dentition, and taking out the teeth, which were already strong and well
formed, but not yet deteriorated by mastication. I fancy my Etruscan
colleague must have done the same three thousand years ago, when he
carried out the prosthesis in question, for the large tooth employed by
him does not show any signs of being worn by mastication.

This large tooth is solidly fixed by means of two pivots to the gold
band that encircles it. Another pivot served to fix the second
bicuspid, also artificial. This tooth, as already stated, has now
disappeared, but the pivot that fixed it to its ring is still in its
place. In carrying out this prosthesis the dentist has contrived the
series of rings that support the teeth in such a manner that they
remained above the gum, and thus the harmful effects of contact and of
the pressure of an extraneous body was avoided. At the same time, this
arrangement, by distancing the rings from the dental neck that narrows
off conically, added to the firmness of the prosthesis.

[Illustration: FIG. 18

Etruscan appliance for supporting two inserted human teeth, one of
which is now wanting. (Civic Museum of Corneto.)]

Another dental appliance (Fig. 18) which is in the custody of the Civic
Museum of Corneto, was also found in a very old Etruscan tomb. It is
formed by two bands of rolled gold; one of these is labial, the other
lingual, and they are soldered together at their extremities, forming
by the help of four partitions, also of gold, five square spaces. Three
of these served for the reception of the natural teeth supporting
the prosthesis; the other two maintained, by means of pivots, two
inserted human teeth; one of these is lost; the other is still in
its place, solidly fixed by its pivot. These inserted human teeth,
by the religious laws we have before mentioned, could not have been
taken from corpses; probably they belonged to the person himself, and
having fallen out through alveolitis, had been reapplied in the manner
described above.

[Illustration: FIG. 19

Etruscan appliance supporting one inserted tooth (upper middle incisor
on the right) which is now disappeared. (Museum of the Conte Bruschi at
Corneto.)]

Two Etruscan dental appliances are to be found in the Museum of the
Conte Bruschi at Corneto: one is similar to those already described,
and the other, instead, is of a special kind. The first (Fig. 19) is
formed by a series of four rings, embracing the upper canine on the
right and the three neighboring incisors. It was destined to support
a single inserted tooth, the middle incisor on the right; this has
disappeared, while the pivot by which it was fixed to the ring is still
there, as well as the three natural teeth that afforded support to the
appliance.

[Illustration: FIG. 20

Etruscan appliance intended to avoid the bad effects of convergence,
or, perhaps, to support a purely ornamental artificial substitute.
(Museum of Conte Bruschi at Corneto.)]

The other appliance (Fig. 20) is formed by two rings; the one surrounds
the left upper canine, the other the left middle incisor. Between these
two rings there is not the usual ring crossed by a pivot, but simply
a small horizontal bar of gold soldered to the two rings. I suppose
that the person not liking to wear false teeth (one meets with this
repugnance also at the present day), the dentist has limited himself to
putting a horizontal bar of gold between the two teeth on either side
of the missing one, in order to maintain them in their normal position
and so avoid the bad effects of convergence.

[Illustration: FIG. 21

Dental appliance still adhering to the jaw, discovered in an Etruscan
necropolis near Orvieto, and now in the possession of the Ghent
University.]

Another ancient dental appliance discovered in an Etruscan necropolis
near Orvieto is now in the possession of the Ghent University, to
which it was sold.[107] It still adheres to a piece of upper jaw (Fig.
21), in which there are four teeth on each side, that is, on the right,
the canine, the two bicuspids, and the first molar; on the left, the
canine, the second bicuspid, and the two first molars. The alveoli of
the four incisors are of normal width and depth, this signifying that
these teeth remained in their places until the end of life. The dental
appliance, still supported by this fragment of a jaw, is made of the
purest gold. It is composed of a small band curved back upon itself,
the ends being soldered together, and, by the aid of two partitions,
also of pure gold, it forms three compartments, two small lateral
ones, and one centre one of double the size. The lateral compartment
on the right contains the canine of the same side; that on the left
must have contained the left central incisor, that has now disappeared,
while the large central compartment must evidently have contained the
two incisors on the right side. As there is no pivot in the whole
appliance, and as the alveoli are not obliterated, there can be no
doubt that the appliance was simply destined to prevent the loss of the
two right incisors by keeping them steady.

[Illustration: FIG. 22

The same piece as in the preceding figure, seen from the palatal side.]

It is to be noted, with regard to the Etruscan dental appliances above
described, that the gold bands of which they were constructed covered
a considerable part of the dental crown, so that these prosthetic
appliances certainly could not have had the pretension of escaping
the notice of others, they being, on the contrary, most visible. It
is in consequence to be surmised that in those times the wearing of
false teeth and other kinds of dental appliance was not a thing to be
ashamed of; indeed, that it rather constituted a luxury, a sort of
refinement only accessible to persons of means. Besides this, as the
gold in which these works were carried out was of the purest quality
and in consequence very soft, the appliances would not have possessed
sufficient solidity if the softness of the pure gold had not been
counteracted by the width and thickness of the bands or strips.

[Illustration: FIG. 23

Etruscan appliance (found in 1865 in a tomb by Cervetri), destined
perhaps to support a purely ornamental artificial substitute.
(Belonging to Castellani’s collection, Rome.)]

[Illustration: FIG. 24

A reproduction of the gold piece forming the appliance seen in Fig. 23.]

In those of the Etruscan appliances destined for the application of
inserted teeth, the gum was not made to support the prosthesis, and did
not, therefore, suffer any compression from the extraneous body, this
resting entirely, like a bridge, upon the neighboring teeth. From which
it may be seen that twenty-five centuries and more before our time the
Etruscans dentists already practised a system of bridge work, and,
relatively to the age, carried it out with sufficient ability.

CHAPTER VII.

THE ROMANS.

For many centuries the Romans, according to the saying of Pliny,
lived entirely “without doctors, although not without medicine;”[108]
that is, there existed without doubt a popular medicine and also a
sacerdotal medicine, but still there were no persons whose exclusive
occupation it was to cure disease.

The medical art, properly so called, was introduced into Rome by the
Greeks. The first Greek doctor who went to Rome was Archagathus (in the
year 535 after the foundation of the city, that is, 218 years before
Christ). His arrival was at first welcomed, so much so that he was made
a Roman citizen and a shop bought for him in the Acilian square, at the
expense of the State. However, his popularity was of brief duration.
Being an intrepid operator, the use and abuse he made of steel and fire
gained for him the not very honorable qualification of the butcher, and
he soon became the horror of all the population.

But it appears that dentistry had begun to be practised in Rome
prior to the coming of Archagathus, that is, long before the medical
profession existed. We have the clear proof of this in the Law of the
Twelve Tables, wherein we find mention made of teeth bound with gold.
The Law of the Twelve Tables was written in Rome 450 years before
Christ, by a body of ten magistrates (_decemviri_) expressly named for
that purpose, as up to that time no written law had existed.

As gold was at that time somewhat scarce, and fears were entertained
that it would become still scarcer (to the great damage of the State)
by reason of the custom that prevailed among the wealthy of burning
or burying gold articles with the corpses to honor the memory of the
deceased, or, rather, to satisfy the pride of the survivors, it was
thought necessary to prohibit this abuse by a special disposition
of the law referring to funeral pomps. This disposition was thus
formulated: “_Neve aurum addito, ast quoi auro dentes iuncti escunt
(sunt) im cum illo sepelirei vrive sine fraude esto_;”[109] that is,
“Neither shall gold be added thereto (to the corpse); but it shall not
be unlawful to bury or to burn it with the gold with which the teeth
may perchance be bound together.”

From this it results that at the time when the Law of the Twelve Tables
was written, that is, four centuries and a half before the Christian
era, there were already individuals in Rome who practised dental
operations. And these individuals cannot have been medical men, as at
that epoch (corresponding pretty nearly with the date of Hippocrates’
birth) Rome had as yet no doctors.

The inquiry naturally suggests itself whether the gold mentioned in the
legal dispositions above cited was used for fixing artificial teeth or
simply for strengthening unsteady natural teeth. Some authors, Serre
among them,[110] have pronounced in favor of the first hypothesis,
others, as, for example, Geist-Jacobi,[111] are rather disposed to
accept the second. In truth, however, we do not possess sufficient
historical data to definitely resolve this problem. I myself am rather
of opinion that artificial teeth were already in use in Rome, as they
were, even before this time, among the Etruscans. Indeed, if we take
into consideration the priority of the Etruscan civilization to the
Roman and the relations of vicinity existing between Etruria and the
Roman State, of which it afterward became a part, it is even possible
that dental prosthesis was first practised in Rome by Etruscans.

In a Greek-Roman necropolis near Teano (Province of Caserta, Italy)
there was found in February, 1907, a prosthetic piece of a very
peculiar construction, and which may be considered as quite unique in
its kind. It is an appliance destined to support three inserted human
teeth (the two lower central incisors and the lateral incisor on the
right). These teeth—lost perhaps by the patient himself, in consequence
of alveolar pyorrhea—were fixed by means of a system of rings, made of
laminated gold wire, turned around the teeth and then soldered.

By the examination of the piece it is easy to argue that the author of
this prosthesis made at first three separate rings by tightly turning
the laminated gold wire around each of the three teeth to be applied,
and by soldering together the ends of the wire forming each ring, after
having taken away the tooth, in order not to spoil it in making the
soldering. Then, with another laminated gold wire of sufficient length,
he soldered the three rings together in due position, put the appliance
in the mouth and turned the two ends of the wire around the sound
teeth, serving as a support for the lateral incisor on the left and
the two canines. After this, he took the apparatus delicately out of
the mouth, made the soldering necessary for finishing the skeleton of
the apparatus, forcibly put the three teeth in their respective rings
again, and applied the prosthesis.

This ingenious appliance was found still adherent to the mandible of a
skeleton, in a tomb which, according to the eminent archæologist Dalli
Osso, belongs to a period comprised between the third and the fourth
century before Christ.

From the nature of the objects found in the tomb near the skeleton (a
necklace, perfume vessels, etc.) it was quite evident that the skeleton
bearing the above-described prosthesis was that of a woman.

As the said appliance was found in South Italy (the ancient “Magna
Græcia”) it is quite probable that it was made by some dentist of the
Greek colonies.

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

[Illustration: FIG. 25

Seen from behind.

FIG. 26

Seen from above.

A prosthetic piece of very peculiar construction (see description),
found in 1907 near Teano, Italy.]

The Romans, as well as the Hebrews, and other peoples of antiquity,
attributed great importance to the integrity of the dental system. This
may be deduced with certainty from another article in the Law of the
Twelve Tables (Table VII, at the rubric _De delictis_), which says:
“_Qui dentem ex gingiva excusserit libero homini, trecentis assibus
multator, qui servo C L._” (Whoever shall cause the tooth of a free man
to fall shall pay a fine of three hundred _as_, and for that of a slave
one hundred and fifty.) The _as_ was worth about ten cents American
money, so that the first fine amounted to about thirty dollars and the
second to about fifteen dollars. These sums, because of the difference
in the monetary value in those times, were considered heavy fines.

After the Romans had conquered Greece (146 B.C.) a very great number
of Greek doctors went to Rome. The wealth, luxury, and ever-increasing
corruption of the metropolis caused the practice of the medical art
(which was almost entirely in the hands of the Greeks) to become a
great source of lucre. But an art practised with the sole purpose
of making money soon degenerates to the level of a trade; it is,
therefore, hardly to be wondered at if very few doctors of that epoch
have merited being recorded in history.

Among these few, the name Asclepiades (born at Prusa, in Asia Minor;
died in Rome ninety-six years B.C.) shines with particular lustre. He
was the founder of the “methodic school,” whose curative precepts,
largely based upon hygiene, come nearer to those of modern scientific
medicine. Unfortunately, all the writings of this great physician,
whose name is almost as glorious as that of Hippocrates, have been
lost; we do not know, therefore, whether and in how far he contributed
to the development of our specialty.

But one of the first places in the history of dental art is due without
doubt to Cornelius Celsus, of whom we will now speak.

CORNELIUS CELSUS. The historical researches in regard to the life of
this celebrated author have given but meagre results. It is uncertain
whether his birthplace was Rome or Verona. The precise dates of his
birth and death are also unknown; but it is very probable that he was
born about thirty years before Christ, and that he died during the
fifth decade of the first century.

Aulus Cornelius Celsus belonged to the illustrious patrician family of
the Cornelii. He was a man of great erudition, and wrote on the most
varied subjects, and among others, on agriculture, on rhetoric, on the
art of warfare, on medicine, etc. All these writings, however, are lost
to us excepting his excellent treatise on medicine.

Some historians consider that Celsus was a true doctor by profession;
others, instead, hold that he never undertook the cure of the sick.
Neither the one nor the other of these opinions is quite acceptable;
and it is much more likely, as Daremberg observes in his valuable
_Histoire des Sciences Médicales_, that Celsus was one of those
philiatri mentioned by Galen, who had studied medicine rather from
books than at the bedside of the sick, but who, although not doctors by
profession, in case of necessity, put their knowledge and skill into
practice on behalf of their relations and friends.[112]

The work of Celsus, gathered in great part from Greek authors, has an
especial value, because it sums up, in an admirable manner, the whole
of the medical and surgical science of the ancients, from the earliest
times up to the days of Augustus.

