PART III.. Third Period—Modern Times.

THIRD PERIOD—MODERN TIMES.

CHAPTER X.

THE SIXTEENTH CENTURY.

We have now arrived at the sixteenth century. The middle ages, that is, the period of transition between ancient and modern civilization, has now come to an end. Events of the highest importance, such as the invention of printing (1436), the taking of Constantinople by the Turks (1453), with the consequent emigration of many Greek men of letters and science, who took up their residence in the West and especially in Italy, and lastly, the discovery of America (1492), marked the beginning of a new era, and are the most essential factors in bringing about the revival of art and science.

In the midst of the vigorous intellectual life which characterized the sixteenth century, dentistry, too, like many other branches of science, made very notable progress; we, therefore, in this period shall have to record many important facts and many important names.

It is, indeed, in the sixteenth century, and, to be more precise, about the year 1544, that we meet for the first time with a monograph, in which dental affections are spoken of independently of general medicine and surgery. The book we allude to, by WALTER HERMANN RYFF, is also noteworthy because it is not written like the preceding works, in Latin, the customary language of the learned, but, instead, in German, that is, in a living tongue.

As we are now mentioning the first German author on Dentistry, it may be permitted us briefly to glance at the beginning of medicine and dental art among the German peoples.

Among the Germans, as in other nations, the first to practise the healing art were priests, priestesses, and wise women. To cure disease they used partly empirical remedies, and partly witchcraft and superstitious means of every kind. Thus, to facilitate dentition, it was thought an excellent thing to pass a thread through the eyes of a mouse and then to tie the blood-covered thread around the neck of the child. It was held, besides—and this prejudice has left even until now some traces—that the putting of the milk teeth, when they fall out, into the nest of a mouse assures the cutting of new teeth.

We must here mention, with regard to the origin of dentistry among the Germans, a very important fact related by Joseph Linderer, a fact which shows that even among the ancient Germans recourse was had to the application of artificial teeth.

We here reproduce the very words of the said author, translated literally:

“Being by chance a few years ago at Dresden and visiting the Museum of Antiquities, my attention was attracted, in the last room, to two osseous pieces, which with other objects were enclosed in a glass case, with the written inscriptions: Comb-shaped osseous pieces, found in ancient German urns. As soon as I had observed them, I saw at once that they were artificial teeth; but as I had to be contented with examining them through the glass of the case, it was not possible for me to decide whether these pieces were really of bone, as they seemed to be, or of another substance. Taking into account their antiquity, their whiteness is very notable. Every piece is composed, if I remember rightly, of five teeth, that is, of a canine and four incisors; the chief difference of these pieces from the prosthetic pieces in ivory still in use (the author is writing in 1848) consists in this, that the pieces of which I speak have not at all a broad base, designed to rest on the gums, the base having instead the same thickness as the rest. The five teeth are well separated from one another. Besides, the canine makes the proper angle with the incisors, and at each side of the piece is found, in a convenient place, a hole, which shows that these teeth were fastened to those of the subject by means of a metallic or other kind of thread. As the above-described pieces are white, we must infer that they were removed from the mouth of the respective individuals before the body was burnt, and afterward put into the urn with the ashes, just as they used to put in coins, bits of arrows, and the like.”

For many centuries dental surgery—which, however, was still in a very primitive state—was practised in Germany, as in many other countries, principally by barbers. These in certain places, and at certain periods, formed corporate bodies, whose members were legally authorized to extract teeth and to practise minor surgery in general. But besides barbers, there were various kinds of individuals, unfurnished with any authorization—tooth-drawers, charlatans, wandering story-tellers, necromancers, Jews, and even hangmen—who invaded the field of medical practice, in spite of its being forbidden them, except in fairs, to administer medicaments and to perform surgical operations.

In 1460 there appeared in Germany a book on Surgery by Heinrich von Pfolsprundt, Knight of the Teutonic Order. The author had acquired great experience as surgeon in the military expeditions of his order, and we see from his book that he was very skilled in the cure of wounds and fractures. On the other hand, he shows himself hostile to every bloody operation with the exception of rhinoplast. Pains of the teeth and gums were cured by him by means of beverages.

Mesue was Surgeon to the Caliph Haroun al Raschid, who flourished 786-809. If the reference to Mesue is correct, it would, therefore, indicate that the filling of teeth with gold was known to the Arabs as early as the latter part of the eighth century. Examination of the writings of Mesue has thus far failed to bring to light any record therein of the treatment of caries by gold filling, although in his work previously referred to (see page 138) the other methods quoted by the anonymous author of Zahnarzneybuchlein are fully set forth.

