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PUBLISHED UNDER THE AUSPICES OF

THE NATIONAL DENTAL ASSOCIATION
OF THE UNITED STATES OF AMERICA

History of Dentistry

FROM THE MOST ANCIENT TIMES

UNTIL THE END OF THE

EIGHTEENTH CENTL'RY

Dr. VINCENZO gUERINI, Cav. Uff.

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' * ^ e .

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.

48242

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 ^4

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 11.
SECOND PERIOD— THE MIDDLE AGES.

CHAPTER VIII.
The Arabians . 121

CHAPTER IX.
Thirteenth to Fifteenth Centuries ... 140

viii CONTENTS

PART III.
THIRD PERIOD— MODERN TIMES.

CHAPTER X.
Thb Sixtbbnih Century i6i

CHAPTER XI.
The Seventeenth Century 218

CHAPTER XU.
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 Ferine, Dexter, and
Cigrand, are out of print and difficult to obtain. The Geschichte der Zahn-
heilkundey by Geist-Jacobi, and Notice sur rHistoire de V Art DentairCy
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/w// 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 in-
activity 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

X INTRODUCTION

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 in-
serted 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 Hittory of Dentistry ^

National Dental dissociation , 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 sup-
posed 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

18 FIRST PERIOD— ANTIQU ITT

patient recovered, the respect and veneration of the people for the sacer-
dotal 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 purifica-
tion 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 sug-
gested 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 treat-
ment 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 effica-
cious, among all those recommended, against the various maladies.

Another custom that served to furnish useful elements for the develop-
ment 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 descrip-
tion of the malady and of the treatment that had proved useful in dis-
pelling 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 utili'/ed in a great measure
bv 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.

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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 Flgyptians of old
is now no longer limited to the scanty notices handed down to us bv 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.* 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. I he cele-
brated Egyptian scholar. Prof. George Ebers, procured it, toward the

* See Introduction to the German translation of the Kbers papyrus, by Heinrich Joachim,
Berlin, 1890.

20 FIRST PERIOD— ANTIQUITY

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 repro-
duce some passages of it, so as to give our readers an idea of the style of
writing.^

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.

Fig. I

I3:*f|:SPia::>lic'l,-sf-^AlstSiria-

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*
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

* 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.

* See page 185 of the German translation of Dr. Joachim.

DENTAL ART AMONG THE EGYPTIANS 21

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 pre-
vious or at a much earlier epoch.

Fig. 2

Part of Ebers' papyrus in Egyptian hieratic characters containing eleven dental prescripiions.

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
bennul blisters in the teeth and to strengthen the flesh (gum)."

It is somewhat difficult to say what is meant by bennul 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 I

Dough '■ I

Honey . " 1

Oil "I

To be applied on the part as a plaster."

FIRST PERIOD— ANTIQU ITT

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

"Fennel seeds Part

Dough

Anest-plant

Honey

Incense

Water

The other was still more complicated and thus compounded:

««r^s

Dam-plant Part

Anest-plant

Incense

Amaa-plant

Man-plant

Saffron

Aloe wood

Annek-plant

Cyperus

Onion

Water

f >

At page 89 of the papyrus^ 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 i

Fresh dates

Uah corn

To be left stand and then to be masticated nine times."

((

This is the second receipt:

Anest-plant

Dough

Green lead

Sebests'

Cake

Dam-plant

Fennel seeds

Olive oil

Water

To be used like the preceding one.

Part

* See the German translation by Joachim, page 162.
' A fruit resembling cherries.

DENTAL ART AMONG THE EGTPTIANS 23

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 i

Green lead " i

Honey " i

To be mixed and the teeth rubbed with it."

The following is another remedy for the same purpose:

it
<<

"Powder of flint stones Part i

Green lead " i

Honey " i

To be rubbed on the teeth."

Next comes a remedy "to cure the growth of uxedu in the teeth,"
that is:

"Dough Part

Beans

Honey

Verdigris

Green lead "

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 aflPections of the most diflPerent parts of the body.
By confronting all the passages of the papyrus in which one finds the
word uxeduy Joachim deduces that it does not indicate any special dis-
ease, but has the general signification of "a painful swelling." Accord-
ing to Geist-Jacobi, by "growth of the uxedu in the teeth" may be
understood an alveolar abscess and the consequent swelling of the sur-
rounding 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 i

Incense . . " i

Onion " I

To be reduced to a paste, and applied on the tooth."

24 FIRST PERIOD— ANTIQUITY

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

"Incense Part i

Verdigris ** i

Green lead " i

Mix and apply on the tooth."

The other is compounded of :

"Water Part i

Absinth " i

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 i

Sweet beer " i

Sut-plant " I

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 i

Duat-plant " i

Sweet beer " i

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^^^

Onion " Ti

Cake "j\

Dough ** \

Anest-plant " 1J T

Water " ^

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

DENTAL ART AMONG THE EGYPTIANS 25

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 affec-
tions. These must consequently have been frequent enough, which
demonstrates the erroneousness of the opinion held by some, who affirm,
as does Mummery,* 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 Ixxii of the papyrus^ 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 opera-
tive 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

* On the Relations of the Human Teeth to those of the Lower Animals, by John R.
Mummery. Trans. Odontological Society of Great Britain, May, i860.
' See German translation by Joachim, p. 120,

26 FIRST PERIOD-^ANTIQUITT

second book of Herodotus we find the following passage: "The exer-
cise 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 diflPerent 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."^

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.' "^

In another part of the Historyy 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 i486, 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.

' Herodoti Halicamassei historia, 1570 fol. Euterpe, page 53.
' Herodoti Halicamassei historia, lib. vi.

DENTAL ART AMONG THE EGTPTIANS 27

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^ tells us that, according to Belzoni* and others, arti-
ficial teeth made of wood and very roughly fashioned have been found
in Egyptian sarcophagi.

George H. Ferine, a dentist of New York, in an article on the history
of dentistry,' 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 orna-
mentation, 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*
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,* writes, among other things, that the renowned archeologist^
Mr, ForbeSy 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

^ Die Zahnheilkunde, Erlangen, 1851, p. 348.

' G. B. Belzoni (1778 to 1823), ^ celebrated Italian traveller and archeologist, visited
Egypt and Nubia, and wrote, in English, a report on his discoveries, which was published
in 1 82 1. 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.

* New England Journal of Dentistry, 1883, vol. ii, p. 162.

* 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.

* See Giomale di Corrispondenza pei Dentisti, October, 1885, p. 227.

28 FIRST FERIOD-^ANTIQlJlTr

\m 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 he 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/

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 misti-
fication? It has, in fact, been reported' that the pretended Egyptian
stopping in a mummy existing in an Knglish 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 con-
tradictory statements on the part of the most competent authorities.

The celebrated Kgj'ptologist, Prof, George Kbers, 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.'

* I Thr olt-quotcd «ttttrmrnts of Mr. l\irland with rcrercnce to Egyptian dental art are
rrwrdrd in the trtinsuctionii of the first monthU* meeting of the College of Dentists, an
extinct Kn^liKh dcnttil usHocintion, and published in the j^uarterly Journal of Dental
ScirniT, 1857% vol. i, p. 40, where the following note by the secretary' appears: "Mr.
Purbnd repudiated the idea of the Chinese having been the first to manufacture teeth, and
referred tt» numerous s|>ecimens in the British Museum, manufactured between four thousand
and iwt^ thousand years ago by the Kg>'ptians, who he considered were the original makers.
On the subjeci of fiini, Mr. Purland said he had discovered pieces of wood in the centre,
and remarkeii u|H>n the aitificial teeth he had found in mummies.**

Again, at |>age 6< of the same journal, in an article entitled ** Dental Memoranda,** by
'l\ IHirland, l>eniisf, l*h.D., the author says:

** ReliK>ni and others disa>vereil rudely manufactureiJ teeth in the sarcophagi of the
t^vptians. .As regar\ls the use of gold leaf. Sir C»ardner Wilkinson observes, as a singular
fact, that the K^vi^tians st\>p|MHl teeth with gi^ld.

** It is true that rudely manufacturer! teeth have been t\)und in the heads of Kg>-ptian
mummies, but it is e\)ually true that teeth of a NTr>* superku make and adaptation have also
been found, »Mue carve\l in iu^rv, i>tben5 in swannvre w\hhI, and >s»>me ha>*e been found fixed
U|HU^ gi^ld plate*. Of these varnMies, Awu^ arr de|xvsited in the valuable and extensive
museum beku^giixg t\^ Jiviae|^ Ma>Yr, Fsq., K.S,A.,of Liver|XH^; others arr in the museums
of B^ilin and l^aiis, and I am in |xvssrssk« of a ux>th R^und piw^ed to a stump in the
bead of a nuu^uwv in the c\>IWctk^^ of a lanu^nted friend.

*H>f st\)p|Mi\g with gi^M, seNxral instances bavr c\ui>e u^ my notke^ patticularh in a
mummy m the Salt c\^lectku\, A4d bv Si^bebv. in i8^^ in which three teeth bad been
st\>p|^v \ baxe ei^eawuxU t\> tracts the mummy, but in vain/*— K. C. K.]

♦ l%i^xmale di axctis|H¥Hkn*a pel Ueniisti. iVtoher. iS$i. p. iiv>.
« lWi^J«c«ihk iirschkhie dec ZlKllll«i&wndl^ ^ ^

DENTAL ART AMONG THE EGYPTIANS 29

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."* 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;' and
Mummery, as well, although he made the most conscientious researches
on this subject, could not arrive at any positive results whatever.'

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 formulae 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 archeological 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 Pheniciey 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

* Geist-Jacobi, Geschichte der Zahnheilkunde, p. 9. ' Ibid.

' Ibid.

30 FIRST PERIOD— ANTIQUITY

four incisors united together with gold wire;' two of the incisors would
appear to have helonged to another individual, and to have been applied

Phanic

appliai

e found at Sidon, as represented ir

itofRer

sMis

n de Phenicie.

' 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. Gaillardoi was part of the inferior and not of the superior
jaw. In the latter case, the fgure in Renan's book ought to be reversed, in the manner
here shown:

Thes;

efigu,

sed, as it ought to be if the piece found at Sidon belonged to a lower jaw.

Neither do we understand on what ground Dr. Gaillardot has based his affirn
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. J and 6) are
from photographs of specimens of work done by native Hindu dentists. Fig. 5 is a roughly
carved artilicial tooth of ivory attached by a gold wire ligature to the adjacent natural

Fic. 5

Fig. 6

iUk 'ialt

Examples of dental prosthesis as practised by the Hindus at the present time.

teeth, all of which, with the anificial tooth attached, were (ubsequently lost by alveolar
disease. Fig. 6 is a similar carved artiRcial tooth of ivory a ~

by a thread ligature, the supporting teeth with thr
lost by alveolar disease. TheK ■pecimefi*
H. B. Osbom, of Burma, duiini

DENTAL ART AMONG THE EGYPTIANS 31

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."*

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 Phoenicia and in its large and industrious cities Tyre and
Sidon. The remains discovered in many of the Phoenician 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.

^ Renan, Mission de Phenicie, p. 472.

CHAPTER 11.
THE HEBREWS.

In the Hebrew literature, as principally represented by the Bible and
by the Talmud, there does not exist any book on medicine. Notwith-
standing 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,^
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):

* The number varies according to the different *«»
dentes elephantis, we find in English and in oth'

THE HEBREJVS 33

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

' J. Bouillet, Precis d'histoire de la Medecine, Paris, 1883, p. 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,* taken from the most
celebrated medical books of China,' 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-tongy 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 formulae are therefore incomprehensible
by most people.

2. Fong'lari'tong, This kind of toothache is also caused by cold. The
pain is very great, but the gums are neither red nor swollen.

3. Te-tong. Is also produced by chill. The gums are red and swollen;
there is no 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

* La medecine chez les Chinois, par le Capitaine P. P. Dabry, Consul de France en Chine,
Membre de la Societe Asiatique de Paris, 1863.

' One of these books, Nuei-King, is said to hav« I
before the Christian era, by the Empeio"

n*o

DENTISTRT AMONG THE CHINESE 35

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 con-
dition either of the gums or of the alveoli.

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

6. Tn-hiue-totig, 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 distin-
guished by the aid of a magnifying glass. A remedy must immediately
be administered to destroy these worms, otKerwise the patient runs the
risk of having his other teeth attacked in the same manner, and of their
falling out. The remedies against this afl^ection 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 medi-
cament 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:

36 FIRST PERIOD— ANTIQUITY

"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 ; amongothers, 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 tooth-
ache 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 fistulae 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 ingredi-
ents. A lotion is also prescribed.

In the next chapter the following affections are described:

1. Ta-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 abun-
dance. 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; appari-
tion of the root of the tooth; absence of ulceration. Children of five

DENTISTRY AMONG THE CHINESE 37

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. Ta-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, after-
ward 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. Ta-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'tna-ya-kan. An illness common to children after the small-
pox; 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 eflx)rt 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

38 FIRST PERIOD—ANTIQUITT

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 after-
ward 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 acupunc-
ture, 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 reestablishing 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 punc-
turing; 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

DENTISTRT AMONG THE CHINESE 39

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
tsuny 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 punc-
turing 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 peri-
auricular 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-tchey 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;^ their

' See Bouillet, work quoted at p. 31.

40 FIRST PERIOD— ANTIQUITY

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.*

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 punc-
ture with the so-called "mox^," that is, with a kind of vegetable wool
obtained from the leaves and dried tips of the artemisia. One com-
presses 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,^ 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 con-
sumed without destroying the skin itself."

The application of the moxa is not as painful as might be thought,

* Dabry, op. cit., p. x (introduction), pp. i, 2, 4, 10, 11.

' This author wrote toward the end of the seventeenth century ; one of his works is entitled
De Acupunctura.

DENTISTRY AMONG THE CHINESE 41

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-tchey which we have
mentioned once before, the cauterization is generally repeated seven
times, but in certairr 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 punc-
turing is held to be unnecessary or even dangerous; one, therefore, only
applies the moxa in these cases.*

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.^

' Dabry, op. cit., p. 424.

* See Histoire de la Chirurgie depuis son origine, par MM. Dujardin et Peyrihie, Paris,
1774 to 1780.

CHAPTER IV.

CUSTOMS RELATING TO THE TEETH AMONG
DIFFERENT PRIMITIVE PEOPLES.

Joseph Murphy, in his book, A Natural History of the Human Teethy^
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 embellish-
ment or with some other object — perhaps, as suggested by Joseph
Linderer,^ 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.'

Dyeing the teeth black is considered a great embellishment among
many races of Asia and Oceanica; this operation is sometimes preceded

^ London, 1811.

' Die Zahnheilkunde, etc., 1851, p. 347.

' J. Bontii, De medicina Indorum, 1642, lib. iv.

CUSTOMS RELATING TO THE TEETH 43

by another, viz., the filling up of the interdental spaces very cleverly
with gold leaf.*

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.'

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 efl^ects, as it
would otherwise cause them to assume a dark blue tint." The inhabi-
tants of the Pelew Islands make use of the wild thistle and shell chalk
to blacken the teeth. It is also the custom to blackernthe 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*

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
efl^ect of a row of teeth.

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

* Carabelli, Handbuch der Zahnheilkunde, 1844, i, 8.
' Linderer, op. cit.

' [The newer civilization of Japan has caused this custom to largely fall into disuse.
— E. C K.]

* Carabelli, loc. cit. » Linderer, loc. cit.

44 FIRST PERIOD— ANTIQUITY

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.^

* Carabelli, op. cit., p. 17.

CHAPTER V.
THE GREEKS.

An ancient Greek physician — Asklepios, afterward called iEscu-
lapius^ — 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, after-
ward did the rest, and magnified the healing and restoring powers of
iEsculapius 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 ^Esculapii,^ 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 purga-
tives and of the extraction of teeth.

According, therefore, to these traditions, dental surgery had its origin
with iEsculapius, 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 ^Esculapius, Machaon and
Podalirius,' 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 ^sculapius must have lived between the twelfth and thirteenth
centuries B.C. Many temples were built and dedicated to ^sculapius ;
these were called asklepeiay after the Greek form of his name. The priests
were called Asklepiadi^ and alleged their direct descent from iEsculapius
himself.

* The Greek name Asklepios became in the Latin, -^sculapius; the two names are there-
fore equivalents.

' See Cicero, De Natura deorum, lib. iii, chap. xxii.

' [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.]

46 FIRS T PERIOD— J N TIQUI TT

The temples of iEsculapius 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 observa-
tion 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 odontagogori)y 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 iSsculapius, 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 oJohtagogon may have
been deposited in the temple of Apollo before the building of iSscuIapian
temples. Indeed, who can tell if i^sculapius 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

THE GREEKS 47

Serre' 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 .

Fig. 7

Phceniciiin origin, found In Crimea (see
~ osthcsis, pp. 60-65 snd 187).

Hippocrates. The sacerdotal and philosophical schools of medicine,
as well as the gymnasiums, were the three great sources whence Hip-
pocrates 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 jEscu-
lapius 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 uncenain

' Prakiische Darstellung aller Operationen der Zahnarznei-kunst, von Johann Jakob
Joseph Serre, Berlin, pp. 7 to 13.

48 FIRST PERIOD— ANTIQUITT

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 gymnasi-
arch 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 dis-
tinguished 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.^

Neither Hippocrates nor others before him had ever dissected corpses;
it is, therefore, not to be wondered at that the anatomical notions con-
tained 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.

^ Guardia, Histoire de la Medecine, p. 250.

THE GREEKS 49

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 "micro-
cosmos," 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 funda-
mental humors — the blood, the pituita or mucus, the yellow bile, and
the black bile or atrabile.

Health, says Hippocrates,^ 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 col-
lect in the interior of the body, not only the part that remains deprived
of its presence will suflFer, 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 diflFerent 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 sepa-
rately of the aflFections 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 carnibusy 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."'

* Hippocratis opera, Genevse, 1657 to 1662, De natura hominis, p. 225.
^ Page 251.

50 FIRST PERIOD— ANTIQUITT

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." ^

There is a passage in this same book De carnibusy in which the great
importance of the teeth for clear pronunciation of words is alluded to:
"The body," says Hippocrates,^ "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,' 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 un-
healthy, one burns, separately, the head of a hare, and three mice, after

» Page 252. ' Page 253. ' De morbis mulierum, lib. ii, p. 666

THE GREEKS 51

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,*
and passes it through a sieve; one then mixes equal parts of these ingredi-
ents and with this mixture one rubs the teeth and the interior of the mouth;
afterward one rubs them again with greasy wooP 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;' one immerses these substances in half
a cotyle* 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:*^

" 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 aflFections 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 mastica-
tories, 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 ex-
tracted, Hippocrates considered the extraction of teeth a very easy opera-

* The use of carbonate of lime or chalk as a dentifrice evidently goes back to antiquity.

* Unwashed woo! — 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 doaors of antiquity. One now obtains
lanolin from it.

* The obole was about three-quarters of a gram.

* The cotyle was a little more than a quarter of a liter. • Page 507.

FIRST PERIOD— ANTIQUITY

tion, 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." '

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,'
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

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

medicine became secularized through its abandoning the ^sculapian
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 commen-
taries on this treatise of Hippocrates, He says, among other things.

' Page II.

' See Daremberg, Dictionnaire dcs Antiqui

s Greques et Romaines, article "Chirurgie."

THE GREEKS 53

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 import-
ance, 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 medi-
cating; 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

54 FIRST PERIOD— ANTIQUITT

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. ^
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 Hip-
pocrates 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,^ and the mode in which this is evacuated consti-
tutes 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.'
If by eflPect 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."*

And farther on one reads:

* The various editions here offer numerous variations, but the sense is ever)'where obscure.

* See Bouillet, Precis d'Histoire de la Medecine, p. 94.

* On Epidemics, lib. ii, section i, p. 1002.
^ De morbis vulgaribus, lib. iv, p. 1131.

THE GREEKS 55

"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 con-
tiguous tooth; on the other side there was only a half root^ and rounded."

Toward the end of the fourth book on EpidemicSy 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."^

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."^

A little after we find the practice of bleeding mentioned; and contem-
porarily 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.'**

Toward the commencement of the sixth book the following observa-
tion is registered:

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

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."'

* That is a very short root. * Page 1138.
' De morbis vulgaribus, h'b. v, p. 11 57. * Page 1157.

* De morbis vulgaribus, lib. vi, section i, p. 1164. * Ibid., vii, p. 1223.

56 FIRST PERIOD— ANTIQUITT

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. "^

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."^

Some passages in the Epidemicsy^ 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.* 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.*

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."
It is also a most unfavorable sign when the teeth get very dry."

"Necrosis of a tooth heals the abscess formed at the gum.^ This
is very easily explained by the fall of the tooth. But Hippocrates knew
very well that the aflFection 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,

* Page 1229. ' De morbis vulgaribus, lib. vii, p. 1238.

' 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 Litre,
Introduction to the books on Epidemics.)

* De morbis vulgaribus, lib. iii, p. 1009; lib. vi, section iii, p. 1 176.

* De morbis vulgaribus lib. iv, p. 1138 ; Aphorisms, lib. iv. No. 53, p. 1251.

* Coacae prai^notiones, No. 235, p. 157 ; Praedictorum, lib. i. No. 48, p. 71.
^ Coacse pracnotiones, No. 236; p. 157.

THE GREEKS

the patient be saved, there will be suppuration and exfoliation of the
bone."^

According to Hippocrates, "violent pains in the lower jaw give reason
to fear a necrosis of the bone."^

"Gingival hemorrhage in cases of persistent diarrhea is an unfavor-
able symptom."' In fact, the easy and frequent occurring of hemor-
rhage 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 atmos-
pheric 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."*

"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."*

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

"In many who have enlargement of the spleen the gums become
aflFected and the mouth has a bad smell."'

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."^ Finally, in the
Book on Internal Diseases, Hippocrates describes diflFerent species of
splenic maladies, to one of which he assigns the following symptoms:

"The belly becomes swollen, the spleen enlarged and hard, the patient
suflFers 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."*

The cases of splenic swellings spoken of by Hippocrates in the above
passages must have been owing, without doubt, to grave cachectic condi-
tions (among which, probably, scurvy); and we know that gingivitis,
with all its possible consequences (among which expulsive periodontitis),

* Loc. cit., No. 237.

^ Loc. cit., No. 241, p. 157; No. 648, p. 222.

