PART II.. Second Period—the Middle Ages.

SECOND PERIOD—THE MIDDLE AGES.

CHAPTER VIII.

THE ARABIANS.

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.

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.

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.

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.

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.

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.”

“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.”

“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.”

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, 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.

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.

Abulcasis’ dental cautery and the tube through which it was applied, in order to preserve the neighboring parts from the action of the heat.]

“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.”

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, 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.

Set of fourteen dental scrapers (Abulcasis).]

Twelve dental scrapers as represented in another manuscript codex of Abulcasis.]

We now consider the chapter on the extraction of teeth. 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. 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, 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.

Forceps for loosening the tooth previous to extraction (Abulcasis).]

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.

Forceps for performing the extraction after the tooth has been loosened (Abulcasis).]

Nothing better, in truth, could have been done with such imperfect instruments. But it is possible that even then there perhaps existed, for the extraction of teeth, other instruments, so shaped as to be able to act with greater force. Abulcasis himself alludes to the existence of dental instruments not mentioned by him. It is probable, therefore, that the barbers, in spite of the scorn with which Abulcasis overwhelms them, used, for the extraction of teeth, forceps far more suitable than those described by him. These individuals, certainly unfurnished with a scientific education, must have had, however, a great practice in the extraction of teeth, being perhaps almost the only ones to whom recourse was had for this operation. They performed it very quickly, as may be argued from the words of Abulcasis himself. It is no wonder, therefore, that not unfrequently the work of these fatui tonsores was the cause of more or less serious injuries, but for the most part it had the advantage of not making the patients suffer excessive torture.

Another very interesting chapter is that which treats of the extraction of dental roots and fragments of the maxillary bone.

Forceps for extracting the root when the tooth breaks in the extraction. These figures are evidently very badly drawn, as are most of the figures to be seen in Abulcasis’ work.]

When, says the author, on extracting a tooth, this breaks, so that the root remains in the socket, it is necessary first of all to soften the part, by applying for a day and a night, or for two days, some cotton wool well smeared with butter; then attempts must be made to extract the root with a pair of forceps, the jaws of which are like the beak of a pheasant or stork.

Elevator to be used when the extraction of a root by means of the root forceps proves impossible (Abulcasis).]

If this is not successful, it is necessary to remove with a scalpel the whole of the gum which covers the root; then under it must be insinuated a small elevator having the shape here below represented.

If not even in this way can the end be attained, recourse must be made to one of the following instruments, choosing that which in every particular case seems to be the most suitable.

Besides these, says the author, use may be also made of some of the instruments which serve for the removal of tartar.

It is precisely in this chapter that Abulcasis speaks of the great variety and multiplicity of dental instruments; which, he says, cannot, like other kinds of instruments, be all enumerated and described. He then adds that a skilful surgeon will be able to devise new instruments, according as the peculiarities of each single case require them.

Elevators (Abulcasis.)]

For the extraction of a splinter or necrosed fragment of the maxillary bone, the same instruments must be used which serve for the extraction of dental roots; but also a pair of forceps may be used (Figs. 50 and 51).

It will be necessary to grip with them the osseous fragment firmly, so that it cannot escape whilst it is being extracted. The part shall then be medicated with fitting remedies.

Whenever it is thought proper, the bone must be scraped and all the diseased part of it removed.

When a tooth is irregularly placed, or projects above the level of the others, a deformity ensues which is particularly displeasing in women. The way of correcting this varies according to the nature of the case. It consists sometimes in the simple extraction of the misplaced tooth. But when there exists an intimate (osseous) union of the irregular tooth with another one, it is necessary to operate for the resection of the former with an instrument of the following shape, that is, like a small axe:

An instrument like a small axe, for resecting irregularly situated teeth (Abulcasis).]

The operation must be performed in many days, not only on account of the hardness of the tooth, but also in order not to shake any of the neighboring teeth.

In other cases, the deformity, consisting in one tooth projecting above the level of the others, may be corrected with a saw.

The instrument must be made entirely of Indian iron, and the operation, like the preceding one, is to be carried out in several days, that the fall of the tooth may not be provoked by excessive shaking. The file (Fig. 55), too, must be used to destroy the edges and points of broken teeth, that they may not injure the tongue, or give any trouble in speaking.

Forceps for extraction of splinter or necrosed fragments of the maxillary bones (Abulcasis).]

A dental saw (Abulcasis).]

Another dental saw (Abulcasis).]

When, in consequence of a blow or fall, one or more teeth have become loose so that the patient cannot bite his food with them, if the use of styptic remedies has been found of no use, it will be necessary to bind and make such teeth firm by a gold or silver wire. Gold is to be preferred as being unalterable, whilst silver in a few days turns green. Having chosen, therefore, a suitable gold wire of perfectly uniform consistency, it must be passed at its middle part between two firm teeth, that is between the two nearest on one side to the loosened tooth or teeth; then, by binding tightly around the sound tooth and each of the loosened teeth the two lengths of the wire and crossing them in the dental interstices so as to form a kind of network, the sound and firm tooth of the opposite side will be reached, and this too must be wound around in a mesh, as it were, of the said network. Then, turning back, the same operation must be repeated, but inversely, until the point of departure is reached. All this must be done with much skill, so as to render the loose teeth completely unmovable. When the wire is tied, this must be done near the dental roots, so that the knot may not get untied; then with a pair of scissors the remaining part must be cut off and its two ends joined and twisted with a pair of pincers, hiding them between the sound tooth and the neighboring loose one. Such a ligature should remain in place during a whole lifetime; and in case it should come undone or the wire should break, it will be necessary to renew the operation. The following figure represents the ligature described:

Ligation for steadying teeth in cases of blow or fall (Abulcasis).]

“Sometimes, when one or two teeth have fallen out, they are replaced in the sockets and bound in the aforesaid manner and remain there. The operation must be carried out with great delicacy and ability, by skilful hands.”

As may be seen from the above quotation, in the days of Abulcasis replanting was already performed, although it is probable that the ligature was then left permanently.

The author says, next, that the vacancy left by fallen teeth can be filled up with artificial ones, made of ox bone, they also being fixed in the manner above described; and he adds that they will be found not only of advantage from the esthetic but also from the functional point of view.

Speaking of the cure of the ranula, Abulcasis says that when the tumor, examined by the clear light of the sun, appears brown or black, hard and insensible, it is not to be operated, it being then of a cancerous nature. If, instead, it is whitish and full of liquid, it must be seized with a hook, and by means of a fine scalpel extirpated. The hemorrhage must be combated with powdered blue vitriol. After the operation mouth washes must be used of vinegar and salt.

In cases of fracture of the lower jaw it is not only necessary to cure the fracture itself according to the rules which the author prescribes for the various cases, but it is also necessary to pay attention to the teeth and with a gold or silver wire, or a silk thread, to tie, in the manner already described, those teeth which in consequence of the wound have become loose, but the consolidation of which may be hoped for.

A dental file (Abulcasis).]

MESUE THE YOUNGER, a disciple of Avicenna, is of opinion that when a tooth is the seat of violent pain, this may easily propagate itself to the other teeth; and therefore advises, if the pain does not soon cease, to extract the tooth affected, without delay. This operation, however, must not be performed, says the author, whilst the pain is at its height, but rather when it is somewhat lessened, otherwise, the extraction of the tooth may result in a syncope sometimes ending in death, or else be the cause of intense inflammation and of suppuration, which, also, may, in certain cases, place the patient’s life in danger. He recommends an infinite number of remedies against odontalgia; in these, however, there is nothing new to us. As to the removal of a tooth, this may be obtained in three different ways, that is, with the forceps, with eradicating remedies, or by cauterization. In order to cause a tooth to fall out by the use of acrid, eradicating substances, the author advises to proceed in the following manner: The tooth is first freed, by means of a scalpel, from the surrounding gum; the eradicating remedy is next applied to the root of the tooth, every needful precaution, however, being taken that it may not injure the neighboring teeth. Cauterization, when practised to produce the exfoliation of a diseased tooth, may be performed, according to Mesue, either with a small red-hot iron, passed through a little metal tube in order to protect the neighboring parts, or with the heated kernel of a nut, or with a grain of burning incense.

To cure a dental fistula, Mesue cauterized it to the very bottom with a cautery in the form of a probe, or extracted the tooth, which by reason of its diseased root was the cause of the fistula; and when the bone was likewise affected, he laid bare the carious part, which he then scraped.

AVENZOAR. The last of the great Arabian physicians was Avenzoar. He was born at Peñaflor, near Seville, in 1070 and died in 1162. He became famous by his very valuable work on medicine, entitled the Teisir. It is strange, however, that in this book there is hardly anything about the treatment of dental diseases. Against caries and looseness of the teeth the author limits himself to recommending bloodletting either from the ranine or the basilic vein. Apart from this, he speaks neither of operations nor of remedies for diseases of the teeth. Probably at the time in which Avenzoar wrote, that is, in the first half of the twelfth century, doctors in general did not occupy themselves with the curing of teeth at all, this being abandoned entirely to barbers and other persons. This would sufficiently explain why this author is so silent in regard to dental diseases.

But what can have been the reason for doctors refusing thus contemptuously to occupy themselves with so important a branch of therapeutics? In every age there have been a great number of ignorant persons, who either in good faith, or else for imposture, have practised, within a more or less limited circle, the art of healing, usually dedicating themselves to some particular class of diseases. Even in our days, notwithstanding the superabundance of duly qualified doctors, there is, especially in certain countries, no small number of quacks, secretists, bone-setters, chiropodists, and the like. It is, therefore, not to be wondered at that in times when dentistry was still in its infancy there should have been persons more or less ignorant who undertook tooth drawing and the concoction and sale of specifics against odontalgia. The doctors, on their part, under the pretext of being unwilling to have anything to do with these individuals, found it very convenient to dispense with the cure of dental diseases and with the extraction of teeth, this operation being sometimes too difficult for them, on account of their want of practice, besides being almost always very painful, and considered, even from the most ancient times, capable of eventually producing evil consequences, among which, in some cases, even the death of the patient.

But perhaps this was not the only reason for the fact above mentioned. In the middle ages the extraction of one or more teeth was sometimes inflicted as a punishment; for example, for having eaten flesh during Lent, or on those found guilty of felony, for having refused to contribute sums of money demanded from them by their liege lord. Now, as this punishment was carried out on the guilty ones by the executors of public justice, it is only natural that doctors should have refused to practise an operation which would have degraded their profession by bringing it down nearly to the class of the hangman.