In cases of hemorrhage ensuing on the extraction of teeth, the best hemostatic, according to Pfaff, is essence of turpentine, a remedy which in these cases he had always found efficient. He introduced a little ball of lint bathed in this essence as deeply as possible into the alveolus, applying upon it some blotting paper reduced to pulp or some dry lint that the patient compressed tightly by closing his teeth.

Gingival abscesses as well as fistulæ of the maxillary region almost always owe their origin, says Pfaff, to decayed teeth, and can, therefore, in general, not be cured except by the extraction of these teeth.

The prosthetic methods described by this author are, for the most part, identical with those of Fauchard and the other French dentists already mentioned. As to the materials used for prosthesis at different periods, Pfaff mentions, besides ivory, bone, hippopotamus tusk, teeth of sea cow, and human teeth, also teeth made of silver, of mother of pearl, and even of copper enamelled.

The chief merit one must concede to Philip Pfaff is that of having been the first to make use of plaster models. It is, therefore, to two Germans—Pfaff and Purmann, the latter who, as we have already seen, used wax models—that one of the greatest progressive movements in dental prosthesis is indebted, that is, the method of taking casts and making models, of which method one finds no trace whatever in the authors of antiquity, and which, it would appear, was not known even to Fauchard himself. The wax casts of an entire jaw were taken by Pfaff in two pieces, one of the right half of the jaw, and the other of the left; which were then reunited, and one thus avoided spoiling the cast in removing it from the mouth.

Another great merit of Philip Pfaff is that of having first carried out the capping of an exposed dental pulp, previous to stopping a tooth.

Notwithstanding this, Pfaff is not the first who, as Geist-Jacobi is inclined to believe,482 had dared to apply a filling over an exposed dental pulp without first cauterizing it. As we have already seen, Fauchard did not hesitate in the least to fill a tooth when the dental pulp had become exposed in scraping the carious cavity. But the French dentist carried out, with much delicacy, a simple filling, whilst Pfaff first capped the dental nerve.

Jacob Christian Schaffer. In 1757 the evangelical pastor, J. Ch. Schaffer (we do not know if he was at the same time a dentist, or merely an amateur in odontology), wrote a little book483 to disprove the existence of worms in decayed teeth, and to show the fallacy of believing that the supposed worms may be made to drop out by means of fumigations of henbane seeds. His book appeared, as a matter of fact, rather behind-hand, for in it Schaffer repeats in substance what Houllier had already said two centuries earlier, and after him various other authors, including Fauchard. At any rate, to coöperate in the complete destruction of error and in the diffusion of truth is always laudable. We feel, however, bound to add that in the very same year in which Schaffer’s pamphlet was published, Dufour, a Frenchman, described a worm that had been taken out of a decayed tooth, and called attention to the fact that it was altogether different from the “dental worms” described by Andry.484

Bourdet. An excellent book on dentistry485 appeared in France in the year 1757, the work of Bourdet, a celebrated dentist and elegant writer, in whom the gifts of literary and scientific culture were coupled with a vast experience and a profound spirit of observation. His merits procured him the honor of being appointed dentist to the King.

This author condemns as harmful the use of hard substances (such as bone rings, etc.) that people are in the habit of putting into children’s hands during the period of the first dentition, in the idea that by pressing these objects between the gums, as children instinctively do, they cut their teeth more easily. As to emollients, he holds them to be completely useless, and prefers to all these remedies the use of lemon juice.

According to Bourdet, the teeth are so apt to decay, partly because of the frequent changes of temperature to which they are exposed, and partly because, differently from the bones, they are not provided with any protective organic covering.

In many cases of caries, Bourdet extracted the tooth, filled it with lead or gold leaf, and replanted it; but if, in extracting, the alveolus had been somewhat injured (a thing very likely to happen with the instruments of the period), he replanted the tooth immediately, to preserve the alveolus from the damaging action of the air, and carried out the stopping at a later time.

