A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century

To afford support and maintain the three artificial teeth in position, the Etruscan dentist of about three thousand years ago, ingeniously made use of the canine and the lateral incisor on the right, the canine, the first bicuspid, and the first molar on the left, connecting them by a continuous series of pure gold rings soldered together. The dentist had not employed human teeth to replace the incisors which the individual had lost; according to the religious laws of the time, the dead were held sacred, and it would probably have been considered sacrilege to use their teeth; or it may also be that the patient had declared his aversion to the idea of substituting his own teeth by those of a dead man. However this may be, the Etruscan dentist thought well to replace the missing incisors with a somewhat large ox tooth; upon this he had made a groove, so as to give it the appearance of two teeth. In reality this ox tooth occupies the place not only of the two middle incisors, but also of the lateral incisor on the left. Perhaps by a natural anomaly the individual may never have had this tooth; or, more probably still, some length of time may have elapsed between the loss of one of the three and the other two, so that when he made up his mind to have recourse to a prosthetic appliance, the space normally occupied by the three incisors was already notably diminished, and the void could therefore be filled by an ox tooth so adjusted as to represent only two teeth.

Fig. 16

Fig. 17

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.

Fig. 18

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.

Fig. 19

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.

Fig. 20

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.

Fig. 21

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.

Fig. 22

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.

Fig. 23

Fig. 24

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.

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 Medicina113 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 mulse115 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 minium116 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 grape119 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 paper124 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.”

Fig. 27

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 hemina150 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 sextaries151 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 murex152 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 gagates154 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.