The author then speaks434 of the accidents which may arise from caries and from other dental diseases, not only in the parts nearest to the teeth, but also in localities more or less distant from them, for example, fistulæ reaching as far as the cheek bone or the eye, necrotic destruction of the maxillary bones, etc.

The first volume of Fauchard’s work finishes with a collection of most interesting cases, which may be read even at the present day with pleasure, and from which one may derive some useful information. These cases are about eighty in number, spread over fifteen chapters, according to the various nature of the cases themselves. This valuable collection gives clear evidence of Fauchard’s eminence both as operator and observer, and affords at the same time an idea of the extent of his practice which enabled him to collect so considerable a number of cases of more than common interest.

Chapter XXV contains some observations on “well-authenticated cases” of regeneration of permanent teeth in individuals of ages varying from fifteen to seventy-five years. We will here give two of them by way of curiosities:

“In the year 1708 Mademoiselle Deshayes, now the wife of M. de Sève, residing at Paris in rue de Baune, and who was then fourteen years of age, had the first large molar on the right side of the inferior jaw extracted by me, because decayed and causing pain. The following year she returned to have her teeth cleaned by me, and whilst doing this I observed that the tooth extracted had been wholly regenerated.”435

“In the year 1720 the eldest son of M. Duchemin, player in ordinary to the King, who was then sixteen years old, came to me to have the second large molar on the left side of the lower jaw extracted. It was very much decayed. I drew it, and a year and a half after the tooth was completely regenerated.”436

In Chapter XXVIII the author relates twelve cases of dental irregularities corrected by him with satisfactory and at times even surprising results. We here refer, in Fauchard’s own words, to the last two of these cases, not because of their being the most important, but because from them it is evident that Fauchard was not the only dentist who undertook such corrections, although he was perhaps the only one who, in certain cases, carried them out with a rapid method.

“In the year 1719 M. l’abbé Morin, about twenty-two years of age, whose countenance was greatly deformed from the bad arrangement of the incisors and canines, consulted various colleagues of mine as to the possibility of correcting the irregularity of his teeth. Some found the thing so difficult that they advised him to do nothing at all, that is, not to risk any attempt. He came to me by chance one day whilst another dentist was with me. We both examined his mouth with much attention. Now, as this dentist was my elder, and I believed him to have more experience than I had, I begged him to give me his opinion as to the best method to follow in this case, in order to insure success. Whether it be that he would not give me advice, or that he was not in a position to be able to do so, the fact is, that his answer was not such as I could have wished. I therefore felt myself obliged to tell him that I hoped to put this gentleman’s teeth in order within three or four days. My colleague was not aware that this could be done so quickly; urged by curiosity, he returned when the time I had indicated had elapsed, and found, not without surprise, M. Morin’s teeth reduced to perfect order.”437

“Several years ago the wife of M. Gosset, Reviseur des Comptes, sent for me to examine the teeth of her daughter, then twelve years of age. I found the lateral incisor on the left side of the lower jaw strongly inclined toward the palate in such a manner as to constitute a real disfigurement. Interrogated by the mother as to the possibility of remedying this, I replied that it could easily be done in eight or ten days, with the method of threads, if the young girl were only sent every day to my house. As, however, the young lady received instruction from several masters who came to her house each day, my proposal was not accepted, in order not to distract her from her studies. This induced me to say to the mother that, if she were willing, I would put the crooked tooth into its natural position in a few minutes. Surprised at so short a time being demanded for the operation, she consented to my performing it immediately. Making use of the file, I began by separating the tooth from the neighboring ones which pressed upon it, slightly diminishing the space it ought to have occupied. This done, I straightened the tooth with the pelican, placing it in its natural position, to the great astonishment of the young girl’s mother and of other persons present, who told me they had many times seen similar corrections that had been carried out by the late M. Carmeline and others, never, however, with this method or in so short a time. As soon as I had reduced the tooth to its normal position I fixed it to those next to it by means of a piece of common thread, which I left there eight days; and during that time I made the young girl rinse her mouth four or five times a day with an astringent mouth wash. After the tooth had become firm, it would not have been suspected that it had ever been out of its normal position.”438

