instruments. But it is possible that even then there perhaps existed,
for the extraction of teeth, other instruments, so shaped as to be
able to act with greater force. Abulcasis himself[217] alludes to the
existence of dental instruments not mentioned by him. It is probable,
therefore, that the barbers, in spite of the scorn with which Abulcasis
overwhelms them, used, for the extraction of teeth, forceps far more
suitable than those described by him. These individuals, certainly
unfurnished with a scientific education, must have had, however, a
great practice in the extraction of teeth, being perhaps almost the
only ones to whom recourse was had for this operation. They performed
it very quickly, as may be argued from the words of Abulcasis himself.
It is no wonder, therefore, that not unfrequently the work of these
_fatui tonsores_[218] was the cause of more or less serious injuries,
but for the most part it had the advantage of not making the patients
suffer excessive torture.
Another very interesting chapter is that which treats of the extraction
of dental roots and fragments of the maxillary bone.[219]
[Illustration: FIG. 41, FIG. 42
Forceps for extracting the root when the tooth breaks in the
extraction. These figures are evidently very badly drawn, as are most
of the figures to be seen in Abulcasis’ work.]
When, says the author, on extracting a tooth, this breaks, so that the
root remains in the socket, it is necessary first of all to soften the
part, by applying for a day and a night, or for two days, some cotton
wool well smeared with butter; then attempts must be made to extract
the root with a pair of forceps, the jaws of which are like the beak of
a pheasant or stork.
[Illustration: FIG. 43
Elevator to be used when the extraction of a root by means of the root
forceps proves impossible (Abulcasis).]
If this is not successful, it is necessary to remove with a scalpel
the whole of the gum which covers the root; then under it must be
insinuated a small elevator having the shape here below represented.
If not even in this way can the end be attained, recourse must be made
to one of the following instruments, choosing that which in every
particular case seems to be the most suitable.
Besides these, says the author, use may be also made of some of the
instruments which serve for the removal of tartar.
It is precisely in this chapter that Abulcasis speaks of the great
variety and multiplicity of dental instruments; which, he says, cannot,
like other kinds of instruments, be all enumerated and described.
He then adds that a skilful surgeon will be able to devise new
instruments, according as the peculiarities of each single case require
them.
[Illustration: FIG. 44]
[Illustration: FIGS. 45, 46, 47]
[Illustration: FIG. 48
Elevators (Abulcasis.)]
For the extraction of a splinter or necrosed fragment of the maxillary
bone, the same instruments must be used which serve for the extraction
of dental roots; but also a pair of forceps may be used (Figs. 50 and
51).
It will be necessary to grip with them the osseous fragment firmly, so
that it cannot escape whilst it is being extracted. The part shall then
be medicated with fitting remedies.
Whenever it is thought proper, the bone must be scraped and all the
diseased part of it removed.
When a tooth is irregularly placed, or projects above the level of
the others,[220] a deformity ensues which is particularly displeasing
in women. The way of correcting this varies according to the nature
of the case. It consists sometimes in the simple extraction of the
misplaced tooth. But when there exists an intimate (osseous) union of
the irregular tooth with another one, it is necessary to operate for
the resection of the former with an instrument of the following shape,
that is, like a small axe:
[Illustration: FIG. 49
An instrument like a small axe, for resecting irregularly situated
teeth (Abulcasis).]
The operation must be performed in many days, not only on account of
the hardness of the tooth, but also in order not to shake any of the
neighboring teeth.
In other cases, the deformity, consisting in one tooth projecting above
the level of the others, may be corrected with a saw.
The instrument must be made entirely of Indian iron, and the operation,
like the preceding one, is to be carried out in several days, that the
fall of the tooth may not be provoked by excessive shaking. The file
(Fig. 55), too, must be used to destroy the edges and points of broken
teeth, that they may not injure the tongue, or give any trouble in
speaking.
[Illustration: FIG. 50, FIG. 51
Forceps for extraction of splinter or necrosed fragments of the
maxillary bones (Abulcasis).]
[Illustration: FIG. 52
A dental saw (Abulcasis).]
[Illustration: FIG. 53
Another dental saw (Abulcasis).]
When, in consequence of a blow or fall, one or more teeth have become
loose so that the patient cannot bite his food with them, if the use
of styptic remedies has been found of no use, it will be necessary to
bind and make such teeth firm by a gold or silver wire. Gold is to
be preferred as being unalterable, whilst silver in a few days turns
green. Having chosen, therefore, a suitable gold wire of perfectly
uniform consistency, it must be passed at its middle part between two
firm teeth, that is between the two nearest on one side to the loosened
tooth or teeth; then, by binding tightly around the sound tooth and
each of the loosened teeth the two lengths of the wire and crossing
them in the dental interstices so as to form a kind of network, the
sound and firm tooth of the opposite side will be reached, and this
too must be wound around in a mesh, as it were, of the said network.
Then, turning back, the same operation must be repeated, but inversely,
until the point of departure is reached. All this must be done with
much skill, so as to render the loose teeth completely unmovable. When
the wire is tied, this must be done near the dental roots, so that the
knot may not get untied; then with a pair of scissors the remaining
part must be cut off and its two ends joined and twisted with a pair of
pincers, hiding them between the sound tooth and the neighboring loose
one. Such a ligature should remain in place during a whole lifetime;
and in case it should come undone or the wire should break, it will be
necessary to renew the operation. The following figure represents the
ligature described:
[Illustration: FIG. 54
Ligation for steadying teeth in cases of blow or fall (Abulcasis).]
“Sometimes, when one or two teeth have fallen out, they are replaced
in the sockets and bound in the aforesaid manner and remain there.
The operation must be carried out with great delicacy and ability, by
skilful hands.”
As may be seen from the above quotation, in the days of Abulcasis
replanting was already performed, although it is probable that the
ligature was then left permanently.
The author says, next, that the vacancy left by fallen teeth can be
filled up with artificial ones, made of ox bone, they also being fixed
in the manner above described; and he adds that they will be found not
only of advantage from the esthetic but also from the functional point
of view.
Speaking of the cure of the ranula,[221] Abulcasis says that when the
tumor, examined by the clear light of the sun, appears brown or black,
hard and insensible, it is not to be operated, it being then of a
cancerous nature. If, instead, it is whitish and full of liquid, it
must be seized with a hook, and by means of a fine scalpel extirpated.
The hemorrhage must be combated with powdered blue vitriol. After the
operation mouth washes must be used of vinegar and salt.
In cases of fracture of the lower jaw[222] it is not only necessary
to cure the fracture itself according to the rules which the author
prescribes for the various cases, but it is also necessary to pay
attention to the teeth and with a gold or silver wire, or a silk
thread, to tie, in the manner already described, those teeth which in
consequence of the wound have become loose, but the consolidation of
which may be hoped for.
[Illustration: FIG. 55
A dental file (Abulcasis).]
MESUE THE YOUNGER, a disciple of Avicenna, is of opinion that when a
tooth is the seat of violent pain, this may easily propagate itself
to the other teeth; and therefore advises, if the pain does not soon
cease, to extract the tooth affected, without delay. This operation,
however, must not be performed, says the author, whilst the pain is at
its height, but rather when it is somewhat lessened, otherwise, the
extraction of the tooth may result in a syncope sometimes ending in
death, or else be the cause of intense inflammation and of suppuration,
which, also, may, in certain cases, place the patient’s life in danger.
He recommends an infinite number of remedies against odontalgia; in
these, however, there is nothing new to us. As to the removal of a
tooth, this may be obtained in three different ways, that is, with
the forceps, with eradicating remedies, or by cauterization. In
order to cause a tooth to fall out by the use of acrid, eradicating
substances, the author advises to proceed in the following manner:
The tooth is first freed, by means of a scalpel, from the surrounding
gum; the eradicating remedy is next applied to the root of the tooth,
every needful precaution, however, being taken that it may not injure
the neighboring teeth. Cauterization, when practised to produce the
exfoliation of a diseased tooth, may be performed, according to Mesue,
either with a small red-hot iron, passed through a little metal tube in
order to protect the neighboring parts, or with the heated kernel of a
nut, or with a grain of burning incense.[223]
To cure a dental fistula, Mesue cauterized it to the very bottom with a
cautery in the form of a probe, or extracted the tooth, which by reason
of its diseased root was the cause of the fistula; and when the bone
was likewise affected, he laid bare the carious part, which he then
scraped.[224]
AVENZOAR. The last of the great Arabian physicians was Avenzoar. He
was born at Peñaflor, near Seville, in 1070 and died in 1162. He became
famous by his very valuable work on medicine, entitled the _Teisir_. It
is strange, however, that in this book there is hardly anything about
the treatment of dental diseases. Against caries and looseness of the
teeth the author limits himself to recommending bloodletting either
from the ranine or the basilic vein. Apart from this, he speaks neither
of operations nor of remedies for diseases of the teeth.[225] Probably
at the time in which Avenzoar wrote, that is, in the first half of the
twelfth century, doctors in general did not occupy themselves with the
curing of teeth at all, this being abandoned entirely to barbers and
other persons. This would sufficiently explain why this author is so
silent in regard to dental diseases.
But what can have been the reason for doctors refusing thus
contemptuously to occupy themselves with so important a branch of
therapeutics? In every age there have been a great number of ignorant
persons, who either in good faith, or else for imposture, have
practised, within a more or less limited circle, the art of healing,
usually dedicating themselves to some particular class of diseases.
Even in our days, notwithstanding the superabundance of duly qualified
doctors, there is, especially in certain countries, no small number of
quacks, secretists, bone-setters, chiropodists, and the like. It is,
therefore, not to be wondered at that in times when dentistry was still
in its infancy there should have been persons more or less ignorant
who undertook tooth drawing and the concoction and sale of specifics
against odontalgia. The doctors, on their part, under the pretext of
being unwilling to have anything to do with these individuals, found it
very convenient to dispense with the cure of dental diseases and with
the extraction of teeth, this operation being sometimes too difficult
for them, on account of their want of practice, besides being almost
always very painful, and considered, even from the most ancient times,
capable of eventually producing evil consequences, among which, in some
cases, even the death of the patient.
But perhaps this was not the only reason for the fact above mentioned.
In the middle ages the extraction of one or more teeth was sometimes
inflicted as a punishment; for example, for having eaten flesh during
Lent,[226] or on those found guilty of felony, for having refused to
contribute sums of money demanded from them by their liege lord. Now,
as this punishment was carried out on the guilty ones by the executors
of public justice, it is only natural that doctors should have refused
to practise an operation which would have degraded their profession by
bringing it down nearly to the class of the hangman.
CHAPTER IX.
THIRTEENTH TO FIFTEENTH CENTURIES.
BRUNO OF LONGOBUCCO. After the Arabian period, the first author whom
we must mention is Bruno of Longobucco, of the school of Bologna,
who lived in the thirteenth century and wrote a treatise on surgery,
which gave him a certain renown.[227] This book, however, contains but
little about diseases of the teeth. The author shows himself a great
friend of the actual cautery, and advises its use in the cure of dental
caries and of various diseases of the gums. He says nothing about the
extraction of teeth; instead, he recommends, as a means for making
a diseased tooth fall out, that the milky juice of the tithymal be
applied around its root after having been reduced to the consistency of
paste by the addition of flour.[228]
LANFRANCHI, of Milan, another writer of the thirteenth century, who
acquired great fame by his book _Chirurgia magna et parva_—partially
translated into German, more than two centuries later, by Otto
Brunfels—also shows himself very timid in the sphere of dentistry,
and to combat dental pains he recommends, by preference, the use of
narcotics. He is not at all favorable to the extraction of teeth; and
especially that of the molars is considered by him a very dangerous
operation.[229]
TEODORICO BORGOGNONI (1205 to 1298), known also under the name of
Teodorico of Cervia, is according to Hæsar the first author who made
mention of sialorrhea following mercurial frictions. Worthy of note,
too, is what he says in regard to fistulas of the gums, or, in general,
of the maxillary region. He advises that in every case of this kind
special attention be paid to the state of the dental roots; when there
is a discharge of ichorous pus, the roots are certainly affected; and
then the diseased teeth must all be extracted as soon as possible.[230]
JOHN GADDESDEN, an English doctor who flourished at Oxford in the
first half of the fourteenth century, wrote a very curious medical
book, taken the greater part from Pliny and the Arabian writers and
entitled _Rosa anglica: practica medicinæ a capite ad pedes_ (English
rose: the practice of medicine from head to foot). In his time many
strange methods of cure were in use, sometimes simply ridiculous,
and others even filthy; and the _Rosa anglica_ furnishes us with
not few examples. In order to make a tooth fall, Gaddesden advises
the application of dried crow’s dung reduced to powder, or else to
anoint it with the fat of a green frog. This last means would be quite
infallible and would make the tooth fall out on the spot. It had such
power that if peradventure an ox in grazing chews a little frog with
the grass, its teeth will all fall out on the instant! We do not know
whether the author himself believed in the marvellous virtues of the
fat of green frogs. It is certain, however, that he enumerates this
among his “secrets,” and says that he has gained much money from it
through the mediation of the barbers.
Other absurdities of the same kind are the following: The brain of the
hare can, by being rubbed on the gums and jaws, serve for two important
purposes, since it has not only the virtue of facilitating dentition,
but also of making teeth grow again to those who have lost them! The
brain of a partridge applied to a carious tooth makes it fall in pieces!
