Local Obtundents.
BY A. W. HAIDLE, D.D.S.
Read before the 38th Annual Meeting of the Michigan Dental Association.
Local obtundents, or to use a more general term, local anaes-
thetics, are employed to temporarily abolish the sensibility of a
part, and allow slight incisions or operations to be made pain-
lessly.
Their effect is in some degree due to a paralysis of the end
plates of the terminal branches of the cutaneous nerves, and
possibly to some extent to a sedative action upon the blood ves-
sels and tissues, analagous to that which is produced by rubbing
or scratching, which gives temporary relief in itching. Local
obtundents may be divided into two general groups:
1st. Agents which are applied or administered as drugs,
either singly, or in combination with others.
2nd. Agents which are applied to produce thermal changes.
In the first division we find the following : aconite, atropine,
campho-phenique, carbolic acid, chloral, chloroform, cocaine,
menthol, morphine, opium, pyrethrum and veratrine.
As thermal agents we may employ : ice, ether spray, rhig-
oline, chloride of ethyl and chloride of methyl.
The greater number of the remedies mentioned in the first
group are rarely used alone, being more frequently employed in
combination with other drugs, and we find in our dental litera-
ture and text-books, and in the discussions of dental societies,
numerous formulae given, some of which are good, others ineffi-
cient, and, skill, others which should be used with great caution.
In order to construct a formula which shall prove efficient in
obtunding the sensibility of the oral tissues, it will first be well
to examine into the histology and physiology of these tissues,
and into their relations with the general nervous and vascular
systems. We find that the mucous membrane covering the
alveolar process consists of an epithelial covering, lying upon a
connective tissue stroma, the tunica propria. The epithelium is
of the stratified squamous variety, and is continuous with the
epidermis on the one hand and with the covering of the pharynx
on the other. It occupies a place as regards power of absorption,
midway between the two, having greater power of absorption
than the epidermis, and less power than the mucous membrane
of any part of the alimentary canal below the mouth. The
tunica propria is composed of interlacing bundles of fibrous con-
nective tissue, and possesses numerous simple papillae, which
encroach on the epithelial layer, but do not appear on the free
surface of the mucous membrane.
The larger blood vessels lie within the sub-mucous tissue, and
give off branches which extend through the deeper layers of the
mucosa to the superficial portions of the connective tissue
stratum ; on reaching the outer boundary of the latter the arte-
ries break up into rich sub-epithelial capillary networks, and
where papillae are present, enter the minute elevations to supply
their apices with terminal capillary loups. The nerve-fibers,
largely of the medullated variety, accompany the blood-vessels,
and end in a sub-epithelial plexus; and special terminations—
the end bulbs—are found in the apices of some of the papillae.
It will readily be seen that for the drug to accomplish its
purpose of destroying sensibility, it must pass through the several
layers of cells which make up the epithelium, and which range
from the irregularly-shaped columnar and polyhedral cells, to
the large, flat and scaly type so characteristic of the outer layers
of stratified squamous epithelium, and must therefore possess in
a marked degree either the power of penetration or the property
of being easily absorbed.
By comparison with the mucous membrane lining the lower
portions of the alimentary canal, it is found that while the
mucous membrane of the stomach and of the intestines is espe-
cially adapted to the function of absorption as well as of secre-
tion, that of the mouth is distinctively a secreting and not an
absorbing tissue.
When, therefore, the power of penetration or the property of
being easily absorbed are not inherent in the drug which is to
form the basis of the formula, it becomes nfecessary to add a drug
which will aid absorption.
Absorption can be aided in two ways : first, by increasing
the circulation at the point of application, which can be accom-
plished by gently rubbing the part, or by the application of irri-
tant substances ; and second, by the use of an agent possessing
endosmotic power. Such agents we have in chloroform and ether.
Water, oils and resins do not have this property.
It is thought by some that alcohol possesses powers of endos-
mosis, but Waller has proved by experiments on the skin that
this is not true. While it is as great a solvent of the sebaceous
matter found in the skin as chloroform, it is not absorbed as
quickly as this agent. Experiments on this point were made
with iodide of potassium, which is a drug very readily detected
in the urine. Waller, therefore, concludes that absorption is
aided more by the endosmotic than by the solvent power of a
drug.
