The author never had any opportunity of observing any such anomalies;

notwithstanding, he refers to cases of the kind observed by other

anatomists of his time, and, in a particular manner, to the case of a

triple dental series in a youth who died at the age of eighteen. As the

truth of the fact was testified to by highly respectable medical men,

Eustachius lends faith thereto. “Neither can it be said”—he adds—“that

in the case we are speaking of the new teeth erupted from other sockets

before the temporary ones were shed, for there would then have been

only a double and not a triple series; indeed, the series would not

even have been double along all the line, but only along the line of

the temporary teeth; and besides this, the double series would not have

been maintained up to eighteen years of age—the time of the death of

the subject—but only until the shedding of the deciduous teeth.”

“That teeth are sometimes cut in the palate is a fact attested to by

Alessandro de Benedetti and others. It has also occurred, within my own

experience, to observe this in the person of a Roman woman, who had a

tooth in the roof of the mouth, near the opening which is in proximity

to the incisors,[296] and at Gubbio there is, in the monastery of the

Trinità, a nephew of the distinguished jurisconsult Girolamo Gabrielli,

who at the age of eighteen cut a tooth in the middle of the palate.”

“Pliny and Solinus tell of individuals born with all their teeth. Other

authors, that Pheretes was without teeth all his life.”

“I hold it to be a fable that some women lose a tooth for each child

they bear.”

“In some cases it has happened that the falling out and renewal of the

teeth has not taken place before the age of thirteen or fourteen. In

other cases, the same teeth were shed and renewed twice, that is, once

after the seventh year, and again after the fourteenth year. It ought

also to be mentioned that in some young persons of twenty, the last

molar, or wisdom tooth, having been drawn, it was renewed during the

same year. Lastly, it is also to be noted that in strong and healthy

young persons, one of the other molars being extracted, it is sometimes

renewed.”[297]

In the last chapter[298] the author alludes to some dental affections.

In referring to the fluxions to which teeth are subject, he says he

has observed more than one case in which such a quantity of matter

resembling chalk was collected in the alveoli, that these gradually

being filled thereby, all the teeth became loosened and dropped out

little by little.

Speaking of dental diseases requiring surgical intervention, the author

remarks that dental surgery was, in his days, a most abject calling,

notwithstanding its having had, according to Cicero, a very high

initiator—Æsculapius, the god of medicine.

AMBROISE PARÉ. Whilst the anatomy of the dental system was illustrated

by the researches of Fallopius and Eustachius, the celebrated French

surgeon Ambroise Paré was contributing in the highest degree to the

progress of practical dentistry.

[Illustration: Ambroise Paré.]

Ambroise Paré (Latinized Paræus) was born at Bourg-Hersent in the year

1517. His father and one of his brothers were box-makers; another

brother was a barber. We have no very precise information about the

early years of his life; so much is certain, however, that Ambroise

Paré did not enjoy any of those advantages deriving from a good

literary education, and after having received some instruction from a

chaplain, whose disciple and servant he was at one and the same time,

he was bound over as apprentice to a barber, who also taught him the

art of bleeding. Toward the age of sixteen we find him in Paris in

the employ of a _chirurgien-barbier_. After this he practised minor

surgery for some years in the Hôtel-Dieu. But having undertaken the

study of surgery without literary preparation and without any knowledge

of Latin, he was obliged, especially for the latter reason, to contend

with great difficulties, so that, although he had acquired in a few

years sufficient practice in surgery to enable him to pass from the

Hôtel-Dieu to the sanitary service of the French army, it was only in

1554, that is, at thirty-seven years of age, that he was permitted to

take the examination required for becoming a member of the College

of Surgeons of Paris. Within the short space of five months he was

successively named Bachelor, Licentiate, and Doctor in Surgery. His

reputation, which had already become extraordinary even before he had

any academic degree, procured him introduction to the Court of France

as surgeon in ordinary. In 1562 he became chief surgeon to the Court

and occupied this post under the reigns of Charles IX and Henri III.

Ambroise Paré was a Protestant, and it is said that in the massacre of

St. Bartholomew’s night, he owed his escape to the king, Charles IX,

who, to save his life, hid him in his wardrobe. He died full of honors,

in the year 1592.

In his works this great surgeon treats the subject of dental maladies

and their cure very thoroughly; this may be in part attributed to the

circumstance of his having first been simply a barber (and, therefore,

also a tooth-puller) and afterward a surgeon-barber, which placed him

in very favorable conditions for acquiring vast experience in the

practice of dentistry.

In Chapter II, Book IV, of his works,[299] Ambroise Paré speaks of the

anatomy and physiology of the teeth. It must, however, be confessed

that Vesalius and, still more so, Eustachius treat of dental anatomy

with much more exactness than he does.

After having spoken of the incisors and the canines, he says that the

ten upper molars generally have three roots, and very often four,

whilst the ten lower ones have only three; this is because the lower

jaw is harder than the upper, and also because the lower molars,

_estant assises sur la racine, et non suspendues, comme celles de la

mandibule d’en haut, n’avoient besoin de tant de racines pour leur

stabilité asseurance_.[300]

Ambroise Paré, too, admits that the teeth grow throughout the whole

lifetime, and that the wearing away consequent on reciprocal friction

and mastication is compensated in this way.

Galen had already affirmed, and Ambroise Paré also held erroneously,

that the exquisite sensibility of the teeth aids the sense of taste.

In speaking of the development of the teeth, Ambroise Paré says only

that they are already solid and osseous before birth, he himself

having observed this in dissecting the jaws of a child who had died

immediately after birth.

In Chapter VII, Book XIII,[301] Paré treats of fracture of the lower

jaw. The method of cure he proposes is altogether identical with that

of Celsus. With regard to the teeth, he says that “_si elles sont

divisées, ebranlées, ou separées hors de leurs alvéoles ou petites

cavités, elles doivent estre reduites en leurs places et seront liées

et attachées contre celles qui sont fermes, avecques un fil d’or ou

d’argent, ou de lin. Et les y faut tenir jusques à ce qu’elles soient

bien affermies, et le callus soient refait et rendu solide._”[302]

Toothache, says Paré,[303] is, of all others, the most atrocious pain

that can torment a man without being followed by death. It depends, in

many cases, on a humorous fluxion of a hot or cold nature which flows

into the alveolus, forcing the tooth outward, loosening it, and causing

the patient so much pain on the slightest pressure being exercised on

it, that he cannot dare to bite with it in the least. If, however, the

tooth is corroded, hollowed out, or pierced to the root, the pain is so

strong, when the patient drinks—particularly if the liquid is cold—that

he seems to have had a stab with a stiletto inside the tooth.

If the pain is acute and pungent, like that produced by needles

being thrust into the diseased tooth; if the patient complains of a

strong pulsation at the root of the tooth, and in the temples; if the

application of cold remedies calms the pain, all these signs indicate

that the cause of the evil is heat. Instead, the cause of the pain may

be held to be cold when the patient complains of a great heaviness

in the head, emits a quantity of saliva, and finds relief in the

application of hot remedies. In the treatment of toothache one must

fulfil the following three indications:

1. Regulate fittingly the mode of living.

2. Evacuate or dissipate the morbid humors; this may be effected

by various means, namely, by purgatives, by bleeding, by gingival

scarification, by the application of leeches on the site of the pain,

by cupping on the back of the neck, or on the shoulders.

3. Applying in each single case the medicaments best adapted for

calming the pain.

The author here goes through a long enumeration of anti-odontalgic

remedies that offer no particular interest, as they are not at all new.

When a decayed tooth becomes the seat of excessive pain, and this does

not yield to any remedy, one must either have recourse to extraction or

cauterize it; this can be done either with potential caustics—such as

oil of vitriol, aqua fortis—or with the actual cautery. By cauterizing,

Paré adds, one burns the nerve, thus rendering it incapable of again

feeling or causing pain.

Erosion or caries[304] is the effect of an acute and acrid humor, that

corrodes and perforates the teeth, often to their very roots. To combat

this morbid condition, even when it is not accompanied by pain, one

must also have recourse (besides general treatment) to cauterization

either with oil of vitriol, with aqua fortis, or with a small actual

cautery.

If, as often happens, that the seat of the erosion lies in such a

manner between two teeth as to make it impossible to apply caustics or

other medicaments, one must file just sufficiently between the healthy

and the corroded tooth to render the part accessible, taking care,

however, to file more on the side of the affected tooth than on that of

the healthy one.

The file may be used, besides, to plane down a tooth that stands out

above the level of the others, and for similar purposes.

If one or more teeth have been shaken by a blow or a fall, or have come

out of their alveoli altogether, the surgeon should not remove them,

but rather reduce them and bind to the neighboring teeth, that they may

entirely reacquire their original firmness.

In allusion to this subject, Ambroise Paré refers to the case of a

friend of his, who having sustained, through a blow from the hilt of

a dagger, a fracture of the lower jaw with almost complete expulsion

of three teeth from their alveoli, had the fracture reduced by him;

after replacing the teeth and binding them to the neighboring ones,

he prescribed astringent mouth washes and liquid or semiliquid

nourishment, such as meat juice, _panada_, barley soup, jelly, and such

like. The patient was completely cured and able to masticate with the

three teeth as well as before.

Also in the case of extraction of a healthy instead of a diseased

tooth, Paré recommends replacing it immediately and binding it to the

neighboring ones, for, he says, by this means the tooth can take root

again.

As we have seen, the first author who speaks of replantation is

Abulcasis, but to Ambroise Paré belongs the merit of having treated the

subject much more explicitly, and of having insisted on the utility

of this operation, indeed, on the duty of carrying it out whenever it

seems indicated.

[Illustration: FIG. 60

Dental files (Ambroise Paré).]

Further, he is the first to mention another very important operation,

namely, transplantation, albeit he himself had never performed it.

The case he refers to has become a generally known anecdote. We give

it in his own words: “_Un homme digne d’estre creu m’a affirmé qu’une

princesse ayant fait arracher une dent, s’en fit remettre subit une

autre d’une sienne demoiselle, laquelle se reprint, et quelque temps

après maschoit dessus comme sus celle qu’elle avoit fait arracher

auparavant._”[305]

[Illustration: FIG. 61

One of the pelicans used by Ambroise Paré.]

[Illustration: FIG. 62

Two other pelicans and a pair of curved pincers (Ambroise Paré).]

Ambroise Paré has recourse to extraction when a tooth is the cause

of very violent pain, or when the existence of a carious cavity and

concomitant putrefying processes render the breath fetid, and endanger

the healthy teeth in its vicinity. If the persistence of a deciduous

tooth should cause the cutting of the corresponding permanent tooth

outside the line of the dental arch, thus giving rise to deformity,

Paré advises laying bare and then extracting the deciduous tooth;

for after this the new tooth may be pressed toward the point before

occupied by the other, until it assumes its natural position.

Sometimes, when a tooth is too firmly planted, one prefers, says Paré,

instead of extracting it, to break off the crown for the purpose

of being able to act directly on the dental nerve with appropriate

remedies, or to destroy the sensibility of the nerve entirely, by

cauterization. This unreasonable and reprehensible method of cure is

also quoted, under the denomination of _deschapellement_, by another

French author, a contemporary of Paré—Urbain Hemard—who observes,

however, that one rarely had recourse to it; for the pain and shock

which are caused by this operation are not less than those caused by

extraction.

It very often happens that the patient cannot indicate exactly which

tooth it is that gives him pain, his sufferings being so acute as to

appear spread over a great part of the jaw. One cannot, therefore,

trust too much to the indications given by the patient as to the point

of departure of the pain, and must take care not to extract a healthy

instead of a diseased tooth.

The extraction of a tooth should not be carried out with too much

violence, as one risks producing luxation of the jaw or concussion

of the brain and the eyes, or even bringing away a portion of the

jaw together with the tooth (the author himself has observed this in

several cases), not to speak of other serious accidents which may

supervene, as, for example, fever, apostema, abundant hemorrhage, and

even death.

In extracting a tooth it is necessary to place the patient on a very

low seat, or even on the ground, with his head between the legs of the

operator.[306] After having laid the tooth bare sufficiently, if one

sees that it is very loose, one may push it out of its socket with

a _poussoir_, that is, with a trifid lever. But if the tooth is too

firmly rooted to be extracted with this instrument, one must make use

of curved pincers, or else one may have recourse to a pelican. The

author notes, however, that much skill is required in using this latter

instrument, for otherwise it will almost certainly happen that several

good teeth will be knocked out, instead of the one intended to be

extracted. In proof of this, he relates the following anecdote, which

we relate in the words of the author, that it may not lose anything of

its quaint originality:

“Je veux icy reciter une histoire d’un maistre barbier, demeurant à

Orleans, nommé maistre François Loüis, lequel avoit par dessus tous,

l’honneur de bien arracher une dent, de façon que tous les samedis

plusieurs paysans ayans mal aux dents venoient vers luy pour les

faire arracher, ce qu’il faisait fort dextrement avec un polican,

et lorsqu’il avoit fait, le jettoit sus un ais en sa boutique. Or

avoit-il un serviteur nouveau, Picard, grand et fort, qui desiroit

tirer les dents à la mode de son maistre. Arriva cependant que ledit

François Louys disnoit, un villageois, requerant qu’on luy arrachait

une dent, ce Picard print l’instrument de son maistre et s’essaya faire

comme luy; mais en lieu d’oster la mauvaise dent au pauvre villageois,

luy en poussa et arracha trois bonnes. Et sentant une douleur extrème,

et voyont trois dents hors de sa bouche, commença à crier contre le

Picard; lequel pour le faire taire luy dit qu’il ne dist mot, et qu’il

ne criast si haut, attendu que si le maistre venoit il luy feroit payer

les trois dent pour une. Donc le maistre oyant tel bruit, sortit hors

de table pour sçavoir la cause et raison de leur noise et contestation;

mais le pauvre paysan redoutant les menaces du Picard, et encore apres

avoir enduré telle douleur qu’on ne luy fist payer triplement la

peine dudit Picard, se tent, n’osant declarer audit maistre ce beau

chef d’œuvre; et ainsi le pauvre badaud de village s’en alla quitte;

et pour une dent qu’il pensoit faire arracher, en remporta trois en sa

bourse, et celle qui luy causoit le mal en sa bouche.”[307] Paré adds

in conclusion: “Partant je conseille à ceux qui voudront faire arracher

les dents, qu’ils aillent aux vieux dentateurs, et non aux jeunes qui

n’auront encore reconneu leurs fautes.”[308]

[Illustration: FIG. 63

Two gum lancets and a trifid lever called “poussoir” (Ambroise Paré).]

But let us now return to our subject. After the extraction of a tooth,

it is necessary—says Paré—to leave the wound to bleed freely, so that

the part may get rid of the morbid humors; then the gums and the

alveolus must be pressed, on both sides, with the fingers, to readjust

the socket, which will have been widened and sometimes even broken in

extracting the tooth. After this, the patient should rinse his mouth

with oxycrate; and when the weather is cold and windy, the patient

should take care to avoid fluxion in the other teeth.

The following chapter speaks, “_de la limosité ou rouillure des dents,

et de la manière de les conserver_.”

After meals the mouth must be rinsed with water and wine, or with

water with a little vinegar added to it, and the teeth cleaned from

all residues of food, so that their putrefying may not spoil the teeth

and make the breath fetid. An earthy yellowish substance, like rust,

often forms on the teeth from want of cleanliness and also when they

are not used to masticate; this substance corrodes the teeth, just

as rust corrodes iron. It is necessary to remove this substance, by

scraping the teeth with small instruments suitable for the purpose, and

then the teeth themselves must be rubbed with a little aqua fortis and

aqua vitæ mixed together, to take away what the instruments have not

been able to remove. In order to preserve the teeth it is necessary,

besides, to rub the teeth frequently with appropriate dentifrices.

Among these the author mentions simple bread crust, burnt and reduced

to powder.

In Chapter III of Book XVII he speaks of artificial teeth. Sometimes,

says Paré, by the effect of a blow, the front teeth are lost; this

not only constitutes a deformity, but is also the cause of defects

of speech. Therefore, after the necessary treatment, when the gums

are hardened, the lost teeth must be substituted with artificial ones

made out of bone, ivory, or the teeth of the _Rohart_,[309] which are

excellent for this purpose; and the artificial teeth must be tied to

the neighboring ones with gold or silver wire.

[Illustration: FIG. 64

The palatine obturator with sponge of Ambroise Paré.]

Chapter IV of the same book is most important, for palatal obturators

are therein spoken of for the first time. “Sometimes a portion of the

bone of the palate is destroyed by the shot of an arquebus, or by some

other wound or by a syphilitic ulcer (_par ulcère de verole_), the

patients being thereby disabled from properly pronouncing words and

from making themselves understood. To repair this defect we have found

an expedient through the help and ministry of our art. It consists

in the application of an instrument somewhat larger than the palatal

perforation; this is made of gold or silver, of about the thickness of

a crown (coin), and has the form of a vaulted roof, to which a sponge

is attached; when introduced into the aperture, the sponge, absorbing

the humidity natural to such parts, will very soon swell up, and thus

the instrument is held firm. In this way, words are better pronounced.”

Besides the above instrument, the author gives us the figure of another

instrument, _sans esponge_ (without sponge), which, taken altogether,

is like a large cuff button. The small part, designed to be introduced

into the aperture of the palate, can be made to turn round from below,

by means of a small pair of pincers, so as to fix the obturator.

[Illustration: FIG. 65

Paré’s palatine obturator without sponge.]

In the last chapter of Book XVIII, first dentition and the treatment

required during this period are spoken of. The cutting of teeth, says

Paré, is accompanied by pain, itching, and pricking of the gums; often,

as well by diarrhea, fever, epileptic convulsions, which sometimes end

fatally. The symptoms by which it may be known that teeth are about

to come forth are as follows: The wet-nurse feels the mouth of the

suckling infant to be hotter than usual; the gums are swollen; the

child is restless, crying often and sleeping but little; it emits a

quantity of saliva from the mouth, and frequently puts its fingers in

its mouth, trying to rub its gums, and soothe, in this way, the pain

and itching which it feels. It is then necessary to treat the nurse as

if she had fever, and the infant should be suckled less than usual;

some cooling and thirst quenching drinks should be given to it—for a

child in such conditions suffers from intense thirst; the nurse should

often rub the gums of the little patient with softening and soothing

substances, as, for example, oil of sweet almonds, fresh butter, honey,

or mucilage made from the seeds of the fleawort or of the quince;

the brains of a hare (these may be roasted or boiled) have not only

a very soothing action, but also, according to a very ancient belief

shared by Paré, possess the occult property of aiding the cutting of

the teeth. But oftentimes, neither these nor other remedies are of any

use, because the gums are too hard and the teeth cannot cut their way

through at all; the tension of the gums then produces very violent

pain, fever, and other accidents, death even supervening in some cases.

The author, therefore, advises lancing the gums deeply, just above the

tooth which ought to appear, thus opening it a way, that it may more

easily come out. He relates that he has performed this operation on his

own children in the presence of many medical authorities.

Almost as if to show the high value of this operative procedure, Paré

tells the case of a child, the son of the Duke of Nevers, who died

at the age of about eight months without having cut any teeth. He,

together with other doctors, was invited to carry out an autopsy. No

lesion whatever was found sufficient to cause death, but the gums were

very hard, thick, and swollen; an incision into them showed that

the teeth were ready to come out, if only their eruption had been

facilitated by lancing at the right time. Paré and the other doctors

were of the unanimous opinion that death was caused solely by the

impossibility of cutting the teeth on account of the hardness of the

gums.

Among the many strange cases given in Book XIX (_Des monstres et

prodiges_), Paré also speaks—trusting to the word of Alexander

Benedetti—of the case of a woman, who, after the complete loss of her

teeth caused by age, cut them all again at eighty years of age.

Although Paré treats so amply and with such competence all that

concerns dental diseases and their cure, he does not make the least

allusion to the stopping of teeth, beyond recommending, as had already

been done by Celsus, that when a tooth that is to be extracted shows a

large cavity, the latter should be well filled with linen or lead, so

that the tooth be not fractured under the pressure of the instrument

and so leave the root behind in the alveolus.

A century before Ambroise Paré, Giovanni d’Arcoli had already mentioned

the filling of teeth with gold leaf, and, as we have seen already,

there is very good reason to believe that the practice of this

operation dated back to a still earlier period. How is it, then, that

the illustrious French surgeon does not say a word about this? Very

probably stoppings were not at all in use among French _dentateurs_ and

perhaps, even in Italy, this operation was only rarely carried out.

JACQUES HOULLIER (1498 to 1562), a celebrated French physician and

surgeon, also known under the Latinized name of Jacobus Hollerius,

was the first to stand out, although timidly, against the theory of

dental worms. He did not decidedly deny their existence, this having

been affirmed by so many illustrious writers; he, however, speaks of

them as if the point were a doubtful one: “_It is said_ that worms are

generated in the teeth, which corrode the teeth themselves, and produce

a pain which is not very violent and causes itching with little or no

salivation (_vermes ajunt subnasci dentibus, et hos corrodere, à quibus

dolor non ita fortis, pruriginosus, nulla aut pauca salivatio_).”

But even while putting in doubt the existence of dental worms, he

believes it his duty to enumerate the various remedies, recommended for

their destruction. As to fumigations with the seeds of the hyoscyamus,

Houllier, declares that what is believed by the common people, and

what has been written by doctors of antiquity about worms being killed

and seen to fall from the teeth by the effect of these fumigations, is

all nonsense. In fact, he says, when the seeds of the hyoscyamus are

burnt there fly away from them what appear to be little worms, even

if the fumes do not reach the worm-eaten tooth. (_Quod autem vulgus

sibi persuadet, et ab antiquis medicis scriptum est de suffumigio è

semine hyoscyami, videtur fabulosum. Nam inde ajunt manifeste vermes

excidere. Re vera, incenso semine, evolant tanqua vermiculi, etiam si

non attingit fumus vermiculosum dentem._)

Apart from this, in the works of Houllier, nothing is found that is

of interest for the history of dentistry. He repeats several errors

and prejudices of the ancients; he says, for example, that men have

ordinarily thirty-two teeth, women, twenty-eight; and he, too, believes

in the expulsive virtues of the fat of green frogs when applied to a

tooth (_adeps ranæ viridis dentem depellit_).

Houllier does not contribute in any way to dental therapeutics, he only

enumerates the methods of cure recommended by preceding authors.[310]

VOLCHERUS COITER (1534 to 1600), of Gröningen, an ardent student of

anatomy, and a pupil of Fallopius, Eustachius, and Aranzio, studied

with great attention the development of bones, dissecting many fetuses

and children of various ages for that purpose. He clearly states his

opinion that the teeth are not bones, since they do not pass, like the

latter, through the cartilaginous stage, but are derived instead from a

mucous substance.[311]

JOHANN JACOB WECKER, a doctor of Colmar, published in 1576 a valuable

medical work composed of synoptical tables, in which is briefly

summarized the best of what had been written by preceding Greek, Latin,

and Arabic authors.

One gathers from this author that at the time in which he wrote it

was considered an excellent preservative against the plague to rub

the teeth with theriac, mithridate, angelica, and zedoary. From this

it may be perceived that even in those days doctors had understood

the importance of the cleanliness and disinfection of the mouth as a

prophylactic against infective diseases.

In the above-mentioned book may be found a sufficiently complete

exposition of dental therapeutics of that and of the preceding periods.

There is nothing, however, which is not already known to us from our

examination of the earlier writers. Worthy of notice is the information

that, among other things, to facilitate the cutting of teeth rubbing

the jaws with turpentine was recommended at that time.[312]

[Illustration: Volcherus Coiter.]

DONATO ANTONIO OF ALTOMARE, a Neapolitan physician and philosopher,

dedicated a long chapter of his _Ars medica_[313] to the subject of

dental pains and their treatment. He classifies these pains with great

accuracy, taking into account their seat and causes, and pointing

out in each single case the method of cure to be followed according

to the warm, cold, dry, or humid nature of the pain. In what he says,

however, we do not find anything new.

GIULIO CESARE ARANZIO (1530 to 1589), a celebrated surgeon and

anatomist of Bologna, in which city he taught from the age of

twenty-six years until his death, is of the opinion that parulides—that

is to say, inflammations or abscesses of the gums—and epulides—that

is fleshy excrescences of the same—are usually caused by caries or

putrescence of the teeth; but that in certain individuals, from

a peculiar weakness of the gums, these are easily attacked by

inflammation when the wind is in the south.

In the case of parulides, to soothe the pain and to accelerate the

suppurative process, emollient substances should be used; afterward it

is necessary to open the abscess with a lancet, to wash the mouth with

mulse, and to aid the process of cicatrization by using syrup of roses.

As to epulides, these must be made to disappear, by sprinkling the

tumor with the powder of gall-nuts, or by moistening them frequently

with a decoction of gall-nuts, or with sulphur water. But if they

do not yield to these remedies, and are the cause of functional

disturbances, the surest and most prudent method of cure would be the

use of the red-hot iron.

GIOVANNI ANDREA DELLA CROCE, a celebrated Venetian physician and

surgeon, was the author of a most valuable treatise on surgery, which

was published first in Latin (_Chirurgiæ universalis opus absolutum_,

Venetitiis, 1573), and then in Italian under the title of _Chirurgia

universale e perfetta_, Venezia, 1583. According to this author, dental

fistulæ are more common to the lower jaw than to the upper one. To

cure these fistulæ, it is necessary to extract the diseased teeth from

which they originate, even should they ache but little or not at all.

To confirm this, he relates in full a very interesting case of a dental

fistula, that he cured by the extraction of a tooth which hardly ached

at all.

Flajani[314] chose to see in this case a precocious example of the

opening of Highmore’s antrum through the alveolus. But the description

given by Andrea della Croce of his case does not at all warrant this

supposition.

At the end of his book Andrea della Croce gives us the figures of many

dental instruments, which have, however, nothing new about them.

GEROLAMO CAPIVACCI, of Padua, repeats the advice (already given by

preceding authors) to avoid, in eating and drinking, the rapid changes

from heat to cold, and _vice versa_, since, says he, nature does not

tolerate these rough changes.[315] In the mercurial treatment of

syphilis,[316] he recommends the patient, as soon as the action of the

remedy manifests itself in the oral cavity, to keep a piece of gold in

his mouth, that the mercury, on account of its particular affinity,

may unite with the gold and the harmful effects of this strange remedy

on the mouth may be thus avoided. A strange method of curing mercurial

stomatitis!

JOHANN SCHENCK VON GRAFENBERG (1530 to 1598), a celebrated doctor of

Freyburg-in-Breisgau, has left us, in his _Observationes medicæ_, a

very rich and interesting collection of clinical cases. In this work he

refers to many observations upon dental diseases by earlier authors,

which, however, have already been noted by us in their time and place.

Among other things, Schenck von Grafenberg relates that Cardanus

was able, more than twenty times, to calm a violent toothache which

tormented him by lightly pressing the sick tooth between the thumb and

index finger of his left hand.

PETER FOREEST (1522 to 1597), a very famous Dutch doctor of Alkmaar,

repeats the very old error—already in decisive terms denied by Andreas

Vesalius—that women have only twenty-eight teeth, whilst men usually

have thirty-two. To the two central incisors he gives the name of

_columellares_. Sugar and all sweet things, says this author, are

very harmful to the teeth, and he gives as a proof the fact that

apothecaries have, in general, very bad teeth, on account of the

frequency with which they taste syrups and the like. Perhaps things are

now changed, since I am not aware that chemists in our days are to be

distinguished by the bad state of their teeth!

In regard to toothache, Foreest records an important observation

which he had made on himself; an aching tooth which a surgeon had not

succeeded in extracting, but which was simply loosened, ceased, without

anything else being done, from giving him pain, and in a short while

became firm again, and he continued to use this tooth for about five

years. However, on a renewal of the pain he was obliged at last to have

it extracted. On the strength of this observation, the author believes

that in certain appropriate cases, recourse may be had to the luxation

of a tooth, rather than to its extraction to obtain a cessation of

toothache.

This method of cure had already been advised by a still earlier writer,

that is, by Avicenna. When a subluxation produces the rupture of the

dental nerve, this, in its results is equivalent to a replantation.

Foreest is the first to speak of the violent inflammation of the gums

and of the whole mouth, caused by the application of artificial teeth

of ivory fixed in their place with gold wire. This cannot at all

astonish us when we consider how imperfectly, in those days, dental

prosthesis was carried out and how the immobility of the artificial

pieces, caused them to be a source of permanent irritation to the

neighboring parts, especially on account of the difficulty met with in

giving proper care to cleanliness. He, therefore, entirely rejects the

application of artificial teeth. He is likewise but little inclined

to the use of the pelican, it being very easy to break the teeth with

it, and, instead, he recommends the use, whenever it be possible, of

another instrument which he calls _pes bovinus_.

Foreest relates several cases of dental fistulæ which he had cured by

the extraction of the faulty teeth. In one of these cases, observed in

a lady, the fistula had opened between the nose and the cheek, so that

a malady of the upper jaw was feared (and, in fact, as William Sprengel

observes, it is not improbable that this was a case of affection of

Highmore’s antrum); he obtained a complete cure in a short time by the

extraction of a diseased tooth.

According to Peter Foreest, the existence of dental worms is as certain

as is that of intestinal, auricular, and other worms. Even on the

pretended efficacy of remedies, capable of making the teeth fall out

without pain, he does not throw the slightest doubt.

Foreest attributes to his master, Benedictus of Faenza, the merit of

having introduced into therapeutics the trephining of teeth for the

cure of certain violent pains not accompanied by any external lesion

of the tooth. We know, however, that the invention of this operation

dates back to Archigenes. Benedictus trephined the tooth with a very

fine drill (_stylo vel terebello subtilissimo_) and then filled it with

theriac, using, likewise, as occasion required, other remedies.

To demonstrate the propriety and the necessity of laying bare the neck

of the tooth before extracting it, he relates a case in which fracture

of the jaw was the result of having neglected this precaution.

Among the sundry causes of the looseness of teeth, he mentions the

softening of the dental nerve (_emollitio_), but this erroneous opinion

had already been expressed by Galen.

As a means of cleaning teeth and keeping them free from tartar, he

advises, among other things, the use of pumice-stone powder. He

disapproves, however, of the use of oil of vitriol—unless in very

minute quantities of, at the very most, one or two drops.[317]

URBAIN HÉMARD, a surgeon to the Cardinal d’Armagnac, published in 1582,

at Lyons, a booklet entitled: _Recherche de la vraye anathomie des

dents, nature et proprietez d’icelles, où est amplement discouru de

ce qu’elles ont plus que les autres os; avecque les maladies qui leur

adviennent, et les remedies_. This is the first dental monograph that

appeared in France. The pamphlet is written with much erudition, but

its contents are almost entirely taken from preceding authors. Hémard

indicates by the term _deschapellement_ (decrowning) the removal of the

crown of a tooth for curative purposes. He speaks of this operation as

of a method but recently introduced into therapeutics; but, and very

reasonably, too, he shows himself somewhat hostile to such a method of

cure.

As to what concerns the anatomy of the teeth, Hémard’s book does not

contain anything original. The following passage, transcribed by

Portal,[318] shows luminously that Urbain Hémard, instead of making

researches of his own, has simply copied the Italian Eustachius,

translating the latter almost literally. The beauty of it is that

Portal had not noticed the plagiarism in the least, since he says that

if Urbain Hémard had taken into account the researches of Fallopius and

Eustachius as well, his book would have acquired still greater value.

But, in truth, he has taken into account, and has valued the researches

of Eustachius so much as to palm them off as his own! We here

quote, side by side, with a paragraph taken from Hémard’s book, the

corresponding passage of Eustachius, that our readers may be convinced

of the truth of what we have stated:

EUSTACHIUS.

... aperta utraque maxilla occurrunt incisores, canini,

ac tres molares, nimirum secundus, tertius et quartus;

partim mucosi, partim ossei, non obscuræ magnitudinis,

suisque præsepiolis undique vallati:

* * * * *

incisoribus autem et caninis docta manu detractis,

tenuissimum interstitium vix osseum factum conspicitur;

quo pari diligentia amoto, obviam veniunt totidem

incisores et canini pene mucosi et longe minores, qui

post alios priores in propriis caveis latentes, singuli

singulis e regione oppositi collocati essent, nisi

utriusque maxillæ caninus magna ex parte proximo incisori

incumberet, eumque propterea fere occultaret.[319]

Primorum molarium et genuinorum qui circa septennium ac

longe etiam postea oriuntur, fateor me nullum vestigium

vidisse.

HÉMARD.

... leur ayant ouverte l’une et l’autre mâchoire, j’y

ai trouvé seulement les dents incisoyres, les canines,

et les trois mâchelieres de chaque cousté de mâchoire;

à sçavoir la seconde, la troysième et la quatrième,

lesquelles estoit partie osseuses parti mucillagineuses,

de médiocre grandeur, garnies à l’entour de leurs petits

estuis ou alvéoles. Et depuis ayant tirees dehors

lesdictes dents incisives et canines, il se trouve un

entre-deux osseux; lequel ayant pareillement osté, il

se presente de dessoubs autant de dents incisives et

canines, toutes presque mucillagineuses, représentant la

substance d’un blanc d’œuf à demy cuite moindres pourtant

que les précédentes estant cachées dans les mesmes

estuits après les premières.

* * * * *

Quant est des premieres mâchelieres et des gemeles qui

à sept ans, ou longtemps après commencent à sortir,

je confesse n’en avoir trouvé jamais aucune trace n’y

commencement.

EUSTACHIUS.

Verisimile tamen est, rationique consentaneum, eos

perinde ac secundos incisores et caninos rude quoddam,

sed minus perspicuum initium ortus in utero sumere;

sensimque postea similiter formari et absolvi

HÉMARD.

Toutesfois, il est vraysemblable et raisonable aussi,

qu’elles ayent pris dans la matrice, tout ainsi que

les incisoyres et canines secondes, quelque petit

commencement de naysance et forme, moins apparante

toutefois, mais qui depuis se façonne et parfaict tout

ainsi que des autres.

At the time when Urbain Hémard was publishing his pamphlet in France,

several other monographs were already appearing in various parts of

Europe on teeth and their affections. A few years after Ryff had

initiated dental literature in Germany, other odontological writings

were published in Spain and in Italy.

[Illustration: FIG. 66

Title page of Francisco Martinez’s book (Valladolid, 1557).]

FRANCISCO MARTINEZ,[320] in 1557, gave to the press in Valladolid

a _Coloquio breve y compendioso sobre la materia de la dentadura y

maravillosa obra de la boca, con muchos remedios y avisos necessarios,

y la orden de curar y adreçar los dientes_.

[Illustration: FIG. 67

Four of the instruments represented in Francisco Martinez’s book.]

[Illustration: FIG. 68

A dental excavator used for ascertaining which one among several

decayed teeth was the one causing the pain (F. Martinez).]

[Illustration: FIG. 69

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

[Illustration: FIG. 70

A pelican (F. Martinez).]

[Illustration: Girolamo Fabrizio.]

In the same year and city was printed a Latin pamphlet, _De dentione_,

by Franciscus Martinus de Castrillo, probably the author of the

preceding book. In 1563 was published in Venice the excellent treatise

of Eustachius on the anatomy of the teeth (_Libellus de dentibus_). At

Frankfort was published, in 1576, the second dental monograph in the

German language, _Zahnarzney_, by Adam Bodenstein von Carlstad; and

two years later Petrus Monavius published in Basle a Latin pamphlet on

dental diseases (_De dentium affectibus_).

[Illustration: FIG. 71

FIG. 72

Different kinds of forceps (F. Martinez).]

The above-mentioned works, apart from the book of Eustachius, which is,

of its kind, a real masterpiece, have but little importance. We have

cited them here solely to show in what years and in what countries the

very first dental monographs appeared.

GIROLAMO FABRIZIO, of Aquapendente (1537 to 1619), a celebrated

anatomist and surgeon, wrote some very valuable works, among which a

treatise on surgery, in which the part relative to the affections of

the dental system is treated briefly but with great orderliness and

clearness, thus giving a very precise idea of what dental surgery was

at the end of the sixteenth century.

The principal operations which it is necessary to perform on teeth are,

he says, seven in number,[321] viz.:

1. Forced opening of the dental arches in cases of prolonged

constriction of the same, so as to prevent the patient from dying of

hunger.

2. Cleaning of the teeth.

3. Medication of carious cavities.

4. Filling with gold-leaf.

5. Removal or resection of teeth abnormally situated.

6. Removal of any unevenness or sharpness of the teeth.

7. Extraction.

[Illustration: FIG. 73

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

[Illustration: FIG. 74

A dental scraper.

A universal toothpick and a file for sharpening its points.

An instrument for removing sharp corners from the molar teeth (F.

Martinez).]

[Illustration: FIG. 75

A figure representing St. Apollonia, reproduced from the last page of

F. Martinez’s book.]

In regard to the first operation, the author first of all examines

the various causes of the constriction of the dental arches, and

according to the various nature of this, he indicates in what cases it

is fitting to have recourse to the forced opening of the jaws by means

of appropriate dilators, and in what cases it is best to avoid it. In

the latter case one must seek to feed the patient in other ways—that

is, either by alimentary clysters, or by a little tube passed through

a space already existing or purposely made by the extraction of one

or two teeth; or else by letting a cannula reach down to the pharynx,

through the nose, or, lastly, by introducing a cannula into the oral

cavity through the free space existing behind the last molars. But in

regard to this last method, Fabricius notes that if the constriction

is of a spasmodic nature, the spasm may affect not only the elevator

muscles of the jaws, but also those that govern deglutition, including

sometimes even those of the tongue itself, and in this case, as the

food introduced into the oral cavity could not be swallowed, it is

preferable to convey it directly into the pharynx, by means of a

cannula passed through the nostrils.

The second of the above-mentioned operations[322] is designed, says

Fabricius, to take away the dirtiness of the teeth and the bad odor of

the mouth (_dentium immunditiam et oris fœtorem tollit_). The dental

tartar (_ostracoderma_) must be removed by slender instruments of an

appropriate shape, which, for people of high position (_promagnatibus_)

shall be made of silver. This advice is sufficient to make us

understand that Fabricius, although an excellent surgeon, had no

practice in dental operations; otherwise he would have known that the

hardness and adhesion of tartar is generally so great that its removal

absolutely requires scrapers of tempered steel and not of a soft metal

like silver.

To arrest caries, he first drops into the carious hollow, by means

of a small silver funnel, some drops of oil of vitriol, or of some

other caustic liquid; and then he performs actual cauterization with

appropriate instruments; after which the cavity is filled with gold

leaf (auro foliato).

When one or more teeth have appeared in an irregular position and

offend the walls of the oral cavity or else the tongue, the excision

(resection) of the tooth or teeth must be performed with a pair of

strong pincers, whose shape must vary according to whether the teeth

are situated externally or internally with regard to the dental arches.

But as after the resection there will almost always remain some points

or sharp irregularities, which by their presence would continue

to irritate the soft parts, it will be necessary to remove these

irritating prominences by means of the file.

As to extraction, Fabricius of Aquapendente counsels great prudence in

performing the operation, and on this point he repeats all the warnings

already given by Celsus, an author whom he greatly admires and the

study of whose writings he warmly recommends.

It seems that in those times there was more than sufficient reason

to inculcate extreme caution in regard to the extraction of teeth.

This was not then performed by true dentists, but rather by barbers

and by ignorant tooth-pullers, or else, in exceptional cases, by

general surgeons, very skilful, perhaps, in everything else, but

little practised in the operation we are speaking of; besides this,

the instruments left much to be desired; and lastly there was not,

nor could there be, any idea of asepsis. What wonder, therefore, if

the extraction of teeth was frequently the cause of serious injuries!

Fabricius relates that it often happened to him to have to extract,

in little fragments, half or sometimes a whole jaw, which had been

attacked by putrefaction, as the result of the extraction of one single

tooth. This, adds the author, may easily happen, because, when the

jaw is attacked by pus in one point, its very anatomical constitution

favors the rapid spreading of the putrefying process to the other

parts of the bone, as this latter, apart from its external lamina, is

entirely composed of a sponge-like substance.

The instruments which are used for the extraction of teeth, are,

says Fabricius, of nine kinds;[323] and the most important among

them—generically called _forceps_—are indicated by special names,

taken from their resemblance to the mouth or beak of certain animals.

Thus, the forceps with which it is usual to perform the extraction of

molar teeth are called “pelicans,” and of these there are two kinds,

according as they are used for the right or the left side, for the

upper molars or the lower ones.

A third kind of instrument goes under the name of “beak” (rostrum), and

serves for the extraction of the incisors.

A fourth kind is the “crow’s beak,” or “crow’s bill,” which is used for

the extraction of roots.

Two other instruments are named in Italian “cagnoli,” for they imitate

the strong bite of the dog (in Italian _cane_) and are used in cases

where the pelican is not adapted.

A seventh instrument is called by the Latin term of _terebra_ (drill

or auger). It is used instead of a lever to separate the teeth from

one another when they are too close to each other, and so render their

extraction much easier.

The eighth instrument is a “trifid lever” (_vectis trifidus_), so

called because it is furnished with three points.

The ninth and last kind of instruments are the _dentiscalpia_, slender,

sharp, and oblong tools, with which the gums are separated from the

teeth before extraction.

Fabricius also speaks of dental prosthesis, but very briefly. He says

that artificial teeth are made of ivory or of bone (for example, from

the tibia of the ox) and are fastened by gold wire. One has recourse to

this means especially to correct the bad appearance and the defects in

speech deriving from the loss of the front teeth.

This author also makes some allusion to palatal obturators,[324] but in

very general terms, limiting himself to saying that when a perforation

exists in the hard palate, it may be corrected by a piece of sponge

or cotton, or with a plate of silver fixed in the palate, so as to

close up the aperture (_corrigitur spongia, vel gossypio, vel lamina

argentea, quæ palato appendatur, ut foramen obstruat_).

For epulides and parulides Fabricius advises the same methods of cure

that had been recommended by Paul of Ægina.

In the case of flaccidity of the gums accompanied by looseness of

the teeth, the treatment must consist, first of all, in superficial

cauterization with the red-hot iron, after which the gums must be

smeared with honey, the mouth washed with mulse, and lastly astringent

powders must be used.

If the gums are much swollen, in near relation to the molar teeth, the

use of the red-hot iron, says Fabricius, becomes very difficult from

the want of space, and from the close vicinity of the healthy parts,

which must not be injured. In such a case, it is necessary to remove,

with suitable cutting instruments, as much as is possible of the morbid

tissue (_caro crassa et putrida_); then to cauterize the remaining

part, making the cautery, if necessary, pass through a tube, so as not

to injure the surrounding parts. When, however, the gingival swelling

bleeds very easily, and its excision thus might give rise to a profuse

hemorrhage, it will be best to perform the operation with cutting

instruments heated red-hot.

Fabricius remarks that although other authors do not make any allusion

to these large gingival excrescences, he had had occasion to observe

several cases, and had also had various instruments especially

constructed for their cure.[325]

JOHANN HEURN, or in Latin Heurnius (1543 to 1601), of Utrecht, in his

book on the diseases of the eyes, ears, nose, teeth, and mouth, treats

sufficiently at length of dental diseases and their cure, but without

adding anything of importance to what had been written by preceding

authors. His work is a mere compilation, which would be without any

importance whatever if it did not serve to show what credit was still

given at that period to all the errors and prejudices which are to be

found in the writings of the ancients.

Heurnius, although he wrote a long time after Vesalius, still adheres,

in regard to the number of teeth, to the already mentioned opinion of

Aristotle; he says, in fact, that women rarely have thirty-two teeth

like men.[326]

He warns those who suffer from odontalgia not to have recourse

thoughtlessly to tooth-drawers, but to recur, instead, to the doctor,

who will always treat the affection according to the cause on which it

depends.

And here the author repeats the numerous distinctions found in many

preceding writers, and especially in Arculanus. The pain may be

located in the gums, in the dental nerve, or in the very substance of

the tooth; and in each of these cases it may depend on warm or cold

matter, on dryness, humidity, etc.

[Illustration: FIG. 76

A Dutch dentist. (From a picture of the XVI century.) By Lucas Van

Leyden.]

The method of treatment must vary in all these cases; and in regard

to this the author enters into minute particulars, commencing with

dietetic cure—which itself must be varied according to the causes

of the affection—and then treats of all the other therapeutic

means—purgatives, bloodletting, revulsives, local narcotic or resolvent

medicaments, and so forth. The letting of blood was, it seems, a very

favorite method of cure; not only were the veins of the arm opened, but

also those of the tongue, of the gums, of the lips, and of the ears!

Another remedy which the author seems to have a predilection for is

oil of vitriol. When a tooth shows a carious perforation, he applies

inside it, by means of a split feather, a drop of oil of vitriol,

which, says he, causes the fall of the tooth after a few days.

Elsewhere he says that “sometimes worms are produced in carious teeth;

to kill them a drop of oil of vitriol is an excellent remedy; and

this at the same time cures the decay of the tooth and takes away the

sensibility of the nerve.”

This passage does not agree very well with the preceding one, according

to which oil of vitriol would act much more radically by causing the

tooth to fall out altogether. But we will not take exception to so

small a matter; so much the more, as the author, if he were still

alive, might perhaps show us by some subtle distinction that the

contradiction alluded to is only an apparent one!

To free the teeth from tartar, Heurn likewise counsels oil of vitriol,

diluted, however, with other liquids.

A tooth must not be sacrificed excepting when it is loose and attacked

by incipient necrosis, so as to leave no hope of arresting the

putrefactive process. It is then our duty, says Heurn, to remove the

tooth without causing much pain. For this purpose, after the tooth has

been separated all around from the gums, it must be raised somewhat

from the alveolus; then it must be sprinkled with powder of euphorbia,

or a paste made with flour and the juice of the tithymalus must be

applied around it, taking care, however, to cover the neighboring teeth

with wax. After two or three days the tooth will be so loose that

it can be pulled out very easily with the fingers or with a pair of

pincers.

Dental surgery properly so called has been entirely neglected by Heurn.

He was perhaps so persuaded of the efficacy of the above-mentioned

remedies as to believe that every other species of intervention was

useless. On the contrary, he does not abstain from speaking very

seriously of the miraculous virtues of certain remedies (serpent

scales, dog’s teeth, etc.); and tells us, among other things, that the

broth made from a frog, when held for a length of time in the mouth,

soothes dental pains, whatever be the causes from which they originate.

One would seem to have gone back again to the days of Pliny!

THE STORY OF THE GOLDEN TOOTH.

In 1593 a rumor spread throughout Germany of a great marvel that had

appeared at Schweidnitz in Silesia: a golden tooth had erupted in the

mouth of a child aged seven years, which, more precisely designated,

was the first large molar on the left of the lower jaw.

In our days news of such a kind would be immediately qualified, and

universally held to be an imposture. But three centuries ago the most

marvellous and unlikely things were easily believed in, often even by

the learned; and, therefore, the fact alluded to was taken into serious

consideration, so much so that for a long time many learned pamphlets

and dissertations were written concerning it.

JACOB HORST, Physician and Professor of Medicine at the Julius

University in Helmstadt, published, in 1595, a very singular book on

the golden tooth of the Silesian child.[327] Without raising any doubt

as to the reality of the fact, he maintained that the phenomenon was

produced from the effect partly of natural and partly of supernatural

causes, in relation with the constellation under which the child was

born. On the day of its birth, that is, December 22, 1585, the sun was

in conjunction with Saturn in the sign of Aries. In consequence of

this circumstance the nutritive force had developed marvellously on

account of the increase in heat, and consequently, instead of osseous

substance, golden matter had been secreted!

After having explained (!) in this way the origin of the phenomenon,

Horst passes on to examine what events may be portended by this

unheard-of marvel, he not having the least doubt that it—like

earthquakes, eclipses, and comets—must be the precursory sign of

important events. Supporting his assertions by arguments of various

kinds, some of which are taken from the Bible, he concludes that the

gold tooth of the Silesian child means neither more nor less than the

approach of the golden age! The Roman Emperor would sweep the Turks,

the enemies of Christianity, out of Europe, and the Millenium or

Golden Age would commence. As the tooth was situated on the left side

of the lower jaw, it might be deduced, according to Horst, that heavy

calamities would precede the beginning of the epoch of happiness thus

predicted. On the other hand, as the golden tooth was the last of the

dental series of the child, this was to signify that the golden epoch

thus foretold would be the last of the ages of this world before the

universal judgment!

MARTIN RULAND, in the same year, 1595, wrote about the gold tooth.[328]

Shortly after, he was answered by JOHANN INGOLSTETTER; and the

controversy which arose between them in this important subject lasted

for a long time, without, however, leading to any definite conclusion.

BALTHASAR CAMINDUS, a doctor of Frankfort, meanwhile had noted that for

some months the marvellous Silesian boy had not lent himself to being

examined by the learned, becoming terribly enraged whenever they wished

to compel him. From this he inferred that it was a case of nothing else

but an imposture, and that the famous tooth could not have anything

special about it, save that its crown had been very skilfully covered

with a thin plate of gold.

In spite of this the discussions on the portentous tooth continued for

a long time; and even one hundred years after, that is, in 1695, a new

dissertation appeared on the golden tooth.

The greater number of those who wrote on this subject did not throw

the slightest doubt upon the reality of the fact, but only sought to

explain in the most varied ways the genesis of this phenomenon.

DUNCAN LIDDEL. Among those who had the good sense not to put faith in

the thing, and who very decidedly affirmed that this was a mere case

of imposture, Duncan Liddel, a Scotchman and professor in a German

University, deserves to be recorded.[329]

He had heard that the famous gold tooth was larger than the others,

and that the neighboring molar was wanting; from which he argued that

this was simply the case of a tooth the crown of which had been covered

with a plate of gold. Answering the arguments of Horst, he accused him

of gross ignorance in the most elementary notions of astronomy, and

this for having affirmed that when the famous child was born, that is,

December 22, the sun happened to be in conjunction with Saturn in the

sign of the Ram. As the sun does not enter the sign of the Ram until

March, if it had been there on December 22 this would have been a

greater portent than if the whole body of the child had been formed of

nothing else but teeth of gold![330]

The above-mentioned fact is not the only one of its kind. Serres

relates that once there was a great noise made in Poland about the

pretended golden teeth of another child who was carried round from city

to city for the purpose of making money. A Franciscan monk had sought

to explain, in one of his writings, the formation of these teeth.

The anatomist Kircher answered him in a pamphlet which had the very

suitable epigraph: _O præclare pater, nimium ne crede colori_.[331] In

fact, the pretended teeth were only covered with a layer of tartar of

golden color. As the falsity of the pretended miracle might be brought

to light at any moment with much scandal, a bishop thought it well

to put an end in haste to the comedy, by ordering the removal of the

deceitful layer of tartar from the teeth of the child, to be performed

in public, so that the imposture might be made completely clear.

From the above story we can, at any rate, deduce an important

conclusion for the history of dental art, that is to say, that even

as early as 1593 there was an artificer (we do not know whether a

goldsmith or dentist) who knew how to construct a gold crown, although

only for the purposes of deception.

CHAPTER XI.

THE SEVENTEENTH CENTURY.

The first signs of the separation of dental science from general

medicine were to be perceived in the sixteenth century, the period

in which, as we have seen, the earliest dental monographs appeared.

From that time this separation tended to accentuate itself ever

more strongly; dental monographs became more numerous and dentistry

progressed ever more rapidly, both in its scientific and practical

aspects.

In the seventeenth century, about which we are now to speak, we shall

have to call attention to many facts of the highest importance for

the development of dentistry, and with regard to literature, it is

worthy of note that while the publications on dentistry that appeared

in the various countries of Europe during the preceding century only

amounted to about twenty (taking also into account several pamphlets on

the famous golden tooth!), in the seventeenth century the number was

considerably higher, that is, about a hundred. We shall speak of the

most important of these, as also of the works on general medicine or on

surgery of the same period, that present some interest from the point

of view of dentistry.

JOHANN STEPHAN STROBELBERGER, physician to the imperial baths of

Carlsbad, published in the year 1630 a very curious book, the title

of which, being translated, runs somewhat as follows: _Complete

Treatise of Gout in the teeth, or, more properly said, of Odontagra

or toothache; in which are set forth, theoretically and practically,

for the use of physicians and surgeons, the means of mitigating these

pains, as well as the various modes of ably extracting teeth with or

without instruments_.”[332]

This book merely presents some interest, because it gives us a clear

idea of the pitiful state in which the dental art still was in the

first half of the seventeenth century, and shows us most clearly

what enormous progress our specialty has made in little less than

two centuries. Apart from this, Strobelberger’s monograph is of no

importance, it being nothing more than a most accurate compilation of

all that is to be found on the subject of dental affections in earlier

works, especially from the medical point of view; the surgical part

of dental therapeutics is treated in a much less complete manner, and

prosthesis is entirely excluded from the plan of the work, which,

however, is fully in accordance with the title of the book.

Under the generic name of gout,[333] or podagra, are meant, says

the author (Chapter I), all the affections produced by diseased

humors, falling “by drops” into the articular cavities and the parts

surrounding them. Strictly speaking, however, only gout in the feet is

named _podagra_, whilst when the disease is seated in other parts of

the body it is indicated by other names, gout in the hands being called

_chiragra_; in the fingers _dactilagra_; in the knee, _gonagra_; in the

elbow, _pechiagra_; in the shoulder, _omagra_; in the spinal column,

_rachisagra_, and so on. When the seat of the evil is in the teeth or

in their articulations, by analogy it is denominated odontagra, or

odontalgia, an affection which Paul of Ægina was the first to consider

as being of a gouty nature (Chapter II).