FIFTH CHAPTER.

ON CARIOUS AND HOLLOW TEETH.

Corrosion is a disease and defect of the teeth when they become carious and hollow, which most often happens in the molars, especially if one does not clean them of the adhering food which becomes moist and consequently produces bad, sharp moisture that eats and corrodes them, always gradually increasing, until it spoils the teeth entirely, which afterward must fall away in pieces not without pains.

“Mesue ut supra capite proprio.” This, as Mesue writes, is chiefly cured and removed in three ways. First, by purging as treated upon above. Second, by dissolving the material which renders them hollow and eats them away; also by boiling cockles that grow in barley or wheat, in vinegar and holding this in the mouth. In this vinegar the root of caper and ginger and other similar remedies must have been previously boiled. Third, by removing the decay, which is done in two ways. First, by scraping and cleaning the hole and the carious part with a fine chisel, knife, or file, or other suitable instrument, as is well known to practitioners, and then by filling the cavity with gold leaves for the preservation of the other portion of the tooth. Second, by using suitable medicine, such as oak apples or wild galls, with which the tooth is filled after having been cleaned.

The following editions of Zahnarzneybuchlein, besides the Basle and Mayence editions noted by Dr. Guerini at page 166, were issued and copies thereof are preserved in the libraries of the several collectors as stated. Edition of 1530, printed by Michael Blum, Leipzig, in collection of Edward C. Kirk. Edition of 1536, printed by Chr. Egenolff, Frankfurt a/M, in collection of William H. Trueman. Edition of 1541, printed by Chr. Egenolff, Frankfurt a/M, in Dental Cosmos library and collection of E. Sauvez. Edition of 1576, printed by Chr. Egenolffserben, in collection of H. E. Friesell.—E. C. K.]

The book, therefore, lacks importance from a dental point of view, except in the sense that it shows how little skilled in the cure of dental affections were the German surgeons of those days.

It is worthy of note that this author, also, speaks of anesthetic inhalations; he, however, only translates, almost to a word, what Guy de Chauliac says on this subject.

Toward the end of the fifteenth century and in the first half of the sixteenth there were published in German, by anonymous authors, some short translations and compilations on dental subjects, taken especially from Greek and Arabian authors. Of these writings, the first one known, taken from Galen and Abulcasis, was printed at Basle in 1490; and another—one of the best—saw the light at Mayence in 1532. These works were perhaps due to intelligent barbers, or perhaps—and this seems to be the most probable—they were written, through the initiative of enterprising printers, by doctors and surgeons, who wished to remain unknown, on account of the special subject treated; for, owing to the fact that the diseases of the dental system were generally left in the hands of barbers and other unprofessional persons, the doctors and surgeons of those days would have been ashamed to interest themselves in such things.

WALTER HERMANN RYFF, of Strasburg, was born in the beginning of the sixteenth century, and died about 1570. He was a rather mediocre doctor and surgeon, and a man of the worst morals, so much so that many cities expelled him from their midst. He wrote many medical works, in which, however, there is very little original matter. Their principal merit consists, perhaps, in the fact that they were written not in Latin, as then was universally customary, but rather in the vernacular of the author and in a popular style; so that Ryff may be looked upon as the first who endeavored to diffuse among the people useful medical and hygienic knowledge.

Among Ryff’s books there are two which are very important to us. One is his Major Surgery, and the other is a pamphlet entitled Useful Instruction on the Way to Keep Healthy, to Strengthen and Reinvigorate the Eyes and the Sight. With Further Instruction on the Way of Keeping the Mouth Fresh, the Teeth Clean, and the Gums Firm.

Of these books, there now only exist some extremely rare copies; so much so that neither Albert von Haller nor Kurt and Wilhelm Sprengel, who rendered such great services to the history of surgery, ever had the pleasure of examining them. Dr. Geist-Jacobi has been more fortunate than they, and has therefore been able to give us some very interesting information about their contents.

The Major Surgery is a mere compilation which does not contain anything new of importance. It was published in part in 1545, and in part in 1572, after the death of the author. The work is illustrated with very beautiful wood engravings; and it is just this which gives the principal value to this book. Some of the illustrations contained in the first part of it—that is, in that published in 1545—represent dental instruments, notwithstanding dental surgery is not treated in this part of the book. The author gives notice that he will treat all that concerns dental affections in the latter part of this book, in a special chapter. Unfortunately, this chapter was never written, because death prevented Ryff from completing the second part of his work.

