 Glycerole of Thymol.....402 Granulation.........21 Green Iodide of Mercury . . . 309 Gum Arabic.........140 Guiacol...........279 Gutta Percha.........322 TT^MATINICS......120 -*- -*■ Haemetics.......108 Haemostatics.........134 Hamamelis.........302 Hare-Lip..........50 Harlan's Method of Treating Alveolar Pyorrhoea . . . 363 Hall's (Marshall) Ready Meth- od in Asphyxia.....201 Hectic Fever.........25 Hemorrhage Fellowing the Ex- traction of Teeth .... 297 Hemlock..........275 Herbst's Obtundent......268 Hoffman's Anodyne.....188 Honey of Borate of Sodium . . 395 Howard's Method of Artificial Respiration and Resusci- tation .........202 Hirudo...........73 Hydrargyri Chloridum Corrosi- vum ..........304 Chloridum Mite.....307 Hydrargyrum........303 cum Creta . . •.....309 Iodidum Viride......309 Hydragogues. . . >......115 Hydrate of Amylene.....220 of Chloral........251 of Potash....._ • • 370 Hydrochlorate of Ammonia . .219 of Morphine.......335 Hydrochloric Acid......168 Hydrobromic Acid......168 Hydrobromic Ether......287 Hydrogen Peroxide......360 Hydronaphthol........341 Hyperaemia.........10 PAGE Hypercementosis.......56 Hypersensitive Dentine . . . .55 Hypersthenics.......134 Hypertrophy of Alveolar Pro- cesses ........56 of Gums.......52 Hynotics........132 Hypodermic Method. . . .71 Hypophosphites......363 Hypophosphite of Lime . . . 238 of Quinine......385 of Sodium ........365 IMPACTED TOOTH ... 48 ■*■ Important Points in Diag- nosing Affections of the Mouth.......37 Incompatibility........79 Inflammation with Special Ref- erence to the Mucous Membrane of the Mouth 10 of Peridental Membrane . 38 of Dental Pulp . . . . 54 of Mucous Membrane of the Mouth, Syphilitic . . 45 Inhalants........138 Injections........138 Infusions........137 Infusum Capsici.....247 Ingluvin...........360 Iodide of Potassium . . . .317 of Zinc........411 Iodine .........316 Iodized Collodion.....274 Iodoform........310 Iodoformum.........310 Iodol............315 Iodum............316 Iridis Rhizome........321 Iron and Preparations .... 293 Irritants...........123 Irritations..........u of Dental Pulp......54 of Teething.......37 Ischaemia..........n Isonandra Gutta.......322 JABORANDI........365 J Jamaica Dogwood .... 366 Japanese Camphor......331 KANDOL.........422 Kino.........326 Krameria..........323 442 GENERAL INDEX. PAGE T ABARRAQUE'S Solution . 325 ■*—' Lacmus........327 Lanolin...........418 Laudanum.........356 Laughing Gas........342 Laxatives..........134 Lead Poisoning.......43 Water..........369 Leeches...........73 Lentitives..........126 Leopard's Bane.......229 Lime............240 Liniment........241 Water..........241 Liniments..........138 Linimentum Calcis......241 Camphorae.......244 Saponis........T 244 Terebinthinae......400 Liquefied Nitrous Oxide . . . 343 Liquor Ammonii Acetatis . . .217 Calcis..........241 Ferri Perchloridi.....295 Ferri Subsulphatis .... 296 Gutta Percha.......323 Plumbi Subacetatis Dilutus 369 Potassii Arsenitis.....146 Sodae Chloratae.....325 Potassii Permanganatis . . 379 Zinci Chloridi......409 Listerine..........154 Lithium.......... . 326 Lithii Benzoas........327 Lithii Bromidum.......236 Lithii Carbonas.......326 Lithii Citrate.........326 Lithii Salicylas........326 Lithontriptics........122 Litmus...........327 Local Anaesthesia .... 203, 269 Bloodletting.......73 Lotions...........138 Lunar Caustic........226 MAGNESIA.......328 Magnesii Chloridum . .416 Magnesii Sulphas......329 Marigold..........239 Marshall Hall's Ready Method 201 Matico...........330 May Apple.........370 Measurement of Medicinal Sub- stances ........6^ Meadow Saffron.......271 PAGE Menthol...........331 Mel Boracis.........395 Sodii Boracis......156 Mercury...........303 with Chalk ....... 309 Bichloride of......304 Mercurial Ointment.....309 Poisoning........43 Mercuric Chloride......304 Mercurous Chloride.....307 Methyl Chloride.......418 Methyl Ether........333 Methyl-Ethylic Ether .... 333 Metric System of Weights and Measures.......65 Micro-Organisms.......27 Mild Chloride of Mercury . . 307 Mistura Cretae........280 Mixed Chloroform Narcosis . . 258 Mixtures...........138 Monobromated Camphor . . . 246 Monsel's Solution and Powder 296 Morphina..........333 Morphinae Acetas......334 Hydrochloras or Murias . 335 Sulphas.........335 Morphine..........333 Narcosis........258 Muriate of Ammonia . . . .219 of Morphine......335 Muriatic Acid........168 Myrrh............339 Myrrha...........339 TVTAPHTHALIN......340 -^ Napelline.......184 Naphthalene........340 Naphthol..........341 Narcotics..........108 Nasal Polypus........50 Nauseants..........114 Necrosed Teeth.......58 Necrosis of Alveolar Process . 42 of Jaw.........48 Nelaton's Method of Resuscita- tion ..........199 Nervines..........134 Neurotics..........108 Nitrate of Silver.......226 of Potassium......376 Nitre............376 Nitric Acid.........170 Nitrite of Amyl.......221 Nitrous Oxide........342 GENERAL INDEX. 443 PAGE Nitrous Oxide, Action and Ad- ministration of . . 345, 346 Nitrous Powders.......377 Nutritives..........134 Nux Vomica.........348 f^BTUNDING Mixtures, Use W of...........206 Odontomes.........57 Oil of Cajuput.......350 of Camphor.......245 of Cinnamon......262 of Cloves........351 of Peppermint......426 of Pyrethrum......381 of Sanitas........400 of Sweet Almonds .... 349 of Turpentine......399 of Vitriol........176 Oils, Essential........425 Ointment of Carbolic Acid . . 159 of Galls.........167 of Tannic Acid.....182 of Veratrine.......405 Ointments..........138 Oleate of Aluminum.....421 of Arsenic........421 of Bismuth.......421 of Cadmium.......422 of Copper........421 of Lead.........420 of Mercury.......420 of Nickel........422 of Silver........422 of Zinc.........420 Oleates, Medicinal .... 138, 419 Oleum Amygdalae Dulcis . . . 349 Cajuputi........350 Camphorae.......245 Caryophilli.......351 Cinnamomi.......262 Eucalypti....... 292 Morrhuae........352 Sanitas.........4°° Terebinthinae......399 Opium...........353 Organic Defects of Structure . 57 Orris Rhizome........321 Root..........321 Ossification of Dental Pulp . . 55 Oxide of Potassium.....370 of Zinc.........411 Oxyphosphate of Zinc Filling Material.......173 PAGE pAPAIN or Papaiva . . . .357 -*■ Paraldehyde......357 Pellitory..........380 Peppermint Camphor . . . .331 Pepsin...........358 Pepsinum..........358 Saccharatum......358 Perchloride of Iron.....296 Periodontitis.........38 Permanganate of Potassium . 377 Peroxide of Hydrogen .... 360 Peruvian Bark........259 Petroleum Ointment.....403 Phenate of Sodium.....391 Phenol Sodique . . .162, 391, 392 Phosphate of Lime......364 of Sodium........364 Phosphates.........363 Phosphites.........363 Phosphorus......... 364 Phosphor Necrosis......42 Phosphoric Acid.......171 in the Anhvdrous State . .172 Pills .....'.......138 Pilocarpus..........365 Pinus Canadensis......422 Piscidia Erythrina......366 Pix Canadensis.......423 Plasters...........138 Plethora..........10 Plumbi Acetas........367 Podophyllum........370 Poisons...........92 Symptoms and Antidotes for, Acids, Mineral ... 93 Aconite.........93 Alkalies.........93 Antimony........93 Arsenious Acid.....94 Argenti Nitras •.....94 Atropine........94 Belladonna......94 Cannabis Indica .... 94 Cantharides.....94 Carbolic Acid.....95 Chloral.......95 Chlorine Water .... 95 Chloroform......95 Conium.......96 Copper, Sulphate of. . . 96 Corrosive Sublimate . . 96 Creasote.......96 Croton Oil......96 Digitalis.......96 444 GENERAL INDEX. PAGE Poisons, Hydrocyanic Acid . . 97 Hyoscyamus.....97 Iodine.......97 Lead Salts......97 Mercury ....... 98 Morphine......98 Nux Vomica.....98 Opium.......98 Oxalic Acid......98 Phosphorus......98 Potash and Soda Salts . . 98 Silver, Nitrate of. . . .99 Stramonium.....99 Strychnine......99 Tobacco.......99 Zinc Salts......99 Poke Root........406 Posological Tables.....81 Potassa Alum......213 Caustica.......370 cum Calce......371 Potassii Bicarbonas . . . .371 Potassii Bromidum.....372 Chloras.......374 Iodidum.......317 Nitras.........376 Permanganas......377 Poultices..........138 Pulpitis...........54 Powdered Subsulphate of Iron 296 Precipitated Chalk......279 Prepared Chalk.......279 Preventive Measures against Dangers of Anaesthesia . 199 Prickly Ash.........407 Prince's Method of Treating Alveolar Abscess . . . 362 Protectives - ......126 Protiodide of Mercury .... 309 Protoxide of Nitrogen .... 342 Prunus Virginiana......380 Pulse, the..........99 Variations in, Frequency of 100 Pulvis Ferri Subsulphatis . . . 296 Ipecac et opii......355 Purgatives.........134 Purified Animal Charcoal. . . 248 Pus.............21 Pyorrhoea, Alveolar.....52 Pyrethrum.........380 QUERCUS Alba......381 Quicksilver......303 Quillaia Bark.....382 PAGE Quillaya Saponaria......382 Quininae........260, 383 Hypophosphis......385 Sulphas.......260, 3.83 Quinine...........260 Quinoline..........250 RAPID Breathing as a Pain Obtunder.......206 Refrigerants.........135 Recession of Gums.....57 Reduced Iron........296 Resolvents.........135 Resorcin..........386 Respiration at Various Ages . 102 Restoratives.........135 Resuscitation, Methods of. . . 200 Rhatany..........323 Rheum...........387 Rhigolene..........388 Rhubarb..........387 Riggs' Disease........52 Robinson Remedy......162 Rubefacients........123 Rules for Administering Anaes- thetics ........194 for Regulating Doses ... 68 C ACCHARATED Pepsin . . 302 •^ Sal Ammoniac.....219 Salicylic Acid........174 Salicyl Resorcin Ketone . . . 387 Salicylate of Lithium.....326 Salicylate of Sodium.....396 Salivation..........43 Saltpetre..........376 Sandaraca..........389 Sandarach.........389 Sanitas...........351 Scarifications........74 Scurvy...........44 Scrofula...........46 Sedatives..........112 Sensitive Dentine......55 Serpentaria.........390 Sesquicarbonate of Sodium . . 393 Setons and Issues......72 Shellac...........390 Sialagogues.........135 Soap Liniment........244 Sodae Phenas........391 Sodii Bicarbonas.......393 Boras..........394 Bromidum.......236 GENERAL INDEX. 445 PAGE Sodii Hypophosphis.....365 Pyrophosphas......365 Phosphas ........ 364 Salicylas........396 Sulphis.........396 Solubility of Chemicals in Water and Alcohol . . 105 Solution of Acetate of Ammo- nia ..........217 of Chlorinated Soda . . . 325 of Chloride of Zinc . . . 409 of Gutta Percha.....323 of Permanganate of Potas- sium .........379 of Subsulphate of Iron . . 296 Soporifics..........108 S. Am. Soap Tree Bark ... 382 Spastics...........113 Spirit of Chloroform.....257 of Cinnamon......263 of Nitrous Ether.....189 of Mindererus......217 Spiritus ^Etheris Compositus . 188 yEtheris. Nitrosi.....189 Camphorae.......244 Chloroformi.......257 Cinnamomi.......263 Spinants..........113 Stannum Chloridum.....416 Stenocarpine........424 Stimulants.........in Stomachics.........in Stomatitis..........44 Gangrenous.......46 Ulcerous........45 Mercurial........43 Syphilitic........45 Strychnine.........348 Strychninae Sulphas.....348 Syphilitic Inflammation of Mouth........45 Styptic Colloid.......182 Cotton.........415 Styptics...........I36 Subnitrate of Bismuth .... 234 Subsulphate of Iron.....296 Sugar of Lead........367 Sudorifics..........118 Sulfanol...........423 Sulphate of Atropine.....230 of Cadmium......237 of Copper........283 of Magnesium......329 of Morphine......335 PAGE Sulphate of Quinine . . . 260, 383 of Strychnine......348 of Zinc.........413 Sulphite of Aluminium .... 414 of Lime.........238 of Soda.........396 Sulpho-Carbolates of Zinc, So- dium, Potassium, Mag- nesium, Calcium and Quinine......160 Sulpho-Carbolic Acid. . . .159 Sulfonal........423 Sulphonal........423 Sulphuric Acid......176 Ether........187 Sulphurous Acid.....179 Suppositories.......139 Suppurants.......124 Suppuration.......21 Sylvester's Method of Resusci- tation .......200 Symptoms of Inflammation . 17 Synopsis of Treatment of Af- fections of the Mouth . 