After having spoken of the sensibility of the teeth (Chapter III),

of the various kinds of dental pains (Chapter IV), of the different

causes, external and internal, which produce them (Chapters V to

VII), of the signs which make known their special nature in each case

(Chapters VIII to X), and of the prognosis (Chapter XI), the author

occupies himself very minutely, throughout the rest of the book, with

all that concerns means of cure, dedicating to this subject sixty-seven

chapters and a long appendix.

If, after the publication of Strobelberger’s book, all previous works

treating of dental affections had been entirely lost, it would be of

inestimable value for the history of dentistry, the author having

gathered together in an almost complete manner—citing faithfully the

respective authors—all that had been written about dental diseases

before him. On the other hand, the book contains almost nothing

original; therefore, rather than analyze minutely its contents—which

would involve a long repetition of things already noted—we limit

ourselves merely to a few observations.

Strobelberger, like Heurnius, is of opinion that for the cure of

dental pains it is necessary to have recourse to doctors rather than

to _dentispices_, or tooth drawers (Chapter XII); however, he does

not consider the calling of the latter absolutely useless; indeed, he

expressly advises (page 174) that they should be applied to for the

instrumental extraction of the teeth, it not being possible for such

operations to be carried out well and without danger except by those

who, through great practice, have acquired the necessary skill in the

use of the relative instruments. He refers to the words of Hollerius,

already quoted, as to the falseness of the opinion that fumigations

made with the seeds of hyoscyamus cause the worms to fall out of the

teeth. Notwithstanding, he does not in the least doubt the existence of

the worms themselves; and he, like Heurnius, recommends killing them

with oil of vitriol or with a decoction made from a frog cooked in

water and vinegar (Chapter XXXIII). From this, one clearly perceives

that the doubts expressed by Hollerius about the existence of dental

worms had not in the least shaken the popular belief in them. Nor,

indeed, could it be otherwise when one considers that Hollerius, as

we duly noted in another place, had not the courage either decidedly

to deny the existence of dental worms, or to formulate in a clear

and explicit manner the doubts which had arisen in his mind on this

subject. We are, therefore, unable to recognize the merit which

Linderer[334] and Geist-Jacobi[335] have attributed to this author,

viz., that of having effectually affirmed the non-existence of dental

worms.

Among innumerable vegetable remedies recommended by Strobelberger

against odontalgia, we will only cite two American plants, the guaiacum

and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum

(Chapter XXXVI) the author says that, used as a mouth wash, it has the

triple virtue of strengthening the gums, of preventing putrefactive

processes, and of calming toothache.

The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII)

for the first time in this work, but, as we learn from Strobelberger

himself, Heurnius has already obtained, experimenting in his own

case, the cessation of an attack of toothache by holding in his mouth

spoonfuls of tepid decoction of nicotiana for the space of two hours.

The same soothing effects may be obtained, says the author, from the

smoke of tobacco; but he attributes this not to the narcotic action of

the remedy, but to the fact that it causes the flow of much saliva from

the mouth and mucus from the nostrils, through which the morbid humors

which provoke the pain are eliminated.

To those suffering from odontalgia, says Strobelberger (Chapter XL),

the internal use of certain mineral waters is also of value, and

especially that of the waters of Carlsbad (Thermæ Carolinæ). Like

many other remedies, they are useful in rendering the secretions more

active, favoring thus the elimination of morbid substances from the

blood. For the same object of purifying the organism and dispersing

the accumulated humors causing the pain, many other means of cure

were in usage, such as aperients (Chapter XXV), phlebotomy, and

arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification

and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI),

masticatories, viz., substances intended to be chewed for the purpose

of exciting salivary secretion (Chapter XXVI), sternutatories, viz.,

substances which provoke sneezing (Chapter XXVII), and so forth.

Like Arculanus, Strobelberger makes a distinction between the _real_

and the _false_ cure of odontalgia (_cura vera et cura mendosa_). This

latter he also subdivides in _palliative_ cure and _vain_ cure (Chapter

LV). The palliative cure is constituted by the use of narcotics and

stupefying remedies (Chapter LVI), whilst the vain cure is represented

by certain remedies which he calls “fanatical” or rather “fantastical.”

The _vain_ cure, in its turn, undergoes a new distinction, since it

comprises three species of remedies, that is, the wearing of amulets,

the superstitious remedies, and the ridiculous remedies. Indeed, this

last apellation might also fittingly be applied to the preceding ones!

One would be inclined to believe that the author who qualifies these

remedies as vain, fantastic, superstitious, and ridiculous was a

thoroughly unprejudiced man; however, this is not so. Strobelberger,

too, had to pay his tribute to the dominating prejudices of his

century; this manifestly appears from various passages in his book,

and especially from the Chapters XVI and XLIV. The first of these

bears the following title: “How to procure immunity from toothache,”

and Strobelberger therein asserts in all seriousness, basing his

assertion on the authority of Rhazes, that “if the canine tooth of a

lion be suspended to a child’s neck before the milk teeth fall out

and during the eruption of the second teeth, it will secure the child

immunity from dental pains.” In Chapter XLIV the author speaks of those

animals whose teeth are useful to man as remedies against toothache,

and reiterates—lending, as it seems, perfect faith thereto—various

prejudices that are found in Pliny and other writers of antiquity.

As to the remedies which Strobelberger recognizes as _vain_—that is, as

devoid of real curative virtue—he remarks that they may nevertheless be

useful by acting powerfully on the imagination of the sufferer, thus

causing, in fact, the cessation of pain (Chapter LVII). This clear and

explicit affirmation of the efficacy of suggestion in a book published

270 years ago is certainly not without interest.

If, says Strobelberger, a place is to be accorded, in dental

therapeutics, to the _vain_ remedies, among these, amulets deserve the

preference; and the best accredited amulet is the root of the lepidium,

already recommended by Dioscorides, who affirms that if it be hung

around the neck of the sufferer it will cause the pain to cease.

One of the _superstitious_ remedies to be used against this affection

(Chapter LVIII), consists in touching the aching tooth with the tooth

of a dead person, and afterward greasing it with horse’s marrow.

Among the _ridiculous_ remedies (Chapter LIX), the author describes one

that was especially in use among soldiers. With a piece of chalk or of

rubble one writes on a table:

Chiacia Chiacia Chiacia

X O X X O X X O X

One then pricks the tooth with a knife or an iron toothpick until it

bleeds slightly; then thrusting the point of the instrument, to which

the blood adheres, into the first cross, then into the second, then

into the third, and so on, one asks the patient each time if the tooth

still pains him. Before one gets to the last cross the pain ceases!

This stolid cure, says the author, has no other value than that of the

scarification of the part affected.

Strobelberger held, as did many of the preceding authors, that the

extraction of a tooth ought to be the _last_ remedy, that is, to be

had recourse to when all others, including cauterization, which he

considers as the _last but one_, have proved ineffectual. There are

cases, however, in which the extraction of a tooth is absolutely

indicated, and here, by the way, the author acquaints us with the

following poetic aphorism, which expressed the unanimous opinion of

doctors:

Si dens pertusus, vel putridus esse notatur,

Corrumpens alios, tunc protinus ejiciatur.

That is, if one finds that a tooth is hollow or decayed, and corrupts

the others, it must at once be extracted.

Strobelberger, like the greater number of his predecessors, is fully

persuaded that diseased teeth may be made to fall out by the use of

special remedies; indeed, this clearly appears from the title of the

work itself, as, without doubt, the reader will already have observed.

Such remedies are called by him “odontagoga,” and he describes them

at great length in five different chapters (X to XIV) of the second

section of his book, dedicated to the surgical care of the teeth.

In regard to _violent extraction_ of teeth, Strobelberger shows still

greater cautiousness and timidity than Celsus or Abulcasis. He requires

that, after the gum has been detached, one should endeavor to extract

the tooth with the fingers or by means of a thread; if, however, this

does not succeed, one may have recourse to the trifid lever; only at

last, that is, when even the lever has failed, does he allow the use of

an appropriate dental forceps.

[Illustration: Wilhelm Fabry.]

ARNAULD GILLES, a Frenchman, in the year 1622, published in Paris a

work whose curious title we will here note: _The flower of the remedies

against toothache_.[336] We know nothing else about this publication,

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

compilation.

DUPONT, another Frenchman, in 1633, published an important pamphlet,

which I have, unfortunately, not been able to see. I can, therefore,

only quote what Sprengel says of it.[337] Dupont recommends, in cases

of obstinate toothache, the extraction and immediate replantation of

the tooth; which, he says, becomes quite firm again, but will no more

cause any pain. In confirmation of this, Denis Pomaret related, a

little later, a case in which a healthy tooth having been pulled out

by mistake, and immediately put back into the socket and treated with

astringent remedies, became perfectly firm again.[338]

Although Abulcasis and Ambroise Paré had already recommended the

replantation of teeth, the loss of which had been caused by trauma,

and although Peter Foreest had already made known as a result of his

own personal experience that the luxation (not, however, complete

extraction) of a tooth and its successive replantation is capable of

causing toothache to cease, nevertheless, we must recognize that the

merit of having elevated replantation in non-traumatic cases to a

special method of cure must be attributed to Dupont.

WILHELM FABRY (1560 to 1634), a German, and native of the small town

of Hilden near Cologne, better known by his Latin name of Fabricius

Hildanus, was chief doctor to the city of Berne, and acquired great

fame as well by his extraordinary professional ability as by his works,

consisting principally in reports of many hundreds of important and

instructive clinical cases. He is rightly considered one of the most

illustrious German surgeons. His writings have largely contributed not

only to the progress of surgery in general, but also to that of dental

surgery in particular.

One of his observations clearly shows the etiological relation

frequently existing between a prosopalgia or a supposed hemicrania and

a dental affection. The case referred to is that of a lady who had been

subject for six months to violent pain in the upper teeth of one side

of the jaw. The toothache little by little disappeared, giving place to

an obstinate cephalalgia in the same side of the head, which gradually

became so intense as to be perfectly insupportable, the patient being

particularly subject to it when the weather was cold and damp. After

four years of atrocious suffering, and after innumerable remedies had

been tried without avail, Fabricius Hildamus—having had the luminous

idea of seeking the cause of the evil in the teeth—obtained a complete

cure, without further trouble, by extracting four of the patient’s

teeth, which were decayed.

Nowadays, it is an all-important canon of medical practice, that

in every case of neuralgia occurring within the region influenced

by the trifacial nerve one should give particular attention to the

state of the teeth and carefully treat every affection of the same.

Notwithstanding—we say it with regret—there are still medical men who

ignore or neglect this precept, and prescribe internal remedies or

have recourse to injections of morphine when they ought, in the first

place, to call in the aid of a dentist. How many patients would have

been delivered from slow martyrdom if the example of the clear-seeing

physician of Berne had been followed from his days up to the present

time!

Fabricius Hildanus relates, besides, many cases of dental fistula,

cured by him through the extraction of roots or of decayed teeth. In

one such case the fistula dated from fourteen years back. Fabricius

Hildanus, contrary to the opinion of many other doctors, extracted a

decayed tooth, and by this operation obtained, in a brief period of

time, the complete recovery of the patient.

Among the many very important clinical cases cited by Fabricius

Hildanus, the following deserves to be recorded: In the year 1590 a

woman presented herself to him who had a hard tumor in the space behind

the last molar on the right side. The author, after having prepared

the patient for the operation by the methods then in use (that is, by

aperient medicine, by bleeding, and appropriate diet), destroyed the

tumor by the application of escharotic substances. The remaining wound,

however, defying all the cicatrizing remedies which the author had

recourse to, one after the other, by reason of its being continually

disturbed by the movements of the jaws, he then thought of maintaining

the dental arches in a determined position, and this he obtained by

means of two pieces of wood somewhat hollowed out above and below,

which he placed on the right and on the left between the upper and the

lower teeth, fixing them to the teeth themselves by brass wires passing

through two openings made expressly in each of the two pieces of wood.

In this way he succeeded in obtaining the absolute immobility of the

jaws and the complete cure of the wound in a few days, during which

time the patient was nourished with liquid food.[339]

A very interesting case, inasmuch as it demonstrated the damage and

peril which may result from certain absurd means of cure, was reported

to this author by Claudio Deodato, physician to the Prince-Bishop of

Basle. The case was that of a patient who, after having tried in vain a

great number of remedies for a stubborn toothache, finally had recourse

to the use of aqua fortis; but this substance, which in those days was

in frequent use for dental caries and for toothache, produced most

deleterious effects in the patient, that is to say, the loss of almost

all his teeth, necrosis of the inferior jaw, with fistulous sinuses and

ulceration of the neck, abundant sanious discharge, fever, a cachectic

condition, incipient necrosis of the upper jaw, etc.[340] Fabricius

Hildanus, consulted by Claudio Deodato about this most serious case,

proposed both a local and a general treatment, the result of which is,

however, not mentioned in his book.

In the fifth “_centuria_ of medical and surgical observations and

cures”[341] we find a case of oral surgery, to which it is worth while

briefly to refer here. It relates to an epulis situated next to the

upper canine of the left side. The tumor, already of ancient date,

had at this time reached the size of a walnut, was very hard, livid

in color, irregular in form, and adhered somewhat to the upper lip;

according to the author, it was of a cancerous nature. After the usual

preparative measures, Fabricius Hildanus proceeded to the ablation of

the tumor, and to this end he first pierced it with a curved needle and

strong thread, in order to get a good hold on it, and he then removed

it entirely down to the bone, by means of a curved bistoury.[342]

Fabricius Hildanus, having dissected several abortive fetuses of under

four months, was able to verify the exactitude of the assertion made

by Hippocrates, afterward luminously confirmed by different Italian

anatomists, that the teeth begin to be formed during intra-uterine

life. And with reference to this he also relates the following fact:

The wife of a Protestant minister gave birth to a female child which

already had a fully developed tooth, a lower middle incisor, equal in

size to that of a child of two years old, and which interfered with the

sucking by injuring the nipple of the mother’s breast and the tongue of

the child itself. So it was necessary that it should be removed. But it

was found to be so firm that the surgeon sought in vain to extract it

with a thread, and was obliged to have recourse to the forceps.[343]

Observation XXXI of the third _centuria_ relates a case of rhinoplasty.

