Of the cleanliness of the teeth, it seems, great care was taken, for dentifrices were in great use. These, as we have already seen, were made of the most varied substances—stag’s horn burnt, ashes obtained by burning the head of the mouse, of the hare, of the wolf, etc., eggshells burnt and reduced to powder, pumice stone, and so on. For the cleanliness of the mouth, for strengthening the teeth and gums, mouth washes of sundry kinds were likewise adopted, especially formed of decoctions of astringent substances in water, wine, and vinegar.

Not only among the Romans was great care given to the cleanliness and beauty of the teeth, but also among many other nations. In this regard the following poem of Catullus, in which he lashes the silly vanity of a Celtiberian resident in Rome, who made continual show of his white teeth, is somewhat interesting:

Strabo. From Strabo we learn that the Cantabri and other peoples of Spain used to clean their teeth and sometimes even to wash their face not with fresh, but with old urine, which, so it seems, was kept for the purpose, in suitable cisterns!156

In regard to this filthy custom, Joseph Linderer says157 that the superstition has reached even to our times, although not widely diffused, that, to beautify the face, it is useful to wash it with urine. He relates that he knew a girl who, to become beautiful, had recourse to this heroic method, but, unfortunately, without at all obtaining the desired end!

Martial. In the epigrams of Martial (about 40 to 101 A.D.) allusions of great value with regard to several points concerning the subject we are treating of are found.

Toothpicks (dentiscalpia) are mentioned by this poet several times; from which we may argue that they were in great use. They were ordinarily made of lentisk wood (Pistacia lentiscus), as may be deduced from the Epigram LXXIV of Book VI, in which the author ridicules the old dandy who, stretched at length on the triclinium, cleans with lentiski the toothless mouth, to give himself the air of a man not too far stricken in years.158 Besides, in Book XIV, containing, for the greater part, saws and sayings on objects of common use, there is an epigram bearing the title of “Dentiscalpium,” in which the author says that toothpicks of lentisk are to be preferred, but that, in their absence, quill toothpicks may be used.159

Fig. 28

From other sources we learn that in those days metal toothpicks were also made use of. So in a satire of Petronius, it is said that Trimalchiones made use of a silver toothpick (spina argentea). Objects of this kind, both Roman and of other origin, are even now in existence, and may be found in various collections of antiquities. In Crimea a most elegant gold object, of Greek make, was found, which is, by its two ends, both a toothpick and an ear-picker. It belongs most probably to the fourth century before Christ.160

In an object found in the north of Switzerland, and coming from a Roman military colony of the times of the Empire, the toothpick and ear-picker are joined at one of their ends, by a pivot, to other toilet articles.161

Fig. 29

Fig. 30

Caylus, in his valuable work Recueil d’antiquités égyptiennes, étrusques, grecques, romaines et gauloises (Paris, 1752 to 1767), gives the picture of a toothpick and ear-picker of bronze, two inches long, with the middle part wrought in spiral form, so as to increase the solidity of the article, and also to enable the hand to keep it easily firm in all positions. It was found in the north of France, at Bavai (the ancient Bagacum), and forms part of the collection of M. Mignon of Douai.162

Martial is one of the first Roman writers who speak clearly of artificial teeth. In Epigram LVI of Book XIV, the poet, by a bold personification, makes the dentifrice powder say to a toothless old woman, furnished with false teeth: “What have you got to do with me? Let a girl use me. I am not accustomed to clean bought teeth.”163

Elsewhere164 Martial atrociously derides a courtesan, who, among her other physical defects, was also without an eye: “Without any shame thou usest purchased locks of hair and teeth. Whatever will you do for the eye, Laelia? These are not to be bought!”165

This epigram shows that, while dental prosthesis was already in use, ocular prosthesis did not as yet exist.