If the basis of a formula is not sufficiently powerful in its
action, an adjuvant should be added—a drug which will inten -
sify or enhance the action of the basis. Such a drug we again
find in the volatile liquids mentioned above, which are also aids
to absorption. Heated applications act more energetically by
increasing the circulation in the part.
It may be necessary to add a corrective to the formula. The
basis may be too irritant or caustic and its harmful effects must
be corrected. These effects may be either local or general, and
the corrective used depends entirely upon the nature and action
of the drug to be corrected. Only a few years ago chloral was
extensively used as a local anaesthetic, and its irritant and caus-
tic effects were demonstrated by the many cases of inflammation
and sloughing of the part which resulted.
The local and the general effects of chloral are antagonized
by carbolic acid, by atropine and by several others of the alka-
loids. The nature of the action of these antagonistic drugs seems
to be somewhat obscure. In commenting upon it, Brunton says :
" Some regard the effect of one drug in counteracting another as
a case of chemical combination or substitution, the second drug
either becoming added on to a compound of the first with some
of the tissues; or else displacing it from such a compound with
the tissues. Others, again, think that no chemical action of this
sort takes place, but that each drug acts upon the tissue by itself,
— one, for example, exciting, and the other paralyzing."
Again, it may be necessary to add to the formula a limiting
agent, a drug which will limit the endosmotio power of the basis.
This may be accomplished in two ways : first, by the action of
coagulants on the albumen of the protoplasm of the tissue cells ;
and second, by coagulative action on the blood capillaries and on
the albumen of the serum contained in the tissues. Coagulation
of the albumen of cell protoplasm may be produced by the use
of such agents as carbolic acid, tannic acid, lead acetate, mer-
curic chloride, silver nitrate, copper sulphate, zinc chloride, etc.,
all of which combine with the albumen to form albuminates.
Coagulation of the albumen of the serum in the tissues, and of
the blood capillaries, may be produced by the use of astringents,
including among those already mentioned as coagulants, others
of the mineral and vegetable acids, alcohol, alum, and still other
salts of the heavier metals.
In nearly all cases it will be necessary to employ a diluent,
and the agent employed for this purpose should also be a solvent.
The nature of the diluent must depend largely upon the nature
of the basis, the diluents commonly used being chloroform, ether,
alcohol, distilled water and glycerine.
Finally, it must be observed that the mixture is antiseptic,
and that the agents employed are compatible with each other, to
such a degree at least as not to prevent the accomplishment of
the desired result. The mixture should be reasonably stable.
It will not be necessary to add to the formula a drug for each
effect, for an agent may be employed to accomplish several)
results. As an example of such an agent chloroform may be-
mentioned ; this may be employed as an adjuvant, an aid to
absorption, a diluent, and it is also a solvent of almost unlimited'
power and scope. A good formula is given in Gorgas' Dental'
Medicine, which is as follows:
R.	Tinctura aconiti..............j fl. ounce.
Menthol.....................x grains.
Chloroformi.................j fl. drachm.
M. S. Apply freely to gum about tooth for several minutes.
Aconite forms the basis and is a powerful nerve sedative. Its
action when applied locally is to irritate the sensory nerve end-
ings, causing a peculiar numbness and tingling, and afterward
paralysis. Menthol is employed as an adjuvant, has marked
antesthetic action and is also antiseptic. The chloroform is the
diluent and is an aid to absorption as well.
Another, and an excellent formula from the same source is
as follows :
R. Chloroformi purificati..........
Tincturte aconiti.............
Alcoholis, aa.................j fl. ounce.
Morphinte sulphat....... .....vj grains.
M. S. Apply for one or two minutes to gum over root of
tooth to be extracted.
A formula constructed by Dr. von Bonhorst contains :
R. Chloroformi.....................
Aetheris sulph................
Spiriti lavandulte............
Pyrethri (fl. ext.), aa...... j fl. ounce.
M. S. Apply for one or two minutes to gum over root of
tooth to be extracted.