The treatment of odontalgia embraces, according to Gaddesden, both
general and special means of cure. To the former belong purgatives,
bloodletting, scarifications of the labial and sublingual mucous
membrane, leeches, the application of scarified cuppings under the
chin. The special means of cure are represented by a great number of
plasters, powders, and ointments, in the composition of which almost
constantly hyoscyamus and pyrethrum take part. When odontalgia depends
on caries, the author advises, among other things, the use of a
red-hot iron. Against the supposed worms of carious teeth he counsels
fumigations with the burnt seeds of hyoscyamus or of leeks. In cases of
dental fistulas, it is necessary to cauterize the fistulous tract, to
extract the diseased tooth, and if the bone be also affected, to scrape
it. To clean the teeth: Gaddesden recommends several dentifrices; some
of which are composed of pulverized cuttle bone, either with addition
of meerschaum, pumice stone, burnt hartshorn, in different proportions
and combinations, or used quite alone; others are made with myrrh and
alum.
Since Gaddesden affirms the existence of means capable of promoting
the fall of any tooth, we should suppose that he says nothing about
instrumental extraction, or at least that he considers it entirely
useless; for if in order to make a tooth fall out, it be sufficient to
smear it with frog’s fat, why should there ever be any need to have
recourse to the very painful extraction by means of the forceps?
However, this is not so; the author treats of instrumental extraction
as a very important operation, without being at all afraid of
being reproved for contradicting himself. Besides, to anyone who
thus reproved him he perhaps would have answered, without being
disconcerted, that it is not always possible to have the fat of frogs
or the dung of crows in readiness.
The extraction of a tooth is only justifiable, says Gaddesden, when
all the remedies employed against odontalgia have proved useless and
when, on the other hand, the pain has its seat in the tooth itself and
not in the nerves or gums. Before undertaking the operation, however,
the patient must be prepared for it with an evacuant cure, that is,
by injections and purgatives. For the operation itself the author
recommends the same rules given by Celsus, and says, besides, that the
head of the patient ought to be held firm by an assistant. In certain
cases, the extraction can be performed, better than with the forceps,
by means of an instrument in the form of a lever, broad at one end,
narrow and sharpened at the other. But when a tooth is very firmly
seated, its extraction is always dangerous; therefore, in such a case,
Gaddesden recommends, before having recourse to the operation, the use
either of acrid substances, such as the milky juice of the euphorbiaceæ
(for example, of the tithymal), or else of a red-hot iron; and this,
for the purpose of promoting the fall of the tooth, or of rendering
it, at least, so far movable that it can be extracted without any
difficulty.
GUY DE CHAULIAC, the greatest surgeon of the middle ages, was born
about 1300, in a little village on the confines of Auvergne, which
still preserves the name of Chaulhac; he died in 1368. This author
immortalized his name by a work which even up to the eighteenth
century was, as it were, the official code for the teaching of
surgery. Guy wrote his _Chirurgia magna_ in barbarous Latin—such as
was then used by the learned; but his book was soon translated into
French, Provençal, and afterward also into Italian, English, Dutch,
and Hebrew. E. Nicaise, who, in 1890, gave to the scientific world a
very valuable new edition of Guy de Chauliac,[231] and who made very
accurate researches on all that regards this author and his work, has
succeeded in finding in the libraries of Europe and America as many as
thirty-four manuscript copies of the _High Surger_.[232] The survival
of so many copies, in spite of all the destructive agencies which have
been in action during more than 500 years, is a very clear proof of the
wide diffusion which this work obtained even before the invention of
printing.
Guy’s work was printed for the first time in 1478, and the editions
that have been published since then in various countries are in all
about 130.
This book is very important for our subject, since we may gather from
it very clearly the condition of dentistry in the fourteenth century;
but, on the other hand, we see from it, with equal clearness, that
this branch of the healing art had not made any progress from the
time of Abulcasis to that of Guy de Chauliac (about two centuries
and one-half), and that this most famous surgeon did not contribute
anything worthy of note to the development of dentistry.
On the anatomy and physiology of the teeth Guy de Chauliac expresses
himself very briefly: “Teeth are of the nature of bones, although they
are possessed of sensibility, due to some nerves which the third pair
sends to their roots. The number of these latter may vary from one to
four, according to the different teeth. The uses of these organs are
well known.”[233]
Worthy of being recorded are the names which Guy gives to the
different kinds of teeth. After having said that these latter are
generally thirty-two, but sometimes only twenty-eight, he adds, that
the sixteen teeth of each jaw are divided into: _deux duelles, deux
quadruples, deux canines, huiet maschelieres[234] et deux caisseaux_
(in the barbarous Latin: _duo duales, duo quadrupli, duo canini,
octo molares et duo caysales_). So that the two middle incisors were
then called _duales_; the lateral incisors were called _quadrupli_,
because, together with the middle ones, they formed a series of four
teeth. Guy gives the name of _caysales_ (_caisseaux_) to the last two
molars; but Joubert, one of the translators and commentators of Guy de
Chauliac, tells us that the molars in general were called in Languedoc
_caisseaux_: “Les cinq molaires sont appelées en Languedoc _caisseaux_,
parce qu’elles servent à casser les choses dures, comme les noix et
semblables.” In regard to the canines of the upper jaw, we learn that
they were called _oeillères_ (eye teeth), because their root was
believed to reach near the eye.[235]
According to Guy de Chauliac, _les dents sont engendrées non
seulement en l’enfance, ains aux autres ages_.[236] And this passage
was commented by Joubert in the following note, which we reproduce
textually:
“En Languedoc, près de Pezenas y a une gentil femme, nommé Mademoiselle
de Lobatiere, dès long temps vieille édentée, à laquelle (comme
tesmoignent beaucoup de gens très-dignes de foy) environ l’an 70 de
son age, sont sorties cinq ou six dents nouvelles. Le conciliateur
tesmoigne avoir veu, à qui les dents perdues devant l’an 60 ont été
derechef engendrées, moindre toutes fois que les premieres et plus
foibles.”[237] (In Languedoc, near Pezenas, there is a lady named
Mademoiselle de Lobatiere, who having been for a long time old and
toothless (according to the testimony of persons well worthy of
belief), at about the age of seventy got five or six new teeth. The
Conciliator[238] testifies to having seen teeth grow anew—smaller,
however, and weaker than the first—in persons who had lost them before
the age of sixty years).
In regard to the pathology and therapy of the teeth, Guy but rarely
abandons the footsteps of the Arabian writers. Following the example
of one of these, Ali Abbas, he admits five or six dental maladies:
pain, corrosion, congelation, and _agacement_ (teeth set on edge),
limosity or fetidness, fall or loosening.[239] As to the cure, this is
divided into universal and particular. The former includes, before all,
hygienic rules, and then purgatives, bloodletting of the cephalic vein
or the veins of the lips or tongue, revulsion, obtained by means of
cupping glasses, friction, etc., and the remedies for curing the rheums
of the head, or for throwing out the phlegmatic humors (pyrethrum,
mastic, and the like).
The hygienic rules are the following: Not to eat food apt to putrefy,
such as fish and milk foods; to avoid food or drink either too hot or
too cold, and especially the rapid succession of cold and hot, or _vice
versa_; not to bite hard things, nor to eat viscous food, such as figs
and confectionery made with honey; to avoid certain foods which are
known to be bad for the teeth, such as leeks; not to clean the teeth
too roughly, but to rub them with honey and burnt salt, to which, very
advantageously, may be added some vinegar.
Before speaking of the special methods of cure of single dental
affections, Guy observes that operations on the teeth are _particular_
(proper) to barbers and to “dentatores,”[240] to whom doctors have
abandoned them. But it is safest of all, says he, to have such
operations performed under the direction of doctors. These, however,
to be in a position to give advice in regard to diseases of the
teeth, must know the various methods of cure which are suited to
these diseases, that is to say, mouth washes, gargles, masticatories,
fillings, evaporations, anointments, rubbings, fumigations,
cauterizations, sternutatories, instillations into the ears, and manual
operations.
Lastly, Guy notes that the “_dentator_”[241] must be provided with all
the appropriate instruments, that is, with “rasoirs, rapes, spatumes,
droits et courbes, eslevatoires simples et à deux branches, tenailles
dentelées, et diverses esprouvettes, cannules, deschaussoirs, tarieres,
aussi des limes, et plusieurs autres necessaires a cette besogne” (in
Latin: rasoriis, raspatoriis, et spatuminibus rectis et curvis, et
levatoriis simplicibus et cum duobus ramis, tenaculis dentatis, et
probis diversis, cannulis, scalpis et terebellis, et etiam limis.)[242]
Whilst Abulcasis bitterly declaims against the barbers, because they,
in spite of their ignorance, permit themselves to perform operations
on the teeth, and especially to extract them, Guy de Chauliac speaks
in quite a different tone. He recognizes that such operations are
_particular_, which is as much as to say, in modern language, that the
practice of dental surgery constitutes a _specialty_. Guy, it is true,
expresses his desire that dental operations be performed, for greater
security, under the direction of doctors, but he does not use one word
of blame or contempt against the _dentatores_, thus leaving it to be
understood that, according to him, their art had every good reason
to exist. Besides, from the enumeration of the surgical instruments
which Guy says are necessary to them, we can easily argue that the
_dentatores_ of the fourteenth century were not, as at the very first
one might be led to believe, mere “tooth-pullers,” but that, at least,
the best among them cured teeth as well as the scanty knowledge and
means of cure then available enabled them to do.
In the chapter on odontalgia,[243] Guy de Chauliac distinguishes
between the pains, the point of departure of which is in the tooth
itself, and those resulting from disease in other parts, for example,
from apostema[244] of the gums; in these latter cases, in order to
cause the pain to cease, it is necessary to cure the part from which
the pain is derived, taking into account the nature of the disease and
its causes.
When the pain is situated in the root of the tooth or in its nerve, it
is necessary, says the author, to distinguish whether it is caused by
an accumulation of morbid matter, or whether it is, instead, a simple
pain _without matter_. Besides, it is necessary to distinguish, in the
first case, whether the matter producing the pain is hot, cold, or
windy; and also, in the second case, it is necessary to ascertain if
the pain is of a warm, cold, dry, or humid nature. As may be seen, the
principles and subtle distinctions of the pneumatic school were then in
full vigor.
The treatment must vary according to all the aforesaid cases; but the
means of cure advised by Guy de Chauliac do not present any special
interest, as they are almost entirely taken from Galen and from the
Arabian authors, and especially from Rhazes, Ali Abbas, and Avicenna.
On coming to speak of the looseness of teeth,[245] Guy says that
this may depend on various causes: that is, on a fall or a blow; on
humidity, which softens the nerve and ligament;[246] on dryness and
lack of nourishment of the teeth; and lastly, on corrosion of the gums.
The looseness of teeth, which depends on dryness or want of nutrition,
as in the old and in consumptive people, is incurable. In other kinds
of looseness, astringents are useful; but it is also well that the
patient should speak but little, that he should not touch or move the
loose tooth, nor use it in masticating. In cases of corrosion of the
gums, this disease must be cured.
If looseness of the teeth follows a blow, it is well, first of all, to
let blood, and then to use astringents and excitants. When all this is
of no avail, Guy advises that the loose teeth be tied to the healthy
ones with a little gold chain,[247] after the manner of Abulcasis. And
if, says he, the teeth fall out, they may be replaced with teeth of
another person, or with artificial teeth of ox bone, fixing them in
their place with a fine ligature; and, he adds, that such teeth are
serviceable for a long time. Here are the precise words of the text:
“Et si les dents tombent, qu’on y mette des dents d’un autre, ou qu’on
en forge d’os de vache, et soient lisez finement, et on s’en sert
long-temps.”
This extremely concise manner of treating dental prosthesis, summing
all up in some thirty words, is in strong contrast with the usual
fulness of explanation and methodical accuracy of Guy de Chauliac, to
whom, very justly, could be given the title of founder of didactical
surgery. Such a strange contrast cannot be explained, unless by
admitting that Guy considered dental prosthesis as foreign to the
general plan of his book, that is, as something which did not directly
concern surgeons, and for which, therefore, a mere allusion ought to
be sufficient. Without the slightest doubt, dental prosthesis was
practised neither by doctors nor surgeons, but by the _dentatores_.
Abulcasis, too, certainly for the same reason, is extremely brief
in speaking of artificial teeth, but, on the other hand, he very
minutely describes the process of ligating loose teeth. Guy omits this
description entirely, and only alludes briefly to this therapeutic
practice. From this it is easy to perceive that whilst Abulcasis
considered this operation within the province of surgeons, Guy de
Chauliac was disposed to exclude it from the field of general surgery,
considering that this, too, like the other dental operations, belonged
to the _dentatores_. In his days, in short, dentistry had become much
more clearly specialized than it was in the days of Abulcasis.
After having spoken of the looseness of teeth, Guy de Chauliac goes on
to treat of caries, in a short chapter, entitled “De la Pourriture, des
vers, de corrosion et pertuifement des dents.”
The method of cure, he says, is double, viz., universal and particular.
The general treatment embraces the hygienic and therapeutic means
already mentioned. As to the particular or local treatment, it
consists, first of all, in washing the teeth with aqua vitæ or with a
vinous decoction of mint, salvia, melissa, pepper, or pyrethrum. Then
it is necessary to fill the carious cavity with gallia[248] and root of
cyperus,[249] mastich, myrrh, sulphur, and camphor, wax, ammoniacum,
asafetida and the like. As may be seen, Guy does no more than mention
the substances used in his days for the filling of carious teeth, and
does not tell us what various combinations were formed with the said
materials, nor the proportions in which they were used. In short, he
does not give us any formula for the composition of a filling mass, and
from this may be inferred, without fear of error, that this operation
also was never performed by him, consequently it, too, was not
practised by doctors and surgeons, but rather by the _dentatores_.
