To these words, literally translated from Renan’s work, we will only add the following considerations:
Egypt was, in its time, a great centre of civilization, whose influence was strongly predominant in all the neighboring region, and especially in ancient Phœnicia and in its large and industrious cities Tyre and Sidon. The remains discovered in many of the Phœnician tombs would of themselves alone be sufficient to demonstrate luminously the enormous influence exercised by the Egyptian civilization on the life and customs of that people. Now, if there were dentists in Sidon capable of applying false teeth, it may reasonably be admitted that the dentists of the great Egyptian metropoli Thebes and Memphis were able to do as much and more, the level of civilization being without doubt higher there than in Tyre or in Sidon, or in other non-Egyptian cities.
In the Hebrew literature, as principally represented by the Bible and by the Talmud, there does not exist any book on medicine. Notwithstanding the vicinity and the close relations of the Hebrews with Egypt, medical science never reached the degree of development among this people that it did in the land of the Pharaohs.
In the Bible we do not find the least trace of dental medicine or dental surgery. Indeed, although the books of Moses contain a great number of exceedingly wise hygienic precepts, there are not any that refer directly to the teeth or to the mouth. We may therefore conclude, with a certain degree of probability, that the Hebrews had in general good teeth and that dental affections were very rare among them.
The word tooth or teeth occurs in the Bible more than fifty times,23 but very few of the passages in which it is to be met with present any interest so far as our subject is concerned.
That the Hebrews attached great importance to the integrity of the dental apparatus is plainly seen from the following verses of the book of Exodus (xxi: 23 to 27):
23. ... thou shalt give life for life,
24. Eye for eye, tooth for tooth, hand for hand, foot for foot,
25. Burning for burning, wound for wound, stripe for stripe.
26. And if a man smite the eye of his servant, or the eye of his maid, that it perish; he shall let him go free for his eye’s sake.
27. And if he smite out his manservant’s tooth or his maidservant’s tooth; he shall let him go free for his tooth’s sake.
These legislative measures show clearly enough that among the Hebrews the loss of a tooth was considered a lesion of great gravity, as they thought it of sufficient importance to be named in the same category as the loss of an eye, of a hand, or of a foot. If anyone caused the loss of an eye or of a tooth to his servant, the punishment was the same in both cases; that is, he was obliged to give him his liberty, thus undergoing the loss of his purchase money.
Beauty and whiteness of the teeth were also in great repute. Thus we read in the Song of Solomon (iv: 2):
“Thy teeth are like a flock of sheep that are even shorn, which came up from the washing; whereof every one bear twins, and none is barren among them.”
In another part of the Song (vi: 6) he repeats these same words, thus giving it to be understood how great was his admiration for the beautiful teeth of his beloved.
From various passages of the Bible, one perceives that integrity and soundness of the teeth was considered a prime element of force and vigor. In Psalm iii: 7 David says: “Arise, O Lord; save me, O my God: for thou hast smitten all mine enemies upon the cheek bone; thou hast broken the teeth of the ungodly.” (That is, reduced them to impotence.) And in Psalm viii: 6 we read: “Break their teeth, O God, in their mouth.”
On the other hand, in one of the Proverbs of Solomon (xxv: 19), broken or decayed teeth are taken to symbolize weakness: “Confidence in an unfaithful man in time of trouble is like a broken tooth, and a foot out of joint.” (In the Latin translation, instead of “broken tooth” stands “dens putridus.” Perhaps the corresponding expression in the Hebrew language, signifies in a general sense a decayed or injured tooth.)
The uncomfortable sensation produced on the teeth by acid substances (teeth on edge) is to be found several times alluded to in the Bible. In the Book of Proverbs (x: 26), one reads: “As vinegar to the teeth, and as smoke to the eyes, so is the sluggard to them that send him.” And Jeremiah says (xxxi: 29, 30): “In those days they shall say no more, The fathers have eaten a sour grape, and the children’s teeth are set on edge. But every one shall die for his own iniquity; every man that eateth the sour grape, his teeth shall be set on edge.”
As is apparent, there is nothing in the passages quoted that can be in any way connected with the treatment of dental affections; neither is it to be wondered at, when one reflects that even in the Talmud—which is much less ancient—medicine in general is hardly at all spoken of. This famous code as to practical life is almost silent with regard to therapeutic medicine, and only recommends hygienic practices. An axiom of the Rabbi Banaah is worthy of note, and may be quoted here as bearing on the subject, and also because many Christians might be found to conform willingly thereto:
“Wine is the best of all remedies; and it is in places where wine is wanting that one is in need of pharmaceutic remedies.”24
For above 4000 years science and religion among the Chinese, as well as their customs, have remained quite unchanged. The inhabitants of the Celestial Empire can vaunt a most ancient civilization; which is, however, altogether stationary; neither has their medicine made any progress, and its actual state represents with sufficient exactness what it was in primitive ages.
