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Title: A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century

Author: Vincenzo Guerini

Release date: May 3, 2016 [eBook #51991]
                Most recently updated: October 23, 2024

Language: English

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*** START OF THE PROJECT GUTENBERG EBOOK A HISTORY OF DENTISTRY FROM THE MOST ANCIENT TIMES UNTIL THE END OF THE EIGHTEENTH CENTURY ***

  ————————————————————————————————————————————————————————
  Transcriber’s note:

  No major corrections have been made in the text, except
  a few to have consistency in spelling and hyphenations.
  Captions have been added to the portraits of dentists for
  clarity.
  —————————————————————————————————————————————————————————

  PUBLISHED UNDER THE AUSPICES OF

[Illustration: The National Dental Association’s mark.]

  THE NATIONAL DENTAL ASSOCIATION
  OF THE UNITED STATES OF AMERICA

  A
  HISTORY OF DENTISTRY

  FROM THE MOST ANCIENT TIMES
  UNTIL THE END OF THE
  EIGHTEENTH CENTURY

  BY
  DR. VINCENZO GUERINI, CAV. UFF.

  SURGEON-DENTIST, NAPLES, ITALY; DENTIST BY APPOINTMENT
  TO THE ROYAL HOUSE; DENTIST OF THE SURGICAL CLINIC OF
  THE UNIVERSITY OF NAPLES; EDITOR OF THE ITALIAN REVIEW
  L’ODONTO-STOMATOLOGIA; AUTHOR OF MANY ODONTOLOGICAL
  WORKS; HONORARY PRESIDENT AD VITAM OF THE ITALIAN
  ODONTOLOGICAL SOCIETY; MEMBER OF THE ITALIAN SOCIETY OF
  SCIENTISTS, LITERARY MEN, AND ARTISTS; OFFICER OF THE
  ORDER OF THE CROWN OF ITALY; DOCTOR OF DENTAL SURGERY
  AD HONOREM OF THE CHICAGO COLLEGE OF DENTAL SURGERY;
  HONORARY MEMBER OF THE NATIONAL DENTAL ASSOCIATION,
  U.S.A.; MEMBER OF THE EXECUTIVE COUNCIL OF THE FEDERATION
  DENTAIRE INTERNATIONALE; TITULAR MEMBER OF THE SOCIETY OF
  THE PARIS DENTAL SCHOOL AND DISPENSARY; HONORARY MEMBER
  OF THE ODONTOLOGICAL SOCIETY OF MALAGA, ETC.

  With 104 Engravings and 20 Plates

[Illustration: Printer’s mark.]

  LEA & FEBIGER
  PHILADELPHIA AND NEW YORK
  1909

  COPYRIGHT, 1909
  BY THE
  NATIONAL DENTAL ASSOCIATION OF THE
  UNITED STATES OF AMERICA




PREFACE.


The idea of writing a History of Dentistry first suggested itself to me
ten years ago, when I was charged by the Organizing Committee of the
Eleventh International Congress of Medicine with the reproduction and
description of all the appliances of ancient dental prosthesis existing
in the museums of Italy.

The highly interesting researches in which I then became engaged in
order to carry out worthily the important mission intrusted to me,
awoke in me the desire to gain still further acquaintance with all
that relates to dental art in the time of the ancients. I was thus
urged on to ever fresh efforts, not only in the discovery of prosthetic
appliances and other objects of ancient dentistry, but in the study,
as well, of dental literature and of all the written matter that might
throw light on dentistry in past ages.

This subject has already occupied many before me, and each one has
brought to it his contribution of greater or less value, some in the
form of short pamphlets, others in that of larger works.

The end I proposed to myself was to write a History of Dentistry which
should be much more complete, more circumstantial, and more exact than
those published hitherto, and which, instead of being, as are many of
these works, simply a compilation, should represent, at least in part,
the fruits of personal research and scrupulous examination of a vast
number of works of various kinds containing elements utilizable for the
purpose.

The first part of my work, which I now offer to the public, comprises
the remote origin of Dentistry and its development throughout the ages
as far as the end of the eighteenth century. In a short time I hope to
publish the second part of it, viz., the History of Dentistry during
the last hundred years.

I have carefully collected the greatest possible number of historical
data, keeping in view the consideration that some facts, although of
little value in themselves, may possess a certain importance for the
student desirous of procuring historical information relating to some
particular point of dental science.

If this book should, as I hope it may, contribute to the diffusion of
exact historical knowledge as to the origin and gradual development of
dentistry, my labor will not have been lost, for it will have realized
the object, a highly practical one, which has guided me in writing it.

  VINCENZO GUERINI.




CONTENTS.


  PART I.

  FIRST PERIOD—ANTIQUITY.


  CHAPTER I.

  DENTAL ART AMONG THE EGYPTIANS                                       19


  CHAPTER II.

  THE HEBREWS                                                          32


  CHAPTER III.

  DENTISTRY AMONG THE CHINESE                                          34


  CHAPTER IV.

  CUSTOMS RELATING TO THE TEETH AMONG DIFFERENT PRIMITIVE PEOPLES      42


  CHAPTER V.

  THE GREEKS                                                           45


  CHAPTER VI.

  DENTAL ART AMONG THE ETRUSCANS                                       67


  CHAPTER VII.

  THE ROMANS                                                           77


  PART II.

  SECOND PERIOD—THE MIDDLE AGES.


  CHAPTER VIII.

  THE ARABIANS                                                        121


  CHAPTER IX.

  THIRTEENTH TO FIFTEENTH CENTURIES                                   140


  PART III.

  THIRD PERIOD—MODERN TIMES.


  CHAPTER X.

  THE SIXTEENTH CENTURY                                               161


  CHAPTER XI.

  THE SEVENTEENTH CENTURY                                             218


  CHAPTER XII.

  THE EIGHTEENTH CENTURY                                              255




INTRODUCTION.


Every dentist who has ever given any thought to the development of his
profession must have realized the growing necessity for an accessible
and authoritative history of the dental art. The early efforts in
this direction by Duval, Fitch, Carabelli, Snell, Linderer, Harris,
and others, followed in this country by the more recent essays of
Perine, Dexter, and Cigrand, are out of print and difficult to obtain.
The _Geschichte der Zahnheilkunde_, by Geist-Jacobi, and _Notice
sur l’Histoire de l’Art Dentaire_, by Lemerle, have given to the
practitioners of Germany and France valuable information which the
English-speaking dentist has often sadly lacked.

Realizing this situation, at the first meeting of the National Dental
Association, the late Dr. R. Finley Hunt offered the resolution: “That
a Committee of Three be appointed by the President to report at the
next annual meeting a measure looking to the preparation of a _full
history_ of the Dental Profession.” After a careful consideration of
the subject, this committee reluctantly concluded that, “whereas a
complete history of dentistry may some day be the result of the effort
now being made, this Association must confine its first attempts to
the history of dentistry in America.” In a letter to the committee
the late Dr. W. D. Miller said: “Of course, a universal history of
dentistry would be very interesting and valuable, but its compilation
would naturally cost an immense amount of labor.” Aside from this, it
did not seem possible that the data for a proper history of the early
development of the dental art in Africa and Europe could be collected
by an association working in America.

After several years of what may have seemed a policy of masterly
inactivity the unexpected happened, and the committee was able to
report at the Buffalo meeting of the Association that Dr. Vincenzo
Guerini, of Naples, Italy, had written a history of dentistry from
the earliest times to the beginning of the nineteenth century, and
that this work, translated into English and fully revised, had been
generously placed in the hands of the committee for publication under
the auspices of the National Dental Association, in token of the
distinguished author’s appreciation of American dental development.

The Association, deeply sensible of this high compliment, and fully
realizing this opportunity for accomplishing a purpose which had
hitherto seemed impossible, gladly arranged for the publication of
the book. After the delay incidental to the production of a work of
this character, and the necessary subscribers being obtained, this
exhaustive history of early dentistry, by the greatest authority on
that subject in the world, is presented for the serious consideration
of the thoughtful and studious members of the profession.

Dr. Guerini has spent many years of his professional life and large
amounts of money in collecting the material for this work. Our
historical records are scattered through a vast literature, and much
of it is of great antiquity, and it has never before been gathered
together and arranged in such a consecutive, logical order.

The importance and value of dental art and science as a humane service
are well recognized, but we are so accustomed to view the question from
the modern standpoint that we, generally speaking, overlook the immense
work done by our predecessors reaching far back in unbroken line to the
mists of antiquity. It was they who laid the foundations upon which
modern dentistry has been built, and no man can peruse the record of
their efforts as set forth in Dr. Guerini’s book without developing a
higher appreciation of their work and a keener realization of the worth
and dignity of the calling which they in common with ourselves followed.

It has been deemed wise to make a few amendments and commentaries, and
when that has been done the amendment has in each case been inserted as
a foot-note and designated by the initials of the commentator.

The supervision of the work while passing through the press and the
correction of proofs have been entrusted to Dr. Edward C. Kirk, of the
Committee; the index has been prepared by the chairman.

  CHARLES MCMANUS, D.D.S.,
  _Chairman of Committee on History of Dentistry,
  National Dental Association, U. S. A._




A HISTORY OF DENTISTRY.




PART I.

FIRST PERIOD—ANTIQUITY.




INTRODUCTION.


The first beginnings of dental art were undoubtedly the same as those
of general medicine, for it is evident that in primitive times, when
the healing art was still in its rudimentary stage, no divisions could
have existed in it.

Scientific medicine, whose most ancient representative is Hippocrates,
was preceded for the course of many centuries by sacerdotal medicine
and by popular medicine.

Necessity, instinct, and even mere chance must have taught primitive
man some simple curative practices, in the same manner that they taught
him gradually to prepare his food and to satisfy the other wants of
life. It was in this way that popular medicine, which is found without
exception among all races and is perhaps as ancient as man himself, had
its earliest beginning.

As regards sacerdotal medicine, it was principally derived from the
false ideas prevalent among primitive peoples about the causes of
maladies. When, for example, an individual in full health was seized
with sudden illness, no one could imagine, in those times of profound
ignorance, that this happened in a natural manner; the fact was
therefore attributed to a supernatural cause, that is, to his having
been stricken by the wrath of some divinity. In this state of things
it was believed to be absolutely necessary to propitiate the inimical
or vengeful divinity, so that the patient might be restored to health.
It was, therefore, very natural that the intervention of sacerdotal
aid should be sought, that is, of the supposed intermediaries between
human beings and the gods. The priests, on their side, were ready to
occupy themselves with such cases, for their services were always well
recompensed, and, added to this, if the patient recovered, the respect
and veneration of the people for the sacerdotal caste was considerably
increased, whilst if he did not, this simply meant that he or his
family was not worthy of receiving the desired pardon, or that, anyhow,
the Divinity, for good reasons of his own, would not grant it.

However, it being to the interest of the priests to obtain the greatest
possible number of cures, they did not limit themselves merely to
offering up prayers and sacrifices and to imposing on the patients the
purification of themselves and other religious exercises; they also
put into practice—always to the accompaniment of ritualistic words and
ceremonies—the means of cure which their own experience and that of
others suggested to them. The art of healing the sick was transmitted
from generation to generation in the sacerdotal caste, acquiring an
ever greater development and complexity in proportion to the making of
new observations and fresh experiences. It is to be understood that in
this manner the priests became more and more skilful in the treatment
of disease; they were really the doctors of those times, albeit their
curative practices were mixed up with an ample dose of imposture. This,
at least in many cases, must have had, besides, the advantage of acting
favorably on the patients by means of suggestion.

We learn from Herodotus that the Babylonians used to carry the sick
into the public squares; the passers-by were expected to make inquiries
as to their illnesses, and if it so happened that they or any of their
acquaintances had been similarly afflicted, to come to the aid of
the patient by offering their advice and making known the means of
treatment that had effected recovery, exhorting him, at the same time,
to have recourse to them.

This usage had without doubt its advantages, as it must have led,
little by little, to the recognition of such remedies as were most
efficacious, among all those recommended, against the various maladies.

Another custom that served to furnish useful elements for the
development of the art of medicine was that of the votive tables, hung
in the temples by patients after their recovery, in sign of gratitude
for having received the invoked blessings. These tables contained a
brief description of the malady and of the treatment that had proved
useful in dispelling it. If we reflect that dental affections are often
of long duration and very tormenting, the thought naturally suggests
itself that among the votive tables not a few must have referred to
maladies of the teeth.

The numberless cases recorded by votive tables afforded precious
clinical material, which without doubt was utilized in a great measure
by the priests in compiling the earliest medical writings, and, as we
shall see later, Hippocrates himself stored up all the medical records
existing in the celebrated temple of Cos.

[Illustration: _Introduction of Ebers’ Papyrus, transcribed in Egyptian
hieroglyphic characters._]




CHAPTER I.

DENTAL ART AMONG THE EGYPTIANS.


Among the people of ancient times, the Egyptian nation was, without
doubt, the one in which civilization first took its rise and had its
earliest development. From the time of Menes, first King of Egypt (3892
B.C.), the inhabitants of the valley of the Nile were well advanced on
the path of civilization, and under the fourth dynasty, dating from
3427 years before the Christian era, they had already attained a high
degree of progress.

Medical art and science in every country have always progressed in
proportion to the general civilization, for the treatment of disease is
one of the first and most important manifestations of civilized life.
It is therefore natural that the healing art should have flourished
earlier in Egypt than elsewhere, that is, in the midst of the oldest
civilized people.

There, as in other countries, medicine was practised for some time only
by the sacerdotal caste; but not all the members of this caste were
doctors and priests at one and the same time; there was a special class
among them, called “pastophori,” whose mission it was to cure the sick.

Our knowledge of medicine as practised among the Egyptians of old is
now no longer limited to the scanty notices handed down to us by Greek
and Roman writers. The researches made by students of Egyptian lore
have placed original medical writings in our hands, now already partly
interpreted, that permit us to form a sufficiently exact idea of the
science of Medicine in ancient Egypt.

These valuable documents, denominated papyri, from the material on
which they are written, now exist in great numbers in the Berlin
Museum, in the British Museum, and in those of Leyden, Turin, Paris,
and other cities; but the most important of the papyri treating of
medical subjects is certainly the papyrus of Ebers, in the library of
the Leipzig University.[1] This very valuable papyrus—the most ancient
of all known works on Medicine—is the best written of all the Egyptian
medical papyri, and is also the best preserved and most voluminous.
In size it is 30 centimeters high, 20 meters long, and the whole text
is divided into 108 sections or pages, each one of about 20 to 22
lines. The celebrated Egyptian scholar, Prof. George Ebers, procured
it, toward the beginning of the year 1873, from an inhabitant of
Luxor, in Upper Egypt. He published a beautiful edition of it two years
later in Leipzig; and in 1890 Dr. Heinrich Joachim published a German
translation of the whole papyrus, with an introduction and explanatory
notes.

The Ebers’ papyrus is written in hieratic characters. We here reproduce
some passages of it, so as to give our readers an idea of the style of
writing.[2]

Lepsius and with him the greater part of Egyptologists are of opinion
that the Ebers’ papyrus is not an original work at all, but simply a
copy of medical writings of still earlier date, belonging to different
epochs, and which were collected and reunited to form a kind of manual
on medicine.

[Illustration: FIG. 1

Part of Ebers’ papyrus in Egyptian hieratic characters containing three
dental prescriptions.]

From some indications existing in the papyrus itself, Ebers has been
able to argue, with quasi certainty, that the papyrus was written
toward the year 1550 B.C. But some parts of it have their origin in a
far more remote epoch; they go back, that is, to thirty-seven centuries
or more before the Christian era. In fact, at page ciii of the Ebers’
papyrus[3] one reads:

“Beginning of the book about the treatment of the _uxedu_ in all the
members of a person, such as was found in a writing under the feet of
the God Anubis, in the city of Letopolis; it was brought to His Majesty
Usaphais, King of Upper and Lower Egypt.” Now, as Joachim remarks,
the Usaphais herein named was the fifth king of the first Egyptian
dynasty, and he reigned toward 3700 before the Christian era. Hence, it
may be argued that some, at least, of the writings from which the Ebers’
papyrus was taken were composed in the very remote epoch to which we
have just alluded, or perhaps still farther, for it is impossible to
know whether the book, deposited by unknown hands at the foot of the
statue of the God Anubis, had been written but a short time previous or
at a much earlier epoch.

[Illustration: FIG. 2

Part of Ebers’ papyrus in Egyptian hieratic characters containing
eleven dental prescriptions.]

Dental and gingival maladies are in no way neglected in the Ebers’
papyrus. At page 72, a remedy is prescribed “against the throbbing of
the _bennut_ blister in the teeth,” then two other remedies “to cure
the _bennut_ blisters in the teeth and to strengthen the flesh (gum).”

It is somewhat difficult to say what is meant by _bennut_ blisters; but
perhaps it means small, gingival abscesses of dental origin. The first
of the above remedies—probably meant to calm the pricking or throbbing
pain that, in such cases, often accompanies the dental malady—consisted
of:

  “Seps-grains                           Part 1
   Dough                                   ”  1
   Honey                                   ”  1
   Oil                                     ”  1
  To be applied on the part as a plaster.”

The other two remedies, very likely intended for the cure of dental
fistulæ, were to be used as masticatories. The first consists of:

  “Fennel seeds    Part 1
   Dough             ”  1
   Anest-plant       ”  1
   Honey             ”  1
   Incense           ”  1
   Water             ”  1”

The other was still more complicated and thus compounded:

  “Dâm-plant       Part 1
   Anest-plant       ”  1
   Incense           ”  1
   Amaa-plant        ”  1
   Man-plant         ”  1
   Saffron           ”  1
   Aloe wood         ”  1
   Annek-plant       ”  1
   Cyperus           ”  1
   Onion             ”  1
   Water             ”  1”

At page 89 of the papyrus[4] we find two other remedies, having the
same object, that is, “to cure the bennut blisters in the teeth and to
strengthen the flesh.”

The first is compounded in this way:

  “Cow’s milk                                             Part 1
   Fresh dates                                              ”  1
   Uah corn                                                 ”  1
  To be left stand and then to be masticated nine times.”

This is the second receipt:

  “Anest-plant                        Part 1
   Dough                                ”  1
   Green lead                           ”  1
   Sebests[5]                           ”  1
   Cake                                 ”  1
   Dâm-plant                            ”  1
   Fennel seeds                         ”  1
   Olive oil                            ”  1
   Water                                ”  1
  To be used like the preceding one.”

In this same page 89 many other remedies corresponding to various
indications are prescribed.

  “To strengthen the teeth:

   Powder of the fruit of the dum-palm      Part 1
   Green lead                                 ”  1
   Honey                                      ”  1
  To be mixed and the teeth rubbed with it.”

The following is another remedy for the same purpose:

  “Powder of flint stones       Part 1
   Green lead                     ”  1
   Honey                          ”  1
  To be rubbed on the teeth.”

Next comes a remedy “to cure the growth of _uxedu_ in the teeth,” that
is:

  “Dough      Part 1
   Beans        ”  1
   Honey        ”  1
   Verdigris    ”  1
   Green lead   ”  1
  To be powdered, mixed, and applied on the teeth.”

The word _uxedu_ recurs more than thirty-five times in the Ebers’
papyrus, in relation to affections of the most different parts of the
body. By confronting all the passages of the papyrus in which one finds
the word _uxedu_, Joachim deduces that it does not indicate any special
disease, but has the general signification of “a painful swelling.”
According to Geist-Jacobi, by “growth of the uxedu in the teeth” may
be understood an alveolar abscess and the consequent swelling of the
surrounding parts.

Another remedy is intended for “the cure of the tooth that gnaws unto
the upper part of the flesh.”

The translator of the papyrus remarks that by the “upper part of the
flesh” is to be understood the gum. The remedy would, therefore,
correspond to the indication of curing a tooth “that gnaws or gives
pain unto the gum.” But as one sees, even putting it in these words,
the meaning is anything but clear. Perhaps the destructive action of
the carious process, reaching as far as the gum, is what is here meant
to be alluded to. Meanwhile here is the receipt:

  “Cumin       Part 1
   Incense       ”  1
   Onion         ”  1
  To be reduced to a paste, and applied on the tooth.”

Besides the remedies already given, the two following are prescribed
for strengthening the teeth:

  “Incense                    Part 1
  Verdigris                     ”  1
  Green lead                    ”  1

  Mix and apply on the tooth.”

The other is compounded of:

  “Water                Part 1
   Absinth                ”  1
  To be used as above.”

We next find a formula, preceded by this very vague indication:
“Chewing remedy for curing the teeth.”

  “Amaa-plant       Part 1
   Sweet beer         ”  1
   Sut-plant          ”  1
  To be masticated and then spit on the ground.”

Another masticatory is intended to “strengthen and cure the teeth,” and
is compounded thus:

  “Saffron        Part 1
  Duat-plant        ”  1
  Sweet beer        ”  1

  To be masticated and then spit on the ground.”

Finally, we have a medicament “for curing the gnawing of the blood in
the tooth.” It is complicated enough, being compounded with:

  “The fruit of the gebu       Part 1/32
   Onion                         ”  1/64
   Cake                          ”  1/16
   Dough                         ”  1/8
   Anest-plant                   ”  1/32
   Water                         ”  1/2
  One leaves it to stand and then chews for four days.”

But what meaning is to be attributed to the “gnawing of the blood in
the tooth?”

It is almost certain that this figurative expression referred to the
pain deriving from caries and pulpitis. It may have had its origin in
the observation of two phenomena, that is, first of all, the pulsating
character which the pain alluded to often assumes, and the eventual
issuing of blood from the cavity of a tooth affected by caries and
pulpitis, when the pulp is exposed. At any rate, the Egyptian doctors
of remotest antiquity undoubtedly did not ignore the presence of blood
in the interior of the tooth.

From what we have related, it clearly appears that at that remote epoch
many remedies were already in use for combating dental affections.
These must consequently have been frequent enough, which demonstrates
the erroneousness of the opinion held by some, who affirm, as does
Mummery,[6] that in ancient times diseases of the teeth were extremely
rare.

Besides this, it is fully evident, from the Ebers’ papyrus, that at the
time in which this was written, dental pathology and therapy were still
in a very primitive condition, and formed a part of general medicine,
from which they showed as yet no tendency to separate; so true is
this, that the remedies intended for the treatment of the teeth do not
constitute a special section of the work, but are to be found among
medicaments of an altogether different nature. Thus, at page lxxii of
the papyrus[7] we find, first, three remedies against the itch; then
five remedies for the cure of pustules in various parts of the body;
next an ointment and a potion for the _bennut blisters_ in whatever
part of the body they may occur; after this, three medicaments against
the _bennut blisters_ of the teeth; and lastly, a plaster for curing
crusts and itching in whatsoever part of the body.

One finds no mention of dental surgery in the Ebers’ papyrus. No
conclusions could be drawn from this fact if the work only spoke of
medical treatment, for then it might reasonably be supposed that the
compiler had purposely occupied himself with this subject only; but, on
the contrary, the Ebers’ papyrus frequently makes mention of operative
interventions, and among these, of the use of the knife and of the
red-hot iron for the treatment of abscesses and of certain tumors.
Therefore, there being no mention made in the papyrus of any dental
operation, not even of extraction, gives us reason to suspect that at
that remote epoch no surgical operation was carried out on the teeth,
and that, as yet, no instruments existed for practising extraction.

In the time of the celebrated historian Herodotus, of Halicarnassus,
who lived in the fifth century previous to the Christian era (about
from 500 to 424 B.C.), that is, more than a thousand years after
the time in which the Ebers’ papyrus was written, the dental art in
Egypt had made remarkable progress, and was exercised by specialists.
In fact, in the second book of Herodotus we find the following
passage: “The exercise of medicine is regulated and divided amongst
the Egyptians in such a manner that special doctors are deputed to
the curing of every kind of infirmity; and no doctor would ever lend
himself to the treatment of different maladies. Thus, Egypt is quite
full of doctors: those for the eyes; those for the head; some for the
teeth; others for the belly; or for occult maladies.”[8]

Having here had occasion to refer to the _History_ of Herodotus, we
will quote two passages of this famous work, which have a certain
interest for our subject;

“Whilst the tyrant Hippias, after having been driven out of Athens (510
B.C.), was marching against Greece at the head of the Persian army and
had already arrived at Marathon, he happened one day to sneeze and to
cough in a more vehement manner than usual; and he being already an
old man, and his teeth all shaking, a violent fit of coughing suddenly
drove one of them out of his mouth, and it having fallen into the dust,
Hippias set to work, with great diligence, to search for it; but the
tooth not coming to light, he drew a long sigh, and then said, turning
to those who were standing by: ‘This land is not ours, neither shall we
ever be able to have it in our power; what clings to my tooth is all of
it that will ever belong to me.’”[9]

In another part of the _History_, that is, in the ninth book, Herodotus
recounts as follows:

“When the corpses buried after the battle of Platea were already
despoiled of their flesh, a curious fact was seen; for the people of
Platea having collected the bones of those who had perished, there
was found amongst them a skull altogether devoid of commissures, and
composed of one single bone. A jaw was also found, the teeth of which,
comprising the molars, appeared to be made all of one piece, as though
composed of a single bone.”

Relative to this last passage of Herodotus, we may remark, as does
Stark, that the total synostosis of the skull bones is certainly very
rare, but that, nevertheless, one has authentic examples of the same,
not only in ancient but also in relatively modern times, witness the
famous skull of Albrecht von Brandenburg, surnamed the German Achilles,
who died in 1486, and was buried in the monastery of Heilbronn. As to
teeth united together and forming a single piece, no example exists
save in very ancient authors, for instance, in Valerius Maximus, who
recounts a similar marvellous fact of Prusia, King of Bithynia, and in
Plutarch, who attests to a similar fact in the person of Pyrrhus, King
of Epirus.

It is very difficult to establish within what limits the activity
of the dentists alluded to by Herodotus was displayed. It has been
affirmed by some that dental art in ancient Egypt was very far
advanced, and that not only the application of artificial teeth, and
even of pivot teeth, but also stoppings, were practised by the Egyptian
dentists of those days. Here are some data on this subject:

Joseph Linderer[10] tells us that, according to Belzoni[11] and others,
artificial teeth made of wood and very roughly fashioned have been
found in Egyptian sarcophagi.

George H. Perine, a dentist of New York, in an article on the history
of dentistry,[12] says: “Both filled and artificial teeth have been
found in the mouths of mummies, the cavities in the former stopped with
gold and in some cases with gilded wood. Whether these fillings were
inserted during life for the purpose of preserving the teeth, or after
death for ornamentation, it is, of course, impossible to say. That the
Egyptians were exceedingly fond of embellishing their persons with
gold ornaments and bright colored materials is a fact which has been
clearly established, and the discovery of mummies—of exalted personages
no doubt—some organs of which were gilded and embellished with showy
colors proves that their fondness for display accompanied them even
to the grave.” To this may be added, that after an embalmment of the
highest class[13] it was usual to gild the eyebrows, the point of the
nose, the lips, and the teeth of the corpse, and place a gold coin
between the teeth, or cover over the tongue with a thin gold plate.

Dr. J. G. Van Marter, a dentist in Rome, in an article on prehistoric
dentistry,[14] writes, among other things, that _the renowned
archæologist, Mr. Forbes, had seen mummies’ teeth stopped with gold_.

The great defect of all the assertions referred to is that of not being
accompanied by any element of proof, wherewith to demonstrate their
truth. When, for example, we are told that Mr. Purland possesses, in
his collection of antiquities, a tooth pivoted on to the root of a
mummy’s tooth, the question suggests itself naturally: If this tooth
is, as it appears, separated from the jaw of the mummy to which it is
said to have belonged, how can we be certain that the tooth itself is
really that of a mummy? Until sufficient proof of this be furnished, we
cannot but consider the above assertion as absolutely without value.[15]

The same may be said as to the assertions of Wilkinson and Forbes with
regard to mummies’ teeth stopped with gold. Where and by whom were
these mummies found? And where are they preserved? Was the stopping,
too, verified at the time of the finding of the mummy, in such a manner
as to exclude all possibility of fraud, or was it discovered afterward,
in circumstances such as to suggest the possibility of a mistification?
It has, in fact, been reported[16] that the pretended Egyptian stopping
in a mummy existing in an English museum was nothing else than a
practical joke, carried out, besides, in a very awkward manner.

In opposition to the above assertions, we have the most absolute
contradictory statements on the part of the most competent authorities.

The celebrated Egyptologist, Prof. George Ebers, has only been able, in
spite of the most accurate research, to arrive at completely negative
results in all that has reference to the dental art of the ancient
Egyptians.[17]

The distinguished craniologist Prof. Emil Schmidt, of Leipzig, who
owns a collection of several hundred mummies’ skulls, writes thus on
the question now before us: “In no jaw have I ever found anything that
could be attributed to the work of dentists: no fillings, no filing or
trepanning of teeth, no prosthesis.”[18] Virchow, who also examined
a great many Egyptian skulls, among which were several belonging to
royal mummies, did not find any indications of dentists’ work;[19] and
Mummery, as well, although he made the most conscientious researches on
this subject, could not arrive at any positive results whatever.[20]

Between the affirmations of some and the negations of others, it is
very difficult to say on which side the truth lies. For my own part,
I fail to find that there is the least proof of the ancient Egyptians
having known how to insert gold fillings and still less to apply
pivot teeth. But at the same time I think it cannot be doubted that
the Egyptian dentists knew how to apply artificial teeth. And even
though it may not be possible to demonstrate this by direct proof,
one is equally prone to admit it when one considers, on the one hand,
the remarkable ability of the ancient Egyptians in all plastic arts,
and, on the other hand, the great importance they attributed to the
beautifying of the human body; so much so, that even in so ancient
a document as the Ebers’ papyrus, one finds formulæ for medicaments
against baldness, for lotions for the hair, and other kinds of
cosmetics. Is it likely, therefore, that so refined and ingenious a
people should not have found the means of remedying the deformity
resulting from the loss of one or more front teeth?

Fortunately, however, we are not bound to content ourselves with simple
suppositions, for a well-authenticated archæological discovery made
in the month of May, 1862, has put us in possession of an irrefutable
proof.

The discovery to which we allude is registered in Renan’s _Mission de
Phénicie_, and was the result of researches made in the necropolis of
Saida (the ancient Sidon) by Dr. Gaillardot, Renan’s colleague in his
important scientific mission. In a grave in one of the most ancient
parts of the necropolis, Dr. Gaillardot found, in the midst of the sand
that filled the grave, a quantity of small objects, among which were
two copper coins, an iron ring, a vase of most graceful outline, a
scarab, twelve very small statuettes of majolica representing Egyptian
divinities, which probably formed a necklace, to judge by the holes
bored in them. But among the objects found (which, together with that
we are about to mention, are now in the Louvre at Paris), the most
important of all is “a part of the upper jaw of a woman, with the two
canines and the four incisors united together with gold wire;[21] two
of the incisors would appear to have belonged to another individual,
and to have been applied as substitutes for lost teeth. This piece,
discovered in one of the most ancient tombs of the necropolis, proves
that dental art in Sidon was sufficiently advanced.”[22]

[Illustration: FIG. 3

Phœnician appliance found at Sidon, as represented in a cut of Renan’s
Mission de Phénicie.]

To these words, literally translated from Renan’s work, we will only
add the following considerations:

Egypt was, in its time, a great centre of civilization, whose influence
was strongly predominant in all the neighboring region, and especially
in ancient Phœnicia and in its large and industrious cities Tyre and
Sidon. The remains discovered in many of the Phœnician tombs would of
themselves alone be sufficient to demonstrate luminously the enormous
influence exercised by the Egyptian civilization on the life and
customs of that people. Now, if there were dentists in Sidon capable of
applying false teeth, it may reasonably be admitted that the dentists
of the great Egyptian metropoli Thebes and Memphis were able to do as
much and more, the level of civilization being without doubt higher
there than in Tyre or in Sidon, or in other non-Egyptian cities.




CHAPTER II.

THE HEBREWS.


In the Hebrew literature, as principally represented by the Bible
and by the Talmud, there does not exist any book on medicine.
Notwithstanding the vicinity and the close relations of the Hebrews
with Egypt, medical science never reached the degree of development
among this people that it did in the land of the Pharaohs.

In the Bible we do not find the least trace of dental medicine or
dental surgery. Indeed, although the books of Moses contain a great
number of exceedingly wise hygienic precepts, there are not any that
refer directly to the teeth or to the mouth. We may therefore conclude,
with a certain degree of probability, that the Hebrews had in general
good teeth and that dental affections were very rare among them.

The word _tooth_ or _teeth_ occurs in the Bible more than fifty
times,[23] but very few of the passages in which it is to be met with
present any interest so far as our subject is concerned.

That the Hebrews attached great importance to the integrity of the
dental apparatus is plainly seen from the following verses of the book
of Exodus (xxi: 23 to 27):

23. ... thou shalt give life for life,

24. Eye for eye, tooth for tooth, hand for hand, foot for foot,

25. Burning for burning, wound for wound, stripe for stripe.

26. And if a man smite the eye of his servant, or the eye of his maid,
that it perish; he shall let him go free for his eye’s sake.

27. And if he smite out his manservant’s tooth or his maidservant’s
tooth; he shall let him go free for his tooth’s sake.

These legislative measures show clearly enough that among the Hebrews
the loss of a tooth was considered a lesion of great gravity, as they
thought it of sufficient importance to be named in the same category as
the loss of an eye, of a hand, or of a foot. If anyone caused the loss
of an eye or of a tooth to his servant, the punishment was the same
in both cases; that is, he was obliged to give him his liberty, thus
undergoing the loss of his purchase money.

Beauty and whiteness of the teeth were also in great repute. Thus we
read in the Song of Solomon (iv: 2):

“Thy teeth are like a flock of sheep that are even shorn, which came
up from the washing; whereof every one bear twins, and none is barren
among them.”

In another part of the Song (vi: 6) he repeats these same words,
thus giving it to be understood how great was his admiration for the
beautiful teeth of his beloved.

From various passages of the Bible, one perceives that integrity and
soundness of the teeth was considered a prime element of force and
vigor. In Psalm iii: 7 David says: “Arise, O Lord; save me, O my God:
for thou hast smitten all mine enemies upon the cheek bone; thou hast
broken the teeth of the ungodly.” (That is, reduced them to impotence.)
And in Psalm viii: 6 we read: “Break their teeth, O God, in their
mouth.”

On the other hand, in one of the Proverbs of Solomon (xxv: 19), broken
or decayed teeth are taken to symbolize weakness: “Confidence in an
unfaithful man in time of trouble is like a broken tooth, and a foot
out of joint.” (In the Latin translation, instead of “broken tooth”
stands “dens putridus.” Perhaps the corresponding expression in the
Hebrew language, signifies in a general sense a decayed or injured
tooth.)

The uncomfortable sensation produced on the teeth by acid substances
(teeth on edge) is to be found several times alluded to in the Bible.
In the Book of Proverbs (x: 26), one reads: “As vinegar to the teeth,
and as smoke to the eyes, so is the sluggard to them that send him.”
And Jeremiah says (xxxi: 29, 30): “In those days they shall say no
more, The fathers have eaten a sour grape, and the children’s teeth are
set on edge. But every one shall die for his own iniquity; every man
that eateth the sour grape, his teeth shall be set on edge.”

As is apparent, there is nothing in the passages quoted that can be in
any way connected with the treatment of dental affections; neither is
it to be wondered at, when one reflects that even in the Talmud—which
is much less ancient—medicine in general is hardly at all spoken of.
This famous code as to practical life is almost silent with regard
to therapeutic medicine, and only recommends hygienic practices. An
axiom of the Rabbi Banaah is worthy of note, and may be quoted here as
bearing on the subject, and also because many Christians might be found
to conform willingly thereto:

“Wine is the best of all remedies; and it is in places where wine is
wanting that one is in need of pharmaceutic remedies.”[24]




CHAPTER III.

DENTISTRY AMONG THE CHINESE.


For above 4000 years science and religion among the Chinese, as well
as their customs, have remained quite unchanged. The inhabitants of
the Celestial Empire can vaunt a most ancient civilization; which is,
however, altogether stationary; neither has their medicine made any
progress, and its actual state represents with sufficient exactness
what it was in primitive ages.

In Europe, various works have been written about the medicine of the
Chinese, one of the best being that of Dabry,[25] taken from the most
celebrated medical books of China,[26] and which may be considered as a
compendium of the medical science of this people.

In this work we find two chapters relating to our specialty: the first
of these (p. 286) speaks of toothache, the second (p. 292) treats of
all the other dental and gingival diseases.

The Chinese call the toothache _ya-tong_, and distinguish a great many
varieties of the malady, that is:

1. _Fong-je-tong._ This kind of toothache is caused by sudden cold,
and has the following characteristic symptoms: Red and swollen gums,
which after a little time discharge purulent and fetid mucus; abundant
salivation; acute pain; swelling of the cheek. It is to be cured with
draughts, mouth washes, and various kinds of frictions.

We consider it useless to give the particulars of the various receipts,
because Dabry hardly ever translates the names of the drugs of which
they are compounded. These formulæ are therefore incomprehensible by
most people.

2. _Fong-lan-tong._ This kind of toothache is also caused by cold. The
pain is very great, but the gums are neither red nor swollen.

3. _Ye-tong._ Is also produced by chill. The gums are red and swollen;
there is no discharge of mucus; great pain, which is aggravated by cold
liquids. If the malady lasts for some time, the gums end by becoming
black, and the teeth are loosened; the pain becomes more intense in
spitting. In this stage of the malady the sufferer no longer fears
cold drinks, but rather desires them, to soothe the pain. The cure
varies according to whether the malady be of recent or of old date;
it consists in the use of internal remedies (pills, potions), or of
frictions on the part where the pain is situated.

4. _Han-tong._ This is also owing to the action of the cold. Pains in
the cheek and forehead proceeding from the teeth; no diseased condition
either of the gums or of the alveoli.

5. _Tou-tan-tong._ Violent cough and toothache at the same time;
difficulty in masticating.

6. _Yn-hiue-tong._ The gums are pale, or violet-red, hard and lumpy,
sometimes bleeding; the toothache is continuous. Among the numerous
remedies recommended against this malady (mouth washes, frictions,
draughts, pills), one particularly deserves mention: it is the urine of
a child used as a mouth wash.

7. _Tchong-che-tong._ Pain in the teeth after mastication; there is
also sometimes excoriation of the gums; flow of purulent mucus mixed
with blood; bad-smelling breath; the tooth falls; it is decayed,
and one can perfectly well distinguish a small hole; the root is
unsound; in extracting the tooth one sometimes brings away together
with it a little white worm, with a black spot on the head, which
can be distinguished by the aid of a magnifying glass. A remedy must
immediately be administered to destroy these worms, otherwise the
patient runs the risk of having his other teeth attacked in the same
manner, and of their falling out. The remedies against this affection
are most numerous, and belong for the most part to the oftentimes cited
categories. One of them presents a certain interest, its basis being
arsenic.

In Dabry’s book it is described in the following manner: “Arsenic (gr.
1.80), _houang-tan_ (gr. 3.60); pulverize, mix with water, and with a
part of the mass form a small pill, which put close to the aching tooth
or into the ear, if afraid of the arsenic; then sleep. Cure certain.”

8. Toothache, the effect of general weakness, following principally on
abuse of coition. It is to be cured by the use of internal medicine,
or by local remedies to be rubbed on the painful spot. Some of the
medicaments registered in this paragraph have reference to the special
case, in which the teeth are loosened through excess of coition.
Among others there is a prescription for a dentifrice powder for
strengthening the teeth, to be used every morning.

9. Toothache following on a blow. It is to be cured by using a certain
dentifrice powder, composed of six ingredients. Another medicament
consists in heating about an ounce and one-half of silver in some
recipient, and then pouring wine upon it, and rinsing the mouth with it.

Besides these nine kinds of toothache, the Chinese doctors recognized
a peculiar morbid condition of the teeth and their surrounding parts,
which is thus described in Dabry’s book:

“It sometimes occurs, after recovery from illness, that convalescents,
in order to acquire strength, drink too great a quantity of wine; and
that this after a certain time produces a beginning of inflammation of
the stomach. In such cases the teeth often fall out, the breath becomes
fetid, and if the patient eats hot food, the empty alveoli as well as
the cheeks are painful.”

Various internal medicaments and dentifrice powders are prescribed for
combating this morbid condition. One of these latter includes a great
number of ingredients in its composition; among others, the bones of
mice.

Mention is also made of certain remedies, to which recourse may be had
at times, for allaying violent dental pains, of whatsoever kind, or
whatever be the cause that occasions them.

One of these remedies is composed of different substances (among them,
garlic and saltpetre), to be pulverized and made into pills. If the
pain be on the left side, one introduces one of the pills into the
right ear, and _vice versa_.

The formula is also given for a very complicated medicated powder,
to be snuffed up in the left nostril if the person suffering from
toothache be a man; in the right if a woman.

Another powder is to be smelt with the right nostril or with the left,
corresponding to the side on which the pain is located.

Abscesses and fistulæ of the gums are spoken of as follows:

“It sometimes occurs that an abscess forms in some one point of the
gum; this communicates great pain to the tooth near it; the abscess
is white, with discharge of purulent matter.” The treatment consists
in the use of different medicated powders, to be rubbed on the
affected part. Two of the powders contain musk, besides several other
ingredients. A lotion is also prescribed.

In the next chapter the following affections are described:

1. _Ya-heou._ Gums are red, soft, and swollen, and a fetid and purulent
matter exudes from them; the teeth are not painful; if the gums are
lanced, blood of a pale red color flows from them in abundance. This
malady is to be treated with various internal medicines and sometimes
with scarification.

2. _Ja-suen._ Gums swollen; little by little they are corroded and
destroyed by ulceration, which leaves the roots of the teeth bared;
the patient has an aversion for hot food; continued pain in the teeth;
discharge of purulent and fetid mucus; by the slightest exposure to
cold the pain becomes very violent. This affection is to be combated
with internal remedies and local treatment (frictions with medicated
powders; application of an ointment of very complicated preparation).

3. _Tchuen-ya-kan._ The gums are painful for a few days; apparition
of the root of the tooth; absence of ulceration. Children of five or
six years of age are frequently exposed to this malady. The best means
of cure consists in the extraction of the tooth. There are, besides,
various internal and external remedies prescribed. One of these latter
contains verdigris and three other ingredients. Among those to be used
internally there is a decoction prepared with twelve different drugs,
two of which are mint and rhubarb. The quantity of rhubarb is about
seven and one-half grams; therefore, this prescription is certainly
intended to act as a purgative.

4. _Ya-ting._ The right or left gum suddenly swells; a tumor forms
of about the size of a grain of sorgo; in the beginning it is red,
afterward black; severe pain in the cheek and neck; itching in the
cheek; the tumor afterward bursts, giving exit to blood, and becomes
black; it ought to be pricked directly (before it opens of itself)
with a silver needle; blood of a violet color will flow from it, which
should be left free course until it regains its ordinary color. The
sufferer has at the same time pains in the stomach, great thirst,
abdominal pains, and sometimes even delirium.

5. _Ya-jong._ Gums swollen and painful, abscess, fever, swollen cheeks;
great thirst, and vomiting of a liquid kind; dejections dry. The
treatment consists in the methodical use of certain medicines to be
used internally, among which is rhubarb. If one neglects to make use of
this treatment, an ulceration sets in with discharge of a purulent and
sanguine mucus; it is then necessary to rub the part with a medicinal
substance called by the Chinese, _ping-pang-san_. Should the tooth be
somewhat loose, it ought to be extracted and the gum rubbed again with
the substance just now named.

6. _Tso-ma-ya-kan._ An illness common to children after the smallpox;
ulceration of the gums, which turn black; fetid breath. In certain
cases the gums are hard and the mucous membrane of the cheek is also
attacked; all the teeth shake; there is flow of blood from the gums,
upon which certain spots begin to form that are clearly distinguishable
as small holes. These holes must be filled with a particular medicinal
substance (named _lay-ma-ting-kouei-sse_), and, besides, one ought to
make use of various other internal and external remedies.

This is a very serious illness. In the case of recovery, the patient
ought to abstain from taking any heating aliment for one hundred days.

7. _Tsee-kin-tong_ or _tsee-ly-tong_. Gums swollen; slight but
continuous pain, aggravated by the effort of the wind; the gums become
ulcerated little by little, with discharge of purulent and sanguine
mucus; and the root of the tooth is afterward seen to be uncovered.
This malady is to be treated by means of draughts, pills, mouth washes,
and frictions of various kinds.

After the treatise on the maladies referred to above, we find in
Dabry’s book a long series of “general remedies for every kind of
toothache.” There are about forty of these, and decoctions and powders
predominate among them, the latter to be rubbed on the painful spot.
Decoctions are the form of medicament most in use among the Chinese.
In this list of about forty anti-odontalgic remedies we find as many
as eighteen decoctions, seven for internal use, and the others to
be employed as mouth washes. Some of the latter are compounded with
vinegar instead of with water.

Four remedies of the above list are to be made into a paste and formed
into pills, to be applied upon the aching tooth.

Another medicament is also to be formed into pills and applied inside
the ear.

The following remedy is particularly worthy of note:

“One roasts a bit of garlic, crushes it between the teeth, and
afterward mixes it with chopped horseradish seeds, reducing the whole
to a paste with human milk; one then forms it into pills; these are to
be introduced into the nose on the side opposed to that where the pain
is situated.”

Two other remedies, in powder, are to be snuffed up through the nose.

A powder to prevent the progress of caries is prescribed, with which
the tooth should be rubbed every day, or it may be applied on the
decayed spot.

Finally, two powders are also prescribed for whitening the teeth. One
of these is compounded of seven ingredients, among which is musk; the
other has only three substances in its composition: salt (gram 25),
musk (gram 1.8), _tsang-eul-tsee_ (gram 36).

A therapeutic method much in vogue among the Chinese is acupuncture,
which is used in the treatment of the greatest variety of affections,
including those of the dental system. The doctors of the Celestial
Empire have the greatest faith in this operation, which they hold
capable of removing obstacles to the free circulation of humors and
vital spirits, thus reëstablishing that equilibrium of the organic
forces which constitutes health, and the absence of which causes
disease.

The Chinese doctors prefer to use gold or silver needles for
puncturing; but they also frequently use needles of the best steel.
These instruments vary very much in length, in thickness, and in form,
and there are not less than nine distinct kinds of puncturing needles.

Every doctor who intends dedicating himself to the practice of this
operation has to begin by the most accurate study of the elective
points for puncturing according to the various affections; he should
also know to what depth precisely to drive the needles in each case,
in order to reach the site of the morbific principle and procure
convenient exit for it; he ought to know equally well how long to
leave the needle in the affected part, so as to obtain the best
possible therapeutic results in each case.

The points of election for carrying out puncturing in various maladies
are spread over the whole superficies of the body, and amount in
number to 388. Each of these is known by a special name. Each site of
election stands in determinate relations, as to distance, to the known
anatomical points, and may, therefore, be easily and precisely found
by appropriate measurement. The unity of length for these measurements
is called _tsun_, and is divided into ten _fen_; its value varies,
however, according to whether the said measurements be taken on the
head, the trunk, or the extremities. For the head, the length of the
_tsun_ is calculated as equal to the distance existing between the
inner and the outer angle of the eye; for the trunk, it is equivalent
to the eighth part of the horizontal line between the two breast
nipples; and for the extremities, it is equal to the length of the
second phalanx of the middle finger, measured with the joints bent.

There are twenty-six points of election upon which to carry out
puncturing used as a remedy against toothache. There are also six other
points of election for pains in the gums.

One would naturally be disposed to believe that these points of
election would be situated in proximity to the teeth. Instead, many
of them are situated in distant parts of the body—for example, in the
elbow, in the hands, the feet, the vertebral region, the coccyx, and
so on. However, about half of them are to be found in the labial,
maxillary, and periauricular regions.

The puncturing of every point of election is almost always indicated
for the cure of not only one but several, and, indeed, very often
many, maladies; for example, the puncture carried out on the point of
election, _kin-tche_, situated at the outer extremity of the bend of
the elbow, may be utilized in more than twenty-five morbid conditions;
among which are pains in the arm, paralysis of the arm, edema of the
whole body, excessive perspiring, vomiting, hematemesis, toothache,
boils, gastralgia, hemiplegia, and even cholera!

This mode of cure depends on the special relation of each point of
election to the so-called canals of transmission and communication
(named in Chinese _king_) through which the blood and the vital spirits
circulate, and which serve at the same time to transmit the “innate
heat” and “the radical moisture” to all parts of the body.

And here we must be allowed a brief digression in explanation of what
we have just said.

The anatomical notions of the Chinese are very erroneous;[27] their
ideas on the functions of the human body and of human life in general,
differ considerably from ours. They recognize two natural principles of
vitality, one they call _yang_ (vital, primordial, or “innate heat”),
the other _yn_ (radical moisture). The spirits (that is the air) and
the blood serve as vehicles to these two essential principles of life;
that is, vital heat and radical moisture. The constant equilibrium, the
accord, the perfect union of these two essential principles of life
constitute a state of health. From their alteration, corruption, or
disunion originate all diseases.

There are twelve principal sources of vitality in the human organism;
that is, twelve organs from which the two aforesaid vital principles
are distributed throughout the body: The heart, the liver, the two
kidneys, the lungs, and the spleen are the seat and origin of radical
moisture; the large and the small intestine, the two ureters, the
gall-bladder, and the stomach are the seat and origin of vital heat.
These twelve sources of life are in intimate relation with one another
by means of the canals of communication, through which the blood and
the vital spirits (air) circulate, carrying with them into every part
of the body vital heat and radical moisture.[28]

The points of election upon which to carry out puncturing are situated
along the course of the large lines of communication and transmission;
and that explains, according to the Chinese medical theories, why a
puncture carried out on a given point of the body can prove useful in
relieving a variety of maladies even in distant parts of the organism.

Puncturing is almost always associated with cauterization, for after
having drawn out the needle, it is usual to cauterize the site of the
puncture with the so-called “_moxa_,” that is, with a kind of vegetable
wool obtained from the leaves and dried tips of the artemisia. One
compresses this substance very tightly between the fingers into the
shape of a small cone. One next applies a small coin with a hole in the
centre upon the site of election; the cone of moxa is placed on the
hole in the coin and lighted at its top. As the cone is very compact,
it burns slowly enough, without developing excessive heat, so that,
according to Ten Rhyne,[29] who was an enthusiast for this mode of
cure, “the epidermis is drawn without violence and rises gently into a
small blister. The moxa, whilst burning, draws out the _peccant humors_
visibly, absorbing them in such a manner that they are totally consumed
without destroying the skin itself.”

The application of the moxa is not as painful as might be thought,
and even children support it without much crying. The number of times
for repeating the operation varies according to the malady and the
site of application, etc. Thus, in the point _kin-tche_, which we have
mentioned once before, the cauterization is generally repeated seven
times, but in certain cases the number may be brought up to 200.

There are certain points of election for which puncturing alone is
prescribed without subsequent cauterization; in other instances, the
puncturing is held to be unnecessary or even dangerous; one, therefore,
only applies the moxa in these cases.[30]

In Japan, the moxa was still more in use than in China. According
to Ten Rhyne, from the remotest times the moxa has been the best
and almost the sole mode of treatment for illness in Japan, and was
regarded not only as an excellent remedy, but also as an excellent
preservative; so much so that even convicts condemned to perpetual
imprisonment had permission to go out every six months to undergo this
cure.

Dental affections also were especially treated with the moxa, and,
judging by what Ten Rhyne says on the subject, it would seem that this
caustic, when used against toothache, was usually applied in the region
of the mental foramen.[31]




CHAPTER IV.

CUSTOMS RELATING TO THE TEETH AMONG DIFFERENT PRIMITIVE PEOPLES.


Joseph Murphy, in his book, _A Natural History of the Human Teeth_,[32]
says that the natives of Hindostan, especially the Brahmins or priests
of Brahma, take extreme care of their teeth. Every morning they rub
them for about an hour with a small twig of the fig tree, at the same
time that, turned toward the rising sun, they recite their prayers
and invoke Heaven’s blessing on themselves and their families. As
this custom is prescribed in the most ancient codes and religious
writings of India, it reverts, without doubt, to the remotest ages,
and, therefore, demonstrates the great importance that this people,
and particularly the Brahmin caste, has ever attributed to beauty and
cleanliness of the teeth. Murphy affirms that the Brahmins, in general,
have magnificent teeth; and that this depends, certainly in great part,
on the assiduous and scrupulous care that they take of them.

From the writings of their ancient poets one also deduces in what high
esteem the people of India held beautiful teeth, considering them one
of the principal ornaments of the face. The lover, says Murphy, never
neglected, in enumerating the beauties of his lady-love, to praise the
whiteness and regularity of her teeth.

Among some of the people of India, when the second dentition is
completed, it is customary to separate the teeth one from the other
with a file; we do not know, however, whether this is done as an
embellishment or with some other object—perhaps, as suggested by Joseph
Linderer,[33] to prevent caries.

Anyhow, this and other customs in vogue in various parts of India and
in many islands of Oceanica demonstrate that these peoples attribute
great importance to the teeth.

The substituting of gold teeth for those missing has been in use in
Java from exceedingly remote times.[34]

Dyeing the teeth black is considered a great embellishment among many
races of Asia and Oceanica; this operation is sometimes preceded by
another, viz., the filling up of the interdental spaces very cleverly
with gold leaf.[35]

In Sumatra and the neighboring islands many women file their teeth down
to the gums; others file them into points; or partially remove the
enamel so as to render it easier to apply the black dye; this being
held to be the height of elegance. Men of high rank and condition dye
their upper teeth black and cover the lower ones with fine gold plates,
which in a full light produces what they consider a fine contrast. The
natives of other islands gild the upper central incisors and dye the
others black.[36]

In Japan, the married women may easily be distinguished from the others
by their black and shining teeth. The coloring preparation they use
to blacken the teeth is composed of urine, raspings of iron, and a
substance called _saki_. This mixture has a most unpleasant odor, and
if applied on the skin acts as a caustic. Its action on the teeth is
so powerful that they do not regain their whiteness even after a lapse
of years. In applying this substance, and also for some time after,
the women take care to preserve their gums and lips from its effects,
as it would otherwise cause them to assume a dark blue tint.[37] The
inhabitants of the Pelew Islands make use of the wild thistle and
shell chalk to blacken the teeth. It is also the custom to blacken the
teeth among the inhabitants of Tonkin and Siam, the women of the Maria
Islands, and the single ladies of Java.

Some of the peoples of Eastern India plane their teeth down to an even
level; and from the habit of masticating areca nuts mixed with chalk
and other substances, their lips and teeth are dyed red. At Macassar
the natives have their teeth dyed red; they also substitute missing
teeth by artificial ones made of gold, silver, or tombac.[38]

Negroes, especially those of Abyssinia, very often file their incisors
into points to resemble the form of the canines; this is in order to
give themselves an air of greater ferocity.

Murphy relates that the inhabitants of one of the islands of the
Sound make an incision in the upper lip in a parallel line with the
mouth, and large enough to allow the tongue to pass. After the margins
have healed they have a great resemblance to the lips. This kind of
artificial mouth is made to support a shell, carved in such a manner as
to produce the effect of a row of teeth.

The natives of the Sandwich Islands sacrifice their front teeth to
conciliate the favor of their god Eatoa.[39]

Among the natives of New South Wales, it is the custom when a youth
reaches virility to knock out his front teeth with a stone; this
operation being carried out by the _kuradshis_ or wizards.

The savages of Peru are also in the habit of making the front teeth
fall out; the reason of the custom is that the space thus made is
regarded by them as an embellishment.[40]




CHAPTER V.

THE GREEKS.


An ancient Greek physician—Asklepios, afterward called
Æsculapius[41]—by the ability he displayed in the art of healing, so
impressed the minds of the simple and uncultured at that primitive
epoch as to be held in repute rather as a god than as a man. Not only
was he held to be the author of wonderful cures, but it was also
affirmed that he had resuscitated the dead; no doubt from his having
in some case or other of apparent death restored the individual to
consciousness by the assistance he rendered him. Exaggeration, so
natural to ignorant minds, afterward did the rest, and magnified the
healing and restoring powers of Æsculapius to such an extent that it is
not to be wondered at that he should have been looked upon as a divine
being. With the lapse of time, various traditions formed around his
name, among which there was, however, finally such discrepancy that
the popular voice spoke no more of one, but of many Æsculapii,[42] and
to one of these was attributed, among other merits, that of having
invented the probe and the art of bandaging wounds, while another was
held to be the inventor of purgatives and of the extraction of teeth.

According, therefore, to these traditions, dental surgery had its
origin with Æsculapius, the god of Medicine. But what was the precise
epoch in which this benefactor of humanity lived?

We learn from Homer that two sons of Æsculapius, Machaon and
Podalirius,[43] took special part, as doctors, in the siege of Troy.
This celebrated siege, which lasted ten years, took place in the
twelfth century before the Christian era (that is, 1193 to 1184 B.C.);
admitting, therefore, the account of the parentage to be authentic, one
may argue therefrom that Æsculapius must have lived between the twelfth
and thirteenth centuries B.C. Many temples were built and dedicated to
Æsculapius; these were called _asklepeia_, after the Greek form of his
name. The priests were called _Asklepiadi_, and alleged their direct
descent from Æsculapius himself.

The temples of Æsculapius became so numerous in time that they were
to be found in almost every Greek city. The most celebrated were those
of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great
city of Agrigentum, in Sicily. The Asklepiadi not only performed the
temple rites, but were doctors at the same time, for as interpreters
of the wisdom of the god, they also occupied themselves in curing the
sick. From this it resulted that these temples became in time, through
observation and experience, schools of medical science.

But besides this sacerdotal medicine, there was also a lay medicine
in Greece. Many great philosophers, especially Pythagoras, Alcmeon
of Croton, Empedocles, Anaxagoras, and Democritus, occupied
themselves with physiology, with hygiene, and with medicine; also the
gymnasiarchs, or directors of gymnasiums, or schools of gymnastics,
an art having for its end to increase physical strength and maintain
health, cultivated medicine, particularly that part of it which
concerns hygiene, dietetics, and surgery as applied to the treatment of
violent lesions, such as fractures, luxations, etc.

The Asklepiadi often themselves imparted the principles of medicine
to students outside their caste. Lay medicine thus gradually came to
supplant sacerdotal medicine, especially after Hippocrates, who through
his works, exercised a preponderant influence in the secularization
of the science. However, the Asklepiadi, on their side, continued to
practise medicine up to the time when the pagan temples fell into
complete ruin, through the advance of Christianity.

On the columns of the asklepeia and on the votive tables were written
the names of those cured by the god, together with indications
regarding their various maladies and the treatment by virtue of which
the sick had been restored to health.

Surgical instruments of proved utility were deposited in the temples.
Celius Aurelianus makes mention of a leaden instrument used for the
extraction of teeth (_plumbeum odontagogon_), which was exhibited in
the temple of Apollo, at Delphi.

As a matter of fact, it would seem more natural that this instrument
should have been shown in the temple of Æsculapius, he being the
god of Medicine, and believed, besides, to be the inventor of
dental extraction. One is rather inclined by this to think that the
_odontagogon_ may have been deposited in the temple of Apollo before
the building of Æsculapian temples. Indeed, who can tell if Æsculapius
himself, not yet deified, may not have deposited there a model of the
instrument he had invented!

From the fact of the _odontagogon_ in the temple of Apollo being made
of lead, Erasistratus, Celius Aurelianus, and other ancient writers
have drawn the deduction that it was only permissible to extract teeth
when they were loose enough to be taken out with a leaden instrument.
But Serre[44] observes, not without reason, that if a tooth be so
unsteady as to be able to be extracted with leaden pincers, this may
just as well be done, and perhaps even better, by pinching the tooth
between the fingers, no other aid being required than a handkerchief
to prevent them from slipping. Avulsive pincers of lead would be,
therefore, a nearly useless invention; so it is much more probable,
as Serre remarks, that the original pincers were of iron, and that
the inventor, reserving these for his own use, made a simple model of
the same in lead (this being easier to do) and deposited it in the
temple of Apollo, in order to make known the form of the instrument
to contemporaries and to posterity, naturally supposing that whoever
wished to copy it would understand of himself, or learn from the
priests, that it was to be made of iron and not of lead.

[Illustration: FIG. 7

Portrayal of a dental operation on a vase of Phœnician origin, found in
Crimea (see Cigrand, Rise, Fall, and Revival of Dental Prosthesis, pp.
60-63 and 287).]

HIPPOCRATES. The sacerdotal and philosophical schools of medicine, as
well as the gymnasiums, were the three great sources whence Hippocrates
derived his first knowledge of medicine.

Hippocrates was born in the island of Cos, toward the year 460 B.C. He
belonged to the sacerdotal caste of the Asklepiadi, and was, according
to some of his earliest biographers, the nineteenth descendant of
Æsculapius on his father’s side, and the twentieth descendant of
Hercules on his mother’s side. The time of his death is even still more
uncertain than that of his birth, for, according to some, he died at
eighty-three, according to others, at eighty-five, at ninety, at one
hundred and four, and even at one hundred and nine years of age.

Hippocrates was initiated in the study of medicine by his own father,
Heraclides; but in the medical art he also had as a teacher the
gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under
the sophist Gorgia and philosophy under the celebrated Democritus. He
treasured up all the records of medical practice that were preserved
in the temple of Cos; but according to some ancient authors he is said
to have set fire afterward to this temple, and to have left his native
country in order to flee from the resentment he had aroused. Probably
it was the priests themselves who attributed the burning of the temple
(which certainly took place at that time) to Hippocrates, out of
jealousy for his growing fame; though it may also be possible that this
great man, having first collected together all that was useful among
the medical records that were to be found there, afterward courageously
destroyed this centre of superstition, so that medicine, ceasing to
be confused with imposture and being despoiled of the supernatural
character attributed to it, which paralyzed its progress, should become
a liberal and human art, based purely on the observation of clinical
facts and the study of natural laws.

For a long time, Hippocrates travelled in various parts of Europe,
Asia, and Africa, everywhere making valuable observations. He finally
returned to his native country, where through the practice of medicine
and by his immortal writings he acquired such esteem and veneration
that his compatriots almost tributed him with divine honors after death.

Not all, however, of the works that make up the so-called collection of
Hippocrates were really written by the father of medicine. Two of his
sons—Thessalus and Draco—and his son-in-law Polybius also distinguished
themselves by the practice of medicine and by their admirable writings,
which together with those of other doctors of that period were
erroneously included in the collection of Hippocrates’ works. At any
rate, the collection of Hippocrates faithfully represents the state
of medicine and surgery at the epoch in which he and his disciples
flourished, that is, toward the end of the fifth and during the fourth
century before the Christian era.[45]

Neither Hippocrates nor others before him had ever dissected corpses;
it is, therefore, not to be wondered at that the anatomical notions
contained in the Hippocratic works should be scarce and very often
inexact. The physiological notions also are highly deficient and
imperfect, which is, indeed, very natural, for an exact knowledge of
the functions of the human body presupposes an exact knowledge of the
relative organs.

The philosophical ideas of the time had considerable influence on the
medical theories of Hippocrates and his successors. The universe was
considered as constituted by four elements: earth, air, fire, water. To
each of these elements a special quality was attributed, and, thus, one
recognized four fundamental qualities, viz., cold, dryness, heat, and
moisture. Man—the most perfect being—was regarded as a “microcosmos,”
or small world in himself, that is, a sort of compendium of the whole
universe, and his organism, in correlation to the four primordial
elements of the universe, was believed to be constituted of four
fundamental humors—the blood, the pituita or mucus, the yellow bile,
and the black bile or atrabile.

Health, says Hippocrates,[46] depends on the just relation one to
another of these principles, as to composition, force, and quantity,
and on their perfect mixture; instead, when one of the four principles
is wanting or in excess, or separates itself from the other components
of the organism, one has a diseased condition. In fact, he adds,
if some one humor flow from the body in a measure superior to its
superabundance, such a loss will occasion illness. If, then, the humor
separated from the others collect in the interior of the body, not
only the part that remains deprived of its presence will suffer, but
also that into which the flow takes place and where the engorgement is
produced.

We have here briefly stated these generalities in order to make
ourselves clearly understood in speaking hereafter on different
subjects, whether with regard to Hippocrates or to other authors of the
time.

In the works of Hippocrates there is not one chapter that treats
separately of the affections of the teeth, just as there is no book
in which he speaks separately of diseases of the vascular or nervous
systems, and so on. There are, nevertheless, a great number of passages
scattered throughout the Hippocratic collection from which we can
deduce very clearly the great importance that the Father of Medicine
ascribed to the teeth and to their maladies.

In the book _De carnibus_, the formation of the teeth is spoken of
among other things. It might have been supposed that Hippocrates
would have been ignorant of the fact that the formation of the teeth
commences in the intra-uterine life. This, however, is not the case;
in fact, he says: “The first teeth are formed by the nourishment of
the fetus in the womb, and after birth by the mother’s milk. Those
that come forth after these are shed are formed by food and drink. The
shedding of the first teeth generally takes place at about seven years
of age, those that come forth after this grow old with the man, unless
some illness destroys them.”[47] And a little farther on one reads:
“From seven to fourteen the larger teeth come forth and all the others
that substitute those derived from the nourishment of the fetus in the
womb. In the fourth septennial period of life there appear in most
people two teeth that are called wisdom teeth.”[48]

There is a passage in this same book _De carnibus_, in which the great
importance of the teeth for clear pronunciation of words is alluded
to: “The body,” says Hippocrates,[49] “attracts the air into itself;
the air expelled through the void produces a sound, because the head
resounds. The tongue articulates, and by its movements, coming into
contact with the palate and the teeth, renders the sounds distinct.”

The book _De dentitione_ is written in the form of brief sentences
or aphorisms, and speaks of the accidents that often accompany the
eruption of the deciduous teeth. The most important passages in this
short treatise are the following:

“Children who during dentition have their bowels frequently moved are
less subject to convulsions than those who are constipated.”

“Those who during dentition have a severe attack of fever rarely have
convulsions.”

“Those who during dentition do not get thinner and who are very drowsy
run the risk of becoming subject to convulsions.”

“On conditions of equality, those children who cut their teeth in the
winter get over the teething period the best.”

“Not all the children seized with convulsions during dentition succumb
to these; many are saved.”

“In the case of children who suffer with cough the period of dentition
is prolonged, and they get thinner than the others when the teeth come
forth.”

In the third book of Aphorisms, where Hippocrates speaks of the
illnesses that prevail in the various seasons of the year and in
the various ages of life, mention is also made of the accidents of
dentition. The twenty-fifth aphorism says: “At the time of dentition,
children are subject to irritation of the gums, fevers, convulsions,
diarrhea; this occurs principally at the time when the canines begin to
come forth, and in children who are very fat or constipated.”

The works of Hippocrates are nearly silent on the hygiene of the
teeth; but in the second book, on the diseases of women,[50] some
prescriptions are to be found against bad-smelling breath. We translate
the passage integrally:

“When a woman’s mouth smells and her gums are black and unhealthy, one
burns, separately, the head of a hare, and three mice, after having
taken out the intestines of two of them (not, however, the liver or the
kidneys); one pounds in a stone mortar some marble or whitestone,[51]
and passes it through a sieve; one then mixes equal parts of these
ingredients and with this mixture one rubs the teeth and the interior
of the mouth; afterward one rubs them again with greasy wool[52] and
one washes the mouth with water. One soaks the dirty wool in honey and
with it one rubs the teeth and the gums, inside and outside. One pounds
dill and anise-seeds, two oboles of myrrh;[53] one immerses these
substances in half a cotyle[54] of pure white wine; one then rinses the
mouth with it, holding it in the mouth for some time; this is to be
done frequently, and the mouth to be rinsed with the said preparation
fasting and after each meal. It is an excellent thing to take small
quantities of food of a very sustaining nature. The medicament
described above cleans the teeth and gives them a sweet smell. It is
known under the name of Indian medicament.”

In the book _De affectionibus_ there is a passage where it is said that
inflammation of the gums is produced by accumulations of pituita, and
that, in like cases, masticatories are of use, as these remedies favor
the secretion of saliva, and thus tend to dissipate the engorgement
caused by pituita.

Still more important, however, is the following passage of the same
book:[55]

“In cases of toothache, if the tooth is decayed and loose it must be
extracted. If it is neither decayed nor loose, but still painful, it is
necessary to desiccate it by cauterizing. Masticatories also do good,
as the pain derives from pituita insinuating itself under the roots of
the teeth. Teeth are eroded and become decayed partly by pituita, and
partly by food, when they are by nature weak and badly fixed in the
gums.”

Hippocrates, therefore, considers affections of the teeth to depend in
part on natural dispositions, that is, on congenital weakness of the
dental system, in part on accumulations of pituita, and the corroding
action of the same. If a painful tooth were not loose, it was not
to be extracted; but one was to have recourse to cauterization and
to masticatories, intended the one and the other to dissipate the
accumulation of pituita, believed by him to be the cause of toothache.

It is easily to be understood that as only loose teeth were to be
extracted, Hippocrates considered the extraction of teeth a very easy
operation, notwithstanding that the instruments then in use cannot
have been other than very imperfect; and this is clearly to be seen
from a passage in the book entitled _De medico_, where, after having
spoken of the articles and instruments that ought to be kept in a
doctor’s office (_officina medici_), he adds:

“These are the instruments necessary to the doctor’s operating room
and in the handling of which the disciple should be exercised; as to
the pincers for pulling out teeth, anyone can handle them, because
evidently the manner in which they are to be used is simple.”[56]

[Illustration: FIG. 8

Very ancient dental forceps and two other dental (?) instruments
existing in the Archæological Museum of Athens.]

Having made mention of the _officina medici_, we think it opportune
to explain here with some precision what is to be understood by this
term.[57] Medicine and surgery were practised in ancient times in open
shops; this was so in Greece, and later also in Rome. When the practice
of medicine became secularized through its abandoning the Æsculapian
temples, doctors’ shops began to arise in the most important centres
of population, to which those in need of assistance resorted or were
carried. In time these stations for the practice of medicine, and
particularly of surgery, became more and more numerous.

The Hippocratic collection contains a special treatise (_De officina
medici_), which speaks of the conditions these places were expected
to fulfil, the articles therein to be contained, the instruments, the
general rules relative to operations, the bandages, etc.

About six hundred years later, Galen wrote three books of commentaries
on this treatise of Hippocrates. He says, among other things, that the
doctor’s shop ought to be spacious and furnished with wide openings, to
let in abundance of light. These medical stations to which the sick and
infirm repaired in great numbers to ask advice, to undergo operations,
or receive medical dressings, must have been of great importance, as is
to be presumed from the cited books of Hippocrates and Galen.

The greatest doctors of antiquity practised the medical art in these
places. It is also said that the great philosopher and naturalist,
Aristotle, who came of a race of doctors, had inherited a doctor’s shop
of great value, but that notwithstanding this he refused to dedicate
himself to the medical profession.

The doctors’ shops were at the same time real pharmacies, where doctors
prepared medicines, and where all the remedies then in use, either
simple or compounded, were kept and sold to the public. Besides, there
were to be found instruments of every kind and articles for medicating;
and, therefore, bandages, compresses, lint, sponges, cupping glasses,
cauteries, knives, bistouries, lancets, sounds, needles, hooks,
pincers, files, saws, scrapers, splints, appliances for replacement of
luxated bones, speculums, trepans, apparatus for fumigation, trusses,
and a thousand things besides.

Naturally, dentistry was also practised in these shops, either by
doctors who occupied themselves with dental maladies as with those of
any other part of the body, or, later on, by individuals who dedicated
themselves exclusively to this specialty.

Medicine and surgery were exercised, however, not only in doctors’
shops, but also at the patients’ houses, and it was Hippocrates who
especially inaugurated clinical medicine—that is, the practice of
visiting patients in their beds.

But we must not digress from our argument.

Many observations relative to the teeth are to be found in the seven
books of Hippocrates on _Epidemics_. Unfortunately, the observations
are not always given in clear and precise terms, which principally
depends on the fact that these books consist for the most part of
simple and most concise notes, written by Hippocrates on cases observed
by him, and not intended for publication under such form, but rather
constituting the material for further work.

Here is a passage from the fourth book on _Epidemics_, which reveals
Hippocrates’ extraordinary power of observation, for even teeth that
had fallen out were minutely examined by him, to the end of acquiring
precise ideas on the anatomical conformation of these organs, held by
him to be of the highest importance.

“In the youth suffering from a phagedenic affection in the mouth, the
lower teeth fell out, as well as the front upper ones, which left a
cavity in the bone. The loss of a bone in the roof of the mouth causes
depression in the middle of the nose; the falling out of the upper
front teeth sometimes causes a flattening of the point of the nose. The
fifth teeth counting from the front ones had four roots (two of which
were almost united to the two contiguous teeth), the points of which
were all turned inward. Suppurations arising from the third tooth are
more frequent than from any of the others; and the dense discharge from
the nose and pains in the temples are specially owing to it. This tooth
is more apt to decay than the others; but the fifth does so, as well.
This tooth had a tubercle in the middle and two in the front; a small
tubercle in the internal part, on the side of the other two, had first
begun to decay.[58] The seventh tooth had only one large, sharp-pointed
root. In the Athenian boy, there was pain in a lower tooth on the left,
and in an upper one on the right. When the pain ceased, there was
suppuration of the right ear.”

This last fact—of the suppuration of the ear—is mentioned by
Hippocrates not as a simple coincidence, but as a fact intimately
connected with the cessation of the toothache. This may be argued
from the general ideas of Hippocrates in regard to the beginning and
the resolution of diseases. He considers a malady to be produced by
a humor, which becomes localized in a given point of the body. The
_crisis_ gives exit to the peccant humor,[59] and the mode in which
this is evacuated constitutes the _critical phenomenon_; the same may
be represented either by a profuse perspiration, by abundant urine, by
diarrhea, by vomiting, by expectoration, by bleeding or discharge of
other humors from the nose, by the issuing of pus from the ear, and
even by deposits on the teeth.[60] If by effect of _organic sympathies_
the morbid humor, instead of being thrown outward, be transported into
another region of the body, this constitutes the so-called _metastasis_.

The hints just given will serve to render some of the passages which we
quote from the works of Hippocrates more intelligible.

In the fourth book on _Epidemics_ we find among other clinical cases
the following:

“Egesistratus had a suppuration near the eye. An abscess manifested
itself near the last tooth; the eye directly got quite well; there was
a dense discharge of pus from the nostrils; and small, rounded pieces
of flesh were detached from the gums. It seemed as though a suppuration
at the third tooth were going to take place, but it went back; and
suddenly the jaw and the eye swelled up.”[61]

And farther on one reads:

“In Egesistratus the two last teeth were decayed in the parts where
they touched one another. The last had two tuberosities above the gum,
one on the decayed side, the other on the opposite side. In the part
in which the two teeth were in contact with one another there were two
roots in each, large and similar, and corresponding to those of the
contiguous tooth; on the other side there was only a half root[62] and
rounded.”

Toward the end of the fourth book on _Epidemics_, we find repeated an
observation which we have already noted:

“The third upper tooth is found to be decayed more frequently than all
the others. Sometimes a suppuration is produced all around it.”[63]

In the following passage mention is made of a mouth wash against
toothache, the basis of which is castoreum and pepper:

“In consequence of a violent toothache the wife of Aspasius had her
cheeks swollen up; but on making use of a mouth wash of castoreum and
pepper she found great relief.”[64]

A little after we find the practice of bleeding mentioned; and
contemporarily an allusion to the use of alum—with regard to a painful
swelling of the gums, that is to say, a gingivitis:

“Melisandrus suffered severe pain and swelling of the gums; he was
bled in the arm. Egyptian alum, if used in this malady, arrests its
development.”[65]

Toward the commencement of the sixth book the following observation is
registered:

“Among those individuals whose heads are long-shaped, some have thick
necks, strong members and bones; others have strongly arched palates,
their teeth are disposed irregularly, crowding one on the other, and
they are molested by headache and otorrhea.”[66]

While we should be tempted to attribute the knowledge of the relations
between malformation of the skull, ogival palate, and bad arrangement
of the teeth to quite modern studies, we are obliged to admit, and
to our great surprise, that these relations were already noted,
twenty-four centuries back, by the great physician of Cos.

In the seventh book on _Epidemics_, a case of scorbutus is described,
where incense and a decoction of lentils proved useful against the
lesions of the buccal cavity:

“... Large tubercles, of the size of grapes, had formed on the gums
close to the teeth, black and livid, but not painful, except when the
patient took food. For the mouth, incense powder mixed with some other
ingredients proved useful. The internal use of the decoction of lentils
also did good to the ulcers of the mouth.”[67]

In the same book there is a passage in which Hippocrates warns against
the use of origanum, as harmful to the teeth and eyes:

“Origanum in drinks is harmful to affections of the eyes, and also to
the teeth.”[68]

Farther on a case of necrosis of the jaw is mentioned:

“Cardias, the son of Metrodorus, by reason of pains in the teeth
was subject to mortification of the jaw. Excrescences of a fleshy
kind formed on the gums, that grew most rapidly; the suppuration was
moderate; the molars fell out and afterward the jaw itself.”[69]

Some passages in the _Epidemics_,[70] and in other books of
Hippocrates, even when not referring directly to pathological
conditions of the teeth, are of value as demonstrating what importance
the author attaches to the dental organs, and to the phenomena of which
they may possibly become the site.

In establishing the diagnosis of a malady, he recommends searching for
its point of departure; for example, if it has begun with a headache,
an earache, a pain in the side, and adds, that in some cases the nature
of the malady is revealed by the teeth, in some others by swelling of
the glands.[71] The truth and importance of this observation are not to
be doubted.

In fevers, Hippocrates considers it an unfavorable sign if there
be a deposit of viscous matter on the teeth, especially when the
patient keeps his mouth half open, that is, when he lies in a state of
stupor.[72]

Other prognostics drawn from the teeth or the gums are the following:

“Grinding of the teeth in those who have not this habit when in full
health, gives reason to fear a furious delirium and death; but if the
patient, already delirious, presents this sign, it is an absolutely
fatal one.[73] It is also a most unfavorable sign when the teeth get
very dry.”

“Necrosis of a tooth heals the abscess formed at the gum.[74] This is
very easily explained by the fall of the tooth. But Hippocrates knew
very well that the affection does not always take such a favorable
course; he therefore adds, immediately after:

“In the case of necrosis of a tooth the supervening of a strong fever
with delirium gives reason to fear a fatal exit. If, notwithstanding
this, the patient be saved, there will be suppuration and exfoliation
of the bone.”[75]

According to Hippocrates, “violent pains in the lower jaw give reason
to fear a necrosis of the bone.”[76]

“Gingival hemorrhage in cases of persistent diarrhea is an unfavorable
symptom.”[77] In fact, the easy and frequent occurring of hemorrhage of
the gums may, in many cases, be an indication of profound alteration
of the blood, a condition serious in itself, but still more so when
associated with obstinate diarrhea.

In different parts of the books of Hippocrates, the influence of
atmospheric conditions on the production of dental and gingival
maladies is alluded to.

“Much inconvenience was caused to various persons at that period of
time by swelling of the fauces, by inflammation of the tongue, by
abscesses of the gums.”[78]

“After the snow, there were west winds and light rains; colds in
the head, with or without fever, were very frequent; in one of the
patients, pains were produced in the teeth on the right side, and in
the eye and eyebrow.”[79]

In more than one of his books Hippocrates speaks of special dental
or gingival symptoms, having their origin in different maladies,
especially those of the spleen:

“In many who have enlargement of the spleen the gums become affected
and the mouth has a bad smell.”[80]

In another place we read:

“Among those persons who have an enlargement of the spleen, the bilious
ones have a bad color, are subject to ulcerations of a bad nature,
their breath is fetid, and they themselves are thin.”[81] Finally,
in the _Book on Internal Diseases_, Hippocrates describes different
species of splenic maladies, to one of which he assigns the following
symptoms:

“The belly becomes swollen, the spleen enlarged and hard, the patient
suffers acute pain in it. The complexion of the individual is altered.
A bad smell emanates from the ears. The gums are detached from the
teeth and smell bad; the limbs wither, etc.”[82]

The cases of splenic swellings spoken of by Hippocrates in the above
passages must have been owing, without doubt, to grave cachectic
conditions (among which, probably, scurvy); and we know that
gingivitis, with all its possible consequences (among which expulsive
periodontitis), is not only a constant symptom in scurvy, but is
also frequent in all diseases attended by profound disorders of
nutrition.[83]

Setting on edge of the teeth is counted by Hippocrates among the many
symptoms to which a protracted leucorrhea may give rise:

“One should ask women who have been troubled for some time with a white
flux whether they suffer from headache, pains in the kidneys and in
the lower part of the belly, as well as setting on edge of the teeth,
dimming of the sight, singing in the ears.”[84]

Hippocrates had also observed that the phenomenon of setting the teeth
on edge (_stupor dentium_) may be produced as well by acids in general,
also by acid vomiting;[85] and that it may also be produced in many
individuals by a strident sound.[86]

In the second book of _Epidemics_ we find a proposition of the
following tenor:

“Long-lived individuals have a greater number of teeth;”[87] which
is as much as to say that “the having a greater number of teeth is a
sign of longevity.” This prejudice is to be found repeated by many
authors subsequent to the epoch of Hippocrates, and among these by
Aristotle and Pliny. Not even the greatest men are infallible; there
is, therefore, no reason to be scandalized if Hippocrates should really
have fallen into such an error. Anyhow, it should be observed that
only the first and the third book on _Epidemics_ are held to be really
authentic, while the other five were probably compiled by other doctors
of the school of Hippocrates who did not limit themselves merely to
gathering together the many isolated notes and observations left in
writing or derived from the oral teachings of their master, but took
it upon themselves to introduce into the compilation something of
their own besides. It is, therefore, anything but certain that the
above-mentioned error is really to be attributed to Hippocrates.

The probable origin of this prejudice, which certainly originated among
the people and was afterward accepted by the doctors, is easily to
be guessed at. Individuals blessed with dental arches of remarkable
beauty and perfection may sometimes convey the impression of having
a greater number of teeth than others, for those two rows of regular
white teeth, close to one another, strike the optic sense much more
vividly than teeth of the ordinary kind. This impression is somewhat
analogous, at least as regards color—to the optical illusion which
causes a white circle to appear larger than a black one of equal
diameter. Now, without doubt, individuals with a perfect denture are
mostly healthy and well constituted, and, therefore, live longer, in
general, than others. It is also to be noted that these people usually
keep all their teeth to a more or less advanced age; and there is no
doubt that among adults of the same age, those who have a less number
of teeth, by reason of having lost several of them, are, in general,
individuals whose organic constitutions are less good, whose health is
less satisfactory, and who are, therefore, destined in all probability
to live a shorter time than the others. It is, therefore, perfectly
true, _but only in a certain and very limited sense_ that “long-lived
individuals have a greater number of teeth.”

Geist-Jacobi, perhaps in order to dissipate the erroneous signification
of the Hippocratic proposition cited above and to place in evidence
that part of it which may be true, has thought well to translate it
thus:

“He who lives long keeps many teeth.” But this translation does not
render faithfully the idea expressed in the original Greek, ὁι
μαχρόβιοι πλείους ὁδόντας ἔχουσιν (literally, the long-lived have
more teeth); a proposition that the most celebrated commentators
of Hippocrates interpret in the sense given by us, and which Litré
translates excellently well in these words: “_Avoir des dents en plus
grand nombre est un signe de longévité_.”

Notwithstanding this prejudice, which survived vigorously for many
centuries, the regular number of teeth was not unknown at the time
of Hippocrates. This is to be perceived from a brief treatise of the
Hippocratic collection, entitled _De hominis structura_, wherein is
written:

“The teeth, together with the molars, are thirty-two.”

Among the many and many counsels of practical value registered in the
works of Hippocrates, the following deserves special mention:

“When a person has an ulcer of long duration on the margin of the
tongue, one should examine the teeth on that side, to see if some one
of them does not, by chance, present a sharp point.”[88]

In fact, it not infrequently occurs that a lingual ulcer deriving from
irritation produced by a broken or sharp tooth assumes a malignant
aspect that causes it to be mistaken for a cancerous ulcer, and
medical men may even be so far misled as to advise the extreme remedy
of amputation of the tongue. If, however, the consulting surgeon has
some experience, he will not neglect in the first place to examine
accurately the state of the patient’s teeth; it then mostly happens
that after the removal of the offending tooth a complete cure is
obtained in a brief space of time. How much anxiety would not such poor
sufferers be spared if physicians in general were acquainted with the
counsel given by Hippocrates twenty-four centuries ago!

In speaking of fracture of the lower jaw, Hippocrates recommends
binding the teeth next to the lesion together. He distinguishes between
the complete and the incomplete fracture; he then speaks separately of
the fracture of the symphysis. Treating of the incomplete fracture, he
says:

“If the teeth in proximity of the lesion be shaken, one ought, after
having reduced the fracture, to bind them one to the other, until the
consolidation of the bone, using preferably gold wire for the purpose;
but if this be wanting, linen thread can be used instead, and not only
ought the two teeth next to the site of the fracture to be bound, but
several of the others besides.”[89]

[Illustration: FIG. 9

Two Greek appliances existing in the Archæological Museum of Athens.]

Farther on, when speaking of complete fractures, he renews this advice
in these words:

“After having carried out the coaptation, the teeth ought, as we have
said already, to be bound one to the other; this greatly contributes
to obtaining the immobility of the fragments, particularly if properly
carried out.”[90]

Also, in cases of fracture of the symphysis, Hippocrates recommends
“binding the teeth together on the right and left of the lesion.” And
after having spoken of the best adapted means of constraint in such
kinds of fractures, he adds: “If the reduction has been well performed,
and the part kept in proper repose, the consolidation takes place in
a short time and the teeth do not undergo any damage; in the contrary
case, the cure is retarded, the fragments reunite in a bad position,
and the teeth are injured and become useless.”[91]

From what we have referred, it is easy to perceive how much importance
Hippocrates attached to the dental system, what knowledge he possessed
as to the pathological conditions of the teeth, the gums, and the jaws,
and what means of treatment he used. But in what relates to therapy it
will perhaps not be useless to make some further observations.

One of Hippocrates’ aphorisms says:

“Cold is the enemy of the bones, the teeth, the nerves, the brain, and
the spinal marrow.”[92]

From this it is easy to conclude that Hippocrates was no friend to
hydrotherapic treatment, and that he considered the use of cold drinks
bad for the teeth, and cold applications harmful in dental diseases.

The idea expressed in the aphorism just quoted is to be found repeated
in the book entitled _On the Use of Liquids_;[93] and in this same
treatise we find _vinegar_ recommended shortly after in cases of
_burning of the teeth_ (an expression probably meant to indicate those
pathological conditions of the teeth and gums which are accompanied by
a sense of burning).

Some of the Hippocratic maxims, full of wisdom and good sense, will
forever conserve their importance, whatever be the degree of perfection
to which medical science may come.

“Diseases, says he, should be combated in their origin;”[94] which
is as much as to say, that it is not enough to apply symptomatic or
palliative means of cure, but that it is necessary, rather to seek and
to combat the true causes of disease. And in another place we find
written:

“One should take care of two things in illnesses—to do good and not
to do harm. The art of curing includes three terms: the malady, the
patient, and the doctor. The latter is the minister of the art; the
patient has to combat the malady together with him.”[95]

It is only too true, that not all the representatives of the healing
art keep sufficiently in view the precept _to do good and not to do
harm_; nor do all patients comport themselves in such a manner as to
contribute, in accordance with Hippocrates’ wise counsel, to the work
of their own cure.

ARISTOTLE, the greatest philosopher of antiquity, was born at Stagira,
in Macedonia, and lived from 384 to 322 B.C. He wrote most excellent
works on all branches of human knowledge, and was the founder of
Natural History and Comparative Anatomy. His acquaintance with anatomy
as illustrated principally in his treatise _On the Different Parts of
Animals_, is absolutely extraordinary for the time in which he lived.
One chapter of this work[96] is altogether dedicated to the study of
the teeth; but he also speaks of these organs in many other of his
works, particularly in his _History of Animals_, which is a real and
proper treatise on zoölogy, wherein the author records a great number
of notes about the peculiarities presented by the dental system, in the
different classes of animals.

In spite of the great errors into which he has fallen, his ideas about
the teeth are, taken as a whole, quite worthy of attention, especially
when one considers the remote epoch in which this great philosopher
wrote. We will here give a brief notice of the most important of his
observations relating to the dental organs.

The form, the disposition, the number of the teeth, varies in animals,
according to the quality of their food and according to whether the
teeth serve merely to divide and to chew the alimentary substances, or
as instruments of offence and defence as well. In man, the teeth serve
principally for mastication, but the front ones have, besides, another
most important office, namely, that of assisting in the articulation of
words, in the pronunciation of certain letters.

In those animals in which the teeth also serve as weapons, it is to
be observed either that some of them protrude like those of the boar,
or that they are sharp and saw-like in their disposition, as in the
lion, the panther, the dog, etc. No animal possesses at the same time
protruding and saw-like teeth.

The teeth are not always equal in number in both jaws; the animals
provided with horns have no teeth in the front of the upper jaw; this,
however, is also to be observed in animals without horns, as for
example, in the camel. Among the animals provided with horns there are
none which have protruding or saw-like teeth.

In general, the front teeth are pointed and the back ones broad.
Nevertheless, all the teeth of the seal are pointed, with a saw-like
disposition, perhaps because this animal marks the transition from the
quadruped to the fish, all of which, with few exceptions, have their
teeth formed in that way. Animals with saw-like teeth have generally
very large mouths.

No animal has ever more than one row of teeth in each jaw; however,
says Aristotle, if Ctesias[97] is to be believed, there is an animal in
India, named marticora, which has a triple row of teeth.

The molar teeth are never changed either in man or in any known animal;
the pig never changes its teeth.

One can judge the age of many animals by their teeth. As the animal
grows older, the teeth become darker in color, except in the case of
the horse, whose teeth grow whiter with age.

The last molars are cut by men and women about the twentieth year; but
in some cases, and especially with women, they have been known to come
forth—not without pain—very much later, even so late as at eighty years
of age.

The man has more teeth than the woman; this peculiarity is also to be
found in the female of some animals (such as sheep, goats, and pigs).

Individuals provided with many teeth generally live the longest, those
instead who have fewer teeth (or simply far apart) are generally
shorter lived.

The teeth are generated by the nourishment distributed in the jawbone;
they are, in consequence, of the same nature as bones. Their surface,
however, is very much harder than that of the bones. The teeth,
contrarily to all other bones, grow throughout life, so as to provide
for their wearing away through mastication; and for this reason they
lengthen when the antagonizing teeth are wanting.[98]

The teeth differ from all the other bones, therein that they are
generated after the body has been already constituted; they are,
therefore, secondary formations; and precisely for this reason are able
to be shed and to be renewed.

Some of the veins of the head, says Aristotle, terminate with very
slender branches inside the teeth.[99]

The dental system of the monkey is altogether similar to that of man.

The molar teeth exist in viviparous quadrupeds as well as in man; in
the oviparous quadrupeds and in fish they are wanting. They serve to
grind food, a function in which the lateral movements of the inferior
jaw have, in many animals, a large share. For this reason, in animals
who have no molars, these lateral movements do not exist.

In birds, the beak takes the place of the lips and teeth; the substance
of which it is formed is similar to that of the horn or the nails.

In those animals which, instead of having all the teeth sharp, are
furnished with incisors, canines, and molars, these three species of
teeth are disposed in the same order as in man.

The setting on edge of the teeth may be produced not only by eating
acid things, but also simply by seeing them eaten. This sensation may
be made to cease by the use of purslane and salt.

In the book entitled _Problems_, many of which have reference to
medical matters, one is to be found to the following effect:

“Why do figs, when they are soft and sweet, produce damage to the
teeth?” Perhaps, answers Aristotle, because the viscous softness of
the fig causes small particles of its pulp to adhere to the gums and
insinuate themselves into the dental interstices, where they very
easily become the cause of putrefactive processes. But, he adds, it may
also be that harm is produced to the teeth by masticating the small
hard grains of this fruit.

In Aristotle’s _Mechanics_, the following question relative to the
extraction of the teeth is discussed:

“Why do doctors extract teeth more easily by adding the weight of the
odontagra (dental forceps) than by using the hand only? Can it be said
that this occurs because the tooth escapes from the hand more easily
than from the forceps? Ought not the irons to slip off the tooth more
easily than the fingers, whose tips being soft can be applied around
about the tooth much better? The dental forceps,” adds Aristotle, “is
formed by two levers, acting in contrary sense and having a single
fulcrum represented by the commissure of the instrument. By means
of this double lever it is much easier to move the tooth, but after
having moved it, it is easier to extract it with the hand than with the
instrument.”

From this passage of Aristotle one may draw various conclusions. First
of all, it appears that, at that time, the extraction of teeth was
a common enough operation carried out by doctors in general, or, at
least, by specialists not indicated by any particular denomination
but called doctors (in Greek, ιατροι) just the same as those
who dealt with the maladies of every other part of the body. If,
therefore (which, however, is very doubtful), there existed in Greece,
as there certainly did in Egypt, individuals who occupied themselves
_exclusively_ with the treatment of the teeth, they cannot have formed
a distinct class of professionals, but merely a section of the medical
class. Herodotus, too, as we have already seen, does not say, speaking
of Egypt, that there was a proper class of dentists, but gives us
to understand that the Egyptian doctors did not occupy themselves
indiscriminately with the treatment of all maladies, for some dedicated
themselves to curing the eyes, others to the treatment of maladies of
the head, others to those of the teeth, and so on.

From the Aristotelian passage on the extraction of teeth, just quoted,
it may be concluded that in those times the Hippocratic precept, that
only loose teeth were to be extracted, was not observed, for otherwise,
Aristotle could not have said that dental forceps are useful to loosen
the teeth, but that after this has been done the extraction of the
tooth may be more easily effected by means of the fingers than with the
instrument.

This last assertion appears very strange. It demonstrates that either
the instruments then in use were very imperfect, or that Aristotle,
although the son of a doctor and himself possessed of vast medical
knowledge, had absolutely no experience as to the extraction of teeth;
and, therefore, speaking theoretically, and without any practical
basis, he ran into error, as even the greatest men are apt to do when
drawing conclusions from purely theoretical reasonings.

From Aristotle to Galen, that is, for the space of five centuries,
the anatomy of the dental system, so far as may be deduced from the
writings preserved to us, made no sensible progress. But in respect
to this, one must take into consideration some historical facts of
capital importance. The school of medicine of Alexandria, which arose
about three centuries before Christ, numbered among its most brilliant
luminaries the celebrated doctors Herophilus and Erasistratus, who
were the initiators of the dissection of human corpses,[100] thus
giving a great impulse to anatomical research. It is, therefore, hardly
admissible that these two great anatomists, who studied with profound
attention even the most complicated internal organs, should have
neglected the anatomy of the teeth. Unfortunately, however, not all the
results of their researches have come down to us; nor is this to be
wondered at, especially if we reflect on the large number of precious
works entirely lost by the destruction of the celebrated library of
Alexandria, A.D. 642.

When we come to speak of Archigenes, we shall see how he, in certain
cases, advised trepanning the teeth. This would lead to the belief that
in his times, viz., toward the end of the first century after Christ,
the existence of the central cavity of the tooth was not ignored, and
that, therefore, the structure of these organs had already been the
object of study.

As to diseases of the teeth and their treatment, there is no doubt that
Herophilus and Erasistratus must have occupied themselves with these
subjects; and the same may be asserted of Heraclides of Tarentum, a
celebrated doctor who lived in the third century before the Christian
era. Indeed, we read in Cœlius Aurelianus,[101] that the record had
come down through the works of Herophilus and Heraclides of Tarentum,
of persons having died by the extraction of a tooth.[102] The same
writer also alludes to a passage of Erasistratus, relating to the
_odontagogon_ already mentioned, which was exhibited in the temple
of Apollo, and to the practical signification to be attributed to
the fact of this instrument being of lead and not of hard metal. Now,
if Herophilus, Heraclides of Tarentum, and Erasistratus all spoke of
the serious peril to which the extraction of a tooth may give rise,
and therefore recommended not having recourse to it too lightly, it
is evident that they had given serious attention to this operation
and consequently also to the morbid conditions that may render it
necessary.




CHAPTER VI.

DENTAL ART AMONG THE ETRUSCANS.


Much earlier than the foundation of Rome (B.C. 753) there flourished
in that part of Middle Italy today called Tuscany the highly civilized
people known by the name of Etruscans or Toschi. Their political
organization had the form of a confederation of twelve principal
cities,[103] the federal capital being Tarquinii. The Etruscan people
were industrious, intelligent, and artistic in the highest degree,
possessing special skill in the decorative arts, splendid monuments,
some of which still remain to us; they were fond of luxury in all its
manifestations, and took great care of their persons; at the same time,
however, they were a laborious and courageous race, not only most
active and enterprising in agriculture, in art and commerce, but also
brave warriors and hardy navigators.

In their long sea voyages the Etruscans frequently visited Egypt and
Phœnicia, trading especially in the more flourishing cities, which
were at that time Memphis in Egypt, and Tyre and Sidon in Phœnicia.
On the other hand, the Phœnicians, who were also active merchants and
navigators, not only visited Etruria and other regions of Italy very
frequently, but also established numerous colonies in many islands of
the Mediterranean, and especially in those nearer to Italy.

This continual intercourse between Etruscans, on the one side, and
Egyptians and Phœnicians, on the other, accounts for the great
influence exercised by the Egyptian and Phœnician civilization upon
the later developed Etruscan culture—an influence manifesting itself
very distinctly in the works of art of the latter, which often have an
altogether Oriental character, and not seldom represent scenes drawn
from the domestic life of the Egyptians and Phœnicians.[104]

[Illustration: FIG. 10, FIG. 11, FIG. 12

Dentures in terra-cotta, such as the Etruscans used to present to their
divinities as votive offerings in order to be cured, or after having
been cured of dental maladies.]

As to what concerns dental art, everything leads up to the belief that
it was practised by the Egyptians and Phœnicians earlier than by the
Etruscans, whose civilization, as already hinted, is certainly less
ancient. Nevertheless, in comparing the dental appliances found in the
Etruscan tombs with the sole authentic dental appliance of Phœnician
workmanship known at the present day,[105] we cannot but be struck
with the great superiority of the Etruscan appliances. It is therefore
probable that the Etruscans, although they had learned the dental art
from the Egyptians and Phœnicians, had subsequently carried it to a
much higher degree of perfection than it had arrived at in Egypt or in
Phœnicia. An analogous fact has come to pass in our own times. Dental
art in America, which emanated from the French and English schools,
soon took on so vigorous a development as indisputably to acquire first
rank.

Before describing in detail the dental appliances found up to now in
Etruscan tombs, we will consider a question touching very closely upon
the argument which we are treating and which has already been discussed
in Professor Deneffe’s book, already cited.

How is it that the dental appliances of the Phœnicians, Greeks,
Etruscans, and Romans should have come down to us, notwithstanding
cremation?

In the first place, if one reflects that the teeth offer an altogether
special resistance to the action of fire, and if one also remembers
that gold was the substance employed for the construction of the
appliances in question, and that this metal does not melt save at a
very high temperature, it no longer appears marvellous if, in many
cases at least, the dental appliances should have been able to resist
the cremating process.

In the second place, the cremation may possibly sometimes have been
incomplete—that is to say, the skeleton may not have been altogether
reduced to ashes; therefore, among the residuum of this incomplete
combustion, a piece of a jaw may easily have remained, and incidentally
also its prosthetic appliance.

But besides all this, it must be considered that the custom of burning
corpses was not at all general among ancient people. Indeed, cremation
was not in use either among the Egyptians, the Phœnicians, the Hebrews,
or the Chinese; the Greeks only resorted to it in exceptional cases.
The most ancient tombs of the Etruscans show that at the epoch of their
settling in Italy, cremation was in general use among them. But little
by little, as they entered into commercial relations with the Egyptian,
the Phœnician, and the Greek peoples, who did not burn their dead, the
custom of burial substituted that of cremation. Toward the end of the
sixth century before Christ there were to be found in southern Etruria,
one beside the other, tombs for the burial of corpses and others for
cremation.

One sometimes finds in one and the same tomb a cinerarium (urn for
conserving ashes) and skeletons enclosed in sarcophagi or resting on
mortuary couches.

At Tarquinii and Orvieto burial generally prevails.

In the fifth century B.C., the epoch in which the Law of the Twelve
Tables was promulgated, burial and cremation were equally in use among
the Romans. In the second century of the Christian era burial was
already prevalent, and through the influence of Christianity became
general during the third and fourth centuries.[106]

[Illustration: FIG. 13

Tooth crowns found in an Etruscan tomb of the ancient
Vitulonia (Archæological Museum of Florence). The
enamel-capsules of these teeth (four molars and one
canine) are perfectly well preserved, whilst the ivory
has entirely disappeared.]

[Illustration: FIG. 14

The same tooth crowns of the preceding figure, seen from
the side of the concavity of the enamel capsules.]

Notwithstanding cremation, which certainly must have destroyed a great
number of the dental appliances of that time, and in spite of the many
different destructive agents which successively did their work on those
human remains during so many centuries, not a few prosthetic pieces of
Etruscan workmanship have come down to us; from which we may argue that
dental prosthesis was not an exceptional fact among this people, as
some may perhaps suppose, but, on the contrary, must have been a very
usual practice.

The dental appliances discovered up to now among Etruscan remains are
preserved in different Italian museums, with the exception of some few
existing in private collections or of others that have passed out of
Italy into other countries.

In the museum of Pope Julius in Rome there is a dental appliance found
at Valsiarosa in one of the many Etruscan tombs excavated in that
locality near Civita Castellana, the ancient Falerii (Fig. 15). This
appliance is formed by a series of four gold rings meant to encircle
four teeth (canine, bicuspids, and first molar). The third ring is
traversed by a pivot riveted at the two extremities, which was meant to
hold fast an artificial tooth (the second bicuspid); this is wanting,
however. One naturally puts the question. How is the disappearance of
this tooth to be accounted for, it having been traversed by the pivot,
which is still found in its place? The suppositions are two: Either the
artificial tooth was made of some not very durable material, which, in
the course of time, became reduced to powder or fell to pieces, or may
have been destroyed in some other way; or else the artificial tooth,
instead of being simply perforated to allow the pivot to pass through,
was cleft longitudinally at its base and, being introduced into the
ring sat, so to speak, astride the pivot. In the second case, which,
however, seems to me the less probable of the two, the tooth may merely
have come off the pivot and gotten lost.

In the Civic Museum of Corneto, the ancient Tarquinii, there are two
dental appliances, one of which (Figs. 16 and 17) is of the greatest
interest. It was found in one of the most ancient tombs in the
necropolis of Tarquinii. This specimen of prosthesis is formed of three
teeth; the two upper central incisors and the second bicuspid on the
left, which is no longer in existence.

[Illustration: FIG. 15

Etruscan appliance found at Valsiarosa, destined to support an
artificial bicuspid, now disappeared.]

To afford support and maintain the three artificial teeth in position,
the Etruscan dentist of about three thousand years ago, ingeniously
made use of the canine and the lateral incisor on the right, the
canine, the first bicuspid, and the first molar on the left, connecting
them by a continuous series of pure gold rings soldered together. The
dentist had not employed human teeth to replace the incisors which
the individual had lost; according to the religious laws of the time,
the dead were held sacred, and it would probably have been considered
sacrilege to use their teeth; or it may also be that the patient had
declared his aversion to the idea of substituting his own teeth by
those of a dead man. However this may be, the Etruscan dentist thought
well to replace the missing incisors with a somewhat large ox tooth;
upon this he had made a groove, so as to give it the appearance of two
teeth. In reality this ox tooth occupies the place not only of the two
middle incisors, but also of the lateral incisor on the left. Perhaps
by a natural anomaly the individual may never have had this tooth; or,
more probably still, some length of time may have elapsed between the
loss of one of the three and the other two, so that when he made up his
mind to have recourse to a prosthetic appliance, the space normally
occupied by the three incisors was already notably diminished, and
the void could therefore be filled by an ox tooth so adjusted as to
represent only two teeth.

[Illustration: FIG. 16

Etruscan appliance for supporting three artificial teeth, two of which
were made of one ox tooth. (Civic Museum of Corneto.)]

[Illustration: FIG. 17

The same appliance reversed.]

When I was intrusted with the reproduction of all the ancient
prosthetic pieces existing in the Italian museums, I met with special
difficulty in the reproduction of the above-mentioned piece; and this
because I could not succeed in procuring an ox tooth that was not
worn away by the effects of mastication. The idea then occurred to me
of sectioning the upper jaw of a calf at about the age of the second
dentition, and taking out the teeth, which were already strong and well
formed, but not yet deteriorated by mastication. I fancy my Etruscan
colleague must have done the same three thousand years ago, when he
carried out the prosthesis in question, for the large tooth employed by
him does not show any signs of being worn by mastication.

This large tooth is solidly fixed by means of two pivots to the gold
band that encircles it. Another pivot served to fix the second
bicuspid, also artificial. This tooth, as already stated, has now
disappeared, but the pivot that fixed it to its ring is still in its
place. In carrying out this prosthesis the dentist has contrived the
series of rings that support the teeth in such a manner that they
remained above the gum, and thus the harmful effects of contact and of
the pressure of an extraneous body was avoided. At the same time, this
arrangement, by distancing the rings from the dental neck that narrows
off conically, added to the firmness of the prosthesis.

[Illustration: FIG. 18

Etruscan appliance for supporting two inserted human teeth, one of
which is now wanting. (Civic Museum of Corneto.)]

Another dental appliance (Fig. 18) which is in the custody of the Civic
Museum of Corneto, was also found in a very old Etruscan tomb. It is
formed by two bands of rolled gold; one of these is labial, the other
lingual, and they are soldered together at their extremities, forming
by the help of four partitions, also of gold, five square spaces. Three
of these served for the reception of the natural teeth supporting
the prosthesis; the other two maintained, by means of pivots, two
inserted human teeth; one of these is lost; the other is still in
its place, solidly fixed by its pivot. These inserted human teeth,
by the religious laws we have before mentioned, could not have been
taken from corpses; probably they belonged to the person himself, and
having fallen out through alveolitis, had been reapplied in the manner
described above.

[Illustration: FIG. 19

Etruscan appliance supporting one inserted tooth (upper middle incisor
on the right) which is now disappeared. (Museum of the Conte Bruschi at
Corneto.)]

Two Etruscan dental appliances are to be found in the Museum of the
Conte Bruschi at Corneto: one is similar to those already described,
and the other, instead, is of a special kind. The first (Fig. 19) is
formed by a series of four rings, embracing the upper canine on the
right and the three neighboring incisors. It was destined to support
a single inserted tooth, the middle incisor on the right; this has
disappeared, while the pivot by which it was fixed to the ring is still
there, as well as the three natural teeth that afforded support to the
appliance.

[Illustration: FIG. 20

Etruscan appliance intended to avoid the bad effects of convergence,
or, perhaps, to support a purely ornamental artificial substitute.
(Museum of Conte Bruschi at Corneto.)]

The other appliance (Fig. 20) is formed by two rings; the one surrounds
the left upper canine, the other the left middle incisor. Between these
two rings there is not the usual ring crossed by a pivot, but simply
a small horizontal bar of gold soldered to the two rings. I suppose
that the person not liking to wear false teeth (one meets with this
repugnance also at the present day), the dentist has limited himself to
putting a horizontal bar of gold between the two teeth on either side
of the missing one, in order to maintain them in their normal position
and so avoid the bad effects of convergence.

[Illustration: FIG. 21

Dental appliance still adhering to the jaw, discovered in an Etruscan
necropolis near Orvieto, and now in the possession of the Ghent
University.]

Another ancient dental appliance discovered in an Etruscan necropolis
near Orvieto is now in the possession of the Ghent University, to
which it was sold.[107] It still adheres to a piece of upper jaw (Fig.
21), in which there are four teeth on each side, that is, on the right,
the canine, the two bicuspids, and the first molar; on the left, the
canine, the second bicuspid, and the two first molars. The alveoli of
the four incisors are of normal width and depth, this signifying that
these teeth remained in their places until the end of life. The dental
appliance, still supported by this fragment of a jaw, is made of the
purest gold. It is composed of a small band curved back upon itself,
the ends being soldered together, and, by the aid of two partitions,
also of pure gold, it forms three compartments, two small lateral
ones, and one centre one of double the size. The lateral compartment
on the right contains the canine of the same side; that on the left
must have contained the left central incisor, that has now disappeared,
while the large central compartment must evidently have contained the
two incisors on the right side. As there is no pivot in the whole
appliance, and as the alveoli are not obliterated, there can be no
doubt that the appliance was simply destined to prevent the loss of the
two right incisors by keeping them steady.

[Illustration: FIG. 22

The same piece as in the preceding figure, seen from the palatal side.]

It is to be noted, with regard to the Etruscan dental appliances above
described, that the gold bands of which they were constructed covered
a considerable part of the dental crown, so that these prosthetic
appliances certainly could not have had the pretension of escaping
the notice of others, they being, on the contrary, most visible. It
is in consequence to be surmised that in those times the wearing of
false teeth and other kinds of dental appliance was not a thing to be
ashamed of; indeed, that it rather constituted a luxury, a sort of
refinement only accessible to persons of means. Besides this, as the
gold in which these works were carried out was of the purest quality
and in consequence very soft, the appliances would not have possessed
sufficient solidity if the softness of the pure gold had not been
counteracted by the width and thickness of the bands or strips.

[Illustration: FIG. 23

Etruscan appliance (found in 1865 in a tomb by Cervetri), destined
perhaps to support a purely ornamental artificial substitute.
(Belonging to Castellani’s collection, Rome.)]

[Illustration: FIG. 24

A reproduction of the gold piece forming the appliance seen in Fig. 23.]

In those of the Etruscan appliances destined for the application of
inserted teeth, the gum was not made to support the prosthesis, and did
not, therefore, suffer any compression from the extraneous body, this
resting entirely, like a bridge, upon the neighboring teeth. From which
it may be seen that twenty-five centuries and more before our time the
Etruscans dentists already practised a system of bridge work, and,
relatively to the age, carried it out with sufficient ability.




CHAPTER VII.

THE ROMANS.


For many centuries the Romans, according to the saying of Pliny,
lived entirely “without doctors, although not without medicine;”[108]
that is, there existed without doubt a popular medicine and also a
sacerdotal medicine, but still there were no persons whose exclusive
occupation it was to cure disease.

The medical art, properly so called, was introduced into Rome by the
Greeks. The first Greek doctor who went to Rome was Archagathus (in the
year 535 after the foundation of the city, that is, 218 years before
Christ). His arrival was at first welcomed, so much so that he was made
a Roman citizen and a shop bought for him in the Acilian square, at the
expense of the State. However, his popularity was of brief duration.
Being an intrepid operator, the use and abuse he made of steel and fire
gained for him the not very honorable qualification of the butcher, and
he soon became the horror of all the population.

But it appears that dentistry had begun to be practised in Rome
prior to the coming of Archagathus, that is, long before the medical
profession existed. We have the clear proof of this in the Law of the
Twelve Tables, wherein we find mention made of teeth bound with gold.
The Law of the Twelve Tables was written in Rome 450 years before
Christ, by a body of ten magistrates (_decemviri_) expressly named for
that purpose, as up to that time no written law had existed.

As gold was at that time somewhat scarce, and fears were entertained
that it would become still scarcer (to the great damage of the State)
by reason of the custom that prevailed among the wealthy of burning
or burying gold articles with the corpses to honor the memory of the
deceased, or, rather, to satisfy the pride of the survivors, it was
thought necessary to prohibit this abuse by a special disposition
of the law referring to funeral pomps. This disposition was thus
formulated: “_Neve aurum addito, ast quoi auro dentes iuncti escunt
(sunt) im cum illo sepelirei vrive sine fraude esto_;”[109] that is,
“Neither shall gold be added thereto (to the corpse); but it shall not
be unlawful to bury or to burn it with the gold with which the teeth
may perchance be bound together.”

From this it results that at the time when the Law of the Twelve Tables
was written, that is, four centuries and a half before the Christian
era, there were already individuals in Rome who practised dental
operations. And these individuals cannot have been medical men, as at
that epoch (corresponding pretty nearly with the date of Hippocrates’
birth) Rome had as yet no doctors.

The inquiry naturally suggests itself whether the gold mentioned in the
legal dispositions above cited was used for fixing artificial teeth or
simply for strengthening unsteady natural teeth. Some authors, Serre
among them,[110] have pronounced in favor of the first hypothesis,
others, as, for example, Geist-Jacobi,[111] are rather disposed to
accept the second. In truth, however, we do not possess sufficient
historical data to definitely resolve this problem. I myself am rather
of opinion that artificial teeth were already in use in Rome, as they
were, even before this time, among the Etruscans. Indeed, if we take
into consideration the priority of the Etruscan civilization to the
Roman and the relations of vicinity existing between Etruria and the
Roman State, of which it afterward became a part, it is even possible
that dental prosthesis was first practised in Rome by Etruscans.

In a Greek-Roman necropolis near Teano (Province of Caserta, Italy)
there was found in February, 1907, a prosthetic piece of a very
peculiar construction, and which may be considered as quite unique in
its kind. It is an appliance destined to support three inserted human
teeth (the two lower central incisors and the lateral incisor on the
right). These teeth—lost perhaps by the patient himself, in consequence
of alveolar pyorrhea—were fixed by means of a system of rings, made of
laminated gold wire, turned around the teeth and then soldered.

By the examination of the piece it is easy to argue that the author of
this prosthesis made at first three separate rings by tightly turning
the laminated gold wire around each of the three teeth to be applied,
and by soldering together the ends of the wire forming each ring, after
having taken away the tooth, in order not to spoil it in making the
soldering. Then, with another laminated gold wire of sufficient length,
he soldered the three rings together in due position, put the appliance
in the mouth and turned the two ends of the wire around the sound
teeth, serving as a support for the lateral incisor on the left and
the two canines. After this, he took the apparatus delicately out of
the mouth, made the soldering necessary for finishing the skeleton of
the apparatus, forcibly put the three teeth in their respective rings
again, and applied the prosthesis.

This ingenious appliance was found still adherent to the mandible of a
skeleton, in a tomb which, according to the eminent archæologist Dalli
Osso, belongs to a period comprised between the third and the fourth
century before Christ.

From the nature of the objects found in the tomb near the skeleton (a
necklace, perfume vessels, etc.) it was quite evident that the skeleton
bearing the above-described prosthesis was that of a woman.

As the said appliance was found in South Italy (the ancient “Magna
Græcia”) it is quite probable that it was made by some dentist of the
Greek colonies.

The above apparatus belongs to the archæological collection of Signor
Luigi Nobile, in Teano, in whose possession it was found.

[Illustration: FIG. 25

Seen from behind.

FIG. 26

Seen from above.

A prosthetic piece of very peculiar construction (see description),
found in 1907 near Teano, Italy.]

The Romans, as well as the Hebrews, and other peoples of antiquity,
attributed great importance to the integrity of the dental system. This
may be deduced with certainty from another article in the Law of the
Twelve Tables (Table VII, at the rubric _De delictis_), which says:
“_Qui dentem ex gingiva excusserit libero homini, trecentis assibus
multator, qui servo C L._” (Whoever shall cause the tooth of a free man
to fall shall pay a fine of three hundred _as_, and for that of a slave
one hundred and fifty.) The _as_ was worth about ten cents American
money, so that the first fine amounted to about thirty dollars and the
second to about fifteen dollars. These sums, because of the difference
in the monetary value in those times, were considered heavy fines.

After the Romans had conquered Greece (146 B.C.) a very great number
of Greek doctors went to Rome. The wealth, luxury, and ever-increasing
corruption of the metropolis caused the practice of the medical art
(which was almost entirely in the hands of the Greeks) to become a
great source of lucre. But an art practised with the sole purpose
of making money soon degenerates to the level of a trade; it is,
therefore, hardly to be wondered at if very few doctors of that epoch
have merited being recorded in history.

Among these few, the name Asclepiades (born at Prusa, in Asia Minor;
died in Rome ninety-six years B.C.) shines with particular lustre. He
was the founder of the “methodic school,” whose curative precepts,
largely based upon hygiene, come nearer to those of modern scientific
medicine. Unfortunately, all the writings of this great physician,
whose name is almost as glorious as that of Hippocrates, have been
lost; we do not know, therefore, whether and in how far he contributed
to the development of our specialty.

But one of the first places in the history of dental art is due without
doubt to Cornelius Celsus, of whom we will now speak.

CORNELIUS CELSUS. The historical researches in regard to the life of
this celebrated author have given but meagre results. It is uncertain
whether his birthplace was Rome or Verona. The precise dates of his
birth and death are also unknown; but it is very probable that he was
born about thirty years before Christ, and that he died during the
fifth decade of the first century.

Aulus Cornelius Celsus belonged to the illustrious patrician family of
the Cornelii. He was a man of great erudition, and wrote on the most
varied subjects, and among others, on agriculture, on rhetoric, on the
art of warfare, on medicine, etc. All these writings, however, are lost
to us excepting his excellent treatise on medicine.

Some historians consider that Celsus was a true doctor by profession;
others, instead, hold that he never undertook the cure of the sick.
Neither the one nor the other of these opinions is quite acceptable;
and it is much more likely, as Daremberg observes in his valuable
_Histoire des Sciences Médicales_, that Celsus was one of those
philiatri mentioned by Galen, who had studied medicine rather from
books than at the bedside of the sick, but who, although not doctors by
profession, in case of necessity, put their knowledge and skill into
practice on behalf of their relations and friends.[112]

The work of Celsus, gathered in great part from Greek authors, has an
especial value, because it sums up, in an admirable manner, the whole
of the medical and surgical science of the ancients, from the earliest
times up to the days of Augustus.

The first book of the work _De Medicina_[113] does not contain anything
of great importance in regard to dentistry. The following hygienic
precept is, however, worthy of note: “After rising, if it be not
winter, the mouth should be rinsed with a quantity of fresh water.”
In regard to the hygiene of the mouth, nothing more is found in the
work of Celsus; and it is also necessary to note that the aforesaid
precept forms part of a chapter, in which he speaks of the rules of
life, which must be observed by weak people, to which class—the author
remarks—belong a greater part of the inhabitants of cities and almost
all literary men. According to Celsus, therefore, perfectly healthy
and strong people would not even need to wash their mouths with fresh
water, and perhaps the keen-witted Roman doctor was not wrong; for it
is very probable that the saliva and mucous secretion of the mouth,
in perfectly healthy individuals with normal constitutions, have the
power of combating the pathogenic germs that produce caries and other
diseases of the teeth and mouth. In this way the fact can be explained
of many peasants and the greater part of the individuals of the negro
race having such good teeth, without possessing even the remotest idea
of what hygiene of the mouth may be. And here I venture to refer to a
passage in which Celsus alludes to the relation between diseases and
civilization with its vices: “It is probable that in ancient times,
although there was but little knowledge of medicine, health was for
the most part well preserved; this being due to good habits, not yet
spoiled by intemperance and idleness. These two vices, first in Greece
and then among us, have brought upon us a very host of evils; whence it
is that in our days, in spite of the intricate art of medicine—once not
necessary to us, as it is not necessary to other peoples—few among us
attain the beginning of old age.”[114]

In the second book, speaking of the various kinds of disease to which
the different periods of life are subject, he writes: “Children are
especially subject to serpiginous ulcers of the mouth, called by the
Greeks aphthæ.... There are also infirmities due to dentition, such as
ulceration of the gums, convulsions, fever, looseness of the bowels;
and it is especially the eruption of the canine teeth which produces
these disturbances. To these, however, very fat children are more
particularly liable, and those, also, who have costive bowels.”

In Chapter XXV of the fifth book we find the receipt for a narcotic
drug, recommended by the author for producing sleep in persons
tormented with odontalgic and other pains. This receipt is very
complicated, being composed of ten ingredients, among which are acorns,
castoreum, cinnamon, poppy, mandrake, and pepper.

Most important for our subject is Chapter IX, of the sixth book, where
the author treats of odontalgia. “In toothache, which may be numbered
among the worst of tortures, the patient,” says Celsus, “must abstain
entirely from wine, and at first, even from food; afterward, he may
partake of soft food, but very sparingly, so as not to irritate the
teeth by mastication. Meanwhile by means of a sponge he must let the
steam of hot water reach the affected part, and apply externally,
on the side corresponding with the pain, a cerate of cypress or of
iris, upon which he must then place some wool and keep the head well
covered up. But when the pain is violent, the use of purgatives is
very beneficial, the application of hot cataplasms on the cheek, and
the keeping in the mouth of some hot liquid, prepared with fitting
medicine, changing this liquid, however, very frequently. For this
purpose the root of cinquefoil may be boiled in wine, or that of
hyoscyamus (henbane), or a poppy-head, seedless and not too dry, or
the root of the mandrake. But in regard to the last three remedies,
one must be careful not to swallow the decoction whilst it is kept
in the mouth. For the same purpose one may boil the bark of the root
of the white poplar in wine, or the scrapings off a stag’s horn in
vinegar or figs in mulse[115] or in vinegar and honey. It is useful
also to pass repeatedly around the tooth the end of a probe which has
first been wrapped around with wool and then dipped in hot oil. It is
customary also to apply around the tooth certain remedies, after the
manner of plasters. For this purpose the inside of the peel of dried,
bitter pomegranates may be pounded with equal quantities of gall-nut
and pine bark; to these must be added a little minium[116] and the
whole mixed together with the addition of rain water to form a paste;
or else a similar paste may be formed with equal parts of panax,[117]
poppy, peucedanum,[118] and taminia grape[119] without stones; or with
three parts of galbanum to one of poppy. On the cheek, however, must be
applied at the same time the cerate spoken of above, covered over with
wool.”

Celsus then speaks of a revulsive adopted, in his times, against
odontalgia. It was composed of myrrh and cardamom, _ana_ one part;
saffron, pyrethrum, figs, pepper, _ana_ four parts; mustard seed,
eight parts. The plaster, spread on linen, was to be applied on the
shoulder corresponding to the side of the pain, and, according as this
was situated in a tooth of the upper or lower jaw, the revulsive was
applied on the back of the shoulder, or in front.

When a tooth is decayed, Celsus advises that there should be no haste
in drawing it; but that the pain be combated, if the above medicines
are not sufficient, with others more energetic. A mixture may, for
example be applied to the tooth, composed of one part of poppy, two
of pepper, and ten of sory,[120] pounded and mixed to a paste with
galbanum; or else, especially in the case of a molar tooth, the remedy
of Menemacus, resulting from saffron, one part; cardamom, soot from
incense, figs, pepper, pyrethrum, _ana_ four parts; mustard seed, eight
parts; or even a more complicated remedy made with pyrethrum, pepper,
and elaterium,[121] _ana_ one part; scissile alum,[122] poppy, taminia
grape, crude sulphur, bitumen, laurel berries, mustard seed, _ana_ two
parts.

“If, says Celsus, the pain renders necessary the removal of the tooth,
this may be made to fall to pieces, by introducing into the cavity a
pepper berry without its skin, or a berry of ivy, pared in the same
way. The same result may be obtained in the following manner: The sharp
bone (aculeus) of that flat fish called by the Greeks trygon and by us
pastinaca, must first be roasted and then reduced to powder and mixed
with resin, so as to form a paste; which applied around the tooth will
make it fall out. Likewise, scissile alum induces the fall of the
tooth, when introduced into its hollow. This substance, however, is
best introduced into the small cavity, after being wrapped around with
a tuft of wool, for thus the pain is soothed and the tooth preserved.”

Somewhat curious is the following passage, in which Celsus speaks of
the superiority of a method of cure used by peasants, compared to the
remedies advised by the doctors. From his words we clearly see that he,
as we have already remarked, did not belong to the class of doctors
properly so called.

“These are the remedies accepted and held in account among the doctors.
But it is known through the experience of peasants, that when a tooth
aches one must pluck up wild mint by the roots, put it into a large
vessel, pour water on it, and make the patient sit near it, covered all
around with a blanket; and red hot stones should then be thrown into
the water, so that they be entirely immersed; and then the patient,
wrapped all around, as we have said before, and keeping his mouth open,
receives into it the steam evaporated from the water. Thus profuse
perspiration is induced, and a great quantity of pituita flows from the
mouth, and with this a cure is obtained for a very long period, often
for more than a year.”

In the six following chapters of the sixth book, Celsus treats of the
diseases which affect the soft parts of the mouth. Against tonsillitis,
he recommends, among other things, the application of a remedy
principally made of the juice of the sweet pomegranate, cooked, by a
slow fire, to the consistency of honey. The same remedy is also of
great value, according to the author, for the cure of ulcers of the
mouth, when they are accompanied by inflammation, and are somewhat
foul and of a reddish color. But under such circumstances it will also
be necessary to keep frequently in the mouth an astringent decoction,
to which a little honey has been added. The exercise of walking is
also profitable, as well as the taking of food that is not acid. When,
however, the ulcers begin to be clean, the mouth should be frequently
filled with a softening liquid or even with simple pure water. It is
also helpful to drink genuine wine and to eat rather freely, avoiding,
however, acid food. The ulcers must be sprinkled with a powder composed
of two parts of scissile alum to three of unripe gall-nuts. If,
however, the ulcers are already covered with a scab similar to those
produced on burns, some of those compositions should be used which are
called by the Greeks _antheræ_; for example, a remedy may be formed
of equal parts of cyperus,[123] myrrh, sandarac, and alum; or another
which contains saffron, myrrh, _ana_ two parts; iris, scissile alum,
sandarac, _ana_ four parts; cyperus, eight parts.

“Much more dangerous, says Celsus, are those ulcers of the mouth which
the Greeks call _aphthæ_; they oftentimes lead to death in children;
in adult men and women, however, there is not the same danger. These
ulcers begin in the gums; then they attack the palate and the whole
of the mouth, and finally extend to the uvula and to the fauces; when
these parts are attacked, it is not very likely that a child will
recover.”

As to the ulcers of the tongue, Celsus says that those which are
situated at the borders of this organ last a very long time, and he
adds: “It should be seen whether there may not be some sharp tooth
opposite, which hinders the ulcer from healing; in case such a tooth
exists, it should have its edge taken off with a file.”

He then passes on to speak of the diseases of the gums: “Often small
painful tumors, called by the Greeks _parulides_, are produced on
the gums. It is necessary at the very first to rub them softly with
powdered salt, or with a mixture of burnt mineral salt, cyperus, and
catmint, meanwhile keeping the mouth open until there flows from it a
good quantity of pituita; after which the mouth must be rinsed with
a decoction of lentils. But if the inflammation is great, the same
remedies must be used as are adopted for the ulcers in the mouth, and
between the tooth and the gum must be inserted a small tent of soft
lint, on which has been smeared some one of those compositions which
we have said are called _antheræ_. If this, owing to the hardness of
the tumor, is not possible, then by means of a sponge the steam of hot
water should be made to act upon the diseased part, and, besides, an
emollient cerate must be applied upon it.

“Should suppuration show itself, it will be necessary to use the
above-mentioned steam for a longer period; to keep in the mouth hot
mulse, in which some figs have been cooked, and to lance the tumor
before it is perfectly ripe, so that the pus may not, by remaining too
long in the diseased part, injure the bone. But if the tumor be of
great size, it will be more advisable to remove it entirely, so that
the tooth remain free on both sides. After the pus has been extracted,
if the wound be a small one, it is sufficient to keep hot water in the
mouth, and to use externally fomentations of steam, as mentioned above;
if it be large, it will be fitting to use the decoction of lentils and
the same remedies with which all other ulcers of the mouth are cured.

“It also happens, sometimes, that from an ulcer of the gums—whether it
follow a parulis or not—one may have for a long period a discharge of
pus, on account of a broken or rotten tooth, or else on account of a
disease of the bone; in this case there very often exists a fistula.
Then the latter must be opened, the tooth extracted, and if any bony
fragment exist, this should be removed; and if there be anything else
diseased, this should be scraped away. Afterward, the same remedies
which have been indicated for the other ulcers of the mouth must be
used.

“If the gums separate from the teeth, it will be useful, in this
case also, to employ those remedies called _antheræ_. But it is also
beneficial to chew unripe pears and apples and to keep their juices in
the mouth. Equal advantage can be derived from keeping vinegar in the
mouth, provided it be not too strong.

“Whenever ulcers of the mouth are attacked by gangrene, it is necessary
first to consider whether the whole body be unhealthy, and in that
case, to do what is necessary to strengthen it. When the gangrenous
ulcer is superficial, the use of _antheræ_ is sufficient; when it is
somewhat deeper, a mixture must be applied on it, of two parts of
burnt paper[124] to one of orpiment;[125] when it is very deep, three
parts of burnt paper to a fourth part of orpiment must be used; or
else, equal parts of roasted salt and roasted iris; or lastly, equal
parts of chalcites, lime, and orpiment. It is, however, necessary to
dip a small pledget of lint in oil of roses, and put it on the caustic
medicinals, so that these may not injure the neighboring healthy parts.
If the disease is in the gums, and some of the teeth are loose, it is
necessary to pull them out, for they greatly hinder the cure. When
this latter, however, cannot be obtained by drugs, the ulcer must be
cauterized with a red-hot iron.”

Chapter XII of the seventh book is, of all the work of Celsus, the
one which presents to us the greatest interest, since there the author
treats of the surgical operations required by the diseases of the
dental apparatus.

He first speaks of the looseness of the teeth, caused by the weakness
of their roots, or by the flaccidity of the gums, and says that in
these cases it is necessary to touch the gums lightly with a red-hot
iron, then to smear them with honey and wash them with mulse, and later
on to strengthen them by means of astringent substances.

“When a tooth aches, and it is thought well to extract it, because
medicaments are of no use, the gum must be detached all around, and
then the tooth must be shaken until it is well loosened, it being very
dangerous to draw a firm tooth, as this may sometimes give rise to a
dislocation of the lower jaw. And greater still is the danger in regard
to the upper teeth, as this might cause a shock to the temples and
eyes. After having well loosened the tooth, it must be pulled out by
the fingers, if this is possible; or if not, with the forceps.”

[Illustration: FIG. 27

Dental and surgical instruments represented in a funeral marble of the
Lateran Museum, Rome.]

It is clear that this method of tooth drawing—so excessively cautious
and timid—must have been very torturing to the poor patients. A
thousand years and more after Celsus, Abulcasis still counsels the same
exaggerated precautions, and says that the extraction of a tooth must
not be performed in a rapid and violent way after the manner of the
barbers. From this one may see that the operation spoken of was then
very often performed by certain unprofessional persons, who, being very
familiar with it, carried it out with great indifference and rapidity,
thus sparing the patients the long-protracted martyrdom which the
erudite doctors, followers of Celsus, thought necessary to make them
endure. Very probably the same happened in the days of the wise Roman
doctor.

When there is a large carious hollow in the tooth to be extracted,
Celsus recommends that it should first be filled up either with lint
or with lead, in order to prevent the tooth from breaking under the
pressure of the instrument. “The latter,” he continues, “must be made
to act in a straight direction, in order to avoid fracture of the bone.
The danger of fracture is still greater in the case of short teeth;
often the forceps, not being able to grasp the tooth well, takes hold
of the bone with it and fractures the latter. When after the extraction
of a tooth much blood flows from the wound, this indicates that some
part of the bone has been broken. It is necessary then to search for
the detached piece of bone with the probe and to extract it with the
forceps. If this be not successful, an incision must be made in the
gums just as large as is necessary for the extraction of the fragment.
When this is not taken out, it often happens that the jaw swells in
such a manner as to prevent the patient from opening his mouth. In such
a case it is necessary to apply to the cheek a hot cataplasm of flour
and figs, so as to induce suppuration, after which the gums must be
lanced and the splinter of bone extracted.”

When the teeth show blackish stains, Celsus advises such stains to
be scraped away, and the teeth afterward to be rubbed with a mixture
of pounded rose leaves, gall-nuts, and myrrh, and the mouth to be
frequently washed with pure wine. It is necessary besides, says the
author, to keep the head well covered, to walk a great deal, and to
partake of no acid food.

“If by effect of a blow or other accident some of the teeth become
loose, it is necessary to bind them with gold wire to the neighboring
firm teeth, and besides to keep in the mouth astringent substances, for
example, wine in which the rind of pomegranates has been boiled, or
into which some burning hot gall-nuts have been thrown.”

“When in a child a permanent tooth appears before the fall of the milk
tooth, it is necessary to dissect the gum all around the latter and
extract it; the other tooth must then be pushed with the finger, day by
day, toward the place that was occupied by the one extracted; and this
is to be done until it has firmly reached its right position.”

“Now and again it happens that when a tooth is pulled out its root
remains in the socket; it is then necessary to extract it at once, with
the forceps adapted for the purpose, called by the Greeks _rizagra_.”

The last book of the work of Celsus treats chiefly of fractures and
dislocations. In the first chapter the position and form of the bones
of the whole human body are described, although not very exactly.
Speaking of the teeth, the author says: “The teeth are harder than the
bones, and are fixed, some on the _maxilla_ (lower jaw) and some on the
overhanging bone of the cheeks.”[126]

“The first four teeth, being cutting teeth (incisors), are called by
the Greeks _tomici_. These are flanked on both sides by one canine.
Beyond this there ordinarily exist, on both sides, five grinders,
except in the case of those persons in whom the last molars, which
commonly are cut very late, have not yet appeared. The incisors and
the canines are fixed with one single root; but the molars at least
with two, some even with three or four. In general, the shorter the
tooth, so much the longer is its root. A straight tooth commonly has a
straight root, a curved tooth has it generally curved. The root of a
temporary tooth produces in children a new tooth, which usually pushes
out the first; sometimes, however, the new tooth appears either above
or below it.”

In the seventh chapter Celsus treats of fractures in general, but in
particular of those of the lower jaw.

“To reduce a fracture of this bone, it should be pressed in a proper
manner, from the inside of the mouth and from the outside, with the
forefinger and thumb of both hands. Then in the case of a transverse
fracture (in which case generally an unevenness in the level of the
teeth is produced), it is necessary, after having set the fragments
in place, to tie together the two teeth nearest to the fracture with
a silk thread, or else, if these are loose, the following ones. After
this, one should apply externally, on the part corresponding to the
lesion, a thick compress, dipped in wine and oil and sprinkled with
flour and powdered olibanum. This compress is to be fixed by a bandage
or by a strip of soft leather, with a longitudinal slit in the middle
to embrace the chin, the two ends being tied together above the head.
The patient must fast the first two days; then he may be nourished with
liquid food, but in small quantities, abstaining, however, completely
from wine. On the third day it is necessary to take off the apparatus,
and after having fomented the part with the steam of hot water, to
replace it. The same is to be done on the fifth day, and so on, until
the inflammation has subsided, which generally happens from the seventh
to the ninth day. After the symptoms of inflammation have vanished, the
patient may take abundant nourishment; he must, however, abstain from
chewing until the fracture is completely consolidated; and, therefore,
he will continue to nourish himself with soups and like food. He must
also entirely abstain from speaking, especially during the first few
days. Fractures of the jaw commonly heal from the fourteenth to the
twenty-first day.

“In luxations of the jaw (Chapter XII) the bone is always displaced
forward; but sometimes only on one side, and sometimes on both sides.
When the dislocation is only on one side, the chin and the whole jaw
are found deviated toward the part opposite to the luxation; and
the similar teeth of the two dental arches do not correspond; but
instead under the upper incisors will be found the canine tooth of
the dislocated part. If, however, the luxation is bilateral, the
chin inclines and projects forward; the lower teeth are farther in
front than the upper ones, and the muscles of the temples are tightly
stretched. The reduction of the luxation must be performed as quickly
as possible. The patient having been made to sit down, an assistant
holds the head firmly from behind; or else the patient is made to sit
with his shoulders against a wall, with a hard cushion between this and
his head, whilst the assistant holds the head against the cushion, and
so keeps it steady. Then the operator, after wrapping his two thumbs in
linen cloth or strips, that they may not slip, introduces them into the
patient’s mouth and, applying the other fingers on the outside, firmly
grasps the jaw. Then whilst lowering the back part of the latter, he
shakes the chin and pushes it upward and backward, seeking to shut the
mouth, and in this way making the jaw return to its natural position.

“The bone having been replaced, if the accident should have given rise
to pains in the eyes and neck, it will be well to draw blood from the
arm. After the luxation has been reduced, the patient must be nourished
for some time on liquid food, and abstain, as much as possible, from
speaking.”

CAIUS PLINIUS SECUNDUS. After Celsus, a very celebrated writer on
medicine and natural science was Caius Plinius Secundus. He was born
at Como in the year 23 of the Christian era, and flourished from the
days of Nero to those of Vespasian. Endowed with a liberal education,
he gave himself up to public life, filling many important posts, among
which, that of Governor of Spain under Nero and his successors. In
the year 79 after Christ, while he was in command of the Roman fleet
at Misenum, the tremendous eruption of Vesuvius took place, by which
Pompeii, Herculaneum, and other neighboring cities were destroyed.
Pliny, driven by the desire to study that marvellous and awful natural
phenomenon, betook himself to Stabia, but was there suffocated by the
ashes and smoke erupted by Vesuvius.

In spite of the many places occupied by him, Pliny found time to
write many works, and among these the thirty-seven books on _Natural
History_, which have given him eternal fame.

It is not at all to be wondered at that this immense work contains a
great number of fables, superstitions, and errors of every kind. To
sift the true from the false was not an easy thing, at a time when
there was almost no idea as to how natural phenomena were produced,
and when all scientific criticism was impossible, for the very simple
reason that true science did not exist.

To give an idea of the great absurdities which were believed in at that
epoch, and which were considered possible even by higher intellects
such as Pliny’s, the following passages will suffice: “In many
mountains of India, according to what Ctesia writes, there are men
with dogs’ heads, who clothe themselves with the skins of wild beasts
and bark instead of speaking. There are also a kind of men having only
one leg, and who have great speed in leaping. Others are without any
neck and have their eyes between their shoulders. Megasthenes writes
that among the nomad Indians are men who instead of a nose have only
holes, and have their legs bent like serpents. At the extreme confines
of India, toward the East, are men without any mouth and with their
bodies entirely covered with hair, who live on nothing but air and
odors, which they inhale through the nose.”[127]

In Pliny’s day the most prodigious virtues were attributed to herbs; in
regard to this the following example is sufficient:

“The herb near which dogs may have made water, when gathered, but
without being touched by iron, cures luxations very promptly.”[128]

It must not be thought that Pliny accepted such beliefs without
reserve. He notes them, because preceding authors had accepted them,
and because if certain things appear to us evidently absurd, their
absurdity could not be equally evident at a period when little more
than nothing was known in regard to physical and physiological laws,
and when the impossibility of rationally explaining natural effects
led men to admit the existence of marvellous virtues and influences in
every being and in all bodies. On the other hand, Pliny expressly says,
for his own justification, in Chapter I of Book VII: “I do not want to
bind my faith in many things which I am about to say; but rather refer
the readers to the authors from whom I have taken them.”

As is to be expected, we find in Pliny’s works, in regard to teeth, a
strange mixture of truth and errors.

In Chapter XV of Book VII, after having said that some children are
born with teeth, and after having cited, as examples, Manius Curius,
who was therefore called Dentatus, and Gnæus Papirius Carbo, both
illustrious men, he adds:

“In women such a thing was considered a bad augury in the days of the
kings. In fact, Valeria having been born with teeth, the seers said
that she would be the ruin of the city to which she would be taken; she
was sent to Suessa Pometia, which in those days was a very flourishing
city; and, in fact, the prediction was verified. Some, instead of
teeth, have an entire bone; of this there was an example in the son of
Prusias, King of Bithynia, who instead of upper teeth had one single
bone.”

“The teeth alone are not consumed by fire, and do not burn with the
rest of the body. And yet these teeth, which withstand the flames,
are worn away and hollowed out by pituita. They wear out by being
used. Nor are they necessary for mastication alone, for the foremost
ones regulate the voice and words, producing by the beat of the tongue
special sounds.”

“Men have thirty-two teeth, women a lesser number. It is, however,
believed that augury may be taken from the teeth; and to have a greater
number than usual is considered an indication of long life. The
presence of two eye teeth at the right side of the upper jaw presages
favorable fortune, as was verified in Agrippina, the mother of Domitius
Nero; on the left side, however, they are of sad foreboding.”

“The last teeth, which are called the genuine teeth, appear toward the
twentieth year of age; many persons, however, do not have them until
their eightieth year. Teeth fall out in old age and then spring up
again; of this there can be no doubt. Mutianus writes of having known
a certain Zancle of Samothracia, in whom teeth reappeared after he had
completed his one hundred and fourth year. Timarcus, son of Nicocles of
Paphus, had two rows of molar teeth, whilst a brother of his did not
change his incisor teeth at all, which, therefore, wore down little
by little. There once lived a man who had a tooth in his palate. The
canine teeth, when by any chance they fall out, do not reappear any
more.”[129]

“In the teeth of man there exists a poisonous substance which has the
effect of dimming the brightness of a looking-glass when they are
presented uncovered before it; and if they are uncovered in front of
young unfledged pigeons, these take ill and die.”[130]

The second of these two statements is but a prejudice, like many
others; but we find the first very strange indeed, it being a
surprising thing that a man like Pliny should have attributed to
an imaginary poison of the teeth what is the simple effect of the
moistures of the breath.

In Chapters CXV and CXVII of Book XI are found some observations which
are somewhat interesting to us:

“A man’s breath becomes infected by the bad quality of food, by the bad
state of the teeth, and still more by old age.”

“Simple food is very beneficial to man; the variety of flavors
instead is very harmful. Sour or too abundant foods are digested with
difficulty, and also those which are ravenously swallowed. As a remedy,
vomiting has come into use; but it makes the body cold and is most
pernicious to the eyes and to the teeth.”

There is no doubt that the habit of often provoking vomitus—which,
in those times of excessive corruption and intemperance, had come
into general use—must have resulted in enormous harm to the teeth,
especially by the action exercised upon them by the hydrochloric
acid contained in the gastric juice, and by the organic acids of
fermentation.

Among the vegetable remedies in those times considered of use against
odontalgia, the principal ones are mentioned in Chapter CV of Book XXV:

“It is beneficial against toothache to chew the root of panax, and
likewise to wash the teeth with its juice. It is also useful to
chew the root of hyoscyamus soaked in vinegar, or else that of the
polemonium. It is also beneficial to chew the roots of the plantain, or
to wash the teeth in a decoction of plantain in vinegar. A decoction of
the leaves is also useful, not only in the case of simple toothache,
but also when the gums are tender and easily bleed. The seed of
the same plant cures inflammations and abscesses of the gums. The
aristolochia strengthens the gums and the teeth. The same effect may be
produced by masticating the verbena with its root, or by washing the
mouth with a decoction of it in wine or vinegar. Similarly the roots
of the cinquefoil are helpful when boiled down to a third, in wine or
vinegar; however, they must first be washed in salt water or brine. The
decoction must be kept for a long time in the mouth.

“Instead of using the decoction of cinquefoil, some prefer to rub the
loose teeth with the ashes of this plant. Besides the above-mentioned
remedies, the root of the verbascum boiled in wine, hyssop, and the
juice of the peucedanum with opium are also employed; and it is also
beneficial to pour into the nostrils, on the side opposite to that of
the sick tooth, some drops of the juice of anagallis.

“It is said that if senecio be taken from the earth, and the aching
tooth be touched three times with it, spitting alternatively three
times, and then the herb be replanted in the same spot, so that it may
continue to live, the tooth will never give pain any more.”[131]

“In the fuller’s thistle,[132] an herb which grows near rivers, is
found a small worm, which has the power of curing dental pains, when
the said worm is killed by rubbing it on the teeth, or when it is
closed up with wax in the hollow teeth.”[133]

“Apollonius writes that a very efficacious remedy for pains in the gums
is to scratch them with the tooth of a man who has suffered a violent
death.”[134]

“It is considered very beneficial for toothache to bite off a piece
from wood which has been struck by lightning, and to touch the sick
tooth with it; but whilst biting off the little piece of wood, it is
necessary to keep both hands behind the back.”[135]

“Experience teaches that against the bad odor of the breath it is
useful to wash the mouth with pure wine before sleeping, and that to
avoid aching of the teeth, it is a good thing to rinse the mouth, in
the morning, with several mouthfuls of fresh water, but of an odd
number.”[136]

“A remedy for toothache is to touch the diseased teeth with the
tooth of a hyena,[137] or to scratch the gums with the tooth of a
hippopotamus which has been taken from the left side of the jaw.”[138]

“The ashes of stag’s horn, rubbed over loose and aching teeth, makes
them firm and soothes the pain. Some consider that to produce the same
effect, of greater virtue is the powder of the horn, unburnt. Both
the ashes and the powder of stag’s horn are employed as a dentifrice.
The ashes of the head of a wolf are a great remedy for toothache.
Such pains are also made to cease by wearing certain bones that are
oftentimes found in the dung of this animal. The ashes of the head of a
hare is a useful dentifrice; and if spikenard be added, it will lessen
the bad smell of the mouth. Some mix with it the ashes of the heads of
mice. In the side of the hare is a bone as sharp as a needle; and many
advise pricking the teeth with this when they ache. The heel of the ox
kindled and brought close to loose teeth makes them firm. The ashes of
this bone mingled with myrrh is a good dentifrice. A good dentifrice
is also made from the ashes of the feet of a goat. To strengthen teeth
loosened by a blow, asses’ milk or the ashes of the teeth of this
animal are very useful. In the heart of the horse there is a bone like
an eye-tooth; it is said that it is very beneficial to pick with it the
teeth that ache. The carpenter’s glue boiled in water and plastered
on to the teeth also takes away their pain; but soon after it must be
taken away and the mouth rinsed with wine in which have been boiled the
rinds of sweet pomegranates. It is also thought beneficial to wash the
teeth with goat’s milk or with ox-gall.”[139]

“Butter, either alone or with honey, is very useful for children; and
is very helpful, especially during dentition, in the diseases of the
gums, and to cure the ulcers of the mouth. To prevent the disorders
that generally accompany dentition, it is a useful thing that the child
should wear a wolf’s tooth, or one of the first teeth lost by a horse.
The rubbing of the gums with goat’s milk or with hare’s brain renders
the cutting of teeth much easier.”[140]

“To sweeten the breath it is very helpful to rub the teeth and the gums
with wool and honey.”[141]

“The filth of the tail of sheep rolled up in little balls, and left to
dry and then reduced to powder and rubbed on the teeth, is marvellously
useful against the loosening and other diseases of the teeth themselves
and against the cankerous ulcers of the gums.”[142]

“Eggshells deprived of their internal membrane and afterward burnt
afford a good dentifrice.”[143] (Hence we see that the use of carbonate
of lime as a dentifrice is a very ancient one.)

“If the head of a dog that has died mad be burnt, the ashes obtained
may be advantageously used against toothache, mixing it with cyprine
oil and then dropping the mixture into the ear, on the side of the
pain. It is beneficial also to pick the sick tooth with the longest
tooth, on the left side, of a dog; or with the frontal bones of a
lizard, taken from the head of the animal at full moon, and which
have not touched the earth. The teeth of a dog, boiled in wine until
this is reduced to one-half, thus, furnish a mouth wash which can
be advantageously used against toothache. In the cases of difficult
dentition, benefit is derived by rubbing the gums with the ashes of
the teeth of a dog, mixed with honey. Such ashes are also used as a
dentifrice. In hollow teeth it is useful to introduce the ashes of
the dung of mice, or of the dried liver of lizards. It is the opinion
of some, that in order not to be subject to toothache, a mouse should
be eaten twice a month. If earth-worms be cooked in oil, this latter
has the virtue of calming toothache when dropped into the ear on the
side of the pain. The same effect is obtained by rubbing the teeth
with the ashes of the aforesaid worms, after they have been burnt in
a terra-cotta vase; and if such ashes be introduced into the hollow
teeth, these fall out very easily. A good remedy against toothache is
to wash the mouth with vinegar of squills in which earth-worms and
the root of the mulberry have been boiled. The ashes of the shells of
snails mixed with myrrh, rubbed on the gums, strengthens them. Even
the slough which the snakes cast off in spring can furnish a remedy
against toothache. For this purpose it must be boiled in oil, with
the addition of resin of the larch, and then the oil dropped into the
ear. For the same purpose, according to some, oil of roses is useful,
when a spider, caught with the left hand, has been pounded in it. If a
sparrow’s fledglings be burnt with dry vine twigs, the resulting ashes
rubbed with vinegar on the teeth makes all pain cease in them.[144] It
is stated by many that to improve the odor of the breath, it is well
to rub the teeth with ashes of mice mixed with honey. Some also mingle
with this the root of fennel. Picking the teeth with the quill of a
vulture renders the breath sour. It makes the teeth firm to pick them
with a porcupine’s quill. A decoction of swallows in wine sweetened
with honey cures ulcers of the tongue and lips. Scaldings in the mouth
produced by hot food or drinks are readily healed with the milk of a
bitch.”[145]

That Pliny did not put great faith in many of the things which he
relates is clearly proved by several passages of his book, and among
others by the following:

“One can hardly relate without laughing, some things, which, however,
I will not omit, because they are found already written. They say
that the ox has a small stone in the head, which it spits out when
it fears death; but if its head be suddenly cut off, and the stone
extracted, this, worn by a child, helps it in wondrous manner to cut
its teeth.”[146]

In Book XXXI, Pliny speaks of various waters—mineral, thermal,
etc.—especially from the medical point of view. It was already known
in those days that those waters were most active agents. And in this
respect a fact which the author relates in Chapter VI of Book XXV is
worth mentioning:

“When Caesar Germanicus moved his camp beyond the Rhine, there was
found, in the whole maritime tract of the country, only one spring of
fresh water, the drinking of which, within two years, produced the fall
of teeth and a loosening of the knee-joints. The doctors called these
evils stomacace and scelotyrbe.”

Sea salt and nitre are of use, according to Pliny, against various
maladies of the teeth and mouth. He counsels the application of salt
on lint to the ulcers of the oral cavity, and to rub it on the gums
when they are swollen. To prevent diseases of the teeth, it would be
advantageous, every morning before breaking one’s fast, to keep a
little salt under the tongue until it is dissolved. Against the pain
of the teeth it would be beneficial to use common salt dissolved in
vinegar, or nitre in wine.

“The rubbing of the blackened teeth with burnt nitre gives them back
their natural color.”[147]

The prophylactic remedies against odontalgia believed in, at that
period, were sufficiently numerous, and, among many other such things,
Pliny informs us that in order not to be subject to toothache, it is
sufficient to wash the mouth three times a year with the blood of the
tortoise.[148] Analogous virtue was also attributed to the brain of the
shark, which was boiled in oil, and this put by for washing the teeth
with once a year.

Besides the many anti-odontalgic remedies so far related, several
others are found enumerated in Chapter XXVI of Book XXXII:

“The pain in the teeth is lessened by picking the gums with the bones
of the sea dragon. It is also very beneficial to pick the gums with
the sharp bone of the puffin.[149] If the same be pounded together
with white hellebore, and the mixture thus obtained be rubbed on the
diseased teeth, they may be made to fall out without pain. The ashes,
also, of salt fish burnt in an earthen vase, with the addition of
powdered marble, is a remedy against toothache. Frogs are also boiled
in a hemina[150] of vinegar, the decoction being then used to wash
the teeth with; but this, however, must be kept in the mouth for
some length of time. In order to render this remedy less nauseous,
Sallustius Dionisius used to hang several frogs, by their hind feet,
over a vase in which he boiled the vinegar, so that the juices of the
animals might drip into this from their mouths. To make loose teeth
firm, some advise the soaking of two frogs, after having cut off
their feet, in a hemina of wine, and the washing of the mouth with
the latter. Others tie them, whole, on the jaws. Some, to strengthen
unsteady teeth, rinse them with a decoction made by boiling ten frogs
in three sextaries[151] of vinegar, until the liquor is reduced to
one-third. By others, thirty-six hearts of frogs are well boiled in
a sextary of old oil, in a copper vessel, and the oil is then used
against toothache, dropping it into the ear, on the side of the pain.
Some, after having boiled the liver of a frog, pound it with honey, and
smear it on the sore teeth. If the teeth are decayed and fetid, many
counsel the drying of a hundred frogs in an oven, leaving them there
for one night, then the addition of an equal weight of salt, reducing
the whole to powder, and rubbing the teeth with it. In such cases the
ashes of crabs are also used. That of the murex[152] is adopted as a
simple dentifrice.”

“The cutting of teeth is facilitated by rubbing the gums of the child
with the ashes of dolphin’s teeth mixed with honey, or even simply by
touching the gums with a tooth of this animal.”[153]

In Chapter XXXIV of Book XXXVI it is said that the decoction of
gagates[154] in wine cures the diseases of the teeth; and in Chapter
XLII of the same book are praised the dentifrice powders made of pumice
stone.

From the examination of Pliny’s work several important facts come out.

The diseases of the teeth were, in those days, most common; very
often we find mention of loose teeth, and the medicines suited to
make them firm again; from which we may deduce the great frequency
of alveolar pyorrhea. It is reasonable to think that such a fact was
caused principally by the intemperate life of those times, in which
the followers of Epicurus were extremely numerous and the unbridled
desire for pleasure reached such a degree that no abhorrence was felt
of provoking vomit during the course of a long banquet, in order to
continue dining merrily.

Concerning the teeth, their affections, and the means of healing and
preventing them, the strangest superstitions existed, and this not
only among the common, but also among educated and learned people. The
number of remedies reputed useful against diseases of the teeth was
extraordinarily great; but the modern saying, “therapeutic wealth is
poverty,” could have been applied only too well.

Of the cleanliness of the teeth, it seems, great care was taken, for
dentifrices were in great use. These, as we have already seen, were
made of the most varied substances—stag’s horn burnt, ashes obtained
by burning the head of the mouse, of the hare, of the wolf, etc.,
eggshells burnt and reduced to powder, pumice stone, and so on. For the
cleanliness of the mouth, for strengthening the teeth and gums, mouth
washes of sundry kinds were likewise adopted, especially formed of
decoctions of astringent substances in water, wine, and vinegar.

Not only among the Romans was great care given to the cleanliness and
beauty of the teeth, but also among many other nations. In this regard
the following poem of Catullus, in which he lashes the silly vanity of
a Celtiberian resident in Rome, who made continual show of his white
teeth, is somewhat interesting:

  “Egnatius, quod candidos habet dentes
  Renidet usquequaque; seu ad rei ventum est
  Subsellium, cum orator excitat fletum,
  Renidet ille: seu pii ad rogum filii
  Lugetur, orba cum flet unicum mater,
  Renidet ille; quidquid est, ubicumque est,
  Quodcumque agit, renidet: hunc habet morbum,
  Neque elegantem, ut arbitror, neque urbanum.
  Quare monendus es mihi, bone Egnati,
  Si Urbanus esses, aut Sabinus, aut Tiburs,
  Aut parcus Umber, aut obesus Hetruscus,
  Aut Lanuvinus ater, atque dentatus,
  Aut Transpadanus, ut meos quoque attingam,
  Aut quilibet, qui puriter lavit dentes:
  Tamen renidere usquequaque te nollem;
  Nam risu inepto res ineptior nulla est.
  Nunc, Celtiber, in celtiberia terra
  Quod quisque minxit, hoc solet sibi mane
  Dentem, atque russam defricare gingivam.
  Ut quo iste vester expolitior dens est,
  Hoc te amplius bibisse prædicet lotii.”[155]

STRABO. From Strabo we learn that the Cantabri and other peoples of
Spain used to clean their teeth and sometimes even to wash their face
not with fresh, but with old urine, which, so it seems, was kept for
the purpose, in suitable cisterns![156]

In regard to this filthy custom, Joseph Linderer says[157] that the
superstition has reached even to our times, although not widely
diffused, that, to beautify the face, it is useful to wash it with
urine. He relates that he knew a girl who, to become beautiful, had
recourse to this heroic method, but, unfortunately, without at all
obtaining the desired end!

MARTIAL. In the epigrams of Martial (about 40 to 101 A.D.) allusions of
great value with regard to several points concerning the subject we are
treating of are found.

Toothpicks (_dentiscalpia_) are mentioned by this poet several
times; from which we may argue that they were in great use. They
were ordinarily made of lentisk wood (_Pistacia lentiscus_), as may
be deduced from the Epigram LXXIV of Book VI, in which the author
ridicules the old dandy who, stretched at length on the triclinium,
cleans with _lentiski_ the toothless mouth, to give himself the air
of a man not too far stricken in years.[158] Besides, in Book XIV,
containing, for the greater part, saws and sayings on objects of common
use, there is an epigram bearing the title of “Dentiscalpium,” in which
the author says that toothpicks of lentisk are to be preferred, but
that, in their absence, quill toothpicks may be used.[159]

[Illustration: FIG. 28

An ancient toothpick and ear-picker of gold, found in Crimea.]

From other sources we learn that in those days metal toothpicks
were also made use of. So in a satire of Petronius, it is said that
Trimalchiones made use of a silver toothpick (_spina argentea_).
Objects of this kind, both Roman and of other origin, are even now in
existence, and may be found in various collections of antiquities. In
Crimea a most elegant gold object, of Greek make, was found, which is,
by its two ends, both a toothpick and an ear-picker. It belongs most
probably to the fourth century before Christ.[160]

In an object found in the north of Switzerland, and coming from a
Roman military colony of the times of the Empire, the toothpick and
ear-picker are joined at one of their ends, by a pivot, to other toilet
articles.[161]

[Illustration: FIG. 29

A metal toothpick and ear-picker joined to other toilet articles. An
object found in Switzerland, in the ancient seat of a Roman military
colony.]

[Illustration: FIG. 30

An ancient toothpick and ear-picker of bronze, found in the north of
France, at Bavai (the ancient Bagacum).]

Caylus, in his valuable work _Recueil d’antiquités égyptiennes,
étrusques, grecques, romaines et gauloises_ (Paris, 1752 to 1767),
gives the picture of a toothpick and ear-picker of bronze, two inches
long, with the middle part wrought in spiral form, so as to increase
the solidity of the article, and also to enable the hand to keep it
easily firm in all positions. It was found in the north of France, at
Bavai (the ancient Bagacum), and forms part of the collection of M.
Mignon of Douai.[162]

Martial is one of the first Roman writers who speak clearly of
artificial teeth. In Epigram LVI of Book XIV, the poet, by a bold
personification, makes the dentifrice powder say to a toothless old
woman, furnished with false teeth: “What have you got to do with me?
Let a girl use me. I am not accustomed to clean bought teeth.”[163]

Elsewhere[164] Martial atrociously derides a courtesan, who, among her
other physical defects, was also without an eye: “Without any shame
thou usest purchased locks of hair and teeth. Whatever will you do for
the eye, Laelia? These are not to be bought!”[165]

This epigram shows that, while dental prosthesis was already in use,
ocular prosthesis did not as yet exist.

To a plagiarist, who passed off Martial’s poetry as his own, the latter
says: “With our verses, O Fidentinus, dost thou think thyself and
desire to be thought a poet. Even so, it seems to Ægle that she has all
her teeth, because of her false teeth of bone and ivory.”[166]

There is, therefore, not the least doubt that in the days of Martial
artificial teeth were in use; and that these, as may be seen from
the epigram just now quoted, were made of ivory and bone; we do not
know whether they were formed also of other substances. The question,
however, arises: In those times did they manufacture movable artificial
sets, or was the dental art then limited to fixing the artificial teeth
unmovably to the neighboring firm teeth, by means of silk threads, gold
wire, and the like? The answer to this question may be found in another
epigram of Martial,[167] where the latter ridicules a wanton old woman,
telling her, among other things still worse, that she at night lays
down her teeth just as she does the silken robes.[168]

It is, therefore, beyond all doubt that, at that period, the manner of
constructing movable artificial sets was known; and most probably not
only partial pieces were made, but even full sets. In fact, from the
verse quoted above we have justly the impression that the poet means a
whole set rather than a few teeth.

From the words of Martial, it may also be concluded that these dentures
could be put on and off with the greatest ease; or, as we may say, by
a maneuver as simple as that of removing any articles of apparel; they
must, therefore, have been extremely well constructed.

This alone should be sufficient, even were further proof wanting,
to give us an idea of the degree of development and of the point of
perfection reached by dental prosthesis at that time. But besides this,
we now also possess an ancient Roman piece furnishing a palpable proof
of the ability and ingenuity of the dentists of that epoch. Some few
years since, I had occasion, in the pursuit of dental archæological
research, to visit the Museum of Pope Julius in Rome, where I was shown
a prosthetic piece, not yet exhibited to the general public, that had
been discovered a few months previous in excavating at Satricum, near
Rome. I was invited to give an opinion as to this appliance, and, after
having examined it accurately, became aware, not without some emotion,
I am fain to confess, that I held in my hands a prosthetic piece of
exceptional historical importance, that is, no less than a specimen of
ancient _crown work_.

[Illustration: FIG. 31

Roman appliance found at Satricum; crown of lower incisor made of gold.]

[Illustration: FIG. 32

The same, seen from below.]

The appliance found at Satricum (Fig. 31) is made in the following
manner: Two small plates of gold, stamped out, represent respectively
the lingual and labial superficies of a middle lower incisor; these
two pieces soldered together form the crown of the tooth. At its base
the crown is soldered, back and front, to a narrow strip of gold which
folds back on itself at each end, so as to tightly encircle the two
neighboring teeth on the right and on the left, which thus serve as
supports to the appliance.

We are now, therefore, able not only to affirm that the Etruscans knew
how to execute a kind of _bridge work_, but that later the dentists of
ancient Rome even carried out _crown work_.

This, notwithstanding the examples of dental prosthesis discovered
up to now in Roman and Etruscan tombs, can in no way be considered
as representing all the varieties of dental prosthesis of ancient
construction. It is to be hoped that, in spite of the destructive
action of time, in continuing the excavations and archæological
researches, many other specimens of early dental prosthesis will yet
come to light. In any case, judging by some indications to be found
in Latin literature, it must be admitted that the Roman dentists of
antiquity constructed other kinds of prosthesis besides the specimens
we possess, and in particular movable dentures. We are led to suppose
this, not only from the above cited epigram of Martial, but also from
what we read in one of the satires of Horace, who dates contemporarily
with Augustus, and therefore anteriorly to Martial. Speaking of two
old witches who had been put to flight by Priapus, Horace writes: “You
would have laughed to see those two old witches run toward the town,
losing in their flight, Canidia, her false teeth, Sagania, her false
hair.”[169]

Now, as Prof. Deneffe very rightly observes, the prosthetic appliances
of antiquity known to us are so firmly fixed to the natural teeth
that no race, however unbridled, could ever have made them fall out
of the mouth. It must, therefore, be admitted, as I have said, that
the ancients constructed other kinds of dental appliances, of which no
specimens have, as yet, been discovered.

Neither in Celsus nor in Pliny, nor in any other Roman writers on
medicine, do we find any allusion to the art of dentistry. The doctors
of those days probably had no idea of the advantages which could be
derived from dental prosthesis in regard to digestion and consequently
to the health of the whole body. They therefore must have considered
artificial teeth as something totally foreign to their art, and
intended solely to hide a physical defect. It is therefore not at all
surprising that they have not treated of this subject.

As the art of setting artificial teeth was exercised by persons not
belonging to the medical profession, it is very probable that these
persons also undertook the extraction of teeth and the cure of dental
pains. Martial (Book X, Epigram LVI) names a certain Cascellius, who,
he says, “extracts or cures diseased teeth,”[170] and this is the first
dentist whose name has been sent down to us. In spite of this, nothing
permits us to affirm that there existed at that time a class of real
dentists, viz., of persons dedicated to the exclusive cure of dental
disease. There are strong reasons for doubting this, especially when
we consider that the Latin language has no word corresponding to the
word dentist. If there had existed a true dental profession, there
ought also to have existed a name for indicating the individuals who
exercised it. Therefore, it must be considered highly probable that,
although there undoubtedly existed individuals who were especially
skilled in the cure of the diseases of the teeth, such persons did
not form a special class; perhaps, among those to whom recourse was
had for the cure of dental diseases, some were doctors, particularly
skilled in such diseases, others were perhaps barbers, and so forth.
As to the far-fetched deductions of Geist-Jacobi, according to whom the
name given to dentists by the Romans must have been that of _artifex
dentium_ or _artifex medicus dentium_, these are founded, above all, on
imagination. It is extremely improbable that such names existed, when
one considers that they are not met with, even once, in the whole range
of Latin literature.

SCRIBONIUS LARGUS. Among the writers on Medicine in the early period of
the Empire, one of the most eminent was, without any doubt, Scribonius
Largus, physician to the Emperor Claudius, whom he accompanied to
England in the year 43.

Scribonius Largus, in his book _De compositione medicamentorum_,
pronounces himself energetically against the division of Medicine into
single special branches. He declaims against the many who attributed
to themselves the name of doctors, simply because they knew how to
cure some diseases. According to him, the true doctor must be skilled
in curing all kinds of affections. This, in truth, was possible in
those times, but would be almost impossible nowadays, on account of the
enormous development of the healing art. The ideas, however, expressed
by Scribonius Largus have a certain historical importance, for they
show that in his times the medical art had certainly the tendency to
split up into many special branches, among which there must certainly
have been dentistry, but that the necessity of such separation was not
by any means universally recognized; the great doctors of those days
undertook the cure of the diseases of the teeth, as well as those of
any other part of the body.

The tenth chapter of the book of Scribonius Largus treats of the cure
of odontalgia. The author begins by saying that it is the opinion of
many that the only true remedy against toothache is the forceps. With
all this, he adds, there are many medicaments, from which great benefit
may be derived against these pains, without it always being necessary
to have recourse to extraction. Even when a tooth is affected with
caries, says the author, it is not always advisable to extract it; but
it is much better, in many cases, to cut away the diseased part with a
scalpel adapted for the purpose.

“Violent toothache may be calmed in various ways, viz., with mouth
washes, masticatories, fumigations, or by the direct application of
fitting medicaments. It is beneficial to rinse the mouth frequently
with a decoction of parietaria or of cypress berries, or to apply to
the tooth the root or the seeds of the hyoscyamus wrapped up in a
cloth, and dipped from time to time in boiling water, or to chew the
portulaca (purslane), or to keep for some time its juice in the mouth.”

“Suitable also against toothache are fumigations made with the seeds of
the hyoscyamus scattered on burning charcoal; these must be followed
by rinsings of the mouth with hot water; in this way sometimes, as it
were, small worms are expelled.”[171]

This passage of Scribonius Largus has given rise to the idea that the
dental caries depends upon the presence of small worms, which eat
away the substance of the tooth. Such an explanation must have well
succeeded in satisfying the popular fancy; and it is for this that
such a prejudice, although fought against by Jacques Houllier in the
sixteenth century, has continued even to our days.

With regard to this I would like to record the following fact: Not many
years ago there lived in Aversa, a small town near Naples, Italy, a
certain Don Angelo Fontanella, a violin player, who professed himself
to be the possessor of an infallible remedy against toothache. When
summoned by the sufferer, he carried with him, in a bundle, a tile,
a large iron plate, a funnel, a small curved tube adjustable to the
apex of the funnel, a piece of bees’ wax, and a small packet of onion
seed. Having placed the tile on a table, the iron plate was put upon
it, after it had been heated red hot. Then the operator let a piece
of bees’ wax fall upon the red-hot iron, together with a certain
quantity of the onion seed; then, having promptly covered the whole
with the funnel and made the patient approach, he brought the apex of
the said funnel close to the sick tooth, in such a way as to cause the
prodigious, if somewhat stinking, fumes produced by the combustion of
the wax with the onion seed to act upon it. In the case of a lower
tooth, the above-mentioned curved tube was adapted to the funnel, so
that the fumes might equally reach the tooth. The remedy, for the most
part, had a favorable result, whether because the beneficial effect was
due to the action of the hot vapor on the diseased tooth, or to the
active principles resulting from the combustion of the wax and onion
seed, or to both, or perhaps also, at least in certain cases, to the
suggestion that was thus brought to bear upon the sufferer. It would
not be at all worth while to discuss here such a point. The interesting
part is that when the patient had declared that he no longer felt
the pain, Don Angelo, with a self-satisfied smile, turned the funnel
upside down, and showed on its internal surface a quantity of what he
pretended to be worms, which he affirmed had come out of the carious
tooth. Great was the astonishment of the patient and of the bystanders,
none of whom raised the least doubt as to the nature and origin of
these small bodies, no one having the faintest suspicion even that
these, instead of coming from the tooth, might come from the onion seed!

According to Scribonius Largus, toothache might also be taken away by
fumigations of burnt bitumen. He affirms also that great benefit may
be derived against odontalgia by masticating the wild mint, or the root
of the pyrethrum, or by covering the diseased tooth with a plaster
composed of peucedanum juice, opopanax, incense, and stoneless raisins.
But before making use of this last remedy, he advises that the tooth
and the gums near it should be fomented with very hot oil, by means of
a toothpick or ear-picker wrapped around, at one end, with some wool.
If the pain does not entirely cease, or comes on again, it is well,
says the author, to continue the fomentations with hot oil, above the
plaster, until the pain ceases. To strengthen loose teeth, Scribonius
advises frequent rinsings of the mouth with asses’ milk or with wine
in which have been cooked the roots of the sorrel until the liquid has
boiled down to one-third. Another remedy which he recommends against
looseness of the teeth is composed of honey and alum mixed together in
a mortar, in the proportion of two parts of the first to one of the
second, and then cooked in an earthen vase, so as to render the mixture
more homogeneous, and to give it more consistency. He also speaks of
a third medicament, resulting from cooking strong vinegar, alum, and
cedria[172] in a copper vessel until it has the consistency of honey.
This remedy would serve not only to make loose teeth firm, but the
author assures us also that whoever rubs the teeth with it, three times
a month, will never be subject to dental pains.

Scribonius Largus gives the receipts for various dentifrice powders in
use at that period. The skin of the radish dried in the sun, pounded
to powder, and then passed through a sieve, would furnish a good
dentifrice, suited to strengthen the teeth and to keep them healthy.
Very white glass, similar to crystal, reduced to a very fine powder
and mixed with spikenard, is also, according to Scribonius Largus, a
valuable dentifrice.

Octavia, sister of Augustus, used a powder which our author highly
commends, saying that it strengthens the teeth and makes them very
beautiful.[173] To prepare it, one must take a sextary[174] of barley
flour and knead it well to a paste with vinegar and honey mixed
together, and must divide the mass into six balls, each of which must
be mixed with half an ounce of salt; these balls must then be cooked
in the oven until carbonized; and lastly pounded to powder, as much
spikenard being added as is necessary to give it an agreeable perfume.

Scribonius Largus also lets us know the tooth powder made use of by
Messalina, the wife of the Emperor Claudius; this was composed of
calcined stag’s horn, mastic of Chios, and sal ammoniac, mixed in
the proportion of an ounce of mastic and an ounce and a half of sal
ammoniac to a sextary of the ashes of stag’s horn.

SERVILIUS DAMOCRATES, a Greek physician, who acquired great renown in
Rome toward the middle of the first century, was the author of many
valuable works, both in verse and prose, which, unfortunately, have
been lost. His works are mentioned by Galen, who testifies to his great
esteem for Damocrates, calling him an eminent physician, and quoting
various passages from his works, and among others three poetical
receipts for dentifrice powders. From these receipts it appears that
Damocrates attached the greatest importance to the cleanliness of the
teeth, and that he considered this the indispensable condition for
avoiding disease of the teeth and gums.

ANDROMACHUS THE ELDER, of Crete, the physician of Nero, who conferred
upon him, for the first time, the title of _archiater_, became famous
through his _theriac_, an extremely complicated remedy, the virtues of
which were sung by him in a Greek poem, dedicated to the Emperor. The
theriac was considered an antidote against all poisons and a remedy
against the greater part of diseases, in short, as a real panacea.
It is not even necessary to remark that this portentous medicine,
which has held a post of honor, from ancient times almost up to the
present day, was also used against odontalgia; and in those cases in
which this was produced by caries, Andromachus advised the filling up
of the cavity with the electuary which he rendered so famous. As the
chief basis of the theriac was opium, combined with stimulating and
aromatic substances, there is no doubt that its use locally or even
internally would prove beneficial, temporarily at least, in many cases
of odontalgia.[175]

ARCHIGENES, of Apamea, a city of Syria, lived in Rome toward the end
of the first century and at the beginning of the second, under the
Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great
fame as a physician and as an operator, and distinguished himself
particularly by daring amputations and trepannings. He recommends
various remedies against odontalgia, among which are mouth washes
of strong hot vinegar, in which gall-nuts or halicaccabum[176] have
been boiled. He usually introduced into carious teeth a mixture of
turpentine and vitriol of iron (_sory ægyptium_), or a mixture of
pepper, and oil of spikenard or of almonds, and this was also dropped
into the ear, on the side on which the pain was felt.

Archigenes, too, like other great physicians of that time, recommended
various remedies taken from the animal kingdom against diseases of
the teeth, which now seem very strange to us, but at that period
appear to have been in great use. Thus, it would be of great benefit
to hold in the mouth for some length of time a mixture of vinegar and
water in which a frog has been well cooked. The slough of a serpent,
burnt and then reduced, by the addition of oil, to the consistency of
solidified honey, would be a valuable remedy, which being introduced
into a carious hollow, and plastered all around the tooth and on the
surrounding parts, would cause the most violent pain to cease. And,
moreover, desiring to cause a diseased tooth to fall out, it would be
enough to apply to and press upon it a piece of the unburnt slough of a
serpent. Two excellent anti-odontalgic remedies to be introduced into
carious hollows would be roasted earth-worms and spikenard ointment
mixed with the crushed eggs of spiders. It would be also of use to drop
into the ear on the side of the aching tooth some oil of sesamum in
which earth-worms have been cooked.

When the pain is situated in broken teeth, Archigenes advises them to
be cauterized with a red-hot iron.

Against bleeding of the gums, he recommends rubbing them with very
finely pulverized alum and myrtle and the application of astringent and
tonic liquids.

When odontalgia appears to depend upon an inflammatory condition, he
advises the aching teeth to be plastered up with a mixture composed of
red nitre, pounded peach kernels, and resin.

Archigenes repeatedly recommends the cleaning of the teeth and of the
carious cavities before applying to the former or introducing into the
latter the appropriate remedies.[177]

But Archigenes’ principal merit, so far as concerns the art of
dentistry, consists in his having guessed that odontalgia, in certain
cases, arises from a disease of the interior part of the tooth (viz.,
from inflammation of the pulp) and in having discovered an excellent
method for curing such cases. When a tooth appeared discolored,
without being affected by caries, and was the seat of violent pains,
against which every remedy had proved of no avail, Archigenes
perforated it with a small trephine, invented by himself for the
purpose. He applied the instrument to that part of the crown which was
most discolored and drilled right down to the centre of the tooth.[178]

Without doubt this talented surgeon was induced to adopt this method of
cure by the idea of the existence of morbid substances in the interior
of the tooth and by the consequent indication of giving them a free
exit.

The operation devised by Archigenes proves, among other things, two
important facts: first, that the anatomical constitution of the teeth
had already been explored, seeing that Archigenes did not ignore the
existence of the pulp cavity; and secondly, that Archigenes was greatly
opposed to the extraction of a tooth unless absolutely necessary.
It might be thought that such aversion depended upon an exaggerated
idea of the dangers connected with the extraction of a tooth, an idea
widely diffused at that period; but regarding such a daring surgeon as
Archigenes was, it is more logical to suppose that in similar cases he
had recourse to trephining and not to extraction, especially on account
of the importance he attached to the preservation of the tooth.

Surgery in ancient times was eminently conservative; later on—partly
by effect of its own progress—it became too readily inclined to the
removal of diseased parts; in modern times it has again become what it
was originally, and what it must ever be, viz., conservative in the
highest possible degree.

CLAUDIUS GALEN, after Hippocrates the greatest physician of ancient
times, was born at Pergamus, a city in Asia Minor, in the year 131 of
our era. His father Nicon, a man of great abilities, who was at the
same time a man of letters, a philosopher, a mathematician, and an
architect, had put him, at a very early age, to the study of science
and of the liberal arts. Galen began to study medicine at the age
of seventeen, under the guidance of skilful doctors of his native
country; he made several journeys in order to have the benefit of the
instruction of celebrated masters, and finally frequented the renowned
medical school at Alexandria. On going to Rome, in the thirty-fourth
year of his life, he soon acquired in that city a very high renown.
He died in the first decade of the third century, but we do not know
exactly in what year.

Galen was a most prolific writer, and his works, considering the period
in which they were written, form a real medical encyclopedia. Anatomy
through his researches made considerable progress, for he studied with
the utmost care and attention (especially in apes) the bones, muscles,
heart, bloodvessels, brain, nerves, and every other part of the
organism. His anatomical researches enabled him to correct many errors,
but as he had dissected almost exclusively animals and not human
corpses, he himself fell into several errors, especially in attributing
to man parts which he does not possess, for example, the intermaxillary
bone.

Galen justly observed that the inferior maxilla (resulting, according
to him, from the union of two bones, which, indeed, is embryologically
true) has in man, proportionally to the other bones of the skeleton, a
lesser length than in animals.

He holds that the teeth must be enumerated among the bones, and does
not admit any doubt to be raised on this point, as these parts can be
looked upon neither as cartilages, nor as arteries, nor as veins, nor
as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat,
nor as hair—a method of reasoning by elimination which is very specious
but far too weak!

Galen indicates exactly the number of incisor, canine, and molar teeth
(without, however, making any distinction between small and large
molars), and speaks of the different functions of these three kinds of
teeth. Not always, he says, are the molars of each jaw five in number
on each side; in some individuals there appear only four; in others
six. The incisors and canines have but one root; the upper molars have
generally three, but sometimes, though not often, four; the lowers have
for the most part two, rarely three.

Galen is the first author who speaks of the nerves of the teeth. He
says that these organs are furnished with soft, that is sensitive,
nerves[179] belonging to the third pair.[180] The teeth, according to
him, are furnished with nerves, both because, as naked bones, they have
need of sensibility, so that the animal may avoid being injured or
destroyed by mechanical or physical agencies, and because the teeth,
together with the tongue and the other parts of the mouth, are designed
for the perception of the various flavors.[181]

In regard to odontalgia, Galen made some very important observations on
his own person:

“Once when I was troubled with toothache, I directed my attention to
the seat of the pain, and thus I perceived very clearly, that not only
was the tooth painful but also pulsating, which is analogous to what
happens in inflammations of the soft parts. To my astonishment, I had
to persuade myself that inflammation may arise even in a tooth, in
spite of the dental substance being hard and lapideous. But another
time, when I again was attacked by odontalgia, I perceived very
distinctly that the pain was not localized in the tooth, but rather in
the inflamed gums. Having, therefore, suffered these two kinds of pain,
I have acquired the absolute certainty that, in certain cases, the
pain is situated in the gums, in others, on the contrary, in the very
substance of the tooth.”

When a tooth becomes livid, Galen deduces from this that the tooth
is the seat of a morbid process equivalent to inflammation. Besides,
he says, we cannot be surprised that the teeth may be subject to a
phlogistic process, when we consider that these, like the soft parts,
assimilate nourishment. The teeth, by effect of mastication, are
continually worn down, but nutrition repairs the losses, and they,
therefore, preserve the same size. But when a tooth from want of its
antagonist is consumed but little or not at all by mastication, we
see that it grows gradually longer, for the very reason that under
such conditions the increase due to nutrition is not counteracted by a
corresponding waste.

The nutritive process of the teeth may, according to Galen, be altered
either by excess or by defect; from which arise morbid conditions,
quite different the one from the other. An excess of nutrition produces
a phlogistic process analogous to that of the soft parts; a defect of
nutrition makes the teeth thin, arid, and weak. The first of these
pathological states is met with especially in young men and must be
fought against with the ordinary antiphlogistic means, designed to
eliminate the excess of humors (evacuant, resolvent, revulsive, and
astringent remedies). As to defect of nutrition, this is met with most
frequently in old people. It has the effect not only of making the
teeth thin, but also of enlarging the alveoli, from which there results
a looseness of the teeth more or less noticeable. Against this morbid
condition we do not possess, says Galen, any direct remedy; however, it
can be combated, up to a certain point, by strengthening the gums with
astringent medicaments, so that they may close tightly around the teeth
and thus make them firm.

Dental caries is produced, according to Galen, by the internal action
of acrid and corroding humors, that is, it is produced in the same
manner as those cutaneous ulcers which appear without any influence
of external causes. The cure must consist in acting upon such
vicious humors by means of local or general medicaments according to
circumstances and also in strengthening the substance itself of the
teeth by the use of astringents and tonic remedies.[182]

After these preliminary remarks, Galen gives a minute description of
the numerous remedies which, from his own experience and from that of
other great doctors, were to be considered useful for the cure of the
various affections of the teeth and gums.

Against gingivitis and the pains deriving from it, the best remedy,
according to Galen, consists in keeping in the mouth the oil of the
lentisk moderately warm; noting, however, that such a remedy is the
more efficacious the more recently it has been prepared.

A decoction of the root of the hyoscyamus in vinegar, used as a mouth
wash, is another remedy recommended by Galen against the pains in the
gums. It would also be of benefit to apply on the inflamed gums a
powder composed of one part of salt to four of alum, afterward washing
the mouth with wine or with a decoction of olive leaves. If the gums
are ulcerated, Galen recommends them to be cauterized with boiling
oil, using for the purpose a little wool wrapped around a probe or
toothpick. This medicament, says Galen, greatly modifies the diseased
part, exciting a reparative process in it, to aid which, however,
suitable remedies must be used, and especially frictions with a mixture
of gall-nuts and myrrh reduced to a fine powder.

For the cure of epulides the application of green vitrol, together with
an equal quantity of powdered myrtle and a little alum, is especially
recommended.

In dentition, if the gums are painful, it is advisable to rub them with
the milk of a bitch. The teeth, moreover, appear very readily, says
Galen, if the gums be rubbed with hare’s brain.

Against odontalgia, properly so called, independent, that is, of
diseases of the gums, Galen particularly recommends warm applications,
either on the cheek or directly on the tooth. Externally, on the side
of the pain, may be applied dirty (!) pieces of linen, well warmed,
or else small bags full of roasted salt, or cataplasms of linseed
or barley flour. But if it is desired to act directly upon the sick
tooth, this may be rubbed with a branch of origanum (wild marjoram)
dipped in hot oil, or else, after applying a bit of wax on the tooth,
the heated end of a probe may be laid upon it; or lastly, fumigations
may be made by burning the seeds of the hyoscyamus. In case the above
remedies, or others like them, be found of no use, Galen recommends
them to be adopted anew after having perforated the sick tooth by means
of a small drill. But if even from this no benefit be derived, and it
is considered well to remove the tooth, this can be done without pain
by the application of special medicaments. Among these the root of
pyrethrum kept in very strong vinegar for forty days and then pounded
takes the first place. The remedy is applied after having well cleaned
the sick tooth, and after having covered the others with wax. At the
end of an hour the tooth will have already become so loose that it can
be drawn out with the fingers or with the mere help of a style. The
same effect may be obtained, says Galen, by the application of blue
vitriol mixed with very strong vinegar.

To prevent a carious tooth from producing pain or fetor, he advises the
carious hollow to be filled up with black veratrum mixed to a paste
with honey.

To restore to blackened teeth their whiteness, Galen advises them to
be rubbed with special medicaments, one of which is made up of dried
figs, burnt and pounded, with spikenard and honey. He gives, besides
the receipts of many dentifrice powders and tinctures designed both to
strengthen the teeth and gums and as preservatives against the diseases
of these parts. Such powders and tinctures do not offer any interest
to us, since they do not much differ from those recommended by other
authors whom we have previously quoted.

When one or more teeth, in consequence of a trauma, or from other
cause, become loose and project above the level of the others, Galen
removes the whole exuberant part by means of a small iron file. In
performing this operation, after having covered the gums with a soft
piece of cloth, he holds the tooth to be filed steady with the fingers
of the left hand, using the file in such a way as not to give the tooth
any shock. Besides, he does not complete the operation at one sitting,
but rather interrupts it as soon as the patient feels any pain, and
continues it after one or two days. In the meanwhile, he makes use of
remedies suited to strengthen the loosened teeth, and bids the patient
remain silent and nourish himself with liquid or soft food.

When the teeth, without the action of external causes, become loosened,
Galen holds that this is due to a relaxation of the dental nerve in
consequence of an excessive abundance of humors. In such cases he
counsels the use of desiccative remedies.

Galen, like ancient authors in general, is not very favorable to
the extraction of teeth with the forceps. Even he seems convinced
that a tooth may be made to fall out, without pain, by means of the
application of certain remedies, to which we have already alluded.
However, in one of the Galenic books[183] we find the precept already
given by Celsus, that before extracting a tooth the gums must be
detached all around; from which one may argue that, at least in certain
cases, instrumental extraction was considered inevitable. Galen even
alludes to the pain which sometimes remains after the extraction of a
tooth, and is of the opinion that this depends upon an inflammatory
condition of the stump of the dental nerve.

In Galen are found recorded many means of cure, recommended by
celebrated doctors of ancient times. Elsewhere we have already spoken
of some remedies counselled by Damocrates, by Andromachus the elder,
and by Archigenes. Apollonius, as a medicament against odontalgia,
advised that the juice of the beet root be dropped into the nostrils,
or else a liquid prepared from cumin seed, myrrh, cucumber, and
woman’s milk. Heraclides of Tarentum recommended against the pains and
looseness of teeth that a vinous decoction of black veratrum, mandrake,
and hyoscyamus root should be kept in the mouth. Criton prescribed, for
strengthening loose teeth, that the mouth should be frequently washed
with a vinous decoction of lentisk, myrtle, and gall-nuts.

CELIUS AURELIANUS. In the book _De morbis acutis et chronicis_, written
by Celius Aurelianus (who lived, according to some, in the third
century, according to others, in the fourth or at the beginning of the
fifth), a very interesting chapter on odontalgia is found. He shows
himself to be, for the most part, a follower of Celsus. During the
violence of the pain he advises abstinence from food and rest in bed
with the head somewhat raised. As remedies he recommends several mouth
washes (infusions or decoctions made with wine or vinegar and with
various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil,
poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides,
the application of wool soaked in hot oil on the cheek of the affected
side, or the application of little warm bags, and also that some hot
oil, or the juice of fenugreek,[184] should be kept in the mouth,
or milk with honey. When the pain is excessively violent, he has
recourse to bloodletting, and after two days’ fasting, he begins to
feed the patient with liquid and warm food. If the bowels are closed
he prescribes the use of clysters, and when, in spite of all, the
pain persists, he has recourse to scarified cuppings on the cheek, in
correspondence with the pain. In certain cases he also proceeds to
scarification of the gums, or else he detaches them all around from
the tooth, by means of a special instrument called a _pericharacter_.
It would often turn out useful to apply to an aching tooth a grain of
incense warmed by the fire and wrapped in a thin piece of cloth, or to
press between the teeth, where the pain is situated, several pieces of
cloth, in succession, in which some powder of incense has been wrapped,
and which are dipped into hot oil before being used. The author,
moreover, commends external fomentations made by means of sponges
soaked with emollient decoctions and afterward squeezed; and also the
application of moderately hot cataplasms.

[Illustration: FIG. 33

Roman dental forceps found (1894) at Hamburg, Germany, in the ancient
Roman castle Saalburg. (Geist-Jacobi.)]

When the odontalgia has already become inveterate and recurs in
paroxysms, separated by intervals of calm, Celius Aurelianus counsels,
among other things, that the general health be strengthened by
temperate living, exercise, rubbing of the whole body (an ancient
practice, now revived under the name of massage). He recommends,
besides, special rubbing of the cheeks (to be carried out with a rough
cloth), and also of the gums and teeth, and indicates a great number
of medicaments, some of which are to be used during the paroxysms and
others during the periods of calm. In regard to the use of narcotics,
he very shrewdly observes that such remedies take away sensibility but
not pain. Some doctors of those days, for the cure of odontalgia, had
recourse to sternutatories, or to the dropping of special medicaments
into the nose or into the ear, but Celius Aurelianus seems to have
put but little faith in such means of cure. He, moreover, solemnly
reproaches those who, to cure odontalgia, are too hasty in having
recourse to the extraction of the aching tooth. To remove a part,
says he, is not to cure it; and if every tooth that aches has to be
extracted, it would be necessary to draw them all out when they all
ache. Therefore, before having recourse to extraction, every other
means of cure should first be tried. If the removal of the tooth
becomes indispensable, he advises that it should never be performed
during the violence of the pain, for from this serious consequences
might arise (a prejudice which has not yet entirely vanished, and
which is met with, sometimes, not only among common people, but even
among physicians); and a still greater danger would be the extraction
of teeth neither carious nor loose, seeing that, by consensus, the
muscles, the eyes, and the brain might suffer. The author, on this
point, quotes Herophilus and Heraclides of Tarentum, who related
some cases in which the extraction of a tooth was followed by death.
He alludes, moreover, to a passage of Erasistratus, regarding the
“odontagogon of lead” (_plumbeum odontagogum_) which was exposed in
the temple of Apollo at Delphi; as much as to show that it was not
lawful to extract teeth other than those which were so loose that an
instrument of lead was sufficiently strong to extract them.

When the looseness of the teeth seems to depend upon the flaccidity
of the gums, Celius Aurelianus recommends astringent mouth washes:
decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince,
of myrtle berries, etc.; and besides these, lentiscine oil and asses’
milk, which latter was also believed to possess astringent virtues.
Against hemorrhages of the gums, he advises the use of very fine coral
powder, or of alum with honey.

GNAEUS MARCELLUS EMPIRICUS, of Burdigala (Bordeaux), who lived at the
end of the fourth century and at the beginning of the fifth, wrote
a book, _De medicamenti_, which shows, more than anything else, the
decadence of the medical science in those days. Regarding the diseases
of the teeth and their cure, Marcellus does not tell us anything new.
He freely copies Scribonius Largus and other authors, not adding
anything save a few methods of cure, which are exceedingly strange
and superstitious. To get rid of toothache, it is sufficient that the
patient, when the moon is waning, and in the days of Mars (Tuesday)
or of Jupiter (Thursday), repeat seven times the words _argidam_,
_margidam_, _sturgidam_. It is a great pity that a curative method so
simple and easy be efficacious in two days of the week alone, and even
then on condition that the moon be waning.

The following method is also a very good one: Whilst in the open
country, one must take a frog by the head, open its mouth and spit into
it, then having begged the animal to take the toothache with it, must
replace it on the ground and let it free. To remove loose teeth easily,
it is necessary to keep in reserve some juice of black ivy mixed with
a little green oil; in case of necessity, the nose of the patient
must be anointed with it, and after having drawn a deep inspiration,
he must put a little stone between his teeth, and stay with his mouth
open, inclined a little forward, so as to let all the morbid humor
flow out, which sometimes flows very abundantly and even may reach to
three herminæ.[185] Having afterward rubbed the nose with pure oil, and
washed the mouth with wine, the teeth will be free from every pain and
may be very easily pulled out. If the root[186] of a tooth be rubbed
with dried African sponge, the tooth will fall out within three days;
naturally, says the author, care must be taken not to touch, whilst
doing this, any healthy tooth. He who desires never to be subject to
pain in the teeth, may obtain this end by the following method: When
at the beginning of spring he sees the first swallow, he must go in
silence to some running water, take some of it in his mouth, rub his
teeth with the middle fingers of both his hands, and say: “_Hirundo,_
_tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non
doleant toto anno._”[187]

The same must be done each following year, so as to continue to enjoy
the effects of such a cure!

ADAMANTIUS, an Alexandrine philosopher and physician, who probably
lived in the fourth century, paid much attention to the diseases of
the teeth, as may be argued from two chapters of the _Tetrabiblos_
of Ætius. One of these chapters is entitled, according to the Latin
translation of Giano Cornario: “Cura dentium a calido morbo doloroso
affectorum, ex Adamantio, sophista.”[188] This writer clearly belonged
to the pneumatic school, founded as early as 69 A.D. by Athenæus
of Cilicia. According to the pneumatics (so called, because they
admitted the existence in the animal organism of an aëriform principle,
_pneuma_, to which they attributed great importance), heat and dryness
gave rise to acute maladies; the phlegmatic affections generally arose
from humidity, and melancholy was brought on by cold and dryness, as
every object dries up and becomes cold on the approach of death. The
author says that the cure must vary according as the disease affects
in a greater degree the gums or the teeth themselves with or without
participation of the dental nerves and neighboring parts. He makes,
in regard to this, many subtle distinctions; but the remedies which
he counsels do not offer to us any special interest, being almost
identical with those that had been recommended by Galen and by other
doctors prior to Adamantius. The latter also gives much importance
to dietetic therapy; he prescribes that such patients should nourish
themselves with pottages of barley, or of spelt, with eggs, lettuce,
pumpkins, and other cooling food, abstaining, however, from wine.[189]

The author enumerates among the causes of such dental affections the
dryness of the air, the autumnal season, the dry constitution of the
individual, a troubled life, and scanty nourishment. The use of sour
and piquant substances is not favorable to these patients, so much so
that the mulberry preserve produces, not unfrequently, violent dental
pains in them. Adamantius, therefore, advises, in such cases, not to
use strongly astringent mouth washes, but rather lenitive, moistening,
and emollient substances; simple lukewarm water, decoction of bran,
licorice juice, starch with boiled must of wine diluted with warm
water, milk, especially asses’ milk, decoction of mallows and the
like.[190]

The work of Adamantius from which Ætius has taken the above-mentioned
chapters is lost to us. Of his writings there only remain to us
the treatise _on the winds_ and the one _on physiognomics_. In this
latter book the author attributes great importance to the canine teeth
as physiognomonic elements, and from their shape and size he makes
deductions in regard to the character of the individual.

ORIBASIUS (316 to 403), the most celebrated of all the compilers who
appeared during that long period of decadence, wrote, by order of the
Emperor Julian the Apostate, whose physician and friend he was, a
whole medical encyclopedia and later on a summary (synopsis) of this
same work of his. In the books of Oribasius are found many things
about dentition and diseases of the teeth, but they are all taken,
substantially, from preceding authors, and therefore it is not worth
while repeating them.

ÆTIUS OF AMIDA, a celebrated Greek writer on medicine, lived at the
end of the fifth century, and at the beginning of the sixth, and has
also left us a kind of medical encyclopedia, which, being divided into
four sections, each composed of four books, was called _Tetrabiblos_.
He teaches that the mucous membrane of the gums, tongue, and mouth
is provided with nerves from a portion of the third pair of cerebral
nerves, and that the teeth, too, by a small hole existing at the end
of every root, receive tiny ramifications of sensitive nerves, having
the same origin. The nutrition of the teeth is understood by Ætius in
the following way: The nourishment which reaches the dental nerves is
not entirely assimilated by them; these only appropriate the liquid or
soft part and reject the drier part. This accumulates in the alveoli,
becomes by degrees more tenacious and denser, finally being transformed
into osseous substance and forming the nutriment of the teeth; these,
therefore, tend to grow continually, although the waste arising from
the mechanical action of mastication prevents them from undergoing
any real or visible growth. On the other hand, in the old, from the
weakening of the nutritive functions, the teeth become thin and loose,
and finally fall out.[191]

Ætius advises that during dentition hard objects to chew should not be
given to children, seeing that the gums being hardened by these and
becoming almost callous would render the cutting of the teeth very
difficult.[192]

For curing parulides, he recommends emollients at the beginning of the
disease, and later on astringents. But if the inflammation of the gums
does not resolve and passes into suppuration, he prefers to perform the
excision of the parulis, instead of making a simple incision, which
might very easily cause the abscess to change into a fistula.[193]

The epulis, according to Ætius, is a fleshy excrescence of the
gums, brought on by inflammation. To cure it, he uses, during the
inflammatory period, emollients, and then, when the inflammation has
subsided, astringents and weak caustics. Lastly, if the epulis resist
these remedies, he takes hold of it with a vulsella and proceeds to
remove it with a small scalpel.[194]

When the incision of a fistula of the gums and the use of appropriate
remedies are not sufficient for curing it, Ætius advises the extraction
of the diseased tooth, from which the fistula has its origin.[195]

Apart from what has been mentioned, Ætius does not tell us, in regard
to dental diseases, anything worthy of note, and in many places he only
repeats Galen’s observations.

PAUL OF ÆGINA (seventh century) establishes a very clear distinction
between epulis and parulis. The epulis is a fleshy excrescence of the
gums in the neighborhood of a tooth; the parulis is an abscess of the
gums. To cure the former affection it is necessary, says the author,
to seize and stretch the tumor with a vulsella or with a hook and to
perform its excision. As to the parulis, although not unfrequently it
is sufficient, for curing it, to give an exit to the pus by means of
a slight incision, the author, however, usually prefers the method of
cure recommended by Ætius, viz., excision. After such operations he
orders the patient to rinse his mouth with wine and on the morrow with
hydromel.[196] From the third day onward he sprinkles the wound with
a cicatrizing powder, until a complete cure is obtained. But if the
wound, instead of healing, be transformed into a putrid ulcer resisting
all the ordinary means of cure, it is necessary to cauterize the part
affected with an oval-shaped cautery.[197]

In extracting a tooth, the operation is begun by detaching the gum all
around it as far as the alveolar border; then the tooth is seized with
the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus,
recommends that before extracting a tooth deeply attacked by caries,
the cavity be filled up with lint, in order to avoid the crumbling of
the tooth under the pressure of the instrument. On the other hand, he
too is convinced that a diseased tooth can be made to fall out without
pain, by the use of suitable remedies.

When supernumerary teeth cause an irregularity of the dental arches,
this must be corrected, says the author, either by resection of such
teeth, if they are very firm, or by their extraction.

If a tooth projects above the level of the others, the protruding part
must be removed with the file. This instrument must also be employed to
remove the sharp edges of broken teeth.

Tartar incrustations must be removed either with scrapers or by means
of a small file.[198]

During the period of dentition one must not give children any food
which requires mastication, and to soften the gums they must be
anointed with hen’s fat or with hare’s brain.[199]

To preserve the teeth and to keep them healthy, Paul of Ægina
recommends all tainted food to be avoided, and also all possibility of
indigestion and frequent vomitings; the use of very hard or glutinous
food or of such as may easily leave a residuum between the teeth, for
example, dried figs, and likewise very cold food and such as set the
teeth on edge. He also advises that hard things should never be broken
with the teeth and that the latter be carefully cleaned, especially
after the last meal of the day.[200]

Paul of Ægina also belongs to the class of compilers; but in utilizing
the writings of the great physicians who had preceded him, he gives
evidence of exquisite good sense, and not infrequently subjects the
assertions of his predecessors to an intelligent and enlightened
criticism. Besides, he inserts here and there observations and
experiences of his own that are not without interest. He has always
been, and rightly so, considered one of the greatest physicians of
ancient times, the great reputation which he justly held among the
Arabs contributing not a little to his renown.

This author is the last of the Byzantine period, and with him,
therefore, we must close the earlier part of the history of dentistry.
If, before passing to the middle period, we cast a glance over the
ground already traversed, it is easy to perceive that dental art, in
ancient times, reached its highest degree of development at the time
when the Roman civilization was in its greatest splendor, when, in the
capital of the world, wealth, luxury, and the refinements of social
life marvellously increased its needs, and by this also gave an impulse
to the evolution of all human activity. But ancient civilization,
after having reached its culminating point, soon fell into decadence,
and this necessarily would result in a hindrance to the development
of dental art. From the days of Archigenes right up to those of Paul
of Ægina, dentistry did not make the least progress; indeed, as far
as prosthetic dentistry is concerned, there was probably a retrograde
movement, it being very likely that when Italy was subject to the
dominion of the barbarians and when Christianity—which but recently had
asserted itself—was strongly imposing on the human mind a deep contempt
for all that regarded the welfare and beauty of the human body, no one
could, any longer, think of artificially repairing the losses sustained
by the dental system through disease or injury.




PART II.

SECOND PERIOD—THE MIDDLE AGES.




CHAPTER VIII.

THE ARABIANS.


The religious fanaticism excited by Islamism, transformed the obscure
and nomad inhabitants of Arabia into a conquering nation, who very soon
extended their power over a considerable part of Asia, Africa, and
Europe. Spain, invaded by the Arabs in 711, fell almost entirely into
their hands. After having by force of arms rendered themselves powerful
and dreaded, the Arabians acquired also great fame by the culture of
art and science within the limits allowed them by their religious
code; and in these, for more than four centuries, they maintained an
incontestable preëminence.

Unfortunately, as the Koran most absolutely prohibited the dissection
of dead bodies, all serious anatomical research was thereby rendered
impossible. This was a very great hindrance to the progress of anatomy,
of physiology, and, in consequence, of the whole of medical science.
The Arabians certainly had the merit of keeping alive the study of
medicine in an age of decadence and barbarism; but, apart from the
important progress realized by them in chemistry and pharmacology,
it may be affirmed that the Arabs contributed but scantily to the
development of the healing art; they followed almost entirely in the
footsteps of Galen and other ancient, and especially Greek, authors.

One of the characteristics of Arabian medical art consists in the
aversion to bloody operations and in the effort to avoid them. A like
tendency shows itself also in the sphere of dentistry; the Arabians,
even more than their Greek and Roman predecessors, were reluctant to
extract teeth, and employed all possible means, in order to avoid the
operation.

RHAZES (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was
born in Persia toward the middle of the ninth century, and gave himself
up to the study of medicine when about thirty years of age, having
previously been a musician. He wrote many works which, unfortunately,
have, for the most part, been lost. Rhazes did not have recourse to
the extraction of teeth, save as a last resource when every other
attempt at cure had proved useless; which method would no doubt have
deserved high praise, had the author been inspired by the principles of
conservative surgery, rather than by unjustifiable fears. Caries of the
teeth is, according to him, identical with that of the bones. To hinder
its progress and propagation to the neighboring teeth, he advises the
carious cavity to be filled with a “cement” composed of mastic and
alum. We have here a laudable attempt at permanent stopping of decayed
teeth, although it is clear that the duration of such stopping, owing
to the nature of the materials employed, could not be a long one.
Furthermore, he counselled the patient to abstain from the use of acid
food or drink and to rub the teeth with powder of gall-nuts and pepper.

To strengthen loosened teeth, he recommended astringent mouth washes
and sundry dentifrice powders. Others, partly taken from Galen, are
recommended by him for prophylactic purposes and for cleansing and
beautifying the teeth.

Against periodontitis and the pains produced by it, he sometimes had
recourse to bleeding. He commended, besides, opium, oil of roses,
pepper, and honey, and also the scarification of the gums and the
application of a leech. If, however, these remedies did not succeed, he
applied his theriac, which was composed of castoreum, pepper, ginger,
storax, opium, and other ingredients, to the roots of the teeth. If
even this method of cure failed, he touched the root of the diseased
tooth with a red-hot iron, or sought to provoke its fall by the use
of special medicaments, such as coloquintida and arsenic (a substance
to which he had recourse, particularly in those cases where there was
ulceration of the gums). It is no wonder that such means of cure would
sometimes produce, as a final result, the actual falling out of the
tooth; and this, as is natural, served to strengthen the belief that
the same result could also be obtained with less energetic remedies,
but which were supposed to be equally endowed with expulsory virtues.

Rhazes relates an interesting case of regeneration of a whole lower
jaw; he, however, observes that the newly formed osseous mass was less
hard than the original bone.[201]

ALI ABBAS, another great Persian physician (who died in 994), wrote a
lengthy treatise on theoretic and practical medicine, one chapter of
which is dedicated to the diseases of the teeth. When a molar tooth
is affected by caries, and the pain cannot be subdued in any other
way, Ali Abbas applies, inside the carious cavity, the end of a small
metallic tube, into which he repeatedly introduces red-hot needles,
leaving them in the tube until quite cooled. Should even this have no
effect, he tries to provoke the fall of the tooth by the application of
asses’ milk with assafetida, or, finally, extracts it.[202]

He cures epulis, like Paul of Ægina, by excision. As to parulis, or
abscess of the gums, he opens it with a lancet or a wooden stylus.

When the dental arch is deformed by the existence of supernumerary
teeth, he removes these with an instrument in the shape of a beak.[203]

SERAPION (Jahiak Ebn Serapion), who lived in the tenth century, and
up to the beginning of the eleventh, contributed but slightly to the
development of medicine and dentistry, as he was in his writings little
more than a mere compiler. He indicates with great precision the number
of dental roots, and expresses an opinion that the upper molars have
need of their three roots in order to keep firm in spite of their
pendent position, whilst two roots alone are sufficient to keep the
lower molars in place, on account of the support which they receive
from the jaw. Serapion, like Galen, admits the nutrition and continual
growth of the teeth—a growth which is produced in the same proportion
as the waste due to mastication—and he too makes the dental diseases
depend upon an alteration in the nutritive process, either by excess or
by defect.

Against dental pains of phlogistic origin, he recommends bloodletting,
purgatives, and many local medicaments, reproduced in great part from
Rhazes. In cases of persistent odontalgia due to caries, he advises, as
an excellent remedy, the application of opium in the carious cavity.
To strengthen loosened teeth, he first employs astringents, and if
these are of no use, as often happens in the old, he binds the loose
teeth together and to the neighboring healthy ones, by means of gold or
silver wire.

In Serapion, too, we find many formulas for dentifrice powders, some of
which are intended simply for cleaning the teeth, others for special
prophylactic or curative purposes.[204]

AVICENNA. One of the greatest luminaries of medicine among the Arabs
was Avicenna (Ebn Sina). He was born in 980 son of a high Persian
functionary; he lived a very adventurous life, held some very high
places, and died in 1037. Among his works, the most important is the
_Canon_, a book which procured him the title of “second Galen” and the
still more pompous one of “prince of doctors.” A very evident proof of
the immense fame which he acquired is the fact that among many oriental
peoples Avicenna, even in our own days, is considered the greatest
master of medicine.

The anatomy and physiology of the teeth are treated by Avicenna very
minutely, but nevertheless he does not teach us, in regard to these,
anything new. Like Galen, Avicenna admits that the teeth continually
grow, and as a proof he gives the fact of the lengthening of the teeth,
which, owing to the absence of antagonists, are not subject to any
pressure or friction.

He gives much good advice with regard to the preservation and
cleanliness of the teeth, to which he attaches very great importance;
and on this point he remarks that the use of very hard tooth powders
must be avoided, as these are liable to injure the dental substance. To
this latter are also harmful, says the author, some narcotic remedies,
employed against odontalgia. Burnt hartshorn is, according to him, a
most valuable dentifrice. To remove tartar from the teeth, he indicates
many remedies, and especially dentifrices of meerschaum, salt, burnt
shells of snails and oysters, sal ammoniac, burnt gypsum (plaster
of Paris), verdigris with honey, etc. Among the substances able to
facilitate dentition, he enumerates several oils and fats, besides the
brain of the hare and the milk of the bitch, and he disapproves the
custom of giving to children, during dentition, hard objects to chew,
in the erroneous belief that the biting of such objects is useful in
facilitating the cutting of the teeth; he recommends, instead, the gums
to be rubbed with the fingers. When the teeth begin to appear, he drops
some oil into the ears of the child and covers its head, neck, and jaws
with a plaster spread on cotton that has been soaked in oil.

Avicenna minutely examines the various causes of odontalgia, and among
them includes also the little worms by which the dental substance was
supposed to be gnawed away.

When a tooth becomes the seat of intense pain, accompanied by a
throbbing feeling, Avicenna considers that this is due to an excessive
accumulation of humors in the root; he therefore advises, as already
Archigenes had done, the tooth to be drilled, in order to empty it, and
afterward to introduce into it appropriate remedies.

According to Avicenna, he who has a loosened tooth and desires to make
it firm again, must avoid using it in mastication, must not touch it
with the fingers, nor move it with the tongue; besides this, he must
speak as little as possible, and make use of astringent remedies.

To remove a tooth, Avicenna made use of either the forceps or the
“eradicating remedies,” in which he, too, had full confidence. Like
the greater part of his predecessors, Avicenna is of the opinion that
the extraction of a firm tooth must be avoided as much as possible, as
it may give place to an injury of the jaw, or become harmful to the
visual organ, or bring on fever. On this point he remarks that, if an
aching tooth appears to be sound, it is not always necessary to perform
its extraction in order to cause even the most rebellious odontalgia
to cease; in certain cases he obtained a complete cessation of the
pain after having simply shaken the tooth without completing its
extraction; which according to him was due to the double reason that by
shaking the tooth a resolution of the morbid matter stagnating under it
is provoked, and the action of the medicaments that are afterward made
use of is thus favored.

Among the eradicating remedies, the author enumerates white arsenic,
orpiment, coloquintida, tithymallus, the fat of frogs, and others. He
remarks, however, that before using them it is advantageous to detach
the gum all around.

Against the supposed worms in carious teeth, he praises fumigations
made with the seeds of the hyoscyamus, garlic, or onion.

Arsenic is used by him not only for the above-mentioned purpose, but
also for the cure of fistulas and foul ulcers of the gums.

When a tooth has become abnormally long, Avicenna makes use of the file
to reduce it to a proper size; and in performing such an operation, he
holds the tooth firmly between the fingers, or with a pair of pincers
suited for the purpose. As a consecutive treatment, he prescribes
frictions with alum, laurel berries, and aristolochia.[205]

ABULCASIS. Among the Arabian authors, he who has the greatest
importance in regard to dental art is undoubtedly Abulcasis
(Abul-Casem-chalaf-ben-Abbas). Whilst Avicenna was one of the greatest
physicians, Abulcasis was one of the greatest surgeons; and very justly
he has been called the genius of Arabian surgery.

Abulcasis had his birthplace in Alzahra, a small Spanish village, five
miles from Cordova; from this he derived the name of Alzaravius, by
which he is also known. Historians are not agreed upon the date of his
birth. According to the most probable opinion, he was born about the
year 1050 and died in 1122 at Cordova, a city which, on account of its
celebrated school, was then a most important centre of scientific and
literary culture.

Among the works of Abulcasis, the one which brought him the greatest
fame was the treatise _De Chirurgia_. It is divided into three
books, in the first of which he speaks of all the diseases which can
be treated by cauterization; in the second are described all the
operations which are performed by cutting, perforating, or extracting
(wherefore, obstetrics is also included in this book); in the third,
lastly, the author treats, region by region, of fractures and luxations.

Chapters XIX, XX, and XXI of the first book have reference to diseases
of the teeth and gums. As these chapters are very short, we are pleased
to give here an almost literal translation of them:

“When in the lower part of the gums, or in the palate, there appears a
little tumor, which afterward becomes purulent and opens and changes
into a fistula, against which no medical remedy is of any use, it is
necessary for thee to take a cautery corresponding in size to the
aperture of the fistula, and after having heated it, to introduce it
there and to keep it applied there until the cauterizing iron reaches
the bottom of the said fistula and beyond. This thou shalt do once or
twice, and then shalt use fitting medicaments until a complete cure
is obtained. This is attained when suppuration ceases. Otherwise one
cannot do less than uncover the bone and extract that part of it which
is diseased.”[206]

“When through excess of moisture the gums become flaccid, the teeth
loose, and of no use are the remedies employed by thee, thou shalt lay
the patient’s head on thy lap, and after having applied to the tooth,
where it borders on the gum, the end of an appropriate little metal
tube, in this thou shalt quickly introduce the cautery of which mention
will be made in the following chapter; and thou shalt prolong the
application as long as suffices to let the patient feel the heat right
in the root of the tooth. This thou shalt repeat as often as thou shalt
think necessary. Then the patient shall keep salt water in the mouth
for an hour. By effect of such a cure, the corrupted moisture will dry
up, the gums will regain their tone, and the tooth its firmness.”[207]

“When toothache depends upon cold, or if there exist some worm in the
tooth, and the medicaments are of no use, recourse must be made to
cauterization, which in such cases may be performed in two ways, viz.,
either by means of butter or with a cautery. Desiring to use butter,
some of it must be warmed in an iron or copper spoon; a little cotton
must then be wrapped around the extremity of a probe, dipped into the
boiling butter, and then immediately applied to the tooth, keeping it
there in contact until it has cooled. This must be repeated several
times, so that the action of the heat reaches right down to the root
of the tooth. If thou preferest, thou canst use cold butter, applied
to the aching tooth by means of a little tuft of wool or cotton, upon
which thou shalt lay a red-hot iron; prolonging the application of this
until the heat has reached the very root of the tooth.

“To perform the cauterization directly with the iron, thou must first
rest on the tooth a small tube of iron or copper, designed to preserve
the neighboring parts from the action of the heat, and which must,
therefore, be of sufficient thickness. Through such a tube thou shalt
apply on the tooth a cautery of the shape given here below, and shalt
keep it there until it is cooled. This thou shalt do several times.
The pain will cease the same day or on the morrow. It is, however,
necessary that after the cauterization the patient should keep his
mouth, for an hour, full of good butter. The shape of the cautery is
as follows (Fig. 34): Thou canst perform the cauterization with one or
other of its two extremities, as is most convenient.”[208]

In regard to epulis, Abulcasis prescribes that after catching hold of
the little tumor with a hook or a vulsella its complete excision should
be performed. This done, one must wait awhile, until the hemorrhage
ceases, and then either a little “zegi” pulverized,[209] or other
drying and styptic powder, must be applied on the part. If the epulis
recurs, which very often happens, the excision must be repeated and
this followed by cauterization, since after this latter the evil will
not return.[210]

Abulcasis is the first author who has taken into serious consideration
dental tartar and who has recommended that a scrupulous cleansing of
the teeth should be performed. The chapter relating to this, “On the
Scraping of the Teeth,” is very interesting and is worthy of being here
reproduced.[211]

[Illustration: FIG. 34

Abulcasis’ dental cautery and the tube through which it was applied, in
order to preserve the neighboring parts from the action of the heat.]

“Sometimes on the surface of the teeth, both inside and outside, as
well as under the gums, are deposited rough scales, of ugly appearance,
and black, green, or yellow in color; thus corruption is communicated
to the gums, and so the teeth are in process of time denuded. It is
necessary for thee to lay the patient’s head upon thy lap and to scrape
the teeth and molars, on which are observed either true incrustations,
or something similar to sand, and this until nothing more remains
of such substances, and until also the dirty color of the teeth
disappears, be it black, or green, or yellowish, or of any other color.
If a first scraping is sufficient, so much the better; if not, thou
shalt repeat it on the following day, or even on the third or fourth
day, until the desired purpose is obtained. Thou must know, however,
that the teeth need scrapers of various shapes and figures, on account
of the very nature of this operation. In fact, the scalpel with which
the teeth must be scraped on the inside is unlike that with which
thou shalt scrape the outside; and that with which thou shalt scrape
the interstices between the teeth shall likewise have another shape.
Therefore, thou must have all this series of scalpels ready if so it
pleases God.”[212]

The work of Abulcasis is, so far as we know, the first book in which
are found figures of dental instruments. We do not know, however, how
far such figures are exact, that is, to what degree of faithfulness
they represent the instruments which Abulcasis really employed as the
original figures of the book of Abulcasis were copied and recopied
by successive transcribers of the work. And that such copies have
been very often unfaithful may be deduced from the fact that not
unfrequently figures of surgical instruments are found in the book
which do not at all agree with the verbal description which the author
gives of such instruments.

In the edition by John Channing, we find at the end of the chapter on
the scraping of the teeth two series of figures. The first series is
found under the Arabic text, and is composed of the fourteen figures
reproduced as Fig. 35; the other series, existing under the Latin text,
has only twelve figures, as shown in Fig. 36.

As Channing has made his translation from two different Arabic copies
of Abulcasis,[213] among the corresponding figures of which there
exists a very notable difference, he, for the greater part, had to
follow the plan of reproducing the figures of both codices. But besides
this numerical difference, there is also a considerable difference
in the shape of the instruments represented. We must, therefore, ask
ourselves which of the two series of figures is to be regarded as the
more faithful representation of the instruments used by Abulcasis. Most
probably the first series. In it we find figured some scrapers which
have a certain resemblance to those actually in use; besides this, the
figures of the first series seem to be drawn with greater accuracy than
those of the second. Among other things it may be noticed that the
handle of each instrument (excepting the last two) is furnished with
a row of prominences, which, it is almost certain, were designed to
afford a better grip in holding the scrapers during the operation.

[Illustration: FIG. 35

Set of fourteen dental scrapers (Abulcasis).]

[Illustration: FIG. 36

Twelve dental scrapers as represented in another manuscript codex of
Abulcasis.]

We now consider the chapter on the extraction of teeth.[214] The author
begins by saying that it is necessary to use all possible means to cure
an attack of odontalgia, and to be very slow in deciding to extract a
tooth, as this is a very noble organ, the want of which cannot in any
way be perfectly supplied. When there is no way of avoiding extraction
and the patient is obliged by pain to submit to this, it is necessary
first to ascertain which is the aching tooth, as very often the pain
deceives the patient, so that he may indicate as the seat of the pain
another tooth which is perfectly sound, and desire it to be extracted;
after which, naturally, the pain does not cease, if not when the
diseased tooth is also extracted, as often happens in the hands of
the barbers.[215] The aching tooth having been well ascertained, it
is necessary to detach the gum from the tooth, all around, with a
sufficiently strong scalpel. Then either with the fingers or with a
light pair of forceps the tooth must be shaken very gently, until it
is loosened. Then the surgeon, keeping the head of the patient firmly
between his knees, applies a stronger pair of forceps and extracts the
tooth in a straight direction, so as not to break it. If it is not
possible to draw it out, one of those elevators must be taken which the
author advises for the extraction of roots (as may be seen afterward),
and by insinuating it under the tooth the surgeon must endeavor to
extract it. When the tooth is corroded and hollow, it is necessary to
fill the cavity with lint, compressing it hard inside with the end of
a probe,[216] so that the tooth may not break under the pressure of
the instrument. In all cases, the operator must take great care not to
break the tooth, for if this happens the remaining part will give the
patient still greater suffering. It is necessary, therefore, to avoid
acting like the ignorant and foolish barbers, who in their temerity
do not observe any of the above-mentioned rules, and therefore very
often cause the patients great injuries, the least among which is the
breaking of the tooth, the root being left in the socket, or else the
taking away, together with the tooth, of a piece of the maxillary bone,
as the author often happened to see. After the extraction the patient
must rinse his mouth with wine, or with vinegar and salt. If, as often
happens, hemorrhage is produced, a little powdered blue vitriol must be
applied inside the wound; and if this is not sufficient, the part must
be cauterized with a red-hot iron.

[Illustration: FIG. 37, FIG. 38

Forceps for loosening the tooth previous to extraction (Abulcasis).]

The small forceps (Figs. 37 and 38) to be used in loosening the tooth
must have the handle shorter than the jaws and be sufficiently strong
not to bend when pressure is put upon the tooth.

The large forceps (Figs. 39 and 40) with which the extraction must be
performed should be made of very good Indian or Damascene iron, and
have the handle longer than the jaws; these, moreover, on the inside
must be toothed, or striated after the manner of files, so that they
may have a perfectly firm grip, without slipping.

From the foregoing quotations and on examining the annexed figures,
it very clearly appears that the extraction of teeth was performed by
Abulcasis with excessive timidity and in a manner which must have been
torturing to the poor patients. These had to undergo, first of all, the
detachment of the gums, then the prolonged shaking of the tooth either
with the fingers or with the forceps, then the attempt at extraction by
means of a stronger pair of forceps, but, so far as can be seen from
the figure, very little fitted for the purpose; and finally, in many
cases, fresh maneuverings to extract the tooth with an elevator.

[Illustration: FIG. 39, FIG. 40

Forceps for performing the extraction after the tooth has been loosened
(Abulcasis).]

Nothing better, in truth, could have been done with such imperfect
instruments. But it is possible that even then there perhaps existed,
for the extraction of teeth, other instruments, so shaped as to be
able to act with greater force. Abulcasis himself[217] alludes to the
existence of dental instruments not mentioned by him. It is probable,
therefore, that the barbers, in spite of the scorn with which Abulcasis
overwhelms them, used, for the extraction of teeth, forceps far more
suitable than those described by him. These individuals, certainly
unfurnished with a scientific education, must have had, however, a
great practice in the extraction of teeth, being perhaps almost the
only ones to whom recourse was had for this operation. They performed
it very quickly, as may be argued from the words of Abulcasis himself.
It is no wonder, therefore, that not unfrequently the work of these
_fatui tonsores_[218] was the cause of more or less serious injuries,
but for the most part it had the advantage of not making the patients
suffer excessive torture.

Another very interesting chapter is that which treats of the extraction
of dental roots and fragments of the maxillary bone.[219]

[Illustration: FIG. 41, FIG. 42

Forceps for extracting the root when the tooth breaks in the
extraction. These figures are evidently very badly drawn, as are most
of the figures to be seen in Abulcasis’ work.]

When, says the author, on extracting a tooth, this breaks, so that the
root remains in the socket, it is necessary first of all to soften the
part, by applying for a day and a night, or for two days, some cotton
wool well smeared with butter; then attempts must be made to extract
the root with a pair of forceps, the jaws of which are like the beak of
a pheasant or stork.

[Illustration: FIG. 43

Elevator to be used when the extraction of a root by means of the root
forceps proves impossible (Abulcasis).]

If this is not successful, it is necessary to remove with a scalpel
the whole of the gum which covers the root; then under it must be
insinuated a small elevator having the shape here below represented.

If not even in this way can the end be attained, recourse must be made
to one of the following instruments, choosing that which in every
particular case seems to be the most suitable.

Besides these, says the author, use may be also made of some of the
instruments which serve for the removal of tartar.

It is precisely in this chapter that Abulcasis speaks of the great
variety and multiplicity of dental instruments; which, he says, cannot,
like other kinds of instruments, be all enumerated and described.
He then adds that a skilful surgeon will be able to devise new
instruments, according as the peculiarities of each single case require
them.

[Illustration: FIG. 44]

[Illustration: FIGS. 45, 46, 47]

[Illustration: FIG. 48

Elevators (Abulcasis.)]

For the extraction of a splinter or necrosed fragment of the maxillary
bone, the same instruments must be used which serve for the extraction
of dental roots; but also a pair of forceps may be used (Figs. 50 and
51).

It will be necessary to grip with them the osseous fragment firmly, so
that it cannot escape whilst it is being extracted. The part shall then
be medicated with fitting remedies.

Whenever it is thought proper, the bone must be scraped and all the
diseased part of it removed.

When a tooth is irregularly placed, or projects above the level of
the others,[220] a deformity ensues which is particularly displeasing
in women. The way of correcting this varies according to the nature
of the case. It consists sometimes in the simple extraction of the
misplaced tooth. But when there exists an intimate (osseous) union of
the irregular tooth with another one, it is necessary to operate for
the resection of the former with an instrument of the following shape,
that is, like a small axe:

[Illustration: FIG. 49

An instrument like a small axe, for resecting irregularly situated
teeth (Abulcasis).]

The operation must be performed in many days, not only on account of
the hardness of the tooth, but also in order not to shake any of the
neighboring teeth.

In other cases, the deformity, consisting in one tooth projecting above
the level of the others, may be corrected with a saw.

The instrument must be made entirely of Indian iron, and the operation,
like the preceding one, is to be carried out in several days, that the
fall of the tooth may not be provoked by excessive shaking. The file
(Fig. 55), too, must be used to destroy the edges and points of broken
teeth, that they may not injure the tongue, or give any trouble in
speaking.

[Illustration: FIG. 50, FIG. 51

Forceps for extraction of splinter or necrosed fragments of the
maxillary bones (Abulcasis).]

[Illustration: FIG. 52

A dental saw (Abulcasis).]

[Illustration: FIG. 53

Another dental saw (Abulcasis).]

When, in consequence of a blow or fall, one or more teeth have become
loose so that the patient cannot bite his food with them, if the use
of styptic remedies has been found of no use, it will be necessary to
bind and make such teeth firm by a gold or silver wire. Gold is to
be preferred as being unalterable, whilst silver in a few days turns
green. Having chosen, therefore, a suitable gold wire of perfectly
uniform consistency, it must be passed at its middle part between two
firm teeth, that is between the two nearest on one side to the loosened
tooth or teeth; then, by binding tightly around the sound tooth and
each of the loosened teeth the two lengths of the wire and crossing
them in the dental interstices so as to form a kind of network, the
sound and firm tooth of the opposite side will be reached, and this
too must be wound around in a mesh, as it were, of the said network.
Then, turning back, the same operation must be repeated, but inversely,
until the point of departure is reached. All this must be done with
much skill, so as to render the loose teeth completely unmovable. When
the wire is tied, this must be done near the dental roots, so that the
knot may not get untied; then with a pair of scissors the remaining
part must be cut off and its two ends joined and twisted with a pair of
pincers, hiding them between the sound tooth and the neighboring loose
one. Such a ligature should remain in place during a whole lifetime;
and in case it should come undone or the wire should break, it will be
necessary to renew the operation. The following figure represents the
ligature described:


[Illustration: FIG. 54

Ligation for steadying teeth in cases of blow or fall (Abulcasis).]

“Sometimes, when one or two teeth have fallen out, they are replaced
in the sockets and bound in the aforesaid manner and remain there.
The operation must be carried out with great delicacy and ability, by
skilful hands.”

As may be seen from the above quotation, in the days of Abulcasis
replanting was already performed, although it is probable that the
ligature was then left permanently.

The author says, next, that the vacancy left by fallen teeth can be
filled up with artificial ones, made of ox bone, they also being fixed
in the manner above described; and he adds that they will be found not
only of advantage from the esthetic but also from the functional point
of view.

Speaking of the cure of the ranula,[221] Abulcasis says that when the
tumor, examined by the clear light of the sun, appears brown or black,
hard and insensible, it is not to be operated, it being then of a
cancerous nature. If, instead, it is whitish and full of liquid, it
must be seized with a hook, and by means of a fine scalpel extirpated.
The hemorrhage must be combated with powdered blue vitriol. After the
operation mouth washes must be used of vinegar and salt.

In cases of fracture of the lower jaw[222] it is not only necessary
to cure the fracture itself according to the rules which the author
prescribes for the various cases, but it is also necessary to pay
attention to the teeth and with a gold or silver wire, or a silk
thread, to tie, in the manner already described, those teeth which in
consequence of the wound have become loose, but the consolidation of
which may be hoped for.

[Illustration: FIG. 55

A dental file (Abulcasis).]

MESUE THE YOUNGER, a disciple of Avicenna, is of opinion that when a
tooth is the seat of violent pain, this may easily propagate itself
to the other teeth; and therefore advises, if the pain does not soon
cease, to extract the tooth affected, without delay. This operation,
however, must not be performed, says the author, whilst the pain is at
its height, but rather when it is somewhat lessened, otherwise, the
extraction of the tooth may result in a syncope sometimes ending in
death, or else be the cause of intense inflammation and of suppuration,
which, also, may, in certain cases, place the patient’s life in danger.
He recommends an infinite number of remedies against odontalgia; in
these, however, there is nothing new to us. As to the removal of a
tooth, this may be obtained in three different ways, that is, with
the forceps, with eradicating remedies, or by cauterization. In
order to cause a tooth to fall out by the use of acrid, eradicating
substances, the author advises to proceed in the following manner:
The tooth is first freed, by means of a scalpel, from the surrounding
gum; the eradicating remedy is next applied to the root of the tooth,
every needful precaution, however, being taken that it may not injure
the neighboring teeth. Cauterization, when practised to produce the
exfoliation of a diseased tooth, may be performed, according to Mesue,
either with a small red-hot iron, passed through a little metal tube in
order to protect the neighboring parts, or with the heated kernel of a
nut, or with a grain of burning incense.[223]

To cure a dental fistula, Mesue cauterized it to the very bottom with a
cautery in the form of a probe, or extracted the tooth, which by reason
of its diseased root was the cause of the fistula; and when the bone
was likewise affected, he laid bare the carious part, which he then
scraped.[224]

AVENZOAR. The last of the great Arabian physicians was Avenzoar. He
was born at Peñaflor, near Seville, in 1070 and died in 1162. He became
famous by his very valuable work on medicine, entitled the _Teisir_. It
is strange, however, that in this book there is hardly anything about
the treatment of dental diseases. Against caries and looseness of the
teeth the author limits himself to recommending bloodletting either
from the ranine or the basilic vein. Apart from this, he speaks neither
of operations nor of remedies for diseases of the teeth.[225] Probably
at the time in which Avenzoar wrote, that is, in the first half of the
twelfth century, doctors in general did not occupy themselves with the
curing of teeth at all, this being abandoned entirely to barbers and
other persons. This would sufficiently explain why this author is so
silent in regard to dental diseases.

But what can have been the reason for doctors refusing thus
contemptuously to occupy themselves with so important a branch of
therapeutics? In every age there have been a great number of ignorant
persons, who either in good faith, or else for imposture, have
practised, within a more or less limited circle, the art of healing,
usually dedicating themselves to some particular class of diseases.
Even in our days, notwithstanding the superabundance of duly qualified
doctors, there is, especially in certain countries, no small number of
quacks, secretists, bone-setters, chiropodists, and the like. It is,
therefore, not to be wondered at that in times when dentistry was still
in its infancy there should have been persons more or less ignorant
who undertook tooth drawing and the concoction and sale of specifics
against odontalgia. The doctors, on their part, under the pretext of
being unwilling to have anything to do with these individuals, found it
very convenient to dispense with the cure of dental diseases and with
the extraction of teeth, this operation being sometimes too difficult
for them, on account of their want of practice, besides being almost
always very painful, and considered, even from the most ancient times,
capable of eventually producing evil consequences, among which, in some
cases, even the death of the patient.

But perhaps this was not the only reason for the fact above mentioned.
In the middle ages the extraction of one or more teeth was sometimes
inflicted as a punishment; for example, for having eaten flesh during
Lent,[226] or on those found guilty of felony, for having refused to
contribute sums of money demanded from them by their liege lord. Now,
as this punishment was carried out on the guilty ones by the executors
of public justice, it is only natural that doctors should have refused
to practise an operation which would have degraded their profession by
bringing it down nearly to the class of the hangman.




CHAPTER IX.

THIRTEENTH TO FIFTEENTH CENTURIES.


BRUNO OF LONGOBUCCO. After the Arabian period, the first author whom
we must mention is Bruno of Longobucco, of the school of Bologna,
who lived in the thirteenth century and wrote a treatise on surgery,
which gave him a certain renown.[227] This book, however, contains but
little about diseases of the teeth. The author shows himself a great
friend of the actual cautery, and advises its use in the cure of dental
caries and of various diseases of the gums. He says nothing about the
extraction of teeth; instead, he recommends, as a means for making
a diseased tooth fall out, that the milky juice of the tithymal be
applied around its root after having been reduced to the consistency of
paste by the addition of flour.[228]

LANFRANCHI, of Milan, another writer of the thirteenth century, who
acquired great fame by his book _Chirurgia magna et parva_—partially
translated into German, more than two centuries later, by Otto
Brunfels—also shows himself very timid in the sphere of dentistry,
and to combat dental pains he recommends, by preference, the use of
narcotics. He is not at all favorable to the extraction of teeth; and
especially that of the molars is considered by him a very dangerous
operation.[229]

TEODORICO BORGOGNONI (1205 to 1298), known also under the name of
Teodorico of Cervia, is according to Hæsar the first author who made
mention of sialorrhea following mercurial frictions. Worthy of note,
too, is what he says in regard to fistulas of the gums, or, in general,
of the maxillary region. He advises that in every case of this kind
special attention be paid to the state of the dental roots; when there
is a discharge of ichorous pus, the roots are certainly affected; and
then the diseased teeth must all be extracted as soon as possible.[230]

JOHN GADDESDEN, an English doctor who flourished at Oxford in the
first half of the fourteenth century, wrote a very curious medical
book, taken the greater part from Pliny and the Arabian writers and
entitled _Rosa anglica: practica medicinæ a capite ad pedes_ (English
rose: the practice of medicine from head to foot). In his time many
strange methods of cure were in use, sometimes simply ridiculous,
and others even filthy; and the _Rosa anglica_ furnishes us with
not few examples. In order to make a tooth fall, Gaddesden advises
the application of dried crow’s dung reduced to powder, or else to
anoint it with the fat of a green frog. This last means would be quite
infallible and would make the tooth fall out on the spot. It had such
power that if peradventure an ox in grazing chews a little frog with
the grass, its teeth will all fall out on the instant! We do not know
whether the author himself believed in the marvellous virtues of the
fat of green frogs. It is certain, however, that he enumerates this
among his “secrets,” and says that he has gained much money from it
through the mediation of the barbers.

Other absurdities of the same kind are the following: The brain of the
hare can, by being rubbed on the gums and jaws, serve for two important
purposes, since it has not only the virtue of facilitating dentition,
but also of making teeth grow again to those who have lost them! The
brain of a partridge applied to a carious tooth makes it fall in pieces!

The treatment of odontalgia embraces, according to Gaddesden, both
general and special means of cure. To the former belong purgatives,
bloodletting, scarifications of the labial and sublingual mucous
membrane, leeches, the application of scarified cuppings under the
chin. The special means of cure are represented by a great number of
plasters, powders, and ointments, in the composition of which almost
constantly hyoscyamus and pyrethrum take part. When odontalgia depends
on caries, the author advises, among other things, the use of a
red-hot iron. Against the supposed worms of carious teeth he counsels
fumigations with the burnt seeds of hyoscyamus or of leeks. In cases of
dental fistulas, it is necessary to cauterize the fistulous tract, to
extract the diseased tooth, and if the bone be also affected, to scrape
it. To clean the teeth: Gaddesden recommends several dentifrices; some
of which are composed of pulverized cuttle bone, either with addition
of meerschaum, pumice stone, burnt hartshorn, in different proportions
and combinations, or used quite alone; others are made with myrrh and
alum.

Since Gaddesden affirms the existence of means capable of promoting
the fall of any tooth, we should suppose that he says nothing about
instrumental extraction, or at least that he considers it entirely
useless; for if in order to make a tooth fall out, it be sufficient to
smear it with frog’s fat, why should there ever be any need to have
recourse to the very painful extraction by means of the forceps?

However, this is not so; the author treats of instrumental extraction
as a very important operation, without being at all afraid of
being reproved for contradicting himself. Besides, to anyone who
thus reproved him he perhaps would have answered, without being
disconcerted, that it is not always possible to have the fat of frogs
or the dung of crows in readiness.

The extraction of a tooth is only justifiable, says Gaddesden, when
all the remedies employed against odontalgia have proved useless and
when, on the other hand, the pain has its seat in the tooth itself and
not in the nerves or gums. Before undertaking the operation, however,
the patient must be prepared for it with an evacuant cure, that is,
by injections and purgatives. For the operation itself the author
recommends the same rules given by Celsus, and says, besides, that the
head of the patient ought to be held firm by an assistant. In certain
cases, the extraction can be performed, better than with the forceps,
by means of an instrument in the form of a lever, broad at one end,
narrow and sharpened at the other. But when a tooth is very firmly
seated, its extraction is always dangerous; therefore, in such a case,
Gaddesden recommends, before having recourse to the operation, the use
either of acrid substances, such as the milky juice of the euphorbiaceæ
(for example, of the tithymal), or else of a red-hot iron; and this,
for the purpose of promoting the fall of the tooth, or of rendering
it, at least, so far movable that it can be extracted without any
difficulty.

GUY DE CHAULIAC, the greatest surgeon of the middle ages, was born
about 1300, in a little village on the confines of Auvergne, which
still preserves the name of Chaulhac; he died in 1368. This author
immortalized his name by a work which even up to the eighteenth
century was, as it were, the official code for the teaching of
surgery. Guy wrote his _Chirurgia magna_ in barbarous Latin—such as
was then used by the learned; but his book was soon translated into
French, Provençal, and afterward also into Italian, English, Dutch,
and Hebrew. E. Nicaise, who, in 1890, gave to the scientific world a
very valuable new edition of Guy de Chauliac,[231] and who made very
accurate researches on all that regards this author and his work, has
succeeded in finding in the libraries of Europe and America as many as
thirty-four manuscript copies of the _High Surger_.[232] The survival
of so many copies, in spite of all the destructive agencies which have
been in action during more than 500 years, is a very clear proof of the
wide diffusion which this work obtained even before the invention of
printing.

Guy’s work was printed for the first time in 1478, and the editions
that have been published since then in various countries are in all
about 130.

This book is very important for our subject, since we may gather from
it very clearly the condition of dentistry in the fourteenth century;
but, on the other hand, we see from it, with equal clearness, that
this branch of the healing art had not made any progress from the
time of Abulcasis to that of Guy de Chauliac (about two centuries
and one-half), and that this most famous surgeon did not contribute
anything worthy of note to the development of dentistry.

On the anatomy and physiology of the teeth Guy de Chauliac expresses
himself very briefly: “Teeth are of the nature of bones, although they
are possessed of sensibility, due to some nerves which the third pair
sends to their roots. The number of these latter may vary from one to
four, according to the different teeth. The uses of these organs are
well known.”[233]

Worthy of being recorded are the names which Guy gives to the
different kinds of teeth. After having said that these latter are
generally thirty-two, but sometimes only twenty-eight, he adds, that
the sixteen teeth of each jaw are divided into: _deux duelles, deux
quadruples, deux canines, huiet maschelieres[234] et deux caisseaux_
(in the barbarous Latin: _duo duales, duo quadrupli, duo canini,
octo molares et duo caysales_). So that the two middle incisors were
then called _duales_; the lateral incisors were called _quadrupli_,
because, together with the middle ones, they formed a series of four
teeth. Guy gives the name of _caysales_ (_caisseaux_) to the last two
molars; but Joubert, one of the translators and commentators of Guy de
Chauliac, tells us that the molars in general were called in Languedoc
_caisseaux_: “Les cinq molaires sont appelées en Languedoc _caisseaux_,
parce qu’elles servent à casser les choses dures, comme les noix et
semblables.” In regard to the canines of the upper jaw, we learn that
they were called _oeillères_ (eye teeth), because their root was
believed to reach near the eye.[235]

According to Guy de Chauliac, _les dents sont engendrées non
seulement en l’enfance, ains aux autres ages_.[236] And this passage
was commented by Joubert in the following note, which we reproduce
textually:

“En Languedoc, près de Pezenas y a une gentil femme, nommé Mademoiselle
de Lobatiere, dès long temps vieille édentée, à laquelle (comme
tesmoignent beaucoup de gens très-dignes de foy) environ l’an 70 de
son age, sont sorties cinq ou six dents nouvelles. Le conciliateur
tesmoigne avoir veu, à qui les dents perdues devant l’an 60 ont été
derechef engendrées, moindre toutes fois que les premieres et plus
foibles.”[237] (In Languedoc, near Pezenas, there is a lady named
Mademoiselle de Lobatiere, who having been for a long time old and
toothless (according to the testimony of persons well worthy of
belief), at about the age of seventy got five or six new teeth. The
Conciliator[238] testifies to having seen teeth grow anew—smaller,
however, and weaker than the first—in persons who had lost them before
the age of sixty years).

In regard to the pathology and therapy of the teeth, Guy but rarely
abandons the footsteps of the Arabian writers. Following the example
of one of these, Ali Abbas, he admits five or six dental maladies:
pain, corrosion, congelation, and _agacement_ (teeth set on edge),
limosity or fetidness, fall or loosening.[239] As to the cure, this is
divided into universal and particular. The former includes, before all,
hygienic rules, and then purgatives, bloodletting of the cephalic vein
or the veins of the lips or tongue, revulsion, obtained by means of
cupping glasses, friction, etc., and the remedies for curing the rheums
of the head, or for throwing out the phlegmatic humors (pyrethrum,
mastic, and the like).

The hygienic rules are the following: Not to eat food apt to putrefy,
such as fish and milk foods; to avoid food or drink either too hot or
too cold, and especially the rapid succession of cold and hot, or _vice
versa_; not to bite hard things, nor to eat viscous food, such as figs
and confectionery made with honey; to avoid certain foods which are
known to be bad for the teeth, such as leeks; not to clean the teeth
too roughly, but to rub them with honey and burnt salt, to which, very
advantageously, may be added some vinegar.

Before speaking of the special methods of cure of single dental
affections, Guy observes that operations on the teeth are _particular_
(proper) to barbers and to “dentatores,”[240] to whom doctors have
abandoned them. But it is safest of all, says he, to have such
operations performed under the direction of doctors. These, however,
to be in a position to give advice in regard to diseases of the
teeth, must know the various methods of cure which are suited to
these diseases, that is to say, mouth washes, gargles, masticatories,
fillings, evaporations, anointments, rubbings, fumigations,
cauterizations, sternutatories, instillations into the ears, and manual
operations.

Lastly, Guy notes that the “_dentator_”[241] must be provided with all
the appropriate instruments, that is, with “rasoirs, rapes, spatumes,
droits et courbes, eslevatoires simples et à deux branches, tenailles
dentelées, et diverses esprouvettes, cannules, deschaussoirs, tarieres,
aussi des limes, et plusieurs autres necessaires a cette besogne” (in
Latin: rasoriis, raspatoriis, et spatuminibus rectis et curvis, et
levatoriis simplicibus et cum duobus ramis, tenaculis dentatis, et
probis diversis, cannulis, scalpis et terebellis, et etiam limis.)[242]

Whilst Abulcasis bitterly declaims against the barbers, because they,
in spite of their ignorance, permit themselves to perform operations
on the teeth, and especially to extract them, Guy de Chauliac speaks
in quite a different tone. He recognizes that such operations are
_particular_, which is as much as to say, in modern language, that the
practice of dental surgery constitutes a _specialty_. Guy, it is true,
expresses his desire that dental operations be performed, for greater
security, under the direction of doctors, but he does not use one word
of blame or contempt against the _dentatores_, thus leaving it to be
understood that, according to him, their art had every good reason
to exist. Besides, from the enumeration of the surgical instruments
which Guy says are necessary to them, we can easily argue that the
_dentatores_ of the fourteenth century were not, as at the very first
one might be led to believe, mere “tooth-pullers,” but that, at least,
the best among them cured teeth as well as the scanty knowledge and
means of cure then available enabled them to do.

In the chapter on odontalgia,[243] Guy de Chauliac distinguishes
between the pains, the point of departure of which is in the tooth
itself, and those resulting from disease in other parts, for example,
from apostema[244] of the gums; in these latter cases, in order to
cause the pain to cease, it is necessary to cure the part from which
the pain is derived, taking into account the nature of the disease and
its causes.

When the pain is situated in the root of the tooth or in its nerve, it
is necessary, says the author, to distinguish whether it is caused by
an accumulation of morbid matter, or whether it is, instead, a simple
pain _without matter_. Besides, it is necessary to distinguish, in the
first case, whether the matter producing the pain is hot, cold, or
windy; and also, in the second case, it is necessary to ascertain if
the pain is of a warm, cold, dry, or humid nature. As may be seen, the
principles and subtle distinctions of the pneumatic school were then in
full vigor.

The treatment must vary according to all the aforesaid cases; but the
means of cure advised by Guy de Chauliac do not present any special
interest, as they are almost entirely taken from Galen and from the
Arabian authors, and especially from Rhazes, Ali Abbas, and Avicenna.

On coming to speak of the looseness of teeth,[245] Guy says that
this may depend on various causes: that is, on a fall or a blow; on
humidity, which softens the nerve and ligament;[246] on dryness and
lack of nourishment of the teeth; and lastly, on corrosion of the gums.

The looseness of teeth, which depends on dryness or want of nutrition,
as in the old and in consumptive people, is incurable. In other kinds
of looseness, astringents are useful; but it is also well that the
patient should speak but little, that he should not touch or move the
loose tooth, nor use it in masticating. In cases of corrosion of the
gums, this disease must be cured.

If looseness of the teeth follows a blow, it is well, first of all, to
let blood, and then to use astringents and excitants. When all this is
of no avail, Guy advises that the loose teeth be tied to the healthy
ones with a little gold chain,[247] after the manner of Abulcasis. And
if, says he, the teeth fall out, they may be replaced with teeth of
another person, or with artificial teeth of ox bone, fixing them in
their place with a fine ligature; and, he adds, that such teeth are
serviceable for a long time. Here are the precise words of the text:
“Et si les dents tombent, qu’on y mette des dents d’un autre, ou qu’on
en forge d’os de vache, et soient lisez finement, et on s’en sert
long-temps.”

This extremely concise manner of treating dental prosthesis, summing
all up in some thirty words, is in strong contrast with the usual
fulness of explanation and methodical accuracy of Guy de Chauliac, to
whom, very justly, could be given the title of founder of didactical
surgery. Such a strange contrast cannot be explained, unless by
admitting that Guy considered dental prosthesis as foreign to the
general plan of his book, that is, as something which did not directly
concern surgeons, and for which, therefore, a mere allusion ought to
be sufficient. Without the slightest doubt, dental prosthesis was
practised neither by doctors nor surgeons, but by the _dentatores_.

Abulcasis, too, certainly for the same reason, is extremely brief
in speaking of artificial teeth, but, on the other hand, he very
minutely describes the process of ligating loose teeth. Guy omits this
description entirely, and only alludes briefly to this therapeutic
practice. From this it is easy to perceive that whilst Abulcasis
considered this operation within the province of surgeons, Guy de
Chauliac was disposed to exclude it from the field of general surgery,
considering that this, too, like the other dental operations, belonged
to the _dentatores_. In his days, in short, dentistry had become much
more clearly specialized than it was in the days of Abulcasis.

After having spoken of the looseness of teeth, Guy de Chauliac goes on
to treat of caries, in a short chapter, entitled “De la Pourriture, des
vers, de corrosion et pertuifement des dents.”

The method of cure, he says, is double, viz., universal and particular.
The general treatment embraces the hygienic and therapeutic means
already mentioned. As to the particular or local treatment, it
consists, first of all, in washing the teeth with aqua vitæ or with a
vinous decoction of mint, salvia, melissa, pepper, or pyrethrum. Then
it is necessary to fill the carious cavity with gallia[248] and root of
cyperus,[249] mastich, myrrh, sulphur, and camphor, wax, ammoniacum,
asafetida and the like. As may be seen, Guy does no more than mention
the substances used in his days for the filling of carious teeth, and
does not tell us what various combinations were formed with the said
materials, nor the proportions in which they were used. In short, he
does not give us any formula for the composition of a filling mass, and
from this may be inferred, without fear of error, that this operation
also was never performed by him, consequently it, too, was not
practised by doctors and surgeons, but rather by the _dentatores_.

When the aforesaid means of cure—that is, the mouth washes and the
filling—are of no use, Guy advises the margins of the carious cavity
being taken away with a scalpel and file, so that alimentary substances
may not be retained inside it. However, here are his words, which seem
especially to refer to cases of interstitial caries:

“Si ces choses n’y valent rien, la dent soit esbuschaillee avec un
ciseau et lime,[250] e qu’on luy fasse un passage, à ce que la viande
ne s’arreste au trou.” If advantage is not even derived from such an
operation, recourse must be had to cauterization, or, if necessary, to
extraction.

Even Guy de Chauliac believes in the worms of the teeth, and against
these he recommends the usual fumigations. He advises that the seeds
of leek, onion, and hyoscyamus be mixed with goat’s tallow and made
into pills of a dram each in weight, one of which is to be used for
each fumigation: “Si dans le trou il y a un ver, apres le susdit
lavement,[251] la dent soit suffumiguée avec une graine de porreau et
d’oignon et semence d’hyosciame, confits avec suif de bouc; et qu’on
en fasse des pilules chacune d’une drachme et qu’on y en employe une à
chaque fois.”

In the following chapter Guy treats “De la limosite et laide couleur
des dents.” Here, too, he recommends, before all, the general hygienic
rules above mentioned. Besides, he advises the mouth being rinsed with
a vinous decoction of wild mint and of pepper, and then the use of the
following dentifrice:

“℞—_Cuttle-bone, small white seashells, pumice stone, burnt stag’s
horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and
reeds._ All these substances must be reduced to powder together, or
each one separately.” Use may also be made of a liquid dentifrice thus
prepared:

“℞—_Sal ammoniac and rock salt, half a pound of each; saccharine
alum, one-quarter of a pound._ These to be reduced to a powder and
placed in an alembic of glass, so as to obtain a liquid, with which the
teeth must be rubbed by means of a little scarlet cloth.”

If these means of cure are of no avail, on account of the presence of
hardened limosity (tartar), this must be removed by scraping it away
with appropriate instruments. “Et si cela ne profite, à cause qu’il
y a là des limosites endurcies; soient rasclées avec des rapes et
spatumes.”[252]

Against the setting of teeth on edge (_endormement et congelation des
dents_; _stupor et congelatio dentium_), Guy de Chauliac recommends
hot wine or aqua vitæ, to be kept in the mouth; or the teeth to be
rubbed with roasted salt; or the application to them of hot roasted
walnuts and filberts and similar things which convey heat; or lastly,
masticating substances, which possess heating properties, such as the
portulaca (purslane) and its seeds.

The chapter on the extraction of teeth and of dental roots is a simple
summary of what Abulcasis says on this subject; some passages of this
author are copied word for word.

Whilst the Arabian surgeon treats rather lengthily of the deformities
of the dental arches, and the methods to be employed in correcting
these, Guy de Chauliac almost entirely neglects this subject and
limits himself to saying that if any tooth has become abnormally
lengthened, it is necessary to reduce it to the right length with the
file, but operating “wisely,” so as not to loosen it:

“S’il y a quelque dent augmentée outre nature, soit egalisée et
applanie sagement avec la lime, que ne soit ébranlée.”

Guy strongly throws doubt upon the efficacy of supposed eradicating
remedies. In regard to this he says: “The ancients mention many
medicaments, which draw out the teeth without iron instruments or
which make them more easy to draw out; such as the milky juice of the
tithymal with pyrethrum, the roots of the mulberry and caper, citrine
arsenic, aqua fortis, the fat of forest frogs. But these remedies
promise much and operate but little—_mais ils donnent beaucoup de
promesses, et peu d’operations_.”

From the book of Guy de Chauliac we can gather a very important fact,
which is worth mentioning here; that is to say, that some surgeons of
that period made use already of anesthetic inhalations, especially for
amputations. Here is what Guy says:[253]

“Some prescribe medicaments which send the patient to sleep, so
that the incision may not be felt, such as opium, the juice of the
morel,[254] hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge
is soaked by them in these juices and left to dry in the sun; and when
they have need of it they put this sponge into warm water and then hold
it under the nostrils of the patient until he goes to sleep. Then they
perform the operation.”

It seems that the narcosis thus obtained was sufficiently intense,
since Guy also speaks of the means used to awaken the patient. These
consisted in applying another sponge, soaked in vinegar, under the
nose, or in dropping into the nostrils and ears the juice of rue or
fennel.

Guy lets us know that other surgeons made the patients go to sleep by
giving them opium to drink; but he decidedly disapproves of such a
practice, as he has heard of patients who through this have died.

VALESCUS OF TARANTA (called by the French authors Valescon or Balescon
de Tarente or Tharare), professor at the University of Montpellier
at the beginning of the fifteenth century, wrote a valuable treatise
on medicine and surgery, entitled _Philonium pharmaceuticum et
chirurgicum, de medendis omnibus humani corporis affectibus_. As to
the diseases of the teeth, he especially follows Guy de Chauliac, but
treats the subject at greater length, profiting by what has been
written on the subject by all the ancient writers, and especially the
Arabians.

Among the many remedies which he recommends against toothache, here are
some:

“℞—Wild mint, pyrethrum, white pepper, myrrh, two drams of each; let
these be pulverized and made into a paste with the pulp of raisins or
with white wax and with some turpentine; and let this mass be divided
into small balls as large as filberts, of which one must be masticated
at a time, with the aching teeth.”[255]

Another masticatory is composed of origanum, pyrethrum, cinnamon, and
ginger, made into a paste with the yolk of an egg cooked under the
coals.

To calm dental pains, the vapors of a decoction of wild lavender,
marjoram, rue, chamelea, and melilot are often efficacious. As to
fumigations, they can be made not only with vegetable substances (onion
or mustard seed, rue, etc.), but also by burning scrapings of the hoof
of an ass. The fumes may be made to reach the aching tooth, by means of
a funnel. Here are the words of the author: “Fiant suffitus ex rasura
ungulæ asini, et fumus recipiatur per infundibulum.”

Decayed teeth may be filled, according to Valescus, to satisfy four
different indications: To calm or prevent pain, to prevent any further
spreading of the caries, to kill the worms, and to sweeten the breath.
He advises that the carious cavities should be filled up with powdered
nigella, pepper, myrrh, salt, and theriac; or else with pyrethrum, gum
ammoniac, and opium; or else with celery seeds pulverized, opium, and
hyoscyamus; or with the cast-off skin of serpents boiled in vinegar;
or with gallia and cyperus. The filling with these last two substances
are especially suitable, according to the author, to preserve the teeth
from further spreading of the caries: “Si gallia et cyperus cavis
dentibus applicentur, dentes ulterius non corrodentur.”

To kill the supposed worms of the teeth, Valescus counsels three
different methods, of which the first consists of the usual fumigations
with seeds of hyoscyamus, onion, leek, coloquintida; the second
consists in filling the carious cavity with a mixture of myrrh and
aloes; and lastly, the third, in applying inside the cavity the milky
juice of the tithymal, or the juice of the persicaria.[256]

In regard to tartar of the teeth—which he calls _materia lapidea_,
_i. e._, stony substance—Valescus says that it must be removed little
by little, either with iron instruments or with dentifrices partly
cleansing and partly styptic. After the tartar has been removed, it is
necessary to wash the teeth often with white wine and to rub them with
roasted salt.[257]

Valescus, too, like the majority of ancient writers, is not at all
favorable to the extraction of teeth. He says that recourse must not be
had to this operation except when a tooth is the cause of most violent
pain and every remedy has been of no avail. But the reasons which he
gives in support of this opinion are very plausible; and whilst most of
the authors who preceded him showed themselves adverse to extraction,
because they considered it dangerous, he does not allude in the least
to such dangers, but wishes extraction to be avoided, if possible,
“because the teeth, even when they are in some parts corroded, yet
nevertheless, after the pain is calmed, aid mastication and besides
render the others firmer.”[258]

This author agrees with Galen in considering the teeth as bones, but
he is of opinion that they differ from the other bones in more than
one respect; that is, first of all, on account of their sensibility;
secondly, because, whilst the other bones are formed in the uterus, the
teeth are formed outside the uterus; and lastly, for a reason which
cannot but appear very strange to us, that is: “The bones are produced
by the sperm and menstrual blood, whilst the teeth are produced by the
blood in which there has remained the virtue of the sperm.”[259] This
passage gives us an idea of the state of embryological knowledge of
those days!

PIETRO OF ARGELATA (or of La Cerlata), professor of surgery at Bologna
(died in 1433), wrote a treatise on surgery in six books, in which
diseases of the teeth are also taken into serious consideration. He
speaks of a great number of dental instruments, which, however, are
the same as those enumerated by Guy de Chauliac. His methods of cure
do not offer anything very new, being for the most part identical with
those of Avicenna and Abulcasis. He considers cleanliness of the teeth
of the greatest importance; shows what great injury is done by dental
tartar—which by him is considered a very important sign of the bad
state of the teeth—he counsels the removal of it by means of scrapers,
files, or the use of strong dentifrice powders; and to make the teeth
white, he even advises the use of aqua fortis.

He says nothing in regard to the filling of decayed teeth; he, however,
counsels the cleansing of the carious cavities with aqua fortis, or
even, in some cases, the widening of them, in order to render them
shallower and therefore less liable to retain alimentary residues.

Pietro of Argelata cured dental fistulas by means of caustics and
arsenic. He counselled simple palliative means of cure for hard
epulides of a cancerous nature. In regard to soft, benignant epulides,
he was little favorable to excision, as this might cause hemorrhage;
he preferred ligating the tumor; or he repeatedly cauterized it with
boiling oil or other caustics, until he caused it to fall.[260]

BARTOLOMEO MONTAGNANA, who taught surgery in the University of Padua
and died in 1460, recommended, as an excellent anti-odontalgic remedy,
a mixture of camphor and opium. In his days, faith in the pretended
eradicating virtues of certain substances was being gradually lost;
but, on the other hand, a tendency now arose to neglect, in regard
to the teeth, the conservative principle, to which the ancients had
held so jealously; and little by little the extraction of a tooth
began to be considered an operation of small or no importance, that
could be performed with the greatest indifference. Montagnana himself
considers the extraction of a tooth as the best means of curing
odontalgia, whilst the ancients did not have recourse to it, saving as
a last resource. Notwithstanding this, if the caries was not deep, he
preferred to extraction the use of caustics and a red-hot iron.[261]

GIOVANNI PLATEARIO, a professor at Pisa in the latter half of the
fifteenth century, cauterized carious teeth with a small piece of
kindled ash wood, or with a red-hot iron, and held that cauterization
was more effectual when, before performing it, the carious hollow had
been filled up with theriac.[262]

He, too, made the administration of purgatives or bloodletting precede
the extraction of a tooth. Plateario has, however, the merit of having
introduced the sitting position for operations on the teeth, whilst
preceding surgeons made the patient lie in a horizontal position, or
held his head steady between their knees, as may be read in Abulcasis
and in other writers. Besides, he recommends taking care, when the
extraction of a tooth had to be performed, that the surrounding air
should be pure; perhaps because he thought that when operating in
a place where the air was tainted, complications might more easily
arise, on account of contagious substances reaching the inside of the
wound; or perhaps because he judged, not without reason, that certain
accidents, such as syncope, could more easily happen, and were more
dangerous in a tainted atmosphere than in the midst of pure, vivifying
air. After the operation, he prescribed astringent mouth washes.
Against dental worms, whose existence no one at that period doubted
in the least, Plateario recommended various remedies, chiefly under
the form of fumigations; and among these latter, those performed with
burnt opium. Against ulcerations of the gums and mouth he commended
the use of wine and aromatic substances. An excellent remedy was also,
according to him, lime dissolved in very strong hot vinegar, and
mixed, after complete evaporation of the liquid, with a fourth part of
orpiment.

GIOVANNI OF ARCOLI (in Latin, _Joannes Arculanus_), professor at
Bologna and afterward at Padua (who died in 1484), wrote a commentary
on a celebrated book of medicine, which Rhazes had dedicated to the
glorious King Almansor, great patron of science and art.[263]

In this most valuable work of Arculanus there are several chapters
relative to diseases of the teeth; and this subject is treated rather
fully and with great accuracy.

The author, first of all, treats of the anatomy and physiology of the
teeth; he, however, falls into many errors, for instance, in regard to
the number of dental roots. (“The first six teeth of the upper jaw have
only one root; the first six of the lower not more than two; the molars
of the upper jaw have three; those of the lower generally only two in
like manner; the _neguezid_[264] of the upper jaw have four roots, but
the two lower neguezid have only three.”)

According to him there is not the least doubt that the teeth grow
during the whole lifetime, thus repairing the continual waste caused
by use; and among other proofs he adduces that, whilst in the old all
other organs shrink and waste away through lack of nourishment, the
teeth, on the contrary, show very frequently an increase in length.

For the preservation of teeth—considered by him, quite rightly, a
matter of great importance—Giovanni of Arcoli repeats the various
counsels given on the subject by preceding writers, but he gives
them as ten distinct canons or rules, creating in this way a kind of
decalogue of dental hygiene. These rules are: (1) It is necessary to
guard against the corruption of food and drink within the stomach;
therefore, easily corruptible food—milk, salt fish, etc.—must not be
partaken of, and after meals all excessive movement, coition, bathing,
and other causes that impair the digestion, must also be avoided. (2)
Everything must be avoided that may provoke vomiting. (3) Sweet and
viscous food—such as dried figs, preserves made with honey, etc.—must
not be partaken of. (4) Hard things must not be broken with the teeth.
(5) All food, drink, and other substances that can set the teeth on
edge must be avoided. (6) Food that is too hot or too cold must be
avoided, and especially the rapid succession of hot and cold, and _vice
versa_. (7) Leeks must not be eaten, as such a food, by its own nature,
is injurious to the teeth. (8) The teeth must be cleaned, at once,
after every meal, from the particles of food left in them; and for this
purpose must be used thin pieces of wood somewhat broad at the ends,
but not sharp pointed or edged; and preference should be given to small
cypress twigs, to the wood of aloes, of pine, rosemary, of juniper, and
similar sorts of wood which are rather bitter and styptic; care must,
however, be taken not to search too long in the dental interstices
and not to injure the gums or shake the teeth. (9) After this, it is
necessary to rinse the mouth, using by preference a vinous decoction
of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper
seeds, root of cyperus, and rosemary leaves. (10) The teeth must be
rubbed with suitable dentifrices before going to bed, or else in the
morning before breakfast. Although Avicenna recommended various oils
for this purpose, Giovanni of Arcoli appears very hostile to oleaginous
frictions, because he considers them very injurious to the stomach. He
observes, besides, that whilst moderate frictions of brief duration
are helpful to the teeth, strengthen the gums, prevent the formation
of tartar, and sweeten the breath, too rough or too prolonged rubbing
is, on the contrary, harmful to the teeth and makes them liable to
many diseases. As a dentifrice, he recommends a mixture of two parts
of honey to one of the best sugar; or the ashes of the burnt head of a
hare; or burnt salt made into an electuary by the addition of honey.
To use the last two dentifrices, a quantity about equal in volume to
a filbert must be wrapped and tied inside a thin, loosely woven piece
of linen cloth, and with this the teeth must then be rubbed. Finally,
theriac, too, is considered by him a very good dentifrice. According to
Arculanus, dental pains are sometimes situated in the very substance of
the tooth, at other times in the nerve, and at others in the gums.

The dental substance may become painful, owing to bad “complexion”
(viz., constitution), without there being any morbid matter in it.
When, however, such matter exists, it may proceed from the head or
from the stomach, and in certain cases it gives rise to an apostema of
the tooth; in other cases it corrodes the latter; and at other times
generates (!) in it a worm, which in its turn corrodes the tooth.

In regard to the diagnosis of dental pains, it is necessary first
of all to examine the state of the gums, that is to say, to observe
whether these, in the aching spot, appear healthy, or whether, on the
contrary, they are discolored or tumid, sanguinolent, suppurating, or
the seat of corrosion or putrefaction, or if, when pressure is put
upon them, an exit of matter is produced. In such cases it may be
considered that the gums are the seat of the pain. But if none of these
symptoms are observed, and if, on comparing the gums of the aching spot
with the other gingival regions, no difference is observed, this means
that the cause of the pain exists either in the substance of the tooth
itself, or else in its nerve. In this latter case the pain is usually
very violent, and principally localized in the root of the tooth, but
also extending along the jaw, and the tooth itself is often, as it
were, benumbed. When, however, the pain is not situated either in the
gums or in the dental nerve, but in the very substance of the tooth,
this latter is very often corroded (carious), and very often in the
hollow there exists a worm; and this may be deduced from the fact that
during the intervals of calm the patient sometimes feels a peculiar
sensation, the movement of the worm in the diseased tooth; when,
however, these signs are wanting, we shall find at any rate that the
whole tooth is painful in the direction of its length, instead of the
pain being localized in the root of the tooth and radiating along the
jaw.

When the cause of the pain resides in the gums the extraction of the
tooth is neither necessary nor beneficial, but is, on the contrary,
always harmful, since, in spite of the loss of the tooth, the cessation
of the pain is not obtained; when the pain is situated in the tooth
itself, the removal of the latter always makes the pain cease; lastly,
when the dental nerve is the seat of the evil, the removal of the tooth
sometimes takes away the pain, at other times it does not.

Among the many anti-odontalgic remedies, Arculanus enumerates pepper
mixed with tar, pepper with asafetida, mustard seeds with asafetida,
and the like. When a tooth is to be cauterized, it is necessary to
protect the healthy teeth with bits of cloth dipped in rose water or
else with some kind of paste. Sometimes it is useful to drill the tooth
with a small trephine so that the cautery may act more deeply, thus
giving better results.

In regard to the filling of decayed teeth, Giovanni of Arcoli says
that, in the choice of the substances to be used, the _complexion_
(constitution) of the teeth must be taken into consideration; and
according as this is cold or warm, it is necessary to perform the
filling with substances which are, by their own nature, warm or cold,
thus acting in opposition to the dyscrasia of the tooth:

“_Eligantur calida aut frigida secundum opportunitatem, in contrarium
dyscrasiæ dentis._”

As to the quality of the complexion, this might be deduced, says the
author, from various signs, among which the color of the gums, these
being red in the warm and humid complexion, yellowish in the warm and
dry, brownish in the cold and dry, and whitish in the cold and humid
complexion. When, however, the complexion does not show any distinct
characteristic, and varies but little from the average, Arculanus
advises the teeth being filled with gold-leaf: “_Ubi non fuerit multus
recessus a mediocritate, impleatur cum foliis auri._”

Although Arculanus is the first writer who alludes to the filling of
teeth with gold, nevertheless it is by no means admissible that he was
himself the inventor of gold filling. His words do not at all sound
to us as the announcement of a new discovery, as the enunciation of a
new fact, in which the author himself had had, at least, a part, be
it great or small. Nothing of all this; the advice as to filling the
teeth, in certain cases, with gold leaf is given quite impersonally,
and is found, as if it were a point of minor importance, at the end
of a long paragraph, which includes various other counsels in regard
to the filling of teeth, one of which is, that this operation should
not be performed with too great violence.[265] In short, the writer
does not show the least intention of putting in evidence the aforesaid
fact, or of giving to it any special importance. We must, therefore,
hold that gold filling had already been in use for a long time among
dentists, and that Arculanus simply mentions what was done by the
dentists of those days. (See note page 164.) It is evident, on the
other hand, that he had no special competence in dental art, when we
consider that he was even ignorant of the exact number of dental roots.
Naturally, the question here arises: At what period did gold begin to
be used for the filling of teeth? But unfortunately history has not,
up to the present, furnished us any evidence which may lead to the
solution of this problem.

For the eradication of a tooth Arculanus gives three very precise
indications: (1) When the pain resists every other means of cure. (2)
When there is any danger of the disease spreading to the neighboring
healthy teeth. (3) When the tooth is troublesome in speaking and in
masticating.

Before extraction, the patient must be prepared for it by bloodletting,
purgatives, and narcotics; and the operation must be commenced by
separating the gums from the tooth.

Arculanus admits, like many of his predecessors, that the eradication
of a tooth may be effected not only by the forceps and other suitable
instruments, but also by other means. One of these would be the use of
the actual cautery, repeatedly applied inside the hollow of the tooth,
if this is decayed; or, in the contrary case, made to act all around
its root (neck). The fall of the tooth might also be obtained with
potential cauteries and especially by the application of boiling oil,
or of a grain of incense heated to the melting point.

It is plain that Giovanni of Arcoli has simply copied these things
from preceding authors, since if he had made a trial of the pretended
eradicating means, he would soon have verified their inefficiency.

Against hemorrhage of the gums, Arculanus recommends arsenic, lime,
gall-nuts, alum, and oil of roses. But, says he, the surest remedy is
the red-hot iron; and still more effectual, cauterization by means of
red-hot gold.

Giovanni of Arcoli’s work is not only noteworthy because it mentions
gold filling for the first time, but also because in it are given the
drawings of three dental instruments, among which the pelican (here
called _pulicanum_). According to Carabelli, the first author who has
mentioned the pelican was the Dutchman Peter Foreest; according to
Geist-Jacobi, instead, it was the German Walter Ryff. But both these
statements are false, because as we have just now said, the pelican
was already named and designed (not very well, it is true) in the book
of the Italian Giovanni of Arcoli, who died in 1484, that is, even
before either Walter Ryff or Peter Foreest came into the world. Neither
does Giovanni of Arcoli say one word that might imply that he was the
inventor of the pelican, and so we are led to believe that in his days
this instrument had already been in use for some time. In the text he
only says: “The teeth are to be extracted with suitable instruments,
whose figures may be seen in the margin.”[266]

We here reproduce the three figures alluded to, with the relative
indications. The first (Fig. 56) represents the pelican; the second
(Fig. 57) is a pair of curved forceps, which seems, in those days,
to have been the instrument most commonly used for the extraction of
teeth, since this figure is accompanied by the very generic indication
“shape of the forceps for extracting teeth;” finally, the third (Fig.
58) represents the forceps used for extracting dental fragments
(roots), and which from the long and straight shape of its jaws, was
called “stork’s bill” (rostrum ciconiæ).

ALESSANDRO BENEDETTI, of Verona, who lived from 1460 to 1525, and
taught medicine at Padua, was, for his times, a man of uncommon
scientific merit; but to the development of the dental art he did not
contribute anything very worthy of note.

He relates that he once abstained from buying a slave simply because
the teeth of the latter were like those of wild beasts, a thing which
he considered as a bad omen.

According to him, toothache is a disease proper to man, no other animal
being liable to it.

To keep free from odontalgia, there is, says he, a very simple means,
which consists in rubbing the teeth once a year with the blood of a
tortoise.

This is the first writer who has noted the harmful effect which mercury
has on the gums and teeth, whether this remedy be used internally or
externally, that is, by friction.

[Illustration: FIG. 56

The pelican as represented in Giovanni d’Arcoli’s work. Forceps pro
extrahendis dentibus pulicanum dicta.]

[Illustration: FIG. 57

Dental forceps (Giovanni d’Arcoli.) Forcipum pro extrahendis dentibus
forma.]

[Illustration: FIG. 58

The forceps called “stork’s bill,” as represented in Giovanni
d’Arcoli’s work. Forceps pro extrahendis fragmentis quod Rostrum
Ciconiæ dicent.]

Benedetti recommends that before proceeding to the extraction of a
tooth an accurate diagnosis should be made, so that it may not happen
that, by mistaking for true odontalgia a pain localized in the gums
or in the jaw, a sound tooth be drawn, under the belief that it is
the cause of the pain; for, this happening, not only would the pain
continue, but there would be, in addition, the loss of a sound tooth,
and also the disadvantage of the neighboring ones becoming less firm,
for want of support.

This author, too, attributes great importance to dental worms,
believing them to be one of the principal and most frequent causes
of odontalgia. To kill them he recommends the usual fumigations and
several other remedies, among which the juice of the leaves of the
centaury or of the peach tree, but especially applications of aqua vitæ.

When it is thought well to have recourse to opium to calm toothache, he
advises this to be used with the utmost prudence; and on this point, he
relates having witnessed a fatal case, in the person of a gentleman of
Padua, by the incautious use of this remedy.

In extraction Benedetti repeats all the precautionary measures
recommended by the ancients, and he, too, advises that recourse should
not be had to this operation, if not as a last remedy, that is, when
every other means of cure has been found useless.[267]

GIOVANNI OF VIGO. The celebrated surgeon Giovanni of Vigo (1460 to
1520), speaking of abscesses of the gums,[268] says that the abscess
must be first brought to maturity by fitting remedies, if it has not
ripened spontaneously, then it must be opened with a lancet, and
lastly, to cleanse the diseased part and to aid cicatrization, honey of
roses or Egyptian ointment must be used. This latter is thus composed
of: “℞—Verdigris, rock alum, _ana_ two ounces; honey of roses, one
ounce; plantain water and pomegranate wine, _ana_ two and one-half
ounces. The whole to be made to boil, and to be stirred with a small
rod, until the mixture is reduced to the consistency of honey.”

For the cure of old fistulas he employs not only the above-mentioned
Egyptian ointment, but also arsenic and corrosive sublimate.

Giovanni of Vigo is very brief in speaking on the treatment of dental
caries, doubtless because he attributed little or no value to the
numerous methods of cure recommended by his predecessors. The treatment
advised by him is, however, very noteworthy. He says that by means of
a drill, file, scalpel, or other suitable instrument, it is necessary
to remove the whole of the putrefied or corroded part of the teeth, and
then, to preserve it, to fill the cavity with gold leaf.

This clear and simple manner of speaking of gold filling as a cure for
caries makes us suppose that Giovanni of Vigo was not at all a stranger
to the practice of dentistry, as we must think of many preceding
writers, but, on the contrary, that he was not less skilled in dental
operations than he was in the other branches of surgery. Again, history
tells us that Giovanni of Vigo was surgeon to the Roman court; so it
would have been strange, indeed, if the Pope, if the haughty prelates,
accustomed as they were to all kinds of refinement and comfort, should
have intrusted the care of their teeth to lowborn barbers and quacks,
whilst they could dispose of the services of so eminent a surgeon.

It may, however, be seen from the very book of Giovanni of Vigo,[269]
that in his days doctors and surgeons were, in general, little skilled
in dental matters. Speaking of the extraction of teeth, he says: “For
this operation there is need of a practised man, and, therefore, many
medical and surgical authorities have expressed an opinion that this
operation should be left to expert barbers and to the itinerant quacks
who operate in public places. He, therefore, who desires to perform
this manual operation in the best manner will derive great advantage
by frequenting men who are expert in performing it and by seeing and
impressing well on his memory their manner of operating.”[270]




PART III.

THIRD PERIOD—MODERN TIMES.




CHAPTER X.

THE SIXTEENTH CENTURY.


We have now arrived at the sixteenth century. The middle ages, that
is, the period of transition between ancient and modern civilization,
has now come to an end. Events of the highest importance, such as the
invention of printing (1436), the taking of Constantinople by the Turks
(1453), with the consequent emigration of many Greek men of letters
and science, who took up their residence in the West and especially
in Italy, and lastly, the discovery of America (1492), marked the
beginning of a new era, and are the most essential factors in bringing
about the revival of art and science.

In the midst of the vigorous intellectual life which characterized the
sixteenth century, dentistry, too, like many other branches of science,
made very notable progress; we, therefore, in this period shall have to
record many important facts and many important names.

It is, indeed, in the sixteenth century, and, to be more precise, about
the year 1544, that we meet for the first time with a monograph, in
which dental affections are spoken of independently of general medicine
and surgery. The book we allude to, by WALTER HERMANN RYFF, is also
noteworthy because it is not written like the preceding works, in
Latin, the customary language of the learned, but, instead, in German,
that is, in a living tongue.

As we are now mentioning the first German author on Dentistry, it may
be permitted us briefly to glance at the beginning of medicine and
dental art among the German peoples.

Among the Germans, as in other nations, the first to practise the
healing art were priests, priestesses, and wise women. To cure disease
they used partly empirical remedies, and partly witchcraft and
superstitious means of every kind. Thus, to facilitate dentition, it
was thought an excellent thing to pass a thread through the eyes of a
mouse and then to tie the blood-covered thread around the neck of the
child. It was held, besides—and this prejudice has left even until now
some traces—that the putting of the milk teeth, when they fall out,
into the nest of a mouse assures the cutting of new teeth.

We must here mention, with regard to the origin of dentistry among the
Germans, a very important fact related by Joseph Linderer,[271] a fact
which shows that even among the ancient Germans recourse was had to the
application of artificial teeth.

We here reproduce the very words of the said author, translated
literally:

“Being by chance a few years ago at Dresden and visiting the Museum
of Antiquities, my attention was attracted, in the last room, to two
osseous pieces, which with other objects were enclosed in a glass case,
with the written inscriptions: _Comb-shaped osseous pieces, found in
ancient German urns._ As soon as I had observed them, I saw at once
that they were artificial teeth; but as I had to be contented with
examining them through the glass of the case, it was not possible for
me to decide whether these pieces were really of bone, as they seemed
to be, or of another substance. Taking into account their antiquity,
their whiteness is very notable. Every piece is composed, if I remember
rightly, of five teeth, that is, of a canine and four incisors; the
chief difference of these pieces from the prosthetic pieces in ivory
still in use (the author is writing in 1848) consists in this, that the
pieces of which I speak have not at all a broad base, designed to rest
on the gums, the base having instead the same thickness as the rest.
The five teeth are well separated from one another. Besides, the canine
makes the proper angle with the incisors, and at each side of the piece
is found, in a convenient place, a hole, which shows that these teeth
were fastened to those of the subject by means of a metallic or other
kind of thread. As the above-described pieces are white, we must infer
that they were removed from the mouth of the respective individuals
before the body was burnt, and afterward put into the urn with the
ashes, just as they used to put in coins, bits of arrows, and the like.”

For many centuries dental surgery—which, however, was still in a very
primitive state—was practised in Germany, as in many other countries,
principally by barbers. These in certain places, and at certain
periods, formed corporate bodies, whose members were legally authorized
to extract teeth and to practise minor surgery in general. But besides
barbers, there were various kinds of individuals, unfurnished with
any authorization—tooth-drawers, charlatans, wandering story-tellers,
necromancers, Jews, and even hangmen—who invaded the field of medical
practice, in spite of its being forbidden them, except in fairs, to
administer medicaments and to perform surgical operations.[272]

In 1460 there appeared in Germany a book on Surgery by Heinrich von
Pfolsprundt, Knight of the Teutonic Order.[273] The author had acquired
great experience as surgeon in the military expeditions of his order,
and we see from his book that he was very skilled in the cure of wounds
and fractures. On the other hand, he shows himself hostile to every
bloody operation with the exception of rhinoplast. Pains of the teeth
and gums were cured by him by means of beverages.[274]

[Illustration: Title page of Zahnarzneybuchlein.]

  [The accompanying reproduction of the title page and
  two text pages from an edition of _Zahnarzneybuchlein_,
  printed by Michael Blum, in Leipzig, 1530, and translated
  below, is of interest in connection with the history of
  the use of gold-foil as a filling material, in that a
  marginal note refers to Mesue as the author from whom the
  three methods of treating caries has been derived, one
  of these methods being the filling of the carious cavity
  with gold-foil.

  Mesue was Surgeon to the Caliph Haroun al Raschid, who
  flourished 786-809. If the reference to Mesue is correct,
  it would, therefore, indicate that the filling of teeth
  with gold was known to the Arabs as early as the latter
  part of the eighth century. Examination of the writings
  of Mesue has thus far failed to bring to light any record
  therein of the treatment of caries by gold filling,
  although in his work previously referred to (see page
  138) the other methods quoted by the anonymous author of
  _Zahnarzneybuchlein_ are fully set forth.

  [Illustration: Latin text.]

  [_Translation._]


  FIFTH CHAPTER.

  ON CARIOUS AND HOLLOW TEETH.

  Corrosion is a disease and defect of the teeth when they
  become carious and hollow, which most often happens in
  the molars, especially if one does not clean them of
  the adhering food which becomes moist and consequently
  produces bad, sharp [acid] moisture that eats and
  corrodes them, always gradually increasing, until it
  spoils the teeth entirely, which afterward must fall away
  in pieces not without pains.

  “_Mesue ut supra capite proprio._” This, as Mesue writes,
  is chiefly cured and removed in three ways. First, by
  purging as treated upon above. Second, by dissolving the
  material which renders them hollow and eats them away;
  also by boiling cockles that grow in barley or wheat, in
  vinegar and holding this in the mouth. In this vinegar
  the root of caper and ginger and other similar remedies
  must have been previously boiled. Third, by removing the
  decay, which is done in two ways. First, by scraping
  and cleaning the hole and the carious part with a fine
  chisel, knife, or file, or other suitable instrument, as
  is well known to practitioners, and then by filling the
  cavity with gold leaves for the preservation of the other
  portion of the tooth. Second, by using suitable medicine,
  such as oak apples or wild galls, with which the tooth is
  filled after having been cleaned.

  [Illustration: German text.]

  The following editions of _Zahnarzneybuchlein_, besides
  the Basle and Mayence editions noted by Dr. Guerini at
  page 166, were issued and copies thereof are preserved
  in the libraries of the several collectors as stated.
  Edition of 1530, printed by Michael Blum, Leipzig, in
  collection of Edward C. Kirk. Edition of 1536, printed
  by Chr. Egenolff, Frankfurt a/M, in collection of
  William H. Trueman. Edition of 1541, printed by Chr.
  Egenolff, Frankfurt a/M, in _Dental Cosmos_ library and
  collection of E. Sauvez. Edition of 1576, printed by Chr.
  Egenolffserben, in collection of H. E. Friesell.—E. C. K.]

The book, therefore, lacks importance from a dental point of view,
except in the sense that it shows how little skilled in the cure of
dental affections were the German surgeons of those days.

It is worthy of note that this author, also, speaks of anesthetic
inhalations; he, however, only translates, almost to a word, what Guy
de Chauliac says on this subject.

Toward the end of the fifteenth century and in the first half of
the sixteenth there were published in German, by anonymous authors,
some short translations and compilations on dental subjects, taken
especially from Greek and Arabian authors.[275] Of these writings, the
first one known, taken from Galen and Abulcasis, was printed at Basle
in 1490; and another—one of the best—saw the light at Mayence in 1532.
These works were perhaps due to intelligent barbers, or perhaps—and
this seems to be the most probable—they were written, through the
initiative of enterprising printers, by doctors and surgeons, who
wished to remain unknown, on account of the special subject treated;
for, owing to the fact that the diseases of the dental system were
generally left in the hands of barbers and other unprofessional
persons, the doctors and surgeons of those days would have been ashamed
to interest themselves in such things.

WALTER HERMANN RYFF, of Strasburg, was born in the beginning of the
sixteenth century, and died about 1570. He was a rather mediocre doctor
and surgeon, and a man of the worst morals, so much so that many cities
expelled him from their midst.[276] He wrote many medical works, in
which, however, there is very little original matter. Their principal
merit consists, perhaps, in the fact that they were written not in
Latin, as then was universally customary, but rather in the vernacular
of the author and in a popular style; so that Ryff may be looked upon
as the first who endeavored to diffuse among the people useful medical
and hygienic knowledge.

Among Ryff’s books there are two which are very important to us. One
is his _Major Surgery_, and the other is a pamphlet entitled _Useful
Instruction on the Way to Keep Healthy, to Strengthen and Reinvigorate
the Eyes and the Sight. With Further Instruction on the Way of Keeping
the Mouth Fresh, the Teeth Clean, and the Gums Firm._[277]

Of these books, there now only exist some extremely rare copies; so
much so that neither Albert von Haller nor Kurt and Wilhelm Sprengel,
who rendered such great services to the history of surgery, ever
had the pleasure of examining them. Dr. Geist-Jacobi has been more
fortunate than they, and has therefore been able to give us some very
interesting information about their contents.

The _Major Surgery_ is a mere compilation which does not contain
anything new of importance. It was published in part in 1545, and in
part in 1572, after the death of the author. The work is illustrated
with very beautiful wood engravings; and it is just this which gives
the principal value to this book. Some of the illustrations contained
in the first part of it—that is, in that published in 1545—represent
dental instruments, notwithstanding dental surgery is not treated in
this part of the book. The author gives notice that he will treat all
that concerns dental affections in the latter part of this book, in a
special chapter. Unfortunately, this chapter was never written, because
death prevented Ryff from completing the second part of his work.

[Illustration: FIG. 59

Pelican and dental forceps (Walter Hermann Ryff).]

The dental instruments represented in his _Major Surgery_ are many
in number. Among them, first of all, are found the fourteen dental
scrapers of Abulcasis, then the “duck-bill”—designed for the extraction
of dental roots and broken teeth—various kinds of pelican (Fig. 59 A),
the “common dental forceps” (Fig. 59 B), the “goat’s foot,” and many
other kinds of elevators, among which, observes Geist-Jacobi, may be
seen instruments even now in use, and even some which are said to have
been recently invented.

Ryff’s other book is especially noteworthy because, as we have
already mentioned, it treats, for the first time, of dental matters,
independently of general medicine and surgery. This pamphlet, printed
at Würzburg about the year 1544, is made up of sixty-one pages, and
is divided into three parts, the first of which is dedicated to the
eyes, the second to the teeth, and the third to the first dentition.
It is written in popular style, and the author certainly intended it
for the instruction of the public, and not for professional men; so
true is this, that in it he does not speak of the technical part of the
extraction of teeth, or of gold filling—a method already known for a
long time—or of dental prosthesis.

The first part, relative to diseases of the eyes and the manner of
curing them, has no importance for us. The second part begins with the
following paragraph:

“The eyes and the teeth have an extraordinary affinity or reciprocal
relation to one another, by which they very easily communicate to each
other their defects and diseases, so that the one cannot be perfectly
healthy without the other being so too.”[278]

This last statement is absolutely false, as a disease of the eyes
may very well exist with a perfect condition of the teeth, and _vice
versa_. However, Ryff has the merit of being, perhaps, the first who
has noted the undeniable relation which exists between the dental and
ocular affections.

After a rapid glance at the anatomy and physiology of the teeth, the
author enumerates the causes of dental disease, which, according to
him, are principally heat, cold, the gathering of humors, and traumatic
actions.

The prophylaxis of dental diseases is beyond any doubt one of the
best parts of the book; however, the ten rules counselled by Ryff
for keeping the teeth healthy—rules which Dr. Geist-Jacobi has made
known to us in full—are reproduced, almost to a word, from Giovanni
d’Arcoli’s work; therefore, the author has no other merit than that
of having translated them into the vulgar tongue, thus diffusing
the knowledge of useful precepts for preventing dental diseases. We
refrain from reproducing the aforesaid rules here, as they are, with
slight variations, identical with those which we gave when speaking of
Arculanus.

Nor can any credit be given to Ryff for the rules which he gives in
regard to the diagnosis of dental pains, as this part of his work is
also taken wholly from the Italian author just mentioned.

After these diagnostic rules Ryff, continuing to translate from the
book of Giovanni d’Arcoli, adds:

“If the pain comes from the gums, extraction is of no use; if it comes
from the tooth, extraction makes it cease; when, lastly, it is in the
nerve, sometimes extraction removes it, and sometimes it does not,
according as the matter obtains or not a free exit.”

The barbers and tooth-drawers, he says, must well remember this rule,
in order to avoid extracting, thoughtlessly and with no benefit, sound
teeth, since then the pain persists in spite of the operation. Also, it
must be borne in mind that, in case of violent pain, it is necessary to
operate as soon as possible, so that the patient may not faint or be
attacked by the falling sickness, if the pain should be communicated to
the heart or brain.

The idea that violent dental pains could give rise to syncope or to
epilepsy (in regard to which we only observe that even very recent
writers enumerate dental caries among the causes of the so-called
reflex epilepsy) is also found in Giovanni d’Arcoli, who expresses
himself in regard to this in the following terms: “Such very violent
pains are sometimes followed by syncope or epilepsy, through injury
communicated to the heart or brain.”[279]

“The most atrocious pain,” says Ryff, “is when an apostema ripens in
the root;” literal translation of words written about a century before
by Arculanus: “Fortissima dolor est, qui provenit ab apostemate, quod
in radice dentis maturatur.”

Likewise taken from Arculanus is the observation (already made,
however, by much more ancient writers) that “when the cheeks swell,
toothache ceases.” Arculanus, however, expresses himself in a less
absolute manner, and therefore more corresponding to the truth, since
he says “the pain generally ceases” (secundum plurimum dolor sedatur).

Even in regard to the therapeutics of dental pains, Ryff does not tell
us anything new. Dr. Geist-Jacobi gives this author the merit of having
made, in regard to the cure of dental pains, a distinction between
_cura mendosa_ (that is, imperfect, palliative, tending simply to calm
the pain) and _cura vera_ (that is, directed against the causes of
the disease). But this very important distinction is also taken from
Arculanus, who in his turn took it from Mesue. In fact, after having
spoken of the general rules relative to the cure of dental diseases,
Giovanni of Arcoli adds: “As to the particular therapy, it is divided
into _cura mendosa_ and _cura vera_, as may be found in Mesue. And the
_cura mendosa_ is so called because it calms the pain by abolishing
sensibility, not by taking away the cause of it. Such is, for the sake
of example, the cure, consisting in fumigations of henbane, made to
reach the diseased tooth by means of a small tube, adapted to a funnel.”

The third part of Ryff’s pamphlet has as its title:

“How the pains of the gums should be calmed or mitigated in suckling
infants, so as to promote the cutting of the teeth without pain.”

This part, as Geist-Jacobi informs us, is very brief, not taking up
more than a page and one-half of print. Neither does it contain
anything of importance. To render the cutting of teeth easier, Ryff
advises that infants should have little wax candles given to them to
chew and the gums anointed with butter, duck’s fat, hare’s brains, and
the like. The tooth of a wolf may be hung around the neck of the child,
so that it may gnaw at it. It is also recommended that the head of the
child should be bathed with an infusion of chamomile.

From what has been said, one may see very clearly that the aforesaid
book is, from the scientific point of view, entirely valueless,
because the best part of it is merely copied from the work of Giovanni
d’Arcoli. However, the author has the indisputable merit of having
endeavored to diffuse the knowledge of useful precepts of dental
hygiene. His book, besides, we repeat, has great historical value, for
from it dates the beginning of odontologic literature, properly so
called.

On this point we believe it is necessary to correct an error into which
Dr. Geist-Jacobi has fallen. At the beginning of his very valuable
article on Walter Hermann Ryff[280] he says: “In the fifth century of
the Christian era, the iatrosophist Adamantius of Alexandria published
an exclusively odontalgic work, of which, however, we only know the
title.” The same he repeats in his _History of Dental Art_ (pp. 55 and
56), without, however, giving us any proof of his statement. “Of the
odontologic treatise of Adamantius,” he says, “unfortunately the title
alone is known to us, and even that has reached us indirectly, that is,
by means of Ætius; it is of the following tenor.”

Now, whoever takes the trouble to translate these Greek words will
easily perceive that they do not constitute one title, but two distinct
ones (which even Dr. Geist-Jacobi has had to unite by the conjunction
_and_). These, however, are nothing more than the titles of two
chapters of the _Tetrabiblos_ of Ætius, as anyone may see for himself
by turning over the pages of this work either in the Greek original, or
in the beautiful Latin translation of Giano Cornario (Venice, 1553).
In this great composition of Ætius dental diseases are treated of in
Chapters XXVII to XXXV of Sermo IV, Tetrabiblos II; and the two Greek
titles above referred to are the titles of Chapters XXVII and XXXI.

In the translation of Giano Cornario they read as follows:

_Cura dentium a calido morbo doloroso affectorum, ex Adamantio
sophista_ (cure of teeth affected by warm, painful disease, according
to Adamantius the sophist).

_Cura dentium a siccitate dolore affectorum, ex Adamantio sophista_
(cure of teeth affected by pain from dryness, according to Adamantius
the sophist).

The work of Adamantius, from which Ætius took the contents of the
chapters thus entitled, is lost to us, but we have no reason, and not
even the least indication, for supposing that this work was a treatise
on dental diseases, and not one on general medicine. It is absurd to
consider the above-mentioned titles as belonging to an odontological
monograph, on the one hand, because, admitting for a moment the
existence of such a work, it should have had but one title and not two,
and on the other hand, because it is by no means to be supposed that a
great and wise physician, such as Adamantius undoubtedly was, should
have had the whim to write a book, not on dental disease or on dental
pains in general, but only and exclusively on dental pains caused by
heat or by dryness. What reason would there have been for not extending
the treatment of the subject to those cases of odontalgia resulting
from humidity or from cold, that is, from causes as common and,
according to the ideas of that time, very frequently associated with
one of the first two (as humidity with heat, and cold with dryness)?

Besides, if the titles of the two chapters spoken of be compared with
those of the others, in which Ætius treats of dental affections, such
analogy will be noticed between the various titles as to make us
consider that they have been formulated by Ætius himself, even when the
contents of these chapters are taken from other writers. So that the
two aforesaid titles not only do not belong to any dental work, but
probably they have never existed, even as simple titles of chapters,
in the medical book of Adamantius, from which the contents of the two
chapters of Ætius above mentioned have been taken.

In order that every one may easily be convinced that the two titles
made so conspicuous by Dr. Geist-Jacobi have nothing particular about
them, but are, instead, perfectly analogous to the titles of various
other chapters of Ætius, we give here the translation of the titles
of five chapters, all concerning dental maladies, that is, the two
chapters in discussion and other three:

Chapter XXVII: Cure of teeth affected by warm, painful disease,
according to Adamantius the sophist.

Chapter XXIX: Cure of teeth affected with pain from humidity.

Chapter XXXI: Cure of teeth affected by pain from dryness, according to
Adamantius the sophist.

Chapter XXXII: Cure of teeth affected by pain from heat and humidity.

Chapter XXXIII: Cure of decayed teeth, according to Galen.

It appears very clear, therefore, from the great analogy existing
between the headings of all the above-mentioned chapters, that the
titles referred to by Geist-Jacobi have not at all the historical
importance and significance that he attributes to them, and that the
same have been formulated by Ætius himself. To argue from such titles
that Adamantius was the author of a book on dentistry is not only
inadmissible, for all the reasons already given, but also because
if it were allowable to reason with such lightness, it might also
be stated—by arguing from the title of Chapter XXXIII—that Galen
was the author of a monograph on the treatment of dental caries; a
thing which is absolutely untrue. Consequently, the beginning of
odontologic literature cannot be traced back to Adamantius, but, as Dr.
Geist-Jacobi would have it, to an author much less ancient, that is,
to Walter Hermann Ryff, or, if it is preferred, even to the anonymous
writers of the odontologic compilations which appeared in Germany at
the end of the fifteenth century.

ANDREAS VESALIUS. We must now speak of Andreas Vesalius, an
extraordinary man, who by his genius infused new life into medical
science, and who, although he gave but little attention to dental
matters, yet fully deserves a place of honor in the history of
dentistry; for this, like every other branch of medicine, received
great advantage from his reforming work, which broke down forever the
authority of Galen, thus freeing the minds of medical men from an
enslavement which made every real progress impossible.

Andreas Vesalius was born at Brussels, December 31, 1514. He studied
at Louvain and then at Paris, where at that time great scientists
taught, and among others the celebrated anatomist Jacques Dubois,
generally known by the Latinized name of Sylvius.[281] The latter, a
great admirer of Galen, whose anatomical writings served as texts for
his lectures, became jealous of the young Belgian student, who was
his assistant, and who gave undoubted proofs of great genius, and of
extraordinary passion in anatomical research. Vesalius often defied the
greatest dangers in order to obtain corpses either from the cemetery
of the Innocents or from the scaffold at Montfaucon. He soon surpassed
his most illustrious masters, and at only twenty-five years of age
published splendid anatomical plates, which astonished the learned. He
acquired also great renown as surgeon, and in this capacity he followed
the army of Charles V in one of his wars against France. After having
been professor of anatomy in the celebrated University of Louvain
(Belgium), he was invited by the Venetian Republic to teach in the
University of Padua, which, through him, became the first anatomical
school in Europe. Yielding to the requests of the magistrates of
Bologna and Pisa, he also taught in those famous universities, before
immense audiences.

[Illustration: Andreas Vesalius.]

Before Vesalius, Galen’s anatomy had served as the constant basis
for the teaching of this science. Although even from the end of the
fifteenth century dead bodies were dissected in all the principal
universities, the teachers of anatomy always conformed, in their
descriptions, to those of Galen, so that the authority of this master,
held infallible, prevailed even over the reality of facts.

Vesalius, for the first time, dared to unveil and clearly put in
evidence the errors of Galen; but this made him many enemies among the
blind followers and worshippers of that demigod of medicine. Europe
resounded with the invectives that were bestowed upon Vesalius. Among
others, there rose against him Eustachio at Rome, Dryander at Marburg,
Sylvius at Paris, and this last did not spare any calumny that might
degrade his old pupil, who had become so celebrated. In spite of this,
the fame of Vesalius kept on growing more and more, so much so that
Charles V called him to Madrid, to the post of chief physician of his
Court, a place which he kept under Philip II, also after the abdication
of Charles V. The good fortune of Vesalius, unhappily, was not to be of
long duration. In 1564 a Spanish gentleman died, in spite of the care
bestowed upon him by Vesalius, and the illustrious scientist requested
from the family, and with difficulty obtained, the permission to
dissect the body. At the moment in which the thoracic cavity was opened
the heart was seen, or thought to be seen, beating. The matter reached
the ears of the relations of the deceased, and they accused Vesalius,
before the Inquisition, of murder and sacrilege; and he certainly would
not have escaped death except by the intervention of Philip II, who, to
save him, desired that he should go on a pilgrimage to the Holy Land,
as an expiation. On his return, the ship which carried Vesalius was
wrecked, and he was cast on a desert beach of the Isle of Zante, where,
according to the testimony of a Venetian traveller, he died of hunger,
October 15, 1564.

Vesalius left to the world an immortal monument, his splendid treatise
on Anatomy,[282] published by him when only twenty-eight years of age,
and of which, from 1543 to 1725, not less than fifteen editions were
issued. The appearance of this work marked the commencement of a new
era. The struggle between the supporters of Galen and those of Vesalius
rendered necessary, on both sides, active research concerning the
structure of the human body, so that anatomy, the principal basis of
scientific medicine, gradually became more and more perfect, and, as
a consequence of this, as well as of the importance which the direct
observation of facts acquired over the authority of the ancients,
there began in all branches of medicine a continual, ever-increasing
progress, which gave and still gives splendid results, such as would
have been impossible under the dominion of Galenic dogmatism.

In the great work of Vesalius the anatomy of the teeth is unfortunately
treated with much less accuracy than that of the other parts of the
body. However, his description of the dental apparatus[283] is far
more exact than that of Galen, and represents real progress. The number
of the roots of the molar teeth (large and small) is indicated by Galen
in a very vague and inexact manner, since he says that the ten upper
molars have generally three, sometimes four roots, and that the lower
ones have generally two, and rarely three. Vesalius, having examined
the teeth and the number of their roots in a great number of skulls,
was able to be much more precise. In regard to roots, he makes, for the
first time, a very clear distinction between the premolars next to the
canine (small molars) and the other three, and says that the former
in the upper jaw usually have two roots, and in the lower, one only,
whilst the last three upper molars usually have three roots and the
lower ones two. As everyone sees, these indications are, in the main,
exact.

Other important facts established by Vesalius are as follows:

The canines are, of all the teeth, those which have the longest roots.
The middle upper incisors are larger and broader than the lateral
ones, and their roots are longer. The roots of the last molars are
smaller than those of the two preceding molars. In the penultimate
and antepenultimate molars, more often than in the other teeth, it
sometimes happens that a greater number of roots than usual are found,
it being not very rare to meet with upper molars with four roots, and
lower ones with three. The molars are not always five in each half jaw;
sometimes there are only four, either on each side, or on one side
only, in only one jaw or in both. Such differences generally depend
on the last molar, which does not always appear externally, remaining
sometimes completely hidden in the maxillary bone, or only just
piercing with some of its cusps the thin plate of bone which covers it;
a thing which Vesalius could observe in many skulls in the cemeteries.

In regard to the last molar, the author speaks of its tardy eruption
and of the violent pains which not unfrequently accompany it. The
doctors, he adds, not recognizing the cause of the pain, to make it
cease have recourse to the extraction of teeth, or else, attributing it
to some defects of the humors, overwhelm the sufferer with pills and
other internal remedies, whereas the best remedy would have been the
scarification of the gums in the region of the last molar and sometimes
the piercing of the osseous plate which covers it.

This curative method, of which no one can fail to recognize the
importance, was experimented by Vesalius on himself, in his
twenty-sixth year, precisely at the time that he had just begun to
write his great treatise on anatomy.

The existence of the central chamber of the teeth appears to have been
unknown to Galen, as he does not allude to it in the least. Vesalius
was the first to put this most important anatomical fact in evidence.
He expresses an opinion that the central cavity facilitates the
nutrition of the tooth. He says, besides, that when a hole is produced
in a tooth by reason of acrid corrosive humors, the corrosion, when
once the internal cavity is reached, spreads rapidly and deeply in the
tooth, owing to the existence of the said cavity, and sometimes reaches
even the end of the root.

In the chapter in which Vesalius treats of the anatomy of the teeth
(Chapter XI, p. 40), two very well-drawn figures are found, one of
which represents a section of a lower molar, showing the pulp cavity
and its prolongation into the two root canals. The other represents the
upper and lower teeth of the right side, in their reciprocal positions,
and shows very clearly their general shape, the length of their roots,
and the number of these.

The changes which take place in the alveolus, after the extraction of
a tooth have not escaped the notice of Vesalius. He says that after
an extraction the walls of the alveolus approach one another, and the
cavity is gradually obliterated.

Aristotle had affirmed that men have a greater number of teeth than
women. Vesalius declares this opinion absolutely false—although, after
Aristotle, it has been repeated by many other ancient writers—and says
that anyone can convince himself that the assertion of Aristotle is
contrary to the truth, as it is possible for everybody to count his own
teeth.

In spite of this, we find the above-mentioned error even in writers
subsequent to Vesalius; for example, in Heurnius (professor at Leyden
toward the end of the sixteenth century), who expresses an opinion that
rarely do women have thirty-two teeth, like men.

We find but little in Vesalius concerning the development of the teeth.
He, indeed, made some observations and researches on this point, but
these, from their insufficiency, led him to quite mistaken conclusions.
The teeth of children, he says, have imperfect, soft, and, as it were,
medullary roots; and the part of the tooth which appears above the gums
is united to the root, so to say, as a mere appendix, after the fall of
which there grows from the root the permanent tooth. This error arose
in the mind of Vesalius from observing that when children lose their
milk teeth, these have the appearance of a kind of stump, as if the
root had actually remained in the socket. Besides this, he had observed
with what facility the milk teeth fall out; and he here calls to mind
that, when about seven years old, he himself and his companions used to
pluck out their loosened teeth, and especially the incisors, with their
fingers, or with a thread tied around the tooth. The softness of the
dental roots in children, the easy fall of the milk teeth, and the want
of the lower part of the roots in these, must have raised the idea
in his mind that the roots of the milk teeth remained in the socket,
and that the upper part of the temporary teeth, instead of being a
continuation of the root, was joined to this as a simple appendix, and
in a very weak way, as though designed to remain in place for a limited
length of time only.

In Vesalius[284] is found a dental terminology—Latin, Greek, Hebrew,
and Arabic—which affords some interest. The incisors are called in
Latin _incisorii_, _risorii_, _quaterni_, _quadrupli_; and the two
middle incisors have been denominated by some authors _duales_. The
canines are called in Greek kynodontes, which means the same as the
Latin _canini_, dog’s teeth. In Latin they have been also denominated
_mordentes_, and by some also _risorii_, a name which by others is
given to the incisors, as we have already seen. The molars have
also been called in Latin _maxillares_, _paxillares_, _mensales_,
_genuini_.[285] But some authors give this last name only to the last
molars, or wisdom teeth, _dentes sensus et sapientiæ et intellectus_.
These teeth have also been called _serotini_ (that is, tardy), _ætatem
complentes_ (that is, completing the age, the growth), and also, in
barbaric Latin, _cayseles_ or _caysales_, _negugidi_, etc.

In the rebellion against the authority of the ancients, Vesalius had
a predecessor whose name, deservedly famous, may be recorded here.
PARACELSUS (born in 1493 at Maria-Einsiedeln, Switzerland), on being
nominated, in 1527, Professor of Medicine and Surgery at Basle,
inaugurated his lectures by burning in the presence of his audience,
who were stunned by such temerity, the writings of Galen and Avicenna,
just as Luther, seven years before, had burnt in the public square of
Wittenberg the papal bulls and decretals. The sixteenth century, in its
exuberance of intellectual life, was undoubtedly one of the grandest
centuries in history; human thought in that glorious epoch shattered
its chains, and declared its freedom both in matters of science and of
religion.

Paracelsus, a man of powerful genius, but not well balanced in mind, of
corrupt morals, and of an unlimited pride, had, notwithstanding these
undeniable defects, the merit of beginning a healthy reform in the
science and practice of medicine, by substituting the study of nature
for the authority of the ancients and by giving a great importance to
chemistry, both for the explanation of organic phenomena and for the
cure of disease.

It is to be lamented that this man of genius did not contribute in any
way to the progress of dentistry. His works have no importance for
us. As a matter of mere curiosity we only record here that Paracelsus
considered the too precocious development of the teeth as a great
anomaly, and regarded as monsters those children who were born with
teeth.[286]

[Illustration: Paracelcus.]

[Illustration: Gian Filippo Ingrassia.]

[Illustration: Gabriel Fallopius.]

GIAN FILIPPO INGRASSIA (1510 to 1580), a distinguished Sicilian
anatomist, was one of the first who spoke of the dental germ. He says
that the existence of the tooth properly so called is preceded by that
of a soft dental substance enclosed in the bone, and which he considers
almost as a secretion of the latter.

MATTEO REALDO COLOMBO, of Cremona, a pupil of Vesalius and his
successor in the professorship of Anatomy at Padua, added but little,
as regards the teeth, to what his master has taught. He combated the
erroneous idea that the teeth were formed in the alveoli shortly before
their eruption. Having dissected the jaws of many fetuses, and having
always observed in them the existence of teeth, he could affirm with
every certainty that the teeth begin to be formed in intra-uterine life.

Like Vesalius, Realdo Colombo believed that the permanent teeth were
developed from the roots of the milk teeth; and, therefore, he advised
the utmost caution in extracting these, since, if the whole root were
removed, the tooth would not grow again.[287]

GABRIEL FALLOPIUS (1523 to 1562), the eminent anatomist of Modena, also
a disciple of Vesalius, carried out accurate and successful researches
in regard to the development of the teeth, and made them known in his
book, _Observationes anatomicæ_, published at Venice in 1562, the year
in which he died.

His investigations enabled him to show the falsity of the opinion held
by Vesalius, that the permanent teeth are developed from the roots of
the temporary ones. He was, besides, the first who spoke in clear terms
of the dental follicle.

The teeth, says Fallopius,[288] are generated twice over, that is,
the first time in the uterus, after the formation of the jaws, and
the second time in extra-uterine life, before the seventh year. The
first teeth are, at the time of birth, still imperfect, without roots,
completely enclosed in their alveoli, and formed of two different
substances; the part with which they must break their way out is
osseous and hollowed; the deeper part, instead, is soft and humid
and is seen covered with a thin pellicle, a thing which may also be
observed in the feathers of birds when they are still tender. In
fact, the part of the feather which comes out of the skin is hard and
corneous, whilst the part which is embedded in the wings is soft and
humid and has the appearance of coagulated blood or mucus. So also in
the fetal teeth, the part corresponding to the future root presents
itself like coagulated mucus. Little by little this soft substance
hardens and becomes osseous, thus constituting the root of the tooth.

Fallopius’ reference to the analogy between the development of teeth
and that of feathers was highly important, as a point of departure
for embryological researches which showed clearly the real nature of
teeth, thus destroying the mistaken idea—held by Galen and many other
authors—that these organs were bones.

On coming to speak of the teeth generated in extra-uterine life, that
is of the permanent teeth, Fallopius relates having observed that
they have their origin in the following manner: A membranous follicle
is formed inside the bone furnished with two apices, one posterior
(that is to say, deeper down, more distant from the surface of the
gums), to which is joined a small nerve, a small artery, and a small
vein (_cui nervulus, et arteriola, et venula applicantur_); the other
anterior (that is more superficial), which terminates in a filament
or small string, like a tail. This string reaches right to the gum,
passing through a very narrow aperture in the bone, by the side of the
tooth which is to be substituted by the new one. Inside the follicle
is formed a special white and tenacious substance, and from this the
tooth itself, which at first is osseous only in the part nearest the
surface, whilst the deeper part is still soft, that is, formed of the
above-mentioned substance. Each tooth comes out traversing and widening
the narrow aperture through which the “tail” of the follicle passes.
The latter breaks, and the tooth comes out of the gum, bare and hard;
and in process of time the formation of its deeper part is completed.

The author says that his long and laborious researches into the
development of the teeth were carried out with great accuracy, and
he is, therefore, in a position to give as absolute certainties the
facts exposed by him. Indeed, the observations of Fallopius were, for
the most part, confirmed by subsequent research. As to the “tail”
of the dental follicle, it is identical with the _iter dentis_ or
_gubernaculum dentis_ of some authors. Fallopius described it as a
simple string, but later on this prolongation of the dental follicle
has been considered, at least by some, as the narrowest part or neck
of the follicle itself, that is, as a channel through which the tooth
passes, widening it, on its way out, and precisely for this reason it
has been called _iter dentis_ (the way of the tooth) or _gubernaculum
dentis_ (helm or guide of the tooth).

BARTHOLOMEUS EUSTACHIUS, another great anatomist of the sixteenth
century, occupied himself in the study of teeth with special interest,
and wrote a very valuable monograph on this subject. He was a native
of San Severino, Marche (Italy), and a contemporary of Vesalius,
Ingrassia, Realdo Colombo, and Fallopius; he died in 1574, after having
immortalized his name through many anatomical discoveries and writings
of the highest value.

[Illustration: Bartholomeus Eustachius]

His book on the teeth, _Libellus de dentibus_, published at Venice in
1563, is the first treatise ever written on the anatomy of teeth,
and represents a noteworthy progress in this branch of study.

In this little book—divided into thirty chapters, forming in all
ninety-five pages—the author treats with great accuracy and in an
admirable manner all that concerns the anatomy, physiology, and
development of the teeth.

Eustachius not only treasured up what ancient authors had written on
this subject, but he himself made very long and patient researches and
observations on men and animals, on living individuals as well as on
corpses, and not only on adult subjects, but also on children of every
age, on stillborn children and on abortive fetuses.

The macroscopic anatomy of the teeth was brought by him to a high
degree of perfection. Very wonderful, among other things, is the
accuracy with which he studied and specified in several synoptical
tables the number of the roots of molar teeth, and all the variations
occurring not only in their number, but also in their form, length, etc.

In Chapter IV, speaking of the means by which teeth are held in their
sockets, Eustachius mentions in quite explicit terms the ligaments of
the teeth. He begins by saying that the perfect correspondence between
the dental roots and the alveoli, both in shape and in size, is one of
the elements which contribute to the firmness of the teeth, since the
alveolus, being exactly applied, on all sides, to the root or roots
of the tooth, causes the latter, by this simple fact, to be fixed in
a determined position. Also, the nerves inserted in each single tooth
contribute, as was already the opinion of Galen, to the stability of
these organs. “There exist besides”—Eustachius continues—“very strong
ligaments, principally attached to the roots, by which these latter
are tightly connected with the alveoli” (_adsunt præterea vincula
fortissima radicibus præcipue adherentia, quibus præsepiolis arctissime
colligantur_). Lastly, says the author, the gums, too, embracing the
teeth at their exit from the alveoli, contribute to their firmness.
And here Eustachius notes that in the joining of the gums to the teeth
there is great analogy to that of the skin with the finger nails;
a very proper observation, which makes us almost suppose that the
perspicacious mind of Eustachius may have guessed the kindred nature of
nails and teeth.

In Chapter XV are related the researches made by the author to
ascertain at what period the development of the teeth begins. Here is a
passage of this chapter, almost literally translated:

“Hippocrates, before anyone else, wrote that the first teeth are
formed in the uterus. Wishing to assure myself thereof, I dissected
many abortive fetuses, and by very careful observations I found it to
be true that the teeth have their origin during intra-uterine life.
Wherefore, the opinion of those who consider that the first teeth are
formed from the milk, and those of the second dentition from food
and drink, must be declared entirely false. In fact, by opening both
jaws of a stillborn fetus, one may find, on each side of each jaw,
the incisors, the canine, and three molars, partly mucous and partly
osseous, and already sufficiently large and entirely surrounded by
their alveoli. Then removing, with a skilful hand, the incisors and
the canines, there may be observed a very thin partition only just
ossified; and if this be removed with equal care, an equal number of
incisors and canines, almost mucous and very much smaller, appear,
which, enclosed in special alveoli behind the first, would exactly
correspond in position each with its congener, if in both jaws the
canine were not resting for the greater part on the next incisor so as
almost to hide it.”

As to the molars (by which name also the bicuspids are here meant),
Eustachius says that he found but three on each side, and no trace
whatever of the others. Nevertheless, he considers it quite probable
that the germs of the latter should also exist in the fetus, although
so small as to escape observation. He gives many ingenious reasons in
support of his mode of thinking, and comes to the general conclusion,
that not only the temporary teeth but also the permanent ones have,
all of them, their origin during fetal life; a false conclusion simply
because too general, and which shows once more how, in biological
science, one runs great risk of falling into error whenever one tries
to draw too free deductions from observed phenomena.

The researches of Fallopius and Eustachius confirm and complete each
other. These two eminent anatomists, who gave great glory to Italy
by their immortal discoveries and works, were the first to shed a
brilliant light upon the development of the teeth, and thus opened up
the way to all subsequent research on odontogeny.

In settling the period in which the formation of the teeth begins,
Fallopius was still more successful than Eustachius. His patient
investigations showed him that the development of the teeth commences
partly in the uterus and partly after birth, which is perfectly true,
as was made clear by later embryological researches. Fallopius found in
each fetal jaw twelve teeth.[289] In this he agrees perfectly with his
contemporary, Eustachius, who, as we have seen a short while ago, found
in fetusus, only just born, the incisors, the canines, and three molars
for each side of each jaw. Eustachius, however, observed in the fetus
the germs of the permanent incisors and canines as well, a thing not
noted by Fallopius.

It is not to be wondered at that some discrepancy should exist between
the observations of these two eminent anatomists. The researches of
which we are speaking are sufficiently delicate and difficult; and
even much more recent authors are far from agreeing perfectly, as far
as regards the period, in which the development of the teeth begins.
Serres, in his _Essai sur l’anatomie et la physiologie des dents_
(Paris, 1817), sustains the view that in the fetus he has observed the
germs of all the teeth, both temporary and permanent, while Joseph
Linderer (_Handbuch der Zahnheilkunde_, Berlin, 1842) says that,
although he has followed the preparative method indicated by Serres, he
could never discover in the fetus the germs of all the teeth. Perhaps,
he adds, the time when the development of the teeth begins varies
considerably in individuals, just as we remark differences in the time
of eruption.

In Chapter XVII of his book, Eustachius speaks of the process of
formation of the teeth, which he studied in abortive fetuses, in
stillborn children, in children a few months old, and also in kids.

On dissecting a fetal jaw, there may be found on each side, as we
have already seen, the incisors, the canines, and three molars, still
soft and imperfect, separated from one another by very thin osseous
partitions. Each of these teeth is enclosed within a follicle or little
bag of a grayish white color, rather more mucous and glutinous than
membranous, and in form somewhat like the pod of a vegetable, with the
only difference that it shows an opening at one of the extremities,
from which the tooth somewhat protrudes, as if it were germinating. The
more recent and softer the tooth, the more its follicle has a mucous
appearance and differs from the nature of membranes. As it does not
adhere to the underlying tooth, it is easy to separate them. As to
the tooth, it is at that period of its development partly osseous and
partly mucous, since that part which later on projects from the gum
soon becomes transformed into a white thin and concave scale, which
gives the idea of one of the little cells of a honeycomb. This scale
is harder and more conspicuous in the incisors, since these, at this
stage, are better formed; the canines are less advanced in development,
and the molars still less; and among these latter, those are less
developed which are more distant from the canines. The deeper part
of the tooth consists of a mucous and tenacious substance, harder,
however, than the substance of the follicle, and of a whitish color
with a tendency to dark red, translucent, and somewhat brilliant.

Thus, says Eustachius, the teeth present themselves in a human fetus;
but he who cannot obtain a human fetus may observe the same things in a
kid.

Although the author does not express himself very explicitly, he seems
to consider the follicle of the tooth substantially identical with
its ligament. “This is at first mucous, but afterward, becoming more
consistent, causes the tooth to adhere to the socket and gum very
firmly, as if it were glued.”

“As the part of the tooth which comes out of the gum projects from
the aperture of the follicle like a gem from its bezel, so—says
Eustachius—some believe that the crown of a temporary tooth is a mere
appendix, and that the follicle comes out of its concavity through
a dividing line which they imagine to exist between this supposed
appendix and the remaining part of the tooth. But assuredly those who
assert such things show that they have studied the anatomy of the teeth
so carelessly that, by this one error, they make manifest their great
ignorance together with their great temerity.[290] The line which is
observed on the tooth on the part corresponding to the adhesion of the
gingival margin and of the dental ligament is very superficial, and
after having scraped it away, there does not remain any trace of a
division. But apart from this everyone can very easily observe, even in
infants, or in kids, that the tooth when ossified does not present any
line of division and that the still mucous follicle envelops it freely,
and may be easily separated from the tooth; which would not be the
case, if the follicle issued from between the tooth and its supposed
appendix.”

Thus, Eustachius declares entirely false the opinion already expressed
by Celsus, that the permanent tooth grows from the root of the milk
tooth. He affirms clearly and decisively that between the external and
the radical part of a milk tooth no real division exists, and that
the ossification of the tooth, beginning from the crown, proceeds
without any interruption right down to the end of the root. If it
were true, says he, that in children only the imaginary epiphysis or
appendix falls, and that the new tooth is substantially represented
by the remaining part of the first, it could never happen, as instead
it often does, that the new tooth appears before the first one falls.
Besides, between the lower part of the first tooth and the upper part
of the second no correspondence exists either in size or shape, as
ought necessarily to be the case if the two parts were joined together.
This is not all; the lower part of the temporary tooth is perforated,
and receives in its interior bloodvessels and nerves, whilst the upper
part of the permanent tooth is quite massive and imperforated. How,
then, could this second tooth transmit bloodvessels and nerves into
the cavity of the first? Again, how could the continuity of these
bloodvessels and nerves with their respective branches be possible, if
an imperforate body, such as the crown of the permanent tooth, were
really interposed?

But what is the use of so many arguments? exclaimed Eustachius. To
remove even the slightest doubt and to put an end to any controversy
on such a point, only one fact is sufficient, which is revealed to us
by anatomical dissection, and that is, that the teeth which appear
about the seventh year are not only not united to those which fall at
the same period, but cannot even be in contact with them, owing to the
presence of a thin osseous partition.

In the following chapter[291] Eustachius speaks of the central cavity
of the teeth and of the substance contained in it. In young teeth,
he says, the dental cavity is very large, in proportion to the size
of the tooth. According to some anatomists, the central cavity of a
tooth is coated by a very soft and thin membrane, formed by a tissue
of very small vessels and nerves; and besides, this cavity is filled
with marrow, like hollow bones. The observations of the author,
however, do not agree with these statements. The dental cavity does
not contain any fatty substance analogous to the marrow of bones. As
to the above-mentioned membrane, Eustachius doubts its existence. The
large hollow existing in children’s teeth contains, he says, a mucous
substance, somewhat hard, and very smooth at its surface—almost like
a cuticle—but which has rather the appearance of a concretion than of
a membranous tissue. At any rate, adds Eustachius, if the substance
alluded to is made to dry up in the shade, it acquires an appearance
not unlike that of a membrane. It is certain, however, that at an early
age the substance contained in the dental cavity does not adhere to
the walls of the latter after the manner of a periosteum, but is found
in simple contact with the same, and can, therefore, be separated from
them with the greatest ease.

As years pass by, the dental cavity becomes narrower and narrower,
because the substance contained inside the tooth gradually becomes
ossified at the surface, adhering to the dental scale previously
formed, in the very same manner as the internal or woody part of a tree
adheres to the bark. Of the two hard substances which make up a tooth,
the outer one is white, tense, and dense, like marble, the underlying
one, instead, is somewhat dark, rough, and less compact. To observe
accurately the above-mentioned facts, the author advises searching for
them, first, in the molar teeth of the ox or the ram, and then in human
teeth, and likewise, first in children or in recently born animals, and
then in adults.

Chapters XIX and XX are, comparatively speaking, of little importance.
In the former the author undertakes especially to examine the opinions
of Galen on dental bloodvessels and nerves, and discusses whether
it were known to him that these vessels and nerves penetrate into
the internal part of the teeth. In the latter, Eustachius speaks of
the great difficulties that are encountered in dissecting dental
bloodvessels and nerves, and reproves those who, by inaccurate
illustrative figures, convey the erroneous idea that these parts are
very clearly and easily observable.

In Chapter XXI the author goes on to speak of the best mode of
proceeding in order to make successful observation of the small nerves
and vessels going to the roots of the teeth. These researches are much
more easily made in large animals than in man; and therefore such
things as cannot be observed well in the latter must be studied in the
former.

In the first place, it is necessary to dissect the lower jaw; and
after having done so several times, with all the accuracy required in
making researches of this kind, one may proceed to study the dental
nerves and vessels of the upper jaw, which is much more difficult.
Having opened up the inside of the lower jaw, one observes a cavity
full of marrow, and within this a nerve enclosed entirely in its own
sheath. Having removed the marrow, and opened the sheath lengthwise,
one perceives that the nerve therein enclosed is constituted (analogous
to what may be observed in the large nerves of the limbs) by several
nervous strings, and that among these runs a comparatively large
artery, besides small vascular branches of minor importance. If one
then removes the sheath from the bone, together with the nerve and the
vessels contained in it, raising it very gently, one sees, issuing
therefrom, some very slender fibers, on the nature of which it is,
however, difficult to pronounce; and, considering their thinness, one
can hardly conceive that they are composed of three different elements,
that is, of small nervous, arterial, and venous twigs. At any rate,
the author admits that this may be so. On arriving at the lesser
teeth, the nerve and the artery that accompanies it divide into two
branches, one of which traverses the opening presented by the bone at
that point (_mental foramen_), and is destined to the lower lip; the
other directs its course toward the roots of the incisors. The small
twigs which penetrate into the roots of the incisor and canine teeth
are less slender than those which enter the roots of the molars, and
are easily to be seen not only in large animals, but also in man. If
the tooth of an ox or that of a ram be split through the middle, the
mucous substance contained in the interior is seen to be traversed
by small bloodvessels; and one perceives, besides, certain fibers,
which are probably nerves. All these things, says Eustachius, I have
observed many times in different animals, in some cases more, in others
less distinctly. But it is an exceedingly difficult thing to follow
the single twigs, of which we have spoken, from their origin to their
insertion, or, _vice versa_, from their insertion to their origin. And
so, adds the great anatomist, being able to observe but a small part
of the things I should like to see, I find myself compelled, in my
perplexity, to supply by the aid of ratiocination the deficiency of
the senses. I therefore maintain that the interior part of a tooth is
susceptible of experiencing pain accompanied by a feeling of pulsation
(a fact already mentioned by Galen), because a nerve and an artery
penetrate into it. In the ox the penetration of bloodvessels into the
roots of the teeth can be more readily ascertained than in man. It may
be admitted that the same occurs in the human teeth; and this, for the
reasons already given, and also because only by admitting the existence
of an artery within the cavity of the tooth can be explained the
copious flow of florid red blood from a decayed tooth, which has, in
some cases, been known to imperil the life of a patient. And I myself,
says Eustachius, have observed with my own eyes an accident of this
kind.

The author then passes on to speak of the eruption of the teeth,[292]
but the data with which he furnishes us are neither very precise nor
very exact.

Eustachius, without declaring himself for or against it, cites, in
this chapter, the opinion of those who believe in the possibility of a
third dentition in old people. He returns to this subject in the last
chapter but one of his book, which treats of dental anomalies: “Ali,”
says he, “testifies to old persons having had all their teeth renewed.
This has been derided as chimerical by medical men of later date, or at
least only admitted under the condition that such teeth be of a nature
completely different from the first.”

Our teeth, says the author, grow old together with us, and toward the
term of life they abandon us, a fact which also distinguishes them
from the other bones. When, however, it occurs, through illness, that
the teeth are extracted or fall out spontaneously before the period of
old age, the alveoli become filled up with a bony substance; and in
addition the two osseous scales of the maxillary bones approach one
another and unite together in such a manner as to form a sharp margin,
every vestige of a cavity being obliterated.

Speaking of the nutrition and growth of the teeth,[293] Eustachius says
that—given the existence of the dental nerves and bloodvessels—it is
not difficult to explain how the teeth are nourished, grow, live, and
feel. He therefore rejects the opinion of those who held that the teeth
of the lower jaw derived their nourishment from the marrow contained
within this bone, and that those of the upper jaw received it from a
humorous substance similar to marrow, existing in the large cavity
of the upper maxillary bone. Against the supporters of this opinion
Eustachius raises, among others, the following objections, viz., that
the marrow of the inferior jaw does not in any way touch the teeth,
so that such a mode of nourishment cannot be imagined, and that it is
completely erroneous that the large cavity of the upper maxillary bone
contains a humor similar to marrow. This passage of Eustachius’ book
gives clear evidence that he was well acquainted with the maxillary
sinus, described a century later by the English anatomist, Highmore,
who gave it his name. The existence of this cavity was, besides,
already known before the time of Eustachius.

The author also says that those who believe that the internal cavity of
the teeth contains marrow, and that this serves to nourish them, are
grossly deceived.

In the same chapter, Eustachius confutes an opinion, at that time
generally diffused and put forward for the first time by Aristotle,
viz., that the teeth grow throughout a whole lifetime. In the senile
age, he says, the teeth become impaired still earlier than the other
organs. They become thinner by deficiency of nourishment, and, at the
same time, discolored; the incisors and canines, as they waste away,
come to be also less sharp than they were; and the molars, losing their
tubercles or cups, become levelled down and smooth. If, notwithstanding
the evident wearing out of the teeth, they seem sometimes to grow
longer, this appearance is not to be trusted, for it happens not
unfrequently that the teeth appear to have grown longer simply by
atrophy of the gums, or also because some humor or other morbid
substance pushes them outward.

As to the sensibility of the teeth,[294] Eustachius is of the opinion
that these organs possess, besides the sensibility to pain, two other
species of sensibility; for, following the ideas of Galen, he also
holds that the teeth together with the tongue partake in the sense
of taste; and he further considers the disagreeable sensation known
as _setting on edge of the teeth_, as a species of tactile sensation
peculiar to these organs.

But in which part of the tooth does the faculty of feeling reside?

Among the authors previous to, or contemporaries of, Eustachius, some
affirmed that the sensibility of the tooth resides in the pellicle
which lines its inside cavity, others in the membrane which, like
periosteum, clothes the root of the tooth, others in both these parts.
Eustachius does not show himself more partial to the one than the other
of these opinions; he is, however, firmly persuaded that the hard
substance of the tooth is also endowed with sensibility. Though it is
not easy to explain how this may be, he considers it probable that
the nerve, fraying itself out inside of the tooth in minute filaments
at the time when the substance of the tooth is still soft and mucous,
intermixes intimately with it, thus communicating to it the faculty of
feeling, which then persists in it, even after the ossification of the
tooth. Such an hypothesis is certainly worthy of the lofty intellect of
Eustachius, and has in itself, so it seems to me, something of truth.

In the two following chapters,[295] the author speaks in a masterly and
admirable manner of the functions of the teeth and of their utility.

Among many other true and interesting observations, he remarks that by
the loss of their teeth even the most powerful dogs become cowards.

Besides what concerns the human teeth, excellent notions of comparative
anatomy, above all in what regards the monkey, the dog, and the
ruminants, are to be found in this little but most precious book of
Eustachius.

The teeth, says he, are not equally hard in all animals, and many
ancient authors have affirmed that ferocious animals have much harder
teeth than tame ones.

Chapter XXIX, relating to dental anomalies, is one of the most
interesting. We here quote the greater part of it.

“Some historians relate that Pyrrhus, King of Epirus, Eurifeus, of
Greece, and many others, had, instead of teeth, a continuous bone,
furrowed by somewhat deep vertical lines, in no way different from what
one sees in the multiple molars of the goat. It has never happened
to me, says Eustachius, to witness a similar union of all the teeth;
I have, however, sometimes observed continuity between three or four
molars, precisely in the same manner as in sheep. It also once happened
to me to observe in the case of an old man, a fellow citizen of mine,
that the teeth were covered up on every side by a hard and almost stony
substance, and no longer exhibited any trace of separation, offering
instead the appearance of a single bone.”

“One reads that Timarchus, of Cyprus, had two rows or series of teeth
and Hercules three.”

The author never had any opportunity of observing any such anomalies;
notwithstanding, he refers to cases of the kind observed by other
anatomists of his time, and, in a particular manner, to the case of a
triple dental series in a youth who died at the age of eighteen. As the
truth of the fact was testified to by highly respectable medical men,
Eustachius lends faith thereto. “Neither can it be said”—he adds—“that
in the case we are speaking of the new teeth erupted from other sockets
before the temporary ones were shed, for there would then have been
only a double and not a triple series; indeed, the series would not
even have been double along all the line, but only along the line of
the temporary teeth; and besides this, the double series would not have
been maintained up to eighteen years of age—the time of the death of
the subject—but only until the shedding of the deciduous teeth.”

“That teeth are sometimes cut in the palate is a fact attested to by
Alessandro de Benedetti and others. It has also occurred, within my own
experience, to observe this in the person of a Roman woman, who had a
tooth in the roof of the mouth, near the opening which is in proximity
to the incisors,[296] and at Gubbio there is, in the monastery of the
Trinità, a nephew of the distinguished jurisconsult Girolamo Gabrielli,
who at the age of eighteen cut a tooth in the middle of the palate.”

“Pliny and Solinus tell of individuals born with all their teeth. Other
authors, that Pheretes was without teeth all his life.”

“I hold it to be a fable that some women lose a tooth for each child
they bear.”

“In some cases it has happened that the falling out and renewal of the
teeth has not taken place before the age of thirteen or fourteen. In
other cases, the same teeth were shed and renewed twice, that is, once
after the seventh year, and again after the fourteenth year. It ought
also to be mentioned that in some young persons of twenty, the last
molar, or wisdom tooth, having been drawn, it was renewed during the
same year. Lastly, it is also to be noted that in strong and healthy
young persons, one of the other molars being extracted, it is sometimes
renewed.”[297]

In the last chapter[298] the author alludes to some dental affections.
In referring to the fluxions to which teeth are subject, he says he
has observed more than one case in which such a quantity of matter
resembling chalk was collected in the alveoli, that these gradually
being filled thereby, all the teeth became loosened and dropped out
little by little.

Speaking of dental diseases requiring surgical intervention, the author
remarks that dental surgery was, in his days, a most abject calling,
notwithstanding its having had, according to Cicero, a very high
initiator—Æsculapius, the god of medicine.

AMBROISE PARÉ. Whilst the anatomy of the dental system was illustrated
by the researches of Fallopius and Eustachius, the celebrated French
surgeon Ambroise Paré was contributing in the highest degree to the
progress of practical dentistry.

[Illustration: Ambroise Paré.]

Ambroise Paré (Latinized Paræus) was born at Bourg-Hersent in the year
1517. His father and one of his brothers were box-makers; another
brother was a barber. We have no very precise information about the
early years of his life; so much is certain, however, that Ambroise
Paré did not enjoy any of those advantages deriving from a good
literary education, and after having received some instruction from a
chaplain, whose disciple and servant he was at one and the same time,
he was bound over as apprentice to a barber, who also taught him the
art of bleeding. Toward the age of sixteen we find him in Paris in
the employ of a _chirurgien-barbier_. After this he practised minor
surgery for some years in the Hôtel-Dieu. But having undertaken the
study of surgery without literary preparation and without any knowledge
of Latin, he was obliged, especially for the latter reason, to contend
with great difficulties, so that, although he had acquired in a few
years sufficient practice in surgery to enable him to pass from the
Hôtel-Dieu to the sanitary service of the French army, it was only in
1554, that is, at thirty-seven years of age, that he was permitted to
take the examination required for becoming a member of the College
of Surgeons of Paris. Within the short space of five months he was
successively named Bachelor, Licentiate, and Doctor in Surgery. His
reputation, which had already become extraordinary even before he had
any academic degree, procured him introduction to the Court of France
as surgeon in ordinary. In 1562 he became chief surgeon to the Court
and occupied this post under the reigns of Charles IX and Henri III.
Ambroise Paré was a Protestant, and it is said that in the massacre of
St. Bartholomew’s night, he owed his escape to the king, Charles IX,
who, to save his life, hid him in his wardrobe. He died full of honors,
in the year 1592.

In his works this great surgeon treats the subject of dental maladies
and their cure very thoroughly; this may be in part attributed to the
circumstance of his having first been simply a barber (and, therefore,
also a tooth-puller) and afterward a surgeon-barber, which placed him
in very favorable conditions for acquiring vast experience in the
practice of dentistry.

In Chapter II, Book IV, of his works,[299] Ambroise Paré speaks of the
anatomy and physiology of the teeth. It must, however, be confessed
that Vesalius and, still more so, Eustachius treat of dental anatomy
with much more exactness than he does.

After having spoken of the incisors and the canines, he says that the
ten upper molars generally have three roots, and very often four,
whilst the ten lower ones have only three; this is because the lower
jaw is harder than the upper, and also because the lower molars,
_estant assises sur la racine, et non suspendues, comme celles de la
mandibule d’en haut, n’avoient besoin de tant de racines pour leur
stabilité asseurance_.[300]

Ambroise Paré, too, admits that the teeth grow throughout the whole
lifetime, and that the wearing away consequent on reciprocal friction
and mastication is compensated in this way.

Galen had already affirmed, and Ambroise Paré also held erroneously,
that the exquisite sensibility of the teeth aids the sense of taste.

In speaking of the development of the teeth, Ambroise Paré says only
that they are already solid and osseous before birth, he himself
having observed this in dissecting the jaws of a child who had died
immediately after birth.

In Chapter VII, Book XIII,[301] Paré treats of fracture of the lower
jaw. The method of cure he proposes is altogether identical with that
of Celsus. With regard to the teeth, he says that “_si elles sont
divisées, ebranlées, ou separées hors de leurs alvéoles ou petites
cavités, elles doivent estre reduites en leurs places et seront liées
et attachées contre celles qui sont fermes, avecques un fil d’or ou
d’argent, ou de lin. Et les y faut tenir jusques à ce qu’elles soient
bien affermies, et le callus soient refait et rendu solide._”[302]

Toothache, says Paré,[303] is, of all others, the most atrocious pain
that can torment a man without being followed by death. It depends, in
many cases, on a humorous fluxion of a hot or cold nature which flows
into the alveolus, forcing the tooth outward, loosening it, and causing
the patient so much pain on the slightest pressure being exercised on
it, that he cannot dare to bite with it in the least. If, however, the
tooth is corroded, hollowed out, or pierced to the root, the pain is so
strong, when the patient drinks—particularly if the liquid is cold—that
he seems to have had a stab with a stiletto inside the tooth.

If the pain is acute and pungent, like that produced by needles
being thrust into the diseased tooth; if the patient complains of a
strong pulsation at the root of the tooth, and in the temples; if the
application of cold remedies calms the pain, all these signs indicate
that the cause of the evil is heat. Instead, the cause of the pain may
be held to be cold when the patient complains of a great heaviness
in the head, emits a quantity of saliva, and finds relief in the
application of hot remedies. In the treatment of toothache one must
fulfil the following three indications:

1. Regulate fittingly the mode of living.

2. Evacuate or dissipate the morbid humors; this may be effected
by various means, namely, by purgatives, by bleeding, by gingival
scarification, by the application of leeches on the site of the pain,
by cupping on the back of the neck, or on the shoulders.

3. Applying in each single case the medicaments best adapted for
calming the pain.

The author here goes through a long enumeration of anti-odontalgic
remedies that offer no particular interest, as they are not at all new.

When a decayed tooth becomes the seat of excessive pain, and this does
not yield to any remedy, one must either have recourse to extraction or
cauterize it; this can be done either with potential caustics—such as
oil of vitriol, aqua fortis—or with the actual cautery. By cauterizing,
Paré adds, one burns the nerve, thus rendering it incapable of again
feeling or causing pain.

Erosion or caries[304] is the effect of an acute and acrid humor, that
corrodes and perforates the teeth, often to their very roots. To combat
this morbid condition, even when it is not accompanied by pain, one
must also have recourse (besides general treatment) to cauterization
either with oil of vitriol, with aqua fortis, or with a small actual
cautery.

If, as often happens, that the seat of the erosion lies in such a
manner between two teeth as to make it impossible to apply caustics or
other medicaments, one must file just sufficiently between the healthy
and the corroded tooth to render the part accessible, taking care,
however, to file more on the side of the affected tooth than on that of
the healthy one.

The file may be used, besides, to plane down a tooth that stands out
above the level of the others, and for similar purposes.

If one or more teeth have been shaken by a blow or a fall, or have come
out of their alveoli altogether, the surgeon should not remove them,
but rather reduce them and bind to the neighboring teeth, that they may
entirely reacquire their original firmness.

In allusion to this subject, Ambroise Paré refers to the case of a
friend of his, who having sustained, through a blow from the hilt of
a dagger, a fracture of the lower jaw with almost complete expulsion
of three teeth from their alveoli, had the fracture reduced by him;
after replacing the teeth and binding them to the neighboring ones,
he prescribed astringent mouth washes and liquid or semiliquid
nourishment, such as meat juice, _panada_, barley soup, jelly, and such
like. The patient was completely cured and able to masticate with the
three teeth as well as before.

Also in the case of extraction of a healthy instead of a diseased
tooth, Paré recommends replacing it immediately and binding it to the
neighboring ones, for, he says, by this means the tooth can take root
again.

As we have seen, the first author who speaks of replantation is
Abulcasis, but to Ambroise Paré belongs the merit of having treated the
subject much more explicitly, and of having insisted on the utility
of this operation, indeed, on the duty of carrying it out whenever it
seems indicated.

[Illustration: FIG. 60

Dental files (Ambroise Paré).]

Further, he is the first to mention another very important operation,
namely, transplantation, albeit he himself had never performed it.
The case he refers to has become a generally known anecdote. We give
it in his own words: “_Un homme digne d’estre creu m’a affirmé qu’une
princesse ayant fait arracher une dent, s’en fit remettre subit une
autre d’une sienne demoiselle, laquelle se reprint, et quelque temps
après maschoit dessus comme sus celle qu’elle avoit fait arracher
auparavant._”[305]

[Illustration: FIG. 61

One of the pelicans used by Ambroise Paré.]

[Illustration: FIG. 62

Two other pelicans and a pair of curved pincers (Ambroise Paré).]

Ambroise Paré has recourse to extraction when a tooth is the cause
of very violent pain, or when the existence of a carious cavity and
concomitant putrefying processes render the breath fetid, and endanger
the healthy teeth in its vicinity. If the persistence of a deciduous
tooth should cause the cutting of the corresponding permanent tooth
outside the line of the dental arch, thus giving rise to deformity,
Paré advises laying bare and then extracting the deciduous tooth;
for after this the new tooth may be pressed toward the point before
occupied by the other, until it assumes its natural position.

Sometimes, when a tooth is too firmly planted, one prefers, says Paré,
instead of extracting it, to break off the crown for the purpose
of being able to act directly on the dental nerve with appropriate
remedies, or to destroy the sensibility of the nerve entirely, by
cauterization. This unreasonable and reprehensible method of cure is
also quoted, under the denomination of _deschapellement_, by another
French author, a contemporary of Paré—Urbain Hemard—who observes,
however, that one rarely had recourse to it; for the pain and shock
which are caused by this operation are not less than those caused by
extraction.

It very often happens that the patient cannot indicate exactly which
tooth it is that gives him pain, his sufferings being so acute as to
appear spread over a great part of the jaw. One cannot, therefore,
trust too much to the indications given by the patient as to the point
of departure of the pain, and must take care not to extract a healthy
instead of a diseased tooth.

The extraction of a tooth should not be carried out with too much
violence, as one risks producing luxation of the jaw or concussion
of the brain and the eyes, or even bringing away a portion of the
jaw together with the tooth (the author himself has observed this in
several cases), not to speak of other serious accidents which may
supervene, as, for example, fever, apostema, abundant hemorrhage, and
even death.

In extracting a tooth it is necessary to place the patient on a very
low seat, or even on the ground, with his head between the legs of the
operator.[306] After having laid the tooth bare sufficiently, if one
sees that it is very loose, one may push it out of its socket with
a _poussoir_, that is, with a trifid lever. But if the tooth is too
firmly rooted to be extracted with this instrument, one must make use
of curved pincers, or else one may have recourse to a pelican. The
author notes, however, that much skill is required in using this latter
instrument, for otherwise it will almost certainly happen that several
good teeth will be knocked out, instead of the one intended to be
extracted. In proof of this, he relates the following anecdote, which
we relate in the words of the author, that it may not lose anything of
its quaint originality:

“Je veux icy reciter une histoire d’un maistre barbier, demeurant à
Orleans, nommé maistre François Loüis, lequel avoit par dessus tous,
l’honneur de bien arracher une dent, de façon que tous les samedis
plusieurs paysans ayans mal aux dents venoient vers luy pour les
faire arracher, ce qu’il faisait fort dextrement avec un polican,
et lorsqu’il avoit fait, le jettoit sus un ais en sa boutique. Or
avoit-il un serviteur nouveau, Picard, grand et fort, qui desiroit
tirer les dents à la mode de son maistre. Arriva cependant que ledit
François Louys disnoit, un villageois, requerant qu’on luy arrachait
une dent, ce Picard print l’instrument de son maistre et s’essaya faire
comme luy; mais en lieu d’oster la mauvaise dent au pauvre villageois,
luy en poussa et arracha trois bonnes. Et sentant une douleur extrème,
et voyont trois dents hors de sa bouche, commença à crier contre le
Picard; lequel pour le faire taire luy dit qu’il ne dist mot, et qu’il
ne criast si haut, attendu que si le maistre venoit il luy feroit payer
les trois dent pour une. Donc le maistre oyant tel bruit, sortit hors
de table pour sçavoir la cause et raison de leur noise et contestation;
mais le pauvre paysan redoutant les menaces du Picard, et encore apres
avoir enduré telle douleur qu’on ne luy fist payer triplement la
peine dudit Picard, se tent, n’osant declarer audit maistre ce beau
chef d’œuvre; et ainsi le pauvre badaud de village s’en alla quitte;
et pour une dent qu’il pensoit faire arracher, en remporta trois en sa
bourse, et celle qui luy causoit le mal en sa bouche.”[307] Paré adds
in conclusion: “Partant je conseille à ceux qui voudront faire arracher
les dents, qu’ils aillent aux vieux dentateurs, et non aux jeunes qui
n’auront encore reconneu leurs fautes.”[308]

[Illustration: FIG. 63

Two gum lancets and a trifid lever called “poussoir” (Ambroise Paré).]

But let us now return to our subject. After the extraction of a tooth,
it is necessary—says Paré—to leave the wound to bleed freely, so that
the part may get rid of the morbid humors; then the gums and the
alveolus must be pressed, on both sides, with the fingers, to readjust
the socket, which will have been widened and sometimes even broken in
extracting the tooth. After this, the patient should rinse his mouth
with oxycrate; and when the weather is cold and windy, the patient
should take care to avoid fluxion in the other teeth.

The following chapter speaks, “_de la limosité ou rouillure des dents,
et de la manière de les conserver_.”

After meals the mouth must be rinsed with water and wine, or with
water with a little vinegar added to it, and the teeth cleaned from
all residues of food, so that their putrefying may not spoil the teeth
and make the breath fetid. An earthy yellowish substance, like rust,
often forms on the teeth from want of cleanliness and also when they
are not used to masticate; this substance corrodes the teeth, just
as rust corrodes iron. It is necessary to remove this substance, by
scraping the teeth with small instruments suitable for the purpose, and
then the teeth themselves must be rubbed with a little aqua fortis and
aqua vitæ mixed together, to take away what the instruments have not
been able to remove. In order to preserve the teeth it is necessary,
besides, to rub the teeth frequently with appropriate dentifrices.
Among these the author mentions simple bread crust, burnt and reduced
to powder.

In Chapter III of Book XVII he speaks of artificial teeth. Sometimes,
says Paré, by the effect of a blow, the front teeth are lost; this
not only constitutes a deformity, but is also the cause of defects
of speech. Therefore, after the necessary treatment, when the gums
are hardened, the lost teeth must be substituted with artificial ones
made out of bone, ivory, or the teeth of the _Rohart_,[309] which are
excellent for this purpose; and the artificial teeth must be tied to
the neighboring ones with gold or silver wire.

[Illustration: FIG. 64

The palatine obturator with sponge of Ambroise Paré.]

Chapter IV of the same book is most important, for palatal obturators
are therein spoken of for the first time. “Sometimes a portion of the
bone of the palate is destroyed by the shot of an arquebus, or by some
other wound or by a syphilitic ulcer (_par ulcère de verole_), the
patients being thereby disabled from properly pronouncing words and
from making themselves understood. To repair this defect we have found
an expedient through the help and ministry of our art. It consists
in the application of an instrument somewhat larger than the palatal
perforation; this is made of gold or silver, of about the thickness of
a crown (coin), and has the form of a vaulted roof, to which a sponge
is attached; when introduced into the aperture, the sponge, absorbing
the humidity natural to such parts, will very soon swell up, and thus
the instrument is held firm. In this way, words are better pronounced.”

Besides the above instrument, the author gives us the figure of another
instrument, _sans esponge_ (without sponge), which, taken altogether,
is like a large cuff button. The small part, designed to be introduced
into the aperture of the palate, can be made to turn round from below,
by means of a small pair of pincers, so as to fix the obturator.

[Illustration: FIG. 65

Paré’s palatine obturator without sponge.]

In the last chapter of Book XVIII, first dentition and the treatment
required during this period are spoken of. The cutting of teeth, says
Paré, is accompanied by pain, itching, and pricking of the gums; often,
as well by diarrhea, fever, epileptic convulsions, which sometimes end
fatally. The symptoms by which it may be known that teeth are about
to come forth are as follows: The wet-nurse feels the mouth of the
suckling infant to be hotter than usual; the gums are swollen; the
child is restless, crying often and sleeping but little; it emits a
quantity of saliva from the mouth, and frequently puts its fingers in
its mouth, trying to rub its gums, and soothe, in this way, the pain
and itching which it feels. It is then necessary to treat the nurse as
if she had fever, and the infant should be suckled less than usual;
some cooling and thirst quenching drinks should be given to it—for a
child in such conditions suffers from intense thirst; the nurse should
often rub the gums of the little patient with softening and soothing
substances, as, for example, oil of sweet almonds, fresh butter, honey,
or mucilage made from the seeds of the fleawort or of the quince;
the brains of a hare (these may be roasted or boiled) have not only
a very soothing action, but also, according to a very ancient belief
shared by Paré, possess the occult property of aiding the cutting of
the teeth. But oftentimes, neither these nor other remedies are of any
use, because the gums are too hard and the teeth cannot cut their way
through at all; the tension of the gums then produces very violent
pain, fever, and other accidents, death even supervening in some cases.
The author, therefore, advises lancing the gums deeply, just above the
tooth which ought to appear, thus opening it a way, that it may more
easily come out. He relates that he has performed this operation on his
own children in the presence of many medical authorities.

Almost as if to show the high value of this operative procedure, Paré
tells the case of a child, the son of the Duke of Nevers, who died
at the age of about eight months without having cut any teeth. He,
together with other doctors, was invited to carry out an autopsy. No
lesion whatever was found sufficient to cause death, but the gums were
very hard, thick, and swollen; an incision into them showed that
the teeth were ready to come out, if only their eruption had been
facilitated by lancing at the right time. Paré and the other doctors
were of the unanimous opinion that death was caused solely by the
impossibility of cutting the teeth on account of the hardness of the
gums.

Among the many strange cases given in Book XIX (_Des monstres et
prodiges_), Paré also speaks—trusting to the word of Alexander
Benedetti—of the case of a woman, who, after the complete loss of her
teeth caused by age, cut them all again at eighty years of age.

Although Paré treats so amply and with such competence all that
concerns dental diseases and their cure, he does not make the least
allusion to the stopping of teeth, beyond recommending, as had already
been done by Celsus, that when a tooth that is to be extracted shows a
large cavity, the latter should be well filled with linen or lead, so
that the tooth be not fractured under the pressure of the instrument
and so leave the root behind in the alveolus.

A century before Ambroise Paré, Giovanni d’Arcoli had already mentioned
the filling of teeth with gold leaf, and, as we have seen already,
there is very good reason to believe that the practice of this
operation dated back to a still earlier period. How is it, then, that
the illustrious French surgeon does not say a word about this? Very
probably stoppings were not at all in use among French _dentateurs_ and
perhaps, even in Italy, this operation was only rarely carried out.

JACQUES HOULLIER (1498 to 1562), a celebrated French physician and
surgeon, also known under the Latinized name of Jacobus Hollerius,
was the first to stand out, although timidly, against the theory of
dental worms. He did not decidedly deny their existence, this having
been affirmed by so many illustrious writers; he, however, speaks of
them as if the point were a doubtful one: “_It is said_ that worms are
generated in the teeth, which corrode the teeth themselves, and produce
a pain which is not very violent and causes itching with little or no
salivation (_vermes ajunt subnasci dentibus, et hos corrodere, à quibus
dolor non ita fortis, pruriginosus, nulla aut pauca salivatio_).”

But even while putting in doubt the existence of dental worms, he
believes it his duty to enumerate the various remedies, recommended for
their destruction. As to fumigations with the seeds of the hyoscyamus,
Houllier, declares that what is believed by the common people, and
what has been written by doctors of antiquity about worms being killed
and seen to fall from the teeth by the effect of these fumigations, is
all nonsense. In fact, he says, when the seeds of the hyoscyamus are
burnt there fly away from them what appear to be little worms, even
if the fumes do not reach the worm-eaten tooth. (_Quod autem vulgus
sibi persuadet, et ab antiquis medicis scriptum est de suffumigio è
semine hyoscyami, videtur fabulosum. Nam inde ajunt manifeste vermes
excidere. Re vera, incenso semine, evolant tanqua vermiculi, etiam si
non attingit fumus vermiculosum dentem._)

Apart from this, in the works of Houllier, nothing is found that is
of interest for the history of dentistry. He repeats several errors
and prejudices of the ancients; he says, for example, that men have
ordinarily thirty-two teeth, women, twenty-eight; and he, too, believes
in the expulsive virtues of the fat of green frogs when applied to a
tooth (_adeps ranæ viridis dentem depellit_).

Houllier does not contribute in any way to dental therapeutics, he only
enumerates the methods of cure recommended by preceding authors.[310]

VOLCHERUS COITER (1534 to 1600), of Gröningen, an ardent student of
anatomy, and a pupil of Fallopius, Eustachius, and Aranzio, studied
with great attention the development of bones, dissecting many fetuses
and children of various ages for that purpose. He clearly states his
opinion that the teeth are not bones, since they do not pass, like the
latter, through the cartilaginous stage, but are derived instead from a
mucous substance.[311]

JOHANN JACOB WECKER, a doctor of Colmar, published in 1576 a valuable
medical work composed of synoptical tables, in which is briefly
summarized the best of what had been written by preceding Greek, Latin,
and Arabic authors.

One gathers from this author that at the time in which he wrote it
was considered an excellent preservative against the plague to rub
the teeth with theriac, mithridate, angelica, and zedoary. From this
it may be perceived that even in those days doctors had understood
the importance of the cleanliness and disinfection of the mouth as a
prophylactic against infective diseases.

In the above-mentioned book may be found a sufficiently complete
exposition of dental therapeutics of that and of the preceding periods.
There is nothing, however, which is not already known to us from our
examination of the earlier writers. Worthy of notice is the information
that, among other things, to facilitate the cutting of teeth rubbing
the jaws with turpentine was recommended at that time.[312]

[Illustration: Volcherus Coiter.]

DONATO ANTONIO OF ALTOMARE, a Neapolitan physician and philosopher,
dedicated a long chapter of his _Ars medica_[313] to the subject of
dental pains and their treatment. He classifies these pains with great
accuracy, taking into account their seat and causes, and pointing
out in each single case the method of cure to be followed according
to the warm, cold, dry, or humid nature of the pain. In what he says,
however, we do not find anything new.

GIULIO CESARE ARANZIO (1530 to 1589), a celebrated surgeon and
anatomist of Bologna, in which city he taught from the age of
twenty-six years until his death, is of the opinion that parulides—that
is to say, inflammations or abscesses of the gums—and epulides—that
is fleshy excrescences of the same—are usually caused by caries or
putrescence of the teeth; but that in certain individuals, from
a peculiar weakness of the gums, these are easily attacked by
inflammation when the wind is in the south.

In the case of parulides, to soothe the pain and to accelerate the
suppurative process, emollient substances should be used; afterward it
is necessary to open the abscess with a lancet, to wash the mouth with
mulse, and to aid the process of cicatrization by using syrup of roses.

As to epulides, these must be made to disappear, by sprinkling the
tumor with the powder of gall-nuts, or by moistening them frequently
with a decoction of gall-nuts, or with sulphur water. But if they
do not yield to these remedies, and are the cause of functional
disturbances, the surest and most prudent method of cure would be the
use of the red-hot iron.

GIOVANNI ANDREA DELLA CROCE, a celebrated Venetian physician and
surgeon, was the author of a most valuable treatise on surgery, which
was published first in Latin (_Chirurgiæ universalis opus absolutum_,
Venetitiis, 1573), and then in Italian under the title of _Chirurgia
universale e perfetta_, Venezia, 1583. According to this author, dental
fistulæ are more common to the lower jaw than to the upper one. To
cure these fistulæ, it is necessary to extract the diseased teeth from
which they originate, even should they ache but little or not at all.
To confirm this, he relates in full a very interesting case of a dental
fistula, that he cured by the extraction of a tooth which hardly ached
at all.

Flajani[314] chose to see in this case a precocious example of the
opening of Highmore’s antrum through the alveolus. But the description
given by Andrea della Croce of his case does not at all warrant this
supposition.

At the end of his book Andrea della Croce gives us the figures of many
dental instruments, which have, however, nothing new about them.

GEROLAMO CAPIVACCI, of Padua, repeats the advice (already given by
preceding authors) to avoid, in eating and drinking, the rapid changes
from heat to cold, and _vice versa_, since, says he, nature does not
tolerate these rough changes.[315] In the mercurial treatment of
syphilis,[316] he recommends the patient, as soon as the action of the
remedy manifests itself in the oral cavity, to keep a piece of gold in
his mouth, that the mercury, on account of its particular affinity,
may unite with the gold and the harmful effects of this strange remedy
on the mouth may be thus avoided. A strange method of curing mercurial
stomatitis!

JOHANN SCHENCK VON GRAFENBERG (1530 to 1598), a celebrated doctor of
Freyburg-in-Breisgau, has left us, in his _Observationes medicæ_, a
very rich and interesting collection of clinical cases. In this work he
refers to many observations upon dental diseases by earlier authors,
which, however, have already been noted by us in their time and place.
Among other things, Schenck von Grafenberg relates that Cardanus
was able, more than twenty times, to calm a violent toothache which
tormented him by lightly pressing the sick tooth between the thumb and
index finger of his left hand.

PETER FOREEST (1522 to 1597), a very famous Dutch doctor of Alkmaar,
repeats the very old error—already in decisive terms denied by Andreas
Vesalius—that women have only twenty-eight teeth, whilst men usually
have thirty-two. To the two central incisors he gives the name of
_columellares_. Sugar and all sweet things, says this author, are
very harmful to the teeth, and he gives as a proof the fact that
apothecaries have, in general, very bad teeth, on account of the
frequency with which they taste syrups and the like. Perhaps things are
now changed, since I am not aware that chemists in our days are to be
distinguished by the bad state of their teeth!

In regard to toothache, Foreest records an important observation
which he had made on himself; an aching tooth which a surgeon had not
succeeded in extracting, but which was simply loosened, ceased, without
anything else being done, from giving him pain, and in a short while
became firm again, and he continued to use this tooth for about five
years. However, on a renewal of the pain he was obliged at last to have
it extracted. On the strength of this observation, the author believes
that in certain appropriate cases, recourse may be had to the luxation
of a tooth, rather than to its extraction to obtain a cessation of
toothache.

This method of cure had already been advised by a still earlier writer,
that is, by Avicenna. When a subluxation produces the rupture of the
dental nerve, this, in its results is equivalent to a replantation.

Foreest is the first to speak of the violent inflammation of the gums
and of the whole mouth, caused by the application of artificial teeth
of ivory fixed in their place with gold wire. This cannot at all
astonish us when we consider how imperfectly, in those days, dental
prosthesis was carried out and how the immobility of the artificial
pieces, caused them to be a source of permanent irritation to the
neighboring parts, especially on account of the difficulty met with in
giving proper care to cleanliness. He, therefore, entirely rejects the
application of artificial teeth. He is likewise but little inclined
to the use of the pelican, it being very easy to break the teeth with
it, and, instead, he recommends the use, whenever it be possible, of
another instrument which he calls _pes bovinus_.

Foreest relates several cases of dental fistulæ which he had cured by
the extraction of the faulty teeth. In one of these cases, observed in
a lady, the fistula had opened between the nose and the cheek, so that
a malady of the upper jaw was feared (and, in fact, as William Sprengel
observes, it is not improbable that this was a case of affection of
Highmore’s antrum); he obtained a complete cure in a short time by the
extraction of a diseased tooth.

According to Peter Foreest, the existence of dental worms is as certain
as is that of intestinal, auricular, and other worms. Even on the
pretended efficacy of remedies, capable of making the teeth fall out
without pain, he does not throw the slightest doubt.

Foreest attributes to his master, Benedictus of Faenza, the merit of
having introduced into therapeutics the trephining of teeth for the
cure of certain violent pains not accompanied by any external lesion
of the tooth. We know, however, that the invention of this operation
dates back to Archigenes. Benedictus trephined the tooth with a very
fine drill (_stylo vel terebello subtilissimo_) and then filled it with
theriac, using, likewise, as occasion required, other remedies.

To demonstrate the propriety and the necessity of laying bare the neck
of the tooth before extracting it, he relates a case in which fracture
of the jaw was the result of having neglected this precaution.

Among the sundry causes of the looseness of teeth, he mentions the
softening of the dental nerve (_emollitio_), but this erroneous opinion
had already been expressed by Galen.

As a means of cleaning teeth and keeping them free from tartar, he
advises, among other things, the use of pumice-stone powder. He
disapproves, however, of the use of oil of vitriol—unless in very
minute quantities of, at the very most, one or two drops.[317]

URBAIN HÉMARD, a surgeon to the Cardinal d’Armagnac, published in 1582,
at Lyons, a booklet entitled: _Recherche de la vraye anathomie des
dents, nature et proprietez d’icelles, où est amplement discouru de
ce qu’elles ont plus que les autres os; avecque les maladies qui leur
adviennent, et les remedies_. This is the first dental monograph that
appeared in France. The pamphlet is written with much erudition, but
its contents are almost entirely taken from preceding authors. Hémard
indicates by the term _deschapellement_ (decrowning) the removal of the
crown of a tooth for curative purposes. He speaks of this operation as
of a method but recently introduced into therapeutics; but, and very
reasonably, too, he shows himself somewhat hostile to such a method of
cure.

As to what concerns the anatomy of the teeth, Hémard’s book does not
contain anything original. The following passage, transcribed by
Portal,[318] shows luminously that Urbain Hémard, instead of making
researches of his own, has simply copied the Italian Eustachius,
translating the latter almost literally. The beauty of it is that
Portal had not noticed the plagiarism in the least, since he says that
if Urbain Hémard had taken into account the researches of Fallopius and
Eustachius as well, his book would have acquired still greater value.
But, in truth, he has taken into account, and has valued the researches
of Eustachius so much as to palm them off as his own! We here
quote, side by side, with a paragraph taken from Hémard’s book, the
corresponding passage of Eustachius, that our readers may be convinced
of the truth of what we have stated:

  EUSTACHIUS.

  ... aperta utraque maxilla occurrunt incisores, canini,
  ac tres molares, nimirum secundus, tertius et quartus;
  partim mucosi, partim ossei, non obscuræ magnitudinis,
  suisque præsepiolis undique vallati:

       *       *       *       *       *

  incisoribus autem et caninis docta manu detractis,
  tenuissimum interstitium vix osseum factum conspicitur;
  quo pari diligentia amoto, obviam veniunt totidem
  incisores et canini pene mucosi et longe minores, qui
  post alios priores in propriis caveis latentes, singuli
  singulis e regione oppositi collocati essent, nisi
  utriusque maxillæ caninus magna ex parte proximo incisori
  incumberet, eumque propterea fere occultaret.[319]

  Primorum molarium et genuinorum qui circa septennium ac
  longe etiam postea oriuntur, fateor me nullum vestigium
  vidisse.

  HÉMARD.

  ... leur ayant ouverte l’une et l’autre mâchoire, j’y
  ai trouvé seulement les dents incisoyres, les canines,
  et les trois mâchelieres de chaque cousté de mâchoire;
  à sçavoir la seconde, la troysième et la quatrième,
  lesquelles estoit partie osseuses parti mucillagineuses,
  de médiocre grandeur, garnies à l’entour de leurs petits
  estuis ou alvéoles. Et depuis ayant tirees dehors
  lesdictes dents incisives et canines, il se trouve un
  entre-deux osseux; lequel ayant pareillement osté, il
  se presente de dessoubs autant de dents incisives et
  canines, toutes presque mucillagineuses, représentant la
  substance d’un blanc d’œuf à demy cuite moindres pourtant
  que les précédentes estant cachées dans les mesmes
  estuits après les premières.

       *       *       *       *       *

  Quant est des premieres mâchelieres et des gemeles qui
  à sept ans, ou longtemps après commencent à sortir,
  je confesse n’en avoir trouvé jamais aucune trace n’y
  commencement.

  EUSTACHIUS.

  Verisimile tamen est, rationique consentaneum, eos
  perinde ac secundos incisores et caninos rude quoddam,
  sed minus perspicuum initium ortus in utero sumere;
  sensimque postea similiter formari et absolvi

  HÉMARD.

  Toutesfois, il est vraysemblable et raisonable aussi,
  qu’elles ayent pris dans la matrice, tout ainsi que
  les incisoyres et canines secondes, quelque petit
  commencement de naysance et forme, moins apparante
  toutefois, mais qui depuis se façonne et parfaict tout
  ainsi que des autres.

At the time when Urbain Hémard was publishing his pamphlet in France,
several other monographs were already appearing in various parts of
Europe on teeth and their affections. A few years after Ryff had
initiated dental literature in Germany, other odontological writings
were published in Spain and in Italy.

[Illustration: FIG. 66

Title page of Francisco Martinez’s book (Valladolid, 1557).]

FRANCISCO MARTINEZ,[320] in 1557, gave to the press in Valladolid
a _Coloquio breve y compendioso sobre la materia de la dentadura y
maravillosa obra de la boca, con muchos remedios y avisos necessarios,
y la orden de curar y adreçar los dientes_.

[Illustration: FIG. 67

Four of the instruments represented in Francisco Martinez’s book.]

[Illustration: FIG. 68

A dental excavator used for ascertaining which one among several
decayed teeth was the one causing the pain (F. Martinez).]

[Illustration: FIG. 69

A chisel and a mallet for separating teeth (F. Martinez).]

[Illustration: FIG. 70

A pelican (F. Martinez).]

[Illustration: Girolamo Fabrizio.]

In the same year and city was printed a Latin pamphlet, _De dentione_,
by Franciscus Martinus de Castrillo, probably the author of the
preceding book. In 1563 was published in Venice the excellent treatise
of Eustachius on the anatomy of the teeth (_Libellus de dentibus_). At
Frankfort was published, in 1576, the second dental monograph in the
German language, _Zahnarzney_, by Adam Bodenstein von Carlstad; and
two years later Petrus Monavius published in Basle a Latin pamphlet on
dental diseases (_De dentium affectibus_).

[Illustration: FIG. 71

FIG. 72

Different kinds of forceps (F. Martinez).]

The above-mentioned works, apart from the book of Eustachius, which is,
of its kind, a real masterpiece, have but little importance. We have
cited them here solely to show in what years and in what countries the
very first dental monographs appeared.

GIROLAMO FABRIZIO, of Aquapendente (1537 to 1619), a celebrated
anatomist and surgeon, wrote some very valuable works, among which a
treatise on surgery, in which the part relative to the affections of
the dental system is treated briefly but with great orderliness and
clearness, thus giving a very precise idea of what dental surgery was
at the end of the sixteenth century.

The principal operations which it is necessary to perform on teeth are,
he says, seven in number,[321] viz.:

1. Forced opening of the dental arches in cases of prolonged
constriction of the same, so as to prevent the patient from dying of
hunger.

2. Cleaning of the teeth.

3. Medication of carious cavities.

4. Filling with gold-leaf.

5. Removal or resection of teeth abnormally situated.

6. Removal of any unevenness or sharpness of the teeth.

7. Extraction.

[Illustration: FIG. 73

Instruments for removing deposits from the teeth (F. Martinez).]

[Illustration: FIG. 74

A dental scraper.

A universal toothpick and a file for sharpening its points.

An instrument for removing sharp corners from the molar teeth (F.
Martinez).]

[Illustration: FIG. 75

A figure representing St. Apollonia, reproduced from the last page of
F. Martinez’s book.]

In regard to the first operation, the author first of all examines
the various causes of the constriction of the dental arches, and
according to the various nature of this, he indicates in what cases it
is fitting to have recourse to the forced opening of the jaws by means
of appropriate dilators, and in what cases it is best to avoid it. In
the latter case one must seek to feed the patient in other ways—that
is, either by alimentary clysters, or by a little tube passed through
a space already existing or purposely made by the extraction of one
or two teeth; or else by letting a cannula reach down to the pharynx,
through the nose, or, lastly, by introducing a cannula into the oral
cavity through the free space existing behind the last molars. But in
regard to this last method, Fabricius notes that if the constriction
is of a spasmodic nature, the spasm may affect not only the elevator
muscles of the jaws, but also those that govern deglutition, including
sometimes even those of the tongue itself, and in this case, as the
food introduced into the oral cavity could not be swallowed, it is
preferable to convey it directly into the pharynx, by means of a
cannula passed through the nostrils.

The second of the above-mentioned operations[322] is designed, says
Fabricius, to take away the dirtiness of the teeth and the bad odor of
the mouth (_dentium immunditiam et oris fœtorem tollit_). The dental
tartar (_ostracoderma_) must be removed by slender instruments of an
appropriate shape, which, for people of high position (_promagnatibus_)
shall be made of silver. This advice is sufficient to make us
understand that Fabricius, although an excellent surgeon, had no
practice in dental operations; otherwise he would have known that the
hardness and adhesion of tartar is generally so great that its removal
absolutely requires scrapers of tempered steel and not of a soft metal
like silver.

To arrest caries, he first drops into the carious hollow, by means
of a small silver funnel, some drops of oil of vitriol, or of some
other caustic liquid; and then he performs actual cauterization with
appropriate instruments; after which the cavity is filled with gold
leaf (auro foliato).

When one or more teeth have appeared in an irregular position and
offend the walls of the oral cavity or else the tongue, the excision
(resection) of the tooth or teeth must be performed with a pair of
strong pincers, whose shape must vary according to whether the teeth
are situated externally or internally with regard to the dental arches.
But as after the resection there will almost always remain some points
or sharp irregularities, which by their presence would continue
to irritate the soft parts, it will be necessary to remove these
irritating prominences by means of the file.

As to extraction, Fabricius of Aquapendente counsels great prudence in
performing the operation, and on this point he repeats all the warnings
already given by Celsus, an author whom he greatly admires and the
study of whose writings he warmly recommends.

It seems that in those times there was more than sufficient reason
to inculcate extreme caution in regard to the extraction of teeth.
This was not then performed by true dentists, but rather by barbers
and by ignorant tooth-pullers, or else, in exceptional cases, by
general surgeons, very skilful, perhaps, in everything else, but
little practised in the operation we are speaking of; besides this,
the instruments left much to be desired; and lastly there was not,
nor could there be, any idea of asepsis. What wonder, therefore, if
the extraction of teeth was frequently the cause of serious injuries!
Fabricius relates that it often happened to him to have to extract,
in little fragments, half or sometimes a whole jaw, which had been
attacked by putrefaction, as the result of the extraction of one single
tooth. This, adds the author, may easily happen, because, when the
jaw is attacked by pus in one point, its very anatomical constitution
favors the rapid spreading of the putrefying process to the other
parts of the bone, as this latter, apart from its external lamina, is
entirely composed of a sponge-like substance.

The instruments which are used for the extraction of teeth, are,
says Fabricius, of nine kinds;[323] and the most important among
them—generically called _forceps_—are indicated by special names,
taken from their resemblance to the mouth or beak of certain animals.
Thus, the forceps with which it is usual to perform the extraction of
molar teeth are called “pelicans,” and of these there are two kinds,
according as they are used for the right or the left side, for the
upper molars or the lower ones.

A third kind of instrument goes under the name of “beak” (rostrum), and
serves for the extraction of the incisors.

A fourth kind is the “crow’s beak,” or “crow’s bill,” which is used for
the extraction of roots.

Two other instruments are named in Italian “cagnoli,” for they imitate
the strong bite of the dog (in Italian _cane_) and are used in cases
where the pelican is not adapted.

A seventh instrument is called by the Latin term of _terebra_ (drill
or auger). It is used instead of a lever to separate the teeth from
one another when they are too close to each other, and so render their
extraction much easier.

The eighth instrument is a “trifid lever” (_vectis trifidus_), so
called because it is furnished with three points.

The ninth and last kind of instruments are the _dentiscalpia_, slender,
sharp, and oblong tools, with which the gums are separated from the
teeth before extraction.

Fabricius also speaks of dental prosthesis, but very briefly. He says
that artificial teeth are made of ivory or of bone (for example, from
the tibia of the ox) and are fastened by gold wire. One has recourse to
this means especially to correct the bad appearance and the defects in
speech deriving from the loss of the front teeth.

This author also makes some allusion to palatal obturators,[324] but in
very general terms, limiting himself to saying that when a perforation
exists in the hard palate, it may be corrected by a piece of sponge
or cotton, or with a plate of silver fixed in the palate, so as to
close up the aperture (_corrigitur spongia, vel gossypio, vel lamina
argentea, quæ palato appendatur, ut foramen obstruat_).

For epulides and parulides Fabricius advises the same methods of cure
that had been recommended by Paul of Ægina.

In the case of flaccidity of the gums accompanied by looseness of
the teeth, the treatment must consist, first of all, in superficial
cauterization with the red-hot iron, after which the gums must be
smeared with honey, the mouth washed with mulse, and lastly astringent
powders must be used.

If the gums are much swollen, in near relation to the molar teeth, the
use of the red-hot iron, says Fabricius, becomes very difficult from
the want of space, and from the close vicinity of the healthy parts,
which must not be injured. In such a case, it is necessary to remove,
with suitable cutting instruments, as much as is possible of the morbid
tissue (_caro crassa et putrida_); then to cauterize the remaining
part, making the cautery, if necessary, pass through a tube, so as not
to injure the surrounding parts. When, however, the gingival swelling
bleeds very easily, and its excision thus might give rise to a profuse
hemorrhage, it will be best to perform the operation with cutting
instruments heated red-hot.

Fabricius remarks that although other authors do not make any allusion
to these large gingival excrescences, he had had occasion to observe
several cases, and had also had various instruments especially
constructed for their cure.[325]

JOHANN HEURN, or in Latin Heurnius (1543 to 1601), of Utrecht, in his
book on the diseases of the eyes, ears, nose, teeth, and mouth, treats
sufficiently at length of dental diseases and their cure, but without
adding anything of importance to what had been written by preceding
authors. His work is a mere compilation, which would be without any
importance whatever if it did not serve to show what credit was still
given at that period to all the errors and prejudices which are to be
found in the writings of the ancients.

Heurnius, although he wrote a long time after Vesalius, still adheres,
in regard to the number of teeth, to the already mentioned opinion of
Aristotle; he says, in fact, that women rarely have thirty-two teeth
like men.[326]

He warns those who suffer from odontalgia not to have recourse
thoughtlessly to tooth-drawers, but to recur, instead, to the doctor,
who will always treat the affection according to the cause on which it
depends.

And here the author repeats the numerous distinctions found in many
preceding writers, and especially in Arculanus. The pain may be
located in the gums, in the dental nerve, or in the very substance of
the tooth; and in each of these cases it may depend on warm or cold
matter, on dryness, humidity, etc.

[Illustration: FIG. 76

A Dutch dentist. (From a picture of the XVI century.) By Lucas Van
Leyden.]

The method of treatment must vary in all these cases; and in regard
to this the author enters into minute particulars, commencing with
dietetic cure—which itself must be varied according to the causes
of the affection—and then treats of all the other therapeutic
means—purgatives, bloodletting, revulsives, local narcotic or resolvent
medicaments, and so forth. The letting of blood was, it seems, a very
favorite method of cure; not only were the veins of the arm opened, but
also those of the tongue, of the gums, of the lips, and of the ears!

Another remedy which the author seems to have a predilection for is
oil of vitriol. When a tooth shows a carious perforation, he applies
inside it, by means of a split feather, a drop of oil of vitriol,
which, says he, causes the fall of the tooth after a few days.

Elsewhere he says that “sometimes worms are produced in carious teeth;
to kill them a drop of oil of vitriol is an excellent remedy; and
this at the same time cures the decay of the tooth and takes away the
sensibility of the nerve.”

This passage does not agree very well with the preceding one, according
to which oil of vitriol would act much more radically by causing the
tooth to fall out altogether. But we will not take exception to so
small a matter; so much the more, as the author, if he were still
alive, might perhaps show us by some subtle distinction that the
contradiction alluded to is only an apparent one!

To free the teeth from tartar, Heurn likewise counsels oil of vitriol,
diluted, however, with other liquids.

A tooth must not be sacrificed excepting when it is loose and attacked
by incipient necrosis, so as to leave no hope of arresting the
putrefactive process. It is then our duty, says Heurn, to remove the
tooth without causing much pain. For this purpose, after the tooth has
been separated all around from the gums, it must be raised somewhat
from the alveolus; then it must be sprinkled with powder of euphorbia,
or a paste made with flour and the juice of the tithymalus must be
applied around it, taking care, however, to cover the neighboring teeth
with wax. After two or three days the tooth will be so loose that
it can be pulled out very easily with the fingers or with a pair of
pincers.

Dental surgery properly so called has been entirely neglected by Heurn.
He was perhaps so persuaded of the efficacy of the above-mentioned
remedies as to believe that every other species of intervention was
useless. On the contrary, he does not abstain from speaking very
seriously of the miraculous virtues of certain remedies (serpent
scales, dog’s teeth, etc.); and tells us, among other things, that the
broth made from a frog, when held for a length of time in the mouth,
soothes dental pains, whatever be the causes from which they originate.
One would seem to have gone back again to the days of Pliny!


THE STORY OF THE GOLDEN TOOTH.

In 1593 a rumor spread throughout Germany of a great marvel that had
appeared at Schweidnitz in Silesia: a golden tooth had erupted in the
mouth of a child aged seven years, which, more precisely designated,
was the first large molar on the left of the lower jaw.

In our days news of such a kind would be immediately qualified, and
universally held to be an imposture. But three centuries ago the most
marvellous and unlikely things were easily believed in, often even by
the learned; and, therefore, the fact alluded to was taken into serious
consideration, so much so that for a long time many learned pamphlets
and dissertations were written concerning it.

JACOB HORST, Physician and Professor of Medicine at the Julius
University in Helmstadt, published, in 1595, a very singular book on
the golden tooth of the Silesian child.[327] Without raising any doubt
as to the reality of the fact, he maintained that the phenomenon was
produced from the effect partly of natural and partly of supernatural
causes, in relation with the constellation under which the child was
born. On the day of its birth, that is, December 22, 1585, the sun was
in conjunction with Saturn in the sign of Aries. In consequence of
this circumstance the nutritive force had developed marvellously on
account of the increase in heat, and consequently, instead of osseous
substance, golden matter had been secreted!

After having explained (!) in this way the origin of the phenomenon,
Horst passes on to examine what events may be portended by this
unheard-of marvel, he not having the least doubt that it—like
earthquakes, eclipses, and comets—must be the precursory sign of
important events. Supporting his assertions by arguments of various
kinds, some of which are taken from the Bible, he concludes that the
gold tooth of the Silesian child means neither more nor less than the
approach of the golden age! The Roman Emperor would sweep the Turks,
the enemies of Christianity, out of Europe, and the Millenium or
Golden Age would commence. As the tooth was situated on the left side
of the lower jaw, it might be deduced, according to Horst, that heavy
calamities would precede the beginning of the epoch of happiness thus
predicted. On the other hand, as the golden tooth was the last of the
dental series of the child, this was to signify that the golden epoch
thus foretold would be the last of the ages of this world before the
universal judgment!

MARTIN RULAND, in the same year, 1595, wrote about the gold tooth.[328]
Shortly after, he was answered by JOHANN INGOLSTETTER; and the
controversy which arose between them in this important subject lasted
for a long time, without, however, leading to any definite conclusion.

BALTHASAR CAMINDUS, a doctor of Frankfort, meanwhile had noted that for
some months the marvellous Silesian boy had not lent himself to being
examined by the learned, becoming terribly enraged whenever they wished
to compel him. From this he inferred that it was a case of nothing else
but an imposture, and that the famous tooth could not have anything
special about it, save that its crown had been very skilfully covered
with a thin plate of gold.

In spite of this the discussions on the portentous tooth continued for
a long time; and even one hundred years after, that is, in 1695, a new
dissertation appeared on the golden tooth.

The greater number of those who wrote on this subject did not throw
the slightest doubt upon the reality of the fact, but only sought to
explain in the most varied ways the genesis of this phenomenon.

DUNCAN LIDDEL. Among those who had the good sense not to put faith in
the thing, and who very decidedly affirmed that this was a mere case
of imposture, Duncan Liddel, a Scotchman and professor in a German
University, deserves to be recorded.[329]

He had heard that the famous gold tooth was larger than the others,
and that the neighboring molar was wanting; from which he argued that
this was simply the case of a tooth the crown of which had been covered
with a plate of gold. Answering the arguments of Horst, he accused him
of gross ignorance in the most elementary notions of astronomy, and
this for having affirmed that when the famous child was born, that is,
December 22, the sun happened to be in conjunction with Saturn in the
sign of the Ram. As the sun does not enter the sign of the Ram until
March, if it had been there on December 22 this would have been a
greater portent than if the whole body of the child had been formed of
nothing else but teeth of gold![330]

The above-mentioned fact is not the only one of its kind. Serres
relates that once there was a great noise made in Poland about the
pretended golden teeth of another child who was carried round from city
to city for the purpose of making money. A Franciscan monk had sought
to explain, in one of his writings, the formation of these teeth.
The anatomist Kircher answered him in a pamphlet which had the very
suitable epigraph: _O præclare pater, nimium ne crede colori_.[331] In
fact, the pretended teeth were only covered with a layer of tartar of
golden color. As the falsity of the pretended miracle might be brought
to light at any moment with much scandal, a bishop thought it well
to put an end in haste to the comedy, by ordering the removal of the
deceitful layer of tartar from the teeth of the child, to be performed
in public, so that the imposture might be made completely clear.

From the above story we can, at any rate, deduce an important
conclusion for the history of dental art, that is to say, that even
as early as 1593 there was an artificer (we do not know whether a
goldsmith or dentist) who knew how to construct a gold crown, although
only for the purposes of deception.




CHAPTER XI.

THE SEVENTEENTH CENTURY.


The first signs of the separation of dental science from general
medicine were to be perceived in the sixteenth century, the period
in which, as we have seen, the earliest dental monographs appeared.
From that time this separation tended to accentuate itself ever
more strongly; dental monographs became more numerous and dentistry
progressed ever more rapidly, both in its scientific and practical
aspects.

In the seventeenth century, about which we are now to speak, we shall
have to call attention to many facts of the highest importance for
the development of dentistry, and with regard to literature, it is
worthy of note that while the publications on dentistry that appeared
in the various countries of Europe during the preceding century only
amounted to about twenty (taking also into account several pamphlets on
the famous golden tooth!), in the seventeenth century the number was
considerably higher, that is, about a hundred. We shall speak of the
most important of these, as also of the works on general medicine or on
surgery of the same period, that present some interest from the point
of view of dentistry.

JOHANN STEPHAN STROBELBERGER, physician to the imperial baths of
Carlsbad, published in the year 1630 a very curious book, the title
of which, being translated, runs somewhat as follows: _Complete
Treatise of Gout in the teeth, or, more properly said, of Odontagra
or toothache; in which are set forth, theoretically and practically,
for the use of physicians and surgeons, the means of mitigating these
pains, as well as the various modes of ably extracting teeth with or
without instruments_.”[332]

This book merely presents some interest, because it gives us a clear
idea of the pitiful state in which the dental art still was in the
first half of the seventeenth century, and shows us most clearly
what enormous progress our specialty has made in little less than
two centuries. Apart from this, Strobelberger’s monograph is of no
importance, it being nothing more than a most accurate compilation of
all that is to be found on the subject of dental affections in earlier
works, especially from the medical point of view; the surgical part
of dental therapeutics is treated in a much less complete manner, and
prosthesis is entirely excluded from the plan of the work, which,
however, is fully in accordance with the title of the book.

Under the generic name of gout,[333] or podagra, are meant, says
the author (Chapter I), all the affections produced by diseased
humors, falling “by drops” into the articular cavities and the parts
surrounding them. Strictly speaking, however, only gout in the feet is
named _podagra_, whilst when the disease is seated in other parts of
the body it is indicated by other names, gout in the hands being called
_chiragra_; in the fingers _dactilagra_; in the knee, _gonagra_; in the
elbow, _pechiagra_; in the shoulder, _omagra_; in the spinal column,
_rachisagra_, and so on. When the seat of the evil is in the teeth or
in their articulations, by analogy it is denominated odontagra, or
odontalgia, an affection which Paul of Ægina was the first to consider
as being of a gouty nature (Chapter II).

After having spoken of the sensibility of the teeth (Chapter III),
of the various kinds of dental pains (Chapter IV), of the different
causes, external and internal, which produce them (Chapters V to
VII), of the signs which make known their special nature in each case
(Chapters VIII to X), and of the prognosis (Chapter XI), the author
occupies himself very minutely, throughout the rest of the book, with
all that concerns means of cure, dedicating to this subject sixty-seven
chapters and a long appendix.

If, after the publication of Strobelberger’s book, all previous works
treating of dental affections had been entirely lost, it would be of
inestimable value for the history of dentistry, the author having
gathered together in an almost complete manner—citing faithfully the
respective authors—all that had been written about dental diseases
before him. On the other hand, the book contains almost nothing
original; therefore, rather than analyze minutely its contents—which
would involve a long repetition of things already noted—we limit
ourselves merely to a few observations.

Strobelberger, like Heurnius, is of opinion that for the cure of
dental pains it is necessary to have recourse to doctors rather than
to _dentispices_, or tooth drawers (Chapter XII); however, he does
not consider the calling of the latter absolutely useless; indeed, he
expressly advises (page 174) that they should be applied to for the
instrumental extraction of the teeth, it not being possible for such
operations to be carried out well and without danger except by those
who, through great practice, have acquired the necessary skill in the
use of the relative instruments. He refers to the words of Hollerius,
already quoted, as to the falseness of the opinion that fumigations
made with the seeds of hyoscyamus cause the worms to fall out of the
teeth. Notwithstanding, he does not in the least doubt the existence of
the worms themselves; and he, like Heurnius, recommends killing them
with oil of vitriol or with a decoction made from a frog cooked in
water and vinegar (Chapter XXXIII). From this, one clearly perceives
that the doubts expressed by Hollerius about the existence of dental
worms had not in the least shaken the popular belief in them. Nor,
indeed, could it be otherwise when one considers that Hollerius, as
we duly noted in another place, had not the courage either decidedly
to deny the existence of dental worms, or to formulate in a clear
and explicit manner the doubts which had arisen in his mind on this
subject. We are, therefore, unable to recognize the merit which
Linderer[334] and Geist-Jacobi[335] have attributed to this author,
viz., that of having effectually affirmed the non-existence of dental
worms.

Among innumerable vegetable remedies recommended by Strobelberger
against odontalgia, we will only cite two American plants, the guaiacum
and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum
(Chapter XXXVI) the author says that, used as a mouth wash, it has the
triple virtue of strengthening the gums, of preventing putrefactive
processes, and of calming toothache.

The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII)
for the first time in this work, but, as we learn from Strobelberger
himself, Heurnius has already obtained, experimenting in his own
case, the cessation of an attack of toothache by holding in his mouth
spoonfuls of tepid decoction of nicotiana for the space of two hours.

The same soothing effects may be obtained, says the author, from the
smoke of tobacco; but he attributes this not to the narcotic action of
the remedy, but to the fact that it causes the flow of much saliva from
the mouth and mucus from the nostrils, through which the morbid humors
which provoke the pain are eliminated.

To those suffering from odontalgia, says Strobelberger (Chapter XL),
the internal use of certain mineral waters is also of value, and
especially that of the waters of Carlsbad (Thermæ Carolinæ). Like
many other remedies, they are useful in rendering the secretions more
active, favoring thus the elimination of morbid substances from the
blood. For the same object of purifying the organism and dispersing
the accumulated humors causing the pain, many other means of cure
were in usage, such as aperients (Chapter XXV), phlebotomy, and
arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification
and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI),
masticatories, viz., substances intended to be chewed for the purpose
of exciting salivary secretion (Chapter XXVI), sternutatories, viz.,
substances which provoke sneezing (Chapter XXVII), and so forth.

Like Arculanus, Strobelberger makes a distinction between the _real_
and the _false_ cure of odontalgia (_cura vera et cura mendosa_). This
latter he also subdivides in _palliative_ cure and _vain_ cure (Chapter
LV). The palliative cure is constituted by the use of narcotics and
stupefying remedies (Chapter LVI), whilst the vain cure is represented
by certain remedies which he calls “fanatical” or rather “fantastical.”
The _vain_ cure, in its turn, undergoes a new distinction, since it
comprises three species of remedies, that is, the wearing of amulets,
the superstitious remedies, and the ridiculous remedies. Indeed, this
last apellation might also fittingly be applied to the preceding ones!

One would be inclined to believe that the author who qualifies these
remedies as vain, fantastic, superstitious, and ridiculous was a
thoroughly unprejudiced man; however, this is not so. Strobelberger,
too, had to pay his tribute to the dominating prejudices of his
century; this manifestly appears from various passages in his book,
and especially from the Chapters XVI and XLIV. The first of these
bears the following title: “How to procure immunity from toothache,”
and Strobelberger therein asserts in all seriousness, basing his
assertion on the authority of Rhazes, that “if the canine tooth of a
lion be suspended to a child’s neck before the milk teeth fall out
and during the eruption of the second teeth, it will secure the child
immunity from dental pains.” In Chapter XLIV the author speaks of those
animals whose teeth are useful to man as remedies against toothache,
and reiterates—lending, as it seems, perfect faith thereto—various
prejudices that are found in Pliny and other writers of antiquity.

As to the remedies which Strobelberger recognizes as _vain_—that is, as
devoid of real curative virtue—he remarks that they may nevertheless be
useful by acting powerfully on the imagination of the sufferer, thus
causing, in fact, the cessation of pain (Chapter LVII). This clear and
explicit affirmation of the efficacy of suggestion in a book published
270 years ago is certainly not without interest.

If, says Strobelberger, a place is to be accorded, in dental
therapeutics, to the _vain_ remedies, among these, amulets deserve the
preference; and the best accredited amulet is the root of the lepidium,
already recommended by Dioscorides, who affirms that if it be hung
around the neck of the sufferer it will cause the pain to cease.

One of the _superstitious_ remedies to be used against this affection
(Chapter LVIII), consists in touching the aching tooth with the tooth
of a dead person, and afterward greasing it with horse’s marrow.

Among the _ridiculous_ remedies (Chapter LIX), the author describes one
that was especially in use among soldiers. With a piece of chalk or of
rubble one writes on a table:

   Chiacia        Chiacia        Chiacia
  X   O   X      X   O   X      X   O   X

One then pricks the tooth with a knife or an iron toothpick until it
bleeds slightly; then thrusting the point of the instrument, to which
the blood adheres, into the first cross, then into the second, then
into the third, and so on, one asks the patient each time if the tooth
still pains him. Before one gets to the last cross the pain ceases!
This stolid cure, says the author, has no other value than that of the
scarification of the part affected.

Strobelberger held, as did many of the preceding authors, that the
extraction of a tooth ought to be the _last_ remedy, that is, to be
had recourse to when all others, including cauterization, which he
considers as the _last but one_, have proved ineffectual. There are
cases, however, in which the extraction of a tooth is absolutely
indicated, and here, by the way, the author acquaints us with the
following poetic aphorism, which expressed the unanimous opinion of
doctors:

  Si dens pertusus, vel putridus esse notatur,
  Corrumpens alios, tunc protinus ejiciatur.

That is, if one finds that a tooth is hollow or decayed, and corrupts
the others, it must at once be extracted.

Strobelberger, like the greater number of his predecessors, is fully
persuaded that diseased teeth may be made to fall out by the use of
special remedies; indeed, this clearly appears from the title of the
work itself, as, without doubt, the reader will already have observed.
Such remedies are called by him “odontagoga,” and he describes them
at great length in five different chapters (X to XIV) of the second
section of his book, dedicated to the surgical care of the teeth.

In regard to _violent extraction_ of teeth, Strobelberger shows still
greater cautiousness and timidity than Celsus or Abulcasis. He requires
that, after the gum has been detached, one should endeavor to extract
the tooth with the fingers or by means of a thread; if, however, this
does not succeed, one may have recourse to the trifid lever; only at
last, that is, when even the lever has failed, does he allow the use of
an appropriate dental forceps.

[Illustration: Wilhelm Fabry.]

ARNAULD GILLES, a Frenchman, in the year 1622, published in Paris a
work whose curious title we will here note: _The flower of the remedies
against toothache_.[336] We know nothing else about this publication,
which, however, to judge from its title, cannot be other than a mere
compilation.

DUPONT, another Frenchman, in 1633, published an important pamphlet,
which I have, unfortunately, not been able to see. I can, therefore,
only quote what Sprengel says of it.[337] Dupont recommends, in cases
of obstinate toothache, the extraction and immediate replantation of
the tooth; which, he says, becomes quite firm again, but will no more
cause any pain. In confirmation of this, Denis Pomaret related, a
little later, a case in which a healthy tooth having been pulled out
by mistake, and immediately put back into the socket and treated with
astringent remedies, became perfectly firm again.[338]

Although Abulcasis and Ambroise Paré had already recommended the
replantation of teeth, the loss of which had been caused by trauma,
and although Peter Foreest had already made known as a result of his
own personal experience that the luxation (not, however, complete
extraction) of a tooth and its successive replantation is capable of
causing toothache to cease, nevertheless, we must recognize that the
merit of having elevated replantation in non-traumatic cases to a
special method of cure must be attributed to Dupont.

WILHELM FABRY (1560 to 1634), a German, and native of the small town
of Hilden near Cologne, better known by his Latin name of Fabricius
Hildanus, was chief doctor to the city of Berne, and acquired great
fame as well by his extraordinary professional ability as by his works,
consisting principally in reports of many hundreds of important and
instructive clinical cases. He is rightly considered one of the most
illustrious German surgeons. His writings have largely contributed not
only to the progress of surgery in general, but also to that of dental
surgery in particular.

One of his observations clearly shows the etiological relation
frequently existing between a prosopalgia or a supposed hemicrania and
a dental affection. The case referred to is that of a lady who had been
subject for six months to violent pain in the upper teeth of one side
of the jaw. The toothache little by little disappeared, giving place to
an obstinate cephalalgia in the same side of the head, which gradually
became so intense as to be perfectly insupportable, the patient being
particularly subject to it when the weather was cold and damp. After
four years of atrocious suffering, and after innumerable remedies had
been tried without avail, Fabricius Hildamus—having had the luminous
idea of seeking the cause of the evil in the teeth—obtained a complete
cure, without further trouble, by extracting four of the patient’s
teeth, which were decayed.

Nowadays, it is an all-important canon of medical practice, that
in every case of neuralgia occurring within the region influenced
by the trifacial nerve one should give particular attention to the
state of the teeth and carefully treat every affection of the same.
Notwithstanding—we say it with regret—there are still medical men who
ignore or neglect this precept, and prescribe internal remedies or
have recourse to injections of morphine when they ought, in the first
place, to call in the aid of a dentist. How many patients would have
been delivered from slow martyrdom if the example of the clear-seeing
physician of Berne had been followed from his days up to the present
time!

Fabricius Hildanus relates, besides, many cases of dental fistula,
cured by him through the extraction of roots or of decayed teeth. In
one such case the fistula dated from fourteen years back. Fabricius
Hildanus, contrary to the opinion of many other doctors, extracted a
decayed tooth, and by this operation obtained, in a brief period of
time, the complete recovery of the patient.

Among the many very important clinical cases cited by Fabricius
Hildanus, the following deserves to be recorded: In the year 1590 a
woman presented herself to him who had a hard tumor in the space behind
the last molar on the right side. The author, after having prepared
the patient for the operation by the methods then in use (that is, by
aperient medicine, by bleeding, and appropriate diet), destroyed the
tumor by the application of escharotic substances. The remaining wound,
however, defying all the cicatrizing remedies which the author had
recourse to, one after the other, by reason of its being continually
disturbed by the movements of the jaws, he then thought of maintaining
the dental arches in a determined position, and this he obtained by
means of two pieces of wood somewhat hollowed out above and below,
which he placed on the right and on the left between the upper and the
lower teeth, fixing them to the teeth themselves by brass wires passing
through two openings made expressly in each of the two pieces of wood.
In this way he succeeded in obtaining the absolute immobility of the
jaws and the complete cure of the wound in a few days, during which
time the patient was nourished with liquid food.[339]

A very interesting case, inasmuch as it demonstrated the damage and
peril which may result from certain absurd means of cure, was reported
to this author by Claudio Deodato, physician to the Prince-Bishop of
Basle. The case was that of a patient who, after having tried in vain a
great number of remedies for a stubborn toothache, finally had recourse
to the use of aqua fortis; but this substance, which in those days was
in frequent use for dental caries and for toothache, produced most
deleterious effects in the patient, that is to say, the loss of almost
all his teeth, necrosis of the inferior jaw, with fistulous sinuses and
ulceration of the neck, abundant sanious discharge, fever, a cachectic
condition, incipient necrosis of the upper jaw, etc.[340] Fabricius
Hildanus, consulted by Claudio Deodato about this most serious case,
proposed both a local and a general treatment, the result of which is,
however, not mentioned in his book.

In the fifth “_centuria_ of medical and surgical observations and
cures”[341] we find a case of oral surgery, to which it is worth while
briefly to refer here. It relates to an epulis situated next to the
upper canine of the left side. The tumor, already of ancient date,
had at this time reached the size of a walnut, was very hard, livid
in color, irregular in form, and adhered somewhat to the upper lip;
according to the author, it was of a cancerous nature. After the usual
preparative measures, Fabricius Hildanus proceeded to the ablation of
the tumor, and to this end he first pierced it with a curved needle and
strong thread, in order to get a good hold on it, and he then removed
it entirely down to the bone, by means of a curved bistoury.[342]

Fabricius Hildanus, having dissected several abortive fetuses of under
four months, was able to verify the exactitude of the assertion made
by Hippocrates, afterward luminously confirmed by different Italian
anatomists, that the teeth begin to be formed during intra-uterine
life. And with reference to this he also relates the following fact:

The wife of a Protestant minister gave birth to a female child which
already had a fully developed tooth, a lower middle incisor, equal in
size to that of a child of two years old, and which interfered with the
sucking by injuring the nipple of the mother’s breast and the tongue of
the child itself. So it was necessary that it should be removed. But it
was found to be so firm that the surgeon sought in vain to extract it
with a thread, and was obliged to have recourse to the forceps.[343]

Observation XXXI of the third _centuria_ relates a case of rhinoplasty.
In the year 1590, when the Duke of Savoy made war on the inhabitants of
Geneva, a girl named Susanna N. fell into the hands of the soldiers,
who tried to deflower her; enraged at not succeeding in their intent,
they cut off her nose. Two years later the girl went to Lausanne,
the residence of J. Griffon, an eminent surgeon of that time, who
performed the rhinoplastic operation on her in so splendid a manner
that one would have taken the new nose for a natural one, not only
from its normal appearance, but also because the scar was hardly
visible. Fabricius Hildanus, having had occasion to see and examine
the patient several times, even up to twenty-one years after the
operation, was able to testify to the perfect condition of the nose;
in the extreme cold of the winter, however, it was apt to become livid
at the point. He does not describe the operative process followed by
Griffon, but merely says that the first inventor of this operation was
Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had
undertaken the reproduction of the same from his own conception of it,
based on the information imparted to him in conversation, by an Italian
who had been operated upon by Tagliacozzi.

JOHANN SCHULTES (1595 to 1645), a physician in Ulm, was the author of a
very important work entitled _Armamentarium chirurgicum_, in which are
given plates and descriptions of almost all the surgical instruments
that had been in use up to that date. As to the part relating to dental
and oral surgery, we find the following instruments named in this work:

1. Several kinds of pelicans; an instrument which was so called from
its resemblance to the beak of the bird of the same name, and used for
extracting the molar teeth.

2. The common dental forceps, then named _cagnolo_ by the Italians,
because of the supposed likeness to a dog’s muzzle.

3. The crow’s beak forceps (_rostrum corvinum_), designed for the
extraction of dental roots, and, therefore, corresponding to the
rhizagra of Celsus.

4. Two special dental forceps, or _dentiduces_, for the removal of
teeth which could not be extracted either with the pelican or with the
common dental forceps.

5. Bifid and trifid elevators (_vectes bifidi et trifidi_), to be used
for the extracting of incisors and canine teeth, as well as roots.

6. _Dentiscalpia_ for detaching the gum from the tooth before
proceeding to extract it, in order that this may be the more easily
accomplished and with less danger.

7. A silver funnel or cannula (_infundibulum seu fistula argentea_),
for nourishing patients affected with trismus, by conveying liquid food
into the fauces, through the free space behind the last molars.

8. Forceps more or less like in form to the beak of the parrot or the
vulture (_rostrum psittacinum et vulturinum_), for the removal or
resection of teeth that have grown in abnormal positions.

9. A screw dilator (_dilatatorium cum cochlea_), for gradually opening
the dental arches in cases of spasmodic constriction of the jaws.[344]

[Illustration: _A plate of Schulte’s “Armamentarium Chirurgicum,”
showing some dental and other operations._]

[Illustration: FIG. 77

A plate from Schultes’ “Armamentarium chirurgicum,” showing several
dental instruments.]

MARCO AURELIO SEVERINO (1580 to 1656), of Tarsia, a celebrated
professor of surgery in the Neapolitan University, had a great
predilection for the use of the cauterizing iron, which he also used
very frequently in curing caries and other dental diseases. At times,
to effect a cessation of violent toothache, he would have recourse to
the cauterization of the antihelix! Against flaccidity of the gums and
loosening of the teeth he also used cauterization, disapproving the use
of astringent substances, as these cannot get so far as the roots of
the affected teeth. Severino boasts of having cured by cauterization at
least two hundred cases of dental diseases.

LAZARE RIVIÈRE (1589 to 1655), a professor at the University of
Montpelier, also known by his latinized name of Lazarus Riverius,
treats of dental affections and their cure, in various parts of his
works, considering them, however, almost exclusively from a medical
point of view.

He speaks first of all of the different causes of odontalgia, and,
among these, does not omit to mention worms. These, he says, may
be generated in the carious cavities, owing to the putrefaction of
substances retained in their interior. Whenever odontalgia is caused
by worms, the pain, says Rivière, is not continuous, but ceases and
returns at brief intervals; besides, the sufferer perceives at times
the movement of the worm inside the tooth!

What one reads in the works of this author as to remedies to be used
for odontalgia clearly demonstrates how irrationally dental diseases
were treated in the seventeenth century and what tortures were
inflicted on the patients. In many cases, and especially when the pain
was held to be occasioned by “hot humors,” the treatment was begun by
bleeding in the arm. The following day an aperient was administered.
Afterward, if the pain still persisted, the sufferer was cupped in
the region of the scapulæ or of the spine, blisters were applied to
the nape of the neck or behind the ears, resinous plasters to the
temples; all this without taking into account the remedies which were
introduced into the ears, or the various medications or operations
performed on the aching part itself, and many other things besides.
In fact, in order to cure a toothache, the whole body of the sufferer
was seized upon and put to torture, and in the majority of cases they
assuredly finished by extracting the diseased tooth! When we reflect
on the extraordinary frequency of dental disorders we cannot do less
than recognize that the dentists, by the radical change effected in the
methods of treatment, have diminished in no small degree the sufferings
of humanity!

According to Rivière, the small veins (sic) that nourish the teeth pass
through the ear (!); and this would explain how the cessation of a
toothache may be obtained by the introduction of certain remedies into
the meatus auditorius externus. Relief may be obtained, for instance,
by dropping oil of bitter almonds into the ear on the side affected by
the pain, or by allowing the vapor of hot vinegar, in which pennyroyal
or origanum has been boiled, to penetrate into it. Others, adds the
author, pour a little pure vinegar into the ear, which is especially
efficacious against “hot fluxions.” When, however, the toothache
depends on a “cold fluxion,” it calms the pain wonderfully to drop
into the ear a tepid mixture of garlic juice and theriac. The same
advantage, says the author, may be obtained by introducing a piece of
garlic, peeled and cut into the form of a suppository, into the ear.

The author also makes a lengthy enumeration of anodyne and narcotic
remedies (among which opium), observing, however, that those remedies,
unless the vehemence of the pain obliges the use of them, ought not
to have the preference, it being much more rational and much more
advantageous to institute a cure which aims directly at the cause
itself of the pain (fluxions, worms, etc.).

He informs us that Amatus Lusitanus, a celebrated physician of the
sixteenth century, extolled, as a remedy for toothache, a decoction of
gum sandarach in wine and vinegar; the said decoction was to be made
with an ounce of sandarach in six ounces of wine and the same quantity
of vinegar, and ought to be kept in the mouth some length of time,
whilst hot.

Rivière further speaks of various masticatories, which were composed of
mastich, staphisagria, pyrethrum, henbane, etc.

He also mentions oil of cloves, which even then was used against
toothache, by introducing into carious cavities a small piece of
cotton-wool soaked in it. Oil of camphor was used in the same manner,
but the most efficacious of all, according to the author, was oil of
boxwood.

As to worms in the teeth, they may be destroyed by the use of bitter
substances!

In the case of a caries penetrating into the inner cavity of the tooth,
to effect the cessation of pain, it is necessary to burn the nerve with
the actual cautery, or with aqua fortis, or with oil of vitriol. If
this be repeated several times, the tooth gradually falls to pieces.

After having enumerated all these remedies, the author speaks of the
extraction of the teeth, and of all the precautions with which this
must be carried out in order to avoid the various accidents which may
result from the operations and may even, sometimes, become a cause of
death.

When abundant hemorrhage follows the extraction of a tooth, this may
often be made to cease by applying a small, very compact ball of linen
into the alveolus and maintaining it there by pressure during one or
two hours. Should this not suffice, one can combine with compression
the use of astringent substances. Finally, as a last remedy, use may be
made of the red-hot iron.

In the case of timid patients, who shrink from an instrumental
operation, recourse may be had to eradicating remedies, the
author being fully convinced of their efficacy. Indeed, one of
these—helleboraster—is said to be so powerful that, when rubbed on
the teeth, these fall out within the space of a few hours; for which
reason it is absolutely necessary, in making use of it, to cover over
the neighboring teeth with wax, so that the healthy ones may not also
fall out, as happened, says the author, in the case of a poor peasant.

The internal use of mercury, and even the use of certain mercurial
preparations used by women as cosmetics, is of damage to the teeth and
imparts to them a blackish or dirty looking color.

Numerous remedies exist for cleaning the teeth, but according to
Rivière the best way of cleaning them consists in rubbing them with
a small stick immersed in sulphuric acid (_spiritus sulphuris aut
vitrioli_) and afterward drying them with a piece of linen. This remedy
not only cleans and renders the teeth white, but it preserves them also
from caries! If the teeth are very dirty, the spirit of vitriol may be
used pure; otherwise one mixes it with _mel rosatum_ or with water.

The great enthusiasm shown by Rivière for the above-mentioned remedy
does not, however, derive from a long experience, made by himself or by
others, of its advantages, but is based principally on a fact referred
to by Montanus, and which,[345] we will here recount, because, from it,
one clearly perceives how credulously our forebears accepted general
affirmations and formulated therapeutic precepts.

Montanus recounts in one of his writings, how, being in Rome in his
early youth, he became acquainted with a woman of about twenty years
of age, known by the name of Maria Greca (by the way the author speaks
of her, one is led to suspect she was a courtesan); and how, having
seen her again, thirty years later, and found her in pretty much
the same conditions as formerly, he expressed his surprise at this;
whereupon Maria Greca told him that she herself believed that she owed
the conservation of her beauty to the habit, already of many years’
standing, of using one or two drops of oil of vitriol every morning, as
a friction for the teeth and gums. In her youth she had had very bad
teeth, but by reason of this cure they had become, and were at the time
being, beautiful and perfectly firm; the gums also were in excellent
condition; it seemed, therefore, to her that this conservation of
health and freshness, in spite of her fifty years, depended precisely
on the daily use, in the manner described, of oil of vitriol![346]

Rivière, besides, recommends tobacco ashes for cleaning the teeth, a
counsel not yet given by any previous author. He also gives the formulæ
for two dentifrice powders, the basis of which is alum; he calls
attention to the great importance of taking assiduous care to keep
the teeth clean, and advises that after each meal the residues of food
be removed from the interstices of the teeth and the mouth well rinsed
with wine.[347]

NICOLAUS TULP, in Latin, Tulpius (1593 to 1674), a distinguished
physician and anatomist of Amsterdam, contradicts the then prevailing
opinion among doctors, that is, that the cure of dental affections
and the operations relating thereto were matters to be held in little
account. He observes that diseases of the teeth may give rise to the
most serious consequences, which can even be the cause of death,
and are, therefore, worthy of being taken into equally serious
consideration as all the other diseases of the several parts of the
human body.

This author relates a clinical case tending to demonstrate how
incisions made in the gums, advised in the first place by Vesalius,
in order to facilitate the erupting of the last molar, are not always
exempt from danger. A young doctor of Amsterdam, by name Goswin Hall,
being tormented by insupportable pain caused by the difficult eruption
of a wisdom tooth, had the gum lanced above it. But the pain, instead
of diminishing, became worse; fever and delirium supervened, followed
by death! (Here, however, we must be allowed to observe that nothing
demonstrates that the real cause of death was the lancing of the gum,
or that without this the case would have had a different termination.
An event can occur after another and yet be quite independent of the
former and result from quite different causes.)

Among the cases cited by Tulp, the following is also worthy of
mention. He relates having arrested a violent and persistent attack of
hemorrhage, which came on after the extraction of a tooth, by applying
and compressing a piece of sponge inside the alveolus.[348]

The belief that dental caries and toothache could be caused by worms
was, at that time, still in full vigor, and it gained still greater
force by reason of observations recorded by different scientists, whose
affirmations could with difficulty be doubted, for at that period the
greater number still swore blindly _in verba magistri_.

OLIGERUS JACOBAENS (1650 to 1701), a Danish physician and anatomist,
who taught in the University of Copenhagen, declared that in scraping
the decayed cavity of a tooth that was the cause of violent pain, he
had seen a worm come forth, which, having been put into water, moved
about in it for a long time.

MARTIN SIX, having split some decayed teeth a short time after they had
been extracted, asserts that he determined the existence of worms in
them. (It is probable that this observer, as well as others, mistook
the dental pulp for a worm, an unpardonable error, in truth, at a time
when the anatomical constitution of the teeth had already been very
well studied by several scientists, and especially by the celebrated
Bartolomeo Eustachius.)

GABRIEL CLAUDER (1633 to 1691) not only believed in dental worms, but
maintained besides that these were the most frequent among all the
causes of toothache. In a certain way, to sustain this opinion of his,
he relates a case in which a tooth of healthy appearance being the seat
of great pain, a tooth-drawer had asserted that there must be a worm in
its interior; and, in fact, on the tooth being extracted and afterward
split, the little animal whose existence the tooth-drawer had divined,
was found to be existing inside of it!

PHILIP SALMUTH asserts that by using rancid oil he got a worm out of
the decayed tooth of a person suffering from violent toothache, thus
causing the cessation of the pain. The worm, he says, was an inch and a
half in length (!) and similar in form to a cheese maggot.

NICOLAUS PECHLIN (1646 to 1706), professor of medicine at Kiel,
testifies to having seen five such dental worms, like maggots, come out
by the use of honey, though he does not say whether they issued from
several cavities or from one only!

GOTTFRIED SCHULZ. But all this is nothing compared to what Gottfried
Schulz has dared to assert, viz., that by using the gastric juice of
the pig, worms of great size can be enticed out of decayed teeth; some
of these even reaching the dimension of an earth-worm!

It is not much to be wondered at that these things should have been
blindly believed in, if we reflect that only a short time previous
to this the story of the golden tooth had been taken seriously by
men of great erudition, and that in the very epoch of which we are
speaking the illustrious anatomist THOMAS BARTHOLIN (1616 to 1680), of
Copenhagen, relates having seen a man, at Padua, who had an iron tooth!
Besides, the possibility of such a phenomenon was explained in a most
curious manner by THOMAS MINADOUS, who explained that in the same way
as iron is generated in the macrocosm, that is, in the world, so it is
equally admissible that it may be generated in the microcosm, that is,
in man![349]

NATHANIEL HIGHMORE. In the year 1651 the English physician and
anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a
treatise on anatomy (_Corporis humani disquisitio anatomica_, etc.), by
which he acquired a celebrity superior, perhaps, to his merits. This
work, however, served without doubt to diffuse the knowledge of an
anatomical fact of the highest importance, especially from the point of
view of dentistry and surgery.

There is no doubt that the existence of the maxillary sinus was already
known before Highmore, the celebrated anatomists Vesalius, Ingrassias,
Eustachius, and Fallopius having spoken of it very clearly; only
through ignorance of the history of anatomy has it been affirmed by
many that this cavity was discovered by Highmore, to whom is only
due the merit of having described the maxillary sinus, by him called
_antrum_, most accurately, and of having made known the possibility
of a communication between it and the mouth. Highmore calls attention
to the fact that the inferior wall of the antrum often presents small
projections, which correspond with the tops of the alveoli, and that
the osseous lamina which interposes between these latter and the
maxillary sinus is often extremely thin; for which reason, it may
easily happen that, in extracting one of the teeth below the cavity,
one may bring away together with the tooth the small osseous plate that
forms the bottom of the alveolus, thus leaving the maxillary sinus
open at its inferior part. With regard to this, he refers to a most
interesting case which afterward acquired a high degree of notoriety.
It relates to a lady who had suffered from toothache for some years,
and who from time to time had had several decayed teeth extracted,
without, however, finding relief. The pain only ceased after the
patient had had the left upper canine removed. But after this operation
an incessant flow of humors from the alveolus of the extracted tooth
took place. The patient, in great anxiety at this circumstance and
desirous of seeing clearly into the causes of it, herself explored
the affected part with a silver probe, the entire length of which
penetrated into the cavity, producing in the patient the effect of its
having reached the eye. Still more amazed, and urged on by the desire
of becoming still better acquainted with the extent of the evil, she
now made use of a long feather, which she had previously stripped,
and discovered to her painful surprise that this new instrument of
exploration entered to so great a distance that it, according to her
idea, penetrated into the skull. From this she derived argument for
the belief that the morbid phenomenon had its origin in her brain.
Believing herself affected with a serious malady, she consulted
Highmore, who had the satisfaction of being able to tranquillize her
completely by making her understand that the jaw bone is hollow in the
inside, and that its cavity had remained open underneath in consequence
of the extraction of the canine tooth; and also, that the feather had
not penetrated to such a distance as she supposed, but had curved
inside the bone. As to the discharge which had given so much trouble
and alarm, Highmore considered it quite a natural circumstance, derived
simply from the opening of the antrum, as he held that in many cases
the maxillary sinus contains mucus, and that this condition was,
therefore, altogether normal. So he did not propose any treatment, and
the lady thenceforth supported her infirmity with resignation.

This most interesting case soon became generally known, and
contributed, without doubt, not a little to attract the attention of
medical men to the anatomical peculiarities which Highmore had pointed
out in the upper maxillary bone, thus causing his name to become
inseparably associated with the maxillary sinus.

It is evident, however, that Highmore never even suspected to what
very important practical applications his description would give rise.
He knew nothing about the diseases of the antrum, and believed that,
even in perfectly normal conditions, this cavity is often filled with
liquid; the idea, therefore, of its being advisable, in certain cases,
to extract a tooth and perforate the alveolus in order to give exit to
the liquid contained in the maxillary sinus never occurred to him.

About fifty years went by before a rational treatment for affections of
the antrum was initiated, the merit of which, as we shall see at its
time and place, was due to William Cowper. During that half century
maladies of the maxillary sinus continued to be badly diagnosticated
and badly treated.

BERNARDO VALENTINI. In the year 1686, that is, thirty-five years after
the publication of Highmore’s book, Bernardo Valentini, professor at
the University of Giessen, described a case of tumefaction and abscess
in the cheek, treated by him with emollient remedies, and in which,
although according to him caries of the underlying bone did not exist,
the separation of a sufficiently large osseous fragment took place.
Without doubt the affection of the cheek was derived in this case from
some disease of the antrum; however, it would appear that Valentini
did not in the least perceive any such casual relation, as he makes no
allusion whatever to it.[350]

ANTONIO MOLINETTI, professor at the University of Padua, had,
however, ten years previously, diagnosticated and cured an affection
of the antrum by means of an operation. In his book _Dissertationes
anatomico-pathologicæ_, published at Venice in 1675, Molinetti relates
that in a case of abscess of the maxillary sinus, which caused the
patient great suffering, he performed the operation of trepanning the
upper maxillary bone anteriorly, after incision of the soft parts
overlying it. In a certain way we may, therefore, consider Molinetti as
a precursor of William Cowper.

Having spoken of the very important anatomical fact illustrated by
Highmore, we will now also speak briefly of those authors who, in
the seventeenth century, occupied themselves with the anatomy of the
teeth. Their number is sufficiently large; we will, however, only make
mention of such as contributed to the development of this branch of
science, or who, at least, expressed some opinion worthy of note.

The celebrated anatomist ADRIAN SPIEGEL (1578 to 1625), better known by
the Latinized name of _Spigelius_, wrote nothing noteworthy about the
teeth, but he appears to have been the first to affirm that the teeth
are more firmly fixed in the alveolus, when their roots are curved
after the manner of hooks.[351]

DIEMERBROEK, a Dutchman, relates several cases of dental anomalies,
as for example, of teeth being cut in the palate, and which injured
the tongue. The author cites his own case, relating that having
had a canine tooth extracted when well advanced in years, it was,
nevertheless, succeeded by a new one. He relates, besides, that he
had seen in Utrecht a woman, aged fifty-six years, who again cut two
incisors after having lost the former ones two years previously. Apart
from this, Diemerbroeck tells us nothing of interest or importance
regarding the teeth, often repeating old ideas, the falseness of which
had already been luminously demonstrated. For instance, he says that
the permanent teeth are developed from the roots of the deciduous ones
remaining in the alveoli; an unpardonable error for an anatomist of
the seventeenth century, for which he was afterward taken to task by
Duverney.[352]

THOMAS BARTHOLIN, whom we have already mentioned, speaks of a tooth
which had made all the round of the alveolar border; that is to say,
of a dental arch constituted by a single piece; and the Italian
anatomist BERNARDO GENGA makes mention of an analogous case.[353] It is
superfluous to add that these authors allowed themselves to be deceived
by false appearances, owing especially to an abundant and uniform
deposit of tartar on the surface of the teeth and in their interstices,
which gave to the dental arch the appearance of one continuous piece.

RINALDUS FREDERICUS, in his erudite dissertation entitled _De dentium
statu naturali et præternaturali_, spoke of the dental system with
sufficient thoroughness, if we consider the epoch in which he wrote. He
commences his work with a long chapter on the importance and dignity
of the teeth (_dignitas dentium_). Among other things, he relates that
formerly, in certain parts of India, the teeth were so highly valued as
to be offered in sacrifice to the gods. He says, too, on the authority
of certain authors, that the ancients were led to believe that the
teeth served for the resurrection of the body, from the circumstance of
their not showing signs of corruption when found in sarcophagi.

Discoursing of the genesis of the teeth, Fredericus says that “every
tooth is at first enclosed within a follicle, that is, in a frail,
skin-like membrane, in the same manner as the grain in the wheat-ear.”
Taking this comparison as his point of departure,[354] he gives to
dentition the name _germination_.

This author says that the teeth of the Ethiopians and of the Indians
are generally whiter than those of the northern peoples, but that those
of the Indians soon lose their primitive whiteness by reason of the
widely diffused habit of chewing betel-nuts.

Fredericus refers to an experiment which, according to him,
demonstrates the “sympathetic relations” between the teeth and the ear
(whilst in reality it only proves the facility with which sounds may be
transmitted through solid bodies). “If, by night,” says he, “one holds
tightly between one’s teeth the end of a stick, stuck upright in the
ground, one hears the footsteps of a person approaching from afar much
more easily.”

Through the researches of three great men, Marcello Malpighi, Friedrich
Ruysch, and Antoni van Leeuwenhoeck, an altogether new science arose
in the seventeenth century, viz., histology, or the anatomy of the
tissues, whose revelations contributed not a little to the development
of modern odontology.

MARCELLO MALPIGHI (1628 to 1694), the celebrated Italian anatomist,
was the initiator of microscopic observations on the tissues, and is,
therefore, justly considered the founder of histology, within the range
of which he made most important discoveries.[355]

FRIEDERICH RUYSCH (1638 to 1731), professor at Amsterdam, rendered
his name illustrious particularly by bringing to a high degree
of perfection the processes of anatomical preparations and of
embalming.[356]

His magnificent injections, carried out with a method of his own
invention, enabled him to trace the most minute vascular ramifications
and to demonstrate the existence of capillary vessels in parts where
their presence had as yet never been suspected.

Ruysch studied accurately the anatomical constitution of the teeth, and
especially their vessels. He called attention to the membrane which
lines the maxillary sinus, and discovered in it a number of bloodvessels.

But in addition to his purely anatomical observations, this author
also merits our consideration from the point of view of pathology. He
confirmed a most important fact to which allusion had already been made
by preceding authors, that is, the atrophy of the alveolar parietes as
following on the extraction or on the falling out of teeth. Ruysch,
however, makes the observation that atrophy of the alveolar parietes
may also precede the falling out of the teeth, and rather be the cause
than an effect of it. In such cases the teeth, before falling out,
always become more and more loosened, proportionately to the atrophic
process. This pathological condition, against which none of the
astringent remedies habitually used are of avail, is mostly considered,
says Ruysch, to be owing to scurvy; but, he adds, the accumulation
of tartar may also be the cause of it. Substantially, Ruysch affirms
the relation existing between the accumulations of tartar and the
production of that very frequent disease that was afterward named
expulsive periodontitis or alveolar pyorrhea.

This author also relates two cases of polypous affection of the
maxillary sinus. In one of these cases, the existence of a polypus in
the maxillary sinus was determined by Ruysch while dissecting a corpse.
The other case relates to a female patient upon whom two surgeons had
performed the extraction of several molar teeth and the extirpation of
an epulis believed by them to be of a malignant character. After the
operation they cauterized the diseased part to a great depth with a
red-hot iron, reaching as far as the maxillary sinus, which remained
open, and from which Ruysch afterward extracted with his little finger
several polypi.[357]

ANTONI VAN LEEUWENHOEK (1632 to 1723), like the preceding author, a
Dutchman, was the first maker of powerful microscopes, by means of
which he made many important discoveries; among others, that of the
tubular structure of the dentine or tooth bone. This discovery he made
known and demonstrated in the year 1678, before the Royal Society in
London. In his description of the structure of the teeth, Leeuwenhoek
says that 600 to 700 of the dentinal tubuli have hardly the consistence
of one hair of a beard.[358]

In the year 1683 he discovered in the tartar scraped from between
the teeth a form of microörganism upon which he laid special stress.
This observation he embodied in the form of a contribution which was
presented to the Royal Society of London on September 14, 1683. This
paper is of particular importance, not only because of the careful,
objective nature of the description given of the bodies seen by him,
but also for the illustrations which accompany it. From a perusal of
the text and an inspection of the plates, there remains little room for
doubt that the bodies described by Leeuwenhoek were not animalcules, as
he believed, but bacteria.[359]

DOMENICO GAGLIARDI, professor of anatomy and of medicine at Rome,
published an excellent work on the anatomy of the bones,[360] in which
he occupies himself not only with the structure of bones, properly
so called, but also with that of the teeth. He considers the enamel
to be formed by parallel and contiguous fibers, coated, so to speak,
by a concreted juice, _sui generis_, which acquires a much greater
consistence than that of the bones. Gagliardi says that by rubbing
teeth hard together, or striking them with a steel, he was able to
extract sparks from them.[361]

JEAN DUVERNEY (1648 to 1730), a celebrated French anatomist, wrote
a good monograph[362] about the teeth. As different anatomists of
the sixteenth century had already done, he examined many fetal jaws
in order to study in them the formation of the teeth. In relating
his observations, he says that he found in every alveolus a mass of
soft viscous matter, having the form of the tooth that is to derive
from it, and which may be considered as its nucleus. This nucleus
is entirely surrounded by a membrane, which the author likens to
that which surrounds the fetus, and to which he gives the name of
_choroid membrane_. From the surface of the nucleus a gelatinous juice
transpires, which, thickening in layers, forms the enamel and the rest
of the tooth. The choroid membrane is abundantly furnished with nerves,
and with blood and lymph vessels. Into the interior of the teeth
penetrate vascular and nervous branches which serve to maintain its
vitality. In fetal jaws one finds, besides the germs of the deciduous
teeth, also those of the permanent ones. The “choroid membrane” does
not follow the tooth when it issues from the alveolus; it remains
instead within the latter, forming the peridental membrane.

Duverney says that in old people the root cavity diminishes in so
considerable a manner, and the vessels are so compressed that they
almost entirely disappear. It is then that a period of decadence begins
in the tooth, it is more feebly nourished, wears away more rapidly than
hitherto, and becomes shorter.

The author also speaks of senile atrophy of the jaws, especially of the
alveolar processes. With regard to this, he observes that if in old age
the lower jaw advances beyond the upper, this depends wholly on the
disappearance of the alveolar border, which projected more in the upper
than in the lower one.

Duverney admits the existence of direct vascular relation between the
gums and the teeth; because in the case of diseases of the gums it is
rare not to find the teeth altered as well.

From the point of view of the development and nutrition of the teeth,
Duverney finds much analogy between the tusks of the elephant, the
teeth, properly so called, the feathers of birds, and the hair of
mammifera.[363]

GOTTFRIED BIDLOO, a Dutch anatomist, expresses the idea that the air
contributes, after the eruption of the teeth, to hardening them. He did
not, however, give any proof of this opinion of his.[364]

CLOPTON HAVERS, an Englishman, wrote a book on osteology, by which he
acquired great reputation,[365] and in which he treats as well of teeth
and their structure. This author believes the enamel of the teeth to be
of the nature of stone, and the ivory of the nature of bone. The dental
roots, which, he says, are precisely of a bony nature, are covered over
with a periosteum, which is in close relation with the gums and with
the periosteum of the jaw bone. Clopton Havers held that the dental
follicle no longer furnishes any nourishment to the enamel from the
moment that this has reached its perfect formation. On the other hand,
he assures his readers that he has observed, through the microscope,
nervous threads which, departing from the bulb of the tooth, traverse
the ivory through small canals, arriving thus at the periosteum. By
this anatomical disposition the sensibility of the teeth may, according
to him, be explained.[366]

Having made this passing allusion to the anatomy of the teeth in the
seventeenth century, we will now resume the illustration of those facts
relating to the pathological and curative part of the science.

WALTER HARRIS, an Englishman, in a pamphlet on acute infantile
maladies,[367] recommends again, in cases of difficult dentition, the
incision of the gums, a curative practice which had already fallen into
disuse.[368]

In the authors of that time we find registered a great number of cases
of epulis. HIOB VAN MEEKREN speaks of an enormous tumor of the gum that
developed in consequence of a traumatic action which had occasioned
the loss of a tooth. Before deciding on the extirpation of the tumor,
the author thought well to pierce it with a bistoury, to be able to
judge whether its ablation might not possibly give rise to a dangerous
hemorrhage. The wound having bled but little, he proceeded to operate;
but the tumor was so large that it was necessary to remove it in
various portions.[369]

The same author refers to a case of a soft epulis, bleeding easily,
that developed after a badly performed dental extraction. It was to
be foreseen that the ablation of such a tumor would give rise to an
abundant hemorrhage. This was, however, staunched by simply using
astringent powders, without having recourse to the actual cautery,
which the operator had held in readiness.[370]

DANIEL MAJOR, wishing to remove a large epulis by tying it, was
obliged, in order to keep the ligature in position, to pass the thread
through a circular incision made at the base of the tumor. He first
used a thread of silk, afterward a silver one, and tightened the
ligature every day until the epulis fell off.[371]

JOHANN ACOLUTHUS was obliged, in order to extirpate a large epulis,
to previously split the labial commissure. After the ablation of the
principal mass of the tumor, he destroyed the remaining part of it by
application of the red-hot iron.[372]

One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin,
Preuss, Bern, Valentini, etc. This last author even speaks of an
epidemic of epulis. However this may be, it is very probable that
epulis was much more frequent in past times than it is now, and this
probably depended partly on the incongruous modes of treating diseases
of the mouth, and partly on the slight attention paid to cleanliness of
the teeth.

KORNELIS VAN SOOLINGEN, a celebrated Dutch physician and surgeon,
who flourished toward the end of the seventeenth century, speaks
contemptuously of dental operations, and especially of extractions.
He says that such operations ought to be left to charlatans, used to
taking out teeth with the point of the sword, and to doing many other
things of like nature! This unjust contempt was at that time widely
diffused in the medical class, it resulted, however, substantially,
from the great difficulties encountered by doctors and surgeons in
general, in performing the operation of extraction, owing to want of
practice, and also from the desire to avoid the responsibility of the
accidents to which the extraction might give rise; so true is this,
that an author of the preceding century, THEODOR ZWINGER (1538 to
1588), a celebrated Swiss doctor and professor at Basle, had declared
with great frankness that the extracting of teeth ought to be left
to barbers and charlatans, as it might easily occasion unpleasant
accidents, such as fractures of the jaw, laceration of the gums,
serious hemorrhage, and the like.

In spite of his contempt for practical dentistry, Kornelis van
Soolingen takes the treatment of dental affections into attentive
consideration. For the stopping of carious teeth, he recommends a
mixture similar to that which Rhazes had recommended many centuries
before, that is, a cement of mastic and turpentine; because, says he,
when the stopping is made with metallic substances, it is never so
perfect as to entirely impede the penetration of moisture.

Great credit is due to Kornelis for having first brought into usage the
instrument makers’ emery wheels for grinding down sharp edges of teeth,
thus initiating the practice of trepanning the teeth with sphere-shaped
burs.[373]

PAUL WURFBEIN refers to a case of extensive necrosis of the lower jaw,
in which a certain Dr. Bürlin having removed the necrotic portion,
regeneration of the bone took place.

FRIEDERICH DEKKERS (1648 to 1730) refers a similar case, in which,
although quite one-half of the lower jaw had been removed, the bone
formed again completely.[374]

BENJAMIN MARTIN, apothecary to the Prince de Condé, was the author of
a pamphlet on the teeth,[375] in which he gave a succinct description
of these organs and spoke briefly of their diseases. He shows himself
decidedly opposed to the use of the file and to the application of
false teeth, because, according to him, both of these things may be
the cause of great harm. With regard to the file, he says that nothing
so easily tends to loosen the teeth as the use of this instrument, not
to speak of various other inconveniences, among which is the danger of
opening the interior cavity of the tooth.[376]

MATTHIAS GOTTFRIED PURMANN (1648 to 1721), a celebrated surgeon of
Breslau, was the first to make mention of models in dental prosthesis.
As to the mode in which these models were obtained, some admit as
natural that he first took a cast, and formed the model on this; but as
Purmann does not hint in the least at such a process, the supposition
is altogether gratuitous. Indeed, his description rather excludes any
probability that the model was taken from a cast. Here is the literal
translation, as nearly as possible, of the passage in which Purmann
speaks of artificial teeth and of the mode of applying them.

“The front teeth, or pronouncing teeth, ought, when they are wanting,
to be substituted by artificial ones, in order to avoid defects of
pronunciation, as well as to obviate deformity of the mouth, and this
is carried out in the following manner: One has other teeth made
of bone, or of ivory, according to the number, the size, and the
proportions of those wanting; for which purpose one may previously have
a model executed in wax, reproducing the particular conditions of the
teeth and jaws, in order afterward to make and exactly adjust the whole
on the pattern of it; then, when the base of these teeth is well fitted
on the jaw and small holes have been made in the artificial teeth and
also in the natural ones next to them, one applies the artificial teeth
in the existing void and fixes them as neatly as possible with a silver
wire by the help of pincers.”[377]

It would appear that the author is here describing a prosthetic method,
which he had never practised himself; and this results from the fact
of his advising the perforation of the natural teeth for the passage
of the silver wire destined to keep the prosthetic piece in its place.
Evidently desiring to describe the mode practised by the specialists of
those days for fixing artificial teeth, he erroneously imagines that
the metal thread was passed through the holes drilled in the natural
teeth; this would have been impossible, first, because of the atrocious
pain due to the sensibility of the dentine and of the dental pulp, and
then because of the pathological consequences to which the perforation
of the teeth would have given rise. We may, therefore, surely hold that
Purmann is simply describing, and not even accurately, a prosthetic
method already in use among the specialists of that period.

On examination of the passage cited above—which, however, is not so
clear as might be desired—it would appear that the models of which the
author speaks were most probably quite different from those in use now.
It is almost certain that the specialists of those days first made a
sketch of the prosthetic part to be constructed, using for the purpose
a piece of wax which they partly modelled with the hand and partly
carved; and after having tried on this model until it fitted perfectly
in the mouth, and was in every way satisfactory, they probably passed
it on to a craftsman to make an exact reproduction of it in bone or
ivory.

In the year 1632 a little book was published in Naples, having for its
title, _Nuova et utilissima prattica di tutto quello ch’al diligente
Barbiero s’appartiene; composta per Cintio d’Amato_.[378] This pamphlet
was reprinted in Venice in 1669, and again in Naples in 1671. We here
make mention of it, not for any special importance which it really has
as regards the development of the dental art, but because of its being
most probably _the first book in the Italian language in which dental
matters are spoken of independently of general medicine and surgery_.

TOMMASO ANTONIO RICCIO. The edition of 1671 was published under the
supervision of Tommaso Antonio Riccio, who was for many years a
disciple of Cintio d’Amato, and who greatly eulogizes his master and
praises his work. He expresses himself in the following bombastic
manner: “This book, the offspring of Master Cintio d’Amato, excellent
in the Barber’s Art, ought to find a place in the bosom of Eternity;
because by reason of its having been twice given to the light, it has
proved its worthiness to live forever in the memory of men, gaining
for itself, by its excellence, immortal glory before all such as are
practised in the Art.”

The book—which consists of about one hundred and eighty pages, and
is illustrated by several admirable engravings—contains, among other
things, two pages of verses, written by various authors, viz., by
Cintio d’Amato himself, by Giovan Battista Bergazzano, also a barber,
and by others. The greater part of these verses are in praise of the
two doctors and _Martyrs in Christ, Cosmos and Damianus, special
protectors of the Art and of the author_.

The verses of Cintio d’Amato reveal the possession of a literary and
poetic culture above the ordinary, in spite of his being only a master
barber. As to his book, it may be considered, for the time in which it
was written, as an excellent treatise on so-called minor surgery. The
author expounds, in a few chapters, the anatomical notions relating to
bleeding; speaks at great length of this operation and of everything
concerning it; refers with much detail to all pertaining to the use of
leeches, cupping, scarification, cauteries, issues, blistering, primary
treatment of the wounded, nursing of the sick, etc.; at the end of the
book there is also a long chapter on the embalming of corpses.

As regards the treatment of the teeth and gums the author dedicates
six chapters thereto, entitled, respectively: “On the relaxation of
the gums” (Chapter XXXVII); “Preparation for strengthening the gums
and making the teeth firm” (Chapter XXXVIII); “On tartar and spots on
the teeth” (Chapter XXXIX); “Another preparation for whitening and
preserving the teeth” (Chapter XL); “Mode of burning hart’s horn, very
necessary in preparations for the teeth” (Chapter XLVII); “‘Water of
salt,’ which makes the teeth white and is also good for ulcers of the
gums” (Chapter XLIX).

Evidently Cintio d’Amato treats of dental matters only within extremely
restricted limits. He tells us nothing with regard to the treatment of
toothache, nothing about caries, about prosthesis, and, what is still
more remarkable, he does not allude even in passing to the extraction
of teeth. Now, if in a book treating _of all that which appertains to
the diligent barber_, the most important dental subjects are passed
over in silence, this shows that, contrary to the generally diffused
opinion of today, the dental art was not at that time (at least not in
Italy) exclusively, or even in great part, in the hands of the barber.
Even at that time there must have been dental specialists, and the
proof of this may be found in d’Amato’s book itself, in the chapter
entitled “Necessity and Origin of the Barber’s Art.”[379] The author,
after having spoken of the divisions which the practice of the medical
art had undergone from the most remote times, and after having alluded
to the great number of parts into which Medicine was divided in the
time of Galen, adds: “Which may also be seen in our own times, for as
many as are the members of the human body, so many are nowadays the
various kinds of doctors and of medicines. Some are for the teeth,
some are for the ears, some for sexual maladies, others are ordinary
doctors, others cure cataracts, others ruptures and stone, some make
new ears, lips, noses, and others remedy harelips.”

As, under the generic name of doctors, Cintio d’Amato also comprises
surgeons, it results from the above passage that in his time, that
is, in the seventeenth century, there were surgeons who dedicated
themselves specially to the treatment of the teeth; there were, in
fact, dentists; and even admitting that the greater number of these
were no better than simple tooth-pullers, this cannot be true of
them all indiscriminately. Cintio d’Amato’s book demonstrates in the
most vivid manner that even among the barber and phlebotomist class,
that is, among the practitioners of minor surgery, there were, at
that time, men of considerable culture. This ought to hold good with
still greater reason concerning surgeons, whose professional level
was certainly superior to that of barbers;[380] and as dentists
belonged to the class of surgeons (whence the denomination still in
use of “surgeon-dentist”), it is but natural to admit that besides
the ignorant tooth-puller there were even then more or less cultured
dentists well capable of treating dental diseases and performing dental
operations within the limits permitted by the knowledge of the times.

The six chapters in which Cintio d’Amato speaks of matters referring
to the teeth do not contain anything whatever of real importance;
notwithstanding this, we will here refer to the beginning of Chapter
XXXIX, treating “Of tartar and spots on the teeth,” because it is of
some historical interest:

[Illustration: A TOOTH-PULLER AT A PUBLIC PLACE IN HOLLAND

_From an engraving of the Seventeenth Century._]

“It happens in general that owing to vapors that rise from the stomach,
a certain deposit is formed on the teeth, which may be perceived by
rubbing them with a rough cloth on waking. One ought, therefore, to
rub and clean them every morning, for, if one is not aware of this, or
considers it of little account, the teeth become discolored and covered
with a thick tartar, which often causes them to decay and to fall out.
It is then necessary that the diligent barber should remove the said
tartar with the instruments destined for this purpose.”

We have seen that the practice of the dental art was for the most
part in other hands than in the barber’s. Nevertheless, the important
operation of the removal of tartar was also carried out by him. If,
therefore, even the barbers, who were not in the least the true
representatives of the dental art of that period, carried out such an
important operation, it may logically be argued from this, in support
of what we have said before, that the sphere of action of the true
dental specialists of those times (especially of the best among them)
was not at all so limited as imagined by those who affirm that in past
times dentists properly so called did not exist, but only tooth-pullers.

The barbers, however, having become, in a certain manner, members of
the medical class, sought to extend their sphere of action, and it is
probable that in a later period than that of Tiberio Malfi and Cintio
d’Amato they invaded the whole field of dental activity; for which
reason, when the barber’s art came down to a very low level, the dental
art must have degenerated, too, and have been represented for a certain
time only by ignorant barbers and tooth-pullers. Vicissitudes similar
to these have occurred in different epochs, not only in various parts
of Italy, but also in other countries of Europe.

FLEURIMOND. In 1682 a little book on dental hygiene was published
in Paris by a certain Fleurimond, the title of which was: _Moyens
de conserver les dents belles et bonnes_. Portal, in his history of
anatomy and surgery, makes mention of this pamphlet, and, briefly
alluding to certain parts of it, he says: “The author proves by
observation that acids act upon the enamel of the teeth. He makes some
very just reflections upon dentition. Fleurimond speaks of a tooth
powder invented by him, but does not say how compounded.”[381]

In fact, it seems that this pamphlet was compiled from a commercial
point of view, viz., that of making known the special tooth powder
invented by the author. The era of advertisement had already begun!

ANTON NUCK (1650 to 1692), a Dutch surgeon and anatomist, who taught
most ably in the University of Leyden, devoted great attention to
dental surgery and prosthesis. Relative to the extraction of teeth,
he says that, in order to be able to carry out this most important
operation, an exact anatomical knowledge of the alveoli and of the
teeth themselves is required. He insists on a principle of capital
importance that has only had its full application in the nineteenth
century, viz., that the instruments to be used for the extraction of
teeth ought to vary according to the tooth to be extracted. For the
removal of the incisors, he says, the “goat’s foot” should have the
preference; the canines ought to be extracted with the common dental
forceps, but sometimes, when they are decayed, they may be extracted
with greater security with the pelican; for the small molars the
straight-branched pelican is to be preferred, for the large molars the
curved pelican; as to the extraction of roots or of splinters of bone,
this ought to be carried out with the _rostrum corvinum_.

The author counsels never to extract teeth during pregnancy, except
under circumstances of the greatest urgency, and especially to avoid
the extracting of the upper canines (or eye teeth), this being capable
of producing pernicious effect on the visual organs of the fetus!

The best way of obtaining the cessation of a violent toothache
without having recourse to extraction is, according to the author,
cauterization of the antitragus, an operation which he carried out
with a special cauterizing instrument, made to pass through a small
tube, the better to localize and to limit the action of the red-hot
iron. With regard to this means of cure already recommended by other
authors, we may remark that, although it seems ridiculous at first
sight, and although no one could be so senseless as to make use of it
in our days, nevertheless, for the times of which we are writing, when
the curing of toothache was in a great measure effected by indirect
means, this remedy might well stand on a level with many others,
and was not perhaps altogether inefficacious. It is a sufficiently
well-known physiological fact that the application of a strong stimulus
in one part of the body may diminish or suppress a painful sensation in
another part of the organism. It is an equally well-known fact that it
is in no way a matter of indifference, in producing this phenomenon,
to what part the stimulus be applied, especially because of the great
difference existing in the relations of the several parts of the body
with the brain—the centre of sensation. It is, therefore, very possible
that the cauterization of the antitragus may really have the effect of
causing strong toothache to cease, at least temporarily.

Nuck used a variety of remedies to arrest dental hemorrhage, such as
tinder, burnt linen, vitriol, sulphuric acid and the cauterizing iron.

As to the use of the file, far from rejecting it entirely, as does
Martin, he holds it necessary in many cases for planing down points and
sharp edges of broken teeth, as well as for removing, at least in a
measure, the inconvenience and deformed appearance caused by irregular
teeth. He says the file may be used without causing the slightest
harm, if one takes care not to approach the inner cavity of the tooth
too nearly, and above all not to penetrate right to it, which would
give rise to intolerable pain. Such an accident, he adds, may happen
much more easily when, instead of using the file, whole pieces of teeth
are removed with the excising forceps.

This author acquaints us with a tooth powder, much used in his time,
especially by Parisian ladies. The ingredients were powdered cuttle
fish, coral powder, cream of tartar, Armenian bole, and powder of red
roses.

At that time artificial teeth were generally made of ivory; Nuck,
however, observes that it soon becomes yellow by the action of food
and drink, and of the saliva itself. He therefore recommends, instead,
the use of hippopotamus’ tusks, giving the preference to the whitest.
According to Nuck, artificial teeth made of hippopotamus’ tusks would
be capable of preserving their color even for seventy years. In the
case of all the teeth of the lower jaw being wanting, the entire dental
arch ought to be framed in with a single piece of ivory or tusk of
hippopotamus.[382]

CARLO MUSITANO, a celebrated Neapolitan doctor (1635 to 1714).
According to Carlo Musitano, the real cause of toothache consists in
the irritant action of saline or acid particles on the extremely thin
membrane that lines the alveoli or on the exquisitely sensitive nerves
of the teeth. As he believes, these particles have an angular form,
sometimes pointed or even hooked, and they reach the sensitive parts
either directly from the outside, through the air, the food or drink
(especially when the teeth are already decayed), or else through the
blood and other humors, which often, by reason of their deteriorated
quality, contain great quantities of such irritant particles.

Among the various influences which may be conducive to toothache,
atmospheric conditions ought also to be included; thus, says the
author, the inhabitants of the Baltic littorals, and other northern
peoples, are very subject to toothache, for the reason that in those
regions the air contains, in abundance, saline particles of various
kinds which penetrate into the organism by the act of respiration. It
is said, on the contrary, that in Egypt, where the air is remarkably
mild, the teeth are not subject either to pain or to decay.

Musitano, too, believes in worms in the teeth, but does not admit, as
preceding authors had done, that they generate spontaneously. He holds
instead that they result from the eggs of flies and other insects,
which, together with food, are introduced into the carious cavities and
there develop by the heat of the mouth.

The treatment of toothache ought to differ according to its causes. If
the pain be owing to acidity, one uses medicines adapted for tempering
the acids; if it be owing to the action of saline substances, one has
recourse to remedies which dissolve them; if to worms, to such remedies
as destroy them, and so on. Purgatives and bleeding ought, however,
never to be used as remedies against toothache; for, far from doing
good, they often do harm. As to the other torments usually inflicted on
poor sufferers, they are the punishment of their sins, for God often
gives the unrighteous into the hands of doctors! (This language will
perhaps appear less strange when the reader comes to know that Carlo
Musitano was at one and the same time priest and physician!)

After a lengthy enumeration of medicaments to be used against
toothache, which we pass over in silence because already known, the
author speaks of two remedies which carry us back absolutely to the
days of Pliny! He relates us a fact experienced by himself, that, by
touching an aching tooth with the leg of a frog completely cleaned of
the flesh, the pain ceases altogether. Also, if the aching tooth be
touched with the root of a tooth extracted from the jaw of a corpse,
the pain ceases, the tooth becomes as cold as ice, and often, after a
certain time, it falls to pieces.

As to worms, the best mode of destroying them is by using bitter
substances, such as myrrh, aloes, colocynth, _centaurea minor_, etc.,
but sometimes the use of sweet substances, such as honey, is a good
means of drawing them out of the carious cavities!

Musitano also cites a great number of remedies against the setting on
edge of the teeth. Among the best of these he mentions urine applied to
the teeth whilst still warm! Alkali in general, and particularly lye,
such as is used for washing purposes, are good remedies against the
setting on edge of the teeth.

The treatment of loose teeth ought to vary according to whether this
pathological condition depends on old age, or on scurvy, on syphilis,
on superabundance of humors, etc. Sometimes, especially in old persons,
it may be useful to bind the teeth with gold wire, in order to prevent
their falling out, but this operation must be very ably performed,
otherwise it may give rise to inflammation.

Relative to artificial teeth, Musitano says that they are made of ivory
or hippopotamus tusks; of these last he does not speak as of a novelty;
we may, therefore, deem it probable that hippopotamus tusks were used
in Naples for making artificial teeth even before the Dutchman Anton
Nuck (contemporary of Musitano) made mention of them in his writings.

In cases of difficult dentition, the best remedy, according to
Musitano, for facilitating the eruption of the teeth consists in
friction of the gums, once, or at most twice, with blood drawn fresh
from the comb of a cock! If, however, even this remedy fails to
produce the desired effect, it will then be necessary to lance the gum
at the point where the tooth is to erupt, or to press it hard with the
thumb, that the tooth may the easier come through.

The sole merit of this author (as to what concerns our specialty)
consists in his having declared bleeding useless, or even harmful in
the treatment of toothache, and, besides, in his having recommended,
with great warmth and in most impressive terms, cleanliness of the
teeth. What is more beautiful, says he, than a mouth furnished with
white teeth, similar to so many pearls? And what is more abominable
than black or livid teeth, covered with a fetid deposit or with tartar?
Unclean teeth spoil the appearance of the person, and nauseate those
who behold them.[383]

WILLIAM COWPER (1666 to 1709). Toward the end of the seventeenth
century the celebrated English doctor and anatomist, William Cowper,
opened up a new field of action to oral surgery by inaugurating the
rational treatment of the diseases of the maxillary sinus. In order to
empty Highmore’s antrum of deposits and to be able to carry out the
necessary irrigations, he extracted in most cases the first permanent
molar, and then penetrated through its alveolus into the sinus with a
pointed instrument.

JAMES DRAKE, also an Englishman and a contemporary of Cowper, operated
in the same manner; and it was this author who made known in a book
of his[384] the operative method of Cowper; for which reason the
above-mentioned proceeding is sometimes called “the Cowper-Drake
operation.” A certain time elapsed, however, before it became generally
known. Thus, in a book published by JOHANN HOFFMANN in 1713 there is no
mention made of this operation, albeit the author refers therein[385]
to the case of a young girl, one of whose canine teeth having been
extracted by him, there ensued a considerable flow of whitish pus from
the maxillary sinus. In speaking of this case, Hoffmann stigmatizes
many of the surgeons of his time who were not acquainted with the
existence of Highmore’s antrum, and therefore, in cases of patients
whose teeth had fallen out as an effect of syphilis, if they happened
to penetrate with the sound into the maxillary sinus, believed this to
be an accidental excavation of the bone, produced by caries.

However, the honor of having initiated the rational treatment of
diseases of the maxillary sinus is not exclusively due to William
Cowper and to James Drake; a large share is also due to the celebrated
German physician and anatomist, Heinrich Meibom. The mucous membrane
of the maxillary sinus was considered by him as the real point of
departure of the diseases which occur in this cavity, it being liable
to become inflamed and to suppurate, thus giving rise to much pain and
to various accidents. Meibom rejects the operation of Molinetti, that
is, the trepanning of the cavity from the front, the lesion produced
in the soft parts of the face being likely to give rise to unpleasant
consequences. “Some, he adds, try the introduction of medicated vapors
into the antrum,[386] but the best way is to _open the maxillary sinus
by extracting a tooth, as the pus generally makes its way as far as
the roots of the teeth_.”[387] The author says that his father, who
was also a physician, had already used the above method with success.
He does not speak at all of the artificial opening of the antrum by
perforation; but, as is well known, this is not necessary in many
cases, so that, even now, the operation is sometimes reduced to
procuring the opening of the sinus by the simple extraction of a tooth,
as was, in fact, practised by Heinrich Meibom and his father.

Seeing that Heinrich Meibom was born twenty-eight years before William
Cowper, and was already known to the scientific world when Cowper was
still a child, it is very probable that his operative method, having
come to the knowledge of the latter, was only followed up and perfected
by him.

CHARLES ST. YVES (1667 to 1733), oculist in Paris, records an
interesting case of a secondary affection of the maxillary sinus.
The point of departure of the evil was an abscess in the orbit.
The suppurative process, after having produced an erosion and the
perforation of the orbital plane, had reached by propagation the antrum
of Highmore, whence the pus took its way, issuing through the nose.
St. Yves had a molar tooth extracted on the affected side (we do not
know which side it was), after which, day by day, he made injections
of detersive liquids through the orbital fistula, which returned
constantly through the alveolus of the extracted tooth. By this means
the cure of the patient was obtained.[388]

CHRISTOPHER SCHELHAMMER (1649 to 1716), who was professor in various
German universities, and distinguished himself specially as an
anatomist and as an ear doctor, strongly recommends stopping decayed
teeth as the best means of causing pain to cease. If, however, the
stopping does not hold, by reason of the cavity being too extended,
it is then necessary, says Schelhammer, to extract the tooth; this,
however, may very well be stopped after extraction, and then
replanted, for it will take root again, but no longer be the cause of
any pain.[389]

PIERRE DIONIS, a celebrated surgeon and anatomist of Paris (died 1718),
in his _Anatomie de l’homme_,[390] admits the possibility of a double
dental series, holding the case, however, to be of very rare occurrence.

Another work of his, entitled _Cours d’operations de Chirurgie_,
wherein he treats very extensively of diseases of the teeth and mouth,
and their surgical cure, is of much more importance in relation
to dentistry. He recognizes the high importance of this part of
surgery, but expresses the opinion that one of the dental operations,
that is the extraction of teeth, ought to be left entirely to the
tooth-pullers, not only because they are, by reason of great practice,
better qualified to perform it than general surgeons, but also because
the output of force required for this tooth-pulling operation renders
the hand heavy and tremulous, and, lastly, because, according to him,
it always has something of charlatanism about it. (This is a luminous
example of how preconceived ideas can influence the minds even of men
of the greatest talent.)

Pierre Dionis, like many of the preceding authors, had frequently
occasion to observe cases of epulis. He speaks at great length of the
treatment of this affection, as well as of parulis, but says nothing on
the subject of sufficient importance to be worth recording.

Dental operations, according to Dionis, are of seven kinds:

1. _The opening of the dental arches in the case of spasmodic
constriction of the jaws._ This operation, of the greatest importance
for nourishing and keeping patients alive, is carried out by means of a
lever and of a screw dilator.

2. _The cleaning of the teeth._ For this, as for the other operations,
says Dionis, a certain amount of skill is required. The author advises
the use of gold instruments if one be called upon to clean the teeth of
persons of rank. This appears rather strange in the present levelling
times, but Pierre Dionis lived in the days of Louis XIV, whose doctor
he was, that is, in a period of unbridled luxury, when the nobles and
those in power would have nothing in common with the lower classes.

3. _Operations for the preservation of the teeth._ These, says Dionis,
are of the greatest importance, it being necessary to oppose a barrier
to the destructive processes of the teeth. Caries, when so situated
as to permit of it, ought to be scraped away; for approximal caries
one ought to have recourse to the file; in the case of caries of the
triturating surfaces, cauterization should be used, by applying a drop
of oil of vitriol with a miniature paint brush. Should the caries,
however, be in a very advanced stage, it is better to make use of the
cauterizing iron. But in cases of intense and persistent pain there is
no other remedy than extraction.

4. _Stopping of the carious cavity._ Dionis does not enumerate this
operation among those intended for the preservation of the teeth.
At that period, this operation was performed solely with a view to
preventing the penetration into and the retention within the carious
cavity of alimentary substances, and the disadvantages caused thereby.
The carious process, says the author, often ceases altogether, and
the pain then generally ceases also. However, as the residual cavity
often becomes troublesome in various ways, among others by making the
breath offensive, it is better to stop it. For this purpose, gold or
silver leaf is generally made use of; but this mode of stopping is not
durable, because gold or silver in leaf is apt to become loosened and
fall out. It is therefore preferable, says Dionis, to make a stopping
with a piece of gold or silver corresponding in size and shape to the
cavity.[391] Many, he adds, prefer lead as a stopping, on account of
its softness, whilst others simply use wax.

5. _The use of the file._ The indications given by Pierre Dionis for
using the file do not differ from those we find in other authors.
Dionis warns, however, against using the file to level down a tooth
which has become lengthened through the loss of its antagonist, for
after a certain time it would again project above the level of the
others.

6. _Extraction._ This operation, says Dionis, ought not to be performed
too lightly, but only in those cases in which it is really necessary;
that is, when a tooth is the cause of insupportable pain and its crown
is almost entirely worn away; when nothing remains of a tooth but its
root; when a tooth is so loosened in its socket as to leave no hope
of its again becoming firm; when supernumerary teeth or irregularly
planted teeth give rise to inconvenience or deformity; and lastly, to
remove deciduous teeth that have become loosened. The opinion that
if the loosened milk teeth be not promptly extracted they cause the
permanent teeth to grow irregularly, is, however, considered by Dionis
to be a prejudice.

Dionis strongly doubts whether a tooth that has been extracted
and replanted can really take root again, as had been affirmed by
Dupont, Pomaret, and other authors. This shows that Dionis had had no
experience on this point.

7. _The application of artificial teeth._ These teeth, says Dionis,
are generally made of ivory, but may also be made of ox bone, which
is less liable to turn yellow than ivory. He does not mention the
use of hippopotamus tusks, but we learn from him that one Guillemeau
made artificial teeth with a composition of his own invention, which
was obtained by fusing together white wax and a small quantity of
gum elemi, and then adding ground mastic, powder of white coral and
of pearls. This fact is, as everyone can see, most important, for it
constitutes the first step toward the manufacture and use of mineral
teeth. Dionis tells us that the teeth made of Guillemeau’s composition
never became yellow, and that it was also very good for stopping
decayed teeth.[392] It would seem, therefore, that it could be used as
cement is now used.

The Guillemeau of whom Dionis speaks is probably Jacques Guillemeau,
the author of a book now no longer to be found, which was translated
from the French, first into Dutch, and afterward into German. Crowley,
in his _Dental Bibliography_, only quotes the German edition, published
at Dresden in 1710, the title of which runs thus: _Der aufrichtige
Augen und Zahnarzt_.[393]

JEAN VERDUC, also a Frenchman, relates a case of the surgeon
Carmeline,[394] analogous to that of Denis Pomaret, in which a sound
tooth which had been extracted by mistake was immediately replanted and
took root again, becoming quite firm. However, Verduc does not speak
of replantation as a special method of cure, but merely refers to the
above case incidentally in speaking of the extraction of teeth. He
considers this operation a most dangerous one, and advises not having
recourse to it except in cases of utmost necessity. Notwithstanding
this, Verduc gives us to understand that teeth were drawn with
sufficient ability by most of the operators of the time, and precisely
because of this he omits describing the manner of performing the
operation. According to Verduc, the drawing of teeth is often of little
or no advantage against toothache.[395] In proof of this assertion he
relates the case of a hypochondriac, who little by little had as many
as eighteen teeth extracted, without, however, getting the better or
the wiser; but as this case does not prove anything at all, one is
disposed to think that Verduc, in relating it, had the intention of
being humorous.

MONSIEUR DE LAVAUGUYON. To another French surgeon, Monsieur de
Lavauguyon, also a contemporary of Dionis, belongs the merit of having
declared useless, in the greater number of cases, the practice, at that
time general, of separating the gums from the tooth before proceeding
to the extraction of the latter. He says that this is only necessary
when a tooth, either because broken or because its crown emerges too
little above the gum, offers an insufficient hold for the pelican.[396]

Our historical survey has now reached the end of the seventeenth
century. Embracing at a glance the whole of this last period of
time, we remark, among many facts of minor importance, some events
which, in the history of the development of dental art, stand out in
strong relief. Such are the replantation of teeth used as a special
curative method by Dupont and others; the method of plugging in cases
of alveolar hemorrhage, the credit of which is due to Rivière and to
Tulpius; the description of the maxillary sinus given by Highmore; the
rational treatment of affections of the antrum, inaugurated by Meibom,
Cowper, and Drake; the researches into the microscopic structure of
the teeth, brilliantly initiated by Leeuwenhoek, who discovered the
dentinal tubuli; the use of models introduced by Purmann into the
workmanship of prosthetic pieces; the employment of hippopotamus’
tusks in making artificial teeth, first recommended by Nuck; and the
invention of Guillemeau, which was the first step toward the use of
mineral teeth.

[Illustration: Lorenz Heister.]




CHAPTER XII.

THE EIGHTEENTH CENTURY.


Although there have been, even from the most remote times, individuals
who have dedicated themselves exclusively to the cure of dental
maladies, or to repairing the losses of the dental system by artificial
means, and notwithstanding the progress gradually accomplished in this
branch of the medical art, which progress was especially remarkable
during the sixteenth and seventeenth centuries, it is not to be denied
that, up to the beginning of the eighteenth century, dentistry was, in
great part, considered one with medicine and surgery in general. It is
but natural that dental art (and the same may be said of every special
branch of medicine) could not assume a real individuality until it had
attained to the higher grades of its development. As a matter of fact,
dentistry, toward the end of the seventeenth century, was already a
true specialty, although it counted but few worthy representatives
at that time. The definite separation between the science and art of
dentistry and general medicine and surgery, although it may have been
retarded, could not fail to take place; and this, as we shall presently
see, was effected by the celebrated French dentist Pierre Fauchard.

But, to remain faithful to chronological order, we will first speak
briefly of some other writers.

LUDWIG CRON, a barber of Leipsic, in a pamphlet published in 1717,
with the title _The barber’s apprentice versed in bleeding and tooth
pulling_,[397] declares, in a still more emphatic and general way than
De Lavauguyon, that it is useless to detach the gum before proceeding
to extract a tooth. This barber, strong in his own experience, dares
to assert absolutely useless this ancient practice, advised first by
Cornelius Celsus, and recommended after him, and in homage to his
authority, by many other writers. It is, therefore, possible that
even previous to Cron and De Lavauguyon many operators had dispensed
with the practice recommended by Celsus, although this had become an
accepted canon of the high medical profession.

LORENZ HEISTER (1683 to 1758), of Frankfort-am-Main, one of the most
celebrated surgeons of the eighteenth century, wrote a dissertation on
toothache,[398] treating besides very extensively of dental affections
and their cure in a masterly work on surgery, published for the first
time in 1718, and which went through numerous editions in various
languages.

When the caries of a tooth is superficial, Heister advises the removal
of the decayed part with the file; or, when the caries is deep down,
the cavity ought first to be well cleaned with a toothpick or other
like instrument, then filled with heated white wax, or mastic, the
stopping being renewed as often as may be necessary. When a molar tooth
is decayed, especially in the centre, the best way, says Heister, is to
fill it with gold or lead leaf, or with a piece of the latter fitting
into the cavity. If the carious cavity of a painful molar cannot be
cleaned as it ought to be, the dropping of a little oil of cloves or
of cinnamon or of guaiacum into it will be found useful, or even a
few drops of spirit of vitriol; for in this manner one obtains at the
same time the double advantage of destroying the impurities contained
in the carious cavity and of soothing the pain. But if by chance the
pain should persist, recourse must be had to the cauterizing iron, or
to extraction. Sometimes, however, even the most violent toothache
can be made to cease, either by scarifying the gums (a method already
recommended by Pliny), by cauterizing the antitragus, or by pressing
the aching tooth hard between the fingers, as Schelhammer[399] and some
other writers had advised.

Heister writes at length on the extraction of teeth, on the indications
and counterindications appertaining thereto, on the instruments with
which the operation should be carried out, and so on. Regarding the
position of the patients, he thinks it best to place them on a low
seat or on the ground, if the tooth to be extracted is situated in the
lower jaw, but if an upper tooth is to be extracted, patients should be
placed on a chair or on a bed.

Movable prosthetic pieces are mentioned for the first time by this
author. Although he is very concise in his manner of speaking of
artificial teeth (this indicating that dental prosthesis was considered
outside the sphere of action of the general surgeon), we nevertheless
learn from him that partial sets of teeth made of ivory or hippopotamus
tusks, and without special appliances for fixing them, were then in
use, which, when applied in the void between the neighboring teeth,
were maintained in position simply by their form. The author advises
keeping prosthetic pieces very clean, removing them every evening
before going to bed, and not putting them back in the mouth until they
have been well cleaned.

Heister also speaks of nasal prosthesis; this was then carried out by
applying noses made of wood or of silver, properly painted. In cases
of trismus, this author altogether rejects the forcible opening of
the jaws by means of screw dilators and such like instruments, as they
act too violently, and, according to him, only aggravate the morbid
condition. Even the extraction of a tooth is useless in such cases, as
the patient can always absorb a certain quantity of liquid food through
the closed teeth. On the other hand, the author expresses himself in
favor of the incision of the gums in cases of difficult dentition.
According to him, convulsions and the other nervous symptoms which
children are subject to during the period of dentition depend wholly
on the hardness and strained condition of the gum. It is, therefore,
natural that the symptoms should disappear when an incision of the
gums, reaching to the tooth that is coming through, has caused the
tension to cease.

The author speaks very particularly of the treatment of epulis and
parulis; but his views on this subject contain nothing of great
importance.

RENÉ JACQUES CROISSANT DE GARENGEOT (1688 to 1759), the celebrated
French surgeon, speaks very little of dental surgery in his works. He
declares himself averse to the carrying out of too many operations on
the teeth, and especially disapproves the use of the file, because,
according to him, it ruins the enamel.[400] For a long time, especially
in France, Garengeot was believed to have been the inventor of the
key known by his name; but he merely perfected this instrument. In
fact, through a later author, Lecluse, it clearly results that the
key existed before Garengeot. “For extracting,” writes Lecluse, “one
may make use of the pelican that Garengeot has constructed on the
English key.” In a note, he afterward adds, “that the English key is
an instrument used by dentists in England.” However, it is not in the
least certain that the key is really an instrument of English origin.

Loder, who wrote at the end of the eighteenth century, informs us that
the so-called English key was called the German key in England; it is,
therefore, not improbable, that this instrument, as some maintain, had
its origin in Germany.[401]

JOHANN JUNKER (1679 to 1759), professor of medicine at the University
of Halle, wrote on dental maladies, not only in a treatise on surgery,
published in 1721, but also in three dissertations which were published
some time later, and were entitled respectively: _De affectibus
dentium_ (1740), _De dentitione difficili_ (1745), _De odontalgia_
(1746). The author, however, for the most part, only repeats things
already known; his writings have, therefore, little or no importance
for us. He counsels the Cowper-Drake operation in treating the
affections of Highmore’s antrum; in carrying out the operation,
however, he thinks the extraction of the second molar to be preferable
to that of the first. To prevent the formation of tartar on the teeth,
he advises assiduous care in keeping the mouth clean, and recommends,
among other things, rubbing the teeth with sage. He disapproves having
recourse too readily to metal instruments to remove tartar from the
teeth, because, according to him, it favors the production of dental
caries. He holds it dangerous to extract the upper or lower canines
when they are not loose, as, by reason of the depth of their roots an
injury to the surrounding nerves may be the result, which not only
might cause great pain, but in the case of the upper canines might lead
to inflammation of the eye, and even of the dura mater!

When the caries is incipient, Junker advises rubbing the teeth several
times a day for some time with common salt, in order that this should
penetrate into their structure.[402]

GUILLAUME MAQUEST DE LA MOTTE (1655 to 1737), a distinguished French
surgeon and the writer of an excellent treatise (_Traité complet de
chirurgie_, Paris, 1722), repeats the advice already given by preceding
authors, to which he annexes the highest importance, that is, the
opening in time of abscesses of the gums and of the palate even before
they be completely matured, in order to prevent the suppurative process
from extending and damaging the bone below. This author relates having
several times arrested serious hemorrhage following on the extraction
of teeth, by applying a little vitriol inside the alveolus, and, on
this, graduated compresses, which the patient pressed on the part with
the teeth of the opposite jaw.[403]

JOHANN ADOLPH GÖRITZ, of Regensburg, in one of his writings published
in 1725, disapproves the too frequent recurrence to extraction of the
teeth, that is, carrying out the operation when it is not absolutely
necessary. He is also averse to the application of artificial teeth.
In support of his opinion he relates a case in which, a certain time
after the application of an artificial tooth, the natural ones to which
it had been fixed became loose, so that it was necessary to proceed
to the fixing of all three, that is, the artificial tooth and the two
neighboring ones, to the firm teeth beyond them; these, however, became
loosened in their turn, and it was at last necessary to extract six
teeth. The great space thus created was filled with a prosthetic piece
made of hippopotamus tusk; but the author did not believe much good
would come of this either. In fact, he is of opinion that the natural
teeth should be preserved by every possible means, and that, on the
other hand, even in the case of a few being lost, it is better not to
resort to substitutes. In the worst case, should the dental void cause
too great inconvenience by damaging the pronunciation, or for some
other reason, it may be filled by an “imitation” in soft wood.[404]

[Illustration: Pierre Fauchard.]

If one takes into consideration the by no means slight inconvenience
to which fixed artificial teeth gave rise, one cannot but admit
the aversion to them, expressed by Göritz and others, to have been
justified.

ERNST FERDINAND GEBAUER, in 1726, made known a case in which, a tooth
having been badly extracted by an incapable surgeon, the upper jaw was
so seriously injured that a diffusive carious process ensued, which
after many years’ suffering brought the patient to the grave.[405]

JOHANN BERNHARDT FISCHER (1685 to 1772), a very famous doctor, born
in Lübeck, who had the honor of becoming archiater of the Russian
Empire, related, in 1726, a case of replantation, similar to those by
Pomaret and Carmeline; but HEINRICH BASS (1690 to 1754), of Bremen,
professor of anatomy and surgery in Halle, endeavored to demonstrate
that in these cases the tooth did not really take root, but was rather
maintained in position by the contracting of the surrounding gum. One
perceives from this that there were still, at that time, discordant
opinions on the subject of replantation, and that this operation was
far from occupying, in dental surgery, the accredited position it has
acquired today.

Heinrich Bass also combats the abuse of extracting teeth
inconsiderately, without absolute necessity, and expresses the opinion
that this is especially blamable in the case of teeth of the upper
jaw, principally because the extraction of either the canine or of the
first or second large upper molars might easily produce the opening
of Highmore’s antrum, and thus give rise to regrettable accidents. He
is not, however, averse, like Göritz, to the use of artificial teeth;
indeed, he advises the application of whole dental sets, even in the
upper jaw, so long as there be two natural teeth existing to fix the
prosthetic piece to.[406]

PIERRE FAUCHARD, the founder of modern scientific dentistry, was born
in Brittany about the year 1690, and died at Paris in the year 1761.
His celebrated work, _Le Chirurgien Dentiste_, was already written in
the year 1723, but not published until 1728. It marks a new epoch in
the history of dental art. The most renowned physicians, surgeons, and
anatomists of the time testified their admiration for Fauchard’s work,
which was translated into German in 1733, and afterward went through
two French editions in the years 1746 and 1786.[407] We have been able
to obtain the second edition[408] of this most important treatise, and
of this we now intend making use for accurately analyzing the work, as
it is probably more complete than the first, whilst the third, having
been published after the author’s death, is probably merely a reprint.

The work consists of two volumes in duodecimo, in all 863 pages. In
the beginning there is the portrait of the author and a long and
interesting preface. The portrait, which we here reproduce, has also
its historical importance, and this for two reasons, the first of
which being that in it Fauchard is revealed to us as a person of very
distinguished appearance, and this gives us an idea of the social
condition of the surgeon-dentists of his time; the second, because
there are annexed to the portrait the following Latin verses, by a
certain Moraine, in which, whilst eulogizing the writings of the author
and his ability in the treatment of the teeth, and in restoring force
and beauty to them, he counsels him “to despise the tooth of envy,” as
it will certainly break against his merit.

  Dum dextra et scriptis solamina dentibus affers
  Illorum in tuto sunt decor atque salus.
  Invidiæ spernas igitur, Faucharde, cruentos
  Dentes; nam virtus frangere novit eos.

That Fauchard, in common with all men of rare merit, had to combat all
his life against envy, we are able to perceive from what we read at
the end of the second volume of his work. The author here says that
“the rumor having been falsely set about that he has abandoned the
profession; which rumor cannot have been invented otherwise than by
those individuals who, sacrificing honor to interest, would attract to
themselves the persons who honor the author with their confidence; he
therefore finds it necessary to give warning that he still continues
the practice of his art in Paris, in the _Rue de la Comédie Française_,
together with his brother-in-law and sole student, M. Duchemin.”

More than a century and a half has passed by since Fauchard was
obliged to defend himself against lies invented and set about to his
damage by envious colleagues, but even at the present day, when,
given the high grade that civilization has reached, and professional
competition ought not to make use of other weapons than intelligence,
study, and application, some do not hesitate to have recourse to means
equally disloyal, ignoble, and shameless as those practised by some
contemptible dentists of the middle of the eighteenth century.

[Illustration: A CHARLATAN ON HIS PUBLIC STAGE]

The preface of Fauchard’s book is especially important for the notices
therein contained regarding the author, as well as the conditions of
dental art at that period. And first of all, we find in it the proof of
what we have already said elsewhere, namely, that even before Fauchard,
there were not only tooth-pullers but also dentists properly so
called. Indeed, Fauchard makes mention also of the examination that
aspirant dentists had to undergo as far back as the year 1700. It may
interest our readers if we here give in detail some extracts in which
the author speaks on these subjects:

“Although surgery in general,” says Fauchard, “has been greatly
perfected in these latter times; although important discoveries have
been made in anatomy and in the modes of operating, and many learned
and interesting observations have been published, nevertheless,
dentists nowhere find in works on surgery sufficient aids to guide
them in all their operations.” These last words should be sufficient
alone to prove that the dentists spoken of by Fauchard were not mere
tooth-pullers.

“The authors who have written on anatomy, on surgical diseases and
operations, have only treated very superficially the part relating
to maladies of the mouth and teeth. If some writers have spoken in
particular about the teeth and their diseases, as, for instance, Urbain
Hemard and B. Martin, they have not done so in a sufficiently ample
manner.

“Besides, there does not exist any public or private course of surgery
in which the theory of dental maladies is amply taught and in which one
can receive fundamental instruction in this art, so necessary for the
healing of these maladies and of those of the neighboring parts.

“This branch of the art having been but little cultivated, if not
wholly abandoned by the most celebrated surgeons, their negligence has
caused it to fall into the hands of persons without theory and without
experience, who practise it in a haphazard fashion, guided neither by
principles nor method. In Paris, it is only since 1700 that people’s
eyes have become opened to this abuse.

“In this town, those who intend to become dentists are now obliged to
undergo an examination, but although the examiners be most learned
and well versed in all the other parts of surgery, I think, if I may
be allowed to express my opinion, that as they do not ordinarily
themselves practise dental surgery, it would not be amiss on these
occasions to admit an able and experienced dentist, who might sound
the aspirant as to the difficulties which have come before him in the
course of the long practice of his art, and who could communicate to
them the means of surmounting them. In this way one would not have
to acknowledge that the attainment of the greater part of dental
experts[409] is below mediocrity.

“To supply this want of instruction it would have been of great use
if some able dentist, for example the late _Monsieur Carmeline_, who,
in his day, practised with general applause, had made us acquainted
with his mode of operating and with the knowledge acquired through the
successful treatment of a great number of important cases.

“What this celebrated surgeon-dentist has not done, I today dare to
undertake. I shall at least afford an example of what he might have
done with greater erudition and better success.

“From my youth I was destined to the surgical profession; the other
arts I have practised[410] have never made me lose sight of it. I was
the disciple of Alexandre Poteleret, surgeon-in-chief to His Majesty’s
ships, who had great experience in diseases of the mouth. To him I owe
the first rudiments of the knowledge I have acquired in the surgical
speciality I practise, and the progress I made under this able man gave
me the emulation that has led me to further important discoveries. I
have collected among different writers what seemed to me most reliable.
I have frequently discussed these matters with the ablest surgeons and
doctors of my acquaintance, and have neglected nothing in order to
profit by their counsels and by their ideas.

“The experience which I have acquired during an uninterrupted practice
of more than forty years has led me insensibly to the acquirement
of further knowledge and to the modification of what seemed to me
defective in my earlier ideas. I offer to the public the results of my
labors and of my studies, hoping that they may be of some use to those
who wish to exercise the profession of surgeon-dentist.”

The reason why dentists before the time of Fauchard published hardly
anything concerning their art, was perhaps out of a sentiment of
jealousy, which rendered them (that is, the best of the profession and
therefore the ones most capable of writing) but little disposed to make
known to others the results of their studies and of their experience,
lest the fruits of their long labors should be utilized by others
and they themselves be materially damaged by competition. That this
sentiment of jealous egotism really existed in many dentists may be, in
a certain manner, deduced from a few words of Fauchard himself, who,
although he has the very great merit of breaking with mean, old-world
prejudices, nevertheless expresses the prevalent idea of the time,
consisting in the belief that every artificer, every inventor, had
not only the right, but also the duty of surrounding his discoveries
with secrecy and mystery. These are the words in which, making known
a certain improvement in dental prosthesis invented by him, he at
the same time expressed his conviction that by so doing he is acting
against his own interests:

“I have perfected and also invented several artificial pieces both for
substituting a part of the teeth and for remedying their entire loss,
and these pieces substitute them so well that they serve perfectly
for the same uses as the natural teeth. To the prejudice of my own
interests I now give the most exact description possible of them.”

Now, although a man of elevated mind, such as Fauchard, may have been
capable of sacrificing his material interests to higher aims, it
is not, however, to be wondered at, taking also into consideration
the lesser degree of culture and of professional ability of his
predecessors, that none among them should have been found sufficiently
disinterested to publish the results of their particular studies and
experience, besides all those technical details which according to the
ideas of that time constituted the secrets of the profession.

In the course of this history, we have seen that the dental art
was practised from the most remote times and in the most various
countries, remaining, notwithstanding, for centuries in an embryonal
condition. It was toward the end of the seventeenth and the beginning
of the eighteenth century that, in the midst of the highly advanced
civilization of the great French capital, it attained a high degree
of development, entitling it to be considered a special branch of the
medical art.

It would, therefore, be wrong to believe that the dental art was
created, for the most part, by Fauchard, and one clearly perceives,
from the perusal of his work, that although he made most important
contributions to this specialty, which he cultivated with passion,
nevertheless, the greater part of the things therein treated of were
already known before his time, although no reference to them is to
be found in previous works; and this for the reasons we have already
suggested. The highest merit of Fauchard consists, still more than in
his inventions and improvements, in his having most ably collected
and incorporated in a single work the whole doctrine of dental art,
theoretical as well as practical, thus setting in full light the
importance of the specialty, and giving it a solid scientific basis.

France is therefore the first country where modern dentistry reached a
high degree of development and also the first country where, earlier
than elsewhere, that is, about 1700, the dentists began to form a
well-defined class, to belong to which it was necessary to pass a
special examination. This examination, as we learn from Fauchard, was
held before a commission of which no dentist formed a part, and exactly
for this reason gave but negative results and responded but little
to its intended aim. The greater number of those who were authorized
to practise dentistry after undergoing this examination showed a
professional ability below mediocrity. Nevertheless, although few in
number, good and able dentists were in no way wanting, as clearly
appears from the preface to Fauchard’s work, and better still from
the following paragraph,[411] wherein the author speaks of the great
perfection reached by dental surgery in Paris:

“The teeth and the other parts of the mouth being subject, as we
have seen in the course of this work, to so many important diseases,
requiring the aid of the most able dentists, it is strange that the
sovereigns of foreign countries, the heads of republics, and also the
administrators of our own provinces do not provide for the expense of
sending young surgeons to Paris, to be instructed in a part of surgery
so essential, and, notwithstanding, so ignored and neglected everywhere
excepting in this great city, where it has reached its highest
perfection, both as regards the embellishment of the mouth and the cure
of diseases, often of a most serious nature. These scholars would,
thereafter, form others and would render great services to their nation
and to their fellow citizens.”

In the first chapter of his work, Fauchard speaks “of the structure,
position, and connection of the teeth; of their origin and of their
growth.” He distinguishes in each tooth a body, a root, and a neck,
making the remark, however, that this last is to be considered as
forming part of the body. According to the author, the name of “crown”
can only be applied suitably to the body of the molar teeth, but not
to that of the incisors or of the canines, which has no resemblance
with a crown. Although in the adult the number of the teeth is
normally thirty-two, it may be that some persons have, nevertheless,
thirty-one, thirty, twenty-nine, or even only twenty-eight teeth, and
this independently of any eventual loss, but for the simple reason that
the wisdom teeth are often cut very late in life (even after fifty
years of age), or do not all come forth, or sometimes are never cut at
all. The author refers to some cases of a supernumerary tooth situated
in general between the two superior central incisors and similar in
form to the lateral incisors. He also observed two individuals who
had each thirty-four teeth, sixteen in the lower and eighteen in the
upper jaw, and in these cases the two supernumeraries were situated
behind the incisors. Fauchard declares the popular opinion expressed
also by some ancient authors, of the milk teeth having no roots, to
be false. The roots of these teeth, he says, are gradually worn away
before the latter are shed, when the permanent teeth are just on the
point of coming through; however, if it so happens that one or more of
the milk teeth be extracted some time before the period in which they
are usually shed, their roots are found to be as long and as strong in
proportion to the body as those of the permanent teeth. In children one
finds, besides the twenty deciduous teeth, the germs of the thirty-two
permanent ones, for which reason it may be said that children have in
all thirty-two teeth without counting the germs that may sometimes be
found at the extremities of the roots of the large molars. As, however,
the existence of such germs is an exceptional fact, the twelve large
molars, if extracted, are not ordinarily regenerated. This may be
possible, however, if the germs in question exist, and, indeed, the
author observed two persons in both of whom a large molar had been
regenerated in the place of the one which had to be extracted.

Fauchard gives an excellent description of the alveoli and of the
roots of the teeth; he alludes to the varieties which these latter
may present, and to the importance of the same from the point of view
of extraction. Thus, speaking of the molars, he says: “Their roots
sometimes touch one another at the points, whilst at the base, close
to the body of the tooth, they are far apart. These are the so-called
_dents barrées_ (barred teeth), which it is so difficult to extract,
it being unavoidable to bring away together with the tooth the spongy
osseous part occupying the interval between the roots.”

In this same chapter the author calls our attention to some anomalies
worthy of note. He says that he has observed teeth that seemed to him
to be derived from the union of two or three germs. He also relates
that a colleague of his showed him a tooth that appeared to be formed
by the union of two, between the roots of which was a third tooth whose
crown was united to the vault formed by the roots of the first two.

Fauchard describes exactly the pulp cavity and the root canals, and
speaks of their gradual restriction, ending in an almost entire
disappearance in old age.[412] He treats of the nerves, of the
arteries, and of the veins of the teeth in a most detailed manner;
then, after alluding to their general structure, he goes on to speak
of the microscopic constitution of the enamel, following in this the
description given of it in 1699 by the academician La Hire.

In regard to the development of the teeth, Fauchard repeats what Urbain
Hémard had previously written. He apparently ignores the researches
of the Italian anatomists, from whom, and especially from Eustachius,
Urbain Hémard had literally reproduced all that concerns odontogeny.

In the second chapter Fauchard speaks “of the maladies of children at
the period of teething and of the remedies best adapted thereto.” Among
other means of treatment, he advises the incision of the gum when this
is red, swollen, and distended and the tooth below it can be felt. For
the incisors and canines a simple incision ought to be made in the same
curve as the dental arch; for the molars a crosswise incision should
be made directly down to the tooth below, taking care not to leave
any strips of uncut gingival tissue, lest these, being distended by
the emerging tooth, should continue to be the cause of pain and other
morbid phenomena.

Although Fauchard does not tell us anything substantially new about
teething maladies and their treatment, he nevertheless treats this
subject with much practical good sense, and does not merely make
servile repetition of what preceding authors have written about it.

In the three following chapters the author speaks of the utility of the
teeth, of the rules to be observed for their preservation, of the modes
of keeping them white, and of strengthening the gums.

From a passage in the fifth chapter we learn that tooth brushes were
then already in use. Fauchard, however, advises the use of small
sponges in their stead. He says: “Those who use brushes of horsehair,
or pieces of cloth or of linen for cleaning the teeth, do not reflect
that all these materials are too rough, and that the practice of using
them frequently and without discretion often exercises a destructive
action upon the teeth.[413] Not without good reason, I advise the
abandonment of this usage, it being preferable, after having had the
teeth cleaned by the dentist, to wash the mouth every morning with
tepid water, and to rub the teeth up and down, inside and outside, with
a small, very fine sponge wetted in water; and it is still better to
add to this water a fourth part of aqua vitæ the better to fortify the
gums and render the teeth firm.”

Instead of a small sponge, says Fauchard, the end of a root of
marshmallow or lucern, which has first been subjected to a special
preparation, may be used with benefit for rubbing the teeth. The author
gives a long and minute description of this preparation, which we,
however, omit, because devoid of historical interest.

As, however, the above means are not always sufficient for preserving
the teeth and gums in good condition, it is necessary in many cases,
says Fauchard, to make use of some paste, powder, or mouth wash. The
author mentions a great number of compositions of this kind, giving
the formula for each one—almost always most complicated—and indicating
the peculiar advantages of each of them. We will here quote one of the
formulæ as an example.

“_A spirituous water, desiccative, balsamic, antiscorbutic, efficacious
against many maladies of the mouth_:

“℞—good sarsaparilla, four ounces; aristolochia rotunda, dried rinds
of bitter organes, of lemons, and pomegranates, _ana_ three ounces;
pyrethrum, two ounces; cloves, one ounce; mustard seeds, one ounce;
wild rocket seeds, two ounces. Pound well in a mortar and put the whole
into a retort with a long neck. Add thereto half a pound of pulverized
candied sugar and the same quantity of clarified rose honey. Pour in
three pints of good spirit of wine. Cork the retort well and leave all
to digest in a cool place for five or six days. Then heat the retort
forty-eight hours in the water bath over a slow fire, without letting
the liquid come to the boil. Afterward, when cold, decant in a glass
bottle, to be kept well corked. Pour another three pints of spirit of
wine on the residue of the drugs; cork the retort again, replacing it
in the water bath for forty-eight hours, and regulating the fire as
above. Then, after letting it cool, pour off the liquid into the same
bottle. Next remove all the residue from the retort, place it in a
thick, white linen cloth, and force the remaining liquid through it,
and add to that in the bottle. Put back half of the entire quantity of
liquid in the same retort, and add thereto aloetic elixir and _baume du
commandeur_, _ana_ four ounces; pulverized dragon’s blood, three ounces
and a half; pulverized gum of guaiac and Peruvian balsam, _ana_ three
ounces; gum lac, two ounces. Cork the retort again and replace it in
the water bath for forty-eight hours, as above. Let cool, decant the
liquid in another glass bottle, and cork well. Pour the remaining half
of the first liquid upon the rest of the drugs, replace the retort in
the water bath for forty-eight hours, let cool, and pour the contents
in the last bottle. Filter the liquid well, and pour it into a bottle
of sufficient size to be able to add the following liquids: aqua
vulneraria and first cinnamon water, _ana_ three pints; second cinnamon
water, three half-pints; spirit of cochlearia, four pints. Shake the
bottle well, filter again, and store in well-corked bottles.”

The author adds that the doses of the different drugs may be reduced
in proportion to the quantity of liquor to be prepared; and that he
prepares so large a quantity at a time because of the great sale he has
for it among his clients.

The preparation in question is counselled by the author as a remedy
against pathological conditions, and of the gums especially. One makes
use of it in the following manner: Pour from seven to eight drops
into a wineglass of water; wet the tip of the finger and rub the gums
and the teeth well. Or mix seven or eight drops in a good spoonful of
water, using a fine sponge to rub the teeth and gums.

The example we have cited suffices to show how much care one took at
that time in the preparation of substances destined to be used in the
preservation of the teeth, and demonstrates at the same time that
Fauchard, inventor of that and many other preparations, besides being
an able surgeon-dentist, was also exceedingly well versed in dental
materia medica.

Chapter VII treats of the general causes of dental, alveolar, and
gingival diseases, and contains the complete enumeration of these
maladies. The causes of dental affections may be of two orders, viz.,
internal (general diseases, dyscrasic conditions) and external (the
action of heat and cold, mechanical causes, etc.).

After having spoken in particular of various causes, Fauchard adds:
“Little or no care as to the cleanliness of the teeth is ordinarily the
cause of all the maladies that destroy them.”

The author divides maladies of the dental apparatus into three classes,
that is:

1. Maladies deriving from external causes and acting, therefore,
especially on the crown or uncovered part of the tooth.

2. Maladies of the hidden parts of the tooth, that is, of the neck and
root.

3. Symptomatic maladies, deriving from the teeth.

In the first class the author includes 45 pathological states, 17
in the second and 41 in the third, making up a total of 103 morbid
conditions. This should be sufficient to give us an idea of the
accuracy with which Fauchard studied the maladies of the dental
apparatus, especially if one considers that preceding authors
had reduced these maladies to a very small number. Fauchard’s
classification is very complete, for notwithstanding the progress
made in succeeding years in this science, the pathological conditions
not to be found comprised in it are exceedingly few. Naturally,
the 103 diseases enumerated by Fauchard do not represent as many
distinct morbid entities. The author, in classifying dental maladies,
keeps especially in view the requirements of the practitioner, and
therefore makes numerous distinctions in each morbid process. Thus,
he distinguishes a great many varieties of caries, viz., the soft and
putrid caries, the dry caries, the caries in part dry and in part soft,
the caries complicated by fracture, the superficial caries, the deeper
and the deepest, the caries of the different surfaces of the crown, and
so on. Also in the classification of other morbid processes, Fauchard
makes multifarious distinctions.

The passage referring to worms in the teeth deserves to be here
reproduced:[414]

“Sometimes worms are to be found in the carious cavities of the teeth,
or in the deposit of tartar that covers them, and to these the name
of dental worms has been given. Observations recorded by illustrious
authors are extant which attest this. Not having ever seen these worms,
I neither admit nor deny their existence. Nevertheless, I conceive the
thing nor to be physically impossible, although at the same time I do
not believe at all that these worms destroy the teeth or cause them to
decay, but rather that the eggs of some insect having been introduced
into the carious cavity of the tooth, either through alimentary
substances or through the saliva, these eggs thus deposited have
developed and produced the worms alluded to. However this may be, as
they are not the real cause of the caries, their eventual presence does
not require any particular consideration.” Fauchard again recurs to the
subject of worms in Chapter VIII, in speaking of the particular causes
of caries.[415]

“It was, and is still, believed by the vulgar and also by some writers
that all toothache is caused by worms, which little by little destroy
the tissue of the osseous fibers and the nervous threads. If this were
so, the explanation of pains and of decay in the teeth would be very
simple. This opinion is founded on pretended experiences relating
to these insects, which may, it is said, be made to fall out of the
teeth by the smoke of henbane seeds; this, however, has been declared
fabulous by Andry, dean of the medical faculty of Paris, as well as
other similar facts which he exposes in his book on the generation of
worms.[416]

“Andry relates, however, that with the help of the microscope one may
succeed in seeing certain worms that form beneath the deposit collected
upon the teeth as the effect of want of cleanliness; these worms, he
says, are exceedingly small and characterized by a small round head
with a small black spot; the body is long and fine, pretty nearly like
the worms seen in vinegar through the microscope. He adds that these
worms destroy the teeth little by little, causing a bad odor, but
not much pain. He believes it an error of the imagination to ascribe
violent pains in the teeth to dental worms, and holds that these only
produce a very slight, dull pain accompanied by itching.

“I have done everything possible,” continues Fauchard, “to convince
myself with my own eyes of the existence of these worms. I have made
use of the excellent microscopes of Manteville, sworn surgeon of Paris,
and have made a great number of experiments with them both on caries
in teeth newly extracted as well as on tartar of different consistency
accumulated on the same, but have never succeeded in discovering any
worms. I am also still less disposed to believe in the existence of
these animals, because Hémard declares that he has never been able
to find any worms in carious cavities. I am thoroughly convinced
of Andry’s sincerity; neither do I doubt the truth of the facts he
relates; but it is easy to perceive from his own words how little the
pretended healers of teeth and their specifics for killing worms are to
be held in account; from the moment that, according to this writer, the
pains for which one is most obliged to have recourse to remedies are
almost always those not proceeding from the cause in question.”

In short, Fauchard does not believe at all that dental caries is
occasioned by worms; and only from respect for the authority of Andry
and other writers does he admit the accidental existence of these
little animals in the carious cavities or upon the teeth, refusing,
however, to attribute any importance to the same as regards the
etiology of caries.

This disease, says Fauchard,[417] is produced by a humor that
insinuates itself into the midst of the osseous fibers of the teeth,
and displacing the particles which compose these fibers, gives rise to
their destruction. The causes from which these disorders derive may be
external or internal. The external causes are blows, violent efforts
made by the teeth; the improper use of the file, the application of
acids or of other substances that injure the enamel, alteration of
the saliva, impressions of heat or cold, and also certain kinds of
nourishment. Blows or violent efforts may produce caries, according to
the writer, by occasioning the effusion of the liquid contained in the
vessels. The author gives analogous explanations for the other external
causes. As to the internal causes, they consist, he says, in alteration
of the blood and of the humors.

The teeth, says Fauchard, are more subject to caries than all the rest
of the bones in the human body, because, their tissues being denser,
the vessels are on this account closer together and more easily liable
to be obstructed, choked up, and broken. Besides, the position of the
teeth exposes them more than the other bones to the immediate action
of external causes capable of producing the disorders alluded to; and
finally, what demonstrates the dental caries to be produced, for the
most part, by external causes, is that false teeth, either human or
formed from those of animals, sometimes become carious just in the same
way as the natural ones; which evidently happens by the sole action of
external causes.

It is undeniable that the ideas expressed by Fauchard on the pathogeny
of caries, cannot hold good against criticism. Nevertheless, we owe a
great deal to this author for having once for all put an end to the
ridiculous theory of dental worms, and for having tried to find a
reasonable explanation of the manner in which caries is produced.

The teeth, says Fauchard, have not all the same disposition toward this
morbid process; indeed, notable differences are to be observed in this
respect. The molars are, in fact, more apt to become decayed than the
incisors or the canines; and the upper incisors and canines are more
subject to this disease than the inferior ones, because, by reason of
their position, they are more frequently uncovered and more exposed to
heat and cold, whether in eating and drinking or whether in the mere
aspiration or expiration of the air. It is to be observed, besides,
that when the eruption of the last molars is considerably delayed they
easily decay.[418]

Having very frequently observed the symmetrical decay of corresponding
teeth on both sides of the same jaw, Fauchard considers that these
cases are not simply accidental, but rather holds that the fact
depends on a special cause, which, however, is not easy to determine.
He offers, at any rate, a sufficiently good explanation when he says
that as certain morbid causes (bad humors, etc.) must affect both
sides of the mouth identically, it is but natural that the effects of
such causes should be altogether analogous on the right and on the
left, and manifest themselves symmetrically on teeth having the same
configuration, the same structure, and the same consistence.

Before speaking of the treatment of caries,[419] Fauchard alludes to
the fallaciousness of the many remedies against toothache which were
largely sold at his time by charlatans and impostors of every kind.

“Some pretend to cure toothache with an elixir or some special essence;
others with plasters; others by means of prayers and signing with the
cross; others with specifics for killing the worms that are supposed
to gnaw the tooth and so cause pain; others pretend to be so clever
that they can cure the most inveterate toothache by merely touching the
tooth with a finger dipped into or washed with some rare and mysterious
liquid; others finally promise to cure every kind of toothache by
scarifying the ears with the lancet or cauterizing them with a red-hot
iron.”

“I am well aware,” adds Fauchard, “that it can be alleged in favor
of this last prejudice that the celebrated Italian doctor Valsalva
indicates with great precision the point in which the actual cautery
is to be applied to the ear, in order to calm toothache. He also
determines the size of the iron and the manner of applying it. The
authority of so celebrated an author, whose opinion is certainly worthy
of respect, should induce me to believe that there may perhaps be
some cases in which it is possible to use this remedy with success;
nevertheless, I cannot persuade myself that such treatment can be
useful in common cases of toothache.

“At Nantes, a city of Brittany, I knew a Turk, a watchmaker by
profession, who was renowned for this mode of curing toothache. But I
also know that, in spite of the pretended cures, the greater number
of those who put themselves into his hands were obliged finally to
have recourse to me, in order to find relief for their sufferings. I
afterward saw several other persons use the same remedy with no better
success.

“There are, besides, an infinity of other remedies vaunted as
efficacious against toothache, but the greater number of them are so
ridiculous and extravagant that it would be both tiresome and useless
to speak of them. We will, nevertheless, give one more mentioned by M.
de Brantôme.”[420]

The author here quotes a passage of this writer, wherein he says that,
having been suffering from toothache for two days, the apothecary of
Elizabeth of France, wife of Philip II of Spain, brought him a most
singular herb, which when held in the hollow of the hand had the virtue
of making the pain cease immediately; and in this way he was, in fact,
effectually cured.

And here Fauchard expresses himself of the same opinion as Urbain
Hémard, who believes the cure of toothache by means of words, or by
the touch of paper on which certain signs are written, or remedies
held in the hand, etc., to be merely the effect of the force of the
imagination, and he opines that the patient, having a vivid belief in
the mysterious thing proposed to him remains under the impression of
an inward commotion, by the effect of which it may well be that the
morbid humor is deviated from the painful part to other parts of the
body. The effects of the various passions on the bodily functions are,
says Fauchard, very well known. Thus, when under the influence of anger
the wounded at times do not feel any pain, and those who suffering from
a tormenting toothache go to a dentist to have the tooth drawn are
sometimes seized by such great fear as not to feel the pain any longer,
and go away, only to return later on renewal of their sufferings;
although there have been cases where the pain ceased altogether.

In spite of this explanation, of which we will not here discuss the
value, allowing it, however, as satisfactory enough, Fauchard continues
by making a most curious consideration, which as it is of a somewhat
surprising effect in a scientific work, we will not deprive our readers
of it. He believes it to be his duty to give the following warning,
namely, that “the modes of cure, by means of certain words, of certain
signs, laying on of hands, written charms, etc., savoring much of
superstition and of diabolic artifice, are prohibited by the Church as
sinning against the first Commandment, as much in him who practises
them as him who consents thereto.”

After the above preliminaries, the author passes on to treat the
important subject of the mode of curing caries.[421] According to him,
when caries has not yet attacked the internal cavity of the tooth at
all, or only in a very slight degree, there are four modes of curing
it: the first consists in the use of files or scrapers, the second in
the application of lead, the third in the use of oil of cinnamon or
of cloves, and the fourth in the application of the actual cautery.
Fauchard expresses most energetically his disapproval of the means
of cure recommended by Dionis in cases of caries of the triturating
surfaces, which consisted in the cauterizing of the decayed spot
with a drop of oil of vitriol applied by means of a miniature paint
brush, declaring this to be both dangerous and hurtful because of the
destructive and corrosive action of the oil of vitriol and because of
the impossibility of limiting its action solely to the affected part of
the tooth.

The general method of cure followed by Fauchard is described by him in
these terms:

“When a tooth is but slightly decayed, it is sufficient to remove the
caries with the instruments of which I will speak hereafter, and to
fill the cavity with lead. If, however, the cavity be rather deeper
and occasions pain, one should, after having scraped it, put a small
ball of cotton-wool soaked in oil of cinnamon or of cloves into the
hollow of the caries every day. This medication must be continued for a
sufficient time, taking care to squeeze in the cotton-wool by degrees
to accustom the sensitive parts to the pressure. Four or five days
later one removes the material from the carious cavity. This treatment
sometimes prevents a return of the pain; it produces on the osseous
fibers of the tooth a slight but sufficient exfoliation and impedes
the progress of the caries. If the pain should not cease after having
continued this method for a sufficient length of time, one should then
have recourse to the actual cautery and stop the tooth after a certain
time, if the form and situation of the decayed cavity permit it; for
one sometimes meets with cavities that are not able to maintain the
stopping.

“If the caries penetrates as far as the cavity of the tooth, it may
give rise to an abscess; and this I have often observed in persons to
whom the caries of the incisors or of the canines occasioned great
pain. In such cases I introduce the extremity of the sound into the
cavity of the tooth in order to facilitate the evacuation of matter.
As soon as the pus is evacuated the pain ceases. I then leave these
patients in repose for two or three months; after this time, I stop the
decayed tooth or teeth to avoid their getting worse.”

As anyone may perceive, the methods used by Fauchard against caries
left much to be desired, when compared with those now in use. With such
imperfect methods it is but natural that one did not always succeed in
obtaining the immediate cessation of the pain resulting from caries.
The want of additional remedies was, therefore, felt; and, in fact,
Fauchard tells us[422] of two with which he had experimented and found
most efficacious against toothache. The first is a resinous plaster
to be applied to the temples; the other is a paste to be applied, in
quantity equal to the size of a small bean, between the gums and the
cheek, and which was composed of various ingredients, among others,
pyrethrum, black pepper, ginger, stavesacre, mace, cloves, cinnamon,
sea salt, and vinegar. After having given the mode of preparation and
application of the two above-mentioned remedies, Fauchard adds: “These
remedies prove especially efficacious if one takes care to introduce a
little cotton-wool or lint into the decayed cavity, soaked in oil of
cloves, or cinnamon, mixed with an equal quantity of extract of opium,
and if one resorts opportunely to bleeding and purging; which ought
never to be neglected in the case of plethoric persons.”

Finally, the author speaks of another remedy,[423] and one which we
never should have expected to find in his book; but he assures us that
by it many persons who had almost all the teeth decayed and suffered
very often from toothache found great relief.

“It consists in rinsing the mouth every morning and also in the evening
before going to bed with a few spoonfuls of one’s own urine immediately
after it has been emitted, always provided the individual be not ill.
One is to hold it in the mouth for some time, and the practice ought to
be continued. This remedy is good but undoubtedly not pleasant, except
in so far as that it procures great relief. Some of those to whom I
have recommended it, and who have used it, have assured me that in
this manner they were relieved of pain to which, up to then, they had
continually been subject. It is rather difficult in the beginning to
accustom one’s self to it; but what would one not do to secure one’s
self health and repose.”

In order to explain the virtue of the urine as a remedy, the author
pauses to speak of its chemical composition, and then adds:

“The rectified spirit of urine[424] could be substituted for the human
urine. One should then take two drams of this substance and mix it with
two or three ounces of aqua vitæ, or water of cresses or of cochlearia.
Sal volatile[425] has the same virtues. Those who wish to make use of
it should dissolve fifteen to thirty grains of it in the same quantity
of the above liquid.”

Fauchard then passes on to speak of trepanning of the teeth when they
are worn away or decayed and cause pain.[426] He begins by saying that
most varieties of pain caused by the canines and the incisors when
worn away or decayed cease after the use of the trepan. He, however,
understands the term trepanning in a very wide sense, comprehending
therein the use of any instrument whatever (even a needle or a pin)
with which one penetrates into the inner cavity of the teeth.

In interstitial caries of the canines and incisors one ought, says
Fauchard, first to enlarge the interstice with a small file of a
convenient shape, then to scrape the decayed cavity, and finally to
open up the canal or inner cavity of the tooth with a perforator or
with a small trepan.

“In this way the pus or other humors that may have collected in the
tooth can easily find their way out, and the pain will cease at once or
in a short time.”

The author describes with much minuteness the manner of trepanning, and
then adds:

“After this operation one should let a few weeks pass without doing
anything to the affected tooth, and afterward, in order to impede
further decay, one must put a little cotton-wool into it soaked in oil
of cinnamon or of cloves. The tooth must be left in this state for
some months, taking care to renew the cotton-wool. It is necessary to
observe that in beginning to put in the cotton-wool this should be done
with lightness and without pressing it down much, so that if pus should
gather again it may be able to make its way through the cotton-wool,
the principal object of this being to hinder the penetrating of
alimentary substances into the tooth, which would be the cause of
further decay. If the cotton were pressed into the tooth from the
beginning, the pus, not being able to find an exit, would accumulate,
and might cause much pain, if the nervous parts of the tooth were
not yet dried up or destroyed. The same thing might happen after the
application of a lead stopping, and one would be obliged to remove it
and let considerable time pass before putting it in again.”

Further on the author says that while the trepanning of incisors or
canines almost always causes the pain to cease, by opening up an exit
to the morbid matter retained within the cavity of such teeth, the
same is not the case with the molars, these having several roots and
several cavities, of great variety, which lend themselves but little to
accurate trepanning. “Hémard,” he adds, “judges it necessary to extract
these teeth, or at least to break off the crown (_les déchapeller_),
in order to give exit to the corrupt matter that is closed up in the
cavity; this sometimes causes the pain to cease. He (Hémard) says that
he has seen many abscesses in the interior of teeth, which were not
externally decayed, and that after having broken off the crown he found
within the cavity a corrupt matter of an insupportable smell.”

Relative to such cases, Fauchard says that, besides the teeth, also the
surrounding parts suffer and are imperilled by these conditions. “The
greater part of the violent fluxions deriving therefrom often terminate
in abscesses and fistulæ of the gums and of the surrounding parts, and
sometimes with considerable and dangerous decay of the bone, as I have
related in some of my observations.”

One sees that Fauchard was clinically very well acquainted with the
grave forms of pulpitis and their possible consequences, although
ignoring the true nature of this process, which has only been studied
and illustrated much more recently.

Chapter XL (page 177) treats of dental tartar, of its cause, of the
harmful effects it produces, and of the prophylaxis and therapy
relating thereto. Three illustrations which are added to this chapter
represent the different aspects of a mass of tartar of exceptional
size formed around the body of a lower molar. The surgeon Bassuel, a
friend of the author, had removed this mass of tartar, together with
the entire molar, from the jaw of an old woman. The mass itself was
almost the size of a hen’s egg, the superficies being very irregular;
it rendered mastication altogether impossible and caused the cheek to
stand out in such a way as to give the appearance of a tumor.[427]

In the following chapter[428] the author enumerates the various dental
operations: “Cleaning the teeth, separating them, shortening them,
removing the caries, cauterizing, stopping, straightening crooked
teeth, steadying loose teeth, trepanning, simple drawing of teeth,
replacing them in their own alveoli, or transplanting them to another
mouth, and finally substituting artificial teeth for those wanting.” He
then adds: “All these operations require in him who carries them out
a light, secure, and skilful hand and a perfect theoretic knowledge,
by which he may decide on the opportuneness of performing them, of
deferring them, or of abandoning them altogether. In fact, one may know
perfectly well how to carry out an operation and nevertheless undertake
it in a case in which it is not at all proper to operate. Into such
an error no one can fall save through sheer ignorance of the cause of
the disease or of the right means of curing it. From this it must be
concluded that the knowledge required in order to be a good dentist is
not so limited as some imagine, and that the imprudence and the danger
of placing one’s self in ignorant hands is as great as the temerity of
those who undertake to exercise so delicate a profession without the
knowledge of even its first elements.”

Before speaking in detail of all the above operations, the author
dedicates a lengthy chapter[429] to describing with the greatest
minuteness the position to be given in general, as well as in special
cases, to the head and body of the patient, and the manner in which
the dentist should place himself with regard to the former, so as to
be able to make a proper use of each of his hands. As a rule, Fauchard
made the patient seat himself in a convenient arm-chair; in exceptional
cases he placed him on a sofa, or on a bed. He draws this subject to a
close with the following words:

“It is, indeed, surprising that the greater part of those who practise
tooth drawing should ordinarily seat the patient on the ground, this
being both indecent and not very clean. This position is not only
uncomfortable, but causes sometimes a sense of fear, especially in
pregnant women, to whom it may, besides, prove very harmful. But it is
still more surprising that certain authors should even nowadays affirm
this to be the most convenient position, while it is instead one to be
entirely rejected.”

In speaking of extraction of the teeth,[430] Fauchard begins by saying
that the milk teeth, although destined to be shed, should never be
extracted, except in cases of absolute necessity, as, for instance,
when being decayed, they give rise to intolerable pain. The alveoli of
the infantile jaw are weak, whilst the roots of the deciduous teeth
are sometimes firmer and more solid than one would believe, and hence
it is that in extracting a milk tooth one runs the risk of injuring
the alveolus and even of carrying away a portion of it altogether with
the tooth, not to speak of the danger of damaging or even destroying
the germ of the permanent tooth lying below. Besides, Fauchard adds,
there are sometimes deciduous teeth that are never shed and never
renewed. One must, therefore, defer drawing children’s teeth as long as
possible unless they are loose. When, however, intolerance of pain or a
caries endangering the integrity of the neighboring teeth oblige one to
recur without delay to extraction, one should carry out the operation
with prudence and judgment, so as to avoid the dangers alluded to. It
sometimes happens, says Fauchard, that one finds in children a crooked
tooth by the side of a straight one; in these cases ignorant
tooth-drawers have often been known to remove the crooked (permanent)
tooth, and to leave the straight, viz., the deciduous one, which
afterward falls of itself, the individual thus remaining deprived of
one of his teeth for the rest of his life. The rule to be observed in
order to avoid a similar error is always to extract the older of the
two teeth and to leave the one that has been cut more recently, which
is easily recognized by its being ordinarily firmer in the socket and
of a better color than the first.

And here the author inveighs against all the charlatans of his day who
dared, without being dentists, to perform dental operations, and whose
number, it would seem, was ever increasing, so much so that he is led
to exclaim: “There will shortly be more dentists than persons affected
with dental diseases!” In proof of this he relates the case of a
cutler of Paris, who extracted the molar tooth of a young girl because
black spots having appeared on it, he believed it to be decayed; but
perceiving that he had only removed the crown (it was a deciduous
tooth about to fall out), and thinking that he had broken the tooth,
proceeded to extract the root, removing, in his gross ignorance, the
permanent tooth on the point of coming through.

Returning to the indications for the extraction of teeth, Fauchard
says that when a tooth planted irregularly in the mouth cannot be
straightened by any of those means to which he afterward alludes, and
occasions damage or inconvenience or constitutes a deformity, the sole
remedy is its removal. As to decayed teeth and the pain that they
produce, when the evil cannot be remedied with oil of cinnamon or oil
of cloves, with the actual cautery, or by stopping, one must have
recourse to extraction, and this to satisfy four different indications,
that is, before all, to procure the cessation of violent pain; in the
second place, to prevent the caries from being communicated to the
neighboring teeth; thirdly, to remove the fetid smell deriving from
the substances that are retained within the carious cavity, and to
impede the teeth on the same side from becoming covered with tartar,
as inevitably happens when by reason of painfulness in eating they are
forced to be inactive; fourth and lastly, because the dental caries,
not infrequently gives rise to other diseases, which ordinarily cannot
be cured unless the cause from which it arises be recognized and
suppressed.

“Sometimes,” continues Fauchard, “such violent and obstinate pain
arises in a tooth that we are obliged to extract it, although not
decayed nor presenting deformity.”

The author combats the old prejudice, that it is not right to draw
teeth in cases of pregnant women or of nursing mothers, lest the
operation should prove dangerous to the patient or to the fetus, or
produce alteration or arrest of the milk secretion. Only the fear
arising from this prejudice can, according to the author, cause any
of the dreaded contingencies. The dentist ought, therefore, to seek
to dissipate the fears of these patients, by persuading them of the
innocuous nature of the operation as well as of its short duration,
and should represent to them, on the other hand (if the operation
be really necessary), the advantages of promptly deciding on it, to
avoid the harm and the peril that prolonged suffering and the tortures
of sleeplessness might occasion to themselves as well as to the
unborn child or to the suckling infant, such as abortion, premature
confinement, alteration of the milk, etc.

According to Fauchard, “one should always take the precaution of hiding
the instruments from the patient’s sight, especially in the case of
extracting a tooth, so as not to terrify him.”

The author then speaks of cases where it is necessary to open the jaws
by force;[431] of the instruments to be used; of the mode of employing
them; of all the precautions to be observed under such circumstances;
of the necessity that may eventually arise of sacrificing some one
tooth when the enforced opening of the jaws has been impracticable; of
the advisability of sacrificing preferably in such cases one of the
premolars in order to damage as little as possible the masticatory
function and the appearance of the face; of the instruments best
adapted for carrying out this operation; of the danger it presents and
of the best mode of avoiding it; finally, of what it is necessary to do
in given cases to keep the mouth open, in order to not be obliged to
repeat the operation a second time.

The six following chapters of the first volume treat very extensively
of the anatomy and physiology of the gums,[432] of gingival diseases
and their treatment.[433] The subject is treated in a masterly manner,
although these chapters do not offer anything of original importance.

The same may be said of Chapter XXII, in which the author speaks of
scorbutic affections and of their treatment.

The chapters we have cited are accompanied by four plates, representing
thirteen instruments for use in the treatment of the above diseases.

[Illustration: FIG. 78

Instruments for opening the mouth in cases of lockjaw (Fauchard).]

The author then speaks[434] of the accidents which may arise from
caries and from other dental diseases, not only in the parts nearest
to the teeth, but also in localities more or less distant from them,
for example, fistulæ reaching as far as the cheek bone or the eye,
necrotic destruction of the maxillary bones, etc.

The first volume of Fauchard’s work finishes with a collection of
most interesting cases, which may be read even at the present day
with pleasure, and from which one may derive some useful information.
These cases are about eighty in number, spread over fifteen chapters,
according to the various nature of the cases themselves. This valuable
collection gives clear evidence of Fauchard’s eminence both as operator
and observer, and affords at the same time an idea of the extent of his
practice which enabled him to collect so considerable a number of cases
of more than common interest.

Chapter XXV contains some observations on “_well-authenticated cases_”
of regeneration of permanent teeth in individuals of ages varying from
fifteen to seventy-five years. We will here give two of them by way of
curiosities:

“In the year 1708 Mademoiselle Deshayes, now the wife of M. de Sève,
residing at Paris in rue de Baune, and who was then fourteen years of
age, had the first large molar on the right side of the inferior jaw
extracted by me, because decayed and causing pain. The following year
she returned to have her teeth cleaned by me, and whilst doing this I
observed that the tooth extracted had been wholly regenerated.”[435]

“In the year 1720 the eldest son of M. Duchemin, player in ordinary
to the King, who was then sixteen years old, came to me to have the
second large molar on the left side of the lower jaw extracted. It was
very much decayed. I drew it, and a year and a half after the tooth was
completely regenerated.”[436]

In Chapter XXVIII the author relates twelve cases of dental
irregularities corrected by him with satisfactory and at times even
surprising results. We here refer, in Fauchard’s own words, to the last
two of these cases, not because of their being the most important, but
because from them it is evident that Fauchard was not the only dentist
who undertook such corrections, although he was perhaps the only one
who, in certain cases, carried them out with a rapid method.

“In the year 1719 M. l’abbé Morin, about twenty-two years of age,
whose countenance was greatly deformed from the bad arrangement of the
incisors and canines, consulted various colleagues of mine as to the
possibility of correcting the irregularity of his teeth. Some found the
thing so difficult that they advised him to do nothing at all, that is,
not to risk any attempt. He came to me by chance one day whilst another
dentist was with me. We both examined his mouth with much attention.
Now, as this dentist was my elder, and I believed him to have more
experience than I had, I begged him to give me his opinion as to
the best method to follow in this case, in order to insure success.
Whether it be that he would not give me advice, or that he was not in
a position to be able to do so, the fact is, that his answer was not
such as I could have wished. I therefore felt myself obliged to tell
him that I hoped to put this gentleman’s teeth in order within three
or four days. My colleague was not aware that this could be done so
quickly; urged by curiosity, he returned when the time I had indicated
had elapsed, and found, not without surprise, M. Morin’s teeth reduced
to perfect order.”[437]

“Several years ago the wife of M. Gosset, Reviseur des Comptes, sent
for me to examine the teeth of her daughter, then twelve years of age.
I found the lateral incisor on the left side of the lower jaw strongly
inclined toward the palate in such a manner as to constitute a real
disfigurement. Interrogated by the mother as to the possibility of
remedying this, I replied that it could easily be done in eight or ten
days, with the method of threads, if the young girl were only sent
every day to my house. As, however, the young lady received instruction
from several masters who came to her house each day, my proposal was
not accepted, in order not to distract her from her studies. This
induced me to say to the mother that, if she were willing, I would put
the crooked tooth into its natural position in a few minutes. Surprised
at so short a time being demanded for the operation, she consented
to my performing it immediately. Making use of the file, I began by
separating the tooth from the neighboring ones which pressed upon it,
slightly diminishing the space it ought to have occupied. This done,
I straightened the tooth with the pelican, placing it in its natural
position, to the great astonishment of the young girl’s mother and of
other persons present, who told me they had many times seen similar
corrections that had been carried out by the late M. Carmeline and
others, never, however, with this method or in so short a time. As soon
as I had reduced the tooth to its normal position I fixed it to those
next to it by means of a piece of common thread, which I left there
eight days; and during that time I made the young girl rinse her mouth
four or five times a day with an astringent mouth wash. After the tooth
had become firm, it would not have been suspected that it had ever been
out of its normal position.”[438]

In Chapter XXX the author gives an account of five cases of dental
replantation and one of transplantation. This last operation was
carried out on a captain who had the upper canines on the left side
decayed and aching; he inquired of the author if it were possible to
draw it and replace it by another person’s tooth. Having received an
affirmative reply, the officer sent immediately for a soldier of his
company to whom he had already spoken on the subject. This man’s
canine was found by Fauchard to be too large; nevertheless, for want
of better he extracted and transplanted it, after having diminished it
in length and in thickness. This it was not possible to do without the
cavity of the tooth remaining open, and for this reason, when, after
about two weeks’ time it had become quite firm, he stopped it. But the
stopping immediately caused such insupportable pain (which circumstance
astonished the writer not a little) that he was obliged to take it out
again the following day, on which the pain ceased directly. Fauchard
saw this patient eight years afterward, and was assured by him that the
transplanted tooth had lasted him six years, but that its crown had
been gradually destroyed by caries. The root had been extracted by a
dentist, not without considerable pain.[439]

We now give one of his cases of replantation in the words of the author
himself:

“On April 10, 1725, the eldest daughter of M. Tribuot, organ builder
to His Majesty the King, called on me; she was tormented by violent
toothache caused by caries of the first small molar on the right side
of the upper jaw; but although she was desirous of having the tooth
removed, to be freed of the pain, she, on the other hand, could not,
without difficulty, make up her mind, thinking of the disfigurement
which its loss would occasion, and thus it was that she was induced to
ask me if it would not be possible to put it back again after having
extracted it, as I had already done in the case of her younger sister.
I replied that this might very well be done, provided the tooth came
out without being broken, without any splintering of the alveolus, or
great laceration of the gum. The patient, upon this, completely made up
her mind. I extracted the tooth very carefully so as not to break it,
neither were the gum nor the alveolus injured in any way. I therefore
was induced to put the decayed tooth back in its alveolus, and having
done this, I took care to tie it to the neighboring teeth with a
common thread, which I left in position for a few days. The tooth
became perfectly firm, and only caused pain for two days after being
replanted.... To better preserve it, I stopped the carious cavity.”[440]

Not without interest is a case of disease of Highmore’s antrum,
originating in the following way. A charlatan attempted to extract by
means of a common key a canine tooth which had erupted in an abnormal
position. He applied the hollow of the key to the tooth and beat upon
the handle with a stone. But the tooth, instead of penetrating into the
hollow of the key, was driven into the maxillary sinus.[441]

Two important cases of “stony excrescence” of the gums (probably
osteomas) are to be found in Chapter XXXII. One of these tumors was
removed by the dentist Carmeline after the patient had been tortured
with useless operations by surgeons, who, not recognizing the true seat
of the evil and mistaking it for a tumor in the cheek, had, over and
above all the rest, produced a permanent disfigurement of the patient’s
face and a perforation of the cheek that he was obliged to keep closed
for the remainder of his life with a wax plug, to prevent the exit of
the saliva and of liquid or masticated aliments.[442]

Several important observations on obstinate cases of cephalalgia,
prosopalgia, otalgia, and other varieties of pain arising from dental
caries are to be found in Chapter XXXIII. In all these cases the
removal of the decayed tooth or teeth procured the prompt cessation of
pain. Among others worthy of note is a case of violent otalgia caused
by the decay of a lower molar, which, however, was itself not painful.
This circumstance drew Fauchard himself into error, causing him to
believe that the otalgia was independent of the decayed tooth; he
therefore merely stopped the tooth to prevent the caries from extending
farther. The pain in the ear continued, however, and the patient
therefore consulted a doctor of the Faculty of Paris, Coutier, who told
her that the decayed tooth might be the cause of the earache, and that,
therefore, before undertaking any other cure, she ought to have it
extracted. This advice was followed and the earache ceased promptly and
completely.[443]

In another case a patient twenty-seven years of age was tormented by
violent pain in all her teeth on the left side, in the temple and the
ear, as well as in the chin, the palate, and the throat. The doctors
and surgeons consulted decided the cause to be rheumatism. The patient
was bled not less than four times and subjected to various other
methods of treatment (purgatives, clysters, poultices, etc.), but all
in vain. She, however, perceiving that one of her teeth was decayed,
had it taken out. It was believed that the cause of the malady had thus
been found and removed; but an hour later the pain began again with
the same violence as before, continuing for some months; after this
it ceased of itself. On the return of the pain, later on, in all its
former intensity, the patient consulted the very able surgeon Petit,
who advised her to see Fauchard, as possibly the malady might have its
cause and point of departure in some bad tooth. Fauchard found one of
the inferior molars decayed. This being extracted, the pain promptly
ceased, not to return any more.[444]

Chapter XXXV contains twelve cases of serious maladies arising from
dental diseases. One of these cases was observed in a patient aged
fifty-seven years, who in consequence of caries of the last inferior
molar on the right lost through necrosis a considerable portion of the
lower jaw, including the whole of the right condyle; he was affected,
besides, with caries of the temporal bone, in so advanced a degree
that the probe could reach the dura mater; he was, therefore, in
serious danger of his life, had to undergo several surgical operations
of exceptional gravity, and even after recovery remained permanently
subject to various disturbances, such as a salivary fistula, paralysis
of the lower eyelid, etc. And all this because the surgeons whom
the patient had called in had directed all their attention to the
secondary facts, instead of suppressing the primary cause of the evil,
represented by a dental affection.

A case observed by the surgeon Juton and communicated by him to the
author is also a very important one. The patient was suffering with a
large abscess on the right side of the lower jaw, accompanied by such
great swelling of the cheek that it was impossible to open the mouth
wide enough to examine the teeth. Juton proposed opening the abscess
immediately, but the patient would not consent. The following day
he was sent for in great haste. The gathering had changed its seat,
making its way between the skin and muscles of the neck, where it now
formed so huge a tumefaction that the patient was in danger of being
suffocated. The abscess was now immediately opened, but the swelling
of the face still persisted; it was therefore only after a month had
elapsed that it was possible to extract the root of the last molar,
which had been the original cause of the whole malady. The surgeon
observed that the liquid injected into the fistulous opening in the
neck issued from the alveolus of the last molar. After the extraction
of the root a prompt recovery was effected.[445]

The second volume of Fauchard’s work is entirely devoted to operative
dentistry and prosthesis.

Before speaking of the modes of cleaning, filing, and stopping the
teeth, the author combats the opinion maintained by some, that these
operations are in part useless, in part also dangerous, as having the
effect of loosening the teeth, of depriving them of their enamel, and
ruining them.

Fauchard then describes the instruments proper for detaching the
tartar;[446] he speaks of the method to be followed in cleaning the
teeth in order to not endanger the enamel;[447] he speaks of the
different kinds of dental files, of their different uses in relation to
the various cases and indications; of the precautions to be taken in
making use of them;[448] of the instruments to be used for scraping and
cleaning the carious cavities and of the mode of employing them.[449]

All of the above-named instruments are illustrated by figures, in
contemplating which one cannot but reflect on the inferiority of the
instruments then in use as compared with those of the present day.
The greater admiration is therefore due to Fauchard’s talent, which,
in spite of such imperfect and at times absolutely primitive means,
enabled him to obtain the brilliant results cited in his observations.

[Illustration: FIG. 79

Instruments for detaching dental tartar (Fauchard).]

Chapter VI is dedicated to the stopping of decayed teeth. The sole
materials used by the author for stopping were lead, tin, and gold.
“Fine tin,” he says, “is preferable to lead, for lead turns black much
more easily and is much less durable; both are preferable to gold,
because lighter and adapting themselves better to the unevenness of
the carious cavities. Besides, gold being dear, not everyone can or
will make the corresponding outlay.” The author here adds that those
who, from vanity or because possessed by the opinion that gold has
special virtues, will not have their tooth stopped except with it, not
unfrequently find dentists who, as the saying, goes, content them and
cozen them by using leaf tin or lead colored yellow, and making them
pay for it as gold stopping!

[Illustration: FIG. 80

Some of the dental files used by Fauchard. The little
square figure represents a small grooved wedge destined
to be inserted in large interdental spaces, in order to
give more firmness to the teeth to be filed.]

The leaf metals were introduced and compressed into the carious
cavities by means of three kinds of pluggers, which would nowadays be
considered altogether insufficient and unfit for the purpose, but which
then, nevertheless, served to produce excellent stoppings. The author
speaks[450] of a lead stopping which had lasted in perfect condition
for forty years.

Before stopping the tooth the cavity was scraped and its opening
widened, if necessary, but no special form was given to the cavity
itself, as is done at the present day.

[Illustration: FIG. 81

Instruments for scraping the carious cavities (Fauchard).]

As at that time the state of the dental pulp was not taken into
consideration before stopping a tooth, it often occurred that the
stopping caused violent pain, which rendered its removal necessary.[451]

Fauchard says that “if the sensibility of the carious cavity be too
great, the lead ought only to be pressed in very lightly at first,
then after one or two days a little more, continuing thus until it is
properly compressed and fitted in, always provided, of course, that the
pain does not increase. The sensitive parts of the tooth become thus
more easily used to the pressure of the lead, and the pain is in this
manner avoided or moderated.”[452]

[Illustration: FIG. 82

Three instruments for plugging teeth. The two small figures represent
silver plates for straightening teeth (Fauchard).]

The author also makes the remark[453] that sometimes, in scraping a
carious cavity, “it is not possible to avoid uncovering and touching
the nerve with the instruments; one becomes aware of this by the pain
caused, and better still by a little blood issuing from the dental
vessels.” In such cases, Fauchard advises stopping of the tooth
immediately, for if it be carried out with delay, it is sure to be
followed by inflammation and great pain, rendering necessary the
removal of the lead or even the extraction of the tooth.

[Illustration: FIG. 83

A gum lancet and two elevators, the second of which is destined to act
from inside outward (Fauchard).]

Cauterization of the teeth[454] continued to be much used in Fauchard’s
time, and this is very easily explainable when one considers that there
was not then any other means of destroying the dental pulp. In making
use of the actual cautery, the immediate end in view was to cause the
cessation of obstinate toothache. “When the teeth give great pain and
no relief is to be derived from the use of other remedies, one ought
to cauterize the caries after having removed the extraneous substances
that may eventually be found in the carious cavity. After the
cauterization one scrapes the cavity and fills it up with cotton-wool
soaked in oil of cinnamon. Later on one stops the tooth.”[455]

[Illustration: FIG. 84

An extracting instrument called by Fauchard lever or tirtoire, and the
handle of a pelican without the hooks.]

The chapter in which Fauchard treats of the correction of dental
irregularities is of particular interest. In speaking of his
observations, we have already seen that in this field also he knew
how to obtain splendid and admirable results. He, nevertheless, made
use of the most simple means—the file, pressure with the fingers,
common threads or silk ones, little plates of silver or gold. At
times, for straightening teeth, he made use of the pelican and the
straight pincers, afterward tying the teeth in their normal position.
He rarely had recourse to extraction as a means of carrying out dental
corrections.[456]

[Illustration: FIG. 85

Fauchard’s simple pelican (with one changeable hook).]

[Illustration: FIG. 86

Fauchard’s double pelican.]

To steady loose teeth,[457] Fauchard, as did the ancients, made use
of gold threads. When the spaces separating a loose tooth from
the neighboring ones were too large, he introduced small pieces of
hippopotamus ivory into them of about the height of a line, and not
exceeding the tooth itself in thickness; on each side of these was a
vertical groove destined to serve as a support to the next tooth. Each
of these pieces was furnished with two holes, through which were passed
the gold threads which served to bind together the teeth and the piece
of ivory itself. This latter was fixed close down to the gum.

[Illustration: FIG. 87

Dental forceps (Fauchard).]

Fauchard occupies himself in three different chapters (X, XI, XII) at
great length with the extraction of teeth. He describes a pelican of
his own invention, and speaks of the advantages it presents over other
pelicans previously in use. Notwithstanding this, it cannot be said
that the instruments used by Fauchard for extracting teeth and roots
show a sensible improvement on those in use before his time.

[Illustration: FIG. 88

Straight forceps and crane’s bill or crow’s bill forceps (Fauchard).]

Among the most usual operations, the author enumerates transplantation
and especially replantation of the teeth.[458] Whenever, says
Fauchard, a wrong tooth is extracted by accident, it ought to be
immediately replanted, and the same ought to be done when violent pain
renders it necessary to extract a tooth that is not much decayed, as
the patient is thus relieved without losing the tooth.[459] Fauchard
adds that this operation succeeds excellently in the case of incisors
and canines, and very often, too, with small molars.

[Illustration: FIG. 89

Cutting forceps (Fauchard).]

[Illustration: FIG. 90

Cutting forceps (Fauchard).]

After having spoken of transplantation, he says:[460] “There is another
mode of replacing human or natural teeth which I have never yet
seen used except by a provincial dentist whose name I ignore.” This
special method consists in the transplantation of a tooth—it matters
little whether recently extracted or not—after having made three or
four notches in its root of about a line in depth. The author goes
on to describe all the particularities of the operation, and then
adds: “After twenty-five or thirty days one removes the thread, and
the tooth is found to be firm in the alveolus, owing to the fact that
this latter, exercising a pressure on the root on every side, becomes
perfectly moulded upon it. In this manner, the tooth will remain
mortised, and may be preserved for a considerable time.”

[Illustration: FIG. 91

Pincers used by Fauchard in the operation of tying teeth
with gold wire. The three larger figures represent
natural or artificial teeth in which holes and horizontal
grooves have been made in order to fix them with gold
threads. The two smaller represent pieces of hippopotamus
ivory with a vertical groove on each side, destined to
fill large interdental spaces and to steady loose teeth
by means of gold ligatures.]

This method, invented by an unknown provincial dentist, has been
recently applied by Znamenski, of Moscow, for the implantation of
artificial teeth made of porcelain, of caoutchouc, or gutta-percha.

One of Fauchard’s greatest merits consists in the improvements
introduced by him in dental prosthesis and in his having, besides, been
the first to treat of this most important part of dental art in a clear
and particularized manner.

The materials then most used in dental prosthesis were human teeth,
hippopotamus tusks, ivory of the best quality, and ox bone.[461]

The author minutely describes the methods to be followed to repair
dental losses in every possible case and of whatever extent.

According to the circumstances, Fauchard used, for maintaining
artificial teeth in their place, linen, silk, or gold thread, passed
through holes made in them, and tied to the natural teeth.

When a set of two, three, four, or more teeth was to be applied,
Fauchard first prepared them separately and then united them together
by means of one or two threads of gold or silver in such a manner
that the set formed at last a single piece, which was then fixed to
the natural teeth. When the piece consisted of several teeth it was
reinforced with a small plate of gold or silver fixed to its inside
by means of small tacks of the same metal riveted on one side to the
plate, on the other to the front part of each tooth.

The author remarks that a similar prosthetic piece lasted longer than
those previously described, but required proportionately much more
work and much greater expense. He adds that, by employing this plate,
one can even dispense with threading and fixing the teeth together
with gold or silver wire; but that it was then necessary to make a
horizontal groove at the back of each tooth corresponding to the width
and thickness of the plate, which could be fitted into the serial
groove and fixed to each single tooth by means of two small rivets.[462]

At other times the prosthesis was carried out in a single piece of
material (ivory, hippopotamus tusk, etc.) that was carved in such a
manner as to substitute exactly the teeth wanting, it being fixed to
the natural teeth in the usual manner.

Fauchard sometimes left the dental roots in their place (if they were
in good condition), applying upon them artificial crowns, which he
either bound to the neighboring teeth or fixed with screws to the
respective roots.

“When one wishes to apply an artificial crown to the root of a natural
tooth, one files away the part of the root that emerges above the gum,
and even more if possible. One then removes, with proper instruments,
all that is decayed in the root itself; after which one stops the root
canal with lead and fits the base of the artificial tooth to the root
in such a manner that they correspond perfectly to each other. One
drills one or two holes in the tooth through which to pass the ends of
a thread, which serves to fasten it to the natural teeth on each side
of it, as described above.

“If the root canal has been very considerably enlarged by the carious
process, so as to have rendered it necessary to stop it, the root
being, nevertheless, still quite steady, one bores a small hole in the
lead as deep and as straight as possible, without, however, penetrating
farther down than the root canal. The artificial crown is then united
to the root by a pivot in the manner I shall now describe.”[463]

The method of applying pivot teeth is described with great accuracy.
In it the author considers all the different circumstances that may
present themselves, and says, among other things, that if the root is
still sensitive to pain, one should apply the actual cautery inside
the canal, before fitting the artificial crown to the root. For fixing
the pivot inside the artificial crown (which was generally the crown
of a human tooth), Fauchard used a special cement made with gum lac,
Venetian turpentine, and powdered white coral.[464]

In the case of there not being any whole teeth to which the prosthetic
piece would be fixed, but only roots, Fauchard made two holes in it
in perfect correspondence with the canals of two roots, and fixed the
prosthetic piece to these by means of two pyramidal screws.[465]

This method suggests in a certain way the idea of bridge work.

In Chapters XVII, XVIII, XXIV, and XXV, Fauchard describes various
methods for the application of entire sets of false teeth, both upper
and lower, as well as double.

The author says that if the lower jaw is entirely toothless, a set
of teeth can be adapted thereto without the need of any special
contrivance; however, it is necessary that the prosthetic piece
should fit perfectly, so that the configuration of the maxillary arch
and the irregularities of the gum, finding themselves in complete
correspondence with the piece itself, may keep it steady in its place.
The support offered by the tongue interiorly, by the cheeks and the
under lip exteriorly, contributes to keep the artificial set steady;
one can thus masticate as easily with it as with one’s own teeth,
especially if the teeth of the upper jaw be still existing and the
individual be already sufficiently used to the wearing of it.[466]

With regard to the application of an entire set of upper teeth, one
learns from Fauchard that although some attempt had been made in this
direction before this time, the results had been very unsatisfactory.
He relates that: “In 1737 a lady of high rank, of about the age of
sixty, who had not lost any of her lower teeth, but was deprived
entirely of the upper ones, applied to M. Caperon, dentist to the King,
who was most able in his profession, in the hope that he might be able
to furnish her mouth with an upper set. But he said that, no tooth
whatever being left in existence, every possible point of attachment
was wanting, and it would therefore be as difficult to do this as it
would be to build in the air.”[467] He, however, directed the lady
to Fauchard, who asked for a few days to think the matter over, and
succeeded in devising a means of applying an upper set of teeth, which,
in fact, entirely satisfied the wishes and wants of the client. “As
this lady,” says the author, “simply wished to have the front of her
mouth decorated, and to be able to pronounce more perfectly, I gave
less extension to the set. The lady eats easily with it and could not
now do without it. For greater convenience she has two similar sets,
which she uses alternately.”[468]

[Illustration: FIG. 92

Complete dentures (Fauchard). _f. 3_ represents an enamelled denture
with artificial gums; _f. 4_ and _f. 5_, steel springs.]

[Illustration: FIG. 93

An upper denture supported by springs fixed to a gold appliance which
embraces the natural teeth of the lower jaw (Fauchard).]

The author describes with great minuteness the manner in which the
prosthetic apparatus in question was constructed and supported, and
then speaks of the successive improvements introduced by him into this
most important part of prosthetic dentistry, particularly in what
regards the springs destined for the support of the upper set of teeth.

[Illustration: FIG. 94

A spring denture for a case in which the lower front teeth still exist.
Figs. 1 to 6, various parts of the apparatus (Fauchard).]

Fauchard also relates having made an attempt to apply an upper set of
teeth without the aid of springs, which proved successful in three
cases. “One can,” says he, “adopt an entire set of teeth to the upper
jaw, of much greater simplicity than those described, and which is
maintained in its place by the sole support of the cheeks and the lower
teeth. It must be very light indeed and serves almost solely to improve
the appearance and the pronunciation; but when the individual gets used
to it, he can also masticate with it. A set of teeth of this kind ought
to adhere well to the gums and to be constructed in such a manner that
the cheeks may afford it sufficient pressure and support together with
the aid of the lower teeth; these latter sometimes bring it back into
its place, without anyone perceiving the movement except the wearer
himself. Not long since I had to renovate a set of teeth of this kind
made by me more than twenty-four years ago, and worn by the owner to
the greatest advantage. I have since made two others which have proved
most useful to the persons wearing them. It is true that there are
few mouths adapted for wearing these sets, so much so that, excepting
the three referred to, I have never made any others. To be able to
construct similar sets successfully, the dentist must be possessed of
skill and ingenuity. Apart from this, they are the most suitable for
persons who cannot spend much, as they cost less to make.”[469]

Fauchard did not merely content himself with having perfected dental
prosthesis in the manner alluded to; he also succeeded in giving a
quite natural appearance to artificial teeth. To reach this end he
placed the art of the enameller under contribution to the dental art.
Thus he had artificial pieces covered over with enamel, imparting
to them the hue that seemed to him best adapted, and also imitating
admirably the natural color of the gums, so as to render the illusion
perfect. The pieces to be enamelled were worked by special rules, which
are minutely given in Chapter XIX of the second volume of his book.

Fauchard also brought the palatine prosthesis to a high degree of
perfection. He describes five different obturators of the palate,
which of themselves alone would be sufficient to testify to the highly
inventive genius of the author, although they are defective in being
somewhat too complicated. Some of these fixtures are a combination of a
dental set and palatine obturator.

We ought now to mention, in the order of chronology, some authors of
lesser importance.

VASSE and DE DIEST wrote about the danger of fatal hemorrhage following
on dental operations.[470] They report a few cases of this kind, giving
the blame of these accidents, however, to the carelessness of the
operator.

LAVINI published in Florence, in the year 1740, a very good treatise on
dentistry (_Trattato sopra la qualità de’ denti, col modo di cavarli,
mantenerli e fortificarli_), which, however, marks no advance on the
work of Fauchard.

M. BUNON (died 1749), a French dentist, wrote four admirable works on
dentistry, which were published from 1741 to 1744. We will here briefly
allude to the most salient ideas therein contained.

This author combated strenuously some prejudices then generally
diffused; such as that of its not being advisable to extract teeth
during pregnancy, and that of the extraction of an upper canine (eye
tooth) being attended with great danger. He demonstrated the absurdity
of the latter idea by putting in evidence the anatomical fact that the
upper canines are innervated by the infra-orbital nerve, which does not
stand in any relation whatever to the organ of sight.[471]

Among the other remedies recommended by him against the disorders
and perils of first dentition, there is one most curious, not to say
ridiculous: he advises rubbing the nape of the neck, the shoulders, the
back, and the lower limbs of the child, but in doing this the friction
should proceed from above downward, in order to offer resistance to
the flow of humors toward the upper parts of the body. The utility and
efficacy of this kind of massage in favoring the process of dentition
seems, of a truth, very open to question.

Bunon speaks at length of _erosion of the teeth_, and declares himself
to be the discoverer of this disease, which destroys the enamel of the
teeth already before their eruption. The first molars, the canines, and
the incisors are much more frequently damaged and affected by it than
the other teeth. According to Bunon, it is generally due to measles,
smallpox, malignant fevers, or scurvy, when children are subject to
these maladies during dentition, and more especially during the first.
He is of the opinion that erosion not only generates caries, but may be
considered as being the origin of the greater part of dental affections.

This author distinguishes three principal kinds of dental tartar, the
black, the pale yellow, and the brownish yellow; he admits, however,
two other kinds that are less frequent, that is, the red tartar and the
green.

He relates having observed in the jaw of a child, who died at the age
of three years and a half, a splintering of the alveolar parietes in
all directions, and attributes this phenomena to disproportion between
the size of the teeth and the alveoli. On the basis of his anatomical
observations, he says that caries only appears on teeth that have
already come out of the gums, whilst erosion is produced in teeth not
yet erupted, indeed, at times, several years previous to their eruption.

We will also mention, by way of a curiosity, Bunon’s proposal to
substitute the word legs for that of dental roots.[472]

FR. A. GERAULDY, a French dentist, wrote (1737) an excellent
treatise on dental maladies and on the mode of preserving the teeth.
His book, which was also translated into German,[473] contributed
to the diffusion of knowledge relative to dental prophylaxis and
therapeutics, but apart from this brought no increment to the progress
of practical dentistry. Some of the ideas of the author, however,
merit consideration. He clearly expresses the opinion that the shedding
of the milk teeth is brought about by the pressure exercised upon them
by the germs of the permanent teeth in course of development. The loss
of the teeth in young subjects, or in those who have not yet reached
forty years of age, is explained by the author in an altogether special
manner. He relates that Louis XIV, at the age of thirty-five, had lost
all his upper teeth, and the considerations he makes on the subject
bring him to the conclusion that the precocious loss of the upper teeth
depends in many cases on a paralysis of the nervous fibers that go to
them, which paralysis is probably caused by a dissolute and intemperate
life, having as its consequence the weakening of the organism and,
above all, of the nervous system. Without doubt there is some truth in
Gerauldy’s ideas, it being well known that the falling of the teeth (as
well as of the nails and the hair) often depends on nutritive disorders
deriving from nervous disturbances. We have the clear proof of this in
certain cases of tabes dorsalis accompanied by the spontaneous falling
of the teeth and nails.

JOSEPH HURLOCK, an Englishman, published a treatise in 1742,[474] in
which he warmly recommends lancing the gums in cases of difficult
dentition; he declares this to be entirely without danger, and affirms
that it constitutes the sole means of salvation for not a few infants
who without it would die of convulsions.

MOUTON, in 1746, that is, in the same year in which the second edition
of Fauchard’s work was issued, gave to the light a monograph, the first
extant, on mechanical dentistry.[475] The methods of this author for
the most part do not differ from those of Fauchard, nevertheless one
finds several important innovations in his work. To prevent the further
deterioration of teeth already much destroyed, and to preserve them
some time longer, Mouton had recourse to the application of “calottes
d’or,” that is, gold crowns. He used this for the front teeth as well
as for the molars, but in the former case he had them enamelled to give
them the same appearance as natural teeth.

Mouton also invented a new method of applying artificial teeth. Up to
then the ordinary method had been that of fixing them to the natural
teeth by means of threads passed through holes made in the artificial
teeth expressly for that purpose. Mouton is the first to speak of
artificial teeth fixed to the natural teeth adjoining them by means of
springs or clasps.

This author relates having carried out several transplantations with
perfect success, a thing that contributed greatly to his renown not
only in France, but also in England. He distinguished himself, besides,
by the correction of dental irregularities. Lastly, it is to be
noted that this author frequently had recourse, as a remedy against
toothache, to the stretching of the dental nerve by means of moving and
partially raising the tooth (subluxation).

A. WESTPHAL. In proof of the great utility of lancing the gums in
cases of difficult dentition, A. Westphal reports a case in which the
difficult eruption of an upper canine tooth provoked considerable
inflammation and protrusion of the eye on the same side as the tooth;
these symptoms promptly disappeared, however, as soon as the gum was
lanced down to the tooth itself.[476]

J. BERTIN also declares himself in favor of this operation; he
recommends never to neglect it in cases of difficult dentition, and to
make the said incisions deep and wide enough.[477]

L. H. RUNGE, a surgeon of Bremen, published, in 1750, a monograph on
the diseases of the frontal and maxillary sinuses. He says that in
cases of inflammation of Highmore’s antrum, the pus may make its way,
corroding the bone, as far as the alveoli, or, sometimes, as far as
the orbital cavity; and, _vice versa_, alveolar suppuration can give
rise, by diffusion, to abscess of the maxillary sinus. In this latter,
tumors of various kinds may form (polypi, cysts, sarcomas, cancers,
exostosis), the existence of which is ignored at first, and only
becomes manifest tardily. Runge’s father, who was also a surgeon, had
occasion to observe, and to treat an important case of disease of the
maxillary sinus, with considerable dilatation of the same, not only
on the side of the cheek, but also on the side of the palate and of
the nasal fossæ. With a strong scalpel he perforated the outer wall of
the antrum above the molars (keeping the cheek detached) and enlarged
the aperture by making the instrument turn around on its own axis,
thus giving exit to a considerable quantity of non-purulent liquid.
Detersive and aromatic injections were used for some time. The canine
tooth, situated obliquely, having been extracted, its alveolus was
found to communicate with the antrum. From this moment, the injections
being continued, a rapid improvement was obtained and the patient was
so completely cured that no deformity of the face remained.

Runge relates a case in which, having extracted a canine tooth, he
found a cyst adhering to its root. From this he is induced to believe
that in the case related above the disorder was also to be attributed
to a large cyst having its origin in the root of the canine.

According to him, the ozena always stands in relation to a suppurative
affection of the maxillary sinus, and for its treatment one must,
therefore, have recourse to Drake’s operations.[478]

GEORG HEURMANN, a surgeon in Copenhagen, recommends making use, after
the Cowper-Drake operation, of a small cannula in order to facilitate
the exit of the pathological material contained in the sinus, and
also to render it easier to introduce into it medicated or detersive
substances.[479]

LÉCLUSE. One of the most celebrated French dentists of the eighteenth
century is Lécluse. Dental literature was enriched by him with several
works, partly written in popular style, partly addressed to dental
specialists. In 1750 he published his _Traité utile au public, où
l’on enseigne la méthode de remédier aux douleurs et aux accidents
qui précèdent et qui accompagnent la sortie des premières dents, de
procurer un arrangement aux secondes, enfin de les entretenir et de
les conserver pendant le cours de la vie_. The work seems to have been
very favorably received, as its first edition, printed in Nancy, was
followed by a second, printed in Paris, only four years later. In 1755
he published another book: _Eclaircissements essentiels pour parvenir
à préserver les dents de la carie et le conserver jusqu’à l’extrème
vieillesse_. But the most important of his works is the _Nouveaux
éléments d’odontologie_,[480] the first edition of which was published
in 1754, and followed by a second in 1782.

We do not enter into a minute examination of these works, which, taken
altogether, do not contain anything very new. We will only remark
that Lécluse treated in a succinct but correct manner the anatomy of
the mouth; invented some and perfected other instruments, the most
important of which is the elevator that still bears his name, and
finally, that he frequently performed the operation of replantation,
warmly recommended by him as an excellent means of cure in certain
cases of caries. The extracted tooth was stopped and afterward
replanted, and, says Lécluse, became fast within eight days, proving as
serviceable as a perfectly healthy tooth, and never again causing any
pain.

PHILIP PFAFF, dentist to Frederick the Great, King of Prussia, was
the first among the Germans who wrote a real treatise on dentistry.
His book[481] contains, in 184 succinctly but well-written pages, the
anatomical and physiological notions relative to the teeth, as well as
all that belongs to dental pathology, therapy, and prosthesis.

Besides a few observations about supernumerary teeth, Pfaff relates
several cases in which the incisors, inferior as well as superior,
were renewed (twice consecutively), that is, once at the usual epoch,
and the second time between the seventh and thirteenth years. He also
cites from the anatomical tables of Kulmus the following epitaph in low
Latin, that seems to allude to a case of third dentition:

  “Decanus in Kirchberg, sine dente canus, ut anus
  Interum dentescit, ter juvenescit, his requiescit.”

In cases of hemorrhage ensuing on the extraction of teeth, the best
hemostatic, according to Pfaff, is essence of turpentine, a remedy
which in these cases he had always found efficient. He introduced a
little ball of lint bathed in this essence as deeply as possible into
the alveolus, applying upon it some blotting paper reduced to pulp or
some dry lint that the patient compressed tightly by closing his teeth.

Gingival abscesses as well as fistulæ of the maxillary region almost
always owe their origin, says Pfaff, to decayed teeth, and can,
therefore, in general, not be cured except by the extraction of these
teeth.

The prosthetic methods described by this author are, for the most
part, identical with those of Fauchard and the other French dentists
already mentioned. As to the materials used for prosthesis at different
periods, Pfaff mentions, besides ivory, bone, hippopotamus tusk, teeth
of sea cow, and human teeth, also teeth made of silver, of mother of
pearl, and even of copper enamelled.

The chief merit one must concede to Philip Pfaff is that of having
been the first to make use of plaster models. It is, therefore, to
two Germans—Pfaff and Purmann, the latter who, as we have already
seen, used wax models—that one of the greatest progressive movements
in dental prosthesis is indebted, that is, the method of taking casts
and making models, of which method one finds no trace whatever in the
authors of antiquity, and which, it would appear, was not known even to
Fauchard himself. The wax casts of an entire jaw were taken by Pfaff
in two pieces, one of the right half of the jaw, and the other of the
left; which were then reunited, and one thus avoided spoiling the cast
in removing it from the mouth.

Another great merit of Philip Pfaff is that of having first carried out
the capping of an exposed dental pulp, previous to stopping a tooth.

Notwithstanding this, Pfaff is not the first who, as Geist-Jacobi is
inclined to believe,[482] _had dared to apply a filling over an exposed
dental pulp without first cauterizing it_. As we have already seen,
Fauchard did not hesitate in the least to fill a tooth when the dental
pulp had become exposed in scraping the carious cavity. But the French
dentist carried out, with much delicacy, a simple filling, whilst Pfaff
first capped the dental nerve.

JACOB CHRISTIAN SCHAFFER. In 1757 the evangelical pastor, J. Ch.
Schaffer (we do not know if he was at the same time a dentist, or
merely an amateur in odontology), wrote a little book[483] to disprove
the existence of worms in decayed teeth, and to show the fallacy of
believing that the supposed worms may be made to drop out by means of
fumigations of henbane seeds. His book appeared, as a matter of fact,
rather behind-hand, for in it Schaffer repeats in substance what
Houllier had already said two centuries earlier, and after him various
other authors, including Fauchard. At any rate, to coöperate in the
complete destruction of error and in the diffusion of truth is always
laudable. We feel, however, bound to add that in the very same year in
which Schaffer’s pamphlet was published, DUFOUR, a Frenchman, described
a worm that had been taken out of a decayed tooth, and called attention
to the fact that it was altogether different from the “dental worms”
described by Andry.[484]

BOURDET. An excellent book on dentistry[485] appeared in France in
the year 1757, the work of Bourdet, a celebrated dentist and elegant
writer, in whom the gifts of literary and scientific culture were
coupled with a vast experience and a profound spirit of observation.
His merits procured him the honor of being appointed dentist to the
King.

This author condemns as harmful the use of hard substances (such
as bone rings, etc.) that people are in the habit of putting into
children’s hands during the period of the first dentition, in the
idea that by pressing these objects between the gums, as children
instinctively do, they cut their teeth more easily. As to emollients,
he holds them to be completely useless, and prefers to all these
remedies the use of lemon juice.

According to Bourdet, the teeth are so apt to decay, partly because
of the frequent changes of temperature to which they are exposed, and
partly because, differently from the bones, they are not provided with
any protective organic covering.

In many cases of caries, Bourdet extracted the tooth, filled it with
lead or gold leaf, and replanted it; but if, in extracting, the
alveolus had been somewhat injured (a thing very likely to happen with
the instruments of the period), he replanted the tooth immediately, to
preserve the alveolus from the damaging action of the air, and carried
out the stopping at a later time.

Even in certain cases of violent toothache not depending on caries,
Bourdet luxated the tooth and replaced it in position directly. But as
some dentists had accused him of having passed off as new an operation
already made known by Mouton since the year 1746, Bourdet defended
himself by saying that whilst Mouton only shook the tooth, raising it a
little, simply to distend the nerve, he, instead, effected a complete
luxation, in order altogether to interrupt the continuity of the nerve.
Anyhow, this operation was not new, as it had already been recommended
and practised by Peter Foreest, in the sixteenth century, and in an
even more remote epoch by the Arabian surgeon Abulcasis.

Sometimes, when the permanent canine comes forth, it has not room
enough, and therefore grows outward. In this case Bourdet extracts the
first premolar; the canine then advances gradually of itself toward
the space left by the extracted tooth, until it occupies its place
exactly. He also counsels the extraction of the first premolar on the
opposite side of the jaw, in order to preserve the perfect symmetry of
the dental arch on both sides. When the arch formed by the jaws is too
large and of an ugly appearance, Bourdet advises extracting the first
upper and lower premolars, so that the maxillary arches may acquire a
more regular form. In cases in which the defect of form exists only in
the lower jaw, that is, in children who have protruding chins, Bourdet
corrects this deformity by extracting the first lower molars shortly
after their eruption, that is, toward seven years of age. In this
manner, says the author, the lower jaw grows smaller and the deformity
disappears. The inventor of this method, as Bourdet himself tells us,
was the dentist Capuron.

Bourdet made prosthetic pieces, whose base, representing the gums
and the alveoli, was made entirely of gold and covered over with
flesh-colored enamel on the outside, so as to simulate the natural
appearance of the gums; the teeth were adjusted into the artificial
alveoli and fixed with small pins. At other times he made use of a
single piece of hippopotamus tusk, in which he carved not only the
base, but also the three back teeth on each side, whilst the ten front
teeth were human teeth fixed to the base with rivets.

One of Bourdet’s principal merits is that of having brought artificial
plates to perfection by fixing them not, as heretofore, to the opening
of the palate or inside the nose, but by means of lateral clasps fitted
to the teeth.

In a special pamphlet, published in 1764,[486] Bourdet treats of the
diseases of Highmore’s antrum. To facilitate the exit of pathological
humors from the sinus, after the Cowper operation, he introduced a
small cannula, forked at one end, into the antrum and fixed the two
branches of the fork to the neighboring teeth by tying.

In some diseases of the maxillary sinus (polypus, sarcoma, etc.)
Bourdet recommends cauterizing.

Besides his principal work, the pamphlet on the diseases of Highmore’s
antrum, and some others of less importance, Bourdet wrote an excellent
book on dental hygiene,[487] which had the honor of two translations,
one German, the other Italian; the latter published in Venice in 1773.

This celebrated author inveighs bitterly against charlatans and quack
dentists, and throws light on all their impostures. It appears,
however, that in the midst of this despicable class, so justly
condemned by him, there existed a courageous though unscientific
operator, to whom posterity would have attributed due honor had his
name been handed down, for he was the first, in all probability, to
try the implanting of teeth in artificial alveoli. This is, at least,
what we deduce from a passage in one of Bourdet’s works, in which we
read that a charlatan sought to impose on the public the belief that
he could make a hole in the jawbone and plant therein an expressly
prepared artificial tooth, which in a brief space of time would become
perfectly firm and as useful as a natural one. Bourdet adds that an
attentive investigation led to the recognition of the said tooth being
simply that of a sheep. It would appear, therefore, that the operation
had been in reality performed, it matters but little whether with the
tooth of a sheep or with one of another kind.

JOURDAIN was another eminent writer on dental matters, at this period.
Rather than a true surgeon-dentist like Fauchard and Bourdet, Jourdain
was a general surgeon who had dedicated himself with particular
predilection to the study and treatment of oral and maxillary diseases.
And precisely for this reason his writings, although of great
scientific importance, are far from possessing for dental art, properly
so-called, the same value as the works of Fauchard, Bourdet, and other
great dentists of the eighteenth century. His works, as Geist-Jacobi
justly observes, give us the impression of his having been a theorist
rather than a practical dentist.

In 1759 Jourdain described in the _Journal de Médecine_[488] an
improved pelican and another instrument to be used for straightening
teeth inclined inward. Two years later he published his treatise on
the diseases of Highmore’s antrum and on fractures and caries of the
maxillary bone.[489] After this, appeared his book on the formation of
the teeth.[490] He therein describes with great accuracy the dental
follicle from its first appearing to the moment of birth, following
it throughout its evolution. This lengthy book is most interesting,
for it is not a mere compilation, but gives the results of personal
research and experience. But by far the most important of all the works
of this author is his treatise on the diseases and surgical operations
of the mouth.[491] This book went through several French editions,
was translated into German in 1784, and has had, besides, two English
editions in America of comparatively recent date, that is, at Baltimore
in 1849, and at Philadelphia in 1851; all of which proves the great
value of the work; it treats, however, much more of general surgery
of the mouth and neighboring regions than of dental art properly so
called. The first volume of 626 pages is almost entirely dedicated
to the diseases of the maxillary sinus, which, for this author, were
ever the object of favorite and particular study. He is not in favor
of carrying out irrigation of the antrum through the mouth, even when
an alveolar opening has resulted spontaneously through the extraction
of a decayed tooth; he prefers instead, whenever this is possible, the
reopening of the nasal orifice, by means of sounds and cannulæ adapted
for the purpose, that is, varying in thickness and in length, and
curved according to the necessities of the case. The natural opening of
the antrum being reëstablished, one irrigates the cavity through it by
means of a cannula to which a small syringe has been screwed. When the
teeth are sound, notwithstanding the diseased condition of the antrum,
Jourdain is absolutely contrary to the performing of the Cowper-Drake
operation. When, on the contrary, the malady owes its origin to decayed
teeth, Jourdain extracts them, but, as already said, carries out the
detersive and medicated injections through the natural opening.

The author divides the collections of the maxillary sinus into purulent
and lymphatic. The purulent are painful and corrode the bone, the
lymphatic are not painful and do not corrode the bone, but distend and
soften it, producing external tumefaction which yields to pressure,
and, on this being diminished, gave out a characteristic sound. These
so-called lymphatic gatherings referred to by Jourdain are none other
than mucous cysts of the maxillary sinus. Also the other diseases
of Highmore’s antrum (polypi, etc.) are taken by this author into
attentive and minute consideration.

The second part of the work is dedicated to the other diseases of the
maxillary bones (especially of the inferior one), as well as to those
of the lips, cheeks, salivary ducts, gums, frenum linguæ, etc. Dental
hemorrhage and difficult dentition are also spoken of in this volume.

The author relates, with regard to the latter subject, that he had
observed, in corpses of infants who had succumbed to a difficult
dentition, that the crowns of the erupting teeth were covered by the
alveolar margins folded upon them. This, according to him, must be the
reason why even lancing of the gums proves useless in some cases of
difficult dentition; it is therefore necessary, whenever it is possible
to recognize the existence of this state of things, to destroy the bony
margins that oppose the erupting of the teeth; the author declares that
he has frequently done this, with fortunate results.

In 1784 Jourdain published a treatise on artificial dentures.[492]
He therein specially speaks of a complete denture with four springs,
perfectly adapted to the purpose of mastication. The author attributes
the merit of its invention to MASSEZ, who had imagined it toward 1772.
If we may judge, however, by what Joseph Linderer says,[493] this
denture appears to have been too complicated, even when compared with
those described by Fauchard.

LAMORIER and RUSSEL, contemporaries of Jourdain, also studied the
diseases of the maxillary sinus, and published in the _Mémoires
de l’Académie de Chirurgie_, vol. iv, several important cases of
polypi and other diseases of the antrum. Lamorier is not in favor
of the Cowper-Drake operation. He recommends perforating the antrum
immediately above the first molars, or rather between it and the malar
bone. In this he seems to have been influenced by the considerations
that the wall of the cavity here presents the least thickness, and that
this is the most dependent part of the sinus. But he did not always
deem it necessary to make a perforation here, when a fistulous opening
had previously formed in some other place. His method of operating is
as follows: The jaws being closed, the angle of the mouth is drawn
outward and slightly upward with a curved instrument called by the
author a speculum; this done, the gum is incised below the molar
apophysis and the bone laid bare, and then pierced with a spear-pointed
punch. The opening is afterward enlarged if found necessary.

Several contributions to the knowledge of the diseases of the maxillary
sinus and their treatment were made about this time by Beaupréau,
Dubertrand, Caumont, Dupont, Chastanet, Doublet, David, and especially
by Thomas Bordenave, who published an important work on this subject,
collecting a great number of clinical cases of great interest. Speaking
of the Cowper-Drake operation, he expresses the opinion that the tooth
to be extracted is not the same in all cases, for if some one of the
teeth situated below the maxillary sinus should either show signs of
decay or be the seat of persistent pain, the choice should fall upon
that one. If, however, these teeth are all apparently sound, the one
should be chosen that, under percussion, is most sensible to pain. In
those cases in which the choice is altogether free, Bordenave prefers
the extraction of the first large molar, for the double reason that
it is generally situated in correspondence to the central part of the
cavity, and that it is separated from the antrum by a very thin osseous
lamina. In certain cases, the maxillary sinus is divided, by body
lamellæ, into various cavities, and then, as one easily understands,
it may be necessary to extract more than one tooth for the evacuation
of the pathological contents. When the teeth situated below the antrum
have fallen out, or have been extracted some time, and their alveoli
are in consequence obliterated, it will be better to have recourse
to Lamorier’s method. This method may besides be useful, according
to Bordenave, either when all the teeth are sound and it would
consequently be a pity to sacrifice any of them, or in special cases
(such as large polypi of Highmore’s antrum, extraneous bodies, etc.) in
which the Cowper-Drake operation would not afford sufficient space.

L. B. LENTIN, a German, in 1756, published a pamphlet[494] in which
he recommended electricity as a means of cure for toothache. Other
writers recommended the use of the magnet, which means of cure had
already been advised for various affections by Patacelus. During the
latter half of the seventeenth century, Talbot, J. J. Weckes, and P.
Borelli related several cures of headache and toothache by the use of
the magnet. In the eighteenth century F. W. Klaerich, a medical man
in Göttingen, wrote that he had used the magnet advantageously in not
less than 130 cases of toothache.[495] We find it recommended later by
others, Brunner, and particularly J. G. Teske, who, in 1765, wrote a
pamphlet entitled _New experiments for the curing of toothache by means
of magnetic steel_.[496]

He considers the use of the magnet as the most efficacious of all
remedies against toothache, and believes its action to be similar to
that of electricity.

In the following year, however, the belief in the new means of cure was
sensibly shaken by F. E. Glaubrecht, who declared that although the
magnet calms or causes the cessation of the pain at first, it returns
constantly and with much greater violence.[497] The curing efficacy
of the magnet in cases of toothache was highly vaunted in France by
Condamine.[498]

PASCH attributes the effects of the magnet to the chill produced in the
parts to which it is applied; in proof of this he adduces the fact that
if the magnet becomes heated by being kept some time in the hand, it
loses its efficacy altogether, whilst on the other side one may obtain
the very same beneficial results with a simple steel spatula, just on
account of the action of the cold; finally, he adds that the chill
produced by the magnet on the affected part explains very well not only
the good, but also the bad effects which it produces in many cases,
such as increase of the pain, inflammation, tumefaction, and even at
times spasmodic contractions.[499] Thenceforth the enthusiasm for the
magnetic cure diminished gradually, all the more so inasmuch as that
shortly after the celebrated English dentist Thomas Berdmore ridiculed
it by placing it in the same class as charms, exorcisms, and other
foolish and superstitious means of cure.[500]

ADAM ANTON BRUNNER. One of the most distinguished German dentists in
the second half of the eighteenth century was Adam Anton Brunner. His
two principal works are the _Introduction to the science necessary
for a dentist_,[501] and the _Treatise on the eruption of the milk
teeth_.[502]

This author falls into various errors with regard to deciduous teeth.
According to him they are twenty-four in number, and without roots; but
these may develop in those milk teeth which in exceptional cases remain
in their places after the period in which they generally are shed.

A milk tooth, says Brunner, ought never to be extracted unless there be
manifest signs of the presence of the corresponding permanent tooth, or
when it is painful and decayed. Badly grown teeth can often be put in
order solely by the pressure of the fingers frequently repeated, but
when this is not sufficient, one must have recourse to waxed threads or
to special contrivances.

In applying a pivot tooth, he screws the pivot to the artificial crown
and perforates the root canal only just sufficiently to admit the other
extremity, which he drives in by little strokes of a hammer upon the
crown, without its being necessary to use cement. We learn from this
author that in his time there were turners and other craftsmen who
occupied themselves with dental prosthesis.[503]

Brunner prefers gold for fillings to any other substance whatever.

J. G. PASCH, whose name we have already mentioned, relates the case of
a young maidservant becoming suddenly affected with deafness, and who
recovered her hearing completely on the eruption of one of her wisdom
teeth. From a passage of this author’s we learn that at that time
many had recourse to the crushing of the infra-orbital nerve as a cure
for certain cases of toothache. He, however, decidedly rejects such a
remedy, as it proves for the most part ineffectual and may, besides,
produce very serious consequences. This author carried out many
experiments as to the effects of acids on the teeth.[504]

C. A. GRÄBNER[505] recommends not deceiving children by extracting
their teeth unexpectedly, but rather to persuade them of the necessity
of the operation; for by deceiving them one loses their confidence, and
in many cases inspires them with an invincible aversion to the dentist.

This author invented a so-called “calendar of dentition,” for the
purpose of showing at a glance the period of eruption of each of
the deciduous and permanent teeth, and as well for noting down the
time at which the various teeth are changed, so as to avoid every
possible error in this respect. This calendar consists of a figure or
diagram representing the two dental arches, with transversal lines
that separate the different teeth one from the other, the relative
indications being also given.

The observations of this most sensible and conscientious dentist with
regard to the extraction of teeth are worthy of note: “The haphazard
pulling out of a tooth is an easy enough thing; the only requisites for
doing this are impudence and the audacity natural to the half-starved
charlatan. But to carry out the extraction of a tooth in such a manner
that, whatever be the circumstances of the case, no disgrace may accrue
to the operator or damage to the patient, requires serious knowledge,
ability, and prudence.”

RUEFF relates the case of a man, aged forty years, who, having made
use of fumigations of henbane seeds to relieve himself of violent
toothache, obtained the desired end, but at the same time lost his
virile power. He, however, reacquired his force by the care of the
author.[506]

THOMAS BERDMORE was the dentist of George III of England, and one of
the first and most eminent representatives of the dental art in that
country. Before him, no one had had the appointment of dentist to
the royal family. In the year 1768 he published an excellent work on
dentistry,[507] that was translated into various languages and went
through many editions; the last of these appeared in Baltimore in the
year 1844, that is, seventy-six years after the first English edition—a
splendid proof of the worth and fame of this work.

Berdmore contributed to the progress of dentistry in England not only
by his writings, but also by imparting theoretical and practical
instruction to many medical students desirous of practising dental art
as a specialty.[508] One of these was ROBERT WOOFFENDALE, who went to
America in the year 1766, and was the first dentist whose name is there
recorded.

Berdmore considers as the principal advantage of the application of
single artificial teeth the support they afford to the neighboring
ones. Although in no way an impassioned partisan of dental grafting,
like his contemporary, the celebrated surgeon Hunter, he, nevertheless,
sometimes had recourse to replantation, recognizing the advantages to
be derived from this operation, provided it be ably and opportunely
carried out; but he was decidedly averse to transplantation. Before
definitely inserting a gold filling, Berdmore considers it a good
practice to try the tolerance of the tooth with a temporary filling
of cement or some other like substance. His experiments as to the
action of acids on the teeth are most interesting. He found that nitric
acid destroys the enamel in a quarter of an hour; muriatic acid acts
almost as rapidly, but with the difference that it also alters the
color of the interior parts; sulphuric acid renders the teeth very
white, and, even if used for three or four days, only destroys a small
portion of the dental substance, but by reason of its action the enamel
becomes rough and can be easily scraped away with a knife. Remarkable
experiments on this subject were also made later by Kemme.[509]

PIERRE AUZEBI, a dentist at Lyons, published a treatise on odontology
in 1771, which is only remarkable for certain strange ideas that he
therein exposes, the entire book being in complete contradiction with
the great progress already realized, at that period, in dental science.
Auzebi likens the human body to a hydraulic machine, formed by the
union of solid and liquid parts. For him the bones are merely _folded
membranes_ and the teeth are _bones composed of small membranes_. The
author declares that he is unable to admit the theory of germs in the
genesis of the teeth because “these germs, being all in identical
conditions as to heat and moisture, ought all to develop at the same
time like the grains of corn in a field.” Rather than having their
origin from special germs, the teeth, he says, are derived from
lymph, this being, according to Auzebi, the fundamental substance
from which all the hard parts of the body are generated. A drop of
lymph gathered at the bottom of the alveolus hardens and constitutes
the first beginning in the formation of the teeth. Beneath this other
lymph is gradually collected, which pushes upward and the part of the
tooth already formed, surrounds the dental vessels, and thus becomes
the root of the tooth. To facilitate dentition he recommends, among
other things, rubbing the gums with hard, rough, and angular bodies.
He also maintains, as does Brunner, that the milk teeth have no roots,
contradicting, in this respect, the opinion of Fauchard, of Bunon, of
Bourdet, who decidedly affirm that the deciduous teeth are furnished
with roots, precisely the same as the permanent ones. According to
him, when it so happens that the milk teeth have roots, they are not
shed. To calm toothache, the author recommended a sedative elixir,
the aspirating of a few drops of which sufficed to obtain the desired
effect.[510]

JOHN AITKIN, in 1771, perfected the English key, so as to render the
extraction of the teeth easier and to avoid the danger of fracturing
the alveolus or the tooth itself, and of injuring the gums.[511]

FRÈRE CÔME, a celebrated French surgeon, also contributed to the
perfecting of this instrument.[512]

In 1771-72, Fr. L. Weyland and Henkel recorded some very important
cases of diseases of Highmore’s antrum.[513]

W. BROMFIELD, in a collection of surgical observations and cases
published in London in the year 1773, also speaks of affections of the
maxillary sinus. He says that he has had opportunity of persuading
himself that the purulent gatherings of this cavity not unfrequently
discharge spontaneously during the night, finding their exit through
the natural orifice of the antrum, when the body is in the horizontal
position.[514]

JOHN HUNTER, the celebrated surgeon, must be named among the most
illustrious champions of odontology in England. He was born February
13, 1728. His first instructor in medical studies was his brother,
William Hunter, a scientist of great merit, whose school of anatomy in
London was attended by numerous students from all parts of the British
Kingdom. Under so excellent a guide John Hunter made rapid progress,
and in less than twenty years became the most famous physiologist and
professor of surgery of that day. He was surgeon-general to the English
army.

His _Natural History of the Human Teeth_ (London, 1771) and his
_Practical Treatise on the Diseases of the Teeth_ (London, 1778)
initiated in England a new epoch for the dental art, which, abandoning
its blind empiricism, began to take its stand on the basis of rigorous
scientific observation.

But although Hunter’s merits were great with respect to the scientific
development of odontology, we must remember that he was a general
surgeon, and not a dentist, and that precisely for this reason he had
not, neither could he have, other than a restricted personal experience
relative to the treatment of dental diseases. This explains why the
anatomical and physiological part of Hunter’s works on the teeth is so
far superior to the part concerning practical treatment.

Indeed, in the field of practice, this author often falls into grave
contradictions, and is frequently hesitating and uncertain on important
points of dental therapeutics.

Hunter gives a very long and detailed description of all the parts
constituting the oral cavity and the masticatory apparatus. He sought
to establish a scientific nomenclature for the teeth, and in fact the
denominations of _cuspidati_ for the canine teeth and of _bicuspids_
or _bicuspidati_ for the small molars originated with him. Hunter says
that the enamel of the teeth is a fibrous structure, and that its
fibers depart from the body of the tooth like rays. He believes it
to be entirely inorganic, as it is absolutely impossible to convert
it into animal mucus. The tooth is constituted for the most part by
a long mass (it is thus he calls the dentine), which is, however,
much harder and denser than any other bone. This part of the tooth is
formed of concentric lamellæ, and is vascular, as is proved by the
exostosis of the roots and the adhesions that exist at times between
the roots and the alveoli. Hunter gives a good description of the
pulp cavity and of the pulp itself. He studied odontogeny with great
care, as is demonstrated by his special researches on this point. He
admits the existence of distinct germs for the enamel and for the
dentine. According to him the incisors are formed from three points
of ossification, the canines from one, and the molars from three
or four. The tooth after its eruption is an extraneous body “with
respect to a circulation through its substance, but they have most
certainly a living principle by which means they make part of the
body, and are capable of uniting with any part of a living body.” The
milk teeth, says Hunter, are not shed by a mechanical action of the
second teeth, but by an organizing law of Nature. The physiology of
the masticatory apparatus is treated by Hunter with great accuracy and
most extensively. This author combats, by many arguments, the opinion
that the teeth grow continually; he explains the apparent lengthening
of those teeth whose antagonists are wanting, by the tendency of
the alveoli to fill up, which, however, is not possible in normal
conditions, because of the constant pressure exercised upon the teeth
by their antagonists.

Caries, says Hunter, is a disease of altogether obscure origin; it is
not owing to external irritation or to chemical processes, and seems to
be a morbid form altogether peculiar to the teeth. Only in very rare
cases does it attack the roots of the teeth. It rarely appears after
fifty years of age. Hunter does not admit that this disease may be
communicated by one tooth to another. As to its treatment, the caries,
if superficial, may be completely removed by filing the decayed part
of the tooth before the disease penetrates to the cavity, and its
spreading will thus be arrested for a time at least. In cases where
the caries penetrates to some depth, without, however, the destruction
of the crown of the tooth being so extensive as to render it useless,
Hunter believed the best mode of treatment to be extraction and
replanting of the tooth after having subjected it to boiling in order
to cleanse it perfectly and to destroy its vitality entirely, this
being, according to him, the mode of preventing the further destruction
of the tooth, which once dead can no longer be the seat of any disease.
If, instead, one wishes to have recourse to cauterization of the
nerve, it is necessary to reach as far as the apex of the root; which,
however, is not always possible. This is a very important point, for no
one before Hunter had yet affirmed the necessity of entirely destroying
the diseased pulp as an indispensable condition of the success of the
filling to be later carried out in order to conserve the tooth.

Hunter is extremely concise when speaking of the filling of teeth;
considering the great importance of this argument, his conciseness can
only depend on his having had no personal experience in the matter. He
considers lead preferable for fillings.

The frequent occurrence of erosion of the teeth, whether of the
cuneiform variety or of other kinds, did not escape the attention of
this acute observer, but he was not able to give any explanation of it.

In cases of empyema of Highmore’s antrum, Hunter advises the opening of
the cavity through the alveolus of the first or second large molar.

Periodontitis is classified by the author among the diseases of the
alveolar process. He occupies himself with this affection at great
length, seeking to explain the mode in which it is produced. He
distinguishes two forms of the disease, according to whether or not
there be exit of pus from the alveolus. The alveolar process is,
in his opinion, the principal seat of the disease, to which, as a
complication, is added the retraction of the gums. For the diseased
alveolus the tooth becomes, in a certain manner, an extraneous body, of
which it tends to rid itself. The alveolar margins undergo absorption;
the bottom of the alveolus tends to fill up, analogously to what occurs
after extraction, and the falling out of the tooth ensues as a natural
consequence of this process. An altogether similar process, producing
the falling out of the teeth, is the normal consequence of senility.

The author considers that the malady in question has as its point of
departure an irritation caused by a tooth; and as almost a proof of
this he relates a case in which the extraction of the affected tooth,
an upper incisor which became too long, and the transplantation of
another tooth caused the cessation of the morbid process and the
perfect consolidation of the transplanted tooth. However, Hunter does
not draw from this isolated case the conclusion that transplantation
may be elevated to a method of cure for this malady. Indeed, he says
that, so far as is known to him, there is no means of prevention
or of cure for it. His treatment, therefore, is merely directed to
the curing, in so far as is possible, the phlogistic symptoms, by
scarifications of the gum and by the use of astringent remedies. He
does not exclude the possibility of a complete recovery, but the mode
in which this obtains seems to him as obscure as is the nature of the
disease itself.

In speaking of the correction of dental irregularities, Hunter advises
not to extract the milk teeth unless this be an absolute necessity.
He says, besides, that it is useless to extract any tooth whatever,
unless one endeavors at the same time to force the irregular tooth or
teeth into their normal position by exercising the requisite pressure
upon them. In young subjects the regulating of crooked teeth is an easy
matter, because of the softness of the maxillary bone. However, it
should not be undertaken before all the bicuspids have come through.
To correct protrusion of the upper jaw, the author recommends the
extraction of a bicuspid on each side. To regulate the incisors it is
sometimes necessary to make them rotate on their axis with the forceps.
In certain cases of protrusion of the lower jaw one may have recourse
with advantage to the inclined plane.

As a general rule, it is useless to lay bare a tooth with the
lancet before extracting it, although in certain cases this may be
advantageous in order to render its extraction easier and less painful.

Hunter was a strenuous partisan of replantation and transplantation of
the teeth; he made various experiments on animals, and treated this
important argument with particular fulness and much better than had
been done up to then by others.

In cases of difficult dentition he considered incision of the gums most
useful and, if necessary, to be had recourse to several times.

FOUCOU, the French dentist, in 1774, made known a compressor invented
by him for arresting hemorrhage ensuing on the extraction of teeth.
This instrument, which could be used for either jaw, exercised its
pressure not only in a vertical direction, but also laterally, and
did not give much inconvenience to the patient. Carabelli, who wrote
seventy years later, speaks with praise of Foucou’s compressor, which
he considers the best instrument of its kind.

COURTOIS, in his book published in 1775,[515] says that the enamel
of the teeth only reaches its perfection of development at twenty
to twenty-two years of age, and begins thenceforward to wear away
gradually. In speaking of the enamel, he advises avoiding the use of
the file as much as possible. This author’s book is interesting for the
many important clinical cases it contains.

WILLICH, in 1778, related a most curious case relating to a woman,
aged forty years, who had never had her menstrual function, but
had, nevertheless, given birth to two children; the extraction of a
tooth was followed by an alveolar hemorrhage that lasted an hour;
thenceforward, this hemorrhage recurred regularly each month, for the
space of eight years.

BÜCKING, in 1782, published a _Complete Guide to the Extraction of
the Teeth_,[516] wherein he minutely describes all the instruments,
their use, the position of the operator and of the patient, indicating
at the same time the instruments best adapted for the extraction of
each tooth. He declares himself averse to the practice of subluxation
as a means of cure for toothache, a method which, first recommended
by the Arab physician Avicenna, and later, in the sixteenth century,
by Peter Foreest, had fallen into oblivion for a long time, and was
again brought into credit by two celebrated French dentists, Mouton
and Bourdet, the latter of whom relates having had recourse to it
successfully in not less than six hundred cases.

Notwithstanding the high authority of this illustrious dentist, Bücking
does not consider this method of cure advisable, adducing, however,
in support of his opinion, arguments of no great value, viz., that
teeth after subluxation continue painful for a certain time, and that
they always remain in an oblique position. The method in question,
which has the effect of breaking the dental nerve, is, in our opinion,
practically equivalent to a replantation, or is, in point of fact, a
replantation, when the luxation of the tooth is complete. The arguments
that Bücking brings forward against it are futile; the first objection,
for the most part, does not subsist, and, in any case, the persistence
of pain for a short time would be of small importance compared with the
great advantage of preserving the tooth; as to the second, it is to be
understood of itself that subluxation performed by means of the pelican
(the instrument then used for the operation) would cause the tooth to
assume an oblique position; but even supposing it did not straighten
up of itself, there could not have been any difficulty for the good
dentists of that period in forcing the tooth again into normal position
and in maintaining it there. The weak side of the operation consisted
rather in the fact of its being probably carried out without due
consideration of the dangers resulting from the possible alterations of
the dental pulp.

At the time of which we are writing many believed that the enamel
of the teeth could be regenerated altogether or in part, and that,
therefore, it was of no great consequence that it should be worn
away by the use of the file or of abrasive dentifrice powders. Thus,
for example, the renowned surgeon Theden expressly recommended such
powders, as the best adapted for cleaning the teeth and for freeing
them from tartar.[517]

VAN WY,[518] the Dutch surgeon, in 1784, related two cases of
regeneration of the maxillary bones; other cases of the same kind were
related some years later by Percy and Boulet.[519]

CHOPART and DESAULT recommended, in cases of difficult dentition, the
excision of the gum in correspondence with the teeth that are to come
out, rather than simple incisions.[520]

[Illustration: Antonio Campani.]

[Illustration: FIG. 96

Pelican for extracting incisor, canine, and molar teeth (Campani,
1786).]

ANTONIO CAMPANI, of Florence, published in 1786 a treatise on
dentistry,[521] very elegantly printed, and illustrated with thirty-six
plates very neatly carried out. This book, however, contains nothing of
real importance for the development of dentistry.

BENJAMIN BELL, the English surgeon, a contemporary of Hunter, also
devoted much attention to diseases of the teeth, and, if it may be
argued from the clear and precise manner in which he expresses his
opinions on various questions relating to dental pathology and therapy,
it would seem that he had much greater experience in this field than
the celebrated Hunter.

[Illustration: FIG. 97

Pelicans for extracting wisdom teeth (Campani).]

With regard to incision of the gums, in cases of difficult dentition,
this author contradicts certain assertions of the German surgeon
Isenflamm (1782), who argued that when the tooth is already to be
perceived through the gum, the incisions are altogether useless, while
if the tooth be still at some depth, the gingival incision will soon
close again, so that the cicatrix will render the eruption of the
tooth still more difficult. Bell admits, too, that lancing the gum is
altogether superfluous when the tooth has pierced the tissue, all the
more so that the accidents provoked by the eruption are then generally
already passed and gone, but the operation ought, in his opinion, to
take place much earlier; and should the wound close again before the
tooth has erupted, the gum must be lanced a second time.

[Illustration: FIG. 98

Campani’s forceps: The first for molar teeth when loose or after having
been shaken with the pelican; the second for deciduous teeth.]

Bell contradicts the opinion of Jourdain and Hunter that the morbid
gatherings of Highmore’s antrum are generally consequent upon the
closing of the normal opening of the cavity in the middle meatus. In
many cases of disease of the maxillary sinus this orifice remains
open, the liquid therein collected discharging itself not unfrequently
through it, in certain positions of the body. Instead of penetrating
into the antrum through the nasal orifice, as Jourdain would have
it, Bell advises opening the cavity by Lamorier’s, or, better still,
by Drake’s method. Except in special cases, the first or second molar
ought to be extracted, but preferably the second. After trepanning the
alveolus and emptying the cavity, the opening should be closed with a
conically shaped peg to prevent its slipping into the cavity. From time
to time the liquid that tends to reaccumulate should be allowed exit,
and detersive injections should be made, preferably of lime water.

[Illustration: FIG. 99

Two key instruments with changeable hooks (Campani).]

Looseness of the teeth, which in old age may be considered a normal
condition, is always a disease when it occurs in youth. In certain
cases its cause is unknown, in others it depends on an affection of the
gums, either of a scorbutic nature or consequent on an accumulation of
tartar.

[Illustration: FIG. 100

An instrument especially destined to extract loose bicuspid teeth. The
screw in the interior of the instrument allowed the hook to be brought
to just the right point in each case (Campani).]

According to Bell, dental caries is generally owing to a bad condition
of the humors of the entire body and to a peculiar morbid disposition,
rather than to external causes acting locally, although these latter
may contribute, together with the general causes, to the producing of
the disease.

[Illustration: FIG. 101

Campani’s dental cauteries: The large ones for cases of post-extractive
hemorrhage; the small ones for the cauterization of carious cavities.]

[Illustration: Nicholas Dubois Dechémant.]

This author was decidedly averse to the use of the file. For stopping
carious cavities he advises the use of mastic, gum lac, or wax,
if the cavity is large and funnel-shaped; this stopping, however,
requires to be renewed frequently. But when the cavity, wider at the
bottom, narrows toward the surface, one ought to use gold or, still
better, tin-foil. The pulp ought always to be destroyed previously by
cauterization.

Bell advises great caution in carrying out transplantation, it having
been proved by many examples that contagious maladies of a serious
nature may easily be communicated in this way from one individual to
another.[522]

In the case of a young woman who had an upper incisor transplanted,
WATSON observed undoubted symptoms of syphilitic infection with
supervening accidents of exceptional gravity, which in spite of careful
treatment ended in death.[523]

Hunter also relates having observed, in seven cases of transplantation,
very serious accidents which, however, he did not believe to be owing
to syphilis, although bearing a certain symptomatic resemblance to it.
Contrariwise, the well-known German surgeon Richter not only admitted
the possibility of transmitting syphilis through a transplanted tooth,
but even that the transplantation of an altogether healthy tooth from
the mouth of a person undoubtedly free from syphilis might be followed
by serious accidents of a syphilitic nature, and this because the
possible existence of a latent syphilis in the person to whose mouth
the tooth was transplanted cannot be excluded; in which case the
abnormal stimulus exercised by the transplanted tooth might very well
give rise to syphilitic manifestations. Therefore, the fact that the
person who furnished the tooth was and continued to be in a state of
perfect health (as precisely in the case cited by Watson) would not
be sufficient proof that the accidents ensuing on the transplantation
might not be of a syphilitic nature.

LETTSON also observed, in certain cases of transplantation, accidents
of more or less gravity which he held to be due to syphilis, calling,
however, to mind a case cited by Kuhn, of Philadelphia, where the
possibility of syphilis was not to be thought of, as the morbid
symptoms disappeared entirely, without any treatment, as soon as the
transplanted tooth was removed.[524]

AUGUST G. RICHTER, the above-named German surgeon, in those portions
of his work dedicated to dental affections and diseases of Highmore’s
antrum, treated these subjects with admirable clearness and order,
without contributing, however, anything original to the development of
dental surgery.[525]

NICHOLAS DUBOIS DE CHEMANT, in 1788, of whom we shall later have
occasion to speak again, published in Paris his first pamphlet on
mineral teeth, entitled _Sur les avantages des nouvelles dents, et
rateliers artificiels, incorruptibles, sans odeur_.

JEAN JACQUES JOSEPH SERRE (1759 to 1830). Among the dentists of the
end of the eighteenth century and the beginning of the nineteenth, a
special mention is due to Jean Jacques Joseph Serre. He was born at
Mons, in Belgium, but his remarkable practical and scientific activity
was chiefly called into exercise in Vienna and in Berlin. He published
several works, the most important of which is a practical treatise on
dental operations.[526]

Among his minor works, one edited in Vienna, in 1788, treats of
toothache during pregnancy; another, printed in Leipsic in 1791, treats
most extensively of diseases of the gums; a third speaks of the mode of
maintaining the teeth and gums in good condition. This little book of
dental hygiene, like the rest of Serre’s books, met with great favor,
and went through two editions in a brief space of time (Berlin, 1809 to
1812).

The works of this author show great study, very wide practice, and an
admirable spirit of observation and research. They had the merit of
greatly contributing to raise the level of dental culture in Germany,
and one finds in them a pretty nearly complete account of the dentistry
of that period. Apart from this, they possess a special interest
because of the vast number of dates and important historical facts
therein contained.

As it would be useless here to enter into a minute analysis of the
contents of these books, we will limit ourselves to mentioning a few
ideas of which Serre was a strenuous supporter.

He combats an old prejudice that had recently been reinforced by the
authority of Jourdain, that is, that it does harm to extract a tooth
when the soft parts around it are inflamed and swollen. He likewise
combats the prejudice, also of very ancient date, that teeth ought not
to be extracted during pregnancy. Only, he considers it as well to
avoid the cauterization of the dental pulp in cases of gestation. In
extracting teeth, the forceps ought only to be used after the tooth has
been luxated by means of the pelican. Serre highly approves of this
instrument, although he recognizes it to be a dangerous one in the
hands of those who do not know how to make a proper use of it. This
author invented or perfected various extracting instruments, among
which a conical screw for extraction of roots hollowed out by caries
deserves particular mention, and which, under a somewhat modified form,
is still in use.

[Illustration: Jean Jacques Joseph Serre.]

One of the most interesting chapters of Serre’s great work is the one
in which he treats of affections of Highmore’s cavity.[527] He speaks
at length of the anatomy of the maxillary sinus, of its relation to the
teeth situated below it, of the various modes in which the diseases
of the antrum are produced, of their symptoms and treatment. He passes
in review the various operative methods, and finds that in general the
Cowper-Drake is the one to be preferred to all the others. He says
that to open the sinus the simple extraction of a molar suffices in
the greater number of cases, the trepanning of the alveolus not being
generally necessary.

J. ARNEMAN, in 1766, published at Göttingen a synopsis of surgical
instruments[528] that deserves mention in so far that the dental
instruments of that time as well as those of earlier periods are
therein taken into account with sufficient exactness.

A. F. HECKER attributed the accidents of difficult dentition to a
special alteration of the saliva caused by the irritation deriving
from the erupting teeth. In these cases the saliva is supposed by him
to acquire a high degree of acridness and to become almost similar to
the poison of rabies. Departing from this theory, the author declares
it to be necessary to mitigate the irritation produced on the gums
and other parts of the mouth by the altered condition of the saliva,
as well as to modify the quality of the saliva itself and to promote
the elimination of the same from the body by emetics and aperients.
According to him, liquid carbonate of potash administered in drops,
together with syrup of poppy heads, manna, etc., is a most useful
remedy, having specially for its effect to diminish the acridness of
the saliva.

Besides this remedy, the author extols the use of blisters behind the
ears, as also of tepid baths, which calm pain and spasms, favor the
excretions, and procure repose and sleep. He rejects the incision of
the gums as altogether useless, and is most opposed to the use of
opium, which he states renders children liable to apoplexy.

And here we will mention, rather by way of curiosity than for any real
historical interest which they possess, two pamphlets on _odontitis_,
published respectively in 1791 and 1794 by Ploucquet and Kappis, who
maintained that not only the dental pulp, but all the parts that form
the tooth are susceptible of inflammation.[529] In Kappis’ pamphlet
we find the following ideas developed, upon which we do not think
necessary to comment. The inflammatory process consists essentially
in the increased flow of humors to a given part and in a more or less
intense reaction of the vital force. Both of these things may take
place in the teeth. These are liable to swell, that is, to undergo
an increase of all their dimensions, in proof of which assertion the
author relates the case of an individual, who when attacked by a
violent toothache had found the spaces between his teeth so narrowed
that it was no longer possible to make use of his usual toothpick,
even if he had tried to do so regardless of pain. But when the
toothache was over, the same toothpick again became serviceable as
before. He says that there is no cause for wonder that in odontitis no
redness of the teeth is to be perceived, for in other inflammations
as well, redness is wanting, and, moreover, it exists in the interior
membrane of the tooth. As in other inflammations, so also in odontitis,
the usual issue is resolution. Dental fistulæ may derive from internal
suppuration. The impurities deposited on the teeth are by him supposed
to be owing to an increase of their secretion! According to the author,
caries, the breaking down of teeth apparently healthy, as well as
their falling out, is generally caused by an inflammation of these
organs, that is, by odontitis, an affection that, he says, may be of
very varied kind, the principal forms being the rheumatic, arthritic,
sympathetic, and gastric.

RANIERI GERBI.[530] In a book by this author we find recommended a
very singular cure for toothache, even of the most violent nature. It
is in no way scientific, and is besides not particularly pleasant,
notwithstanding that the author, professor at the University of Pisa,
was a scientist of merit, enjoying special esteem as a mathematician
and cultivator of natural sciences.

Under the name of _curculio anti-odontalgicus_ he describes an insect
living habitually inside the flowers of the _carduus spinosissimus_,
that could be used with great advantage against toothache, in the
following manner: One crushes fourteen or fifteen larvæ of the insect
between the thumb and forefinger, and then rubs the two fingers
together until the matter remaining upon them is entirely absorbed.
Instead of the larvæ (which, as is known, represent the first stage
of insect life) one may also use the fully developed insects. One
then applies the two fingers that have crushed the insects or their
larvæ upon the decayed and aching tooth. If the pain is of a nature
to be cured by this means, it diminishes almost instantaneously,
and ceases altogether in a few minutes. It is said that the fingers
preserve their healing power for a great length of time, even a whole
year, and in proof of these assertions Ranieri Gerbi speaks of no
less than six hundred cures performed! Other insects besides the
_curculio anti-odontalgicus_, used in the same manner, are said to
possess the same curative properties, among them the _curculio jaceæ_,
_carabus chrysocephalus_, and the _curculio Bacchus_, which last,
says Gerbi, has long been used for this purpose by the peasants of
Tuscany. The author also says that some German doctors and naturalists
experimented with success with several insects indigenous to Germany
as remedies against toothache. These insects, also mentioned in a
work published in Bayreuth in 1796, author unknown, are:[531] the
_coccinella septempunctata_, the _coccinella bipunctata_, the _carabus
ferrugineus_, the _chrysomela sanguinolenta_, the _chrysomela populi_,
the cantharis or Spanish fly, and others. Later on, Hirsch also
extolled the healing power of another insect, the _cynips rosarum_.
With regard to the mode of application, Gerbi says that instead of
crushing and rubbing these insects or their larvæ between the fingers,
one can use a piece of wash leather in a similar manner.

It is to be observed, however, that the insects that are found
generally in the ripe wild teasle—or more precisely their larvæ—had
already been used for a long time as a remedy against toothache;
indeed, we even find these means of cure recommended in the natural
history of Pliny. In a book entitled _Histoire d’un voyage aux îles
Malouines fait en 1763 et 1764_, by a certain Dom Pernetty, this
author speaks of some remedies made known to him by the Superior of
the Franciscan friars of Montevideo; and among others one finds the
following: “One draws out the worm that is generally found in the head
of the fuller’s teasle when this is ripe. One rolls this worm between
the index finger and the thumb, lightly pressing it until it dies
of languor. The one or the other of the two fingers applied on the
aching tooth will have the virtue, for a year at least, of making the
toothache cease.”[532]

HEINRICH CALLISEN, in an excellent treatise on surgery[533] published
at Copenhagen in 1788, writes at sufficient length and with great
accuracy on dental and maxillary diseases. According to this writer,
it rarely suffices to trepan one alveolus for the treatment of the
morbid collections of Highmore’s antrum, as the maxillary sinus is
very often divided by partitions into various cells, so that in order
to give exit to the pus contained in each of them, it is necessary to
extract several teeth and trepan their alveoli.[534] One ought not,
therefore, to give the preference to this method, unless in the case of
the teeth in question being decayed. But should they all be in a good
state, or should a large opening be necessary because of the nature
of the disease in the cavity, it will be better to follow Lamorier’s
method, that is, to incise the gum crosswise under the malar process
and then, after scraping away the periosteum, trepan the bone. Further,
in the case of the disease in the maxillary sinus having given rise to
tumefaction, softening of the bone, and fluctuation in the palatine
region, it is precisely there that the perforation ought to be carried
out. To prevent the reclosing of the opening before the cure is
completed, the author advises the use of pledgets, small bougies, a
piece of prepared sponge, or even a small tube. According to Callisen,
the injections through the nasal orifice of the maxillary sinus are
partly impracticable, and partly of no utility.

It always does more harm than good to file or to scrape the decayed
part of a tooth, without stopping it afterward, as by thus doing, says
the author, one only renders it still more liable to the access and
the action of harmful external influences. In preparing the cavity
for stopping, the bottom of it should be more ample than its external
aperture, that the filling may remain firm.

For extracting molars, he makes use either of the pelican or of the
key; for the incisors and the canines, of the forceps; and for roots,
of the goat’s foot.

Callisen treats incipient _idiopathic_ epulis by destroying it through
cauterization, after having covered the teeth with wax; if the epulis
be large and more or less hard, he removes it with the bistoury; as to
_symptomatic_ epulis, he holds the removal of the original cause to be
the best mode of treatment.

This author declares himself decidedly in favor of replantation and
transplantation, expressing the idea that these methods are always
to be preferred to the application of artificial teeth. He maintains
that after a tooth has been replanted, and its consolidation has taken
place, there is no possibility of any further pain, the nerve being
broken. The author relates a brilliant cure which he carried out upon
a lieutenant, who, during the siege of Copenhagen, had received a blow
that had sent all his front teeth into his mouth. Callisen immediately
put them all back in their places with such ability that they became
perfectly firm again. With reference to transplantation, he only
believes in its being possible for teeth with a single root.

In works published toward 1790, Lentin and Conradi, devoted their
particular attention to the morbid conditions that produce looseness
and spontaneous falling of the teeth. For the treatment of these
conditions Conradi recommended general and local remedies. The general
remedies were directed to the suppressing of acridness in the blood,
which he considered to be an etiological element of primary importance.
As to the local remedies, they ought specially to consist in keeping
the teeth clean by the use of a toothbrush, in painting the gums with
tincture of catechu and myrrh, and in rinsing the mouth frequently with
a decoction of cinchona or of willow bark. Against toothache caused by
caries, he particularly advises essence of cloves, introduced into the
carious cavity on a piece of cotton-wool.[535]

FRIEDRICH HIRSCH was much less disposed than were many of the preceding
writers to incision of the gums in cases of difficult dentition.
Against the accidents connected with this morbid condition, he
prefers, in general, the use of gentle aperients or of emetics, and
regards the scarification of the gums as opportune only in cases
where symptoms indicating a high degree of nervous tension manifest
themselves.

Against incipient caries, Hirsch used simple cauterization, which
he held to be capable of arresting the morbid process, at least in
many cases. He says, however, that when a real carious cavity exists,
it is absolutely necessary to stop it; and for this purpose, rather
than metallic or resinous fillings, he prefers a cement of turpentine
and quicklime, made into a paste with varnish of oil of linseed.
Nevertheless, when it is a case of the lower teeth, tin-foil is also,
according to him, an excellent filling material.

Like some of the preceding authors, Hirsch admitted the existence of
_interior caries_ in apparently healthy teeth, and was the first to
indicate a good mode of diagnosticating these occult dental affections.
It consists in tapping the suspected teeth with a sound until one finds
the one in which the percussion provokes pain, and this will be the
diseased tooth. One detaches the gum from the neck of this tooth, and
at the point, on the neck itself or on the beginning of the root, where
a small protrusion is found, one perforates the tooth with a chisel,
or some other fit instrument, so as to penetrate to the interior of
it. Through this passage one introduces into the tooth a fine, curved,
red-hot sound, repeating the operation several times. Lastly, one fills
the cavity with lead; and in this manner the tooth will be cured and no
longer painful.

In speaking of the correction of dental anomalies, Hirsch relates a
case in which the deformity consisted in the union of two central
incisors, which formed one single piece, resembling a paddle, and
spoiled the appearance of the face. He divided them with a saw,
cauterized the surfaces of the section, scarified the gum, and, to
gain a little space, introduced a small wedge, until the gum had grown
up within the new dental interstice, thus giving an altogether normal
appearance to the part.

It is noteworthy that Hirsch made use almost exclusively of the goat’s
foot for the extraction of teeth, of whatever kind they might be, the
instrument being rather longer, however, than that ordinarily known by
this name, and making his left hand serve as a lever rest.

To arrest strong hemorrhage ensuing from the extraction of teeth,
Hirsch used scraped parchment, which he introduced into the alveolus
and pressed with force into it by means of a sound; then he superposed
compresses and kept the jaws tight together with a bandage passed
around the head.

This author, too, was very favorable to replantation. As to
transplantation, he says that even when the gum and the alveolus are
quite healthy, the individual entirely free from scurvy and syphilis,
and not above fifty years of age, the transplanted teeth do not take
root perfectly except in an average of one case in three. For carrying
out this operation he never made use of teeth extracted from the mouth
of a living person, but, on the contrary, he used the teeth of young
and healthy subjects who had died a violent death; these were, besides,
carefully cleaned before transplanting them, and in this way the author
believed the transmission of disease to be nearly impossible.[536]

[Illustration: FIG. 102

Full lower set in hippopotamus ivory, with human front teeth;
seventeenth century. (From Guerini’s collection.)]

[Illustration: FIG. 103

Upper denture in ivory, at the end of the eighteenth century, for a
case in which the last molars and the front teeth were present. (From
Guerini’s collection.)]

J. E. WICHMANN combated energetically the practice, then pretty
general, of endeavoring to facilitate the eruption of the teeth
by incision of the gums. He considered this practice as one to be
absolutely rejected, supporting his opinion on the consideration that
dentition, being an altogether physiological process, which, moreover,
takes place in parts relatively of but little importance, never can
give rise of itself alone to serious accidents. Besides this, he says,
it is very difficult to say which tooth precisely is about to erupt
and at what point. The incisions would, therefore, have to be made
by chance, which would often render the morbid condition still more
serious.

K. A. BLUMENTHAL endeavored to confute Wichmann’s opinions, with but
little success; for, indeed, the same opinions, expressed later by J.
H. Sternberg in a more detailed manner and with ampler views of the
subject, met with ever-increasing approval. Thenceforth, the practice
of gingival incisions in cases of difficult dentition fell more and
more into discredit.[537]

ROBERT BUNON,[538] the French dentist, is one of the most illustrious
personalities to be met with in the history of our profession. He was
born at the beginning of the eighteenth century, and devoted himself
betimes to the dental art, gathering instruction therein partly from
different dentists and partly from the few odontological books he
was able to find. In this manner he learned pretty much all that was
known at that time by dentists in general. He then decided to travel,
in order to acquire further knowledge and experience. He practised
especially in the north of France and in what is now the state of
Belgium; at Antwerp, Brussels, Givet, Maubeuge, Cambrai. In his ardent
thirst for knowledge, when he happened to pass through a town where
some dentist of note resided, he never neglected to call on him, thus
acquiring fresh information and perfecting himself as well in the
practical exercise of his profession. At the same time, his desire to
learn all that was new concerning dental art and science was so intense
that he had translations made of the medical and surgical works of
Latin, Italian, German, and English authors. However, all this reading,
although it enlarged his general knowledge, taught him nothing, or
almost nothing, about those subjects that interested him above all the
others. His practical experiences, meanwhile, brought a great number of
patients to his notice, and, being by nature a very acute observer, he
was able to establish the existence of many facts up to then unknown.
At this time he commenced his studies on dental erosion, on the
development of the teeth, and on the prophylaxis of dental maladies,
his favorite subject. “I felt,” he writes, “that the necessity of
having recourse day by day to the extraction of teeth resulted from
deficient knowledge on our part, and I considered this extreme remedy
as one of the greatest evils to humanity.”[539] He therefore endeavored
to extend his own knowledge in every possible way, and as one means
of doing this he visited hospitals and schools; and, ardent champion
as he was of conservative dentistry and of prophylaxis, he succeeded
in interesting medical men and surgeons, midwives and schoolmasters,
and parish priests as well, in the question of the preservation of
the teeth. The teeth he extracted he kept for the purpose of studying
the conformation, the lesions, the dental anomalies; sometimes he
split them up to examine the dental pulp. And he never neglected an
opportunity of procuring anatomical pieces that appeared interesting to
him.

In 1728 Fauchard’s book, _Le Chirurgien Dentiste_, appeared. The fame
of this work reached Belgium, where Bunon then was, and he immediately
set about trying to get a copy of it. After searching in various towns,
he finally found one in Givet. He read it with the greatest interest,
and later, in one of his works, spoke of it in terms of highest praise.
It would seem, however, that he did not learn much that was new to
him by reading this book, which proves that he already possessed a
vast odontological culture and was also profoundly versed in technical
dentistry, which forms the most important part of Fauchard’s book. He
was somewhat astonished at finding in this celebrated author’s work
hardly anything on the subjects that principally interested him, that
is, the erosion, the development of the teeth, and the prophylaxis of
caries. This circumstance very clearly reveals the different mental
tendencies in these two great men, the one, drawn toward the practical
side of the profession which principally interests him and forms the
basis of his work, the other, an impassioned searcher into causes, and
student of prophylaxis.

After the perusal of Fauchard’s book, Bunon, who had already conceived
the idea of publishing the results of his observations and of his own
particular studies, felt more than ever the propriety and necessity
of doing so; and to realize his idea, he established himself toward
the year 1735 at Paris. Two years later, just when the manuscript of
his work was almost finished, Gerauldy’s book appeared. Bunon relates
that he opened this book in fear and trembling; its title, _The art of
preserving the teeth_, gave him reason to fear that Gerauldy might have
profited by some of the ideas and observations he had communicated to
various persons, to write a book similar to the one that he himself had
it in his mind to publish.[540] He was able, fortunately, to convince
himself immediately that his fears of being forestalled and plagiarized
were unfounded.

Notwithstanding, Bunon was determined not to publish his book until the
opportune moment and with all possible probability of success. With
this object in view, he made up his mind first to obtain the diploma
of surgeon-dentist. To reach this aim, he was obliged to conform to
the regulations of the _Edict of May_, 1699, which then regulated
the practising of dentistry, and this was as much as to say that he
was obliged to enter the College of Surgery, to undertake two years’
practice with a regularly licensed surgeon, to undergo theoretical
and practical examinations, and to take oath before the Chief Surgeon
of the Realm. Once in possession of the diploma of surgeon-dentist,
he was separated thenceforward from the vulgar crowd of charlatans
and invested with all the prestige which a degree, so rarely acquired
at that time, conferred upon its possessor; but before facing public
opinion he desired to make himself known, and, so to say, first to
try his ground, by making known some of his newer ideas, and see what
reception they might meet with from his colleagues and the public in
general. He, therefore, published, in January, 1741, in the newspaper
_Mercure de France_, a letter on the so-called _eye tooth_,[541]
combating the then widely diffused prejudice that the extraction of an
upper canine constituted a grave peril to the eye. He demonstrated the
absurdity of this idea by putting in evidence the anatomical fact that
the upper canines are innervated by the infra-orbital nerve, which has
no relation whatever with the visual organ.

Still better to further his object of making himself a name, he
published in the same year and in the aforementioned paper his
dissertation on the teeth of pregnant women.[542] There he demonstrated
the falseness of the idea that one ought never to extract teeth during
the state of gestation, and brought into relief the necessity of
treating the dental diseases of pregnant women with still more accuracy
than those of other persons.

These publications, bearing as they did the marks of good sense,
favorably interested the public opinion. The way was therefore
prepared, and Bunon judging the moment to have come for publishing
his work, placed it in the hands of a literary man for the necessary
corrections of style. He also showed his manuscript to several persons
of consideration, but was grieved to perceive that the new ideas put
forward in it were skeptically received. He now thought it might be as
well to appeal to the judgment of a highly competent authority, and
fixed on M. de la Peyronie, Head Surgeon of the Realm. This gentleman,
after reading the work, highly praised the author, and Bunon gained
permission to publish the book under his patronage, on consideration
that he should give his word to furnish the proof of the many
assertions made therein on all kinds of subjects.

The goal was now reached, and Bunon, on the strength of such
illustrious patronage, published his book in March of 1743, under the
title, _Essay on the maladies of the teeth, wherein are suggested the
means of obtaining their good conformation from the earliest age, and
of assuring their preservation during the whole course of life_.[543]

All the principal journals of the time (_Journal des Savants_, _Journal
de Trévoux_, _Journal de Verdun_, _Mercure de France_, etc.) published
extracts from the book and eulogized the author, who had even the high
satisfaction of receiving an honorable mention from the Royal Academy
of Surgery, in the public sitting held in 1743.

Bunon, therefore, was now famous, and had, besides, gained wealthy
clients, as we see from the perusal of his observations, where the best
names in France are to be met with, put in evidence by him without
the least thought of professional secrecy. He could now enjoy his
well-merited successes, in accordance with the thought expressed by him
in one of his books: “All those who labor for the progress of an art
have legitimate right to the honor and to all the recompenses to which
success is entitled.”[544]

The study of Bunon’s work proves, in fact, that he had good right to
be proud of having written it. The mere perusal of it, however, does
not suffice to enable the reader to judge of its merits, for to do this
properly, it is necessary to study at the same time his other book,
published in 1746, entitled _Experiences and demonstrations made at the
Hospital of Salpêtrière and at St. Côme, before the Royal Academy of
Surgery, serving as continuation and proof to the Essay on the maladies
of the teeth_.[545] The essay is, in fact, a small 12mo book of 212
pages, written in a concise style, and, strange to say, most concise in
the most important points.

Many facts of great moment are given under the form of rapid
indications, or of assertions without proof; thus their importance is
apt to pass completely unobserved by those who do not take the trouble
of studying this work thoroughly and with the help of the explanations,
illustrations, and comments contained in the second book we have
referred to.

M. A. Barden, of the École Odontotechnique of Paris, was the first
to undertake a serious and conscientious study of Bunon’s works. By
so doing he has thrown full light on the author’s great merits, and
brought forward the high scientific importance of his works.

One of the important questions studied by Bunon concerns the hygiene
to be observed in order to obtain the development of a good dentition.
On this question he rightly establishes the principle that hygiene and
dental prophylaxis should begin from the period of the formation of
the milk teeth. He works out this principle with rigorous logic, and
finishes by tracing the hygiene of the mother during pregnancy, of the
woman (be she mother or nurse) during the nursing period, and of the
nursling as well.

As to the accidents of first dentition, Bunon sets forth a highly
scientific opinion, fully coinciding with the ideas of modern writers,
that is, that dentition is not the sole cause, nor even the principal
cause, of such accidents, but simply a coöperating cause. He made the
observation that in healthy infants, children of healthy parents and
nursed by healthy women, the time of teething is gotten over without
difficulty, while serious accidents occur frequently in weak and sickly
children not brought up and nourished according to hygienic principles,
or born, as not often happens, with special hereditary predispositions.

One of Bunon’s merits is that of having attributed to the first
teeth all the importance they really have, and of having insisted
on the necessity of attentively curing their maladies. He also drew
attention to the dangers that may result from the eventual persistence
of the first teeth at the epoch of the second dentition, or from the
persistence of their roots after the destruction of the crown by
caries. These roots, he says, by their contact with the neighboring
permanent teeth may infect them, and cause them to decay.

Bunon’s researches into the development of the teeth enabled him to
describe precisely the position that the various teeth of the second
dentition occupy in the jaw with regard to the milk teeth, before these
are shed.

Bunon was, besides, the first author who studied accurately dental
hypoplasia, and it is greatly to his honor that his ideas and
observations about this pathological condition have been accepted and
confirmed in substance by the greater part of the authors who have come
after him, having remarkable worth even at the present day. According
to him, this congenital defect of the teeth is owing to infantile
maladies, such as hereditary syphilis, infantile scurvy, malignant
fevers, smallpox, or measles; the harmful effects of these maladies,
however, are limited to the teeth in progress of development, and have
no influence on those that have already come forth. Erosion, as this
defect was termed by Bunon, sometimes affects the first teeth, but is
to be found much more frequently in the second or permanent ones. Those
most often affected are the first molars, and in frequency follow the
incisors, the canines, the premolars; the second and third molars are
the most rarely affected.

Bunon studied with great accuracy the means of preventing anomalous
positions of the permanent teeth, owing, according to him, almost
always to want of space. In certain cases he advises the extraction of
the milk tooth in order to facilitate the eruption of the permanent
one, and, necessity urging, he does not hesitate to sacrifice one of
the permanent teeth to procure the advantage of a normal position of
the others. With regard to this subject, the following passage is
worthy of note, for in it we find sketched out the theory of preventive
extraction as a means of facilitating the eruption of the wisdom tooth:
“It is better to have the teeth incomplete as to number than to have
the ordinary number badly arranged; for the mouth will appear none the
less well furnished because of having one or two teeth the less; the
other teeth will be commodiously distributed, and the last molars will
find sufficient room when they come forth; thus, the disorders which
these teeth often occasion will be avoided.”[546]

After caries, Bunon considers dental tartar as the most potent enemy to
the vitality of the teeth. He distinguishes three principal species:
the black, the lemon or light yellow, and the brownish yellow; however,
he allows of two other varieties of less frequent occurrence, the red
and the green tartar.

At a period when an extraordinary confusion obtained with regard to
gingivitis, because of the great number of varieties allowed, Bunon
strongly affirms the unity of this morbid process, and considers tartar
as the constant cause of it, without denying, however, that other
causes of various kinds may contribute at the same time to produce it.

In cases of scorbutic stomatitis, Bunon advises, and very rightly, the
complete removal of tartar from the teeth before having recourse to any
other local treatment. He also insists on the necessity of attending to
the teeth and gums, and especially of freeing the former from tartar
before undertaking the specific treatment of syphilis, considering
the good state of the teeth and gums as one of the most important
prophylactic measures against mercurial stomatitis.

Anyone who takes the trouble of reading Bunon’s works attentively
cannot help admiring his depth of insight, his spirit of observation,
his exquisite clinical sense, and his ingenuity. As illustrating this
last quality of his, we may cite two cases of fracture of the lower jaw
that he succeeded in curing in a short time by the method of binding
the teeth, the preceding attempts of experienced surgeons having
entirely failed. One of these cases is particularly interesting. The
seat of the fracture corresponded with the bicuspids, which, however,
had fallen out from the effects of trauma; the neighboring teeth were
also loosened. Bunon filled the empty space left by the bicuspids
with a piece of ivory, provided with two holes; then, by an
ingenious crossing of threads passing from the second molar on the
one side to the second bicuspid on the other, very tightly tied, he
formed, so to speak, one single block, and succeeded in bringing about
the consolidation of the shaking teeth and the complete cure of the
fracture, which was effected in less than a month.

[Illustration: RUSPINI WITH HIS FAMILY IN A COUNTRY PLACE

_From an old painting in oil._]

[Illustration: _The Italian dentist Ruspini presenting the children of
his orphanage to the members of the Free Masons Hall in London with
whose aid the institution had been founded._]

The unfavorable judgments passed on Bunon by some writers result, in a
great measure, from the circumstance that one finds quoted in his books
certain modes of treatment that today appear positively ridiculous.
But those who, very wrongly and with deplorable levity, consider Bunon
as nothing more than a vulgar empiric, ought to reflect that even the
greatest men cannot altogether avoid the influence of the ideas and the
prejudices of their time. Some tribute they are almost fatally bound
to pay to these prejudices. It is, therefore, not to be wondered at,
if one finds in Bunon’s works, as well as in those of many other old
writers, indications given of more or less strange remedies. Thus, as
facilitating the eruption of teeth, he recommends among other remedies
the rubbing of the gums with a mixture of honey, fresh butter, hare’s
brains, and oil of lilies, or with the fat of an old cock, dog’s milk,
and pig’s brains. Against the disorders and dangers of the teething
period he also advises rubbing the nape of the infant’s neck, the
shoulders, the back, and the lower limbs, always taking care, however,
to rub from above downward, thus offering opposition to the flow of
humors toward the upper parts of the body.

These means and methods of treatment reflect, so to speak, the medical
ideas and the curative practices of that time, and come down, in part,
from remote ages, as evidently appears from what is said in different
parts of this book. But such small blemishes ought certainly not
to be taken into account in passing judgment on Bunon’s works, the
most substantial part of which is made up of very original ideas and
observations. The high intrinsic value of Bunon’s works gives him a
just right to be considered one of the most illustrious forerunners of
modern scientific dentistry.

BARTOLOMEO RUSPINI, an Italian dentist, exercised his profession in
London with great success for more than thirty years. He was patronized
by all the greatest personages of the Kingdom and also by the Royal
family, from whom he received special marks of distinction. He attained
a very conspicuous position, and with the aid of the London Freemasons’
Lodge, of which he was an influential member, but chiefly by the
results of his professional work, he was able to found an orphanage
that was called by his name, being moved to do this by his great love
for children, whose dental maladies and disorders had always been an
object of particular study for him. In 1768 he published _A Treatise
on the Teeth, Their Structure and Various Diseases_. This book was
remarkably well received and went through a number of editions, the
last in the year 1797. Ruspini did not, in reality, contribute very
much to the development of dental science. He is, however, to be
especially remembered as the inventor of a very good mouth mirror, a
means of examination which afterward gradually came into general use.

       *       *       *       *       *

Having brought our history of dentistry up to the end of the eighteenth
century, in order to complete our work we must now speak of an
innovation in dental prosthesis, which, although gradually brought to
perfection in the following century, was first introduced at that time.
We allude to the


INVENTION OF MINERAL TEETH.

The merit of this invention is due, in part, to an individual outside
the dental profession, namely, to the French chemist Duchâteau, of
St. Germain en Laye, near Paris, who first had the idea of employing
porcelain as material for dental prosthesis. However, his idea would
not have yielded fruitful results had it not been for the coöperation
of the dentist Dubois de Chemant, who succeeded in putting it into
practice.

The circumstances connected with this invention were the following:
The chemist Duchâteau had for some time worn a denture of hippopotamus
ivory, but as usually happened with all the prosthetic pieces of that
time, which were made of organic material, and were, therefore, subject
to decay, this denture had acquired a very disagreeable odor, resulting
from the action of the buccal humors. Besides which, Duchâteau being
obliged, by reason of his profession, to continually taste pharmaceutic
preparations, his denture had gradually become impregnated with
medicinal substances that imparted a nauseous taste to everything he
ate. The unpleasantness of this was a subject of much consideration
with him, and thus it was that, to remedy the evil, he gradually
matured the idea of having a porcelain denture made, on the model of
the ivory one. In the year 1774 he applied to the porcelain manufactory
of M. Guerhard in Paris for the carrying out of his design. The first
trial was not successful, for in the baking the paste contracted so
much that the denture was no longer of the right dimensions. To remedy
this, he now had another and larger denture made, to allow for its
contraction in the baking. But the results did not correspond with
his wishes, and many trials were still necessary before Duchâteau
was able to obtain a denture which he judged fit for use, although
not without defects. As this denture, because of its dead whiteness,
produced an unpleasant effect, he had a yellowish tint, resembling that
of the natural teeth, given to it, and, as is usual with painting on
porcelain, fixed this color by baking a second time.

However, this denture proving unserviceable, Duchâteau was obliged to
put it aside and begin new experiments. These were made with a special
kind of porcelain paste used in France for the first time in 1740,
which vitrified in baking at 12° to 25° by Wedgwood’s pyrometer, whilst
the usual porcelain required a temperature of 72° to 75° by the same
test; but the results thus obtained were no better than the preceding
ones, and upon these new failures Duchâteau applied to the dentist
Dubois de Chemant, of Paris, for his collaboration. Together they made
fresh attempts, modifying the composition of the paste by adding a
certain quantity of pipe clay and other coloring earths to it. These
modifications enabled them to carry out the baking of the pieces at a
much lower temperature, and after various experiments the final result
was a denture that fitted the gums well enough, and which, in point of
fact, Duchâteau was able to wear.

Encouraged by this success, he tried to manufacture like dentures for
personages of high rank, hoping to gain money thereby, but his want
of knowledge of the dental art prevented him from succeeding in his
undertaking. However, in 1776 he laid this new process before the Royal
Academy of Surgeons in Paris, receiving the thanks of that body as well
as an honorable mention.

Whilst Duchâteau, discouraged by failure, was giving up all idea of
deriving profit from the practical application of his invention, Dubois
de Chemant, on the contrary, did not cease working for a moment, in
order to bring the new method of prosthesis to perfection. Little by
little he introduced important modifications into the composition
of the mineral paste used in the manufacture of the dentures,
incorporating therewith Fontainebleau sand, alicant soda, marl, red
oxide of iron, and cobalt. His experiments and researches aimed at
three principal ends, viz.:

1. The obtaining of mineral teeth offering all the gradations of color
presented by natural ones.

2. The arriving at a rigorous calculation of the contraction of the
mineral paste in the baking, so as to be able to make prosthetic pieces
of the desired form and dimensions.

3. The perfecting of the means of attachment of the prosthetic pieces,
and, in particular, of the springs.

By working with intelligence and perseverance, Dubois de Chemant
gradually obtained satisfactory results, and when, in 1788, he
published his first pamphlet on mineral teeth, he had already made
dentures and partial prosthetic pieces for a certain number of persons,
who wore them to great advantage.

As to the chemist Duchâteau, from 1776 to 1788, that is, during
the twelve years subsequent to his communication to the Academy of
Surgeons, he did absolutely nothing at all. He is, therefore, entitled
to the credit of having had a happy idea and of having endeavored
to put it into practice; but the merit of having given life to the
idea, abandoned for so many years by him with whom it originated, is
exclusively due to Dubois de Chemant; he is, therefore, with reason
considered the true inventor of mineral teeth.

Dubois de Chemant, however, was so unjust as to take the whole credit
of the invention for himself, declaring in his writings that the
original idea had been exclusively his own, and was in no way due to
Duchâteau.

In 1789 Dubois de Chemant made his invention known to the Academy of
Sciences and to the Faculty of Medicine of Paris; both pronounced in
favor of it, and in consequence of the opinion given by such high
authorities, he soon after obtained an inventor’s patent from Louis XVI.

Dubois’ successes now aroused the envy of many of his colleagues, and
especially of Dubois Foucou, the king’s dentist, who, together with
the greater part of the dentists of Paris and the chemist Duchâteau,
brought an action against him, accusing him of having usurped the
invention of Duchâteau, and demanding, for this reason, the annulment
of the inventor’s patent that had been granted him. But the law
courts, in an opinion dated January 26, 1792, rejected the demand for
annulment, recognized the patent of invention as fully valid, and
condemned Dubois Foucou, Duchâteau, and their confederates to the costs
of the judgment.

Paris being at that time in full revolution, Dubois de Chemant was
induced to emigrate to England. He established himself in London, and
there obtained a patent without much difficulty, according him the
exclusive right, for fourteen years, of manufacturing dentures of
mineral paste.

Dubois de Chemant wrote several pamphlets in order to make known to the
public this new kind of dental prosthesis and its advantages; some of
these were published in Paris (1788, 1790, 1824), and others during his
long residence in London, where he remained from 1792 to 1817. In these
pamphlets he upholds the great superiority of “the incorruptible teeth
of mineral paste” over all other kinds of artificial teeth; he calls
special attention to the fact that teeth of bone, ivory, and of every
other organic substance whatever gradually become spoilt through the
action of the saliva, of oral heat, of food and drink, etc., and not
only lose their primitive color and assume a dirty hue, most unpleasant
to the eye, but acquire a bad odor, at times quite insupportable,
becoming, besides, a cause of irritation to the gums and the mucous
membrane of the mouth, not to speak of their gradual softening and
wearing out, which renders them unserviceable after a certain time. All
these disadvantages were avoided by using the new prosthetic material,
this being incorruptible and inalterable.

The prosthetic appliances by Dubois de Chemant were made in one single
piece that represented the gums and teeth, whether in the case of
one or more teeth, or of whole dental sets. He used to take a cast
of the parts on which the prosthesis was to be applied, and by a
process, the details of which are not known; he succeeded in obtaining
prosthetic pieces that fitted the parts perfectly, notwithstanding
the difficulties resulting from the shrinking of the paste in baking.
If the piece required retouching, he did this by means of special
tools for grinding down porcelain. He could, besides, drill holes
in the porcelain for the application of the means of attachment. In
fact, Dubois de Chemant was the creator of a new method of prosthesis
applicable to any and every case, and which gained the praise and
admiration of the great doctors and scientists of that day, among whom
may be mentioned Geoffroy, Vicq d’Asyr, Descemet, Bajet, Petit Radel,
Darcet, Sabatier, Jenner, and others. The Paris Faculty of Medicine
gave it as their judgment that the prosthetic pieces manufactured by
Dubois de Chemant united the qualities of beauty, solidity, and comfort
to the exigencies of hygiene.

These eulogies must, however, be received with a certain reserve, as,
beyond doubt, the mineral teeth of that time still left much to be
desired. In England, where, as we have already said, they had been
introduced by the inventor, they at first obtained a great success,
which was, however, of short duration, and Maury[547] tells us that
toward 1814 they had fallen into great discredit and had been entirely
abandoned; this signifies that practically they did not fulfil the
expectations held out.

DUBOIS FOUCOU and FONZI. Among the first who occupied themselves
with the manufacturing of mineral teeth, contributing also to their
improvement, are to be named Dubois Foucou, to whom we have already
made reference, and Fonzi, an Italian by birth, who exercised the
profession of dentist in Paris. Dubois Foucou made some improvements in
the coloring of porcelain teeth, and in 1808 published a pamphlet in
which he explained his mode of proceeding in manufacturing them.[548]
In the same year Fonzi made known a new kind of teeth,[549] which he
called _terro-metallic_. These differed from those of Dubois de Chemant
in that they were all single teeth intended to be applied on a base by
means of small hooks of platina, with which each tooth was furnished.
In addition to this important innovation, Fonzi also discovered the
means of imitating in some degree the semitransparent tint peculiar to
natural teeth.

Notwithstanding this, the teeth made by Fonzi, of which there are
still some specimens in various dental museums, had anything but a good
appearance, and there still remained much to be done before mineral
teeth reached the height of perfection which they attained later on.

[Illustration: FIG. 104

Earliest specimens of mineral teeth.]

The credit of having introduced many new improvements in the
manufacture of mineral teeth belongs especially to the Americans. Among
those who particularly distinguished themselves in this department of
dental art, we may note Charles W. Peale, Samuel W. Stockton, James
Alcock, and Dr. Elias Wildman. But the most brilliant results, as is
well known, were obtained by the celebrated Samuel S. White, who, by
an intelligent and persevering activity, dedicated almost exclusively
to improving mineral teeth and to bringing them into general use,
contributed vastly to the progress of modern dental art. Samuel S.
White undoubtedly stands forth as one of the noblest and grandest
figures in the history of dentistry, and his name will ever be recorded
with honor and veneration by dentists of all ages.




FOOTNOTES:

[1] See Introduction to the German translation of the Ebers’ papyrus,
by Heinrich Joachim, Berlin, 1890.

[2] The Egyptians had three different kinds of writing: the
hieroglyphic, the hieratic, and the demotic. The hieroglyphic style,
which is the most ancient and is chiefly to be found on monuments and
in religious texts, consists of figures representing every kind of
object; the hieratic or sacerdotal style is an abbreviation of the
hieroglyphic writing; the demotic or popular style, the least ancient,
resulted from further abbreviations of the hieratic.

[3] See page 185 of the German translation of Dr. Joachim.

[4] See the German translation by Joachim, page 162.

[5] A fruit resembling cherries.

[6] On the Relations of the Human Teeth to those of the Lower Animals,
by John R. Mummery. Trans. Odontological Society of Great Britain, May,
1860.

[7] See German translation by Joachim, p. 120.

[8] Herodoti Halicarnassei historia, 1570 fol. Euterpe, page 53.

[9] Herodoti Halicarnassei historia, lib. vi.

[10] Die Zahnheilkunde, Erlangen, 1851, p. 348.

[11] G. B. Belzoni (1778 to 1823), a celebrated Italian traveller and
archeologist, visited Egypt and Nubia, and wrote, in English, a report
on his discoveries, which was published in 1821. We have not been able
to procure this book; we have, however, read the Italian version,
published in Naples in 1831, without coming across any mention of
artificial teeth found in Egyptian sarcophagi. Therefore, unless the
work has undergone some mutilation in the Italian translation, we do
not know whence Joseph Linderer can have taken the above notice.

[12] New England Journal of Dentistry, 1883, vol. ii, p. 162.

[13] According to Herodotus and Diodorus, there were three different
modes of embalming in use among the Egyptians; the most expensive of
these cost one talent (about 5600 francs), the second in order 20 minae
(about 1900 francs), while for the less wealthy there was a third
class, at a much more economical rate.

[14] See Giornale di Corrispondenza pei Dentisti, October, 1885, p. 227.

[15] [The oft-quoted statements of Mr. Purland with reference to
Egyptian dental art are recorded in the transactions of the first
monthly meeting of the College of Dentists, an extinct English dental
association, and published in the Quarterly Journal of Dental Science,
1857, vol. i, p. 49, where the following note by the secretary appears:
“Mr. Purland repudiated the idea of the Chinese having been the first
to manufacture teeth, and referred to numerous specimens in the British
Museum, manufactured between four thousand and five thousand years ago
by the Egyptians, who he considered were the original makers. On the
subject of flint, Mr. Purland said he had discovered pieces of wood
in the centre, and remarked upon the artificial teeth he had found in
mummies.”

Again, at page 63 of the same journal, in an article entitled “Dental
Memoranda,” by T. Purland, Dentist, Ph.D., the author says:

“Belzoni and others discovered rudely manufactured teeth in the
sarcophagi of the Egyptians. As regards the use of gold leaf, Sir
Gardner Wilkinson observes, as a singular fact, that the Egyptians
stopped teeth with gold.

“It is true that rudely manufactured teeth have been found in the
heads of Egyptian mummies, but it is equally true that teeth of a very
superior make and adaptation have also been found, some carved in
ivory, others in sycamore wood, and some have been found fixed upon
gold plates. Of these varieties, some are deposited in the valuable and
extensive museum belonging to Joseph Mayer, Esq., F.S.A., of Liverpool;
others are in the museums of Berlin and Paris, and I am in possession
of a tooth found pivoted to a stump in the head of a mummy in the
collection of a lamented friend.

“Of stopping with gold, several instances have come to my notice,
particularly in a mummy in the Salt collection, sold by Sotheby, in
1836, in which three teeth had been stopped. I have endeavored to trace
the mummy, but in vain.”—E. C. K.]

[16] Giornale di Corrispondenza pei Dentisti, October, 1885, p. 229.

[17] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 9.

[18] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 9.

[19] Ibid.

[20] Ibid.

[21] The incisors represented in the cut of Renan’s work do not at
all give the anatomical form of upper incisors, but of lower ones.
Therefore, either the figure itself has been badly drawn, or the
piece found by Dr. Gaillardot was part of the inferior and not of the
superior jaw. In the latter case, the figure in Renan’s book ought to
be reversed, in the manner here shown:

[Illustration: FIG. 4

The same figure reversed, as it ought to be if
the piece found at Sidon belonged to a lower jaw.]

[Illustration: FIG. 5, FIG. 6

Examples of dental prosthesis as practised by the
Hindus at the present time.]

Neither do we understand on what ground Dr. Gaillardot has based
his affirmation of the piece discovered having belonged to a female
skeleton, as it is well known that there is no characteristic
difference between a male and a female jaw.

[Interesting examples of the survival of this primitive type of dental
prosthesis are found among the Hindus at the present time. The two
illustrations (Figs. 5 and 6) are from photographs of specimens of work
done by native Hindu dentists. Fig. 5 is a roughly carved artificial
tooth of ivory attached by a gold wire ligature to the adjacent
natural teeth, all of which, with the artificial tooth attached, were
subsequently lost by alveolar disease. Fig. 6 is a similar carved
artificial tooth of ivory attached to the adjoining teeth by a thread
ligature, the supporting teeth with the attached ivory tooth also
having been lost by alveolar disease. These specimens were removed and
sent to the writer by Dr. H. B. Osborn, of Burma, during the present
year (1909).—E. C. K.]

[22] Renan, Mission de Phénicie, p. 472.

[23] The number varies according to the different translations. So,
instead of the Latin dentes elephantis, we find in English and in other
languages the word _ivory_.

[24] J. Bouillet, Précis d’histoire de la Médecine, Paris, 1883, p. 24.

[25] La médecine chez les Chinois, par le Capitaine P. P. Dabry, Consul
de France en Chine, Membre de la Société Asiatique de Paris, 1863.

[26] One of these books, Nuei-King, is said to have been written
twenty-seven centuries before the Christian era, by the Emperor
Houang-ty, the founder of Chinese medicine.

[27] See Bouillet, work quoted at p. 31.

[28] Dabry, op. cit., p. x (introduction), pp. 1, 2, 4, 10, 11.

[29] This author wrote toward the end of the seventeenth century; one
of his works is entitled De Acupunctura.

[30] Dabry, op. cit., p. 424.

[31] See Histoire de la Chirurgie depuis son origine, par MM. Dujardin
et Peyrihle, Paris, 1774 to 1780.

[32] London, 1811.

[33] Die Zahnheilkunde, etc., 1851, p. 347.

[34] J. Bontii, De medicina Indorum, 1642, lib. iv.

[35] Carabelli, Handbuch der Zahnheilkunde, 1844, i, 8.

[36] Linderer, op. cit.

[37] [The newer civilization of Japan has caused this custom to largely
fall into disuse.—E. C. K.]

[38] Carabelli, loc. cit.

[39] Linderer, loc. cit.

[40] Carabelli, op. cit., p. 17.

[41] The Greek name Asklepios became in the Latin, Æsculapius; the two
names are therefore equivalents.

[42] See Cicero, De Natura deorum, lib. iii, chap. xxii.

[43] [Homer speaks of them as “two excellent physicians,” and refers to
Machaon as “a blameless physician,” and admits that “a medical man is
equivalent to _many_ others.” Their renown was continued in a poem of
Arctinus, wherein one was represented as without a rival in surgery,
the other as sagacious in detecting morbid symptoms.—C. M.]

[44] Praktische Darstellung aller Operationen der Zahnarznei-kunst, von
Johann Jakob Joseph Serre, Berlin, pp. 7 to 13.

[45] Guardia, Histoire de la Médecine, p. 250.

[46] Hippocratis opera, Genevæ, 1657 to 1662, De natura hominis, p. 225.

[47] Page 251.

[48] Page 252.

[49] Page 253.

[50] De morbis mulierum, lib. ii, p. 666.

[51] The use of carbonate of lime or chalk as a dentifrice evidently
goes back to antiquity.

[52] Unwashed wool—that is, wool not cleansed of the fat secreted by
the skins of the animals from whom it is taken—was much in use by the
doctors of antiquity. One now obtains _lanolin_ from it.

[53] The obole was about three-quarters of a gram.

[54] The cotyle was a little more than a quarter of a liter.

[55] Page 507.

[56] Page 21.

[57] See Daremberg, Dictionnaire des Antiquités Grecques et Romaines,
article “Chirurgie.”

[58] The various editions here offer numerous variations, but the sense
is everywhere obscure.

[59] See Bouillet, Précis d’Histoire de la Médecine, p. 94.

[60] On Epidemics, lib. ii, section i, p. 1002.

[61] De morbis vulgaribus, lib. iv, p. 1131.

[62] That is a very short root.

[63] Page 1138.

[64] De morbis vulgaribus, lib. v, p. 1157.

[65] Page 1157.

[66] De morbis vulgaribus, lib. vi, section i, p. 1164.

[67] Ibid., vii, p. 1223.

[68] Page 1229.

[69] De morbis vulgaribus, lib. vii, p. 1238.

[70] The title of these seven books of Hippocrates might cause a false
idea to be conceived. They do not precisely treat of epidemics in the
sense given to the word in the present day; instead, they describe the
maladies which predominated during four years, in successive periods of
time, according with the variations of the atmospheric conditions. (See
Litré, Introduction to the books on Epidemics.)

[71] De morbis vulgaribus, lib. iii, p. 1009; lib. vi, section iii, p.
1176.

[72] De morbis vulgaribus, lib. iv, p. 1138; Aphorisms, lib. iv, No.
53, p. 1251.

[73] Coacæ prænotiones, No. 235, p. 157; Prædictorum, lib. i, No. 48,
p. 71.

[74] Coacæ prænotiones, No. 236, p. 157.

[75] Loc. cit., No. 237.

[76] Loc. cit., No. 239.

[77] Loc. cit., No. 241, p. 157; No. 648, p. 222.

[78] De morbis vulgaribus, lib. iii, p. 1083.

[79] Ibid., lib. iv, p. 1121.

[80] Prædictorum, lib. ii, p. 111.

[81] De affectionibus, p. 521.

[82] De internis affectionibus, p. 549.

[83] Paul Dubois, Aide-mémoire du chirurgien-dentiste, Paris, 1894, 2me
partie, pp. 415, 416.

[84] Prædictorum, lib. ii, p. 108.

[85] De internis affectionibus, p. 534.

[86] De humoribus, p. 49.

[87] De morbis vulgaribus, lib. ii, section vi, p. 1050.

[88] Prædictorum, lib. ii, p. 96.

[89] De articulis, p. 799.

[90] Loc. cit.

[91] De articulis, p. 800.

[92] Aphorism, lib. v, No. 18, p. 1253.

[93] De liquidorum usu, p. 426.

[94] De locis in homine, p. 419.

[95] De morbis vulgaribus, lib. i, p. 948.

[96] De partibus animalium, lib. iii, cap. i.

[97] Ctesias, of Cnydus, wrote various works, somewhat earlier than
Aristotle; one of which, the History of India, is very interesting, but
also contains not a few fables.

[98] This, as well as other errors of Aristotle, we shall find
repeated throughout the lapse of centuries by many authors, Galen not
excluded, who, in fact, by the authority of his name, gave them valid
confirmation.

[99] The distinction between arteries and veins was, at that time, not
yet well known, though we already find, in this passage of Aristotle,
allusion made to the relations between the teeth and the bloodvessels.

[100] According to the testimony of Celsus, a very serious author and
in every way worthy of belief, Herophilus and Erasistratus dissected
not only corpses, but also living men, namely, malefactors consigned to
them by the kings of Egypt, in order that they might make researches
into the normal conditions of the organs during life, and their mode of
functioning. See Cornel. Cels., De re medica, lib. i, Preface.

[101] Cœlii Aureliani de morbis acutis et chronicis, lib. viii,
Amstelædami, 1755, Pars ii, lib. ii, cap. iv, De dolore dentium.

[102] Herophilus et Heraclides Tarentinus mori quosdam detractione
dentis memoraverunt.

[103] Arretium, Cære, Clusium, Cortona, Fæsulæ, Falerii, Pisæ,
Russellæ, Tarquinii, Vetulonia, Volaterræ, Volsinii.

[104] Deneffe, La prothèse dentaire dans l’antiquité, p. 51.

[105] Dr. Cigrand in his book The Rise, Fall, and Revival of Dental
Prosthesis, after having spoken of the Phœnician dental appliance
described in Renan’s work, adds: “There are scores of specimens of
Phœnician dental art in home collections and also at the Columbian
World’s Fair.” However, until these specimens of Phœnician dental art
are described and their origin is exactly known, their authenticity
will always remain a matter of doubt. [Cigrand is in error. The
specimens he speaks of were mainly imagined.—W. H. TRUEMAN.]

[106] Deneffe, op. cit., pp. 60, 61.

[107] Deneffe, op. cit., p. 63.

[108] Plinius, lib. xxix, cap. v.

[109] This article forms part of the tenth table. The Law of the Twelve
Tables was lost, but citations and passages are to be found in Cicero
and in the works of other Roman jurisconsults, and by the aid of these
it has been possible to reconstruct, at least in part, this very
ancient code of laws. See Dionysii Gothofredi, Corpus juris civilis.
Amstelodami, 1663; and also Thesaurus juris romani cum prefat. Ottonis,
Tome iii, Trajecti ad Rhenum, 1733.

[110] Josef Serre, Zahnarznei kunst, Berlin, 1804, p. 6.

[111] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 26.

[112] See note, p. 15, Hist. Relations of Medicine and Surgery,
Allbutt. (C. M.)

[113] A. Corn. Celsi de Medicina libri octo, Patavii, MDCCXXII.

[114] Celsus, lib. i, Preface.

[115] Wine with honey.

[116] [_Minium_ is an ancient name for red oxide of lead; it was also
applied to mercuric sulphide or vermilion, and the term vermilion was
also used as a designation for _granum tinctorum_ or _kermes_, the
_coccus ilicis_, a variety of cochineal extolled by Galen for its
medicinal properties. The exact nature of the meaning of minium in this
connection is not altogether clear.—E. C. K.]

[117] A species of herb (all-heal).

[118] Peucedanum officinale, hog’s fennel.

[119] A species of wild grape thus called because it is red like minium
(vermilion).

[120] Species of mineral. [An impure copper sulphide.—E. C. K.]

[121] Condensed juice of the seeds of the momordica elaterium, a
bitter, irritating, and drastic substance.

[122] According to De Giorgi (Sinonimia chimico-farmacotecnica, Milan,
1889), scissile alum is one of the many names for blue vitriol or
sulphate of copper.

[123] [The _cyperus rotundus_, recommended by Dioscorides in the
treatment of ulcers in the mouth. Esteemed also by the Arab medical
writers Serapion, Avicenna, and Rhazes. Not the cypress, _cupressus
sempervirens_.—E. C. K.]

[124] Here is meant the paper made of papyrus and called in Latin
charta.

[125] Trisulphide of arsenic.

[126] Celsus did not know of the upper maxillary bones as distinct
bones. The same may be said of the other bones of the head. Celsus
speaks of the osseous sutures and openings, but not of the different
bones of the skull and face.

[127] C. Plinii Secundi, Historiæ Mundi, lib. vii, cap. ii.

[128] Lib. xxiv, cap. cxi.

[129] Lib. xi, cap. lxiii.

[130] Lib. xi, cap. lxiv.

[131] Cap. cvi.

[132] Dipsacus fullonum.

[133] Cap. cviii.

[134] Lib. xxviii, cap. ii.

[135] Lib. xxviii, cap. xi.

[136] Lib. xxviii, cap. xiv.

[137] Ibid., cap. xxvii.

[138] Ibid., cap. xxix.

[139] Ibid., cap. xlix.

[140] Ibid., cap. lxxviii.

[141] Lib. xxix, cap. ix.

[142] Lib. xxix, cap. x.

[143] Lib. xxix, cap. xi.

[144] Lib. xxx, cap. viii.

[145] Lib. xxx, cap. ix.

[146] Lib. xxx, cap. xlvii.

[147] Lib. xxxi, cap. xlv, xlvi.

[148] Lib. xxxii, cap. xiv.

[149] Trygon pastinaca, a large fish whose tail is armed with sharp and
strong bones.

[150] A measure equal to 0.274 liter.

[151] [The sextarius was accorded different values, thus a sextary of
oil was ℥xviij, of wine ℥xx, and of honey, ℥xvij.—E. C. K.]

[152] [Lat., the purple fish, a carnivorous marine mollusk.—E. C. K.]

[153] Lib. xxxii, cap. xlviii.

[154] A kind of lignite, now called jet.

[155] Ignatius, because he has white teeth, is always laughing; if
he be present at the felon’s trial, whilst the counsel is moving all
to tears, he laughs; he laughs even when everyone is mourning at
the funeral pyre of a dutiful son, whilst the mother is weeping for
her only child. He laughs at everything, everywhere, and whatever
he be doing; this is his weakness, which methinks is neither polite
nor elegant. Wherefore, I must tell thee, O good Ignatius, even if
thou wert a citizen of Rome, or a Sabine, or of Tibur, or one of the
thrifty Umbrians, or of the fat Etruscans, or wert thou a black and
large-toothed Lanuvin, or a Transpadane, if I may speak of my own
people, or belonging to any people that cleanly wash their teeth; even
then I would not have thee be always laughing; for nothing is more
silly than a silly laugh. Now, O Celtiberian, in thy Celtiberian land,
each is accustomed, with the water he has himself emitted, to rub his
teeth and gums. Wherefore the cleaner are thy teeth, the more surely
stale dost thou accuse thyself of having drunk.

[156] Rerum geographicarum libri. Lutetiæ Parisiorum, 1620. Lib. iii,
p. 164; quippe qui urina in cisternis inveterata laventur, eaque cum
ipsi, tum eorum uxores dentes tergant; quod Cantabros facere et eorum
confines ajunt (Carabelli, Systematisches Handbuch der Zahnheilkunde,
Wien, 1844, i, 12).

[157] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 412.

[158] Medio recumbit imus ille qui lecto, Calvam trifilem segmentatus
unguento, Foditque tonsis ora laxa lentiscis; Mentitur, Esculane; non
habet dentes.

[159] Lentiscum melius; sed si tibi frondea cuspis Defuerit, dentes penna
levare potest.

[160] Antiq. du Bosphore au Musée de l’Ermitage, pl. xxx, 8 et 9
(Dictionnaire des antiquités grecques et romaines, par Daremberg,
Saglio, etc.).

[161] Mittheilung. d. antiq. Gesellschaft in Zürich, xv, pl. xi, 32
(Daremberg and Saglio, ibid.)

[162] Caylus, vol. vi, pl. cxxx, 5.

[163] Dentifricium ad edentulam: Quid mecum est tibi? me puella sumat, Emptos
non soleo polire dentes.

[164] Lib. xii, epig. xxiii.

[165] Dentibus atque comis, nec te pudet, uteris emptis. Quid facies oculo,
Lælia? non emitur.

[166] Nostris versibus esse te poetam, Fidentine, putas, cupisque eredi? Sic
dentata sic videtur Ægle, Emptis ossibus, indicoque cornu. (Lib. i,
epig. lxxii.)

[167] Lib. ix, epig. xxxviii.

[168] Nec dentes aliter quam serica nocte reponas.

[169] Horat. Sat. viii, lib. i.

[170] Eximit aut reficit dentem Cascellius ægrum.

[171] Suffire autem oportet ore aperto alterci semine carbonibus
asperso, subinde os colluere aqua calida; interdum enim quasi vermiculi
quidam eiciuntur.

[172] Gum of the cedar tree.

[173] Dentifricium, quod splendidos facit dentes et confirmat, chap.
xi, lix.

[174] A Roman measure of capacity, equal to a little more than half a
liter.

[175] The origin of the theriac, according to what Galen writes in
his book De antidotis, is to be traced back to Mithridates, King of
Pontus, who lived from the year 132 to the year 63 B.C. This king,
patron of Art and Science, was, for his times, an eminent toxicologist.
By making experiments on condemned criminals he sought to discover
by what drugs the action of the various poisons, both mineral and
vegetable, and those inoculated by the bites of poisonous animals might
be counteracted. He afterward mixed the various antidotes together
for the purpose of obtaining a remedy that might prove a preservative
against the action of any poison whatever. This universal remedy,
the receipt of which was carried to Rome by Pompey, the conqueror of
that great king, was named _mithridatium_, after the name of him who
had composed it. Andromachus modified the mithridate; he took away
certain ingredients and added others, reducing the number of them from
about eighty to sixty-five. The principal modification was that of
introducing into the composition of this drug the flesh of the viper;
wherefore, Galen is of the opinion that the theriac (so called from the
Greek word _therion_, a noxious animal) was more efficacious than the
mithridate against the bite of the viper. The theriac still exists in
the French pharmacopeia, although considerably simplified. In every 4
grams it contains 5 centigrams of opium.

[176] A species of solanaceæ of the Physalis genus, probably the
Physalis alkekengi.

[177] Galeni de compositione medicamentorum secundum locos, liber v.

[178] J. R. Duval, Recherches historiques sur l’art du dentiste chez
les anciens, Paris, 1808, p. 19. (See Carabelli, p. 13.)

[179] Galen admits three kinds of nerves: soft or sensitive nerves,
originating from the brain; hard or motor nerves, originating from the
spinal marrow; medial nerves, motor-sensitive, originating from the
medulla oblongata.

[180] Galen distinguishes seven pairs of cerebral nerves; his third
pair corresponds to the trigeminus.

[181] Galeni de usu partium corporis humani, lib. xvi.

[182] Galeni de compositione medicamentorum secundum locos, lib. v.

[183] Medicus, chap. xix.

[184] Trigonella fœnum græcum, a papilionaceous plant.

[185] [About twenty-eight fluid ounces.—E. C. K.]

[186] Under the name of _root_, the ancients meant also the _neck_ of
the tooth.

[187] Swallow, I tell thee, as this water will not be again in my
mouth, even so my teeth will not ache for the whole year.

[188] The cure of teeth affected by warm painful disease; according to
Adamantius the sophist.

[189] Ætii tetrabibl., ii, sermo iv, cap. xxvii.

[190] Ibid., cap. xxxi.

[191] Ætii tetrabibl., ii, sermo iv, cap. xix.

[192] Ibid., i, sermo iv, cap. ix.

[193] Ibid., ii, sermo iv, cap. xxiv.

[194] Tetrabibl., ii, sermo iv, cap. xxv.

[195] Ibid., cap. xxvi.

[196] [The author quoted directs hydromel to be made from one part of
honey and eight parts of water boiled until it has ceased frothing.—E.
C. K.]

[197] Pauli Æginetæ de re medica, lib. vi, cap. xxvii.

[198] Lib. vi, cap. xxviii.

[199] Ibid., cap. ix.

[200] Ibid., cap. xxix.

[201] Rasis opera, Venetiis, 1508.

[202] Haly Abbas Pract., lib. v, cap. lxxviii.

[203] Ibid., cap. xxxiii.

[204] Serapionis practica, Venetiis, 1503.

[205] Avicennæ opera in re medica, Venetiis, 1564.

[206] Abulcasis de Chirurgia, lib. i, cap. xix, p. 47; Latin
translation by Channing with the Arabic text in front, Oxford, 1778.

[207] Cap. xx, p. 47.

[208] Cap. xxi, p. 49.

[209] Zegi was the name given by the Arabs to blue vitriol.

[210] Lib. ii, cap. xxviii, p. 181.

[211] Lib. ii, cap. xxix, pp. 181 to 183.

[212] This great Mahommedan surgeon was, it seems, very religious. His
book begins with the words: “In the name of the merciful God, Lord
perfect in goodness,” and almost every chapter ends with “If God so
wills,” and the like.

[213] These two manuscript codices are found in the Bodleian Library at
Oxford.

[214] Lib. ii, cap. xxx, p. 185.

[215] The Arabic word used by the author means more precisely “those
who apply cupping glasses.” Channing has translated it by _tonsores_,
barbers.

[216] An advice already given by Celsus.

[217] Lib. ii, cap. xxxi, p. 191.

[218] Silly barbers.

[219] Lib. ii, cap. xxxi, p. 187.

[220] Lib. ii, cap. xxxii, p. 193.

[221] Lib. ii, cap. xxxv, p. 197.

[222] Lib. iii, cap. iv, p. 545.

[223] [In connection with the practice of applying medicines to the
teeth or upon the gums, with the object of rendering the operation of
tooth extraction less difficult, the use of arsenical compounds as an
ingredient of these topical applications is of peculiar interest. In
an Italian translation of the writings of Johannes Mesue, published
at Venice in 1521, the following interesting reference to the use of
arsenic appears:

“The son of Zachariah Arazi compounds a medicine to assist the
extraction of the teeth. ℞—Pyrethrum, colquintida root and the bark of
the mulberry root, the seed and leaves of almezeron, huruc, and yellow
arsenic, milk of alscebram or pieces of it, ground very thoroughly
with vinegar; then pour some of it over bdellium and halasce, of each,
equal parts, dry and dissolve in strong vinegar and make trochisi of
it, and with them anoint the roots of the tooth from hour to hour; this
facilitates the extraction of it.

“There is also another medicine with which one fills the decayed tooth
and breaks it: ℞—Seeds of almezeron and milk of alscebram compounded
with liquid pitch, and fill with it the decayed tooth. Another one:
℞—Bauras, bark of the willow, of each, one part; yellow arsenic, two
parts; compound with honey and place it upon and around the tooth and
immediately extract it.

“The fat of the green frog which lives upon the trees breaks teeth
which are anointed with it the same as when you anoint them with milk
of alscebram or titimallo, and similarly also the milk of celso with
yellow arsenic.”

In this connection it is also interesting to note that the ancient
Arabian medical writers referred to the red sulphide of arsenic or
realgar as sandarach. The term Sandarach was clearly used by these
writers to designate two different medicaments—one the gum-vernix,
exudate of the Juniper tree, and which we now know as Sandarach gum.
They also apply the term to red arsenic, as above stated. Avicenna
clearly distinguishes between the two kinds of Sandarach, and says
with regard to the gum-vernix or Juniper Sandarach that it is the best
of all known remedies for toothache. While, as shown by Dr. Guerini,
many of the medicaments used as topical applications to facilitate
the extraction of teeth were wholly without any possible effect of
that character, it cannot be doubted that the application of arsenical
preparations, such as those referred to by Mesue, could not fail to
set up an arsenical necrosis about the roots of the tooth, rendering
it loose and easy of removal, but necessarily with the disadvantage of
producing a dangerously extensive necrosis of the tissues.

_Mesue Vulgar._—Impresso in Venitia per Cesaro Arrivabeno Venitiano a
di vinti octubrio, mille cinquecento e vintiuno.

Delle Medicini Particulare, Libro Quarto, Capitolo XLI.—E. C. K.]

[224] Joannis Mesue opera, Venetiis, 1562.

[225] Sprengel, Geschichte der Chirurgie, Part II, p. 279.

[226] Linderer, Handbuch der Zahnheilkunde, Berlin, 1848, ii, 403.

[227] Bruni Chirurgia magna.

[228] Sprengel, Geschichte der Chirurgie, Part II, p. 280.

[229] Sprengel, loc. cit.

[230] Sprengel, loc. cit.

[231] La Grande Chirurgie de Guy de Chauliac, chirurgien maistre en
médecine de l’Université de Montpellier, composée en l’an 1363, revue
et collationnée sur les manuscrits et imprimés latins et français par
E. Nicaise, 1890.

[232] Of these copies, twenty-two are written in Latin, four in French,
two in Provençal, three in English, one in Netherlandish (Dutch), one
in Italian, and one in Hebrew.

[233] Nicaise, La Grande Chirurgie de Guy de Chauliac, Second Chapitre:
De l’Anatomie de la face et de ses parties, p. 47.

[234] Here, as elsewhere, is preserved the old orthography of the text.

[235] Nicaise, p. 711.

[236] Teeth may be produced not only in infancy, but also at a later
age.

[237] Nicaise, p. 205.

[238] Pietro of Albano (1250 to 1316), the writer of many books, among
which one bearing the title of Conciliator differentiorum philosophorum
et præcipue medicorum, is often quoted by Guy de Chauliac and by many
others under the name of Conciliator.

[239] Nicaise, p. 505.

[240] Appropriatæ barbitonsoribus et dentatoribus.

[241] In one Latin manuscript of 1461 instead of _dentator_ we already
find the word _dentista_.

[242] Nicaise, p. 506. To make clear the meaning of these names, the
following must be noted: The _rasoirs_ (_rasoria_) were instruments
with one cutting edge alone, which were used in performing any kind
of incision. _Raspatoria_ (râpes, _i. e._, rasps) signified almost
certainly scrapers, not rasps. The _spatumes_ were instruments with
one or two cutting edges, of various shapes, but usually small.
_Esprouvettes_ (Latin, _probæ_) were the sounds or probes. _Scalpra_
means scalpels, but in this case has especially the meaning of
_déchaussoirs_, gum lancets. _Terebelli_ (French, _Tarières_) are the
trepans or perforators.

[243] Nicaise, p. 507.

[244] By the word _apostema_, Guy de Chauliac, and many other writers,
indicate every pathological condition in which the normal elements of
the tissues are separated from one another, by a humorous or gaseous
gathering, or by any phlogistic or neoplastic formation. The word
signifies, in Greek, _removal_, just like the Latin word _abscessus_.
In fact, these two terms were often used as synonyms; but at other
times the word apostema had a wider meaning, and included, besides the
abscess, the phlegmon, the furunculus, the anthrax, erysipelas, herpes,
and other dermal affections, especially the pustulous ones, edema and
other serous gatherings, subcutaneous emphysema and other gaseous
gatherings, glandular tumefactions, cysts, benignant and malignant
tumors.

[245] De la dent esbranlée et affoiblie, Nicaise, p. 509.

[246] “De l’humidité qui amollist le nerf et le ligament.”

[247] Evidently the author speaks of a “little gold chain,” because, as
he is not versed in the practice of dentistry, he does not know that it
was a simple gold wire which was used for keeping loose teeth firm. A
small chain as thin as a thread could not be possibly made, and would
even then be excessively weak.

[248] This name was first given to medicaments containing gall-nuts,
then, by extension, also to compound remedies not containing such
substance, and to which was given the name of _aliptæ_, v. Nicaise, p.
677.

[249] According to Nicaise, the Cyperus esculentus (in French,
“souchet”) is here referred to.

[250] In the Latin text: Buccelletur cum scalpro et lima.

[251] Here lavement means mouth wash, not injection.

[252] Cum raspatoriis et spatuminibus radantur.

[253] Treatise vi, doctrine i, chap. viii: “Des membres qu’il faut
amputer,” etc., Nicaise, p. 435.

[254] According to Joubert several solanaceæ had this name, among
others _Solanum nigrum_ and _Solanum somniferum_ (Physalis somnifera
L.), which probably corresponds to the _Strychnos hypnoticus_ of
Dioscorides.

[255] Valesci Philonium, etc.; Francofurti MDXCIX, cap. lxiv, De dolore
dentium, p. 195 et seq.

[256] Plant belonging to the order of the Polygonaceæ.

[257] “Materia lapidea paullatim abradatur ferro et dentifriciis partim
mundificativis, et partim stypticis. Deinde colluantur denies sæpe vino
albo, et fricentur sale torrefacto.” Cap. lxvii, De colore dentium
præter naturam, p. 202.

[258] “Quoniam, licet ex parte corrosi sint, attamen dolore sedato
masticationem iuvant, et alios firmiores reddunt.” Appendices, p. 205.

[259] “Ossa fiunt ex spermate et sanguine menstruo; dentes autem ex
sanguine, in quo remansit virtus spermatis.” Appendices, p. 205.

[260] Petri de Largelata chirurgiæ libri sex, Venetiis, 1480.

[261] _Bartolomæi Montagnanæ_ Consilia, Venetiis, 1497.

[262] Johannis Platearii Salernitani practica brevis, Lugduni, 1525.

[263] Joannis Arculani commentaria in nonum librum Rasis ad regem
Almansorem, etc., Venetiis, 1542.

[264] This Arabian word was used to indicate the last molars.

[265] “Regimen autem implendo dentem corrosum est, ut impleatur in
causa calida cum frigidis, et in frigida cum calidis. Secundo, ut non
impleatur cum labore et vehementia addente in dolore, et ex propriis
est gallia cum ciperis aut cum mastiche, et eligantur ex suprascriptis,
calida aut frigida secundum opportunitatem, in contrarium dyscrasiæ
dentis, sed ubi non fuerit multus recessus a mediocritate impleatur cum
foliis auri.” Cap. xlviii, p. 195.

[266] In the Venetian edition (1542), however, all the figures which
Arculanus inserted in his work are found in the beginning of the book,
in a single table, together with the indication of the use to which
each single instrument was destined.

[267] Alexandri Benedicti Veronensis de re medica opus, lib. vi, de
affectibus dentium.

[268] Opera domini Joannis de Vigo in chyrurgia. Lugduni, 1521, lib.
ii, tract. iii, cap. xiv, fol. 40.

[269] [The editions and translations of Vigo seem to have been endless.
A French translation of his treatise on the wounds caused by firearms
is said to have fallen into the hands of Paré, and had an inspiring
influence upon the barber’s boy.—C. M.]

[270] Lib. v, cap. v, De doloribus dentium, fol. cxvii to cxix.

[271] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 406.

[272] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 80.

[273] A religious order of knights, established toward the close of the
twelfth century, viz., during the third crusade. The original object
of the association was to defend the Christian religion against the
infidels, and to take care of the sick in the Holy Land.

[274] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 82.

[275] Geist-Jacobi, p. 88.

[276] Albert von Haller, Bibliotheca chirurgica, i, 190.

[277] Nuetzlicher Bericht, wie man die Augen und das Gesicht schaerfen
und gesund erhalten, die Zaehne frisch und fest erhalten soll.
Würzburg, 1548.

[278] See Giornale di Corrispondenza pei dentisti, 1895, xxiv, 289.

[279] Joannis Arculani. Commentaria, Venetiis, 1542, cap. xlviii, De
dolore dentium, p. 192.

[280] “The first dental book in the German language” (see Giornale di
Corrispondenza pei dentisti, loc. cit.).

[281] A Latin translation of the French name _Du bois_.

[282] De humani corporis fabrica, libri septem.

[283] De humani corporis fabrica libri septem, cap. xi, De dentibus,
pp. 40 to 42 (complete edition of the works of Vesalius, published at
Leyden in 1725).

[284] Lib. i, cap. xlii, p. 141.

[285] From _gena_, a cheek.

[286] Blandin, Anatomie du système dentaire, Paris, 1836, p. 19.

[287] Portal, Histoire de l’anatomie et de la chirurgie, tome i, p. 545.

[288] Observationes anatomicæ, p. 39, et seq.

[289] _In utero duodecim dentes formantur in malis, et totidem in
maxilla_ (in the uterus are formed twelve teeth in the upper jaw and
as many in the lower). Fallopii Gabrielis observationes anatomicæ,
Venetiis, 1562, p. 39.

[290] This sharp reproof and accusation of ignorance are made for the
benefit of the immortal anatomist Andreas Vesalius, to the number of
whose adversaries Eustachius likewise belonged. What unjust fury of
party passion!

[291] Chap. xviii, p. 54.

[292] Chap. xxii, p. 65.

[293] Chap. xxiii, p. 70.

[294] Chap. xxv, xxvi.

[295] Chap. xxvii, xxviii.

[296] The inferior orifice of the foramen incisivum.

[297] It is superfluous to say that these cases are unreal and simply
dependent upon erroneous observations; for instance, in the case of
the second molar being extracted before the erupting of the third,
the second molar figured as, and supposed to be, the latter, when,
finally, the wisdom tooth appeared, it was believed to be the last
molar renewed. It is no rare thing, also, in these days, not only for
unprofessional persons, but also for medical practitioners, to fall
into errors of this kind, especially because, in similar cases, the
wisdom tooth, having but a limited space in which to erupt, is in the
habit of filling the void left by the second molar, where it meets with
less resistance.

[298] Page 93.

[299] Œuvres complètes d’Ambroise Paré, accompagnées de notes
historiques et critiques, par J. F. Malgaigne, Paris, 1840, vol. i, p.
231.

[300] The lower molars, being seated on the roots and not suspended
like those of the upper jaw, are not in want of so many roots to assure
their stability.

[301] Vol. ii, p. 307.

[302] ... if they are divided, shaken, or separated from their alveoli
or little cavities, they must be reduced into their places and should
be bound and fastened against those that are firm with a thread of
gold, silver, or flax. And they must be held thus until they are quite
firm and the callus is formed and have become solid.

[303] Lib. xv, ch. xvi, vol. ii, p. 443.

[304] Lib. xv, cap. xxvii, vol. ii, p. 448.

[305] A man, worthy of being believed, has assured me that a certain
princess having had a tooth taken out, immediately had it replaced by
another supplied by one of her ladies, which took root, and after a
time she masticated with it as well as she had done with the former one.

[306] Lib. xv, cap. xxviii.

[307] I will here tell a story of a master barber living at Orleans,
named maistre François Louys, who had the honor of pulling a tooth
better than any one else, so that on Saturdays many country folks
having toothache came to him to have them pulled out, which he did very
dexterously with a pelican, and when he had done, threw it on a bench
in his shop. Now he had a new servant, Picard, tall and strong, who
wanted to pull teeth like his master. It happened that whilst the said
François Louys was dining, a villager wanting a tooth pulled, Picard
took his master’s instrument and tried to do like him, but instead of
taking out the bad tooth, he knocked and tore out three good ones for
him, who, feeling great pain and seeing three teeth out of his mouth,
began to cry out against Picard, but he, to make him hold his peace,
told him not to say a word about it and not to shout so, because if his
master came he would make him pay for three teeth instead of one. Now
the master, hearing such a noise, came out from table to know the cause
of it and the reason of the quarrel, but the poor peasant fearing the
threats of Picard and still more after enduring such pain being made
to pay a threefold fee by the said Picard, was silent, not daring to
reveal to the master this fine piece of work of the said Picard; and
thus the poor bumpkin went away, and for one tooth that he had thought
to have pulled, he carried away three in his pouch and the one that
hurt him in his mouth.”

[308] For which reason I advise those who would have their teeth pulled
to go to the older tooth-pullers, and not to the younger ones who will
not yet have recognized their shortcomings.”

[309] An old French word meaning perhaps hippopotamus.

[310] Jacobi Hollerii medici parisiensis omnia opera practica, Genevæ,
1635, lib. ii, p. 117, et seq.

[311] Blandin, Anatomie du système dentaire, Paris, 1836, p. 25.

[312] Hoann Jac. Weckerus, medicinæ utriusque syntaxes, ex Græcorum,
Latinorum, Arabumque thesauris collectæ, Basilea, 1576.

[313] Donati Antonii ab Altomari medici ac philosophi neapolitani Ars
Medica, Venetiis, 1558, cap. xli, p. 190.

[314] Collezione d’osservazioni e riflessioni, vol. iii, oss. 84, p.
374.

[315] Hieronymi Capivacci Patavini opera omnia, Venetiis, 1617, edit.
sexta, lib. i, cap. liii; de affectibus dentium, p. 515.

[316] Lib. ii, cap. v, de lue venerea, p. 712.

[317] Petri Foresti, Alcmariani, opera omnia quatuor tomis digesta,
Rothomagi, 1653.

[318] Histoire de l’anatomie et de la chirurgie, Paris, 1770.

[319] Hémard has omitted translating this passage, probably because he
did not well understand it.

[320] [For a fuller review of this author see A Dental Book of the
Sixteenth Century, by Julio Endelman, Dental Cosmos, 1903, vol. xlv, p.
39.—E. C. K.]

[321] Hieronymi Fabricii ab Aquapendente opera chirurgica, Lugduni
Batavorum, 1723, cap. xxxii, p. 451.

[322] Cap. xxxiii, p. 455.

[323] Cap. xxxiv, p. 456; _de instrumentis extrahendis dentibus
idoneis_.

[324] Cap. xxxv, p. 457.

[325] Cap. xxx, de gingivarum chirurgia, p. 450.

[326] Joannis Heurnii Ultrajectini de morbis oculorum, aurum, nasi,
dentium et oris, liber Raphelengii, 1602, cap. xi, de dentium et oris
passionibus, p. 79.

[327] De aureo dente maxillari pueri Silesii, Lipsiæ, 1595.

[328] Martini Rulandi, Nova et in omni memoria inaudita historia de
aureo dente, Francofurti, 1595.

[329] Liddelius, Tractatus de dente aureo pueri Silesiani, Hamburg,
1626.

[330] [In the introductory portion of Liddell’s work on the “Golden
Tooth” is published a number of letters bearing on the case, among
others one which gives rather a circumstantial account of the
imposture, and of which the following is a translation:

“Herr Balthazer Caminæus sends Greeting:

“For your letter, most kind Herr Doctor Caselius, in which you
explicitly desired me to thank (my) colleagues for their good wishes,
‘wedding wishes,’ and to inform you as to the ‘Golden Tooth,’ I have
long been in debt to you—not that I intended to leave your letter
unanswered, but because no messengers presented themselves. Now that
I have found one, I announce that I have obeyed your commands. As for
the ‘Golden Tooth,’ I ought not to hide from you that we have more
than once marvelled at your shrewdness, in that you are so anxious to
ascribe the devices of wickedness and the tricks (fakes) of cunning
to Nature. For it was no portent, only a deception and pure cheat, so
that unless some Lemnian (Prometheus or Vulcan) should come to their
aid, these acute authors will, nay, already are, a by-word to those
who are more cautious and not so prone to believe. For the ‘Golden
Toothed’ boy, according to the account brought thither by many persons,
both by letter and oral report, some of whom had themselves seen
this wonder, hailed from a village near Schwidnitz in Silesia, and
had been so trained by his swindling father or master, that, at his
will, whenever in any assembly of men, some very simple and illiterate
persons desired to see the tooth and had paid the fee, for the rascals
made great gains, he would open his mouth wide and allow himself to be
touched. But if educated men and those who seemed likely to make more
careful scrutiny and experiment on any point, presented themselves,
he contorted his countenance, remained silent, and simulated a kind
of madness, the idea being that he permitted himself to be examined
at stated times only when the conditions allowed. Now, the tooth was
covered with a plate, lamina (or layer), skilfully wrought of the best
gold, and the gold was let down so deep into the gum that the cheat
was not observed. However, as the plate was sometimes rubbed with a
touch-stone as a test and was daily worn down by chewing, the real
tooth at last began to appear. Of this fact a certain nobleman got an
inkling, came to the place pretty drunk, and demanded that the tooth
should be shown him, when the young fellow, at his master’s word, kept
silent, the nobleman struck his dagger into the boy’s mouth, wounding
him so badly that the aid of a surgeon had to be called, and so the
deception was fully exposed.

“Thus the Herr Baron Fabianus, in Crema, at present Rector Magnificus
of our University, told me the story in full, and those inhabitants of
the place who have scholarly tastes maintain it to a man. The author
of the fraud, if I remember aright, was said to have taken refuge in
flight, the boy to be in chains.

“Our Pelargus, who is a native of Schwidnitz, can inform you more
fully. I have often heard from him the same facts which I am writing.
Farewell, and laugh in safety as much as you please at those sagacious
authors.

“FRANKFORT, December 31, 1595.”

Elsewhere it is stated that the boy who was the possessor of the
“Golden Tooth” was born December 22, 1586. As Horst’s Treatise appeared
in 1595, the Silesian boy was probably not over seven or eight years of
age. We also find that the “Golden Tooth” was a lower molar, and upon
the left side, and further, that there was no molar posterior to it.—E.
C. K.]

[331] Illustrious Father, do not believe too much in the
color.—[Virgil, Ec. ii, 16.]

[332] Joh. Stephani Strobelbergeri, thermiatri cæsarei emeriti,
etc., de dentium podagre, seu potius de odontagra, doloreve dentium,
tractatus absolutissimus, in quo, tam doloris istius mitigandi
rationes, quam dentium sine et cum ferro artificiose extrahendorum
varii modi, theoretice ac practice proponuntur, in medicorum ac
chirurgorum quorumvis gratiam. Lepsiæ, 1630.

[333] In Latin, _gutta_, that is, drop.

[334] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 422.

[335] Geschichte der Zahnheilkunde, p. 101.

[336] Arnauld Gilles, La fleur des remèdes contre le mal des dents,
Paris, 1622.

[337] Remèdes contre le mal des dents, Paris, 1633.

[338] Sprengel, Geschichte der Chirurgie, Part II, p. 293.

[339] Guilhelmi Fabricii Hilandi opera omnia, Francofurti ad Moenum,
1646, Centuria I observatio xxxviii, p. 33.

[340] Cent. iv, obs. xxi, p. 302.

[341] The most important of Fabricius Hildanus’ works consists of six
_centuriæ_ (hundreds) of remarkable cases, published by the author in
successive epochs, and which were afterward reunited under the title of
_Observationum et curationum chirurgicarum centuriæ sex_.

[342] Cent. v, obs. xxvii, p. 406.

[343] G. F. Hildani, opera omnia, Epist. ad J. Rheterium, p. 1010.

[344] Joannis Sculteti, Ulmensis, armamentarium chirurgicum,
Francofurti, 1666, Plates X, XI, XII, XXXII.

[345] Giovanni Battista Montano (1488 to 1551), of Verona, Professor of
Medicine at Padua.

[346] It is marvellous that an intelligent physician should have lent
faith to such a story, related, too, by such a woman, never reflecting
that the daily use of sulphuric acid for the space of thirty years,
that is, about 11,000 applications, instead of curing and beautifying
bad teeth, would certainly rather have had the effect of totally
destroying the denture of even a mastodon.

[347] Lazari Riverii, opera medica omnia, Genevæ, 1737; Praxeos medicæ
liber sextus, cap. i; De dolore dentium, cap. ii; De dentium nigredine
et erosione.

[348] Nicolai Tulpii, Amstelodamensis, Osservationes medicæ,
Amstelodami, 1685, lib. i, cap. xxxvi, p. 68; cap. xlix, p. 90.

[349] Sprengel, Geschichte der Chirurgie, vol. ii, pp. 294, 299.

[350] Sprengel, op. cit., p. 297.

[351] Blandin, Anatomie du système dentaire, Paris, 1836, p. 26.

[352] Blandin, op. cit., p. 27; Portal, Histoire de l’anatomie et de la
chirurgie, Paris, 1770, vol. iii, p. 495.

[353] Blandin, op. cit., p. 26; Portal, op. cit.

[354] Totus dens primum inclusus est folliculo seu membrana tenui ac
pellucida non secus ac granum in arista.

[355] Bouillet, Précis d’histoire de la médecine, p. 221.

[356] Bouillet, op. cit., p. 222.

[357] Friderici Ruyschii observationum anatomico-chirurgicorum,
centuria, Amstelodami, 1691; Portal, op. cit., vol. iii.

[358] Portal, op. cit., vol. iii.

[359] A. C. Abbott, The Principles of Bacteriology, Philadelphia, 1905,
p. 19.

[360] Anatome ossium, Romæ, 1689.

[361] Portal, vol. iv, p. 111; Blandin, p. 28.

[362] Jean Guichard Duverney, Mémoire sur les dents, Paris, 1689.

[363] Blandin, op cit.; Portal, vol. iii, p. 495.

[364] Blandin, p. 31.

[365] On Some New Observations of the Bones and the Parts Belonging
to Them, London, 1691. The accurate description given by Havers of
the canals containing the nourishing vessels of the bone has caused
these canals to be known, even up to the present day, by the name of
“Haversian canals.”

[366] Portal, vol. iv, p. 134; Blandin, p. 31.

[367] De morbis acutis infantum, London, 1689.

[368] Sprengel, Geschichte der Chirurgie, vol. ii, p. 298.

[369] Meekren, Observationes medico-chirurgicæ, cap. xv, p. 84.

[370] Op. cit., cap. xxviii, p. 120.

[371] Sprengel, vol. ii, p. 298.

[372] Sprengel, loc. cit.

[373] Soolingen’s Manuale operatien der chirurgie, Amsterdam, 1684.

[374] Sprengel, op. cit., p. 300.

[375] Dissertation sur les dents, à Paris Chez Denys Thierry, MDCLXXIX.

[376] Portal, op. cit., vol. iii, p. 361.

[377] Purmann’s Wundarzenei, Halberstadt, 1684, Part I, chap. xxxii.

[378] New and very useful practice of all that which belongs to the
diligent barber; composed by Cintio d’Amato.

[379] The art of beautifying the human body was comprised by the
ancients among the many and various parts of the medical art, under
the name of _decorative medicine_. The barbers considered themselves
members of the medical class, as practitioners of decorative medicine
and in a certain degree also of surgery.

[380] In a chapter entitled “Of the Excellence and Nobility of the
Barber’s Office,” Cintio d’Amato speaks of several barbers of that
period, who were in great repute by their writings, or by the high
offices with which they were invested, or by honors received from
princes and sovereigns. Among the writers, Tiberio Malfi, barber of
Montesarchio, deserves mention; he published, in 1626, a book entitled
The Barber, written in excellent style, and giving proof of solid
literary culture, and of much erudition. This work treats of all that
concerns the barber’s art (decorative medicine, bleeding, etc.). In it,
however, there is absolutely nothing about the treatment of the teeth
or their extraction; and this constitutes a valid confirmation of our
own opinion, that is, that the dental art was not at that time in any
way in the hands of the barbers.

[381] Portal, vol. iii, p. 618.

[382] Antonii Nuck operationes et experimenta chirurgica, Lugduni
Batavorum, 1692.

[383] Caroli Musitani opera omnia, pp. 121 to 128, Venetiis, 1738.

[384] J. Drake, Anthropologia nova, London, 1707.

[385] J. M. Hoffmann, Disquisitiones anatomico-pathologicæ, Altorf,
1713, p. 321.

[386] Probably through the nose.

[387] H. Meibomii de abscessum internorma natura et constitutione
discursus. Dresdæ et Lipsiæ, 1718, p. 114. (This edition was published
after the author’s death, which took place in 1700.)

[388] St. Yves, Nouveau traité des maladies des yeux, 1722, p. 80.

[389] Sprengel, Geschichte der Chirurgie, vol. ii, p. 301. Carabelli,
Systematisches, Handbuch der Zahnheilkunde, vol. i, p. 60.

[390] This work was published in 1690.

[391] Here one also verifies the absurdities pronounced by those who,
not being dentists, but merely general practitioners or surgeons, still
risk speaking on dental subjects.

[392] Dionis, Cours d’opérations de chirurgie, Paris, 1716, p. 507 and
following.

[393] [The Dresden edition of 1710 of Guillemeau’s work contains
no reference to the artificial tooth composition as mentioned by
Dionis.—E. C. K.]

[394] Carmeline was a most able surgeon-dentist. We learn this from a
passage in Pierre Fauchard’s book (Le Chirurgien Dentiste, Préf., p.
13). As we shall see, the author praises him very highly and laments
his not having written any book making known the results of his long
experience.

[395] Sprengel, Geschichte der Chirurgie, vol. ii, p. 305.

[396] Traité complet des opérations de chirurgie, par Mons. de
Lavauguyon, Paris, 1696, p. 644.

[397] Der beym aderlassen und Zahn-ausziehen Geschickten Barbiergesell,
Leipsic, 1717.

[398] De dentium dolore, Altdorf, 1711.

[399] Schelhammer wrote a dissertation “on the cure of toothache by
touch,” _De odontalgia tactu sananda_, Kiel, 1701. In the same year and
in the same city, another pamphlet, by B. Krysingius, was written on
the same subject. (See Crowley, Dental Bibliography, p. 13.)

[400] Sprengel, op. cit., vol. ii, p. 311.

[401] Joseph Linderer, Handbuch der Zahnheilkunde, vol. ii, p. 129.

[402] Sprengel, op. cit., vol. ii, p. 367; Carabelli, op. cit. p. 65.

[403] Sprengel, op. cit., vol. ii, p. 310.

[404] Sprengel, op. cit., vol. ii, p. 309.

[405] Sprengel, loc. cit.

[406] Sprengel, op. cit., vol. ii, p. 310.

[407] Le Chirurgien Dentiste ou Traité des Dents, où l’on enseigne
les moyens de les entretenir propres & saines, de les embellir, d’en
réparer la perte & de remédier à leurs maladies, à celles des Gencives
& aux accidens qui peuvent survenir aux autres parties voisines des
Dents. Avec des Observations & des Réflexions sur plusieurs cas
singuliers. Ouvrage enrichi de quarante-deux Planches en taille douce.
Par Pierre Fauchard, Chirurgien Dentiste à Paris.

[408] Deuxième édition, revue, corrigée et considérablement augmentée,
à Paris, 1746.

[409] _Experts pour les Dents._ This was probably the title which was
bestowed in the relative diploma on those who passed the examination in
question.

[410] We have not been able to find any work in which particular
records of Fauchard’s life are given, and hence do not know to which of
the other arts he had dedicated himself.

[411] Vol. ii, p. 366.

[412] Page 21.

[413] Pages 73, 74.

[414] Vol. i, p. 131.

[415] Page 142.

[416] De la génération des vers dans le corps de l’homme, Paris, 1700.

[417] Vol. i, p. 143.

[418] Page 149.

[419] Chap. ix, p. 154.

[420] Dames illustres, vie d’Elizabeth, p. 179.

[421] Page 161.

[422] Page 165.

[423] Page 167.

[424] Liquid ammonia.

[425] Subcarbonate of ammonia.

[426] Chap. x, p. 169.

[427] Page 407.

[428] Chap. xii, p. 183.

[429] Chap. xiii, p. 185.

[430] Chap. xiv, p. 194.

[431] Chap. xv, p. 205.

[432] Chap. xvi.

[433] Chap. xvii to xxi.

[434] Chap. xxiii, p. 282.

[435] Page 330.

[436] Page 331.

[437] Page 368.

[438] Page 370.

[439] Page 383.

[440] Page 376.

[441] Chap. xxxi, p. 391.

[442] Page 397.

[443] Page 411.

[444] Page 418.

[445] Chap. xxxviii, p. 481.

[446] Vol. ii, chap. ii.

[447] Chap. iii.

[448] Chap. iv.

[449] Chap. v.

[450] Vol. ii, p. 71.

[451] Vol. ii, p. 77.

[452] Vol. ii, p. 78.

[453] Ibid.

[454] Chap. vii.

[455] Vol. ii, p. 80.

[456] Vol. ii, chap. viii, p. 87.

[457] Chap. ix, p. 117.

[458] Speaking of transplantation, he says: “On voit par des
expériences journalières que des dents transplantées d’un alvéole dans
l’alvéole d’une bouche différente se sont conservées plusieurs années
fermes et solides sans recevoir aucune altération, et servant à toutes
les fonctions auxquelles les dents sont propres.” (Vol. ii, p. 187.)

[459] Page 188.

[460] Vol. ii, p. 192.

[461] Vol. ii, chap. xiii, p. 215.

[462] Vol. ii, pp. 217 to 224.

[463] Vol. ii, p. 225.

[464] Vol. ii, p. 229.

[465] Chap. xvi, pp. 252, 255.

[466] Vol. ii, chap. xvii, p. 260.

[467] Vol. ii, chap. xxiv, p. 339.

[468] Vol. ii, p. 340.

[469] Vol. ii, p. 353.

[470] Jean de Diest, An hæmorrhage ex dentium evulsione chirurgi
incuria lethalis? Paris, 1735. David Vasse, Hæmorrhagia ex dentium
evulsione, chirurgi incuria lethalis, Paris, 1735.

[471] M. Bunon, Sur un prejugé très-pernicieux, concernant les maux de
dents qui surviennent aux femmes grosses, Paris, 1741.

[472] M. Bunon, Essai sur les maladies des dents, Paris, 1743.
Expériences et démonstrations pour servir de suite et de preuves à
l’essai sur les maladies des dents, Paris, 1746.

[473] Abhandlung von Zahnkrankheiten, etc., Strassburg, 1754.

[474] A Practical Treatise upon Dentition or the Breeding of the Teeth
in Children.

[475] Essai d’Odontotechnique, ou Dissertation sur les Dents
Artificielles.

[476] Sprengel, Part ii, p. 319.

[477] Journal de Médecine, 1756.

[478] L. H. Runge. De Morbis sinuum ossis frontis, maxillæ superioris,
etc., Rintel, 1750.

[479] Sprengel, Part ii (?), p. 322.

[480] Nouveaux éléments d’Odontologie, contenant l’anatomie de la
bouche, ou la description de toutes les parties qui la composent, et
de leur usage; et la pratique abregée du dentiste, avec plusieurs
observations, par M. Lécluse, Chirurgien dentiste de Sa Majesté le Roi
de Pologne, etc., Paris, 1754 (vol. in 12mo of pages viii-222 with six
plates).

[481] Abhandlung von den Zähnen des menschlichen Körpers und deren
Krankheiten, 1756.

[482] Geist-Jacobi, p. 164.

[483] Die eingebildeten würmer in Zähnen, Regenburg, 1757.

[Schaffer’s publication is of considerable interest in that his
illustration here reproduced exhibits one of the devices somewhat
generally employed for the eradication of dental worms as a cure for
toothache. In the title of his work Schaffer describes himself as
Protestant preacher at Regensburg, member of the Royal Society of
Fine Arts at Göttingen, of the Royal Society of Science at Duisberg,
honorary member of the Fine Arts at Leipsic.

[Illustration: Fig. I., Fig. II., Fig. III., Fig. IV., Fig. V.,
Fig. VI., Fig. VII., Fig. VIII., Fig. IX., Fig. X., Fig. XI., Fig. XII.]

The several details of the plate are designated as follows:

Fig. I. The supposed worms, with single and double tails, or actually
seed buds of the henbane driven out by heat, natural size.

Fig. II. Kidney-shaped seed of the henbane, natural size, without seed
buds.

Fig. III. Another such seed, natural size, with the pith being driven
out in bow-shape.

Figs. IV and V. Slightly magnified supposed entrails of the tooth
worms, actually the inner basis substance for the development of the
seed lobes.

Fig. VI. Portion of the skin and driven out supposed entrails of the
tooth worms, strongly magnified: (_aa_) skin still attached; (_b_)
supposed entrails.

Fig. VII. Seed same as Fig. II, magnified: (_a_) external pellicle;
(_b_) seed bud.

Fig. VIII. Seed of Fig. III, magnified: (_aa_) external pellicle; (_b_)
node; (_c_) seed bud driven out in bow-shape.

Figs. IX, X, and XI. Three kinds of supposed tooth worms, magnified;
the lettering corresponds in all three: (_a_) head; (_b_) brown spot
or mouth; (_c_) body; (_d_) apparent opening or anus; (_ee_) single or
double tail; (_ff_) brown spot of the tail; also an apparent opening.

Fig. XII. Representation of the utensils and the mode in which they
are arranged during the application of the supposed remedy against
tooth worms: (_a_) earthen pot; (_b_) opening visible on one side;
(_c_) opening in the bottom; (_dd_) iron passing through the two side
openings, on which the wax balls (containing henbane seeds) are laid
inside the pot; (_e_) smoke arising through the opening in the top,
which is directed into the mouth; (_ff_) bowl of water in which the pot
is set, into which the supposed worms fall and in which they are found
after the cure.

It would seem not at all improbable that the inhalation of vapors
arising from heated henbane seeds might in some cases, _e.g._, of
odontalgia from pulpitis, produce a sedative effect by the action of
the hyoscyamine given off. Assuming that the method possessed even a
slight therapeutic value, that factor in connection with the apparently
tangible evidence of the existence of tooth worms which it afforded to
the ignorant, makes the method a most interesting example of the way in
which superstition and ignorance about medical matters are kept alive
and sustained by a very slight increment of truth.

Another interesting reference to the use of henbane seeds for the
cure of toothache by fumigation as found in an old Saxon manuscript
of the ninth or tenth century, a translation of which is published in
Leechdoms, Worthcunning, and Starcraft of Early England, vol. ii, p.
51, a collection of documents illustrating the history of science in
England before the Norman conquest, published under direction of the
Master of the Rolls. The reference is as follows:

“For tooth wark, if a worm eat _the tooth_, take an old holly leaf and
one of the lower umbels of hartwort and the upward _part_ of sage,
boil two doles (that is, two of worts to one of water) in water, pour
into a bowl and yawn over it, then the worms shall fall into the bowl.
If a worm eat the teeth, take holly rind over a year old, and root of
Carline thistle, boil in so hot _water_! Hold in the mouth as hot as
thou hottest may. For tooth worms, take acorn meal and henbane seed
and wax, of all equally much, mingle _these_ together, work into a
wax candle and burn it, let it reek into the mouth, put a black cloth
under, then will the worms fall on it.”—E. C. K.]

[484] Recueil périodique d’observations de Médecine, Chirurgie, etc.,
par Vandermonde, Paris, 1757, Tome vii, p. 256.

[485] Recherches et observations sur toutes les parties de l’art du
dentiste, 2 vols., Paris, 1757.

[486] Sur les dépôts du sinus maxillaire.

[487] Soins faciles pour la propreté de la bouche et pour la
conservation des dents, Paris, 1759.

[488] Vol. x, pp. 47 to 148.

[489] Traité des dépôts dans le sinus maxillaire, des fractures et des
caries de l’une et de l’autre mâchoire, Paris, 1761.

[490] Essais sur la formation des dents, comparée avec celle des os,
suivis de plusieurs expériences tant sur les os que sur les parties qui
entrent dans leur constitution, Paris, 1766.

[491] Traité des maladies et des opérations réellement chirurgicales
de la bouche et des parties qui y correspondent, suivi de notes,
d’observations, et de consultations interessantes, tant anciennes que
modernes, 2 vols. 8vo, Paris, 1778.

[492] Réflexions et éclaircissements sur la construction et les usages
des rateliers complets et artificiels.

[493] Die Zahnheilkunde, Erlangen, 1851, p. 398.

[494] Von der Wirkung der elektrischen Erschütterung im Zahnweh.

[495] Geist-Jacobi, p. 165.

[496] Neue Versuche zu Curirung der Zahnschmerzen vermittelst eines
magnetischen Stahles, Königsberg, 1765.

[497] F. E. Glaubrecht, De odontalgia, Argentorati, 1766.

[498] Journal de Médecine, 1767, p. 265.

[499] Jos. G. Pasch, Abhundlung aus der Wandarznei von den Zähnen,
etc., Wien, 1767.

[500] Th. Berdmore, A treatise on the disorders and deformities of the
teeth and gums, London, 1768.

[501] Einleitung zur nöthigen Wissenschaft eines Zahnarztes, Wien, 1766.

[502] Abhandlung von der Hervorbrechlung der Milchzähne, Wien, 1771.

[503] J. Linderer, vol. ii, p. 431.

[504] Geist-Jacobi, p. 166.

[505] Gedanken über das Hervorkommen und Wechseln der Zähne, 1768.

[506] Carabelli, p. 91.

[507] A treatise on the disorders and deformities of the teeth and
gums, London, 1768.

[508] See The Rise, Fall, and Revival of Dental Prosthesis, by B. J.
Cigrand, p. 148.

[509] Carabelli, p. 91.

[510] Carabelli, p. 93; Lemerle, Notice sur l’histoire de l’art
dentaire, p. 117.

[511] J. Aitkin, Essays on several important subjects in surgery,
London, 1771.

[512] Sprengel, vol. ii, p. 348.

[513] Sprengel, p. 350.

[514] Bromfield, Chirurgical observations and cases, London, 1773.

[515] Le dentiste observateur, Paris, 1775.

[516] Vollständige Anweisung zum Zahn-ausziehen, Stendal, 1782.

[517] Theden, Neue Bemerkungen und Erfahrungen, Berlin, 1782, part
second, p. 254.

[518] J. van Wy, Heelkundige Mengel stoffen, Amsterdam, 1784.

[519] Journal de Médecine, 1791, tomes 86, 87.

[520] Sprengel, p. 356 to 357.

[521] Odontologia, ossia Trattato sopra i Denti.

[522] Benjamin Bell, System of Surgery, 1783 to 1787, vol. iii.

[523] Medical Transactions of the College of Physicians of London,
1783, vol. iii, p. 325.

[524] Memoirs of the London Medical Society, 1787, vol. i.

[525] August Gottlieb Richter, Anfangsgründe der Wundarzneikunst, vol.
ii (1787) and vol. iv (1797).

[526] Praktische Darstellung aller Operationen der Zahnarznekunst,
Berlin, 1803 and 1804.

[527] Chapter xlii.

[528] Uebersicht der Chirurgischen Instrumente.

[529] Ploucquet, Primæ lineæ odontitidis, sive inflammationis ipsorum
dentium, Tubingæ, 1791; Kappis, Primæ lineæ odontitidis, etc., Tubingæ,
1794.

[530] Storia naturale di un nuovo insetto, Firenze, 1794.

[531] Der anfrichtige Lahnarzt.

[532] Without comment!

[533] Principia systematis chirurgiæ hodiernæ.

[534] The anatomical fact alluded to by the author, far from presenting
itself very often, as he says, is of rare occurrence, and cannot be
held in account for establishing a general operative rule.

[535] Sprengel, pp. 372, 373.

[536] Hirsch, Praktische Bemerkungen über die Zähne und einige
Krankheiten derselben, Jena, 1796.

[537] Sprengel, pp. 376, 377.

[538] For all that regards Bunon’s life and writings we have availed
ourselves of the excellent historical work of A. Barden, “Un
précurseur: Bunon,” a communication presented to the Geneva Session of
the International Dental Federation (August, 1906).

[539] Expériences et démonstrations, p. 13.

[540] Ibid., p. 60.

[541] Lettre sur la prétendue dent œillère.

[542] Sur un préjugé très pernicieux, concernant les maux de dents qui
surviennent aux femmes grosses.

[543] Essai sur les maladies des dents, où l’on propose les moyens de
leur procurer une bonne conformation dès la plus tendre enfance, et
d’en assurer la conservation pendant tout le cours de la vie.

[544] Expériences et démonstrations, avertissement, p. xix.

[545] Expériences et démonstrations faites à l’Hôpital de la
Salptêrière et à St. Côme, en presence de l’Académie Royale de
Chirurgie, pour servir de suite et de preuves à l’Essai sur les
maladies des dents.

[546] Essay, p. 127.

[547] F. Maury. Traité complet de l’art du dentiste, d’après l’état
actuel des connaissances, 2 vols., Paris, 1828.

[548] Exposé de nouveaux procédés pour la confection des dents dites de
composition, par M. Dubois Faucou, Paris, 1808.

[549] Rapport sur les dents artificielles terro-metalliques, Paris,
1808.




INDEX.

  A

  Abbott, A. C., 237

  Abulcasis, 86, 125

  Abyssinia, negroes of, file incisors into points, 43

  Acoluthus, Johann, 240

  Acupuncture, 38

  Adamantius, 116, 117

  Advertisements, 245

  Ægina, Paul of, 219

  Æsculapius, 45, 46

  Ætius of Amida, 117, 170

  Age of animals judged by the teeth, Aristotle on, 62

  Aitkin, John, 317

  Alcock, James, 348

  Ali Abbas, 122

  Altomare, Donato Antonio, 200

  Alveolar pyorrhea, 96, 237

  Andromachus the Elder, 106, 113

  Andry, 269, 309

  Anesthetic, 149

  Antrum of Highmore, 186, 233, 249, 250, 257, 282, 304, 310, 311, 313,
    318, 320, 325, 330, 333

  Aphthæ, Celsus on, 84

  Apollonius, 92, 113

  Appolonia, Saint, 209

  Aquapendente, Fabrizio of, 207

  Arabians, 121

  Aranzio Giulio Cesare, 201

  Arcagatus, 77

  Archigenes, 65, 106, 113

  Arcoli, Giovanni of (Arculanus), 153, 168, 199

  Argelata, Pietro of, 151

  Aristotle, 53, 61, 64

  Arnemann, J., 331

  Arsenic, 35, 85, 122, 125, 138, 152, 157

  Asclepiades, 80

  Asklepiadi, priests of the temple of Æsculapius, 45, 46

  Astringent mouth washes, 97, 115, 116, 122, 153

  Atmospheric conditions, influence on dental maladies, 57, 116, 247

  Aurelianus, Celius, 46, 65, 113, 114

  Auzeki, Pierre, 317

  Avenzoar, 139

  Avicenna, 84, 123


  B

  Babylonians, treatment of sick by the, 18

  Bacteria, 237

  Barbers, 86, 130, 132, 139, 144, 159, 162, 166, 169, 188, 240, 242,
    243, 244, 245, 255

  Barden, A., 340

  Bartholin, Thomas, 232, 235

  Bass, Heinrich, 259

  Bell, Benjamin, 324

  Belzoni, G. B., on Egyptian dentistry, 27

  Benedetti, Alessandro, 157, 187

  Benedictus of Faenza, 203

  Berdmore, Thomas, 315, 316

  Bertin, J., 304

  Bible, reference to teeth in the, 32, 33

  Bidloo, Gottfried, 239

  Birds, teeth of, 63

  Blum, Michael, 164

  Blumenthal, K. A., 337

  Bodenstein, Adam, 205

  Bordenare, Thomas, 313

  Bourdet, 309

  Brahmins, care of the teeth among the, 42

  Bridge work, 297
    Etruscan attempts at, 76, 101

  Bromfield, W., 318

  Brunner, Adam Anton, 315

  Bruno of Longobucco, 140

  Bruschi, Etruscan dental appliances in Museum of Count, 73

  Bücking, 321

  Bunon, Robert, 301, 337


  C

  “Calendar of dentition,” 315

  Callisen, Heinrich, 333

  Camindus, Balthasar, 215

  Campani, Antonio, 323, 327

  Capivacci, Gerolamo, 201

  Carabelli, 157, 317, 321

  Carbonate of lime, ancient dentifrice mentioned by Pliny, 94

  Caries, dental, 24, 110, 122, 147, 251, 269, 319, 335

  Carmeline, 253, 261, 283

  Cascellius, first dentist mentioned by name, 102

  Castellani collection, Rome, Etruscan appliances in, 76

  Catullus, 97

  Cauteries, dental, 328

  Cauterization, 25, 40, 85, 107, 111, 118, 126, 138, 152, 212, 227,
    246, 289, 310

  Caylus, 99

  Celius Aurelianus, 46, 65, 113

  Celsus, 65, 80, 83, 84, 85, 86, 87, 102

  “Cement” filling, 122, 240
    of Guillemeau, 253

  Channing, John, 126

  Charlatans, 159, 162, 277, 310, 316

  Chauliac, Guy de, 146

  Chemant, Nicholas Dubois de, 329, 344

  Chinese, anatomical notions of, 39
    dentistry among the, 34

  Chopart, 322

  Cigrand, 47, 68, 316

  Cintio d’Amato, 242

  Clasps, 303

  Clauder, Gabriel, 232

  Cleanliness of the teeth among the Romans, 97, 106, 107

  Coiter, Volcherus, 200

  Coition, toothache from, 35

  Cold applications, harmful to the teeth, 61

  Colombo, Matteo Realdo, 177

  Côme, Frère, 318

  Compressor of Foucou, 321

  Condamine, 314

  Corneto, museum of, Etruscan appliances in, 71, 72, 73

  Cos, temple of, medical records in, 18, 46, 48

  Courtois, 321

  Cowper, William, 234, 249

  Cremation among the ancients, 69

  Criton, 113

  Croce, Giovanni Andrea della, 201

  Cron, Ludwig, 255

  Crowley’s “Dental Bibliography,” 253, 256

  Crown, artificial, 296, 315
    gold, 217, 303

  Ctesias of Cydnus, 62

  Customs of primitive peoples, 42


  D

  Dabry, P. P., “La médecine chez les Chinois,” 34

  Dalli Osso, archeologist, 78

  Damocrates, Servilius, 106

  Daremberg, “Histoire des sciences médicales,” 80, 99

  De Lavauguyon, 253, 255

  Décorative medicine, 244

  Dekkers, Friederich, 241

  Delphi, temple of Apollo at, 46, 114

  Deneffe, “La prothèse dentaire dans l’antiquité,” 67, 75, 102

  Dental appliance, Etruscan, found at Tarquinii, 71
      near Teano, Italy, 79
      at Valsiarosa, 70
    art among the ancient Germans, 162
        the Etruscans, 67
        the Romans, 77, 102
      first beginnings of, 17
      practised by specialists in ancient Egypt, 25
    caries, 110, 122, 147, 251, 269, 319
    irregularities, 280, 290, 303, 320
    maladies given in Ebers’ papyrus, 21
    surgery not mentioned in Ebers’ papyrus, 25
    and surgical instruments of the Romans, 86
    terminology found in Vesalius, 176

  Dentateurs, 199

  Dentator, 144, 147

  Dentiduces, 226

  Dentifrices, 35, 38, 51, 87, 93, 94, 96, 97, 105, 112, 124, 141, 148,
    154, 247, 322

  Dentine, structure of, 237, 319

  Dentisculpia (toothpicks), 98, 226

  Dentispices, 219

  Dentist, the word itself, 102, 144
    Cascellius the first, 102

  Dentista, 144

  Dentistry, condition of, before Fauchard, 260
    in the middle ages, 121
    as a true specialty, 255, 263

  Dentists, examination of, 261, 339

  Dentition, “Calendar” of, 315
    third, 91, 143, 185, 199, 306

  Dentures, complete, 298, 313, 336
    porcelain, 344
    spring, 299, 300

  Deodato, Claudio, 224

  Desault, 322

  Deschapellement (uncrowning), 194, 204, 275

  Diemerbroek, 235

  Diest, Jean de, 301

  Dionis, Pierre, 251

  Dioscorides, 84

  Dissection prohibited by the Koran, 121

  Doctors’ shops in ancient Greece and Rome, 52

  Drake, James, 249

  Dubois de Chemant, Nicholas, 329, 344
    Foucou, 346, 347
    Jacques, 172

  Duchâteau, 344

  Duchemin, student of Fauchard, 260

  Dufour, 309

  Dupont, 223

  Duverney, Jean, 238


  E

  Ears and the teeth, 54, 56, 94, 228, 236, 250, 315

  Ebers’ papyrus, 19
    George, on dental art of Egyptians, 28

  Egypt, special doctors for the teeth in ancient, 26, 64

  Egyptians, dental art among the, 19, 67
    prescriptions of the, 21, 22, 23, 24

  Eighteenth century, 255

  Electricity, use of, for toothache, 314

  Elevator of Lécluse, 305

  Elevators, 133, 134, 305

  Enamel, artificial use of, 301, 310
    structure of dental, 238

  Endelman, Julio, 205

  English key, 257, 317

  Epilepsy, 169

  Epulis, 117, 118, 123, 127, 239, 251, 334

  Erasistratus, 65

  Erosion, dental, 302, 320, 337, 341

  Etruscans, dental appliances of, 70, 71, 72, 73, 74, 76
    art among the, 67, 70
    votive offerings of, 67

  Eustachius, Bartholomeus, 178, 204

  Examination of dentists, 261, 339

  “Experts pour les dents,” 261

  Extraction of teeth, 25, 45, 51, 64, 82, 86, 103, 108, 112, 114, 118,
      122, 124, 128, 137, 141, 151, 152, 158, 160, 193, 210, 222, 240,
      246, 252, 276, 292, 315, 321, 337
    death from, 65, 114, 137, 139
    of eye-teeth, 301, 339
    pain after, 112
    as a punishment, 139

  Eyes and the teeth, 54, 89, 168, 246, 301, 304


  F

  Fabrizio of Aquapendente (Fabricius), 207

  Fabry, Wilhelm (Fabricius Hildanus), 223

  Fallopius, Gabriel, 177

  Fauchard, Pierre, 255, 259

  Filing of teeth by people of India, 42
    by women of Sumatra, 43

  Filling of teeth, 122, 147, 150, 151, 155, 159, 164, 199, 208, 240,
    252, 256, 285, 309, 315, 320, 328

  Fingers, extraction of teeth with the, 64

  Fischer, Johann Bernhardt, 259

  Fistulæ, dental, 22, 140, 152, 201, 203, 224

  Fleurimond, 245

  Follicle, dental, 177

  Fontanella, Don Angelo, anecdote of, 104

  Fonzi, 347

  Forceps, cutting, 294
    extracting, 46, 52, 86, 87, 114, 131, 157, 167, 207, 211, 226,
      278, 292, 293, 325, 330, 334

  Foreest, Peter, 157, 202

  Foucou, 321, 346, 347

  Fracture of lower jaw, 59, 137, 190, 342

  Fractures and dislocations, Celsus on, 87

  Fredericus, Rinaldus, 235

  Frogs, use of, for dental maladies, 95, 107, 125, 138


  G

  Gaddesden, John, 140

  Gagliardi, Domenico, 238

  Gaillardot, Dr., researches in necropolis of Sidon, 29

  Galen, Claudius, 52, 63, 65, 80, 82, 108, 109, 121

  Garengeot, Croissant de, 257

  Gebauer, Ernst Ferdinand, 259

  Geist-Jacobi, 23, 59, 78, 102, 114, 157, 163, 166, 169, 220, 306,
    311, 314

  Genga, Bernardo, 235

  Gerauldy, Fr. A., 302, 338

  Gerbi, Ranieri, 332

  “German key,” 257

  Germans, dentistry among the, 161

  Ghent, University of, Etruscan appliance in museum of, 74

  Gilles, Arnauld, 222

  Gingivitis, treatment of, by Galen, 111

  Giovanni of Arcoli, 153, 168, 199
    of Vigo, 159

  Glaubrecht, F. E., 314

  Gold appliances of the Etruscans, 71
      of the Romans, 101
    bands, mentioned in law of the Twelve Tables, 77
    crown, 217, 303
    fillings, 29, 156, 159, 164, 208, 252, 256, 285, 309, 315, 316, 329
    teeth, substitution of, in Java, 42
        in Macassar, 43
    wire, use of, 30, 87, 135, 146

  Golden tooth, story of the, 214

  Göritz, Johann Adolph, 258

  Gout, 219

  Gräbner, C. A., 315

  Grafenberg, Johann Schenck von, 202

  Greek doctors in Rome, 79

  Greeks, ancient appliance of the, 60
    dentistry among the ancient, 45, 77

  Griffon, J., 225

  Guerhard, 344

  Guillemeau, Jacques, 253

  Gums, diseases of, according to Celsus, 84

  Guy de Chauliac, 142


  H

  Haller, Albert von, 166

  Harris, Walter, 239

  Havers, Clopton, 239

  Hebrews, dental affections rare among the ancient, 32

  Hecker, A. F., 331

  Heister, Lorenz, 255

  Hémard, Urbain, 194, 203

  Hemorrhage after extraction, 229, 231, 258, 301, 306, 321, 335
    of the gums, 115, 157

  Henkel, 318

  Heraclides of Tarentum, 65, 113

  Herodotus, 18, 25, 64

  Herophilus, 65

  Heurmann, Georg, 305

  Heurn, Johann (Heurnius), 175, 212

  Hieratic characters, Ebers’ papyrus in, 20

  Highmore, Nathaniel, 186, 232

  Hindostan, care of the teeth by the natives of, 42

  Hindu dentists, primitive type of dental prosthesis by, 30

  Hippias, anecdote from Herodotus on, 26

  Hippocrates, 17, 18, 47, 108

  Hirsch, Friedrich, 334

  Histology, 236

  Hoffmann, Johann, 249

  Homer, refers to sons of Æsculapius, 45

  Horace, false teeth mentioned in satire of, 102

  Horst, Jacob, 214

  Houllier, Jacques, 199

  Hunter, John, 316, 318, 324

  Hurlock, Joseph, 303

  Hygiene of the mouth, 80, 87, 92, 106, 107, 127, 144, 153, 196, 230,
    248, 266, 310, 330, 341

  Hypoplasia, dental, 341


  I

  Immunity from toothache, 221

  Implantation, 311

  India, people of, customs relating to the teeth of, 42

  Ingolstetter, Johann, 215

  Ingrassia, Gian Filippo, 177

  Instruments, 52, 128, 144, 151, 157, 167, 192, 201, 206, 207, 211, 226,
       227, 241, 279, 284, 331
    for extracting, 321, 323, 327
    of gold, 251
    of the Romans, 86

  Iron, tooth of, 232

  Irregularities, dental, 280, 290, 303, 320, 342


  J

  Jacobaens, Oligerus, 231

  Java, substitution of gold teeth by people of, 42

  Joachim, Heinrich, translation of Ebers’ papyrus by, 19

  Jourdain, 311

  Junker, Johann, 257


  K

  Key with changeable hooks, 326
    English, 257, 317
    of Garengeot, 257

  Kircher, 217

  Kirk, E. C., 28, 30, 43, 82, 83, 84, 96, 115, 118, 138, 164, 216,
    307, 308

  Klaerich, F. W., 314

  Knights of the Teutonic Order, 163

  Koran, dissection prohibited by the, 121


  L

  Lancets, gum, 195

  Lancing of the gums, 198, 239, 257, 265, 303, 304, 312, 321, 322,
    324, 331, 334, 336

  Lanfranchi, 140

  Lavini, 301

  Law of the Twelve Tables, 69, 77, 78

  Le Hire, 265

  Lead for filling teeth, 285, 309, 320, 335

  Lécluse, 257, 305

  Leeuwenhoek, Antoni van, 237

  Lemerle, 317

  Lemorier, 313

  Lentin, L. B., 314

  Lentisk wood, toothpicks of, 98

  Lepsius, opinion of, on Ebers’ papyrus, 20

  Lettson, 329

  Leucorrhea, 58

  Leyden, Lucus van, 213

  Liddel, Duncan, 216

  Ligatures, Abulcasis on, 135

  Linderer, Joseph, 27, 42, 98, 139, 162, 181, 220, 257, 313

  Loder, 257

  Longevity, influence of number of teeth on, 58

  Lusitanus, Amatus, 229

  Luxations of jaw, 88


  M

  Magnet, use of, for toothache, 314

  Major, Daniel, 240

  Malpighi, Marcello, 236

  Manteville, 269

  Marcellus, 115

  Martial, epigrams of, 98

  Martin, Benjamin, 241

  Martinez, Francisco, 205

  Massage, ancient practice of, 114

  Massez, 313

  Maxillary sinus, 186, 233, 249, 250, 257, 282, 304, 310, 311, 313,
    318, 320, 325, 330, 333

  Mechanical dentistry, first work on, 303

  Medicine in ancient Eygpt, 19
    decorative, 244

  Medicine, most ancient work on, 19
    sacerdotal, 17
    special branches of, 103

  Meibom, Heinrich, 250

  Mercury, harmful effects of, 158, 202, 230

  Mesue the younger, 137, 164

  Mice, use of, for dental maladies, 36, 50, 93, 94, 97

  Microörganisms, 237

  Microscopes, 236, 237, 269

  Middle ages, dentistry in the, 121

  Minadous, Thomas, 232

  Mineral teeth, 254, 329, 344, 348
    waters of Carlsbad, 220

  Models in dental prosthesis, 241, 306

  Modern times, dentistry of, 161

  Molinetti, Antonio, 234

  Monavius, Petrus, 205

  Monkey, dental system of, 63

  Montagnana, Bartolomeo, 152

  Montanus, Giovanni Battista, 230

  Moraine’s verses on Fauchard, 260

  Motte, G. M. de la, 258

  Mouth mirror, 344
    washes, 55, 97, 111, 265, 274

  Mouton, 303, 309

  “Moxa,” use of, by Chinese, 40

  Mummery, J. R., 25, 29

  Mummies, Egyptian, 27, 28, 49

  Murphy, Joseph, 42

  Museum of antiquities, Dresden, 162
    (archæological) of Athens, 52
    (archæological) of Florence, 70
    of Corneto, 71, 72, 73
    of Count Bruschi, 73
    of Pope Julius, Rome, 70, 101
    of University of Ghent, 74

  Musitano, Carlo, 247


  N

  Nasal prosthesis, 256

  Necrosis of lower jaw, 241
    of the teeth, 56

  Nerves of teeth, 109

  Neuralgia, 224

  Nicaise, E., 142

  Nobile, Luigi, 78

  Nomenclature, 88, 318

  Nuck, Anton, 245

  Number of teeth, 59, 109


  O

  Obturators, 197, 198, 211, 301, 310

  Oceanica, dyeing the teeth black by races of, 42

  Odontagogon, 46, 65, 114

  Odontagra, 64

  Odontalgia, 34, 38, 51, 92, 95, 103, 106, 107, 109, 111, 113, 124,
    137, 141, 145, 150, 152, 154, 158, 190, 202, 219, 220, 221, 228,
    247, 248, 271, 283, 314, 332

  Odontitis, 331

  Operative dentistry, Fauchard on, 284

  Oribasius, 117

  Orvieto, 69, 74


  P

  Papyrus of Ebers, 19

  Paracelsus, 176

  Paré, Ambroise, 188

  Pasch, J. G., 314, 315

  “Pastophori” treatment of sick by, 19

  Paul of Ægina, 118

  Peale, Charles W., 348

  Pechlin, Nicolaus, 232

  Pelican (extracting instrument), 157, 158, 167, 193, 206, 211, 226,
    281, 290, 291, 292, 311, 323, 324, 330, 334

  Perine, Geo. H., 27

  Periodontitis, 122, 320

  Petronius, 98

  Peyronie, de la, 339

  Pfaff, Philip, 305

  Pfolsprundt, Heinrich von, 163

  Phœnicia, ancient dental appliance found at Sidon, 29
    influence of, on Etruscan dentistry, 67

  Phœnician vase, with portrayal of dental operation, 47

  Pietro of Albano, 144
    of Argelata, 151

  Pig, teeth of the, 62

  Pincers, ligature, 295

  Plaster models, 306

  Plateario, Giovanni, 152

  Pliny, 89, 102

  Pluggers, 288

  Pomaret, Denis, 223

  Portal, 245

  Poteleret, Alexandre, 262

  Pregnancy, extraction of teeth during, 301, 339

  Prescriptions, Chinese, 35
    dental, of Hippocrates, 50
    Egyptian, 20, 21, 22, 23, 24

  Priesthood, ancient, treatment of sick by, 17

  Primitive peoples, customs relating to teeth of, 42

  Prosthesis, dental, 146, 211, 296

  Prosthetic pieces, movable, 256

  Pulp-capping, 306

  Pulp, inflammation of, recognized by Archigenes, 107

  Pumice stone in dentifrices, 96, 97, 141, 203

  Purland, T., 28

  Purmann, Matthias Gottfried, 241

  Pyorrhea (alveolar), 96, 237


  Q

  Quacks, 159, 162, 277, 310

  Quill toothpicks mentioned by Martial, 98


  R

  Ranula, Abulcasis on the cure of, 137

  Renan, “Mission de Phénicie,” 29

  Replantation, 136, 191, 251, 281, 293, 305, 309, 316, 321, 334, 335

  Rhazes, 84, 121, 122, 153

  Riccio, Tommaso Antonio, 242

  Richter, A. G., 329

  Rivière Lazare (Riverius), 228

  Rizagra (Greek forceps), 87

  Romans, dental art among the, 77

  Rome, Arcagatus the first Greek doctor in, 77

  Rueff, 316

  Ruland Martin, 215

  Runge, L. H., 304

  Ruspini, Bartholomeo, 343

  Russel, 313

  Ruysch, Friederich, 236

  Ryff, Walter, 157, 161, 166


  S

  Saalburg, forceps found in ancient castle of, 114

  Saliva, 331

  Salmuth, Philip, 232

  Sandwich Islands, natives of, sacrifice front teeth, 43

  Satricum, example of gold crown work found at, 101

  Saws, dental, used by Abulcasis, 136

  Scalers, Abulcasis on use of, 127
    of Fauchard, 285
    of silver mentioned by Fabricius, 210

  Schaffer, Jacob Christian, 306

  Schelhammer, Christopher, 250

  Schmidt, Prof. Emil, 29

  Schultes, Johann (Scultetus), 226

  Schulz, Gottfried, 232

  Scorbutus, case of, mentioned by Hippocrates, 55

  Scribonius Largus, 103

  Scultetus, 226

  Scurvy, 57, 237

  Secrecy among dentists, 262

  Senile decay, 186, 238

  Serapion, 123

  Serre, 47, 78, 330

  Serres, 181, 217

  Seventeenth century, dentistry in the, 218

  Severino, Marco Aurelio, 227

  Shops of doctors in ancient Greece and Rome, 52

  Sidon, necropolis of, 29

  Silesian child, golden tooth of the, 214

  Silver, toothpicks of, mentioned in satire of Petronius, 98

  Six, Martin, 231

  Sixteenth century, dentistry in the, 161

  Spiegel, Adrian (Spigelius), 235

  Sprengel, “Geschichte der Chirurgie,” 139, 166, 223, 253, 257, 259,
    304, 337

  Sternberg, J. H., 337

  Stockton, Samuel W., 348

  Story of the Golden Tooth, 214

  Strabo, 98

  Strobelberger, Johann Stephan, 218

  St. Yves, Charles, 250

  Surgeon-dentist, 244, 339

  Surgery, ancient, eminently conservative, 108

  Surgical instruments deposited in the temples, 46

  Sylvius, 172


  T

  Tagliacozzi, Gaspare, 226

  Talmud, the, 32

  Tartar, dental, 119, 127, 150, 151, 237, 244, 258, 275, 302, 342

  Teano, Italy, prosthetic piece found near, 78

  Teeth, artificial, Dionis on, 252
      of the Etruscans, 70
      mentioned by Martial, 100
      opposition to use of, 241, 258
      Paré on, 197,
      Romans, 78
    care of the, _See_ Hygiene of the mouth.
      among the Brahmans, 42
        the Romans, 97
    dignity and importance of the, 235
    dyeing black, by married women of Japan, 43
        by races of Asia and Oceanica, 42
      red, by people of eastern India and Macassar, 43
    gilding of the, in Sumatra, 43
    of mummies, 28, 29, 49
    names of, as given by Guy de Chauliac, 143
    number of, indicated by Galen, 109
      influence on long life of, 58
    pivot, no evidence of Egyptian knowledge of, 29
    Pliny on persons born with, 89
    trepanning of, advised by Archigenes, 65

  Terminology, dental, found in Vesalius, 176

  Teske, J. G., 314

  Theodorico Borgognoni, 140

  Theriac, famous remedy of Andromachus, 106

  Tin for filling teeth, 285, 329, 335

  Tobacco, 220, 230

  Tonsillitis, Celsus on, 83

  Tooth brushes, 266, 334

  Tooth of iron, 232
    story of the golden, 214

  Toothache, 35, 51, 80, 92, 103, 106, 107, 109, 113, 115, 126, 150,
      190, 202
    immunity from, 221

  Toothpick and ear-picker of gold found in Crimea, 99

  Toothpicks, 94, 98, 208

  Transplantation, 282, 293, 303, 321, 329, 334, 335

  Treatment of dental disorders by the Chinese, 35

  Trephine, use of, by Archigenes, 108

  Trueman, Wm. H., 68

  Tulp, Nicolaus, 231


  U

  Uncrowning of teeth, 194, 204, 275

  Urine, 35, 43, 97, 98, 274

  Uxedu, painful swelling, referred to in Ebers’ papyrus, 20, 23


  V

  Valentini, Bernardo, 234

  Valescus of Taranta, 149

  Valsiarosa, dental appliance found at, 70, 72

  Van Leeuwenhoek, Antonie, 237

  Van Marter, J. G., 27

  Van Meekren, Hiob, 239

  Van Soolingen, Kornelis, 240

  Van Wy, J., 322

  Vasse, David, 301

  Verduc, Jean, 253

  Vesalius, Andreas, 172

  Vigo, Giovanni of, 159

  Virchow, 29

  Votive offerings, dental, of Etruscans, 68
    tables in ancient temples, 18, 46


  W

  Weapons, teeth of animals as, 62

  Wecker, Johann Jacob, 200

  Westphal, A., 304

  Weyland, Fr. L., 318

  White, Samuel S., 348

  Wichmann, J. E., 336

  Wildman, Elias, 348

  Wilkinson, Sir Gardner, 28

  Willich, 321

  Wooffendale, Robert, 316

  Worms, dental, 104, 125, 126, 141, 148, 150, 153, 158, 199, 203, 214,
    220, 228, 229, 231, 232, 247, 268, 307, 309

  Wurfbein, Paul, 241


  Z

  Znamenski, 295

  Zwinger, Theodor, 240







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