Pelican and dental forceps (Walter Hermann Ryff).]

The dental instruments represented in his Major Surgery are many in number. Among them, first of all, are found the fourteen dental scrapers of Abulcasis, then the “duck-bill”—designed for the extraction of dental roots and broken teeth—various kinds of pelican (Fig. 59 A), the “common dental forceps” (Fig. 59 B), the “goat’s foot,” and many other kinds of elevators, among which, observes Geist-Jacobi, may be seen instruments even now in use, and even some which are said to have been recently invented.

Ryff’s other book is especially noteworthy because, as we have already mentioned, it treats, for the first time, of dental matters, independently of general medicine and surgery. This pamphlet, printed at Würzburg about the year 1544, is made up of sixty-one pages, and is divided into three parts, the first of which is dedicated to the eyes, the second to the teeth, and the third to the first dentition. It is written in popular style, and the author certainly intended it for the instruction of the public, and not for professional men; so true is this, that in it he does not speak of the technical part of the extraction of teeth, or of gold filling—a method already known for a long time—or of dental prosthesis.

The first part, relative to diseases of the eyes and the manner of curing them, has no importance for us. The second part begins with the following paragraph:

“The eyes and the teeth have an extraordinary affinity or reciprocal relation to one another, by which they very easily communicate to each other their defects and diseases, so that the one cannot be perfectly healthy without the other being so too.”

This last statement is absolutely false, as a disease of the eyes may very well exist with a perfect condition of the teeth, and vice versa. However, Ryff has the merit of being, perhaps, the first who has noted the undeniable relation which exists between the dental and ocular affections.

After a rapid glance at the anatomy and physiology of the teeth, the author enumerates the causes of dental disease, which, according to him, are principally heat, cold, the gathering of humors, and traumatic actions.

The prophylaxis of dental diseases is beyond any doubt one of the best parts of the book; however, the ten rules counselled by Ryff for keeping the teeth healthy—rules which Dr. Geist-Jacobi has made known to us in full—are reproduced, almost to a word, from Giovanni d’Arcoli’s work; therefore, the author has no other merit than that of having translated them into the vulgar tongue, thus diffusing the knowledge of useful precepts for preventing dental diseases. We refrain from reproducing the aforesaid rules here, as they are, with slight variations, identical with those which we gave when speaking of Arculanus.

Nor can any credit be given to Ryff for the rules which he gives in regard to the diagnosis of dental pains, as this part of his work is also taken wholly from the Italian author just mentioned.

After these diagnostic rules Ryff, continuing to translate from the book of Giovanni d’Arcoli, adds:

“If the pain comes from the gums, extraction is of no use; if it comes from the tooth, extraction makes it cease; when, lastly, it is in the nerve, sometimes extraction removes it, and sometimes it does not, according as the matter obtains or not a free exit.”

The barbers and tooth-drawers, he says, must well remember this rule, in order to avoid extracting, thoughtlessly and with no benefit, sound teeth, since then the pain persists in spite of the operation. Also, it must be borne in mind that, in case of violent pain, it is necessary to operate as soon as possible, so that the patient may not faint or be attacked by the falling sickness, if the pain should be communicated to the heart or brain.

The idea that violent dental pains could give rise to syncope or to epilepsy (in regard to which we only observe that even very recent writers enumerate dental caries among the causes of the so-called reflex epilepsy) is also found in Giovanni d’Arcoli, who expresses himself in regard to this in the following terms: “Such very violent pains are sometimes followed by syncope or epilepsy, through injury communicated to the heart or brain.”

“The most atrocious pain,” says Ryff, “is when an apostema ripens in the root;” literal translation of words written about a century before by Arculanus: “Fortissima dolor est, qui provenit ab apostemate, quod in radice dentis maturatur.”

Likewise taken from Arculanus is the observation (already made, however, by much more ancient writers) that “when the cheeks swell, toothache ceases.” Arculanus, however, expresses himself in a less absolute manner, and therefore more corresponding to the truth, since he says “the pain generally ceases” (secundum plurimum dolor sedatur).

Even in regard to the therapeutics of dental pains, Ryff does not tell us anything new. Dr. Geist-Jacobi gives this author the merit of having made, in regard to the cure of dental pains, a distinction between cura mendosa (that is, imperfect, palliative, tending simply to calm the pain) and cura vera (that is, directed against the causes of the disease). But this very important distinction is also taken from Arculanus, who in his turn took it from Mesue. In fact, after having spoken of the general rules relative to the cure of dental diseases, Giovanni of Arcoli adds: “As to the particular therapy, it is divided into cura mendosa and cura vera, as may be found in Mesue. And the cura mendosa is so called because it calms the pain by abolishing sensibility, not by taking away the cause of it. Such is, for the sake of example, the cure, consisting in fumigations of henbane, made to reach the diseased tooth by means of a small tube, adapted to a funnel.”

