Local anesthesia : its scientific basis and practical use / by Heinrich Braun ; translated and edited by Malcolm L. Harris.

  • Braun, Heinrich, 1862-1934.
Date:
1924
Catalogue details

Licence: Public Domain Mark

Credit: Local anesthesia : its scientific basis and practical use / by Heinrich Braun ; translated and edited by Malcolm L. Harris. Source: Wellcome Collection.

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    Bleichsteiner, in 1892, reported 1400 extractions. Following the use of dilute solutions the anesthesia of the alveolar process became insufficient. It was possible to anesthetize the gums and alveolar periosteum with certainty, but the pulp and peridental membrane could rarely be suffi¬ ciently anesthetized for dental operations. The author does not believe that Legrand, a pupil of Reclus, should be credited with the statement that all extractions can be rendered painless with the use of a 1 per cent solution of cocaine, nor does he believe those who are sceptical regarding the use of any injection. Laewen and Quere made the following state¬ ments regarding cocaine injected into the gums and as to its anesthetic effect upon teeth with living pulp: (1) In no case is absolute anesthesia obtained; (2) in the majority of cases there is a marked lessening of pain; (3) in a certain number of cases cocaine does not seem to produce a per¬ ceptible analgesia. Quere, Reclus, and Dastre agree that in the latter class of cases osteoperiostitis of the alveolar process is present. Those with the formation of abscesses and inflammatory infections of the gums are the cases, however, in which anesthesia is most necessary. The con¬ ditions are different for the physician because he sees patients whose teeth have been neglected and frequently extracts teeth which the dentist could have preserved. For ten years the author has extracted teeth with a 1 per cent cocaine solution and he agrees entirely with Quere. This applies not only to cases as above mentioned but also to persons with thick bones in whom the anesthesia frequently failed in extraction of the lower molars. The patient could never be promised a painless extraction, for which reason this method of injection has never been generally accepted. According to the author’s experience the anesthesia is more certain if a more dilute solution is used and the gums and alveolar periosteum infil¬ trated with Schleich’s solution. One thing is certain, that these solutions do not produce serious general symptoms when used for these injections. The infiltration of the gums and periosteum with Schleich’s solution only produces a satisfactory anesthesia when the tooth to be extracted has been freed of its pulp. The local anesthetic methods have not been materially improved by the countless combinations of various anesthetic substances. With a 2 or 3 per cent /3-eucaine (Reclus, Thiesing) and tropacocaine solutions (Dillenz and others) approximately the same.effect is obtained as from a 1 per cent cocaine solution. More highly concentrated solutions of these agents are not free from possible injury and their use may be associated with considerable danger. A description of the various substitutes for cocaine has already been described in Chapter VII. Reports of injury to the gums following the injection of anesthetic solutions occupy a most important place in dental literature. All of the pain-relieving drugs have been attended with swelling and edema of the tissues following injection, but it is difficult to determine whether the swelling should be attributed to the injection or the extraction. The most carefully performed extraction is always followed by more or less crushing of the bone or soft parts and naturally takes place in an operative field which is always infected^with