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358 DENTAL MEDICINE
pelled from the syringe, and the gum at the point the needle of
syringe is to enter, should be obtunded by applying a few drops of
the solution to the mucous membrane, so as to render the punc-
ture painless. It is recommended to inject the solution at three
points, two punctures on the labial or buccal surface, and one on
the palatine or lingual surface. The point of the needle should
be inserted about one-sixth of an inch below the free margin of
the gum, and pressed in obliquely, upwards or downwards, as the
case may be, in a direction towards the apex of the tooth, until
the point of the needle rests against the bone ; all of the soft
tissues must be penetrated. With the needle in position, and a
finger placed on either side and pressed with some force against
the gum to keep the tissues in place, the solution should be
slowly injected, when the gum should appear completely blanched
in the neighborhood of the puncture. After injecting the solu-
tion the needle should not be withdrawn for several seconds, and
then a finger should be placed over the puncture to prevent anv
escape of the solution. Some six or seven minutes elapse before
the full anaesthetic effects of the cocaine are obtained. Dr. Gask
recommends placing a few crystals of the salt just around the
neck of the tooth to render painless the application of the forceps,
and he prefers for injection hydrochlorate of cocaine in the form
of half-grain tabloids. Rinsing the mouth with hot water before
the injection of cocaine solution, and again afterwards, and re-
peating the injection, is a method which is attended with satis-
factory results.
The best syringe for hypodermic use consists of one made alto-
gether of metal with no leather packing as this is unclean. The
metal piston is accurately ground to fit the metal barrel, and the
piston should be touched with glycerine before using the syringe,
as this is easily washed off. Such a syringe can be boiled with-
out the slightest injury, which should be done every time it
is used.
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 in-
jects in the neighborhood of the seat of operation, and during its