CHAPTER VII.

THE ROMANS.

For many centuries the Romans, according to the saying of Pliny,

lived entirely “without doctors, although not without medicine;”[108]

that is, there existed without doubt a popular medicine and also a

sacerdotal medicine, but still there were no persons whose exclusive

occupation it was to cure disease.

The medical art, properly so called, was introduced into Rome by the

Greeks. The first Greek doctor who went to Rome was Archagathus (in the

year 535 after the foundation of the city, that is, 218 years before

Christ). His arrival was at first welcomed, so much so that he was made

a Roman citizen and a shop bought for him in the Acilian square, at the

expense of the State. However, his popularity was of brief duration.

Being an intrepid operator, the use and abuse he made of steel and fire

gained for him the not very honorable qualification of the butcher, and

he soon became the horror of all the population.

But it appears that dentistry had begun to be practised in Rome

prior to the coming of Archagathus, that is, long before the medical

profession existed. We have the clear proof of this in the Law of the

Twelve Tables, wherein we find mention made of teeth bound with gold.

The Law of the Twelve Tables was written in Rome 450 years before

Christ, by a body of ten magistrates (_decemviri_) expressly named for

that purpose, as up to that time no written law had existed.

As gold was at that time somewhat scarce, and fears were entertained

that it would become still scarcer (to the great damage of the State)

by reason of the custom that prevailed among the wealthy of burning

or burying gold articles with the corpses to honor the memory of the

deceased, or, rather, to satisfy the pride of the survivors, it was

thought necessary to prohibit this abuse by a special disposition

of the law referring to funeral pomps. This disposition was thus

formulated: “_Neve aurum addito, ast quoi auro dentes iuncti escunt

(sunt) im cum illo sepelirei vrive sine fraude esto_;”[109] that is,

“Neither shall gold be added thereto (to the corpse); but it shall not

be unlawful to bury or to burn it with the gold with which the teeth

may perchance be bound together.”

From this it results that at the time when the Law of the Twelve Tables

was written, that is, four centuries and a half before the Christian

era, there were already individuals in Rome who practised dental

operations. And these individuals cannot have been medical men, as at

that epoch (corresponding pretty nearly with the date of Hippocrates’

birth) Rome had as yet no doctors.

The inquiry naturally suggests itself whether the gold mentioned in the

legal dispositions above cited was used for fixing artificial teeth or

simply for strengthening unsteady natural teeth. Some authors, Serre

among them,[110] have pronounced in favor of the first hypothesis,

others, as, for example, Geist-Jacobi,[111] are rather disposed to

accept the second. In truth, however, we do not possess sufficient

historical data to definitely resolve this problem. I myself am rather

of opinion that artificial teeth were already in use in Rome, as they

were, even before this time, among the Etruscans. Indeed, if we take

into consideration the priority of the Etruscan civilization to the

Roman and the relations of vicinity existing between Etruria and the

Roman State, of which it afterward became a part, it is even possible

that dental prosthesis was first practised in Rome by Etruscans.

In a Greek-Roman necropolis near Teano (Province of Caserta, Italy)

there was found in February, 1907, a prosthetic piece of a very

peculiar construction, and which may be considered as quite unique in

its kind. It is an appliance destined to support three inserted human

teeth (the two lower central incisors and the lateral incisor on the

right). These teeth—lost perhaps by the patient himself, in consequence

of alveolar pyorrhea—were fixed by means of a system of rings, made of

laminated gold wire, turned around the teeth and then soldered.

By the examination of the piece it is easy to argue that the author of

this prosthesis made at first three separate rings by tightly turning

the laminated gold wire around each of the three teeth to be applied,

and by soldering together the ends of the wire forming each ring, after

having taken away the tooth, in order not to spoil it in making the

soldering. Then, with another laminated gold wire of sufficient length,

he soldered the three rings together in due position, put the appliance

in the mouth and turned the two ends of the wire around the sound

teeth, serving as a support for the lateral incisor on the left and

the two canines. After this, he took the apparatus delicately out of

the mouth, made the soldering necessary for finishing the skeleton of

the apparatus, forcibly put the three teeth in their respective rings

again, and applied the prosthesis.

This ingenious appliance was found still adherent to the mandible of a

skeleton, in a tomb which, according to the eminent archæologist Dalli

Osso, belongs to a period comprised between the third and the fourth

century before Christ.

From the nature of the objects found in the tomb near the skeleton (a

necklace, perfume vessels, etc.) it was quite evident that the skeleton

bearing the above-described prosthesis was that of a woman.

As the said appliance was found in South Italy (the ancient “Magna

Græcia”) it is quite probable that it was made by some dentist of the

Greek colonies.

The above apparatus belongs to the archæological collection of Signor

Luigi Nobile, in Teano, in whose possession it was found.

[Illustration: FIG. 25

Seen from behind.

FIG. 26

Seen from above.

A prosthetic piece of very peculiar construction (see description),

found in 1907 near Teano, Italy.]

The Romans, as well as the Hebrews, and other peoples of antiquity,

attributed great importance to the integrity of the dental system. This

may be deduced with certainty from another article in the Law of the

Twelve Tables (Table VII, at the rubric _De delictis_), which says:

“_Qui dentem ex gingiva excusserit libero homini, trecentis assibus

multator, qui servo C L._” (Whoever shall cause the tooth of a free man

to fall shall pay a fine of three hundred _as_, and for that of a slave

one hundred and fifty.) The _as_ was worth about ten cents American

money, so that the first fine amounted to about thirty dollars and the

second to about fifteen dollars. These sums, because of the difference

in the monetary value in those times, were considered heavy fines.

After the Romans had conquered Greece (146 B.C.) a very great number

of Greek doctors went to Rome. The wealth, luxury, and ever-increasing

corruption of the metropolis caused the practice of the medical art

(which was almost entirely in the hands of the Greeks) to become a

great source of lucre. But an art practised with the sole purpose

of making money soon degenerates to the level of a trade; it is,

therefore, hardly to be wondered at if very few doctors of that epoch

have merited being recorded in history.

Among these few, the name Asclepiades (born at Prusa, in Asia Minor;

died in Rome ninety-six years B.C.) shines with particular lustre. He

was the founder of the “methodic school,” whose curative precepts,

largely based upon hygiene, come nearer to those of modern scientific

medicine. Unfortunately, all the writings of this great physician,

whose name is almost as glorious as that of Hippocrates, have been

lost; we do not know, therefore, whether and in how far he contributed

to the development of our specialty.

But one of the first places in the history of dental art is due without

doubt to Cornelius Celsus, of whom we will now speak.

CORNELIUS CELSUS. The historical researches in regard to the life of

this celebrated author have given but meagre results. It is uncertain

whether his birthplace was Rome or Verona. The precise dates of his

birth and death are also unknown; but it is very probable that he was

born about thirty years before Christ, and that he died during the

fifth decade of the first century.

Aulus Cornelius Celsus belonged to the illustrious patrician family of

the Cornelii. He was a man of great erudition, and wrote on the most

varied subjects, and among others, on agriculture, on rhetoric, on the

art of warfare, on medicine, etc. All these writings, however, are lost

to us excepting his excellent treatise on medicine.

Some historians consider that Celsus was a true doctor by profession;

others, instead, hold that he never undertook the cure of the sick.

Neither the one nor the other of these opinions is quite acceptable;

and it is much more likely, as Daremberg observes in his valuable

_Histoire des Sciences Médicales_, that Celsus was one of those

philiatri mentioned by Galen, who had studied medicine rather from

books than at the bedside of the sick, but who, although not doctors by

profession, in case of necessity, put their knowledge and skill into

practice on behalf of their relations and friends.[112]

The work of Celsus, gathered in great part from Greek authors, has an

especial value, because it sums up, in an admirable manner, the whole

of the medical and surgical science of the ancients, from the earliest

times up to the days of Augustus.

The first book of the work _De Medicina_[113] does not contain anything

of great importance in regard to dentistry. The following hygienic

precept is, however, worthy of note: “After rising, if it be not

winter, the mouth should be rinsed with a quantity of fresh water.”

In regard to the hygiene of the mouth, nothing more is found in the

work of Celsus; and it is also necessary to note that the aforesaid

precept forms part of a chapter, in which he speaks of the rules of

life, which must be observed by weak people, to which class—the author

remarks—belong a greater part of the inhabitants of cities and almost

all literary men. According to Celsus, therefore, perfectly healthy

and strong people would not even need to wash their mouths with fresh

water, and perhaps the keen-witted Roman doctor was not wrong; for it

is very probable that the saliva and mucous secretion of the mouth,

in perfectly healthy individuals with normal constitutions, have the

power of combating the pathogenic germs that produce caries and other

diseases of the teeth and mouth. In this way the fact can be explained

of many peasants and the greater part of the individuals of the negro

race having such good teeth, without possessing even the remotest idea

of what hygiene of the mouth may be. And here I venture to refer to a

passage in which Celsus alludes to the relation between diseases and

civilization with its vices: “It is probable that in ancient times,

although there was but little knowledge of medicine, health was for

the most part well preserved; this being due to good habits, not yet

spoiled by intemperance and idleness. These two vices, first in Greece

and then among us, have brought upon us a very host of evils; whence it

is that in our days, in spite of the intricate art of medicine—once not

necessary to us, as it is not necessary to other peoples—few among us

attain the beginning of old age.”[114]

In the second book, speaking of the various kinds of disease to which

the different periods of life are subject, he writes: “Children are

especially subject to serpiginous ulcers of the mouth, called by the

Greeks aphthæ.... There are also infirmities due to dentition, such as

ulceration of the gums, convulsions, fever, looseness of the bowels;

and it is especially the eruption of the canine teeth which produces

these disturbances. To these, however, very fat children are more

particularly liable, and those, also, who have costive bowels.”

In Chapter XXV of the fifth book we find the receipt for a narcotic

drug, recommended by the author for producing sleep in persons

tormented with odontalgic and other pains. This receipt is very

complicated, being composed of ten ingredients, among which are acorns,

castoreum, cinnamon, poppy, mandrake, and pepper.

Most important for our subject is Chapter IX, of the sixth book, where

the author treats of odontalgia. “In toothache, which may be numbered

among the worst of tortures, the patient,” says Celsus, “must abstain

entirely from wine, and at first, even from food; afterward, he may

partake of soft food, but very sparingly, so as not to irritate the

teeth by mastication. Meanwhile by means of a sponge he must let the

steam of hot water reach the affected part, and apply externally,

on the side corresponding with the pain, a cerate of cypress or of

iris, upon which he must then place some wool and keep the head well

covered up. But when the pain is violent, the use of purgatives is

very beneficial, the application of hot cataplasms on the cheek, and

the keeping in the mouth of some hot liquid, prepared with fitting

medicine, changing this liquid, however, very frequently. For this

purpose the root of cinquefoil may be boiled in wine, or that of

hyoscyamus (henbane), or a poppy-head, seedless and not too dry, or

the root of the mandrake. But in regard to the last three remedies,

one must be careful not to swallow the decoction whilst it is kept

in the mouth. For the same purpose one may boil the bark of the root

of the white poplar in wine, or the scrapings off a stag’s horn in

vinegar or figs in mulse[115] or in vinegar and honey. It is useful

also to pass repeatedly around the tooth the end of a probe which has

first been wrapped around with wool and then dipped in hot oil. It is

customary also to apply around the tooth certain remedies, after the

manner of plasters. For this purpose the inside of the peel of dried,

bitter pomegranates may be pounded with equal quantities of gall-nut

and pine bark; to these must be added a little minium[116] and the

whole mixed together with the addition of rain water to form a paste;

or else a similar paste may be formed with equal parts of panax,[117]

poppy, peucedanum,[118] and taminia grape[119] without stones; or with

three parts of galbanum to one of poppy. On the cheek, however, must be

applied at the same time the cerate spoken of above, covered over with

wool.”

Celsus then speaks of a revulsive adopted, in his times, against

odontalgia. It was composed of myrrh and cardamom, _ana_ one part;

saffron, pyrethrum, figs, pepper, _ana_ four parts; mustard seed,

eight parts. The plaster, spread on linen, was to be applied on the

shoulder corresponding to the side of the pain, and, according as this

was situated in a tooth of the upper or lower jaw, the revulsive was

applied on the back of the shoulder, or in front.

When a tooth is decayed, Celsus advises that there should be no haste

in drawing it; but that the pain be combated, if the above medicines

are not sufficient, with others more energetic. A mixture may, for

example be applied to the tooth, composed of one part of poppy, two

of pepper, and ten of sory,[120] pounded and mixed to a paste with

galbanum; or else, especially in the case of a molar tooth, the remedy

of Menemacus, resulting from saffron, one part; cardamom, soot from

incense, figs, pepper, pyrethrum, _ana_ four parts; mustard seed, eight

parts; or even a more complicated remedy made with pyrethrum, pepper,

and elaterium,[121] _ana_ one part; scissile alum,[122] poppy, taminia

grape, crude sulphur, bitumen, laurel berries, mustard seed, _ana_ two

parts.

“If, says Celsus, the pain renders necessary the removal of the tooth,

this may be made to fall to pieces, by introducing into the cavity a

pepper berry without its skin, or a berry of ivy, pared in the same

way. The same result may be obtained in the following manner: The sharp

bone (aculeus) of that flat fish called by the Greeks trygon and by us

pastinaca, must first be roasted and then reduced to powder and mixed

with resin, so as to form a paste; which applied around the tooth will

make it fall out. Likewise, scissile alum induces the fall of the

tooth, when introduced into its hollow. This substance, however, is

best introduced into the small cavity, after being wrapped around with

a tuft of wool, for thus the pain is soothed and the tooth preserved.”

Somewhat curious is the following passage, in which Celsus speaks of

the superiority of a method of cure used by peasants, compared to the

remedies advised by the doctors. From his words we clearly see that he,

as we have already remarked, did not belong to the class of doctors

properly so called.