* De morbis vulgaribus, lib. iii, p. 1083.

* Prxdictorum, lib. ii, p. ill.

' De intemis affectionibus, p. 549.

' Loc. cit., No. 239.

*Ibid., lib. iv, p. 1121.
^ De affeaionibus, p. 521

58 FIRST PERIOD— ANTIQUITT

is not only a constant symptom in scurvy, but is also frequent in all dis-
eases attended by profound disorders of nutrition.^

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 suflFer 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."^

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;' and that it may also be produced in many
individuals by a strident sound.*

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

"Long-lived individuals have a greater number of teeth;"* 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, there-
fore, 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

* Paul Dubois, Aide-memoire du chirurgien-dentiste, Paris, 1894, 2me partie, pp. 415,
416.

^ Prsedictorum, lib. ii, p. 108. ' De internis affectionibus, p. 534.

* De humoribus, p. 49. * De morbis vulgaribus, lib. ii, section vi, p. 1050.

THE GREEKS 59

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 significa-
tion 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, ol fia-jK^fjofim Ttheofji;
odouTo^ liouatv (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 Litre translates excellently well in these
words: ^^ Avoir des dents en plus grand nombre est un signe de longevite/'

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 Hippo-
cratic collection, entitled De hominis structural 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."*

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

* Prafdictorum, lib. ii, p. 96.

^H 60 FIRST ^f^^^^^t

^^M the complete and the incomplete fracture; he then speaks separately ^^M
^H of the fracture of the symphysis. Treating of the incomplete fracture, ^H
^V he ^H
^M "If the teeth in proximity of the lesion be shaken, one ought, after ^H
^H having reduced the fracture, to bind them one to the other, until the ^H
^^^ consolidation of the bone, using preferably gold wire for the purpose; ^^M
^H but if this be wanting, linen thread can be used instead, and not only ^|
^^1 ought the two teeth next to the site of the fracture to be bound, but ^^^^^H
^H several of the others besides.'" ^^^^^M

^H 9 ^^^^1

Kflili] IB

^^.

^^F Two Greek appliances existing in the Archsological Museum of Athens. ^H

^H Farther on, when speaking of complete fractures, he renews this advice ^H
^H In these words: ^H
^H "After having carried out the coaptation, the teeth ought, as we have ^H
^H said already, to be bound one to the other; this greatly contributes ^H
^H to obtaining the immobility of the fragments, particularly if property ^H
^H carried out."' ^H
^H Also, in cases of fracture of the svmphvsis, Hippocrates recommends ^H
^H "binding the teeth together on the right and left of the lesion." And ^H
^H after having spoken of the best adapted means uf constraint in such ^H
^H kinds of fractures, he adds: " If the reduction has been well performed, ^H
^H and the part kept in proper repose, the consolidation takes place in a short ^H
^^B time and the reeth do not undergo any damage; in the contrary case, the ^^^^H

^^^B ' De articulis, p. ' Loc. cit. ^^^^^^^

THE GREEKS

cure is retarded, the fragments reunite in a bad position, and the teeth
are injured and become useless."^

From what we have referred, it is easy to perceive how much impor-
tance 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 obser-
vations.

One of Hippocrates' aphorisms says:

" Cold is the enemy of the bones, the teeth, the nerves, the brain, and
the spinal marrow."'

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;^ 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;"* 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."*

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 Animalsy is absolutely extraordinary for the time in which he lived.

* De articulis, p. 800.

' De liquidorum usu, p. 426.

* De morbis vulgaribus, lib. i, p. 948.

* Aphorism, lib. v, No. 18, p. 1253.
^ De locis in homine, p. 419.

Iff' Ults^r nRlOD-ANTIQUITr

\\)\ sM^^V4 v^ lhi>i work* ij* altogether dedicated to the study of the
KViKt Km^ Kv ♦Uxo x|H*ak« of these organs in many other of his works,
|.v«4U4v^Kul\ iu hU History uf Auimals^ which is a real and proper treatise
v^u A^v^v^w whi^ivin thr author records a great number of notes about
ihv ^H'vuii«uiiivM (MVM'iUril by the dental system, in the different classes

\\\ %(iuv of \\w gu^ar rrrorN into which he has fallen, his ideas about
\\\y is'vlh *4iVi U\\k\'\\ aM a whole, quite worthy of attention, especially
\\\\\\\ Ky\w soumidnw ihr remote epoch in which this great philosopher
v\u»lv \N\^ will luMr give a brief notice of the most important of his
ubmv»uioUii ubuiutt «» the dental organs.

I \w l(Miu, [\w dimpoMiiion, the number of the teeth, varies in animals,
anohllMu Ui [\w (jualiiv of their food and according to whether the teeth
kKWK \\w\sA\ In diviile and to chew the alimentary substances, or as
(U^UMliUMMti ol dlliHU'i' and defence as well. In man, the teeth serve
\\\[\\\ \yA\\ loi MiamlicatioM, but the front ones have, besides, another most
liMlMMIMlM olhus lunnelv, that of aNNisting in the articulation of words,
li) \\w |Mniuih( liMMiM or certain letterw.

li) (hMM« aniiHfiU in which the teeth also serve as weapons, it is to be
nhmiMd sA\\w\ that Mime of them protrude like those of the boar,
iM llhtl llu<v au> nhaip and Naw-like in their disposition, as in the lion,
I hi' htMMluM, llu^ d<i(ii etc. No animal possesses at the same time pro-
MMillMU (Mhl naw likr lerth.

I hi' \v\^\\\ air Mill alwavM e(|ual in number in both jaws; the animals
MmUiIi'iI Willi liiMiu have no teeth in the front of the upper jaw; this,
linm u-li h iiImi III he obMeived in animals without horns, as for example,
III llii* I iiliii'l Ainniid the animals provided with horns there are none
^Jihli liiiM» |iiMtniding ni waw-like teeth.

Ill yi'lii«liil» th«' hnlU lerfh are pointed and the back ones broad. Never-
llii liMM, iill ihr imh oC the weal are pointed, with a saw-like disposition,
|iiihti|i>i lMuiii*ir thiN animal marks the transition from the quadruped
IM ihi' liMh, III! nl which, with few exceptions, have their teeth formed in
ihiil Wii\ AmimmIn with saw-like teeth have generally very large mouths.

Nil iinim.il h.iN rvrr more than one row of teeth in each jaw; however,
mi\M Aii»it<»tlr, il C'trsias^ is to be believed, there is an animal in India,
ihiinrd iniirticdra, which has a triple row of teeth.

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

( )nr t ;iii judge the age of many animals by their teeth. As the animal

' Or piirtthus animalium, lib. iii, cap. i.

' Ocsia.s, of C'nydus, wrote various works, somewhat earlier than Aristotle; one of which,
fhr History of India, is very interesting, but also contains not a few fables.

THE GREEKS 63

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 jaw-
bone; 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. -

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.^

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.

* This, as well as other errors of Aristotle, we shall Bnd 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.

' The distinction between arteries and veins was, at that time, not yet well known, though
we already Bnd, in this passage of Aristotle, allusion made to the relations between the teeth
and the bloodvessels.

64 FIRST PERIOD— ANTIQUITY

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 in-
sinuate 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 extrac-
tion 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, carpoc) 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 GREEKS 65

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 impor-
tance. 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 initia-
tors of the dissection of human corpses,* 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 destruc-
tion 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 exist-
ence of the central cavity of the tooth was not ignored, and that, there-
fore, the structure of these organs had already been the 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 Coelius Aurelianus,^ 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.' 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 signifi-

* 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 re-
searches into the normal conditions of the organs during life, and their mode of functioning.
See Cornel. Cels., De re medica, lib. i. Preface.

' Coelii Aureliani de morbis acutis et chronicis, lib. viii, Amstelaedami, 1755> Pars ii, lib.
ii, cap. iv, De dolore dentium.

* Herophilus et Heraclides Tarentinus mori quosdam detractione dentis memoraverunt.

66 FIRST PERIOD— ANTIQUITY

cation 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/
the federal capital being Tarquinii. The Etruscan people were indus-
trious, 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 agri-
culture, in art and commerce, but also brave warriors and hardy
navigators.

In their long sea voyages the Etruscans frequently visited Egypt and
Phoenicia, trading especially in the more flourishing cities, which were
at that time Memphis in Egypt, and Tyre and Sidon in Phoenicia. On
the other hand, the Phoenicians, 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 Phoenicians, on the other, accounts for the great influence
exercised by the Egyptian and Phoenician 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 Phoenicians.'

As to what concerns dental art, everything leads up to the belief that
it was practised by the Egyptians and Phoenicians 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 Phoenician work-

» Arretium, Caere, Clusium, Cortona, Faesulae, Falerii, Pisar, Russcllae, Tarquinii, Vetulonia,
Volaterrae, Volsinii.

' DenefFe, La prothese dentaire dans Fantiquite, p. 51*

68 FIRST PEklOD-ANTlQUlTV

manship known at the present day,' we cannot but be struck with the
great superiority of" the Etruscan appliances. It is therefore probable

' Dr. a^rand in li[& book The- Rise. Full, and Kcviv;il of Dentil Prosrhcsis, after having
spoken of the Phurnician denral appliance described in Kenan's work, adds; "There are
scores of specimens of Phccnician denial an in home collcciiunii and also ar the Columbian
World's Fair." However, uniil these specimens of Phoenician denial art are described and
their origin is exactly known, their auihenticit)' will always remain a matter of doubt.
[Cigrand is in error. The specimens he speaks of wet« mainly imanined.— W. H. Tri'EMan. ]

DENTAL ART AMONG THE ETRUSCANS 69

that the Etruscans, although they had learned the dental art from the
Egyptians and Phoenicians, had subsequently carried it to a much higher
degree of perfection than it had arrived at in Egypt or in Phoenicia. 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 Phoenicians, 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 com-
bustion, 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 Phoenicians, 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 Phoenician, 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

FIRST PERIOD— ANTIQUITY

was already prevalent, and through the influence of Christianity became
general during the third and fourth centuries.^

Notwithstanding cremation, which certainly must have destroyed a
great number of the dental appliances of that time, and in spite of the
many diflferent destructive agents which successively did their work
on those human remains during so many centuries, not a few prosthetic

Fig. 13

Fig. 14

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

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

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 diflferent 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

* DenefFe, op. cit., pp. 60, 61.

DENTAL ART AMONG THE ETRUSCANS 71

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 aniticial 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 Cornefo, the ancient Tarquinit, there are
two dental appliances, one of which (Figs. i6 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.

Fig. 15

^m^

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 repace 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

FIRST PERIOD—ANTIQUnr

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.

When I was intrusted with the reproduction of all the ancient pros-
thetic 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

DENTAL ART AMONG THE ETRUSCANS

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.

Fig. i8

Eltuscan appliance for supporting two inserted hui

(Civic Museum of Cometo.)

Another dental appliance (Fig. i8) 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

Etruscan applia

re supporting <
r disappeared.

(Mus

toorh (upper middle incisor on the righr) which
1 of the Conte Bruschi at Cometo.)

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.

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

74 FIRST PERIOD— AKTIQVITr

by a series ot tour 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 bv which it was fixed to the ring is still there, as well as the three
natural teeth that afforded support to the appliance.

scan appli

ided to avoid the bad ctfVct
artificial substitute. (Mu

of convergence, or, perhaps, to support
k-um of Conte Bruschi ai Cometo,)

The other appliance (Fig. 20) is formed bv 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 st
horizontal bar of gold between the iwo 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.

Another ancient dental appliance discovered In ,in Etruscan necropolis
near Orvieto is now in the possession of the Ghent University, to which

DENTAL ART AMONG THE ETRUSCANS 75

it was sold.' 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

Fig. 11

piece as in the preceding figure, seen from (he palatal side.

the left must have contained the left central incisor, that has now dis-
appeared, while the large central compartment must evidently have con-
tained 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.

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

' Deneffe, op. cit., p. 63.

76 FIRST PERIOD— ANT IQUITr

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.

Fig, 13

purely ornament a

ippliance (found in 1SJ65 in a (omb by Cervetn), destined perhaps to support i
iticiat substitute. (Belonging to Casiellani's collection, Rome.)

1 Fig. 13.

A reprod union of the gold piece forming the appliance

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,
Hved entirely "without doctors, although not without medicine;"^ 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 dura-
tion. 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 aJJitOy asi quoi auro denies iuncti e scant (sunt) im cum illo sepelirei
vrive sine fraude esto^"^ that is, "Neither shall gold be added thereto

' Plinius, lib. xxix, cap. v.

* 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 juris-
consults, 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-

78 FIRST PERIOD— ANTIQUITY

(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 opera-
tions. 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,* have pronounced in favor of the first hypothesis, others,
as, for example, Geist-Jacobi,^ are rather disposed to accept the second.
In truth, however, we do not possess sufficient historical data to defi-
nitely 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 nearTeano (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

* Josef Serre, Zahnarznei kunst, Berlin, 1804, p. 6.
^ Geist-Jacobi, Geschichte der 2^hnheilkunde, p. 26.

THE ROMANS

•9

put the three teeth in their respective rings again, and applied the pros-
thesis.

This ingenious appliance was found still adherent to the mandible of
a skeleton, in a tomb which, according to the eminent archaeologist
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
Graecia") it is quite probable that it was made by some dentist of the
Greek colonies.

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

Fig. 25

Fig. 26

Seen from behind.

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 Jelictis), which says: ''Qui
dentem ex gingiva excusserit libera hominiy trecentis assibus multoiory
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

80 FIRST PERIOD— ANTIQUITY

wondered at if ven* few doctors of that epoch have merited being recorded
in histor}'.

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. AH 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
Medicalesy 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.*

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 MeJicitw^ does not contain anything
of great importance in regard to dentistry. The following hygienic pre-
cept 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

* See note, p. 15, Hist. Relations of Medicine and Surger>% Allbutt. (C M.)
=» A. Corn. Celsi de Medicina libri octo, Patavii, MDCCXXII.

THE ROMANS 81

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 possess-
ing 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."*

In the second book, speaking of the various kinds of disease to which
the different periods of life are subject, he writes: "Children are espe-
cially subject to serpiginous ulcers of the mouth, called by the Greeks
aphthae. . 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 tor-
mented with odontalgic and other pains. This receipt is very compli-
cated, being composed of ten ingredients, among which are acorns,
castoreum, cinnamon, poppy, mandrake, and pepper.

Most important for our subject is Chapter IX,of thesixth 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 mastica-

' Celsus, lib. i, Preface.

82 FIRST PERIOD— ANTIQUITY

tion. 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* 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 custom-
ary also to apply around the tooth certain remedies, after the manner of
plasters. For this purpose the inside of the peel of dried, bitter pome-
granates may be pounded with equal quantities of gall-nut and pine bark;
to these must be added a little minium^ 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,' poppy, peucedanum,* and
taminia grape* 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 odon-
talgia. 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

* Wine with honey.

^ [A/iniwm 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 kermeSy 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.]

' A species of herb (all-heal). * Peucedanum officinale, hog*s fennel.

* A species of wild grape thus called because it is red like minium (vermilion).

THE ROMANS 83

be applied to the tooth, composed of one part of poppy, two of pepper,
and ten of sory,^ pounded and mixed to a paste with galbanum; or else,
especially in the case of a molar tpoth, the remedy of Menemacus, result-
ing 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,'
ana one part; scissile alum,^ poppy, taminia grape, crude sulphur, bitu-
men, 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 intro-
duced 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 aflfect the soft parts of the mouth. Against tonsillitis,
he recommends, among other things, the application of a remedy prin-
cipally made of the juice of the sweet pomegranate, cooked, by a slow fire,

* Species of mineral. [An impure copper sulphide. — E. C, K.]

^ Condensed juice of the seeds of the momordica elaterium, a bitter, irritating, and
drastic substance.

' According to De Giorgi (Sinonimia chimico-farmacotecnica, Milan, 1889), scissile
alum is one of the many names for blue vitriol or sulphate of copper.

84 FIRST PERIOD— ANTIQUITT

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 composi-
tions should be used which are called by the Greeks antherce; for example,
a remedy may be formed of equal parts of cyperus,^ myrrh, sandarac,
and alum; or another which contains saflfron, 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 aphtha; 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 oflf" 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
anthertp. If this, owing to the hardness of the tumor, is not possible,
then by means of a spoftge the steam of hot water should be made to act

^ [The cyperus rotundus^ recommended by Dioscorides in the treatment of ulcers in the
mouth. Esteemed also by the Arab medical writers Scrapion, Avicenna, and Rhazes. Not
the cypress, cuprcssus sempervirens, — E. C. K.]

THE ROMANS 85

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 anthene. 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 antherce is sufficient; when it is somewhat deeper,
a mixture must be applied on it, of two parts of burnt paper* to one of
orpiment;^ 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."

* Here is meant the paper made of papyrus and called in Latin charta
' Trisulphide of arsenic.

86 FIRST PERIOD— ANTIQUITY

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
ihem 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 danger-
ous 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

FiC, 21

a*^=^

Denial and surgical instritmvnts represented it
Lateran Museum, Ron

ral marble of the

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."

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.

THE ROMANS 87

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 success-
ful, 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 eflfect 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. Speak-
ing 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 over-
hanging bone of the cheeks."^

* 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.

88 FIRST PERIOD— ANTIQUITY

"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 fore-
finger and thumb of both hands. Then in the case of a transverse fracture
(ill which case generally an unevenness in the level of the teeth is pro-
duced), 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,
il theMe are loose, the following ones. After this, one should apply
exteriuilly, on the part corresponding to the lesion, a thick compress,
dipped in wine and oil and sprinkled with flour and powdered olibanum.
Thih conipieHN \h to he fixed by a bandage or by a strip of soft leather,
with M longitudinal Nlit in the middle to embrace the chin, the two ends
being tied t<igether above the head. The patient must fast the first two
d#iV'»»J th«*n he in;iv be nourished with liquid food, but in small quantities,
»iliM»iining, howevet, completely from wine. On the third day it is neces-
ttMiy IM t^ke oir the apparjitus, and after having fomented the part with
the tileinn nl hoi waler, to replace it. The same is to be done on the fifth
diiv, Mhd M» on, until the inflammation has subsided, which generally
hiippenu Imhii the Nevenih to the ninth day. After the symptoms of in-
ihiMiinfilinn h»ivr viiniNhed. the patient may take abundant nourishment;
he niuhi, hnwrvei. ahhiain from chewing until the fracture is completely
iOMwilidaied; and, thnefore, he will continue to nourish himself with
boiipb and like Innd. Ilr must also entirely abstain from speaking,
thprtiallv dining the lir.st few days. Fractures of the jaw commonly
heal frnin the rniiiitHiuh to the twenty-first day.

**ln liixatinns of the jaw (Chapter XII) the bone is always displaced
forward; but smnetimes only on one side, and sometimes on both sides.
When the dislocation is only on one side, the chin and the w^hole 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

THE ROMANS 89

part. If, however, the luxation is bilateral, the chin inclines and pro-
jects 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 y
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 suflice: "In many mountains of

90 FIRST PERIOD— ANTIQUITY

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."^

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."^

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 justi-
fication, 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 Gnaeus 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 flourish-
ing city; and, in fact, the prediction was verified. Some, instead of teeth,
have an entire bone; of this there was an example in the son of Prusias,
King of Bithynia, who instead of upper teeth had one single bone."

"The teeth alone are not consumed by fire, and do not 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

* C. Plinii Secundi, Historic Mundi, lib. vii, cap. ii. ^ Lib. xxiv, cap. cxi.

THE ROMANS 91

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."^

" 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 pre-
sented uncovered before it; and if they are uncovered in front of young
unfledged pigeons, these take ill and die."^

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 observa-
tions 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.

' Lib. xi, cap. Ixiii. ^ Lib. xi, cap. Ixiv

92 FIRST PERIOD— ANTIQUITY

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

''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 inflamma-
tions and abscesses of the gums. The aristolochia strengthens the gums
and the teeth. The same eflPect may be produced bv masticating the
verbena with its root, or by washing the mouth with a decoction of it
in wine or Wnegar. 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 nHne, 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 eanh, 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."*

"In the fuller's thistle,* 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.'*'

"Apollonius writes that a \ti\ efficacious remedy for pains in the
gums is to scratch them with the tooth of a man who has suffered a
violent death.'**

" It is considered ver\ beneficial for toothache to bite off a piece from
wood which has been struck bv lightning, and to touch the sick tooth
with it; but whilst biting off the linle piece of wood, it is necessar\* to keep
both hands behind the back."^

''Experience teaches that against the bad odor of the breath it is
useful to wash the mouth uith pure wine before sleeping, and that to

^ Cap. oi. ' Dipsacus fullonum.

' Cap. o-iii. * Lib. xxviii, cap. it. ^ Lib. xxviii, cap. xi.

THE ROMANS 93

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."*

"A remedy for toothache is to touch the diseased teeth with the tooth
of a hyena,' or to scratch the gums with the tooth of a hippopotamus
which has been taken from the left side of the jaw."'

**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 often-
times 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."*

"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."*

"To sweeten the breath it is very helpful to rub the teeth and the
gums with wool and honey."*

"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."^

* Lib. xxviii, cap. xiv. ^ Ibid., cap. xxvii. ^ Ibid., cap. xxix.

* Ibid., cap. xlix. • Ibid., cap. Ixxviii. • Lib. xxix, cap. ix.
^ Lib. xxix, cap. x.

94 FIRST PERIOD— ANTIQUITY

" Eggshells deprived of their internal membrane and afterward burnt
afford a good dentifrice."* (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 tooth-
ache. 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 intro-
duce 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 tooth-
ache. 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.^ 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.'''

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:

' Lib. xxix, cap. xi. * Lib. xxx, cap. viii. ' Lib. xxx, cap. ix.

THE ROMANS 95

**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. "^

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."^

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.'
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.* 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'* of

' Lib. XXX, cap. xlvii. * Lib. xxxi, cap. xlv, xlvi. ^ Lib. xxxii, cap. xiv.

* Trygon pastinaca, a large fish whose tail is armed with sharp and strong bones.
*A measure equal to 0.274 liter.

96 FIRST PERIOD— ANTIQUITY

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* 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 ccabs are also
used. That of the murex' 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."'

