When the odontalgia has already become inveterate and recurs in paroxysms, separated by intervals of calm, Celius Aurelianus counsels, among other things, that the general health be strengthened by temperate living, exercise, rubbing of the whole body (an ancient practice, now revived under the name of massage). He recommends, besides, special rubbing of the cheeks (to be carried out with a rough cloth), and also of the gums and teeth, and indicates a great number of medicaments, some of which are to be used during the paroxysms and others during the periods of calm. In regard to the use of narcotics, he very shrewdly observes that such remedies take away sensibility but not pain. Some doctors of those days, for the cure of odontalgia, had recourse to sternutatories, or to the dropping of special medicaments into the nose or into the ear, but Celius Aurelianus seems to have put but little faith in such means of cure. He, moreover, solemnly reproaches those who, to cure odontalgia, are too hasty in having recourse to the extraction of the aching tooth. To remove a part, says he, is not to cure it; and if every tooth that aches has to be extracted, it would be necessary to draw them all out when they all ache. Therefore, before having recourse to extraction, every other means of cure should first be tried. If the removal of the tooth becomes indispensable, he advises that it should never be performed during the violence of the pain, for from this serious consequences might arise (a prejudice which has not yet entirely vanished, and which is met with, sometimes, not only among common people, but even among physicians); and a still greater danger would be the extraction of teeth neither carious nor loose, seeing that, by consensus, the muscles, the eyes, and the brain might suffer. The author, on this point, quotes Herophilus and Heraclides of Tarentum, who related some cases in which the extraction of a tooth was followed by death. He alludes, moreover, to a passage of Erasistratus, regarding the “odontagogon of lead” (plumbeum odontagogum) which was exposed in the temple of Apollo at Delphi; as much as to show that it was not lawful to extract teeth other than those which were so loose that an instrument of lead was sufficiently strong to extract them.
When the looseness of the teeth seems to depend upon the flaccidity of the gums, Celius Aurelianus recommends astringent mouth washes: decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince, of myrtle berries, etc.; and besides these, lentiscine oil and asses’ milk, which latter was also believed to possess astringent virtues. Against hemorrhages of the gums, he advises the use of very fine coral powder, or of alum with honey.
Gnaeus Marcellus Empiricus, of Burdigala (Bordeaux), who lived at the end of the fourth century and at the beginning of the fifth, wrote a book, De medicamenti, which shows, more than anything else, the decadence of the medical science in those days. Regarding the diseases of the teeth and their cure, Marcellus does not tell us anything new. He freely copies Scribonius Largus and other authors, not adding anything save a few methods of cure, which are exceedingly strange and superstitious. To get rid of toothache, it is sufficient that the patient, when the moon is waning, and in the days of Mars (Tuesday) or of Jupiter (Thursday), repeat seven times the words argidam, margidam, sturgidam. It is a great pity that a curative method so simple and easy be efficacious in two days of the week alone, and even then on condition that the moon be waning.
The following method is also a very good one: Whilst in the open country, one must take a frog by the head, open its mouth and spit into it, then having begged the animal to take the toothache with it, must replace it on the ground and let it free. To remove loose teeth easily, it is necessary to keep in reserve some juice of black ivy mixed with a little green oil; in case of necessity, the nose of the patient must be anointed with it, and after having drawn a deep inspiration, he must put a little stone between his teeth, and stay with his mouth open, inclined a little forward, so as to let all the morbid humor flow out, which sometimes flows very abundantly and even may reach to three herminæ.185 Having afterward rubbed the nose with pure oil, and washed the mouth with wine, the teeth will be free from every pain and may be very easily pulled out. If the root186 of a tooth be rubbed with dried African sponge, the tooth will fall out within three days; naturally, says the author, care must be taken not to touch, whilst doing this, any healthy tooth. He who desires never to be subject to pain in the teeth, may obtain this end by the following method: When at the beginning of spring he sees the first swallow, he must go in silence to some running water, take some of it in his mouth, rub his teeth with the middle fingers of both his hands, and say: “Hirundo, tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non doleant toto anno.”187
The same must be done each following year, so as to continue to enjoy the effects of such a cure!
Adamantius, an Alexandrine philosopher and physician, who probably lived in the fourth century, paid much attention to the diseases of the teeth, as may be argued from two chapters of the Tetrabiblos of Ætius. One of these chapters is entitled, according to the Latin translation of Giano Cornario: “Cura dentium a calido morbo doloroso affectorum, ex Adamantio, sophista.”188 This writer clearly belonged to the pneumatic school, founded as early as 69 A.D. by Athenæus of Cilicia. According to the pneumatics (so called, because they admitted the existence in the animal organism of an aëriform principle, pneuma, to which they attributed great importance), heat and dryness gave rise to acute maladies; the phlegmatic affections generally arose from humidity, and melancholy was brought on by cold and dryness, as every object dries up and becomes cold on the approach of death. The author says that the cure must vary according as the disease affects in a greater degree the gums or the teeth themselves with or without participation of the dental nerves and neighboring parts. He makes, in regard to this, many subtle distinctions; but the remedies which he counsels do not offer to us any special interest, being almost identical with those that had been recommended by Galen and by other doctors prior to Adamantius. The latter also gives much importance to dietetic therapy; he prescribes that such patients should nourish themselves with pottages of barley, or of spelt, with eggs, lettuce, pumpkins, and other cooling food, abstaining, however, from wine.189
The author enumerates among the causes of such dental affections the dryness of the air, the autumnal season, the dry constitution of the individual, a troubled life, and scanty nourishment. The use of sour and piquant substances is not favorable to these patients, so much so that the mulberry preserve produces, not unfrequently, violent dental pains in them. Adamantius, therefore, advises, in such cases, not to use strongly astringent mouth washes, but rather lenitive, moistening, and emollient substances; simple lukewarm water, decoction of bran, licorice juice, starch with boiled must of wine diluted with warm water, milk, especially asses’ milk, decoction of mallows and the like.190
The work of Adamantius from which Ætius has taken the above-mentioned chapters is lost to us. Of his writings there only remain to us the treatise on the winds and the one on physiognomics. In this latter book the author attributes great importance to the canine teeth as physiognomonic elements, and from their shape and size he makes deductions in regard to the character of the individual.
Oribasius (316 to 403), the most celebrated of all the compilers who appeared during that long period of decadence, wrote, by order of the Emperor Julian the Apostate, whose physician and friend he was, a whole medical encyclopedia and later on a summary (synopsis) of this same work of his. In the books of Oribasius are found many things about dentition and diseases of the teeth, but they are all taken, substantially, from preceding authors, and therefore it is not worth while repeating them.
Ætius of Amida, a celebrated Greek writer on medicine, lived at the end of the fifth century, and at the beginning of the sixth, and has also left us a kind of medical encyclopedia, which, being divided into four sections, each composed of four books, was called Tetrabiblos. He teaches that the mucous membrane of the gums, tongue, and mouth is provided with nerves from a portion of the third pair of cerebral nerves, and that the teeth, too, by a small hole existing at the end of every root, receive tiny ramifications of sensitive nerves, having the same origin. The nutrition of the teeth is understood by Ætius in the following way: The nourishment which reaches the dental nerves is not entirely assimilated by them; these only appropriate the liquid or soft part and reject the drier part. This accumulates in the alveoli, becomes by degrees more tenacious and denser, finally being transformed into osseous substance and forming the nutriment of the teeth; these, therefore, tend to grow continually, although the waste arising from the mechanical action of mastication prevents them from undergoing any real or visible growth. On the other hand, in the old, from the weakening of the nutritive functions, the teeth become thin and loose, and finally fall out.191
Ætius advises that during dentition hard objects to chew should not be given to children, seeing that the gums being hardened by these and becoming almost callous would render the cutting of the teeth very difficult.192
For curing parulides, he recommends emollients at the beginning of the disease, and later on astringents. But if the inflammation of the gums does not resolve and passes into suppuration, he prefers to perform the excision of the parulis, instead of making a simple incision, which might very easily cause the abscess to change into a fistula.193
The epulis, according to Ætius, is a fleshy excrescence of the gums, brought on by inflammation. To cure it, he uses, during the inflammatory period, emollients, and then, when the inflammation has subsided, astringents and weak caustics. Lastly, if the epulis resist these remedies, he takes hold of it with a vulsella and proceeds to remove it with a small scalpel.194
When the incision of a fistula of the gums and the use of appropriate remedies are not sufficient for curing it, Ætius advises the extraction of the diseased tooth, from which the fistula has its origin.195
Apart from what has been mentioned, Ætius does not tell us, in regard to dental diseases, anything worthy of note, and in many places he only repeats Galen’s observations.
Paul of Ægina (seventh century) establishes a very clear distinction between epulis and parulis. The epulis is a fleshy excrescence of the gums in the neighborhood of a tooth; the parulis is an abscess of the gums. To cure the former affection it is necessary, says the author, to seize and stretch the tumor with a vulsella or with a hook and to perform its excision. As to the parulis, although not unfrequently it is sufficient, for curing it, to give an exit to the pus by means of a slight incision, the author, however, usually prefers the method of cure recommended by Ætius, viz., excision. After such operations he orders the patient to rinse his mouth with wine and on the morrow with hydromel.196 From the third day onward he sprinkles the wound with a cicatrizing powder, until a complete cure is obtained. But if the wound, instead of healing, be transformed into a putrid ulcer resisting all the ordinary means of cure, it is necessary to cauterize the part affected with an oval-shaped cautery.197
In extracting a tooth, the operation is begun by detaching the gum all around it as far as the alveolar border; then the tooth is seized with the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus, recommends that before extracting a tooth deeply attacked by caries, the cavity be filled up with lint, in order to avoid the crumbling of the tooth under the pressure of the instrument. On the other hand, he too is convinced that a diseased tooth can be made to fall out without pain, by the use of suitable remedies.
When supernumerary teeth cause an irregularity of the dental arches, this must be corrected, says the author, either by resection of such teeth, if they are very firm, or by their extraction.
If a tooth projects above the level of the others, the protruding part must be removed with the file. This instrument must also be employed to remove the sharp edges of broken teeth.
Tartar incrustations must be removed either with scrapers or by means of a small file.198
During the period of dentition one must not give children any food which requires mastication, and to soften the gums they must be anointed with hen’s fat or with hare’s brain.199
To preserve the teeth and to keep them healthy, Paul of Ægina recommends all tainted food to be avoided, and also all possibility of indigestion and frequent vomitings; the use of very hard or glutinous food or of such as may easily leave a residuum between the teeth, for example, dried figs, and likewise very cold food and such as set the teeth on edge. He also advises that hard things should never be broken with the teeth and that the latter be carefully cleaned, especially after the last meal of the day.200
Paul of Ægina also belongs to the class of compilers; but in utilizing the writings of the great physicians who had preceded him, he gives evidence of exquisite good sense, and not infrequently subjects the assertions of his predecessors to an intelligent and enlightened criticism. Besides, he inserts here and there observations and experiences of his own that are not without interest. He has always been, and rightly so, considered one of the greatest physicians of ancient times, the great reputation which he justly held among the Arabs contributing not a little to his renown.
This author is the last of the Byzantine period, and with him, therefore, we must close the earlier part of the history of dentistry. If, before passing to the middle period, we cast a glance over the ground already traversed, it is easy to perceive that dental art, in ancient times, reached its highest degree of development at the time when the Roman civilization was in its greatest splendor, when, in the capital of the world, wealth, luxury, and the refinements of social life marvellously increased its needs, and by this also gave an impulse to the evolution of all human activity. But ancient civilization, after having reached its culminating point, soon fell into decadence, and this necessarily would result in a hindrance to the development of dental art. From the days of Archigenes right up to those of Paul of Ægina, dentistry did not make the least progress; indeed, as far as prosthetic dentistry is concerned, there was probably a retrograde movement, it being very likely that when Italy was subject to the dominion of the barbarians and when Christianity—which but recently had asserted itself—was strongly imposing on the human mind a deep contempt for all that regarded the welfare and beauty of the human body, no one could, any longer, think of artificially repairing the losses sustained by the dental system through disease or injury.
The religious fanaticism excited by Islamism, transformed the obscure and nomad inhabitants of Arabia into a conquering nation, who very soon extended their power over a considerable part of Asia, Africa, and Europe. Spain, invaded by the Arabs in 711, fell almost entirely into their hands. After having by force of arms rendered themselves powerful and dreaded, the Arabians acquired also great fame by the culture of art and science within the limits allowed them by their religious code; and in these, for more than four centuries, they maintained an incontestable preëminence.
Unfortunately, as the Koran most absolutely prohibited the dissection of dead bodies, all serious anatomical research was thereby rendered impossible. This was a very great hindrance to the progress of anatomy, of physiology, and, in consequence, of the whole of medical science. The Arabians certainly had the merit of keeping alive the study of medicine in an age of decadence and barbarism; but, apart from the important progress realized by them in chemistry and pharmacology, it may be affirmed that the Arabs contributed but scantily to the development of the healing art; they followed almost entirely in the footsteps of Galen and other ancient, and especially Greek, authors.
One of the characteristics of Arabian medical art consists in the aversion to bloody operations and in the effort to avoid them. A like tendency shows itself also in the sphere of dentistry; the Arabians, even more than their Greek and Roman predecessors, were reluctant to extract teeth, and employed all possible means, in order to avoid the operation.
Rhazes (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was born in Persia toward the middle of the ninth century, and gave himself up to the study of medicine when about thirty years of age, having previously been a musician. He wrote many works which, unfortunately, have, for the most part, been lost. Rhazes did not have recourse to the extraction of teeth, save as a last resource when every other attempt at cure had proved useless; which method would no doubt have deserved high praise, had the author been inspired by the principles of conservative surgery, rather than by unjustifiable fears. Caries of the teeth is, according to him, identical with that of the bones. To hinder its progress and propagation to the neighboring teeth, he advises the carious cavity to be filled with a “cement” composed of mastic and alum. We have here a laudable attempt at permanent stopping of decayed teeth, although it is clear that the duration of such stopping, owing to the nature of the materials employed, could not be a long one. Furthermore, he counselled the patient to abstain from the use of acid food or drink and to rub the teeth with powder of gall-nuts and pepper.
To strengthen loosened teeth, he recommended astringent mouth washes and sundry dentifrice powders. Others, partly taken from Galen, are recommended by him for prophylactic purposes and for cleansing and beautifying the teeth.
Against periodontitis and the pains produced by it, he sometimes had recourse to bleeding. He commended, besides, opium, oil of roses, pepper, and honey, and also the scarification of the gums and the application of a leech. If, however, these remedies did not succeed, he applied his theriac, which was composed of castoreum, pepper, ginger, storax, opium, and other ingredients, to the roots of the teeth. If even this method of cure failed, he touched the root of the diseased tooth with a red-hot iron, or sought to provoke its fall by the use of special medicaments, such as coloquintida and arsenic (a substance to which he had recourse, particularly in those cases where there was ulceration of the gums). It is no wonder that such means of cure would sometimes produce, as a final result, the actual falling out of the tooth; and this, as is natural, served to strengthen the belief that the same result could also be obtained with less energetic remedies, but which were supposed to be equally endowed with expulsory virtues.
Rhazes relates an interesting case of regeneration of a whole lower jaw; he, however, observes that the newly formed osseous mass was less hard than the original bone.201
Ali Abbas, another great Persian physician (who died in 994), wrote a lengthy treatise on theoretic and practical medicine, one chapter of which is dedicated to the diseases of the teeth. When a molar tooth is affected by caries, and the pain cannot be subdued in any other way, Ali Abbas applies, inside the carious cavity, the end of a small metallic tube, into which he repeatedly introduces red-hot needles, leaving them in the tube until quite cooled. Should even this have no effect, he tries to provoke the fall of the tooth by the application of asses’ milk with assafetida, or, finally, extracts it.202
He cures epulis, like Paul of Ægina, by excision. As to parulis, or abscess of the gums, he opens it with a lancet or a wooden stylus.
When the dental arch is deformed by the existence of supernumerary teeth, he removes these with an instrument in the shape of a beak.203
Serapion (Jahiak Ebn Serapion), who lived in the tenth century, and up to the beginning of the eleventh, contributed but slightly to the development of medicine and dentistry, as he was in his writings little more than a mere compiler. He indicates with great precision the number of dental roots, and expresses an opinion that the upper molars have need of their three roots in order to keep firm in spite of their pendent position, whilst two roots alone are sufficient to keep the lower molars in place, on account of the support which they receive from the jaw. Serapion, like Galen, admits the nutrition and continual growth of the teeth—a growth which is produced in the same proportion as the waste due to mastication—and he too makes the dental diseases depend upon an alteration in the nutritive process, either by excess or by defect.
Against dental pains of phlogistic origin, he recommends bloodletting, purgatives, and many local medicaments, reproduced in great part from Rhazes. In cases of persistent odontalgia due to caries, he advises, as an excellent remedy, the application of opium in the carious cavity. To strengthen loosened teeth, he first employs astringents, and if these are of no use, as often happens in the old, he binds the loose teeth together and to the neighboring healthy ones, by means of gold or silver wire.
In Serapion, too, we find many formulas for dentifrice powders, some of which are intended simply for cleaning the teeth, others for special prophylactic or curative purposes.204
Avicenna. One of the greatest luminaries of medicine among the Arabs was Avicenna (Ebn Sina). He was born in 980 son of a high Persian functionary; he lived a very adventurous life, held some very high places, and died in 1037. Among his works, the most important is the Canon, a book which procured him the title of “second Galen” and the still more pompous one of “prince of doctors.” A very evident proof of the immense fame which he acquired is the fact that among many oriental peoples Avicenna, even in our own days, is considered the greatest master of medicine.
The anatomy and physiology of the teeth are treated by Avicenna very minutely, but nevertheless he does not teach us, in regard to these, anything new. Like Galen, Avicenna admits that the teeth continually grow, and as a proof he gives the fact of the lengthening of the teeth, which, owing to the absence of antagonists, are not subject to any pressure or friction.
He gives much good advice with regard to the preservation and cleanliness of the teeth, to which he attaches very great importance; and on this point he remarks that the use of very hard tooth powders must be avoided, as these are liable to injure the dental substance. To this latter are also harmful, says the author, some narcotic remedies, employed against odontalgia. Burnt hartshorn is, according to him, a most valuable dentifrice. To remove tartar from the teeth, he indicates many remedies, and especially dentifrices of meerschaum, salt, burnt shells of snails and oysters, sal ammoniac, burnt gypsum (plaster of Paris), verdigris with honey, etc. Among the substances able to facilitate dentition, he enumerates several oils and fats, besides the brain of the hare and the milk of the bitch, and he disapproves the custom of giving to children, during dentition, hard objects to chew, in the erroneous belief that the biting of such objects is useful in facilitating the cutting of the teeth; he recommends, instead, the gums to be rubbed with the fingers. When the teeth begin to appear, he drops some oil into the ears of the child and covers its head, neck, and jaws with a plaster spread on cotton that has been soaked in oil.
Avicenna minutely examines the various causes of odontalgia, and among them includes also the little worms by which the dental substance was supposed to be gnawed away.
When a tooth becomes the seat of intense pain, accompanied by a throbbing feeling, Avicenna considers that this is due to an excessive accumulation of humors in the root; he therefore advises, as already Archigenes had done, the tooth to be drilled, in order to empty it, and afterward to introduce into it appropriate remedies.
According to Avicenna, he who has a loosened tooth and desires to make it firm again, must avoid using it in mastication, must not touch it with the fingers, nor move it with the tongue; besides this, he must speak as little as possible, and make use of astringent remedies.
To remove a tooth, Avicenna made use of either the forceps or the “eradicating remedies,” in which he, too, had full confidence. Like the greater part of his predecessors, Avicenna is of the opinion that the extraction of a firm tooth must be avoided as much as possible, as it may give place to an injury of the jaw, or become harmful to the visual organ, or bring on fever. On this point he remarks that, if an aching tooth appears to be sound, it is not always necessary to perform its extraction in order to cause even the most rebellious odontalgia to cease; in certain cases he obtained a complete cessation of the pain after having simply shaken the tooth without completing its extraction; which according to him was due to the double reason that by shaking the tooth a resolution of the morbid matter stagnating under it is provoked, and the action of the medicaments that are afterward made use of is thus favored.
Among the eradicating remedies, the author enumerates white arsenic, orpiment, coloquintida, tithymallus, the fat of frogs, and others. He remarks, however, that before using them it is advantageous to detach the gum all around.
Against the supposed worms in carious teeth, he praises fumigations made with the seeds of the hyoscyamus, garlic, or onion.
Arsenic is used by him not only for the above-mentioned purpose, but also for the cure of fistulas and foul ulcers of the gums.
When a tooth has become abnormally long, Avicenna makes use of the file to reduce it to a proper size; and in performing such an operation, he holds the tooth firmly between the fingers, or with a pair of pincers suited for the purpose. As a consecutive treatment, he prescribes frictions with alum, laurel berries, and aristolochia.205
Abulcasis. Among the Arabian authors, he who has the greatest importance in regard to dental art is undoubtedly Abulcasis (Abul-Casem-chalaf-ben-Abbas). Whilst Avicenna was one of the greatest physicians, Abulcasis was one of the greatest surgeons; and very justly he has been called the genius of Arabian surgery.
Abulcasis had his birthplace in Alzahra, a small Spanish village, five miles from Cordova; from this he derived the name of Alzaravius, by which he is also known. Historians are not agreed upon the date of his birth. According to the most probable opinion, he was born about the year 1050 and died in 1122 at Cordova, a city which, on account of its celebrated school, was then a most important centre of scientific and literary culture.
Among the works of Abulcasis, the one which brought him the greatest fame was the treatise De Chirurgia. It is divided into three books, in the first of which he speaks of all the diseases which can be treated by cauterization; in the second are described all the operations which are performed by cutting, perforating, or extracting (wherefore, obstetrics is also included in this book); in the third, lastly, the author treats, region by region, of fractures and luxations.
Chapters XIX, XX, and XXI of the first book have reference to diseases of the teeth and gums. As these chapters are very short, we are pleased to give here an almost literal translation of them:
“When in the lower part of the gums, or in the palate, there appears a little tumor, which afterward becomes purulent and opens and changes into a fistula, against which no medical remedy is of any use, it is necessary for thee to take a cautery corresponding in size to the aperture of the fistula, and after having heated it, to introduce it there and to keep it applied there until the cauterizing iron reaches the bottom of the said fistula and beyond. This thou shalt do once or twice, and then shalt use fitting medicaments until a complete cure is obtained. This is attained when suppuration ceases. Otherwise one cannot do less than uncover the bone and extract that part of it which is diseased.”206
“When through excess of moisture the gums become flaccid, the teeth loose, and of no use are the remedies employed by thee, thou shalt lay the patient’s head on thy lap, and after having applied to the tooth, where it borders on the gum, the end of an appropriate little metal tube, in this thou shalt quickly introduce the cautery of which mention will be made in the following chapter; and thou shalt prolong the application as long as suffices to let the patient feel the heat right in the root of the tooth. This thou shalt repeat as often as thou shalt think necessary. Then the patient shall keep salt water in the mouth for an hour. By effect of such a cure, the corrupted moisture will dry up, the gums will regain their tone, and the tooth its firmness.”207
“When toothache depends upon cold, or if there exist some worm in the tooth, and the medicaments are of no use, recourse must be made to cauterization, which in such cases may be performed in two ways, viz., either by means of butter or with a cautery. Desiring to use butter, some of it must be warmed in an iron or copper spoon; a little cotton must then be wrapped around the extremity of a probe, dipped into the boiling butter, and then immediately applied to the tooth, keeping it there in contact until it has cooled. This must be repeated several times, so that the action of the heat reaches right down to the root of the tooth. If thou preferest, thou canst use cold butter, applied to the aching tooth by means of a little tuft of wool or cotton, upon which thou shalt lay a red-hot iron; prolonging the application of this until the heat has reached the very root of the tooth.
“To perform the cauterization directly with the iron, thou must first rest on the tooth a small tube of iron or copper, designed to preserve the neighboring parts from the action of the heat, and which must, therefore, be of sufficient thickness. Through such a tube thou shalt apply on the tooth a cautery of the shape given here below, and shalt keep it there until it is cooled. This thou shalt do several times. The pain will cease the same day or on the morrow. It is, however, necessary that after the cauterization the patient should keep his mouth, for an hour, full of good butter. The shape of the cautery is as follows (Fig. 34): Thou canst perform the cauterization with one or other of its two extremities, as is most convenient.”208
In regard to epulis, Abulcasis prescribes that after catching hold of the little tumor with a hook or a vulsella its complete excision should be performed. This done, one must wait awhile, until the hemorrhage ceases, and then either a little “zegi” pulverized,209 or other drying and styptic powder, must be applied on the part. If the epulis recurs, which very often happens, the excision must be repeated and this followed by cauterization, since after this latter the evil will not return.210
Abulcasis is the first author who has taken into serious consideration dental tartar and who has recommended that a scrupulous cleansing of the teeth should be performed. The chapter relating to this, “On the Scraping of the Teeth,” is very interesting and is worthy of being here reproduced.211
“Sometimes on the surface of the teeth, both inside and outside, as well as under the gums, are deposited rough scales, of ugly appearance, and black, green, or yellow in color; thus corruption is communicated to the gums, and so the teeth are in process of time denuded. It is necessary for thee to lay the patient’s head upon thy lap and to scrape the teeth and molars, on which are observed either true incrustations, or something similar to sand, and this until nothing more remains of such substances, and until also the dirty color of the teeth disappears, be it black, or green, or yellowish, or of any other color. If a first scraping is sufficient, so much the better; if not, thou shalt repeat it on the following day, or even on the third or fourth day, until the desired purpose is obtained. Thou must know, however, that the teeth need scrapers of various shapes and figures, on account of the very nature of this operation. In fact, the scalpel with which the teeth must be scraped on the inside is unlike that with which thou shalt scrape the outside; and that with which thou shalt scrape the interstices between the teeth shall likewise have another shape. Therefore, thou must have all this series of scalpels ready if so it pleases God.”212
The work of Abulcasis is, so far as we know, the first book in which are found figures of dental instruments. We do not know, however, how far such figures are exact, that is, to what degree of faithfulness they represent the instruments which Abulcasis really employed as the original figures of the book of Abulcasis were copied and recopied by successive transcribers of the work. And that such copies have been very often unfaithful may be deduced from the fact that not unfrequently figures of surgical instruments are found in the book which do not at all agree with the verbal description which the author gives of such instruments.
In the edition by John Channing, we find at the end of the chapter on the scraping of the teeth two series of figures. The first series is found under the Arabic text, and is composed of the fourteen figures reproduced as Fig. 35; the other series, existing under the Latin text, has only twelve figures, as shown in Fig. 36.
As Channing has made his translation from two different Arabic copies of Abulcasis,213 among the corresponding figures of which there exists a very notable difference, he, for the greater part, had to follow the plan of reproducing the figures of both codices. But besides this numerical difference, there is also a considerable difference in the shape of the instruments represented. We must, therefore, ask ourselves which of the two series of figures is to be regarded as the more faithful representation of the instruments used by Abulcasis. Most probably the first series. In it we find figured some scrapers which have a certain resemblance to those actually in use; besides this, the figures of the first series seem to be drawn with greater accuracy than those of the second. Among other things it may be noticed that the handle of each instrument (excepting the last two) is furnished with a row of prominences, which, it is almost certain, were designed to afford a better grip in holding the scrapers during the operation.
We now consider the chapter on the extraction of teeth.214 The author begins by saying that it is necessary to use all possible means to cure an attack of odontalgia, and to be very slow in deciding to extract a tooth, as this is a very noble organ, the want of which cannot in any way be perfectly supplied. When there is no way of avoiding extraction and the patient is obliged by pain to submit to this, it is necessary first to ascertain which is the aching tooth, as very often the pain deceives the patient, so that he may indicate as the seat of the pain another tooth which is perfectly sound, and desire it to be extracted; after which, naturally, the pain does not cease, if not when the diseased tooth is also extracted, as often happens in the hands of the barbers.215 The aching tooth having been well ascertained, it is necessary to detach the gum from the tooth, all around, with a sufficiently strong scalpel. Then either with the fingers or with a light pair of forceps the tooth must be shaken very gently, until it is loosened. Then the surgeon, keeping the head of the patient firmly between his knees, applies a stronger pair of forceps and extracts the tooth in a straight direction, so as not to break it. If it is not possible to draw it out, one of those elevators must be taken which the author advises for the extraction of roots (as may be seen afterward), and by insinuating it under the tooth the surgeon must endeavor to extract it. When the tooth is corroded and hollow, it is necessary to fill the cavity with lint, compressing it hard inside with the end of a probe,216 so that the tooth may not break under the pressure of the instrument. In all cases, the operator must take great care not to break the tooth, for if this happens the remaining part will give the patient still greater suffering. It is necessary, therefore, to avoid acting like the ignorant and foolish barbers, who in their temerity do not observe any of the above-mentioned rules, and therefore very often cause the patients great injuries, the least among which is the breaking of the tooth, the root being left in the socket, or else the taking away, together with the tooth, of a piece of the maxillary bone, as the author often happened to see. After the extraction the patient must rinse his mouth with wine, or with vinegar and salt. If, as often happens, hemorrhage is produced, a little powdered blue vitriol must be applied inside the wound; and if this is not sufficient, the part must be cauterized with a red-hot iron.
The small forceps (Figs. 37 and 38) to be used in loosening the tooth must have the handle shorter than the jaws and be sufficiently strong not to bend when pressure is put upon the tooth.
The large forceps (Figs. 39 and 40) with which the extraction must be performed should be made of very good Indian or Damascene iron, and have the handle longer than the jaws; these, moreover, on the inside must be toothed, or striated after the manner of files, so that they may have a perfectly firm grip, without slipping.
From the foregoing quotations and on examining the annexed figures, it very clearly appears that the extraction of teeth was performed by Abulcasis with excessive timidity and in a manner which must have been torturing to the poor patients. These had to undergo, first of all, the detachment of the gums, then the prolonged shaking of the tooth either with the fingers or with the forceps, then the attempt at extraction by means of a stronger pair of forceps, but, so far as can be seen from the figure, very little fitted for the purpose; and finally, in many cases, fresh maneuverings to extract the tooth with an elevator.