“These are the remedies accepted and held in account among the doctors.

But it is known through the experience of peasants, that when a tooth

aches one must pluck up wild mint by the roots, put it into a large

vessel, pour water on it, and make the patient sit near it, covered all

around with a blanket; and red hot stones should then be thrown into

the water, so that they be entirely immersed; and then the patient,

wrapped all around, as we have said before, and keeping his mouth open,

receives into it the steam evaporated from the water. Thus profuse

perspiration is induced, and a great quantity of pituita flows from the

mouth, and with this a cure is obtained for a very long period, often

for more than a year.”

In the six following chapters of the sixth book, Celsus treats of the

diseases which affect the soft parts of the mouth. Against tonsillitis,

he recommends, among other things, the application of a remedy

principally made of the juice of the sweet pomegranate, cooked, by a

slow fire, to the consistency of honey. The same remedy is also of

great value, according to the author, for the cure of ulcers of the

mouth, when they are accompanied by inflammation, and are somewhat

foul and of a reddish color. But under such circumstances it will also

be necessary to keep frequently in the mouth an astringent decoction,

to which a little honey has been added. The exercise of walking is

also profitable, as well as the taking of food that is not acid. When,

however, the ulcers begin to be clean, the mouth should be frequently

filled with a softening liquid or even with simple pure water. It is

also helpful to drink genuine wine and to eat rather freely, avoiding,

however, acid food. The ulcers must be sprinkled with a powder composed

of two parts of scissile alum to three of unripe gall-nuts. If,

however, the ulcers are already covered with a scab similar to those

produced on burns, some of those compositions should be used which are

called by the Greeks _antheræ_; for example, a remedy may be formed

of equal parts of cyperus,[123] myrrh, sandarac, and alum; or another

which contains saffron, myrrh, _ana_ two parts; iris, scissile alum,

sandarac, _ana_ four parts; cyperus, eight parts.

“Much more dangerous, says Celsus, are those ulcers of the mouth which

the Greeks call _aphthæ_; they oftentimes lead to death in children;

in adult men and women, however, there is not the same danger. These

ulcers begin in the gums; then they attack the palate and the whole

of the mouth, and finally extend to the uvula and to the fauces; when

these parts are attacked, it is not very likely that a child will

recover.”

As to the ulcers of the tongue, Celsus says that those which are

situated at the borders of this organ last a very long time, and he

adds: “It should be seen whether there may not be some sharp tooth

opposite, which hinders the ulcer from healing; in case such a tooth

exists, it should have its edge taken off with a file.”

He then passes on to speak of the diseases of the gums: “Often small

painful tumors, called by the Greeks _parulides_, are produced on

the gums. It is necessary at the very first to rub them softly with

powdered salt, or with a mixture of burnt mineral salt, cyperus, and

catmint, meanwhile keeping the mouth open until there flows from it a

good quantity of pituita; after which the mouth must be rinsed with

a decoction of lentils. But if the inflammation is great, the same

remedies must be used as are adopted for the ulcers in the mouth, and

between the tooth and the gum must be inserted a small tent of soft

lint, on which has been smeared some one of those compositions which

we have said are called _antheræ_. If this, owing to the hardness of

the tumor, is not possible, then by means of a sponge the steam of hot

water should be made to act upon the diseased part, and, besides, an

emollient cerate must be applied upon it.

“Should suppuration show itself, it will be necessary to use the

above-mentioned steam for a longer period; to keep in the mouth hot

mulse, in which some figs have been cooked, and to lance the tumor

before it is perfectly ripe, so that the pus may not, by remaining too

long in the diseased part, injure the bone. But if the tumor be of

great size, it will be more advisable to remove it entirely, so that

the tooth remain free on both sides. After the pus has been extracted,

if the wound be a small one, it is sufficient to keep hot water in the

mouth, and to use externally fomentations of steam, as mentioned above;

if it be large, it will be fitting to use the decoction of lentils and

the same remedies with which all other ulcers of the mouth are cured.

“It also happens, sometimes, that from an ulcer of the gums—whether it

follow a parulis or not—one may have for a long period a discharge of

pus, on account of a broken or rotten tooth, or else on account of a

disease of the bone; in this case there very often exists a fistula.

Then the latter must be opened, the tooth extracted, and if any bony

fragment exist, this should be removed; and if there be anything else

diseased, this should be scraped away. Afterward, the same remedies

which have been indicated for the other ulcers of the mouth must be

used.

“If the gums separate from the teeth, it will be useful, in this

case also, to employ those remedies called _antheræ_. But it is also

beneficial to chew unripe pears and apples and to keep their juices in

the mouth. Equal advantage can be derived from keeping vinegar in the

mouth, provided it be not too strong.

“Whenever ulcers of the mouth are attacked by gangrene, it is necessary

first to consider whether the whole body be unhealthy, and in that

case, to do what is necessary to strengthen it. When the gangrenous

ulcer is superficial, the use of _antheræ_ is sufficient; when it is

somewhat deeper, a mixture must be applied on it, of two parts of

burnt paper[124] to one of orpiment;[125] when it is very deep, three

parts of burnt paper to a fourth part of orpiment must be used; or

else, equal parts of roasted salt and roasted iris; or lastly, equal

parts of chalcites, lime, and orpiment. It is, however, necessary to

dip a small pledget of lint in oil of roses, and put it on the caustic

medicinals, so that these may not injure the neighboring healthy parts.

If the disease is in the gums, and some of the teeth are loose, it is

necessary to pull them out, for they greatly hinder the cure. When

this latter, however, cannot be obtained by drugs, the ulcer must be

cauterized with a red-hot iron.”

Chapter XII of the seventh book is, of all the work of Celsus, the

one which presents to us the greatest interest, since there the author

treats of the surgical operations required by the diseases of the

dental apparatus.

He first speaks of the looseness of the teeth, caused by the weakness

of their roots, or by the flaccidity of the gums, and says that in

these cases it is necessary to touch the gums lightly with a red-hot

iron, then to smear them with honey and wash them with mulse, and later

on to strengthen them by means of astringent substances.

“When a tooth aches, and it is thought well to extract it, because

medicaments are of no use, the gum must be detached all around, and

then the tooth must be shaken until it is well loosened, it being very

dangerous to draw a firm tooth, as this may sometimes give rise to a

dislocation of the lower jaw. And greater still is the danger in regard

to the upper teeth, as this might cause a shock to the temples and

eyes. After having well loosened the tooth, it must be pulled out by

the fingers, if this is possible; or if not, with the forceps.”

[Illustration: FIG. 27

Dental and surgical instruments represented in a funeral marble of the

Lateran Museum, Rome.]

It is clear that this method of tooth drawing—so excessively cautious

and timid—must have been very torturing to the poor patients. A

thousand years and more after Celsus, Abulcasis still counsels the same

exaggerated precautions, and says that the extraction of a tooth must

not be performed in a rapid and violent way after the manner of the

barbers. From this one may see that the operation spoken of was then

very often performed by certain unprofessional persons, who, being very

familiar with it, carried it out with great indifference and rapidity,

thus sparing the patients the long-protracted martyrdom which the

erudite doctors, followers of Celsus, thought necessary to make them

endure. Very probably the same happened in the days of the wise Roman

doctor.

When there is a large carious hollow in the tooth to be extracted,

Celsus recommends that it should first be filled up either with lint

or with lead, in order to prevent the tooth from breaking under the

pressure of the instrument. “The latter,” he continues, “must be made

to act in a straight direction, in order to avoid fracture of the bone.

The danger of fracture is still greater in the case of short teeth;

often the forceps, not being able to grasp the tooth well, takes hold

of the bone with it and fractures the latter. When after the extraction

of a tooth much blood flows from the wound, this indicates that some

part of the bone has been broken. It is necessary then to search for

the detached piece of bone with the probe and to extract it with the

forceps. If this be not successful, an incision must be made in the

gums just as large as is necessary for the extraction of the fragment.

When this is not taken out, it often happens that the jaw swells in

such a manner as to prevent the patient from opening his mouth. In such

a case it is necessary to apply to the cheek a hot cataplasm of flour

and figs, so as to induce suppuration, after which the gums must be

lanced and the splinter of bone extracted.”

When the teeth show blackish stains, Celsus advises such stains to

be scraped away, and the teeth afterward to be rubbed with a mixture

of pounded rose leaves, gall-nuts, and myrrh, and the mouth to be

frequently washed with pure wine. It is necessary besides, says the

author, to keep the head well covered, to walk a great deal, and to

partake of no acid food.

“If by effect of a blow or other accident some of the teeth become

loose, it is necessary to bind them with gold wire to the neighboring

firm teeth, and besides to keep in the mouth astringent substances, for

example, wine in which the rind of pomegranates has been boiled, or

into which some burning hot gall-nuts have been thrown.”

“When in a child a permanent tooth appears before the fall of the milk

tooth, it is necessary to dissect the gum all around the latter and

extract it; the other tooth must then be pushed with the finger, day by

day, toward the place that was occupied by the one extracted; and this

is to be done until it has firmly reached its right position.”

“Now and again it happens that when a tooth is pulled out its root

remains in the socket; it is then necessary to extract it at once, with

the forceps adapted for the purpose, called by the Greeks _rizagra_.”

The last book of the work of Celsus treats chiefly of fractures and

dislocations. In the first chapter the position and form of the bones

of the whole human body are described, although not very exactly.

Speaking of the teeth, the author says: “The teeth are harder than the

bones, and are fixed, some on the _maxilla_ (lower jaw) and some on the

overhanging bone of the cheeks.”[126]

“The first four teeth, being cutting teeth (incisors), are called by

the Greeks _tomici_. These are flanked on both sides by one canine.

Beyond this there ordinarily exist, on both sides, five grinders,

except in the case of those persons in whom the last molars, which

commonly are cut very late, have not yet appeared. The incisors and

the canines are fixed with one single root; but the molars at least

with two, some even with three or four. In general, the shorter the

tooth, so much the longer is its root. A straight tooth commonly has a

straight root, a curved tooth has it generally curved. The root of a

temporary tooth produces in children a new tooth, which usually pushes

out the first; sometimes, however, the new tooth appears either above

or below it.”

In the seventh chapter Celsus treats of fractures in general, but in

particular of those of the lower jaw.

“To reduce a fracture of this bone, it should be pressed in a proper

manner, from the inside of the mouth and from the outside, with the

forefinger and thumb of both hands. Then in the case of a transverse

fracture (in which case generally an unevenness in the level of the

teeth is produced), it is necessary, after having set the fragments

in place, to tie together the two teeth nearest to the fracture with

a silk thread, or else, if these are loose, the following ones. After

this, one should apply externally, on the part corresponding to the

lesion, a thick compress, dipped in wine and oil and sprinkled with

flour and powdered olibanum. This compress is to be fixed by a bandage

or by a strip of soft leather, with a longitudinal slit in the middle

to embrace the chin, the two ends being tied together above the head.

The patient must fast the first two days; then he may be nourished with

liquid food, but in small quantities, abstaining, however, completely

from wine. On the third day it is necessary to take off the apparatus,

and after having fomented the part with the steam of hot water, to

replace it. The same is to be done on the fifth day, and so on, until

the inflammation has subsided, which generally happens from the seventh

to the ninth day. After the symptoms of inflammation have vanished, the

patient may take abundant nourishment; he must, however, abstain from

chewing until the fracture is completely consolidated; and, therefore,

he will continue to nourish himself with soups and like food. He must

also entirely abstain from speaking, especially during the first few

days. Fractures of the jaw commonly heal from the fourteenth to the

twenty-first day.

“In luxations of the jaw (Chapter XII) the bone is always displaced

forward; but sometimes only on one side, and sometimes on both sides.

When the dislocation is only on one side, the chin and the whole jaw

are found deviated toward the part opposite to the luxation; and

the similar teeth of the two dental arches do not correspond; but

instead under the upper incisors will be found the canine tooth of

the dislocated part. If, however, the luxation is bilateral, the

chin inclines and projects forward; the lower teeth are farther in

front than the upper ones, and the muscles of the temples are tightly

stretched. The reduction of the luxation must be performed as quickly

as possible. The patient having been made to sit down, an assistant

holds the head firmly from behind; or else the patient is made to sit

with his shoulders against a wall, with a hard cushion between this and

his head, whilst the assistant holds the head against the cushion, and

so keeps it steady. Then the operator, after wrapping his two thumbs in

linen cloth or strips, that they may not slip, introduces them into the

patient’s mouth and, applying the other fingers on the outside, firmly

grasps the jaw. Then whilst lowering the back part of the latter, he

shakes the chin and pushes it upward and backward, seeking to shut the

mouth, and in this way making the jaw return to its natural position.

“The bone having been replaced, if the accident should have given rise

to pains in the eyes and neck, it will be well to draw blood from the

arm. After the luxation has been reduced, the patient must be nourished

for some time on liquid food, and abstain, as much as possible, from

speaking.”

CAIUS PLINIUS SECUNDUS. After Celsus, a very celebrated writer on

medicine and natural science was Caius Plinius Secundus. He was born

at Como in the year 23 of the Christian era, and flourished from the

days of Nero to those of Vespasian. Endowed with a liberal education,

he gave himself up to public life, filling many important posts, among

which, that of Governor of Spain under Nero and his successors. In

the year 79 after Christ, while he was in command of the Roman fleet

at Misenum, the tremendous eruption of Vesuvius took place, by which

Pompeii, Herculaneum, and other neighboring cities were destroyed.

Pliny, driven by the desire to study that marvellous and awful natural

phenomenon, betook himself to Stabia, but was there suffocated by the

ashes and smoke erupted by Vesuvius.

In spite of the many places occupied by him, Pliny found time to

write many works, and among these the thirty-seven books on _Natural

History_, which have given him eternal fame.

It is not at all to be wondered at that this immense work contains a

great number of fables, superstitions, and errors of every kind. To

sift the true from the false was not an easy thing, at a time when

there was almost no idea as to how natural phenomena were produced,

and when all scientific criticism was impossible, for the very simple

reason that true science did not exist.