In Chapter XXX the author gives an account of five cases of dental replantation and one of transplantation. This last operation was carried out on a captain who had the upper canines on the left side decayed and aching; he inquired of the author if it were possible to draw it and replace it by another person’s tooth. Having received an affirmative reply, the officer sent immediately for a soldier of his company to whom he had already spoken on the subject. This man’s canine was found by Fauchard to be too large; nevertheless, for want of better he extracted and transplanted it, after having diminished it in length and in thickness. This it was not possible to do without the cavity of the tooth remaining open, and for this reason, when, after about two weeks’ time it had become quite firm, he stopped it. But the stopping immediately caused such insupportable pain (which circumstance astonished the writer not a little) that he was obliged to take it out again the following day, on which the pain ceased directly. Fauchard saw this patient eight years afterward, and was assured by him that the transplanted tooth had lasted him six years, but that its crown had been gradually destroyed by caries. The root had been extracted by a dentist, not without considerable pain.439

We now give one of his cases of replantation in the words of the author himself:

“On April 10, 1725, the eldest daughter of M. Tribuot, organ builder to His Majesty the King, called on me; she was tormented by violent toothache caused by caries of the first small molar on the right side of the upper jaw; but although she was desirous of having the tooth removed, to be freed of the pain, she, on the other hand, could not, without difficulty, make up her mind, thinking of the disfigurement which its loss would occasion, and thus it was that she was induced to ask me if it would not be possible to put it back again after having extracted it, as I had already done in the case of her younger sister. I replied that this might very well be done, provided the tooth came out without being broken, without any splintering of the alveolus, or great laceration of the gum. The patient, upon this, completely made up her mind. I extracted the tooth very carefully so as not to break it, neither were the gum nor the alveolus injured in any way. I therefore was induced to put the decayed tooth back in its alveolus, and having done this, I took care to tie it to the neighboring teeth with a common thread, which I left in position for a few days. The tooth became perfectly firm, and only caused pain for two days after being replanted.... To better preserve it, I stopped the carious cavity.”440

Not without interest is a case of disease of Highmore’s antrum, originating in the following way. A charlatan attempted to extract by means of a common key a canine tooth which had erupted in an abnormal position. He applied the hollow of the key to the tooth and beat upon the handle with a stone. But the tooth, instead of penetrating into the hollow of the key, was driven into the maxillary sinus.441

Two important cases of “stony excrescence” of the gums (probably osteomas) are to be found in Chapter XXXII. One of these tumors was removed by the dentist Carmeline after the patient had been tortured with useless operations by surgeons, who, not recognizing the true seat of the evil and mistaking it for a tumor in the cheek, had, over and above all the rest, produced a permanent disfigurement of the patient’s face and a perforation of the cheek that he was obliged to keep closed for the remainder of his life with a wax plug, to prevent the exit of the saliva and of liquid or masticated aliments.442

Several important observations on obstinate cases of cephalalgia, prosopalgia, otalgia, and other varieties of pain arising from dental caries are to be found in Chapter XXXIII. In all these cases the removal of the decayed tooth or teeth procured the prompt cessation of pain. Among others worthy of note is a case of violent otalgia caused by the decay of a lower molar, which, however, was itself not painful. This circumstance drew Fauchard himself into error, causing him to believe that the otalgia was independent of the decayed tooth; he therefore merely stopped the tooth to prevent the caries from extending farther. The pain in the ear continued, however, and the patient therefore consulted a doctor of the Faculty of Paris, Coutier, who told her that the decayed tooth might be the cause of the earache, and that, therefore, before undertaking any other cure, she ought to have it extracted. This advice was followed and the earache ceased promptly and completely.443