In Chapter XXXIV of Book XXXVI it is said that the decoction of
gagates* 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 prin-
cipally 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

' [The sextarius was accorded different values, thus a sextary of oil was Sxviij, of wine
5xx, and of honey, Jxvij. — E. C. K.]
' [Lat., the purple fish, a carnivorous marine mollusk. — E. C. K.]
' Lib. xxxii, cap. xlviii. * A kind of lignite, now called jet.

THE ROMANS 97

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 denti-
frices 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 cleanli-
ness 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 praedicet lotii."*

' 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.

98 FIRST PERIOD— ANTIQUITY

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!*

In regard to this filthy custom, Joseph Linderer says' that the super-
stition 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 loi 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 (Ptstacia 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

Fig. 28

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

the toothless mouth, to give himself the air of a man not too far stricken
in years.' 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.*

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 Trimal-
chiones made use of a silver toothpick {spina argentea). Objects of this
kind, both Roman and of other origin, are even now in existence, and

* Rerum geographicarum libri. ' Lutetix 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).

* Handbuch der Zahnheilkunde, Berlin, 1848, ii, 412.
' Medio recumbit imus ille qui lecto,

Calvam trifilem segmentatus unguento,
Foditque tonsis ora laxa lentiscis;
Mentitur, Esculane; non habet dentes.

* Lentiscum melius; sed si tibi frondea cuspis
Defuerit, dentes penna levare potest.

THE ROMANS

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.'

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.'

Fig. 29

lal looihpicl: and
eriand,

ilet articles. An object foa

Hilary colony.

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

Caylus, in his valuable work Recuetl d'anttquites egyptiennes, eirusques,
grecques, romaines et gaulotses (Paris, 1752 to 1767), gives the picture
of a toothpick and earpicker of bronze, two inches long, with the middle
part wrought in spiral form, so as to increase the solidity of the anicle,
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.'

' Antiq. du Bosphore au Musee de I'Ermitagc, pi. xxx, 8 et 9 (Dictiimnaire des antiquite
fCtecques et romaines, par Daremberg, Saglio, etc).

' Mitiheilung. d. antiq. Gesellschaft in Ziirich, xv, pi. xi, 32 (Daremberg and Saglio, ibid.]
' Caylus, vol. vi, pi. cxxx, 5.

100 FIRST PERIOD— ANTIQUITY

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. "^

Elsewhere' 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!"'

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 ^gle that she has all
her teeth, because of her false teeth of bone and ivory.'**

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, how-
ever, arises: In those times did they manufacture movable artificial
sets, or was the dental art then limited to fixing the artificial teeth un-
movably to the neighboring firm teeth, by means of silk threads, gold
wire, and the like ^ The answer to this question may be found in another
epigram of Martial,^ 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.^

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

^ Dentifricium ad edentulam:

Quid mecum est tibi ? me puella sumat,

Emptos non soleo polire dentes.
^ Lib. xii, epig. xxiii.
' Dentibus atque comis, nee te pudet, uteris emptis.

Quid facies oculo, Laelia ? non emitur.
* Nostris versibus esse te poetam,

Fidentine, putas, cupisque eredi ?

Sic dentata sic videtur i^gle,

Emptis ossibus, indicoque cornu. (Lib. i, epig. Ixxii.)
' Lib. ix, epig. xxxviii. • Nee dentes aliter quam serica nocte reponas

THE ROMANS 101

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 archeological 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 con-
fess, that 1 held in my hands a prosthetic piece of exceptional historical
importance, that is, no less than a specimen of ancient crown work.

ide or gold.

Fic. 31

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 construc-
tion. It is to be hoped that, in spite of the destructive action of time,
in continuing the excavations and archeological researches, many other
specimens of early dental prosthesis will yet come to light. In any case,

102 FIRST PERIOD— ANTIQUITY

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."^

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 con-
structed 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 be-
longing 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,"' 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,

^ Horat. Sat. viii, lib. i. ' Eximit aut reficit dentem Cascellius segrum.

THE ROMANS 103

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 dentiumy 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 accom-
panied to England in the year 43.

Scribonius Largus, in his book De compositione medicamentorurriy
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 decoc-
tion 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

104 FIRST PERIOD— ANTIQUITY

by rinsings of the mouth with hot water; in this way sometimes, as it were,
small worms are expelled."^

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 suc-
ceeded 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 sum-
moned 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

* Suffire autem oportet ore aperto alterci semine carbonibus asperso, subinde os colluere
aqua calida; interdum enim quasi vermiculi quidam eiciuntur.

THE ROMANS 105

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* 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 denti-
frice, 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.' To prepare it, one must take a sextary' 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

* Gum of the cedar tree.

' Dentifricium, quod splendidos facit dentes et confirmat, chap, xi, lix.

' A Roman measure of capacity, equal to a little more than half a liter.

106 FIRST PERIOD— ANTIQUITY

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 poet-
ical 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 avoid-
ing disease of the teeth and gums.

Andromachus the Elder, of Crete, the physician of Nero, who con-
ferred upon him, for the first time, the title of archiatery became famous
through his theriacy 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 sub-
stances, there is no doubt that its use locally or even internally would
prove beneficial, temporarily at least, in many cases of odontalgia.^

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

* 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 mithriJatium, 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 theriorij 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.

THE ROMANS 107

fame as a physician and as an operator, and distinguished himself partic-
ularly 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* have been boiled. He
usually introduced into carious teeth a mixture of turpentine and vitriol
of iron (^sory {egypUuni)^ 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 theni 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.'

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

* A species of solanacear of the Physalis genus, probably the Physalis alkekengi.
^ Galeni de compositione medicamentorum secundum locos, liber v.

108 FIRST PERIOD— ANTIQUITY

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.^

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
wa« originally, and what it must ever be, viz., conservative in the highest
possible degree.

Cl-AUDIUS (lALKN, after Hippocrates the greatest physician of ancient
times, was born at Pergamus, a city in Asia Minor, in the year 131 of our
rr«4. 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. ( Jalen began to study medicine at the age of seventeen, under the
guidaiUT (»f skilful doctors of his native country; he made several journeys
in ordn 10 have the benefit of the instruction of celebrated masters, and
finally rie<|uented the renowned medical school at Alexandria. On
g<m\B to Rome, in the thirty-fourth year of his life, he soon acquired in
that v'itv a very high renown. He died in the first decade of the third
v'i'miu v» but Nve ilo not know exactly in what year.

( Jalih was a n\ost prolific writer, and his works, considering the period
\\\ whivh thev were written, fiirm a real medical encyclopedia. Anatomy
Ouough his researches made considerable progress, for he studied with

^ j. K- lH(\4l, KvvhvrchfK hixtoriqucs sur Tart du dentiste chez les anciens, Paris, 1808,

THE ROMANS 109

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 gener-
ally 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*
belonging to the third pair.' 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.'

In regard to odontalgia, Galen made some very important observa-
tions 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

^ 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.

' Galen distinguishes seven pairs of cerebral nerves; his third pair corresponds to the
trigeminus.

' Galeni de usu partium corporis humani, lib. xvi.

no FIRST PERIOD— ANTIQUITY

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 iapideous. 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 ac-
quired 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 phlo-
gistic 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 strength-
ening 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 astrin-
gents and tonic remedies.^

After these preliminary remarks, Galen gives a minute descr?"*^'* '^^

* Galeni de composttioiie rn*

THE ROMANS 111

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 tooth-
pick. 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 recom-
mended.

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
branchoforiganum (wild marjoram) dipped in hot oil, orelse, 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 hyoscya-
mus. In case the above remedies, or others like them, be found of no
use, Galen recommends them to be adopted anew after having perfor-
ated 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
I wax. At the end of an hour the tooth will have already become
that it can be drawn out with the fingers or with the mere help

112 FIRST PERIOD— ANTIQUITY

of a style. The same effect may be obtained, says Galen, by the appli-
cation 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 per-
forming 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 conse-
quence 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^ 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 j^iiiiM

^ Medicus, chap. xix.

THE ROMANS 113

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 morhis 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, hyos-
cyamus, 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,*
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 peri character. 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 ex-
ternal fomentations made by means of sponges soaked with emollient
decoctions and afterward squeezed; and also the application of moder-
ately hot cataplasms.

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
^"^^%f exercise, rubbing of the whole body (an ancient practice, now

Tfigonella foenum graecum, a papilionaceous plant.

114

FIRST PERIOD—ANTIQUITT

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
obser>'e8 that such remedies take away sensibility but not pain. Some
doctors of those days, for the cure of odontalgia, had recourse to sternuta-
tories, 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
rxlrmtalgia, are too hasty in having recourse to the extraction of the aching
cooth. 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 extrac-

^'G- a

Xtmi'dti dtnvA forceps found (1894) at Hamburg, Germany, in the ancient

Roman castle Saalburg. (Geist-Jacobi.)

tion, tytry other means of cure should first be tried. If the removal of
the trxnh becomes indispensable, he advises that it should never be per-
formed during the violence of the pain, for from this serious consequences
might arise fa prejudice which has not ytt entirely vanished, and which
is met with, s^>metimes, not only among common people, but even among
physicians); and a still greater danger would be the extraction of teeth
neither carious nor Ux>se, 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 Krasistratus, 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

THE ROMANS 115

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 medicamentiy which shows, more than anything else, the deca-
dence 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 super-
stitious. 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 argidaruy margiJaniy siurgidam.
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 herminae.* 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' 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 fol-
lowing method : When at the beginning of spring he sees the first swallow,
he must go in silence to some running water, take some of it in his mouth,
rub his teeth with the middle fingers of both his hands, and say: ^^Hirundoy

* [About twenty-eight fluidounces. — E. C. K.]

' Under the name of rooi, the ancients meant also the neck of the tooth.

IIG FIRST PERIOD— ANTIQUITT

it hi dtcOy quomodo hoc tn rostro iteriim tjoh erit^ sic mi hi denies non doleant
toto anno.^^^

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 prob-
ably 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
^tius. One of these chapters is entitled, according to the Latin trans-
lation of Giano Cornario: **Cura dentium a calido morbo doloroso
affectorum, ex Adamantio, sophista."* This writer clearly belonged to
the pneumatic school founded as early as 69 a. d. by Athenaeus of Cilicia.
According to the pneumatics (so called, because they admitted the exist-
ence in the animal organism of an aeriform principle, pneumay 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 dis-
tinctions; 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.'

The author enumerates among the causes of such dental affections the
dryness of the air, the autumnal season, the dry constitution of the indi-
vidual, 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.*
\ The work of Adamantius from which .-^tius has taken the above-
mentioned chapters is lost to us. Of his writings there only remain to

' 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.

- The cure of teeth affected by warm painful disease; according to Adamantius the sophist.
^ J¥a\\ tetrabibl., ii, sermo iv, cap. xxvii. * Ibid., cap. xxxi

THE ROMANS 117

us the treatise on the winds and the one on physiognomies. In this latter
book the author attributes great importance to the canine teeth as physiog-
nomonic elements^ and from their shape and size he makes deductions
in regard to th^ 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, sub-
stantially, from preceding authors, and therefore it is not worth while
repeating them.

^Tius 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 Tetrahihlos. 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 £tius in the following way:
The nourishment which reaches the dental nerves is not entirely assimi-
lated 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 sub-
stance 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.^

£tius 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.'

For curing parulides, he reco nmends 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.'

The epulis, according to £tius, is a fleshy excrescence of the gums,
brought on by inflammation. To cure it, he uses, during the inflammatory

' JEui tetrabibl., ii, sermo iv, cap. xix. ' Ibid., i, sermo iv, cap. ix.

' Ibid., ii, semio iv, cap. xxiv.

IIH FIRST PLRIOD—ASTIfJL'lTY

pcriocL emoUieiits* and then, when the uiflanmuraon has subsided,
tiingcms 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 smaO
scalpel.'

When the incision of a fistula of the gums and the use of appropriate
remedies are not sufficiem for curing it, jEtius advises the extraction of
the diseased tootlu from which the fistula has its origin.'

Apart from what has been mentioned, JEtius does not tell us, in regard
to dental diseasri, anrthii^ worthy of note, and in manv places he onlv
repeats Galen's observations.

Paul of Sxa^x (seventh century- > establishes a ven- dear 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 necessari". says the author, to sieze
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 giire an exit to the pus by means of a slight incision, the
author, however, usually prefers the method of cure recommended bv
.Etius, viz., excision. .After such operations he orders the patient to
rinse his mouth with wine and on the morrow with hydromel.' 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 ordinari' means of
cure, it is necessari' to cauterize the part affected with an ovat-shaped
cauter*".*

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 .£gina, like Celsus,
recommends that before extracting a tooth deeply attacked by caries,
the caviri' 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,
bv the use of suitable remedies.

\Mien supemumerar} teeth cause an irregularity of the dental arches,
this must be corrected, says the autlK^r. either by resection of such teeth,
if thev are ven* 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 alsao be emplo\ed
to remove the sharp edges of broken teeth.

- TctrabibU ii, scnno h, cap. \x%. '" IW., cap, vv\i.

< [The aorfior qnoied directs hf-dromcl to be made ftoai one pan ot~ honex and e^*hi
pans of wanr bofled and] ii bas oeased lirodui^ — E. C. K.]
^ hdi JBflBdtar de ic acdica, fih. «i capL

THE ROMANS 119

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

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. ^

To preserve the teeth and to keep them healthy, Paul of iEgina recom-
mends all tainted food to be avoided, and also all possibility of indiges-
tion 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.'

Paul of iEgina 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 asser-
tions 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, con-
sidered one of the greatest physicians of ancient times, the great reputa-
tion 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 civiliza-
tion 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 Archi-
genes right up to those of Paul of iEgina, 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.

' Lib. vi, cap. xxviii. ' Ibid., cap. ix. ^ Ibid., cap. xxix.

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 power-
ful 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 incon-
testable preeminence.

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 aver-
sion to bloody operations and in the effort to avoid them. A like ten-
dency 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.

122 SECOND PERIOD-THE MIDDLE AGES

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 appli-
cation 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.*

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

' Rasis opera, Venedis, 1508.

THE ARABIANS 123

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.^

He cures epulis, like Paul of iEgina, 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.^

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.'

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 Canoriy
2L 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,

* Haly Abbas Pract., lib. v, cap. Ixxviii. * Ibid., cap. xxxiii.

' Serapionis practica, Venetiis, 1503.

124 SECOND PERIOD— THE MIDDLE AGES

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 cleanli-
ness 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 enumer-
ates 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 recom-
mends, 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 throb-
bing feeling, Avicenna considers that this is due to an excessive accumu-
lation 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 ex-
traction in order to cause even the most rebellious odontalgia to cease ;
in certain cases he obtained a complete cessation of the pain after having

THE ARABIANS 125

simply shaken the tooth without completing its extraction; which accord-
ing 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 aristo lochia.^

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 11 22 at Cordova, a city which, on account of its cele-
brated 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 dis-
eases 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

* Avicennae opera in re meJica, Venetiis, 1564.

126 SECOND PERIOD— THE MIDDLE AGES

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."*

"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
eflFect of such a cure, the corrupted moisture will dry up, the gums will
regain their tone, and the tooth its firmness."*

**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

^ Abulcasis de Chirurgia, lib. i, cap. xix, p. 47; Latin translation by Channing with the
Arabic text in front, Oxford, 1778.
^ Cap. XX, p 47.

THE ARABIANS

127

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 extrem-
ities, as is most convenient."*

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,^ 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.'

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.*

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

' Cap. xxi, p. 49. ' Zegi was the name given by the Arabs to blue vitriol.

^ Lib. ii, cap. xxviii, p. 181. * Lib. ii, cap. xxix, pp. 181 to 183.

128 SECOND PERIOD-THE MIDDLE AGES

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."^

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 diflferent Arabic copies
of Abulcasis,* 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 differ-
ence, 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 instru-
ments 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.

We now consider the chapter on the extraction of teeth.' The author
begins by saving 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

* This great Mahommedan surgeon was, it seems, ver>' religious. His book begins with
the words: **ln the name of the merciful God, Lord perfect in goodness," and almost
every chapter ends with **If God so wills," and the like.

' These two manuscript codices are found in the Bodleian Library- at Oxford.

* Lib. ii, cap. xxx, p. 185.

THE ARABIANS

129

patient is obliged by pain to submit to this, it is necessary first to ascer-
tain which is the aching tooth, as very often the pain deceives the patient.

/VAAA/vaJ\Aj\.

Fig. 35

A A/WV-AJ^. AV- ZUkj\A /VA

±0

\A A A A ,A A_AA A A AAA

.AuA^A A A iA A A A A

A-A.^. A A A A A A.

/\ , A>\y\AA >v A>vy\AA A

A A. A A^A A A A A A

£)

A— A A AAA A A A

A A A- A A A A

/\ /\ A A y^

A-A^..,A A A A-A.^A-Af)

A-ZV-A,A A A ^ ^ ^^ ^^^-^^Vy\

AAAAA/^^^/%^/^^

:l^

Set of fourteen dental scrapers (Abulcasis).

130

SECOND PERIOD— THE MIDDLE AGES

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

Fig. 36

0=:^

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

often happens in the hands of the barbers.* The aching tooth having been
well ascertained, it is necessary to detach the gum from the tooth, all

* The Arabic word used by the author means more precisely "those who apply cupping
glasses." Channing has translated it by tonsoresy barbers.

THE ARABIANS 131

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,* 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 re-

FiG. 37

Fig. 38

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

maining 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.

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

* An advice already given by Celsus.

132 SECOND PERIOD— THE MIDDLE AGES

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 Abul-
casis 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.

Fig. 39

Fig. 40

' ^VaVa<^.vVa^p:;wV>^

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 himselP 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 unfrcquer^'" • fatui tonsores* was the cause

• 1J^ ■ Silly barbm.

THE ARABIANS

133

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.*

Fig. 41

vV tLA f \ (\ A A

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.

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

* Lib. ii, cap. xxxi, p. 187.

SECOND PERIOD-THE MIDDLE AGES

to one of the following instruments, choosing that which in even' par-
ticular case seems to be the most suitable.

Besides these, savs the author, use mav be also made of some of the
instruments which ser\'e 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.

Fig. 44

Figs. 45, 46, 47

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,* a deformity ensues which is particularly displeasing in women.
The way of correcting this varies according to the nature of the case.

« Lib. "

THE ARABIANS

135

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:

Fig. 49

An instrument like a small axe, for reseaing 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 opera-
tion, 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.

Fig. 50

Fig. 51

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

When, in consequence of a blow or fall, one or more teeth have become
loose so that the patient cannot bi e 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 pre-
ferred 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

136

SECOND PERIOD— THE MIDDLE AGES

lengths of the wire and crossing them in the dental interstices so as to
form a kind of network, the sound and iirm 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 com-
pletely 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

Fig. 52

A dental saw (Abulcasis).
Fig. 53

Another dental saw (Abulcasis).

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:

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

THE ARABIANS 137

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,^ 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^ 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.

Fig. 55

:v/ ""/ J C ^

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 in-
finite 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 fol-
lowing 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

• Lib. ii, cap. xxxv, p. 197. ' Lib. iii, cap. iv, p. 545.

138 SECOND PERIOD— THE MIDDLE AGES

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/

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.^

* [In connection with the praaice of applying medicines to the teeth or upon the gums,
with the object of rendering the operation of tooth extraaion 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 1 52 1,
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. I^ — 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:
I^ — Seeds of almezereon and milk of alscebram compounded with liquid pitch, and fill
with it the decayed tooth. Another one: I^ — Bauras, bark of the willow, of each, one
part; yellow arsenic, two parts; compound with honey and plue 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 conneaion 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-vemix,
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-vemix 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 applica-
tion 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, — Impress© in Venitia per Cesaro Arrivabeno Venitiano a di vinti octubrio,
mille cinquecento e vintiuno.

Delle Medicini Particulare, Libro Quarto, Capitolo XLI. — E. C. K.]

' Joannis Mesue opera, Venetiis, 1562.

THE ARABIANS WW)

AvENZOAR. The last of the great Arabian physicians was Aven/oar.
He was born at Penaflor, 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 blcmdletting
either from the ranine or the basilic vein. Apart from this, he speaks
neither of operations nor of remedies for diseases of the teeth.' Probably
at the time in which Avenzoar wrote, that is, in the first half of the twelfth
centur)', 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 s^i silent
in regard to dental diseases.

But what can have been the reason for doctors refusing thus contemptu-
ously to occupy themselves with so important a branch of therapeutics J
In every age there have been a great number of ignorant pers^>ns, 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 dentistr>' was still in its infancy there should have becm
persons more or less ignorant who undenook uxnh drawing and the
concoction and sale of specifics against odontalgia. The drxrtors, on their
part, under the pretext of being unwilling to have anything to do with
these indi\iduals, found it very convenient to dispense with the cure of
dental diseases and with the extraction of teeth, this operati^in being
sometimes too difficult for them, on account of their want of practice,
besides being almost always vtry painful, and considered, ev<m from the
most ancient times, capable of eventually producing evil c^^nMrquences,
among which, in some cases, even the death of the patient.

But perhaps this was not the only reason for the fact aix^ve mtntumtd.
In the middle ages the extraction of one or more teeth was u^tnt itnt%
inflicted as a punishment; for example, for having eaten flevh during I^ent^'
or on those found guilty of felony, for having refused to contribute usm%
of money demanded from them by their liege lord. NV/w. as thii puniih-
ment was carried out on the guilty ones by the crxecutoti fA publn
justice, it is only natural that doctors sKould have refused to pr^tise an
operatirjn miiich would have degraded their profession b} brinpnz it
dawn nearly to the cUss ^>f 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.* 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.'

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.'

Teodorico Borgognoni (1205 to 1298), known also under the name
of Teodorico of Cervia, is according to Haesar 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 aflPected; and then the
diseased teeth must all be extracted as soon as possible.*

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 angltca: practica meJictnce a captte 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;

* Bruni Chirurgia magna. ^ Sprengel, Geschichte der Chirurgie, Part II, p. 280.

' Sprengel, loc. cit. * Sprengel, loc. cit.

THIRTEENTH TO FIFTEENTH CENTURIES 141

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 annoint 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 im-
portant 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 mem-
brane, 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 meer-
schaum, pumice stone, burnt hartshorn, in different proportions and com-
binations, 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 instru-
mental 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.