In Europe, various works have been written about the medicine of the Chinese, one of the best being that of Dabry,25 taken from the most celebrated medical books of China,26 and which may be considered as a compendium of the medical science of this people.
In this work we find two chapters relating to our specialty: the first of these (p. 286) speaks of toothache, the second (p. 292) treats of all the other dental and gingival diseases.
The Chinese call the toothache ya-tong, and distinguish a great many varieties of the malady, that is:
1. Fong-je-tong. This kind of toothache is caused by sudden cold, and has the following characteristic symptoms: Red and swollen gums, which after a little time discharge purulent and fetid mucus; abundant salivation; acute pain; swelling of the cheek. It is to be cured with draughts, mouth washes, and various kinds of frictions.
We consider it useless to give the particulars of the various receipts, because Dabry hardly ever translates the names of the drugs of which they are compounded. These formulæ are therefore incomprehensible by most people.
2. Fong-lan-tong. This kind of toothache is also caused by cold. The pain is very great, but the gums are neither red nor swollen.
3. Ye-tong. Is also produced by chill. The gums are red and swollen; there is no discharge of mucus; great pain, which is aggravated by cold liquids. If the malady lasts for some time, the gums end by becoming black, and the teeth are loosened; the pain becomes more intense in spitting. In this stage of the malady the sufferer no longer fears cold drinks, but rather desires them, to soothe the pain. The cure varies according to whether the malady be of recent or of old date; it consists in the use of internal remedies (pills, potions), or of frictions on the part where the pain is situated.
4. Han-tong. This is also owing to the action of the cold. Pains in the cheek and forehead proceeding from the teeth; no diseased condition either of the gums or of the alveoli.
5. Tou-tan-tong. Violent cough and toothache at the same time; difficulty in masticating.
6. Yn-hiue-tong. The gums are pale, or violet-red, hard and lumpy, sometimes bleeding; the toothache is continuous. Among the numerous remedies recommended against this malady (mouth washes, frictions, draughts, pills), one particularly deserves mention: it is the urine of a child used as a mouth wash.
7. Tchong-che-tong. Pain in the teeth after mastication; there is also sometimes excoriation of the gums; flow of purulent mucus mixed with blood; bad-smelling breath; the tooth falls; it is decayed, and one can perfectly well distinguish a small hole; the root is unsound; in extracting the tooth one sometimes brings away together with it a little white worm, with a black spot on the head, which can be distinguished by the aid of a magnifying glass. A remedy must immediately be administered to destroy these worms, otherwise the patient runs the risk of having his other teeth attacked in the same manner, and of their falling out. The remedies against this affection are most numerous, and belong for the most part to the oftentimes cited categories. One of them presents a certain interest, its basis being arsenic.
In Dabry’s book it is described in the following manner: “Arsenic (gr. 1.80), houang-tan (gr. 3.60); pulverize, mix with water, and with a part of the mass form a small pill, which put close to the aching tooth or into the ear, if afraid of the arsenic; then sleep. Cure certain.”
8. Toothache, the effect of general weakness, following principally on abuse of coition. It is to be cured by the use of internal medicine, or by local remedies to be rubbed on the painful spot. Some of the medicaments registered in this paragraph have reference to the special case, in which the teeth are loosened through excess of coition. Among others there is a prescription for a dentifrice powder for strengthening the teeth, to be used every morning.
9. Toothache following on a blow. It is to be cured by using a certain dentifrice powder, composed of six ingredients. Another medicament consists in heating about an ounce and one-half of silver in some recipient, and then pouring wine upon it, and rinsing the mouth with it.
Besides these nine kinds of toothache, the Chinese doctors recognized a peculiar morbid condition of the teeth and their surrounding parts, which is thus described in Dabry’s book:
“It sometimes occurs, after recovery from illness, that convalescents, in order to acquire strength, drink too great a quantity of wine; and that this after a certain time produces a beginning of inflammation of the stomach. In such cases the teeth often fall out, the breath becomes fetid, and if the patient eats hot food, the empty alveoli as well as the cheeks are painful.”
Various internal medicaments and dentifrice powders are prescribed for combating this morbid condition. One of these latter includes a great number of ingredients in its composition; among others, the bones of mice.
Mention is also made of certain remedies, to which recourse may be had at times, for allaying violent dental pains, of whatsoever kind, or whatever be the cause that occasions them.
One of these remedies is composed of different substances (among them, garlic and saltpetre), to be pulverized and made into pills. If the pain be on the left side, one introduces one of the pills into the right ear, and vice versa.