Even in certain cases of violent toothache not depending on caries, Bourdet luxated the tooth and replaced it in position directly. But as some dentists had accused him of having passed off as new an operation already made known by Mouton since the year 1746, Bourdet defended himself by saying that whilst Mouton only shook the tooth, raising it a little, simply to distend the nerve, he, instead, effected a complete luxation, in order altogether to interrupt the continuity of the nerve. Anyhow, this operation was not new, as it had already been recommended and practised by Peter Foreest, in the sixteenth century, and in an even more remote epoch by the Arabian surgeon Abulcasis.

Sometimes, when the permanent canine comes forth, it has not room enough, and therefore grows outward. In this case Bourdet extracts the first premolar; the canine then advances gradually of itself toward the space left by the extracted tooth, until it occupies its place exactly. He also counsels the extraction of the first premolar on the opposite side of the jaw, in order to preserve the perfect symmetry of the dental arch on both sides. When the arch formed by the jaws is too large and of an ugly appearance, Bourdet advises extracting the first upper and lower premolars, so that the maxillary arches may acquire a more regular form. In cases in which the defect of form exists only in the lower jaw, that is, in children who have protruding chins, Bourdet corrects this deformity by extracting the first lower molars shortly after their eruption, that is, toward seven years of age. In this manner, says the author, the lower jaw grows smaller and the deformity disappears. The inventor of this method, as Bourdet himself tells us, was the dentist Capuron.

Bourdet made prosthetic pieces, whose base, representing the gums and the alveoli, was made entirely of gold and covered over with flesh-colored enamel on the outside, so as to simulate the natural appearance of the gums; the teeth were adjusted into the artificial alveoli and fixed with small pins. At other times he made use of a single piece of hippopotamus tusk, in which he carved not only the base, but also the three back teeth on each side, whilst the ten front teeth were human teeth fixed to the base with rivets.

One of Bourdet’s principal merits is that of having brought artificial plates to perfection by fixing them not, as heretofore, to the opening of the palate or inside the nose, but by means of lateral clasps fitted to the teeth.

In a special pamphlet, published in 1764,486 Bourdet treats of the diseases of Highmore’s antrum. To facilitate the exit of pathological humors from the sinus, after the Cowper operation, he introduced a small cannula, forked at one end, into the antrum and fixed the two branches of the fork to the neighboring teeth by tying.

In some diseases of the maxillary sinus (polypus, sarcoma, etc.) Bourdet recommends cauterizing.

Besides his principal work, the pamphlet on the diseases of Highmore’s antrum, and some others of less importance, Bourdet wrote an excellent book on dental hygiene,487 which had the honor of two translations, one German, the other Italian; the latter published in Venice in 1773.

This celebrated author inveighs bitterly against charlatans and quack dentists, and throws light on all their impostures. It appears, however, that in the midst of this despicable class, so justly condemned by him, there existed a courageous though unscientific operator, to whom posterity would have attributed due honor had his name been handed down, for he was the first, in all probability, to try the implanting of teeth in artificial alveoli. This is, at least, what we deduce from a passage in one of Bourdet’s works, in which we read that a charlatan sought to impose on the public the belief that he could make a hole in the jawbone and plant therein an expressly prepared artificial tooth, which in a brief space of time would become perfectly firm and as useful as a natural one. Bourdet adds that an attentive investigation led to the recognition of the said tooth being simply that of a sheep. It would appear, therefore, that the operation had been in reality performed, it matters but little whether with the tooth of a sheep or with one of another kind.

Jourdain was another eminent writer on dental matters, at this period. Rather than a true surgeon-dentist like Fauchard and Bourdet, Jourdain was a general surgeon who had dedicated himself with particular predilection to the study and treatment of oral and maxillary diseases. And precisely for this reason his writings, although of great scientific importance, are far from possessing for dental art, properly so-called, the same value as the works of Fauchard, Bourdet, and other great dentists of the eighteenth century. His works, as Geist-Jacobi justly observes, give us the impression of his having been a theorist rather than a practical dentist.

In 1759 Jourdain described in the Journal de Médecine488 an improved pelican and another instrument to be used for straightening teeth inclined inward. Two years later he published his treatise on the diseases of Highmore’s antrum and on fractures and caries of the maxillary bone.489 After this, appeared his book on the formation of the teeth.490 He therein describes with great accuracy the dental follicle from its first appearing to the moment of birth, following it throughout its evolution. This lengthy book is most interesting, for it is not a mere compilation, but gives the results of personal research and experience. But by far the most important of all the works of this author is his treatise on the diseases and surgical operations of the mouth.491 This book went through several French editions, was translated into German in 1784, and has had, besides, two English editions in America of comparatively recent date, that is, at Baltimore in 1849, and at Philadelphia in 1851; all of which proves the great value of the work; it treats, however, much more of general surgery of the mouth and neighboring regions than of dental art properly so called. The first volume of 626 pages is almost entirely dedicated to the diseases of the maxillary sinus, which, for this author, were ever the object of favorite and particular study. He is not in favor of carrying out irrigation of the antrum through the mouth, even when an alveolar opening has resulted spontaneously through the extraction of a decayed tooth; he prefers instead, whenever this is possible, the reopening of the nasal orifice, by means of sounds and cannulæ adapted for the purpose, that is, varying in thickness and in length, and curved according to the necessities of the case. The natural opening of the antrum being reëstablished, one irrigates the cavity through it by means of a cannula to which a small syringe has been screwed. When the teeth are sound, notwithstanding the diseased condition of the antrum, Jourdain is absolutely contrary to the performing of the Cowper-Drake operation. When, on the contrary, the malady owes its origin to decayed teeth, Jourdain extracts them, but, as already said, carries out the detersive and medicated injections through the natural opening.

The author divides the collections of the maxillary sinus into purulent and lymphatic. The purulent are painful and corrode the bone, the lymphatic are not painful and do not corrode the bone, but distend and soften it, producing external tumefaction which yields to pressure, and, on this being diminished, gave out a characteristic sound. These so-called lymphatic gatherings referred to by Jourdain are none other than mucous cysts of the maxillary sinus. Also the other diseases of Highmore’s antrum (polypi, etc.) are taken by this author into attentive and minute consideration.

The second part of the work is dedicated to the other diseases of the maxillary bones (especially of the inferior one), as well as to those of the lips, cheeks, salivary ducts, gums, frenum linguæ, etc. Dental hemorrhage and difficult dentition are also spoken of in this volume.

The author relates, with regard to the latter subject, that he had observed, in corpses of infants who had succumbed to a difficult dentition, that the crowns of the erupting teeth were covered by the alveolar margins folded upon them. This, according to him, must be the reason why even lancing of the gums proves useless in some cases of difficult dentition; it is therefore necessary, whenever it is possible to recognize the existence of this state of things, to destroy the bony margins that oppose the erupting of the teeth; the author declares that he has frequently done this, with fortunate results.

In 1784 Jourdain published a treatise on artificial dentures.492 He therein specially speaks of a complete denture with four springs, perfectly adapted to the purpose of mastication. The author attributes the merit of its invention to Massez, who had imagined it toward 1772. If we may judge, however, by what Joseph Linderer says,493 this denture appears to have been too complicated, even when compared with those described by Fauchard.

Lamorier and Russel, contemporaries of Jourdain, also studied the diseases of the maxillary sinus, and published in the Mémoires de l’Académie de Chirurgie, vol. iv, several important cases of polypi and other diseases of the antrum. Lamorier is not in favor of the Cowper-Drake operation. He recommends perforating the antrum immediately above the first molars, or rather between it and the malar bone. In this he seems to have been influenced by the considerations that the wall of the cavity here presents the least thickness, and that this is the most dependent part of the sinus. But he did not always deem it necessary to make a perforation here, when a fistulous opening had previously formed in some other place. His method of operating is as follows: The jaws being closed, the angle of the mouth is drawn outward and slightly upward with a curved instrument called by the author a speculum; this done, the gum is incised below the molar apophysis and the bone laid bare, and then pierced with a spear-pointed punch. The opening is afterward enlarged if found necessary.