When the aforesaid means of cure—that is, the mouth washes and the
filling—are of no use, Guy advises the margins of the carious cavity
being taken away with a scalpel and file, so that alimentary substances
may not be retained inside it. However, here are his words, which seem
especially to refer to cases of interstitial caries:
“Si ces choses n’y valent rien, la dent soit esbuschaillee avec un
ciseau et lime,[250] e qu’on luy fasse un passage, à ce que la viande
ne s’arreste au trou.” If advantage is not even derived from such an
operation, recourse must be had to cauterization, or, if necessary, to
extraction.
Even Guy de Chauliac believes in the worms of the teeth, and against
these he recommends the usual fumigations. He advises that the seeds
of leek, onion, and hyoscyamus be mixed with goat’s tallow and made
into pills of a dram each in weight, one of which is to be used for
each fumigation: “Si dans le trou il y a un ver, apres le susdit
lavement,[251] la dent soit suffumiguée avec une graine de porreau et
d’oignon et semence d’hyosciame, confits avec suif de bouc; et qu’on
en fasse des pilules chacune d’une drachme et qu’on y en employe une à
chaque fois.”
In the following chapter Guy treats “De la limosite et laide couleur
des dents.” Here, too, he recommends, before all, the general hygienic
rules above mentioned. Besides, he advises the mouth being rinsed with
a vinous decoction of wild mint and of pepper, and then the use of the
following dentifrice:
“℞—_Cuttle-bone, small white seashells, pumice stone, burnt stag’s
horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and
reeds._ All these substances must be reduced to powder together, or
each one separately.” Use may also be made of a liquid dentifrice thus
prepared:
“℞—_Sal ammoniac and rock salt, half a pound of each; saccharine
alum, one-quarter of a pound._ These to be reduced to a powder and
placed in an alembic of glass, so as to obtain a liquid, with which the
teeth must be rubbed by means of a little scarlet cloth.”
If these means of cure are of no avail, on account of the presence of
hardened limosity (tartar), this must be removed by scraping it away
with appropriate instruments. “Et si cela ne profite, à cause qu’il
y a là des limosites endurcies; soient rasclées avec des rapes et
spatumes.”[252]
Against the setting of teeth on edge (_endormement et congelation des
dents_; _stupor et congelatio dentium_), Guy de Chauliac recommends
hot wine or aqua vitæ, to be kept in the mouth; or the teeth to be
rubbed with roasted salt; or the application to them of hot roasted
walnuts and filberts and similar things which convey heat; or lastly,
masticating substances, which possess heating properties, such as the
portulaca (purslane) and its seeds.
The chapter on the extraction of teeth and of dental roots is a simple
summary of what Abulcasis says on this subject; some passages of this
author are copied word for word.
Whilst the Arabian surgeon treats rather lengthily of the deformities
of the dental arches, and the methods to be employed in correcting
these, Guy de Chauliac almost entirely neglects this subject and
limits himself to saying that if any tooth has become abnormally
lengthened, it is necessary to reduce it to the right length with the
file, but operating “wisely,” so as not to loosen it:
“S’il y a quelque dent augmentée outre nature, soit egalisée et
applanie sagement avec la lime, que ne soit ébranlée.”
Guy strongly throws doubt upon the efficacy of supposed eradicating
remedies. In regard to this he says: “The ancients mention many
medicaments, which draw out the teeth without iron instruments or
which make them more easy to draw out; such as the milky juice of the
tithymal with pyrethrum, the roots of the mulberry and caper, citrine
arsenic, aqua fortis, the fat of forest frogs. But these remedies
promise much and operate but little—_mais ils donnent beaucoup de
promesses, et peu d’operations_.”
From the book of Guy de Chauliac we can gather a very important fact,
which is worth mentioning here; that is to say, that some surgeons of
that period made use already of anesthetic inhalations, especially for
amputations. Here is what Guy says:[253]
“Some prescribe medicaments which send the patient to sleep, so
that the incision may not be felt, such as opium, the juice of the
morel,[254] hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge
is soaked by them in these juices and left to dry in the sun; and when
they have need of it they put this sponge into warm water and then hold
it under the nostrils of the patient until he goes to sleep. Then they
perform the operation.”
It seems that the narcosis thus obtained was sufficiently intense,
since Guy also speaks of the means used to awaken the patient. These
consisted in applying another sponge, soaked in vinegar, under the
nose, or in dropping into the nostrils and ears the juice of rue or
fennel.
Guy lets us know that other surgeons made the patients go to sleep by
giving them opium to drink; but he decidedly disapproves of such a
practice, as he has heard of patients who through this have died.
VALESCUS OF TARANTA (called by the French authors Valescon or Balescon
de Tarente or Tharare), professor at the University of Montpellier
at the beginning of the fifteenth century, wrote a valuable treatise
on medicine and surgery, entitled _Philonium pharmaceuticum et
chirurgicum, de medendis omnibus humani corporis affectibus_. As to
the diseases of the teeth, he especially follows Guy de Chauliac, but
treats the subject at greater length, profiting by what has been
written on the subject by all the ancient writers, and especially the
Arabians.
Among the many remedies which he recommends against toothache, here are
some:
“℞—Wild mint, pyrethrum, white pepper, myrrh, two drams of each; let
these be pulverized and made into a paste with the pulp of raisins or
with white wax and with some turpentine; and let this mass be divided
into small balls as large as filberts, of which one must be masticated
at a time, with the aching teeth.”[255]
Another masticatory is composed of origanum, pyrethrum, cinnamon, and
ginger, made into a paste with the yolk of an egg cooked under the
coals.
To calm dental pains, the vapors of a decoction of wild lavender,
marjoram, rue, chamelea, and melilot are often efficacious. As to
fumigations, they can be made not only with vegetable substances (onion
or mustard seed, rue, etc.), but also by burning scrapings of the hoof
of an ass. The fumes may be made to reach the aching tooth, by means of
a funnel. Here are the words of the author: “Fiant suffitus ex rasura
ungulæ asini, et fumus recipiatur per infundibulum.”
Decayed teeth may be filled, according to Valescus, to satisfy four
different indications: To calm or prevent pain, to prevent any further
spreading of the caries, to kill the worms, and to sweeten the breath.
He advises that the carious cavities should be filled up with powdered
nigella, pepper, myrrh, salt, and theriac; or else with pyrethrum, gum
ammoniac, and opium; or else with celery seeds pulverized, opium, and
hyoscyamus; or with the cast-off skin of serpents boiled in vinegar;
or with gallia and cyperus. The filling with these last two substances
are especially suitable, according to the author, to preserve the teeth
from further spreading of the caries: “Si gallia et cyperus cavis
dentibus applicentur, dentes ulterius non corrodentur.”
To kill the supposed worms of the teeth, Valescus counsels three
different methods, of which the first consists of the usual fumigations
with seeds of hyoscyamus, onion, leek, coloquintida; the second
consists in filling the carious cavity with a mixture of myrrh and
aloes; and lastly, the third, in applying inside the cavity the milky
juice of the tithymal, or the juice of the persicaria.[256]
In regard to tartar of the teeth—which he calls _materia lapidea_,
_i. e._, stony substance—Valescus says that it must be removed little
by little, either with iron instruments or with dentifrices partly
cleansing and partly styptic. After the tartar has been removed, it is
necessary to wash the teeth often with white wine and to rub them with
roasted salt.[257]
Valescus, too, like the majority of ancient writers, is not at all
favorable to the extraction of teeth. He says that recourse must not be
had to this operation except when a tooth is the cause of most violent
pain and every remedy has been of no avail. But the reasons which he
gives in support of this opinion are very plausible; and whilst most of
the authors who preceded him showed themselves adverse to extraction,
because they considered it dangerous, he does not allude in the least
to such dangers, but wishes extraction to be avoided, if possible,
“because the teeth, even when they are in some parts corroded, yet
nevertheless, after the pain is calmed, aid mastication and besides
render the others firmer.”[258]
This author agrees with Galen in considering the teeth as bones, but
he is of opinion that they differ from the other bones in more than
one respect; that is, first of all, on account of their sensibility;
secondly, because, whilst the other bones are formed in the uterus, the
teeth are formed outside the uterus; and lastly, for a reason which
cannot but appear very strange to us, that is: “The bones are produced
by the sperm and menstrual blood, whilst the teeth are produced by the
blood in which there has remained the virtue of the sperm.”[259] This
passage gives us an idea of the state of embryological knowledge of
those days!
PIETRO OF ARGELATA (or of La Cerlata), professor of surgery at Bologna
(died in 1433), wrote a treatise on surgery in six books, in which
diseases of the teeth are also taken into serious consideration. He
speaks of a great number of dental instruments, which, however, are
the same as those enumerated by Guy de Chauliac. His methods of cure
do not offer anything very new, being for the most part identical with
those of Avicenna and Abulcasis. He considers cleanliness of the teeth
of the greatest importance; shows what great injury is done by dental
tartar—which by him is considered a very important sign of the bad
state of the teeth—he counsels the removal of it by means of scrapers,
files, or the use of strong dentifrice powders; and to make the teeth
white, he even advises the use of aqua fortis.
He says nothing in regard to the filling of decayed teeth; he, however,
counsels the cleansing of the carious cavities with aqua fortis, or
even, in some cases, the widening of them, in order to render them
shallower and therefore less liable to retain alimentary residues.
Pietro of Argelata cured dental fistulas by means of caustics and
arsenic. He counselled simple palliative means of cure for hard
epulides of a cancerous nature. In regard to soft, benignant epulides,
he was little favorable to excision, as this might cause hemorrhage;
he preferred ligating the tumor; or he repeatedly cauterized it with
boiling oil or other caustics, until he caused it to fall.[260]
BARTOLOMEO MONTAGNANA, who taught surgery in the University of Padua
and died in 1460, recommended, as an excellent anti-odontalgic remedy,
a mixture of camphor and opium. In his days, faith in the pretended
eradicating virtues of certain substances was being gradually lost;
but, on the other hand, a tendency now arose to neglect, in regard
to the teeth, the conservative principle, to which the ancients had
held so jealously; and little by little the extraction of a tooth
began to be considered an operation of small or no importance, that
could be performed with the greatest indifference. Montagnana himself
considers the extraction of a tooth as the best means of curing
odontalgia, whilst the ancients did not have recourse to it, saving as
a last resource. Notwithstanding this, if the caries was not deep, he
preferred to extraction the use of caustics and a red-hot iron.[261]
GIOVANNI PLATEARIO, a professor at Pisa in the latter half of the
fifteenth century, cauterized carious teeth with a small piece of
kindled ash wood, or with a red-hot iron, and held that cauterization
was more effectual when, before performing it, the carious hollow had
been filled up with theriac.[262]
He, too, made the administration of purgatives or bloodletting precede
the extraction of a tooth. Plateario has, however, the merit of having
introduced the sitting position for operations on the teeth, whilst
preceding surgeons made the patient lie in a horizontal position, or
held his head steady between their knees, as may be read in Abulcasis
and in other writers. Besides, he recommends taking care, when the
extraction of a tooth had to be performed, that the surrounding air
should be pure; perhaps because he thought that when operating in
a place where the air was tainted, complications might more easily
arise, on account of contagious substances reaching the inside of the
wound; or perhaps because he judged, not without reason, that certain
accidents, such as syncope, could more easily happen, and were more
dangerous in a tainted atmosphere than in the midst of pure, vivifying
air. After the operation, he prescribed astringent mouth washes.
Against dental worms, whose existence no one at that period doubted
in the least, Plateario recommended various remedies, chiefly under
the form of fumigations; and among these latter, those performed with
burnt opium. Against ulcerations of the gums and mouth he commended
the use of wine and aromatic substances. An excellent remedy was also,
according to him, lime dissolved in very strong hot vinegar, and
mixed, after complete evaporation of the liquid, with a fourth part of
orpiment.
GIOVANNI OF ARCOLI (in Latin, _Joannes Arculanus_), professor at
Bologna and afterward at Padua (who died in 1484), wrote a commentary
on a celebrated book of medicine, which Rhazes had dedicated to the
glorious King Almansor, great patron of science and art.[263]
In this most valuable work of Arculanus there are several chapters
relative to diseases of the teeth; and this subject is treated rather
fully and with great accuracy.
The author, first of all, treats of the anatomy and physiology of the
teeth; he, however, falls into many errors, for instance, in regard to
the number of dental roots. (“The first six teeth of the upper jaw have
only one root; the first six of the lower not more than two; the molars
of the upper jaw have three; those of the lower generally only two in
like manner; the _neguezid_[264] of the upper jaw have four roots, but
the two lower neguezid have only three.”)
According to him there is not the least doubt that the teeth grow
during the whole lifetime, thus repairing the continual waste caused
by use; and among other proofs he adduces that, whilst in the old all
other organs shrink and waste away through lack of nourishment, the
teeth, on the contrary, show very frequently an increase in length.
For the preservation of teeth—considered by him, quite rightly, a
matter of great importance—Giovanni of Arcoli repeats the various
counsels given on the subject by preceding writers, but he gives
them as ten distinct canons or rules, creating in this way a kind of
decalogue of dental hygiene. These rules are: (1) It is necessary to
guard against the corruption of food and drink within the stomach;
therefore, easily corruptible food—milk, salt fish, etc.—must not be
partaken of, and after meals all excessive movement, coition, bathing,
and other causes that impair the digestion, must also be avoided. (2)
Everything must be avoided that may provoke vomiting. (3) Sweet and
viscous food—such as dried figs, preserves made with honey, etc.—must
not be partaken of. (4) Hard things must not be broken with the teeth.