142 SECOND PERIOD— THE MIDDLE AGES

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 instru-
ment 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 sub-
stances, such as the milky juice of the euphorbiaceae (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 13CX), in a little village on the confines of Auvergne, which still
preserves the name of Chaulhac; he died in 1368. This author immor-
talized 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, Provencal, 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,* and who made very accura e 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} 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

' La Grande Chirurgie de Guy de Chauliac, chirurgien maistre en medecine de TUni-
versite de Montpellier, composee en I'an 1363, revue et collationnee sur les manuscrits et
imprimes latins et fran^ais par £. Nicaise, 1890.

^ Of these copies, twenty-two are written in Laftn. four in Frendi, two in Provencal, three
in English, one in Netherlandish ^ **.

THIRTEENTH TO FIFTEENTH CENTURIES 143

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 ex-
presses 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 diflPerent teeth. The uses of these organs are well
known."*

Worthy of being recorded are the names which Guy gives to the dif-
ferent 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 duellesy deux quadruples ^ deux
canitiesy huiet maschelieres^ et deux caisseaux (in the barbarous Latin:
duo dualeSy duo quadruplty duo cantnty octo molar es et duo cay sales). So
that the two middle incisors were then called duales; the lateral incisors
were called quadrupliy 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 appelees en Languedoc
caisseauxy parce qu'elles servent a casser les choses dures, comme les
noix et semblables." In regard to the canines of the upper jaw, we
learn that they were called oeilleres (eye teeth), because their root was
believed to reach near the eye.'

According to Guy de Chauliac, les dents sont engendrees non seulement
en Venfancey ains aux autres ages.* And this passage was commented by
Joubert in the following note, which we reproduce textually:

"En Languedoc, pres de Pezenas y a unc gentil fenime, nomme
Mademoiselle de Lobatiere, des long temps vieille edentee, a laquelle
(comme tesmoignent beaucoup de gens tres-dignes de foy) environ Tan
70 de son age, sont sorties cinq ou six dents nouvelles. Le conciliateur
tesmoigne avoir veu, a qui les dents perdues devant Tan 60 ont ete derechef
engendrees, moindre toutes fois que les premieres et plus foibles."* (In
Languedoc, near Pezenas, there is a lady named Mademoiselle de Loba-
tiere, who having been for a long time old and toothless (according to

* Nicaise, La Grande Chirurgie de Ciuy de Chauliac, Second Chapitre: De TAnatoniie
de la face et de ses parties, p. 47.

' Here, as elsewhere, is preserved the old orthography of the text.
'Nicaise, p. 711.

* Teeth may be produced not only in infancy, but also at a later age.

* Nicaise, p. 205.

144 SECOND PERIOD— THE MIDDLE AGES

the testimony of persons well worthy of belief), at about the age of seventy
got five or six new teeth. The Conciliator* 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.' 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 confec-
tionery 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 affec-
tions, Guy observes that operations on the teeth are particular (proper)
to barbers and to " dentatores,"' 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 '' Jeniator** must be provided with all the
appropriate instruments, that is, with "rasoirs, rapes, spatumes, droits
et courbes, eslevatoires simples et a deux branches, tenailles dentelees,
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

' Pietro of Albano (1250 to 13 16), the writer of many books, among which one bearing
the title of Conciliator diflPerentiorum philosophorum et praecipue medicorum, is often quoted
by Guy de Chauliac and by many others under the name of Conciliator.

^ Nicaise, p. 505. ' Appropriatae barbitonsoribus et dentatoribus.

* In one Latin manuscript of 146 1 instead ofJettiaior we »l»^'*« <qd the word dtntistm.

THIRTEENTH TO FIFTEENTH CENTURIES 145

et cum duobus ramis^ tenaculis dentatis^ et probis diversis, cannulis,
scalpis et terebellis, et etiam limis."*

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
dentatoresy 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,^ 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' 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,

* 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 (rapes, 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, proba) were the sounds or probes.
Scalpra means scalpels, but in this case has especially the meaning of dechaussoirSy gum
lancets. Terebelli (French, Tarieres) are the trepans or perforators.

' Nicaise, p. 507.

' By the word apostemoy Guy de Chauliac, and many other writers, indicate every patho-
logical 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, ery-
sipelas, 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,
zo

146 SECOND PERIOD— THE MIDDLE AGES

whether the matter producing the pain is hot, cold, or windy; and also,
in the second case, it is necessary to ascertain if the pain is of a warm,
cold, dry, or humid nature. ' As may be seen, the principles and subtle
distinctions of the pneumatic school were then in 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, ^ 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;^ on dryness and lack of nourish-
ment 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,' 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 suflicient. Without the

* De la dent esbranlee et aflPoiblie, Nicaise, p. 509.

* '*De rhumidite qui amollist le nerf et le ligament."

^ 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 Arm. A small chain as thin at a thee*'* '^■U mm^ be possibly made,
and would even then be excessively wea^

THIRTEENTH TO FIFTEENTH CENTURIES 147

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 vitae or with a vinous decoction
of mint, salvia, melissa, pepper, or pyrethrum. Then it is necessary to
fill the carious cavity with gallia* and root of cyperus,' 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,' e qu'on luy fasse un passage, a ce que la viande ne s'arreste

* 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 alipta^ V. Nicaise, p. 677.

'According to Nicaise, the Cyperus esculentus (in French, "souchet") is here referred to.

' In the Latin text: Buccelletur cum scalpro et lima.

148 SECOND PERIOD— THE MIDDLE AGES

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,* la dent soit suffumiguee 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 a 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:

"I^ — Cuttle-honey small white seashellsy pumice stoney burnt stags horny
nttrey alumy rock salty burnt roots of irisy aristolochiay and reeds. All
these substances must be reduced to powder together, or each one sepa-
rately." Use may also be made of a liquid dentifrice thus prepared:

"I^ — Sal ammoniac and rock salty half a pound of each; saccharine alumy
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, a cause qu'il y a
la des limosites endurcies; soient rasclees avec des rapes et spatumes."'

Against the setting of teeth on edge {endormement et congelation des
dents; stupor et congelatio dentium)y Guy de Chauliac recommends hot
wine or aqua vitae, 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 sub-
stances, 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,

* Here lavement means mouth wash, not injection.
' Cum raspatoriis et spatuminibus radantur.

THIRTEENTH TO FIFTEENTH CENTURIES 149

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 augmentee outre nature, soit egalisee et applanie
sagement avec la lime, que ne soit ebranlee."

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 — mats Us donnent heaucoup de promessesy 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:*

"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,'
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 con-
sisted 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 Mont-
pellier at the beginning of the fifteenth century, wrote a valuable treatise
on medicine and surgery, entitled Philonium pharmaceuticum et chirur-
gicuniy de medendis omnibus humani corporis affectibus. As to the dis-
eases of the teeth, he especially follows Guy de Chauliac, but treats the

' Treatise vi, doctrine i, chap, viii: "Des membres qu'il faut amputer/' etc., Nicaise,

p. 435-
' According to Joubert several solanacese had this name, among others Solanum nigrum

and Solanum somniferum (Physalis somnifera L.), which probably corresponds to the

Sfrychnos hypnoticus of Dioscorides.

150 SECOND PERIOD— THE MIDDLE AGES

•

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:

"I^ — ^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. "^

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 fumi-
gations, 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
ungulae asini, et fumus recipiatur per infundibulum."

Decayed teeth may be filled, according to Valescus, to satisfy four dif-
ferent indications: To calm or prevent pain, to prevent any further spread-
ing 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 suit-
able, 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.^

In regard to tartar of the teeth — which he calls materia lapidea^ /. e,y
stony substance — Valescus says that it must be removed little by little,
either with iron instruments or with dentifrices partly cleansing and partly

* Valesci Philonium, etc. ; Francofurti MDXCIX, cap. Ixiv, De dolore dentium, p. 195
et seq.

' Plant belonging to the order of the Polygonaceae.

THIRTEENTH TO FIFTEENTH CENTURIES 151

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.^

Valescus, too, like the majority of ancient writers, is not at all favor-
able 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."'

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, be-
cause, 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."' 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,

* ''Materia lapidea paullatim abradatur ferro et dentifriciis partim mundificativis, et
partim stypticis. Deinde colluantur dentes sarpe vino albo, et fricentur sale torrefacto."
Cap. Ixviiy De colore dentium pneter naturam, p. 202.

' ''Quoniam, licet ex parte corrosi sint, attamen dolore sedato masticationem iuvant,
et alios firmiores reddunt." Appendices, p. 205.

' "Ossa fiunt ex spermate et sanguine menstruo; dentes autem ex sanguine, in quo
remansit vinus spermatis." Appendices, p. 205.

152 SECOND PERIOD— THE MIDDLE AGES

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.^

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.^

Giovanni Plateario, a professor at Pisa in the latter half of the fif-
teenth 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'

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,

* Petri de Largelata chirurgiae libri sex, Venetiis, 1480.

' Bartolomai Montagnana Consilia, Venetiis, 1 497*

^ Johannis Platearii Salemitani practica brevis, Lugduni, 1525.

THIRTEENTH TO FIFTEENTH CENTURIES 153

he prescribed astringent mouth washes. Against dental worms, whose
existence no one at that period doubted in the least, Plateario recom-
mended various remedies, chiefly under the form of fumigations; and
among these latter, those performed with burnt opium. Against ulcera-
tions of the gums and mouth he commended the use of wine and aro-
matic 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.^

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^ 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: (i) 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,

» Joannis Arculani commentaria in nonum librum Rasis ad regem Almansorem, etc.,
Vcnctiis, 1542.

* This Arabian word was used to indicate the last molars.

154 SECOND PERIOD— THE MIDDLE AGES

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, aild
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 in-
jurious 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 denti-
frices before going to bed, or else in the morning before breakfast. Al-
though 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 contxaryi they are
discolored or tumid, sanguinolent, suppuradr-
or putrefaction, or if, when pressure •"

THIRTEENTH TO FIFTEENTH CENTURIES 155

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, how-
ever, 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 asa-
fetida, 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 caltda aut frigida secundum opportunitatemy in contrarium
dyscrasia 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

156 SECOND PERIOD— THE MIDDLE AGES

characteristic, and varies but little from the average, Arculanus advises
the teeth being filled with gold-leaf: *'Uhi non fuerit multus recessus
a medtocritatey 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.* 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 indi-
cations: (i) 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

*'* 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
suprascnptis, calida aut frigida secundum opportunitatem, in contrarium dyscrasise dentis,
sed ubi non fuerit multus recessus a mediocritate impleatur cum foliis auri." Cap. xlviii,
p. 195.

THIRTEENTH TO FIFTEENTH CENTURIES 157

(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 puli-
canuni). 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 peli-
can, 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."^

We here reproduce the three figures alluded to, with the relative indi-
cations. 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
ciconiae).

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

* 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 indica-
tion of the use to which each single instrument was destined.

158

SECOND PERIOD— THE MIDDLE AGES

the teeth of the latter were like those of wild beasts, a thing which he con-
sidered 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.

V"»ito

Fig. 56

iiniiiiniiimrm

*n-v^^

■ bmlU...«mm»« mm«m««»^mm4«^l

The pelican as represented in Giovanni d'Arcoli's work. Forceps pro extrahendis

dentibus pulicanum dicta.

Fig. 57

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

Fig. 58

The forceps called "stork's bill," as represented in Giovanni d'Arcoli's work. Forceps

pro extrahendis fragment's quod Rostrum Ciconiae 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 dis-
advantage of the neighboring ones becoming less firm, for want of support.

This author, too, attributes great importance to dental worms, believ-
ing them to be one of the principal and most frequent causes of odon-
talgia. To kill them he recommends the usual fumigations and several

THIRTEENTH TO FIFTEENTH CENTURIES 159

other remedies, among which the juice of the leaves of the centaury or
of the peach tree, but especially applications of aqua vitae.

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 recom-
mended 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.^

Giovanni of Vigo. The celebrated surgeon Giovanni of Vigo (1460
to 1520), speaking of abscesses of the gums,^ says that the abscess must
be first brought to maturity by fitting remedies, if it has not ripened spon-
taneously, then it must be opened with a lancet, and lastly, to cleanse
the diseased part and to aid cicatrization, honey of roses or Egyptian oint-
ment must be used. This latter is thus composed of: **I^ — ^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.

' Alexandri Benedict! Veronensis de re medica opus, lib. vi, de affectibus dentium.
'Opera domini Joannis de Vigo in chyrurgia. Lugduni, 1521, lib. ii, tract, iii, cap. xiv,
fol. 40.

160 SECOND PERIOD— THE MIDDLE AGES

It may, however, be seen from the very book of Giovanni of Vigo,^
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."'

[* The editions and translations of Vigo seem to have been endless. A French trans-
lation of his treatise on the wounds caused by firearms is said to have fallen into the
hands of Pare, and had an inspiring influence upon the barber's boy. — C. M.]

^ Lib. V, cap. v, De doloribus dentium, fol. cxvii to cxix.

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 begin-
ning 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
II

162 THIRD PERIOD— MODERN TIMES

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,* 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 authoriza-
tion — tooth-drawers, charlatans, wandering story-tellers, necromancers,
Jews, and even hangmen — ^who invaded the field of medical practice,

^ Handbuch der Zahnheilkunde, Berlin, 1848, ii, 406.

THE SIXTEENTH CENTURY 163

in spite of its being forbidden them, except in fairs, to administer medica-
ments and to perform surgical operations.'

In 1460 there appeared in Germany a book on Surgery by Heinrich
von Pfolsprundt, Knight of the Teutonic Order.' The author had
acquired great experience as surgeon in the mlHtary 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.^

0tgtteD 33uc^

lein/x»]K)eraIlcrlcikraiv«

(ffftcii wfy iKor<4^ti ter i3cctt/cKQ98(n

«ii|>bcm0iilm«/2lnceitiM/tnc)iK/

iC«ntcU» Cdf% Mb tttHtmmi^

IcTat.

Title page of Zahnarzneybuchleii

' Geisi-Jacobi, Geschichte der Zahnheilkunde, p. 80.

* A religious order of knights, established toward the close of the twelfth century,
during the third crusade. The original object of the association was to defend the Chrii
religion against the infidels, and to take care of the sick in the Holy Land.

* Geict-Jacobi, Geschichte der Zahnheilkunde, p. 8z.

164 THIRD PERIOD— MODERN TIMES

[The accompanying reproduction of the title page and two text pages from an edition
of Zahnarxneybuchlein^ 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. Examina-
tion 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 Zahnarzneyhuchlein
are fully set forth.

^wn Senem

C^rrofto iji erne ffrancF^de tonb t^e^el
ber 501 xomn fie Mc^engff t)rtb ^ol n>r rbS
iveb^d om twi^m ben hadtiml 9e(cl)td)t
t>omem!<f Itci>ert fo em er ifl vnnX> fte ntc^e
vw bar itnf>itiig^e fpetfe rctiiigct/n^elc^s
ftttl notrbr/ v\\X> mad)t ^arnaay hS\c fc^l
nrffe feitc^ttg^ett bte fte am fnfi im e^et/
vtib ^mmer all m eltd) vbaiyant n^mmct
bafe fte aiic^ gaiiQ vn^ aar ^it yn Berber
bet/x^itnb bamaci^mc^fcitfie fct^titerQeit
m&ffefi fhlcFtd^t n^gt 0tiilett»

tVTefue ^^^ ^^^ ^^ ^^ tYTefite fc^rei1>ee vwt

vt ftn,«^wtfli4)brcveirle7we^ficiinre m mt4

cavitt ^^^^' ^^ ^^f^^ '^^^ purgtnmg ab obeii

pmi»» t^rt / 5ttm atibem mit refolmVunaber

*^^ * maeertenbieftemtobolecmibit^eg^frtfi/

alfo b40 man IfodK ratten boa tm 0ont

aber tx^e^tj n^ed^fi/mtt efjtge tmb im mtm

be l[>albe/aber mtt efftge bo capptcBVO0t4

Qel mtt ^^gn^er tnne gefotten tf{/x>nb ber

glei4)en anbere remebta me^n

fT'rflnj/fl/iofi.]

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

THE SIXTEENTH CENTURY 165

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.

**Mesuf 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 Ble, or other suitable instrument, as is
well known to practitioners, and then by filling the cavity with gold leaves for the preser-
vation 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.

Sum tnteett bM ntM bie Aiia|>oIun9
weg^ nimmct/wddfe and} anfiwc^ctle^
toe^ft Q€fd)id)t/ ^nm erfim bae man t>M
loc^ vn^ Ote aufefrcffimQc mit mem fnb4
tikft mciffc[d)tn abcv meffcrd)m vetlc^e/
abet mit cittern M^cm muniment battsn
bcquemi(tUd)/w€^ fd)abe/vttX> teiniQc/
alo h'f practicf ^rttert tt?ol wiffenfvttb t>av^
in er$afoufig tea otiberti tc^lee X>es ianii
^M tSd)lid)m mit golt blettern in f^Uet^
Znm anient X>m maim aebrandjc ertitc^
b^rju tmlid) W€l<i)e^efQ)ict mit (Bailee
cpffel vnX> U)il0cr QatQen (o ber ictn nad)
ter rtmtgurtg barmit wixbt QefilUu

Vlim pUfctt famctt mit bem gnme fi^f
xaci$vwmifii}t / vendue t>armittc bmd)
tinen ttidyur hen Qd^d)ertm ^n»

<Salbannm ifi tin gunimt glct(f>bem
6libatt0anfft>ieaneQc^9lt€im gelegcr^
Imbertbeif fc^mcrQcm

60 hie ^Icti $cffe mit ^p^pannac^ gc
fuUet tt^erbm fhike e^r belt fa^merQm .

(Corelleri ytfi^ffcn tonb in hie ^Im 3m
fScUgt ntad)t ficanefaUen.

The following editions of Zahttarzneybuchlein, besides the Basle and Mayence editions
noted by Dr. Guerini at page i66, 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.]

166 THIRD PERIOD-MODERN TIMES

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 inha-
lations; 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/ 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.* 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 Healthyy to Strengthen and Reinvigorate
the Eyes and the Sight. fVith Further Instruction on the Way of Keeping
the Mouth Freshy the Teeth Clean^ and the Gums Firm}

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

* Geist-Jacobi, p. 88. " Albert von Haller, Bibliotheca chirurgica, i, 190.

' Nuetzlicher Bericht, wie man die Augen und das Gesicht schaerfen und gesund erhalten,
die Zaehne frisch und fest erhalten soil. Wiirzburg, 1548.

THE SIXTEENTH CENTURY 167

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
Brst part of it — that is, in that published in 1545 — represent dental instru-
ments, 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.

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.

RylTs other book is especially noteworthy because, as we have already
mentioned, it treats, for the first time, of dental matters, independently

168 THIRD PERIOD— MODERN TIMES

of general medicine and surgery. This pamphlet, printed at Wiirz-
burg 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."*

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, RyflF has the merit of being, perhaps, the first who has noted
the undeniable relation which exists between the dental and ocular aflFec-
tions.

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 knowl-
edge 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 RyflF 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 RyflF, 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."

* See Giomale di Corrispondenza pei dentisti, 1895, xxiv, 289.

THE SIXTEENTH CENTURr 169

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 epi-
lepsy (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."^

"The most atrocious pain," says RyflF, "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
veray 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 RyflF'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

' Joannis Arculani. Commentaria, Venetiis, 1542, cap. xlviii, De dolore dentium, p. 192.

170 THIRD PERIOD-MODERN TIMES

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^ 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 ^tius;
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 ^tius, 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 ^tius 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 affectoruniy ex Adamantio sophista
(cure of teeth affected by warm, painful disease, according to Adaman-
tius the sophist).

Cura dentium a stccitate dolore affectorum^ ex Adamantio sophista
(cure of teeth affected by pain from dryness, according to Adamantius
the sophist).

* "The first dental book in the German language*' (see Giomale di Corrispondenza
pei dentisti, loc. cit.).

THE SIXTEENTH CENTURY 171

The work of Adamantius, from which ^tius 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 ^tius treats of dental affections, such analogy
will be noticed between the various titles as to make us consider that
they have been formulated by ^Etius 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 ^Etius
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 ^Etius, 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 signifi-
cance that he attributes to them, and that the same have been formulated

172 THIRD PERIOD—MODERN TIMES

by iEtius 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 Adaman-
tius, 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.* 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 assist-
ant, 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 Inno-
cents 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.

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

' A Latin translation of the French name Du hois.

THE SIXTEENTH CENTURY 173

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 re-
sounded 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 expia-
tion. 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,* 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 Vesa-
lius 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.

^ De humani corporis fabrica, libri septem.

174 THIRD PERIOD-MODERN TIMES

However, his description of the dental apparatus^ 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 antepenulti-
mate molars, more often than in the other teeth, it sometimes happens
that a greater number of roots than usual are found, it being not 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 im-
portance, 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.

* 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).

THE SIXTEENTH CENTURY 175

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 numberof 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 con-
trary 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, medul-
lary 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.

170 THIRD PERIOD-MODERN TIMES

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* is found a dental terminology — Latin, Greek, Hebrew,
and Arabic — which affords some interest. The incisors are called in
Latin incisoriij risorii\ quaterniy 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 caniniy dog's
teeth. In Latin they have been also denominated morJenteSy and by some
also risoriiy 2l name which by others is given to the incisors, as we have
already seen. The molars have also been called in Latin maxillares^
paxillaresy mensaleSy genuini^ But some authors give this last name
only to the last molars, or wisdom teeth, denies sensus et sapientia et
intellectus. These teeth have also been called serotini (that is, tardy),
cetatem complentes (that is, completing the age, the growth), and also,
in barbaric Latin, cayseles or caysalesy negugidiy 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 author-
ity 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 con-
sidered the too precocious development of the teeth as a great anomaly,
and regarded as monsters those children who were born with teeth.'

' Lib. i, cap. xlii, p. 141. ^ From gena^ a cheek.

^ Blandin, Anatomie du systeme dentaire, Paris, 1836, p ig

THE SIXTEENTH CENTURY Yll

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.

Matted 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. ^

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 anatomic(By 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,^ 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, in-
stead, 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.

* Portal, Histoire de I'anatomie et de la chirurgie, tome i, p. 545.
' Observationes anatomicae, p. 39, et seq.
12

178 THIRD PERIOD— MODERN TIMES

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 nervulusy
et arterioloy et venula applicantur); the other anterior (that is more super-
ficial), 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 develop-
ment of the teeth were carried out with great accuracy, and he is, there-
fore, 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 nar-
rowest 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 immortal-
ized his name through many anatomical discoveries and writings of the
highest value.