Several contributions to the knowledge of the diseases of the maxillary sinus and their treatment were made about this time by Beaupréau, Dubertrand, Caumont, Dupont, Chastanet, Doublet, David, and especially by Thomas Bordenave, who published an important work on this subject, collecting a great number of clinical cases of great interest. Speaking of the Cowper-Drake operation, he expresses the opinion that the tooth to be extracted is not the same in all cases, for if some one of the teeth situated below the maxillary sinus should either show signs of decay or be the seat of persistent pain, the choice should fall upon that one. If, however, these teeth are all apparently sound, the one should be chosen that, under percussion, is most sensible to pain. In those cases in which the choice is altogether free, Bordenave prefers the extraction of the first large molar, for the double reason that it is generally situated in correspondence to the central part of the cavity, and that it is separated from the antrum by a very thin osseous lamina. In certain cases, the maxillary sinus is divided, by body lamellæ, into various cavities, and then, as one easily understands, it may be necessary to extract more than one tooth for the evacuation of the pathological contents. When the teeth situated below the antrum have fallen out, or have been extracted some time, and their alveoli are in consequence obliterated, it will be better to have recourse to Lamorier’s method. This method may besides be useful, according to Bordenave, either when all the teeth are sound and it would consequently be a pity to sacrifice any of them, or in special cases (such as large polypi of Highmore’s antrum, extraneous bodies, etc.) in which the Cowper-Drake operation would not afford sufficient space.

L. B. Lentin, a German, in 1756, published a pamphlet494 in which he recommended electricity as a means of cure for toothache. Other writers recommended the use of the magnet, which means of cure had already been advised for various affections by Patacelus. During the latter half of the seventeenth century, Talbot, J. J. Weckes, and P. Borelli related several cures of headache and toothache by the use of the magnet. In the eighteenth century F. W. Klaerich, a medical man in Göttingen, wrote that he had used the magnet advantageously in not less than 130 cases of toothache.495 We find it recommended later by others, Brunner, and particularly J. G. Teske, who, in 1765, wrote a pamphlet entitled New experiments for the curing of toothache by means of magnetic steel.496

He considers the use of the magnet as the most efficacious of all remedies against toothache, and believes its action to be similar to that of electricity.

In the following year, however, the belief in the new means of cure was sensibly shaken by F. E. Glaubrecht, who declared that although the magnet calms or causes the cessation of the pain at first, it returns constantly and with much greater violence.497 The curing efficacy of the magnet in cases of toothache was highly vaunted in France by Condamine.498

Pasch attributes the effects of the magnet to the chill produced in the parts to which it is applied; in proof of this he adduces the fact that if the magnet becomes heated by being kept some time in the hand, it loses its efficacy altogether, whilst on the other side one may obtain the very same beneficial results with a simple steel spatula, just on account of the action of the cold; finally, he adds that the chill produced by the magnet on the affected part explains very well not only the good, but also the bad effects which it produces in many cases, such as increase of the pain, inflammation, tumefaction, and even at times spasmodic contractions.499 Thenceforth the enthusiasm for the magnetic cure diminished gradually, all the more so inasmuch as that shortly after the celebrated English dentist Thomas Berdmore ridiculed it by placing it in the same class as charms, exorcisms, and other foolish and superstitious means of cure.500

Adam Anton Brunner. One of the most distinguished German dentists in the second half of the eighteenth century was Adam Anton Brunner. His two principal works are the Introduction to the science necessary for a dentist,501 and the Treatise on the eruption of the milk teeth.502

This author falls into various errors with regard to deciduous teeth. According to him they are twenty-four in number, and without roots; but these may develop in those milk teeth which in exceptional cases remain in their places after the period in which they generally are shed.

A milk tooth, says Brunner, ought never to be extracted unless there be manifest signs of the presence of the corresponding permanent tooth, or when it is painful and decayed. Badly grown teeth can often be put in order solely by the pressure of the fingers frequently repeated, but when this is not sufficient, one must have recourse to waxed threads or to special contrivances.

