The method of treatment must vary in all these cases; and in regard to this the author enters into minute particulars, commencing with dietetic cure—which itself must be varied according to the causes of the affection—and then treats of all the other therapeutic means—purgatives, bloodletting, revulsives, local narcotic or resolvent medicaments, and so forth. The letting of blood was, it seems, a very favorite method of cure; not only were the veins of the arm opened, but also those of the tongue, of the gums, of the lips, and of the ears!

Another remedy which the author seems to have a predilection for is oil of vitriol. When a tooth shows a carious perforation, he applies inside it, by means of a split feather, a drop of oil of vitriol, which, says he, causes the fall of the tooth after a few days.

Elsewhere he says that “sometimes worms are produced in carious teeth; to kill them a drop of oil of vitriol is an excellent remedy; and this at the same time cures the decay of the tooth and takes away the sensibility of the nerve.”

This passage does not agree very well with the preceding one, according to which oil of vitriol would act much more radically by causing the tooth to fall out altogether. But we will not take exception to so small a matter; so much the more, as the author, if he were still alive, might perhaps show us by some subtle distinction that the contradiction alluded to is only an apparent one!

To free the teeth from tartar, Heurn likewise counsels oil of vitriol, diluted, however, with other liquids.

A tooth must not be sacrificed excepting when it is loose and attacked by incipient necrosis, so as to leave no hope of arresting the putrefactive process. It is then our duty, says Heurn, to remove the tooth without causing much pain. For this purpose, after the tooth has been separated all around from the gums, it must be raised somewhat from the alveolus; then it must be sprinkled with powder of euphorbia, or a paste made with flour and the juice of the tithymalus must be applied around it, taking care, however, to cover the neighboring teeth with wax. After two or three days the tooth will be so loose that it can be pulled out very easily with the fingers or with a pair of pincers.

Dental surgery properly so called has been entirely neglected by Heurn. He was perhaps so persuaded of the efficacy of the above-mentioned remedies as to believe that every other species of intervention was useless. On the contrary, he does not abstain from speaking very seriously of the miraculous virtues of certain remedies (serpent scales, dog’s teeth, etc.); and tells us, among other things, that the broth made from a frog, when held for a length of time in the mouth, soothes dental pains, whatever be the causes from which they originate. One would seem to have gone back again to the days of Pliny!

THE STORY OF THE GOLDEN TOOTH.

In 1593 a rumor spread throughout Germany of a great marvel that had appeared at Schweidnitz in Silesia: a golden tooth had erupted in the mouth of a child aged seven years, which, more precisely designated, was the first large molar on the left of the lower jaw.

In our days news of such a kind would be immediately qualified, and universally held to be an imposture. But three centuries ago the most marvellous and unlikely things were easily believed in, often even by the learned; and, therefore, the fact alluded to was taken into serious consideration, so much so that for a long time many learned pamphlets and dissertations were written concerning it.

Jacob Horst, Physician and Professor of Medicine at the Julius University in Helmstadt, published, in 1595, a very singular book on the golden tooth of the Silesian child.327 Without raising any doubt as to the reality of the fact, he maintained that the phenomenon was produced from the effect partly of natural and partly of supernatural causes, in relation with the constellation under which the child was born. On the day of its birth, that is, December 22, 1585, the sun was in conjunction with Saturn in the sign of Aries. In consequence of this circumstance the nutritive force had developed marvellously on account of the increase in heat, and consequently, instead of osseous substance, golden matter had been secreted!

After having explained (!) in this way the origin of the phenomenon, Horst passes on to examine what events may be portended by this unheard-of marvel, he not having the least doubt that it—like earthquakes, eclipses, and comets—must be the precursory sign of important events. Supporting his assertions by arguments of various kinds, some of which are taken from the Bible, he concludes that the gold tooth of the Silesian child means neither more nor less than the approach of the golden age! The Roman Emperor would sweep the Turks, the enemies of Christianity, out of Europe, and the Millenium or Golden Age would commence. As the tooth was situated on the left side of the lower jaw, it might be deduced, according to Horst, that heavy calamities would precede the beginning of the epoch of happiness thus predicted. On the other hand, as the golden tooth was the last of the dental series of the child, this was to signify that the golden epoch thus foretold would be the last of the ages of this world before the universal judgment!

Martin Ruland, in the same year, 1595, wrote about the gold tooth.328 Shortly after, he was answered by Johann Ingolstetter; and the controversy which arose between them in this important subject lasted for a long time, without, however, leading to any definite conclusion.

Balthasar Camindus, a doctor of Frankfort, meanwhile had noted that for some months the marvellous Silesian boy had not lent himself to being examined by the learned, becoming terribly enraged whenever they wished to compel him. From this he inferred that it was a case of nothing else but an imposture, and that the famous tooth could not have anything special about it, save that its crown had been very skilfully covered with a thin plate of gold.

In spite of this the discussions on the portentous tooth continued for a long time; and even one hundred years after, that is, in 1695, a new dissertation appeared on the golden tooth.

The greater number of those who wrote on this subject did not throw the slightest doubt upon the reality of the fact, but only sought to explain in the most varied ways the genesis of this phenomenon.

Duncan Liddel. Among those who had the good sense not to put faith in the thing, and who very decidedly affirmed that this was a mere case of imposture, Duncan Liddel, a Scotchman and professor in a German University, deserves to be recorded.329

He had heard that the famous gold tooth was larger than the others, and that the neighboring molar was wanting; from which he argued that this was simply the case of a tooth the crown of which had been covered with a plate of gold. Answering the arguments of Horst, he accused him of gross ignorance in the most elementary notions of astronomy, and this for having affirmed that when the famous child was born, that is, December 22, the sun happened to be in conjunction with Saturn in the sign of the Ram. As the sun does not enter the sign of the Ram until March, if it had been there on December 22 this would have been a greater portent than if the whole body of the child had been formed of nothing else but teeth of gold!330

The above-mentioned fact is not the only one of its kind. Serres relates that once there was a great noise made in Poland about the pretended golden teeth of another child who was carried round from city to city for the purpose of making money. A Franciscan monk had sought to explain, in one of his writings, the formation of these teeth. The anatomist Kircher answered him in a pamphlet which had the very suitable epigraph: O præclare pater, nimium ne crede colori.331 In fact, the pretended teeth were only covered with a layer of tartar of golden color. As the falsity of the pretended miracle might be brought to light at any moment with much scandal, a bishop thought it well to put an end in haste to the comedy, by ordering the removal of the deceitful layer of tartar from the teeth of the child, to be performed in public, so that the imposture might be made completely clear.

From the above story we can, at any rate, deduce an important conclusion for the history of dental art, that is to say, that even as early as 1593 there was an artificer (we do not know whether a goldsmith or dentist) who knew how to construct a gold crown, although only for the purposes of deception.

CHAPTER XI.

THE SEVENTEENTH CENTURY.

The first signs of the separation of dental science from general medicine were to be perceived in the sixteenth century, the period in which, as we have seen, the earliest dental monographs appeared. From that time this separation tended to accentuate itself ever more strongly; dental monographs became more numerous and dentistry progressed ever more rapidly, both in its scientific and practical aspects.

In the seventeenth century, about which we are now to speak, we shall have to call attention to many facts of the highest importance for the development of dentistry, and with regard to literature, it is worthy of note that while the publications on dentistry that appeared in the various countries of Europe during the preceding century only amounted to about twenty (taking also into account several pamphlets on the famous golden tooth!), in the seventeenth century the number was considerably higher, that is, about a hundred. We shall speak of the most important of these, as also of the works on general medicine or on surgery of the same period, that present some interest from the point of view of dentistry.

Johann Stephan Strobelberger, physician to the imperial baths of Carlsbad, published in the year 1630 a very curious book, the title of which, being translated, runs somewhat as follows: Complete Treatise of Gout in the teeth, or, more properly said, of Odontagra or toothache; in which are set forth, theoretically and practically, for the use of physicians and surgeons, the means of mitigating these pains, as well as the various modes of ably extracting teeth with or without instruments.”332

This book merely presents some interest, because it gives us a clear idea of the pitiful state in which the dental art still was in the first half of the seventeenth century, and shows us most clearly what enormous progress our specialty has made in little less than two centuries. Apart from this, Strobelberger’s monograph is of no importance, it being nothing more than a most accurate compilation of all that is to be found on the subject of dental affections in earlier works, especially from the medical point of view; the surgical part of dental therapeutics is treated in a much less complete manner, and prosthesis is entirely excluded from the plan of the work, which, however, is fully in accordance with the title of the book.

Under the generic name of gout,333 or podagra, are meant, says the author (Chapter I), all the affections produced by diseased humors, falling “by drops” into the articular cavities and the parts surrounding them. Strictly speaking, however, only gout in the feet is named podagra, whilst when the disease is seated in other parts of the body it is indicated by other names, gout in the hands being called chiragra; in the fingers dactilagra; in the knee, gonagra; in the elbow, pechiagra; in the shoulder, omagra; in the spinal column, rachisagra, and so on. When the seat of the evil is in the teeth or in their articulations, by analogy it is denominated odontagra, or odontalgia, an affection which Paul of Ægina was the first to consider as being of a gouty nature (Chapter II).

After having spoken of the sensibility of the teeth (Chapter III), of the various kinds of dental pains (Chapter IV), of the different causes, external and internal, which produce them (Chapters V to VII), of the signs which make known their special nature in each case (Chapters VIII to X), and of the prognosis (Chapter XI), the author occupies himself very minutely, throughout the rest of the book, with all that concerns means of cure, dedicating to this subject sixty-seven chapters and a long appendix.

If, after the publication of Strobelberger’s book, all previous works treating of dental affections had been entirely lost, it would be of inestimable value for the history of dentistry, the author having gathered together in an almost complete manner—citing faithfully the respective authors—all that had been written about dental diseases before him. On the other hand, the book contains almost nothing original; therefore, rather than analyze minutely its contents—which would involve a long repetition of things already noted—we limit ourselves merely to a few observations.

Strobelberger, like Heurnius, is of opinion that for the cure of dental pains it is necessary to have recourse to doctors rather than to dentispices, or tooth drawers (Chapter XII); however, he does not consider the calling of the latter absolutely useless; indeed, he expressly advises (page 174) that they should be applied to for the instrumental extraction of the teeth, it not being possible for such operations to be carried out well and without danger except by those who, through great practice, have acquired the necessary skill in the use of the relative instruments. He refers to the words of Hollerius, already quoted, as to the falseness of the opinion that fumigations made with the seeds of hyoscyamus cause the worms to fall out of the teeth. Notwithstanding, he does not in the least doubt the existence of the worms themselves; and he, like Heurnius, recommends killing them with oil of vitriol or with a decoction made from a frog cooked in water and vinegar (Chapter XXXIII). From this, one clearly perceives that the doubts expressed by Hollerius about the existence of dental worms had not in the least shaken the popular belief in them. Nor, indeed, could it be otherwise when one considers that Hollerius, as we duly noted in another place, had not the courage either decidedly to deny the existence of dental worms, or to formulate in a clear and explicit manner the doubts which had arisen in his mind on this subject. We are, therefore, unable to recognize the merit which Linderer334 and Geist-Jacobi335 have attributed to this author, viz., that of having effectually affirmed the non-existence of dental worms.

Among innumerable vegetable remedies recommended by Strobelberger against odontalgia, we will only cite two American plants, the guaiacum and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum (Chapter XXXVI) the author says that, used as a mouth wash, it has the triple virtue of strengthening the gums, of preventing putrefactive processes, and of calming toothache.

The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII) for the first time in this work, but, as we learn from Strobelberger himself, Heurnius has already obtained, experimenting in his own case, the cessation of an attack of toothache by holding in his mouth spoonfuls of tepid decoction of nicotiana for the space of two hours.

The same soothing effects may be obtained, says the author, from the smoke of tobacco; but he attributes this not to the narcotic action of the remedy, but to the fact that it causes the flow of much saliva from the mouth and mucus from the nostrils, through which the morbid humors which provoke the pain are eliminated.

To those suffering from odontalgia, says Strobelberger (Chapter XL), the internal use of certain mineral waters is also of value, and especially that of the waters of Carlsbad (Thermæ Carolinæ). Like many other remedies, they are useful in rendering the secretions more active, favoring thus the elimination of morbid substances from the blood. For the same object of purifying the organism and dispersing the accumulated humors causing the pain, many other means of cure were in usage, such as aperients (Chapter XXV), phlebotomy, and arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI), masticatories, viz., substances intended to be chewed for the purpose of exciting salivary secretion (Chapter XXVI), sternutatories, viz., substances which provoke sneezing (Chapter XXVII), and so forth.

Like Arculanus, Strobelberger makes a distinction between the real and the false cure of odontalgia (cura vera et cura mendosa). This latter he also subdivides in palliative cure and vain cure (Chapter LV). The palliative cure is constituted by the use of narcotics and stupefying remedies (Chapter LVI), whilst the vain cure is represented by certain remedies which he calls “fanatical” or rather “fantastical.” The vain cure, in its turn, undergoes a new distinction, since it comprises three species of remedies, that is, the wearing of amulets, the superstitious remedies, and the ridiculous remedies. Indeed, this last apellation might also fittingly be applied to the preceding ones!

One would be inclined to believe that the author who qualifies these remedies as vain, fantastic, superstitious, and ridiculous was a thoroughly unprejudiced man; however, this is not so. Strobelberger, too, had to pay his tribute to the dominating prejudices of his century; this manifestly appears from various passages in his book, and especially from the Chapters XVI and XLIV. The first of these bears the following title: “How to procure immunity from toothache,” and Strobelberger therein asserts in all seriousness, basing his assertion on the authority of Rhazes, that “if the canine tooth of a lion be suspended to a child’s neck before the milk teeth fall out and during the eruption of the second teeth, it will secure the child immunity from dental pains.” In Chapter XLIV the author speaks of those animals whose teeth are useful to man as remedies against toothache, and reiterates—lending, as it seems, perfect faith thereto—various prejudices that are found in Pliny and other writers of antiquity.

As to the remedies which Strobelberger recognizes as vain—that is, as devoid of real curative virtue—he remarks that they may nevertheless be useful by acting powerfully on the imagination of the sufferer, thus causing, in fact, the cessation of pain (Chapter LVII). This clear and explicit affirmation of the efficacy of suggestion in a book published 270 years ago is certainly not without interest.

If, says Strobelberger, a place is to be accorded, in dental therapeutics, to the vain remedies, among these, amulets deserve the preference; and the best accredited amulet is the root of the lepidium, already recommended by Dioscorides, who affirms that if it be hung around the neck of the sufferer it will cause the pain to cease.

One of the superstitious remedies to be used against this affection (Chapter LVIII), consists in touching the aching tooth with the tooth of a dead person, and afterward greasing it with horse’s marrow.

Among the ridiculous remedies (Chapter LIX), the author describes one that was especially in use among soldiers. With a piece of chalk or of rubble one writes on a table:

One then pricks the tooth with a knife or an iron toothpick until it bleeds slightly; then thrusting the point of the instrument, to which the blood adheres, into the first cross, then into the second, then into the third, and so on, one asks the patient each time if the tooth still pains him. Before one gets to the last cross the pain ceases! This stolid cure, says the author, has no other value than that of the scarification of the part affected.

Strobelberger held, as did many of the preceding authors, that the extraction of a tooth ought to be the last remedy, that is, to be had recourse to when all others, including cauterization, which he considers as the last but one, have proved ineffectual. There are cases, however, in which the extraction of a tooth is absolutely indicated, and here, by the way, the author acquaints us with the following poetic aphorism, which expressed the unanimous opinion of doctors:

That is, if one finds that a tooth is hollow or decayed, and corrupts the others, it must at once be extracted.

Strobelberger, like the greater number of his predecessors, is fully persuaded that diseased teeth may be made to fall out by the use of special remedies; indeed, this clearly appears from the title of the work itself, as, without doubt, the reader will already have observed. Such remedies are called by him “odontagoga,” and he describes them at great length in five different chapters (X to XIV) of the second section of his book, dedicated to the surgical care of the teeth.

In regard to violent extraction of teeth, Strobelberger shows still greater cautiousness and timidity than Celsus or Abulcasis. He requires that, after the gum has been detached, one should endeavor to extract the tooth with the fingers or by means of a thread; if, however, this does not succeed, one may have recourse to the trifid lever; only at last, that is, when even the lever has failed, does he allow the use of an appropriate dental forceps.

Arnauld Gilles, a Frenchman, in the year 1622, published in Paris a work whose curious title we will here note: The flower of the remedies against toothache.336 We know nothing else about this publication, which, however, to judge from its title, cannot be other than a mere compilation.

Dupont, another Frenchman, in 1633, published an important pamphlet, which I have, unfortunately, not been able to see. I can, therefore, only quote what Sprengel says of it.337 Dupont recommends, in cases of obstinate toothache, the extraction and immediate replantation of the tooth; which, he says, becomes quite firm again, but will no more cause any pain. In confirmation of this, Denis Pomaret related, a little later, a case in which a healthy tooth having been pulled out by mistake, and immediately put back into the socket and treated with astringent remedies, became perfectly firm again.338

Although Abulcasis and Ambroise Paré had already recommended the replantation of teeth, the loss of which had been caused by trauma, and although Peter Foreest had already made known as a result of his own personal experience that the luxation (not, however, complete extraction) of a tooth and its successive replantation is capable of causing toothache to cease, nevertheless, we must recognize that the merit of having elevated replantation in non-traumatic cases to a special method of cure must be attributed to Dupont.

Wilhelm Fabry (1560 to 1634), a German, and native of the small town of Hilden near Cologne, better known by his Latin name of Fabricius Hildanus, was chief doctor to the city of Berne, and acquired great fame as well by his extraordinary professional ability as by his works, consisting principally in reports of many hundreds of important and instructive clinical cases. He is rightly considered one of the most illustrious German surgeons. His writings have largely contributed not only to the progress of surgery in general, but also to that of dental surgery in particular.

One of his observations clearly shows the etiological relation frequently existing between a prosopalgia or a supposed hemicrania and a dental affection. The case referred to is that of a lady who had been subject for six months to violent pain in the upper teeth of one side of the jaw. The toothache little by little disappeared, giving place to an obstinate cephalalgia in the same side of the head, which gradually became so intense as to be perfectly insupportable, the patient being particularly subject to it when the weather was cold and damp. After four years of atrocious suffering, and after innumerable remedies had been tried without avail, Fabricius Hildamus—having had the luminous idea of seeking the cause of the evil in the teeth—obtained a complete cure, without further trouble, by extracting four of the patient’s teeth, which were decayed.

Nowadays, it is an all-important canon of medical practice, that in every case of neuralgia occurring within the region influenced by the trifacial nerve one should give particular attention to the state of the teeth and carefully treat every affection of the same. Notwithstanding—we say it with regret—there are still medical men who ignore or neglect this precept, and prescribe internal remedies or have recourse to injections of morphine when they ought, in the first place, to call in the aid of a dentist. How many patients would have been delivered from slow martyrdom if the example of the clear-seeing physician of Berne had been followed from his days up to the present time!

Fabricius Hildanus relates, besides, many cases of dental fistula, cured by him through the extraction of roots or of decayed teeth. In one such case the fistula dated from fourteen years back. Fabricius Hildanus, contrary to the opinion of many other doctors, extracted a decayed tooth, and by this operation obtained, in a brief period of time, the complete recovery of the patient.

Among the many very important clinical cases cited by Fabricius Hildanus, the following deserves to be recorded: In the year 1590 a woman presented herself to him who had a hard tumor in the space behind the last molar on the right side. The author, after having prepared the patient for the operation by the methods then in use (that is, by aperient medicine, by bleeding, and appropriate diet), destroyed the tumor by the application of escharotic substances. The remaining wound, however, defying all the cicatrizing remedies which the author had recourse to, one after the other, by reason of its being continually disturbed by the movements of the jaws, he then thought of maintaining the dental arches in a determined position, and this he obtained by means of two pieces of wood somewhat hollowed out above and below, which he placed on the right and on the left between the upper and the lower teeth, fixing them to the teeth themselves by brass wires passing through two openings made expressly in each of the two pieces of wood. In this way he succeeded in obtaining the absolute immobility of the jaws and the complete cure of the wound in a few days, during which time the patient was nourished with liquid food.339

A very interesting case, inasmuch as it demonstrated the damage and peril which may result from certain absurd means of cure, was reported to this author by Claudio Deodato, physician to the Prince-Bishop of Basle. The case was that of a patient who, after having tried in vain a great number of remedies for a stubborn toothache, finally had recourse to the use of aqua fortis; but this substance, which in those days was in frequent use for dental caries and for toothache, produced most deleterious effects in the patient, that is to say, the loss of almost all his teeth, necrosis of the inferior jaw, with fistulous sinuses and ulceration of the neck, abundant sanious discharge, fever, a cachectic condition, incipient necrosis of the upper jaw, etc.340 Fabricius Hildanus, consulted by Claudio Deodato about this most serious case, proposed both a local and a general treatment, the result of which is, however, not mentioned in his book.

In the fifth “centuria of medical and surgical observations and cures”341 we find a case of oral surgery, to which it is worth while briefly to refer here. It relates to an epulis situated next to the upper canine of the left side. The tumor, already of ancient date, had at this time reached the size of a walnut, was very hard, livid in color, irregular in form, and adhered somewhat to the upper lip; according to the author, it was of a cancerous nature. After the usual preparative measures, Fabricius Hildanus proceeded to the ablation of the tumor, and to this end he first pierced it with a curved needle and strong thread, in order to get a good hold on it, and he then removed it entirely down to the bone, by means of a curved bistoury.342

Fabricius Hildanus, having dissected several abortive fetuses of under four months, was able to verify the exactitude of the assertion made by Hippocrates, afterward luminously confirmed by different Italian anatomists, that the teeth begin to be formed during intra-uterine life. And with reference to this he also relates the following fact:

The wife of a Protestant minister gave birth to a female child which already had a fully developed tooth, a lower middle incisor, equal in size to that of a child of two years old, and which interfered with the sucking by injuring the nipple of the mother’s breast and the tongue of the child itself. So it was necessary that it should be removed. But it was found to be so firm that the surgeon sought in vain to extract it with a thread, and was obliged to have recourse to the forceps.343

Observation XXXI of the third centuria relates a case of rhinoplasty. In the year 1590, when the Duke of Savoy made war on the inhabitants of Geneva, a girl named Susanna N. fell into the hands of the soldiers, who tried to deflower her; enraged at not succeeding in their intent, they cut off her nose. Two years later the girl went to Lausanne, the residence of J. Griffon, an eminent surgeon of that time, who performed the rhinoplastic operation on her in so splendid a manner that one would have taken the new nose for a natural one, not only from its normal appearance, but also because the scar was hardly visible. Fabricius Hildanus, having had occasion to see and examine the patient several times, even up to twenty-one years after the operation, was able to testify to the perfect condition of the nose; in the extreme cold of the winter, however, it was apt to become livid at the point. He does not describe the operative process followed by Griffon, but merely says that the first inventor of this operation was Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had undertaken the reproduction of the same from his own conception of it, based on the information imparted to him in conversation, by an Italian who had been operated upon by Tagliacozzi.

Johann Schultes (1595 to 1645), a physician in Ulm, was the author of a very important work entitled Armamentarium chirurgicum, in which are given plates and descriptions of almost all the surgical instruments that had been in use up to that date. As to the part relating to dental and oral surgery, we find the following instruments named in this work:

1. Several kinds of pelicans; an instrument which was so called from its resemblance to the beak of the bird of the same name, and used for extracting the molar teeth.

2. The common dental forceps, then named cagnolo by the Italians, because of the supposed likeness to a dog’s muzzle.

3. The crow’s beak forceps (rostrum corvinum), designed for the extraction of dental roots, and, therefore, corresponding to the rhizagra of Celsus.

4. Two special dental forceps, or dentiduces, for the removal of teeth which could not be extracted either with the pelican or with the common dental forceps.

5. Bifid and trifid elevators (vectes bifidi et trifidi), to be used for the extracting of incisors and canine teeth, as well as roots.

6. Dentiscalpia for detaching the gum from the tooth before proceeding to extract it, in order that this may be the more easily accomplished and with less danger.

7. A silver funnel or cannula (infundibulum seu fistula argentea), for nourishing patients affected with trismus, by conveying liquid food into the fauces, through the free space behind the last molars.

8. Forceps more or less like in form to the beak of the parrot or the vulture (rostrum psittacinum et vulturinum), for the removal or resection of teeth that have grown in abnormal positions.