37 Syphilitic Inflammation of the Mouth.......45 Teeth........57 Syrup of Lacto-Phosphate of Lime.....241, 364 Syrups.........139 Syrupus Calcii Lacto-phospha- tis........241 Hypophosphitum.... 364 TABLE of Doses of Medi- cines .......81 of Equivalents.....68 Tannic Acid.......180 Tartaric Acid.......183 Tartrate of Chinoline .... 250 Terchloride of Gold .... 232 of Phenol......398 Terebinthina.......399 Terebinthene, Terpine, Terpi- nal Terebene .... 400 Teriodide of Formyl .... 310 Terminations of Inflammation . 28 Tests for Arsenic.....152 Tetraiodopyrrol......315 Thermometers......102 Thiersch's Method of Morphia Narcosis......258 Thrush......... 50 Thymol.........401 446 GENERAL INDEX. PAGE Tinctura Aconiti......185 Arnica.......229 Calendula......240 Capsici.......247 Eucalypti......292 Gelsemii.......299 Iodi........318 Iodi Composita . . . .318 Krameriae......324 Myrrhae.......340 Opii........356 Opii Camphorata .... 356 Opii Deodorata . . . .356 Pyrethri.......381 Tinctures........139 Tonics.........no Topical Remedies . . . 70, 108 Treatment of Dangerous Symp- toms of Anaesthesia . . 199 of Inflammation .... 29 Trichloroacetic Acid .... 425 Troches of Chlorate of Potas- sium .......375 Troy Weight.......64 Tumor of Jaws, Malignant Form of......47 of Upper Jaws.....47 Turpentine.....r . 399 ULCERATION, Alveolar. . 41 Ulcers of Mouth, Syph- ilitic .......45 Ulitis.........44 Unerupted Impacted Tooth . . 48 Unguentum Acidi Carbolici. . 159 Acidi Tannici.....182 Boricum.......156 Creasoti.......278 Gallae........167 Hydrargyri......309 ■yALERIAN......403 * Valerianate of Ammonium 218 PAGE Varnish, Colored.....391 Aqueous.......391 Transparent ..... 390 Dental.......3'6 Vaselin.........4°3 Vaseline........4°3 Veratrina........4°5 Veratrine........405 Veratrum Viride......406 Vesicants......123, 136 Vinum Opii.......355 Pepsini.......359 Virginia Snake Root .... 390 Vitalized Air.......197 Voltaic Narcotism.....205 \X7"ALB'S Method of Using * " Cocaine......269 Obolinskie's Method. . . 270 Raymond's Method . . . 269 Weights and Measures ... 64 White Oak Bark.....381 Witch Hazel...... . 302 Wild Cherry.......380 Windle's Method of Admin- istering Anaesthetics . . 198 Wine of Opium.......355 Wood Charcoal.......248 VANTHOXYLUM.....407 \/ELLOW Cinchona .... 259 ■^ Jasmine.......298 Yversen's Method of Admin- istering Anaesthetics . . 198 VINCI Chloridum.....408 ^ Iodidum.......411 Oxidum.........411 Sulphas.........413 APRIL, 1889. 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Medical Soc. of Bombay, etc. Dr. Hector C. Cameron, Surgeon and Lecturer to Western Infirmary, Glasgow; Surgeon to Glasgow Hospital for Children, etc. William Macewen, m.b., m.d., Lecturer on Systematic and Clinical Surgery, Royal Infirmary; Surgeon to Royal Infirmary and Children's Hospital, Glasgow, etc. WITH COLORED PLATES AND NUMEROUS WOOD ENGRAVINGS. Octavo. 650 Pages. Cloth, $4.50 ; Leather, $5.50. A treatise on Diseases of the Skin, with reference to Diagnosis and Treatment, including an Analysis of 11,000 Consecutive Cases. Thoroughly illustrated by new and handsome wood engravings, and several colored and steel plates prepared, under the direction of the author, from special drawings by Dr. John Wilson. PARTICULARLY STRONG IN TREATMENT. J8^° Special attention is given to the Differential Diagnosis of Skin Diseases and to the treatment. There are over 150 prescriptions, which will serve as hints to the physician in dealing with obstinate and chronic cases. 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With Many Improvements for 1889. 