In applying a pivot tooth, he screws the pivot to the artificial crown and perforates the root canal only just sufficiently to admit the other extremity, which he drives in by little strokes of a hammer upon the crown, without its being necessary to use cement. We learn from this author that in his time there were turners and other craftsmen who occupied themselves with dental prosthesis.503

Brunner prefers gold for fillings to any other substance whatever.

J. G. Pasch, whose name we have already mentioned, relates the case of a young maidservant becoming suddenly affected with deafness, and who recovered her hearing completely on the eruption of one of her wisdom teeth. From a passage of this author’s we learn that at that time many had recourse to the crushing of the infra-orbital nerve as a cure for certain cases of toothache. He, however, decidedly rejects such a remedy, as it proves for the most part ineffectual and may, besides, produce very serious consequences. This author carried out many experiments as to the effects of acids on the teeth.504

C. A. Gräbner505 recommends not deceiving children by extracting their teeth unexpectedly, but rather to persuade them of the necessity of the operation; for by deceiving them one loses their confidence, and in many cases inspires them with an invincible aversion to the dentist.

This author invented a so-called “calendar of dentition,” for the purpose of showing at a glance the period of eruption of each of the deciduous and permanent teeth, and as well for noting down the time at which the various teeth are changed, so as to avoid every possible error in this respect. This calendar consists of a figure or diagram representing the two dental arches, with transversal lines that separate the different teeth one from the other, the relative indications being also given.

The observations of this most sensible and conscientious dentist with regard to the extraction of teeth are worthy of note: “The haphazard pulling out of a tooth is an easy enough thing; the only requisites for doing this are impudence and the audacity natural to the half-starved charlatan. But to carry out the extraction of a tooth in such a manner that, whatever be the circumstances of the case, no disgrace may accrue to the operator or damage to the patient, requires serious knowledge, ability, and prudence.”

Rueff relates the case of a man, aged forty years, who, having made use of fumigations of henbane seeds to relieve himself of violent toothache, obtained the desired end, but at the same time lost his virile power. He, however, reacquired his force by the care of the author.506

Thomas Berdmore was the dentist of George III of England, and one of the first and most eminent representatives of the dental art in that country. Before him, no one had had the appointment of dentist to the royal family. In the year 1768 he published an excellent work on dentistry,507 that was translated into various languages and went through many editions; the last of these appeared in Baltimore in the year 1844, that is, seventy-six years after the first English edition—a splendid proof of the worth and fame of this work.

Berdmore contributed to the progress of dentistry in England not only by his writings, but also by imparting theoretical and practical instruction to many medical students desirous of practising dental art as a specialty.508 One of these was Robert Wooffendale, who went to America in the year 1766, and was the first dentist whose name is there recorded.

Berdmore considers as the principal advantage of the application of single artificial teeth the support they afford to the neighboring ones. Although in no way an impassioned partisan of dental grafting, like his contemporary, the celebrated surgeon Hunter, he, nevertheless, sometimes had recourse to replantation, recognizing the advantages to be derived from this operation, provided it be ably and opportunely carried out; but he was decidedly averse to transplantation. Before definitely inserting a gold filling, Berdmore considers it a good practice to try the tolerance of the tooth with a temporary filling of cement or some other like substance. His experiments as to the action of acids on the teeth are most interesting. He found that nitric acid destroys the enamel in a quarter of an hour; muriatic acid acts almost as rapidly, but with the difference that it also alters the color of the interior parts; sulphuric acid renders the teeth very white, and, even if used for three or four days, only destroys a small portion of the dental substance, but by reason of its action the enamel becomes rough and can be easily scraped away with a knife. Remarkable experiments on this subject were also made later by Kemme.509