(5) All food, drink, and other substances that can set the teeth on
edge must be avoided. (6) Food that is too hot or too cold must be
avoided, and especially the rapid succession of hot and cold, and _vice
versa_. (7) Leeks must not be eaten, as such a food, by its own nature,
is injurious to the teeth. (8) The teeth must be cleaned, at once,
after every meal, from the particles of food left in them; and for this
purpose must be used thin pieces of wood somewhat broad at the ends,
but not sharp pointed or edged; and preference should be given to small
cypress twigs, to the wood of aloes, of pine, rosemary, of juniper, and
similar sorts of wood which are rather bitter and styptic; care must,
however, be taken not to search too long in the dental interstices
and not to injure the gums or shake the teeth. (9) After this, it is
necessary to rinse the mouth, using by preference a vinous decoction
of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper
seeds, root of cyperus, and rosemary leaves. (10) The teeth must be
rubbed with suitable dentifrices before going to bed, or else in the
morning before breakfast. Although Avicenna recommended various oils
for this purpose, Giovanni of Arcoli appears very hostile to oleaginous
frictions, because he considers them very injurious to the stomach. He
observes, besides, that whilst moderate frictions of brief duration
are helpful to the teeth, strengthen the gums, prevent the formation
of tartar, and sweeten the breath, too rough or too prolonged rubbing
is, on the contrary, harmful to the teeth and makes them liable to
many diseases. As a dentifrice, he recommends a mixture of two parts
of honey to one of the best sugar; or the ashes of the burnt head of a
hare; or burnt salt made into an electuary by the addition of honey.
To use the last two dentifrices, a quantity about equal in volume to
a filbert must be wrapped and tied inside a thin, loosely woven piece
of linen cloth, and with this the teeth must then be rubbed. Finally,
theriac, too, is considered by him a very good dentifrice. According to
Arculanus, dental pains are sometimes situated in the very substance of
the tooth, at other times in the nerve, and at others in the gums.
The dental substance may become painful, owing to bad “complexion”
(viz., constitution), without there being any morbid matter in it.
When, however, such matter exists, it may proceed from the head or
from the stomach, and in certain cases it gives rise to an apostema of
the tooth; in other cases it corrodes the latter; and at other times
generates (!) in it a worm, which in its turn corrodes the tooth.
In regard to the diagnosis of dental pains, it is necessary first
of all to examine the state of the gums, that is to say, to observe
whether these, in the aching spot, appear healthy, or whether, on the
contrary, they are discolored or tumid, sanguinolent, suppurating, or
the seat of corrosion or putrefaction, or if, when pressure is put
upon them, an exit of matter is produced. In such cases it may be
considered that the gums are the seat of the pain. But if none of these
symptoms are observed, and if, on comparing the gums of the aching spot
with the other gingival regions, no difference is observed, this means
that the cause of the pain exists either in the substance of the tooth
itself, or else in its nerve. In this latter case the pain is usually
very violent, and principally localized in the root of the tooth, but
also extending along the jaw, and the tooth itself is often, as it
were, benumbed. When, however, the pain is not situated either in the
gums or in the dental nerve, but in the very substance of the tooth,
this latter is very often corroded (carious), and very often in the
hollow there exists a worm; and this may be deduced from the fact that
during the intervals of calm the patient sometimes feels a peculiar
sensation, the movement of the worm in the diseased tooth; when,
however, these signs are wanting, we shall find at any rate that the
whole tooth is painful in the direction of its length, instead of the
pain being localized in the root of the tooth and radiating along the
jaw.
When the cause of the pain resides in the gums the extraction of the
tooth is neither necessary nor beneficial, but is, on the contrary,
always harmful, since, in spite of the loss of the tooth, the cessation
of the pain is not obtained; when the pain is situated in the tooth
itself, the removal of the latter always makes the pain cease; lastly,
when the dental nerve is the seat of the evil, the removal of the tooth
sometimes takes away the pain, at other times it does not.
Among the many anti-odontalgic remedies, Arculanus enumerates pepper
mixed with tar, pepper with asafetida, mustard seeds with asafetida,
and the like. When a tooth is to be cauterized, it is necessary to
protect the healthy teeth with bits of cloth dipped in rose water or
else with some kind of paste. Sometimes it is useful to drill the tooth
with a small trephine so that the cautery may act more deeply, thus
giving better results.
In regard to the filling of decayed teeth, Giovanni of Arcoli says
that, in the choice of the substances to be used, the _complexion_
(constitution) of the teeth must be taken into consideration; and
according as this is cold or warm, it is necessary to perform the
filling with substances which are, by their own nature, warm or cold,
thus acting in opposition to the dyscrasia of the tooth:
“_Eligantur calida aut frigida secundum opportunitatem, in contrarium
dyscrasiæ dentis._”
As to the quality of the complexion, this might be deduced, says the
author, from various signs, among which the color of the gums, these
being red in the warm and humid complexion, yellowish in the warm and
dry, brownish in the cold and dry, and whitish in the cold and humid
complexion. When, however, the complexion does not show any distinct
characteristic, and varies but little from the average, Arculanus
advises the teeth being filled with gold-leaf: “_Ubi non fuerit multus
recessus a mediocritate, impleatur cum foliis auri._”
Although Arculanus is the first writer who alludes to the filling of
teeth with gold, nevertheless it is by no means admissible that he was
himself the inventor of gold filling. His words do not at all sound
to us as the announcement of a new discovery, as the enunciation of a
new fact, in which the author himself had had, at least, a part, be
it great or small. Nothing of all this; the advice as to filling the
teeth, in certain cases, with gold leaf is given quite impersonally,
and is found, as if it were a point of minor importance, at the end
of a long paragraph, which includes various other counsels in regard
to the filling of teeth, one of which is, that this operation should
not be performed with too great violence.[265] In short, the writer
does not show the least intention of putting in evidence the aforesaid
fact, or of giving to it any special importance. We must, therefore,
hold that gold filling had already been in use for a long time among
dentists, and that Arculanus simply mentions what was done by the
dentists of those days. (See note page 164.) It is evident, on the
other hand, that he had no special competence in dental art, when we
consider that he was even ignorant of the exact number of dental roots.
Naturally, the question here arises: At what period did gold begin to
be used for the filling of teeth? But unfortunately history has not,
up to the present, furnished us any evidence which may lead to the
solution of this problem.
For the eradication of a tooth Arculanus gives three very precise
indications: (1) When the pain resists every other means of cure. (2)
When there is any danger of the disease spreading to the neighboring
healthy teeth. (3) When the tooth is troublesome in speaking and in
masticating.
Before extraction, the patient must be prepared for it by bloodletting,
purgatives, and narcotics; and the operation must be commenced by
separating the gums from the tooth.
Arculanus admits, like many of his predecessors, that the eradication
of a tooth may be effected not only by the forceps and other suitable
instruments, but also by other means. One of these would be the use of
the actual cautery, repeatedly applied inside the hollow of the tooth,
if this is decayed; or, in the contrary case, made to act all around
its root (neck). The fall of the tooth might also be obtained with
potential cauteries and especially by the application of boiling oil,
or of a grain of incense heated to the melting point.
It is plain that Giovanni of Arcoli has simply copied these things
from preceding authors, since if he had made a trial of the pretended
eradicating means, he would soon have verified their inefficiency.
Against hemorrhage of the gums, Arculanus recommends arsenic, lime,
gall-nuts, alum, and oil of roses. But, says he, the surest remedy is
the red-hot iron; and still more effectual, cauterization by means of
red-hot gold.
Giovanni of Arcoli’s work is not only noteworthy because it mentions
gold filling for the first time, but also because in it are given the
drawings of three dental instruments, among which the pelican (here
called _pulicanum_). According to Carabelli, the first author who has
mentioned the pelican was the Dutchman Peter Foreest; according to
Geist-Jacobi, instead, it was the German Walter Ryff. But both these
statements are false, because as we have just now said, the pelican
was already named and designed (not very well, it is true) in the book
of the Italian Giovanni of Arcoli, who died in 1484, that is, even
before either Walter Ryff or Peter Foreest came into the world. Neither
does Giovanni of Arcoli say one word that might imply that he was the
inventor of the pelican, and so we are led to believe that in his days
this instrument had already been in use for some time. In the text he
only says: “The teeth are to be extracted with suitable instruments,
whose figures may be seen in the margin.”[266]
We here reproduce the three figures alluded to, with the relative
indications. The first (Fig. 56) represents the pelican; the second
(Fig. 57) is a pair of curved forceps, which seems, in those days,
to have been the instrument most commonly used for the extraction of
teeth, since this figure is accompanied by the very generic indication
“shape of the forceps for extracting teeth;” finally, the third (Fig.
58) represents the forceps used for extracting dental fragments
(roots), and which from the long and straight shape of its jaws, was
called “stork’s bill” (rostrum ciconiæ).
ALESSANDRO BENEDETTI, of Verona, who lived from 1460 to 1525, and
taught medicine at Padua, was, for his times, a man of uncommon
scientific merit; but to the development of the dental art he did not
contribute anything very worthy of note.
He relates that he once abstained from buying a slave simply because
the teeth of the latter were like those of wild beasts, a thing which
he considered as a bad omen.
According to him, toothache is a disease proper to man, no other animal
being liable to it.
To keep free from odontalgia, there is, says he, a very simple means,
which consists in rubbing the teeth once a year with the blood of a
tortoise.
This is the first writer who has noted the harmful effect which mercury
has on the gums and teeth, whether this remedy be used internally or
externally, that is, by friction.
[Illustration: FIG. 56
The pelican as represented in Giovanni d’Arcoli’s work. Forceps pro
extrahendis dentibus pulicanum dicta.]
[Illustration: FIG. 57
Dental forceps (Giovanni d’Arcoli.) Forcipum pro extrahendis dentibus
forma.]
[Illustration: FIG. 58
The forceps called “stork’s bill,” as represented in Giovanni
d’Arcoli’s work. Forceps pro extrahendis fragmentis quod Rostrum
Ciconiæ dicent.]
Benedetti recommends that before proceeding to the extraction of a
tooth an accurate diagnosis should be made, so that it may not happen
that, by mistaking for true odontalgia a pain localized in the gums
or in the jaw, a sound tooth be drawn, under the belief that it is
the cause of the pain; for, this happening, not only would the pain
continue, but there would be, in addition, the loss of a sound tooth,
and also the disadvantage of the neighboring ones becoming less firm,
for want of support.
This author, too, attributes great importance to dental worms,
believing them to be one of the principal and most frequent causes
of odontalgia. To kill them he recommends the usual fumigations and
several other remedies, among which the juice of the leaves of the
centaury or of the peach tree, but especially applications of aqua vitæ.
When it is thought well to have recourse to opium to calm toothache, he
advises this to be used with the utmost prudence; and on this point, he
relates having witnessed a fatal case, in the person of a gentleman of
Padua, by the incautious use of this remedy.
In extraction Benedetti repeats all the precautionary measures
recommended by the ancients, and he, too, advises that recourse should
not be had to this operation, if not as a last remedy, that is, when
every other means of cure has been found useless.[267]
GIOVANNI OF VIGO. The celebrated surgeon Giovanni of Vigo (1460 to
1520), speaking of abscesses of the gums,[268] says that the abscess
must be first brought to maturity by fitting remedies, if it has not
ripened spontaneously, then it must be opened with a lancet, and
lastly, to cleanse the diseased part and to aid cicatrization, honey of
roses or Egyptian ointment must be used. This latter is thus composed
of: “℞—Verdigris, rock alum, _ana_ two ounces; honey of roses, one
ounce; plantain water and pomegranate wine, _ana_ two and one-half
ounces. The whole to be made to boil, and to be stirred with a small
rod, until the mixture is reduced to the consistency of honey.”
For the cure of old fistulas he employs not only the above-mentioned
Egyptian ointment, but also arsenic and corrosive sublimate.
Giovanni of Vigo is very brief in speaking on the treatment of dental
caries, doubtless because he attributed little or no value to the
numerous methods of cure recommended by his predecessors. The treatment
advised by him is, however, very noteworthy. He says that by means of
a drill, file, scalpel, or other suitable instrument, it is necessary
to remove the whole of the putrefied or corroded part of the teeth, and
then, to preserve it, to fill the cavity with gold leaf.
This clear and simple manner of speaking of gold filling as a cure for
caries makes us suppose that Giovanni of Vigo was not at all a stranger
to the practice of dentistry, as we must think of many preceding
writers, but, on the contrary, that he was not less skilled in dental
operations than he was in the other branches of surgery. Again, history
tells us that Giovanni of Vigo was surgeon to the Roman court; so it
would have been strange, indeed, if the Pope, if the haughty prelates,
accustomed as they were to all kinds of refinement and comfort, should
have intrusted the care of their teeth to lowborn barbers and quacks,
whilst they could dispose of the services of so eminent a surgeon.
It may, however, be seen from the very book of Giovanni of Vigo,[269]
that in his days doctors and surgeons were, in general, little skilled
in dental matters. Speaking of the extraction of teeth, he says: “For
this operation there is need of a practised man, and, therefore, many
medical and surgical authorities have expressed an opinion that this
operation should be left to expert barbers and to the itinerant quacks
who operate in public places. He, therefore, who desires to perform
this manual operation in the best manner will derive great advantage
by frequenting men who are expert in performing it and by seeing and
impressing well on his memory their manner of operating.”[270]
PART III.
THIRD PERIOD—MODERN TIMES.
CHAPTER X.
THE SIXTEENTH CENTURY.
We have now arrived at the sixteenth century. The middle ages, that
is, the period of transition between ancient and modern civilization,
has now come to an end. Events of the highest importance, such as the
invention of printing (1436), the taking of Constantinople by the Turks
(1453), with the consequent emigration of many Greek men of letters
and science, who took up their residence in the West and especially
in Italy, and lastly, the discovery of America (1492), marked the
beginning of a new era, and are the most essential factors in bringing
about the revival of art and science.
In the midst of the vigorous intellectual life which characterized the
sixteenth century, dentistry, too, like many other branches of science,
made very notable progress; we, therefore, in this period shall have to
record many important facts and many important names.