His book on the teeth, Libellus de dentibusy published at Venice in 1563,

THE SIXTEENTH CENTURT 179

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 praterea vinculo fortissima radicibus prcecipue adherentiay quibus
prasepiolis 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 ascer-
tain 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,

180 THIRD PERIOD-MODERN TIMES

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 what-
ever 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 investi-
gations 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. ^ 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

* In utero duodocim denies formantur in malts, et totidem in maxilla (in the uterus are
formed twelve teeth in the upper jaw and as many in the lower). Fallopii Gabrielis observa-
tiones anatomicx, Venetiis, 1562, p. 39.

THE SIXTEENTH CENTURT 181

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 Vanatomie 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 differ-
ences 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 under-
lying 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 liga-
ment. "This is at first mucous, but afterward, becoming more consistent,

182 THIRD PERIOD— MODERN TIMES

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/ 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 sub-
stantially 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.

* 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!

THE SIXTEENTH CENTURY 183

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^ 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 mem-
brane, 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 accu-
rately 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 impor-
tance. 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

' Chap. \v'\\\, p. 54.

184 THIRD PERIOD— MODERN TIMES

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 versQy 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

THE SIXTEENTH CENTURY 185

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, ^ 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
diff^erent 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 addi-
tion 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,^ 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

' Chap, xxii, p. 65. ' Chap, xxiii, p. 70.

186 THIRD PERIOD— MODERN TIMES

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 gener-
ally 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 appear-
ance 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,* Eustachius is of the opinion that these
organs possess, besides the sensibility to pain, two other species of sensi-
bility; 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 teethy
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 tooih is still soft and mucous, intermixes intimately
with it, thus communicating to it the faculty of feeling, which then per-
sists 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.

* Chap. XXV, xxvi.

THE SIXTEENTH CENTURT 187

In the two following chapters/ 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 compara-
tive anatomy, above all in what regards the monkey, the dog, and the rumi-
nants, 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 inter-
esting. 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, fur-
rowed 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 sub-
stance, 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 anato-
mists 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

' Chap, xxviiy xxviii.

188 THIRD PERIOD— MODERN TIMES

tooth in the roof of the mouth, near the opening which is in proximity
to the incisor^/ and at Gubbio there is, in the monastery of the Trinita,
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 per-
sons, one of the other molars being extracted, it is sometimes renewed."^

In the last chapter* 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, not-
withstanding its having had, according to Cicero, a very high initiator —
^sculapius, the god of medicine.

Ambroise Pare. Whilst the anatomy of the dental system was illus-
trated by the researches of Fallopius and Eustachius, the celebrated
French surgeon Ambroise Pare was contributing in the highest degree to
the progress of practical dentistry.

Ambroise Pare (Latinized Paraeus) 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 Pare

' The inferior orifice of the foramen incisivum.

^ 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.

^ Page 93.

THE SIXTEENTH CENTURY 189

did not enjoy any of those advantages deriving from a good literary educa-
tion, 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-harhier. After this he practised minor surgery for some years
in the Hotel-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 Hotel-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 extraor-
dinary even before he had any academic degree, procured him introduc-
tion 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 Pare 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 ward-
robe. 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 cir-
cumstance 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,^ Ambroise Pare 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
raciney et non suspenduesy comme celles de la mandibule d^en hauty navotent
besoin de tant de racines pour leur stabilite asseurance?

^ CEuvres completes d'Ambroise Pare, accompagnees de notes historiques et critiques, par
J. F. Malgaigne, Paris, 1840, vol. i, p. 231.

* 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.

190 THIRD PERIOD— MODERN TIMES

Ambroise Pare, 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 Pare also held erroneously,
that the exquisite sensibility of the teeth aids the sense of taste.

In speaking of the development of the teeth, Ambroise Pare 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, ^ Pare 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 "j/ elles sont diviseesy ehranleesy
ou separees hors de leurs alveoles ou petites cavitesy elles dotvent estre
reduites en leurs places et seront liees et attache es contre celles qui sont
fermeSy avecques un fil d^or ou d'argenty ou de lin, Et les y faut tenir
jusques a ce qu^ elles soient bien affermiesy et le callus soient refait et rendu
solider'

Toothache, says Pare,^ 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 pulsa-
tion 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 treat-
ment 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

* Vol. ii, p. 307.

^ . . . 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
Rrm and the callus is formed and have become solid.

^ Lib. XV, ch. xvi, vol. ii, p. 443.

THE SIXTEENTH CENTURT 191

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,
Pare adds, one burns the nerve, thus rendering it incapable of again feeling
or causing pain.

Erosion or caries* 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 Pare 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 astrin-
gent mouth washes and liquid or semiliquid nourishment, such as meat
juice, panada, barley soup, jelly, and such like. The patient was com-
pletely 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,
Pare recommends replacing it immediately and binding it to the neighbor-
ing 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 Pare belongs the merit of having treated the subject

* Lib. XV, cap. xxvii, vol. ii, p. 448.

192

THIRD PERIOD— MODERN TIMES

much more explicity, and of having insisted on the utility of this opera-
tion, indeed, on the duty of carrying it out whenever it seems indicated.
Further, he is the first to mention another very important operation,
namely, transplantation, albeit he himself had never performed it. The
case he refers to has become a generally known anecdote. We give it in

Fig. 6o

m^vi

Dental files (Ambroise Pare).

his own words: "f/n homme digne d^estre creu ma affirme qu^une prin-
cesse ayant fait arracher une denty s*en fit remettre subit une autre d'une
sienne demoiselle^ laquelle se reprinty et quelque temps apres maschoit
dessus comme sus celle qu^elle avoit fait arracher auparavant^^

* 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 writh it as well as she had done with the former
one.

THE SIXTEENTH CENTURT

1!W

Ambroise Pare has recourse to extraction when a tooth is the cause of
very violent pain, or when the existence of a carious cavity and concomi-
tant putrefying processes render the breath fetid, and endanger the healthy

Fig. 6i

One or the pelicans used by Ambroise Pare.
Fig. 62

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, Pare advises laying bare and

194 THIRD PERIOD— MODERN TIMES

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 Pare,
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 deschapellementy by another French author, a con-
temporary of Pare — 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 vio-
lence, 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.*
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 poussoity 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 cer-
tainly 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, demeurani a
Orleans, nomme maistre Fran9ois Loiiis, lequel avoit par dessus tous,
rhonneur de bien arracher une dent, de fa^on 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

* Lib. XV, cap. xxviii.

THE SIXTEENTH CENTURY

195

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 a la mode de
son maistre. Arriva cependant que ledit Francois Louys disnoit, un
villageois, requerant qu'on luy arrachait une dent, ce Picard print Tinstru-
ment 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.

Fig. 63

Mjllfc.

Two gum lancets and a trifid lever called "poussoir" (Ambroise Pare).

Et sentant une douleur extreme, et voyont trois dents hors de sa bouche,
commen^a a 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. Done le maistre oyant tel
bruit, sortit hors de table pour s^avoir la cause et raison de leur noise et
contestation; mais le pauvre paysan redoutant les menaces du Picard,
et encore apres avoir endure telle douleur qu'on ne luy fist payer triple-

196 THIRD PERIOD— MODERN TIMES

ment la peine dudit Picard, se teut, n'osant declarer audit maistre ce
beau chef d'oeuvre; et ainsi le pauvre badaud de village s'en alia 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.'*^ Pare adds in con-
clusion: " Partant je conseille a ceux qui voudront faire arracher les dents,
qu'ils aillent aux vieux dentateurs, et non aux jeunes qui n'auront encore
reconneu leurs fautes."^

But let us now return to our subject. After the extraction of a tooth,
it is necessary — says Pare — to leave the wound to bleed freely, so 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 *^Je la limosite ou rouillure des dents ^
et de la maniere 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

* I will here tell a story of a master barber living at Orleans, named maistre Francois
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 Fran9ois 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."

^ 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 short-
comings."

THE SIXTEENTH CENTURT

197

be rubbed with a little aqua fortis and aqua vitae 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 Pare, 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. There-
fore, 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 Roharty^ which are excellent for this purpose;
and the artificial teeth must be tied to the neighboring ones with gold or
silver wire.

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

Fig. 64

The palatine obturator with sponge of Ambroise Pare.

Other wound or by a syphilitic ulcer {par ulcere de verole)y 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 perfora-
tion; 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

' An old French word meaning perhaps hippopotamus.

198 THIRD PERIOD—MODERN TIMES

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.

In the last chapter of Book XVIII, first dentition and the treatment
required during this period are spoken of. The cutting of teeth, says
Pare, 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 quench-
ing 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

Fig. 65

Fare's palatine obturator without sponge.

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 Pare, 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. Pare
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,

THE SIXTEENTH CENTURT 199

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. Pare 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
proJiges)y Pare 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 Pare 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 aready
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 Pare, 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 HoUerius,
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: "/^ 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^ a quibus dolor nan ita fortisj
pruriginosusj nulla aut pauca salivatio),**

But even while putting in doubt the existence of dental worms, he be-
lieves 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. (Qt^od autem vulgus sibi persuadety et
ab antiquis medicis scriptum est de suffumigio e semine hyoscyamiy videtur

200 THIRD PERIOD— MODERN TIMES

fabulosum. Nam inde ajunt manifeste vermes exciJere. Re verOy incenso
semtney evolant tanqua vermiculiy etiam si non attingit fumus vermiculo-
sum Jentem.)

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 ex-
pulsive virtues of the fat of green frogs when applied to a tooth {adeps
ranee viridis dent em de pell it).

Houllier does not contribute in any way to dental therapeutics, he only
enumerates the methods of cure recommended by preceding authors/

VoLCHERUS CoiTER (1534 to 1600), of Groningen, 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.^

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 impor-
tance of the cleanliness and disinfection of the mouth as a prophylactic
against infective diseases.

In the above-mentioned bo.ok 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.'

DoNATO Antonio of Altomare, a Neapolitan physician and philos-
opher, dedicated a long chapter of his Ars medica* to the subject of
dental pains and their treatment. He classifies these pains with great

* Jacobi Hollerii medici parisiensis omnia opera practica, Genevae, 1635, ^^^* "> P- ^'7»
et seq.

^ Blandin, Anatomic du systeme dentaire, Paris, 1836, p. 25.

^ Hoann Jac. Weckerus, medicinae utriusque syntaxes, ex Graecorum, Latinorum,
Arabumque thesauris collectse, Basilea, 1576.

* Donati Antonii ab Altomari medici ac philosophi neapolitani Ars Medica, Venetiis,
1558, cap. xli, p. 190.

THE SIXTEENTH CENTURT 201

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 (Chirurgice universalis opus ahsolutuniy
Venetitiis, 1573), and then in Italian under the title of Chirurgia
universale e perfetta^ Venezia, 1583. According to this author, dental
fistulae are more common to the lower jaw than to the upper one. To
cure these fistulae, it is necessary to extract the diseased teeth from which
they originate, even should they ache but Httle 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* 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 supposi-
tion.

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

' Collezione d'osservazioni e riflessioni, vol. iii, oss. 84, p. 374.

202 THIRD PERIOD— MODERN TIMES

these rough changes.^ In the mercurial treatment of syphilis,' he recom-
mends 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 harm-
ful 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 Observation's medicaj
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 colu^
mellares. 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 suc-
ceeded 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 ex-
tracted. 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

* Hieronymi Capivacci Patavini opera omnia, Venetiis, 1617, edit, sexta, lib. i, cap.
liii; de afFectibus dentium, p. 515.

* Lib. ii, cap. v, de lue venerea, p. 712.

THE SIXTEENTH CENTURT 203

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 fistulae 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 High-
more's antrum); he obtained a complete cure in a short time by the extrac-
tion 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 pre-
tended 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 dis-
approves, however, of the use of oil of vitriol — unless in very minute
quantities of, at the very most, one or two drops.*

Urbain Hemard, a surgeon to the Cardinal d'Armagnac, published
in 1582, at Lyons, a booklet entitled: Recherche de la vraye anathomie
des dentSy nature et proprietez d^icelleSy oil est amplement discouru de ce
quelles ont plus que les autres os; avecque les maladies qui leur adviennenty
et les remedies. This is the first dental monograph that appeared in
France. The pamphlet is written with much erudition, but its contents

^ Petri Foresti, Alcmariani, opera omnia quatuor tomis digesta, Rothomagi, 1653.

204

THIRD PERIOD—MODERN TIMES

are almost entirely taken from preceding authors. Hemard 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, Hemard's book does not
contain anything original. The following passage, transcribed by Portal/
shows luminously that Urbain Hemard, 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 Hemard 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 Hemard's book, the corresponding passage of Eustachius, that our
readers may be convinced of the truth of what we have stated:

EUSTACHIUS.

. . . apcrta utraque maxilla occurrunt
incisores, canini, ac tres molares, nimirum
secundus, tertius et quartus; partim mucosi,
partim ossci, non obscuras magnitudinis,
suisque prsesepiolis undique vallati:

incisoribus autem et caninis docta manu
detractis, tenuissimum interstitium vix
osseum factum conspicitur; quo pari dili-
gentia amoto, obviam veniunt totidem
incisores et canini pene mucosi et longe
minores, qui post alios priores in propriis
caveis latentes, singuli singulis c regione
oppositi collocati essent, nisi utriusque
maxillx caninus magna ex parte proximo
incisori incumberet, eumque propterea fere
occultaret.^

Primorum molarium et genuinorum qui
circa septennium ac longe etiam postea ori-
untur, fateor me nullum vestigium vidisse.

HEMARD.

. . . leur ayant ouverte Tune et Tautre
machoire, j'y ai trouve seulement les dents
incisoyres, les canines, et les trois mache-
lieres de chaque couste de machoire; a
s9avoir la seconde, la troysieme et la qua-
trieme, lesquelles estoit partie osseuses
parti mucillagineuseSyde mediocre grandeur,
garnies a Tentour de leurs petits estuis
ou alveoles. Et depuis ayant tirees dehors
lesdictes dents incisives et canines, il se
trouve un entre-deux osseux; lequel ayant
pareillement oste, il se presente de dessoubs
autant de dents incisives et canines, toutes
presque mucillagineuses, representant la
substance d*un blanc d'ocuf a demy cuite
moindres pourtant que les precedentes
estant cachees dans les mesmes estuits
aprcs les premieres.

Quant est des premieres machelieres
et des gemeles qui a sept ans, ou long-
temps apres commencent a sortir, je con-
fesse n*en avoir trouve jamais aucune
trace n*v commencement.

^ Histoire de Tanatomie et de la chirurgie, Paris, 1770.

^ Hemard has omitted translating this passage, probably because he did not well under*
stand \x.

THE SIXTEENTH CENTURY 205

EUSTACHIUS. HEMARD.

Verisimile tamen est, rationique consen- Toutesfois, il est vraysemblable et raison-

taneum, eos perinde ac secundos incisores able aussi,qu'ellesayent prisdanslamatrice,

et caninos rude quoddam, sed minus perspi- lout ainsi que les inctsoyres el canines

cuum initium oitus in utero sumere; secondes, quelque petit commencement de

sensimque postea similiter formari el absolvi naysance et forme, moins apparante toute-
fois, mais qui depuis se fafonne el parfaict

At the time when Urbain Hemard was publishing his pamphlet in
France, several other monographs were already appearing in various
parts of Europe on teeth and their atFections. A few years after Ryff
had initiated dental literature in Germany, other odontological writings
were published in Spain and in Italy.

COLOQVIO BREVE Y

copcdiofo. Sobrc la materia d la dc

tadiira, ymarauillofaobradlabo

ca.Co mochosrcmedios y aui

{<x necciTarios.Yla orde

dc curar>yadrc{ar

lot dientes .

f Dirigido>al muy altoy muy pode
lofofciionel Principe d6 Carlos nrofc-
iior.Co|)ue(1o por el Bnchiller Fricifco
Marti nez.Nitural dcia villa dc Caltrillo
dc ontc]o.EftSt< en Valtadolid. ifsj*
Con preuilegie.
cEfla tafikdo en 1^ V U. Bii^

page of Francisco Martinez's book (Valladolid, 1557).

206

THIRD PERIOD— MODERN TIMES

Francisco Martinez/ 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 necessariosj y la orden de
curar y adre^ar los dientes.

Fig. 67

Four of the instruments represented in Francisco Martinez's book.

Fig. 68

A dental excavator used for ascertaining which one among several decayed teeth

was the one causing the pain (F. Martinez).

Fig. 69

pm«r^W l »,^V,; ,'<mt.llil.AAtTT??

^.\k« ««\X\^>« \ *\N%\ M\« VV^ \W^\%«« \« .%> \«\ •

\'''"M'tbilitl||

A chisel and a mallet for separating teeth (F. Martinez).

Fig. 70

A pelican (F. Martinez).

*[For a fuller review of this author see A Dental Book of the Sixteenth Centuiy, by
Julio Endelman, Dental Cosmos, 1903, vol. xlv, p. 39. — E. C. K.]

THE SIXTEENTH CENTURT

207

In the same year and city was printed a Latin pamphlet, De dentioney
by Franciscus Martinus de Castrillo, probably the author of the pre-
ceding 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, Zahnarzneyy by Adam Bodenstein von Carlstad;
and two years later Petrus Monavius published in Basle a Latin pamphlet
on dental diseases {De dentium affectibus).

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.

208

THIRD PERIOD— MODERN TIMES

The principal operations which it is necessary to perform on teeth are,
he says, seven in number/ viz. : | aJ

I. Forced opening of the dental arches in cases of prolonged constric-
tion of the same, so as to prevent the patient from dying of hunger.

Fig. 73

^ l^yT. ^>i^'?»-^^VA.^VR■v:cs7^. ;^t^k^v■ ; ^ ■,vy.>^

^?j::i^^5S:^r >^

rgg

Instruments for removing deposits from the teeth (F. Martinez).

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),

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.

* Hieronymi Fabricii ab Aquapendente opera chirurgica, Lugduni Batavorum, '7^3»
cap. xxxii, p. 451.

THE SIXTEENTH CENTURY 209

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

Fo. t$%

Virgo martircgre^

pronobis Apolonia;
ntnde pr^cti ad dominll

ne pro ream cruninO:
Vcxcmur inorbo d£ci&

A figure representing St. Apoitonia, reproduced froin the tin page of F. ManJnez's book.

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

210 THIRD PERIOD— MODERN TIMES

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^ is designed, says
Fabricius, to take away the dirtiness of the teeth and the bad odor of the
mouth {dentium imrnunditiam et oris foetorem tollii). The dental tartar
(pstracodermd) 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 instru-
ments; 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 (resec-
tion) 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 ex-
ternally or internally with regard to the dental arches. But as after the
resection there will almost always remain some points or sharp irregular-
ities, 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 opera-
tion 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

* Cap. xxxiii, p. 455.

THE SIXTEENTH CENTURT 211

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 com-
posed of a sponge-like substance.

The instruments which are used for the extraction of teeth, are, says
Fabricius, of nine kinds ;^ and the most important among them — gen-
erically 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 dentiscalpiay 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,^ 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 spongiay vel gossypioy vel lamina argentea^ qua palato
appendatur^ ut foramen obstruat),

' Cap. xxxiv, p. 456; de instrumentis extrahendts dentibus idoneis,
' Cap. XXXV, p. 457.

212 THIRD PERIOD— MODERN TIMES

For epulides and parulides Fabricius advises the same methods of cure
that had been recommended by Paul of ^gina.

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 suit-
able cutting instruments, as much as is possible of the morbid tissue
(^caro crass a et putriJa); 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 allu-
sion to these large gingival excrescences, he had had occasion to observe
several cases, and had also had various instruments especially constructed
for their cure.^

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.'

He warns those who suffer from odontalgia not to have recourse thought-
lessly 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

* Cap. XXX, de gingivarum chirurgia, p. 450.

^ Joannis Heumii Ultrajectini de morbis oculorum, aurum, nasi, dentium et oris, liber
Raphelengii, 1602, cap. xi, de dentium et oris passionibus, p. 79.

THE SIXTEENTH CENTURy

213

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.

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 —

Fti;, 76

A D.

Van L.vdcn,

and then treats of all the other therapeutic means — purgatives, blood-
letting, revulsives, local narcotic or resolvent medicaments, and so fonh.
The letting of blood was, it seems, a very favorite method of cure; not
onlv 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

214 THIRD PERIOrh-MODUtX TIMES

inside it, by means of a split feather, a drop ot oil ot TkrioL wiiiclu says
he« causes the fall of the tooth after a few days.

Fllsewhere 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 die
same time cures the decay of the tooth and takes away die sensibility of
the nerve/'

This passage does not agree ver\' well with die preceding one, according
to which oil of vitriol would act much more radicaUy by causing die tooth
to fall out altogether. But we wfll not take exception to so smaU a matt^;
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 ordy an
apparent one!

To free the teeth from tanar, Heum likewise counsels oil of \-itriol,
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 Heum, 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 ^4th 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 I59^{ 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 (lays news of such a kind would be immediately qualified,
and universally held to be an imposture. But three centuries ago the

THE SIXTEENTH CENTURT 215

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. ^ 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 conjunc-
tion with Saturn in the sign of Aries. In consequence of this circum-
stance 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 un-
heard-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.'
Shortly after, he was answered by Johann Ingolstetter; and the con-
troversy 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

^ De aureo dente maxillari pueri Silesii, Lipsiar, 1595'

' Martini Rulandi, Nova et in omni memoria inaudita histona de aureo dente, Franco-
furti, 1595.

216 THIRD PERIOD— MODERN TIMES

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.^

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 ac-
cused 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 P

^ Liddelius, Tractatus de dente aureo pueri Silesiani, Hamburg, 1626.

*[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 circum-
stantial account of the imposture, and of which the following is a translation:
Herr Balthazer Caminaeus 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 imform 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 experi-

THE SIXTEENTH CENTURT 217

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 pre-
tended 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 pneclare pateVy nimium ne crede colori,^ 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 con-
clusion 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.

ment 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 Uni-
versity, 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."

Klsewhere 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.]

' Illustrious Father, do not believe too much in the color. — [Virgil, Ec. ii, 16.]

CHAPTER XL
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 con-
siderably 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 teethy or^ more properly saidy of Odontagra or toothache;
tn which are setforth^ theoretically and practically^for the use of physicians
and surgeons y the means of mitigating these pains y as well as the various
modes of ably extracting teeth with or without instruments, ^^^

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

* Joh. Stephani Strobelbergeri, thermiatri caesarei 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 vani modi,
theoretice ac practice proponuntur, in medicorum ac chirurgorum quorumvis gratiam.
Lepsiar, 1630.