The first book of the work _De Medicina_[113] does not contain anything
of great importance in regard to dentistry. The following hygienic
precept is, however, worthy of note: “After rising, if it be not
winter, the mouth should be rinsed with a quantity of fresh water.”
In regard to the hygiene of the mouth, nothing more is found in the
work of Celsus; and it is also necessary to note that the aforesaid
precept forms part of a chapter, in which he speaks of the rules of
life, which must be observed by weak people, to which class—the author
remarks—belong a greater part of the inhabitants of cities and almost
all literary men. According to Celsus, therefore, perfectly healthy
and strong people would not even need to wash their mouths with fresh
water, and perhaps the keen-witted Roman doctor was not wrong; for it
is very probable that the saliva and mucous secretion of the mouth,
in perfectly healthy individuals with normal constitutions, have the
power of combating the pathogenic germs that produce caries and other
diseases of the teeth and mouth. In this way the fact can be explained
of many peasants and the greater part of the individuals of the negro
race having such good teeth, without possessing even the remotest idea
of what hygiene of the mouth may be. And here I venture to refer to a
passage in which Celsus alludes to the relation between diseases and
civilization with its vices: “It is probable that in ancient times,
although there was but little knowledge of medicine, health was for
the most part well preserved; this being due to good habits, not yet
spoiled by intemperance and idleness. These two vices, first in Greece
and then among us, have brought upon us a very host of evils; whence it
is that in our days, in spite of the intricate art of medicine—once not
necessary to us, as it is not necessary to other peoples—few among us
attain the beginning of old age.”[114]

In the second book, speaking of the various kinds of disease to which
the different periods of life are subject, he writes: “Children are
especially subject to serpiginous ulcers of the mouth, called by the
Greeks aphthæ.... There are also infirmities due to dentition, such as
ulceration of the gums, convulsions, fever, looseness of the bowels;
and it is especially the eruption of the canine teeth which produces
these disturbances. To these, however, very fat children are more
particularly liable, and those, also, who have costive bowels.”

In Chapter XXV of the fifth book we find the receipt for a narcotic
drug, recommended by the author for producing sleep in persons
tormented with odontalgic and other pains. This receipt is very
complicated, being composed of ten ingredients, among which are acorns,
castoreum, cinnamon, poppy, mandrake, and pepper.

Most important for our subject is Chapter IX, of the sixth book, where
the author treats of odontalgia. “In toothache, which may be numbered
among the worst of tortures, the patient,” says Celsus, “must abstain
entirely from wine, and at first, even from food; afterward, he may
partake of soft food, but very sparingly, so as not to irritate the
teeth by mastication. Meanwhile by means of a sponge he must let the
steam of hot water reach the affected part, and apply externally,
on the side corresponding with the pain, a cerate of cypress or of
iris, upon which he must then place some wool and keep the head well
covered up. But when the pain is violent, the use of purgatives is
very beneficial, the application of hot cataplasms on the cheek, and
the keeping in the mouth of some hot liquid, prepared with fitting
medicine, changing this liquid, however, very frequently. For this
purpose the root of cinquefoil may be boiled in wine, or that of
hyoscyamus (henbane), or a poppy-head, seedless and not too dry, or
the root of the mandrake. But in regard to the last three remedies,
one must be careful not to swallow the decoction whilst it is kept
in the mouth. For the same purpose one may boil the bark of the root
of the white poplar in wine, or the scrapings off a stag’s horn in
vinegar or figs in mulse[115] or in vinegar and honey. It is useful
also to pass repeatedly around the tooth the end of a probe which has
first been wrapped around with wool and then dipped in hot oil. It is
customary also to apply around the tooth certain remedies, after the
manner of plasters. For this purpose the inside of the peel of dried,
bitter pomegranates may be pounded with equal quantities of gall-nut
and pine bark; to these must be added a little minium[116] and the
whole mixed together with the addition of rain water to form a paste;
or else a similar paste may be formed with equal parts of panax,[117]
poppy, peucedanum,[118] and taminia grape[119] without stones; or with
three parts of galbanum to one of poppy. On the cheek, however, must be
applied at the same time the cerate spoken of above, covered over with
wool.”

Celsus then speaks of a revulsive adopted, in his times, against
odontalgia. It was composed of myrrh and cardamom, _ana_ one part;
saffron, pyrethrum, figs, pepper, _ana_ four parts; mustard seed,
eight parts. The plaster, spread on linen, was to be applied on the
shoulder corresponding to the side of the pain, and, according as this
was situated in a tooth of the upper or lower jaw, the revulsive was
applied on the back of the shoulder, or in front.

When a tooth is decayed, Celsus advises that there should be no haste
in drawing it; but that the pain be combated, if the above medicines
are not sufficient, with others more energetic. A mixture may, for
example be applied to the tooth, composed of one part of poppy, two
of pepper, and ten of sory,[120] pounded and mixed to a paste with
galbanum; or else, especially in the case of a molar tooth, the remedy
of Menemacus, resulting from saffron, one part; cardamom, soot from
incense, figs, pepper, pyrethrum, _ana_ four parts; mustard seed, eight
parts; or even a more complicated remedy made with pyrethrum, pepper,
and elaterium,[121] _ana_ one part; scissile alum,[122] poppy, taminia
grape, crude sulphur, bitumen, laurel berries, mustard seed, _ana_ two
parts.

“If, says Celsus, the pain renders necessary the removal of the tooth,
this may be made to fall to pieces, by introducing into the cavity a
pepper berry without its skin, or a berry of ivy, pared in the same
way. The same result may be obtained in the following manner: The sharp
bone (aculeus) of that flat fish called by the Greeks trygon and by us
pastinaca, must first be roasted and then reduced to powder and mixed
with resin, so as to form a paste; which applied around the tooth will
make it fall out. Likewise, scissile alum induces the fall of the
tooth, when introduced into its hollow. This substance, however, is
best introduced into the small cavity, after being wrapped around with
a tuft of wool, for thus the pain is soothed and the tooth preserved.”

Somewhat curious is the following passage, in which Celsus speaks of
the superiority of a method of cure used by peasants, compared to the
remedies advised by the doctors. From his words we clearly see that he,
as we have already remarked, did not belong to the class of doctors
properly so called.

“These are the remedies accepted and held in account among the doctors.
But it is known through the experience of peasants, that when a tooth
aches one must pluck up wild mint by the roots, put it into a large
vessel, pour water on it, and make the patient sit near it, covered all
around with a blanket; and red hot stones should then be thrown into
the water, so that they be entirely immersed; and then the patient,
wrapped all around, as we have said before, and keeping his mouth open,
receives into it the steam evaporated from the water. Thus profuse
perspiration is induced, and a great quantity of pituita flows from the
mouth, and with this a cure is obtained for a very long period, often
for more than a year.”

In the six following chapters of the sixth book, Celsus treats of the
diseases which affect the soft parts of the mouth. Against tonsillitis,
he recommends, among other things, the application of a remedy
principally made of the juice of the sweet pomegranate, cooked, by a
slow fire, to the consistency of honey. The same remedy is also of
great value, according to the author, for the cure of ulcers of the
mouth, when they are accompanied by inflammation, and are somewhat
foul and of a reddish color. But under such circumstances it will also
be necessary to keep frequently in the mouth an astringent decoction,
to which a little honey has been added. The exercise of walking is
also profitable, as well as the taking of food that is not acid. When,
however, the ulcers begin to be clean, the mouth should be frequently
filled with a softening liquid or even with simple pure water. It is
also helpful to drink genuine wine and to eat rather freely, avoiding,
however, acid food. The ulcers must be sprinkled with a powder composed
of two parts of scissile alum to three of unripe gall-nuts. If,
however, the ulcers are already covered with a scab similar to those
produced on burns, some of those compositions should be used which are
called by the Greeks _antheræ_; for example, a remedy may be formed
of equal parts of cyperus,[123] myrrh, sandarac, and alum; or another
which contains saffron, myrrh, _ana_ two parts; iris, scissile alum,
sandarac, _ana_ four parts; cyperus, eight parts.

“Much more dangerous, says Celsus, are those ulcers of the mouth which
the Greeks call _aphthæ_; they oftentimes lead to death in children;
in adult men and women, however, there is not the same danger. These
ulcers begin in the gums; then they attack the palate and the whole
of the mouth, and finally extend to the uvula and to the fauces; when
these parts are attacked, it is not very likely that a child will
recover.”

As to the ulcers of the tongue, Celsus says that those which are
situated at the borders of this organ last a very long time, and he
adds: “It should be seen whether there may not be some sharp tooth
opposite, which hinders the ulcer from healing; in case such a tooth
exists, it should have its edge taken off with a file.”

He then passes on to speak of the diseases of the gums: “Often small
painful tumors, called by the Greeks _parulides_, are produced on
the gums. It is necessary at the very first to rub them softly with
powdered salt, or with a mixture of burnt mineral salt, cyperus, and
catmint, meanwhile keeping the mouth open until there flows from it a
good quantity of pituita; after which the mouth must be rinsed with
a decoction of lentils. But if the inflammation is great, the same
remedies must be used as are adopted for the ulcers in the mouth, and
between the tooth and the gum must be inserted a small tent of soft
lint, on which has been smeared some one of those compositions which
we have said are called _antheræ_. If this, owing to the hardness of
the tumor, is not possible, then by means of a sponge the steam of hot
water should be made to act upon the diseased part, and, besides, an
emollient cerate must be applied upon it.

“Should suppuration show itself, it will be necessary to use the
above-mentioned steam for a longer period; to keep in the mouth hot
mulse, in which some figs have been cooked, and to lance the tumor
before it is perfectly ripe, so that the pus may not, by remaining too
long in the diseased part, injure the bone. But if the tumor be of
great size, it will be more advisable to remove it entirely, so that
the tooth remain free on both sides. After the pus has been extracted,
if the wound be a small one, it is sufficient to keep hot water in the
mouth, and to use externally fomentations of steam, as mentioned above;
if it be large, it will be fitting to use the decoction of lentils and
the same remedies with which all other ulcers of the mouth are cured.

“It also happens, sometimes, that from an ulcer of the gums—whether it
follow a parulis or not—one may have for a long period a discharge of
pus, on account of a broken or rotten tooth, or else on account of a
disease of the bone; in this case there very often exists a fistula.
Then the latter must be opened, the tooth extracted, and if any bony
fragment exist, this should be removed; and if there be anything else
diseased, this should be scraped away. Afterward, the same remedies
which have been indicated for the other ulcers of the mouth must be
used.

“If the gums separate from the teeth, it will be useful, in this
case also, to employ those remedies called _antheræ_. But it is also
beneficial to chew unripe pears and apples and to keep their juices in
the mouth. Equal advantage can be derived from keeping vinegar in the
mouth, provided it be not too strong.

“Whenever ulcers of the mouth are attacked by gangrene, it is necessary
first to consider whether the whole body be unhealthy, and in that
case, to do what is necessary to strengthen it. When the gangrenous
ulcer is superficial, the use of _antheræ_ is sufficient; when it is
somewhat deeper, a mixture must be applied on it, of two parts of
burnt paper[124] to one of orpiment;[125] when it is very deep, three
parts of burnt paper to a fourth part of orpiment must be used; or
else, equal parts of roasted salt and roasted iris; or lastly, equal
parts of chalcites, lime, and orpiment. It is, however, necessary to
dip a small pledget of lint in oil of roses, and put it on the caustic
medicinals, so that these may not injure the neighboring healthy parts.
If the disease is in the gums, and some of the teeth are loose, it is
necessary to pull them out, for they greatly hinder the cure. When
this latter, however, cannot be obtained by drugs, the ulcer must be
cauterized with a red-hot iron.”

Chapter XII of the seventh book is, of all the work of Celsus, the
one which presents to us the greatest interest, since there the author
treats of the surgical operations required by the diseases of the
dental apparatus.

He first speaks of the looseness of the teeth, caused by the weakness
of their roots, or by the flaccidity of the gums, and says that in
these cases it is necessary to touch the gums lightly with a red-hot
iron, then to smear them with honey and wash them with mulse, and later
on to strengthen them by means of astringent substances.

“When a tooth aches, and it is thought well to extract it, because
medicaments are of no use, the gum must be detached all around, and
then the tooth must be shaken until it is well loosened, it being very
dangerous to draw a firm tooth, as this may sometimes give rise to a
dislocation of the lower jaw. And greater still is the danger in regard
to the upper teeth, as this might cause a shock to the temples and
eyes. After having well loosened the tooth, it must be pulled out by
the fingers, if this is possible; or if not, with the forceps.”

[Illustration: FIG. 27

Dental and surgical instruments represented in a funeral marble of the
Lateran Museum, Rome.]

It is clear that this method of tooth drawing—so excessively cautious
and timid—must have been very torturing to the poor patients. A
thousand years and more after Celsus, Abulcasis still counsels the same
exaggerated precautions, and says that the extraction of a tooth must
not be performed in a rapid and violent way after the manner of the
barbers. From this one may see that the operation spoken of was then
very often performed by certain unprofessional persons, who, being very
familiar with it, carried it out with great indifference and rapidity,
thus sparing the patients the long-protracted martyrdom which the
erudite doctors, followers of Celsus, thought necessary to make them
endure. Very probably the same happened in the days of the wise Roman
doctor.

