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COCAINE. 359
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 excitant 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. (See Vapocaine.) A
mixture of cocaine and guaiacol in crystalline form, made into a
thick paste, is recommended for hypersensitive dentine.
Dr. A. C. Gask recommends painting the palate with a five
per cent, solution of cocaine for obtaining impressions of mouths
which exhibit great intolerance to the introduction of all impres-
sion materials; also a 20 per cent, solution applied to the mucous
membrane on cotton, for service in wedging and separating teeth,
in forcing silk, etc., up in high conical edges, in removing por-
tions of overhanging gum, in lancing abscesses, in treating
alveolar pyorrhoea, in extirpation of pulps, and in the treatment
of teeth very sensitive from periodontitis; also in the form of a
i^ grain compressed tabloid placed in the cavity, to relieve the
pain following extraction.
Dangers of Cocaine.—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, second-
arily, the heart; its evil effects are most liable in neurotic sub-
jects ; 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 admin-
istration 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.
Patients of a sanguine temperament and in good health are the