It is, indeed, in the sixteenth century, and, to be more precise, about
the year 1544, that we meet for the first time with a monograph, in
which dental affections are spoken of independently of general medicine
and surgery. The book we allude to, by WALTER HERMANN RYFF, is also
noteworthy because it is not written like the preceding works, in
Latin, the customary language of the learned, but, instead, in German,
that is, in a living tongue.
As we are now mentioning the first German author on Dentistry, it may
be permitted us briefly to glance at the beginning of medicine and
dental art among the German peoples.
Among the Germans, as in other nations, the first to practise the
healing art were priests, priestesses, and wise women. To cure disease
they used partly empirical remedies, and partly witchcraft and
superstitious means of every kind. Thus, to facilitate dentition, it
was thought an excellent thing to pass a thread through the eyes of a
mouse and then to tie the blood-covered thread around the neck of the
child. It was held, besides—and this prejudice has left even until now
some traces—that the putting of the milk teeth, when they fall out,
into the nest of a mouse assures the cutting of new teeth.
We must here mention, with regard to the origin of dentistry among the
Germans, a very important fact related by Joseph Linderer,[271] a fact
which shows that even among the ancient Germans recourse was had to the
application of artificial teeth.
We here reproduce the very words of the said author, translated
literally:
“Being by chance a few years ago at Dresden and visiting the Museum
of Antiquities, my attention was attracted, in the last room, to two
osseous pieces, which with other objects were enclosed in a glass case,
with the written inscriptions: _Comb-shaped osseous pieces, found in
ancient German urns._ As soon as I had observed them, I saw at once
that they were artificial teeth; but as I had to be contented with
examining them through the glass of the case, it was not possible for
me to decide whether these pieces were really of bone, as they seemed
to be, or of another substance. Taking into account their antiquity,
their whiteness is very notable. Every piece is composed, if I remember
rightly, of five teeth, that is, of a canine and four incisors; the
chief difference of these pieces from the prosthetic pieces in ivory
still in use (the author is writing in 1848) consists in this, that the
pieces of which I speak have not at all a broad base, designed to rest
on the gums, the base having instead the same thickness as the rest.
The five teeth are well separated from one another. Besides, the canine
makes the proper angle with the incisors, and at each side of the piece
is found, in a convenient place, a hole, which shows that these teeth
were fastened to those of the subject by means of a metallic or other
kind of thread. As the above-described pieces are white, we must infer
that they were removed from the mouth of the respective individuals
before the body was burnt, and afterward put into the urn with the
ashes, just as they used to put in coins, bits of arrows, and the like.”
For many centuries dental surgery—which, however, was still in a very
primitive state—was practised in Germany, as in many other countries,
principally by barbers. These in certain places, and at certain
periods, formed corporate bodies, whose members were legally authorized
to extract teeth and to practise minor surgery in general. But besides
barbers, there were various kinds of individuals, unfurnished with
any authorization—tooth-drawers, charlatans, wandering story-tellers,
necromancers, Jews, and even hangmen—who invaded the field of medical
practice, in spite of its being forbidden them, except in fairs, to
administer medicaments and to perform surgical operations.[272]
In 1460 there appeared in Germany a book on Surgery by Heinrich von
Pfolsprundt, Knight of the Teutonic Order.[273] The author had acquired
great experience as surgeon in the military expeditions of his order,
and we see from his book that he was very skilled in the cure of wounds
and fractures. On the other hand, he shows himself hostile to every
bloody operation with the exception of rhinoplast. Pains of the teeth
and gums were cured by him by means of beverages.[274]
[Illustration: Title page of Zahnarzneybuchlein.]
[The accompanying reproduction of the title page and
two text pages from an edition of _Zahnarzneybuchlein_,
printed by Michael Blum, in Leipzig, 1530, and translated
below, is of interest in connection with the history of
the use of gold-foil as a filling material, in that a
marginal note refers to Mesue as the author from whom the
three methods of treating caries has been derived, one
of these methods being the filling of the carious cavity
with gold-foil.
Mesue was Surgeon to the Caliph Haroun al Raschid, who
flourished 786-809. If the reference to Mesue is correct,
it would, therefore, indicate that the filling of teeth
with gold was known to the Arabs as early as the latter
part of the eighth century. Examination of the writings
of Mesue has thus far failed to bring to light any record
therein of the treatment of caries by gold filling,
although in his work previously referred to (see page
138) the other methods quoted by the anonymous author of
_Zahnarzneybuchlein_ are fully set forth.
[Illustration: Latin text.]
[_Translation._]
FIFTH CHAPTER.
ON CARIOUS AND HOLLOW TEETH.
Corrosion is a disease and defect of the teeth when they
become carious and hollow, which most often happens in
the molars, especially if one does not clean them of
the adhering food which becomes moist and consequently
produces bad, sharp [acid] moisture that eats and
corrodes them, always gradually increasing, until it
spoils the teeth entirely, which afterward must fall away
in pieces not without pains.
“_Mesue ut supra capite proprio._” This, as Mesue writes,
is chiefly cured and removed in three ways. First, by
purging as treated upon above. Second, by dissolving the
material which renders them hollow and eats them away;
also by boiling cockles that grow in barley or wheat, in
vinegar and holding this in the mouth. In this vinegar
the root of caper and ginger and other similar remedies
must have been previously boiled. Third, by removing the
decay, which is done in two ways. First, by scraping
and cleaning the hole and the carious part with a fine
chisel, knife, or file, or other suitable instrument, as
is well known to practitioners, and then by filling the
cavity with gold leaves for the preservation of the other
portion of the tooth. Second, by using suitable medicine,
such as oak apples or wild galls, with which the tooth is
filled after having been cleaned.
[Illustration: German text.]
The following editions of _Zahnarzneybuchlein_, besides
the Basle and Mayence editions noted by Dr. Guerini at
page 166, were issued and copies thereof are preserved
in the libraries of the several collectors as stated.
Edition of 1530, printed by Michael Blum, Leipzig, in
collection of Edward C. Kirk. Edition of 1536, printed
by Chr. Egenolff, Frankfurt a/M, in collection of
William H. Trueman. Edition of 1541, printed by Chr.
Egenolff, Frankfurt a/M, in _Dental Cosmos_ library and
collection of E. Sauvez. Edition of 1576, printed by Chr.
Egenolffserben, in collection of H. E. Friesell.—E. C. K.]
The book, therefore, lacks importance from a dental point of view,
except in the sense that it shows how little skilled in the cure of
dental affections were the German surgeons of those days.
It is worthy of note that this author, also, speaks of anesthetic
inhalations; he, however, only translates, almost to a word, what Guy
de Chauliac says on this subject.
Toward the end of the fifteenth century and in the first half of
the sixteenth there were published in German, by anonymous authors,
some short translations and compilations on dental subjects, taken
especially from Greek and Arabian authors.[275] Of these writings, the
first one known, taken from Galen and Abulcasis, was printed at Basle
in 1490; and another—one of the best—saw the light at Mayence in 1532.
These works were perhaps due to intelligent barbers, or perhaps—and
this seems to be the most probable—they were written, through the
initiative of enterprising printers, by doctors and surgeons, who
wished to remain unknown, on account of the special subject treated;
for, owing to the fact that the diseases of the dental system were
generally left in the hands of barbers and other unprofessional
persons, the doctors and surgeons of those days would have been ashamed
to interest themselves in such things.
WALTER HERMANN RYFF, of Strasburg, was born in the beginning of the
sixteenth century, and died about 1570. He was a rather mediocre doctor
and surgeon, and a man of the worst morals, so much so that many cities
expelled him from their midst.[276] He wrote many medical works, in
which, however, there is very little original matter. Their principal
merit consists, perhaps, in the fact that they were written not in
Latin, as then was universally customary, but rather in the vernacular
of the author and in a popular style; so that Ryff may be looked upon
as the first who endeavored to diffuse among the people useful medical
and hygienic knowledge.
Among Ryff’s books there are two which are very important to us. One
is his _Major Surgery_, and the other is a pamphlet entitled _Useful
Instruction on the Way to Keep Healthy, to Strengthen and Reinvigorate
the Eyes and the Sight. With Further Instruction on the Way of Keeping
the Mouth Fresh, the Teeth Clean, and the Gums Firm._[277]
Of these books, there now only exist some extremely rare copies; so
much so that neither Albert von Haller nor Kurt and Wilhelm Sprengel,
who rendered such great services to the history of surgery, ever
had the pleasure of examining them. Dr. Geist-Jacobi has been more
fortunate than they, and has therefore been able to give us some very
interesting information about their contents.
The _Major Surgery_ is a mere compilation which does not contain
anything new of importance. It was published in part in 1545, and in
part in 1572, after the death of the author. The work is illustrated
with very beautiful wood engravings; and it is just this which gives
the principal value to this book. Some of the illustrations contained
in the first part of it—that is, in that published in 1545—represent
dental instruments, notwithstanding dental surgery is not treated in
this part of the book. The author gives notice that he will treat all
that concerns dental affections in the latter part of this book, in a
special chapter. Unfortunately, this chapter was never written, because
death prevented Ryff from completing the second part of his work.
[Illustration: FIG. 59
Pelican and dental forceps (Walter Hermann Ryff).]
The dental instruments represented in his _Major Surgery_ are many
in number. Among them, first of all, are found the fourteen dental
scrapers of Abulcasis, then the “duck-bill”—designed for the extraction
of dental roots and broken teeth—various kinds of pelican (Fig. 59 A),
the “common dental forceps” (Fig. 59 B), the “goat’s foot,” and many
other kinds of elevators, among which, observes Geist-Jacobi, may be
seen instruments even now in use, and even some which are said to have
been recently invented.
Ryff’s other book is especially noteworthy because, as we have
already mentioned, it treats, for the first time, of dental matters,
independently of general medicine and surgery. This pamphlet, printed
at Würzburg about the year 1544, is made up of sixty-one pages, and
is divided into three parts, the first of which is dedicated to the
eyes, the second to the teeth, and the third to the first dentition.
It is written in popular style, and the author certainly intended it
for the instruction of the public, and not for professional men; so
true is this, that in it he does not speak of the technical part of the
extraction of teeth, or of gold filling—a method already known for a
long time—or of dental prosthesis.
The first part, relative to diseases of the eyes and the manner of
curing them, has no importance for us. The second part begins with the
following paragraph:
“The eyes and the teeth have an extraordinary affinity or reciprocal
relation to one another, by which they very easily communicate to each
other their defects and diseases, so that the one cannot be perfectly
healthy without the other being so too.”[278]
This last statement is absolutely false, as a disease of the eyes
may very well exist with a perfect condition of the teeth, and _vice
versa_. However, Ryff has the merit of being, perhaps, the first who
has noted the undeniable relation which exists between the dental and
ocular affections.
After a rapid glance at the anatomy and physiology of the teeth, the
author enumerates the causes of dental disease, which, according to
him, are principally heat, cold, the gathering of humors, and traumatic
actions.
The prophylaxis of dental diseases is beyond any doubt one of the
best parts of the book; however, the ten rules counselled by Ryff
for keeping the teeth healthy—rules which Dr. Geist-Jacobi has made
known to us in full—are reproduced, almost to a word, from Giovanni
d’Arcoli’s work; therefore, the author has no other merit than that
of having translated them into the vulgar tongue, thus diffusing
the knowledge of useful precepts for preventing dental diseases. We
refrain from reproducing the aforesaid rules here, as they are, with
slight variations, identical with those which we gave when speaking of
Arculanus.
Nor can any credit be given to Ryff for the rules which he gives in
regard to the diagnosis of dental pains, as this part of his work is
also taken wholly from the Italian author just mentioned.
After these diagnostic rules Ryff, continuing to translate from the
book of Giovanni d’Arcoli, adds:
“If the pain comes from the gums, extraction is of no use; if it comes
from the tooth, extraction makes it cease; when, lastly, it is in the
nerve, sometimes extraction removes it, and sometimes it does not,
according as the matter obtains or not a free exit.”
The barbers and tooth-drawers, he says, must well remember this rule,
in order to avoid extracting, thoughtlessly and with no benefit, sound
teeth, since then the pain persists in spite of the operation. Also, it
must be borne in mind that, in case of violent pain, it is necessary to
operate as soon as possible, so that the patient may not faint or be
attacked by the falling sickness, if the pain should be communicated to
the heart or brain.
The idea that violent dental pains could give rise to syncope or to
epilepsy (in regard to which we only observe that even very recent
writers enumerate dental caries among the causes of the so-called
reflex epilepsy) is also found in Giovanni d’Arcoli, who expresses
himself in regard to this in the following terms: “Such very violent
pains are sometimes followed by syncope or epilepsy, through injury
communicated to the heart or brain.”[279]
“The most atrocious pain,” says Ryff, “is when an apostema ripens in
the root;” literal translation of words written about a century before
by Arculanus: “Fortissima dolor est, qui provenit ab apostemate, quod
in radice dentis maturatur.”
Likewise taken from Arculanus is the observation (already made,
however, by much more ancient writers) that “when the cheeks swell,
toothache ceases.” Arculanus, however, expresses himself in a less
absolute manner, and therefore more corresponding to the truth, since
he says “the pain generally ceases” (secundum plurimum dolor sedatur).