The formula is also given for a very complicated medicated powder, to be snuffed up in the left nostril if the person suffering from toothache be a man; in the right if a woman.
Another powder is to be smelt with the right nostril or with the left, corresponding to the side on which the pain is located.
Abscesses and fistulæ of the gums are spoken of as follows:
“It sometimes occurs that an abscess forms in some one point of the gum; this communicates great pain to the tooth near it; the abscess is white, with discharge of purulent matter.” The treatment consists in the use of different medicated powders, to be rubbed on the affected part. Two of the powders contain musk, besides several other ingredients. A lotion is also prescribed.
In the next chapter the following affections are described:
1. Ya-heou. Gums are red, soft, and swollen, and a fetid and purulent matter exudes from them; the teeth are not painful; if the gums are lanced, blood of a pale red color flows from them in abundance. This malady is to be treated with various internal medicines and sometimes with scarification.
2. Ja-suen. Gums swollen; little by little they are corroded and destroyed by ulceration, which leaves the roots of the teeth bared; the patient has an aversion for hot food; continued pain in the teeth; discharge of purulent and fetid mucus; by the slightest exposure to cold the pain becomes very violent. This affection is to be combated with internal remedies and local treatment (frictions with medicated powders; application of an ointment of very complicated preparation).
3. Tchuen-ya-kan. The gums are painful for a few days; apparition of the root of the tooth; absence of ulceration. Children of five or six years of age are frequently exposed to this malady. The best means of cure consists in the extraction of the tooth. There are, besides, various internal and external remedies prescribed. One of these latter contains verdigris and three other ingredients. Among those to be used internally there is a decoction prepared with twelve different drugs, two of which are mint and rhubarb. The quantity of rhubarb is about seven and one-half grams; therefore, this prescription is certainly intended to act as a purgative.
4. Ya-ting. The right or left gum suddenly swells; a tumor forms of about the size of a grain of sorgo; in the beginning it is red, afterward black; severe pain in the cheek and neck; itching in the cheek; the tumor afterward bursts, giving exit to blood, and becomes black; it ought to be pricked directly (before it opens of itself) with a silver needle; blood of a violet color will flow from it, which should be left free course until it regains its ordinary color. The sufferer has at the same time pains in the stomach, great thirst, abdominal pains, and sometimes even delirium.
5. Ya-jong. Gums swollen and painful, abscess, fever, swollen cheeks; great thirst, and vomiting of a liquid kind; dejections dry. The treatment consists in the methodical use of certain medicines to be used internally, among which is rhubarb. If one neglects to make use of this treatment, an ulceration sets in with discharge of a purulent and sanguine mucus; it is then necessary to rub the part with a medicinal substance called by the Chinese, ping-pang-san. Should the tooth be somewhat loose, it ought to be extracted and the gum rubbed again with the substance just now named.
6. Tso-ma-ya-kan. An illness common to children after the smallpox; ulceration of the gums, which turn black; fetid breath. In certain cases the gums are hard and the mucous membrane of the cheek is also attacked; all the teeth shake; there is flow of blood from the gums, upon which certain spots begin to form that are clearly distinguishable as small holes. These holes must be filled with a particular medicinal substance (named lay-ma-ting-kouei-sse), and, besides, one ought to make use of various other internal and external remedies.
This is a very serious illness. In the case of recovery, the patient ought to abstain from taking any heating aliment for one hundred days.
7. Tsee-kin-tong or tsee-ly-tong. Gums swollen; slight but continuous pain, aggravated by the effort of the wind; the gums become ulcerated little by little, with discharge of purulent and sanguine mucus; and the root of the tooth is afterward seen to be uncovered. This malady is to be treated by means of draughts, pills, mouth washes, and frictions of various kinds.
After the treatise on the maladies referred to above, we find in Dabry’s book a long series of “general remedies for every kind of toothache.” There are about forty of these, and decoctions and powders predominate among them, the latter to be rubbed on the painful spot. Decoctions are the form of medicament most in use among the Chinese. In this list of about forty anti-odontalgic remedies we find as many as eighteen decoctions, seven for internal use, and the others to be employed as mouth washes. Some of the latter are compounded with vinegar instead of with water.
Four remedies of the above list are to be made into a paste and formed into pills, to be applied upon the aching tooth.
Another medicament is also to be formed into pills and applied inside the ear.
The following remedy is particularly worthy of note:
“One roasts a bit of garlic, crushes it between the teeth, and afterward mixes it with chopped horseradish seeds, reducing the whole to a paste with human milk; one then forms it into pills; these are to be introduced into the nose on the side opposed to that where the pain is situated.”
Two other remedies, in powder, are to be snuffed up through the nose.
A powder to prevent the progress of caries is prescribed, with which the tooth should be rubbed every day, or it may be applied on the decayed spot.
Finally, two powders are also prescribed for whitening the teeth. One of these is compounded of seven ingredients, among which is musk; the other has only three substances in its composition: salt (gram 25), musk (gram 1.8), tsang-eul-tsee (gram 36).
A therapeutic method much in vogue among the Chinese is acupuncture, which is used in the treatment of the greatest variety of affections, including those of the dental system. The doctors of the Celestial Empire have the greatest faith in this operation, which they hold capable of removing obstacles to the free circulation of humors and vital spirits, thus reëstablishing that equilibrium of the organic forces which constitutes health, and the absence of which causes disease.
The Chinese doctors prefer to use gold or silver needles for puncturing; but they also frequently use needles of the best steel. These instruments vary very much in length, in thickness, and in form, and there are not less than nine distinct kinds of puncturing needles.
Every doctor who intends dedicating himself to the practice of this operation has to begin by the most accurate study of the elective points for puncturing according to the various affections; he should also know to what depth precisely to drive the needles in each case, in order to reach the site of the morbific principle and procure convenient exit for it; he ought to know equally well how long to leave the needle in the affected part, so as to obtain the best possible therapeutic results in each case.
The points of election for carrying out puncturing in various maladies are spread over the whole superficies of the body, and amount in number to 388. Each of these is known by a special name. Each site of election stands in determinate relations, as to distance, to the known anatomical points, and may, therefore, be easily and precisely found by appropriate measurement. The unity of length for these measurements is called tsun, and is divided into ten fen; its value varies, however, according to whether the said measurements be taken on the head, the trunk, or the extremities. For the head, the length of the tsun is calculated as equal to the distance existing between the inner and the outer angle of the eye; for the trunk, it is equivalent to the eighth part of the horizontal line between the two breast nipples; and for the extremities, it is equal to the length of the second phalanx of the middle finger, measured with the joints bent.
There are twenty-six points of election upon which to carry out puncturing used as a remedy against toothache. There are also six other points of election for pains in the gums.
One would naturally be disposed to believe that these points of election would be situated in proximity to the teeth. Instead, many of them are situated in distant parts of the body—for example, in the elbow, in the hands, the feet, the vertebral region, the coccyx, and so on. However, about half of them are to be found in the labial, maxillary, and periauricular regions.
The puncturing of every point of election is almost always indicated for the cure of not only one but several, and, indeed, very often many, maladies; for example, the puncture carried out on the point of election, kin-tche, situated at the outer extremity of the bend of the elbow, may be utilized in more than twenty-five morbid conditions; among which are pains in the arm, paralysis of the arm, edema of the whole body, excessive perspiring, vomiting, hematemesis, toothache, boils, gastralgia, hemiplegia, and even cholera!
This mode of cure depends on the special relation of each point of election to the so-called canals of transmission and communication (named in Chinese king) through which the blood and the vital spirits circulate, and which serve at the same time to transmit the “innate heat” and “the radical moisture” to all parts of the body.
And here we must be allowed a brief digression in explanation of what we have just said.
The anatomical notions of the Chinese are very erroneous;27 their ideas on the functions of the human body and of human life in general, differ considerably from ours. They recognize two natural principles of vitality, one they call yang (vital, primordial, or “innate heat”), the other yn (radical moisture). The spirits (that is the air) and the blood serve as vehicles to these two essential principles of life; that is, vital heat and radical moisture. The constant equilibrium, the accord, the perfect union of these two essential principles of life constitute a state of health. From their alteration, corruption, or disunion originate all diseases.
There are twelve principal sources of vitality in the human organism; that is, twelve organs from which the two aforesaid vital principles are distributed throughout the body: The heart, the liver, the two kidneys, the lungs, and the spleen are the seat and origin of radical moisture; the large and the small intestine, the two ureters, the gall-bladder, and the stomach are the seat and origin of vital heat. These twelve sources of life are in intimate relation with one another by means of the canals of communication, through which the blood and the vital spirits (air) circulate, carrying with them into every part of the body vital heat and radical moisture.28
The points of election upon which to carry out puncturing are situated along the course of the large lines of communication and transmission; and that explains, according to the Chinese medical theories, why a puncture carried out on a given point of the body can prove useful in relieving a variety of maladies even in distant parts of the organism.