Among the drugs employed without combination with other
-drugs cocaine is the most important. An alkaloid occurring in
colorless, transparent prisms, its salts are readily soluble in chlo-
roform, ether, alcohol and water, and are rapidly absorbed.
The dose is gr. ss to gr. j. For epidermic application a
solution in chloroform may be used varying in strength from a
>6 per cent, to 20 per cent, solution. Dr. Hewitt, of Chicago,
recommends the following formula for all operations about the
.gums:
R.	Cocaine .......................cxx grains.
Atropine........................grain.
Strophanthin..................I grain.
Naphthol hydrate .............x grains.
Oil of cloves...... ..........
Oil of cassia.................
Chloroform, aa................ij drachms.
Glycerine.....................-j drachm.
The basis of this formula is cocaine, which used in this
amount and proportion makes a 22 per cent, solution, very
strong for epidermic application. It should be used with cau-
tion, and never be injected into the gums. This formula is
deficient in correctives. Stroplianthin is a very unstable and
unreliable heart stimulant, and the quantity of atropine is too
small. Carbolic acid would be more efficient as a corrective
than naphthol.
Among the thermal agents mentioned, ice is never used as an
anaesthetic, but is frequently employed to reduce inflammation,
having a pronounced sedative effect. The ether spray is rarely
employed, not being so effective as others of the thermal agents
mentioned.
Rhigoline, one of the lighter products of petroleum distilla-
tion, is also rarely used because of its odor and the inconvenience
of its application. It is a colorless liquid, of a disagreeable odor,
quite volatile and inflammable, and produces an effect similar to
the other volatile, freezing agents.
Chloride of ethyl is probably the most convenient and pop-
ular of the thermal agents of the present day. It is a clear,
colorless liquid, possessing an agreeable, ethereal odor, and boils
at 50° F. It is manufactured in France and is not found in the
U. S. P. It is produced by the action of chlorine on ethyl alco-
hol, and is found in commerce in glass flasks which contain
about three drachms. The method of application is to break the
point of the flask, and after having protected the surrounding
tissues, to direct the spray to the part to be anaesthetized. It
evaporates very readily and causes intense cold, completely
freezing the part, and rendering all slight operations painless.
The best effect is produced when the flask is held at a distance of
ten or twelve inches from the part, thus allowing the liquid to
become vaporized before reaching the tissues. The patient
should be instructed to breathe through the nose, and care should
be taken that the application is not too prolonged, for if the part
be too much deprived of blood, death, and subsequent sloughing
of the tissue results. The anaesthetic stage is indicated by a
whitening of the tissues and by the formation of ice crystals on
the free margin of the gum.
Chloride of methyl, though not so extensively used, because-
of its greater comparative cost and the clumsiness of the appa-
ratus in which it is contained, is a gas at 70° F. with a slight
ethereal odor. It can be liquefied by pressure, and in commerce
we find it in the liquid state held in copper flasks which contain
about one quart.
As the chloride of ethyl, it is manufactured in France and is
not found in the U. S. P. It is made from the remnants of
beets UBed in the manufacture of beet sugar, extracting from
these remnants the chlorate of tri-methylamine, which upon the
addition of heat produces chloride of methyl. Its action differs
from the action of the chloride of ethyl only in intensity, the
former producing more cold and in less time than the latter.
DISCUSSION. —COCAINE. —LOCAL OBTUNDENTS.
Dr. Carrow, Ann Arbor, Mich.: My learned colleague
has given us some very interesting facts concerning the action of
cocaine upon the lower animals. But we must bear in mind the
fact that there is a great difference between experimentation
upon the lower animals in the laboratory and the practical use
of the drug which the pharmacist furnishes us.