When there is a large carious hollow in the tooth to be extracted,
Celsus recommends that it should first be filled up either with lint
or with lead, in order to prevent the tooth from breaking under the
pressure of the instrument. “The latter,” he continues, “must be made
to act in a straight direction, in order to avoid fracture of the bone.
The danger of fracture is still greater in the case of short teeth;
often the forceps, not being able to grasp the tooth well, takes hold
of the bone with it and fractures the latter. When after the extraction
of a tooth much blood flows from the wound, this indicates that some
part of the bone has been broken. It is necessary then to search for
the detached piece of bone with the probe and to extract it with the
forceps. If this be not successful, an incision must be made in the
gums just as large as is necessary for the extraction of the fragment.
When this is not taken out, it often happens that the jaw swells in
such a manner as to prevent the patient from opening his mouth. In such
a case it is necessary to apply to the cheek a hot cataplasm of flour
and figs, so as to induce suppuration, after which the gums must be
lanced and the splinter of bone extracted.”

When the teeth show blackish stains, Celsus advises such stains to
be scraped away, and the teeth afterward to be rubbed with a mixture
of pounded rose leaves, gall-nuts, and myrrh, and the mouth to be
frequently washed with pure wine. It is necessary besides, says the
author, to keep the head well covered, to walk a great deal, and to
partake of no acid food.

“If by effect of a blow or other accident some of the teeth become
loose, it is necessary to bind them with gold wire to the neighboring
firm teeth, and besides to keep in the mouth astringent substances, for
example, wine in which the rind of pomegranates has been boiled, or
into which some burning hot gall-nuts have been thrown.”

“When in a child a permanent tooth appears before the fall of the milk
tooth, it is necessary to dissect the gum all around the latter and
extract it; the other tooth must then be pushed with the finger, day by
day, toward the place that was occupied by the one extracted; and this
is to be done until it has firmly reached its right position.”

“Now and again it happens that when a tooth is pulled out its root
remains in the socket; it is then necessary to extract it at once, with
the forceps adapted for the purpose, called by the Greeks _rizagra_.”

The last book of the work of Celsus treats chiefly of fractures and
dislocations. In the first chapter the position and form of the bones
of the whole human body are described, although not very exactly.
Speaking of the teeth, the author says: “The teeth are harder than the
bones, and are fixed, some on the _maxilla_ (lower jaw) and some on the
overhanging bone of the cheeks.”[126]

“The first four teeth, being cutting teeth (incisors), are called by
the Greeks _tomici_. These are flanked on both sides by one canine.
Beyond this there ordinarily exist, on both sides, five grinders,
except in the case of those persons in whom the last molars, which
commonly are cut very late, have not yet appeared. The incisors and
the canines are fixed with one single root; but the molars at least
with two, some even with three or four. In general, the shorter the
tooth, so much the longer is its root. A straight tooth commonly has a
straight root, a curved tooth has it generally curved. The root of a
temporary tooth produces in children a new tooth, which usually pushes
out the first; sometimes, however, the new tooth appears either above
or below it.”

In the seventh chapter Celsus treats of fractures in general, but in
particular of those of the lower jaw.

“To reduce a fracture of this bone, it should be pressed in a proper
manner, from the inside of the mouth and from the outside, with the
forefinger and thumb of both hands. Then in the case of a transverse
fracture (in which case generally an unevenness in the level of the
teeth is produced), it is necessary, after having set the fragments
in place, to tie together the two teeth nearest to the fracture with
a silk thread, or else, if these are loose, the following ones. After
this, one should apply externally, on the part corresponding to the
lesion, a thick compress, dipped in wine and oil and sprinkled with
flour and powdered olibanum. This compress is to be fixed by a bandage
or by a strip of soft leather, with a longitudinal slit in the middle
to embrace the chin, the two ends being tied together above the head.
The patient must fast the first two days; then he may be nourished with
liquid food, but in small quantities, abstaining, however, completely
from wine. On the third day it is necessary to take off the apparatus,
and after having fomented the part with the steam of hot water, to
replace it. The same is to be done on the fifth day, and so on, until
the inflammation has subsided, which generally happens from the seventh
to the ninth day. After the symptoms of inflammation have vanished, the
patient may take abundant nourishment; he must, however, abstain from
chewing until the fracture is completely consolidated; and, therefore,
he will continue to nourish himself with soups and like food. He must
also entirely abstain from speaking, especially during the first few
days. Fractures of the jaw commonly heal from the fourteenth to the
twenty-first day.

“In luxations of the jaw (Chapter XII) the bone is always displaced
forward; but sometimes only on one side, and sometimes on both sides.
When the dislocation is only on one side, the chin and the whole jaw
are found deviated toward the part opposite to the luxation; and
the similar teeth of the two dental arches do not correspond; but
instead under the upper incisors will be found the canine tooth of
the dislocated part. If, however, the luxation is bilateral, the
chin inclines and projects forward; the lower teeth are farther in
front than the upper ones, and the muscles of the temples are tightly
stretched. The reduction of the luxation must be performed as quickly
as possible. The patient having been made to sit down, an assistant
holds the head firmly from behind; or else the patient is made to sit
with his shoulders against a wall, with a hard cushion between this and
his head, whilst the assistant holds the head against the cushion, and
so keeps it steady. Then the operator, after wrapping his two thumbs in
linen cloth or strips, that they may not slip, introduces them into the
patient’s mouth and, applying the other fingers on the outside, firmly
grasps the jaw. Then whilst lowering the back part of the latter, he
shakes the chin and pushes it upward and backward, seeking to shut the
mouth, and in this way making the jaw return to its natural position.

“The bone having been replaced, if the accident should have given rise
to pains in the eyes and neck, it will be well to draw blood from the
arm. After the luxation has been reduced, the patient must be nourished
for some time on liquid food, and abstain, as much as possible, from
speaking.”

CAIUS PLINIUS SECUNDUS. After Celsus, a very celebrated writer on
medicine and natural science was Caius Plinius Secundus. He was born
at Como in the year 23 of the Christian era, and flourished from the
days of Nero to those of Vespasian. Endowed with a liberal education,
he gave himself up to public life, filling many important posts, among
which, that of Governor of Spain under Nero and his successors. In
the year 79 after Christ, while he was in command of the Roman fleet
at Misenum, the tremendous eruption of Vesuvius took place, by which
Pompeii, Herculaneum, and other neighboring cities were destroyed.
Pliny, driven by the desire to study that marvellous and awful natural
phenomenon, betook himself to Stabia, but was there suffocated by the
ashes and smoke erupted by Vesuvius.

In spite of the many places occupied by him, Pliny found time to
write many works, and among these the thirty-seven books on _Natural
History_, which have given him eternal fame.

It is not at all to be wondered at that this immense work contains a
great number of fables, superstitions, and errors of every kind. To
sift the true from the false was not an easy thing, at a time when
there was almost no idea as to how natural phenomena were produced,
and when all scientific criticism was impossible, for the very simple
reason that true science did not exist.

To give an idea of the great absurdities which were believed in at that
epoch, and which were considered possible even by higher intellects
such as Pliny’s, the following passages will suffice: “In many
mountains of India, according to what Ctesia writes, there are men
with dogs’ heads, who clothe themselves with the skins of wild beasts
and bark instead of speaking. There are also a kind of men having only
one leg, and who have great speed in leaping. Others are without any
neck and have their eyes between their shoulders. Megasthenes writes
that among the nomad Indians are men who instead of a nose have only
holes, and have their legs bent like serpents. At the extreme confines
of India, toward the East, are men without any mouth and with their
bodies entirely covered with hair, who live on nothing but air and
odors, which they inhale through the nose.”[127]

In Pliny’s day the most prodigious virtues were attributed to herbs; in
regard to this the following example is sufficient:

“The herb near which dogs may have made water, when gathered, but
without being touched by iron, cures luxations very promptly.”[128]

It must not be thought that Pliny accepted such beliefs without
reserve. He notes them, because preceding authors had accepted them,
and because if certain things appear to us evidently absurd, their
absurdity could not be equally evident at a period when little more
than nothing was known in regard to physical and physiological laws,
and when the impossibility of rationally explaining natural effects
led men to admit the existence of marvellous virtues and influences in
every being and in all bodies. On the other hand, Pliny expressly says,
for his own justification, in Chapter I of Book VII: “I do not want to
bind my faith in many things which I am about to say; but rather refer
the readers to the authors from whom I have taken them.”

As is to be expected, we find in Pliny’s works, in regard to teeth, a
strange mixture of truth and errors.

In Chapter XV of Book VII, after having said that some children are
born with teeth, and after having cited, as examples, Manius Curius,
who was therefore called Dentatus, and Gnæus Papirius Carbo, both
illustrious men, he adds:

“In women such a thing was considered a bad augury in the days of the
kings. In fact, Valeria having been born with teeth, the seers said
that she would be the ruin of the city to which she would be taken; she
was sent to Suessa Pometia, which in those days was a very flourishing
city; and, in fact, the prediction was verified. Some, instead of
teeth, have an entire bone; of this there was an example in the son of
Prusias, King of Bithynia, who instead of upper teeth had one single
bone.”

“The teeth alone are not consumed by fire, and do not burn with the
rest of the body. And yet these teeth, which withstand the flames,
are worn away and hollowed out by pituita. They wear out by being
used. Nor are they necessary for mastication alone, for the foremost
ones regulate the voice and words, producing by the beat of the tongue
special sounds.”

“Men have thirty-two teeth, women a lesser number. It is, however,
believed that augury may be taken from the teeth; and to have a greater
number than usual is considered an indication of long life. The
presence of two eye teeth at the right side of the upper jaw presages
favorable fortune, as was verified in Agrippina, the mother of Domitius
Nero; on the left side, however, they are of sad foreboding.”

“The last teeth, which are called the genuine teeth, appear toward the
twentieth year of age; many persons, however, do not have them until
their eightieth year. Teeth fall out in old age and then spring up
again; of this there can be no doubt. Mutianus writes of having known
a certain Zancle of Samothracia, in whom teeth reappeared after he had
completed his one hundred and fourth year. Timarcus, son of Nicocles of
Paphus, had two rows of molar teeth, whilst a brother of his did not
change his incisor teeth at all, which, therefore, wore down little
by little. There once lived a man who had a tooth in his palate. The
canine teeth, when by any chance they fall out, do not reappear any
more.”[129]

“In the teeth of man there exists a poisonous substance which has the
effect of dimming the brightness of a looking-glass when they are
presented uncovered before it; and if they are uncovered in front of
young unfledged pigeons, these take ill and die.”[130]

The second of these two statements is but a prejudice, like many
others; but we find the first very strange indeed, it being a
surprising thing that a man like Pliny should have attributed to
an imaginary poison of the teeth what is the simple effect of the
moistures of the breath.

In Chapters CXV and CXVII of Book XI are found some observations which
are somewhat interesting to us:

“A man’s breath becomes infected by the bad quality of food, by the bad
state of the teeth, and still more by old age.”

“Simple food is very beneficial to man; the variety of flavors
instead is very harmful. Sour or too abundant foods are digested with
difficulty, and also those which are ravenously swallowed. As a remedy,
vomiting has come into use; but it makes the body cold and is most
pernicious to the eyes and to the teeth.”

There is no doubt that the habit of often provoking vomitus—which,
in those times of excessive corruption and intemperance, had come
into general use—must have resulted in enormous harm to the teeth,
especially by the action exercised upon them by the hydrochloric
acid contained in the gastric juice, and by the organic acids of
fermentation.

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

“It is beneficial against toothache to chew the root of panax, and
likewise to wash the teeth with its juice. It is also useful to
chew the root of hyoscyamus soaked in vinegar, or else that of the
polemonium. It is also beneficial to chew the roots of the plantain, or
to wash the teeth in a decoction of plantain in vinegar. A decoction of
the leaves is also useful, not only in the case of simple toothache,
but also when the gums are tender and easily bleed. The seed of
the same plant cures inflammations and abscesses of the gums. The
aristolochia strengthens the gums and the teeth. The same effect may be
produced by masticating the verbena with its root, or by washing the
mouth with a decoction of it in wine or vinegar. Similarly the roots
of the cinquefoil are helpful when boiled down to a third, in wine or
vinegar; however, they must first be washed in salt water or brine. The
decoction must be kept for a long time in the mouth.

“Instead of using the decoction of cinquefoil, some prefer to rub the
loose teeth with the ashes of this plant. Besides the above-mentioned
remedies, the root of the verbascum boiled in wine, hyssop, and the
juice of the peucedanum with opium are also employed; and it is also
beneficial to pour into the nostrils, on the side opposite to that of
the sick tooth, some drops of the juice of anagallis.