Puncturing is almost always associated with cauterization, for after having drawn out the needle, it is usual to cauterize the site of the puncture with the so-called “moxa,” that is, with a kind of vegetable wool obtained from the leaves and dried tips of the artemisia. One compresses this substance very tightly between the fingers into the shape of a small cone. One next applies a small coin with a hole in the centre upon the site of election; the cone of moxa is placed on the hole in the coin and lighted at its top. As the cone is very compact, it burns slowly enough, without developing excessive heat, so that, according to Ten Rhyne,29 who was an enthusiast for this mode of cure, “the epidermis is drawn without violence and rises gently into a small blister. The moxa, whilst burning, draws out the peccant humors visibly, absorbing them in such a manner that they are totally consumed without destroying the skin itself.”
The application of the moxa is not as painful as might be thought, and even children support it without much crying. The number of times for repeating the operation varies according to the malady and the site of application, etc. Thus, in the point kin-tche, which we have mentioned once before, the cauterization is generally repeated seven times, but in certain cases the number may be brought up to 200.
There are certain points of election for which puncturing alone is prescribed without subsequent cauterization; in other instances, the puncturing is held to be unnecessary or even dangerous; one, therefore, only applies the moxa in these cases.30
In Japan, the moxa was still more in use than in China. According to Ten Rhyne, from the remotest times the moxa has been the best and almost the sole mode of treatment for illness in Japan, and was regarded not only as an excellent remedy, but also as an excellent preservative; so much so that even convicts condemned to perpetual imprisonment had permission to go out every six months to undergo this cure.
Dental affections also were especially treated with the moxa, and, judging by what Ten Rhyne says on the subject, it would seem that this caustic, when used against toothache, was usually applied in the region of the mental foramen.31
Joseph Murphy, in his book, A Natural History of the Human Teeth,32 says that the natives of Hindostan, especially the Brahmins or priests of Brahma, take extreme care of their teeth. Every morning they rub them for about an hour with a small twig of the fig tree, at the same time that, turned toward the rising sun, they recite their prayers and invoke Heaven’s blessing on themselves and their families. As this custom is prescribed in the most ancient codes and religious writings of India, it reverts, without doubt, to the remotest ages, and, therefore, demonstrates the great importance that this people, and particularly the Brahmin caste, has ever attributed to beauty and cleanliness of the teeth. Murphy affirms that the Brahmins, in general, have magnificent teeth; and that this depends, certainly in great part, on the assiduous and scrupulous care that they take of them.
From the writings of their ancient poets one also deduces in what high esteem the people of India held beautiful teeth, considering them one of the principal ornaments of the face. The lover, says Murphy, never neglected, in enumerating the beauties of his lady-love, to praise the whiteness and regularity of her teeth.
Among some of the people of India, when the second dentition is completed, it is customary to separate the teeth one from the other with a file; we do not know, however, whether this is done as an embellishment or with some other object—perhaps, as suggested by Joseph Linderer,33 to prevent caries.
Anyhow, this and other customs in vogue in various parts of India and in many islands of Oceanica demonstrate that these peoples attribute great importance to the teeth.
The substituting of gold teeth for those missing has been in use in Java from exceedingly remote times.34
Dyeing the teeth black is considered a great embellishment among many races of Asia and Oceanica; this operation is sometimes preceded by another, viz., the filling up of the interdental spaces very cleverly with gold leaf.35
In Sumatra and the neighboring islands many women file their teeth down to the gums; others file them into points; or partially remove the enamel so as to render it easier to apply the black dye; this being held to be the height of elegance. Men of high rank and condition dye their upper teeth black and cover the lower ones with fine gold plates, which in a full light produces what they consider a fine contrast. The natives of other islands gild the upper central incisors and dye the others black.36
In Japan, the married women may easily be distinguished from the others by their black and shining teeth. The coloring preparation they use to blacken the teeth is composed of urine, raspings of iron, and a substance called saki. This mixture has a most unpleasant odor, and if applied on the skin acts as a caustic. Its action on the teeth is so powerful that they do not regain their whiteness even after a lapse of years. In applying this substance, and also for some time after, the women take care to preserve their gums and lips from its effects, as it would otherwise cause them to assume a dark blue tint.37 The inhabitants of the Pelew Islands make use of the wild thistle and shell chalk to blacken the teeth. It is also the custom to blacken the teeth among the inhabitants of Tonkin and Siam, the women of the Maria Islands, and the single ladies of Java.
Some of the peoples of Eastern India plane their teeth down to an even level; and from the habit of masticating areca nuts mixed with chalk and other substances, their lips and teeth are dyed red. At Macassar the natives have their teeth dyed red; they also substitute missing teeth by artificial ones made of gold, silver, or tombac.38
Negroes, especially those of Abyssinia, very often file their incisors into points to resemble the form of the canines; this is in order to give themselves an air of greater ferocity.
Murphy relates that the inhabitants of one of the islands of the Sound make an incision in the upper lip in a parallel line with the mouth, and large enough to allow the tongue to pass. After the margins have healed they have a great resemblance to the lips. This kind of artificial mouth is made to support a shell, carved in such a manner as to produce the effect of a row of teeth.
The natives of the Sandwich Islands sacrifice their front teeth to conciliate the favor of their god Eatoa.39
Among the natives of New South Wales, it is the custom when a youth reaches virility to knock out his front teeth with a stone; this operation being carried out by the kuradshis or wizards.
The savages of Peru are also in the habit of making the front teeth fall out; the reason of the custom is that the space thus made is regarded by them as an embellishment.40
An ancient Greek physician—Asklepios, afterward called Æsculapius41—by the ability he displayed in the art of healing, so impressed the minds of the simple and uncultured at that primitive epoch as to be held in repute rather as a god than as a man. Not only was he held to be the author of wonderful cures, but it was also affirmed that he had resuscitated the dead; no doubt from his having in some case or other of apparent death restored the individual to consciousness by the assistance he rendered him. Exaggeration, so natural to ignorant minds, afterward did the rest, and magnified the healing and restoring powers of Æsculapius to such an extent that it is not to be wondered at that he should have been looked upon as a divine being. With the lapse of time, various traditions formed around his name, among which there was, however, finally such discrepancy that the popular voice spoke no more of one, but of many Æsculapii,42 and to one of these was attributed, among other merits, that of having invented the probe and the art of bandaging wounds, while another was held to be the inventor of purgatives and of the extraction of teeth.
According, therefore, to these traditions, dental surgery had its origin with Æsculapius, the god of Medicine. But what was the precise epoch in which this benefactor of humanity lived?
We learn from Homer that two sons of Æsculapius, Machaon and Podalirius,43 took special part, as doctors, in the siege of Troy. This celebrated siege, which lasted ten years, took place in the twelfth century before the Christian era (that is, 1193 to 1184 B.C.); admitting, therefore, the account of the parentage to be authentic, one may argue therefrom that Æsculapius must have lived between the twelfth and thirteenth centuries B.C. Many temples were built and dedicated to Æsculapius; these were called asklepeia, after the Greek form of his name. The priests were called Asklepiadi, and alleged their direct descent from Æsculapius himself.
The temples of Æsculapius became so numerous in time that they were to be found in almost every Greek city. The most celebrated were those of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great city of Agrigentum, in Sicily. The Asklepiadi not only performed the temple rites, but were doctors at the same time, for as interpreters of the wisdom of the god, they also occupied themselves in curing the sick. From this it resulted that these temples became in time, through observation and experience, schools of medical science.
But besides this sacerdotal medicine, there was also a lay medicine in Greece. Many great philosophers, especially Pythagoras, Alcmeon of Croton, Empedocles, Anaxagoras, and Democritus, occupied themselves with physiology, with hygiene, and with medicine; also the gymnasiarchs, or directors of gymnasiums, or schools of gymnastics, an art having for its end to increase physical strength and maintain health, cultivated medicine, particularly that part of it which concerns hygiene, dietetics, and surgery as applied to the treatment of violent lesions, such as fractures, luxations, etc.
The Asklepiadi often themselves imparted the principles of medicine to students outside their caste. Lay medicine thus gradually came to supplant sacerdotal medicine, especially after Hippocrates, who through his works, exercised a preponderant influence in the secularization of the science. However, the Asklepiadi, on their side, continued to practise medicine up to the time when the pagan temples fell into complete ruin, through the advance of Christianity.
On the columns of the asklepeia and on the votive tables were written the names of those cured by the god, together with indications regarding their various maladies and the treatment by virtue of which the sick had been restored to health.
Surgical instruments of proved utility were deposited in the temples. Celius Aurelianus makes mention of a leaden instrument used for the extraction of teeth (plumbeum odontagogon), which was exhibited in the temple of Apollo, at Delphi.
As a matter of fact, it would seem more natural that this instrument should have been shown in the temple of Æsculapius, he being the god of Medicine, and believed, besides, to be the inventor of dental extraction. One is rather inclined by this to think that the odontagogon may have been deposited in the temple of Apollo before the building of Æsculapian temples. Indeed, who can tell if Æsculapius himself, not yet deified, may not have deposited there a model of the instrument he had invented!
From the fact of the odontagogon in the temple of Apollo being made of lead, Erasistratus, Celius Aurelianus, and other ancient writers have drawn the deduction that it was only permissible to extract teeth when they were loose enough to be taken out with a leaden instrument. But Serre44 observes, not without reason, that if a tooth be so unsteady as to be able to be extracted with leaden pincers, this may just as well be done, and perhaps even better, by pinching the tooth between the fingers, no other aid being required than a handkerchief to prevent them from slipping. Avulsive pincers of lead would be, therefore, a nearly useless invention; so it is much more probable, as Serre remarks, that the original pincers were of iron, and that the inventor, reserving these for his own use, made a simple model of the same in lead (this being easier to do) and deposited it in the temple of Apollo, in order to make known the form of the instrument to contemporaries and to posterity, naturally supposing that whoever wished to copy it would understand of himself, or learn from the priests, that it was to be made of iron and not of lead.
Hippocrates. The sacerdotal and philosophical schools of medicine, as well as the gymnasiums, were the three great sources whence Hippocrates derived his first knowledge of medicine.
Hippocrates was born in the island of Cos, toward the year 460 B.C. He belonged to the sacerdotal caste of the Asklepiadi, and was, according to some of his earliest biographers, the nineteenth descendant of Æsculapius on his father’s side, and the twentieth descendant of Hercules on his mother’s side. The time of his death is even still more uncertain than that of his birth, for, according to some, he died at eighty-three, according to others, at eighty-five, at ninety, at one hundred and four, and even at one hundred and nine years of age.
Hippocrates was initiated in the study of medicine by his own father, Heraclides; but in the medical art he also had as a teacher the gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under the sophist Gorgia and philosophy under the celebrated Democritus. He treasured up all the records of medical practice that were preserved in the temple of Cos; but according to some ancient authors he is said to have set fire afterward to this temple, and to have left his native country in order to flee from the resentment he had aroused. Probably it was the priests themselves who attributed the burning of the temple (which certainly took place at that time) to Hippocrates, out of jealousy for his growing fame; though it may also be possible that this great man, having first collected together all that was useful among the medical records that were to be found there, afterward courageously destroyed this centre of superstition, so that medicine, ceasing to be confused with imposture and being despoiled of the supernatural character attributed to it, which paralyzed its progress, should become a liberal and human art, based purely on the observation of clinical facts and the study of natural laws.
For a long time, Hippocrates travelled in various parts of Europe, Asia, and Africa, everywhere making valuable observations. He finally returned to his native country, where through the practice of medicine and by his immortal writings he acquired such esteem and veneration that his compatriots almost tributed him with divine honors after death.
Not all, however, of the works that make up the so-called collection of Hippocrates were really written by the father of medicine. Two of his sons—Thessalus and Draco—and his son-in-law Polybius also distinguished themselves by the practice of medicine and by their admirable writings, which together with those of other doctors of that period were erroneously included in the collection of Hippocrates’ works. At any rate, the collection of Hippocrates faithfully represents the state of medicine and surgery at the epoch in which he and his disciples flourished, that is, toward the end of the fifth and during the fourth century before the Christian era.45
Neither Hippocrates nor others before him had ever dissected corpses; it is, therefore, not to be wondered at that the anatomical notions contained in the Hippocratic works should be scarce and very often inexact. The physiological notions also are highly deficient and imperfect, which is, indeed, very natural, for an exact knowledge of the functions of the human body presupposes an exact knowledge of the relative organs.
The philosophical ideas of the time had considerable influence on the medical theories of Hippocrates and his successors. The universe was considered as constituted by four elements: earth, air, fire, water. To each of these elements a special quality was attributed, and, thus, one recognized four fundamental qualities, viz., cold, dryness, heat, and moisture. Man—the most perfect being—was regarded as a “microcosmos,” or small world in himself, that is, a sort of compendium of the whole universe, and his organism, in correlation to the four primordial elements of the universe, was believed to be constituted of four fundamental humors—the blood, the pituita or mucus, the yellow bile, and the black bile or atrabile.
Health, says Hippocrates,46 depends on the just relation one to another of these principles, as to composition, force, and quantity, and on their perfect mixture; instead, when one of the four principles is wanting or in excess, or separates itself from the other components of the organism, one has a diseased condition. In fact, he adds, if some one humor flow from the body in a measure superior to its superabundance, such a loss will occasion illness. If, then, the humor separated from the others collect in the interior of the body, not only the part that remains deprived of its presence will suffer, but also that into which the flow takes place and where the engorgement is produced.
We have here briefly stated these generalities in order to make ourselves clearly understood in speaking hereafter on different subjects, whether with regard to Hippocrates or to other authors of the time.
In the works of Hippocrates there is not one chapter that treats separately of the affections of the teeth, just as there is no book in which he speaks separately of diseases of the vascular or nervous systems, and so on. There are, nevertheless, a great number of passages scattered throughout the Hippocratic collection from which we can deduce very clearly the great importance that the Father of Medicine ascribed to the teeth and to their maladies.
