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360 DENTAL MEDICINE.

most favorable subjects in the use of cocaine ; while the nervous,
hysterical, and those exhibiting great dread of the impending
operation, as well as pregnant women, may be regarded as un-
favorable subjects. Great care should also be taken to prevent
even the weakest solution of cocaine from running down into the
fauces, and restorative agents should always be at hand.
Cocaine appears to be absorbed with extraordinary rapidity,
and the stronger the solution which is locally applied, the greater
the danger of toxic symptoms. The rapidity of the absorption
varies in the different tissues, absorption occurring most rapidly
through the conjunctiva, then through the nose, larynx, mouth
and ear. A ten per cent, solution is sufficiently strong for most
purposes, and is less dangerous than one of greater strength.
Treatment of Cocaine Poisoning.—The treatment of cocaine
poisoning consists of measures to rouse the heart, especially
ighalations of the nitrite of amy!, and such restoratives as
brandy, whiskey, aromatic spirits of ammonia, strychnine,
atropine, digitalis, ether and chloroform (when convulsions
are present), or five minims of carbonate of ammonia by
injection. The hot baths, hot drinks, and hot sinapisms
over the heart, and friction are often serviceable; also artifi-
cial respiration. M. Elroy recommends flagellation with wet
towels, massage, and artificial respiration, if asphyxia threat-
inhalations of chloroform against tetanization of the
ens ; res-
piratory muscles ; where there is great pallor to provoke vaso-
dilatation, and to diminish the encumberment of the central cir-
culation by the inhalation of amyl nitrite. If these means prove
ineffectual and deglutition is impossible, give hypodermic injec-
tions of caffein and of sulphuric ether (15, 30, even 45 minims).
M. Chouppe recommends in addition the hypodermic injections
of morphine, but only in the very outset, and as large as from
one-half to five-eighths of a grain.
Efforts should be made to moderate the reflex excitability of
the nervous system, sustain the heart, and reestablish the equilib-
rium of the blood-pressure.
Dr. Curtis recommends a preparation called volasem as an
antidote to the effect of cocaine.