“It is said that if senecio be taken from the earth, and the aching
tooth be touched three times with it, spitting alternatively three
times, and then the herb be replanted in the same spot, so that it may
continue to live, the tooth will never give pain any more.”[131]

“In the fuller’s thistle,[132] an herb which grows near rivers, is
found a small worm, which has the power of curing dental pains, when
the said worm is killed by rubbing it on the teeth, or when it is
closed up with wax in the hollow teeth.”[133]

“Apollonius writes that a very efficacious remedy for pains in the gums
is to scratch them with the tooth of a man who has suffered a violent
death.”[134]

“It is considered very beneficial for toothache to bite off a piece
from wood which has been struck by lightning, and to touch the sick
tooth with it; but whilst biting off the little piece of wood, it is
necessary to keep both hands behind the back.”[135]

“Experience teaches that against the bad odor of the breath it is
useful to wash the mouth with pure wine before sleeping, and that to
avoid aching of the teeth, it is a good thing to rinse the mouth, in
the morning, with several mouthfuls of fresh water, but of an odd
number.”[136]

“A remedy for toothache is to touch the diseased teeth with the
tooth of a hyena,[137] or to scratch the gums with the tooth of a
hippopotamus which has been taken from the left side of the jaw.”[138]

“The ashes of stag’s horn, rubbed over loose and aching teeth, makes
them firm and soothes the pain. Some consider that to produce the same
effect, of greater virtue is the powder of the horn, unburnt. Both
the ashes and the powder of stag’s horn are employed as a dentifrice.
The ashes of the head of a wolf are a great remedy for toothache.
Such pains are also made to cease by wearing certain bones that are
oftentimes found in the dung of this animal. The ashes of the head of a
hare is a useful dentifrice; and if spikenard be added, it will lessen
the bad smell of the mouth. Some mix with it the ashes of the heads of
mice. In the side of the hare is a bone as sharp as a needle; and many
advise pricking the teeth with this when they ache. The heel of the ox
kindled and brought close to loose teeth makes them firm. The ashes of
this bone mingled with myrrh is a good dentifrice. A good dentifrice
is also made from the ashes of the feet of a goat. To strengthen teeth
loosened by a blow, asses’ milk or the ashes of the teeth of this
animal are very useful. In the heart of the horse there is a bone like
an eye-tooth; it is said that it is very beneficial to pick with it the
teeth that ache. The carpenter’s glue boiled in water and plastered
on to the teeth also takes away their pain; but soon after it must be
taken away and the mouth rinsed with wine in which have been boiled the
rinds of sweet pomegranates. It is also thought beneficial to wash the
teeth with goat’s milk or with ox-gall.”[139]

“Butter, either alone or with honey, is very useful for children; and
is very helpful, especially during dentition, in the diseases of the
gums, and to cure the ulcers of the mouth. To prevent the disorders
that generally accompany dentition, it is a useful thing that the child
should wear a wolf’s tooth, or one of the first teeth lost by a horse.
The rubbing of the gums with goat’s milk or with hare’s brain renders
the cutting of teeth much easier.”[140]

“To sweeten the breath it is very helpful to rub the teeth and the gums
with wool and honey.”[141]

“The filth of the tail of sheep rolled up in little balls, and left to
dry and then reduced to powder and rubbed on the teeth, is marvellously
useful against the loosening and other diseases of the teeth themselves
and against the cankerous ulcers of the gums.”[142]

“Eggshells deprived of their internal membrane and afterward burnt
afford a good dentifrice.”[143] (Hence we see that the use of carbonate
of lime as a dentifrice is a very ancient one.)

“If the head of a dog that has died mad be burnt, the ashes obtained
may be advantageously used against toothache, mixing it with cyprine
oil and then dropping the mixture into the ear, on the side of the
pain. It is beneficial also to pick the sick tooth with the longest
tooth, on the left side, of a dog; or with the frontal bones of a
lizard, taken from the head of the animal at full moon, and which
have not touched the earth. The teeth of a dog, boiled in wine until
this is reduced to one-half, thus, furnish a mouth wash which can
be advantageously used against toothache. In the cases of difficult
dentition, benefit is derived by rubbing the gums with the ashes of
the teeth of a dog, mixed with honey. Such ashes are also used as a
dentifrice. In hollow teeth it is useful to introduce the ashes of
the dung of mice, or of the dried liver of lizards. It is the opinion
of some, that in order not to be subject to toothache, a mouse should
be eaten twice a month. If earth-worms be cooked in oil, this latter
has the virtue of calming toothache when dropped into the ear on the
side of the pain. The same effect is obtained by rubbing the teeth
with the ashes of the aforesaid worms, after they have been burnt in
a terra-cotta vase; and if such ashes be introduced into the hollow
teeth, these fall out very easily. A good remedy against toothache is
to wash the mouth with vinegar of squills in which earth-worms and
the root of the mulberry have been boiled. The ashes of the shells of
snails mixed with myrrh, rubbed on the gums, strengthens them. Even
the slough which the snakes cast off in spring can furnish a remedy
against toothache. For this purpose it must be boiled in oil, with
the addition of resin of the larch, and then the oil dropped into the
ear. For the same purpose, according to some, oil of roses is useful,
when a spider, caught with the left hand, has been pounded in it. If a
sparrow’s fledglings be burnt with dry vine twigs, the resulting ashes
rubbed with vinegar on the teeth makes all pain cease in them.[144] It
is stated by many that to improve the odor of the breath, it is well
to rub the teeth with ashes of mice mixed with honey. Some also mingle
with this the root of fennel. Picking the teeth with the quill of a
vulture renders the breath sour. It makes the teeth firm to pick them
with a porcupine’s quill. A decoction of swallows in wine sweetened
with honey cures ulcers of the tongue and lips. Scaldings in the mouth
produced by hot food or drinks are readily healed with the milk of a
bitch.”[145]

That Pliny did not put great faith in many of the things which he
relates is clearly proved by several passages of his book, and among
others by the following:

“One can hardly relate without laughing, some things, which, however,
I will not omit, because they are found already written. They say
that the ox has a small stone in the head, which it spits out when
it fears death; but if its head be suddenly cut off, and the stone
extracted, this, worn by a child, helps it in wondrous manner to cut
its teeth.”[146]

In Book XXXI, Pliny speaks of various waters—mineral, thermal,
etc.—especially from the medical point of view. It was already known
in those days that those waters were most active agents. And in this
respect a fact which the author relates in Chapter VI of Book XXV is
worth mentioning:

“When Caesar Germanicus moved his camp beyond the Rhine, there was
found, in the whole maritime tract of the country, only one spring of
fresh water, the drinking of which, within two years, produced the fall
of teeth and a loosening of the knee-joints. The doctors called these
evils stomacace and scelotyrbe.”

Sea salt and nitre are of use, according to Pliny, against various
maladies of the teeth and mouth. He counsels the application of salt
on lint to the ulcers of the oral cavity, and to rub it on the gums
when they are swollen. To prevent diseases of the teeth, it would be
advantageous, every morning before breaking one’s fast, to keep a
little salt under the tongue until it is dissolved. Against the pain
of the teeth it would be beneficial to use common salt dissolved in
vinegar, or nitre in wine.

“The rubbing of the blackened teeth with burnt nitre gives them back
their natural color.”[147]

The prophylactic remedies against odontalgia believed in, at that
period, were sufficiently numerous, and, among many other such things,
Pliny informs us that in order not to be subject to toothache, it is
sufficient to wash the mouth three times a year with the blood of the
tortoise.[148] Analogous virtue was also attributed to the brain of the
shark, which was boiled in oil, and this put by for washing the teeth
with once a year.

Besides the many anti-odontalgic remedies so far related, several
others are found enumerated in Chapter XXVI of Book XXXII:

“The pain in the teeth is lessened by picking the gums with the bones
of the sea dragon. It is also very beneficial to pick the gums with
the sharp bone of the puffin.[149] If the same be pounded together
with white hellebore, and the mixture thus obtained be rubbed on the
diseased teeth, they may be made to fall out without pain. The ashes,
also, of salt fish burnt in an earthen vase, with the addition of
powdered marble, is a remedy against toothache. Frogs are also boiled
in a hemina[150] of vinegar, the decoction being then used to wash
the teeth with; but this, however, must be kept in the mouth for
some length of time. In order to render this remedy less nauseous,
Sallustius Dionisius used to hang several frogs, by their hind feet,
over a vase in which he boiled the vinegar, so that the juices of the
animals might drip into this from their mouths. To make loose teeth
firm, some advise the soaking of two frogs, after having cut off
their feet, in a hemina of wine, and the washing of the mouth with
the latter. Others tie them, whole, on the jaws. Some, to strengthen
unsteady teeth, rinse them with a decoction made by boiling ten frogs
in three sextaries[151] of vinegar, until the liquor is reduced to
one-third. By others, thirty-six hearts of frogs are well boiled in
a sextary of old oil, in a copper vessel, and the oil is then used
against toothache, dropping it into the ear, on the side of the pain.
Some, after having boiled the liver of a frog, pound it with honey, and
smear it on the sore teeth. If the teeth are decayed and fetid, many
counsel the drying of a hundred frogs in an oven, leaving them there
for one night, then the addition of an equal weight of salt, reducing
the whole to powder, and rubbing the teeth with it. In such cases the
ashes of crabs are also used. That of the murex[152] is adopted as a
simple dentifrice.”

“The cutting of teeth is facilitated by rubbing the gums of the child
with the ashes of dolphin’s teeth mixed with honey, or even simply by
touching the gums with a tooth of this animal.”[153]

In Chapter XXXIV of Book XXXVI it is said that the decoction of
gagates[154] in wine cures the diseases of the teeth; and in Chapter
XLII of the same book are praised the dentifrice powders made of pumice
stone.

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

The diseases of the teeth were, in those days, most common; very
often we find mention of loose teeth, and the medicines suited to
make them firm again; from which we may deduce the great frequency
of alveolar pyorrhea. It is reasonable to think that such a fact was
caused principally by the intemperate life of those times, in which
the followers of Epicurus were extremely numerous and the unbridled
desire for pleasure reached such a degree that no abhorrence was felt
of provoking vomit during the course of a long banquet, in order to
continue dining merrily.

Concerning the teeth, their affections, and the means of healing and
preventing them, the strangest superstitions existed, and this not
only among the common, but also among educated and learned people. The
number of remedies reputed useful against diseases of the teeth was
extraordinarily great; but the modern saying, “therapeutic wealth is
poverty,” could have been applied only too well.

Of the cleanliness of the teeth, it seems, great care was taken, for
dentifrices were in great use. These, as we have already seen, were
made of the most varied substances—stag’s horn burnt, ashes obtained
by burning the head of the mouse, of the hare, of the wolf, etc.,
eggshells burnt and reduced to powder, pumice stone, and so on. For the
cleanliness of the mouth, for strengthening the teeth and gums, mouth
washes of sundry kinds were likewise adopted, especially formed of
decoctions of astringent substances in water, wine, and vinegar.

Not only among the Romans was great care given to the cleanliness and
beauty of the teeth, but also among many other nations. In this regard
the following poem of Catullus, in which he lashes the silly vanity of
a Celtiberian resident in Rome, who made continual show of his white
teeth, is somewhat interesting:

  “Egnatius, quod candidos habet dentes
  Renidet usquequaque; seu ad rei ventum est
  Subsellium, cum orator excitat fletum,
  Renidet ille: seu pii ad rogum filii
  Lugetur, orba cum flet unicum mater,
  Renidet ille; quidquid est, ubicumque est,
  Quodcumque agit, renidet: hunc habet morbum,
  Neque elegantem, ut arbitror, neque urbanum.
  Quare monendus es mihi, bone Egnati,
  Si Urbanus esses, aut Sabinus, aut Tiburs,
  Aut parcus Umber, aut obesus Hetruscus,
  Aut Lanuvinus ater, atque dentatus,
  Aut Transpadanus, ut meos quoque attingam,
  Aut quilibet, qui puriter lavit dentes:
  Tamen renidere usquequaque te nollem;
  Nam risu inepto res ineptior nulla est.
  Nunc, Celtiber, in celtiberia terra
  Quod quisque minxit, hoc solet sibi mane
  Dentem, atque russam defricare gingivam.
  Ut quo iste vester expolitior dens est,
  Hoc te amplius bibisse prædicet lotii.”[155]

STRABO. From Strabo we learn that the Cantabri and other peoples of
Spain used to clean their teeth and sometimes even to wash their face
not with fresh, but with old urine, which, so it seems, was kept for
the purpose, in suitable cisterns![156]

In regard to this filthy custom, Joseph Linderer says[157] that the
superstition has reached even to our times, although not widely
diffused, that, to beautify the face, it is useful to wash it with
urine. He relates that he knew a girl who, to become beautiful, had
recourse to this heroic method, but, unfortunately, without at all
obtaining the desired end!

MARTIAL. In the epigrams of Martial (about 40 to 101 A.D.) allusions of
great value with regard to several points concerning the subject we are
treating of are found.

Toothpicks (_dentiscalpia_) are mentioned by this poet several
times; from which we may argue that they were in great use. They
were ordinarily made of lentisk wood (_Pistacia lentiscus_), as may
be deduced from the Epigram LXXIV of Book VI, in which the author
ridicules the old dandy who, stretched at length on the triclinium,
cleans with _lentiski_ the toothless mouth, to give himself the air
of a man not too far stricken in years.[158] Besides, in Book XIV,
containing, for the greater part, saws and sayings on objects of common
use, there is an epigram bearing the title of “Dentiscalpium,” in which
the author says that toothpicks of lentisk are to be preferred, but
that, in their absence, quill toothpicks may be used.[159]

[Illustration: FIG. 28

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

From other sources we learn that in those days metal toothpicks
were also made use of. So in a satire of Petronius, it is said that
Trimalchiones made use of a silver toothpick (_spina argentea_).
Objects of this kind, both Roman and of other origin, are even now in
existence, and may be found in various collections of antiquities. In
Crimea a most elegant gold object, of Greek make, was found, which is,
by its two ends, both a toothpick and an ear-picker. It belongs most
probably to the fourth century before Christ.[160]

In an object found in the north of Switzerland, and coming from a
Roman military colony of the times of the Empire, the toothpick and
ear-picker are joined at one of their ends, by a pivot, to other toilet
articles.[161]

[Illustration: FIG. 29

A metal toothpick and ear-picker joined to other toilet articles. An
object found in Switzerland, in the ancient seat of a Roman military
colony.]

[Illustration: FIG. 30

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

Caylus, in his valuable work _Recueil d’antiquités égyptiennes,
étrusques, grecques, romaines et gauloises_ (Paris, 1752 to 1767),
gives the picture of a toothpick and ear-picker of bronze, two inches
long, with the middle part wrought in spiral form, so as to increase
the solidity of the article, and also to enable the hand to keep it
easily firm in all positions. It was found in the north of France, at
Bavai (the ancient Bagacum), and forms part of the collection of M.
Mignon of Douai.[162]

Martial is one of the first Roman writers who speak clearly of
artificial teeth. In Epigram LVI of Book XIV, the poet, by a bold
personification, makes the dentifrice powder say to a toothless old
woman, furnished with false teeth: “What have you got to do with me?
Let a girl use me. I am not accustomed to clean bought teeth.”[163]

Elsewhere[164] Martial atrociously derides a courtesan, who, among her
other physical defects, was also without an eye: “Without any shame
thou usest purchased locks of hair and teeth. Whatever will you do for
the eye, Laelia? These are not to be bought!”[165]

This epigram shows that, while dental prosthesis was already in use,
ocular prosthesis did not as yet exist.

To a plagiarist, who passed off Martial’s poetry as his own, the latter
says: “With our verses, O Fidentinus, dost thou think thyself and
desire to be thought a poet. Even so, it seems to Ægle that she has all
her teeth, because of her false teeth of bone and ivory.”[166]

There is, therefore, not the least doubt that in the days of Martial
artificial teeth were in use; and that these, as may be seen from
the epigram just now quoted, were made of ivory and bone; we do not
know whether they were formed also of other substances. The question,
however, arises: In those times did they manufacture movable artificial
sets, or was the dental art then limited to fixing the artificial teeth
unmovably to the neighboring firm teeth, by means of silk threads, gold
wire, and the like? The answer to this question may be found in another
epigram of Martial,[167] where the latter ridicules a wanton old woman,
telling her, among other things still worse, that she at night lays
down her teeth just as she does the silken robes.[168]

It is, therefore, beyond all doubt that, at that period, the manner of
constructing movable artificial sets was known; and most probably not
only partial pieces were made, but even full sets. In fact, from the
verse quoted above we have justly the impression that the poet means a
whole set rather than a few teeth.

From the words of Martial, it may also be concluded that these dentures
could be put on and off with the greatest ease; or, as we may say, by
a maneuver as simple as that of removing any articles of apparel; they
must, therefore, have been extremely well constructed.

This alone should be sufficient, even were further proof wanting,
to give us an idea of the degree of development and of the point of
perfection reached by dental prosthesis at that time. But besides this,
we now also possess an ancient Roman piece furnishing a palpable proof
of the ability and ingenuity of the dentists of that epoch. Some few
years since, I had occasion, in the pursuit of dental archæological
research, to visit the Museum of Pope Julius in Rome, where I was shown
a prosthetic piece, not yet exhibited to the general public, that had
been discovered a few months previous in excavating at Satricum, near
Rome. I was invited to give an opinion as to this appliance, and, after
having examined it accurately, became aware, not without some emotion,
I am fain to confess, that I held in my hands a prosthetic piece of
exceptional historical importance, that is, no less than a specimen of
ancient _crown work_.

[Illustration: FIG. 31

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

[Illustration: FIG. 32

The same, seen from below.]

The appliance found at Satricum (Fig. 31) is made in the following
manner: Two small plates of gold, stamped out, represent respectively
the lingual and labial superficies of a middle lower incisor; these
two pieces soldered together form the crown of the tooth. At its base
the crown is soldered, back and front, to a narrow strip of gold which
folds back on itself at each end, so as to tightly encircle the two
neighboring teeth on the right and on the left, which thus serve as
supports to the appliance.

We are now, therefore, able not only to affirm that the Etruscans knew
how to execute a kind of _bridge work_, but that later the dentists of
ancient Rome even carried out _crown work_.

This, notwithstanding the examples of dental prosthesis discovered
up to now in Roman and Etruscan tombs, can in no way be considered
as representing all the varieties of dental prosthesis of ancient
construction. It is to be hoped that, in spite of the destructive
action of time, in continuing the excavations and archæological
researches, many other specimens of early dental prosthesis will yet
come to light. In any case, judging by some indications to be found
in Latin literature, it must be admitted that the Roman dentists of
antiquity constructed other kinds of prosthesis besides the specimens
we possess, and in particular movable dentures. We are led to suppose
this, not only from the above cited epigram of Martial, but also from
what we read in one of the satires of Horace, who dates contemporarily
with Augustus, and therefore anteriorly to Martial. Speaking of two
old witches who had been put to flight by Priapus, Horace writes: “You
would have laughed to see those two old witches run toward the town,
losing in their flight, Canidia, her false teeth, Sagania, her false
hair.”[169]

Now, as Prof. Deneffe very rightly observes, the prosthetic appliances
of antiquity known to us are so firmly fixed to the natural teeth
that no race, however unbridled, could ever have made them fall out
of the mouth. It must, therefore, be admitted, as I have said, that
the ancients constructed other kinds of dental appliances, of which no
specimens have, as yet, been discovered.

Neither in Celsus nor in Pliny, nor in any other Roman writers on
medicine, do we find any allusion to the art of dentistry. The doctors
of those days probably had no idea of the advantages which could be
derived from dental prosthesis in regard to digestion and consequently
to the health of the whole body. They therefore must have considered
artificial teeth as something totally foreign to their art, and
intended solely to hide a physical defect. It is therefore not at all
surprising that they have not treated of this subject.

As the art of setting artificial teeth was exercised by persons not
belonging to the medical profession, it is very probable that these
persons also undertook the extraction of teeth and the cure of dental
pains. Martial (Book X, Epigram LVI) names a certain Cascellius, who,
he says, “extracts or cures diseased teeth,”[170] and this is the first
dentist whose name has been sent down to us. In spite of this, nothing
permits us to affirm that there existed at that time a class of real
dentists, viz., of persons dedicated to the exclusive cure of dental
disease. There are strong reasons for doubting this, especially when
we consider that the Latin language has no word corresponding to the
word dentist. If there had existed a true dental profession, there
ought also to have existed a name for indicating the individuals who
exercised it. Therefore, it must be considered highly probable that,
although there undoubtedly existed individuals who were especially
skilled in the cure of the diseases of the teeth, such persons did
not form a special class; perhaps, among those to whom recourse was
had for the cure of dental diseases, some were doctors, particularly
skilled in such diseases, others were perhaps barbers, and so forth.
As to the far-fetched deductions of Geist-Jacobi, according to whom the
name given to dentists by the Romans must have been that of _artifex
dentium_ or _artifex medicus dentium_, these are founded, above all, on
imagination. It is extremely improbable that such names existed, when
one considers that they are not met with, even once, in the whole range
of Latin literature.

SCRIBONIUS LARGUS. Among the writers on Medicine in the early period of
the Empire, one of the most eminent was, without any doubt, Scribonius
Largus, physician to the Emperor Claudius, whom he accompanied to
England in the year 43.

Scribonius Largus, in his book _De compositione medicamentorum_,
pronounces himself energetically against the division of Medicine into
single special branches. He declaims against the many who attributed
to themselves the name of doctors, simply because they knew how to
cure some diseases. According to him, the true doctor must be skilled
in curing all kinds of affections. This, in truth, was possible in
those times, but would be almost impossible nowadays, on account of the
enormous development of the healing art. The ideas, however, expressed
by Scribonius Largus have a certain historical importance, for they
show that in his times the medical art had certainly the tendency to
split up into many special branches, among which there must certainly
have been dentistry, but that the necessity of such separation was not
by any means universally recognized; the great doctors of those days
undertook the cure of the diseases of the teeth, as well as those of
any other part of the body.

The tenth chapter of the book of Scribonius Largus treats of the cure
of odontalgia. The author begins by saying that it is the opinion of
many that the only true remedy against toothache is the forceps. With
all this, he adds, there are many medicaments, from which great benefit
may be derived against these pains, without it always being necessary
to have recourse to extraction. Even when a tooth is affected with
caries, says the author, it is not always advisable to extract it; but
it is much better, in many cases, to cut away the diseased part with a
scalpel adapted for the purpose.

“Violent toothache may be calmed in various ways, viz., with mouth
washes, masticatories, fumigations, or by the direct application of
fitting medicaments. It is beneficial to rinse the mouth frequently
with a decoction of parietaria or of cypress berries, or to apply to
the tooth the root or the seeds of the hyoscyamus wrapped up in a
cloth, and dipped from time to time in boiling water, or to chew the
portulaca (purslane), or to keep for some time its juice in the mouth.”

“Suitable also against toothache are fumigations made with the seeds of
the hyoscyamus scattered on burning charcoal; these must be followed
by rinsings of the mouth with hot water; in this way sometimes, as it
were, small worms are expelled.”[171]

This passage of Scribonius Largus has given rise to the idea that the
dental caries depends upon the presence of small worms, which eat
away the substance of the tooth. Such an explanation must have well
succeeded in satisfying the popular fancy; and it is for this that
such a prejudice, although fought against by Jacques Houllier in the
sixteenth century, has continued even to our days.

With regard to this I would like to record the following fact: Not many
years ago there lived in Aversa, a small town near Naples, Italy, a
certain Don Angelo Fontanella, a violin player, who professed himself
to be the possessor of an infallible remedy against toothache. When
summoned by the sufferer, he carried with him, in a bundle, a tile,
a large iron plate, a funnel, a small curved tube adjustable to the
apex of the funnel, a piece of bees’ wax, and a small packet of onion
seed. Having placed the tile on a table, the iron plate was put upon
it, after it had been heated red hot. Then the operator let a piece
of bees’ wax fall upon the red-hot iron, together with a certain
quantity of the onion seed; then, having promptly covered the whole
with the funnel and made the patient approach, he brought the apex of
the said funnel close to the sick tooth, in such a way as to cause the
prodigious, if somewhat stinking, fumes produced by the combustion of
the wax with the onion seed to act upon it. In the case of a lower
tooth, the above-mentioned curved tube was adapted to the funnel, so
that the fumes might equally reach the tooth. The remedy, for the most
part, had a favorable result, whether because the beneficial effect was
due to the action of the hot vapor on the diseased tooth, or to the
active principles resulting from the combustion of the wax and onion
seed, or to both, or perhaps also, at least in certain cases, to the
suggestion that was thus brought to bear upon the sufferer. It would
not be at all worth while to discuss here such a point. The interesting
part is that when the patient had declared that he no longer felt
the pain, Don Angelo, with a self-satisfied smile, turned the funnel
upside down, and showed on its internal surface a quantity of what he
pretended to be worms, which he affirmed had come out of the carious
tooth. Great was the astonishment of the patient and of the bystanders,
none of whom raised the least doubt as to the nature and origin of
these small bodies, no one having the faintest suspicion even that
these, instead of coming from the tooth, might come from the onion seed!

According to Scribonius Largus, toothache might also be taken away by
fumigations of burnt bitumen. He affirms also that great benefit may
be derived against odontalgia by masticating the wild mint, or the root
of the pyrethrum, or by covering the diseased tooth with a plaster
composed of peucedanum juice, opopanax, incense, and stoneless raisins.
But before making use of this last remedy, he advises that the tooth
and the gums near it should be fomented with very hot oil, by means of
a toothpick or ear-picker wrapped around, at one end, with some wool.
If the pain does not entirely cease, or comes on again, it is well,
says the author, to continue the fomentations with hot oil, above the
plaster, until the pain ceases. To strengthen loose teeth, Scribonius
advises frequent rinsings of the mouth with asses’ milk or with wine
in which have been cooked the roots of the sorrel until the liquid has
boiled down to one-third. Another remedy which he recommends against
looseness of the teeth is composed of honey and alum mixed together in
a mortar, in the proportion of two parts of the first to one of the
second, and then cooked in an earthen vase, so as to render the mixture
more homogeneous, and to give it more consistency. He also speaks of
a third medicament, resulting from cooking strong vinegar, alum, and
cedria[172] in a copper vessel until it has the consistency of honey.
This remedy would serve not only to make loose teeth firm, but the
author assures us also that whoever rubs the teeth with it, three times
a month, will never be subject to dental pains.

Scribonius Largus gives the receipts for various dentifrice powders in
use at that period. The skin of the radish dried in the sun, pounded
to powder, and then passed through a sieve, would furnish a good
dentifrice, suited to strengthen the teeth and to keep them healthy.
Very white glass, similar to crystal, reduced to a very fine powder
and mixed with spikenard, is also, according to Scribonius Largus, a
valuable dentifrice.