I would not disparage the value of such experiments, for they
are of much service to us. But when we are told that a drug
has a certain effect upon the lower animals we must not think
that the same drug will necessarily produce a like effect on the
human animal. I have found cocaine a safe and effective ana??,
thetic. I use a great deal of it in my practice. During the
school year I have used, in my hospital practice, five ounces of
cocaine. That is a large amount. In my private practice I, of
course, do not use so much. Ordinarily I apply this in 4 per
cent, solution, although I do use it in 6, 8, and in the nose, 10
per cent, solutions, being careful not to apply too much of the
stronger solution. And yet, without exercising extreme care,
either with respect to the patient or the strength of the solution,
I can recall but one case where I have had trouble. In this
case there was an idiosyncrasy against the UBe of this drug of
which the patient was aware. She had a decided intermittent
pulse. The operation was the removal of a truncated body
which occluded the nostril. I gave her cocaine. I noticed none
-of the manifestations which my learned colleague has told us
appear as a result of the administration of cocaine, except the
irregular action of the heart. All other symptoms, dilation of
the pupil, hurried respirations, etc., usually present under chlo-
roform anaesthesia, I found in this case.
After an extensive use of this drug I am convinced that it is
one of the best anaesthetic agents, at least for the ophthalmol-
ogist. I am partial to the large crystals of Parke, Davis & Co.
In operating upon the eye I drop the solution on the cornea.
After four applications, made three minutes apart, two drops
applied each time, the eye is sufficiently benumbed to enable me
do open the eye and to perform the necessary operation without
the slightest sensation on the part of the patient, and by this I
mean absolutely does not feel it.
When operating upon small tumors, epithelioma of the
tonsils or a small growth on the pharynx, I use about a quarter
of a drachm of the 4 per cent, solution, going around every
side of the tumor. The blood-letting which naturally follows
the making of the incisions is sufficient to overcome what might
otherwise be a dangerous tendency. I have been called in by
other physicians in cases where there was exhilaration followed
by extreme nervous condition and a low condition generally of
the system, after the use of cocaine ; and I have experienced the
same thing in my own practice. But in all these cases a gener-
ous dose of whisky was sufficent to do away with all ill effects.
I think in dental practice the solutions used are not strong
enough. Probably we will never arrive at the stage when anaes-
thesia, especially that produced by cocaine, will entirely benumb
the tissues at the end of the fangs of the tooth, because we can-
not reach the spot so as to deposit the cocaine there. But if the
drug be applied about the superficial parts of the tooth I am sure
the extraction can be accomplished without the patient having
the slightest sensation. And if, instead of a one-half per cent,
solution a drop or two of an 8 or 10 per cent, solution be applied
to the surrounding surface before the rubber dam is adjusted,
and as is so frequently the case, the thread or clamp jammed up
into the alveolar process, operations would be painless and the
irritation attendant upon such operations done away with.
As to the newer preparations of cocaine, which Dr. Cushny
tells us are to come into general use, I would say the old prepara-
tion—hydrochlorate of cocaine—is good enough for my purpose ;
it is in itself a perfect drug.
Dr. Hoff, Ann Arbor, Mich.: Do you use a corrective
remedy in connection with cocaine solution?
Dr. Carrow : I use simply a water solution except, in
some cases, I accompany the hydrochlorate of cocaine with
atropine ; the effect of the atropine is greatly increased when the
same quantity of hydrochlorate of cocaine is added to it.
C. P. Pruyn, D.D.S., Chicago, Ill.: Shortly after Nikolsky
made his first experiments I procured some cocaine and began to
use it locally, but with little effect as we used it at that time.
I then began a series of experiments, using dogs for this purpose.
The learned gentleman who has preceded me tells us that exper-
iments upon dogs, and those upon man are not analogous.
There are, however, many things that we need to know that can
be learned only through experiments upon the lower animals.
Many times I have seen symptoms that would have alarmed me
had I not seen the same things when experimenting upon dogs.
Usually I procured two dozen dogs and paired them accord-
ing to size and make-up. To one I gave cocaine; to its mate I
administered the same dose of cocaine but first reinforced it with
an antidote. For this purpose I found morphine best. I gave
the morphine say twenty minutes before administering the
cooaine.
I used small doses in all experiments as well as in practice.
In one case five minims of a 4 per cent, solution produced
marked dyspnoea. I now use altogether a 2 per cent, solution ;
I find I can accomplish with it all that I formerly accomplished
with the 4 per cent, solution. I am surprised that Dr. Carrow
should recommend such large doses. At Goshen, Indiana, death
occurred from the administration of a little more than one grain.