The third part of Ryff’s pamphlet has as its title:

“How the pains of the gums should be calmed or mitigated in suckling infants, so as to promote the cutting of the teeth without pain.”

This part, as Geist-Jacobi informs us, is very brief, not taking up more than a page and one-half of print. Neither does it contain anything of importance. To render the cutting of teeth easier, Ryff advises that infants should have little wax candles given to them to chew and the gums anointed with butter, duck’s fat, hare’s brains, and the like. The tooth of a wolf may be hung around the neck of the child, so that it may gnaw at it. It is also recommended that the head of the child should be bathed with an infusion of chamomile.

From what has been said, one may see very clearly that the aforesaid book is, from the scientific point of view, entirely valueless, because the best part of it is merely copied from the work of Giovanni d’Arcoli. However, the author has the indisputable merit of having endeavored to diffuse the knowledge of useful precepts of dental hygiene. His book, besides, we repeat, has great historical value, for from it dates the beginning of odontologic literature, properly so called.

On this point we believe it is necessary to correct an error into which Dr. Geist-Jacobi has fallen. At the beginning of his very valuable article on Walter Hermann Ryff he says: “In the fifth century of the Christian era, the iatrosophist Adamantius of Alexandria published an exclusively odontalgic work, of which, however, we only know the title.” The same he repeats in his History of Dental Art (pp. 55 and 56), without, however, giving us any proof of his statement. “Of the odontologic treatise of Adamantius,” he says, “unfortunately the title alone is known to us, and even that has reached us indirectly, that is, by means of Ætius; it is of the following tenor.”

Now, whoever takes the trouble to translate these Greek words will easily perceive that they do not constitute one title, but two distinct ones (which even Dr. Geist-Jacobi has had to unite by the conjunction and). These, however, are nothing more than the titles of two chapters of the Tetrabiblos of Ætius, as anyone may see for himself by turning over the pages of this work either in the Greek original, or in the beautiful Latin translation of Giano Cornario (Venice, 1553). In this great composition of Ætius dental diseases are treated of in Chapters XXVII to XXXV of Sermo IV, Tetrabiblos II; and the two Greek titles above referred to are the titles of Chapters XXVII and XXXI.

In the translation of Giano Cornario they read as follows:

Cura dentium a calido morbo doloroso affectorum, ex Adamantio sophista (cure of teeth affected by warm, painful disease, according to Adamantius the sophist).

Cura dentium a siccitate dolore affectorum, ex Adamantio sophista (cure of teeth affected by pain from dryness, according to Adamantius the sophist).

The work of Adamantius, from which Ætius took the contents of the chapters thus entitled, is lost to us, but we have no reason, and not even the least indication, for supposing that this work was a treatise on dental diseases, and not one on general medicine. It is absurd to consider the above-mentioned titles as belonging to an odontological monograph, on the one hand, because, admitting for a moment the existence of such a work, it should have had but one title and not two, and on the other hand, because it is by no means to be supposed that a great and wise physician, such as Adamantius undoubtedly was, should have had the whim to write a book, not on dental disease or on dental pains in general, but only and exclusively on dental pains caused by heat or by dryness. What reason would there have been for not extending the treatment of the subject to those cases of odontalgia resulting from humidity or from cold, that is, from causes as common and, according to the ideas of that time, very frequently associated with one of the first two (as humidity with heat, and cold with dryness)?

Besides, if the titles of the two chapters spoken of be compared with those of the others, in which Ætius treats of dental affections, such analogy will be noticed between the various titles as to make us consider that they have been formulated by Ætius himself, even when the contents of these chapters are taken from other writers. So that the two aforesaid titles not only do not belong to any dental work, but probably they have never existed, even as simple titles of chapters, in the medical book of Adamantius, from which the contents of the two chapters of Ætius above mentioned have been taken.

In order that every one may easily be convinced that the two titles made so conspicuous by Dr. Geist-Jacobi have nothing particular about them, but are, instead, perfectly analogous to the titles of various other chapters of Ætius, we give here the translation of the titles of five chapters, all concerning dental maladies, that is, the two chapters in discussion and other three: