In the authors of that time we find registered a great number of cases of epulis. Hiob Van Meekren speaks of an enormous tumor of the gum that developed in consequence of a traumatic action which had occasioned the loss of a tooth. Before deciding on the extirpation of the tumor, the author thought well to pierce it with a bistoury, to be able to judge whether its ablation might not possibly give rise to a dangerous hemorrhage. The wound having bled but little, he proceeded to operate; but the tumor was so large that it was necessary to remove it in various portions.369

The same author refers to a case of a soft epulis, bleeding easily, that developed after a badly performed dental extraction. It was to be foreseen that the ablation of such a tumor would give rise to an abundant hemorrhage. This was, however, staunched by simply using astringent powders, without having recourse to the actual cautery, which the operator had held in readiness.370

Daniel Major, wishing to remove a large epulis by tying it, was obliged, in order to keep the ligature in position, to pass the thread through a circular incision made at the base of the tumor. He first used a thread of silk, afterward a silver one, and tightened the ligature every day until the epulis fell off.371

Johann Acoluthus was obliged, in order to extirpate a large epulis, to previously split the labial commissure. After the ablation of the principal mass of the tumor, he destroyed the remaining part of it by application of the red-hot iron.372

One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin, Preuss, Bern, Valentini, etc. This last author even speaks of an epidemic of epulis. However this may be, it is very probable that epulis was much more frequent in past times than it is now, and this probably depended partly on the incongruous modes of treating diseases of the mouth, and partly on the slight attention paid to cleanliness of the teeth.

Kornelis van Soolingen, a celebrated Dutch physician and surgeon, who flourished toward the end of the seventeenth century, speaks contemptuously of dental operations, and especially of extractions. He says that such operations ought to be left to charlatans, used to taking out teeth with the point of the sword, and to doing many other things of like nature! This unjust contempt was at that time widely diffused in the medical class, it resulted, however, substantially, from the great difficulties encountered by doctors and surgeons in general, in performing the operation of extraction, owing to want of practice, and also from the desire to avoid the responsibility of the accidents to which the extraction might give rise; so true is this, that an author of the preceding century, Theodor Zwinger (1538 to 1588), a celebrated Swiss doctor and professor at Basle, had declared with great frankness that the extracting of teeth ought to be left to barbers and charlatans, as it might easily occasion unpleasant accidents, such as fractures of the jaw, laceration of the gums, serious hemorrhage, and the like.

In spite of his contempt for practical dentistry, Kornelis van Soolingen takes the treatment of dental affections into attentive consideration. For the stopping of carious teeth, he recommends a mixture similar to that which Rhazes had recommended many centuries before, that is, a cement of mastic and turpentine; because, says he, when the stopping is made with metallic substances, it is never so perfect as to entirely impede the penetration of moisture.

Great credit is due to Kornelis for having first brought into usage the instrument makers’ emery wheels for grinding down sharp edges of teeth, thus initiating the practice of trepanning the teeth with sphere-shaped burs.373

Paul Wurfbein refers to a case of extensive necrosis of the lower jaw, in which a certain Dr. Bürlin having removed the necrotic portion, regeneration of the bone took place.

Friederich Dekkers (1648 to 1730) refers a similar case, in which, although quite one-half of the lower jaw had been removed, the bone formed again completely.374

Benjamin Martin, apothecary to the Prince de Condé, was the author of a pamphlet on the teeth,375 in which he gave a succinct description of these organs and spoke briefly of their diseases. He shows himself decidedly opposed to the use of the file and to the application of false teeth, because, according to him, both of these things may be the cause of great harm. With regard to the file, he says that nothing so easily tends to loosen the teeth as the use of this instrument, not to speak of various other inconveniences, among which is the danger of opening the interior cavity of the tooth.376

Matthias Gottfried Purmann (1648 to 1721), a celebrated surgeon of Breslau, was the first to make mention of models in dental prosthesis. As to the mode in which these models were obtained, some admit as natural that he first took a cast, and formed the model on this; but as Purmann does not hint in the least at such a process, the supposition is altogether gratuitous. Indeed, his description rather excludes any probability that the model was taken from a cast. Here is the literal translation, as nearly as possible, of the passage in which Purmann speaks of artificial teeth and of the mode of applying them.

“The front teeth, or pronouncing teeth, ought, when they are wanting, to be substituted by artificial ones, in order to avoid defects of pronunciation, as well as to obviate deformity of the mouth, and this is carried out in the following manner: One has other teeth made of bone, or of ivory, according to the number, the size, and the proportions of those wanting; for which purpose one may previously have a model executed in wax, reproducing the particular conditions of the teeth and jaws, in order afterward to make and exactly adjust the whole on the pattern of it; then, when the base of these teeth is well fitted on the jaw and small holes have been made in the artificial teeth and also in the natural ones next to them, one applies the artificial teeth in the existing void and fixes them as neatly as possible with a silver wire by the help of pincers.”377

It would appear that the author is here describing a prosthetic method, which he had never practised himself; and this results from the fact of his advising the perforation of the natural teeth for the passage of the silver wire destined to keep the prosthetic piece in its place. Evidently desiring to describe the mode practised by the specialists of those days for fixing artificial teeth, he erroneously imagines that the metal thread was passed through the holes drilled in the natural teeth; this would have been impossible, first, because of the atrocious pain due to the sensibility of the dentine and of the dental pulp, and then because of the pathological consequences to which the perforation of the teeth would have given rise. We may, therefore, surely hold that Purmann is simply describing, and not even accurately, a prosthetic method already in use among the specialists of that period.