9. A screw dilator (dilatatorium cum cochlea), for gradually opening the dental arches in cases of spasmodic constriction of the jaws.344

Fig. 77

Marco Aurelio Severino (1580 to 1656), of Tarsia, a celebrated professor of surgery in the Neapolitan University, had a great predilection for the use of the cauterizing iron, which he also used very frequently in curing caries and other dental diseases. At times, to effect a cessation of violent toothache, he would have recourse to the cauterization of the antihelix! Against flaccidity of the gums and loosening of the teeth he also used cauterization, disapproving the use of astringent substances, as these cannot get so far as the roots of the affected teeth. Severino boasts of having cured by cauterization at least two hundred cases of dental diseases.

Lazare Rivière (1589 to 1655), a professor at the University of Montpelier, also known by his latinized name of Lazarus Riverius, treats of dental affections and their cure, in various parts of his works, considering them, however, almost exclusively from a medical point of view.

He speaks first of all of the different causes of odontalgia, and, among these, does not omit to mention worms. These, he says, may be generated in the carious cavities, owing to the putrefaction of substances retained in their interior. Whenever odontalgia is caused by worms, the pain, says Rivière, is not continuous, but ceases and returns at brief intervals; besides, the sufferer perceives at times the movement of the worm inside the tooth!

What one reads in the works of this author as to remedies to be used for odontalgia clearly demonstrates how irrationally dental diseases were treated in the seventeenth century and what tortures were inflicted on the patients. In many cases, and especially when the pain was held to be occasioned by “hot humors,” the treatment was begun by bleeding in the arm. The following day an aperient was administered. Afterward, if the pain still persisted, the sufferer was cupped in the region of the scapulæ or of the spine, blisters were applied to the nape of the neck or behind the ears, resinous plasters to the temples; all this without taking into account the remedies which were introduced into the ears, or the various medications or operations performed on the aching part itself, and many other things besides. In fact, in order to cure a toothache, the whole body of the sufferer was seized upon and put to torture, and in the majority of cases they assuredly finished by extracting the diseased tooth! When we reflect on the extraordinary frequency of dental disorders we cannot do less than recognize that the dentists, by the radical change effected in the methods of treatment, have diminished in no small degree the sufferings of humanity!

According to Rivière, the small veins (sic) that nourish the teeth pass through the ear (!); and this would explain how the cessation of a toothache may be obtained by the introduction of certain remedies into the meatus auditorius externus. Relief may be obtained, for instance, by dropping oil of bitter almonds into the ear on the side affected by the pain, or by allowing the vapor of hot vinegar, in which pennyroyal or origanum has been boiled, to penetrate into it. Others, adds the author, pour a little pure vinegar into the ear, which is especially efficacious against “hot fluxions.” When, however, the toothache depends on a “cold fluxion,” it calms the pain wonderfully to drop into the ear a tepid mixture of garlic juice and theriac. The same advantage, says the author, may be obtained by introducing a piece of garlic, peeled and cut into the form of a suppository, into the ear.

The author also makes a lengthy enumeration of anodyne and narcotic remedies (among which opium), observing, however, that those remedies, unless the vehemence of the pain obliges the use of them, ought not to have the preference, it being much more rational and much more advantageous to institute a cure which aims directly at the cause itself of the pain (fluxions, worms, etc.).

He informs us that Amatus Lusitanus, a celebrated physician of the sixteenth century, extolled, as a remedy for toothache, a decoction of gum sandarach in wine and vinegar; the said decoction was to be made with an ounce of sandarach in six ounces of wine and the same quantity of vinegar, and ought to be kept in the mouth some length of time, whilst hot.

Rivière further speaks of various masticatories, which were composed of mastich, staphisagria, pyrethrum, henbane, etc.

He also mentions oil of cloves, which even then was used against toothache, by introducing into carious cavities a small piece of cotton-wool soaked in it. Oil of camphor was used in the same manner, but the most efficacious of all, according to the author, was oil of boxwood.

As to worms in the teeth, they may be destroyed by the use of bitter substances!

In the case of a caries penetrating into the inner cavity of the tooth, to effect the cessation of pain, it is necessary to burn the nerve with the actual cautery, or with aqua fortis, or with oil of vitriol. If this be repeated several times, the tooth gradually falls to pieces.

After having enumerated all these remedies, the author speaks of the extraction of the teeth, and of all the precautions with which this must be carried out in order to avoid the various accidents which may result from the operations and may even, sometimes, become a cause of death.

When abundant hemorrhage follows the extraction of a tooth, this may often be made to cease by applying a small, very compact ball of linen into the alveolus and maintaining it there by pressure during one or two hours. Should this not suffice, one can combine with compression the use of astringent substances. Finally, as a last remedy, use may be made of the red-hot iron.

In the case of timid patients, who shrink from an instrumental operation, recourse may be had to eradicating remedies, the author being fully convinced of their efficacy. Indeed, one of these—helleboraster—is said to be so powerful that, when rubbed on the teeth, these fall out within the space of a few hours; for which reason it is absolutely necessary, in making use of it, to cover over the neighboring teeth with wax, so that the healthy ones may not also fall out, as happened, says the author, in the case of a poor peasant.

The internal use of mercury, and even the use of certain mercurial preparations used by women as cosmetics, is of damage to the teeth and imparts to them a blackish or dirty looking color.

Numerous remedies exist for cleaning the teeth, but according to Rivière the best way of cleaning them consists in rubbing them with a small stick immersed in sulphuric acid (spiritus sulphuris aut vitrioli) and afterward drying them with a piece of linen. This remedy not only cleans and renders the teeth white, but it preserves them also from caries! If the teeth are very dirty, the spirit of vitriol may be used pure; otherwise one mixes it with mel rosatum or with water.

The great enthusiasm shown by Rivière for the above-mentioned remedy does not, however, derive from a long experience, made by himself or by others, of its advantages, but is based principally on a fact referred to by Montanus, and which,345 we will here recount, because, from it, one clearly perceives how credulously our forebears accepted general affirmations and formulated therapeutic precepts.