To a plagiarist, who passed off Martial’s poetry as his own, the latter says: “With our verses, O Fidentinus, dost thou think thyself and desire to be thought a poet. Even so, it seems to Ægle that she has all her teeth, because of her false teeth of bone and ivory.”166

There is, therefore, not the least doubt that in the days of Martial artificial teeth were in use; and that these, as may be seen from the epigram just now quoted, were made of ivory and bone; we do not know whether they were formed also of other substances. The question, however, arises: In those times did they manufacture movable artificial sets, or was the dental art then limited to fixing the artificial teeth unmovably to the neighboring firm teeth, by means of silk threads, gold wire, and the like? The answer to this question may be found in another epigram of Martial,167 where the latter ridicules a wanton old woman, telling her, among other things still worse, that she at night lays down her teeth just as she does the silken robes.168

It is, therefore, beyond all doubt that, at that period, the manner of constructing movable artificial sets was known; and most probably not only partial pieces were made, but even full sets. In fact, from the verse quoted above we have justly the impression that the poet means a whole set rather than a few teeth.

From the words of Martial, it may also be concluded that these dentures could be put on and off with the greatest ease; or, as we may say, by a maneuver as simple as that of removing any articles of apparel; they must, therefore, have been extremely well constructed.

This alone should be sufficient, even were further proof wanting, to give us an idea of the degree of development and of the point of perfection reached by dental prosthesis at that time. But besides this, we now also possess an ancient Roman piece furnishing a palpable proof of the ability and ingenuity of the dentists of that epoch. Some few years since, I had occasion, in the pursuit of dental archæological research, to visit the Museum of Pope Julius in Rome, where I was shown a prosthetic piece, not yet exhibited to the general public, that had been discovered a few months previous in excavating at Satricum, near Rome. I was invited to give an opinion as to this appliance, and, after having examined it accurately, became aware, not without some emotion, I am fain to confess, that I held in my hands a prosthetic piece of exceptional historical importance, that is, no less than a specimen of ancient crown work.

The appliance found at Satricum (Fig. 31) is made in the following manner: Two small plates of gold, stamped out, represent respectively the lingual and labial superficies of a middle lower incisor; these two pieces soldered together form the crown of the tooth. At its base the crown is soldered, back and front, to a narrow strip of gold which folds back on itself at each end, so as to tightly encircle the two neighboring teeth on the right and on the left, which thus serve as supports to the appliance.

We are now, therefore, able not only to affirm that the Etruscans knew how to execute a kind of bridge work, but that later the dentists of ancient Rome even carried out crown work.

This, notwithstanding the examples of dental prosthesis discovered up to now in Roman and Etruscan tombs, can in no way be considered as representing all the varieties of dental prosthesis of ancient construction. It is to be hoped that, in spite of the destructive action of time, in continuing the excavations and archæological researches, many other specimens of early dental prosthesis will yet come to light. In any case, judging by some indications to be found in Latin literature, it must be admitted that the Roman dentists of antiquity constructed other kinds of prosthesis besides the specimens we possess, and in particular movable dentures. We are led to suppose this, not only from the above cited epigram of Martial, but also from what we read in one of the satires of Horace, who dates contemporarily with Augustus, and therefore anteriorly to Martial. Speaking of two old witches who had been put to flight by Priapus, Horace writes: “You would have laughed to see those two old witches run toward the town, losing in their flight, Canidia, her false teeth, Sagania, her false hair.”169

Now, as Prof. Deneffe very rightly observes, the prosthetic appliances of antiquity known to us are so firmly fixed to the natural teeth that no race, however unbridled, could ever have made them fall out of the mouth. It must, therefore, be admitted, as I have said, that the ancients constructed other kinds of dental appliances, of which no specimens have, as yet, been discovered.

Neither in Celsus nor in Pliny, nor in any other Roman writers on medicine, do we find any allusion to the art of dentistry. The doctors of those days probably had no idea of the advantages which could be derived from dental prosthesis in regard to digestion and consequently to the health of the whole body. They therefore must have considered artificial teeth as something totally foreign to their art, and intended solely to hide a physical defect. It is therefore not at all surprising that they have not treated of this subject.