On examination of the passage cited above—which, however, is not so clear as might be desired—it would appear that the models of which the author speaks were most probably quite different from those in use now. It is almost certain that the specialists of those days first made a sketch of the prosthetic part to be constructed, using for the purpose a piece of wax which they partly modelled with the hand and partly carved; and after having tried on this model until it fitted perfectly in the mouth, and was in every way satisfactory, they probably passed it on to a craftsman to make an exact reproduction of it in bone or ivory.

In the year 1632 a little book was published in Naples, having for its title, Nuova et utilissima prattica di tutto quello ch’al diligente Barbiero s’appartiene; composta per Cintio d’Amato.378 This pamphlet was reprinted in Venice in 1669, and again in Naples in 1671. We here make mention of it, not for any special importance which it really has as regards the development of the dental art, but because of its being most probably the first book in the Italian language in which dental matters are spoken of independently of general medicine and surgery.

Tommaso Antonio Riccio. The edition of 1671 was published under the supervision of Tommaso Antonio Riccio, who was for many years a disciple of Cintio d’Amato, and who greatly eulogizes his master and praises his work. He expresses himself in the following bombastic manner: “This book, the offspring of Master Cintio d’Amato, excellent in the Barber’s Art, ought to find a place in the bosom of Eternity; because by reason of its having been twice given to the light, it has proved its worthiness to live forever in the memory of men, gaining for itself, by its excellence, immortal glory before all such as are practised in the Art.”

The book—which consists of about one hundred and eighty pages, and is illustrated by several admirable engravings—contains, among other things, two pages of verses, written by various authors, viz., by Cintio d’Amato himself, by Giovan Battista Bergazzano, also a barber, and by others. The greater part of these verses are in praise of the two doctors and Martyrs in Christ, Cosmos and Damianus, special protectors of the Art and of the author.

The verses of Cintio d’Amato reveal the possession of a literary and poetic culture above the ordinary, in spite of his being only a master barber. As to his book, it may be considered, for the time in which it was written, as an excellent treatise on so-called minor surgery. The author expounds, in a few chapters, the anatomical notions relating to bleeding; speaks at great length of this operation and of everything concerning it; refers with much detail to all pertaining to the use of leeches, cupping, scarification, cauteries, issues, blistering, primary treatment of the wounded, nursing of the sick, etc.; at the end of the book there is also a long chapter on the embalming of corpses.

As regards the treatment of the teeth and gums the author dedicates six chapters thereto, entitled, respectively: “On the relaxation of the gums” (Chapter XXXVII); “Preparation for strengthening the gums and making the teeth firm” (Chapter XXXVIII); “On tartar and spots on the teeth” (Chapter XXXIX); “Another preparation for whitening and preserving the teeth” (Chapter XL); “Mode of burning hart’s horn, very necessary in preparations for the teeth” (Chapter XLVII); “‘Water of salt,’ which makes the teeth white and is also good for ulcers of the gums” (Chapter XLIX).

Evidently Cintio d’Amato treats of dental matters only within extremely restricted limits. He tells us nothing with regard to the treatment of toothache, nothing about caries, about prosthesis, and, what is still more remarkable, he does not allude even in passing to the extraction of teeth. Now, if in a book treating of all that which appertains to the diligent barber, the most important dental subjects are passed over in silence, this shows that, contrary to the generally diffused opinion of today, the dental art was not at that time (at least not in Italy) exclusively, or even in great part, in the hands of the barber. Even at that time there must have been dental specialists, and the proof of this may be found in d’Amato’s book itself, in the chapter entitled “Necessity and Origin of the Barber’s Art.”379 The author, after having spoken of the divisions which the practice of the medical art had undergone from the most remote times, and after having alluded to the great number of parts into which Medicine was divided in the time of Galen, adds: “Which may also be seen in our own times, for as many as are the members of the human body, so many are nowadays the various kinds of doctors and of medicines. Some are for the teeth, some are for the ears, some for sexual maladies, others are ordinary doctors, others cure cataracts, others ruptures and stone, some make new ears, lips, noses, and others remedy harelips.”