Doubtless many of you have seen reports of this case. The
gentleman was about fifty years old. He was a banker, a man
of sedentary habits ; he was not well preserved. He suffered
from rheumatism and neuralgia and had chronic diarrhoea. He
went to a dentist for an operation, as he was suffering so greatly
from neuralgia. Seven or eight minims of a 2 per cent, solution
of cocaine was given him and the operation performed satisfac-
torily. A month later he went to another dentist who gave him
eight minims of a 4 per cent, solution and extracted several
roots. In neither case were there toxicological effects. Ten days
later, having other roots to be extracted, he went to the first
dentist. This dentist had, in the mean time, seen a report of a
formula published by Dr. Barrett, of Buffalo, which was as fol-
lows :
R. Atropiae..................................grain
Strophanthii.........................I grain
Cocaine mur..........................1 grains
Acidi carbolici......................x grains
01. caryophyli....................... 3 minims
Aqua distil...........................j ounce
He injected of that about ten minims, or possibly, a little
more. Instantly there was a state of collapse and in twenty
minutes the man was dead. Cases of this sort alarm us.
I took my little son, a lad of about ten years, to a rhi-
nologist to have a simple operation performed on the nose. I
took him about eleven o'clock in the morning, a time when
digestion had taken place. The doctor applied a 10 per cent,
solution of cocaine by means of a swab. The poisonous effects
were rachelwilliams@example.net. The little lad was given aromatic
spirits of ammonia and whisky. He soon recovered. A week
later I again took him to the doctor, at the same hour of the day,
but I gave him a cup of coffee and a sandwich as reinforcement.
The same amount of the solution was used as before, but there
were no ill effects. A short time after that he was taken again
for a similar operation, at the same hour, but without the rein-
forcement. Everything was apparently all right. The opera-
tion was performed and the little fellow started from the office ;
then the poison began to take effect, and it was with the greatest
difficulty that he reached my own office. The spasmodic effects
were very marked in this instance. I applied the usual restor-
atives and resorted to artificial respiration.
In the name of my profession I would like to enter a protest
against the claims made for cocaine by the gentleman who pre-
ceded me. It seems to me this drug is one that should be
handled with a great deal of care. In dental practice the sys-
temic effects of the drug are more marked than in cases of
amputation of limbs, for instance, for the vital nerve centers are
reached through the reflexes in operations about the mouth.
All these patent nostrums, put forth as specifics for pain, have
as their active principle cocaine. Somebody is going to suffer;
thousands have already suffered. Note the way in which rhi-
nologists use it. There is a case of chronic catarrhal condition;
perhaps an operation has been performed. A prescription con-
taining cocaine is written out. The patient takes it and expe-
riences relief. He gets more of it, and then a little more, and
thus is established a habit far more terrible than the opium habit.
Cocaine is a good remedy. I myself use it. But do not let
us abuse the good things we have. Let all who intend to
make use of this drug first experiment on the lower animals that
they may become familiar with its action.
A French doctor is using cocaine in oil with a little acid for
preservation. He thinks the cocaine is not so readily absorbed
as when used with water. I have had no experience with this
myself.
Dr. Cushny: I am gratified that so high a tribute should
be paid to experimental pharmacology. The experimental phar-
macologist was quite aware of the anaesthetic properties of cocaine
twenty years before it came into use in medical practice. You
will find it described in the text-book, for example, written in
1880, in which the author described fully the local anaesthesia
produced by this drug; and although this book was written four
years before the introduction of the drug, cocaine iB there recom-
mended in cases of operation upon the eye and upon the larynx.
I am much surprised that so small a dose as that given in the
■case at Goshen should have resulted in death. It is perhaps a
question whether the drug used was pure or not, and whether
death was not due to shock rather than to the drug. This same
question arises in connection with the use of chloroform and ether,
from the use of which so many deaths occur, especially in dentis-
try. Many times death is caused by shock. Complete insensi-
bility is not always produced; the nervous system is weakened
both by the drug and by the shock and death results.