As the art of setting artificial teeth was exercised by persons not belonging to the medical profession, it is very probable that these persons also undertook the extraction of teeth and the cure of dental pains. Martial (Book X, Epigram LVI) names a certain Cascellius, who, he says, “extracts or cures diseased teeth,”170 and this is the first dentist whose name has been sent down to us. In spite of this, nothing permits us to affirm that there existed at that time a class of real dentists, viz., of persons dedicated to the exclusive cure of dental disease. There are strong reasons for doubting this, especially when we consider that the Latin language has no word corresponding to the word dentist. If there had existed a true dental profession, there ought also to have existed a name for indicating the individuals who exercised it. Therefore, it must be considered highly probable that, although there undoubtedly existed individuals who were especially skilled in the cure of the diseases of the teeth, such persons did not form a special class; perhaps, among those to whom recourse was had for the cure of dental diseases, some were doctors, particularly skilled in such diseases, others were perhaps barbers, and so forth. As to the far-fetched deductions of Geist-Jacobi, according to whom the name given to dentists by the Romans must have been that of artifex dentium or artifex medicus dentium, these are founded, above all, on imagination. It is extremely improbable that such names existed, when one considers that they are not met with, even once, in the whole range of Latin literature.

Scribonius Largus. Among the writers on Medicine in the early period of the Empire, one of the most eminent was, without any doubt, Scribonius Largus, physician to the Emperor Claudius, whom he accompanied to England in the year 43.

Scribonius Largus, in his book De compositione medicamentorum, pronounces himself energetically against the division of Medicine into single special branches. He declaims against the many who attributed to themselves the name of doctors, simply because they knew how to cure some diseases. According to him, the true doctor must be skilled in curing all kinds of affections. This, in truth, was possible in those times, but would be almost impossible nowadays, on account of the enormous development of the healing art. The ideas, however, expressed by Scribonius Largus have a certain historical importance, for they show that in his times the medical art had certainly the tendency to split up into many special branches, among which there must certainly have been dentistry, but that the necessity of such separation was not by any means universally recognized; the great doctors of those days undertook the cure of the diseases of the teeth, as well as those of any other part of the body.

The tenth chapter of the book of Scribonius Largus treats of the cure of odontalgia. The author begins by saying that it is the opinion of many that the only true remedy against toothache is the forceps. With all this, he adds, there are many medicaments, from which great benefit may be derived against these pains, without it always being necessary to have recourse to extraction. Even when a tooth is affected with caries, says the author, it is not always advisable to extract it; but it is much better, in many cases, to cut away the diseased part with a scalpel adapted for the purpose.

“Violent toothache may be calmed in various ways, viz., with mouth washes, masticatories, fumigations, or by the direct application of fitting medicaments. It is beneficial to rinse the mouth frequently with a decoction of parietaria or of cypress berries, or to apply to the tooth the root or the seeds of the hyoscyamus wrapped up in a cloth, and dipped from time to time in boiling water, or to chew the portulaca (purslane), or to keep for some time its juice in the mouth.”

“Suitable also against toothache are fumigations made with the seeds of the hyoscyamus scattered on burning charcoal; these must be followed by rinsings of the mouth with hot water; in this way sometimes, as it were, small worms are expelled.”171

This passage of Scribonius Largus has given rise to the idea that the dental caries depends upon the presence of small worms, which eat away the substance of the tooth. Such an explanation must have well succeeded in satisfying the popular fancy; and it is for this that such a prejudice, although fought against by Jacques Houllier in the sixteenth century, has continued even to our days.

With regard to this I would like to record the following fact: Not many years ago there lived in Aversa, a small town near Naples, Italy, a certain Don Angelo Fontanella, a violin player, who professed himself to be the possessor of an infallible remedy against toothache. When summoned by the sufferer, he carried with him, in a bundle, a tile, a large iron plate, a funnel, a small curved tube adjustable to the apex of the funnel, a piece of bees’ wax, and a small packet of onion seed. Having placed the tile on a table, the iron plate was put upon it, after it had been heated red hot. Then the operator let a piece of bees’ wax fall upon the red-hot iron, together with a certain quantity of the onion seed; then, having promptly covered the whole with the funnel and made the patient approach, he brought the apex of the said funnel close to the sick tooth, in such a way as to cause the prodigious, if somewhat stinking, fumes produced by the combustion of the wax with the onion seed to act upon it. In the case of a lower tooth, the above-mentioned curved tube was adapted to the funnel, so that the fumes might equally reach the tooth. The remedy, for the most part, had a favorable result, whether because the beneficial effect was due to the action of the hot vapor on the diseased tooth, or to the active principles resulting from the combustion of the wax and onion seed, or to both, or perhaps also, at least in certain cases, to the suggestion that was thus brought to bear upon the sufferer. It would not be at all worth while to discuss here such a point. The interesting part is that when the patient had declared that he no longer felt the pain, Don Angelo, with a self-satisfied smile, turned the funnel upside down, and showed on its internal surface a quantity of what he pretended to be worms, which he affirmed had come out of the carious tooth. Great was the astonishment of the patient and of the bystanders, none of whom raised the least doubt as to the nature and origin of these small bodies, no one having the faintest suspicion even that these, instead of coming from the tooth, might come from the onion seed!

According to Scribonius Largus, toothache might also be taken away by fumigations of burnt bitumen. He affirms also that great benefit may be derived against odontalgia by masticating the wild mint, or the root of the pyrethrum, or by covering the diseased tooth with a plaster composed of peucedanum juice, opopanax, incense, and stoneless raisins. But before making use of this last remedy, he advises that the tooth and the gums near it should be fomented with very hot oil, by means of a toothpick or ear-picker wrapped around, at one end, with some wool. If the pain does not entirely cease, or comes on again, it is well, says the author, to continue the fomentations with hot oil, above the plaster, until the pain ceases. To strengthen loose teeth, Scribonius advises frequent rinsings of the mouth with asses’ milk or with wine in which have been cooked the roots of the sorrel until the liquid has boiled down to one-third. Another remedy which he recommends against looseness of the teeth is composed of honey and alum mixed together in a mortar, in the proportion of two parts of the first to one of the second, and then cooked in an earthen vase, so as to render the mixture more homogeneous, and to give it more consistency. He also speaks of a third medicament, resulting from cooking strong vinegar, alum, and cedria172 in a copper vessel until it has the consistency of honey. This remedy would serve not only to make loose teeth firm, but the author assures us also that whoever rubs the teeth with it, three times a month, will never be subject to dental pains.

Scribonius Largus gives the receipts for various dentifrice powders in use at that period. The skin of the radish dried in the sun, pounded to powder, and then passed through a sieve, would furnish a good dentifrice, suited to strengthen the teeth and to keep them healthy. Very white glass, similar to crystal, reduced to a very fine powder and mixed with spikenard, is also, according to Scribonius Largus, a valuable dentifrice.

Octavia, sister of Augustus, used a powder which our author highly commends, saying that it strengthens the teeth and makes them very beautiful.173 To prepare it, one must take a sextary174 of barley flour and knead it well to a paste with vinegar and honey mixed together, and must divide the mass into six balls, each of which must be mixed with half an ounce of salt; these balls must then be cooked in the oven until carbonized; and lastly pounded to powder, as much spikenard being added as is necessary to give it an agreeable perfume.

Scribonius Largus also lets us know the tooth powder made use of by Messalina, the wife of the Emperor Claudius; this was composed of calcined stag’s horn, mastic of Chios, and sal ammoniac, mixed in the proportion of an ounce of mastic and an ounce and a half of sal ammoniac to a sextary of the ashes of stag’s horn.

Servilius Damocrates, a Greek physician, who acquired great renown in Rome toward the middle of the first century, was the author of many valuable works, both in verse and prose, which, unfortunately, have been lost. His works are mentioned by Galen, who testifies to his great esteem for Damocrates, calling him an eminent physician, and quoting various passages from his works, and among others three poetical receipts for dentifrice powders. From these receipts it appears that Damocrates attached the greatest importance to the cleanliness of the teeth, and that he considered this the indispensable condition for avoiding disease of the teeth and gums.

Andromachus the Elder, of Crete, the physician of Nero, who conferred upon him, for the first time, the title of archiater, became famous through his theriac, an extremely complicated remedy, the virtues of which were sung by him in a Greek poem, dedicated to the Emperor. The theriac was considered an antidote against all poisons and a remedy against the greater part of diseases, in short, as a real panacea. It is not even necessary to remark that this portentous medicine, which has held a post of honor, from ancient times almost up to the present day, was also used against odontalgia; and in those cases in which this was produced by caries, Andromachus advised the filling up of the cavity with the electuary which he rendered so famous. As the chief basis of the theriac was opium, combined with stimulating and aromatic substances, there is no doubt that its use locally or even internally would prove beneficial, temporarily at least, in many cases of odontalgia.175

Archigenes, of Apamea, a city of Syria, lived in Rome toward the end of the first century and at the beginning of the second, under the Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great fame as a physician and as an operator, and distinguished himself particularly by daring amputations and trepannings. He recommends various remedies against odontalgia, among which are mouth washes of strong hot vinegar, in which gall-nuts or halicaccabum176 have been boiled. He usually introduced into carious teeth a mixture of turpentine and vitriol of iron (sory ægyptium), or a mixture of pepper, and oil of spikenard or of almonds, and this was also dropped into the ear, on the side on which the pain was felt.

Archigenes, too, like other great physicians of that time, recommended various remedies taken from the animal kingdom against diseases of the teeth, which now seem very strange to us, but at that period appear to have been in great use. Thus, it would be of great benefit to hold in the mouth for some length of time a mixture of vinegar and water in which a frog has been well cooked. The slough of a serpent, burnt and then reduced, by the addition of oil, to the consistency of solidified honey, would be a valuable remedy, which being introduced into a carious hollow, and plastered all around the tooth and on the surrounding parts, would cause the most violent pain to cease. And, moreover, desiring to cause a diseased tooth to fall out, it would be enough to apply to and press upon it a piece of the unburnt slough of a serpent. Two excellent anti-odontalgic remedies to be introduced into carious hollows would be roasted earth-worms and spikenard ointment mixed with the crushed eggs of spiders. It would be also of use to drop into the ear on the side of the aching tooth some oil of sesamum in which earth-worms have been cooked.

When the pain is situated in broken teeth, Archigenes advises them to be cauterized with a red-hot iron.

Against bleeding of the gums, he recommends rubbing them with very finely pulverized alum and myrtle and the application of astringent and tonic liquids.

When odontalgia appears to depend upon an inflammatory condition, he advises the aching teeth to be plastered up with a mixture composed of red nitre, pounded peach kernels, and resin.

Archigenes repeatedly recommends the cleaning of the teeth and of the carious cavities before applying to the former or introducing into the latter the appropriate remedies.177

But Archigenes’ principal merit, so far as concerns the art of dentistry, consists in his having guessed that odontalgia, in certain cases, arises from a disease of the interior part of the tooth (viz., from inflammation of the pulp) and in having discovered an excellent method for curing such cases. When a tooth appeared discolored, without being affected by caries, and was the seat of violent pains, against which every remedy had proved of no avail, Archigenes perforated it with a small trephine, invented by himself for the purpose. He applied the instrument to that part of the crown which was most discolored and drilled right down to the centre of the tooth.178

Without doubt this talented surgeon was induced to adopt this method of cure by the idea of the existence of morbid substances in the interior of the tooth and by the consequent indication of giving them a free exit.

The operation devised by Archigenes proves, among other things, two important facts: first, that the anatomical constitution of the teeth had already been explored, seeing that Archigenes did not ignore the existence of the pulp cavity; and secondly, that Archigenes was greatly opposed to the extraction of a tooth unless absolutely necessary. It might be thought that such aversion depended upon an exaggerated idea of the dangers connected with the extraction of a tooth, an idea widely diffused at that period; but regarding such a daring surgeon as Archigenes was, it is more logical to suppose that in similar cases he had recourse to trephining and not to extraction, especially on account of the importance he attached to the preservation of the tooth.

Surgery in ancient times was eminently conservative; later on—partly by effect of its own progress—it became too readily inclined to the removal of diseased parts; in modern times it has again become what it was originally, and what it must ever be, viz., conservative in the highest possible degree.

Claudius Galen, after Hippocrates the greatest physician of ancient times, was born at Pergamus, a city in Asia Minor, in the year 131 of our era. His father Nicon, a man of great abilities, who was at the same time a man of letters, a philosopher, a mathematician, and an architect, had put him, at a very early age, to the study of science and of the liberal arts. Galen began to study medicine at the age of seventeen, under the guidance of skilful doctors of his native country; he made several journeys in order to have the benefit of the instruction of celebrated masters, and finally frequented the renowned medical school at Alexandria. On going to Rome, in the thirty-fourth year of his life, he soon acquired in that city a very high renown. He died in the first decade of the third century, but we do not know exactly in what year.

Galen was a most prolific writer, and his works, considering the period in which they were written, form a real medical encyclopedia. Anatomy through his researches made considerable progress, for he studied with the utmost care and attention (especially in apes) the bones, muscles, heart, bloodvessels, brain, nerves, and every other part of the organism. His anatomical researches enabled him to correct many errors, but as he had dissected almost exclusively animals and not human corpses, he himself fell into several errors, especially in attributing to man parts which he does not possess, for example, the intermaxillary bone.

Galen justly observed that the inferior maxilla (resulting, according to him, from the union of two bones, which, indeed, is embryologically true) has in man, proportionally to the other bones of the skeleton, a lesser length than in animals.

He holds that the teeth must be enumerated among the bones, and does not admit any doubt to be raised on this point, as these parts can be looked upon neither as cartilages, nor as arteries, nor as veins, nor as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat, nor as hair—a method of reasoning by elimination which is very specious but far too weak!

Galen indicates exactly the number of incisor, canine, and molar teeth (without, however, making any distinction between small and large molars), and speaks of the different functions of these three kinds of teeth. Not always, he says, are the molars of each jaw five in number on each side; in some individuals there appear only four; in others six. The incisors and canines have but one root; the upper molars have generally three, but sometimes, though not often, four; the lowers have for the most part two, rarely three.

Galen is the first author who speaks of the nerves of the teeth. He says that these organs are furnished with soft, that is sensitive, nerves179 belonging to the third pair.180 The teeth, according to him, are furnished with nerves, both because, as naked bones, they have need of sensibility, so that the animal may avoid being injured or destroyed by mechanical or physical agencies, and because the teeth, together with the tongue and the other parts of the mouth, are designed for the perception of the various flavors.181

In regard to odontalgia, Galen made some very important observations on his own person:

“Once when I was troubled with toothache, I directed my attention to the seat of the pain, and thus I perceived very clearly, that not only was the tooth painful but also pulsating, which is analogous to what happens in inflammations of the soft parts. To my astonishment, I had to persuade myself that inflammation may arise even in a tooth, in spite of the dental substance being hard and lapideous. But another time, when I again was attacked by odontalgia, I perceived very distinctly that the pain was not localized in the tooth, but rather in the inflamed gums. Having, therefore, suffered these two kinds of pain, I have acquired the absolute certainty that, in certain cases, the pain is situated in the gums, in others, on the contrary, in the very substance of the tooth.”

When a tooth becomes livid, Galen deduces from this that the tooth is the seat of a morbid process equivalent to inflammation. Besides, he says, we cannot be surprised that the teeth may be subject to a phlogistic process, when we consider that these, like the soft parts, assimilate nourishment. The teeth, by effect of mastication, are continually worn down, but nutrition repairs the losses, and they, therefore, preserve the same size. But when a tooth from want of its antagonist is consumed but little or not at all by mastication, we see that it grows gradually longer, for the very reason that under such conditions the increase due to nutrition is not counteracted by a corresponding waste.

The nutritive process of the teeth may, according to Galen, be altered either by excess or by defect; from which arise morbid conditions, quite different the one from the other. An excess of nutrition produces a phlogistic process analogous to that of the soft parts; a defect of nutrition makes the teeth thin, arid, and weak. The first of these pathological states is met with especially in young men and must be fought against with the ordinary antiphlogistic means, designed to eliminate the excess of humors (evacuant, resolvent, revulsive, and astringent remedies). As to defect of nutrition, this is met with most frequently in old people. It has the effect not only of making the teeth thin, but also of enlarging the alveoli, from which there results a looseness of the teeth more or less noticeable. Against this morbid condition we do not possess, says Galen, any direct remedy; however, it can be combated, up to a certain point, by strengthening the gums with astringent medicaments, so that they may close tightly around the teeth and thus make them firm.

Dental caries is produced, according to Galen, by the internal action of acrid and corroding humors, that is, it is produced in the same manner as those cutaneous ulcers which appear without any influence of external causes. The cure must consist in acting upon such vicious humors by means of local or general medicaments according to circumstances and also in strengthening the substance itself of the teeth by the use of astringents and tonic remedies.182

After these preliminary remarks, Galen gives a minute description of the numerous remedies which, from his own experience and from that of other great doctors, were to be considered useful for the cure of the various affections of the teeth and gums.

Against gingivitis and the pains deriving from it, the best remedy, according to Galen, consists in keeping in the mouth the oil of the lentisk moderately warm; noting, however, that such a remedy is the more efficacious the more recently it has been prepared.

A decoction of the root of the hyoscyamus in vinegar, used as a mouth wash, is another remedy recommended by Galen against the pains in the gums. It would also be of benefit to apply on the inflamed gums a powder composed of one part of salt to four of alum, afterward washing the mouth with wine or with a decoction of olive leaves. If the gums are ulcerated, Galen recommends them to be cauterized with boiling oil, using for the purpose a little wool wrapped around a probe or toothpick. This medicament, says Galen, greatly modifies the diseased part, exciting a reparative process in it, to aid which, however, suitable remedies must be used, and especially frictions with a mixture of gall-nuts and myrrh reduced to a fine powder.

For the cure of epulides the application of green vitrol, together with an equal quantity of powdered myrtle and a little alum, is especially recommended.

In dentition, if the gums are painful, it is advisable to rub them with the milk of a bitch. The teeth, moreover, appear very readily, says Galen, if the gums be rubbed with hare’s brain.

Against odontalgia, properly so called, independent, that is, of diseases of the gums, Galen particularly recommends warm applications, either on the cheek or directly on the tooth. Externally, on the side of the pain, may be applied dirty (!) pieces of linen, well warmed, or else small bags full of roasted salt, or cataplasms of linseed or barley flour. But if it is desired to act directly upon the sick tooth, this may be rubbed with a branch of origanum (wild marjoram) dipped in hot oil, or else, after applying a bit of wax on the tooth, the heated end of a probe may be laid upon it; or lastly, fumigations may be made by burning the seeds of the hyoscyamus. In case the above remedies, or others like them, be found of no use, Galen recommends them to be adopted anew after having perforated the sick tooth by means of a small drill. But if even from this no benefit be derived, and it is considered well to remove the tooth, this can be done without pain by the application of special medicaments. Among these the root of pyrethrum kept in very strong vinegar for forty days and then pounded takes the first place. The remedy is applied after having well cleaned the sick tooth, and after having covered the others with wax. At the end of an hour the tooth will have already become so loose that it can be drawn out with the fingers or with the mere help of a style. The same effect may be obtained, says Galen, by the application of blue vitriol mixed with very strong vinegar.

To prevent a carious tooth from producing pain or fetor, he advises the carious hollow to be filled up with black veratrum mixed to a paste with honey.