38th YEAR. The Physician's Visiting List. (LINDSAY & BLAKISTON'S.) CONTENTS. Almanac for 1889 and 1890. Table of Signs to be used in keeping accounts. Mahshall Hall's Ready Method in Asphyxia. Poisons and Antidotes. The Metric ok Fhench Decimal System of Weights and Measures. Dosb Table, revised and rewritten for 1888, by Ho- (bart Amory Hare, m. d., Demonstrator of Thera- peutics, University of Pennsylvania. List cf New Remedies for 1888, by same author. Aids to Diagnosis and Treatment of Diseases of the Eye, Dr. L. Webster Fox, Clinical Asst. Eye Dept. Jefferson Medical College Hospital, and G. M. Gould. Diagram Showing Eruption of Milk Teeth, Dr. Louis Starr, Prof, of Diseases of Children, Univer- sity Hospital, Philadelphia. Posological Table, Meadows. Disinfectants and Disinfecting. Examination of Urine, Dr. J. Daland, based u/>on Tyson's "Practical Examination of Urine." 5th Edition. Incompatibility, Prof. S. O. L. Potter. 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Interleaved, tucks and Pencil, 1.25 5o " " II 1.50 5o il " *v*- {feSrT} «*■ 3-oo PERPETUAL EDITION, without Dates. f3§£*Can be commenced at any time, and used until full. Similar in style, con- tents and arrangement to the regular edition. No. 1. Containing space for over 1300 names, with blank page opposite each Visiting List page. Bound in Red Leather cover, with Pocket and Pencil, $1.25 No. 2. Containing space for 2600 names, with blank page opposite each Visiting List page. Bound like No. 1, with Pocket and Pencil.....1.50 These lists, without dates, are particularly useful to young physicians unable to estimate the number of patients they may have during the first years of Practice, and to physicians in localities where epidemics occur frequently. " 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."—Gaitlard's Medical Journal. ., {?' , become Standard."—Southern Clinic. 11 uS ■ as the season3 comes this old favorite."—Michigan Medical News. •1 tVS qUlte convenient for the pocket, and possesses every desirable quality."—Medical Herald. <« w km°St P°P " VisitinS List extant."—Buffalo Medical and Surgical Journal. • < 'Pif- aXe.u. 1\'oryears» a"d do not hesitate to pronounce it equal, if not superior, to any."—Southern Clinic. ., ... Visiting List is too well known to require either description or commendation from us."—Cincinnati Medical News. J USX READY. THE SEVENTH REVISED AND ENLARGED EDITION OF ROBERTS' PRACTICE. THE THEORY AND PRACTICE OF MEDICINE. By Fred. T. Roberts, m.d., f.r.cp., Professor of Materia Medica and Therapeu- tics at University Hospital, Physician to Univers:.*v College Hospital, etc. Seventh Edition. Revised and Enlarged. One vc.-roe, 8vo., with nu- merous Illustrations. Cloth Binding, $5.50; Leather, $6.50 The present edition has been fully revised throughout, and in some parts rewritten or re- arranged. While an endeavor has been made to bring every subject up to date in all its aspects, special attention has been given to the questions of treatment, with the view of bringing into notice important therapeutic agents or methods which have been recently introduced. The unexceptional large and rapid sale of this book, and the universal commendation it has received from the profession, seems to be a sufficient guarantee of its merit as a Text-book. The publishers are in receipt of numerous letters from professors in the medical schools, speaking favorably of it, and below they give a few extracts from the medical press, American and English, attesting its superiority and value to both student and practitioner. The present edi- tion has been thoroughly revised and much of it re-written. " The best Text-book for students in the English language. We know of no work in the English language, or in any other, which competes with this one."—Edinburgh Medical Journal. " Dr. Roberts' book is admirably fitted to supply the want of a good Handbook, so much felt by every medical student."—Student's fournal and Hospital Gazette. " There are great excellencies in this book, which will make it a favorite with the student." — Richmond and Louisville Journal. "We heartily recommend it to students, teachers, and practitioners."