Even in regard to the therapeutics of dental pains, Ryff does not tell
us anything new. Dr. Geist-Jacobi gives this author the merit of having
made, in regard to the cure of dental pains, a distinction between
_cura mendosa_ (that is, imperfect, palliative, tending simply to calm
the pain) and _cura vera_ (that is, directed against the causes of
the disease). But this very important distinction is also taken from
Arculanus, who in his turn took it from Mesue. In fact, after having
spoken of the general rules relative to the cure of dental diseases,
Giovanni of Arcoli adds: “As to the particular therapy, it is divided
into _cura mendosa_ and _cura vera_, as may be found in Mesue. And the
_cura mendosa_ is so called because it calms the pain by abolishing
sensibility, not by taking away the cause of it. Such is, for the sake
of example, the cure, consisting in fumigations of henbane, made to
reach the diseased tooth by means of a small tube, adapted to a funnel.”
The third part of Ryff’s pamphlet has as its title:
“How the pains of the gums should be calmed or mitigated in suckling
infants, so as to promote the cutting of the teeth without pain.”
This part, as Geist-Jacobi informs us, is very brief, not taking up
more than a page and one-half of print. Neither does it contain
anything of importance. To render the cutting of teeth easier, Ryff
advises that infants should have little wax candles given to them to
chew and the gums anointed with butter, duck’s fat, hare’s brains, and
the like. The tooth of a wolf may be hung around the neck of the child,
so that it may gnaw at it. It is also recommended that the head of the
child should be bathed with an infusion of chamomile.
From what has been said, one may see very clearly that the aforesaid
book is, from the scientific point of view, entirely valueless,
because the best part of it is merely copied from the work of Giovanni
d’Arcoli. However, the author has the indisputable merit of having
endeavored to diffuse the knowledge of useful precepts of dental
hygiene. His book, besides, we repeat, has great historical value, for
from it dates the beginning of odontologic literature, properly so
called.
On this point we believe it is necessary to correct an error into which
Dr. Geist-Jacobi has fallen. At the beginning of his very valuable
article on Walter Hermann Ryff[280] he says: “In the fifth century of
the Christian era, the iatrosophist Adamantius of Alexandria published
an exclusively odontalgic work, of which, however, we only know the
title.” The same he repeats in his _History of Dental Art_ (pp. 55 and
56), without, however, giving us any proof of his statement. “Of the
odontologic treatise of Adamantius,” he says, “unfortunately the title
alone is known to us, and even that has reached us indirectly, that is,
by means of Ætius; it is of the following tenor.”
Now, whoever takes the trouble to translate these Greek words will
easily perceive that they do not constitute one title, but two distinct
ones (which even Dr. Geist-Jacobi has had to unite by the conjunction
_and_). These, however, are nothing more than the titles of two
chapters of the _Tetrabiblos_ of Ætius, as anyone may see for himself
by turning over the pages of this work either in the Greek original, or
in the beautiful Latin translation of Giano Cornario (Venice, 1553).
In this great composition of Ætius dental diseases are treated of in
Chapters XXVII to XXXV of Sermo IV, Tetrabiblos II; and the two Greek
titles above referred to are the titles of Chapters XXVII and XXXI.
In the translation of Giano Cornario they read as follows:
_Cura dentium a calido morbo doloroso affectorum, ex Adamantio
sophista_ (cure of teeth affected by warm, painful disease, according
to Adamantius the sophist).
_Cura dentium a siccitate dolore affectorum, ex Adamantio sophista_
(cure of teeth affected by pain from dryness, according to Adamantius
the sophist).
The work of Adamantius, from which Ætius took the contents of the
chapters thus entitled, is lost to us, but we have no reason, and not
even the least indication, for supposing that this work was a treatise
on dental diseases, and not one on general medicine. It is absurd to
consider the above-mentioned titles as belonging to an odontological
monograph, on the one hand, because, admitting for a moment the
existence of such a work, it should have had but one title and not two,
and on the other hand, because it is by no means to be supposed that a
great and wise physician, such as Adamantius undoubtedly was, should
have had the whim to write a book, not on dental disease or on dental
pains in general, but only and exclusively on dental pains caused by
heat or by dryness. What reason would there have been for not extending
the treatment of the subject to those cases of odontalgia resulting
from humidity or from cold, that is, from causes as common and,
according to the ideas of that time, very frequently associated with
one of the first two (as humidity with heat, and cold with dryness)?
Besides, if the titles of the two chapters spoken of be compared with
those of the others, in which Ætius treats of dental affections, such
analogy will be noticed between the various titles as to make us
consider that they have been formulated by Ætius himself, even when the
contents of these chapters are taken from other writers. So that the
two aforesaid titles not only do not belong to any dental work, but
probably they have never existed, even as simple titles of chapters,
in the medical book of Adamantius, from which the contents of the two
chapters of Ætius above mentioned have been taken.
In order that every one may easily be convinced that the two titles
made so conspicuous by Dr. Geist-Jacobi have nothing particular about
them, but are, instead, perfectly analogous to the titles of various
other chapters of Ætius, we give here the translation of the titles
of five chapters, all concerning dental maladies, that is, the two
chapters in discussion and other three:
Chapter XXVII: Cure of teeth affected by warm, painful disease,
according to Adamantius the sophist.
Chapter XXIX: Cure of teeth affected with pain from humidity.
Chapter XXXI: Cure of teeth affected by pain from dryness, according to
Adamantius the sophist.
Chapter XXXII: Cure of teeth affected by pain from heat and humidity.
Chapter XXXIII: Cure of decayed teeth, according to Galen.
It appears very clear, therefore, from the great analogy existing
between the headings of all the above-mentioned chapters, that the
titles referred to by Geist-Jacobi have not at all the historical
importance and significance that he attributes to them, and that the
same have been formulated by Ætius himself. To argue from such titles
that Adamantius was the author of a book on dentistry is not only
inadmissible, for all the reasons already given, but also because
if it were allowable to reason with such lightness, it might also
be stated—by arguing from the title of Chapter XXXIII—that Galen
was the author of a monograph on the treatment of dental caries; a
thing which is absolutely untrue. Consequently, the beginning of
odontologic literature cannot be traced back to Adamantius, but, as Dr.
Geist-Jacobi would have it, to an author much less ancient, that is,
to Walter Hermann Ryff, or, if it is preferred, even to the anonymous
writers of the odontologic compilations which appeared in Germany at
the end of the fifteenth century.
ANDREAS VESALIUS. We must now speak of Andreas Vesalius, an
extraordinary man, who by his genius infused new life into medical
science, and who, although he gave but little attention to dental
matters, yet fully deserves a place of honor in the history of
dentistry; for this, like every other branch of medicine, received
great advantage from his reforming work, which broke down forever the
authority of Galen, thus freeing the minds of medical men from an
enslavement which made every real progress impossible.
Andreas Vesalius was born at Brussels, December 31, 1514. He studied
at Louvain and then at Paris, where at that time great scientists
taught, and among others the celebrated anatomist Jacques Dubois,
generally known by the Latinized name of Sylvius.[281] The latter, a
great admirer of Galen, whose anatomical writings served as texts for
his lectures, became jealous of the young Belgian student, who was
his assistant, and who gave undoubted proofs of great genius, and of
extraordinary passion in anatomical research. Vesalius often defied the
greatest dangers in order to obtain corpses either from the cemetery
of the Innocents or from the scaffold at Montfaucon. He soon surpassed
his most illustrious masters, and at only twenty-five years of age
published splendid anatomical plates, which astonished the learned. He
acquired also great renown as surgeon, and in this capacity he followed
the army of Charles V in one of his wars against France. After having
been professor of anatomy in the celebrated University of Louvain
(Belgium), he was invited by the Venetian Republic to teach in the
University of Padua, which, through him, became the first anatomical
school in Europe. Yielding to the requests of the magistrates of
Bologna and Pisa, he also taught in those famous universities, before
immense audiences.
[Illustration: Andreas Vesalius.]
Before Vesalius, Galen’s anatomy had served as the constant basis
for the teaching of this science. Although even from the end of the
fifteenth century dead bodies were dissected in all the principal
universities, the teachers of anatomy always conformed, in their
descriptions, to those of Galen, so that the authority of this master,
held infallible, prevailed even over the reality of facts.
Vesalius, for the first time, dared to unveil and clearly put in
evidence the errors of Galen; but this made him many enemies among the
blind followers and worshippers of that demigod of medicine. Europe
resounded with the invectives that were bestowed upon Vesalius. Among
others, there rose against him Eustachio at Rome, Dryander at Marburg,
Sylvius at Paris, and this last did not spare any calumny that might
degrade his old pupil, who had become so celebrated. In spite of this,
the fame of Vesalius kept on growing more and more, so much so that
Charles V called him to Madrid, to the post of chief physician of his
Court, a place which he kept under Philip II, also after the abdication
of Charles V. The good fortune of Vesalius, unhappily, was not to be of
long duration. In 1564 a Spanish gentleman died, in spite of the care
bestowed upon him by Vesalius, and the illustrious scientist requested
from the family, and with difficulty obtained, the permission to
dissect the body. At the moment in which the thoracic cavity was opened
the heart was seen, or thought to be seen, beating. The matter reached
the ears of the relations of the deceased, and they accused Vesalius,
before the Inquisition, of murder and sacrilege; and he certainly would
not have escaped death except by the intervention of Philip II, who, to
save him, desired that he should go on a pilgrimage to the Holy Land,
as an expiation. On his return, the ship which carried Vesalius was
wrecked, and he was cast on a desert beach of the Isle of Zante, where,
according to the testimony of a Venetian traveller, he died of hunger,
October 15, 1564.
Vesalius left to the world an immortal monument, his splendid treatise
on Anatomy,[282] published by him when only twenty-eight years of age,
and of which, from 1543 to 1725, not less than fifteen editions were
issued. The appearance of this work marked the commencement of a new
era. The struggle between the supporters of Galen and those of Vesalius
rendered necessary, on both sides, active research concerning the
structure of the human body, so that anatomy, the principal basis of
scientific medicine, gradually became more and more perfect, and, as
a consequence of this, as well as of the importance which the direct
observation of facts acquired over the authority of the ancients,
there began in all branches of medicine a continual, ever-increasing
progress, which gave and still gives splendid results, such as would
have been impossible under the dominion of Galenic dogmatism.
In the great work of Vesalius the anatomy of the teeth is unfortunately
treated with much less accuracy than that of the other parts of the
body. However, his description of the dental apparatus[283] is far
more exact than that of Galen, and represents real progress. The number
of the roots of the molar teeth (large and small) is indicated by Galen
in a very vague and inexact manner, since he says that the ten upper
molars have generally three, sometimes four roots, and that the lower
ones have generally two, and rarely three. Vesalius, having examined
the teeth and the number of their roots in a great number of skulls,
was able to be much more precise. In regard to roots, he makes, for the
first time, a very clear distinction between the premolars next to the
canine (small molars) and the other three, and says that the former
in the upper jaw usually have two roots, and in the lower, one only,
whilst the last three upper molars usually have three roots and the
lower ones two. As everyone sees, these indications are, in the main,
exact.
Other important facts established by Vesalius are as follows:
The canines are, of all the teeth, those which have the longest roots.
The middle upper incisors are larger and broader than the lateral
ones, and their roots are longer. The roots of the last molars are
smaller than those of the two preceding molars. In the penultimate
and antepenultimate molars, more often than in the other teeth, it
sometimes happens that a greater number of roots than usual are found,
it being not very rare to meet with upper molars with four roots, and
lower ones with three. The molars are not always five in each half jaw;
sometimes there are only four, either on each side, or on one side
only, in only one jaw or in both. Such differences generally depend
on the last molar, which does not always appear externally, remaining
sometimes completely hidden in the maxillary bone, or only just
piercing with some of its cusps the thin plate of bone which covers it;
a thing which Vesalius could observe in many skulls in the cemeteries.
In regard to the last molar, the author speaks of its tardy eruption
and of the violent pains which not unfrequently accompany it. The
doctors, he adds, not recognizing the cause of the pain, to make it
cease have recourse to the extraction of teeth, or else, attributing it
to some defects of the humors, overwhelm the sufferer with pills and
other internal remedies, whereas the best remedy would have been the
scarification of the gums in the region of the last molar and sometimes
the piercing of the osseous plate which covers it.
This curative method, of which no one can fail to recognize the
importance, was experimented by Vesalius on himself, in his
twenty-sixth year, precisely at the time that he had just begun to
write his great treatise on anatomy.
The existence of the central chamber of the teeth appears to have been
unknown to Galen, as he does not allude to it in the least. Vesalius
was the first to put this most important anatomical fact in evidence.
He expresses an opinion that the central cavity facilitates the
nutrition of the tooth. He says, besides, that when a hole is produced
in a tooth by reason of acrid corrosive humors, the corrosion, when
once the internal cavity is reached, spreads rapidly and deeply in the
tooth, owing to the existence of the said cavity, and sometimes reaches
even the end of the root.
In the chapter in which Vesalius treats of the anatomy of the teeth
(Chapter XI, p. 40), two very well-drawn figures are found, one of
which represents a section of a lower molar, showing the pulp cavity
and its prolongation into the two root canals. The other represents the
upper and lower teeth of the right side, in their reciprocal positions,
and shows very clearly their general shape, the length of their roots,
and the number of these.
The changes which take place in the alveolus, after the extraction of
a tooth have not escaped the notice of Vesalius. He says that after
an extraction the walls of the alveolus approach one another, and the
cavity is gradually obliterated.
Aristotle had affirmed that men have a greater number of teeth than
women. Vesalius declares this opinion absolutely false—although, after
Aristotle, it has been repeated by many other ancient writers—and says
that anyone can convince himself that the assertion of Aristotle is
contrary to the truth, as it is possible for everybody to count his own
teeth.
In spite of this, we find the above-mentioned error even in writers
subsequent to Vesalius; for example, in Heurnius (professor at Leyden
toward the end of the sixteenth century), who expresses an opinion that
rarely do women have thirty-two teeth, like men.
We find but little in Vesalius concerning the development of the teeth.