To restore to blackened teeth their whiteness, Galen advises them to be rubbed with special medicaments, one of which is made up of dried figs, burnt and pounded, with spikenard and honey. He gives, besides the receipts of many dentifrice powders and tinctures designed both to strengthen the teeth and gums and as preservatives against the diseases of these parts. Such powders and tinctures do not offer any interest to us, since they do not much differ from those recommended by other authors whom we have previously quoted.

When one or more teeth, in consequence of a trauma, or from other cause, become loose and project above the level of the others, Galen removes the whole exuberant part by means of a small iron file. In performing this operation, after having covered the gums with a soft piece of cloth, he holds the tooth to be filed steady with the fingers of the left hand, using the file in such a way as not to give the tooth any shock. Besides, he does not complete the operation at one sitting, but rather interrupts it as soon as the patient feels any pain, and continues it after one or two days. In the meanwhile, he makes use of remedies suited to strengthen the loosened teeth, and bids the patient remain silent and nourish himself with liquid or soft food.

When the teeth, without the action of external causes, become loosened, Galen holds that this is due to a relaxation of the dental nerve in consequence of an excessive abundance of humors. In such cases he counsels the use of desiccative remedies.

Galen, like ancient authors in general, is not very favorable to the extraction of teeth with the forceps. Even he seems convinced that a tooth may be made to fall out, without pain, by means of the application of certain remedies, to which we have already alluded. However, in one of the Galenic books183 we find the precept already given by Celsus, that before extracting a tooth the gums must be detached all around; from which one may argue that, at least in certain cases, instrumental extraction was considered inevitable. Galen even alludes to the pain which sometimes remains after the extraction of a tooth, and is of the opinion that this depends upon an inflammatory condition of the stump of the dental nerve.

In Galen are found recorded many means of cure, recommended by celebrated doctors of ancient times. Elsewhere we have already spoken of some remedies counselled by Damocrates, by Andromachus the elder, and by Archigenes. Apollonius, as a medicament against odontalgia, advised that the juice of the beet root be dropped into the nostrils, or else a liquid prepared from cumin seed, myrrh, cucumber, and woman’s milk. Heraclides of Tarentum recommended against the pains and looseness of teeth that a vinous decoction of black veratrum, mandrake, and hyoscyamus root should be kept in the mouth. Criton prescribed, for strengthening loose teeth, that the mouth should be frequently washed with a vinous decoction of lentisk, myrtle, and gall-nuts.

Celius Aurelianus. In the book De morbis acutis et chronicis, written by Celius Aurelianus (who lived, according to some, in the third century, according to others, in the fourth or at the beginning of the fifth), a very interesting chapter on odontalgia is found. He shows himself to be, for the most part, a follower of Celsus. During the violence of the pain he advises abstinence from food and rest in bed with the head somewhat raised. As remedies he recommends several mouth washes (infusions or decoctions made with wine or vinegar and with various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil, poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides, the application of wool soaked in hot oil on the cheek of the affected side, or the application of little warm bags, and also that some hot oil, or the juice of fenugreek,184 should be kept in the mouth, or milk with honey. When the pain is excessively violent, he has recourse to bloodletting, and after two days’ fasting, he begins to feed the patient with liquid and warm food. If the bowels are closed he prescribes the use of clysters, and when, in spite of all, the pain persists, he has recourse to scarified cuppings on the cheek, in correspondence with the pain. In certain cases he also proceeds to scarification of the gums, or else he detaches them all around from the tooth, by means of a special instrument called a pericharacter. It would often turn out useful to apply to an aching tooth a grain of incense warmed by the fire and wrapped in a thin piece of cloth, or to press between the teeth, where the pain is situated, several pieces of cloth, in succession, in which some powder of incense has been wrapped, and which are dipped into hot oil before being used. The author, moreover, commends external fomentations made by means of sponges soaked with emollient decoctions and afterward squeezed; and also the application of moderately hot cataplasms.

Fig. 33