—Boston Medical and Swgtcal Journal. " It is unsurpassed by any work that has fallen into our hands as a compendium for students." The Clinic. " We particularly commend it to students about to enter upon the practice of their profession." —St. Louis Medical and Surgical Journal. " If there is a book in the whole of medical literature in which so much is said in so few words, it has never come within our reach."—Chicago Medical Journal. BY THE SAME AUTHOR. NOTES ON MATERIA MEDICA AND PHARMACY. ESPECIALLY ARRANGED FOR THE USE OF STUDENTS. 16mo, Cloth, $2.00. For sale by all Booksellers; or will be sent by mail, postpaid, on receipt of price by the Publishers, P. Blakiston, Son & Co., 1012 Walnut Street, Philadelphia. "IT STANDS WITHOUT AN EQUAL AS THE MOST COMPLETE WORK ON PRACTICE IN THE ENGLISH LANGUAGE."—New York Medical Journal. FAGGE'S PRACTICE OF MEDICINE. Two Large Royal Octavo Volumes. Containing over 1900 Pages. PRICE, HANDSOMELY BOUND IN CLOTH, S8.00. The Principles and Practice of Medicine. By CHARLES HILTON FAGGE, M.D., F.R.CP., F.R.M.C.S., Examiner in Medicine, University of London ; Physician to, and Lecturer on Pathology in, Guy's Hospital; Senior Physician to Evelina Hospital for Sick Children, etc. EDITED AND ARRANGED FOR THE PRESS By P. H. Pye-Smith, M.D., F.R.CP., Lecturer on Medicine in Guy's Hospital, London, etc., WITH A SECTION ON CUTANEOUS AFFECTIONS, BY THE EDITOR, A CHAPTER ON CAR- DIAC DISEASES, BY SAMUEL WlLKES, M. D., F.R.S., AND TWO INDEXES, ONE OF AUTHORS AND ONE OF SUBJECTS, BY ROBERT EDMUND CARRINGTON. Two Volumes. Royal Octavo. 1900 Pages. Price in Cloth, $8.00. Full Leather, $10.00. Half Morocco, $12.00. Half Russia, $12.00. It is based on laborious researches into the pathological and clinical records of Guy's Hospital, London, during the twenty years in which the author has 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 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. It is the first of importance emanating from Guy's Hospital, and the only two-volume work on the Practice of Medicine that has been issued for a number of years. Several subjects, such as Syphilis, that are usually omitted or but slightly spoken of in a general work of this character, receive full attention. Dr. Walter Moxon, one of Dr. Fagge's contemporaries, and a great personal friend, writes of him, in a recent number of the London Lancet:— " Fagge was, to my mind, the type of true medical greatness. I believe he was capable of any kind of excellence. His greatness as a physician became evident to observers of character very soon after his brilliant student career had placed him on the staff of Guy's Hospital: he did not merely group already known facts, but he found new facts. Former volumes of Guy's Hospital Reports contain ample and most valuable proof of his greatness as a physician. His power of observation was sustained by immense memory, and brought into action by vivid and constant suggestiveness of intelligence. He was a physician by grace of nature, and being gifted with a quickness of perception, a genius for clinical facts and a patience in observation, he was at onc« recognized as a successful practitioner and a leading figure in the hospital and among the profession. 3i~> Aavaail IVNOIIVN dNIJICIdW do Aa NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDIC '. dNiDiasw do Aavaan tvnoiivn SNOiaaw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiiv NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE SNiDiasw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn snidiqsw do Aavaan lvrjoiivr NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE SNioiasw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn -a o NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE "5 Na- SNOiasw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn snidiqsw do Aavaan tvnoiivn NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE IONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 4 v_ Diasw do Aavaan tvnoiivn snidiosw do Aavaan tvnoiivn snioiosw do Aavaan tvnoiivn IONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 15 X. £;5. ) Q. 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