To give an idea of the great absurdities which were believed in at that

epoch, and which were considered possible even by higher intellects

such as Pliny’s, the following passages will suffice: “In many

mountains of India, according to what Ctesia writes, there are men

with dogs’ heads, who clothe themselves with the skins of wild beasts

and bark instead of speaking. There are also a kind of men having only

one leg, and who have great speed in leaping. Others are without any

neck and have their eyes between their shoulders. Megasthenes writes

that among the nomad Indians are men who instead of a nose have only

holes, and have their legs bent like serpents. At the extreme confines

of India, toward the East, are men without any mouth and with their

bodies entirely covered with hair, who live on nothing but air and

odors, which they inhale through the nose.”[127]

In Pliny’s day the most prodigious virtues were attributed to herbs; in

regard to this the following example is sufficient:

“The herb near which dogs may have made water, when gathered, but

without being touched by iron, cures luxations very promptly.”[128]

It must not be thought that Pliny accepted such beliefs without

reserve. He notes them, because preceding authors had accepted them,

and because if certain things appear to us evidently absurd, their

absurdity could not be equally evident at a period when little more

than nothing was known in regard to physical and physiological laws,

and when the impossibility of rationally explaining natural effects

led men to admit the existence of marvellous virtues and influences in

every being and in all bodies. On the other hand, Pliny expressly says,

for his own justification, in Chapter I of Book VII: “I do not want to

bind my faith in many things which I am about to say; but rather refer

the readers to the authors from whom I have taken them.”

As is to be expected, we find in Pliny’s works, in regard to teeth, a

strange mixture of truth and errors.

In Chapter XV of Book VII, after having said that some children are

born with teeth, and after having cited, as examples, Manius Curius,

who was therefore called Dentatus, and Gnæus Papirius Carbo, both

illustrious men, he adds:

“In women such a thing was considered a bad augury in the days of the

kings. In fact, Valeria having been born with teeth, the seers said

that she would be the ruin of the city to which she would be taken; she

was sent to Suessa Pometia, which in those days was a very flourishing

city; and, in fact, the prediction was verified. Some, instead of

teeth, have an entire bone; of this there was an example in the son of

Prusias, King of Bithynia, who instead of upper teeth had one single

bone.”

“The teeth alone are not consumed by fire, and do not burn with the

rest of the body. And yet these teeth, which withstand the flames,

are worn away and hollowed out by pituita. They wear out by being

used. Nor are they necessary for mastication alone, for the foremost

ones regulate the voice and words, producing by the beat of the tongue

special sounds.”

“Men have thirty-two teeth, women a lesser number. It is, however,

believed that augury may be taken from the teeth; and to have a greater

number than usual is considered an indication of long life. The

presence of two eye teeth at the right side of the upper jaw presages

favorable fortune, as was verified in Agrippina, the mother of Domitius

Nero; on the left side, however, they are of sad foreboding.”

“The last teeth, which are called the genuine teeth, appear toward the

twentieth year of age; many persons, however, do not have them until

their eightieth year. Teeth fall out in old age and then spring up

again; of this there can be no doubt. Mutianus writes of having known

a certain Zancle of Samothracia, in whom teeth reappeared after he had

completed his one hundred and fourth year. Timarcus, son of Nicocles of

Paphus, had two rows of molar teeth, whilst a brother of his did not

change his incisor teeth at all, which, therefore, wore down little

by little. There once lived a man who had a tooth in his palate. The

canine teeth, when by any chance they fall out, do not reappear any

more.”[129]

“In the teeth of man there exists a poisonous substance which has the

effect of dimming the brightness of a looking-glass when they are

presented uncovered before it; and if they are uncovered in front of

young unfledged pigeons, these take ill and die.”[130]

The second of these two statements is but a prejudice, like many

others; but we find the first very strange indeed, it being a

surprising thing that a man like Pliny should have attributed to

an imaginary poison of the teeth what is the simple effect of the

moistures of the breath.

In Chapters CXV and CXVII of Book XI are found some observations which

are somewhat interesting to us:

“A man’s breath becomes infected by the bad quality of food, by the bad

state of the teeth, and still more by old age.”

“Simple food is very beneficial to man; the variety of flavors

instead is very harmful. Sour or too abundant foods are digested with

difficulty, and also those which are ravenously swallowed. As a remedy,

vomiting has come into use; but it makes the body cold and is most

pernicious to the eyes and to the teeth.”

There is no doubt that the habit of often provoking vomitus—which,

in those times of excessive corruption and intemperance, had come

into general use—must have resulted in enormous harm to the teeth,

especially by the action exercised upon them by the hydrochloric

acid contained in the gastric juice, and by the organic acids of

fermentation.

Among the vegetable remedies in those times considered of use against

odontalgia, the principal ones are mentioned in Chapter CV of Book XXV:

“It is beneficial against toothache to chew the root of panax, and

likewise to wash the teeth with its juice. It is also useful to

chew the root of hyoscyamus soaked in vinegar, or else that of the

polemonium. It is also beneficial to chew the roots of the plantain, or

to wash the teeth in a decoction of plantain in vinegar. A decoction of

the leaves is also useful, not only in the case of simple toothache,

but also when the gums are tender and easily bleed. The seed of

the same plant cures inflammations and abscesses of the gums. The

aristolochia strengthens the gums and the teeth. The same effect may be

produced by masticating the verbena with its root, or by washing the

mouth with a decoction of it in wine or vinegar. Similarly the roots

of the cinquefoil are helpful when boiled down to a third, in wine or

vinegar; however, they must first be washed in salt water or brine. The

decoction must be kept for a long time in the mouth.

“Instead of using the decoction of cinquefoil, some prefer to rub the

loose teeth with the ashes of this plant. Besides the above-mentioned

remedies, the root of the verbascum boiled in wine, hyssop, and the

juice of the peucedanum with opium are also employed; and it is also

beneficial to pour into the nostrils, on the side opposite to that of

the sick tooth, some drops of the juice of anagallis.

“It is said that if senecio be taken from the earth, and the aching

tooth be touched three times with it, spitting alternatively three

times, and then the herb be replanted in the same spot, so that it may

continue to live, the tooth will never give pain any more.”[131]

“In the fuller’s thistle,[132] an herb which grows near rivers, is

found a small worm, which has the power of curing dental pains, when

the said worm is killed by rubbing it on the teeth, or when it is

closed up with wax in the hollow teeth.”[133]

“Apollonius writes that a very efficacious remedy for pains in the gums

is to scratch them with the tooth of a man who has suffered a violent

death.”[134]

“It is considered very beneficial for toothache to bite off a piece

from wood which has been struck by lightning, and to touch the sick

tooth with it; but whilst biting off the little piece of wood, it is

necessary to keep both hands behind the back.”[135]

“Experience teaches that against the bad odor of the breath it is

useful to wash the mouth with pure wine before sleeping, and that to

avoid aching of the teeth, it is a good thing to rinse the mouth, in

the morning, with several mouthfuls of fresh water, but of an odd

number.”[136]

“A remedy for toothache is to touch the diseased teeth with the

tooth of a hyena,[137] or to scratch the gums with the tooth of a

hippopotamus which has been taken from the left side of the jaw.”[138]

“The ashes of stag’s horn, rubbed over loose and aching teeth, makes

them firm and soothes the pain. Some consider that to produce the same

effect, of greater virtue is the powder of the horn, unburnt. Both

the ashes and the powder of stag’s horn are employed as a dentifrice.

The ashes of the head of a wolf are a great remedy for toothache.

Such pains are also made to cease by wearing certain bones that are

oftentimes found in the dung of this animal. The ashes of the head of a

hare is a useful dentifrice; and if spikenard be added, it will lessen

the bad smell of the mouth. Some mix with it the ashes of the heads of

mice. In the side of the hare is a bone as sharp as a needle; and many

advise pricking the teeth with this when they ache. The heel of the ox

kindled and brought close to loose teeth makes them firm. The ashes of

this bone mingled with myrrh is a good dentifrice. A good dentifrice

is also made from the ashes of the feet of a goat. To strengthen teeth

loosened by a blow, asses’ milk or the ashes of the teeth of this

animal are very useful. In the heart of the horse there is a bone like

an eye-tooth; it is said that it is very beneficial to pick with it the

teeth that ache. The carpenter’s glue boiled in water and plastered

on to the teeth also takes away their pain; but soon after it must be

taken away and the mouth rinsed with wine in which have been boiled the

rinds of sweet pomegranates. It is also thought beneficial to wash the

teeth with goat’s milk or with ox-gall.”[139]

“Butter, either alone or with honey, is very useful for children; and

is very helpful, especially during dentition, in the diseases of the

gums, and to cure the ulcers of the mouth. To prevent the disorders

that generally accompany dentition, it is a useful thing that the child

should wear a wolf’s tooth, or one of the first teeth lost by a horse.

The rubbing of the gums with goat’s milk or with hare’s brain renders

the cutting of teeth much easier.”[140]

“To sweeten the breath it is very helpful to rub the teeth and the gums

with wool and honey.”[141]

“The filth of the tail of sheep rolled up in little balls, and left to

dry and then reduced to powder and rubbed on the teeth, is marvellously

useful against the loosening and other diseases of the teeth themselves

and against the cankerous ulcers of the gums.”[142]

“Eggshells deprived of their internal membrane and afterward burnt

afford a good dentifrice.”[143] (Hence we see that the use of carbonate

of lime as a dentifrice is a very ancient one.)

“If the head of a dog that has died mad be burnt, the ashes obtained

may be advantageously used against toothache, mixing it with cyprine

oil and then dropping the mixture into the ear, on the side of the

pain. It is beneficial also to pick the sick tooth with the longest

tooth, on the left side, of a dog; or with the frontal bones of a

lizard, taken from the head of the animal at full moon, and which

have not touched the earth. The teeth of a dog, boiled in wine until

this is reduced to one-half, thus, furnish a mouth wash which can

be advantageously used against toothache. In the cases of difficult

dentition, benefit is derived by rubbing the gums with the ashes of

the teeth of a dog, mixed with honey. Such ashes are also used as a

dentifrice. In hollow teeth it is useful to introduce the ashes of

the dung of mice, or of the dried liver of lizards. It is the opinion

of some, that in order not to be subject to toothache, a mouse should

be eaten twice a month. If earth-worms be cooked in oil, this latter

has the virtue of calming toothache when dropped into the ear on the

side of the pain. The same effect is obtained by rubbing the teeth

with the ashes of the aforesaid worms, after they have been burnt in

a terra-cotta vase; and if such ashes be introduced into the hollow

teeth, these fall out very easily. A good remedy against toothache is

to wash the mouth with vinegar of squills in which earth-worms and

the root of the mulberry have been boiled. The ashes of the shells of

snails mixed with myrrh, rubbed on the gums, strengthens them. Even

the slough which the snakes cast off in spring can furnish a remedy

against toothache. For this purpose it must be boiled in oil, with

the addition of resin of the larch, and then the oil dropped into the

ear. For the same purpose, according to some, oil of roses is useful,

when a spider, caught with the left hand, has been pounded in it. If a

sparrow’s fledglings be burnt with dry vine twigs, the resulting ashes

rubbed with vinegar on the teeth makes all pain cease in them.[144] It

is stated by many that to improve the odor of the breath, it is well

to rub the teeth with ashes of mice mixed with honey. Some also mingle

with this the root of fennel. Picking the teeth with the quill of a

vulture renders the breath sour. It makes the teeth firm to pick them

with a porcupine’s quill. A decoction of swallows in wine sweetened

with honey cures ulcers of the tongue and lips. Scaldings in the mouth

produced by hot food or drinks are readily healed with the milk of a

bitch.”[145]

That Pliny did not put great faith in many of the things which he

relates is clearly proved by several passages of his book, and among

others by the following:

“One can hardly relate without laughing, some things, which, however,

I will not omit, because they are found already written. They say

that the ox has a small stone in the head, which it spits out when

it fears death; but if its head be suddenly cut off, and the stone

extracted, this, worn by a child, helps it in wondrous manner to cut

its teeth.”[146]

In Book XXXI, Pliny speaks of various waters—mineral, thermal,

etc.—especially from the medical point of view. It was already known

in those days that those waters were most active agents. And in this

respect a fact which the author relates in Chapter VI of Book XXV is

worth mentioning:

“When Caesar Germanicus moved his camp beyond the Rhine, there was

found, in the whole maritime tract of the country, only one spring of

fresh water, the drinking of which, within two years, produced the fall

of teeth and a loosening of the knee-joints. The doctors called these

evils stomacace and scelotyrbe.”

Sea salt and nitre are of use, according to Pliny, against various

maladies of the teeth and mouth. He counsels the application of salt

on lint to the ulcers of the oral cavity, and to rub it on the gums

when they are swollen. To prevent diseases of the teeth, it would be

advantageous, every morning before breaking one’s fast, to keep a

little salt under the tongue until it is dissolved. Against the pain

of the teeth it would be beneficial to use common salt dissolved in

vinegar, or nitre in wine.

“The rubbing of the blackened teeth with burnt nitre gives them back

their natural color.”[147]

The prophylactic remedies against odontalgia believed in, at that

period, were sufficiently numerous, and, among many other such things,

Pliny informs us that in order not to be subject to toothache, it is

sufficient to wash the mouth three times a year with the blood of the

tortoise.[148] Analogous virtue was also attributed to the brain of the

shark, which was boiled in oil, and this put by for washing the teeth

with once a year.

