From the Most Ancient Times Until the End of the Eighteenth ...

F ROM TH E M O ST ANC I ENT T IM E S

UNT I L TH E E N D O F TH E

E IGH TE ENTH CENTURY

DR . VINCEN Z O GUERIN I,CAV . UF F .

Ii !

SURGEON—DENTI ST , NAP LES , ITALY ; DENTI ST B Y AP PO INTMENT TO THE ROYAL HOUSE ; DENTI ST OF THESURGI CAL CLINI C OF THE UNIVERSITY OF NAP LES ; EDITOR OF THE ITALIAN REVIEW

L’ODONTO - STOMATOLOGIA ; AUTHOR OF MANY ODONTOLOGICAL W ORK S ;

HONORARY PRESIDENT AD V ITAM OF THE ITALIAN ODONTOLOGI CAL SOCIETY ; MEMB ER OF THE ITALIAN SOC IETYOF SCIENTI STS , LITERARY MEN , AND ARTI STS ; OFFICER OF THE ORDER OF THE CROWN OF ITALY ; DO CTOR

OF DENTAL SURGERY AD HONOREM OF THE CHICAGO COLLEGE OF DENTAL SURGERY ; HONORARYMEMB ER OF THE NATIONAL DENTAL ASSOCIATION , U . S . A . ; MEMB ER OF THE EX ECUTIV E

COUNCI L OF THE FEDERATION DENTAIRE INTERNATIONALE ; TITULAR MEMB EROF THE SOCIETY OF THE PAR I S DENTAL SCHOOL AND DISP ENSARY '

HONORARY MEMB ER OF THE ODONTOLOGI CALSOCIETY OF MALAGA , ETC .

LEA FE B IGE RPHILADELPH IA AND NEW YORK

I 9 O 9

COPYRIGHT, 1 909

BY THE

NATIONAL DENTAL AS SOCIATION OF THE

UNITED STATE S OF AMERICA

P R E F A C E .

TH E idea of writing a History of Dentistry first suggested itself tome ten years ago , when I was charged by the O rganizing Committee ofthe Eleventh International Congress of Medicine with the reproductionand description of all the appliances of ancient dental p rosthesi s existingin the mu seums of Italy .

The highly interesting researches in which I then became engagedin order to carryout worthily the important mission intru sted to me

,

awoke in me the desire to gain'

still further acquaintance with all thatrelates to dental art in the time of the ancients . I was thu s u rged on toever fresh efTorts , not only in the discovery of prosthetic appliances andother objects of ancient dentistry

,but in the study , as well , of dental

l iterature and of all the written matter that might throw light on dentistryin past ages .This subj ect has already occupied many before me

,and each one has

brought to it hi s contribution of greater or less value , some in the formof short p amphlets , others in that of larger works .The end I proposed to myself was tO

'

write a History of Dentistrywhich shou ld be much more complete , more c ircumstantial , and moreexact than those published hitherto

,and which

,in stead of being, as are

many of these works,s imply a compilation

,should represent , at least in

part, the fru its -

of personal research and scrupu lou s examination of avast number of works of variou s kinds containing elements util izab lefor the purpose .

The first part of m y _

work,which I now offer to the public , comprises

the remote origin of Dentistry and its development throughout the agesas far as the end of the eighteenth centu ry . In a short time I hope topublish the second part of it, viz . , the History of Dentistry during thelast hundred years .I have carefu lly collected the greatest poss ible number of historical data ,

keeping in view the consideration that some facts , although of l ittle valuein themselves

,may possess a certain importance for the student desirou s

of procuring historical information relating to some particular point ofdental science .If this book should , as I hope it may , contribute to the diffusion of

exact historical knowledge as to the origin and gradual developmentof dentistry

,my labor will not have been lost , for it will have realized

the object,a highly practical one

,which has gu ided me in writing it .

VINCENZO GUERINI .

C O N T E N T S .

PAR T I .

FIRST PERIOD—ANTIQUITY .

CHAPT E R I .

DENTAL ART AMONG THE EGYPTIANS

CHAPTE R I I .

TH E HEBREW S

C HA P T E R I I I.

DENTISTRY AMONG THE CH INE S E

CHA PT E R IV.

CUSTOM S RELATING To THE TEETH AMONG DIFFERENT PRIM ITIVE PEOPLE S

CHAPT E R V.

THE GREEK S

CHAP T E R V I.

DENTAL ART AMONG THE ETRUS CANS

CHA PT E R V I I .

THE ROMANS

PAR T I I .

SECOND PERIOD—THE MIDDLE AGES .

CHAP T E R V I I I.

TH E ARAB IANS

C HAP T E R I X .

TH IRTEENTH To FIFTEENTH CENTURIE S

v iii CON TEN TS

PAR T I I I .

THIRD PERIOD MODERN TIMES .

CHA PTE R X.

THE S IXTEENTH CENTURY

CHAPTE R X I.

THE SEVENTEENTH CENTURY

CHAPT E R X I l .

THE E IGHTEENTH CENTURY

INTRODUCTION .

EVERY dentist who has ever given any thought to the development ofhis profession must have realized the growing necessity for an accessibleand authoritative history of the dental art . The early efforts In thi sd irection by Duval

,Fitch

,Carabelli

,Snell

,Linde re r, Harris , and others ,

followed in thi s country by the more recent essays of Perine,Dexter

,and

Cigrand , are out of print and difficu lt to obtain . The Ger chz’

chte der Z a /m

he zi

l lzuna’e, by Geist- Jacobi , and N otice s ur f

’

H z

i

s toz'

re d’e Z

’

Art D enta z‘

re ,

by Lem e rle, have given to the practitioners of Germany and France

valuab le information which the English - speaking dentist has often sadlylacked .

Realizing thi s situation,at the first meeting of the National Dental

Association , the late Dr . R . Finley Hunt ofTe red the resolution : “Thata Committee of Three be appointed by the President to report at thenext annual meeting a measure looking to the preparation of a fu ll his toryof the Dental Profession .

” After a carefu l consideration of the subject,

thi s committee reluctantly concluded that,

“ whereas a complete historyof denti stry m ay some day be the resu lt of the effort now being made ,this Association mu st confine its first attempts to the history of dentistryin America .

”In a letter to the committee the late Dr . W. D . Miller said :

“Of course , a universal history of dentistry wou ld be very interesting andvaluable

,but its compilation wou ld natu rally cost an immense amount

of labor . Aside from this , it did not seem possible that the data fora proper history of the early development of the dental art in Africa andEurope cou ld 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 reportat the BufTalo meeting of the Association that Dr . Vincenzo Guerin i

,

of Naple s ,'

Italy, had written a history of denti stry from the earliesttimes to the beginning of the nineteenth century , and that thi s work ,tran slated into English and fully revised

,had been generously placed

in the hands of the committee for publication under the auspices of theNational Dental Association , in token of the distingu ished author ’ sappreciation of American dental development .The Association

,deeply sensible of this high compliment , and fully

realizing.

this opportunity for accomplishing a purpose which had hitherto

x IN TRODUCTION

seemed impossible,gladly arranged for the publication of the book .

After the delay incidental to the production of a work of thi s character,and the necessary subscribers being obtained , this exhau stive historyof early dentistry , by the greatest authority on that subject in the world ,i s presented for the Se riou s con sideration of the thoughtful and studiou smembers of the profession .

Dr . Guerini has spent many years of his professional life and largeamounts of money in collecting the material for this work . Our historicalrecords are scattered through a vast literature

,and much of it i s of great

antiquity , and it has never before been gathered together and arranged insuch a consecutive , logical order .The importance and value of dental art and science as a humaneservice are well recognized , but we are so accustomed to View the questionfrom the modern standpoint that we , generally speaking, overlook theimmense work done by our predecessors reaching far back in unbrokenline to the mists of antiqu ity . It was they who laid the foundation s uponwhich modern dentistry has been bu ilt, and no man can peruse therecord of their efforts a s set forth in Dr . Guerini

’

s book without developinga higher appreciation of their work and a keener realization of the worthand 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 inse rted as a foOt- note and designated by the initials of the commentator.The supervis ion of the work while p assing through the press and thecorrection of proofs have been entru sted to Dr . Edward C . Kirk , of theCommittee ; the index has been prepared by the chairman .

CHARLE S McMANU S,

Cba irm an of Com m ittee on History of Dentistry ,

Nationa l Denta l Associa tion, U. S . A .

A H ISTORY O F D ENT ISTRY .

P A R T I .

FIRST PERIOD— ANTIQUITY .

IN T R O DUC T I O N .

TH E fi rst beginnings of dental art were undoubtedly the same as thoseof general med ic ine , for it is evident that in primitive times , when thehealing art was still in its rudimentary Stage , no d ivisions could haveexisted in it .Scientific med icine , whose most ancient representative i s Hippocrates ,

was preceded for the course ofmany centuries by sacerdotal medicine andby popu lar medic ine . PNecessity

,instinct, and even mere chance mu st have taught primitive

man some simple curative practices , in the same manner that they taughthim gradually to prepare his food and to satisfy the other wants ofl ife . It was in this way that popu lar medic ine , which is found withoutexception among all races and is perhaps a s ancient as man himself

,

had its earliest beginning.

AS regard s sacerdotal med icine , it was principally derived from the falseideas prevalent among primitive peoples about the cau ses of maladies .When

, for example , an ind ividual in full health was seized with suddenillness

,no one cou ld imagine , in those times of profound ignorance ,

that this happened in a natural manner ; the fact was therefore attributedto a supernatural cause , that is , to h is having been stricken by the wrathof some d ivinity . In this State of th ings it was believed to be absolutelynecessary to prop itiate the inimical or vengefu l d ivinity

, so that thepatient might be restored to health . It was , therefore , very natural thatthe intervention of sacerdotal aid shou ld be sought, that is , of the supposed intermed iaries between human beings and the gods . The priests

,

on ’ their s ide,were ready to occupy themselves with such cases , for

their services were always well recompensed , and , added to th is , if the

18 FIRST PERIOD—AN TIQUITY

patient recovered,the respect and veneration of the people for the sacer

dotal caste was considerab ly increased , whilst if he d id not, this S implymeant that he or h is family was not worthy of receiving the desiredpardon

,or that

,anyhow

,the D ivin ity , 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 d id not l imit themselves merely to offeringup prayers and sacrifices and to imposing on the patients the purific ation of themselves and other religiou s exercises ; they also put into practice— always to the accompaniment of rituali stic word s and ceremoniesthe means of cu re which their own experience and that of others suggested to them . The art of healing the sick was transmitted fromgeneration to generation in the sacerdotal caste , acqu iring an evergreater development and complexity in proportion to the making of

new ob servation s and fresh experiences . It i s to be understood thatin thi s manner the priests became more and more skilfu l in the treatment of disease ; they were really the doctors of those times , albeit theircurative practices were mixed up with an ample dose of impostu re .

This,at least in many cases , mu st have had , besides , the advantage of

acting favorably on the patients by means of suggestion .

We learn from Herodotu s that the Babylonians u sed to carry thesick into the publ ic squares ; the passers - by were expected to makeinqu iries as to their illnesses , and if it so happened that they or any oftheir acquaintances had been s imilarly affl icted , to come to the aidof the patient by offering their advice and making known the means oftreatment that had effected recovery, exhorting him ,

at the same time,

to have recourse to them .

This u sage had without doubt its advantages,a s it must have led

,

l ittle by little , to the recogn ition of such remed ies as were most e ffic ac ious , among all those recommended , against the variou s malad ies .Another cu stom that served to furni sh u sefu l elements for the development of the art of medicine was that of the votive tables , hung in thetemples by patients after their recovery, in sign

'

of gratitude for havingreceived the invoked blessings . These tables contained a brief d e sc ription of the malady and of the treatment that had proved u sefu l in dispelling it . If we reflect that dental affection s are often of long durationand very tormenting, the thought naturally suggests itself that amongthe votive tables not a few mu st have referred to malad ies of the teeth .

The numberless ca ses recorded by votive tables afforded preciou scl in ical material , which without doubt was utilized in a great measureby the priests in compiling the earliest medical writings

,and

,as we shall

se e later, Hippocrates himself Stored up all the medical records existingin the celebrated temple of Cos .

C H A P T E R I .

DENTAL ART AMONG THE EGYPTIANS .

AMONG the people of ancient times , the Egyptian nation was , withoutdoubt

,the one in which civil ization first took its rise and had its earliest

development . From the time of Menes , first King of Egypt (3892the inhab itants of the valley of the Nile were well advanced on the pathof c ivilization , and under the fourth dynasty , dating from 3427 yearsbefore the Christian era , they had already attained a high degree ofprogress .Medical art and science in every country have always progressed in

proportion to the general civilization , for the treatment of disease i sone of the first and most important manifestation s of civil ized life . It

is therefore natural that the healing art shou ld have flourished earlier inEgypt than elsewhere

,that is , in the midst of the oldest civil ized people .

There,as in other countries , medicine was practi sed for some time

only by the sacerdotal caste ; but not all the members of this ca ste weredoctors and priests at one and the same time ; there was a special classamong them

,called “

pa stophori, whose miss ion it was to cure the sick .

Our knowledge of medicine as practised among the Egyptians of oldis now no longer limited to the scanty notices handed down to us by Greekand Roman writers . The researches made by students of Egyptian lorehave placed original med ical writings in our hands , now already partlyinterpreted , that permit u s to form a sufficiently exact idea of the scienc eofMedicine in ancient Egypt .These valuable documents , denominated papyri , from the material

on which they are written , now exist in great numbers in the BerlinMu seum ,

in the British Mu seum ,and in those of Leyden

,Tu rin

,Pari s

,

and other cities ; but the most important of the papyri treating of medicalsubjects is certa inly the papyru s of Ebers , in the lib rary of the LeipzigUniversity .

1 This very valuable papyru s— the most ancient of all knownworks on Medicine— is the best written of all the Egyptian med icalpapyri

,and is also the best preserved and most voluminou s . In s ize

it i s 30 centimeters h igh , 20 meters long, and the whole text is d ividedinto 108 sections or pages , each one of about 20 to 22 l ines . The celebrated Egyptian scholar

,Prof. George Ebers , procured it , toward the

1 Se e Introduction to the Ge rm an translation Of the E be rs p apyru s , by He inrich Joachim ,

Be rlin, I 890 .

20 FIRST PERIOD—AN TIQUIT)”

beginning of the year 1873 , from an inhab itant of Luxor, in Upper Egypt .He published a beautifu l ed ition of it two years later in Leipzig ; andin 1890 Dr . Heinrich Joachim published a German translation of thewhole papyru s, with an introduction and explanatory notes .The Ebers p apyru s i s written in hieratic characters . We here reproduce some passage s of it, so as to give our readers an idea of the style ofwriting .

1

Lepsiu s and with him the greater p art of Egyptologists are of op inionthat the Ebers papyru s is not an original work at all , but s imply a copyof medical writings of still earl ier date , belonging to different epochs ,and which were collected and reunited to form a kind of manu al onmedicine .

FIG . 1

lawm an

Part of Ebe rs ’ papyrus in Egypt ian hie ratic cha racte rs conta in ing thre e denta l pre scri ption s .

From some indications existing in the papyru s itself, Ebers has beenable to argu e, with qu as i certainty, that the papyru s was written towardthe year 1550 B .C . But some parts of it have their origin in a far moreremote epoch ; they go back, that is , to thirty- seven centuries or morebefore the Christian era . In fact, at page cii i of the Ebers p apyru s2one reads :

“ Beginning of the book about the treatment of the u xea’u in all the

members of a person , such as was found in a writing under the feet ofthe God Anubis , in the city of Letopolis ; it was brought tO ‘

His MajestyUsaphais , King ofUpper and Lower Egypt .

” Now,as Joach im remarks

,

the Usaphais herein named was the fifth king of the first Egypti an

1 The Egyptians had thre e d iffe rent kind s of writing : the hie roglyphic , the hie ratic , and

the dem otic . The hie roglyphic style,which is the m ost anc ient and is chiefly to be found

on m onum ents and in re ligiou s texts,consists of figure s re pre senting eve ry kind of obje ct ;

the hie ratic or sace rdotal style is an abbreviation of the hie roglyphic writing ; the d em otic orpopu lar style

,the lea st anc ient, re su lted from furthe r abbreviations of the hie ratic .

2 See page 185 of the Ge rm an translation of Dr. Joachim .

DENT/IL ART AMONG THE EGYP TIAN S 21

dynasty,and he reigned toward 3 700 before the Christian era . Hence

,

it may be argued that some , at least, of the writings from which theEbers papyru s was taken were composed in the very remote epoch towhich we have ju st alluded , or perha ps still farther, for it i s impossib leto know whether the book

,depos ited 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 earl ier epoch .

FIG . 2

Part of Ebe rs’ papyrus in Egyptian hie ratic characte rs conta ining e leven denta l pre sc ri ption s .

Dental and gingival malad ies are in no way neglected in the Ebersp apyru s . At page 72 , a remedy is prescribed

“ against the throbbingof the bennut blister in the teeth

,then two other remedies “ to cu re the

bennu t blisters in the teeth and to strengthen the fleshIt is somewhat d ifli cult to say what i s meant by bennu t blisters ;

but perhap s it means small,gingival ab scesses of dental origin . The

first of the above remedies— probably meant to calm the pricking orthrobbing pain that

,in such cases

,often accompanies the dental malady

consisted of:

Sep s—gra insDoughHoneyOil

To be applied on the part a s a plaste r.


The other two remedies , very likely intended for' the cu re of dental

fistulae , were to be used as masticatories . The first consists of

Part I

I

The other was still more complicated and thu s compounded

Part I

( C

I

At page 89 of the papyrus 1 we find two other remedies , having thesame object, that is , to cure the bennut bl isters in the teeth and tostrengthen the flesh .

”

The first i s compounded in thi s way :

Cow’

s m ilkFre sh date s

Uab corn

To be left stand and then to be m a sticated n ine tim e s .

This i s the Second receipt :

Ane st—plantDoughGreen le adSebests2

CakeDam - plantFenne l se ed sO live oilWate r

To be used like the pre ced ing one .

1 Se e the Ge rm an translation by Joachim ,page 1 62 .

2 A fruit re sem bling Che rrie s .

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The other two remedies , very l ikely intended for the cure of dentalfistu la ,

were to be u sed as masticatories . The first consists of :Part 1

‘C

The other was still more complicated and thus compounded :

Part I

( 6

At page 89 of the papyru s 1 we find two other remedies having thesame object, that is to cure the bennut blisters in the teeth and tostrengt hen the flesh .

The first i s compounded in th i s way :

Cow’

s m i lkFre sh date s

Uah corn

To be left stand and then to be m asticated nine tim e s .

This i s the second receipt :

Ane st—plantDoughGreen le adSebests2

CakeDi m - plantFenne l se e d sO live oilWate r

To be used l ike the pre ced ing one .

1 Se e the Ge rm an translation by Joachim,page 162.

2 A fruit re sem bling Che rrie s .

DEN TAL ART AMONG THE EGYPTIAN S 23

In this same page 89 many other remedies correspond ing to variou sind ications are prescribed .

To strengthen the tee th :

Powde r of the fruit of the dum - pa lmGre en le adHoney

To be m ixed and the te eth rubbed with it.

The following is another remedy for the same purpose

Powde r of fl int stone sGre en le adHoney

To be rubbed on the te e th.

Next comes a remedy to cure the growth of uxedu in the teeth,

that i s :

DoughBe ansHoneyVe rd igrisGre en lead

To be powde red,m ixed , and applied on the te e th.

The word uxedu recurs more than thirty- five times in the Eberspapyru s , in relation to affections of the most d ifie rent parts of the body .

By confronting all the pass ages of the papyrus in which one finds theword uxedu

,Joachim deduces that it does not indicate any special dis

ease,but has the general signification of “ a painfu l swelling .

” According to Geist—Jacob i

,by “ growth of the uxedu in the teeth may be

understood an alveolar ab scess 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 p art ofthe flesh” i s to be understood the gum . The remedy wou ld , therefore ,correspond to the ind ication of curing a tooth “ that gnaws or gives painunto the gum . But as one sees , even putting it in these words , themean ing is anything but clear . Perhaps the destructive action of thecariou s process , reaching as far as the gum ,

i s what i s here meant to bea lluded to . Meanwhile here is the receipt :

Cum inIncense

OnionTo be reduced to a pa ste

,and applied on the tooth.

24 FIRST PERIOD—AN TIQUIT)’

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

Incense

Ve rd igri sGre en le ad

Mix and apply on the tooth.

The other i s compounded of

Wate r

AbsinthTo be used a s above .

We next find a formu la , preceded by this very vague indication :Chewing remedy for curing the teeth .

Am aa- plantSwe et be e rSut—plant

To be m asticated and then spit on the ground .

Another masticatory i s intended to Strengthen and cure the teeth ,and is compounded thu s :

Saffron

Duat—plantSwe et be e r

To be m a sticated and then spit on the ground .

Finally,we have a medicament “for curing the gnawing of the b lood

in the tooth .

”It i s complicated enough , being compounded with :

The fru it of the ge buOn ionCakeDoughAne st- plantWate r

One le ave s it to stand and then chews for

But what meaning is to be attributed to the gnawing of the b loodin the tooth ?”It i s almost certain that this figurative expression referred to the painderiving from caries and pu lp iti s . It may have had its origin in theob servation of two phenomena, that is , first of all, the pul sating character

DEN TAL ART AMONG TH E EGYPTIAN S 25

which the pain alluded to often assumes , and the eventual i ssu ing of bloodfrom the cavity of a tooth affected by caries and pu lp iti s , when the pu lpi s exposed . At any rate

,the Egyptian doctors of remotest antiqu ity

undoubtedly did not ignore the presence of blood in the interior of thetooth .

From what we have related , it clearly appears that at that remoteepoch many remedies were already in use for combating dental affe ctions . These mu st consequently have been frequent enough , whichdemonstrates the erroneou sness of the opinion held by some , who affi rm ,

a s does Mummery,

1 that in ancient times d iseases of the teeth wereextremely rare .

Besides this,it i s fu lly evident , from the Ebers p apyru s , that at the time

in which this was written,dental p athology and therapy were still in a

very primitive condition,and formed a part of general med icine , from

which they showed as yet no tendency to separate ; so true i s this , thatthe remedies intended for the treatment of the teeth do not constitute aspecia l section of the work , but are to be found among medicaments ofan altogether d ifferent nature . Thu s , at page lxxi i of the papyru s2 wefind , first , three remedies against the itch ; then five remedies for the cure ofpustu les in variou s parts of the body ; next an ointment and a potion forthe bennut blis ters in whatever part of the body they may occur ; after this ,three medicaments against the bennut blis ters of the teeth ; and lastly,a plaster for curing cru sts and itch ing in whatsoever p art of the body .

One finds no mention of dental su rgery in the Ebers p apyru s . Noconclu sions could be drawn from this fact if the work only spoke ofmedical treatment

,for then it might reasonably be supposed that the

compiler had purposely occupied himself with thi s subject only ; but ,on the contrary, the Ebers papyru s frequently makes mention of operative interventions , and among these , of the u se of the knife and of the redhot iron for the treatment of abscesses and of certain tumors . Therefore ,there being no mention made in the papyrus of any dental operation , noteven of extraction , gives u s reason to su spect that at that remote epochno su rgical operation was carried out on the teeth , and that , as yet , noinstruments existed for practis ing extraction .

In the time of the celebrated historian Herodotu s , of Halicarnassus ,who l ived in the fifth century previou s to the Christian era (about from500 to that is

,more than a thousand years after the time in

which the Ebers papyrus wa s written , the dental art in Egypt had maderemarkable progress

,and wa s exerc ised by specialists . In fact , in the

1 On the Re lations of the Hum an Te e th to those of the Lowe r An im a l s,by John R .

Mum m ery. Tran s . Odontologica l Soc iety of Gre at Brita in,May, 1860 .

2 Se e Ge rm an translation by Joachim ,p . 120.


second book of Herodotus we find the following passage : The exe r

c ise of medicine is regu lated and divided amongst the Egyptian s insuch a manner that special doctors are deputed to the curing of everykind of infirmity ; and no doctor wou ld ever lend himself to the treatmentof different maladies . Thu s , Egypt is qu ite fu ll of doctors : those for theeyes ; those for the head ; some for the teeth ; others for the belly ; or foroccult maladies .” 1

Having here had occasion to refer to the H is tory of Herodotu s , wewill quote two passages of this famou s work , which have a certain interestfor our subject ;

“Whilst the tyrant Hipp ias,after having been driven out of Athen s

(5 10 was marching against Greece at the head of the Persian armyand had already arrived at Marathon

,he happened one day to sneeze

and to cough in a more vehement manner than u sual ; and he beingalready 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 intothe dust, Hipp ias set to work, with great d iligence, to search for it ; butthe tooth not coming to light

,he drew a long sigh

,and then said

,turn ing

to those who were standing by : ‘This land is not ours , neither shall weever be ab le to have it in our power ; what clings to my tooth is all of itthat will ever belong to me ” 2

In another part of the H is tory , that is , in the ninth book, Herodotu srecounts as follows :

“When the corpses buried after the b attle of Platea were alreadydespoiled of their flesh

,a curious fact was seen ; for the people of Platea

having collected the bones of those who had perished , there wa s foundamongst them a sku l l altogether devoid of commissures , and composed ofone single bone . A jaw was also found , the teeth of which , compris ingthe molars , appeared to be made all of one p iece, as though composed ofa single bone .

Relative to this last p assage of Herodotu s , we may remark , as doesStark , that the total synostosis of the skull bones is certainly very rare ,but that

,nevertheless

,one has authentic

‘

exam ple s of the same , not onlyin ancient but also in relatively modern times , witness the famou s sku llof Albrecht von Brandenbu rg, surnamed the German Achilles , whod ied in 1486 , and wa s buried in the monastery of Heilbronn . As toteeth united together and forming a single piece , no example exists savein very ancient authors

, for in stance, in Valerius Maximu s , who recountsa s imilar marvellous fact of Pru s ia , King of Bithynia , and in Plutarchwho attests to a similar fact in the person of Pyrrhu s , King of Epiru s .

1 He rodoti Halicarnasse i historia,I 570 fol . Eute rpe , page 53 .

2 He rodoti Halicarnasse i historia, l i b .

“vi .

DEN TAL ART AMONG TH E EGYPTIAN S 27

It i s very d ifficult to estab lish within what limits the activity of thedentists alluded to by Herodotus was displayed . It has been affirmedby 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 denti sts of those

d ays . Here are some data on th is subjectJoseph Linde re r1 tells us that, accord ing to Belzoni2 and others , arti

fic ial teeth made of wood and very roughly fashioned have been foundin Egyptian sarcop hagi .George H . Perine

,a dentist of New York , in an article on the h istory

of dentistry ,3 says : “Both filled and artificial teeth have been found inthe mouth s of mummies , the cavities in the former Stopped with gold andin some cases with gilded wood . Whether these fi ll ings were insertedduring life for the purpose of preserving the teeth , or after death for ornamentation , it is , of course , imposs ib le to say . That the Egyptians wereexceed ingly fond of embelli sh ing their persons with gold ornaments andbright colored materials i s a fact which has been clearly established ,and the discove ry of mummies—of exalted personages no doubt— someorgans of which were gilded and embelli shed with showy colors provesthat their fondness for display accompanied them even to the grave .

”

To this may be added,that after an embalmment of the highest class“

it was u sual to gild the eyebrows,the point of the nose , the lip s , 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 prehistoricdentistry , 5 writes , among other things , that the renown ed a rcheologis t,

Mr . Forbes , had s een m um m ies’

te e th s topp ed w ith gold .

The great defect of all the assertions, referred to is that of not beingaccompan ied by any element of proof, wherewith to demonstrate theirtruth . When

,for example

,we are told that Mr . Purland possesses , in

1 Die Zahnhe i lkunde , E rlangen ,185 1 , p . 348.

2 G . B . Be lzoni (1 7 78 to a ce le brated Ital ian trave l le r and archeologist, vi sitedEgypt and Nubia

,and wrote

,in English

,a re port on his d i scove rie s

,which wa s published

in 182 1 . We have not be en able to procure thi s book ; we have , howeve r, re ad the Ita l ianve rsion

,publi shed in Naple s in 1 83 1 , without com ing ac ross any m ention of art ific ia l te e th

found in Egyptian sarcophagi . The re fore,unle ss the work ha s unde rgone som e m uti lation

in the Ital ian translation,we do not know whence Jose ph Linde re r can have taken the

above notice .

3 New England Journa l of Dentistry,1883 , vol . i i , p . 162 .

‘1 Ac cord ing toHe rodotus and Diodorus,the re we re thre e d iffe rent m ode s of em ba lm ing in

use am ong the E gyptians ; the m ost expensive of the se cost one ta lent (about 5600 franc s),the se cond in orde r 20 m inae (about 1900 francs), whi le for the le s s we a lthy the re was a

third c lass,at a m uch m ore e conom ica l rate .

5 Se e Giorna le di Corrispondenza pe i Dentisti,O ctobe r

,1885 , p . 227 .


his collection of antiqu ities , a tooth p ivoted on to the root of a mummy ’ stooth

,the question suggests itself naturally : If this tooth i s , as it appears ,

separated from the j aw of the mummy to which it is s aid to have belonged ,how can we be certain that the tooth itself is really that of a mummy ?Until sufficient proof of thi s be furn ished , we cannot but consider theabove assertion as ab solutely without value .

1

The same may be said as to the assertions of Wilkin son and Forbeswith regard to mummies ’ teeth stopped with gold . Where and by whomwere these mummies found ? And where are they preserved ? Wa s

the stopping,too

,verified at the time of the finding of the mummy , in

such a manner as to exclude all possib il ity of fraud , or was it d iscoveredafterward , in circumstances such as to suggest the possib ility of a mistific ation ? It has , in fact, been reported 2 that the pretended Egyptianstopping in a mummy existing in an English mu seum was nothing elsethan a practical joke

,carried out

,besides

,in a very awkward manner .

In opposition to the above assertions , we have the most absolute contradic tory statements on the part of the most competent authorities .The celebrated Egyptologist

,Prof. George Ebers

,has only been able

,

in sp ite of the most accurate research , to arrive at completely negativeresu lts in all that has reference to the dental art of the ancient Egyptian s . 3

1

[The oft- quoted statem ents of Mr . Purland with re fe renc e to Egyptian denta l art are

re corded in the transactions of the first m onthly m e eting of the Col lege of Denti sts,an

extinct English denta l assoc iation ,and published in the Quarte rly Journa l of Denta l

Sc ienc e , 1857 , vol. i , p . whe re the fol lowing note by the se c retary appe ars : “Mr.

Purland re pud iated the idea of the Chine se having be en the first to m anufacture te eth, and

referred tonum e rous spe c im ens in the Briti shMuseum,m anufactured betwe en four thousand

and five thousand ye ars ago by the Egyptians, whohe conside red we re the origina l m ake rs .

On the subje ct of fl int,Mr. Purland sa id he had d i scove red pie ce s of wood in the centre

,

and rem arked upon the ai tific ia l te e th he had found in m um m ie s .

”

Again,at page 63 of the sam e journal

,in an artic le entitle d “

Denta l Mem oranda , byT. Purland

,Denti st

,Ph.D .

,the author says

“ Be lzon i and othe rs d iscove red rude ly m anufacture d te e th in the sarcophagi of the

Egyptians . As regard s the u se of gold le af, Sir Gardne r Wi lkinson ob se rve s

,as a singu lar

fact,that the Egyptian s stopped te eth with gold .

“It is true that rude ly m anufactured te e th have be en found in the he ad s of Egyptian

m um m ie s,but it is equa l ly true that te ethof a ve ry supe rior m ake and adaptation have a lso

be en found , som e carve d in ivory, othe rs in sycam ore wood , and som e have been found fixed

upon gold plate s. Of the se varietie s, som e are de posited in the va luable and exten sivem u seum be longing to Jose ph Maye r

,E sq .

,of Live rpool ; others are in the m useum s

of Be rl in and Paris,and I am in posse ss ion of a tooth found pivoted to a stum p in the

he ad of a m um m y in the col le ction of a lam ente d friend .

“Of stopping with gold

,seve ra l instance s have com e to m y notic e

,particu larly in a

m um m y in the Sa lt col le ction,sold by Sothe by

,in 1836 , in which thre e te e th had be en

stopped . I have ende avored to trac e the m um m y,but in va in .

—E . C. K . ]2 Giorna le di Corri spondenza p e i Dentisti

, Octobe r,1885, p . 229.

3 Ge ist- Jacobi,Ge schichte de r Zahnhe i lkunde

,p . 9.


four incisors united together with gold wire ; 1 two of the incisors wou ldappear to have belonged to another individual , and to have been applied

Phoen ic ian appliance found at S idon,a s re pre sented in a cut of Renan

’

sMi ssion de Phén i c1e .

1 The inc i sors re pre sented in the cut of Renan’

s work do not at all give the anatom ic a lform of upper inc i sors, but of lowe r one s . The refore

,e ither the figure itse lf has be en bad ly

drawn ,or the pie ce found by Dr. Gaillardot was part of the infe rior and not of the supe rior

jaw. In the latte r case , the figure in Renan’

s book ought to be reve rsed , in the m anne r

here shown :

The sam e figure reve rsed , a s itought tobe if the pie ce found at S idon be longe d toa lowe r jaw.

Ne ithe r do we understand on what ground Dr. Gaillardot has based his affi rm ation of

the . p i e ce d i scove red having be longed to a fem a le Ske leton, as it is we l l known that the re

is no characte ri stic d iffe rence between a m ale and'

a fem a le jaw.

[Inte re sting exam ple s of the surviva l of thi s prim itive type of denta l prosthe si s are

found am ong the Hindus at the pre sent t im e . The two i l lu strations (Figs. 5 and 6) arefrom photographs of Spe c im ens of work dOn e by native Hindu denti sts. Fig. 5 is a roughlycarved artific ia l tooth of ivory attached by a gold wire ligature to the adjac ent natura l

F1G . 6

Exam ple s of denta l prosthe si s a s p racti se d by the Hindu s at the pre sent tim e .

te e th,all of which

,with the artific iaf tooth attached , we re sub sequently lost by a lveolar

d i se ase . Fig . 6 is a s im i lar carved artific ia l tooth of ivory attached to the adjoin ing te ethby a thre ad ligature

,the supporting te eth with the attached ivory tooth a l sohaving be en

lost by a lveolar d i se a se . The se Spe c im ens we re rem oved and sent to the write r by Dr.

H. B . O sborn,of Burm a

,during the pre sent ye ar (I

i

909).— E . C. K . ]

DEN TAL ART AMONG TH E EGYPTIAN S 3 1

as sub stitutes for lost teeth . This p iece,discovered in one of the most

ancient tomb s of the necropolis , proves that dental art in S idon wassufli c iently advanced .

” 1

To. these words,l iterally tran slated from Renan ’ s work , we will only

add the following consideration s :Egypt was

,in its time , a great centre of

'

c iviliz ation , whose influencewas strongly predominant in all the neighboring region

,and especially

in ancient Phoenicia and in its large and industriou s cities Tyre andS idon . The remains d iscovered in many of the Phoenician tombs wouldof themselves alone be suffic ient to demonstrate luminously the enormousinfluence exercised by the Egyptian civilization on the life and cu stomsof that people . Now,

if the re .we re dentists in S idon capable of applyingfalse teeth

,it may reasonably be admitted that the dentists of the great

Egyptian metropoli Thebes and Memphis were ab le to do as much andmore

,the level of civil ization being without doubt h igher there than in

Tyre or in S idon , or in other non - Egyptian cities .

1 Renan ,Mi ssion de Phénic ie , p . 472 .

C H A P T E R I I.

THE HEBREWS .

IN the Hebrew literature , as principally represented by the Bible andby the Talmud

,there does not exist any book on medicine . Notwith

standing the vicinity and the close relation s of the Hebrews with Egypt,

medical science never reached the degree of development among thispeople that it d id 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 hygien ic precepts , there are not any that refer d irectlyto the teeth or to the mouth . We may therefore conclude

,with a certain

degree of probab ility, 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 Bib le more than fifty times,

1

but very few of the passages in which it i s to be met with present anyinterest so far as our subj ect is concerned .

That the Hebrews attached great importance to the integrity of thedental apparatu s is plainly seen from the following verses of the bookof Exodus (xxi : 23 to23 . thou shalt give life for l ife ,24 . Eye for eye , tooth for tooth , hand for hand , foot for foot,25 . Burning for burn ing, wound for wound, stripe for stripe .

26 . And if a man smite the eye of his servant, or the eye of his maidthat 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 maid servant ’ stooth ; he shall let him go free for his tooth ’ s s ake .

These legislative measures show clearly enough that among the Hebrewsthe loss of a tooth was considered a les ion of great gravity , as they thoughtit of sufficient importance to be named in the same category a s the los sof an eye

, of a hand , or of a foot . If anyone cau sed the loss of an eye orof a tooth to his servant

, the‘

punishm ent was the same in both cases ; thatis , he wa s obliged to give h im his liberty , thu s undergoing the loss of hispurchase money .

Beauty and whiteness of the teeth were also in great repute . Thuswe r e ad in the Song of Solomon (iv : 2)

1 The num be r varie s ac cord ing to the d iffe rent translations . So,inste ad of the Latin

d ente s e lephantis, we find'

in Engli sh and in othe r language s the word ivory .

TH E H EBREWS 33

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 barrenamong them .

”

In another part of the Song (vi : 6) he repeats these same words , thusgiving it to be understood how great wa s his admiration for the beautifulteeth of his beloved .

From variou s passages of the Bib le,one perceives that integrity and

soundness of the teeth was considered a prime element of force and vigorIn Psalm iii : 7 David says :

“Arise , O Lord ; s ave me , O my Godfor thou hast smitten . all mine enemies upon the cheek bone ; thou hastb roken the teeth of the ungodly .

”

(That is , reduced them to impotence .)And - in Psalm viii : 6 we read : Break their teeth

, O God , in theirmouth .

”

On the other hand , in one of the Proverb s of Solomon (xxv : I 9),broken or decayed teeth are taken to symbolize weakness : “ Confidencein an unfaithfu l man in time of troub le i s like a b roken tooth

,and a

foot out of joint .” (In the Latin translation , in stead of“ broken tooth”

stands dens p utridus .

” Perhaps the corresponding express ion in the

Hebrew language,signifies in a general sen se a decayed or injured tooth .)

The uncomfortable sen sation produced on the teeth by acid substances(teeth on edge) is to be found several times alluded to in the Bib le . In

the Book of Proverb s (x : one reads : “As vinegar to the teeth,and

a s smoke to,

the eyes,so is the sluggard to them that send him .

” AndJeremiah says (xxxi : 29 , “ In those days they shall say no more

,

The fathers have eaten a sou r grape , and the children ’ s teeth are set onedge . But every one shall die for his own iniqu ity ; every man thateateth 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 itto be wondered at

, when one reflects that even in the Talmud—which ismuch less -ancient— medicine in “general is hardly at all spoken of. Thisfam ou S

'

cod e as to practical life is almost silent with regard to therapeuticmedicine

,and only recommends hygienic p ractices . An axiom of the

Rabb i Banaah i s worthy of note,and may be quoted here as bearing on

the subject,and also becau se 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 .

” 1

1 J . Boui lle t,Préc i s d ’histoire de la Méde c ine , Pari s, 1883 , p . 24.

C H A P T E R I I I .

DENTISTRY AMONG THE CHINESE .

FOR above 4000 years sc ience and religion among the Chinese as

well as their customs , have remained qu ite unchanged . The inhab itantsof the Ce le stia l

_

Em pire can vaunt a most ancient civilization ; which _i s‘ ,

however,altogether stationary; neither has their medicine made any

progress,and its actual state represents with suffi c ient exactness what

it was in primitive ages .In Europe , variou s works have been written about the medicine of theChinese

,one of the best being that of Dabry, 1 taken from t he most

celebrated medica l books of China , 2 and which may be considered as

a Compendium of the medical science of th is people .

Inth is work we find two chapters relating to our specialty : the firstof these (p . 286) speaks of toothache, the second (p . 292) treats Of all the

’

other dental and gingival d iseases .The Chinese call the ' toothache ya—tong , and d istingu i sh a great manyvarieties of the malady , th at is :

1 . Fong—je—tong . This kind of toothache is cau sed by sudden cold , _

and has the following characteristic symptoms : Red and swollen gums ,which after a little time discharge purulent

'

and fetid mucu s ; abundantsalivation ; acute p ain ; swelling of the cheek . It i s to be cured withdraughts , mouth washes , and various kinds of friction s .We consider it u seless to give the particu lars of the variou s receipts ,becau se Dabry hardly ever translates the names of the drugs of whichthey are compounded . These formu la are therefore incomprehensib leby most people .

2 . Fong- lan- tong . This kind of toothache is also cau sed by cold . The

pain is very great,but the gums are neither red nor swollen .

3 . Te - tong . Is also produced by chill . The gums are red and swollen ;there is no d ischarge of mucu s ; great p ain , which is aggravated by coldl iqu id s . If the malady lasts for some time , the gums end by becomingblack, and the teeth are loosened ; the pain becomes more intense inspitting. In th is ‘ stage of the malady the sufferer no longer fears colddrinks , but rather desires them ,

to soothe the pain . The cu re varies

1 La m éde c ine chez le s Chinoi s, par le Capita ine P. P . Dabry

,Consu l de France en Chine ,

Mem bre de la Soc iété Asiatique de Pari s,1863 .

2 One of the se books, Nue i- K ing, is said to have be en .written twenty- seven centurie sbe fore the Christian e ra

,by the Em pe ror Houang- ty, the founde r of Chine se m ed ic ine .

DEN TISTRY AMONG TH E CH IN ESE 35

accord ing to whether the malady be of recent or of old date ; it cons istsin the use of internal remed ies (pills , potions), or of frictions on the partwhere the pain is s ituated .

4 . H an - tong . This is al so owing to the action of the cold . Pain s inthe cheek

,

and forehead proceed ing from the teeth ; no d iseased cond ition either of the gum s or of the alveoli .

Ton - ta n - tong . Violent cough and toothache at the same time ;d ifficulty in masticating .

6 . Yn - hine - tong f The gums are pale , or violet- red , hard and lumpysometimes b leed ing ; the toothache i s continuou s . Among the numerousremed ies recommended against th is malady (mouth washes , friction s ,draughts , pill s), one particu larly deserves mention : it i s the urine of achild used as a mouth wash .

7 . Tehong- ehe - tong . Pain in the teeth after mastication ; there is

also sometimes excoriation of the gums ; flow of puru lent mucu s mixedwith blood ; bad - smelling breath ; the tooth falls ; it i s decayed , andone can perfectly well . d istingu ish a small hole ; the root i s unsound ;in extracting the tooth one sometimes brings away together with it alittle white worm , with a black spot on the head , which can be distinguished by the aid of a magnifying glass . A remedy mu st immed iatelybe administered to destroy these worms , otherwise the patient runs therisk of having his other teeth attacked in the same manner , and of theirfalling out . The remed ies against thi s affection are most numerou s ,and belong for the most part to the oftentimes C ited categories . One ofthem presents a certain interest

,its basis being arsen ic .

In Dabry’

s book it i s described in the following manner : Arsenic(gr . hou ang

- tan (gr . pu lverize,mix with water, and with

a part of the mass form a small p ill , which put close to the aching toothor into the ear

, if afraid of the arsen ic ; then sleep . Cu re certa in .

8 . Toothache,the effect of general weakness , following principally

on abuse of coition . It i s to be cured,by the use of interna l med icine ,

or by local remed ies to be rubbed on the painfu l spot . Some of themedicaments registered in this paragraph have reference to the specia lcase , in which the teeth are loosened through excess of coition . Amongothers there i s a prescription for a dentifrice powder for Strengtheningthe teeth , to be u sed every morning.

9 . Toothache following on a blow . It i s to be cured by u sing acertain dentifrice powder, composed of six ingredients . Another medic am ent consists in heating about an ounce and one - half of s ilver in somerecip ient

,and then pouring wine upon it , and rinsing the mouth with it .

Besides these n ine kind s of toothache,the Chinese doctors recognized

a pecu liar morb id cond ition of the teeth and their surrounding parts ,which is thu s described in Dabry

’

s book :

FIRST PERIOD—AN TIQUITY

It sometimes occurs , after recovery from illness, that convalescents ,in order to acqu ire strength , drink too great a quantity of wine ; andthat this after a certain time produces a beginning of inflammation ofthe stomach . In such c ase s

'

the teeth often fall out , the breath becomesfetid , and if the patient eats hot food , the empty alveoli as well a s thecheeks are pa infu l .”Variou s internal medicaments and dentifrice powders are prescribed forcombating this morb id condition . One of these latter includes a greatnumber of ingred ients in its composition among others , the bones ofmice .

IVIention i s also made of certain remedies , to which recourse may behad at times

,for allaying violent denta l '

pa ins , of whatsoever kind , orwhatever be the cau se that occasions them .

One of these remedies is composed of d ifferent substances (amongthem

,garlic and saltpetre), to be pu lverized and made into p ills . If

the p ain be on the left side , one introduces one of the p ill s into the rightear, and v ice v ers a .

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

Another powder is to be smelt with the right nostril o r with the leftcorrespond ing to the side on which the pain is located .

Abscesses and fistu la of the gums are spoken of as follows:It sometimes occu rs that an ab scess forms in some one point of

the gum ; this communicates great pain to the tooth near it ; the ab scessis white

, with . discharge of puru lent matter .” The treatment consi sts

in the use of different med icated powders , to be rubbed on the affectedpart . Two of the powders contain mu sk , besides several other ingredients . A lotion is also prescribed .

In the next chapter the following affections are describedI . Ya - heou .

- Gums are red,soft

,and

'

swollen,and a fetid and

puru lent matter exudes from them ; the teeth are not painful ; if thegums are lanced

,blood of a pale red color flows from them in abun

dance . This m alady is to be treated with variou s Internal medicinesand sometimes with sc arific ation .

2 . f a - s u en . Gums swollen ; little by little they are cor roded anddestroyed by ulceration, which leaves the roots of the teeth bared ; thepatient has an avers ion for hot food ; continued pain in the teeth ;discharge of puru lent and fetid mucu s ; by the slightest exposure tocold the pain becomes very violent . This affection is to be combatedwith internal remedies and local treatment (frictions with medicatedpowders ; application of an ointment of very complicated preparation).3 . Tehu en -

ya- han . The gums are painfu l for a few days ; appari

tion of the root of the tooth ; absence of u lceration . Children of five


book a long series of general remedies for every kind of toothache .

There are about forty of these, and decoctions and - powders predominateamong them

,the latter to be rubbed on the painfu l spot . Decoctions

are the form of medicament most in use among the Chinese . In thislist of about forty anti - odontalgic remedies we find as many as eighteendecoctions

,seven for internal u se , and the others to be employed as

mouth washes . Some of the latter are compounded with vinegarinstead of with water .Four remedies of the above list are to be made into a paste and formed

into p ills,to be applied upon the aching tooth .

Another medicament is also to be formed into pill s and applied insidethe ear .The following remedy is particu larly worthy of note :“One roasts a bit of garlic , cru shes it between the teeth , and after

ward mixes it with chopped horseradish seeds , reducing the whole toa paste with human milk ; one then forms it into p ills ; these are to beintroduced into the nose on the side opposed to that where the painis situated .

”

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

A powder to prevent the progress of caries is prescribed , with whichthe tooth shou ld be rubbed every day, or it may be applied on the decayedspot .Finally; two powders are also prescribed for whiten ing the teeth . One

of these is compounded of seven ingredients,among which is mu sk ;

the other has only three substances in its composition : salt (grammusk (gram ts ang

- enl—is ee (gramA therapeutic method much in vogue among the Chinese is acupunc

ture,which is used in the treatment of the greatest variety of affections

,

including those of the dental system . The doctors of the CelestialEmpire have the greatest faith in this operation

,which they hold

capable of removing obstacles to the free circu lation of humors andvital sp irits , thu s re éstablishing that equ il ib rium of the organic forceswhich constitutes health

,and the ab sence of which cau ses d isease .

The Chinese doctors prefer to use gold or s ilver needles for puncturing ; but they also frequently use needles of the best Steel . Theseinstruments vary very much in length , in th ickness , and in form ,

andthere are not less than nine d istinct kinds of punctu ring needles .Every doctor who intends dedicating himself to the practice of this

operation has to begin by the most accu rate study of the elective pointsfor puncturing according to the variou s affections ; he should alsoknow to what depth precisely to drive the needles in each case

,in order

to reach the site of the m orbific princip le and procu re convenient exit

DEN TISTRY AMONG TH E CH IN E SE 39

for it ; he ought to know equally well how long to leave the needle inthe affected part, so as to obta in the best possib le therapeutic resultsin each case .

The points of election for carrying out puncturing in various malad iesare spread over the whole supe rfic ie s of the body , and amount in numberto 388. Each of these is known by a special name . Each s ite of electionStands in determinate relations , as to distance, to the known anatomicalpoints

,and may

,therefore , be easily and precisely found by appropriate

measurement . The unity of lengt h for these measurements is calledts u n

,and is d ivided into ten fen ; its value varies , however, accord ing to

whether the said measurements be taken on the head,the trunk

,or the

extremities . For the head , the length of the tsun i s calcu lated as equal tothe distance exi sting between the inner and the outer angle of the eye ; forthe trunk , it i s equ ivalent to the eighth part of the horizontal line betweenthe two breast n ipples ; and for the extremities , it i s equal to the lengthof the second phalanx of the middle finger, measured with the jointsbent .There are twenty- s ix points of election upon which to carry out puncturing used as a remedy again st toothache . There are also six otherpoints of election for pains in the gums .One wou ld naturally be disposed to believe that these points of election

wou ld be situated in proximity to the teeth . Instead , many of them aresituated in distant parts of the body— for example , in the elbow,

in thehands , the feet, the vertebral region , the coccyx , and so on . However

,

about half of them are to be found in the labial , maxillary, and periauricul ar 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 ,hin- tche , situated at the outer extremity of the bend of the elbow,

maybe utilized in more than twenty- five morbid conditions ; among whichare p ains in the arm , paralysis of the arm , edema of the whole body,excess ive perspiring, vomiting, hematemesis, toothache , boils , gastralgia ,hemiplegia

,and even Cholera !

This mode of cure depends on the special relation of each point ofelection to the so- called canals of transmission and communication(named in Chinese hing) through which the blood and the Vital Spiritscircu late , and which serve at the same time to transmit the “ innate heat”and “ the radical moisture” to all p arts of the body .

And here we mu st be allowed a brief digression in explanation of whatwe have just said .

The anatomical notions of the Chinese are very erroneou s ; 1 their1 Se e Boui l let, work quoted at p . 3 1 .


ideas on the function s of the human body and of human life in general ,differ considerably from ours . They recognize two natural principle sof vitality, one they call yang (vital , primordial or

“ innate the

other yn (radical moisture). The spirits (that is the air) and the bloodserve as vehicles to these two essential principles of l ife ; that is , vitalheat and radical moisture . The constant equ il ibrium , the accord , theperfect union of these two essential principles of l ife constitute a stateof health . From their alteration , corruption , or disunion originate alldiseases .There are twelve principal sources of vitality in the human organism ;

that is,twelve organs from which the two aforesaid vital principles

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 thestomach are the seat and origin of vital heat . These twelve sources oflife are In intimate relation with one another by means of the canalsof communication , through which the blood and the vital Spirits (air)circu late

,carrying with them into

'

eve ry part Of the body vital heat andradical moisture .

1

The pom ts of election upon which to carry out puncturing are situatedalong the course of the large lines of communication and transmission ;and that explains

,according to the Chinese medical theories

, why apunctu re carried out on a given pointk of the body can prove u sefu l inrelieving a variety of maladies even in d istant p arts of the organism .

Puncturing is almost always associated with cauterization , for afterhaving drawn out the needl e , it i s u sual to cauterize the site of the pUncture with the so- called “moxd

,

” that is,with a kind Of vegetable wool

obtained from the l eaves and dried tip s of the artemis ia . One compresses this sub stance very tightly between the fingers into the shapeof a small cone . One next appl ies a small coin with a hole in thecentre upon the site of election ; the cone of moxa is placed on thehole in the coin and lighted at its top . AS the cone is very compact,it burn s slowly enough

,without developing excess ive heat , so that,

according to Ten Rhyne ,2 who was an enthu s iast for this mode of cure ,“ the epidermis i s drawn without violence and rises gently into a smallbli ster . The moxa , whi l st burning, draws out the p e ccant hum orsvis ib ly , absorb ing them in such a manner that they are totally consumed without destroying the skin itself.”The application of the moxa is not as painfu l as might be thought,

1 Dabry,op . Cit .

,p . x (introduction), pp . 1

, 2, 4, 10 , I I .

2 Thi s author wrote toward the end of the seventeenth century ; one of his work s is entitledDe Acupunctura .

DEN TI STRY AMONG TH E CH IN E SE 41

and even children support it without much crying . The number oftimes for repeating the operation varies according to the malady andthe site of application , etc . Thu s , in the point hin - tche , which we havementioned once before , the cauterization is generally repeated seventimes

,but in certa in cases the number may be brought up to 200 .

There are certain points of election for which puncturing alone isprescribed without sub sequent cauterization ; in other instances , the puneturing is held to be unnecessary or even dangerous ; one , therefore , onlyapplies the moxa in these cases . 1In 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 i llness in Japan , and was regardednot only as an excellent remedy

,but also as an excellent preservative ;

so much so that even convicts condemned to perpetual imprisonmenthad permiss ion 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 wou ld seem thatthis cau stic , when u sed against toothache , was u sually applied in theregion of the mental foramen 2

1 Dabry,Op . Cit .

,p . 424.

2 Se e Hi stoire de la Chirurgie depu i s son origine, par MM . Duj ard in e t Pevrihle

,Pari s

,

I 7 74 to 1 780 .

C H A P T E R I V

CUSTOMS RELATING TO THE TEETH AMONGDIFFERENT PRIMITIVE PEOPLES .

JO S EPH MURPHY, in h is book,A N a tura l H is tory of the H um an Te eth,1

s ays that the natives of Hindostan , especially the Brahmins or priestsof 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 sametime that

,turned toward the ris ing sun,

they recite their prayers andinvoke Heaven ’ s bless ing on themselves and their families . As thiscu stom is prescribed in the most ancient codes and religiou s writings ofIndia , it reverts , without doubt, to the remotest ages , and , therefore ,demonstrates the great importance that this people

,and particu larly the

Brahmin caste,has ever attributed to beauty and cleanl ines s of the teeth .

Murphy affi rms that the Brahmins , in general , have magnificent teeth ;and that this depends , certainly in great part, on the ass iduou s andscrupulou s care that they take of them .

From the writings of their ancient poets one also deduces in what highesteem the people of India held beautifu l teeth , considering them oneof the principal ornaments of the face . The lover, s ays Murphy, neverneglected , in enumerating the beauties of his l ady- love , to praise thewhiteness and regu larity of her teeth .

Among some of the people of India , when the second dentition iscompleted , it is cu stomary to separate the teeth one from the other witha file ; we do not know, however, whether this is done as an embelli shment or with some other object— perhaps

,as suggested by Joseph

Linde re r,2 to prevent caries .

Anyhow, this and other cu stoms in vogue in various parts of Indiaand in many islands of Oceanica demonstrate that these peop les attributegreat importance to the teeth

.

The substituting of gold teeth for those m i ssm g has been in use inJava from exceedingly remote times . 3Dyeing the teeth black is considered a great embellishment amongmany races of Asia and Oceanica ; th is operation is sometimes preceded

1 London,181 1 .

2 Die Zahnhe i lkunde,e tc .

,185 1 , p . 347 .

3 J . Bontii,De m ed ic ina Indorum

,1642 , l i b. iv.

CUSTOMS RELATING TO THE TEETH 43

by another, viz . , the fi ll ing up of the interdental spaces very cleverlywith gold leaf. 1In Sumatra and the neighboring island s many women file their teeth

down to the gums ; others file them into points ; or partially remove theenamel so a s to render it easier to apply the - black dye ; th is being heldto be the height of elegance . Men of high rank and condition dye theirupper teeth black and cover the lower ones with fine gold plates , whichin a full l ight produces what they consider a fine contrast . The nativesof other islands gild the upper central inci sors and dye the others black .

2

In Japan , the married women may easily be d istingu ished from theothers by their black and shining teeth . The coloring preparation theyu se to blacken the teeth is composed of urine

,rasp ings of iron

,and a

sub stance called s ahi . This m ixture has a most unpleasant odor,and

if applied on the skin acts as a cau stic . Its action on the teeth is so

powerfu l that they do not regain their whiteness even after a lapse ofyears .

1

In applying th is sub stance,and also for some time after

,the

women take care to preserve their gums and lips from its effects,as it

wou ld otherwise cause them to assume a dark blue tint . 3 The inhabitants of the Pelew Islands make u se of the wild th istle and shell chalkto blacken the teeth . It i s also the cu stom to blacken the teeth amongthe inhab itants of Tonkin and S iam

,the women of the Maria Is lands ,

and the single lad ies of Java .

Some of the peoples of Eastern India plane their teeth down to aneven level ; and from the hab it of masticating areca nuts mixed withchalk and other sub stances

,their lip s and teeth are dyed red . At

Macassar the natives have their teeth dyed red ; they also substitutemiss ing teeth by artificial ones made of gold , s ilver, or tombac .

‘1

Negroes , especially those of Abyssinia , very often fi le their inc isorsinto points to resemble the form of the canines ; this is in order to givethemselves an air of greater ferocity .

Murphy relates that the inhab itants of one of the islands of the Soundmake an inci sion in the upper lip in a parallel l ine with the mouth

,and

large enough to allow the tongue to pass . After the margins have healedthey have a great resemblance to the lip s. This kind of artificial mouthis 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 toconcil iate the favor of their god Eatoa .

5

1 Carabe l li,Handbuch de r Zahnhe i lkunde

,1844, i , 8.

2 Linde re r,Op . Cit.

3

[The newe r c ivi lization of Japan ha s caused thi s custom to large ly fa l l into d i su se .

E . c . K . ]‘1 Carabe l li , loc . c it. 5 Linde re r, loc . c it .


Among the natives of New South Wales,it i s the cu stom when a youth

reaches virility to knock out his front teeth with a stone ; this operationbeing Carried out by the huradshis orwizards .The savages of Peru are also in the hab it of making the front teeth

fall out; the reason of the cu stom is that the space thus made regardedby them as an embellishment . 1

1 Carabel l i,op . Cit .,

p . 1 7 .


The temples of IEscu lapius became so numerous in time that theywere to be found in almost every Greek city . The most celebrated werethose of Epidauru s , Cos , Cnydus , and Rhodes , as well as that of the greatcity of Agrigentum ,

in S icily . The Askle p iadi not only performed thetemple 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 resu lted that these temples became in time , through ob servation and experience

,schools of medical science .

But besides this sacerdotal medicine , there was also a lay m edicine inGreece . Many great philosophers , especially Pythagoras , Alcm eon of

Croton,Empedocles

,Anaxagoras , and Democritus , occupied themselves

with physiology,with hygiene

,and with medicine ; also the gymnasiarch s,

or directors of gymnasiums , or schools of gymnastics , an art h avingfor its end to increase physical strength and mainta in health , cu ltivatedmedicine

,particularly that part of it which concern s hygiene , d ietetics ,

and surgery as applied to the treatment of violent lesions , such as fractu res ,luxations

,etc .

The Asklepiadi often themselves imparted the principles of medicineto students outs ide their caste . Lay medicine thu s gradu ally came tosupplant sacerdotal medicine

,especially after Hippocrates , who through

his works , exercised a preponderant influence in the secu l arization of

the science . However, the Asklep iad i, on their s ide , continued to p ractisemedicine up to the time when the pagan temples fell into complete ru in ,through the advance of Christianity .

On the colum ns'of the asklepe ia arid on the votive tables were written

the names of those cu red by the god,together with indications regarding

their various maladies and the treatment by Vi rtue of which the sick hadbeen restored to health .

Surgical instruments of proved util ity were - deposited in the temples .Celiu s Aurelianu s makes mention of a leaden instrum ent u sed for theextraction of teeth (plum beum Odontagogon), which was exhibited in thetemple of Apollo

,at Delphi .

As a matter of fact, it wou ld seem more natural that this in strumentshou ld have been shown in the temple of tE sculapius , he being the godof Medicine , and believed , besides , to be the inventor of dental extraction .

On e is rather inclined by this to think that the odontagogon may havebeen deposited in the temple of Apollo before the bu ild ing of lE sculap iantemples . Indeed

,who can tell if [E scu lapiu s himself, not yet deified ,

may not have deposited there a model of thei

instrum ent he had invented !From the fact of the odontagogon in

'

the temple of Apollo being madeof lead , Erasistratu s , Celiu s Aurelianu s , and other ancient writers h avedrawn the deduction that it was only permiss ib le to extract teeth whenthey were loose enough to be taken out with a leaden in strument . But

TH E GREEKS 47

Serre 1 observes , not without reason , that if a tooth be so unsteady a sto be able to be extracted with leaden p incers

,th is may just as well

be done, and perhap s even better, by pinching the tooth between thefingers , no other aid being requ ired than a handkerchief to prevent themfrom S l ipp ing . Avul sive p incers of lead wou ld be , therefore , a nearlyu seless invention ; so it i s much more p robable , as Serre remarks , thatthe original p incers were of i ron , and that the inventor, reserving thesefor his own use , made a simple model of the same in lead (thi s beingeasier to do) and deposited it in the temple of Apollo , in order to makeknown the form of the instrument to contemporaries and to posterity

,

naturally supposing that whoever wished to copy it wou ld understandof himself, or learn from the priests , that it was to be made of i ron andnot of lead .

Portraya l of a denta l ope ration on a vase of Phoenic ian origin,found in Cr im ea (se e

Cigrand , Rise , Fa l l , and Reviva l of Denta l Prosthe s i s , pp . 60—63 and

H IPPOCRATE S . The Sacerdotal and philosophical schools of medicine ,as well as the gymnasiums

,were the three great sou rces whence Hip

poc rate s 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 , accordingto some of h is earliest b iographers

,the nineteenth descendant of E scu

lap iu s on his father’ s side

,and the twentieth descendant of Hercu le s on

his mother’ s s ide . The time of his death is even still more uncerta in1 Prakti sche Darste l lung a l le r Ope rationen de r Z ahnarz ne i- kunst, von Johann Jakob

Jose ph Se rre,Be rl in

,pp . 7 to 1 3 .


than that of his b irth , 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 fatherHe rac lide s ; but in the medical art he also had as a teacher the gym nasi

arch He rodicus of Selymbria ; besides , he studied eloquence under thesophist Gorgia and philosophy under the celebrated Democritu s . Hetreasured up all the records of medical p ractice th at were preserved inthe temple of Cos ; but according to some ancient authors he is - s aid toh ave set fire afterward to this temple , and to have left his native countryin order to flee from the resentment he had arou sed . Prob ably it was

the priests themselves who attributed the burn ing of the temple (whichcertainly t ook place at that time) to Hippocrates , out of j ealou sy for hisgrowing fame ; though it may also be possible that this great man , havingfirst collected together all that was u sefu l among the medical records th atwere to be found there

,afterward courageou sly destroyed this centre of

superstition,so that medicine

,ceasing to be confu sed with imposture

and being despoiled of the supernatu ral character attributed to it, whichp aralyzed its progres s , shou ld become a liberal and human art , basedpurely on the ob servation of clin ical facts and the study of natu ral laws .For a long time

,Hippocrates travelled in variou s p arts of Eu rope ,

Asia , and Africa , everywhere making valuable observations . He finallyreturned to his native country

,where through the practice of medicine

and by his immortal writings he acqu ired such esteem and venerationthat his compatriots almost tributed him with divine honors after death .

Not all , however, of the works that make up the so—called collectionof Hippocrates were really written by the father of medicine . Two of

his sons—Thessalu s and Draco— and his son - in - law Polybiu s also distinguishe d themselves by the practice of medicine and by their admirablewritings , which together with those of other doctors of that period wereerroneou sly included in the collection of Hippocrates ’ works . At any rate

,

the collection of Hippocrates faithfu lly represents the state of medic ineand surgery at the epoch in which he and his disciples flourished , that i s ,toward the end of the fifth and during the fourth centu ry before theChristi an era .

1

Neither Hippocrates nor others before him had ever di s sected corpses ;it i s , therefore , not to be wondered at that the anatom ical notions contained in the Hippocratic works shou ld be scarce and very often inexact .The physiological notions also are highly deficient and imperfect, whichis , indeed, very natural , for an exact knowledge of the functions of thehuman body presupposes an exact knowledge of the relative organs .

1 Guard ia,Histoire de la Méde c ine , p . 250 .

TH E GREEKS

The philosophical ideas of the time had considerable influence on themedical theories of Hippocrates and his successors . The universe wasconsidered 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 , andmoisture . Man— the most perfect being—was regarded as a “microcosmos

,

” or small world in himself, that is , a sort of compendium of thewhole universe

,and his organism ,

in correlation to the fou r primordialelements of the universe , was believed to be constituted of four fundamental humors—the blood , the pitu ita or mucus , the yellow bile , andthe black bile or atrab ile .

Health , says Hippocrates , 1 depends on the ju st relation one to anotherof the se principles , as to composition , force , and quantity, and on theirperfect mixture ; in stead , when one of the fou r principles is wanting orin excess

,or separates itself from the other components of the organ ism

,

one has a diseased condition . In fact, he adds , if some one humor flowfrom the body in a measure superior to its superabundance, such a losswill occas ion illness . If, then , the humor separated from the others collect in the interior of the body, not only the part that remains deprivedof its presence will suffer, but also that into which the flow takes placeand where the engorgement i s produced .

We have here briefly stated these generalities in order to makeourselves clearly understood in speaking hereafter on d ifferent 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 separate ly of the affections of the teeth , ju st as there i s no book in whichhe speaks separately of diseases of the vascu lar or nervou s systems , andso on . There are

,nevertheless

,a great number of passages scattered

throughout the Hippocratic collection from which we can deduce veryclearly the great importance that the Father of Medicine ascribed to theteeth and to their maladies .In the book D e carnibu s , the formation of the teeth is spoken of among

other things . It might have been supposed that Hippocrates would havebeen ignorant of the fact that the formation of the teeth commences in theintra- uterine life . This , however, i s not the case ; in fact, he says : “Thefirst teeth are formed by the nourishment of the fetus in the womb , andafter birth by the mother ’ s milk . Those that come forth after these areshed are formed by food and drink . The shedding of the first teethgenerally takes place at about seven years of age , those that come forthafter this grow old with the man , unles s some illness destroys them .

1 Hippoc ratis ope ra , Geneva ,1657 to 1662 , De natura hom inis, p . 225 .

2 Page 25 1 .

50 FIRST!

“PERIOD—AN TIQUITY

And a little farther on one reads : From seven to fourteen the largerteeth come forth and all the others that substitute those derived from thenourishment of the fetus in the womb . In the fourth septennial periodof l ife there appear in most people two teeth that are called wisdomteeth .

” 1

There is a passage in th is same book D e earnibus , in which the great .

importance of the teeth for clear pronunciation of words is alluded to °

“The body,

” says Hippocrates , 2 “ attracts the air into itself ; the air

expelled through the void produces a sound , becau se the head resounds .The tongue articulates , and by its movements , coming into contact withthe palate and the teeth

,renders the sounds distinct .”

The book De dentitione i s written in the form of brief sentences oraphorisms

,and speaks of the accidents that often accompany the eruption

of the deciduou s teeth . The most important passages in thi s shorttreatise are the following

“ Children who during dentition have their bowels frequently movedare less subject to convul s ions than those who are constipated .

”

“Those who during dentition have a severe attack of fever rarely haveconvu ls ions .”

“Those who during dentition do not get thinner and who are verydrowsy run the risk of becoming subject to convu ls ions .

“On conditions of equality, those children who cut their teeth in the

winter get over the teething period the best .“Not all the ch ildren seized with convu l sions during dentition succum b

to these ; many are saved .

”

“In the case of children who suffer with cough the period of dentition

i s prolonged,and they get thinner than the others when the teeth come

forth .

”

In the third book of Aphorisms , where Hippocrates speaks of theillnesses that p revail in the variou s seasons of the year and in the

'

various

ages of life , mention is also made of the accidents of dentition . Thetwenty- fifth aphorism says : “At the time of dentition , ch ildren aresubject to irritation of the gums , fevers , convu l sions , diarrhea ; thi s occursprincipally at the time when the canines begin to come forth , and inchildren 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 , 3 some prescriptionsare to be found against bad—smelling breath . We translate the passageintegrally

“When a woman ’ s mouth smells and her gums are black and un

healthy, one burns , separately, the head of a hare , and three mice , after

1 Page 252 .

2 Page 253 .

3 De m orbis m ulie rum,l ib . i i

,p , 666 .

TH E GREEKS 5 1

having taken out the intestines of two of them (not , however, the liver orthe kidneys); one pounds in a stone mortar some marble or whitestone , 1and passes it through a sieve ; one then mixes equal p arts of these ingred ients and with this mixture one rub s the teeth and the interior of the mouth ;afterward one rubs them again with greasy wool2 and one washes themouth with water . One soaks the dirty wool in honey and with it onerubs the teeth and the gums , in side and outside . One pounds d il l andanise- seeds

,two oboles of myrrh ; 3 one immerses these substances in half

a cotyle 4 of pure white wine ; one then rinses the mouth with it, holding itin the mouth for some time ; thi s is to be done frequently, and the mouthto be rin sed with the said preparation fasting and after each meal . It i san excellent th ing to take small quantities of food of a very sustainingnature . The medicament described above clean s the teeth and givesthem a sweet smell . It i s known under the name of Indian medicament .”

In the book D e afieetionibu s there i s a passage where it i s said thatinflammation of the gums is produced by accumu lation s of pitu ita

,and

that,in like cases , masticatories are of use , a s these remedies favor the

secretion of saliva , and thu s tend to dissip ate the engorgement causedby pitu ita .

Still more important, however, i s the following passage of the samebook 5

“In cases of toothache , if the tooth is decayed and loose it mu st be

extracted . If it i s neither decayed nor loose , but stil l painful , it i snecessary to desiccate it by cauterizing . Masticatories al so do good

,

as the pain derives from p itu ita insm uating itself under the roots of theteeth . Teeth are eroded and become decayed partly by pitu ita , andpartly by food

,when they are by nature weak and badly fixed in the

gums .Hippocrates , therefore , considers affection s of the teeth to depend

in part on natural dispositions , that i s , on congenital weakness of thedental system , in part on accumul ations of pitu ita , and the corrodingaction of the same . If a painful tooth were not loose

,it was not to be

extracted ; but one was to have recou rse to cauterization and to masticatories

,intended the one and the other to dissip ate the accumulation of

pitu ita , believed by him to be the cau se of toothache .

It i s easily to be understood that as only loose teeth were to be extracted , Hippocrates considered the extraction of teeth a very easy opera

1 The u se of c arbonate of lim e or chalk as a dentifrice evidently goe s back to antiquity .

2Unwashed wool—that is,wool not c le ansed of the fat se c reted by the skins of the anim al s

from whom it is taken— wa s m uch in use by the doctors of antiqu ity . One now obtain slanol in from it.

3 The obole was about thre e - quarte rs of a gram .

‘1 The cotyle was a l ittle m ore than a quarte r of a lite r.

5 Page 50 7 .

52 FIRST PERIOD e —AN TIQUITY

tion,notwithstanding that the instruments then in use cannot have been

other than very imperfect ; and this is C learly to be seen from a p assagein the book entitled D e m edieo, where , after having spoken of the articlesand instruments that ought to be kept in a doctor ’ s offi ce (ofi cina m edic i),he adds :

“These are the instruments necessary to the doctor’ s operating roomand in the handling of which the discip le shou ld be exercised ; as to thep incers for pu ll ing out teeth , anyone can handle them , becau se evident lythe manner ' im which they are to be u sed is simple .” 1

Having made mention of the ofi eina m edici, we think it opportuneto explain here with some precision what is to be understood by th is term .

2

Medicine and surgery were practised in anc ient times in open shop s ;this was so in Greece , and later al so in Rome . When the practice of

FIG . 8

Ve ry anc ient d enta l forcep s and two othe r denta l instrum ents exi sting in the

Archa ological Museum ofAthens.

medicine became secul arized through its abandoning the [E scu l ap iantemples

,doctors ’ shops began to arise in the most important centres of

popu l ation , to which those in need of assistance resorted or were carried .

In time these stations for the practice of mCHic ine , and particul arly ofsurgery, became more and more numerou s .The Hippocratic collection contains a special treatise (D e ofi eina

m ediei), which speaks of the conditions these places were expected tofulfil , the articles therein tobe contained , the instruments , the generalrule s relative to operations , the bandages , etc .

About six hundred years later, Galen wrote three books of commemtaries on this treatise of Hippocrates . He says

,among other th ings ,

1 Page 2 1 .

2 Se e Darem berg, Dictionnaire de s Antiqu ités Greque s et Rom aine s,art ic le Chirurgie .


depression in the middle of the nose ; the fall ing out of the upper front teethsometimes causes a flattening of the point of the nose . The fifth teethcounting from the front ones had four roots (two of which were almostunited to the two contiguou s teeth), the points of which were all turnedinward . Suppurations ari sing from the th ird tooth are more frequentthan from any of the others ; and the dense discharge from the nose andpains in the temples are specially owing to it . This tooth is more aptto decay than the others ; but the fifth does so , as well . This tooth hada tubercle in the middle and two in the front ; a small tubercle in theinternal part

,on the s ide of the other two , had “first begun to decay .

1

The seventh tooth had only one large,sharp - pointed root . In the

Athenian boy,there wa s pain in a lower tooth on the left, and in an

upper one on the right . When the pa in ceased,there was suppuration

of the right ear .”

This last fact—of the suppu ration of the ear— i s mentioned by Hippoc rate s not as a s imple coincidence , but as a fact intimately connectedwith the cessation of the toothache . This may be argued from the generalideas of Hippocrates in regard to the beginning and the resolution of

diseases . He considers a malady to be produced by a humor, whichbecomes local ized in a given point of the body . The cr is is gives exitto the peccant humor

,

2 and the mode in which this i s evacuated constitute s the critica l phenom enon ; the same may be represented either bya profuse persp iration

,by abundant u rine

,by diarrhea

,by vomiting

,by

expectoration , by bleeding or discharge of other humors from the nose ,by the is su ing of pus from the ear, and even by deposits on the teeth .

3

If by effect of organ ic sym p a thies the morbid humor, instead of beingthrown outward

,be tran sported into another region of the body , thi s

constitutes the so- called m eta s ta s is .

The hints just given will serve to render some of the passages which wequote from the works of Hippocrates more intelligib le .

In the fourth book on Ep idem ics we find among other cl in ical cases thefollowing :

“Ege sistratus had a suppuration near the eye . An abscess manifested

itself near the last tooth ; the eye d irectly got qu ite well ; there was adense discharge of pus from the nostril s ; and small , rounded p ieces offlesh were detached from the gums . It seemed as though a suppurationat the third tooth were going to take place

,but it went back ; and suddenly

the j aw and the eye swelledAnd farther on one reads :

1 The variou s ed itions he re offe r num e rou s vari ations,but the sense is eve rywhe re ob scure .

2 Se e Bou i llet, Préc i s d ’Histoire de la Méde c ine , p . 94.

3 On E pidem ic s,l ib . i i

,se ction 1

,p . 1002 .

‘1 De m orbis vulgaribus, l ib . iv,p . 1 13 1 .

TH E GREEKS 55

In Ege sistratus the two last teeth were decayed in the parts wherethey touched one another . The last had two tube rositie s ‘

above the gum ,

one on the decayed side,the other on the opposite s ide . In the part in

which the two teeth were in contact with one another there were tworoots in each

,large and similar

,and corresponding to those of the con

tiguous tooth ; on the other s ide there was only' a half root 1 and rounded .

”

Toward the end of the fourth book on Ep idem ics , we find repeated anob servation which we have already noted :

“ The third upper tooth is found to be decayed more frequently thanall the others . Sometimes a Suppuration is produced all around it .

” 2

In the following passage mention is made of a mouth wash againsttoothache

,the basis ofwhich 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 andpepper she found great relief.”2A little after we find the practice of bleeding mentioned ; and contem

porarily an allu sion tothe u se of alum~ —with regard to a painfu l swell ingof the gums

,that is to say, a gingiviti s :

“Me lisandrus suffered severe p ain and swelling of the gums ; he was

bled in the arm . Egyptian alum , if used in this malady , arrests itsdevelopment .” 4Toward the commencement of the s ixth book the following observa

tion is registered :“ Among those individuals whose heads are long- shaped

,some have

thick necks , strong members and bones ; others have Strongly archedpalates , their teeth are disposed irregu larly, crowding one on the other,and they are molested by headache and otorrhea .

” 5

While we should be tempted to attribute the knowledge of the relation sbetween malformation of the skull , ogival palate , and bad arrangementof the teeth to qu ite modern Studies , we are obliged to admit, and to ourgreat surpri se , that these relations were already noted , twenty- fourcenturies b ack

,by the great physician of Cos .

In the seventh book on Ep idem ics , a case of scorbutu s i s described ,where incense and a decoction of lentils proved u sefu l against the lesionsof the buccal cavity :

Large tubercles,of the s ize 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 mixedwith some other ingredients proved usefu l . The internal u se of thedecoction of lentils also d id good to the u lcers of the mouth .

” 6

1 That is a ve ry Short root .

2 Page 1 138.

3 De m orbis vulgaribus , l i b . v,p . 1 157 .

4 Page 1 157 .

5 De m orbis vulgaribu s, l ib . vi,se ction i

,p . 1 164.

11 Ibid .,vi i

,p . 1 223 .


In the same book there is a passage in which Hippocrates warns againstthe use of origanum ,

as harmfu l to the teeth and eyes“O riganum in drinks is harmfu l to affections of the eyes , and al so

to the teeth .

” 1

Farther on a case of necrosis of the j aw is mentioned :

Cardias , the son of Me trodorus , by reason of pains in the teeth wassubj ect to m ortification of the j aw . Excrescences of a fleshy kind formedon the gums , that grew most rap idly ; the suppuration was moderatethe molars fell out and afterward the jaw itself.Some passages in the Ep idem ics , 3 and in other books of Hippocrates ,

even when not referring directly to pathological conditions of the teethare of value as demonstrating what importance the author attaches tothe dental organs , and to the phenomena of which they may possiblybecome the s ite .In estab lish ing the diagnosis of a malady , he recommends searching

for its point of departure ; for example , if it has begun with a headache,an earac he, a pain in the side , and adds , that in some cases the natureof the malady is revealed by the teeth , in some others by swelling ofthe glands .4 The truth and importance of th is observation are not tobe doubted .

In fevers,Hippocrates considers it an unfavorable S ign if there be a

deposit of viscou s matter on the teeth , especially when the patient keep shis mouth half open , that is , when he lies in a state of stupor . 5Other prognostics drawn from the tee th or the gums are the following“Grinding of the teeth in those who have not this h ab it when in ful l

health,gives reason to fear a furiou s d elirium and death ; but if the

patient, already delirious , presents this sign , it is an ab solutely fatal one . 6It is also a most unfavorable s ign when the teeth get very dry .

“Necrosis of a tooth heals the ab scess formed at the gum .

7 Thisis very easily explained by the fall of the tooth . But Hippocrates knewvery well that the affection does not always take such a favorable cou rse ;he therefore adds

,immediately after

“In the case of necros is of a tooth the supervening of a strong fever

with delirium gives reason to fear a fatal exit . If, notwithstanding this ,1 Page 1229 .

2 De m orbis vulgaribus, l i b . vi i,p . 123 8.

2 The t it le of the se seven books of Hippoc rate s m ight cause a fa lse ide a to be conc e ived .

They do not pre c ise ly tre at of e pidemic s in the sense given to the word in the pre sent day ;in ste ad

,they d e scribe the m alad ie s which pre dom inate d during four ye ars

,in succe ssive

pe riod s of tim e,accord ing with the variations of the atm osphe ric cond itions . (Se e Litre

'

,

Introduction to the books on Epidem ic s .)4 De m orbis vulgaribus, l ib . i i i

,p . 1009 ; l ib . vi

,se ction i i i

,p . 1 1 76 .

5 De m orbis vulgaribus l ib . iv,p . 1 138 ; Aphorism s

,l ib . iv

,NO . 53 , p . 1 25 1 .

‘1 Coaca p ra notione s, No. 235 , p . 157 Pra dictorum ,l i b . i

,No. 48, p . 7 1 .

7Coaca p ra notione s, No. 236 ; p . 157 .

TH E GREEKS 57

the patie nt be saved , there will be suppuration and exfoliation of thebone .

” 1

According to Hippocrates , violent pains in the lower j aw give reasonto fear a necrosis of the bone .

”2

Gingival hemorrhage in cases of persistent d iarrhea is an unfavorable symptom .

”3 In fact, the easy and frequent occurring of hem orrhage of the gums may, in many cases , be an indication of profoundalteration of the blood , a condition seriou s in itself, but still more so whenassociated with ob stinate d iarrhea .

In different parts of the books of Hippocrates,the influence of atmos

phe ric conditions on the production of dental and gingival maladies isalluded to .

“Much inconvenience was“ caused to variou s persons at that period oftime by swelling of the fauces , by inflammation of the tongue , by ab scessesof the gums .”4

“After the snow, there were west winds and light rains ; colds in thehead , - with or without fever

,were very frequent ; in one of the patients ,

pain s were produced in the teeth on the right side,and in the eye and

eyebrow .

” 5

In more than one of his books Hippocrates speaks of special dentalor 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 h as a bad smell .” 6

In another place we read“ Among those persons who have an enlargement of the spleen , theb il iou s ones have a b ad color

,are subject to u lcerations of a bad natu re ,

their breath i s fetid,and they themselves are th in .

” 7 Finally,in the

Book on I nterna l D is ea s es,Hippocrates describes different species of

sp lenic maladies , to one of which he ass igns the following symptoms :“The belly becomes swollen

,the sp leen 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 theteeth and smell b ad ; the limbs wither, etc .

”8

The cases of splenic swellings spoken of by Hippocrates in the abovepassages mu st have been owing

,without doubt

,to grave cachectic condi

tions (among which , probably, scurvy); and we know that gingivitis ,with all its possib le consequences (among which expu l s ive periodontiti s)

1 Loc . Cit .,No. 23 7 .

2 Loc . Cit .,No. 239 .

3 Loc . Cit ., No. 241 , p . 157 ; No. 648, p . 222 .

De m orbis vu lgaribu s, li b . i i i,p . 1083 .

5 Ibid .,l i b . iv

,p . 1 1 2 1 .

Pra dictorum,lib . i i

,p . 1 1 1 .

7De affe ctionibu s

,p . 52 1 .

De inte rnis affe ctionibu s,p . 549 .


i s not only a constant symptom in scurvy,but is al so frequent in all dis

eases attended by profound disorders of nutrition .

1

Setting on edge of the teeth is counted by Hippocrates among the manysymptoms to which a protracted leucorrhea may give ri se :

“One shou ld ask women who have been troubled for some time with

a white flux whether they suffer from headache , pains in the kidneys and inthe lower part of the belly , as well as setting on edge of the teeth , dimmingof the sight, singing in the ears .”2Hippocrates had also ob served that the phenomenon of setting the

teeth on edge (stupor dentium ) may be produced as well by acids ingeneral

,also by acid vomiting ; 3 and that it may also be produced in many

individuals by a strident sound .

4

In the second book of Ep idem ics we find a proposition of the followingtenor :

“ Long- lived individuals have a greater number of teeth ; ” 5 which isa s much as to say that “ the having a greater number of teeth i s a S ignof longevity .

” This prejudice is to be found repeated by many authorssub sequ ent to the epoch of Hippocrates , and among these by Aristotleand Pliny . Not even the greatest men are infallib le ; there is , therefore , no reason to be scandalized if Hippocrates should really have falleninto such an error . Anyhow, it shou ld be ob served that only the firstand the third book on Ep i dem i cs are held to be really authentic ,while the other five were prob ably compiled by other doctors of theschool of Hippocrates who did not lim it themselves merely to gatheringtogether the many isolated notes and ob servations left in writing or derivedfrom the oral teachings of their master, but took it upon themselves tointroduce into the compilation someth ing of their own besides . It i s

,

therefore,anyth ing but certain that the abovementioned error is really

to be attributed to Hippocrates .The probable origin of this p rejudice , which certainly originated among

the people and was afterward accepted by the doctors , is easily to b eguessed at . Individuals blessed with dental arches of remarkablebeauty and perfection may sometimes convey the impression of having agreater number of teeth than others

,for those two rows of regular white

teeth , close to one another, strike the optic sense much more vividlythan teeth of the ordinary kind . This impression is somewhat analogous ,at least as regards color— to the optical illu sion which cau ses a white circleto appear larger than a black one of equal diameter . Now

,without

doubt, ind ividuals with a perfect dentu re are mostly healthy and well

Pau l Duboi s, Aide - m ém oire du chirurgien- dentiste , Pari s, 1894, 2m e partie , pp . 4 15,

2 Pra dictorum ,l ib . i i , p . 108.

2 De inte rnis affe ctionibus,p . 534.

2De hum oribus

,p . 49 .

5 De m orbis vu lgaribu s , l ib . i i, se ction vi , p . 1050 .

THE GREEKS 59

constituted , and , therefore , l ive longer, in general , than others . It i sal so to be noted that these people usually keep all their teeth to a moreor less advanced age ; and there is no doubt that among adults of the sameage

,those who have a less number of teeth

,by reason of having lost

several of them ,are

,in general

,ind ividuals whose organic constitution s

are less good , whose health is less s atisfactory, and who are , therefore ,destined in all prob ab ility to l ive a shorter time than the others . It i s ,therefore , perfectly true , bu t only in a certa in a nd v ery lim ited s ens e that“ long- l ived individuals h ave a greater number of teeth .

”

Geist—Jacob i , perh aps in order to d issipate the erroneou s s ignific a

tion of the Hippocratic proposition cited above and to place in evidencethat p art of it which may be\true , has thought well to translate it thu s :

“ He who l ives long keep s III/any teeth . But this translation does notrender faithfu lly the idea expressed in the original Greek

,of [I aX‘OéfltOt miste r) ;

(355m ; é’

youozu (l iterally , the long- l ived have more teeth); a propositionthat the most celebrated commentators of Hippocrates interpret in thesense given by us , and which Litré translates excellently well in thesewords : “

Avoir des dents en p lu s gra nd nom bre es t un s ign e de longetfz te

'

.

Notwith standing this prejudice,which su rvived vigorou sly for many

centuries , the regular number of teeth was not unknown at the time ofHippocrates . This is to be perceived from a brief treatise of the Hippocratic collection

,entitled D e hom in is s tru ctura , wherein i s written :

“ The teeth,together with the molars

,are thirty- two.

”

Am ong the many and many counsel s of practical value registered inthe works of Hippocrates , the following deserves special ment ion :

“When a person has an u lcer of long duration on the margin of thetongue

,one shou ld examine the teeth on that s ide

,to se e if some one of

them does not,by chance

,present a sharp point .” 1

In fact,it not infrequently occurs that a lingual u lcer deriving from

irritation produced by a broken or sharp tooth assumes a malign antaspect that cau ses it to be mistaken for a cancerou s u lcer, and medicalmen may even be so far misled as to advise the extreme remedy of

amputation of the tongue . If, however, the consulting surgeon has someexperience

,he will not neglect in the first p lace to examine accurately

the state of the patient’ s teeth ; it then mostly happens that after theremoval of the offending tooth a complete cu re i s obtained in a briefsp ace of time . How much anxiety wou ld not such poor sufferers bespared if physician s in general were acquainted with the counsel givenby

'

Hippoc rate s twenty- fou r centuries ago 'In Speaking of fracture of the lower j aw, Hippocrates recommends

b ind ing the teeth next to the les ion together . He distingu ishes between

1 Pra d ictorum ,l i b . i i

,p . 96 .


the complete and the incomplete fracture ; he then speaks sep aratelyof 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 theconsolid ation of the bone , using preferab ly gold wire for the purpose ;but if this be wanting, l inen thread can be u sed instead , and not onlyought the two teeth next to the site of the fracture to be bound , butseveral of the others besides .” 1

Two Gre ek appliance s exi sting in the Archa ological Museum of Athens.

Farther on , when speaking of complete fractu res , he renews th is advicein these words

“After h aving carried out the coaptation , the teeth ought, as we havesaid already

,to be bound one to the other ; thi s greatly contribute s

to obtaining the immobility of the fragments , particularly if properlycarried out .

”2

Also , in cases of fracture of the symphysis , Hippocrates recommend sbind ing the teeth together on the right and left of the lesion .

” Andafter h aving spoken of the best adapted means of constraint in suchkinds 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

1 De articulis,p . 799 .

2 Loc . Cit.


One chapter of thi s work1 is altogether dedicated to the study of theteeth ; but he also speaks of these organs in many other of his works ,particul arly in h is H is toryofAnim a ls , which is a real and proper treatiseon z oOlogy, wherein the author records a great number of notes aboutthe pecul iarities presented by the dental system , in the different classesof animal s .In sp ite of the great errors into which he has fallen , hi s ideas about

the teeth are,taken as a whole

,qu ite worthy of attention , especially

when one considers the remote epoch in which this great philosopherwrote . We will here give a brief notice of the most important of hisob servations 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 teethserve merely to divide and to chew the al imentary sub stances

,or as

instruments of offence and defence a s well . In man , the teeth serveprincipally for mastication , but the front ones have , besides, another mostimportant office

,namely, that of assisting in the articul ation of words ,

in the pronunciation of certain letters .In those animals in which the teeth also serve as weapons , it i s to be

observed either that some of them protrude like those of the boar,or that they are sharp and saw- l ike in their d isposition , as in the l ion ,the panther, the dog, etc . No animal possesses at the same time protruding and saw- l ike teeth .

The teeth are not always equ al in m i m be r in both j aws ; the animal sprovided with horns have no teeth in the front of the upper jaw ; thi s ,however, i s al so to be ob served in animals without horns , as for example ,in the camel . Among the animals provided with horn s there are nonewhich have protruding or saw- l ike teeth .

In general , the front teeth are pointed and the back ones broad . Neverthe le ss , all the teeth of the seal are pointed , with a saw- l ike disposition ,perhaps becau se this animal marks the transition from the quadrupedto the fish, all - of which , with few exceptions , have their teeth formed inthat way . Animals with saw- l ike teeth have generally very large mouth s .No animal has ever more than one row of teeth in each j aw ; howeversays Aristotle , if Ctesias2 is to be believed , there is an animal in India ,named m articora

, which has a triple row of teeth .

The molar teeth are never changed either in man or in any knownanimal ; the p ig never changes its teeth .

One can judge the age of many animals by their teeth . As the animal

1 De parti bu s anim alium,l ib . i i i

,cap . 1.

2 Cte sias, of Cnydu s, wrote variou s works,som ewhat e arl ier than Ari stotle ; one ofwhich,

the History of Ind ia,is ve ry inte re sting

,but a l so contains not a few fable s.

THE GREEKS 63

grows older, the teeth become darker in color, except in the case of thehorse

,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 knownto come forth— not without pain— very m uch later

,even so late as at

eighty years of age .

The man has more teeth than the woman ; this pecu l iarity is al so tobe found in the female of some anim als (such as sheep , goats , and p igs).

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 . Theirsurface

,however

,i s very much harder than that of the bones . The teeth ,

contrarily to all other bones , grow throughout l ife , so as to provide fortheir wearing away through mastication ; and for this reason they lengthenwhen the antagonizing teeth are wanting .

1

The teeth differ from all the other bones , therein that they are generatedafter the body has been already constituted ; they are, therefore , secondaryformations ; and precisely for this reason are able to be shed and to berenewed .

Some of the veins of the head , says Aristotle , terminate with veryslender branches inside the teeth .

2

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

The molar teeth exist in viviparou s qu adrupeds as well as in man ;in the oviparou s quadrupeds and in fish they are wanting . They serveto grind food

,a function in which the lateral movements of the inferior

jaw have , in many animals , a large share . For this reason , in animal swho have no molars

,these lateral movements do not exist .

In b irds , the beak takes the place of the l ip s and teeth ; the substanceof which it i s formed is similar to that of the horn or the nail s .In those animals which , in stead of having all the teeth sharp , are

furnished with incisors , canines , and molars , these three spec ie s of teethare disposed in the same order as in man .

The setting on edge of the teeth may be produced not only by eatingacid things

,but also simply by seeing them eaten . This sensation may

be made to cease by the use of purslane and salt .

1 This,as we l l as othe r e rrors of Aristotle , we sha l l find repe ated throughout the lapse

of c enturie s by m any authors,Galen not exc luded , who, in fact, by the authority of his nam e

,

gave them va l id confirm at ion .

2 The d istinction be twe en arte rie s and ve ins was, at that tim e,not ye t we l l known,

thoughwe a lre ady find

,in this passage ofAri stotle , a l lu s ion m ade to the re lations betwe en the te eth

and the bloodve sse ls .


In the book entitled P roblem s , many of which have reference to medicalmatters , one is to be found to the following effect :

“Why do figs , when they are soft and sweet, produce damage to theteeth ?” Perhap s

,answers Aristotle

,because the Vi scous softness of

the fig causes small p articles of its pu lp to adhere to the gums and inS inuate themselves into the dental interstice s , where they very easilybecome the cau se of putrefactive processes . But, he adds , it may

-

alsobe that harm is produced to the teeth by masticating the small hardgrains of this fru it .In Aristotle ’ s ll/I e chan ics , the following question relative to the extrac

tion of the teeth is discussed“Why do doctors extract teeth more easily by adding the weight of

the odontagra (dental forcep s) than by u sing the hand only ? Can itbe said that th is occurs becau se the tooth escapes from the hand moreeasily than from the forceps ? Ought not the irons -to sl ip off the toothmore easily than the fingers , whose tip s being soft can be applied aroundabout the tooth much better ? The dental forceps ,” adds Aristotle, “ i sformed by two levers , acting in contrary sen se and having a single fu lcrumrepresented by the commissure of the instrument . By means of thisdouble lever it is much easier to move the tooth , but after having movedit, it is easier to extract it with the hand than with the instrument .From this p assage of Aristotle one may draw variou s conclusions .

First of all “, it appears that, at that time , the extraction of teeth was acommon enough operation carried out by“ doctors in general , or, at least,by specialists not indicated by any particu l ar denomination but cal leddoctors (in Greek , ca rpoc) ju st the same as those who dealt with themaladies of every other p art of the body . If, therefore (which , however,is very doubtfu l), there existed in Greece, as there certainly did in Egypt,individuals who occupied themselves ebcclu s ioely with the treatment ofthe teeth , they cannot have formed a distinct cl ass of profess ionals ,

"

but

merely a section of the med ical class . Herodotus , too, as we have alreadyseen , does not say, speaking of Egypt, that there was a proper class ofdentists , but gives us to understand that the Egyptian doctors d id notoccupy themselves indiscriminately with the treatment of all maladies ,for some dedicated themselves to curing the eyes

,others to - the treatment

ofmaladies of the head , others to those of the teeth , and so on .

From the Aristoteli an passage on the extraction of teeth , just quoted ,it may be concluded that in those times the Hippocratic precept, th atonly loose teeth were to be extracted

, was not observed , for otherwise ,Aristotle cou ld not have said that dental forceps are usefu l to loosen theteeth , but that after th is has been done the extraction of the tooth may bemore easily effected by means of the fingers than with the instrument .This last assertion appears very Strange . It demonstrates that either

THE GREEKS 65

the instruments then in use were very imperfect , or that Aristotle , althoughthe 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 frompurely 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 thewritingspreserved to us , made no sensib le progress . But in respect to this , onemust take into consideration some historical facts of cap ital importance . The school of medicine of Alexandria , which arose about threecenturies before Christ

,numbered among its most brill iant luminaries

the celebrated doctors Herophilus and Erasistratus , who were the in iti ators of the dissection of human corp ses , 1 thus giving a great impulseto anatomical research . It is , therefore , hardly admissible that thesetwo great anatomists , who studied with profound attention even the mostcomplicated internal organs

,should have neglected the anatomy of the

teeth . Unfortunately , however, not all the resu lts of their researcheshave come down to us ; nor is this to be wondered at, especially if wereflect on the large number of preciou s works entirely lost by the de struction of the celebrated lib rary of Alexandria , A .D . 642 .

When we come to speak of Archigenes , we Shall s e e how he , in certa incases , advised trepanning the teeth . This wou ld lead to the belief thatin his times , viz .

,toward the end Of the first century after Christ , the exist

ence of the central cavity of the tooth was not ignored,and that , there

fore , the structure of these organs had already been the obj ect of study .

As to d iseases of the teeth and their treatment,there is no doubt that

Herophilus and Erasistratus mu st h ave occupied themselves with thesesubjects ; and the same may be asserted of He rac lide s of Tarentum , acelebrated doctor who lived in the th ird century before the Christian era .

Indeed , we read in Coe lius Aurelianus , 2 that the record had come downthrough the works of Herophilu s and He rac lid e s of Tarentum , of personshaving died by the extraction of a tooth .

3 The same writer also alludes toa passage of Erasi stratus

,relating to the odontagogon already mentioned ,

which was exhib ited in the temple of Apollo,and to the practical s ignifi

1 Accord ing to the te stim ony of Ce lsus,a ve ry se riou s author and in e ve ry way worthy of

be lie f, He rophi lus and E rasistratus d i sse cted not on ly corpse s,but al so l iving m en

,nam e ly ,

m a le factors consigned to them by the kings of Egypt,in orde r that they m ight m ake re

searche s into the norm a l cond itions of the organ s during life,and the ir m ode of function ing .

Se e Corne l . Ce ls .,De re m ed ic a

,l ib . i

,Pre face .

2 Coe lii Aure liani de m orbis acutis e t chron ic is,l ib . vi i i

,Am ste la d am i

,1 755 , Pars i i , l i b .

i i , cap . iv,De dolore d entium .

5 He rophi lu s e t He rac lide s Tarentinu s m ori quosdam d e trac tione dentis m em orave run t.


cation to be attributed to the fact of thi s instrument being of lead andnot of hard metal . Now, if Herophilus , He rac lid e s of Tarentum

,and

Erasistratu s all spoke of the seriou s peril to which the extraction of atooth may give rise

,and therefore recommended not having recourse to

it too lightly, it is evident that they had given seriou s attention to thisoperation and consequently also to the morb id conditions that mayrender it necessary .

C H A P T E R V I .

DENTAL ART AMONG THE ETRUSCANS .

MUCH earlier than the foundation of Rome (B .C . 753) there flourishedin that part of Middle Italy today called Tuscany the h ighly civil izedpeople known by the name of Etruscans or Toschi . Their politicalorganization had the form of a confederation of twelve principal cities , 1the federal cap ital being Tarqu inii . The Etruscan people were indu strious , intell igent, and artistic in the highest degree , possessing specialskill in the decorative arts

,splendid monuments

,some ofwhich Still remain

to us ; they were fond of luxury in all its manifestations , and took greatcare of their person s ; at the same time , however, they were a laboriou sand courageou s race

,not only most active and enterprising in agri

culture, in art and commerce , but also brave warriors and hardy

navigators .In their long sea voyages the Etru scans frequently visited Egypt and

Phoenicia , trading especially in the more flourishing cities , which wereat th at time Memphis in Egypt

,and Tyre and S idon in Phoenici a . On

the other hand,the Phoenicians

,who were also active merchants and

navigators,not only visited Etruri a and other regions of Italy very

frequently, but also established numerou s colonies in many isl ands ofthe Mediterranean , and especially in those nearer to Italy .

This continual intercourse between Etru scans , on the one side , andEgyptians and Phoenicians

,on the other

,accounts for the great influence

exerci sed by the Egyptian and Phoenician civil ization upon the laterdeveloped Etru scan culture— an influence manifesting itself very distinctlyin the works of art of the latter

,which often have an altogether Oriental

character, and not seldom represent scenes drawn from the domestic l ifeof the Egyptians and Phoenic ians . 2As to what concerns dental art

,everything leads up to the belief that

it was practised by the Egyptians and Phoenicians earl ier than by theEtruscans , whose civilization , as already hinted , i s certainly less ancient .Nevertheless , in comparing the dental appliances found

'

in the Etru scantombs with the sole authentic dental appliance of Phoenician work

1 Arre tium , Ca re , Clus ium ,Cortona

,Fa su la

,Fa le ri i

,Pi sa

,Russe lla

,Tarquin ii, Ve tu lonia

Volate rra,Volsinii.

2 Deneffe , La prothése d enta ire d ans l’

antiquité , p . 5 1 .

68 FIRST PERIOD—ANTIQUITY

m anship known at the pre sent d ay,1we cannot but be struck with the

great superiority of the Etru sc an appliances . It is therefore p rob able

F IG . 10

F IG . 1 1

FIG . 12

Denture s in te rra - cotta,such as the Etru scans u sed to pre sent to the ir d ivinitie s as votive

offe rings in ord e r to be cured,or afte r having be en cured of d enta l m a lad ie s .

1 Dr. Cigrand in his book The Ri se , Fa l l , and Reviva l of Denta l Prosthe s i s,afte r having

Spoken of the Phoen ic ian d enta l appliance de sc ribed in Renan ’

s work,add s :

“The re are

score s of spe c im ens of Phoenic ian denta l art in hom e col le ctions and a lso at the Colum bianWorld ’

s Fa ir .

”Howeve r

,unti l the se spe c im en s of Phoenic ian denta l art are de sc ri bed and

the ir origin is exactly known,the ir authentic ity wi ll a lways rem a in a m atte r of doubt .

[Cigrand is in e rror. The spe c im en s he Spe ak s ofwe re m ainly im agined .

-W. H. TRUEMAN .J

0'

FIRST PERIOD—AN TIQUITY

was already prevalent, and through the influence of Christi an ity becamegeneral during the third and fourth centuries . 1Notwithstanding cremation

,which certainly mu st have destroyed a

great number of the dental appliances of that time , and in sp ite of themany different destructive agents which success ively did their workon those human remains during so many centuries , not a few prosthetic

FIG . 13 FIG . 14

Tooth crown s found in an Etruscan The sam e tooth—crowns of the pre ced ingtom b of the anc ientVitulonia (Archa ological figure

,seen from the sid e of the concavity

Museum of F lorence). The enam e l—cap of the enam e l cap sule s.su le s of the se te eth (four m olars and one

canine) are pe rfe ctly we l l pre served , whi lstthe ivory has entire ly d i sapp e ared .

pieces of Etru scan workmanship have come down to us ; from which wemay argue that dental p rosthesis was not an exceptional fact amongthis people

,as some may perhaps suppose

,but, on the contrary, mu st

have been a very u sual practice .

The dental appliances discovered up to now among Etru scan remainsare preserved in different Italian mu seums , with the exception of somefew existing in private

'

colle c tions or of others that have passed out ofItalyi nto other countries .In the mu seum of Pope Jul iu s in Rome there is a dental appl iance

found at Va ls iarosa in one of the many Etru scan tombs excavated in thatlocality near Civita Castellana

,the ancient Falerii (Fig. This

1 Deneffe,op . Cit . , pp . 60

,6 1 .

DEN TAL ART AMONG THE ETRUSCAN S 7 1

appliance is formed by a series of four gold rings meant to encircle fourteeth (can ine , b icu sp ids , and first molar). The third ring is traversed bya pivot riveted at the two extremities , which was meant to hold fast anartificial tooth (the second bicusp id); thi s i s wanting, however . One

naturally puts the question , How is the disappearance of this tooth tobe accounted for, it having been traversed by the pivot , wh ich i s stillfound in its place ? The suppositions are two : Either the artific ial toothwas made of some not very durable material , which , in the course of time ,became reduced to powder or fell to p ieces , or may have been destroyedin some other way ; or else the artificial tooth , in stead of being simplyperforated to allow the p ivot to pass through , was cleft longitudinally atits base and

,being introduced into the ring sat, so to speak, astride the

p ivot . In the second case , which , however, seems to me the less probableof the two , the tooth may merely have come off the p ivot and gotten lost .In the Civic Mu seum of Corneto , the ancient Tarquinii, there are

two dental appliances,one of which (Figs . 16 and 1 7) is of the greatest

interest . It was found in one of the most ancient tombs in the necropolisof Tarquinii. This specimen of prosthesis is formed of three teeth ;the two upper central incisors and the second bicu sp id on the left, whichis no longer in existence .

FIG . 15

Etruscan applianc e found at Valsiarosa , d e stined to support an artific ia l bicuspid,

now d isappe ared .

To afford support and maintain the three artificial teeth in position ,the Etru scan dentist of about three thousand years ago , ingeniouslymade use of the canine and the lateral incisor on the right , the canine ,the first b icu sp id , and the first molar on the left, connecting them by acontinuous series of pure gold rings soldered together . The dentist hadnot employed human teeth to replace the incisors which the individualhad lost ; according to the religiou s laws of the time , the dead were heldsacred , and it would probably have been considered sacrilege to use theirteeth ; or it may also be that the patient had declared his avers ion to theidea of substituting his own teeth by those of a dead man . Howeverthis may be , the Etru scan dentist thought well to repace the missingincisors with a somewhat large 0x tooth ; upon this he had made a groove ,so as to give it the appearance of two teeth . In reality this ox toothoccupies the place not only of the two middle incisors

,but also of the

lateral inc isor on the left . Perhaps by a natural anomaly the ind ividual


may never have had this tooth ; or, more probably still, some length oftime may have elapsed between the los s of one of the three and the othertwo

,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 cou ld therefore be filled by an ox tooth

so adju sted as to represent only two teeth .

When I was intru sted with the reproduction of all the ancient prosthetic p ieces existing in the Italian mu seums , I met with Special difficu ltyin the reproduction of the above—mentioned p iece ; and this becau se I

FIG . 16

Etrusc an appliance for supporting thre e artific ia l te eth, two of which we re m ade

of one ox tooth. (Civic Mu seum of Corneto).

FIG . 1 7

The sam e applianc e reve rsed .

cou ld not succeed in procuring an ox tooth that was not worn away bythe effects of mastication . The idea then occurred to me of section ingthe upper jaw of a calf at about the age of the second dentition , andtaking out the teeth , which were already strong and well formed , but notyet deteriorated by mastication . I fancy my Etru scan colleague mu sthave done the same three thou sand years ago , when he carried out theprosthesis in question , for the large tooth employed by him does notshow any signs of being worn by mastication .

This large tooth is solidly fixed by means of two pivots to the gold band

DEN TAL ART AMONG TH E ETRUSCAN S 73

th at encircles it . Another pivot served to fix the second bicusp id , alsoartificial . This tooth , as already Stated , has now disappeared , but thep ivot that fixed it to its ring is still in its place . In carrying out th isprosthesis the dentist has contrived the series of rings that support theteeth in such a manner that they remained above the gum , and thu s theharmful effects of contact and of the pressure of an extraneous bodywas avoided . At the same time , this arrangement , by d istancing therings from the dental neck that narrows off conically , added to thefirmness of the prosthesis .

FIG . 18

Etrusc an appliance for supporting two in se rted hum an te eth,one of which is now wanting .

(Civic Museum of Corneto.)

Another dental appliance (Fig . 18) which is in the custody of theCivic Mu seum of Corneto , was also found in a very old Etru scantomb . It i s formed by two bands of rolled gold ; one of these is lab ial ,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 supportingthe prosthesis ; the other two maintained , by means of pivots , two insertedhuman teeth ; one of these is lost ; the other is stil l in its place , solidlyfixed by its p ivot . These in serted human teeth

,by the religiou s laws we

FIG . 19

Etruscan appliance supporting one inse rte d tooth (uppe r m idd le inc i sor on the right)whichis now d i sappe ared . (Muse um of the Conte B ruschi at Corne to.)

have before mentioned , cou ld not have been taken from corpses ; probablythey belonged to the person himself, and having fallen out throughalveoliti s

,had been reapplied in the manner described above .

Two Etru scan dental appliances are to be found in the Museum of

the Conte Bru schi at Corneto : one is s imilar to those already described ,and the other, instead , i s of a Special kind . The first (Fig . 19) i s formed


by a series of four rings , embracing the upper canine on the right and thethree neighboring incisors . It wa s destined to support a s ingle insertedtooth

,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 .

FIG . 20

Etruscan applianc e intended to avoid the bad effe cts of conve rgence , or, pe rhap s, to supporta pure ly ornam enta l artific ia l sub stitute . (Mu seum of Conte Bruschi at Corneto.)

The other appliance (Fig . 20) i s formed by two rings ;

’

the one surroundsthe left upper canine , the other the l eft

“ middle incisor . Between thesetwo rings there is not the u sual ring crossed by a p ivot, but simply asmall horizontal bar of gold soldered to the .two rings . I suppose thatthe person not liking to wear false teeth (one meets with this repugnance

FIG . 2 1

Denta l appliance sti l l adhe ring to the jaw,d i scove red in an E trusc an ne cropoli s ne ar

Orvi e to, and now in the posse ssion of the Ghent Un ive rsity .

also at the present day), the dentist has' l imited himself to putting a

horizontal bar of gold between the two teeth on either side of the miss ingone , in order to maintain them in their normal position and so avoid thebad effects of convergence .

Another ancient dental appliance. discovered in an Etru scan necropolisnear Orvieto is now in the possession of the Ghent Univers ity, to which

DEN TAL ART AMONG TH E ETRUSCAN S 7 5

‘it was sold .

1 It still adheres to a piece of upper j aw (Fig . in wh ichthere are four teeth on each side , that is , on the right , the canine , the twobicu sp id s

,and the first molar ; on the left , the canine , the second bicusp id ,

and the two first molars . The alveoli of the fou r inc isors are of normalwidth and depth , this signifying that these teeth remained in their placesuntil the end of life . The dental appliance

,still supported by this fragment

of a j aw,i s made of the purest gold . It is composed of a small band

curved back upon itself, the ends being soldered together, and , by theaid of two partitions , also of pure gold , it forms three compartments ,two small lateral ones , and one centre one of double the size . The lateralcompartment on the right contains the canine of the same side ; that on

FIG . 22

The sam e pie ce a s in the pre ced ing figure , se en from the pa lata l Sid e .

the left must have contained the left central incisor , that has now disappeared

,while the large central compartment mu st evidently have con

tained the two incisors on the right side . As there is no p ivot in thewhole appliance

,and as the alveoli are not obl iterated

,there can be no

doubt that the appliance was simply destined to p revent the loss of thetwo right incisors by keep ing them steady .

It i s to be noted , with regard to the Etruscan dental appliances abovedescribed

,that the gold bands of which they were constructed covered a

considerable part of the dental crown , so that these prosthetic appliancescertainly cou ld not have had the pretension of escap ing the notice of

1 Deneffe , op . Cit .,p . 63 .

76 FIRST PERIOD é AN TIQUITY

others,they being

,on the contrary , most visib le . It is in consequence

to be surmised that in those times the wearing of false teeth and otherkinds of dental appliance was not a thing to be ashamed of; indeed ,that it rather constituted a luxury , a sort of refinement only accessible topersons of means . Besides thi s , as the gold in which these works werecarried out was of the purest qri ality and in consequence very soft, theappliances would not have posses sed sufficient s olidity if the softness ofthe pure gold had not been counteracted by the width and thicknessof the bands or strips .

FIG. 23

Etrusc an appliance (found in 1 865 in a tom b by Ce rve tri), d e stined pe rhap s to Support a

pure ly ornam enta l artific ia l sub stitute . (Be longing to Ca ste l lan i’

s col le ction ,Rom e .)

FIG . 24

A reproduction of the gold pie ce form ing the applianc e se en in Fig. 23 .

In those of the Etru scan appliances destined for the application of

in serted teeth,the gum wa s not made to support the prosthesi s

,and did

not,therefore

,suffer any compression from the extraneou s body

,th is

resting entirely,l ike a b ridge

,upon the neighboring teeth. From which

it may be seen that twenty- five centuries and more before our timethe Etruscans dentists already practised a system of bridge work

,and

,

relatively to the age , carried it out with sufli c ient ab ility .

7 8 FIRST PERIOD—AN TIQUITY

(to the corpse); but it shall not be unlawfu l to bu ry or to bu rn it with thegold with which the teeth may perchance be bound together .”

From this it resu lts that at the time when the ’ Law of the TwelveTables was written , that is , fou r centuries and a half before the Christian '

era,there were already individuals in Rome who practi sed dental opera

tions . And these individuals cannot have been medical men , as at th atepoch (corresponding pretty nearly with the date of Hippocrates

’ birth)Rome had as yet no doctors .The inqu iry naturally suggests itself whether the gold mentioned in

the legal dispositions above cited was used for fixing artificial teeth orsimply for Strengthening unsteady natural teeth . Some a uthors, Serream ong them

,

1 have pronounced in favor of the first hypothesis , others ,as

,for example , Geist -Jacob i

,

2 are rather d isposed to accept the second .

In truth , however, we do not possess sufli c ient historical d ata to definite ly resolve this problem . I myself am rather of op inion that artific ialteeth were already in use in Rome , as they were , even before this time ,among the Etru scans . Indeed , ifwe take into consideration the priorityof the Etru scan civilization to the Roman and the relations of vicinityexisting between Etruria and the Roman State , of which it afterwardbecame a part , it i s even possib le that dental p rosthesis was first prac ti sedin Rome by Etru scans .In a Greek- Roman necropoli s near Teano (Province of Caserta , Italy)there wa s found in February , 1907 , a prosthetic p iece of a very pecu li arconstruction , and which may be considered

‘

as qu ite uniqu e in its kind .

It i s an appliance destined to support three inserted human teeth (thetwo lower central incisors and the lateral inci sor on the right). Theseteeth— lost perhap s by the patient himself

,in conseque nce of alveolar

pyorrhea —were fixed by m eans of a system of rings,made of laminated

gold wire,turned around the teeth and then soldered .

By the examination of the p iece it i s easy to argue that the author ofthi s prosthesis made at first three separate rings by tightly turning thelaminated gold wire around each of the three teeth to be applied , and bysoldering together the end s of the wire forming each ring

,after h aving

taken away the tooth,in order not to spoil it in making the soldering .

Then , with another laminated gold wire of sufli c ient length,

-he solderedthe three rings together in du e position , put the appliance in the mouthand turned the two end s of the wire around the sound teeth , servingas a support for the l ateral inci sor on the left a nd the two canines .

After th is , he took the apparatu s delicately out of the mouth , made thesoldering necessary for fini shing the skeleton of the apparatu s

,forcibly

1 Josef Se rre,Z ahnarz ne i kun st

,Be rlin,

1804, p . 6 .

2 Ge i st- Jacobi,Ge schichte de r Zahnhe i lkunde

,p . 26 .

TH E ROMAN S 7 9

put the three teeth in their re spective rings again , and applied the prosthesi s .This ingeniou s appliance wa s found still adherent to the mandible of

-

a skeleton,in a tomb which

,accord ing to the eminent archa ologist

Dall i O sso , belongs to a period compri sed between the third and thefourth century before Christ .From the nature of the objects found in the tomb near the skeleton (anecklace

,perfume vessels , etc .) it was quite evident that the skeleton

bearing the above - described p rosthesi s wa s th at of a woman .

As the said appliance was found in South Italy (the ancient MagnaGra c ia”) it i s qu ite p robable that it was made by some denti st of theGreek colonies .The above apparatus belongs to the archeological collection of SignorLuigi Nobile

,in Teano

,in whose possession it was found

FIG . 25 FIG . 26

Se en from behind . Seen from above .

A prosthetic pie c e of very pe cu liar construction (see d e scri ption), found in 1907ne ar Teano

,Ita ly.

The Romans , as well as the Hebrews , and other people s of antiqu ity ,attributed great importance to the integrity of the dental system . Thismay be ‘

deduc e d with certainty from another article in the Law of theTwelve Tables (Table VII, at the rubric D e de lictz s), which says :

“

Qu i

dentem ex ging i<v a ex cus serit l i bero hom z n z

,tre centis a s s zbu s m u lta zor

,

gu i s er<vo C L . (Whoever shall cau se the tooth of a free man to fall

shall p ay a fine of three hundred a s,and for that of a slave one hundred

and fifty .) The a s was worth about ten cents American money, so thatthe first fine amounted to about thirty dollars and the second to aboutfifteen dollars . These sums

,becau se of the difference in the monetary

value in those times,were considered heavy fine

After the Romans had conquered Greece ( 146 B .C .) a very great numberofGreek doctors“went to Rome . The wealth

,luxury , and ever- increa sing

corruption of the metropolis cau sed the practice of the medical art (whichwas almost entirely in the hands of the Greeks) to become a great sourceof lucre . But an art practised with the sole purpose of making moneysoon 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 recordedin history .

Among these few,the name Asclepiades (born at PruSa , in Asia Minor ;

died in Rome ninety- six years B .C .) shines with particu lar lu stre . Hewas the founder of the “ methodic school ,” whose curative precepts ,largely based upon

'

hygiene , come nearer to those of modern scientificmedicine . Unfortunately, all the writings of this great physician , whosename is almost as gloriou s as that of Hippocrate s ,

‘

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 withoutdoubt to Cornelius Celsu s , ofwhom we will now speak .

CORNELIUS CELSU S . The historical researches in regard to the lifeof this celebrated author have given but meagre resu lts . It is uncertainwhether his b irthplace was Rom e or Verona . The precise dates of hisbirth and death are also unknown ; but it i s very probable that he wasborn about thirty years before Christ, and that he died du ring the fifthdecade of the first centu ry .

Aulus Corneliu s Celsu s be longed'

to the illu strious patrician “

familyof the Corne lii . He was a man of great erudition , and wrote on themost varied subjects , and among others , on agriculture , on rhetoric ,on the art of warfare, on medicine , etc . All these writings , however, arelost to us excepting his excellent treatise on medicine .

Some historians consider that Celsu s was a true doctor by profes s ion ;others , instead , hold that he never undertook the cure of the s ick . Neitherthe one nor the other of these op inions i s quite acceptable ; and it is muchmore likely , as Darem be rg observes in his valuable H is toire des S ciencesMe

'

dica les , that Celsu s wa s one of those philiatri mentioned by Galen ,who had studied medicine rather from books than at the bedside of thesick, but who, although not doctors by profession , in case of necess ity,put

“ their knowledge and skill into practice on behalf of their relationsand friends . 1The work of Celsus

,gathered in great part from Greek authors

,has

an especial value , becau se it sums up , in an admirable manner, the wholeof the medical and su rgical science of the ancients

,from the earliest

times up to the days of Augustu s .The first book of the work D e Medicina 2 does not contain anything

of great importance in regard to dentistry . The following hygienic precept is , however, worthy of note : “ After ris ing

,if it be not winter

,the

mouth shou ld be rinsed with a quantity of fresh water .” In regard to

1 Se e note , p . 1 5 , Hi st . Re lations of Me d i c ine and Surge ry,Al lbutt . (C . M .)

2 A. Corn . Ce lsi de Med ic ina li bri octo,Patavu

,MDCCXXII.

TH E ROMAN S 81

the hygiene of the mouth , nothing more is found in the work of Celsu s ;and it is also necessary to note that the aforesaid precept forms part of achapter

,in which he speaks of the rules of life , which mu st be observed

by weak people,to which class— the author remarks— belong a greater

part of the inhab itants of cities and almost all l iterary men . Accordingto Celsus

,therefore , perfectly healthy and strong people would not even

need to wash their mouths with fresh water, and perhaps the keen - wittedRoman doctor was not wrong ; for it is very probable that the salivaand mucou s secretion of the mouth , in perfectly healthy individuals withnormal constitutions

,have the power of combating the pathogenic germs

that produce caries and other d iseases of the teeth and mouth . In th isway the fact can be explained '

of many peasants and the greater part ofthe individuals of the negro race having such good teeth , without possessing even the remotest idea of what hygiene of the mouth may be . Andhere I venture to refer to a passage in which Celsus alludes tothe relationbetween diseases and civil ization with its vices : “

It i s p robable thatin anc ient times

,although there was but l ittle knowledge of medicine ,

health was for the most part well p reserved ; th is being due to goodhabits

,not yet spoiled by intemperance and id lenes s . These two vices

,

first in Greece and then among us , have brought upon u s a very host ofevils ; whence it i s that in our days , in sp ite of the intricate art ofmedicine—once not necessary to us , as it is not necessary to other peop les—fewamong us attain the beginning of old age .

”

In the second book,speaking

'

of the various kinds of disease to whichthe different periods of life are subject

,he writes : “ Children are espe

c ia lly subject to serp iginous u lcers of the mouth , called by the Greeksaphtha . There are also infirm itie s due to dentition, such asu lceration of the gums

,convuls ions , fever, looseness of the bowels ; and

it is especially the eruption of the canine teeth which ' produces thesedisturbances . To these, however, very fat children are more particu larlyliable, and those , also , who have costive bowels .”In Chapter XXV of the fifth book we find the receipt for a narcotic

d rug, recommended by the author for producing sleep in persons torm ente d with odontalgic and other pains . This receipt i s very compl ic ated , being composed of ten ingredients , among which are acorns ,castoreum , c innamon , poppy, mandrake , and pepper .Most important for our subject 18 Chapter IX ,of the sixth book,whe re the

author treats ofodonta lgia .

“In toothache , which may be numbered among

the worst of tortures , the patient,” says Celsu s , “must abstain entirelyfrom wine , and at first, even from food ; afterward , he may partake ofsoft food , but very sparingly, so as not to irritate the teeth by mastica

1 Ce lsus,lib 1 Pre face .


tion . Meanwhile by means of a sponge he mu st let the steam of hot waterreach the affected part

,and apply externally, on the Side corresponding

with the pain,a cerate of cypress or of i ri s , upon which he mu st then

place some wool and keep the head well covered up . But when the painis violent

,the use of purgatives is very beneficial , the appl ication of

hot cataplasms on the cheek,and the keeping in the mouth of some hot

liqu id,prepared with fitting medicine, changing this liqu id , however,

very frequently . For this pu rpose the root of c inquefoil may be boiledin wine

,or that of hyoscyamus (henbane), or a poppy- head , seedles s

and not too dry,or the root of the mandrake . But in regard to the la st

three remedies,one mu st be carefu l not to swallow the decoction whil st

it i s kept in the mouth . For the same purpose one may boil the barkof the root of the white poplar in wine , or the scrapings off a stag’ s hornin vinegar or figs in mu lse 1 or in vinegar and honey . It is u sefu l also topass repeatedly around the tooth the end of a probe which has firstbeen wrapped around with wool and then dipped in hot oil . It is cu stomary also to apply around the tooth certain remedies , after the manner ofplasters . For this purpose the inside of the peel of dried

,bitter pome

granates may be pounded with equal quantities of gall - nut and pine barkto these must be added a little minium2 and the whole mixed togetherwith the addition of rain water to form a paste ; or else a similar pastemay be form e d with equal parts of panax , 3 poppy, peucedanum ,

4 andtam inia grape 5 without stones ; or with three p arts of galb anum to one ofpoppy . On the cheek, however, mu st be applied at the same time thecerate spoken of above , covered over with wool .”

Celsu s then speaks of a revu ls ive adopted , in h is times , against odonta lgia . It was composed of myrrh and cardamom , ana one part ; saffron ,pyrethrum , figs , pepper , ana fou r p arts ; mu stard seed , eight parts . Theplaster, spread on l inen , was to be applied on the shou lder correspondingto the side of the pain , and , according as this was S ituated in a tooth ofthe upper or lower j aw, the revu l s ive was applied on the back of theshou lder, or in front .When a tooth is decayed , Celsu s advises that there shou ld be no hastein drawing it ; but that the pain be combated , if the above medicines arenot sufficient

,with others more energetic . A mixtu re may

, for example

1 Wine with honey.

2 [M in ium is an anc ient nam e for red oxid e of le ad ; it wa s a lso applied to m e rcuricsu lphid e or ve rm i lion

,and the te rm ve rm i lion was a lso used as a d e signation for granum

tinctorum or herm es , the coccus il icis,

a variety of cochine a l extol led by Galen for its

m ed ic ina l prope rtie s . The exact nature of the m e aning of m inium in thi s conne ction is

not a ltogethe r c le an—E . C . K . ]5 A Spe c ie s of he rb (all- he a l). 4 Peucedanum offic ina le

,hog’ s fenne l .

5 A spe c ie s of wi ld grape thus cal led be cau se it is red like m in ium (ve rm i lion).

TH E ROMAN S 83

be applied to the tooth , composed of one part of poppy , two of pepper,and ten of sory , 1 pounded and mixed to a paste with galbanum ; or else ,espec ially in the case of a molar tooth , the remedy ofMenem acus , resulting from saffron , one part ; cardamom , soot from incense , figs , pepper ,pyrethrum

,ana four parts ; mu stard seed , eight parts ; or even a more

complicated remedy made with pyrethrum,pepper

,and elaterium

,

2

an a one part ; scissile alum ,

3 poppy,tam inia grape , crude su lphu r , bitu

men,laurel berries , mustard seed , ana two parts .

“If, says Celsu s , the pain renders necessary the removal of the tooth ,

this may be made to fall to p ieces , by introducing into the cavity a pepperberry without its skin , or a berry of ivy, pared in the same way . Thesame resu lt may be obtained in the following manner : The sharp bone(acu leu s)of that flat fish called by the Greeks trygon and by us pastinaca ,mu st first be roasted and then reduced to powder and mixed with res in

,

so as to form a paste ; which applied around the tooth will make it fallout . Likewise , scis sile alum

' induces the fall of the tooth , when introduc ed into its hollow . This sub stance , however, i s best introducedinto the small cavity

,after being wrapped around with a tuft of wool

,

for thu s the pain is soothed and the tooth preserved .

”

Somewhat curiou s is the following pass age,in which Celsu s Speaks

of the superiority of a method of cure u sed by peasants , compared to theremedies advised by the doctors . From his words we clearly se e thathe , as we have already remarked , did not belong to the cla ss of doctorsproperly so called .

“These are the remedies accepted and held in account among thedoctors . But it is known through the experience of peasants , that whena tooth aches one mu st p luck up wild mint by the roots , put it into alarge vessel , pour water on it, and make the patient s it near it , covered allaround with a blanket ; and red hot stones shou ld then be thrown into thewater, so that they be entirely immersed ; and then the patient , wrappedall a round

,as we have said before , and keep ing his mouth open , receives

into it the steam evaporated from the water . Thus profuse perspirationis induced , and a great quantity of pitu ita flows from the mouth , and withthis a cure is obtained for a very long period , often for more than a year .In the six following chapters of the s ixth book , Celsus treats of the

d iseases which affect the soft parts of the mouth . Against tonsillitis ,he recommends

,among other things

,the application of a remedy prin

c ipa lly made of the ju ice of the sweet pomegranate , cooked , by a slow fire,

1 Spe c ie s of m ine ral . [An im pure coppe r su lphid e —E . C. K .]2 Condensed juice of the se ed s of the m om ord ica e late rium

,a bitte r

,i rritating

,and

dra stic sub stance .

2 Accord ing to De Giorgi (Sinonim ia chim ico- farm acote cnica,Mi lan

,sc i ss i le

a lum is one of the m any nam e s for blue vitriol or su l phate of coppe r.


to the consistency of honey . The same remedy is also of great value ,according to the author, for the cure of u lcers of the mouth , when theyare accompanied by inflammation , and are somewhat fou l and of areddish color . But under such C ircumstances it will al so be necessary tokeep frequently in the mouth an astringent decoction , to which a littlehoney has been added . The exerc ise of walking is also profitable, aswell as the taking of food that is not acid . When , however, the ulcersbegin to be clean

,the mouth shou ld be frequently filled with a softening

liqu id or even with simple pure water . It i s al so helpful to drink genu inewine and to eat rather freely, avoid ing, however, acid food . The ulcersmu st be sprinkled with a powder composed of two parts of sciss ile alumto three of unripe gall- nuts . If, however, the u lcers are already coveredwith a scab similar to those produced on burns

,some of those compos i

tions shou ld be u sed which are called by the Greeks anthem »

; for example ,a remedy may be formed of equal parts of cyperu s

,

1 myrrh,s andarac

,

and alum ; or another which contains saffron , myrrh , ana two parts ;iris

,scis sile alum , sandarac , ana fou r p arts ; cyperus , eight parts .

“Much more dangerous , s ays Celsus , are those u lcers of the mouthwhich the Greeks call aphthce ; they oftentimes lead to death in children ;in adu lt men and women , however, there is not the same danger . Theseu lcers begin in the gums ; then they attack the palate and the whole ofthe m outh, '

and finally extend to the uvu la and to the fauces ; when thesep arts are attacked , it i s not very likely that a child will recover .”

As to the u lcers of the tongue , Celsus s ays that those which are situ atedat the borders of this organ last a very long time

,and he adds : “

It

shou ld be seen whether there may not be some sharp tooth opposite,

which hinders the u lcer from healing ; in ca se such a tooth exists , it shou ldhave its edge taken off with a file .

”

He then passes on to speak of the diseases of the gums : Oftensmall p ainfu l tumors , called by the Greeks paru lides , are produced onthe gums . It i s necessary at the very first to rub them softly withpowdered salt

,or with a mixture of burnt mineral s alt

,cyperu s , and

catmint, meanwhile keeping the mouth open until there flows from ita good quantity of pitu ita ; after which the mouth must be rin sed with adecoction of lentils . But if the inflammation is great, the same remediesmu st be u sed as are adopted for the u lcers in the mouth

,and between the

tooth and the gum must be inserted a small tent of soft lint, on which hasbeen smeared some one of those compositions which we have said are calledantherce . If this , owing to the hardness of “ the tumor

,i s not poss ible

,

then by means of a sponge the steam of hot water shou ld be made to act1

[The cyp erus rotundus , re com m end ed by Dioscorid e s in the tre atm ent of ulce rs in the

m outh. E ste em ed a lso by the Arab m ed ica l write rs Se rapion,Avi cenna , and Rhaze s . Not

the cypre ss,cupres sus s em p erv irens .

—E . C . K .J


Chapter XII of the seventh book is , of all the work of Celsu s , the onewhich presents to us the greatest interest, since there the author treats ofthe su rgical Operations requ ired by the diseases of the dental apparatu s .He first speaks of the looseness of the teeth , cau sed by the weakness of

their roots,or by the flac c id ity of the gums , and says that in these cases

it is necessary to touch the gums lightly with a red - hot iron , then to smearthem with honey and wash them with mu lse , and later on to strengthenthem by means of astringent substances .

“When a tooth aches,and it is thought well to extract it, becau se

medicaments are of no use , the gum mu st be detached all around , and

then the tooth mu st be shaken until it i s well loosened , it being very dangerous to draw a firm tooth , as th is may sometimes give rise to a dislocationof the lower j aw . And greater still i s the danger in regard to the upper

FIG . 27

Denta l and surgic a l instrum ents re pre sented in a fune ra l m arble of theLate ran Museum

,Rom e .

teeth , as this might cause a shock to the temples and eyes . After havingwell loosened the tooth

,it must be pu lled out by the fingers

,if this is

poss ib le ; or if not , with the forceps .It i s Clear that this method of tooth drawing—so excess ively cautiou sand timid—mu st have been very torturing to the poor patients . Athousand years and more after Celsu s , Abu lcasis still counsels the sameexaggerated precautions , and says that the extraction of a tooth mu stnot be performed in a rapid and violent way after the manner of thebarbers . From this one may se e that the operation spoken of was thenvery often performed by certain unprofessional persons

, who, being veryfamiliar with it, carried it out with great indifl e renc e and rapid ity, thu ssparing the patients the long- protracted martyrdom which the erud itedoctors , followers of Celsu s , thought necessary to make them endure .

Very probably the same happened in the days of thewise Roman doctor .

THE ROMAN S 87

When there is a large cariou s hollow in the tooth to be extracted,

Celsus recommends that it shou ld first be filled up either with lint orwith lead

,in order to prevent the tooth from breaking under the pressure

of the instrument . “The latter,

” he continues , “ must be made to act ina straight d irection

,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

fractu res the latter . When after the extraction of a tooth much bloodflows from the wound , this indicates that some part of the bone has beenbroken . It i s necessary then to search for the detached piece of bonewith the probe and to extract it with the forceps . If this be not successful , an incision mu st be made in the gums ju st as large as is necessaryfor the extraction of the fragment . When this i s not taken out, it oftenhappens that the j aw swells in“ such a manner as to prevent the patientfrom opening his mouth . In such a case it is necessary to apply to thecheek a hot cataplasm of flour and figs , so as to induce suppuration afterwhich the gums must be lanced and the spl inter of bone extracted .

When the teeth show blackish stain s , Celsus advises such stain s to bescraped away, and the teeth afterward to be rubbed with a mixture ofpounded rose leaves , gall- nuts , and myrrh , and the mouth to be frequentlywashed with pure wine . It is necessary besides , s ays the author , to keepthe head well covered

,to walk a great deal

,and to partake of no acid food .

“If by effect of a blow or other acc ident some of the teeth become

loose , it i s necessary to bind them with gold wire to the neighboringfirm 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 th rown .

”

“When in a child a permanent tooth appears before the fall of the milktooth

,it is necessary to dissect the gum all around the latter and extract

it ; the other tooth mu st then be pu shed with the finger, day by day,toward the place that was occupied by the one extracted ; and th is is tobe done until it has firmly reached its right position .

“Now and again it happens that when a tooth is pu lled out its root

remains in the socket ; it i s then necessary to extract it at once, with theforceps adapted for the purpose , called by the Greeks r iz agra .

”

The last book of the work of Celsus treats ch iefly of fractures anddislocations . In the first chapter the position and form of the bones ofthe whole human body are described

,although not very exactly . Speak

ing of the teeth,the author says : “The teeth are harder than the bones ,

and are fixed,some on the m a x illa (lower j aw) and some on the over

hanging bone of the cheeks .” 1

1 Ce l sus d id not know of the uppe r m axi llary bone s as d istinct bone s . The sam e m ay be

sa id of the othe r bone s of the he ad . Ce lsus spe aks of the osseous suture s and open ings ,but not of the d iffe rent bone s of the skul l and face .


The first four teeth,being cutting teeth (incisors), are called by the

Greeks tom ici . These are flanked on both sides by one canine . Beyondthis there ordinarily exist

,on both sides

,five grinders

,except in the case

of those person s in whom the last molars,which commonly are cut verylate

,have not yet appeared . The incisors and the canines are fixed

with one single root ; but the molars at least with two , some even withthree or four . In general , the shorter the tooth , so much the longer i sits root . A straight tooth commonly has a straight root

,a curved

tooth has it generally curved . The root of a temporary tooth p roducesin children a new tooth

,which u sually pu shes out the first ; sometimes ,

however,the new tooth appears either above or below it .”

In the seventh chapter Celsu s treats of fractu res in general, but inparticul ar of those of the lower j aw .

“To reduce a fractu re of this bone,it should be pressed in a proper

manner, from the inside of the mouth and from the outs ide, with the forefinger and thumb of both hands . Then in the case of a transverse fractu re(in which case generally an unevenness in the level of the teeth is p roduc e d), it i s necessary, after having se t the fragments in place , to tietogether the two teeth nearest to the fracture with a silk thread , or el se ,if these are loose

,the following ones . After this , one shou ld apply

externally, on the part corresponding to the les ion , a thick compress ,dipped in Wine and oil and sprinkled with flou r and powdered olib anum .

This compress is to be fixed by a bandage or by a strip of soft leather ,with a longitudinal sl it in the middle to embrace the chin , the two .endsbeing tied together above the head . The patient mu st fast the first twodays ; then he may be nourished with liqu id food , but in small quantities ,ab staining, however, completely from wine . On the third day it is ne c e ssary to take off the apparatu s

,and after h aving 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 generallyhappens from the seventh to the ninth day . After the symptoms of inflam m ation have vanished

,the patient may take abundant nourishment ;

he mu st, however, abstain from chewing until the fracture i s completelyconsolidated ; and , therefore , he will continue to nourish h imself withsoups and like food . He mu st also entirely abstain from speaking,especially during the first few days . Fractures of the jaw commonlyheal from the fourteenth to the twenty- first day .

“In luxations of the j aw (Chapter XII) the bone i s always disp laced

forward ; but sometimes only on one side , and sometimes on both sides .When the dislocation is only on one side

,the ch in and the whole j aw

are found deviated toward the part opposite to the luxation ; and thesimilar teeth of the two dental arches do not correspond ; but insteadunder the upper incisors will b e found the canine tooth of the di slocated

THE ROMAN S 89

part . If, however, the luxation is b ilateral , the chin incl ines and projec ts forward ; the lower teeth are farther in front than the upper ones , andthe mu scles of the temples are tightly stretched . The reduction of theluxation must be performed as qu ickly as possible . The patient havingbeen made to sit down

,an ass istant holds the head firmly from behind ; or

else the patient i s made to s it with his shou lders against a wall,with a

hard cushion between this and his head,whilst the assistant holds the

head aga inst the cu shion,and so keeps it steady . Then the operator ,

after wrapping his two thumbs in linen cloth or strips , that they maynot sl ip

,introduces them into the

’

patient ’ s mouth and,applying the other

fingers on the outside,firmly grasps the j aw . Then whilst lowering the

back part of the latter, he shakes the Chin and pu shes it upward andbackward , seeking to shut the mouth , and in this way making the j awreturn to its natural position .

“The bone having been replaced,if the accident shou ld have given

rise to p ains 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 liqu id food , and abstain , as much as possib le , fromspeaking .

”

CAIUS PLINIUS S ECUNDUS . After Celsu s,a very celebrated writer

on medic ine and natural sc ience was Caiu s Pliniu s Secundus . Hewas born at Como in the year 23 of the Christian era , and flourishedfrom the days of Nero to those of Vespasian . Endowed with a liberaleducation , he gave himself up to public life , fill ing many important posts ,among which , that of Governor of Sp ain under Nero and his successors .In the year 79 after Christ, while he was in command of the Roman fleetat Misenum , the tremendou s eruption of Vesuvius took place , by whichPompeii , Herculaneum ,

and other neighboring cities were destroyed .

Pliny, driven by the desire to study that marvellou s and awfu l naturalphenomenon , betook himself to Stab ia , but was there suffocated by theashes and smoke erupted by Vesuviu s .In sp ite of the many places occup ied by him

,Pliny found time to write

many works,and among these the thirty- seven books on N a tu ra l H is tory ,

which have given him eternal fame .

It i s not at all to be wondered at that this immense work contain sa 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 , andwhen all scientific critici sm was impossib le

,for the very simple reason

that true science did not exist .To give an idea of the great absurdities which were believed in at thatepoch , and which were considered poss ible even by higher intellects suchas Pliny ’ s

,the following passages wil l suffice : In many mountains of


India , according to what Cte sia writes , there are men with dogs ’ heads ,who clothe themselves with the skins of wild beasts and bark instead ofspeaking . There are also a kind of men having only one leg, and whohave great speed in leaping . Others are without any neck and havetheir eyes between their shou lders . Megasthene s writes that among thenomad Indians are men who instead of a nose have only holes , and h avetheir legs bent like serpents . At the extreme confines of India , towardthe East

,are men without any mouth and with their bodies entirely

covered with hair, who l ive on nothing but air and odors , which they

inhale through the nose .

” 1

In Pliny ’ s day the most prodigiou s 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 .

” 2

It mu st not be thought that Pliny accepted such beliefs without reserve .

He notes them , because preceding authors had accepted them , andbecause if certain things appear to us evidently absurd , their ab surditycou ld not be equally evident at a period when little more than nothingwas known in regard to physical and physiological laws , and when theimpossib ility of rationally explaining natural effects led men to admitthe existence of marvellou s virtues and influences in every being and inall bodies . On the other hand

,Pliny expressly says , for his own ju sti

fic ation , in Chapter I of Book VII : I do not want to b ind my faith inmany things which I am about to say ; but rather refer the readers to theauthors 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 childrenare born with teeth

,and after having cited, as examples , Manius Curius ,

who was therefore called Dentatu s,and Gna us Pap irius Carbo , both

illu striou s men,he adds :

“In women such a th ing was considered a bad augury in the days

of the kings . In fact,Valeria having been born with teeth , the seers

said that she wou ld be the ru in of the city to which she wou ld be taken ;she was sent to Sue ssa Pom etia

,which in those days was a very flourish

ing 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 bu rn with

the rest of the body . And yet these teeth,which with stand the flames

,

are worn away and hollowed out by pitu ita . They wear out by being

1 C. Plini i Se cundi, - Hi storia Mund i,li b . Vi i

,cap . 11.

2 Lib. xxiv,cap . cxi.

THE ROMAN S 9 1

u sed . Nor are they necessary for mastication alone , for the foremostones regu late the voice and words

,producing by the beat of the tongue

special sounds .“Men have thirty- two teeth

,women a lesser number . It i s

,however

,

believed that augury may be taken from the teeth ; and to have a greaternumber than usual is conside red an indication of long l ife . The presenceof two eye teeth at the right side of the upper j aw presages favorablefortune

,a s was verified in Agrippina , the mother of Domitiu s Nero ;

on the left side , however, they are - of sad foreboding .

”

“The last teeth, which are called the genu ine teeth , appear toward the

twentieth year of age ; many persons , however, do not have them until theireightieth year . Teeth fall out in old age and then spring up again ; ofthis there can be no doubt . Mutianus writes of having known a certainZ ancle of Samothracia , in whom teeth reappeared after he had completedhis one hundred and fourth year . Tim arcus, son ofNicoc le s of Paphu s ,had two rows of molar teeth , whilst a brother of his d id not change h isincisor teeth at all

, which , therefore , wore down little by little . Thereonce lived a man who had a tooth in h is palate . The can ine teeth , whenby any chance they fall out

,do not reappear any more .

” 1

“In the teeth of man there exists a poisonous sub stance which has the

effect of dimming the brightnes s of a looking- glass when they are p resented uncovered before it ; and if they are uncovered in front of youngunfledge d pigeons , these take ill and die .

”2

The second of these two statements is but a'

prejudic e , l ike many others ;but we find the first very strange indeed , it b eing a surprising thing thata man like Pliny shou ld have attributed to an imaginary poison of theteeth what is the simple effect of the moistures of the breath .

In Chapters CXV and CXVII of Book XI are found some ob servations

'

which are somewhat interesting to u s

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

”

S imple food is very benefic ial to man ; the variety of flavors insteadi s very harmful . Sour or too abundant foods are digested with diffi culty ,and also those which are ravenously swallowed . As a

'

rem edy, vomitinghas come into use ; but it makes the body cold and is most pern iciou s tothe eyes and to the teeth .

”

There is no doubt that the hab it of often provoking vomitu s—which ,in those times of excess ive corruption and intemperance , had come intogeneral use— must have resu lted in enormou s harm to the teeth , especiallyby the action exercised upon them by the hydrochloric acid contained inthe gastric ju ice

,and by the organic acid s of fermentation .

1 Lib. xi,cap . lxi i i . 2 Lib. xi , cap . lxiv


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 benefic ial against toothache to chew the root of panax , and

likewise to wash the teeth with its ju ice . It is also u seful to chew theroot of hyoscyamus soaked in Vinegar, or else that of the polemonium .

It i s also beneficial to chew the roots of the plantain , or to wash the teethin a decoction of plantain in vinegar . A decoction of the leaves is alsou seful , not only in the case of simple toothache , but also when the gumsare tender and easily bleed . The seed of the same plant cures inflam m a

tions and ab scesses of the gums . The aristolochia strengthens the gumsand the teeth . The same effect may be produced by masticating theverbena with its root

,or by washing the mouth with a decoction of it

in Wine or vinega r f S imilarly the roots of the cinquefoil a re helpful whenboiled down to a third , in wine or vinegar ; however, they mu st first bewashed in salt water or brine . The decoction mu st be ' kept for a longtime 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—mentionedremedies , the root of the verbascum boiled in wine , hyssop , and theju ice of the peucedanum with op ium are also employed ; and it is alsobeneficial to pou r into the nostril s , on the side opposite to that of the s icktooth

,some .drops of the ju ice of anagallis .

“It i s said that if senecio be taken from the earth , and the aching

tooth be touched three times with it,sp itting 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 .

” 1

In the fuller’ s thistle,

2 an herb which grows near rivers,i s found a

small worm,which has the power of curing dental p ains

,when the said

worm is killed by rubb ing it on the teeth,or when it is closed up with

wax in the hollow teeth .

” 3

“Apolloniu s writes that a very efficacious remedy for p ains in thegums is to scratch them with the tooth of a man who has suffered a

violent death .

”4

“It is considered very beneficial for toothache to b ite off a piece from

wood which has been struck by lightning,and to touch the sick tooth

with it ; but whilst b iting off the l ittle p iece ofwood , it is necessary to keepboth hands behind the back .

” 5

“ Experience teaches that against the bad odor of the breath it i su sefu l to wash the mouth with pure wine before sleep ing, and that to

2 D i psacus fu l lonum .

4 Lib. xxvi i i,cap . 11.

5 Lib. xxvi i i,c ap . xi .


Eggshells deprived of their internal membrane and afterward burntafford a good dentifrice .

” 1

(Hence we see that the use of carbonate ofl ime 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 advantageou sly u sed against toothache , mixing it with cyprineoil and then dropping the mixture into the ’

e ar, on the side of the pain .

It is beneficial also to pick the sick tooth with the longest tooth , on theleft s ide

,of a dog ; or with the frontal bones of a lizard , taken from the

head of the animal at fu ll moon , a nd which have not touched the earth .

The teeth of a dog, boiled in wine until thi s i s reduced to one—half, thu s ,furnish a mouth wash which can be advantageou sly u sed against toothache . In the cases of difli cult dentition,

benefit i s derived by rubbingthe gums with the ashes of the teeth of a dog, mixed with honey . Suchashes are also u sed as a dentifrice . In hollow teeth it i s u sefu l to introduce the ashes of the dung of mice

,or of the dried liver of l izards . It is

the opinion of some , that in order not to be subject to toothache , a mou seshou ld be eaten twice a month . If earth - worms be cooked in oil , thislatter has the virtue of calming toothache when dropped into the ear onthe side of the pain . The same effect is obtained by rubb ing the teethwith 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 washthe mouth with vinegar of squ il ls in which earth- worms and the root ofthe mu lberry have been boiled . The

’

ashe s of the shells of snails mixedwith myrrh , rubbed on the gums , strengthens them . Even the sloughwhich the snakes cast off in spring can fu rn ish a remedy against toothache . For this purpose it mu st be boiled in oil

, .with the addition of

re S In of the larch , and then the oil dropped into the ear . For the samepurpose , according to some , oil of roses is u sefu l , when a sp ider, caughtwith the left hand

,ha s been pounded in it . If a sparrow’ s fledglings

be bu rnt with dry vine twigs,the resu lting ashes rubbed with vinegar on

the teeth makes all p ain cease in them .

2 It is stated by many that.

toimprove the odor of the b reath

,it i s 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 qu il l of a vu lture renders the breath sour . It

makes the teeth firm to pick them with a porcupine ’ s qu ill . A decoctionof swallows in wine sweetened with honey ' cures u lcers of the tongueand lips . Scaldings in the mouth produced by hot food or drinks arereadily healed with the milk of a b itch .

” 3

That Pliny did not put great faith in many of the things which herelates is clearly proved by several passages of his book, and amongothers by the following

1 Lib. xxix,cap . xi .

2 Lib. xxx,cap . vii i . 3 Lib. xxx

,cap . ix .

TH E ROMAN S

One can hardly relate without laughing, some th ings , wh ich , however ,I will not omit , because they are found already written . They say that theox has a small stone in the head , which it sp its out when it fears death ;but if its head be suddenly cut off

,and the stone extracted

,th is

,worn

by a child,help s it in wondrou s manner to cut its teeth .

” 1

In Book XXXI, Pliny speaks of various waters—mineral , thermal ,etc .

—especially from the med ical point of view . It was already knownin those days that those waters were most active agents . And in thi srespect a fact which the author relates in Chapter VI of Book XXV i sworth mentioning :

“When Caesar Germanicu s 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 theseevil s stomacace and scelotyrbe .

”

Sea 'salt and nitre are of u se , accord ing to Pliny , again st variou s malad iesof the teeth and mouth . He counsel s the application of salt on lint tothe ulcers of the oral cavity

,and to rub it on the gums when they are

swollen . To prevent diseases of the teeth,it wou ld be advantageou s

,

every morning before b reaking one ’ s fast , to keep a little salt under thetongue until it i s d issolved . Again st the pain of the teeth it would bebeneficial to u se common salt d is solved in vinegar, or nitre in wine .

“The rubb ing of the b lackened teeth with bu rnt nitre gives them back

their natural color .”2The prophylactic remedies aga inst

'

odonta lgia believed in , at that period ,were sufficiently numerou s

,and

,among many other such things

,Pliny

informs us that in order not to be subject to toothache , it i s sufficientto wash the mouth three times a year with the blood of the tortoise .

3

Analogou s virtue was ,also attributed to the brain of the shark

,which

was boiled in oil,and thi s put by for washing the teeth with once a year .

Besides the many anti- odontalgic r emed ies so far related , several others"are found enumerated in “ Chapter XXVI of Book XXXII

“The pain in the teeth i s lessened by p icking the gums with the bonesof the sea dragon . It i s al so very benefic ial to p ick the gums with the.

sharp bone of the puffin .

4 If the same be pounded together with whitehellebore , and the mixture thu s obtained be rubbed on the d isea sed teeth ,they may be made to fall out without pain . The ashes , also , of saltfish burnt in an earthen vase

,with the addition of powdered marble

,

i s a remedy against toothache . Frogs are also boiled in a hemina 5 of

1 Lib. xxx,cap . xlvii . 2 Lib. xxxi

,cap . xlv

,xlvi . 3 Lib. xxxi i

,cap . xiv .

4 Trygon pastinaca,a large fish whose tai l is arm ed with sharp and strong bone s .

5 A m e asure e qua l to l ite r.


vinegar,the decoction being then used to wash the teeth with ; but thi s ,

however, mu st be kept in the mouth for some length of time . In orderto render this rem edy les s n au seous , Sa llu stiUs Dion

'

isius u sed to hangseveral frogs

,by their hind feet

,over a vase in which he boiled the vinegar

,

so that the ju ice s of the animals might drip into thi s from '

the ir mouth s .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 themouth with the latter.

- Others tie them,whole

,on the j aws . Some

,to

strengthen unste ady teeth , rin se them with a decoction made by boilingten frogs in three sextarie s 1 of vinegar, until the liquor is reduced to onethird . By others , th irty- six hearts of frogs are well boiled in a sextaryof old oil , in a copper vessel , and the oil i s then used again st 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 soreteeth . 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 theaddition of an equal weight of salt ; reducing the whole to powder , andrubbing the teeth with it . In such cases the ashes of crab s are alsou sed . That Of the mu rex2 i s adopted a s a simple dentifrice .

”

“The cutting of teeth is facilitated '

by rubbing the gums of the childwith the ashes of dolphin ’ s teeth mixed with honey

,or even simply by

touching the‘gum s with a tooth of th is an im al .” 3

In Chapter XXXIV of Book -XXXVI it is said that the decoction ofgagate s

4 in wine cu res the d iseases of\the teeth ; and in Chapter XLII ofthe same book are praised the dentifrice powders made of pumice stone .

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

The diseases of the teeth were , in those days , most common ; very oftenwe find mention of loose teeth , and the medicines su ited to make themfirm again ; from which we may deduce the great frequency of alveolarpyorrhea . It is reasonable to think that such a fact 'was cau sed princ ipally by the intemperate life of those times

,in which the followers of

Epicu ru s were extremely numerou s and the unbridled desire for pleasurereached such a degree that no abhorrence was felt of provoking vomitduring the cou rse of a long banquet

,in order tocontinue dining merrily .

Concerning the teeth , their affections , and the means of healing andpreventing them , the strangest superstitions existed , and this not onlyamong the common , but al so among educated and learned people .

The number of remedies reputed u sefu l against diseases of the teeth

1 [The sextarius wa s accord ed d iffe rent va lue s,thus a sextary of oil was 3 xviij, of wine

oxx ,and of honey

, 5 xvij.— E . C . K .J2 [Lat. , the purple fish, a carnivorous m arine m ol lusk — E . C . K . ]3 Lib. xxxii , c ap . xlvii i . 4 A kind of lignite , now ca l led je t.

TH E ROMAN S 97

was extraordinarily'

gre at ; but the modern saying, therapeutic wealthi s poverty

,

” cou ld have been applied only too well .Of the cleanliness of the teeth , it seems , great care was taken , for denti

fric e s were in great use . These , as we have already seen , were madeof the most varied sub stances— stag’ s horn burnt , ashes obtained byburn ing the head of the mou se , of the hare ,“ of the wolf, etc .

,eggshells

burnt and reduced to powder, pumice stone , and so on . For the c le anliness of the mouth , for Strengthening the teeth and gums , mouth washesof sundry kinds were likewise adopted , especially formed of decoctionsof astringent sub stances in water, wine , and vinegar .Not only among the Romans was great care given to the cleanliness andbeauty of the teeth , but also among many other nations . In this regardthe following poem of Catullus , in which he lashes the silly vanity of aCeltiberian resident in Rome

,who made continual show of his white

teeth,is somewhat interesting :

Egnatius, quod c and idos habe t dente sRenide t u squequaque ; se u ad re i ventum e st

Sub se llium ,cum orator excitat fle tum

,

Renide t i l le : se u pi i ad rOgum filii

Luge tur, orba cum fle t unicum m ate r,

Renide t i l le ; quidquid e st,ubicum que e st

,

Quodcum que agit,renidet : hunc habe t m orbum ,

Neque e legantem,ut arbitror

, neque urbanum .

Quare m onendus e s m ihi,bone Egnati,

Si Urbanus e sse s, aut Sabinu s , aut Ti burs,Aut parcu s Um be r, aut obe sus He truscus

,

Aut Lanuvinus ate r,atque dentatus

,

Aut Tran spadanu s , ut m eos quoque attingam ,

Aut quilibe t, qu i purite r lavit d ente sTam en renide re usquequaque te nollem ;

Nam risu ine pto re s ine ptior nu l la e st.

Nunc,Ce ltibe r

,in ce ltibe ria te rra

Quod qu i sque m inxit, hoc solet si bi m ane

Dentem , atque russam de fricare gingivam .

Ut quo i ste ve ste r expolitior dens e st,Hoc te am p liu s bibisse p ra dice t lotii.

1 Ignatiu s , be cause he ha s white te e th,is a lway s laughing ; if he be pre sent at the fe lon

’

s

tria l , whi l st the counse l is m oving a ll to te ars , he laughs ; he laughs even when eve ryone ism ourning at the fune ra l pyre of a dutiful son

,whi l st the m othe r is we e ping for he r only chi ld .

He laughs at eve rything, eve rywhe re , and Whateve r he be doing ; this is his we akne ss , whichm e thinks is ne ithe r pol ite nor e legant . Whe re fore

, I m ust te l l the e, O good Ignatius , even

if thou we rt a c itizen of Rom e,or a Sabine

,or of Ti bur

,or one of the thrifty Um brians ,

or of the fat Etruscans,or we rt thou a black and large - toothed Lanuv in ,

or a Transpad ane,

if I m ay spe ak of m y own people , or be longing to any people that c le an ly wa sh the i r te e th ;even then I would not have the e be a lways laughing ; for nothing is m ore si l ly than a si l lylaugh. Now

, O Ce lti be rian, in thy Ce lti be rian land , e ach is accustom ed

,with the wate r

he has him se lf em itted , to rub his te e th and gum s . Whe re fore the c le ane r a re thy te e th,

the m ore sure ly stale dost thou acc use thyse lfof having d runk .


STRABO . From Strabo we learn that the Cantabri and other peoplesof Spain u sed to clean their teeth and sometimes even to wash theirface not with fresh , but with old urine

,which , so it seems , was kept for

the pu rpose , in su itable cisterns ! 1In regard to this fi lthy custom , Joseph Linde re r says2 that the super

stition has reached even to our times , although not widely diffused , that,to beautify the face , it i s u sefu l to wash it with urine . He relates thathe knew a girl who

,to become beautifu l , had recourse to this heroic

method,but, unfortunately, without at all obtaining the desired end !

MARTIAL . In the epigrams ofMartial (about 40 to 10 1 A .D .) allu s ionsof great value with regard to several points concern ing the subject weare treating of are found .

Toothp icks (dentis ca lp ia) are mentioned by this poet several time s ;from which we may argue that they Were in great u se . They wereordinarily made of lentisk wood (P is ta cia lentis cu s), as may be deducedfrom the Epigram LXXIV of Book VI, in which the author rid icules theold dandy who, stretched at length on the tricl in ium , cleans with lentishi

FIG . 28

An anc ient toothpick and e ar- picke r of gold,found in Crim e a .

the toothless mouth , to give himself the air of a man not too far strickenin years .3 Besides , in Book XIV,

containing, for the greater part, s aws

and sayings on objects of common use , there is an epigram bearing thetitle of “

Dentisc alp ium ,

” in which the author says that toothp icks oflentisk are to be preferred , but that, in their ab sence, qu il l toothpicksmay be used .

4

From other sou rces we learn that in those days me tal toothpickswere also made use of. So in a satire of Petroniu s

,it i s said that Trim al

chiones made use of a silver toothpick (sp ina a rgentea). Objects of thi skind , both Roman and of other origin , are even now in existence , and

1 Re rum geographicarum l i bri . Lute tia Parisiorum,1620 . Lib. i i i

,p . 164 ; qui ppe

qu i urina in Ci ste rni s invete rata laventur, e aque cum i psi,tum eorum uxore s dente s te rgant ;

quod Cantabros face re et eorum confine s ajunt (Carabe l l i , System ati sche s Hand buch d e rZahnhe i lkunde

, Wien , 1844, i ,2Hand buch d e r Zahnhe i lkunde , Be rlin ,

1848, i i , 412 .

3 Med io re cum bit im us i l le qui le cto,Ca lvam trifilem segm entatu s unguento,Foditque tonsis ora laxa lentiscis ;Mentitur

,E scu lane ; non habet dente s .

4 Lentiscum m e lius ; sed si ti bi fronde a cu spi sDe fue rit

,dente s penna levare pote st .

TH E ROMAN S 99

may be found in variou s collection s of antiqu ities . In Crimea a mostelegant gold object , of Greek make , was found , wh ich is , by its two ends ,both a toothpick and an ear- picker . It belongs most probably to thefourth centu ry before Christ . 1In an object found in the north of Switzerland , and coming from aRoman 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 toiletarticles .2

FIG . 29

m eta l toothpick and e ar- picke r joined to othe r toi let arti c le s . obje ct found inSwitze rland

,in the anc ient se at of a Rom an m i litary colony .

FIG . 30

An anc ient toothpi ck and e ar- pi cke r of bronze,found in the north of France ,

at Bava i (the anc ient Bagacum ).

Caylu s,in h i s valuable work Re cu e il d

’

a ntiqu ite’

s égyptiennes , étrusqu es ,

gre cques , rom a ines et gau lois es (Paris , 1 752 to gives the p ictureof a toothp ick and e arp icke r of bronze , two inches long. with the middlep art wrought in sp iral form , so as to increase the solid ity of the art icle ,and also to enable the hand to keep it ea sily firm in all positions . It

was found in the north of France , at Bavai (the ancient Bagacum ), andforms part of the collection of M . Mignon of Douai .3

1 Antiq . du Bosphore au Musée de l ’Erm itage , pl . xxx , 8 e t 9 (Dictionnai re de s antiqu itégre cque s e t rom aine s

, p ar Darem be rg, Saglio,2Mitthe ilung . d . antiq . Ge se l l schaft in Z iirich, xv , pl . xi , 3 2 (Darem be rg and Saglio, i bid .)3 Caylus, vol . vi , pl . cxxx , 5 .


Martial i s one of the first Roman writers who speak clearly of artificialteeth . In Epigram LVI of Book XIV, the poet , by a bold personification ,makes the dentifrice powder say to a toothles s old woman , fu rnishedwith false teeth : “What have you got to do with me ? Let a girl useme . I am not accu stomed to clean bought teeth ” 1

Elsewhere2 Martial atrociously derides a courtesan , who , among herother physical defects , was also without an eye : “Without any shamethou u sest purchased locks of hair and teeth . Whatever will you dofor the eye , Laelia ? These are not to be bought !

” 5

This ep igram shows that,while dental p rosthesis was already in u se ,

ocu lar 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 Fid entinu s , dost thou think thyself anddesire to be thought a poet . Even so , it seems to ZEgle that she has allher teeth

,becau se of her fal se teeth of bone and ivory .

” 4

There is,therefore , not the least doubt that in the days of Martial

artificial teeth were in u se ; and that these , as may be seen from theep igram ju st now quoted , were made of ivory and bone ; we do not knowwhether they were formed also of

'

othe r substances . The question , however

,arises :

'

In those times did they manufactu re movable artific i a lsets

,or was the dental art then limited to fixing the artificial teeth un

movably to the neighboring firm teeth,by means of silk threads

,gold

wire,and the l ike ? The answer to th is question may be found in another

ep igram of Martial , 5 where the latter ridicu le s a wanton old woman ,telling her

,among other things still worse , that she at n ight lays down

her teeth ju st as she does the silken robes .6It i s , therefore , beyond all doubt that, at that period , the manner of

constru cting movable artificial sets wa s known ; and most probably notonly partial p ieces were made , but even fu ll sets . In fact , from the versequoted above we have justly the impres sion that the poet means a wholeset rather than a few teeth .

From the words ofMartial,it may also be concluded that these dentu res

cou ld be put on and OH"with the greatest ease ; or , as we may say,by a

1Dentifricium ad edentu lam

Qu id m e cum e st ti bi ? m e pue lla sum at,

Em ptos non soleo pol ire dente s2 Lib. xii

,e p ig. xxii i .

3 Dentibus atque com i s, ne c te pude t, ute ris em ptis .

Qu id fac ie s ocu lo,La l ia ? non em itur:

4 Nostris ve rsibu s e sse te poetam ,

Fidentine,putas , cupisque e red i ?

Sic dentata sic vide tur IEgle ,Em ptis ossibus , ind icoque cornu . (Lib. i

,e p ig . lxxii .)

5 Lib. ix,e pig. xxxviii . 5 Ne c d ente s a lite r quam se ric a nocte re pona s


judging by some indication s to be found in Latin literature , it must beadmitted that the Roman dentists of antiquity constructed other kind sof prosthesis besides the specimens we possess , and in particular movabledentures . We are led to suppose th is , not only from the above citedep igram ofMartial , but also from what we read in one of the satires ofHorace

,who dates contemporarily with Augu stu s

,and therefore anteriorly

to Martial . Speaking of two old witches who had been put to -flight

by Priapu s,Horace writes : “

You wou ld have laughed to see those twoold witches run toward the town , los ing in their fl ight, Canid ia , her falseteeth

, Sagania , her false hair .” 1

Now,as Prof. Deneffe very rightly ob serves , the prosthetic appliances

of antiqu ity k nown to u s are so firmly fixed to the natural teeth that norace

,however unbridled , cou ld ever have made them fall out of the mouth .

It must, therefore , be admitted , as I have said , that the ancients constructed other kind s of dental appliances , of which no specimens have ,as yet, been discovered .

Neither in Celsu s nor in Pliny, nor in any other Roman writers onmedicine

,do we find any allu sion to the art of dentistry . The doctors

of those days probably had no idea of the advantages which cou ld bederived from dental prosthesis in regard to d igestion and consequentlyto the health . of the whole body . They therefore must have consideredartificial teeth as something totally foreign to their art, and intended solelyto hide a physical defect . It i s therefore not at all su rprising that theyhave not treated of th is subject .As the art of setting artific ial teeth was exerc ised by persons not belonging to the med ical p rofess ion , it is very probable that these personsalso undertook the extraction of teeth and the cure of dental pains .Martial (Book X,

Epigram LVI) names'

a certain Casc e llius , who,

he says , extracts or cures d iseased teeth ,”2 and th is i s the first dentistwhose name has been sent down to u s . In sp ite of th is , nothing permitsus to affi rm that there existed at that time a class of real dentists

,viz .

,

of persons dedicated to the exclu sive cu re of dental d isease . There arestrong reasons for doubting this , especially when we consider th at theLatin 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

mu st be considered highly probable that,although there undoubtedly

existed ind ividuals whowere especially skilled in the cure of the d iseasesof the teeth , such

'

pe rsons d id not form a special class ; perhaps , amongthose to whom recou rse was had for the cure of dental diseases , some weredoctors , particu larly skilled in such d iseases , others were perhaps barbers ,

1 Horat. Sat . vi ii,l i b . i . 2 Exim it aut refic it d entem Casce llius a grum .

TH E ROMAN S 103

and so forth . As to the fa r- fetched deduction s ofGeist- Jacob i,accord ing

to whom the name given to dentists by the Romans mu st have beenthat of artifex dentium or a rtifex m edicu s 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 .

SCR IBON IU S LARGU S . Among the writers on Medicine in the earlyperiod of the Empire , one of the most eminent was , without any doubt ,Sc riboniu s Largus , physician to the Emperor Claudiu s , whom he ac companied to England in the year 43 .

Sc riboniu s Largus , in his book D e com pos itione m edicam entorum,

pronounces himself energetica lly against the division of Medicine intosingle special b ranches . He decla ims again st the m any

‘

who attributed tothemselves the name of doctors , simply becau se they knew how to curesome diseases . According to him , the true doctor mu st be skilled incuring

'

a ll kinds of affections . This , in truth , was possible in'

those times,

but would be almost impossib le nowadays , on account of the enormou sdevelopment of the healing art . The ideas , however, expressed bySc ribonius Largus have a certain historical importance , for they showthat in h is times the medical art had certainly the tendency to split upinto many special b ranches

,among which there mu st certainly have been

dentistry, but that the necess ity of such separation was not by any means

universally recognized ; the great doctors of those days undertook thecure of the d isea ses of the teeth , as well as those of any other part ofthe body .

The tenth chapter of the book of Sc ribonius Largus treats of the cureof odontalgia . The author begin s by saying that it i s the opinion ofmanythat the only true remedy against toothache is the forcep s . With all th is

,

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 i s affected with caries,says

the author,it i s not always advisable to extract it ; but it i s much better,

in many cases,to cut away the diseased part with a scalpel adapted for

the purpo se .

“Violent toothache may be calmed in variou s ways , viz ., with mouth

washes , masticatories , fumigations, or by the direct application of fittingmedicaments . It i s beneficial to rin se the mouth frequently with a d e coction of parietaria or of cypres s berries , or to apply to the tooth the root orthe seeds of the hyoscyamus wrapped up in a cloth , and dipped fromtime to time in boiling water

,or to chew the portu laca (purslane), or to

keep for some time its ju ice in the mouth .

”

“ Su itab le also against toothache are fumigations made with the seedsof the hyoscyamu s scattered on burning charcoal ; these must be followed

104 F IRST PERIOD—AN TIQUITY

by rinsings of the mouth with hot water ; in this way

'

som e tim e s,as it were

,

small worms are expelled .

” 1

This passage of S c ribonius Largu s has given rise to the idea that thedental caries depends upon the presence of small worms , which eat awaythe sub stance of the tooth . Such an explanation mu st have well succ e ed ed in satisfying the popular fancy ; and it i s for th is th at such aprejudice , although fought against by Jacques Houllie r in the s ixteenthcentury, has continued even to our days .With regard to thi s I wou ld l ike to record the following fact : Notmany years ago there l ived in Aversa , a small town near Naples , Italy , acertain Don Angelo Fontanella , a violin player, who professed himself tobe the possessor of an infallible remedy against toothache . When sum

m oned by the sufferer, he carried with him , in a bundle , a tile , a largeiron plate

,a funnel , a small curved tube adju stable to the apex of the

funnel , a p iece 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 thered - hot iron , together - with a certain quantity of the onion seed ; then ,having promptly covered the whole with the funnel and made the patientapproach

,he brought the apex of the said funnel close to the sick tooth

,

in such a way as to cau se the p rodigiou s , if somewhat stinking, fumesproduced by the combu stion of the wax with the onion seed to act uponit . In the case of a lower tooth , the abovementioned cu rved tube wasadapted to the funnel

,so that the fumes might equally reach the tooth .

The remedy,for - the most part , had a favorab le resu lt, whether becau se

the beneficial effect was due to the action of the hot vapor on the diseasedtooth

,or to the active p rinciples re su lting from the combu stion of the

wax and onion seed , or to both , or perhap s also , at least in certain case s ,to the suggestion that was thu s b rought to bear upon the sufl Ere r . It

wou ld not be at all worth while to discus s here such a point . Theinteresting part is th at when the patient had declared that he no longerfelt the pain , Don Angelo , with a self- satisfie d smile , turned the funnelup side down , and showed on its internal su rface a quantity of what hepretended to be worms

,which he affi rmed 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 natu re and origin of thesesmall bodies

,no one having the faintest su sp icion even that these , in stead

of coming from the tooth , might come from the onion seedAccording to Sc riboniu s Largu s , toothache might also be taken awayby fumigations of bu rnt b itumen . He affi rms also th at great benefit

1 Suffire autem oportet ore ape rto alte rc i sem ine carbonibu s aspe rso, subinde os colluere

aqua cal ida ; inte rdum en im quasi ve rm iculi qu idam e ic iuntur.


proportion of an ounce ofmastic and an ounce and ' a half of sa l ammoniacto -

a sextary of the ashes of stag’ s horn .

S ERVILIU S DAMOCRATE S , a Greek physician , who acquired greatrenown in Rome toward the middle of the first century, was the authorof many valuable works , both in verse and prose , which , unfortunately ,have been lost . His works are mentioned by Galen , who testifies to hi sgreat esteem for Dam ocrate s , calling him an eminent physician , andquoting various passages from his works , and among Others three poe tical receipts for dentifrice powders . From these receipts it appears thatDam oc rate s attached the greatest importance to the cleanliness of theteeth

,and that he considered this the indispensable condition for avoid

ing disease of the teeth and gums .ANDROMACHU S THE ELDER, of Crete the physician of Nero , who con

ferred upon him ,for the first time , the title of archiater , became famou s

through his ther ia c, an extremely complicated remedy, the virtues ofwhichwere sung by him in a Greek poem , dedicated to the Emperor . Thetheriac was considered an antidote against all poison s and a remedyagain st 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 aga inst odontalgia ; and in those cases in which this was

produced by caries , Androm achus advised the fill ing up of the cavitywith the electuary which he rendered so famous . As the chief basis ofthe theriac was opium ,

combined With stimulating and aromatic sub

stances,there is no doubt that its use locally or even internally would

prove beneficial,temporarily at least

,in many cases of odontalgia .

1

ARCH IGENE S,of Apamea , a city of Syria , l ived in Rome toward the

end of the first century and at the beginning of the second , under theEmperors Domitian , Nerva , Trajan , and Hadrian . He acqu ired great

1 The origin of the the riac,accord ing to what Galen write s in his book De antidotis

,is

to be traced back toMithridate s, King of Pontus, who l ived from the,ye ar 132 to the ye ar

63 B .C. This king, patron of Art and Sc ience , wa s, for his tim e s,an em inent toxicologist .

By m aking expe rim ents on condem ned crim inals he sought to d i scove r by what drugs theaction of the variou s poi son s, both m inera l and vegetable

,and those inocu lated by the bite s

of poisonous anim a l s m ight be counte racted . He afte rward m ixed the various antidote stoge the r for the purpose of obta ining a rem edy that m ight prove a pre se rvative aga inst theaction of any poison whateve r. Thi s unive rsa l rem edy

,the re ce i pt of which was carried

to Rom e by Pom pey, the Conque ror of that gre at-

king, wa s nam ed m ithridatium,afte r the

nam e of him who had com posed it. And rom achus m od ified the m ithridate ; he took awayce rtain ingred ients and added othe rs

,reduc ing the num be r of them from about e ighty to

s ixty- five . The princ i pa l m od ific ation was that of introduc ing into the com position of thisdrug the fle sh of the vipe r ; whe re fore , Galen is of the Opinion that the the riac (so c al ledfrom the Gre ek word ther ion , a noxiou s anim a l)was m ore e ffic ac ious than the m ithridateagainst the bite of the vipe r. The the riac sti l l exi sts in the French pharm acope ia

,a lthough

conside rably sim plified . In eve ry 4 gram s it conta ins 5 centigram s of opium .

THE ROMAN S 107

fame as a physician and as an operator, and distinguished h imself pa rticu larly by daring amputations and trepannings . He recommends variousremedies against odontalgia , among which are mouth washes of stronghot vinegar

,in which gall- nuts or ha lic acc abum 1 have been boiled . He

usually introduced into carious teeth a mixture of turpentine and vitriolof iron (sory cegyptium ), or a mixture of pepper , and oil of spikenard orof almonds , and this was also dropped into the ear, on the side on whichthe pain was felt .Archigenes

,too

,l ike other great physicians of that time

,recommended

various remedies taken from the animal kingdom against d iseases of theteeth

,which now seem very strange to us

,but at that period appear to

have been in great use . Thus,it wou ld be of great benefit to hold in

the mouth for some length of time a mixture of vinegar and water inwhich a frog has been well cooked . The slough of a serpent

,burnt and

then reduced,by the add ition of oil , to the consistency of solid ified honey,

would be a valuable remedy, which being introduced into a carioushollow

,and plastered all around the tooth and on the surrounding parts ,

would cause the most violent pain to cease . And , moreover , desiringto cause a diseased tooth to fall out, it wou ld be enough to apply to andpress upon it a p iece of the unburnt slough of a serpent . Two excellentanti- odontalgic remedies to be introduced into carious hollows wou ldbe roasted earth - worms and spikenard ointment mixed with the crushedeggs of sp iders . It wou ld be also of use to drop into the ear on the sideof the aching tooth some oil of sesamum in which earth - worms have beencooked .

When the pain is s ituated in broken teeth , Archigenes advises then. tobe cauterized with a red - hot iron .

Against bleeding of the gums , he recommends rubbing them with veryfinely pu lverized alum and myrtle and the application of astringent andtonic l iqu ids .When odontalgia appears to depend upon an inflammatory condition

,

he advises the aching teeth to be pla stered up with a mixture composedof red nitre

,pounded peach kernels , and res in .

Archigenes repeatedly recommends the cleaning of the teeth and of

the carious cavities before applying to the former or introducing intothe latter the appropriate remedies .2But Archigenes ’ principal merit , so far as concerns the art of dentistry ,

consists in his having guessed that odontalgia , in certain cases , arisesfrom a disease of the interior part of the tooth (viz .

, from inflammationof the pu lp) and in having discovered an excellent method for curing

1 A Spe c i e s of solanace a of the Physa l i s genus , probably the Physa li s a lkekengi .2 Galeni de com positione m ed ic am entorum se cundum locos , l i be r v .


such cases . When a tooth appeared discolored , without being afie c te d

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 thatpart of the crown which was most discolored and drilled right downto the centre of the tooth .

1

Without doubt th is talented surgeon was induced to adopt th is ’ methodof cure by the idea of the existence of morbid substances in the interiorof the tooth and by the consequent indication of giving them a free exit .The operation devised by Archigenes proves , among other things , twoimportant facts : first , that the anatomical constitution of the teeth hadalready been explored , seeing that Archigenes d id not ignore the existenceof the pulp cavity ; and secondly , that Archigenes was greatly opposedto the extraction of a tooth unless ab solutely necessary . It might bethought that such avers ion depended upon an exaggerated idea of thedangers connected with the extraction of a tooth , an idea widely diffu sedat that period ; but regarding such ' a daring surgeon as Archigenes was

,

it i s more logical to suppose that in similar cases he had recourse totrephining 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— partlyby effect of its own progress— it became too readily inclined to theremoval of diseased parts ; in modern times it has again become what itwas originally

,and what it mu st ever\ be , viz .

, conservative in the highestpossib le degree .

CLAUDIUS GALEN , after Hippocrates the greatest physician of ancienttimes

,was born at Pergamus , a city in Asia Minor, in the year 13 1 of our

era . His father Nicon , a man of great ab ilities,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 a t the age of s eventeen , under theguidance of skilfu l doctors of his native country ; he made several journeysin order to have the benefit of the instruction of celebrated masters

,and

finally frequented the renowned medical school at Alexandria . Ongoing to Rome , in the thirty- fourth year of his l ife , he soon acqu i red inthat

'

c ity a very high renown . He died in the first decade of the thirdcentury , but we do

,mot knowexactly 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

1 J . R . Duva l,Re che rche s hi storique s sur l ’art du d enti ste che z le s anc iens, Paris, 1808,

p . 19 . (Se e Carabe lli ,

110 FIRST PERIOD - ANTIQUITY

happens in inflam m ations of the soft p arts. To my astonishment, Ihad to persuade myself that inflammation may arise even in a tooth , insp ite of the dental sub stance being hard and lap ideous . But anothert ime

,when I again wa s attacked by odontalgia , I perceived very distinctly

that the pain was not localized in the tooth , but rather in the inflamedgums . Having

,therefore

,suffered these two kinds of pain , I have ac

qu i red the absolute certainty that , in certain cases , the pain is situated inthe gums , in others , on the contrary, in the very substance of the tooth .

When a tooth becomes l ivid , Galen deduces from this that the tooth isthe seat of a morb id process equ ivalent to inflammation . Besides

,he

says, we cannot be surprised that the teeth may be subject to a phlogistic

process,when we consider that these , l ike the soft parts , ass imilate

nourishment . The teeth , by effect of mastication , are continually wOrndown

,but nutrition repairs the losses , and they, therefore , preserve the

same size . But when a tooth from want of its antagonist is consumed butl ittle or not at all by ma stication , we see that it grows gradually longer, forthe very reason that under such cond itions the increase due to nutrition i snot counteracted by ' a corresponding wastThe nutritive process of the teeth may , according to Galen , be altered

either by excess or by defect ; from which arise morb id condition s , qu itedifferent the one from the other . An excess of nutrition produces a phlogistic process analogous to that of the soft parts ; a defect of nutrition makesthe teeth thin

,arid

,and weak . The first of these pathological states i s

met with especially in young men and must be fought again st with theordinary antiphlogistic means , designed to eliminate the excess of humors(evacuant , resolvent , revu l s ive , and astringent remedies). As to defect

'

of nutrition,this i s 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 resu lts a looseness of the teeth more or less noticeable .

Against this morb id Condition we do not possess , says Galen , any directremedy ; however, it can be combated , up to a certa in point , by strengthen ing the gums with astringent medicaments , so that they may closetightly around the teeth and thus make them firm .

Dental caries is produced , accord ing to Galen , by the internal actionof acrid and corroding humors

,that is

,it is produced in the same manner

as those cutaneous ulcers which appear without any influence of externalcauses . The cure must consist in acting upon such vic iou s humors -bymeans of local or general medicaments accord ing to circumstances andalso in strengthening the sub stance itself of the teeth by the u se of astringents and tonic remedies . 1After these preliminary remarks

,Galen gives a minute description of

1 Galeni de com positione m ed icam entorum se cundum locos , l i b . v .

TH E ROMAN S 111

the numerou s remed ies which , from his own experience and from thatof other great doctors , were to be considered useful for the cure of thevariou s affections of the teeth and gums .Against gingiviti s and the pain s deriving from it , the best remedy ,

according to Galen , consists in keeping in the mouth the oil of thelentisk moderately warm ; noting, however, that such a remedy is themore efficacious the more recently it has been prepared .

A decoction of the root of the hyoscyamus in vinegar,used as a mouth

wash , i s'

another remedy recommended by Galen against the pains inthe gums . It wou ld also be of benefit to apply on the inflamed gums apowder composed of one part of salt to four of alum ,

afterward wash ingthe mouth with wine or with a decoction of ol ive leaves . If the gumsare ulcerated , Galen recommends them to be cauterized with boil ingoil , us ing for the pu rpose a little wool wrapped around a probe or toothp ick . This medicament, says Galen , greatly modifies the diseased part,exciting a reparative process in it

,to aid which

,however

,suitable remedies

mu st be used , and especially frictions with a mixture of gall - nuts andmyrrh reduced to a fine powder .For the cure of epul ides the application of green vitrol , together with an

equal quantity of powdered myrtle and a l ittle a‘lum,i s especially re com

mended .

In dentition , if the gums are painful , it i s advisable to rub them withthe milk of a b itch . 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 application s , eitheron the cheek or directly on the tooth . Externally

,on the side of the pain ,

may be applied dirty ( l) p ieces of l inen , well warmed , or else small bagsfull of roasted salt

,or cataplasms of l in seed or barley flour . But if it

i s desired to act d irectly upon the sick tooth , th is may be rubbed with abranch of origanum (wild marjoram)dipped in hot oil , or else , after applyinga b it of wax on the tooth , the heated end of a probe may be laid upon it ;or lastly

, fumigation s may be made by burn ing the seeds of the hyoscyam us . 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 nobenefit b e derived

,and it is considered well to remove the tooth , th is can

be done without pain by the application of special med icaments . Amongthese the root of pyrethrum kept in very strong vinegar for forty daysand then pounded takes the first place . The remedy is applied afterhaving well cleaned the sick tooth

,and after having covered the others

with wax . At the end of an hour the tooth will have already becomeso loose that it can be drawn out with the fingers or with the mere help


of a style . The sam e effect may be obtained , says Galen , by the app lication 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 pastewith honeyTo restore to blackened teeth their whiteness , Galen advises them tobe rubbed with special med icaments

,one of which is made up of dried

figs , burnt and pounded , with spikenard and honey . He gives , besidesthe receipts of many dentifrice powders and tinctu res des igned both tostrengthen the teeth and gums and as preservatives against the diseasesof these p arts . Such powders and tinctures do not offer any interest tous

,since they do not much differ from those recommended by other

authors whom we have previou sly 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 , Galenremoves the whole exuberant part by means of a small iron file . In performing this operation

,after h aving covered the gums with a soft p iece

of cloth , he holds the tooth to be filed steady with the fingers of the lefthand , u s ing 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 ratherinterrupts it as soon as the patient feel s any pain

,and continues it after

one or two days . In the meanwhile, he makes use of remedies su itedto strengthen the loosened teeth

,and b ids the patient remain silent and

nourish himself with liqu id 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 conse

quenc e of an excess ive abundance of humors . In such cases he counselsthe use of desiccative remedies .Galen , l ike ancient authors in general , i s not ve ry

'

favorable to theextraction of teeth with the forcep s . Even he seems convinced that atooth may be made to fall out , without pain , by means of the applicationof certain remedies

,to which we have already alluded . However, in

one of the Galen ic books 1 We find the precept already given by Celsu s ,that before extracting a tooth the gums must be detached all around ;from which one may argue that

,at least in certain cases , in strumental

extraction wa s considered inevitable . Galen even alludes to the painwhich sometimes remains after the extraction of a tooth , and is of theopinion that this depends upon an inflammatory condition of the Stumpof the dental nerve .

In Galen are found recorded many means of cure,recommended by

celebrated doctors of ancient times . Elsewhere we have already spoken

1 Med icu s, chap . xix .


revived under the name of massage). He recommends , besides , spec ialrubbing of the' cheeks (to be carried out with a rough cloth), and also ofthe gums and teeth , and indicates a great number of medicaments , someof which are to be u sed during the paroxysms and others du ring theperiods of calm . In regard to the use of narcotics , he very shrewdlyobserves that

_ such remedies take away sensib ility but not pain . Somedoctors of those days , for the cure of odontalgia , had recourse to ste rnuta

tories,or to the dropping of special medicaments into the nose or into the

ear,but Celiu s Aurel ianus seems to have put but l ittle 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 , i s not to cu re it ; and if every tooththat aches ha s to be extracted , it wou ld be necessary to draw them allout when they all ache . Therefore , before h aving recourse to extrac

FIG . 33

Rom an d enta l forcep s found (1894) at Ham burg,Ge rm any

,in the anc ient

Rom an castle Saa lburg. (Ge i st- Jacobi .)

tion , every other means of cure should first be tried . If the removal ofthe tooth becomes indispensable

,he advises that it shou ld never be per

formed during the violence of the pain , for from th is serious consequencesmight arise (a prejudice which has not yet entirely vanished , and which13 met with , sometim es , not only among common people , but even amongphysicians); and a

'

still greater danger would be the extraction of teethneither cariou s nor loose

,seeing that

,by consensus

,the muscles , the eyes ,

and the brain might suffer . The author, on this point, quotes Herophilu sand He rac lide s of Tarentum

, who related some cases in which theextraction of a tooth was followed by death He alludes

,moreover,

to a passage of Erasistratu s,regarding the odontagogon of lead ”

(plum beum odontagogum ) which was exposed in the temple of Apolloat Delphi ; as much as to show that it was not lawful - to extract teeth

TH E ROMAN S 115

other than those which were so loose that an instrument of lead wassufficiently strong to extract them .

When the looseness of the teeth seems to depend upon the flac c idityof the gums , Celius Aurelianu s recommends astringent mouth washes :decoctions of rind of pomegranate , of gall- nuts , of acacia , of qu ince , ofmyrtle berries

,etc . ; and besides these , lentiscine oil and asses ’ milk ,

which latter was also believed to possess astringent virtues . Againsthemorrhages of the gums , he advises the u se of very fine coral powder

,

or of alum with honey .

GNAEU S MARC ELLU S EMPIRICUS , of Burd igala (Bordeaux), who livedat the end of the fourth century and at the beginning of the fifth , wrotea book

, D e m edicam enti,which shows

,more than anything else , the deca

dence of the med ical science in those days . Regarding the diseases ofthe teeth and their cure

,Marcellu s does not tell u s anything new . He

freely copies Sc ribonius Largus and other authors , not adding anyth ingsave a

'

few methods of cure , which are exceedingly strange and superstitious . To get rid of toothache

,it i s suffic ient that the patient, when

the moon is waning,and in the days of Mars (Tuesday) or of Jupiter

(Thursday), repeat seven times the words argida m ,m a rgida m , s tu rgidam .

It i s a great p ity that a curative method so simple and easy be efficaciousin two days of the week alone , and even then on cond ition that the moonbe waning .

The following method is also a very good one : Whilst in the opencountry, one mu st take a frog by the head , open its mouth and sp it intoit, then having begged the animal to take the toothache with it , mustreplace it on the ground and let it free . To remove loose teeth easily

,

it i s necessary to keep in reserve some ju ice of black ivy mixed with alittle green oil ; in case of necess ity, the nose of the patient must beanointed with it

,and after having drawn a deep insp iration

,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 morb id humor flow out , which sometimesflows - very abundantly and even may reach to three hermina .

1 Havingafterward 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 root2 of a tooth be rubbed with dried African sponge , the toothwill fall out within three days ; naturally , s ays the author, care must betaken not to touch , whilst doing this , any healthy tooth . He who desiresnever to be subject to pain in the teeth

,may obtain thi s end by the fol

lowing 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 : “H iru ndo,1 [About twenty- e ight fluidounce s .—E . C. K .J2 Unde r the nam e of root, the anc ients m e ant a lso the ne ck of the tooth.


tibi dico, quom odo hoc in ros tro iterum non er it,s ic m ihi dentes non doleant

toto a nno.

1

The sam e must be done each following year, so as to continue to enjoythe effects of such a cu re !ADAMANTIUS , an Al 'exandrine philosopher and physician , who probably lived in the fourth century, paid m uch attention to the diseases ofthe teeth , a s m ay be argued from two chapters of the Tetrabiblos of

IEti'

t'

i s . One of these chapters is entitled , according to the Latin tran slation of Giano Cornario: “ Cura dentium a calido morbo dolorosoaffe

'

c torum ,ex Adam antio, sophista .

”2 This writer clearly belonged tothe pneumatic school , founded as early as 69 A . D . by Athena u s of Cilic ia .

According to the pneumatic s (so called , becau se they admitted the existence in the anim al organism of an aériform principle

, pn eum a ,to which

they attributed great importance), heat and dryness gave ri se to acu tem aladies ; the phlegmatic affections generally arose from humid ity, andme lancholywas brought on by cold and dryness , a

'

s eve ryobje c t dries up andbecom es cold on the approach of death . The author says that the cure'

r'

nIISt vary '

according as the disease affects in a greater degree the gumsOr the teeth themselves with or without p articipation of the dental nervesand neighboring parts . He makes , in regard to this , many subtle distinCtions ; but the remedies which he counsels do not offer to u s any specialinterest

,being almost identical with those that had been recommended

by Galen and by other doctors prior to Adam antius . The latter al sogives much importance to dietetic thefapy; he prescribes that such patientsshou ld nou rish themsel 'ves with pottages of barley, or of spelt , with eggs ,

and other cooling food , abstaining, however, fromwine .

3

The author enumerates among the causes of such dent ‘al affections thedryness of the air, the autumnal season , the dry constitution of the individual , a troubled life , and scanty nourishment . The u se of sour andpiquant substances i s not favorable to these p atients , so much so thatthe mulberry preserve produces , not -

unfre que-

ntly; viole nt dental painsin them . Adam antius

,therefore , advi

‘ses,in such “ cases

,not to use

strongly astringent mouth washes , but"rather len itive , moistening, and

emollient substances ; s imple lukewarm water, decoction of bran , l icoriceju ice, starch with boiled mu st of wine diluted with warm water, milk,especially asses

’ milk,decoction of m allows and the “l ike .

4

EThe work of Adam antius from which IEtiu s has taken the above-riient

'

ioned chapters is lost to u s . Of his . wr itings‘there only 'rem ain to

1 Swa llow,I te l l the e

,as this Wate r wi l l not be aga in in m y m outh

,even So m y te e th wi l l

not ache for the whole ye ar.

2The cure of te eth affe cted by warm painful d is‘

e aSe ; ac cord ing toAdam antius the sophist .

3 IEtii i i,se rm o iv ,

'

cap . v ii. 4 Ibid . , cap . xxxi


period,emollients

,and then , when the inflammation has subsided , as

tringents and weak cau stics . Lastly, if the epu l i s resist these remedies ,he takes hold of it with a vul sell a and proceeds to remove it with a smallscalpel .1When the incision of a fistul a of the gums and the use of appropriateremedies are not sufli c ient for curing it, IEtius advises the extraction ofthe diseased tooth

,from which the fistu l a has its origin .

2

Apart from what has been mentioned , IEtius does not tell us , in regardto dental diseases

,anything worthy of note , and in many places he only

repeats Galen ’ s ob servations .PAUL OF IEGINA (seventh centu ry) establi shes a very clear distinction

between epul i s and paru l i s . The epul i s i s a fleshy excrescence of thegums in the neighborhood of a tooth ; the parul i s i s an abscess of the gums .To cu re the former affection it i s necessary, says the author, to siezeand stretch the tumor with a vu l sella or with a hook and to perform itsexcision . As to the paru l is , although not unfrequently it i s suflic ient,

for cu ring it, to give an exit to the pu s by means of a slight incision , theauthor

,however

,u sually prefers the method of cu re recommended by

IEtiu s , Viz .,excision . After such operations he orders the patient to

rinse his mouth with wine and on the morrow with hydromel .3 From thethird day onward he sprinkles the wound with a cicatrizing powder

,

until a complete cure is obtained . But if the wound , in stead of healing,be transformed into a putrid u lcer resisting all the ordinary means ofcure , it i s necessary to cauterize the part affected with an oval - shapedcautery .

4

In extracting a tooth , the operation i s begun by detaching the gum allaround it as far as the alveolar border ; then the tooth i s seized withthe forceps , shaken loose , and drawn out . Paul of IEgina , l ike 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 thetooth under the pressure of the instrument . On the other hand

,he too

is convinced that a dis eased tooth can be made to fall out without pain ,by the “

use of su itable remedies .When supernumerary teeth cause an irregu larity of the dental arches

,

this mu st be corrected , says the author, either by resection ofs uch teeth ,if they are very firm

,or by their extraction .

If a tooth projects above the level of the others , the protruding partmu st be removed with the fi le . This instrument mu st al so be employedto remove the sharp edges of broken teeth .

1Tetrabibl ., i i , se rm o iv, c ap . xxv.

2 Ibid .,c ap . xxvi .

3 [The author quoted d ire cts hyd rom e l to be m ade from one pa rt of honey and e ightpart s of water boi led unt i l it has c e ased frothing .

—E . C . K .J4 Paul i IEgineta de re m ed ica , li b . vi

,c ap . xxvii .

THE ROMAN S 119

Tartar incrustations mu st be removed either with scrapers or by meansof a small file .

1

During the period of dentition one must not give children any foodwhich requ ires mastication , and to soften the gums they mu st be anointedwith hen ’ s fat or with hare ’ s brain .

2

To preserve the teeth and to keep them healthy, Paul of IEgina re com

mends all ta inted food to be avoided , and also all poss ib il ity of indigestion and frequent vomitings ; the use of very hard or glutinou s food or ofsuch as may easily leave a residuum between the teeth , for example ,dried figs , and l ikewise very cold food and such as set the teeth on edge .

He also advises that hard things shou ld never be broken With the teethand that the latter be carefu lly cleaned

,especially after the last meal of

the day ?

Paul of IEgina also belongs to the class of compilers ; but in utilizingthe writings of the great physicians who had preceded him ,

he givesevidence of exqu is ite good sense , and not infrequently subjects the assertions of his p re de c eSsors to an intelligent and enlightened critici sm .

Besides,he inserts here and there ob servations and experiences of his own

that are not without interest . He has always been , and rightly so, con

s id e re d one of the greatest physicians of ancient times , the great reputation which he justly held among the Arab s contributing not a little to h isrenown .

This author i s the last of the Byzantine period,and with him

,therefore ,

we m u st close the earlier p art of the history of dentistry . If, beforepas sing to the middle period

, we cast a glance over the ground alreadytraversed

,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 cap ital of the world , wealth ,

luxury,and the refinements of social l ife marvellou sly increased its

needs,and by this also gave an impul se to the evolution of all human

activity . But ancient civilization,after h aving reached its cu lminating

point , soon fell into decadence , and this necessarily wou ld resu lt in ahindrance to the development of dental art . From the days of Archigenes right up to those of Paul of IEgina , dentistry did not make theleast progress ; indeed , as far as prosthetic dentistry is concerned , therewa s 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 thehuman mind a deep contempt for all that regarded the welfare and beautyof the human body

,no one cou ld , any longer, think of artificially repairing

the losses sustained by the dental system through disease or injury .

1 Lib. vi,c ap . xxvi i i . Ibid . , cap . ix .

3 Ibid .,cap . xxix .

122 SECOND PERIOD—TH E MIDDLE AGE S

unfortunately, have, for the most part, been lost . Rhazes d id not haverecourse to the extraction of teeth , s ave as a last resource when everyother attempt at cure had proved useless ; which method would no doubthave deserved high praise

,had the author been inspired by the principles

of conservative surgery, rather than by unjustifiable fears . Caries ofthe teeth i s

,according to him , identical with that of the bones . To

hinder its progres s and propagation to the neighboring teeth , he advisesthe carious cavity to be filled with a “ cement” composed of mastic andalum . We have" here a laudable attempt at permanent stopping of

decayed teeth,although it is Clear that the duration of such stopp ing,

owing to the nature of the materials employed , cou ld not be a long one .

Furthermore,he counselled the patient to ab stain from the u se 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 washesand sundry dentifrice powders . Others , partly taken from Galen , arerecommended by him for prophylactic purposes and for clean sing andbeautifying the teeth .

Against periodontitis and the pains produced by it, he sometimeshad recourse to bleeding . He commended

,besides

,op ium , oil of roses ,

pepper, and honey, and also the sc arific ation of the gums and the appl ication of a leech . If

,however

,these remedies d id not succeed

,he applied

his theriac , which wa s 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

‘

Ihe diseased tooth with a red - hotiron , or sought to provoke its fall by the use of special medicaments ,such as coloquintida and arsen ic (a sub stance to which he had recourse ,p articul arly in those cases where there was u lceration of the gums).It i s no wonder that such means of cure wou ld sometimes produce , asa final resu lt, the actual fall ing out of the tooth ; and this , as i s natural ,served to strengthen the belief that the same resu lt could also be obtainedwith less energetic remedies

,but which were supposed to be equally

endowed with expul sory virtues .Rhazes relates an interesting case of regeneration of a whole lower

j aw ; he , however, observes that the newly formed osseou s mass wasles s hard than the original bone .

1

ALI ABBAS,another great Persian physician (who died in wrote

a lengthy treatise on theoretic and practical medicine,one chapter of

which is dedicated to the diseases of the teeth . When amolar tooth isaffected by caries

,and the pain cannot be subdued in any other way,

Ali Abbas applies,in side the cariou s cavity , the end of a small metall ic

tube , i nto which he repeatedly introduces red - hot needles,leaving them

1 Rasi s ope ra,Venetiis

,1508.

TH E ARAB IAN S 123

in the tube until qu ite cooled . Should even th is have no effect, he triesto provoke the fall of the tooth by the application of asses ’ milk withassafetida , or, finally , extracts it .

1

He cu res epul i s , l ike Paul of IEgina , by exci sion . As to parul is,or

bsc e ss 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 .

2

S ERAPION (Jahiak Ebn Serapion), who lived in the tenth century ,and up to the beginning of the eleventh , contributed but slightly to thedevelopment of medicine and dentistry, as he was in his writings littlemore than a mere compiler . He indicates with great precision the numberof dental roots

,and expresses an opin ion 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 , onaccount of the support which they receive from the j aw . Serap ion , l ikeGalen

,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 thenutritive process , either by excess or by defect .Against dental pains of phlogistic origin , he recommends b loodletting,pu rgatives

,and many local medicaments

,reproduced in great part from

Rhazes . In cases of persistent odontalgia due to caries , he advises , asan excellent remedy

,the application of opium in the carious cavity . To

strengthen loosened teeth , he first employs astringents , and if these areof no use , as often happens in the old , .he binds the loose teeth togetherand to the neighboring healthy ones

,by means of gold or silver wire .

In Serap ion,too

,we find many formu las for dentifrice powders , som

of which are intended simply for cleaning the teeth , others for specialprophylactic or curative purposes .3AV ICENNA . One of the greatest luminaries of medicine among theArabs was Avicenna (Ebn Sina). He was born in 980 son of a high Persianfunctionary ; he lived a very adventurous l ife , held some very high places ,and died in 103 7 . Among his works

,the most important is the Canon ,

a book which procured him the title of “ second Galen ” and the stillmore pompous one of prince of doctors . A very evident proof of theimmense fame which he acqu i red is the fact that among many orientalpeoples Avicenna

,even in our own days , i s considered the greatest

master of medicine .

The anatomy and phys iology of the teeth are treated by Avicennavery minutely

,but nevertheless he does not teach us , in regard to these ,

1 Ha lyAbbas Pract .,l i b . v

,cap . lxxvi i i . 2 Ibid .

,c ap . xxxii i .

3 Se rapion is practica ,Vene tiis, 1 503 .

124 SECOND PERIOD—TH E MIDDLE AGES

anything new . Like Galen , Avicenna adm its that the teeth continuallygrow

,and as a proof he gives the fact of the lengthening of the teeth ,

which,owing to the ab sence of antagonists , are not subj ect to any

pressure or friction .

He gives much good advice with regard to _ the preservation and c le anlieness of the teeth

,to which he attaches very great importance ; and on th is

point he remarks that the u se of very hard tooth powders mu st be avoided ,a s these are liable to injure the dental substance . To this latter are alsoharmful , says the author, some narcotic rem edies , em ployed again stodontalgia . Burnt hartshorn is

,according to him , a m ost valuable

dentifrice . To remove tartar from the teeth, he indicates many remedies ,and especially dentifrices of meerschaum , salt, burnt shells of snails andoysters

,sal ammoniac

,burnt gypsum (plaster of Paris), verdigri s with

honey, etc . Among the sub stances able to facilitate dentition , he enum e r

ates several oils and fats , besides the brain of the hare and the milk ofthe bitch

,and he disapproves the cu stom of giving to children , during

dentition , hard objects to chew,in . the erroneous belief that the biting

of such objects is u seful in facilitating the cutting of the teeth ; he re commends , in stead , the gums to be rubbed with the finge rs . When the teethbegin to appear, he drops som e oil into the e ars ~of~ the ch ild and coversits head , neck , and j aws with a plaster spread on cotton that ha s beensoaked in oil .Avicenna m inute ly examines the variou s causes of odontalgia , andamong them includes also the l ittle worms by which the dental substancewas supposed to be gnawed away .

When a tooth becomes the seat of intense pain , accompanied by a th‘rob

bing feeling, Avicenna considers that this is due to an exce s sive ac cum u

l ation of humors in the root ; he therefore advises , a s already Archigeneshad done , the tooth to be drilled , in order to empty it, and afterwardto introduce into it appropriate remedies .According to Avicenna

,he who has a loosened tooth and desires to

m ake it firm again , must avoid using it in m astication , m ust not touch itwith the fingers , nor move it with the tongue ; besides this , he mu st speakas little as possible , and make use of astringent remedies .To remove a tooth

, _

Avic enna made use of either the forceps or theeradicating remedies

,in which he , too , had fu ll confidence . Like

the greater part of his predecessors,Avicenna is of the op in ion that

the extraction of a firm tooth must be avoided as much as possible,as

it may give place to an injury of the j aw,or become harmfu l to the visual

organ , or bring on fever . On this point he remarks that, if an ach ingtooth 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


into a fi stu la,again st which no medical remedy is of any use , it is neces sary

for thee to take a cautery corresponding in size to the apertu re of thefistula , and after h aving heated it , to introduce it there and to keep itappl ied there until the cauterizing iron reaches the bottom of the said fistu l aand beyond . This thou shalt do once or twice , and then shalt u se fittingmedicaments until a complete cure is obtained . This is attained whensuppu ration ceases . Otherwise one cannot do less than uncover the boneand extract that part of it which is diseased .

” 1

When through excess of moistu re the gums become flaccid,the teeth

loose,and of no u se 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 qu ickly introduce the cautery of which mention will bemade in the following chapter ; and thou shalt prolong the applicationas long as suffices to let the patient feel the heat right in the root of thetooth . This thou shalt repeat as often as thou shalt think necessary .

Then the patient shall keep salt water in the mouth for an hou r . Byeffect of such a cure , the corrupted moisture will dry up , the gums willregain their tone , and the tooth its firm ne ss .

”2

“When toothache depends upon cold,or if there exist some worm

in the tooth , and the medicaments are of no use , recourse mu st be made tocauterization , which in such cases may be performed in two ways , viz .

,

either by means of butter or with a cautery . Desiring to us e butter,some of it mu st be warmed in an irOn Or copper spoon ; a little cottonmu st then be wrapped around the extremity of a probe , dipped into theboiling butter , and then immediately applied to the tooth , keep ing itthere in contact until it has cooled . This mu st be repeated several times ,so that the action of the heat reaches right down to the root of the tooth .

If thou pre fe re st , thou canst use cold butter, applied to the aching toothby 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 reachedthe very root of the tooth.

“To perform the cauterization directly with the iron,thou mu st first

rest on the tooth a small tube of iron or copper, designed to preserve theneighboring parts from the action of the heat , and which must, therefore ,be of sufficient th ickness . Through such a tube thou .shalt apply on thetooth a cautery of the shape given here below

,and shalt keep it there

until it i s cooled . This thou shalt do several times . The pain willcease the same day or on the morrow. It is , however, necessary that

1 Abu l c a s i s d e Chirurgia , li b . i,cap . xix

,p . 47 ; Latin translation by Char ming with the

Arabic text in front, Oxford , 1 7 78.

2 Cap . xx, p 47 .

TH E ARAB IAN S 127

after the cauterization the patient shou ld keep his mouth , for an hour ,fu ll of good butter . The shape of the cautery is as follows (Fig .

Thou canst perform the cauterization with one or other of its two extremities

,as is most convenient .” 1

In regard to epu l is , Abu lcas is p rescribes that after catch ing hold ofthe little tumor with a hook or a vul sell a its complete excis ion shouldbe performed . This done , one mu st wait awhile , until the hemorrhageceases

,and then either a l ittle “ zegi” pu lverized , 2 or other drying and

styptic powder,mu st be applied on the part . If the epu l is recurs , which

very often happens , the excision mu st be repeated and this followed b ycauterization , since after this latter the evil will not return .

3

Abu lcasis i s the first author who has taken into seriou s considerationdental tartar and who

.has recommended that a scrupulou s cleansing of

the teeth shou ld be performed . The chapter relating to this , “On the

Scrap ing of the Teeth ,” is very interesting and is worthy of being herereproduced .

4

FIG . 34

Abu lcasi s ’ d enta l caute ry and the tube through which it was applied,in ord e r to pre se rve

the ne ighboring parts from the action of the heat.

Sometimes on the surface of the teeth , both inside and outside , as wellas under the gums , are deposited rough scales , of ugly appearance , andbl ack, green , or yellow in color ; thu s corruption is communicated to thegums , and so the teeth are in process of time denuded . It i s necessaryfor thee to lay the patient ’ s head upon thy lap and to scrape the teethand molars

,on which are ob served either true incru stations , or something

similar to sand , and this until nothing more remains of such sub stances ,and until also the dirty color of the teeth disappears , be it b lack , or green ,or yellowish , or of any other color . If a first scraping is sufficient , som uch the better ; if not , thou shalt repeat it on the following day , or evenon the th ird or fourth day,

'

until the desired purpose is obtained . Thoumu st know, however, that the teeth need scrapers of variou s shapes andfigures , on account of the very nature of this operation . In fact, thescalpel with which the teeth mu st be scraped on the inside is unlike

1 Cap . xxi,p . 49 .

2 Zegi was the nam e given by the Arabs to blue vitriol .Lib. i i , cap . xxvii i

,p . 18 1 .

4 Lib. i i,cap . xxix

,pp . 18 1 to 183 .


that with which thou shalt scrape the outside ; and that with which thoushalt scrape the interstices between the teeth shall l ikewise have anothershape . Therefore , thou mu st have all th is series of scalpel s readyif so it pleases God .

” 1

The work ofAbu lcasis is , so far as we know, the first book in which a refound figures of dental in struments . We do not know, however, howfar such figures are exact, that i s , to what degree of faithfulness theyrepresent the instruments which Abu lcas is really employed as the originalfigures of the book of Abu lcasis were copied and recopied by succe s s ivetranscribers of the work . And that such copies have been very oftenunfaithful may be deduced from the fact that not unfrequently figures ofsurgical in struments are found in the book which do not at all agreewith 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 isfound under the Arab ic text, and is composed of the fourteen figuresreproduced as Fig . 35 ; the other series , existing under the Latin text,has only twelve figures , as shown in Fig. 36 .

As Channing has m ade his translation from two diffe re nt Arabic c opiesof Abulcasis,2 among the corresponding figures of which there exists avery notable difference , he , for the greater part, had to follow the plan ofreproducing the figures of both codices . But besides this numerical d ifference

,there is al so a considerab le d ifference in the shape of the instruments

represented . We mu st, therefore , ask Ourselves which of the two series offigures is to be regarded as the more faithful representation of the instruments u sed by Abu lcasis . Most probably the first series . In it we findfigured some scrapers which have a certain resemblance to those actuallyin use ; besides this , the figures of the first series seem to be drawn withgreater accuracy than those of the second . Among other things it maybe noticed that the handle of each instrument (excepting the last two)i s furnished with a row of prominences , which , it is alm ost certain , weredesigned to afford a

' better grip in hold ing the scrapers during theoperation .

We now consider the chapter on the extraction of teeth .

3 The authorbegins by saying that it i s necessary to

,

use all possible means to cure anattack of odontalgia , and to be very slow in deciding to extract a tooth

,

as this i s a very noble organ,the want of which cannot in any way be

perfectly supplied . When there is no way of avoid ing extraction and the

1 This great Mahom m ed an surgeon was,it se em s

,ve ry rel igious . His book begins with

the word s :'“In the nam e of the m e rc ifu l God

,Lord pe rfe ct in goodne ss,

”and a lm ost

e ve ry chapte r end s with “If God sowi l ls,

”and the l ike .

2 The se two m anusc ri pt cod ice s are found in the 'Bod le ian Li brary at Oxford .

3 Lib. i i,cap . xxx , p . 185 .


so that he may indicate a s the seat of the pain another tooth which isperfectly sound , and desire it to be extracted ; after which , natu rally, thepain does not cease

,if not when the diseased tooth is al so extracted , as

FIG. 36

Twe lve denta l scrap ers as repre sented in anothe r m anusc ript cod ex of Abu lcasi s .

often happens in the hands of the barbers .,

1 The aching tooth having beenwell ascertained , it is necessary to detach the gum from the tooth , all

1 The Arabic word used by the author m e ans m ore pre c i se ly those who apply cuppingglasse s .

”Char ming ha s translated it by tonsores , barbe rs .

TH E ARABIAN S 13 1

around,with a sufficiently Strong scalpel . Then either with the fingers

or with a light pair of forcep s the tooth must be shaken very gently, untilit is loosened . Then the su rgeon , keeping the head of the patient firmlybetween his knees

,applies a stronger pair of forcep s and extracts the

tooth in a straight direction , so as not to b reak it . If it is not possible todraw it out, one of those elevators must be taken which the author advisesfor the extraction of roots (as may be seen afterward), and by insinu atingit under the tooth the surgeon must endeavor to extract it . When thetooth is corroded and -hollow, it is neces sary to fill the cavity with lint ,compress ing it hard inside with the end of a p robe , 1 so that the tooth maynot break under the pressure of the instrument . In all cases

,the operator

must take great care not to break the tooth , for if th is happens the t e

FIG . 3 7

FIG . 38

Forcep s for loosening the - tooth previous to extraction (Abulcasi s).

maining part will give the patient still greater suffering . It i s necessary ,therefore , to avoid acting like the ignorant and foolish barbers , who intheir temerity do not ob serve any of the abovementioned ru les , andtherefore very often cause the patients great injuries , the least amongwhich is the breaking of the tooth

,the root being left in the socket , or

else the taking away,together with the tooth

, of a p iece of the maxillarybone , as the author often happened to se e . After the extraction thepatient must rin se his mouth with Wine , or with vinegar and salt . If,

as often happens,hemorrhage is produced , a little powdered blue vitriol

mu st be applied ins ide the wound ; and if th is i s not suffic ient , the partm u st be cauterized with a red - hot iron .

The small forceps (Figs . 3 7 and 38) to be u sed in loosening the toothmust have the handle shorter than the j aws and be sufli c iently strongnot to bend when pressure is put upon the tooth .

The large forceps (Figs . 39 and 40) with which the extraction mu st

1An advice a lre ady given by Ce lsus .


be performed shou ld be made of very good Indian or Damascene iron ,and have the handle longer than the j aws ; these , moreover, on the insidemu st be toothed , or striated after the manner of files , so that they mayhave a perfectly firm grip , without sl ipping .

From the foregoing quotations and on examining the annexed figures , itvery clearly appears that the extraction of teeth was performed by Abu lcasis with excess ive timidity and in a manner which mu st have beentorturing to the poor patients . These had to undergo , first of all, thedetachment of the gums , then the prolonged shaking of the tooth eitherwith the fingers or with the forceps , then the attempt at extraction bymeans of a stronger pair of forceps , but , so far as can be seen from thefigure , very little fitted for the pu rpose ; and finally , in many cases , freshmaneuverings to extract the tooth with an elevator .

FIG . 3 9

FIG . 40

Forcep s for pe rform ing the extraction afte r the tooth has be en loosened (Abu lc asi s).

Nothing better,in truth

,

'cou ld have been done with such imperfectinstruments . But it is possib le that even then there perhap s existed

,

for the extraction of teeth , other instruments , so shaped as to be ableto act with greater force . Abulcasis himself1 alludes to the exi stenceof

,

dental instruments not mentioned by him . It is probable,therefore ,

that the b arbers , in sp ite of the scorn with which Abulcas is overwhelmsthem ,

u sed , for the extraction of teeth , forceps far more su itable thanthose described by him . These individuals

,certainly unfurn ished with

a scientific education,must have had

,however

,a great practice in the

extraction of teeth , being perhaps almost the only ones to whom recoursewas had for this operation . They performed it very qu ickly

,as may be

argued from the words of Abu lcasis h imself. It is no wonder, therefore ,that not unfrequently the work of these fatu i tonsores 2 was the cau se

1 Lib. i i, c ap . xxxi,p . 19 1 .

2 S i l ly barbe rs .


to one of the following instruments , choosing that which in every partic ular case seems to be the most su itable .

Besides these,says the author, us e may be also made of some of the

instruments which serve for the removal of tartar .It is precisely in this chapter that Abu lcasis speaks of the great variety

and multipl ic ity of dental instruments ; which, he says , cannot, l ike otherkinds of instruments , be all enumerated and described . He then addsthat a skilful surgeon will be able to devise new instruments , accordingas the pecul iarities of each single case requ ire them .

FIG . 44

F10 8 . 45, 46, 47

FIG . 48

E levators (Abu lc asi s )

For the extraction of a splinter or necrosed fragment of the maxillarybone , the same instruments mu st be u sed which serve for the extraction ofdental roots ; but also a pair of forceps may be u sed (Figs . 50 andIt will be necessary to grip with them the osseou s fragment firmly,

so that it cannot escape whilst it i s being extracted . The part shall thenbe medicated with fitting remedies .Whenever it i s thought proper, the bone must be scraped and all thedisea sed part of it removed .

When a tooth is irregu l arly placed , or projects above the level of theothers , 1 a deformity ensues which is particu larly displeasing in women .

The way of correcting this varies accord ing to the nature of the case .

1 Lib. i i,cap . xxxi i , p . 193 .

THE ARABIAN S 135

It consists sometimes in the S imple extraction of the misp laced tooth .

But when there exists an intimate (osseou s) union of the irregular toothwith another one , it is necessary to operate for the resection of the formerwith an instrument of the following shape , that is , l ike a small axe

FIG . 49

An instrum ent like a sma l l axe,for re se cting irregu larly situated te eth (Abu lcasi s).

The operation mu st be performed in many days , not only on accountof the hardness of the tooth , but also in order not to shake any of theneighboring 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 mu st be made entirely of Indian iron , and the operation , l ike the preceding one , is to be carried out in several d ays , th atthe fall of the tooth may not be provoked by exces sive shaking . The file(Fig . too

,mu st b e u sed to destroy the edges and points of broken teeth

that they may not injure the tongue , or give any trouble in speaking .

FIG . 50

FIG . 5 1

Force p s for extraction of splinte r or ne c rosed fragm ents of the m axi l lary bone s (Abu lcasi s).

When , in consequence of a blow or fall , one or more teeth have becomeloose so that the patient cannot b i ' e h is food with them

,if the use of

styptic remedies has been found of no use , it will be necessary to b indand 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 su itable gold wire of perfectly uniform consistency ,it mu st 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 bindingtightly 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 toform a kind of network, the sound and firm tooth of the opposite sidewill be reached

,and thi s too mu st be wound around in a mesh

,as it were

,

of the said network . Then , turning back, the same operation must berepeated , but inversely, until the point of departure is reached . Allthis mu st be done with much skill

,so as to render the loose teeth com

ple te ly unmovable . When the wire is tied,this mu st be done near the

dental roots,so that the knot may not get untied ; then with a pair Of

FIG. 52

A denta l saw (Abulcasi s).

FIG . 53

Another d enta l saw (Abu lca s i s).

scis sors the remaining part mu st be cut off and its two ends joined andtwisted with a pair of pincers , hiding them between the sound tooth andthe neighboring loose one . Such a ligature shou ld remain in placeduring a whole lifetime ; and in case it should come undone or the wireshou ld break

,it will be necessary to renew the operation . The following

figure represents the ligature described :

FIG . 54

Ligation for ste adying te eth in case s of blow or fa l l (Abu lcasi s).

Sometimes , when one or two teeth have fallen out,'

they are replacedin the sockets and bound in the aforesaid manner and remain there .

The operation must be carried out with great delicacy and ab ility,by

skilful hands .”

As may be seen from the above quotation,in the d ays of Abulcas is

138 SECOND PERIOD—T TH E MIDDLE AGES

the tooth , every needfu l precaution , however, being taken that it may notinjure the neighboring teeth . Cauterization , when practised to producethe exfoliation of a diseased tooth , may be performed , according toMe sue , either with a small red - hot iron

,passed through a l ittle metal tube

in order to protect the neighboring parts,or with the heated kernel of a

nut,or with a grain of bu rning incense .

1

To cure a dental fistu la , Me sue cauterized it to the very bottom witha cautery in the form of a probe , or extracted the tooth , Which by reasonof its diseased root was the cause of the fi stu la ; and when the bonewas likewise affected , he laid bare the cariou s part, which he thenscraped .

2

1 [In connection with the practice of applying m ed ic ine s to the te eth or upon the gum s,

with the obje ct of rende ring the ope ration of tooth extraction le ss d iffi cult,the use of

arsen ica l com pound s as an ingred ient of the se topic a l applications is of pe culiar inte re st .In

“

an Ita lian translation of the writings of .Johanne s Me sue , published at Venice in 152 1 ,

the following intere sting re fe rence to the use of arsenic appears“The son of Zachariah Arazi com pound s a m ed ic ine to a ssi st the extraction of the

te eth. R—‘ Pyrethrum

,colquintida root and the bark of the m u lbe rry root, the se ed and

le ave s of alm e z e ron ,huruc

,and ye l low arsenic

,m i lk of alscebram or pie ce s of it , ground

ve ry thoroughly with vinegar ; then pour som e of it over bd e l lium and ha lasce,of e ach

,

e qua l part s, d ry and d i ssolve in strong vinegar and m ake trochisi of it, . and with them

anoint the roots of the tooth from hour to hour ; this fac i litate s the extraction of it .

“The re is a lso anothe r m ed ic ine with which one fi l ls the de cayed tooth and bre aks i t

R—Se ed s of alm e z e reon and m i lk of alscebram com pound ed with liquid pitch

,and fi l l

with it the d e cayed tooth. Anothe r one R—w -Bauras,bark of the wi llow

,of e ach

,one

part ; ye l low arsenic,two parts ; com pound .vVith honey and pl u e it upon and around the

tooth and im m ed iate ly extract it.“The fat of the gre en frog which live s upon the tre e s breaks te e th whi ch are anointed

with it the sam e as when you anoint them with m i lk of a lscebram or titim allo, and sim i larlya l so the m i lk of ce lso with ye llow arsenic .

”

In this conne ction it is a lso inte re sting to note that the anc ient Arabian m ed ica l writersre fe rred to the re d

,sulphide of arseni c or re algar as sandarach. The te rm Sandarach was

c le arly u sed by these write rs to de signate two d iffe rent m ed icam ents—one the gum - ve rnix,exudate of the Juni pe r tre e , and which we now know

'

a s Sandarach gum . They also applythe te rm to

'

red arsenic , as above stated . Avicenna c le arly di stingui she s betwe en the two

kind s of Sandarach, and says with regard to the gum- vernix or Juniper Sand arach that It

is the be st of all known rem ed ie s for toothache . Whi le , as shown by Dr. Gue rini,m any

of the m ed ic am ents u sed as topica l applications to fac i litate the extraction of te e th we re

whol ly without any possi b le effe ct of that characte r, it cannot be doubted that the application of arsen ica l preparations

,such as those re fe rred to by Me sne

,cou ld not fa i l to set Up

an arsenica l ne c ros i s about the roots of the tooth,rende ring it loose and easy of rem ova l

,

but ne c e ssari ly with the d i sadvantage of produc ing a d ange rously extensive ne c rosi s of theti ssue s .

Mesn e Vu lga r .

— Im pre s so in Venitia p e r Ce saroArrivabenoVenitiano a d i vinti octubrio,m i l le c inque cento e vintiuno.

De lle 'Medic ini Particu lare,Libro Quarto

,Capitolo XLI .

—E . C . K .J2 Joann is Me sne Ope ra , Vene tiis, 1562 .

THE ARAB IAN S 139

AVENZ OAR . The last of the great Arab ian physic ians was Avenz oar .

He was born at Pe fiaflor, near Seville , in 1070 and d ied in 1 162 . Hebecame famou s by his very valuable work on med ic ine , entitled theTe is ir . It is strange , however , that in this book there is hardly anyth ingabout the treatment of dental d iseases . Against caries and loosenessof the teeth the author limits himself to recommending bloodlettingeither from the ranine or the basilic vein . Apart from this

,he speaks

neither of operations nor of remedies for diseases of the teeth .

1 Probablyat the time in which Aven z oar wrote , that is , in the fi rst half of the twelfthcentury

,doctors in general did not occupy themselves with the cu ring

of teeth at all , this being abandoned entirely to barbers and otherperson s . This would sufficiently explain why this author is so silentin regard to dental diseases .But what can have been the reason for doctors refus ing thu s contem ptu

ously to occupy themselves with so important a branch of therapeutics ?In every age there have been a great number of ignorant persons , whoeither in good faith , or else for imposture , have practised , with in a moreor less limited circle , the art of healing’ , u sually dedicating themselvesto some particu lar class of d iseases . Even in our days , notwithstandingthe superabundance of duly qualified doc t ors , there i s , especially incertain countries , no small number of quacks , se cre tists , bone—setters ,Chiropodists , and the like . It i s , therefore , not to be wondered at thatin times when dentistry was still in its infancy there shou ld have beenpersons more or less ignorant who undertook tooth drawing and theconcoction and sale of specifics against odontalgia . The doctors

,on their

part, under the pretext of being unwill ing to have anything to do withthese individuals , found it very convenient to dispense with the cure ofdental d iseases and with the extraction of teeth , this operation beingsometimes too difficult for them ,

on account of their want of practice ,besides being almost always very painfu l , and considered , even from themost ancien t 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 some imesinfl icted as a punishment ; for example , for having eaten fl esh during Lent , 2or on those found gu ilty of felony , for having refu sed to contribute sumsof money demanded from them by their liege lord . Now

,as this punish

ment was carried out on the gu ilty ones by the executors of publicjustice , it is only natural that doctors shou ld have refused to practise anoperation which would have degraded their profession by bringing itdown nearly to the class of the hangman .

Sprenge l,Ge schichte d e r Chirurgie

,Pa rt II, p . 279 .

2 Linde re r,Hand buch de r Zahnhe i lkunde

,Be rl in, 1848, i i , 403 .

C H A P T E R I X .

THIRTEENTH TO FIFTEENTH CENTURIES .

BRUNO OF LONGOBUCCO . After the Arabian period , the first authorwhom we mu st mention is Bruno of Longobucco , of the school of Bologna ,who lived in the th irteenth century and wrote a treatise 0n surgery

,

which gave him a certain renown .

1 This book, however , contains butl ittle about d iseases of the teeth . The author shows himself a great friendof the actual cautery , and advises its u se in the cure of dental caries andof variou s diseases of the gums . He says nothing about the extractionofteeth ; instead , he recommends , as a means for making a diseased toothfall out , that the milky ju ice of the tithymal be applied around its rootafter having been redu ced to the consistency of paste by the add itionof flour .

2

LANFRANCH I,of Milan , another writer of the thirteenth century , who

acqu ired great fame by his book Chz'

ru rgz'

a m agna et pam a— partiallytranslated intoGerman

,more than two centuries later

,by Otto Brunfe ls

also shows himself very timid in the s phere of dentistry, and to combatdental pains he recommends , by preference , the use of narcotics . Heis not at all favorable to the extraction of teeth ; and especially that ofthe molars is considered by him a very dangerou s Operation .

3

TEODORICO BORGOGNONI ( 1205 to known also under the nameof Teodorico of Cervia , i s according to Haasar the first author who mademention of sialorrhea following mercurial frictions . Worthy of note,too , is what he says in regard to fistu las of the gums , or, in general ,of the maxillary region . He advises that in every case of this kindspecial attention be paid to the state of the dental r00 ts ; when there i sa discharge of ichorou s pus , the roots are certainly affected ; and then thediseased teeth mu st all be extracted as soon as possible .

4

JOHN GADDE SDEN , an English doctor who flourished at Oxford inthe first half of the fourteenth century

,wrote a ve ry curious m edical book,

taken the greater part from Pliny and the Arab ian writers and entitledRos a angl z

'

ca : p ra ctical m edicina? a cap z'

te ad p edes (Engli sh rose : the practiceof medicine from head to foot). In his time many strange methods ofcure were in use , sometimes simply ridicu lous , and others even filthy '

1 Brun i Chi rurgia m agna .

2 Sprenge l,Ge schichte de r Chirurgie

,Part II

,p . 280 .

3 Sprenge l,loc . c it. 4 Sprenge l

,loc . cit.


The extraction of a tooth is only ju stifiable , says Gaddesden , when allthe remedies employed against odontalgia have proved u seless 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 patientmu st be prepared for it with an evacu ant cu re , th at is , by injections andpurgatives . For the operation itself the author recommends the sameru les given by Celsus , and says , besides , that the head of the patientought to be held firm by an assistant . In certain cases , the extractioncan be performed , better than with the forceps , by means of an instrument in the form of a lever, broad at one end , narrow and sharpenedat the other . But when a tooth i s very firmly seated , its extraction isalways dangerou s ; therefore , in such a case , Gaddesden recommends,before having recourse to the operation , the use either of acrid sub

stances,such as the milky ju ice of the euphorb iaceae (for example , of the

tithymal), or el se of a red - hot iron ; and this , for the purpose of promotingthe fall of the tooth

,or of rendering it, at least, so far movable that

it can be extracted without any difficu lty .

GUY DE CHAULIAC,the greatest surgeon of the middle ages

,was born

about 1300 , in a little village on the confines of Auvergne , which stillpreserves the name of Chaulhac ; he died in 1368 . This author im m or

taliz ed his n ame by a work which even up to the eighteenth centurywas , as it were , the official code for the teaching of surgery . Guy wrotehis Chz

'

ru rgia m agna in barbarou s Latin— such as was then used by thelearned ; but his book was soon trans lated into French , Provencal , andafterward 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 Chau liac , 1 and who made very ac cura e researches on all thatregards this author and his work

,has succeeded in finding in the libraries

of Europe and America as many as thirty- fou r manu script copies ofthe H igh S urger .

2 The survival of so many copies , in spite of all thedestructive agencies which have been in action during more than 500years, is a very clear proof of the wide diffusion which this work obtainedeven before the invention of printing .

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

This book is very important for our subject , S ince we may gather fromit very clearly the condition of dentistry in the fourteenth centu ry ; but ,on the other hand

,we see from it

,with equal clearness

,that th is branch

1 La Grand e Chirurgie d e Guy d e Chau liac , chiru rgien m a istre en m éd e c i‘ne de l ’Unive rsité de Montpe l l ie r

,com posée en l

’

an 1363 , revue e t col lationnée sur le s m anusc rits e t

im prim és latins et franca i s p ar E . Nic a i se , 1890 .

2 Of the se copie s , twenty- two are written in Latin ,four in French, two in Provencal , thre e

in Engli sh, one in Ne the rland ish (Dutch), one in Ital ian ,and one in He brew.

TH IRTEEN TH TO FIFTEEN TH CEN TURIES 143

of the heal ing art had not made any progres s from the time of Abu lcas i sto that of Guy de Chau l iac (about two centuries and one- half), and thatth is most famou s surgeon did not contribute anyth ing worthy of noteto the development of dentistry .

On the anatomy and physiology of the teeth Guy de Chauliac expresses h imself very briefly : “Teeth are of the nature of bones

,although

they are posses sed of sensib il ity , due to some nerves which the third pairsends to their roots . The number of these latter may vary from one tofour, according to the different teeth . The u ses of these organs are wellknown .

” 1

Worthy of being recorded are the names which Guy gives to the diffe rent kinds of teeth . After h aving said that these latter are generallythirty- two

,but sometimes only twenty- eight

,he adds

,that the sixteen

teeth of each j aw are divided into : deux du elles , deux gu adruples , deuxcanines , hu z

'

e t m as chel ieres 2 at deux ca i’

s s eaux (in the barbarou s Latin :duo du a les , duo quadrupl i, duo can in z

'

, octo m olares et duo cays a les). Sothat the two middle incisors were then called du a les ; the lateral inc isorswere called qu adrupl i , becau se , together with the middle ones , they formeda series of four teeth . Guy gives the name of cays a les (ca z

'

s s e aux) to thelast two molars ; but ‘

Joube rt, one of the transl ators and commentatorsof Guy de Chaul iac , tells us that the molars in general were called inLanguedoc ca iss eaux

“ Les cinq molaires sont appelées en Languedocca is s e aux , parce qu ’elles servent a casser le s choses dures , comme lesnoix e t semblables .” In regard to the canines of the upper j aw,

we

learn that they were called oe illéres (eye teeth), because their root wa s

believed to reach near the eye .

3

According to Guy de Chau l iac , les dents sont engendre’

es non s eu lem ent

en l’

enfance , a z'

ns a ux a u tres ages .

4 And this passage was commented byJoubert in the following note

,which we reproduce textually :

“ En Languedoc, pres de Pezenas y a une gentil femme

,nommé

Mademoiselle de Lobatie re,des long temps vieille édentée , a laquelle

(comme te sm oignent beaucoup de gens tres - dignes de foy) environ l’an

70 de son age , sont sorties cinq on six dents nouvelles . Le concil iateurte sm oigne avoir veu , aqui les dents perdues devant l

’ an 60 ont été derechefengendrées

,moindre toutes fois que les premieres e t plu s foibles .

” 5(In

Languedoc , near Pezenas , there is a lady named Mademoiselle de Lobatiere , who having been for a long time old and toothless (according to

1 Nic ai se , La Grande Chirurgie de Guy d e Chau liac , Se cond Chapitre : De l’

Anatom ie

d e la face e t de se s partie s, p . 47 .

2 He re , as e l sewhe re , is pre se rved the old orthography of the text.3 Nica i se , p . 7 1 I .

4 Te e th m ay be p roduc ed not only in infancy , but a lso at a late r age.

5 Nicaise,p . 205.

144 SECOND PERIOD— TH E MIDDLE AGE S

the testimony of persons well worthy of belief), at about the age of seventygot five or six new teeth . The Conciliator1 testifies to having seen teethgrow 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 rarelyabandon s the footsteps of the Arab ian writers . Following the exampleof one of the se , Ali Abbas , he admits five or six dental maladie s : pain ,corrosion

,congelation

,and aga cem ent (teeth s e t on edge), lim osity or

fetidnes s, fall or loosening .

2 As to the cure , this i s divided into universaland particu l ar . The former includes

,before all , hygien ic ru le s , and

then . purgative s,bloodletting of the cephalic vein or the veins of the

lip s or tongue , revu l sion , obtained by means of cupping glasses , friction ,etc .

,and the remed ies for curing the rheums of the head , or for throwing

out the phlegmatic humors (pyrethrum ,mastic

,and the l ike).

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 toocold

,and especially the rapid succession of cold and hot , or cvice m rs a ;

not to b ite hard things,nor to eat Vi scou s food , such as figs and confe c

tione ry made with honey ; to avoid certain foods which are known'

to bebad for the teeth , such as leeks ; not to clean the teeth too roughly , butto rub them with honey and burnt salt

,to which

,very advantageou sly

,

may be added some vinegar .Before speaking of the special methods of cure of s ingle dental affe c

tions , Guy ob serves that operations onthe teeth are p a rticu lar (proper)to barbers and to “

dentatore s ,”3 to whom doctors have ab andoned

them . But - it" i s safest of all , says he , to have such operations performedunder the d irection of - doctors . These

,however

,to be in a position to

give advice in regard to diseases of the teeth , mu st know the variou smethods of cure which are su ited to these diseases , th at is to say , mouthwashes , gargles ,masticatories , fill ings , evaporations , anointments , rubb ings ,fumigations , cauterizations , sternutatories , in‘stillations into the ears , andmanual Operations .Lastly , Guy notes th at the denta tor mu st be provided with all theappropriate instruments

,that is

,with rasoirs

,rapes

, spatum e s , droitse t courbes , e slevatoire s simples e t a deux branches , tenailles dentelées ,e t diverses e sprouvette s , c annule s , de schau ssoirs , tarie re s , auss i desl imes , et plu sieurs autres necessaires a cette besogne (in I atin : ra soriis ,raspatorii s , e t spatum inibus re c tis e t curv i s

,e t levatoriis sim plic ibu s

1 Pietro of Albano (1250 to the write r of m any books, am ong which one be aringthe title of Conc i l iator d iffe rentiorum philosophorum e t p rae c ipue m ed icorum

,is often quoted ’

by Guy d e Chaul iac and by m any othe rs unde r the nam e of Conc i liator .

2 N ica i se,p . 505 .

3 App rOpriatx barbiton soribu s et dentatoribus .

4 In one Latin m anu sc ri pt of 146 1 in ste ad of dentator we a lre ady find the word dentis ta .

6 SECOND PERIOD—THE MIDDLE AGES

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 ful l vigor .The treatment mu st vary according to all the aforesaid cas es ; butthe means of cure advised by Guy de Chau l iac do not present anyspeci al interest

,as they are almost entirely taken from Galen and

from the Arab ian authors , and especially from Rhazes , Ali Abbas , andAvicenna .

On coming to speak of the looseness of teeth , 1 Guy s ays that this maydepend on various causes : th at i s

,on a fall or a blow ; on humidity,

which softens the nerve and ligament ; 2 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 kind sof looseness , astringents are u sefu l ; but it i s also well that the patientshou ld speak but l ittle

,that he should not touch or move the loose tooth ,

nor use it in mastic ating . In cases of corrosion of the gums , th is diseasemu st be cu red .

If looseness of the teeth follows'

a blow,it i s well

,first of all , to let blood ,

and then to use astringents and excitants . When all th is i s of no avail ,Guy advise s that the loose teeth be tied to the healthy ones with a littlegold chain , 3 after the manner ofAbu lcas is . And if, says he , the teeth fallout, they may be replaced with te e th

\

of another person,or with artificial

teeth of ox bone, fix1ng them in their place with a fine ligature ; and ,

he adds , that such teeth are serviceable for a long time . Here are theprecise words of the text : “

Et si le s dents tombent , qu ’on y mette de sdents d ’

un autre,ou qu ’on en forge d ’os de vache, e t soient lisez finem ent,

e t on s ’en sert long- temps .”

This extremely concise manner of treating dental prosthesis , summingall up in some thirty words , i s in strong contrast with the usual fu lnes sof explanation and methodical accuracy of Guy de Chaul iac , 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 planof his book,that is

,as something which did not directly concern surgeons

,and for

which , therefore , a mere allus ion ought to be sufficient . Without the

1 De la dent e sbranlée e t affoiblie,Nica ise , p . 509 .

2 “De l’

hum id ité qui am ollist le ne rf et le l igam ent .

”

3 Evident ly the author spe aks of a “ l itt le gold cha in,be cause

, as he is not ve rsed in the

practice of denti stry,he doe s not know that it was a sim ple gold wire which was used for

ke e ping loose te e th firm . A sm a l l chain as thin a s a thre ad cou ld not be possibly m ade ,

and wou ld even then be . exce ss ive ly we ak .

TH IRTEEN TH TO FIFTEEN TH CEN TURIES 47

sl ightest doubt,dental prosthesis was practised neither by doctors nor

surgeons , but by the denta tores .

Abulcas is,too

,certainly for the same reason , i s extremely brief in

speaking of artificial teeth , but, on the other hand , he very minutelydescribes the process of l igating loose teeth . Guy omits this descriptionentirely

,and only alludes briefly to thi s therapeutic practice . From

this it is easy to perceive that whilst Abulcasis considered this operationwithin the province of surgeons , Guy de Chau l iac was disposed to excludeit from the field of general surgery, considering that th is , too like theother dental operations

,belonged to the denta tores . In his days , in short,

dentistry had become much more clearly specialized than it was in thedays of Abulcas is .After having spoken of the looseness of teeth

,Guy de Chau l iac goes

on to treat of caries , in a short chapter, entitled “De l a Pourritu re , dese rs , de corrosion e t pe rtuifem ent des dents .”

The method of cure,he says

,is double , viz .

,universal and particul ar .

The general treatment embraces the hygienic and therapeutic meansalready mentioned . As to the particular or local treatment, it consists ,first of “all

,in washing the teeth with aqua vitae or with a vinous decoction

of mint, salvia, melissa , pepper, or pyrethrum . Then it is necessary tofill the carious cavity with gall ia 1 and root of cyperus , 2 mastich , myrrh ,sulphur

,and camphor

, wax,ammoniacum ,

asafetid a and the like . Asmay be seen , Guy does no more than mention the sub stances u sed inhis days for the fill ing of carious teeth

,and does not tell us what variou s

combinations were formed with the said materials,nor the proportions

in which they were used . In short, he does not give u s any formula forthe composition of a fill ing mass

,and from this may be inferred , without

fear of error, that th is operation also wa s never performed by him ,

consequently it, too , wa s not practised by doctors and surgeons , butrather by the dentatores .

When the aforesaid means of cure— that is , the mouth washes and thefilling

— are of no u se , Guy advises the margins of the cariou s cavity beingtaken away with a scalpel and fi le

,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 :“ S i ces choses n ’

y valent rien , l a dent soit e sbu schaille e avec un ciseaue t lime , 3 e qu ’on luy fasse un passage

,a c e que l a viande ne s

’

arre ste

1 This nam e was first given to m ed icam ents conta in ing ga l l- nuts, then ,by extension, a lso

to com pound rem ed ie s not conta ining such sub stance , and to which was given the nam e

of a liptae, v . Nica ise,p . 677 .

2Accord ing toNica ise , the Cype rus e scu lentus (in French, souche t is he re re fe rred to.

3 In the Latin text : Bucce lle tur cum sca lpro e t l im a .

148 SECOND PERIOD fl TH E MIDDLE AGES

au trou . If advantage is not even derived from such an operation ,recourse mu st be had to cauterization , or , if necessary, to extraction .

Even Guy de Chau l iac believes in the worms of the teeth , and againstthese he recommends the u sual fumigations . He advises that the seedsof leek

,onion

,and hyoscyamu s be mixed with goat ’ s tallow and made

into pill s of a dram each in weight, one of which is to be u sed foreach fumigation : “ S i dans le trou il y a un ver , apres le su sditlavement

,

1 l a dent soit suffum iguée avec une graine de porreau e t d’

oignon

e t semence d ’

hyosc iam e , confits avec su if de bouc ; e t qu ’on en fassedes p ilu les ch acune d ’une drachme e t qu ’on y en employe une a chaquefois .In the following chapter Guy treats “De l a lim os ite e t laide cou leur de s

dents .” Here , too , he recommends , before all , the general hygienic ru le sabove mentioned . Besides , he advises the mouth being rinsed with avinous decoction of wild mint and of pepper

,and then the us e of the

following dentifrice :“R— Cuttle - bone , sm a ll white s e ashells

, pum ice s tone , burnt s tag’

s horn ,

n itre , a lum , rock s a lt, burnt roots of ir is , a ris tolochia,and reeds . All

these substances mu st be reduced to powder together, or each one separately .

” Use may also be made of a liqu id dentifrice thu s prepared :“R— S a l am m onia c and rock s a lt, ha lf a pound of ea ch; s a ccharine a lum ,

one -

quarter of a pound . These to be reduced to“

a powder and placed inan alembic of glass

,so as to obtain a liqu id

,with which the teeth must

b e rubbed by means of a l ittle sc arlef cloth .

”

If these means of cure are of no avail , on account of the presence ofhardened lim osity (tartar), thi s mu st be removed by scraping it awaywith appropriate instruments . “

Et s i cela me profite , a cau se qu’ il y a

15 de s lim osite s endurcies ; soient ra sc lée s avec de s rapes et spatum e s .

” 2

Against the setting of teeth on edge (endorm em ent et congela tion des

dents ; s tupor et congela tio dentium ), Guy de Chaul i ac recommends hotwine or aqua vitae , to be kept in the mouth ; or the teeth to be rubbedwith roasted salt ; or the app l ication to them of hot roasted walnuts andfilbe rts and similar things which convey heat ; or lastly , masticating sub

stances,which possess heating properties

,such as the portu laca (purslane)

and its seeds .The chapter on the extraction of teeth and of dental roots is a simplesummary of what Abu lcasis s ays on this subject ; some passages of thisauthor are copied word for word .

Whilst the Arab ian surgeon treats rather lengthily of the deformitiesof the dental arches , and the methods to be employed in correcting these ,

1 He re lavem ent m e an s m outh wa sh, not inje ction .

2 Cum raspatoriis et spatum inibus rad antur.


subject at greater length , profiting by what has been written on thesubj ect by all the ancient writers , and especial ly the Arab ians .Among the many remedies which he recommends against toothachehere are some

“

R—Wild mint , pyrethrum ,white pepper

,myrrh

,two drams of each ;

let these be pulverized and made into a paste with the pu lp of raisins orwith white wax and with some turpentine ; and let this mass be dividedinto small balls as large as filbe rts , of which one must be masticated at atime

,with the aching teeth .

”1

Another masticatory is composed of origanum , pyrethrum, cinnamon ,and ginger

,made into a paste with the yolk of an egg cooked under the

coal s .To calm dental pains

,the vapors of a decoction of wild lavender,

marjoram,rue

,cham e le a , and melilot are often efficac iou s . As to fumi

gations, they can be made not only with vegetable sub stances (onion ormustard seed , rue , but also by burn ing scrapings of the hoof of anass . The fumes may be made to reach the aching tooth , by means of afunnel . Here are the words of the author : “ Fiant sufiitus ex rasuraungulae asini , e t fum us recipiatur per infundibulum s

Decayed teeth may be filled , according to Vale scus , to satisfy four diffe rent indications : To calm or prevent pain , to prevent any further spreading of the caries , to kill the worms , and to sweeten the breath . He advisesthat the carious cavities should be filled up with powdered nigella , pepper,myrrh

,salt

,and theriac ; or else with pyre thrum , gum ammoniac , and

opium ; or el se with celery seeds pu lverized , opium , and hyoscyamus ;or with the cast- off skin of serpents boiled in Vinegar ; or with gall i a andcyperus . The fill ing with these last two subs tances are especially suitable, according to

’

the author, to pre se rve‘

the'

te e th from further spreadingof the caries : ‘

fS i galli a et cyperu s c avis dentibus applic entur, dentes'

ulte rius non corrodentur .

”

To kill the supposed worms of the teeth , Vale scus counsels threed ifferent methods

,of which the first consists of the u sual fumigation s

with seeds of hyoscyamus , onion , leek , coloqu intid a ; the second consistsin fill ing the carious cavity with a mixture of myrrh and aloes ; and lastly ,the third

,in applying inside the cavity the milky ju ice of the tithymal

,or

the ju ice of the persicaria .

2

In regard to tartar of the teeth—which he calls m a teria lap idea , i . e .,

stony sub stance— Vale scu s says that it mu st be removed little by little ,either with iron instruments or with dentifrices partly cleansing and partly

1 Vale sc i Phi lon ium,e tc . ; Francofurti MDXCIX,

cap . lxiv,De dolore dentium

,p . 195

e t se q .

2 Plant be longing to the orde r of the Polygonace ae .

TH IRTEEN TH TO FIFTEEN TH“

CEN TURIE S 15 1

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 . 1Vale scus , too , l ike the majority of ancient writers , i s not at all favorable to the extraction of teeth . He says that recourse mu st not be hadto this operation except when a tooth is the cau se of most violent painand every remedy has been of no avail . But the reasons which he givesin support of this opin ion are very plau sib le ; and whilst most of theauthors who preceded him showed themselves adverse to extraction

,

becau se they considered it dangerou s,he does not allude in the least to

such dangers,but wishes extraction to be avoided

,if poss ib le, “ becau se

the teeth , even when they are in some parts corroded , yet nevertheless ,after the pain is calmed , aid mastication and besides render the othersfirm er .

” 2

This author agrees with Galen in considering the teeth as bones , buthe i s of opinion that they differ from the other bones in more than onerespect ; that is , _

first of all , on account of their sensib ility ; secondly, becau se , whilst the other bones are formed in the uteru s , the teeth are formedoutside the uterus ; and lastly, for a reason which cannot but appear verystrange to u s

, th at is : “ The bones are produced by the sperm andmenstrual blood , whilst the teeth are produced by the b lood in which thereha s remained the virtue of the sperm .

” 3 This passage gives u s an ideaof the state of embryological knowledge of those days !PI ETRo OFARGE LATA (or ofLa Ce rlata), professor of surgery at Bologna

(died in wrote a treatise on surgery in six books,in which diseases

of the teeth are also taken into seriou s consideration . He speaks of agreat number of dental in struments

,which

,however

,are the same a s those

enumerated by Guy de Chaul iac . His methods of cure do not offeranything very new, being for the most part identical with those ofAvicennaand Abu lcasi s . He considers cleanliness of the teeth of the greatestimportance ; shows what great injury is done by dental tartar—whichby him is con sidered a very important sign of the bad state of the teeth— he counsel s the removal of it by means of scrapers , files , or the u se

of strong dentifrice powders ; and to make the teeth white , he evenadvises the use of aqua fortis .He says nothing in regard to the fill ing of decayed teeth ; he, however,

counsels the cleansing of the cariou s cavities with aqu a forti s , or even ,

1 “Mate ria lapidea paullatim abradatur fe rro e t d entifriciis partim m und ificativis,e t

partim stypticis . De ind e col luantur dente s saspe vino a l bo,e t fricentur sa le torre facto.

”

Cap . lxvi i,De colore d entium prmte r naturam ,

p . 202 .

2 “

Quon iam , licet ex parte corrosi s int,attam en dolore sedato m asticationem iuvant,

e t a lios firm iore s reddunt. Append ic e s, p . 205 .

3 “O ssa fiunt ex spe rm ate et sangu ine m en struo ; d ente s autem ex sangu ine

,in quo

rem ansit virtus spe rm atis .

”Append ice s

,p . 205 .

152 SE COND PERIOD—TH E MIDDLE AGES

in some cases , the widening of them ,in order to render them shallower

and therefore les s l iable to retain alimentary residues .Pietro of Arge lata cu red dental fistu l as by means of cau stics and

arsenic . He counselled simple palliative means of cu re for hard epul idesof a cancerous nature . In regard to soft , benignant epu l ides , he waslittle favorable to exci sion

,as this might cau se hemorrhage ; he preferred

ligating the tumor ; or he repeatedly cauterized it with boiling oil or Othercau stics , until he cau sed it to fall . 1BARTOLOMEO MONTAGNANA

,who taught su rgery in the Univers ity of

Padua and died in 1460 , recommended , as an excellent anti- odontalgicremedy

,a mixture of camphor and opium . In his days

,faith in the

pretended eradicating virtues of certain sub stances was being gradu allylost ; but, on the other hand , a tendency now arose to neglect , in regardto the teeth , the conservative principle , to which the ancients had held soj ealou sly ; and little by little the extraction of a tooth began to be consideredan operation of small or no importance

,that cou ld be performed with the

greatest indifference . Montagnana h imself considers the extraction of atooth as the best means of curing odontalgia , whilst the ancients did nothave recourse to it

,saving as a last resource . Notwithstanding this , if

the caries was not deep , he preferred to extraction the u se of caustic s anda red—hot iron .

2

GIOVANNI PLATEARIO,a professor at Pisa in the latter half of the fif

te enth century, cauterized cariou s teeth with a small piece of kindledash wood , or with a red - hot iron

, and held that cauterization was moreeffectu al when

,before performing it

,the cariou s hollow had been filled

up with theriac .

3

He , too , made the adm in istration of purgatives or bloodletting precedethe extraction of a tooth . Plate ario has

,however

,the merit of having

introduced the sitting position for operations on the teeth , whilst preced ingsurgeons made the patient lie in a horizontal position , or held his headsteady between their knees

,a s may be read in Abu lcas is and in other

writers . Besides,he recommends taking care

,when the extraction of a

tooth had to be performed , that the surrounding air shou ld be pure ;perhaps becau se he thought ' that when operating in a place where theair was tainted

,complications might more easily arise , on account of

contagiou s sub stances reach ing the inside of the wound ; or perhapsbecau se he judged

,not without reason

,that certain accidents , such as

syncope , cou ld more easily happen , and were more dangerou s in a taintedatmosphere than in the midst of pure, vivifying air . After the operation ,

1 Petri de Large lata chirurgiae libri sex,Vene tiis

,1480 .

2 B artolom ae i Montagnanee Consi lia , Vene tiis , 1497 .

3 Johanni s Platearii Sa lem itan i practica b revi s , Lugduni, 1525 .

154 SECOND PERIOD— TH E MIDDLE AGES

drink,and other substances that can set the teeth on edge mu st be

avoided . (6) Food that is too hot or too cold must be avoided , andespecially the rapid succession of hot and cold , and v ice vers a . . (7)Leeks mu st not be eaten

,as such a food , by its own nature , i s in

jurious to the teeth . (8) The teeth mu st be cleaned , at once , afterevery meal

, from the particles of food left in them ; and for this purposemust be used thin pieces of wood somewhat broad at the ends , but notsharp pointed or edged ; and preference shou ld be given to small cypresstwigs

,to the wood of aloes , of p ine , rosemary, of juniper, and simil ar

sorts of wood which are rather bitter and styptic ; care mu st , however,be taken not to search too long in the dental interstices and not to injurethe gums or shake the teeth . (9) After this , it is neces sary to rinse themouth

,u s ing by preference a vinou s decoction of s age

,or one of cinnamon ,

mastich,gallia

,moschata

,cubeb

,juniper seeds , root of cyperus , and

rosemary leaves . The teeth mu st be rubbed with su itable dentifric e s before going to bed

,or else in the morning before breakfast . Al

though Avicenna recommended variou s oils for this purpose , Giovanni ofArcoli appears very hostile to oleaginous frictions , becau se he considersthem very injuriou s to the stomach . He observes

,besides

,th at whilst

moderate frictions of brief duration are helpful to the teeth , strengthen thegums , prevent the formation of tartar, and sweeten the breath , too roughor too prolonged rubbing is, on the contrary , harmful to the teeth andmakes them liable to many diseases . As a

'

dentifric e , he recommend sa mixture of two parts of honey to on e of the best sugar ; or the ashesof the burnt head of a hare ; or burnt salt made into an electuary by theaddition of honey . To use the last twodentifrices , a quantity aboutequal in volume to a filbe rt must be wrapped and tied inside a thin ,loosely woven piece of l inen cloth , and with this the teeth mu st then berubbed . Finally, theriac , too , i s considered by him a very good dentifrice .According to Arculanus , dental pains are sometimes situated in the verysub stance of the tooth

,at other times in the nerve

,and at others in ' the

gums .The dental sub stance may become painful

,owing to b ad complexion

(viz ., constitution), without there being any morbid matter in it . When ,

however, such matter exists , it may proceed from the head or from thestomach , 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 ( l) init a worm

,which in its turn corrodes the tooth .

In regard to the diagnosis of dental pains , it is necessary first of all toexamine the state of the gums

,that is to say

,to ob serve whether these ,

in the aching spot,appear healthy

,or whether

,on the contrary

,they are

discolored or tumid,sangu inolent , suppurating, or the seat of corrosion

or putrefaction , or if, when pressure is put upon them , an exit of matter

TH IRTEEN TH TO FIFTEEN TH CENTURIE S 155

i s produced . In such cases it may be considered that the gums are theseat of the pain . But if none of these symptoms are ob served , and if,on comparing the gums of the aching spot with the other gingival regions

,

no difference is ob served , thi s means that the cause of the pain existseither in the substance of the tooth itself, or els e in its nerve . In th isl atter case the pain is u sually very violent,

'

and principally local ized inthe rOot of the tooth , but also extending along the j aw, and the tooth itselfis often , as it were , benumbed . When , however, the pain is not situatedeither in the gums or in the dental nerve , but in the very substance of thetooth , this latter is very often corroded (cariou s), and very often in thehollow there exists a worm ; and this may be deduced from the factthat during the intervals of

.calm the patient sometimes feel s a pecu l i ar

sensation,the movement of the worm in the diseased tooth ; when , how

ever, these signs are wanting, we sh all find at any rate th at the wholetooth is painfu l in the d irection of its length

,in stead of the pain being

localized in the root of the tooth and radiating along the j aw .

When the cau sei

of the pain res ides in the gums the extraction of thetooth is neither necessary nor beneficial , but is , on the contrary, alwaysh armful , s ince , in sp ite of the los s of the tooth , the ces sation of the painis not obtained ; when the pain is situated in the tooth itself, the removalof the latter always makes the pain cease ; l astly , -when the dental nerve i sthe 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 remed ies , Arculanus enumeratespepper mixed with tar

,pepper with asafetida , mu stard seed s with asa

fetida , and the like . When a tooth is to be cauterized , it is necessaryto protect the healthy teeth with b its of cloth d ipped in rose water orelse with some kind of paste . Sometimes it is u seful to drill the toothwith a small trephine so that the cautery may act more deeply, thusgiving better resu lts .In regard to the fill ing of decayed teeth , Giovanni of Arcoli says that,

in the choice of the substances to be u sed , the com plexion (constitution)of the teeth must be taken into consideration ; and according as th is iscold or warm

,it i s necessary to perform the fill ing with sub stances which

are , by their own nature , warm or cold , thus acting in opposition to thedyscrasi a of the tooth :

“Eligantur ca lida aut frigida s ecundum opportunita tem ,

in contra rium

dys cras ice dentis .

”

As to the quality of the complexion , this might be deduced , says theauthor

, from variou s signs , among which the color of the gums , thesebeing red in the warm and humid complexion , ye llovVish in the warmand dry

,brownish in the cold and dry

,and whitish in the cold and humid

complexion . When,however

,the complexion does not show any distinct

156 SECOND PERIOD fi TH E MIDDLE AGES

characteristic,and varies but l ittle from the average , Arcu lanu s advises

the teeth being filled with gold - leaf : “s

.

non fu erit m u ltu s r e ces s us

a mediocritate,im ple a tu r cum foliis au r i .

Although Arcu lanus is the first writer who alludes to the filling of

teeth with gold , nevertheless it is by no means admis sible that he washimself the inventor of gold fill ing . His words do not at all sound to u sas the announcement of a new discovery, as the enunciation of a newfact, in which the author himself had had , at least , a part , be it great orsmall . Nothing of all th is ; the advice as to fill ing the teeth

,in certain

cases,with gold leaf i s given qu ite impersonally , and is found , as if it

were a point of minor importance , at the end of a long paragraph ,which includes variou s other counsels in regard to the fill ing of teeth , oneof which is , that this operation shou ld not be performed with too greatviolence .

1 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 mu st , therefore , hold that gold fill ing had already been in u se for

a long time among dentists,and that Arculanus s imply mentions what

was done by the dentists of those days . (See note page It i sevident , on the other hand , that he had no special competence in dentalart , when we consider that he was even ignorant of the exact number ofdental roots . Naturally

,the question here arises : At what period did

gold begin to be u sed for the fill ing of teeth ? But unfortunately historyhas not , up to the p resent, furn ished u s any evidence which may lead tothe solution of this problem .

For the eradication of a tooth Arcu lanus 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 neighboringhealthy teeth . (3) When the tooth i s troublesome in speaking and inmasticating .

Before extraction,the patient mu st be prepared for it by bloodletting,

purgatives , and narcotics ; and t he operation mu st b e commenced byseparating the gums from the tooth .

j

Arcu lanus admits,l ike many of his predecessors , that the eradication

of a tooth may be effected not only by the forceps and other su itableinstruments , but also by other means . One of these wou ld be the u se

of the actual cautery,repeatedly applied inside the hollow of the tooth , if

this i s decayed ; or , in the contrary case , made to act all around its root

Regim en autem im p lendo d entem corrosum e st,ut im p le atur in causa c a lida cum

frigid is , er in frigida cum ca lid is . Se cundo,ut non im p le atur cum labore e t vehem entia

addente in dolore,e t ex propri i s e st ga l l ia cum c ipe ris aut cum m a stiche

,e t e ligantur ex

sup rascriptis, ca l ida aut frigida se cundum opportunitatem ,in contrarium dysc ras ia? dentis,

sed ubi non fue rit m ultus re ce ssu s a m edioc ritate im p le atur cum foliis auri .

p . 195 .

Cap . xlvii i ,

158 SECOND PERIOD—THE MIDDLE AGES

the teeth of the latter were like those ofwild beasts , a thing which he consid e red as a bad omen .

According to him,toothache is a d isease 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 rubb ing the teeth once a year with the b lood of a tortoise .This i s the first writer who has noted the harmfu l effect which mercuryhas on the gums and teeth

,whether this remedy be u sed internally or

externally,that is

,by friction .

FIG . 56

The pe l ican as repre sented in Giovann i d ’

Arcoli’

s work. Force ps pro extrahendis

dentibus pulicanum d icta .

Denta l forcep s (Giovann i d’

Arcoli). Forcip urii pro extrahendis dentibus form a .

FIG . 58

The forcep s ca l led stork ’ s bi ll,

as repre sented in Giovanni d ’Arcoli’ s work . Force p spro extrahend is fragm entis quod Rostrum Ciconiae dicent.

Benedetti recommends that before proceeding to the extraction of atooth an accu rate d iagnosis shou ld be made

,so that it may not happen

that, by mistaking for true odontalgia a pain localized in the gums orin the j aw, a sound tooth be drawn , under the belief that it is the cau seof the pain ; for, this happening, not only wou ld the pain continue , butthere wou ld be

,in addition

,the loss of a sound tooth

,and also the dis

advantage of the neighboring ones becoming less firm, for want of support .

This author, too , attributes great importance to dental worms , be lieving them to be one of the princi pal and most frequent cau ses of odontalgia . To kill them he recommends the u sual fumigations and several

TH IRTEENTH TO FIFTEEN TH CEN TURIE S 159

other remedies,among which the ju ice of the leaves of the centau ry or

of the peach tree , but especially applications of aqua vitae .When it is thought well to have recou rse to opium to calm toothache

,

he advises this to be u sed 'with the utmost prudence ; and on this point ,he relates h aving witnessed a fatal case , in the person of a gentleman ofPadu a

,by the incautious use of this remedy .

In extraction Benedetti repeats all the precautionary measures re commended by the ancients , and he , too , advises that recourse shou ld not behad to this operation

,if not as a last remedy

,that is , when every other

means of cu re has been found useless .1GIOVANNI OF VIGO . The celeb rated surgeon Giovanni of Vigo (1460

to speaking of ab scesses of the gums , 2 s ays that the ab scess mu stbe first brought to maturity by fitting remedies , if it has not ripened spontaneously, then it mu st b e opened with a lancet, and lastly, to cleansethe diseased part and to aid cicatrization

,honey of roses or Egyptian oint

ment mu st b e u sed . This latter is thus composed of“

R— Verdigris ,rock alum , an a two ounces ; honey of roses , one ounce ; plantain waterand pomegranate wine , ana

i

two and one- half ounces . The whole to bemade to boil

,and to be stirred with a small rod

,until the mixture is

reduced to the cons istency of honey .

For the cure of old fistul as he employs not only the above - mentionedEgyptian ointment

,

-but also arsenic and corrosive sublimate .

Giovanni of Vigo is very brief in speaking on the treatment of dentalcaries , doubtles s becau se he attributed little or no value to the numerou smethods of cure recommended by his predecessors . The treatmentadvised by him is , however, very noteworthy . He says that by meansof a drill , fi le

,scalpel

,or other su itable 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 fill ing as a cure forcaries makes us suppose that Giovanni of Vigo was not at all a strangerto the practice of dentistry

,as we mu st th ink of many preceding writers ,

but, on the contrary, that he was not less skilled in dental operation sthan he was in the other b ranches of surgery . Again , history tells u sthat Giovanni of Vigo was surgeon to the Roman court ; so it wou ld havebeen strange

,indeed

,if the Pope

, if the haughty prelates , accu stomed asthey were to all kind s of refinement and comfort, shou ld have intru stedthe care of their teeth to lowborn barbers and quacks , whilst they couldd ispose of the services of so eminent a su rgeon .

1 Alexandri Benedict i Ve ronensis de re m ed ic a Opus , l i b . Vi,de affe ctibus dentium .

2 Ope ra dom in i Joanni s d e Vigo in chyrurgia . Lugduni, 1 52 1 , l i b . i i,tract . i i i , cap . xiv,

fol . 40 .

160 SECOND PERIOD fl -THE MIDDLE AGE S ‘

It may, however be seen from the very book of Giovanni of Vigo , 1that in his days doctors and su rgeons were , in general , l ittle skilled indental matters . Speaking of the extraction of teeth , he says : “ Forthis operation there is need of a practised man , and , therefore , manymedical and surgical authorities have expressed an opinion that ‘ thisoperation shou ld be left to expert b arbers and to the itinerant quackswho operate in public places . He , therefore , who desires to performthis manu al operation in the best manner will derive great advantageby frequenting men who are expert in performing it and by seeing andimpressing well on his memory their manner of Operating .

[1 The e d itions and trans lations of Vigo se em to have be en end le ss. A French trans

lation of his tre ati se on the wounds c ause d by fire arm s is said to have fa l len into the

hand s of Paré, and had an inspiring influence upon the barbe r’ s boy .

—C. M . ]2 Lib. v

,cap . v , De doloribus d entium , fol . cxvi i to cxix.

2 TH IRD PERIOD—MODERN TIME S

tie the b lood - covered thread around the neck of the child . It was held ,besides— and thi s prejudice has left even until now some traces— that theputting of the milk teeth , when they fall out, into the nest of a mou seassures 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 Linde re r, 1 a fact

which shows that even among the ancient Germans recourse was had tothe application of artificial teeth .

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

l iterally :Being by chance a few years ago at Dresden and visiting the Museum

ofAntiqu ities , my attention was attracted,in the last room , to two osseou s

p ieces,which with other objects were enclosed in a glass case

,with the

written inscriptions : Com b- shap ed os s eous p ie ces , found in ancient

Germ an urns . As soon as I had ob served them , I saw at once thatthey were artificial teeth ; but as I had to be contented with examiningthem . through the glass of the case , it was not possible for me to decidewhether these pieces were reallyof bone, as they seemed to be , or of anothersub stance . Taking into account their antiqu ity, their whiteness i s verynotable . Every piece is composed

,if I remember rightly

,of five teeth ,

that is , of a canine and fou r incisors ; the ch ief difference of these p iecesfrom the prosthetic pieces in ivory s till in u se (the author is writing in1848) consists in this , that the p ieces of which I speak have not at all ab road b ase , designed to rest on the gums , the b ase having instead thesame thickness as the rest . The five teeth are well separated from oneanother . Besides

,the canine makes the proper angle with the incisors ,

and at each side of the p iece is found , in a convenient place , a hole , whichshows that these t eeth were fastened to those of the subject by means ofa metall ic or other kind of thread . As the abovedescribed pieces arewhite , we mu st infer that they were removed from the mouth of therespective individu als before the body was bu rnt , and afterward put intothe urn with the ashes

,ju st as they u sed to put in coins , bits of arrows ,

and the like .

”

For many centuries dental su rgery—which , however, was still in a veryprimitive state— wa s practised in Germany

,a s

- 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 b arbers ,there were variou s kinds of individu als

,unfurnished with any authoriz a

tion— tooth - drawers,Charlatans

,wandering story—tellers

,necromancers ,

Jews, and even hangmen—who invaded the field of medical practice ,

1 Hand buch de r Zahnhe i lkunde,Be rl in

,1848, i i, 406 .

THE SIXTEEN TH CEN TURY 163

in spite of its being forb idden them ,except in fairs , to administer medica

ments and to perform surgical operations . 1In 1460 there appeared in Germany a book on Su rgery by Heinrich

von Pfolsprundt, Knight of the Teutonic O rder .2 The author hadacqu ired great experience as su rgeon in the military expeditions of hisorder, and we se e from his book that he was very skilled in the cu reof wounds and fractures . On the other hand , he shows himself hostileto every bloody operation with the exception of rhinoplast . Pains ofthe teeth and gums were cured by him by means of beverages . 3

d ’eytenvnbgebred)enbar13cm gegogmaufs bemtomatostelrob ut) cubem meOctxtermDoctor"[fiber

1313

Title page of Z ahnarz neybuchle in .

1 Ge i st- Jacobi,Ge schichte d e r Zahnhe i lkunde

,p . 80 .

2 A re ligiou s ord e r of knights , e stabli shed toward the c lose of the twe lfth century, viz .,

during the third crusade . The origina l obje ct of the assoc iation was to defend the Christianre l igion aga inst the infide ls , and to take care of the sick in the Holy Land .

3 Ge i st—Jacobi,Ge schichte de r Zahnhe i lkunde , p . 82 .

164 TH IRD PERIOD—MODERN TIMES

[The accom panying re production of the tit le page and two text page s from an ed itionof Z ahnarz neybuchle in ,

printe d by Michae l Blum ,in Le ipzig, 1530, and translated be low

,

is of inte re st in conne ct ion wi th the hi story of the use of gold - foi l as a fil l ing m ate ria l,

in that a m argina l note re fe rs to Me sue as the author from whom the thre e m ethod s of

tre ating carie s has been de rived , one of the se m e thods be ing the fi l l ing of the cariousc avity with gold - foi l .Me sue was Surgeon to the Ca l i ph Haroun al Raschid

,who flouri shed 786 - 809 . If the

re fe rence to Me sue is corre ct, it would , the re fore , ind icate that the fi l l ing of te eth withgold was known to the Arabs as e arly as the latte r part of the e ighth c entury. Exam ination of the writings of Me sue has thus far fa i led to bring to l ight any re cord the re in of

the tre atm ent of c arie s by gold fi l l ing,a lthough inhis work previously re fe rred to (se e

page 138) the othe r m ethod s quote d by the anonym ous author of Z ahnarz neybuchle in

are ful ly se t forth.

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iamebr.

[Trans lation .]

FIFTH CHAPTER.

ON CARIOU S AND HOLLOW TEETH .

Corrosion is a d i se ase and de fe ct of the te eth when they be com e carious and hol low,

which m ost often happens in the m olars,e spec ia l ly if one doe s not c le an them of the

166 TH IRD PERIOD~ MODERN TIMES

The book,therefore

,lacks importance from a dental po int of View,

except in the sense that it shows how little skilled in the cure of dentalaffections were the German surgeons of those days .

It i s worthy of note that this author, also, speaks of anesthetic inhalations ; he , however, only translates , a lmost to a word , what Guy deChau l iac says on this subject .Toward the end of the fifteenth century and in the first half of thesixteenth there were published in German

,by anonymou s authors

,some

short translation s and compilation s on dental subjects,taken especially

from Greek and Arabian authors . 1 Of these writings , the first one known ,taken from Galen and Abu lcas is , was printed at Basle in 1490 ; and

another—one of the best— saw the light at Mayence in 1532 . Theseworks were perhaps due to intelligent b arbers

,or perhaps— and thi s

seems to be the most probable— they were written , through the initiativeof enterprising printers , by doctors and su rgeons , who wished to remainunknown , on account of the special subject treated ; for, owing to the factthat the diseases of the dental system were generally left in the hands ofb arbers and other unprofes sional persons , the doctors and surgeons ofthose days wou ld have been ashamed to interest themselves in suchthings .WALTER HERMANN RYFE , of Strasburg, was born in the beginning - of

the sixteenth century, and died about 1570 . He was a rather mediocredoctor and surgeon , and a man of the worst morals

,so much so that

many cities expelled him from their -midst .2 He wrote many medicalworks

,in which

,however

,there i s very little original matter . Their

principal merit consists , perhaps , in the fact that they were written notin Latin

,as then wa s universally cu stomary, but rather in the vernacu l ar

of the author and in a popu l ar style ; so that Ryff may be looked upon asthe first who endeavored to diffuse among the people u seful medical andhygienic knowledge .

Among Ryff’

s books there are two which are very - important to us .

One i s his Major S urgery, and the other i s a pamphlet entitled Us efulIns tru ction on the Way to Keep H e althy, to S trengthen and Re inv igora te

the Eyes and the S ight. With F urther Ins tru ction on the Way of K eepingthe Mou th F resh

,the Te eth Clean, and the Gum s F irm .3

Of these books , there now only exist some extremely rare copies ; somuch so that neither Albert von Haller nor Ku rt and Wilhelm Sprengel ,who rendered such great services to the history of su rgery, ever had thepleasure of examining them . Dr . Geist- Jacob i has been more fortunate

1 Ge i st- Jacobi,p . 88.

2 Albe rt von Ha l le r,Bibliothe ca

'

chirurgica, i , 190 .

3 Nuetz liche r Be richt,wie m an die Augen und das Ge sicht schae rfen und ge sund e rha lten ,

die Z aehne frisch und fe st e rhalten sol l . Wurzburg, 1548.

TH E SIXTEEN TH CEN TURY 167

than they,and has therefore been able to give u s some very interesting

information about their contents .The Major S urgery is a mere compilation which does not containanything new of importance . It was published in part in 1545, andin part in 1572 , after the death of the author . The work is illustratedwith very beautifu l wood engravings ; and it is just this which gives theprincipal value to th is book . Some of the il lustration s contained in thefirst 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 concern sdental affections in the latter part of th is book , in a spec ial chapter .Unfortunately

,this chapter was never written , becau se death prevented

Ryff from completing the second part of his work .

FIG . 59

Pe l ican and d enta l forcep s (Wa lte r He rm ann Ryff).

The dental instruments represented in his Major S urgery are many innumber . Among them , first of all , are found the fourteen dental scrapersof Abu lcasis , then the “ duck—bill”— designed for the extraction of dentalroots and broken teeth— variou s kinds of pelican (Fig . 59 A), the

“ commondental forceps” (Fig . 59 B), the

“ goat ’ s foot,” and many other kinds ofelevators , among which , observes Geist- Jacob i , may be seen instrumentseven now in use

, and even some which are said to have been recentlyinvented .

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 p amphlet,printed at Wi'i rz

burg about the year 1544, is made up of sixty—one pages , and is dividedinto three parts

,the first of which is dedicated to the eyes , the second to

the teeth,and the third to the first dentition . It i s 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 notspeak of the technical p art of the extraction of teeth , or of gold fillinga method already known for a long time—or of dental prosthesis .The first p art

,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 eachothe r

_

the ir defects and diseases , so th at the one cannot be perfectly healthywithout the other being so too .

” 1

This last statement i s absolutely false,as a disease of the eyes may

very well exist with a perfect condition of the teeth , and v ice v ers a .

However,Ryfl has the merit of being, perhaps , the first who has noted

the undeniab le relation which exists between the dental and ocu lar affe ctions .After a rapid glance at the anatomy and physiology of the teeth , theauthor enumerates the causes of dental d isease

,which

,according to him ,

are princ ipally heat,cold

,the gathering of humors , and traumatic actions .

The prophylaxis of dental d ise ase sgis beyond any doubt one of the

best parts of the book ; however, the ten rules counselled by Ryfl forkeeping the teeth healthy— ru les which Dr . Geist—Jacob i h as madeknown to us in fu ll— are reproduced

,almost to a word

,from Giovanni

d’

Arcoli’

s work ; therefore , the author has no other merit than that ofhaving translated them into the vulgar tongue , thu s diffu s ing the knowledge of u sefu l precepts for preventing dental d iseases . We refrain fromreproducing the aforesaid ru les here

,as they are

,with slight variations

,

identical with those which we gave when speaking of Arcu lanu s .

Nor can any credit be given to Ryff for the ru les which he gives inregard to the d iagnosi s of dental pains , as this part of his work is alsotaken wholly from the Italian author just mentioned .

After these diagnostic rules Ryff , continu ing to translate from the bookofGiovanni d ’

Arcoli, adds :“If the pain comes from the gums

,extraction is of no u se ; if it comes

from the tooth , extraction makes it cease ; when , l astly, it i s in the nerve ,sometimes extraction removes it

,and sometimes it does not

,according as

the matter obtains or not a free exit .”

1 Se e Giorna le d i Corri spondenza p e i d entisti , 1895 , xxiv, 289 .


than a page and one - half of print . Neither does it contain anything ofimportance . To render the cutting of teeth easier

,Ryff advises that

infants should have little wax candles given to them to chew and thegums anointed with butter, duck’ s fat, hare ’ s b rains , and the like . Thetooth of a wolf may be hung around the neck of the ch ild , so that it maygnaw at it . It is also recommended that the head of the child shou ld beb athed with an infusion of chamomile .From what has been said , one may see very clearly th at the aforesaid

book is, from the scientific point of view, entirely valueless , becau se

the best part of it i s merely copied from thework of Giovanni d ’Arcoli.However

,the author has the indisputable merit of having endeavored

to diffuse the knowledge of u sefu l precepts of dental hygiene . His book ,besides

, we repeat, has great historical value, for from it dates thebeginning of odontologic literature

,properly so called .

On this point we believe it is necessary .to correct an error into whichDr .

_

Ge ist- j acob i has fallen . At the beginning of his very valuable articleon Walter Hermann Ryff1 he says : In the fifth centu ry of the

'

Christian

era,the iatrosophist Adamantins of Alexandria published an exclus ively

odontalgic work, of which , however, we only know the title .

” Thesame he repeats in his H is tory of D ental Art (pp . 55 and without ,however

,giving us any proof of his statement . “

Of the odontologictreatise ofAdam antius

,he says

,unfortunately the title alone i s known

to us,and even that has reached us indirectly, that is , by means of IEtius ;

it i s of the following tenor .”

Now, whoever takes the trouble to translate these Greek words willeasily perceive that they do not constitute one title

,but two distinct ones

(which even Dr . Geist- Jacob i has had to unite by the conjunction and).These

,however , are nothing more than the titles of two chapters of the

Tetrabiblos of ZEtius , as anyone may se e for himself by turning over thepages of this work either in the Greek original

,or in the beautifu l Latin

translation of Giano Cornario (Venice, In thi s great compositionof [Etiu s dental di seases are treated of in Chapters XXVII to XXXV of

Sermo IV, Tetrab iblos II ; and the two Greek titles above referred toare the titles of Chapters XXVII and XXXI .

In the translation of Giano Cornario they read as followsCura dentium a ca l ido m orbo doloroso afie ctorum ,

ex Adam antio sophis ta

(cure of teeth affected by warm ,painful dise ase

,according to Adaman

tiu s the sophist).Cura dentium a s iccitate dolore afiectorum ,

ex Adam antio sophis ta

(cure of teeth affected by pain from dryness , accord ing to Adam antius

the sophist).

The first denta l book in the Ge rm an language (se e Giorna le di Corrispondenzap e i d entisti, loc .

THE SIXTEEN TH CEN TURY 17 1

The work of Adamantins , from which IEtius took the contents of thechapters thu s entitled , is lost to us , but we have no reason , and not eventhe least indication

, for supposing that this work was a treatise on dentald iseases

,and not one on general medicine . It i s ab su rd 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 shou ld h ave had but one title and not two , and on the other

hand,becau se it i s by no means to be supposed that a great and wise

physician,such as Adam antius undoubtedly was , shou ld h ave had the

whim to write a book,not on dental d isease or on dental pains in general ,

but only and exclus ively on dental pain s cau sed by heat or by dryness .What reason wou ld there have been for not extending the treatment ofthe subject to those cases of odontalgia resu lting from humidity or fromcold

,that is , from causes a s common and , according to the ideas of th at

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 withthose of the others , in which [Etius treats of dental affections , such analogywill b e noticed between the variou s titles a s to make us consider thatthey h ave been formu l ated by ZEtiu s himself, even when the contents ofthese chapters are taken from other writers . So that the two aforesaidtitle s not only do‘ not belong to any dental work

,but prob ably they

have never existed,even as simple titles of chapters , in the medical book

of Adam antius , from which the contents of the two chapters of [Etiusabove mentioned have been taken .

In order'

that every one m ay easily be convinced that the two titlesmade so conspicuou s by Dr. Geist- Jacobi have noth ing particul ar aboutthem ,

but are , in stead , perfectly analogou s to the titles of variou s otherchapters of ZEtiu s

,we give here the translation of the titles of five chapters ,

all concerning dental maladies,that i s

,the two chapters in discu s sion

and other three :Chapter XXVII : Cure of teeth afl e cted by warm , painfu l d iseaseaccording to Adam antius the sophist .Chapter XXIX : Cure of teeth affected with pain from humidity .

Chapter XXXI : Cure of teeth afl e cted by pain from dryness , accord ingto Adam antius 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 abovementioned chapters,that the titles referred

to by Geist- Jacob i have not at all the h istorical importance and signifi

cance that he attributes to them,and that the same have been formu lated


by ZEtiuS himself. To argue from such titles that Adam antius was theauthor of a book on dentistry is' not only inadmissible , for all the reasonsalready given

,but also becau se if it were allowable to reason with such

lightness,it might also be stated— by argu ing from the title of Chapter

XXXIII— that Galen wa s the author of a monograph on the treatmentof dental caries ; a thing which is absolutely untrue . Consequently, thebeginning of odontologic literature cannot be traced back to Adamantiu s

,but, as Dr . Geist—Jacob i wou ld have it, to an author much

_les sancient

,that is

,to Walter Hermann Ryff, or, if it i s preferred , even to the

anonymou s writers of the odontologic compilations which appeared inGermany at the end of the fifteenth century .

ANDREAS VE SALIUS . We mu st now speak of Andreas Vesaliu s , anextraordinary man

, who by his geniu s infused new l ife into medicalscience

,and who

,although he gave but l ittle attention to dental matters ,

yet fu lly deserves a place of honor in the history of dentistry ; for th is ,l ike every other branch of medicine, received great advantage fromhis reforming work, which broke down forever the authority of Galen ,thu s freeing the minds of medical men from an enslavement whichmade every real progress impossib le .

Andreas Vesaliu s was born at Bru ssels,December 3 1 , 15 14 . He

.

studied at Louvain and then at Paris , where at that time great scientiststaught, and among others the celebrated anatomist Jacques Dubois ,generally known by the Latinized name of Sylviu s . 1 The latter , a greatadmirer of Galen ,

'

whose anatomical writings served as texts for hislectures , became jealous of the young Belgian Student , who was h is a ssistant

,and who gave undoubted proofs of great genius

,and of extraordinary

passion in anatomical research . Vesalius often defied the greatestdangers in order to obtain corpses either from the cemetery of the Innocents or from the scaffold at Montfaucon . He soon surpassed his mostillu striou s masters , and at only twenty- five years of age published splendidanatomical plates , which astonished the learned . He acqu ired also greatrenown as surgeon , and in this capacity he followed the army of CharlesV in one of his wars against France . After having been professor ofanatomy in the celeb rated University of Louvain (Belgium), he wa s

invited by the Venetian Republic to teach in the Univers ity of Padua,

wh ich , through him , became the first anatomical school in Eu rope .

Yield ing to the requests of the magistrates of Bologna and Pisa , he alsotaught in those famou s universities

,before immense audiences .

Before Vesaliu s , Galen ’ s anatomy had served as the constant b asis forthe teaching of this science . Although even from the end of the fifteenthcentury dead bodies were dissected in all the principal universities

,the

1 A Latin translation of the French nam e Du bois .


teachers of anatom y always conformed , in their descriptions , to those ofGalen

,so that the authority of this master, held infall ible , prevailed even

over the reality of facts .Vesaliu s , for the first time , dared to unveil and clearly put in evidencethe errors of Galen ; but this made him many enemies among the blindfollowers and worshippers of that demigod of medicine . Europe re

sounded with the invectives that were bestowed upon Vesaliu s . Amongothers

,there rose against him Eu stachio at Rome

, Dryand er at Marbu rg,Sylvius at Paris

,and this last d id not Spare any calumny that might

degrade his old pupil , who had become so celebrated . In sp ite of this ,the fame of Vesaliu s kept on growing more and more , so much so thatCharles V called him to Madrid

,to the post of ch ief physician of his

Court,

. a place which he kept under Phil ip II,also after the abdication

of Charles V . The good fortune of Vesaliu s , unhappily,was not to

be of long duration . In 1564 a Spanish gentleman died , in sp ite of thecare bestowed uponn

him by Vesaliu s,and the illu striou s scientist requested

from the family,and with difli culty obtained , the permission to dissect

the body . At the moment in which the thoracic cavity was opened theheart was seen

,or thought to be seen

,he ating. The matter reached the

ears of the relations of the deceased , and they accu sed Vesaliu s , beforethe Inqu is ition

,of murder and sacrilege ; and he certainly would not have

escaped death except by the intervention of Philip II, who, to save h im ,

desired that he shou ld go on a p ilgrimage to the Holy Land,as an exp ia

tion . On his return,the Ship which carried Vesal ius was wrecked , and

he was cast on a desert beach of the Isle of Z ante , where, according tothe testimony of a Venetian traveller

,he died of hunger

,Octob er 15 , 1564 .

Vesalius left to the world an immortal monument,his splendid treatise

on Anatomy,

1 published by him when only twenty- eight years of age ,and ofwhich

, from 1543 to 1 725, not less than fifteen editions were i s sued .

The appearance of this work marked the commencement of a newera . The Struggle between the supporters of Galen and those of Vesalius rendered necessary

,on both sides

,active research concern ing the

Structu re of the human body,so that‘ anatomy, the principal b asis of

scientific medicine,gradually became more and more perfect , and , as

a consequence of this , as well a s of the importance which the directob servation of facts acqu ired over the authority of the ancients , therebegan in all b ranches of medicine a continual , ever- increasing progres s ,which gave and still gives splendid resu lts , such as would have beenimpossible under the dominion of Galenic dogmatism .

In the great work of Vesaliu s the anatomy of the teeth is unfortunatelytreated with much less accu racy than that of the other parts of the body .

1 De hum ani corpori s fab ric a , li bri se ptem .


However,his description of the dental apparatu s1 is far more exact

than that of Galen , and represents real progress . The number of theroots of the molar teeth (large and small) i s indicated by Galen in avery vague and inexact manner, s ince he says th at the ten upper molarshave generally three

,sometimes four roots , and that the lower ones have

generally two,and rarely three . Vesaliu s , having examined the teeth

and the number of their roots in a great number of sku lls , was ab le tobe much more preci se . In regard to roots, he makes , for the first time ,a very clear distinction between the premolars next to the canine (smallmolars) and the other three , and says that the former in the upper j awu sually have two roots

,and in the lower

,one only, whilst the last three

upper molars u sually have three roots and the lower ones two . Aseveryone sees

,these indication s are

,in the main , exact .

Other important facts established by Vesaliu s are a s 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 thanthose of the two preceding molars . In the penu ltimate and antepenu lti

mate molars,more often than in the other teeth , it sometimes happens

that a greater number of roots than usual are found , it being not veryrare to meet with upper molars with four roots , and lower ones with three .

The molars are not always five in each half j aw ; sometimes there areonly fou r, either on each S ide, or on one side only, in only one j aw or inboth . Such differences generally depend on the last molar

,which does

not always appear externally, remaining sometimes completely hiddenin the maxillary bone , or only ju st p iercing with some of its cu sp s the thinplate of bone wh ich covers it ; a thing which Vesaliu s cou ld ob serve inmany Sku ll s 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 . Thedoctors , he adds , not recognizing the cause of the pain , to make it ceasehave recourse to the extraction of teeth , or else , attributing it to somedefects of the humors , overwhelm the sufferer with pill s and other internalremedies , whereas the best remedy wou ld have been the sc arific ation of

the gums in the region of the last molar and sometimes the piercing ofthe osseou s plate which covers it .This curative method , of which no one c an fail to recognize the importance , wa s experimented by Vesalius on himself, in his twenty- sixthyear, precisely at the time that he had ju st begun to write his great treatiseon anatomy .

1 De hum an i corpori s fabric a l ibri septem,cap . xi

,De d entibus

,pp . 40 to 42 (com plete

ed ition of the works of Ve sa l ius,publi shed at Leyd en in

17 6 TH IRD PERIOD—MODERN TIME S

mu st have raised the idea in his mind that the roots of the milk teethremained in the socket

,and that the upper part of the temporary teeth ,

instead of being a continuation of the root, wa s joined to this as a simpleappendix

,and in a very weak way, as though designed to remain in place

for a limited length of time only .

In Vesaliu s1 i s found a dental terminology— Latin , Greek, Hebrew,

and Arabic—which afford s some interest . The incisors are called inLatin zn cz sor z z

,r i sor i i

, gu aterni, qu adrupli; and the two middle incisorshave been denominated by some authors du a les . The canines are calledin Greek kynodonte s , which means the same as the Latin can in i, dog’ steeth . In Latin they have been also denominated m ordentes , and by somealso risorii

,a name which by others is given to the incisors , as we have

already seen . The molars have also been called in Latin m axillares,

paxillares , m ens a les , genu ini .2 But some authors give th is last name

only to the l ast molars,or Wisdom teeth

,dentes s ensu s et s ap ientia; et

intelle ctus . These teeth have also been called s erotin i (that i s, tardy),asta tem com plentes (that i s , completing the age , the growth), and al so

,

in barbaric Latin,cays eles or cays a les , negugidi , etc .

In the rebellion again st the authority of the ancients , Vesal iu shad a predecessor whose name

,deservedly famou s

,may be recorded

here . PARACELSU S (born in 1493 at Maria- Einsiedeln,Switzerl and), on

being nominated,in 1527 , Professor of Medicine and Surgery at Basle ,

inaugurated hi s lectures by burning in the presence of his audience , whowere Stunned by such temerity

, the writings of Galen and Avicenna ,ju st as Luther, Seven years before , had burnt in the publ ic squ are ofWittenberg the papal bull s and decretals . The sixteenth centu ry,

'

in

its exuberance of intellectual l ife, was undoubtedly one of the grandestcenturies in history ; human thought in that gloriou s epoch shattered itschains

,and declared its freedom both in matters of Science and of rel igion .

Paracelsus,a man of powerfu l genius , but not well b alanced in mind ,

of corrupt moral s,and of an unlimited pride

,had

,notwithstanding these

undeniable defects,the merit of beginning a healthy reform in the science

and practice ofmedicine,by substituting the study of nature for the author

ity of the ancients and by giving a great importance to chemistry, both forthe explanation of organ ic phenomena and for the cure of disease .

It is to be lamented that this man of geniu s d id not contribute in anyway to the progres s of dentistry . His works have no importance for us .

As a matter of mere cur10 5 1ty we only record here that Paracelsu s conside red the too precociou s development of the teeth as a great anomalyand regarded as monsters those ch ildren who were born with teeth .

3

1 Lib. i,cap . xl i i

,p . 14 1 .

2 From gena , a che ek .

3 Bland in,Anatom ie du system e denta ire , Pari s, 1836 , p 19


Fallop iu s ’ reference to the analogy between the development of teethand that of feathers was highly important, as a point of departure forembryological researches which Showed clearly the real nature of teeth

,

thu s 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 , Fallopiu s relates having ob served that theyhave their origin in the following manner : A membranou s foll icle - is

formed inside the bone fu rni shed with two apices , one posterior (that i sto 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 (cu i nervulus ,et a rteriola , et v enu la applicantu r); the other anterior (that is more superfic ial), which terminates in a filament or small string, l ike a tail . Thisstring reaches right to the gum ,

passing through a very narrow aperturein the bone

,by the side of the tooth which i s to be sub stituted by the new

one . Inside the follicle is formed a special white and tenacious substance,

and from this the tooth itself, which at first i s osseous only in the partnearest the surface

,whilst the deeper part is still soft, that is , formed of

the abovementioned substance . Each tooth comes out traversing andwidening the narrow aperture through which the “ tail” of the folliclepasses . The latter breaks , and the tooth comes out of the gum ,

b areand hard ; and in process of time the formation of its deeper p art i scompleted .

The author says that his long and faborious researches into the development of the teeth were carried out with great accu racy, and he is , therefore , in a position to give as absolute certainties the facts exposed byhim . Indeed

,the ob servations of Fallopiu s were

, for the most part ,confirmed by sub sequent research . As to the “ tail” of the dental foll icle

,

it i s identical With the iter dentis or guberna cu lum dentis of some authors .Fallopiu s described it a s a simple String, but l ater on thi s prolongationof the dental foll icle has ' been considered

,at least by some

,as the nar

rowe st part or neck of the follicle itself, th at is , a s a channel throughwhich 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 _gubern acu lum

dentis (helm or gu ide of the tooth).

BARTHOLOMEUS EUSTACH IUS,another gre at

'

anatom ist of the s ixteenthcentury

,occupied himself in the Study of teeth with special interest , and

wrote a very valuable monograph on this subject . He was a native ofSan Severino

,Marche (Italy), and a contemporary ofVesal ius , Ingrassia ,

Realdo Colombo,and Fallopiu s ; he died in 1574 , after h aving immortal

iz e d his name through many anatomical d iscoveries and writings of thehighest value .

His book on the teeth, Libellu s de dentibu s , published at Venice in 1563 ,


and those of the second dentition from food and drink, mu st be declaredentirely false . In fact, by opening both j aws of a stillborn fetu s , onemay find

,on each side of each j aw, the incisors , the canine , and three

molars,partly mucou s and partly osseous

,and already sufficiently

large and entirely surrounded by their alveoli . Then removing,with a

skilfu l h and , the incisors and the canines , there may be observed a verythin partition only ju st Os sified ; and if thi s be removed with equal care ,an equal number of incisors and canines , almost mucou s and very muchsmaller

,appear

,which

,enclosed in special alveoli beh ind. the first

,would

exactly correspond in position each with its congener , if in both j awsthe canine were not resting for the greater part on the next incisor so asalmost to hide it .”

As to the molars (by which name also the bicusp id s are here meant),Eustachiu s s ays th at he found but three on each side, and no trace whatever of the others . Nevertheless , he considers it qu ite probable that thegerms of the l atter Shou ld also exist in the fetus , although so small as “toescape observation . He gives many ingenious reasons in support of hismode of thinking, and comes to the general conclusion , th at not onlythe temporary teeth but also the permanent ones have

,all of them

,their

origin during fetal l ife ; a false conclusion simply becau se too general ,and which - Shows once more how

,in b iological science

,one runs great

risk of falling into error whenever one tries to draw too free deductionsfrom ob served phenomena .

j

The researches of Fallopiu s and Eustachiu s confirm and complete eachother . These two eminent anatomists , who gave great glory to Italyby their immortal discoveries and works , were the first to shed a brill iantl ight upon the development of the teeth , and thu s opened up the way toall . Subsequent research on odontogeny .

In settling the period in which the formation of the teeth begins,

Fallopiu s was still more successfu l th an Eu stachiu s . His patient investigations showed him that the development of the teeth commences p artlyin the uteru s and partly after b irth , which is perfectly true , as was madeclear by later embryological researches . Fallopiu s found in each fetaljaw twelve teeth .

1 In this he agrees perfectly with his contemporary,

Eu stachius , who, as we have seen a short while ago , found in fetusus ,only ju st born , the incisors , the canines , and three molars for each S ide ofeach j aw . Eu stachiu s

,however, ob served in the fe tu s ‘ the germs of the

permanent incisors and can ines a s well,a thing not noted by Fa llop ius .

It i s not to be wondered at that some discrepancy Shou ld exist between

1 In utero duodocim dentes form antur in m alis , et totidem in m ax illa (in the ute ru s are

form ed twe lve te eth in the uppe r jaw and a s m any in the lowe r). Fa l lopii Gabrie l i s ob se rvatione s anatom icae , Venetiis, 1562 , p . 39 .


the observation s of these two eminent anatomists . The researches ofwhich we are Speaking are sufli c iently delicate and difli cu lt ; and even muchmore recent authors are far from agreeing perfectly, as far as regard s theperiod

,in which the development of the teeth begins . Serres , in h is E s s a i

s ur l’

anatom ie et la phys iologie des dents (Paris , su stain s the Viewthat in the fetu s he has ob served the germs of all the teeth , both temporaryand permanent

,while Joseph Linde re r (H andbu ch der Z ahnhe ilku nde ,

Berlin, 1842) says that, although he has followed the preparative method

indicated by Serres,he cou ld never di scover in the fetus the germs of

all the teeth . Perhaps , he adds , the time when the development of theteeth begins varies considerab ly in individuals

,ju st as we remark differ

eme es in the time of eruption .

In Chapter XVII of his book , Eu stach iu s speaks of the p rocess offormation of the teeth , which he Stud ied in abortive fetu ses , in stillbornchildren

,in ch ildren a few month s old , and also in kid s .

On dissecting a fetal j aw,there may be found on each side , as we have

already seen,the incisors

,the canine s

,and three molars , still soft and

imperfect,separated from one another by very th in osseou s partitions .

Each of these teeth is enclosed within a follicle or little b ag of a grayishwhite color

,rather more mucou s and glutinou s than membranou s , and

in form somewhat like the pod of a vegetable , with the only differencethat it Shows an opening at one of the extremitie s , from which the toothsomewhat protrudes

,as if it were “ germinating . The more recent and

softer the tooth,the more its follicle ha s a mucou s appearance and differs

from the natu re of membranes . As it does not adhere to the underlying tooth , it is easy to separate them . As to the tooth , it i s at thatperiod of its development partly osseous and partly mucou s , s ince thatpart which later on projects from the gum soon becomes transformedinto a white th in and concave scale

,which gives the idea of one of the

little cells of a honeycomb . This scale i s harder and more consp icuou sin the incisors

,since these

,at this stage

,are better formed ; the canines

are less advanced in development,and the molars still les s ; 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 tenaciou ssub stance , harder, however, than the sub stance of the follicle , and of awhitish color with a tendency to dark red

,translucent

,and somewhat

brilliant .Thu s , says Eu stachiu s , the teeth present themselves in a human fetu s ;

but he who cannot obtain a human fetu s may ob serve the same thingsin a kid .

Although the author does not express himself very explicitly , he seemsto consider the follicle of the tooth sub stanti ally identical with its ligament . This is at first mucou s , but afterward , becoming more consistent,


causes the tooth to adhere to the socket and gum very firmly, as if it wereglued .

”

“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— s ays Eustachiu s— 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 linewhich they imagine to exist between this supposed appendix and theremaining part of the tooth . But as su redly those who assert such th ingsshow 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 .

1 The line which i s ob served on the tooth on thepart corresponding to the adhesion of the gingival margin and of the dentalligament is very superficial , and after h aving scraped it away, there doesnot remain any trace of a divi sion . But apart from this everyone canvery easily observe

,even in infants , or in kids , that the tooth when ossified

does not present any line of division and that the Still mu cou s foll icleenvelops it freely

,and may be easily separated from the tooth ; which

would not be the case,if the follicle i s sued from between the tooth and

its supposed appendix .

”

Thu s,Eu stachiu s decl ares entirely false the opinion already expres sed

by Celsu s,that the permanent tooth grows from the root of the milk tooth .

He affi rms clearly and decisively that between the external and the radicalp art 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 sub

stantially represented by the remaining part of the first, it could neverhappen

,as in stead 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 , andreceives in its interior bloodve ss e ls and nerves

,whilst the upper part of

the permanent tooth is qu ite massive and imperforated . How,then ,

could this second tooth“ transmit bloodve sse ls and nerves into the cavityof the first ? Again

,how cou ld the continu ity of these bloodve sse ls

and nerves with their resp ective b ranches be possib le,if an imperforate

body, such as the crown of the permanent tooth,were really interposed ?

But what i s the u se of so many arguments ? exclaimed Eu stachiu s .

1 This sharp re proof and accusation of ignorance are m ad e for the bene fit of the im m orta lanatom ist Andre as Ve sa l ius

,to the num be r of whose adve rsarie s Eustachius l ikewise

be longed . What unju st fury of party passion !


difficu lties that are encountered in dissecting dental bloodve s se ls andnerves

,and reproves those who, by inaccurate illu strative figures , convey

the erroneou s idea that these parts are very clearly and easily ob servab le .

In Chapter XXI the author goes on to speak of the best mode ofproceeding in order to make successful ob servation of the small nervesand vessels going to the roots of the teeth . These researches are muchmore easily made in large animals than in man ; and therefore such thingsas cannot be ob served well in the l atter mu st 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 requ ired in making

researches of this kind,one may proceed to study the dental nerves and

vessels of the upper j aw,which is much more difficu lt . Having opened

up the inside of the lower j aw,one ob serves a cavity full of marrow, and

within this a nerve enclosed entirely in its own sheath . Having removedthe marrow

,and opened the sheath lengthwise

,one perceives th at the

nerve therein enclosed is constituted (analogou s to what may be ob servedin the large nerves of the limbs)by several nervou s strings, and that amongthese runs a comparatively large artery

,besides small vascu lar 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 , is su ing therefrom ,some very slender fibers

,on the nature

of which it i s,however

,difficu lt to pronounce ; and , considering their

thinness , one c an hardly conceive that they are composed of three differentelements , that is , of small nervou s , arterial , and venous twigs . At anyrate, the author admits that this may be so. On arriving at the lesserteeth , the nerve and the artery that accompanies it d ivide into two branches ,one of which traverses the opening presented by the bone at that point(m ental foram en), and is destined to the lower lip ; the other directs itscourse toward the roots of the incisors . The small twigs which penetrateinto the roots of the incisor and can ine teeth are less slender than thosewhich enter the roots of the molars , and are easily to be seen not only inlarge animals

,but also in man . If the tooth of an ox or that of a ram

be spl it through the middle,the mucou s substance contained in the

interior is seen to be traversed by small bloodve sse ls ; and one perceives ,besides , certain fibers , which are prob ably nerves . All these things , s aysEustachiu s , I have ob served many times in different animals , in somecases more , in others less distinctly . But it i s an exceedingly diffi cultth ing to follow the single twigs

, of which we have spoken , from theirorigin to their insertion

,or

,v ice <vers a

, from their insertion to their origin .

And so, adds the great anatomist, being able to observe but a small

part of the things I shou ld l ike to see,I find myself compelled , in my

perplexity, to supply by the aid of ratiocination the deficiency of thesenses . I therefore maintain that the interior part of a tooth is su sceptible


of experiencing pain accompanied by a feeling of pu l sation (a fact alreadymentioned by Galen), because a nerve and an artery penetrate into it .In the ox the penetration of bloodve sse ls into the roots of the teeth canbe more readily ascertained than in man . It may be admitted that thesame occurs in the human teeth ; and this , for the reasons already given ,and also becau se only by admitting the existence of an artery within thecavity of the tooth can be explained the copious flow of florid red b loodfrom a decayed tooth

,which has

,in some cases

,been known to imperil

the life of a patient . And I myself, s ays Eu stachius , have ob servedwith my own eyes an accident of this kind .

The author then passes on to speak of the eruption of the teeth , 1 butthe data with which he furn ishes us are neither very precise nor veryexact .Eu stachiu s , without declaring h imself for or against it , cites , in th is

chapter,the Op in ion of those who believe in the poss ib ility of a third

dentition in old p_

_

eople . He returns to this subject in the last chapterbut one of his book

,which treats of dental anomalies : Ali

,

” s ays he,

“ testifies to old persons having had all their teeth renewed . This hasbeen derided as chimerical by medical men of l ater date , or at least onlyadmitted under the condition that such teeth be of a nature completelydifferent from the first .”

Our teeth,says the author

,grow old together with u s , and toward

the term of l ife they ab andon us , a fact which also d istingu i shes themfrom the other bones . When

,however

,it occurs , through illness , that

the teeth are extracted or fall out spontaneou sly before the period of

old age , the alveoli become filled up with a bony sub stance ; and in addition the two osseou s scales of the maxillary bones approach one anotherand unite together in such a manner as to form a sharp margin , everyvestige of a cavity being obl iterated .

Speaking of the nutrition and growth of the teeth , 2 Eustach iu s s aysthat—given the existence of the dental nerves and bloodve sse ls —it i snot d ifficu lt to explain how the teeth are nou ri shed , grow, l ive , and feel .He therefore rejects the opinion of those who held that the teeth of thelower j aw derived their nou rishment from the marrow contained with inthis bone , and that those of the upper j aw received it from a humorou ssub stance similar to marrow

,existing in the large cavity of the upper

maxillary bone . Against the supporters . of this opinion Eu stachiu sraises , among others , the following objection s , viz .

,that the marrow of

the inferior j aw does not in any way touch the teeth , so that such a modeof nou rishment cannot be imagined

,and that it is completely erroneou s

that the large cavity of the upper maxillary bone contains a humor

1 Chap . xxii,p . 65.

2 Chap . xxii i,p . 70 .


s imilar to marrow . This passage of Eu stachius ’ book gives clear evidencethat he was well acquainted with the maxill ary S inu s , described a centurylater by the English anatomist

,Highmore

,who gave it h is name . The

existence of this cavity was, besides , already known before the time ofEustachius .The author also says th at those who believe that the internal cavity of

the teeth contains marrow,and that this serves to nou ri sh them , are

grossly deceived .

In the same chapter, Eu stach iu s confutes an opinion , at that time generally diffu sed and put forward for the first .time by Aristotle , viz .

, thatthe teeth grow throughout a whole lifetime . In the senile age , he says ,the teeth become impaired still earl ier than the other organs . Theybecome thinner by deficiency of nourishment, and , at the same time ,discolored ; the incisors and canines , as they waste away , come to be alsoless sharp than they were ; and the molars , losing their tubercles or cups ,become levelled down and smooth . If, notwithstanding the evidentwearing out of the teeth , they seem sometimes to grow longer, th is appearance is not to be tru sted , for it happens not unfrequently that the teethappear to have grown longer simply by atrophy

.of the gums , or alsobecause some humor or other morb id sub stance pu shes them outward .

As to the sensib il ity of the teeth,

1 Eustachius is of the opinion that theseorgans possess , besides the sensib il ity to pain , two other species of sensibility ; for, following the ideas of Galen , he also hold s that the teethtogether with the tongu e partake '

in i he sense of taste ; and he furtherconsiders the disagreeab le sensation known as s etting on edge of the tee th,as a species of tactile sensation pecu l iar to these organs .But in which part of the tooth does the faculty of feeling reside ?Among the authors previous to, or contemporaries of, Eu stach ius ,some affi rmed that the sensib il ity of the tooth res ides in the pellicle whichlines its ins ide cavity, others in the membrane which , l ike periosteum ,

clothes the root of the tooth,others in both these parts . Eu stachiu s

does not Show himself more partial to the one than the other of theseopinions ; he is , however, firmly persu aded that the hard sub stance of thetooth is also endowed with sensib ility . Though it is not easy to explainhow this may be , he considers it probable that the nerve , frayingitself out inside of the tooth in minute fil aments at the time when thesubstance of the tooth is Still soft and m ucous , interm ixes intimatelywith it, thus communicating to it the faculty of feeling, which then persists in it, even after the ossification of the tooth . Such an hypothesis iscerta inly worthy of the lofty intellect of Eustachiu s

,and has in itself, So

it seems to me,something of truth .

1 Chap . xxv,xxvi .


tooth in the roof of the mouth , near the opening which is in proximityto the incisors

,

1 and at Gubbio there is , in the monastery of the Trinita,a nephew of the distingu ished jurisconsu lt Girolamo Gabrielli , who atthe age of eighteen cut a tooth in the middle of the palate .

”

“ Pliny and Solinus tell of individuals born with all their teeth . Otherauthors

,that Phe re te s was without teeth all h is 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 i s , on

after the seventh year,and again after the fourteenth year . It ought

also to be mentioned that in some young person s 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 per

son s,One of the other molars being extracted , it i s sometimes renewed .

” 2

In the last chapter3 the author alludes to some dental affections . In

referring to the fluxions to which teeth are subject, he s ays he has ob servedmore than one case in which such a quantity of matter resembling chalkwas collected in the alveoli

,that these

.

gradually being filled thereby, allthe teeth became loosened and dropped out l ittle by little .

Speaking of dental d iseases requ iring surgical intervention , the authorremarks that

,dental surgery was

,in his days

,a most abject call ing, not

withstanding its having had,according to Cicero

,a very high initi ator

IE sculapius , the god of medicine .AMBROI S E PARE. Whilst the anatomy of the dental system wa s il lu s

trated by the researches of Fallopius and Eu stachiu s , the celebratedFrench surgeon Ambroise Paré was contributing in the highest degree tothe progress of practical dentistry .

Ambroise Paré (Latinized Parze us)wa s born at Bou rg—Hersent in theyear 15 1 7 . His father and one of his brothers were box- makers ; anotherbrother wa s a barber . We have no very precise information about theearly years of his life ; so much is certain , however , that Ambroise Paré

1The infe rior orifice of the foram en inc i s ivum .

2 It is supe rfluous to say that the se case s are unre a l and simp ly de pendent upon e rroneous

ob se rvations ; for in stance , in the case of the se cond m olar be ing extracted be fore the e ruptingof the third , the se cond m olar figured as

,and supposed to be

,the latte r

,when, fina l ly, the

wi sdom tooth appe ared , it was be lieved to be the la st m olar renewed . It is no rare thing,a lso, in the se d ays

,not only for unprofe ssiona l pe rsons , but a l so for m ed i ca l practitione rs ,

to fal l into e rrors of thi s kind,e spe c ia lly be cau se , in Sim i lar case s

,the wi sdom tooth

,having

but a lim ited Space in which to e rupt,is in the habit of fi lling the void le ft by the se cond

m olar, whe re it m e ets with le ss re si stance .

3 Page 93 .


Ambroise Paré,too

,admits that the teeth grow throughout the whole

lifetime , and that the wearing away consequent on reciprocal friction andmastication is compensated in this way .

Galen had already affirmed,and Ambroise Paré also held erroneously

,

that the exqu is ite sen sib il ity of the teeth aid s the sen se of taste .

In speaking of the development of the teeth , Ambroise Paré says onlythat they are already solid and osseou s before b irth

,he himself having

ob served this in d is secting the j aws of a child who had d ied immediatelyafter b irth .

In Chapter VII, Book XIII, 1 Paré treats of fracture of the lower j aw .

The method of cu re he proposes is altogether identical with that of Celsus .With regard to the teeth

,he says that s i elles sont div is e

'

es,ebranlees

,

ou s epare'

es hors de leurs a lve’

oles ou petites cav ités,e lles doitj ent es tre

redu ites en“

leurs pla ces et s eront lic'

e s et atta che’

e s contre celles qu i son t

ferm e s,a<ve cqu es un fil d

’

or ou d’

a rgent, ou de l in . E t le s y fau t ten irju squ e s a cc qu

’

elles soient bien afierrnie s , et le ca llu s soient refa it et rendusol ide .

”2

Toothache , s ays Paré, 3 is , of all others , the most atrocious pain thatcan torment a man without being followed by death . It depends, inmany cases , on a humorous fluxion of a hot or cold nature which flowsinto the alveolu s , forcing the tooth outward , loosening it, and c au sm gthe patient so much pain on the slightest pressure being exercised on it,th at he cannot dare to b ite with it

_

in the least . If, however, the toothis corroded , hollowed out, or pierced to the root

,the p ain is so strong,

when the patient drinks— particu larly if the liqu id is cold— that he seemsto fhave had a stab ’with a Stiletto inside the tooth .

If the pain is acute and pungent,l ike that

‘ produc ed by needles beingthru st into the diseased tooth ; if the patient complains of a Strong pu l sation at the root of the tooth , and in the temples ; if the application of coldremedies calms the pain , all these sign s indicate th at the cau se of the evili s heat . Instead , the cau se of the pain may be held to be cold when thepatient complain s of a great heaviness in the head

,emits a quantity of

sal iva , and find s relief in the application of hot remedies . In the treatment of toothache one mu st fulfil the following three indication s

1 . Regu l ate fittingly the mode of l iving .

2 . Evacuate or dis sipate the morb id humors ; this .may be effectedby variou s means , namely , by purgative s , by “ bleeding

,by gingival

1 Vol . i i,p . 307 .

2 if they are d ivid ed , shaken ,or se parate d from the ir a lveoli or l ittle cavitie s

,they

m ust be reduced into the ir place s and shou ld be bound and fastened against those that are

firm with a threadof gold , Si lve r, or flax . And they m ust be -he ld thu s unti l they are qu ite

firm and the ca l lu s is form ed and have be com e sol id .

3 Lib. xv,ch. xvi

, vol . i i , p .

“ 443 .


sc arific ation ,by the appl ication of leeches on the site of the pain

,by

cupping on the b ack of the neck , or on the Shou lders .3 . Applying in each single ca se the medicaments best adapted forcalming the pain .

The author here goes through a long enumeration of anti - odontalgicremedies that offer no particu l ar interest , as they are not at all new .

When a decayed tooth becomes the seat of excessive p ain,and this

does not yield to any remedy,one mu st either have recourse to extraction

or cauterize it ; th is can be done either with potential cau stics— such asoil of vitriol , aqu a fortis —or with the actu al cautery . By cauterizing

,

Pare adds , one burn s the nerve , thu s rendering it incapable of again feelingor cau s ing pain .

Erosion or caries 1 i s the effect of an acute and acrid humor, that corrodesand perforates the teeth , often to their very roots . To combat thismorbid condition

,even when it is not accompanied by p ain , one mu st

al so have recourse (besides general treatment) to cauterization eitherwith 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 mannerbetween two teeth a s to make it impossib le to apply c austic s

’

or othermedicaments

,one mu st fi le ju st suffi ciently between the healthy and the

corroded tooth to render the part accessib le , taking care , however, to filemore on the side of the afl e cte d tooth than on that of the healthy one .

The fi le may be u sed,besides

,to plane down a tooth that Stands out

above the level of the others , and for S imil ar pu rposes .If one or more teeth have been shaken by a blow or a fall , or have come

out of their alveoli altogether, the su rgeon shou ld not remove them ,but

rather reduce them and b ind to the neighboring teeth,th at they may

entirely 'reacqu ire their original firmness .In allus ion to this subject

,Ambroise Paré refers to the case of a friend

of his , who having su stained, through a blow from the hilt of a dagger ,a fracture of the lower j aw with almost complete expu l s ion of threeteeth from their alveoli

,had the fracture reduced by him ; after replacing

the teeth and b inding them to the neighboring ones,he prescribed a strin

gent mouth washes and liqu id or semiliqu id nourishment,such as meat

ju ice , panada , barley soup , j elly, and such like . The patient was comp le te ly cured and able to masticate with the three teeth a s well as before .

Also in the case of extraction of a healthy in stead of a disea sed tooth ,Paré recommend s replacing it immediately and binding it to the neighboring ones

,for

,he says

,by th is means the tooth can take root again .

AS we have seen,the first authorwho Speaks of replantation i s Abu lcasi s ,

but to Ambroise Paré belongs the merit of fhav ing treated the subject

1 Lib. xv,cap . xxvi i , vol . i i , p . 448.


much more explic ity, and of having in sisted on the utility of this operation

,indeed

,on the duty of carrying it outwhenever it seems indicated .

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

FIG . 60

Dental fi le s (Am broi se

his own words : Un hom m e digne d’

es tre creu m’

a afi rm e’

qu’

une princes s e ayant fa it a rra cher une dent

,s’

en fit re'

m ettre subit une a utre d’

une

s ienne dem ois elle,laqu elle s e reprint, et qu elque tem ps apres m as choit

des su s com m e s u s celle qu’

elle a <voitfa it arra cher aup a ra‘v ant.

”1

1 A m an,worthy of be ing be l ieve d ; ha s assured m e that a c e rtain prince ss having had a

tooth taken out , im m ed iate ly had it re placed by anothe r supp l ie d by one of he r lad ie s, whichtook root

,and afte r a tim e she m asticated with it a s we l l a s she had done with the form e r

one .


then extracting the '

de ciduou s tooth ; for after this the new tooth may bepressed toward the point before occup ied by the other, until it as sumes it sn atural position .

Sometimes,when a tooth is too firmly planted , one prefers , says Paré ,

in stead of extracting it, to break off the crown for the pu rpose of beingable to act d irectly on the dental nerve with appropriate remedies

,or

to destroy the sen sib ility of the nerve entirely, by cauteriz ation . Thisunreasonable and reprehensib le method of cure is also quoted

,under

the denomination Of des chap ellem ent, by another French author, a contemporary of Pare— Urbain Hem ard—who ob serves , however, that onerarely had recou rse to it ; for the pain and Shock which are cau sed by thi soperation are not less than those cau sed by extraction .

It very often happens that the patient cannot indicate exactly whichtooth it is that gives him pain , his sufl e rings being so acute a s to appearspread over a great part of the j aw . One cannot , therefore , tru st toomuch to the indication s given by the patient a s to the point of departureof the pain

,and mu st take care not to extract a healthy instea d of a

diseased tooth .

The extraction of a tooth should not be carried out with too much vio

lence , as one risks producing luxation of the j aw or concus sion of thebrain and the eyes

,or even bringing away a portion of the j aw together

with the tooth (the author h imself has' ob served thi s in several cases),

not to speak of other seriou s accidents which may supervene, as , forexample

,fever

,apostema

,abundant hemorrhage

,and even death .

In extracting a tooth it i s necessary to place the patient on a very lowseat, or even on the ground , with his head between the legs of the operator .1After having laid the tooth b are suflic iently, if one sees that it i s veryloose

,one may pu sh it out of its socket with a pou s soir , that is , with a

trifid lever . But if the tooth is too firmly rooted to be extracted with th isin strument

,one mu st make use of curved p incers

,or else one may have

recourse to a pelican . The author notes , however, that much skill i srequ ired in u sing this latter in strument

,for otherwise it will almost cer

tainly happen that several good teeth will be knocked out, instead of theone intended to be extracted . In proof of th is , he relates the followinganecdote

,which we relate in the words of the author, th at it may not

lose anyth ing of its quaint originality :“

Je veux icy reciter une histoire d ’un maistre barb ier , demeu rant aO rleans , nommé maistre Francois Loi

'

i is,lequel avoit par dessu s tou s ,

l’

honneur de b ien arracher une dent,de facon que tous les s amedis

plusieurs paysans ayans mal aux dents venoient Vers luy pou r les fairearracher

, c e qu ’ il faisa it fort dextrem ent avec un polican , e t lorsqu’

il

1 Lib. xv,cap . xxvii i .

TH E S IXTEEN TH CEN TURY 195

avoit fait, le jettoit sus un a is en sa boutique . O r avoit- il um serviteu rnouveau ,

Picard,grand e t fort, qu i de siroit tirer les dents a l a mode de

son maistre . Arriva cependant que led it Francois Louys disnoit, un

villageois,reque rant qu

’on luy arrachait une dent, c c Picard print l’

instru

ment de son maistre e t s’

e ssaya faire comme’

luy ; mais en lieu d’oster l a

mauvaise dent au pauvre vill ageois , luy en pou ss a e t arracha trois bonnes .

FIG . 63

Two gum lance ts and a trifid leve r cal led pou ssoir (Am broi se Pare).

E t sentant une dou leur extreme , e t voyont troi s dents hors de sa bouche ,com m enca a crier

' contre le Picard ; lequel pour le faire taire luy d itqu ’ il ne dist mot, et qu ’ il ne c riast si haut

,attendu que S i le maistre venoit

il luy fe roit payer les trois dent pour une . Donc le maistre oyant telb ru it, sortit horS de tab le pour seavoir la cau se e t raison de leu r noise e tcontestation ; mais le pauvre paysan redoutant les menaces du Picard ,et encore apres avoir endu ré telle douleur qu ’on ne luy fist payer trip le


ment la peine dudit Picard , se teut, n ’

osant declarer audit maistre c c

beau chef d ’oeuvre ; e t ainsi le pauvre b adaud de Village s ’en alla qu itte ;et pour une dent qu ’ il pensoit faire arracher, en remporta trois en sa

bourse,et celle qui luy c au soit le mal en sa bouche .

” 1 Paré adds in conc lusion : Partant je conseille aceux qu i voudront faire arracher les dents ,qu

’

il s aillent aux vieux dentateurs , et non aux j eunes qu i n’

auront encorere conneu leurs fautes .”2But let us now return to our subject . After the extraction of a tooth ,

it is necessary— says Pare— to leave the wound to bleed freely, so th atthe part may get rid of the morb id humors ; then the gums and thealveolu s must be pressed

,on both sides

,with the fingers

,to readju st the

socket,which will have been widened and sometimes even broken in

extracting the tooth . After this,the patient shou ld rinse his mouth

with oxycrate ; and when the weather is cold and windy, the patientshou ld take care to avoid fluxion in the other teeth .

The following chapter speaks “de la lim os ite

’

ou rou illu re des dents,

et de la m aniere de les cons erv er .

”

After meals the mouth mu st be rinsed with water and wine , or withwater with a little vinegar added to it

,and the teeth cleaned from all

res idues of food , so that their putrefying may not spoil the teeth and makethe breath fetid . An earthy yellowish sub stance , l ike ru st , often formson the teeth from want of cleanliness and also when they are not u sed tomasticate ; th is sub stance corrodes the teeth , just as rust corrodes iron .

It i s necessary to remove this sub stance,by scraping the teeth with small

in struments su itab le for the purpose,and then the teeth themselves must

1 I wi l l he re te l l a story of a m aste r barbe r l iving at Orle ans, nam ed m ai stre Francoi sLouys, who had the honor of pu l ling a tooth bette r than any one e lse

,so that on Saturdays

m any country folk s having toothache cam e to him to have them pu l led out,which he did

ve ry dexte rously with a pe l ic an,and when he had

.

done , threw it on a bench in his Shop .

Now he had a new se rvant,Pic ard

,ta l l and strong, whowanted to pu l l te eth l ike his m aste r.

It happened that whi l st the said Francoi s Louys was d ining,a vi l lage r wanting a tooth

pu l led , Picard took his m aste r’

s in strum ent and tried to do like him,but inste ad of taking

out the bad tooth,he knocked and tore out thre e good one s for him

,who, fe e l ing gre at

pain and se e ing thre e te e th out of his m outh,be gan to c ry out aga inst Pic ard , but he , tom ake '

him hold his pe ace,told him not to say a word about it and not to shout so, be cause if his

m aste r c am e he wou ld m ake him pay for thre e te eth instead of one . Now the m aste r, he aringsuch a noise

,cam e out from table to know the c au se of it and the re ason of the quarre l

,

but the poor pe asant fe aring the thre ats of Pic ard a nd Sti l l m ore afte r enduring such pa inbe ing m ade to pay a thre e fold fe e by the “

said Pic ard , was si lent, not daring to reve a l to the

m aste r this fine pie ce of work of the said Picard ; and thu s the poor bum pkin went away,and for one tooth that he

'

had thought to have pul led , he carried away thre e in his pouchand the one that hurt him in his m outh.

2 For which reason I advi se those who wou ld have the ir te e th pul led to go to the olde rtooth- pu l le rs, and not to the younge r one s who wi l l not ye t have re cognized the ir shortcom ings .


into the aperture of the palate,can be made to tu rn round from below

,

by means of a small p air of pincers,so as to fix the obturator .

In the last chapter of Book XVIII, first dentition and the treatmentrequ ired during this period are spoken of. The cutting of teeth , saysParé, i s accompanied by pain , itching, and pricking of the gums ; often ,as well by diarrhea, fever, epileptic convu l s ions , which sometimes endfatally . The symptoms by which it may be known that teeth are aboutto come forth are as follows : The wet- nu rse feel s the mouth of thesuckling infant to be hotter than u su al ; the gums are swollen ; the childis restless, crying often and sleep ing but l ittle ; it emits a quantity of

sal iva from the mouth , and frequently puts its fingers in its mouth , tryingto rub its gums , and soothe, in this way, the p ain and itching which itfeel s . It is then neces sary to treat the nurse as if she had fever, and theinfant shou ld be suckled less than u sual ; som e cooling and thirst quenching drinks shou ld be given to it— for a child in such condition s suffersfrom intense thirst ; the nu rse shou ld often rub the gums of the l ittle p atientwith softening and soothing sub stances

,a s , for example , oil of sweet

FIG . 65

Pare s palatine obturator without Sponge .

almonds fresh butter, honey, or mucilage made from the seeds of thefle awort or of the qu ince ; the brains of a hare (these may be roasted orboiled) have not only a very soothing action , but al so, according to a veryancient belief sh ared by Paré, possess th e occu lt p roperty of aiding thecutting of the teeth . But oftentimes , neither these nor other remediesare of any use

,because the gums are too hard and the teeth cannot cut

their way through at all ; the ten sion of the gums then produces very violentp ain , fever, and other accidents , death even supervening in some cases .The author

,therefore , advises lancing the gums deeply, ju st above the

tooth which ought to appear, thu s opening it a way, th at it may moreeasily come out . He relates th at he has performed this op eration on hisown children in the presence of many medical authorities .Almost as if to show the high value of this operative procedure , Parétells the case of a child , the son of the Duke of Nevers

,who died at the age

of about eight month s without h aving cut any teeth . He, together withother doctors

, wa s invited to carry out an . autop sy. No lesion whateverwas found sufficient to cau se death

,but the gums were very hard

,th ick

,


and swollen ; an incision into them showed that the teeth were ready tocome out, if only their eruption had been facilitated by lancing at theright time . Paré and the other doctors were of the unanimous opinionthat death was caused solely by the impossib il ity of cutting the teeth onaccount of the hardness of the gums .Among the many strange cases given in Book XIX (D es m ons tres e t

prodiges), Paré also speaks— tru sting to the word of Alexander Benedetti—of the case of a woman , who, after the complete loss of her teeth cau sedby age

, cut them all again at eighty years of age .Although Paré treats so amply and with such competent e all th atconcern s dental d iseases and their cure , he does not make the leastallu sion to the stopping of teeth , beyond recommending, as had areadybeen done by Celsu s , that when a tooth that is to be extracted shows alarge cavity

,the latter should be well filled with linen or lead

,so th at the

tooth b e not fractured under the pressure of the ' inSt'

rum ent and so leavethe root behind in the alveolus .A century before Ambroise Paré , Giovanni d ’Arcoli had alreadymentioned the fill ing of teeth with gold leaf

,and

,as we have seen already,

there is very good reason to believe that the practice of th i s operationdated b ack to a Still earlier period . How is it, then , th at the illustriou sFrench surgeon does not say a word about th is ? Very prob ably Stopp ingswere not at all in use among French denta teurs and perhap s

,even in

Italy, this operation was only rarely carried out .

JACQUE S HOULLIER ( 1498 to a celeb rated French physician andsurgeon , also known under the Latin ized name of Jacobus Holle rius ,was the first to stand out, although timidly, against the theory of dentalworms . He did not decidedly deny their existence

,this having been

affirmed by so many illustriou s writers ; he , however, speaks of themas if the point were a doubtfu l one : “I t is s a id th at worms are generatedin the teeth , which corrode the teeth themselves , and produce a pain whichi s not very violent and cau ses itch ing with little or no salivation (verm es

ajunt subna s ci dentibus,e t hos corrodere

,a qu ibus dolor non ita fortis ,

pru riginosus , nulla au t pau ca s a liva tio).But even while putting in doubt the existence of dental worms , he be

lieve s it h is duty to enumerate the variou s remedies,recommended for

their destruction . As to fumigation s with the seeds of the hyoscyamu s,Houllie r, declares that what is believed by the common people , and whathas been written by doctors of antiqu ity about worms being killed andseen to fall from the teeth by the effect of these fumigations , i s all nonsense .In fact, he says , when the seed s of the hyoscyamu s are burnt there flyaway from them what appear to be little worms

,even if the fumes do not

reach the worm- eaten tooth . (Quod au tem vu lgus s ibi persu adet, e t

ab antiqu is m edicis s criptum es t de suflum igio e s em ine hyos cyam i, v idetur


fabu los um . N am inde ajunt m an ifes te <verm es excidere . Re evera , incenso

s em ine , e‘volant tanqu a v erm icu li , e tiam s i non attingit fum us v erm icu lo

s um dentem .)Apart from this

,in the works of Houllie r, nothing is found that is of

interest for the history of dentistry . He repeats several errors andprejudices of the ancients ; he s ays , for example , that men have ordinarilythirty- two teeth

,women

,twenty- eight ; and he , too , believes in the ex

pul s ive virtues of the fat of green frogs when applied to a tooth (adepsran ee <viridis dentem depell it).

Houllie r does not contribute in any way to dental therapeutic s , he onlyenumerates the methods of cure recommended by preceding authors .1VOLCH E RU S COITER (1534 to of GrOningen , an ardent student ofanatomy

,and a pupil of Fallopiu s , Eu stachiu s , and Aranz io, studied

with great attention the development of bones , dissecting many fetu ses andchildren of variou s ages for that purpose . He clearly States hi s opinionthat the teeth are not bones

,S ince they do not pass

,l ike the latter, through

the cartilaginou s stage,but are derived instead from a mucou s sub stance .2

JOHANN JACOB WECKER,a doctor of Colmar

,published in 1576 a

valuable medical work composed of synoptical tab les , in which is b rieflysummarized 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 itwas considered an excellent preservative again st the p lague to rub theteeth with theriac , mithridate, angel ica , and zedoary. From this it maybe perceived that even in those days doctors had understood the importance of the cleanl iness and disinfection of the mouth as a prophylacticagainst infective diseases .In the abovementioned book may be found a suffi ciently completeexposition of dental therapeutics of that and of the preceding periods .There i s noth ing, however , which is not already known to u s from our

examination of the earlier writers . Worthy of notice is the informationthat , among other th ings , to facilitate the cutting of teeth rubb ing thej aws with turpentine wa s recommended at that time .3DoNATo ANTONIO OF ALTOMARE

,a Neapolitan physician and philos

opher, dedicated a long chapter of his Ars m edica‘1 to the subject of

dental p ain s and their treatment . He classifies these pains with great

1 Jacobi Holle ri i m edic i parisien sis om nia ope ra practica , Geneva ,1635 , l i b . i i

,p . 1 1 7 ,

e t seq .

2 Bland in,Anatom ie du system e dentaire

,Pari s

,1836 , p . 25 .

3 Hoann Jac . We cke ru s, m ed ic ina ‘

utriusque syntaxe s,

ex Gra corum ,Latinorum ,

Arabum que the sauri s col le cta,Basi le a

,1576 .

1 Donat i Antonii ab Altom ari m ed ic i ac philOSOphi ne apolitani Ars Medic afVene tiis ,1558, cap . xli

,p . 190 .


accuracy,taking into account their seat and cau ses , and pointing out in

each S ingle case the method of cure to be followed accord ing to the warm,

cold,dry

,or humid natu re of the pain . In what he says , however, we

do not find anything new .

GIULIO CE SARE ARAN Z IO (1530 to a celebrated surgeon andanatomist of Bologna , in which city he taught from the age of twentysix years until his death , i s of the opin ion that paru l ides— that is to s ay ,

inflam m ations or ab scesses of the gums— and epu l ides— that is fleshyexcrescences of the same— are u sually cau sed by caries or putrescenceof the teeth ; but that in certain ind ividuals , from a pecu l iar weaknessof the gums , these are easily attacked by inflammation when the wind isin the south .

In the case of paru l ides , to soothe the p ain and to accelerate thesuppurative process , emollient sub stances shou ld be u sed ; afterward iti s necessary to open the ab scess with a lancet

,to wash the mouth with

mu l se , and to aid the process of cicatrization by u s ing syrup of roses .As to epu l ides , these mu st b e made to dis appear, by sprinkl ing thetumor with the powder of gall—nuts , or by moisten ing them frequentlywith a decoction of gall- nuts , or with su lphu r water . But if they do notyield to these remed ies , and are the cau se of functional d isturb ances ,the surest and most prudent method of cu re wou ld be the use of thered - hot iron .

GIOVANNI ANDREA DELLA CROCE ,a celeb rated Venetian physician

and surgeon , was the author of a most valuable treatise on su rgery, whichwas publ ished first in Latin (Chiru rgia u ni!v ers a lis opus absolutum ,

Vene titiis , and then in Italian under the title of Chirurgia

un iivers a le e perfetta , Venezia , 1583 . According to this author,dental

fistula are more common to the lower j aw than to the upper one . Tocure these fistu la , it is necessary to extract the diseased teeth from whichthey origin ate »

,even Shou ld they ache but l ittle or not at all . To confirm

this,he relates in fu ll a very interesting case of a dental fi stu la , that he

cured by the extraction of a tooth which hardly ached at all .Flaj ani1 chose to see in this case a precociou s example of the open ing

of Highmore’ s antrum through the alveolu s . But the description givenby Andrea della Croce of his case does not at all warrant this supposition .

At the end of his book Andrea della Croce gives u s the figu res of manydental instruments , which have , however, nothing new about them .

GEROLAMO CAPIVACCI , of Padu a , repeats the advice (already given bypreceding authors) to avoid , in eating and drinking, the rapid changesfrom heat to cold , and v ice v ers a

,since

,says he

,nature does not tolerate

1 Collezione d ’

osse rvaz ioni e rifle ssioni,vol . i i i

,0 5 3 . 84, p . 3 74 .

202 TH IRD PERI OD—MODERN TIMES

these rough changes .1 In the mercurial treatment of syphili s , 2 he re commends the patient

,as soon a s the action of the remedy manifests itself

in the oral cavity,to keep a piece of gold in his mouth , that the mercu ry,

on account of its particu l ar affinity, may unite with the gold and the harmful efl e cts of this strange rem edy on the mouth may be thu s avoided .

A Strangemethod of cu ring mercurial stomatiti s !JOHANN SCHENCK VON GRAFENB ERG (1530 to a celeb rateddoctor of Freybu rg- in - Breisgau ,

has left u s , in his Obs erv a tiones m edicce ,

a very rich and interesting collection of clin ical cases . In this work herefers to many ob servations upon dental diseases by earlier authors , which ,however

,have already been noted by u S in their time and place . Among

other th ings, Schenck von Grafenberg relates that Cardanu s wa s able ,more than twenty times

,to calm a Violent tooth ache which tormented

him by lightly pressing the sick tooth between the thumb and indexfinger of his left hand .

PETER FORE E ST ( 1522 to a very famou s Dutch doctor ofAlkmaar,repeats the very old error— already in decisive terms denied by And rea sVesal iu s— th at women have only twenty- eight teeth

,whilst men u sually

have thirty- two. To the two central incisors he gives the name of colu

m ella res . Sugar and all sweet things , s ays this author, are very harmfu lto the teeth

,and he gives a s a proof the fact th at apothecaries h ave

,in

general,very b ad teeth , on account of the frequency with which they

taste syrup s and the like . Perhap s things are now changed , s ince Iam not aware that chemists in our d ays are to be distingu i shed by theb ad state of their teeth !In regard to tooth ache , Fore e st records an important ob servation which

he h ad made on himself; an aching tooth which a su rgeon had not succ e eded in extracting, but which was s imply loosened , ceased , withoutanyth ing else being done

,from giving him pain

,and in a short while

became firm again , and he continued to u se thi s tooth for about five years .However

,on a renewal of the p ain he was obliged at last to h ave it ex

tracted . On the Strength of thi s ob servation , the author believes thatin certain appropriate cases , recourse may be had to the luxation of atooth

,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 thedental nerve, this , in its resu lts i s equ ivalent to a replantation .

Fore e st is the first to speak of the violent inflammation of the gumsand of the whole mouth , cau sed by the application of artificial teeth ofivory fixed in their place with gold wire . This cannot at all astonish

1Hie ronym i Cap ivac c i Patavini opera om nia, Veneti i s, 1 6 1 7 , ed it . sexta,li b . 1

,cap .

li ii ; de affe ctibus d entium ,p . 5 15 .

2 Lib. i i,cap . v

, de lue vene re a , p . 7 12 .


are almost entirely taken from preceding 'authors . Hém ard indicatesby the term des chap ellem ent (decrowning) the removal of the crown of atooth for curative pu rposes . He speaks of th is operation as of a methodbut . re c ently introduced into therapeutics ; but, and very reasonably , too ,he Shows himself somewhat hostile to such a method of cure .

As to what concern s the anatomy of the teeth , Hém ard’

s book does notcontain anything original . The following passage , transcribed by Portal , 1shows luminou sly that Urb ain Hém ard

,instead of making researches of

his own , has simply copied the Italian Eu stachiu s , translating the latteralmost literally . The beauty of it i s that Portal had not noticed theplagiarism in the least

,S ince he says that if Urbain Hém ard had taken

into account the researches of Fallop iu s and Eu stachiu s as well , his bookwou ld have acqu ired Still greater value . But, in truth , he has taken intoaccount , and has valued the researches of Eu stach iu s somuch as to palmthem off as his own ! We here quote , s ide by side , with a paragraph takenfrom Hém ard

’

s book , the corresponding passage of Eu stachiu s , that ourreaders may be convinced of the truth of what we have Stated

EU STACH IUS . HEMARD .

ape rta utraque m axi lla occurruntincisore s

,c an ini , ac tre s m olare s, nim irum

se cundus, te rtiu s e t quartus ; partim m ucosi,

partim osse i,non obscura m agnitudinis,

suisque pra se piolis und ique vallati

incisoribu s autem et caninis docta m anu

d e tractis , tenuissim um inte rstitium vixosse um factum con spicitur ; quo pari d i li

gentia arrioto, obviam veniunt totidemincisore s et c an in i pene m ucosi e t longem inore s, qui post a lios priore s in propri i sc ave i s latente s, singuli Singu lis e regioneoppositi col locati e ssent, n i si utriu squem axilla caninu s m agna ex parte proxim oinc i sori incum be ret e um que prOpte re a fe reoc cultare t.

2

Prim orum m olarium e t genuinorum qui Quant e st de s prem ie re s m fiche lie re s

c irc a se ptennium ac longe e tiam poste a ori et d e s gem e le s qui 51 se pt ans,ou long

untur,fateor m e nu l lum ve stigi-um vidisse . tem p s aprés com m encent a sortir

, je con

fe sse n’

en avoir trouvé jam ai s aucune

trace n’

y com m encem ent .

1 Hi stoire de l ’anatom ie e t d e la chirurgie,Pari s

,1 7 70 .

2 Hem ard has om itted translating thi s passage,probably be cause he d id not we l l unde r

stand it .

leur ayant ouve rte l ’une et l ’autrem achoire

, j’

y ai trouve’ seu lem ent le s dents

inc isoyre s, le s c an ine s, e t le s troi s m ache

l ie re s de chaque couste de m fichoire ; 51

scavoir”

la se conde,la troysiem e et la qua

triem e , le sque l le s e stoit partie osse u se s

parti m ucillagineu se s, de m ediocre grandeur,garn ie s a l ’entour de leurs pe tits e stuis

ou a lvéole s . E t de pu i s ayant tire e s dehorsle sd icte s dents inc i sive s et canine s

,il se

trouve um entre - deux osseux ; leque l ayantpare i l lem ent oste

,il se pre sente de d e ssoubs

autant de dents inc i sive s e t c anine s,toute s

pre sque m uc illagineu se s, re presentant la

substance d ’

un blanc d ’

oeuf a dem y cuitem oindre s pourtant que le s pre' cedente se stant cachée s d ans le s m e sm e s e stuit s

apres le s prem i e re s .


EUSTACHIUS . HEMARD .

Ve ri sim i le tam en e st,rationique consen Toutes IS i l e st vraysem blable et ra i son

taneum,eos pe rinde ac se cundos incisore s able au ssi

, qu e l le s ayent pris dans la m atrice,

e t caninos rude quodd am ,sed m inus pe rspi tout a in si que le s incisoyre s e t c an ine s

cuum initium ortus in ute ro sum e re ; se conde s, que lque petit com m encem ent d e

sensim que poste a s im i lite r form ari e t absolvi naysance e t form e, m oins apparante toute

foi s, m ai s qui de pu is se faconne et parfaict

tout a insi que de s autre s .

At the time when.

Urb ain Hém ard wa s publishing his pamphlet inFrance

,several other monographs were already appearing in variou s

p arts of Europe on teeth and their affection s . A few years after Ryffhad in itiated dental l iteratu re in Germany

,other Odontological writings

were published in Spain and in Italy.

FIG. 66

CO LO Qj’

IO BREVE Y

copcdiofo. Sobrc lam ate ria (I la dé

tadura, ym arauil lofa obra d 13 ha

ca.C6 m uchos rem ed ios y 3 111

fos ncceffariol aordé

dc curar, yadrccar

los dientes .

1]Dirigido,alm uyaltoym uypodel ofofe i

'

ion el Principe dc”

: Carlos m o(e

fior.C6pueflopor c l Bach iller Pri mftoMartine z .Natural de lavil la dc Cattrillodc onic!o.Efl ite enValladolid. 1 y5 7 .

Con prcuilegio.

( EttataffadoenLVII. mm.

page of Franc i sco Martine z’ s book (Va l ladol id ,


FRANC I SCO MARTINEZ,

1 in 1557 , gave to the press in Valladol id aColoqu io brev e y com pendioso sobre la m a ter ia de la dentadura y m araw llos a

obra de la boca , con m uchos rem edios y a <visos neces s arzos , y la orden de

cu rar y adrecar los dientes .

FIG . 67

Four of the instrum ents repre sente d in Franc iscoMart ine z’8 book.

FIG . 68

denta l excavator used for a scerta ining whi ch one am ong seve ral de cayed te eth

wa s the one causing the pain (F . Martine z).

FIG . 69

chi se l and a m a l let for sep arating t e eth (F. Martine z).

FIG . 70

A pe l ican (F . Martine z).

1

[For a fu lle r review of thi s author se e A Denta l Book of the Sixte enth Centu i y,by

Jul io Endelm an,Dental Cosm os

,1 903 , vol . xlv, p . 39 .

—~E . C . K .]


In the same year and city was printed a Latin pamphlet , D e dentione,

by Franciscu s Martinu s de Castril lo , prob ably the author of the preced ing book . In 1563 was publi shed in Venice the excellent treatiseof Eu stachiu s on the anatomy of the teeth (Libellus de dentibu s). AtFrankfort was published , in 1576 , the second dental monograph in theGerman language , Z ahna rz ney, by Adam Bodenstein von Carlstad ;

and two years later Petru s Monavius published in Basle a Latin pamphleton dental d iseases (D e dentium afle ctibus).

FIG . 7 1

FIG . 72

Diffe rent kind s of forcep s (F . Mart ine z).

The above—mentioned works,apart from the book of Eu stach iu s , which

is , of its kind , a real masterpiece , have but l ittle importance . We havecited them here solely to Show in what years and in what countries thevery first dental monograph s appeared .

GIROLAMO FABRIZIO, of Aquapendente (153 7 to a celeb rated

anatomist and surgeon,wrote some very valuable works

,among which

a treatise on surgery,in which the part relative to the afl e c tions of the

dental system is treated briefly but with great orderliness and clearness ,thu s giving a very preci se idea of what .d enta l surgery was at the end ofthe sixteenth century .

8 TH IRD PERIOD -'

MODERN TIMES

The princip al operations which it i s neces sary to'perform on teeth are ,

he s ays,seven in number , 1 viz . : lit]

1 .Forced opening of the dental arches in cases of prolonged constric

tion of the sam e , so as to prevent the p atient from dying. of hunger .

FIG . 73

Instrum ents for rem oving deposits from the te e th (F . Martine z).

FIG . 74

A d ental s crape r:

A unive rsa l toothpi ck and a file for sharpen ing its point s .

An instrum ent for rem oving sharp corne rs from the m olar te eth (F . Martine z).

Cleaning of the teeth .

Medication of cariou s ca vities .Filling with gold - leaf.Removal or resection of teeth abnormally S ituated .

Removal of any unevenness or Sharpnes s of the teeth .

Extraction .

1 Hieronym i Fab ric i i ab Aquapendente ope ra chirurgica , Lugduni Batavorum ,1 723 ,

c ap . xxxi i , p . 45 1 .


deglutition , including sometimes even those of the tongue itself, and inthis 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 cannu l apassed through the nostrils .The second of the abovementioned operations 1 i s designed , saysFabriciu s

,to take away the dirtiness of the teeth and the bad odor of the

mouth (dentium im m unditiam e t oris fce torem tollit). The dental tartar(os tra coderm a)mu st be removed by Slender in struments of an appropriateshape

,which

,for people of high position (prom agna tibu s) 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 wou ld have known that the hardness and adhesion of tartaris generally so great that its removal absolutely requ ires scrapers oftempered steel and not of a soft metal like silver .To arrest caries , he first drops into the cariou s hollow,

by means of asmall silver funnel

,some drops of oil of vitriol , or of some other caustic

l iqu id ; and then he performs actual .cauterization with appropriate in struments ; after which the cavity is filled with gold leaf (auro foliato).

When one or more teeth have appeared in an irregu lar position andoffend the walls of the oral cavity or else the tongue

,the excision (t e se c

tion)of the tooth or teeth mu st be performed with a pair of strong pincers ,whose Shape mu st vary according to whether the teeth are S ituated exte rna lly or internally with regard to the dental arches . But as after theresection there will almost always

'

rem ain some points or_

sharp irregu larities , which by their p resence would continue to irritate the soft parts , itwill be necessary to remove these irritating prominences by means ofthe file .

AS to extraction,Fabriciu s of Aquapendente counsel s great prudence

in performing the operation,and on this point he repeats all the warnings

already given by Celsu s,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 rea son to

incu lcate extreme caution in regard to the extraction of teeth . Thiswas not then performed by true dentists

,but rather by barbers and by

ignorant tooth pu llers,or else

,in exceptional cases

,by general surgeons ,

very skilful , perhaps , in everything else , but l ittle practised in the operation we

"

are speaking of; besides this , the instruments left much to bedesired ; and lastly there wa s not, nor cou ld there be , any idea of asep sis .What wonder, therefore , if the extra ction of teeth was frequently the cau seof seriou s injuries ! Fabric ius relates that it often happened to him tohave to extract, in l ittle fragments , half or sometimes a whole j aw,

which

1 Cap . xxxii i,p . 455 .


had been attacked by putrefaction , as the resu lt of the extraction of onesingle tooth . This , adds the author, may easily happen , becau se , whenthe j aw is attacked by pus in one point , its very anatomical con stitutionfavors the rapid spreading of the putrefying process to the other parts ofthe bone

,as this latter, apart from its external lamina , is entirely com

posed of a sponge- l ike sub stance .

The instruments which are u sed for the extraction of teeth,are

,s ays

Fabriciu s , of nine kinds ; 1 and the most important among them— gene rica lly called forceps— are indicated by special n ames , taken _

from theirresemblance to the mouth or beak of certain animal s . Thu s

,the forceps

with which it i s u sual to perform the extraction of molar teeth are called“ pelican s

,and of these there are two kinds , accord ing as they are u sed

for the right or the left side , for the upper molars or the lower one s .A third kind of in strument goes under the name of “ beak” (rostrum),and serves for the extraction of the incisors .A fourth kind is the “ crow’ s b eak

,

” or “ crow’ s b ill,which is u sed

for the extraction of roots .Two other in struments are named in Italian cagnoli, for they imitate

the Strong bite of the dog (in Ital ian cane) and are u sed in cases wh erethe pelican i s not adapted .

A seventh instrument is called by the Latin term of terebra (drill orauger). It i s u sed in stead of a lever to separate the teeth from one anotherwhen they are too close to each other, and so render their extractionmuch easier .The eighth in strument i s a trifid lever (v e ctis trifidu s), so called

becau se it '

is furn ished with three points .The ninth and last kind of in struments are the dentis ca lp ia ,

Slender,

sharp , and - oblong tools,with which the gums are separated from the

teeth before extraction .

Fabricius al so Speaks of dental prosthesi s , but very briefly . He Saysthat artificial teeth are made of ivory or of bone (for example , from thetib ia of the ox) and are fastened by gold wire . One has recourse to thismeans especially to correct the b ad appearance and the defects in speechderiving from the los s of the front teeth .

This author also makes some allu sion to palatal obturators,

2 but invery general terms

,l imiting 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 s ilver fixed in the palate , so as to close up theaperture (corrigitur spongia ,

‘vel gos syp io, v el lam ina a rgente a , quce pa la to

appenda tur , u i foram en obs tru a i).

1 cap . xxxiv,p . 456 ; de instrum entis extrahend i s dentibus idoneis .

2 Cap . xxxv,p . 457 .


For epul ides and paru l id es Fabric ius advises the same methods of curethat had been recommended by Paul of ZEgina .

In the case of flacc idity of the gums accompanied by loosenes s of theteeth

,the treatment mu st consist

,first of all, in superficial cauterization

with the red - hot iron,after which the gums mu st b e smeared with honey

,

the mouth washed with mul se,and lastly astringent powders mu st b e

u sed .

If the gums are much swollen , in near relation to the molar teeth , theuse of the red - hot iron

,says Fabriciu s , becomes very d iffi cu lt from the

want of space , and from the close vicinity of the healthy parts , whichmu st not be injured . In such a case , it i s neces sary to remove , with su itab le cutting instruments ; a s much as i s pos sib le of the morb id tis sue(ca ro cras s a et putrida); then to cauterize the remaining part, makingthe cautery, if necessary, pass through a tube , so as not to injure thesurrounding parts . When , however, the gingival swell ing bleed s veryeasily , and its excision thu s might give rise to a profu se hemorrhage ,it will b e best to perform the operation with cutting instruments heatedred - hotFabriciu s remarks that although other authors do not make any allu

s ion to these large gingival excrescences,he had had occasion to ob serve

several cases , and had also had various in struments especially constructedfor their cu re .

1

JOHANN HEURN , or in Lat in Heurnius ( 1543 to of Utrecht , inhis book on the d iseases of the eyes

,B ars, nose , teeth , and mouth , treats

sufficiently at length of dental d iseases and their cure , but without addinganything of importance to what had been written by preceding authors .His work i s a mere compilation , which wou ld be without any importancewhatever if it d id not serve to Show what cred it wa s still given at th atperiod to all the errors and prejudices which are to be found in thewritings of the ancients .Heurniu s , although he wrote a long time after Vesaliu s , still adheres ,in regard to the number of teeth , to the already mentioned opinion ofAristotle ; he says, in fact, that women rarely have thirty- two teeth likemen .

2

He warns those who suffer from odontalgia not to have recourse thoughtlessly to tooth 'drawers , but to recu r, in stead , to the doctor , whowill alwaystreat the affection according to the cau se on which it depends .And here the author repeats the numerou s distinction s found in manypreced ing writers

,and especially in Arculanu s . The pain may be located

1 Cap . xxx, de gingivarum Chirurgia , p . 450 .

2 Joanni s He urnii Ultraje ctini de m orbis oculorum,aurum

,nasi , dentium et ori s

,li be r

Raphe lengii, 1602, cap . xi , d e d entium e t ori s passionibus, p . 79 .

14 TH IRD PERIOD —MODERN TIME S

inside it,by means of a split feather, a drop of oil of vitriol , whiCh, says

he,cau ses the fall of the tooth after a few days .Elsewhere he says that sometimes worms are produced in cariou s teeth ;

to kill them a drop of oil of vitriol is an excellent remedy ; and this at thesame time cu res the decay of the tooth and takes away the sensib il ity ofthe nerve .

”

This passage does not agree very well with the preceding one,according

to which oil of vitriol wou ld act much more radically by cau sing the toothto 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

u s by some subtle distinction that the contradiction alluded to i s only anapparent one !To free the teeth from tartar, Heurn l ikewise counsel s oil of vitriol ,diluted , however, with other liqu id s .A tooth mu st not be sacrificed excepting when it is loose and attackedby incip ient necrosis

, so a s to leave no hope of arresting the putrefactiveprocess . It i s then our duty, says Heuru ,

to remove the tooth withoutcau sing much pain . For this pu rpose , after the tooth ha s been separatedall around from the gums , it mu st be raised somewhat from the alveolu s ;then it mu st be sprinkled with powder of euphorb ia , or a paste made withflour and the juice of the tithymalu s mu st be applied around it , takingcare , however to cover the neighboring teeth with wax . After two orthree days the tooth will b e so loose that i t can be pu lled out very easilywith the fingers or with a pair of pince

\

rs .Dental su rgery properly so called has been entirely neglected by

Heurn . He was perhap s so persuaded of the efficacy of the abovementioned remedies as to believe that every other species of interventionwas u seless . On the contrary

,he does not ab stain from Speaking very

seriou sly of the miracu lou s virtues of certain remedies (serpent scales ,dog’ s teeth , and tells us

,among other things

,that the broth made

from a frog, when held for a length of time in the mouth , soothes dentalpain s , whatever he the cau ses from which they originate . One wou ldseem 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 thathad appeared at Schweidnitz in S ilesia : a golden tooth had erupted inthe mouth of a child aged seven years

,which

,more preci sely designated

,

was the first large molar on the left of the lower j aw .

In our days news of such a kind would be immediately qualified ,and universally held to be an impostu re . But three centuries ago the


most marvellou s and unlikely th ings were easily believed in,often even

by the learned ; and , therefore , the fact alluded to was taken into seriou scon sideration

,so much so that for a long time many learned pamphlets

and d issertations were written concern ing it .JACOB HORST

,Physician and Profe s sor . of Medicine at the Ju liu s

Univers ity in Helmstadt, published , in 1595, a very S ingular book on thegolden tooth of the S ilesian child .

1 Without ra i sing any doubt a s to thereality of the fact , he maintained that the phenomenon was producedfrom the effect partly of natural and partly of supernatural cau ses , inrelation with the constellation under which the child was born . On theday of its b irth , that is , December 22 , 1585 , the sun was in conjunction with S aturn in the sign of Aries . In consequence of this circumstance the nutritive force had developed marvellou sly on account of theincrease in heat, and consequently, instead of osseou s sub stance , goldenmatter 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 umheard - of marvel , he not having the least doubt that it— l ike earthqu akes ,eclip ses

,and comets— mu st be the precu rsory Sign of important events .

Supporting his assertions by arguments of variou s kinds , some ofwhich are

taken from the Bible , he concludes that the gold tooth of the S ilesian childmeans neither more nor less than the approach of the golden age ! TheRoman Emperor wou ld sweep the Turks , the enemies of Chri stianity ,out of Eu rope , and the Millenium or Golden Age wou ld commence .

AS the tooth was S ituated on the left S ide of the lower j aw,it might be

deduced,according to Horst

,that heavy calamities would precede the

beginning of the epoch Of happ iness thu s p red icted . On the otherhand , as the golden ' tooth was the last of the dental series of the child ,this wa s to signify that the golden epoch thu s foretold wou ld be the lastof the ages of thi s world before the universal judgment !MARTIN RULAND

,in the same year

, 1595 , wrote about the gold tooth .

2

Shortly after, he was answered by JOHANN INGOLSTETTER ; and the controve rsy which arose between them in this important subject lasted fora long time , without, however, lead ing to any definite conclu sion .

BALTHASAR CAMINDU S,a doctor of Frankfort , meanwhile had noted

that for some months the marvellous S ilesian boy had not lent himselfto being examined by the learned

,becoming terribly enraged whenever

they wished to compel h im . From this he inferred that it was a case ofnothing else but an imposture

,and that the famou s tooth cou ld not have

1 De aureo dente m axillari pue ri Sile Si i , L ipsia ,1595 .

2 Martin i Ru landi,Nova er in om n i m em oria inaud ita historia de aureo dente , Franco

furti,1595 .


anyth ing special about it, s ave that its crown had been very skilfu llycovered with a thin plate of gold .

In sp ite of this the discu ssions on the portentou s tooth continued fora 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 thi s subject did not throwthe slightest doubt upon the reality of the fact, but only sought to explainin the most varied ways the genesi s of this phenomenon .

DUNCAN LIDD E L . Among those who had the good sense not to putfaith in the thing, and who very decidedly affi rmed that this was a merecase of impostu re , Duncan Lidde l , a Scotchman and profes sor in a GermanUniversity, deserves to be recorded .

1

He had heard that the famous gold tooth was larger than the others ,and that the neighboring molar was wanting ; from which he arguedthat this was S imply the case of a tooth the crown of which had beencovered with a plate of gold . Answering the arguments of Horst, he accused him of gross ignorance in the most elementary notions of astronomy,and th is for having affirmed that when the famou s child wa s born , that is ,December 22 , the sun happened to be in conjunction with Saturn in theS ign of the Ram . As

.

the sun does not enter the S ign of the Ram untilMarch , if it had been there on December 22 this wou l d have been '

a

greater portent than if the whole body of the child had been formed ofnothing else but teeth of gold !2

1 Lidde liu s, Tractatu s d e dente aureo pue ri Sile siani, Ham burg, 1626 .

2 [In the introductory portion of Lidde ll’

s work on the“Golden Tooth is publi shed a

num be r of lette rs bearing on the case,am ong othe rs one which give s rathe r a c ircum

stantia l ac count of the im posture , and of which the fol lowing is a trans lation :He rr Balthaz e r Cam ina us sends Gre etingFor your le tte r

,m ost kind He rr Doctor Case lius

,in which you exp lic itly de sired m e

to thank (m y) col le ague s for the ir good wi she s ,‘

wedd ing wi she s,

’

and to im form you a s

to the Golden Tooth,

’

I have long be en in de bt to .you—not that I intended to le ave

your lette r unanswered,but be cause no m e s senge rs pre sented them se lve s . Now that I

have found one,I announce that I have obeyed your com m and s . As for the

‘Gold enTooth

,

’

I ought not to hide from you that we have m ore than once m arve l led at yourshrewdne ss

,in that you are so anxious to ascri be the device s of wickedne ss and the tricks

(fake s) of cunn ing toNature . For it was no portent,on ly a de ception and pure che at

,so

that un le ss som e Lem nian (Prom e the us or Vu lcan) shou ld com e to the ir aid,the se acute

authors wi l l,nay, a lready are

,a by

-word to those who are m ore cautious and not so proneto be l ieve . For the Golden Toothed ’

boy, ac cord ing to the ac count brought thithe r bym any pe rsons

,both by lette r and ora l report

,som e of whom had them se lve s se en thi s

wonde r,ha i led from a vi llage ne ar Schwidnitz in S i le sia , and had be en so tra ined by his

swind ling fathe r or m aste r, that, at his wi l l , wheneve r in any assem bly of m en , som e ve ry

sim ple and i l literate pe rson s de sire d to se e the tooth and had pa id the fe e,for the rasca l s

m ade gre at ga ins, he wou ld Open his m outh wide and a l low him se lf to be touched . But

if e ducated m en and those who se em ed l i ke ly to m ake m ore care fu l scrutiny and exp e ri

C H A P T E R X I .

THE SEVENTEENTH CENTURY .

TH E first sign s of the sep aration of dental science from general medic inewere to be perceived in the sixteenth century, the period in which , as we

have seen,the earl iest dental monograph s appeared . From that time

thi s separation tended to accentuate itself ever more strongly ; dentalmonographs became more numerou s and denti stry . progressed evermore rap idly

,both in its scientific and practical a sp ects .

In the seventeenth century, about which we .are now to speak, weshall have to call attention to many facts of the highest importance forthe development of dentistry

,and with regard to literature

,it i s worthy

of note that while the publication s on dentistry that appeared in thevarious countries of Eu rope during the preceding century only amountedto about twenty (taking also into account several pamphlets on thefamous golden tooth l), in

_the seventeenth century the number was consid e rably higher, that i s , about a hundred . We Shall speak of the mostimportant of these , a s also of the works on general medicine or on surgeryof the Same period , that present some interest from the

'point of V iew of

denti stry .

JOHANN STEPHAN STROB E LB E RGER ,physician to the imperial baths

of Carlsbad,publ ished in the year 1630 a very curiou s book, the title of

which , being tran slated , runs somewhat as follows : Com plete Tre a tis e

of Gou t in the teeth,or

,m ore prop erly s a id, of Odontagra or tootha che ;

in which are s etforth, theoretica lly and pra ctica lly , for the u s e of phys ician sand s urgeons , the m eans of m itigating thes e p a ins , as we ll a s the v ar iou s

m odes of ably extra cting tee th with or withou t ins trum ents .

This book merely presents some interest,becau se it gives u s a clear

idea of the p itifu l state in which the dental art still was in the first halfof the seventeenth century

,and Shows us most clearly what enormou s

p rogress our specialty ha s made in l ittle less than two centuries . Apartfrom this , Strobe lbe rge r

’

s monograph is of no importance, it being

1

Joh. Ste phan i Strobe lbe rge ri, the rm iatri ca sare i em e riti,e tc .

, de d entium podagre , se upotiu s de odontagra , doloreve dentium ,

tractatus absolutissim u s,in quo, tam dolori s istiu s

m itigandi ratione s, quam dentium sine et cum fe rro artific iose extrahendorum vari i m od i ,theore ti c e ac practi c e proponuntur, in m edicorum ac chirurgorum quorum vis gratiam .

Le p sia ,1630 .

TH E SE VEN TEEN TH CEN TURY 219

nothing more than a most accurate compilation of all that is to be foundon the subj ect of dental affection s in earlier works , especially from themedical point of View ; the surgical part of dental therapeutics i s treatedin a much less complete manner, and prosthesis is entirely excluded fromthe plan of the work, which , however , i s fully, in accordance with the titleof the book .

Under the generic name of gout,

1 or podagra , are meant , says theauthor (Chapter I), all the affection s produced by d iseased humors ,fall ing “ by drop s into the articu lar cavities and the parts surrouud ingthem . Strictly speaking

,however, only gout in the feet is n amed podagr a ,

whilst when the disea se is seated in other parts of the body it is ind icatedby other names

,gout in the hands being called chiragra ; in the fingers

da ctilagra ; in the knee , gonagra ; in the elbow, pe chiagra ; in the shou lder,om agra ; in the sp inal column , ra chis agra , and so on . When the seat ofthe evil is in the teeth

-

or in their articu l ation s , by analogy it is denominatedodontagra

,or odontalgia

,an affection which Pau l of ZEgina was the

first to consider as being of a gouty nature (ChapterAfter having spoken of the sen sib il ity of the teeth (Chapter III), of tah

variou s kinds of dental p ain s (Chapter IV), of the different cau ses , externaland internal

,which produce them (Chapte rt oVII), of the sign s which

make known their special n ature in each case (Chapters VIII to X),and of the prognosis (Chapter XI), the author occupies h imself veryminutely, throughout the rest of the book , with all that concern s mean sof cure, dedicating to this subject s ixty- seven chapters and a long appendix .

If, after the publication of Strobe lbe rge r’

s book , all previou s workstreating of dental afl e ctions had been entirely lost, it wou ld be of inestimable value for the h istory of dentistry, the author having gatheredtogether in an almost complete manner— citing faithfu lly the respectiveauthors— all that had been written about dental diseases before h im .

On the other hand,the book contain s almost nothing original ; therefore ,

rather than analyze minutely its contents—which wou ld involve a longrepetition of things already noted~—we l imit ourselves merely to a fewob servation s .Strobe lbe rge r, l ike Heurnius , is of op inion that for the cure of dentalp ains it i s necessary to have recou rse to doctors rather than to dentisp ices ,or tooth drawers (Chapter XII); however, he does not con sider the callingof the latter ab solutely u seless ; indeed , he expressly advises (page 1 74)that they Shou ld be applied to for the in strumental extraction of the teeth ,it not being possib le for such operation s to be carried out well and without danger except by those who, through great p ractice , have acqu iredthe necessary skill in the u se of the relative in struments . He refers to

1 In Latin, gutta , that is, d rop .


the words of Holle rius , already quoted , as to the falseness of the op in ionthat fumigation s made with the seed s of hyoscyamu s cau se the worms tofall out of the teeth . Notwithstanding

,he does not in the least doubt the

existence of the worms themselves ; and he , l ike Heurnius, recommendskilling them with oil of vitriol or with a decoction made from a frog cookedin water and vinegar (Chapter XXXIII). From this , one clearly perc e ive s that the doubts expressed by Holle rius about the existence of dentalworms had not in the least shaken the popul ar bel ief in them . Nor,indeed

,could it be otherwise when one considers that Holle riu s , as we

duly noted in another place,had not the courage either decidedly to deny

the existence of dental worms , or to formu late in a clear and explic itmanner the doubts which had arisen in h is mind on this subject . Weare

,therefore , unable to recognize the merit which Linde re r1 and Geist

Jacob i2 have attributed to th is author, viz .,that of having effectually

afli rm ed the non - existence of dental worms .Among innumerable vegetable remedies recommended by Strobelberger again st odontalgia

, we will only c ite two American plants , theguaiacum and the tobacco - plant (Nicotiana tabacum).

'

Of the decoctionof guaiacum (Chapter XXXVI) the author says that, u sed as a mouthwash , it has the triple virtue of strengthening the gums , of preventingputrefactive 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 Strobe lbe rge r himself,

Heurnius ha s already obtained , experimenting in his own case , thecessation of an attack of toothache by hold ing in his mouth spoonfu l sof tep id decoction of nicotiana for the Space of two hours .The same sooth ing effects may be obtained , says the author, from

the smoke of tobacco ; but he attributes thi s not to the n arcotic action ofthe remedy, but to the fact that it c au ses the flow of much sal iva fromthe mouth and mucu s from the nostril s

,through which the morbid

humors which provoke the pain are eliminatedTo those suffering from odontalgia

,says Strobe lbe rge r (Chapter XL),

the internal use of certain mineral waters is al so of value,and especially

that of the waters of Carlsbad (Therma Carolina ). Like many otherremedies , they are u seful in rendering the secretions more active , favoringthu s the elimination of morb id sub stances from the blood . For thesame object of purifying the organism and dispersing the accumulatedhumors causing the pain

,many other means of cure were in usage, such

as aperients (Chapter XXV), phlebotomy, and arteriotomy (ChapterXXVIII), leeching (Chapter XXIX), sc arific ation and cupping (Chapter

1 Handbuch de r Zahnhe i lkunde,Be rlin

,1848, 11, 422 .

2 Ge schichte de r Zahnhe i lkunde , p . 10 1 .


Among the r idicu lou s remedies (Chapter LIX), the author describesone that was especially in u se among soldiers . With a p iece of chalkor of rubble one writes on a table :

Chiac ia Chiac ia

X O X X O X

One then pricks the tooth with a knife or an iron toothp ick until itbleed s sl ightly ; then thru sting the point of the in strument, to whichthe blood adheres

,into the first cross

,then into the second , then into the

third,and soon , one asks the patient each time if the tooth Still p ain s

h im . Before one gets to the last cross the pain ceases ! This stolidcure

,says the author

,has no other value than that Of the sc arific ation

of the part affected.Strobe lbe rge r held , as did many of the preceding authors , that the extrac

tion of a tooth ought to be the la s t remedy, that is , to be had recourse towhen all others , including cauterization , which he considers as the las tbut one

,have proved inefl e ctua l . There are cases , however, in which

the extraction of a tooth is ab solutely ind ic ated,and here

,by the way,

the author acqu aints u s with the following poetic aphorism ,which

expressed the unan imou s op in ion of doctors :

Si den s p e rtusu s, ve l putridus e sse notatur,

Corrum pen s al ios,tunc protinus e j i c iatur.

That i s,if one finds that a tooth i s hollow or decayed and corrupts the

others , it mu st at Once be extracted .

Strobe lbe rge r, l ike the greater number of his predecessors , is fullypersuaded that diseased teeth may be made to fall out by the use of specialremedies ; indeed , this clearly appears from the title .of the work itself,as , without doubt , the reader will already haVe ob served . Such remediesare called by him “

odontagoga , and he describes them at great lengthin five different chapters (X to XIV) of the second section of his book ,dedicated to the surgical care of the teeth .

“In regard to v iolent extra ction of teeth, Strobe lbe rge r shows still greater

cautiou sness and timid ity than Cel su s or Abu lcasis . He requ ires that ,after the gum has been detached , one shou ld endeavor to extract thetooth with the fingers or by means of a thread ; if, however, this does notsucceed , one may have recourse to the trifid lever ; only at last, that is ,when even the lever has failed

,does he a llow the u se of an appropriate

dental forcep s .ARNAULD GILLE S

,a Frenchman

,in the year 1622 , publ ished in Pari s

a work whose curiou s title we will here note : The flower of the remedies

aga ins t tootha che .

1 We know nothing else about th is publication ,

1 Arnau ld Gille s , La fle ur’

de s rem ed e s contre le m al de s dents, Pari s, 1622 .


every case of neu ralgia occu rring within the region - influenc ed by the trifacial nerve one shou ld give particu l ar attention to the state of the teethand carefu lly treat every affection of the same . Notwithstanding—wesay it with regret— there are Still medical men who ignore or neglectthis precept

,and prescribe internal remedies or have recourse to injection s

of morphine when they ought, in the first place, to call in the aid of adentist . How many patients wou ld h ave been delivered from Slowmartyrdom if the example of the clear- seeing physician of Berne hadbeen followed from his days up to the present time !Fabric iu s Hildanu s fe late s , besides , many cases of dental fistu la

,

cu red by him through the extraction of roots"

or of decayed teeth . In

one such case the fistu l a dated from fourteen years b ack . Fabriciu sHildanu s , contrary to the opinion of many other doctors , extracted adecayed tooth

,and by this operation obtained

,in a brief period of time

,

the complete recovery of the patient .Among the many very important cl in ical cases cited by Fabriciu s

Hildanu s , the following deserves to be recorded : In the year 1590 awoman presented herself to

_

him who had a hard tumor in the sp ace behindthe last molar on the right side . The author

,after having prepared the

patient for the operation by the methods then in u se (that is , by aperientmedicine , by bleeding, and appropri ate d iet), destroyed the tumor bythe application of escharotic sub stances . The remaining wound

,how

ever, defying all the cicatrizing remedies which the author had recourseto , one after the other, by reason ofi its being continually disturbed bythe movements of the j aws

,he then thought of maintaining the dental

arches in a determined position,and thi s he obtained by means of two

pieces ofwood somewhat hollowedout 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 madeexpressly in each of the two pieces of wood . In this way he succeededin obtaining the ab solute immobility of the j aws and the complete cureof the wound in a few days

,during which time the patient was nou rished

with liqu id food .

1

A very interesting case,inasmuch a s it demonstrated the damage and

peril which may resu lt from certain absurd means of cure, was reportedto this author by Claudio Deodato

,physician to the Prince- Bishop of

Basle . The case wa s that of a patient who, after having tried in vaina great number of remedies for a Stubborn toothache , finally hadrecourse to the u se of aqua fortis ; but this substance , which in those dayswas in frequent use for dental caries and for toothache , produced most

1 Guilhe lm i Fabricu Hilandi ope ra om n ia , Francofurti ad Moenum,1646, Centuria I

obse rvatio xxxviii,p . 33 .


deleterious effects in the patient , that is to say, the loss of almost all h isteeth

,necrosis of the inferior jaw, with fistulous sinu ses and u lceration

of the neck, abundant saniou s d ischarge , fever, a cachectic condition ,incip ient necrosis of the upper j aw, etc .

1 Fabriciu s Hildanu s , consu ltedby Claudio Deodato about this most seriou s case , proposed both a localand a general treatment

,the resu lt of which is , however, not mentioned

in his book .

In the fifth centuria of medical and surgical ob servations and cureswe find a case of oral surgery, to which it is worth while briefly to referhere . It relates to an epu l i s S ituated next to the upper canine of theleft s ide . The tumor, already of ancient date , had at this time reached thes ize of a walnut, wa s very hard , l ivid in color, i rregul ar in form , andadhered somewhat to the upper l ip ; according to the author, it was of

a cancerous n ature . After the usual prep arative measure s , Fabriciu sHildanu s proceeded to the ablation of the tumor, and to this end he firstp ierced 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 meansof a curved b istoury .

3

Fabric ius Hildanu s,having dis sected several abortive fetuses of under

four months , was able to verify the '

exactitude of the assertion made byHippocrates , afte rward luminou sly confirmed by different Italian anatomists , that the teeth begin to be formed during intra- uterine life . Andwith reference to this he also relates the following factThe wife of a Protestant minister gave b irth to a female child whichalready had a fu l ly developed tooth

,a lower middle inci sor, equal in size

to that of a child of two years old,and which interfered with the sucking

by injuring the n ipple of the mother ’ s breast and the tongue of the childitself. So it was necessary that it shou ld be removed But it was foundto be so firm that the surgeon sought in vain to extract it with a thread ,and was obliged to have recourse to the forcep s .1Ob servation XXXI of the third centuria relates a case of rhinoplasty .

In the year 1590 , when the Duke of Savoy made war on the inhab itantsof Geneva, a girl n amed Su sanna N . fell into the hands of the soldiers ,who tried to deflower her ; enraged at not succeeding in their intent, theycut off her nose . Two years later the girl went to Lau sanne

,the residence

of J . Griffon , an eminent su rgeon of that time , who performed therhinoplastic operation on her in so sp lendid a manner that one wou ld

1 Cent . iv,obs . xxi

,p . 302 .

2 The m ost im portant of Fabric ius Hild anus ’ works cons i sts of Six centuria (hund red s)of rem arkable case s

, publi shed by the author in succe ss ive e pochs, and whichwe re afte rward

re un ited unde r the title of Obs ervationum et curationum chirurg icarum centur ia s ex .

3 Cent. v,obs . xxvii

,p . 406 .

1 G . F . Hildani, ope ra om n ia , Epi st . ad J . Rhe te rium,p . 10 10 .

I S


have taken the new nose for a natu ral one , not-

only from its normalappearance

, but also becau se the scar was hardly Vi s ib le . Fabriciu sHildanus , having had occasion to se e and examine the patient severaltimes

,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 firstinventor of this operation was Gaspare Tagliacozzi , of the Universityof Bologna , and that Griffon had undertaken the reprodu ction of the samefrom his own conception of it, based on the information imparted to him inconversation

,by an Italian who had been operated upon by Tagliacozzi .

JOHANN S CHULTE S ( 1595 to a physician in Ulm ,was the author

of a very important work entitled Arm am entarium chiru rgicum ,in which

are given plates and descriptions of almost all the su rgical in strumentsthat had been in use up to that date . As to the part relating to dentaland oral surgery, we find the following instruments n amed in this work :

1 . Several kinds of pelicans ; an instrument which was so called fromits resemblance to the beak of the b ird of the s ame name , and u sed forextracting the molar teeth .

2 . The common dental forcep s,then named cagnolo by the Itali an s ,

becau se of the supposed likeness to a dog’ s muzzle .

3 . The crow’ s beak forceps (ros trum corv inum ), designed for theextraction of dental roots

,and

,therefore

,corresponding to the rhiz agra

of Celsu s .4 . Two special dental forcep s

,or dentidu ces , for the removal of teeth

which cou ld not be extracted either with the pel ican or with the commondental forcep s .5 . Bifid and trifid elevators (v e ctes bifidi e t trifidi), to be u sed for theextracting of incisors and canine teeth

,as well as roots .

6 . D entis ca lp ia for detaching the gum from the tooth before proceedingto extract it, in order that this may be the more easily accompli shed andwith less danger .7 . A silver funnel or cannul a (infundibu lum s eu fis tu la argentea),

for nouri sh ing patients affected with trismu s,by conveying l iqu id food

into the fauces,through the free Space behind the last molars .

8 . Forcep s more or les s like in form to the beak of the parrot or thevulture (ros trum p s itta cinum ci vu lturinum ), for the removal or resectionof teeth that have grown in abnormal position s .9 . A screw dilator (dilatatorium cum cochlea), for gradually opening

the dental arches in cases of spasmodic constriction of the j aws . 1

1 Joann i s Sculteti, Ulm en sis, arm am entarium chirurgicum ,

Francofurti, 1 666, Plate sX,XI

, XII, XXXII.


MARCO AURELIO S EVERINO ( 1580 to of Tarsia , a celebratedprofessor of surgery in the Neapolitan University

,had a great predilection

FIG . 77

Aplate from Schu lte s Arm am entarium chirurgi cum ,showing seve ra l de nta l instrum ents .

for the u se of the cauterizing iron,which he also u sed very frequently

in curing caries and other dental disea ses . At times,to effect a cessation

of violent toothache,he wou ld h ave recourse to the cauterization of the

228 TH IRD PERIGD r —MODERN TIME S

antihelix ! Against fl accidity of the gums and loosening of the teeth healso u sed cauterization

,disapproving the use of astringent substances ,

as these cannot get so far as the roots of the affected teeth . Severinoboasts of having cured by cauterization at least two hundred cases ofdental diseases .LAZ ARE R IVIERE ( 1589 to a professor at the University of

Montpelier,also known by his latin ized name of Lazaru s Rive rius ,

treats of dental affections and their cure , in variou s parts of his works ,considering them

,however

,almost exclu sively from a medical point of

View .

He speaks first of all of the different cau ses of odontalgia , and , amongthese

,does not omit to mention worms . These

,he says

,may be generated

in the cariou s cavities,owing to the putrefaction of substances retained

in their interior . Whenever odontalgia is cau sed by worms , the pain ,says Riviere

, is not continuou s , but ceases and return s at brief intervals ;besides

,the sufferer perceives at times the m ovement of the worm in

s ide the tooth !'

What one reads in the works of this author as to remedies to be u sedfor odontalgia clearly demonstrates how irrationally dental d isea ses weretreated in the seventeenth century and what tortures were infl icted on thepatients . In many cases , and especially when the pain wa s held to be occas ioned by “ hot humors

,

” the treatment wa s begun by bleeding in the arm .

The following day an aperient was admin istered . Afterward , if the painstill persisted

,the sufferer was cupped in the r egion of the scapu lae or of

the spine , bl isters were applied to the n ape of the neck or behind the ears ,res inou s plasters to the temples ; all th i s without taking into account theremedies which were introduced into the ears

,or the variou s medication s

or operation s performed on the aching part itself,and many other things

besides . In fact,in order to cu re a toothache

,the whole body of the

sufferer was seized upon and put to tortu re , and in the majority of‘ cases

they assuredly finished by extracting the diseased tooth ! When we reflecton the extraordinary frequency of dental d isorders we cannot do lessthan recogn ize that the dentists

,by the radical change effected in the

methods of treatment,have diminished in no small degree the suffer

ings of humanity !According to Riviere

,the small veins (sic) that nourish the teeth pass

through the ear and th is wou ld explain how !the cessation of a toothache may be obtained by the introduction of certain remedies into themeatu s auditoriu s externu s . Relief may be obtained, for in stance , bydropp ing 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

l ittle pure vinegar into the ear,which is espec ially efficaciou s against

230 TH IRD PERIOD r —MODERN TIME S

with in the space of a few hours ; for which reason it is ab solutely ne c e ssary

,in making us e of it, to cover over the neighboring teeth with wax

,

so that the healthy ones may not al so fall out, as happened , says theauthor, in the case of a poor peasant ;The internal use of mercury, and even the u se of certain mercurialpreparations u sed by women as co smetic s , i s of damage to the teeth andimparts to them a blackish or dirty looking color .Numerou s remedies exis t for cleaning the teeth , but according toRiviere the best way of cleaning them consists in rubbing them witha small stick immersed in su lphuric acid (sp z

'

r z

'

tu s s u lphur is aut v itr ioli)and afterward drying them with a piece of l inen . This remedy notonly clean s and renders the teeth white , but it preserves them also fromcaries ! If the teeth are very dirty, the sp irit of vitriol may be u sedpu re ; otherwise one mixes it with m el ros a tum or with water .The great enthu siasm shown by Riviere for the above- mentionedremedy does not

,however

,derive from a long experience

,made by him

self or by others , of its advantages , but is based principally on a factreferred to by Montanu s , and which , 1 we will here recount , because , fromit,one clearly perceives how credu lou sly our forebears accepted general

affirmations and formu lated therapeutic precepts .Montanu s recounts in one of his writings , how, being in Rome in his

early youth, he became acqu ainted with a woman of about twenty yearsof age , known by the name of Maria Greca (by the way the authorspeaks of her, one is led to su spect she wa s a courtesan); and how,

havingseen her again

,thirty years l ater

,and found her in pretty much the same

conditions as formerly, he expressed his su rprise at this ; whereuponMaria Greca told him that she herself believed that she owed the conservation of her beauty to the hab it

,already of many years ’ standing,

of u sing one or two drops of oil of vitriol every morning, as a friction forthe teeth and gums . In her youth she had had very bad teeth , but byreason of this cure they had become , and were at the time being, beautifu land perfectly firm ; the gums also were in excellent condition ; it seemed ,therefore

,to her that this con servation of health and freshness

,in sp ite

of her fifty years , depended precisely on the daily use , in the mannerdescribed , of oil of vitriol !2Riviere

,besides

,recommend s tobacco ashes for clean ing the teeth , a

counsel not yet given by any previou s author . He also gives the formulae

for two dentifrice powders,the basis of which is alum ; he call s attention

1 Giovann i Batt i sta Montano (1488 to of Ve rona , Profe ssor of Med ic ine at Padua .

2 It is m arve llous that an inte l ligent physic ian shou ld have lent fa ith to such a story,re lated ,

too, by such a wom an,neve r refle cting that the d ai ly use of su lphuric ac id for the space of

thirty ye ars, that is, about application s,in ste ad of curing and be autifying bad te e th,

would ce rta inly rathe r have had the effe ct of total ly de stroying the denture of even a m astodon .

TH E SEVEN TEEN TH CEN TURY 1

to the great importance of taking ass iduou s care to keep the teeth clean ,and advises that after each m eal the res idues of food be removed fromthe interstices of the teeth and the mouth well rin sed with wine .

1

NICOLAU S TULP , in Latin , Tu lp iu s (1593 to a distingu i shedphysician and anatomist of Amsterdam ,

contradicts the then prevail ingop inion among doctors

,that is

,that the cure of dental affection s and the

operation s relating thereto were matters to be held in little account .He observes that di seases of the teeth may give rise to the most seriou scon sequences

,which can even be the cau se of death , and are , therefore ,

worthy of being taken into equally seriou s consideration as all the otherd iseases of the several parts of the human body .

This author relates a clin ical case tending to demonstrate how incis ion smade in the gums

,advised in the first place by Vesalius , in order to

facilitate the erupting of the last molar, are not always exempt fromdanger . A young doctor of Amsterdam ,

by name Goswin Hall,being

tormented by insupportab le pain cau sed by the diffi cult eruption of awisdom tooth , had

: the gum l anced above it . But the pain , in stead ofdiminishing, became worse ; fever and delirium supervened , followed bydeath ! (Here, however, we mu st be allowed to observe that nothingdemonstrates that the real cau se of death was the lancing of the gum ,

or that without this the case would h ave had a different terminat ion .

An event can occur after another and yet be qu ite independent of theformer and resu lt from qu ite different causes .)Among the cases cited by Tu lp , the following is also worthy ofmention .

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 p iece of sponge inside the alveolu s .2The belief that dental caries and toothache cou ld be cau sed by worms

was , at that time , still in fu l l vigor, and it gained still greater force byreason of observations recorded by different scientists , whose affi rmation scould with difficulty be doubted

,for at that period the greater number

still swore blindly in v erba m agz'

s trz .

OLIGERU S JACOBAEN S (1650 to a Danish physician and anatomist, who taught in theUnivers ity of Copenhagen , declared that in scrapingthe decayed cavity of a tooth that wa s the cau se of violent pain , he hadseen a worm come forth

,which

,having been put into water, moved about

in it for a long time .

MARTIN S IX , having spl it some decayed teeth a short time after theyhad been extracted

,asserts that he determined the existence of worms in

1 Lazari Rive ri i , ope ra m ed ica om n ia,Geneva

,1 73 7 ; Praxeos m ed ica l i be r sextus, cap . i ;

De dolore dentium , cap . 11; De d entium nigre dine e t e rosione .

2 Nicola i Tulpu ,Am ste lod am ensis

, O sse rvatione s m ed ica , Am ste lodam i, 1685 , l i b . i ,cap . xxxvi , p . 68 ; cap . xlix

,p . 90 .


them . (It i s probable that this ob server, as well as others , mistook thedental pulp for a worm ,

an unpardonab le er ror, in truth , at a time whenthe anatomical constitution of the teeth had already been very wellstudied by several scientists , and especially by the celebrated BartolomeoEu stachius .)GAB RIE L CLAUD E R (1633 to 169 1) not only believed in dental worms ,

but maintained besides that these were the most frequent among all thecau ses of toothache . In a certain way, to su stain this opin ion of his , herelates a case in which a tooth of healthy appearance being the seat ofgreat pain

,a tooth - drawer had asserted that there - mu st 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 , wa s foundto be existing inside of it !

_PH ILIP SALMUTH asserts that by u sing rancid oil he got a worm out

of the decayed tooth of a person suffering from violent toothache, thu scau s ing the cessation of the pain . The worm , he says , was an inch anda half in length and similar in form to a cheese maggot .NICOLAUS PE CH LIN (1646 to professor of medicine at Kiel ,

testifies to having seen five such dental worms , l ike maggots , come outby the use of honey, though he does not say whether they issued fromseveral cavities or from one only !GOTTFRIED SCHULZ . But all this is nothing compared to what

Gottfried Schu lz has dared to assert, viz .,that by using the gastric ju ice

of the pig, worms of great size can be e nticed out of decayed teeth ; someof these even reaching the dimension of an earth -worm !It is not much to be wondered at that these th ings shou ld h ave been

blindly believed in , if we reflect that only a short time previou s to thisthe story of the .golden tooth had been taken seriou sly by men of greaterudition

,and that in the very epoch of which we are speaking the illus

triou s anatomist THOMAS '

BARTHOLIN (16 16 to of Copenhagen ,relates having seen a man

,at Padu a

, who had an iron tooth ! Beside s ,the possibility of such a phenomenon was explained in a most curiou smanner by THOMAS MINADOU s

, who explained that in the same wayas iron is generated in the macrocosm

,that is , in the world , so it i s

equally admissib le that it may be generated in the microcosm ,that is ,

in man !1NATHANIEL H IGHMORE . In the year 165 1 the English physician andanatomist Nathaniel Highmore ( 16 13 to of Hampton , publisheda treatise on anatomy (Corporis hum ani ana tom ica

,by

which he acqu ired a celebrity superior,perhaps

,to his merits . This

work, however, served without doubt to diffu se the knowledge of an

1 Sprenge l , Ge schichte de r Chirurgie , vol . i i , pp . 294, 299 .


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 contribute d , without doubt, not a little to attract the attention of medical mento the anatomical pecul iarities which Highmore had pointed out in theupper maxillary bone , thus causing his name to become inseparablyassociated with the maxill ary sinu s .It i s evident, however, that Highmore never even suspected to what

very important practical application s hi s description would give rise .

He knew nothing about the di seases of the antrum , and believed that,even in perfectly normal condition s , this cavity is often filled with liqu id ;the idea

,therefore , of its being advisable , in certain cases , to extract a

tooth and perforate the alveolu s in order to give exit to the liqu id contained in the maxillary sinu s never occurred to him .

About fifty years went by before a rational treatment for affection s ofthe antrum was in itiated , the merit of which , as we shall se e at its timeand place

,was due to Will iam Cowper . During that half century

maladies of the maxillary sinu s continued to be badly diagnosticated andbadly treated .

BERNARDO VALENTINI . In the year 1686, that i s , thirty- five yearsafter the publication of Highmore ’ s book, Bern ardo Valentini , professorat the University of Giessen , described a case of tumefaction and ab sces sin the cheek

,treated by him with emollient remed ies

,and in which ,

although according to him caries of ,the underlying bone did not exist ,

the separation of a sufli c iently large osseou s fragm ent took place . Without doubt the affection of the cheek was derived in th is ca se from somedisease of the antrum ; however, 1t would appear that Valentini d id notin the least perceive any such casu al relation , as he makes no allu sionwhatever to it .

1

ANTONIO MOLINETTI , professor at the Univers ity Of Padua , had , however

,ten years previously, diagnosticated and cured an affection of the

antrum by means of an operation . In his book D z

'

s s erta tz'

ones ana

tom z

'

co-

pathologz'

caz,publ ished at Venice in 1675, Molinetti relates that

in a case of ab scess of the maxillary sinu s , which cau sed the patient greatsuffering, he performed the operation of trep ann ing the upper maxillarybone anteriorly, after inc i sion of the soft parts overlying it . In a certainway we may, therefore , consider Molinetti as a precursor of WilliamCowper .Having spoken of the very important anatomical fact illu strated by

Highmore , we will now also speak briefly of those authors who, ln theseventeenth century, occupied themselves with the anatomy of the teeth .

1 Sprenge l,op . Cit.

,p . 297 .


Their number i s suffic iently large ; we will , however, only make mentionof such as contributed to the development of this branch of science , orwho

,at least

,expressed some opinion worthy of note .

The celebrated anatomist ADRIAN SPIEGEL ( 1578 to 162 better knownby the Latin ized name of Sp z

'

gel iu s , wrote noth ing noteworthy aboutthe teeth

,but he appears to have been the '

first to affi rm that the teethare more firmly fixed in the alveolu s , when their roots are curved afterthe manner of hooks . 1DIEMERBROEK

,a Dutchman

,re lates several cases of dental anomalies

,

as for example , of teeth being cut in the palate , and which injured thetongue . The author cites his own case, relating that having had acanine tooth extracted when well advanced in years , it was , nevertheles s ,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 previou sly . Apart from this, D iemerbroeck tells u s noth ing of interest or importance regarding the teeth

,

often repeating old ideas , the falseness of which had already been lum inously demonstrated . For in stance

,he says that the permanent teeth are

developed from the roots of the deciduou s 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 .

2

THOMAS BARTHOLIN,whom we have already mentioned , speaks of

a tooth which had made all the round of the alveolar border ; that i sto say, of a dental arch constituted by a single piece ; and the Italiananatomist B ERNARDO GENGA makes mention of an analogou s case .

3

It is superfluou s to add that these authors allowed themselves to bedeceived by false appearances

,owing especially to an abundant and uni

form deposit of tartar on the surface of the teeth and in their interstices ,which gave to the dental arch the appearance of one continuou s p iece .

RINALDU S FRE D ER ICU S,in his erudite d i ssertation entitled D e dentium

s ta tu na tura l i et pra ierna tura l i, spokeof the dental system with sufficientthoroughness , ifwe con sider the epoch in which he wrote . He commenceshis work with a long chapter on the importance and dign ity of the teeth(dign z

'

tas dentium ). Among other th ings , he relates that formerly, incerta in 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 resu rrection of the body

,from the circumstance of their not showing sign s of

corruption when found in sarcophagi .

1 Bland in ,Anatom ic du system e dentaire , Pari s , 1836 , p . 26 .

2 Bland in,op . Cit.

,p . 27 ; Porta l, Hi stoire d e l

’

anatom ie e t de la chirurgie,Pari s

,1 7 70 ,

vol . i i i,p . 495 .

3 Bland in,op . Cit.

,p . 26 ; Portal , Op . c it.


D i scou rs ing of the genesis of the teeth , Fred e ricu s says that everytooth i s at first enclosed within a follicle , that i s , in a frail , skin—l ikemembrane

,in the same manner as the grain in the wheat- ear.

” Takingthi s comparison as hi s point of departure , 1 he gives to dentition the namegerm ina tion .

This author says that the teeth of the Ethiopians and of the Indiansare generally whiter than those of the northern peoples , but that thoseof the Indian s soon lose their primitive whitenes s by reason of the widelydiffused habit of chewing betel nuts .Frede ricu s refers to an experiment which , according to him ,

demonstrates the “ sympathetic relations ” between the teeth and the ear (whilstin real ity it only proves the facil ity with which sounds may be transmittedthrough solid bodie s).

“If, by night,” s ays he , “ one hold s ’ tightly

between one ’ s teeth the end of a stick,stuck upright in the ground ,

one hears the footstep s of a person approach ing from afar much moreeasily .

”

Through the researches of three great men,Marcello Malpighi

,

Friedrich Ruysch,and Anton i van Le euwenhoe ck, an altogether new

science arose in the seventeenth centu ry, viz . ,

histology,or the anatomy

of the tis sues, whose revelation s contributed not a little to the development of modern odontology .

MARCELLO MALPIGH I ( 1628 to the celebrated Italian anatomist,

wa s the initiator of microscop ic ob servation s on the ti s sues , and is , therefore , ju stly considered the founder Of histology , within the range ofwhichhe made most important discoveries .2FRIEDERICH RUYSCH (1638 to professor at Amsterdam ,

renderedhis name illu striou s particularly by bringing to a high degree of perfectionthe processes of anatomical preparations and of embalming .

3

His magnificent injection s , carried out with a method of his owninvention , enabled h im to trace the most minute vascu lar ramification sand to demonstrate the existence of cap illary vessel s 1n parts where theirpresence had as yet never been su spected .

Ruysch studied accurately the anatomical constitution of the teeth,and

especially their vessel s . He called attention to the membrane which linesthe maxillary sinu s

,and discovered in it a number of bloodve s se ls .

But in addition to his purely anatomical ob servation s , this author alsomerits our consideration from the point of view of pathology . He confirmed a most important fact to which allu sion had already been madeby preceding authors , that i s , the atrophy of the alveolar parietes a s

1 Totus d en s prim um inc lusu s e st follicu lo seu m em brana tenu i ac pe l luc ida non se cu s ac

granum in arista .

Boui l le t, Préc i s d ’

histoire d e la m éde c ine,p . 22 1 .

3 Bou i l le t,op . Cit .

,p . 222 .


DOMENICO GAGLIARDI , professor of anatomy and of medicine at Rome ,publ ished an excellent work on the anatomy of the bones , 1 in which heoccupies himself not only with the structure of bones , properly so called ,but also with that of the teeth . He considers the enamel to be formedby parallel and contiguou s fibers , coated , so to speak , by a concretedju ice

,s u i generis , which acqu ires a m uch greater consistence than that

of the bones . Gagliard i says that by rubbing teeth hard together,or

striking them with a steel,he was able to extract sparks from them .

2

j EAN DUVERNEY ( 1648 to a celebrated French anatomist ,wrote a good monograph 3 about the teeth . As different anatomists ofthe sixteenth century had already done

,he examined many fetal j aws

in order to study in them the formation of the teeth . In relating hisob servation s

,he says that he found in every alveolu s a mass of soft viscou s

matter,having the form of the tooth that i s to derive from It, and which

may be considered as its nucleu s . This nucleu s i s entirely surroundedby a membrane

,which the author likens to that which surrounds the

fetu s , and to which he give s the name of choroid m em brane . From thesurface of the nucleu s a gelatinou s ju ice tran spires

,which

,thicken ing

in layers , forms the enamel and the rest of the tooth . The choroidmembrane is abundantly furn ished with nerves

,and with blood and

lymph vessel s . Into the interior of the teeth penetrate vascu lar andnervou s b ranches which serve to m am tain l ts V1tality . In fetal j aws onefinds , besides the germs of the deciduou s teeth , also those of the permanentones . The “ choroid membrane does not follow the tooth when itis sues from the alveolu s ; it remains in stead within the latter, formingthe peridental membraneDuverney says that in Old people the root cavity diminishes in so con

side rable a manner,and the vessels are so compressed that they almost

entirely d isappear . It is then that a period of decadence begin s in thetooth , it is more feebly ‘ nourished

,wears away more rapidly than hitherto ,

and becomes shorter .The author also speaks of senile atrophy of the j aws , especially of thealveolar processes . With regard to this

,he ob serves that if in old age

the lower j aw advances beyond the upper,this depends wholly on the

disappearance of the alveolar border, which projected more in the upperthan in the lower one .

Duverney admits the existence of direct vascu lar relation between thegums and the teeth ; because in the case of diseases of the gums it is rarenot to find the teeth altered as well .From the point of View of the development and nutrition of the teeth

1 Anatom e os s ium,Rom a

,1689 .

2 Portal,vol . iv

,p . 1 1 1 ; Bland in ,

p . 28.

3 Je an Gu ichard Duve rney, Mém 01re sur le s dents, Pari s, 1689 .


Duverney finds much analogy between the tu sks of the elephant,the

teeth,properly so called

,the feathers of b irds , and the hair of m am m ife ra .

1

GOTTFRIED B IDLOO,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 op inion of his ?

CLOPTON HAVERS,an Englishman

,wrote a book on osteology

,by which

he acqu ired ' great reputation,3 and in which he treats as well of teethand their structure . This author bel ieves the enamel of the teeth tobe of the nature of stone , and the ivory of the nature of bone . Thedental roots

,which

,he says

,are preci sely of a bony nature

,are covered

over with a pe riosteum ,«which i s in close relation with the gums and with

the periosteum of the j aw bone . Clopton Havers held that the dentalfollicle no longer furnishes any nou ri shment “to the enamel from themom ent that th is has reached its perfect formation . On the other hand ,he assures his readers that he has ob served , through the microscope ,nervou s thread s which

,departing from the bu lb of the tooth

,traverse the

ivory through small canals,arriving thu s at the periosteum . By thi s

anatomical d isposition the sensib il ity of the teeth may , according to him ,

be explained .

4

Having made this pass ing allu sion to the anatomy of the teeth in theseventeenth century

, we will now resume the illustration of those factsrelating to the pathological and curative part of the science .

WALTER HARRI S,an En

gl ishman

,in a pamphlet on acute infantile

malad ies , 5 recommends aga in , in cases of diffi cult dentition , the Incisionof the gums , a curative practice which had already fallen into disu se .

In the authors of that time we find registered a great number of casesof epu l is . H IOB VAN ME EKREN speaks of an enormou s tumor of thegum that developed in consequence of a traumatic action which hadoccasioned the loss of a tooth . Before deciding on the extirpation of thetumor, the author thought well to pierce it with a b istoury , to be ab le tojudge whether its ablation might not possib ly give u se to a dangerou shemorrhage . The wound having bled but l ittle

,he proceeded to operate ;

but the tumor was so large that it wa s necessary to remove it in variou sportions .

7

The same author refers to a case of a soft epu l i s,bleeding easily

,that

1 Bland in, op c it ; Porta l , vol . i i i , p . 495 .

2 Bland in, p . 3 1 .

3 On Som e New O b se rvations of the Bone s and the Parts Be longing to Them ,London,

169 1 . The accurate de scription given by Have rs of the cana ls conta ining the nouri shingve sse l s of the bone has cau sed the se c ana ls to be known

,even up to the pre sent d ay , by the

nam e of“Have rsian c anal s .

”

4 Porta l , vol . iv, p . 134 ; Bland in ,p . 3 1 . De m orbis acutis infantum

,London ,

1689 .

6 Sprenge l , Ge schichte de r Chirurgie,vol. 11

,p . 298.

7 Me ekren, Obse rvatione s m ed ico- chirurgica

,c ap . xv

,p . 84 .


developed after a badlyperformed dental extract ion . Itwa s to be foreseenthat the ab lation of such a tumor would give rise to an abundant hem orrhage . This wa s , however, staunched by simply _u sing astringent powders

,

without having recourse to the actu al cautery, which the operator hadheld in readiness .1DANIEL MAJOR, wishing to remove a large epu l i s by tying it, was

obliged,in order to'

ke ep.the ligatu re in p0 3 1t10n, to pass the thread through

a circu lar inci sion made at the base of the tumor . He first u sed athread of s ilk, afterward a silver one , and tightened the ligatu re everyday until the epu l i s fell off ?JOHANN ACOLUTHU S wa s obliged , in order to extirpate a large epul i s ,to previou sly spl it the labial commissure . After the ablation Of theprincipal mass of the tumor, he destroyed the remaining part .of it byapplication of the red - hot iron .

3

One read s of other cases of epu l i s in Sta lpaart van der Wyl , Me rcklin ,

Preu ss,Bern

,Valentin i

,etc . This last author even speaks of an ep i

demic of epu li s . However this may be , it i s very probable that epu l i swas much more frequent in past times than it is now,

and thi s probablydepended partly on the incongruou s modes of treating d iseases of themouth , and partly on the sligh t attention paid to cleanlines s of the teeth .

KORNELI S VAN SOOLING EN ,a celebrated Dutch physician and surgeon

,

who flourished toward the end of the seventeenth century,speaks con

tem ptuously of dental operation s , a nd especially of extraction s . He sfaysthat such operations ought to be left to Charlatans , u sed to taking Outteeth with the point of the sword

,and to doing many other things of l ike

nature ! This unjust contempt was at that time widely diffu sed in themedical class , it resu lted , however, substantially, from the great difficultiesencountered by

_doctors and surgeons in general , in performing theoperation of extraction

,owing to want of practice

,and al so from ' the

desire to avoid the responsib ility of the accidents to which the extractionmight give rise ; so true is th is , that an author of the preceding century ,THEODOR Z W INGER ( 1538 to a celeb rated Swiss doctor and profe ssor at Basle , had declared with great frankness that the extracting ofteeth ought to be left to barbers and Charlatans

,as it might easily occasion

unpleasant accidents , such as fractures of the jaw,lace ration of the gums ,

seriou s hemorrhage,and the l ike .

In sp ite of his contempt for practical denti stry,Kornelis van Soolingen

takes the treatment of dental affection s into attentive .conside rat1on . Forthe stopping of carious teeth

,he recommends a mixture similar to th at

which Rhazes had recommended many centuries before , that i s , a cementof mastic and turpentine ; becau se , says he , when the stopping is made

1 Op . c it.,cap . xxvii i

,p . 1 20 .

2 Sprenge l,vol . i i , p . 298.

3 Sprenge l , loc . cit .


holes have been made in the artificial teeth and also in the natu ralones next to them

,one appl ies the artificial teeth in the exi sting void

and fixes them as neatly as possib le with a silver wire by the he lp'

of

pincers .” 1

It wou ld appear that the author is here describ ing a prosthetic method ,which he had never practised himself; and thi s resu lts from the fact ofhis advising the perforation of the natu ral teeth for the passage of the s ilverwire destined to keep the prosthetic p iece in its p lace . Evidently desiringto describ e the “ mode practised by the specialists of those days for fixingartificial teeth , he erroneou sly imagines that the metal thread was pas sedthrough the holes drilled in the natural teeth ; thi s wou ld have been im possib le

,first

,because of the atrociou s pain due to the sensib il ity of the

dentine and of the dental pu lp , and then becau se of the p athologic a lcon sequences to which the perforation of the teeth wou ld have given rise .

We may,therefore , su rely hold that Purm ann i s s imply describ ing, and

not even accurately,a prosthetic method already in u se among the

speciali sts of that period .

On examination of the passage cited above—which , however, i s notso clear as might be desired— it wou ld appear that the models of whichthe author speaks were most probably qu ite d ifferent from those in u se

now . It i s almost certain that the speciali sts of those days first made asketch of the prosthetic p art to be constructed , u sing for the pu rposea p iece of wax which they partly modelled with the hand and p artlycarved ; and after h aving tried on th i s m odel until it fitted perfectly inthe mouth

,and was in every way s ati sfactory, they probably passed

it on to a craftsman to make an exact reproduction of it in bone orivory .

In the year 1632 a little book wa s published in Naples , having for itstitle

, N uova e t u tz'

l z'

s s z

'

m a pra ttica cl z'

tutto quello ch’

a l cl iligente- B ar

hiero s’

app artiene ; com pos ta per Cintio cl’

zfm a to? This p amphlet was

reprinted in Venice in 1 669 , and again in Naples in 167 1 . We heremake mention of it , not for any special im portance which it really has as

regards the development of the dental art,but becau se of its being most

probably the firs t hook in the I ta l ian langu age in which cl enta l m a tters

are spoken of indep endently of genera l m edicine and surgery .

TOMMASO ANTONIO RICC IO . The edition of 167 1 was publi shedunder the supervision of Tommaso Antonio '

Ric c io, who was for manyyears a disciple of Cintio d ’

Am ato, and who greatly eu logizes his masterand praises his work . He expresses himself in the following bombastic

1 Purm ann’

s Wundarz ene i,Ha lbe rstad t

,1684, Part I, chap . xxxi i .

2 New and ve ry use ful practice of a ll that which be longs to the d i ligent barbe r ; com pose dby Cintio d

’

Am ato.

THE SE VEN TEEN TH CEN TURY 243

manner : This book,the offspring ofMaster Cintio d ’Am ato, excellent

in the Barber ’ s Art,ought to find a place in the bosom of Eternity ; becau se

by reason of its having been twice given to the light, it has proved itsworthiness to live forever in the memory of men , gaining for itself, byits excellence

,immortal glory before all su ch as are practised in the

Art .”The book—which consists of about one hundred and eighty pages

,

and is illu strated by several admirab le engravings— contain s , amongother things

,two pages of verses , written by variou s authors , viz .

,by

Cintio dT

Am ato himself, by Giovan Battista Be rgaz z ano, al so a barber,and by others . The greater part of these verses are in p raise of thetwo doctors and Ma rtyrs in Chris t, Cosm os and D am iana s

, specia l pro

tectors of the Art and of the author .

The verses of Cintio d ’

Am ato reveal the possession of a l iterary andpoetic culture above the ordinary , in sp ite of his being only a masterbarber. As to his book

,it may be considered

,for the time in which it

wa s written,as an excellent treatise on so- called minor surgery . The

author expounds,in a few chapters , the anatomical notion s relating to

bleed ing ; speaks at great length of th is operation and of everythingconcern ing it ; refers with much detail to all perta ining to the u se of leeches ,cupping, sc arific ation ,

cauteries,i s sues

,bl istering

,primary treatment of

the wounded , nursing of the sick, etc . ; at the end of the book there i sal so a long chapter on the embalming of corpses .As regard s the treatment of the teeth and gums the author dedicates

six chapters thereto , entitled , respectively : On the rel axation of thegums” (Chapter XXXVII);

“ Preparation for strengt hening the gumsand making the teeth firm (Chapter XXXVIII);

“On tartar andspots on the teeth” (Chapter XXXIX);

“Another prep aration for

whitening and preserving the teeth” (Chapter XL); Mode of burning hart ’ s horn , very necessary in p reparation s for the teeth” (ChapterXLVII).

‘Water of salt , ’ which makes the teeth white and is al sogood for ulcers of the gums” (Chapter XLIX).Evidently Cintio d ’

Am ato treats of dental matters only within extremelyrestricted limits . He tells us nothing with regard to the treatment oftoothache , nothing about caries , about p rosthesis , and , what is stil l moreremarkable , he does not allude even in passing to the extraction of teeth .

NOW ,if in a book treating of a ll tha twhich app erta ins to the diligent ba rber ,

the-

most important dental subjects are passed over in s ilence,this shows

that, contrary to the generally diffused opin ion of today, the dental artwas not at that time (at least not in Italy) exclu sively, or even in greatpart , in the hands of the barber . Even at that time there mu st havebeen dental speciali sts

,and the proof of this may be found in d ’Am ato

’

s

book itself, in the chapter entitled “Necess ity and O rigin of the Barber’ s


Art .” 1 The author, after having spoken of the divisions which thepractice of the medical art had undergone from the most remote times ,and after having alluded to the great number of parts into which Medicinewas 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, somany 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 cu re cataracts , others ruptures and

stone,some make new ears

,l ip s

,noses , and others remedy harel ip s .”

As , under the ge neric name of doctors , Cintio d ’Am ato also comprisessurgeons , it results from the above passage that in his time , that i s , inthe seventeenth century , there were surgeons who dedicated themselvesspecially to the treatment of the teeth ; there were , in fact, denti sts ; andeven admitting that the greater number of these were no better thansimple tooth - pullers

,this cannot be true of them all indiscriminately .

Cintio d’Am ato

’

s book demonstrates in the most vivid manner that evenamong the barber and phlebotomist class

,that i s

,among the practitioners

of minor surgery , there were , at that time , men of considerable culture .

This ought to hold good with still greater reason concern ing surgeons,

whose profess ional level wa s certainly superior to that of barbers ; 2 andas dentists belonged to the class of surgeons (whence the denominationstill in use of “surgeon it is but natural to admit that beside sthe ignorant tooth - pu ller there were; even then more or les s cu ltureddentists well capable of treating dental diseases and performing dentaloperations within the limits permitted by the knowledge of the times .The six chapters in which Cintio d ’

Am ato speaks of matters referringto 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,becau se it is of some his

toric al interest

1 The art of be autifying the hum an body wa s com pri sed by the anc ients am ong the m anyand various parts of the m ed ica l art

,und e r the nam e of decorativ e m edic ine . The barbe rs

conside red them se lve s m em be rs of the m ed ica l c lass, as practitione rs of de corative m ed ic ineand in a c e rta in degre e a lso of surge ry.

2 In a chapte r entitled “Of the Exce l lence and Nobi lity of the Barbe r’ s Ofli ce , Cintio

d’

Am ato spe aks of se ve ra l barbe rs of that pe riod,whowe re in gre at re pute by the ir writings

,

or by the high ofli ce s with which they we re inve sted , or by honors re c e ived from prince s andsove re igns . Am ong the write rs

,Ti be rio Malfi

,barbe r of Monte sarchio, de se rve s m ention ;

he publ ished , in 1626 , a book entitled The Barbe r, written in exce l lent style,and giving

proof of sol id l ite rary culture,and of m uch e rud ition . Thi s work tre ats of all that

conce rns the barbe r’ s art (de corative m e d ic ine,ble ed ing

,In it

,howeve r

,the re is

ab solute ly nothing about the tre atm ent of the te e th or their extraction ; and thi s constitute sa val id confirm ation of our own opinion

,that is , that .the d ental art was not at that tim e in

any way in the hand s of the barbe rs.


It happens in general that owing to vapors that rise from the stomach ,a certain deposit i s formed on the teeth , which may be perceived byrubbing them with a rough cloth on waking . One ought , therefore , torub and clean them every morning

,for, if one i s not aware of thi s , or

considers it of l ittle account , the teeth become discolored and coveredwith a thick tartar

,which often causes them to decay and to fall out .

It i s then necessary that the dil igent barber shou ld remove the said tartarwith the instruments destined for this purpose .

We have seen that the practice of the dental art wa s for the most partin other hands than in the barber ’ s . Nevertheless

,the important op era

tion of the removal of tartar wa s also carried out by him . If, therefore ,even the barbers

,whowere 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 special i sts of those times(especially of the best among them)was not at all so limited as imaginedby those who affi rm that in past times dentists properly so called d id notexist , but only tooth - pu llers .The barbers

,however

,having become

,in a certain manner

,members

of the medical class,sought to extend their sphere of action , and it i s

probable that in a later period than that of Tiberio Malfi and Cintiod’

Am ato 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 mu st

h ave degenerated , too , and have been represented for a certain tim e onlyby ignorant barbers and tooth - pu llers . Vicissitudes similar to thesehave occurred in different epochs

,not only in variou s p arts of Italy,

but al so in other countries of Europe .

FLEURIMOND . In 1682 a little book on dental hygiene was publishedin Paris by a certain Fleurimond

,the title of which was : Moyens de

cons erv er les dents be lle s et bonnes . Portal,in hi s hi story of an atomy

and surgery, makes mention of th is p amphlet, and , briefly allud ing tocertain parts of it , he says : “The author proves by observation thatacid s act upon the enamel of the teeth . He makes some very just refle ction s upon dentition . Fleurimond speaks of a tooth powder invented byhim

,but does not say how compounded .

” 1

In fact, it seems that thi s pamphlet was compiled from a commercialpoint of view

,viz .

,that ofmaking known the special tooth powder invented

by the author . The era of advertisement had already begun !ANTON NUCK ( 1650 to a Dutch surgeon and anatomist , who

taught most ably in the Univers ity of Leyden , devoted great attentionto dental surgery and prosthesis . Relative to the extraction of teeth , he

1 Porta l,vol . i i i , p . 6 18 .


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 themselvesi s requ ired . He insists on a principle of capital importance that hasonly had its fu ll application in the nineteenth century, viz .

, that theinstruments to be u sed for the extraction of teeth ought to vary accordingto 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 b eextracted with the common dental forceps

,but sometimes

,when they

are decayed,theymay be extracted with greater security with the pelican ;

for the small molars the straight- branched pelican i s to be preferred ,for the large molars the curved pelican ; a s to the extraction of root sor of spl inters of bone , thi s ought to be carried out with the ros trum

corv inum .

The author counsel s never to extract teeth during pregnancy,except

under c ircumstances of the greatest urgency, and especially to avoid theextracting of the upper canines (or eye teeth), this being capable of produc ing pernic iou s effect on the visual

'

organs of the fetu s !The best way of obtaining the cessation of a violent toothache withouthaving recourse to extraction is , according to the author, cauterization ofthe antitragu s

,an operation which he carried out with a special cauter

izing instrument , made to pass through a small tube , the better to local izeand to limit the action of the red - hot iron . With regard to this means ofcure already recommended by other authors; we may remark that , althoughit seems ridiculou s at first sight

,and although no .one could be so sense

less a s to make u se of it in our days , nevertheless , for the times of whichwe are writing

,when the cu ring of toothache was in a great measu re

e ffe cted'

by indirect means , thi s remedy might well stand on a level withmany others , and was not perhap s altogether inefli c ac iou s . It i s a suffic iently wellknown physiological fact that the application of a strongstimu lu s in one part of the body may diminish or suppress a painfu lsensation in another part of the organism . It is an equ ally well- knownfact that it is in no way a matter of ind ifference , in producing thi s phenom enon

, to what part the stimu lu s be applied , especially becau se of thegreat d ifference existing in the relation s of the several parts of the bodywith the b rain— the centre of sensation . It is , therefore , very poss ib lethat the cauterization of the antitragu s may really have the effect ofcau sing strong toothache to cease , at lea st temporarily .

Nuck u sed a variety of remedies to arrest dental hemorrhage,such as

tinder, burnt linen , vitriol , su lphuric 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 plan ing down points and sharpedges of broken teeth , as well as for removing, at least in a measure ,the inconvenience and deformed appearance cau sed by irregu lar teeth .

TH IRD PERIOD—MODERN TIME S

The treatment of toothache ought to differ according to its causes .If the pain be owing to

.acidity

,one u ses medicines adapted for tempering

the acids ; if it be owing to the action of saline sub stances, one has recou rseto remedies which dissolve them ; if to worms , to such remedies a s destroythem , and so on . Purgatives and bleeding ought

,however

,never to b e

u sed as remedies against toothache ; for, far from doing good , _

they oftendo harm . As to the other torments u su ally infl icted on poor sufferers

,

they are the punishment of their s in s , for God often gives the unrighteou sinto the hands of doctors ! (This language will perhap s appear les sstrange when the reader comes to know that Carlo Mu sitano was at oneand the sam e time priest and physician !)After a lengthy enumeration of medicaments to be u sed against toothache , which we pass over in silence becau se already known , the authorspeaks of two remedies which carry u s back ab solutely to the days ofPliny ! He relates u s a fact experienced by himself, that, by touchingan aching tooth with the leg of a frog completely cleaned of the flesh ,the pain ceases altogether . Also , if the aching tooth be tou ched with theroot of a tooth extracted from the j aw of a corpse , the pain ceases , thetooth becomes as cold as ice

,and often

,after a certain time , it fall s to

pieces .As to worms

,the best mode of destroying them is by u sing bitter sub

stances , such a s myrrh,aloes

,colocynth

, centaurea m inor , etc . ,but some

times the u se of sweet sub stances,s\

uch as honey, i s a good means ofdrawing them out of the cariou s ’cavities !Mu sitano also cites a great num ber of remedies against the setting on

edge of the teeth . Among the best of these he mention s u rine applied tothe teeth whilst stil l warm ! Alkal i in general , and particu larly lye,such as i s u sed for washing purposes , are good remedies against thesetting on edge of the teeth .

The treatment of loose teeth ought to vary according to whether thispathological condition depend s on O ld age , or on scu rvy, on syphili s ,on superabundance of humors , etc . Sometimes , especially in old person s ,it may be u sefu l to b ind the teeth with gold wire , in order to prevent theirfalling out, but this operation mu st b e very ably performed , otherwise itmay give rise to inflammation .

Relative to artificial teeth,Mu sitano says that they are made of ivory

or hippopotamu s tu sks ; of these la st he does not speak as of a novelty ;we may

,therefore , deem it probable that hippopotamu s tu sks were u sed

in Naples for making artific ial teeth even before the Dutchman AntonNuck (contemporary ofMu sitano)made mention of them in his writings .In cases of diffi cu lt dentition , the best remedy, according to Mu sitano ,

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 wil lthen 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 th is author (as to what concerns our specialty)consists in his having declared bleed ing u seless

,or even harmfu l in the

treatment of toothache , and besides , in his having recommended , withgreat warmth and in most impressive terms , cleanliness of the teeth .

What is more beautifu l , says he , th an a mouth furn ished with white teeth ,s imilar to so many p e arls .

P And what is more abominable than blackor livid teeth

,covered with a fetid deposit or with tartar ? Unclean teeth

spoil the appearance of the person , and nauseate those who beholdthem .

1

WILLIAM COWPER ( 1666 to Toward the end of the seventeenthcentury the “celeb rated English doctor and anatomist

,William Cowper

,

opened up a new field of action to oral surgery by inaugurating therational treatment of the diseases of the maxillary sinu s . In order toempty Highmore ’ s antrum of deposits and to be able to carry out thenecessary irrigations , he extracted in most cases the first permanentmolar, and then penetrated through its alveolu s into the sinu s with apointed in strument .JAME S DRAKE

,also an Engli shman and a contemporary of Cowper,

operated in the same manner ; and it wa s thi s author who made knownin a book of his2 the Operative method of Cowper ; for which reasonthe abovementioned proceeding i s sometimes called “ the CowperDrake operation .

” A certain time elap sed,however

,before it became

generally known . Thus , in a book published by JOHANN HOFFMANNin 1 7 13 there i s no mention made of th is operation , albeit the authorrefers therein 3 to the case of a young girl , one ofwhose canine teeth havingbeen extracted by him

,there en sued a considerab le flow of whitish pus

from the maxillary S inu s . In speaking of this case , Hoffmann stigmatizesmany of the surgeons of his time who were not acqu ainted with thee xi stence of Highmore ’ s antrum

,and therefore , in cases of patients whose

teeth had fallen out as an effect of syphil i s,if they happened to penetrate

with the sound into the maxillary sinu s,bel ieved thi s to be an accidental

excavation of the bone , produced by caries .However , the honor of having in itiated the rational treatment of d is

e ases of the maxillary sinu s i s not exclu sively due to Will iam Cowperand to James Drake ; a large share i s al so due to the celebrated German

1 Carol i Musitani ope ra om n ia,pp . 12 1 to 128, Vene tiis, 1 73 8 .

2 J . Drake , Anthropologia nova , London ,1 707 .

3 J . M. Hoffm ann , Disquisitione s anatom ico-

pathologica ,Altorf

,1 7 13 , p . 3 2 1 .


physician and anatomist,Heinrich Me ibom . The mucou s membrane of

the maxillary sinu s was con sidered by him as the real point of departureof the diseases which occur in this cavity, it b eing liable to becomeinflamed and to suppu rate

,thu s giving ri se to much pain and to variou s

accidents . Me ibom rej ects the operation of Molinetti , that i s , the trepanning of the cavity from the front , the lesion produced in the soft partsof the face being l ikely to give rise to unpleasant consequences . “ Somehe adds

,try the introduc t1on of medicated vapors into the antrum ,

but the best way i s to open the m ax illary s inus by extra cting'

a tooth,

a s the pu s genera lly m a laes its way a s far as the roots of the tee th.

”2 The

author says that hi s father, who was also a physician , had already u sedthe above method with success . He does not speak at all of the artificialopening of the antrum by perforation ; but , a s i s well known , this is notnecessary in many cases

,so that, even now, the operation i s sometimes

reduced to procuring the open ing of the s inu s by the simple extraction ofa tooth

,as was , in fact, practised by Heinrich Me ibom and his father .

Seeing that Heinrich Me ibom was born twenty- eight years beforeWilliam Cowper

,and wa s already known to the scientific world when

Cowper wa s still a child,it i s very probable that hi s operative method ,

having come to the knowledge of the latter, was only followed up andperfected by him .

CHARLE S ST. YvE s (1667 to ocul i st in Pari s , records an interesting case of a secondary affection of the maxill ary sinu s . The point ofdeparture of the evil was an ab scess in the orbit . The suppurativeprocess , after having produced an erosion and the perforation of theorb ital plane , had reached by propagation the antrum of Highmore ,whence the pus took its way, is su ing through the nose . St . Yves had amolar tooth extracted on the affected side (we do not know which sideit was), after which , day by day , he made injection s of detersive liqu id sthrough the orbital fistu l a

,which returned constantly through the

alveolu s of the extracted tooth . By this means the cure of the patientwas obtained .

3

CHRI STOPHER SCH E LHAMMER (1649 to who was professor invariou s German universities

,and distingu i shed himself spec ially as an

anatomist and as an ear doctor, strongly recommends stopping decayedteeth as the best means of cau s ing pain to cease . If, however, the stopping does not hold , by reason of the cavity being too extended , it i s thennecessary, says Sche lham m e r, to extract the tooth ; thi s, however, may

1 Probably through the nose .

2 H. Me ibom ii d e absce ssum inte rnorm a natura e t constitutione d iscursus . Dre sda e t

Li psia ,1 7 18, p . 1 14 . (Thi s ed ition was publi shed afte r the author

’

s de ath, which tookplace in

3 St . Yve s , Nouve au traité d e s m a lad ie s de s yeux, 1 722 , p . 80.


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 . S topping of the ca riou s cav ity . D ion is does not enumerate thisoperation among those intended for the preservation of the teeth . Atthat period

,this operation was performed solely with a view to pre

venting the penetration into and the retention with in the carious cavityof alimentary substances , and the disadvantages cau sed thereby . Thecarious p rocess , says the author, often ceases altogether , and the pain thengenerally ceases also . However, as the residual cavity often becomestroublesome in variou s ways

,among others by making the breath offensive ,

it i s better to stop it . ‘ For this purpose , gold or s ilver leaf i s generallymade use of; but thi s mode of stopping is not durable , becau se gold ors ilver in leaf i s apt to become loosened and fall out . It is therefore prefe rable , says Dion is , to make a stopp ing with a piece of gold or s ilvercorresponding in size and shape to the cavity ? Many, he adds , preferlead as a stopping

,on account of its softness , whilst others simply

use wax .

5 . The u s e of the file . The indications given by Pierre D ioni s for u singthe file do not differ from those we find in other authors . D ionis warns ,however, against u sing the file to level down a tooth which has becomelengthened through the loss of its antagonist , for after a certain time itwould again project above the level of the others .6 . E xtra ction . This ope ration ,

says D ioni s,ought not to be performed

too lightly, but only in those cases in which it i s really necessary ; that is ,when a tooth is the cause of in supportable pain and its crown is almostentirely worn away ; when nothing remain s of a tooth but it s root ; when atooth i s so loosened in its socket as to leave no hope of its again becomingfirm ; when supernumerary teeth or irregu larly planted teeth give ri se toinconvenience or deformity ; and lastly , to remove deciduous teeth thathave become loosened . The opin ion that if the loosened milk teeth benot promptly extracted they cause the permanent teeth to grow irregu larly ,i s , however, considered by Dioni s to be a prejudice .

Dionis strongly doubts whether a tooth that has been extracted andreplanted can really take root again

,as had been a ffi rmed by Dupont ,

Pom are t, and other authors . This shows that Dion is had “had no expe

rienc e on this point .7 . The appl ica tion of a rtific ia l teeth. These teeth

,says D ionis

,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 hippopotam us tu sks , but we learn from him that one Guillem e au made arti

1 He re one a lso ve rifie s the absurd itie s pronounced by those who, not be ing d enti sts , but

m e re ly gene ra l practitione rs or surgeon s,sti l l ri sk spe aking on de nta l subje cts .


fic ia l teeth with a composition of - his own invention , which was obtainedby fu sing together white wax and a small quantity of gum elemi , and thenadding ground mastic , powder ofwhite coral and of pearls . This fact is , aseveryone can see

,most important

,for it constitutes the first step toward

the manufacture and u se of mineral teeth . Dion is tells us that the teethmade of Guillem e au

’

s composition never became yellow, and that it wa s

also very good for stopp ing decayed teeth .

1 It would seem,therefore

,

that it could be u sed as cement i s now u sed .

The Guillem e au of whom D ion is speaks is probably Jacques Guille

m e au ,the author of a book now no longer to be found , which was trans

lated from the French , first into Dutch , and afterward into German .

Crowley,in his D enta l B ibliography , only quotes the German edition ,

published at Dresden in 1 7 10 ,the title of which runs thu s : D

a ufrichtige zfugen und Z ahnarz t ?

J EAN VERDUC , also a Frenchman , relate s a case of the surgeon Carmeline? analogou s to that of Den is Pom are t, in which a sound toothwhich had been extracted by mistake was immediately replanted andtook root again

,becoming qu ite firm . However, Ve rduc does not speak

of replantation as a . spe c ia l method of cure , but merely refers to the abovecase incidentally in speaking of the extraction of teeth . He considers thi soperation a most dangerou s one , and advises not having recou rse toit except in cases of utmost necess ity . Notwithstand ing thi s

, Ve rduc

gives u s to understand that teeth were drawn with suffi cient ab il ity bymost of the operators of the time , and prec isely becau se of this he omitsdescrib ing the manner of performing the operation . Accord ing to Ve rducthe drawing of teeth i s often of l ittle or no advantage again st toothache .

In proof of this assertion he relates the case of a hypochondriac,

- who

l ittle by l ittle had as many as eighteen teeth extracted,without

,however

,

getting the better or the wiser ; but as this case does not prove anythingat all

,one is disposed to think that Ve rduc , in relating it , had the intention

of being humorou s .MONS IEUR D E LAVAUGUYON . To another French surgeon

,Monsieur

de Lavauguyon,also a contemporary of D ion is

,belongs the merit of

having declared useless , in the greater number of cases , the practice , atthat time general

,of separating the gums from the tooth before proceeding

1 Dion i s , Cours d’

opérations de chirurgie,Pari s

,1 7 16 , p . 507 and fol lowing .

2 [The Dre sd en ed ition of 1 7 10 of Guillem e au’

s work conta ins no refe renc e to the

artific ia l tooth com position a s m entioned by Dioni s — E . C. K . ]3 Carm e line was a m ost able surgeon- denti st. We le arn thi s from a passage in Pie rre

Fauchard’

s book (Le Chirurgien Denti ste , Pref. , p . As we shal l se e,the author praise s

him ve ry highly and lam ents his not having written any book m aking known the re su lts ofhis long expe rience .

‘1 Sprenge l,Ge schichte d e r Chiru rgie

,vol . i i

,p . 305.


to ”the extraction of the latter . He says that this i s only necessary whena tooth

,either because broken or becau se its crown emerges too little

above the gum ,offers an in sufficient hold for the pelican ?

Our historical survey has now reached the end of the seventeenthcentury . Embracing at a glance the whole of thi s 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 m ethod byDupont and others ; the method of plugging in cases of alveolar hem orrhage , the cred it of which is due to Riviere and to Tu lp iu s ; the de sc ription of the maxillary sinus given by Highmore ; the rational treatmentof affections of the antrum , inaugurated by Me ibom , Cowper, andDrake ; the researches into the microscop ic structure of the teeth , brilliantly in itiated by Leeuwenhoek, who discovered the dentinal tubu l i ;the u se of models introduced by Purm ann into the workmansh ip of

prosthetic p ieces ; the employment of hippopotamus ’ tu sks in makingartificial teeth , first recommended by Nuck ; and the invention of Ga il lem e au

, which was the first step toward the use of mineral teeth .

1 Traité com ple t de Operations de chirurgie , parMons . de Lavauguyon, Paris, 1696, p . 644.

C H A P T E R X I I .

THE EIGHTEENTH CENTURY .

ALTHOUGH there have been,even from the most remote times , ind i

viduals who have dedicated themselves exclu s ively to the cure of dentalmalad ie s

,or to repairing the losses of the dental system by artificial

mean s,and notwith standing the progress gradually accomplished in thi s

branch of the medical art,which progress was espec ially remarkable

during the sixteenth and seventeenth centuries , it is not to be den ied that ,up to the beginning of the eighteenth century, dentistry was , in great p art,considered one with med ic ine and surgery in general . It i s but naturalthat dental art (and the same may be said of every special b ranch of

medic ine) cou ld not as sume a real ind ividuality until it had atta ined tothe h igher grades of - its development. As a matter of fact, denti stry,toward the end of the seventeenth century , wa s already a true specialty,although it counted but few worthy representatives at that time . Thedefinite separation between the science and art of denti stry and generalmed icine and su rgery

,although it may have been retarded

,cou ld not fail

to take place ; and th is , as we shall p resently se e , wa s effected by the“celeb rated French dentist Pierre Fauchard .

But, to remain faithful to chronological order, we will first speakbriefly of some other writers .LUDW IG CRON

,a barber of Leip sic

,in a p amphlet publ ished in 1 7 17

with the title The barber ’s app rentice v ers ed in ble eding and tooth pu lling ,declares , in a still more emphatic and general way‘

than De Lavauguyonthat it is u seless to detach the gum before proceeding to extract a tooth .

This b arber, strong in his own experience , dares to assert ab solutely u se

les s thi s ancient practice,advised first by Corneliu s Celsu s

,and re com

mended after him,and in homage to his authority, by many other writers .

It i s , therefore , possible that even previou s to Cron and De Lavauguyonmany operators had dispensed with the practice recommended by Celsu s

,

although this had become an accepted canon of the high medical profe ssion .

LORENZ H E I STER ( 1683 to of Frankfort - am -Main,one of the

most celebrated surgeons of the eighteenth century,wrote a di ssertation

on toothache ,2 treating besides very extensively of dental affections and

1 De r heym ade rla ssen und Zahn- ausziehen Ge schickten Barbie rge se ll, Le i psic , 1 7 1 7 .

2 De dentium dolore,Altdorf, 1 7 1 1 .


their cu re in a masterly work on surgery, published for'

the first time in1 7 1 8, and which went through numerou s edition s in variou s languages .When the caries of a tooth i s superficial

,Heister advises the removal

of the decayed p art with the file ; or, when the caries i s deep down ,the cavity ought first to be well cleaned with a toothpick or other likein strument

,then filled with heated white wax

,or mastic

,the stopping

being renewed as often as may be necessary . When a molar tooth i sdecayed

,especially in the centre

,the best way, says Heister, i s to fil l it

with gold or lead leaf,or with a piece of the l atter fitting into the cavity .

If the cariou s cavity of a painfu l molar cannot be cleaned as it ought to be,the dropping of a little oil of cloves or of cinnamon or of gu aiacum intoit will be found u sefu l

,or even a few drop s of sp irit of vitriol ; for in thi s

manner one obtains at the same time the double advantage of destroyingthe impurities contained in the cariou s cavity and of soothing the pain .

But if by chance the pain shou ld persist , recourse mu st be had to thecauterizing 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 antitragu sor by pres sing the aching tooth hard between the fingers

,as Sche lham m er

and some other writers had advised .

Heister writes at length on the extraction of teeth , on the indication sand counterindic ations appertain ing thereto , on the in struments withwhich the operation shoul d be carried out

,and so on . Regarding the

position of the p atients,he thinks it best to place them on a low seat or

on the ground,if the tooth to be extracted i s situated in the lower jaw,

but if an upper tooth is to be extracted , patients shou ld be placed on achair or on a bed .

Movable prosthetic p ieces are mentioned for the first time by t hi sauthor . Although he is very concise in hi s manner of speaking of artificialteeth (thi s ind icating that - dental p rosthesis was considered outside thesphere of action of the general surgeon), we nevertheless learn from himthat p artial sets of teeth made of ivory or hippopotamu s tu sks

,and

without special appliances for fixing them,were then in u se , which ,

when applied in the void between the neighboring teeth,were maintained

in position simply by their form . The author advises keep ing prostheticp ieces 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 al so speaks of nasal prosthesis ; this was then carried out byapplying noses made of wood or of silver

,properly painted . In cases of

1 Sche lham m e r wrote a d i sse rtation on the cure of toothache by touch, D e odonta lgia

ta ctu s au anda,Kie l, 1 70 1 . In the sam e ye ar and in the sam e c ity

,anothe r pam phle t , by

B . Krysingius, was written on the sam e subje ct . (Se e Crowley, Dental Bibliography,p .


to be preferable to that of the first . To prevent the formation of tartaron the teeth

,he advises assiduou s care in keeping the mouth clean

,and

recommends,among other things

,rubbing the teeth with sage . He dis

approves having recourse too readily to metal instruments to removetartar from the teeth , bec ause , according to him , it favors the productionof dental caries . He hold s it dangerou s to extract the upper or lowercan ines when they are not loose , as , by reason of the depth of their rootsan injury to the surrounding nerves may be the resu lt, which not onlymight cau se great pain , but in the case of the upper canines

“ might leadto inflammation of the eye , and even of the dura mater !When the caries i s incip ient, Junker advises rubb ing the teeth several

times a day for some time with common salt, in order that thi s shou ldpenetrate into their structure ?

GUILLAUME MAQUE ST DE LA MOTTE (1655 to a di stingu i shedF rench surgeon and the writer of an excellent treatise (Tra ité com p let

de chirurg i e , Pari s , repeats the advice already given by precedingauthors

,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 becompletely matured

,in order to prevent the suppu rative process from

extending and damaging the bone below . This author relates havingseveral times arrested seriou s hemorrhage following on the extraction ofteeth, by applying a little vitriol in side the alveolu s , and , on this , graduatedcompresses

,which the patient pressed on the part with the teeth of the

opposite j aw ?

JOHANN ADOLPH GORITZ, of Regensburg, in one of his writings pub

lishe d in 1 725, disapproves the too frequent recurrence to extraction ofthe teeth , that i s , carrying out the operation when 1t is not absolutelynecessary . He is al so averse to the appl ication 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 na tural ones to which it had been

fixed became loose,so that it was necessary to proceed to the fixing of all

three,that i s

,the artificial tooth and the two neighboring ones , to the firm

teeth beyond them ; these , however, became loosened in their tu rn , andit was at last necessary to extract six teeth . The great space thu s createdwas filled with a prosthetic p iece made of hippopotamu s tu sk ; but theauthor did not believe much good wou ld come of thi s either . In fact, heis of opinion that the natu ral teeth shou ld be preserved by every possib lemeans , and that, on the other hand , even in the case of a few being lost,it i s better not to resort to sub stitu tes . In the worst case , shou ld thedental void cause too great inconvenience by damaging the pronuncia

1 Sprenge l,op . cit .

,vol . i i

,p . 367 ; Carabe l li , op . c it. p . 65 .

2 Sprenge l,op . cit.

,vol . 11

,p . 3 10 .


second edition 1 of this most important treatise , and of thi s we now intendmaking u se for accu rately analyzing the work , as it i s p rob ably morecomplete than the first, whilst the third , having been published after theauthor ’ s death , i s p robably merely a reprint .The work consists of two volumes in duodec imo , in all 863 pages . In

the beginning there is the portrait of the author and a long and interestingpreface . The portrait

,which we here reproduce

,has also its historical

importance,and thi s for two reasons , the first of which being that in it

Fauchard is revealed to us as a person of very,

distingu ished appearance,

and thi s gives u s an idea of the social condition of the surgeon denti stsof his time ; the second , because there are annexed to the portrait thefollowing Latin verses , by

'

a certain Moraine,in which

,whilst eu logizing

the writings of the author and his ab ility in the treatment of the teeth ,and in restoring force and beauty to them ,

he counsel s him to desp isethe tooth of envy ,” as it will certainly break against his merit .

Dum dextra et scrip tis solam ina dentibus affe rs

Illorum in tuto sunt d e cor atque sa lus .

Invid ia spe rnas igitur, Faucharde , c ruentosDente s ; nam virtus frange re novit eos .

. That Fauchard , in common with all men of rare me rit, had to combatall his l ife again st envy

, we are able to perceive from what we read atthe end of’ the second volume of his work . The author here says that“ the rumor having been falsely se t\ about that he has abandoned the profe ssion ; which rumor cannot have been invented otherwise than by thoseindividuals who

,sacrificing honor to interest

,wou ld attract to themselves

the persons who honor the author“

with their confidence ; he thereforefinds it necessary to give warning that he still continues the practice ofh is art in Paris

,in the Ru e de la Com e

’

dic F ranga is e , together with hi sbrother- in - law and sole student, M . Duchemin .

”

More than a century and a half has passed by since Fauchard wasobliged to defend himself against l ie s invented and se t about to his damageby enviou s colleagues

,but even at the present day

,when

,given the high

grade that civil ization has reached,and professional competition ought not

to make use of other weapons than intell igence,study

,and application ,

some do not hesitate to h ave recou rse to means equally disloyal,ignoble ,

and shameles s as those p ractised by some contemptible dentists of themiddle of the eighteenth century .

The preface of Fauchard ’ s book is especially important for the noticestherein 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 ofwhat we havealready said elsewhere

,namely

,that even before Fauchard , there were not

1 De uxiem e ed ition revue,corrigé e t considérable m ent augm entée

,aPari s

,1 746 .


his mode of operating and with the knowledge acqu i red through thesuccessfu l treatment of a great number of important cases .

“What this celebrated surgeon - denti st has not done , I today dare toundertake . I shall at least afford an example of what he might have donewith greater erudition and better success .

“ From my youth I was destined to the surgical p rofession ; the otherarts I have practised 1 have never made me lose sight of it . I was thedisciple of Alexandre Pote le ret, surgeon - in - chief to His Majesty’ s ship s ,who had great experience in di seases of the mouth . To him I owe thefirst rudiments of the knowledge I have acqu ired in the su rgical specialityI practise , and the progress I made under thi s able man gave me theemu lation that has led me to further important discoveries . I havecollected among different writers what seemed ‘ to me most reli able .

I have frequently discu ssed these matters with the ablest su rgeons anddoctors of my acquaintance

,and have neglected nothing in order to profit

by their counsels and by their ideas .“The experience which I have acqu ired during an uninterrupted prac

tice of more than forty years has led me insen sibly to the acqu irement offurther knowledge and to the modification ofwhat seemed to me defective"in my earlier ideas . I offer to the publ ic the result s of my labors and ofmy studies , hoping that they may be of some u se to those who wish toexerci se the profession of surgeon dentist .”

The reason why dentists before the time of Fauchard publi shed hardly.

anything concern ing their art, was perhap s out of a sentiment of j ealou sy,

which rendered them (that is , the best of the profession and therefore theones most capable ofwriting) but l ittle d isposed to make known to othersthe resu lts of their studies and of their experience

,lest the fru its of their

long labors shou ld be utilized by others and they themselves b e materiallydamaged by competition . That this sentiment of j ealou s egotismreally existed in many dentists may be

,in a certain manner

,deduced from

a few words of Fauc hard himself, who , although he has the very greatmerit of breaking with mean

,old - world prejud ices

,nevertheless expresses

the prevalent idea of the time,consi sting in the belief that every arti

fic e r, every inventor, had not only the right , but also the duty of surround

ing his discoveries with secrecy and mystery . These are the words inwhich

,making

_known a certain improvement in dental prosthesis invented by him , he at the same time expressed his conviction that by so

doing he i s acting against his own interests :“I have perfected and also invented several artificial p ieces both for

sub stituting a part of the teeth and for remedying their entire loss,and

1We have not be en able to find any work in which particular re cord s of Fauchard’

s l ifea re given ,

and hence do not know to which of the othe r a rts he had d ed icated him se lf.

TH E E IGH TEEN TH CEN TURY 26 3

these p ieces sub stitute them so well that they serve perfectly for the sameu ses as the natural teeth . To the prejudice of my own interests I nowgive the most exact description possib le 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 isnot

,however

,to be wondered at , taking also into consideration the lesser

degree of cultu re and of profes sional ab il ity of his p redeces sors , that noneamong them shou ld have been found suffi ciently disinterested to publishthe resu lts of their p articu l ar studies and experience , bes ides all thosetechnical details which according to the ideas of that time constitutedthe secrets of the profession .

In the course of thi s history , we have seen that the dental art wasp ractised from the most remote times and in the most variou s countries ,remaining

,notwithstanding, for centu ries in an embryonal condition . It

was toward the end of the seventeenth and the beginn ing of the eighteenthcentury that , in the midst of the highly advanced civil ization of the greatFrench cap ital

,it“ attained a high degree of development

,entitl ing it to

be considered a special b ranch of the medical art .It wou ld

,therefore

,be wrong to believe that the dental art was created ,

for the most p art , by Fauchard , and one clearly perceives , from the peru salof his work, that although he made most important contribution s to thisspecialty

,which he cu ltivated with pass ion

,nevertheles s

,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 thisfor the reasons we 'have already suggested . The highest merit of Fauchardconsi sts

,still more than in his inventions and improvements

,in hi s having

most ab ly co°llected and incorporated in a single work the whole doctrineof dental art

,theoretical a s well a s practical

,thu s setting in fu l l l ight the

importance of the spec ialty, and giving it a solid scientific b asis .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 1 700 , the denti sts began to form a welldefined class , to belong to which it was necessary to pas s a special exam ination . This examination

,a s we learn from Fauchard

,was held before

a commission of which no denti st formed a part,and exactly for this

reason gave but negative resu lts and responded but l ittle to its intendedaim . The greater number of those who were authorized to practisedentistry after undergoing this examination showed a profess ional ab il itybelow 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 , 1

1 Vol . i i,p . 366 .


Wherein the author speaks of the great perfection reached by dentalsurgery in Paris

“The teeth and the other parts of the mouth being subject, as we

have seen in the cou rse of this work, to so many important d iseases,

requ i ring the aid of the most able dentists , it i s strange that the sovereign sof foreign countries , the heads of republics , and also the administratorsof our own provinces do not provide for the expense of sending youngsurgeons 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 regard s

the embell i shment of the mouth and the cure of d iseases , often of amost seriou s nature . These scholars wou ld , thereafter, form others andwou ld render great services to their nation and to their fellow citizen s .In the first chapter of his work , Fauchard speaks “

of the structu re ,position

,and connection of the teeth ; of their origin and of their growth .

”

He distingu ishes in ea ch tooth a body, a root , and a neck , making theremark

,however

,that this last i s to be considered as forming part of the

body . According to the author, the name of “ crown” can only be appliedsu itably to the body of the molar teeth , but not to that of the incisors orof the canines , which has no resemblance with a crown . Although inthe adu lt the number of the teeth is normally thirty—two, it may be thatsome persons have , nevertheless , thirty- one , thirty, twenty- nine

,or even

only twenty- eight teeth,and this independently of any eventual loss

,but

for the s imple reason that the wisdom teeth are often cut very late in l ife(even after fifty years of age), or do not all come forth , or sometimes arenever cut at all . The author refers to some cases of a supernumerarytooth situated in general between the two superior central incisors andsimilar in form to the lateral incisors . He also observed two individual swho had each thirty- four teeth , sixteen in the lower and eighteen inthe upper j aw,

and in these cases the two supernumeraries were situatedbehind the incisors . Fauchard declares the popul ar op inion expressedalso 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 thel atter are shed

,when the permanent teeth are ju st on the point of coming

through ; however, if it so happens that one or more of the . milk teeth beextracted some time before the“ period in which they are u sually shed

,

their roots are found to be as long and as strong in proportion to the bodyas those of the permanent teeth . In children one finds

,besides the

twenty deciduou s teeth,the germs of the thirty—two permanent ones

,

for which reason it may be said that children have in all thirty- two teethwithout counting the germs that may sometimes be found at the extremities of the roots of the large molars . As , however, the existence of suchgerms is an exceptional fact , the twelve large molars , if extracted , are


teething maladies and their treatment,he nevertheless treats thi s subject

with much practical good sense , and does nOt merely make .servile repetition ofwhat 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 ob served for their preservation , of the modes of

keep ing them white,and of strengthening the gums .

From a passage in the fifth chapter we learn that tooth e she s werethen already in use . Fauchard , however, advises the u se of small spongesin their stead . He says : Those who u se bru shes of horsehair, or p iecesof cloth or of l inen for cleaning the teeth , do not reflect that all thesematerial s are too rough , and that the practice of u s ing them frequentlyand without discretion often exercises a destructive action upon theteeth ? 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 tep id water , and to rub the teethup and down , in side and outside , with a small , very fine sponge wetted inwater ; and it is still better to add to this water a fourth part of aqu a vitathe 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 p reparation ,may be u se d with benefit for rubbing the teeth . The author gives along and minute description of this preparation

,which we

,however

,

omit,becau 'se devoid of historical interest .

As,however

,the above means are x not always sufli c ient for preserving

the teeth and gums in good condition , it i s necessary in many cases , saysFauchard

,to make u se of some paste , powder, or mouth wash . The

author mentions a great number of composition s of this kind,giving the

formul a for each one— almost a lways most complicated— and indicatingthe -pecu l iar advantages of each of them . We will here quote one of theformu la as an example .

“A sp irituous wa ter

,des i cca ti v e

,ba ls am ic

,antis corbutic , eflica cious

aga inst m any m a ladies of the m ou th“

R— good sarsap 'arilla , four ounces ; aristolochia rotunda , dried rind sof bitter organes , of lemons , and pomegranates , ana three ounces ; pyrethrum two ounces ; cloves , one ounce ; mu stard seeds , one ounce ; wildrocket seed s

,two ounces . Pound well in a mortar and put the whole into

a retort with a long neck . Add thereto half a pound of pu lverizedcandied sugar and the same qu antity of' clarified rose honey . Pour inthree p ints of good spirit of wine . Cork the retort well and leave all todigest in a cool place for five or six days . Then heat the retort forty- eighthours

'

in the water bath over a slow fire,without letting the liqu id come

1 Page s 73 , 74.

TH E EIGHTEEN TH CEN TURY 267

to the boil . Afterward , when cold , decant in a glas s bottle , to be kept wellcorked . Pour another three p ints of sp irit of wine on the res idue of thedrugs ; cork the retort again , replacing it in the water b ath for forty- eighthours , and regu lating the fire a s above . Then , after letting it cool ,pour off the liqu id into the same bottle . Next remove all the residue fromthe retort

,place it in a thick , white linen ‘cloth , and force the remain ing

l iqu id through it , and add to that in the bottle . Put back half of theentire quantity of l iqu id in the same retort, and add thereto aloeticelixir and baum e du com m andeu r

,ana four ounces ; pu lverized 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 . Letcool

,decant the liqu id in another glass bottle

,and cork well . Pour the

remain ing half of the first l iqu i d upon the rest of the drugs,rep lace

the retort in the water bath for forty- eight hours , let cool , and pou r thecontents in the last bottle . Filter the liqu id well

,and pour it into a ' bottle

of sufficient s ize to be able to add the following liqu id s : aqua vulnerari aand first cinnamon water

, ana three pints ; second cinnamon water, threhalf- pints ; sp irit of cochlearia , fou r p ints Shake the bottle well

,filter

again,and store in wellcorked bottles .

The author adds that the doses of the d ifferent drugs may be reducedin proportion to the quantity of l iquor to be prep ared ; and that he p repares so large a quantity at a time becau se of the great sale he has for itamong his cl ients .The preparation in question is counselled by the author as a remedyagain st pathological condition s

,and of the gums especially . One makes

use of it in the following manner : Pour from seven to eight drop s into awineglas s of water ; wet the tip of the finger and rub the gums and theteeth well . Or mix seven or eight drop s in a good spoonfu l of water,using a fine sponge to rub the teeth and gums .The example we have cited suffi ces to show how much care one tookat that time in the preparation of sub stances destined to be u sed in thepreservation of the teeth

,and demonstrates at the same time that Fauch

ard , inventor of that and many other preparation s , besides being an ablesurgeon dentist

,was also exceedingly well versed in dental materia medica .

Chapter VII treats of the general cau ses of dental , alveolar, and gingivaldi sea ses , and contain s the complete enumeration of these maladies .The cau ses of dental affection s may be of two orders , viz .

,internal (general

diseases , dyscras ic condition s) and external (the action of heat and cold ,mechanical cau ses

,

After having spoken in particu l ar of variou s cau ses,Fauchard adds :

Little or no care as to the cleanl iness of the teeth is ordinarily thecau se of all the maladies that destroy them .


The author divides maladies of the dental apparatu s into three classes , .

that is :1 .

'

Maladies deriving from external cau ses and acting, therefore , espec ially on the crown or uncovered part of the tooth .

2 . Maladies of the hidden parts of the tooth; that is , of the neck androot .3 . Symptomatic maladies , deriving from the teeth .

In the first cl ass the author includes 45 pathological states , 1 7 in thesecond and 4 1 in the third , making up a total of 103 morbid conditions .This shou ld be sufficient to give us an idea of the accuracy with whichFauchard studied the maladies of the dental apparatu s , especially if oneconsiders that preceding authors had reduced these maladies to a verysmall number . F auchard ’ s classification is very complete , for notwithstanding the progress made in succeeding years in this sc ienc e

,. the

pathological conditions not to be found comprised in it are exceedinglyfew . Natu rally, the 103 diseases enumerated by Fauchard do not represent as many distinct morb id entities . The author, in classifying dentalmaladies

,keeps especially in view the requ irements of the practitioner

,

and therefore makes numerou s distinction s in each morb id process .Thu s

,he distingu ishes a great many varieties of caries

,viz .

,the soft and

putrid caries , the dry caries , the caries in part dry and in part soft, thecaries complicated by fracture , the superficial caries , the .deeper and thed eepest

,the caries of the different surfaces of the crown

,

‘ and so on .

Also in the classification of other m orbid processes , Fauchard makesmultifariou s d istinctions .The passage referring to worms in the teeth deserves to be herereproduced : 1

“ Sometimes worms are to be found in the cariou s cavitie s of the teeth ,or in the deposit of tartar that covers them

,and to these the name of dental

worms has been given . Observation s recorded by illu striou s authorsare extant which attest thi s . Not having ever seen these worms

, I ne ithe t

admit nor deny their existence . Nevertheless, I conceive the thing nor

to be physically imposs ib le , although at the same time I do not believeat all that these worms destroy the teeth or cau se them to decay

,but rather

that the eggs of some insect having been introduced into the cariou s cavityof the tooth , either through al imentary sub stances or through the saliva ,these eggs thu s deposited . have developed and produced the wormsalluded to . However this may be

,as they are not the real cau se of the

caries , their eventual presence does not requ i re any particu l ar con sideration .

” Fauchard again recurs to the subj ect of worms in Chapter VIII,in speaking of the particu lar causes of caries ?

1Vol . 1,p . 13 1 .

2 Page 142 .


particles which compose these fibers,gives rise to their destruction . The

causes from which these d isorders derive m ay be external or internal .The external cau ses are blows , violent efforts made by the teeth ; theimproper u se of the file , the app lic ation of acids or of other sub stancesthat 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 effu sion

of the liqu id contained in the vessel s . The author gives analogou sexplanations for the other external cau ses . As to the internal cau ses ,they consi st

,he says

,in alteration of the blood and of the humors .

The teeth,says Fauchard

,are more subj ect to caries than all the

rest of the bones in the human body, becau se, their ti s sues being denser,the vessels are on this account closer together and more easily liable tobe ob structed

,choked up , and broken . Besides

,the position of the teeth

exposes them more than the other bones to the immediate action of externalcau ses capable of producing the disorders alluded to ; and finally , whatdemonstrates the dental caries to be produced

, for the most part , byexternal cau ses

,i s that false teeth

,either human or formed from those

of animals,sometimes become cariou s ju st in the same way as the natural

ones ; which evidently happens by the sole action of external cau ses .It is undeniable that the ideas expressed by Fauchard on the patho

geny of caries , cannot hold good against critici sm . Nevertheless,we

owe a great deal to this author for having once for all put an end to theridiculous theory of dental worms , and for having tried to find a reasonable explanation of the manner in which caries is p roducedThe teeth

,says Fauchard

,have not all the same disposition toward this

morbid proces s ; indeed , notable differences are to be ob served in thi srespect . The molars are

,in fact

,more apt to become decayed than the

inci sors or the canines ; and the upper inci sors and canines are moresubject to this di sease than the inferior ones

,becau se

,by reason of their

position , they are more frequently uncovered and more exposed to heatand cold , whether in eating and drinking or whether in the mere asp iration or expiration of the air . It i s to be observed

,besides

,that when

the eruption of the last molars i s con siderably delayed they easily decay ?

Having very frequently ob served the symmetrical decay of corresponding teeth on both sides of the same j aw

,Fauchard considers that these

cases are not simply accidental,but rather holds that the fact depends

on a special cau se , which , however, is not easy to determine . He offers,

at any rate, a suffi ciently good explanation when he says that as certainmorbid cau ses (bad humors , etc .) mu st affect both sides of the mouthidentically, it i s but natural that the effects of such cau ses shou ld be

1 Page 149.

TH E EIGH TEEN TH CEN TURY 27 1

altogether analogou s on the right and on the left , and manifest themselvessymmetrically on teeth having the same configuration , the same structure ,and the same consistence .

Before speaking of the treatment of caries , 1 Fauchard alludes to thefallaciou sness of the many remedies again st toothache which were largelysold at hi s time by Charlatan s and impostors of every kind .

Some pretend to cu re toothache with an el ixir or some special essence ;others with pla sters ; others by means of prayers and signing with the cros s ;others with specifics for kill ing the worms that are supposed to gnaw thetooth and so cau se pain ; others p retend to be so clever that they can curethe most inveterate toothache by merely touch ing the tooth with a fingerd ipped into or washed with some rare and mysteriou s l iqu id ; othersfinally promise to cure every kind of toothache by scarifying the ears withthe lancet or cauterizing them with a red - hot iron .

”

“I am well aware ,” adds Fauchard , “that it can be alleged in favor ofthis last prejud ice that the celeb rated Ital ian doctor Valsalva ind icateswith great preci sion the point in‘ which the actu al cautery is to be appl iedto the ear, in order to calm toothache . He also determines the size ofthe iron and the manner of applying it . The authority of so celebratedan author

,whose op in ion is certainly worthy of respect , shou ld induce me

to believe that there may perhap s be some cases in which it i s poss ib leto use this remedy with success ; nevertheless , I cannot persu ade myselfthat such treatment can be u seful in common cases of toothache .

“At Nantes,a city of Brittany , I knew a Turk , a watchmaker by

profession , who was renowned for thi s mode of curing toothache . But

I also know that,in sp ite of the p retended cures

,the greater number of

those who put themselves into his hands were obliged finally to haverecourse to me , in order to find relief for their sufferings . I afterwardsaw several other persons u se the same remedy with no better succes s .

“There are,besides

,an infinity of other remedies vaunted a s effi caciou s

again st toothache , but the greater number of them are so rid icu lou s andextravagant that it would be both tiresome and u seless to speak of them .

We will , nevertheles s , give one more men tioned by M . de BrantOm e .

”2

The author here quotes a passage of th is writer, wherein he says that ,having been suffering from toothache for two days , the apothecaryof Elizabeth of France

,wife of Philip II of Sp ain , brought him a most

singu lar herb , which when held in the hollow of the hand had the virtueof making the pain cease immediately ; and in thi s way he was , in fact ,effectually cured .

And here Fauchard expresses himself of the same op in ion as Urb ainHem ard , who believes the cure of toothache by means of words , or by the

1 Chap . ix,p . 154.

2 Dame s i l lustre s, vie d’

E liz abe th,p . 1 79 .


touch of paper on which certain signs are written , _

or remedies held in thehand

,etc . , to be merely the effect of the force of the imagination , and he

opines that the patient,having a vivid belief in the mysteriou s thing

proposed to him remain s under the impression of an inward commotion ,by the effect of which it may well be that the morb id humor is deviatedfrom the painful part to other parts of the body . The effects of the variou spassions on the bodily functions are , s ays 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 greatfear as not to feel the pain any longer

,and go

'

away, only to return lateron renewal of their sufferings ; although there have been cases where thepain ceased altogether .In sp ite of this explanation , ofwhich we will not here discu ss the value ,allowing it

,however, a s satisfactory enough , Fauchard continues by making

a most curiou s consideration,which as it i s of a somewhat surpris ing

effect in a scientific work , we will not deprive our readers of it . He believesit to be his duty to give the following warning, namely , that “the modesof cure , by means of certain words , of certain sign s , l aying on of hands ,written charms , etc .

, savoring much of superstition and of diabolicartifice , are prohib ited by the Church as sinning against the first Commandment, as much in him who practi ses them as him who consentsthereto .

”

After the above preliminaries, the

'

author passes on to treat the important subject of the mode of curing carie s ? According to him ,

whencaries has not yet attacked the internal cavity of the tooth at all , or onlyin a very slight degree

,there are fou r modes of curing it : the first consists

in the u se of files or scrapers,the second in the application of lead , the

third in the u se of oil of cinnamon or of cloves , and the fourth in theapplication of the actu al cautery . Fauchard expresses most energeticallyhis d isapproval of the means of cure recommended by D ion is in casesof caries of the triturating surfaces

,which consisted in the cauterizing

of the decayed spot with a drop of oil of vitriol appl ied by means of aminiature p aint bru sh , declaring this to be both dangerou s and hu rtfu lbecau se of the destructive and corrosive action of the oil of vitriol andbecause of the impossib ility of l imiting its action solely to the affected partof the tooth .

The general method of cure followed by Fauchard is described by himin these terms

“When a tooth is but slightly decayed,it i s sufficient to remove the

caries with the in struments of which I will speak hereafter,and to fil l

1 Page 16 1 .


never should have expected to find in his book ; .but he assures us thatby it many person s who had almost all the teeth decayed and suffered veryoften from toothache found great relief.

“It consists in rin sing the mouth every morning and also in the evening

before going to bed with a few spoonful s of one ’ s own u rin ‘e immediatelyafter it has been emitted , always provided the individual be not ill . One

i s to hold it in the mouth for some time , and the practice ought to becontinued . This remedy is good but undoubtedly not pleasant, except inso far a s that it p rocures great relief. Some of those to whom I haverecommended it

,and who have u sed 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 d ifficult in the beginn ing to accustomone ’ s self to it ; but what wou ld one not do to secure one’ s self healthand repose .

”

In order to explain the virtue of the urine as a remedy, the authorpauses to speak of its chemical composition , and then adds

“The rectified sp irit of urine 1 cou ld be sub stituted for the human urine .One shou ld then take two drams of thi s sub stance and mix it with twoor three ounces of aqua vita , or water of cresses or of cochlearia . Salvolatile2 has the same virtues . Those who wish to make use of it shou ldd issolve fifteen to thirty grains of it in the same quantity of the abovel iquid .

”

Fauchard then passes on to speak of trepanning of the teeth whenthey are worn away or decayed and cau se pain .

3 He begins by sayingthat most varieties of pain caused by the canines and the inci sors whenworn away or decayed cease after the u se of the trepan . He

,however

,

understands the term trepanning in a very wide sen se , comprehendingtherein the u se of any instrum ent whatever (even a needle or a p in) withwhich one penetrates into the inner cavity of the teeth .

In interstitial caries of the canines and incisors one ought,says Fauch

ard , 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 ina short time .

”

The author describes with much minuteness the manner of trep anning,and then addsAfter this operation one should let a few weeks pass without doing

anything to the affected tooth , and afterward , in order to impede furtherdecay, one mu st put a little cotton - wool into it soaked in oil of cinnamon

1 L iqu id am m onia .

2 Subcarbonate of am m onia .

3 Chap . x,p . 169.

TH E EIGH TEEN TH CEN TURY 27 5

or of cloves . The tooth mu st b e left in this state for some months , takingcare to renew the cotton - wool . It i s necessary to observe that in beginningto put in the cotton - wool this shou ld be done with lightness and withoutp ress ing it down much

, so that if pu s shou ld gather again it may be ableto make its way through the cotton - wool , the princip al object of thisbeing to hinder the penetrating of alimentary sub stances into the tooth ,which would be the cau se of further decay . If the cotton were p ressedinto the tooth from the beginn ing, the pus , not being able to find an exit ,wou ld accumu late , and might cause much p ain , if the nervou s p artsof the tooth were not yet dried up or destroyed . The same thingmight happen after the appl ication of a lead stopp ing, and one would beobliged to remove it and let con siderable time pass before putting it inagain .

Further on the author says that while the trepann ing of incisors orcanines almost always cau ses the pain to cease , by opening up an exitto the morb id matter retained with in the cavity of such teeth

,the same

is not the case with the molars , these having several roots and severalcavities

, of great variety, which lend themselves but l ittle to accuratetrep anning .

“Hem ard , he adds , “judges it necessary to extract these

teeth,or at least to break off the crown (les dechap eller), in order to give

exit to the corrupt matter that is closed up in the cavity ; th is sometimescauses the pain to cease . He (Hem ard) s ays that he has seen manyabscesses in the interior of teeth , which were not externally decayed , andthat after having broken off the crown he found within the cavity acorrupt matter of an insupportab le smell .Relative to such cases , Fauchard says that, besides the teeth , also the

surrounding parts suffer and are imperilled by these condition s . “Thegreater part of the violent fluxions deriving therefrom often terminate inab scesses and fistula of the gums and of the surrounding parts

,and

sometimes with considerable and dangerou s decay of the bone,as I have

related in some of my ob servations .”

One sees that Fauchard was clin ically very well acquainted with thegrave forms of pu lp itis and their possible consequences , although ignoringthe true nature of this process , which has only been stud ied and illu stratedmuch more recently .

Chap ter XL (page 1 7 7) treats of dental tartar, of its cau se , of the harmful effects it produces , and of the prophylaxi s and therapy relating thereto .

Three illu strations which are added to this chapter represent the difforent aspects of a mass of tartar of exceptional s ize formed around thebody of a lower molar . The su rgeon Ba ssue l , a friend of the author ,had removed this mass of tartar

,together with the entire molar

, from thej aw of an old woman . The mass itself wa s almost the size of a hen ’ segg, the supe rfic ie s being very irregul ar ; it rendered mastication altogether

27 6 TH IRD PERIOD—MODERN TIMES

impossible and cau sed the cheek to stand out in such a way a s to givethe appearance of a tumor .In the following chapter2 the author enumerates the variou s dental

operations . C“ leaning the teeth,separating them , shortening them ,

removing the caries,cauterizing, stopp ing, straightening crooked teeth ,

steadying loose teeth,trepanning

,simple drawing of teeth , replacing the rri

in their own alveoli , or tran splanting them to another mouth , and finallysubstituting artificial teeth for those wanting .

” He then adds : “Allthese operations requ ire in him who carries them out a light, secure , andskilfu l hand and a perfect theoretic knowledge , by which he may decideon 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 nevertheles s undertake it in a case inwhich it i s not at all proper to operate . Into such an error no one canfall save through sheer ignorance of the cau se of the disease or of the rightmeans of cu ring it . From this it mu st be concluded that the knowledgerequ ired in order to be a good de ntist is not so limited as some imagine ,and that the imprudence and the danger of placing one ’ s self in ignoranthands is as great a s the temerity of those who undertake to exercise sodelicate a profession without the knowledge of even its first elements .”Before speaking in detail of all the above operations , the author ded i

cates a lengthy chapter3 to describ ing with the greatest minuteness theposition to be given in general , as well a s in special cases , to the head andbody of the patient , and the manner in which the denti st shou ld placehimself with regard to the former , so as to be able to make a proper u se ofeach of his hands . As a ru le , Fauchard made the patient seat himselfin a convenient arm - chair ; in exceptional cases he placed him on a sofaor on a bed . He draws this subject to a close with the following words :

“It is, indeed , surpris ing that the greater part of those who practise

tooth drawing shou ld ordinarily seat the patient on the ground,this

being both indecent and not very clean . This position is not only un

comfortable , but cau ses sometimes a sense of fear, especially in p regnantwomen , to whom it may, besides , prove very harmful . But it is - stillmore surprising that certain authors shou ld even nowadays affi rm thisto be the most convenient position , while it i s in stead one to be entirelyrej ected .

”

In speaking of extraction of the teeth , ‘1 Fauchard begin s by saying thatthe 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 intolerab le pain

'

The alveoli of the infantile j aw are

1 Page 407 .

2 Chap . xii,p . 183 .

3 Chap . xii i,p . 185 .

‘1 Chap . xiv,p . 194.


cariou s cavity,and to impede the teeth on the s ame side from becoming

covered with tartar,as inevitably h appens when by reason of painfu lnes s

in eating they are forced to be inactive ; fourth and lastly, becau se thedental caries

,not infrequently gives rise to other diseases , which ordinarily

cannot be cu red unless the cau se from which it arises be recognizedand suppressedSometimes

,continues Fauchard

,

“ such violent and obstin ate painarises in a tooth that we are obliged to extract it , although not decayednor presenting deformity .

”

The author combats the old prejudice , that it i s not right to drawteeth in cases of pregnant women or of nursing mothers , le st the operationshould prove dangerou s to the patient or to

_the fetu s,or produce alterationor arrest of the milk secretion . Only the fear arising from this prejudice can

,according to the author, cau se any of the dreaded contingencies .

The denti st ought, t herefore , to seek to dissip ate the“ fears of these patients ,

by persuading them of the innocuou s nature of the operation as well asof its short duration

,and should

_

repre sent to them , on the other hand(if the operation be really necessary), the advantages of promptly decidingon it, to avoid the harm and the peril that prolonged suffering and the

tortures of sleeplessness might occasion to themselves as well as to theunborn child or to the suckling infant , such as abortion , prematureconfinement, 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 ofextracting a tooth

,so as not to terrify him .

”

The author then speaks of cases where it is necessary to open the j awsby force ; 1 of the instruments to be u sed ; of the mode of employing them ;of all the precaution s to be observed under such circumstances ; of thenecessity that may eventual ly arise of s acrificing some one tooth whenthe enforced opening of the j aws has been impracticable ; of the advisa

bility of s acrificing preferably in such cases one of the premolars inorder to damage as l ittle as possible the masticatory function and theappearance of the face ; of the instruments best adapted for carrying outthis operation ; of the danger it presents and of the best mode of avoiding it ; finally, of what it i s necessary to do in given cases to keep themouth open , in order to not be obliged to repeat the operation a secondtime .

The six following chapters of the first volume treat very exten sively ofthe anatomy and physiology of the gums

,

2of gingival d iseases and their

treatment .3 The subject is treated in a masterly manner,although these

chapters do not offer anything of original importance .

1 Chap . xv,p . 205 .

2 Chap . xvi . 3 Chap . xv11 to xxi .

THE EIGH TEEN TH CEN TURY 279

The same may be said of Chapter XXII, in which the author speaksof scorbutic affections and of their treatment .The chapters we have cited are accompan ied by four plates , re pre

senting thirteen instruments for u se in the treatment of the above diseases .

FIG . 78

Instrum ents for open ing the m outh in ca se s of lockjaw (Fauchard).

The author then speaks 1 of the accidents which may ari se from cariesand from other dental diseases , not only in the parts nearest to the teeth ,but also in localities more or les s distant from them

, for example , fistu la

1 Chap . xxi i i, p . 282 .


reaching as far as the cheek bone or the eye , necrotic destruction of themaxill ary bones , etc .

The first volume of Fauchard ’ s work finishes with a collection of mostinteresting c ase s ,which may be read even at the present day with plea su re ,and from which one may derive some u sefu l information . These casesare about eighty in number, spread over fifteen chapters , according tothe variou s natu re of

l

the cases themselves ; This valu able collectiongives clear evidence of Fauchard ’ s eminence both as operator and observer,and affords at the same time an idea of the extent of his p ractice whichenabled him to collect so considerab le a number of cases of more thancommon interest .Chapter XXV contain s some ob servations on “well- au thentic ated cas es

of regeneration of permanent teeth in individu als of ages varying fromfifteen to seventy—five years . We will here give two of them by way of

cu rios ities :“In the year 1 708 Mademoiselle Deshayes , now the wife of M . de Seve ,

resid ing at Paris in rue de Baune,and who wa s then fou rteen years of

age,had the first large molar on the right side of the inferior j aw extracted

by me,becau se decayed and cau sing pain . The following year she t e

turned to have her teeth cleaned by me,and whilst doing th is I ob served

that the tooth extracted had been wholly regenerated .

” 1

“In the year 1 720 the eldest son of M . Duchemin , player in ordinary to

the King, whowas then sixteen years old , came to me to have the secondlarge molar on the left side of the lower ' j aw extracted . It was verym uch decayed . I drew it , and a year and a half after the tooth was

completely regenerated .

” 2

In Chapter XXVIII the author relates twelve cases of dental irregu l arities corrected by him with s atisfactory and at times even surpri singresu lts . We here refer, in Fauchard s own words , to the last two of thesecases

,not becau se of their being the most important, but becau se

from them it is evident that Fauchard was not the only dentist whoundertook such corrections

,although he was perhaps the only one who,

in certain cases,carried them out with a rapid method .

“In the year 1 7 19 M . l ’ abbe Morin

,about twenty- two years of age ,

whose countenance was greatly deformed from the b ad arrangement ofthe incisors an d canines

,consu lted variou s colleagu es of mine as to the

possib ility of correcting the i rregu l arity of his teeth . Some found thething so d ifli cu lt th at they advised him to do nothing at all

,th at is , not to

risk any attempt . He came to me by chance one day whilst another dentistwas with me . We both examined his mouth with much attention .

Now, as thi s dentist was my elder,and I believed him to have more exp e ri

1 Page 330 .

2 Page 33 1 .


already spoken on the subject . This man ’ s canine was found byFauchard to be too large ; nevertheless , for want of better he extracted andtransplanted it

,after having diminished it in length and in th ickness .

This it 'was not possible to do without the cavity of the tooth remainingopen

,and for this reason , when , after about twoweeks

’ time it had becomequ ite firm

,he stopped it . But the stopp ing immediately cau sed such

insupportable p ain (which circumstance astonished the writer not alittle) that he was obliged to take it out again the following day, on whichthe pain ceased directly . Fauchard saw this p atient eight years afterward ,and was assu red by him that the transplanted tooth had lasted him sixyears

,but that its crown had been gradually destroyed by caries . The

root had been extracted by a dentist, not without con siderable pain ?

We now give one of his ca ses of replantation in the words of the authorhimself :

“On April 10 , 1 725 , the eldest daughter of M . Tribuot, organ bu ilder

to His Majesty the King,called on me ; she was tormented by violent

toothache cau sed by caries of the first small molar on the right side ofthe upper j aw ; but although she was desirou s of having the tooth removed ,to be freed of the pain , she , on the other hand , could not , without d iffi cu lty ,make up her mind , thinking of the disfigurement which its lo ss wou ldoccasion , and thu s it was that she was induced to ask me if it wou ld notbe possible to put it back again after having extracted it, as I had alreadydone in the case of her younger sister . I repl ied that thi s might very wellbe done , provided the tooth came out without being broken , withoutany splintering of the alveolu s , or great laceration of the gum . Thepatient, 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 alveolu s

injured in any way . I therefore was induced to put the decayed tooth backin its alveolus , and having done thi s , I took care to tie it to the neighboringteeth 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 cariou s

cavity .

” 2

Not without interest i s a case of d isease of Highmore ’ s antrum,origin

ating in the following way. A charlatan attempted to extract by means ofa 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 handlewith a stone . But the tooth

,instead of penetrating into the hollow of

the key, wa s driven into the maxillary sinu s ?Two important cases of “ stony excrescence of the gums (probablyosteomas) are to be found in Chapter XXXII . One of these tumors

1 Page 383 .

2 Page 3 76 .

3 Chap . xxxi,p . 3 9 1 .


was removed by the dentist Carmeline after the patient had been torturedwith u seless operation s by surgeons , who, not recognizing the true seat ofthe evil and mistaking it for a tumor in the cheek , had , over and aboveall 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 theremainder of his l ife with . a wax plug, to prevent the exit of the sal ivaand of l iqu id or masticated al iments ?Several important ob servation s on obstinate cases of cephalalgia , pro

sopalgia , otalgia , and other varieties of pain arising from dental cariesare to be found in Chapter XXXIII . In all these cases the removal ofthe decayed tooth or teeth procured the p rompt ces sation of pain . Amongothers worthy of note is a case of violent otalgia caused by thedecay of a lower molar, which , however, was itself not painfu l . Thiscircumstance drew Fauchard himself into error, cau sing him to believethat the otalgia was independent of the decayed tooth ; he thereforemere ly stopped the tooth to p revent the caries from extending farther .The pain in the "

ear continued,however

,and the patient therefore

.

consulted a doctor of the Facu lty of Paris , Coutier, who told her that thedecayed tooth might '

be the cau se 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 p romptly and completely ?

In another case a patient twenty—seven years of age was tormentedby violent pain in all her teeth on the left side , in the temple and theear, a s well a s in the chin , the palate, and the throat . The doctors andsurgeons consu lted decided the cau se to be rheumatism . The p atientwas bled not less than four times and subjected to variou s other methodsof treatment (purgatives , clysters , pou ltices , but all in vain . She ,however

,perceiving that one of her teeth wa s decayed , had it taken out .

It was believed that the cau se of the malady had thu s b een found andremoved ; but an hour later the pain began again with the same violencea s before

,continu ing for some months ; after thi s it cea sed of itself.

On the return of the pain , l ater on , in all its former intensity, the patientconsu lted the very able surgeon Petit

,who advised her to se e Fauchard ,

as poss ibly the malady might have its cause and point of departure insome bad tooth . Fauchard found one of the inferior molars decayed .

This being extracted,the pain promptly ceased

,not to return any more .

3

Chapter XXXV contain s twelve cases of seriou s maladies arisingfrom dental diseases . One of these cases was observed in a patientaged fifty- seven years

, who in con sequence of caries of the last inferiormolar on the right lost through necrosis a considerable portion of thelower j aw

,including the whole of the right condyle ; he was affected ,

1 Page 397. 2 Page 4 1 1 .

3 Page 418.


besides,with carie s of the temporal bone , in so advanced a degree that

the probe cou ld reach the dura mater ; he was , therefore , in seriou sdanger of his l ife , had to undergo several surgical operations of exceptionalgravity

,and even after recovery remained permanently subject to variou s

d isturbances , such as a salivary fistul a , paralysis of the lower eyelid , etc .

And all this becau se the surgeons whom the patient had called in haddirected all their attention to the secondary facts , in stead of suppress ingthe primary cause of the evil , represented by a dental affection .

A case observed by the surgeon Juton and communicated by him tothe author is also a very important one . The patient was suffering witha large abscess on the right side of the lower j aw, accompanied by suchgreat swelling of the cheek that it wa s impossible to open the mouth wideenough to examine the teeth . Juton proposed opening the absces simmediately, but the patient wou ld not consent . The following dayhe was sent for in great haste . The gathering had changed its seat ,making its way between the skin and mu scles of the neck , where it nowformed so huge a tumefaction that the patient was in danger of beingsuflocate d . The abscess was now immediately opened

,but the swelling

of the face still persisted ; it was therefore only after a month had elapsedthat it wa s possible to extract the root of the last molar, which. had beenthe original cau se of the whole malady . The surgeon ob served that theliqu id inj ected into the fistu lous open ing in the neck issued from thealveolu s of the last molar . After the extraction of the root a promptrecovery was effected ?

The second volume of Fauchard ’s work is entirely devoted to operativedentistry and prosthesis .Before speaking of the modes of cleaning, fil ing

,and stopping the

teeth , the author combats the opin ion maintained by some , that theseoperation s are in part useless , in part also dangerou s , a s having the effectof loosen ing the teeth , of depriving them Of their enamel

,and ru in ing

them .

Fauchard then describes the in struments proper for detaching thetartar ; 2 he speaks of the method to be followed in cleaning the teeth inorder to not endanger the enamel ; 3 he speaks of the d ifferent kind s ofdental files , of their different u ses in relation to the variou s cases andindications ; of the precautions to be taken in making use of them ; ‘1 ofthe in struments to be u sed for scraping and cleaning the cariou s cavitie sand of the mode of employing them .

5

All of the above—named instruments are illu strated by figures,in con

tem plating which one cannot but reflect on the inferiority of the instruments then in u se as compared with those of the present day . The greater

1 Chap . xxxvii i,p . 481 .

2 Vol . i i,chap . i i . 3 Chap . i i i . 4 Chap . iv.

5 Chap . v .


dentists who, as the saying goes , content them and cozen them by u singleaf tin or lead colored yellow,

and making them pay for it as goldstopping !

FIG . 80

Som e of the denta l file s used by Fauchard . The l i tt le square figure repre sents a sm a l lgrooved we dge de stined to be inse rted in large inte rdenta l space s , in orde r to give m ore

firm ne ss to the te eth to be fi led .

The leaf metals were introduced and comp ressed into the cariou scavities by means of three kinds of pluggers , which wou ld nowadaysbe considered altogether insuffi cient and unfit for the purpose, but whichthen , nevertheless , served to produce excellent Stoppings . The authorspeaks 1 of a lead stopping which had lasted in perfect condition for fortyyears .

1 Vol . i i,p . 7 1 .


Before stopping the tooth the cavity was scraped and its openingwidened

,if neces sary, but no special was given to the cavity itself,

as i s done at the present d ay .

FIG . 8 1

Instrum ents for scraping the c arious cavi tie s (Fauchard)

As at that time the state of the dental pu lp was not taken into con sideration before stopping a tooth

,it often occurred that the stopp ing caused

violent pain,which rendered its removal neces sary ?

Fauchard says that “ if the sensib il ity of the carious cavity be too great ,the lead ought only to be pres sed in very lightly at first

,then after one or

1 Vol . i i , p . 77 .


two days a little more , continu ing thu s until it is p roperly compre ssedand fitted in

,always provided , of cou rse , that the pain does not increase .

The sensitive parts of the tooth become thu s more easily u sed to the pressure of the lead , and the pain i s in this manner avoided or moderated .

” 1

F IG . 82

Thre e instrum ents for plugging te eth. The two sm a l l figure s repre sent s i lve r plate sfor stra ightening te e th (Fauchard).

The author also makes the remark2 th at sometimes,in scrap ing a cariou s

cavity, “ it i s not possible to avoid uncovering and touching the nervewith the instruments ; one becomes aware of thi s by the pain cau sed , andbetter Still by a little blood issu ing from the dental vessel s .” In such

1 Vol . i i,p . 78 .

2 Ibid .


may eventually be found in the cariou s cavity . After the cauterizationone scrapes the cavity and fills it up with cotton - wool soaked in oil ofcinnamon . Later on one stops the tooth .

FIG . 84

An extracting instrum ent ca l le d by Fauchard leve r or tirtoire,and

’

the hand le of ap e l ican without the hooks .

The chapter in which Fauchard treats of the correction of dentalirregularities is of particu lar interest . In speaking of his observations ,we have already seen that in this field also he knew how to obtain splendidand admirable results . He , nevertheles s , made use of the most simple

1 Vol . i i , p . 80 .

TH E EIGH TEENTH CEN TURY 1

means— the file , pressure with the fingers , common threads or silk ones,l ittle plates of silver or gold . At times , for straightening teeth , he madeuse of the pelican and the straight pincers , afterward tying the teeth in

FIG . 85 FIG . 86

Fauchard’

s sim ple pe li can (with Fauchard’

s doubl e pe l i can .

one change able hook).

their normal position . He rarely had recou rse to extraction a s a meansof carrying out dental corrections ?To steady loose teeth

,

2 Fauchard , as did the ancients , made use of gold1 Vol . i i , chap . vi i i

,p . 87 .

2 Chap . ix, p . 1 1 7 .

-292 TH IRD PERIOD—MODERN TIMES

threads . When the spaces separating a loose tooth from the neighboringones were too large

,he introduced small p ieces of hippopotamu s ivory into

them of about the height of a line , and not exceeding the tooth itself inthicknes s ; on each side of these was a vertical groove destined to serveas a support to the next tooth . Each of these pieces was furn ished

Dental forcep s (Fauchard).

with two holes , through which were passed the gold threads which servedto b ind together the teeth and the piece of ivory it self. This latter wa s

fixed close down to the gum .

Fauchard occupies himself in three different chapters (X,XI, XII)

at great length with the extraction of teeth . He describes a pelican of


a wrong tooth is extracted by acc ident,it ought to be imm ediately

replanted , and the same ought to be done when violent pain renders itnecessary to extract a tooth that is not much decayed

,as the patient is

thu s relieved without losing the tooth ? Fauchard adds that this operation succeeds excellently in the case of incisors and canines

,and very

often,too

,with small molars .

FIG . 89 FIG. 90

Cutting forcep s (Fauchard). Cutt ing forcep s (Fauchard).I

After having spoken of tran splantation , he says 2 “There i s anothermode of replacing human or natural teeth which I have never yet seenUsed except by a provincial dentist whose name I

'

ignore .

” This specialmethod consists in the transplantationof a tooth— it matters l ittle whetherrecently extracted or not— after having made three or four notches in

1 Page 188.

2Vol . 11, p . 192 .

TH E EIGHTEENTH CENTURY 295

its root of about a line in depth . The author goes on to describ e all theparticu larities of the operation , and then adds :

“After twenty- five orthirty days one removes the thread , and the tooth i s found to be firm inthe alveolus

,owing to the fact that thi s latter, exercis ing a pressure on the

FIG. 9 1

Pince rs used by Fauchard in the ope rat ion of tying te eth with gold wire . The thre e

large r figure s repre sent natural or artific ia l te eth in whi ch hole s and hori zonta l groove shave be en m ade in orde r to fix them with gold thre ad s . The two sm a l le r repre sentpie ce s of hippopotam us ivory with a ve rti ca l groove on e ach side

,d e stined to fil l large

inte rdenta l space s and to ste ady loose te eth by m e ans of gold l igature s .

root on every side,becomes perfectly mou lded upon it . In this manner,

the tooth will remain mortised , and may be preserved for a considerab letime .

”

This method,invented by an unknown provincial dentist

,has been

recently applied by Z nam enski, of Moscow,for the implantation of arti

fic ial teeth made of porcela in , of caoutchouc , or gutta - percha .


One of Fauchard ’

s greatest merits consists in the improvements introduc ed by him in dental p rosthesi s and in his having, besides , been thefirst to treat of thi s most important part of dental art in a clear andparticularized manner .The material s then most u sed in dental prosthesis were human teeth ,hippopotamu s tu sks , ivory of the best qu ality, and ox—bone .

1

The author minutely describes the methods to be followed to repairdental losses in every possible case and of whatever extent .

According to the circumstances , Fauchard u sed , for maintaining artific ial teeth in their place , l inen , silk, or gold thread , passed through holesmade in them

,and tied to the natural teeth .

When a set of two , three , fou r, or more teeth was to be applied,Fauchard

first prepared them separately and then united them together by means ofone or two thread s of gold or silver in such a manner that the se t formedat la st a single piece

,which was then fixed to the natu ral teeth . When the

piece consisted of several teeth it wa s reinforced with a small plate ofgold or silver fixed to its in side by means of small tacks of the same metalriveted on one side to the plate

,on the other to the front part of each tooth .

The author remarks that a similar prosthetic p iece lasted longer thanthose previou sly described

,but requ i red p roportionately much more work

and much greater expense . He adds that,by employing thi s p late , one

can even dispen se with threading and fixing the teeth together with goldor silver wire ; but that it was then necessary to make a horizontal groovat the b ack of each tooth corresponding to‘ the width and thicknes s of theplate

,which cou ld be fitted into the serial groove and fixed to each single

tooth by means of two small rivets ?At other times the prosthesis was carried out in a single piece of material(ivory, hippopotamu s tu sk, etc .) that was carved in such a manner as tosub stitute exactly the teeth wanting, it being fixed to the natural teethin the u su al 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 n atural

tooth , one files away the part of the root that emerges above the gum ,and

even more if possib le . One then removes,with proper in struments

,all

that is decayed in the root itself; after which one stops the root canal withlead and fits the base of the artificial tooth to the root in such a mannerthat they correspond perfectly to each other . One drill s one or two holesin the tooth through which to pass the ends of a thread , which servesto fasten it to the natu ral teeth on each side of it , as described above .

1 Vol . i i,chap . xi i i

,p . 2 1 5 .

2 Vol . i i,pp . 2 1 7 to 224 .


existence,every possib le point of attachment wa s wanting, and it would

therefore be as difficu lt to do this as it wou ld be to bu ild in the air .” 1 He,however

,directed the lady to Fauchard , who asked for a few days to think

the matter over,and succeeded in devis ing a means of applying an

FIG. 92

Com ple te denture s (Fauchard). f. 3 re pre sents an enam e l le d d enture with art ificia lgum s ; f. 4 and f. 5, ste e l springs .

upper set of teeth , which , in fact, entirely satisfied the wishes and wantsof the cl ient . “As this l ady, says the author, “ simply wished to have thefront of her mouth decorated , and to be able to pronounce more perfectly,

1 Vol . i i,chap . xxiv, p . 339.

TH E EIGH TEEN TH CEN TURY 299

I gave les s exten sion to the'

s et . The lady eats eas ily with it and couldnot now do without it . For greater convenience she has two similarsets

,which she u ses alternately .

” 1

The author describes with great minutenes s the manner in which theprosthetic apparatu s in question was constructed and supported

,and then

FIG. 93

An Uppe r denture supported by Springs fixe d to a gold appliance whi ch em brace s thenatura l te e th of the lowe r jaw (Faucha rd).

speaks of the success ive improvements introduced by him into thi s mostimportant part of prosthetic dentistry , particu larly in what regards thesprings destined for the support of the upper se t of teeth .

Fauchard also relates having made an attempt to apply an upper se tof teeth without the aid of springs , which proved successful in three cases .“One can ,” s ays he , “adopt an entire set of teeth to the upper j aw, of

1 Vol . i i,p . 340 .


much greater s implicity than those described , and which is maintained inits place by the sole support of the cheeks and the lower teeth . It mustb e very light indeed and serves almost solely to improve the appearanceand the pronunciation ; but when the individual gets used to it, he can alsomasticate with it . A set of teeth of this kind ought to adhere well to the

FIG. 94

A spring denture for a case in whi ch the lowe r front te e th sti l l exi st. Figs . 1 to 6,

various parts of the apparatus (Fauchard).

gums and to be constructed in such a manner that the cheeks may affordit suffi cient pressure and support together with the aid of the lower teeth ;these latter sometimes bring it b ack into its place

,without anyone per

c e iving the movement except the wearer himself. Not long since I hadto renovate a set of teeth of this kind made by me more than twenty


attended with great danger . He demonstrated the ab surdity of thelatter idea by putting in evidence the anatomical fact that

'

the uppercanines are innervated by the infraorb ital nerve , which does not stand inany relation whatever to the organ of sight ?Among the other remedies recommended by him again st the disordersand perils of first dentition , there is one most cu riou s , not to s ay ridicu lou she advises rubbing the nape of the neck , the shou lders , the b ack, and thelower l imbs of the child , but in doing thi s the friction shou ld procee dfrom above downward , in order to offer resi stance to the flow of humorstoward the upper parts of the body . The util ity and effi cacy of thi s kindof massage in favoring the process of dentition seems , of a truth , veryopen to question .

Bunon speaks at lengt h of eros ion of the te eth, and declares himself tobe the discoverer of thi s disease , which destroys the enamel of the teethalready before their eruption . The first molars

,the canines, and the

incisors are much more frequently damaged and affected by it than theother teeth . According to Bunon

,it is generally due to measles , smallpox ,

malignant fevers,or scurvy

,when children are subject to these maladie s

during dentition,and more especially du ring 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 distingu i shes three princip al kinds of dental tartar, .theb lack, the p ale yellow,

and the brownish yellow ; he admits , however,two other kinds that are les s frequent

,that i s

,the red tartar and the green .

He relates having observed in the jaw of a child , who died at the ageof three years and a half

,a splintering of the alveolar p arietes in all

directions , and attributes this phenomena to disproportion between thesize of the teeth and the alveoli . On the basis of his anatomical ob servation s , he says that caries only appears on teeth that have already come outof the gums , whilst erosion is produced in teeth not yet erupted , indeed ,at times , several years previou s to their eruption .

We will al so mention,by way of a curiosity, Bunon

’

s proposal to substitute the word legs for that of dental roots .2FR . A . GERAULDY

,a French dentist

,wrote ( 1 73 7) an excellent treatise

on dental maladies and on the mode of preserving the teeth . His book,

which wa s also tran slated into German,

3 contributed to the diffusion ofknowledge relative to dental prophylaxis and therapeutics

,but apart from

this brought no increment to the progress of practical dentistry . Some

1 M . Bunon , Sur un prejugé tres- pe rnic ieux, conce rnant le s m aux d e de nts qui sur

viennent aux fem m e s gros se s,Pari s

,1 74 1 .

2 M. Bunon, E ssa i sur le s m a lad ie s d e s dents,Pari s, 1743 . Expérience s et dem onstra

tions pour se rvir de su ite e t de preuve s a l ’ e ssa i sur le s m a lad ie s d e s d ents , Pari s, 1 746 .

3 Abhand lung von Zahnkrankhe iten,e tc .

, Strassburg, 1 754.


of the ideas of the author, however , merit con sideration . He clearlyexpresses the opinion that the shedding of the milk teeth is brought aboutby the pressure exerci sed upon them by the germs of the permanent teethin course of development . The loss of the teeth in young subjects , or inthose who have not yet reached forty years of age , i s explained by theauthor in an altogether special manner . He relates that Lou is XIV,

atthe age of thirty- five , had lost all his upper teeth , and the consideration she ma kes on the subject bring him to the conclu sion that the precociou sloss of the upper teeth depends in many cases on a paralysis of the nervou sfibers that go to them

,which paralysis is prob ably cau sed by -

a dissoluteand intemperate life

,having as its con sequence the weakening of the organ

ism and,above all

, of the nervou s system . Without doubt there i s sometruth in Ge rauldy

’

s ideas , it being well known that the fall ing of the teeth(as well as of the nails and the hair) often depends on nutritive disordersderiving from nervous d isturb ances . We have the clear proof of thi s incertain cases of tabes dorsali s accompanied by the spontaneou s fall ingof the teeth and nails .JO S EPH HURLOCK

,an Englishman

,publi shed a treatise in in

which he warmly recommends lancing the gums in cases of d iffi cu ltdentition ; he de clares thi s to be entirely without - danger, and afli rm s thatit con stitutes the sole means of s alvation for not a few infants whowithoutit wou ld d ie of convu l s ions .MOUTON

,in 1 746 , that i s , in the same year in which the second edition

of Fauchard ’ s work was i s sued , gave to the l ight a monograph , thefirst extant , on mechanical dentistry ? The methods of thi s author forthe m ost part do not differ from those of Fauchard , nevertheles s onefinds several important innovation s in his work . To prevent the furtherdeterioration 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 u sed this for the front teeth as well a s for themolars , but in the former case he had them enamelled to give them thesame appearance as natural teeth .

Mouton also invented a new method of applying artificial teeth . Up tothen the ordinary method had been that of fixing them to the natu ralteeth by means of threads passed through holes made in the artificial teethexpressly for that purpose . Mouton is the first to speak of artificialteeth fixed to the natural teeth adjoining

.

them by means of sp ringsor clasps .This author relates havm g carried out several tran splantations withperfect succes s

,a thing that contributed greatly to his renown not only

in France,but also in England . He distingu i shed himself

,besides

,by the

A Practica l Tre ati se upon Dentition or the Breed ing of the Te eth in Chi ld ren .

2 E ssa i d ’

Odontote chnique , ou D i sse rtation sur le s Dents Artificie lle s .


correction of dental irregu larities . Lastly, it is to be noted that th isauthor frequently had recou rse , as a remedy against toothache , to thestretching -of the dental nerve by means of moving and partially raisingthe tooth (subluxation).

A . WE STPHAL . In proof of the great utility of l ancing the gums incases of difficu lt dentition , A .Westphal reports a case in which the difficu ltruption of an upper canine tooth provoked cons iderable inflammationand protrusion of the eye on the same side as the tooth ; these symptomspromptly disappeared

,however

,as soon as the gum wa s

~lanc ed down tothe tooth itself ?

J . B ERTIN also declares himself in favor of this operation ; he re com

mends never to neglect it in cases of diffi cu lt dentition , and to make thesaid incision s deep and wide enough ?

L . H . RUNGE , a surgeon of Bremen , publi shed , in 1 750 ,a monograph on

the disea ses of the frontal and maxillary sinu ses . He says t hat in casesof inflammation of Highmore ’s antrum ,

the pus may make its way, corrod ing the bone

,as far as the alveoli , or, sometimes , as far a s the orb ital

cavity ; and , v ice v ers a , alveolar suppu ration can give rise , by diffusion ,to ab scess of the maxill ary sinu s . In this latter

,tumors of variou s kinds

may form (polypi , cysts , sarcomas , cancers , exostosis), the exi stence ofwhich is ignored at first

,and only becomes manifest tardily . Runge ’ s

father,who wa s also a surgeon

,had occasion to ob serve , and to treat

an important case of disease of the maxillary sinu s , with considerabledil atation of the same

,not only On the sideof the cheek , but al so on the

side of the palate and of the nasal fossa . With a strong scalpel he perforated the outer wall of the antrum above the molars (keep ing the cheekdetached) and enlarged the apertu re by making the in strument tu rnaround on its own axis , thu s giving exit to a considerab le quantity of nonpurulent liqu id . Deters ive and aromatic inje ctions we re u sed for sometime . The canine tooth

,s ituated oblique ly,

'

having been extracted , itsalveolu s was found to communicate with the antrum . From this moment ,the inj ections be ing continued , a rapid improvement was obtained and thepatient 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 i s induced to believe that in thecase related above the disorder wa s also to be attributed to a large cysthaving its origin in the root of the can ine .

According to him , the ozena always stands in relation to a suppurativeaffection of the maxillary sinu s

,and for its treatment one mu st, therefore ,

have recourse to Drake ’ s operations ?

1 Sprenge l,Part i i

,p, 3 19 .

2 Journa l d e Méde c ine , 1 756 .

3 L . H. Runge . De Morbis sinuum ossis fronti s, m axil la supe riori s

,e tc .

,Rinte l

,1 750 .


second time between the seventh and thirteenth years . He also citesfrom the anatomical tables of Kulm us the followm g epitaph in low Latin ,that seems to allude to a case of third dentition :

“De canus in Kirchbe rg, sine dente canns

,ut anus

Inte rum dente scit, te r juvene sc1t, hic requie sc it .

In cases of hemorrhage ensu ing on the extraction of teeth , the besthemos-tatic

,according to Pfaff , i s essence of turpentine , a remedy which

in these cases he had always found efficient . He introduced a l ittle b allof l int b athed in this essence as deeply as possib le into the alveolu s , applying upon it some blotting paper reduced to pu lp or some dry lint that thepatient compressed tightly by clos ing his teeth .

Gingival ab sces ses as well as fi stu la of the maxillary region almostalways owe their origin , s ays Pfaff, to decayed teeth , and can , therefore ,in general

,not be cu red except by the extraction of these teeth .

The prosthetic methods described by this author are,for the most p art ,

identical with those of Fauchard and the other French dentists alreadymentioned . As to the material s u sed for prosthesis at d ifferent period s ,Pfaff mentions , besides ivory, bone , hippopotamu s tu sk, teeth of sea cow,

and human teeth , also teeth made of silver, of mother of pearl , andeven of copper enamelled .

The chief merit one mu st concede to_

Philip Pfaff is that of having beenthe first to make use of plaster models . It i s , the re fore , '

to two German s— Pfaff and Purm ann , the latter who , as we have already seen , u sed wax

models - that one of the gre ate st‘

progre ssive movements in.

dental prosthesis i s indebted , that i s , the method of taking casts and making models ,of which m ethod

'

one finds no trace whatever in the authors of antiqu ity ,and which

,it wou ld appear, was not known even to Fauchard himself.

The wax casts of an entire jaw were taken by Pfaff in two pieces , one of theright half of -the j aw, and the other of the left ; which were

—

then reunited,

and one thu s avoided spoiling the cast in removing it from the mouth .

Another great merit of Philip Pfaff is that of having first carried outthe capping of an exposed dental pu lp

,previous to stopping a tooth .

Notwithstanding this , Pfaff is not the first who, as Geist—Jacob i i sincl ined to believe , 1 had da red to app ly a filling ov er an expos ed denta l

pu lp withou tfirs t cau teriz ing it. As we have already seen,Fauchard did

not hesitate in the least to fill a tooth when the dental pulp had becomeexposed in scraping the cariou s cavity . But the French dentist carriedout , with much delicacy, a .

,sim ple fill ing

,whilst Pfaff first capped the

dental nerve .

JACOB CHRI STIAN SCHAFFER . In 1 757 the evangel ical p astor, J . Ch .

Schaffer (we do not know if he was at the same time a denti st, or merely an

1 Ge i st- Jacobi,p . 164.

THE EIGHTEEN TH CENTURY 307

amateu r in odontology), wrote a little book1 to d isprove the existenceof worms in decayed teeth , and to show the fallacy of bel ieving that the

1 Die e inge bi lde ten wurm e r in Zahnen,Regenburg, 1 757 .

[Schaffe r’

s publi cation is of consid e rable inte re st in that his i l lustration he re reprod uc ed exhi bits one of the device s som ewhat gene ra l ly em ployed for the e rad ic ation of

d enta l worm s a s a cure for toothache . In the title of his work Schaffe r de scri be s him se lfas Prote stant pre ache r at Regen sburg , m em be r of the Roya l Soc iety of Fine Art s at

Gottingen,of the Roya l Soc iety of Sc ience at Duisbe rg, honorary m em be r of the Fine

Arts at Le ips ic .

The seve ra l detai ls of the plate are de signate d as fol lows

Fig. I. The suppose d worm s,with single and double tai l s

,or actua l ly se ed bud s of

the henbane driven out by he at , natura l size .

Fig . II. K idney- shape d se ed of the henbane , natura l si ze , without se ed bud s .

Fig . III. Anothe r such se e d,natura l si ze

,with the pith be ing driven out in bow

shape .

Figs . IV and V. S l ight ly m agnifie d supposed entrai l s of the tooth worm s,actual ly the

inne r basi s sub stance for the deve lopm ent of the se e d lobe s .

Fig . VI. Portion of the skin and driven out suppose d entra i ls of the tooth worm s,

strongly m agnifie d : (aa) skin sti l l attached ; (b) suppose d entra i l s .

Fig. VII . Se e d sam e as Fig . II,m agnifie d : (a) exte rna l pe l l ic le ; (b) se ed bud .

Fig. VIII. Se ed of Fig . III,m agn ified : (aa) exte rna l pe l li c le ; (b) node ; (c) se ed

bud driven out in bow- shape .

F igs . IX,X

,and XI. Thre e kind s of supposed tooth worm s

,m agnifie d ; the lette ring

corre spond s in a ll thre e : (a) he ad ; (b) brown spot or m outh ; (c) body ; (d) apparentOpen ing or anus ; (cc) single or dou ble ta i l ; (fl) brown spot of the tai l ; al so an apparentopen ing.

Fig . XII. Repre sentation of the utens i l s and the m ode in which they are arrangedduring the application of the supposed rem edy aga in st tooth worm s : (a) e arthen pot ;

(b) opening vi si b le on one side ; (c) op ening in the bottom ; (dd) iron passing throughthe two side openings , on which the wax ba l ls (containing henbane se ed s) are la id in sidethe pot ; (e) sm oke ari sing through the open ing in the top , which is d ire cted into the

m outh ; (fl ) bowl of water in which the pot is set,into which the supposed worm s fal l

and in which they are found afte r the cure .

It wou ld se em not at all im probable that the inha lation of vapors arising from he ated

henbane se e ds m ight in som e case s , e . g .,ofodontalgia from pu l piti s , produce a sedative effe ct

by the ac tion of the hyoscyam ine given off. Assum ing that the m ethod posse sse d even a

sl ight the rape ut ic va lue,that factor in conne ction with the apparently tangib le evidence

of the exi stence of tooth worm s which it afford ed to the ignorant,m ake s the m ethod a

m ost inte re sting exam ple of the way in which supe rstition and ignorance about m ed ica lm atte rs are kept a l ive and susta ined bV a ve ry s light increm ent of truth.

Anothe r inte re sting re fe rence to the use of henbane se ed s for the cure of toothache byfum igat ion as found in an old Saxon m anuscript of the ninth or tenth century

,a tran sla

tion of which is publi shed in Le e chdom s ,Worthcunning , and Starcraft of Early England ,vol . 11

,p . 5 1 , a col le ction of doc um ents i l lu strating the history of sc ience in England

be fore the Norm an conque st,publ i shed unde r d ire ction of the Maste r of the Rol ls .

The re fe rence is as fol lows :

For tooth wark,if a

'

worm e at the tooth, take an old hol ly le af and one of the lowe r

um be ls of hartwort and the upward p art of sage , boi l two dole s (that is , two of worts toone of wate r) in wate r, pour into a bowl and yawn ove r it

,then the worm s shal l fal l into

308 TH IRD. PERIOD—MODERN TIME S

I.supposed worms may be made to drop out by means of fumigation s of

’

henbane seeds . His book appeared , as a matter of fact, rather behind

the bowl . If a worm e at the te eth,take hol ly rind ove r a ye ar old , and root of Carl ine

thi stle , boi l in so, hot water ! Hold in the m outh as hot as thou hotte st m ay. For tooth

worm s,ta ke acorn

'

m e alIand ' henbane seed and wax, of all j e qually m uch

,m ingle thes e

toge the r , work into a wax cand le and burn it,le t it re ek into the

i

m outh, put a black

c loth unde r, then wi l l the worm s fall ’ on —E . C. K.]


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 towardthe space left by the extracted tooth , until it occupies its place exac tly .

He also counsel s the extraction of the first premolar on the opposite sideof the j aw,

in order to preserve the perfect symmetry of the dental arch onboth sides . When the arch formed by the j aws is too large and of an uglyappearance

,Bourdet advises extracting the first upper and lower premolars ,

so that the maxillary arches may acqu i re a more regu lar form . In casesin which the defect of form exists only in the lower j aw, that is , in childrenwho have protruding chins , Bourdet corrects thi s deformity by extractingthe first lower molars shortly after their eruption , that i s , toward sevenyears of age . In this manner , says the author, the lower j aw grows smallerand the deformity disappears . The inventor of this method , as Bourdethimself tells us

,was the dentist Capu ron .

Bourdet made prosthetic p ieces , whose base , representing the gums andthe alveol i

,was made entirely of gold and covered over with flesh - colored

enamel on the outside,so as to s imu late the natural appearance of the

gums ; the teeth were adju sted into the artificial alveoli and fixed withsmall pins . At other times he made u se of a single piece of hippopotamustu sk, in which he carved not only the base, but also the three back teethon each side , whilst the ten front teeth were human teeth fixed to the b asewith rivets .One of Bourdet’ s princ ipal men ts i s that of having brought artificialp lates to perfection by fixing them not

,as heretofore

,to the opening of the

palate or in side the nose,but by means of lateral Clasps fitted to the teeth .

In a special pamphlet,published in Bourdet treats of the diseases

of Highmore ’ s antrum . To facil itate the exit of pathological_humors

from the sinu s , after the Cowper operation , he introduced a small cannu la ,forked at one end , into the antrum and fixed the two branches of the forkto the neighboring teeth by tying .

In some diseases of the maxillary sinu s (polypu s , sarcoma , etc .) Bourdetrecommends cauterizing .

Besides his principal work,the pamphlet on the diseases of Highmore ’ s

antrum ,and . som e others of les s importance

,Bourdet wrote an excellent

book on dental hygiene , 2 l

which had the honor of two translations,one

German , the other Italian ; the latter published in Venice in 1 773 .

This celebrated author inveighs b itterly against Charlatans and quackdentists , and throws light on all their impostures . It appears

,however

that in the m id st'

of thi s despicable class, so ju stly condemned by him

,

1 Sur le s de'

p6ts du sinus m axil la ire .

2 Soins fac i le s pour la p roprieté d e la bouche e t pour la conse rvation de s dents,Pari s

,1 759 .

THE EIGH TEEN TH CEN TURY 3 11

there existed a courageou s though unscientific operator, to whom posteritywould have attributed due honor had his name been handed down

,

for he was the first , in all probab il ity , to try the implanting of teeth inartificial alveoli . This is , at least , what we deduce from a passage in oneof Bourdet ’ s works , in which we read that a charlatan sought to imposeon the public the belief that he cou ld make a hole in the j awbone andplant therein an expressly prepared artificial tooth

,which in a brief space

of time would become perfectly firm and as u sefu l as a natural one .

Bourdet adds that an attentive investigation led to the recognition of thesaid tooth being simply that of a sheep . It would appear, therefore , thatthe operation had been in reality performed , it matters but l ittle whetherwith 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 - denti st li ke Fauchard and Bourdet , Jourdainwas a general surgeon who had dedicated himself with particu lar predilection to the study and treatment of oral and maxillary d iseases . Andprecisely for this reason his writings , although of great scientific Importance

,are far from possess ing for dental art, properly so- called , the same

value as the works of Fauchard , Bou rdet, and other great denti sts of theeighteenth century . His works , as Geist- Jacob i justly ob serves , give usthe impress ion of his having been a theori st rather than a practical dentist .In 1 759 Jourdain described in the j ourna l de Me

'

de cine 1 an improvedpelican and another in strument to be u sed for straightening teeth inclinedinward . Two years later he published his treatise on the diseases ofHighmore ’ s antrum and on fractures and caries of the maxill ary bone ?

After thi s,appeared his book on the formation of the teeth ? He therein

describes with great accu racy the dental follicle from its first appearingto the moment of birth

,following it throughout its evolution . This lengt hy

book i s most interesting, for it i s not a mere compilation , but gives the

resu lts of personal research and experience . But by far the most important of all the works of thi s author is his treati se on the disea ses andsurgical operation s of the mouth .

4 This book went through severalFrench edition s , was tran slated into German in 1 784, and has had , besides ,two English editions in America of comparatively recent date , that i s ,at Baltimore in 1849, and at Philadelphia in 185 1 ; all of which proves

1 Vol . x,pp . 47 to 148.

2 Tra ité de s dép6ts dans le sinus m axilla ire,d e s fracture s e t d e s c arie s d e l ’une et d e l ’autre

m achoire,Paris

,1 76 1 .

3 E ssa is sur la form ation de s d ents, com parée ave c ce l le d e s 0 3 , suivi s d e plusie urs experieme e s tant sur le s os que sur le s partie s qui entrent dans leur constitution ,

Pari s,1 766 .

4 Traité de s m alad ie s e t de s opérations rée l lem ent chirurgica le s de la bouche e t d e s partie squi y corre spondent, suivi de note s

, d’

obse rvations , e t de consu ltations inte re ssante s , tantanc ienne s que m ode rne s , 2 vols . 8vo

,Paris, 1 7 78 .

3 12 TH IRD PERIOD '—MODERN TIMES

the great value of the work ; it treats , however, much more of generalsurgery of the mouth and neighboring regions than of dental art properlyso called . The first volume of 626 pages i s almost entirely dedicated tothe diseases of the maxillary sinu s , which , for this author , were ever theobject of favorite and particu l ar study . He is not in favor of carrying outi rrigation of the antrum through the mouth , even when an alveolar opening has resu lted spontaneou sly through the extraction of a decayed tooth ;he prefers in stead , whenever this is possible , the reopen ing of the nasalorifice

,by means of sounds and cannu la adapted for the purpose , that is ,

varying in thickness and in length , and curved according to the necessitie sof the case . The natural open ing of the antrum being re éstablishe d ,

one irrigates the cavity through it by mean s of a cannu l a to which a smallsyringe ha s been screwed . When the teeth are sound , notwithstandingthe diseased condition of the antrum , Jourdain i s absolutely contrary tothe 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,c arrie s iout the deters ive and medicated injections through

the natural opening .

The author divides the collections of the maxillary sinu s into pu ru lent andlymphatic . The pu ru lent are p ainfu l and corrode the bone , the lymphaticare not painfu l and do not corrode the bone , but distend and soften it ,producing external tumefaction which yield s to pressure , and , on this beingdiminished , gave out a characteri stic sound . These so- called lymphaticgatherings referred to by Jou rdain are none other than mucou s cystsof the maxillary sinu s . Also the other d isea ses of Highmore ’ s antrum(polypi , etc .) are taken by this author into attentive and minute con sideration .

The second part of the work is dedicated to the Other diseases of themaxillary bones (especially of the inferior one), as well as to those of thelip s , cheeks , salivary ducts , gums , frenum lingua ,

etc .

'Dental hem orrhage and difficu lt dentition are also spoken of in thi s volume .

The author relates,with regard to the latter subject , that he had

observed , in corpses of infants who had succumbed to a diffi cu lt dentition , that the crowns of the erupting teeth were covered by the alveolarmargin s folded upon them . This , according to him ,

mu st be the reason whyeven lancing of the gums proves u seless in some cases of difficu lt dentition ;it i s therefore necessary, whenever it i s possible to recognize the existenceof this state of things , to destroy the bony margins that oppose the eruptingof the teeth ; the author declares that he has frequently done thi s, withfortunate resu lts .In 1784 Jourdain published a treatise on artificial dentures ? He1 Réflexions e t éc la irc is sem ents sur la con struction e t le s u sage s de s rate lie rs com ple ts e t

artificie ls .


some time,and their alveoli are in consequence obliterated , it will be

better to have recourse to Lam orie r’ s method . This method may besidesbe u sefu l , according to Bordenave , either when all the teeth are sound andit wou ld consequently be a pity to sacrifice any of them , or in special cases(such as large polypi of Highmore

’ s antrum , extraneou s bodies , etc .)in which the Cowper- Drake operation wou ld not afford sufficient space .

L . B . LENTIN , a German , in 1 756 , published a pamphlet1 in which herecommended electric ity as a means of cure for toothache . Other writersrecommended the u se of the magnet, which means of cure had alreadybeen advised for variou s affection s by Patac e lus . During the latter h alfof the seventeenth century, Talbot , J . J .We cke s , and P . Borell i rel atedseveral cu res of headache and toothache by the use of the magnet . In

the eighteenth centu ry F . W . Klae rich, a medical man in GOttingen ,

wrote that he had u sed the magnet advantageou sly in not les s than 130

cases of toothache ? We find it recommended later by others , Brunner,and particu larly J . G . Teske

, who, in 1 765 , wrote a pamphlet entitledN ew exp er im ents for the cur ing of tootha che by m e ans of m agnetic

s tee l .3

He considers the u se of the magnet as the most efficaciou s of all remediesagainst toothache

,and believes its action to be similar to that of electric ity .

In the following year, however, the belief in the new means of curewas sensib ly shaken by F . E . Glaubrecht

, who declared that althoughthe magnet calms or cau ses the cessation of the pain at first, it returnsconstantly and with much greater violence .

1 The cu ring efficacy of themagnet in cases of toothache was highly vaunted in France by Condamine .

5

PASCH attributes the effects of the magnet to the chill produced in theparts to which it i s applied ; in proof of thi s he adduces the fact that if themagnet becomes heated by being kept some time in the hand

,it loses its

effi cacy altogether, whilst on the other side one may obtain the verysame beneficial resu lts with a simple steel spatula , just on account of theaction of the cold ; finally , he adds that the chill produced by the magneton the affected part explain s very well not only the good

, but also thebad effects which it produces in many cases

,such as increase of the pain

inflammation , tumefaction , and even at times sp asmodic contractions .Thenceforth the enthu siasm for the magnetic cure diminished gradually

,

all the more so inasmuch as that shortly after the celebrated English

1 Von de rWirkung d e r e lektri schen E rschiitte rung im Zahnweh.

2 Ge i st- Jacobi,p . 165 .

3 Neue Ve rsuche z u Curirung de r Zahnschm e rzen ve rm itte l st e ine s m agnet i schen Stahle s ,Konigsbe rg

,1 765 .

4F . E . Glaubre cht

,De odonta lgia

,Argentorati,

3 Journal d e Méde c ine , 1 767 , p . 265 .

3

Jos . G . Pa sch, Abhund lung aus d e r Wandarz ne i von d en Z '

ahnen ,e tc . , Wien ,

1 767 .

THE E IGH TEEN TH CEN TURY 3 15

dentist Thomas Be rdm ore ridicu led it by placing it in the same class ascharms

,exorcisms

,and other foolish and superstitiou s means of cu re .

1

ADAM ANTON BRUNNER . One of the most distingu ished Germandentists in the second half of the eighteenth century was Adam AntonBrunner . His two princip al works are the I ntrodu ction to the s cien ce

ne cess a ry for a dentis t? and the Trea tis e on the erup tion of the m il le te eth?

This author fall s into variou s errors with regard to deciduou s teeth .

According to him they are twenty- four in number, and without roots ;but these may develop in those milk teeth which in exceptional casesremain in their places after the period in which they generally are shed .

A milk tooth,says Brunner, ought never to be extracted unles s there

be manifest signs of the p resence of the corresponding permanent tooth ,or when it is painful and decayed . Badly grown teeth can often be putin order solely by the pressure of the fingers frequently repeated , but whenthis i s not suffi cient , one mu st h ave recourse to waxed threadsor to specialcontrivances .In applying a pivot tooth , he screws the p ivot to the artificial crownand perforates the root canal only ju st sufficiently to admit the otherextremity

,which he drives in by little strokes of a hammer upon the

crown,without its being necessary to use cement . We learn from thi s

author that in his time there were turners and other craftsmen whooccupied themselves with dental p rosthesis ?Brunner prefers gold for fillings to any other sub stance whatever .J . G . PASCH , whose name we have already mentioned , relates thecase of a young maidservant becoming suddenly affected with deafness ,and who recovered her hearing completely on the eruption of one of herwisdom teeth . From a passage of thi s author ’ s we learn that at thattime many had recourse to the cru shing of the infraorbital nerve a s acure for certain cases of toothache . He , however, decidedly rejectssuch a remedy, as it proves for the most part ineffectual and may, besides ,produce very seriou s con sequences . This author carried out manyexperiments as to the effects of acid s on the teeth .

5

C . A . GRABNER6 recommends not deceiving children by extractingtheir teeth unexpectedly

,but rather to persu ade them of the necessity of

the operation ; for by deceiving them one loses their confidence , and inmany cases inspire s them with an invincible aversion to the dentist .This author invented a so- called “ calendar of dentition ,” for the

1 Th. Be rdm ore , A tre ati se on the d isorde rs and de form itie s of the te e th and gum s,London ,

1 768.

2 E in le itung z ur nothigen Wissenschaft e ine s Zahnarzte s , Wien ,1 766 .

3 Abhand lung von d e r He rvorbre chlung de rMilchz'

ahne,Wien,

1 7 7 1 .

‘1 J . Linde re r, vol . i i , p . 43 1 .3 Ge i st- Jacobi , p . 166 .

3 Gedanken iibe r das He rvorkom m en und We chse ln de r Zahne , 1 768.


purpose of showing at a glance the period of eruption of each of thedeciduous and permanent

.teeth

,and as well for noting down the time

at which the variou s teeth are changed , so as to avoid every possibleerror in this respect . This calendar consists of a figu re or diagramrepresenting the two dental arches

,with transversal l ines that separate

the different teeth one from the other, the relative indication s being alsogiven .

The observations of this -most sen sib le and conscientiou s dentist withregard to the extraction of teeth are worthy of note : “ The haphazardpu ll ing out of a tooth is an easy enough thing ; the only requ i s ites for doingthis 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 , whateverbe the circumstances of the case , no disgrace may accrue to the operato ror damage to the patient

,requ ires serious knowledge , ab il ity, and pru

dence ? ’

RUE FF relates the case of a man,aged forty years

, who, having madeuse of fum igations of henbane seeds to relieve h imself of violent toothache , obtained the desired end , but at the s ame time lost his viri le power .He , however, reacqu ired his force by the care of the author ?THOMAS B ERDMORE was the

,dentist of George III of England , and one

of the first and most eminent representatives of the dental art in th atcountry . .Before him ,

no one had had the appointment of dentist to theroyal family . In the year 1 768 he publ ished an excellent work on

‘ dentistry? that was translated into variou s languages and went through manyeditions ; the last of these appeared in Baltimore in the year 1844, that is ,seventy- six years after the first English edition— a sp lend id proof of theworth and fame of this work .

Be rdm ore contributed to the progress of denti stry in England not onlyby his writings , but also by imparting theoretical and practical in structionto many medical students desirous of practi sing dental art as a specialty ?

One of these wa s ROB ERT WOOFF E NDALE , who went to America in theyear 1 766 , and was the first dentist whose name is there recorded .

Be rdm ore 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 partis an of dental grafting

,l ike hi s

contemporary, the celeb rated surgeon Hunter , he , nevertheless , sometimeshad 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 definitelyinserting a gold fill ing, Be rdm ore considers it a good practice to try the

1 Carabe l li,p . 9 1 .

2A tre ati se on the d i sorde rs and d eform itie s of the te e th and gum s,London

,1 768 .

3 Se e The Ri se,Fal l

,and Reviva l of Denta l Prosthe si s

,by B . J . Cigrand , p . 148.


FRERE C6ME , a celebrated French surgeon , _also contributed to the

perfecting of this in strument ?In 1 77 1

-7 2 , Fr . L . Weyland and Henkel recorded some very important cases of diseases of Highmore ’ s antrum ?

W . BROMFIELD,in a collection of su rgical ob servation s and cases pub

lished in London in the year 1 773 , also speaks of affection s of the maxill arysinu s . He says that he has had opportunity of persu ading himself thatthe puru lent gatherings of this cavity not unfrequently discharge spontaneou sly during the night , finding their exit through the

3natu

ralorifice

of the antrum ,when the body 1S in the horizontal position ?

JOHN HUNTER, the celeb rated surgeon , must be named among themost illu striou s champion s of odontology in England .

’ He was bornFebruary 13 , 1728 . His first in structor in medical studies was his brother ,William Hunter, a scientist of great merit, whose school of anatomy inLondon was attended by 'num e rou s students from all parts of the BritishKingdom . Under so excellent a gu ide John Hunter made rap id p rogress ,and in less than twenty years became the most famou s physiologist andprofessor of surgery of that day . He was surgeon - general to the Englisharmy .

His N a tu ra l H is tory of the H um an Te eth (London , 1 77 1) and hisP ra ctica l Trea tis e on the D is ea s es of the Teeth - (London , 1 778) in itiatedin England a new epoch for the dental art , which , abandoning its blindempiric ism , began to take its stand on the basis of rigorous scientificob servation .

But although Hunter ’ s merits were great with respect to the scientificdevelopment of odontology

, we mu st remember that he was a generalsurgeon

,and not a dentist , and that precisely for th is reason he had not,

neither “cou ld he have , other than a restricted personal experience relativeto the treatment of dental disea ses . This explain s why the anatomicaland physiological part of Hunter ’ s works on the teeth is so far superiorto the part concern ing practical treatment .Indeed , in the field of practice , thi s author often falls into grave con

tradic tion s , and is frequently hesitating and uncertain on important pointsof dental therapeutics .Hunter gives a very long and detailed description of all the p arts con

stituting the oral cavity and the mastic atory apparatu s . He sought toestablish a scientific nomenclature for the teeth

,and in fact the denomina

tion s of cu sp ida ti for the canine teeth and of bicu sp ids or bicusp idatifor the small molars originated with him . Hunter says that the enamelof the teeth is a fibrou s structure

,and that its fibers depart from the body

1 Sprenge l,vol . i i

,p . 348 .

2 Sprenge l,p . 350 .

3 Brom fie ld , Chirurgica l ob se rvations and case s,London,

1 773 .

THE EIGH TEEN TH CEN TURY 3 19

of the tooth like rays . He believes it to be entirely inorganic , a s it i sab solutely impossib le to convert it into animal mucus . The tooth i sconstituted for the most part by a long mass (it i s thu s he calls the dentine),which is

,however

,much harder and denser than any other bone . This

part of the tooth is formed of concentric lamella , and is vascu lar , as isproved by the exostosis of the roots and the adhesions th at exist at timesbetween the roots and the alveoli . Hunter gives a good description ofthe pulp cavity and of the pu lp itself. He studied odontogeny with greatcare , as is demonstrated by his special researches on this point . Headmits the existence of distinct germs for the enamel and for the dentine .

According to him the incisors are formed from three points of oss ification,

the canines from one,and the molars from three or four . The tooth after

its eruption is an extraneou s body with respect to a circulation throughits substance

,but they have most certainly a living principle by which

means they make part of the body , and are capable of uniting with anypart of a living body .

” The milk teeth,s ays Hunter, are not shed by a

mechanical action of the second teeth,but by an organizing law ofNature .

The physiology of the masticatory apparatu s is treated by Hunter withgreat accuracy and most extensively . This author combats , by manyarguments , the opinion that the teeth grow continually ; he exp lain s theapparent lengthening of those teeth whose antagonists are wanting, by thetendency of the a lveoli to fill up ,which, however, is not possib le in normalcondition s , becau se of the constant pressu re exercised upon the teeth bytheir antagonists .Caries , says Hunter, i s a disease of altogether obscure origin ; it is not

owing to extern al irritation or to chemical processes,and seems to be a

morb id form altogether pecu l iar to the teeth . Only in very rare casesdoes it attack the roots of the teeth . It rarely appears after fifty years ofage . Hunter does not admit that this d isease may b e communicated byone tooth to another . As to its treatment

,the caries

,if superficial , may

be completely removed by fil ing the decayed part of the tooth before thed isease penetrates to the cavity

,and its sp reading will thu s 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

exten sive as to render it useles s,Hunter believed the best mode of treat

ment to be extraction and replanting of the tooth after having subjectedit to boil ing in order to clean se it perfectly and to destroy its vital ity entirely,this being, according to him , the mode of preventing the further destructionof 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 fa r a s the apex of the root ; which , however, i snot always possible . This is a very important point

,for no one before

Hunter had yet affi rmed the necess ity of entirely destroying the diseased


pulp as an indispensable condition of the succes s of the fill ing to be latercarried out in order to conserve the tooth .

Hunter is extremely concise when speaking of the fill ing of teeth ;considering the great importance of this argument, his concisenesscan 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 cuneiformvariety or of other kinds , did not escape the attention of this acute ob server ,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 largemolar .Periodontiti s i s class ified by the author among the diseases of ~ the

alveolar process . He occupies himselfwith this affection at great lengt h ,seeking to explain the mode in which it i s p roduced . He distingu i shestwo forms of the disease , according to whether or not there be exit ofpus from the alveolus . The alveolar process is , in his op in ion , theprincipal seat of the disease , to which

“

, as a complication , is added the re traction of the gii m s . For the diseased alveolu s the tooth b ecomes

,in a

certain manner, an extraneou s body, of which it tends to rid itself. Thealveolar margins undergo ab sorption ; the bottom of the alveolus tends tofill up ,

analogously to what occurs after extraction,and the falling out of

the tooth ensues as a natural consequence of this process . An altogetherS imilar process , producing the falling out of the teeth

, is the normalconsequence of senility .

The author considers that-

the malady in question has as its point ofdepartu re an irritation caused by a tooth ; and a s almost a proof of thishe relates a case in which the extraction of the affected tooth

,an upper

incisor which became too long, and the transplantation of another toothcaused the cessation of the morb id process and the

”

perfect consolid ation of the transplanted tooth . However, Hunter does not draw fromthis i solated case the conclu sion that tran splantation may be elevatedto a method of cure for this malady . Indeed , he says that, so far as isknown to h im , there i s no means of prevention or of cure for it . Histreatment , therefore , i s merely directed to the cu ring, in so far a s is

possib le , the phlogistic symptoms , by sc arific ations of the gum and by theuse of astringent remedies . He does not exclude the possib ility of a comp lete recovery, but the mode in which this obtains seems to him as ob scureas is the nature of the disease itself.In speaking of the correction of dental irregularities

,Hunter advise s

nm to extract the milk teeth unless this be -

an absolute necess ity . Hesays , besides , that it i s u seless to extract any“ tooth whatever

,unless one

endeavors at the same time to force the irregu lar tooth or teeth into their


himself averse to the practice of subluxation as a means of cure for toothache

,a method which

,first recommended by the Arab physic ian Avicenna

,

and later,in the sixteenth century

,by Peter Fore e st, had fallen into

oblivion for a long time , and was again brought into cred it by two celebrate d French dentists , Mouton and Bourdet, the latter of whom relateshaving had recourse to it successfu lly in not less than six hundredcases .Notwithstanding the high authority of th is illu striou s dentist, Buckingdoes not consider this method of cure advisable , adducing , however ,in support of his opinion , arguments of no great value , viz .

, that teethafter subluxation continue painfu l for a certain time , and that they alwaysremain in an oblique position . The method in question , which has theeffect of breaking the dental nerve , i s , in our opinion , practically .equ ivalentto a replantation , or is , in point of fact, a replantation , when the luxationof the tooth is complete . The arguments that B ii cking brings forwardagainst it are futile ; the first objection , for the most part, does not subsist ,and , in any case , the pers istence of pain for a short time wou ld be of smallimportance compared with the great advantage of preserving the tooth ; asto the second , it i s to be understood of itself th at subluxation performedby means of the pelican (the instrument then u sed for the operation)would cau se the tooth to assume an oblique position ; but even supposingit did not straighten up of itself, there

“could not have been any diffi cultyfor the good dentists of that period in forcing the tooth again into normalposition and in maintaining it there . The weak side of the operationconsisted rather in the fact of its being prob ably carried out without dueconsideration of the dangers resu lting from the possible alterations of thedental pu lp .

At the time of which we are writing many believed that the enamel ofthe teeth cou ld 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 . Thu s , for exam ple , the renownedsurgeon Theden expressly recommended such powders , as the best adaptedfor cleaning the teeth and for freeing them from tartar ?VANWY ? the Dutch surgeon

,in 1 784 , related two cases of regeneration

of the maxillary bones ; other cases of the same kind were related someyears later by Percy and Boulet .3CHOPART and DE SAULT recommended

,in cases of d ifli cu lt dentition ,

the excis ion of the gum in correspondence with the teeth that are to comeout, rather than simple incisions ?

1 Theden, Ne ue Bem e rkungen und E rfahrungen

,Be rl in

,1 782 , part se cond , p . 254.

2 J . van Wy, He e lkundige Menge l stoffen,Am ste rdam ,

1 784.

3 Journal de Méde c ine,1 79 1 , tom e s 86, 87 .

‘1 Sprenge l,p . 356 to 357 .

324 TH IRD PE RIOD—MODERN TIME S

B ENJAMIN B ELL , the Engl ish .su rgeon , a contemporary of Hunter,also devoted much attention to d iseases of the teeth , and , if it may beargued from the clear and precise manner in which he expresses hi sopinions on variou s questions relating to dental pathology and therapyit would seem that he had much greater experience in this field thanc elebrated Hunter .

FIG. 97

Pe l i cans for extracting Wi sdom te eth (Cam pani).

With regard to incision of the gums , in cases of difficult dentition , thisa uthor contradicts certain assertions of the German surgeon Isenflam m

who argued that when the tooth is already to be perceived throughthe gum ,

the incis ions are altogether u seless ,While ifi

the tooth be still atsome depth , the gingival inc ision will soon close

“again , so that the cicatrix


will render the eruption of the tooth still more diffi cu lt . Bell admits , too ,that lancing the gum is altoge the r superfluou s when the tooth has p iercedthe ti ssue , all the more so that the acc idents provoked by the e rup

tion are then generally already passed and gone,but the operation ought ,

in his opinion,to take place much earlier ; and shou ld the wound close

again before the tooth has erupted , the gum mu st be lanced a second time .

FIG . 98

Cam pani ’ s forcep s : The first for m olar te e th when loose or afte r having be en shakenwi th the pe l i can ; the se cond for de c iduous te e th.

Bell contradicts the op in ion of Jou rdain and Hunter that the morb idgatherings ofHighmore ’ s antrum are generally consequent upon the clos ingof the normal opening of the cavity in the middle meatu s . In manycases of disease of the maxillary sinu s thi s orifice remain s open

,the

liqu id 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 wou ld have it , Bell advises openingthe cavity by Lam orie r’ s , or, better stil l, by Drake ’ s method . Except inspecial cases , the first or second molar ought to be extracted , but preferably the second . After trepanning the alveolu s and emptying the cavity,

FIG . 99

Two key instrum ents w ith change able hooks (Cam pani).

the Open ing shou ld be closed with a con ically shaped peg to preventits sl ipp ing into the cavity . From time to time the liqu id th at tends toreaccumu l ate. shou ld b e allowed ex1t, and deters ive inj ections shou ld bein ade , preferably of l ime water .


rather than to external cau ses acting locally, although these latter maycontribute , together with the general cau ses , to the producm g of thedi sease .

FIG . 1 0 1

Cam an i ’ s d enta l caute rie s : The lar e one s for case s Of ost - extrac tive hem orrha e:

theP g P

sm a l l one s for the caute ri zat ion of cariou s c avit1e s .

This author was decidedly averse to the u se of the file . For stopp ingcariou s cavities he advises the use of mastic , gum l ac , or wax , if the cavityis large and funnel - shaped ; thi s stopping, however, requ ires to be renewedfrequently . But when the cavity

,wider at the bottom

,narrows toward


teeth,entitled S ur les av antages des nouv elles dents , et r a tel iers a rtificie ls ,

incorruptibles , s ans odeur .

J EAN JACQUE S JO S EPH S ERRE ( 1 759 to Among the dentists ofthe end of the eighteenth century and the beginning of the nineteenth ,a special mention is due to Jean Jacques Joseph Serre . He was born atMons

,in Belgium

,but his remarkable practical and scientific activity

was chiefly called into exerci se in Vienna and in Berlin . He publ ishedseveral works

,the most important of which is a practical treatise on

dental operation s . 1Among his minor works

,one edited in Vienna , in 1 788, treats of tooth

ache during pregnancy ; another, printed in Leip sic in 1 79 1 , treats mostexten sively of diseases of the gums ; a third speaks of the mode of maintaining the teeth and gums in good condition . This little book of dentalhygiene

,l ike the rest of Serre ’ s books , met with great favor , and went

through two edition s in a b rief space of time (Berl in , 1809 toThe works of this author show great study , very wide practice , and anadmirab le sp irit of ob servation and research . They had the merit ofgreatly contributing to raise the level of dental culture in Germany , andone finds in them a pretty nearly complete account of the dentistry ofthat period . Apart from this , they possess a special interest becau se ofthe vast number of dates and im portant historical facts therein contained .

As it would be u seless here to enter into a minute analysis of the contentsof these books , we will l imit ourselves to mentioning a few ideas of whichSerre was a strenuou s supporter .He combats an old prejudice that had recently been reinforced by theauthority of Jourdain , that is , that it does harm to extract a tooth whenthe soft parts around it are inflamed and swollen . He likewise combatsthe prejudice , also of very ancient date , that teeth ought not to be extractedduring pregnancy . Only , he considers it as well to avoid the cauterizationof the dental pu lp in cases of gestation . In extracting teeth

,the forceps

ought only to be u sed after the tooth has been luxated by means of thepelican . Serre highly approves of this in strument , although he recogniz e s it to be a dangerou s one in the hands of those who do not knowhow to make a proper use of it . This author invented or perfected variou sextracting instruments , among which a conical screw for extraction of

roots hollowed out by caries deserves particu l ar mention,and which

,

under a somewhat modified form,i s still . in u se .

One of the most interesting chapters of Serre ’ s great work is the onein which he treats of affections of Highmore ’ s cavity ? He speaks atlength of the anatomy of the maxill ary sinu s

, of its rel ation to the teeth

1 Prakti sche Darste lling a l le r Ope rationen de r Z ahnarz ne ikunst, Be rl in ,1803 and 1804 .

2 Chapte r xli i .


u sual toothp ick , even if he had tried to do So regardless of pain . But

when the toothache was over, the same toothpick again became serviceab le as before . He says that there is no cau se for wonder that in odontiti s no redness of the teeth i s to be perceived , for in other inflam m ations

as well,redness is wanting

,and , moreover , it exists in the interior mem

brane of the.

tooth . As in other inflam m ations, so also in odontiti s , the

u sual is sue i s resolution . Dental fistu la may derive from_internal sup ;

put ation . The impurities deposited on the teeth are by him supposedto be owing

_to an increase of their secretion ! According to the author ,caries

,the breaking down of teeth apparently healthy, as well as their fall

ing out,i s generally cau sed 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 GERB I ? In a book by th is author we find recommended avery singu lar cure for toothache , even of the most violent nature . It

is in no way scientific , and is bes ides not p articu larly pleasant, notwithstanding that the author

,professor at the University of Pisa

,wa s a

scientist of merit , enjoying special esteem as a mathematician and

cu ltivator of natural sciences .Under the name of curcu lio anti- odonta lgicu s he describes an in sectliving habitually inside the flowers of the carduus sp inos is s im us

,that

could be u sed with great advantage against toothache , in the followingmanner : One crushes fourteen or fifteen larva of the insect between thethumb and forefinger, and then rub s the two fingers together until thematter remaining upon them is entirely ab sorbed . Instead of the larva(which , as is known , represent the first stage of insect l ife) one may alsouse the fu lly developed in sects . One then applies the two fingers thathave cru shed the insects or their larva '

upon the . decayed and achingtooth . If the pain is of a nature to be cured by this means , it d imini shesalmost in stantaneou sly

,and ceases altogether in a few minutes . It i s

said that the fingers p reserve their healing power for a great length oftime

,even a whole year

,and in p roof of these assertions Ranieri Gerb i

speaks of no less th an six hundred cu res performed ! Other insectsbesides the cu rcu lio anti- odonta lgicu s , u sed in the sam e manner, are saidto possess the same curative properties

,among them the curcu l io ja cece ,

carabu s chrysocepha lus , and the curcu lio B a cchu s , which last , s ays Gerbi ,has long been u sed for thi s purpose by the pe a sants of Tu scany . Theauthor also says that some German doctors and naturali sts experimentedwith succes s with several insects indigenou s to Germany as remediesagainst toothache . These in sects

,also mentioned in a work published in

Bayreuth in 1 796 , author unknown,are :2 the cocc inella s eptem pun cta ta ,

1 Storia natura le di un nuovo in se tto,Firenze

,1 794.

2 De r aufrichtige Lahnarz t .

THE EIGHTEEN TH CEN TURY 3 33

the coccinella bipuncta ta , the ca rabu s ferrugineus , the chrysom ela s angu ino

l enta,the chrysom e la popu l i , the cantharis or Spanish fly

,and Others .

Later on,Hirsch also extolled the heal ing power of another in sect , the

cyn ip s ros a rum . With regard to the mode of application , Gerb i saysthat instead of cru shing and rubbing these in sects or their larva betweenthe fingers

,one can u se a piece ofwash leathet in a similar manner .

It i s to be observed , however, that the insects that are found generallyin the ripe wild teasle—or more preci sely their larva — had already beenu sed for a long time as a remedy again st toothache ; indeed , we even findthese means of cure recommended in the natural history of Pliny . In abook entitled H is toire d ’un voyage aux tles Ma lou ines fa it en 1 763 et

1 764, by a certain Dom Pe rne tty, thi s author speaks of some remediesmade known to him by the Superior of the Franciscan friars of Monte;video ; and among others one finds the following : “

One draws out theworm that is generally found in the head of the fu ller’ s teasle when th is i sripe . One rolls th is worm between the index finger and the thumb , l ightlyp res sing it until it d ies of l anguor . The one or the other of the two fingersapplied on the aching tooth will have the virtue, for a year at least , ofmaking the toothache cease .

” 1

HE INRICH CALLI S EN ,in an excellent treatise on surgery2 published at

Copenhagen in 1 788, writes at sufficient length and with great accuracyon dental and maxill ary diseases . According to this writer

,it rarely

sufli c e s to trepan one alveolu s for the treatment of the morb id collection sof Highmore ’ s antrum

,as the maxill ary sinu s i s very often d ivided by

part itions into variou s cells, so that in order to give exit to the pu s

contained in each of them,it i s necessary to extrac t several teeth and

trepan their alveoli . 3 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 shou ld a large opening be

necessary becau se of the nature of the disease in the cavity , it will b e betterto follow Lam orie r’ s method

,that i s

,to inci se the gum crosswise under

the malar proces s and then,after scraping away the periosteum ,

trepanthe bone . Fu rther

,in the case of the disease in the maxillary sinu s

h aving given rise to tumefaction,softening of the bone , and flu ctuation

in the palatine region,it i s precisely there that the perforation ought to

be carried out . To prevent the reclos ing of the opening before thecure is completed

,the author advises the u se of pledgets , small bougies ,

a piece of prepared sponge,or even a small tube

,According to Ca llisen ,

1 Without com m ent ! 2 Princ i pia system ati s chiru rgia hod ie rna .

3 The anatom ica l fact a l luded to by the author,far from pre sen ting itse lf ve ry ofte n

,

a s he says, is of rare occurrence,and c annot be he ld in ac count for e stabli shing a ge ne ra l

Ope rative rule .


the injections through the nasal orifice of the maxill ary sinus are partlyimpracticable

,and partly of no util ity .

It always does more harm than good to file or to scrape the decayedpart of a tooth , without stopp ing it afterward , as by thu s doing, says theauthor

,one only renders it still more liable to the acces s and the action of

harmfu l external influences . In preparing the cavity for stopping, thebottom of it shou ld be more ample than its external aperture, that thefilling may remain firm .

For extracting molars , he makes u se either of the pelican or of thekey ; for the incisors and the canines , of the forceps ; and for roots,of 'thegoat’ s foot .Callisen treats incip ient idiopa thic epu l is by destroying - it through

Cauterization,after having covered the teeth with wax ; if the epu l i s

be large and more or less hard , he removes it with the b istoury ; as tosym ptom atic epul i s , he holds the removal of the original c ause to be thebest mode of treatment .This author declares himself decidedly in favor _

of,replantation and

transplantation , expressing the idea that these methods are always to bepreferred to the application of artificial teeth . He maintains that after atooth has been replanted , and its consolid ation has taken place , there isno possibility of any further p ain , the nerve being broken . The authorrelates a brilliant cure which he carried out upon a lieutenant, who,du ring the siege of Copenhagen

,had rec eived a blow that had sent

all his front teeth into his mouth : Callisen immediately put them all

back in their places with such ab ility that they became perfectly firmagain . With reference to transplantation

,he only believes in its being

possib le for teeth with a single root .In works published toward 1 790 , Lentin and .Conradi , devoted their

particu lar attention to the morbid conditions that produce loosenes s andspontaneou s falling of the teeth . For the treatment of these condition sConradi recommended general and local remedies . The general remedieswere directed to the suppress ing of acridness in the b lood

,which he con

sid e red to be an etiological element of primary importance . As to thelocal remedies , they ought specially to consist in keeping the teeth cleanby the u se of a toothbru sh , in painting the gums with tinctu re of catechuand myrrh , and in rin s ing the mouth frequently with a decoction of

cinchona or of willow bark . Against toothache cau sed by caries , he particu larly advises essence of cloves , introduced into the cariou s cavity ona p iece of cotton - wool ?FRIEDRICH H IRSCH was much less d isposed than were many of the

preceding writers to incision of the gums in cases of difli cult dentition.

1 Sprenge l, pp 3 72 , 3 73


above fifty years of age , the transplanted teeth donot take root perfectlyexcept in an average of one case in three . For carrying out thi s operationhe never made u se of teeth. extracted from the mouth of a’ l iving person ,but

,on the contrary

,he u sed the teeth “

of young and healthy subj ects

FIG . 102

Fu l l lowe r set in hippopotam u s ivory, with hum an front te eth ; sevente enth century .

(From Gue rini’

s col le ction .)

FIG . 1 03

Uppe r denture in ivory , at the end of the e ighte enth century, for a c ase in whi ch the

l a st m ol ars and the front te e th we re pre sent . (From Gue rini’

s

who had died a violent .death ; these were , besides, careful ly cleanedbefore transplanting them

,and in this way the author believed the tran s

mission of disease to be nearly impossib le .

1

E11} E . WICHMANN combated energetically the practice,then pretty

general , of - endeavoring to facilitate the eruption of the teeth by

1 Hirsch,Prakti sche Bem e rkungen ube r die Zahne und e inige Krankhe iten derse l ben ,

Jena,1 796 .

TH E EIGH TEEN TH CENTURY

incision of the gums . He considered this practice as one to be absolutelyrejected

,supporting his opinion on the consideration that dentition ,

being an altogether physiological p rocess,which

,moreover, takes place

in parts relatively of but l ittle importance , never can give rise of itselfalone to seriou s accidents . Besides this , he says , it i s very d ifficu lt tosay which tooth precisely i s about to erupt and at what point . Theincis ion s would

,therefore , have to be made by chance , which wou ld often

render the morb id cond ition still more seriou s .K . A . BLUMENTHAL endeavored to confute Wichm ann

’

s opinions ,with but l ittle success ; for, indeed , the same opin ions , expressed laterby J . H . Sternberg in a more detailed manner and with ampler viewsof the subject

,met with ever- increasing approval . Thenceforth , the

practice of gingival incision s in cases of d ifficult dentition fell moreand more into discred it . 1ROB ERT BUNON

,

2 the French dentist,i s one of the most illus triou s per

sonalitie s to be met with in the history of our profession . He was bornat 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 thismanner he learned pretty much all thatwas known at that time by dentistsin general . He then decided to travel

,in order to acqu i re further knowl

edge and experience . He practi sed especially in the north of France andin what is now the state of Belgium ; at Antwerp , Brus sels , Givet , Mau

beuge , Cambrai . In his ardent thirst for knowledge , when he happenedto pas s through a town where some dentist of note resided , he neverneglected to call on him

,thus acqu iring fresh information and per

fe c ting himself as well in the practical exerci se of his profession . Atthe s ame time

,his desire to learn all that was new concerning dental art

and science was so intense that he had transl ation s made of the medicaland surgical works of Latin

, Italian , German , and English authors .However, all thi s reading, although it enlarged his general knowledge ,taught him noth ing, or almost nothing, about those subjects that interestedhim above all the others . His practical experiences , meanwhile , broughta great number of patients to h is notice

,and

,being by nature a very

acute ob server, he was ab le to estab lish the existence of many facts upto then unknown . At this time he commenced his studies on dentalerosion , on the development of the teeth , and on the prophylaxis of dentalmaladies , his favorite subject . “

I felt,” he writes , “ that the necessityof having recou rse day by day to the extraction of teeth resulted from

Sprenge l, pp 3 76, 3 7 7

2 For a ll that regard s Bunon’

s l ife and writings we have avai led ourse lve s of the exce l lenthi storic a l work of A. Barden,

“Um précurseur : Bunon,” a com m unication pre sented to the

Geneva Se ssion of the Inte rnationa l Denta l Fede ration (August,2 2


deficient knowledge on our part, and I considered this extreme remedyas one of the greatest evils to hum anityf

’ 1 He therefore endeavoredto extend his own knowledge in every possib le way, and as one means ofdoing this he vis ited hospitals and schools ; and , ardent champion as hewas of conservative dentistry and of prophylaxis , he succeeded in interesting medical men and surgeons , midwives and schoolmasters , and parishpriests as well

,in the question of the preservation of the teeth . The teeth

he extracted he kept for the purpose of studying the conformation , thelesion s

,the dental anomalies ; sometimes he split them up to examine

the dental pu lp . And he never neglected an opportunity of procu ringanatomical p ieces that appeared interesting to him .

In 1 728 Fauchard’ s book , Le Chirurgien D entis te , appeared . The

fame of this work reached Belgium , where Bunon then wa s , and heimmediately set about trying to get a copy of it . After searching in varioustowns

,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 highe st '

praise . It

wou ld seem ,however

,that he did not learn much that wa s new to him by

reading this book,which proves that he already possessed a vast odonto

logical cu lture and was also profoundly versed in techn ical dentistry,

which forms the most important p art of Fauchard ’ s book . He was

somewhat astonished at finding in th is celebrated author’ s work hardlyanything on the subjects that princip ally interested him

,that i s

, the erosion , the development of the teeth , and the prophylaxis of caries . Thiscircumstance very clearly reveals the different mental tendencies in thesetwo great men , the one , drawn toward the practical side of the professionwhich principally interests him and forms the b asis of his work

,the other

an impassioned searcher into cau ses , and' student of prophylaxis .

After the peru sal of Fauchard ’ s book , Bunon , who had already conc e ive d the idea of publish ing the resu lt s of his ob servations and of hisown particu l ar studies , felt more than ever the propriety and necessity ofdoing so; and to realize his idea , he establi shed himself toward the year1 735 at Paris . Two years later, ju st when the manu script of h is workwa s almost finished , Ge rau ldy

’

s book appeared . Bunon relates that heopened thi s book in fear and trembling ; it s title , The a rt of pres erv ingthe te eth

, gave him reason to fear that Ge rauldy might have profited bysome of the ideas and ob servation s he had communicated to variou spersons , to write a book similar to the one that he himself had it in hi smind to pub lish .

2 He was able , fortunately, to convince himself im m edi

ately that his fears of being forestalled and plagiarized were unfounded .

Notwithstanding, Bunon was determined not to publish his book unti lthe opportune moment and with all possib le probab ility of success . With

1 Experience s e t dem onstrations, p . 1 3 .

2 Ibid . ,p . 60 .


The goal was now reached,and Bunon , on the strength of such

illustriou s patronage , published his book in March of 1 743 , under thetitle

,E s s ay on the m a ladie s of the tee th, where in are sugges ted the m e an s

of obta in ing the ir good conform a tion from the e a rlies t age , and of as s uringthe ir pres erv ation during the whole cours e of l ife .

1

All the principal jou rnals of the time (j ourna l des S av ants , j ourna lde Tre

'

voux , j ou rna l de Verdun , Mercure de F rance , etc .)“ published

extracts from the book and eulogized the author, who had even the highsatisfaction of receiving an honorable mention from the Royal Academyof Surgery

,in the public sitting held in 1 743 .

Bunon , therefore , was now famou s , and had , besides , gained wealthyclients

,as we see from the peru sal of his ob servations , where the best

names in France are to be met with, put in evidence by him without the

least thought of professional secrecy . He cou ld now enjoy his wellmerited successes , in accordance with the thought expressed by him inone of his books : “All those who l abor for the progres s of an art havelegitimate right to the honor and to all the recompenses to which successi s entitled .

”2

The study of Bunon ’

s work proves , in fact, that he had good right to beproud of having written it . The mere peru sal of it , however, does notsuffice to enable the reader to judge of its merits , for to do this properly,it i s necessary to study at the same time his other book

,publi shed in

1 746 , entitled E xp eriences and dem ons tra tions m ade at the H osp ita l ofS a lp

’

e triere and a t S t. com e, before the Roya l d cadem y of S urgery, s erv ing

a s continu ation and proof to the E s s ay on the m a ladies of the teeth..

3 Theessay is , in fact, a small 12mo book of 2 12 pages , written in a conci sestyle , and , strange to say, most concise in the most important points .Many facts of great moment are given under the form of rapid indica

tion s , or of assertions without proof; thu s their importance i s apt to p as scompletely unob served by those whodo not take the trouble of studyingthis work thoroughly and with the help of the explanation s , il lu strations ,and comments contained in the second book we have referred to .

M . A . Barden , of the Ecole Odontote chnique of Paris , was the firstto undertake a seriou s and con scientiou s study of Bunon ’

s works . Byso doing he has thrown fu ll l ight on the author ’ s great merits

,and

brought forward the high scientific importance of his works .

1 E ssa i sur le s m alad ie s d e s dents, oii l’

on propose le s m oyens d e leur procure r une bonneconform ation dés la plus tendre enfance

,et d

’

en assure r la conse rvat ion pendant tout lecour de la vie .

2 Experience s et dem onstrations, ave rti ssem ent,p . xix .

3 Expérience s et dem onstrations fa ite s a l ’Hopital de la Salpterie re e t a St . Com e,en

1’

A Rpre sence de cadem i e oyale de Chi rurgi e , pour se rvxr de su ite et de preuve s a l E ssa i surle s m aladie s de s dents.

THE EIGH TEENTH CEN TURY 341

One of the important question s studied by Bunon concern s the hygieneto be ob served in order to obtain the development of a good dentition . On

this question he rightly establishes the principle that hygiene and dentalp rophylaxis shou ld begin from the period of the formation of the milkteeth . He works out this princ iple with rigorou s logic , and finishesby tracing the hygiene of the mother during pregnancy , of the woman(be she mother or nurse) during the nu rsing period , and of the nu rsl ingas well .As to the accidents of first dentition , Bunon sets forth a highly scientificop in ion

, fu lly coinciding with the ideas of modern writers , that is , thatdentition is not the sole cau se , nor even the princip al cau se , of suchaccidents

, but simply a cooperating cau se . He made the ob servationthat in healthy infants , children of healthy parents and nursed by healthywomen , the time of teething IS gotten over without difficu lty

,while

seriou s accidents occu r frequently in weak and sickly children not b roughtup an d nourished according to hygien ic princip les , or born , a s not oftenhappens

,with spec i al hereditary p red ispositions .

On e of Bunon’

s merits i s that of having attributed to the first teeth allthe importance they really have

,and of having insisted on the necessity

of attentively curing their maladies . He also drew attention to thedangers that may resu lt from the eventu al persistence of the first teeth atthe epoch of the second dentition , or from the persistence of their rootsafter the destruction of the crown by caries . These roots

,he says

,by

their contact with the neighboring permanent teeth may infect them,

i nd cau se them to decay .

Bunon’

s researches into the development of the teeth enabled him todescribe p recisely the position that the variou s teeth of the second dentition occupy in the j aw with regard to the milk teeth

,before these are

shed .

Bunon was,besides

,the first authorwho studied accu rately dental hypo

plas ia , and it is greatly to his honor that his ideas and ob servation s aboutthis p athological condition have been accepted and confirmed in substanceby the greater part of the au thors who have come after him

,having

remarkable worth even at' the present day . According to him

,this con

genital defect of the teeth i s owing to infantile m a ladie s,such as hereditary

syphili s , infantile scurvy, malignant fevers , smallpox , or measles ; theharmfu l effects of these maladies , however , are limited to the teeth inprogres s of development, and have no influence on those that have alreadycome forth . Erosion , as this defect was termed by B unon , sometimesaffects the first teeth , but i s to be found much more frequently in thesecond or permanent oines . 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 m ost rarely affected .


Bunon studied with great accuracy the means of preventing anomalou spositions of the permanent teeth , owing, according to him ,

almost alwaysto want of sp ace . In certain cases he advises the extraction of the milktooth in order to facilitate the eruption of the permanent one , and , necessityurging, he does not hesitate to sacrifice one of the permanent teeth toprocure the advantage of a normal position of the others . With regardto this subject , the 'following passage is worthy of note , for in it we finds ketched out the theory of preventive extraction as a means of facil itatingthe eruption of the wisdom tooth : “

It is better to have the teeth incomp lete as to number than to have the ordinary number b adly arranged ;for the mouth will appear none the less

’

well furn ished becau se of havingone or two teeth the less ; the other teeth will be commodiou sly distributed ,and the last molars will find suffi cient room when they come forth ; thu s ,the disorders which these teeth often occasion will b e avoided .

” 1

After caries,Bunon considers dental tartar as the most potent enemy

to the vitality of the teeth . He distingu i shes three principal species :the black, the lemon or light yellow, and the brownish yellow ; however,he allows of two other varieties of les s frequent occu rrence , the red andthe green tartar .At a period when an extraordinary confu sion obtained with regard togingiviti s

,becau se of the great number of varieties allowed , Bunon strongly

affirms the unity of thi s morb id process,and considers tartar as the con

stant cau se '

of it, without denying, however, that other causes of variou skinds 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 recou rse toany other local treatment . He also insists on the necessity of attendingto the teeth and gums , and especially of freeing the former from tartarbefore undertaking the specific treatment of syphil is

,considering the good

s tate of the teeth and gums as one of the most important prophylacticmeasures against mercurial stomatiti s .Anyone who takes the trouble of reading Bunon ’

s works attentivelyc annot help admiring his depth of ins ight , his spirit of ob servation , hisexqu is ite cl in ical sen se , and his ingenu ity . As il lu strating thi s last qu alityof his, we may cite two cases of fracture of the lower j aw that he succeededin curing in a short time by the method of b inding the teeth

,the preceding

attempts of experienced surgeons having entirely failed . One of thesec ases is particu larly interesting . The seat of the fracture correspondedwith the bicu sp ids , which , however, had fallen out from the effects oftrauma ; the neighboring teeth were also loosened . Bunon filled the emptys pace left by the b icu spid s with a p iece of ivory

,provided with two holes ;

1 E ssay, p . 127 .


1 797 . Ruspini d id not, in reality , contribute very much to the developm ent of dental sc ience . He is , however, to be especially remembered as

the inventor of a very good mouth mirror, a means of examination whichafterward gradually came into general use .

Having brought our history of dentistry up to the end of the eighteenthcentury

,in order to complete our work we mu st now speak of an innova

tion in dental p rosthesis,which

,although gradu ally brought to perfection

in the following century, was first introduced at that time . We allude tothe

INVENTIONor MINERAL TEETH.

The merit of this invention is due , in part, to an individual outsidethe dental profession , namely, to the French chemist Duchfite au

,of St .

Germain en Laye,near Paris , who first had the idea of employing porcelain

as material for dental prosthesis . However, his idea wou ld not haveyielded fru itfu l resu lts had it not been for the cooperation of the dentistDubois de Chemant , who succeeded in putting it into practice .

The circumstances connected with this invention were the following :The chemist Duchfite au had for some time worn a denture of hippopotam u s ivory

,but as u sually happened with all the prosthetic p ieces of that

time,which were made of organic material , and were , therefore , subject

to decay, this denture had acquired a very disagreeable odor, resultingfrom the action of the buccal humors . Besides which

,Duchfite au

being obliged , by reason of his profession , to continu ally taste pharmac eutic preparation s , his denture had gradu ally become impregnated withmedicinal sub stances that imparted a n au seou s taste to everything heate . The unpleasantness of this was a subject of much considerationwith him

,and thu s it was that

,to remedy the evil

,he gradu ally matu red

the idea of having a porcelain dentu re made , on the model of the ivoryone . In the year 1 774. he applied to the porcelain manufactory of M .

Guerhard in Paris for the carrying out of his design . The first tri alwas not successfu l , for in the b aking the paste contracted so much thatthe dentu re was no longer of the right dimensions . To remedy this

,he

now had another and larger denture made , to allow for it s contractionin the b aking . But the resu lts did not correspond with his wishes

,and

many trials we re still necessary before Duchfite au wa s able to obtain adenture which he . judged fit for u se , although not without defects . Asthi s dentu re , becau se of it s dead whiteness , produced an unpleasanteffect, he had a yellowish tint, resembling that of the natural teeth , givento it

,and , as is u su al with painting on porcelain , fixed this color by baking

a second time .

TH E EIGH TEEN TH CEN TURY 345

However,this denture proving unserviceab le , Duchfite au was ob liged

to put it a s ide and begin new experiments . These were made with aspecial kind of porcelain paste u sed in France for the first time in 1 740 ,

which vitrified in baking at 12° to 25° by Wedgwood’ s pyrometer

,whilst

the usual porcela in requ ired a temperature of 72° to 75° by the sametest ; but the resu lt s thu s obtained were no better than the p recedingones

,and upon these new failures Duchfite au applied to the dentist

Dubois de Chemant , of Paris , for his collaboration . Together theymade fresh attempts , modifying the composition of the paste by addinga certain quantity of p ipe clay and other coloring earths to it . Thesemodifications enabled them to carry out the b aking of the p ieces at amuch lower temperature , and after variou s experiments the final resu ltwa s a denture that fitted the gums well enough , and which , in point offact

,Duchfite au , was able to wear .

Encouraged by this success , he tried to manufacture like dentures forpersonages of high rank , hop ing to gain money thereby , but his want ofknowledge of the dental art prevented him

.

from succeeding in his undertaking . However

,in 1 776 he laid this new process before the Royal

Academy of Surgeons in Paris , receiving the thanks of that body as wellas an honorab le mention .

Whilst Duchfite au ,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 heintroduced important modification s into the composition of the mineralpaste u sed in the manufacture of the dentures , incorporating therewithFontaineb leau sand , alicant soda , marl , red oxide of iron , and cobalt .His experiments and researches a imed at three p rincipal ends , viz .

I . The obtain ing of mineral teeth offering all the gradation s of colorp resented by natural ones .2 . The arriving at a rigorou s calculation of the contraction of the mineral

paste in the b aking, so as to be ab le to make prosthetic p ieces of thedesired form and dimension s .3 . The perfecting of the means of attachment of the prosthetic p ieces ,and

,in p articu lar

, of the springs .By working with intelligence and perseverance

,Dubois de Chemant

gradually obtained satisfactory resu lts , and when , in 1 788, he publishedhis first pamphlet on mineral teeth

,he had already made dentures and

partial p rosthetic pieces for a certain number of person s,who wore them

to great advantage .As to the chemist Duchfite au , from 1 7 76 to 1 788, that is , during the

twelve years sub sequent to his communication to the Academy of Surgeons , he did ab solutely nothing at all . He is , therefore, entitled to the


cred it of having had a happy idea and of having endeavored to put it intopractice ; but the merit of having given life to the idea , abandoned forso many years by him with whom it originated , i s exclus ively due toDubois de Chemant ; he i s, therefore , with reason considered the trueinventor of m ineral teeth .

Dubois de Chemant , however, was so unjust as to take the wholecredit of the invention for himself, declaring in h is writings that theoriginal idea had been exclu sively his own , and was in no way due toDuchfite au .

In 1 789 Dubois de Chemant made his invention known to the Academyof Sciences and to the Facu lty of Medicine of Pari s ; both pronounced infavor of it, and in consequence of the op in ion given by such high authorit ies

,he soon after obtained an inventor ’ s patent from Lou i s XVI .

Dubois ’ successes now arou sed the envy of many of his colleagues , andespecially of Dubois Foucou , the king’ s dentist, who, together with thegreater part of the denti sts of Paris and the chemist Duchate au

,brought

an action against h im , accus ing him of having u su rped the inventionof Duchate au ,

and demanding, for th is reason , the annulment of the ln

ventor’ s patent that had been granted him . But the law courts , in an

opinion dated January 26 , 1 792 , rejected the demand for annu lment ,recognized the patent of invention as fully valid , and condemned DuboisFoucou ,

Duchate au , and their confederates to the costs of the judgment .Pari s being at th at time in full revolution , Dubois de Chemant was

induced to emigrate to England . He established h imself in London,and

there obtained a patent without much difficulty,according him the

exclus ive right,for fourteen years , of manufacturing dentu res of mineral

paste .

Dubois de Chemant wrote several pamphlets in order to make knownto the public thi s new kind of dental p rosthesis and its advantages ; someof these were published in Paris ( 1 788, 1 790 , and others during hislong residence in London , where he remained from 1 792 to 18 1 7 . In

these pamphlets he upholds the great superiority of “ the incorruptib leteeth of mineral paste” over all other kinds of artificial teeth ; he callsspecial attention to the fact that teeth of bone , ivory, and of every otherorganic sub stance whatever gradually become spoilt through the action ofthe saliva , of oral heat , of food and drink , etc .

, and not only lose theirprimitive color and assume a dirty hue , m ost u np le asant to the eye , butacqu ire a bad odor

,at times qu ite insupportable , becoming, besides , a

cau se of i rritation to the gums and the mucou s membrane of the mouth ,not to speak of their gradual softening and wearing out , which rendersthem unserviceable after a certain time . All these d isadvantages wereavoided by u sing the new prosthetic material , thi s being incorruptib leand inalterab le .


Notwithstanding this,the teeth made by Fon Z I , of which there are still

some specimens in variou s dental mu seums , had anything but a goodappearance

,and there still remained much. to be done before mineral

teeth reached the height of perfection which they attained later onThe credit of having introduced many new improvements in the manu

facture of mineral teeth belongs especially to the American s . Amongthose who particu l arly di stingu i shed themselves in this dep artment ofdental art

,we may note Charles W. Peale , Samuel W . Stockton , James

Alcock,and Elia s Wildman . But the most brilliant results , as i s

FIG . 104.

E arlie st spe c im ens of m ine ra l te eth.

well known , were obtained by the celeb rated Samuel White, who, by

an intelligent and persevering activity,dedicated almost exclu sively to

improving mineral teeth and to bringing them into ~

gene ral u se , contributed va stly to the progress of modern dental art . Samuel S . Whiteundoubtedly stands forth as one of the noblest and grandest figu res inthe history of dentistry , and his name will ever be recorded with honorand veneration by dentists of all ages .

I N D E X .

ABBOTT, A. C .,23 7

Abulca si s, 86, 125Abyssinia, negroe s of, file inc isors into points43

Acoluthus, Johann,240

Acupuncture , 38Adam antins, 1 16 , 1 17Adverti sem ents

, 245

n ina,Pau l of

, 2 19E sculap ius, 45, 46

ZEtius ofAm ida , 1 1 7 , 1 70

Age of anim a ls judged by the te eth Aristotleon

,62

Aitkin,John

, 3 1 7Alcock , Jam e s

, 348

Ali Abbas, 122Altom are

,DonatoAntonio

,200

lveolar pyorrhe a, 96, 23 7ndrom achus the E lde r, 106, 1 13And ry, 269, 309Ane sthe tic , 149Antrum of Highm ore

,186

,233 , 249, 250 ,

257 , 282 , 304, 3 10, 3 1 1 , 3 13 , 3 18, 3 20 ,

325 , 3 30 , 333

phthae, Ce lsu s on , 84Apol lonius

,

32 , 1 13

ppolonia , a int, 209

Aquapendente,Fabriz io of, 207

Arabians,12 1

Aranz ioGiu lio Ce sare , 20 1rcagatus , 7 7Archigene s

,65 , 106 , 1 13

rcoli, Giovanni of (Arculanus), 153 , 168,

I 9rnata

,Pie tro of

,151

ristotle, 53 , 6 1 , 64

Arnem ann, J .

, 33 1

rsenic, 35 , 85 , 122, 125 , 138, 152 , 157

sc le piade s, 80

Asklepiad i, prie sts of the tem ple of TE sculap ins, 45, 46

Astringent m outh washe s, 97 , 1 15 , 1 16 , 122

153Atm osphe ric cond itions, influence on denta lm a lad ie s, 57 , 1 16 , 247

Aure l ianus , Ce l ius, 65, 1 13 , 1 14Auz eki

,Pie rre

, 3 17Avenz oar

,139

Avicenna , 84, 123

BABYLONIANS,tre atm ent of sick by the , 18

Bacte ria,23 7

Barbe rs,86

,1 30 , 132 , 139 , 144, 159 , 162 ,

166 , 188, 240 , 242 , 243 , 244 ,245 ,

255Barden,

A., 340

Barthol in , Thom a s, 23 2 , 235Bass, He inrich, 259Be l l

,Benjam in

, 3 24Be lzon i

,G . B .

,on Egyptian dentistry, 2 7

Benedett i, Ale ssandro, 157 , 187Bened ictus of Faenza , 203Be rdm ore , Thom as

, 3 15, 3 16

Be rtin , J ., 304

Bible , refe rence to te eth in the, 32 , 33

Bidloo, Gottfried , 239Bird s , te e th of, 63Blum

,Michae l

,164

Blum entha l, K . A., 33 7

Bodenste in, Adam ,205

Bordenare , Thom a s, 3 13

Bourdet, 309Brahm ins, care of the teeth am ong the , 42Bridgework , 297

Etru sc an attem pts at, 76 , 10 1Brom fie ld , W. , 3 18

Brunne r, Ad am Anton, 3 15

B runoofLongobucco, 140Bruschi, Etrusc an denta l appliance s in

Museum of Count, 73

Bucking, 32 1Bunon, Robe rt, 30 1 , 33 7

CALENDAR of dentition, 3 15Callisen ,

He inrich, 333Cam indus , Ba lthasar, 2 15Cam pani , Anton io, 3 23 , 3 27Capivacc i, Ge rolam o, 20 1Carabe ll i , 157 , 3 1 7 , 3 2 1Carbonate of l im e

, anc ient dentifrice m en

tioned by Pliny , 94Carie s, denta l , 24, 1 10 , 122 , 147 , 25 1 , 269 ,

3 19 , 335Carm e l ine , 253 , 26 1 , 283Casce llius, first d entist m entioned by nam e ,

102

350 INDEX

Caste l lan i col le ction , Rom e,Etruscan appli Denta l appliance , Etrusc an ,

found at Tar

anc e s in, 76 quinii, 7 1

Catu llus, 97 ne ar Te ano,Ita ly, 79

Caute rie s, d ental , 3 28 at Va lsiaros a, 70

Caute rization, 25 , 40 , 85, 107 , 1 1 1 , 1 18, 126, art am ong the anc ient Ge rm an s,162

138, 152, 2 12 , 227 , 246, 289, 3 10 the Etru scan s,67

Caylus, 99 the Rom ans, 7 7 , 102

Ce l ius Aure l ianu s, 46, 65 , 1 13 fi rst beginn ings of, 1 7Ce lsus, 65 , 80, 83 , 84, 85, 86, 87 , 102 practised by Spe c ia l i sts in anc ientCem ent

” fi l ling,122, 240 Egypt

, 25of Guillem e au

, 253 carie s, 1 10 , 122 , 147 , 25 1 , 269, 3 19Channing, John,

126 irregu laritie s, 280 , 290 , 303 , 320

Charlatans,159 , 162 , 27 7 , 3 10, 3 16 m a lad ie s given in E be rs ’ papyrus, 2 1

Chauliac, Guy de , 146 surge ry not m entioned in E be rs’ papy

Chem ant, Nicholas Duboi s de , 329 , 344 rus, 25

Chine se,anatom ica l notions of, 39 and surgica l in strum ents of the Rom ans

,

dentistry am ong the, 34 86

Chopart, 322 te rm inology found in Ve sal iu s , 1 76

Cigrand , 47 , 68, 3 16 Dentateurs, 199Cintio d

’

Am ato, 242 Dentator

,144, 147

Clasps, 303 Dentidu ce s, 226

Claude t , Gabrie l, 232 Dentifrice s

, 35 , 38, 5 1 , 87 , 93 , 94, 96, 97 , 105 ,Cle an l ine ss of the te eth am ong the Rom ans, 1 1 2

,124, 14 1 , 148, 154, 247 , 322

97 , 106 , 107 Dentine,structure of, 23 7 , 3 19

Coite r,Volche ru s

, 200 Dentisculpia (toothpicks),Coitioii

,toothache from , 35 Dentispice s, 2 19

Cold applications, harm ful to the te e th, Dentist

,the word itse lf, 102 , 144

6 1 Ca sce llius the first,102

Colom bo,Matteo Re aldo, 1 77 Denti sta , 144

C6m e,Frere , 3 18 Dentistry, cond ition of

,be fore Fauchard , 260

Com pre ssor of Foucou, 32 1 in the m idd le age s,1 2 1

Condam ine , 3 14 as a true spe c ia lty, 255 , 263Corne to

,m useum of

,Etrusc an appliance s ; Dentists, exam ination of

, 26 1 , 339in

, 7 1 , 72 , 73 1 “Dentitioii , Calendar”of, 3 15

Cos,tem ple of, m ed ica l re cord s in, 18, 46, 48 third

, 9 1 , 143 , 185, 199, 306

Courtois, 32 1 Denture s,com plete , 298, 3 13 , 336

Cowpe r,Wi l l iam ,234, 249 porce lain

, 344Crem ation am ong the anc ients, 69 spring

, 299, 300

Criton,1 13 Deodato, Claud io, 224

Croc e , Giovanni Andrea de lla, 20 1 De sau lt, 322

Cron , Ludwig, 255 De schape llem ent (uncrowning), 1 94, 204, 275Crowley’ s “

Denta l Bibliography,

253 , 256 D iem e rbroek , 235Crown ,

artific ial , 296, 3 15 ‘ D ie st, Jean de , 30 1gold , 2 1 7 , 303 D ioni s

,Pie rre

, 25 1Cte sias of Cydnu s, 62 D ioscoride s, 84Cu stom s of prim itive people s, 42 Di sse ction prohibited by the Koran ,

12 1

Doctors’

shops in anc ient Gre e ce and

Rom e, 52

1Drake,Jam e s

, 249Dubois de Chem ant

,N icholas, 329, 344

DABRY,P . P .

,Le s m éde c ine che z le s Foucou , 347

Chinoi s,

”

34 Jacque s, 1 72Dal l i O sso

,archeologist

, 78“

Duchate au, 344

Dam ocrate s,Se rvilius

,106 Duche m in

,student of Fauchard 260

Darem be rg, Hi stoire de s sc ience s m ed i Dufour, 309

c a le s,

”Dupont, 223

De Lavauguyon , 253 , 255 Duve rney,Jean

, 238De corative m ed ic ine , 244Dekke rs, Friede rich, 241De l phi

,tem ple ofApol lo at

, 46 , 1 14Deneffe ,

“La prothese denta ire dans l ’anti EARS and the tee th, 54, 56 , 94, 228, 236 , 250 ,

qu i te,67 , 75, 102 3 15

352 INDEX

He i ste r,Lorenz, 255

Hém ard , Urbain,194, 203

Hem orrhage afte r extraction, 229 , 23 1 , 258,

30 1 , 306 , 32 i , 335of the gum s

,1 15, 157

Henke l, 3 18

He rac lide s ofTarentum , 65, 1 13He rodotus

,18

, 25, 64He rophi lus

,65

Heurm ann,Georg, 305

Heurn, Johann (Heurnius), 1 75, 2 12Hie ratic characte rs, Ebe rs

’ papyrus in, 20Highm ore , Nathanie l , 186, 232Hindostan

,care of the te eth by the native s

of, 42

Hindu dentists, prim itive type ofdenta lprosthe si s by

, 30

Hi ppias,ane cdote from He rodotus on, 26

Hi ppoc rate s, 1 7 , 18, 47 , 108Hirsch, Fried rich, -

334Hi stology, 236Hoffm ann

, Johann, 249Hom e r

,re fe rs to sonso E sculapius, 45

Horace,fa lse te e th m entioned in satire of

,102

Horst, Jacob , 2 14Hou llie r; Jacque s, 199Hunte r

,John

, 3 16, 3 18, 324Hurlock, Jose ph, 303Hygiene of the m outh

, 80 , 87 , 92 , 106 , 107 ,

34- 1

Hypoplasm , denta l , 341

IMMUNITY from toothache, 22 1

Im plantation, 3 1 1

Ind ia , people of,custom s re lating to the

te eth of, 42

Ingolstette r, Johann, 2 15Ingra ssia

,Gian Fi lippo

,1 77

Instrum ents, 52 , 128, 144, 15 1 , 157 , 167 , 192 ,

284, 33 f

for extracting, 32 1 , 323 , 327

of gold , 25 1

of the Rom ans,86

Iron,tooth of

, 232

Irregu laritie s,dental

, 280, 290, 303 , 320 , 342

JACOBAEN s , OLIGERUS , 23 1Java , substitution of gold te e th by people of,42

Joachim ,He inrich

,translation of Ebe rs

papyrus by, I 9Jourdain

, 3 1 1

Junke r,Johann, 257

KEY With change able hooks, 326

Engli sh, 257 , 3 1 7

of Garengeot, 257K irche r, 2 1 7K irk , E . C.

, 28, 30 , 43 , 82 , 83 , 84, 96 , 1 15 ,

Klae rich, F . W., 3 14Knights of the Teutonic O rde r, 163Koran

, d i sse ction prohi bited by the , 12 1

LANCETs, gum ,

195Lanc ing of the gum s

,198, 239, 257 , 265,

Lanfranchi , 140

Lavini, 30 1

Law of the Twe lve Table s,69, 7 7 , 78

Le Hire, 265

Le ad for fi ll ing tee th, 285 , 309, 320, 335Lec luse

, 257 , 305Le e uwenhoek

,Antoni van

,23 7

Lem e rle, 3 1 7

Lem orie r, 3 13

Lentin, L . B ., 3 14

Lentisk wood , toothpicks of, 98Le psius, opin ion of, on E be rs

’ papyrus, 20Le ttson , 329Leucorrhe a , 58

Leyden,Lucus van

, 2 13Lidde l, Dunc an

, 2 16

Ligature s,Abu lcasis on

,135

Linde re r, Jose ph, 27 , 42 , 98, 139, 162 , 181 ,220 , 257 , 3 13

Lode r, 257Longevity

,influence of num be r of te eth on,

58

Lusitanus,Am atus, 229

Luxations of jaw, 88

MAGNET,use of

,for toothache , 3 14

Major,Danie l , 240

Mal pighi , Marce l lo, 236

Manteville, 269

Marce llus, 1 15Martial

,e pigram s of

, 98

Martin,Benjam in

, 241

Martinez,Franc isco, 205

Massage , anc ient practice of, 1 14Masse z

, 3 13Maxillary sinus

,186, 23 3 , 249 , 250 , 257 ,

282, 304, 3 10, 3 1 1 , 3 13 , 3 18, 320 , 3 25, 330 ,

333M e chanic a l dentistry, first work on, 303Med ic ine in anc ient Eygpt, 19

de corative , 244

INDEX 353

Med ic ine , m ost anc ient work on ,19 Odontalgia, 34, 38, 5 1 , 92 , 95, 103 , 106 , 107 ,

sace rdota l , 1 7 109 , 1 1 1 , 1 13 , 1 24, 13 7 , 141 , 145, 150 , 152 ,spe c ia l branche s of

,103 154, 2 19, 220, 22 1 , 228, 247 .

Me ibom,He inrich

,250 3 14, 3 32

Me rcury,harm ful effe cts of, 158, 202, 230 Odontitis , 33 1

Me sue the younge r,13 7 , 164 Ope rative denti stry, Fauchard on

,284

Mice,use of

,for denta l m aladie s, 36, 50 , 93 , Ori basius, 1 1 7

94, 97 Orvieto, 69 , 74Mic roOrganism s

, 23 7Mic roscope s, 236, 269Midd le age s , d enti stry in the

,12 1

Minadous,Thom as

, 232

Mine ra l te e th, 254, 3 29 , 344, 348wate rs of Carlsbad

, 220

Mode ls in denta l prosthe sis, 241 , 306Mode rn tim e s

, d entistry of, 16 1Mol ine tti

,Anton io

, 234Monaviu s

,Petrus, 205

Monkey,denta l system of

,63

Montagnana,Bartolom eo

,152

Montanus,Giovanni Battista

, 230

Moraine ’ s ve rse s on Fauchard , 260Motte , G . M. de la

, 258

Mouth m irror, 344

washe s, 55, 97 , m , 265, 274

Mouton, 303 , 309

“Moxa,

”u se of, by Chine se , 40

Mum m e ry, J . R .

, 25 , 29Mum m ie s

,Egyptian

, 27 , 28, 49Murphy

,Jose ph

, 42

Museum of antiqu itie s, Dre sden ,162

(archeological) ofAthen s, 52(archeologica l) of F lorence , 70of Corneto, 7 1 ,of Count Bruschi , 73of Pope Jul ius

,Rom e

, 70, 101

ofUnive rsity ofGhent, 74

Musitano, Carlo, 247

NASAL prosthe si s, 256

Ne c rosi s of lowe r j aw, 241

of the te eth, 56

Ne rve s of te eth,109

Ne ura lgia, 224

Nic ai se,E . 142

Nobi le, Luigi , 78

Nom e ric lature ,Nuck

,Anton

, 245Num be r of te e th

, 59, 109

OBTURATOR s , 197 , 198,Oce anica

,dye ing the tee th black by race s

42

Odontagogon, 46 , 65, 1 14Odontagra

,64

23

PAPYRUS of Ebe rs,19

Parace lsus, 1 76Paré, Am broi se , 188Pa sch, J . G .

, 3 14, 3 15“Pastophori

”tre atm ent of sick by, 19

Pau l ofTEgina, 1 18Pe a le , Charle s W.

, 348

Pe chlin,Nicolaus

, 232

Pe l ican . (extractiiig instrum ent), 157 , 158,2 1 1 , 226, 281 ,

3 I I 323 , 324, 330 334Pe rine , Geo. H., 27Pe riodontitis

,

Pe tronius, 98

Peyronie , de la , 3339Pfaff

,Phi li p

, 305Pfolsprundt, He inrich von

,163

Phoen ic ia,

anc ient denta l appliance found

at S idon , 29influence of

,on Etrusc an dentistry, 67

Phoenic ian va se,with portraya l

Alof dentalOpe ration

, 47PietroofAlbano

,144

ofArge lata, 15 1Pig

,te e th of the

,62

Pinc e rs,ligature

, 295Plaste r m ode ls, 306Plate ario

,Giovanni

,152

Pliny,89, 102

Plugge rs,288

Pom aret,Denis, 223

Portal , 245Pote le re t

,Alexandre , 262

Pregnancy,extraction of te eth during, 30 1 ,

339Pre sc ri ptions, Chine se , 35

d ental , of Hippoc rate s, 50Egyptian , 2o, 2 1 , 22 , 23 , 24

Prie sthood,anc ient

,tre atm ent of sick by, 1 7

Prim itive people s,custom s re lating to te e th

of, 42

Prosthe si s, denta l ,

Prosthe tic pie ce s, m ovable , 256Pu l p - capping

, 306Pul p

,inflam m ation of

,re cognized by Archi

gene s , 107Pum ice stone in dentifrice s

, 96, 97 ,Rut land , T.

, 28

Purm ann, Matthias Gottfried , 24 1Pyorrhe a (a lveolar), 96, 23 7

4 INDEX

Q

QUACK S , 159 , 1 62, 2 77 , 3 10Qui ll toothpicks m entioned by Martial, 98

RANULA , Abu lcasis on the cure of,13 7

Renan,

“Mission de Phénic ie ,”29

Re plantation,136 , 19 1 , 25 1 , 281 , 293 , 305 ,

Rhaze s, 84, 12 1 , - 122 , 153

Ricc io, Tom m a soAntonio, 242Richte r, A. G .

, 3 29Riviere Lazare (Rive rius), 228Riz agra (Gre ek force p s), 87Rom ans

, denta l art am ong the , 7 7Rom e , Arcagatu s the first Gre ek doctor in, 7 7Rueff

, 3 16

Ru land Martin, . 2 15

Run'ge

,L . H.

, 304Rusp ini, Bartholom eo, 343Russe l , 3 13Ruysch, Friederich, 236Ryff,Wa lte r

,157 , 16 1 , 166

SAALBURG,force ps found in anc ient castle of,

1 14Sa l iva

, 33 1

Salm uth, Phi li p, 232

Sandwich Island s,native s of

,sacrifice front

te e th, 43

Satricum ,exam ple of gold c rown work found

at,10 1

Saws, denta l , u sed by Abulcasi s, 136

Sca le rs, Abu lcasi s on use of,127

of Fauchard, 285

of si lve r m entioned by Fabric ius, 2 10

Schaffe r, Jacob Christian , 306

Sche lham m e r,Chri stophe r, 250

Schm idt,Prof. Em i l, 29

Schulte s , Johann (Sculte tus), 226Schu lz, Gottfried , 232Scorbutus

,c ase of

,m entioned by Hi ppoc rate s,

55Sc ribonius Largus, 103Sculte tu s, 226Scurvy

, 57 , 23 7Se c re cy am ong dentists

, 262Seni le de cay, 186, 238Se rapion

,123

Se rre, 47 , 78, 330

Se rre s,181 , 2 1 7

Sevente enth century, dentistry in the, 2 18

Seve rino,Marco Aure l io

, 227Shops of doctors in anc ient Gree ce andRom e

, 52S idon

,ne cropol is of

, 29

Si le sian chi ld,golden tooth of the , 2 14

S i lve r,toothpicks of

,m entioned in satire of

Pe tron ius, 98Six

,Martin

, 23 1

S ixte enth c entury, denti stry in the,16 1

Spiege l,Adrian (Spige l ius), 235

Sprenge l,

“Ge schichte de r Chirurgie , 139,

Ste rnbe rg, J . H., 3 3 7

Stockton,Sam ue l W., 348

Story of the Golden Tooth, 2 14Strabo, 98Strobe lbe rge r, Johann Ste phan, 2 18St. Yve s, Charle s , 250Surgeon denti st

, 244, 339Surge ry

,anc ient, em inently conse rvative , 108

Surgica l in strum ents de posited in the tem ple s,46

Sylvius,1 72

TAGLiAcoz z i,GASPARE

, 226

Ta lm ud,the , 32

Tartar,dental

,1 19 , 127 , 150, 15 1 , 23 7 , 244,

Te ano, Ita ly, prostheti c p i e ce found near, 78

Te eth,artific ia l , D ionis on , 252

of the Etruscans, 70

m entioned by Martial,100

opposition to use of, 241 , 258

Paré on ,197 ,

Rom ans , 78

c are of the . S ee Hygiene of the m outh.

am ong the Brahm ans, 42

the Rom ans, 97d ignity and im portance of the

, 235dye ing black

,by m arried wom en of

Japan , 43by race s of A3 1a and O ce an ica ,

42

red , by people of e aste rn Ind ia and

Macassar, 43gi ld ing of the

,in Sum atra

, 43of m um m ie s

, 28, 29, 49nam e s of

,as given by Guy d e Chau l iac ,

143num be r of

,ind icated by Ga len

,109

influence on long life of, 58

pivot,no evidence of Egyptian knowl

edge of, 29Pliny on pe rson s born with

, 89tre panning of

,advi sed byArchigene s, 65

Te rm inology, dental , found in Ve sal ius , 1 76

Te ske , J . G ., 3 14Theodorico Borgognoni , 140The r

é

iac,fam ous rem edy of Androm achus ,

Io

Tin for fi l ling te eth, 285, 329, 335

Tobac co,Tonsi ll iti s

,Ce lsu s on

,83

Tooth brushe s, 266 , 3 34

From the Most Ancient Times Until the End of the Eighteenth ...

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