THE GREEKS.
An ancient Greek physician—Asklepios, afterward called
Æsculapius[41]—by the ability he displayed in the art of healing, so
impressed the minds of the simple and uncultured at that primitive
epoch as to be held in repute rather as a god than as a man. Not only
was he held to be the author of wonderful cures, but it was also
affirmed that he had resuscitated the dead; no doubt from his having
in some case or other of apparent death restored the individual to
consciousness by the assistance he rendered him. Exaggeration, so
natural to ignorant minds, afterward did the rest, and magnified the
healing and restoring powers of Æsculapius to such an extent that it is
not to be wondered at that he should have been looked upon as a divine
being. With the lapse of time, various traditions formed around his
name, among which there was, however, finally such discrepancy that
the popular voice spoke no more of one, but of many Æsculapii,[42] and
to one of these was attributed, among other merits, that of having
invented the probe and the art of bandaging wounds, while another was
held to be the inventor of purgatives and of the extraction of teeth.
According, therefore, to these traditions, dental surgery had its
origin with Æsculapius, the god of Medicine. But what was the precise
epoch in which this benefactor of humanity lived?
We learn from Homer that two sons of Æsculapius, Machaon and
Podalirius,[43] took special part, as doctors, in the siege of Troy.
This celebrated siege, which lasted ten years, took place in the
twelfth century before the Christian era (that is, 1193 to 1184 B.C.);
admitting, therefore, the account of the parentage to be authentic, one
may argue therefrom that Æsculapius must have lived between the twelfth
and thirteenth centuries B.C. Many temples were built and dedicated to
Æsculapius; these were called _asklepeia_, after the Greek form of his
name. The priests were called _Asklepiadi_, and alleged their direct
descent from Æsculapius himself.
The temples of Æsculapius became so numerous in time that they were
to be found in almost every Greek city. The most celebrated were those
of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great
city of Agrigentum, in Sicily. The Asklepiadi not only performed the
temple rites, but were doctors at the same time, for as interpreters
of the wisdom of the god, they also occupied themselves in curing the
sick. From this it resulted that these temples became in time, through
observation and experience, schools of medical science.
But besides this sacerdotal medicine, there was also a lay medicine
in Greece. Many great philosophers, especially Pythagoras, Alcmeon
of Croton, Empedocles, Anaxagoras, and Democritus, occupied
themselves with physiology, with hygiene, and with medicine; also the
gymnasiarchs, or directors of gymnasiums, or schools of gymnastics,
an art having for its end to increase physical strength and maintain
health, cultivated medicine, particularly that part of it which
concerns hygiene, dietetics, and surgery as applied to the treatment of
violent lesions, such as fractures, luxations, etc.
The Asklepiadi often themselves imparted the principles of medicine
to students outside their caste. Lay medicine thus gradually came to
supplant sacerdotal medicine, especially after Hippocrates, who through
his works, exercised a preponderant influence in the secularization
of the science. However, the Asklepiadi, on their side, continued to
practise medicine up to the time when the pagan temples fell into
complete ruin, through the advance of Christianity.
On the columns of the asklepeia and on the votive tables were written
the names of those cured by the god, together with indications
regarding their various maladies and the treatment by virtue of which
the sick had been restored to health.
Surgical instruments of proved utility were deposited in the temples.
Celius Aurelianus makes mention of a leaden instrument used for the
extraction of teeth (_plumbeum odontagogon_), which was exhibited in
the temple of Apollo, at Delphi.
As a matter of fact, it would seem more natural that this instrument
should have been shown in the temple of Æsculapius, he being the
god of Medicine, and believed, besides, to be the inventor of
dental extraction. One is rather inclined by this to think that the
_odontagogon_ may have been deposited in the temple of Apollo before
the building of Æsculapian temples. Indeed, who can tell if Æsculapius
himself, not yet deified, may not have deposited there a model of the
instrument he had invented!
From the fact of the _odontagogon_ in the temple of Apollo being made
of lead, Erasistratus, Celius Aurelianus, and other ancient writers
have drawn the deduction that it was only permissible to extract teeth
when they were loose enough to be taken out with a leaden instrument.
But Serre[44] observes, not without reason, that if a tooth be so
unsteady as to be able to be extracted with leaden pincers, this may
just as well be done, and perhaps even better, by pinching the tooth
between the fingers, no other aid being required than a handkerchief
to prevent them from slipping. Avulsive pincers of lead would be,
therefore, a nearly useless invention; so it is much more probable,
as Serre remarks, that the original pincers were of iron, and that
the inventor, reserving these for his own use, made a simple model of
the same in lead (this being easier to do) and deposited it in the
temple of Apollo, in order to make known the form of the instrument
to contemporaries and to posterity, naturally supposing that whoever
wished to copy it would understand of himself, or learn from the
priests, that it was to be made of iron and not of lead.
[Illustration: FIG. 7
Portrayal of a dental operation on a vase of Phœnician origin, found in
Crimea (see Cigrand, Rise, Fall, and Revival of Dental Prosthesis, pp.
60-63 and 287).]
HIPPOCRATES. The sacerdotal and philosophical schools of medicine, as
well as the gymnasiums, were the three great sources whence Hippocrates
derived his first knowledge of medicine.
Hippocrates was born in the island of Cos, toward the year 460 B.C. He
belonged to the sacerdotal caste of the Asklepiadi, and was, according
to some of his earliest biographers, the nineteenth descendant of
Æsculapius on his father’s side, and the twentieth descendant of
Hercules on his mother’s side. The time of his death is even still more
uncertain than that of his birth, for, according to some, he died at
eighty-three, according to others, at eighty-five, at ninety, at one
hundred and four, and even at one hundred and nine years of age.
Hippocrates was initiated in the study of medicine by his own father,
Heraclides; but in the medical art he also had as a teacher the
gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under
the sophist Gorgia and philosophy under the celebrated Democritus. He
treasured up all the records of medical practice that were preserved
in the temple of Cos; but according to some ancient authors he is said
to have set fire afterward to this temple, and to have left his native
country in order to flee from the resentment he had aroused. Probably
it was the priests themselves who attributed the burning of the temple
(which certainly took place at that time) to Hippocrates, out of
jealousy for his growing fame; though it may also be possible that this
great man, having first collected together all that was useful among
the medical records that were to be found there, afterward courageously
destroyed this centre of superstition, so that medicine, ceasing to
be confused with imposture and being despoiled of the supernatural
character attributed to it, which paralyzed its progress, should become
a liberal and human art, based purely on the observation of clinical
facts and the study of natural laws.
For a long time, Hippocrates travelled in various parts of Europe,
Asia, and Africa, everywhere making valuable observations. He finally
returned to his native country, where through the practice of medicine
and by his immortal writings he acquired such esteem and veneration
that his compatriots almost tributed him with divine honors after death.
Not all, however, of the works that make up the so-called collection of
Hippocrates were really written by the father of medicine. Two of his
sons—Thessalus and Draco—and his son-in-law Polybius also distinguished
themselves by the practice of medicine and by their admirable writings,
which together with those of other doctors of that period were
erroneously included in the collection of Hippocrates’ works. At any
rate, the collection of Hippocrates faithfully represents the state
of medicine and surgery at the epoch in which he and his disciples
flourished, that is, toward the end of the fifth and during the fourth
century before the Christian era.[45]
Neither Hippocrates nor others before him had ever dissected corpses;
it is, therefore, not to be wondered at that the anatomical notions
contained in the Hippocratic works should be scarce and very often
inexact. The physiological notions also are highly deficient and
imperfect, which is, indeed, very natural, for an exact knowledge of
the functions of the human body presupposes an exact knowledge of the
relative organs.
The philosophical ideas of the time had considerable influence on the
medical theories of Hippocrates and his successors. The universe was
considered as constituted by four elements: earth, air, fire, water. To
each of these elements a special quality was attributed, and, thus, one
recognized four fundamental qualities, viz., cold, dryness, heat, and
moisture. Man—the most perfect being—was regarded as a “microcosmos,”
or small world in himself, that is, a sort of compendium of the whole
universe, and his organism, in correlation to the four primordial
elements of the universe, was believed to be constituted of four
fundamental humors—the blood, the pituita or mucus, the yellow bile,
and the black bile or atrabile.
Health, says Hippocrates,[46] depends on the just relation one to
another of these principles, as to composition, force, and quantity,
and on their perfect mixture; instead, when one of the four principles
is wanting or in excess, or separates itself from the other components
of the organism, one has a diseased condition. In fact, he adds,
if some one humor flow from the body in a measure superior to its
superabundance, such a loss will occasion illness. If, then, the humor
separated from the others collect in the interior of the body, not
only the part that remains deprived of its presence will suffer, but
also that into which the flow takes place and where the engorgement is
produced.
We have here briefly stated these generalities in order to make
ourselves clearly understood in speaking hereafter on different
subjects, whether with regard to Hippocrates or to other authors of the
time.
In the works of Hippocrates there is not one chapter that treats
separately of the affections of the teeth, just as there is no book
in which he speaks separately of diseases of the vascular or nervous
systems, and so on. There are, nevertheless, a great number of passages
scattered throughout the Hippocratic collection from which we can
deduce very clearly the great importance that the Father of Medicine
ascribed to the teeth and to their maladies.
In the book _De carnibus_, the formation of the teeth is spoken of
among other things. It might have been supposed that Hippocrates
would have been ignorant of the fact that the formation of the teeth
commences in the intra-uterine life. This, however, is not the case;
in fact, he says: “The first teeth are formed by the nourishment of
the fetus in the womb, and after birth by the mother’s milk. Those
that come forth after these are shed are formed by food and drink. The
shedding of the first teeth generally takes place at about seven years
of age, those that come forth after this grow old with the man, unless
some illness destroys them.”[47] And a little farther on one reads:
“From seven to fourteen the larger teeth come forth and all the others
that substitute those derived from the nourishment of the fetus in the
womb. In the fourth septennial period of life there appear in most
people two teeth that are called wisdom teeth.”[48]
There is a passage in this same book _De carnibus_, in which the great
importance of the teeth for clear pronunciation of words is alluded
to: “The body,” says Hippocrates,[49] “attracts the air into itself;
the air expelled through the void produces a sound, because the head
resounds. The tongue articulates, and by its movements, coming into
contact with the palate and the teeth, renders the sounds distinct.”
The book _De dentitione_ is written in the form of brief sentences
or aphorisms, and speaks of the accidents that often accompany the
eruption of the deciduous teeth. The most important passages in this
short treatise are the following:
“Children who during dentition have their bowels frequently moved are
less subject to convulsions than those who are constipated.”
“Those who during dentition have a severe attack of fever rarely have
convulsions.”
“Those who during dentition do not get thinner and who are very drowsy
run the risk of becoming subject to convulsions.”
“On conditions of equality, those children who cut their teeth in the
winter get over the teething period the best.”
“Not all the children seized with convulsions during dentition succumb
to these; many are saved.”
“In the case of children who suffer with cough the period of dentition
is prolonged, and they get thinner than the others when the teeth come
forth.”
In the third book of Aphorisms, where Hippocrates speaks of the
illnesses that prevail in the various seasons of the year and in
the various ages of life, mention is also made of the accidents of
dentition. The twenty-fifth aphorism says: “At the time of dentition,
children are subject to irritation of the gums, fevers, convulsions,
diarrhea; this occurs principally at the time when the canines begin to
come forth, and in children who are very fat or constipated.”
The works of Hippocrates are nearly silent on the hygiene of the
teeth; but in the second book, on the diseases of women,[50] some
prescriptions are to be found against bad-smelling breath. We translate
the passage integrally:
“When a woman’s mouth smells and her gums are black and unhealthy, one
burns, separately, the head of a hare, and three mice, after having
taken out the intestines of two of them (not, however, the liver or the
kidneys); one pounds in a stone mortar some marble or whitestone,[51]
and passes it through a sieve; one then mixes equal parts of these
ingredients and with this mixture one rubs the teeth and the interior
of the mouth; afterward one rubs them again with greasy wool[52] and
one washes the mouth with water. One soaks the dirty wool in honey and
with it one rubs the teeth and the gums, inside and outside. One pounds
dill and anise-seeds, two oboles of myrrh;[53] one immerses these
substances in half a cotyle[54] of pure white wine; one then rinses the
mouth with it, holding it in the mouth for some time; this is to be
done frequently, and the mouth to be rinsed with the said preparation
fasting and after each meal. It is an excellent thing to take small
quantities of food of a very sustaining nature. The medicament
described above cleans the teeth and gives them a sweet smell. It is
known under the name of Indian medicament.”
In the book _De affectionibus_ there is a passage where it is said that
inflammation of the gums is produced by accumulations of pituita, and
that, in like cases, masticatories are of use, as these remedies favor
the secretion of saliva, and thus tend to dissipate the engorgement
caused by pituita.
Still more important, however, is the following passage of the same
book:[55]
“In cases of toothache, if the tooth is decayed and loose it must be
extracted. If it is neither decayed nor loose, but still painful, it is
necessary to desiccate it by cauterizing. Masticatories also do good,
as the pain derives from pituita insinuating itself under the roots of
the teeth. Teeth are eroded and become decayed partly by pituita, and
partly by food, when they are by nature weak and badly fixed in the
gums.”
Hippocrates, therefore, considers affections of the teeth to depend in
part on natural dispositions, that is, on congenital weakness of the
dental system, in part on accumulations of pituita, and the corroding
action of the same. If a painful tooth were not loose, it was not
to be extracted; but one was to have recourse to cauterization and
to masticatories, intended the one and the other to dissipate the
accumulation of pituita, believed by him to be the cause of toothache.
It is easily to be understood that as only loose teeth were to be
extracted, Hippocrates considered the extraction of teeth a very easy
operation, notwithstanding that the instruments then in use cannot
have been other than very imperfect; and this is clearly to be seen
from a passage in the book entitled _De medico_, where, after having
spoken of the articles and instruments that ought to be kept in a
doctor’s office (_officina medici_), he adds:
“These are the instruments necessary to the doctor’s operating room
and in the handling of which the disciple should be exercised; as to
the pincers for pulling out teeth, anyone can handle them, because
evidently the manner in which they are to be used is simple.”[56]
[Illustration: FIG. 8
Very ancient dental forceps and two other dental (?) instruments
existing in the Archæological Museum of Athens.]
Having made mention of the _officina medici_, we think it opportune
to explain here with some precision what is to be understood by this
term.[57] Medicine and surgery were practised in ancient times in open
shops; this was so in Greece, and later also in Rome. When the practice
of medicine became secularized through its abandoning the Æsculapian
temples, doctors’ shops began to arise in the most important centres
of population, to which those in need of assistance resorted or were
carried. In time these stations for the practice of medicine, and
particularly of surgery, became more and more numerous.
The Hippocratic collection contains a special treatise (_De officina
medici_), which speaks of the conditions these places were expected
to fulfil, the articles therein to be contained, the instruments, the
general rules relative to operations, the bandages, etc.
About six hundred years later, Galen wrote three books of commentaries
on this treatise of Hippocrates. He says, among other things, that the
doctor’s shop ought to be spacious and furnished with wide openings, to
let in abundance of light. These medical stations to which the sick and
infirm repaired in great numbers to ask advice, to undergo operations,
or receive medical dressings, must have been of great importance, as is
to be presumed from the cited books of Hippocrates and Galen.
The greatest doctors of antiquity practised the medical art in these
places. It is also said that the great philosopher and naturalist,
Aristotle, who came of a race of doctors, had inherited a doctor’s shop
of great value, but that notwithstanding this he refused to dedicate
himself to the medical profession.