I think different antidotes are indicated according to the stage
of poisoning. If the exhilaration reaches a sufficiently high point
a narcotic, such as chloral, is indicated ; in the stage of depression,
undoubtedly the best drug is caffein injected subcutaneously or
taken through the mouth, as suggested by Dr. Pruyn. This
drug is a stimulant to the heart and to the nervous system.
The idea of using cocaine in oil is certainly a very curious one.
It might retard the action of the cocaine, but before the drug
takes effect it must be absorbed. I do not see that the oil is of
■special benefit.
Dr. Carrow: I feel that I must attempt to clear myself
from the rather grave charge brought against me. Now, if I
were to have anything done to my teeth I should want to go to
such a man as Dr. Pruyn. He evidently is a close observer, and
a careful and conscientious man—that is the kind of man I try
to be in my own practice.
Now I do not want to advocate cocaine too strongly ; I hardly
know that I can. But I would like to ask this question : Because
now and then death has occurred from the use of nitrous oxide,
■will you discard it ? I think not. Because we have reports of
deaths occurring from the use of chloroform, shall we empty our
carboys of this drug and let our patients stand the shock occasioned
the nervous system by the amputation of a limb or the removal
of a tumor? I think not. Care should be exercised in using
this drug, but I believe in giving it. In the case cited at Goshen,
who knows what effect that particular combination of drugs may
have had? I believe in a 4 per cent solution of cocaine. I make
this solution fresh every morning. I take a drachm bottle which
my little pipette is made to fit, and pour into it a drachm of
saturated solution of boracic acid—which is as near water as you
can get—then I turn out into my hand from my cocaine bottle
what I think is about two grains—I never measure it exactly—and
put that into the bottle. If at night any of this solution is left
it is thrown away and a fresh supply made the following morning.
By exercising care in this way and reinforcing the patient, as
suggested by Dr. Pruyn, I ams ure no ill effects will follow, and
we may proceed with the full conviction that we are doing the
best possible for our patients with the sanction which science,
through experimentation upon the lower animals, has given us.
I am glad Dr. Pruyn spoke of the liability of contracting the
cocaine habit—a most fascinating habit. I never write out a
prescription for cocaine. I buy the drug rayself and often the
patient is not aware what he is taking ; I am particular about
this, especially if I think the person morally weak; for a strong
man I would have no fear.
Dr. Taft : I would like to ask Dr. Pruyn the relative effect
of cocaine when applied to the surface and when injected.
Dr. Pruyn : The effect of cocaine when applied locally is
not so marked as when injected. In the latter case the effect is
almost instantaneous.
Dr. Watling: Have you ever had trouble with sloughing
at the point where the needle is inserted ? I myself am a little
shy of cocaine and have not used it much. But I have often seen
this trouble when the drug has been injected; it is a question in
my mind whether this is caused by the drug itself or by poison
on the needle.
Dr. Pruyn: I have seen this effect but think it is due
usually to dirt on the needle, or perhaps to septic poison on its
point, not to the drug.
Dr. Watling: Is this more likely to occur on the gums
than anywhere else ?
Dr. Pruyn : No.
Dr. Taft : I do not know much about cocaine, but from the
results produced when it was first introduced I have always re-
garded it as an unsafe agent to use miscellaneously. In the use
of anything to which great danger is attached, the operator should
be in the best possible condition, physically and mentally; the
dentist because of business pressure or physical depression, is fre-
quently not in a condition to make clear discriminations, and I
think this is the cause many times of ill results. Where a dan-
gerous agent is employed, as in the case of cocaine, special regard
should be given to this point.
Dr. Birge : At no time have tools and appliances been so
perfect rachelwilliams@example.net. Yet with all our improved machinery all
our advanced, scientific methods of treatment, operations upon
the teeth are attended with more or less pain. How to eliminate
this is a subjeot which is receiving more attention from the pro-
fession than any other at the present day. And here the charla-
tans too are active; one cannot pick up a paper that has not one
or more advertisements setting forth that by using some patent
nostrum teeth may be extracted without pain.