Besides the many anti-odontalgic remedies so far related, several

others are found enumerated in Chapter XXVI of Book XXXII:

“The pain in the teeth is lessened by picking the gums with the bones

of the sea dragon. It is also very beneficial to pick the gums with

the sharp bone of the puffin.[149] If the same be pounded together

with white hellebore, and the mixture thus obtained be rubbed on the

diseased teeth, they may be made to fall out without pain. The ashes,

also, of salt fish burnt in an earthen vase, with the addition of

powdered marble, is a remedy against toothache. Frogs are also boiled

in a hemina[150] of vinegar, the decoction being then used to wash

the teeth with; but this, however, must be kept in the mouth for

some length of time. In order to render this remedy less nauseous,

Sallustius Dionisius used to hang several frogs, by their hind feet,

over a vase in which he boiled the vinegar, so that the juices of the

animals might drip into this from their mouths. To make loose teeth

firm, some advise the soaking of two frogs, after having cut off

their feet, in a hemina of wine, and the washing of the mouth with

the latter. Others tie them, whole, on the jaws. Some, to strengthen

unsteady teeth, rinse them with a decoction made by boiling ten frogs

in three sextaries[151] of vinegar, until the liquor is reduced to

one-third. By others, thirty-six hearts of frogs are well boiled in

a sextary of old oil, in a copper vessel, and the oil is then used

against toothache, dropping it into the ear, on the side of the pain.

Some, after having boiled the liver of a frog, pound it with honey, and

smear it on the sore teeth. If the teeth are decayed and fetid, many

counsel the drying of a hundred frogs in an oven, leaving them there

for one night, then the addition of an equal weight of salt, reducing

the whole to powder, and rubbing the teeth with it. In such cases the

ashes of crabs are also used. That of the murex[152] is adopted as a

simple dentifrice.”

“The cutting of teeth is facilitated by rubbing the gums of the child

with the ashes of dolphin’s teeth mixed with honey, or even simply by

touching the gums with a tooth of this animal.”[153]

In Chapter XXXIV of Book XXXVI it is said that the decoction of

gagates[154] in wine cures the diseases of the teeth; and in Chapter

XLII of the same book are praised the dentifrice powders made of pumice

stone.

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

The diseases of the teeth were, in those days, most common; very

often we find mention of loose teeth, and the medicines suited to

make them firm again; from which we may deduce the great frequency

of alveolar pyorrhea. It is reasonable to think that such a fact was

caused principally by the intemperate life of those times, in which

the followers of Epicurus were extremely numerous and the unbridled

desire for pleasure reached such a degree that no abhorrence was felt

of provoking vomit during the course of a long banquet, in order to

continue dining merrily.

Concerning the teeth, their affections, and the means of healing and

preventing them, the strangest superstitions existed, and this not

only among the common, but also among educated and learned people. The

number of remedies reputed useful against diseases of the teeth was

extraordinarily great; but the modern saying, “therapeutic wealth is

poverty,” could have been applied only too well.

Of the cleanliness of the teeth, it seems, great care was taken, for

dentifrices were in great use. These, as we have already seen, were

made of the most varied substances—stag’s horn burnt, ashes obtained

by burning the head of the mouse, of the hare, of the wolf, etc.,

eggshells burnt and reduced to powder, pumice stone, and so on. For the

cleanliness of the mouth, for strengthening the teeth and gums, mouth

washes of sundry kinds were likewise adopted, especially formed of

decoctions of astringent substances in water, wine, and vinegar.

Not only among the Romans was great care given to the cleanliness and

beauty of the teeth, but also among many other nations. In this regard

the following poem of Catullus, in which he lashes the silly vanity of

a Celtiberian resident in Rome, who made continual show of his white

teeth, is somewhat interesting:

“Egnatius, quod candidos habet dentes

Renidet usquequaque; seu ad rei ventum est

Subsellium, cum orator excitat fletum,

Renidet ille: seu pii ad rogum filii

Lugetur, orba cum flet unicum mater,

Renidet ille; quidquid est, ubicumque est,

Quodcumque agit, renidet: hunc habet morbum,

Neque elegantem, ut arbitror, neque urbanum.

Quare monendus es mihi, bone Egnati,

Si Urbanus esses, aut Sabinus, aut Tiburs,

Aut parcus Umber, aut obesus Hetruscus,

Aut Lanuvinus ater, atque dentatus,

Aut Transpadanus, ut meos quoque attingam,

Aut quilibet, qui puriter lavit dentes:

Tamen renidere usquequaque te nollem;

Nam risu inepto res ineptior nulla est.

Nunc, Celtiber, in celtiberia terra

Quod quisque minxit, hoc solet sibi mane

Dentem, atque russam defricare gingivam.

Ut quo iste vester expolitior dens est,

Hoc te amplius bibisse prædicet lotii.”[155]

STRABO. From Strabo we learn that the Cantabri and other peoples of

Spain used to clean their teeth and sometimes even to wash their face

not with fresh, but with old urine, which, so it seems, was kept for

the purpose, in suitable cisterns![156]

In regard to this filthy custom, Joseph Linderer says[157] that the

superstition has reached even to our times, although not widely

diffused, that, to beautify the face, it is useful to wash it with

urine. He relates that he knew a girl who, to become beautiful, had

recourse to this heroic method, but, unfortunately, without at all

obtaining the desired end!

MARTIAL. In the epigrams of Martial (about 40 to 101 A.D.) allusions of

great value with regard to several points concerning the subject we are

treating of are found.

Toothpicks (_dentiscalpia_) are mentioned by this poet several

times; from which we may argue that they were in great use. They

were ordinarily made of lentisk wood (_Pistacia lentiscus_), as may

be deduced from the Epigram LXXIV of Book VI, in which the author

ridicules the old dandy who, stretched at length on the triclinium,

cleans with _lentiski_ the toothless mouth, to give himself the air

of a man not too far stricken in years.[158] Besides, in Book XIV,

containing, for the greater part, saws and sayings on objects of common

use, there is an epigram bearing the title of “Dentiscalpium,” in which

the author says that toothpicks of lentisk are to be preferred, but

that, in their absence, quill toothpicks may be used.[159]

[Illustration: FIG. 28

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

From other sources we learn that in those days metal toothpicks

were also made use of. So in a satire of Petronius, it is said that

Trimalchiones made use of a silver toothpick (_spina argentea_).

Objects of this kind, both Roman and of other origin, are even now in

existence, and may be found in various collections of antiquities. In

Crimea a most elegant gold object, of Greek make, was found, which is,

by its two ends, both a toothpick and an ear-picker. It belongs most

probably to the fourth century before Christ.[160]

In an object found in the north of Switzerland, and coming from a

Roman military colony of the times of the Empire, the toothpick and

ear-picker are joined at one of their ends, by a pivot, to other toilet

articles.[161]

[Illustration: FIG. 29

A metal toothpick and ear-picker joined to other toilet articles. An

object found in Switzerland, in the ancient seat of a Roman military

colony.]

[Illustration: FIG. 30

An ancient toothpick and ear-picker of bronze, found in the north of

France, at Bavai (the ancient Bagacum).]

Caylus, in his valuable work _Recueil d’antiquités égyptiennes,

étrusques, grecques, romaines et gauloises_ (Paris, 1752 to 1767),

gives the picture of a toothpick and ear-picker of bronze, two inches

long, with the middle part wrought in spiral form, so as to increase

the solidity of the article, and also to enable the hand to keep it

easily firm in all positions. It was found in the north of France, at

Bavai (the ancient Bagacum), and forms part of the collection of M.

Mignon of Douai.[162]

Martial is one of the first Roman writers who speak clearly of

artificial teeth. In Epigram LVI of Book XIV, the poet, by a bold

personification, makes the dentifrice powder say to a toothless old

woman, furnished with false teeth: “What have you got to do with me?

Let a girl use me. I am not accustomed to clean bought teeth.”[163]

Elsewhere[164] Martial atrociously derides a courtesan, who, among her

other physical defects, was also without an eye: “Without any shame

thou usest purchased locks of hair and teeth. Whatever will you do for

the eye, Laelia? These are not to be bought!”[165]

This epigram shows that, while dental prosthesis was already in use,

ocular prosthesis did not as yet exist.

To a plagiarist, who passed off Martial’s poetry as his own, the latter

says: “With our verses, O Fidentinus, dost thou think thyself and

desire to be thought a poet. Even so, it seems to Ægle that she has all

her teeth, because of her false teeth of bone and ivory.”[166]

There is, therefore, not the least doubt that in the days of Martial

artificial teeth were in use; and that these, as may be seen from

the epigram just now quoted, were made of ivory and bone; we do not

know whether they were formed also of other substances. The question,

however, arises: In those times did they manufacture movable artificial

sets, or was the dental art then limited to fixing the artificial teeth

unmovably to the neighboring firm teeth, by means of silk threads, gold

wire, and the like? The answer to this question may be found in another

epigram of Martial,[167] where the latter ridicules a wanton old woman,

telling her, among other things still worse, that she at night lays

down her teeth just as she does the silken robes.[168]

It is, therefore, beyond all doubt that, at that period, the manner of

constructing movable artificial sets was known; and most probably not

only partial pieces were made, but even full sets. In fact, from the

verse quoted above we have justly the impression that the poet means a

whole set rather than a few teeth.

From the words of Martial, it may also be concluded that these dentures

could be put on and off with the greatest ease; or, as we may say, by

a maneuver as simple as that of removing any articles of apparel; they

must, therefore, have been extremely well constructed.

This alone should be sufficient, even were further proof wanting,

to give us an idea of the degree of development and of the point of

perfection reached by dental prosthesis at that time. But besides this,

we now also possess an ancient Roman piece furnishing a palpable proof

of the ability and ingenuity of the dentists of that epoch. Some few

years since, I had occasion, in the pursuit of dental archæological

research, to visit the Museum of Pope Julius in Rome, where I was shown

a prosthetic piece, not yet exhibited to the general public, that had

been discovered a few months previous in excavating at Satricum, near

Rome. I was invited to give an opinion as to this appliance, and, after

having examined it accurately, became aware, not without some emotion,

I am fain to confess, that I held in my hands a prosthetic piece of

exceptional historical importance, that is, no less than a specimen of

ancient _crown work_.

[Illustration: FIG. 31

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

[Illustration: FIG. 32

The same, seen from below.]

The appliance found at Satricum (Fig. 31) is made in the following

manner: Two small plates of gold, stamped out, represent respectively

the lingual and labial superficies of a middle lower incisor; these

two pieces soldered together form the crown of the tooth. At its base

the crown is soldered, back and front, to a narrow strip of gold which

folds back on itself at each end, so as to tightly encircle the two

neighboring teeth on the right and on the left, which thus serve as

supports to the appliance.

We are now, therefore, able not only to affirm that the Etruscans knew

how to execute a kind of _bridge work_, but that later the dentists of

ancient Rome even carried out _crown work_.

This, notwithstanding the examples of dental prosthesis discovered

up to now in Roman and Etruscan tombs, can in no way be considered

as representing all the varieties of dental prosthesis of ancient

construction. It is to be hoped that, in spite of the destructive

action of time, in continuing the excavations and archæological

researches, many other specimens of early dental prosthesis will yet

come to light. In any case, judging by some indications to be found

in Latin literature, it must be admitted that the Roman dentists of

antiquity constructed other kinds of prosthesis besides the specimens

we possess, and in particular movable dentures. We are led to suppose

this, not only from the above cited epigram of Martial, but also from

what we read in one of the satires of Horace, who dates contemporarily

with Augustus, and therefore anteriorly to Martial. Speaking of two

old witches who had been put to flight by Priapus, Horace writes: “You

would have laughed to see those two old witches run toward the town,

losing in their flight, Canidia, her false teeth, Sagania, her false

hair.”[169]

Now, as Prof. Deneffe very rightly observes, the prosthetic appliances

of antiquity known to us are so firmly fixed to the natural teeth

that no race, however unbridled, could ever have made them fall out

of the mouth. It must, therefore, be admitted, as I have said, that

the ancients constructed other kinds of dental appliances, of which no

specimens have, as yet, been discovered.

Neither in Celsus nor in Pliny, nor in any other Roman writers on

medicine, do we find any allusion to the art of dentistry. The doctors

of those days probably had no idea of the advantages which could be

derived from dental prosthesis in regard to digestion and consequently

to the health of the whole body. They therefore must have considered

artificial teeth as something totally foreign to their art, and

intended solely to hide a physical defect. It is therefore not at all

surprising that they have not treated of this subject.

As the art of setting artificial teeth was exercised by persons not

belonging to the medical profession, it is very probable that these

persons also undertook the extraction of teeth and the cure of dental

pains. Martial (Book X, Epigram LVI) names a certain Cascellius, who,

he says, “extracts or cures diseased teeth,”[170] and this is the first

dentist whose name has been sent down to us. In spite of this, nothing

permits us to affirm that there existed at that time a class of real

dentists, viz., of persons dedicated to the exclusive cure of dental

disease. There are strong reasons for doubting this, especially when

we consider that the Latin language has no word corresponding to the

word dentist. If there had existed a true dental profession, there

ought also to have existed a name for indicating the individuals who

exercised it. Therefore, it must be considered highly probable that,

although there undoubtedly existed individuals who were especially

skilled in the cure of the diseases of the teeth, such persons did

not form a special class; perhaps, among those to whom recourse was

had for the cure of dental diseases, some were doctors, particularly

skilled in such diseases, others were perhaps barbers, and so forth.

As to the far-fetched deductions of Geist-Jacobi, according to whom the

name given to dentists by the Romans must have been that of _artifex

dentium_ or _artifex medicus dentium_, these are founded, above all, on

imagination. It is extremely improbable that such names existed, when

one considers that they are not met with, even once, in the whole range

of Latin literature.

SCRIBONIUS LARGUS. Among the writers on Medicine in the early period of

the Empire, one of the most eminent was, without any doubt, Scribonius

Largus, physician to the Emperor Claudius, whom he accompanied to

England in the year 43.