In the book De carnibus, the formation of the teeth is spoken of among other things. It might have been supposed that Hippocrates would have been ignorant of the fact that the formation of the teeth commences in the intra-uterine life. This, however, is not the case; in fact, he says: “The first teeth are formed by the nourishment of the fetus in the womb, and after birth by the mother’s milk. Those that come forth after these are shed are formed by food and drink. The shedding of the first teeth generally takes place at about seven years of age, those that come forth after this grow old with the man, unless some illness destroys them.”47 And a little farther on one reads: “From seven to fourteen the larger teeth come forth and all the others that substitute those derived from the nourishment of the fetus in the womb. In the fourth septennial period of life there appear in most people two teeth that are called wisdom teeth.”48
There is a passage in this same book De carnibus, in which the great importance of the teeth for clear pronunciation of words is alluded to: “The body,” says Hippocrates,49 “attracts the air into itself; the air expelled through the void produces a sound, because the head resounds. The tongue articulates, and by its movements, coming into contact with the palate and the teeth, renders the sounds distinct.”
The book De dentitione is written in the form of brief sentences or aphorisms, and speaks of the accidents that often accompany the eruption of the deciduous teeth. The most important passages in this short treatise are the following:
“Children who during dentition have their bowels frequently moved are less subject to convulsions than those who are constipated.”
“Those who during dentition have a severe attack of fever rarely have convulsions.”
“Those who during dentition do not get thinner and who are very drowsy run the risk of becoming subject to convulsions.”
“On conditions of equality, those children who cut their teeth in the winter get over the teething period the best.”
“Not all the children seized with convulsions during dentition succumb to these; many are saved.”
“In the case of children who suffer with cough the period of dentition is prolonged, and they get thinner than the others when the teeth come forth.”
In the third book of Aphorisms, where Hippocrates speaks of the illnesses that prevail in the various seasons of the year and in the various ages of life, mention is also made of the accidents of dentition. The twenty-fifth aphorism says: “At the time of dentition, children are subject to irritation of the gums, fevers, convulsions, diarrhea; this occurs principally at the time when the canines begin to come forth, and in children who are very fat or constipated.”
The works of Hippocrates are nearly silent on the hygiene of the teeth; but in the second book, on the diseases of women,50 some prescriptions are to be found against bad-smelling breath. We translate the passage integrally:
“When a woman’s mouth smells and her gums are black and unhealthy, one burns, separately, the head of a hare, and three mice, after having taken out the intestines of two of them (not, however, the liver or the kidneys); one pounds in a stone mortar some marble or whitestone,51 and passes it through a sieve; one then mixes equal parts of these ingredients and with this mixture one rubs the teeth and the interior of the mouth; afterward one rubs them again with greasy wool52 and one washes the mouth with water. One soaks the dirty wool in honey and with it one rubs the teeth and the gums, inside and outside. One pounds dill and anise-seeds, two oboles of myrrh;53 one immerses these substances in half a cotyle54 of pure white wine; one then rinses the mouth with it, holding it in the mouth for some time; this is to be done frequently, and the mouth to be rinsed with the said preparation fasting and after each meal. It is an excellent thing to take small quantities of food of a very sustaining nature. The medicament described above cleans the teeth and gives them a sweet smell. It is known under the name of Indian medicament.”
In the book De affectionibus there is a passage where it is said that inflammation of the gums is produced by accumulations of pituita, and that, in like cases, masticatories are of use, as these remedies favor the secretion of saliva, and thus tend to dissipate the engorgement caused by pituita.
Still more important, however, is the following passage of the same book:55
“In cases of toothache, if the tooth is decayed and loose it must be extracted. If it is neither decayed nor loose, but still painful, it is necessary to desiccate it by cauterizing. Masticatories also do good, as the pain derives from pituita insinuating itself under the roots of the teeth. Teeth are eroded and become decayed partly by pituita, and partly by food, when they are by nature weak and badly fixed in the gums.”
Hippocrates, therefore, considers affections of the teeth to depend in part on natural dispositions, that is, on congenital weakness of the dental system, in part on accumulations of pituita, and the corroding action of the same. If a painful tooth were not loose, it was not to be extracted; but one was to have recourse to cauterization and to masticatories, intended the one and the other to dissipate the accumulation of pituita, believed by him to be the cause of toothache.
It is easily to be understood that as only loose teeth were to be extracted, Hippocrates considered the extraction of teeth a very easy operation, notwithstanding that the instruments then in use cannot have been other than very imperfect; and this is clearly to be seen from a passage in the book entitled De medico, where, after having spoken of the articles and instruments that ought to be kept in a doctor’s office (officina medici), he adds:
“These are the instruments necessary to the doctor’s operating room and in the handling of which the disciple should be exercised; as to the pincers for pulling out teeth, anyone can handle them, because evidently the manner in which they are to be used is simple.”56