Montanus recounts in one of his writings, how, being in Rome in his early youth, he became acquainted with a woman of about twenty years of age, known by the name of Maria Greca (by the way the author speaks of her, one is led to suspect she was a courtesan); and how, having seen her again, thirty years later, and found her in pretty much the same conditions as formerly, he expressed his surprise at this; whereupon Maria Greca told him that she herself believed that she owed the conservation of her beauty to the habit, already of many years’ standing, of using one or two drops of oil of vitriol every morning, as a friction for the teeth and gums. In her youth she had had very bad teeth, but by reason of this cure they had become, and were at the time being, beautiful and perfectly firm; the gums also were in excellent condition; it seemed, therefore, to her that this conservation of health and freshness, in spite of her fifty years, depended precisely on the daily use, in the manner described, of oil of vitriol!346

Rivière, besides, recommends tobacco ashes for cleaning the teeth, a counsel not yet given by any previous author. He also gives the formulæ for two dentifrice powders, the basis of which is alum; he calls attention to the great importance of taking assiduous care to keep the teeth clean, and advises that after each meal the residues of food be removed from the interstices of the teeth and the mouth well rinsed with wine.347

Nicolaus Tulp, in Latin, Tulpius (1593 to 1674), a distinguished physician and anatomist of Amsterdam, contradicts the then prevailing opinion among doctors, that is, that the cure of dental affections and the operations relating thereto were matters to be held in little account. He observes that diseases of the teeth may give rise to the most serious consequences, which can even be the cause of death, and are, therefore, worthy of being taken into equally serious consideration as all the other diseases of the several parts of the human body.

This author relates a clinical case tending to demonstrate how incisions made in the gums, advised in the first place by Vesalius, in order to facilitate the erupting of the last molar, are not always exempt from danger. A young doctor of Amsterdam, by name Goswin Hall, being tormented by insupportable pain caused by the difficult eruption of a wisdom tooth, had the gum lanced above it. But the pain, instead of diminishing, became worse; fever and delirium supervened, followed by death! (Here, however, we must be allowed to observe that nothing demonstrates that the real cause of death was the lancing of the gum, or that without this the case would have had a different termination. An event can occur after another and yet be quite independent of the former and result from quite different causes.)

Among the cases cited by Tulp, the following is also worthy of mention. He relates having arrested a violent and persistent attack of hemorrhage, which came on after the extraction of a tooth, by applying and compressing a piece of sponge inside the alveolus.348

The belief that dental caries and toothache could be caused by worms was, at that time, still in full vigor, and it gained still greater force by reason of observations recorded by different scientists, whose affirmations could with difficulty be doubted, for at that period the greater number still swore blindly in verba magistri.

Oligerus Jacobaens (1650 to 1701), a Danish physician and anatomist, who taught in the University of Copenhagen, declared that in scraping the decayed cavity of a tooth that was the cause of violent pain, he had seen a worm come forth, which, having been put into water, moved about in it for a long time.

Martin Six, having split some decayed teeth a short time after they had been extracted, asserts that he determined the existence of worms in them. (It is probable that this observer, as well as others, mistook the dental pulp for a worm, an unpardonable error, in truth, at a time when the anatomical constitution of the teeth had already been very well studied by several scientists, and especially by the celebrated Bartolomeo Eustachius.)

Gabriel Clauder (1633 to 1691) not only believed in dental worms, but maintained besides that these were the most frequent among all the causes of toothache. In a certain way, to sustain this opinion of his, he relates a case in which a tooth of healthy appearance being the seat of great pain, a tooth-drawer had asserted that there must be a worm in its interior; and, in fact, on the tooth being extracted and afterward split, the little animal whose existence the tooth-drawer had divined, was found to be existing inside of it!

Philip Salmuth asserts that by using rancid oil he got a worm out of the decayed tooth of a person suffering from violent toothache, thus causing the cessation of the pain. The worm, he says, was an inch and a half in length (!) and similar in form to a cheese maggot.

Nicolaus Pechlin (1646 to 1706), professor of medicine at Kiel, testifies to having seen five such dental worms, like maggots, come out by the use of honey, though he does not say whether they issued from several cavities or from one only!

Gottfried Schulz. But all this is nothing compared to what Gottfried Schulz has dared to assert, viz., that by using the gastric juice of the pig, worms of great size can be enticed out of decayed teeth; some of these even reaching the dimension of an earth-worm!

It is not much to be wondered at that these things should have been blindly believed in, if we reflect that only a short time previous to this the story of the golden tooth had been taken seriously by men of great erudition, and that in the very epoch of which we are speaking the illustrious anatomist Thomas Bartholin (1616 to 1680), of Copenhagen, relates having seen a man, at Padua, who had an iron tooth! Besides, the possibility of such a phenomenon was explained in a most curious manner by Thomas Minadous, who explained that in the same way as iron is generated in the macrocosm, that is, in the world, so it is equally admissible that it may be generated in the microcosm, that is, in man!349

Nathaniel Highmore. In the year 1651 the English physician and anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a treatise on anatomy (Corporis humani disquisitio anatomica, etc.), by which he acquired a celebrity superior, perhaps, to his merits. This work, however, served without doubt to diffuse the knowledge of an anatomical fact of the highest importance, especially from the point of view of dentistry and surgery.

There is no doubt that the existence of the maxillary sinus was already known before Highmore, the celebrated anatomists Vesalius, Ingrassias, Eustachius, and Fallopius having spoken of it very clearly; only through ignorance of the history of anatomy has it been affirmed by many that this cavity was discovered by Highmore, to whom is only due the merit of having described the maxillary sinus, by him called antrum, most accurately, and of having made known the possibility of a communication between it and the mouth. Highmore calls attention to the fact that the inferior wall of the antrum often presents small projections, which correspond with the tops of the alveoli, and that the osseous lamina which interposes between these latter and the maxillary sinus is often extremely thin; for which reason, it may easily happen that, in extracting one of the teeth below the cavity, one may bring away together with the tooth the small osseous plate that forms the bottom of the alveolus, thus leaving the maxillary sinus open at its inferior part. With regard to this, he refers to a most interesting case which afterward acquired a high degree of notoriety. It relates to a lady who had suffered from toothache for some years, and who from time to time had had several decayed teeth extracted, without, however, finding relief. The pain only ceased after the patient had had the left upper canine removed. But after this operation an incessant flow of humors from the alveolus of the extracted tooth took place. The patient, in great anxiety at this circumstance and desirous of seeing clearly into the causes of it, herself explored the affected part with a silver probe, the entire length of which penetrated into the cavity, producing in the patient the effect of its having reached the eye. Still more amazed, and urged on by the desire of becoming still better acquainted with the extent of the evil, she now made use of a long feather, which she had previously stripped, and discovered to her painful surprise that this new instrument of exploration entered to so great a distance that it, according to her idea, penetrated into the skull. From this she derived argument for the belief that the morbid phenomenon had its origin in her brain. Believing herself affected with a serious malady, she consulted Highmore, who had the satisfaction of being able to tranquillize her completely by making her understand that the jaw bone is hollow in the inside, and that its cavity had remained open underneath in consequence of the extraction of the canine tooth; and also, that the feather had not penetrated to such a distance as she supposed, but had curved inside the bone. As to the discharge which had given so much trouble and alarm, Highmore considered it quite a natural circumstance, derived simply from the opening of the antrum, as he held that in many cases the maxillary sinus contains mucus, and that this condition was, therefore, altogether normal. So he did not propose any treatment, and the lady thenceforth supported her infirmity with resignation.