Scribonius Largus, in his book _De compositione medicamentorum_,

pronounces himself energetically against the division of Medicine into

single special branches. He declaims against the many who attributed

to themselves the name of doctors, simply because they knew how to

cure some diseases. According to him, the true doctor must be skilled

in curing all kinds of affections. This, in truth, was possible in

those times, but would be almost impossible nowadays, on account of the

enormous development of the healing art. The ideas, however, expressed

by Scribonius Largus have a certain historical importance, for they

show that in his times the medical art had certainly the tendency to

split up into many special branches, among which there must certainly

have been dentistry, but that the necessity of such separation was not

by any means universally recognized; the great doctors of those days

undertook the cure of the diseases of the teeth, as well as those of

any other part of the body.

The tenth chapter of the book of Scribonius Largus treats of the cure

of odontalgia. The author begins by saying that it is the opinion of

many that the only true remedy against toothache is the forceps. With

all this, he adds, there are many medicaments, from which great benefit

may be derived against these pains, without it always being necessary

to have recourse to extraction. Even when a tooth is affected with

caries, says the author, it is not always advisable to extract it; but

it is much better, in many cases, to cut away the diseased part with a

scalpel adapted for the purpose.

“Violent toothache may be calmed in various ways, viz., with mouth

washes, masticatories, fumigations, or by the direct application of

fitting medicaments. It is beneficial to rinse the mouth frequently

with a decoction of parietaria or of cypress berries, or to apply to

the tooth the root or the seeds of the hyoscyamus wrapped up in a

cloth, and dipped from time to time in boiling water, or to chew the

portulaca (purslane), or to keep for some time its juice in the mouth.”

“Suitable also against toothache are fumigations made with the seeds of

the hyoscyamus scattered on burning charcoal; these must be followed

by rinsings of the mouth with hot water; in this way sometimes, as it

were, small worms are expelled.”[171]

This passage of Scribonius Largus has given rise to the idea that the

dental caries depends upon the presence of small worms, which eat

away the substance of the tooth. Such an explanation must have well

succeeded in satisfying the popular fancy; and it is for this that

such a prejudice, although fought against by Jacques Houllier in the

sixteenth century, has continued even to our days.

With regard to this I would like to record the following fact: Not many

years ago there lived in Aversa, a small town near Naples, Italy, a

certain Don Angelo Fontanella, a violin player, who professed himself

to be the possessor of an infallible remedy against toothache. When

summoned by the sufferer, he carried with him, in a bundle, a tile,

a large iron plate, a funnel, a small curved tube adjustable to the

apex of the funnel, a piece of bees’ wax, and a small packet of onion

seed. Having placed the tile on a table, the iron plate was put upon

it, after it had been heated red hot. Then the operator let a piece

of bees’ wax fall upon the red-hot iron, together with a certain

quantity of the onion seed; then, having promptly covered the whole

with the funnel and made the patient approach, he brought the apex of

the said funnel close to the sick tooth, in such a way as to cause the

prodigious, if somewhat stinking, fumes produced by the combustion of

the wax with the onion seed to act upon it. In the case of a lower

tooth, the above-mentioned curved tube was adapted to the funnel, so

that the fumes might equally reach the tooth. The remedy, for the most

part, had a favorable result, whether because the beneficial effect was

due to the action of the hot vapor on the diseased tooth, or to the

active principles resulting from the combustion of the wax and onion

seed, or to both, or perhaps also, at least in certain cases, to the

suggestion that was thus brought to bear upon the sufferer. It would

not be at all worth while to discuss here such a point. The interesting

part is that when the patient had declared that he no longer felt

the pain, Don Angelo, with a self-satisfied smile, turned the funnel

upside down, and showed on its internal surface a quantity of what he

pretended to be worms, which he affirmed had come out of the carious

tooth. Great was the astonishment of the patient and of the bystanders,

none of whom raised the least doubt as to the nature and origin of

these small bodies, no one having the faintest suspicion even that

these, instead of coming from the tooth, might come from the onion seed!

According to Scribonius Largus, toothache might also be taken away by

fumigations of burnt bitumen. He affirms also that great benefit may

be derived against odontalgia by masticating the wild mint, or the root

of the pyrethrum, or by covering the diseased tooth with a plaster

composed of peucedanum juice, opopanax, incense, and stoneless raisins.

But before making use of this last remedy, he advises that the tooth

and the gums near it should be fomented with very hot oil, by means of

a toothpick or ear-picker wrapped around, at one end, with some wool.

If the pain does not entirely cease, or comes on again, it is well,

says the author, to continue the fomentations with hot oil, above the

plaster, until the pain ceases. To strengthen loose teeth, Scribonius

advises frequent rinsings of the mouth with asses’ milk or with wine

in which have been cooked the roots of the sorrel until the liquid has

boiled down to one-third. Another remedy which he recommends against

looseness of the teeth is composed of honey and alum mixed together in

a mortar, in the proportion of two parts of the first to one of the

second, and then cooked in an earthen vase, so as to render the mixture

more homogeneous, and to give it more consistency. He also speaks of

a third medicament, resulting from cooking strong vinegar, alum, and

cedria[172] in a copper vessel until it has the consistency of honey.

This remedy would serve not only to make loose teeth firm, but the

author assures us also that whoever rubs the teeth with it, three times

a month, will never be subject to dental pains.

Scribonius Largus gives the receipts for various dentifrice powders in

use at that period. The skin of the radish dried in the sun, pounded

to powder, and then passed through a sieve, would furnish a good

dentifrice, suited to strengthen the teeth and to keep them healthy.

Very white glass, similar to crystal, reduced to a very fine powder

and mixed with spikenard, is also, according to Scribonius Largus, a

valuable dentifrice.

Octavia, sister of Augustus, used a powder which our author highly

commends, saying that it strengthens the teeth and makes them very

beautiful.[173] To prepare it, one must take a sextary[174] of barley

flour and knead it well to a paste with vinegar and honey mixed

together, and must divide the mass into six balls, each of which must

be mixed with half an ounce of salt; these balls must then be cooked

in the oven until carbonized; and lastly pounded to powder, as much

spikenard being added as is necessary to give it an agreeable perfume.

Scribonius Largus also lets us know the tooth powder made use of by

Messalina, the wife of the Emperor Claudius; this was composed of

calcined stag’s horn, mastic of Chios, and sal ammoniac, mixed in

the proportion of an ounce of mastic and an ounce and a half of sal

ammoniac to a sextary of the ashes of stag’s horn.

SERVILIUS DAMOCRATES, a Greek physician, who acquired great renown in

Rome toward the middle of the first century, was the author of many

valuable works, both in verse and prose, which, unfortunately, have

been lost. His works are mentioned by Galen, who testifies to his great

esteem for Damocrates, calling him an eminent physician, and quoting

various passages from his works, and among others three poetical

receipts for dentifrice powders. From these receipts it appears that

Damocrates attached the greatest importance to the cleanliness of the

teeth, and that he considered this the indispensable condition for

avoiding disease of the teeth and gums.

ANDROMACHUS THE ELDER, of Crete, the physician of Nero, who conferred

upon him, for the first time, the title of _archiater_, became famous

through his _theriac_, an extremely complicated remedy, the virtues of

which were sung by him in a Greek poem, dedicated to the Emperor. The

theriac was considered an antidote against all poisons and a remedy

against the greater part of diseases, in short, as a real panacea.

It is not even necessary to remark that this portentous medicine,

which has held a post of honor, from ancient times almost up to the

present day, was also used against odontalgia; and in those cases in

which this was produced by caries, Andromachus advised the filling up

of the cavity with the electuary which he rendered so famous. As the

chief basis of the theriac was opium, combined with stimulating and

aromatic substances, there is no doubt that its use locally or even

internally would prove beneficial, temporarily at least, in many cases

of odontalgia.[175]

ARCHIGENES, of Apamea, a city of Syria, lived in Rome toward the end

of the first century and at the beginning of the second, under the

Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great

fame as a physician and as an operator, and distinguished himself

particularly by daring amputations and trepannings. He recommends

various remedies against odontalgia, among which are mouth washes

of strong hot vinegar, in which gall-nuts or halicaccabum[176] have

been boiled. He usually introduced into carious teeth a mixture of

turpentine and vitriol of iron (_sory ægyptium_), or a mixture of

pepper, and oil of spikenard or of almonds, and this was also dropped

into the ear, on the side on which the pain was felt.

Archigenes, too, like other great physicians of that time, recommended

various remedies taken from the animal kingdom against diseases of

the teeth, which now seem very strange to us, but at that period

appear to have been in great use. Thus, it would be of great benefit

to hold in the mouth for some length of time a mixture of vinegar and

water in which a frog has been well cooked. The slough of a serpent,

burnt and then reduced, by the addition of oil, to the consistency of

solidified honey, would be a valuable remedy, which being introduced

into a carious hollow, and plastered all around the tooth and on the

surrounding parts, would cause the most violent pain to cease. And,

moreover, desiring to cause a diseased tooth to fall out, it would be

enough to apply to and press upon it a piece of the unburnt slough of a

serpent. Two excellent anti-odontalgic remedies to be introduced into

carious hollows would be roasted earth-worms and spikenard ointment

mixed with the crushed eggs of spiders. It would be also of use to drop

into the ear on the side of the aching tooth some oil of sesamum in

which earth-worms have been cooked.

When the pain is situated in broken teeth, Archigenes advises them to

be cauterized with a red-hot iron.

Against bleeding of the gums, he recommends rubbing them with very

finely pulverized alum and myrtle and the application of astringent and

tonic liquids.

When odontalgia appears to depend upon an inflammatory condition, he

advises the aching teeth to be plastered up with a mixture composed of

red nitre, pounded peach kernels, and resin.

Archigenes repeatedly recommends the cleaning of the teeth and of the

carious cavities before applying to the former or introducing into the

latter the appropriate remedies.[177]

But Archigenes’ principal merit, so far as concerns the art of

dentistry, consists in his having guessed that odontalgia, in certain

cases, arises from a disease of the interior part of the tooth (viz.,

from inflammation of the pulp) and in having discovered an excellent

method for curing such cases. When a tooth appeared discolored,

without being affected by caries, and was the seat of violent pains,

against which every remedy had proved of no avail, Archigenes

perforated it with a small trephine, invented by himself for the

purpose. He applied the instrument to that part of the crown which was

most discolored and drilled right down to the centre of the tooth.[178]

Without doubt this talented surgeon was induced to adopt this method of

cure by the idea of the existence of morbid substances in the interior

of the tooth and by the consequent indication of giving them a free

exit.

The operation devised by Archigenes proves, among other things, two

important facts: first, that the anatomical constitution of the teeth

had already been explored, seeing that Archigenes did not ignore the

existence of the pulp cavity; and secondly, that Archigenes was greatly

opposed to the extraction of a tooth unless absolutely necessary.

It might be thought that such aversion depended upon an exaggerated

idea of the dangers connected with the extraction of a tooth, an idea

widely diffused at that period; but regarding such a daring surgeon as

Archigenes was, it is more logical to suppose that in similar cases he

had recourse to trephining and not to extraction, especially on account

of the importance he attached to the preservation of the tooth.

Surgery in ancient times was eminently conservative; later on—partly

by effect of its own progress—it became too readily inclined to the

removal of diseased parts; in modern times it has again become what it

was originally, and what it must ever be, viz., conservative in the

highest possible degree.

CLAUDIUS GALEN, after Hippocrates the greatest physician of ancient

times, was born at Pergamus, a city in Asia Minor, in the year 131 of

our era. His father Nicon, a man of great abilities, who was at the

same time a man of letters, a philosopher, a mathematician, and an

architect, had put him, at a very early age, to the study of science

and of the liberal arts. Galen began to study medicine at the age

of seventeen, under the guidance of skilful doctors of his native

country; he made several journeys in order to have the benefit of the

instruction of celebrated masters, and finally frequented the renowned

medical school at Alexandria. On going to Rome, in the thirty-fourth

year of his life, he soon acquired in that city a very high renown.

He died in the first decade of the third century, but we do not know

exactly in what year.

Galen was a most prolific writer, and his works, considering the period

in which they were written, form a real medical encyclopedia. Anatomy

through his researches made considerable progress, for he studied with

the utmost care and attention (especially in apes) the bones, muscles,

heart, bloodvessels, brain, nerves, and every other part of the

organism. His anatomical researches enabled him to correct many errors,

but as he had dissected almost exclusively animals and not human

corpses, he himself fell into several errors, especially in attributing

to man parts which he does not possess, for example, the intermaxillary

bone.

Galen justly observed that the inferior maxilla (resulting, according

to him, from the union of two bones, which, indeed, is embryologically

true) has in man, proportionally to the other bones of the skeleton, a

lesser length than in animals.

He holds that the teeth must be enumerated among the bones, and does

not admit any doubt to be raised on this point, as these parts can be

looked upon neither as cartilages, nor as arteries, nor as veins, nor

as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat,

nor as hair—a method of reasoning by elimination which is very specious

but far too weak!

Galen indicates exactly the number of incisor, canine, and molar teeth

(without, however, making any distinction between small and large

molars), and speaks of the different functions of these three kinds of

teeth. Not always, he says, are the molars of each jaw five in number

on each side; in some individuals there appear only four; in others

six. The incisors and canines have but one root; the upper molars have

generally three, but sometimes, though not often, four; the lowers have

for the most part two, rarely three.

Galen is the first author who speaks of the nerves of the teeth. He

says that these organs are furnished with soft, that is sensitive,

nerves[179] belonging to the third pair.[180] The teeth, according to

him, are furnished with nerves, both because, as naked bones, they have

need of sensibility, so that the animal may avoid being injured or

destroyed by mechanical or physical agencies, and because the teeth,

together with the tongue and the other parts of the mouth, are designed

for the perception of the various flavors.[181]

In regard to odontalgia, Galen made some very important observations on

his own person:

“Once when I was troubled with toothache, I directed my attention to

the seat of the pain, and thus I perceived very clearly, that not only

was the tooth painful but also pulsating, which is analogous to what

happens in inflammations of the soft parts. To my astonishment, I had

to persuade myself that inflammation may arise even in a tooth, in

spite of the dental substance being hard and lapideous. But another

time, when I again was attacked by odontalgia, I perceived very

distinctly that the pain was not localized in the tooth, but rather in

the inflamed gums. Having, therefore, suffered these two kinds of pain,

I have acquired the absolute certainty that, in certain cases, the

pain is situated in the gums, in others, on the contrary, in the very

substance of the tooth.”