The very able papers to which we have listened this morning
and the discussions upon them will certainly enable us the better
to cope with this matter. But all that has been said has been along
the line of extraction. I think there are many other cases in which
the dentist can make good use of cocaine. In the small cavities
up under the gums it is well to touch the gum with a 10 or 20
per cent solution for a few moments before adjusting the rubber
dam and the clamp ; you will find there is not so much complaint
about the clamp's hurting. When extracting the pulp I use a
spoon-pointed syringe, injecting the cocaine in and around the
pulp; then open with bur and extract with a barb. This can
be done without pain to the patient and enables one to clean out
the pulp and fill the tooth at one sitting. I have been afraid to
inject cocaine directly for extraction of teeth. As Dr. Carrow
has stated, it is hardly possible to inject cocaine deep down at the
apex of the root because of the alveolar prccesB; but injection
into the gums will help the first taking hold of the tooth.
I have always held it a religious duty not to inject any prep-
aration whose formula I did not know. It is not safe nor is it
just to the patient.
I have used ethyl chloride a great deal and like it. Some-
times it leaves the gums intensely red and sore ; a little vaselire
rubbed on will relieve this. The following formula is one which,
although I have not yet used sufficiently to speak with entire con-
fidence, will, I think, prove very good:
R. Sulph. atropine.......................4 grain
Strophan thin.......................4 grain
Carbolic acid (95 per cent.).........v gtts
Hydrochlorate cocaine.......................xx	grains
Distil, water........................q. s. j fl. ounce
I inject four to six drops hypodermically.
I think the profession should "squelch" patent nostrums,
and that all dental journals advertising such remedies should be
taken off the list. Dentists can make up their own formulae ; if
we cease buying these nostrums they will soon be withdrawn
from the market.
Dr. Bethel, Kent, Ohio: I have always been very con-
servative in using drugs. Cocaine I consider a very dangerous
article and think it should be used very cautiously. Indeed, it
is a question in my mind whether it should be used at all hypo-
dermically, especially above al or 2 per cent, solution. I think,
too, a third person should be present when it is administered,
just as in the case of administering chloroform or nitrous oxide.
Of course, there is a question as to whether the ill effects from the
use of cocaine be due to the drug itself or carelessness in using
it—whether to the impure article or septio poison due to an
improperly kept syringe.
There is a great demand in these days for cheap things, and
in order to cheapen some articles it is necessary to adulterate
them ; hence, many of our dental medicines are impure, cocaine
among others. Of course, to obtain the best results our drugs
must be pure. On the other hand, a drug may be pure when
purchased but become impure through improper care. This is a
point which is very important. If possible procure all drugs in
•original packages from reliable dealers.
All dental societies should take some aotion in regard to
patent nostrums. To the gentleman who spoke a few moments
ago in regard to striking from the list all journals advertising
■patent nostrums, I would say the editor is not always responsi-
ble for the action of the publishers in advertising matters, and in
justice to the publishers, I might say that many times they would
prefer not to print such advertisements—they often do not
receive any pay for it.
There is a great demand for painless extraction. And
undoubtedly, as Dr. Taft has said, most of the formulae on the
market for producing anaesthesia contain more or less cocaine.
If a formula could be obtained that would be effectual and not
contain this drug it would be a great boon to the profession as
well as to suffering humanity.
I give a formula which, while I do not claim it to be the
ideal anaesthetic, yet is one from which I have obtained good
results:
R. Carbolic acid crystals..............10	grains
Gum camphor........................ 8	grains
Iodoform........................... | drachm
Listerine.......................... 2	ounces
Pond's extract of hamamelis........ 2	ounces
In the preparation of this the carbolic aoid and gum camphor
should be mixed first. (Gum camphor when mixed with carbolic
acid crystals melts down and forms a clear liquid.) To this add-
the iodoform followed by the listerine and hamamelis. The
bottle should be shaken occasionally for, at least, twenty-four
hours. The liquid is then filtered. Iodoform has considerable
ansesthetic properties; camphor is said to increase solubility
of the iodoform. Not all the iodoform is dissolved and what is
taken up is held mechanically in the mixture, but enough is
incorporated by constant shaking.
Dr. Hoff : I have thought that if we had some formula
upon which we all could report, our attention would in this way
be called to the question of formula-making and in this way we
might be able to do something toward doing away with quack
nostrums. I offer the following for test:
R. Cocaine.............................| grain
Morphine sulph ......................| grain
Atropine (tablet)....................grain
Carbolized water (|	per cent.).......xxx gtts
As you will observe, this formula contains both morphine and
atropine. Morphine acts more promptly when introduced as a
preliminary drug. All three ingredients are local ansesthetics.
According to Dr. Cushny's statements the whole of this prepa-
ration could be safely used. I scarcely ever use more than five
or six drops for six teeth.
Dr. Taft : Every well informed, self-respecting dentist who
feels prepared for his profession should have a thorough knowl-
edge of the things entering into his equipment. He who makes
use of patent nostrums has not that knowledge. In a general
way he may know of what the compound is composed, but the
exact formulae is not disclosed, for obvious reasons, and he who
uses them acknowledges his own weakness; he is worshiping
unknown gods.
In relying too much upon anaesthetics we are weakening our
influence over our patients. There is a certain psychical power
which every dentist and physician, too, has or ought to have
over his patients, which causes that person to have implicit faith
in whatever you may do or say. When such patients come to
you and the question is asked: " Do you wish to take an anaes-
thetic ?" reply, " Oh, no. I do not suffer very much under
your hands." If we resort too freely to anaesthetics this confi-
dence on part of the patient is destroyed. Therefore, I would
say to you, especially the younger members of the profession,
bear in mind that you have a power which you ought to cultivate
and use for the benefit of your patient, and not throw aside for
these things out of the use of which so much iniquity, danger
and harm are likely to arise.
Dr. Jackson: There is one thing which has not been spoken
of. How many of you are careful to use pure distilled water ?
It is just as easy to introduce poison into the system through the
water used as in any other way. It is well, too, even if you have
disinfected the instrument, to dip its point, just before using, into
carbolic acid.
Dr. Pruyn was asked to give his method of injecting.
Dr. Pruyn : I do not know that my method is very different
from that employed here at the University of Michigan. I use
a hypodermic glass barrel syringe with a minim gauge on the
flange. This gauge I consider very important. On my own
instrument there is a little bar on the piston which can be set at
any point on the gauge. By using this sort of instrument there
is no danger of injeoting more of the fluid than is intended. I
have cut off the point about one half; the ordinary hypodermic
syringe point is too long for our work. A fine point is best, but
not one so fine as to be too elastic.
I think the point of Dr. Jackson's a very good one. Even
when sterilized water is used it is well to dip the point of the
instrument into some antiseptic solution, for disease germs float-
ing about in the air may have been deposited there. Bichloride
solution, or a week solution of cinnamon water are, I think, prefer-
able to carbolic acid. The cinnamon solution need not be strong
enough to act as an escharotic solution is apt to weaken it; for
that reason cinnamon is perhaps better for this purpose.
Dr. Parker : I have found very good results from the
injection of aqua pura. I have tried this remedy in perhaps half
a dozen cases of broken roots. It works admirably. No bad
effects follow its use, and according to the patients, operations
under it are painless. Probably this is the result of the psychologi-
cal effect spoken of by Dr. Taft.
Dr. Pruyn : I have used this same valuable prescription in
many cases and I could not distinguish the slightest difference
between its effect—so far as sense of pain is concerned—and those
of a 4 per cent solution of cocaine. I have had no sloughing nor
ill effect of any kind. I have imagined that better results were
obtained when warm water was used.
Dr. Parker: I have thought it best to use water just as
cold as I could.
Dr. Pruyn : I have thought that perhaps the effect from
use of water came from pressure upon the nerve terminal filaments.
There may be something in this.
A Member: A young lady presented herself to me to have
some roots extracted. She had been told to ask for cocaine or
something of that kind. I offered nitrous oxide but she did not
wish to take that. I applied extract of hamamelis and extracted
three teeth painlessly.

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