This most interesting case soon became generally known, and contributed, without doubt, not a little to attract the attention of medical men to the anatomical peculiarities which Highmore had pointed out in the upper maxillary bone, thus causing his name to become inseparably associated with the maxillary sinus.

It is evident, however, that Highmore never even suspected to what very important practical applications his description would give rise. He knew nothing about the diseases of the antrum, and believed that, even in perfectly normal conditions, this cavity is often filled with liquid; the idea, therefore, of its being advisable, in certain cases, to extract a tooth and perforate the alveolus in order to give exit to the liquid contained in the maxillary sinus never occurred to him.

About fifty years went by before a rational treatment for affections of the antrum was initiated, the merit of which, as we shall see at its time and place, was due to William Cowper. During that half century maladies of the maxillary sinus continued to be badly diagnosticated and badly treated.

Bernardo Valentini. In the year 1686, that is, thirty-five years after the publication of Highmore’s book, Bernardo Valentini, professor at the University of Giessen, described a case of tumefaction and abscess in the cheek, treated by him with emollient remedies, and in which, although according to him caries of the underlying bone did not exist, the separation of a sufficiently large osseous fragment took place. Without doubt the affection of the cheek was derived in this case from some disease of the antrum; however, it would appear that Valentini did not in the least perceive any such casual relation, as he makes no allusion whatever to it.350

Antonio Molinetti, professor at the University of Padua, had, however, ten years previously, diagnosticated and cured an affection of the antrum by means of an operation. In his book Dissertationes anatomico-pathologicæ, published at Venice in 1675, Molinetti relates that in a case of abscess of the maxillary sinus, which caused the patient great suffering, he performed the operation of trepanning the upper maxillary bone anteriorly, after incision of the soft parts overlying it. In a certain way we may, therefore, consider Molinetti as a precursor of William Cowper.

Having spoken of the very important anatomical fact illustrated by Highmore, we will now also speak briefly of those authors who, in the seventeenth century, occupied themselves with the anatomy of the teeth. Their number is sufficiently large; we will, however, only make mention of such as contributed to the development of this branch of science, or who, at least, expressed some opinion worthy of note.

The celebrated anatomist Adrian Spiegel (1578 to 1625), better known by the Latinized name of Spigelius, wrote nothing noteworthy about the teeth, but he appears to have been the first to affirm that the teeth are more firmly fixed in the alveolus, when their roots are curved after the manner of hooks.351

Diemerbroek, a Dutchman, relates several cases of dental anomalies, as for example, of teeth being cut in the palate, and which injured the tongue. The author cites his own case, relating that having had a canine tooth extracted when well advanced in years, it was, nevertheless, succeeded by a new one. He relates, besides, that he had seen in Utrecht a woman, aged fifty-six years, who again cut two incisors after having lost the former ones two years previously. Apart from this, Diemerbroeck tells us nothing of interest or importance regarding the teeth, often repeating old ideas, the falseness of which had already been luminously demonstrated. For instance, he says that the permanent teeth are developed from the roots of the deciduous ones remaining in the alveoli; an unpardonable error for an anatomist of the seventeenth century, for which he was afterward taken to task by Duverney.352

Thomas Bartholin, whom we have already mentioned, speaks of a tooth which had made all the round of the alveolar border; that is to say, of a dental arch constituted by a single piece; and the Italian anatomist Bernardo Genga makes mention of an analogous case.353 It is superfluous to add that these authors allowed themselves to be deceived by false appearances, owing especially to an abundant and uniform deposit of tartar on the surface of the teeth and in their interstices, which gave to the dental arch the appearance of one continuous piece.

Rinaldus Fredericus, in his erudite dissertation entitled De dentium statu naturali et præternaturali, spoke of the dental system with sufficient thoroughness, if we consider the epoch in which he wrote. He commences his work with a long chapter on the importance and dignity of the teeth (dignitas dentium). Among other things, he relates that formerly, in certain parts of India, the teeth were so highly valued as to be offered in sacrifice to the gods. He says, too, on the authority of certain authors, that the ancients were led to believe that the teeth served for the resurrection of the body, from the circumstance of their not showing signs of corruption when found in sarcophagi.

Discoursing of the genesis of the teeth, Fredericus says that “every tooth is at first enclosed within a follicle, that is, in a frail, skin-like membrane, in the same manner as the grain in the wheat-ear.” Taking this comparison as his point of departure,354 he gives to dentition the name germination.

This author says that the teeth of the Ethiopians and of the Indians are generally whiter than those of the northern peoples, but that those of the Indians soon lose their primitive whiteness by reason of the widely diffused habit of chewing betel-nuts.

Fredericus refers to an experiment which, according to him, demonstrates the “sympathetic relations” between the teeth and the ear (whilst in reality it only proves the facility with which sounds may be transmitted through solid bodies). “If, by night,” says he, “one holds tightly between one’s teeth the end of a stick, stuck upright in the ground, one hears the footsteps of a person approaching from afar much more easily.”

Through the researches of three great men, Marcello Malpighi, Friedrich Ruysch, and Antoni van Leeuwenhoeck, an altogether new science arose in the seventeenth century, viz., histology, or the anatomy of the tissues, whose revelations contributed not a little to the development of modern odontology.