In the year 1590, when the Duke of Savoy made war on the inhabitants of

Geneva, a girl named Susanna N. fell into the hands of the soldiers,

who tried to deflower her; enraged at not succeeding in their intent,

they cut off her nose. Two years later the girl went to Lausanne,

the residence of J. Griffon, an eminent surgeon of that time, who

performed the rhinoplastic operation on her in so splendid a manner

that one would have taken the new nose for a natural one, not only

from its normal appearance, but also because the scar was hardly

visible. Fabricius Hildanus, having had occasion to see and examine

the patient several times, even up to twenty-one years after the

operation, was able to testify to the perfect condition of the nose;

in the extreme cold of the winter, however, it was apt to become livid

at the point. He does not describe the operative process followed by

Griffon, but merely says that the first inventor of this operation was

Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had

undertaken the reproduction of the same from his own conception of it,

based on the information imparted to him in conversation, by an Italian

who had been operated upon by Tagliacozzi.

JOHANN SCHULTES (1595 to 1645), a physician in Ulm, was the author of a

very important work entitled _Armamentarium chirurgicum_, in which are

given plates and descriptions of almost all the surgical instruments

that had been in use up to that date. As to the part relating to dental

and oral surgery, we find the following instruments named in this work:

1. Several kinds of pelicans; an instrument which was so called from

its resemblance to the beak of the bird of the same name, and used for

extracting the molar teeth.

2. The common dental forceps, then named _cagnolo_ by the Italians,

because of the supposed likeness to a dog’s muzzle.

3. The crow’s beak forceps (_rostrum corvinum_), designed for the

extraction of dental roots, and, therefore, corresponding to the

rhizagra of Celsus.

4. Two special dental forceps, or _dentiduces_, for the removal of

teeth which could not be extracted either with the pelican or with the

common dental forceps.

5. Bifid and trifid elevators (_vectes bifidi et trifidi_), to be used

for the extracting of incisors and canine teeth, as well as roots.

6. _Dentiscalpia_ for detaching the gum from the tooth before

proceeding to extract it, in order that this may be the more easily

accomplished and with less danger.

7. A silver funnel or cannula (_infundibulum seu fistula argentea_),

for nourishing patients affected with trismus, by conveying liquid food

into the fauces, through the free space behind the last molars.

8. Forceps more or less like in form to the beak of the parrot or the

vulture (_rostrum psittacinum et vulturinum_), for the removal or

resection of teeth that have grown in abnormal positions.

9. A screw dilator (_dilatatorium cum cochlea_), for gradually opening

the dental arches in cases of spasmodic constriction of the jaws.[344]

[Illustration: _A plate of Schulte’s “Armamentarium Chirurgicum,”

showing some dental and other operations._]

[Illustration: FIG. 77

A plate from Schultes’ “Armamentarium chirurgicum,” showing several

dental instruments.]

MARCO AURELIO SEVERINO (1580 to 1656), of Tarsia, a celebrated

professor of surgery in the Neapolitan University, had a great

predilection for the use of the cauterizing iron, which he also used

very frequently in curing caries and other dental diseases. At times,

to effect a cessation of violent toothache, he would have recourse to

the cauterization of the antihelix! Against flaccidity of the gums and

loosening of the teeth he also used cauterization, disapproving the use

of astringent substances, as these cannot get so far as the roots of

the affected teeth. Severino boasts of having cured by cauterization at

least two hundred cases of dental diseases.

LAZARE RIVIÈRE (1589 to 1655), a professor at the University of

Montpelier, also known by his latinized name of Lazarus Riverius,

treats of dental affections and their cure, in various parts of his

works, considering them, however, almost exclusively from a medical

point of view.

He speaks first of all of the different causes of odontalgia, and,

among these, does not omit to mention worms. These, he says, may

be generated in the carious cavities, owing to the putrefaction of

substances retained in their interior. Whenever odontalgia is caused

by worms, the pain, says Rivière, is not continuous, but ceases and

returns at brief intervals; besides, the sufferer perceives at times

the movement of the worm inside the tooth!

What one reads in the works of this author as to remedies to be used

for odontalgia clearly demonstrates how irrationally dental diseases

were treated in the seventeenth century and what tortures were

inflicted on the patients. In many cases, and especially when the pain

was held to be occasioned by “hot humors,” the treatment was begun by

bleeding in the arm. The following day an aperient was administered.

Afterward, if the pain still persisted, the sufferer was cupped in

the region of the scapulæ or of the spine, blisters were applied to

the nape of the neck or behind the ears, resinous plasters to the

temples; all this without taking into account the remedies which were

introduced into the ears, or the various medications or operations

performed on the aching part itself, and many other things besides.

In fact, in order to cure a toothache, the whole body of the sufferer

was seized upon and put to torture, and in the majority of cases they

assuredly finished by extracting the diseased tooth! When we reflect

on the extraordinary frequency of dental disorders we cannot do less

than recognize that the dentists, by the radical change effected in the

methods of treatment, have diminished in no small degree the sufferings

of humanity!

According to Rivière, the small veins (sic) that nourish the teeth pass

through the ear (!); and this would explain how the cessation of a

toothache may be obtained by the introduction of certain remedies into

the meatus auditorius externus. Relief may be obtained, for instance,

by dropping oil of bitter almonds into the ear on the side affected by

the pain, or by allowing the vapor of hot vinegar, in which pennyroyal

or origanum has been boiled, to penetrate into it. Others, adds the

author, pour a little pure vinegar into the ear, which is especially

efficacious against “hot fluxions.” When, however, the toothache

depends on a “cold fluxion,” it calms the pain wonderfully to drop

into the ear a tepid mixture of garlic juice and theriac. The same

advantage, says the author, may be obtained by introducing a piece of

garlic, peeled and cut into the form of a suppository, into the ear.

The author also makes a lengthy enumeration of anodyne and narcotic

remedies (among which opium), observing, however, that those remedies,

unless the vehemence of the pain obliges the use of them, ought not

to have the preference, it being much more rational and much more

advantageous to institute a cure which aims directly at the cause

itself of the pain (fluxions, worms, etc.).

He informs us that Amatus Lusitanus, a celebrated physician of the

sixteenth century, extolled, as a remedy for toothache, a decoction of

gum sandarach in wine and vinegar; the said decoction was to be made

with an ounce of sandarach in six ounces of wine and the same quantity

of vinegar, and ought to be kept in the mouth some length of time,

whilst hot.

Rivière further speaks of various masticatories, which were composed of

mastich, staphisagria, pyrethrum, henbane, etc.

He also mentions oil of cloves, which even then was used against

toothache, by introducing into carious cavities a small piece of

cotton-wool soaked in it. Oil of camphor was used in the same manner,

but the most efficacious of all, according to the author, was oil of

boxwood.

As to worms in the teeth, they may be destroyed by the use of bitter

substances!

In the case of a caries penetrating into the inner cavity of the tooth,

to effect the cessation of pain, it is necessary to burn the nerve with

the actual cautery, or with aqua fortis, or with oil of vitriol. If

this be repeated several times, the tooth gradually falls to pieces.

After having enumerated all these remedies, the author speaks of the

extraction of the teeth, and of all the precautions with which this

must be carried out in order to avoid the various accidents which may

result from the operations and may even, sometimes, become a cause of

death.

When abundant hemorrhage follows the extraction of a tooth, this may

often be made to cease by applying a small, very compact ball of linen

into the alveolus and maintaining it there by pressure during one or

two hours. Should this not suffice, one can combine with compression

the use of astringent substances. Finally, as a last remedy, use may be

made of the red-hot iron.

In the case of timid patients, who shrink from an instrumental

operation, recourse may be had to eradicating remedies, the

author being fully convinced of their efficacy. Indeed, one of

these—helleboraster—is said to be so powerful that, when rubbed on

the teeth, these fall out within the space of a few hours; for which

reason it is absolutely necessary, in making use of it, to cover over

the neighboring teeth with wax, so that the healthy ones may not also

fall out, as happened, says the author, in the case of a poor peasant.

The internal use of mercury, and even the use of certain mercurial

preparations used by women as cosmetics, is of damage to the teeth and

imparts to them a blackish or dirty looking color.

Numerous remedies exist for cleaning the teeth, but according to

Rivière the best way of cleaning them consists in rubbing them with

a small stick immersed in sulphuric acid (_spiritus sulphuris aut

vitrioli_) and afterward drying them with a piece of linen. This remedy

not only cleans and renders the teeth white, but it preserves them also

from caries! If the teeth are very dirty, the spirit of vitriol may be

used pure; otherwise one mixes it with _mel rosatum_ or with water.

The great enthusiasm shown by Rivière for the above-mentioned remedy

does not, however, derive from a long experience, made by himself or by

others, of its advantages, but is based principally on a fact referred

to by Montanus, and which,[345] we will here recount, because, from it,

one clearly perceives how credulously our forebears accepted general

affirmations and formulated therapeutic precepts.

Montanus recounts in one of his writings, how, being in Rome in his

early youth, he became acquainted with a woman of about twenty years

of age, known by the name of Maria Greca (by the way the author speaks

of her, one is led to suspect she was a courtesan); and how, having

seen her again, thirty years later, and found her in pretty much

the same conditions as formerly, he expressed his surprise at this;

whereupon Maria Greca told him that she herself believed that she owed

the conservation of her beauty to the habit, already of many years’

standing, of using one or two drops of oil of vitriol every morning, as

a friction for the teeth and gums. In her youth she had had very bad

teeth, but by reason of this cure they had become, and were at the time

being, beautiful and perfectly firm; the gums also were in excellent

condition; it seemed, therefore, to her that this conservation of

health and freshness, in spite of her fifty years, depended precisely

on the daily use, in the manner described, of oil of vitriol![346]

Rivière, besides, recommends tobacco ashes for cleaning the teeth, a

counsel not yet given by any previous author. He also gives the formulæ

for two dentifrice powders, the basis of which is alum; he calls

attention to the great importance of taking assiduous care to keep

the teeth clean, and advises that after each meal the residues of food

be removed from the interstices of the teeth and the mouth well rinsed

with wine.[347]

NICOLAUS TULP, in Latin, Tulpius (1593 to 1674), a distinguished

physician and anatomist of Amsterdam, contradicts the then prevailing

opinion among doctors, that is, that the cure of dental affections

and the operations relating thereto were matters to be held in little

account. He observes that diseases of the teeth may give rise to the

most serious consequences, which can even be the cause of death,

and are, therefore, worthy of being taken into equally serious

consideration as all the other diseases of the several parts of the

human body.

This author relates a clinical case tending to demonstrate how

incisions made in the gums, advised in the first place by Vesalius,

in order to facilitate the erupting of the last molar, are not always

exempt from danger. A young doctor of Amsterdam, by name Goswin Hall,

being tormented by insupportable pain caused by the difficult eruption

of a wisdom tooth, had the gum lanced above it. But the pain, instead

of diminishing, became worse; fever and delirium supervened, followed

by death! (Here, however, we must be allowed to observe that nothing

demonstrates that the real cause of death was the lancing of the gum,

or that without this the case would have had a different termination.

An event can occur after another and yet be quite independent of the

former and result from quite different causes.)

Among the cases cited by Tulp, the following is also worthy of

mention. He relates having arrested a violent and persistent attack of

hemorrhage, which came on after the extraction of a tooth, by applying

and compressing a piece of sponge inside the alveolus.[348]

The belief that dental caries and toothache could be caused by worms

was, at that time, still in full vigor, and it gained still greater

force by reason of observations recorded by different scientists, whose

affirmations could with difficulty be doubted, for at that period the

greater number still swore blindly _in verba magistri_.

OLIGERUS JACOBAENS (1650 to 1701), a Danish physician and anatomist,

who taught in the University of Copenhagen, declared that in scraping

the decayed cavity of a tooth that was the cause of violent pain, he

had seen a worm come forth, which, having been put into water, moved

about in it for a long time.

MARTIN SIX, having split some decayed teeth a short time after they had

been extracted, asserts that he determined the existence of worms in

them. (It is probable that this observer, as well as others, mistook

the dental pulp for a worm, an unpardonable error, in truth, at a time

when the anatomical constitution of the teeth had already been very

well studied by several scientists, and especially by the celebrated

Bartolomeo Eustachius.)

GABRIEL CLAUDER (1633 to 1691) not only believed in dental worms, but

maintained besides that these were the most frequent among all the

causes of toothache. In a certain way, to sustain this opinion of his,

he relates a case in which a tooth of healthy appearance being the seat

of great pain, a tooth-drawer had asserted that there must be a worm in

its interior; and, in fact, on the tooth being extracted and afterward

split, the little animal whose existence the tooth-drawer had divined,

was found to be existing inside of it!

PHILIP SALMUTH asserts that by using rancid oil he got a worm out of

the decayed tooth of a person suffering from violent toothache, thus

causing the cessation of the pain. The worm, he says, was an inch and a

half in length (!) and similar in form to a cheese maggot.