Octavia, sister of Augustus, used a powder which our author highly
commends, saying that it strengthens the teeth and makes them very
beautiful.[173] To prepare it, one must take a sextary[174] of barley
flour and knead it well to a paste with vinegar and honey mixed
together, and must divide the mass into six balls, each of which must
be mixed with half an ounce of salt; these balls must then be cooked
in the oven until carbonized; and lastly pounded to powder, as much
spikenard being added as is necessary to give it an agreeable perfume.

Scribonius Largus also lets us know the tooth powder made use of by
Messalina, the wife of the Emperor Claudius; this was composed of
calcined stag’s horn, mastic of Chios, and sal ammoniac, mixed in
the proportion of an ounce of mastic and an ounce and a half of sal
ammoniac to a sextary of the ashes of stag’s horn.

SERVILIUS DAMOCRATES, a Greek physician, who acquired great renown in
Rome toward the middle of the first century, was the author of many
valuable works, both in verse and prose, which, unfortunately, have
been lost. His works are mentioned by Galen, who testifies to his great
esteem for Damocrates, calling him an eminent physician, and quoting
various passages from his works, and among others three poetical
receipts for dentifrice powders. From these receipts it appears that
Damocrates attached the greatest importance to the cleanliness of the
teeth, and that he considered this the indispensable condition for
avoiding disease of the teeth and gums.

ANDROMACHUS THE ELDER, of Crete, the physician of Nero, who conferred
upon him, for the first time, the title of _archiater_, became famous
through his _theriac_, an extremely complicated remedy, the virtues of
which were sung by him in a Greek poem, dedicated to the Emperor. The
theriac was considered an antidote against all poisons and a remedy
against the greater part of diseases, in short, as a real panacea.
It is not even necessary to remark that this portentous medicine,
which has held a post of honor, from ancient times almost up to the
present day, was also used against odontalgia; and in those cases in
which this was produced by caries, Andromachus advised the filling up
of the cavity with the electuary which he rendered so famous. As the
chief basis of the theriac was opium, combined with stimulating and
aromatic substances, there is no doubt that its use locally or even
internally would prove beneficial, temporarily at least, in many cases
of odontalgia.[175]

ARCHIGENES, of Apamea, a city of Syria, lived in Rome toward the end
of the first century and at the beginning of the second, under the
Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great
fame as a physician and as an operator, and distinguished himself
particularly by daring amputations and trepannings. He recommends
various remedies against odontalgia, among which are mouth washes
of strong hot vinegar, in which gall-nuts or halicaccabum[176] have
been boiled. He usually introduced into carious teeth a mixture of
turpentine and vitriol of iron (_sory ægyptium_), or a mixture of
pepper, and oil of spikenard or of almonds, and this was also dropped
into the ear, on the side on which the pain was felt.

Archigenes, too, like other great physicians of that time, recommended
various remedies taken from the animal kingdom against diseases of
the teeth, which now seem very strange to us, but at that period
appear to have been in great use. Thus, it would be of great benefit
to hold in the mouth for some length of time a mixture of vinegar and
water in which a frog has been well cooked. The slough of a serpent,
burnt and then reduced, by the addition of oil, to the consistency of
solidified honey, would be a valuable remedy, which being introduced
into a carious hollow, and plastered all around the tooth and on the
surrounding parts, would cause the most violent pain to cease. And,
moreover, desiring to cause a diseased tooth to fall out, it would be
enough to apply to and press upon it a piece of the unburnt slough of a
serpent. Two excellent anti-odontalgic remedies to be introduced into
carious hollows would be roasted earth-worms and spikenard ointment
mixed with the crushed eggs of spiders. It would be also of use to drop
into the ear on the side of the aching tooth some oil of sesamum in
which earth-worms have been cooked.

When the pain is situated in broken teeth, Archigenes advises them to
be cauterized with a red-hot iron.

Against bleeding of the gums, he recommends rubbing them with very
finely pulverized alum and myrtle and the application of astringent and
tonic liquids.

When odontalgia appears to depend upon an inflammatory condition, he
advises the aching teeth to be plastered up with a mixture composed of
red nitre, pounded peach kernels, and resin.

Archigenes repeatedly recommends the cleaning of the teeth and of the
carious cavities before applying to the former or introducing into the
latter the appropriate remedies.[177]

But Archigenes’ principal merit, so far as concerns the art of
dentistry, consists in his having guessed that odontalgia, in certain
cases, arises from a disease of the interior part of the tooth (viz.,
from inflammation of the pulp) and in having discovered an excellent
method for curing such cases. When a tooth appeared discolored,
without being affected by caries, and was the seat of violent pains,
against which every remedy had proved of no avail, Archigenes
perforated it with a small trephine, invented by himself for the
purpose. He applied the instrument to that part of the crown which was
most discolored and drilled right down to the centre of the tooth.[178]

Without doubt this talented surgeon was induced to adopt this method of
cure by the idea of the existence of morbid substances in the interior
of the tooth and by the consequent indication of giving them a free
exit.

The operation devised by Archigenes proves, among other things, two
important facts: first, that the anatomical constitution of the teeth
had already been explored, seeing that Archigenes did not ignore the
existence of the pulp cavity; and secondly, that Archigenes was greatly
opposed to the extraction of a tooth unless absolutely necessary.
It might be thought that such aversion depended upon an exaggerated
idea of the dangers connected with the extraction of a tooth, an idea
widely diffused at that period; but regarding such a daring surgeon as
Archigenes was, it is more logical to suppose that in similar cases he
had recourse to trephining and not to extraction, especially on account
of the importance he attached to the preservation of the tooth.

Surgery in ancient times was eminently conservative; later on—partly
by effect of its own progress—it became too readily inclined to the
removal of diseased parts; in modern times it has again become what it
was originally, and what it must ever be, viz., conservative in the
highest possible degree.

CLAUDIUS GALEN, after Hippocrates the greatest physician of ancient
times, was born at Pergamus, a city in Asia Minor, in the year 131 of
our era. His father Nicon, a man of great abilities, who was at the
same time a man of letters, a philosopher, a mathematician, and an
architect, had put him, at a very early age, to the study of science
and of the liberal arts. Galen began to study medicine at the age
of seventeen, under the guidance of skilful doctors of his native
country; he made several journeys in order to have the benefit of the
instruction of celebrated masters, and finally frequented the renowned
medical school at Alexandria. On going to Rome, in the thirty-fourth
year of his life, he soon acquired in that city a very high renown.
He died in the first decade of the third century, but we do not know
exactly in what year.

Galen was a most prolific writer, and his works, considering the period
in which they were written, form a real medical encyclopedia. Anatomy
through his researches made considerable progress, for he studied with
the utmost care and attention (especially in apes) the bones, muscles,
heart, bloodvessels, brain, nerves, and every other part of the
organism. His anatomical researches enabled him to correct many errors,
but as he had dissected almost exclusively animals and not human
corpses, he himself fell into several errors, especially in attributing
to man parts which he does not possess, for example, the intermaxillary
bone.

Galen justly observed that the inferior maxilla (resulting, according
to him, from the union of two bones, which, indeed, is embryologically
true) has in man, proportionally to the other bones of the skeleton, a
lesser length than in animals.

He holds that the teeth must be enumerated among the bones, and does
not admit any doubt to be raised on this point, as these parts can be
looked upon neither as cartilages, nor as arteries, nor as veins, nor
as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat,
nor as hair—a method of reasoning by elimination which is very specious
but far too weak!

Galen indicates exactly the number of incisor, canine, and molar teeth
(without, however, making any distinction between small and large
molars), and speaks of the different functions of these three kinds of
teeth. Not always, he says, are the molars of each jaw five in number
on each side; in some individuals there appear only four; in others
six. The incisors and canines have but one root; the upper molars have
generally three, but sometimes, though not often, four; the lowers have
for the most part two, rarely three.

Galen is the first author who speaks of the nerves of the teeth. He
says that these organs are furnished with soft, that is sensitive,
nerves[179] belonging to the third pair.[180] The teeth, according to
him, are furnished with nerves, both because, as naked bones, they have
need of sensibility, so that the animal may avoid being injured or
destroyed by mechanical or physical agencies, and because the teeth,
together with the tongue and the other parts of the mouth, are designed
for the perception of the various flavors.[181]

In regard to odontalgia, Galen made some very important observations on
his own person:

“Once when I was troubled with toothache, I directed my attention to
the seat of the pain, and thus I perceived very clearly, that not only
was the tooth painful but also pulsating, which is analogous to what
happens in inflammations of the soft parts. To my astonishment, I had
to persuade myself that inflammation may arise even in a tooth, in
spite of the dental substance being hard and lapideous. But another
time, when I again was attacked by odontalgia, I perceived very
distinctly that the pain was not localized in the tooth, but rather in
the inflamed gums. Having, therefore, suffered these two kinds of pain,
I have acquired the absolute certainty that, in certain cases, the
pain is situated in the gums, in others, on the contrary, in the very
substance of the tooth.”

When a tooth becomes livid, Galen deduces from this that the tooth
is the seat of a morbid process equivalent to inflammation. Besides,
he says, we cannot be surprised that the teeth may be subject to a
phlogistic process, when we consider that these, like the soft parts,
assimilate nourishment. The teeth, by effect of mastication, are
continually worn down, but nutrition repairs the losses, and they,
therefore, preserve the same size. But when a tooth from want of its
antagonist is consumed but little or not at all by mastication, we
see that it grows gradually longer, for the very reason that under
such conditions the increase due to nutrition is not counteracted by a
corresponding waste.

The nutritive process of the teeth may, according to Galen, be altered
either by excess or by defect; from which arise morbid conditions,
quite different the one from the other. An excess of nutrition produces
a phlogistic process analogous to that of the soft parts; a defect of
nutrition makes the teeth thin, arid, and weak. The first of these
pathological states is met with especially in young men and must be
fought against with the ordinary antiphlogistic means, designed to
eliminate the excess of humors (evacuant, resolvent, revulsive, and
astringent remedies). As to defect of nutrition, this is met with most
frequently in old people. It has the effect not only of making the
teeth thin, but also of enlarging the alveoli, from which there results
a looseness of the teeth more or less noticeable. Against this morbid
condition we do not possess, says Galen, any direct remedy; however, it
can be combated, up to a certain point, by strengthening the gums with
astringent medicaments, so that they may close tightly around the teeth
and thus make them firm.

Dental caries is produced, according to Galen, by the internal action
of acrid and corroding humors, that is, it is produced in the same
manner as those cutaneous ulcers which appear without any influence
of external causes. The cure must consist in acting upon such
vicious humors by means of local or general medicaments according to
circumstances and also in strengthening the substance itself of the
teeth by the use of astringents and tonic remedies.[182]

After these preliminary remarks, Galen gives a minute description of
the numerous remedies which, from his own experience and from that of
other great doctors, were to be considered useful for the cure of the
various affections of the teeth and gums.

Against gingivitis and the pains deriving from it, the best remedy,
according to Galen, consists in keeping in the mouth the oil of the
lentisk moderately warm; noting, however, that such a remedy is the
more efficacious the more recently it has been prepared.

A decoction of the root of the hyoscyamus in vinegar, used as a mouth
wash, is another remedy recommended by Galen against the pains in the
gums. It would also be of benefit to apply on the inflamed gums a
powder composed of one part of salt to four of alum, afterward washing
the mouth with wine or with a decoction of olive leaves. If the gums
are ulcerated, Galen recommends them to be cauterized with boiling
oil, using for the purpose a little wool wrapped around a probe or
toothpick. This medicament, says Galen, greatly modifies the diseased
part, exciting a reparative process in it, to aid which, however,
suitable remedies must be used, and especially frictions with a mixture
of gall-nuts and myrrh reduced to a fine powder.

For the cure of epulides the application of green vitrol, together with
an equal quantity of powdered myrtle and a little alum, is especially
recommended.

In dentition, if the gums are painful, it is advisable to rub them with
the milk of a bitch. The teeth, moreover, appear very readily, says
Galen, if the gums be rubbed with hare’s brain.

Against odontalgia, properly so called, independent, that is, of
diseases of the gums, Galen particularly recommends warm applications,
either on the cheek or directly on the tooth. Externally, on the side
of the pain, may be applied dirty (!) pieces of linen, well warmed,
or else small bags full of roasted salt, or cataplasms of linseed
or barley flour. But if it is desired to act directly upon the sick
tooth, this may be rubbed with a branch of origanum (wild marjoram)
dipped in hot oil, or else, after applying a bit of wax on the tooth,
the heated end of a probe may be laid upon it; or lastly, fumigations
may be made by burning the seeds of the hyoscyamus. In case the above
remedies, or others like them, be found of no use, Galen recommends
them to be adopted anew after having perforated the sick tooth by means
of a small drill. But if even from this no benefit be derived, and it
is considered well to remove the tooth, this can be done without pain
by the application of special medicaments. Among these the root of
pyrethrum kept in very strong vinegar for forty days and then pounded
takes the first place. The remedy is applied after having well cleaned
the sick tooth, and after having covered the others with wax. At the
end of an hour the tooth will have already become so loose that it can
be drawn out with the fingers or with the mere help of a style. The
same effect may be obtained, says Galen, by the application of blue
vitriol mixed with very strong vinegar.

To prevent a carious tooth from producing pain or fetor, he advises the
carious hollow to be filled up with black veratrum mixed to a paste
with honey.

To restore to blackened teeth their whiteness, Galen advises them to
be rubbed with special medicaments, one of which is made up of dried
figs, burnt and pounded, with spikenard and honey. He gives, besides
the receipts of many dentifrice powders and tinctures designed both to
strengthen the teeth and gums and as preservatives against the diseases
of these parts. Such powders and tinctures do not offer any interest
to us, since they do not much differ from those recommended by other
authors whom we have previously quoted.

When one or more teeth, in consequence of a trauma, or from other
cause, become loose and project above the level of the others, Galen
removes the whole exuberant part by means of a small iron file. In
performing this operation, after having covered the gums with a soft
piece of cloth, he holds the tooth to be filed steady with the fingers
of the left hand, using the file in such a way as not to give the tooth
any shock. Besides, he does not complete the operation at one sitting,
but rather interrupts it as soon as the patient feels any pain, and
continues it after one or two days. In the meanwhile, he makes use of
remedies suited to strengthen the loosened teeth, and bids the patient
remain silent and nourish himself with liquid or soft food.

When the teeth, without the action of external causes, become loosened,
Galen holds that this is due to a relaxation of the dental nerve in
consequence of an excessive abundance of humors. In such cases he
counsels the use of desiccative remedies.

Galen, like ancient authors in general, is not very favorable to
the extraction of teeth with the forceps. Even he seems convinced
that a tooth may be made to fall out, without pain, by means of the
application of certain remedies, to which we have already alluded.
However, in one of the Galenic books[183] we find the precept already
given by Celsus, that before extracting a tooth the gums must be
detached all around; from which one may argue that, at least in certain
cases, instrumental extraction was considered inevitable. Galen even
alludes to the pain which sometimes remains after the extraction of a
tooth, and is of the opinion that this depends upon an inflammatory
condition of the stump of the dental nerve.

In Galen are found recorded many means of cure, recommended by
celebrated doctors of ancient times. Elsewhere we have already spoken
of some remedies counselled by Damocrates, by Andromachus the elder,
and by Archigenes. Apollonius, as a medicament against odontalgia,
advised that the juice of the beet root be dropped into the nostrils,
or else a liquid prepared from cumin seed, myrrh, cucumber, and
woman’s milk. Heraclides of Tarentum recommended against the pains and
looseness of teeth that a vinous decoction of black veratrum, mandrake,
and hyoscyamus root should be kept in the mouth. Criton prescribed, for
strengthening loose teeth, that the mouth should be frequently washed
with a vinous decoction of lentisk, myrtle, and gall-nuts.

CELIUS AURELIANUS. In the book _De morbis acutis et chronicis_, written
by Celius Aurelianus (who lived, according to some, in the third
century, according to others, in the fourth or at the beginning of the
fifth), a very interesting chapter on odontalgia is found. He shows
himself to be, for the most part, a follower of Celsus. During the
violence of the pain he advises abstinence from food and rest in bed
with the head somewhat raised. As remedies he recommends several mouth
washes (infusions or decoctions made with wine or vinegar and with
various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil,
poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides,
the application of wool soaked in hot oil on the cheek of the affected
side, or the application of little warm bags, and also that some hot
oil, or the juice of fenugreek,[184] should be kept in the mouth,
or milk with honey. When the pain is excessively violent, he has
recourse to bloodletting, and after two days’ fasting, he begins to
feed the patient with liquid and warm food. If the bowels are closed
he prescribes the use of clysters, and when, in spite of all, the
pain persists, he has recourse to scarified cuppings on the cheek, in
correspondence with the pain. In certain cases he also proceeds to
scarification of the gums, or else he detaches them all around from
the tooth, by means of a special instrument called a _pericharacter_.
It would often turn out useful to apply to an aching tooth a grain of
incense warmed by the fire and wrapped in a thin piece of cloth, or to
press between the teeth, where the pain is situated, several pieces of
cloth, in succession, in which some powder of incense has been wrapped,
and which are dipped into hot oil before being used. The author,
moreover, commends external fomentations made by means of sponges
soaked with emollient decoctions and afterward squeezed; and also the
application of moderately hot cataplasms.

[Illustration: FIG. 33

Roman dental forceps found (1894) at Hamburg, Germany, in the ancient
Roman castle Saalburg. (Geist-Jacobi.)]

When the odontalgia has already become inveterate and recurs in
paroxysms, separated by intervals of calm, Celius Aurelianus counsels,
among other things, that the general health be strengthened by
temperate living, exercise, rubbing of the whole body (an ancient
practice, now revived under the name of massage). He recommends,
besides, special rubbing of the cheeks (to be carried out with a rough
cloth), and also of the gums and teeth, and indicates a great number
of medicaments, some of which are to be used during the paroxysms and
others during the periods of calm. In regard to the use of narcotics,
he very shrewdly observes that such remedies take away sensibility but
not pain. Some doctors of those days, for the cure of odontalgia, had
recourse to sternutatories, or to the dropping of special medicaments
into the nose or into the ear, but Celius Aurelianus seems to have
put but little faith in such means of cure. He, moreover, solemnly
reproaches those who, to cure odontalgia, are too hasty in having
recourse to the extraction of the aching tooth. To remove a part,
says he, is not to cure it; and if every tooth that aches has to be
extracted, it would be necessary to draw them all out when they all
ache. Therefore, before having recourse to extraction, every other
means of cure should first be tried. If the removal of the tooth
becomes indispensable, he advises that it should never be performed
during the violence of the pain, for from this serious consequences
might arise (a prejudice which has not yet entirely vanished, and
which is met with, sometimes, not only among common people, but even
among physicians); and a still greater danger would be the extraction
of teeth neither carious nor loose, seeing that, by consensus, the
muscles, the eyes, and the brain might suffer. The author, on this
point, quotes Herophilus and Heraclides of Tarentum, who related
some cases in which the extraction of a tooth was followed by death.
He alludes, moreover, to a passage of Erasistratus, regarding the
“odontagogon of lead” (_plumbeum odontagogum_) which was exposed in
the temple of Apollo at Delphi; as much as to show that it was not
lawful to extract teeth other than those which were so loose that an
instrument of lead was sufficiently strong to extract them.

When the looseness of the teeth seems to depend upon the flaccidity
of the gums, Celius Aurelianus recommends astringent mouth washes:
decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince,
of myrtle berries, etc.; and besides these, lentiscine oil and asses’
milk, which latter was also believed to possess astringent virtues.
Against hemorrhages of the gums, he advises the use of very fine coral
powder, or of alum with honey.

GNAEUS MARCELLUS EMPIRICUS, of Burdigala (Bordeaux), who lived at the
end of the fourth century and at the beginning of the fifth, wrote
a book, _De medicamenti_, which shows, more than anything else, the
decadence of the medical science in those days. Regarding the diseases
of the teeth and their cure, Marcellus does not tell us anything new.
He freely copies Scribonius Largus and other authors, not adding
anything save a few methods of cure, which are exceedingly strange
and superstitious. To get rid of toothache, it is sufficient that the
patient, when the moon is waning, and in the days of Mars (Tuesday)
or of Jupiter (Thursday), repeat seven times the words _argidam_,
_margidam_, _sturgidam_. It is a great pity that a curative method so
simple and easy be efficacious in two days of the week alone, and even
then on condition that the moon be waning.

The following method is also a very good one: Whilst in the open
country, one must take a frog by the head, open its mouth and spit into
it, then having begged the animal to take the toothache with it, must
replace it on the ground and let it free. To remove loose teeth easily,
it is necessary to keep in reserve some juice of black ivy mixed with
a little green oil; in case of necessity, the nose of the patient
must be anointed with it, and after having drawn a deep inspiration,
he must put a little stone between his teeth, and stay with his mouth
open, inclined a little forward, so as to let all the morbid humor
flow out, which sometimes flows very abundantly and even may reach to
three herminæ.[185] Having afterward rubbed the nose with pure oil, and
washed the mouth with wine, the teeth will be free from every pain and
may be very easily pulled out. If the root[186] of a tooth be rubbed
with dried African sponge, the tooth will fall out within three days;
naturally, says the author, care must be taken not to touch, whilst
doing this, any healthy tooth. He who desires never to be subject to
pain in the teeth, may obtain this end by the following method: When
at the beginning of spring he sees the first swallow, he must go in
silence to some running water, take some of it in his mouth, rub his
teeth with the middle fingers of both his hands, and say: “_Hirundo,_
_tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non
doleant toto anno._”[187]

The same must be done each following year, so as to continue to enjoy
the effects of such a cure!

ADAMANTIUS, an Alexandrine philosopher and physician, who probably
lived in the fourth century, paid much attention to the diseases of
the teeth, as may be argued from two chapters of the _Tetrabiblos_
of Ætius. One of these chapters is entitled, according to the Latin
translation of Giano Cornario: “Cura dentium a calido morbo doloroso
affectorum, ex Adamantio, sophista.”[188] This writer clearly belonged
to the pneumatic school, founded as early as 69 A.D. by Athenæus
of Cilicia. According to the pneumatics (so called, because they
admitted the existence in the animal organism of an aëriform principle,
_pneuma_, to which they attributed great importance), heat and dryness
gave rise to acute maladies; the phlegmatic affections generally arose
from humidity, and melancholy was brought on by cold and dryness, as
every object dries up and becomes cold on the approach of death. The
author says that the cure must vary according as the disease affects
in a greater degree the gums or the teeth themselves with or without
participation of the dental nerves and neighboring parts. He makes,
in regard to this, many subtle distinctions; but the remedies which
he counsels do not offer to us any special interest, being almost
identical with those that had been recommended by Galen and by other
doctors prior to Adamantius. The latter also gives much importance
to dietetic therapy; he prescribes that such patients should nourish
themselves with pottages of barley, or of spelt, with eggs, lettuce,
pumpkins, and other cooling food, abstaining, however, from wine.[189]

The author enumerates among the causes of such dental affections the
dryness of the air, the autumnal season, the dry constitution of the
individual, a troubled life, and scanty nourishment. The use of sour
and piquant substances is not favorable to these patients, so much so
that the mulberry preserve produces, not unfrequently, violent dental
pains in them. Adamantius, therefore, advises, in such cases, not to
use strongly astringent mouth washes, but rather lenitive, moistening,
and emollient substances; simple lukewarm water, decoction of bran,
licorice juice, starch with boiled must of wine diluted with warm
water, milk, especially asses’ milk, decoction of mallows and the
like.[190]

The work of Adamantius from which Ætius has taken the above-mentioned
chapters is lost to us. Of his writings there only remain to us
the treatise _on the winds_ and the one _on physiognomics_. In this
latter book the author attributes great importance to the canine teeth
as physiognomonic elements, and from their shape and size he makes
deductions in regard to the character of the individual.

ORIBASIUS (316 to 403), the most celebrated of all the compilers who
appeared during that long period of decadence, wrote, by order of the
Emperor Julian the Apostate, whose physician and friend he was, a
whole medical encyclopedia and later on a summary (synopsis) of this
same work of his. In the books of Oribasius are found many things
about dentition and diseases of the teeth, but they are all taken,
substantially, from preceding authors, and therefore it is not worth
while repeating them.

ÆTIUS OF AMIDA, a celebrated Greek writer on medicine, lived at the
end of the fifth century, and at the beginning of the sixth, and has
also left us a kind of medical encyclopedia, which, being divided into
four sections, each composed of four books, was called _Tetrabiblos_.
He teaches that the mucous membrane of the gums, tongue, and mouth
is provided with nerves from a portion of the third pair of cerebral
nerves, and that the teeth, too, by a small hole existing at the end
of every root, receive tiny ramifications of sensitive nerves, having
the same origin. The nutrition of the teeth is understood by Ætius in
the following way: The nourishment which reaches the dental nerves is
not entirely assimilated by them; these only appropriate the liquid or
soft part and reject the drier part. This accumulates in the alveoli,
becomes by degrees more tenacious and denser, finally being transformed
into osseous substance and forming the nutriment of the teeth; these,
therefore, tend to grow continually, although the waste arising from
the mechanical action of mastication prevents them from undergoing
any real or visible growth. On the other hand, in the old, from the
weakening of the nutritive functions, the teeth become thin and loose,
and finally fall out.[191]

Ætius advises that during dentition hard objects to chew should not be
given to children, seeing that the gums being hardened by these and
becoming almost callous would render the cutting of the teeth very
difficult.[192]

For curing parulides, he recommends emollients at the beginning of the
disease, and later on astringents. But if the inflammation of the gums
does not resolve and passes into suppuration, he prefers to perform the
excision of the parulis, instead of making a simple incision, which
might very easily cause the abscess to change into a fistula.[193]

The epulis, according to Ætius, is a fleshy excrescence of the
gums, brought on by inflammation. To cure it, he uses, during the
inflammatory period, emollients, and then, when the inflammation has
subsided, astringents and weak caustics. Lastly, if the epulis resist
these remedies, he takes hold of it with a vulsella and proceeds to
remove it with a small scalpel.[194]

When the incision of a fistula of the gums and the use of appropriate
remedies are not sufficient for curing it, Ætius advises the extraction
of the diseased tooth, from which the fistula has its origin.[195]

Apart from what has been mentioned, Ætius does not tell us, in regard
to dental diseases, anything worthy of note, and in many places he only
repeats Galen’s observations.

PAUL OF ÆGINA (seventh century) establishes a very clear distinction
between epulis and parulis. The epulis is a fleshy excrescence of the
gums in the neighborhood of a tooth; the parulis is an abscess of the
gums. To cure the former affection it is necessary, says the author,
to seize and stretch the tumor with a vulsella or with a hook and to
perform its excision. As to the parulis, although not unfrequently it
is sufficient, for curing it, to give an exit to the pus by means of
a slight incision, the author, however, usually prefers the method of
cure recommended by Ætius, viz., excision. After such operations he
orders the patient to rinse his mouth with wine and on the morrow with
hydromel.[196] From the third day onward he sprinkles the wound with
a cicatrizing powder, until a complete cure is obtained. But if the
wound, instead of healing, be transformed into a putrid ulcer resisting
all the ordinary means of cure, it is necessary to cauterize the part
affected with an oval-shaped cautery.[197]

In extracting a tooth, the operation is begun by detaching the gum all
around it as far as the alveolar border; then the tooth is seized with
the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus,
recommends that before extracting a tooth deeply attacked by caries,
the cavity be filled up with lint, in order to avoid the crumbling of
the tooth under the pressure of the instrument. On the other hand, he
too is convinced that a diseased tooth can be made to fall out without
pain, by the use of suitable remedies.

When supernumerary teeth cause an irregularity of the dental arches,
this must be corrected, says the author, either by resection of such
teeth, if they are very firm, or by their extraction.

If a tooth projects above the level of the others, the protruding part
must be removed with the file. This instrument must also be employed to
remove the sharp edges of broken teeth.

Tartar incrustations must be removed either with scrapers or by means
of a small file.[198]

During the period of dentition one must not give children any food
which requires mastication, and to soften the gums they must be
anointed with hen’s fat or with hare’s brain.[199]

To preserve the teeth and to keep them healthy, Paul of Ægina
recommends all tainted food to be avoided, and also all possibility of
indigestion and frequent vomitings; the use of very hard or glutinous
food or of such as may easily leave a residuum between the teeth, for
example, dried figs, and likewise very cold food and such as set the
teeth on edge. He also advises that hard things should never be broken
with the teeth and that the latter be carefully cleaned, especially
after the last meal of the day.[200]

Paul of Ægina also belongs to the class of compilers; but in utilizing
the writings of the great physicians who had preceded him, he gives
evidence of exquisite good sense, and not infrequently subjects the
assertions of his predecessors to an intelligent and enlightened
criticism. Besides, he inserts here and there observations and
experiences of his own that are not without interest. He has always
been, and rightly so, considered one of the greatest physicians of
ancient times, the great reputation which he justly held among the
Arabs contributing not a little to his renown.

This author is the last of the Byzantine period, and with him,
therefore, we must close the earlier part of the history of dentistry.
If, before passing to the middle period, we cast a glance over the
ground already traversed, it is easy to perceive that dental art, in
ancient times, reached its highest degree of development at the time
when the Roman civilization was in its greatest splendor, when, in the
capital of the world, wealth, luxury, and the refinements of social
life marvellously increased its needs, and by this also gave an impulse
to the evolution of all human activity. But ancient civilization,
after having reached its culminating point, soon fell into decadence,
and this necessarily would result in a hindrance to the development
of dental art. From the days of Archigenes right up to those of Paul
of Ægina, dentistry did not make the least progress; indeed, as far
as prosthetic dentistry is concerned, there was probably a retrograde
movement, it being very likely that when Italy was subject to the
dominion of the barbarians and when Christianity—which but recently had
asserted itself—was strongly imposing on the human mind a deep contempt
for all that regarded the welfare and beauty of the human body, no one
could, any longer, think of artificially repairing the losses sustained
by the dental system through disease or injury.

PART II.

SECOND PERIOD—THE MIDDLE AGES.

CHAPTER VIII.

THE ARABIANS.

The religious fanaticism excited by Islamism, transformed the obscure
and nomad inhabitants of Arabia into a conquering nation, who very soon
extended their power over a considerable part of Asia, Africa, and
Europe. Spain, invaded by the Arabs in 711, fell almost entirely into
their hands. After having by force of arms rendered themselves powerful
and dreaded, the Arabians acquired also great fame by the culture of
art and science within the limits allowed them by their religious
code; and in these, for more than four centuries, they maintained an
incontestable preëminence.

Unfortunately, as the Koran most absolutely prohibited the dissection
of dead bodies, all serious anatomical research was thereby rendered
impossible. This was a very great hindrance to the progress of anatomy,
of physiology, and, in consequence, of the whole of medical science.
The Arabians certainly had the merit of keeping alive the study of
medicine in an age of decadence and barbarism; but, apart from the
important progress realized by them in chemistry and pharmacology,
it may be affirmed that the Arabs contributed but scantily to the
development of the healing art; they followed almost entirely in the
footsteps of Galen and other ancient, and especially Greek, authors.

One of the characteristics of Arabian medical art consists in the
aversion to bloody operations and in the effort to avoid them. A like
tendency shows itself also in the sphere of dentistry; the Arabians,
even more than their Greek and Roman predecessors, were reluctant to
extract teeth, and employed all possible means, in order to avoid the
operation.

RHAZES (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was
born in Persia toward the middle of the ninth century, and gave himself
up to the study of medicine when about thirty years of age, having
previously been a musician. He wrote many works which, unfortunately,
have, for the most part, been lost. Rhazes did not have recourse to
the extraction of teeth, save as a last resource when every other
attempt at cure had proved useless; which method would no doubt have
deserved high praise, had the author been inspired by the principles of
conservative surgery, rather than by unjustifiable fears. Caries of the
teeth is, according to him, identical with that of the bones. To hinder
its progress and propagation to the neighboring teeth, he advises the
carious cavity to be filled with a “cement” composed of mastic and
alum. We have here a laudable attempt at permanent stopping of decayed
teeth, although it is clear that the duration of such stopping, owing
to the nature of the materials employed, could not be a long one.
Furthermore, he counselled the patient to abstain from the use of acid
food or drink and to rub the teeth with powder of gall-nuts and pepper.

To strengthen loosened teeth, he recommended astringent mouth washes
and sundry dentifrice powders. Others, partly taken from Galen, are
recommended by him for prophylactic purposes and for cleansing and
beautifying the teeth.

Against periodontitis and the pains produced by it, he sometimes had
recourse to bleeding. He commended, besides, opium, oil of roses,
pepper, and honey, and also the scarification of the gums and the
application of a leech. If, however, these remedies did not succeed, he
applied his theriac, which was composed of castoreum, pepper, ginger,
storax, opium, and other ingredients, to the roots of the teeth. If
even this method of cure failed, he touched the root of the diseased
tooth with a red-hot iron, or sought to provoke its fall by the use
of special medicaments, such as coloquintida and arsenic (a substance
to which he had recourse, particularly in those cases where there was
ulceration of the gums). It is no wonder that such means of cure would
sometimes produce, as a final result, the actual falling out of the
tooth; and this, as is natural, served to strengthen the belief that
the same result could also be obtained with less energetic remedies,
but which were supposed to be equally endowed with expulsory virtues.

Rhazes relates an interesting case of regeneration of a whole lower
jaw; he, however, observes that the newly formed osseous mass was less
hard than the original bone.[201]

ALI ABBAS, another great Persian physician (who died in 994), wrote a
lengthy treatise on theoretic and practical medicine, one chapter of
which is dedicated to the diseases of the teeth. When a molar tooth
is affected by caries, and the pain cannot be subdued in any other
way, Ali Abbas applies, inside the carious cavity, the end of a small
metallic tube, into which he repeatedly introduces red-hot needles,
leaving them in the tube until quite cooled. Should even this have no
effect, he tries to provoke the fall of the tooth by the application of
asses’ milk with assafetida, or, finally, extracts it.[202]

He cures epulis, like Paul of Ægina, by excision. As to parulis, or
abscess of the gums, he opens it with a lancet or a wooden stylus.

When the dental arch is deformed by the existence of supernumerary
teeth, he removes these with an instrument in the shape of a beak.[203]

SERAPION (Jahiak Ebn Serapion), who lived in the tenth century, and
up to the beginning of the eleventh, contributed but slightly to the
development of medicine and dentistry, as he was in his writings little
more than a mere compiler. He indicates with great precision the number
of dental roots, and expresses an opinion that the upper molars have
need of their three roots in order to keep firm in spite of their
pendent position, whilst two roots alone are sufficient to keep the
lower molars in place, on account of the support which they receive
from the jaw. Serapion, like Galen, admits the nutrition and continual
growth of the teeth—a growth which is produced in the same proportion
as the waste due to mastication—and he too makes the dental diseases
depend upon an alteration in the nutritive process, either by excess or
by defect.

Against dental pains of phlogistic origin, he recommends bloodletting,
purgatives, and many local medicaments, reproduced in great part from
Rhazes. In cases of persistent odontalgia due to caries, he advises, as
an excellent remedy, the application of opium in the carious cavity.
To strengthen loosened teeth, he first employs astringents, and if
these are of no use, as often happens in the old, he binds the loose
teeth together and to the neighboring healthy ones, by means of gold or
silver wire.

In Serapion, too, we find many formulas for dentifrice powders, some of
which are intended simply for cleaning the teeth, others for special
prophylactic or curative purposes.[204]

AVICENNA. One of the greatest luminaries of medicine among the Arabs
was Avicenna (Ebn Sina). He was born in 980 son of a high Persian
functionary; he lived a very adventurous life, held some very high
places, and died in 1037. Among his works, the most important is the
_Canon_, a book which procured him the title of “second Galen” and the
still more pompous one of “prince of doctors.” A very evident proof of
the immense fame which he acquired is the fact that among many oriental
peoples Avicenna, even in our own days, is considered the greatest
master of medicine.

The anatomy and physiology of the teeth are treated by Avicenna very
minutely, but nevertheless he does not teach us, in regard to these,
anything new. Like Galen, Avicenna admits that the teeth continually
grow, and as a proof he gives the fact of the lengthening of the teeth,
which, owing to the absence of antagonists, are not subject to any
pressure or friction.

He gives much good advice with regard to the preservation and
cleanliness of the teeth, to which he attaches very great importance;
and on this point he remarks that the use of very hard tooth powders
must be avoided, as these are liable to injure the dental substance. To
this latter are also harmful, says the author, some narcotic remedies,
employed against odontalgia. Burnt hartshorn is, according to him, a
most valuable dentifrice. To remove tartar from the teeth, he indicates
many remedies, and especially dentifrices of meerschaum, salt, burnt
shells of snails and oysters, sal ammoniac, burnt gypsum (plaster
of Paris), verdigris with honey, etc. Among the substances able to
facilitate dentition, he enumerates several oils and fats, besides the
brain of the hare and the milk of the bitch, and he disapproves the
custom of giving to children, during dentition, hard objects to chew,
in the erroneous belief that the biting of such objects is useful in
facilitating the cutting of the teeth; he recommends, instead, the gums
to be rubbed with the fingers. When the teeth begin to appear, he drops
some oil into the ears of the child and covers its head, neck, and jaws
with a plaster spread on cotton that has been soaked in oil.

Avicenna minutely examines the various causes of odontalgia, and among
them includes also the little worms by which the dental substance was
supposed to be gnawed away.

When a tooth becomes the seat of intense pain, accompanied by a
throbbing feeling, Avicenna considers that this is due to an excessive
accumulation of humors in the root; he therefore advises, as already
Archigenes had done, the tooth to be drilled, in order to empty it, and
afterward to introduce into it appropriate remedies.

According to Avicenna, he who has a loosened tooth and desires to make
it firm again, must avoid using it in mastication, must not touch it
with the fingers, nor move it with the tongue; besides this, he must
speak as little as possible, and make use of astringent remedies.

To remove a tooth, Avicenna made use of either the forceps or the
“eradicating remedies,” in which he, too, had full confidence. Like
the greater part of his predecessors, Avicenna is of the opinion that
the extraction of a firm tooth must be avoided as much as possible, as
it may give place to an injury of the jaw, or become harmful to the
visual organ, or bring on fever. On this point he remarks that, if an
aching tooth appears to be sound, it is not always necessary to perform
its extraction in order to cause even the most rebellious odontalgia
to cease; in certain cases he obtained a complete cessation of the
pain after having simply shaken the tooth without completing its
extraction; which according to him was due to the double reason that by
shaking the tooth a resolution of the morbid matter stagnating under it
is provoked, and the action of the medicaments that are afterward made
use of is thus favored.

Among the eradicating remedies, the author enumerates white arsenic,
orpiment, coloquintida, tithymallus, the fat of frogs, and others. He
remarks, however, that before using them it is advantageous to detach
the gum all around.

Against the supposed worms in carious teeth, he praises fumigations
made with the seeds of the hyoscyamus, garlic, or onion.

Arsenic is used by him not only for the above-mentioned purpose, but
also for the cure of fistulas and foul ulcers of the gums.

When a tooth has become abnormally long, Avicenna makes use of the file
to reduce it to a proper size; and in performing such an operation, he
holds the tooth firmly between the fingers, or with a pair of pincers
suited for the purpose. As a consecutive treatment, he prescribes