As, under the generic name of doctors, Cintio d’Amato also comprises surgeons, it results from the above passage that in his time, that is, in the seventeenth century, there were surgeons who dedicated themselves specially to the treatment of the teeth; there were, in fact, dentists; and even admitting that the greater number of these were no better than simple tooth-pullers, this cannot be true of them all indiscriminately. Cintio d’Amato’s book demonstrates in the most vivid manner that even among the barber and phlebotomist class, that is, among the practitioners of minor surgery, there were, at that time, men of considerable culture. This ought to hold good with still greater reason concerning surgeons, whose professional level was certainly superior to that of barbers;380 and as dentists belonged to the class of surgeons (whence the denomination still in use of “surgeon-dentist”), it is but natural to admit that besides the ignorant tooth-puller there were even then more or less cultured dentists well capable of treating dental diseases and performing dental operations within the limits permitted by the knowledge of the times.

The six chapters in which Cintio d’Amato speaks of matters referring to the teeth do not contain anything whatever of real importance; notwithstanding this, we will here refer to the beginning of Chapter XXXIX, treating “Of tartar and spots on the teeth,” because it is of some historical interest:

“It happens in general that owing to vapors that rise from the stomach, a certain deposit is formed on the teeth, which may be perceived by rubbing them with a rough cloth on waking. One ought, therefore, to rub and clean them every morning, for, if one is not aware of this, or considers it of little account, the teeth become discolored and covered with a thick tartar, which often causes them to decay and to fall out. It is then necessary that the diligent barber should remove the said tartar with the instruments destined for this purpose.”

We have seen that the practice of the dental art was for the most part in other hands than in the barber’s. Nevertheless, the important operation of the removal of tartar was also carried out by him. If, therefore, even the barbers, who were not in the least the true representatives of the dental art of that period, carried out such an important operation, it may logically be argued from this, in support of what we have said before, that the sphere of action of the true dental specialists of those times (especially of the best among them) was not at all so limited as imagined by those who affirm that in past times dentists properly so called did not exist, but only tooth-pullers.

The barbers, however, having become, in a certain manner, members of the medical class, sought to extend their sphere of action, and it is probable that in a later period than that of Tiberio Malfi and Cintio d’Amato they invaded the whole field of dental activity; for which reason, when the barber’s art came down to a very low level, the dental art must have degenerated, too, and have been represented for a certain time only by ignorant barbers and tooth-pullers. Vicissitudes similar to these have occurred in different epochs, not only in various parts of Italy, but also in other countries of Europe.

Fleurimond. In 1682 a little book on dental hygiene was published in Paris by a certain Fleurimond, the title of which was: Moyens de conserver les dents belles et bonnes. Portal, in his history of anatomy and surgery, makes mention of this pamphlet, and, briefly alluding to certain parts of it, he says: “The author proves by observation that acids act upon the enamel of the teeth. He makes some very just reflections upon dentition. Fleurimond speaks of a tooth powder invented by him, but does not say how compounded.”381

In fact, it seems that this pamphlet was compiled from a commercial point of view, viz., that of making known the special tooth powder invented by the author. The era of advertisement had already begun!

Anton Nuck (1650 to 1692), a Dutch surgeon and anatomist, who taught most ably in the University of Leyden, devoted great attention to dental surgery and prosthesis. Relative to the extraction of teeth, he says that, in order to be able to carry out this most important operation, an exact anatomical knowledge of the alveoli and of the teeth themselves is required. He insists on a principle of capital importance that has only had its full application in the nineteenth century, viz., that the instruments to be used for the extraction of teeth ought to vary according to the tooth to be extracted. For the removal of the incisors, he says, the “goat’s foot” should have the preference; the canines ought to be extracted with the common dental forceps, but sometimes, when they are decayed, they may be extracted with greater security with the pelican; for the small molars the straight-branched pelican is to be preferred, for the large molars the curved pelican; as to the extraction of roots or of splinters of bone, this ought to be carried out with the rostrum corvinum.

The author counsels never to extract teeth during pregnancy, except under circumstances of the greatest urgency, and especially to avoid the extracting of the upper canines (or eye teeth), this being capable of producing pernicious effect on the visual organs of the fetus!

The best way of obtaining the cessation of a violent toothache without having recourse to extraction is, according to the author, cauterization of the antitragus, an operation which he carried out with a special cauterizing instrument, made to pass through a small tube, the better to localize and to limit the action of the red-hot iron. With regard to this means of cure already recommended by other authors, we may remark that, although it seems ridiculous at first sight, and although no one could be so senseless as to make use of it in our days, nevertheless, for the times of which we are writing, when the curing of toothache was in a great measure effected by indirect means, this remedy might well stand on a level with many others, and was not perhaps altogether inefficacious. It is a sufficiently well-known physiological fact that the application of a strong stimulus in one part of the body may diminish or suppress a painful sensation in another part of the organism. It is an equally well-known fact that it is in no way a matter of indifference, in producing this phenomenon, to what part the stimulus be applied, especially because of the great difference existing in the relations of the several parts of the body with the brain—the centre of sensation. It is, therefore, very possible that the cauterization of the antitragus may really have the effect of causing strong toothache to cease, at least temporarily.

Nuck used a variety of remedies to arrest dental hemorrhage, such as tinder, burnt linen, vitriol, sulphuric acid and the cauterizing iron.

As to the use of the file, far from rejecting it entirely, as does Martin, he holds it necessary in many cases for planing down points and sharp edges of broken teeth, as well as for removing, at least in a measure, the inconvenience and deformed appearance caused by irregular teeth. He says the file may be used without causing the slightest harm, if one takes care not to approach the inner cavity of the tooth too nearly, and above all not to penetrate right to it, which would give rise to intolerable pain. Such an accident, he adds, may happen much more easily when, instead of using the file, whole pieces of teeth are removed with the excising forceps.

This author acquaints us with a tooth powder, much used in his time, especially by Parisian ladies. The ingredients were powdered cuttle fish, coral powder, cream of tartar, Armenian bole, and powder of red roses.

At that time artificial teeth were generally made of ivory; Nuck, however, observes that it soon becomes yellow by the action of food and drink, and of the saliva itself. He therefore recommends, instead, the use of hippopotamus’ tusks, giving the preference to the whitest. According to Nuck, artificial teeth made of hippopotamus’ tusks would be capable of preserving their color even for seventy years. In the case of all the teeth of the lower jaw being wanting, the entire dental arch ought to be framed in with a single piece of ivory or tusk of hippopotamus.382

Carlo Musitano, a celebrated Neapolitan doctor (1635 to 1714). According to Carlo Musitano, the real cause of toothache consists in the irritant action of saline or acid particles on the extremely thin membrane that lines the alveoli or on the exquisitely sensitive nerves of the teeth. As he believes, these particles have an angular form, sometimes pointed or even hooked, and they reach the sensitive parts either directly from the outside, through the air, the food or drink (especially when the teeth are already decayed), or else through the blood and other humors, which often, by reason of their deteriorated quality, contain great quantities of such irritant particles.

Among the various influences which may be conducive to toothache, atmospheric conditions ought also to be included; thus, says the author, the inhabitants of the Baltic littorals, and other northern peoples, are very subject to toothache, for the reason that in those regions the air contains, in abundance, saline particles of various kinds which penetrate into the organism by the act of respiration. It is said, on the contrary, that in Egypt, where the air is remarkably mild, the teeth are not subject either to pain or to decay.

Musitano, too, believes in worms in the teeth, but does not admit, as preceding authors had done, that they generate spontaneously. He holds instead that they result from the eggs of flies and other insects, which, together with food, are introduced into the carious cavities and there develop by the heat of the mouth.

The treatment of toothache ought to differ according to its causes. If the pain be owing to acidity, one uses medicines adapted for tempering the acids; if it be owing to the action of saline substances, one has recourse to remedies which dissolve them; if to worms, to such remedies as destroy them, and so on. Purgatives and bleeding ought, however, never to be used as remedies against toothache; for, far from doing good, they often do harm. As to the other torments usually inflicted on poor sufferers, they are the punishment of their sins, for God often gives the unrighteous into the hands of doctors! (This language will perhaps appear less strange when the reader comes to know that Carlo Musitano was at one and the same time priest and physician!)

After a lengthy enumeration of medicaments to be used against toothache, which we pass over in silence because already known, the author speaks of two remedies which carry us back absolutely to the days of Pliny! He relates us a fact experienced by himself, that, by touching an aching tooth with the leg of a frog completely cleaned of the flesh, the pain ceases altogether. Also, if the aching tooth be touched with the root of a tooth extracted from the jaw of a corpse, the pain ceases, the tooth becomes as cold as ice, and often, after a certain time, it falls to pieces.

As to worms, the best mode of destroying them is by using bitter substances, such as myrrh, aloes, colocynth, centaurea minor, etc., but sometimes the use of sweet substances, such as honey, is a good means of drawing them out of the carious cavities!

Musitano also cites a great number of remedies against the setting on edge of the teeth. Among the best of these he mentions urine applied to the teeth whilst still warm! Alkali in general, and particularly lye, such as is used for washing purposes, are good remedies against the setting on edge of the teeth.

The treatment of loose teeth ought to vary according to whether this pathological condition depends on old age, or on scurvy, on syphilis, on superabundance of humors, etc. Sometimes, especially in old persons, it may be useful to bind the teeth with gold wire, in order to prevent their falling out, but this operation must be very ably performed, otherwise it may give rise to inflammation.

Relative to artificial teeth, Musitano says that they are made of ivory or hippopotamus tusks; of these last he does not speak as of a novelty; we may, therefore, deem it probable that hippopotamus tusks were used in Naples for making artificial teeth even before the Dutchman Anton Nuck (contemporary of Musitano) made mention of them in his writings.

In cases of difficult dentition, the best remedy, according to Musitano, for facilitating the eruption of the teeth consists in friction of the gums, once, or at most twice, with blood drawn fresh from the comb of a cock! If, however, even this remedy fails to produce the desired effect, it will then be necessary to lance the gum at the point where the tooth is to erupt, or to press it hard with the thumb, that the tooth may the easier come through.

The sole merit of this author (as to what concerns our specialty) consists in his having declared bleeding useless, or even harmful in the treatment of toothache, and, besides, in his having recommended, with great warmth and in most impressive terms, cleanliness of the teeth. What is more beautiful, says he, than a mouth furnished with white teeth, similar to so many pearls? And what is more abominable than black or livid teeth, covered with a fetid deposit or with tartar? Unclean teeth spoil the appearance of the person, and nauseate those who behold them.383

William Cowper (1666 to 1709). Toward the end of the seventeenth century the celebrated English doctor and anatomist, William Cowper, opened up a new field of action to oral surgery by inaugurating the rational treatment of the diseases of the maxillary sinus. In order to empty Highmore’s antrum of deposits and to be able to carry out the necessary irrigations, he extracted in most cases the first permanent molar, and then penetrated through its alveolus into the sinus with a pointed instrument.

James Drake, also an Englishman and a contemporary of Cowper, operated in the same manner; and it was this author who made known in a book of his384 the operative method of Cowper; for which reason the above-mentioned proceeding is sometimes called “the Cowper-Drake operation.” A certain time elapsed, however, before it became generally known. Thus, in a book published by Johann Hoffmann in 1713 there is no mention made of this operation, albeit the author refers therein385 to the case of a young girl, one of whose canine teeth having been extracted by him, there ensued a considerable flow of whitish pus from the maxillary sinus. In speaking of this case, Hoffmann stigmatizes many of the surgeons of his time who were not acquainted with the existence of Highmore’s antrum, and therefore, in cases of patients whose teeth had fallen out as an effect of syphilis, if they happened to penetrate with the sound into the maxillary sinus, believed this to be an accidental excavation of the bone, produced by caries.

However, the honor of having initiated the rational treatment of diseases of the maxillary sinus is not exclusively due to William Cowper and to James Drake; a large share is also due to the celebrated German physician and anatomist, Heinrich Meibom. The mucous membrane of the maxillary sinus was considered by him as the real point of departure of the diseases which occur in this cavity, it being liable to become inflamed and to suppurate, thus giving rise to much pain and to various accidents. Meibom rejects the operation of Molinetti, that is, the trepanning of the cavity from the front, the lesion produced in the soft parts of the face being likely to give rise to unpleasant consequences. “Some, he adds, try the introduction of medicated vapors into the antrum,386 but the best way is to open the maxillary sinus by extracting a tooth, as the pus generally makes its way as far as the roots of the teeth.”387 The author says that his father, who was also a physician, had already used the above method with success. He does not speak at all of the artificial opening of the antrum by perforation; but, as is well known, this is not necessary in many cases, so that, even now, the operation is sometimes reduced to procuring the opening of the sinus by the simple extraction of a tooth, as was, in fact, practised by Heinrich Meibom and his father.

Seeing that Heinrich Meibom was born twenty-eight years before William Cowper, and was already known to the scientific world when Cowper was still a child, it is very probable that his operative method, having come to the knowledge of the latter, was only followed up and perfected by him.

Charles St. Yves (1667 to 1733), oculist in Paris, records an interesting case of a secondary affection of the maxillary sinus. The point of departure of the evil was an abscess in the orbit. The suppurative process, after having produced an erosion and the perforation of the orbital plane, had reached by propagation the antrum of Highmore, whence the pus took its way, issuing through the nose. St. Yves had a molar tooth extracted on the affected side (we do not know which side it was), after which, day by day, he made injections of detersive liquids through the orbital fistula, which returned constantly through the alveolus of the extracted tooth. By this means the cure of the patient was obtained.388

Christopher Schelhammer (1649 to 1716), who was professor in various German universities, and distinguished himself specially as an anatomist and as an ear doctor, strongly recommends stopping decayed teeth as the best means of causing pain to cease. If, however, the stopping does not hold, by reason of the cavity being too extended, it is then necessary, says Schelhammer, to extract the tooth; this, however, may very well be stopped after extraction, and then replanted, for it will take root again, but no longer be the cause of any pain.389

Pierre Dionis, a celebrated surgeon and anatomist of Paris (died 1718), in his Anatomie de l’homme,390 admits the possibility of a double dental series, holding the case, however, to be of very rare occurrence.

Another work of his, entitled Cours d’operations de Chirurgie, wherein he treats very extensively of diseases of the teeth and mouth, and their surgical cure, is of much more importance in relation to dentistry. He recognizes the high importance of this part of surgery, but expresses the opinion that one of the dental operations, that is the extraction of teeth, ought to be left entirely to the tooth-pullers, not only because they are, by reason of great practice, better qualified to perform it than general surgeons, but also because the output of force required for this tooth-pulling operation renders the hand heavy and tremulous, and, lastly, because, according to him, it always has something of charlatanism about it. (This is a luminous example of how preconceived ideas can influence the minds even of men of the greatest talent.)

Pierre Dionis, like many of the preceding authors, had frequently occasion to observe cases of epulis. He speaks at great length of the treatment of this affection, as well as of parulis, but says nothing on the subject of sufficient importance to be worth recording.

Dental operations, according to Dionis, are of seven kinds:

1. The opening of the dental arches in the case of spasmodic constriction of the jaws. This operation, of the greatest importance for nourishing and keeping patients alive, is carried out by means of a lever and of a screw dilator.

2. The cleaning of the teeth. For this, as for the other operations, says Dionis, a certain amount of skill is required. The author advises the use of gold instruments if one be called upon to clean the teeth of persons of rank. This appears rather strange in the present levelling times, but Pierre Dionis lived in the days of Louis XIV, whose doctor he was, that is, in a period of unbridled luxury, when the nobles and those in power would have nothing in common with the lower classes.

3. Operations for the preservation of the teeth. These, says Dionis, are of the greatest importance, it being necessary to oppose a barrier to the destructive processes of the teeth. Caries, when so situated as to permit of it, ought to be scraped away; for approximal caries one ought to have recourse to the file; in the case of caries of the triturating surfaces, cauterization should be used, by applying a drop of oil of vitriol with a miniature paint brush. Should the caries, however, be in a very advanced stage, it is better to make use of the cauterizing iron. But in cases of intense and persistent pain there is no other remedy than extraction.

4. Stopping of the carious cavity. Dionis does not enumerate this operation among those intended for the preservation of the teeth. At that period, this operation was performed solely with a view to preventing the penetration into and the retention within the carious cavity of alimentary substances, and the disadvantages caused thereby. The carious process, says the author, often ceases altogether, and the pain then generally ceases also. However, as the residual cavity often becomes troublesome in various ways, among others by making the breath offensive, it is better to stop it. For this purpose, gold or silver leaf is generally made use of; but this mode of stopping is not durable, because gold or silver in leaf is apt to become loosened and fall out. It is therefore preferable, says Dionis, to make a stopping with a piece of gold or silver corresponding in size and shape to the cavity.391 Many, he adds, prefer lead as a stopping, on account of its softness, whilst others simply use wax.

5. The use of the file. The indications given by Pierre Dionis for using the file do not differ from those we find in other authors. Dionis warns, however, against using the file to level down a tooth which has become lengthened through the loss of its antagonist, for after a certain time it would again project above the level of the others.

6. Extraction. This operation, says Dionis, ought not to be performed too lightly, but only in those cases in which it is really necessary; that is, when a tooth is the cause of insupportable pain and its crown is almost entirely worn away; when nothing remains of a tooth but its root; when a tooth is so loosened in its socket as to leave no hope of its again becoming firm; when supernumerary teeth or irregularly planted teeth give rise to inconvenience or deformity; and lastly, to remove deciduous teeth that have become loosened. The opinion that if the loosened milk teeth be not promptly extracted they cause the permanent teeth to grow irregularly, is, however, considered by Dionis to be a prejudice.

Dionis strongly doubts whether a tooth that has been extracted and replanted can really take root again, as had been affirmed by Dupont, Pomaret, and other authors. This shows that Dionis had had no experience on this point.

7. The application of artificial teeth. These teeth, says Dionis, are generally made of ivory, but may also be made of ox bone, which is less liable to turn yellow than ivory. He does not mention the use of hippopotamus tusks, but we learn from him that one Guillemeau made artificial teeth with a composition of his own invention, which was obtained by fusing together white wax and a small quantity of gum elemi, and then adding ground mastic, powder of white coral and of pearls. This fact is, as everyone can see, most important, for it constitutes the first step toward the manufacture and use of mineral teeth. Dionis tells us that the teeth made of Guillemeau’s composition never became yellow, and that it was also very good for stopping decayed teeth.392 It would seem, therefore, that it could be used as cement is now used.

The Guillemeau of whom Dionis speaks is probably Jacques Guillemeau, the author of a book now no longer to be found, which was translated from the French, first into Dutch, and afterward into German. Crowley, in his Dental Bibliography, only quotes the German edition, published at Dresden in 1710, the title of which runs thus: Der aufrichtige Augen und Zahnarzt.393

Jean Verduc, also a Frenchman, relates a case of the surgeon Carmeline,394 analogous to that of Denis Pomaret, in which a sound tooth which had been extracted by mistake was immediately replanted and took root again, becoming quite firm. However, Verduc does not speak of replantation as a special method of cure, but merely refers to the above case incidentally in speaking of the extraction of teeth. He considers this operation a most dangerous one, and advises not having recourse to it except in cases of utmost necessity. Notwithstanding this, Verduc gives us to understand that teeth were drawn with sufficient ability by most of the operators of the time, and precisely because of this he omits describing the manner of performing the operation. According to Verduc, the drawing of teeth is often of little or no advantage against toothache.395 In proof of this assertion he relates the case of a hypochondriac, who little by little had as many as eighteen teeth extracted, without, however, getting the better or the wiser; but as this case does not prove anything at all, one is disposed to think that Verduc, in relating it, had the intention of being humorous.