The doctors’ shops were at the same time real pharmacies, where doctors
prepared medicines, and where all the remedies then in use, either
simple or compounded, were kept and sold to the public. Besides, there
were to be found instruments of every kind and articles for medicating;
and, therefore, bandages, compresses, lint, sponges, cupping glasses,
cauteries, knives, bistouries, lancets, sounds, needles, hooks,
pincers, files, saws, scrapers, splints, appliances for replacement of
luxated bones, speculums, trepans, apparatus for fumigation, trusses,
and a thousand things besides.
Naturally, dentistry was also practised in these shops, either by
doctors who occupied themselves with dental maladies as with those of
any other part of the body, or, later on, by individuals who dedicated
themselves exclusively to this specialty.
Medicine and surgery were exercised, however, not only in doctors’
shops, but also at the patients’ houses, and it was Hippocrates who
especially inaugurated clinical medicine—that is, the practice of
visiting patients in their beds.
But we must not digress from our argument.
Many observations relative to the teeth are to be found in the seven
books of Hippocrates on _Epidemics_. Unfortunately, the observations
are not always given in clear and precise terms, which principally
depends on the fact that these books consist for the most part of
simple and most concise notes, written by Hippocrates on cases observed
by him, and not intended for publication under such form, but rather
constituting the material for further work.
Here is a passage from the fourth book on _Epidemics_, which reveals
Hippocrates’ extraordinary power of observation, for even teeth that
had fallen out were minutely examined by him, to the end of acquiring
precise ideas on the anatomical conformation of these organs, held by
him to be of the highest importance.
“In the youth suffering from a phagedenic affection in the mouth, the
lower teeth fell out, as well as the front upper ones, which left a
cavity in the bone. The loss of a bone in the roof of the mouth causes
depression in the middle of the nose; the falling out of the upper
front teeth sometimes causes a flattening of the point of the nose. The
fifth teeth counting from the front ones had four roots (two of which
were almost united to the two contiguous teeth), the points of which
were all turned inward. Suppurations arising from the third tooth are
more frequent than from any of the others; and the dense discharge from
the nose and pains in the temples are specially owing to it. This tooth
is more apt to decay than the others; but the fifth does so, as well.
This tooth had a tubercle in the middle and two in the front; a small
tubercle in the internal part, on the side of the other two, had first
begun to decay.[58] The seventh tooth had only one large, sharp-pointed
root. In the Athenian boy, there was pain in a lower tooth on the left,
and in an upper one on the right. When the pain ceased, there was
suppuration of the right ear.”
This last fact—of the suppuration of the ear—is mentioned by
Hippocrates not as a simple coincidence, but as a fact intimately
connected with the cessation of the toothache. This may be argued
from the general ideas of Hippocrates in regard to the beginning and
the resolution of diseases. He considers a malady to be produced by
a humor, which becomes localized in a given point of the body. The
_crisis_ gives exit to the peccant humor,[59] and the mode in which
this is evacuated constitutes the _critical phenomenon_; the same may
be represented either by a profuse perspiration, by abundant urine, by
diarrhea, by vomiting, by expectoration, by bleeding or discharge of
other humors from the nose, by the issuing of pus from the ear, and
even by deposits on the teeth.[60] If by effect of _organic sympathies_
the morbid humor, instead of being thrown outward, be transported into
another region of the body, this constitutes the so-called _metastasis_.
The hints just given will serve to render some of the passages which we
quote from the works of Hippocrates more intelligible.
In the fourth book on _Epidemics_ we find among other clinical cases
the following:
“Egesistratus had a suppuration near the eye. An abscess manifested
itself near the last tooth; the eye directly got quite well; there was
a dense discharge of pus from the nostrils; and small, rounded pieces
of flesh were detached from the gums. It seemed as though a suppuration
at the third tooth were going to take place, but it went back; and
suddenly the jaw and the eye swelled up.”[61]
And farther on one reads:
“In Egesistratus the two last teeth were decayed in the parts where
they touched one another. The last had two tuberosities above the gum,
one on the decayed side, the other on the opposite side. In the part
in which the two teeth were in contact with one another there were two
roots in each, large and similar, and corresponding to those of the
contiguous tooth; on the other side there was only a half root[62] and
rounded.”
Toward the end of the fourth book on _Epidemics_, we find repeated an
observation which we have already noted:
“The third upper tooth is found to be decayed more frequently than all
the others. Sometimes a suppuration is produced all around it.”[63]
In the following passage mention is made of a mouth wash against
toothache, the basis of which is castoreum and pepper:
“In consequence of a violent toothache the wife of Aspasius had her
cheeks swollen up; but on making use of a mouth wash of castoreum and
pepper she found great relief.”[64]
A little after we find the practice of bleeding mentioned; and
contemporarily an allusion to the use of alum—with regard to a painful
swelling of the gums, that is to say, a gingivitis:
“Melisandrus suffered severe pain and swelling of the gums; he was
bled in the arm. Egyptian alum, if used in this malady, arrests its
development.”[65]
Toward the commencement of the sixth book the following observation is
registered:
“Among those individuals whose heads are long-shaped, some have thick
necks, strong members and bones; others have strongly arched palates,
their teeth are disposed irregularly, crowding one on the other, and
they are molested by headache and otorrhea.”[66]
While we should be tempted to attribute the knowledge of the relations
between malformation of the skull, ogival palate, and bad arrangement
of the teeth to quite modern studies, we are obliged to admit, and
to our great surprise, that these relations were already noted,
twenty-four centuries back, by the great physician of Cos.
In the seventh book on _Epidemics_, a case of scorbutus is described,
where incense and a decoction of lentils proved useful against the
lesions of the buccal cavity:
“... Large tubercles, of the size of grapes, had formed on the gums
close to the teeth, black and livid, but not painful, except when the
patient took food. For the mouth, incense powder mixed with some other
ingredients proved useful. The internal use of the decoction of lentils
also did good to the ulcers of the mouth.”[67]
In the same book there is a passage in which Hippocrates warns against
the use of origanum, as harmful to the teeth and eyes:
“Origanum in drinks is harmful to affections of the eyes, and also to
the teeth.”[68]
Farther on a case of necrosis of the jaw is mentioned:
“Cardias, the son of Metrodorus, by reason of pains in the teeth
was subject to mortification of the jaw. Excrescences of a fleshy
kind formed on the gums, that grew most rapidly; the suppuration was
moderate; the molars fell out and afterward the jaw itself.”[69]
Some passages in the _Epidemics_,[70] and in other books of
Hippocrates, even when not referring directly to pathological
conditions of the teeth, are of value as demonstrating what importance
the author attaches to the dental organs, and to the phenomena of which
they may possibly become the site.
In establishing the diagnosis of a malady, he recommends searching for
its point of departure; for example, if it has begun with a headache,
an earache, a pain in the side, and adds, that in some cases the nature
of the malady is revealed by the teeth, in some others by swelling of
the glands.[71] The truth and importance of this observation are not to
be doubted.
In fevers, Hippocrates considers it an unfavorable sign if there
be a deposit of viscous matter on the teeth, especially when the
patient keeps his mouth half open, that is, when he lies in a state of
stupor.[72]
Other prognostics drawn from the teeth or the gums are the following:
“Grinding of the teeth in those who have not this habit when in full
health, gives reason to fear a furious delirium and death; but if the
patient, already delirious, presents this sign, it is an absolutely
fatal one.[73] It is also a most unfavorable sign when the teeth get
very dry.”
“Necrosis of a tooth heals the abscess formed at the gum.[74] This is
very easily explained by the fall of the tooth. But Hippocrates knew
very well that the affection does not always take such a favorable
course; he therefore adds, immediately after:
“In the case of necrosis of a tooth the supervening of a strong fever
with delirium gives reason to fear a fatal exit. If, notwithstanding
this, the patient be saved, there will be suppuration and exfoliation
of the bone.”[75]
According to Hippocrates, “violent pains in the lower jaw give reason
to fear a necrosis of the bone.”[76]
“Gingival hemorrhage in cases of persistent diarrhea is an unfavorable
symptom.”[77] In fact, the easy and frequent occurring of hemorrhage of
the gums may, in many cases, be an indication of profound alteration
of the blood, a condition serious in itself, but still more so when
associated with obstinate diarrhea.
In different parts of the books of Hippocrates, the influence of
atmospheric conditions on the production of dental and gingival
maladies is alluded to.
“Much inconvenience was caused to various persons at that period of
time by swelling of the fauces, by inflammation of the tongue, by
abscesses of the gums.”[78]
“After the snow, there were west winds and light rains; colds in
the head, with or without fever, were very frequent; in one of the
patients, pains were produced in the teeth on the right side, and in
the eye and eyebrow.”[79]
In more than one of his books Hippocrates speaks of special dental
or gingival symptoms, having their origin in different maladies,
especially those of the spleen:
“In many who have enlargement of the spleen the gums become affected
and the mouth has a bad smell.”[80]
In another place we read:
“Among those persons who have an enlargement of the spleen, the bilious
ones have a bad color, are subject to ulcerations of a bad nature,
their breath is fetid, and they themselves are thin.”[81] Finally,
in the _Book on Internal Diseases_, Hippocrates describes different
species of splenic maladies, to one of which he assigns the following
symptoms:
“The belly becomes swollen, the spleen enlarged and hard, the patient
suffers acute pain in it. The complexion of the individual is altered.
A bad smell emanates from the ears. The gums are detached from the
teeth and smell bad; the limbs wither, etc.”[82]
The cases of splenic swellings spoken of by Hippocrates in the above
passages must have been owing, without doubt, to grave cachectic
conditions (among which, probably, scurvy); and we know that
gingivitis, with all its possible consequences (among which expulsive
periodontitis), is not only a constant symptom in scurvy, but is
also frequent in all diseases attended by profound disorders of
nutrition.[83]
Setting on edge of the teeth is counted by Hippocrates among the many
symptoms to which a protracted leucorrhea may give rise:
“One should ask women who have been troubled for some time with a white
flux whether they suffer from headache, pains in the kidneys and in
the lower part of the belly, as well as setting on edge of the teeth,
dimming of the sight, singing in the ears.”[84]
Hippocrates had also observed that the phenomenon of setting the teeth
on edge (_stupor dentium_) may be produced as well by acids in general,
also by acid vomiting;[85] and that it may also be produced in many
individuals by a strident sound.[86]
In the second book of _Epidemics_ we find a proposition of the
following tenor:
“Long-lived individuals have a greater number of teeth;”[87] which
is as much as to say that “the having a greater number of teeth is a
sign of longevity.” This prejudice is to be found repeated by many
authors subsequent to the epoch of Hippocrates, and among these by
Aristotle and Pliny. Not even the greatest men are infallible; there
is, therefore, no reason to be scandalized if Hippocrates should really
have fallen into such an error. Anyhow, it should be observed that
only the first and the third book on _Epidemics_ are held to be really
authentic, while the other five were probably compiled by other doctors
of the school of Hippocrates who did not limit themselves merely to
gathering together the many isolated notes and observations left in
writing or derived from the oral teachings of their master, but took
it upon themselves to introduce into the compilation something of
their own besides. It is, therefore, anything but certain that the
above-mentioned error is really to be attributed to Hippocrates.
The probable origin of this prejudice, which certainly originated among
the people and was afterward accepted by the doctors, is easily to
be guessed at. Individuals blessed with dental arches of remarkable
beauty and perfection may sometimes convey the impression of having
a greater number of teeth than others, for those two rows of regular
white teeth, close to one another, strike the optic sense much more
vividly than teeth of the ordinary kind. This impression is somewhat
analogous, at least as regards color—to the optical illusion which
causes a white circle to appear larger than a black one of equal
diameter. Now, without doubt, individuals with a perfect denture are
mostly healthy and well constituted, and, therefore, live longer, in
general, than others. It is also to be noted that these people usually
keep all their teeth to a more or less advanced age; and there is no
doubt that among adults of the same age, those who have a less number
of teeth, by reason of having lost several of them, are, in general,
individuals whose organic constitutions are less good, whose health is
less satisfactory, and who are, therefore, destined in all probability
to live a shorter time than the others. It is, therefore, perfectly
true, _but only in a certain and very limited sense_ that “long-lived
individuals have a greater number of teeth.”
Geist-Jacobi, perhaps in order to dissipate the erroneous signification
of the Hippocratic proposition cited above and to place in evidence
that part of it which may be true, has thought well to translate it
thus:
“He who lives long keeps many teeth.” But this translation does not
render faithfully the idea expressed in the original Greek, ὁι
μαχρόβιοι πλείους ὁδόντας ἔχουσιν (literally, the long-lived have
more teeth); a proposition that the most celebrated commentators
of Hippocrates interpret in the sense given by us, and which Litré
translates excellently well in these words: “_Avoir des dents en plus
grand nombre est un signe de longévité_.”
Notwithstanding this prejudice, which survived vigorously for many
centuries, the regular number of teeth was not unknown at the time
of Hippocrates. This is to be perceived from a brief treatise of the
Hippocratic collection, entitled _De hominis structura_, wherein is
written:
“The teeth, together with the molars, are thirty-two.”
Among the many and many counsels of practical value registered in the
works of Hippocrates, the following deserves special mention:
“When a person has an ulcer of long duration on the margin of the
tongue, one should examine the teeth on that side, to see if some one
of them does not, by chance, present a sharp point.”[88]
In fact, it not infrequently occurs that a lingual ulcer deriving from
irritation produced by a broken or sharp tooth assumes a malignant
aspect that causes it to be mistaken for a cancerous ulcer, and
medical men may even be so far misled as to advise the extreme remedy
of amputation of the tongue. If, however, the consulting surgeon has
some experience, he will not neglect in the first place to examine
accurately the state of the patient’s teeth; it then mostly happens
that after the removal of the offending tooth a complete cure is
obtained in a brief space of time. How much anxiety would not such poor
sufferers be spared if physicians in general were acquainted with the
counsel given by Hippocrates twenty-four centuries ago!
In speaking of fracture of the lower jaw, Hippocrates recommends
binding the teeth next to the lesion together. He distinguishes between
the complete and the incomplete fracture; he then speaks separately of
the fracture of the symphysis. Treating of the incomplete fracture, he
says:
“If the teeth in proximity of the lesion be shaken, one ought, after
having reduced the fracture, to bind them one to the other, until the
consolidation of the bone, using preferably gold wire for the purpose;
but if this be wanting, linen thread can be used instead, and not only
ought the two teeth next to the site of the fracture to be bound, but
several of the others besides.”[89]
[Illustration: FIG. 9
Two Greek appliances existing in the Archæological Museum of Athens.]
Farther on, when speaking of complete fractures, he renews this advice
in these words:
“After having carried out the coaptation, the teeth ought, as we have
said already, to be bound one to the other; this greatly contributes
to obtaining the immobility of the fragments, particularly if properly
carried out.”[90]
Also, in cases of fracture of the symphysis, Hippocrates recommends
“binding the teeth together on the right and left of the lesion.” And
after having spoken of the best adapted means of constraint in such
kinds of fractures, he adds: “If the reduction has been well performed,
and the part kept in proper repose, the consolidation takes place in
a short time and the teeth do not undergo any damage; in the contrary
case, the cure is retarded, the fragments reunite in a bad position,
and the teeth are injured and become useless.”[91]
From what we have referred, it is easy to perceive how much importance
Hippocrates attached to the dental system, what knowledge he possessed
as to the pathological conditions of the teeth, the gums, and the jaws,
and what means of treatment he used. But in what relates to therapy it
will perhaps not be useless to make some further observations.
One of Hippocrates’ aphorisms says:
“Cold is the enemy of the bones, the teeth, the nerves, the brain, and
the spinal marrow.”[92]
From this it is easy to conclude that Hippocrates was no friend to
hydrotherapic treatment, and that he considered the use of cold drinks
bad for the teeth, and cold applications harmful in dental diseases.
The idea expressed in the aphorism just quoted is to be found repeated
in the book entitled _On the Use of Liquids_;[93] and in this same
treatise we find _vinegar_ recommended shortly after in cases of
_burning of the teeth_ (an expression probably meant to indicate those
pathological conditions of the teeth and gums which are accompanied by
a sense of burning).
Some of the Hippocratic maxims, full of wisdom and good sense, will
forever conserve their importance, whatever be the degree of perfection
to which medical science may come.
“Diseases, says he, should be combated in their origin;”[94] which
is as much as to say, that it is not enough to apply symptomatic or
palliative means of cure, but that it is necessary, rather to seek and
to combat the true causes of disease. And in another place we find
written:
“One should take care of two things in illnesses—to do good and not
to do harm. The art of curing includes three terms: the malady, the
patient, and the doctor. The latter is the minister of the art; the
patient has to combat the malady together with him.”[95]
It is only too true, that not all the representatives of the healing
art keep sufficiently in view the precept _to do good and not to do
harm_; nor do all patients comport themselves in such a manner as to
contribute, in accordance with Hippocrates’ wise counsel, to the work
of their own cure.
ARISTOTLE, the greatest philosopher of antiquity, was born at Stagira,
in Macedonia, and lived from 384 to 322 B.C. He wrote most excellent
works on all branches of human knowledge, and was the founder of
Natural History and Comparative Anatomy. His acquaintance with anatomy
as illustrated principally in his treatise _On the Different Parts of
Animals_, is absolutely extraordinary for the time in which he lived.
One chapter of this work[96] is altogether dedicated to the study of
the teeth; but he also speaks of these organs in many other of his
works, particularly in his _History of Animals_, which is a real and
proper treatise on zoölogy, wherein the author records a great number
of notes about the peculiarities presented by the dental system, in the
different classes of animals.
In spite of the great errors into which he has fallen, his ideas about
the teeth are, taken as a whole, quite worthy of attention, especially
when one considers the remote epoch in which this great philosopher
wrote. We will here give a brief notice of the most important of his
observations relating to the dental organs.
The form, the disposition, the number of the teeth, varies in animals,
according to the quality of their food and according to whether the
teeth serve merely to divide and to chew the alimentary substances, or
as instruments of offence and defence as well. In man, the teeth serve
principally for mastication, but the front ones have, besides, another
most important office, namely, that of assisting in the articulation of
words, in the pronunciation of certain letters.
In those animals in which the teeth also serve as weapons, it is to
be observed either that some of them protrude like those of the boar,
or that they are sharp and saw-like in their disposition, as in the
lion, the panther, the dog, etc. No animal possesses at the same time
protruding and saw-like teeth.
The teeth are not always equal in number in both jaws; the animals
provided with horns have no teeth in the front of the upper jaw; this,
however, is also to be observed in animals without horns, as for
example, in the camel. Among the animals provided with horns there are
none which have protruding or saw-like teeth.
In general, the front teeth are pointed and the back ones broad.
Nevertheless, all the teeth of the seal are pointed, with a saw-like
disposition, perhaps because this animal marks the transition from the
quadruped to the fish, all of which, with few exceptions, have their
teeth formed in that way. Animals with saw-like teeth have generally
very large mouths.
No animal has ever more than one row of teeth in each jaw; however,
says Aristotle, if Ctesias[97] is to be believed, there is an animal in
India, named marticora, which has a triple row of teeth.
The molar teeth are never changed either in man or in any known animal;
the pig never changes its teeth.
One can judge the age of many animals by their teeth. As the animal
grows older, the teeth become darker in color, except in the case of
the horse, whose teeth grow whiter with age.
The last molars are cut by men and women about the twentieth year; but
in some cases, and especially with women, they have been known to come
forth—not without pain—very much later, even so late as at eighty years
of age.
The man has more teeth than the woman; this peculiarity is also to be
found in the female of some animals (such as sheep, goats, and pigs).
Individuals provided with many teeth generally live the longest, those
instead who have fewer teeth (or simply far apart) are generally
shorter lived.
The teeth are generated by the nourishment distributed in the jawbone;
they are, in consequence, of the same nature as bones. Their surface,
however, is very much harder than that of the bones. The teeth,
contrarily to all other bones, grow throughout life, so as to provide
for their wearing away through mastication; and for this reason they
lengthen when the antagonizing teeth are wanting.[98]
The teeth differ from all the other bones, therein that they are
generated after the body has been already constituted; they are,
therefore, secondary formations; and precisely for this reason are able
to be shed and to be renewed.
Some of the veins of the head, says Aristotle, terminate with very
slender branches inside the teeth.[99]
The dental system of the monkey is altogether similar to that of man.
The molar teeth exist in viviparous quadrupeds as well as in man; in
the oviparous quadrupeds and in fish they are wanting. They serve to
grind food, a function in which the lateral movements of the inferior
jaw have, in many animals, a large share. For this reason, in animals
who have no molars, these lateral movements do not exist.
In birds, the beak takes the place of the lips and teeth; the substance
of which it is formed is similar to that of the horn or the nails.
In those animals which, instead of having all the teeth sharp, are
furnished with incisors, canines, and molars, these three species of
teeth are disposed in the same order as in man.
The setting on edge of the teeth may be produced not only by eating
acid things, but also simply by seeing them eaten. This sensation may
be made to cease by the use of purslane and salt.
In the book entitled _Problems_, many of which have reference to
medical matters, one is to be found to the following effect:
“Why do figs, when they are soft and sweet, produce damage to the
teeth?” Perhaps, answers Aristotle, because the viscous softness of
the fig causes small particles of its pulp to adhere to the gums and
insinuate themselves into the dental interstices, where they very
easily become the cause of putrefactive processes. But, he adds, it may
also be that harm is produced to the teeth by masticating the small
hard grains of this fruit.
In Aristotle’s _Mechanics_, the following question relative to the
extraction of the teeth is discussed:
“Why do doctors extract teeth more easily by adding the weight of the
odontagra (dental forceps) than by using the hand only? Can it be said
that this occurs because the tooth escapes from the hand more easily
than from the forceps? Ought not the irons to slip off the tooth more
easily than the fingers, whose tips being soft can be applied around
about the tooth much better? The dental forceps,” adds Aristotle, “is
formed by two levers, acting in contrary sense and having a single
fulcrum represented by the commissure of the instrument. By means
of this double lever it is much easier to move the tooth, but after
having moved it, it is easier to extract it with the hand than with the
instrument.”
From this passage of Aristotle one may draw various conclusions. First
of all, it appears that, at that time, the extraction of teeth was
a common enough operation carried out by doctors in general, or, at
least, by specialists not indicated by any particular denomination
but called doctors (in Greek, ιατροι) just the same as those
who dealt with the maladies of every other part of the body. If,
therefore (which, however, is very doubtful), there existed in Greece,
as there certainly did in Egypt, individuals who occupied themselves
_exclusively_ with the treatment of the teeth, they cannot have formed
a distinct class of professionals, but merely a section of the medical
class. Herodotus, too, as we have already seen, does not say, speaking
of Egypt, that there was a proper class of dentists, but gives us
to understand that the Egyptian doctors did not occupy themselves
indiscriminately with the treatment of all maladies, for some dedicated
themselves to curing the eyes, others to the treatment of maladies of
the head, others to those of the teeth, and so on.
From the Aristotelian passage on the extraction of teeth, just quoted,
it may be concluded that in those times the Hippocratic precept, that
only loose teeth were to be extracted, was not observed, for otherwise,
Aristotle could not have said that dental forceps are useful to loosen
the teeth, but that after this has been done the extraction of the
tooth may be more easily effected by means of the fingers than with the
instrument.
This last assertion appears very strange. It demonstrates that either
the instruments then in use were very imperfect, or that Aristotle,
although the son of a doctor and himself possessed of vast medical
knowledge, had absolutely no experience as to the extraction of teeth;
and, therefore, speaking theoretically, and without any practical
basis, he ran into error, as even the greatest men are apt to do when
drawing conclusions from purely theoretical reasonings.
From Aristotle to Galen, that is, for the space of five centuries,
the anatomy of the dental system, so far as may be deduced from the
writings preserved to us, made no sensible progress. But in respect
to this, one must take into consideration some historical facts of
capital importance. The school of medicine of Alexandria, which arose
about three centuries before Christ, numbered among its most brilliant
luminaries the celebrated doctors Herophilus and Erasistratus, who
were the initiators of the dissection of human corpses,[100] thus
giving a great impulse to anatomical research. It is, therefore, hardly
admissible that these two great anatomists, who studied with profound
attention even the most complicated internal organs, should have
neglected the anatomy of the teeth. Unfortunately, however, not all the
results of their researches have come down to us; nor is this to be
wondered at, especially if we reflect on the large number of precious
works entirely lost by the destruction of the celebrated library of
Alexandria, A.D. 642.
When we come to speak of Archigenes, we shall see how he, in certain
cases, advised trepanning the teeth. This would lead to the belief that
in his times, viz., toward the end of the first century after Christ,
the existence of the central cavity of the tooth was not ignored, and
that, therefore, the structure of these organs had already been the
object of study.
As to diseases of the teeth and their treatment, there is no doubt that
Herophilus and Erasistratus must have occupied themselves with these
subjects; and the same may be asserted of Heraclides of Tarentum, a
celebrated doctor who lived in the third century before the Christian
era. Indeed, we read in Cœlius Aurelianus,[101] that the record had
come down through the works of Herophilus and Heraclides of Tarentum,
of persons having died by the extraction of a tooth.[102] The same
writer also alludes to a passage of Erasistratus, relating to the
_odontagogon_ already mentioned, which was exhibited in the temple
of Apollo, and to the practical signification to be attributed to
the fact of this instrument being of lead and not of hard metal. Now,
if Herophilus, Heraclides of Tarentum, and Erasistratus all spoke of
the serious peril to which the extraction of a tooth may give rise,
and therefore recommended not having recourse to it too lightly, it
is evident that they had given serious attention to this operation
and consequently also to the morbid conditions that may render it
necessary.