In another case a patient twenty-seven years of age was tormented by violent pain in all her teeth on the left side, in the temple and the ear, as well as in the chin, the palate, and the throat. The doctors and surgeons consulted decided the cause to be rheumatism. The patient was bled not less than four times and subjected to various other methods of treatment (purgatives, clysters, poultices, etc.), but all in vain. She, however, perceiving that one of her teeth was decayed, had it taken out. It was believed that the cause of the malady had thus been found and removed; but an hour later the pain began again with the same violence as before, continuing for some months; after this it ceased of itself. On the return of the pain, later on, in all its former intensity, the patient consulted the very able surgeon Petit, who advised her to see Fauchard, as possibly the malady might have its cause and point of departure in some bad tooth. Fauchard found one of the inferior molars decayed. This being extracted, the pain promptly ceased, not to return any more.444

Chapter XXXV contains twelve cases of serious maladies arising from dental diseases. One of these cases was observed in a patient aged fifty-seven years, who in consequence of caries of the last inferior molar on the right lost through necrosis a considerable portion of the lower jaw, including the whole of the right condyle; he was affected, besides, with caries of the temporal bone, in so advanced a degree that the probe could reach the dura mater; he was, therefore, in serious danger of his life, had to undergo several surgical operations of exceptional gravity, and even after recovery remained permanently subject to various disturbances, such as a salivary fistula, paralysis of the lower eyelid, etc. And all this because the surgeons whom the patient had called in had directed all their attention to the secondary facts, instead of suppressing the primary cause of the evil, represented by a dental affection.

A case observed by the surgeon Juton and communicated by him to the author is also a very important one. The patient was suffering with a large abscess on the right side of the lower jaw, accompanied by such great swelling of the cheek that it was impossible to open the mouth wide enough to examine the teeth. Juton proposed opening the abscess immediately, but the patient would not consent. The following day he was sent for in great haste. The gathering had changed its seat, making its way between the skin and muscles of the neck, where it now formed so huge a tumefaction that the patient was in danger of being suffocated. The abscess was now immediately opened, but the swelling of the face still persisted; it was therefore only after a month had elapsed that it was possible to extract the root of the last molar, which had been the original cause of the whole malady. The surgeon observed that the liquid injected into the fistulous opening in the neck issued from the alveolus of the last molar. After the extraction of the root a prompt recovery was effected.445

The second volume of Fauchard’s work is entirely devoted to operative dentistry and prosthesis.

Before speaking of the modes of cleaning, filing, and stopping the teeth, the author combats the opinion maintained by some, that these operations are in part useless, in part also dangerous, as having the effect of loosening the teeth, of depriving them of their enamel, and ruining them.

Fauchard then describes the instruments proper for detaching the tartar;446 he speaks of the method to be followed in cleaning the teeth in order to not endanger the enamel;447 he speaks of the different kinds of dental files, of their different uses in relation to the various cases and indications; of the precautions to be taken in making use of them;448 of the instruments to be used for scraping and cleaning the carious cavities and of the mode of employing them.449

All of the above-named instruments are illustrated by figures, in contemplating which one cannot but reflect on the inferiority of the instruments then in use as compared with those of the present day. The greater admiration is therefore due to Fauchard’s talent, which, in spite of such imperfect and at times absolutely primitive means, enabled him to obtain the brilliant results cited in his observations.

Fig. 79

Chapter VI is dedicated to the stopping of decayed teeth. The sole materials used by the author for stopping were lead, tin, and gold. “Fine tin,” he says, “is preferable to lead, for lead turns black much more easily and is much less durable; both are preferable to gold, because lighter and adapting themselves better to the unevenness of the carious cavities. Besides, gold being dear, not everyone can or will make the corresponding outlay.” The author here adds that those who, from vanity or because possessed by the opinion that gold has special virtues, will not have their tooth stopped except with it, not unfrequently find dentists who, as the saying, goes, content them and cozen them by using leaf tin or lead colored yellow, and making them pay for it as gold stopping!

Fig. 80

The leaf metals were introduced and compressed into the carious cavities by means of three kinds of pluggers, which would nowadays be considered altogether insufficient and unfit for the purpose, but which then, nevertheless, served to produce excellent stoppings. The author speaks450 of a lead stopping which had lasted in perfect condition for forty years.

Before stopping the tooth the cavity was scraped and its opening widened, if necessary, but no special form was given to the cavity itself, as is done at the present day.

Fig. 81

As at that time the state of the dental pulp was not taken into consideration before stopping a tooth, it often occurred that the stopping caused violent pain, which rendered its removal necessary.451

Fauchard says that “if the sensibility of the carious cavity be too great, the lead ought only to be pressed in very lightly at first, then after one or two days a little more, continuing thus until it is properly compressed and fitted in, always provided, of course, that the pain does not increase. The sensitive parts of the tooth become thus more easily used to the pressure of the lead, and the pain is in this manner avoided or moderated.”452

Fig. 82

The author also makes the remark453 that sometimes, in scraping a carious cavity, “it is not possible to avoid uncovering and touching the nerve with the instruments; one becomes aware of this by the pain caused, and better still by a little blood issuing from the dental vessels.” In such cases, Fauchard advises stopping of the tooth immediately, for if it be carried out with delay, it is sure to be followed by inflammation and great pain, rendering necessary the removal of the lead or even the extraction of the tooth.

Fig. 83

Cauterization of the teeth454 continued to be much used in Fauchard’s time, and this is very easily explainable when one considers that there was not then any other means of destroying the dental pulp. In making use of the actual cautery, the immediate end in view was to cause the cessation of obstinate toothache. “When the teeth give great pain and no relief is to be derived from the use of other remedies, one ought to cauterize the caries after having removed the extraneous substances that may eventually be found in the carious cavity. After the cauterization one scrapes the cavity and fills it up with cotton-wool soaked in oil of cinnamon. Later on one stops the tooth.”455

Fig. 84

The chapter in which Fauchard treats of the correction of dental irregularities is of particular interest. In speaking of his observations, we have already seen that in this field also he knew how to obtain splendid and admirable results. He, nevertheless, made use of the most simple means—the file, pressure with the fingers, common threads or silk ones, little plates of silver or gold. At times, for straightening teeth, he made use of the pelican and the straight pincers, afterward tying the teeth in their normal position. He rarely had recourse to extraction as a means of carrying out dental corrections.456

Fig. 85

Fig. 86

To steady loose teeth,457 Fauchard, as did the ancients, made use of gold threads. When the spaces separating a loose tooth from the neighboring ones were too large, he introduced small pieces of hippopotamus ivory into them of about the height of a line, and not exceeding the tooth itself in thickness; on each side of these was a vertical groove destined to serve as a support to the next tooth. Each of these pieces was furnished with two holes, through which were passed the gold threads which served to bind together the teeth and the piece of ivory itself. This latter was fixed close down to the gum.

Fig. 87

Fauchard occupies himself in three different chapters (X, XI, XII) at great length with the extraction of teeth. He describes a pelican of his own invention, and speaks of the advantages it presents over other pelicans previously in use. Notwithstanding this, it cannot be said that the instruments used by Fauchard for extracting teeth and roots show a sensible improvement on those in use before his time.

Fig. 88

Among the most usual operations, the author enumerates transplantation and especially replantation of the teeth.458 Whenever, says Fauchard, a wrong tooth is extracted by accident, it ought to be immediately replanted, and the same ought to be done when violent pain renders it necessary to extract a tooth that is not much decayed, as the patient is thus relieved without losing the tooth.459 Fauchard adds that this operation succeeds excellently in the case of incisors and canines, and very often, too, with small molars.

Fig. 89

Fig. 90

After having spoken of transplantation, he says:460 “There is another mode of replacing human or natural teeth which I have never yet seen used except by a provincial dentist whose name I ignore.” This special method consists in the transplantation of a tooth—it matters little whether recently extracted or not—after having made three or four notches in its root of about a line in depth. The author goes on to describe all the particularities of the operation, and then adds: “After twenty-five or thirty days one removes the thread, and the tooth is found to be firm in the alveolus, owing to the fact that this latter, exercising a pressure on the root on every side, becomes perfectly moulded upon it. In this manner, the tooth will remain mortised, and may be preserved for a considerable time.”