He, indeed, made some observations and researches on this point, but
these, from their insufficiency, led him to quite mistaken conclusions.
The teeth of children, he says, have imperfect, soft, and, as it were,
medullary roots; and the part of the tooth which appears above the gums
is united to the root, so to say, as a mere appendix, after the fall of
which there grows from the root the permanent tooth. This error arose
in the mind of Vesalius from observing that when children lose their
milk teeth, these have the appearance of a kind of stump, as if the
root had actually remained in the socket. Besides this, he had observed
with what facility the milk teeth fall out; and he here calls to mind
that, when about seven years old, he himself and his companions used to
pluck out their loosened teeth, and especially the incisors, with their
fingers, or with a thread tied around the tooth. The softness of the
dental roots in children, the easy fall of the milk teeth, and the want
of the lower part of the roots in these, must have raised the idea
in his mind that the roots of the milk teeth remained in the socket,
and that the upper part of the temporary teeth, instead of being a
continuation of the root, was joined to this as a simple appendix, and
in a very weak way, as though designed to remain in place for a limited
length of time only.
In Vesalius[284] is found a dental terminology—Latin, Greek, Hebrew,
and Arabic—which affords some interest. The incisors are called in
Latin _incisorii_, _risorii_, _quaterni_, _quadrupli_; and the two
middle incisors have been denominated by some authors _duales_. The
canines are called in Greek kynodontes, which means the same as the
Latin _canini_, dog’s teeth. In Latin they have been also denominated
_mordentes_, and by some also _risorii_, a name which by others is
given to the incisors, as we have already seen. The molars have
also been called in Latin _maxillares_, _paxillares_, _mensales_,
_genuini_.[285] But some authors give this last name only to the last
molars, or wisdom teeth, _dentes sensus et sapientiæ et intellectus_.
These teeth have also been called _serotini_ (that is, tardy), _ætatem
complentes_ (that is, completing the age, the growth), and also, in
barbaric Latin, _cayseles_ or _caysales_, _negugidi_, etc.
In the rebellion against the authority of the ancients, Vesalius had
a predecessor whose name, deservedly famous, may be recorded here.
PARACELSUS (born in 1493 at Maria-Einsiedeln, Switzerland), on being
nominated, in 1527, Professor of Medicine and Surgery at Basle,
inaugurated his lectures by burning in the presence of his audience,
who were stunned by such temerity, the writings of Galen and Avicenna,
just as Luther, seven years before, had burnt in the public square of
Wittenberg the papal bulls and decretals. The sixteenth century, in its
exuberance of intellectual life, was undoubtedly one of the grandest
centuries in history; human thought in that glorious epoch shattered
its chains, and declared its freedom both in matters of science and of
religion.
Paracelsus, a man of powerful genius, but not well balanced in mind, of
corrupt morals, and of an unlimited pride, had, notwithstanding these
undeniable defects, the merit of beginning a healthy reform in the
science and practice of medicine, by substituting the study of nature
for the authority of the ancients and by giving a great importance to
chemistry, both for the explanation of organic phenomena and for the
cure of disease.
It is to be lamented that this man of genius did not contribute in any
way to the progress of dentistry. His works have no importance for
us. As a matter of mere curiosity we only record here that Paracelsus
considered the too precocious development of the teeth as a great
anomaly, and regarded as monsters those children who were born with
teeth.[286]
[Illustration: Paracelcus.]
[Illustration: Gian Filippo Ingrassia.]
[Illustration: Gabriel Fallopius.]
GIAN FILIPPO INGRASSIA (1510 to 1580), a distinguished Sicilian
anatomist, was one of the first who spoke of the dental germ. He says
that the existence of the tooth properly so called is preceded by that
of a soft dental substance enclosed in the bone, and which he considers
almost as a secretion of the latter.
MATTEO REALDO COLOMBO, of Cremona, a pupil of Vesalius and his
successor in the professorship of Anatomy at Padua, added but little,
as regards the teeth, to what his master has taught. He combated the
erroneous idea that the teeth were formed in the alveoli shortly before
their eruption. Having dissected the jaws of many fetuses, and having
always observed in them the existence of teeth, he could affirm with
every certainty that the teeth begin to be formed in intra-uterine life.
Like Vesalius, Realdo Colombo believed that the permanent teeth were
developed from the roots of the milk teeth; and, therefore, he advised
the utmost caution in extracting these, since, if the whole root were
removed, the tooth would not grow again.[287]
GABRIEL FALLOPIUS (1523 to 1562), the eminent anatomist of Modena, also
a disciple of Vesalius, carried out accurate and successful researches
in regard to the development of the teeth, and made them known in his
book, _Observationes anatomicæ_, published at Venice in 1562, the year
in which he died.
His investigations enabled him to show the falsity of the opinion held
by Vesalius, that the permanent teeth are developed from the roots of
the temporary ones. He was, besides, the first who spoke in clear terms
of the dental follicle.
The teeth, says Fallopius,[288] are generated twice over, that is,
the first time in the uterus, after the formation of the jaws, and
the second time in extra-uterine life, before the seventh year. The
first teeth are, at the time of birth, still imperfect, without roots,
completely enclosed in their alveoli, and formed of two different
substances; the part with which they must break their way out is
osseous and hollowed; the deeper part, instead, is soft and humid
and is seen covered with a thin pellicle, a thing which may also be
observed in the feathers of birds when they are still tender. In
fact, the part of the feather which comes out of the skin is hard and
corneous, whilst the part which is embedded in the wings is soft and
humid and has the appearance of coagulated blood or mucus. So also in
the fetal teeth, the part corresponding to the future root presents
itself like coagulated mucus. Little by little this soft substance
hardens and becomes osseous, thus constituting the root of the tooth.
Fallopius’ reference to the analogy between the development of teeth
and that of feathers was highly important, as a point of departure
for embryological researches which showed clearly the real nature of
teeth, thus destroying the mistaken idea—held by Galen and many other
authors—that these organs were bones.
On coming to speak of the teeth generated in extra-uterine life, that
is of the permanent teeth, Fallopius relates having observed that
they have their origin in the following manner: A membranous follicle
is formed inside the bone furnished with two apices, one posterior
(that is to say, deeper down, more distant from the surface of the
gums), to which is joined a small nerve, a small artery, and a small
vein (_cui nervulus, et arteriola, et venula applicantur_); the other
anterior (that is more superficial), which terminates in a filament
or small string, like a tail. This string reaches right to the gum,
passing through a very narrow aperture in the bone, by the side of the
tooth which is to be substituted by the new one. Inside the follicle
is formed a special white and tenacious substance, and from this the
tooth itself, which at first is osseous only in the part nearest the
surface, whilst the deeper part is still soft, that is, formed of the
above-mentioned substance. Each tooth comes out traversing and widening
the narrow aperture through which the “tail” of the follicle passes.
The latter breaks, and the tooth comes out of the gum, bare and hard;
and in process of time the formation of its deeper part is completed.
The author says that his long and laborious researches into the
development of the teeth were carried out with great accuracy, and
he is, therefore, in a position to give as absolute certainties the
facts exposed by him. Indeed, the observations of Fallopius were, for
the most part, confirmed by subsequent research. As to the “tail”
of the dental follicle, it is identical with the _iter dentis_ or
_gubernaculum dentis_ of some authors. Fallopius described it as a
simple string, but later on this prolongation of the dental follicle
has been considered, at least by some, as the narrowest part or neck
of the follicle itself, that is, as a channel through which the tooth
passes, widening it, on its way out, and precisely for this reason it
has been called _iter dentis_ (the way of the tooth) or _gubernaculum
dentis_ (helm or guide of the tooth).
BARTHOLOMEUS EUSTACHIUS, another great anatomist of the sixteenth
century, occupied himself in the study of teeth with special interest,
and wrote a very valuable monograph on this subject. He was a native
of San Severino, Marche (Italy), and a contemporary of Vesalius,
Ingrassia, Realdo Colombo, and Fallopius; he died in 1574, after having
immortalized his name through many anatomical discoveries and writings
of the highest value.
[Illustration: Bartholomeus Eustachius]
His book on the teeth, _Libellus de dentibus_, published at Venice in
1563, is the first treatise ever written on the anatomy of teeth,
and represents a noteworthy progress in this branch of study.
In this little book—divided into thirty chapters, forming in all
ninety-five pages—the author treats with great accuracy and in an
admirable manner all that concerns the anatomy, physiology, and
development of the teeth.
Eustachius not only treasured up what ancient authors had written on
this subject, but he himself made very long and patient researches and
observations on men and animals, on living individuals as well as on
corpses, and not only on adult subjects, but also on children of every
age, on stillborn children and on abortive fetuses.
The macroscopic anatomy of the teeth was brought by him to a high
degree of perfection. Very wonderful, among other things, is the
accuracy with which he studied and specified in several synoptical
tables the number of the roots of molar teeth, and all the variations
occurring not only in their number, but also in their form, length, etc.
In Chapter IV, speaking of the means by which teeth are held in their
sockets, Eustachius mentions in quite explicit terms the ligaments of
the teeth. He begins by saying that the perfect correspondence between
the dental roots and the alveoli, both in shape and in size, is one of
the elements which contribute to the firmness of the teeth, since the
alveolus, being exactly applied, on all sides, to the root or roots
of the tooth, causes the latter, by this simple fact, to be fixed in
a determined position. Also, the nerves inserted in each single tooth
contribute, as was already the opinion of Galen, to the stability of
these organs. “There exist besides”—Eustachius continues—“very strong
ligaments, principally attached to the roots, by which these latter
are tightly connected with the alveoli” (_adsunt præterea vincula
fortissima radicibus præcipue adherentia, quibus præsepiolis arctissime
colligantur_). Lastly, says the author, the gums, too, embracing the
teeth at their exit from the alveoli, contribute to their firmness.
And here Eustachius notes that in the joining of the gums to the teeth
there is great analogy to that of the skin with the finger nails;
a very proper observation, which makes us almost suppose that the
perspicacious mind of Eustachius may have guessed the kindred nature of
nails and teeth.
In Chapter XV are related the researches made by the author to
ascertain at what period the development of the teeth begins. Here is a
passage of this chapter, almost literally translated:
“Hippocrates, before anyone else, wrote that the first teeth are
formed in the uterus. Wishing to assure myself thereof, I dissected
many abortive fetuses, and by very careful observations I found it to
be true that the teeth have their origin during intra-uterine life.
Wherefore, the opinion of those who consider that the first teeth are
formed from the milk, and those of the second dentition from food
and drink, must be declared entirely false. In fact, by opening both
jaws of a stillborn fetus, one may find, on each side of each jaw,
the incisors, the canine, and three molars, partly mucous and partly
osseous, and already sufficiently large and entirely surrounded by
their alveoli. Then removing, with a skilful hand, the incisors and
the canines, there may be observed a very thin partition only just
ossified; and if this be removed with equal care, an equal number of
incisors and canines, almost mucous and very much smaller, appear,
which, enclosed in special alveoli behind the first, would exactly
correspond in position each with its congener, if in both jaws the
canine were not resting for the greater part on the next incisor so as
almost to hide it.”
As to the molars (by which name also the bicuspids are here meant),
Eustachius says that he found but three on each side, and no trace
whatever of the others. Nevertheless, he considers it quite probable
that the germs of the latter should also exist in the fetus, although
so small as to escape observation. He gives many ingenious reasons in
support of his mode of thinking, and comes to the general conclusion,
that not only the temporary teeth but also the permanent ones have,
all of them, their origin during fetal life; a false conclusion simply
because too general, and which shows once more how, in biological
science, one runs great risk of falling into error whenever one tries
to draw too free deductions from observed phenomena.
The researches of Fallopius and Eustachius confirm and complete each
other. These two eminent anatomists, who gave great glory to Italy
by their immortal discoveries and works, were the first to shed a
brilliant light upon the development of the teeth, and thus opened up
the way to all subsequent research on odontogeny.
In settling the period in which the formation of the teeth begins,
Fallopius was still more successful than Eustachius. His patient
investigations showed him that the development of the teeth commences
partly in the uterus and partly after birth, which is perfectly true,
as was made clear by later embryological researches. Fallopius found in
each fetal jaw twelve teeth.[289] In this he agrees perfectly with his
contemporary, Eustachius, who, as we have seen a short while ago, found
in fetusus, only just born, the incisors, the canines, and three molars
for each side of each jaw. Eustachius, however, observed in the fetus
the germs of the permanent incisors and canines as well, a thing not
noted by Fallopius.
It is not to be wondered at that some discrepancy should exist between
the observations of these two eminent anatomists. The researches of
which we are speaking are sufficiently delicate and difficult; and
even much more recent authors are far from agreeing perfectly, as far
as regards the period, in which the development of the teeth begins.
Serres, in his _Essai sur l’anatomie et la physiologie des dents_
(Paris, 1817), sustains the view that in the fetus he has observed the
germs of all the teeth, both temporary and permanent, while Joseph
Linderer (_Handbuch der Zahnheilkunde_, Berlin, 1842) says that,
although he has followed the preparative method indicated by Serres, he
could never discover in the fetus the germs of all the teeth. Perhaps,
he adds, the time when the development of the teeth begins varies
considerably in individuals, just as we remark differences in the time
of eruption.
In Chapter XVII of his book, Eustachius speaks of the process of
formation of the teeth, which he studied in abortive fetuses, in
stillborn children, in children a few months old, and also in kids.
On dissecting a fetal jaw, there may be found on each side, as we
have already seen, the incisors, the canines, and three molars, still
soft and imperfect, separated from one another by very thin osseous
partitions. Each of these teeth is enclosed within a follicle or little
bag of a grayish white color, rather more mucous and glutinous than
membranous, and in form somewhat like the pod of a vegetable, with the
only difference that it shows an opening at one of the extremities,
from which the tooth somewhat protrudes, as if it were germinating. The
more recent and softer the tooth, the more its follicle has a mucous
appearance and differs from the nature of membranes. As it does not
adhere to the underlying tooth, it is easy to separate them. As to
the tooth, it is at that period of its development partly osseous and
partly mucous, since that part which later on projects from the gum
soon becomes transformed into a white thin and concave scale, which
gives the idea of one of the little cells of a honeycomb. This scale
is harder and more conspicuous in the incisors, since these, at this
stage, are better formed; the canines are less advanced in development,
and the molars still less; and among these latter, those are less
developed which are more distant from the canines. The deeper part
of the tooth consists of a mucous and tenacious substance, harder,
however, than the substance of the follicle, and of a whitish color
with a tendency to dark red, translucent, and somewhat brilliant.
Thus, says Eustachius, the teeth present themselves in a human fetus;
but he who cannot obtain a human fetus may observe the same things in a
kid.
Although the author does not express himself very explicitly, he seems
to consider the follicle of the tooth substantially identical with
its ligament. “This is at first mucous, but afterward, becoming more
consistent, causes the tooth to adhere to the socket and gum very
firmly, as if it were glued.”
“As the part of the tooth which comes out of the gum projects from
the aperture of the follicle like a gem from its bezel, so—says
Eustachius—some believe that the crown of a temporary tooth is a mere
appendix, and that the follicle comes out of its concavity through
a dividing line which they imagine to exist between this supposed
appendix and the remaining part of the tooth. But assuredly those who
assert such things show that they have studied the anatomy of the teeth
so carelessly that, by this one error, they make manifest their great
ignorance together with their great temerity.[290] The line which is
observed on the tooth on the part corresponding to the adhesion of the
gingival margin and of the dental ligament is very superficial, and
after having scraped it away, there does not remain any trace of a
division. But apart from this everyone can very easily observe, even in
infants, or in kids, that the tooth when ossified does not present any
line of division and that the still mucous follicle envelops it freely,
and may be easily separated from the tooth; which would not be the
case, if the follicle issued from between the tooth and its supposed
appendix.”
Thus, Eustachius declares entirely false the opinion already expressed
by Celsus, that the permanent tooth grows from the root of the milk
tooth. He affirms clearly and decisively that between the external and
the radical part of a milk tooth no real division exists, and that
the ossification of the tooth, beginning from the crown, proceeds
without any interruption right down to the end of the root. If it
were true, says he, that in children only the imaginary epiphysis or
appendix falls, and that the new tooth is substantially represented
by the remaining part of the first, it could never happen, as instead
it often does, that the new tooth appears before the first one falls.
Besides, between the lower part of the first tooth and the upper part
of the second no correspondence exists either in size or shape, as
ought necessarily to be the case if the two parts were joined together.
This is not all; the lower part of the temporary tooth is perforated,
and receives in its interior bloodvessels and nerves, whilst the upper
part of the permanent tooth is quite massive and imperforated. How,
then, could this second tooth transmit bloodvessels and nerves into
the cavity of the first? Again, how could the continuity of these
bloodvessels and nerves with their respective branches be possible, if
an imperforate body, such as the crown of the permanent tooth, were
really interposed?
But what is the use of so many arguments? exclaimed Eustachius. To
remove even the slightest doubt and to put an end to any controversy
on such a point, only one fact is sufficient, which is revealed to us
by anatomical dissection, and that is, that the teeth which appear
about the seventh year are not only not united to those which fall at
the same period, but cannot even be in contact with them, owing to the
presence of a thin osseous partition.
In the following chapter[291] Eustachius speaks of the central cavity
of the teeth and of the substance contained in it. In young teeth,
he says, the dental cavity is very large, in proportion to the size
of the tooth. According to some anatomists, the central cavity of a
tooth is coated by a very soft and thin membrane, formed by a tissue
of very small vessels and nerves; and besides, this cavity is filled
with marrow, like hollow bones. The observations of the author,
however, do not agree with these statements. The dental cavity does
not contain any fatty substance analogous to the marrow of bones. As
to the above-mentioned membrane, Eustachius doubts its existence. The
large hollow existing in children’s teeth contains, he says, a mucous
substance, somewhat hard, and very smooth at its surface—almost like
a cuticle—but which has rather the appearance of a concretion than of
a membranous tissue. At any rate, adds Eustachius, if the substance
alluded to is made to dry up in the shade, it acquires an appearance
not unlike that of a membrane. It is certain, however, that at an early
age the substance contained in the dental cavity does not adhere to
the walls of the latter after the manner of a periosteum, but is found
in simple contact with the same, and can, therefore, be separated from
them with the greatest ease.
As years pass by, the dental cavity becomes narrower and narrower,
because the substance contained inside the tooth gradually becomes
ossified at the surface, adhering to the dental scale previously
formed, in the very same manner as the internal or woody part of a tree
adheres to the bark. Of the two hard substances which make up a tooth,
the outer one is white, tense, and dense, like marble, the underlying
one, instead, is somewhat dark, rough, and less compact. To observe
accurately the above-mentioned facts, the author advises searching for
them, first, in the molar teeth of the ox or the ram, and then in human
teeth, and likewise, first in children or in recently born animals, and
then in adults.
Chapters XIX and XX are, comparatively speaking, of little importance.
In the former the author undertakes especially to examine the opinions
of Galen on dental bloodvessels and nerves, and discusses whether
it were known to him that these vessels and nerves penetrate into
the internal part of the teeth. In the latter, Eustachius speaks of
the great difficulties that are encountered in dissecting dental
bloodvessels and nerves, and reproves those who, by inaccurate
illustrative figures, convey the erroneous idea that these parts are
very clearly and easily observable.
In Chapter XXI the author goes on to speak of the best mode of
proceeding in order to make successful observation of the small nerves
and vessels going to the roots of the teeth. These researches are much
more easily made in large animals than in man; and therefore such
things as cannot be observed well in the latter must be studied in the
former.
In the first place, it is necessary to dissect the lower jaw; and
after having done so several times, with all the accuracy required in
making researches of this kind, one may proceed to study the dental
nerves and vessels of the upper jaw, which is much more difficult.
Having opened up the inside of the lower jaw, one observes a cavity
full of marrow, and within this a nerve enclosed entirely in its own
sheath. Having removed the marrow, and opened the sheath lengthwise,
one perceives that the nerve therein enclosed is constituted (analogous
to what may be observed in the large nerves of the limbs) by several
nervous strings, and that among these runs a comparatively large
artery, besides small vascular branches of minor importance. If one
then removes the sheath from the bone, together with the nerve and the
vessels contained in it, raising it very gently, one sees, issuing
therefrom, some very slender fibers, on the nature of which it is,
however, difficult to pronounce; and, considering their thinness, one
can hardly conceive that they are composed of three different elements,
that is, of small nervous, arterial, and venous twigs. At any rate,
the author admits that this may be so. On arriving at the lesser
teeth, the nerve and the artery that accompanies it divide into two
branches, one of which traverses the opening presented by the bone at
that point (_mental foramen_), and is destined to the lower lip; the
other directs its course toward the roots of the incisors. The small
twigs which penetrate into the roots of the incisor and canine teeth
are less slender than those which enter the roots of the molars, and
are easily to be seen not only in large animals, but also in man. If
the tooth of an ox or that of a ram be split through the middle, the
mucous substance contained in the interior is seen to be traversed
by small bloodvessels; and one perceives, besides, certain fibers,
which are probably nerves. All these things, says Eustachius, I have
observed many times in different animals, in some cases more, in others
less distinctly. But it is an exceedingly difficult thing to follow
the single twigs, of which we have spoken, from their origin to their
insertion, or, _vice versa_, from their insertion to their origin. And
so, adds the great anatomist, being able to observe but a small part
of the things I should like to see, I find myself compelled, in my
perplexity, to supply by the aid of ratiocination the deficiency of
the senses. I therefore maintain that the interior part of a tooth is
susceptible of experiencing pain accompanied by a feeling of pulsation
(a fact already mentioned by Galen), because a nerve and an artery
penetrate into it. In the ox the penetration of bloodvessels into the
roots of the teeth can be more readily ascertained than in man. It may
be admitted that the same occurs in the human teeth; and this, for the
reasons already given, and also because only by admitting the existence
of an artery within the cavity of the tooth can be explained the
copious flow of florid red blood from a decayed tooth, which has, in
some cases, been known to imperil the life of a patient. And I myself,
says Eustachius, have observed with my own eyes an accident of this
kind.
The author then passes on to speak of the eruption of the teeth,[292]
but the data with which he furnishes us are neither very precise nor
very exact.
Eustachius, without declaring himself for or against it, cites, in
this chapter, the opinion of those who believe in the possibility of a
third dentition in old people. He returns to this subject in the last
chapter but one of his book, which treats of dental anomalies: “Ali,”
says he, “testifies to old persons having had all their teeth renewed.
This has been derided as chimerical by medical men of later date, or at
least only admitted under the condition that such teeth be of a nature
completely different from the first.”
Our teeth, says the author, grow old together with us, and toward the
term of life they abandon us, a fact which also distinguishes them
from the other bones. When, however, it occurs, through illness, that
the teeth are extracted or fall out spontaneously before the period of
old age, the alveoli become filled up with a bony substance; and in
addition the two osseous scales of the maxillary bones approach one
another and unite together in such a manner as to form a sharp margin,
every vestige of a cavity being obliterated.
Speaking of the nutrition and growth of the teeth,[293] Eustachius says
that—given the existence of the dental nerves and bloodvessels—it is
not difficult to explain how the teeth are nourished, grow, live, and
feel. He therefore rejects the opinion of those who held that the teeth
of the lower jaw derived their nourishment from the marrow contained
within this bone, and that those of the upper jaw received it from a
humorous substance similar to marrow, existing in the large cavity
of the upper maxillary bone. Against the supporters of this opinion
Eustachius raises, among others, the following objections, viz., that
the marrow of the inferior jaw does not in any way touch the teeth,
so that such a mode of nourishment cannot be imagined, and that it is
completely erroneous that the large cavity of the upper maxillary bone
contains a humor similar to marrow. This passage of Eustachius’ book
gives clear evidence that he was well acquainted with the maxillary
sinus, described a century later by the English anatomist, Highmore,
who gave it his name. The existence of this cavity was, besides,
already known before the time of Eustachius.
The author also says that those who believe that the internal cavity of
the teeth contains marrow, and that this serves to nourish them, are
grossly deceived.
In the same chapter, Eustachius confutes an opinion, at that time
generally diffused and put forward for the first time by Aristotle,
viz., that the teeth grow throughout a whole lifetime. In the senile
age, he says, the teeth become impaired still earlier than the other
organs. They become thinner by deficiency of nourishment, and, at the
same time, discolored; the incisors and canines, as they waste away,
come to be also less sharp than they were; and the molars, losing their
tubercles or cups, become levelled down and smooth. If, notwithstanding
the evident wearing out of the teeth, they seem sometimes to grow
longer, this appearance is not to be trusted, for it happens not
unfrequently that the teeth appear to have grown longer simply by
atrophy of the gums, or also because some humor or other morbid
substance pushes them outward.
As to the sensibility of the teeth,[294] Eustachius is of the opinion
that these organs possess, besides the sensibility to pain, two other
species of sensibility; for, following the ideas of Galen, he also
holds that the teeth together with the tongue partake in the sense
of taste; and he further considers the disagreeable sensation known
as _setting on edge of the teeth_, as a species of tactile sensation
peculiar to these organs.
But in which part of the tooth does the faculty of feeling reside?
Among the authors previous to, or contemporaries of, Eustachius, some
affirmed that the sensibility of the tooth resides in the pellicle
which lines its inside cavity, others in the membrane which, like
periosteum, clothes the root of the tooth, others in both these parts.
Eustachius does not show himself more partial to the one than the other
of these opinions; he is, however, firmly persuaded that the hard
substance of the tooth is also endowed with sensibility. Though it is
not easy to explain how this may be, he considers it probable that
the nerve, fraying itself out inside of the tooth in minute filaments
at the time when the substance of the tooth is still soft and mucous,
intermixes intimately with it, thus communicating to it the faculty of
feeling, which then persists in it, even after the ossification of the
tooth. Such an hypothesis is certainly worthy of the lofty intellect of
Eustachius, and has in itself, so it seems to me, something of truth.
In the two following chapters,[295] the author speaks in a masterly and
admirable manner of the functions of the teeth and of their utility.
Among many other true and interesting observations, he remarks that by
the loss of their teeth even the most powerful dogs become cowards.
Besides what concerns the human teeth, excellent notions of comparative
anatomy, above all in what regards the monkey, the dog, and the
ruminants, are to be found in this little but most precious book of
Eustachius.
The teeth, says he, are not equally hard in all animals, and many
ancient authors have affirmed that ferocious animals have much harder
teeth than tame ones.
Chapter XXIX, relating to dental anomalies, is one of the most
interesting. We here quote the greater part of it.
“Some historians relate that Pyrrhus, King of Epirus, Eurifeus, of
Greece, and many others, had, instead of teeth, a continuous bone,
furrowed by somewhat deep vertical lines, in no way different from what
one sees in the multiple molars of the goat. It has never happened
to me, says Eustachius, to witness a similar union of all the teeth;
I have, however, sometimes observed continuity between three or four
molars, precisely in the same manner as in sheep. It also once happened
to me to observe in the case of an old man, a fellow citizen of mine,
that the teeth were covered up on every side by a hard and almost stony
substance, and no longer exhibited any trace of separation, offering
instead the appearance of a single bone.”
“One reads that Timarchus, of Cyprus, had two rows or series of teeth
and Hercules three.”