Monsieur de Lavauguyon. To another French surgeon, Monsieur de Lavauguyon, also a contemporary of Dionis, belongs the merit of having declared useless, in the greater number of cases, the practice, at that time general, of separating the gums from the tooth before proceeding to the extraction of the latter. He says that this is only necessary when a tooth, either because broken or because its crown emerges too little above the gum, offers an insufficient hold for the pelican.396

Our historical survey has now reached the end of the seventeenth century. Embracing at a glance the whole of this last period of time, we remark, among many facts of minor importance, some events which, in the history of the development of dental art, stand out in strong relief. Such are the replantation of teeth used as a special curative method by Dupont and others; the method of plugging in cases of alveolar hemorrhage, the credit of which is due to Rivière and to Tulpius; the description of the maxillary sinus given by Highmore; the rational treatment of affections of the antrum, inaugurated by Meibom, Cowper, and Drake; the researches into the microscopic structure of the teeth, brilliantly initiated by Leeuwenhoek, who discovered the dentinal tubuli; the use of models introduced by Purmann into the workmanship of prosthetic pieces; the employment of hippopotamus’ tusks in making artificial teeth, first recommended by Nuck; and the invention of Guillemeau, which was the first step toward the use of mineral teeth.

CHAPTER XII.

THE EIGHTEENTH CENTURY.

Although there have been, even from the most remote times, individuals who have dedicated themselves exclusively to the cure of dental maladies, or to repairing the losses of the dental system by artificial means, and notwithstanding the progress gradually accomplished in this branch of the medical art, which progress was especially remarkable during the sixteenth and seventeenth centuries, it is not to be denied that, up to the beginning of the eighteenth century, dentistry was, in great part, considered one with medicine and surgery in general. It is but natural that dental art (and the same may be said of every special branch of medicine) could not assume a real individuality until it had attained to the higher grades of its development. As a matter of fact, dentistry, toward the end of the seventeenth century, was already a true specialty, although it counted but few worthy representatives at that time. The definite separation between the science and art of dentistry and general medicine and surgery, although it may have been retarded, could not fail to take place; and this, as we shall presently see, was effected by the celebrated French dentist Pierre Fauchard.

But, to remain faithful to chronological order, we will first speak briefly of some other writers.

Ludwig Cron, a barber of Leipsic, in a pamphlet published in 1717, with the title The barber’s apprentice versed in bleeding and tooth pulling,397 declares, in a still more emphatic and general way than De Lavauguyon, that it is useless to detach the gum before proceeding to extract a tooth. This barber, strong in his own experience, dares to assert absolutely useless this ancient practice, advised first by Cornelius Celsus, and recommended after him, and in homage to his authority, by many other writers. It is, therefore, possible that even previous to Cron and De Lavauguyon many operators had dispensed with the practice recommended by Celsus, although this had become an accepted canon of the high medical profession.

Lorenz Heister (1683 to 1758), of Frankfort-am-Main, one of the most celebrated surgeons of the eighteenth century, wrote a dissertation on toothache,398 treating besides very extensively of dental affections and their cure in a masterly work on surgery, published for the first time in 1718, and which went through numerous editions in various languages.

When the caries of a tooth is superficial, Heister advises the removal of the decayed part with the file; or, when the caries is deep down, the cavity ought first to be well cleaned with a toothpick or other like instrument, then filled with heated white wax, or mastic, the stopping being renewed as often as may be necessary. When a molar tooth is decayed, especially in the centre, the best way, says Heister, is to fill it with gold or lead leaf, or with a piece of the latter fitting into the cavity. If the carious cavity of a painful molar cannot be cleaned as it ought to be, the dropping of a little oil of cloves or of cinnamon or of guaiacum into it will be found useful, or even a few drops of spirit of vitriol; for in this manner one obtains at the same time the double advantage of destroying the impurities contained in the carious cavity and of soothing the pain. But if by chance the pain should persist, recourse must be had to the cauterizing iron, or to extraction. Sometimes, however, even the most violent toothache can be made to cease, either by scarifying the gums (a method already recommended by Pliny), by cauterizing the antitragus, or by pressing the aching tooth hard between the fingers, as Schelhammer399 and some other writers had advised.

Heister writes at length on the extraction of teeth, on the indications and counterindications appertaining thereto, on the instruments with which the operation should be carried out, and so on. Regarding the position of the patients, he thinks it best to place them on a low seat or on the ground, if the tooth to be extracted is situated in the lower jaw, but if an upper tooth is to be extracted, patients should be placed on a chair or on a bed.