Pierre Auzebi, a dentist at Lyons, published a treatise on odontology in 1771, which is only remarkable for certain strange ideas that he therein exposes, the entire book being in complete contradiction with the great progress already realized, at that period, in dental science. Auzebi likens the human body to a hydraulic machine, formed by the union of solid and liquid parts. For him the bones are merely folded membranes and the teeth are bones composed of small membranes. The author declares that he is unable to admit the theory of germs in the genesis of the teeth because “these germs, being all in identical conditions as to heat and moisture, ought all to develop at the same time like the grains of corn in a field.” Rather than having their origin from special germs, the teeth, he says, are derived from lymph, this being, according to Auzebi, the fundamental substance from which all the hard parts of the body are generated. A drop of lymph gathered at the bottom of the alveolus hardens and constitutes the first beginning in the formation of the teeth. Beneath this other lymph is gradually collected, which pushes upward and the part of the tooth already formed, surrounds the dental vessels, and thus becomes the root of the tooth. To facilitate dentition he recommends, among other things, rubbing the gums with hard, rough, and angular bodies. He also maintains, as does Brunner, that the milk teeth have no roots, contradicting, in this respect, the opinion of Fauchard, of Bunon, of Bourdet, who decidedly affirm that the deciduous teeth are furnished with roots, precisely the same as the permanent ones. According to him, when it so happens that the milk teeth have roots, they are not shed. To calm toothache, the author recommended a sedative elixir, the aspirating of a few drops of which sufficed to obtain the desired effect.510

John Aitkin, in 1771, perfected the English key, so as to render the extraction of the teeth easier and to avoid the danger of fracturing the alveolus or the tooth itself, and of injuring the gums.511

Frère Côme, a celebrated French surgeon, also contributed to the perfecting of this instrument.512

In 1771-72, Fr. L. Weyland and Henkel recorded some very important cases of diseases of Highmore’s antrum.513

W. Bromfield, in a collection of surgical observations and cases published in London in the year 1773, also speaks of affections of the maxillary sinus. He says that he has had opportunity of persuading himself that the purulent gatherings of this cavity not unfrequently discharge spontaneously during the night, finding their exit through the natural orifice of the antrum, when the body is in the horizontal position.514

John Hunter, the celebrated surgeon, must be named among the most illustrious champions of odontology in England. He was born February 13, 1728. His first instructor in medical studies was his brother, William Hunter, a scientist of great merit, whose school of anatomy in London was attended by numerous students from all parts of the British Kingdom. Under so excellent a guide John Hunter made rapid progress, and in less than twenty years became the most famous physiologist and professor of surgery of that day. He was surgeon-general to the English army.

His Natural History of the Human Teeth (London, 1771) and his Practical Treatise on the Diseases of the Teeth (London, 1778) initiated in England a new epoch for the dental art, which, abandoning its blind empiricism, began to take its stand on the basis of rigorous scientific observation.

But although Hunter’s merits were great with respect to the scientific development of odontology, we must remember that he was a general surgeon, and not a dentist, and that precisely for this reason he had not, neither could he have, other than a restricted personal experience relative to the treatment of dental diseases. This explains why the anatomical and physiological part of Hunter’s works on the teeth is so far superior to the part concerning practical treatment.

Indeed, in the field of practice, this author often falls into grave contradictions, and is frequently hesitating and uncertain on important points of dental therapeutics.

Hunter gives a very long and detailed description of all the parts constituting the oral cavity and the masticatory apparatus. He sought to establish a scientific nomenclature for the teeth, and in fact the denominations of cuspidati for the canine teeth and of bicuspids or bicuspidati for the small molars originated with him. Hunter says that the enamel of the teeth is a fibrous structure, and that its fibers depart from the body of the tooth like rays. He believes it to be entirely inorganic, as it is absolutely impossible to convert it into animal mucus. The tooth is constituted for the most part by a long mass (it is thus he calls the dentine), which is, however, much harder and denser than any other bone. This part of the tooth is formed of concentric lamellæ, and is vascular, as is proved by the exostosis of the roots and the adhesions that exist at times between the roots and the alveoli. Hunter gives a good description of the pulp cavity and of the pulp itself. He studied odontogeny with great care, as is demonstrated by his special researches on this point. He admits the existence of distinct germs for the enamel and for the dentine. According to him the incisors are formed from three points of ossification, the canines from one, and the molars from three or four. The tooth after its eruption is an extraneous body “with respect to a circulation through its substance, but they have most certainly a living principle by which means they make part of the body, and are capable of uniting with any part of a living body.” The milk teeth, says Hunter, are not shed by a mechanical action of the second teeth, but by an organizing law of Nature. The physiology of the masticatory apparatus is treated by Hunter with great accuracy and most extensively. This author combats, by many arguments, the opinion that the teeth grow continually; he explains the apparent lengthening of those teeth whose antagonists are wanting, by the tendency of the alveoli to fill up, which, however, is not possible in normal conditions, because of the constant pressure exercised upon the teeth by their antagonists.

Caries, says Hunter, is a disease of altogether obscure origin; it is not owing to external irritation or to chemical processes, and seems to be a morbid form altogether peculiar to the teeth. Only in very rare cases does it attack the roots of the teeth. It rarely appears after fifty years of age. Hunter does not admit that this disease may be communicated by one tooth to another. As to its treatment, the caries, if superficial, may be completely removed by filing the decayed part of the tooth before the disease penetrates to the cavity, and its spreading will thus be arrested for a time at least. In cases where the caries penetrates to some depth, without, however, the destruction of the crown of the tooth being so extensive as to render it useless, Hunter believed the best mode of treatment to be extraction and replanting of the tooth after having subjected it to boiling in order to cleanse it perfectly and to destroy its vitality entirely, this being, according to him, the mode of preventing the further destruction of the tooth, which once dead can no longer be the seat of any disease. If, instead, one wishes to have recourse to cauterization of the nerve, it is necessary to reach as far as the apex of the root; which, however, is not always possible. This is a very important point, for no one before Hunter had yet affirmed the necessity of entirely destroying the diseased pulp as an indispensable condition of the success of the filling to be later carried out in order to conserve the tooth.

Hunter is extremely concise when speaking of the filling of teeth; considering the great importance of this argument, his conciseness can only depend on his having had no personal experience in the matter. He considers lead preferable for fillings.

The frequent occurrence of erosion of the teeth, whether of the cuneiform variety or of other kinds, did not escape the attention of this acute observer, but he was not able to give any explanation of it.

In cases of empyema of Highmore’s antrum, Hunter advises the opening of the cavity through the alveolus of the first or second large molar.

Periodontitis is classified by the author among the diseases of the alveolar process. He occupies himself with this affection at great length, seeking to explain the mode in which it is produced. He distinguishes two forms of the disease, according to whether or not there be exit of pus from the alveolus. The alveolar process is, in his opinion, the principal seat of the disease, to which, as a complication, is added the retraction of the gums. For the diseased alveolus the tooth becomes, in a certain manner, an extraneous body, of which it tends to rid itself. The alveolar margins undergo absorption; the bottom of the alveolus tends to fill up, analogously to what occurs after extraction, and the falling out of the tooth ensues as a natural consequence of this process. An altogether similar process, producing the falling out of the teeth, is the normal consequence of senility.

The author considers that the malady in question has as its point of departure an irritation caused by a tooth; and as almost a proof of this he relates a case in which the extraction of the affected tooth, an upper incisor which became too long, and the transplantation of another tooth caused the cessation of the morbid process and the perfect consolidation of the transplanted tooth. However, Hunter does not draw from this isolated case the conclusion that transplantation may be elevated to a method of cure for this malady. Indeed, he says that, so far as is known to him, there is no means of prevention or of cure for it. His treatment, therefore, is merely directed to the curing, in so far as is possible, the phlogistic symptoms, by scarifications of the gum and by the use of astringent remedies. He does not exclude the possibility of a complete recovery, but the mode in which this obtains seems to him as obscure as is the nature of the disease itself.

