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diff --git a/old/51991-0.txt b/old/51991-0.txt deleted file mode 100644 index c9c922c..0000000 --- a/old/51991-0.txt +++ /dev/null @@ -1,17244 +0,0 @@ -The Project Gutenberg EBook of A History of Dentistry from the most -Ancient Times until the end of the E, by Vincenzo Guerini - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - - - -Title: A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century - -Author: Vincenzo Guerini - -Release Date: May 3, 2016 [EBook #51991] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK A HISTORY OF DENTISTRY *** - - - - -Produced by deaurider, Turgut Dincer and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - ———————————————————————————————————————————————————————— - Transcriber’s note: - - No major corrections have been made in the text, except - a few to have consistency in spelling and hyphenations. - Captions have been added to the portraits of dentists for - clarity. - ————————————————————————————————————————————————————————— - - PUBLISHED UNDER THE AUSPICES OF - -[Illustration: The National Dental Association’s mark.] - - THE NATIONAL DENTAL ASSOCIATION - OF THE UNITED STATES OF AMERICA - - A - HISTORY OF DENTISTRY - - FROM THE MOST ANCIENT TIMES - UNTIL THE END OF THE - EIGHTEENTH CENTURY - - BY - DR. VINCENZO GUERINI, CAV. UFF. - - SURGEON-DENTIST, NAPLES, ITALY; DENTIST BY APPOINTMENT - TO THE ROYAL HOUSE; DENTIST OF THE SURGICAL CLINIC OF - THE UNIVERSITY OF NAPLES; EDITOR OF THE ITALIAN REVIEW - L’ODONTO-STOMATOLOGIA; AUTHOR OF MANY ODONTOLOGICAL - WORKS; HONORARY PRESIDENT AD VITAM OF THE ITALIAN - ODONTOLOGICAL SOCIETY; MEMBER OF THE ITALIAN SOCIETY OF - SCIENTISTS, LITERARY MEN, AND ARTISTS; OFFICER OF THE - ORDER OF THE CROWN OF ITALY; DOCTOR OF DENTAL SURGERY - AD HONOREM OF THE CHICAGO COLLEGE OF DENTAL SURGERY; - HONORARY MEMBER OF THE NATIONAL DENTAL ASSOCIATION, - U.S.A.; MEMBER OF THE EXECUTIVE COUNCIL OF THE FEDERATION - DENTAIRE INTERNATIONALE; TITULAR MEMBER OF THE SOCIETY OF - THE PARIS DENTAL SCHOOL AND DISPENSARY; HONORARY MEMBER - OF THE ODONTOLOGICAL SOCIETY OF MALAGA, ETC. - - With 104 Engravings and 20 Plates - -[Illustration: Printer’s mark.] - - LEA & FEBIGER - PHILADELPHIA AND NEW YORK - 1909 - - COPYRIGHT, 1909 - BY THE - NATIONAL DENTAL ASSOCIATION OF THE - UNITED STATES OF AMERICA - - - - -PREFACE. - - -The idea of writing a History of Dentistry first suggested itself to me -ten years ago, when I was charged by the Organizing Committee of the -Eleventh International Congress of Medicine with the reproduction and -description of all the appliances of ancient dental prosthesis existing -in the museums of Italy. - -The highly interesting researches in which I then became engaged in -order to carry out worthily the important mission intrusted to me, -awoke in me the desire to gain still further acquaintance with all -that relates to dental art in the time of the ancients. I was thus -urged on to ever fresh efforts, not only in the discovery of prosthetic -appliances and other objects of ancient dentistry, but in the study, -as well, of dental literature and of all the written matter that might -throw light on dentistry in past ages. - -This subject has already occupied many before me, and each one has -brought to it his contribution of greater or less value, some in the -form of short pamphlets, others in that of larger works. - -The end I proposed to myself was to write a History of Dentistry which -should be much more complete, more circumstantial, and more exact than -those published hitherto, and which, instead of being, as are many of -these works, simply a compilation, should represent, at least in part, -the fruits of personal research and scrupulous examination of a vast -number of works of various kinds containing elements utilizable for the -purpose. - -The first part of my work, which I now offer to the public, comprises -the remote origin of Dentistry and its development throughout the ages -as far as the end of the eighteenth century. In a short time I hope to -publish the second part of it, viz., the History of Dentistry during -the last hundred years. - -I have carefully collected the greatest possible number of historical -data, keeping in view the consideration that some facts, although of -little value in themselves, may possess a certain importance for the -student desirous of procuring historical information relating to some -particular point of dental science. - -If this book should, as I hope it may, contribute to the diffusion of -exact historical knowledge as to the origin and gradual development of -dentistry, my labor will not have been lost, for it will have realized -the object, a highly practical one, which has guided me in writing it. - - VINCENZO GUERINI. - - - - -CONTENTS. - - - PART I. - - FIRST PERIOD—ANTIQUITY. - - - CHAPTER I. - - DENTAL ART AMONG THE EGYPTIANS 19 - - - CHAPTER II. - - THE HEBREWS 32 - - - CHAPTER III. - - DENTISTRY AMONG THE CHINESE 34 - - - CHAPTER IV. - - CUSTOMS RELATING TO THE TEETH AMONG DIFFERENT PRIMITIVE PEOPLES 42 - - - CHAPTER V. - - THE GREEKS 45 - - - CHAPTER VI. - - DENTAL ART AMONG THE ETRUSCANS 67 - - - CHAPTER VII. - - THE ROMANS 77 - - - PART II. - - SECOND PERIOD—THE MIDDLE AGES. - - - CHAPTER VIII. - - THE ARABIANS 121 - - - CHAPTER IX. - - THIRTEENTH TO FIFTEENTH CENTURIES 140 - - - PART III. - - THIRD PERIOD—MODERN TIMES. - - - CHAPTER X. - - THE SIXTEENTH CENTURY 161 - - - CHAPTER XI. - - THE SEVENTEENTH CENTURY 218 - - - CHAPTER XII. - - THE EIGHTEENTH CENTURY 255 - - - - -INTRODUCTION. - - -Every dentist who has ever given any thought to the development of his -profession must have realized the growing necessity for an accessible -and authoritative history of the dental art. The early efforts in -this direction by Duval, Fitch, Carabelli, Snell, Linderer, Harris, -and others, followed in this country by the more recent essays of -Perine, Dexter, and Cigrand, are out of print and difficult to obtain. -The _Geschichte der Zahnheilkunde_, by Geist-Jacobi, and _Notice -sur l’Histoire de l’Art Dentaire_, by Lemerle, have given to the -practitioners of Germany and France valuable information which the -English-speaking dentist has often sadly lacked. - -Realizing this situation, at the first meeting of the National Dental -Association, the late Dr. R. Finley Hunt offered the resolution: “That -a Committee of Three be appointed by the President to report at the -next annual meeting a measure looking to the preparation of a _full -history_ of the Dental Profession.” After a careful consideration of -the subject, this committee reluctantly concluded that, “whereas a -complete history of dentistry may some day be the result of the effort -now being made, this Association must confine its first attempts to -the history of dentistry in America.” In a letter to the committee -the late Dr. W. D. Miller said: “Of course, a universal history of -dentistry would be very interesting and valuable, but its compilation -would naturally cost an immense amount of labor.” Aside from this, it -did not seem possible that the data for a proper history of the early -development of the dental art in Africa and Europe could be collected -by an association working in America. - -After several years of what may have seemed a policy of masterly -inactivity the unexpected happened, and the committee was able to -report at the Buffalo meeting of the Association that Dr. Vincenzo -Guerini, of Naples, Italy, had written a history of dentistry from -the earliest times to the beginning of the nineteenth century, and -that this work, translated into English and fully revised, had been -generously placed in the hands of the committee for publication under -the auspices of the National Dental Association, in token of the -distinguished author’s appreciation of American dental development. - -The Association, deeply sensible of this high compliment, and fully -realizing this opportunity for accomplishing a purpose which had -hitherto seemed impossible, gladly arranged for the publication of -the book. After the delay incidental to the production of a work of -this character, and the necessary subscribers being obtained, this -exhaustive history of early dentistry, by the greatest authority on -that subject in the world, is presented for the serious consideration -of the thoughtful and studious members of the profession. - -Dr. Guerini has spent many years of his professional life and large -amounts of money in collecting the material for this work. Our -historical records are scattered through a vast literature, and much -of it is of great antiquity, and it has never before been gathered -together and arranged in such a consecutive, logical order. - -The importance and value of dental art and science as a humane service -are well recognized, but we are so accustomed to view the question from -the modern standpoint that we, generally speaking, overlook the immense -work done by our predecessors reaching far back in unbroken line to the -mists of antiquity. It was they who laid the foundations upon which -modern dentistry has been built, and no man can peruse the record of -their efforts as set forth in Dr. Guerini’s book without developing a -higher appreciation of their work and a keener realization of the worth -and dignity of the calling which they in common with ourselves followed. - -It has been deemed wise to make a few amendments and commentaries, and -when that has been done the amendment has in each case been inserted as -a foot-note and designated by the initials of the commentator. - -The supervision of the work while passing through the press and the -correction of proofs have been entrusted to Dr. Edward C. Kirk, of the -Committee; the index has been prepared by the chairman. - - CHARLES MCMANUS, D.D.S., - _Chairman of Committee on History of Dentistry, - National Dental Association, U. S. A._ - - - - -A HISTORY OF DENTISTRY. - - - - -PART I. - -FIRST PERIOD—ANTIQUITY. - - - - -INTRODUCTION. - - -The first beginnings of dental art were undoubtedly the same as those -of general medicine, for it is evident that in primitive times, when -the healing art was still in its rudimentary stage, no divisions could -have existed in it. - -Scientific medicine, whose most ancient representative is Hippocrates, -was preceded for the course of many centuries by sacerdotal medicine -and by popular medicine. - -Necessity, instinct, and even mere chance must have taught primitive -man some simple curative practices, in the same manner that they taught -him gradually to prepare his food and to satisfy the other wants of -life. It was in this way that popular medicine, which is found without -exception among all races and is perhaps as ancient as man himself, had -its earliest beginning. - -As regards sacerdotal medicine, it was principally derived from the -false ideas prevalent among primitive peoples about the causes of -maladies. When, for example, an individual in full health was seized -with sudden illness, no one could imagine, in those times of profound -ignorance, that this happened in a natural manner; the fact was -therefore attributed to a supernatural cause, that is, to his having -been stricken by the wrath of some divinity. In this state of things -it was believed to be absolutely necessary to propitiate the inimical -or vengeful divinity, so that the patient might be restored to health. -It was, therefore, very natural that the intervention of sacerdotal -aid should be sought, that is, of the supposed intermediaries between -human beings and the gods. The priests, on their side, were ready to -occupy themselves with such cases, for their services were always well -recompensed, and, added to this, if the patient recovered, the respect -and veneration of the people for the sacerdotal caste was considerably -increased, whilst if he did not, this simply meant that he or his -family was not worthy of receiving the desired pardon, or that, anyhow, -the Divinity, for good reasons of his own, would not grant it. - -However, it being to the interest of the priests to obtain the greatest -possible number of cures, they did not limit themselves merely to -offering up prayers and sacrifices and to imposing on the patients the -purification of themselves and other religious exercises; they also -put into practice—always to the accompaniment of ritualistic words and -ceremonies—the means of cure which their own experience and that of -others suggested to them. The art of healing the sick was transmitted -from generation to generation in the sacerdotal caste, acquiring an -ever greater development and complexity in proportion to the making of -new observations and fresh experiences. It is to be understood that in -this manner the priests became more and more skilful in the treatment -of disease; they were really the doctors of those times, albeit their -curative practices were mixed up with an ample dose of imposture. This, -at least in many cases, must have had, besides, the advantage of acting -favorably on the patients by means of suggestion. - -We learn from Herodotus that the Babylonians used to carry the sick -into the public squares; the passers-by were expected to make inquiries -as to their illnesses, and if it so happened that they or any of their -acquaintances had been similarly afflicted, to come to the aid of -the patient by offering their advice and making known the means of -treatment that had effected recovery, exhorting him, at the same time, -to have recourse to them. - -This usage had without doubt its advantages, as it must have led, -little by little, to the recognition of such remedies as were most -efficacious, among all those recommended, against the various maladies. - -Another custom that served to furnish useful elements for the -development of the art of medicine was that of the votive tables, hung -in the temples by patients after their recovery, in sign of gratitude -for having received the invoked blessings. These tables contained a -brief description of the malady and of the treatment that had proved -useful in dispelling it. If we reflect that dental affections are often -of long duration and very tormenting, the thought naturally suggests -itself that among the votive tables not a few must have referred to -maladies of the teeth. - -The numberless cases recorded by votive tables afforded precious -clinical material, which without doubt was utilized in a great measure -by the priests in compiling the earliest medical writings, and, as we -shall see later, Hippocrates himself stored up all the medical records -existing in the celebrated temple of Cos. - -[Illustration: _Introduction of Ebers’ Papyrus, transcribed in Egyptian -hieroglyphic characters._] - - - - -CHAPTER I. - -DENTAL ART AMONG THE EGYPTIANS. - - -Among the people of ancient times, the Egyptian nation was, without -doubt, the one in which civilization first took its rise and had its -earliest development. From the time of Menes, first King of Egypt (3892 -B.C.), the inhabitants of the valley of the Nile were well advanced on -the path of civilization, and under the fourth dynasty, dating from -3427 years before the Christian era, they had already attained a high -degree of progress. - -Medical art and science in every country have always progressed in -proportion to the general civilization, for the treatment of disease is -one of the first and most important manifestations of civilized life. -It is therefore natural that the healing art should have flourished -earlier in Egypt than elsewhere, that is, in the midst of the oldest -civilized people. - -There, as in other countries, medicine was practised for some time only -by the sacerdotal caste; but not all the members of this caste were -doctors and priests at one and the same time; there was a special class -among them, called “pastophori,” whose mission it was to cure the sick. - -Our knowledge of medicine as practised among the Egyptians of old is -now no longer limited to the scanty notices handed down to us by Greek -and Roman writers. The researches made by students of Egyptian lore -have placed original medical writings in our hands, now already partly -interpreted, that permit us to form a sufficiently exact idea of the -science of Medicine in ancient Egypt. - -These valuable documents, denominated papyri, from the material on -which they are written, now exist in great numbers in the Berlin -Museum, in the British Museum, and in those of Leyden, Turin, Paris, -and other cities; but the most important of the papyri treating of -medical subjects is certainly the papyrus of Ebers, in the library of -the Leipzig University.[1] This very valuable papyrus—the most ancient -of all known works on Medicine—is the best written of all the Egyptian -medical papyri, and is also the best preserved and most voluminous. -In size it is 30 centimeters high, 20 meters long, and the whole text -is divided into 108 sections or pages, each one of about 20 to 22 -lines. The celebrated Egyptian scholar, Prof. George Ebers, procured -it, toward the beginning of the year 1873, from an inhabitant of -Luxor, in Upper Egypt. He published a beautiful edition of it two years -later in Leipzig; and in 1890 Dr. Heinrich Joachim published a German -translation of the whole papyrus, with an introduction and explanatory -notes. - -The Ebers’ papyrus is written in hieratic characters. We here reproduce -some passages of it, so as to give our readers an idea of the style of -writing.[2] - -Lepsius and with him the greater part of Egyptologists are of opinion -that the Ebers’ papyrus is not an original work at all, but simply a -copy of medical writings of still earlier date, belonging to different -epochs, and which were collected and reunited to form a kind of manual -on medicine. - -[Illustration: FIG. 1 - -Part of Ebers’ papyrus in Egyptian hieratic characters containing three -dental prescriptions.] - -From some indications existing in the papyrus itself, Ebers has been -able to argue, with quasi certainty, that the papyrus was written -toward the year 1550 B.C. But some parts of it have their origin in a -far more remote epoch; they go back, that is, to thirty-seven centuries -or more before the Christian era. In fact, at page ciii of the Ebers’ -papyrus[3] one reads: - -“Beginning of the book about the treatment of the _uxedu_ in all the -members of a person, such as was found in a writing under the feet of -the God Anubis, in the city of Letopolis; it was brought to His Majesty -Usaphais, King of Upper and Lower Egypt.” Now, as Joachim remarks, -the Usaphais herein named was the fifth king of the first Egyptian -dynasty, and he reigned toward 3700 before the Christian era. Hence, it -may be argued that some, at least, of the writings from which the Ebers’ -papyrus was taken were composed in the very remote epoch to which we -have just alluded, or perhaps still farther, for it is impossible to -know whether the book, deposited by unknown hands at the foot of the -statue of the God Anubis, had been written but a short time previous or -at a much earlier epoch. - -[Illustration: FIG. 2 - -Part of Ebers’ papyrus in Egyptian hieratic characters containing -eleven dental prescriptions.] - -Dental and gingival maladies are in no way neglected in the Ebers’ -papyrus. At page 72, a remedy is prescribed “against the throbbing of -the _bennut_ blister in the teeth,” then two other remedies “to cure -the _bennut_ blisters in the teeth and to strengthen the flesh (gum).” - -It is somewhat difficult to say what is meant by _bennut_ blisters; but -perhaps it means small, gingival abscesses of dental origin. The first -of the above remedies—probably meant to calm the pricking or throbbing -pain that, in such cases, often accompanies the dental malady—consisted -of: - - “Seps-grains Part 1 - Dough ” 1 - Honey ” 1 - Oil ” 1 - To be applied on the part as a plaster.” - -The other two remedies, very likely intended for the cure of dental -fistulæ, were to be used as masticatories. The first consists of: - - “Fennel seeds Part 1 - Dough ” 1 - Anest-plant ” 1 - Honey ” 1 - Incense ” 1 - Water ” 1” - -The other was still more complicated and thus compounded: - - “Dâm-plant Part 1 - Anest-plant ” 1 - Incense ” 1 - Amaa-plant ” 1 - Man-plant ” 1 - Saffron ” 1 - Aloe wood ” 1 - Annek-plant ” 1 - Cyperus ” 1 - Onion ” 1 - Water ” 1” - -At page 89 of the papyrus[4] we find two other remedies, having the -same object, that is, “to cure the bennut blisters in the teeth and to -strengthen the flesh.” - -The first is compounded in this way: - - “Cow’s milk Part 1 - Fresh dates ” 1 - Uah corn ” 1 - To be left stand and then to be masticated nine times.” - -This is the second receipt: - - “Anest-plant Part 1 - Dough ” 1 - Green lead ” 1 - Sebests[5] ” 1 - Cake ” 1 - Dâm-plant ” 1 - Fennel seeds ” 1 - Olive oil ” 1 - Water ” 1 - To be used like the preceding one.” - -In this same page 89 many other remedies corresponding to various -indications are prescribed. - - “To strengthen the teeth: - - Powder of the fruit of the dum-palm Part 1 - Green lead ” 1 - Honey ” 1 - To be mixed and the teeth rubbed with it.” - -The following is another remedy for the same purpose: - - “Powder of flint stones Part 1 - Green lead ” 1 - Honey ” 1 - To be rubbed on the teeth.” - -Next comes a remedy “to cure the growth of _uxedu_ in the teeth,” that -is: - - “Dough Part 1 - Beans ” 1 - Honey ” 1 - Verdigris ” 1 - Green lead ” 1 - To be powdered, mixed, and applied on the teeth.” - -The word _uxedu_ recurs more than thirty-five times in the Ebers’ -papyrus, in relation to affections of the most different parts of the -body. By confronting all the passages of the papyrus in which one finds -the word _uxedu_, Joachim deduces that it does not indicate any special -disease, but has the general signification of “a painful swelling.” -According to Geist-Jacobi, by “growth of the uxedu in the teeth” may -be understood an alveolar abscess and the consequent swelling of the -surrounding parts. - -Another remedy is intended for “the cure of the tooth that gnaws unto -the upper part of the flesh.” - -The translator of the papyrus remarks that by the “upper part of the -flesh” is to be understood the gum. The remedy would, therefore, -correspond to the indication of curing a tooth “that gnaws or gives -pain unto the gum.” But as one sees, even putting it in these words, -the meaning is anything but clear. Perhaps the destructive action of -the carious process, reaching as far as the gum, is what is here meant -to be alluded to. Meanwhile here is the receipt: - - “Cumin Part 1 - Incense ” 1 - Onion ” 1 - To be reduced to a paste, and applied on the tooth.” - -Besides the remedies already given, the two following are prescribed -for strengthening the teeth: - - “Incense Part 1 - Verdigris ” 1 - Green lead ” 1 - - Mix and apply on the tooth.” - -The other is compounded of: - - “Water Part 1 - Absinth ” 1 - To be used as above.” - -We next find a formula, preceded by this very vague indication: -“Chewing remedy for curing the teeth.” - - “Amaa-plant Part 1 - Sweet beer ” 1 - Sut-plant ” 1 - To be masticated and then spit on the ground.” - -Another masticatory is intended to “strengthen and cure the teeth,” and -is compounded thus: - - “Saffron Part 1 - Duat-plant ” 1 - Sweet beer ” 1 - - To be masticated and then spit on the ground.” - -Finally, we have a medicament “for curing the gnawing of the blood in -the tooth.” It is complicated enough, being compounded with: - - “The fruit of the gebu Part 1/32 - Onion ” 1/64 - Cake ” 1/16 - Dough ” 1/8 - Anest-plant ” 1/32 - Water ” 1/2 - One leaves it to stand and then chews for four days.” - -But what meaning is to be attributed to the “gnawing of the blood in -the tooth?” - -It is almost certain that this figurative expression referred to the -pain deriving from caries and pulpitis. It may have had its origin in -the observation of two phenomena, that is, first of all, the pulsating -character which the pain alluded to often assumes, and the eventual -issuing of blood from the cavity of a tooth affected by caries and -pulpitis, when the pulp is exposed. At any rate, the Egyptian doctors -of remotest antiquity undoubtedly did not ignore the presence of blood -in the interior of the tooth. - -From what we have related, it clearly appears that at that remote epoch -many remedies were already in use for combating dental affections. -These must consequently have been frequent enough, which demonstrates -the erroneousness of the opinion held by some, who affirm, as does -Mummery,[6] that in ancient times diseases of the teeth were extremely -rare. - -Besides this, it is fully evident, from the Ebers’ papyrus, that at the -time in which this was written, dental pathology and therapy were still -in a very primitive condition, and formed a part of general medicine, -from which they showed as yet no tendency to separate; so true is -this, that the remedies intended for the treatment of the teeth do not -constitute a special section of the work, but are to be found among -medicaments of an altogether different nature. Thus, at page lxxii of -the papyrus[7] we find, first, three remedies against the itch; then -five remedies for the cure of pustules in various parts of the body; -next an ointment and a potion for the _bennut blisters_ in whatever -part of the body they may occur; after this, three medicaments against -the _bennut blisters_ of the teeth; and lastly, a plaster for curing -crusts and itching in whatsoever part of the body. - -One finds no mention of dental surgery in the Ebers’ papyrus. No -conclusions could be drawn from this fact if the work only spoke of -medical treatment, for then it might reasonably be supposed that the -compiler had purposely occupied himself with this subject only; but, on -the contrary, the Ebers’ papyrus frequently makes mention of operative -interventions, and among these, of the use of the knife and of the -red-hot iron for the treatment of abscesses and of certain tumors. -Therefore, there being no mention made in the papyrus of any dental -operation, not even of extraction, gives us reason to suspect that at -that remote epoch no surgical operation was carried out on the teeth, -and that, as yet, no instruments existed for practising extraction. - -In the time of the celebrated historian Herodotus, of Halicarnassus, -who lived in the fifth century previous to the Christian era (about -from 500 to 424 B.C.), that is, more than a thousand years after -the time in which the Ebers’ papyrus was written, the dental art in -Egypt had made remarkable progress, and was exercised by specialists. -In fact, in the second book of Herodotus we find the following -passage: “The exercise of medicine is regulated and divided amongst -the Egyptians in such a manner that special doctors are deputed to -the curing of every kind of infirmity; and no doctor would ever lend -himself to the treatment of different maladies. Thus, Egypt is quite -full of doctors: those for the eyes; those for the head; some for the -teeth; others for the belly; or for occult maladies.”[8] - -Having here had occasion to refer to the _History_ of Herodotus, we -will quote two passages of this famous work, which have a certain -interest for our subject; - -“Whilst the tyrant Hippias, after having been driven out of Athens (510 -B.C.), was marching against Greece at the head of the Persian army and -had already arrived at Marathon, he happened one day to sneeze and to -cough in a more vehement manner than usual; and he being already an -old man, and his teeth all shaking, a violent fit of coughing suddenly -drove one of them out of his mouth, and it having fallen into the dust, -Hippias set to work, with great diligence, to search for it; but the -tooth not coming to light, he drew a long sigh, and then said, turning -to those who were standing by: ‘This land is not ours, neither shall we -ever be able to have it in our power; what clings to my tooth is all of -it that will ever belong to me.’”[9] - -In another part of the _History_, that is, in the ninth book, Herodotus -recounts as follows: - -“When the corpses buried after the battle of Platea were already -despoiled of their flesh, a curious fact was seen; for the people of -Platea having collected the bones of those who had perished, there -was found amongst them a skull altogether devoid of commissures, and -composed of one single bone. A jaw was also found, the teeth of which, -comprising the molars, appeared to be made all of one piece, as though -composed of a single bone.” - -Relative to this last passage of Herodotus, we may remark, as does -Stark, that the total synostosis of the skull bones is certainly very -rare, but that, nevertheless, one has authentic examples of the same, -not only in ancient but also in relatively modern times, witness the -famous skull of Albrecht von Brandenburg, surnamed the German Achilles, -who died in 1486, and was buried in the monastery of Heilbronn. As to -teeth united together and forming a single piece, no example exists -save in very ancient authors, for instance, in Valerius Maximus, who -recounts a similar marvellous fact of Prusia, King of Bithynia, and in -Plutarch, who attests to a similar fact in the person of Pyrrhus, King -of Epirus. - -It is very difficult to establish within what limits the activity -of the dentists alluded to by Herodotus was displayed. It has been -affirmed by some that dental art in ancient Egypt was very far -advanced, and that not only the application of artificial teeth, and -even of pivot teeth, but also stoppings, were practised by the Egyptian -dentists of those days. Here are some data on this subject: - -Joseph Linderer[10] tells us that, according to Belzoni[11] and others, -artificial teeth made of wood and very roughly fashioned have been -found in Egyptian sarcophagi. - -George H. Perine, a dentist of New York, in an article on the history -of dentistry,[12] says: “Both filled and artificial teeth have been -found in the mouths of mummies, the cavities in the former stopped with -gold and in some cases with gilded wood. Whether these fillings were -inserted during life for the purpose of preserving the teeth, or after -death for ornamentation, it is, of course, impossible to say. That the -Egyptians were exceedingly fond of embellishing their persons with -gold ornaments and bright colored materials is a fact which has been -clearly established, and the discovery of mummies—of exalted personages -no doubt—some organs of which were gilded and embellished with showy -colors proves that their fondness for display accompanied them even -to the grave.” To this may be added, that after an embalmment of the -highest class[13] it was usual to gild the eyebrows, the point of the -nose, the lips, and the teeth of the corpse, and place a gold coin -between the teeth, or cover over the tongue with a thin gold plate. - -Dr. J. G. Van Marter, a dentist in Rome, in an article on prehistoric -dentistry,[14] writes, among other things, that _the renowned -archæologist, Mr. Forbes, had seen mummies’ teeth stopped with gold_. - -The great defect of all the assertions referred to is that of not being -accompanied by any element of proof, wherewith to demonstrate their -truth. When, for example, we are told that Mr. Purland possesses, in -his collection of antiquities, a tooth pivoted on to the root of a -mummy’s tooth, the question suggests itself naturally: If this tooth -is, as it appears, separated from the jaw of the mummy to which it is -said to have belonged, how can we be certain that the tooth itself is -really that of a mummy? Until sufficient proof of this be furnished, we -cannot but consider the above assertion as absolutely without value.[15] - -The same may be said as to the assertions of Wilkinson and Forbes with -regard to mummies’ teeth stopped with gold. Where and by whom were -these mummies found? And where are they preserved? Was the stopping, -too, verified at the time of the finding of the mummy, in such a manner -as to exclude all possibility of fraud, or was it discovered afterward, -in circumstances such as to suggest the possibility of a mistification? -It has, in fact, been reported[16] that the pretended Egyptian stopping -in a mummy existing in an English museum was nothing else than a -practical joke, carried out, besides, in a very awkward manner. - -In opposition to the above assertions, we have the most absolute -contradictory statements on the part of the most competent authorities. - -The celebrated Egyptologist, Prof. George Ebers, has only been able, in -spite of the most accurate research, to arrive at completely negative -results in all that has reference to the dental art of the ancient -Egyptians.[17] - -The distinguished craniologist Prof. Emil Schmidt, of Leipzig, who -owns a collection of several hundred mummies’ skulls, writes thus on -the question now before us: “In no jaw have I ever found anything that -could be attributed to the work of dentists: no fillings, no filing or -trepanning of teeth, no prosthesis.”[18] Virchow, who also examined -a great many Egyptian skulls, among which were several belonging to -royal mummies, did not find any indications of dentists’ work;[19] and -Mummery, as well, although he made the most conscientious researches on -this subject, could not arrive at any positive results whatever.[20] - -Between the affirmations of some and the negations of others, it is -very difficult to say on which side the truth lies. For my own part, -I fail to find that there is the least proof of the ancient Egyptians -having known how to insert gold fillings and still less to apply -pivot teeth. But at the same time I think it cannot be doubted that -the Egyptian dentists knew how to apply artificial teeth. And even -though it may not be possible to demonstrate this by direct proof, -one is equally prone to admit it when one considers, on the one hand, -the remarkable ability of the ancient Egyptians in all plastic arts, -and, on the other hand, the great importance they attributed to the -beautifying of the human body; so much so, that even in so ancient -a document as the Ebers’ papyrus, one finds formulæ for medicaments -against baldness, for lotions for the hair, and other kinds of -cosmetics. Is it likely, therefore, that so refined and ingenious a -people should not have found the means of remedying the deformity -resulting from the loss of one or more front teeth? - -Fortunately, however, we are not bound to content ourselves with simple -suppositions, for a well-authenticated archæological discovery made -in the month of May, 1862, has put us in possession of an irrefutable -proof. - -The discovery to which we allude is registered in Renan’s _Mission de -Phénicie_, and was the result of researches made in the necropolis of -Saida (the ancient Sidon) by Dr. Gaillardot, Renan’s colleague in his -important scientific mission. In a grave in one of the most ancient -parts of the necropolis, Dr. Gaillardot found, in the midst of the sand -that filled the grave, a quantity of small objects, among which were -two copper coins, an iron ring, a vase of most graceful outline, a -scarab, twelve very small statuettes of majolica representing Egyptian -divinities, which probably formed a necklace, to judge by the holes -bored in them. But among the objects found (which, together with that -we are about to mention, are now in the Louvre at Paris), the most -important of all is “a part of the upper jaw of a woman, with the two -canines and the four incisors united together with gold wire;[21] two -of the incisors would appear to have belonged to another individual, -and to have been applied as substitutes for lost teeth. This piece, -discovered in one of the most ancient tombs of the necropolis, proves -that dental art in Sidon was sufficiently advanced.”[22] - -[Illustration: FIG. 3 - -Phœnician appliance found at Sidon, as represented in a cut of Renan’s -Mission de Phénicie.] - -To these words, literally translated from Renan’s work, we will only -add the following considerations: - -Egypt was, in its time, a great centre of civilization, whose influence -was strongly predominant in all the neighboring region, and especially -in ancient Phœnicia and in its large and industrious cities Tyre and -Sidon. The remains discovered in many of the Phœnician tombs would of -themselves alone be sufficient to demonstrate luminously the enormous -influence exercised by the Egyptian civilization on the life and -customs of that people. Now, if there were dentists in Sidon capable of -applying false teeth, it may reasonably be admitted that the dentists -of the great Egyptian metropoli Thebes and Memphis were able to do as -much and more, the level of civilization being without doubt higher -there than in Tyre or in Sidon, or in other non-Egyptian cities. - - - - -CHAPTER II. - -THE HEBREWS. - - -In the Hebrew literature, as principally represented by the Bible -and by the Talmud, there does not exist any book on medicine. -Notwithstanding the vicinity and the close relations of the Hebrews -with Egypt, medical science never reached the degree of development -among this people that it did in the land of the Pharaohs. - -In the Bible we do not find the least trace of dental medicine or -dental surgery. Indeed, although the books of Moses contain a great -number of exceedingly wise hygienic precepts, there are not any that -refer directly to the teeth or to the mouth. We may therefore conclude, -with a certain degree of probability, that the Hebrews had in general -good teeth and that dental affections were very rare among them. - -The word _tooth_ or _teeth_ occurs in the Bible more than fifty -times,[23] but very few of the passages in which it is to be met with -present any interest so far as our subject is concerned. - -That the Hebrews attached great importance to the integrity of the -dental apparatus is plainly seen from the following verses of the book -of Exodus (xxi: 23 to 27): - -23. ... thou shalt give life for life, - -24. Eye for eye, tooth for tooth, hand for hand, foot for foot, - -25. Burning for burning, wound for wound, stripe for stripe. - -26. And if a man smite the eye of his servant, or the eye of his maid, -that it perish; he shall let him go free for his eye’s sake. - -27. And if he smite out his manservant’s tooth or his maidservant’s -tooth; he shall let him go free for his tooth’s sake. - -These legislative measures show clearly enough that among the Hebrews -the loss of a tooth was considered a lesion of great gravity, as they -thought it of sufficient importance to be named in the same category as -the loss of an eye, of a hand, or of a foot. If anyone caused the loss -of an eye or of a tooth to his servant, the punishment was the same -in both cases; that is, he was obliged to give him his liberty, thus -undergoing the loss of his purchase money. - -Beauty and whiteness of the teeth were also in great repute. Thus we -read in the Song of Solomon (iv: 2): - -“Thy teeth are like a flock of sheep that are even shorn, which came -up from the washing; whereof every one bear twins, and none is barren -among them.” - -In another part of the Song (vi: 6) he repeats these same words, -thus giving it to be understood how great was his admiration for the -beautiful teeth of his beloved. - -From various passages of the Bible, one perceives that integrity and -soundness of the teeth was considered a prime element of force and -vigor. In Psalm iii: 7 David says: “Arise, O Lord; save me, O my God: -for thou hast smitten all mine enemies upon the cheek bone; thou hast -broken the teeth of the ungodly.” (That is, reduced them to impotence.) -And in Psalm viii: 6 we read: “Break their teeth, O God, in their -mouth.” - -On the other hand, in one of the Proverbs of Solomon (xxv: 19), broken -or decayed teeth are taken to symbolize weakness: “Confidence in an -unfaithful man in time of trouble is like a broken tooth, and a foot -out of joint.” (In the Latin translation, instead of “broken tooth” -stands “dens putridus.” Perhaps the corresponding expression in the -Hebrew language, signifies in a general sense a decayed or injured -tooth.) - -The uncomfortable sensation produced on the teeth by acid substances -(teeth on edge) is to be found several times alluded to in the Bible. -In the Book of Proverbs (x: 26), one reads: “As vinegar to the teeth, -and as smoke to the eyes, so is the sluggard to them that send him.” -And Jeremiah says (xxxi: 29, 30): “In those days they shall say no -more, The fathers have eaten a sour grape, and the children’s teeth are -set on edge. But every one shall die for his own iniquity; every man -that eateth the sour grape, his teeth shall be set on edge.” - -As is apparent, there is nothing in the passages quoted that can be in -any way connected with the treatment of dental affections; neither is -it to be wondered at, when one reflects that even in the Talmud—which -is much less ancient—medicine in general is hardly at all spoken of. -This famous code as to practical life is almost silent with regard -to therapeutic medicine, and only recommends hygienic practices. An -axiom of the Rabbi Banaah is worthy of note, and may be quoted here as -bearing on the subject, and also because many Christians might be found -to conform willingly thereto: - -“Wine is the best of all remedies; and it is in places where wine is -wanting that one is in need of pharmaceutic remedies.”[24] - - - - -CHAPTER III. - -DENTISTRY AMONG THE CHINESE. - - -For above 4000 years science and religion among the Chinese, as well -as their customs, have remained quite unchanged. The inhabitants of -the Celestial Empire can vaunt a most ancient civilization; which is, -however, altogether stationary; neither has their medicine made any -progress, and its actual state represents with sufficient exactness -what it was in primitive ages. - -In Europe, various works have been written about the medicine of the -Chinese, one of the best being that of Dabry,[25] taken from the most -celebrated medical books of China,[26] and which may be considered as a -compendium of the medical science of this people. - -In this work we find two chapters relating to our specialty: the first -of these (p. 286) speaks of toothache, the second (p. 292) treats of -all the other dental and gingival diseases. - -The Chinese call the toothache _ya-tong_, and distinguish a great many -varieties of the malady, that is: - -1. _Fong-je-tong._ This kind of toothache is caused by sudden cold, -and has the following characteristic symptoms: Red and swollen gums, -which after a little time discharge purulent and fetid mucus; abundant -salivation; acute pain; swelling of the cheek. It is to be cured with -draughts, mouth washes, and various kinds of frictions. - -We consider it useless to give the particulars of the various receipts, -because Dabry hardly ever translates the names of the drugs of which -they are compounded. These formulæ are therefore incomprehensible by -most people. - -2. _Fong-lan-tong._ This kind of toothache is also caused by cold. The -pain is very great, but the gums are neither red nor swollen. - -3. _Ye-tong._ Is also produced by chill. The gums are red and swollen; -there is no discharge of mucus; great pain, which is aggravated by cold -liquids. If the malady lasts for some time, the gums end by becoming -black, and the teeth are loosened; the pain becomes more intense in -spitting. In this stage of the malady the sufferer no longer fears -cold drinks, but rather desires them, to soothe the pain. The cure -varies according to whether the malady be of recent or of old date; -it consists in the use of internal remedies (pills, potions), or of -frictions on the part where the pain is situated. - -4. _Han-tong._ This is also owing to the action of the cold. Pains in -the cheek and forehead proceeding from the teeth; no diseased condition -either of the gums or of the alveoli. - -5. _Tou-tan-tong._ Violent cough and toothache at the same time; -difficulty in masticating. - -6. _Yn-hiue-tong._ The gums are pale, or violet-red, hard and lumpy, -sometimes bleeding; the toothache is continuous. Among the numerous -remedies recommended against this malady (mouth washes, frictions, -draughts, pills), one particularly deserves mention: it is the urine of -a child used as a mouth wash. - -7. _Tchong-che-tong._ Pain in the teeth after mastication; there is -also sometimes excoriation of the gums; flow of purulent mucus mixed -with blood; bad-smelling breath; the tooth falls; it is decayed, -and one can perfectly well distinguish a small hole; the root is -unsound; in extracting the tooth one sometimes brings away together -with it a little white worm, with a black spot on the head, which -can be distinguished by the aid of a magnifying glass. A remedy must -immediately be administered to destroy these worms, otherwise the -patient runs the risk of having his other teeth attacked in the same -manner, and of their falling out. The remedies against this affection -are most numerous, and belong for the most part to the oftentimes cited -categories. One of them presents a certain interest, its basis being -arsenic. - -In Dabry’s book it is described in the following manner: “Arsenic (gr. -1.80), _houang-tan_ (gr. 3.60); pulverize, mix with water, and with a -part of the mass form a small pill, which put close to the aching tooth -or into the ear, if afraid of the arsenic; then sleep. Cure certain.” - -8. Toothache, the effect of general weakness, following principally on -abuse of coition. It is to be cured by the use of internal medicine, -or by local remedies to be rubbed on the painful spot. Some of the -medicaments registered in this paragraph have reference to the special -case, in which the teeth are loosened through excess of coition. -Among others there is a prescription for a dentifrice powder for -strengthening the teeth, to be used every morning. - -9. Toothache following on a blow. It is to be cured by using a certain -dentifrice powder, composed of six ingredients. Another medicament -consists in heating about an ounce and one-half of silver in some -recipient, and then pouring wine upon it, and rinsing the mouth with it. - -Besides these nine kinds of toothache, the Chinese doctors recognized -a peculiar morbid condition of the teeth and their surrounding parts, -which is thus described in Dabry’s book: - -“It sometimes occurs, after recovery from illness, that convalescents, -in order to acquire strength, drink too great a quantity of wine; and -that this after a certain time produces a beginning of inflammation of -the stomach. In such cases the teeth often fall out, the breath becomes -fetid, and if the patient eats hot food, the empty alveoli as well as -the cheeks are painful.” - -Various internal medicaments and dentifrice powders are prescribed for -combating this morbid condition. One of these latter includes a great -number of ingredients in its composition; among others, the bones of -mice. - -Mention is also made of certain remedies, to which recourse may be had -at times, for allaying violent dental pains, of whatsoever kind, or -whatever be the cause that occasions them. - -One of these remedies is composed of different substances (among them, -garlic and saltpetre), to be pulverized and made into pills. If the -pain be on the left side, one introduces one of the pills into the -right ear, and _vice versa_. - -The formula is also given for a very complicated medicated powder, -to be snuffed up in the left nostril if the person suffering from -toothache be a man; in the right if a woman. - -Another powder is to be smelt with the right nostril or with the left, -corresponding to the side on which the pain is located. - -Abscesses and fistulæ of the gums are spoken of as follows: - -“It sometimes occurs that an abscess forms in some one point of the -gum; this communicates great pain to the tooth near it; the abscess -is white, with discharge of purulent matter.” The treatment consists -in the use of different medicated powders, to be rubbed on the -affected part. Two of the powders contain musk, besides several other -ingredients. A lotion is also prescribed. - -In the next chapter the following affections are described: - -1. _Ya-heou._ Gums are red, soft, and swollen, and a fetid and purulent -matter exudes from them; the teeth are not painful; if the gums are -lanced, blood of a pale red color flows from them in abundance. This -malady is to be treated with various internal medicines and sometimes -with scarification. - -2. _Ja-suen._ Gums swollen; little by little they are corroded and -destroyed by ulceration, which leaves the roots of the teeth bared; -the patient has an aversion for hot food; continued pain in the teeth; -discharge of purulent and fetid mucus; by the slightest exposure to -cold the pain becomes very violent. This affection is to be combated -with internal remedies and local treatment (frictions with medicated -powders; application of an ointment of very complicated preparation). - -3. _Tchuen-ya-kan._ The gums are painful for a few days; apparition -of the root of the tooth; absence of ulceration. Children of five or -six years of age are frequently exposed to this malady. The best means -of cure consists in the extraction of the tooth. There are, besides, -various internal and external remedies prescribed. One of these latter -contains verdigris and three other ingredients. Among those to be used -internally there is a decoction prepared with twelve different drugs, -two of which are mint and rhubarb. The quantity of rhubarb is about -seven and one-half grams; therefore, this prescription is certainly -intended to act as a purgative. - -4. _Ya-ting._ The right or left gum suddenly swells; a tumor forms -of about the size of a grain of sorgo; in the beginning it is red, -afterward black; severe pain in the cheek and neck; itching in the -cheek; the tumor afterward bursts, giving exit to blood, and becomes -black; it ought to be pricked directly (before it opens of itself) -with a silver needle; blood of a violet color will flow from it, which -should be left free course until it regains its ordinary color. The -sufferer has at the same time pains in the stomach, great thirst, -abdominal pains, and sometimes even delirium. - -5. _Ya-jong._ Gums swollen and painful, abscess, fever, swollen cheeks; -great thirst, and vomiting of a liquid kind; dejections dry. The -treatment consists in the methodical use of certain medicines to be -used internally, among which is rhubarb. If one neglects to make use of -this treatment, an ulceration sets in with discharge of a purulent and -sanguine mucus; it is then necessary to rub the part with a medicinal -substance called by the Chinese, _ping-pang-san_. Should the tooth be -somewhat loose, it ought to be extracted and the gum rubbed again with -the substance just now named. - -6. _Tso-ma-ya-kan._ An illness common to children after the smallpox; -ulceration of the gums, which turn black; fetid breath. In certain -cases the gums are hard and the mucous membrane of the cheek is also -attacked; all the teeth shake; there is flow of blood from the gums, -upon which certain spots begin to form that are clearly distinguishable -as small holes. These holes must be filled with a particular medicinal -substance (named _lay-ma-ting-kouei-sse_), and, besides, one ought to -make use of various other internal and external remedies. - -This is a very serious illness. In the case of recovery, the patient -ought to abstain from taking any heating aliment for one hundred days. - -7. _Tsee-kin-tong_ or _tsee-ly-tong_. Gums swollen; slight but -continuous pain, aggravated by the effort of the wind; the gums become -ulcerated little by little, with discharge of purulent and sanguine -mucus; and the root of the tooth is afterward seen to be uncovered. -This malady is to be treated by means of draughts, pills, mouth washes, -and frictions of various kinds. - -After the treatise on the maladies referred to above, we find in -Dabry’s book a long series of “general remedies for every kind of -toothache.” There are about forty of these, and decoctions and powders -predominate among them, the latter to be rubbed on the painful spot. -Decoctions are the form of medicament most in use among the Chinese. -In this list of about forty anti-odontalgic remedies we find as many -as eighteen decoctions, seven for internal use, and the others to -be employed as mouth washes. Some of the latter are compounded with -vinegar instead of with water. - -Four remedies of the above list are to be made into a paste and formed -into pills, to be applied upon the aching tooth. - -Another medicament is also to be formed into pills and applied inside -the ear. - -The following remedy is particularly worthy of note: - -“One roasts a bit of garlic, crushes it between the teeth, and -afterward mixes it with chopped horseradish seeds, reducing the whole -to a paste with human milk; one then forms it into pills; these are to -be introduced into the nose on the side opposed to that where the pain -is situated.” - -Two other remedies, in powder, are to be snuffed up through the nose. - -A powder to prevent the progress of caries is prescribed, with which -the tooth should be rubbed every day, or it may be applied on the -decayed spot. - -Finally, two powders are also prescribed for whitening the teeth. One -of these is compounded of seven ingredients, among which is musk; the -other has only three substances in its composition: salt (gram 25), -musk (gram 1.8), _tsang-eul-tsee_ (gram 36). - -A therapeutic method much in vogue among the Chinese is acupuncture, -which is used in the treatment of the greatest variety of affections, -including those of the dental system. The doctors of the Celestial -Empire have the greatest faith in this operation, which they hold -capable of removing obstacles to the free circulation of humors and -vital spirits, thus reëstablishing that equilibrium of the organic -forces which constitutes health, and the absence of which causes -disease. - -The Chinese doctors prefer to use gold or silver needles for -puncturing; but they also frequently use needles of the best steel. -These instruments vary very much in length, in thickness, and in form, -and there are not less than nine distinct kinds of puncturing needles. - -Every doctor who intends dedicating himself to the practice of this -operation has to begin by the most accurate study of the elective -points for puncturing according to the various affections; he should -also know to what depth precisely to drive the needles in each case, -in order to reach the site of the morbific principle and procure -convenient exit for it; he ought to know equally well how long to -leave the needle in the affected part, so as to obtain the best -possible therapeutic results in each case. - -The points of election for carrying out puncturing in various maladies -are spread over the whole superficies of the body, and amount in -number to 388. Each of these is known by a special name. Each site of -election stands in determinate relations, as to distance, to the known -anatomical points, and may, therefore, be easily and precisely found -by appropriate measurement. The unity of length for these measurements -is called _tsun_, and is divided into ten _fen_; its value varies, -however, according to whether the said measurements be taken on the -head, the trunk, or the extremities. For the head, the length of the -_tsun_ is calculated as equal to the distance existing between the -inner and the outer angle of the eye; for the trunk, it is equivalent -to the eighth part of the horizontal line between the two breast -nipples; and for the extremities, it is equal to the length of the -second phalanx of the middle finger, measured with the joints bent. - -There are twenty-six points of election upon which to carry out -puncturing used as a remedy against toothache. There are also six other -points of election for pains in the gums. - -One would naturally be disposed to believe that these points of -election would be situated in proximity to the teeth. Instead, many -of them are situated in distant parts of the body—for example, in the -elbow, in the hands, the feet, the vertebral region, the coccyx, and -so on. However, about half of them are to be found in the labial, -maxillary, and periauricular regions. - -The puncturing of every point of election is almost always indicated -for the cure of not only one but several, and, indeed, very often -many, maladies; for example, the puncture carried out on the point of -election, _kin-tche_, situated at the outer extremity of the bend of -the elbow, may be utilized in more than twenty-five morbid conditions; -among which are pains in the arm, paralysis of the arm, edema of the -whole body, excessive perspiring, vomiting, hematemesis, toothache, -boils, gastralgia, hemiplegia, and even cholera! - -This mode of cure depends on the special relation of each point of -election to the so-called canals of transmission and communication -(named in Chinese _king_) through which the blood and the vital spirits -circulate, and which serve at the same time to transmit the “innate -heat” and “the radical moisture” to all parts of the body. - -And here we must be allowed a brief digression in explanation of what -we have just said. - -The anatomical notions of the Chinese are very erroneous;[27] their -ideas on the functions of the human body and of human life in general, -differ considerably from ours. They recognize two natural principles of -vitality, one they call _yang_ (vital, primordial, or “innate heat”), -the other _yn_ (radical moisture). The spirits (that is the air) and -the blood serve as vehicles to these two essential principles of life; -that is, vital heat and radical moisture. The constant equilibrium, the -accord, the perfect union of these two essential principles of life -constitute a state of health. From their alteration, corruption, or -disunion originate all diseases. - -There are twelve principal sources of vitality in the human organism; -that is, twelve organs from which the two aforesaid vital principles -are distributed throughout the body: The heart, the liver, the two -kidneys, the lungs, and the spleen are the seat and origin of radical -moisture; the large and the small intestine, the two ureters, the -gall-bladder, and the stomach are the seat and origin of vital heat. -These twelve sources of life are in intimate relation with one another -by means of the canals of communication, through which the blood and -the vital spirits (air) circulate, carrying with them into every part -of the body vital heat and radical moisture.[28] - -The points of election upon which to carry out puncturing are situated -along the course of the large lines of communication and transmission; -and that explains, according to the Chinese medical theories, why a -puncture carried out on a given point of the body can prove useful in -relieving a variety of maladies even in distant parts of the organism. - -Puncturing is almost always associated with cauterization, for after -having drawn out the needle, it is usual to cauterize the site of the -puncture with the so-called “_moxa_,” that is, with a kind of vegetable -wool obtained from the leaves and dried tips of the artemisia. One -compresses this substance very tightly between the fingers into the -shape of a small cone. One next applies a small coin with a hole in the -centre upon the site of election; the cone of moxa is placed on the -hole in the coin and lighted at its top. As the cone is very compact, -it burns slowly enough, without developing excessive heat, so that, -according to Ten Rhyne,[29] who was an enthusiast for this mode of -cure, “the epidermis is drawn without violence and rises gently into a -small blister. The moxa, whilst burning, draws out the _peccant humors_ -visibly, absorbing them in such a manner that they are totally consumed -without destroying the skin itself.” - -The application of the moxa is not as painful as might be thought, -and even children support it without much crying. The number of times -for repeating the operation varies according to the malady and the -site of application, etc. Thus, in the point _kin-tche_, which we have -mentioned once before, the cauterization is generally repeated seven -times, but in certain cases the number may be brought up to 200. - -There are certain points of election for which puncturing alone is -prescribed without subsequent cauterization; in other instances, the -puncturing is held to be unnecessary or even dangerous; one, therefore, -only applies the moxa in these cases.[30] - -In Japan, the moxa was still more in use than in China. According -to Ten Rhyne, from the remotest times the moxa has been the best -and almost the sole mode of treatment for illness in Japan, and was -regarded not only as an excellent remedy, but also as an excellent -preservative; so much so that even convicts condemned to perpetual -imprisonment had permission to go out every six months to undergo this -cure. - -Dental affections also were especially treated with the moxa, and, -judging by what Ten Rhyne says on the subject, it would seem that this -caustic, when used against toothache, was usually applied in the region -of the mental foramen.[31] - - - - -CHAPTER IV. - -CUSTOMS RELATING TO THE TEETH AMONG DIFFERENT PRIMITIVE PEOPLES. - - -Joseph Murphy, in his book, _A Natural History of the Human Teeth_,[32] -says that the natives of Hindostan, especially the Brahmins or priests -of Brahma, take extreme care of their teeth. Every morning they rub -them for about an hour with a small twig of the fig tree, at the same -time that, turned toward the rising sun, they recite their prayers -and invoke Heaven’s blessing on themselves and their families. As -this custom is prescribed in the most ancient codes and religious -writings of India, it reverts, without doubt, to the remotest ages, -and, therefore, demonstrates the great importance that this people, -and particularly the Brahmin caste, has ever attributed to beauty and -cleanliness of the teeth. Murphy affirms that the Brahmins, in general, -have magnificent teeth; and that this depends, certainly in great part, -on the assiduous and scrupulous care that they take of them. - -From the writings of their ancient poets one also deduces in what high -esteem the people of India held beautiful teeth, considering them one -of the principal ornaments of the face. The lover, says Murphy, never -neglected, in enumerating the beauties of his lady-love, to praise the -whiteness and regularity of her teeth. - -Among some of the people of India, when the second dentition is -completed, it is customary to separate the teeth one from the other -with a file; we do not know, however, whether this is done as an -embellishment or with some other object—perhaps, as suggested by Joseph -Linderer,[33] to prevent caries. - -Anyhow, this and other customs in vogue in various parts of India and -in many islands of Oceanica demonstrate that these peoples attribute -great importance to the teeth. - -The substituting of gold teeth for those missing has been in use in -Java from exceedingly remote times.[34] - -Dyeing the teeth black is considered a great embellishment among many -races of Asia and Oceanica; this operation is sometimes preceded by -another, viz., the filling up of the interdental spaces very cleverly -with gold leaf.[35] - -In Sumatra and the neighboring islands many women file their teeth down -to the gums; others file them into points; or partially remove the -enamel so as to render it easier to apply the black dye; this being -held to be the height of elegance. Men of high rank and condition dye -their upper teeth black and cover the lower ones with fine gold plates, -which in a full light produces what they consider a fine contrast. The -natives of other islands gild the upper central incisors and dye the -others black.[36] - -In Japan, the married women may easily be distinguished from the others -by their black and shining teeth. The coloring preparation they use -to blacken the teeth is composed of urine, raspings of iron, and a -substance called _saki_. This mixture has a most unpleasant odor, and -if applied on the skin acts as a caustic. Its action on the teeth is -so powerful that they do not regain their whiteness even after a lapse -of years. In applying this substance, and also for some time after, -the women take care to preserve their gums and lips from its effects, -as it would otherwise cause them to assume a dark blue tint.[37] The -inhabitants of the Pelew Islands make use of the wild thistle and -shell chalk to blacken the teeth. It is also the custom to blacken the -teeth among the inhabitants of Tonkin and Siam, the women of the Maria -Islands, and the single ladies of Java. - -Some of the peoples of Eastern India plane their teeth down to an even -level; and from the habit of masticating areca nuts mixed with chalk -and other substances, their lips and teeth are dyed red. At Macassar -the natives have their teeth dyed red; they also substitute missing -teeth by artificial ones made of gold, silver, or tombac.[38] - -Negroes, especially those of Abyssinia, very often file their incisors -into points to resemble the form of the canines; this is in order to -give themselves an air of greater ferocity. - -Murphy relates that the inhabitants of one of the islands of the -Sound make an incision in the upper lip in a parallel line with the -mouth, and large enough to allow the tongue to pass. After the margins -have healed they have a great resemblance to the lips. This kind of -artificial mouth is made to support a shell, carved in such a manner as -to produce the effect of a row of teeth. - -The natives of the Sandwich Islands sacrifice their front teeth to -conciliate the favor of their god Eatoa.[39] - -Among the natives of New South Wales, it is the custom when a youth -reaches virility to knock out his front teeth with a stone; this -operation being carried out by the _kuradshis_ or wizards. - -The savages of Peru are also in the habit of making the front teeth -fall out; the reason of the custom is that the space thus made is -regarded by them as an embellishment.[40] - - - - -CHAPTER V. - -THE GREEKS. - - -An ancient Greek physician—Asklepios, afterward called -Æsculapius[41]—by the ability he displayed in the art of healing, so -impressed the minds of the simple and uncultured at that primitive -epoch as to be held in repute rather as a god than as a man. Not only -was he held to be the author of wonderful cures, but it was also -affirmed that he had resuscitated the dead; no doubt from his having -in some case or other of apparent death restored the individual to -consciousness by the assistance he rendered him. Exaggeration, so -natural to ignorant minds, afterward did the rest, and magnified the -healing and restoring powers of Æsculapius to such an extent that it is -not to be wondered at that he should have been looked upon as a divine -being. With the lapse of time, various traditions formed around his -name, among which there was, however, finally such discrepancy that -the popular voice spoke no more of one, but of many Æsculapii,[42] and -to one of these was attributed, among other merits, that of having -invented the probe and the art of bandaging wounds, while another was -held to be the inventor of purgatives and of the extraction of teeth. - -According, therefore, to these traditions, dental surgery had its -origin with Æsculapius, the god of Medicine. But what was the precise -epoch in which this benefactor of humanity lived? - -We learn from Homer that two sons of Æsculapius, Machaon and -Podalirius,[43] took special part, as doctors, in the siege of Troy. -This celebrated siege, which lasted ten years, took place in the -twelfth century before the Christian era (that is, 1193 to 1184 B.C.); -admitting, therefore, the account of the parentage to be authentic, one -may argue therefrom that Æsculapius must have lived between the twelfth -and thirteenth centuries B.C. Many temples were built and dedicated to -Æsculapius; these were called _asklepeia_, after the Greek form of his -name. The priests were called _Asklepiadi_, and alleged their direct -descent from Æsculapius himself. - -The temples of Æsculapius became so numerous in time that they were -to be found in almost every Greek city. The most celebrated were those -of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great -city of Agrigentum, in Sicily. The Asklepiadi not only performed the -temple rites, but were doctors at the same time, for as interpreters -of the wisdom of the god, they also occupied themselves in curing the -sick. From this it resulted that these temples became in time, through -observation and experience, schools of medical science. - -But besides this sacerdotal medicine, there was also a lay medicine -in Greece. Many great philosophers, especially Pythagoras, Alcmeon -of Croton, Empedocles, Anaxagoras, and Democritus, occupied -themselves with physiology, with hygiene, and with medicine; also the -gymnasiarchs, or directors of gymnasiums, or schools of gymnastics, -an art having for its end to increase physical strength and maintain -health, cultivated medicine, particularly that part of it which -concerns hygiene, dietetics, and surgery as applied to the treatment of -violent lesions, such as fractures, luxations, etc. - -The Asklepiadi often themselves imparted the principles of medicine -to students outside their caste. Lay medicine thus gradually came to -supplant sacerdotal medicine, especially after Hippocrates, who through -his works, exercised a preponderant influence in the secularization -of the science. However, the Asklepiadi, on their side, continued to -practise medicine up to the time when the pagan temples fell into -complete ruin, through the advance of Christianity. - -On the columns of the asklepeia and on the votive tables were written -the names of those cured by the god, together with indications -regarding their various maladies and the treatment by virtue of which -the sick had been restored to health. - -Surgical instruments of proved utility were deposited in the temples. -Celius Aurelianus makes mention of a leaden instrument used for the -extraction of teeth (_plumbeum odontagogon_), which was exhibited in -the temple of Apollo, at Delphi. - -As a matter of fact, it would seem more natural that this instrument -should have been shown in the temple of Æsculapius, he being the -god of Medicine, and believed, besides, to be the inventor of -dental extraction. One is rather inclined by this to think that the -_odontagogon_ may have been deposited in the temple of Apollo before -the building of Æsculapian temples. Indeed, who can tell if Æsculapius -himself, not yet deified, may not have deposited there a model of the -instrument he had invented! - -From the fact of the _odontagogon_ in the temple of Apollo being made -of lead, Erasistratus, Celius Aurelianus, and other ancient writers -have drawn the deduction that it was only permissible to extract teeth -when they were loose enough to be taken out with a leaden instrument. -But Serre[44] observes, not without reason, that if a tooth be so -unsteady as to be able to be extracted with leaden pincers, this may -just as well be done, and perhaps even better, by pinching the tooth -between the fingers, no other aid being required than a handkerchief -to prevent them from slipping. Avulsive pincers of lead would be, -therefore, a nearly useless invention; so it is much more probable, -as Serre remarks, that the original pincers were of iron, and that -the inventor, reserving these for his own use, made a simple model of -the same in lead (this being easier to do) and deposited it in the -temple of Apollo, in order to make known the form of the instrument -to contemporaries and to posterity, naturally supposing that whoever -wished to copy it would understand of himself, or learn from the -priests, that it was to be made of iron and not of lead. - -[Illustration: FIG. 7 - -Portrayal of a dental operation on a vase of Phœnician origin, found in -Crimea (see Cigrand, Rise, Fall, and Revival of Dental Prosthesis, pp. -60-63 and 287).] - -HIPPOCRATES. The sacerdotal and philosophical schools of medicine, as -well as the gymnasiums, were the three great sources whence Hippocrates -derived his first knowledge of medicine. - -Hippocrates was born in the island of Cos, toward the year 460 B.C. He -belonged to the sacerdotal caste of the Asklepiadi, and was, according -to some of his earliest biographers, the nineteenth descendant of -Æsculapius on his father’s side, and the twentieth descendant of -Hercules on his mother’s side. The time of his death is even still more -uncertain than that of his birth, for, according to some, he died at -eighty-three, according to others, at eighty-five, at ninety, at one -hundred and four, and even at one hundred and nine years of age. - -Hippocrates was initiated in the study of medicine by his own father, -Heraclides; but in the medical art he also had as a teacher the -gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under -the sophist Gorgia and philosophy under the celebrated Democritus. He -treasured up all the records of medical practice that were preserved -in the temple of Cos; but according to some ancient authors he is said -to have set fire afterward to this temple, and to have left his native -country in order to flee from the resentment he had aroused. Probably -it was the priests themselves who attributed the burning of the temple -(which certainly took place at that time) to Hippocrates, out of -jealousy for his growing fame; though it may also be possible that this -great man, having first collected together all that was useful among -the medical records that were to be found there, afterward courageously -destroyed this centre of superstition, so that medicine, ceasing to -be confused with imposture and being despoiled of the supernatural -character attributed to it, which paralyzed its progress, should become -a liberal and human art, based purely on the observation of clinical -facts and the study of natural laws. - -For a long time, Hippocrates travelled in various parts of Europe, -Asia, and Africa, everywhere making valuable observations. He finally -returned to his native country, where through the practice of medicine -and by his immortal writings he acquired such esteem and veneration -that his compatriots almost tributed him with divine honors after death. - -Not all, however, of the works that make up the so-called collection of -Hippocrates were really written by the father of medicine. Two of his -sons—Thessalus and Draco—and his son-in-law Polybius also distinguished -themselves by the practice of medicine and by their admirable writings, -which together with those of other doctors of that period were -erroneously included in the collection of Hippocrates’ works. At any -rate, the collection of Hippocrates faithfully represents the state -of medicine and surgery at the epoch in which he and his disciples -flourished, that is, toward the end of the fifth and during the fourth -century before the Christian era.[45] - -Neither Hippocrates nor others before him had ever dissected corpses; -it is, therefore, not to be wondered at that the anatomical notions -contained in the Hippocratic works should be scarce and very often -inexact. The physiological notions also are highly deficient and -imperfect, which is, indeed, very natural, for an exact knowledge of -the functions of the human body presupposes an exact knowledge of the -relative organs. - -The philosophical ideas of the time had considerable influence on the -medical theories of Hippocrates and his successors. The universe was -considered as constituted by four elements: earth, air, fire, water. To -each of these elements a special quality was attributed, and, thus, one -recognized four fundamental qualities, viz., cold, dryness, heat, and -moisture. Man—the most perfect being—was regarded as a “microcosmos,” -or small world in himself, that is, a sort of compendium of the whole -universe, and his organism, in correlation to the four primordial -elements of the universe, was believed to be constituted of four -fundamental humors—the blood, the pituita or mucus, the yellow bile, -and the black bile or atrabile. - -Health, says Hippocrates,[46] depends on the just relation one to -another of these principles, as to composition, force, and quantity, -and on their perfect mixture; instead, when one of the four principles -is wanting or in excess, or separates itself from the other components -of the organism, one has a diseased condition. In fact, he adds, -if some one humor flow from the body in a measure superior to its -superabundance, such a loss will occasion illness. If, then, the humor -separated from the others collect in the interior of the body, not -only the part that remains deprived of its presence will suffer, but -also that into which the flow takes place and where the engorgement is -produced. - -We have here briefly stated these generalities in order to make -ourselves clearly understood in speaking hereafter on different -subjects, whether with regard to Hippocrates or to other authors of the -time. - -In the works of Hippocrates there is not one chapter that treats -separately of the affections of the teeth, just as there is no book -in which he speaks separately of diseases of the vascular or nervous -systems, and so on. There are, nevertheless, a great number of passages -scattered throughout the Hippocratic collection from which we can -deduce very clearly the great importance that the Father of Medicine -ascribed to the teeth and to their maladies. - -In the book _De carnibus_, the formation of the teeth is spoken of -among other things. It might have been supposed that Hippocrates -would have been ignorant of the fact that the formation of the teeth -commences in the intra-uterine life. This, however, is not the case; -in fact, he says: “The first teeth are formed by the nourishment of -the fetus in the womb, and after birth by the mother’s milk. Those -that come forth after these are shed are formed by food and drink. The -shedding of the first teeth generally takes place at about seven years -of age, those that come forth after this grow old with the man, unless -some illness destroys them.”[47] And a little farther on one reads: -“From seven to fourteen the larger teeth come forth and all the others -that substitute those derived from the nourishment of the fetus in the -womb. In the fourth septennial period of life there appear in most -people two teeth that are called wisdom teeth.”[48] - -There is a passage in this same book _De carnibus_, in which the great -importance of the teeth for clear pronunciation of words is alluded -to: “The body,” says Hippocrates,[49] “attracts the air into itself; -the air expelled through the void produces a sound, because the head -resounds. The tongue articulates, and by its movements, coming into -contact with the palate and the teeth, renders the sounds distinct.” - -The book _De dentitione_ is written in the form of brief sentences -or aphorisms, and speaks of the accidents that often accompany the -eruption of the deciduous teeth. The most important passages in this -short treatise are the following: - -“Children who during dentition have their bowels frequently moved are -less subject to convulsions than those who are constipated.” - -“Those who during dentition have a severe attack of fever rarely have -convulsions.” - -“Those who during dentition do not get thinner and who are very drowsy -run the risk of becoming subject to convulsions.” - -“On conditions of equality, those children who cut their teeth in the -winter get over the teething period the best.” - -“Not all the children seized with convulsions during dentition succumb -to these; many are saved.” - -“In the case of children who suffer with cough the period of dentition -is prolonged, and they get thinner than the others when the teeth come -forth.” - -In the third book of Aphorisms, where Hippocrates speaks of the -illnesses that prevail in the various seasons of the year and in -the various ages of life, mention is also made of the accidents of -dentition. The twenty-fifth aphorism says: “At the time of dentition, -children are subject to irritation of the gums, fevers, convulsions, -diarrhea; this occurs principally at the time when the canines begin to -come forth, and in children who are very fat or constipated.” - -The works of Hippocrates are nearly silent on the hygiene of the -teeth; but in the second book, on the diseases of women,[50] some -prescriptions are to be found against bad-smelling breath. We translate -the passage integrally: - -“When a woman’s mouth smells and her gums are black and unhealthy, one -burns, separately, the head of a hare, and three mice, after having -taken out the intestines of two of them (not, however, the liver or the -kidneys); one pounds in a stone mortar some marble or whitestone,[51] -and passes it through a sieve; one then mixes equal parts of these -ingredients and with this mixture one rubs the teeth and the interior -of the mouth; afterward one rubs them again with greasy wool[52] and -one washes the mouth with water. One soaks the dirty wool in honey and -with it one rubs the teeth and the gums, inside and outside. One pounds -dill and anise-seeds, two oboles of myrrh;[53] one immerses these -substances in half a cotyle[54] of pure white wine; one then rinses the -mouth with it, holding it in the mouth for some time; this is to be -done frequently, and the mouth to be rinsed with the said preparation -fasting and after each meal. It is an excellent thing to take small -quantities of food of a very sustaining nature. The medicament -described above cleans the teeth and gives them a sweet smell. It is -known under the name of Indian medicament.” - -In the book _De affectionibus_ there is a passage where it is said that -inflammation of the gums is produced by accumulations of pituita, and -that, in like cases, masticatories are of use, as these remedies favor -the secretion of saliva, and thus tend to dissipate the engorgement -caused by pituita. - -Still more important, however, is the following passage of the same -book:[55] - -“In cases of toothache, if the tooth is decayed and loose it must be -extracted. If it is neither decayed nor loose, but still painful, it is -necessary to desiccate it by cauterizing. Masticatories also do good, -as the pain derives from pituita insinuating itself under the roots of -the teeth. Teeth are eroded and become decayed partly by pituita, and -partly by food, when they are by nature weak and badly fixed in the -gums.” - -Hippocrates, therefore, considers affections of the teeth to depend in -part on natural dispositions, that is, on congenital weakness of the -dental system, in part on accumulations of pituita, and the corroding -action of the same. If a painful tooth were not loose, it was not -to be extracted; but one was to have recourse to cauterization and -to masticatories, intended the one and the other to dissipate the -accumulation of pituita, believed by him to be the cause of toothache. - -It is easily to be understood that as only loose teeth were to be -extracted, Hippocrates considered the extraction of teeth a very easy -operation, notwithstanding that the instruments then in use cannot -have been other than very imperfect; and this is clearly to be seen -from a passage in the book entitled _De medico_, where, after having -spoken of the articles and instruments that ought to be kept in a -doctor’s office (_officina medici_), he adds: - -“These are the instruments necessary to the doctor’s operating room -and in the handling of which the disciple should be exercised; as to -the pincers for pulling out teeth, anyone can handle them, because -evidently the manner in which they are to be used is simple.”[56] - -[Illustration: FIG. 8 - -Very ancient dental forceps and two other dental (?) instruments -existing in the Archæological Museum of Athens.] - -Having made mention of the _officina medici_, we think it opportune -to explain here with some precision what is to be understood by this -term.[57] Medicine and surgery were practised in ancient times in open -shops; this was so in Greece, and later also in Rome. When the practice -of medicine became secularized through its abandoning the Æsculapian -temples, doctors’ shops began to arise in the most important centres -of population, to which those in need of assistance resorted or were -carried. In time these stations for the practice of medicine, and -particularly of surgery, became more and more numerous. - -The Hippocratic collection contains a special treatise (_De officina -medici_), which speaks of the conditions these places were expected -to fulfil, the articles therein to be contained, the instruments, the -general rules relative to operations, the bandages, etc. - -About six hundred years later, Galen wrote three books of commentaries -on this treatise of Hippocrates. He says, among other things, that the -doctor’s shop ought to be spacious and furnished with wide openings, to -let in abundance of light. These medical stations to which the sick and -infirm repaired in great numbers to ask advice, to undergo operations, -or receive medical dressings, must have been of great importance, as is -to be presumed from the cited books of Hippocrates and Galen. - -The greatest doctors of antiquity practised the medical art in these -places. It is also said that the great philosopher and naturalist, -Aristotle, who came of a race of doctors, had inherited a doctor’s shop -of great value, but that notwithstanding this he refused to dedicate -himself to the medical profession. - -The doctors’ shops were at the same time real pharmacies, where doctors -prepared medicines, and where all the remedies then in use, either -simple or compounded, were kept and sold to the public. Besides, there -were to be found instruments of every kind and articles for medicating; -and, therefore, bandages, compresses, lint, sponges, cupping glasses, -cauteries, knives, bistouries, lancets, sounds, needles, hooks, -pincers, files, saws, scrapers, splints, appliances for replacement of -luxated bones, speculums, trepans, apparatus for fumigation, trusses, -and a thousand things besides. - -Naturally, dentistry was also practised in these shops, either by -doctors who occupied themselves with dental maladies as with those of -any other part of the body, or, later on, by individuals who dedicated -themselves exclusively to this specialty. - -Medicine and surgery were exercised, however, not only in doctors’ -shops, but also at the patients’ houses, and it was Hippocrates who -especially inaugurated clinical medicine—that is, the practice of -visiting patients in their beds. - -But we must not digress from our argument. - -Many observations relative to the teeth are to be found in the seven -books of Hippocrates on _Epidemics_. Unfortunately, the observations -are not always given in clear and precise terms, which principally -depends on the fact that these books consist for the most part of -simple and most concise notes, written by Hippocrates on cases observed -by him, and not intended for publication under such form, but rather -constituting the material for further work. - -Here is a passage from the fourth book on _Epidemics_, which reveals -Hippocrates’ extraordinary power of observation, for even teeth that -had fallen out were minutely examined by him, to the end of acquiring -precise ideas on the anatomical conformation of these organs, held by -him to be of the highest importance. - -“In the youth suffering from a phagedenic affection in the mouth, the -lower teeth fell out, as well as the front upper ones, which left a -cavity in the bone. The loss of a bone in the roof of the mouth causes -depression in the middle of the nose; the falling out of the upper -front teeth sometimes causes a flattening of the point of the nose. The -fifth teeth counting from the front ones had four roots (two of which -were almost united to the two contiguous teeth), the points of which -were all turned inward. Suppurations arising from the third tooth are -more frequent than from any of the others; and the dense discharge from -the nose and pains in the temples are specially owing to it. This tooth -is more apt to decay than the others; but the fifth does so, as well. -This tooth had a tubercle in the middle and two in the front; a small -tubercle in the internal part, on the side of the other two, had first -begun to decay.[58] The seventh tooth had only one large, sharp-pointed -root. In the Athenian boy, there was pain in a lower tooth on the left, -and in an upper one on the right. When the pain ceased, there was -suppuration of the right ear.” - -This last fact—of the suppuration of the ear—is mentioned by -Hippocrates not as a simple coincidence, but as a fact intimately -connected with the cessation of the toothache. This may be argued -from the general ideas of Hippocrates in regard to the beginning and -the resolution of diseases. He considers a malady to be produced by -a humor, which becomes localized in a given point of the body. The -_crisis_ gives exit to the peccant humor,[59] and the mode in which -this is evacuated constitutes the _critical phenomenon_; the same may -be represented either by a profuse perspiration, by abundant urine, by -diarrhea, by vomiting, by expectoration, by bleeding or discharge of -other humors from the nose, by the issuing of pus from the ear, and -even by deposits on the teeth.[60] If by effect of _organic sympathies_ -the morbid humor, instead of being thrown outward, be transported into -another region of the body, this constitutes the so-called _metastasis_. - -The hints just given will serve to render some of the passages which we -quote from the works of Hippocrates more intelligible. - -In the fourth book on _Epidemics_ we find among other clinical cases -the following: - -“Egesistratus had a suppuration near the eye. An abscess manifested -itself near the last tooth; the eye directly got quite well; there was -a dense discharge of pus from the nostrils; and small, rounded pieces -of flesh were detached from the gums. It seemed as though a suppuration -at the third tooth were going to take place, but it went back; and -suddenly the jaw and the eye swelled up.”[61] - -And farther on one reads: - -“In Egesistratus the two last teeth were decayed in the parts where -they touched one another. The last had two tuberosities above the gum, -one on the decayed side, the other on the opposite side. In the part -in which the two teeth were in contact with one another there were two -roots in each, large and similar, and corresponding to those of the -contiguous tooth; on the other side there was only a half root[62] and -rounded.” - -Toward the end of the fourth book on _Epidemics_, we find repeated an -observation which we have already noted: - -“The third upper tooth is found to be decayed more frequently than all -the others. Sometimes a suppuration is produced all around it.”[63] - -In the following passage mention is made of a mouth wash against -toothache, the basis of which is castoreum and pepper: - -“In consequence of a violent toothache the wife of Aspasius had her -cheeks swollen up; but on making use of a mouth wash of castoreum and -pepper she found great relief.”[64] - -A little after we find the practice of bleeding mentioned; and -contemporarily an allusion to the use of alum—with regard to a painful -swelling of the gums, that is to say, a gingivitis: - -“Melisandrus suffered severe pain and swelling of the gums; he was -bled in the arm. Egyptian alum, if used in this malady, arrests its -development.”[65] - -Toward the commencement of the sixth book the following observation is -registered: - -“Among those individuals whose heads are long-shaped, some have thick -necks, strong members and bones; others have strongly arched palates, -their teeth are disposed irregularly, crowding one on the other, and -they are molested by headache and otorrhea.”[66] - -While we should be tempted to attribute the knowledge of the relations -between malformation of the skull, ogival palate, and bad arrangement -of the teeth to quite modern studies, we are obliged to admit, and -to our great surprise, that these relations were already noted, -twenty-four centuries back, by the great physician of Cos. - -In the seventh book on _Epidemics_, a case of scorbutus is described, -where incense and a decoction of lentils proved useful against the -lesions of the buccal cavity: - -“... Large tubercles, of the size of grapes, had formed on the gums -close to the teeth, black and livid, but not painful, except when the -patient took food. For the mouth, incense powder mixed with some other -ingredients proved useful. The internal use of the decoction of lentils -also did good to the ulcers of the mouth.”[67] - -In the same book there is a passage in which Hippocrates warns against -the use of origanum, as harmful to the teeth and eyes: - -“Origanum in drinks is harmful to affections of the eyes, and also to -the teeth.”[68] - -Farther on a case of necrosis of the jaw is mentioned: - -“Cardias, the son of Metrodorus, by reason of pains in the teeth -was subject to mortification of the jaw. Excrescences of a fleshy -kind formed on the gums, that grew most rapidly; the suppuration was -moderate; the molars fell out and afterward the jaw itself.”[69] - -Some passages in the _Epidemics_,[70] and in other books of -Hippocrates, even when not referring directly to pathological -conditions of the teeth, are of value as demonstrating what importance -the author attaches to the dental organs, and to the phenomena of which -they may possibly become the site. - -In establishing the diagnosis of a malady, he recommends searching for -its point of departure; for example, if it has begun with a headache, -an earache, a pain in the side, and adds, that in some cases the nature -of the malady is revealed by the teeth, in some others by swelling of -the glands.[71] The truth and importance of this observation are not to -be doubted. - -In fevers, Hippocrates considers it an unfavorable sign if there -be a deposit of viscous matter on the teeth, especially when the -patient keeps his mouth half open, that is, when he lies in a state of -stupor.[72] - -Other prognostics drawn from the teeth or the gums are the following: - -“Grinding of the teeth in those who have not this habit when in full -health, gives reason to fear a furious delirium and death; but if the -patient, already delirious, presents this sign, it is an absolutely -fatal one.[73] It is also a most unfavorable sign when the teeth get -very dry.” - -“Necrosis of a tooth heals the abscess formed at the gum.[74] This is -very easily explained by the fall of the tooth. But Hippocrates knew -very well that the affection does not always take such a favorable -course; he therefore adds, immediately after: - -“In the case of necrosis of a tooth the supervening of a strong fever -with delirium gives reason to fear a fatal exit. If, notwithstanding -this, the patient be saved, there will be suppuration and exfoliation -of the bone.”[75] - -According to Hippocrates, “violent pains in the lower jaw give reason -to fear a necrosis of the bone.”[76] - -“Gingival hemorrhage in cases of persistent diarrhea is an unfavorable -symptom.”[77] In fact, the easy and frequent occurring of hemorrhage of -the gums may, in many cases, be an indication of profound alteration -of the blood, a condition serious in itself, but still more so when -associated with obstinate diarrhea. - -In different parts of the books of Hippocrates, the influence of -atmospheric conditions on the production of dental and gingival -maladies is alluded to. - -“Much inconvenience was caused to various persons at that period of -time by swelling of the fauces, by inflammation of the tongue, by -abscesses of the gums.”[78] - -“After the snow, there were west winds and light rains; colds in -the head, with or without fever, were very frequent; in one of the -patients, pains were produced in the teeth on the right side, and in -the eye and eyebrow.”[79] - -In more than one of his books Hippocrates speaks of special dental -or gingival symptoms, having their origin in different maladies, -especially those of the spleen: - -“In many who have enlargement of the spleen the gums become affected -and the mouth has a bad smell.”[80] - -In another place we read: - -“Among those persons who have an enlargement of the spleen, the bilious -ones have a bad color, are subject to ulcerations of a bad nature, -their breath is fetid, and they themselves are thin.”[81] Finally, -in the _Book on Internal Diseases_, Hippocrates describes different -species of splenic maladies, to one of which he assigns the following -symptoms: - -“The belly becomes swollen, the spleen enlarged and hard, the patient -suffers acute pain in it. The complexion of the individual is altered. -A bad smell emanates from the ears. The gums are detached from the -teeth and smell bad; the limbs wither, etc.”[82] - -The cases of splenic swellings spoken of by Hippocrates in the above -passages must have been owing, without doubt, to grave cachectic -conditions (among which, probably, scurvy); and we know that -gingivitis, with all its possible consequences (among which expulsive -periodontitis), is not only a constant symptom in scurvy, but is -also frequent in all diseases attended by profound disorders of -nutrition.[83] - -Setting on edge of the teeth is counted by Hippocrates among the many -symptoms to which a protracted leucorrhea may give rise: - -“One should ask women who have been troubled for some time with a white -flux whether they suffer from headache, pains in the kidneys and in -the lower part of the belly, as well as setting on edge of the teeth, -dimming of the sight, singing in the ears.”[84] - -Hippocrates had also observed that the phenomenon of setting the teeth -on edge (_stupor dentium_) may be produced as well by acids in general, -also by acid vomiting;[85] and that it may also be produced in many -individuals by a strident sound.[86] - -In the second book of _Epidemics_ we find a proposition of the -following tenor: - -“Long-lived individuals have a greater number of teeth;”[87] which -is as much as to say that “the having a greater number of teeth is a -sign of longevity.” This prejudice is to be found repeated by many -authors subsequent to the epoch of Hippocrates, and among these by -Aristotle and Pliny. Not even the greatest men are infallible; there -is, therefore, no reason to be scandalized if Hippocrates should really -have fallen into such an error. Anyhow, it should be observed that -only the first and the third book on _Epidemics_ are held to be really -authentic, while the other five were probably compiled by other doctors -of the school of Hippocrates who did not limit themselves merely to -gathering together the many isolated notes and observations left in -writing or derived from the oral teachings of their master, but took -it upon themselves to introduce into the compilation something of -their own besides. It is, therefore, anything but certain that the -above-mentioned error is really to be attributed to Hippocrates. - -The probable origin of this prejudice, which certainly originated among -the people and was afterward accepted by the doctors, is easily to -be guessed at. Individuals blessed with dental arches of remarkable -beauty and perfection may sometimes convey the impression of having -a greater number of teeth than others, for those two rows of regular -white teeth, close to one another, strike the optic sense much more -vividly than teeth of the ordinary kind. This impression is somewhat -analogous, at least as regards color—to the optical illusion which -causes a white circle to appear larger than a black one of equal -diameter. Now, without doubt, individuals with a perfect denture are -mostly healthy and well constituted, and, therefore, live longer, in -general, than others. It is also to be noted that these people usually -keep all their teeth to a more or less advanced age; and there is no -doubt that among adults of the same age, those who have a less number -of teeth, by reason of having lost several of them, are, in general, -individuals whose organic constitutions are less good, whose health is -less satisfactory, and who are, therefore, destined in all probability -to live a shorter time than the others. It is, therefore, perfectly -true, _but only in a certain and very limited sense_ that “long-lived -individuals have a greater number of teeth.” - -Geist-Jacobi, perhaps in order to dissipate the erroneous signification -of the Hippocratic proposition cited above and to place in evidence -that part of it which may be true, has thought well to translate it -thus: - -“He who lives long keeps many teeth.” But this translation does not -render faithfully the idea expressed in the original Greek, ὁι -μαχρόβιοι πλείους ὁδόντας ἔχουσιν (literally, the long-lived have -more teeth); a proposition that the most celebrated commentators -of Hippocrates interpret in the sense given by us, and which Litré -translates excellently well in these words: “_Avoir des dents en plus -grand nombre est un signe de longévité_.” - -Notwithstanding this prejudice, which survived vigorously for many -centuries, the regular number of teeth was not unknown at the time -of Hippocrates. This is to be perceived from a brief treatise of the -Hippocratic collection, entitled _De hominis structura_, wherein is -written: - -“The teeth, together with the molars, are thirty-two.” - -Among the many and many counsels of practical value registered in the -works of Hippocrates, the following deserves special mention: - -“When a person has an ulcer of long duration on the margin of the -tongue, one should examine the teeth on that side, to see if some one -of them does not, by chance, present a sharp point.”[88] - -In fact, it not infrequently occurs that a lingual ulcer deriving from -irritation produced by a broken or sharp tooth assumes a malignant -aspect that causes it to be mistaken for a cancerous ulcer, and -medical men may even be so far misled as to advise the extreme remedy -of amputation of the tongue. If, however, the consulting surgeon has -some experience, he will not neglect in the first place to examine -accurately the state of the patient’s teeth; it then mostly happens -that after the removal of the offending tooth a complete cure is -obtained in a brief space of time. How much anxiety would not such poor -sufferers be spared if physicians in general were acquainted with the -counsel given by Hippocrates twenty-four centuries ago! - -In speaking of fracture of the lower jaw, Hippocrates recommends -binding the teeth next to the lesion together. He distinguishes between -the complete and the incomplete fracture; he then speaks separately of -the fracture of the symphysis. Treating of the incomplete fracture, he -says: - -“If the teeth in proximity of the lesion be shaken, one ought, after -having reduced the fracture, to bind them one to the other, until the -consolidation of the bone, using preferably gold wire for the purpose; -but if this be wanting, linen thread can be used instead, and not only -ought the two teeth next to the site of the fracture to be bound, but -several of the others besides.”[89] - -[Illustration: FIG. 9 - -Two Greek appliances existing in the Archæological Museum of Athens.] - -Farther on, when speaking of complete fractures, he renews this advice -in these words: - -“After having carried out the coaptation, the teeth ought, as we have -said already, to be bound one to the other; this greatly contributes -to obtaining the immobility of the fragments, particularly if properly -carried out.”[90] - -Also, in cases of fracture of the symphysis, Hippocrates recommends -“binding the teeth together on the right and left of the lesion.” And -after having spoken of the best adapted means of constraint in such -kinds of fractures, he adds: “If the reduction has been well performed, -and the part kept in proper repose, the consolidation takes place in -a short time and the teeth do not undergo any damage; in the contrary -case, the cure is retarded, the fragments reunite in a bad position, -and the teeth are injured and become useless.”[91] - -From what we have referred, it is easy to perceive how much importance -Hippocrates attached to the dental system, what knowledge he possessed -as to the pathological conditions of the teeth, the gums, and the jaws, -and what means of treatment he used. But in what relates to therapy it -will perhaps not be useless to make some further observations. - -One of Hippocrates’ aphorisms says: - -“Cold is the enemy of the bones, the teeth, the nerves, the brain, and -the spinal marrow.”[92] - -From this it is easy to conclude that Hippocrates was no friend to -hydrotherapic treatment, and that he considered the use of cold drinks -bad for the teeth, and cold applications harmful in dental diseases. - -The idea expressed in the aphorism just quoted is to be found repeated -in the book entitled _On the Use of Liquids_;[93] and in this same -treatise we find _vinegar_ recommended shortly after in cases of -_burning of the teeth_ (an expression probably meant to indicate those -pathological conditions of the teeth and gums which are accompanied by -a sense of burning). - -Some of the Hippocratic maxims, full of wisdom and good sense, will -forever conserve their importance, whatever be the degree of perfection -to which medical science may come. - -“Diseases, says he, should be combated in their origin;”[94] which -is as much as to say, that it is not enough to apply symptomatic or -palliative means of cure, but that it is necessary, rather to seek and -to combat the true causes of disease. And in another place we find -written: - -“One should take care of two things in illnesses—to do good and not -to do harm. The art of curing includes three terms: the malady, the -patient, and the doctor. The latter is the minister of the art; the -patient has to combat the malady together with him.”[95] - -It is only too true, that not all the representatives of the healing -art keep sufficiently in view the precept _to do good and not to do -harm_; nor do all patients comport themselves in such a manner as to -contribute, in accordance with Hippocrates’ wise counsel, to the work -of their own cure. - -ARISTOTLE, the greatest philosopher of antiquity, was born at Stagira, -in Macedonia, and lived from 384 to 322 B.C. He wrote most excellent -works on all branches of human knowledge, and was the founder of -Natural History and Comparative Anatomy. His acquaintance with anatomy -as illustrated principally in his treatise _On the Different Parts of -Animals_, is absolutely extraordinary for the time in which he lived. -One chapter of this work[96] is altogether dedicated to the study of -the teeth; but he also speaks of these organs in many other of his -works, particularly in his _History of Animals_, which is a real and -proper treatise on zoölogy, wherein the author records a great number -of notes about the peculiarities presented by the dental system, in the -different classes of animals. - -In spite of the great errors into which he has fallen, his ideas about -the teeth are, taken as a whole, quite worthy of attention, especially -when one considers the remote epoch in which this great philosopher -wrote. We will here give a brief notice of the most important of his -observations relating to the dental organs. - -The form, the disposition, the number of the teeth, varies in animals, -according to the quality of their food and according to whether the -teeth serve merely to divide and to chew the alimentary substances, or -as instruments of offence and defence as well. In man, the teeth serve -principally for mastication, but the front ones have, besides, another -most important office, namely, that of assisting in the articulation of -words, in the pronunciation of certain letters. - -In those animals in which the teeth also serve as weapons, it is to -be observed either that some of them protrude like those of the boar, -or that they are sharp and saw-like in their disposition, as in the -lion, the panther, the dog, etc. No animal possesses at the same time -protruding and saw-like teeth. - -The teeth are not always equal in number in both jaws; the animals -provided with horns have no teeth in the front of the upper jaw; this, -however, is also to be observed in animals without horns, as for -example, in the camel. Among the animals provided with horns there are -none which have protruding or saw-like teeth. - -In general, the front teeth are pointed and the back ones broad. -Nevertheless, all the teeth of the seal are pointed, with a saw-like -disposition, perhaps because this animal marks the transition from the -quadruped to the fish, all of which, with few exceptions, have their -teeth formed in that way. Animals with saw-like teeth have generally -very large mouths. - -No animal has ever more than one row of teeth in each jaw; however, -says Aristotle, if Ctesias[97] is to be believed, there is an animal in -India, named marticora, which has a triple row of teeth. - -The molar teeth are never changed either in man or in any known animal; -the pig never changes its teeth. - -One can judge the age of many animals by their teeth. As the animal -grows older, the teeth become darker in color, except in the case of -the horse, whose teeth grow whiter with age. - -The last molars are cut by men and women about the twentieth year; but -in some cases, and especially with women, they have been known to come -forth—not without pain—very much later, even so late as at eighty years -of age. - -The man has more teeth than the woman; this peculiarity is also to be -found in the female of some animals (such as sheep, goats, and pigs). - -Individuals provided with many teeth generally live the longest, those -instead who have fewer teeth (or simply far apart) are generally -shorter lived. - -The teeth are generated by the nourishment distributed in the jawbone; -they are, in consequence, of the same nature as bones. Their surface, -however, is very much harder than that of the bones. The teeth, -contrarily to all other bones, grow throughout life, so as to provide -for their wearing away through mastication; and for this reason they -lengthen when the antagonizing teeth are wanting.[98] - -The teeth differ from all the other bones, therein that they are -generated after the body has been already constituted; they are, -therefore, secondary formations; and precisely for this reason are able -to be shed and to be renewed. - -Some of the veins of the head, says Aristotle, terminate with very -slender branches inside the teeth.[99] - -The dental system of the monkey is altogether similar to that of man. - -The molar teeth exist in viviparous quadrupeds as well as in man; in -the oviparous quadrupeds and in fish they are wanting. They serve to -grind food, a function in which the lateral movements of the inferior -jaw have, in many animals, a large share. For this reason, in animals -who have no molars, these lateral movements do not exist. - -In birds, the beak takes the place of the lips and teeth; the substance -of which it is formed is similar to that of the horn or the nails. - -In those animals which, instead of having all the teeth sharp, are -furnished with incisors, canines, and molars, these three species of -teeth are disposed in the same order as in man. - -The setting on edge of the teeth may be produced not only by eating -acid things, but also simply by seeing them eaten. This sensation may -be made to cease by the use of purslane and salt. - -In the book entitled _Problems_, many of which have reference to -medical matters, one is to be found to the following effect: - -“Why do figs, when they are soft and sweet, produce damage to the -teeth?” Perhaps, answers Aristotle, because the viscous softness of -the fig causes small particles of its pulp to adhere to the gums and -insinuate themselves into the dental interstices, where they very -easily become the cause of putrefactive processes. But, he adds, it may -also be that harm is produced to the teeth by masticating the small -hard grains of this fruit. - -In Aristotle’s _Mechanics_, the following question relative to the -extraction of the teeth is discussed: - -“Why do doctors extract teeth more easily by adding the weight of the -odontagra (dental forceps) than by using the hand only? Can it be said -that this occurs because the tooth escapes from the hand more easily -than from the forceps? Ought not the irons to slip off the tooth more -easily than the fingers, whose tips being soft can be applied around -about the tooth much better? The dental forceps,” adds Aristotle, “is -formed by two levers, acting in contrary sense and having a single -fulcrum represented by the commissure of the instrument. By means -of this double lever it is much easier to move the tooth, but after -having moved it, it is easier to extract it with the hand than with the -instrument.” - -From this passage of Aristotle one may draw various conclusions. First -of all, it appears that, at that time, the extraction of teeth was -a common enough operation carried out by doctors in general, or, at -least, by specialists not indicated by any particular denomination -but called doctors (in Greek, ιατροι) just the same as those -who dealt with the maladies of every other part of the body. If, -therefore (which, however, is very doubtful), there existed in Greece, -as there certainly did in Egypt, individuals who occupied themselves -_exclusively_ with the treatment of the teeth, they cannot have formed -a distinct class of professionals, but merely a section of the medical -class. Herodotus, too, as we have already seen, does not say, speaking -of Egypt, that there was a proper class of dentists, but gives us -to understand that the Egyptian doctors did not occupy themselves -indiscriminately with the treatment of all maladies, for some dedicated -themselves to curing the eyes, others to the treatment of maladies of -the head, others to those of the teeth, and so on. - -From the Aristotelian passage on the extraction of teeth, just quoted, -it may be concluded that in those times the Hippocratic precept, that -only loose teeth were to be extracted, was not observed, for otherwise, -Aristotle could not have said that dental forceps are useful to loosen -the teeth, but that after this has been done the extraction of the -tooth may be more easily effected by means of the fingers than with the -instrument. - -This last assertion appears very strange. It demonstrates that either -the instruments then in use were very imperfect, or that Aristotle, -although the son of a doctor and himself possessed of vast medical -knowledge, had absolutely no experience as to the extraction of teeth; -and, therefore, speaking theoretically, and without any practical -basis, he ran into error, as even the greatest men are apt to do when -drawing conclusions from purely theoretical reasonings. - -From Aristotle to Galen, that is, for the space of five centuries, -the anatomy of the dental system, so far as may be deduced from the -writings preserved to us, made no sensible progress. But in respect -to this, one must take into consideration some historical facts of -capital importance. The school of medicine of Alexandria, which arose -about three centuries before Christ, numbered among its most brilliant -luminaries the celebrated doctors Herophilus and Erasistratus, who -were the initiators of the dissection of human corpses,[100] thus -giving a great impulse to anatomical research. It is, therefore, hardly -admissible that these two great anatomists, who studied with profound -attention even the most complicated internal organs, should have -neglected the anatomy of the teeth. Unfortunately, however, not all the -results of their researches have come down to us; nor is this to be -wondered at, especially if we reflect on the large number of precious -works entirely lost by the destruction of the celebrated library of -Alexandria, A.D. 642. - -When we come to speak of Archigenes, we shall see how he, in certain -cases, advised trepanning the teeth. This would lead to the belief that -in his times, viz., toward the end of the first century after Christ, -the existence of the central cavity of the tooth was not ignored, and -that, therefore, the structure of these organs had already been the -object of study. - -As to diseases of the teeth and their treatment, there is no doubt that -Herophilus and Erasistratus must have occupied themselves with these -subjects; and the same may be asserted of Heraclides of Tarentum, a -celebrated doctor who lived in the third century before the Christian -era. Indeed, we read in Cœlius Aurelianus,[101] that the record had -come down through the works of Herophilus and Heraclides of Tarentum, -of persons having died by the extraction of a tooth.[102] The same -writer also alludes to a passage of Erasistratus, relating to the -_odontagogon_ already mentioned, which was exhibited in the temple -of Apollo, and to the practical signification to be attributed to -the fact of this instrument being of lead and not of hard metal. Now, -if Herophilus, Heraclides of Tarentum, and Erasistratus all spoke of -the serious peril to which the extraction of a tooth may give rise, -and therefore recommended not having recourse to it too lightly, it -is evident that they had given serious attention to this operation -and consequently also to the morbid conditions that may render it -necessary. - - - - -CHAPTER VI. - -DENTAL ART AMONG THE ETRUSCANS. - - -Much earlier than the foundation of Rome (B.C. 753) there flourished -in that part of Middle Italy today called Tuscany the highly civilized -people known by the name of Etruscans or Toschi. Their political -organization had the form of a confederation of twelve principal -cities,[103] the federal capital being Tarquinii. The Etruscan people -were industrious, intelligent, and artistic in the highest degree, -possessing special skill in the decorative arts, splendid monuments, -some of which still remain to us; they were fond of luxury in all its -manifestations, and took great care of their persons; at the same time, -however, they were a laborious and courageous race, not only most -active and enterprising in agriculture, in art and commerce, but also -brave warriors and hardy navigators. - -In their long sea voyages the Etruscans frequently visited Egypt and -Phœnicia, trading especially in the more flourishing cities, which -were at that time Memphis in Egypt, and Tyre and Sidon in Phœnicia. -On the other hand, the Phœnicians, who were also active merchants and -navigators, not only visited Etruria and other regions of Italy very -frequently, but also established numerous colonies in many islands of -the Mediterranean, and especially in those nearer to Italy. - -This continual intercourse between Etruscans, on the one side, and -Egyptians and Phœnicians, on the other, accounts for the great -influence exercised by the Egyptian and Phœnician civilization upon -the later developed Etruscan culture—an influence manifesting itself -very distinctly in the works of art of the latter, which often have an -altogether Oriental character, and not seldom represent scenes drawn -from the domestic life of the Egyptians and Phœnicians.[104] - -[Illustration: FIG. 10, FIG. 11, FIG. 12 - -Dentures in terra-cotta, such as the Etruscans used to present to their -divinities as votive offerings in order to be cured, or after having -been cured of dental maladies.] - -As to what concerns dental art, everything leads up to the belief that -it was practised by the Egyptians and Phœnicians earlier than by the -Etruscans, whose civilization, as already hinted, is certainly less -ancient. Nevertheless, in comparing the dental appliances found in the -Etruscan tombs with the sole authentic dental appliance of Phœnician -workmanship known at the present day,[105] we cannot but be struck -with the great superiority of the Etruscan appliances. It is therefore -probable that the Etruscans, although they had learned the dental art -from the Egyptians and Phœnicians, had subsequently carried it to a -much higher degree of perfection than it had arrived at in Egypt or in -Phœnicia. An analogous fact has come to pass in our own times. Dental -art in America, which emanated from the French and English schools, -soon took on so vigorous a development as indisputably to acquire first -rank. - -Before describing in detail the dental appliances found up to now in -Etruscan tombs, we will consider a question touching very closely upon -the argument which we are treating and which has already been discussed -in Professor Deneffe’s book, already cited. - -How is it that the dental appliances of the Phœnicians, Greeks, -Etruscans, and Romans should have come down to us, notwithstanding -cremation? - -In the first place, if one reflects that the teeth offer an altogether -special resistance to the action of fire, and if one also remembers -that gold was the substance employed for the construction of the -appliances in question, and that this metal does not melt save at a -very high temperature, it no longer appears marvellous if, in many -cases at least, the dental appliances should have been able to resist -the cremating process. - -In the second place, the cremation may possibly sometimes have been -incomplete—that is to say, the skeleton may not have been altogether -reduced to ashes; therefore, among the residuum of this incomplete -combustion, a piece of a jaw may easily have remained, and incidentally -also its prosthetic appliance. - -But besides all this, it must be considered that the custom of burning -corpses was not at all general among ancient people. Indeed, cremation -was not in use either among the Egyptians, the Phœnicians, the Hebrews, -or the Chinese; the Greeks only resorted to it in exceptional cases. -The most ancient tombs of the Etruscans show that at the epoch of their -settling in Italy, cremation was in general use among them. But little -by little, as they entered into commercial relations with the Egyptian, -the Phœnician, and the Greek peoples, who did not burn their dead, the -custom of burial substituted that of cremation. Toward the end of the -sixth century before Christ there were to be found in southern Etruria, -one beside the other, tombs for the burial of corpses and others for -cremation. - -One sometimes finds in one and the same tomb a cinerarium (urn for -conserving ashes) and skeletons enclosed in sarcophagi or resting on -mortuary couches. - -At Tarquinii and Orvieto burial generally prevails. - -In the fifth century B.C., the epoch in which the Law of the Twelve -Tables was promulgated, burial and cremation were equally in use among -the Romans. In the second century of the Christian era burial was -already prevalent, and through the influence of Christianity became -general during the third and fourth centuries.[106] - -[Illustration: FIG. 13 - -Tooth crowns found in an Etruscan tomb of the ancient -Vitulonia (Archæological Museum of Florence). The -enamel-capsules of these teeth (four molars and one -canine) are perfectly well preserved, whilst the ivory -has entirely disappeared.] - -[Illustration: FIG. 14 - -The same tooth crowns of the preceding figure, seen from -the side of the concavity of the enamel capsules.] - -Notwithstanding cremation, which certainly must have destroyed a great -number of the dental appliances of that time, and in spite of the many -different destructive agents which successively did their work on those -human remains during so many centuries, not a few prosthetic pieces of -Etruscan workmanship have come down to us; from which we may argue that -dental prosthesis was not an exceptional fact among this people, as -some may perhaps suppose, but, on the contrary, must have been a very -usual practice. - -The dental appliances discovered up to now among Etruscan remains are -preserved in different Italian museums, with the exception of some few -existing in private collections or of others that have passed out of -Italy into other countries. - -In the museum of Pope Julius in Rome there is a dental appliance found -at Valsiarosa in one of the many Etruscan tombs excavated in that -locality near Civita Castellana, the ancient Falerii (Fig. 15). This -appliance is formed by a series of four gold rings meant to encircle -four teeth (canine, bicuspids, and first molar). The third ring is -traversed by a pivot riveted at the two extremities, which was meant to -hold fast an artificial tooth (the second bicuspid); this is wanting, -however. One naturally puts the question. How is the disappearance of -this tooth to be accounted for, it having been traversed by the pivot, -which is still found in its place? The suppositions are two: Either the -artificial tooth was made of some not very durable material, which, in -the course of time, became reduced to powder or fell to pieces, or may -have been destroyed in some other way; or else the artificial tooth, -instead of being simply perforated to allow the pivot to pass through, -was cleft longitudinally at its base and, being introduced into the -ring sat, so to speak, astride the pivot. In the second case, which, -however, seems to me the less probable of the two, the tooth may merely -have come off the pivot and gotten lost. - -In the Civic Museum of Corneto, the ancient Tarquinii, there are two -dental appliances, one of which (Figs. 16 and 17) is of the greatest -interest. It was found in one of the most ancient tombs in the -necropolis of Tarquinii. This specimen of prosthesis is formed of three -teeth; the two upper central incisors and the second bicuspid on the -left, which is no longer in existence. - -[Illustration: FIG. 15 - -Etruscan appliance found at Valsiarosa, destined to support an -artificial bicuspid, now disappeared.] - -To afford support and maintain the three artificial teeth in position, -the Etruscan dentist of about three thousand years ago, ingeniously -made use of the canine and the lateral incisor on the right, the -canine, the first bicuspid, and the first molar on the left, connecting -them by a continuous series of pure gold rings soldered together. The -dentist had not employed human teeth to replace the incisors which -the individual had lost; according to the religious laws of the time, -the dead were held sacred, and it would probably have been considered -sacrilege to use their teeth; or it may also be that the patient had -declared his aversion to the idea of substituting his own teeth by -those of a dead man. However this may be, the Etruscan dentist thought -well to replace the missing incisors with a somewhat large ox tooth; -upon this he had made a groove, so as to give it the appearance of two -teeth. In reality this ox tooth occupies the place not only of the two -middle incisors, but also of the lateral incisor on the left. Perhaps -by a natural anomaly the individual may never have had this tooth; or, -more probably still, some length of time may have elapsed between the -loss of one of the three and the other two, so that when he made up his -mind to have recourse to a prosthetic appliance, the space normally -occupied by the three incisors was already notably diminished, and -the void could therefore be filled by an ox tooth so adjusted as to -represent only two teeth. - -[Illustration: FIG. 16 - -Etruscan appliance for supporting three artificial teeth, two of which -were made of one ox tooth. (Civic Museum of Corneto.)] - -[Illustration: FIG. 17 - -The same appliance reversed.] - -When I was intrusted with the reproduction of all the ancient -prosthetic pieces existing in the Italian museums, I met with special -difficulty in the reproduction of the above-mentioned piece; and this -because I could not succeed in procuring an ox tooth that was not -worn away by the effects of mastication. The idea then occurred to me -of sectioning the upper jaw of a calf at about the age of the second -dentition, and taking out the teeth, which were already strong and well -formed, but not yet deteriorated by mastication. I fancy my Etruscan -colleague must have done the same three thousand years ago, when he -carried out the prosthesis in question, for the large tooth employed by -him does not show any signs of being worn by mastication. - -This large tooth is solidly fixed by means of two pivots to the gold -band that encircles it. Another pivot served to fix the second -bicuspid, also artificial. This tooth, as already stated, has now -disappeared, but the pivot that fixed it to its ring is still in its -place. In carrying out this prosthesis the dentist has contrived the -series of rings that support the teeth in such a manner that they -remained above the gum, and thus the harmful effects of contact and of -the pressure of an extraneous body was avoided. At the same time, this -arrangement, by distancing the rings from the dental neck that narrows -off conically, added to the firmness of the prosthesis. - -[Illustration: FIG. 18 - -Etruscan appliance for supporting two inserted human teeth, one of -which is now wanting. (Civic Museum of Corneto.)] - -Another dental appliance (Fig. 18) which is in the custody of the Civic -Museum of Corneto, was also found in a very old Etruscan tomb. It is -formed by two bands of rolled gold; one of these is labial, the other -lingual, and they are soldered together at their extremities, forming -by the help of four partitions, also of gold, five square spaces. Three -of these served for the reception of the natural teeth supporting -the prosthesis; the other two maintained, by means of pivots, two -inserted human teeth; one of these is lost; the other is still in -its place, solidly fixed by its pivot. These inserted human teeth, -by the religious laws we have before mentioned, could not have been -taken from corpses; probably they belonged to the person himself, and -having fallen out through alveolitis, had been reapplied in the manner -described above. - -[Illustration: FIG. 19 - -Etruscan appliance supporting one inserted tooth (upper middle incisor -on the right) which is now disappeared. (Museum of the Conte Bruschi at -Corneto.)] - -Two Etruscan dental appliances are to be found in the Museum of the -Conte Bruschi at Corneto: one is similar to those already described, -and the other, instead, is of a special kind. The first (Fig. 19) is -formed by a series of four rings, embracing the upper canine on the -right and the three neighboring incisors. It was destined to support -a single inserted tooth, the middle incisor on the right; this has -disappeared, while the pivot by which it was fixed to the ring is still -there, as well as the three natural teeth that afforded support to the -appliance. - -[Illustration: FIG. 20 - -Etruscan appliance intended to avoid the bad effects of convergence, -or, perhaps, to support a purely ornamental artificial substitute. -(Museum of Conte Bruschi at Corneto.)] - -The other appliance (Fig. 20) is formed by two rings; the one surrounds -the left upper canine, the other the left middle incisor. Between these -two rings there is not the usual ring crossed by a pivot, but simply -a small horizontal bar of gold soldered to the two rings. I suppose -that the person not liking to wear false teeth (one meets with this -repugnance also at the present day), the dentist has limited himself to -putting a horizontal bar of gold between the two teeth on either side -of the missing one, in order to maintain them in their normal position -and so avoid the bad effects of convergence. - -[Illustration: FIG. 21 - -Dental appliance still adhering to the jaw, discovered in an Etruscan -necropolis near Orvieto, and now in the possession of the Ghent -University.] - -Another ancient dental appliance discovered in an Etruscan necropolis -near Orvieto is now in the possession of the Ghent University, to -which it was sold.[107] It still adheres to a piece of upper jaw (Fig. -21), in which there are four teeth on each side, that is, on the right, -the canine, the two bicuspids, and the first molar; on the left, the -canine, the second bicuspid, and the two first molars. The alveoli of -the four incisors are of normal width and depth, this signifying that -these teeth remained in their places until the end of life. The dental -appliance, still supported by this fragment of a jaw, is made of the -purest gold. It is composed of a small band curved back upon itself, -the ends being soldered together, and, by the aid of two partitions, -also of pure gold, it forms three compartments, two small lateral -ones, and one centre one of double the size. The lateral compartment -on the right contains the canine of the same side; that on the left -must have contained the left central incisor, that has now disappeared, -while the large central compartment must evidently have contained the -two incisors on the right side. As there is no pivot in the whole -appliance, and as the alveoli are not obliterated, there can be no -doubt that the appliance was simply destined to prevent the loss of the -two right incisors by keeping them steady. - -[Illustration: FIG. 22 - -The same piece as in the preceding figure, seen from the palatal side.] - -It is to be noted, with regard to the Etruscan dental appliances above -described, that the gold bands of which they were constructed covered -a considerable part of the dental crown, so that these prosthetic -appliances certainly could not have had the pretension of escaping -the notice of others, they being, on the contrary, most visible. It -is in consequence to be surmised that in those times the wearing of -false teeth and other kinds of dental appliance was not a thing to be -ashamed of; indeed, that it rather constituted a luxury, a sort of -refinement only accessible to persons of means. Besides this, as the -gold in which these works were carried out was of the purest quality -and in consequence very soft, the appliances would not have possessed -sufficient solidity if the softness of the pure gold had not been -counteracted by the width and thickness of the bands or strips. - -[Illustration: FIG. 23 - -Etruscan appliance (found in 1865 in a tomb by Cervetri), destined -perhaps to support a purely ornamental artificial substitute. -(Belonging to Castellani’s collection, Rome.)] - -[Illustration: FIG. 24 - -A reproduction of the gold piece forming the appliance seen in Fig. 23.] - -In those of the Etruscan appliances destined for the application of -inserted teeth, the gum was not made to support the prosthesis, and did -not, therefore, suffer any compression from the extraneous body, this -resting entirely, like a bridge, upon the neighboring teeth. From which -it may be seen that twenty-five centuries and more before our time the -Etruscans dentists already practised a system of bridge work, and, -relatively to the age, carried it out with sufficient ability. - - - - -CHAPTER VII. - -THE ROMANS. - - -For many centuries the Romans, according to the saying of Pliny, -lived entirely “without doctors, although not without medicine;”[108] -that is, there existed without doubt a popular medicine and also a -sacerdotal medicine, but still there were no persons whose exclusive -occupation it was to cure disease. - -The medical art, properly so called, was introduced into Rome by the -Greeks. The first Greek doctor who went to Rome was Archagathus (in the -year 535 after the foundation of the city, that is, 218 years before -Christ). His arrival was at first welcomed, so much so that he was made -a Roman citizen and a shop bought for him in the Acilian square, at the -expense of the State. However, his popularity was of brief duration. -Being an intrepid operator, the use and abuse he made of steel and fire -gained for him the not very honorable qualification of the butcher, and -he soon became the horror of all the population. - -But it appears that dentistry had begun to be practised in Rome -prior to the coming of Archagathus, that is, long before the medical -profession existed. We have the clear proof of this in the Law of the -Twelve Tables, wherein we find mention made of teeth bound with gold. -The Law of the Twelve Tables was written in Rome 450 years before -Christ, by a body of ten magistrates (_decemviri_) expressly named for -that purpose, as up to that time no written law had existed. - -As gold was at that time somewhat scarce, and fears were entertained -that it would become still scarcer (to the great damage of the State) -by reason of the custom that prevailed among the wealthy of burning -or burying gold articles with the corpses to honor the memory of the -deceased, or, rather, to satisfy the pride of the survivors, it was -thought necessary to prohibit this abuse by a special disposition -of the law referring to funeral pomps. This disposition was thus -formulated: “_Neve aurum addito, ast quoi auro dentes iuncti escunt -(sunt) im cum illo sepelirei vrive sine fraude esto_;”[109] that is, -“Neither shall gold be added thereto (to the corpse); but it shall not -be unlawful to bury or to burn it with the gold with which the teeth -may perchance be bound together.” - -From this it results that at the time when the Law of the Twelve Tables -was written, that is, four centuries and a half before the Christian -era, there were already individuals in Rome who practised dental -operations. And these individuals cannot have been medical men, as at -that epoch (corresponding pretty nearly with the date of Hippocrates’ -birth) Rome had as yet no doctors. - -The inquiry naturally suggests itself whether the gold mentioned in the -legal dispositions above cited was used for fixing artificial teeth or -simply for strengthening unsteady natural teeth. Some authors, Serre -among them,[110] have pronounced in favor of the first hypothesis, -others, as, for example, Geist-Jacobi,[111] are rather disposed to -accept the second. In truth, however, we do not possess sufficient -historical data to definitely resolve this problem. I myself am rather -of opinion that artificial teeth were already in use in Rome, as they -were, even before this time, among the Etruscans. Indeed, if we take -into consideration the priority of the Etruscan civilization to the -Roman and the relations of vicinity existing between Etruria and the -Roman State, of which it afterward became a part, it is even possible -that dental prosthesis was first practised in Rome by Etruscans. - -In a Greek-Roman necropolis near Teano (Province of Caserta, Italy) -there was found in February, 1907, a prosthetic piece of a very -peculiar construction, and which may be considered as quite unique in -its kind. It is an appliance destined to support three inserted human -teeth (the two lower central incisors and the lateral incisor on the -right). These teeth—lost perhaps by the patient himself, in consequence -of alveolar pyorrhea—were fixed by means of a system of rings, made of -laminated gold wire, turned around the teeth and then soldered. - -By the examination of the piece it is easy to argue that the author of -this prosthesis made at first three separate rings by tightly turning -the laminated gold wire around each of the three teeth to be applied, -and by soldering together the ends of the wire forming each ring, after -having taken away the tooth, in order not to spoil it in making the -soldering. Then, with another laminated gold wire of sufficient length, -he soldered the three rings together in due position, put the appliance -in the mouth and turned the two ends of the wire around the sound -teeth, serving as a support for the lateral incisor on the left and -the two canines. After this, he took the apparatus delicately out of -the mouth, made the soldering necessary for finishing the skeleton of -the apparatus, forcibly put the three teeth in their respective rings -again, and applied the prosthesis. - -This ingenious appliance was found still adherent to the mandible of a -skeleton, in a tomb which, according to the eminent archæologist Dalli -Osso, belongs to a period comprised between the third and the fourth -century before Christ. - -From the nature of the objects found in the tomb near the skeleton (a -necklace, perfume vessels, etc.) it was quite evident that the skeleton -bearing the above-described prosthesis was that of a woman. - -As the said appliance was found in South Italy (the ancient “Magna -Græcia”) it is quite probable that it was made by some dentist of the -Greek colonies. - -The above apparatus belongs to the archæological collection of Signor -Luigi Nobile, in Teano, in whose possession it was found. - -[Illustration: FIG. 25 - -Seen from behind. - -FIG. 26 - -Seen from above. - -A prosthetic piece of very peculiar construction (see description), -found in 1907 near Teano, Italy.] - -The Romans, as well as the Hebrews, and other peoples of antiquity, -attributed great importance to the integrity of the dental system. This -may be deduced with certainty from another article in the Law of the -Twelve Tables (Table VII, at the rubric _De delictis_), which says: -“_Qui dentem ex gingiva excusserit libero homini, trecentis assibus -multator, qui servo C L._” (Whoever shall cause the tooth of a free man -to fall shall pay a fine of three hundred _as_, and for that of a slave -one hundred and fifty.) The _as_ was worth about ten cents American -money, so that the first fine amounted to about thirty dollars and the -second to about fifteen dollars. These sums, because of the difference -in the monetary value in those times, were considered heavy fines. - -After the Romans had conquered Greece (146 B.C.) a very great number -of Greek doctors went to Rome. The wealth, luxury, and ever-increasing -corruption of the metropolis caused the practice of the medical art -(which was almost entirely in the hands of the Greeks) to become a -great source of lucre. But an art practised with the sole purpose -of making money soon degenerates to the level of a trade; it is, -therefore, hardly to be wondered at if very few doctors of that epoch -have merited being recorded in history. - -Among these few, the name Asclepiades (born at Prusa, in Asia Minor; -died in Rome ninety-six years B.C.) shines with particular lustre. He -was the founder of the “methodic school,” whose curative precepts, -largely based upon hygiene, come nearer to those of modern scientific -medicine. Unfortunately, all the writings of this great physician, -whose name is almost as glorious as that of Hippocrates, have been -lost; we do not know, therefore, whether and in how far he contributed -to the development of our specialty. - -But one of the first places in the history of dental art is due without -doubt to Cornelius Celsus, of whom we will now speak. - -CORNELIUS CELSUS. The historical researches in regard to the life of -this celebrated author have given but meagre results. It is uncertain -whether his birthplace was Rome or Verona. The precise dates of his -birth and death are also unknown; but it is very probable that he was -born about thirty years before Christ, and that he died during the -fifth decade of the first century. - -Aulus Cornelius Celsus belonged to the illustrious patrician family of -the Cornelii. He was a man of great erudition, and wrote on the most -varied subjects, and among others, on agriculture, on rhetoric, on the -art of warfare, on medicine, etc. All these writings, however, are lost -to us excepting his excellent treatise on medicine. - -Some historians consider that Celsus was a true doctor by profession; -others, instead, hold that he never undertook the cure of the sick. -Neither the one nor the other of these opinions is quite acceptable; -and it is much more likely, as Daremberg observes in his valuable -_Histoire des Sciences Médicales_, that Celsus was one of those -philiatri mentioned by Galen, who had studied medicine rather from -books than at the bedside of the sick, but who, although not doctors by -profession, in case of necessity, put their knowledge and skill into -practice on behalf of their relations and friends.[112] - -The work of Celsus, gathered in great part from Greek authors, has an -especial value, because it sums up, in an admirable manner, the whole -of the medical and surgical science of the ancients, from the earliest -times up to the days of Augustus. - -The first book of the work _De Medicina_[113] does not contain anything -of great importance in regard to dentistry. The following hygienic -precept is, however, worthy of note: “After rising, if it be not -winter, the mouth should be rinsed with a quantity of fresh water.” -In regard to the hygiene of the mouth, nothing more is found in the -work of Celsus; and it is also necessary to note that the aforesaid -precept forms part of a chapter, in which he speaks of the rules of -life, which must be observed by weak people, to which class—the author -remarks—belong a greater part of the inhabitants of cities and almost -all literary men. According to Celsus, therefore, perfectly healthy -and strong people would not even need to wash their mouths with fresh -water, and perhaps the keen-witted Roman doctor was not wrong; for it -is very probable that the saliva and mucous secretion of the mouth, -in perfectly healthy individuals with normal constitutions, have the -power of combating the pathogenic germs that produce caries and other -diseases of the teeth and mouth. In this way the fact can be explained -of many peasants and the greater part of the individuals of the negro -race having such good teeth, without possessing even the remotest idea -of what hygiene of the mouth may be. And here I venture to refer to a -passage in which Celsus alludes to the relation between diseases and -civilization with its vices: “It is probable that in ancient times, -although there was but little knowledge of medicine, health was for -the most part well preserved; this being due to good habits, not yet -spoiled by intemperance and idleness. These two vices, first in Greece -and then among us, have brought upon us a very host of evils; whence it -is that in our days, in spite of the intricate art of medicine—once not -necessary to us, as it is not necessary to other peoples—few among us -attain the beginning of old age.”[114] - -In the second book, speaking of the various kinds of disease to which -the different periods of life are subject, he writes: “Children are -especially subject to serpiginous ulcers of the mouth, called by the -Greeks aphthæ.... There are also infirmities due to dentition, such as -ulceration of the gums, convulsions, fever, looseness of the bowels; -and it is especially the eruption of the canine teeth which produces -these disturbances. To these, however, very fat children are more -particularly liable, and those, also, who have costive bowels.” - -In Chapter XXV of the fifth book we find the receipt for a narcotic -drug, recommended by the author for producing sleep in persons -tormented with odontalgic and other pains. This receipt is very -complicated, being composed of ten ingredients, among which are acorns, -castoreum, cinnamon, poppy, mandrake, and pepper. - -Most important for our subject is Chapter IX, of the sixth book, where -the author treats of odontalgia. “In toothache, which may be numbered -among the worst of tortures, the patient,” says Celsus, “must abstain -entirely from wine, and at first, even from food; afterward, he may -partake of soft food, but very sparingly, so as not to irritate the -teeth by mastication. Meanwhile by means of a sponge he must let the -steam of hot water reach the affected part, and apply externally, -on the side corresponding with the pain, a cerate of cypress or of -iris, upon which he must then place some wool and keep the head well -covered up. But when the pain is violent, the use of purgatives is -very beneficial, the application of hot cataplasms on the cheek, and -the keeping in the mouth of some hot liquid, prepared with fitting -medicine, changing this liquid, however, very frequently. For this -purpose the root of cinquefoil may be boiled in wine, or that of -hyoscyamus (henbane), or a poppy-head, seedless and not too dry, or -the root of the mandrake. But in regard to the last three remedies, -one must be careful not to swallow the decoction whilst it is kept -in the mouth. For the same purpose one may boil the bark of the root -of the white poplar in wine, or the scrapings off a stag’s horn in -vinegar or figs in mulse[115] or in vinegar and honey. It is useful -also to pass repeatedly around the tooth the end of a probe which has -first been wrapped around with wool and then dipped in hot oil. It is -customary also to apply around the tooth certain remedies, after the -manner of plasters. For this purpose the inside of the peel of dried, -bitter pomegranates may be pounded with equal quantities of gall-nut -and pine bark; to these must be added a little minium[116] and the -whole mixed together with the addition of rain water to form a paste; -or else a similar paste may be formed with equal parts of panax,[117] -poppy, peucedanum,[118] and taminia grape[119] without stones; or with -three parts of galbanum to one of poppy. On the cheek, however, must be -applied at the same time the cerate spoken of above, covered over with -wool.” - -Celsus then speaks of a revulsive adopted, in his times, against -odontalgia. It was composed of myrrh and cardamom, _ana_ one part; -saffron, pyrethrum, figs, pepper, _ana_ four parts; mustard seed, -eight parts. The plaster, spread on linen, was to be applied on the -shoulder corresponding to the side of the pain, and, according as this -was situated in a tooth of the upper or lower jaw, the revulsive was -applied on the back of the shoulder, or in front. - -When a tooth is decayed, Celsus advises that there should be no haste -in drawing it; but that the pain be combated, if the above medicines -are not sufficient, with others more energetic. A mixture may, for -example be applied to the tooth, composed of one part of poppy, two -of pepper, and ten of sory,[120] pounded and mixed to a paste with -galbanum; or else, especially in the case of a molar tooth, the remedy -of Menemacus, resulting from saffron, one part; cardamom, soot from -incense, figs, pepper, pyrethrum, _ana_ four parts; mustard seed, eight -parts; or even a more complicated remedy made with pyrethrum, pepper, -and elaterium,[121] _ana_ one part; scissile alum,[122] poppy, taminia -grape, crude sulphur, bitumen, laurel berries, mustard seed, _ana_ two -parts. - -“If, says Celsus, the pain renders necessary the removal of the tooth, -this may be made to fall to pieces, by introducing into the cavity a -pepper berry without its skin, or a berry of ivy, pared in the same -way. The same result may be obtained in the following manner: The sharp -bone (aculeus) of that flat fish called by the Greeks trygon and by us -pastinaca, must first be roasted and then reduced to powder and mixed -with resin, so as to form a paste; which applied around the tooth will -make it fall out. Likewise, scissile alum induces the fall of the -tooth, when introduced into its hollow. This substance, however, is -best introduced into the small cavity, after being wrapped around with -a tuft of wool, for thus the pain is soothed and the tooth preserved.” - -Somewhat curious is the following passage, in which Celsus speaks of -the superiority of a method of cure used by peasants, compared to the -remedies advised by the doctors. From his words we clearly see that he, -as we have already remarked, did not belong to the class of doctors -properly so called. - -“These are the remedies accepted and held in account among the doctors. -But it is known through the experience of peasants, that when a tooth -aches one must pluck up wild mint by the roots, put it into a large -vessel, pour water on it, and make the patient sit near it, covered all -around with a blanket; and red hot stones should then be thrown into -the water, so that they be entirely immersed; and then the patient, -wrapped all around, as we have said before, and keeping his mouth open, -receives into it the steam evaporated from the water. Thus profuse -perspiration is induced, and a great quantity of pituita flows from the -mouth, and with this a cure is obtained for a very long period, often -for more than a year.” - -In the six following chapters of the sixth book, Celsus treats of the -diseases which affect the soft parts of the mouth. Against tonsillitis, -he recommends, among other things, the application of a remedy -principally made of the juice of the sweet pomegranate, cooked, by a -slow fire, to the consistency of honey. The same remedy is also of -great value, according to the author, for the cure of ulcers of the -mouth, when they are accompanied by inflammation, and are somewhat -foul and of a reddish color. But under such circumstances it will also -be necessary to keep frequently in the mouth an astringent decoction, -to which a little honey has been added. The exercise of walking is -also profitable, as well as the taking of food that is not acid. When, -however, the ulcers begin to be clean, the mouth should be frequently -filled with a softening liquid or even with simple pure water. It is -also helpful to drink genuine wine and to eat rather freely, avoiding, -however, acid food. The ulcers must be sprinkled with a powder composed -of two parts of scissile alum to three of unripe gall-nuts. If, -however, the ulcers are already covered with a scab similar to those -produced on burns, some of those compositions should be used which are -called by the Greeks _antheræ_; for example, a remedy may be formed -of equal parts of cyperus,[123] myrrh, sandarac, and alum; or another -which contains saffron, myrrh, _ana_ two parts; iris, scissile alum, -sandarac, _ana_ four parts; cyperus, eight parts. - -“Much more dangerous, says Celsus, are those ulcers of the mouth which -the Greeks call _aphthæ_; they oftentimes lead to death in children; -in adult men and women, however, there is not the same danger. These -ulcers begin in the gums; then they attack the palate and the whole -of the mouth, and finally extend to the uvula and to the fauces; when -these parts are attacked, it is not very likely that a child will -recover.” - -As to the ulcers of the tongue, Celsus says that those which are -situated at the borders of this organ last a very long time, and he -adds: “It should be seen whether there may not be some sharp tooth -opposite, which hinders the ulcer from healing; in case such a tooth -exists, it should have its edge taken off with a file.” - -He then passes on to speak of the diseases of the gums: “Often small -painful tumors, called by the Greeks _parulides_, are produced on -the gums. It is necessary at the very first to rub them softly with -powdered salt, or with a mixture of burnt mineral salt, cyperus, and -catmint, meanwhile keeping the mouth open until there flows from it a -good quantity of pituita; after which the mouth must be rinsed with -a decoction of lentils. But if the inflammation is great, the same -remedies must be used as are adopted for the ulcers in the mouth, and -between the tooth and the gum must be inserted a small tent of soft -lint, on which has been smeared some one of those compositions which -we have said are called _antheræ_. If this, owing to the hardness of -the tumor, is not possible, then by means of a sponge the steam of hot -water should be made to act upon the diseased part, and, besides, an -emollient cerate must be applied upon it. - -“Should suppuration show itself, it will be necessary to use the -above-mentioned steam for a longer period; to keep in the mouth hot -mulse, in which some figs have been cooked, and to lance the tumor -before it is perfectly ripe, so that the pus may not, by remaining too -long in the diseased part, injure the bone. But if the tumor be of -great size, it will be more advisable to remove it entirely, so that -the tooth remain free on both sides. After the pus has been extracted, -if the wound be a small one, it is sufficient to keep hot water in the -mouth, and to use externally fomentations of steam, as mentioned above; -if it be large, it will be fitting to use the decoction of lentils and -the same remedies with which all other ulcers of the mouth are cured. - -“It also happens, sometimes, that from an ulcer of the gums—whether it -follow a parulis or not—one may have for a long period a discharge of -pus, on account of a broken or rotten tooth, or else on account of a -disease of the bone; in this case there very often exists a fistula. -Then the latter must be opened, the tooth extracted, and if any bony -fragment exist, this should be removed; and if there be anything else -diseased, this should be scraped away. Afterward, the same remedies -which have been indicated for the other ulcers of the mouth must be -used. - -“If the gums separate from the teeth, it will be useful, in this -case also, to employ those remedies called _antheræ_. But it is also -beneficial to chew unripe pears and apples and to keep their juices in -the mouth. Equal advantage can be derived from keeping vinegar in the -mouth, provided it be not too strong. - -“Whenever ulcers of the mouth are attacked by gangrene, it is necessary -first to consider whether the whole body be unhealthy, and in that -case, to do what is necessary to strengthen it. When the gangrenous -ulcer is superficial, the use of _antheræ_ is sufficient; when it is -somewhat deeper, a mixture must be applied on it, of two parts of -burnt paper[124] to one of orpiment;[125] when it is very deep, three -parts of burnt paper to a fourth part of orpiment must be used; or -else, equal parts of roasted salt and roasted iris; or lastly, equal -parts of chalcites, lime, and orpiment. It is, however, necessary to -dip a small pledget of lint in oil of roses, and put it on the caustic -medicinals, so that these may not injure the neighboring healthy parts. -If the disease is in the gums, and some of the teeth are loose, it is -necessary to pull them out, for they greatly hinder the cure. When -this latter, however, cannot be obtained by drugs, the ulcer must be -cauterized with a red-hot iron.” - -Chapter XII of the seventh book is, of all the work of Celsus, the -one which presents to us the greatest interest, since there the author -treats of the surgical operations required by the diseases of the -dental apparatus. - -He first speaks of the looseness of the teeth, caused by the weakness -of their roots, or by the flaccidity of the gums, and says that in -these cases it is necessary to touch the gums lightly with a red-hot -iron, then to smear them with honey and wash them with mulse, and later -on to strengthen them by means of astringent substances. - -“When a tooth aches, and it is thought well to extract it, because -medicaments are of no use, the gum must be detached all around, and -then the tooth must be shaken until it is well loosened, it being very -dangerous to draw a firm tooth, as this may sometimes give rise to a -dislocation of the lower jaw. And greater still is the danger in regard -to the upper teeth, as this might cause a shock to the temples and -eyes. After having well loosened the tooth, it must be pulled out by -the fingers, if this is possible; or if not, with the forceps.” - -[Illustration: FIG. 27 - -Dental and surgical instruments represented in a funeral marble of the -Lateran Museum, Rome.] - -It is clear that this method of tooth drawing—so excessively cautious -and timid—must have been very torturing to the poor patients. A -thousand years and more after Celsus, Abulcasis still counsels the same -exaggerated precautions, and says that the extraction of a tooth must -not be performed in a rapid and violent way after the manner of the -barbers. From this one may see that the operation spoken of was then -very often performed by certain unprofessional persons, who, being very -familiar with it, carried it out with great indifference and rapidity, -thus sparing the patients the long-protracted martyrdom which the -erudite doctors, followers of Celsus, thought necessary to make them -endure. Very probably the same happened in the days of the wise Roman -doctor. - -When there is a large carious hollow in the tooth to be extracted, -Celsus recommends that it should first be filled up either with lint -or with lead, in order to prevent the tooth from breaking under the -pressure of the instrument. “The latter,” he continues, “must be made -to act in a straight direction, in order to avoid fracture of the bone. -The danger of fracture is still greater in the case of short teeth; -often the forceps, not being able to grasp the tooth well, takes hold -of the bone with it and fractures the latter. When after the extraction -of a tooth much blood flows from the wound, this indicates that some -part of the bone has been broken. It is necessary then to search for -the detached piece of bone with the probe and to extract it with the -forceps. If this be not successful, an incision must be made in the -gums just as large as is necessary for the extraction of the fragment. -When this is not taken out, it often happens that the jaw swells in -such a manner as to prevent the patient from opening his mouth. In such -a case it is necessary to apply to the cheek a hot cataplasm of flour -and figs, so as to induce suppuration, after which the gums must be -lanced and the splinter of bone extracted.” - -When the teeth show blackish stains, Celsus advises such stains to -be scraped away, and the teeth afterward to be rubbed with a mixture -of pounded rose leaves, gall-nuts, and myrrh, and the mouth to be -frequently washed with pure wine. It is necessary besides, says the -author, to keep the head well covered, to walk a great deal, and to -partake of no acid food. - -“If by effect of a blow or other accident some of the teeth become -loose, it is necessary to bind them with gold wire to the neighboring -firm teeth, and besides to keep in the mouth astringent substances, for -example, wine in which the rind of pomegranates has been boiled, or -into which some burning hot gall-nuts have been thrown.” - -“When in a child a permanent tooth appears before the fall of the milk -tooth, it is necessary to dissect the gum all around the latter and -extract it; the other tooth must then be pushed with the finger, day by -day, toward the place that was occupied by the one extracted; and this -is to be done until it has firmly reached its right position.” - -“Now and again it happens that when a tooth is pulled out its root -remains in the socket; it is then necessary to extract it at once, with -the forceps adapted for the purpose, called by the Greeks _rizagra_.” - -The last book of the work of Celsus treats chiefly of fractures and -dislocations. In the first chapter the position and form of the bones -of the whole human body are described, although not very exactly. -Speaking of the teeth, the author says: “The teeth are harder than the -bones, and are fixed, some on the _maxilla_ (lower jaw) and some on the -overhanging bone of the cheeks.”[126] - -“The first four teeth, being cutting teeth (incisors), are called by -the Greeks _tomici_. These are flanked on both sides by one canine. -Beyond this there ordinarily exist, on both sides, five grinders, -except in the case of those persons in whom the last molars, which -commonly are cut very late, have not yet appeared. The incisors and -the canines are fixed with one single root; but the molars at least -with two, some even with three or four. In general, the shorter the -tooth, so much the longer is its root. A straight tooth commonly has a -straight root, a curved tooth has it generally curved. The root of a -temporary tooth produces in children a new tooth, which usually pushes -out the first; sometimes, however, the new tooth appears either above -or below it.” - -In the seventh chapter Celsus treats of fractures in general, but in -particular of those of the lower jaw. - -“To reduce a fracture of this bone, it should be pressed in a proper -manner, from the inside of the mouth and from the outside, with the -forefinger and thumb of both hands. Then in the case of a transverse -fracture (in which case generally an unevenness in the level of the -teeth is produced), it is necessary, after having set the fragments -in place, to tie together the two teeth nearest to the fracture with -a silk thread, or else, if these are loose, the following ones. After -this, one should apply externally, on the part corresponding to the -lesion, a thick compress, dipped in wine and oil and sprinkled with -flour and powdered olibanum. This compress is to be fixed by a bandage -or by a strip of soft leather, with a longitudinal slit in the middle -to embrace the chin, the two ends being tied together above the head. -The patient must fast the first two days; then he may be nourished with -liquid food, but in small quantities, abstaining, however, completely -from wine. On the third day it is necessary to take off the apparatus, -and after having fomented the part with the steam of hot water, to -replace it. The same is to be done on the fifth day, and so on, until -the inflammation has subsided, which generally happens from the seventh -to the ninth day. After the symptoms of inflammation have vanished, the -patient may take abundant nourishment; he must, however, abstain from -chewing until the fracture is completely consolidated; and, therefore, -he will continue to nourish himself with soups and like food. He must -also entirely abstain from speaking, especially during the first few -days. Fractures of the jaw commonly heal from the fourteenth to the -twenty-first day. - -“In luxations of the jaw (Chapter XII) the bone is always displaced -forward; but sometimes only on one side, and sometimes on both sides. -When the dislocation is only on one side, the chin and the whole jaw -are found deviated toward the part opposite to the luxation; and -the similar teeth of the two dental arches do not correspond; but -instead under the upper incisors will be found the canine tooth of -the dislocated part. If, however, the luxation is bilateral, the -chin inclines and projects forward; the lower teeth are farther in -front than the upper ones, and the muscles of the temples are tightly -stretched. The reduction of the luxation must be performed as quickly -as possible. The patient having been made to sit down, an assistant -holds the head firmly from behind; or else the patient is made to sit -with his shoulders against a wall, with a hard cushion between this and -his head, whilst the assistant holds the head against the cushion, and -so keeps it steady. Then the operator, after wrapping his two thumbs in -linen cloth or strips, that they may not slip, introduces them into the -patient’s mouth and, applying the other fingers on the outside, firmly -grasps the jaw. Then whilst lowering the back part of the latter, he -shakes the chin and pushes it upward and backward, seeking to shut the -mouth, and in this way making the jaw return to its natural position. - -“The bone having been replaced, if the accident should have given rise -to pains in the eyes and neck, it will be well to draw blood from the -arm. After the luxation has been reduced, the patient must be nourished -for some time on liquid food, and abstain, as much as possible, from -speaking.” - -CAIUS PLINIUS SECUNDUS. After Celsus, a very celebrated writer on -medicine and natural science was Caius Plinius Secundus. He was born -at Como in the year 23 of the Christian era, and flourished from the -days of Nero to those of Vespasian. Endowed with a liberal education, -he gave himself up to public life, filling many important posts, among -which, that of Governor of Spain under Nero and his successors. In -the year 79 after Christ, while he was in command of the Roman fleet -at Misenum, the tremendous eruption of Vesuvius took place, by which -Pompeii, Herculaneum, and other neighboring cities were destroyed. -Pliny, driven by the desire to study that marvellous and awful natural -phenomenon, betook himself to Stabia, but was there suffocated by the -ashes and smoke erupted by Vesuvius. - -In spite of the many places occupied by him, Pliny found time to -write many works, and among these the thirty-seven books on _Natural -History_, which have given him eternal fame. - -It is not at all to be wondered at that this immense work contains a -great number of fables, superstitions, and errors of every kind. To -sift the true from the false was not an easy thing, at a time when -there was almost no idea as to how natural phenomena were produced, -and when all scientific criticism was impossible, for the very simple -reason that true science did not exist. - -To give an idea of the great absurdities which were believed in at that -epoch, and which were considered possible even by higher intellects -such as Pliny’s, the following passages will suffice: “In many -mountains of India, according to what Ctesia writes, there are men -with dogs’ heads, who clothe themselves with the skins of wild beasts -and bark instead of speaking. There are also a kind of men having only -one leg, and who have great speed in leaping. Others are without any -neck and have their eyes between their shoulders. Megasthenes writes -that among the nomad Indians are men who instead of a nose have only -holes, and have their legs bent like serpents. At the extreme confines -of India, toward the East, are men without any mouth and with their -bodies entirely covered with hair, who live on nothing but air and -odors, which they inhale through the nose.”[127] - -In Pliny’s day the most prodigious virtues were attributed to herbs; in -regard to this the following example is sufficient: - -“The herb near which dogs may have made water, when gathered, but -without being touched by iron, cures luxations very promptly.”[128] - -It must not be thought that Pliny accepted such beliefs without -reserve. He notes them, because preceding authors had accepted them, -and because if certain things appear to us evidently absurd, their -absurdity could not be equally evident at a period when little more -than nothing was known in regard to physical and physiological laws, -and when the impossibility of rationally explaining natural effects -led men to admit the existence of marvellous virtues and influences in -every being and in all bodies. On the other hand, Pliny expressly says, -for his own justification, in Chapter I of Book VII: “I do not want to -bind my faith in many things which I am about to say; but rather refer -the readers to the authors from whom I have taken them.” - -As is to be expected, we find in Pliny’s works, in regard to teeth, a -strange mixture of truth and errors. - -In Chapter XV of Book VII, after having said that some children are -born with teeth, and after having cited, as examples, Manius Curius, -who was therefore called Dentatus, and Gnæus Papirius Carbo, both -illustrious men, he adds: - -“In women such a thing was considered a bad augury in the days of the -kings. In fact, Valeria having been born with teeth, the seers said -that she would be the ruin of the city to which she would be taken; she -was sent to Suessa Pometia, which in those days was a very flourishing -city; and, in fact, the prediction was verified. Some, instead of -teeth, have an entire bone; of this there was an example in the son of -Prusias, King of Bithynia, who instead of upper teeth had one single -bone.” - -“The teeth alone are not consumed by fire, and do not burn with the -rest of the body. And yet these teeth, which withstand the flames, -are worn away and hollowed out by pituita. They wear out by being -used. Nor are they necessary for mastication alone, for the foremost -ones regulate the voice and words, producing by the beat of the tongue -special sounds.” - -“Men have thirty-two teeth, women a lesser number. It is, however, -believed that augury may be taken from the teeth; and to have a greater -number than usual is considered an indication of long life. The -presence of two eye teeth at the right side of the upper jaw presages -favorable fortune, as was verified in Agrippina, the mother of Domitius -Nero; on the left side, however, they are of sad foreboding.” - -“The last teeth, which are called the genuine teeth, appear toward the -twentieth year of age; many persons, however, do not have them until -their eightieth year. Teeth fall out in old age and then spring up -again; of this there can be no doubt. Mutianus writes of having known -a certain Zancle of Samothracia, in whom teeth reappeared after he had -completed his one hundred and fourth year. Timarcus, son of Nicocles of -Paphus, had two rows of molar teeth, whilst a brother of his did not -change his incisor teeth at all, which, therefore, wore down little -by little. There once lived a man who had a tooth in his palate. The -canine teeth, when by any chance they fall out, do not reappear any -more.”[129] - -“In the teeth of man there exists a poisonous substance which has the -effect of dimming the brightness of a looking-glass when they are -presented uncovered before it; and if they are uncovered in front of -young unfledged pigeons, these take ill and die.”[130] - -The second of these two statements is but a prejudice, like many -others; but we find the first very strange indeed, it being a -surprising thing that a man like Pliny should have attributed to -an imaginary poison of the teeth what is the simple effect of the -moistures of the breath. - -In Chapters CXV and CXVII of Book XI are found some observations which -are somewhat interesting to us: - -“A man’s breath becomes infected by the bad quality of food, by the bad -state of the teeth, and still more by old age.” - -“Simple food is very beneficial to man; the variety of flavors -instead is very harmful. Sour or too abundant foods are digested with -difficulty, and also those which are ravenously swallowed. As a remedy, -vomiting has come into use; but it makes the body cold and is most -pernicious to the eyes and to the teeth.” - -There is no doubt that the habit of often provoking vomitus—which, -in those times of excessive corruption and intemperance, had come -into general use—must have resulted in enormous harm to the teeth, -especially by the action exercised upon them by the hydrochloric -acid contained in the gastric juice, and by the organic acids of -fermentation. - -Among the vegetable remedies in those times considered of use against -odontalgia, the principal ones are mentioned in Chapter CV of Book XXV: - -“It is beneficial against toothache to chew the root of panax, and -likewise to wash the teeth with its juice. It is also useful to -chew the root of hyoscyamus soaked in vinegar, or else that of the -polemonium. It is also beneficial to chew the roots of the plantain, or -to wash the teeth in a decoction of plantain in vinegar. A decoction of -the leaves is also useful, not only in the case of simple toothache, -but also when the gums are tender and easily bleed. The seed of -the same plant cures inflammations and abscesses of the gums. The -aristolochia strengthens the gums and the teeth. The same effect may be -produced by masticating the verbena with its root, or by washing the -mouth with a decoction of it in wine or vinegar. Similarly the roots -of the cinquefoil are helpful when boiled down to a third, in wine or -vinegar; however, they must first be washed in salt water or brine. The -decoction must be kept for a long time in the mouth. - -“Instead of using the decoction of cinquefoil, some prefer to rub the -loose teeth with the ashes of this plant. Besides the above-mentioned -remedies, the root of the verbascum boiled in wine, hyssop, and the -juice of the peucedanum with opium are also employed; and it is also -beneficial to pour into the nostrils, on the side opposite to that of -the sick tooth, some drops of the juice of anagallis. - -“It is said that if senecio be taken from the earth, and the aching -tooth be touched three times with it, spitting alternatively three -times, and then the herb be replanted in the same spot, so that it may -continue to live, the tooth will never give pain any more.”[131] - -“In the fuller’s thistle,[132] an herb which grows near rivers, is -found a small worm, which has the power of curing dental pains, when -the said worm is killed by rubbing it on the teeth, or when it is -closed up with wax in the hollow teeth.”[133] - -“Apollonius writes that a very efficacious remedy for pains in the gums -is to scratch them with the tooth of a man who has suffered a violent -death.”[134] - -“It is considered very beneficial for toothache to bite off a piece -from wood which has been struck by lightning, and to touch the sick -tooth with it; but whilst biting off the little piece of wood, it is -necessary to keep both hands behind the back.”[135] - -“Experience teaches that against the bad odor of the breath it is -useful to wash the mouth with pure wine before sleeping, and that to -avoid aching of the teeth, it is a good thing to rinse the mouth, in -the morning, with several mouthfuls of fresh water, but of an odd -number.”[136] - -“A remedy for toothache is to touch the diseased teeth with the -tooth of a hyena,[137] or to scratch the gums with the tooth of a -hippopotamus which has been taken from the left side of the jaw.”[138] - -“The ashes of stag’s horn, rubbed over loose and aching teeth, makes -them firm and soothes the pain. Some consider that to produce the same -effect, of greater virtue is the powder of the horn, unburnt. Both -the ashes and the powder of stag’s horn are employed as a dentifrice. -The ashes of the head of a wolf are a great remedy for toothache. -Such pains are also made to cease by wearing certain bones that are -oftentimes found in the dung of this animal. The ashes of the head of a -hare is a useful dentifrice; and if spikenard be added, it will lessen -the bad smell of the mouth. Some mix with it the ashes of the heads of -mice. In the side of the hare is a bone as sharp as a needle; and many -advise pricking the teeth with this when they ache. The heel of the ox -kindled and brought close to loose teeth makes them firm. The ashes of -this bone mingled with myrrh is a good dentifrice. A good dentifrice -is also made from the ashes of the feet of a goat. To strengthen teeth -loosened by a blow, asses’ milk or the ashes of the teeth of this -animal are very useful. In the heart of the horse there is a bone like -an eye-tooth; it is said that it is very beneficial to pick with it the -teeth that ache. The carpenter’s glue boiled in water and plastered -on to the teeth also takes away their pain; but soon after it must be -taken away and the mouth rinsed with wine in which have been boiled the -rinds of sweet pomegranates. It is also thought beneficial to wash the -teeth with goat’s milk or with ox-gall.”[139] - -“Butter, either alone or with honey, is very useful for children; and -is very helpful, especially during dentition, in the diseases of the -gums, and to cure the ulcers of the mouth. To prevent the disorders -that generally accompany dentition, it is a useful thing that the child -should wear a wolf’s tooth, or one of the first teeth lost by a horse. -The rubbing of the gums with goat’s milk or with hare’s brain renders -the cutting of teeth much easier.”[140] - -“To sweeten the breath it is very helpful to rub the teeth and the gums -with wool and honey.”[141] - -“The filth of the tail of sheep rolled up in little balls, and left to -dry and then reduced to powder and rubbed on the teeth, is marvellously -useful against the loosening and other diseases of the teeth themselves -and against the cankerous ulcers of the gums.”[142] - -“Eggshells deprived of their internal membrane and afterward burnt -afford a good dentifrice.”[143] (Hence we see that the use of carbonate -of lime as a dentifrice is a very ancient one.) - -“If the head of a dog that has died mad be burnt, the ashes obtained -may be advantageously used against toothache, mixing it with cyprine -oil and then dropping the mixture into the ear, on the side of the -pain. It is beneficial also to pick the sick tooth with the longest -tooth, on the left side, of a dog; or with the frontal bones of a -lizard, taken from the head of the animal at full moon, and which -have not touched the earth. The teeth of a dog, boiled in wine until -this is reduced to one-half, thus, furnish a mouth wash which can -be advantageously used against toothache. In the cases of difficult -dentition, benefit is derived by rubbing the gums with the ashes of -the teeth of a dog, mixed with honey. Such ashes are also used as a -dentifrice. In hollow teeth it is useful to introduce the ashes of -the dung of mice, or of the dried liver of lizards. It is the opinion -of some, that in order not to be subject to toothache, a mouse should -be eaten twice a month. If earth-worms be cooked in oil, this latter -has the virtue of calming toothache when dropped into the ear on the -side of the pain. The same effect is obtained by rubbing the teeth -with the ashes of the aforesaid worms, after they have been burnt in -a terra-cotta vase; and if such ashes be introduced into the hollow -teeth, these fall out very easily. A good remedy against toothache is -to wash the mouth with vinegar of squills in which earth-worms and -the root of the mulberry have been boiled. The ashes of the shells of -snails mixed with myrrh, rubbed on the gums, strengthens them. Even -the slough which the snakes cast off in spring can furnish a remedy -against toothache. For this purpose it must be boiled in oil, with -the addition of resin of the larch, and then the oil dropped into the -ear. For the same purpose, according to some, oil of roses is useful, -when a spider, caught with the left hand, has been pounded in it. If a -sparrow’s fledglings be burnt with dry vine twigs, the resulting ashes -rubbed with vinegar on the teeth makes all pain cease in them.[144] It -is stated by many that to improve the odor of the breath, it is well -to rub the teeth with ashes of mice mixed with honey. Some also mingle -with this the root of fennel. Picking the teeth with the quill of a -vulture renders the breath sour. It makes the teeth firm to pick them -with a porcupine’s quill. A decoction of swallows in wine sweetened -with honey cures ulcers of the tongue and lips. Scaldings in the mouth -produced by hot food or drinks are readily healed with the milk of a -bitch.”[145] - -That Pliny did not put great faith in many of the things which he -relates is clearly proved by several passages of his book, and among -others by the following: - -“One can hardly relate without laughing, some things, which, however, -I will not omit, because they are found already written. They say -that the ox has a small stone in the head, which it spits out when -it fears death; but if its head be suddenly cut off, and the stone -extracted, this, worn by a child, helps it in wondrous manner to cut -its teeth.”[146] - -In Book XXXI, Pliny speaks of various waters—mineral, thermal, -etc.—especially from the medical point of view. It was already known -in those days that those waters were most active agents. And in this -respect a fact which the author relates in Chapter VI of Book XXV is -worth mentioning: - -“When Caesar Germanicus moved his camp beyond the Rhine, there was -found, in the whole maritime tract of the country, only one spring of -fresh water, the drinking of which, within two years, produced the fall -of teeth and a loosening of the knee-joints. The doctors called these -evils stomacace and scelotyrbe.” - -Sea salt and nitre are of use, according to Pliny, against various -maladies of the teeth and mouth. He counsels the application of salt -on lint to the ulcers of the oral cavity, and to rub it on the gums -when they are swollen. To prevent diseases of the teeth, it would be -advantageous, every morning before breaking one’s fast, to keep a -little salt under the tongue until it is dissolved. Against the pain -of the teeth it would be beneficial to use common salt dissolved in -vinegar, or nitre in wine. - -“The rubbing of the blackened teeth with burnt nitre gives them back -their natural color.”[147] - -The prophylactic remedies against odontalgia believed in, at that -period, were sufficiently numerous, and, among many other such things, -Pliny informs us that in order not to be subject to toothache, it is -sufficient to wash the mouth three times a year with the blood of the -tortoise.[148] Analogous virtue was also attributed to the brain of the -shark, which was boiled in oil, and this put by for washing the teeth -with once a year. - -Besides the many anti-odontalgic remedies so far related, several -others are found enumerated in Chapter XXVI of Book XXXII: - -“The pain in the teeth is lessened by picking the gums with the bones -of the sea dragon. It is also very beneficial to pick the gums with -the sharp bone of the puffin.[149] If the same be pounded together -with white hellebore, and the mixture thus obtained be rubbed on the -diseased teeth, they may be made to fall out without pain. The ashes, -also, of salt fish burnt in an earthen vase, with the addition of -powdered marble, is a remedy against toothache. Frogs are also boiled -in a hemina[150] of vinegar, the decoction being then used to wash -the teeth with; but this, however, must be kept in the mouth for -some length of time. In order to render this remedy less nauseous, -Sallustius Dionisius used to hang several frogs, by their hind feet, -over a vase in which he boiled the vinegar, so that the juices of the -animals might drip into this from their mouths. To make loose teeth -firm, some advise the soaking of two frogs, after having cut off -their feet, in a hemina of wine, and the washing of the mouth with -the latter. Others tie them, whole, on the jaws. Some, to strengthen -unsteady teeth, rinse them with a decoction made by boiling ten frogs -in three sextaries[151] of vinegar, until the liquor is reduced to -one-third. By others, thirty-six hearts of frogs are well boiled in -a sextary of old oil, in a copper vessel, and the oil is then used -against toothache, dropping it into the ear, on the side of the pain. -Some, after having boiled the liver of a frog, pound it with honey, and -smear it on the sore teeth. If the teeth are decayed and fetid, many -counsel the drying of a hundred frogs in an oven, leaving them there -for one night, then the addition of an equal weight of salt, reducing -the whole to powder, and rubbing the teeth with it. In such cases the -ashes of crabs are also used. That of the murex[152] is adopted as a -simple dentifrice.” - -“The cutting of teeth is facilitated by rubbing the gums of the child -with the ashes of dolphin’s teeth mixed with honey, or even simply by -touching the gums with a tooth of this animal.”[153] - -In Chapter XXXIV of Book XXXVI it is said that the decoction of -gagates[154] in wine cures the diseases of the teeth; and in Chapter -XLII of the same book are praised the dentifrice powders made of pumice -stone. - -From the examination of Pliny’s work several important facts come out. - -The diseases of the teeth were, in those days, most common; very -often we find mention of loose teeth, and the medicines suited to -make them firm again; from which we may deduce the great frequency -of alveolar pyorrhea. It is reasonable to think that such a fact was -caused principally by the intemperate life of those times, in which -the followers of Epicurus were extremely numerous and the unbridled -desire for pleasure reached such a degree that no abhorrence was felt -of provoking vomit during the course of a long banquet, in order to -continue dining merrily. - -Concerning the teeth, their affections, and the means of healing and -preventing them, the strangest superstitions existed, and this not -only among the common, but also among educated and learned people. The -number of remedies reputed useful against diseases of the teeth was -extraordinarily great; but the modern saying, “therapeutic wealth is -poverty,” could have been applied only too well. - -Of the cleanliness of the teeth, it seems, great care was taken, for -dentifrices were in great use. These, as we have already seen, were -made of the most varied substances—stag’s horn burnt, ashes obtained -by burning the head of the mouse, of the hare, of the wolf, etc., -eggshells burnt and reduced to powder, pumice stone, and so on. For the -cleanliness of the mouth, for strengthening the teeth and gums, mouth -washes of sundry kinds were likewise adopted, especially formed of -decoctions of astringent substances in water, wine, and vinegar. - -Not only among the Romans was great care given to the cleanliness and -beauty of the teeth, but also among many other nations. In this regard -the following poem of Catullus, in which he lashes the silly vanity of -a Celtiberian resident in Rome, who made continual show of his white -teeth, is somewhat interesting: - - “Egnatius, quod candidos habet dentes - Renidet usquequaque; seu ad rei ventum est - Subsellium, cum orator excitat fletum, - Renidet ille: seu pii ad rogum filii - Lugetur, orba cum flet unicum mater, - Renidet ille; quidquid est, ubicumque est, - Quodcumque agit, renidet: hunc habet morbum, - Neque elegantem, ut arbitror, neque urbanum. - Quare monendus es mihi, bone Egnati, - Si Urbanus esses, aut Sabinus, aut Tiburs, - Aut parcus Umber, aut obesus Hetruscus, - Aut Lanuvinus ater, atque dentatus, - Aut Transpadanus, ut meos quoque attingam, - Aut quilibet, qui puriter lavit dentes: - Tamen renidere usquequaque te nollem; - Nam risu inepto res ineptior nulla est. - Nunc, Celtiber, in celtiberia terra - Quod quisque minxit, hoc solet sibi mane - Dentem, atque russam defricare gingivam. - Ut quo iste vester expolitior dens est, - Hoc te amplius bibisse prædicet lotii.”[155] - -STRABO. From Strabo we learn that the Cantabri and other peoples of -Spain used to clean their teeth and sometimes even to wash their face -not with fresh, but with old urine, which, so it seems, was kept for -the purpose, in suitable cisterns![156] - -In regard to this filthy custom, Joseph Linderer says[157] that the -superstition has reached even to our times, although not widely -diffused, that, to beautify the face, it is useful to wash it with -urine. He relates that he knew a girl who, to become beautiful, had -recourse to this heroic method, but, unfortunately, without at all -obtaining the desired end! - -MARTIAL. In the epigrams of Martial (about 40 to 101 A.D.) allusions of -great value with regard to several points concerning the subject we are -treating of are found. - -Toothpicks (_dentiscalpia_) are mentioned by this poet several -times; from which we may argue that they were in great use. They -were ordinarily made of lentisk wood (_Pistacia lentiscus_), as may -be deduced from the Epigram LXXIV of Book VI, in which the author -ridicules the old dandy who, stretched at length on the triclinium, -cleans with _lentiski_ the toothless mouth, to give himself the air -of a man not too far stricken in years.[158] Besides, in Book XIV, -containing, for the greater part, saws and sayings on objects of common -use, there is an epigram bearing the title of “Dentiscalpium,” in which -the author says that toothpicks of lentisk are to be preferred, but -that, in their absence, quill toothpicks may be used.[159] - -[Illustration: FIG. 28 - -An ancient toothpick and ear-picker of gold, found in Crimea.] - -From other sources we learn that in those days metal toothpicks -were also made use of. So in a satire of Petronius, it is said that -Trimalchiones made use of a silver toothpick (_spina argentea_). -Objects of this kind, both Roman and of other origin, are even now in -existence, and may be found in various collections of antiquities. In -Crimea a most elegant gold object, of Greek make, was found, which is, -by its two ends, both a toothpick and an ear-picker. It belongs most -probably to the fourth century before Christ.[160] - -In an object found in the north of Switzerland, and coming from a -Roman military colony of the times of the Empire, the toothpick and -ear-picker are joined at one of their ends, by a pivot, to other toilet -articles.[161] - -[Illustration: FIG. 29 - -A metal toothpick and ear-picker joined to other toilet articles. An -object found in Switzerland, in the ancient seat of a Roman military -colony.] - -[Illustration: FIG. 30 - -An ancient toothpick and ear-picker of bronze, found in the north of -France, at Bavai (the ancient Bagacum).] - -Caylus, in his valuable work _Recueil d’antiquités égyptiennes, -étrusques, grecques, romaines et gauloises_ (Paris, 1752 to 1767), -gives the picture of a toothpick and ear-picker of bronze, two inches -long, with the middle part wrought in spiral form, so as to increase -the solidity of the article, and also to enable the hand to keep it -easily firm in all positions. It was found in the north of France, at -Bavai (the ancient Bagacum), and forms part of the collection of M. -Mignon of Douai.[162] - -Martial is one of the first Roman writers who speak clearly of -artificial teeth. In Epigram LVI of Book XIV, the poet, by a bold -personification, makes the dentifrice powder say to a toothless old -woman, furnished with false teeth: “What have you got to do with me? -Let a girl use me. I am not accustomed to clean bought teeth.”[163] - -Elsewhere[164] Martial atrociously derides a courtesan, who, among her -other physical defects, was also without an eye: “Without any shame -thou usest purchased locks of hair and teeth. Whatever will you do for -the eye, Laelia? These are not to be bought!”[165] - -This epigram shows that, while dental prosthesis was already in use, -ocular prosthesis did not as yet exist. - -To a plagiarist, who passed off Martial’s poetry as his own, the latter -says: “With our verses, O Fidentinus, dost thou think thyself and -desire to be thought a poet. Even so, it seems to Ægle that she has all -her teeth, because of her false teeth of bone and ivory.”[166] - -There is, therefore, not the least doubt that in the days of Martial -artificial teeth were in use; and that these, as may be seen from -the epigram just now quoted, were made of ivory and bone; we do not -know whether they were formed also of other substances. The question, -however, arises: In those times did they manufacture movable artificial -sets, or was the dental art then limited to fixing the artificial teeth -unmovably to the neighboring firm teeth, by means of silk threads, gold -wire, and the like? The answer to this question may be found in another -epigram of Martial,[167] where the latter ridicules a wanton old woman, -telling her, among other things still worse, that she at night lays -down her teeth just as she does the silken robes.[168] - -It is, therefore, beyond all doubt that, at that period, the manner of -constructing movable artificial sets was known; and most probably not -only partial pieces were made, but even full sets. In fact, from the -verse quoted above we have justly the impression that the poet means a -whole set rather than a few teeth. - -From the words of Martial, it may also be concluded that these dentures -could be put on and off with the greatest ease; or, as we may say, by -a maneuver as simple as that of removing any articles of apparel; they -must, therefore, have been extremely well constructed. - -This alone should be sufficient, even were further proof wanting, -to give us an idea of the degree of development and of the point of -perfection reached by dental prosthesis at that time. But besides this, -we now also possess an ancient Roman piece furnishing a palpable proof -of the ability and ingenuity of the dentists of that epoch. Some few -years since, I had occasion, in the pursuit of dental archæological -research, to visit the Museum of Pope Julius in Rome, where I was shown -a prosthetic piece, not yet exhibited to the general public, that had -been discovered a few months previous in excavating at Satricum, near -Rome. I was invited to give an opinion as to this appliance, and, after -having examined it accurately, became aware, not without some emotion, -I am fain to confess, that I held in my hands a prosthetic piece of -exceptional historical importance, that is, no less than a specimen of -ancient _crown work_. - -[Illustration: FIG. 31 - -Roman appliance found at Satricum; crown of lower incisor made of gold.] - -[Illustration: FIG. 32 - -The same, seen from below.] - -The appliance found at Satricum (Fig. 31) is made in the following -manner: Two small plates of gold, stamped out, represent respectively -the lingual and labial superficies of a middle lower incisor; these -two pieces soldered together form the crown of the tooth. At its base -the crown is soldered, back and front, to a narrow strip of gold which -folds back on itself at each end, so as to tightly encircle the two -neighboring teeth on the right and on the left, which thus serve as -supports to the appliance. - -We are now, therefore, able not only to affirm that the Etruscans knew -how to execute a kind of _bridge work_, but that later the dentists of -ancient Rome even carried out _crown work_. - -This, notwithstanding the examples of dental prosthesis discovered -up to now in Roman and Etruscan tombs, can in no way be considered -as representing all the varieties of dental prosthesis of ancient -construction. It is to be hoped that, in spite of the destructive -action of time, in continuing the excavations and archæological -researches, many other specimens of early dental prosthesis will yet -come to light. In any case, judging by some indications to be found -in Latin literature, it must be admitted that the Roman dentists of -antiquity constructed other kinds of prosthesis besides the specimens -we possess, and in particular movable dentures. We are led to suppose -this, not only from the above cited epigram of Martial, but also from -what we read in one of the satires of Horace, who dates contemporarily -with Augustus, and therefore anteriorly to Martial. Speaking of two -old witches who had been put to flight by Priapus, Horace writes: “You -would have laughed to see those two old witches run toward the town, -losing in their flight, Canidia, her false teeth, Sagania, her false -hair.”[169] - -Now, as Prof. Deneffe very rightly observes, the prosthetic appliances -of antiquity known to us are so firmly fixed to the natural teeth -that no race, however unbridled, could ever have made them fall out -of the mouth. It must, therefore, be admitted, as I have said, that -the ancients constructed other kinds of dental appliances, of which no -specimens have, as yet, been discovered. - -Neither in Celsus nor in Pliny, nor in any other Roman writers on -medicine, do we find any allusion to the art of dentistry. The doctors -of those days probably had no idea of the advantages which could be -derived from dental prosthesis in regard to digestion and consequently -to the health of the whole body. They therefore must have considered -artificial teeth as something totally foreign to their art, and -intended solely to hide a physical defect. It is therefore not at all -surprising that they have not treated of this subject. - -As the art of setting artificial teeth was exercised by persons not -belonging to the medical profession, it is very probable that these -persons also undertook the extraction of teeth and the cure of dental -pains. Martial (Book X, Epigram LVI) names a certain Cascellius, who, -he says, “extracts or cures diseased teeth,”[170] and this is the first -dentist whose name has been sent down to us. In spite of this, nothing -permits us to affirm that there existed at that time a class of real -dentists, viz., of persons dedicated to the exclusive cure of dental -disease. There are strong reasons for doubting this, especially when -we consider that the Latin language has no word corresponding to the -word dentist. If there had existed a true dental profession, there -ought also to have existed a name for indicating the individuals who -exercised it. Therefore, it must be considered highly probable that, -although there undoubtedly existed individuals who were especially -skilled in the cure of the diseases of the teeth, such persons did -not form a special class; perhaps, among those to whom recourse was -had for the cure of dental diseases, some were doctors, particularly -skilled in such diseases, others were perhaps barbers, and so forth. -As to the far-fetched deductions of Geist-Jacobi, according to whom the -name given to dentists by the Romans must have been that of _artifex -dentium_ or _artifex medicus dentium_, these are founded, above all, on -imagination. It is extremely improbable that such names existed, when -one considers that they are not met with, even once, in the whole range -of Latin literature. - -SCRIBONIUS LARGUS. Among the writers on Medicine in the early period of -the Empire, one of the most eminent was, without any doubt, Scribonius -Largus, physician to the Emperor Claudius, whom he accompanied to -England in the year 43. - -Scribonius Largus, in his book _De compositione medicamentorum_, -pronounces himself energetically against the division of Medicine into -single special branches. He declaims against the many who attributed -to themselves the name of doctors, simply because they knew how to -cure some diseases. According to him, the true doctor must be skilled -in curing all kinds of affections. This, in truth, was possible in -those times, but would be almost impossible nowadays, on account of the -enormous development of the healing art. The ideas, however, expressed -by Scribonius Largus have a certain historical importance, for they -show that in his times the medical art had certainly the tendency to -split up into many special branches, among which there must certainly -have been dentistry, but that the necessity of such separation was not -by any means universally recognized; the great doctors of those days -undertook the cure of the diseases of the teeth, as well as those of -any other part of the body. - -The tenth chapter of the book of Scribonius Largus treats of the cure -of odontalgia. The author begins by saying that it is the opinion of -many that the only true remedy against toothache is the forceps. With -all this, he adds, there are many medicaments, from which great benefit -may be derived against these pains, without it always being necessary -to have recourse to extraction. Even when a tooth is affected with -caries, says the author, it is not always advisable to extract it; but -it is much better, in many cases, to cut away the diseased part with a -scalpel adapted for the purpose. - -“Violent toothache may be calmed in various ways, viz., with mouth -washes, masticatories, fumigations, or by the direct application of -fitting medicaments. It is beneficial to rinse the mouth frequently -with a decoction of parietaria or of cypress berries, or to apply to -the tooth the root or the seeds of the hyoscyamus wrapped up in a -cloth, and dipped from time to time in boiling water, or to chew the -portulaca (purslane), or to keep for some time its juice in the mouth.” - -“Suitable also against toothache are fumigations made with the seeds of -the hyoscyamus scattered on burning charcoal; these must be followed -by rinsings of the mouth with hot water; in this way sometimes, as it -were, small worms are expelled.”[171] - -This passage of Scribonius Largus has given rise to the idea that the -dental caries depends upon the presence of small worms, which eat -away the substance of the tooth. Such an explanation must have well -succeeded in satisfying the popular fancy; and it is for this that -such a prejudice, although fought against by Jacques Houllier in the -sixteenth century, has continued even to our days. - -With regard to this I would like to record the following fact: Not many -years ago there lived in Aversa, a small town near Naples, Italy, a -certain Don Angelo Fontanella, a violin player, who professed himself -to be the possessor of an infallible remedy against toothache. When -summoned by the sufferer, he carried with him, in a bundle, a tile, -a large iron plate, a funnel, a small curved tube adjustable to the -apex of the funnel, a piece of bees’ wax, and a small packet of onion -seed. Having placed the tile on a table, the iron plate was put upon -it, after it had been heated red hot. Then the operator let a piece -of bees’ wax fall upon the red-hot iron, together with a certain -quantity of the onion seed; then, having promptly covered the whole -with the funnel and made the patient approach, he brought the apex of -the said funnel close to the sick tooth, in such a way as to cause the -prodigious, if somewhat stinking, fumes produced by the combustion of -the wax with the onion seed to act upon it. In the case of a lower -tooth, the above-mentioned curved tube was adapted to the funnel, so -that the fumes might equally reach the tooth. The remedy, for the most -part, had a favorable result, whether because the beneficial effect was -due to the action of the hot vapor on the diseased tooth, or to the -active principles resulting from the combustion of the wax and onion -seed, or to both, or perhaps also, at least in certain cases, to the -suggestion that was thus brought to bear upon the sufferer. It would -not be at all worth while to discuss here such a point. The interesting -part is that when the patient had declared that he no longer felt -the pain, Don Angelo, with a self-satisfied smile, turned the funnel -upside down, and showed on its internal surface a quantity of what he -pretended to be worms, which he affirmed had come out of the carious -tooth. Great was the astonishment of the patient and of the bystanders, -none of whom raised the least doubt as to the nature and origin of -these small bodies, no one having the faintest suspicion even that -these, instead of coming from the tooth, might come from the onion seed! - -According to Scribonius Largus, toothache might also be taken away by -fumigations of burnt bitumen. He affirms also that great benefit may -be derived against odontalgia by masticating the wild mint, or the root -of the pyrethrum, or by covering the diseased tooth with a plaster -composed of peucedanum juice, opopanax, incense, and stoneless raisins. -But before making use of this last remedy, he advises that the tooth -and the gums near it should be fomented with very hot oil, by means of -a toothpick or ear-picker wrapped around, at one end, with some wool. -If the pain does not entirely cease, or comes on again, it is well, -says the author, to continue the fomentations with hot oil, above the -plaster, until the pain ceases. To strengthen loose teeth, Scribonius -advises frequent rinsings of the mouth with asses’ milk or with wine -in which have been cooked the roots of the sorrel until the liquid has -boiled down to one-third. Another remedy which he recommends against -looseness of the teeth is composed of honey and alum mixed together in -a mortar, in the proportion of two parts of the first to one of the -second, and then cooked in an earthen vase, so as to render the mixture -more homogeneous, and to give it more consistency. He also speaks of -a third medicament, resulting from cooking strong vinegar, alum, and -cedria[172] in a copper vessel until it has the consistency of honey. -This remedy would serve not only to make loose teeth firm, but the -author assures us also that whoever rubs the teeth with it, three times -a month, will never be subject to dental pains. - -Scribonius Largus gives the receipts for various dentifrice powders in -use at that period. The skin of the radish dried in the sun, pounded -to powder, and then passed through a sieve, would furnish a good -dentifrice, suited to strengthen the teeth and to keep them healthy. -Very white glass, similar to crystal, reduced to a very fine powder -and mixed with spikenard, is also, according to Scribonius Largus, a -valuable dentifrice. - -Octavia, sister of Augustus, used a powder which our author highly -commends, saying that it strengthens the teeth and makes them very -beautiful.[173] To prepare it, one must take a sextary[174] of barley -flour and knead it well to a paste with vinegar and honey mixed -together, and must divide the mass into six balls, each of which must -be mixed with half an ounce of salt; these balls must then be cooked -in the oven until carbonized; and lastly pounded to powder, as much -spikenard being added as is necessary to give it an agreeable perfume. - -Scribonius Largus also lets us know the tooth powder made use of by -Messalina, the wife of the Emperor Claudius; this was composed of -calcined stag’s horn, mastic of Chios, and sal ammoniac, mixed in -the proportion of an ounce of mastic and an ounce and a half of sal -ammoniac to a sextary of the ashes of stag’s horn. - -SERVILIUS DAMOCRATES, a Greek physician, who acquired great renown in -Rome toward the middle of the first century, was the author of many -valuable works, both in verse and prose, which, unfortunately, have -been lost. His works are mentioned by Galen, who testifies to his great -esteem for Damocrates, calling him an eminent physician, and quoting -various passages from his works, and among others three poetical -receipts for dentifrice powders. From these receipts it appears that -Damocrates attached the greatest importance to the cleanliness of the -teeth, and that he considered this the indispensable condition for -avoiding disease of the teeth and gums. - -ANDROMACHUS THE ELDER, of Crete, the physician of Nero, who conferred -upon him, for the first time, the title of _archiater_, became famous -through his _theriac_, an extremely complicated remedy, the virtues of -which were sung by him in a Greek poem, dedicated to the Emperor. The -theriac was considered an antidote against all poisons and a remedy -against the greater part of diseases, in short, as a real panacea. -It is not even necessary to remark that this portentous medicine, -which has held a post of honor, from ancient times almost up to the -present day, was also used against odontalgia; and in those cases in -which this was produced by caries, Andromachus advised the filling up -of the cavity with the electuary which he rendered so famous. As the -chief basis of the theriac was opium, combined with stimulating and -aromatic substances, there is no doubt that its use locally or even -internally would prove beneficial, temporarily at least, in many cases -of odontalgia.[175] - -ARCHIGENES, of Apamea, a city of Syria, lived in Rome toward the end -of the first century and at the beginning of the second, under the -Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great -fame as a physician and as an operator, and distinguished himself -particularly by daring amputations and trepannings. He recommends -various remedies against odontalgia, among which are mouth washes -of strong hot vinegar, in which gall-nuts or halicaccabum[176] have -been boiled. He usually introduced into carious teeth a mixture of -turpentine and vitriol of iron (_sory ægyptium_), or a mixture of -pepper, and oil of spikenard or of almonds, and this was also dropped -into the ear, on the side on which the pain was felt. - -Archigenes, too, like other great physicians of that time, recommended -various remedies taken from the animal kingdom against diseases of -the teeth, which now seem very strange to us, but at that period -appear to have been in great use. Thus, it would be of great benefit -to hold in the mouth for some length of time a mixture of vinegar and -water in which a frog has been well cooked. The slough of a serpent, -burnt and then reduced, by the addition of oil, to the consistency of -solidified honey, would be a valuable remedy, which being introduced -into a carious hollow, and plastered all around the tooth and on the -surrounding parts, would cause the most violent pain to cease. And, -moreover, desiring to cause a diseased tooth to fall out, it would be -enough to apply to and press upon it a piece of the unburnt slough of a -serpent. Two excellent anti-odontalgic remedies to be introduced into -carious hollows would be roasted earth-worms and spikenard ointment -mixed with the crushed eggs of spiders. It would be also of use to drop -into the ear on the side of the aching tooth some oil of sesamum in -which earth-worms have been cooked. - -When the pain is situated in broken teeth, Archigenes advises them to -be cauterized with a red-hot iron. - -Against bleeding of the gums, he recommends rubbing them with very -finely pulverized alum and myrtle and the application of astringent and -tonic liquids. - -When odontalgia appears to depend upon an inflammatory condition, he -advises the aching teeth to be plastered up with a mixture composed of -red nitre, pounded peach kernels, and resin. - -Archigenes repeatedly recommends the cleaning of the teeth and of the -carious cavities before applying to the former or introducing into the -latter the appropriate remedies.[177] - -But Archigenes’ principal merit, so far as concerns the art of -dentistry, consists in his having guessed that odontalgia, in certain -cases, arises from a disease of the interior part of the tooth (viz., -from inflammation of the pulp) and in having discovered an excellent -method for curing such cases. When a tooth appeared discolored, -without being affected by caries, and was the seat of violent pains, -against which every remedy had proved of no avail, Archigenes -perforated it with a small trephine, invented by himself for the -purpose. He applied the instrument to that part of the crown which was -most discolored and drilled right down to the centre of the tooth.[178] - -Without doubt this talented surgeon was induced to adopt this method of -cure by the idea of the existence of morbid substances in the interior -of the tooth and by the consequent indication of giving them a free -exit. - -The operation devised by Archigenes proves, among other things, two -important facts: first, that the anatomical constitution of the teeth -had already been explored, seeing that Archigenes did not ignore the -existence of the pulp cavity; and secondly, that Archigenes was greatly -opposed to the extraction of a tooth unless absolutely necessary. -It might be thought that such aversion depended upon an exaggerated -idea of the dangers connected with the extraction of a tooth, an idea -widely diffused at that period; but regarding such a daring surgeon as -Archigenes was, it is more logical to suppose that in similar cases he -had recourse to trephining and not to extraction, especially on account -of the importance he attached to the preservation of the tooth. - -Surgery in ancient times was eminently conservative; later on—partly -by effect of its own progress—it became too readily inclined to the -removal of diseased parts; in modern times it has again become what it -was originally, and what it must ever be, viz., conservative in the -highest possible degree. - -CLAUDIUS GALEN, after Hippocrates the greatest physician of ancient -times, was born at Pergamus, a city in Asia Minor, in the year 131 of -our era. His father Nicon, a man of great abilities, who was at the -same time a man of letters, a philosopher, a mathematician, and an -architect, had put him, at a very early age, to the study of science -and of the liberal arts. Galen began to study medicine at the age -of seventeen, under the guidance of skilful doctors of his native -country; he made several journeys in order to have the benefit of the -instruction of celebrated masters, and finally frequented the renowned -medical school at Alexandria. On going to Rome, in the thirty-fourth -year of his life, he soon acquired in that city a very high renown. -He died in the first decade of the third century, but we do not know -exactly in what year. - -Galen was a most prolific writer, and his works, considering the period -in which they were written, form a real medical encyclopedia. Anatomy -through his researches made considerable progress, for he studied with -the utmost care and attention (especially in apes) the bones, muscles, -heart, bloodvessels, brain, nerves, and every other part of the -organism. His anatomical researches enabled him to correct many errors, -but as he had dissected almost exclusively animals and not human -corpses, he himself fell into several errors, especially in attributing -to man parts which he does not possess, for example, the intermaxillary -bone. - -Galen justly observed that the inferior maxilla (resulting, according -to him, from the union of two bones, which, indeed, is embryologically -true) has in man, proportionally to the other bones of the skeleton, a -lesser length than in animals. - -He holds that the teeth must be enumerated among the bones, and does -not admit any doubt to be raised on this point, as these parts can be -looked upon neither as cartilages, nor as arteries, nor as veins, nor -as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat, -nor as hair—a method of reasoning by elimination which is very specious -but far too weak! - -Galen indicates exactly the number of incisor, canine, and molar teeth -(without, however, making any distinction between small and large -molars), and speaks of the different functions of these three kinds of -teeth. Not always, he says, are the molars of each jaw five in number -on each side; in some individuals there appear only four; in others -six. The incisors and canines have but one root; the upper molars have -generally three, but sometimes, though not often, four; the lowers have -for the most part two, rarely three. - -Galen is the first author who speaks of the nerves of the teeth. He -says that these organs are furnished with soft, that is sensitive, -nerves[179] belonging to the third pair.[180] The teeth, according to -him, are furnished with nerves, both because, as naked bones, they have -need of sensibility, so that the animal may avoid being injured or -destroyed by mechanical or physical agencies, and because the teeth, -together with the tongue and the other parts of the mouth, are designed -for the perception of the various flavors.[181] - -In regard to odontalgia, Galen made some very important observations on -his own person: - -“Once when I was troubled with toothache, I directed my attention to -the seat of the pain, and thus I perceived very clearly, that not only -was the tooth painful but also pulsating, which is analogous to what -happens in inflammations of the soft parts. To my astonishment, I had -to persuade myself that inflammation may arise even in a tooth, in -spite of the dental substance being hard and lapideous. But another -time, when I again was attacked by odontalgia, I perceived very -distinctly that the pain was not localized in the tooth, but rather in -the inflamed gums. Having, therefore, suffered these two kinds of pain, -I have acquired the absolute certainty that, in certain cases, the -pain is situated in the gums, in others, on the contrary, in the very -substance of the tooth.” - -When a tooth becomes livid, Galen deduces from this that the tooth -is the seat of a morbid process equivalent to inflammation. Besides, -he says, we cannot be surprised that the teeth may be subject to a -phlogistic process, when we consider that these, like the soft parts, -assimilate nourishment. The teeth, by effect of mastication, are -continually worn down, but nutrition repairs the losses, and they, -therefore, preserve the same size. But when a tooth from want of its -antagonist is consumed but little or not at all by mastication, we -see that it grows gradually longer, for the very reason that under -such conditions the increase due to nutrition is not counteracted by a -corresponding waste. - -The nutritive process of the teeth may, according to Galen, be altered -either by excess or by defect; from which arise morbid conditions, -quite different the one from the other. An excess of nutrition produces -a phlogistic process analogous to that of the soft parts; a defect of -nutrition makes the teeth thin, arid, and weak. The first of these -pathological states is met with especially in young men and must be -fought against with the ordinary antiphlogistic means, designed to -eliminate the excess of humors (evacuant, resolvent, revulsive, and -astringent remedies). As to defect of nutrition, this is met with most -frequently in old people. It has the effect not only of making the -teeth thin, but also of enlarging the alveoli, from which there results -a looseness of the teeth more or less noticeable. Against this morbid -condition we do not possess, says Galen, any direct remedy; however, it -can be combated, up to a certain point, by strengthening the gums with -astringent medicaments, so that they may close tightly around the teeth -and thus make them firm. - -Dental caries is produced, according to Galen, by the internal action -of acrid and corroding humors, that is, it is produced in the same -manner as those cutaneous ulcers which appear without any influence -of external causes. The cure must consist in acting upon such -vicious humors by means of local or general medicaments according to -circumstances and also in strengthening the substance itself of the -teeth by the use of astringents and tonic remedies.[182] - -After these preliminary remarks, Galen gives a minute description of -the numerous remedies which, from his own experience and from that of -other great doctors, were to be considered useful for the cure of the -various affections of the teeth and gums. - -Against gingivitis and the pains deriving from it, the best remedy, -according to Galen, consists in keeping in the mouth the oil of the -lentisk moderately warm; noting, however, that such a remedy is the -more efficacious the more recently it has been prepared. - -A decoction of the root of the hyoscyamus in vinegar, used as a mouth -wash, is another remedy recommended by Galen against the pains in the -gums. It would also be of benefit to apply on the inflamed gums a -powder composed of one part of salt to four of alum, afterward washing -the mouth with wine or with a decoction of olive leaves. If the gums -are ulcerated, Galen recommends them to be cauterized with boiling -oil, using for the purpose a little wool wrapped around a probe or -toothpick. This medicament, says Galen, greatly modifies the diseased -part, exciting a reparative process in it, to aid which, however, -suitable remedies must be used, and especially frictions with a mixture -of gall-nuts and myrrh reduced to a fine powder. - -For the cure of epulides the application of green vitrol, together with -an equal quantity of powdered myrtle and a little alum, is especially -recommended. - -In dentition, if the gums are painful, it is advisable to rub them with -the milk of a bitch. The teeth, moreover, appear very readily, says -Galen, if the gums be rubbed with hare’s brain. - -Against odontalgia, properly so called, independent, that is, of -diseases of the gums, Galen particularly recommends warm applications, -either on the cheek or directly on the tooth. Externally, on the side -of the pain, may be applied dirty (!) pieces of linen, well warmed, -or else small bags full of roasted salt, or cataplasms of linseed -or barley flour. But if it is desired to act directly upon the sick -tooth, this may be rubbed with a branch of origanum (wild marjoram) -dipped in hot oil, or else, after applying a bit of wax on the tooth, -the heated end of a probe may be laid upon it; or lastly, fumigations -may be made by burning the seeds of the hyoscyamus. In case the above -remedies, or others like them, be found of no use, Galen recommends -them to be adopted anew after having perforated the sick tooth by means -of a small drill. But if even from this no benefit be derived, and it -is considered well to remove the tooth, this can be done without pain -by the application of special medicaments. Among these the root of -pyrethrum kept in very strong vinegar for forty days and then pounded -takes the first place. The remedy is applied after having well cleaned -the sick tooth, and after having covered the others with wax. At the -end of an hour the tooth will have already become so loose that it can -be drawn out with the fingers or with the mere help of a style. The -same effect may be obtained, says Galen, by the application of blue -vitriol mixed with very strong vinegar. - -To prevent a carious tooth from producing pain or fetor, he advises the -carious hollow to be filled up with black veratrum mixed to a paste -with honey. - -To restore to blackened teeth their whiteness, Galen advises them to -be rubbed with special medicaments, one of which is made up of dried -figs, burnt and pounded, with spikenard and honey. He gives, besides -the receipts of many dentifrice powders and tinctures designed both to -strengthen the teeth and gums and as preservatives against the diseases -of these parts. Such powders and tinctures do not offer any interest -to us, since they do not much differ from those recommended by other -authors whom we have previously quoted. - -When one or more teeth, in consequence of a trauma, or from other -cause, become loose and project above the level of the others, Galen -removes the whole exuberant part by means of a small iron file. In -performing this operation, after having covered the gums with a soft -piece of cloth, he holds the tooth to be filed steady with the fingers -of the left hand, using the file in such a way as not to give the tooth -any shock. Besides, he does not complete the operation at one sitting, -but rather interrupts it as soon as the patient feels any pain, and -continues it after one or two days. In the meanwhile, he makes use of -remedies suited to strengthen the loosened teeth, and bids the patient -remain silent and nourish himself with liquid or soft food. - -When the teeth, without the action of external causes, become loosened, -Galen holds that this is due to a relaxation of the dental nerve in -consequence of an excessive abundance of humors. In such cases he -counsels the use of desiccative remedies. - -Galen, like ancient authors in general, is not very favorable to -the extraction of teeth with the forceps. Even he seems convinced -that a tooth may be made to fall out, without pain, by means of the -application of certain remedies, to which we have already alluded. -However, in one of the Galenic books[183] we find the precept already -given by Celsus, that before extracting a tooth the gums must be -detached all around; from which one may argue that, at least in certain -cases, instrumental extraction was considered inevitable. Galen even -alludes to the pain which sometimes remains after the extraction of a -tooth, and is of the opinion that this depends upon an inflammatory -condition of the stump of the dental nerve. - -In Galen are found recorded many means of cure, recommended by -celebrated doctors of ancient times. Elsewhere we have already spoken -of some remedies counselled by Damocrates, by Andromachus the elder, -and by Archigenes. Apollonius, as a medicament against odontalgia, -advised that the juice of the beet root be dropped into the nostrils, -or else a liquid prepared from cumin seed, myrrh, cucumber, and -woman’s milk. Heraclides of Tarentum recommended against the pains and -looseness of teeth that a vinous decoction of black veratrum, mandrake, -and hyoscyamus root should be kept in the mouth. Criton prescribed, for -strengthening loose teeth, that the mouth should be frequently washed -with a vinous decoction of lentisk, myrtle, and gall-nuts. - -CELIUS AURELIANUS. In the book _De morbis acutis et chronicis_, written -by Celius Aurelianus (who lived, according to some, in the third -century, according to others, in the fourth or at the beginning of the -fifth), a very interesting chapter on odontalgia is found. He shows -himself to be, for the most part, a follower of Celsus. During the -violence of the pain he advises abstinence from food and rest in bed -with the head somewhat raised. As remedies he recommends several mouth -washes (infusions or decoctions made with wine or vinegar and with -various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil, -poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides, -the application of wool soaked in hot oil on the cheek of the affected -side, or the application of little warm bags, and also that some hot -oil, or the juice of fenugreek,[184] should be kept in the mouth, -or milk with honey. When the pain is excessively violent, he has -recourse to bloodletting, and after two days’ fasting, he begins to -feed the patient with liquid and warm food. If the bowels are closed -he prescribes the use of clysters, and when, in spite of all, the -pain persists, he has recourse to scarified cuppings on the cheek, in -correspondence with the pain. In certain cases he also proceeds to -scarification of the gums, or else he detaches them all around from -the tooth, by means of a special instrument called a _pericharacter_. -It would often turn out useful to apply to an aching tooth a grain of -incense warmed by the fire and wrapped in a thin piece of cloth, or to -press between the teeth, where the pain is situated, several pieces of -cloth, in succession, in which some powder of incense has been wrapped, -and which are dipped into hot oil before being used. The author, -moreover, commends external fomentations made by means of sponges -soaked with emollient decoctions and afterward squeezed; and also the -application of moderately hot cataplasms. - -[Illustration: FIG. 33 - -Roman dental forceps found (1894) at Hamburg, Germany, in the ancient -Roman castle Saalburg. (Geist-Jacobi.)] - -When the odontalgia has already become inveterate and recurs in -paroxysms, separated by intervals of calm, Celius Aurelianus counsels, -among other things, that the general health be strengthened by -temperate living, exercise, rubbing of the whole body (an ancient -practice, now revived under the name of massage). He recommends, -besides, special rubbing of the cheeks (to be carried out with a rough -cloth), and also of the gums and teeth, and indicates a great number -of medicaments, some of which are to be used during the paroxysms and -others during the periods of calm. In regard to the use of narcotics, -he very shrewdly observes that such remedies take away sensibility but -not pain. Some doctors of those days, for the cure of odontalgia, had -recourse to sternutatories, or to the dropping of special medicaments -into the nose or into the ear, but Celius Aurelianus seems to have -put but little faith in such means of cure. He, moreover, solemnly -reproaches those who, to cure odontalgia, are too hasty in having -recourse to the extraction of the aching tooth. To remove a part, -says he, is not to cure it; and if every tooth that aches has to be -extracted, it would be necessary to draw them all out when they all -ache. Therefore, before having recourse to extraction, every other -means of cure should first be tried. If the removal of the tooth -becomes indispensable, he advises that it should never be performed -during the violence of the pain, for from this serious consequences -might arise (a prejudice which has not yet entirely vanished, and -which is met with, sometimes, not only among common people, but even -among physicians); and a still greater danger would be the extraction -of teeth neither carious nor loose, seeing that, by consensus, the -muscles, the eyes, and the brain might suffer. The author, on this -point, quotes Herophilus and Heraclides of Tarentum, who related -some cases in which the extraction of a tooth was followed by death. -He alludes, moreover, to a passage of Erasistratus, regarding the -“odontagogon of lead” (_plumbeum odontagogum_) which was exposed in -the temple of Apollo at Delphi; as much as to show that it was not -lawful to extract teeth other than those which were so loose that an -instrument of lead was sufficiently strong to extract them. - -When the looseness of the teeth seems to depend upon the flaccidity -of the gums, Celius Aurelianus recommends astringent mouth washes: -decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince, -of myrtle berries, etc.; and besides these, lentiscine oil and asses’ -milk, which latter was also believed to possess astringent virtues. -Against hemorrhages of the gums, he advises the use of very fine coral -powder, or of alum with honey. - -GNAEUS MARCELLUS EMPIRICUS, of Burdigala (Bordeaux), who lived at the -end of the fourth century and at the beginning of the fifth, wrote -a book, _De medicamenti_, which shows, more than anything else, the -decadence of the medical science in those days. Regarding the diseases -of the teeth and their cure, Marcellus does not tell us anything new. -He freely copies Scribonius Largus and other authors, not adding -anything save a few methods of cure, which are exceedingly strange -and superstitious. To get rid of toothache, it is sufficient that the -patient, when the moon is waning, and in the days of Mars (Tuesday) -or of Jupiter (Thursday), repeat seven times the words _argidam_, -_margidam_, _sturgidam_. It is a great pity that a curative method so -simple and easy be efficacious in two days of the week alone, and even -then on condition that the moon be waning. - -The following method is also a very good one: Whilst in the open -country, one must take a frog by the head, open its mouth and spit into -it, then having begged the animal to take the toothache with it, must -replace it on the ground and let it free. To remove loose teeth easily, -it is necessary to keep in reserve some juice of black ivy mixed with -a little green oil; in case of necessity, the nose of the patient -must be anointed with it, and after having drawn a deep inspiration, -he must put a little stone between his teeth, and stay with his mouth -open, inclined a little forward, so as to let all the morbid humor -flow out, which sometimes flows very abundantly and even may reach to -three herminæ.[185] Having afterward rubbed the nose with pure oil, and -washed the mouth with wine, the teeth will be free from every pain and -may be very easily pulled out. If the root[186] of a tooth be rubbed -with dried African sponge, the tooth will fall out within three days; -naturally, says the author, care must be taken not to touch, whilst -doing this, any healthy tooth. He who desires never to be subject to -pain in the teeth, may obtain this end by the following method: When -at the beginning of spring he sees the first swallow, he must go in -silence to some running water, take some of it in his mouth, rub his -teeth with the middle fingers of both his hands, and say: “_Hirundo,_ -_tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non -doleant toto anno._”[187] - -The same must be done each following year, so as to continue to enjoy -the effects of such a cure! - -ADAMANTIUS, an Alexandrine philosopher and physician, who probably -lived in the fourth century, paid much attention to the diseases of -the teeth, as may be argued from two chapters of the _Tetrabiblos_ -of Ætius. One of these chapters is entitled, according to the Latin -translation of Giano Cornario: “Cura dentium a calido morbo doloroso -affectorum, ex Adamantio, sophista.”[188] This writer clearly belonged -to the pneumatic school, founded as early as 69 A.D. by Athenæus -of Cilicia. According to the pneumatics (so called, because they -admitted the existence in the animal organism of an aëriform principle, -_pneuma_, to which they attributed great importance), heat and dryness -gave rise to acute maladies; the phlegmatic affections generally arose -from humidity, and melancholy was brought on by cold and dryness, as -every object dries up and becomes cold on the approach of death. The -author says that the cure must vary according as the disease affects -in a greater degree the gums or the teeth themselves with or without -participation of the dental nerves and neighboring parts. He makes, -in regard to this, many subtle distinctions; but the remedies which -he counsels do not offer to us any special interest, being almost -identical with those that had been recommended by Galen and by other -doctors prior to Adamantius. The latter also gives much importance -to dietetic therapy; he prescribes that such patients should nourish -themselves with pottages of barley, or of spelt, with eggs, lettuce, -pumpkins, and other cooling food, abstaining, however, from wine.[189] - -The author enumerates among the causes of such dental affections the -dryness of the air, the autumnal season, the dry constitution of the -individual, a troubled life, and scanty nourishment. The use of sour -and piquant substances is not favorable to these patients, so much so -that the mulberry preserve produces, not unfrequently, violent dental -pains in them. Adamantius, therefore, advises, in such cases, not to -use strongly astringent mouth washes, but rather lenitive, moistening, -and emollient substances; simple lukewarm water, decoction of bran, -licorice juice, starch with boiled must of wine diluted with warm -water, milk, especially asses’ milk, decoction of mallows and the -like.[190] - -The work of Adamantius from which Ætius has taken the above-mentioned -chapters is lost to us. Of his writings there only remain to us -the treatise _on the winds_ and the one _on physiognomics_. In this -latter book the author attributes great importance to the canine teeth -as physiognomonic elements, and from their shape and size he makes -deductions in regard to the character of the individual. - -ORIBASIUS (316 to 403), the most celebrated of all the compilers who -appeared during that long period of decadence, wrote, by order of the -Emperor Julian the Apostate, whose physician and friend he was, a -whole medical encyclopedia and later on a summary (synopsis) of this -same work of his. In the books of Oribasius are found many things -about dentition and diseases of the teeth, but they are all taken, -substantially, from preceding authors, and therefore it is not worth -while repeating them. - -ÆTIUS OF AMIDA, a celebrated Greek writer on medicine, lived at the -end of the fifth century, and at the beginning of the sixth, and has -also left us a kind of medical encyclopedia, which, being divided into -four sections, each composed of four books, was called _Tetrabiblos_. -He teaches that the mucous membrane of the gums, tongue, and mouth -is provided with nerves from a portion of the third pair of cerebral -nerves, and that the teeth, too, by a small hole existing at the end -of every root, receive tiny ramifications of sensitive nerves, having -the same origin. The nutrition of the teeth is understood by Ætius in -the following way: The nourishment which reaches the dental nerves is -not entirely assimilated by them; these only appropriate the liquid or -soft part and reject the drier part. This accumulates in the alveoli, -becomes by degrees more tenacious and denser, finally being transformed -into osseous substance and forming the nutriment of the teeth; these, -therefore, tend to grow continually, although the waste arising from -the mechanical action of mastication prevents them from undergoing -any real or visible growth. On the other hand, in the old, from the -weakening of the nutritive functions, the teeth become thin and loose, -and finally fall out.[191] - -Ætius advises that during dentition hard objects to chew should not be -given to children, seeing that the gums being hardened by these and -becoming almost callous would render the cutting of the teeth very -difficult.[192] - -For curing parulides, he recommends emollients at the beginning of the -disease, and later on astringents. But if the inflammation of the gums -does not resolve and passes into suppuration, he prefers to perform the -excision of the parulis, instead of making a simple incision, which -might very easily cause the abscess to change into a fistula.[193] - -The epulis, according to Ætius, is a fleshy excrescence of the -gums, brought on by inflammation. To cure it, he uses, during the -inflammatory period, emollients, and then, when the inflammation has -subsided, astringents and weak caustics. Lastly, if the epulis resist -these remedies, he takes hold of it with a vulsella and proceeds to -remove it with a small scalpel.[194] - -When the incision of a fistula of the gums and the use of appropriate -remedies are not sufficient for curing it, Ætius advises the extraction -of the diseased tooth, from which the fistula has its origin.[195] - -Apart from what has been mentioned, Ætius does not tell us, in regard -to dental diseases, anything worthy of note, and in many places he only -repeats Galen’s observations. - -PAUL OF ÆGINA (seventh century) establishes a very clear distinction -between epulis and parulis. The epulis is a fleshy excrescence of the -gums in the neighborhood of a tooth; the parulis is an abscess of the -gums. To cure the former affection it is necessary, says the author, -to seize and stretch the tumor with a vulsella or with a hook and to -perform its excision. As to the parulis, although not unfrequently it -is sufficient, for curing it, to give an exit to the pus by means of -a slight incision, the author, however, usually prefers the method of -cure recommended by Ætius, viz., excision. After such operations he -orders the patient to rinse his mouth with wine and on the morrow with -hydromel.[196] From the third day onward he sprinkles the wound with -a cicatrizing powder, until a complete cure is obtained. But if the -wound, instead of healing, be transformed into a putrid ulcer resisting -all the ordinary means of cure, it is necessary to cauterize the part -affected with an oval-shaped cautery.[197] - -In extracting a tooth, the operation is begun by detaching the gum all -around it as far as the alveolar border; then the tooth is seized with -the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus, -recommends that before extracting a tooth deeply attacked by caries, -the cavity be filled up with lint, in order to avoid the crumbling of -the tooth under the pressure of the instrument. On the other hand, he -too is convinced that a diseased tooth can be made to fall out without -pain, by the use of suitable remedies. - -When supernumerary teeth cause an irregularity of the dental arches, -this must be corrected, says the author, either by resection of such -teeth, if they are very firm, or by their extraction. - -If a tooth projects above the level of the others, the protruding part -must be removed with the file. This instrument must also be employed to -remove the sharp edges of broken teeth. - -Tartar incrustations must be removed either with scrapers or by means -of a small file.[198] - -During the period of dentition one must not give children any food -which requires mastication, and to soften the gums they must be -anointed with hen’s fat or with hare’s brain.[199] - -To preserve the teeth and to keep them healthy, Paul of Ægina -recommends all tainted food to be avoided, and also all possibility of -indigestion and frequent vomitings; the use of very hard or glutinous -food or of such as may easily leave a residuum between the teeth, for -example, dried figs, and likewise very cold food and such as set the -teeth on edge. He also advises that hard things should never be broken -with the teeth and that the latter be carefully cleaned, especially -after the last meal of the day.[200] - -Paul of Ægina also belongs to the class of compilers; but in utilizing -the writings of the great physicians who had preceded him, he gives -evidence of exquisite good sense, and not infrequently subjects the -assertions of his predecessors to an intelligent and enlightened -criticism. Besides, he inserts here and there observations and -experiences of his own that are not without interest. He has always -been, and rightly so, considered one of the greatest physicians of -ancient times, the great reputation which he justly held among the -Arabs contributing not a little to his renown. - -This author is the last of the Byzantine period, and with him, -therefore, we must close the earlier part of the history of dentistry. -If, before passing to the middle period, we cast a glance over the -ground already traversed, it is easy to perceive that dental art, in -ancient times, reached its highest degree of development at the time -when the Roman civilization was in its greatest splendor, when, in the -capital of the world, wealth, luxury, and the refinements of social -life marvellously increased its needs, and by this also gave an impulse -to the evolution of all human activity. But ancient civilization, -after having reached its culminating point, soon fell into decadence, -and this necessarily would result in a hindrance to the development -of dental art. From the days of Archigenes right up to those of Paul -of Ægina, dentistry did not make the least progress; indeed, as far -as prosthetic dentistry is concerned, there was probably a retrograde -movement, it being very likely that when Italy was subject to the -dominion of the barbarians and when Christianity—which but recently had -asserted itself—was strongly imposing on the human mind a deep contempt -for all that regarded the welfare and beauty of the human body, no one -could, any longer, think of artificially repairing the losses sustained -by the dental system through disease or injury. - - - - -PART II. - -SECOND PERIOD—THE MIDDLE AGES. - - - - -CHAPTER VIII. - -THE ARABIANS. - - -The religious fanaticism excited by Islamism, transformed the obscure -and nomad inhabitants of Arabia into a conquering nation, who very soon -extended their power over a considerable part of Asia, Africa, and -Europe. Spain, invaded by the Arabs in 711, fell almost entirely into -their hands. After having by force of arms rendered themselves powerful -and dreaded, the Arabians acquired also great fame by the culture of -art and science within the limits allowed them by their religious -code; and in these, for more than four centuries, they maintained an -incontestable preëminence. - -Unfortunately, as the Koran most absolutely prohibited the dissection -of dead bodies, all serious anatomical research was thereby rendered -impossible. This was a very great hindrance to the progress of anatomy, -of physiology, and, in consequence, of the whole of medical science. -The Arabians certainly had the merit of keeping alive the study of -medicine in an age of decadence and barbarism; but, apart from the -important progress realized by them in chemistry and pharmacology, -it may be affirmed that the Arabs contributed but scantily to the -development of the healing art; they followed almost entirely in the -footsteps of Galen and other ancient, and especially Greek, authors. - -One of the characteristics of Arabian medical art consists in the -aversion to bloody operations and in the effort to avoid them. A like -tendency shows itself also in the sphere of dentistry; the Arabians, -even more than their Greek and Roman predecessors, were reluctant to -extract teeth, and employed all possible means, in order to avoid the -operation. - -RHAZES (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was -born in Persia toward the middle of the ninth century, and gave himself -up to the study of medicine when about thirty years of age, having -previously been a musician. He wrote many works which, unfortunately, -have, for the most part, been lost. Rhazes did not have recourse to -the extraction of teeth, save as a last resource when every other -attempt at cure had proved useless; which method would no doubt have -deserved high praise, had the author been inspired by the principles of -conservative surgery, rather than by unjustifiable fears. Caries of the -teeth is, according to him, identical with that of the bones. To hinder -its progress and propagation to the neighboring teeth, he advises the -carious cavity to be filled with a “cement” composed of mastic and -alum. We have here a laudable attempt at permanent stopping of decayed -teeth, although it is clear that the duration of such stopping, owing -to the nature of the materials employed, could not be a long one. -Furthermore, he counselled the patient to abstain from the use of acid -food or drink and to rub the teeth with powder of gall-nuts and pepper. - -To strengthen loosened teeth, he recommended astringent mouth washes -and sundry dentifrice powders. Others, partly taken from Galen, are -recommended by him for prophylactic purposes and for cleansing and -beautifying the teeth. - -Against periodontitis and the pains produced by it, he sometimes had -recourse to bleeding. He commended, besides, opium, oil of roses, -pepper, and honey, and also the scarification of the gums and the -application of a leech. If, however, these remedies did not succeed, he -applied his theriac, which was composed of castoreum, pepper, ginger, -storax, opium, and other ingredients, to the roots of the teeth. If -even this method of cure failed, he touched the root of the diseased -tooth with a red-hot iron, or sought to provoke its fall by the use -of special medicaments, such as coloquintida and arsenic (a substance -to which he had recourse, particularly in those cases where there was -ulceration of the gums). It is no wonder that such means of cure would -sometimes produce, as a final result, the actual falling out of the -tooth; and this, as is natural, served to strengthen the belief that -the same result could also be obtained with less energetic remedies, -but which were supposed to be equally endowed with expulsory virtues. - -Rhazes relates an interesting case of regeneration of a whole lower -jaw; he, however, observes that the newly formed osseous mass was less -hard than the original bone.[201] - -ALI ABBAS, another great Persian physician (who died in 994), wrote a -lengthy treatise on theoretic and practical medicine, one chapter of -which is dedicated to the diseases of the teeth. When a molar tooth -is affected by caries, and the pain cannot be subdued in any other -way, Ali Abbas applies, inside the carious cavity, the end of a small -metallic tube, into which he repeatedly introduces red-hot needles, -leaving them in the tube until quite cooled. Should even this have no -effect, he tries to provoke the fall of the tooth by the application of -asses’ milk with assafetida, or, finally, extracts it.[202] - -He cures epulis, like Paul of Ægina, by excision. As to parulis, or -abscess of the gums, he opens it with a lancet or a wooden stylus. - -When the dental arch is deformed by the existence of supernumerary -teeth, he removes these with an instrument in the shape of a beak.[203] - -SERAPION (Jahiak Ebn Serapion), who lived in the tenth century, and -up to the beginning of the eleventh, contributed but slightly to the -development of medicine and dentistry, as he was in his writings little -more than a mere compiler. He indicates with great precision the number -of dental roots, and expresses an opinion that the upper molars have -need of their three roots in order to keep firm in spite of their -pendent position, whilst two roots alone are sufficient to keep the -lower molars in place, on account of the support which they receive -from the jaw. Serapion, like Galen, admits the nutrition and continual -growth of the teeth—a growth which is produced in the same proportion -as the waste due to mastication—and he too makes the dental diseases -depend upon an alteration in the nutritive process, either by excess or -by defect. - -Against dental pains of phlogistic origin, he recommends bloodletting, -purgatives, and many local medicaments, reproduced in great part from -Rhazes. In cases of persistent odontalgia due to caries, he advises, as -an excellent remedy, the application of opium in the carious cavity. -To strengthen loosened teeth, he first employs astringents, and if -these are of no use, as often happens in the old, he binds the loose -teeth together and to the neighboring healthy ones, by means of gold or -silver wire. - -In Serapion, too, we find many formulas for dentifrice powders, some of -which are intended simply for cleaning the teeth, others for special -prophylactic or curative purposes.[204] - -AVICENNA. One of the greatest luminaries of medicine among the Arabs -was Avicenna (Ebn Sina). He was born in 980 son of a high Persian -functionary; he lived a very adventurous life, held some very high -places, and died in 1037. Among his works, the most important is the -_Canon_, a book which procured him the title of “second Galen” and the -still more pompous one of “prince of doctors.” A very evident proof of -the immense fame which he acquired is the fact that among many oriental -peoples Avicenna, even in our own days, is considered the greatest -master of medicine. - -The anatomy and physiology of the teeth are treated by Avicenna very -minutely, but nevertheless he does not teach us, in regard to these, -anything new. Like Galen, Avicenna admits that the teeth continually -grow, and as a proof he gives the fact of the lengthening of the teeth, -which, owing to the absence of antagonists, are not subject to any -pressure or friction. - -He gives much good advice with regard to the preservation and -cleanliness of the teeth, to which he attaches very great importance; -and on this point he remarks that the use of very hard tooth powders -must be avoided, as these are liable to injure the dental substance. To -this latter are also harmful, says the author, some narcotic remedies, -employed against odontalgia. Burnt hartshorn is, according to him, a -most valuable dentifrice. To remove tartar from the teeth, he indicates -many remedies, and especially dentifrices of meerschaum, salt, burnt -shells of snails and oysters, sal ammoniac, burnt gypsum (plaster -of Paris), verdigris with honey, etc. Among the substances able to -facilitate dentition, he enumerates several oils and fats, besides the -brain of the hare and the milk of the bitch, and he disapproves the -custom of giving to children, during dentition, hard objects to chew, -in the erroneous belief that the biting of such objects is useful in -facilitating the cutting of the teeth; he recommends, instead, the gums -to be rubbed with the fingers. When the teeth begin to appear, he drops -some oil into the ears of the child and covers its head, neck, and jaws -with a plaster spread on cotton that has been soaked in oil. - -Avicenna minutely examines the various causes of odontalgia, and among -them includes also the little worms by which the dental substance was -supposed to be gnawed away. - -When a tooth becomes the seat of intense pain, accompanied by a -throbbing feeling, Avicenna considers that this is due to an excessive -accumulation of humors in the root; he therefore advises, as already -Archigenes had done, the tooth to be drilled, in order to empty it, and -afterward to introduce into it appropriate remedies. - -According to Avicenna, he who has a loosened tooth and desires to make -it firm again, must avoid using it in mastication, must not touch it -with the fingers, nor move it with the tongue; besides this, he must -speak as little as possible, and make use of astringent remedies. - -To remove a tooth, Avicenna made use of either the forceps or the -“eradicating remedies,” in which he, too, had full confidence. Like -the greater part of his predecessors, Avicenna is of the opinion that -the extraction of a firm tooth must be avoided as much as possible, as -it may give place to an injury of the jaw, or become harmful to the -visual organ, or bring on fever. On this point he remarks that, if an -aching tooth appears to be sound, it is not always necessary to perform -its extraction in order to cause even the most rebellious odontalgia -to cease; in certain cases he obtained a complete cessation of the -pain after having simply shaken the tooth without completing its -extraction; which according to him was due to the double reason that by -shaking the tooth a resolution of the morbid matter stagnating under it -is provoked, and the action of the medicaments that are afterward made -use of is thus favored. - -Among the eradicating remedies, the author enumerates white arsenic, -orpiment, coloquintida, tithymallus, the fat of frogs, and others. He -remarks, however, that before using them it is advantageous to detach -the gum all around. - -Against the supposed worms in carious teeth, he praises fumigations -made with the seeds of the hyoscyamus, garlic, or onion. - -Arsenic is used by him not only for the above-mentioned purpose, but -also for the cure of fistulas and foul ulcers of the gums. - -When a tooth has become abnormally long, Avicenna makes use of the file -to reduce it to a proper size; and in performing such an operation, he -holds the tooth firmly between the fingers, or with a pair of pincers -suited for the purpose. As a consecutive treatment, he prescribes -frictions with alum, laurel berries, and aristolochia.[205] - -ABULCASIS. Among the Arabian authors, he who has the greatest -importance in regard to dental art is undoubtedly Abulcasis -(Abul-Casem-chalaf-ben-Abbas). Whilst Avicenna was one of the greatest -physicians, Abulcasis was one of the greatest surgeons; and very justly -he has been called the genius of Arabian surgery. - -Abulcasis had his birthplace in Alzahra, a small Spanish village, five -miles from Cordova; from this he derived the name of Alzaravius, by -which he is also known. Historians are not agreed upon the date of his -birth. According to the most probable opinion, he was born about the -year 1050 and died in 1122 at Cordova, a city which, on account of its -celebrated school, was then a most important centre of scientific and -literary culture. - -Among the works of Abulcasis, the one which brought him the greatest -fame was the treatise _De Chirurgia_. It is divided into three -books, in the first of which he speaks of all the diseases which can -be treated by cauterization; in the second are described all the -operations which are performed by cutting, perforating, or extracting -(wherefore, obstetrics is also included in this book); in the third, -lastly, the author treats, region by region, of fractures and luxations. - -Chapters XIX, XX, and XXI of the first book have reference to diseases -of the teeth and gums. As these chapters are very short, we are pleased -to give here an almost literal translation of them: - -“When in the lower part of the gums, or in the palate, there appears a -little tumor, which afterward becomes purulent and opens and changes -into a fistula, against which no medical remedy is of any use, it is -necessary for thee to take a cautery corresponding in size to the -aperture of the fistula, and after having heated it, to introduce it -there and to keep it applied there until the cauterizing iron reaches -the bottom of the said fistula and beyond. This thou shalt do once or -twice, and then shalt use fitting medicaments until a complete cure -is obtained. This is attained when suppuration ceases. Otherwise one -cannot do less than uncover the bone and extract that part of it which -is diseased.”[206] - -“When through excess of moisture the gums become flaccid, the teeth -loose, and of no use are the remedies employed by thee, thou shalt lay -the patient’s head on thy lap, and after having applied to the tooth, -where it borders on the gum, the end of an appropriate little metal -tube, in this thou shalt quickly introduce the cautery of which mention -will be made in the following chapter; and thou shalt prolong the -application as long as suffices to let the patient feel the heat right -in the root of the tooth. This thou shalt repeat as often as thou shalt -think necessary. Then the patient shall keep salt water in the mouth -for an hour. By effect of such a cure, the corrupted moisture will dry -up, the gums will regain their tone, and the tooth its firmness.”[207] - -“When toothache depends upon cold, or if there exist some worm in the -tooth, and the medicaments are of no use, recourse must be made to -cauterization, which in such cases may be performed in two ways, viz., -either by means of butter or with a cautery. Desiring to use butter, -some of it must be warmed in an iron or copper spoon; a little cotton -must then be wrapped around the extremity of a probe, dipped into the -boiling butter, and then immediately applied to the tooth, keeping it -there in contact until it has cooled. This must be repeated several -times, so that the action of the heat reaches right down to the root -of the tooth. If thou preferest, thou canst use cold butter, applied -to the aching tooth by means of a little tuft of wool or cotton, upon -which thou shalt lay a red-hot iron; prolonging the application of this -until the heat has reached the very root of the tooth. - -“To perform the cauterization directly with the iron, thou must first -rest on the tooth a small tube of iron or copper, designed to preserve -the neighboring parts from the action of the heat, and which must, -therefore, be of sufficient thickness. Through such a tube thou shalt -apply on the tooth a cautery of the shape given here below, and shalt -keep it there until it is cooled. This thou shalt do several times. -The pain will cease the same day or on the morrow. It is, however, -necessary that after the cauterization the patient should keep his -mouth, for an hour, full of good butter. The shape of the cautery is -as follows (Fig. 34): Thou canst perform the cauterization with one or -other of its two extremities, as is most convenient.”[208] - -In regard to epulis, Abulcasis prescribes that after catching hold of -the little tumor with a hook or a vulsella its complete excision should -be performed. This done, one must wait awhile, until the hemorrhage -ceases, and then either a little “zegi” pulverized,[209] or other -drying and styptic powder, must be applied on the part. If the epulis -recurs, which very often happens, the excision must be repeated and -this followed by cauterization, since after this latter the evil will -not return.[210] - -Abulcasis is the first author who has taken into serious consideration -dental tartar and who has recommended that a scrupulous cleansing of -the teeth should be performed. The chapter relating to this, “On the -Scraping of the Teeth,” is very interesting and is worthy of being here -reproduced.[211] - -[Illustration: FIG. 34 - -Abulcasis’ dental cautery and the tube through which it was applied, in -order to preserve the neighboring parts from the action of the heat.] - -“Sometimes on the surface of the teeth, both inside and outside, as -well as under the gums, are deposited rough scales, of ugly appearance, -and black, green, or yellow in color; thus corruption is communicated -to the gums, and so the teeth are in process of time denuded. It is -necessary for thee to lay the patient’s head upon thy lap and to scrape -the teeth and molars, on which are observed either true incrustations, -or something similar to sand, and this until nothing more remains -of such substances, and until also the dirty color of the teeth -disappears, be it black, or green, or yellowish, or of any other color. -If a first scraping is sufficient, so much the better; if not, thou -shalt repeat it on the following day, or even on the third or fourth -day, until the desired purpose is obtained. Thou must know, however, -that the teeth need scrapers of various shapes and figures, on account -of the very nature of this operation. In fact, the scalpel with which -the teeth must be scraped on the inside is unlike that with which -thou shalt scrape the outside; and that with which thou shalt scrape -the interstices between the teeth shall likewise have another shape. -Therefore, thou must have all this series of scalpels ready if so it -pleases God.”[212] - -The work of Abulcasis is, so far as we know, the first book in which -are found figures of dental instruments. We do not know, however, how -far such figures are exact, that is, to what degree of faithfulness -they represent the instruments which Abulcasis really employed as the -original figures of the book of Abulcasis were copied and recopied -by successive transcribers of the work. And that such copies have -been very often unfaithful may be deduced from the fact that not -unfrequently figures of surgical instruments are found in the book -which do not at all agree with the verbal description which the author -gives of such instruments. - -In the edition by John Channing, we find at the end of the chapter on -the scraping of the teeth two series of figures. The first series is -found under the Arabic text, and is composed of the fourteen figures -reproduced as Fig. 35; the other series, existing under the Latin text, -has only twelve figures, as shown in Fig. 36. - -As Channing has made his translation from two different Arabic copies -of Abulcasis,[213] among the corresponding figures of which there -exists a very notable difference, he, for the greater part, had to -follow the plan of reproducing the figures of both codices. But besides -this numerical difference, there is also a considerable difference -in the shape of the instruments represented. We must, therefore, ask -ourselves which of the two series of figures is to be regarded as the -more faithful representation of the instruments used by Abulcasis. Most -probably the first series. In it we find figured some scrapers which -have a certain resemblance to those actually in use; besides this, the -figures of the first series seem to be drawn with greater accuracy than -those of the second. Among other things it may be noticed that the -handle of each instrument (excepting the last two) is furnished with -a row of prominences, which, it is almost certain, were designed to -afford a better grip in holding the scrapers during the operation. - -[Illustration: FIG. 35 - -Set of fourteen dental scrapers (Abulcasis).] - -[Illustration: FIG. 36 - -Twelve dental scrapers as represented in another manuscript codex of -Abulcasis.] - -We now consider the chapter on the extraction of teeth.[214] The author -begins by saying that it is necessary to use all possible means to cure -an attack of odontalgia, and to be very slow in deciding to extract a -tooth, as this is a very noble organ, the want of which cannot in any -way be perfectly supplied. When there is no way of avoiding extraction -and the patient is obliged by pain to submit to this, it is necessary -first to ascertain which is the aching tooth, as very often the pain -deceives the patient, so that he may indicate as the seat of the pain -another tooth which is perfectly sound, and desire it to be extracted; -after which, naturally, the pain does not cease, if not when the -diseased tooth is also extracted, as often happens in the hands of -the barbers.[215] The aching tooth having been well ascertained, it -is necessary to detach the gum from the tooth, all around, with a -sufficiently strong scalpel. Then either with the fingers or with a -light pair of forceps the tooth must be shaken very gently, until it -is loosened. Then the surgeon, keeping the head of the patient firmly -between his knees, applies a stronger pair of forceps and extracts the -tooth in a straight direction, so as not to break it. If it is not -possible to draw it out, one of those elevators must be taken which the -author advises for the extraction of roots (as may be seen afterward), -and by insinuating it under the tooth the surgeon must endeavor to -extract it. When the tooth is corroded and hollow, it is necessary to -fill the cavity with lint, compressing it hard inside with the end of -a probe,[216] so that the tooth may not break under the pressure of -the instrument. In all cases, the operator must take great care not to -break the tooth, for if this happens the remaining part will give the -patient still greater suffering. It is necessary, therefore, to avoid -acting like the ignorant and foolish barbers, who in their temerity -do not observe any of the above-mentioned rules, and therefore very -often cause the patients great injuries, the least among which is the -breaking of the tooth, the root being left in the socket, or else the -taking away, together with the tooth, of a piece of the maxillary bone, -as the author often happened to see. After the extraction the patient -must rinse his mouth with wine, or with vinegar and salt. If, as often -happens, hemorrhage is produced, a little powdered blue vitriol must be -applied inside the wound; and if this is not sufficient, the part must -be cauterized with a red-hot iron. - -[Illustration: FIG. 37, FIG. 38 - -Forceps for loosening the tooth previous to extraction (Abulcasis).] - -The small forceps (Figs. 37 and 38) to be used in loosening the tooth -must have the handle shorter than the jaws and be sufficiently strong -not to bend when pressure is put upon the tooth. - -The large forceps (Figs. 39 and 40) with which the extraction must be -performed should be made of very good Indian or Damascene iron, and -have the handle longer than the jaws; these, moreover, on the inside -must be toothed, or striated after the manner of files, so that they -may have a perfectly firm grip, without slipping. - -From the foregoing quotations and on examining the annexed figures, -it very clearly appears that the extraction of teeth was performed by -Abulcasis with excessive timidity and in a manner which must have been -torturing to the poor patients. These had to undergo, first of all, the -detachment of the gums, then the prolonged shaking of the tooth either -with the fingers or with the forceps, then the attempt at extraction by -means of a stronger pair of forceps, but, so far as can be seen from -the figure, very little fitted for the purpose; and finally, in many -cases, fresh maneuverings to extract the tooth with an elevator. - -[Illustration: FIG. 39, FIG. 40 - -Forceps for performing the extraction after the tooth has been loosened -(Abulcasis).] - -Nothing better, in truth, could have been done with such imperfect -instruments. But it is possible that even then there perhaps existed, -for the extraction of teeth, other instruments, so shaped as to be -able to act with greater force. Abulcasis himself[217] alludes to the -existence of dental instruments not mentioned by him. It is probable, -therefore, that the barbers, in spite of the scorn with which Abulcasis -overwhelms them, used, for the extraction of teeth, forceps far more -suitable than those described by him. These individuals, certainly -unfurnished with a scientific education, must have had, however, a -great practice in the extraction of teeth, being perhaps almost the -only ones to whom recourse was had for this operation. They performed -it very quickly, as may be argued from the words of Abulcasis himself. -It is no wonder, therefore, that not unfrequently the work of these -_fatui tonsores_[218] was the cause of more or less serious injuries, -but for the most part it had the advantage of not making the patients -suffer excessive torture. - -Another very interesting chapter is that which treats of the extraction -of dental roots and fragments of the maxillary bone.[219] - -[Illustration: FIG. 41, FIG. 42 - -Forceps for extracting the root when the tooth breaks in the -extraction. These figures are evidently very badly drawn, as are most -of the figures to be seen in Abulcasis’ work.] - -When, says the author, on extracting a tooth, this breaks, so that the -root remains in the socket, it is necessary first of all to soften the -part, by applying for a day and a night, or for two days, some cotton -wool well smeared with butter; then attempts must be made to extract -the root with a pair of forceps, the jaws of which are like the beak of -a pheasant or stork. - -[Illustration: FIG. 43 - -Elevator to be used when the extraction of a root by means of the root -forceps proves impossible (Abulcasis).] - -If this is not successful, it is necessary to remove with a scalpel -the whole of the gum which covers the root; then under it must be -insinuated a small elevator having the shape here below represented. - -If not even in this way can the end be attained, recourse must be made -to one of the following instruments, choosing that which in every -particular case seems to be the most suitable. - -Besides these, says the author, use may be also made of some of the -instruments which serve for the removal of tartar. - -It is precisely in this chapter that Abulcasis speaks of the great -variety and multiplicity of dental instruments; which, he says, cannot, -like other kinds of instruments, be all enumerated and described. -He then adds that a skilful surgeon will be able to devise new -instruments, according as the peculiarities of each single case require -them. - -[Illustration: FIG. 44] - -[Illustration: FIGS. 45, 46, 47] - -[Illustration: FIG. 48 - -Elevators (Abulcasis.)] - -For the extraction of a splinter or necrosed fragment of the maxillary -bone, the same instruments must be used which serve for the extraction -of dental roots; but also a pair of forceps may be used (Figs. 50 and -51). - -It will be necessary to grip with them the osseous fragment firmly, so -that it cannot escape whilst it is being extracted. The part shall then -be medicated with fitting remedies. - -Whenever it is thought proper, the bone must be scraped and all the -diseased part of it removed. - -When a tooth is irregularly placed, or projects above the level of -the others,[220] a deformity ensues which is particularly displeasing -in women. The way of correcting this varies according to the nature -of the case. It consists sometimes in the simple extraction of the -misplaced tooth. But when there exists an intimate (osseous) union of -the irregular tooth with another one, it is necessary to operate for -the resection of the former with an instrument of the following shape, -that is, like a small axe: - -[Illustration: FIG. 49 - -An instrument like a small axe, for resecting irregularly situated -teeth (Abulcasis).] - -The operation must be performed in many days, not only on account of -the hardness of the tooth, but also in order not to shake any of the -neighboring teeth. - -In other cases, the deformity, consisting in one tooth projecting above -the level of the others, may be corrected with a saw. - -The instrument must be made entirely of Indian iron, and the operation, -like the preceding one, is to be carried out in several days, that the -fall of the tooth may not be provoked by excessive shaking. The file -(Fig. 55), too, must be used to destroy the edges and points of broken -teeth, that they may not injure the tongue, or give any trouble in -speaking. - -[Illustration: FIG. 50, FIG. 51 - -Forceps for extraction of splinter or necrosed fragments of the -maxillary bones (Abulcasis).] - -[Illustration: FIG. 52 - -A dental saw (Abulcasis).] - -[Illustration: FIG. 53 - -Another dental saw (Abulcasis).] - -When, in consequence of a blow or fall, one or more teeth have become -loose so that the patient cannot bite his food with them, if the use -of styptic remedies has been found of no use, it will be necessary to -bind and make such teeth firm by a gold or silver wire. Gold is to -be preferred as being unalterable, whilst silver in a few days turns -green. Having chosen, therefore, a suitable gold wire of perfectly -uniform consistency, it must be passed at its middle part between two -firm teeth, that is between the two nearest on one side to the loosened -tooth or teeth; then, by binding tightly around the sound tooth and -each of the loosened teeth the two lengths of the wire and crossing -them in the dental interstices so as to form a kind of network, the -sound and firm tooth of the opposite side will be reached, and this -too must be wound around in a mesh, as it were, of the said network. -Then, turning back, the same operation must be repeated, but inversely, -until the point of departure is reached. All this must be done with -much skill, so as to render the loose teeth completely unmovable. When -the wire is tied, this must be done near the dental roots, so that the -knot may not get untied; then with a pair of scissors the remaining -part must be cut off and its two ends joined and twisted with a pair of -pincers, hiding them between the sound tooth and the neighboring loose -one. Such a ligature should remain in place during a whole lifetime; -and in case it should come undone or the wire should break, it will be -necessary to renew the operation. The following figure represents the -ligature described: - - -[Illustration: FIG. 54 - -Ligation for steadying teeth in cases of blow or fall (Abulcasis).] - -“Sometimes, when one or two teeth have fallen out, they are replaced -in the sockets and bound in the aforesaid manner and remain there. -The operation must be carried out with great delicacy and ability, by -skilful hands.” - -As may be seen from the above quotation, in the days of Abulcasis -replanting was already performed, although it is probable that the -ligature was then left permanently. - -The author says, next, that the vacancy left by fallen teeth can be -filled up with artificial ones, made of ox bone, they also being fixed -in the manner above described; and he adds that they will be found not -only of advantage from the esthetic but also from the functional point -of view. - -Speaking of the cure of the ranula,[221] Abulcasis says that when the -tumor, examined by the clear light of the sun, appears brown or black, -hard and insensible, it is not to be operated, it being then of a -cancerous nature. If, instead, it is whitish and full of liquid, it -must be seized with a hook, and by means of a fine scalpel extirpated. -The hemorrhage must be combated with powdered blue vitriol. After the -operation mouth washes must be used of vinegar and salt. - -In cases of fracture of the lower jaw[222] it is not only necessary -to cure the fracture itself according to the rules which the author -prescribes for the various cases, but it is also necessary to pay -attention to the teeth and with a gold or silver wire, or a silk -thread, to tie, in the manner already described, those teeth which in -consequence of the wound have become loose, but the consolidation of -which may be hoped for. - -[Illustration: FIG. 55 - -A dental file (Abulcasis).] - -MESUE THE YOUNGER, a disciple of Avicenna, is of opinion that when a -tooth is the seat of violent pain, this may easily propagate itself -to the other teeth; and therefore advises, if the pain does not soon -cease, to extract the tooth affected, without delay. This operation, -however, must not be performed, says the author, whilst the pain is at -its height, but rather when it is somewhat lessened, otherwise, the -extraction of the tooth may result in a syncope sometimes ending in -death, or else be the cause of intense inflammation and of suppuration, -which, also, may, in certain cases, place the patient’s life in danger. -He recommends an infinite number of remedies against odontalgia; in -these, however, there is nothing new to us. As to the removal of a -tooth, this may be obtained in three different ways, that is, with -the forceps, with eradicating remedies, or by cauterization. In -order to cause a tooth to fall out by the use of acrid, eradicating -substances, the author advises to proceed in the following manner: -The tooth is first freed, by means of a scalpel, from the surrounding -gum; the eradicating remedy is next applied to the root of the tooth, -every needful precaution, however, being taken that it may not injure -the neighboring teeth. Cauterization, when practised to produce the -exfoliation of a diseased tooth, may be performed, according to Mesue, -either with a small red-hot iron, passed through a little metal tube in -order to protect the neighboring parts, or with the heated kernel of a -nut, or with a grain of burning incense.[223] - -To cure a dental fistula, Mesue cauterized it to the very bottom with a -cautery in the form of a probe, or extracted the tooth, which by reason -of its diseased root was the cause of the fistula; and when the bone -was likewise affected, he laid bare the carious part, which he then -scraped.[224] - -AVENZOAR. The last of the great Arabian physicians was Avenzoar. He -was born at Peñaflor, near Seville, in 1070 and died in 1162. He became -famous by his very valuable work on medicine, entitled the _Teisir_. It -is strange, however, that in this book there is hardly anything about -the treatment of dental diseases. Against caries and looseness of the -teeth the author limits himself to recommending bloodletting either -from the ranine or the basilic vein. Apart from this, he speaks neither -of operations nor of remedies for diseases of the teeth.[225] Probably -at the time in which Avenzoar wrote, that is, in the first half of the -twelfth century, doctors in general did not occupy themselves with the -curing of teeth at all, this being abandoned entirely to barbers and -other persons. This would sufficiently explain why this author is so -silent in regard to dental diseases. - -But what can have been the reason for doctors refusing thus -contemptuously to occupy themselves with so important a branch of -therapeutics? In every age there have been a great number of ignorant -persons, who either in good faith, or else for imposture, have -practised, within a more or less limited circle, the art of healing, -usually dedicating themselves to some particular class of diseases. -Even in our days, notwithstanding the superabundance of duly qualified -doctors, there is, especially in certain countries, no small number of -quacks, secretists, bone-setters, chiropodists, and the like. It is, -therefore, not to be wondered at that in times when dentistry was still -in its infancy there should have been persons more or less ignorant -who undertook tooth drawing and the concoction and sale of specifics -against odontalgia. The doctors, on their part, under the pretext of -being unwilling to have anything to do with these individuals, found it -very convenient to dispense with the cure of dental diseases and with -the extraction of teeth, this operation being sometimes too difficult -for them, on account of their want of practice, besides being almost -always very painful, and considered, even from the most ancient times, -capable of eventually producing evil consequences, among which, in some -cases, even the death of the patient. - -But perhaps this was not the only reason for the fact above mentioned. -In the middle ages the extraction of one or more teeth was sometimes -inflicted as a punishment; for example, for having eaten flesh during -Lent,[226] or on those found guilty of felony, for having refused to -contribute sums of money demanded from them by their liege lord. Now, -as this punishment was carried out on the guilty ones by the executors -of public justice, it is only natural that doctors should have refused -to practise an operation which would have degraded their profession by -bringing it down nearly to the class of the hangman. - - - - -CHAPTER IX. - -THIRTEENTH TO FIFTEENTH CENTURIES. - - -BRUNO OF LONGOBUCCO. After the Arabian period, the first author whom -we must mention is Bruno of Longobucco, of the school of Bologna, -who lived in the thirteenth century and wrote a treatise on surgery, -which gave him a certain renown.[227] This book, however, contains but -little about diseases of the teeth. The author shows himself a great -friend of the actual cautery, and advises its use in the cure of dental -caries and of various diseases of the gums. He says nothing about the -extraction of teeth; instead, he recommends, as a means for making -a diseased tooth fall out, that the milky juice of the tithymal be -applied around its root after having been reduced to the consistency of -paste by the addition of flour.[228] - -LANFRANCHI, of Milan, another writer of the thirteenth century, who -acquired great fame by his book _Chirurgia magna et parva_—partially -translated into German, more than two centuries later, by Otto -Brunfels—also shows himself very timid in the sphere of dentistry, -and to combat dental pains he recommends, by preference, the use of -narcotics. He is not at all favorable to the extraction of teeth; and -especially that of the molars is considered by him a very dangerous -operation.[229] - -TEODORICO BORGOGNONI (1205 to 1298), known also under the name of -Teodorico of Cervia, is according to Hæsar the first author who made -mention of sialorrhea following mercurial frictions. Worthy of note, -too, is what he says in regard to fistulas of the gums, or, in general, -of the maxillary region. He advises that in every case of this kind -special attention be paid to the state of the dental roots; when there -is a discharge of ichorous pus, the roots are certainly affected; and -then the diseased teeth must all be extracted as soon as possible.[230] - -JOHN GADDESDEN, an English doctor who flourished at Oxford in the -first half of the fourteenth century, wrote a very curious medical -book, taken the greater part from Pliny and the Arabian writers and -entitled _Rosa anglica: practica medicinæ a capite ad pedes_ (English -rose: the practice of medicine from head to foot). In his time many -strange methods of cure were in use, sometimes simply ridiculous, -and others even filthy; and the _Rosa anglica_ furnishes us with -not few examples. In order to make a tooth fall, Gaddesden advises -the application of dried crow’s dung reduced to powder, or else to -anoint it with the fat of a green frog. This last means would be quite -infallible and would make the tooth fall out on the spot. It had such -power that if peradventure an ox in grazing chews a little frog with -the grass, its teeth will all fall out on the instant! We do not know -whether the author himself believed in the marvellous virtues of the -fat of green frogs. It is certain, however, that he enumerates this -among his “secrets,” and says that he has gained much money from it -through the mediation of the barbers. - -Other absurdities of the same kind are the following: The brain of the -hare can, by being rubbed on the gums and jaws, serve for two important -purposes, since it has not only the virtue of facilitating dentition, -but also of making teeth grow again to those who have lost them! The -brain of a partridge applied to a carious tooth makes it fall in pieces! - -The treatment of odontalgia embraces, according to Gaddesden, both -general and special means of cure. To the former belong purgatives, -bloodletting, scarifications of the labial and sublingual mucous -membrane, leeches, the application of scarified cuppings under the -chin. The special means of cure are represented by a great number of -plasters, powders, and ointments, in the composition of which almost -constantly hyoscyamus and pyrethrum take part. When odontalgia depends -on caries, the author advises, among other things, the use of a -red-hot iron. Against the supposed worms of carious teeth he counsels -fumigations with the burnt seeds of hyoscyamus or of leeks. In cases of -dental fistulas, it is necessary to cauterize the fistulous tract, to -extract the diseased tooth, and if the bone be also affected, to scrape -it. To clean the teeth: Gaddesden recommends several dentifrices; some -of which are composed of pulverized cuttle bone, either with addition -of meerschaum, pumice stone, burnt hartshorn, in different proportions -and combinations, or used quite alone; others are made with myrrh and -alum. - -Since Gaddesden affirms the existence of means capable of promoting -the fall of any tooth, we should suppose that he says nothing about -instrumental extraction, or at least that he considers it entirely -useless; for if in order to make a tooth fall out, it be sufficient to -smear it with frog’s fat, why should there ever be any need to have -recourse to the very painful extraction by means of the forceps? - -However, this is not so; the author treats of instrumental extraction -as a very important operation, without being at all afraid of -being reproved for contradicting himself. Besides, to anyone who -thus reproved him he perhaps would have answered, without being -disconcerted, that it is not always possible to have the fat of frogs -or the dung of crows in readiness. - -The extraction of a tooth is only justifiable, says Gaddesden, when -all the remedies employed against odontalgia have proved useless and -when, on the other hand, the pain has its seat in the tooth itself and -not in the nerves or gums. Before undertaking the operation, however, -the patient must be prepared for it with an evacuant cure, that is, -by injections and purgatives. For the operation itself the author -recommends the same rules given by Celsus, and says, besides, that the -head of the patient ought to be held firm by an assistant. In certain -cases, the extraction can be performed, better than with the forceps, -by means of an instrument in the form of a lever, broad at one end, -narrow and sharpened at the other. But when a tooth is very firmly -seated, its extraction is always dangerous; therefore, in such a case, -Gaddesden recommends, before having recourse to the operation, the use -either of acrid substances, such as the milky juice of the euphorbiaceæ -(for example, of the tithymal), or else of a red-hot iron; and this, -for the purpose of promoting the fall of the tooth, or of rendering -it, at least, so far movable that it can be extracted without any -difficulty. - -GUY DE CHAULIAC, the greatest surgeon of the middle ages, was born -about 1300, in a little village on the confines of Auvergne, which -still preserves the name of Chaulhac; he died in 1368. This author -immortalized his name by a work which even up to the eighteenth -century was, as it were, the official code for the teaching of -surgery. Guy wrote his _Chirurgia magna_ in barbarous Latin—such as -was then used by the learned; but his book was soon translated into -French, Provençal, and afterward also into Italian, English, Dutch, -and Hebrew. E. Nicaise, who, in 1890, gave to the scientific world a -very valuable new edition of Guy de Chauliac,[231] and who made very -accurate researches on all that regards this author and his work, has -succeeded in finding in the libraries of Europe and America as many as -thirty-four manuscript copies of the _High Surger_.[232] The survival -of so many copies, in spite of all the destructive agencies which have -been in action during more than 500 years, is a very clear proof of the -wide diffusion which this work obtained even before the invention of -printing. - -Guy’s work was printed for the first time in 1478, and the editions -that have been published since then in various countries are in all -about 130. - -This book is very important for our subject, since we may gather from -it very clearly the condition of dentistry in the fourteenth century; -but, on the other hand, we see from it, with equal clearness, that -this branch of the healing art had not made any progress from the -time of Abulcasis to that of Guy de Chauliac (about two centuries -and one-half), and that this most famous surgeon did not contribute -anything worthy of note to the development of dentistry. - -On the anatomy and physiology of the teeth Guy de Chauliac expresses -himself very briefly: “Teeth are of the nature of bones, although they -are possessed of sensibility, due to some nerves which the third pair -sends to their roots. The number of these latter may vary from one to -four, according to the different teeth. The uses of these organs are -well known.”[233] - -Worthy of being recorded are the names which Guy gives to the -different kinds of teeth. After having said that these latter are -generally thirty-two, but sometimes only twenty-eight, he adds, that -the sixteen teeth of each jaw are divided into: _deux duelles, deux -quadruples, deux canines, huiet maschelieres[234] et deux caisseaux_ -(in the barbarous Latin: _duo duales, duo quadrupli, duo canini, -octo molares et duo caysales_). So that the two middle incisors were -then called _duales_; the lateral incisors were called _quadrupli_, -because, together with the middle ones, they formed a series of four -teeth. Guy gives the name of _caysales_ (_caisseaux_) to the last two -molars; but Joubert, one of the translators and commentators of Guy de -Chauliac, tells us that the molars in general were called in Languedoc -_caisseaux_: “Les cinq molaires sont appelées en Languedoc _caisseaux_, -parce qu’elles servent à casser les choses dures, comme les noix et -semblables.” In regard to the canines of the upper jaw, we learn that -they were called _oeillères_ (eye teeth), because their root was -believed to reach near the eye.[235] - -According to Guy de Chauliac, _les dents sont engendrées non -seulement en l’enfance, ains aux autres ages_.[236] And this passage -was commented by Joubert in the following note, which we reproduce -textually: - -“En Languedoc, près de Pezenas y a une gentil femme, nommé Mademoiselle -de Lobatiere, dès long temps vieille édentée, à laquelle (comme -tesmoignent beaucoup de gens très-dignes de foy) environ l’an 70 de -son age, sont sorties cinq ou six dents nouvelles. Le conciliateur -tesmoigne avoir veu, à qui les dents perdues devant l’an 60 ont été -derechef engendrées, moindre toutes fois que les premieres et plus -foibles.”[237] (In Languedoc, near Pezenas, there is a lady named -Mademoiselle de Lobatiere, who having been for a long time old and -toothless (according to the testimony of persons well worthy of -belief), at about the age of seventy got five or six new teeth. The -Conciliator[238] testifies to having seen teeth grow anew—smaller, -however, and weaker than the first—in persons who had lost them before -the age of sixty years). - -In regard to the pathology and therapy of the teeth, Guy but rarely -abandons the footsteps of the Arabian writers. Following the example -of one of these, Ali Abbas, he admits five or six dental maladies: -pain, corrosion, congelation, and _agacement_ (teeth set on edge), -limosity or fetidness, fall or loosening.[239] As to the cure, this is -divided into universal and particular. The former includes, before all, -hygienic rules, and then purgatives, bloodletting of the cephalic vein -or the veins of the lips or tongue, revulsion, obtained by means of -cupping glasses, friction, etc., and the remedies for curing the rheums -of the head, or for throwing out the phlegmatic humors (pyrethrum, -mastic, and the like). - -The hygienic rules are the following: Not to eat food apt to putrefy, -such as fish and milk foods; to avoid food or drink either too hot or -too cold, and especially the rapid succession of cold and hot, or _vice -versa_; not to bite hard things, nor to eat viscous food, such as figs -and confectionery made with honey; to avoid certain foods which are -known to be bad for the teeth, such as leeks; not to clean the teeth -too roughly, but to rub them with honey and burnt salt, to which, very -advantageously, may be added some vinegar. - -Before speaking of the special methods of cure of single dental -affections, Guy observes that operations on the teeth are _particular_ -(proper) to barbers and to “dentatores,”[240] to whom doctors have -abandoned them. But it is safest of all, says he, to have such -operations performed under the direction of doctors. These, however, -to be in a position to give advice in regard to diseases of the -teeth, must know the various methods of cure which are suited to -these diseases, that is to say, mouth washes, gargles, masticatories, -fillings, evaporations, anointments, rubbings, fumigations, -cauterizations, sternutatories, instillations into the ears, and manual -operations. - -Lastly, Guy notes that the “_dentator_”[241] must be provided with all -the appropriate instruments, that is, with “rasoirs, rapes, spatumes, -droits et courbes, eslevatoires simples et à deux branches, tenailles -dentelées, et diverses esprouvettes, cannules, deschaussoirs, tarieres, -aussi des limes, et plusieurs autres necessaires a cette besogne” (in -Latin: rasoriis, raspatoriis, et spatuminibus rectis et curvis, et -levatoriis simplicibus et cum duobus ramis, tenaculis dentatis, et -probis diversis, cannulis, scalpis et terebellis, et etiam limis.)[242] - -Whilst Abulcasis bitterly declaims against the barbers, because they, -in spite of their ignorance, permit themselves to perform operations -on the teeth, and especially to extract them, Guy de Chauliac speaks -in quite a different tone. He recognizes that such operations are -_particular_, which is as much as to say, in modern language, that the -practice of dental surgery constitutes a _specialty_. Guy, it is true, -expresses his desire that dental operations be performed, for greater -security, under the direction of doctors, but he does not use one word -of blame or contempt against the _dentatores_, thus leaving it to be -understood that, according to him, their art had every good reason -to exist. Besides, from the enumeration of the surgical instruments -which Guy says are necessary to them, we can easily argue that the -_dentatores_ of the fourteenth century were not, as at the very first -one might be led to believe, mere “tooth-pullers,” but that, at least, -the best among them cured teeth as well as the scanty knowledge and -means of cure then available enabled them to do. - -In the chapter on odontalgia,[243] Guy de Chauliac distinguishes -between the pains, the point of departure of which is in the tooth -itself, and those resulting from disease in other parts, for example, -from apostema[244] of the gums; in these latter cases, in order to -cause the pain to cease, it is necessary to cure the part from which -the pain is derived, taking into account the nature of the disease and -its causes. - -When the pain is situated in the root of the tooth or in its nerve, it -is necessary, says the author, to distinguish whether it is caused by -an accumulation of morbid matter, or whether it is, instead, a simple -pain _without matter_. Besides, it is necessary to distinguish, in the -first case, whether the matter producing the pain is hot, cold, or -windy; and also, in the second case, it is necessary to ascertain if -the pain is of a warm, cold, dry, or humid nature. As may be seen, the -principles and subtle distinctions of the pneumatic school were then in -full vigor. - -The treatment must vary according to all the aforesaid cases; but the -means of cure advised by Guy de Chauliac do not present any special -interest, as they are almost entirely taken from Galen and from the -Arabian authors, and especially from Rhazes, Ali Abbas, and Avicenna. - -On coming to speak of the looseness of teeth,[245] Guy says that -this may depend on various causes: that is, on a fall or a blow; on -humidity, which softens the nerve and ligament;[246] on dryness and -lack of nourishment of the teeth; and lastly, on corrosion of the gums. - -The looseness of teeth, which depends on dryness or want of nutrition, -as in the old and in consumptive people, is incurable. In other kinds -of looseness, astringents are useful; but it is also well that the -patient should speak but little, that he should not touch or move the -loose tooth, nor use it in masticating. In cases of corrosion of the -gums, this disease must be cured. - -If looseness of the teeth follows a blow, it is well, first of all, to -let blood, and then to use astringents and excitants. When all this is -of no avail, Guy advises that the loose teeth be tied to the healthy -ones with a little gold chain,[247] after the manner of Abulcasis. And -if, says he, the teeth fall out, they may be replaced with teeth of -another person, or with artificial teeth of ox bone, fixing them in -their place with a fine ligature; and, he adds, that such teeth are -serviceable for a long time. Here are the precise words of the text: -“Et si les dents tombent, qu’on y mette des dents d’un autre, ou qu’on -en forge d’os de vache, et soient lisez finement, et on s’en sert -long-temps.” - -This extremely concise manner of treating dental prosthesis, summing -all up in some thirty words, is in strong contrast with the usual -fulness of explanation and methodical accuracy of Guy de Chauliac, to -whom, very justly, could be given the title of founder of didactical -surgery. Such a strange contrast cannot be explained, unless by -admitting that Guy considered dental prosthesis as foreign to the -general plan of his book, that is, as something which did not directly -concern surgeons, and for which, therefore, a mere allusion ought to -be sufficient. Without the slightest doubt, dental prosthesis was -practised neither by doctors nor surgeons, but by the _dentatores_. - -Abulcasis, too, certainly for the same reason, is extremely brief -in speaking of artificial teeth, but, on the other hand, he very -minutely describes the process of ligating loose teeth. Guy omits this -description entirely, and only alludes briefly to this therapeutic -practice. From this it is easy to perceive that whilst Abulcasis -considered this operation within the province of surgeons, Guy de -Chauliac was disposed to exclude it from the field of general surgery, -considering that this, too, like the other dental operations, belonged -to the _dentatores_. In his days, in short, dentistry had become much -more clearly specialized than it was in the days of Abulcasis. - -After having spoken of the looseness of teeth, Guy de Chauliac goes on -to treat of caries, in a short chapter, entitled “De la Pourriture, des -vers, de corrosion et pertuifement des dents.” - -The method of cure, he says, is double, viz., universal and particular. -The general treatment embraces the hygienic and therapeutic means -already mentioned. As to the particular or local treatment, it -consists, first of all, in washing the teeth with aqua vitæ or with a -vinous decoction of mint, salvia, melissa, pepper, or pyrethrum. Then -it is necessary to fill the carious cavity with gallia[248] and root of -cyperus,[249] mastich, myrrh, sulphur, and camphor, wax, ammoniacum, -asafetida and the like. As may be seen, Guy does no more than mention -the substances used in his days for the filling of carious teeth, and -does not tell us what various combinations were formed with the said -materials, nor the proportions in which they were used. In short, he -does not give us any formula for the composition of a filling mass, and -from this may be inferred, without fear of error, that this operation -also was never performed by him, consequently it, too, was not -practised by doctors and surgeons, but rather by the _dentatores_. - -When the aforesaid means of cure—that is, the mouth washes and the -filling—are of no use, Guy advises the margins of the carious cavity -being taken away with a scalpel and file, so that alimentary substances -may not be retained inside it. However, here are his words, which seem -especially to refer to cases of interstitial caries: - -“Si ces choses n’y valent rien, la dent soit esbuschaillee avec un -ciseau et lime,[250] e qu’on luy fasse un passage, à ce que la viande -ne s’arreste au trou.” If advantage is not even derived from such an -operation, recourse must be had to cauterization, or, if necessary, to -extraction. - -Even Guy de Chauliac believes in the worms of the teeth, and against -these he recommends the usual fumigations. He advises that the seeds -of leek, onion, and hyoscyamus be mixed with goat’s tallow and made -into pills of a dram each in weight, one of which is to be used for -each fumigation: “Si dans le trou il y a un ver, apres le susdit -lavement,[251] la dent soit suffumiguée avec une graine de porreau et -d’oignon et semence d’hyosciame, confits avec suif de bouc; et qu’on -en fasse des pilules chacune d’une drachme et qu’on y en employe une à -chaque fois.” - -In the following chapter Guy treats “De la limosite et laide couleur -des dents.” Here, too, he recommends, before all, the general hygienic -rules above mentioned. Besides, he advises the mouth being rinsed with -a vinous decoction of wild mint and of pepper, and then the use of the -following dentifrice: - -“℞—_Cuttle-bone, small white seashells, pumice stone, burnt stag’s -horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and -reeds._ All these substances must be reduced to powder together, or -each one separately.” Use may also be made of a liquid dentifrice thus -prepared: - -“℞—_Sal ammoniac and rock salt, half a pound of each; saccharine -alum, one-quarter of a pound._ These to be reduced to a powder and -placed in an alembic of glass, so as to obtain a liquid, with which the -teeth must be rubbed by means of a little scarlet cloth.” - -If these means of cure are of no avail, on account of the presence of -hardened limosity (tartar), this must be removed by scraping it away -with appropriate instruments. “Et si cela ne profite, à cause qu’il -y a là des limosites endurcies; soient rasclées avec des rapes et -spatumes.”[252] - -Against the setting of teeth on edge (_endormement et congelation des -dents_; _stupor et congelatio dentium_), Guy de Chauliac recommends -hot wine or aqua vitæ, to be kept in the mouth; or the teeth to be -rubbed with roasted salt; or the application to them of hot roasted -walnuts and filberts and similar things which convey heat; or lastly, -masticating substances, which possess heating properties, such as the -portulaca (purslane) and its seeds. - -The chapter on the extraction of teeth and of dental roots is a simple -summary of what Abulcasis says on this subject; some passages of this -author are copied word for word. - -Whilst the Arabian surgeon treats rather lengthily of the deformities -of the dental arches, and the methods to be employed in correcting -these, Guy de Chauliac almost entirely neglects this subject and -limits himself to saying that if any tooth has become abnormally -lengthened, it is necessary to reduce it to the right length with the -file, but operating “wisely,” so as not to loosen it: - -“S’il y a quelque dent augmentée outre nature, soit egalisée et -applanie sagement avec la lime, que ne soit ébranlée.” - -Guy strongly throws doubt upon the efficacy of supposed eradicating -remedies. In regard to this he says: “The ancients mention many -medicaments, which draw out the teeth without iron instruments or -which make them more easy to draw out; such as the milky juice of the -tithymal with pyrethrum, the roots of the mulberry and caper, citrine -arsenic, aqua fortis, the fat of forest frogs. But these remedies -promise much and operate but little—_mais ils donnent beaucoup de -promesses, et peu d’operations_.” - -From the book of Guy de Chauliac we can gather a very important fact, -which is worth mentioning here; that is to say, that some surgeons of -that period made use already of anesthetic inhalations, especially for -amputations. Here is what Guy says:[253] - -“Some prescribe medicaments which send the patient to sleep, so -that the incision may not be felt, such as opium, the juice of the -morel,[254] hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge -is soaked by them in these juices and left to dry in the sun; and when -they have need of it they put this sponge into warm water and then hold -it under the nostrils of the patient until he goes to sleep. Then they -perform the operation.” - -It seems that the narcosis thus obtained was sufficiently intense, -since Guy also speaks of the means used to awaken the patient. These -consisted in applying another sponge, soaked in vinegar, under the -nose, or in dropping into the nostrils and ears the juice of rue or -fennel. - -Guy lets us know that other surgeons made the patients go to sleep by -giving them opium to drink; but he decidedly disapproves of such a -practice, as he has heard of patients who through this have died. - -VALESCUS OF TARANTA (called by the French authors Valescon or Balescon -de Tarente or Tharare), professor at the University of Montpellier -at the beginning of the fifteenth century, wrote a valuable treatise -on medicine and surgery, entitled _Philonium pharmaceuticum et -chirurgicum, de medendis omnibus humani corporis affectibus_. As to -the diseases of the teeth, he especially follows Guy de Chauliac, but -treats the subject at greater length, profiting by what has been -written on the subject by all the ancient writers, and especially the -Arabians. - -Among the many remedies which he recommends against toothache, here are -some: - -“℞—Wild mint, pyrethrum, white pepper, myrrh, two drams of each; let -these be pulverized and made into a paste with the pulp of raisins or -with white wax and with some turpentine; and let this mass be divided -into small balls as large as filberts, of which one must be masticated -at a time, with the aching teeth.”[255] - -Another masticatory is composed of origanum, pyrethrum, cinnamon, and -ginger, made into a paste with the yolk of an egg cooked under the -coals. - -To calm dental pains, the vapors of a decoction of wild lavender, -marjoram, rue, chamelea, and melilot are often efficacious. As to -fumigations, they can be made not only with vegetable substances (onion -or mustard seed, rue, etc.), but also by burning scrapings of the hoof -of an ass. The fumes may be made to reach the aching tooth, by means of -a funnel. Here are the words of the author: “Fiant suffitus ex rasura -ungulæ asini, et fumus recipiatur per infundibulum.” - -Decayed teeth may be filled, according to Valescus, to satisfy four -different indications: To calm or prevent pain, to prevent any further -spreading of the caries, to kill the worms, and to sweeten the breath. -He advises that the carious cavities should be filled up with powdered -nigella, pepper, myrrh, salt, and theriac; or else with pyrethrum, gum -ammoniac, and opium; or else with celery seeds pulverized, opium, and -hyoscyamus; or with the cast-off skin of serpents boiled in vinegar; -or with gallia and cyperus. The filling with these last two substances -are especially suitable, according to the author, to preserve the teeth -from further spreading of the caries: “Si gallia et cyperus cavis -dentibus applicentur, dentes ulterius non corrodentur.” - -To kill the supposed worms of the teeth, Valescus counsels three -different methods, of which the first consists of the usual fumigations -with seeds of hyoscyamus, onion, leek, coloquintida; the second -consists in filling the carious cavity with a mixture of myrrh and -aloes; and lastly, the third, in applying inside the cavity the milky -juice of the tithymal, or the juice of the persicaria.[256] - -In regard to tartar of the teeth—which he calls _materia lapidea_, -_i. e._, stony substance—Valescus says that it must be removed little -by little, either with iron instruments or with dentifrices partly -cleansing and partly styptic. After the tartar has been removed, it is -necessary to wash the teeth often with white wine and to rub them with -roasted salt.[257] - -Valescus, too, like the majority of ancient writers, is not at all -favorable to the extraction of teeth. He says that recourse must not be -had to this operation except when a tooth is the cause of most violent -pain and every remedy has been of no avail. But the reasons which he -gives in support of this opinion are very plausible; and whilst most of -the authors who preceded him showed themselves adverse to extraction, -because they considered it dangerous, he does not allude in the least -to such dangers, but wishes extraction to be avoided, if possible, -“because the teeth, even when they are in some parts corroded, yet -nevertheless, after the pain is calmed, aid mastication and besides -render the others firmer.”[258] - -This author agrees with Galen in considering the teeth as bones, but -he is of opinion that they differ from the other bones in more than -one respect; that is, first of all, on account of their sensibility; -secondly, because, whilst the other bones are formed in the uterus, the -teeth are formed outside the uterus; and lastly, for a reason which -cannot but appear very strange to us, that is: “The bones are produced -by the sperm and menstrual blood, whilst the teeth are produced by the -blood in which there has remained the virtue of the sperm.”[259] This -passage gives us an idea of the state of embryological knowledge of -those days! - -PIETRO OF ARGELATA (or of La Cerlata), professor of surgery at Bologna -(died in 1433), wrote a treatise on surgery in six books, in which -diseases of the teeth are also taken into serious consideration. He -speaks of a great number of dental instruments, which, however, are -the same as those enumerated by Guy de Chauliac. His methods of cure -do not offer anything very new, being for the most part identical with -those of Avicenna and Abulcasis. He considers cleanliness of the teeth -of the greatest importance; shows what great injury is done by dental -tartar—which by him is considered a very important sign of the bad -state of the teeth—he counsels the removal of it by means of scrapers, -files, or the use of strong dentifrice powders; and to make the teeth -white, he even advises the use of aqua fortis. - -He says nothing in regard to the filling of decayed teeth; he, however, -counsels the cleansing of the carious cavities with aqua fortis, or -even, in some cases, the widening of them, in order to render them -shallower and therefore less liable to retain alimentary residues. - -Pietro of Argelata cured dental fistulas by means of caustics and -arsenic. He counselled simple palliative means of cure for hard -epulides of a cancerous nature. In regard to soft, benignant epulides, -he was little favorable to excision, as this might cause hemorrhage; -he preferred ligating the tumor; or he repeatedly cauterized it with -boiling oil or other caustics, until he caused it to fall.[260] - -BARTOLOMEO MONTAGNANA, who taught surgery in the University of Padua -and died in 1460, recommended, as an excellent anti-odontalgic remedy, -a mixture of camphor and opium. In his days, faith in the pretended -eradicating virtues of certain substances was being gradually lost; -but, on the other hand, a tendency now arose to neglect, in regard -to the teeth, the conservative principle, to which the ancients had -held so jealously; and little by little the extraction of a tooth -began to be considered an operation of small or no importance, that -could be performed with the greatest indifference. Montagnana himself -considers the extraction of a tooth as the best means of curing -odontalgia, whilst the ancients did not have recourse to it, saving as -a last resource. Notwithstanding this, if the caries was not deep, he -preferred to extraction the use of caustics and a red-hot iron.[261] - -GIOVANNI PLATEARIO, a professor at Pisa in the latter half of the -fifteenth century, cauterized carious teeth with a small piece of -kindled ash wood, or with a red-hot iron, and held that cauterization -was more effectual when, before performing it, the carious hollow had -been filled up with theriac.[262] - -He, too, made the administration of purgatives or bloodletting precede -the extraction of a tooth. Plateario has, however, the merit of having -introduced the sitting position for operations on the teeth, whilst -preceding surgeons made the patient lie in a horizontal position, or -held his head steady between their knees, as may be read in Abulcasis -and in other writers. Besides, he recommends taking care, when the -extraction of a tooth had to be performed, that the surrounding air -should be pure; perhaps because he thought that when operating in -a place where the air was tainted, complications might more easily -arise, on account of contagious substances reaching the inside of the -wound; or perhaps because he judged, not without reason, that certain -accidents, such as syncope, could more easily happen, and were more -dangerous in a tainted atmosphere than in the midst of pure, vivifying -air. After the operation, he prescribed astringent mouth washes. -Against dental worms, whose existence no one at that period doubted -in the least, Plateario recommended various remedies, chiefly under -the form of fumigations; and among these latter, those performed with -burnt opium. Against ulcerations of the gums and mouth he commended -the use of wine and aromatic substances. An excellent remedy was also, -according to him, lime dissolved in very strong hot vinegar, and -mixed, after complete evaporation of the liquid, with a fourth part of -orpiment. - -GIOVANNI OF ARCOLI (in Latin, _Joannes Arculanus_), professor at -Bologna and afterward at Padua (who died in 1484), wrote a commentary -on a celebrated book of medicine, which Rhazes had dedicated to the -glorious King Almansor, great patron of science and art.[263] - -In this most valuable work of Arculanus there are several chapters -relative to diseases of the teeth; and this subject is treated rather -fully and with great accuracy. - -The author, first of all, treats of the anatomy and physiology of the -teeth; he, however, falls into many errors, for instance, in regard to -the number of dental roots. (“The first six teeth of the upper jaw have -only one root; the first six of the lower not more than two; the molars -of the upper jaw have three; those of the lower generally only two in -like manner; the _neguezid_[264] of the upper jaw have four roots, but -the two lower neguezid have only three.”) - -According to him there is not the least doubt that the teeth grow -during the whole lifetime, thus repairing the continual waste caused -by use; and among other proofs he adduces that, whilst in the old all -other organs shrink and waste away through lack of nourishment, the -teeth, on the contrary, show very frequently an increase in length. - -For the preservation of teeth—considered by him, quite rightly, a -matter of great importance—Giovanni of Arcoli repeats the various -counsels given on the subject by preceding writers, but he gives -them as ten distinct canons or rules, creating in this way a kind of -decalogue of dental hygiene. These rules are: (1) It is necessary to -guard against the corruption of food and drink within the stomach; -therefore, easily corruptible food—milk, salt fish, etc.—must not be -partaken of, and after meals all excessive movement, coition, bathing, -and other causes that impair the digestion, must also be avoided. (2) -Everything must be avoided that may provoke vomiting. (3) Sweet and -viscous food—such as dried figs, preserves made with honey, etc.—must -not be partaken of. (4) Hard things must not be broken with the teeth. -(5) All food, drink, and other substances that can set the teeth on -edge must be avoided. (6) Food that is too hot or too cold must be -avoided, and especially the rapid succession of hot and cold, and _vice -versa_. (7) Leeks must not be eaten, as such a food, by its own nature, -is injurious to the teeth. (8) The teeth must be cleaned, at once, -after every meal, from the particles of food left in them; and for this -purpose must be used thin pieces of wood somewhat broad at the ends, -but not sharp pointed or edged; and preference should be given to small -cypress twigs, to the wood of aloes, of pine, rosemary, of juniper, and -similar sorts of wood which are rather bitter and styptic; care must, -however, be taken not to search too long in the dental interstices -and not to injure the gums or shake the teeth. (9) After this, it is -necessary to rinse the mouth, using by preference a vinous decoction -of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper -seeds, root of cyperus, and rosemary leaves. (10) The teeth must be -rubbed with suitable dentifrices before going to bed, or else in the -morning before breakfast. Although Avicenna recommended various oils -for this purpose, Giovanni of Arcoli appears very hostile to oleaginous -frictions, because he considers them very injurious to the stomach. He -observes, besides, that whilst moderate frictions of brief duration -are helpful to the teeth, strengthen the gums, prevent the formation -of tartar, and sweeten the breath, too rough or too prolonged rubbing -is, on the contrary, harmful to the teeth and makes them liable to -many diseases. As a dentifrice, he recommends a mixture of two parts -of honey to one of the best sugar; or the ashes of the burnt head of a -hare; or burnt salt made into an electuary by the addition of honey. -To use the last two dentifrices, a quantity about equal in volume to -a filbert must be wrapped and tied inside a thin, loosely woven piece -of linen cloth, and with this the teeth must then be rubbed. Finally, -theriac, too, is considered by him a very good dentifrice. According to -Arculanus, dental pains are sometimes situated in the very substance of -the tooth, at other times in the nerve, and at others in the gums. - -The dental substance may become painful, owing to bad “complexion” -(viz., constitution), without there being any morbid matter in it. -When, however, such matter exists, it may proceed from the head or -from the stomach, and in certain cases it gives rise to an apostema of -the tooth; in other cases it corrodes the latter; and at other times -generates (!) in it a worm, which in its turn corrodes the tooth. - -In regard to the diagnosis of dental pains, it is necessary first -of all to examine the state of the gums, that is to say, to observe -whether these, in the aching spot, appear healthy, or whether, on the -contrary, they are discolored or tumid, sanguinolent, suppurating, or -the seat of corrosion or putrefaction, or if, when pressure is put -upon them, an exit of matter is produced. In such cases it may be -considered that the gums are the seat of the pain. But if none of these -symptoms are observed, and if, on comparing the gums of the aching spot -with the other gingival regions, no difference is observed, this means -that the cause of the pain exists either in the substance of the tooth -itself, or else in its nerve. In this latter case the pain is usually -very violent, and principally localized in the root of the tooth, but -also extending along the jaw, and the tooth itself is often, as it -were, benumbed. When, however, the pain is not situated either in the -gums or in the dental nerve, but in the very substance of the tooth, -this latter is very often corroded (carious), and very often in the -hollow there exists a worm; and this may be deduced from the fact that -during the intervals of calm the patient sometimes feels a peculiar -sensation, the movement of the worm in the diseased tooth; when, -however, these signs are wanting, we shall find at any rate that the -whole tooth is painful in the direction of its length, instead of the -pain being localized in the root of the tooth and radiating along the -jaw. - -When the cause of the pain resides in the gums the extraction of the -tooth is neither necessary nor beneficial, but is, on the contrary, -always harmful, since, in spite of the loss of the tooth, the cessation -of the pain is not obtained; when the pain is situated in the tooth -itself, the removal of the latter always makes the pain cease; lastly, -when the dental nerve is the seat of the evil, the removal of the tooth -sometimes takes away the pain, at other times it does not. - -Among the many anti-odontalgic remedies, Arculanus enumerates pepper -mixed with tar, pepper with asafetida, mustard seeds with asafetida, -and the like. When a tooth is to be cauterized, it is necessary to -protect the healthy teeth with bits of cloth dipped in rose water or -else with some kind of paste. Sometimes it is useful to drill the tooth -with a small trephine so that the cautery may act more deeply, thus -giving better results. - -In regard to the filling of decayed teeth, Giovanni of Arcoli says -that, in the choice of the substances to be used, the _complexion_ -(constitution) of the teeth must be taken into consideration; and -according as this is cold or warm, it is necessary to perform the -filling with substances which are, by their own nature, warm or cold, -thus acting in opposition to the dyscrasia of the tooth: - -“_Eligantur calida aut frigida secundum opportunitatem, in contrarium -dyscrasiæ dentis._” - -As to the quality of the complexion, this might be deduced, says the -author, from various signs, among which the color of the gums, these -being red in the warm and humid complexion, yellowish in the warm and -dry, brownish in the cold and dry, and whitish in the cold and humid -complexion. When, however, the complexion does not show any distinct -characteristic, and varies but little from the average, Arculanus -advises the teeth being filled with gold-leaf: “_Ubi non fuerit multus -recessus a mediocritate, impleatur cum foliis auri._” - -Although Arculanus is the first writer who alludes to the filling of -teeth with gold, nevertheless it is by no means admissible that he was -himself the inventor of gold filling. His words do not at all sound -to us as the announcement of a new discovery, as the enunciation of a -new fact, in which the author himself had had, at least, a part, be -it great or small. Nothing of all this; the advice as to filling the -teeth, in certain cases, with gold leaf is given quite impersonally, -and is found, as if it were a point of minor importance, at the end -of a long paragraph, which includes various other counsels in regard -to the filling of teeth, one of which is, that this operation should -not be performed with too great violence.[265] In short, the writer -does not show the least intention of putting in evidence the aforesaid -fact, or of giving to it any special importance. We must, therefore, -hold that gold filling had already been in use for a long time among -dentists, and that Arculanus simply mentions what was done by the -dentists of those days. (See note page 164.) It is evident, on the -other hand, that he had no special competence in dental art, when we -consider that he was even ignorant of the exact number of dental roots. -Naturally, the question here arises: At what period did gold begin to -be used for the filling of teeth? But unfortunately history has not, -up to the present, furnished us any evidence which may lead to the -solution of this problem. - -For the eradication of a tooth Arculanus gives three very precise -indications: (1) When the pain resists every other means of cure. (2) -When there is any danger of the disease spreading to the neighboring -healthy teeth. (3) When the tooth is troublesome in speaking and in -masticating. - -Before extraction, the patient must be prepared for it by bloodletting, -purgatives, and narcotics; and the operation must be commenced by -separating the gums from the tooth. - -Arculanus admits, like many of his predecessors, that the eradication -of a tooth may be effected not only by the forceps and other suitable -instruments, but also by other means. One of these would be the use of -the actual cautery, repeatedly applied inside the hollow of the tooth, -if this is decayed; or, in the contrary case, made to act all around -its root (neck). The fall of the tooth might also be obtained with -potential cauteries and especially by the application of boiling oil, -or of a grain of incense heated to the melting point. - -It is plain that Giovanni of Arcoli has simply copied these things -from preceding authors, since if he had made a trial of the pretended -eradicating means, he would soon have verified their inefficiency. - -Against hemorrhage of the gums, Arculanus recommends arsenic, lime, -gall-nuts, alum, and oil of roses. But, says he, the surest remedy is -the red-hot iron; and still more effectual, cauterization by means of -red-hot gold. - -Giovanni of Arcoli’s work is not only noteworthy because it mentions -gold filling for the first time, but also because in it are given the -drawings of three dental instruments, among which the pelican (here -called _pulicanum_). According to Carabelli, the first author who has -mentioned the pelican was the Dutchman Peter Foreest; according to -Geist-Jacobi, instead, it was the German Walter Ryff. But both these -statements are false, because as we have just now said, the pelican -was already named and designed (not very well, it is true) in the book -of the Italian Giovanni of Arcoli, who died in 1484, that is, even -before either Walter Ryff or Peter Foreest came into the world. Neither -does Giovanni of Arcoli say one word that might imply that he was the -inventor of the pelican, and so we are led to believe that in his days -this instrument had already been in use for some time. In the text he -only says: “The teeth are to be extracted with suitable instruments, -whose figures may be seen in the margin.”[266] - -We here reproduce the three figures alluded to, with the relative -indications. The first (Fig. 56) represents the pelican; the second -(Fig. 57) is a pair of curved forceps, which seems, in those days, -to have been the instrument most commonly used for the extraction of -teeth, since this figure is accompanied by the very generic indication -“shape of the forceps for extracting teeth;” finally, the third (Fig. -58) represents the forceps used for extracting dental fragments -(roots), and which from the long and straight shape of its jaws, was -called “stork’s bill” (rostrum ciconiæ). - -ALESSANDRO BENEDETTI, of Verona, who lived from 1460 to 1525, and -taught medicine at Padua, was, for his times, a man of uncommon -scientific merit; but to the development of the dental art he did not -contribute anything very worthy of note. - -He relates that he once abstained from buying a slave simply because -the teeth of the latter were like those of wild beasts, a thing which -he considered as a bad omen. - -According to him, toothache is a disease proper to man, no other animal -being liable to it. - -To keep free from odontalgia, there is, says he, a very simple means, -which consists in rubbing the teeth once a year with the blood of a -tortoise. - -This is the first writer who has noted the harmful effect which mercury -has on the gums and teeth, whether this remedy be used internally or -externally, that is, by friction. - -[Illustration: FIG. 56 - -The pelican as represented in Giovanni d’Arcoli’s work. Forceps pro -extrahendis dentibus pulicanum dicta.] - -[Illustration: FIG. 57 - -Dental forceps (Giovanni d’Arcoli.) Forcipum pro extrahendis dentibus -forma.] - -[Illustration: FIG. 58 - -The forceps called “stork’s bill,” as represented in Giovanni -d’Arcoli’s work. Forceps pro extrahendis fragmentis quod Rostrum -Ciconiæ dicent.] - -Benedetti recommends that before proceeding to the extraction of a -tooth an accurate diagnosis should be made, so that it may not happen -that, by mistaking for true odontalgia a pain localized in the gums -or in the jaw, a sound tooth be drawn, under the belief that it is -the cause of the pain; for, this happening, not only would the pain -continue, but there would be, in addition, the loss of a sound tooth, -and also the disadvantage of the neighboring ones becoming less firm, -for want of support. - -This author, too, attributes great importance to dental worms, -believing them to be one of the principal and most frequent causes -of odontalgia. To kill them he recommends the usual fumigations and -several other remedies, among which the juice of the leaves of the -centaury or of the peach tree, but especially applications of aqua vitæ. - -When it is thought well to have recourse to opium to calm toothache, he -advises this to be used with the utmost prudence; and on this point, he -relates having witnessed a fatal case, in the person of a gentleman of -Padua, by the incautious use of this remedy. - -In extraction Benedetti repeats all the precautionary measures -recommended by the ancients, and he, too, advises that recourse should -not be had to this operation, if not as a last remedy, that is, when -every other means of cure has been found useless.[267] - -GIOVANNI OF VIGO. The celebrated surgeon Giovanni of Vigo (1460 to -1520), speaking of abscesses of the gums,[268] says that the abscess -must be first brought to maturity by fitting remedies, if it has not -ripened spontaneously, then it must be opened with a lancet, and -lastly, to cleanse the diseased part and to aid cicatrization, honey of -roses or Egyptian ointment must be used. This latter is thus composed -of: “℞—Verdigris, rock alum, _ana_ two ounces; honey of roses, one -ounce; plantain water and pomegranate wine, _ana_ two and one-half -ounces. The whole to be made to boil, and to be stirred with a small -rod, until the mixture is reduced to the consistency of honey.” - -For the cure of old fistulas he employs not only the above-mentioned -Egyptian ointment, but also arsenic and corrosive sublimate. - -Giovanni of Vigo is very brief in speaking on the treatment of dental -caries, doubtless because he attributed little or no value to the -numerous methods of cure recommended by his predecessors. The treatment -advised by him is, however, very noteworthy. He says that by means of -a drill, file, scalpel, or other suitable instrument, it is necessary -to remove the whole of the putrefied or corroded part of the teeth, and -then, to preserve it, to fill the cavity with gold leaf. - -This clear and simple manner of speaking of gold filling as a cure for -caries makes us suppose that Giovanni of Vigo was not at all a stranger -to the practice of dentistry, as we must think of many preceding -writers, but, on the contrary, that he was not less skilled in dental -operations than he was in the other branches of surgery. Again, history -tells us that Giovanni of Vigo was surgeon to the Roman court; so it -would have been strange, indeed, if the Pope, if the haughty prelates, -accustomed as they were to all kinds of refinement and comfort, should -have intrusted the care of their teeth to lowborn barbers and quacks, -whilst they could dispose of the services of so eminent a surgeon. - -It may, however, be seen from the very book of Giovanni of Vigo,[269] -that in his days doctors and surgeons were, in general, little skilled -in dental matters. Speaking of the extraction of teeth, he says: “For -this operation there is need of a practised man, and, therefore, many -medical and surgical authorities have expressed an opinion that this -operation should be left to expert barbers and to the itinerant quacks -who operate in public places. He, therefore, who desires to perform -this manual operation in the best manner will derive great advantage -by frequenting men who are expert in performing it and by seeing and -impressing well on his memory their manner of operating.”[270] - - - - -PART III. - -THIRD PERIOD—MODERN TIMES. - - - - -CHAPTER X. - -THE SIXTEENTH CENTURY. - - -We have now arrived at the sixteenth century. The middle ages, that -is, the period of transition between ancient and modern civilization, -has now come to an end. Events of the highest importance, such as the -invention of printing (1436), the taking of Constantinople by the Turks -(1453), with the consequent emigration of many Greek men of letters -and science, who took up their residence in the West and especially -in Italy, and lastly, the discovery of America (1492), marked the -beginning of a new era, and are the most essential factors in bringing -about the revival of art and science. - -In the midst of the vigorous intellectual life which characterized the -sixteenth century, dentistry, too, like many other branches of science, -made very notable progress; we, therefore, in this period shall have to -record many important facts and many important names. - -It is, indeed, in the sixteenth century, and, to be more precise, about -the year 1544, that we meet for the first time with a monograph, in -which dental affections are spoken of independently of general medicine -and surgery. The book we allude to, by WALTER HERMANN RYFF, is also -noteworthy because it is not written like the preceding works, in -Latin, the customary language of the learned, but, instead, in German, -that is, in a living tongue. - -As we are now mentioning the first German author on Dentistry, it may -be permitted us briefly to glance at the beginning of medicine and -dental art among the German peoples. - -Among the Germans, as in other nations, the first to practise the -healing art were priests, priestesses, and wise women. To cure disease -they used partly empirical remedies, and partly witchcraft and -superstitious means of every kind. Thus, to facilitate dentition, it -was thought an excellent thing to pass a thread through the eyes of a -mouse and then to tie the blood-covered thread around the neck of the -child. It was held, besides—and this prejudice has left even until now -some traces—that the putting of the milk teeth, when they fall out, -into the nest of a mouse assures the cutting of new teeth. - -We must here mention, with regard to the origin of dentistry among the -Germans, a very important fact related by Joseph Linderer,[271] a fact -which shows that even among the ancient Germans recourse was had to the -application of artificial teeth. - -We here reproduce the very words of the said author, translated -literally: - -“Being by chance a few years ago at Dresden and visiting the Museum -of Antiquities, my attention was attracted, in the last room, to two -osseous pieces, which with other objects were enclosed in a glass case, -with the written inscriptions: _Comb-shaped osseous pieces, found in -ancient German urns._ As soon as I had observed them, I saw at once -that they were artificial teeth; but as I had to be contented with -examining them through the glass of the case, it was not possible for -me to decide whether these pieces were really of bone, as they seemed -to be, or of another substance. Taking into account their antiquity, -their whiteness is very notable. Every piece is composed, if I remember -rightly, of five teeth, that is, of a canine and four incisors; the -chief difference of these pieces from the prosthetic pieces in ivory -still in use (the author is writing in 1848) consists in this, that the -pieces of which I speak have not at all a broad base, designed to rest -on the gums, the base having instead the same thickness as the rest. -The five teeth are well separated from one another. Besides, the canine -makes the proper angle with the incisors, and at each side of the piece -is found, in a convenient place, a hole, which shows that these teeth -were fastened to those of the subject by means of a metallic or other -kind of thread. As the above-described pieces are white, we must infer -that they were removed from the mouth of the respective individuals -before the body was burnt, and afterward put into the urn with the -ashes, just as they used to put in coins, bits of arrows, and the like.” - -For many centuries dental surgery—which, however, was still in a very -primitive state—was practised in Germany, as in many other countries, -principally by barbers. These in certain places, and at certain -periods, formed corporate bodies, whose members were legally authorized -to extract teeth and to practise minor surgery in general. But besides -barbers, there were various kinds of individuals, unfurnished with -any authorization—tooth-drawers, charlatans, wandering story-tellers, -necromancers, Jews, and even hangmen—who invaded the field of medical -practice, in spite of its being forbidden them, except in fairs, to -administer medicaments and to perform surgical operations.[272] - -In 1460 there appeared in Germany a book on Surgery by Heinrich von -Pfolsprundt, Knight of the Teutonic Order.[273] The author had acquired -great experience as surgeon in the military expeditions of his order, -and we see from his book that he was very skilled in the cure of wounds -and fractures. On the other hand, he shows himself hostile to every -bloody operation with the exception of rhinoplast. Pains of the teeth -and gums were cured by him by means of beverages.[274] - -[Illustration: Title page of Zahnarzneybuchlein.] - - [The accompanying reproduction of the title page and - two text pages from an edition of _Zahnarzneybuchlein_, - printed by Michael Blum, in Leipzig, 1530, and translated - below, is of interest in connection with the history of - the use of gold-foil as a filling material, in that a - marginal note refers to Mesue as the author from whom the - three methods of treating caries has been derived, one - of these methods being the filling of the carious cavity - with gold-foil. - - Mesue was Surgeon to the Caliph Haroun al Raschid, who - flourished 786-809. If the reference to Mesue is correct, - it would, therefore, indicate that the filling of teeth - with gold was known to the Arabs as early as the latter - part of the eighth century. Examination of the writings - of Mesue has thus far failed to bring to light any record - therein of the treatment of caries by gold filling, - although in his work previously referred to (see page - 138) the other methods quoted by the anonymous author of - _Zahnarzneybuchlein_ are fully set forth. - - [Illustration: Latin text.] - - [_Translation._] - - - FIFTH CHAPTER. - - ON CARIOUS AND HOLLOW TEETH. - - Corrosion is a disease and defect of the teeth when they - become carious and hollow, which most often happens in - the molars, especially if one does not clean them of - the adhering food which becomes moist and consequently - produces bad, sharp [acid] moisture that eats and - corrodes them, always gradually increasing, until it - spoils the teeth entirely, which afterward must fall away - in pieces not without pains. - - “_Mesue ut supra capite proprio._” This, as Mesue writes, - is chiefly cured and removed in three ways. First, by - purging as treated upon above. Second, by dissolving the - material which renders them hollow and eats them away; - also by boiling cockles that grow in barley or wheat, in - vinegar and holding this in the mouth. In this vinegar - the root of caper and ginger and other similar remedies - must have been previously boiled. Third, by removing the - decay, which is done in two ways. First, by scraping - and cleaning the hole and the carious part with a fine - chisel, knife, or file, or other suitable instrument, as - is well known to practitioners, and then by filling the - cavity with gold leaves for the preservation of the other - portion of the tooth. Second, by using suitable medicine, - such as oak apples or wild galls, with which the tooth is - filled after having been cleaned. - - [Illustration: German text.] - - The following editions of _Zahnarzneybuchlein_, besides - the Basle and Mayence editions noted by Dr. Guerini at - page 166, were issued and copies thereof are preserved - in the libraries of the several collectors as stated. - Edition of 1530, printed by Michael Blum, Leipzig, in - collection of Edward C. Kirk. Edition of 1536, printed - by Chr. Egenolff, Frankfurt a/M, in collection of - William H. Trueman. Edition of 1541, printed by Chr. - Egenolff, Frankfurt a/M, in _Dental Cosmos_ library and - collection of E. Sauvez. Edition of 1576, printed by Chr. - Egenolffserben, in collection of H. E. Friesell.—E. C. K.] - -The book, therefore, lacks importance from a dental point of view, -except in the sense that it shows how little skilled in the cure of -dental affections were the German surgeons of those days. - -It is worthy of note that this author, also, speaks of anesthetic -inhalations; he, however, only translates, almost to a word, what Guy -de Chauliac says on this subject. - -Toward the end of the fifteenth century and in the first half of -the sixteenth there were published in German, by anonymous authors, -some short translations and compilations on dental subjects, taken -especially from Greek and Arabian authors.[275] Of these writings, the -first one known, taken from Galen and Abulcasis, was printed at Basle -in 1490; and another—one of the best—saw the light at Mayence in 1532. -These works were perhaps due to intelligent barbers, or perhaps—and -this seems to be the most probable—they were written, through the -initiative of enterprising printers, by doctors and surgeons, who -wished to remain unknown, on account of the special subject treated; -for, owing to the fact that the diseases of the dental system were -generally left in the hands of barbers and other unprofessional -persons, the doctors and surgeons of those days would have been ashamed -to interest themselves in such things. - -WALTER HERMANN RYFF, of Strasburg, was born in the beginning of the -sixteenth century, and died about 1570. He was a rather mediocre doctor -and surgeon, and a man of the worst morals, so much so that many cities -expelled him from their midst.[276] He wrote many medical works, in -which, however, there is very little original matter. Their principal -merit consists, perhaps, in the fact that they were written not in -Latin, as then was universally customary, but rather in the vernacular -of the author and in a popular style; so that Ryff may be looked upon -as the first who endeavored to diffuse among the people useful medical -and hygienic knowledge. - -Among Ryff’s books there are two which are very important to us. One -is his _Major Surgery_, and the other is a pamphlet entitled _Useful -Instruction on the Way to Keep Healthy, to Strengthen and Reinvigorate -the Eyes and the Sight. With Further Instruction on the Way of Keeping -the Mouth Fresh, the Teeth Clean, and the Gums Firm._[277] - -Of these books, there now only exist some extremely rare copies; so -much so that neither Albert von Haller nor Kurt and Wilhelm Sprengel, -who rendered such great services to the history of surgery, ever -had the pleasure of examining them. Dr. Geist-Jacobi has been more -fortunate than they, and has therefore been able to give us some very -interesting information about their contents. - -The _Major Surgery_ is a mere compilation which does not contain -anything new of importance. It was published in part in 1545, and in -part in 1572, after the death of the author. The work is illustrated -with very beautiful wood engravings; and it is just this which gives -the principal value to this book. Some of the illustrations contained -in the first part of it—that is, in that published in 1545—represent -dental instruments, notwithstanding dental surgery is not treated in -this part of the book. The author gives notice that he will treat all -that concerns dental affections in the latter part of this book, in a -special chapter. Unfortunately, this chapter was never written, because -death prevented Ryff from completing the second part of his work. - -[Illustration: FIG. 59 - -Pelican and dental forceps (Walter Hermann Ryff).] - -The dental instruments represented in his _Major Surgery_ are many -in number. Among them, first of all, are found the fourteen dental -scrapers of Abulcasis, then the “duck-bill”—designed for the extraction -of dental roots and broken teeth—various kinds of pelican (Fig. 59 A), -the “common dental forceps” (Fig. 59 B), the “goat’s foot,” and many -other kinds of elevators, among which, observes Geist-Jacobi, may be -seen instruments even now in use, and even some which are said to have -been recently invented. - -Ryff’s other book is especially noteworthy because, as we have -already mentioned, it treats, for the first time, of dental matters, -independently of general medicine and surgery. This pamphlet, printed -at Würzburg about the year 1544, is made up of sixty-one pages, and -is divided into three parts, the first of which is dedicated to the -eyes, the second to the teeth, and the third to the first dentition. -It is written in popular style, and the author certainly intended it -for the instruction of the public, and not for professional men; so -true is this, that in it he does not speak of the technical part of the -extraction of teeth, or of gold filling—a method already known for a -long time—or of dental prosthesis. - -The first part, relative to diseases of the eyes and the manner of -curing them, has no importance for us. The second part begins with the -following paragraph: - -“The eyes and the teeth have an extraordinary affinity or reciprocal -relation to one another, by which they very easily communicate to each -other their defects and diseases, so that the one cannot be perfectly -healthy without the other being so too.”[278] - -This last statement is absolutely false, as a disease of the eyes -may very well exist with a perfect condition of the teeth, and _vice -versa_. However, Ryff has the merit of being, perhaps, the first who -has noted the undeniable relation which exists between the dental and -ocular affections. - -After a rapid glance at the anatomy and physiology of the teeth, the -author enumerates the causes of dental disease, which, according to -him, are principally heat, cold, the gathering of humors, and traumatic -actions. - -The prophylaxis of dental diseases is beyond any doubt one of the -best parts of the book; however, the ten rules counselled by Ryff -for keeping the teeth healthy—rules which Dr. Geist-Jacobi has made -known to us in full—are reproduced, almost to a word, from Giovanni -d’Arcoli’s work; therefore, the author has no other merit than that -of having translated them into the vulgar tongue, thus diffusing -the knowledge of useful precepts for preventing dental diseases. We -refrain from reproducing the aforesaid rules here, as they are, with -slight variations, identical with those which we gave when speaking of -Arculanus. - -Nor can any credit be given to Ryff for the rules which he gives in -regard to the diagnosis of dental pains, as this part of his work is -also taken wholly from the Italian author just mentioned. - -After these diagnostic rules Ryff, continuing to translate from the -book of Giovanni d’Arcoli, adds: - -“If the pain comes from the gums, extraction is of no use; if it comes -from the tooth, extraction makes it cease; when, lastly, it is in the -nerve, sometimes extraction removes it, and sometimes it does not, -according as the matter obtains or not a free exit.” - -The barbers and tooth-drawers, he says, must well remember this rule, -in order to avoid extracting, thoughtlessly and with no benefit, sound -teeth, since then the pain persists in spite of the operation. Also, it -must be borne in mind that, in case of violent pain, it is necessary to -operate as soon as possible, so that the patient may not faint or be -attacked by the falling sickness, if the pain should be communicated to -the heart or brain. - -The idea that violent dental pains could give rise to syncope or to -epilepsy (in regard to which we only observe that even very recent -writers enumerate dental caries among the causes of the so-called -reflex epilepsy) is also found in Giovanni d’Arcoli, who expresses -himself in regard to this in the following terms: “Such very violent -pains are sometimes followed by syncope or epilepsy, through injury -communicated to the heart or brain.”[279] - -“The most atrocious pain,” says Ryff, “is when an apostema ripens in -the root;” literal translation of words written about a century before -by Arculanus: “Fortissima dolor est, qui provenit ab apostemate, quod -in radice dentis maturatur.” - -Likewise taken from Arculanus is the observation (already made, -however, by much more ancient writers) that “when the cheeks swell, -toothache ceases.” Arculanus, however, expresses himself in a less -absolute manner, and therefore more corresponding to the truth, since -he says “the pain generally ceases” (secundum plurimum dolor sedatur). - -Even in regard to the therapeutics of dental pains, Ryff does not tell -us anything new. Dr. Geist-Jacobi gives this author the merit of having -made, in regard to the cure of dental pains, a distinction between -_cura mendosa_ (that is, imperfect, palliative, tending simply to calm -the pain) and _cura vera_ (that is, directed against the causes of -the disease). But this very important distinction is also taken from -Arculanus, who in his turn took it from Mesue. In fact, after having -spoken of the general rules relative to the cure of dental diseases, -Giovanni of Arcoli adds: “As to the particular therapy, it is divided -into _cura mendosa_ and _cura vera_, as may be found in Mesue. And the -_cura mendosa_ is so called because it calms the pain by abolishing -sensibility, not by taking away the cause of it. Such is, for the sake -of example, the cure, consisting in fumigations of henbane, made to -reach the diseased tooth by means of a small tube, adapted to a funnel.” - -The third part of Ryff’s pamphlet has as its title: - -“How the pains of the gums should be calmed or mitigated in suckling -infants, so as to promote the cutting of the teeth without pain.” - -This part, as Geist-Jacobi informs us, is very brief, not taking up -more than a page and one-half of print. Neither does it contain -anything of importance. To render the cutting of teeth easier, Ryff -advises that infants should have little wax candles given to them to -chew and the gums anointed with butter, duck’s fat, hare’s brains, and -the like. The tooth of a wolf may be hung around the neck of the child, -so that it may gnaw at it. It is also recommended that the head of the -child should be bathed with an infusion of chamomile. - -From what has been said, one may see very clearly that the aforesaid -book is, from the scientific point of view, entirely valueless, -because the best part of it is merely copied from the work of Giovanni -d’Arcoli. However, the author has the indisputable merit of having -endeavored to diffuse the knowledge of useful precepts of dental -hygiene. His book, besides, we repeat, has great historical value, for -from it dates the beginning of odontologic literature, properly so -called. - -On this point we believe it is necessary to correct an error into which -Dr. Geist-Jacobi has fallen. At the beginning of his very valuable -article on Walter Hermann Ryff[280] he says: “In the fifth century of -the Christian era, the iatrosophist Adamantius of Alexandria published -an exclusively odontalgic work, of which, however, we only know the -title.” The same he repeats in his _History of Dental Art_ (pp. 55 and -56), without, however, giving us any proof of his statement. “Of the -odontologic treatise of Adamantius,” he says, “unfortunately the title -alone is known to us, and even that has reached us indirectly, that is, -by means of Ætius; it is of the following tenor.” - -Now, whoever takes the trouble to translate these Greek words will -easily perceive that they do not constitute one title, but two distinct -ones (which even Dr. Geist-Jacobi has had to unite by the conjunction -_and_). These, however, are nothing more than the titles of two -chapters of the _Tetrabiblos_ of Ætius, as anyone may see for himself -by turning over the pages of this work either in the Greek original, or -in the beautiful Latin translation of Giano Cornario (Venice, 1553). -In this great composition of Ætius dental diseases are treated of in -Chapters XXVII to XXXV of Sermo IV, Tetrabiblos II; and the two Greek -titles above referred to are the titles of Chapters XXVII and XXXI. - -In the translation of Giano Cornario they read as follows: - -_Cura dentium a calido morbo doloroso affectorum, ex Adamantio -sophista_ (cure of teeth affected by warm, painful disease, according -to Adamantius the sophist). - -_Cura dentium a siccitate dolore affectorum, ex Adamantio sophista_ -(cure of teeth affected by pain from dryness, according to Adamantius -the sophist). - -The work of Adamantius, from which Ætius took the contents of the -chapters thus entitled, is lost to us, but we have no reason, and not -even the least indication, for supposing that this work was a treatise -on dental diseases, and not one on general medicine. It is absurd to -consider the above-mentioned titles as belonging to an odontological -monograph, on the one hand, because, admitting for a moment the -existence of such a work, it should have had but one title and not two, -and on the other hand, because it is by no means to be supposed that a -great and wise physician, such as Adamantius undoubtedly was, should -have had the whim to write a book, not on dental disease or on dental -pains in general, but only and exclusively on dental pains caused by -heat or by dryness. What reason would there have been for not extending -the treatment of the subject to those cases of odontalgia resulting -from humidity or from cold, that is, from causes as common and, -according to the ideas of that time, very frequently associated with -one of the first two (as humidity with heat, and cold with dryness)? - -Besides, if the titles of the two chapters spoken of be compared with -those of the others, in which Ætius treats of dental affections, such -analogy will be noticed between the various titles as to make us -consider that they have been formulated by Ætius himself, even when the -contents of these chapters are taken from other writers. So that the -two aforesaid titles not only do not belong to any dental work, but -probably they have never existed, even as simple titles of chapters, -in the medical book of Adamantius, from which the contents of the two -chapters of Ætius above mentioned have been taken. - -In order that every one may easily be convinced that the two titles -made so conspicuous by Dr. Geist-Jacobi have nothing particular about -them, but are, instead, perfectly analogous to the titles of various -other chapters of Ætius, we give here the translation of the titles -of five chapters, all concerning dental maladies, that is, the two -chapters in discussion and other three: - -Chapter XXVII: Cure of teeth affected by warm, painful disease, -according to Adamantius the sophist. - -Chapter XXIX: Cure of teeth affected with pain from humidity. - -Chapter XXXI: Cure of teeth affected by pain from dryness, according to -Adamantius the sophist. - -Chapter XXXII: Cure of teeth affected by pain from heat and humidity. - -Chapter XXXIII: Cure of decayed teeth, according to Galen. - -It appears very clear, therefore, from the great analogy existing -between the headings of all the above-mentioned chapters, that the -titles referred to by Geist-Jacobi have not at all the historical -importance and significance that he attributes to them, and that the -same have been formulated by Ætius himself. To argue from such titles -that Adamantius was the author of a book on dentistry is not only -inadmissible, for all the reasons already given, but also because -if it were allowable to reason with such lightness, it might also -be stated—by arguing from the title of Chapter XXXIII—that Galen -was the author of a monograph on the treatment of dental caries; a -thing which is absolutely untrue. Consequently, the beginning of -odontologic literature cannot be traced back to Adamantius, but, as Dr. -Geist-Jacobi would have it, to an author much less ancient, that is, -to Walter Hermann Ryff, or, if it is preferred, even to the anonymous -writers of the odontologic compilations which appeared in Germany at -the end of the fifteenth century. - -ANDREAS VESALIUS. We must now speak of Andreas Vesalius, an -extraordinary man, who by his genius infused new life into medical -science, and who, although he gave but little attention to dental -matters, yet fully deserves a place of honor in the history of -dentistry; for this, like every other branch of medicine, received -great advantage from his reforming work, which broke down forever the -authority of Galen, thus freeing the minds of medical men from an -enslavement which made every real progress impossible. - -Andreas Vesalius was born at Brussels, December 31, 1514. He studied -at Louvain and then at Paris, where at that time great scientists -taught, and among others the celebrated anatomist Jacques Dubois, -generally known by the Latinized name of Sylvius.[281] The latter, a -great admirer of Galen, whose anatomical writings served as texts for -his lectures, became jealous of the young Belgian student, who was -his assistant, and who gave undoubted proofs of great genius, and of -extraordinary passion in anatomical research. Vesalius often defied the -greatest dangers in order to obtain corpses either from the cemetery -of the Innocents or from the scaffold at Montfaucon. He soon surpassed -his most illustrious masters, and at only twenty-five years of age -published splendid anatomical plates, which astonished the learned. He -acquired also great renown as surgeon, and in this capacity he followed -the army of Charles V in one of his wars against France. After having -been professor of anatomy in the celebrated University of Louvain -(Belgium), he was invited by the Venetian Republic to teach in the -University of Padua, which, through him, became the first anatomical -school in Europe. Yielding to the requests of the magistrates of -Bologna and Pisa, he also taught in those famous universities, before -immense audiences. - -[Illustration: Andreas Vesalius.] - -Before Vesalius, Galen’s anatomy had served as the constant basis -for the teaching of this science. Although even from the end of the -fifteenth century dead bodies were dissected in all the principal -universities, the teachers of anatomy always conformed, in their -descriptions, to those of Galen, so that the authority of this master, -held infallible, prevailed even over the reality of facts. - -Vesalius, for the first time, dared to unveil and clearly put in -evidence the errors of Galen; but this made him many enemies among the -blind followers and worshippers of that demigod of medicine. Europe -resounded with the invectives that were bestowed upon Vesalius. Among -others, there rose against him Eustachio at Rome, Dryander at Marburg, -Sylvius at Paris, and this last did not spare any calumny that might -degrade his old pupil, who had become so celebrated. In spite of this, -the fame of Vesalius kept on growing more and more, so much so that -Charles V called him to Madrid, to the post of chief physician of his -Court, a place which he kept under Philip II, also after the abdication -of Charles V. The good fortune of Vesalius, unhappily, was not to be of -long duration. In 1564 a Spanish gentleman died, in spite of the care -bestowed upon him by Vesalius, and the illustrious scientist requested -from the family, and with difficulty obtained, the permission to -dissect the body. At the moment in which the thoracic cavity was opened -the heart was seen, or thought to be seen, beating. The matter reached -the ears of the relations of the deceased, and they accused Vesalius, -before the Inquisition, of murder and sacrilege; and he certainly would -not have escaped death except by the intervention of Philip II, who, to -save him, desired that he should go on a pilgrimage to the Holy Land, -as an expiation. On his return, the ship which carried Vesalius was -wrecked, and he was cast on a desert beach of the Isle of Zante, where, -according to the testimony of a Venetian traveller, he died of hunger, -October 15, 1564. - -Vesalius left to the world an immortal monument, his splendid treatise -on Anatomy,[282] published by him when only twenty-eight years of age, -and of which, from 1543 to 1725, not less than fifteen editions were -issued. The appearance of this work marked the commencement of a new -era. The struggle between the supporters of Galen and those of Vesalius -rendered necessary, on both sides, active research concerning the -structure of the human body, so that anatomy, the principal basis of -scientific medicine, gradually became more and more perfect, and, as -a consequence of this, as well as of the importance which the direct -observation of facts acquired over the authority of the ancients, -there began in all branches of medicine a continual, ever-increasing -progress, which gave and still gives splendid results, such as would -have been impossible under the dominion of Galenic dogmatism. - -In the great work of Vesalius the anatomy of the teeth is unfortunately -treated with much less accuracy than that of the other parts of the -body. However, his description of the dental apparatus[283] is far -more exact than that of Galen, and represents real progress. The number -of the roots of the molar teeth (large and small) is indicated by Galen -in a very vague and inexact manner, since he says that the ten upper -molars have generally three, sometimes four roots, and that the lower -ones have generally two, and rarely three. Vesalius, having examined -the teeth and the number of their roots in a great number of skulls, -was able to be much more precise. In regard to roots, he makes, for the -first time, a very clear distinction between the premolars next to the -canine (small molars) and the other three, and says that the former -in the upper jaw usually have two roots, and in the lower, one only, -whilst the last three upper molars usually have three roots and the -lower ones two. As everyone sees, these indications are, in the main, -exact. - -Other important facts established by Vesalius are as follows: - -The canines are, of all the teeth, those which have the longest roots. -The middle upper incisors are larger and broader than the lateral -ones, and their roots are longer. The roots of the last molars are -smaller than those of the two preceding molars. In the penultimate -and antepenultimate molars, more often than in the other teeth, it -sometimes happens that a greater number of roots than usual are found, -it being not very rare to meet with upper molars with four roots, and -lower ones with three. The molars are not always five in each half jaw; -sometimes there are only four, either on each side, or on one side -only, in only one jaw or in both. Such differences generally depend -on the last molar, which does not always appear externally, remaining -sometimes completely hidden in the maxillary bone, or only just -piercing with some of its cusps the thin plate of bone which covers it; -a thing which Vesalius could observe in many skulls in the cemeteries. - -In regard to the last molar, the author speaks of its tardy eruption -and of the violent pains which not unfrequently accompany it. The -doctors, he adds, not recognizing the cause of the pain, to make it -cease have recourse to the extraction of teeth, or else, attributing it -to some defects of the humors, overwhelm the sufferer with pills and -other internal remedies, whereas the best remedy would have been the -scarification of the gums in the region of the last molar and sometimes -the piercing of the osseous plate which covers it. - -This curative method, of which no one can fail to recognize the -importance, was experimented by Vesalius on himself, in his -twenty-sixth year, precisely at the time that he had just begun to -write his great treatise on anatomy. - -The existence of the central chamber of the teeth appears to have been -unknown to Galen, as he does not allude to it in the least. Vesalius -was the first to put this most important anatomical fact in evidence. -He expresses an opinion that the central cavity facilitates the -nutrition of the tooth. He says, besides, that when a hole is produced -in a tooth by reason of acrid corrosive humors, the corrosion, when -once the internal cavity is reached, spreads rapidly and deeply in the -tooth, owing to the existence of the said cavity, and sometimes reaches -even the end of the root. - -In the chapter in which Vesalius treats of the anatomy of the teeth -(Chapter XI, p. 40), two very well-drawn figures are found, one of -which represents a section of a lower molar, showing the pulp cavity -and its prolongation into the two root canals. The other represents the -upper and lower teeth of the right side, in their reciprocal positions, -and shows very clearly their general shape, the length of their roots, -and the number of these. - -The changes which take place in the alveolus, after the extraction of -a tooth have not escaped the notice of Vesalius. He says that after -an extraction the walls of the alveolus approach one another, and the -cavity is gradually obliterated. - -Aristotle had affirmed that men have a greater number of teeth than -women. Vesalius declares this opinion absolutely false—although, after -Aristotle, it has been repeated by many other ancient writers—and says -that anyone can convince himself that the assertion of Aristotle is -contrary to the truth, as it is possible for everybody to count his own -teeth. - -In spite of this, we find the above-mentioned error even in writers -subsequent to Vesalius; for example, in Heurnius (professor at Leyden -toward the end of the sixteenth century), who expresses an opinion that -rarely do women have thirty-two teeth, like men. - -We find but little in Vesalius concerning the development of the teeth. -He, indeed, made some observations and researches on this point, but -these, from their insufficiency, led him to quite mistaken conclusions. -The teeth of children, he says, have imperfect, soft, and, as it were, -medullary roots; and the part of the tooth which appears above the gums -is united to the root, so to say, as a mere appendix, after the fall of -which there grows from the root the permanent tooth. This error arose -in the mind of Vesalius from observing that when children lose their -milk teeth, these have the appearance of a kind of stump, as if the -root had actually remained in the socket. Besides this, he had observed -with what facility the milk teeth fall out; and he here calls to mind -that, when about seven years old, he himself and his companions used to -pluck out their loosened teeth, and especially the incisors, with their -fingers, or with a thread tied around the tooth. The softness of the -dental roots in children, the easy fall of the milk teeth, and the want -of the lower part of the roots in these, must have raised the idea -in his mind that the roots of the milk teeth remained in the socket, -and that the upper part of the temporary teeth, instead of being a -continuation of the root, was joined to this as a simple appendix, and -in a very weak way, as though designed to remain in place for a limited -length of time only. - -In Vesalius[284] is found a dental terminology—Latin, Greek, Hebrew, -and Arabic—which affords some interest. The incisors are called in -Latin _incisorii_, _risorii_, _quaterni_, _quadrupli_; and the two -middle incisors have been denominated by some authors _duales_. The -canines are called in Greek kynodontes, which means the same as the -Latin _canini_, dog’s teeth. In Latin they have been also denominated -_mordentes_, and by some also _risorii_, a name which by others is -given to the incisors, as we have already seen. The molars have -also been called in Latin _maxillares_, _paxillares_, _mensales_, -_genuini_.[285] But some authors give this last name only to the last -molars, or wisdom teeth, _dentes sensus et sapientiæ et intellectus_. -These teeth have also been called _serotini_ (that is, tardy), _ætatem -complentes_ (that is, completing the age, the growth), and also, in -barbaric Latin, _cayseles_ or _caysales_, _negugidi_, etc. - -In the rebellion against the authority of the ancients, Vesalius had -a predecessor whose name, deservedly famous, may be recorded here. -PARACELSUS (born in 1493 at Maria-Einsiedeln, Switzerland), on being -nominated, in 1527, Professor of Medicine and Surgery at Basle, -inaugurated his lectures by burning in the presence of his audience, -who were stunned by such temerity, the writings of Galen and Avicenna, -just as Luther, seven years before, had burnt in the public square of -Wittenberg the papal bulls and decretals. The sixteenth century, in its -exuberance of intellectual life, was undoubtedly one of the grandest -centuries in history; human thought in that glorious epoch shattered -its chains, and declared its freedom both in matters of science and of -religion. - -Paracelsus, a man of powerful genius, but not well balanced in mind, of -corrupt morals, and of an unlimited pride, had, notwithstanding these -undeniable defects, the merit of beginning a healthy reform in the -science and practice of medicine, by substituting the study of nature -for the authority of the ancients and by giving a great importance to -chemistry, both for the explanation of organic phenomena and for the -cure of disease. - -It is to be lamented that this man of genius did not contribute in any -way to the progress of dentistry. His works have no importance for -us. As a matter of mere curiosity we only record here that Paracelsus -considered the too precocious development of the teeth as a great -anomaly, and regarded as monsters those children who were born with -teeth.[286] - -[Illustration: Paracelcus.] - -[Illustration: Gian Filippo Ingrassia.] - -[Illustration: Gabriel Fallopius.] - -GIAN FILIPPO INGRASSIA (1510 to 1580), a distinguished Sicilian -anatomist, was one of the first who spoke of the dental germ. He says -that the existence of the tooth properly so called is preceded by that -of a soft dental substance enclosed in the bone, and which he considers -almost as a secretion of the latter. - -MATTEO REALDO COLOMBO, of Cremona, a pupil of Vesalius and his -successor in the professorship of Anatomy at Padua, added but little, -as regards the teeth, to what his master has taught. He combated the -erroneous idea that the teeth were formed in the alveoli shortly before -their eruption. Having dissected the jaws of many fetuses, and having -always observed in them the existence of teeth, he could affirm with -every certainty that the teeth begin to be formed in intra-uterine life. - -Like Vesalius, Realdo Colombo believed that the permanent teeth were -developed from the roots of the milk teeth; and, therefore, he advised -the utmost caution in extracting these, since, if the whole root were -removed, the tooth would not grow again.[287] - -GABRIEL FALLOPIUS (1523 to 1562), the eminent anatomist of Modena, also -a disciple of Vesalius, carried out accurate and successful researches -in regard to the development of the teeth, and made them known in his -book, _Observationes anatomicæ_, published at Venice in 1562, the year -in which he died. - -His investigations enabled him to show the falsity of the opinion held -by Vesalius, that the permanent teeth are developed from the roots of -the temporary ones. He was, besides, the first who spoke in clear terms -of the dental follicle. - -The teeth, says Fallopius,[288] are generated twice over, that is, -the first time in the uterus, after the formation of the jaws, and -the second time in extra-uterine life, before the seventh year. The -first teeth are, at the time of birth, still imperfect, without roots, -completely enclosed in their alveoli, and formed of two different -substances; the part with which they must break their way out is -osseous and hollowed; the deeper part, instead, is soft and humid -and is seen covered with a thin pellicle, a thing which may also be -observed in the feathers of birds when they are still tender. In -fact, the part of the feather which comes out of the skin is hard and -corneous, whilst the part which is embedded in the wings is soft and -humid and has the appearance of coagulated blood or mucus. So also in -the fetal teeth, the part corresponding to the future root presents -itself like coagulated mucus. Little by little this soft substance -hardens and becomes osseous, thus constituting the root of the tooth. - -Fallopius’ reference to the analogy between the development of teeth -and that of feathers was highly important, as a point of departure -for embryological researches which showed clearly the real nature of -teeth, thus destroying the mistaken idea—held by Galen and many other -authors—that these organs were bones. - -On coming to speak of the teeth generated in extra-uterine life, that -is of the permanent teeth, Fallopius relates having observed that -they have their origin in the following manner: A membranous follicle -is formed inside the bone furnished with two apices, one posterior -(that is to say, deeper down, more distant from the surface of the -gums), to which is joined a small nerve, a small artery, and a small -vein (_cui nervulus, et arteriola, et venula applicantur_); the other -anterior (that is more superficial), which terminates in a filament -or small string, like a tail. This string reaches right to the gum, -passing through a very narrow aperture in the bone, by the side of the -tooth which is to be substituted by the new one. Inside the follicle -is formed a special white and tenacious substance, and from this the -tooth itself, which at first is osseous only in the part nearest the -surface, whilst the deeper part is still soft, that is, formed of the -above-mentioned substance. Each tooth comes out traversing and widening -the narrow aperture through which the “tail” of the follicle passes. -The latter breaks, and the tooth comes out of the gum, bare and hard; -and in process of time the formation of its deeper part is completed. - -The author says that his long and laborious researches into the -development of the teeth were carried out with great accuracy, and -he is, therefore, in a position to give as absolute certainties the -facts exposed by him. Indeed, the observations of Fallopius were, for -the most part, confirmed by subsequent research. As to the “tail” -of the dental follicle, it is identical with the _iter dentis_ or -_gubernaculum dentis_ of some authors. Fallopius described it as a -simple string, but later on this prolongation of the dental follicle -has been considered, at least by some, as the narrowest part or neck -of the follicle itself, that is, as a channel through which the tooth -passes, widening it, on its way out, and precisely for this reason it -has been called _iter dentis_ (the way of the tooth) or _gubernaculum -dentis_ (helm or guide of the tooth). - -BARTHOLOMEUS EUSTACHIUS, another great anatomist of the sixteenth -century, occupied himself in the study of teeth with special interest, -and wrote a very valuable monograph on this subject. He was a native -of San Severino, Marche (Italy), and a contemporary of Vesalius, -Ingrassia, Realdo Colombo, and Fallopius; he died in 1574, after having -immortalized his name through many anatomical discoveries and writings -of the highest value. - -[Illustration: Bartholomeus Eustachius] - -His book on the teeth, _Libellus de dentibus_, published at Venice in -1563, is the first treatise ever written on the anatomy of teeth, -and represents a noteworthy progress in this branch of study. - -In this little book—divided into thirty chapters, forming in all -ninety-five pages—the author treats with great accuracy and in an -admirable manner all that concerns the anatomy, physiology, and -development of the teeth. - -Eustachius not only treasured up what ancient authors had written on -this subject, but he himself made very long and patient researches and -observations on men and animals, on living individuals as well as on -corpses, and not only on adult subjects, but also on children of every -age, on stillborn children and on abortive fetuses. - -The macroscopic anatomy of the teeth was brought by him to a high -degree of perfection. Very wonderful, among other things, is the -accuracy with which he studied and specified in several synoptical -tables the number of the roots of molar teeth, and all the variations -occurring not only in their number, but also in their form, length, etc. - -In Chapter IV, speaking of the means by which teeth are held in their -sockets, Eustachius mentions in quite explicit terms the ligaments of -the teeth. He begins by saying that the perfect correspondence between -the dental roots and the alveoli, both in shape and in size, is one of -the elements which contribute to the firmness of the teeth, since the -alveolus, being exactly applied, on all sides, to the root or roots -of the tooth, causes the latter, by this simple fact, to be fixed in -a determined position. Also, the nerves inserted in each single tooth -contribute, as was already the opinion of Galen, to the stability of -these organs. “There exist besides”—Eustachius continues—“very strong -ligaments, principally attached to the roots, by which these latter -are tightly connected with the alveoli” (_adsunt præterea vincula -fortissima radicibus præcipue adherentia, quibus præsepiolis arctissime -colligantur_). Lastly, says the author, the gums, too, embracing the -teeth at their exit from the alveoli, contribute to their firmness. -And here Eustachius notes that in the joining of the gums to the teeth -there is great analogy to that of the skin with the finger nails; -a very proper observation, which makes us almost suppose that the -perspicacious mind of Eustachius may have guessed the kindred nature of -nails and teeth. - -In Chapter XV are related the researches made by the author to -ascertain at what period the development of the teeth begins. Here is a -passage of this chapter, almost literally translated: - -“Hippocrates, before anyone else, wrote that the first teeth are -formed in the uterus. Wishing to assure myself thereof, I dissected -many abortive fetuses, and by very careful observations I found it to -be true that the teeth have their origin during intra-uterine life. -Wherefore, the opinion of those who consider that the first teeth are -formed from the milk, and those of the second dentition from food -and drink, must be declared entirely false. In fact, by opening both -jaws of a stillborn fetus, one may find, on each side of each jaw, -the incisors, the canine, and three molars, partly mucous and partly -osseous, and already sufficiently large and entirely surrounded by -their alveoli. Then removing, with a skilful hand, the incisors and -the canines, there may be observed a very thin partition only just -ossified; and if this be removed with equal care, an equal number of -incisors and canines, almost mucous and very much smaller, appear, -which, enclosed in special alveoli behind the first, would exactly -correspond in position each with its congener, if in both jaws the -canine were not resting for the greater part on the next incisor so as -almost to hide it.” - -As to the molars (by which name also the bicuspids are here meant), -Eustachius says that he found but three on each side, and no trace -whatever of the others. Nevertheless, he considers it quite probable -that the germs of the latter should also exist in the fetus, although -so small as to escape observation. He gives many ingenious reasons in -support of his mode of thinking, and comes to the general conclusion, -that not only the temporary teeth but also the permanent ones have, -all of them, their origin during fetal life; a false conclusion simply -because too general, and which shows once more how, in biological -science, one runs great risk of falling into error whenever one tries -to draw too free deductions from observed phenomena. - -The researches of Fallopius and Eustachius confirm and complete each -other. These two eminent anatomists, who gave great glory to Italy -by their immortal discoveries and works, were the first to shed a -brilliant light upon the development of the teeth, and thus opened up -the way to all subsequent research on odontogeny. - -In settling the period in which the formation of the teeth begins, -Fallopius was still more successful than Eustachius. His patient -investigations showed him that the development of the teeth commences -partly in the uterus and partly after birth, which is perfectly true, -as was made clear by later embryological researches. Fallopius found in -each fetal jaw twelve teeth.[289] In this he agrees perfectly with his -contemporary, Eustachius, who, as we have seen a short while ago, found -in fetusus, only just born, the incisors, the canines, and three molars -for each side of each jaw. Eustachius, however, observed in the fetus -the germs of the permanent incisors and canines as well, a thing not -noted by Fallopius. - -It is not to be wondered at that some discrepancy should exist between -the observations of these two eminent anatomists. The researches of -which we are speaking are sufficiently delicate and difficult; and -even much more recent authors are far from agreeing perfectly, as far -as regards the period, in which the development of the teeth begins. -Serres, in his _Essai sur l’anatomie et la physiologie des dents_ -(Paris, 1817), sustains the view that in the fetus he has observed the -germs of all the teeth, both temporary and permanent, while Joseph -Linderer (_Handbuch der Zahnheilkunde_, Berlin, 1842) says that, -although he has followed the preparative method indicated by Serres, he -could never discover in the fetus the germs of all the teeth. Perhaps, -he adds, the time when the development of the teeth begins varies -considerably in individuals, just as we remark differences in the time -of eruption. - -In Chapter XVII of his book, Eustachius speaks of the process of -formation of the teeth, which he studied in abortive fetuses, in -stillborn children, in children a few months old, and also in kids. - -On dissecting a fetal jaw, there may be found on each side, as we -have already seen, the incisors, the canines, and three molars, still -soft and imperfect, separated from one another by very thin osseous -partitions. Each of these teeth is enclosed within a follicle or little -bag of a grayish white color, rather more mucous and glutinous than -membranous, and in form somewhat like the pod of a vegetable, with the -only difference that it shows an opening at one of the extremities, -from which the tooth somewhat protrudes, as if it were germinating. The -more recent and softer the tooth, the more its follicle has a mucous -appearance and differs from the nature of membranes. As it does not -adhere to the underlying tooth, it is easy to separate them. As to -the tooth, it is at that period of its development partly osseous and -partly mucous, since that part which later on projects from the gum -soon becomes transformed into a white thin and concave scale, which -gives the idea of one of the little cells of a honeycomb. This scale -is harder and more conspicuous in the incisors, since these, at this -stage, are better formed; the canines are less advanced in development, -and the molars still less; and among these latter, those are less -developed which are more distant from the canines. The deeper part -of the tooth consists of a mucous and tenacious substance, harder, -however, than the substance of the follicle, and of a whitish color -with a tendency to dark red, translucent, and somewhat brilliant. - -Thus, says Eustachius, the teeth present themselves in a human fetus; -but he who cannot obtain a human fetus may observe the same things in a -kid. - -Although the author does not express himself very explicitly, he seems -to consider the follicle of the tooth substantially identical with -its ligament. “This is at first mucous, but afterward, becoming more -consistent, causes the tooth to adhere to the socket and gum very -firmly, as if it were glued.” - -“As the part of the tooth which comes out of the gum projects from -the aperture of the follicle like a gem from its bezel, so—says -Eustachius—some believe that the crown of a temporary tooth is a mere -appendix, and that the follicle comes out of its concavity through -a dividing line which they imagine to exist between this supposed -appendix and the remaining part of the tooth. But assuredly those who -assert such things show that they have studied the anatomy of the teeth -so carelessly that, by this one error, they make manifest their great -ignorance together with their great temerity.[290] The line which is -observed on the tooth on the part corresponding to the adhesion of the -gingival margin and of the dental ligament is very superficial, and -after having scraped it away, there does not remain any trace of a -division. But apart from this everyone can very easily observe, even in -infants, or in kids, that the tooth when ossified does not present any -line of division and that the still mucous follicle envelops it freely, -and may be easily separated from the tooth; which would not be the -case, if the follicle issued from between the tooth and its supposed -appendix.” - -Thus, Eustachius declares entirely false the opinion already expressed -by Celsus, that the permanent tooth grows from the root of the milk -tooth. He affirms clearly and decisively that between the external and -the radical part of a milk tooth no real division exists, and that -the ossification of the tooth, beginning from the crown, proceeds -without any interruption right down to the end of the root. If it -were true, says he, that in children only the imaginary epiphysis or -appendix falls, and that the new tooth is substantially represented -by the remaining part of the first, it could never happen, as instead -it often does, that the new tooth appears before the first one falls. -Besides, between the lower part of the first tooth and the upper part -of the second no correspondence exists either in size or shape, as -ought necessarily to be the case if the two parts were joined together. -This is not all; the lower part of the temporary tooth is perforated, -and receives in its interior bloodvessels and nerves, whilst the upper -part of the permanent tooth is quite massive and imperforated. How, -then, could this second tooth transmit bloodvessels and nerves into -the cavity of the first? Again, how could the continuity of these -bloodvessels and nerves with their respective branches be possible, if -an imperforate body, such as the crown of the permanent tooth, were -really interposed? - -But what is the use of so many arguments? exclaimed Eustachius. To -remove even the slightest doubt and to put an end to any controversy -on such a point, only one fact is sufficient, which is revealed to us -by anatomical dissection, and that is, that the teeth which appear -about the seventh year are not only not united to those which fall at -the same period, but cannot even be in contact with them, owing to the -presence of a thin osseous partition. - -In the following chapter[291] Eustachius speaks of the central cavity -of the teeth and of the substance contained in it. In young teeth, -he says, the dental cavity is very large, in proportion to the size -of the tooth. According to some anatomists, the central cavity of a -tooth is coated by a very soft and thin membrane, formed by a tissue -of very small vessels and nerves; and besides, this cavity is filled -with marrow, like hollow bones. The observations of the author, -however, do not agree with these statements. The dental cavity does -not contain any fatty substance analogous to the marrow of bones. As -to the above-mentioned membrane, Eustachius doubts its existence. The -large hollow existing in children’s teeth contains, he says, a mucous -substance, somewhat hard, and very smooth at its surface—almost like -a cuticle—but which has rather the appearance of a concretion than of -a membranous tissue. At any rate, adds Eustachius, if the substance -alluded to is made to dry up in the shade, it acquires an appearance -not unlike that of a membrane. It is certain, however, that at an early -age the substance contained in the dental cavity does not adhere to -the walls of the latter after the manner of a periosteum, but is found -in simple contact with the same, and can, therefore, be separated from -them with the greatest ease. - -As years pass by, the dental cavity becomes narrower and narrower, -because the substance contained inside the tooth gradually becomes -ossified at the surface, adhering to the dental scale previously -formed, in the very same manner as the internal or woody part of a tree -adheres to the bark. Of the two hard substances which make up a tooth, -the outer one is white, tense, and dense, like marble, the underlying -one, instead, is somewhat dark, rough, and less compact. To observe -accurately the above-mentioned facts, the author advises searching for -them, first, in the molar teeth of the ox or the ram, and then in human -teeth, and likewise, first in children or in recently born animals, and -then in adults. - -Chapters XIX and XX are, comparatively speaking, of little importance. -In the former the author undertakes especially to examine the opinions -of Galen on dental bloodvessels and nerves, and discusses whether -it were known to him that these vessels and nerves penetrate into -the internal part of the teeth. In the latter, Eustachius speaks of -the great difficulties that are encountered in dissecting dental -bloodvessels and nerves, and reproves those who, by inaccurate -illustrative figures, convey the erroneous idea that these parts are -very clearly and easily observable. - -In Chapter XXI the author goes on to speak of the best mode of -proceeding in order to make successful observation of the small nerves -and vessels going to the roots of the teeth. These researches are much -more easily made in large animals than in man; and therefore such -things as cannot be observed well in the latter must be studied in the -former. - -In the first place, it is necessary to dissect the lower jaw; and -after having done so several times, with all the accuracy required in -making researches of this kind, one may proceed to study the dental -nerves and vessels of the upper jaw, which is much more difficult. -Having opened up the inside of the lower jaw, one observes a cavity -full of marrow, and within this a nerve enclosed entirely in its own -sheath. Having removed the marrow, and opened the sheath lengthwise, -one perceives that the nerve therein enclosed is constituted (analogous -to what may be observed in the large nerves of the limbs) by several -nervous strings, and that among these runs a comparatively large -artery, besides small vascular branches of minor importance. If one -then removes the sheath from the bone, together with the nerve and the -vessels contained in it, raising it very gently, one sees, issuing -therefrom, some very slender fibers, on the nature of which it is, -however, difficult to pronounce; and, considering their thinness, one -can hardly conceive that they are composed of three different elements, -that is, of small nervous, arterial, and venous twigs. At any rate, -the author admits that this may be so. On arriving at the lesser -teeth, the nerve and the artery that accompanies it divide into two -branches, one of which traverses the opening presented by the bone at -that point (_mental foramen_), and is destined to the lower lip; the -other directs its course toward the roots of the incisors. The small -twigs which penetrate into the roots of the incisor and canine teeth -are less slender than those which enter the roots of the molars, and -are easily to be seen not only in large animals, but also in man. If -the tooth of an ox or that of a ram be split through the middle, the -mucous substance contained in the interior is seen to be traversed -by small bloodvessels; and one perceives, besides, certain fibers, -which are probably nerves. All these things, says Eustachius, I have -observed many times in different animals, in some cases more, in others -less distinctly. But it is an exceedingly difficult thing to follow -the single twigs, of which we have spoken, from their origin to their -insertion, or, _vice versa_, from their insertion to their origin. And -so, adds the great anatomist, being able to observe but a small part -of the things I should like to see, I find myself compelled, in my -perplexity, to supply by the aid of ratiocination the deficiency of -the senses. I therefore maintain that the interior part of a tooth is -susceptible of experiencing pain accompanied by a feeling of pulsation -(a fact already mentioned by Galen), because a nerve and an artery -penetrate into it. In the ox the penetration of bloodvessels into the -roots of the teeth can be more readily ascertained than in man. It may -be admitted that the same occurs in the human teeth; and this, for the -reasons already given, and also because only by admitting the existence -of an artery within the cavity of the tooth can be explained the -copious flow of florid red blood from a decayed tooth, which has, in -some cases, been known to imperil the life of a patient. And I myself, -says Eustachius, have observed with my own eyes an accident of this -kind. - -The author then passes on to speak of the eruption of the teeth,[292] -but the data with which he furnishes us are neither very precise nor -very exact. - -Eustachius, without declaring himself for or against it, cites, in -this chapter, the opinion of those who believe in the possibility of a -third dentition in old people. He returns to this subject in the last -chapter but one of his book, which treats of dental anomalies: “Ali,” -says he, “testifies to old persons having had all their teeth renewed. -This has been derided as chimerical by medical men of later date, or at -least only admitted under the condition that such teeth be of a nature -completely different from the first.” - -Our teeth, says the author, grow old together with us, and toward the -term of life they abandon us, a fact which also distinguishes them -from the other bones. When, however, it occurs, through illness, that -the teeth are extracted or fall out spontaneously before the period of -old age, the alveoli become filled up with a bony substance; and in -addition the two osseous scales of the maxillary bones approach one -another and unite together in such a manner as to form a sharp margin, -every vestige of a cavity being obliterated. - -Speaking of the nutrition and growth of the teeth,[293] Eustachius says -that—given the existence of the dental nerves and bloodvessels—it is -not difficult to explain how the teeth are nourished, grow, live, and -feel. He therefore rejects the opinion of those who held that the teeth -of the lower jaw derived their nourishment from the marrow contained -within this bone, and that those of the upper jaw received it from a -humorous substance similar to marrow, existing in the large cavity -of the upper maxillary bone. Against the supporters of this opinion -Eustachius raises, among others, the following objections, viz., that -the marrow of the inferior jaw does not in any way touch the teeth, -so that such a mode of nourishment cannot be imagined, and that it is -completely erroneous that the large cavity of the upper maxillary bone -contains a humor similar to marrow. This passage of Eustachius’ book -gives clear evidence that he was well acquainted with the maxillary -sinus, described a century later by the English anatomist, Highmore, -who gave it his name. The existence of this cavity was, besides, -already known before the time of Eustachius. - -The author also says that those who believe that the internal cavity of -the teeth contains marrow, and that this serves to nourish them, are -grossly deceived. - -In the same chapter, Eustachius confutes an opinion, at that time -generally diffused and put forward for the first time by Aristotle, -viz., that the teeth grow throughout a whole lifetime. In the senile -age, he says, the teeth become impaired still earlier than the other -organs. They become thinner by deficiency of nourishment, and, at the -same time, discolored; the incisors and canines, as they waste away, -come to be also less sharp than they were; and the molars, losing their -tubercles or cups, become levelled down and smooth. If, notwithstanding -the evident wearing out of the teeth, they seem sometimes to grow -longer, this appearance is not to be trusted, for it happens not -unfrequently that the teeth appear to have grown longer simply by -atrophy of the gums, or also because some humor or other morbid -substance pushes them outward. - -As to the sensibility of the teeth,[294] Eustachius is of the opinion -that these organs possess, besides the sensibility to pain, two other -species of sensibility; for, following the ideas of Galen, he also -holds that the teeth together with the tongue partake in the sense -of taste; and he further considers the disagreeable sensation known -as _setting on edge of the teeth_, as a species of tactile sensation -peculiar to these organs. - -But in which part of the tooth does the faculty of feeling reside? - -Among the authors previous to, or contemporaries of, Eustachius, some -affirmed that the sensibility of the tooth resides in the pellicle -which lines its inside cavity, others in the membrane which, like -periosteum, clothes the root of the tooth, others in both these parts. -Eustachius does not show himself more partial to the one than the other -of these opinions; he is, however, firmly persuaded that the hard -substance of the tooth is also endowed with sensibility. Though it is -not easy to explain how this may be, he considers it probable that -the nerve, fraying itself out inside of the tooth in minute filaments -at the time when the substance of the tooth is still soft and mucous, -intermixes intimately with it, thus communicating to it the faculty of -feeling, which then persists in it, even after the ossification of the -tooth. Such an hypothesis is certainly worthy of the lofty intellect of -Eustachius, and has in itself, so it seems to me, something of truth. - -In the two following chapters,[295] the author speaks in a masterly and -admirable manner of the functions of the teeth and of their utility. - -Among many other true and interesting observations, he remarks that by -the loss of their teeth even the most powerful dogs become cowards. - -Besides what concerns the human teeth, excellent notions of comparative -anatomy, above all in what regards the monkey, the dog, and the -ruminants, are to be found in this little but most precious book of -Eustachius. - -The teeth, says he, are not equally hard in all animals, and many -ancient authors have affirmed that ferocious animals have much harder -teeth than tame ones. - -Chapter XXIX, relating to dental anomalies, is one of the most -interesting. We here quote the greater part of it. - -“Some historians relate that Pyrrhus, King of Epirus, Eurifeus, of -Greece, and many others, had, instead of teeth, a continuous bone, -furrowed by somewhat deep vertical lines, in no way different from what -one sees in the multiple molars of the goat. It has never happened -to me, says Eustachius, to witness a similar union of all the teeth; -I have, however, sometimes observed continuity between three or four -molars, precisely in the same manner as in sheep. It also once happened -to me to observe in the case of an old man, a fellow citizen of mine, -that the teeth were covered up on every side by a hard and almost stony -substance, and no longer exhibited any trace of separation, offering -instead the appearance of a single bone.” - -“One reads that Timarchus, of Cyprus, had two rows or series of teeth -and Hercules three.” - -The author never had any opportunity of observing any such anomalies; -notwithstanding, he refers to cases of the kind observed by other -anatomists of his time, and, in a particular manner, to the case of a -triple dental series in a youth who died at the age of eighteen. As the -truth of the fact was testified to by highly respectable medical men, -Eustachius lends faith thereto. “Neither can it be said”—he adds—“that -in the case we are speaking of the new teeth erupted from other sockets -before the temporary ones were shed, for there would then have been -only a double and not a triple series; indeed, the series would not -even have been double along all the line, but only along the line of -the temporary teeth; and besides this, the double series would not have -been maintained up to eighteen years of age—the time of the death of -the subject—but only until the shedding of the deciduous teeth.” - -“That teeth are sometimes cut in the palate is a fact attested to by -Alessandro de Benedetti and others. It has also occurred, within my own -experience, to observe this in the person of a Roman woman, who had a -tooth in the roof of the mouth, near the opening which is in proximity -to the incisors,[296] and at Gubbio there is, in the monastery of the -Trinità, a nephew of the distinguished jurisconsult Girolamo Gabrielli, -who at the age of eighteen cut a tooth in the middle of the palate.” - -“Pliny and Solinus tell of individuals born with all their teeth. Other -authors, that Pheretes was without teeth all his life.” - -“I hold it to be a fable that some women lose a tooth for each child -they bear.” - -“In some cases it has happened that the falling out and renewal of the -teeth has not taken place before the age of thirteen or fourteen. In -other cases, the same teeth were shed and renewed twice, that is, once -after the seventh year, and again after the fourteenth year. It ought -also to be mentioned that in some young persons of twenty, the last -molar, or wisdom tooth, having been drawn, it was renewed during the -same year. Lastly, it is also to be noted that in strong and healthy -young persons, one of the other molars being extracted, it is sometimes -renewed.”[297] - -In the last chapter[298] the author alludes to some dental affections. -In referring to the fluxions to which teeth are subject, he says he -has observed more than one case in which such a quantity of matter -resembling chalk was collected in the alveoli, that these gradually -being filled thereby, all the teeth became loosened and dropped out -little by little. - -Speaking of dental diseases requiring surgical intervention, the author -remarks that dental surgery was, in his days, a most abject calling, -notwithstanding its having had, according to Cicero, a very high -initiator—Æsculapius, the god of medicine. - -AMBROISE PARÉ. Whilst the anatomy of the dental system was illustrated -by the researches of Fallopius and Eustachius, the celebrated French -surgeon Ambroise Paré was contributing in the highest degree to the -progress of practical dentistry. - -[Illustration: Ambroise Paré.] - -Ambroise Paré (Latinized Paræus) was born at Bourg-Hersent in the year -1517. His father and one of his brothers were box-makers; another -brother was a barber. We have no very precise information about the -early years of his life; so much is certain, however, that Ambroise -Paré did not enjoy any of those advantages deriving from a good -literary education, and after having received some instruction from a -chaplain, whose disciple and servant he was at one and the same time, -he was bound over as apprentice to a barber, who also taught him the -art of bleeding. Toward the age of sixteen we find him in Paris in -the employ of a _chirurgien-barbier_. After this he practised minor -surgery for some years in the Hôtel-Dieu. But having undertaken the -study of surgery without literary preparation and without any knowledge -of Latin, he was obliged, especially for the latter reason, to contend -with great difficulties, so that, although he had acquired in a few -years sufficient practice in surgery to enable him to pass from the -Hôtel-Dieu to the sanitary service of the French army, it was only in -1554, that is, at thirty-seven years of age, that he was permitted to -take the examination required for becoming a member of the College -of Surgeons of Paris. Within the short space of five months he was -successively named Bachelor, Licentiate, and Doctor in Surgery. His -reputation, which had already become extraordinary even before he had -any academic degree, procured him introduction to the Court of France -as surgeon in ordinary. In 1562 he became chief surgeon to the Court -and occupied this post under the reigns of Charles IX and Henri III. -Ambroise Paré was a Protestant, and it is said that in the massacre of -St. Bartholomew’s night, he owed his escape to the king, Charles IX, -who, to save his life, hid him in his wardrobe. He died full of honors, -in the year 1592. - -In his works this great surgeon treats the subject of dental maladies -and their cure very thoroughly; this may be in part attributed to the -circumstance of his having first been simply a barber (and, therefore, -also a tooth-puller) and afterward a surgeon-barber, which placed him -in very favorable conditions for acquiring vast experience in the -practice of dentistry. - -In Chapter II, Book IV, of his works,[299] Ambroise Paré speaks of the -anatomy and physiology of the teeth. It must, however, be confessed -that Vesalius and, still more so, Eustachius treat of dental anatomy -with much more exactness than he does. - -After having spoken of the incisors and the canines, he says that the -ten upper molars generally have three roots, and very often four, -whilst the ten lower ones have only three; this is because the lower -jaw is harder than the upper, and also because the lower molars, -_estant assises sur la racine, et non suspendues, comme celles de la -mandibule d’en haut, n’avoient besoin de tant de racines pour leur -stabilité asseurance_.[300] - -Ambroise Paré, too, admits that the teeth grow throughout the whole -lifetime, and that the wearing away consequent on reciprocal friction -and mastication is compensated in this way. - -Galen had already affirmed, and Ambroise Paré also held erroneously, -that the exquisite sensibility of the teeth aids the sense of taste. - -In speaking of the development of the teeth, Ambroise Paré says only -that they are already solid and osseous before birth, he himself -having observed this in dissecting the jaws of a child who had died -immediately after birth. - -In Chapter VII, Book XIII,[301] Paré treats of fracture of the lower -jaw. The method of cure he proposes is altogether identical with that -of Celsus. With regard to the teeth, he says that “_si elles sont -divisées, ebranlées, ou separées hors de leurs alvéoles ou petites -cavités, elles doivent estre reduites en leurs places et seront liées -et attachées contre celles qui sont fermes, avecques un fil d’or ou -d’argent, ou de lin. Et les y faut tenir jusques à ce qu’elles soient -bien affermies, et le callus soient refait et rendu solide._”[302] - -Toothache, says Paré,[303] is, of all others, the most atrocious pain -that can torment a man without being followed by death. It depends, in -many cases, on a humorous fluxion of a hot or cold nature which flows -into the alveolus, forcing the tooth outward, loosening it, and causing -the patient so much pain on the slightest pressure being exercised on -it, that he cannot dare to bite with it in the least. If, however, the -tooth is corroded, hollowed out, or pierced to the root, the pain is so -strong, when the patient drinks—particularly if the liquid is cold—that -he seems to have had a stab with a stiletto inside the tooth. - -If the pain is acute and pungent, like that produced by needles -being thrust into the diseased tooth; if the patient complains of a -strong pulsation at the root of the tooth, and in the temples; if the -application of cold remedies calms the pain, all these signs indicate -that the cause of the evil is heat. Instead, the cause of the pain may -be held to be cold when the patient complains of a great heaviness -in the head, emits a quantity of saliva, and finds relief in the -application of hot remedies. In the treatment of toothache one must -fulfil the following three indications: - -1. Regulate fittingly the mode of living. - -2. Evacuate or dissipate the morbid humors; this may be effected -by various means, namely, by purgatives, by bleeding, by gingival -scarification, by the application of leeches on the site of the pain, -by cupping on the back of the neck, or on the shoulders. - -3. Applying in each single case the medicaments best adapted for -calming the pain. - -The author here goes through a long enumeration of anti-odontalgic -remedies that offer no particular interest, as they are not at all new. - -When a decayed tooth becomes the seat of excessive pain, and this does -not yield to any remedy, one must either have recourse to extraction or -cauterize it; this can be done either with potential caustics—such as -oil of vitriol, aqua fortis—or with the actual cautery. By cauterizing, -Paré adds, one burns the nerve, thus rendering it incapable of again -feeling or causing pain. - -Erosion or caries[304] is the effect of an acute and acrid humor, that -corrodes and perforates the teeth, often to their very roots. To combat -this morbid condition, even when it is not accompanied by pain, one -must also have recourse (besides general treatment) to cauterization -either with oil of vitriol, with aqua fortis, or with a small actual -cautery. - -If, as often happens, that the seat of the erosion lies in such a -manner between two teeth as to make it impossible to apply caustics or -other medicaments, one must file just sufficiently between the healthy -and the corroded tooth to render the part accessible, taking care, -however, to file more on the side of the affected tooth than on that of -the healthy one. - -The file may be used, besides, to plane down a tooth that stands out -above the level of the others, and for similar purposes. - -If one or more teeth have been shaken by a blow or a fall, or have come -out of their alveoli altogether, the surgeon should not remove them, -but rather reduce them and bind to the neighboring teeth, that they may -entirely reacquire their original firmness. - -In allusion to this subject, Ambroise Paré refers to the case of a -friend of his, who having sustained, through a blow from the hilt of -a dagger, a fracture of the lower jaw with almost complete expulsion -of three teeth from their alveoli, had the fracture reduced by him; -after replacing the teeth and binding them to the neighboring ones, -he prescribed astringent mouth washes and liquid or semiliquid -nourishment, such as meat juice, _panada_, barley soup, jelly, and such -like. The patient was completely cured and able to masticate with the -three teeth as well as before. - -Also in the case of extraction of a healthy instead of a diseased -tooth, Paré recommends replacing it immediately and binding it to the -neighboring ones, for, he says, by this means the tooth can take root -again. - -As we have seen, the first author who speaks of replantation is -Abulcasis, but to Ambroise Paré belongs the merit of having treated the -subject much more explicitly, and of having insisted on the utility -of this operation, indeed, on the duty of carrying it out whenever it -seems indicated. - -[Illustration: FIG. 60 - -Dental files (Ambroise Paré).] - -Further, he is the first to mention another very important operation, -namely, transplantation, albeit he himself had never performed it. -The case he refers to has become a generally known anecdote. We give -it in his own words: “_Un homme digne d’estre creu m’a affirmé qu’une -princesse ayant fait arracher une dent, s’en fit remettre subit une -autre d’une sienne demoiselle, laquelle se reprint, et quelque temps -après maschoit dessus comme sus celle qu’elle avoit fait arracher -auparavant._”[305] - -[Illustration: FIG. 61 - -One of the pelicans used by Ambroise Paré.] - -[Illustration: FIG. 62 - -Two other pelicans and a pair of curved pincers (Ambroise Paré).] - -Ambroise Paré has recourse to extraction when a tooth is the cause -of very violent pain, or when the existence of a carious cavity and -concomitant putrefying processes render the breath fetid, and endanger -the healthy teeth in its vicinity. If the persistence of a deciduous -tooth should cause the cutting of the corresponding permanent tooth -outside the line of the dental arch, thus giving rise to deformity, -Paré advises laying bare and then extracting the deciduous tooth; -for after this the new tooth may be pressed toward the point before -occupied by the other, until it assumes its natural position. - -Sometimes, when a tooth is too firmly planted, one prefers, says Paré, -instead of extracting it, to break off the crown for the purpose -of being able to act directly on the dental nerve with appropriate -remedies, or to destroy the sensibility of the nerve entirely, by -cauterization. This unreasonable and reprehensible method of cure is -also quoted, under the denomination of _deschapellement_, by another -French author, a contemporary of Paré—Urbain Hemard—who observes, -however, that one rarely had recourse to it; for the pain and shock -which are caused by this operation are not less than those caused by -extraction. - -It very often happens that the patient cannot indicate exactly which -tooth it is that gives him pain, his sufferings being so acute as to -appear spread over a great part of the jaw. One cannot, therefore, -trust too much to the indications given by the patient as to the point -of departure of the pain, and must take care not to extract a healthy -instead of a diseased tooth. - -The extraction of a tooth should not be carried out with too much -violence, as one risks producing luxation of the jaw or concussion -of the brain and the eyes, or even bringing away a portion of the -jaw together with the tooth (the author himself has observed this in -several cases), not to speak of other serious accidents which may -supervene, as, for example, fever, apostema, abundant hemorrhage, and -even death. - -In extracting a tooth it is necessary to place the patient on a very -low seat, or even on the ground, with his head between the legs of the -operator.[306] After having laid the tooth bare sufficiently, if one -sees that it is very loose, one may push it out of its socket with -a _poussoir_, that is, with a trifid lever. But if the tooth is too -firmly rooted to be extracted with this instrument, one must make use -of curved pincers, or else one may have recourse to a pelican. The -author notes, however, that much skill is required in using this latter -instrument, for otherwise it will almost certainly happen that several -good teeth will be knocked out, instead of the one intended to be -extracted. In proof of this, he relates the following anecdote, which -we relate in the words of the author, that it may not lose anything of -its quaint originality: - -“Je veux icy reciter une histoire d’un maistre barbier, demeurant à -Orleans, nommé maistre François Loüis, lequel avoit par dessus tous, -l’honneur de bien arracher une dent, de façon que tous les samedis -plusieurs paysans ayans mal aux dents venoient vers luy pour les -faire arracher, ce qu’il faisait fort dextrement avec un polican, -et lorsqu’il avoit fait, le jettoit sus un ais en sa boutique. Or -avoit-il un serviteur nouveau, Picard, grand et fort, qui desiroit -tirer les dents à la mode de son maistre. Arriva cependant que ledit -François Louys disnoit, un villageois, requerant qu’on luy arrachait -une dent, ce Picard print l’instrument de son maistre et s’essaya faire -comme luy; mais en lieu d’oster la mauvaise dent au pauvre villageois, -luy en poussa et arracha trois bonnes. Et sentant une douleur extrème, -et voyont trois dents hors de sa bouche, commença à crier contre le -Picard; lequel pour le faire taire luy dit qu’il ne dist mot, et qu’il -ne criast si haut, attendu que si le maistre venoit il luy feroit payer -les trois dent pour une. Donc le maistre oyant tel bruit, sortit hors -de table pour sçavoir la cause et raison de leur noise et contestation; -mais le pauvre paysan redoutant les menaces du Picard, et encore apres -avoir enduré telle douleur qu’on ne luy fist payer triplement la -peine dudit Picard, se tent, n’osant declarer audit maistre ce beau -chef d’œuvre; et ainsi le pauvre badaud de village s’en alla quitte; -et pour une dent qu’il pensoit faire arracher, en remporta trois en sa -bourse, et celle qui luy causoit le mal en sa bouche.”[307] Paré adds -in conclusion: “Partant je conseille à ceux qui voudront faire arracher -les dents, qu’ils aillent aux vieux dentateurs, et non aux jeunes qui -n’auront encore reconneu leurs fautes.”[308] - -[Illustration: FIG. 63 - -Two gum lancets and a trifid lever called “poussoir” (Ambroise Paré).] - -But let us now return to our subject. After the extraction of a tooth, -it is necessary—says Paré—to leave the wound to bleed freely, so that -the part may get rid of the morbid humors; then the gums and the -alveolus must be pressed, on both sides, with the fingers, to readjust -the socket, which will have been widened and sometimes even broken in -extracting the tooth. After this, the patient should rinse his mouth -with oxycrate; and when the weather is cold and windy, the patient -should take care to avoid fluxion in the other teeth. - -The following chapter speaks, “_de la limosité ou rouillure des dents, -et de la manière de les conserver_.” - -After meals the mouth must be rinsed with water and wine, or with -water with a little vinegar added to it, and the teeth cleaned from -all residues of food, so that their putrefying may not spoil the teeth -and make the breath fetid. An earthy yellowish substance, like rust, -often forms on the teeth from want of cleanliness and also when they -are not used to masticate; this substance corrodes the teeth, just -as rust corrodes iron. It is necessary to remove this substance, by -scraping the teeth with small instruments suitable for the purpose, and -then the teeth themselves must be rubbed with a little aqua fortis and -aqua vitæ mixed together, to take away what the instruments have not -been able to remove. In order to preserve the teeth it is necessary, -besides, to rub the teeth frequently with appropriate dentifrices. -Among these the author mentions simple bread crust, burnt and reduced -to powder. - -In Chapter III of Book XVII he speaks of artificial teeth. Sometimes, -says Paré, by the effect of a blow, the front teeth are lost; this -not only constitutes a deformity, but is also the cause of defects -of speech. Therefore, after the necessary treatment, when the gums -are hardened, the lost teeth must be substituted with artificial ones -made out of bone, ivory, or the teeth of the _Rohart_,[309] which are -excellent for this purpose; and the artificial teeth must be tied to -the neighboring ones with gold or silver wire. - -[Illustration: FIG. 64 - -The palatine obturator with sponge of Ambroise Paré.] - -Chapter IV of the same book is most important, for palatal obturators -are therein spoken of for the first time. “Sometimes a portion of the -bone of the palate is destroyed by the shot of an arquebus, or by some -other wound or by a syphilitic ulcer (_par ulcère de verole_), the -patients being thereby disabled from properly pronouncing words and -from making themselves understood. To repair this defect we have found -an expedient through the help and ministry of our art. It consists -in the application of an instrument somewhat larger than the palatal -perforation; this is made of gold or silver, of about the thickness of -a crown (coin), and has the form of a vaulted roof, to which a sponge -is attached; when introduced into the aperture, the sponge, absorbing -the humidity natural to such parts, will very soon swell up, and thus -the instrument is held firm. In this way, words are better pronounced.” - -Besides the above instrument, the author gives us the figure of another -instrument, _sans esponge_ (without sponge), which, taken altogether, -is like a large cuff button. The small part, designed to be introduced -into the aperture of the palate, can be made to turn round from below, -by means of a small pair of pincers, so as to fix the obturator. - -[Illustration: FIG. 65 - -Paré’s palatine obturator without sponge.] - -In the last chapter of Book XVIII, first dentition and the treatment -required during this period are spoken of. The cutting of teeth, says -Paré, is accompanied by pain, itching, and pricking of the gums; often, -as well by diarrhea, fever, epileptic convulsions, which sometimes end -fatally. The symptoms by which it may be known that teeth are about -to come forth are as follows: The wet-nurse feels the mouth of the -suckling infant to be hotter than usual; the gums are swollen; the -child is restless, crying often and sleeping but little; it emits a -quantity of saliva from the mouth, and frequently puts its fingers in -its mouth, trying to rub its gums, and soothe, in this way, the pain -and itching which it feels. It is then necessary to treat the nurse as -if she had fever, and the infant should be suckled less than usual; -some cooling and thirst quenching drinks should be given to it—for a -child in such conditions suffers from intense thirst; the nurse should -often rub the gums of the little patient with softening and soothing -substances, as, for example, oil of sweet almonds, fresh butter, honey, -or mucilage made from the seeds of the fleawort or of the quince; -the brains of a hare (these may be roasted or boiled) have not only -a very soothing action, but also, according to a very ancient belief -shared by Paré, possess the occult property of aiding the cutting of -the teeth. But oftentimes, neither these nor other remedies are of any -use, because the gums are too hard and the teeth cannot cut their way -through at all; the tension of the gums then produces very violent -pain, fever, and other accidents, death even supervening in some cases. -The author, therefore, advises lancing the gums deeply, just above the -tooth which ought to appear, thus opening it a way, that it may more -easily come out. He relates that he has performed this operation on his -own children in the presence of many medical authorities. - -Almost as if to show the high value of this operative procedure, Paré -tells the case of a child, the son of the Duke of Nevers, who died -at the age of about eight months without having cut any teeth. He, -together with other doctors, was invited to carry out an autopsy. No -lesion whatever was found sufficient to cause death, but the gums were -very hard, thick, and swollen; an incision into them showed that -the teeth were ready to come out, if only their eruption had been -facilitated by lancing at the right time. Paré and the other doctors -were of the unanimous opinion that death was caused solely by the -impossibility of cutting the teeth on account of the hardness of the -gums. - -Among the many strange cases given in Book XIX (_Des monstres et -prodiges_), Paré also speaks—trusting to the word of Alexander -Benedetti—of the case of a woman, who, after the complete loss of her -teeth caused by age, cut them all again at eighty years of age. - -Although Paré treats so amply and with such competence all that -concerns dental diseases and their cure, he does not make the least -allusion to the stopping of teeth, beyond recommending, as had already -been done by Celsus, that when a tooth that is to be extracted shows a -large cavity, the latter should be well filled with linen or lead, so -that the tooth be not fractured under the pressure of the instrument -and so leave the root behind in the alveolus. - -A century before Ambroise Paré, Giovanni d’Arcoli had already mentioned -the filling of teeth with gold leaf, and, as we have seen already, -there is very good reason to believe that the practice of this -operation dated back to a still earlier period. How is it, then, that -the illustrious French surgeon does not say a word about this? Very -probably stoppings were not at all in use among French _dentateurs_ and -perhaps, even in Italy, this operation was only rarely carried out. - -JACQUES HOULLIER (1498 to 1562), a celebrated French physician and -surgeon, also known under the Latinized name of Jacobus Hollerius, -was the first to stand out, although timidly, against the theory of -dental worms. He did not decidedly deny their existence, this having -been affirmed by so many illustrious writers; he, however, speaks of -them as if the point were a doubtful one: “_It is said_ that worms are -generated in the teeth, which corrode the teeth themselves, and produce -a pain which is not very violent and causes itching with little or no -salivation (_vermes ajunt subnasci dentibus, et hos corrodere, à quibus -dolor non ita fortis, pruriginosus, nulla aut pauca salivatio_).” - -But even while putting in doubt the existence of dental worms, he -believes it his duty to enumerate the various remedies, recommended for -their destruction. As to fumigations with the seeds of the hyoscyamus, -Houllier, declares that what is believed by the common people, and -what has been written by doctors of antiquity about worms being killed -and seen to fall from the teeth by the effect of these fumigations, is -all nonsense. In fact, he says, when the seeds of the hyoscyamus are -burnt there fly away from them what appear to be little worms, even -if the fumes do not reach the worm-eaten tooth. (_Quod autem vulgus -sibi persuadet, et ab antiquis medicis scriptum est de suffumigio è -semine hyoscyami, videtur fabulosum. Nam inde ajunt manifeste vermes -excidere. Re vera, incenso semine, evolant tanqua vermiculi, etiam si -non attingit fumus vermiculosum dentem._) - -Apart from this, in the works of Houllier, nothing is found that is -of interest for the history of dentistry. He repeats several errors -and prejudices of the ancients; he says, for example, that men have -ordinarily thirty-two teeth, women, twenty-eight; and he, too, believes -in the expulsive virtues of the fat of green frogs when applied to a -tooth (_adeps ranæ viridis dentem depellit_). - -Houllier does not contribute in any way to dental therapeutics, he only -enumerates the methods of cure recommended by preceding authors.[310] - -VOLCHERUS COITER (1534 to 1600), of Gröningen, an ardent student of -anatomy, and a pupil of Fallopius, Eustachius, and Aranzio, studied -with great attention the development of bones, dissecting many fetuses -and children of various ages for that purpose. He clearly states his -opinion that the teeth are not bones, since they do not pass, like the -latter, through the cartilaginous stage, but are derived instead from a -mucous substance.[311] - -JOHANN JACOB WECKER, a doctor of Colmar, published in 1576 a valuable -medical work composed of synoptical tables, in which is briefly -summarized the best of what had been written by preceding Greek, Latin, -and Arabic authors. - -One gathers from this author that at the time in which he wrote it -was considered an excellent preservative against the plague to rub -the teeth with theriac, mithridate, angelica, and zedoary. From this -it may be perceived that even in those days doctors had understood -the importance of the cleanliness and disinfection of the mouth as a -prophylactic against infective diseases. - -In the above-mentioned book may be found a sufficiently complete -exposition of dental therapeutics of that and of the preceding periods. -There is nothing, however, which is not already known to us from our -examination of the earlier writers. Worthy of notice is the information -that, among other things, to facilitate the cutting of teeth rubbing -the jaws with turpentine was recommended at that time.[312] - -[Illustration: Volcherus Coiter.] - -DONATO ANTONIO OF ALTOMARE, a Neapolitan physician and philosopher, -dedicated a long chapter of his _Ars medica_[313] to the subject of -dental pains and their treatment. He classifies these pains with great -accuracy, taking into account their seat and causes, and pointing -out in each single case the method of cure to be followed according -to the warm, cold, dry, or humid nature of the pain. In what he says, -however, we do not find anything new. - -GIULIO CESARE ARANZIO (1530 to 1589), a celebrated surgeon and -anatomist of Bologna, in which city he taught from the age of -twenty-six years until his death, is of the opinion that parulides—that -is to say, inflammations or abscesses of the gums—and epulides—that -is fleshy excrescences of the same—are usually caused by caries or -putrescence of the teeth; but that in certain individuals, from -a peculiar weakness of the gums, these are easily attacked by -inflammation when the wind is in the south. - -In the case of parulides, to soothe the pain and to accelerate the -suppurative process, emollient substances should be used; afterward it -is necessary to open the abscess with a lancet, to wash the mouth with -mulse, and to aid the process of cicatrization by using syrup of roses. - -As to epulides, these must be made to disappear, by sprinkling the -tumor with the powder of gall-nuts, or by moistening them frequently -with a decoction of gall-nuts, or with sulphur water. But if they -do not yield to these remedies, and are the cause of functional -disturbances, the surest and most prudent method of cure would be the -use of the red-hot iron. - -GIOVANNI ANDREA DELLA CROCE, a celebrated Venetian physician and -surgeon, was the author of a most valuable treatise on surgery, which -was published first in Latin (_Chirurgiæ universalis opus absolutum_, -Venetitiis, 1573), and then in Italian under the title of _Chirurgia -universale e perfetta_, Venezia, 1583. According to this author, dental -fistulæ are more common to the lower jaw than to the upper one. To -cure these fistulæ, it is necessary to extract the diseased teeth from -which they originate, even should they ache but little or not at all. -To confirm this, he relates in full a very interesting case of a dental -fistula, that he cured by the extraction of a tooth which hardly ached -at all. - -Flajani[314] chose to see in this case a precocious example of the -opening of Highmore’s antrum through the alveolus. But the description -given by Andrea della Croce of his case does not at all warrant this -supposition. - -At the end of his book Andrea della Croce gives us the figures of many -dental instruments, which have, however, nothing new about them. - -GEROLAMO CAPIVACCI, of Padua, repeats the advice (already given by -preceding authors) to avoid, in eating and drinking, the rapid changes -from heat to cold, and _vice versa_, since, says he, nature does not -tolerate these rough changes.[315] In the mercurial treatment of -syphilis,[316] he recommends the patient, as soon as the action of the -remedy manifests itself in the oral cavity, to keep a piece of gold in -his mouth, that the mercury, on account of its particular affinity, -may unite with the gold and the harmful effects of this strange remedy -on the mouth may be thus avoided. A strange method of curing mercurial -stomatitis! - -JOHANN SCHENCK VON GRAFENBERG (1530 to 1598), a celebrated doctor of -Freyburg-in-Breisgau, has left us, in his _Observationes medicæ_, a -very rich and interesting collection of clinical cases. In this work he -refers to many observations upon dental diseases by earlier authors, -which, however, have already been noted by us in their time and place. -Among other things, Schenck von Grafenberg relates that Cardanus -was able, more than twenty times, to calm a violent toothache which -tormented him by lightly pressing the sick tooth between the thumb and -index finger of his left hand. - -PETER FOREEST (1522 to 1597), a very famous Dutch doctor of Alkmaar, -repeats the very old error—already in decisive terms denied by Andreas -Vesalius—that women have only twenty-eight teeth, whilst men usually -have thirty-two. To the two central incisors he gives the name of -_columellares_. Sugar and all sweet things, says this author, are -very harmful to the teeth, and he gives as a proof the fact that -apothecaries have, in general, very bad teeth, on account of the -frequency with which they taste syrups and the like. Perhaps things are -now changed, since I am not aware that chemists in our days are to be -distinguished by the bad state of their teeth! - -In regard to toothache, Foreest records an important observation -which he had made on himself; an aching tooth which a surgeon had not -succeeded in extracting, but which was simply loosened, ceased, without -anything else being done, from giving him pain, and in a short while -became firm again, and he continued to use this tooth for about five -years. However, on a renewal of the pain he was obliged at last to have -it extracted. On the strength of this observation, the author believes -that in certain appropriate cases, recourse may be had to the luxation -of a tooth, rather than to its extraction to obtain a cessation of -toothache. - -This method of cure had already been advised by a still earlier writer, -that is, by Avicenna. When a subluxation produces the rupture of the -dental nerve, this, in its results is equivalent to a replantation. - -Foreest is the first to speak of the violent inflammation of the gums -and of the whole mouth, caused by the application of artificial teeth -of ivory fixed in their place with gold wire. This cannot at all -astonish us when we consider how imperfectly, in those days, dental -prosthesis was carried out and how the immobility of the artificial -pieces, caused them to be a source of permanent irritation to the -neighboring parts, especially on account of the difficulty met with in -giving proper care to cleanliness. He, therefore, entirely rejects the -application of artificial teeth. He is likewise but little inclined -to the use of the pelican, it being very easy to break the teeth with -it, and, instead, he recommends the use, whenever it be possible, of -another instrument which he calls _pes bovinus_. - -Foreest relates several cases of dental fistulæ which he had cured by -the extraction of the faulty teeth. In one of these cases, observed in -a lady, the fistula had opened between the nose and the cheek, so that -a malady of the upper jaw was feared (and, in fact, as William Sprengel -observes, it is not improbable that this was a case of affection of -Highmore’s antrum); he obtained a complete cure in a short time by the -extraction of a diseased tooth. - -According to Peter Foreest, the existence of dental worms is as certain -as is that of intestinal, auricular, and other worms. Even on the -pretended efficacy of remedies, capable of making the teeth fall out -without pain, he does not throw the slightest doubt. - -Foreest attributes to his master, Benedictus of Faenza, the merit of -having introduced into therapeutics the trephining of teeth for the -cure of certain violent pains not accompanied by any external lesion -of the tooth. We know, however, that the invention of this operation -dates back to Archigenes. Benedictus trephined the tooth with a very -fine drill (_stylo vel terebello subtilissimo_) and then filled it with -theriac, using, likewise, as occasion required, other remedies. - -To demonstrate the propriety and the necessity of laying bare the neck -of the tooth before extracting it, he relates a case in which fracture -of the jaw was the result of having neglected this precaution. - -Among the sundry causes of the looseness of teeth, he mentions the -softening of the dental nerve (_emollitio_), but this erroneous opinion -had already been expressed by Galen. - -As a means of cleaning teeth and keeping them free from tartar, he -advises, among other things, the use of pumice-stone powder. He -disapproves, however, of the use of oil of vitriol—unless in very -minute quantities of, at the very most, one or two drops.[317] - -URBAIN HÉMARD, a surgeon to the Cardinal d’Armagnac, published in 1582, -at Lyons, a booklet entitled: _Recherche de la vraye anathomie des -dents, nature et proprietez d’icelles, où est amplement discouru de -ce qu’elles ont plus que les autres os; avecque les maladies qui leur -adviennent, et les remedies_. This is the first dental monograph that -appeared in France. The pamphlet is written with much erudition, but -its contents are almost entirely taken from preceding authors. Hémard -indicates by the term _deschapellement_ (decrowning) the removal of the -crown of a tooth for curative purposes. He speaks of this operation as -of a method but recently introduced into therapeutics; but, and very -reasonably, too, he shows himself somewhat hostile to such a method of -cure. - -As to what concerns the anatomy of the teeth, Hémard’s book does not -contain anything original. The following passage, transcribed by -Portal,[318] shows luminously that Urbain Hémard, instead of making -researches of his own, has simply copied the Italian Eustachius, -translating the latter almost literally. The beauty of it is that -Portal had not noticed the plagiarism in the least, since he says that -if Urbain Hémard had taken into account the researches of Fallopius and -Eustachius as well, his book would have acquired still greater value. -But, in truth, he has taken into account, and has valued the researches -of Eustachius so much as to palm them off as his own! We here -quote, side by side, with a paragraph taken from Hémard’s book, the -corresponding passage of Eustachius, that our readers may be convinced -of the truth of what we have stated: - - EUSTACHIUS. - - ... aperta utraque maxilla occurrunt incisores, canini, - ac tres molares, nimirum secundus, tertius et quartus; - partim mucosi, partim ossei, non obscuræ magnitudinis, - suisque præsepiolis undique vallati: - - * * * * * - - incisoribus autem et caninis docta manu detractis, - tenuissimum interstitium vix osseum factum conspicitur; - quo pari diligentia amoto, obviam veniunt totidem - incisores et canini pene mucosi et longe minores, qui - post alios priores in propriis caveis latentes, singuli - singulis e regione oppositi collocati essent, nisi - utriusque maxillæ caninus magna ex parte proximo incisori - incumberet, eumque propterea fere occultaret.[319] - - Primorum molarium et genuinorum qui circa septennium ac - longe etiam postea oriuntur, fateor me nullum vestigium - vidisse. - - HÉMARD. - - ... leur ayant ouverte l’une et l’autre mâchoire, j’y - ai trouvé seulement les dents incisoyres, les canines, - et les trois mâchelieres de chaque cousté de mâchoire; - à sçavoir la seconde, la troysième et la quatrième, - lesquelles estoit partie osseuses parti mucillagineuses, - de médiocre grandeur, garnies à l’entour de leurs petits - estuis ou alvéoles. Et depuis ayant tirees dehors - lesdictes dents incisives et canines, il se trouve un - entre-deux osseux; lequel ayant pareillement osté, il - se presente de dessoubs autant de dents incisives et - canines, toutes presque mucillagineuses, représentant la - substance d’un blanc d’œuf à demy cuite moindres pourtant - que les précédentes estant cachées dans les mesmes - estuits après les premières. - - * * * * * - - Quant est des premieres mâchelieres et des gemeles qui - à sept ans, ou longtemps après commencent à sortir, - je confesse n’en avoir trouvé jamais aucune trace n’y - commencement. - - EUSTACHIUS. - - Verisimile tamen est, rationique consentaneum, eos - perinde ac secundos incisores et caninos rude quoddam, - sed minus perspicuum initium ortus in utero sumere; - sensimque postea similiter formari et absolvi - - HÉMARD. - - Toutesfois, il est vraysemblable et raisonable aussi, - qu’elles ayent pris dans la matrice, tout ainsi que - les incisoyres et canines secondes, quelque petit - commencement de naysance et forme, moins apparante - toutefois, mais qui depuis se façonne et parfaict tout - ainsi que des autres. - -At the time when Urbain Hémard was publishing his pamphlet in France, -several other monographs were already appearing in various parts of -Europe on teeth and their affections. A few years after Ryff had -initiated dental literature in Germany, other odontological writings -were published in Spain and in Italy. - -[Illustration: FIG. 66 - -Title page of Francisco Martinez’s book (Valladolid, 1557).] - -FRANCISCO MARTINEZ,[320] in 1557, gave to the press in Valladolid -a _Coloquio breve y compendioso sobre la materia de la dentadura y -maravillosa obra de la boca, con muchos remedios y avisos necessarios, -y la orden de curar y adreçar los dientes_. - -[Illustration: FIG. 67 - -Four of the instruments represented in Francisco Martinez’s book.] - -[Illustration: FIG. 68 - -A dental excavator used for ascertaining which one among several -decayed teeth was the one causing the pain (F. Martinez).] - -[Illustration: FIG. 69 - -A chisel and a mallet for separating teeth (F. Martinez).] - -[Illustration: FIG. 70 - -A pelican (F. Martinez).] - -[Illustration: Girolamo Fabrizio.] - -In the same year and city was printed a Latin pamphlet, _De dentione_, -by Franciscus Martinus de Castrillo, probably the author of the -preceding book. In 1563 was published in Venice the excellent treatise -of Eustachius on the anatomy of the teeth (_Libellus de dentibus_). At -Frankfort was published, in 1576, the second dental monograph in the -German language, _Zahnarzney_, by Adam Bodenstein von Carlstad; and -two years later Petrus Monavius published in Basle a Latin pamphlet on -dental diseases (_De dentium affectibus_). - -[Illustration: FIG. 71 - -FIG. 72 - -Different kinds of forceps (F. Martinez).] - -The above-mentioned works, apart from the book of Eustachius, which is, -of its kind, a real masterpiece, have but little importance. We have -cited them here solely to show in what years and in what countries the -very first dental monographs appeared. - -GIROLAMO FABRIZIO, of Aquapendente (1537 to 1619), a celebrated -anatomist and surgeon, wrote some very valuable works, among which a -treatise on surgery, in which the part relative to the affections of -the dental system is treated briefly but with great orderliness and -clearness, thus giving a very precise idea of what dental surgery was -at the end of the sixteenth century. - -The principal operations which it is necessary to perform on teeth are, -he says, seven in number,[321] viz.: - -1. Forced opening of the dental arches in cases of prolonged -constriction of the same, so as to prevent the patient from dying of -hunger. - -2. Cleaning of the teeth. - -3. Medication of carious cavities. - -4. Filling with gold-leaf. - -5. Removal or resection of teeth abnormally situated. - -6. Removal of any unevenness or sharpness of the teeth. - -7. Extraction. - -[Illustration: FIG. 73 - -Instruments for removing deposits from the teeth (F. Martinez).] - -[Illustration: FIG. 74 - -A dental scraper. - -A universal toothpick and a file for sharpening its points. - -An instrument for removing sharp corners from the molar teeth (F. -Martinez).] - -[Illustration: FIG. 75 - -A figure representing St. Apollonia, reproduced from the last page of -F. Martinez’s book.] - -In regard to the first operation, the author first of all examines -the various causes of the constriction of the dental arches, and -according to the various nature of this, he indicates in what cases it -is fitting to have recourse to the forced opening of the jaws by means -of appropriate dilators, and in what cases it is best to avoid it. In -the latter case one must seek to feed the patient in other ways—that -is, either by alimentary clysters, or by a little tube passed through -a space already existing or purposely made by the extraction of one -or two teeth; or else by letting a cannula reach down to the pharynx, -through the nose, or, lastly, by introducing a cannula into the oral -cavity through the free space existing behind the last molars. But in -regard to this last method, Fabricius notes that if the constriction -is of a spasmodic nature, the spasm may affect not only the elevator -muscles of the jaws, but also those that govern deglutition, including -sometimes even those of the tongue itself, and in this case, as the -food introduced into the oral cavity could not be swallowed, it is -preferable to convey it directly into the pharynx, by means of a -cannula passed through the nostrils. - -The second of the above-mentioned operations[322] is designed, says -Fabricius, to take away the dirtiness of the teeth and the bad odor of -the mouth (_dentium immunditiam et oris fœtorem tollit_). The dental -tartar (_ostracoderma_) must be removed by slender instruments of an -appropriate shape, which, for people of high position (_promagnatibus_) -shall be made of silver. This advice is sufficient to make us -understand that Fabricius, although an excellent surgeon, had no -practice in dental operations; otherwise he would have known that the -hardness and adhesion of tartar is generally so great that its removal -absolutely requires scrapers of tempered steel and not of a soft metal -like silver. - -To arrest caries, he first drops into the carious hollow, by means -of a small silver funnel, some drops of oil of vitriol, or of some -other caustic liquid; and then he performs actual cauterization with -appropriate instruments; after which the cavity is filled with gold -leaf (auro foliato). - -When one or more teeth have appeared in an irregular position and -offend the walls of the oral cavity or else the tongue, the excision -(resection) of the tooth or teeth must be performed with a pair of -strong pincers, whose shape must vary according to whether the teeth -are situated externally or internally with regard to the dental arches. -But as after the resection there will almost always remain some points -or sharp irregularities, which by their presence would continue -to irritate the soft parts, it will be necessary to remove these -irritating prominences by means of the file. - -As to extraction, Fabricius of Aquapendente counsels great prudence in -performing the operation, and on this point he repeats all the warnings -already given by Celsus, an author whom he greatly admires and the -study of whose writings he warmly recommends. - -It seems that in those times there was more than sufficient reason -to inculcate extreme caution in regard to the extraction of teeth. -This was not then performed by true dentists, but rather by barbers -and by ignorant tooth-pullers, or else, in exceptional cases, by -general surgeons, very skilful, perhaps, in everything else, but -little practised in the operation we are speaking of; besides this, -the instruments left much to be desired; and lastly there was not, -nor could there be, any idea of asepsis. What wonder, therefore, if -the extraction of teeth was frequently the cause of serious injuries! -Fabricius relates that it often happened to him to have to extract, -in little fragments, half or sometimes a whole jaw, which had been -attacked by putrefaction, as the result of the extraction of one single -tooth. This, adds the author, may easily happen, because, when the -jaw is attacked by pus in one point, its very anatomical constitution -favors the rapid spreading of the putrefying process to the other -parts of the bone, as this latter, apart from its external lamina, is -entirely composed of a sponge-like substance. - -The instruments which are used for the extraction of teeth, are, -says Fabricius, of nine kinds;[323] and the most important among -them—generically called _forceps_—are indicated by special names, -taken from their resemblance to the mouth or beak of certain animals. -Thus, the forceps with which it is usual to perform the extraction of -molar teeth are called “pelicans,” and of these there are two kinds, -according as they are used for the right or the left side, for the -upper molars or the lower ones. - -A third kind of instrument goes under the name of “beak” (rostrum), and -serves for the extraction of the incisors. - -A fourth kind is the “crow’s beak,” or “crow’s bill,” which is used for -the extraction of roots. - -Two other instruments are named in Italian “cagnoli,” for they imitate -the strong bite of the dog (in Italian _cane_) and are used in cases -where the pelican is not adapted. - -A seventh instrument is called by the Latin term of _terebra_ (drill -or auger). It is used instead of a lever to separate the teeth from -one another when they are too close to each other, and so render their -extraction much easier. - -The eighth instrument is a “trifid lever” (_vectis trifidus_), so -called because it is furnished with three points. - -The ninth and last kind of instruments are the _dentiscalpia_, slender, -sharp, and oblong tools, with which the gums are separated from the -teeth before extraction. - -Fabricius also speaks of dental prosthesis, but very briefly. He says -that artificial teeth are made of ivory or of bone (for example, from -the tibia of the ox) and are fastened by gold wire. One has recourse to -this means especially to correct the bad appearance and the defects in -speech deriving from the loss of the front teeth. - -This author also makes some allusion to palatal obturators,[324] but in -very general terms, limiting himself to saying that when a perforation -exists in the hard palate, it may be corrected by a piece of sponge -or cotton, or with a plate of silver fixed in the palate, so as to -close up the aperture (_corrigitur spongia, vel gossypio, vel lamina -argentea, quæ palato appendatur, ut foramen obstruat_). - -For epulides and parulides Fabricius advises the same methods of cure -that had been recommended by Paul of Ægina. - -In the case of flaccidity of the gums accompanied by looseness of -the teeth, the treatment must consist, first of all, in superficial -cauterization with the red-hot iron, after which the gums must be -smeared with honey, the mouth washed with mulse, and lastly astringent -powders must be used. - -If the gums are much swollen, in near relation to the molar teeth, the -use of the red-hot iron, says Fabricius, becomes very difficult from -the want of space, and from the close vicinity of the healthy parts, -which must not be injured. In such a case, it is necessary to remove, -with suitable cutting instruments, as much as is possible of the morbid -tissue (_caro crassa et putrida_); then to cauterize the remaining -part, making the cautery, if necessary, pass through a tube, so as not -to injure the surrounding parts. When, however, the gingival swelling -bleeds very easily, and its excision thus might give rise to a profuse -hemorrhage, it will be best to perform the operation with cutting -instruments heated red-hot. - -Fabricius remarks that although other authors do not make any allusion -to these large gingival excrescences, he had had occasion to observe -several cases, and had also had various instruments especially -constructed for their cure.[325] - -JOHANN HEURN, or in Latin Heurnius (1543 to 1601), of Utrecht, in his -book on the diseases of the eyes, ears, nose, teeth, and mouth, treats -sufficiently at length of dental diseases and their cure, but without -adding anything of importance to what had been written by preceding -authors. His work is a mere compilation, which would be without any -importance whatever if it did not serve to show what credit was still -given at that period to all the errors and prejudices which are to be -found in the writings of the ancients. - -Heurnius, although he wrote a long time after Vesalius, still adheres, -in regard to the number of teeth, to the already mentioned opinion of -Aristotle; he says, in fact, that women rarely have thirty-two teeth -like men.[326] - -He warns those who suffer from odontalgia not to have recourse -thoughtlessly to tooth-drawers, but to recur, instead, to the doctor, -who will always treat the affection according to the cause on which it -depends. - -And here the author repeats the numerous distinctions found in many -preceding writers, and especially in Arculanus. The pain may be -located in the gums, in the dental nerve, or in the very substance of -the tooth; and in each of these cases it may depend on warm or cold -matter, on dryness, humidity, etc. - -[Illustration: FIG. 76 - -A Dutch dentist. (From a picture of the XVI century.) By Lucas Van -Leyden.] - -The method of treatment must vary in all these cases; and in regard -to this the author enters into minute particulars, commencing with -dietetic cure—which itself must be varied according to the causes -of the affection—and then treats of all the other therapeutic -means—purgatives, bloodletting, revulsives, local narcotic or resolvent -medicaments, and so forth. The letting of blood was, it seems, a very -favorite method of cure; not only were the veins of the arm opened, but -also those of the tongue, of the gums, of the lips, and of the ears! - -Another remedy which the author seems to have a predilection for is -oil of vitriol. When a tooth shows a carious perforation, he applies -inside it, by means of a split feather, a drop of oil of vitriol, -which, says he, causes the fall of the tooth after a few days. - -Elsewhere he says that “sometimes worms are produced in carious teeth; -to kill them a drop of oil of vitriol is an excellent remedy; and -this at the same time cures the decay of the tooth and takes away the -sensibility of the nerve.” - -This passage does not agree very well with the preceding one, according -to which oil of vitriol would act much more radically by causing the -tooth to fall out altogether. But we will not take exception to so -small a matter; so much the more, as the author, if he were still -alive, might perhaps show us by some subtle distinction that the -contradiction alluded to is only an apparent one! - -To free the teeth from tartar, Heurn likewise counsels oil of vitriol, -diluted, however, with other liquids. - -A tooth must not be sacrificed excepting when it is loose and attacked -by incipient necrosis, so as to leave no hope of arresting the -putrefactive process. It is then our duty, says Heurn, to remove the -tooth without causing much pain. For this purpose, after the tooth has -been separated all around from the gums, it must be raised somewhat -from the alveolus; then it must be sprinkled with powder of euphorbia, -or a paste made with flour and the juice of the tithymalus must be -applied around it, taking care, however, to cover the neighboring teeth -with wax. After two or three days the tooth will be so loose that -it can be pulled out very easily with the fingers or with a pair of -pincers. - -Dental surgery properly so called has been entirely neglected by Heurn. -He was perhaps so persuaded of the efficacy of the above-mentioned -remedies as to believe that every other species of intervention was -useless. On the contrary, he does not abstain from speaking very -seriously of the miraculous virtues of certain remedies (serpent -scales, dog’s teeth, etc.); and tells us, among other things, that the -broth made from a frog, when held for a length of time in the mouth, -soothes dental pains, whatever be the causes from which they originate. -One would seem to have gone back again to the days of Pliny! - - -THE STORY OF THE GOLDEN TOOTH. - -In 1593 a rumor spread throughout Germany of a great marvel that had -appeared at Schweidnitz in Silesia: a golden tooth had erupted in the -mouth of a child aged seven years, which, more precisely designated, -was the first large molar on the left of the lower jaw. - -In our days news of such a kind would be immediately qualified, and -universally held to be an imposture. But three centuries ago the most -marvellous and unlikely things were easily believed in, often even by -the learned; and, therefore, the fact alluded to was taken into serious -consideration, so much so that for a long time many learned pamphlets -and dissertations were written concerning it. - -JACOB HORST, Physician and Professor of Medicine at the Julius -University in Helmstadt, published, in 1595, a very singular book on -the golden tooth of the Silesian child.[327] Without raising any doubt -as to the reality of the fact, he maintained that the phenomenon was -produced from the effect partly of natural and partly of supernatural -causes, in relation with the constellation under which the child was -born. On the day of its birth, that is, December 22, 1585, the sun was -in conjunction with Saturn in the sign of Aries. In consequence of -this circumstance the nutritive force had developed marvellously on -account of the increase in heat, and consequently, instead of osseous -substance, golden matter had been secreted! - -After having explained (!) in this way the origin of the phenomenon, -Horst passes on to examine what events may be portended by this -unheard-of marvel, he not having the least doubt that it—like -earthquakes, eclipses, and comets—must be the precursory sign of -important events. Supporting his assertions by arguments of various -kinds, some of which are taken from the Bible, he concludes that the -gold tooth of the Silesian child means neither more nor less than the -approach of the golden age! The Roman Emperor would sweep the Turks, -the enemies of Christianity, out of Europe, and the Millenium or -Golden Age would commence. As the tooth was situated on the left side -of the lower jaw, it might be deduced, according to Horst, that heavy -calamities would precede the beginning of the epoch of happiness thus -predicted. On the other hand, as the golden tooth was the last of the -dental series of the child, this was to signify that the golden epoch -thus foretold would be the last of the ages of this world before the -universal judgment! - -MARTIN RULAND, in the same year, 1595, wrote about the gold tooth.[328] -Shortly after, he was answered by JOHANN INGOLSTETTER; and the -controversy which arose between them in this important subject lasted -for a long time, without, however, leading to any definite conclusion. - -BALTHASAR CAMINDUS, a doctor of Frankfort, meanwhile had noted that for -some months the marvellous Silesian boy had not lent himself to being -examined by the learned, becoming terribly enraged whenever they wished -to compel him. From this he inferred that it was a case of nothing else -but an imposture, and that the famous tooth could not have anything -special about it, save that its crown had been very skilfully covered -with a thin plate of gold. - -In spite of this the discussions on the portentous tooth continued for -a long time; and even one hundred years after, that is, in 1695, a new -dissertation appeared on the golden tooth. - -The greater number of those who wrote on this subject did not throw -the slightest doubt upon the reality of the fact, but only sought to -explain in the most varied ways the genesis of this phenomenon. - -DUNCAN LIDDEL. Among those who had the good sense not to put faith in -the thing, and who very decidedly affirmed that this was a mere case -of imposture, Duncan Liddel, a Scotchman and professor in a German -University, deserves to be recorded.[329] - -He had heard that the famous gold tooth was larger than the others, -and that the neighboring molar was wanting; from which he argued that -this was simply the case of a tooth the crown of which had been covered -with a plate of gold. Answering the arguments of Horst, he accused him -of gross ignorance in the most elementary notions of astronomy, and -this for having affirmed that when the famous child was born, that is, -December 22, the sun happened to be in conjunction with Saturn in the -sign of the Ram. As the sun does not enter the sign of the Ram until -March, if it had been there on December 22 this would have been a -greater portent than if the whole body of the child had been formed of -nothing else but teeth of gold![330] - -The above-mentioned fact is not the only one of its kind. Serres -relates that once there was a great noise made in Poland about the -pretended golden teeth of another child who was carried round from city -to city for the purpose of making money. A Franciscan monk had sought -to explain, in one of his writings, the formation of these teeth. -The anatomist Kircher answered him in a pamphlet which had the very -suitable epigraph: _O præclare pater, nimium ne crede colori_.[331] In -fact, the pretended teeth were only covered with a layer of tartar of -golden color. As the falsity of the pretended miracle might be brought -to light at any moment with much scandal, a bishop thought it well -to put an end in haste to the comedy, by ordering the removal of the -deceitful layer of tartar from the teeth of the child, to be performed -in public, so that the imposture might be made completely clear. - -From the above story we can, at any rate, deduce an important -conclusion for the history of dental art, that is to say, that even -as early as 1593 there was an artificer (we do not know whether a -goldsmith or dentist) who knew how to construct a gold crown, although -only for the purposes of deception. - - - - -CHAPTER XI. - -THE SEVENTEENTH CENTURY. - - -The first signs of the separation of dental science from general -medicine were to be perceived in the sixteenth century, the period -in which, as we have seen, the earliest dental monographs appeared. -From that time this separation tended to accentuate itself ever -more strongly; dental monographs became more numerous and dentistry -progressed ever more rapidly, both in its scientific and practical -aspects. - -In the seventeenth century, about which we are now to speak, we shall -have to call attention to many facts of the highest importance for -the development of dentistry, and with regard to literature, it is -worthy of note that while the publications on dentistry that appeared -in the various countries of Europe during the preceding century only -amounted to about twenty (taking also into account several pamphlets on -the famous golden tooth!), in the seventeenth century the number was -considerably higher, that is, about a hundred. We shall speak of the -most important of these, as also of the works on general medicine or on -surgery of the same period, that present some interest from the point -of view of dentistry. - -JOHANN STEPHAN STROBELBERGER, physician to the imperial baths of -Carlsbad, published in the year 1630 a very curious book, the title -of which, being translated, runs somewhat as follows: _Complete -Treatise of Gout in the teeth, or, more properly said, of Odontagra -or toothache; in which are set forth, theoretically and practically, -for the use of physicians and surgeons, the means of mitigating these -pains, as well as the various modes of ably extracting teeth with or -without instruments_.”[332] - -This book merely presents some interest, because it gives us a clear -idea of the pitiful state in which the dental art still was in the -first half of the seventeenth century, and shows us most clearly -what enormous progress our specialty has made in little less than -two centuries. Apart from this, Strobelberger’s monograph is of no -importance, it being nothing more than a most accurate compilation of -all that is to be found on the subject of dental affections in earlier -works, especially from the medical point of view; the surgical part -of dental therapeutics is treated in a much less complete manner, and -prosthesis is entirely excluded from the plan of the work, which, -however, is fully in accordance with the title of the book. - -Under the generic name of gout,[333] or podagra, are meant, says -the author (Chapter I), all the affections produced by diseased -humors, falling “by drops” into the articular cavities and the parts -surrounding them. Strictly speaking, however, only gout in the feet is -named _podagra_, whilst when the disease is seated in other parts of -the body it is indicated by other names, gout in the hands being called -_chiragra_; in the fingers _dactilagra_; in the knee, _gonagra_; in the -elbow, _pechiagra_; in the shoulder, _omagra_; in the spinal column, -_rachisagra_, and so on. When the seat of the evil is in the teeth or -in their articulations, by analogy it is denominated odontagra, or -odontalgia, an affection which Paul of Ægina was the first to consider -as being of a gouty nature (Chapter II). - -After having spoken of the sensibility of the teeth (Chapter III), -of the various kinds of dental pains (Chapter IV), of the different -causes, external and internal, which produce them (Chapters V to -VII), of the signs which make known their special nature in each case -(Chapters VIII to X), and of the prognosis (Chapter XI), the author -occupies himself very minutely, throughout the rest of the book, with -all that concerns means of cure, dedicating to this subject sixty-seven -chapters and a long appendix. - -If, after the publication of Strobelberger’s book, all previous works -treating of dental affections had been entirely lost, it would be of -inestimable value for the history of dentistry, the author having -gathered together in an almost complete manner—citing faithfully the -respective authors—all that had been written about dental diseases -before him. On the other hand, the book contains almost nothing -original; therefore, rather than analyze minutely its contents—which -would involve a long repetition of things already noted—we limit -ourselves merely to a few observations. - -Strobelberger, like Heurnius, is of opinion that for the cure of -dental pains it is necessary to have recourse to doctors rather than -to _dentispices_, or tooth drawers (Chapter XII); however, he does -not consider the calling of the latter absolutely useless; indeed, he -expressly advises (page 174) that they should be applied to for the -instrumental extraction of the teeth, it not being possible for such -operations to be carried out well and without danger except by those -who, through great practice, have acquired the necessary skill in the -use of the relative instruments. He refers to the words of Hollerius, -already quoted, as to the falseness of the opinion that fumigations -made with the seeds of hyoscyamus cause the worms to fall out of the -teeth. Notwithstanding, he does not in the least doubt the existence of -the worms themselves; and he, like Heurnius, recommends killing them -with oil of vitriol or with a decoction made from a frog cooked in -water and vinegar (Chapter XXXIII). From this, one clearly perceives -that the doubts expressed by Hollerius about the existence of dental -worms had not in the least shaken the popular belief in them. Nor, -indeed, could it be otherwise when one considers that Hollerius, as -we duly noted in another place, had not the courage either decidedly -to deny the existence of dental worms, or to formulate in a clear -and explicit manner the doubts which had arisen in his mind on this -subject. We are, therefore, unable to recognize the merit which -Linderer[334] and Geist-Jacobi[335] have attributed to this author, -viz., that of having effectually affirmed the non-existence of dental -worms. - -Among innumerable vegetable remedies recommended by Strobelberger -against odontalgia, we will only cite two American plants, the guaiacum -and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum -(Chapter XXXVI) the author says that, used as a mouth wash, it has the -triple virtue of strengthening the gums, of preventing putrefactive -processes, and of calming toothache. - -The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII) -for the first time in this work, but, as we learn from Strobelberger -himself, Heurnius has already obtained, experimenting in his own -case, the cessation of an attack of toothache by holding in his mouth -spoonfuls of tepid decoction of nicotiana for the space of two hours. - -The same soothing effects may be obtained, says the author, from the -smoke of tobacco; but he attributes this not to the narcotic action of -the remedy, but to the fact that it causes the flow of much saliva from -the mouth and mucus from the nostrils, through which the morbid humors -which provoke the pain are eliminated. - -To those suffering from odontalgia, says Strobelberger (Chapter XL), -the internal use of certain mineral waters is also of value, and -especially that of the waters of Carlsbad (Thermæ Carolinæ). Like -many other remedies, they are useful in rendering the secretions more -active, favoring thus the elimination of morbid substances from the -blood. For the same object of purifying the organism and dispersing -the accumulated humors causing the pain, many other means of cure -were in usage, such as aperients (Chapter XXV), phlebotomy, and -arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification -and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI), -masticatories, viz., substances intended to be chewed for the purpose -of exciting salivary secretion (Chapter XXVI), sternutatories, viz., -substances which provoke sneezing (Chapter XXVII), and so forth. - -Like Arculanus, Strobelberger makes a distinction between the _real_ -and the _false_ cure of odontalgia (_cura vera et cura mendosa_). This -latter he also subdivides in _palliative_ cure and _vain_ cure (Chapter -LV). The palliative cure is constituted by the use of narcotics and -stupefying remedies (Chapter LVI), whilst the vain cure is represented -by certain remedies which he calls “fanatical” or rather “fantastical.” -The _vain_ cure, in its turn, undergoes a new distinction, since it -comprises three species of remedies, that is, the wearing of amulets, -the superstitious remedies, and the ridiculous remedies. Indeed, this -last apellation might also fittingly be applied to the preceding ones! - -One would be inclined to believe that the author who qualifies these -remedies as vain, fantastic, superstitious, and ridiculous was a -thoroughly unprejudiced man; however, this is not so. Strobelberger, -too, had to pay his tribute to the dominating prejudices of his -century; this manifestly appears from various passages in his book, -and especially from the Chapters XVI and XLIV. The first of these -bears the following title: “How to procure immunity from toothache,” -and Strobelberger therein asserts in all seriousness, basing his -assertion on the authority of Rhazes, that “if the canine tooth of a -lion be suspended to a child’s neck before the milk teeth fall out -and during the eruption of the second teeth, it will secure the child -immunity from dental pains.” In Chapter XLIV the author speaks of those -animals whose teeth are useful to man as remedies against toothache, -and reiterates—lending, as it seems, perfect faith thereto—various -prejudices that are found in Pliny and other writers of antiquity. - -As to the remedies which Strobelberger recognizes as _vain_—that is, as -devoid of real curative virtue—he remarks that they may nevertheless be -useful by acting powerfully on the imagination of the sufferer, thus -causing, in fact, the cessation of pain (Chapter LVII). This clear and -explicit affirmation of the efficacy of suggestion in a book published -270 years ago is certainly not without interest. - -If, says Strobelberger, a place is to be accorded, in dental -therapeutics, to the _vain_ remedies, among these, amulets deserve the -preference; and the best accredited amulet is the root of the lepidium, -already recommended by Dioscorides, who affirms that if it be hung -around the neck of the sufferer it will cause the pain to cease. - -One of the _superstitious_ remedies to be used against this affection -(Chapter LVIII), consists in touching the aching tooth with the tooth -of a dead person, and afterward greasing it with horse’s marrow. - -Among the _ridiculous_ remedies (Chapter LIX), the author describes one -that was especially in use among soldiers. With a piece of chalk or of -rubble one writes on a table: - - Chiacia Chiacia Chiacia - X O X X O X X O X - -One then pricks the tooth with a knife or an iron toothpick until it -bleeds slightly; then thrusting the point of the instrument, to which -the blood adheres, into the first cross, then into the second, then -into the third, and so on, one asks the patient each time if the tooth -still pains him. Before one gets to the last cross the pain ceases! -This stolid cure, says the author, has no other value than that of the -scarification of the part affected. - -Strobelberger held, as did many of the preceding authors, that the -extraction of a tooth ought to be the _last_ remedy, that is, to be -had recourse to when all others, including cauterization, which he -considers as the _last but one_, have proved ineffectual. There are -cases, however, in which the extraction of a tooth is absolutely -indicated, and here, by the way, the author acquaints us with the -following poetic aphorism, which expressed the unanimous opinion of -doctors: - - Si dens pertusus, vel putridus esse notatur, - Corrumpens alios, tunc protinus ejiciatur. - -That is, if one finds that a tooth is hollow or decayed, and corrupts -the others, it must at once be extracted. - -Strobelberger, like the greater number of his predecessors, is fully -persuaded that diseased teeth may be made to fall out by the use of -special remedies; indeed, this clearly appears from the title of the -work itself, as, without doubt, the reader will already have observed. -Such remedies are called by him “odontagoga,” and he describes them -at great length in five different chapters (X to XIV) of the second -section of his book, dedicated to the surgical care of the teeth. - -In regard to _violent extraction_ of teeth, Strobelberger shows still -greater cautiousness and timidity than Celsus or Abulcasis. He requires -that, after the gum has been detached, one should endeavor to extract -the tooth with the fingers or by means of a thread; if, however, this -does not succeed, one may have recourse to the trifid lever; only at -last, that is, when even the lever has failed, does he allow the use of -an appropriate dental forceps. - -[Illustration: Wilhelm Fabry.] - -ARNAULD GILLES, a Frenchman, in the year 1622, published in Paris a -work whose curious title we will here note: _The flower of the remedies -against toothache_.[336] We know nothing else about this publication, -which, however, to judge from its title, cannot be other than a mere -compilation. - -DUPONT, another Frenchman, in 1633, published an important pamphlet, -which I have, unfortunately, not been able to see. I can, therefore, -only quote what Sprengel says of it.[337] Dupont recommends, in cases -of obstinate toothache, the extraction and immediate replantation of -the tooth; which, he says, becomes quite firm again, but will no more -cause any pain. In confirmation of this, Denis Pomaret related, a -little later, a case in which a healthy tooth having been pulled out -by mistake, and immediately put back into the socket and treated with -astringent remedies, became perfectly firm again.[338] - -Although Abulcasis and Ambroise Paré had already recommended the -replantation of teeth, the loss of which had been caused by trauma, -and although Peter Foreest had already made known as a result of his -own personal experience that the luxation (not, however, complete -extraction) of a tooth and its successive replantation is capable of -causing toothache to cease, nevertheless, we must recognize that the -merit of having elevated replantation in non-traumatic cases to a -special method of cure must be attributed to Dupont. - -WILHELM FABRY (1560 to 1634), a German, and native of the small town -of Hilden near Cologne, better known by his Latin name of Fabricius -Hildanus, was chief doctor to the city of Berne, and acquired great -fame as well by his extraordinary professional ability as by his works, -consisting principally in reports of many hundreds of important and -instructive clinical cases. He is rightly considered one of the most -illustrious German surgeons. His writings have largely contributed not -only to the progress of surgery in general, but also to that of dental -surgery in particular. - -One of his observations clearly shows the etiological relation -frequently existing between a prosopalgia or a supposed hemicrania and -a dental affection. The case referred to is that of a lady who had been -subject for six months to violent pain in the upper teeth of one side -of the jaw. The toothache little by little disappeared, giving place to -an obstinate cephalalgia in the same side of the head, which gradually -became so intense as to be perfectly insupportable, the patient being -particularly subject to it when the weather was cold and damp. After -four years of atrocious suffering, and after innumerable remedies had -been tried without avail, Fabricius Hildamus—having had the luminous -idea of seeking the cause of the evil in the teeth—obtained a complete -cure, without further trouble, by extracting four of the patient’s -teeth, which were decayed. - -Nowadays, it is an all-important canon of medical practice, that -in every case of neuralgia occurring within the region influenced -by the trifacial nerve one should give particular attention to the -state of the teeth and carefully treat every affection of the same. -Notwithstanding—we say it with regret—there are still medical men who -ignore or neglect this precept, and prescribe internal remedies or -have recourse to injections of morphine when they ought, in the first -place, to call in the aid of a dentist. How many patients would have -been delivered from slow martyrdom if the example of the clear-seeing -physician of Berne had been followed from his days up to the present -time! - -Fabricius Hildanus relates, besides, many cases of dental fistula, -cured by him through the extraction of roots or of decayed teeth. In -one such case the fistula dated from fourteen years back. Fabricius -Hildanus, contrary to the opinion of many other doctors, extracted a -decayed tooth, and by this operation obtained, in a brief period of -time, the complete recovery of the patient. - -Among the many very important clinical cases cited by Fabricius -Hildanus, the following deserves to be recorded: In the year 1590 a -woman presented herself to him who had a hard tumor in the space behind -the last molar on the right side. The author, after having prepared -the patient for the operation by the methods then in use (that is, by -aperient medicine, by bleeding, and appropriate diet), destroyed the -tumor by the application of escharotic substances. The remaining wound, -however, defying all the cicatrizing remedies which the author had -recourse to, one after the other, by reason of its being continually -disturbed by the movements of the jaws, he then thought of maintaining -the dental arches in a determined position, and this he obtained by -means of two pieces of wood somewhat hollowed out above and below, -which he placed on the right and on the left between the upper and the -lower teeth, fixing them to the teeth themselves by brass wires passing -through two openings made expressly in each of the two pieces of wood. -In this way he succeeded in obtaining the absolute immobility of the -jaws and the complete cure of the wound in a few days, during which -time the patient was nourished with liquid food.[339] - -A very interesting case, inasmuch as it demonstrated the damage and -peril which may result from certain absurd means of cure, was reported -to this author by Claudio Deodato, physician to the Prince-Bishop of -Basle. The case was that of a patient who, after having tried in vain a -great number of remedies for a stubborn toothache, finally had recourse -to the use of aqua fortis; but this substance, which in those days was -in frequent use for dental caries and for toothache, produced most -deleterious effects in the patient, that is to say, the loss of almost -all his teeth, necrosis of the inferior jaw, with fistulous sinuses and -ulceration of the neck, abundant sanious discharge, fever, a cachectic -condition, incipient necrosis of the upper jaw, etc.[340] Fabricius -Hildanus, consulted by Claudio Deodato about this most serious case, -proposed both a local and a general treatment, the result of which is, -however, not mentioned in his book. - -In the fifth “_centuria_ of medical and surgical observations and -cures”[341] we find a case of oral surgery, to which it is worth while -briefly to refer here. It relates to an epulis situated next to the -upper canine of the left side. The tumor, already of ancient date, -had at this time reached the size of a walnut, was very hard, livid -in color, irregular in form, and adhered somewhat to the upper lip; -according to the author, it was of a cancerous nature. After the usual -preparative measures, Fabricius Hildanus proceeded to the ablation of -the tumor, and to this end he first pierced it with a curved needle and -strong thread, in order to get a good hold on it, and he then removed -it entirely down to the bone, by means of a curved bistoury.[342] - -Fabricius Hildanus, having dissected several abortive fetuses of under -four months, was able to verify the exactitude of the assertion made -by Hippocrates, afterward luminously confirmed by different Italian -anatomists, that the teeth begin to be formed during intra-uterine -life. And with reference to this he also relates the following fact: - -The wife of a Protestant minister gave birth to a female child which -already had a fully developed tooth, a lower middle incisor, equal in -size to that of a child of two years old, and which interfered with the -sucking by injuring the nipple of the mother’s breast and the tongue of -the child itself. So it was necessary that it should be removed. But it -was found to be so firm that the surgeon sought in vain to extract it -with a thread, and was obliged to have recourse to the forceps.[343] - -Observation XXXI of the third _centuria_ relates a case of rhinoplasty. -In the year 1590, when the Duke of Savoy made war on the inhabitants of -Geneva, a girl named Susanna N. fell into the hands of the soldiers, -who tried to deflower her; enraged at not succeeding in their intent, -they cut off her nose. Two years later the girl went to Lausanne, -the residence of J. Griffon, an eminent surgeon of that time, who -performed the rhinoplastic operation on her in so splendid a manner -that one would have taken the new nose for a natural one, not only -from its normal appearance, but also because the scar was hardly -visible. Fabricius Hildanus, having had occasion to see and examine -the patient several times, even up to twenty-one years after the -operation, was able to testify to the perfect condition of the nose; -in the extreme cold of the winter, however, it was apt to become livid -at the point. He does not describe the operative process followed by -Griffon, but merely says that the first inventor of this operation was -Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had -undertaken the reproduction of the same from his own conception of it, -based on the information imparted to him in conversation, by an Italian -who had been operated upon by Tagliacozzi. - -JOHANN SCHULTES (1595 to 1645), a physician in Ulm, was the author of a -very important work entitled _Armamentarium chirurgicum_, in which are -given plates and descriptions of almost all the surgical instruments -that had been in use up to that date. As to the part relating to dental -and oral surgery, we find the following instruments named in this work: - -1. Several kinds of pelicans; an instrument which was so called from -its resemblance to the beak of the bird of the same name, and used for -extracting the molar teeth. - -2. The common dental forceps, then named _cagnolo_ by the Italians, -because of the supposed likeness to a dog’s muzzle. - -3. The crow’s beak forceps (_rostrum corvinum_), designed for the -extraction of dental roots, and, therefore, corresponding to the -rhizagra of Celsus. - -4. Two special dental forceps, or _dentiduces_, for the removal of -teeth which could not be extracted either with the pelican or with the -common dental forceps. - -5. Bifid and trifid elevators (_vectes bifidi et trifidi_), to be used -for the extracting of incisors and canine teeth, as well as roots. - -6. _Dentiscalpia_ for detaching the gum from the tooth before -proceeding to extract it, in order that this may be the more easily -accomplished and with less danger. - -7. A silver funnel or cannula (_infundibulum seu fistula argentea_), -for nourishing patients affected with trismus, by conveying liquid food -into the fauces, through the free space behind the last molars. - -8. Forceps more or less like in form to the beak of the parrot or the -vulture (_rostrum psittacinum et vulturinum_), for the removal or -resection of teeth that have grown in abnormal positions. - -9. A screw dilator (_dilatatorium cum cochlea_), for gradually opening -the dental arches in cases of spasmodic constriction of the jaws.[344] - -[Illustration: _A plate of Schulte’s “Armamentarium Chirurgicum,” -showing some dental and other operations._] - -[Illustration: FIG. 77 - -A plate from Schultes’ “Armamentarium chirurgicum,” showing several -dental instruments.] - -MARCO AURELIO SEVERINO (1580 to 1656), of Tarsia, a celebrated -professor of surgery in the Neapolitan University, had a great -predilection for the use of the cauterizing iron, which he also used -very frequently in curing caries and other dental diseases. At times, -to effect a cessation of violent toothache, he would have recourse to -the cauterization of the antihelix! Against flaccidity of the gums and -loosening of the teeth he also used cauterization, disapproving the use -of astringent substances, as these cannot get so far as the roots of -the affected teeth. Severino boasts of having cured by cauterization at -least two hundred cases of dental diseases. - -LAZARE RIVIÈRE (1589 to 1655), a professor at the University of -Montpelier, also known by his latinized name of Lazarus Riverius, -treats of dental affections and their cure, in various parts of his -works, considering them, however, almost exclusively from a medical -point of view. - -He speaks first of all of the different causes of odontalgia, and, -among these, does not omit to mention worms. These, he says, may -be generated in the carious cavities, owing to the putrefaction of -substances retained in their interior. Whenever odontalgia is caused -by worms, the pain, says Rivière, is not continuous, but ceases and -returns at brief intervals; besides, the sufferer perceives at times -the movement of the worm inside the tooth! - -What one reads in the works of this author as to remedies to be used -for odontalgia clearly demonstrates how irrationally dental diseases -were treated in the seventeenth century and what tortures were -inflicted on the patients. In many cases, and especially when the pain -was held to be occasioned by “hot humors,” the treatment was begun by -bleeding in the arm. The following day an aperient was administered. -Afterward, if the pain still persisted, the sufferer was cupped in -the region of the scapulæ or of the spine, blisters were applied to -the nape of the neck or behind the ears, resinous plasters to the -temples; all this without taking into account the remedies which were -introduced into the ears, or the various medications or operations -performed on the aching part itself, and many other things besides. -In fact, in order to cure a toothache, the whole body of the sufferer -was seized upon and put to torture, and in the majority of cases they -assuredly finished by extracting the diseased tooth! When we reflect -on the extraordinary frequency of dental disorders we cannot do less -than recognize that the dentists, by the radical change effected in the -methods of treatment, have diminished in no small degree the sufferings -of humanity! - -According to Rivière, the small veins (sic) that nourish the teeth pass -through the ear (!); and this would explain how the cessation of a -toothache may be obtained by the introduction of certain remedies into -the meatus auditorius externus. Relief may be obtained, for instance, -by dropping oil of bitter almonds into the ear on the side affected by -the pain, or by allowing the vapor of hot vinegar, in which pennyroyal -or origanum has been boiled, to penetrate into it. Others, adds the -author, pour a little pure vinegar into the ear, which is especially -efficacious against “hot fluxions.” When, however, the toothache -depends on a “cold fluxion,” it calms the pain wonderfully to drop -into the ear a tepid mixture of garlic juice and theriac. The same -advantage, says the author, may be obtained by introducing a piece of -garlic, peeled and cut into the form of a suppository, into the ear. - -The author also makes a lengthy enumeration of anodyne and narcotic -remedies (among which opium), observing, however, that those remedies, -unless the vehemence of the pain obliges the use of them, ought not -to have the preference, it being much more rational and much more -advantageous to institute a cure which aims directly at the cause -itself of the pain (fluxions, worms, etc.). - -He informs us that Amatus Lusitanus, a celebrated physician of the -sixteenth century, extolled, as a remedy for toothache, a decoction of -gum sandarach in wine and vinegar; the said decoction was to be made -with an ounce of sandarach in six ounces of wine and the same quantity -of vinegar, and ought to be kept in the mouth some length of time, -whilst hot. - -Rivière further speaks of various masticatories, which were composed of -mastich, staphisagria, pyrethrum, henbane, etc. - -He also mentions oil of cloves, which even then was used against -toothache, by introducing into carious cavities a small piece of -cotton-wool soaked in it. Oil of camphor was used in the same manner, -but the most efficacious of all, according to the author, was oil of -boxwood. - -As to worms in the teeth, they may be destroyed by the use of bitter -substances! - -In the case of a caries penetrating into the inner cavity of the tooth, -to effect the cessation of pain, it is necessary to burn the nerve with -the actual cautery, or with aqua fortis, or with oil of vitriol. If -this be repeated several times, the tooth gradually falls to pieces. - -After having enumerated all these remedies, the author speaks of the -extraction of the teeth, and of all the precautions with which this -must be carried out in order to avoid the various accidents which may -result from the operations and may even, sometimes, become a cause of -death. - -When abundant hemorrhage follows the extraction of a tooth, this may -often be made to cease by applying a small, very compact ball of linen -into the alveolus and maintaining it there by pressure during one or -two hours. Should this not suffice, one can combine with compression -the use of astringent substances. Finally, as a last remedy, use may be -made of the red-hot iron. - -In the case of timid patients, who shrink from an instrumental -operation, recourse may be had to eradicating remedies, the -author being fully convinced of their efficacy. Indeed, one of -these—helleboraster—is said to be so powerful that, when rubbed on -the teeth, these fall out within the space of a few hours; for which -reason it is absolutely necessary, in making use of it, to cover over -the neighboring teeth with wax, so that the healthy ones may not also -fall out, as happened, says the author, in the case of a poor peasant. - -The internal use of mercury, and even the use of certain mercurial -preparations used by women as cosmetics, is of damage to the teeth and -imparts to them a blackish or dirty looking color. - -Numerous remedies exist for cleaning the teeth, but according to -Rivière the best way of cleaning them consists in rubbing them with -a small stick immersed in sulphuric acid (_spiritus sulphuris aut -vitrioli_) and afterward drying them with a piece of linen. This remedy -not only cleans and renders the teeth white, but it preserves them also -from caries! If the teeth are very dirty, the spirit of vitriol may be -used pure; otherwise one mixes it with _mel rosatum_ or with water. - -The great enthusiasm shown by Rivière for the above-mentioned remedy -does not, however, derive from a long experience, made by himself or by -others, of its advantages, but is based principally on a fact referred -to by Montanus, and which,[345] we will here recount, because, from it, -one clearly perceives how credulously our forebears accepted general -affirmations and formulated therapeutic precepts. - -Montanus recounts in one of his writings, how, being in Rome in his -early youth, he became acquainted with a woman of about twenty years -of age, known by the name of Maria Greca (by the way the author speaks -of her, one is led to suspect she was a courtesan); and how, having -seen her again, thirty years later, and found her in pretty much -the same conditions as formerly, he expressed his surprise at this; -whereupon Maria Greca told him that she herself believed that she owed -the conservation of her beauty to the habit, already of many years’ -standing, of using one or two drops of oil of vitriol every morning, as -a friction for the teeth and gums. In her youth she had had very bad -teeth, but by reason of this cure they had become, and were at the time -being, beautiful and perfectly firm; the gums also were in excellent -condition; it seemed, therefore, to her that this conservation of -health and freshness, in spite of her fifty years, depended precisely -on the daily use, in the manner described, of oil of vitriol![346] - -Rivière, besides, recommends tobacco ashes for cleaning the teeth, a -counsel not yet given by any previous author. He also gives the formulæ -for two dentifrice powders, the basis of which is alum; he calls -attention to the great importance of taking assiduous care to keep -the teeth clean, and advises that after each meal the residues of food -be removed from the interstices of the teeth and the mouth well rinsed -with wine.[347] - -NICOLAUS TULP, in Latin, Tulpius (1593 to 1674), a distinguished -physician and anatomist of Amsterdam, contradicts the then prevailing -opinion among doctors, that is, that the cure of dental affections -and the operations relating thereto were matters to be held in little -account. He observes that diseases of the teeth may give rise to the -most serious consequences, which can even be the cause of death, -and are, therefore, worthy of being taken into equally serious -consideration as all the other diseases of the several parts of the -human body. - -This author relates a clinical case tending to demonstrate how -incisions made in the gums, advised in the first place by Vesalius, -in order to facilitate the erupting of the last molar, are not always -exempt from danger. A young doctor of Amsterdam, by name Goswin Hall, -being tormented by insupportable pain caused by the difficult eruption -of a wisdom tooth, had the gum lanced above it. But the pain, instead -of diminishing, became worse; fever and delirium supervened, followed -by death! (Here, however, we must be allowed to observe that nothing -demonstrates that the real cause of death was the lancing of the gum, -or that without this the case would have had a different termination. -An event can occur after another and yet be quite independent of the -former and result from quite different causes.) - -Among the cases cited by Tulp, the following is also worthy of -mention. He relates having arrested a violent and persistent attack of -hemorrhage, which came on after the extraction of a tooth, by applying -and compressing a piece of sponge inside the alveolus.[348] - -The belief that dental caries and toothache could be caused by worms -was, at that time, still in full vigor, and it gained still greater -force by reason of observations recorded by different scientists, whose -affirmations could with difficulty be doubted, for at that period the -greater number still swore blindly _in verba magistri_. - -OLIGERUS JACOBAENS (1650 to 1701), a Danish physician and anatomist, -who taught in the University of Copenhagen, declared that in scraping -the decayed cavity of a tooth that was the cause of violent pain, he -had seen a worm come forth, which, having been put into water, moved -about in it for a long time. - -MARTIN SIX, having split some decayed teeth a short time after they had -been extracted, asserts that he determined the existence of worms in -them. (It is probable that this observer, as well as others, mistook -the dental pulp for a worm, an unpardonable error, in truth, at a time -when the anatomical constitution of the teeth had already been very -well studied by several scientists, and especially by the celebrated -Bartolomeo Eustachius.) - -GABRIEL CLAUDER (1633 to 1691) not only believed in dental worms, but -maintained besides that these were the most frequent among all the -causes of toothache. In a certain way, to sustain this opinion of his, -he relates a case in which a tooth of healthy appearance being the seat -of great pain, a tooth-drawer had asserted that there must be a worm in -its interior; and, in fact, on the tooth being extracted and afterward -split, the little animal whose existence the tooth-drawer had divined, -was found to be existing inside of it! - -PHILIP SALMUTH asserts that by using rancid oil he got a worm out of -the decayed tooth of a person suffering from violent toothache, thus -causing the cessation of the pain. The worm, he says, was an inch and a -half in length (!) and similar in form to a cheese maggot. - -NICOLAUS PECHLIN (1646 to 1706), professor of medicine at Kiel, -testifies to having seen five such dental worms, like maggots, come out -by the use of honey, though he does not say whether they issued from -several cavities or from one only! - -GOTTFRIED SCHULZ. But all this is nothing compared to what Gottfried -Schulz has dared to assert, viz., that by using the gastric juice of -the pig, worms of great size can be enticed out of decayed teeth; some -of these even reaching the dimension of an earth-worm! - -It is not much to be wondered at that these things should have been -blindly believed in, if we reflect that only a short time previous -to this the story of the golden tooth had been taken seriously by -men of great erudition, and that in the very epoch of which we are -speaking the illustrious anatomist THOMAS BARTHOLIN (1616 to 1680), of -Copenhagen, relates having seen a man, at Padua, who had an iron tooth! -Besides, the possibility of such a phenomenon was explained in a most -curious manner by THOMAS MINADOUS, who explained that in the same way -as iron is generated in the macrocosm, that is, in the world, so it is -equally admissible that it may be generated in the microcosm, that is, -in man![349] - -NATHANIEL HIGHMORE. In the year 1651 the English physician and -anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a -treatise on anatomy (_Corporis humani disquisitio anatomica_, etc.), by -which he acquired a celebrity superior, perhaps, to his merits. This -work, however, served without doubt to diffuse the knowledge of an -anatomical fact of the highest importance, especially from the point of -view of dentistry and surgery. - -There is no doubt that the existence of the maxillary sinus was already -known before Highmore, the celebrated anatomists Vesalius, Ingrassias, -Eustachius, and Fallopius having spoken of it very clearly; only -through ignorance of the history of anatomy has it been affirmed by -many that this cavity was discovered by Highmore, to whom is only -due the merit of having described the maxillary sinus, by him called -_antrum_, most accurately, and of having made known the possibility -of a communication between it and the mouth. Highmore calls attention -to the fact that the inferior wall of the antrum often presents small -projections, which correspond with the tops of the alveoli, and that -the osseous lamina which interposes between these latter and the -maxillary sinus is often extremely thin; for which reason, it may -easily happen that, in extracting one of the teeth below the cavity, -one may bring away together with the tooth the small osseous plate that -forms the bottom of the alveolus, thus leaving the maxillary sinus -open at its inferior part. With regard to this, he refers to a most -interesting case which afterward acquired a high degree of notoriety. -It relates to a lady who had suffered from toothache for some years, -and who from time to time had had several decayed teeth extracted, -without, however, finding relief. The pain only ceased after the -patient had had the left upper canine removed. But after this operation -an incessant flow of humors from the alveolus of the extracted tooth -took place. The patient, in great anxiety at this circumstance and -desirous of seeing clearly into the causes of it, herself explored -the affected part with a silver probe, the entire length of which -penetrated into the cavity, producing in the patient the effect of its -having reached the eye. Still more amazed, and urged on by the desire -of becoming still better acquainted with the extent of the evil, she -now made use of a long feather, which she had previously stripped, -and discovered to her painful surprise that this new instrument of -exploration entered to so great a distance that it, according to her -idea, penetrated into the skull. From this she derived argument for -the belief that the morbid phenomenon had its origin in her brain. -Believing herself affected with a serious malady, she consulted -Highmore, who had the satisfaction of being able to tranquillize her -completely by making her understand that the jaw bone is hollow in the -inside, and that its cavity had remained open underneath in consequence -of the extraction of the canine tooth; and also, that the feather had -not penetrated to such a distance as she supposed, but had curved -inside the bone. As to the discharge which had given so much trouble -and alarm, Highmore considered it quite a natural circumstance, derived -simply from the opening of the antrum, as he held that in many cases -the maxillary sinus contains mucus, and that this condition was, -therefore, altogether normal. So he did not propose any treatment, and -the lady thenceforth supported her infirmity with resignation. - -This most interesting case soon became generally known, and -contributed, without doubt, not a little to attract the attention of -medical men to the anatomical peculiarities which Highmore had pointed -out in the upper maxillary bone, thus causing his name to become -inseparably associated with the maxillary sinus. - -It is evident, however, that Highmore never even suspected to what -very important practical applications his description would give rise. -He knew nothing about the diseases of the antrum, and believed that, -even in perfectly normal conditions, this cavity is often filled with -liquid; the idea, therefore, of its being advisable, in certain cases, -to extract a tooth and perforate the alveolus in order to give exit to -the liquid contained in the maxillary sinus never occurred to him. - -About fifty years went by before a rational treatment for affections of -the antrum was initiated, the merit of which, as we shall see at its -time and place, was due to William Cowper. During that half century -maladies of the maxillary sinus continued to be badly diagnosticated -and badly treated. - -BERNARDO VALENTINI. In the year 1686, that is, thirty-five years after -the publication of Highmore’s book, Bernardo Valentini, professor at -the University of Giessen, described a case of tumefaction and abscess -in the cheek, treated by him with emollient remedies, and in which, -although according to him caries of the underlying bone did not exist, -the separation of a sufficiently large osseous fragment took place. -Without doubt the affection of the cheek was derived in this case from -some disease of the antrum; however, it would appear that Valentini -did not in the least perceive any such casual relation, as he makes no -allusion whatever to it.[350] - -ANTONIO MOLINETTI, professor at the University of Padua, had, -however, ten years previously, diagnosticated and cured an affection -of the antrum by means of an operation. In his book _Dissertationes -anatomico-pathologicæ_, published at Venice in 1675, Molinetti relates -that in a case of abscess of the maxillary sinus, which caused the -patient great suffering, he performed the operation of trepanning the -upper maxillary bone anteriorly, after incision of the soft parts -overlying it. In a certain way we may, therefore, consider Molinetti as -a precursor of William Cowper. - -Having spoken of the very important anatomical fact illustrated by -Highmore, we will now also speak briefly of those authors who, in -the seventeenth century, occupied themselves with the anatomy of the -teeth. Their number is sufficiently large; we will, however, only make -mention of such as contributed to the development of this branch of -science, or who, at least, expressed some opinion worthy of note. - -The celebrated anatomist ADRIAN SPIEGEL (1578 to 1625), better known by -the Latinized name of _Spigelius_, wrote nothing noteworthy about the -teeth, but he appears to have been the first to affirm that the teeth -are more firmly fixed in the alveolus, when their roots are curved -after the manner of hooks.[351] - -DIEMERBROEK, a Dutchman, relates several cases of dental anomalies, -as for example, of teeth being cut in the palate, and which injured -the tongue. The author cites his own case, relating that having -had a canine tooth extracted when well advanced in years, it was, -nevertheless, succeeded by a new one. He relates, besides, that he -had seen in Utrecht a woman, aged fifty-six years, who again cut two -incisors after having lost the former ones two years previously. Apart -from this, Diemerbroeck tells us nothing of interest or importance -regarding the teeth, often repeating old ideas, the falseness of which -had already been luminously demonstrated. For instance, he says that -the permanent teeth are developed from the roots of the deciduous ones -remaining in the alveoli; an unpardonable error for an anatomist of -the seventeenth century, for which he was afterward taken to task by -Duverney.[352] - -THOMAS BARTHOLIN, whom we have already mentioned, speaks of a tooth -which had made all the round of the alveolar border; that is to say, -of a dental arch constituted by a single piece; and the Italian -anatomist BERNARDO GENGA makes mention of an analogous case.[353] It is -superfluous to add that these authors allowed themselves to be deceived -by false appearances, owing especially to an abundant and uniform -deposit of tartar on the surface of the teeth and in their interstices, -which gave to the dental arch the appearance of one continuous piece. - -RINALDUS FREDERICUS, in his erudite dissertation entitled _De dentium -statu naturali et præternaturali_, spoke of the dental system with -sufficient thoroughness, if we consider the epoch in which he wrote. He -commences his work with a long chapter on the importance and dignity -of the teeth (_dignitas dentium_). Among other things, he relates that -formerly, in certain parts of India, the teeth were so highly valued as -to be offered in sacrifice to the gods. He says, too, on the authority -of certain authors, that the ancients were led to believe that the -teeth served for the resurrection of the body, from the circumstance of -their not showing signs of corruption when found in sarcophagi. - -Discoursing of the genesis of the teeth, Fredericus says that “every -tooth is at first enclosed within a follicle, that is, in a frail, -skin-like membrane, in the same manner as the grain in the wheat-ear.” -Taking this comparison as his point of departure,[354] he gives to -dentition the name _germination_. - -This author says that the teeth of the Ethiopians and of the Indians -are generally whiter than those of the northern peoples, but that those -of the Indians soon lose their primitive whiteness by reason of the -widely diffused habit of chewing betel-nuts. - -Fredericus refers to an experiment which, according to him, -demonstrates the “sympathetic relations” between the teeth and the ear -(whilst in reality it only proves the facility with which sounds may be -transmitted through solid bodies). “If, by night,” says he, “one holds -tightly between one’s teeth the end of a stick, stuck upright in the -ground, one hears the footsteps of a person approaching from afar much -more easily.” - -Through the researches of three great men, Marcello Malpighi, Friedrich -Ruysch, and Antoni van Leeuwenhoeck, an altogether new science arose -in the seventeenth century, viz., histology, or the anatomy of the -tissues, whose revelations contributed not a little to the development -of modern odontology. - -MARCELLO MALPIGHI (1628 to 1694), the celebrated Italian anatomist, -was the initiator of microscopic observations on the tissues, and is, -therefore, justly considered the founder of histology, within the range -of which he made most important discoveries.[355] - -FRIEDERICH RUYSCH (1638 to 1731), professor at Amsterdam, rendered -his name illustrious particularly by bringing to a high degree -of perfection the processes of anatomical preparations and of -embalming.[356] - -His magnificent injections, carried out with a method of his own -invention, enabled him to trace the most minute vascular ramifications -and to demonstrate the existence of capillary vessels in parts where -their presence had as yet never been suspected. - -Ruysch studied accurately the anatomical constitution of the teeth, and -especially their vessels. He called attention to the membrane which -lines the maxillary sinus, and discovered in it a number of bloodvessels. - -But in addition to his purely anatomical observations, this author -also merits our consideration from the point of view of pathology. He -confirmed a most important fact to which allusion had already been made -by preceding authors, that is, the atrophy of the alveolar parietes as -following on the extraction or on the falling out of teeth. Ruysch, -however, makes the observation that atrophy of the alveolar parietes -may also precede the falling out of the teeth, and rather be the cause -than an effect of it. In such cases the teeth, before falling out, -always become more and more loosened, proportionately to the atrophic -process. This pathological condition, against which none of the -astringent remedies habitually used are of avail, is mostly considered, -says Ruysch, to be owing to scurvy; but, he adds, the accumulation -of tartar may also be the cause of it. Substantially, Ruysch affirms -the relation existing between the accumulations of tartar and the -production of that very frequent disease that was afterward named -expulsive periodontitis or alveolar pyorrhea. - -This author also relates two cases of polypous affection of the -maxillary sinus. In one of these cases, the existence of a polypus in -the maxillary sinus was determined by Ruysch while dissecting a corpse. -The other case relates to a female patient upon whom two surgeons had -performed the extraction of several molar teeth and the extirpation of -an epulis believed by them to be of a malignant character. After the -operation they cauterized the diseased part to a great depth with a -red-hot iron, reaching as far as the maxillary sinus, which remained -open, and from which Ruysch afterward extracted with his little finger -several polypi.[357] - -ANTONI VAN LEEUWENHOEK (1632 to 1723), like the preceding author, a -Dutchman, was the first maker of powerful microscopes, by means of -which he made many important discoveries; among others, that of the -tubular structure of the dentine or tooth bone. This discovery he made -known and demonstrated in the year 1678, before the Royal Society in -London. In his description of the structure of the teeth, Leeuwenhoek -says that 600 to 700 of the dentinal tubuli have hardly the consistence -of one hair of a beard.[358] - -In the year 1683 he discovered in the tartar scraped from between -the teeth a form of microörganism upon which he laid special stress. -This observation he embodied in the form of a contribution which was -presented to the Royal Society of London on September 14, 1683. This -paper is of particular importance, not only because of the careful, -objective nature of the description given of the bodies seen by him, -but also for the illustrations which accompany it. From a perusal of -the text and an inspection of the plates, there remains little room for -doubt that the bodies described by Leeuwenhoek were not animalcules, as -he believed, but bacteria.[359] - -DOMENICO GAGLIARDI, professor of anatomy and of medicine at Rome, -published an excellent work on the anatomy of the bones,[360] in which -he occupies himself not only with the structure of bones, properly -so called, but also with that of the teeth. He considers the enamel -to be formed by parallel and contiguous fibers, coated, so to speak, -by a concreted juice, _sui generis_, which acquires a much greater -consistence than that of the bones. Gagliardi says that by rubbing -teeth hard together, or striking them with a steel, he was able to -extract sparks from them.[361] - -JEAN DUVERNEY (1648 to 1730), a celebrated French anatomist, wrote -a good monograph[362] about the teeth. As different anatomists of -the sixteenth century had already done, he examined many fetal jaws -in order to study in them the formation of the teeth. In relating -his observations, he says that he found in every alveolus a mass of -soft viscous matter, having the form of the tooth that is to derive -from it, and which may be considered as its nucleus. This nucleus -is entirely surrounded by a membrane, which the author likens to -that which surrounds the fetus, and to which he gives the name of -_choroid membrane_. From the surface of the nucleus a gelatinous juice -transpires, which, thickening in layers, forms the enamel and the rest -of the tooth. The choroid membrane is abundantly furnished with nerves, -and with blood and lymph vessels. Into the interior of the teeth -penetrate vascular and nervous branches which serve to maintain its -vitality. In fetal jaws one finds, besides the germs of the deciduous -teeth, also those of the permanent ones. The “choroid membrane” does -not follow the tooth when it issues from the alveolus; it remains -instead within the latter, forming the peridental membrane. - -Duverney says that in old people the root cavity diminishes in so -considerable a manner, and the vessels are so compressed that they -almost entirely disappear. It is then that a period of decadence begins -in the tooth, it is more feebly nourished, wears away more rapidly than -hitherto, and becomes shorter. - -The author also speaks of senile atrophy of the jaws, especially of the -alveolar processes. With regard to this, he observes that if in old age -the lower jaw advances beyond the upper, this depends wholly on the -disappearance of the alveolar border, which projected more in the upper -than in the lower one. - -Duverney admits the existence of direct vascular relation between the -gums and the teeth; because in the case of diseases of the gums it is -rare not to find the teeth altered as well. - -From the point of view of the development and nutrition of the teeth, -Duverney finds much analogy between the tusks of the elephant, the -teeth, properly so called, the feathers of birds, and the hair of -mammifera.[363] - -GOTTFRIED BIDLOO, a Dutch anatomist, expresses the idea that the air -contributes, after the eruption of the teeth, to hardening them. He did -not, however, give any proof of this opinion of his.[364] - -CLOPTON HAVERS, an Englishman, wrote a book on osteology, by which he -acquired great reputation,[365] and in which he treats as well of teeth -and their structure. This author believes the enamel of the teeth to be -of the nature of stone, and the ivory of the nature of bone. The dental -roots, which, he says, are precisely of a bony nature, are covered over -with a periosteum, which is in close relation with the gums and with -the periosteum of the jaw bone. Clopton Havers held that the dental -follicle no longer furnishes any nourishment to the enamel from the -moment that this has reached its perfect formation. On the other hand, -he assures his readers that he has observed, through the microscope, -nervous threads which, departing from the bulb of the tooth, traverse -the ivory through small canals, arriving thus at the periosteum. By -this anatomical disposition the sensibility of the teeth may, according -to him, be explained.[366] - -Having made this passing allusion to the anatomy of the teeth in the -seventeenth century, we will now resume the illustration of those facts -relating to the pathological and curative part of the science. - -WALTER HARRIS, an Englishman, in a pamphlet on acute infantile -maladies,[367] recommends again, in cases of difficult dentition, the -incision of the gums, a curative practice which had already fallen into -disuse.[368] - -In the authors of that time we find registered a great number of cases -of epulis. HIOB VAN MEEKREN speaks of an enormous tumor of the gum that -developed in consequence of a traumatic action which had occasioned -the loss of a tooth. Before deciding on the extirpation of the tumor, -the author thought well to pierce it with a bistoury, to be able to -judge whether its ablation might not possibly give rise to a dangerous -hemorrhage. The wound having bled but little, he proceeded to operate; -but the tumor was so large that it was necessary to remove it in -various portions.[369] - -The same author refers to a case of a soft epulis, bleeding easily, -that developed after a badly performed dental extraction. It was to -be foreseen that the ablation of such a tumor would give rise to an -abundant hemorrhage. This was, however, staunched by simply using -astringent powders, without having recourse to the actual cautery, -which the operator had held in readiness.[370] - -DANIEL MAJOR, wishing to remove a large epulis by tying it, was -obliged, in order to keep the ligature in position, to pass the thread -through a circular incision made at the base of the tumor. He first -used a thread of silk, afterward a silver one, and tightened the -ligature every day until the epulis fell off.[371] - -JOHANN ACOLUTHUS was obliged, in order to extirpate a large epulis, -to previously split the labial commissure. After the ablation of the -principal mass of the tumor, he destroyed the remaining part of it by -application of the red-hot iron.[372] - -One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin, -Preuss, Bern, Valentini, etc. This last author even speaks of an -epidemic of epulis. However this may be, it is very probable that -epulis was much more frequent in past times than it is now, and this -probably depended partly on the incongruous modes of treating diseases -of the mouth, and partly on the slight attention paid to cleanliness of -the teeth. - -KORNELIS VAN SOOLINGEN, a celebrated Dutch physician and surgeon, -who flourished toward the end of the seventeenth century, speaks -contemptuously of dental operations, and especially of extractions. -He says that such operations ought to be left to charlatans, used to -taking out teeth with the point of the sword, and to doing many other -things of like nature! This unjust contempt was at that time widely -diffused in the medical class, it resulted, however, substantially, -from the great difficulties encountered by doctors and surgeons in -general, in performing the operation of extraction, owing to want of -practice, and also from the desire to avoid the responsibility of the -accidents to which the extraction might give rise; so true is this, -that an author of the preceding century, THEODOR ZWINGER (1538 to -1588), a celebrated Swiss doctor and professor at Basle, had declared -with great frankness that the extracting of teeth ought to be left -to barbers and charlatans, as it might easily occasion unpleasant -accidents, such as fractures of the jaw, laceration of the gums, -serious hemorrhage, and the like. - -In spite of his contempt for practical dentistry, Kornelis van -Soolingen takes the treatment of dental affections into attentive -consideration. For the stopping of carious teeth, he recommends a -mixture similar to that which Rhazes had recommended many centuries -before, that is, a cement of mastic and turpentine; because, says he, -when the stopping is made with metallic substances, it is never so -perfect as to entirely impede the penetration of moisture. - -Great credit is due to Kornelis for having first brought into usage the -instrument makers’ emery wheels for grinding down sharp edges of teeth, -thus initiating the practice of trepanning the teeth with sphere-shaped -burs.[373] - -PAUL WURFBEIN refers to a case of extensive necrosis of the lower jaw, -in which a certain Dr. Bürlin having removed the necrotic portion, -regeneration of the bone took place. - -FRIEDERICH DEKKERS (1648 to 1730) refers a similar case, in which, -although quite one-half of the lower jaw had been removed, the bone -formed again completely.[374] - -BENJAMIN MARTIN, apothecary to the Prince de Condé, was the author of -a pamphlet on the teeth,[375] in which he gave a succinct description -of these organs and spoke briefly of their diseases. He shows himself -decidedly opposed to the use of the file and to the application of -false teeth, because, according to him, both of these things may be -the cause of great harm. With regard to the file, he says that nothing -so easily tends to loosen the teeth as the use of this instrument, not -to speak of various other inconveniences, among which is the danger of -opening the interior cavity of the tooth.[376] - -MATTHIAS GOTTFRIED PURMANN (1648 to 1721), a celebrated surgeon of -Breslau, was the first to make mention of models in dental prosthesis. -As to the mode in which these models were obtained, some admit as -natural that he first took a cast, and formed the model on this; but as -Purmann does not hint in the least at such a process, the supposition -is altogether gratuitous. Indeed, his description rather excludes any -probability that the model was taken from a cast. Here is the literal -translation, as nearly as possible, of the passage in which Purmann -speaks of artificial teeth and of the mode of applying them. - -“The front teeth, or pronouncing teeth, ought, when they are wanting, -to be substituted by artificial ones, in order to avoid defects of -pronunciation, as well as to obviate deformity of the mouth, and this -is carried out in the following manner: One has other teeth made -of bone, or of ivory, according to the number, the size, and the -proportions of those wanting; for which purpose one may previously have -a model executed in wax, reproducing the particular conditions of the -teeth and jaws, in order afterward to make and exactly adjust the whole -on the pattern of it; then, when the base of these teeth is well fitted -on the jaw and small holes have been made in the artificial teeth and -also in the natural ones next to them, one applies the artificial teeth -in the existing void and fixes them as neatly as possible with a silver -wire by the help of pincers.”[377] - -It would appear that the author is here describing a prosthetic method, -which he had never practised himself; and this results from the fact -of his advising the perforation of the natural teeth for the passage -of the silver wire destined to keep the prosthetic piece in its place. -Evidently desiring to describe the mode practised by the specialists of -those days for fixing artificial teeth, he erroneously imagines that -the metal thread was passed through the holes drilled in the natural -teeth; this would have been impossible, first, because of the atrocious -pain due to the sensibility of the dentine and of the dental pulp, and -then because of the pathological consequences to which the perforation -of the teeth would have given rise. We may, therefore, surely hold that -Purmann is simply describing, and not even accurately, a prosthetic -method already in use among the specialists of that period. - -On examination of the passage cited above—which, however, is not so -clear as might be desired—it would appear that the models of which the -author speaks were most probably quite different from those in use now. -It is almost certain that the specialists of those days first made a -sketch of the prosthetic part to be constructed, using for the purpose -a piece of wax which they partly modelled with the hand and partly -carved; and after having tried on this model until it fitted perfectly -in the mouth, and was in every way satisfactory, they probably passed -it on to a craftsman to make an exact reproduction of it in bone or -ivory. - -In the year 1632 a little book was published in Naples, having for its -title, _Nuova et utilissima prattica di tutto quello ch’al diligente -Barbiero s’appartiene; composta per Cintio d’Amato_.[378] This pamphlet -was reprinted in Venice in 1669, and again in Naples in 1671. We here -make mention of it, not for any special importance which it really has -as regards the development of the dental art, but because of its being -most probably _the first book in the Italian language in which dental -matters are spoken of independently of general medicine and surgery_. - -TOMMASO ANTONIO RICCIO. The edition of 1671 was published under the -supervision of Tommaso Antonio Riccio, who was for many years a -disciple of Cintio d’Amato, and who greatly eulogizes his master and -praises his work. He expresses himself in the following bombastic -manner: “This book, the offspring of Master Cintio d’Amato, excellent -in the Barber’s Art, ought to find a place in the bosom of Eternity; -because by reason of its having been twice given to the light, it has -proved its worthiness to live forever in the memory of men, gaining -for itself, by its excellence, immortal glory before all such as are -practised in the Art.” - -The book—which consists of about one hundred and eighty pages, and -is illustrated by several admirable engravings—contains, among other -things, two pages of verses, written by various authors, viz., by -Cintio d’Amato himself, by Giovan Battista Bergazzano, also a barber, -and by others. The greater part of these verses are in praise of the -two doctors and _Martyrs in Christ, Cosmos and Damianus, special -protectors of the Art and of the author_. - -The verses of Cintio d’Amato reveal the possession of a literary and -poetic culture above the ordinary, in spite of his being only a master -barber. As to his book, it may be considered, for the time in which it -was written, as an excellent treatise on so-called minor surgery. The -author expounds, in a few chapters, the anatomical notions relating to -bleeding; speaks at great length of this operation and of everything -concerning it; refers with much detail to all pertaining to the use of -leeches, cupping, scarification, cauteries, issues, blistering, primary -treatment of the wounded, nursing of the sick, etc.; at the end of the -book there is also a long chapter on the embalming of corpses. - -As regards the treatment of the teeth and gums the author dedicates -six chapters thereto, entitled, respectively: “On the relaxation of -the gums” (Chapter XXXVII); “Preparation for strengthening the gums -and making the teeth firm” (Chapter XXXVIII); “On tartar and spots on -the teeth” (Chapter XXXIX); “Another preparation for whitening and -preserving the teeth” (Chapter XL); “Mode of burning hart’s horn, very -necessary in preparations for the teeth” (Chapter XLVII); “‘Water of -salt,’ which makes the teeth white and is also good for ulcers of the -gums” (Chapter XLIX). - -Evidently Cintio d’Amato treats of dental matters only within extremely -restricted limits. He tells us nothing with regard to the treatment of -toothache, nothing about caries, about prosthesis, and, what is still -more remarkable, he does not allude even in passing to the extraction -of teeth. Now, if in a book treating _of all that which appertains to -the diligent barber_, the most important dental subjects are passed -over in silence, this shows that, contrary to the generally diffused -opinion of today, the dental art was not at that time (at least not in -Italy) exclusively, or even in great part, in the hands of the barber. -Even at that time there must have been dental specialists, and the -proof of this may be found in d’Amato’s book itself, in the chapter -entitled “Necessity and Origin of the Barber’s Art.”[379] The author, -after having spoken of the divisions which the practice of the medical -art had undergone from the most remote times, and after having alluded -to the great number of parts into which Medicine was divided in the -time of Galen, adds: “Which may also be seen in our own times, for as -many as are the members of the human body, so many are nowadays the -various kinds of doctors and of medicines. Some are for the teeth, -some are for the ears, some for sexual maladies, others are ordinary -doctors, others cure cataracts, others ruptures and stone, some make -new ears, lips, noses, and others remedy harelips.” - -As, under the generic name of doctors, Cintio d’Amato also comprises -surgeons, it results from the above passage that in his time, that -is, in the seventeenth century, there were surgeons who dedicated -themselves specially to the treatment of the teeth; there were, in -fact, dentists; and even admitting that the greater number of these -were no better than simple tooth-pullers, this cannot be true of -them all indiscriminately. Cintio d’Amato’s book demonstrates in the -most vivid manner that even among the barber and phlebotomist class, -that is, among the practitioners of minor surgery, there were, at -that time, men of considerable culture. This ought to hold good with -still greater reason concerning surgeons, whose professional level -was certainly superior to that of barbers;[380] and as dentists -belonged to the class of surgeons (whence the denomination still in -use of “surgeon-dentist”), it is but natural to admit that besides -the ignorant tooth-puller there were even then more or less cultured -dentists well capable of treating dental diseases and performing dental -operations within the limits permitted by the knowledge of the times. - -The six chapters in which Cintio d’Amato speaks of matters referring -to the teeth do not contain anything whatever of real importance; -notwithstanding this, we will here refer to the beginning of Chapter -XXXIX, treating “Of tartar and spots on the teeth,” because it is of -some historical interest: - -[Illustration: A TOOTH-PULLER AT A PUBLIC PLACE IN HOLLAND - -_From an engraving of the Seventeenth Century._] - -“It happens in general that owing to vapors that rise from the stomach, -a certain deposit is formed on the teeth, which may be perceived by -rubbing them with a rough cloth on waking. One ought, therefore, to -rub and clean them every morning, for, if one is not aware of this, or -considers it of little account, the teeth become discolored and covered -with a thick tartar, which often causes them to decay and to fall out. -It is then necessary that the diligent barber should remove the said -tartar with the instruments destined for this purpose.” - -We have seen that the practice of the dental art was for the most -part in other hands than in the barber’s. Nevertheless, the important -operation of the removal of tartar was also carried out by him. If, -therefore, even the barbers, who were not in the least the true -representatives of the dental art of that period, carried out such an -important operation, it may logically be argued from this, in support -of what we have said before, that the sphere of action of the true -dental specialists of those times (especially of the best among them) -was not at all so limited as imagined by those who affirm that in past -times dentists properly so called did not exist, but only tooth-pullers. - -The barbers, however, having become, in a certain manner, members of -the medical class, sought to extend their sphere of action, and it is -probable that in a later period than that of Tiberio Malfi and Cintio -d’Amato they invaded the whole field of dental activity; for which -reason, when the barber’s art came down to a very low level, the dental -art must have degenerated, too, and have been represented for a certain -time only by ignorant barbers and tooth-pullers. Vicissitudes similar -to these have occurred in different epochs, not only in various parts -of Italy, but also in other countries of Europe. - -FLEURIMOND. In 1682 a little book on dental hygiene was published -in Paris by a certain Fleurimond, the title of which was: _Moyens -de conserver les dents belles et bonnes_. Portal, in his history of -anatomy and surgery, makes mention of this pamphlet, and, briefly -alluding to certain parts of it, he says: “The author proves by -observation that acids act upon the enamel of the teeth. He makes some -very just reflections upon dentition. Fleurimond speaks of a tooth -powder invented by him, but does not say how compounded.”[381] - -In fact, it seems that this pamphlet was compiled from a commercial -point of view, viz., that of making known the special tooth powder -invented by the author. The era of advertisement had already begun! - -ANTON NUCK (1650 to 1692), a Dutch surgeon and anatomist, who taught -most ably in the University of Leyden, devoted great attention to -dental surgery and prosthesis. Relative to the extraction of teeth, -he says that, in order to be able to carry out this most important -operation, an exact anatomical knowledge of the alveoli and of the -teeth themselves is required. He insists on a principle of capital -importance that has only had its full application in the nineteenth -century, viz., that the instruments to be used for the extraction of -teeth ought to vary according to the tooth to be extracted. For the -removal of the incisors, he says, the “goat’s foot” should have the -preference; the canines ought to be extracted with the common dental -forceps, but sometimes, when they are decayed, they may be extracted -with greater security with the pelican; for the small molars the -straight-branched pelican is to be preferred, for the large molars the -curved pelican; as to the extraction of roots or of splinters of bone, -this ought to be carried out with the _rostrum corvinum_. - -The author counsels never to extract teeth during pregnancy, except -under circumstances of the greatest urgency, and especially to avoid -the extracting of the upper canines (or eye teeth), this being capable -of producing pernicious effect on the visual organs of the fetus! - -The best way of obtaining the cessation of a violent toothache -without having recourse to extraction is, according to the author, -cauterization of the antitragus, an operation which he carried out -with a special cauterizing instrument, made to pass through a small -tube, the better to localize and to limit the action of the red-hot -iron. With regard to this means of cure already recommended by other -authors, we may remark that, although it seems ridiculous at first -sight, and although no one could be so senseless as to make use of it -in our days, nevertheless, for the times of which we are writing, when -the curing of toothache was in a great measure effected by indirect -means, this remedy might well stand on a level with many others, -and was not perhaps altogether inefficacious. It is a sufficiently -well-known physiological fact that the application of a strong stimulus -in one part of the body may diminish or suppress a painful sensation in -another part of the organism. It is an equally well-known fact that it -is in no way a matter of indifference, in producing this phenomenon, -to what part the stimulus be applied, especially because of the great -difference existing in the relations of the several parts of the body -with the brain—the centre of sensation. It is, therefore, very possible -that the cauterization of the antitragus may really have the effect of -causing strong toothache to cease, at least temporarily. - -Nuck used a variety of remedies to arrest dental hemorrhage, such as -tinder, burnt linen, vitriol, sulphuric acid and the cauterizing iron. - -As to the use of the file, far from rejecting it entirely, as does -Martin, he holds it necessary in many cases for planing down points and -sharp edges of broken teeth, as well as for removing, at least in a -measure, the inconvenience and deformed appearance caused by irregular -teeth. He says the file may be used without causing the slightest -harm, if one takes care not to approach the inner cavity of the tooth -too nearly, and above all not to penetrate right to it, which would -give rise to intolerable pain. Such an accident, he adds, may happen -much more easily when, instead of using the file, whole pieces of teeth -are removed with the excising forceps. - -This author acquaints us with a tooth powder, much used in his time, -especially by Parisian ladies. The ingredients were powdered cuttle -fish, coral powder, cream of tartar, Armenian bole, and powder of red -roses. - -At that time artificial teeth were generally made of ivory; Nuck, -however, observes that it soon becomes yellow by the action of food -and drink, and of the saliva itself. He therefore recommends, instead, -the use of hippopotamus’ tusks, giving the preference to the whitest. -According to Nuck, artificial teeth made of hippopotamus’ tusks would -be capable of preserving their color even for seventy years. In the -case of all the teeth of the lower jaw being wanting, the entire dental -arch ought to be framed in with a single piece of ivory or tusk of -hippopotamus.[382] - -CARLO MUSITANO, a celebrated Neapolitan doctor (1635 to 1714). -According to Carlo Musitano, the real cause of toothache consists in -the irritant action of saline or acid particles on the extremely thin -membrane that lines the alveoli or on the exquisitely sensitive nerves -of the teeth. As he believes, these particles have an angular form, -sometimes pointed or even hooked, and they reach the sensitive parts -either directly from the outside, through the air, the food or drink -(especially when the teeth are already decayed), or else through the -blood and other humors, which often, by reason of their deteriorated -quality, contain great quantities of such irritant particles. - -Among the various influences which may be conducive to toothache, -atmospheric conditions ought also to be included; thus, says the -author, the inhabitants of the Baltic littorals, and other northern -peoples, are very subject to toothache, for the reason that in those -regions the air contains, in abundance, saline particles of various -kinds which penetrate into the organism by the act of respiration. It -is said, on the contrary, that in Egypt, where the air is remarkably -mild, the teeth are not subject either to pain or to decay. - -Musitano, too, believes in worms in the teeth, but does not admit, as -preceding authors had done, that they generate spontaneously. He holds -instead that they result from the eggs of flies and other insects, -which, together with food, are introduced into the carious cavities and -there develop by the heat of the mouth. - -The treatment of toothache ought to differ according to its causes. If -the pain be owing to acidity, one uses medicines adapted for tempering -the acids; if it be owing to the action of saline substances, one has -recourse to remedies which dissolve them; if to worms, to such remedies -as destroy them, and so on. Purgatives and bleeding ought, however, -never to be used as remedies against toothache; for, far from doing -good, they often do harm. As to the other torments usually inflicted on -poor sufferers, they are the punishment of their sins, for God often -gives the unrighteous into the hands of doctors! (This language will -perhaps appear less strange when the reader comes to know that Carlo -Musitano was at one and the same time priest and physician!) - -After a lengthy enumeration of medicaments to be used against -toothache, which we pass over in silence because already known, the -author speaks of two remedies which carry us back absolutely to the -days of Pliny! He relates us a fact experienced by himself, that, by -touching an aching tooth with the leg of a frog completely cleaned of -the flesh, the pain ceases altogether. Also, if the aching tooth be -touched with the root of a tooth extracted from the jaw of a corpse, -the pain ceases, the tooth becomes as cold as ice, and often, after a -certain time, it falls to pieces. - -As to worms, the best mode of destroying them is by using bitter -substances, such as myrrh, aloes, colocynth, _centaurea minor_, etc., -but sometimes the use of sweet substances, such as honey, is a good -means of drawing them out of the carious cavities! - -Musitano also cites a great number of remedies against the setting on -edge of the teeth. Among the best of these he mentions urine applied to -the teeth whilst still warm! Alkali in general, and particularly lye, -such as is used for washing purposes, are good remedies against the -setting on edge of the teeth. - -The treatment of loose teeth ought to vary according to whether this -pathological condition depends on old age, or on scurvy, on syphilis, -on superabundance of humors, etc. Sometimes, especially in old persons, -it may be useful to bind the teeth with gold wire, in order to prevent -their falling out, but this operation must be very ably performed, -otherwise it may give rise to inflammation. - -Relative to artificial teeth, Musitano says that they are made of ivory -or hippopotamus tusks; of these last he does not speak as of a novelty; -we may, therefore, deem it probable that hippopotamus tusks were used -in Naples for making artificial teeth even before the Dutchman Anton -Nuck (contemporary of Musitano) made mention of them in his writings. - -In cases of difficult dentition, the best remedy, according to -Musitano, for facilitating the eruption of the teeth consists in -friction of the gums, once, or at most twice, with blood drawn fresh -from the comb of a cock! If, however, even this remedy fails to -produce the desired effect, it will then be necessary to lance the gum -at the point where the tooth is to erupt, or to press it hard with the -thumb, that the tooth may the easier come through. - -The sole merit of this author (as to what concerns our specialty) -consists in his having declared bleeding useless, or even harmful in -the treatment of toothache, and, besides, in his having recommended, -with great warmth and in most impressive terms, cleanliness of the -teeth. What is more beautiful, says he, than a mouth furnished with -white teeth, similar to so many pearls? And what is more abominable -than black or livid teeth, covered with a fetid deposit or with tartar? -Unclean teeth spoil the appearance of the person, and nauseate those -who behold them.[383] - -WILLIAM COWPER (1666 to 1709). Toward the end of the seventeenth -century the celebrated English doctor and anatomist, William Cowper, -opened up a new field of action to oral surgery by inaugurating the -rational treatment of the diseases of the maxillary sinus. In order to -empty Highmore’s antrum of deposits and to be able to carry out the -necessary irrigations, he extracted in most cases the first permanent -molar, and then penetrated through its alveolus into the sinus with a -pointed instrument. - -JAMES DRAKE, also an Englishman and a contemporary of Cowper, operated -in the same manner; and it was this author who made known in a book -of his[384] the operative method of Cowper; for which reason the -above-mentioned proceeding is sometimes called “the Cowper-Drake -operation.” A certain time elapsed, however, before it became generally -known. Thus, in a book published by JOHANN HOFFMANN in 1713 there is no -mention made of this operation, albeit the author refers therein[385] -to the case of a young girl, one of whose canine teeth having been -extracted by him, there ensued a considerable flow of whitish pus from -the maxillary sinus. In speaking of this case, Hoffmann stigmatizes -many of the surgeons of his time who were not acquainted with the -existence of Highmore’s antrum, and therefore, in cases of patients -whose teeth had fallen out as an effect of syphilis, if they happened -to penetrate with the sound into the maxillary sinus, believed this to -be an accidental excavation of the bone, produced by caries. - -However, the honor of having initiated the rational treatment of -diseases of the maxillary sinus is not exclusively due to William -Cowper and to James Drake; a large share is also due to the celebrated -German physician and anatomist, Heinrich Meibom. The mucous membrane -of the maxillary sinus was considered by him as the real point of -departure of the diseases which occur in this cavity, it being liable -to become inflamed and to suppurate, thus giving rise to much pain and -to various accidents. Meibom rejects the operation of Molinetti, that -is, the trepanning of the cavity from the front, the lesion produced -in the soft parts of the face being likely to give rise to unpleasant -consequences. “Some, he adds, try the introduction of medicated vapors -into the antrum,[386] but the best way is to _open the maxillary sinus -by extracting a tooth, as the pus generally makes its way as far as -the roots of the teeth_.”[387] The author says that his father, who -was also a physician, had already used the above method with success. -He does not speak at all of the artificial opening of the antrum by -perforation; but, as is well known, this is not necessary in many -cases, so that, even now, the operation is sometimes reduced to -procuring the opening of the sinus by the simple extraction of a tooth, -as was, in fact, practised by Heinrich Meibom and his father. - -Seeing that Heinrich Meibom was born twenty-eight years before William -Cowper, and was already known to the scientific world when Cowper was -still a child, it is very probable that his operative method, having -come to the knowledge of the latter, was only followed up and perfected -by him. - -CHARLES ST. YVES (1667 to 1733), oculist in Paris, records an -interesting case of a secondary affection of the maxillary sinus. -The point of departure of the evil was an abscess in the orbit. -The suppurative process, after having produced an erosion and the -perforation of the orbital plane, had reached by propagation the antrum -of Highmore, whence the pus took its way, issuing through the nose. -St. Yves had a molar tooth extracted on the affected side (we do not -know which side it was), after which, day by day, he made injections -of detersive liquids through the orbital fistula, which returned -constantly through the alveolus of the extracted tooth. By this means -the cure of the patient was obtained.[388] - -CHRISTOPHER SCHELHAMMER (1649 to 1716), who was professor in various -German universities, and distinguished himself specially as an -anatomist and as an ear doctor, strongly recommends stopping decayed -teeth as the best means of causing pain to cease. If, however, the -stopping does not hold, by reason of the cavity being too extended, -it is then necessary, says Schelhammer, to extract the tooth; this, -however, may very well be stopped after extraction, and then -replanted, for it will take root again, but no longer be the cause of -any pain.[389] - -PIERRE DIONIS, a celebrated surgeon and anatomist of Paris (died 1718), -in his _Anatomie de l’homme_,[390] admits the possibility of a double -dental series, holding the case, however, to be of very rare occurrence. - -Another work of his, entitled _Cours d’operations de Chirurgie_, -wherein he treats very extensively of diseases of the teeth and mouth, -and their surgical cure, is of much more importance in relation -to dentistry. He recognizes the high importance of this part of -surgery, but expresses the opinion that one of the dental operations, -that is the extraction of teeth, ought to be left entirely to the -tooth-pullers, not only because they are, by reason of great practice, -better qualified to perform it than general surgeons, but also because -the output of force required for this tooth-pulling operation renders -the hand heavy and tremulous, and, lastly, because, according to him, -it always has something of charlatanism about it. (This is a luminous -example of how preconceived ideas can influence the minds even of men -of the greatest talent.) - -Pierre Dionis, like many of the preceding authors, had frequently -occasion to observe cases of epulis. He speaks at great length of the -treatment of this affection, as well as of parulis, but says nothing on -the subject of sufficient importance to be worth recording. - -Dental operations, according to Dionis, are of seven kinds: - -1. _The opening of the dental arches in the case of spasmodic -constriction of the jaws._ This operation, of the greatest importance -for nourishing and keeping patients alive, is carried out by means of a -lever and of a screw dilator. - -2. _The cleaning of the teeth._ For this, as for the other operations, -says Dionis, a certain amount of skill is required. The author advises -the use of gold instruments if one be called upon to clean the teeth of -persons of rank. This appears rather strange in the present levelling -times, but Pierre Dionis lived in the days of Louis XIV, whose doctor -he was, that is, in a period of unbridled luxury, when the nobles and -those in power would have nothing in common with the lower classes. - -3. _Operations for the preservation of the teeth._ These, says Dionis, -are of the greatest importance, it being necessary to oppose a barrier -to the destructive processes of the teeth. Caries, when so situated -as to permit of it, ought to be scraped away; for approximal caries -one ought to have recourse to the file; in the case of caries of the -triturating surfaces, cauterization should be used, by applying a drop -of oil of vitriol with a miniature paint brush. Should the caries, -however, be in a very advanced stage, it is better to make use of the -cauterizing iron. But in cases of intense and persistent pain there is -no other remedy than extraction. - -4. _Stopping of the carious cavity._ Dionis does not enumerate this -operation among those intended for the preservation of the teeth. -At that period, this operation was performed solely with a view to -preventing the penetration into and the retention within the carious -cavity of alimentary substances, and the disadvantages caused thereby. -The carious process, says the author, often ceases altogether, and -the pain then generally ceases also. However, as the residual cavity -often becomes troublesome in various ways, among others by making the -breath offensive, it is better to stop it. For this purpose, gold or -silver leaf is generally made use of; but this mode of stopping is not -durable, because gold or silver in leaf is apt to become loosened and -fall out. It is therefore preferable, says Dionis, to make a stopping -with a piece of gold or silver corresponding in size and shape to the -cavity.[391] Many, he adds, prefer lead as a stopping, on account of -its softness, whilst others simply use wax. - -5. _The use of the file._ The indications given by Pierre Dionis for -using the file do not differ from those we find in other authors. -Dionis warns, however, against using the file to level down a tooth -which has become lengthened through the loss of its antagonist, for -after a certain time it would again project above the level of the -others. - -6. _Extraction._ This operation, says Dionis, ought not to be performed -too lightly, but only in those cases in which it is really necessary; -that is, when a tooth is the cause of insupportable pain and its crown -is almost entirely worn away; when nothing remains of a tooth but its -root; when a tooth is so loosened in its socket as to leave no hope -of its again becoming firm; when supernumerary teeth or irregularly -planted teeth give rise to inconvenience or deformity; and lastly, to -remove deciduous teeth that have become loosened. The opinion that -if the loosened milk teeth be not promptly extracted they cause the -permanent teeth to grow irregularly, is, however, considered by Dionis -to be a prejudice. - -Dionis strongly doubts whether a tooth that has been extracted -and replanted can really take root again, as had been affirmed by -Dupont, Pomaret, and other authors. This shows that Dionis had had no -experience on this point. - -7. _The application of artificial teeth._ These teeth, says Dionis, -are generally made of ivory, but may also be made of ox bone, which -is less liable to turn yellow than ivory. He does not mention the -use of hippopotamus tusks, but we learn from him that one Guillemeau -made artificial teeth with a composition of his own invention, which -was obtained by fusing together white wax and a small quantity of -gum elemi, and then adding ground mastic, powder of white coral and -of pearls. This fact is, as everyone can see, most important, for it -constitutes the first step toward the manufacture and use of mineral -teeth. Dionis tells us that the teeth made of Guillemeau’s composition -never became yellow, and that it was also very good for stopping -decayed teeth.[392] It would seem, therefore, that it could be used as -cement is now used. - -The Guillemeau of whom Dionis speaks is probably Jacques Guillemeau, -the author of a book now no longer to be found, which was translated -from the French, first into Dutch, and afterward into German. Crowley, -in his _Dental Bibliography_, only quotes the German edition, published -at Dresden in 1710, the title of which runs thus: _Der aufrichtige -Augen und Zahnarzt_.[393] - -JEAN VERDUC, also a Frenchman, relates a case of the surgeon -Carmeline,[394] analogous to that of Denis Pomaret, in which a sound -tooth which had been extracted by mistake was immediately replanted and -took root again, becoming quite firm. However, Verduc does not speak -of replantation as a special method of cure, but merely refers to the -above case incidentally in speaking of the extraction of teeth. He -considers this operation a most dangerous one, and advises not having -recourse to it except in cases of utmost necessity. Notwithstanding -this, Verduc gives us to understand that teeth were drawn with -sufficient ability by most of the operators of the time, and precisely -because of this he omits describing the manner of performing the -operation. According to Verduc, the drawing of teeth is often of little -or no advantage against toothache.[395] In proof of this assertion he -relates the case of a hypochondriac, who little by little had as many -as eighteen teeth extracted, without, however, getting the better or -the wiser; but as this case does not prove anything at all, one is -disposed to think that Verduc, in relating it, had the intention of -being humorous. - -MONSIEUR DE LAVAUGUYON. To another French surgeon, Monsieur de -Lavauguyon, also a contemporary of Dionis, belongs the merit of having -declared useless, in the greater number of cases, the practice, at that -time general, of separating the gums from the tooth before proceeding -to the extraction of the latter. He says that this is only necessary -when a tooth, either because broken or because its crown emerges too -little above the gum, offers an insufficient hold for the pelican.[396] - -Our historical survey has now reached the end of the seventeenth -century. Embracing at a glance the whole of this last period of -time, we remark, among many facts of minor importance, some events -which, in the history of the development of dental art, stand out in -strong relief. Such are the replantation of teeth used as a special -curative method by Dupont and others; the method of plugging in cases -of alveolar hemorrhage, the credit of which is due to Rivière and to -Tulpius; the description of the maxillary sinus given by Highmore; the -rational treatment of affections of the antrum, inaugurated by Meibom, -Cowper, and Drake; the researches into the microscopic structure of -the teeth, brilliantly initiated by Leeuwenhoek, who discovered the -dentinal tubuli; the use of models introduced by Purmann into the -workmanship of prosthetic pieces; the employment of hippopotamus’ -tusks in making artificial teeth, first recommended by Nuck; and the -invention of Guillemeau, which was the first step toward the use of -mineral teeth. - -[Illustration: Lorenz Heister.] - - - - -CHAPTER XII. - -THE EIGHTEENTH CENTURY. - - -Although there have been, even from the most remote times, individuals -who have dedicated themselves exclusively to the cure of dental -maladies, or to repairing the losses of the dental system by artificial -means, and notwithstanding the progress gradually accomplished in this -branch of the medical art, which progress was especially remarkable -during the sixteenth and seventeenth centuries, it is not to be denied -that, up to the beginning of the eighteenth century, dentistry was, in -great part, considered one with medicine and surgery in general. It is -but natural that dental art (and the same may be said of every special -branch of medicine) could not assume a real individuality until it had -attained to the higher grades of its development. As a matter of fact, -dentistry, toward the end of the seventeenth century, was already a -true specialty, although it counted but few worthy representatives -at that time. The definite separation between the science and art of -dentistry and general medicine and surgery, although it may have been -retarded, could not fail to take place; and this, as we shall presently -see, was effected by the celebrated French dentist Pierre Fauchard. - -But, to remain faithful to chronological order, we will first speak -briefly of some other writers. - -LUDWIG CRON, a barber of Leipsic, in a pamphlet published in 1717, -with the title _The barber’s apprentice versed in bleeding and tooth -pulling_,[397] declares, in a still more emphatic and general way than -De Lavauguyon, that it is useless to detach the gum before proceeding -to extract a tooth. This barber, strong in his own experience, dares -to assert absolutely useless this ancient practice, advised first by -Cornelius Celsus, and recommended after him, and in homage to his -authority, by many other writers. It is, therefore, possible that -even previous to Cron and De Lavauguyon many operators had dispensed -with the practice recommended by Celsus, although this had become an -accepted canon of the high medical profession. - -LORENZ HEISTER (1683 to 1758), of Frankfort-am-Main, one of the most -celebrated surgeons of the eighteenth century, wrote a dissertation on -toothache,[398] treating besides very extensively of dental affections -and their cure in a masterly work on surgery, published for the first -time in 1718, and which went through numerous editions in various -languages. - -When the caries of a tooth is superficial, Heister advises the removal -of the decayed part with the file; or, when the caries is deep down, -the cavity ought first to be well cleaned with a toothpick or other -like instrument, then filled with heated white wax, or mastic, the -stopping being renewed as often as may be necessary. When a molar tooth -is decayed, especially in the centre, the best way, says Heister, is to -fill it with gold or lead leaf, or with a piece of the latter fitting -into the cavity. If the carious cavity of a painful molar cannot be -cleaned as it ought to be, the dropping of a little oil of cloves or -of cinnamon or of guaiacum into it will be found useful, or even a -few drops of spirit of vitriol; for in this manner one obtains at the -same time the double advantage of destroying the impurities contained -in the carious cavity and of soothing the pain. But if by chance the -pain should persist, recourse must be had to the cauterizing iron, or -to extraction. Sometimes, however, even the most violent toothache -can be made to cease, either by scarifying the gums (a method already -recommended by Pliny), by cauterizing the antitragus, or by pressing -the aching tooth hard between the fingers, as Schelhammer[399] and some -other writers had advised. - -Heister writes at length on the extraction of teeth, on the indications -and counterindications appertaining thereto, on the instruments with -which the operation should be carried out, and so on. Regarding the -position of the patients, he thinks it best to place them on a low -seat or on the ground, if the tooth to be extracted is situated in the -lower jaw, but if an upper tooth is to be extracted, patients should be -placed on a chair or on a bed. - -Movable prosthetic pieces are mentioned for the first time by this -author. Although he is very concise in his manner of speaking of -artificial teeth (this indicating that dental prosthesis was considered -outside the sphere of action of the general surgeon), we nevertheless -learn from him that partial sets of teeth made of ivory or hippopotamus -tusks, and without special appliances for fixing them, were then in -use, which, when applied in the void between the neighboring teeth, -were maintained in position simply by their form. The author advises -keeping prosthetic pieces very clean, removing them every evening -before going to bed, and not putting them back in the mouth until they -have been well cleaned. - -Heister also speaks of nasal prosthesis; this was then carried out by -applying noses made of wood or of silver, properly painted. In cases -of trismus, this author altogether rejects the forcible opening of -the jaws by means of screw dilators and such like instruments, as they -act too violently, and, according to him, only aggravate the morbid -condition. Even the extraction of a tooth is useless in such cases, as -the patient can always absorb a certain quantity of liquid food through -the closed teeth. On the other hand, the author expresses himself in -favor of the incision of the gums in cases of difficult dentition. -According to him, convulsions and the other nervous symptoms which -children are subject to during the period of dentition depend wholly -on the hardness and strained condition of the gum. It is, therefore, -natural that the symptoms should disappear when an incision of the -gums, reaching to the tooth that is coming through, has caused the -tension to cease. - -The author speaks very particularly of the treatment of epulis and -parulis; but his views on this subject contain nothing of great -importance. - -RENÉ JACQUES CROISSANT DE GARENGEOT (1688 to 1759), the celebrated -French surgeon, speaks very little of dental surgery in his works. He -declares himself averse to the carrying out of too many operations on -the teeth, and especially disapproves the use of the file, because, -according to him, it ruins the enamel.[400] For a long time, especially -in France, Garengeot was believed to have been the inventor of the -key known by his name; but he merely perfected this instrument. In -fact, through a later author, Lecluse, it clearly results that the -key existed before Garengeot. “For extracting,” writes Lecluse, “one -may make use of the pelican that Garengeot has constructed on the -English key.” In a note, he afterward adds, “that the English key is -an instrument used by dentists in England.” However, it is not in the -least certain that the key is really an instrument of English origin. - -Loder, who wrote at the end of the eighteenth century, informs us that -the so-called English key was called the German key in England; it is, -therefore, not improbable, that this instrument, as some maintain, had -its origin in Germany.[401] - -JOHANN JUNKER (1679 to 1759), professor of medicine at the University -of Halle, wrote on dental maladies, not only in a treatise on surgery, -published in 1721, but also in three dissertations which were published -some time later, and were entitled respectively: _De affectibus -dentium_ (1740), _De dentitione difficili_ (1745), _De odontalgia_ -(1746). The author, however, for the most part, only repeats things -already known; his writings have, therefore, little or no importance -for us. He counsels the Cowper-Drake operation in treating the -affections of Highmore’s antrum; in carrying out the operation, -however, he thinks the extraction of the second molar to be preferable -to that of the first. To prevent the formation of tartar on the teeth, -he advises assiduous care in keeping the mouth clean, and recommends, -among other things, rubbing the teeth with sage. He disapproves having -recourse too readily to metal instruments to remove tartar from the -teeth, because, according to him, it favors the production of dental -caries. He holds it dangerous to extract the upper or lower canines -when they are not loose, as, by reason of the depth of their roots an -injury to the surrounding nerves may be the result, which not only -might cause great pain, but in the case of the upper canines might lead -to inflammation of the eye, and even of the dura mater! - -When the caries is incipient, Junker advises rubbing the teeth several -times a day for some time with common salt, in order that this should -penetrate into their structure.[402] - -GUILLAUME MAQUEST DE LA MOTTE (1655 to 1737), a distinguished French -surgeon and the writer of an excellent treatise (_Traité complet de -chirurgie_, Paris, 1722), repeats the advice already given by preceding -authors, to which he annexes the highest importance, that is, the -opening in time of abscesses of the gums and of the palate even before -they be completely matured, in order to prevent the suppurative process -from extending and damaging the bone below. This author relates having -several times arrested serious hemorrhage following on the extraction -of teeth, by applying a little vitriol inside the alveolus, and, on -this, graduated compresses, which the patient pressed on the part with -the teeth of the opposite jaw.[403] - -JOHANN ADOLPH GÖRITZ, of Regensburg, in one of his writings published -in 1725, disapproves the too frequent recurrence to extraction of the -teeth, that is, carrying out the operation when it is not absolutely -necessary. He is also averse to the application of artificial teeth. -In support of his opinion he relates a case in which, a certain time -after the application of an artificial tooth, the natural ones to which -it had been fixed became loose, so that it was necessary to proceed -to the fixing of all three, that is, the artificial tooth and the two -neighboring ones, to the firm teeth beyond them; these, however, became -loosened in their turn, and it was at last necessary to extract six -teeth. The great space thus created was filled with a prosthetic piece -made of hippopotamus tusk; but the author did not believe much good -would come of this either. In fact, he is of opinion that the natural -teeth should be preserved by every possible means, and that, on the -other hand, even in the case of a few being lost, it is better not to -resort to substitutes. In the worst case, should the dental void cause -too great inconvenience by damaging the pronunciation, or for some -other reason, it may be filled by an “imitation” in soft wood.[404] - -[Illustration: Pierre Fauchard.] - -If one takes into consideration the by no means slight inconvenience -to which fixed artificial teeth gave rise, one cannot but admit -the aversion to them, expressed by Göritz and others, to have been -justified. - -ERNST FERDINAND GEBAUER, in 1726, made known a case in which, a tooth -having been badly extracted by an incapable surgeon, the upper jaw was -so seriously injured that a diffusive carious process ensued, which -after many years’ suffering brought the patient to the grave.[405] - -JOHANN BERNHARDT FISCHER (1685 to 1772), a very famous doctor, born -in Lübeck, who had the honor of becoming archiater of the Russian -Empire, related, in 1726, a case of replantation, similar to those by -Pomaret and Carmeline; but HEINRICH BASS (1690 to 1754), of Bremen, -professor of anatomy and surgery in Halle, endeavored to demonstrate -that in these cases the tooth did not really take root, but was rather -maintained in position by the contracting of the surrounding gum. One -perceives from this that there were still, at that time, discordant -opinions on the subject of replantation, and that this operation was -far from occupying, in dental surgery, the accredited position it has -acquired today. - -Heinrich Bass also combats the abuse of extracting teeth -inconsiderately, without absolute necessity, and expresses the opinion -that this is especially blamable in the case of teeth of the upper -jaw, principally because the extraction of either the canine or of the -first or second large upper molars might easily produce the opening -of Highmore’s antrum, and thus give rise to regrettable accidents. He -is not, however, averse, like Göritz, to the use of artificial teeth; -indeed, he advises the application of whole dental sets, even in the -upper jaw, so long as there be two natural teeth existing to fix the -prosthetic piece to.[406] - -PIERRE FAUCHARD, the founder of modern scientific dentistry, was born -in Brittany about the year 1690, and died at Paris in the year 1761. -His celebrated work, _Le Chirurgien Dentiste_, was already written in -the year 1723, but not published until 1728. It marks a new epoch in -the history of dental art. The most renowned physicians, surgeons, and -anatomists of the time testified their admiration for Fauchard’s work, -which was translated into German in 1733, and afterward went through -two French editions in the years 1746 and 1786.[407] We have been able -to obtain the second edition[408] of this most important treatise, and -of this we now intend making use for accurately analyzing the work, as -it is probably more complete than the first, whilst the third, having -been published after the author’s death, is probably merely a reprint. - -The work consists of two volumes in duodecimo, in all 863 pages. In -the beginning there is the portrait of the author and a long and -interesting preface. The portrait, which we here reproduce, has also -its historical importance, and this for two reasons, the first of -which being that in it Fauchard is revealed to us as a person of very -distinguished appearance, and this gives us an idea of the social -condition of the surgeon-dentists of his time; the second, because -there are annexed to the portrait the following Latin verses, by a -certain Moraine, in which, whilst eulogizing the writings of the author -and his ability in the treatment of the teeth, and in restoring force -and beauty to them, he counsels him “to despise the tooth of envy,” as -it will certainly break against his merit. - - Dum dextra et scriptis solamina dentibus affers - Illorum in tuto sunt decor atque salus. - Invidiæ spernas igitur, Faucharde, cruentos - Dentes; nam virtus frangere novit eos. - -That Fauchard, in common with all men of rare merit, had to combat all -his life against envy, we are able to perceive from what we read at -the end of the second volume of his work. The author here says that -“the rumor having been falsely set about that he has abandoned the -profession; which rumor cannot have been invented otherwise than by -those individuals who, sacrificing honor to interest, would attract to -themselves the persons who honor the author with their confidence; he -therefore finds it necessary to give warning that he still continues -the practice of his art in Paris, in the _Rue de la Comédie Française_, -together with his brother-in-law and sole student, M. Duchemin.” - -More than a century and a half has passed by since Fauchard was -obliged to defend himself against lies invented and set about to his -damage by envious colleagues, but even at the present day, when, -given the high grade that civilization has reached, and professional -competition ought not to make use of other weapons than intelligence, -study, and application, some do not hesitate to have recourse to means -equally disloyal, ignoble, and shameless as those practised by some -contemptible dentists of the middle of the eighteenth century. - -[Illustration: A CHARLATAN ON HIS PUBLIC STAGE] - -The preface of Fauchard’s book is especially important for the notices -therein contained regarding the author, as well as the conditions of -dental art at that period. And first of all, we find in it the proof of -what we have already said elsewhere, namely, that even before Fauchard, -there were not only tooth-pullers but also dentists properly so -called. Indeed, Fauchard makes mention also of the examination that -aspirant dentists had to undergo as far back as the year 1700. It may -interest our readers if we here give in detail some extracts in which -the author speaks on these subjects: - -“Although surgery in general,” says Fauchard, “has been greatly -perfected in these latter times; although important discoveries have -been made in anatomy and in the modes of operating, and many learned -and interesting observations have been published, nevertheless, -dentists nowhere find in works on surgery sufficient aids to guide -them in all their operations.” These last words should be sufficient -alone to prove that the dentists spoken of by Fauchard were not mere -tooth-pullers. - -“The authors who have written on anatomy, on surgical diseases and -operations, have only treated very superficially the part relating -to maladies of the mouth and teeth. If some writers have spoken in -particular about the teeth and their diseases, as, for instance, Urbain -Hemard and B. Martin, they have not done so in a sufficiently ample -manner. - -“Besides, there does not exist any public or private course of surgery -in which the theory of dental maladies is amply taught and in which one -can receive fundamental instruction in this art, so necessary for the -healing of these maladies and of those of the neighboring parts. - -“This branch of the art having been but little cultivated, if not -wholly abandoned by the most celebrated surgeons, their negligence has -caused it to fall into the hands of persons without theory and without -experience, who practise it in a haphazard fashion, guided neither by -principles nor method. In Paris, it is only since 1700 that people’s -eyes have become opened to this abuse. - -“In this town, those who intend to become dentists are now obliged to -undergo an examination, but although the examiners be most learned -and well versed in all the other parts of surgery, I think, if I may -be allowed to express my opinion, that as they do not ordinarily -themselves practise dental surgery, it would not be amiss on these -occasions to admit an able and experienced dentist, who might sound -the aspirant as to the difficulties which have come before him in the -course of the long practice of his art, and who could communicate to -them the means of surmounting them. In this way one would not have -to acknowledge that the attainment of the greater part of dental -experts[409] is below mediocrity. - -“To supply this want of instruction it would have been of great use -if some able dentist, for example the late _Monsieur Carmeline_, who, -in his day, practised with general applause, had made us acquainted -with his mode of operating and with the knowledge acquired through the -successful treatment of a great number of important cases. - -“What this celebrated surgeon-dentist has not done, I today dare to -undertake. I shall at least afford an example of what he might have -done with greater erudition and better success. - -“From my youth I was destined to the surgical profession; the other -arts I have practised[410] have never made me lose sight of it. I was -the disciple of Alexandre Poteleret, surgeon-in-chief to His Majesty’s -ships, who had great experience in diseases of the mouth. To him I owe -the first rudiments of the knowledge I have acquired in the surgical -speciality I practise, and the progress I made under this able man gave -me the emulation that has led me to further important discoveries. I -have collected among different writers what seemed to me most reliable. -I have frequently discussed these matters with the ablest surgeons and -doctors of my acquaintance, and have neglected nothing in order to -profit by their counsels and by their ideas. - -“The experience which I have acquired during an uninterrupted practice -of more than forty years has led me insensibly to the acquirement -of further knowledge and to the modification of what seemed to me -defective in my earlier ideas. I offer to the public the results of my -labors and of my studies, hoping that they may be of some use to those -who wish to exercise the profession of surgeon-dentist.” - -The reason why dentists before the time of Fauchard published hardly -anything concerning their art, was perhaps out of a sentiment of -jealousy, which rendered them (that is, the best of the profession and -therefore the ones most capable of writing) but little disposed to make -known to others the results of their studies and of their experience, -lest the fruits of their long labors should be utilized by others -and they themselves be materially damaged by competition. That this -sentiment of jealous egotism really existed in many dentists may be, in -a certain manner, deduced from a few words of Fauchard himself, who, -although he has the very great merit of breaking with mean, old-world -prejudices, nevertheless expresses the prevalent idea of the time, -consisting in the belief that every artificer, every inventor, had -not only the right, but also the duty of surrounding his discoveries -with secrecy and mystery. These are the words in which, making known -a certain improvement in dental prosthesis invented by him, he at -the same time expressed his conviction that by so doing he is acting -against his own interests: - -“I have perfected and also invented several artificial pieces both for -substituting a part of the teeth and for remedying their entire loss, -and these pieces substitute them so well that they serve perfectly -for the same uses as the natural teeth. To the prejudice of my own -interests I now give the most exact description possible of them.” - -Now, although a man of elevated mind, such as Fauchard, may have been -capable of sacrificing his material interests to higher aims, it -is not, however, to be wondered at, taking also into consideration -the lesser degree of culture and of professional ability of his -predecessors, that none among them should have been found sufficiently -disinterested to publish the results of their particular studies and -experience, besides all those technical details which according to the -ideas of that time constituted the secrets of the profession. - -In the course of this history, we have seen that the dental art -was practised from the most remote times and in the most various -countries, remaining, notwithstanding, for centuries in an embryonal -condition. It was toward the end of the seventeenth and the beginning -of the eighteenth century that, in the midst of the highly advanced -civilization of the great French capital, it attained a high degree -of development, entitling it to be considered a special branch of the -medical art. - -It would, therefore, be wrong to believe that the dental art was -created, for the most part, by Fauchard, and one clearly perceives, -from the perusal of his work, that although he made most important -contributions to this specialty, which he cultivated with passion, -nevertheless, the greater part of the things therein treated of were -already known before his time, although no reference to them is to -be found in previous works; and this for the reasons we have already -suggested. The highest merit of Fauchard consists, still more than in -his inventions and improvements, in his having most ably collected -and incorporated in a single work the whole doctrine of dental art, -theoretical as well as practical, thus setting in full light the -importance of the specialty, and giving it a solid scientific basis. - -France is therefore the first country where modern dentistry reached a -high degree of development and also the first country where, earlier -than elsewhere, that is, about 1700, the dentists began to form a -well-defined class, to belong to which it was necessary to pass a -special examination. This examination, as we learn from Fauchard, was -held before a commission of which no dentist formed a part, and exactly -for this reason gave but negative results and responded but little -to its intended aim. The greater number of those who were authorized -to practise dentistry after undergoing this examination showed a -professional ability below mediocrity. Nevertheless, although few in -number, good and able dentists were in no way wanting, as clearly -appears from the preface to Fauchard’s work, and better still from -the following paragraph,[411] wherein the author speaks of the great -perfection reached by dental surgery in Paris: - -“The teeth and the other parts of the mouth being subject, as we -have seen in the course of this work, to so many important diseases, -requiring the aid of the most able dentists, it is strange that the -sovereigns of foreign countries, the heads of republics, and also the -administrators of our own provinces do not provide for the expense of -sending young surgeons to Paris, to be instructed in a part of surgery -so essential, and, notwithstanding, so ignored and neglected everywhere -excepting in this great city, where it has reached its highest -perfection, both as regards the embellishment of the mouth and the cure -of diseases, often of a most serious nature. These scholars would, -thereafter, form others and would render great services to their nation -and to their fellow citizens.” - -In the first chapter of his work, Fauchard speaks “of the structure, -position, and connection of the teeth; of their origin and of their -growth.” He distinguishes in each tooth a body, a root, and a neck, -making the remark, however, that this last is to be considered as -forming part of the body. According to the author, the name of “crown” -can only be applied suitably to the body of the molar teeth, but not -to that of the incisors or of the canines, which has no resemblance -with a crown. Although in the adult the number of the teeth is -normally thirty-two, it may be that some persons have, nevertheless, -thirty-one, thirty, twenty-nine, or even only twenty-eight teeth, and -this independently of any eventual loss, but for the simple reason that -the wisdom teeth are often cut very late in life (even after fifty -years of age), or do not all come forth, or sometimes are never cut at -all. The author refers to some cases of a supernumerary tooth situated -in general between the two superior central incisors and similar in -form to the lateral incisors. He also observed two individuals who -had each thirty-four teeth, sixteen in the lower and eighteen in the -upper jaw, and in these cases the two supernumeraries were situated -behind the incisors. Fauchard declares the popular opinion expressed -also by some ancient authors, of the milk teeth having no roots, to -be false. The roots of these teeth, he says, are gradually worn away -before the latter are shed, when the permanent teeth are just on the -point of coming through; however, if it so happens that one or more of -the milk teeth be extracted some time before the period in which they -are usually shed, their roots are found to be as long and as strong in -proportion to the body as those of the permanent teeth. In children one -finds, besides the twenty deciduous teeth, the germs of the thirty-two -permanent ones, for which reason it may be said that children have in -all thirty-two teeth without counting the germs that may sometimes be -found at the extremities of the roots of the large molars. As, however, -the existence of such germs is an exceptional fact, the twelve large -molars, if extracted, are not ordinarily regenerated. This may be -possible, however, if the germs in question exist, and, indeed, the -author observed two persons in both of whom a large molar had been -regenerated in the place of the one which had to be extracted. - -Fauchard gives an excellent description of the alveoli and of the -roots of the teeth; he alludes to the varieties which these latter -may present, and to the importance of the same from the point of view -of extraction. Thus, speaking of the molars, he says: “Their roots -sometimes touch one another at the points, whilst at the base, close -to the body of the tooth, they are far apart. These are the so-called -_dents barrées_ (barred teeth), which it is so difficult to extract, -it being unavoidable to bring away together with the tooth the spongy -osseous part occupying the interval between the roots.” - -In this same chapter the author calls our attention to some anomalies -worthy of note. He says that he has observed teeth that seemed to him -to be derived from the union of two or three germs. He also relates -that a colleague of his showed him a tooth that appeared to be formed -by the union of two, between the roots of which was a third tooth whose -crown was united to the vault formed by the roots of the first two. - -Fauchard describes exactly the pulp cavity and the root canals, and -speaks of their gradual restriction, ending in an almost entire -disappearance in old age.[412] He treats of the nerves, of the -arteries, and of the veins of the teeth in a most detailed manner; -then, after alluding to their general structure, he goes on to speak -of the microscopic constitution of the enamel, following in this the -description given of it in 1699 by the academician La Hire. - -In regard to the development of the teeth, Fauchard repeats what Urbain -Hémard had previously written. He apparently ignores the researches -of the Italian anatomists, from whom, and especially from Eustachius, -Urbain Hémard had literally reproduced all that concerns odontogeny. - -In the second chapter Fauchard speaks “of the maladies of children at -the period of teething and of the remedies best adapted thereto.” Among -other means of treatment, he advises the incision of the gum when this -is red, swollen, and distended and the tooth below it can be felt. For -the incisors and canines a simple incision ought to be made in the same -curve as the dental arch; for the molars a crosswise incision should -be made directly down to the tooth below, taking care not to leave -any strips of uncut gingival tissue, lest these, being distended by -the emerging tooth, should continue to be the cause of pain and other -morbid phenomena. - -Although Fauchard does not tell us anything substantially new about -teething maladies and their treatment, he nevertheless treats this -subject with much practical good sense, and does not merely make -servile repetition of what preceding authors have written about it. - -In the three following chapters the author speaks of the utility of the -teeth, of the rules to be observed for their preservation, of the modes -of keeping them white, and of strengthening the gums. - -From a passage in the fifth chapter we learn that tooth brushes were -then already in use. Fauchard, however, advises the use of small -sponges in their stead. He says: “Those who use brushes of horsehair, -or pieces of cloth or of linen for cleaning the teeth, do not reflect -that all these materials are too rough, and that the practice of using -them frequently and without discretion often exercises a destructive -action upon the teeth.[413] Not without good reason, I advise the -abandonment of this usage, it being preferable, after having had the -teeth cleaned by the dentist, to wash the mouth every morning with -tepid water, and to rub the teeth up and down, inside and outside, with -a small, very fine sponge wetted in water; and it is still better to -add to this water a fourth part of aqua vitæ the better to fortify the -gums and render the teeth firm.” - -Instead of a small sponge, says Fauchard, the end of a root of -marshmallow or lucern, which has first been subjected to a special -preparation, may be used with benefit for rubbing the teeth. The author -gives a long and minute description of this preparation, which we, -however, omit, because devoid of historical interest. - -As, however, the above means are not always sufficient for preserving -the teeth and gums in good condition, it is necessary in many cases, -says Fauchard, to make use of some paste, powder, or mouth wash. The -author mentions a great number of compositions of this kind, giving -the formula for each one—almost always most complicated—and indicating -the peculiar advantages of each of them. We will here quote one of the -formulæ as an example. - -“_A spirituous water, desiccative, balsamic, antiscorbutic, efficacious -against many maladies of the mouth_: - -“℞—good sarsaparilla, four ounces; aristolochia rotunda, dried rinds -of bitter organes, of lemons, and pomegranates, _ana_ three ounces; -pyrethrum, two ounces; cloves, one ounce; mustard seeds, one ounce; -wild rocket seeds, two ounces. Pound well in a mortar and put the whole -into a retort with a long neck. Add thereto half a pound of pulverized -candied sugar and the same quantity of clarified rose honey. Pour in -three pints of good spirit of wine. Cork the retort well and leave all -to digest in a cool place for five or six days. Then heat the retort -forty-eight hours in the water bath over a slow fire, without letting -the liquid come to the boil. Afterward, when cold, decant in a glass -bottle, to be kept well corked. Pour another three pints of spirit of -wine on the residue of the drugs; cork the retort again, replacing it -in the water bath for forty-eight hours, and regulating the fire as -above. Then, after letting it cool, pour off the liquid into the same -bottle. Next remove all the residue from the retort, place it in a -thick, white linen cloth, and force the remaining liquid through it, -and add to that in the bottle. Put back half of the entire quantity of -liquid in the same retort, and add thereto aloetic elixir and _baume du -commandeur_, _ana_ four ounces; pulverized dragon’s blood, three ounces -and a half; pulverized gum of guaiac and Peruvian balsam, _ana_ three -ounces; gum lac, two ounces. Cork the retort again and replace it in -the water bath for forty-eight hours, as above. Let cool, decant the -liquid in another glass bottle, and cork well. Pour the remaining half -of the first liquid upon the rest of the drugs, replace the retort in -the water bath for forty-eight hours, let cool, and pour the contents -in the last bottle. Filter the liquid well, and pour it into a bottle -of sufficient size to be able to add the following liquids: aqua -vulneraria and first cinnamon water, _ana_ three pints; second cinnamon -water, three half-pints; spirit of cochlearia, four pints. Shake the -bottle well, filter again, and store in well-corked bottles.” - -The author adds that the doses of the different drugs may be reduced -in proportion to the quantity of liquor to be prepared; and that he -prepares so large a quantity at a time because of the great sale he has -for it among his clients. - -The preparation in question is counselled by the author as a remedy -against pathological conditions, and of the gums especially. One makes -use of it in the following manner: Pour from seven to eight drops -into a wineglass of water; wet the tip of the finger and rub the gums -and the teeth well. Or mix seven or eight drops in a good spoonful of -water, using a fine sponge to rub the teeth and gums. - -The example we have cited suffices to show how much care one took at -that time in the preparation of substances destined to be used in the -preservation of the teeth, and demonstrates at the same time that -Fauchard, inventor of that and many other preparations, besides being -an able surgeon-dentist, was also exceedingly well versed in dental -materia medica. - -Chapter VII treats of the general causes of dental, alveolar, and -gingival diseases, and contains the complete enumeration of these -maladies. The causes of dental affections may be of two orders, viz., -internal (general diseases, dyscrasic conditions) and external (the -action of heat and cold, mechanical causes, etc.). - -After having spoken in particular of various causes, Fauchard adds: -“Little or no care as to the cleanliness of the teeth is ordinarily the -cause of all the maladies that destroy them.” - -The author divides maladies of the dental apparatus into three classes, -that is: - -1. Maladies deriving from external causes and acting, therefore, -especially on the crown or uncovered part of the tooth. - -2. Maladies of the hidden parts of the tooth, that is, of the neck and -root. - -3. Symptomatic maladies, deriving from the teeth. - -In the first class the author includes 45 pathological states, 17 -in the second and 41 in the third, making up a total of 103 morbid -conditions. This should be sufficient to give us an idea of the -accuracy with which Fauchard studied the maladies of the dental -apparatus, especially if one considers that preceding authors -had reduced these maladies to a very small number. Fauchard’s -classification is very complete, for notwithstanding the progress -made in succeeding years in this science, the pathological conditions -not to be found comprised in it are exceedingly few. Naturally, -the 103 diseases enumerated by Fauchard do not represent as many -distinct morbid entities. The author, in classifying dental maladies, -keeps especially in view the requirements of the practitioner, and -therefore makes numerous distinctions in each morbid process. Thus, -he distinguishes a great many varieties of caries, viz., the soft and -putrid caries, the dry caries, the caries in part dry and in part soft, -the caries complicated by fracture, the superficial caries, the deeper -and the deepest, the caries of the different surfaces of the crown, and -so on. Also in the classification of other morbid processes, Fauchard -makes multifarious distinctions. - -The passage referring to worms in the teeth deserves to be here -reproduced:[414] - -“Sometimes worms are to be found in the carious cavities of the teeth, -or in the deposit of tartar that covers them, and to these the name -of dental worms has been given. Observations recorded by illustrious -authors are extant which attest this. Not having ever seen these worms, -I neither admit nor deny their existence. Nevertheless, I conceive the -thing nor to be physically impossible, although at the same time I do -not believe at all that these worms destroy the teeth or cause them to -decay, but rather that the eggs of some insect having been introduced -into the carious cavity of the tooth, either through alimentary -substances or through the saliva, these eggs thus deposited have -developed and produced the worms alluded to. However this may be, as -they are not the real cause of the caries, their eventual presence does -not require any particular consideration.” Fauchard again recurs to the -subject of worms in Chapter VIII, in speaking of the particular causes -of caries.[415] - -“It was, and is still, believed by the vulgar and also by some writers -that all toothache is caused by worms, which little by little destroy -the tissue of the osseous fibers and the nervous threads. If this were -so, the explanation of pains and of decay in the teeth would be very -simple. This opinion is founded on pretended experiences relating -to these insects, which may, it is said, be made to fall out of the -teeth by the smoke of henbane seeds; this, however, has been declared -fabulous by Andry, dean of the medical faculty of Paris, as well as -other similar facts which he exposes in his book on the generation of -worms.[416] - -“Andry relates, however, that with the help of the microscope one may -succeed in seeing certain worms that form beneath the deposit collected -upon the teeth as the effect of want of cleanliness; these worms, he -says, are exceedingly small and characterized by a small round head -with a small black spot; the body is long and fine, pretty nearly like -the worms seen in vinegar through the microscope. He adds that these -worms destroy the teeth little by little, causing a bad odor, but -not much pain. He believes it an error of the imagination to ascribe -violent pains in the teeth to dental worms, and holds that these only -produce a very slight, dull pain accompanied by itching. - -“I have done everything possible,” continues Fauchard, “to convince -myself with my own eyes of the existence of these worms. I have made -use of the excellent microscopes of Manteville, sworn surgeon of Paris, -and have made a great number of experiments with them both on caries -in teeth newly extracted as well as on tartar of different consistency -accumulated on the same, but have never succeeded in discovering any -worms. I am also still less disposed to believe in the existence of -these animals, because Hémard declares that he has never been able -to find any worms in carious cavities. I am thoroughly convinced -of Andry’s sincerity; neither do I doubt the truth of the facts he -relates; but it is easy to perceive from his own words how little the -pretended healers of teeth and their specifics for killing worms are to -be held in account; from the moment that, according to this writer, the -pains for which one is most obliged to have recourse to remedies are -almost always those not proceeding from the cause in question.” - -In short, Fauchard does not believe at all that dental caries is -occasioned by worms; and only from respect for the authority of Andry -and other writers does he admit the accidental existence of these -little animals in the carious cavities or upon the teeth, refusing, -however, to attribute any importance to the same as regards the -etiology of caries. - -This disease, says Fauchard,[417] is produced by a humor that -insinuates itself into the midst of the osseous fibers of the teeth, -and displacing the particles which compose these fibers, gives rise to -their destruction. The causes from which these disorders derive may be -external or internal. The external causes are blows, violent efforts -made by the teeth; the improper use of the file, the application of -acids or of other substances that injure the enamel, alteration of -the saliva, impressions of heat or cold, and also certain kinds of -nourishment. Blows or violent efforts may produce caries, according to -the writer, by occasioning the effusion of the liquid contained in the -vessels. The author gives analogous explanations for the other external -causes. As to the internal causes, they consist, he says, in alteration -of the blood and of the humors. - -The teeth, says Fauchard, are more subject to caries than all the rest -of the bones in the human body, because, their tissues being denser, -the vessels are on this account closer together and more easily liable -to be obstructed, choked up, and broken. Besides, the position of the -teeth exposes them more than the other bones to the immediate action -of external causes capable of producing the disorders alluded to; and -finally, what demonstrates the dental caries to be produced, for the -most part, by external causes, is that false teeth, either human or -formed from those of animals, sometimes become carious just in the same -way as the natural ones; which evidently happens by the sole action of -external causes. - -It is undeniable that the ideas expressed by Fauchard on the pathogeny -of caries, cannot hold good against criticism. Nevertheless, we owe a -great deal to this author for having once for all put an end to the -ridiculous theory of dental worms, and for having tried to find a -reasonable explanation of the manner in which caries is produced. - -The teeth, says Fauchard, have not all the same disposition toward this -morbid process; indeed, notable differences are to be observed in this -respect. The molars are, in fact, more apt to become decayed than the -incisors or the canines; and the upper incisors and canines are more -subject to this disease than the inferior ones, because, by reason of -their position, they are more frequently uncovered and more exposed to -heat and cold, whether in eating and drinking or whether in the mere -aspiration or expiration of the air. It is to be observed, besides, -that when the eruption of the last molars is considerably delayed they -easily decay.[418] - -Having very frequently observed the symmetrical decay of corresponding -teeth on both sides of the same jaw, Fauchard considers that these -cases are not simply accidental, but rather holds that the fact -depends on a special cause, which, however, is not easy to determine. -He offers, at any rate, a sufficiently good explanation when he says -that as certain morbid causes (bad humors, etc.) must affect both -sides of the mouth identically, it is but natural that the effects of -such causes should be altogether analogous on the right and on the -left, and manifest themselves symmetrically on teeth having the same -configuration, the same structure, and the same consistence. - -Before speaking of the treatment of caries,[419] Fauchard alludes to -the fallaciousness of the many remedies against toothache which were -largely sold at his time by charlatans and impostors of every kind. - -“Some pretend to cure toothache with an elixir or some special essence; -others with plasters; others by means of prayers and signing with the -cross; others with specifics for killing the worms that are supposed -to gnaw the tooth and so cause pain; others pretend to be so clever -that they can cure the most inveterate toothache by merely touching the -tooth with a finger dipped into or washed with some rare and mysterious -liquid; others finally promise to cure every kind of toothache by -scarifying the ears with the lancet or cauterizing them with a red-hot -iron.” - -“I am well aware,” adds Fauchard, “that it can be alleged in favor -of this last prejudice that the celebrated Italian doctor Valsalva -indicates with great precision the point in which the actual cautery -is to be applied to the ear, in order to calm toothache. He also -determines the size of the iron and the manner of applying it. The -authority of so celebrated an author, whose opinion is certainly worthy -of respect, should induce me to believe that there may perhaps be -some cases in which it is possible to use this remedy with success; -nevertheless, I cannot persuade myself that such treatment can be -useful in common cases of toothache. - -“At Nantes, a city of Brittany, I knew a Turk, a watchmaker by -profession, who was renowned for this mode of curing toothache. But I -also know that, in spite of the pretended cures, the greater number -of those who put themselves into his hands were obliged finally to -have recourse to me, in order to find relief for their sufferings. I -afterward saw several other persons use the same remedy with no better -success. - -“There are, besides, an infinity of other remedies vaunted as -efficacious against toothache, but the greater number of them are so -ridiculous and extravagant that it would be both tiresome and useless -to speak of them. We will, nevertheless, give one more mentioned by M. -de Brantôme.”[420] - -The author here quotes a passage of this writer, wherein he says that, -having been suffering from toothache for two days, the apothecary of -Elizabeth of France, wife of Philip II of Spain, brought him a most -singular herb, which when held in the hollow of the hand had the virtue -of making the pain cease immediately; and in this way he was, in fact, -effectually cured. - -And here Fauchard expresses himself of the same opinion as Urbain -Hémard, who believes the cure of toothache by means of words, or by -the touch of paper on which certain signs are written, or remedies -held in the hand, etc., to be merely the effect of the force of the -imagination, and he opines that the patient, having a vivid belief in -the mysterious thing proposed to him remains under the impression of -an inward commotion, by the effect of which it may well be that the -morbid humor is deviated from the painful part to other parts of the -body. The effects of the various passions on the bodily functions are, -says Fauchard, very well known. Thus, when under the influence of anger -the wounded at times do not feel any pain, and those who suffering from -a tormenting toothache go to a dentist to have the tooth drawn are -sometimes seized by such great fear as not to feel the pain any longer, -and go away, only to return later on renewal of their sufferings; -although there have been cases where the pain ceased altogether. - -In spite of this explanation, of which we will not here discuss the -value, allowing it, however, as satisfactory enough, Fauchard continues -by making a most curious consideration, which as it is of a somewhat -surprising effect in a scientific work, we will not deprive our readers -of it. He believes it to be his duty to give the following warning, -namely, that “the modes of cure, by means of certain words, of certain -signs, laying on of hands, written charms, etc., savoring much of -superstition and of diabolic artifice, are prohibited by the Church as -sinning against the first Commandment, as much in him who practises -them as him who consents thereto.” - -After the above preliminaries, the author passes on to treat the -important subject of the mode of curing caries.[421] According to him, -when caries has not yet attacked the internal cavity of the tooth at -all, or only in a very slight degree, there are four modes of curing -it: the first consists in the use of files or scrapers, the second in -the application of lead, the third in the use of oil of cinnamon or -of cloves, and the fourth in the application of the actual cautery. -Fauchard expresses most energetically his disapproval of the means -of cure recommended by Dionis in cases of caries of the triturating -surfaces, which consisted in the cauterizing of the decayed spot -with a drop of oil of vitriol applied by means of a miniature paint -brush, declaring this to be both dangerous and hurtful because of the -destructive and corrosive action of the oil of vitriol and because of -the impossibility of limiting its action solely to the affected part of -the tooth. - -The general method of cure followed by Fauchard is described by him in -these terms: - -“When a tooth is but slightly decayed, it is sufficient to remove the -caries with the instruments of which I will speak hereafter, and to -fill the cavity with lead. If, however, the cavity be rather deeper -and occasions pain, one should, after having scraped it, put a small -ball of cotton-wool soaked in oil of cinnamon or of cloves into the -hollow of the caries every day. This medication must be continued for a -sufficient time, taking care to squeeze in the cotton-wool by degrees -to accustom the sensitive parts to the pressure. Four or five days -later one removes the material from the carious cavity. This treatment -sometimes prevents a return of the pain; it produces on the osseous -fibers of the tooth a slight but sufficient exfoliation and impedes -the progress of the caries. If the pain should not cease after having -continued this method for a sufficient length of time, one should then -have recourse to the actual cautery and stop the tooth after a certain -time, if the form and situation of the decayed cavity permit it; for -one sometimes meets with cavities that are not able to maintain the -stopping. - -“If the caries penetrates as far as the cavity of the tooth, it may -give rise to an abscess; and this I have often observed in persons to -whom the caries of the incisors or of the canines occasioned great -pain. In such cases I introduce the extremity of the sound into the -cavity of the tooth in order to facilitate the evacuation of matter. -As soon as the pus is evacuated the pain ceases. I then leave these -patients in repose for two or three months; after this time, I stop the -decayed tooth or teeth to avoid their getting worse.” - -As anyone may perceive, the methods used by Fauchard against caries -left much to be desired, when compared with those now in use. With such -imperfect methods it is but natural that one did not always succeed in -obtaining the immediate cessation of the pain resulting from caries. -The want of additional remedies was, therefore, felt; and, in fact, -Fauchard tells us[422] of two with which he had experimented and found -most efficacious against toothache. The first is a resinous plaster -to be applied to the temples; the other is a paste to be applied, in -quantity equal to the size of a small bean, between the gums and the -cheek, and which was composed of various ingredients, among others, -pyrethrum, black pepper, ginger, stavesacre, mace, cloves, cinnamon, -sea salt, and vinegar. After having given the mode of preparation and -application of the two above-mentioned remedies, Fauchard adds: “These -remedies prove especially efficacious if one takes care to introduce a -little cotton-wool or lint into the decayed cavity, soaked in oil of -cloves, or cinnamon, mixed with an equal quantity of extract of opium, -and if one resorts opportunely to bleeding and purging; which ought -never to be neglected in the case of plethoric persons.” - -Finally, the author speaks of another remedy,[423] and one which we -never should have expected to find in his book; but he assures us that -by it many persons who had almost all the teeth decayed and suffered -very often from toothache found great relief. - -“It consists in rinsing the mouth every morning and also in the evening -before going to bed with a few spoonfuls of one’s own urine immediately -after it has been emitted, always provided the individual be not ill. -One is to hold it in the mouth for some time, and the practice ought to -be continued. This remedy is good but undoubtedly not pleasant, except -in so far as that it procures great relief. Some of those to whom I -have recommended it, and who have used it, have assured me that in -this manner they were relieved of pain to which, up to then, they had -continually been subject. It is rather difficult in the beginning to -accustom one’s self to it; but what would one not do to secure one’s -self health and repose.” - -In order to explain the virtue of the urine as a remedy, the author -pauses to speak of its chemical composition, and then adds: - -“The rectified spirit of urine[424] could be substituted for the human -urine. One should then take two drams of this substance and mix it with -two or three ounces of aqua vitæ, or water of cresses or of cochlearia. -Sal volatile[425] has the same virtues. Those who wish to make use of -it should dissolve fifteen to thirty grains of it in the same quantity -of the above liquid.” - -Fauchard then passes on to speak of trepanning of the teeth when they -are worn away or decayed and cause pain.[426] He begins by saying that -most varieties of pain caused by the canines and the incisors when -worn away or decayed cease after the use of the trepan. He, however, -understands the term trepanning in a very wide sense, comprehending -therein the use of any instrument whatever (even a needle or a pin) -with which one penetrates into the inner cavity of the teeth. - -In interstitial caries of the canines and incisors one ought, says -Fauchard, first to enlarge the interstice with a small file of a -convenient shape, then to scrape the decayed cavity, and finally to -open up the canal or inner cavity of the tooth with a perforator or -with a small trepan. - -“In this way the pus or other humors that may have collected in the -tooth can easily find their way out, and the pain will cease at once or -in a short time.” - -The author describes with much minuteness the manner of trepanning, and -then adds: - -“After this operation one should let a few weeks pass without doing -anything to the affected tooth, and afterward, in order to impede -further decay, one must put a little cotton-wool into it soaked in oil -of cinnamon or of cloves. The tooth must be left in this state for -some months, taking care to renew the cotton-wool. It is necessary to -observe that in beginning to put in the cotton-wool this should be done -with lightness and without pressing it down much, so that if pus should -gather again it may be able to make its way through the cotton-wool, -the principal object of this being to hinder the penetrating of -alimentary substances into the tooth, which would be the cause of -further decay. If the cotton were pressed into the tooth from the -beginning, the pus, not being able to find an exit, would accumulate, -and might cause much pain, if the nervous parts of the tooth were -not yet dried up or destroyed. The same thing might happen after the -application of a lead stopping, and one would be obliged to remove it -and let considerable time pass before putting it in again.” - -Further on the author says that while the trepanning of incisors or -canines almost always causes the pain to cease, by opening up an exit -to the morbid matter retained within the cavity of such teeth, the -same is not the case with the molars, these having several roots and -several cavities, of great variety, which lend themselves but little to -accurate trepanning. “Hémard,” he adds, “judges it necessary to extract -these teeth, or at least to break off the crown (_les déchapeller_), -in order to give exit to the corrupt matter that is closed up in the -cavity; this sometimes causes the pain to cease. He (Hémard) says that -he has seen many abscesses in the interior of teeth, which were not -externally decayed, and that after having broken off the crown he found -within the cavity a corrupt matter of an insupportable smell.” - -Relative to such cases, Fauchard says that, besides the teeth, also the -surrounding parts suffer and are imperilled by these conditions. “The -greater part of the violent fluxions deriving therefrom often terminate -in abscesses and fistulæ of the gums and of the surrounding parts, and -sometimes with considerable and dangerous decay of the bone, as I have -related in some of my observations.” - -One sees that Fauchard was clinically very well acquainted with the -grave forms of pulpitis and their possible consequences, although -ignoring the true nature of this process, which has only been studied -and illustrated much more recently. - -Chapter XL (page 177) treats of dental tartar, of its cause, of the -harmful effects it produces, and of the prophylaxis and therapy -relating thereto. Three illustrations which are added to this chapter -represent the different aspects of a mass of tartar of exceptional -size formed around the body of a lower molar. The surgeon Bassuel, a -friend of the author, had removed this mass of tartar, together with -the entire molar, from the jaw of an old woman. The mass itself was -almost the size of a hen’s egg, the superficies being very irregular; -it rendered mastication altogether impossible and caused the cheek to -stand out in such a way as to give the appearance of a tumor.[427] - -In the following chapter[428] the author enumerates the various dental -operations: “Cleaning the teeth, separating them, shortening them, -removing the caries, cauterizing, stopping, straightening crooked -teeth, steadying loose teeth, trepanning, simple drawing of teeth, -replacing them in their own alveoli, or transplanting them to another -mouth, and finally substituting artificial teeth for those wanting.” He -then adds: “All these operations require in him who carries them out -a light, secure, and skilful hand and a perfect theoretic knowledge, -by which he may decide on the opportuneness of performing them, of -deferring them, or of abandoning them altogether. In fact, one may know -perfectly well how to carry out an operation and nevertheless undertake -it in a case in which it is not at all proper to operate. Into such -an error no one can fall save through sheer ignorance of the cause of -the disease or of the right means of curing it. From this it must be -concluded that the knowledge required in order to be a good dentist is -not so limited as some imagine, and that the imprudence and the danger -of placing one’s self in ignorant hands is as great as the temerity of -those who undertake to exercise so delicate a profession without the -knowledge of even its first elements.” - -Before speaking in detail of all the above operations, the author -dedicates a lengthy chapter[429] to describing with the greatest -minuteness the position to be given in general, as well as in special -cases, to the head and body of the patient, and the manner in which -the dentist should place himself with regard to the former, so as to -be able to make a proper use of each of his hands. As a rule, Fauchard -made the patient seat himself in a convenient arm-chair; in exceptional -cases he placed him on a sofa, or on a bed. He draws this subject to a -close with the following words: - -“It is, indeed, surprising that the greater part of those who practise -tooth drawing should ordinarily seat the patient on the ground, this -being both indecent and not very clean. This position is not only -uncomfortable, but causes sometimes a sense of fear, especially in -pregnant women, to whom it may, besides, prove very harmful. But it is -still more surprising that certain authors should even nowadays affirm -this to be the most convenient position, while it is instead one to be -entirely rejected.” - -In speaking of extraction of the teeth,[430] Fauchard begins by saying -that the milk teeth, although destined to be shed, should never be -extracted, except in cases of absolute necessity, as, for instance, -when being decayed, they give rise to intolerable pain. The alveoli of -the infantile jaw are weak, whilst the roots of the deciduous teeth -are sometimes firmer and more solid than one would believe, and hence -it is that in extracting a milk tooth one runs the risk of injuring -the alveolus and even of carrying away a portion of it altogether with -the tooth, not to speak of the danger of damaging or even destroying -the germ of the permanent tooth lying below. Besides, Fauchard adds, -there are sometimes deciduous teeth that are never shed and never -renewed. One must, therefore, defer drawing children’s teeth as long as -possible unless they are loose. When, however, intolerance of pain or a -caries endangering the integrity of the neighboring teeth oblige one to -recur without delay to extraction, one should carry out the operation -with prudence and judgment, so as to avoid the dangers alluded to. It -sometimes happens, says Fauchard, that one finds in children a crooked -tooth by the side of a straight one; in these cases ignorant -tooth-drawers have often been known to remove the crooked (permanent) -tooth, and to leave the straight, viz., the deciduous one, which -afterward falls of itself, the individual thus remaining deprived of -one of his teeth for the rest of his life. The rule to be observed in -order to avoid a similar error is always to extract the older of the -two teeth and to leave the one that has been cut more recently, which -is easily recognized by its being ordinarily firmer in the socket and -of a better color than the first. - -And here the author inveighs against all the charlatans of his day who -dared, without being dentists, to perform dental operations, and whose -number, it would seem, was ever increasing, so much so that he is led -to exclaim: “There will shortly be more dentists than persons affected -with dental diseases!” In proof of this he relates the case of a -cutler of Paris, who extracted the molar tooth of a young girl because -black spots having appeared on it, he believed it to be decayed; but -perceiving that he had only removed the crown (it was a deciduous -tooth about to fall out), and thinking that he had broken the tooth, -proceeded to extract the root, removing, in his gross ignorance, the -permanent tooth on the point of coming through. - -Returning to the indications for the extraction of teeth, Fauchard -says that when a tooth planted irregularly in the mouth cannot be -straightened by any of those means to which he afterward alludes, and -occasions damage or inconvenience or constitutes a deformity, the sole -remedy is its removal. As to decayed teeth and the pain that they -produce, when the evil cannot be remedied with oil of cinnamon or oil -of cloves, with the actual cautery, or by stopping, one must have -recourse to extraction, and this to satisfy four different indications, -that is, before all, to procure the cessation of violent pain; in the -second place, to prevent the caries from being communicated to the -neighboring teeth; thirdly, to remove the fetid smell deriving from -the substances that are retained within the carious cavity, and to -impede the teeth on the same side from becoming covered with tartar, -as inevitably happens when by reason of painfulness in eating they are -forced to be inactive; fourth and lastly, because the dental caries, -not infrequently gives rise to other diseases, which ordinarily cannot -be cured unless the cause from which it arises be recognized and -suppressed. - -“Sometimes,” continues Fauchard, “such violent and obstinate pain -arises in a tooth that we are obliged to extract it, although not -decayed nor presenting deformity.” - -The author combats the old prejudice, that it is not right to draw -teeth in cases of pregnant women or of nursing mothers, lest the -operation should prove dangerous to the patient or to the fetus, or -produce alteration or arrest of the milk secretion. Only the fear -arising from this prejudice can, according to the author, cause any -of the dreaded contingencies. The dentist ought, therefore, to seek -to dissipate the fears of these patients, by persuading them of the -innocuous nature of the operation as well as of its short duration, -and should represent to them, on the other hand (if the operation -be really necessary), the advantages of promptly deciding on it, to -avoid the harm and the peril that prolonged suffering and the tortures -of sleeplessness might occasion to themselves as well as to the -unborn child or to the suckling infant, such as abortion, premature -confinement, alteration of the milk, etc. - -According to Fauchard, “one should always take the precaution of hiding -the instruments from the patient’s sight, especially in the case of -extracting a tooth, so as not to terrify him.” - -The author then speaks of cases where it is necessary to open the jaws -by force;[431] of the instruments to be used; of the mode of employing -them; of all the precautions to be observed under such circumstances; -of the necessity that may eventually arise of sacrificing some one -tooth when the enforced opening of the jaws has been impracticable; of -the advisability of sacrificing preferably in such cases one of the -premolars in order to damage as little as possible the masticatory -function and the appearance of the face; of the instruments best -adapted for carrying out this operation; of the danger it presents and -of the best mode of avoiding it; finally, of what it is necessary to do -in given cases to keep the mouth open, in order to not be obliged to -repeat the operation a second time. - -The six following chapters of the first volume treat very extensively -of the anatomy and physiology of the gums,[432] of gingival diseases -and their treatment.[433] The subject is treated in a masterly manner, -although these chapters do not offer anything of original importance. - -The same may be said of Chapter XXII, in which the author speaks of -scorbutic affections and of their treatment. - -The chapters we have cited are accompanied by four plates, representing -thirteen instruments for use in the treatment of the above diseases. - -[Illustration: FIG. 78 - -Instruments for opening the mouth in cases of lockjaw (Fauchard).] - -The author then speaks[434] of the accidents which may arise from -caries and from other dental diseases, not only in the parts nearest -to the teeth, but also in localities more or less distant from them, -for example, fistulæ reaching as far as the cheek bone or the eye, -necrotic destruction of the maxillary bones, etc. - -The first volume of Fauchard’s work finishes with a collection of -most interesting cases, which may be read even at the present day -with pleasure, and from which one may derive some useful information. -These cases are about eighty in number, spread over fifteen chapters, -according to the various nature of the cases themselves. This valuable -collection gives clear evidence of Fauchard’s eminence both as operator -and observer, and affords at the same time an idea of the extent of his -practice which enabled him to collect so considerable a number of cases -of more than common interest. - -Chapter XXV contains some observations on “_well-authenticated cases_” -of regeneration of permanent teeth in individuals of ages varying from -fifteen to seventy-five years. We will here give two of them by way of -curiosities: - -“In the year 1708 Mademoiselle Deshayes, now the wife of M. de Sève, -residing at Paris in rue de Baune, and who was then fourteen years of -age, had the first large molar on the right side of the inferior jaw -extracted by me, because decayed and causing pain. The following year -she returned to have her teeth cleaned by me, and whilst doing this I -observed that the tooth extracted had been wholly regenerated.”[435] - -“In the year 1720 the eldest son of M. Duchemin, player in ordinary -to the King, who was then sixteen years old, came to me to have the -second large molar on the left side of the lower jaw extracted. It was -very much decayed. I drew it, and a year and a half after the tooth was -completely regenerated.”[436] - -In Chapter XXVIII the author relates twelve cases of dental -irregularities corrected by him with satisfactory and at times even -surprising results. We here refer, in Fauchard’s own words, to the last -two of these cases, not because of their being the most important, but -because from them it is evident that Fauchard was not the only dentist -who undertook such corrections, although he was perhaps the only one -who, in certain cases, carried them out with a rapid method. - -“In the year 1719 M. l’abbé Morin, about twenty-two years of age, -whose countenance was greatly deformed from the bad arrangement of the -incisors and canines, consulted various colleagues of mine as to the -possibility of correcting the irregularity of his teeth. Some found the -thing so difficult that they advised him to do nothing at all, that is, -not to risk any attempt. He came to me by chance one day whilst another -dentist was with me. We both examined his mouth with much attention. -Now, as this dentist was my elder, and I believed him to have more -experience than I had, I begged him to give me his opinion as to -the best method to follow in this case, in order to insure success. -Whether it be that he would not give me advice, or that he was not in -a position to be able to do so, the fact is, that his answer was not -such as I could have wished. I therefore felt myself obliged to tell -him that I hoped to put this gentleman’s teeth in order within three -or four days. My colleague was not aware that this could be done so -quickly; urged by curiosity, he returned when the time I had indicated -had elapsed, and found, not without surprise, M. Morin’s teeth reduced -to perfect order.”[437] - -“Several years ago the wife of M. Gosset, Reviseur des Comptes, sent -for me to examine the teeth of her daughter, then twelve years of age. -I found the lateral incisor on the left side of the lower jaw strongly -inclined toward the palate in such a manner as to constitute a real -disfigurement. Interrogated by the mother as to the possibility of -remedying this, I replied that it could easily be done in eight or ten -days, with the method of threads, if the young girl were only sent -every day to my house. As, however, the young lady received instruction -from several masters who came to her house each day, my proposal was -not accepted, in order not to distract her from her studies. This -induced me to say to the mother that, if she were willing, I would put -the crooked tooth into its natural position in a few minutes. Surprised -at so short a time being demanded for the operation, she consented -to my performing it immediately. Making use of the file, I began by -separating the tooth from the neighboring ones which pressed upon it, -slightly diminishing the space it ought to have occupied. This done, -I straightened the tooth with the pelican, placing it in its natural -position, to the great astonishment of the young girl’s mother and of -other persons present, who told me they had many times seen similar -corrections that had been carried out by the late M. Carmeline and -others, never, however, with this method or in so short a time. As soon -as I had reduced the tooth to its normal position I fixed it to those -next to it by means of a piece of common thread, which I left there -eight days; and during that time I made the young girl rinse her mouth -four or five times a day with an astringent mouth wash. After the tooth -had become firm, it would not have been suspected that it had ever been -out of its normal position.”[438] - -In Chapter XXX the author gives an account of five cases of dental -replantation and one of transplantation. This last operation was -carried out on a captain who had the upper canines on the left side -decayed and aching; he inquired of the author if it were possible to -draw it and replace it by another person’s tooth. Having received an -affirmative reply, the officer sent immediately for a soldier of his -company to whom he had already spoken on the subject. This man’s -canine was found by Fauchard to be too large; nevertheless, for want -of better he extracted and transplanted it, after having diminished it -in length and in thickness. This it was not possible to do without the -cavity of the tooth remaining open, and for this reason, when, after -about two weeks’ time it had become quite firm, he stopped it. But the -stopping immediately caused such insupportable pain (which circumstance -astonished the writer not a little) that he was obliged to take it out -again the following day, on which the pain ceased directly. Fauchard -saw this patient eight years afterward, and was assured by him that the -transplanted tooth had lasted him six years, but that its crown had -been gradually destroyed by caries. The root had been extracted by a -dentist, not without considerable pain.[439] - -We now give one of his cases of replantation in the words of the author -himself: - -“On April 10, 1725, the eldest daughter of M. Tribuot, organ builder -to His Majesty the King, called on me; she was tormented by violent -toothache caused by caries of the first small molar on the right side -of the upper jaw; but although she was desirous of having the tooth -removed, to be freed of the pain, she, on the other hand, could not, -without difficulty, make up her mind, thinking of the disfigurement -which its loss would occasion, and thus it was that she was induced to -ask me if it would not be possible to put it back again after having -extracted it, as I had already done in the case of her younger sister. -I replied that this might very well be done, provided the tooth came -out without being broken, without any splintering of the alveolus, or -great laceration of the gum. The patient, upon this, completely made up -her mind. I extracted the tooth very carefully so as not to break it, -neither were the gum nor the alveolus injured in any way. I therefore -was induced to put the decayed tooth back in its alveolus, and having -done this, I took care to tie it to the neighboring teeth with a -common thread, which I left in position for a few days. The tooth -became perfectly firm, and only caused pain for two days after being -replanted.... To better preserve it, I stopped the carious cavity.”[440] - -Not without interest is a case of disease of Highmore’s antrum, -originating in the following way. A charlatan attempted to extract by -means of a common key a canine tooth which had erupted in an abnormal -position. He applied the hollow of the key to the tooth and beat upon -the handle with a stone. But the tooth, instead of penetrating into the -hollow of the key, was driven into the maxillary sinus.[441] - -Two important cases of “stony excrescence” of the gums (probably -osteomas) are to be found in Chapter XXXII. One of these tumors was -removed by the dentist Carmeline after the patient had been tortured -with useless operations by surgeons, who, not recognizing the true seat -of the evil and mistaking it for a tumor in the cheek, had, over and -above all the rest, produced a permanent disfigurement of the patient’s -face and a perforation of the cheek that he was obliged to keep closed -for the remainder of his life with a wax plug, to prevent the exit of -the saliva and of liquid or masticated aliments.[442] - -Several important observations on obstinate cases of cephalalgia, -prosopalgia, otalgia, and other varieties of pain arising from dental -caries are to be found in Chapter XXXIII. In all these cases the -removal of the decayed tooth or teeth procured the prompt cessation of -pain. Among others worthy of note is a case of violent otalgia caused -by the decay of a lower molar, which, however, was itself not painful. -This circumstance drew Fauchard himself into error, causing him to -believe that the otalgia was independent of the decayed tooth; he -therefore merely stopped the tooth to prevent the caries from extending -farther. The pain in the ear continued, however, and the patient -therefore consulted a doctor of the Faculty of Paris, Coutier, who told -her that the decayed tooth might be the cause of the earache, and that, -therefore, before undertaking any other cure, she ought to have it -extracted. This advice was followed and the earache ceased promptly and -completely.[443] - -In another case a patient twenty-seven years of age was tormented by -violent pain in all her teeth on the left side, in the temple and the -ear, as well as in the chin, the palate, and the throat. The doctors -and surgeons consulted decided the cause to be rheumatism. The patient -was bled not less than four times and subjected to various other -methods of treatment (purgatives, clysters, poultices, etc.), but all -in vain. She, however, perceiving that one of her teeth was decayed, -had it taken out. It was believed that the cause of the malady had thus -been found and removed; but an hour later the pain began again with -the same violence as before, continuing for some months; after this -it ceased of itself. On the return of the pain, later on, in all its -former intensity, the patient consulted the very able surgeon Petit, -who advised her to see Fauchard, as possibly the malady might have its -cause and point of departure in some bad tooth. Fauchard found one of -the inferior molars decayed. This being extracted, the pain promptly -ceased, not to return any more.[444] - -Chapter XXXV contains twelve cases of serious maladies arising from -dental diseases. One of these cases was observed in a patient aged -fifty-seven years, who in consequence of caries of the last inferior -molar on the right lost through necrosis a considerable portion of the -lower jaw, including the whole of the right condyle; he was affected, -besides, with caries of the temporal bone, in so advanced a degree -that the probe could reach the dura mater; he was, therefore, in -serious danger of his life, had to undergo several surgical operations -of exceptional gravity, and even after recovery remained permanently -subject to various disturbances, such as a salivary fistula, paralysis -of the lower eyelid, etc. And all this because the surgeons whom -the patient had called in had directed all their attention to the -secondary facts, instead of suppressing the primary cause of the evil, -represented by a dental affection. - -A case observed by the surgeon Juton and communicated by him to the -author is also a very important one. The patient was suffering with a -large abscess on the right side of the lower jaw, accompanied by such -great swelling of the cheek that it was impossible to open the mouth -wide enough to examine the teeth. Juton proposed opening the abscess -immediately, but the patient would not consent. The following day -he was sent for in great haste. The gathering had changed its seat, -making its way between the skin and muscles of the neck, where it now -formed so huge a tumefaction that the patient was in danger of being -suffocated. The abscess was now immediately opened, but the swelling -of the face still persisted; it was therefore only after a month had -elapsed that it was possible to extract the root of the last molar, -which had been the original cause of the whole malady. The surgeon -observed that the liquid injected into the fistulous opening in the -neck issued from the alveolus of the last molar. After the extraction -of the root a prompt recovery was effected.[445] - -The second volume of Fauchard’s work is entirely devoted to operative -dentistry and prosthesis. - -Before speaking of the modes of cleaning, filing, and stopping the -teeth, the author combats the opinion maintained by some, that these -operations are in part useless, in part also dangerous, as having the -effect of loosening the teeth, of depriving them of their enamel, and -ruining them. - -Fauchard then describes the instruments proper for detaching the -tartar;[446] he speaks of the method to be followed in cleaning the -teeth in order to not endanger the enamel;[447] he speaks of the -different kinds of dental files, of their different uses in relation to -the various cases and indications; of the precautions to be taken in -making use of them;[448] of the instruments to be used for scraping and -cleaning the carious cavities and of the mode of employing them.[449] - -All of the above-named instruments are illustrated by figures, in -contemplating which one cannot but reflect on the inferiority of the -instruments then in use as compared with those of the present day. -The greater admiration is therefore due to Fauchard’s talent, which, -in spite of such imperfect and at times absolutely primitive means, -enabled him to obtain the brilliant results cited in his observations. - -[Illustration: FIG. 79 - -Instruments for detaching dental tartar (Fauchard).] - -Chapter VI is dedicated to the stopping of decayed teeth. The sole -materials used by the author for stopping were lead, tin, and gold. -“Fine tin,” he says, “is preferable to lead, for lead turns black much -more easily and is much less durable; both are preferable to gold, -because lighter and adapting themselves better to the unevenness of -the carious cavities. Besides, gold being dear, not everyone can or -will make the corresponding outlay.” The author here adds that those -who, from vanity or because possessed by the opinion that gold has -special virtues, will not have their tooth stopped except with it, not -unfrequently find dentists who, as the saying, goes, content them and -cozen them by using leaf tin or lead colored yellow, and making them -pay for it as gold stopping! - -[Illustration: FIG. 80 - -Some of the dental files used by Fauchard. The little -square figure represents a small grooved wedge destined -to be inserted in large interdental spaces, in order to -give more firmness to the teeth to be filed.] - -The leaf metals were introduced and compressed into the carious -cavities by means of three kinds of pluggers, which would nowadays be -considered altogether insufficient and unfit for the purpose, but which -then, nevertheless, served to produce excellent stoppings. The author -speaks[450] of a lead stopping which had lasted in perfect condition -for forty years. - -Before stopping the tooth the cavity was scraped and its opening -widened, if necessary, but no special form was given to the cavity -itself, as is done at the present day. - -[Illustration: FIG. 81 - -Instruments for scraping the carious cavities (Fauchard).] - -As at that time the state of the dental pulp was not taken into -consideration before stopping a tooth, it often occurred that the -stopping caused violent pain, which rendered its removal necessary.[451] - -Fauchard says that “if the sensibility of the carious cavity be too -great, the lead ought only to be pressed in very lightly at first, -then after one or two days a little more, continuing thus until it is -properly compressed and fitted in, always provided, of course, that the -pain does not increase. The sensitive parts of the tooth become thus -more easily used to the pressure of the lead, and the pain is in this -manner avoided or moderated.”[452] - -[Illustration: FIG. 82 - -Three instruments for plugging teeth. The two small figures represent -silver plates for straightening teeth (Fauchard).] - -The author also makes the remark[453] that sometimes, in scraping a -carious cavity, “it is not possible to avoid uncovering and touching -the nerve with the instruments; one becomes aware of this by the pain -caused, and better still by a little blood issuing from the dental -vessels.” In such cases, Fauchard advises stopping of the tooth -immediately, for if it be carried out with delay, it is sure to be -followed by inflammation and great pain, rendering necessary the -removal of the lead or even the extraction of the tooth. - -[Illustration: FIG. 83 - -A gum lancet and two elevators, the second of which is destined to act -from inside outward (Fauchard).] - -Cauterization of the teeth[454] continued to be much used in Fauchard’s -time, and this is very easily explainable when one considers that there -was not then any other means of destroying the dental pulp. In making -use of the actual cautery, the immediate end in view was to cause the -cessation of obstinate toothache. “When the teeth give great pain and -no relief is to be derived from the use of other remedies, one ought -to cauterize the caries after having removed the extraneous substances -that may eventually be found in the carious cavity. After the -cauterization one scrapes the cavity and fills it up with cotton-wool -soaked in oil of cinnamon. Later on one stops the tooth.”[455] - -[Illustration: FIG. 84 - -An extracting instrument called by Fauchard lever or tirtoire, and the -handle of a pelican without the hooks.] - -The chapter in which Fauchard treats of the correction of dental -irregularities is of particular interest. In speaking of his -observations, we have already seen that in this field also he knew -how to obtain splendid and admirable results. He, nevertheless, made -use of the most simple means—the file, pressure with the fingers, -common threads or silk ones, little plates of silver or gold. At -times, for straightening teeth, he made use of the pelican and the -straight pincers, afterward tying the teeth in their normal position. -He rarely had recourse to extraction as a means of carrying out dental -corrections.[456] - -[Illustration: FIG. 85 - -Fauchard’s simple pelican (with one changeable hook).] - -[Illustration: FIG. 86 - -Fauchard’s double pelican.] - -To steady loose teeth,[457] Fauchard, as did the ancients, made use -of gold threads. When the spaces separating a loose tooth from -the neighboring ones were too large, he introduced small pieces of -hippopotamus ivory into them of about the height of a line, and not -exceeding the tooth itself in thickness; on each side of these was a -vertical groove destined to serve as a support to the next tooth. Each -of these pieces was furnished with two holes, through which were passed -the gold threads which served to bind together the teeth and the piece -of ivory itself. This latter was fixed close down to the gum. - -[Illustration: FIG. 87 - -Dental forceps (Fauchard).] - -Fauchard occupies himself in three different chapters (X, XI, XII) at -great length with the extraction of teeth. He describes a pelican of -his own invention, and speaks of the advantages it presents over other -pelicans previously in use. Notwithstanding this, it cannot be said -that the instruments used by Fauchard for extracting teeth and roots -show a sensible improvement on those in use before his time. - -[Illustration: FIG. 88 - -Straight forceps and crane’s bill or crow’s bill forceps (Fauchard).] - -Among the most usual operations, the author enumerates transplantation -and especially replantation of the teeth.[458] Whenever, says -Fauchard, a wrong tooth is extracted by accident, it ought to be -immediately replanted, and the same ought to be done when violent pain -renders it necessary to extract a tooth that is not much decayed, as -the patient is thus relieved without losing the tooth.[459] Fauchard -adds that this operation succeeds excellently in the case of incisors -and canines, and very often, too, with small molars. - -[Illustration: FIG. 89 - -Cutting forceps (Fauchard).] - -[Illustration: FIG. 90 - -Cutting forceps (Fauchard).] - -After having spoken of transplantation, he says:[460] “There is another -mode of replacing human or natural teeth which I have never yet -seen used except by a provincial dentist whose name I ignore.” This -special method consists in the transplantation of a tooth—it matters -little whether recently extracted or not—after having made three or -four notches in its root of about a line in depth. The author goes -on to describe all the particularities of the operation, and then -adds: “After twenty-five or thirty days one removes the thread, and -the tooth is found to be firm in the alveolus, owing to the fact that -this latter, exercising a pressure on the root on every side, becomes -perfectly moulded upon it. In this manner, the tooth will remain -mortised, and may be preserved for a considerable time.” - -[Illustration: FIG. 91 - -Pincers used by Fauchard in the operation of tying teeth -with gold wire. The three larger figures represent -natural or artificial teeth in which holes and horizontal -grooves have been made in order to fix them with gold -threads. The two smaller represent pieces of hippopotamus -ivory with a vertical groove on each side, destined to -fill large interdental spaces and to steady loose teeth -by means of gold ligatures.] - -This method, invented by an unknown provincial dentist, has been -recently applied by Znamenski, of Moscow, for the implantation of -artificial teeth made of porcelain, of caoutchouc, or gutta-percha. - -One of Fauchard’s greatest merits consists in the improvements -introduced by him in dental prosthesis and in his having, besides, been -the first to treat of this most important part of dental art in a clear -and particularized manner. - -The materials then most used in dental prosthesis were human teeth, -hippopotamus tusks, ivory of the best quality, and ox bone.[461] - -The author minutely describes the methods to be followed to repair -dental losses in every possible case and of whatever extent. - -According to the circumstances, Fauchard used, for maintaining -artificial teeth in their place, linen, silk, or gold thread, passed -through holes made in them, and tied to the natural teeth. - -When a set of two, three, four, or more teeth was to be applied, -Fauchard first prepared them separately and then united them together -by means of one or two threads of gold or silver in such a manner -that the set formed at last a single piece, which was then fixed to -the natural teeth. When the piece consisted of several teeth it was -reinforced with a small plate of gold or silver fixed to its inside -by means of small tacks of the same metal riveted on one side to the -plate, on the other to the front part of each tooth. - -The author remarks that a similar prosthetic piece lasted longer than -those previously described, but required proportionately much more -work and much greater expense. He adds that, by employing this plate, -one can even dispense with threading and fixing the teeth together -with gold or silver wire; but that it was then necessary to make a -horizontal groove at the back of each tooth corresponding to the width -and thickness of the plate, which could be fitted into the serial -groove and fixed to each single tooth by means of two small rivets.[462] - -At other times the prosthesis was carried out in a single piece of -material (ivory, hippopotamus tusk, etc.) that was carved in such a -manner as to substitute exactly the teeth wanting, it being fixed to -the natural teeth in the usual manner. - -Fauchard sometimes left the dental roots in their place (if they were -in good condition), applying upon them artificial crowns, which he -either bound to the neighboring teeth or fixed with screws to the -respective roots. - -“When one wishes to apply an artificial crown to the root of a natural -tooth, one files away the part of the root that emerges above the gum, -and even more if possible. One then removes, with proper instruments, -all that is decayed in the root itself; after which one stops the root -canal with lead and fits the base of the artificial tooth to the root -in such a manner that they correspond perfectly to each other. One -drills one or two holes in the tooth through which to pass the ends of -a thread, which serves to fasten it to the natural teeth on each side -of it, as described above. - -“If the root canal has been very considerably enlarged by the carious -process, so as to have rendered it necessary to stop it, the root -being, nevertheless, still quite steady, one bores a small hole in the -lead as deep and as straight as possible, without, however, penetrating -farther down than the root canal. The artificial crown is then united -to the root by a pivot in the manner I shall now describe.”[463] - -The method of applying pivot teeth is described with great accuracy. -In it the author considers all the different circumstances that may -present themselves, and says, among other things, that if the root is -still sensitive to pain, one should apply the actual cautery inside -the canal, before fitting the artificial crown to the root. For fixing -the pivot inside the artificial crown (which was generally the crown -of a human tooth), Fauchard used a special cement made with gum lac, -Venetian turpentine, and powdered white coral.[464] - -In the case of there not being any whole teeth to which the prosthetic -piece would be fixed, but only roots, Fauchard made two holes in it -in perfect correspondence with the canals of two roots, and fixed the -prosthetic piece to these by means of two pyramidal screws.[465] - -This method suggests in a certain way the idea of bridge work. - -In Chapters XVII, XVIII, XXIV, and XXV, Fauchard describes various -methods for the application of entire sets of false teeth, both upper -and lower, as well as double. - -The author says that if the lower jaw is entirely toothless, a set -of teeth can be adapted thereto without the need of any special -contrivance; however, it is necessary that the prosthetic piece -should fit perfectly, so that the configuration of the maxillary arch -and the irregularities of the gum, finding themselves in complete -correspondence with the piece itself, may keep it steady in its place. -The support offered by the tongue interiorly, by the cheeks and the -under lip exteriorly, contributes to keep the artificial set steady; -one can thus masticate as easily with it as with one’s own teeth, -especially if the teeth of the upper jaw be still existing and the -individual be already sufficiently used to the wearing of it.[466] - -With regard to the application of an entire set of upper teeth, one -learns from Fauchard that although some attempt had been made in this -direction before this time, the results had been very unsatisfactory. -He relates that: “In 1737 a lady of high rank, of about the age of -sixty, who had not lost any of her lower teeth, but was deprived -entirely of the upper ones, applied to M. Caperon, dentist to the King, -who was most able in his profession, in the hope that he might be able -to furnish her mouth with an upper set. But he said that, no tooth -whatever being left in existence, every possible point of attachment -was wanting, and it would therefore be as difficult to do this as it -would be to build in the air.”[467] He, however, directed the lady -to Fauchard, who asked for a few days to think the matter over, and -succeeded in devising a means of applying an upper set of teeth, which, -in fact, entirely satisfied the wishes and wants of the client. “As -this lady,” says the author, “simply wished to have the front of her -mouth decorated, and to be able to pronounce more perfectly, I gave -less extension to the set. The lady eats easily with it and could not -now do without it. For greater convenience she has two similar sets, -which she uses alternately.”[468] - -[Illustration: FIG. 92 - -Complete dentures (Fauchard). _f. 3_ represents an enamelled denture -with artificial gums; _f. 4_ and _f. 5_, steel springs.] - -[Illustration: FIG. 93 - -An upper denture supported by springs fixed to a gold appliance which -embraces the natural teeth of the lower jaw (Fauchard).] - -The author describes with great minuteness the manner in which the -prosthetic apparatus in question was constructed and supported, and -then speaks of the successive improvements introduced by him into this -most important part of prosthetic dentistry, particularly in what -regards the springs destined for the support of the upper set of teeth. - -[Illustration: FIG. 94 - -A spring denture for a case in which the lower front teeth still exist. -Figs. 1 to 6, various parts of the apparatus (Fauchard).] - -Fauchard also relates having made an attempt to apply an upper set of -teeth without the aid of springs, which proved successful in three -cases. “One can,” says he, “adopt an entire set of teeth to the upper -jaw, of much greater simplicity than those described, and which is -maintained in its place by the sole support of the cheeks and the lower -teeth. It must be very light indeed and serves almost solely to improve -the appearance and the pronunciation; but when the individual gets used -to it, he can also masticate with it. A set of teeth of this kind ought -to adhere well to the gums and to be constructed in such a manner that -the cheeks may afford it sufficient pressure and support together with -the aid of the lower teeth; these latter sometimes bring it back into -its place, without anyone perceiving the movement except the wearer -himself. Not long since I had to renovate a set of teeth of this kind -made by me more than twenty-four years ago, and worn by the owner to -the greatest advantage. I have since made two others which have proved -most useful to the persons wearing them. It is true that there are -few mouths adapted for wearing these sets, so much so that, excepting -the three referred to, I have never made any others. To be able to -construct similar sets successfully, the dentist must be possessed of -skill and ingenuity. Apart from this, they are the most suitable for -persons who cannot spend much, as they cost less to make.”[469] - -Fauchard did not merely content himself with having perfected dental -prosthesis in the manner alluded to; he also succeeded in giving a -quite natural appearance to artificial teeth. To reach this end he -placed the art of the enameller under contribution to the dental art. -Thus he had artificial pieces covered over with enamel, imparting -to them the hue that seemed to him best adapted, and also imitating -admirably the natural color of the gums, so as to render the illusion -perfect. The pieces to be enamelled were worked by special rules, which -are minutely given in Chapter XIX of the second volume of his book. - -Fauchard also brought the palatine prosthesis to a high degree of -perfection. He describes five different obturators of the palate, -which of themselves alone would be sufficient to testify to the highly -inventive genius of the author, although they are defective in being -somewhat too complicated. Some of these fixtures are a combination of a -dental set and palatine obturator. - -We ought now to mention, in the order of chronology, some authors of -lesser importance. - -VASSE and DE DIEST wrote about the danger of fatal hemorrhage following -on dental operations.[470] They report a few cases of this kind, giving -the blame of these accidents, however, to the carelessness of the -operator. - -LAVINI published in Florence, in the year 1740, a very good treatise on -dentistry (_Trattato sopra la qualità de’ denti, col modo di cavarli, -mantenerli e fortificarli_), which, however, marks no advance on the -work of Fauchard. - -M. BUNON (died 1749), a French dentist, wrote four admirable works on -dentistry, which were published from 1741 to 1744. We will here briefly -allude to the most salient ideas therein contained. - -This author combated strenuously some prejudices then generally -diffused; such as that of its not being advisable to extract teeth -during pregnancy, and that of the extraction of an upper canine (eye -tooth) being attended with great danger. He demonstrated the absurdity -of the latter idea by putting in evidence the anatomical fact that the -upper canines are innervated by the infra-orbital nerve, which does not -stand in any relation whatever to the organ of sight.[471] - -Among the other remedies recommended by him against the disorders -and perils of first dentition, there is one most curious, not to say -ridiculous: he advises rubbing the nape of the neck, the shoulders, the -back, and the lower limbs of the child, but in doing this the friction -should proceed from above downward, in order to offer resistance to -the flow of humors toward the upper parts of the body. The utility and -efficacy of this kind of massage in favoring the process of dentition -seems, of a truth, very open to question. - -Bunon speaks at length of _erosion of the teeth_, and declares himself -to be the discoverer of this disease, which destroys the enamel of the -teeth already before their eruption. The first molars, the canines, and -the incisors are much more frequently damaged and affected by it than -the other teeth. According to Bunon, it is generally due to measles, -smallpox, malignant fevers, or scurvy, when children are subject to -these maladies during dentition, and more especially during the first. -He is of the opinion that erosion not only generates caries, but may be -considered as being the origin of the greater part of dental affections. - -This author distinguishes three principal kinds of dental tartar, the -black, the pale yellow, and the brownish yellow; he admits, however, -two other kinds that are less frequent, that is, the red tartar and the -green. - -He relates having observed in the jaw of a child, who died at the age -of three years and a half, a splintering of the alveolar parietes in -all directions, and attributes this phenomena to disproportion between -the size of the teeth and the alveoli. On the basis of his anatomical -observations, he says that caries only appears on teeth that have -already come out of the gums, whilst erosion is produced in teeth not -yet erupted, indeed, at times, several years previous to their eruption. - -We will also mention, by way of a curiosity, Bunon’s proposal to -substitute the word legs for that of dental roots.[472] - -FR. A. GERAULDY, a French dentist, wrote (1737) an excellent -treatise on dental maladies and on the mode of preserving the teeth. -His book, which was also translated into German,[473] contributed -to the diffusion of knowledge relative to dental prophylaxis and -therapeutics, but apart from this brought no increment to the progress -of practical dentistry. Some of the ideas of the author, however, -merit consideration. He clearly expresses the opinion that the shedding -of the milk teeth is brought about by the pressure exercised upon them -by the germs of the permanent teeth in course of development. The loss -of the teeth in young subjects, or in those who have not yet reached -forty years of age, is explained by the author in an altogether special -manner. He relates that Louis XIV, at the age of thirty-five, had lost -all his upper teeth, and the considerations he makes on the subject -bring him to the conclusion that the precocious loss of the upper teeth -depends in many cases on a paralysis of the nervous fibers that go to -them, which paralysis is probably caused by a dissolute and intemperate -life, having as its consequence the weakening of the organism and, -above all, of the nervous system. Without doubt there is some truth in -Gerauldy’s ideas, it being well known that the falling of the teeth (as -well as of the nails and the hair) often depends on nutritive disorders -deriving from nervous disturbances. We have the clear proof of this in -certain cases of tabes dorsalis accompanied by the spontaneous falling -of the teeth and nails. - -JOSEPH HURLOCK, an Englishman, published a treatise in 1742,[474] in -which he warmly recommends lancing the gums in cases of difficult -dentition; he declares this to be entirely without danger, and affirms -that it constitutes the sole means of salvation for not a few infants -who without it would die of convulsions. - -MOUTON, in 1746, that is, in the same year in which the second edition -of Fauchard’s work was issued, gave to the light a monograph, the first -extant, on mechanical dentistry.[475] The methods of this author for -the most part do not differ from those of Fauchard, nevertheless one -finds several important innovations in his work. To prevent the further -deterioration of teeth already much destroyed, and to preserve them -some time longer, Mouton had recourse to the application of “calottes -d’or,” that is, gold crowns. He used this for the front teeth as well -as for the molars, but in the former case he had them enamelled to give -them the same appearance as natural teeth. - -Mouton also invented a new method of applying artificial teeth. Up to -then the ordinary method had been that of fixing them to the natural -teeth by means of threads passed through holes made in the artificial -teeth expressly for that purpose. Mouton is the first to speak of -artificial teeth fixed to the natural teeth adjoining them by means of -springs or clasps. - -This author relates having carried out several transplantations with -perfect success, a thing that contributed greatly to his renown not -only in France, but also in England. He distinguished himself, besides, -by the correction of dental irregularities. Lastly, it is to be -noted that this author frequently had recourse, as a remedy against -toothache, to the stretching of the dental nerve by means of moving and -partially raising the tooth (subluxation). - -A. WESTPHAL. In proof of the great utility of lancing the gums in -cases of difficult dentition, A. Westphal reports a case in which the -difficult eruption of an upper canine tooth provoked considerable -inflammation and protrusion of the eye on the same side as the tooth; -these symptoms promptly disappeared, however, as soon as the gum was -lanced down to the tooth itself.[476] - -J. BERTIN also declares himself in favor of this operation; he -recommends never to neglect it in cases of difficult dentition, and to -make the said incisions deep and wide enough.[477] - -L. H. RUNGE, a surgeon of Bremen, published, in 1750, a monograph on -the diseases of the frontal and maxillary sinuses. He says that in -cases of inflammation of Highmore’s antrum, the pus may make its way, -corroding the bone, as far as the alveoli, or, sometimes, as far as -the orbital cavity; and, _vice versa_, alveolar suppuration can give -rise, by diffusion, to abscess of the maxillary sinus. In this latter, -tumors of various kinds may form (polypi, cysts, sarcomas, cancers, -exostosis), the existence of which is ignored at first, and only -becomes manifest tardily. Runge’s father, who was also a surgeon, had -occasion to observe, and to treat an important case of disease of the -maxillary sinus, with considerable dilatation of the same, not only -on the side of the cheek, but also on the side of the palate and of -the nasal fossæ. With a strong scalpel he perforated the outer wall of -the antrum above the molars (keeping the cheek detached) and enlarged -the aperture by making the instrument turn around on its own axis, -thus giving exit to a considerable quantity of non-purulent liquid. -Detersive and aromatic injections were used for some time. The canine -tooth, situated obliquely, having been extracted, its alveolus was -found to communicate with the antrum. From this moment, the injections -being continued, a rapid improvement was obtained and the patient was -so completely cured that no deformity of the face remained. - -Runge relates a case in which, having extracted a canine tooth, he -found a cyst adhering to its root. From this he is induced to believe -that in the case related above the disorder was also to be attributed -to a large cyst having its origin in the root of the canine. - -According to him, the ozena always stands in relation to a suppurative -affection of the maxillary sinus, and for its treatment one must, -therefore, have recourse to Drake’s operations.[478] - -GEORG HEURMANN, a surgeon in Copenhagen, recommends making use, after -the Cowper-Drake operation, of a small cannula in order to facilitate -the exit of the pathological material contained in the sinus, and -also to render it easier to introduce into it medicated or detersive -substances.[479] - -LÉCLUSE. One of the most celebrated French dentists of the eighteenth -century is Lécluse. Dental literature was enriched by him with several -works, partly written in popular style, partly addressed to dental -specialists. In 1750 he published his _Traité utile au public, où -l’on enseigne la méthode de remédier aux douleurs et aux accidents -qui précèdent et qui accompagnent la sortie des premières dents, de -procurer un arrangement aux secondes, enfin de les entretenir et de -les conserver pendant le cours de la vie_. The work seems to have been -very favorably received, as its first edition, printed in Nancy, was -followed by a second, printed in Paris, only four years later. In 1755 -he published another book: _Eclaircissements essentiels pour parvenir -à préserver les dents de la carie et le conserver jusqu’à l’extrème -vieillesse_. But the most important of his works is the _Nouveaux -éléments d’odontologie_,[480] the first edition of which was published -in 1754, and followed by a second in 1782. - -We do not enter into a minute examination of these works, which, taken -altogether, do not contain anything very new. We will only remark -that Lécluse treated in a succinct but correct manner the anatomy of -the mouth; invented some and perfected other instruments, the most -important of which is the elevator that still bears his name, and -finally, that he frequently performed the operation of replantation, -warmly recommended by him as an excellent means of cure in certain -cases of caries. The extracted tooth was stopped and afterward -replanted, and, says Lécluse, became fast within eight days, proving as -serviceable as a perfectly healthy tooth, and never again causing any -pain. - -PHILIP PFAFF, dentist to Frederick the Great, King of Prussia, was -the first among the Germans who wrote a real treatise on dentistry. -His book[481] contains, in 184 succinctly but well-written pages, the -anatomical and physiological notions relative to the teeth, as well as -all that belongs to dental pathology, therapy, and prosthesis. - -Besides a few observations about supernumerary teeth, Pfaff relates -several cases in which the incisors, inferior as well as superior, -were renewed (twice consecutively), that is, once at the usual epoch, -and the second time between the seventh and thirteenth years. He also -cites from the anatomical tables of Kulmus the following epitaph in low -Latin, that seems to allude to a case of third dentition: - - “Decanus in Kirchberg, sine dente canus, ut anus - Interum dentescit, ter juvenescit, his requiescit.” - -In cases of hemorrhage ensuing on the extraction of teeth, the best -hemostatic, according to Pfaff, is essence of turpentine, a remedy -which in these cases he had always found efficient. He introduced a -little ball of lint bathed in this essence as deeply as possible into -the alveolus, applying upon it some blotting paper reduced to pulp or -some dry lint that the patient compressed tightly by closing his teeth. - -Gingival abscesses as well as fistulæ of the maxillary region almost -always owe their origin, says Pfaff, to decayed teeth, and can, -therefore, in general, not be cured except by the extraction of these -teeth. - -The prosthetic methods described by this author are, for the most -part, identical with those of Fauchard and the other French dentists -already mentioned. As to the materials used for prosthesis at different -periods, Pfaff mentions, besides ivory, bone, hippopotamus tusk, teeth -of sea cow, and human teeth, also teeth made of silver, of mother of -pearl, and even of copper enamelled. - -The chief merit one must concede to Philip Pfaff is that of having -been the first to make use of plaster models. It is, therefore, to -two Germans—Pfaff and Purmann, the latter who, as we have already -seen, used wax models—that one of the greatest progressive movements -in dental prosthesis is indebted, that is, the method of taking casts -and making models, of which method one finds no trace whatever in the -authors of antiquity, and which, it would appear, was not known even to -Fauchard himself. The wax casts of an entire jaw were taken by Pfaff -in two pieces, one of the right half of the jaw, and the other of the -left; which were then reunited, and one thus avoided spoiling the cast -in removing it from the mouth. - -Another great merit of Philip Pfaff is that of having first carried out -the capping of an exposed dental pulp, previous to stopping a tooth. - -Notwithstanding this, Pfaff is not the first who, as Geist-Jacobi is -inclined to believe,[482] _had dared to apply a filling over an exposed -dental pulp without first cauterizing it_. As we have already seen, -Fauchard did not hesitate in the least to fill a tooth when the dental -pulp had become exposed in scraping the carious cavity. But the French -dentist carried out, with much delicacy, a simple filling, whilst Pfaff -first capped the dental nerve. - -JACOB CHRISTIAN SCHAFFER. In 1757 the evangelical pastor, J. Ch. -Schaffer (we do not know if he was at the same time a dentist, or -merely an amateur in odontology), wrote a little book[483] to disprove -the existence of worms in decayed teeth, and to show the fallacy of -believing that the supposed worms may be made to drop out by means of -fumigations of henbane seeds. His book appeared, as a matter of fact, -rather behind-hand, for in it Schaffer repeats in substance what -Houllier had already said two centuries earlier, and after him various -other authors, including Fauchard. At any rate, to coöperate in the -complete destruction of error and in the diffusion of truth is always -laudable. We feel, however, bound to add that in the very same year in -which Schaffer’s pamphlet was published, DUFOUR, a Frenchman, described -a worm that had been taken out of a decayed tooth, and called attention -to the fact that it was altogether different from the “dental worms” -described by Andry.[484] - -BOURDET. An excellent book on dentistry[485] appeared in France in -the year 1757, the work of Bourdet, a celebrated dentist and elegant -writer, in whom the gifts of literary and scientific culture were -coupled with a vast experience and a profound spirit of observation. -His merits procured him the honor of being appointed dentist to the -King. - -This author condemns as harmful the use of hard substances (such -as bone rings, etc.) that people are in the habit of putting into -children’s hands during the period of the first dentition, in the -idea that by pressing these objects between the gums, as children -instinctively do, they cut their teeth more easily. As to emollients, -he holds them to be completely useless, and prefers to all these -remedies the use of lemon juice. - -According to Bourdet, the teeth are so apt to decay, partly because -of the frequent changes of temperature to which they are exposed, and -partly because, differently from the bones, they are not provided with -any protective organic covering. - -In many cases of caries, Bourdet extracted the tooth, filled it with -lead or gold leaf, and replanted it; but if, in extracting, the -alveolus had been somewhat injured (a thing very likely to happen with -the instruments of the period), he replanted the tooth immediately, to -preserve the alveolus from the damaging action of the air, and carried -out the stopping at a later time. - -Even in certain cases of violent toothache not depending on caries, -Bourdet luxated the tooth and replaced it in position directly. But as -some dentists had accused him of having passed off as new an operation -already made known by Mouton since the year 1746, Bourdet defended -himself by saying that whilst Mouton only shook the tooth, raising it a -little, simply to distend the nerve, he, instead, effected a complete -luxation, in order altogether to interrupt the continuity of the nerve. -Anyhow, this operation was not new, as it had already been recommended -and practised by Peter Foreest, in the sixteenth century, and in an -even more remote epoch by the Arabian surgeon Abulcasis. - -Sometimes, when the permanent canine comes forth, it has not room -enough, and therefore grows outward. In this case Bourdet extracts the -first premolar; the canine then advances gradually of itself toward -the space left by the extracted tooth, until it occupies its place -exactly. He also counsels the extraction of the first premolar on the -opposite side of the jaw, in order to preserve the perfect symmetry of -the dental arch on both sides. When the arch formed by the jaws is too -large and of an ugly appearance, Bourdet advises extracting the first -upper and lower premolars, so that the maxillary arches may acquire a -more regular form. In cases in which the defect of form exists only in -the lower jaw, that is, in children who have protruding chins, Bourdet -corrects this deformity by extracting the first lower molars shortly -after their eruption, that is, toward seven years of age. In this -manner, says the author, the lower jaw grows smaller and the deformity -disappears. The inventor of this method, as Bourdet himself tells us, -was the dentist Capuron. - -Bourdet made prosthetic pieces, whose base, representing the gums -and the alveoli, was made entirely of gold and covered over with -flesh-colored enamel on the outside, so as to simulate the natural -appearance of the gums; the teeth were adjusted into the artificial -alveoli and fixed with small pins. At other times he made use of a -single piece of hippopotamus tusk, in which he carved not only the -base, but also the three back teeth on each side, whilst the ten front -teeth were human teeth fixed to the base with rivets. - -One of Bourdet’s principal merits is that of having brought artificial -plates to perfection by fixing them not, as heretofore, to the opening -of the palate or inside the nose, but by means of lateral clasps fitted -to the teeth. - -In a special pamphlet, published in 1764,[486] Bourdet treats of the -diseases of Highmore’s antrum. To facilitate the exit of pathological -humors from the sinus, after the Cowper operation, he introduced a -small cannula, forked at one end, into the antrum and fixed the two -branches of the fork to the neighboring teeth by tying. - -In some diseases of the maxillary sinus (polypus, sarcoma, etc.) -Bourdet recommends cauterizing. - -Besides his principal work, the pamphlet on the diseases of Highmore’s -antrum, and some others of less importance, Bourdet wrote an excellent -book on dental hygiene,[487] which had the honor of two translations, -one German, the other Italian; the latter published in Venice in 1773. - -This celebrated author inveighs bitterly against charlatans and quack -dentists, and throws light on all their impostures. It appears, -however, that in the midst of this despicable class, so justly -condemned by him, there existed a courageous though unscientific -operator, to whom posterity would have attributed due honor had his -name been handed down, for he was the first, in all probability, to -try the implanting of teeth in artificial alveoli. This is, at least, -what we deduce from a passage in one of Bourdet’s works, in which we -read that a charlatan sought to impose on the public the belief that -he could make a hole in the jawbone and plant therein an expressly -prepared artificial tooth, which in a brief space of time would become -perfectly firm and as useful as a natural one. Bourdet adds that an -attentive investigation led to the recognition of the said tooth being -simply that of a sheep. It would appear, therefore, that the operation -had been in reality performed, it matters but little whether with the -tooth of a sheep or with one of another kind. - -JOURDAIN was another eminent writer on dental matters, at this period. -Rather than a true surgeon-dentist like Fauchard and Bourdet, Jourdain -was a general surgeon who had dedicated himself with particular -predilection to the study and treatment of oral and maxillary diseases. -And precisely for this reason his writings, although of great -scientific importance, are far from possessing for dental art, properly -so-called, the same value as the works of Fauchard, Bourdet, and other -great dentists of the eighteenth century. His works, as Geist-Jacobi -justly observes, give us the impression of his having been a theorist -rather than a practical dentist. - -In 1759 Jourdain described in the _Journal de Médecine_[488] an -improved pelican and another instrument to be used for straightening -teeth inclined inward. Two years later he published his treatise on -the diseases of Highmore’s antrum and on fractures and caries of the -maxillary bone.[489] After this, appeared his book on the formation of -the teeth.[490] He therein describes with great accuracy the dental -follicle from its first appearing to the moment of birth, following -it throughout its evolution. This lengthy book is most interesting, -for it is not a mere compilation, but gives the results of personal -research and experience. But by far the most important of all the works -of this author is his treatise on the diseases and surgical operations -of the mouth.[491] This book went through several French editions, -was translated into German in 1784, and has had, besides, two English -editions in America of comparatively recent date, that is, at Baltimore -in 1849, and at Philadelphia in 1851; all of which proves the great -value of the work; it treats, however, much more of general surgery -of the mouth and neighboring regions than of dental art properly so -called. The first volume of 626 pages is almost entirely dedicated -to the diseases of the maxillary sinus, which, for this author, were -ever the object of favorite and particular study. He is not in favor -of carrying out irrigation of the antrum through the mouth, even when -an alveolar opening has resulted spontaneously through the extraction -of a decayed tooth; he prefers instead, whenever this is possible, the -reopening of the nasal orifice, by means of sounds and cannulæ adapted -for the purpose, that is, varying in thickness and in length, and -curved according to the necessities of the case. The natural opening of -the antrum being reëstablished, one irrigates the cavity through it by -means of a cannula to which a small syringe has been screwed. When the -teeth are sound, notwithstanding the diseased condition of the antrum, -Jourdain is absolutely contrary to the performing of the Cowper-Drake -operation. When, on the contrary, the malady owes its origin to decayed -teeth, Jourdain extracts them, but, as already said, carries out the -detersive and medicated injections through the natural opening. - -The author divides the collections of the maxillary sinus into purulent -and lymphatic. The purulent are painful and corrode the bone, the -lymphatic are not painful and do not corrode the bone, but distend and -soften it, producing external tumefaction which yields to pressure, -and, on this being diminished, gave out a characteristic sound. These -so-called lymphatic gatherings referred to by Jourdain are none other -than mucous cysts of the maxillary sinus. Also the other diseases -of Highmore’s antrum (polypi, etc.) are taken by this author into -attentive and minute consideration. - -The second part of the work is dedicated to the other diseases of the -maxillary bones (especially of the inferior one), as well as to those -of the lips, cheeks, salivary ducts, gums, frenum linguæ, etc. Dental -hemorrhage and difficult dentition are also spoken of in this volume. - -The author relates, with regard to the latter subject, that he had -observed, in corpses of infants who had succumbed to a difficult -dentition, that the crowns of the erupting teeth were covered by the -alveolar margins folded upon them. This, according to him, must be the -reason why even lancing of the gums proves useless in some cases of -difficult dentition; it is therefore necessary, whenever it is possible -to recognize the existence of this state of things, to destroy the bony -margins that oppose the erupting of the teeth; the author declares that -he has frequently done this, with fortunate results. - -In 1784 Jourdain published a treatise on artificial dentures.[492] -He therein specially speaks of a complete denture with four springs, -perfectly adapted to the purpose of mastication. The author attributes -the merit of its invention to MASSEZ, who had imagined it toward 1772. -If we may judge, however, by what Joseph Linderer says,[493] this -denture appears to have been too complicated, even when compared with -those described by Fauchard. - -LAMORIER and RUSSEL, contemporaries of Jourdain, also studied the -diseases of the maxillary sinus, and published in the _Mémoires -de l’Académie de Chirurgie_, vol. iv, several important cases of -polypi and other diseases of the antrum. Lamorier is not in favor -of the Cowper-Drake operation. He recommends perforating the antrum -immediately above the first molars, or rather between it and the malar -bone. In this he seems to have been influenced by the considerations -that the wall of the cavity here presents the least thickness, and that -this is the most dependent part of the sinus. But he did not always -deem it necessary to make a perforation here, when a fistulous opening -had previously formed in some other place. His method of operating is -as follows: The jaws being closed, the angle of the mouth is drawn -outward and slightly upward with a curved instrument called by the -author a speculum; this done, the gum is incised below the molar -apophysis and the bone laid bare, and then pierced with a spear-pointed -punch. The opening is afterward enlarged if found necessary. - -Several contributions to the knowledge of the diseases of the maxillary -sinus and their treatment were made about this time by Beaupréau, -Dubertrand, Caumont, Dupont, Chastanet, Doublet, David, and especially -by Thomas Bordenave, who published an important work on this subject, -collecting a great number of clinical cases of great interest. Speaking -of the Cowper-Drake operation, he expresses the opinion that the tooth -to be extracted is not the same in all cases, for if some one of the -teeth situated below the maxillary sinus should either show signs of -decay or be the seat of persistent pain, the choice should fall upon -that one. If, however, these teeth are all apparently sound, the one -should be chosen that, under percussion, is most sensible to pain. In -those cases in which the choice is altogether free, Bordenave prefers -the extraction of the first large molar, for the double reason that -it is generally situated in correspondence to the central part of the -cavity, and that it is separated from the antrum by a very thin osseous -lamina. In certain cases, the maxillary sinus is divided, by body -lamellæ, into various cavities, and then, as one easily understands, -it may be necessary to extract more than one tooth for the evacuation -of the pathological contents. When the teeth situated below the antrum -have fallen out, or have been extracted some time, and their alveoli -are in consequence obliterated, it will be better to have recourse -to Lamorier’s method. This method may besides be useful, according -to Bordenave, either when all the teeth are sound and it would -consequently be a pity to sacrifice any of them, or in special cases -(such as large polypi of Highmore’s antrum, extraneous bodies, etc.) in -which the Cowper-Drake operation would not afford sufficient space. - -L. B. LENTIN, a German, in 1756, published a pamphlet[494] in which -he recommended electricity as a means of cure for toothache. Other -writers recommended the use of the magnet, which means of cure had -already been advised for various affections by Patacelus. During the -latter half of the seventeenth century, Talbot, J. J. Weckes, and P. -Borelli related several cures of headache and toothache by the use of -the magnet. In the eighteenth century F. W. Klaerich, a medical man -in Göttingen, wrote that he had used the magnet advantageously in not -less than 130 cases of toothache.[495] We find it recommended later by -others, Brunner, and particularly J. G. Teske, who, in 1765, wrote a -pamphlet entitled _New experiments for the curing of toothache by means -of magnetic steel_.[496] - -He considers the use of the magnet as the most efficacious of all -remedies against toothache, and believes its action to be similar to -that of electricity. - -In the following year, however, the belief in the new means of cure was -sensibly shaken by F. E. Glaubrecht, who declared that although the -magnet calms or causes the cessation of the pain at first, it returns -constantly and with much greater violence.[497] The curing efficacy -of the magnet in cases of toothache was highly vaunted in France by -Condamine.[498] - -PASCH attributes the effects of the magnet to the chill produced in the -parts to which it is applied; in proof of this he adduces the fact that -if the magnet becomes heated by being kept some time in the hand, it -loses its efficacy altogether, whilst on the other side one may obtain -the very same beneficial results with a simple steel spatula, just on -account of the action of the cold; finally, he adds that the chill -produced by the magnet on the affected part explains very well not only -the good, but also the bad effects which it produces in many cases, -such as increase of the pain, inflammation, tumefaction, and even at -times spasmodic contractions.[499] Thenceforth the enthusiasm for the -magnetic cure diminished gradually, all the more so inasmuch as that -shortly after the celebrated English dentist Thomas Berdmore ridiculed -it by placing it in the same class as charms, exorcisms, and other -foolish and superstitious means of cure.[500] - -ADAM ANTON BRUNNER. One of the most distinguished German dentists in -the second half of the eighteenth century was Adam Anton Brunner. His -two principal works are the _Introduction to the science necessary -for a dentist_,[501] and the _Treatise on the eruption of the milk -teeth_.[502] - -This author falls into various errors with regard to deciduous teeth. -According to him they are twenty-four in number, and without roots; but -these may develop in those milk teeth which in exceptional cases remain -in their places after the period in which they generally are shed. - -A milk tooth, says Brunner, ought never to be extracted unless there be -manifest signs of the presence of the corresponding permanent tooth, or -when it is painful and decayed. Badly grown teeth can often be put in -order solely by the pressure of the fingers frequently repeated, but -when this is not sufficient, one must have recourse to waxed threads or -to special contrivances. - -In applying a pivot tooth, he screws the pivot to the artificial crown -and perforates the root canal only just sufficiently to admit the other -extremity, which he drives in by little strokes of a hammer upon the -crown, without its being necessary to use cement. We learn from this -author that in his time there were turners and other craftsmen who -occupied themselves with dental prosthesis.[503] - -Brunner prefers gold for fillings to any other substance whatever. - -J. G. PASCH, whose name we have already mentioned, relates the case of -a young maidservant becoming suddenly affected with deafness, and who -recovered her hearing completely on the eruption of one of her wisdom -teeth. From a passage of this author’s we learn that at that time -many had recourse to the crushing of the infra-orbital nerve as a cure -for certain cases of toothache. He, however, decidedly rejects such a -remedy, as it proves for the most part ineffectual and may, besides, -produce very serious consequences. This author carried out many -experiments as to the effects of acids on the teeth.[504] - -C. A. GRÄBNER[505] recommends not deceiving children by extracting -their teeth unexpectedly, but rather to persuade them of the necessity -of the operation; for by deceiving them one loses their confidence, and -in many cases inspires them with an invincible aversion to the dentist. - -This author invented a so-called “calendar of dentition,” for the -purpose of showing at a glance the period of eruption of each of -the deciduous and permanent teeth, and as well for noting down the -time at which the various teeth are changed, so as to avoid every -possible error in this respect. This calendar consists of a figure or -diagram representing the two dental arches, with transversal lines -that separate the different teeth one from the other, the relative -indications being also given. - -The observations of this most sensible and conscientious dentist with -regard to the extraction of teeth are worthy of note: “The haphazard -pulling out of a tooth is an easy enough thing; the only requisites for -doing this are impudence and the audacity natural to the half-starved -charlatan. But to carry out the extraction of a tooth in such a manner -that, whatever be the circumstances of the case, no disgrace may accrue -to the operator or damage to the patient, requires serious knowledge, -ability, and prudence.” - -RUEFF relates the case of a man, aged forty years, who, having made -use of fumigations of henbane seeds to relieve himself of violent -toothache, obtained the desired end, but at the same time lost his -virile power. He, however, reacquired his force by the care of the -author.[506] - -THOMAS BERDMORE was the dentist of George III of England, and one of -the first and most eminent representatives of the dental art in that -country. Before him, no one had had the appointment of dentist to -the royal family. In the year 1768 he published an excellent work on -dentistry,[507] that was translated into various languages and went -through many editions; the last of these appeared in Baltimore in the -year 1844, that is, seventy-six years after the first English edition—a -splendid proof of the worth and fame of this work. - -Berdmore contributed to the progress of dentistry in England not only -by his writings, but also by imparting theoretical and practical -instruction to many medical students desirous of practising dental art -as a specialty.[508] One of these was ROBERT WOOFFENDALE, who went to -America in the year 1766, and was the first dentist whose name is there -recorded. - -Berdmore considers as the principal advantage of the application of -single artificial teeth the support they afford to the neighboring -ones. Although in no way an impassioned partisan of dental grafting, -like his contemporary, the celebrated surgeon Hunter, he, nevertheless, -sometimes had recourse to replantation, recognizing the advantages to -be derived from this operation, provided it be ably and opportunely -carried out; but he was decidedly averse to transplantation. Before -definitely inserting a gold filling, Berdmore considers it a good -practice to try the tolerance of the tooth with a temporary filling -of cement or some other like substance. His experiments as to the -action of acids on the teeth are most interesting. He found that nitric -acid destroys the enamel in a quarter of an hour; muriatic acid acts -almost as rapidly, but with the difference that it also alters the -color of the interior parts; sulphuric acid renders the teeth very -white, and, even if used for three or four days, only destroys a small -portion of the dental substance, but by reason of its action the enamel -becomes rough and can be easily scraped away with a knife. Remarkable -experiments on this subject were also made later by Kemme.[509] - -PIERRE AUZEBI, a dentist at Lyons, published a treatise on odontology -in 1771, which is only remarkable for certain strange ideas that he -therein exposes, the entire book being in complete contradiction with -the great progress already realized, at that period, in dental science. -Auzebi likens the human body to a hydraulic machine, formed by the -union of solid and liquid parts. For him the bones are merely _folded -membranes_ and the teeth are _bones composed of small membranes_. The -author declares that he is unable to admit the theory of germs in the -genesis of the teeth because “these germs, being all in identical -conditions as to heat and moisture, ought all to develop at the same -time like the grains of corn in a field.” Rather than having their -origin from special germs, the teeth, he says, are derived from -lymph, this being, according to Auzebi, the fundamental substance -from which all the hard parts of the body are generated. A drop of -lymph gathered at the bottom of the alveolus hardens and constitutes -the first beginning in the formation of the teeth. Beneath this other -lymph is gradually collected, which pushes upward and the part of the -tooth already formed, surrounds the dental vessels, and thus becomes -the root of the tooth. To facilitate dentition he recommends, among -other things, rubbing the gums with hard, rough, and angular bodies. -He also maintains, as does Brunner, that the milk teeth have no roots, -contradicting, in this respect, the opinion of Fauchard, of Bunon, of -Bourdet, who decidedly affirm that the deciduous teeth are furnished -with roots, precisely the same as the permanent ones. According to -him, when it so happens that the milk teeth have roots, they are not -shed. To calm toothache, the author recommended a sedative elixir, -the aspirating of a few drops of which sufficed to obtain the desired -effect.[510] - -JOHN AITKIN, in 1771, perfected the English key, so as to render the -extraction of the teeth easier and to avoid the danger of fracturing -the alveolus or the tooth itself, and of injuring the gums.[511] - -FRÈRE CÔME, a celebrated French surgeon, also contributed to the -perfecting of this instrument.[512] - -In 1771-72, Fr. L. Weyland and Henkel recorded some very important -cases of diseases of Highmore’s antrum.[513] - -W. BROMFIELD, in a collection of surgical observations and cases -published in London in the year 1773, also speaks of affections of the -maxillary sinus. He says that he has had opportunity of persuading -himself that the purulent gatherings of this cavity not unfrequently -discharge spontaneously during the night, finding their exit through -the natural orifice of the antrum, when the body is in the horizontal -position.[514] - -JOHN HUNTER, the celebrated surgeon, must be named among the most -illustrious champions of odontology in England. He was born February -13, 1728. His first instructor in medical studies was his brother, -William Hunter, a scientist of great merit, whose school of anatomy in -London was attended by numerous students from all parts of the British -Kingdom. Under so excellent a guide John Hunter made rapid progress, -and in less than twenty years became the most famous physiologist and -professor of surgery of that day. He was surgeon-general to the English -army. - -His _Natural History of the Human Teeth_ (London, 1771) and his -_Practical Treatise on the Diseases of the Teeth_ (London, 1778) -initiated in England a new epoch for the dental art, which, abandoning -its blind empiricism, began to take its stand on the basis of rigorous -scientific observation. - -But although Hunter’s merits were great with respect to the scientific -development of odontology, we must remember that he was a general -surgeon, and not a dentist, and that precisely for this reason he had -not, neither could he have, other than a restricted personal experience -relative to the treatment of dental diseases. This explains why the -anatomical and physiological part of Hunter’s works on the teeth is so -far superior to the part concerning practical treatment. - -Indeed, in the field of practice, this author often falls into grave -contradictions, and is frequently hesitating and uncertain on important -points of dental therapeutics. - -Hunter gives a very long and detailed description of all the parts -constituting the oral cavity and the masticatory apparatus. He sought -to establish a scientific nomenclature for the teeth, and in fact the -denominations of _cuspidati_ for the canine teeth and of _bicuspids_ -or _bicuspidati_ for the small molars originated with him. Hunter says -that the enamel of the teeth is a fibrous structure, and that its -fibers depart from the body of the tooth like rays. He believes it -to be entirely inorganic, as it is absolutely impossible to convert -it into animal mucus. The tooth is constituted for the most part by -a long mass (it is thus he calls the dentine), which is, however, -much harder and denser than any other bone. This part of the tooth is -formed of concentric lamellæ, and is vascular, as is proved by the -exostosis of the roots and the adhesions that exist at times between -the roots and the alveoli. Hunter gives a good description of the -pulp cavity and of the pulp itself. He studied odontogeny with great -care, as is demonstrated by his special researches on this point. He -admits the existence of distinct germs for the enamel and for the -dentine. According to him the incisors are formed from three points -of ossification, the canines from one, and the molars from three -or four. The tooth after its eruption is an extraneous body “with -respect to a circulation through its substance, but they have most -certainly a living principle by which means they make part of the -body, and are capable of uniting with any part of a living body.” The -milk teeth, says Hunter, are not shed by a mechanical action of the -second teeth, but by an organizing law of Nature. The physiology of -the masticatory apparatus is treated by Hunter with great accuracy and -most extensively. This author combats, by many arguments, the opinion -that the teeth grow continually; he explains the apparent lengthening -of those teeth whose antagonists are wanting, by the tendency of -the alveoli to fill up, which, however, is not possible in normal -conditions, because of the constant pressure exercised upon the teeth -by their antagonists. - -Caries, says Hunter, is a disease of altogether obscure origin; it is -not owing to external irritation or to chemical processes, and seems to -be a morbid form altogether peculiar to the teeth. Only in very rare -cases does it attack the roots of the teeth. It rarely appears after -fifty years of age. Hunter does not admit that this disease may be -communicated by one tooth to another. As to its treatment, the caries, -if superficial, may be completely removed by filing the decayed part -of the tooth before the disease penetrates to the cavity, and its -spreading will thus be arrested for a time at least. In cases where -the caries penetrates to some depth, without, however, the destruction -of the crown of the tooth being so extensive as to render it useless, -Hunter believed the best mode of treatment to be extraction and -replanting of the tooth after having subjected it to boiling in order -to cleanse it perfectly and to destroy its vitality entirely, this -being, according to him, the mode of preventing the further destruction -of the tooth, which once dead can no longer be the seat of any disease. -If, instead, one wishes to have recourse to cauterization of the -nerve, it is necessary to reach as far as the apex of the root; which, -however, is not always possible. This is a very important point, for no -one before Hunter had yet affirmed the necessity of entirely destroying -the diseased pulp as an indispensable condition of the success of the -filling to be later carried out in order to conserve the tooth. - -Hunter is extremely concise when speaking of the filling of teeth; -considering the great importance of this argument, his conciseness can -only depend on his having had no personal experience in the matter. He -considers lead preferable for fillings. - -The frequent occurrence of erosion of the teeth, whether of the -cuneiform variety or of other kinds, did not escape the attention of -this acute observer, but he was not able to give any explanation of it. - -In cases of empyema of Highmore’s antrum, Hunter advises the opening of -the cavity through the alveolus of the first or second large molar. - -Periodontitis is classified by the author among the diseases of the -alveolar process. He occupies himself with this affection at great -length, seeking to explain the mode in which it is produced. He -distinguishes two forms of the disease, according to whether or not -there be exit of pus from the alveolus. The alveolar process is, -in his opinion, the principal seat of the disease, to which, as a -complication, is added the retraction of the gums. For the diseased -alveolus the tooth becomes, in a certain manner, an extraneous body, of -which it tends to rid itself. The alveolar margins undergo absorption; -the bottom of the alveolus tends to fill up, analogously to what occurs -after extraction, and the falling out of the tooth ensues as a natural -consequence of this process. An altogether similar process, producing -the falling out of the teeth, is the normal consequence of senility. - -The author considers that the malady in question has as its point of -departure an irritation caused by a tooth; and as almost a proof of -this he relates a case in which the extraction of the affected tooth, -an upper incisor which became too long, and the transplantation of -another tooth caused the cessation of the morbid process and the -perfect consolidation of the transplanted tooth. However, Hunter does -not draw from this isolated case the conclusion that transplantation -may be elevated to a method of cure for this malady. Indeed, he says -that, so far as is known to him, there is no means of prevention -or of cure for it. His treatment, therefore, is merely directed to -the curing, in so far as is possible, the phlogistic symptoms, by -scarifications of the gum and by the use of astringent remedies. He -does not exclude the possibility of a complete recovery, but the mode -in which this obtains seems to him as obscure as is the nature of the -disease itself. - -In speaking of the correction of dental irregularities, Hunter advises -not to extract the milk teeth unless this be an absolute necessity. -He says, besides, that it is useless to extract any tooth whatever, -unless one endeavors at the same time to force the irregular tooth or -teeth into their normal position by exercising the requisite pressure -upon them. In young subjects the regulating of crooked teeth is an easy -matter, because of the softness of the maxillary bone. However, it -should not be undertaken before all the bicuspids have come through. -To correct protrusion of the upper jaw, the author recommends the -extraction of a bicuspid on each side. To regulate the incisors it is -sometimes necessary to make them rotate on their axis with the forceps. -In certain cases of protrusion of the lower jaw one may have recourse -with advantage to the inclined plane. - -As a general rule, it is useless to lay bare a tooth with the -lancet before extracting it, although in certain cases this may be -advantageous in order to render its extraction easier and less painful. - -Hunter was a strenuous partisan of replantation and transplantation of -the teeth; he made various experiments on animals, and treated this -important argument with particular fulness and much better than had -been done up to then by others. - -In cases of difficult dentition he considered incision of the gums most -useful and, if necessary, to be had recourse to several times. - -FOUCOU, the French dentist, in 1774, made known a compressor invented -by him for arresting hemorrhage ensuing on the extraction of teeth. -This instrument, which could be used for either jaw, exercised its -pressure not only in a vertical direction, but also laterally, and -did not give much inconvenience to the patient. Carabelli, who wrote -seventy years later, speaks with praise of Foucou’s compressor, which -he considers the best instrument of its kind. - -COURTOIS, in his book published in 1775,[515] says that the enamel -of the teeth only reaches its perfection of development at twenty -to twenty-two years of age, and begins thenceforward to wear away -gradually. In speaking of the enamel, he advises avoiding the use of -the file as much as possible. This author’s book is interesting for the -many important clinical cases it contains. - -WILLICH, in 1778, related a most curious case relating to a woman, -aged forty years, who had never had her menstrual function, but -had, nevertheless, given birth to two children; the extraction of a -tooth was followed by an alveolar hemorrhage that lasted an hour; -thenceforward, this hemorrhage recurred regularly each month, for the -space of eight years. - -BÜCKING, in 1782, published a _Complete Guide to the Extraction of -the Teeth_,[516] wherein he minutely describes all the instruments, -their use, the position of the operator and of the patient, indicating -at the same time the instruments best adapted for the extraction of -each tooth. He declares himself averse to the practice of subluxation -as a means of cure for toothache, a method which, first recommended -by the Arab physician Avicenna, and later, in the sixteenth century, -by Peter Foreest, had fallen into oblivion for a long time, and was -again brought into credit by two celebrated French dentists, Mouton -and Bourdet, the latter of whom relates having had recourse to it -successfully in not less than six hundred cases. - -Notwithstanding the high authority of this illustrious dentist, Bücking -does not consider this method of cure advisable, adducing, however, -in support of his opinion, arguments of no great value, viz., that -teeth after subluxation continue painful for a certain time, and that -they always remain in an oblique position. The method in question, -which has the effect of breaking the dental nerve, is, in our opinion, -practically equivalent to a replantation, or is, in point of fact, a -replantation, when the luxation of the tooth is complete. The arguments -that Bücking brings forward against it are futile; the first objection, -for the most part, does not subsist, and, in any case, the persistence -of pain for a short time would be of small importance compared with the -great advantage of preserving the tooth; as to the second, it is to be -understood of itself that subluxation performed by means of the pelican -(the instrument then used for the operation) would cause the tooth to -assume an oblique position; but even supposing it did not straighten -up of itself, there could not have been any difficulty for the good -dentists of that period in forcing the tooth again into normal position -and in maintaining it there. The weak side of the operation consisted -rather in the fact of its being probably carried out without due -consideration of the dangers resulting from the possible alterations of -the dental pulp. - -At the time of which we are writing many believed that the enamel -of the teeth could be regenerated altogether or in part, and that, -therefore, it was of no great consequence that it should be worn -away by the use of the file or of abrasive dentifrice powders. Thus, -for example, the renowned surgeon Theden expressly recommended such -powders, as the best adapted for cleaning the teeth and for freeing -them from tartar.[517] - -VAN WY,[518] the Dutch surgeon, in 1784, related two cases of -regeneration of the maxillary bones; other cases of the same kind were -related some years later by Percy and Boulet.[519] - -CHOPART and DESAULT recommended, in cases of difficult dentition, the -excision of the gum in correspondence with the teeth that are to come -out, rather than simple incisions.[520] - -[Illustration: Antonio Campani.] - -[Illustration: FIG. 96 - -Pelican for extracting incisor, canine, and molar teeth (Campani, -1786).] - -ANTONIO CAMPANI, of Florence, published in 1786 a treatise on -dentistry,[521] very elegantly printed, and illustrated with thirty-six -plates very neatly carried out. This book, however, contains nothing of -real importance for the development of dentistry. - -BENJAMIN BELL, the English surgeon, a contemporary of Hunter, also -devoted much attention to diseases of the teeth, and, if it may be -argued from the clear and precise manner in which he expresses his -opinions on various questions relating to dental pathology and therapy, -it would seem that he had much greater experience in this field than -the celebrated Hunter. - -[Illustration: FIG. 97 - -Pelicans for extracting wisdom teeth (Campani).] - -With regard to incision of the gums, in cases of difficult dentition, -this author contradicts certain assertions of the German surgeon -Isenflamm (1782), who argued that when the tooth is already to be -perceived through the gum, the incisions are altogether useless, while -if the tooth be still at some depth, the gingival incision will soon -close again, so that the cicatrix will render the eruption of the -tooth still more difficult. Bell admits, too, that lancing the gum is -altogether superfluous when the tooth has pierced the tissue, all the -more so that the accidents provoked by the eruption are then generally -already passed and gone, but the operation ought, in his opinion, to -take place much earlier; and should the wound close again before the -tooth has erupted, the gum must be lanced a second time. - -[Illustration: FIG. 98 - -Campani’s forceps: The first for molar teeth when loose or after having -been shaken with the pelican; the second for deciduous teeth.] - -Bell contradicts the opinion of Jourdain and Hunter that the morbid -gatherings of Highmore’s antrum are generally consequent upon the -closing of the normal opening of the cavity in the middle meatus. In -many cases of disease of the maxillary sinus this orifice remains -open, the liquid therein collected discharging itself not unfrequently -through it, in certain positions of the body. Instead of penetrating -into the antrum through the nasal orifice, as Jourdain would have -it, Bell advises opening the cavity by Lamorier’s, or, better still, -by Drake’s method. Except in special cases, the first or second molar -ought to be extracted, but preferably the second. After trepanning the -alveolus and emptying the cavity, the opening should be closed with a -conically shaped peg to prevent its slipping into the cavity. From time -to time the liquid that tends to reaccumulate should be allowed exit, -and detersive injections should be made, preferably of lime water. - -[Illustration: FIG. 99 - -Two key instruments with changeable hooks (Campani).] - -Looseness of the teeth, which in old age may be considered a normal -condition, is always a disease when it occurs in youth. In certain -cases its cause is unknown, in others it depends on an affection of the -gums, either of a scorbutic nature or consequent on an accumulation of -tartar. - -[Illustration: FIG. 100 - -An instrument especially destined to extract loose bicuspid teeth. The -screw in the interior of the instrument allowed the hook to be brought -to just the right point in each case (Campani).] - -According to Bell, dental caries is generally owing to a bad condition -of the humors of the entire body and to a peculiar morbid disposition, -rather than to external causes acting locally, although these latter -may contribute, together with the general causes, to the producing of -the disease. - -[Illustration: FIG. 101 - -Campani’s dental cauteries: The large ones for cases of post-extractive -hemorrhage; the small ones for the cauterization of carious cavities.] - -[Illustration: Nicholas Dubois Dechémant.] - -This author was decidedly averse to the use of the file. For stopping -carious cavities he advises the use of mastic, gum lac, or wax, -if the cavity is large and funnel-shaped; this stopping, however, -requires to be renewed frequently. But when the cavity, wider at the -bottom, narrows toward the surface, one ought to use gold or, still -better, tin-foil. The pulp ought always to be destroyed previously by -cauterization. - -Bell advises great caution in carrying out transplantation, it having -been proved by many examples that contagious maladies of a serious -nature may easily be communicated in this way from one individual to -another.[522] - -In the case of a young woman who had an upper incisor transplanted, -WATSON observed undoubted symptoms of syphilitic infection with -supervening accidents of exceptional gravity, which in spite of careful -treatment ended in death.[523] - -Hunter also relates having observed, in seven cases of transplantation, -very serious accidents which, however, he did not believe to be owing -to syphilis, although bearing a certain symptomatic resemblance to it. -Contrariwise, the well-known German surgeon Richter not only admitted -the possibility of transmitting syphilis through a transplanted tooth, -but even that the transplantation of an altogether healthy tooth from -the mouth of a person undoubtedly free from syphilis might be followed -by serious accidents of a syphilitic nature, and this because the -possible existence of a latent syphilis in the person to whose mouth -the tooth was transplanted cannot be excluded; in which case the -abnormal stimulus exercised by the transplanted tooth might very well -give rise to syphilitic manifestations. Therefore, the fact that the -person who furnished the tooth was and continued to be in a state of -perfect health (as precisely in the case cited by Watson) would not -be sufficient proof that the accidents ensuing on the transplantation -might not be of a syphilitic nature. - -LETTSON also observed, in certain cases of transplantation, accidents -of more or less gravity which he held to be due to syphilis, calling, -however, to mind a case cited by Kuhn, of Philadelphia, where the -possibility of syphilis was not to be thought of, as the morbid -symptoms disappeared entirely, without any treatment, as soon as the -transplanted tooth was removed.[524] - -AUGUST G. RICHTER, the above-named German surgeon, in those portions -of his work dedicated to dental affections and diseases of Highmore’s -antrum, treated these subjects with admirable clearness and order, -without contributing, however, anything original to the development of -dental surgery.[525] - -NICHOLAS DUBOIS DE CHEMANT, in 1788, of whom we shall later have -occasion to speak again, published in Paris his first pamphlet on -mineral teeth, entitled _Sur les avantages des nouvelles dents, et -rateliers artificiels, incorruptibles, sans odeur_. - -JEAN JACQUES JOSEPH SERRE (1759 to 1830). Among the dentists of the -end of the eighteenth century and the beginning of the nineteenth, a -special mention is due to Jean Jacques Joseph Serre. He was born at -Mons, in Belgium, but his remarkable practical and scientific activity -was chiefly called into exercise in Vienna and in Berlin. He published -several works, the most important of which is a practical treatise on -dental operations.[526] - -Among his minor works, one edited in Vienna, in 1788, treats of -toothache during pregnancy; another, printed in Leipsic in 1791, treats -most extensively of diseases of the gums; a third speaks of the mode of -maintaining the teeth and gums in good condition. This little book of -dental hygiene, like the rest of Serre’s books, met with great favor, -and went through two editions in a brief space of time (Berlin, 1809 to -1812). - -The works of this author show great study, very wide practice, and an -admirable spirit of observation and research. They had the merit of -greatly contributing to raise the level of dental culture in Germany, -and one finds in them a pretty nearly complete account of the dentistry -of that period. Apart from this, they possess a special interest -because of the vast number of dates and important historical facts -therein contained. - -As it would be useless here to enter into a minute analysis of the -contents of these books, we will limit ourselves to mentioning a few -ideas of which Serre was a strenuous supporter. - -He combats an old prejudice that had recently been reinforced by the -authority of Jourdain, that is, that it does harm to extract a tooth -when the soft parts around it are inflamed and swollen. He likewise -combats the prejudice, also of very ancient date, that teeth ought not -to be extracted during pregnancy. Only, he considers it as well to -avoid the cauterization of the dental pulp in cases of gestation. In -extracting teeth, the forceps ought only to be used after the tooth has -been luxated by means of the pelican. Serre highly approves of this -instrument, although he recognizes it to be a dangerous one in the -hands of those who do not know how to make a proper use of it. This -author invented or perfected various extracting instruments, among -which a conical screw for extraction of roots hollowed out by caries -deserves particular mention, and which, under a somewhat modified form, -is still in use. - -[Illustration: Jean Jacques Joseph Serre.] - -One of the most interesting chapters of Serre’s great work is the one -in which he treats of affections of Highmore’s cavity.[527] He speaks -at length of the anatomy of the maxillary sinus, of its relation to the -teeth situated below it, of the various modes in which the diseases -of the antrum are produced, of their symptoms and treatment. He passes -in review the various operative methods, and finds that in general the -Cowper-Drake is the one to be preferred to all the others. He says -that to open the sinus the simple extraction of a molar suffices in -the greater number of cases, the trepanning of the alveolus not being -generally necessary. - -J. ARNEMAN, in 1766, published at Göttingen a synopsis of surgical -instruments[528] that deserves mention in so far that the dental -instruments of that time as well as those of earlier periods are -therein taken into account with sufficient exactness. - -A. F. HECKER attributed the accidents of difficult dentition to a -special alteration of the saliva caused by the irritation deriving -from the erupting teeth. In these cases the saliva is supposed by him -to acquire a high degree of acridness and to become almost similar to -the poison of rabies. Departing from this theory, the author declares -it to be necessary to mitigate the irritation produced on the gums -and other parts of the mouth by the altered condition of the saliva, -as well as to modify the quality of the saliva itself and to promote -the elimination of the same from the body by emetics and aperients. -According to him, liquid carbonate of potash administered in drops, -together with syrup of poppy heads, manna, etc., is a most useful -remedy, having specially for its effect to diminish the acridness of -the saliva. - -Besides this remedy, the author extols the use of blisters behind the -ears, as also of tepid baths, which calm pain and spasms, favor the -excretions, and procure repose and sleep. He rejects the incision of -the gums as altogether useless, and is most opposed to the use of -opium, which he states renders children liable to apoplexy. - -And here we will mention, rather by way of curiosity than for any real -historical interest which they possess, two pamphlets on _odontitis_, -published respectively in 1791 and 1794 by Ploucquet and Kappis, who -maintained that not only the dental pulp, but all the parts that form -the tooth are susceptible of inflammation.[529] In Kappis’ pamphlet -we find the following ideas developed, upon which we do not think -necessary to comment. The inflammatory process consists essentially -in the increased flow of humors to a given part and in a more or less -intense reaction of the vital force. Both of these things may take -place in the teeth. These are liable to swell, that is, to undergo -an increase of all their dimensions, in proof of which assertion the -author relates the case of an individual, who when attacked by a -violent toothache had found the spaces between his teeth so narrowed -that it was no longer possible to make use of his usual toothpick, -even if he had tried to do so regardless of pain. But when the -toothache was over, the same toothpick again became serviceable as -before. He says that there is no cause for wonder that in odontitis no -redness of the teeth is to be perceived, for in other inflammations -as well, redness is wanting, and, moreover, it exists in the interior -membrane of the tooth. As in other inflammations, so also in odontitis, -the usual issue is resolution. Dental fistulæ may derive from internal -suppuration. The impurities deposited on the teeth are by him supposed -to be owing to an increase of their secretion! According to the author, -caries, the breaking down of teeth apparently healthy, as well as -their falling out, is generally caused by an inflammation of these -organs, that is, by odontitis, an affection that, he says, may be of -very varied kind, the principal forms being the rheumatic, arthritic, -sympathetic, and gastric. - -RANIERI GERBI.[530] In a book by this author we find recommended a -very singular cure for toothache, even of the most violent nature. It -is in no way scientific, and is besides not particularly pleasant, -notwithstanding that the author, professor at the University of Pisa, -was a scientist of merit, enjoying special esteem as a mathematician -and cultivator of natural sciences. - -Under the name of _curculio anti-odontalgicus_ he describes an insect -living habitually inside the flowers of the _carduus spinosissimus_, -that could be used with great advantage against toothache, in the -following manner: One crushes fourteen or fifteen larvæ of the insect -between the thumb and forefinger, and then rubs the two fingers -together until the matter remaining upon them is entirely absorbed. -Instead of the larvæ (which, as is known, represent the first stage -of insect life) one may also use the fully developed insects. One -then applies the two fingers that have crushed the insects or their -larvæ upon the decayed and aching tooth. If the pain is of a nature -to be cured by this means, it diminishes almost instantaneously, -and ceases altogether in a few minutes. It is said that the fingers -preserve their healing power for a great length of time, even a whole -year, and in proof of these assertions Ranieri Gerbi speaks of no -less than six hundred cures performed! Other insects besides the -_curculio anti-odontalgicus_, used in the same manner, are said to -possess the same curative properties, among them the _curculio jaceæ_, -_carabus chrysocephalus_, and the _curculio Bacchus_, which last, -says Gerbi, has long been used for this purpose by the peasants of -Tuscany. The author also says that some German doctors and naturalists -experimented with success with several insects indigenous to Germany -as remedies against toothache. These insects, also mentioned in a -work published in Bayreuth in 1796, author unknown, are:[531] the -_coccinella septempunctata_, the _coccinella bipunctata_, the _carabus -ferrugineus_, the _chrysomela sanguinolenta_, the _chrysomela populi_, -the cantharis or Spanish fly, and others. Later on, Hirsch also -extolled the healing power of another insect, the _cynips rosarum_. -With regard to the mode of application, Gerbi says that instead of -crushing and rubbing these insects or their larvæ between the fingers, -one can use a piece of wash leather in a similar manner. - -It is to be observed, however, that the insects that are found -generally in the ripe wild teasle—or more precisely their larvæ—had -already been used for a long time as a remedy against toothache; -indeed, we even find these means of cure recommended in the natural -history of Pliny. In a book entitled _Histoire d’un voyage aux îles -Malouines fait en 1763 et 1764_, by a certain Dom Pernetty, this -author speaks of some remedies made known to him by the Superior of -the Franciscan friars of Montevideo; and among others one finds the -following: “One draws out the worm that is generally found in the head -of the fuller’s teasle when this is ripe. One rolls this worm between -the index finger and the thumb, lightly pressing it until it dies -of languor. The one or the other of the two fingers applied on the -aching tooth will have the virtue, for a year at least, of making the -toothache cease.”[532] - -HEINRICH CALLISEN, in an excellent treatise on surgery[533] published -at Copenhagen in 1788, writes at sufficient length and with great -accuracy on dental and maxillary diseases. According to this writer, -it rarely suffices to trepan one alveolus for the treatment of the -morbid collections of Highmore’s antrum, as the maxillary sinus is -very often divided by partitions into various cells, so that in order -to give exit to the pus contained in each of them, it is necessary to -extract several teeth and trepan their alveoli.[534] One ought not, -therefore, to give the preference to this method, unless in the case of -the teeth in question being decayed. But should they all be in a good -state, or should a large opening be necessary because of the nature -of the disease in the cavity, it will be better to follow Lamorier’s -method, that is, to incise the gum crosswise under the malar process -and then, after scraping away the periosteum, trepan the bone. Further, -in the case of the disease in the maxillary sinus having given rise to -tumefaction, softening of the bone, and fluctuation in the palatine -region, it is precisely there that the perforation ought to be carried -out. To prevent the reclosing of the opening before the cure is -completed, the author advises the use of pledgets, small bougies, a -piece of prepared sponge, or even a small tube. According to Callisen, -the injections through the nasal orifice of the maxillary sinus are -partly impracticable, and partly of no utility. - -It always does more harm than good to file or to scrape the decayed -part of a tooth, without stopping it afterward, as by thus doing, says -the author, one only renders it still more liable to the access and -the action of harmful external influences. In preparing the cavity -for stopping, the bottom of it should be more ample than its external -aperture, that the filling may remain firm. - -For extracting molars, he makes use either of the pelican or of the -key; for the incisors and the canines, of the forceps; and for roots, -of the goat’s foot. - -Callisen treats incipient _idiopathic_ epulis by destroying it through -cauterization, after having covered the teeth with wax; if the epulis -be large and more or less hard, he removes it with the bistoury; as to -_symptomatic_ epulis, he holds the removal of the original cause to be -the best mode of treatment. - -This author declares himself decidedly in favor of replantation and -transplantation, expressing the idea that these methods are always -to be preferred to the application of artificial teeth. He maintains -that after a tooth has been replanted, and its consolidation has taken -place, there is no possibility of any further pain, the nerve being -broken. The author relates a brilliant cure which he carried out upon -a lieutenant, who, during the siege of Copenhagen, had received a blow -that had sent all his front teeth into his mouth. Callisen immediately -put them all back in their places with such ability that they became -perfectly firm again. With reference to transplantation, he only -believes in its being possible for teeth with a single root. - -In works published toward 1790, Lentin and Conradi, devoted their -particular attention to the morbid conditions that produce looseness -and spontaneous falling of the teeth. For the treatment of these -conditions Conradi recommended general and local remedies. The general -remedies were directed to the suppressing of acridness in the blood, -which he considered to be an etiological element of primary importance. -As to the local remedies, they ought specially to consist in keeping -the teeth clean by the use of a toothbrush, in painting the gums with -tincture of catechu and myrrh, and in rinsing the mouth frequently with -a decoction of cinchona or of willow bark. Against toothache caused by -caries, he particularly advises essence of cloves, introduced into the -carious cavity on a piece of cotton-wool.[535] - -FRIEDRICH HIRSCH was much less disposed than were many of the preceding -writers to incision of the gums in cases of difficult dentition. -Against the accidents connected with this morbid condition, he -prefers, in general, the use of gentle aperients or of emetics, and -regards the scarification of the gums as opportune only in cases -where symptoms indicating a high degree of nervous tension manifest -themselves. - -Against incipient caries, Hirsch used simple cauterization, which -he held to be capable of arresting the morbid process, at least in -many cases. He says, however, that when a real carious cavity exists, -it is absolutely necessary to stop it; and for this purpose, rather -than metallic or resinous fillings, he prefers a cement of turpentine -and quicklime, made into a paste with varnish of oil of linseed. -Nevertheless, when it is a case of the lower teeth, tin-foil is also, -according to him, an excellent filling material. - -Like some of the preceding authors, Hirsch admitted the existence of -_interior caries_ in apparently healthy teeth, and was the first to -indicate a good mode of diagnosticating these occult dental affections. -It consists in tapping the suspected teeth with a sound until one finds -the one in which the percussion provokes pain, and this will be the -diseased tooth. One detaches the gum from the neck of this tooth, and -at the point, on the neck itself or on the beginning of the root, where -a small protrusion is found, one perforates the tooth with a chisel, -or some other fit instrument, so as to penetrate to the interior of -it. Through this passage one introduces into the tooth a fine, curved, -red-hot sound, repeating the operation several times. Lastly, one fills -the cavity with lead; and in this manner the tooth will be cured and no -longer painful. - -In speaking of the correction of dental anomalies, Hirsch relates a -case in which the deformity consisted in the union of two central -incisors, which formed one single piece, resembling a paddle, and -spoiled the appearance of the face. He divided them with a saw, -cauterized the surfaces of the section, scarified the gum, and, to -gain a little space, introduced a small wedge, until the gum had grown -up within the new dental interstice, thus giving an altogether normal -appearance to the part. - -It is noteworthy that Hirsch made use almost exclusively of the goat’s -foot for the extraction of teeth, of whatever kind they might be, the -instrument being rather longer, however, than that ordinarily known by -this name, and making his left hand serve as a lever rest. - -To arrest strong hemorrhage ensuing from the extraction of teeth, -Hirsch used scraped parchment, which he introduced into the alveolus -and pressed with force into it by means of a sound; then he superposed -compresses and kept the jaws tight together with a bandage passed -around the head. - -This author, too, was very favorable to replantation. As to -transplantation, he says that even when the gum and the alveolus are -quite healthy, the individual entirely free from scurvy and syphilis, -and not above fifty years of age, the transplanted teeth do not take -root perfectly except in an average of one case in three. For carrying -out this operation he never made use of teeth extracted from the mouth -of a living person, but, on the contrary, he used the teeth of young -and healthy subjects who had died a violent death; these were, besides, -carefully cleaned before transplanting them, and in this way the author -believed the transmission of disease to be nearly impossible.[536] - -[Illustration: FIG. 102 - -Full lower set in hippopotamus ivory, with human front teeth; -seventeenth century. (From Guerini’s collection.)] - -[Illustration: FIG. 103 - -Upper denture in ivory, at the end of the eighteenth century, for a -case in which the last molars and the front teeth were present. (From -Guerini’s collection.)] - -J. E. WICHMANN combated energetically the practice, then pretty -general, of endeavoring to facilitate the eruption of the teeth -by incision of the gums. He considered this practice as one to be -absolutely rejected, supporting his opinion on the consideration that -dentition, being an altogether physiological process, which, moreover, -takes place in parts relatively of but little importance, never can -give rise of itself alone to serious accidents. Besides this, he says, -it is very difficult to say which tooth precisely is about to erupt -and at what point. The incisions would, therefore, have to be made -by chance, which would often render the morbid condition still more -serious. - -K. A. BLUMENTHAL endeavored to confute Wichmann’s opinions, with but -little success; for, indeed, the same opinions, expressed later by J. -H. Sternberg in a more detailed manner and with ampler views of the -subject, met with ever-increasing approval. Thenceforth, the practice -of gingival incisions in cases of difficult dentition fell more and -more into discredit.[537] - -ROBERT BUNON,[538] the French dentist, is one of the most illustrious -personalities to be met with in the history of our profession. He was -born at the beginning of the eighteenth century, and devoted himself -betimes to the dental art, gathering instruction therein partly from -different dentists and partly from the few odontological books he -was able to find. In this manner he learned pretty much all that was -known at that time by dentists in general. He then decided to travel, -in order to acquire further knowledge and experience. He practised -especially in the north of France and in what is now the state of -Belgium; at Antwerp, Brussels, Givet, Maubeuge, Cambrai. In his ardent -thirst for knowledge, when he happened to pass through a town where -some dentist of note resided, he never neglected to call on him, thus -acquiring fresh information and perfecting himself as well in the -practical exercise of his profession. At the same time, his desire to -learn all that was new concerning dental art and science was so intense -that he had translations made of the medical and surgical works of -Latin, Italian, German, and English authors. However, all this reading, -although it enlarged his general knowledge, taught him nothing, or -almost nothing, about those subjects that interested him above all the -others. His practical experiences, meanwhile, brought a great number of -patients to his notice, and, being by nature a very acute observer, he -was able to establish the existence of many facts up to then unknown. -At this time he commenced his studies on dental erosion, on the -development of the teeth, and on the prophylaxis of dental maladies, -his favorite subject. “I felt,” he writes, “that the necessity of -having recourse day by day to the extraction of teeth resulted from -deficient knowledge on our part, and I considered this extreme remedy -as one of the greatest evils to humanity.”[539] He therefore endeavored -to extend his own knowledge in every possible way, and as one means -of doing this he visited hospitals and schools; and, ardent champion -as he was of conservative dentistry and of prophylaxis, he succeeded -in interesting medical men and surgeons, midwives and schoolmasters, -and parish priests as well, in the question of the preservation of -the teeth. The teeth he extracted he kept for the purpose of studying -the conformation, the lesions, the dental anomalies; sometimes he -split them up to examine the dental pulp. And he never neglected an -opportunity of procuring anatomical pieces that appeared interesting to -him. - -In 1728 Fauchard’s book, _Le Chirurgien Dentiste_, appeared. The fame -of this work reached Belgium, where Bunon then was, and he immediately -set about trying to get a copy of it. After searching in various towns, -he finally found one in Givet. He read it with the greatest interest, -and later, in one of his works, spoke of it in terms of highest praise. -It would seem, however, that he did not learn much that was new to -him by reading this book, which proves that he already possessed a -vast odontological culture and was also profoundly versed in technical -dentistry, which forms the most important part of Fauchard’s book. He -was somewhat astonished at finding in this celebrated author’s work -hardly anything on the subjects that principally interested him, that -is, the erosion, the development of the teeth, and the prophylaxis of -caries. This circumstance very clearly reveals the different mental -tendencies in these two great men, the one, drawn toward the practical -side of the profession which principally interests him and forms the -basis of his work, the other, an impassioned searcher into causes, and -student of prophylaxis. - -After the perusal of Fauchard’s book, Bunon, who had already conceived -the idea of publishing the results of his observations and of his own -particular studies, felt more than ever the propriety and necessity -of doing so; and to realize his idea, he established himself toward -the year 1735 at Paris. Two years later, just when the manuscript of -his work was almost finished, Gerauldy’s book appeared. Bunon relates -that he opened this book in fear and trembling; its title, _The art of -preserving the teeth_, gave him reason to fear that Gerauldy might have -profited by some of the ideas and observations he had communicated to -various persons, to write a book similar to the one that he himself had -it in his mind to publish.[540] He was able, fortunately, to convince -himself immediately that his fears of being forestalled and plagiarized -were unfounded. - -Notwithstanding, Bunon was determined not to publish his book until the -opportune moment and with all possible probability of success. With -this object in view, he made up his mind first to obtain the diploma -of surgeon-dentist. To reach this aim, he was obliged to conform to -the regulations of the _Edict of May_, 1699, which then regulated -the practising of dentistry, and this was as much as to say that he -was obliged to enter the College of Surgery, to undertake two years’ -practice with a regularly licensed surgeon, to undergo theoretical -and practical examinations, and to take oath before the Chief Surgeon -of the Realm. Once in possession of the diploma of surgeon-dentist, -he was separated thenceforward from the vulgar crowd of charlatans -and invested with all the prestige which a degree, so rarely acquired -at that time, conferred upon its possessor; but before facing public -opinion he desired to make himself known, and, so to say, first to -try his ground, by making known some of his newer ideas, and see what -reception they might meet with from his colleagues and the public in -general. He, therefore, published, in January, 1741, in the newspaper -_Mercure de France_, a letter on the so-called _eye tooth_,[541] -combating the then widely diffused prejudice that the extraction of an -upper canine constituted a grave peril to the eye. He demonstrated the -absurdity of this idea by putting in evidence the anatomical fact that -the upper canines are innervated by the infra-orbital nerve, which has -no relation whatever with the visual organ. - -Still better to further his object of making himself a name, he -published in the same year and in the aforementioned paper his -dissertation on the teeth of pregnant women.[542] There he demonstrated -the falseness of the idea that one ought never to extract teeth during -the state of gestation, and brought into relief the necessity of -treating the dental diseases of pregnant women with still more accuracy -than those of other persons. - -These publications, bearing as they did the marks of good sense, -favorably interested the public opinion. The way was therefore -prepared, and Bunon judging the moment to have come for publishing -his work, placed it in the hands of a literary man for the necessary -corrections of style. He also showed his manuscript to several persons -of consideration, but was grieved to perceive that the new ideas put -forward in it were skeptically received. He now thought it might be as -well to appeal to the judgment of a highly competent authority, and -fixed on M. de la Peyronie, Head Surgeon of the Realm. This gentleman, -after reading the work, highly praised the author, and Bunon gained -permission to publish the book under his patronage, on consideration -that he should give his word to furnish the proof of the many -assertions made therein on all kinds of subjects. - -The goal was now reached, and Bunon, on the strength of such -illustrious patronage, published his book in March of 1743, under the -title, _Essay on the maladies of the teeth, wherein are suggested the -means of obtaining their good conformation from the earliest age, and -of assuring their preservation during the whole course of life_.[543] - -All the principal journals of the time (_Journal des Savants_, _Journal -de Trévoux_, _Journal de Verdun_, _Mercure de France_, etc.) published -extracts from the book and eulogized the author, who had even the high -satisfaction of receiving an honorable mention from the Royal Academy -of Surgery, in the public sitting held in 1743. - -Bunon, therefore, was now famous, and had, besides, gained wealthy -clients, as we see from the perusal of his observations, where the best -names in France are to be met with, put in evidence by him without -the least thought of professional secrecy. He could now enjoy his -well-merited successes, in accordance with the thought expressed by him -in one of his books: “All those who labor for the progress of an art -have legitimate right to the honor and to all the recompenses to which -success is entitled.”[544] - -The study of Bunon’s work proves, in fact, that he had good right to -be proud of having written it. The mere perusal of it, however, does -not suffice to enable the reader to judge of its merits, for to do this -properly, it is necessary to study at the same time his other book, -published in 1746, entitled _Experiences and demonstrations made at the -Hospital of Salpêtrière and at St. Côme, before the Royal Academy of -Surgery, serving as continuation and proof to the Essay on the maladies -of the teeth_.[545] The essay is, in fact, a small 12mo book of 212 -pages, written in a concise style, and, strange to say, most concise in -the most important points. - -Many facts of great moment are given under the form of rapid -indications, or of assertions without proof; thus their importance is -apt to pass completely unobserved by those who do not take the trouble -of studying this work thoroughly and with the help of the explanations, -illustrations, and comments contained in the second book we have -referred to. - -M. A. Barden, of the École Odontotechnique of Paris, was the first -to undertake a serious and conscientious study of Bunon’s works. By -so doing he has thrown full light on the author’s great merits, and -brought forward the high scientific importance of his works. - -One of the important questions studied by Bunon concerns the hygiene -to be observed in order to obtain the development of a good dentition. -On this question he rightly establishes the principle that hygiene and -dental prophylaxis should begin from the period of the formation of -the milk teeth. He works out this principle with rigorous logic, and -finishes by tracing the hygiene of the mother during pregnancy, of the -woman (be she mother or nurse) during the nursing period, and of the -nursling as well. - -As to the accidents of first dentition, Bunon sets forth a highly -scientific opinion, fully coinciding with the ideas of modern writers, -that is, that dentition is not the sole cause, nor even the principal -cause, of such accidents, but simply a coöperating cause. He made the -observation that in healthy infants, children of healthy parents and -nursed by healthy women, the time of teething is gotten over without -difficulty, while serious accidents occur frequently in weak and sickly -children not brought up and nourished according to hygienic principles, -or born, as not often happens, with special hereditary predispositions. - -One of Bunon’s merits is that of having attributed to the first -teeth all the importance they really have, and of having insisted -on the necessity of attentively curing their maladies. He also drew -attention to the dangers that may result from the eventual persistence -of the first teeth at the epoch of the second dentition, or from the -persistence of their roots after the destruction of the crown by -caries. These roots, he says, by their contact with the neighboring -permanent teeth may infect them, and cause them to decay. - -Bunon’s researches into the development of the teeth enabled him to -describe precisely the position that the various teeth of the second -dentition occupy in the jaw with regard to the milk teeth, before these -are shed. - -Bunon was, besides, the first author who studied accurately dental -hypoplasia, and it is greatly to his honor that his ideas and -observations about this pathological condition have been accepted and -confirmed in substance by the greater part of the authors who have come -after him, having remarkable worth even at the present day. According -to him, this congenital defect of the teeth is owing to infantile -maladies, such as hereditary syphilis, infantile scurvy, malignant -fevers, smallpox, or measles; the harmful effects of these maladies, -however, are limited to the teeth in progress of development, and have -no influence on those that have already come forth. Erosion, as this -defect was termed by Bunon, sometimes affects the first teeth, but is -to be found much more frequently in the second or permanent ones. Those -most often affected are the first molars, and in frequency follow the -incisors, the canines, the premolars; the second and third molars are -the most rarely affected. - -Bunon studied with great accuracy the means of preventing anomalous -positions of the permanent teeth, owing, according to him, almost -always to want of space. In certain cases he advises the extraction of -the milk tooth in order to facilitate the eruption of the permanent -one, and, necessity urging, he does not hesitate to sacrifice one of -the permanent teeth to procure the advantage of a normal position of -the others. With regard to this subject, the following passage is -worthy of note, for in it we find sketched out the theory of preventive -extraction as a means of facilitating the eruption of the wisdom tooth: -“It is better to have the teeth incomplete as to number than to have -the ordinary number badly arranged; for the mouth will appear none the -less well furnished because of having one or two teeth the less; the -other teeth will be commodiously distributed, and the last molars will -find sufficient room when they come forth; thus, the disorders which -these teeth often occasion will be avoided.”[546] - -After caries, Bunon considers dental tartar as the most potent enemy to -the vitality of the teeth. He distinguishes three principal species: -the black, the lemon or light yellow, and the brownish yellow; however, -he allows of two other varieties of less frequent occurrence, the red -and the green tartar. - -At a period when an extraordinary confusion obtained with regard to -gingivitis, because of the great number of varieties allowed, Bunon -strongly affirms the unity of this morbid process, and considers tartar -as the constant cause of it, without denying, however, that other -causes of various kinds may contribute at the same time to produce it. - -In cases of scorbutic stomatitis, Bunon advises, and very rightly, the -complete removal of tartar from the teeth before having recourse to any -other local treatment. He also insists on the necessity of attending to -the teeth and gums, and especially of freeing the former from tartar -before undertaking the specific treatment of syphilis, considering -the good state of the teeth and gums as one of the most important -prophylactic measures against mercurial stomatitis. - -Anyone who takes the trouble of reading Bunon’s works attentively -cannot help admiring his depth of insight, his spirit of observation, -his exquisite clinical sense, and his ingenuity. As illustrating this -last quality of his, we may cite two cases of fracture of the lower jaw -that he succeeded in curing in a short time by the method of binding -the teeth, the preceding attempts of experienced surgeons having -entirely failed. One of these cases is particularly interesting. The -seat of the fracture corresponded with the bicuspids, which, however, -had fallen out from the effects of trauma; the neighboring teeth were -also loosened. Bunon filled the empty space left by the bicuspids -with a piece of ivory, provided with two holes; then, by an -ingenious crossing of threads passing from the second molar on the -one side to the second bicuspid on the other, very tightly tied, he -formed, so to speak, one single block, and succeeded in bringing about -the consolidation of the shaking teeth and the complete cure of the -fracture, which was effected in less than a month. - -[Illustration: RUSPINI WITH HIS FAMILY IN A COUNTRY PLACE - -_From an old painting in oil._] - -[Illustration: _The Italian dentist Ruspini presenting the children of -his orphanage to the members of the Free Masons Hall in London with -whose aid the institution had been founded._] - -The unfavorable judgments passed on Bunon by some writers result, in a -great measure, from the circumstance that one finds quoted in his books -certain modes of treatment that today appear positively ridiculous. -But those who, very wrongly and with deplorable levity, consider Bunon -as nothing more than a vulgar empiric, ought to reflect that even the -greatest men cannot altogether avoid the influence of the ideas and the -prejudices of their time. Some tribute they are almost fatally bound -to pay to these prejudices. It is, therefore, not to be wondered at, -if one finds in Bunon’s works, as well as in those of many other old -writers, indications given of more or less strange remedies. Thus, as -facilitating the eruption of teeth, he recommends among other remedies -the rubbing of the gums with a mixture of honey, fresh butter, hare’s -brains, and oil of lilies, or with the fat of an old cock, dog’s milk, -and pig’s brains. Against the disorders and dangers of the teething -period he also advises rubbing the nape of the infant’s neck, the -shoulders, the back, and the lower limbs, always taking care, however, -to rub from above downward, thus offering opposition to the flow of -humors toward the upper parts of the body. - -These means and methods of treatment reflect, so to speak, the medical -ideas and the curative practices of that time, and come down, in part, -from remote ages, as evidently appears from what is said in different -parts of this book. But such small blemishes ought certainly not -to be taken into account in passing judgment on Bunon’s works, the -most substantial part of which is made up of very original ideas and -observations. The high intrinsic value of Bunon’s works gives him a -just right to be considered one of the most illustrious forerunners of -modern scientific dentistry. - -BARTOLOMEO RUSPINI, an Italian dentist, exercised his profession in -London with great success for more than thirty years. He was patronized -by all the greatest personages of the Kingdom and also by the Royal -family, from whom he received special marks of distinction. He attained -a very conspicuous position, and with the aid of the London Freemasons’ -Lodge, of which he was an influential member, but chiefly by the -results of his professional work, he was able to found an orphanage -that was called by his name, being moved to do this by his great love -for children, whose dental maladies and disorders had always been an -object of particular study for him. In 1768 he published _A Treatise -on the Teeth, Their Structure and Various Diseases_. This book was -remarkably well received and went through a number of editions, the -last in the year 1797. Ruspini did not, in reality, contribute very -much to the development of dental science. He is, however, to be -especially remembered as the inventor of a very good mouth mirror, a -means of examination which afterward gradually came into general use. - - * * * * * - -Having brought our history of dentistry up to the end of the eighteenth -century, in order to complete our work we must now speak of an -innovation in dental prosthesis, which, although gradually brought to -perfection in the following century, was first introduced at that time. -We allude to the - - -INVENTION OF MINERAL TEETH. - -The merit of this invention is due, in part, to an individual outside -the dental profession, namely, to the French chemist Duchâteau, of -St. Germain en Laye, near Paris, who first had the idea of employing -porcelain as material for dental prosthesis. However, his idea would -not have yielded fruitful results had it not been for the coöperation -of the dentist Dubois de Chemant, who succeeded in putting it into -practice. - -The circumstances connected with this invention were the following: -The chemist Duchâteau had for some time worn a denture of hippopotamus -ivory, but as usually happened with all the prosthetic pieces of that -time, which were made of organic material, and were, therefore, subject -to decay, this denture had acquired a very disagreeable odor, resulting -from the action of the buccal humors. Besides which, Duchâteau being -obliged, by reason of his profession, to continually taste pharmaceutic -preparations, his denture had gradually become impregnated with -medicinal substances that imparted a nauseous taste to everything he -ate. The unpleasantness of this was a subject of much consideration -with him, and thus it was that, to remedy the evil, he gradually -matured the idea of having a porcelain denture made, on the model of -the ivory one. In the year 1774 he applied to the porcelain manufactory -of M. Guerhard in Paris for the carrying out of his design. The first -trial was not successful, for in the baking the paste contracted so -much that the denture was no longer of the right dimensions. To remedy -this, he now had another and larger denture made, to allow for its -contraction in the baking. But the results did not correspond with -his wishes, and many trials were still necessary before Duchâteau -was able to obtain a denture which he judged fit for use, although -not without defects. As this denture, because of its dead whiteness, -produced an unpleasant effect, he had a yellowish tint, resembling that -of the natural teeth, given to it, and, as is usual with painting on -porcelain, fixed this color by baking a second time. - -However, this denture proving unserviceable, Duchâteau was obliged to -put it aside and begin new experiments. These were made with a special -kind of porcelain paste used in France for the first time in 1740, -which vitrified in baking at 12° to 25° by Wedgwood’s pyrometer, whilst -the usual porcelain required a temperature of 72° to 75° by the same -test; but the results thus obtained were no better than the preceding -ones, and upon these new failures Duchâteau applied to the dentist -Dubois de Chemant, of Paris, for his collaboration. Together they made -fresh attempts, modifying the composition of the paste by adding a -certain quantity of pipe clay and other coloring earths to it. These -modifications enabled them to carry out the baking of the pieces at a -much lower temperature, and after various experiments the final result -was a denture that fitted the gums well enough, and which, in point of -fact, Duchâteau was able to wear. - -Encouraged by this success, he tried to manufacture like dentures for -personages of high rank, hoping to gain money thereby, but his want -of knowledge of the dental art prevented him from succeeding in his -undertaking. However, in 1776 he laid this new process before the Royal -Academy of Surgeons in Paris, receiving the thanks of that body as well -as an honorable mention. - -Whilst Duchâteau, discouraged by failure, was giving up all idea of -deriving profit from the practical application of his invention, Dubois -de Chemant, on the contrary, did not cease working for a moment, in -order to bring the new method of prosthesis to perfection. Little by -little he introduced important modifications into the composition -of the mineral paste used in the manufacture of the dentures, -incorporating therewith Fontainebleau sand, alicant soda, marl, red -oxide of iron, and cobalt. His experiments and researches aimed at -three principal ends, viz.: - -1. The obtaining of mineral teeth offering all the gradations of color -presented by natural ones. - -2. The arriving at a rigorous calculation of the contraction of the -mineral paste in the baking, so as to be able to make prosthetic pieces -of the desired form and dimensions. - -3. The perfecting of the means of attachment of the prosthetic pieces, -and, in particular, of the springs. - -By working with intelligence and perseverance, Dubois de Chemant -gradually obtained satisfactory results, and when, in 1788, he -published his first pamphlet on mineral teeth, he had already made -dentures and partial prosthetic pieces for a certain number of persons, -who wore them to great advantage. - -As to the chemist Duchâteau, from 1776 to 1788, that is, during -the twelve years subsequent to his communication to the Academy of -Surgeons, he did absolutely nothing at all. He is, therefore, entitled -to the credit of having had a happy idea and of having endeavored -to put it into practice; but the merit of having given life to the -idea, abandoned for so many years by him with whom it originated, is -exclusively due to Dubois de Chemant; he is, therefore, with reason -considered the true inventor of mineral teeth. - -Dubois de Chemant, however, was so unjust as to take the whole credit -of the invention for himself, declaring in his writings that the -original idea had been exclusively his own, and was in no way due to -Duchâteau. - -In 1789 Dubois de Chemant made his invention known to the Academy of -Sciences and to the Faculty of Medicine of Paris; both pronounced in -favor of it, and in consequence of the opinion given by such high -authorities, he soon after obtained an inventor’s patent from Louis XVI. - -Dubois’ successes now aroused the envy of many of his colleagues, and -especially of Dubois Foucou, the king’s dentist, who, together with -the greater part of the dentists of Paris and the chemist Duchâteau, -brought an action against him, accusing him of having usurped the -invention of Duchâteau, and demanding, for this reason, the annulment -of the inventor’s patent that had been granted him. But the law -courts, in an opinion dated January 26, 1792, rejected the demand for -annulment, recognized the patent of invention as fully valid, and -condemned Dubois Foucou, Duchâteau, and their confederates to the costs -of the judgment. - -Paris being at that time in full revolution, Dubois de Chemant was -induced to emigrate to England. He established himself in London, and -there obtained a patent without much difficulty, according him the -exclusive right, for fourteen years, of manufacturing dentures of -mineral paste. - -Dubois de Chemant wrote several pamphlets in order to make known to the -public this new kind of dental prosthesis and its advantages; some of -these were published in Paris (1788, 1790, 1824), and others during his -long residence in London, where he remained from 1792 to 1817. In these -pamphlets he upholds the great superiority of “the incorruptible teeth -of mineral paste” over all other kinds of artificial teeth; he calls -special attention to the fact that teeth of bone, ivory, and of every -other organic substance whatever gradually become spoilt through the -action of the saliva, of oral heat, of food and drink, etc., and not -only lose their primitive color and assume a dirty hue, most unpleasant -to the eye, but acquire a bad odor, at times quite insupportable, -becoming, besides, a cause of irritation to the gums and the mucous -membrane of the mouth, not to speak of their gradual softening and -wearing out, which renders them unserviceable after a certain time. All -these disadvantages were avoided by using the new prosthetic material, -this being incorruptible and inalterable. - -The prosthetic appliances by Dubois de Chemant were made in one single -piece that represented the gums and teeth, whether in the case of -one or more teeth, or of whole dental sets. He used to take a cast -of the parts on which the prosthesis was to be applied, and by a -process, the details of which are not known; he succeeded in obtaining -prosthetic pieces that fitted the parts perfectly, notwithstanding -the difficulties resulting from the shrinking of the paste in baking. -If the piece required retouching, he did this by means of special -tools for grinding down porcelain. He could, besides, drill holes -in the porcelain for the application of the means of attachment. In -fact, Dubois de Chemant was the creator of a new method of prosthesis -applicable to any and every case, and which gained the praise and -admiration of the great doctors and scientists of that day, among whom -may be mentioned Geoffroy, Vicq d’Asyr, Descemet, Bajet, Petit Radel, -Darcet, Sabatier, Jenner, and others. The Paris Faculty of Medicine -gave it as their judgment that the prosthetic pieces manufactured by -Dubois de Chemant united the qualities of beauty, solidity, and comfort -to the exigencies of hygiene. - -These eulogies must, however, be received with a certain reserve, as, -beyond doubt, the mineral teeth of that time still left much to be -desired. In England, where, as we have already said, they had been -introduced by the inventor, they at first obtained a great success, -which was, however, of short duration, and Maury[547] tells us that -toward 1814 they had fallen into great discredit and had been entirely -abandoned; this signifies that practically they did not fulfil the -expectations held out. - -DUBOIS FOUCOU and FONZI. Among the first who occupied themselves -with the manufacturing of mineral teeth, contributing also to their -improvement, are to be named Dubois Foucou, to whom we have already -made reference, and Fonzi, an Italian by birth, who exercised the -profession of dentist in Paris. Dubois Foucou made some improvements in -the coloring of porcelain teeth, and in 1808 published a pamphlet in -which he explained his mode of proceeding in manufacturing them.[548] -In the same year Fonzi made known a new kind of teeth,[549] which he -called _terro-metallic_. These differed from those of Dubois de Chemant -in that they were all single teeth intended to be applied on a base by -means of small hooks of platina, with which each tooth was furnished. -In addition to this important innovation, Fonzi also discovered the -means of imitating in some degree the semitransparent tint peculiar to -natural teeth. - -Notwithstanding this, the teeth made by Fonzi, of which there are -still some specimens in various dental museums, had anything but a good -appearance, and there still remained much to be done before mineral -teeth reached the height of perfection which they attained later on. - -[Illustration: FIG. 104 - -Earliest specimens of mineral teeth.] - -The credit of having introduced many new improvements in the -manufacture of mineral teeth belongs especially to the Americans. Among -those who particularly distinguished themselves in this department of -dental art, we may note Charles W. Peale, Samuel W. Stockton, James -Alcock, and Dr. Elias Wildman. But the most brilliant results, as is -well known, were obtained by the celebrated Samuel S. White, who, by -an intelligent and persevering activity, dedicated almost exclusively -to improving mineral teeth and to bringing them into general use, -contributed vastly to the progress of modern dental art. Samuel S. -White undoubtedly stands forth as one of the noblest and grandest -figures in the history of dentistry, and his name will ever be recorded -with honor and veneration by dentists of all ages. - - - - -FOOTNOTES: - -[1] See Introduction to the German translation of the Ebers’ papyrus, -by Heinrich Joachim, Berlin, 1890. - -[2] The Egyptians had three different kinds of writing: the -hieroglyphic, the hieratic, and the demotic. The hieroglyphic style, -which is the most ancient and is chiefly to be found on monuments and -in religious texts, consists of figures representing every kind of -object; the hieratic or sacerdotal style is an abbreviation of the -hieroglyphic writing; the demotic or popular style, the least ancient, -resulted from further abbreviations of the hieratic. - -[3] See page 185 of the German translation of Dr. Joachim. - -[4] See the German translation by Joachim, page 162. - -[5] A fruit resembling cherries. - -[6] On the Relations of the Human Teeth to those of the Lower Animals, -by John R. Mummery. Trans. Odontological Society of Great Britain, May, -1860. - -[7] See German translation by Joachim, p. 120. - -[8] Herodoti Halicarnassei historia, 1570 fol. Euterpe, page 53. - -[9] Herodoti Halicarnassei historia, lib. vi. - -[10] Die Zahnheilkunde, Erlangen, 1851, p. 348. - -[11] G. B. Belzoni (1778 to 1823), a celebrated Italian traveller and -archeologist, visited Egypt and Nubia, and wrote, in English, a report -on his discoveries, which was published in 1821. We have not been able -to procure this book; we have, however, read the Italian version, -published in Naples in 1831, without coming across any mention of -artificial teeth found in Egyptian sarcophagi. Therefore, unless the -work has undergone some mutilation in the Italian translation, we do -not know whence Joseph Linderer can have taken the above notice. - -[12] New England Journal of Dentistry, 1883, vol. ii, p. 162. - -[13] According to Herodotus and Diodorus, there were three different -modes of embalming in use among the Egyptians; the most expensive of -these cost one talent (about 5600 francs), the second in order 20 minae -(about 1900 francs), while for the less wealthy there was a third -class, at a much more economical rate. - -[14] See Giornale di Corrispondenza pei Dentisti, October, 1885, p. 227. - -[15] [The oft-quoted statements of Mr. Purland with reference to -Egyptian dental art are recorded in the transactions of the first -monthly meeting of the College of Dentists, an extinct English dental -association, and published in the Quarterly Journal of Dental Science, -1857, vol. i, p. 49, where the following note by the secretary appears: -“Mr. Purland repudiated the idea of the Chinese having been the first -to manufacture teeth, and referred to numerous specimens in the British -Museum, manufactured between four thousand and five thousand years ago -by the Egyptians, who he considered were the original makers. On the -subject of flint, Mr. Purland said he had discovered pieces of wood -in the centre, and remarked upon the artificial teeth he had found in -mummies.” - -Again, at page 63 of the same journal, in an article entitled “Dental -Memoranda,” by T. Purland, Dentist, Ph.D., the author says: - -“Belzoni and others discovered rudely manufactured teeth in the -sarcophagi of the Egyptians. As regards the use of gold leaf, Sir -Gardner Wilkinson observes, as a singular fact, that the Egyptians -stopped teeth with gold. - -“It is true that rudely manufactured teeth have been found in the -heads of Egyptian mummies, but it is equally true that teeth of a very -superior make and adaptation have also been found, some carved in -ivory, others in sycamore wood, and some have been found fixed upon -gold plates. Of these varieties, some are deposited in the valuable and -extensive museum belonging to Joseph Mayer, Esq., F.S.A., of Liverpool; -others are in the museums of Berlin and Paris, and I am in possession -of a tooth found pivoted to a stump in the head of a mummy in the -collection of a lamented friend. - -“Of stopping with gold, several instances have come to my notice, -particularly in a mummy in the Salt collection, sold by Sotheby, in -1836, in which three teeth had been stopped. I have endeavored to trace -the mummy, but in vain.”—E. C. K.] - -[16] Giornale di Corrispondenza pei Dentisti, October, 1885, p. 229. - -[17] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 9. - -[18] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 9. - -[19] Ibid. - -[20] Ibid. - -[21] The incisors represented in the cut of Renan’s work do not at -all give the anatomical form of upper incisors, but of lower ones. -Therefore, either the figure itself has been badly drawn, or the -piece found by Dr. Gaillardot was part of the inferior and not of the -superior jaw. In the latter case, the figure in Renan’s book ought to -be reversed, in the manner here shown: - -[Illustration: FIG. 4 - -The same figure reversed, as it ought to be if -the piece found at Sidon belonged to a lower jaw.] - -[Illustration: FIG. 5, FIG. 6 - -Examples of dental prosthesis as practised by the -Hindus at the present time.] - -Neither do we understand on what ground Dr. Gaillardot has based -his affirmation of the piece discovered having belonged to a female -skeleton, as it is well known that there is no characteristic -difference between a male and a female jaw. - -[Interesting examples of the survival of this primitive type of dental -prosthesis are found among the Hindus at the present time. The two -illustrations (Figs. 5 and 6) are from photographs of specimens of work -done by native Hindu dentists. Fig. 5 is a roughly carved artificial -tooth of ivory attached by a gold wire ligature to the adjacent -natural teeth, all of which, with the artificial tooth attached, were -subsequently lost by alveolar disease. Fig. 6 is a similar carved -artificial tooth of ivory attached to the adjoining teeth by a thread -ligature, the supporting teeth with the attached ivory tooth also -having been lost by alveolar disease. These specimens were removed and -sent to the writer by Dr. H. B. Osborn, of Burma, during the present -year (1909).—E. C. K.] - -[22] Renan, Mission de Phénicie, p. 472. - -[23] The number varies according to the different translations. So, -instead of the Latin dentes elephantis, we find in English and in other -languages the word _ivory_. - -[24] J. Bouillet, Précis d’histoire de la Médecine, Paris, 1883, p. 24. - -[25] La médecine chez les Chinois, par le Capitaine P. P. Dabry, Consul -de France en Chine, Membre de la Société Asiatique de Paris, 1863. - -[26] One of these books, Nuei-King, is said to have been written -twenty-seven centuries before the Christian era, by the Emperor -Houang-ty, the founder of Chinese medicine. - -[27] See Bouillet, work quoted at p. 31. - -[28] Dabry, op. cit., p. x (introduction), pp. 1, 2, 4, 10, 11. - -[29] This author wrote toward the end of the seventeenth century; one -of his works is entitled De Acupunctura. - -[30] Dabry, op. cit., p. 424. - -[31] See Histoire de la Chirurgie depuis son origine, par MM. Dujardin -et Peyrihle, Paris, 1774 to 1780. - -[32] London, 1811. - -[33] Die Zahnheilkunde, etc., 1851, p. 347. - -[34] J. Bontii, De medicina Indorum, 1642, lib. iv. - -[35] Carabelli, Handbuch der Zahnheilkunde, 1844, i, 8. - -[36] Linderer, op. cit. - -[37] [The newer civilization of Japan has caused this custom to largely -fall into disuse.—E. C. K.] - -[38] Carabelli, loc. cit. - -[39] Linderer, loc. cit. - -[40] Carabelli, op. cit., p. 17. - -[41] The Greek name Asklepios became in the Latin, Æsculapius; the two -names are therefore equivalents. - -[42] See Cicero, De Natura deorum, lib. iii, chap. xxii. - -[43] [Homer speaks of them as “two excellent physicians,” and refers to -Machaon as “a blameless physician,” and admits that “a medical man is -equivalent to _many_ others.” Their renown was continued in a poem of -Arctinus, wherein one was represented as without a rival in surgery, -the other as sagacious in detecting morbid symptoms.—C. M.] - -[44] Praktische Darstellung aller Operationen der Zahnarznei-kunst, von -Johann Jakob Joseph Serre, Berlin, pp. 7 to 13. - -[45] Guardia, Histoire de la Médecine, p. 250. - -[46] Hippocratis opera, Genevæ, 1657 to 1662, De natura hominis, p. 225. - -[47] Page 251. - -[48] Page 252. - -[49] Page 253. - -[50] De morbis mulierum, lib. ii, p. 666. - -[51] The use of carbonate of lime or chalk as a dentifrice evidently -goes back to antiquity. - -[52] Unwashed wool—that is, wool not cleansed of the fat secreted by -the skins of the animals from whom it is taken—was much in use by the -doctors of antiquity. One now obtains _lanolin_ from it. - -[53] The obole was about three-quarters of a gram. - -[54] The cotyle was a little more than a quarter of a liter. - -[55] Page 507. - -[56] Page 21. - -[57] See Daremberg, Dictionnaire des Antiquités Grecques et Romaines, -article “Chirurgie.” - -[58] The various editions here offer numerous variations, but the sense -is everywhere obscure. - -[59] See Bouillet, Précis d’Histoire de la Médecine, p. 94. - -[60] On Epidemics, lib. ii, section i, p. 1002. - -[61] De morbis vulgaribus, lib. iv, p. 1131. - -[62] That is a very short root. - -[63] Page 1138. - -[64] De morbis vulgaribus, lib. v, p. 1157. - -[65] Page 1157. - -[66] De morbis vulgaribus, lib. vi, section i, p. 1164. - -[67] Ibid., vii, p. 1223. - -[68] Page 1229. - -[69] De morbis vulgaribus, lib. vii, p. 1238. - -[70] The title of these seven books of Hippocrates might cause a false -idea to be conceived. They do not precisely treat of epidemics in the -sense given to the word in the present day; instead, they describe the -maladies which predominated during four years, in successive periods of -time, according with the variations of the atmospheric conditions. (See -Litré, Introduction to the books on Epidemics.) - -[71] De morbis vulgaribus, lib. iii, p. 1009; lib. vi, section iii, p. -1176. - -[72] De morbis vulgaribus, lib. iv, p. 1138; Aphorisms, lib. iv, No. -53, p. 1251. - -[73] Coacæ prænotiones, No. 235, p. 157; Prædictorum, lib. i, No. 48, -p. 71. - -[74] Coacæ prænotiones, No. 236, p. 157. - -[75] Loc. cit., No. 237. - -[76] Loc. cit., No. 239. - -[77] Loc. cit., No. 241, p. 157; No. 648, p. 222. - -[78] De morbis vulgaribus, lib. iii, p. 1083. - -[79] Ibid., lib. iv, p. 1121. - -[80] Prædictorum, lib. ii, p. 111. - -[81] De affectionibus, p. 521. - -[82] De internis affectionibus, p. 549. - -[83] Paul Dubois, Aide-mémoire du chirurgien-dentiste, Paris, 1894, 2me -partie, pp. 415, 416. - -[84] Prædictorum, lib. ii, p. 108. - -[85] De internis affectionibus, p. 534. - -[86] De humoribus, p. 49. - -[87] De morbis vulgaribus, lib. ii, section vi, p. 1050. - -[88] Prædictorum, lib. ii, p. 96. - -[89] De articulis, p. 799. - -[90] Loc. cit. - -[91] De articulis, p. 800. - -[92] Aphorism, lib. v, No. 18, p. 1253. - -[93] De liquidorum usu, p. 426. - -[94] De locis in homine, p. 419. - -[95] De morbis vulgaribus, lib. i, p. 948. - -[96] De partibus animalium, lib. iii, cap. i. - -[97] Ctesias, of Cnydus, wrote various works, somewhat earlier than -Aristotle; one of which, the History of India, is very interesting, but -also contains not a few fables. - -[98] This, as well as other errors of Aristotle, we shall find -repeated throughout the lapse of centuries by many authors, Galen not -excluded, who, in fact, by the authority of his name, gave them valid -confirmation. - -[99] The distinction between arteries and veins was, at that time, not -yet well known, though we already find, in this passage of Aristotle, -allusion made to the relations between the teeth and the bloodvessels. - -[100] According to the testimony of Celsus, a very serious author and -in every way worthy of belief, Herophilus and Erasistratus dissected -not only corpses, but also living men, namely, malefactors consigned to -them by the kings of Egypt, in order that they might make researches -into the normal conditions of the organs during life, and their mode of -functioning. See Cornel. Cels., De re medica, lib. i, Preface. - -[101] Cœlii Aureliani de morbis acutis et chronicis, lib. viii, -Amstelædami, 1755, Pars ii, lib. ii, cap. iv, De dolore dentium. - -[102] Herophilus et Heraclides Tarentinus mori quosdam detractione -dentis memoraverunt. - -[103] Arretium, Cære, Clusium, Cortona, Fæsulæ, Falerii, Pisæ, -Russellæ, Tarquinii, Vetulonia, Volaterræ, Volsinii. - -[104] Deneffe, La prothèse dentaire dans l’antiquité, p. 51. - -[105] Dr. Cigrand in his book The Rise, Fall, and Revival of Dental -Prosthesis, after having spoken of the Phœnician dental appliance -described in Renan’s work, adds: “There are scores of specimens of -Phœnician dental art in home collections and also at the Columbian -World’s Fair.” However, until these specimens of Phœnician dental art -are described and their origin is exactly known, their authenticity -will always remain a matter of doubt. [Cigrand is in error. The -specimens he speaks of were mainly imagined.—W. H. TRUEMAN.] - -[106] Deneffe, op. cit., pp. 60, 61. - -[107] Deneffe, op. cit., p. 63. - -[108] Plinius, lib. xxix, cap. v. - -[109] This article forms part of the tenth table. The Law of the Twelve -Tables was lost, but citations and passages are to be found in Cicero -and in the works of other Roman jurisconsults, and by the aid of these -it has been possible to reconstruct, at least in part, this very -ancient code of laws. See Dionysii Gothofredi, Corpus juris civilis. -Amstelodami, 1663; and also Thesaurus juris romani cum prefat. Ottonis, -Tome iii, Trajecti ad Rhenum, 1733. - -[110] Josef Serre, Zahnarznei kunst, Berlin, 1804, p. 6. - -[111] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 26. - -[112] See note, p. 15, Hist. Relations of Medicine and Surgery, -Allbutt. (C. M.) - -[113] A. Corn. Celsi de Medicina libri octo, Patavii, MDCCXXII. - -[114] Celsus, lib. i, Preface. - -[115] Wine with honey. - -[116] [_Minium_ is an ancient name for red oxide of lead; it was also -applied to mercuric sulphide or vermilion, and the term vermilion was -also used as a designation for _granum tinctorum_ or _kermes_, the -_coccus ilicis_, a variety of cochineal extolled by Galen for its -medicinal properties. The exact nature of the meaning of minium in this -connection is not altogether clear.—E. C. K.] - -[117] A species of herb (all-heal). - -[118] Peucedanum officinale, hog’s fennel. - -[119] A species of wild grape thus called because it is red like minium -(vermilion). - -[120] Species of mineral. [An impure copper sulphide.—E. C. K.] - -[121] Condensed juice of the seeds of the momordica elaterium, a -bitter, irritating, and drastic substance. - -[122] According to De Giorgi (Sinonimia chimico-farmacotecnica, Milan, -1889), scissile alum is one of the many names for blue vitriol or -sulphate of copper. - -[123] [The _cyperus rotundus_, recommended by Dioscorides in the -treatment of ulcers in the mouth. Esteemed also by the Arab medical -writers Serapion, Avicenna, and Rhazes. Not the cypress, _cupressus -sempervirens_.—E. C. K.] - -[124] Here is meant the paper made of papyrus and called in Latin -charta. - -[125] Trisulphide of arsenic. - -[126] Celsus did not know of the upper maxillary bones as distinct -bones. The same may be said of the other bones of the head. Celsus -speaks of the osseous sutures and openings, but not of the different -bones of the skull and face. - -[127] C. Plinii Secundi, Historiæ Mundi, lib. vii, cap. ii. - -[128] Lib. xxiv, cap. cxi. - -[129] Lib. xi, cap. lxiii. - -[130] Lib. xi, cap. lxiv. - -[131] Cap. cvi. - -[132] Dipsacus fullonum. - -[133] Cap. cviii. - -[134] Lib. xxviii, cap. ii. - -[135] Lib. xxviii, cap. xi. - -[136] Lib. xxviii, cap. xiv. - -[137] Ibid., cap. xxvii. - -[138] Ibid., cap. xxix. - -[139] Ibid., cap. xlix. - -[140] Ibid., cap. lxxviii. - -[141] Lib. xxix, cap. ix. - -[142] Lib. xxix, cap. x. - -[143] Lib. xxix, cap. xi. - -[144] Lib. xxx, cap. viii. - -[145] Lib. xxx, cap. ix. - -[146] Lib. xxx, cap. xlvii. - -[147] Lib. xxxi, cap. xlv, xlvi. - -[148] Lib. xxxii, cap. xiv. - -[149] Trygon pastinaca, a large fish whose tail is armed with sharp and -strong bones. - -[150] A measure equal to 0.274 liter. - -[151] [The sextarius was accorded different values, thus a sextary of -oil was ℥xviij, of wine ℥xx, and of honey, ℥xvij.—E. C. K.] - -[152] [Lat., the purple fish, a carnivorous marine mollusk.—E. C. K.] - -[153] Lib. xxxii, cap. xlviii. - -[154] A kind of lignite, now called jet. - -[155] Ignatius, because he has white teeth, is always laughing; if -he be present at the felon’s trial, whilst the counsel is moving all -to tears, he laughs; he laughs even when everyone is mourning at -the funeral pyre of a dutiful son, whilst the mother is weeping for -her only child. He laughs at everything, everywhere, and whatever -he be doing; this is his weakness, which methinks is neither polite -nor elegant. Wherefore, I must tell thee, O good Ignatius, even if -thou wert a citizen of Rome, or a Sabine, or of Tibur, or one of the -thrifty Umbrians, or of the fat Etruscans, or wert thou a black and -large-toothed Lanuvin, or a Transpadane, if I may speak of my own -people, or belonging to any people that cleanly wash their teeth; even -then I would not have thee be always laughing; for nothing is more -silly than a silly laugh. Now, O Celtiberian, in thy Celtiberian land, -each is accustomed, with the water he has himself emitted, to rub his -teeth and gums. Wherefore the cleaner are thy teeth, the more surely -stale dost thou accuse thyself of having drunk. - -[156] Rerum geographicarum libri. Lutetiæ Parisiorum, 1620. Lib. iii, -p. 164; quippe qui urina in cisternis inveterata laventur, eaque cum -ipsi, tum eorum uxores dentes tergant; quod Cantabros facere et eorum -confines ajunt (Carabelli, Systematisches Handbuch der Zahnheilkunde, -Wien, 1844, i, 12). - -[157] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 412. - -[158] Medio recumbit imus ille qui lecto, Calvam trifilem segmentatus -unguento, Foditque tonsis ora laxa lentiscis; Mentitur, Esculane; non -habet dentes. - -[159] Lentiscum melius; sed si tibi frondea cuspis Defuerit, dentes penna -levare potest. - -[160] Antiq. du Bosphore au Musée de l’Ermitage, pl. xxx, 8 et 9 -(Dictionnaire des antiquités grecques et romaines, par Daremberg, -Saglio, etc.). - -[161] Mittheilung. d. antiq. Gesellschaft in Zürich, xv, pl. xi, 32 -(Daremberg and Saglio, ibid.) - -[162] Caylus, vol. vi, pl. cxxx, 5. - -[163] Dentifricium ad edentulam: Quid mecum est tibi? me puella sumat, Emptos -non soleo polire dentes. - -[164] Lib. xii, epig. xxiii. - -[165] Dentibus atque comis, nec te pudet, uteris emptis. Quid facies oculo, -Lælia? non emitur. - -[166] Nostris versibus esse te poetam, Fidentine, putas, cupisque eredi? Sic -dentata sic videtur Ægle, Emptis ossibus, indicoque cornu. (Lib. i, -epig. lxxii.) - -[167] Lib. ix, epig. xxxviii. - -[168] Nec dentes aliter quam serica nocte reponas. - -[169] Horat. Sat. viii, lib. i. - -[170] Eximit aut reficit dentem Cascellius ægrum. - -[171] Suffire autem oportet ore aperto alterci semine carbonibus -asperso, subinde os colluere aqua calida; interdum enim quasi vermiculi -quidam eiciuntur. - -[172] Gum of the cedar tree. - -[173] Dentifricium, quod splendidos facit dentes et confirmat, chap. -xi, lix. - -[174] A Roman measure of capacity, equal to a little more than half a -liter. - -[175] The origin of the theriac, according to what Galen writes in -his book De antidotis, is to be traced back to Mithridates, King of -Pontus, who lived from the year 132 to the year 63 B.C. This king, -patron of Art and Science, was, for his times, an eminent toxicologist. -By making experiments on condemned criminals he sought to discover -by what drugs the action of the various poisons, both mineral and -vegetable, and those inoculated by the bites of poisonous animals might -be counteracted. He afterward mixed the various antidotes together -for the purpose of obtaining a remedy that might prove a preservative -against the action of any poison whatever. This universal remedy, -the receipt of which was carried to Rome by Pompey, the conqueror of -that great king, was named _mithridatium_, after the name of him who -had composed it. Andromachus modified the mithridate; he took away -certain ingredients and added others, reducing the number of them from -about eighty to sixty-five. The principal modification was that of -introducing into the composition of this drug the flesh of the viper; -wherefore, Galen is of the opinion that the theriac (so called from the -Greek word _therion_, a noxious animal) was more efficacious than the -mithridate against the bite of the viper. The theriac still exists in -the French pharmacopeia, although considerably simplified. In every 4 -grams it contains 5 centigrams of opium. - -[176] A species of solanaceæ of the Physalis genus, probably the -Physalis alkekengi. - -[177] Galeni de compositione medicamentorum secundum locos, liber v. - -[178] J. R. Duval, Recherches historiques sur l’art du dentiste chez -les anciens, Paris, 1808, p. 19. (See Carabelli, p. 13.) - -[179] Galen admits three kinds of nerves: soft or sensitive nerves, -originating from the brain; hard or motor nerves, originating from the -spinal marrow; medial nerves, motor-sensitive, originating from the -medulla oblongata. - -[180] Galen distinguishes seven pairs of cerebral nerves; his third -pair corresponds to the trigeminus. - -[181] Galeni de usu partium corporis humani, lib. xvi. - -[182] Galeni de compositione medicamentorum secundum locos, lib. v. - -[183] Medicus, chap. xix. - -[184] Trigonella fœnum græcum, a papilionaceous plant. - -[185] [About twenty-eight fluid ounces.—E. C. K.] - -[186] Under the name of _root_, the ancients meant also the _neck_ of -the tooth. - -[187] Swallow, I tell thee, as this water will not be again in my -mouth, even so my teeth will not ache for the whole year. - -[188] The cure of teeth affected by warm painful disease; according to -Adamantius the sophist. - -[189] Ætii tetrabibl., ii, sermo iv, cap. xxvii. - -[190] Ibid., cap. xxxi. - -[191] Ætii tetrabibl., ii, sermo iv, cap. xix. - -[192] Ibid., i, sermo iv, cap. ix. - -[193] Ibid., ii, sermo iv, cap. xxiv. - -[194] Tetrabibl., ii, sermo iv, cap. xxv. - -[195] Ibid., cap. xxvi. - -[196] [The author quoted directs hydromel to be made from one part of -honey and eight parts of water boiled until it has ceased frothing.—E. -C. K.] - -[197] Pauli Æginetæ de re medica, lib. vi, cap. xxvii. - -[198] Lib. vi, cap. xxviii. - -[199] Ibid., cap. ix. - -[200] Ibid., cap. xxix. - -[201] Rasis opera, Venetiis, 1508. - -[202] Haly Abbas Pract., lib. v, cap. lxxviii. - -[203] Ibid., cap. xxxiii. - -[204] Serapionis practica, Venetiis, 1503. - -[205] Avicennæ opera in re medica, Venetiis, 1564. - -[206] Abulcasis de Chirurgia, lib. i, cap. xix, p. 47; Latin -translation by Channing with the Arabic text in front, Oxford, 1778. - -[207] Cap. xx, p. 47. - -[208] Cap. xxi, p. 49. - -[209] Zegi was the name given by the Arabs to blue vitriol. - -[210] Lib. ii, cap. xxviii, p. 181. - -[211] Lib. ii, cap. xxix, pp. 181 to 183. - -[212] This great Mahommedan surgeon was, it seems, very religious. His -book begins with the words: “In the name of the merciful God, Lord -perfect in goodness,” and almost every chapter ends with “If God so -wills,” and the like. - -[213] These two manuscript codices are found in the Bodleian Library at -Oxford. - -[214] Lib. ii, cap. xxx, p. 185. - -[215] The Arabic word used by the author means more precisely “those -who apply cupping glasses.” Channing has translated it by _tonsores_, -barbers. - -[216] An advice already given by Celsus. - -[217] Lib. ii, cap. xxxi, p. 191. - -[218] Silly barbers. - -[219] Lib. ii, cap. xxxi, p. 187. - -[220] Lib. ii, cap. xxxii, p. 193. - -[221] Lib. ii, cap. xxxv, p. 197. - -[222] Lib. iii, cap. iv, p. 545. - -[223] [In connection with the practice of applying medicines to the -teeth or upon the gums, with the object of rendering the operation of -tooth extraction less difficult, the use of arsenical compounds as an -ingredient of these topical applications is of peculiar interest. In -an Italian translation of the writings of Johannes Mesue, published -at Venice in 1521, the following interesting reference to the use of -arsenic appears: - -“The son of Zachariah Arazi compounds a medicine to assist the -extraction of the teeth. ℞—Pyrethrum, colquintida root and the bark of -the mulberry root, the seed and leaves of almezeron, huruc, and yellow -arsenic, milk of alscebram or pieces of it, ground very thoroughly -with vinegar; then pour some of it over bdellium and halasce, of each, -equal parts, dry and dissolve in strong vinegar and make trochisi of -it, and with them anoint the roots of the tooth from hour to hour; this -facilitates the extraction of it. - -“There is also another medicine with which one fills the decayed tooth -and breaks it: ℞—Seeds of almezeron and milk of alscebram compounded -with liquid pitch, and fill with it the decayed tooth. Another one: -℞—Bauras, bark of the willow, of each, one part; yellow arsenic, two -parts; compound with honey and place it upon and around the tooth and -immediately extract it. - -“The fat of the green frog which lives upon the trees breaks teeth -which are anointed with it the same as when you anoint them with milk -of alscebram or titimallo, and similarly also the milk of celso with -yellow arsenic.” - -In this connection it is also interesting to note that the ancient -Arabian medical writers referred to the red sulphide of arsenic or -realgar as sandarach. The term Sandarach was clearly used by these -writers to designate two different medicaments—one the gum-vernix, -exudate of the Juniper tree, and which we now know as Sandarach gum. -They also apply the term to red arsenic, as above stated. Avicenna -clearly distinguishes between the two kinds of Sandarach, and says -with regard to the gum-vernix or Juniper Sandarach that it is the best -of all known remedies for toothache. While, as shown by Dr. Guerini, -many of the medicaments used as topical applications to facilitate -the extraction of teeth were wholly without any possible effect of -that character, it cannot be doubted that the application of arsenical -preparations, such as those referred to by Mesue, could not fail to -set up an arsenical necrosis about the roots of the tooth, rendering -it loose and easy of removal, but necessarily with the disadvantage of -producing a dangerously extensive necrosis of the tissues. - -_Mesue Vulgar._—Impresso in Venitia per Cesaro Arrivabeno Venitiano a -di vinti octubrio, mille cinquecento e vintiuno. - -Delle Medicini Particulare, Libro Quarto, Capitolo XLI.—E. C. K.] - -[224] Joannis Mesue opera, Venetiis, 1562. - -[225] Sprengel, Geschichte der Chirurgie, Part II, p. 279. - -[226] Linderer, Handbuch der Zahnheilkunde, Berlin, 1848, ii, 403. - -[227] Bruni Chirurgia magna. - -[228] Sprengel, Geschichte der Chirurgie, Part II, p. 280. - -[229] Sprengel, loc. cit. - -[230] Sprengel, loc. cit. - -[231] La Grande Chirurgie de Guy de Chauliac, chirurgien maistre en -médecine de l’Université de Montpellier, composée en l’an 1363, revue -et collationnée sur les manuscrits et imprimés latins et français par -E. Nicaise, 1890. - -[232] Of these copies, twenty-two are written in Latin, four in French, -two in Provençal, three in English, one in Netherlandish (Dutch), one -in Italian, and one in Hebrew. - -[233] Nicaise, La Grande Chirurgie de Guy de Chauliac, Second Chapitre: -De l’Anatomie de la face et de ses parties, p. 47. - -[234] Here, as elsewhere, is preserved the old orthography of the text. - -[235] Nicaise, p. 711. - -[236] Teeth may be produced not only in infancy, but also at a later -age. - -[237] Nicaise, p. 205. - -[238] Pietro of Albano (1250 to 1316), the writer of many books, among -which one bearing the title of Conciliator differentiorum philosophorum -et præcipue medicorum, is often quoted by Guy de Chauliac and by many -others under the name of Conciliator. - -[239] Nicaise, p. 505. - -[240] Appropriatæ barbitonsoribus et dentatoribus. - -[241] In one Latin manuscript of 1461 instead of _dentator_ we already -find the word _dentista_. - -[242] Nicaise, p. 506. To make clear the meaning of these names, the -following must be noted: The _rasoirs_ (_rasoria_) were instruments -with one cutting edge alone, which were used in performing any kind -of incision. _Raspatoria_ (râpes, _i. e._, rasps) signified almost -certainly scrapers, not rasps. The _spatumes_ were instruments with -one or two cutting edges, of various shapes, but usually small. -_Esprouvettes_ (Latin, _probæ_) were the sounds or probes. _Scalpra_ -means scalpels, but in this case has especially the meaning of -_déchaussoirs_, gum lancets. _Terebelli_ (French, _Tarières_) are the -trepans or perforators. - -[243] Nicaise, p. 507. - -[244] By the word _apostema_, Guy de Chauliac, and many other writers, -indicate every pathological condition in which the normal elements of -the tissues are separated from one another, by a humorous or gaseous -gathering, or by any phlogistic or neoplastic formation. The word -signifies, in Greek, _removal_, just like the Latin word _abscessus_. -In fact, these two terms were often used as synonyms; but at other -times the word apostema had a wider meaning, and included, besides the -abscess, the phlegmon, the furunculus, the anthrax, erysipelas, herpes, -and other dermal affections, especially the pustulous ones, edema and -other serous gatherings, subcutaneous emphysema and other gaseous -gatherings, glandular tumefactions, cysts, benignant and malignant -tumors. - -[245] De la dent esbranlée et affoiblie, Nicaise, p. 509. - -[246] “De l’humidité qui amollist le nerf et le ligament.” - -[247] Evidently the author speaks of a “little gold chain,” because, as -he is not versed in the practice of dentistry, he does not know that it -was a simple gold wire which was used for keeping loose teeth firm. A -small chain as thin as a thread could not be possibly made, and would -even then be excessively weak. - -[248] This name was first given to medicaments containing gall-nuts, -then, by extension, also to compound remedies not containing such -substance, and to which was given the name of _aliptæ_, v. Nicaise, p. -677. - -[249] According to Nicaise, the Cyperus esculentus (in French, -“souchet”) is here referred to. - -[250] In the Latin text: Buccelletur cum scalpro et lima. - -[251] Here lavement means mouth wash, not injection. - -[252] Cum raspatoriis et spatuminibus radantur. - -[253] Treatise vi, doctrine i, chap. viii: “Des membres qu’il faut -amputer,” etc., Nicaise, p. 435. - -[254] According to Joubert several solanaceæ had this name, among -others _Solanum nigrum_ and _Solanum somniferum_ (Physalis somnifera -L.), which probably corresponds to the _Strychnos hypnoticus_ of -Dioscorides. - -[255] Valesci Philonium, etc.; Francofurti MDXCIX, cap. lxiv, De dolore -dentium, p. 195 et seq. - -[256] Plant belonging to the order of the Polygonaceæ. - -[257] “Materia lapidea paullatim abradatur ferro et dentifriciis partim -mundificativis, et partim stypticis. Deinde colluantur denies sæpe vino -albo, et fricentur sale torrefacto.” Cap. lxvii, De colore dentium -præter naturam, p. 202. - -[258] “Quoniam, licet ex parte corrosi sint, attamen dolore sedato -masticationem iuvant, et alios firmiores reddunt.” Appendices, p. 205. - -[259] “Ossa fiunt ex spermate et sanguine menstruo; dentes autem ex -sanguine, in quo remansit virtus spermatis.” Appendices, p. 205. - -[260] Petri de Largelata chirurgiæ libri sex, Venetiis, 1480. - -[261] _Bartolomæi Montagnanæ_ Consilia, Venetiis, 1497. - -[262] Johannis Platearii Salernitani practica brevis, Lugduni, 1525. - -[263] Joannis Arculani commentaria in nonum librum Rasis ad regem -Almansorem, etc., Venetiis, 1542. - -[264] This Arabian word was used to indicate the last molars. - -[265] “Regimen autem implendo dentem corrosum est, ut impleatur in -causa calida cum frigidis, et in frigida cum calidis. Secundo, ut non -impleatur cum labore et vehementia addente in dolore, et ex propriis -est gallia cum ciperis aut cum mastiche, et eligantur ex suprascriptis, -calida aut frigida secundum opportunitatem, in contrarium dyscrasiæ -dentis, sed ubi non fuerit multus recessus a mediocritate impleatur cum -foliis auri.” Cap. xlviii, p. 195. - -[266] In the Venetian edition (1542), however, all the figures which -Arculanus inserted in his work are found in the beginning of the book, -in a single table, together with the indication of the use to which -each single instrument was destined. - -[267] Alexandri Benedicti Veronensis de re medica opus, lib. vi, de -affectibus dentium. - -[268] Opera domini Joannis de Vigo in chyrurgia. Lugduni, 1521, lib. -ii, tract. iii, cap. xiv, fol. 40. - -[269] [The editions and translations of Vigo seem to have been endless. -A French translation of his treatise on the wounds caused by firearms -is said to have fallen into the hands of Paré, and had an inspiring -influence upon the barber’s boy.—C. M.] - -[270] Lib. v, cap. v, De doloribus dentium, fol. cxvii to cxix. - -[271] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 406. - -[272] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 80. - -[273] A religious order of knights, established toward the close of the -twelfth century, viz., during the third crusade. The original object -of the association was to defend the Christian religion against the -infidels, and to take care of the sick in the Holy Land. - -[274] Geist-Jacobi, Geschichte der Zahnheilkunde, p. 82. - -[275] Geist-Jacobi, p. 88. - -[276] Albert von Haller, Bibliotheca chirurgica, i, 190. - -[277] Nuetzlicher Bericht, wie man die Augen und das Gesicht schaerfen -und gesund erhalten, die Zaehne frisch und fest erhalten soll. -Würzburg, 1548. - -[278] See Giornale di Corrispondenza pei dentisti, 1895, xxiv, 289. - -[279] Joannis Arculani. Commentaria, Venetiis, 1542, cap. xlviii, De -dolore dentium, p. 192. - -[280] “The first dental book in the German language” (see Giornale di -Corrispondenza pei dentisti, loc. cit.). - -[281] A Latin translation of the French name _Du bois_. - -[282] De humani corporis fabrica, libri septem. - -[283] De humani corporis fabrica libri septem, cap. xi, De dentibus, -pp. 40 to 42 (complete edition of the works of Vesalius, published at -Leyden in 1725). - -[284] Lib. i, cap. xlii, p. 141. - -[285] From _gena_, a cheek. - -[286] Blandin, Anatomie du système dentaire, Paris, 1836, p. 19. - -[287] Portal, Histoire de l’anatomie et de la chirurgie, tome i, p. 545. - -[288] Observationes anatomicæ, p. 39, et seq. - -[289] _In utero duodecim dentes formantur in malis, et totidem in -maxilla_ (in the uterus are formed twelve teeth in the upper jaw and -as many in the lower). Fallopii Gabrielis observationes anatomicæ, -Venetiis, 1562, p. 39. - -[290] This sharp reproof and accusation of ignorance are made for the -benefit of the immortal anatomist Andreas Vesalius, to the number of -whose adversaries Eustachius likewise belonged. What unjust fury of -party passion! - -[291] Chap. xviii, p. 54. - -[292] Chap. xxii, p. 65. - -[293] Chap. xxiii, p. 70. - -[294] Chap. xxv, xxvi. - -[295] Chap. xxvii, xxviii. - -[296] The inferior orifice of the foramen incisivum. - -[297] It is superfluous to say that these cases are unreal and simply -dependent upon erroneous observations; for instance, in the case of -the second molar being extracted before the erupting of the third, -the second molar figured as, and supposed to be, the latter, when, -finally, the wisdom tooth appeared, it was believed to be the last -molar renewed. It is no rare thing, also, in these days, not only for -unprofessional persons, but also for medical practitioners, to fall -into errors of this kind, especially because, in similar cases, the -wisdom tooth, having but a limited space in which to erupt, is in the -habit of filling the void left by the second molar, where it meets with -less resistance. - -[298] Page 93. - -[299] Œuvres complètes d’Ambroise Paré, accompagnées de notes -historiques et critiques, par J. F. Malgaigne, Paris, 1840, vol. i, p. -231. - -[300] The lower molars, being seated on the roots and not suspended -like those of the upper jaw, are not in want of so many roots to assure -their stability. - -[301] Vol. ii, p. 307. - -[302] ... if they are divided, shaken, or separated from their alveoli -or little cavities, they must be reduced into their places and should -be bound and fastened against those that are firm with a thread of -gold, silver, or flax. And they must be held thus until they are quite -firm and the callus is formed and have become solid. - -[303] Lib. xv, ch. xvi, vol. ii, p. 443. - -[304] Lib. xv, cap. xxvii, vol. ii, p. 448. - -[305] A man, worthy of being believed, has assured me that a certain -princess having had a tooth taken out, immediately had it replaced by -another supplied by one of her ladies, which took root, and after a -time she masticated with it as well as she had done with the former one. - -[306] Lib. xv, cap. xxviii. - -[307] I will here tell a story of a master barber living at Orleans, -named maistre François Louys, who had the honor of pulling a tooth -better than any one else, so that on Saturdays many country folks -having toothache came to him to have them pulled out, which he did very -dexterously with a pelican, and when he had done, threw it on a bench -in his shop. Now he had a new servant, Picard, tall and strong, who -wanted to pull teeth like his master. It happened that whilst the said -François Louys was dining, a villager wanting a tooth pulled, Picard -took his master’s instrument and tried to do like him, but instead of -taking out the bad tooth, he knocked and tore out three good ones for -him, who, feeling great pain and seeing three teeth out of his mouth, -began to cry out against Picard, but he, to make him hold his peace, -told him not to say a word about it and not to shout so, because if his -master came he would make him pay for three teeth instead of one. Now -the master, hearing such a noise, came out from table to know the cause -of it and the reason of the quarrel, but the poor peasant fearing the -threats of Picard and still more after enduring such pain being made -to pay a threefold fee by the said Picard, was silent, not daring to -reveal to the master this fine piece of work of the said Picard; and -thus the poor bumpkin went away, and for one tooth that he had thought -to have pulled, he carried away three in his pouch and the one that -hurt him in his mouth.” - -[308] For which reason I advise those who would have their teeth pulled -to go to the older tooth-pullers, and not to the younger ones who will -not yet have recognized their shortcomings.” - -[309] An old French word meaning perhaps hippopotamus. - -[310] Jacobi Hollerii medici parisiensis omnia opera practica, Genevæ, -1635, lib. ii, p. 117, et seq. - -[311] Blandin, Anatomie du système dentaire, Paris, 1836, p. 25. - -[312] Hoann Jac. Weckerus, medicinæ utriusque syntaxes, ex Græcorum, -Latinorum, Arabumque thesauris collectæ, Basilea, 1576. - -[313] Donati Antonii ab Altomari medici ac philosophi neapolitani Ars -Medica, Venetiis, 1558, cap. xli, p. 190. - -[314] Collezione d’osservazioni e riflessioni, vol. iii, oss. 84, p. -374. - -[315] Hieronymi Capivacci Patavini opera omnia, Venetiis, 1617, edit. -sexta, lib. i, cap. liii; de affectibus dentium, p. 515. - -[316] Lib. ii, cap. v, de lue venerea, p. 712. - -[317] Petri Foresti, Alcmariani, opera omnia quatuor tomis digesta, -Rothomagi, 1653. - -[318] Histoire de l’anatomie et de la chirurgie, Paris, 1770. - -[319] Hémard has omitted translating this passage, probably because he -did not well understand it. - -[320] [For a fuller review of this author see A Dental Book of the -Sixteenth Century, by Julio Endelman, Dental Cosmos, 1903, vol. xlv, p. -39.—E. C. K.] - -[321] Hieronymi Fabricii ab Aquapendente opera chirurgica, Lugduni -Batavorum, 1723, cap. xxxii, p. 451. - -[322] Cap. xxxiii, p. 455. - -[323] Cap. xxxiv, p. 456; _de instrumentis extrahendis dentibus -idoneis_. - -[324] Cap. xxxv, p. 457. - -[325] Cap. xxx, de gingivarum chirurgia, p. 450. - -[326] Joannis Heurnii Ultrajectini de morbis oculorum, aurum, nasi, -dentium et oris, liber Raphelengii, 1602, cap. xi, de dentium et oris -passionibus, p. 79. - -[327] De aureo dente maxillari pueri Silesii, Lipsiæ, 1595. - -[328] Martini Rulandi, Nova et in omni memoria inaudita historia de -aureo dente, Francofurti, 1595. - -[329] Liddelius, Tractatus de dente aureo pueri Silesiani, Hamburg, -1626. - -[330] [In the introductory portion of Liddell’s work on the “Golden -Tooth” is published a number of letters bearing on the case, among -others one which gives rather a circumstantial account of the -imposture, and of which the following is a translation: - -“Herr Balthazer Caminæus sends Greeting: - -“For your letter, most kind Herr Doctor Caselius, in which you -explicitly desired me to thank (my) colleagues for their good wishes, -‘wedding wishes,’ and to inform you as to the ‘Golden Tooth,’ I have -long been in debt to you—not that I intended to leave your letter -unanswered, but because no messengers presented themselves. Now that -I have found one, I announce that I have obeyed your commands. As for -the ‘Golden Tooth,’ I ought not to hide from you that we have more -than once marvelled at your shrewdness, in that you are so anxious to -ascribe the devices of wickedness and the tricks (fakes) of cunning -to Nature. For it was no portent, only a deception and pure cheat, so -that unless some Lemnian (Prometheus or Vulcan) should come to their -aid, these acute authors will, nay, already are, a by-word to those -who are more cautious and not so prone to believe. For the ‘Golden -Toothed’ boy, according to the account brought thither by many persons, -both by letter and oral report, some of whom had themselves seen -this wonder, hailed from a village near Schwidnitz in Silesia, and -had been so trained by his swindling father or master, that, at his -will, whenever in any assembly of men, some very simple and illiterate -persons desired to see the tooth and had paid the fee, for the rascals -made great gains, he would open his mouth wide and allow himself to be -touched. But if educated men and those who seemed likely to make more -careful scrutiny and experiment on any point, presented themselves, -he contorted his countenance, remained silent, and simulated a kind -of madness, the idea being that he permitted himself to be examined -at stated times only when the conditions allowed. Now, the tooth was -covered with a plate, lamina (or layer), skilfully wrought of the best -gold, and the gold was let down so deep into the gum that the cheat -was not observed. However, as the plate was sometimes rubbed with a -touch-stone as a test and was daily worn down by chewing, the real -tooth at last began to appear. Of this fact a certain nobleman got an -inkling, came to the place pretty drunk, and demanded that the tooth -should be shown him, when the young fellow, at his master’s word, kept -silent, the nobleman struck his dagger into the boy’s mouth, wounding -him so badly that the aid of a surgeon had to be called, and so the -deception was fully exposed. - -“Thus the Herr Baron Fabianus, in Crema, at present Rector Magnificus -of our University, told me the story in full, and those inhabitants of -the place who have scholarly tastes maintain it to a man. The author -of the fraud, if I remember aright, was said to have taken refuge in -flight, the boy to be in chains. - -“Our Pelargus, who is a native of Schwidnitz, can inform you more -fully. I have often heard from him the same facts which I am writing. -Farewell, and laugh in safety as much as you please at those sagacious -authors. - -“FRANKFORT, December 31, 1595.” - -Elsewhere it is stated that the boy who was the possessor of the -“Golden Tooth” was born December 22, 1586. As Horst’s Treatise appeared -in 1595, the Silesian boy was probably not over seven or eight years of -age. We also find that the “Golden Tooth” was a lower molar, and upon -the left side, and further, that there was no molar posterior to it.—E. -C. K.] - -[331] Illustrious Father, do not believe too much in the -color.—[Virgil, Ec. ii, 16.] - -[332] Joh. Stephani Strobelbergeri, thermiatri cæsarei emeriti, -etc., de dentium podagre, seu potius de odontagra, doloreve dentium, -tractatus absolutissimus, in quo, tam doloris istius mitigandi -rationes, quam dentium sine et cum ferro artificiose extrahendorum -varii modi, theoretice ac practice proponuntur, in medicorum ac -chirurgorum quorumvis gratiam. Lepsiæ, 1630. - -[333] In Latin, _gutta_, that is, drop. - -[334] Handbuch der Zahnheilkunde, Berlin, 1848, ii, 422. - -[335] Geschichte der Zahnheilkunde, p. 101. - -[336] Arnauld Gilles, La fleur des remèdes contre le mal des dents, -Paris, 1622. - -[337] Remèdes contre le mal des dents, Paris, 1633. - -[338] Sprengel, Geschichte der Chirurgie, Part II, p. 293. - -[339] Guilhelmi Fabricii Hilandi opera omnia, Francofurti ad Moenum, -1646, Centuria I observatio xxxviii, p. 33. - -[340] Cent. iv, obs. xxi, p. 302. - -[341] The most important of Fabricius Hildanus’ works consists of six -_centuriæ_ (hundreds) of remarkable cases, published by the author in -successive epochs, and which were afterward reunited under the title of -_Observationum et curationum chirurgicarum centuriæ sex_. - -[342] Cent. v, obs. xxvii, p. 406. - -[343] G. F. Hildani, opera omnia, Epist. ad J. Rheterium, p. 1010. - -[344] Joannis Sculteti, Ulmensis, armamentarium chirurgicum, -Francofurti, 1666, Plates X, XI, XII, XXXII. - -[345] Giovanni Battista Montano (1488 to 1551), of Verona, Professor of -Medicine at Padua. - -[346] It is marvellous that an intelligent physician should have lent -faith to such a story, related, too, by such a woman, never reflecting -that the daily use of sulphuric acid for the space of thirty years, -that is, about 11,000 applications, instead of curing and beautifying -bad teeth, would certainly rather have had the effect of totally -destroying the denture of even a mastodon. - -[347] Lazari Riverii, opera medica omnia, Genevæ, 1737; Praxeos medicæ -liber sextus, cap. i; De dolore dentium, cap. ii; De dentium nigredine -et erosione. - -[348] Nicolai Tulpii, Amstelodamensis, Osservationes medicæ, -Amstelodami, 1685, lib. i, cap. xxxvi, p. 68; cap. xlix, p. 90. - -[349] Sprengel, Geschichte der Chirurgie, vol. ii, pp. 294, 299. - -[350] Sprengel, op. cit., p. 297. - -[351] Blandin, Anatomie du système dentaire, Paris, 1836, p. 26. - -[352] Blandin, op. cit., p. 27; Portal, Histoire de l’anatomie et de la -chirurgie, Paris, 1770, vol. iii, p. 495. - -[353] Blandin, op. cit., p. 26; Portal, op. cit. - -[354] Totus dens primum inclusus est folliculo seu membrana tenui ac -pellucida non secus ac granum in arista. - -[355] Bouillet, Précis d’histoire de la médecine, p. 221. - -[356] Bouillet, op. cit., p. 222. - -[357] Friderici Ruyschii observationum anatomico-chirurgicorum, -centuria, Amstelodami, 1691; Portal, op. cit., vol. iii. - -[358] Portal, op. cit., vol. iii. - -[359] A. C. Abbott, The Principles of Bacteriology, Philadelphia, 1905, -p. 19. - -[360] Anatome ossium, Romæ, 1689. - -[361] Portal, vol. iv, p. 111; Blandin, p. 28. - -[362] Jean Guichard Duverney, Mémoire sur les dents, Paris, 1689. - -[363] Blandin, op cit.; Portal, vol. iii, p. 495. - -[364] Blandin, p. 31. - -[365] On Some New Observations of the Bones and the Parts Belonging -to Them, London, 1691. The accurate description given by Havers of -the canals containing the nourishing vessels of the bone has caused -these canals to be known, even up to the present day, by the name of -“Haversian canals.” - -[366] Portal, vol. iv, p. 134; Blandin, p. 31. - -[367] De morbis acutis infantum, London, 1689. - -[368] Sprengel, Geschichte der Chirurgie, vol. ii, p. 298. - -[369] Meekren, Observationes medico-chirurgicæ, cap. xv, p. 84. - -[370] Op. cit., cap. xxviii, p. 120. - -[371] Sprengel, vol. ii, p. 298. - -[372] Sprengel, loc. cit. - -[373] Soolingen’s Manuale operatien der chirurgie, Amsterdam, 1684. - -[374] Sprengel, op. cit., p. 300. - -[375] Dissertation sur les dents, à Paris Chez Denys Thierry, MDCLXXIX. - -[376] Portal, op. cit., vol. iii, p. 361. - -[377] Purmann’s Wundarzenei, Halberstadt, 1684, Part I, chap. xxxii. - -[378] New and very useful practice of all that which belongs to the -diligent barber; composed by Cintio d’Amato. - -[379] The art of beautifying the human body was comprised by the -ancients among the many and various parts of the medical art, under -the name of _decorative medicine_. The barbers considered themselves -members of the medical class, as practitioners of decorative medicine -and in a certain degree also of surgery. - -[380] In a chapter entitled “Of the Excellence and Nobility of the -Barber’s Office,” Cintio d’Amato speaks of several barbers of that -period, who were in great repute by their writings, or by the high -offices with which they were invested, or by honors received from -princes and sovereigns. Among the writers, Tiberio Malfi, barber of -Montesarchio, deserves mention; he published, in 1626, a book entitled -The Barber, written in excellent style, and giving proof of solid -literary culture, and of much erudition. This work treats of all that -concerns the barber’s art (decorative medicine, bleeding, etc.). In it, -however, there is absolutely nothing about the treatment of the teeth -or their extraction; and this constitutes a valid confirmation of our -own opinion, that is, that the dental art was not at that time in any -way in the hands of the barbers. - -[381] Portal, vol. iii, p. 618. - -[382] Antonii Nuck operationes et experimenta chirurgica, Lugduni -Batavorum, 1692. - -[383] Caroli Musitani opera omnia, pp. 121 to 128, Venetiis, 1738. - -[384] J. Drake, Anthropologia nova, London, 1707. - -[385] J. M. Hoffmann, Disquisitiones anatomico-pathologicæ, Altorf, -1713, p. 321. - -[386] Probably through the nose. - -[387] H. Meibomii de abscessum internorma natura et constitutione -discursus. Dresdæ et Lipsiæ, 1718, p. 114. (This edition was published -after the author’s death, which took place in 1700.) - -[388] St. Yves, Nouveau traité des maladies des yeux, 1722, p. 80. - -[389] Sprengel, Geschichte der Chirurgie, vol. ii, p. 301. Carabelli, -Systematisches, Handbuch der Zahnheilkunde, vol. i, p. 60. - -[390] This work was published in 1690. - -[391] Here one also verifies the absurdities pronounced by those who, -not being dentists, but merely general practitioners or surgeons, still -risk speaking on dental subjects. - -[392] Dionis, Cours d’opérations de chirurgie, Paris, 1716, p. 507 and -following. - -[393] [The Dresden edition of 1710 of Guillemeau’s work contains -no reference to the artificial tooth composition as mentioned by -Dionis.—E. C. K.] - -[394] Carmeline was a most able surgeon-dentist. We learn this from a -passage in Pierre Fauchard’s book (Le Chirurgien Dentiste, Préf., p. -13). As we shall see, the author praises him very highly and laments -his not having written any book making known the results of his long -experience. - -[395] Sprengel, Geschichte der Chirurgie, vol. ii, p. 305. - -[396] Traité complet des opérations de chirurgie, par Mons. de -Lavauguyon, Paris, 1696, p. 644. - -[397] Der beym aderlassen und Zahn-ausziehen Geschickten Barbiergesell, -Leipsic, 1717. - -[398] De dentium dolore, Altdorf, 1711. - -[399] Schelhammer wrote a dissertation “on the cure of toothache by -touch,” _De odontalgia tactu sananda_, Kiel, 1701. In the same year and -in the same city, another pamphlet, by B. Krysingius, was written on -the same subject. (See Crowley, Dental Bibliography, p. 13.) - -[400] Sprengel, op. cit., vol. ii, p. 311. - -[401] Joseph Linderer, Handbuch der Zahnheilkunde, vol. ii, p. 129. - -[402] Sprengel, op. cit., vol. ii, p. 367; Carabelli, op. cit. p. 65. - -[403] Sprengel, op. cit., vol. ii, p. 310. - -[404] Sprengel, op. cit., vol. ii, p. 309. - -[405] Sprengel, loc. cit. - -[406] Sprengel, op. cit., vol. ii, p. 310. - -[407] Le Chirurgien Dentiste ou Traité des Dents, où l’on enseigne -les moyens de les entretenir propres & saines, de les embellir, d’en -réparer la perte & de remédier à leurs maladies, à celles des Gencives -& aux accidens qui peuvent survenir aux autres parties voisines des -Dents. Avec des Observations & des Réflexions sur plusieurs cas -singuliers. Ouvrage enrichi de quarante-deux Planches en taille douce. -Par Pierre Fauchard, Chirurgien Dentiste à Paris. - -[408] Deuxième édition, revue, corrigée et considérablement augmentée, -à Paris, 1746. - -[409] _Experts pour les Dents._ This was probably the title which was -bestowed in the relative diploma on those who passed the examination in -question. - -[410] We have not been able to find any work in which particular -records of Fauchard’s life are given, and hence do not know to which of -the other arts he had dedicated himself. - -[411] Vol. ii, p. 366. - -[412] Page 21. - -[413] Pages 73, 74. - -[414] Vol. i, p. 131. - -[415] Page 142. - -[416] De la génération des vers dans le corps de l’homme, Paris, 1700. - -[417] Vol. i, p. 143. - -[418] Page 149. - -[419] Chap. ix, p. 154. - -[420] Dames illustres, vie d’Elizabeth, p. 179. - -[421] Page 161. - -[422] Page 165. - -[423] Page 167. - -[424] Liquid ammonia. - -[425] Subcarbonate of ammonia. - -[426] Chap. x, p. 169. - -[427] Page 407. - -[428] Chap. xii, p. 183. - -[429] Chap. xiii, p. 185. - -[430] Chap. xiv, p. 194. - -[431] Chap. xv, p. 205. - -[432] Chap. xvi. - -[433] Chap. xvii to xxi. - -[434] Chap. xxiii, p. 282. - -[435] Page 330. - -[436] Page 331. - -[437] Page 368. - -[438] Page 370. - -[439] Page 383. - -[440] Page 376. - -[441] Chap. xxxi, p. 391. - -[442] Page 397. - -[443] Page 411. - -[444] Page 418. - -[445] Chap. xxxviii, p. 481. - -[446] Vol. ii, chap. ii. - -[447] Chap. iii. - -[448] Chap. iv. - -[449] Chap. v. - -[450] Vol. ii, p. 71. - -[451] Vol. ii, p. 77. - -[452] Vol. ii, p. 78. - -[453] Ibid. - -[454] Chap. vii. - -[455] Vol. ii, p. 80. - -[456] Vol. ii, chap. viii, p. 87. - -[457] Chap. ix, p. 117. - -[458] Speaking of transplantation, he says: “On voit par des -expériences journalières que des dents transplantées d’un alvéole dans -l’alvéole d’une bouche différente se sont conservées plusieurs années -fermes et solides sans recevoir aucune altération, et servant à toutes -les fonctions auxquelles les dents sont propres.” (Vol. ii, p. 187.) - -[459] Page 188. - -[460] Vol. ii, p. 192. - -[461] Vol. ii, chap. xiii, p. 215. - -[462] Vol. ii, pp. 217 to 224. - -[463] Vol. ii, p. 225. - -[464] Vol. ii, p. 229. - -[465] Chap. xvi, pp. 252, 255. - -[466] Vol. ii, chap. xvii, p. 260. - -[467] Vol. ii, chap. xxiv, p. 339. - -[468] Vol. ii, p. 340. - -[469] Vol. ii, p. 353. - -[470] Jean de Diest, An hæmorrhage ex dentium evulsione chirurgi -incuria lethalis? Paris, 1735. David Vasse, Hæmorrhagia ex dentium -evulsione, chirurgi incuria lethalis, Paris, 1735. - -[471] M. Bunon, Sur un prejugé très-pernicieux, concernant les maux de -dents qui surviennent aux femmes grosses, Paris, 1741. - -[472] M. Bunon, Essai sur les maladies des dents, Paris, 1743. -Expériences et démonstrations pour servir de suite et de preuves à -l’essai sur les maladies des dents, Paris, 1746. - -[473] Abhandlung von Zahnkrankheiten, etc., Strassburg, 1754. - -[474] A Practical Treatise upon Dentition or the Breeding of the Teeth -in Children. - -[475] Essai d’Odontotechnique, ou Dissertation sur les Dents -Artificielles. - -[476] Sprengel, Part ii, p. 319. - -[477] Journal de Médecine, 1756. - -[478] L. H. Runge. De Morbis sinuum ossis frontis, maxillæ superioris, -etc., Rintel, 1750. - -[479] Sprengel, Part ii (?), p. 322. - -[480] Nouveaux éléments d’Odontologie, contenant l’anatomie de la -bouche, ou la description de toutes les parties qui la composent, et -de leur usage; et la pratique abregée du dentiste, avec plusieurs -observations, par M. Lécluse, Chirurgien dentiste de Sa Majesté le Roi -de Pologne, etc., Paris, 1754 (vol. in 12mo of pages viii-222 with six -plates). - -[481] Abhandlung von den Zähnen des menschlichen Körpers und deren -Krankheiten, 1756. - -[482] Geist-Jacobi, p. 164. - -[483] Die eingebildeten würmer in Zähnen, Regenburg, 1757. - -[Schaffer’s publication is of considerable interest in that his -illustration here reproduced exhibits one of the devices somewhat -generally employed for the eradication of dental worms as a cure for -toothache. In the title of his work Schaffer describes himself as -Protestant preacher at Regensburg, member of the Royal Society of -Fine Arts at Göttingen, of the Royal Society of Science at Duisberg, -honorary member of the Fine Arts at Leipsic. - -[Illustration: Fig. I., Fig. II., Fig. III., Fig. IV., Fig. V., -Fig. VI., Fig. VII., Fig. VIII., Fig. IX., Fig. X., Fig. XI., Fig. XII.] - -The several details of the plate are designated as follows: - -Fig. I. The supposed worms, with single and double tails, or actually -seed buds of the henbane driven out by heat, natural size. - -Fig. II. Kidney-shaped seed of the henbane, natural size, without seed -buds. - -Fig. III. Another such seed, natural size, with the pith being driven -out in bow-shape. - -Figs. IV and V. Slightly magnified supposed entrails of the tooth -worms, actually the inner basis substance for the development of the -seed lobes. - -Fig. VI. Portion of the skin and driven out supposed entrails of the -tooth worms, strongly magnified: (_aa_) skin still attached; (_b_) -supposed entrails. - -Fig. VII. Seed same as Fig. II, magnified: (_a_) external pellicle; -(_b_) seed bud. - -Fig. VIII. Seed of Fig. III, magnified: (_aa_) external pellicle; (_b_) -node; (_c_) seed bud driven out in bow-shape. - -Figs. IX, X, and XI. Three kinds of supposed tooth worms, magnified; -the lettering corresponds in all three: (_a_) head; (_b_) brown spot -or mouth; (_c_) body; (_d_) apparent opening or anus; (_ee_) single or -double tail; (_ff_) brown spot of the tail; also an apparent opening. - -Fig. XII. Representation of the utensils and the mode in which they -are arranged during the application of the supposed remedy against -tooth worms: (_a_) earthen pot; (_b_) opening visible on one side; -(_c_) opening in the bottom; (_dd_) iron passing through the two side -openings, on which the wax balls (containing henbane seeds) are laid -inside the pot; (_e_) smoke arising through the opening in the top, -which is directed into the mouth; (_ff_) bowl of water in which the pot -is set, into which the supposed worms fall and in which they are found -after the cure. - -It would seem not at all improbable that the inhalation of vapors -arising from heated henbane seeds might in some cases, _e.g._, of -odontalgia from pulpitis, produce a sedative effect by the action of -the hyoscyamine given off. Assuming that the method possessed even a -slight therapeutic value, that factor in connection with the apparently -tangible evidence of the existence of tooth worms which it afforded to -the ignorant, makes the method a most interesting example of the way in -which superstition and ignorance about medical matters are kept alive -and sustained by a very slight increment of truth. - -Another interesting reference to the use of henbane seeds for the -cure of toothache by fumigation as found in an old Saxon manuscript -of the ninth or tenth century, a translation of which is published in -Leechdoms, Worthcunning, and Starcraft of Early England, vol. ii, p. -51, a collection of documents illustrating the history of science in -England before the Norman conquest, published under direction of the -Master of the Rolls. The reference is as follows: - -“For tooth wark, if a worm eat _the tooth_, take an old holly leaf and -one of the lower umbels of hartwort and the upward _part_ of sage, -boil two doles (that is, two of worts to one of water) in water, pour -into a bowl and yawn over it, then the worms shall fall into the bowl. -If a worm eat the teeth, take holly rind over a year old, and root of -Carline thistle, boil in so hot _water_! Hold in the mouth as hot as -thou hottest may. For tooth worms, take acorn meal and henbane seed -and wax, of all equally much, mingle _these_ together, work into a -wax candle and burn it, let it reek into the mouth, put a black cloth -under, then will the worms fall on it.”—E. C. K.] - -[484] Recueil périodique d’observations de Médecine, Chirurgie, etc., -par Vandermonde, Paris, 1757, Tome vii, p. 256. - -[485] Recherches et observations sur toutes les parties de l’art du -dentiste, 2 vols., Paris, 1757. - -[486] Sur les dépôts du sinus maxillaire. - -[487] Soins faciles pour la propreté de la bouche et pour la -conservation des dents, Paris, 1759. - -[488] Vol. x, pp. 47 to 148. - -[489] Traité des dépôts dans le sinus maxillaire, des fractures et des -caries de l’une et de l’autre mâchoire, Paris, 1761. - -[490] Essais sur la formation des dents, comparée avec celle des os, -suivis de plusieurs expériences tant sur les os que sur les parties qui -entrent dans leur constitution, Paris, 1766. - -[491] Traité des maladies et des opérations réellement chirurgicales -de la bouche et des parties qui y correspondent, suivi de notes, -d’observations, et de consultations interessantes, tant anciennes que -modernes, 2 vols. 8vo, Paris, 1778. - -[492] Réflexions et éclaircissements sur la construction et les usages -des rateliers complets et artificiels. - -[493] Die Zahnheilkunde, Erlangen, 1851, p. 398. - -[494] Von der Wirkung der elektrischen Erschütterung im Zahnweh. - -[495] Geist-Jacobi, p. 165. - -[496] Neue Versuche zu Curirung der Zahnschmerzen vermittelst eines -magnetischen Stahles, Königsberg, 1765. - -[497] F. E. Glaubrecht, De odontalgia, Argentorati, 1766. - -[498] Journal de Médecine, 1767, p. 265. - -[499] Jos. G. Pasch, Abhundlung aus der Wandarznei von den Zähnen, -etc., Wien, 1767. - -[500] Th. Berdmore, A treatise on the disorders and deformities of the -teeth and gums, London, 1768. - -[501] Einleitung zur nöthigen Wissenschaft eines Zahnarztes, Wien, 1766. - -[502] Abhandlung von der Hervorbrechlung der Milchzähne, Wien, 1771. - -[503] J. Linderer, vol. ii, p. 431. - -[504] Geist-Jacobi, p. 166. - -[505] Gedanken über das Hervorkommen und Wechseln der Zähne, 1768. - -[506] Carabelli, p. 91. - -[507] A treatise on the disorders and deformities of the teeth and -gums, London, 1768. - -[508] See The Rise, Fall, and Revival of Dental Prosthesis, by B. J. -Cigrand, p. 148. - -[509] Carabelli, p. 91. - -[510] Carabelli, p. 93; Lemerle, Notice sur l’histoire de l’art -dentaire, p. 117. - -[511] J. Aitkin, Essays on several important subjects in surgery, -London, 1771. - -[512] Sprengel, vol. ii, p. 348. - -[513] Sprengel, p. 350. - -[514] Bromfield, Chirurgical observations and cases, London, 1773. - -[515] Le dentiste observateur, Paris, 1775. - -[516] Vollständige Anweisung zum Zahn-ausziehen, Stendal, 1782. - -[517] Theden, Neue Bemerkungen und Erfahrungen, Berlin, 1782, part -second, p. 254. - -[518] J. van Wy, Heelkundige Mengel stoffen, Amsterdam, 1784. - -[519] Journal de Médecine, 1791, tomes 86, 87. - -[520] Sprengel, p. 356 to 357. - -[521] Odontologia, ossia Trattato sopra i Denti. - -[522] Benjamin Bell, System of Surgery, 1783 to 1787, vol. iii. - -[523] Medical Transactions of the College of Physicians of London, -1783, vol. iii, p. 325. - -[524] Memoirs of the London Medical Society, 1787, vol. i. - -[525] August Gottlieb Richter, Anfangsgründe der Wundarzneikunst, vol. -ii (1787) and vol. iv (1797). - -[526] Praktische Darstellung aller Operationen der Zahnarznekunst, -Berlin, 1803 and 1804. - -[527] Chapter xlii. - -[528] Uebersicht der Chirurgischen Instrumente. - -[529] Ploucquet, Primæ lineæ odontitidis, sive inflammationis ipsorum -dentium, Tubingæ, 1791; Kappis, Primæ lineæ odontitidis, etc., Tubingæ, -1794. - -[530] Storia naturale di un nuovo insetto, Firenze, 1794. - -[531] Der anfrichtige Lahnarzt. - -[532] Without comment! - -[533] Principia systematis chirurgiæ hodiernæ. - -[534] The anatomical fact alluded to by the author, far from presenting -itself very often, as he says, is of rare occurrence, and cannot be -held in account for establishing a general operative rule. - -[535] Sprengel, pp. 372, 373. - -[536] Hirsch, Praktische Bemerkungen über die Zähne und einige -Krankheiten derselben, Jena, 1796. - -[537] Sprengel, pp. 376, 377. - -[538] For all that regards Bunon’s life and writings we have availed -ourselves of the excellent historical work of A. Barden, “Un -précurseur: Bunon,” a communication presented to the Geneva Session of -the International Dental Federation (August, 1906). - -[539] Expériences et démonstrations, p. 13. - -[540] Ibid., p. 60. - -[541] Lettre sur la prétendue dent œillère. - -[542] Sur un préjugé très pernicieux, concernant les maux de dents qui -surviennent aux femmes grosses. - -[543] Essai sur les maladies des dents, où l’on propose les moyens de -leur procurer une bonne conformation dès la plus tendre enfance, et -d’en assurer la conservation pendant tout le cours de la vie. - -[544] Expériences et démonstrations, avertissement, p. xix. - -[545] Expériences et démonstrations faites à l’Hôpital de la -Salptêrière et à St. Côme, en presence de l’Académie Royale de -Chirurgie, pour servir de suite et de preuves à l’Essai sur les -maladies des dents. - -[546] Essay, p. 127. - -[547] F. Maury. Traité complet de l’art du dentiste, d’après l’état -actuel des connaissances, 2 vols., Paris, 1828. - -[548] Exposé de nouveaux procédés pour la confection des dents dites de -composition, par M. Dubois Faucou, Paris, 1808. - -[549] Rapport sur les dents artificielles terro-metalliques, Paris, -1808. - - - - -INDEX. - - A - - Abbott, A. C., 237 - - Abulcasis, 86, 125 - - Abyssinia, negroes of, file incisors into points, 43 - - Acoluthus, Johann, 240 - - Acupuncture, 38 - - Adamantius, 116, 117 - - Advertisements, 245 - - Ægina, Paul of, 219 - - Æsculapius, 45, 46 - - Ætius of Amida, 117, 170 - - Age of animals judged by the teeth, Aristotle on, 62 - - Aitkin, John, 317 - - Alcock, James, 348 - - Ali Abbas, 122 - - Altomare, Donato Antonio, 200 - - Alveolar pyorrhea, 96, 237 - - Andromachus the Elder, 106, 113 - - Andry, 269, 309 - - Anesthetic, 149 - - Antrum of Highmore, 186, 233, 249, 250, 257, 282, 304, 310, 311, 313, - 318, 320, 325, 330, 333 - - Aphthæ, Celsus on, 84 - - Apollonius, 92, 113 - - Appolonia, Saint, 209 - - Aquapendente, Fabrizio of, 207 - - Arabians, 121 - - Aranzio Giulio Cesare, 201 - - Arcagatus, 77 - - Archigenes, 65, 106, 113 - - Arcoli, Giovanni of (Arculanus), 153, 168, 199 - - Argelata, Pietro of, 151 - - Aristotle, 53, 61, 64 - - Arnemann, J., 331 - - Arsenic, 35, 85, 122, 125, 138, 152, 157 - - Asclepiades, 80 - - Asklepiadi, priests of the temple of Æsculapius, 45, 46 - - Astringent mouth washes, 97, 115, 116, 122, 153 - - Atmospheric conditions, influence on dental maladies, 57, 116, 247 - - Aurelianus, Celius, 46, 65, 113, 114 - - Auzeki, Pierre, 317 - - Avenzoar, 139 - - Avicenna, 84, 123 - - - B - - Babylonians, treatment of sick by the, 18 - - Bacteria, 237 - - Barbers, 86, 130, 132, 139, 144, 159, 162, 166, 169, 188, 240, 242, - 243, 244, 245, 255 - - Barden, A., 340 - - Bartholin, Thomas, 232, 235 - - Bass, Heinrich, 259 - - Bell, Benjamin, 324 - - Belzoni, G. B., on Egyptian dentistry, 27 - - Benedetti, Alessandro, 157, 187 - - Benedictus of Faenza, 203 - - Berdmore, Thomas, 315, 316 - - Bertin, J., 304 - - Bible, reference to teeth in the, 32, 33 - - Bidloo, Gottfried, 239 - - Birds, teeth of, 63 - - Blum, Michael, 164 - - Blumenthal, K. A., 337 - - Bodenstein, Adam, 205 - - Bordenare, Thomas, 313 - - Bourdet, 309 - - Brahmins, care of the teeth among the, 42 - - Bridge work, 297 - Etruscan attempts at, 76, 101 - - Bromfield, W., 318 - - Brunner, Adam Anton, 315 - - Bruno of Longobucco, 140 - - Bruschi, Etruscan dental appliances in Museum of Count, 73 - - Bücking, 321 - - Bunon, Robert, 301, 337 - - - C - - “Calendar of dentition,” 315 - - Callisen, Heinrich, 333 - - Camindus, Balthasar, 215 - - Campani, Antonio, 323, 327 - - Capivacci, Gerolamo, 201 - - Carabelli, 157, 317, 321 - - Carbonate of lime, ancient dentifrice mentioned by Pliny, 94 - - Caries, dental, 24, 110, 122, 147, 251, 269, 319, 335 - - Carmeline, 253, 261, 283 - - Cascellius, first dentist mentioned by name, 102 - - Castellani collection, Rome, Etruscan appliances in, 76 - - Catullus, 97 - - Cauteries, dental, 328 - - Cauterization, 25, 40, 85, 107, 111, 118, 126, 138, 152, 212, 227, - 246, 289, 310 - - Caylus, 99 - - Celius Aurelianus, 46, 65, 113 - - Celsus, 65, 80, 83, 84, 85, 86, 87, 102 - - “Cement” filling, 122, 240 - of Guillemeau, 253 - - Channing, John, 126 - - Charlatans, 159, 162, 277, 310, 316 - - Chauliac, Guy de, 146 - - Chemant, Nicholas Dubois de, 329, 344 - - Chinese, anatomical notions of, 39 - dentistry among the, 34 - - Chopart, 322 - - Cigrand, 47, 68, 316 - - Cintio d’Amato, 242 - - Clasps, 303 - - Clauder, Gabriel, 232 - - Cleanliness of the teeth among the Romans, 97, 106, 107 - - Coiter, Volcherus, 200 - - Coition, toothache from, 35 - - Cold applications, harmful to the teeth, 61 - - Colombo, Matteo Realdo, 177 - - Côme, Frère, 318 - - Compressor of Foucou, 321 - - Condamine, 314 - - Corneto, museum of, Etruscan appliances in, 71, 72, 73 - - Cos, temple of, medical records in, 18, 46, 48 - - Courtois, 321 - - Cowper, William, 234, 249 - - Cremation among the ancients, 69 - - Criton, 113 - - Croce, Giovanni Andrea della, 201 - - Cron, Ludwig, 255 - - Crowley’s “Dental Bibliography,” 253, 256 - - Crown, artificial, 296, 315 - gold, 217, 303 - - Ctesias of Cydnus, 62 - - Customs of primitive peoples, 42 - - - D - - Dabry, P. P., “La médecine chez les Chinois,” 34 - - Dalli Osso, archeologist, 78 - - Damocrates, Servilius, 106 - - Daremberg, “Histoire des sciences médicales,” 80, 99 - - De Lavauguyon, 253, 255 - - Décorative medicine, 244 - - Dekkers, Friederich, 241 - - Delphi, temple of Apollo at, 46, 114 - - Deneffe, “La prothèse dentaire dans l’antiquité,” 67, 75, 102 - - Dental appliance, Etruscan, found at Tarquinii, 71 - near Teano, Italy, 79 - at Valsiarosa, 70 - art among the ancient Germans, 162 - the Etruscans, 67 - the Romans, 77, 102 - first beginnings of, 17 - practised by specialists in ancient Egypt, 25 - caries, 110, 122, 147, 251, 269, 319 - irregularities, 280, 290, 303, 320 - maladies given in Ebers’ papyrus, 21 - surgery not mentioned in Ebers’ papyrus, 25 - and surgical instruments of the Romans, 86 - terminology found in Vesalius, 176 - - Dentateurs, 199 - - Dentator, 144, 147 - - Dentiduces, 226 - - Dentifrices, 35, 38, 51, 87, 93, 94, 96, 97, 105, 112, 124, 141, 148, - 154, 247, 322 - - Dentine, structure of, 237, 319 - - Dentisculpia (toothpicks), 98, 226 - - Dentispices, 219 - - Dentist, the word itself, 102, 144 - Cascellius the first, 102 - - Dentista, 144 - - Dentistry, condition of, before Fauchard, 260 - in the middle ages, 121 - as a true specialty, 255, 263 - - Dentists, examination of, 261, 339 - - Dentition, “Calendar” of, 315 - third, 91, 143, 185, 199, 306 - - Dentures, complete, 298, 313, 336 - porcelain, 344 - spring, 299, 300 - - Deodato, Claudio, 224 - - Desault, 322 - - Deschapellement (uncrowning), 194, 204, 275 - - Diemerbroek, 235 - - Diest, Jean de, 301 - - Dionis, Pierre, 251 - - Dioscorides, 84 - - Dissection prohibited by the Koran, 121 - - Doctors’ shops in ancient Greece and Rome, 52 - - Drake, James, 249 - - Dubois de Chemant, Nicholas, 329, 344 - Foucou, 346, 347 - Jacques, 172 - - Duchâteau, 344 - - Duchemin, student of Fauchard, 260 - - Dufour, 309 - - Dupont, 223 - - Duverney, Jean, 238 - - - E - - Ears and the teeth, 54, 56, 94, 228, 236, 250, 315 - - Ebers’ papyrus, 19 - George, on dental art of Egyptians, 28 - - Egypt, special doctors for the teeth in ancient, 26, 64 - - Egyptians, dental art among the, 19, 67 - prescriptions of the, 21, 22, 23, 24 - - Eighteenth century, 255 - - Electricity, use of, for toothache, 314 - - Elevator of Lécluse, 305 - - Elevators, 133, 134, 305 - - Enamel, artificial use of, 301, 310 - structure of dental, 238 - - Endelman, Julio, 205 - - English key, 257, 317 - - Epilepsy, 169 - - Epulis, 117, 118, 123, 127, 239, 251, 334 - - Erasistratus, 65 - - Erosion, dental, 302, 320, 337, 341 - - Etruscans, dental appliances of, 70, 71, 72, 73, 74, 76 - art among the, 67, 70 - votive offerings of, 67 - - Eustachius, Bartholomeus, 178, 204 - - Examination of dentists, 261, 339 - - “Experts pour les dents,” 261 - - Extraction of teeth, 25, 45, 51, 64, 82, 86, 103, 108, 112, 114, 118, - 122, 124, 128, 137, 141, 151, 152, 158, 160, 193, 210, 222, 240, - 246, 252, 276, 292, 315, 321, 337 - death from, 65, 114, 137, 139 - of eye-teeth, 301, 339 - pain after, 112 - as a punishment, 139 - - Eyes and the teeth, 54, 89, 168, 246, 301, 304 - - - F - - Fabrizio of Aquapendente (Fabricius), 207 - - Fabry, Wilhelm (Fabricius Hildanus), 223 - - Fallopius, Gabriel, 177 - - Fauchard, Pierre, 255, 259 - - Filing of teeth by people of India, 42 - by women of Sumatra, 43 - - Filling of teeth, 122, 147, 150, 151, 155, 159, 164, 199, 208, 240, - 252, 256, 285, 309, 315, 320, 328 - - Fingers, extraction of teeth with the, 64 - - Fischer, Johann Bernhardt, 259 - - Fistulæ, dental, 22, 140, 152, 201, 203, 224 - - Fleurimond, 245 - - Follicle, dental, 177 - - Fontanella, Don Angelo, anecdote of, 104 - - Fonzi, 347 - - Forceps, cutting, 294 - extracting, 46, 52, 86, 87, 114, 131, 157, 167, 207, 211, 226, - 278, 292, 293, 325, 330, 334 - - Foreest, Peter, 157, 202 - - Foucou, 321, 346, 347 - - Fracture of lower jaw, 59, 137, 190, 342 - - Fractures and dislocations, Celsus on, 87 - - Fredericus, Rinaldus, 235 - - Frogs, use of, for dental maladies, 95, 107, 125, 138 - - - G - - Gaddesden, John, 140 - - Gagliardi, Domenico, 238 - - Gaillardot, Dr., researches in necropolis of Sidon, 29 - - Galen, Claudius, 52, 63, 65, 80, 82, 108, 109, 121 - - Garengeot, Croissant de, 257 - - Gebauer, Ernst Ferdinand, 259 - - Geist-Jacobi, 23, 59, 78, 102, 114, 157, 163, 166, 169, 220, 306, - 311, 314 - - Genga, Bernardo, 235 - - Gerauldy, Fr. A., 302, 338 - - Gerbi, Ranieri, 332 - - “German key,” 257 - - Germans, dentistry among the, 161 - - Ghent, University of, Etruscan appliance in museum of, 74 - - Gilles, Arnauld, 222 - - Gingivitis, treatment of, by Galen, 111 - - Giovanni of Arcoli, 153, 168, 199 - of Vigo, 159 - - Glaubrecht, F. E., 314 - - Gold appliances of the Etruscans, 71 - of the Romans, 101 - bands, mentioned in law of the Twelve Tables, 77 - crown, 217, 303 - fillings, 29, 156, 159, 164, 208, 252, 256, 285, 309, 315, 316, 329 - teeth, substitution of, in Java, 42 - in Macassar, 43 - wire, use of, 30, 87, 135, 146 - - Golden tooth, story of the, 214 - - Göritz, Johann Adolph, 258 - - Gout, 219 - - Gräbner, C. A., 315 - - Grafenberg, Johann Schenck von, 202 - - Greek doctors in Rome, 79 - - Greeks, ancient appliance of the, 60 - dentistry among the ancient, 45, 77 - - Griffon, J., 225 - - Guerhard, 344 - - Guillemeau, Jacques, 253 - - Gums, diseases of, according to Celsus, 84 - - Guy de Chauliac, 142 - - - H - - Haller, Albert von, 166 - - Harris, Walter, 239 - - Havers, Clopton, 239 - - Hebrews, dental affections rare among the ancient, 32 - - Hecker, A. F., 331 - - Heister, Lorenz, 255 - - Hémard, Urbain, 194, 203 - - Hemorrhage after extraction, 229, 231, 258, 301, 306, 321, 335 - of the gums, 115, 157 - - Henkel, 318 - - Heraclides of Tarentum, 65, 113 - - Herodotus, 18, 25, 64 - - Herophilus, 65 - - Heurmann, Georg, 305 - - Heurn, Johann (Heurnius), 175, 212 - - Hieratic characters, Ebers’ papyrus in, 20 - - Highmore, Nathaniel, 186, 232 - - Hindostan, care of the teeth by the natives of, 42 - - Hindu dentists, primitive type of dental prosthesis by, 30 - - Hippias, anecdote from Herodotus on, 26 - - Hippocrates, 17, 18, 47, 108 - - Hirsch, Friedrich, 334 - - Histology, 236 - - Hoffmann, Johann, 249 - - Homer, refers to sons of Æsculapius, 45 - - Horace, false teeth mentioned in satire of, 102 - - Horst, Jacob, 214 - - Houllier, Jacques, 199 - - Hunter, John, 316, 318, 324 - - Hurlock, Joseph, 303 - - Hygiene of the mouth, 80, 87, 92, 106, 107, 127, 144, 153, 196, 230, - 248, 266, 310, 330, 341 - - Hypoplasia, dental, 341 - - - I - - Immunity from toothache, 221 - - Implantation, 311 - - India, people of, customs relating to the teeth of, 42 - - Ingolstetter, Johann, 215 - - Ingrassia, Gian Filippo, 177 - - Instruments, 52, 128, 144, 151, 157, 167, 192, 201, 206, 207, 211, 226, - 227, 241, 279, 284, 331 - for extracting, 321, 323, 327 - of gold, 251 - of the Romans, 86 - - Iron, tooth of, 232 - - Irregularities, dental, 280, 290, 303, 320, 342 - - - J - - Jacobaens, Oligerus, 231 - - Java, substitution of gold teeth by people of, 42 - - Joachim, Heinrich, translation of Ebers’ papyrus by, 19 - - Jourdain, 311 - - Junker, Johann, 257 - - - K - - Key with changeable hooks, 326 - English, 257, 317 - of Garengeot, 257 - - Kircher, 217 - - Kirk, E. C., 28, 30, 43, 82, 83, 84, 96, 115, 118, 138, 164, 216, - 307, 308 - - Klaerich, F. W., 314 - - Knights of the Teutonic Order, 163 - - Koran, dissection prohibited by the, 121 - - - L - - Lancets, gum, 195 - - Lancing of the gums, 198, 239, 257, 265, 303, 304, 312, 321, 322, - 324, 331, 334, 336 - - Lanfranchi, 140 - - Lavini, 301 - - Law of the Twelve Tables, 69, 77, 78 - - Le Hire, 265 - - Lead for filling teeth, 285, 309, 320, 335 - - Lécluse, 257, 305 - - Leeuwenhoek, Antoni van, 237 - - Lemerle, 317 - - Lemorier, 313 - - Lentin, L. B., 314 - - Lentisk wood, toothpicks of, 98 - - Lepsius, opinion of, on Ebers’ papyrus, 20 - - Lettson, 329 - - Leucorrhea, 58 - - Leyden, Lucus van, 213 - - Liddel, Duncan, 216 - - Ligatures, Abulcasis on, 135 - - Linderer, Joseph, 27, 42, 98, 139, 162, 181, 220, 257, 313 - - Loder, 257 - - Longevity, influence of number of teeth on, 58 - - Lusitanus, Amatus, 229 - - Luxations of jaw, 88 - - - M - - Magnet, use of, for toothache, 314 - - Major, Daniel, 240 - - Malpighi, Marcello, 236 - - Manteville, 269 - - Marcellus, 115 - - Martial, epigrams of, 98 - - Martin, Benjamin, 241 - - Martinez, Francisco, 205 - - Massage, ancient practice of, 114 - - Massez, 313 - - Maxillary sinus, 186, 233, 249, 250, 257, 282, 304, 310, 311, 313, - 318, 320, 325, 330, 333 - - Mechanical dentistry, first work on, 303 - - Medicine in ancient Eygpt, 19 - decorative, 244 - - Medicine, most ancient work on, 19 - sacerdotal, 17 - special branches of, 103 - - Meibom, Heinrich, 250 - - Mercury, harmful effects of, 158, 202, 230 - - Mesue the younger, 137, 164 - - Mice, use of, for dental maladies, 36, 50, 93, 94, 97 - - Microörganisms, 237 - - Microscopes, 236, 237, 269 - - Middle ages, dentistry in the, 121 - - Minadous, Thomas, 232 - - Mineral teeth, 254, 329, 344, 348 - waters of Carlsbad, 220 - - Models in dental prosthesis, 241, 306 - - Modern times, dentistry of, 161 - - Molinetti, Antonio, 234 - - Monavius, Petrus, 205 - - Monkey, dental system of, 63 - - Montagnana, Bartolomeo, 152 - - Montanus, Giovanni Battista, 230 - - Moraine’s verses on Fauchard, 260 - - Motte, G. M. de la, 258 - - Mouth mirror, 344 - washes, 55, 97, 111, 265, 274 - - Mouton, 303, 309 - - “Moxa,” use of, by Chinese, 40 - - Mummery, J. R., 25, 29 - - Mummies, Egyptian, 27, 28, 49 - - Murphy, Joseph, 42 - - Museum of antiquities, Dresden, 162 - (archæological) of Athens, 52 - (archæological) of Florence, 70 - of Corneto, 71, 72, 73 - of Count Bruschi, 73 - of Pope Julius, Rome, 70, 101 - of University of Ghent, 74 - - Musitano, Carlo, 247 - - - N - - Nasal prosthesis, 256 - - Necrosis of lower jaw, 241 - of the teeth, 56 - - Nerves of teeth, 109 - - Neuralgia, 224 - - Nicaise, E., 142 - - Nobile, Luigi, 78 - - Nomenclature, 88, 318 - - Nuck, Anton, 245 - - Number of teeth, 59, 109 - - - O - - Obturators, 197, 198, 211, 301, 310 - - Oceanica, dyeing the teeth black by races of, 42 - - Odontagogon, 46, 65, 114 - - Odontagra, 64 - - Odontalgia, 34, 38, 51, 92, 95, 103, 106, 107, 109, 111, 113, 124, - 137, 141, 145, 150, 152, 154, 158, 190, 202, 219, 220, 221, 228, - 247, 248, 271, 283, 314, 332 - - Odontitis, 331 - - Operative dentistry, Fauchard on, 284 - - Oribasius, 117 - - Orvieto, 69, 74 - - - P - - Papyrus of Ebers, 19 - - Paracelsus, 176 - - Paré, Ambroise, 188 - - Pasch, J. G., 314, 315 - - “Pastophori” treatment of sick by, 19 - - Paul of Ægina, 118 - - Peale, Charles W., 348 - - Pechlin, Nicolaus, 232 - - Pelican (extracting instrument), 157, 158, 167, 193, 206, 211, 226, - 281, 290, 291, 292, 311, 323, 324, 330, 334 - - Perine, Geo. H., 27 - - Periodontitis, 122, 320 - - Petronius, 98 - - Peyronie, de la, 339 - - Pfaff, Philip, 305 - - Pfolsprundt, Heinrich von, 163 - - Phœnicia, ancient dental appliance found at Sidon, 29 - influence of, on Etruscan dentistry, 67 - - Phœnician vase, with portrayal of dental operation, 47 - - Pietro of Albano, 144 - of Argelata, 151 - - Pig, teeth of the, 62 - - Pincers, ligature, 295 - - Plaster models, 306 - - Plateario, Giovanni, 152 - - Pliny, 89, 102 - - Pluggers, 288 - - Pomaret, Denis, 223 - - Portal, 245 - - Poteleret, Alexandre, 262 - - Pregnancy, extraction of teeth during, 301, 339 - - Prescriptions, Chinese, 35 - dental, of Hippocrates, 50 - Egyptian, 20, 21, 22, 23, 24 - - Priesthood, ancient, treatment of sick by, 17 - - Primitive peoples, customs relating to teeth of, 42 - - Prosthesis, dental, 146, 211, 296 - - Prosthetic pieces, movable, 256 - - Pulp-capping, 306 - - Pulp, inflammation of, recognized by Archigenes, 107 - - Pumice stone in dentifrices, 96, 97, 141, 203 - - Purland, T., 28 - - Purmann, Matthias Gottfried, 241 - - Pyorrhea (alveolar), 96, 237 - - - Q - - Quacks, 159, 162, 277, 310 - - Quill toothpicks mentioned by Martial, 98 - - - R - - Ranula, Abulcasis on the cure of, 137 - - Renan, “Mission de Phénicie,” 29 - - Replantation, 136, 191, 251, 281, 293, 305, 309, 316, 321, 334, 335 - - Rhazes, 84, 121, 122, 153 - - Riccio, Tommaso Antonio, 242 - - Richter, A. G., 329 - - Rivière Lazare (Riverius), 228 - - Rizagra (Greek forceps), 87 - - Romans, dental art among the, 77 - - Rome, Arcagatus the first Greek doctor in, 77 - - Rueff, 316 - - Ruland Martin, 215 - - Runge, L. H., 304 - - Ruspini, Bartholomeo, 343 - - Russel, 313 - - Ruysch, Friederich, 236 - - Ryff, Walter, 157, 161, 166 - - - S - - Saalburg, forceps found in ancient castle of, 114 - - Saliva, 331 - - Salmuth, Philip, 232 - - Sandwich Islands, natives of, sacrifice front teeth, 43 - - Satricum, example of gold crown work found at, 101 - - Saws, dental, used by Abulcasis, 136 - - Scalers, Abulcasis on use of, 127 - of Fauchard, 285 - of silver mentioned by Fabricius, 210 - - Schaffer, Jacob Christian, 306 - - Schelhammer, Christopher, 250 - - Schmidt, Prof. Emil, 29 - - Schultes, Johann (Scultetus), 226 - - Schulz, Gottfried, 232 - - Scorbutus, case of, mentioned by Hippocrates, 55 - - Scribonius Largus, 103 - - Scultetus, 226 - - Scurvy, 57, 237 - - Secrecy among dentists, 262 - - Senile decay, 186, 238 - - Serapion, 123 - - Serre, 47, 78, 330 - - Serres, 181, 217 - - Seventeenth century, dentistry in the, 218 - - Severino, Marco Aurelio, 227 - - Shops of doctors in ancient Greece and Rome, 52 - - Sidon, necropolis of, 29 - - Silesian child, golden tooth of the, 214 - - Silver, toothpicks of, mentioned in satire of Petronius, 98 - - Six, Martin, 231 - - Sixteenth century, dentistry in the, 161 - - Spiegel, Adrian (Spigelius), 235 - - Sprengel, “Geschichte der Chirurgie,” 139, 166, 223, 253, 257, 259, - 304, 337 - - Sternberg, J. H., 337 - - Stockton, Samuel W., 348 - - Story of the Golden Tooth, 214 - - Strabo, 98 - - Strobelberger, Johann Stephan, 218 - - St. Yves, Charles, 250 - - Surgeon-dentist, 244, 339 - - Surgery, ancient, eminently conservative, 108 - - Surgical instruments deposited in the temples, 46 - - Sylvius, 172 - - - T - - Tagliacozzi, Gaspare, 226 - - Talmud, the, 32 - - Tartar, dental, 119, 127, 150, 151, 237, 244, 258, 275, 302, 342 - - Teano, Italy, prosthetic piece found near, 78 - - Teeth, artificial, Dionis on, 252 - of the Etruscans, 70 - mentioned by Martial, 100 - opposition to use of, 241, 258 - Paré on, 197, - Romans, 78 - care of the, _See_ Hygiene of the mouth. - among the Brahmans, 42 - the Romans, 97 - dignity and importance of the, 235 - dyeing black, by married women of Japan, 43 - by races of Asia and Oceanica, 42 - red, by people of eastern India and Macassar, 43 - gilding of the, in Sumatra, 43 - of mummies, 28, 29, 49 - names of, as given by Guy de Chauliac, 143 - number of, indicated by Galen, 109 - influence on long life of, 58 - pivot, no evidence of Egyptian knowledge of, 29 - Pliny on persons born with, 89 - trepanning of, advised by Archigenes, 65 - - Terminology, dental, found in Vesalius, 176 - - Teske, J. G., 314 - - Theodorico Borgognoni, 140 - - Theriac, famous remedy of Andromachus, 106 - - Tin for filling teeth, 285, 329, 335 - - Tobacco, 220, 230 - - Tonsillitis, Celsus on, 83 - - Tooth brushes, 266, 334 - - Tooth of iron, 232 - story of the golden, 214 - - Toothache, 35, 51, 80, 92, 103, 106, 107, 109, 113, 115, 126, 150, - 190, 202 - immunity from, 221 - - Toothpick and ear-picker of gold found in Crimea, 99 - - Toothpicks, 94, 98, 208 - - Transplantation, 282, 293, 303, 321, 329, 334, 335 - - Treatment of dental disorders by the Chinese, 35 - - Trephine, use of, by Archigenes, 108 - - Trueman, Wm. H., 68 - - Tulp, Nicolaus, 231 - - - U - - Uncrowning of teeth, 194, 204, 275 - - Urine, 35, 43, 97, 98, 274 - - Uxedu, painful swelling, referred to in Ebers’ papyrus, 20, 23 - - - V - - Valentini, Bernardo, 234 - - Valescus of Taranta, 149 - - Valsiarosa, dental appliance found at, 70, 72 - - Van Leeuwenhoek, Antonie, 237 - - Van Marter, J. G., 27 - - Van Meekren, Hiob, 239 - - Van Soolingen, Kornelis, 240 - - Van Wy, J., 322 - - Vasse, David, 301 - - Verduc, Jean, 253 - - Vesalius, Andreas, 172 - - Vigo, Giovanni of, 159 - - Virchow, 29 - - Votive offerings, dental, of Etruscans, 68 - tables in ancient temples, 18, 46 - - - W - - Weapons, teeth of animals as, 62 - - Wecker, Johann Jacob, 200 - - Westphal, A., 304 - - Weyland, Fr. L., 318 - - White, Samuel S., 348 - - Wichmann, J. E., 336 - - Wildman, Elias, 348 - - Wilkinson, Sir Gardner, 28 - - Willich, 321 - - Wooffendale, Robert, 316 - - Worms, dental, 104, 125, 126, 141, 148, 150, 153, 158, 199, 203, 214, - 220, 228, 229, 231, 232, 247, 268, 307, 309 - - Wurfbein, Paul, 241 - - - Z - - Znamenski, 295 - - Zwinger, Theodor, 240 - - - - - -End of the Project Gutenberg EBook of A History of Dentistry from the most -Ancient Times until the end of the E, by Vincenzo Guerini - -*** END OF THIS PROJECT GUTENBERG EBOOK A HISTORY OF DENTISTRY *** - -***** This file should be named 51991-0.txt or 51991-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/1/9/9/51991/ - -Produced by deaurider, Turgut Dincer and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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