Marcello Malpighi (1628 to 1694), the celebrated Italian anatomist, was the initiator of microscopic observations on the tissues, and is, therefore, justly considered the founder of histology, within the range of which he made most important discoveries.355

Friederich Ruysch (1638 to 1731), professor at Amsterdam, rendered his name illustrious particularly by bringing to a high degree of perfection the processes of anatomical preparations and of embalming.356

His magnificent injections, carried out with a method of his own invention, enabled him to trace the most minute vascular ramifications and to demonstrate the existence of capillary vessels in parts where their presence had as yet never been suspected.

Ruysch studied accurately the anatomical constitution of the teeth, and especially their vessels. He called attention to the membrane which lines the maxillary sinus, and discovered in it a number of bloodvessels.

But in addition to his purely anatomical observations, this author also merits our consideration from the point of view of pathology. He confirmed a most important fact to which allusion had already been made by preceding authors, that is, the atrophy of the alveolar parietes as following on the extraction or on the falling out of teeth. Ruysch, however, makes the observation that atrophy of the alveolar parietes may also precede the falling out of the teeth, and rather be the cause than an effect of it. In such cases the teeth, before falling out, always become more and more loosened, proportionately to the atrophic process. This pathological condition, against which none of the astringent remedies habitually used are of avail, is mostly considered, says Ruysch, to be owing to scurvy; but, he adds, the accumulation of tartar may also be the cause of it. Substantially, Ruysch affirms the relation existing between the accumulations of tartar and the production of that very frequent disease that was afterward named expulsive periodontitis or alveolar pyorrhea.

This author also relates two cases of polypous affection of the maxillary sinus. In one of these cases, the existence of a polypus in the maxillary sinus was determined by Ruysch while dissecting a corpse. The other case relates to a female patient upon whom two surgeons had performed the extraction of several molar teeth and the extirpation of an epulis believed by them to be of a malignant character. After the operation they cauterized the diseased part to a great depth with a red-hot iron, reaching as far as the maxillary sinus, which remained open, and from which Ruysch afterward extracted with his little finger several polypi.357

Antoni Van Leeuwenhoek (1632 to 1723), like the preceding author, a Dutchman, was the first maker of powerful microscopes, by means of which he made many important discoveries; among others, that of the tubular structure of the dentine or tooth bone. This discovery he made known and demonstrated in the year 1678, before the Royal Society in London. In his description of the structure of the teeth, Leeuwenhoek says that 600 to 700 of the dentinal tubuli have hardly the consistence of one hair of a beard.358

In the year 1683 he discovered in the tartar scraped from between the teeth a form of microörganism upon which he laid special stress. This observation he embodied in the form of a contribution which was presented to the Royal Society of London on September 14, 1683. This paper is of particular importance, not only because of the careful, objective nature of the description given of the bodies seen by him, but also for the illustrations which accompany it. From a perusal of the text and an inspection of the plates, there remains little room for doubt that the bodies described by Leeuwenhoek were not animalcules, as he believed, but bacteria.359

Domenico Gagliardi, professor of anatomy and of medicine at Rome, published an excellent work on the anatomy of the bones,360 in which he occupies himself not only with the structure of bones, properly so called, but also with that of the teeth. He considers the enamel to be formed by parallel and contiguous fibers, coated, so to speak, by a concreted juice, sui generis, which acquires a much greater consistence than that of the bones. Gagliardi says that by rubbing teeth hard together, or striking them with a steel, he was able to extract sparks from them.361

Jean Duverney (1648 to 1730), a celebrated French anatomist, wrote a good monograph362 about the teeth. As different anatomists of the sixteenth century had already done, he examined many fetal jaws in order to study in them the formation of the teeth. In relating his observations, he says that he found in every alveolus a mass of soft viscous matter, having the form of the tooth that is to derive from it, and which may be considered as its nucleus. This nucleus is entirely surrounded by a membrane, which the author likens to that which surrounds the fetus, and to which he gives the name of choroid membrane. From the surface of the nucleus a gelatinous juice transpires, which, thickening in layers, forms the enamel and the rest of the tooth. The choroid membrane is abundantly furnished with nerves, and with blood and lymph vessels. Into the interior of the teeth penetrate vascular and nervous branches which serve to maintain its vitality. In fetal jaws one finds, besides the germs of the deciduous teeth, also those of the permanent ones. The “choroid membrane” does not follow the tooth when it issues from the alveolus; it remains instead within the latter, forming the peridental membrane.

Duverney says that in old people the root cavity diminishes in so considerable a manner, and the vessels are so compressed that they almost entirely disappear. It is then that a period of decadence begins in the tooth, it is more feebly nourished, wears away more rapidly than hitherto, and becomes shorter.

The author also speaks of senile atrophy of the jaws, especially of the alveolar processes. With regard to this, he observes that if in old age the lower jaw advances beyond the upper, this depends wholly on the disappearance of the alveolar border, which projected more in the upper than in the lower one.

Duverney admits the existence of direct vascular relation between the gums and the teeth; because in the case of diseases of the gums it is rare not to find the teeth altered as well.

From the point of view of the development and nutrition of the teeth, Duverney finds much analogy between the tusks of the elephant, the teeth, properly so called, the feathers of birds, and the hair of mammifera.363

Gottfried Bidloo, a Dutch anatomist, expresses the idea that the air contributes, after the eruption of the teeth, to hardening them. He did not, however, give any proof of this opinion of his.364

Clopton Havers, an Englishman, wrote a book on osteology, by which he acquired great reputation,365 and in which he treats as well of teeth and their structure. This author believes the enamel of the teeth to be of the nature of stone, and the ivory of the nature of bone. The dental roots, which, he says, are precisely of a bony nature, are covered over with a periosteum, which is in close relation with the gums and with the periosteum of the jaw bone. Clopton Havers held that the dental follicle no longer furnishes any nourishment to the enamel from the moment that this has reached its perfect formation. On the other hand, he assures his readers that he has observed, through the microscope, nervous threads which, departing from the bulb of the tooth, traverse the ivory through small canals, arriving thus at the periosteum. By this anatomical disposition the sensibility of the teeth may, according to him, be explained.366

Having made this passing allusion to the anatomy of the teeth in the seventeenth century, we will now resume the illustration of those facts relating to the pathological and curative part of the science.

Walter Harris, an Englishman, in a pamphlet on acute infantile maladies,367 recommends again, in cases of difficult dentition, the incision of the gums, a curative practice which had already fallen into disuse.368