In speaking of the correction of dental irregularities, Hunter advises not to extract the milk teeth unless this be an absolute necessity. He says, besides, that it is useless to extract any tooth whatever, unless one endeavors at the same time to force the irregular tooth or teeth into their normal position by exercising the requisite pressure upon them. In young subjects the regulating of crooked teeth is an easy matter, because of the softness of the maxillary bone. However, it should not be undertaken before all the bicuspids have come through. To correct protrusion of the upper jaw, the author recommends the extraction of a bicuspid on each side. To regulate the incisors it is sometimes necessary to make them rotate on their axis with the forceps. In certain cases of protrusion of the lower jaw one may have recourse with advantage to the inclined plane.

As a general rule, it is useless to lay bare a tooth with the lancet before extracting it, although in certain cases this may be advantageous in order to render its extraction easier and less painful.

Hunter was a strenuous partisan of replantation and transplantation of the teeth; he made various experiments on animals, and treated this important argument with particular fulness and much better than had been done up to then by others.

In cases of difficult dentition he considered incision of the gums most useful and, if necessary, to be had recourse to several times.

Foucou, the French dentist, in 1774, made known a compressor invented by him for arresting hemorrhage ensuing on the extraction of teeth. This instrument, which could be used for either jaw, exercised its pressure not only in a vertical direction, but also laterally, and did not give much inconvenience to the patient. Carabelli, who wrote seventy years later, speaks with praise of Foucou’s compressor, which he considers the best instrument of its kind.

Courtois, in his book published in 1775,515 says that the enamel of the teeth only reaches its perfection of development at twenty to twenty-two years of age, and begins thenceforward to wear away gradually. In speaking of the enamel, he advises avoiding the use of the file as much as possible. This author’s book is interesting for the many important clinical cases it contains.

Willich, in 1778, related a most curious case relating to a woman, aged forty years, who had never had her menstrual function, but had, nevertheless, given birth to two children; the extraction of a tooth was followed by an alveolar hemorrhage that lasted an hour; thenceforward, this hemorrhage recurred regularly each month, for the space of eight years.

Bücking, in 1782, published a Complete Guide to the Extraction of the Teeth,516 wherein he minutely describes all the instruments, their use, the position of the operator and of the patient, indicating at the same time the instruments best adapted for the extraction of each tooth. He declares himself averse to the practice of subluxation as a means of cure for toothache, a method which, first recommended by the Arab physician Avicenna, and later, in the sixteenth century, by Peter Foreest, had fallen into oblivion for a long time, and was again brought into credit by two celebrated French dentists, Mouton and Bourdet, the latter of whom relates having had recourse to it successfully in not less than six hundred cases.

Notwithstanding the high authority of this illustrious dentist, Bücking does not consider this method of cure advisable, adducing, however, in support of his opinion, arguments of no great value, viz., that teeth after subluxation continue painful for a certain time, and that they always remain in an oblique position. The method in question, which has the effect of breaking the dental nerve, is, in our opinion, practically equivalent to a replantation, or is, in point of fact, a replantation, when the luxation of the tooth is complete. The arguments that Bücking brings forward against it are futile; the first objection, for the most part, does not subsist, and, in any case, the persistence of pain for a short time would be of small importance compared with the great advantage of preserving the tooth; as to the second, it is to be understood of itself that subluxation performed by means of the pelican (the instrument then used for the operation) would cause the tooth to assume an oblique position; but even supposing it did not straighten up of itself, there could not have been any difficulty for the good dentists of that period in forcing the tooth again into normal position and in maintaining it there. The weak side of the operation consisted rather in the fact of its being probably carried out without due consideration of the dangers resulting from the possible alterations of the dental pulp.

At the time of which we are writing many believed that the enamel of the teeth could be regenerated altogether or in part, and that, therefore, it was of no great consequence that it should be worn away by the use of the file or of abrasive dentifrice powders. Thus, for example, the renowned surgeon Theden expressly recommended such powders, as the best adapted for cleaning the teeth and for freeing them from tartar.517

Van Wy,518 the Dutch surgeon, in 1784, related two cases of regeneration of the maxillary bones; other cases of the same kind were related some years later by Percy and Boulet.519

Chopart and Desault recommended, in cases of difficult dentition, the excision of the gum in correspondence with the teeth that are to come out, rather than simple incisions.520