THE SEVENTEENTH CENTURT 219

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,^ 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 surrouuding
them. Strictly speaking, however, only gout in the feet is named podagroy
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, rachisagroy 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 ^gina 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 tah
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 inesti-
mable 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 denttspicesy
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 with-
out danger except by those who, through great practice, have acquired
the necessary skill in the use of the relative instruments. He refers to

* In Latin, gutta, that is, drop.

220 THIRD PERIOD— MODERN TIMES

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 per-
ceives 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^ and Geist-
Jacobi^ have attributed to this author, viz., that of having effectually
affirmed the non-existence of dental worms.

Among innumerable vegetable remedies recommended by Strobel-
berger 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 (Thermae Carolinae). 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

^ Handbuch der Zahnheilkunde, Berlin, 1848, ii, 422.
^ Geschichte der Zahnheilkunde, p. loi.

THE SEVENTEENTH CENTURT 221

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 pro-
voke 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 menJosa), 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 mani-
festly 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 recom-
mended 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 aganst 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.

222 THIRD PERIOD— MODERN TIMES

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

XOX XOX XOX

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 extrac-
tion 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 oney have proved ineflFectual. 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 putrid us 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.

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} We know nothing else about this publication,

' Arnauld Gilles, La fleur des remedes contre le mal des dents, Paris, 1622.

THE SEVENTEENTH CENTURT 221

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 mani-
festly 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.

One of the superstitious remedies to be used aganst this affection
(Chapter LVI II), consists in touching the aching tooth with the tooth
of a dead person, and afterward greasing it with horse's marrow.

THE SEVENTEENTH CENTURT 223

which, however, to judge from its title, cannot be other than a mere
compilation.

DupoNT, another Frenchman, in 1633, published an important pam-
phlet, which I have, unfortunately, not been able to see. I can, therefore,
only quote what Sprengel says of it.^ 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. ^

Although Abulcasis and Ambroise Pare 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
HildanuSy was chief doctor to the city of Berne, and acquired great fame
as well by his extraordinary professional ability as by his works, consist-
ing 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

* Remedes contre le mal des dents, Paris, 1633.

' Sprengel, Geschichte der Chirurgie, Part II, p. 293.

224 THIRD PERIOD— MODERN TIMES

every case of neuralgia occurring within the region influenced by the tri-
facial 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, how-
ever, 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.^

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

^ Guilhelmi Fabricii Hilandi opera omnia, Francofurti ad Moenum, 1646, Centuria I
observatio xxxviii, p. ^^.

THE SEVENTEENTH CENTURT 225

deleteribus effects in the patient; that is to say, the loss of ilmost 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.* Fabricius Hildaniis, 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 observation^ and cures"'
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 oh it, and he then removed it entirely down to the bone, by means
of a curved bistoury.'

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 anato-
mists, 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.*

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

* Cent, iv, obs. xxi, p. 302.

' The most important of Fabricius Hildanus' works consists of six centuria (hundreds)
of remarkable cases, published by the author in successive epochs, and which were afterward
reunited under the title of Ohservationum et curationum chirurgicarum centuria sex,

* Cent. V, obs. xxvii, p. 406.

* G. F. Hildani, opera omnia, Epist. ad J. Rheterium, p. loio.

226 THIRD PERIOD— MODERN TIMES

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), ^ physician in Ulm, was the author
of a very important work entitled Armamentarium chirurgicumy 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 froni
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)y designed for the
extraction of dental roots, and, therefore, corresponding to the rhizagra
of Celsus.

4. Two special dental forceps, or dentiducesy 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 (yectes bifidi et trifidi)y 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)y
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)y for the removal or resection
of teeth that have grown in abnormal positions.

9. A screw dilator (dilatatorium cum cochlea)y for gradually opening
the dental arches in cases of spasmodic constriction of the jaws.*

* Joannis Sculteti, Ulmensis, armamentarium chirurgicum, Francofurti, 1666, Plates
X, XI, XII, XXXII.

THE SEVENTEENTH CENTURY 227

Marco Aurelio Severing (1580 to 1656), of Tarsia, a celebrated
professor of surgery in the Neapolitan University, had a great predilection

A plate from Schultes' "

n chirurgi

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

228 THIRD PERIOD-MODERN TIMES

aritiKelix! Against flacbidity 6( the guhls arid loosferiing of the teeth he
also Used cauterization, dii^J>provIng the usie of aistrihgent 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 RivifeRE (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 Riviere, is not continuous, but ceases and returns at brief intervals;
besides, the sufferer perceives at times the movement of the worm in-
side 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 occa-
sioned 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 scapulae 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 suffer-
ings of humanity!

According to Riviere, the small veins (sic) that nourish the teeth pass
through the ear (!); and this would explain how the cessation of a tooth-
ache 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

THE SEVENTEENTH CENTURY 229

"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 advan-
tageous 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.

Riviere 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 tooth-
ache, 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
eflBcacious 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 opera-
tion, 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

230 THIRD PERIOD—MODERN TIMES

within the space of a few hours ; for which reason it is absolutely neces-
sary, 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
Riviere 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 Riviere for the above-mentioned
remedy does not, however, derive from a long experience, made by him-
self or by others, of its advantages, but is based principally on a fact
referred to by Montanus, and which, ^ 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 con-
servation 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!^

Riviere, besides, recommends tobacco ashes for cleaning the teeth, a
counsel not yet given by any previous author. He also gives the formulae
for two dentifrice powders, the basis of which is alum; he calls attention

* Giovanni Battista Montano (1488 to 1551), of Verona, Professor of Medicine at Padua.

* 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.

THE SEVENTEENTH CENTURT 231

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.*

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
detnonstrates 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 compress-
ing a piece of sponge inside the alveolus.'

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 anato-
mist, 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

^ Lazari Riverii, opera medica omnia, Genevac, 1737; Praxeos medicac liber sextus, cap. i;
De dolore dentium, cap. ii; De dentium nigredine et erosione.

' Nicolai Tulpii, Amstelodamensis, Osservationes medicae, Amstelodami, 1685, lib. i,
cap. xxxvi, p. 68; cap. xlix, p. 90.

232 THIRD PERIOD— MODERN TIMES

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 illus-
trious anatomist Thomas Bartholin (16 16 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!^

Nathaniel Highmore. In the year 165 1 the English physician and
anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published
a treatise on anatomy (^Corporis humani disquisitio anatomicay etc.), by
which he acquired a celebrity superior, perhaps, to his merits. This
work, however, served without doubt to diflfuse the knowledge of an

* Sprengel, Geschichte der Chirurgie, vol. ii, pp. 294, 299.

THE SEVENTEENTH CENTURY 233

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 antruniy most accu-
rately, 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 cor-
respond 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 ex-
tracted, without, however, finding relief. The pain only ceased after the
patient Jiad 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 ac-
quainted 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 tran-
quillize 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.

234 THIRD PERIOD— MODERN TIMES

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 contrib-
uted, 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 con-
tained 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. With-
out 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.*

Antonio Molinetti, professor at the University of Padua, had, how-
ever, ten years previously, diagnosticated and cured an affection of the
antrum by means of an operation. In his book Dtssertattones ana"
tomi co-pat hologicay 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
wav 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.

^ Sprengel, op. cit., p. 297.

THE SEVENTEENTH CENTURY 235

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 Spigeliusy 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.*

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, Diemer-
broeck tells us nothing of interest or importance regarding the teeth,
often repeating old ideas, the falseness of which had already been lumin-
ously 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.'

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.*
It is superfluous to add that these authors allowed themselves to be
deceived by false appearances, owing especially to an abundant and uni-
form deposit of tartar on the surface of the teeth and in their interstices,
which gave to the dental arch the appearance of one continuous piece.

RiNALDUS Fredericus, in his erudite dissertation entitled De dentium
statu naturali et prceternaturaliy 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
(Jignitas 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 resur-
rection of the body, from the circumstance of their not showing signs of
corruption when found in sarcophagi.

' Blandin, Anatomie du systeme dentaire, Paris, 1836, p. 26.

* Blandin, op. cit., p. 27; Portal, Histoire dc Tanatomie et dc la chirurgie, Parii, 1770,
vol. iii, p. 495.
' Blandin, op. cit., p. 26 ; Portal, op. cit.

236 THIRD PERIOD— MODERN TIMES

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 cornparison as his point of departure,* he gives to dentition the name
germt nation.

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, demon-
strates 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 develop-
ment of modern odontology.

Marcello Malpighi (1628 to 1694), the celebrated Italian anatomist,
was the initiator of microscopic observations on the tissues, and is, there-
fore, justly considered the founder of histology, within the range of which
he made most important discoveries.^

Friederich Ruysch (1638 to 1731), professor at Amsterdam, rendered
his nam^ illustrious particularly by bringing to a high degree of perfection
the processes of anatomical preparations and of embalming.'

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 con-
firmed a most important fact to which allusion had already been made
by preceding authors, that is, the atrophy of the alveolar parietes as

' ^ofus dens primum inclusus est folliculo seu membrana tenui ac pellucida non secus ;

'^-"Jne. p. 221. * Bouillet, op. cit..

THE SEVENTEENTH CENTURT 237

following on the extraction or oh the falling out of teeth. Ruysch, how-
ever, 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 rehiedies
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, arid from which
Ruysch afterward extracted with his little finger several polypi.*

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 Rbyal 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. ^

In the year 1683 he discovered in the tartar scraped ftom between the
teeth a form of microorganism upon which he laid special stress. This
observation he embodied in the form of a contribution which was pre-
sented 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 hiiti, biit 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.'

* Friderici Ruyschii observationum anatomico-chirurgicorum, centuria, Amstelodami,
1 691; Portal, op. cit., vol. iii.

* Portal, op. cit., vol. iii.

' A. C. Abbott, The Principles of Bacteriology, Philadelphia, 1905, p. 19.

238 THIRD PERIOD—MODERN TIMES

DoMENico Gagliardi, professor of anatomy and of medicine at Rome,
published an excellent work on the anatomy of the bones/ 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.'

Jean Duverney (1648 to 1730), a celebrated French anatomist,
wrote a good monograph' 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 froni 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 con-
siderable 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,

* Anatome ossium, Romae, 1689. * Portal, vol. iv, p. iii; Blandin, p. 28.

' Jean Guichard Duverney, Memoirc sur les dents, Paris, 1689.

THE SEVENTEENTH CENTURT 239

Duverney finds much analogy between the tusks of the elephant, the
teeth, properly so called, the feathers of birds, and the hair of mammifera.*

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.'

Clopton Havers, an Englishman, wrote a book on osteology, by which
he acquired great reputation,' 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.*

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,* recommends again, in cases of difficult dentition, the incision
of the gums, a curative practice which had already fallen into disuse."

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
tumot, 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.^

The same author refers to a case of a soft epulis, bleeding easily, that

* Blandin, op cit.; Portal, vol. iii, p. 495. ' Blandin, p. 31.

* On Some New Observations of the Bones and the Parts Belonging to Them, London,
1 69 1. 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."

* Portal, vol. iv, p. 134; Blandin, p. 31. * De morbis acutis infantum, London, 1689.

* Sprengel, Geschichte der Chirurgie, vol. ii, p. 298.

T Meekren, Observationes medico-chirurgicz, cap. xv, p. 84.

240 THIRb PERIOD— MODERN TIMES

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 hemor-
rhage. This was, however, staunched by simply using astringent powders,
without having rfecoursfe to the actual cautery, which the operator had
held in readiness.*

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 Rrst used a
thread of silk, afterward a silver one, and tightened the ligature every
day until the epulis fell off.'

JoHANN AcoLUTHUs was obliged, in brder 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 pkrt of it by
application of the red-hot iron.'

One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin,
Preuss, Bern, Valentini, etc. This last author even speaks of an epi-
demic 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 con-
temptuously of dental operations, and especially of extractions. Hie 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 diflFused 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 pro-
fessor 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 Sbolingen
takes the treatment of dental aflFections 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

' Op. cit., cap. xxviii, p. 120. ^ Sprengel, vol. ii, p. 298. ^ Sprengel, loc. cit.

THE SEVENTEENTH CENTURT 241

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.*

Paul Wurfbein refers to a case of extensive necrosis of the lower
jaw, in which a certain Dr. Burlin 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.^

Benjamin Martin, apothecary to the Prince de Conde, was the
author of a pamphlet on the teeth,' in which he gave a succinct descrip-
tion of these organs and spoke briefly of their diseases. He shows him-
self 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.*

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 prob-
ability that the model was taken from a cast. Here is the literal trans-
lation, 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 pronunci-
ation, 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

' Soolingen's Manuale operatien der chirurgie, Amsterdam, 1684.

* Sprengel, op. cit., p. 3CX).

* Dissertation sur les dents, a Paris Chez Denys Thierry, MDCLXXIX.

* Portal, op. cit., vol. iii, p. 361.
16

242 THIRD PERIOD—MODERN TIMES

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/'^

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 impos-
sible, 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 cWal diligente Bar-
biero s'appartiene; composta per Cintio d^Amato,^ 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

* Purmann's Wundarzenei, Halberstadt, 1684, Part I, chap, xxxii.

^ New and very useful practice of all that which belongs to the diligent barber; composed
by Cintio d 'Am a to.

THE SEVENTEENTH CENTURY 243

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 Christy Cosmos and DamianuSy special pro-
tectors 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 burn-
ing 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 barbery
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

244 THIRD PERIOD— MODERN TIMES

Art."* 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;' 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; not-
withstanding this, we will here refer to the beginning of Chapter XXXIX,
treating "Of tartar and spots on the teeth," because it is of some his-
torical interest:

* 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 mediiine. The barbers
considered themselves members of the medical class, as practitioners of decorative medicine
and in a certain degree also of surgery.

^ In a chapter entitled **Of the Kxcellence 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.

THE SEVENTEENTH CENTURT 245

" 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 opera-
tion 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 reflec-
tions upon dentition. Fleurimond speaks of a tooth powder invented by
him, but does not say how compounded."*

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

* Portal, vol. iii, p. 618.

246 THIRD PERIOD— MODERN TIMES

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 pro-
ducing 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 cauter-
izing 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 sense-
less 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 suffi-
ciently 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 phe-
nomenon, 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.

THE SEVENTEENTH CENTURT 247

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, how-
ever, 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. Ac-
cording 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.^

Carlo Musitano, a celebrated Neapolitan doctor (1635 to 17 14).
According to Carlo Musitano, the real cause of toothache consists in
the irritant action of saline or acid particles on the extremely thin mem-
brane 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 hoo]|ed, and they reach the sensitive parts either directly
from the outside, tl>rough 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 quan-
tities 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.

* Antonii Nuck operationes et experimenta chirurgica, Lugduni Batavorum, 1692.

248 THIRD PERIOD— MODERN TIMES

The treatment of toothache ought to diflFer 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 tooth-
ache, 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 sub-
stances, such as myrrh, aloes, colocynth, ceniaurea minory etc., but some-
times 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!

THE SEVENTEENTH CENTURT 249

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.*

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^ 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 1 7 13 there is no mention made of this operation, albeit the author
refers therein' 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 dis-
eases 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

^ Caroli Musitani opera omnia, pp. 121 to 128, Venetiis, 1738.

^ J. Drake, Anthropologia nova, London, 1707.

'J. M. Hoffmann, Disquisitiones anatomico-pathologicae, Altorf, 1713, p. 321.

250 THIRD PERIOD— MODERN TIMES

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 tre-
panning 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,*
but the best way is to open the maxillary sinus by extracting a toothy
as the pus generally makes its way as far as the roots of the teeth,*'^ 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 interest-
ing case of a secondary afl^ection 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 afl^ected 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.'

Christopher Schelhammer (1649 to 17 16), 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 stop-
ping does not hold, by reason of the cavity being too extended, it is then
necessary, says Schelhammer, to extract the tooth; this, however, may

* Probably through the nose.

* H. Meibomii de abscessum internorma natura et constitutione discursus. Dresdx et
Lipsise, 1718, p. 114. (This edition was published after the author's death, which took
place in 1700.)

^ St. Yves, Nouveau traite des maladies desyeux, 1722, p. 80.

THE SEVENTEENTH CENTURT 251

very well be stopped after extraction, and then replanted, for it will take
root again, but no longer be the cause of any pain/

Pierre Dionis, a celebrated surgeon and anatomist of Paris (died
1 718), in his Anatomie de rhommey^ 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 Chirurgiey 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 afl^ection, 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

* Sprengel, Geschichte der Chirurgie, vol. ii, p. 301. Carabelli, Systtmatisches, Handbuch
der Zahnheilkunde, vol. i, p. 60.
^ This work was published in 1690.

252 THIRD PERIOD— MODERN TIMES

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 pre-
venting 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 oflFensive,
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 pre-
ferable, says Dionis, to make a stopping with a piece of gold or silver
corresponding in size and shape to the cavity.^ 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 expe-
rience 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 hippo-
potamus tusks, but we learn from him that one Guillemeau made arti-

' 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.

THE SEVENTEENTH CENTURY 253

ficial 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. ^ It would seem, therefore,
that it could be used as cement is now used.

The Guillemeau of whom Dionis speaks is probably Jacques Guille-
meau, the author of a book now no longer to be found, which was trans-
lated from the French, first into Dutch, and afterward into German.
Crowley, in his Dental Bibliography^ only quotes the German edition,
published at Dresden in 1710, the title of which runs thus: Der
aufrichtige Augen und Zahnarzt^

Jean Verduc, also a Frenchman, relates a case of the surgeon Car-
meline,' 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.*
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

' Dionis, Cours d'operations de chirurgie, Paris, 1716, p. 507 and following.

^[The Dresden edition of 1710 of Guillemeau's work contains no reference to the
artificial tooth composition as mentioned by Dionis. — £. C. K.]

^ Carmeline was a most able surgeon-dentist. We learn this from a passage in Pierre
Fauchard's book (Le Chirurgien Dentiste, Pref., 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.

^ Sprengel, Geschichte der Chirurgie, vol. ii, p. 305.

254 THIRD PERIOD— MODERN TIMES

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.*

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 hemor-
rhage, the credit of which is due to Riviere and to Tulpius; the descrip-
tion 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, bril-
liantly 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 Guille-
meau, which was the first step toward the use of mineral teeth.

* Traite complet de operations de chirurgie, par Mons. de Lavauguyon, Paris, 1696, p. 644.

CHAPTER XII.
THE EIGHTEENTH CENTURY.

Although there have been, even from the most remote times, indi-
viduals 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 eflFected 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 17 17,
with the title The barber s apprentice versed in bleeding and tooth pulltngy^
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 use-
less this ancient practice, advised first by Cornelius Celsus, and recom-
mended 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 pro-
fession.

LoRENZ Heister (1683 to 1758), of Frankfort-am-Main, one of the
most celebrated surgeons of the eighteenth century, wrote a dissertation
on toothache,' treating besides very extensively of dental affections and

' Der beym aderlassen und Zahn-ausziehen Geschickten Barbiergesell, Leipsic, 171 7.
' De dentium dolore, Altdorf, 171 1.

256 THIRD PERIOD-MODERN TIMES

their cure in a masterly work on surgery, published for the first time in
1 718, 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*
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

* 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.)

THE EIGHTEENTH CENTURT 257

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.

Rene Jacques Croissant de Garengeot (1688 to 1759), the cele-
brated 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, ac-
cording to him, it ruins the enamel.* 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 Garen-
geot. " For extracting," writes Lecluse, "one may make use of the pelican
that Garengeot has constructed on the English key." In a note, he after-
ward 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.^

JoHANN Junker (1679 to 1759), professor of medicine at the University
of Halle, wrote on dental maladies, not only in a treatise on surgery, pub-
lished in 1 72 1, 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

' Sprengel, op. cit., vol. ii, p. 311.

' Joseph Linderer, Handbuch der Zahnheilkunde, vol. ii, p. 129.

258 THIRD PERIOD— MODERN TIMES

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 dis-
approves 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.*

GuiLLAUME Maquest de LA MoTTE (1655 to 1 737), a distinguished
French surgeon and the writer of an excellent treatise (Traite complet
de chirurgiej 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.'

JoHANN Adolph Goritz, of Regensburg, in one of his writings pub-
lished 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 pronuncia-

* Sprengel, op. cit., vol. ii, p. 367; Carabelli, op. cit. p. 65.
^ Sprengel, op. cit., vol. ii, p. 310.

THE EIGHTEENTH CENTURY 259

tion, or for some other reason, it may be filled by an "imitation" in soft
wood.*

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 Goritz 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.'

JoHANN Bernhardt Fischer (1685 to 1772), a very famous doctor,
born in Liibeck, 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 inconsider-
ately, 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 Goritz, 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.'

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 Dentistey 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.* We have been able to obtain the

* Sprengel, op. cit., vol. ii, p. 309. ' Sprengel, loc. cit.
' Sprengel, op. cit., vol. ii, p. 310.

* Le Chirurgien Dentiste ou Traite des Dents, ou Ton enseigne les moyens de les entretenir
propres & saines, de les embellir, d'en reparer la perte & de remedier a leurs maladies, a
celles des Gencives &c aux accidens qui peuvent survenir aux autres parties voisines des
Dents. Avecdes Observations & des Reflexions sur plusieurs cas singuliers. Ouvrage enrichi
dequarante-deux Planchesen taille douce. Par Pierre Fauchard, Chirurgien Dentiste a Paris.

260 THIRD PERIOD— MODERN TIMES

second edition* 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.
Invidiam spemas 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 pro-
fession; 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 Comedie Fran(aisey 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.

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

* Deuxieme edition revue, corrige et considerablement augmentee, a Paris, 1746.

THE EIGHTEENTH CENTURT 261

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 per-
fected 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 them-
selves 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* 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 Carmeliney who, in
his day, practised with general applause, had made us acquainted with

* Experts pour les Dents. This was probably the title which was bestowed in the relative
diploma on those who passed the examination in question.

262 THIRD PERIOD— MODERN TIMES

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* 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 prac-
tice 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 arti-
ficer, every inventor, had not only the right, but also the duty of surround-
ing his discoveries with secrecy and mystery. These are the words in
which, making known a certain improvement in dental prosthesis in-
vented 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

' 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.

THE EIGHTEENTH CENTURY 263

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 exami-
nation. 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,*

* Vol. ii, p. 366.

264 THIRD PERIOD-MODERN TIMES

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 extrem-
ities 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

THE EIGHTEENTH CENTURT 265

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 barres (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 disappear-
ance in old age.* 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 acade-
mician La Hire.

In regard to the development of the teeth, Fauchard repeats what
Urbain Hemard had previously written. He apparently ignores the
researches of the Italian anatomists, from whom, and especially from
Eustachius, Urbain Hemard 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

* Page 21.

266 THIRD PERIOD— MODERN TIMES

teething maladies and their treatment, he nevertheless treats this subject
with much practical good sense, and does not merely make servile repeti-
tion 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.* 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 vitae
the better to fortify the gums and render the teeth firm."

Instead of a small sponge, says Fauchard, the end of a root of marsh-
mallow 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
formulae as an example.

^^ A spirituous watery desiccativey balsamicy anttscorbuticy efficacious
against many maladies of the mouth:

"I^ — good sarsaparilla, four ounces; aristolochia rotunda, dried rinds
of bitter organes, of lemons, and pomegranates, ana three ounces; pyre-
thrum, 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

» Pages 73, 74.

THE EIGHTEENTH CENTURY 267

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 haume du command eury 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 pre-
pares 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 wiell. 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 Fauch-
ard, 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."

268 THIRD PERIOD— MODERN TIMES

The author divides maladies of the dental apparatus into three classes,
that is:

1 . Maladies deriving from external causes and acting, therefore, espe-
cially 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 not-
withstanding 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 repre-
sent 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:*

"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 neithet
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 considera-
tion." Fauchard again recurs to the subject of worms in Chapter VIII,
in speaking of the particular causes of caries.^

* Vol. i, p. 131. • Page 142.

THE EIGHTEENTH CENTURT 269

" 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. ^

** 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 Hemard 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 'occa-
sioned 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,^ is produced by a humor that insinuates
itself into the midst of the osseous fibers of the teeth, and displacing the

* De la generation des vers dans le corps de rhomme, Paris, I'joo. * Vol. i, p. 143.

270 THIRD PERIOD— MODERN TIMES

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 patho-
geny 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 reason-
able 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 aspira-
tion 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.*

Having very frequently observed the symmetrical decay of correspond-
ing 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

* Page 149.

THE EIGHTEENTH CENTURY 271

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,* 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 suflFerings. 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 Brantome."'

The author here quotes a passage of this writer, wherein he says that,
having been suffering from toothache for two days, the apothecary
of Klizabeth 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
Hemard, who believes the cure of toothache by means of words, or by the

* Chap, ix, p. 154. ' Dames illustres, vie d'Elizabeth, p. 179.

272 THIRD PERIOD— MODERN TIMES

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 Com-
mandment, as much in him who practises them as him who consents
thereto."

After the above preliminaries, the author passes on to treat the impor-
tant subject of the mode of curing caries.^ 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

* Pa^e i6i.

THE EIGHTEENTH CENTURY 273

the cavity with lead. If, however, the cavity be rather deeper and occa-
sions 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* 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 com-
posed 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,' and one which we

* Page 165. • Page 167.

274 THIRD PERIOD— MODERN TIMES

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 con-
tinually 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* 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 vitae, or water of cresses or of cochlearia. Sal
volatile^ 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.' 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 Fauch-
ard, first to enlarge the interstice with a small file of a convenient shape,
then to scrape the decayed cavity, and finally to open up the canal or inner
cavity of the tooth with a perforator or with a small trepan.

*' In this way the pus or other humors that may have collected in the
tooth can easily find their way out, and the pain will cease at once or 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

* Liquid ammonia. ^ Subcarbonate of ammonia. ^ Chap, x, p. 169.

THE EIGHTEENTH CENTURY 275

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. "Hemard," he adds, "judges it necessary to extract these
teeth, or at least to break off the crown {les dechapeller)^ in order to give
exit to the corrupt matter that is closed up in the cavity; this sometimes
causes the pain to cease. He (Hemard) says that he has seen many
abscesses in the interior of teeth, which were not externally decayed, and
that after having broken oflF 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 fistulae 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 harm-
ful effects it produces, and of the prophylaxis and therapy relating thereto.
Three illustrations which are added to this chapter represent the dif-
ferent 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

276 THIRD PERIOD-MODERN TIMES

impossible and caused the cheek to stand out in such a way as to give
the appearance of a tumor. ^

In the following chapter^ 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 dedi-
cates a lengthy chapter'' 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 un-
comfortable, 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, ^ 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

* Page 407. * Chap, xii, p. 183.

'Chap, xiii, p. 185. * Chap, xiv, p. 194.

THE EIGHTEENTH CENTURY 277

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;
\n these cases ignorant tooth drawers have often been known to remove
the crooked (permanent) tooth, and to leave the straight, viz., the decidu-
ous 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 aflpected
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

278 THIRD PERIOD— MODERN TIMES

carious cavity, and to impede the teeth on th© 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 preju-
dice 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;^ 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 advisa-
bility 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 avoid-
ing 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,^ of gingival diseases and their
treatment.' Th6 subject is treated in a masterly manner, although these
chapters do not offer anything of original importance.

* Chap. XV, p. 205. * Chap. xvi. ' Chap, xvii to xxi.

THE EIGHTEENTH CENTVRT

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, repre-
senting thirteen instruments for use in the treatment of the above diseases.

Instruments for opening the mouth in cases of lockjaw (Fauchard).

The author then speaks' 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, fistula;

' Chap, xjtiii, p. zSa.

280 THIRD PERIOD— MODERN TIMES

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 aflFords 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 Seve,
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 re-
turned to have her teeth cleaned by me, and whilst doing this I observed
that the tooth extracted had been wholly regenerated."^

"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.*'^

In Chapter XXVIII the author relates twelve cases of dental irregular-
ities 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. Tabbe 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 experi-

' Page 330. ^ Page 331.

THE EIGHTEENTH CENTURY 281

ence 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 gentle-
man'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 sur-
prise, M. Morin's teeth reduced to perfect order."*

"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. Car-
meline 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.'*^

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

> Page 368. - I'age 370.

282 THIRD PERIOD— MODERN TIMES

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.*

We now give one of his cases of replantation in the words of the author
himself:

"On April lo, 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 disfigurentent 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.*'^

Not without interest is a case of disease of Highmore's antrum, origin-
ating 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.^

Two important cases of *' stony excrescence" of the gums (probably
osteomas) are to be found in Chapter XXXII. One of these tumors

* Page 383. " Page 376. ^ Chap, xxxi, p. 391.

THE EIGHTEENTH CENTURY 283

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.^

Several important observations on obstinate cases of cephalalgia, pro-
sopalgia, 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 con-
sulted 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.^

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.'

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,

» Page 397. » Page 41 1. » Page 418.

284 THIRD PERIOD— MODERN TIMES

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.^

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;^ he speaks of the method to be followed in cleaning the teeth in
order to not endanger the enamel;^ 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;* of
the instruments to be used for scraping and cleaning the carious cavities
and of the mode of employing them.'^

All of the above-named instruments are illustrated by figures, in con-
templating which one cannot but reflect on the inferiority of the instru-
ments then in use as compared with those of the present day. The greater

* Chap, xxxviii, p. 481. ' Vol. ii, chap. ii. ' Chap. iii. * Chap. iv. » Chap. v.

THE EIGHTEENTH CENTURY 285

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.

Chapter VI is dedicated to the stopping of decayed teeth. The
sole materials used by the author for stopping were lead, tin, and gold.

for detaching dental tartar (Kauchard).

"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

286 THIRD PERIOD— MODERN TIMES

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!

Fig. 8o

Some of the denial files used by Fauchard. The little square figure represents a s
grooved wedge destined to be inserted in large interdental spaces. In order to give i
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' of a lead stopping which had lasted in perfect condition for forty
years.

• Vol. ii. p. 71.

THE EIGHTEENTH CENTURr 287

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.

As at that time the state of the dental pulp was not taken into considera-
tion before stopping a tooth, it often occurred that the stopping caused
violent pain, which rendered its removal necessary.'

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

' Vol. li, p. 77-

288 THIRD PERIOD-MODERN TIMES

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 press-
ure of the lead, and the pain is in this manner avoided or moderated.'"

Three instruments for plugging teeth. The two small figures represent silver plates
for straightening teeth (Fauchard).

The author also makes the remark' 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

' Vol. ii, p. 78. • Ibid.

THE EIGHTEENTH CENTURY 289

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.

Fig. 83

>nd of which i:
e outward (Fauchard).

Cauterization of the teeth' 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

■ Chap. vii.

290 THIRD PERIOD— MODERN TIMES

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.'"

Fig. 84

An extracting instrument calletl by Fauchard lever or tirtolre, 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, nevenheless, made use of the most simple

THE EIGHTEENTH CENTURY

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

Fig. 85 Fig. 86

Fauchatd's simple pelican (with Fauchard's double pelican,

one changeable hook).

their normal position. He rarely had recourse to extraction as a means
i»f carrying out dental corrections.*

To steady loose teeth,' Fauchard, as did the ancients, made use of gold

' Vol. ii, chap, viii, p. 87.

'Oiap. ix, p. 117.

THIRD PERIOD-MODERN TIMES

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

Fig. 87

Dental forceps (Fauch,

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.

Fauchard occupies himself in three different chapters (X, XI, XII)
at great length with the extraction of teeth. He describes a pelican of

THE EIGHTEENTH CENTURT

293

^ (iwn invention, and speaks of the advantages it presents over other
s previously in use. Notwithstanding this, it cannot be said
ill the Instruments used by Faucbard for extracting teeth and roots
Sttw a sensible improvement on those in use before his time.

bill fortcps (Fauchard)

Among the most usual operations, the author enumerates transplant;i-
tion and especially replantation of the teeth.' Whenever, says Fauchard,

' Speaking of transplantation, he says: "On voit par des cxpvricncfS journalitrvs i|ul'
dea denes transplantees d'un alveole dans I'alveole d'une bouche difTerente sc sont conwrvecs
plusieurs annees fermes et solides sans recevoir acune alteration, i-t servant a toutes Wn func-
tions auxqudles Its dents sont proprcs." (Vol. ii, p. i8;.)

THIRD PERIOD-MODERN TIMES

• 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.' Fauchard adds that this opera-
tion succeeds excellently in the case of incisors and canines, and very
often, too, with small molars.

Cutting forceps (Fauchard). Cutting forceps (Fauchard).

After having spoken of transplantation, he says:' "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

•Page 188. 'Vol. ii, p. 191.

THE EIGHTEENTH CENTURT 295

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

Fig. 91

Pincers used by Fauchard in the operation of lying teeth with gold wire. The three
larger Bgures 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 (ill large
interdental spaces and to steady loose teeth by means of gold ligatures.

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."

This method, invented by an unknown provincial dentist, has been
recently applied by Znamenski, of Moscow, for the implantation of arti-
ficial teeth made of porcelain, of caoutchouc, or gutta-percha.

296 THIRD PERIOD-MODERN TIMES

One of Fauchard's greatest merits consists in the improvements intro-
duced 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.^

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 arti-
ficial 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.^

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.

• Vol. ii, chap, xiii, p. 215. * Vol. ii, pp. 217 to 224.

THE EIGHTEENTH CENTURY 297

"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."*

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. ^

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 pros-
thetic piece to these by means of two pyramidal screws.'

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 ihe 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.*

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 direc-
tion 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

* Vol. ii, p. 225. * Vol. ii, p. 229.

' Chap, xvi, pp. 252, 255. * Vol. ii, chap, xvii, p. 260.

THIRD PERIOD— MODERN TIMES

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."' 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

Fig. 92

Complete dentures (Fauchard). /. 3 represents an enamelled denture with aitiliciil
gums; /. 4 and /. 5, steel springs.

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,

' Vol. ii, chap. !

'. P- 339-

THE EIGHTEENTH CENTUkT 299

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.'"

The author describes with great minuteness the manner in which the
prosthetic apparatus in question was constructed and supported, and then

Fig. 93

e supported by springs tixei
natural teeth of the lo^

to a gold appliance which e
I jaw (Fauchard).

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.

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

300

THIRD PERIOD— MODERN TIMES

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

A spring denture for a case in which the lower front teeth still exist. Figs, i to 6,

various parts of the apparatus (Fauchard).

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 per-
ceiving 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-

THE EIGHTEENTH CENTURY 301

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.'*^

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 per-
fection. 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.^ 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 qualita Je* dentiy col mo Jo di cavarliy
mantenerli e fortijxcarli)^ 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
difl^used; 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

» Vol. ii, p. 353.

' Jean de Diest, An haemorrhage ex dentium evulsione chirurgi incuria lethalis? Paris,
1735. David Vasse, Hsemorrhagia ex dentium evulsione, chirurgi incuria lethalis, Paris,

'735-

302 THIRD PERIOD— MODERN TIMES

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 infraorbital nerve, which does not stand in
any relation whatever to the organ of sight.^

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 efliicacy 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 teethy 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 aflPected 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 aflPections.

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 observa-
tions, 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 sub-
stitute the word legs for that of dental roots. ^

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,' contributed to the diflPusion of
knowledge relative to dental prophylaxis and therapeutics, but apart from
this brought no increment to the progress of practical dentistry. Some

* M. Bunon, Sur un prejuge tres-pemicieux, concernant les maux de dents qui sur-
viennent aux femmes grosses, Paris, 1741.

^ M. Bunon, Essai sur les maladies des dents, Paris, 1743. Experiences et demonstra-
tions pour servir de suite et de preuves a Tessai sur les maladies des dents, Paris, 1746.

' Abhandlung von Zahnkrankheiten, etc., Strassburg, 1754.

THE EIGHTEENTH CENTURY 303

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 organ-
ism 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,^ 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.^ 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 teefth 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

' A Praaical Treatise upon Dentition or the Breeding of the Teeth in Children.
' Essai d'Odontotechnique, ou Dissertation sur les Dents Artificielles.

304 THIRD PERIOD—MODERN TIMES

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.^

J. Bertin also declares himself in favor of this operation; he recom-
mends never to neglect it in cases of difficult dentition, and to make the
said incisions deep and wide enough.^

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, cor-
roding the bone, as far as the alveoli, or, sometimes, as far as the orbital
cavity; and, Wr^* 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 fossae. With a strong scalpel he per-
forated 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.^

* Sprengcl, Part ii, p, 319. ^ Journal de Medecine, 1756.

' L. H. Runge. Dc Morbis sinuum ossis frontis, maxillx superioris, etc., Rintel, 1750.

THE EIGHTEENTH CENTURY 305

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 sub-
stances/

Lecluse. One of the most celebrated French dentists of the eighteenth
century is Lecluse. Dental literature was enriched by him with several
works, partly written in popular style, partly addressed to dental special-
ists. In 1750 he published his Traite utile au public^ oh Von enseigne
la methode de remedier aux douleurs et aux accidents qui precedent et qui
accompagnent la sortie des premieres dents y de procurer un arrangement
aux secondeSy 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: Eclair-
ctssements essentiels pour parvenir a preserver les dents de la carie et le
conserver jusqua Vextreme vieillesse. But the most important of his
works is the Nouveaux elements d'odontologie^^ 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 Lecluse 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 Lecluse, 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' 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

* Sprengel, Part ii ( ?), p. 322.

' Nouveau elements d'Odontologie, contenant Tanatomie de la bouche, ou la description
de toutes les parties qui la composent, et de leur usage; et la pratique abregee du dentiste,
avec plusieurs observations, par M. Lecluse, Chirurgien dentiste de Sa Majeste le Roi de
Pologne, etc., Paris, 1754 (vol. in i2mo of pages viii-222 with six plates).

' Abhandlung von den Zahnen des menschlichen Korpers und deren Krankheiten, 1756.
30

306 THIRD PERIOD—MODERN TIMES

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, hie 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, apply-
ing 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 fistulae 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 pros-
thesis 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,^ 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

* Geist-Jacobi, p. 164.

THE EIGHTEENTH CENTURY 307

amateur in odontology), wrote a little book^ to disprove the existence
of worms in decayed teeth, and to show the fallacy of believing that the

* Die eingebildeten wiirmer in Zahnen, Regenburg, 1757.

[SchafFer's publication is of considerable interest in that his illustration here repro-
duced 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
Gottingen, of the Royal Society of Science at Duisberg, honorary member of the Fine
Arts at Leipsic.

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. Ill, magnified: {aa) external pellicle; {b) node; (r) 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; (r) body; {J) 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 supF>osed remedy against tooth worms: {a) earthen pot;
{b) opening visible on one side; (f) 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.y 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 transla-
tion 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 toothy 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

308 THIRD PERIOD-MODERN TIMES

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-

the bowl. If a worm eat the teeth, take holly rind over a year old, and root of Carhne
thistle, boil in so hot vialtr! Hold in the mouth as hot as thou hottest may. For tooth

"'A-

worms, take acorn meal and henbane seed and wax, of all equally much, mingle theie
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.]

THE EIGHTEENTH CENTURY 309

hand, for in it SchafFer repeats in substance what HouUier had already
said two centuries earlier, and after him various other authors, including
Fauchard. At any rate, to cooperate 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/

BouRDET. An excellent book on dentistry* 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 pro-
cured 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
eeth 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.

* Recueil periodique d 'observations de Medecine, Chirurgic, etc., par Vandermonde,
Paris, 1757, Tome vii, p. 256.

^ Recherches et observations sur toutes les parties de Tart du dentiste, 2 vols., Paris, 1757.

310 THIRD PERIOD— MODERN TIMES

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,^ 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,^ 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,

^ Sur les depots du sinus maxillaire.

' Soins faciles pour la propriete de la bouche et pour la conservation des dents, Paris, 1759.

THE EIGHTEENTH CENTURY 311

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 predi-
lection to the study and treatment of oral and maxillary diseases. And
precisely for this reason his writings, although of great scientific impor-
tance, 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 Medecine^ 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.'
After this, appeared his book on the formation of the teeth.' 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 impor-
tant of all the works of this author is his treatise on the diseases and
surgical operations of the mouth.* 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

* Vol. X, pp. 47 to 148.

^ Traite des depots dans le sinus maxillaire, des fractures et des caries de Tune et de I'autre
machoire, Paris, 1761.

' Essais sur la formation des dents, comparee avec celle des os, suivis de plusieurs experi-
ences tant sur les os que sur les parties qui entrent dans leur constitution, Paris, 1766.

^ Traite des maladies et des operations reellement chirurgicales de la bouche et des parties
qui y correspondent, suivi de notes, d'observations, et de consultations interessantes, tant
anciennes que modemes, 2 vols. 8vo, Paris, 1778.

312 THIRD PERIOD-MODERN TIMES

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 open-
ing 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 cannulas 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 reestablished,
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 considera-
tion.

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 linguae, etc. Dental hemor-
rhage 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 denti-
tion, 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.* He

' Reflexions et eclaircissements sur la construction et les usages des rateliers complets er
artiflciels.

THE EIGHTEENTH CENTURY 313

therein specially speaks of a complete denture with four springs, per-
fectly 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,^ 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 Memotres de V A cade-
mie de Chirurgiey 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 Beaupreau,
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 lamellae, 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

* Die Zahnheilkunde, Krlangen, 1851, p. 398.

314 THIRD PERIOD— MODERN TIMES

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^ 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 Gottingen,
wrote that he had used the magnet advantageously in not less than 130
cases of toothache.' 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
steels

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.* The curing efficacy of the
magnet in cases of toothache was highly vaunted in France by Condamine.*

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.*
Thenceforth the enthusiasm for the magnetic cure diminished gradually,
all the more so inasmuch as that shortly after the celebrated English

* Von der Wirkung der elektrischen Erschiitterung im Zahnweh.
^ Geist-Jacobi, p. 165.

' Neue Versuche zu Curirung der Zahnschmerzen vermittelst eines magnetischen Stahles,
Konigsberg, 1765.

* F. E. Glaubrecht, De odontalgia, Argentorati, 1766.

* Journal de Medecine, 1767, p. 265.

* Jos. G. Pasch, Abhundlung aus der Wandarznei von den Zahnen, etc., Wien, 1767.

THE EIGHTEENTH CENTURY 315

dentist Thomas Berdmore ridiculed it by placing it in the same class as
charms, exorcisms, and other foolish and superstitious means of cure.*

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 dentisty^ and the Treatise on the eruption of the milk teeth.^

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.*

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 infraorbital 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.*

C. A. Grabner* 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

* Th. Berdmore, A treatise on the disorders and deformities of the teeth and gums, London,
1768.

* Einleitung zur nothigen Wissenschaft eines Zahnarztes, Wien, 1766.
' Abhandlung von der Hervorbrechlung der Milchzahne, Wien, 1771.

* J. Linderer, vol. ii, p. 431. * Geist-Jacobi, p. 166.
' Gedanken iiber das Hervorkommen und Wechseln der Zahne, 1768.

316 THIRD PERIOD— MODERN TIMES

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 pru-
dence."

RuEFF relates the case of a man, aged forty years, who, having made
use of fumigations of henbane seeds to relieve himself of violent tooth-
ache, obtained the desired end, but at the same time lost his virile power*
He, however, reacquired his force by the care of the author.^

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 den-
tistry,' 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.'
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

* Cara belli, p. 91.

' A treatise on the disorders and deformities of the teeth and gums, London, 1768.

' See The Rise, Fall, and Revival of Dental Prosthesis, by B. J. Cigrand, p. 148.

THE EIGHTEENTH CENTURT 317

tolerance of the tooth with a temporary filHng 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.^

Pierre Auzebi, a dentist at Lyons, published a treatise on odontology
in 1 77 1, 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 hones 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 recom-
mends, 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. Accord-
ing 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.'

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.'

* Cara belli, p. 91.

' Carabelli, p. 93; Lemerle, Notice sur Thistoire de Tart dentaire, p. 117.

' J. Aitkin, Essays on several important subjects in surgery, London, 1771.

318 THIRD PERIOD— MODERN TIMES

Frere Come, a celebrated French surgeon, also contributed to the
perfecting of this instrument.^

In 1771-72, Fr. L. Weyland and Henkel recorded some very impor-
tant cases of diseases of Highmore's antrum.'

W. Bromfield, in a collection of surgical observations and cases pub-
lished 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 spon-
taneously during the night, finding their exit through the natural orifice
of the antrum, when the body is in the horizontal position.'

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, 1 778) 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 con-
tradictions, and is frequently hesitating and uncertain on important points
of dental therapeutics.

Hunter gives a very long and detailed description of all the parts con-
stituting the oral cavity and the masticatory apparatus. He sought to
establish a scientific nomenclature for the teeth, and in fact the denomina-
tions 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

* Sprengel, vol. ii, p. 348. * Sprengel, p. 350.

' Bromfield, Chirurgical observations and cases, London, 1773.

THE EIGHTEENTH CENTURY 319

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 lamellae, 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 treat-
ment 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

320 THIRD PERIOD—MODERN TIMES

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 retrac-
tion 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 consolida-
tion 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 com-
plete 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

THE EIGHTEENTH CENTURT 321

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 in-
vented 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,* 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.

BlXKiNG, in 1782, published a Complete Guide to the Extraction of the
Teethy^ 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

' Le dentiste observateur, Paris, 1775.

' Vollstandige Anweisung zum Zahnausziehen, Stendal, 1782.
21

322 THIRD PERIOD-MODERN TIMES

himself averse to the practice of subluxation as a means of cure for tooth-
ache, 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 cele-
brated 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. Bucking
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 Bucking 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.^

Van Wy,^ 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.'

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.*

* Theden, Neue Bemerkungen und Erfahrungen, Berlin, 1782, part second, p. 254.

' J. van Wy, Heelkundige Mengel stoffen, Amsterdam, 1784.

' Journal de Medecine, 1791, tomes 86, 87. * Sprengel, p. 356 to 357.

THE EIGHTEENTH CENTURY 323

Antonio Campani, of Florence, published in 1786 a treatise on den-
tistry,' very elegantly printed, and illustrated with thirty-six plates very

Pelican for extraciing

neatly carried out. This book, however, contains nothing of real impor-
tance for the development of dentistry.

' Odontoiogia, ossia Trattato sopra i Demi.

324 THIRD PERIOD— MODERN TIMES

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 Beld than the
celebrated Hunter.

Fig. 97

;th (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

THE EIGHTEENTH CENTURY 325

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 erup-
tion 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.

Campani's forceps; The first for molar t«eth 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

326

THIRD PERIOD—MODERN TIMES

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 prefer-
ably the second. After trepanning the alveolus and emptying the cavity,

Fig. 99

Two key instruments with changeable hooks (Campani).

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.

THE EIGHTEENTH CENTURY 327

Looseness of the teeth, which in old age may Be considered a norma]
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.

r 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,

.328 THIRD PERIOD— MODERN TIMES

rather than to external causes acting locally, although these latter may
contribute, together with the general causes, to the producing of the
disease.

^^^^

IS of post-extractive hemorrhage; the

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

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THE EIGHTEENTH CENTURY 329

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.*

In the case of a young woman who had an upper incisor transplanted,
Watson observed undoubted symptoms of syphilitic infection with super-
vening accidents of exceptional gravity, which in spite of careful treatment
ended in death. ^

Hunter also relates having observed, in seven cases of transplanta-
tion, very serious accidents which, however, he did not believe to be
owing to syphilis, ialthough 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.^

August G. Richter, the above-named German surgeon, in those
portions of his work dedicated to dental affections and diseases of High-
more's antrum, treated these subjects with admirable clearness and order,
without contributing, however, anything original to the development of
dental surgery.^

Nicholas Dubois de Chemant, in 1788, of whom we shall later have
occasion to speak again, published in Paris his first pamphlet on mineral

' Benjamin Bell, System of Surgery, 1783 to 1787, vol. iii.

' Medical Transactions of the College of Physicians of London, 1783, vol. iii, p. 325.
^ Memoirs of the London Medical Society, 1787, vol. i.

* August Gottlieb Richter, Anfangsgriinde der Wundarzneikunst, vol. ii (1787) and vol.
iv(i797).

330 THIRD PERIOD— MODERN TIMES

teeth, entitled Sur les avantages des nouvelles dentSy et rateliers artificielsy
in corrupt iblesy sans odeur.

Jean Jacques Joseph Serre (1759 to 1830). Among the dentists of
he 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.^

Among his minor works, one edited in Vienna, in 1788, treats of tooth-
ache during pregnancy; another, printed in Leipsic in 1791, treats most
extensively of diseases of the gums; a third speaks of the mode of main-
taining 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 recog-
nizes 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.

One of the most interesting chapters of Serre's great work is the one
in which he treats of affections of Highmore's cavity.' He speaks at
length of the anatomy of the maxillary sinus, of its relation to the teeth

^ Praktische Darsteiiing aller Operationen der Zahnarzneikunst, Berlin, 1803 and 1804.
' Chapter xlii.

THE EIGHTEENTH CENTURT 331

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 Gottingen a synopsis of surgical
instruments^ 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 miti-
gate 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 excre-
tions, 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 odontitisy
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.^ In Kappis* pamphlet we find the
following ideas developed, upon which we do not think necessary to com-
ment. 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

* Uebersicht der Chirurgischen Instrumente.

' Ploucquet, Primac linex odontitidis, sive inflammationis ipsorum dentium, Tubingar,
1 791; Kappis, Primac lineac odontitidis, etc., Tubingae, 1794.

3:i2 THIRD PERJOD-MODERS TIMES

usual toothpick, even if he had tried to do so regardless of pain. But
when the toothache was over, the same toothpick again became semce-
able as before. He savs that there is no cause for wonder that in odon-
this 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 mem-
brane of the tooth. As in other inflammations, so also in odontitis, the
usual issue is resolution. Dental fistulae may derive from internal sup-
puration. 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 fall-
ing out, is generally caused by an inflammation of these organs, that is,
by odontitis, an affection that, he says, may be of ver\' varied kind, the
principal forms being the rheumatic, arthritic, sympathetic, and gastric.

Ranieri Gerbi.^ 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, notwith-
standing 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 spinosissimusj that
could be used with great advantage against toothache, in the following
manner: One crushes fourteen or fifteen larvae of the insect beti^-een the
thumb and forefinger, and then rubs the two fingers together until the
matter remaining upon them is entirely absorbed. Instead of the lar>'ae
(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 larvae 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 antt-odontalgicusy used in the same manner, are said
to possess the same curative properties, among them the curculio jaceay
carahus chrysocephaluSy 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:^ the cocci nella septempunctatay

' Storia naturale di un nuovo insetto, Firenze, 1794. ' Der anfrichtige Lahnarzt.

THE EIGHTEENTH CENTURY 333

the coccinella hi punctata^ the carabus ferrugineuSy the chrysomela sanguino-
lentQy the chrysomela populiy 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 larvae 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 larvae — 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 J*un voyage aux lies Malouines fatt 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 Monte-
video; 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. "^

Heinrich Callisen, in an excellent treatise on surgery^ 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.' 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,

* Without comment! ' Principia systematis chinirgiz hodiernae.

^ 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.

THIRD PERIOD— MODERN TIMES

above fifty years of age, the transplanted teeth do not take root perfectly
except ill 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

Upper denture in ivory, ar the eml of the eighteenth century, for a case in which thfti
last molars and the front teeth were present. {From Guerini's colleaion.)

who had died a violent death; these were, besides, carefully cleaned
before transplanting them, and in this way the author believed the trans-
mission of disease to be nearly impossible.'

[. E. WicHMANN combated energetically the practice, then preny
general, of endeavoring to facilitate the eruption of the teeth by

' Hlrsch. Praktische Berne tk.i net n uherdieZ^hnt iind einice Ktankhciten dcrsclben.
Jena. 1 70.

THE EIGHTEENTH CENTURY 337

incision of the gums. He considered this practice as one to be absolutely
reje.cted, 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.^

Robert Bunon,^ the French dentist, is one of the most illustrious per-
sonalities 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 knowl-
edge and experience. He practised especially in the north of France and
in what is now the state of Belgium; at Antwerp, Brussels, Givet, Mau-
beuge, 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 per-
fecting 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

* Sprengel, pp. 376, 377.

' For all that regards Bunon's life and writings we have availed ourselves of the excellent
historical work of A. Barden, "Un precurseur: Bunon/' a communication presented to the
Geneva Session of the International Dental Federation (August, 1906).
22

338 THIRD PERIOD— MODERN TIMES

deficient knowledge on our part, and I considered this extreme remedy
as one of the greatest evils to humanity."^ 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 inter-
esting 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 odonto-
logical 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 ero-
sion, 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 con-
ceived 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 teethy 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.' He was able, fortunately, to convince himself immedi-
ately 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

* Experiences et demonstrations, p. 13. ' Ibid., p. 60.

THE EIGHTEENTH CENTURY 339

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 y 1699, which then regulated the practis-
ing 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 toothy^
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.' 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.

^ Lettre sur la pretend ue dent oeillere.

' Sur un prejuge tres pernicieux, concernant les maux de dents qui surviennent aux femifies
grosses.

340 THIRD PERIOD— MODERN TIMES

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}

All the principal journals of the time (^Journal des SavantSy Journal
de Trevouxy 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-
n)erited successes, in accordance with the thought expressed by him in
qne 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."^

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
Salpetriere and at St. Come^ before the Royal Academy of Surgery ^ serving
as continuation and proof to the Essay on the maladies of the teethe The
essay is, in fact, a small i2mo 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 indica-
tions, 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 ftcole 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.

* Essai sur les maladies des dents, ou Ton propose les moyens de leur procurer une bonne
conformation des la plus tendre enfance, et d'en assurer la conservation pendant tout le
cour de la vie.

^ Experiences et demonstrations, avertissement, p. xix.

* Experiences et demonstrations faites a THopital de la Salpteriere et a St. Come, en
presence de TAcademie Royale de Chirurgie, pour servir de suite et de preuves a I'Essai sur
les maladies des dents.

THE EIGHTEENTH CENTURT 341

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 cooperating 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 denti-
tion occupy in the jaw with regard to the milk teeth, before these are
shed.

Bunon was, besides, the first author who studied accurately dental hypo-
plasia, 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 con-
genital 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.

342 THIRD PERIOD-MODERN TIMES

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 incom-
plete 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."^

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 con-
stant 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;

* Essay, p. 127.

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THE EIGHTEENTH CENTURT 343

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.

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 oflPering
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 diflFerent 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 con-
sidered 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 par-
ticular 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

344 THIRD PERIOD-MODERN TIMES

1797. Ruspini did not, in reality, contribute very much to the develop-
ment 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 innova-
tion 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 Duchateau, 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 cooperation of the dentist
Dubois de Chemant, who succeeded in putting it into practice.

The circumstances connected with this invention were the following:
The chemist Duchateau had for some time worn a denture of hippopota-
mus 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, Duchateau
being obliged, by reason of his profession, to continually taste pharma-
ceutic 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 Duchateau 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.

THE EIGHTEENTH CENTURY 345

However, this denture proving unserviceable, Duchateau 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 Duchateau 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, Duchateau 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 under-
taking. 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 Duchateau, 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 Duchateau, from 1776 to 1788, that is, during the
twelve years subsequent to his communication to the Academy of Sur-
geons, he did absolutely nothing at all. He is, therefore, entitled to the

346 THIRD PERIOD— MODERN TIMES

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
Duchateau.

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 author-
ities, 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 Duchateau, brought
an action against him, accusing him of having usurped the invention
of Duchateau, and demanding, for this reason, the annulment of the in-
ventor'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, Duchateau, 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 18 17. 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 EIGHTEENTH CENTURT 347

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 re-
sulting from the shrinking of the paste in baking. If the piece required
retouching, he did this by means of special tools for grinding down por-
celain. 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^ 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 profes-
sion 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.'
In the same year Fonzi made known a new kind of teeth,' which he
called terro'tnetallic. These differed from those of Dubois de Chemant
in that they were all single teeth intended to be applied on a base bv
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.

^ F. Maury. Traite complet de I'art du dentiste, d'apres I'etat actuel des connaissances,
2 vols., Paris, 1828.

' Expose de nouveaux procedes pour la confection des dents dites de composition, par
M. Dubois Faucou, Paris, 1808.

' Rapport sur les dents artificielles terro-metalliques, Paris, 1808.

348

THIRD PERIOD— MODERN TIMES

Notwithstanding this, the teeth made by Fonzi, of which there are still
some specimens in various dental nnuseums, 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.

The credit of having introduced many new improvements in the manu-
facture 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. FAias Wildman. But the most brilliant results, as is

Fic

104

rriifiiiiMi

well known, were obtained by the celebrated Samuel S. White, who, by I
an intelligent and persevering activity, dedicated almost exclusively to '
improving mineral teeth and to bringing them into general use, con-
tributed 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.

INDEX.

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

iEgina, Paul of, 219

iEsculapius, 45, 46

iEtiusof 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, 06, 237
Andromachus the Elder, 106, 1 13
Andry, 269, 309
Anesthetic, 14^
Antrum of Highmore, 186, 233, 249, 250,

257, 282, 304, 310, 311, 313, 318, 320,

325, 330» 333
Aphthae, Celsus on, 84

Apollonius, 02, 113

Appolonia, oaint, 20^

Aquapendente, Fabnzio of, 207

Arabians, 121

Aranzio Giulio Cesare, 201

Arca^atus, 77

Archi^enes, 65, 106, 113

Arcoh, Giovanni of (Arculanus), 153, 168,

190
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 iEscula-

pius, 45, 46
Astringent mouth washes, 97, 115, 116, 122,

'53 .
Atmospheric conditions, influence on dental

maladies, 57, 116, 247

Aurelianus, Celius, 46, 65, 113, 114

Auzeki, Pierre, 317

Avenzoar, 139

Avicenna, 84, 123

Babylonians, treatment of sick by the, 18
Bacteria, 2^7

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

Bridgework, 297

Etruscan attempts at, 76, loi

Bromfield, W., 318

Brunner, Adam Anton, 315

Bruno of Longobucco, 140

Bruschi, Etruscan dental appliances in

Museum of Count, 73

Biicking, 321

Bunon, Robert, 301, 337

"Calendar of dentition," 315
Callisen, Heinrich, ^^^
Camindus, Balthasar, 215
Campani, Antonio, 323, 327
Capivacci, Gerolamo, 201
Carabelli, 157,317,321
Carbonate of time, ancient dentifrice men-
tioned by Pliny, 94
Caries, dental, 24, no, 122, 147, 251, 269,

319* 335
Carmeline, 253, 261, 283

Cascellius, first dentist mentioned by name,

102

350

INDEX

Castellani collection, Rome, Etruscan appli-
ances in, 76

Catullus, 97

Cauteries, dental, 328

Cauterization, 25, 40, 85, 107, iii, 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, 30^

Clauder, Gabriel, 232

Cleanliness of the teeth among the Romans,
97, 106, 107

Coiter, Volcherus, 200

Coition, toothache from, 3^

ihil

to the teeth.

Cold applications, harm!

Colombo, Matteo Realdo, 177
Come, Frere, 318
Compressor of Foucou, 321
Condamine, 314
Cometo, 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

Dabry, p. p., "Les medecine chez les

Chinois," 34
Dalli Osso, archeologist, 78
Damocrates, Servilius, 106
Daremberg, "Histoire des sciences medi-

cales," 80, 99
De Lavauguyon, 253, 255
Decorative medicine, 244
Dekkers, Friederich, 241
Delphi, temple of Apollo at, 46, 114
Deneffe, "La prothese dentaire dans I'anti-

quite," 67, 75, 102

Dental appliance, Etruscan, found at Tar-

quinii, 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

canes, no, 122, 147, 251, 269, 319

irregularities, 280, 200, 303, 320

maladies given in Eoers' papyrus, 21

surgery not mentioned in fibers' papy-
rus, 25

and surgical instruments of the Romans,
86

terminology found in Vesalius, 1 76
Dentateurs, 199
Dentator, 144, 147
Dentiduces, 226
Dentifrices, 35, 38,^1, 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 aees, 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
Duchateau, 344

Duchemin, student of Fauchard, 260
Dufour, 309
Dupont, 223
Duvemey, Jean, 238

Ears and the teeth, 54, 56, 94, 228, 236, 250,
315

INDEX

351

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 Lecluse, 305

Elevators, I33».i34,305
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, 6^

Erosion, dental, 302, 320, 337,^41
Etruscans, dental appliances of^ 70, 7I9 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,

3i5» 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

Fabrizio of Aquapendente (Fabricius), 207

Fabry, Wilhelm (Fabricius Hildanus), 223

Fallopius, Gabriel, 177

Faucnard, 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
Fistulae, dental, 22, 140, 152, 201, 203, 224
Fleurimond, 245
Follicle, dental, 177

Fontanella, Don Angelo, anecdote of, 104
Fonzi, 347
Forceps, cutting, 294

extracring, 46, 52, 86, 87, 114, 131, 157,
167, 207, 211, 226, 278, 292, 293,

3^5, 330, 334
Foreest, Peter, 1^7, 202

Foucou, 3i«, 34^.347

Fractureof 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

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, 1 1 1
Giovanni of Arcoli, 153, 168, 199

of Vigo, 159
Glaubrecht, F. E., 314
Gold appliances of the Etruscans, 71
of the Romans, loi

bands, mentioned in law of the Twelve
Tables, 77

crown, 217,303

fillings, 29, 156, 159, 164, 208, 252,
2^6,285,309,315,316,329

teeth, substitution of, in Java, 42
in Macassar, 43

wire, use of, 30, 87, 135, 146
Golden tooth, story of the, 214
Goritz, Johann Adolph, 258
Gout, 219

Grabner, 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

Haller, Albert von, 166

Harris, Walter, 239

Havers, Gopton, 239

Hebrews, dental affections rare among the

ancient, 32
Hcckcr, A.T., 331

352

INDEX

Heister, Lorenz, 255

Hemard, Urbain, 194, 203

Hemorrhage after extraction, 229, 231 » 258,

30«» 30^32^335
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 v^sculapius, 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

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, 2oi5, 207, 211, 226, 227, 241, 279,

284, 33^

for extractmg, 321, 323, 327

of gold, 251

of tne Romans, 86
Iron, tooth of, 232
Irregularities, dental, 280, 290, 303, 320, 342

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

Jacobaens, Oligerus, 231

Java, substitution of gold teeth by people of,

^^ . . .

Joachim, Heinrich, translation of Ebers'

papyrus by, 19

Jourdain, 311
unker, Johann, 257

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
Lecluse, 257, 305
Leeuwenhoek, Antoni van, 237
Lemerle, 317
Lemorier, 313
Lentin, L. B., 314
Lentisk wood, toothpicks of, 08
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,

Lusitanus, Amatus, 229
Luxations of jaw, 88

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

INDEX

353

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
Microorganisms, 237

Microscopes, 236, 237, 260

Middle ages, dentistry in tne, 121

Minadous, Thomas, 232

Mineral teeth, 2^4, 329, 344, 348

waters of Carlsbad, 220
Models in dental prosthesis, 241, 306
Modem 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, in, 265, 274
Mouton, 303, 300
"Moxa," use of, by Chinese, 40
Mummery, J. R., 25, 29
Mummies, Egyptian, 27, 28, 49
Murphy, Josepn, 42
Museum of antiquities, Dresden, 162

iarcheological) of Athens, 52
archeological) of Florence, 70
of Cometo, 71, 72, 73
of Count Bruschi, 73
of Pope Julius, Rome, 70, loi
of University of Ghent, 74
Musitano, Carlo, 247

' Odontalgia, 34, 38, 51, 92, 95, 103, 106, 107,
! 109, III, 113, 124, 137, 141, 145, 150, 152,
I 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

Nasal prosthesis, 256
Necrosis of lower jaw, 241

of the teeth, 56
Nerves of teeth, 109
Neuralgia, 224
Nicaise, £., 142
Nobile, Luigi, 78
Nomenclature, 88, 318
Nuck, Anton, 245
Number of teeth, 59, 109

Obturators, 197, 198, 211, 301, 310
Oceanica, dyeing the teeth black by races of,

Odontagogon, 46, 65, 114
Odontagra, 64

«3

I Papyrus of Ebers, 19
Paracelsus, 176
Pare, Ambroise, 188
Pasch, J. G., 314, 315
"Pastophori" treatment of sick by, 19
Paul ot iEgina, 118
Peale, Charles W., 348
Pechlin, Nicolaus, 232

Pelican (extracting instrument), 157, 158,
167, 193, 206, 211, 226, 281, 290, 291, 292,

3M» 323, 324, 330» 334
Perine, Geo. H., 27

Periodontitis, 122, 320

Petronius, 98

Peyronie, de la, 339

PfafF, Philip, 305

Pfolsprundt, Heinrich von, 163

Phoenicia, ancient dental appliance found

at Sidon, 29

influence of, on Etruscan dentistry, 67
Phoenician 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, 21 1, 296
Prosthetic pieces, movable, 256
Pulp-capping, 306
Pulp, inflammation of, recognized by Archi-

genes, 107
Pumice stone in dentifrices, 96, 97, 141, 203
Purland,T., 28

Purmann, Matthias Gottfried, 241
Pyorrhea (alveolar), 96, 237

354

INDEX

[UACKS, 159, 162, 277, 310

\m\\ toothpicks mentioned by Martial, 98

Ranula, Abulcasis on the cure of, 137

Renan, "Mission de Phenicie,** 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

Riviere 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

Ryfr, Walter, 157, 161, 166

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, 2«, 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,

Sylvius, 172

Saalburg, forceps found in ancient castle of.

Saliva, 331

Salmuth, Philip, 232

Sandwich Islands, natives of, sacrifice front

teeth, 43
Satricum, example of gold crown work found

at, loi
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
Schuiz, Gottfried, 232
Scorbutus, case of, mentioned by Hippocrates,

5.5
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

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
Pare 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,

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,

number of, indicated by Galen, 109
influence on long life of, 58

pivot, no evidence of Egyptian knowl-
edge 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

INDEX

355

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,

Trephine, use of, by Archigenes, 108
Trueman, Wm. H., 68
Tulp, Nicolaus, 231

Uncrowning of teeth, 194, 204, 275
Urine, 35, 43, 97, 98, 274
Uxedu, painful swelling, referred to in Ebers'
papyrus, 20, 23

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

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,

I53» 158, I99» 203, 214, 220, 228, 229,
231, 232, 247, 268, 307, 309
Wurfbein, Paul, 241

Znamenski, 295
Zwinger, Theodor, 240

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Full text of "A history of dentistry from the most ancient times until the end of the eighteenth century"

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