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354 DENTAL MEDICINE.

the fault of want of cleanliness in this particular, and not to the
employment of the drug.
The quantity of cocaine required to produce anaesthesia varies
with the operation and its extent; as a rule for ordinary minor
operations from 25 to 40 minims of a four per cent, solution are
needed. The length of time necessary for the production of
local anaesthesia or insensibility under cocaine varies from three to
ten minutes.
Dr. Bier, of Kiel, quite recently, claimed that by throwing small
quantities of very dilute cocaine solutions into the spinal canal,
the nerves are affected at their roots, and the lower part of the
body is rendered completely insensible to pain, the effect lasting
about three-quarters of an hour. Very curiously, perception of
heat and cold, as well as of touch and pressure, are not affected.
Severe operations, it is claimed, have been satisfactorily per-
formed, but the after-effects—such as dizziness, severe headache
and vomiting—are quite as unpleasant and more prolonged than
those following chloroform and ether.
Dental Uses.—In operations in the mouth, affecting the
mucous membrane and the immediately subjacent tissues, the
salts of cocaine have proved efficient for their local anaesthetic
and anodyne effects. But for operations on deep-seated tissues,
such as are involved in the extraction of teeth, the action of pure
cocaine is not certain in its practicable benefits. Cocaine has,
however, proven very efficient in relieving the pain of the surgi-
cal treatment of alveolar pyorrhoea, the extirpation of the pulps
of teeth, and, in some cases, that of hypersensitive dentine. Ex-
posed pulps are rendered less painful after being treated with a
five per cent, solution of cocaine, to which, in some cases,
morphine has been added. In some cases also, it is claimed,
highly inflamed pulps have been successfully capped, as an ex-
periment, 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 struc-
ture the stronger the solution of cocaine to be employed. The
pure cocaine in the form of crystals, of the hydrochlorate or
other salts, has proven efficient when applied to hvpersensitive