NICOLAUS PECHLIN (1646 to 1706), professor of medicine at Kiel,

testifies to having seen five such dental worms, like maggots, come out

by the use of honey, though he does not say whether they issued from

several cavities or from one only!

GOTTFRIED SCHULZ. But all this is nothing compared to what Gottfried

Schulz has dared to assert, viz., that by using the gastric juice of

the pig, worms of great size can be enticed out of decayed teeth; some

of these even reaching the dimension of an earth-worm!

It is not much to be wondered at that these things should have been

blindly believed in, if we reflect that only a short time previous

to this the story of the golden tooth had been taken seriously by

men of great erudition, and that in the very epoch of which we are

speaking the illustrious anatomist THOMAS BARTHOLIN (1616 to 1680), of

Copenhagen, relates having seen a man, at Padua, who had an iron tooth!

Besides, the possibility of such a phenomenon was explained in a most

curious manner by THOMAS MINADOUS, who explained that in the same way

as iron is generated in the macrocosm, that is, in the world, so it is

equally admissible that it may be generated in the microcosm, that is,

in man![349]

NATHANIEL HIGHMORE. In the year 1651 the English physician and

anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a

treatise on anatomy (_Corporis humani disquisitio anatomica_, etc.), by

which he acquired a celebrity superior, perhaps, to his merits. This

work, however, served without doubt to diffuse the knowledge of an

anatomical fact of the highest importance, especially from the point of

view of dentistry and surgery.

There is no doubt that the existence of the maxillary sinus was already

known before Highmore, the celebrated anatomists Vesalius, Ingrassias,

Eustachius, and Fallopius having spoken of it very clearly; only

through ignorance of the history of anatomy has it been affirmed by

many that this cavity was discovered by Highmore, to whom is only

due the merit of having described the maxillary sinus, by him called

_antrum_, most accurately, and of having made known the possibility

of a communication between it and the mouth. Highmore calls attention

to the fact that the inferior wall of the antrum often presents small

projections, which correspond with the tops of the alveoli, and that

the osseous lamina which interposes between these latter and the

maxillary sinus is often extremely thin; for which reason, it may

easily happen that, in extracting one of the teeth below the cavity,

one may bring away together with the tooth the small osseous plate that

forms the bottom of the alveolus, thus leaving the maxillary sinus

open at its inferior part. With regard to this, he refers to a most

interesting case which afterward acquired a high degree of notoriety.

It relates to a lady who had suffered from toothache for some years,

and who from time to time had had several decayed teeth extracted,

without, however, finding relief. The pain only ceased after the

patient had had the left upper canine removed. But after this operation

an incessant flow of humors from the alveolus of the extracted tooth

took place. The patient, in great anxiety at this circumstance and

desirous of seeing clearly into the causes of it, herself explored

the affected part with a silver probe, the entire length of which

penetrated into the cavity, producing in the patient the effect of its

having reached the eye. Still more amazed, and urged on by the desire

of becoming still better acquainted with the extent of the evil, she

now made use of a long feather, which she had previously stripped,

and discovered to her painful surprise that this new instrument of

exploration entered to so great a distance that it, according to her

idea, penetrated into the skull. From this she derived argument for

the belief that the morbid phenomenon had its origin in her brain.

Believing herself affected with a serious malady, she consulted

Highmore, who had the satisfaction of being able to tranquillize her

completely by making her understand that the jaw bone is hollow in the

inside, and that its cavity had remained open underneath in consequence

of the extraction of the canine tooth; and also, that the feather had

not penetrated to such a distance as she supposed, but had curved

inside the bone. As to the discharge which had given so much trouble

and alarm, Highmore considered it quite a natural circumstance, derived

simply from the opening of the antrum, as he held that in many cases

the maxillary sinus contains mucus, and that this condition was,

therefore, altogether normal. So he did not propose any treatment, and

the lady thenceforth supported her infirmity with resignation.

This most interesting case soon became generally known, and

contributed, without doubt, not a little to attract the attention of

medical men to the anatomical peculiarities which Highmore had pointed

out in the upper maxillary bone, thus causing his name to become

inseparably associated with the maxillary sinus.

It is evident, however, that Highmore never even suspected to what

very important practical applications his description would give rise.

He knew nothing about the diseases of the antrum, and believed that,

even in perfectly normal conditions, this cavity is often filled with

liquid; the idea, therefore, of its being advisable, in certain cases,

to extract a tooth and perforate the alveolus in order to give exit to

the liquid contained in the maxillary sinus never occurred to him.

About fifty years went by before a rational treatment for affections of

the antrum was initiated, the merit of which, as we shall see at its

time and place, was due to William Cowper. During that half century

maladies of the maxillary sinus continued to be badly diagnosticated

and badly treated.

BERNARDO VALENTINI. In the year 1686, that is, thirty-five years after

the publication of Highmore’s book, Bernardo Valentini, professor at

the University of Giessen, described a case of tumefaction and abscess

in the cheek, treated by him with emollient remedies, and in which,

although according to him caries of the underlying bone did not exist,

the separation of a sufficiently large osseous fragment took place.

Without doubt the affection of the cheek was derived in this case from

some disease of the antrum; however, it would appear that Valentini

did not in the least perceive any such casual relation, as he makes no

allusion whatever to it.[350]

ANTONIO MOLINETTI, professor at the University of Padua, had,

however, ten years previously, diagnosticated and cured an affection

of the antrum by means of an operation. In his book _Dissertationes

anatomico-pathologicæ_, published at Venice in 1675, Molinetti relates

that in a case of abscess of the maxillary sinus, which caused the

patient great suffering, he performed the operation of trepanning the

upper maxillary bone anteriorly, after incision of the soft parts

overlying it. In a certain way we may, therefore, consider Molinetti as

a precursor of William Cowper.

Having spoken of the very important anatomical fact illustrated by

Highmore, we will now also speak briefly of those authors who, in

the seventeenth century, occupied themselves with the anatomy of the

teeth. Their number is sufficiently large; we will, however, only make

mention of such as contributed to the development of this branch of

science, or who, at least, expressed some opinion worthy of note.

The celebrated anatomist ADRIAN SPIEGEL (1578 to 1625), better known by

the Latinized name of _Spigelius_, wrote nothing noteworthy about the

teeth, but he appears to have been the first to affirm that the teeth

are more firmly fixed in the alveolus, when their roots are curved

after the manner of hooks.[351]

DIEMERBROEK, a Dutchman, relates several cases of dental anomalies,

as for example, of teeth being cut in the palate, and which injured

the tongue. The author cites his own case, relating that having

had a canine tooth extracted when well advanced in years, it was,

nevertheless, succeeded by a new one. He relates, besides, that he

had seen in Utrecht a woman, aged fifty-six years, who again cut two

incisors after having lost the former ones two years previously. Apart

from this, Diemerbroeck tells us nothing of interest or importance

regarding the teeth, often repeating old ideas, the falseness of which

had already been luminously demonstrated. For instance, he says that

the permanent teeth are developed from the roots of the deciduous ones

remaining in the alveoli; an unpardonable error for an anatomist of

the seventeenth century, for which he was afterward taken to task by

Duverney.[352]

THOMAS BARTHOLIN, whom we have already mentioned, speaks of a tooth

which had made all the round of the alveolar border; that is to say,

of a dental arch constituted by a single piece; and the Italian

anatomist BERNARDO GENGA makes mention of an analogous case.[353] It is

superfluous to add that these authors allowed themselves to be deceived

by false appearances, owing especially to an abundant and uniform

deposit of tartar on the surface of the teeth and in their interstices,

which gave to the dental arch the appearance of one continuous piece.

RINALDUS FREDERICUS, in his erudite dissertation entitled _De dentium

statu naturali et præternaturali_, spoke of the dental system with

sufficient thoroughness, if we consider the epoch in which he wrote. He

commences his work with a long chapter on the importance and dignity

of the teeth (_dignitas dentium_). Among other things, he relates that

formerly, in certain parts of India, the teeth were so highly valued as

to be offered in sacrifice to the gods. He says, too, on the authority

of certain authors, that the ancients were led to believe that the

teeth served for the resurrection of the body, from the circumstance of

their not showing signs of corruption when found in sarcophagi.

Discoursing of the genesis of the teeth, Fredericus says that “every

tooth is at first enclosed within a follicle, that is, in a frail,

skin-like membrane, in the same manner as the grain in the wheat-ear.”

Taking this comparison as his point of departure,[354] he gives to

dentition the name _germination_.

This author says that the teeth of the Ethiopians and of the Indians

are generally whiter than those of the northern peoples, but that those

of the Indians soon lose their primitive whiteness by reason of the

widely diffused habit of chewing betel-nuts.

Fredericus refers to an experiment which, according to him,

demonstrates the “sympathetic relations” between the teeth and the ear

(whilst in reality it only proves the facility with which sounds may be

transmitted through solid bodies). “If, by night,” says he, “one holds

tightly between one’s teeth the end of a stick, stuck upright in the

ground, one hears the footsteps of a person approaching from afar much

more easily.”

Through the researches of three great men, Marcello Malpighi, Friedrich

Ruysch, and Antoni van Leeuwenhoeck, an altogether new science arose

in the seventeenth century, viz., histology, or the anatomy of the

tissues, whose revelations contributed not a little to the development

of modern odontology.

MARCELLO MALPIGHI (1628 to 1694), the celebrated Italian anatomist,

was the initiator of microscopic observations on the tissues, and is,

therefore, justly considered the founder of histology, within the range

of which he made most important discoveries.[355]

FRIEDERICH RUYSCH (1638 to 1731), professor at Amsterdam, rendered

his name illustrious particularly by bringing to a high degree

of perfection the processes of anatomical preparations and of

embalming.[356]

His magnificent injections, carried out with a method of his own

invention, enabled him to trace the most minute vascular ramifications

and to demonstrate the existence of capillary vessels in parts where

their presence had as yet never been suspected.

Ruysch studied accurately the anatomical constitution of the teeth, and

especially their vessels. He called attention to the membrane which

lines the maxillary sinus, and discovered in it a number of bloodvessels.

But in addition to his purely anatomical observations, this author

also merits our consideration from the point of view of pathology. He

confirmed a most important fact to which allusion had already been made

by preceding authors, that is, the atrophy of the alveolar parietes as

following on the extraction or on the falling out of teeth. Ruysch,

however, makes the observation that atrophy of the alveolar parietes

may also precede the falling out of the teeth, and rather be the cause

than an effect of it. In such cases the teeth, before falling out,

always become more and more loosened, proportionately to the atrophic

process. This pathological condition, against which none of the

astringent remedies habitually used are of avail, is mostly considered,

says Ruysch, to be owing to scurvy; but, he adds, the accumulation

of tartar may also be the cause of it. Substantially, Ruysch affirms

the relation existing between the accumulations of tartar and the

production of that very frequent disease that was afterward named

expulsive periodontitis or alveolar pyorrhea.

This author also relates two cases of polypous affection of the

maxillary sinus. In one of these cases, the existence of a polypus in

the maxillary sinus was determined by Ruysch while dissecting a corpse.

The other case relates to a female patient upon whom two surgeons had

performed the extraction of several molar teeth and the extirpation of

an epulis believed by them to be of a malignant character. After the

operation they cauterized the diseased part to a great depth with a

red-hot iron, reaching as far as the maxillary sinus, which remained

open, and from which Ruysch afterward extracted with his little finger

several polypi.[357]

ANTONI VAN LEEUWENHOEK (1632 to 1723), like the preceding author, a

Dutchman, was the first maker of powerful microscopes, by means of

which he made many important discoveries; among others, that of the

tubular structure of the dentine or tooth bone. This discovery he made

known and demonstrated in the year 1678, before the Royal Society in

London. In his description of the structure of the teeth, Leeuwenhoek

says that 600 to 700 of the dentinal tubuli have hardly the consistence

of one hair of a beard.[358]

In the year 1683 he discovered in the tartar scraped from between

the teeth a form of microörganism upon which he laid special stress.

This observation he embodied in the form of a contribution which was

presented to the Royal Society of London on September 14, 1683. This

paper is of particular importance, not only because of the careful,

objective nature of the description given of the bodies seen by him,

but also for the illustrations which accompany it. From a perusal of

the text and an inspection of the plates, there remains little room for

doubt that the bodies described by Leeuwenhoek were not animalcules, as

he believed, but bacteria.[359]

DOMENICO GAGLIARDI, professor of anatomy and of medicine at Rome,

published an excellent work on the anatomy of the bones,[360] in which

he occupies himself not only with the structure of bones, properly

so called, but also with that of the teeth. He considers the enamel

to be formed by parallel and contiguous fibers, coated, so to speak,

by a concreted juice, _sui generis_, which acquires a much greater

consistence than that of the bones. Gagliardi says that by rubbing

teeth hard together, or striking them with a steel, he was able to

extract sparks from them.[361]

JEAN DUVERNEY (1648 to 1730), a celebrated French anatomist, wrote

a good monograph[362] about the teeth. As different anatomists of

the sixteenth century had already done, he examined many fetal jaws

in order to study in them the formation of the teeth. In relating

his observations, he says that he found in every alveolus a mass of

soft viscous matter, having the form of the tooth that is to derive

from it, and which may be considered as its nucleus. This nucleus

is entirely surrounded by a membrane, which the author likens to

that which surrounds the fetus, and to which he gives the name of

_choroid membrane_. From the surface of the nucleus a gelatinous juice

transpires, which, thickening in layers, forms the enamel and the rest

of the tooth. The choroid membrane is abundantly furnished with nerves,

and with blood and lymph vessels. Into the interior of the teeth

penetrate vascular and nervous branches which serve to maintain its

vitality. In fetal jaws one finds, besides the germs of the deciduous

teeth, also those of the permanent ones. The “choroid membrane” does

not follow the tooth when it issues from the alveolus; it remains

instead within the latter, forming the peridental membrane.

Duverney says that in old people the root cavity diminishes in so

considerable a manner, and the vessels are so compressed that they

almost entirely disappear. It is then that a period of decadence begins

in the tooth, it is more feebly nourished, wears away more rapidly than

hitherto, and becomes shorter.

The author also speaks of senile atrophy of the jaws, especially of the

alveolar processes. With regard to this, he observes that if in old age

the lower jaw advances beyond the upper, this depends wholly on the

disappearance of the alveolar border, which projected more in the upper

than in the lower one.

Duverney admits the existence of direct vascular relation between the

gums and the teeth; because in the case of diseases of the gums it is

rare not to find the teeth altered as well.

From the point of view of the development and nutrition of the teeth,

Duverney finds much analogy between the tusks of the elephant, the

teeth, properly so called, the feathers of birds, and the hair of

mammifera.[363]

GOTTFRIED BIDLOO, a Dutch anatomist, expresses the idea that the air

contributes, after the eruption of the teeth, to hardening them. He did

not, however, give any proof of this opinion of his.[364]

CLOPTON HAVERS, an Englishman, wrote a book on osteology, by which he

acquired great reputation,[365] and in which he treats as well of teeth

and their structure. This author believes the enamel of the teeth to be

of the nature of stone, and the ivory of the nature of bone. The dental

roots, which, he says, are precisely of a bony nature, are covered over

with a periosteum, which is in close relation with the gums and with

the periosteum of the jaw bone. Clopton Havers held that the dental

follicle no longer furnishes any nourishment to the enamel from the

moment that this has reached its perfect formation. On the other hand,

he assures his readers that he has observed, through the microscope,

nervous threads which, departing from the bulb of the tooth, traverse

the ivory through small canals, arriving thus at the periosteum. By

this anatomical disposition the sensibility of the teeth may, according

to him, be explained.[366]

Having made this passing allusion to the anatomy of the teeth in the

seventeenth century, we will now resume the illustration of those facts

relating to the pathological and curative part of the science.

WALTER HARRIS, an Englishman, in a pamphlet on acute infantile

maladies,[367] recommends again, in cases of difficult dentition, the

incision of the gums, a curative practice which had already fallen into

disuse.[368]

In the authors of that time we find registered a great number of cases

of epulis. HIOB VAN MEEKREN speaks of an enormous tumor of the gum that

developed in consequence of a traumatic action which had occasioned

the loss of a tooth. Before deciding on the extirpation of the tumor,

the author thought well to pierce it with a bistoury, to be able to

judge whether its ablation might not possibly give rise to a dangerous

hemorrhage. The wound having bled but little, he proceeded to operate;

but the tumor was so large that it was necessary to remove it in

various portions.[369]

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

that developed after a badly performed dental extraction. It was to

be foreseen that the ablation of such a tumor would give rise to an

abundant hemorrhage. This was, however, staunched by simply using

astringent powders, without having recourse to the actual cautery,

which the operator had held in readiness.[370]

DANIEL MAJOR, wishing to remove a large epulis by tying it, was

obliged, in order to keep the ligature in position, to pass the thread

through a circular incision made at the base of the tumor. He first

used a thread of silk, afterward a silver one, and tightened the

ligature every day until the epulis fell off.[371]

JOHANN ACOLUTHUS was obliged, in order to extirpate a large epulis,

to previously split the labial commissure. After the ablation of the

principal mass of the tumor, he destroyed the remaining part of it by

application of the red-hot iron.[372]

One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin,

Preuss, Bern, Valentini, etc. This last author even speaks of an

epidemic of epulis. However this may be, it is very probable that

epulis was much more frequent in past times than it is now, and this

probably depended partly on the incongruous modes of treating diseases

of the mouth, and partly on the slight attention paid to cleanliness of

the teeth.

KORNELIS VAN SOOLINGEN, a celebrated Dutch physician and surgeon,

who flourished toward the end of the seventeenth century, speaks

contemptuously of dental operations, and especially of extractions.

He says that such operations ought to be left to charlatans, used to

taking out teeth with the point of the sword, and to doing many other

things of like nature! This unjust contempt was at that time widely

diffused in the medical class, it resulted, however, substantially,

from the great difficulties encountered by doctors and surgeons in

general, in performing the operation of extraction, owing to want of

practice, and also from the desire to avoid the responsibility of the

accidents to which the extraction might give rise; so true is this,

that an author of the preceding century, THEODOR ZWINGER (1538 to

1588), a celebrated Swiss doctor and professor at Basle, had declared

with great frankness that the extracting of teeth ought to be left

to barbers and charlatans, as it might easily occasion unpleasant

accidents, such as fractures of the jaw, laceration of the gums,

serious hemorrhage, and the like.

In spite of his contempt for practical dentistry, Kornelis van

Soolingen takes the treatment of dental affections into attentive

consideration. For the stopping of carious teeth, he recommends a

mixture similar to that which Rhazes had recommended many centuries

before, that is, a cement of mastic and turpentine; because, says he,

when the stopping is made with metallic substances, it is never so

perfect as to entirely impede the penetration of moisture.

Great credit is due to Kornelis for having first brought into usage the

instrument makers’ emery wheels for grinding down sharp edges of teeth,

thus initiating the practice of trepanning the teeth with sphere-shaped

burs.[373]

PAUL WURFBEIN refers to a case of extensive necrosis of the lower jaw,

in which a certain Dr. Bürlin having removed the necrotic portion,

regeneration of the bone took place.

FRIEDERICH DEKKERS (1648 to 1730) refers a similar case, in which,

although quite one-half of the lower jaw had been removed, the bone

formed again completely.[374]

BENJAMIN MARTIN, apothecary to the Prince de Condé, was the author of

a pamphlet on the teeth,[375] in which he gave a succinct description

of these organs and spoke briefly of their diseases. He shows himself

decidedly opposed to the use of the file and to the application of

false teeth, because, according to him, both of these things may be

the cause of great harm. With regard to the file, he says that nothing

so easily tends to loosen the teeth as the use of this instrument, not

to speak of various other inconveniences, among which is the danger of

opening the interior cavity of the tooth.[376]

MATTHIAS GOTTFRIED PURMANN (1648 to 1721), a celebrated surgeon of

Breslau, was the first to make mention of models in dental prosthesis.

As to the mode in which these models were obtained, some admit as

natural that he first took a cast, and formed the model on this; but as

Purmann does not hint in the least at such a process, the supposition

is altogether gratuitous. Indeed, his description rather excludes any

probability that the model was taken from a cast. Here is the literal

translation, as nearly as possible, of the passage in which Purmann

speaks of artificial teeth and of the mode of applying them.

“The front teeth, or pronouncing teeth, ought, when they are wanting,

to be substituted by artificial ones, in order to avoid defects of

pronunciation, as well as to obviate deformity of the mouth, and this

is carried out in the following manner: One has other teeth made

of bone, or of ivory, according to the number, the size, and the

proportions of those wanting; for which purpose one may previously have

a model executed in wax, reproducing the particular conditions of the

teeth and jaws, in order afterward to make and exactly adjust the whole

on the pattern of it; then, when the base of these teeth is well fitted

on the jaw and small holes have been made in the artificial teeth and

also in the natural ones next to them, one applies the artificial teeth

in the existing void and fixes them as neatly as possible with a silver

wire by the help of pincers.”[377]

It would appear that the author is here describing a prosthetic method,

which he had never practised himself; and this results from the fact

of his advising the perforation of the natural teeth for the passage

of the silver wire destined to keep the prosthetic piece in its place.

Evidently desiring to describe the mode practised by the specialists of

those days for fixing artificial teeth, he erroneously imagines that

the metal thread was passed through the holes drilled in the natural

teeth; this would have been impossible, first, because of the atrocious

pain due to the sensibility of the dentine and of the dental pulp, and

then because of the pathological consequences to which the perforation

of the teeth would have given rise. We may, therefore, surely hold that

Purmann is simply describing, and not even accurately, a prosthetic

method already in use among the specialists of that period.

On examination of the passage cited above—which, however, is not so

clear as might be desired—it would appear that the models of which the

author speaks were most probably quite different from those in use now.

It is almost certain that the specialists of those days first made a

sketch of the prosthetic part to be constructed, using for the purpose

a piece of wax which they partly modelled with the hand and partly

carved; and after having tried on this model until it fitted perfectly

in the mouth, and was in every way satisfactory, they probably passed

it on to a craftsman to make an exact reproduction of it in bone or

ivory.

In the year 1632 a little book was published in Naples, having for its

title, _Nuova et utilissima prattica di tutto quello ch’al diligente

Barbiero s’appartiene; composta per Cintio d’Amato_.[378] This pamphlet

was reprinted in Venice in 1669, and again in Naples in 1671. We here

make mention of it, not for any special importance which it really has

as regards the development of the dental art, but because of its being

most probably _the first book in the Italian language in which dental

matters are spoken of independently of general medicine and surgery_.

TOMMASO ANTONIO RICCIO. The edition of 1671 was published under the

supervision of Tommaso Antonio Riccio, who was for many years a

disciple of Cintio d’Amato, and who greatly eulogizes his master and

praises his work. He expresses himself in the following bombastic

manner: “This book, the offspring of Master Cintio d’Amato, excellent

in the Barber’s Art, ought to find a place in the bosom of Eternity;

because by reason of its having been twice given to the light, it has

proved its worthiness to live forever in the memory of men, gaining

for itself, by its excellence, immortal glory before all such as are

practised in the Art.”

The book—which consists of about one hundred and eighty pages, and

is illustrated by several admirable engravings—contains, among other

things, two pages of verses, written by various authors, viz., by

Cintio d’Amato himself, by Giovan Battista Bergazzano, also a barber,

and by others. The greater part of these verses are in praise of the

two doctors and _Martyrs in Christ, Cosmos and Damianus, special

protectors of the Art and of the author_.

The verses of Cintio d’Amato reveal the possession of a literary and

poetic culture above the ordinary, in spite of his being only a master

barber. As to his book, it may be considered, for the time in which it

was written, as an excellent treatise on so-called minor surgery. The

author expounds, in a few chapters, the anatomical notions relating to

bleeding; speaks at great length of this operation and of everything

concerning it; refers with much detail to all pertaining to the use of

leeches, cupping, scarification, cauteries, issues, blistering, primary

treatment of the wounded, nursing of the sick, etc.; at the end of the

book there is also a long chapter on the embalming of corpses.

As regards the treatment of the teeth and gums the author dedicates

six chapters thereto, entitled, respectively: “On the relaxation of

the gums” (Chapter XXXVII); “Preparation for strengthening the gums

and making the teeth firm” (Chapter XXXVIII); “On tartar and spots on

the teeth” (Chapter XXXIX); “Another preparation for whitening and

preserving the teeth” (Chapter XL); “Mode of burning hart’s horn, very

necessary in preparations for the teeth” (Chapter XLVII); “‘Water of

salt,’ which makes the teeth white and is also good for ulcers of the

gums” (Chapter XLIX).

Evidently Cintio d’Amato treats of dental matters only within extremely

restricted limits. He tells us nothing with regard to the treatment of

toothache, nothing about caries, about prosthesis, and, what is still

more remarkable, he does not allude even in passing to the extraction

of teeth. Now, if in a book treating _of all that which appertains to

the diligent barber_, the most important dental subjects are passed

over in silence, this shows that, contrary to the generally diffused

opinion of today, the dental art was not at that time (at least not in

Italy) exclusively, or even in great part, in the hands of the barber.

Even at that time there must have been dental specialists, and the

proof of this may be found in d’Amato’s book itself, in the chapter

entitled “Necessity and Origin of the Barber’s Art.”[379] The author,

after having spoken of the divisions which the practice of the medical

art had undergone from the most remote times, and after having alluded

to the great number of parts into which Medicine was divided in the

time of Galen, adds: “Which may also be seen in our own times, for as

many as are the members of the human body, so many are nowadays the

various kinds of doctors and of medicines. Some are for the teeth,

some are for the ears, some for sexual maladies, others are ordinary

doctors, others cure cataracts, others ruptures and stone, some make

new ears, lips, noses, and others remedy harelips.”

As, under the generic name of doctors, Cintio d’Amato also comprises

surgeons, it results from the above passage that in his time, that

is, in the seventeenth century, there were surgeons who dedicated

themselves specially to the treatment of the teeth; there were, in

fact, dentists; and even admitting that the greater number of these

were no better than simple tooth-pullers, this cannot be true of

them all indiscriminately. Cintio d’Amato’s book demonstrates in the

most vivid manner that even among the barber and phlebotomist class,

that is, among the practitioners of minor surgery, there were, at

that time, men of considerable culture. This ought to hold good with

still greater reason concerning surgeons, whose professional level

was certainly superior to that of barbers;[380] and as dentists

belonged to the class of surgeons (whence the denomination still in

use of “surgeon-dentist”), it is but natural to admit that besides

the ignorant tooth-puller there were even then more or less cultured

dentists well capable of treating dental diseases and performing dental

operations within the limits permitted by the knowledge of the times.

The six chapters in which Cintio d’Amato speaks of matters referring

to the teeth do not contain anything whatever of real importance;

notwithstanding this, we will here refer to the beginning of Chapter

XXXIX, treating “Of tartar and spots on the teeth,” because it is of

some historical interest:

[Illustration: A TOOTH-PULLER AT A PUBLIC PLACE IN HOLLAND