When a tooth becomes livid, Galen deduces from this that the tooth

is the seat of a morbid process equivalent to inflammation. Besides,

he says, we cannot be surprised that the teeth may be subject to a

phlogistic process, when we consider that these, like the soft parts,

assimilate nourishment. The teeth, by effect of mastication, are

continually worn down, but nutrition repairs the losses, and they,

therefore, preserve the same size. But when a tooth from want of its

antagonist is consumed but little or not at all by mastication, we

see that it grows gradually longer, for the very reason that under

such conditions the increase due to nutrition is not counteracted by a

corresponding waste.

The nutritive process of the teeth may, according to Galen, be altered

either by excess or by defect; from which arise morbid conditions,

quite different the one from the other. An excess of nutrition produces

a phlogistic process analogous to that of the soft parts; a defect of

nutrition makes the teeth thin, arid, and weak. The first of these

pathological states is met with especially in young men and must be

fought against with the ordinary antiphlogistic means, designed to

eliminate the excess of humors (evacuant, resolvent, revulsive, and

astringent remedies). As to defect of nutrition, this is met with most

frequently in old people. It has the effect not only of making the

teeth thin, but also of enlarging the alveoli, from which there results

a looseness of the teeth more or less noticeable. Against this morbid

condition we do not possess, says Galen, any direct remedy; however, it

can be combated, up to a certain point, by strengthening the gums with

astringent medicaments, so that they may close tightly around the teeth

and thus make them firm.

Dental caries is produced, according to Galen, by the internal action

of acrid and corroding humors, that is, it is produced in the same

manner as those cutaneous ulcers which appear without any influence

of external causes. The cure must consist in acting upon such

vicious humors by means of local or general medicaments according to

circumstances and also in strengthening the substance itself of the

teeth by the use of astringents and tonic remedies.[182]

After these preliminary remarks, Galen gives a minute description of

the numerous remedies which, from his own experience and from that of

other great doctors, were to be considered useful for the cure of the

various affections of the teeth and gums.

Against gingivitis and the pains deriving from it, the best remedy,

according to Galen, consists in keeping in the mouth the oil of the

lentisk moderately warm; noting, however, that such a remedy is the

more efficacious the more recently it has been prepared.

A decoction of the root of the hyoscyamus in vinegar, used as a mouth

wash, is another remedy recommended by Galen against the pains in the

gums. It would also be of benefit to apply on the inflamed gums a

powder composed of one part of salt to four of alum, afterward washing

the mouth with wine or with a decoction of olive leaves. If the gums

are ulcerated, Galen recommends them to be cauterized with boiling

oil, using for the purpose a little wool wrapped around a probe or

toothpick. This medicament, says Galen, greatly modifies the diseased

part, exciting a reparative process in it, to aid which, however,

suitable remedies must be used, and especially frictions with a mixture

of gall-nuts and myrrh reduced to a fine powder.

For the cure of epulides the application of green vitrol, together with

an equal quantity of powdered myrtle and a little alum, is especially

recommended.

In dentition, if the gums are painful, it is advisable to rub them with

the milk of a bitch. The teeth, moreover, appear very readily, says

Galen, if the gums be rubbed with hare’s brain.

Against odontalgia, properly so called, independent, that is, of

diseases of the gums, Galen particularly recommends warm applications,

either on the cheek or directly on the tooth. Externally, on the side

of the pain, may be applied dirty (!) pieces of linen, well warmed,

or else small bags full of roasted salt, or cataplasms of linseed

or barley flour. But if it is desired to act directly upon the sick

tooth, this may be rubbed with a branch of origanum (wild marjoram)

dipped in hot oil, or else, after applying a bit of wax on the tooth,

the heated end of a probe may be laid upon it; or lastly, fumigations

may be made by burning the seeds of the hyoscyamus. In case the above

remedies, or others like them, be found of no use, Galen recommends

them to be adopted anew after having perforated the sick tooth by means

of a small drill. But if even from this no benefit be derived, and it

is considered well to remove the tooth, this can be done without pain

by the application of special medicaments. Among these the root of

pyrethrum kept in very strong vinegar for forty days and then pounded

takes the first place. The remedy is applied after having well cleaned

the sick tooth, and after having covered the others with wax. At the

end of an hour the tooth will have already become so loose that it can

be drawn out with the fingers or with the mere help of a style. The

same effect may be obtained, says Galen, by the application of blue

vitriol mixed with very strong vinegar.

To prevent a carious tooth from producing pain or fetor, he advises the

carious hollow to be filled up with black veratrum mixed to a paste

with honey.

To restore to blackened teeth their whiteness, Galen advises them to

be rubbed with special medicaments, one of which is made up of dried

figs, burnt and pounded, with spikenard and honey. He gives, besides

the receipts of many dentifrice powders and tinctures designed both to

strengthen the teeth and gums and as preservatives against the diseases

of these parts. Such powders and tinctures do not offer any interest

to us, since they do not much differ from those recommended by other

authors whom we have previously quoted.

When one or more teeth, in consequence of a trauma, or from other

cause, become loose and project above the level of the others, Galen

removes the whole exuberant part by means of a small iron file. In

performing this operation, after having covered the gums with a soft

piece of cloth, he holds the tooth to be filed steady with the fingers

of the left hand, using the file in such a way as not to give the tooth

any shock. Besides, he does not complete the operation at one sitting,

but rather interrupts it as soon as the patient feels any pain, and

continues it after one or two days. In the meanwhile, he makes use of

remedies suited to strengthen the loosened teeth, and bids the patient

remain silent and nourish himself with liquid or soft food.

When the teeth, without the action of external causes, become loosened,

Galen holds that this is due to a relaxation of the dental nerve in

consequence of an excessive abundance of humors. In such cases he

counsels the use of desiccative remedies.

Galen, like ancient authors in general, is not very favorable to

the extraction of teeth with the forceps. Even he seems convinced

that a tooth may be made to fall out, without pain, by means of the

application of certain remedies, to which we have already alluded.

However, in one of the Galenic books[183] we find the precept already

given by Celsus, that before extracting a tooth the gums must be

detached all around; from which one may argue that, at least in certain

cases, instrumental extraction was considered inevitable. Galen even

alludes to the pain which sometimes remains after the extraction of a

tooth, and is of the opinion that this depends upon an inflammatory

condition of the stump of the dental nerve.

In Galen are found recorded many means of cure, recommended by

celebrated doctors of ancient times. Elsewhere we have already spoken

of some remedies counselled by Damocrates, by Andromachus the elder,

and by Archigenes. Apollonius, as a medicament against odontalgia,

advised that the juice of the beet root be dropped into the nostrils,

or else a liquid prepared from cumin seed, myrrh, cucumber, and

woman’s milk. Heraclides of Tarentum recommended against the pains and

looseness of teeth that a vinous decoction of black veratrum, mandrake,

and hyoscyamus root should be kept in the mouth. Criton prescribed, for

strengthening loose teeth, that the mouth should be frequently washed

with a vinous decoction of lentisk, myrtle, and gall-nuts.

CELIUS AURELIANUS. In the book _De morbis acutis et chronicis_, written

by Celius Aurelianus (who lived, according to some, in the third

century, according to others, in the fourth or at the beginning of the

fifth), a very interesting chapter on odontalgia is found. He shows

himself to be, for the most part, a follower of Celsus. During the

violence of the pain he advises abstinence from food and rest in bed

with the head somewhat raised. As remedies he recommends several mouth

washes (infusions or decoctions made with wine or vinegar and with

various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil,

poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides,

the application of wool soaked in hot oil on the cheek of the affected

side, or the application of little warm bags, and also that some hot

oil, or the juice of fenugreek,[184] should be kept in the mouth,

or milk with honey. When the pain is excessively violent, he has

recourse to bloodletting, and after two days’ fasting, he begins to

feed the patient with liquid and warm food. If the bowels are closed

he prescribes the use of clysters, and when, in spite of all, the

pain persists, he has recourse to scarified cuppings on the cheek, in

correspondence with the pain. In certain cases he also proceeds to

scarification of the gums, or else he detaches them all around from

the tooth, by means of a special instrument called a _pericharacter_.

It would often turn out useful to apply to an aching tooth a grain of

incense warmed by the fire and wrapped in a thin piece of cloth, or to

press between the teeth, where the pain is situated, several pieces of

cloth, in succession, in which some powder of incense has been wrapped,

and which are dipped into hot oil before being used. The author,

moreover, commends external fomentations made by means of sponges

soaked with emollient decoctions and afterward squeezed; and also the

application of moderately hot cataplasms.

[Illustration: FIG. 33

Roman dental forceps found (1894) at Hamburg, Germany, in the ancient

Roman castle Saalburg. (Geist-Jacobi.)]

When the odontalgia has already become inveterate and recurs in

paroxysms, separated by intervals of calm, Celius Aurelianus counsels,

among other things, that the general health be strengthened by

temperate living, exercise, rubbing of the whole body (an ancient

practice, now revived under the name of massage). He recommends,

besides, special rubbing of the cheeks (to be carried out with a rough

cloth), and also of the gums and teeth, and indicates a great number

of medicaments, some of which are to be used during the paroxysms and

others during the periods of calm. In regard to the use of narcotics,

he very shrewdly observes that such remedies take away sensibility but

not pain. Some doctors of those days, for the cure of odontalgia, had

recourse to sternutatories, or to the dropping of special medicaments

into the nose or into the ear, but Celius Aurelianus seems to have

put but little faith in such means of cure. He, moreover, solemnly

reproaches those who, to cure odontalgia, are too hasty in having

recourse to the extraction of the aching tooth. To remove a part,

says he, is not to cure it; and if every tooth that aches has to be

extracted, it would be necessary to draw them all out when they all

ache. Therefore, before having recourse to extraction, every other

means of cure should first be tried. If the removal of the tooth

becomes indispensable, he advises that it should never be performed

during the violence of the pain, for from this serious consequences

might arise (a prejudice which has not yet entirely vanished, and

which is met with, sometimes, not only among common people, but even

among physicians); and a still greater danger would be the extraction

of teeth neither carious nor loose, seeing that, by consensus, the

muscles, the eyes, and the brain might suffer. The author, on this

point, quotes Herophilus and Heraclides of Tarentum, who related

some cases in which the extraction of a tooth was followed by death.

He alludes, moreover, to a passage of Erasistratus, regarding the

“odontagogon of lead” (_plumbeum odontagogum_) which was exposed in

the temple of Apollo at Delphi; as much as to show that it was not

lawful to extract teeth other than those which were so loose that an

instrument of lead was sufficiently strong to extract them.

When the looseness of the teeth seems to depend upon the flaccidity

of the gums, Celius Aurelianus recommends astringent mouth washes:

decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince,

of myrtle berries, etc.; and besides these, lentiscine oil and asses’

milk, which latter was also believed to possess astringent virtues.

Against hemorrhages of the gums, he advises the use of very fine coral

powder, or of alum with honey.

GNAEUS MARCELLUS EMPIRICUS, of Burdigala (Bordeaux), who lived at the

end of the fourth century and at the beginning of the fifth, wrote

a book, _De medicamenti_, which shows, more than anything else, the

decadence of the medical science in those days. Regarding the diseases

of the teeth and their cure, Marcellus does not tell us anything new.

He freely copies Scribonius Largus and other authors, not adding

anything save a few methods of cure, which are exceedingly strange

and superstitious. To get rid of toothache, it is sufficient that the

patient, when the moon is waning, and in the days of Mars (Tuesday)

or of Jupiter (Thursday), repeat seven times the words _argidam_,

_margidam_, _sturgidam_. It is a great pity that a curative method so

simple and easy be efficacious in two days of the week alone, and even

then on condition that the moon be waning.

The following method is also a very good one: Whilst in the open

country, one must take a frog by the head, open its mouth and spit into

it, then having begged the animal to take the toothache with it, must

replace it on the ground and let it free. To remove loose teeth easily,

it is necessary to keep in reserve some juice of black ivy mixed with

a little green oil; in case of necessity, the nose of the patient

must be anointed with it, and after having drawn a deep inspiration,

he must put a little stone between his teeth, and stay with his mouth

open, inclined a little forward, so as to let all the morbid humor

flow out, which sometimes flows very abundantly and even may reach to

three herminæ.[185] Having afterward rubbed the nose with pure oil, and

washed the mouth with wine, the teeth will be free from every pain and

may be very easily pulled out. If the root[186] of a tooth be rubbed

with dried African sponge, the tooth will fall out within three days;

naturally, says the author, care must be taken not to touch, whilst

doing this, any healthy tooth. He who desires never to be subject to

pain in the teeth, may obtain this end by the following method: When

at the beginning of spring he sees the first swallow, he must go in

silence to some running water, take some of it in his mouth, rub his

teeth with the middle fingers of both his hands, and say: “_Hirundo,_

_tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non

doleant toto anno._”[187]

The same must be done each following year, so as to continue to enjoy

the effects of such a cure!

ADAMANTIUS, an Alexandrine philosopher and physician, who probably

lived in the fourth century, paid much attention to the diseases of

the teeth, as may be argued from two chapters of the _Tetrabiblos_

of Ætius. One of these chapters is entitled, according to the Latin

translation of Giano Cornario: “Cura dentium a calido morbo doloroso

affectorum, ex Adamantio, sophista.”[188] This writer clearly belonged

to the pneumatic school, founded as early as 69 A.D. by Athenæus

of Cilicia. According to the pneumatics (so called, because they

admitted the existence in the animal organism of an aëriform principle,

_pneuma_, to which they attributed great importance), heat and dryness

gave rise to acute maladies; the phlegmatic affections generally arose

from humidity, and melancholy was brought on by cold and dryness, as

every object dries up and becomes cold on the approach of death. The

author says that the cure must vary according as the disease affects

in a greater degree the gums or the teeth themselves with or without

participation of the dental nerves and neighboring parts. He makes,

in regard to this, many subtle distinctions; but the remedies which

he counsels do not offer to us any special interest, being almost

identical with those that had been recommended by Galen and by other

doctors prior to Adamantius. The latter also gives much importance

to dietetic therapy; he prescribes that such patients should nourish

themselves with pottages of barley, or of spelt, with eggs, lettuce,

pumpkins, and other cooling food, abstaining, however, from wine.[189]

The author enumerates among the causes of such dental affections the

dryness of the air, the autumnal season, the dry constitution of the

individual, a troubled life, and scanty nourishment. The use of sour

and piquant substances is not favorable to these patients, so much so

that the mulberry preserve produces, not unfrequently, violent dental

pains in them. Adamantius, therefore, advises, in such cases, not to

use strongly astringent mouth washes, but rather lenitive, moistening,

and emollient substances; simple lukewarm water, decoction of bran,

licorice juice, starch with boiled must of wine diluted with warm

water, milk, especially asses’ milk, decoction of mallows and the

like.[190]

The work of Adamantius from which Ætius has taken the above-mentioned

chapters is lost to us. Of his writings there only remain to us

the treatise _on the winds_ and the one _on physiognomics_. In this

latter book the author attributes great importance to the canine teeth

as physiognomonic elements, and from their shape and size he makes

deductions in regard to the character of the individual.

ORIBASIUS (316 to 403), the most celebrated of all the compilers who

appeared during that long period of decadence, wrote, by order of the

Emperor Julian the Apostate, whose physician and friend he was, a

whole medical encyclopedia and later on a summary (synopsis) of this

same work of his. In the books of Oribasius are found many things

about dentition and diseases of the teeth, but they are all taken,

substantially, from preceding authors, and therefore it is not worth

while repeating them.

ÆTIUS OF AMIDA, a celebrated Greek writer on medicine, lived at the

end of the fifth century, and at the beginning of the sixth, and has

also left us a kind of medical encyclopedia, which, being divided into

four sections, each composed of four books, was called _Tetrabiblos_.

He teaches that the mucous membrane of the gums, tongue, and mouth

is provided with nerves from a portion of the third pair of cerebral

nerves, and that the teeth, too, by a small hole existing at the end

of every root, receive tiny ramifications of sensitive nerves, having

the same origin. The nutrition of the teeth is understood by Ætius in

the following way: The nourishment which reaches the dental nerves is

not entirely assimilated by them; these only appropriate the liquid or

soft part and reject the drier part. This accumulates in the alveoli,

becomes by degrees more tenacious and denser, finally being transformed

into osseous substance and forming the nutriment of the teeth; these,

therefore, tend to grow continually, although the waste arising from

the mechanical action of mastication prevents them from undergoing

any real or visible growth. On the other hand, in the old, from the

weakening of the nutritive functions, the teeth become thin and loose,

and finally fall out.[191]

Ætius advises that during dentition hard objects to chew should not be

given to children, seeing that the gums being hardened by these and

becoming almost callous would render the cutting of the teeth very

difficult.[192]

For curing parulides, he recommends emollients at the beginning of the

disease, and later on astringents. But if the inflammation of the gums

does not resolve and passes into suppuration, he prefers to perform the

excision of the parulis, instead of making a simple incision, which

might very easily cause the abscess to change into a fistula.[193]

The epulis, according to Ætius, is a fleshy excrescence of the

gums, brought on by inflammation. To cure it, he uses, during the

inflammatory period, emollients, and then, when the inflammation has

subsided, astringents and weak caustics. Lastly, if the epulis resist

these remedies, he takes hold of it with a vulsella and proceeds to

remove it with a small scalpel.[194]

When the incision of a fistula of the gums and the use of appropriate

remedies are not sufficient for curing it, Ætius advises the extraction

of the diseased tooth, from which the fistula has its origin.[195]

Apart from what has been mentioned, Ætius does not tell us, in regard

to dental diseases, anything worthy of note, and in many places he only

repeats Galen’s observations.

PAUL OF ÆGINA (seventh century) establishes a very clear distinction

between epulis and parulis. The epulis is a fleshy excrescence of the

gums in the neighborhood of a tooth; the parulis is an abscess of the

gums. To cure the former affection it is necessary, says the author,

to seize and stretch the tumor with a vulsella or with a hook and to

perform its excision. As to the parulis, although not unfrequently it

is sufficient, for curing it, to give an exit to the pus by means of

a slight incision, the author, however, usually prefers the method of

cure recommended by Ætius, viz., excision. After such operations he

orders the patient to rinse his mouth with wine and on the morrow with

hydromel.[196] From the third day onward he sprinkles the wound with

a cicatrizing powder, until a complete cure is obtained. But if the

wound, instead of healing, be transformed into a putrid ulcer resisting

all the ordinary means of cure, it is necessary to cauterize the part

affected with an oval-shaped cautery.[197]

In extracting a tooth, the operation is begun by detaching the gum all

around it as far as the alveolar border; then the tooth is seized with

the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus,

recommends that before extracting a tooth deeply attacked by caries,

the cavity be filled up with lint, in order to avoid the crumbling of

the tooth under the pressure of the instrument. On the other hand, he

too is convinced that a diseased tooth can be made to fall out without

pain, by the use of suitable remedies.

When supernumerary teeth cause an irregularity of the dental arches,

this must be corrected, says the author, either by resection of such

teeth, if they are very firm, or by their extraction.

If a tooth projects above the level of the others, the protruding part

must be removed with the file. This instrument must also be employed to

remove the sharp edges of broken teeth.

Tartar incrustations must be removed either with scrapers or by means

of a small file.[198]

During the period of dentition one must not give children any food

which requires mastication, and to soften the gums they must be

anointed with hen’s fat or with hare’s brain.[199]

To preserve the teeth and to keep them healthy, Paul of Ægina

recommends all tainted food to be avoided, and also all possibility of

indigestion and frequent vomitings; the use of very hard or glutinous

food or of such as may easily leave a residuum between the teeth, for

example, dried figs, and likewise very cold food and such as set the

teeth on edge. He also advises that hard things should never be broken

with the teeth and that the latter be carefully cleaned, especially

after the last meal of the day.[200]

Paul of Ægina also belongs to the class of compilers; but in utilizing

the writings of the great physicians who had preceded him, he gives

evidence of exquisite good sense, and not infrequently subjects the

assertions of his predecessors to an intelligent and enlightened

criticism. Besides, he inserts here and there observations and

experiences of his own that are not without interest. He has always

been, and rightly so, considered one of the greatest physicians of

ancient times, the great reputation which he justly held among the

Arabs contributing not a little to his renown.

This author is the last of the Byzantine period, and with him,

therefore, we must close the earlier part of the history of dentistry.

If, before passing to the middle period, we cast a glance over the

ground already traversed, it is easy to perceive that dental art, in

ancient times, reached its highest degree of development at the time

when the Roman civilization was in its greatest splendor, when, in the

capital of the world, wealth, luxury, and the refinements of social

life marvellously increased its needs, and by this also gave an impulse

to the evolution of all human activity. But ancient civilization,

after having reached its culminating point, soon fell into decadence,

and this necessarily would result in a hindrance to the development

of dental art. From the days of Archigenes right up to those of Paul

of Ægina, dentistry did not make the least progress; indeed, as far

as prosthetic dentistry is concerned, there was probably a retrograde

movement, it being very likely that when Italy was subject to the

dominion of the barbarians and when Christianity—which but recently had

asserted itself—was strongly imposing on the human mind a deep contempt

for all that regarded the welfare and beauty of the human body, no one

could, any longer, think of artificially repairing the losses sustained

by the dental system through disease or injury.

PART II.

SECOND PERIOD—THE MIDDLE AGES.

CHAPTER VIII.

THE ARABIANS.

The religious fanaticism excited by Islamism, transformed the obscure

and nomad inhabitants of Arabia into a conquering nation, who very soon

extended their power over a considerable part of Asia, Africa, and

Europe. Spain, invaded by the Arabs in 711, fell almost entirely into

their hands. After having by force of arms rendered themselves powerful

and dreaded, the Arabians acquired also great fame by the culture of

art and science within the limits allowed them by their religious

code; and in these, for more than four centuries, they maintained an

incontestable preëminence.

Unfortunately, as the Koran most absolutely prohibited the dissection

of dead bodies, all serious anatomical research was thereby rendered

impossible. This was a very great hindrance to the progress of anatomy,

of physiology, and, in consequence, of the whole of medical science.

The Arabians certainly had the merit of keeping alive the study of

medicine in an age of decadence and barbarism; but, apart from the

important progress realized by them in chemistry and pharmacology,

it may be affirmed that the Arabs contributed but scantily to the

development of the healing art; they followed almost entirely in the

footsteps of Galen and other ancient, and especially Greek, authors.

One of the characteristics of Arabian medical art consists in the

aversion to bloody operations and in the effort to avoid them. A like

tendency shows itself also in the sphere of dentistry; the Arabians,

even more than their Greek and Roman predecessors, were reluctant to

extract teeth, and employed all possible means, in order to avoid the

operation.

RHAZES (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was

born in Persia toward the middle of the ninth century, and gave himself

up to the study of medicine when about thirty years of age, having

previously been a musician. He wrote many works which, unfortunately,

have, for the most part, been lost. Rhazes did not have recourse to

the extraction of teeth, save as a last resource when every other

attempt at cure had proved useless; which method would no doubt have

deserved high praise, had the author been inspired by the principles of

conservative surgery, rather than by unjustifiable fears. Caries of the

teeth is, according to him, identical with that of the bones. To hinder

its progress and propagation to the neighboring teeth, he advises the

carious cavity to be filled with a “cement” composed of mastic and

alum. We have here a laudable attempt at permanent stopping of decayed

teeth, although it is clear that the duration of such stopping, owing

to the nature of the materials employed, could not be a long one.

Furthermore, he counselled the patient to abstain from the use of acid

food or drink and to rub the teeth with powder of gall-nuts and pepper.

To strengthen loosened teeth, he recommended astringent mouth washes

and sundry dentifrice powders. Others, partly taken from Galen, are

recommended by him for prophylactic purposes and for cleansing and

beautifying the teeth.

Against periodontitis and the pains produced by it, he sometimes had

recourse to bleeding. He commended, besides, opium, oil of roses,

pepper, and honey, and also the scarification of the gums and the

application of a leech. If, however, these remedies did not succeed, he

applied his theriac, which was composed of castoreum, pepper, ginger,

storax, opium, and other ingredients, to the roots of the teeth. If

even this method of cure failed, he touched the root of the diseased

tooth with a red-hot iron, or sought to provoke its fall by the use

of special medicaments, such as coloquintida and arsenic (a substance

to which he had recourse, particularly in those cases where there was

ulceration of the gums). It is no wonder that such means of cure would

sometimes produce, as a final result, the actual falling out of the

tooth; and this, as is natural, served to strengthen the belief that

the same result could also be obtained with less energetic remedies,

but which were supposed to be equally endowed with expulsory virtues.

Rhazes relates an interesting case of regeneration of a whole lower

jaw; he, however, observes that the newly formed osseous mass was less

hard than the original bone.[201]

ALI ABBAS, another great Persian physician (who died in 994), wrote a

lengthy treatise on theoretic and practical medicine, one chapter of

which is dedicated to the diseases of the teeth. When a molar tooth

is affected by caries, and the pain cannot be subdued in any other

way, Ali Abbas applies, inside the carious cavity, the end of a small

metallic tube, into which he repeatedly introduces red-hot needles,

leaving them in the tube until quite cooled. Should even this have no

effect, he tries to provoke the fall of the tooth by the application of

asses’ milk with assafetida, or, finally, extracts it.[202]

He cures epulis, like Paul of Ægina, by excision. As to parulis, or

abscess of the gums, he opens it with a lancet or a wooden stylus.

When the dental arch is deformed by the existence of supernumerary

teeth, he removes these with an instrument in the shape of a beak.[203]

SERAPION (Jahiak Ebn Serapion), who lived in the tenth century, and

up to the beginning of the eleventh, contributed but slightly to the

development of medicine and dentistry, as he was in his writings little

more than a mere compiler. He indicates with great precision the number

of dental roots, and expresses an opinion that the upper molars have

need of their three roots in order to keep firm in spite of their

pendent position, whilst two roots alone are sufficient to keep the

lower molars in place, on account of the support which they receive

from the jaw. Serapion, like Galen, admits the nutrition and continual

growth of the teeth—a growth which is produced in the same proportion

as the waste due to mastication—and he too makes the dental diseases

depend upon an alteration in the nutritive process, either by excess or

by defect.

Against dental pains of phlogistic origin, he recommends bloodletting,

purgatives, and many local medicaments, reproduced in great part from

Rhazes. In cases of persistent odontalgia due to caries, he advises, as

an excellent remedy, the application of opium in the carious cavity.

To strengthen loosened teeth, he first employs astringents, and if

these are of no use, as often happens in the old, he binds the loose

teeth together and to the neighboring healthy ones, by means of gold or

silver wire.

In Serapion, too, we find many formulas for dentifrice powders, some of

which are intended simply for cleaning the teeth, others for special

prophylactic or curative purposes.[204]

AVICENNA. One of the greatest luminaries of medicine among the Arabs

was Avicenna (Ebn Sina). He was born in 980 son of a high Persian

functionary; he lived a very adventurous life, held some very high

places, and died in 1037. Among his works, the most important is the

_Canon_, a book which procured him the title of “second Galen” and the

still more pompous one of “prince of doctors.” A very evident proof of

the immense fame which he acquired is the fact that among many oriental

peoples Avicenna, even in our own days, is considered the greatest

master of medicine.

The anatomy and physiology of the teeth are treated by Avicenna very

minutely, but nevertheless he does not teach us, in regard to these,

anything new. Like Galen, Avicenna admits that the teeth continually

grow, and as a proof he gives the fact of the lengthening of the teeth,

which, owing to the absence of antagonists, are not subject to any

pressure or friction.

He gives much good advice with regard to the preservation and

cleanliness of the teeth, to which he attaches very great importance;

and on this point he remarks that the use of very hard tooth powders

must be avoided, as these are liable to injure the dental substance. To

this latter are also harmful, says the author, some narcotic remedies,

employed against odontalgia. Burnt hartshorn is, according to him, a

most valuable dentifrice. To remove tartar from the teeth, he indicates

many remedies, and especially dentifrices of meerschaum, salt, burnt

shells of snails and oysters, sal ammoniac, burnt gypsum (plaster

of Paris), verdigris with honey, etc. Among the substances able to

facilitate dentition, he enumerates several oils and fats, besides the

brain of the hare and the milk of the bitch, and he disapproves the

custom of giving to children, during dentition, hard objects to chew,

in the erroneous belief that the biting of such objects is useful in

facilitating the cutting of the teeth; he recommends, instead, the gums

to be rubbed with the fingers. When the teeth begin to appear, he drops

some oil into the ears of the child and covers its head, neck, and jaws

with a plaster spread on cotton that has been soaked in oil.

Avicenna minutely examines the various causes of odontalgia, and among

them includes also the little worms by which the dental substance was

supposed to be gnawed away.

When a tooth becomes the seat of intense pain, accompanied by a

throbbing feeling, Avicenna considers that this is due to an excessive

accumulation of humors in the root; he therefore advises, as already

Archigenes had done, the tooth to be drilled, in order to empty it, and

afterward to introduce into it appropriate remedies.

According to Avicenna, he who has a loosened tooth and desires to make

it firm again, must avoid using it in mastication, must not touch it

with the fingers, nor move it with the tongue; besides this, he must

speak as little as possible, and make use of astringent remedies.

To remove a tooth, Avicenna made use of either the forceps or the

“eradicating remedies,” in which he, too, had full confidence. Like

the greater part of his predecessors, Avicenna is of the opinion that

the extraction of a firm tooth must be avoided as much as possible, as

it may give place to an injury of the jaw, or become harmful to the

visual organ, or bring on fever. On this point he remarks that, if an

aching tooth appears to be sound, it is not always necessary to perform

its extraction in order to cause even the most rebellious odontalgia

to cease; in certain cases he obtained a complete cessation of the

pain after having simply shaken the tooth without completing its

extraction; which according to him was due to the double reason that by

shaking the tooth a resolution of the morbid matter stagnating under it

is provoked, and the action of the medicaments that are afterward made

use of is thus favored.

Among the eradicating remedies, the author enumerates white arsenic,

orpiment, coloquintida, tithymallus, the fat of frogs, and others. He

remarks, however, that before using them it is advantageous to detach

the gum all around.

Against the supposed worms in carious teeth, he praises fumigations

made with the seeds of the hyoscyamus, garlic, or onion.

Arsenic is used by him not only for the above-mentioned purpose, but

also for the cure of fistulas and foul ulcers of the gums.

When a tooth has become abnormally long, Avicenna makes use of the file

to reduce it to a proper size; and in performing such an operation, he

holds the tooth firmly between the fingers, or with a pair of pincers

suited for the purpose. As a consecutive treatment, he prescribes

frictions with alum, laurel berries, and aristolochia.[205]

ABULCASIS. Among the Arabian authors, he who has the greatest

importance in regard to dental art is undoubtedly Abulcasis

(Abul-Casem-chalaf-ben-Abbas). Whilst Avicenna was one of the greatest

physicians, Abulcasis was one of the greatest surgeons; and very justly

he has been called the genius of Arabian surgery.

Abulcasis had his birthplace in Alzahra, a small Spanish village, five

miles from Cordova; from this he derived the name of Alzaravius, by

which he is also known. Historians are not agreed upon the date of his

birth. According to the most probable opinion, he was born about the

year 1050 and died in 1122 at Cordova, a city which, on account of its

celebrated school, was then a most important centre of scientific and

literary culture.

Among the works of Abulcasis, the one which brought him the greatest

fame was the treatise _De Chirurgia_. It is divided into three

books, in the first of which he speaks of all the diseases which can

be treated by cauterization; in the second are described all the

operations which are performed by cutting, perforating, or extracting

(wherefore, obstetrics is also included in this book); in the third,

lastly, the author treats, region by region, of fractures and luxations.

Chapters XIX, XX, and XXI of the first book have reference to diseases

of the teeth and gums. As these chapters are very short, we are pleased

to give here an almost literal translation of them:

“When in the lower part of the gums, or in the palate, there appears a

little tumor, which afterward becomes purulent and opens and changes

into a fistula, against which no medical remedy is of any use, it is

necessary for thee to take a cautery corresponding in size to the

aperture of the fistula, and after having heated it, to introduce it

there and to keep it applied there until the cauterizing iron reaches

the bottom of the said fistula and beyond. This thou shalt do once or

twice, and then shalt use fitting medicaments until a complete cure

is obtained. This is attained when suppuration ceases. Otherwise one

cannot do less than uncover the bone and extract that part of it which

is diseased.”[206]

“When through excess of moisture the gums become flaccid, the teeth

loose, and of no use are the remedies employed by thee, thou shalt lay

the patient’s head on thy lap, and after having applied to the tooth,

where it borders on the gum, the end of an appropriate little metal

tube, in this thou shalt quickly introduce the cautery of which mention

will be made in the following chapter; and thou shalt prolong the

application as long as suffices to let the patient feel the heat right

in the root of the tooth. This thou shalt repeat as often as thou shalt

think necessary. Then the patient shall keep salt water in the mouth

for an hour. By effect of such a cure, the corrupted moisture will dry

up, the gums will regain their tone, and the tooth its firmness.”[207]

“When toothache depends upon cold, or if there exist some worm in the

tooth, and the medicaments are of no use, recourse must be made to

cauterization, which in such cases may be performed in two ways, viz.,

either by means of butter or with a cautery. Desiring to use butter,

some of it must be warmed in an iron or copper spoon; a little cotton

must then be wrapped around the extremity of a probe, dipped into the

boiling butter, and then immediately applied to the tooth, keeping it

there in contact until it has cooled. This must be repeated several

times, so that the action of the heat reaches right down to the root

of the tooth. If thou preferest, thou canst use cold butter, applied

to the aching tooth by means of a little tuft of wool or cotton, upon

which thou shalt lay a red-hot iron; prolonging the application of this

until the heat has reached the very root of the tooth.

“To perform the cauterization directly with the iron, thou must first

rest on the tooth a small tube of iron or copper, designed to preserve

the neighboring parts from the action of the heat, and which must,

therefore, be of sufficient thickness. Through such a tube thou shalt

apply on the tooth a cautery of the shape given here below, and shalt

keep it there until it is cooled. This thou shalt do several times.

The pain will cease the same day or on the morrow. It is, however,

necessary that after the cauterization the patient should keep his

mouth, for an hour, full of good butter. The shape of the cautery is

as follows (Fig. 34): Thou canst perform the cauterization with one or

other of its two extremities, as is most convenient.”[208]

In regard to epulis, Abulcasis prescribes that after catching hold of

the little tumor with a hook or a vulsella its complete excision should

be performed. This done, one must wait awhile, until the hemorrhage

ceases, and then either a little “zegi” pulverized,[209] or other

drying and styptic powder, must be applied on the part. If the epulis

recurs, which very often happens, the excision must be repeated and

this followed by cauterization, since after this latter the evil will

not return.[210]

Abulcasis is the first author who has taken into serious consideration

dental tartar and who has recommended that a scrupulous cleansing of

the teeth should be performed. The chapter relating to this, “On the

Scraping of the Teeth,” is very interesting and is worthy of being here

reproduced.[211]

[Illustration: FIG. 34

Abulcasis’ dental cautery and the tube through which it was applied, in

order to preserve the neighboring parts from the action of the heat.]

“Sometimes on the surface of the teeth, both inside and outside, as

well as under the gums, are deposited rough scales, of ugly appearance,

and black, green, or yellow in color; thus corruption is communicated

to the gums, and so the teeth are in process of time denuded. It is

necessary for thee to lay the patient’s head upon thy lap and to scrape

the teeth and molars, on which are observed either true incrustations,

or something similar to sand, and this until nothing more remains

of such substances, and until also the dirty color of the teeth

disappears, be it black, or green, or yellowish, or of any other color.

If a first scraping is sufficient, so much the better; if not, thou

shalt repeat it on the following day, or even on the third or fourth

day, until the desired purpose is obtained. Thou must know, however,

that the teeth need scrapers of various shapes and figures, on account

of the very nature of this operation. In fact, the scalpel with which

the teeth must be scraped on the inside is unlike that with which

thou shalt scrape the outside; and that with which thou shalt scrape

the interstices between the teeth shall likewise have another shape.

Therefore, thou must have all this series of scalpels ready if so it

pleases God.”[212]

The work of Abulcasis is, so far as we know, the first book in which

are found figures of dental instruments. We do not know, however, how

far such figures are exact, that is, to what degree of faithfulness

they represent the instruments which Abulcasis really employed as the

original figures of the book of Abulcasis were copied and recopied

by successive transcribers of the work. And that such copies have

been very often unfaithful may be deduced from the fact that not

unfrequently figures of surgical instruments are found in the book

which do not at all agree with the verbal description which the author

gives of such instruments.

In the edition by John Channing, we find at the end of the chapter on

the scraping of the teeth two series of figures. The first series is

found under the Arabic text, and is composed of the fourteen figures

reproduced as Fig. 35; the other series, existing under the Latin text,

has only twelve figures, as shown in Fig. 36.

As Channing has made his translation from two different Arabic copies

of Abulcasis,[213] among the corresponding figures of which there

exists a very notable difference, he, for the greater part, had to

follow the plan of reproducing the figures of both codices. But besides

this numerical difference, there is also a considerable difference

in the shape of the instruments represented. We must, therefore, ask

ourselves which of the two series of figures is to be regarded as the

more faithful representation of the instruments used by Abulcasis. Most

probably the first series. In it we find figured some scrapers which

have a certain resemblance to those actually in use; besides this, the

figures of the first series seem to be drawn with greater accuracy than

those of the second. Among other things it may be noticed that the

handle of each instrument (excepting the last two) is furnished with

a row of prominences, which, it is almost certain, were designed to

afford a better grip in holding the scrapers during the operation.

[Illustration: FIG. 35

Set of fourteen dental scrapers (Abulcasis).]

[Illustration: FIG. 36

Twelve dental scrapers as represented in another manuscript codex of

Abulcasis.]

We now consider the chapter on the extraction of teeth.[214] The author

begins by saying that it is necessary to use all possible means to cure

an attack of odontalgia, and to be very slow in deciding to extract a

tooth, as this is a very noble organ, the want of which cannot in any

way be perfectly supplied. When there is no way of avoiding extraction

and the patient is obliged by pain to submit to this, it is necessary

first to ascertain which is the aching tooth, as very often the pain

deceives the patient, so that he may indicate as the seat of the pain

another tooth which is perfectly sound, and desire it to be extracted;

after which, naturally, the pain does not cease, if not when the

diseased tooth is also extracted, as often happens in the hands of

the barbers.[215] The aching tooth having been well ascertained, it

is necessary to detach the gum from the tooth, all around, with a

sufficiently strong scalpel. Then either with the fingers or with a

light pair of forceps the tooth must be shaken very gently, until it

is loosened. Then the surgeon, keeping the head of the patient firmly

between his knees, applies a stronger pair of forceps and extracts the

tooth in a straight direction, so as not to break it. If it is not

possible to draw it out, one of those elevators must be taken which the

author advises for the extraction of roots (as may be seen afterward),

and by insinuating it under the tooth the surgeon must endeavor to

extract it. When the tooth is corroded and hollow, it is necessary to

fill the cavity with lint, compressing it hard inside with the end of

a probe,[216] so that the tooth may not break under the pressure of

the instrument. In all cases, the operator must take great care not to

break the tooth, for if this happens the remaining part will give the

patient still greater suffering. It is necessary, therefore, to avoid

acting like the ignorant and foolish barbers, who in their temerity

do not observe any of the above-mentioned rules, and therefore very

often cause the patients great injuries, the least among which is the

breaking of the tooth, the root being left in the socket, or else the

taking away, together with the tooth, of a piece of the maxillary bone,

as the author often happened to see. After the extraction the patient

must rinse his mouth with wine, or with vinegar and salt. If, as often

happens, hemorrhage is produced, a little powdered blue vitriol must be

applied inside the wound; and if this is not sufficient, the part must

be cauterized with a red-hot iron.

[Illustration: FIG. 37, FIG. 38

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

The small forceps (Figs. 37 and 38) to be used in loosening the tooth

must have the handle shorter than the jaws and be sufficiently strong

not to bend when pressure is put upon the tooth.

The large forceps (Figs. 39 and 40) with which the extraction must be

performed should be made of very good Indian or Damascene iron, and

have the handle longer than the jaws; these, moreover, on the inside

must be toothed, or striated after the manner of files, so that they

may have a perfectly firm grip, without slipping.

From the foregoing quotations and on examining the annexed figures,

it very clearly appears that the extraction of teeth was performed by

Abulcasis with excessive timidity and in a manner which must have been

torturing to the poor patients. These had to undergo, first of all, the

detachment of the gums, then the prolonged shaking of the tooth either

with the fingers or with the forceps, then the attempt at extraction by

means of a stronger pair of forceps, but, so far as can be seen from

the figure, very little fitted for the purpose; and finally, in many

cases, fresh maneuverings to extract the tooth with an elevator.

[Illustration: FIG. 39, FIG. 40

Forceps for performing the extraction after the tooth has been loosened

(Abulcasis).]