Movable prosthetic pieces are mentioned for the first time by this author. Although he is very concise in his manner of speaking of artificial teeth (this indicating that dental prosthesis was considered outside the sphere of action of the general surgeon), we nevertheless learn from him that partial sets of teeth made of ivory or hippopotamus tusks, and without special appliances for fixing them, were then in use, which, when applied in the void between the neighboring teeth, were maintained in position simply by their form. The author advises keeping prosthetic pieces very clean, removing them every evening before going to bed, and not putting them back in the mouth until they have been well cleaned.

Heister also speaks of nasal prosthesis; this was then carried out by applying noses made of wood or of silver, properly painted. In cases of trismus, this author altogether rejects the forcible opening of the jaws by means of screw dilators and such like instruments, as they act too violently, and, according to him, only aggravate the morbid condition. Even the extraction of a tooth is useless in such cases, as the patient can always absorb a certain quantity of liquid food through the closed teeth. On the other hand, the author expresses himself in favor of the incision of the gums in cases of difficult dentition. According to him, convulsions and the other nervous symptoms which children are subject to during the period of dentition depend wholly on the hardness and strained condition of the gum. It is, therefore, natural that the symptoms should disappear when an incision of the gums, reaching to the tooth that is coming through, has caused the tension to cease.

The author speaks very particularly of the treatment of epulis and parulis; but his views on this subject contain nothing of great importance.

René Jacques Croissant de Garengeot (1688 to 1759), the celebrated French surgeon, speaks very little of dental surgery in his works. He declares himself averse to the carrying out of too many operations on the teeth, and especially disapproves the use of the file, because, according to him, it ruins the enamel.400 For a long time, especially in France, Garengeot was believed to have been the inventor of the key known by his name; but he merely perfected this instrument. In fact, through a later author, Lecluse, it clearly results that the key existed before Garengeot. “For extracting,” writes Lecluse, “one may make use of the pelican that Garengeot has constructed on the English key.” In a note, he afterward adds, “that the English key is an instrument used by dentists in England.” However, it is not in the least certain that the key is really an instrument of English origin.

Loder, who wrote at the end of the eighteenth century, informs us that the so-called English key was called the German key in England; it is, therefore, not improbable, that this instrument, as some maintain, had its origin in Germany.401

Johann Junker (1679 to 1759), professor of medicine at the University of Halle, wrote on dental maladies, not only in a treatise on surgery, published in 1721, but also in three dissertations which were published some time later, and were entitled respectively: De affectibus dentium (1740), De dentitione difficili (1745), De odontalgia (1746). The author, however, for the most part, only repeats things already known; his writings have, therefore, little or no importance for us. He counsels the Cowper-Drake operation in treating the affections of Highmore’s antrum; in carrying out the operation, however, he thinks the extraction of the second molar to be preferable to that of the first. To prevent the formation of tartar on the teeth, he advises assiduous care in keeping the mouth clean, and recommends, among other things, rubbing the teeth with sage. He disapproves having recourse too readily to metal instruments to remove tartar from the teeth, because, according to him, it favors the production of dental caries. He holds it dangerous to extract the upper or lower canines when they are not loose, as, by reason of the depth of their roots an injury to the surrounding nerves may be the result, which not only might cause great pain, but in the case of the upper canines might lead to inflammation of the eye, and even of the dura mater!

When the caries is incipient, Junker advises rubbing the teeth several times a day for some time with common salt, in order that this should penetrate into their structure.402

Guillaume Maquest de la Motte (1655 to 1737), a distinguished French surgeon and the writer of an excellent treatise (Traité complet de chirurgie, Paris, 1722), repeats the advice already given by preceding authors, to which he annexes the highest importance, that is, the opening in time of abscesses of the gums and of the palate even before they be completely matured, in order to prevent the suppurative process from extending and damaging the bone below. This author relates having several times arrested serious hemorrhage following on the extraction of teeth, by applying a little vitriol inside the alveolus, and, on this, graduated compresses, which the patient pressed on the part with the teeth of the opposite jaw.403

Johann Adolph Göritz, of Regensburg, in one of his writings published in 1725, disapproves the too frequent recurrence to extraction of the teeth, that is, carrying out the operation when it is not absolutely necessary. He is also averse to the application of artificial teeth. In support of his opinion he relates a case in which, a certain time after the application of an artificial tooth, the natural ones to which it had been fixed became loose, so that it was necessary to proceed to the fixing of all three, that is, the artificial tooth and the two neighboring ones, to the firm teeth beyond them; these, however, became loosened in their turn, and it was at last necessary to extract six teeth. The great space thus created was filled with a prosthetic piece made of hippopotamus tusk; but the author did not believe much good would come of this either. In fact, he is of opinion that the natural teeth should be preserved by every possible means, and that, on the other hand, even in the case of a few being lost, it is better not to resort to substitutes. In the worst case, should the dental void cause too great inconvenience by damaging the pronunciation, or for some other reason, it may be filled by an “imitation” in soft wood.404