Fig. 91

One of Fauchard’s greatest merits consists in the improvements introduced by him in dental prosthesis and in his having, besides, been the first to treat of this most important part of dental art in a clear and particularized manner.

The materials then most used in dental prosthesis were human teeth, hippopotamus tusks, ivory of the best quality, and ox bone.461

The author minutely describes the methods to be followed to repair dental losses in every possible case and of whatever extent.

According to the circumstances, Fauchard used, for maintaining artificial teeth in their place, linen, silk, or gold thread, passed through holes made in them, and tied to the natural teeth.

When a set of two, three, four, or more teeth was to be applied, Fauchard first prepared them separately and then united them together by means of one or two threads of gold or silver in such a manner that the set formed at last a single piece, which was then fixed to the natural teeth. When the piece consisted of several teeth it was reinforced with a small plate of gold or silver fixed to its inside by means of small tacks of the same metal riveted on one side to the plate, on the other to the front part of each tooth.

The author remarks that a similar prosthetic piece lasted longer than those previously described, but required proportionately much more work and much greater expense. He adds that, by employing this plate, one can even dispense with threading and fixing the teeth together with gold or silver wire; but that it was then necessary to make a horizontal groove at the back of each tooth corresponding to the width and thickness of the plate, which could be fitted into the serial groove and fixed to each single tooth by means of two small rivets.462

At other times the prosthesis was carried out in a single piece of material (ivory, hippopotamus tusk, etc.) that was carved in such a manner as to substitute exactly the teeth wanting, it being fixed to the natural teeth in the usual manner.

Fauchard sometimes left the dental roots in their place (if they were in good condition), applying upon them artificial crowns, which he either bound to the neighboring teeth or fixed with screws to the respective roots.

“When one wishes to apply an artificial crown to the root of a natural tooth, one files away the part of the root that emerges above the gum, and even more if possible. One then removes, with proper instruments, all that is decayed in the root itself; after which one stops the root canal with lead and fits the base of the artificial tooth to the root in such a manner that they correspond perfectly to each other. One drills one or two holes in the tooth through which to pass the ends of a thread, which serves to fasten it to the natural teeth on each side of it, as described above.

“If the root canal has been very considerably enlarged by the carious process, so as to have rendered it necessary to stop it, the root being, nevertheless, still quite steady, one bores a small hole in the lead as deep and as straight as possible, without, however, penetrating farther down than the root canal. The artificial crown is then united to the root by a pivot in the manner I shall now describe.”463

The method of applying pivot teeth is described with great accuracy. In it the author considers all the different circumstances that may present themselves, and says, among other things, that if the root is still sensitive to pain, one should apply the actual cautery inside the canal, before fitting the artificial crown to the root. For fixing the pivot inside the artificial crown (which was generally the crown of a human tooth), Fauchard used a special cement made with gum lac, Venetian turpentine, and powdered white coral.464

In the case of there not being any whole teeth to which the prosthetic piece would be fixed, but only roots, Fauchard made two holes in it in perfect correspondence with the canals of two roots, and fixed the prosthetic piece to these by means of two pyramidal screws.465

This method suggests in a certain way the idea of bridge work.

In Chapters XVII, XVIII, XXIV, and XXV, Fauchard describes various methods for the application of entire sets of false teeth, both upper and lower, as well as double.

The author says that if the lower jaw is entirely toothless, a set of teeth can be adapted thereto without the need of any special contrivance; however, it is necessary that the prosthetic piece should fit perfectly, so that the configuration of the maxillary arch and the irregularities of the gum, finding themselves in complete correspondence with the piece itself, may keep it steady in its place. The support offered by the tongue interiorly, by the cheeks and the under lip exteriorly, contributes to keep the artificial set steady; one can thus masticate as easily with it as with one’s own teeth, especially if the teeth of the upper jaw be still existing and the individual be already sufficiently used to the wearing of it.466

With regard to the application of an entire set of upper teeth, one learns from Fauchard that although some attempt had been made in this direction before this time, the results had been very unsatisfactory. He relates that: “In 1737 a lady of high rank, of about the age of sixty, who had not lost any of her lower teeth, but was deprived entirely of the upper ones, applied to M. Caperon, dentist to the King, who was most able in his profession, in the hope that he might be able to furnish her mouth with an upper set. But he said that, no tooth whatever being left in existence, every possible point of attachment was wanting, and it would therefore be as difficult to do this as it would be to build in the air.”467 He, however, directed the lady to Fauchard, who asked for a few days to think the matter over, and succeeded in devising a means of applying an upper set of teeth, which, in fact, entirely satisfied the wishes and wants of the client. “As this lady,” says the author, “simply wished to have the front of her mouth decorated, and to be able to pronounce more perfectly, I gave less extension to the set. The lady eats easily with it and could not now do without it. For greater convenience she has two similar sets, which she uses alternately.”468

Fig. 92

Fig. 93

Fig. 94

Fauchard also relates having made an attempt to apply an upper set of teeth without the aid of springs, which proved successful in three cases. “One can,” says he, “adopt an entire set of teeth to the upper jaw, of much greater simplicity than those described, and which is maintained in its place by the sole support of the cheeks and the lower teeth. It must be very light indeed and serves almost solely to improve the appearance and the pronunciation; but when the individual gets used to it, he can also masticate with it. A set of teeth of this kind ought to adhere well to the gums and to be constructed in such a manner that the cheeks may afford it sufficient pressure and support together with the aid of the lower teeth; these latter sometimes bring it back into its place, without anyone perceiving the movement except the wearer himself. Not long since I had to renovate a set of teeth of this kind made by me more than twenty-four years ago, and worn by the owner to the greatest advantage. I have since made two others which have proved most useful to the persons wearing them. It is true that there are few mouths adapted for wearing these sets, so much so that, excepting the three referred to, I have never made any others. To be able to construct similar sets successfully, the dentist must be possessed of skill and ingenuity. Apart from this, they are the most suitable for persons who cannot spend much, as they cost less to make.”469

Fauchard did not merely content himself with having perfected dental prosthesis in the manner alluded to; he also succeeded in giving a quite natural appearance to artificial teeth. To reach this end he placed the art of the enameller under contribution to the dental art. Thus he had artificial pieces covered over with enamel, imparting to them the hue that seemed to him best adapted, and also imitating admirably the natural color of the gums, so as to render the illusion perfect. The pieces to be enamelled were worked by special rules, which are minutely given in Chapter XIX of the second volume of his book.

Fauchard also brought the palatine prosthesis to a high degree of perfection. He describes five different obturators of the palate, which of themselves alone would be sufficient to testify to the highly inventive genius of the author, although they are defective in being somewhat too complicated. Some of these fixtures are a combination of a dental set and palatine obturator.

We ought now to mention, in the order of chronology, some authors of lesser importance.

Vasse and De Diest wrote about the danger of fatal hemorrhage following on dental operations.470 They report a few cases of this kind, giving the blame of these accidents, however, to the carelessness of the operator.

Lavini published in Florence, in the year 1740, a very good treatise on dentistry (Trattato sopra la qualità de’ denti, col modo di cavarli, mantenerli e fortificarli), which, however, marks no advance on the work of Fauchard.

M. Bunon (died 1749), a French dentist, wrote four admirable works on dentistry, which were published from 1741 to 1744. We will here briefly allude to the most salient ideas therein contained.

This author combated strenuously some prejudices then generally diffused; such as that of its not being advisable to extract teeth during pregnancy, and that of the extraction of an upper canine (eye tooth) being attended with great danger. He demonstrated the absurdity of the latter idea by putting in evidence the anatomical fact that the upper canines are innervated by the infra-orbital nerve, which does not stand in any relation whatever to the organ of sight.471

Among the other remedies recommended by him against the disorders and perils of first dentition, there is one most curious, not to say ridiculous: he advises rubbing the nape of the neck, the shoulders, the back, and the lower limbs of the child, but in doing this the friction should proceed from above downward, in order to offer resistance to the flow of humors toward the upper parts of the body. The utility and efficacy of this kind of massage in favoring the process of dentition seems, of a truth, very open to question.

Bunon speaks at length of erosion of the teeth, and declares himself to be the discoverer of this disease, which destroys the enamel of the teeth already before their eruption. The first molars, the canines, and the incisors are much more frequently damaged and affected by it than the other teeth. According to Bunon, it is generally due to measles, smallpox, malignant fevers, or scurvy, when children are subject to these maladies during dentition, and more especially during the first. He is of the opinion that erosion not only generates caries, but may be considered as being the origin of the greater part of dental affections.

This author distinguishes three principal kinds of dental tartar, the black, the pale yellow, and the brownish yellow; he admits, however, two other kinds that are less frequent, that is, the red tartar and the green.

He relates having observed in the jaw of a child, who died at the age of three years and a half, a splintering of the alveolar parietes in all directions, and attributes this phenomena to disproportion between the size of the teeth and the alveoli. On the basis of his anatomical observations, he says that caries only appears on teeth that have already come out of the gums, whilst erosion is produced in teeth not yet erupted, indeed, at times, several years previous to their eruption.

We will also mention, by way of a curiosity, Bunon’s proposal to substitute the word legs for that of dental roots.472

Fr. A. Gerauldy, a French dentist, wrote (1737) an excellent treatise on dental maladies and on the mode of preserving the teeth. His book, which was also translated into German,473 contributed to the diffusion of knowledge relative to dental prophylaxis and therapeutics, but apart from this brought no increment to the progress of practical dentistry. Some of the ideas of the author, however, merit consideration. He clearly expresses the opinion that the shedding of the milk teeth is brought about by the pressure exercised upon them by the germs of the permanent teeth in course of development. The loss of the teeth in young subjects, or in those who have not yet reached forty years of age, is explained by the author in an altogether special manner. He relates that Louis XIV, at the age of thirty-five, had lost all his upper teeth, and the considerations he makes on the subject bring him to the conclusion that the precocious loss of the upper teeth depends in many cases on a paralysis of the nervous fibers that go to them, which paralysis is probably caused by a dissolute and intemperate life, having as its consequence the weakening of the organism and, above all, of the nervous system. Without doubt there is some truth in Gerauldy’s ideas, it being well known that the falling of the teeth (as well as of the nails and the hair) often depends on nutritive disorders deriving from nervous disturbances. We have the clear proof of this in certain cases of tabes dorsalis accompanied by the spontaneous falling of the teeth and nails.

Joseph Hurlock, an Englishman, published a treatise in 1742,474 in which he warmly recommends lancing the gums in cases of difficult dentition; he declares this to be entirely without danger, and affirms that it constitutes the sole means of salvation for not a few infants who without it would die of convulsions.

Mouton, in 1746, that is, in the same year in which the second edition of Fauchard’s work was issued, gave to the light a monograph, the first extant, on mechanical dentistry.475 The methods of this author for the most part do not differ from those of Fauchard, nevertheless one finds several important innovations in his work. To prevent the further deterioration of teeth already much destroyed, and to preserve them some time longer, Mouton had recourse to the application of “calottes d’or,” that is, gold crowns. He used this for the front teeth as well as for the molars, but in the former case he had them enamelled to give them the same appearance as natural teeth.

Mouton also invented a new method of applying artificial teeth. Up to then the ordinary method had been that of fixing them to the natural teeth by means of threads passed through holes made in the artificial teeth expressly for that purpose. Mouton is the first to speak of artificial teeth fixed to the natural teeth adjoining them by means of springs or clasps.

This author relates having carried out several transplantations with perfect success, a thing that contributed greatly to his renown not only in France, but also in England. He distinguished himself, besides, by the correction of dental irregularities. Lastly, it is to be noted that this author frequently had recourse, as a remedy against toothache, to the stretching of the dental nerve by means of moving and partially raising the tooth (subluxation).

A. Westphal. In proof of the great utility of lancing the gums in cases of difficult dentition, A. Westphal reports a case in which the difficult eruption of an upper canine tooth provoked considerable inflammation and protrusion of the eye on the same side as the tooth; these symptoms promptly disappeared, however, as soon as the gum was lanced down to the tooth itself.476

J. Bertin also declares himself in favor of this operation; he recommends never to neglect it in cases of difficult dentition, and to make the said incisions deep and wide enough.477

L. H. Runge, a surgeon of Bremen, published, in 1750, a monograph on the diseases of the frontal and maxillary sinuses. He says that in cases of inflammation of Highmore’s antrum, the pus may make its way, corroding the bone, as far as the alveoli, or, sometimes, as far as the orbital cavity; and, vice versa, alveolar suppuration can give rise, by diffusion, to abscess of the maxillary sinus. In this latter, tumors of various kinds may form (polypi, cysts, sarcomas, cancers, exostosis), the existence of which is ignored at first, and only becomes manifest tardily. Runge’s father, who was also a surgeon, had occasion to observe, and to treat an important case of disease of the maxillary sinus, with considerable dilatation of the same, not only on the side of the cheek, but also on the side of the palate and of the nasal fossæ. With a strong scalpel he perforated the outer wall of the antrum above the molars (keeping the cheek detached) and enlarged the aperture by making the instrument turn around on its own axis, thus giving exit to a considerable quantity of non-purulent liquid. Detersive and aromatic injections were used for some time. The canine tooth, situated obliquely, having been extracted, its alveolus was found to communicate with the antrum. From this moment, the injections being continued, a rapid improvement was obtained and the patient was so completely cured that no deformity of the face remained.

Runge relates a case in which, having extracted a canine tooth, he found a cyst adhering to its root. From this he is induced to believe that in the case related above the disorder was also to be attributed to a large cyst having its origin in the root of the canine.

According to him, the ozena always stands in relation to a suppurative affection of the maxillary sinus, and for its treatment one must, therefore, have recourse to Drake’s operations.478

Georg Heurmann, a surgeon in Copenhagen, recommends making use, after the Cowper-Drake operation, of a small cannula in order to facilitate the exit of the pathological material contained in the sinus, and also to render it easier to introduce into it medicated or detersive substances.479

Lécluse. One of the most celebrated French dentists of the eighteenth century is Lécluse. Dental literature was enriched by him with several works, partly written in popular style, partly addressed to dental specialists. In 1750 he published his Traité utile au public, où l’on enseigne la méthode de remédier aux douleurs et aux accidents qui précèdent et qui accompagnent la sortie des premières dents, de procurer un arrangement aux secondes, enfin de les entretenir et de les conserver pendant le cours de la vie. The work seems to have been very favorably received, as its first edition, printed in Nancy, was followed by a second, printed in Paris, only four years later. In 1755 he published another book: Eclaircissements essentiels pour parvenir à préserver les dents de la carie et le conserver jusqu’à l’extrème vieillesse. But the most important of his works is the Nouveaux éléments d’odontologie,480 the first edition of which was published in 1754, and followed by a second in 1782.

We do not enter into a minute examination of these works, which, taken altogether, do not contain anything very new. We will only remark that Lécluse treated in a succinct but correct manner the anatomy of the mouth; invented some and perfected other instruments, the most important of which is the elevator that still bears his name, and finally, that he frequently performed the operation of replantation, warmly recommended by him as an excellent means of cure in certain cases of caries. The extracted tooth was stopped and afterward replanted, and, says Lécluse, became fast within eight days, proving as serviceable as a perfectly healthy tooth, and never again causing any pain.

Philip Pfaff, dentist to Frederick the Great, King of Prussia, was the first among the Germans who wrote a real treatise on dentistry. His book481 contains, in 184 succinctly but well-written pages, the anatomical and physiological notions relative to the teeth, as well as all that belongs to dental pathology, therapy, and prosthesis.

Besides a few observations about supernumerary teeth, Pfaff relates several cases in which the incisors, inferior as well as superior, were renewed (twice consecutively), that is, once at the usual epoch, and the second time between the seventh and thirteenth years. He also cites from the anatomical tables of Kulmus the following epitaph in low Latin, that seems to allude to a case of third dentition: