CHAPTER XI.. The Seventeenth Century.

THE SEVENTEENTH CENTURY.

The first signs of the separation of dental science from general medicine were to be perceived in the sixteenth century, the period in which, as we have seen, the earliest dental monographs appeared. From that time this separation tended to accentuate itself ever more strongly; dental monographs became more numerous and dentistry progressed ever more rapidly, both in its scientific and practical aspects.

In the seventeenth century, about which we are now to speak, we shall have to call attention to many facts of the highest importance for the development of dentistry, and with regard to literature, it is worthy of note that while the publications on dentistry that appeared in the various countries of Europe during the preceding century only amounted to about twenty (taking also into account several pamphlets on the famous golden tooth!), in the seventeenth century the number was considerably higher, that is, about a hundred. We shall speak of the most important of these, as also of the works on general medicine or on surgery of the same period, that present some interest from the point of view of dentistry.

JOHANN STEPHAN STROBELBERGER, physician to the imperial baths of Carlsbad, published in the year 1630 a very curious book, the title of which, being translated, runs somewhat as follows: Complete Treatise of Gout in the teeth, or, more properly said, of Odontagra or toothache; in which are set forth, theoretically and practically, for the use of physicians and surgeons, the means of mitigating these pains, as well as the various modes of ably extracting teeth with or without instruments.”

This book merely presents some interest, because it gives us a clear idea of the pitiful state in which the dental art still was in the first half of the seventeenth century, and shows us most clearly what enormous progress our specialty has made in little less than two centuries. Apart from this, Strobelberger’s monograph is of no importance, it being nothing more than a most accurate compilation of all that is to be found on the subject of dental affections in earlier works, especially from the medical point of view; the surgical part of dental therapeutics is treated in a much less complete manner, and prosthesis is entirely excluded from the plan of the work, which, however, is fully in accordance with the title of the book.

Under the generic name of gout, or podagra, are meant, says the author (Chapter I), all the affections produced by diseased humors, falling “by drops” into the articular cavities and the parts surrounding them. Strictly speaking, however, only gout in the feet is named podagra, whilst when the disease is seated in other parts of the body it is indicated by other names, gout in the hands being called chiragra; in the fingers dactilagra; in the knee, gonagra; in the elbow, pechiagra; in the shoulder, omagra; in the spinal column, rachisagra, and so on. When the seat of the evil is in the teeth or in their articulations, by analogy it is denominated odontagra, or odontalgia, an affection which Paul of Ægina was the first to consider as being of a gouty nature (Chapter II).

After having spoken of the sensibility of the teeth (Chapter III), of the various kinds of dental pains (Chapter IV), of the different causes, external and internal, which produce them (Chapters V to VII), of the signs which make known their special nature in each case (Chapters VIII to X), and of the prognosis (Chapter XI), the author occupies himself very minutely, throughout the rest of the book, with all that concerns means of cure, dedicating to this subject sixty-seven chapters and a long appendix.

If, after the publication of Strobelberger’s book, all previous works treating of dental affections had been entirely lost, it would be of inestimable value for the history of dentistry, the author having gathered together in an almost complete manner—citing faithfully the respective authors—all that had been written about dental diseases before him. On the other hand, the book contains almost nothing original; therefore, rather than analyze minutely its contents—which would involve a long repetition of things already noted—we limit ourselves merely to a few observations.

Strobelberger, like Heurnius, is of opinion that for the cure of dental pains it is necessary to have recourse to doctors rather than to dentispices, or tooth drawers (Chapter XII); however, he does not consider the calling of the latter absolutely useless; indeed, he expressly advises (page 174) that they should be applied to for the instrumental extraction of the teeth, it not being possible for such operations to be carried out well and without danger except by those who, through great practice, have acquired the necessary skill in the use of the relative instruments. He refers to the words of Hollerius, already quoted, as to the falseness of the opinion that fumigations made with the seeds of hyoscyamus cause the worms to fall out of the teeth. Notwithstanding, he does not in the least doubt the existence of the worms themselves; and he, like Heurnius, recommends killing them with oil of vitriol or with a decoction made from a frog cooked in water and vinegar (Chapter XXXIII). From this, one clearly perceives that the doubts expressed by Hollerius about the existence of dental worms had not in the least shaken the popular belief in them. Nor, indeed, could it be otherwise when one considers that Hollerius, as we duly noted in another place, had not the courage either decidedly to deny the existence of dental worms, or to formulate in a clear and explicit manner the doubts which had arisen in his mind on this subject. We are, therefore, unable to recognize the merit which Linderer and Geist-Jacobi have attributed to this author, viz., that of having effectually affirmed the non-existence of dental worms.

Among innumerable vegetable remedies recommended by Strobelberger against odontalgia, we will only cite two American plants, the guaiacum and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum (Chapter XXXVI) the author says that, used as a mouth wash, it has the triple virtue of strengthening the gums, of preventing putrefactive processes, and of calming toothache.

The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII) for the first time in this work, but, as we learn from Strobelberger himself, Heurnius has already obtained, experimenting in his own case, the cessation of an attack of toothache by holding in his mouth spoonfuls of tepid decoction of nicotiana for the space of two hours.

The same soothing effects may be obtained, says the author, from the smoke of tobacco; but he attributes this not to the narcotic action of the remedy, but to the fact that it causes the flow of much saliva from the mouth and mucus from the nostrils, through which the morbid humors which provoke the pain are eliminated.

To those suffering from odontalgia, says Strobelberger (Chapter XL), the internal use of certain mineral waters is also of value, and especially that of the waters of Carlsbad (Thermæ Carolinæ). Like many other remedies, they are useful in rendering the secretions more active, favoring thus the elimination of morbid substances from the blood. For the same object of purifying the organism and dispersing the accumulated humors causing the pain, many other means of cure were in usage, such as aperients (Chapter XXV), phlebotomy, and arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI), masticatories, viz., substances intended to be chewed for the purpose of exciting salivary secretion (Chapter XXVI), sternutatories, viz., substances which provoke sneezing (Chapter XXVII), and so forth.

Like Arculanus, Strobelberger makes a distinction between the real and the false cure of odontalgia (cura vera et cura mendosa). This latter he also subdivides in palliative cure and vain cure (Chapter LV). The palliative cure is constituted by the use of narcotics and stupefying remedies (Chapter LVI), whilst the vain cure is represented by certain remedies which he calls “fanatical” or rather “fantastical.” The vain cure, in its turn, undergoes a new distinction, since it comprises three species of remedies, that is, the wearing of amulets, the superstitious remedies, and the ridiculous remedies. Indeed, this last apellation might also fittingly be applied to the preceding ones!

One would be inclined to believe that the author who qualifies these remedies as vain, fantastic, superstitious, and ridiculous was a thoroughly unprejudiced man; however, this is not so. Strobelberger, too, had to pay his tribute to the dominating prejudices of his century; this manifestly appears from various passages in his book, and especially from the Chapters XVI and XLIV. The first of these bears the following title: “How to procure immunity from toothache,” and Strobelberger therein asserts in all seriousness, basing his assertion on the authority of Rhazes, that “if the canine tooth of a lion be suspended to a child’s neck before the milk teeth fall out and during the eruption of the second teeth, it will secure the child immunity from dental pains.” In Chapter XLIV the author speaks of those animals whose teeth are useful to man as remedies against toothache, and reiterates—lending, as it seems, perfect faith thereto—various prejudices that are found in Pliny and other writers of antiquity.

As to the remedies which Strobelberger recognizes as vain—that is, as devoid of real curative virtue—he remarks that they may nevertheless be useful by acting powerfully on the imagination of the sufferer, thus causing, in fact, the cessation of pain (Chapter LVII). This clear and explicit affirmation of the efficacy of suggestion in a book published 270 years ago is certainly not without interest.

If, says Strobelberger, a place is to be accorded, in dental therapeutics, to the vain remedies, among these, amulets deserve the preference; and the best accredited amulet is the root of the lepidium, already recommended by Dioscorides, who affirms that if it be hung around the neck of the sufferer it will cause the pain to cease.

One of the superstitious remedies to be used against this affection (Chapter LVIII), consists in touching the aching tooth with the tooth of a dead person, and afterward greasing it with horse’s marrow.

Among the ridiculous remedies (Chapter LIX), the author describes one that was especially in use among soldiers. With a piece of chalk or of rubble one writes on a table:

Chiacia Chiacia Chiacia X O X X O X X O X

One then pricks the tooth with a knife or an iron toothpick until it bleeds slightly; then thrusting the point of the instrument, to which the blood adheres, into the first cross, then into the second, then into the third, and so on, one asks the patient each time if the tooth still pains him. Before one gets to the last cross the pain ceases! This stolid cure, says the author, has no other value than that of the scarification of the part affected.

Strobelberger held, as did many of the preceding authors, that the extraction of a tooth ought to be the last remedy, that is, to be had recourse to when all others, including cauterization, which he considers as the last but one, have proved ineffectual. There are cases, however, in which the extraction of a tooth is absolutely indicated, and here, by the way, the author acquaints us with the following poetic aphorism, which expressed the unanimous opinion of doctors:

Si dens pertusus, vel putridus esse notatur, Corrumpens alios, tunc protinus ejiciatur.

That is, if one finds that a tooth is hollow or decayed, and corrupts the others, it must at once be extracted.

Strobelberger, like the greater number of his predecessors, is fully persuaded that diseased teeth may be made to fall out by the use of special remedies; indeed, this clearly appears from the title of the work itself, as, without doubt, the reader will already have observed. Such remedies are called by him “odontagoga,” and he describes them at great length in five different chapters (X to XIV) of the second section of his book, dedicated to the surgical care of the teeth.

In regard to violent extraction of teeth, Strobelberger shows still greater cautiousness and timidity than Celsus or Abulcasis. He requires that, after the gum has been detached, one should endeavor to extract the tooth with the fingers or by means of a thread; if, however, this does not succeed, one may have recourse to the trifid lever; only at last, that is, when even the lever has failed, does he allow the use of an appropriate dental forceps.

ARNAULD GILLES, a Frenchman, in the year 1622, published in Paris a work whose curious title we will here note: The flower of the remedies against toothache. We know nothing else about this publication, which, however, to judge from its title, cannot be other than a mere compilation.

DUPONT, another Frenchman, in 1633, published an important pamphlet, which I have, unfortunately, not been able to see. I can, therefore, only quote what Sprengel says of it. Dupont recommends, in cases of obstinate toothache, the extraction and immediate replantation of the tooth; which, he says, becomes quite firm again, but will no more cause any pain. In confirmation of this, Denis Pomaret related, a little later, a case in which a healthy tooth having been pulled out by mistake, and immediately put back into the socket and treated with astringent remedies, became perfectly firm again.

Although Abulcasis and Ambroise Paré had already recommended the replantation of teeth, the loss of which had been caused by trauma, and although Peter Foreest had already made known as a result of his own personal experience that the luxation (not, however, complete extraction) of a tooth and its successive replantation is capable of causing toothache to cease, nevertheless, we must recognize that the merit of having elevated replantation in non-traumatic cases to a special method of cure must be attributed to Dupont.

WILHELM FABRY (1560 to 1634), a German, and native of the small town of Hilden near Cologne, better known by his Latin name of Fabricius Hildanus, was chief doctor to the city of Berne, and acquired great fame as well by his extraordinary professional ability as by his works, consisting principally in reports of many hundreds of important and instructive clinical cases. He is rightly considered one of the most illustrious German surgeons. His writings have largely contributed not only to the progress of surgery in general, but also to that of dental surgery in particular.

One of his observations clearly shows the etiological relation frequently existing between a prosopalgia or a supposed hemicrania and a dental affection. The case referred to is that of a lady who had been subject for six months to violent pain in the upper teeth of one side of the jaw. The toothache little by little disappeared, giving place to an obstinate cephalalgia in the same side of the head, which gradually became so intense as to be perfectly insupportable, the patient being particularly subject to it when the weather was cold and damp. After four years of atrocious suffering, and after innumerable remedies had been tried without avail, Fabricius Hildamus—having had the luminous idea of seeking the cause of the evil in the teeth—obtained a complete cure, without further trouble, by extracting four of the patient’s teeth, which were decayed.

Nowadays, it is an all-important canon of medical practice, that in every case of neuralgia occurring within the region influenced by the trifacial nerve one should give particular attention to the state of the teeth and carefully treat every affection of the same. Notwithstanding—we say it with regret—there are still medical men who ignore or neglect this precept, and prescribe internal remedies or have recourse to injections of morphine when they ought, in the first place, to call in the aid of a dentist. How many patients would have been delivered from slow martyrdom if the example of the clear-seeing physician of Berne had been followed from his days up to the present time!

Fabricius Hildanus relates, besides, many cases of dental fistula, cured by him through the extraction of roots or of decayed teeth. In one such case the fistula dated from fourteen years back. Fabricius Hildanus, contrary to the opinion of many other doctors, extracted a decayed tooth, and by this operation obtained, in a brief period of time, the complete recovery of the patient.

Among the many very important clinical cases cited by Fabricius Hildanus, the following deserves to be recorded: In the year 1590 a woman presented herself to him who had a hard tumor in the space behind the last molar on the right side. The author, after having prepared the patient for the operation by the methods then in use (that is, by aperient medicine, by bleeding, and appropriate diet), destroyed the tumor by the application of escharotic substances. The remaining wound, however, defying all the cicatrizing remedies which the author had recourse to, one after the other, by reason of its being continually disturbed by the movements of the jaws, he then thought of maintaining the dental arches in a determined position, and this he obtained by means of two pieces of wood somewhat hollowed out above and below, which he placed on the right and on the left between the upper and the lower teeth, fixing them to the teeth themselves by brass wires passing through two openings made expressly in each of the two pieces of wood. In this way he succeeded in obtaining the absolute immobility of the jaws and the complete cure of the wound in a few days, during which time the patient was nourished with liquid food.

A very interesting case, inasmuch as it demonstrated the damage and peril which may result from certain absurd means of cure, was reported to this author by Claudio Deodato, physician to the Prince-Bishop of Basle. The case was that of a patient who, after having tried in vain a great number of remedies for a stubborn toothache, finally had recourse to the use of aqua fortis; but this substance, which in those days was in frequent use for dental caries and for toothache, produced most deleterious effects in the patient, that is to say, the loss of almost all his teeth, necrosis of the inferior jaw, with fistulous sinuses and ulceration of the neck, abundant sanious discharge, fever, a cachectic condition, incipient necrosis of the upper jaw, etc. Fabricius Hildanus, consulted by Claudio Deodato about this most serious case, proposed both a local and a general treatment, the result of which is, however, not mentioned in his book.

In the fifth “centuria of medical and surgical observations and cures” we find a case of oral surgery, to which it is worth while briefly to refer here. It relates to an epulis situated next to the upper canine of the left side. The tumor, already of ancient date, had at this time reached the size of a walnut, was very hard, livid in color, irregular in form, and adhered somewhat to the upper lip; according to the author, it was of a cancerous nature. After the usual preparative measures, Fabricius Hildanus proceeded to the ablation of the tumor, and to this end he first pierced it with a curved needle and strong thread, in order to get a good hold on it, and he then removed it entirely down to the bone, by means of a curved bistoury.

Fabricius Hildanus, having dissected several abortive fetuses of under four months, was able to verify the exactitude of the assertion made by Hippocrates, afterward luminously confirmed by different Italian anatomists, that the teeth begin to be formed during intra-uterine life. And with reference to this he also relates the following fact:

The wife of a Protestant minister gave birth to a female child which already had a fully developed tooth, a lower middle incisor, equal in size to that of a child of two years old, and which interfered with the sucking by injuring the nipple of the mother’s breast and the tongue of the child itself. So it was necessary that it should be removed. But it was found to be so firm that the surgeon sought in vain to extract it with a thread, and was obliged to have recourse to the forceps.

Observation XXXI of the third centuria relates a case of rhinoplasty. In the year 1590, when the Duke of Savoy made war on the inhabitants of Geneva, a girl named Susanna N. fell into the hands of the soldiers, who tried to deflower her; enraged at not succeeding in their intent, they cut off her nose. Two years later the girl went to Lausanne, the residence of J. Griffon, an eminent surgeon of that time, who performed the rhinoplastic operation on her in so splendid a manner that one would have taken the new nose for a natural one, not only from its normal appearance, but also because the scar was hardly visible. Fabricius Hildanus, having had occasion to see and examine the patient several times, even up to twenty-one years after the operation, was able to testify to the perfect condition of the nose; in the extreme cold of the winter, however, it was apt to become livid at the point. He does not describe the operative process followed by Griffon, but merely says that the first inventor of this operation was Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had undertaken the reproduction of the same from his own conception of it, based on the information imparted to him in conversation, by an Italian who had been operated upon by Tagliacozzi.

JOHANN SCHULTES (1595 to 1645), a physician in Ulm, was the author of a very important work entitled Armamentarium chirurgicum, in which are given plates and descriptions of almost all the surgical instruments that had been in use up to that date. As to the part relating to dental and oral surgery, we find the following instruments named in this work:

1. Several kinds of pelicans; an instrument which was so called from its resemblance to the beak of the bird of the same name, and used for extracting the molar teeth.

2. The common dental forceps, then named cagnolo by the Italians, because of the supposed likeness to a dog’s muzzle.

3. The crow’s beak forceps (rostrum corvinum), designed for the extraction of dental roots, and, therefore, corresponding to the rhizagra of Celsus.

4. Two special dental forceps, or dentiduces, for the removal of teeth which could not be extracted either with the pelican or with the common dental forceps.

5. Bifid and trifid elevators (vectes bifidi et trifidi), to be used for the extracting of incisors and canine teeth, as well as roots.

6. Dentiscalpia for detaching the gum from the tooth before proceeding to extract it, in order that this may be the more easily accomplished and with less danger.

7. A silver funnel or cannula (infundibulum seu fistula argentea), for nourishing patients affected with trismus, by conveying liquid food into the fauces, through the free space behind the last molars.

8. Forceps more or less like in form to the beak of the parrot or the vulture (rostrum psittacinum et vulturinum), for the removal or resection of teeth that have grown in abnormal positions.

9. A screw dilator (dilatatorium cum cochlea), for gradually opening the dental arches in cases of spasmodic constriction of the jaws.

A plate from Schultes’ “Armamentarium chirurgicum,” showing several dental instruments.]

MARCO AURELIO SEVERINO (1580 to 1656), of Tarsia, a celebrated professor of surgery in the Neapolitan University, had a great predilection for the use of the cauterizing iron, which he also used very frequently in curing caries and other dental diseases. At times, to effect a cessation of violent toothache, he would have recourse to the cauterization of the antihelix! Against flaccidity of the gums and loosening of the teeth he also used cauterization, disapproving the use of astringent substances, as these cannot get so far as the roots of the affected teeth. Severino boasts of having cured by cauterization at least two hundred cases of dental diseases.

LAZARE RIVIÈRE (1589 to 1655), a professor at the University of Montpelier, also known by his latinized name of Lazarus Riverius, treats of dental affections and their cure, in various parts of his works, considering them, however, almost exclusively from a medical point of view.

He speaks first of all of the different causes of odontalgia, and, among these, does not omit to mention worms. These, he says, may be generated in the carious cavities, owing to the putrefaction of substances retained in their interior. Whenever odontalgia is caused by worms, the pain, says Rivière, is not continuous, but ceases and returns at brief intervals; besides, the sufferer perceives at times the movement of the worm inside the tooth!

What one reads in the works of this author as to remedies to be used for odontalgia clearly demonstrates how irrationally dental diseases were treated in the seventeenth century and what tortures were inflicted on the patients. In many cases, and especially when the pain was held to be occasioned by “hot humors,” the treatment was begun by bleeding in the arm. The following day an aperient was administered. Afterward, if the pain still persisted, the sufferer was cupped in the region of the scapulæ or of the spine, blisters were applied to the nape of the neck or behind the ears, resinous plasters to the temples; all this without taking into account the remedies which were introduced into the ears, or the various medications or operations performed on the aching part itself, and many other things besides. In fact, in order to cure a toothache, the whole body of the sufferer was seized upon and put to torture, and in the majority of cases they assuredly finished by extracting the diseased tooth! When we reflect on the extraordinary frequency of dental disorders we cannot do less than recognize that the dentists, by the radical change effected in the methods of treatment, have diminished in no small degree the sufferings of humanity!

According to Rivière, the small veins (sic) that nourish the teeth pass through the ear (!); and this would explain how the cessation of a toothache may be obtained by the introduction of certain remedies into the meatus auditorius externus. Relief may be obtained, for instance, by dropping oil of bitter almonds into the ear on the side affected by the pain, or by allowing the vapor of hot vinegar, in which pennyroyal or origanum has been boiled, to penetrate into it. Others, adds the author, pour a little pure vinegar into the ear, which is especially efficacious against “hot fluxions.” When, however, the toothache depends on a “cold fluxion,” it calms the pain wonderfully to drop into the ear a tepid mixture of garlic juice and theriac. The same advantage, says the author, may be obtained by introducing a piece of garlic, peeled and cut into the form of a suppository, into the ear.

The author also makes a lengthy enumeration of anodyne and narcotic remedies (among which opium), observing, however, that those remedies, unless the vehemence of the pain obliges the use of them, ought not to have the preference, it being much more rational and much more advantageous to institute a cure which aims directly at the cause itself of the pain (fluxions, worms, etc.).

He informs us that Amatus Lusitanus, a celebrated physician of the sixteenth century, extolled, as a remedy for toothache, a decoction of gum sandarach in wine and vinegar; the said decoction was to be made with an ounce of sandarach in six ounces of wine and the same quantity of vinegar, and ought to be kept in the mouth some length of time, whilst hot.

Rivière further speaks of various masticatories, which were composed of mastich, staphisagria, pyrethrum, henbane, etc.

He also mentions oil of cloves, which even then was used against toothache, by introducing into carious cavities a small piece of cotton-wool soaked in it. Oil of camphor was used in the same manner, but the most efficacious of all, according to the author, was oil of boxwood.

As to worms in the teeth, they may be destroyed by the use of bitter substances!

In the case of a caries penetrating into the inner cavity of the tooth, to effect the cessation of pain, it is necessary to burn the nerve with the actual cautery, or with aqua fortis, or with oil of vitriol. If this be repeated several times, the tooth gradually falls to pieces.

After having enumerated all these remedies, the author speaks of the extraction of the teeth, and of all the precautions with which this must be carried out in order to avoid the various accidents which may result from the operations and may even, sometimes, become a cause of death.

When abundant hemorrhage follows the extraction of a tooth, this may often be made to cease by applying a small, very compact ball of linen into the alveolus and maintaining it there by pressure during one or two hours. Should this not suffice, one can combine with compression the use of astringent substances. Finally, as a last remedy, use may be made of the red-hot iron.

In the case of timid patients, who shrink from an instrumental operation, recourse may be had to eradicating remedies, the author being fully convinced of their efficacy. Indeed, one of these—helleboraster—is said to be so powerful that, when rubbed on the teeth, these fall out within the space of a few hours; for which reason it is absolutely necessary, in making use of it, to cover over the neighboring teeth with wax, so that the healthy ones may not also fall out, as happened, says the author, in the case of a poor peasant.

The internal use of mercury, and even the use of certain mercurial preparations used by women as cosmetics, is of damage to the teeth and imparts to them a blackish or dirty looking color.

Numerous remedies exist for cleaning the teeth, but according to Rivière the best way of cleaning them consists in rubbing them with a small stick immersed in sulphuric acid (spiritus sulphuris aut vitrioli) and afterward drying them with a piece of linen. This remedy not only cleans and renders the teeth white, but it preserves them also from caries! If the teeth are very dirty, the spirit of vitriol may be used pure; otherwise one mixes it with mel rosatum or with water.

The great enthusiasm shown by Rivière for the above-mentioned remedy does not, however, derive from a long experience, made by himself or by others, of its advantages, but is based principally on a fact referred to by Montanus, and which, we will here recount, because, from it, one clearly perceives how credulously our forebears accepted general affirmations and formulated therapeutic precepts.

Montanus recounts in one of his writings, how, being in Rome in his early youth, he became acquainted with a woman of about twenty years of age, known by the name of Maria Greca (by the way the author speaks of her, one is led to suspect she was a courtesan); and how, having seen her again, thirty years later, and found her in pretty much the same conditions as formerly, he expressed his surprise at this; whereupon Maria Greca told him that she herself believed that she owed the conservation of her beauty to the habit, already of many years’ standing, of using one or two drops of oil of vitriol every morning, as a friction for the teeth and gums. In her youth she had had very bad teeth, but by reason of this cure they had become, and were at the time being, beautiful and perfectly firm; the gums also were in excellent condition; it seemed, therefore, to her that this conservation of health and freshness, in spite of her fifty years, depended precisely on the daily use, in the manner described, of oil of vitriol!

Rivière, besides, recommends tobacco ashes for cleaning the teeth, a counsel not yet given by any previous author. He also gives the formulæ for two dentifrice powders, the basis of which is alum; he calls attention to the great importance of taking assiduous care to keep the teeth clean, and advises that after each meal the residues of food be removed from the interstices of the teeth and the mouth well rinsed with wine.

NICOLAUS TULP, in Latin, Tulpius (1593 to 1674), a distinguished physician and anatomist of Amsterdam, contradicts the then prevailing opinion among doctors, that is, that the cure of dental affections and the operations relating thereto were matters to be held in little account. He observes that diseases of the teeth may give rise to the most serious consequences, which can even be the cause of death, and are, therefore, worthy of being taken into equally serious consideration as all the other diseases of the several parts of the human body.

This author relates a clinical case tending to demonstrate how incisions made in the gums, advised in the first place by Vesalius, in order to facilitate the erupting of the last molar, are not always exempt from danger. A young doctor of Amsterdam, by name Goswin Hall, being tormented by insupportable pain caused by the difficult eruption of a wisdom tooth, had the gum lanced above it. But the pain, instead of diminishing, became worse; fever and delirium supervened, followed by death! (Here, however, we must be allowed to observe that nothing demonstrates that the real cause of death was the lancing of the gum, or that without this the case would have had a different termination. An event can occur after another and yet be quite independent of the former and result from quite different causes.)

Among the cases cited by Tulp, the following is also worthy of mention. He relates having arrested a violent and persistent attack of hemorrhage, which came on after the extraction of a tooth, by applying and compressing a piece of sponge inside the alveolus.

The belief that dental caries and toothache could be caused by worms was, at that time, still in full vigor, and it gained still greater force by reason of observations recorded by different scientists, whose affirmations could with difficulty be doubted, for at that period the greater number still swore blindly in verba magistri.

OLIGERUS JACOBAENS (1650 to 1701), a Danish physician and anatomist, who taught in the University of Copenhagen, declared that in scraping the decayed cavity of a tooth that was the cause of violent pain, he had seen a worm come forth, which, having been put into water, moved about in it for a long time.

MARTIN SIX, having split some decayed teeth a short time after they had been extracted, asserts that he determined the existence of worms in them. (It is probable that this observer, as well as others, mistook the dental pulp for a worm, an unpardonable error, in truth, at a time when the anatomical constitution of the teeth had already been very well studied by several scientists, and especially by the celebrated Bartolomeo Eustachius.)

GABRIEL CLAUDER (1633 to 1691) not only believed in dental worms, but maintained besides that these were the most frequent among all the causes of toothache. In a certain way, to sustain this opinion of his, he relates a case in which a tooth of healthy appearance being the seat of great pain, a tooth-drawer had asserted that there must be a worm in its interior; and, in fact, on the tooth being extracted and afterward split, the little animal whose existence the tooth-drawer had divined, was found to be existing inside of it!

PHILIP SALMUTH asserts that by using rancid oil he got a worm out of the decayed tooth of a person suffering from violent toothache, thus causing the cessation of the pain. The worm, he says, was an inch and a half in length (!) and similar in form to a cheese maggot.

NICOLAUS PECHLIN (1646 to 1706), professor of medicine at Kiel, testifies to having seen five such dental worms, like maggots, come out by the use of honey, though he does not say whether they issued from several cavities or from one only!

GOTTFRIED SCHULZ. But all this is nothing compared to what Gottfried Schulz has dared to assert, viz., that by using the gastric juice of the pig, worms of great size can be enticed out of decayed teeth; some of these even reaching the dimension of an earth-worm!

It is not much to be wondered at that these things should have been blindly believed in, if we reflect that only a short time previous to this the story of the golden tooth had been taken seriously by men of great erudition, and that in the very epoch of which we are speaking the illustrious anatomist THOMAS BARTHOLIN (1616 to 1680), of Copenhagen, relates having seen a man, at Padua, who had an iron tooth! Besides, the possibility of such a phenomenon was explained in a most curious manner by THOMAS MINADOUS, who explained that in the same way as iron is generated in the macrocosm, that is, in the world, so it is equally admissible that it may be generated in the microcosm, that is, in man!

NATHANIEL HIGHMORE. In the year 1651 the English physician and anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a treatise on anatomy (Corporis humani disquisitio anatomica, etc.), by which he acquired a celebrity superior, perhaps, to his merits. This work, however, served without doubt to diffuse the knowledge of an anatomical fact of the highest importance, especially from the point of view of dentistry and surgery.

There is no doubt that the existence of the maxillary sinus was already known before Highmore, the celebrated anatomists Vesalius, Ingrassias, Eustachius, and Fallopius having spoken of it very clearly; only through ignorance of the history of anatomy has it been affirmed by many that this cavity was discovered by Highmore, to whom is only due the merit of having described the maxillary sinus, by him called antrum, most accurately, and of having made known the possibility of a communication between it and the mouth. Highmore calls attention to the fact that the inferior wall of the antrum often presents small projections, which correspond with the tops of the alveoli, and that the osseous lamina which interposes between these latter and the maxillary sinus is often extremely thin; for which reason, it may easily happen that, in extracting one of the teeth below the cavity, one may bring away together with the tooth the small osseous plate that forms the bottom of the alveolus, thus leaving the maxillary sinus open at its inferior part. With regard to this, he refers to a most interesting case which afterward acquired a high degree of notoriety. It relates to a lady who had suffered from toothache for some years, and who from time to time had had several decayed teeth extracted, without, however, finding relief. The pain only ceased after the patient had had the left upper canine removed. But after this operation an incessant flow of humors from the alveolus of the extracted tooth took place. The patient, in great anxiety at this circumstance and desirous of seeing clearly into the causes of it, herself explored the affected part with a silver probe, the entire length of which penetrated into the cavity, producing in the patient the effect of its having reached the eye. Still more amazed, and urged on by the desire of becoming still better acquainted with the extent of the evil, she now made use of a long feather, which she had previously stripped, and discovered to her painful surprise that this new instrument of exploration entered to so great a distance that it, according to her idea, penetrated into the skull. From this she derived argument for the belief that the morbid phenomenon had its origin in her brain. Believing herself affected with a serious malady, she consulted Highmore, who had the satisfaction of being able to tranquillize her completely by making her understand that the jaw bone is hollow in the inside, and that its cavity had remained open underneath in consequence of the extraction of the canine tooth; and also, that the feather had not penetrated to such a distance as she supposed, but had curved inside the bone. As to the discharge which had given so much trouble and alarm, Highmore considered it quite a natural circumstance, derived simply from the opening of the antrum, as he held that in many cases the maxillary sinus contains mucus, and that this condition was, therefore, altogether normal. So he did not propose any treatment, and the lady thenceforth supported her infirmity with resignation.

This most interesting case soon became generally known, and contributed, without doubt, not a little to attract the attention of medical men to the anatomical peculiarities which Highmore had pointed out in the upper maxillary bone, thus causing his name to become inseparably associated with the maxillary sinus.

It is evident, however, that Highmore never even suspected to what very important practical applications his description would give rise. He knew nothing about the diseases of the antrum, and believed that, even in perfectly normal conditions, this cavity is often filled with liquid; the idea, therefore, of its being advisable, in certain cases, to extract a tooth and perforate the alveolus in order to give exit to the liquid contained in the maxillary sinus never occurred to him.

About fifty years went by before a rational treatment for affections of the antrum was initiated, the merit of which, as we shall see at its time and place, was due to William Cowper. During that half century maladies of the maxillary sinus continued to be badly diagnosticated and badly treated.

BERNARDO VALENTINI. In the year 1686, that is, thirty-five years after the publication of Highmore’s book, Bernardo Valentini, professor at the University of Giessen, described a case of tumefaction and abscess in the cheek, treated by him with emollient remedies, and in which, although according to him caries of the underlying bone did not exist, the separation of a sufficiently large osseous fragment took place. Without doubt the affection of the cheek was derived in this case from some disease of the antrum; however, it would appear that Valentini did not in the least perceive any such casual relation, as he makes no allusion whatever to it.

ANTONIO MOLINETTI, professor at the University of Padua, had, however, ten years previously, diagnosticated and cured an affection of the antrum by means of an operation. In his book Dissertationes anatomico-pathologicæ, published at Venice in 1675, Molinetti relates that in a case of abscess of the maxillary sinus, which caused the patient great suffering, he performed the operation of trepanning the upper maxillary bone anteriorly, after incision of the soft parts overlying it. In a certain way we may, therefore, consider Molinetti as a precursor of William Cowper.

Having spoken of the very important anatomical fact illustrated by Highmore, we will now also speak briefly of those authors who, in the seventeenth century, occupied themselves with the anatomy of the teeth. Their number is sufficiently large; we will, however, only make mention of such as contributed to the development of this branch of science, or who, at least, expressed some opinion worthy of note.

The celebrated anatomist ADRIAN SPIEGEL (1578 to 1625), better known by the Latinized name of Spigelius, wrote nothing noteworthy about the teeth, but he appears to have been the first to affirm that the teeth are more firmly fixed in the alveolus, when their roots are curved after the manner of hooks.

DIEMERBROEK, a Dutchman, relates several cases of dental anomalies, as for example, of teeth being cut in the palate, and which injured the tongue. The author cites his own case, relating that having had a canine tooth extracted when well advanced in years, it was, nevertheless, succeeded by a new one. He relates, besides, that he had seen in Utrecht a woman, aged fifty-six years, who again cut two incisors after having lost the former ones two years previously. Apart from this, Diemerbroeck tells us nothing of interest or importance regarding the teeth, often repeating old ideas, the falseness of which had already been luminously demonstrated. For instance, he says that the permanent teeth are developed from the roots of the deciduous ones remaining in the alveoli; an unpardonable error for an anatomist of the seventeenth century, for which he was afterward taken to task by Duverney.

THOMAS BARTHOLIN, whom we have already mentioned, speaks of a tooth which had made all the round of the alveolar border; that is to say, of a dental arch constituted by a single piece; and the Italian anatomist BERNARDO GENGA makes mention of an analogous case. It is superfluous to add that these authors allowed themselves to be deceived by false appearances, owing especially to an abundant and uniform deposit of tartar on the surface of the teeth and in their interstices, which gave to the dental arch the appearance of one continuous piece.

RINALDUS FREDERICUS, in his erudite dissertation entitled De dentium statu naturali et præternaturali, spoke of the dental system with sufficient thoroughness, if we consider the epoch in which he wrote. He commences his work with a long chapter on the importance and dignity of the teeth (dignitas dentium). Among other things, he relates that formerly, in certain parts of India, the teeth were so highly valued as to be offered in sacrifice to the gods. He says, too, on the authority of certain authors, that the ancients were led to believe that the teeth served for the resurrection of the body, from the circumstance of their not showing signs of corruption when found in sarcophagi.

Discoursing of the genesis of the teeth, Fredericus says that “every tooth is at first enclosed within a follicle, that is, in a frail, skin-like membrane, in the same manner as the grain in the wheat-ear.” Taking this comparison as his point of departure, he gives to dentition the name germination.

This author says that the teeth of the Ethiopians and of the Indians are generally whiter than those of the northern peoples, but that those of the Indians soon lose their primitive whiteness by reason of the widely diffused habit of chewing betel-nuts.

Fredericus refers to an experiment which, according to him, demonstrates the “sympathetic relations” between the teeth and the ear (whilst in reality it only proves the facility with which sounds may be transmitted through solid bodies). “If, by night,” says he, “one holds tightly between one’s teeth the end of a stick, stuck upright in the ground, one hears the footsteps of a person approaching from afar much more easily.”

Through the researches of three great men, Marcello Malpighi, Friedrich Ruysch, and Antoni van Leeuwenhoeck, an altogether new science arose in the seventeenth century, viz., histology, or the anatomy of the tissues, whose revelations contributed not a little to the development of modern odontology.

MARCELLO MALPIGHI (1628 to 1694), the celebrated Italian anatomist, was the initiator of microscopic observations on the tissues, and is, therefore, justly considered the founder of histology, within the range of which he made most important discoveries.

FRIEDERICH RUYSCH (1638 to 1731), professor at Amsterdam, rendered his name illustrious particularly by bringing to a high degree of perfection the processes of anatomical preparations and of embalming.

His magnificent injections, carried out with a method of his own invention, enabled him to trace the most minute vascular ramifications and to demonstrate the existence of capillary vessels in parts where their presence had as yet never been suspected.

Ruysch studied accurately the anatomical constitution of the teeth, and especially their vessels. He called attention to the membrane which lines the maxillary sinus, and discovered in it a number of bloodvessels.

But in addition to his purely anatomical observations, this author also merits our consideration from the point of view of pathology. He confirmed a most important fact to which allusion had already been made by preceding authors, that is, the atrophy of the alveolar parietes as following on the extraction or on the falling out of teeth. Ruysch, however, makes the observation that atrophy of the alveolar parietes may also precede the falling out of the teeth, and rather be the cause than an effect of it. In such cases the teeth, before falling out, always become more and more loosened, proportionately to the atrophic process. This pathological condition, against which none of the astringent remedies habitually used are of avail, is mostly considered, says Ruysch, to be owing to scurvy; but, he adds, the accumulation of tartar may also be the cause of it. Substantially, Ruysch affirms the relation existing between the accumulations of tartar and the production of that very frequent disease that was afterward named expulsive periodontitis or alveolar pyorrhea.

This author also relates two cases of polypous affection of the maxillary sinus. In one of these cases, the existence of a polypus in the maxillary sinus was determined by Ruysch while dissecting a corpse. The other case relates to a female patient upon whom two surgeons had performed the extraction of several molar teeth and the extirpation of an epulis believed by them to be of a malignant character. After the operation they cauterized the diseased part to a great depth with a red-hot iron, reaching as far as the maxillary sinus, which remained open, and from which Ruysch afterward extracted with his little finger several polypi.

ANTONI VAN LEEUWENHOEK (1632 to 1723), like the preceding author, a Dutchman, was the first maker of powerful microscopes, by means of which he made many important discoveries; among others, that of the tubular structure of the dentine or tooth bone. This discovery he made known and demonstrated in the year 1678, before the Royal Society in London. In his description of the structure of the teeth, Leeuwenhoek says that 600 to 700 of the dentinal tubuli have hardly the consistence of one hair of a beard.

In the year 1683 he discovered in the tartar scraped from between the teeth a form of microörganism upon which he laid special stress. This observation he embodied in the form of a contribution which was presented to the Royal Society of London on September 14, 1683. This paper is of particular importance, not only because of the careful, objective nature of the description given of the bodies seen by him, but also for the illustrations which accompany it. From a perusal of the text and an inspection of the plates, there remains little room for doubt that the bodies described by Leeuwenhoek were not animalcules, as he believed, but bacteria.

DOMENICO GAGLIARDI, professor of anatomy and of medicine at Rome, published an excellent work on the anatomy of the bones, in which he occupies himself not only with the structure of bones, properly so called, but also with that of the teeth. He considers the enamel to be formed by parallel and contiguous fibers, coated, so to speak, by a concreted juice, sui generis, which acquires a much greater consistence than that of the bones. Gagliardi says that by rubbing teeth hard together, or striking them with a steel, he was able to extract sparks from them.

JEAN DUVERNEY (1648 to 1730), a celebrated French anatomist, wrote a good monograph about the teeth. As different anatomists of the sixteenth century had already done, he examined many fetal jaws in order to study in them the formation of the teeth. In relating his observations, he says that he found in every alveolus a mass of soft viscous matter, having the form of the tooth that is to derive from it, and which may be considered as its nucleus. This nucleus is entirely surrounded by a membrane, which the author likens to that which surrounds the fetus, and to which he gives the name of choroid membrane. From the surface of the nucleus a gelatinous juice transpires, which, thickening in layers, forms the enamel and the rest of the tooth. The choroid membrane is abundantly furnished with nerves, and with blood and lymph vessels. Into the interior of the teeth penetrate vascular and nervous branches which serve to maintain its vitality. In fetal jaws one finds, besides the germs of the deciduous teeth, also those of the permanent ones. The “choroid membrane” does not follow the tooth when it issues from the alveolus; it remains instead within the latter, forming the peridental membrane.

Duverney says that in old people the root cavity diminishes in so considerable a manner, and the vessels are so compressed that they almost entirely disappear. It is then that a period of decadence begins in the tooth, it is more feebly nourished, wears away more rapidly than hitherto, and becomes shorter.

The author also speaks of senile atrophy of the jaws, especially of the alveolar processes. With regard to this, he observes that if in old age the lower jaw advances beyond the upper, this depends wholly on the disappearance of the alveolar border, which projected more in the upper than in the lower one.

Duverney admits the existence of direct vascular relation between the gums and the teeth; because in the case of diseases of the gums it is rare not to find the teeth altered as well.

From the point of view of the development and nutrition of the teeth, Duverney finds much analogy between the tusks of the elephant, the teeth, properly so called, the feathers of birds, and the hair of mammifera.

GOTTFRIED BIDLOO, a Dutch anatomist, expresses the idea that the air contributes, after the eruption of the teeth, to hardening them. He did not, however, give any proof of this opinion of his.

CLOPTON HAVERS, an Englishman, wrote a book on osteology, by which he acquired great reputation, and in which he treats as well of teeth and their structure. This author believes the enamel of the teeth to be of the nature of stone, and the ivory of the nature of bone. The dental roots, which, he says, are precisely of a bony nature, are covered over with a periosteum, which is in close relation with the gums and with the periosteum of the jaw bone. Clopton Havers held that the dental follicle no longer furnishes any nourishment to the enamel from the moment that this has reached its perfect formation. On the other hand, he assures his readers that he has observed, through the microscope, nervous threads which, departing from the bulb of the tooth, traverse the ivory through small canals, arriving thus at the periosteum. By this anatomical disposition the sensibility of the teeth may, according to him, be explained.

Having made this passing allusion to the anatomy of the teeth in the seventeenth century, we will now resume the illustration of those facts relating to the pathological and curative part of the science.

WALTER HARRIS, an Englishman, in a pamphlet on acute infantile maladies, recommends again, in cases of difficult dentition, the incision of the gums, a curative practice which had already fallen into disuse.

In the authors of that time we find registered a great number of cases of epulis. HIOB VAN MEEKREN speaks of an enormous tumor of the gum that developed in consequence of a traumatic action which had occasioned the loss of a tooth. Before deciding on the extirpation of the tumor, the author thought well to pierce it with a bistoury, to be able to judge whether its ablation might not possibly give rise to a dangerous hemorrhage. The wound having bled but little, he proceeded to operate; but the tumor was so large that it was necessary to remove it in various portions.

The same author refers to a case of a soft epulis, bleeding easily, that developed after a badly performed dental extraction. It was to be foreseen that the ablation of such a tumor would give rise to an abundant hemorrhage. This was, however, staunched by simply using astringent powders, without having recourse to the actual cautery, which the operator had held in readiness.

DANIEL MAJOR, wishing to remove a large epulis by tying it, was obliged, in order to keep the ligature in position, to pass the thread through a circular incision made at the base of the tumor. He first used a thread of silk, afterward a silver one, and tightened the ligature every day until the epulis fell off.

JOHANN ACOLUTHUS was obliged, in order to extirpate a large epulis, to previously split the labial commissure. After the ablation of the principal mass of the tumor, he destroyed the remaining part of it by application of the red-hot iron.

One reads of other cases of epulis in Stalpaart van der Wyl, Mercklin, Preuss, Bern, Valentini, etc. This last author even speaks of an epidemic of epulis. However this may be, it is very probable that epulis was much more frequent in past times than it is now, and this probably depended partly on the incongruous modes of treating diseases of the mouth, and partly on the slight attention paid to cleanliness of the teeth.

KORNELIS VAN SOOLINGEN, a celebrated Dutch physician and surgeon, who flourished toward the end of the seventeenth century, speaks contemptuously of dental operations, and especially of extractions. He says that such operations ought to be left to charlatans, used to taking out teeth with the point of the sword, and to doing many other things of like nature! This unjust contempt was at that time widely diffused in the medical class, it resulted, however, substantially, from the great difficulties encountered by doctors and surgeons in general, in performing the operation of extraction, owing to want of practice, and also from the desire to avoid the responsibility of the accidents to which the extraction might give rise; so true is this, that an author of the preceding century, THEODOR ZWINGER (1538 to 1588), a celebrated Swiss doctor and professor at Basle, had declared with great frankness that the extracting of teeth ought to be left to barbers and charlatans, as it might easily occasion unpleasant accidents, such as fractures of the jaw, laceration of the gums, serious hemorrhage, and the like.

In spite of his contempt for practical dentistry, Kornelis van Soolingen takes the treatment of dental affections into attentive consideration. For the stopping of carious teeth, he recommends a mixture similar to that which Rhazes had recommended many centuries before, that is, a cement of mastic and turpentine; because, says he, when the stopping is made with metallic substances, it is never so perfect as to entirely impede the penetration of moisture.

Great credit is due to Kornelis for having first brought into usage the instrument makers’ emery wheels for grinding down sharp edges of teeth, thus initiating the practice of trepanning the teeth with sphere-shaped burs.

PAUL WURFBEIN refers to a case of extensive necrosis of the lower jaw, in which a certain Dr. Bürlin having removed the necrotic portion, regeneration of the bone took place.

FRIEDERICH DEKKERS (1648 to 1730) refers a similar case, in which, although quite one-half of the lower jaw had been removed, the bone formed again completely.

BENJAMIN MARTIN, apothecary to the Prince de Condé, was the author of a pamphlet on the teeth, in which he gave a succinct description of these organs and spoke briefly of their diseases. He shows himself decidedly opposed to the use of the file and to the application of false teeth, because, according to him, both of these things may be the cause of great harm. With regard to the file, he says that nothing so easily tends to loosen the teeth as the use of this instrument, not to speak of various other inconveniences, among which is the danger of opening the interior cavity of the tooth.

MATTHIAS GOTTFRIED PURMANN (1648 to 1721), a celebrated surgeon of Breslau, was the first to make mention of models in dental prosthesis. As to the mode in which these models were obtained, some admit as natural that he first took a cast, and formed the model on this; but as Purmann does not hint in the least at such a process, the supposition is altogether gratuitous. Indeed, his description rather excludes any probability that the model was taken from a cast. Here is the literal translation, as nearly as possible, of the passage in which Purmann speaks of artificial teeth and of the mode of applying them.

“The front teeth, or pronouncing teeth, ought, when they are wanting, to be substituted by artificial ones, in order to avoid defects of pronunciation, as well as to obviate deformity of the mouth, and this is carried out in the following manner: One has other teeth made of bone, or of ivory, according to the number, the size, and the proportions of those wanting; for which purpose one may previously have a model executed in wax, reproducing the particular conditions of the teeth and jaws, in order afterward to make and exactly adjust the whole on the pattern of it; then, when the base of these teeth is well fitted on the jaw and small holes have been made in the artificial teeth and also in the natural ones next to them, one applies the artificial teeth in the existing void and fixes them as neatly as possible with a silver wire by the help of pincers.”

It would appear that the author is here describing a prosthetic method, which he had never practised himself; and this results from the fact of his advising the perforation of the natural teeth for the passage of the silver wire destined to keep the prosthetic piece in its place. Evidently desiring to describe the mode practised by the specialists of those days for fixing artificial teeth, he erroneously imagines that the metal thread was passed through the holes drilled in the natural teeth; this would have been impossible, first, because of the atrocious pain due to the sensibility of the dentine and of the dental pulp, and then because of the pathological consequences to which the perforation of the teeth would have given rise. We may, therefore, surely hold that Purmann is simply describing, and not even accurately, a prosthetic method already in use among the specialists of that period.

On examination of the passage cited above—which, however, is not so clear as might be desired—it would appear that the models of which the author speaks were most probably quite different from those in use now. It is almost certain that the specialists of those days first made a sketch of the prosthetic part to be constructed, using for the purpose a piece of wax which they partly modelled with the hand and partly carved; and after having tried on this model until it fitted perfectly in the mouth, and was in every way satisfactory, they probably passed it on to a craftsman to make an exact reproduction of it in bone or ivory.

In the year 1632 a little book was published in Naples, having for its title, Nuova et utilissima prattica di tutto quello ch’al diligente Barbiero s’appartiene; composta per Cintio d’Amato. This pamphlet was reprinted in Venice in 1669, and again in Naples in 1671. We here make mention of it, not for any special importance which it really has as regards the development of the dental art, but because of its being most probably the first book in the Italian language in which dental matters are spoken of independently of general medicine and surgery.

TOMMASO ANTONIO RICCIO. The edition of 1671 was published under the supervision of Tommaso Antonio Riccio, who was for many years a disciple of Cintio d’Amato, and who greatly eulogizes his master and praises his work. He expresses himself in the following bombastic manner: “This book, the offspring of Master Cintio d’Amato, excellent in the Barber’s Art, ought to find a place in the bosom of Eternity; because by reason of its having been twice given to the light, it has proved its worthiness to live forever in the memory of men, gaining for itself, by its excellence, immortal glory before all such as are practised in the Art.”

The book—which consists of about one hundred and eighty pages, and is illustrated by several admirable engravings—contains, among other things, two pages of verses, written by various authors, viz., by Cintio d’Amato himself, by Giovan Battista Bergazzano, also a barber, and by others. The greater part of these verses are in praise of the two doctors and Martyrs in Christ, Cosmos and Damianus, special protectors of the Art and of the author.

The verses of Cintio d’Amato reveal the possession of a literary and poetic culture above the ordinary, in spite of his being only a master barber. As to his book, it may be considered, for the time in which it was written, as an excellent treatise on so-called minor surgery. The author expounds, in a few chapters, the anatomical notions relating to bleeding; speaks at great length of this operation and of everything concerning it; refers with much detail to all pertaining to the use of leeches, cupping, scarification, cauteries, issues, blistering, primary treatment of the wounded, nursing of the sick, etc.; at the end of the book there is also a long chapter on the embalming of corpses.

As regards the treatment of the teeth and gums the author dedicates six chapters thereto, entitled, respectively: “On the relaxation of the gums” (Chapter XXXVII); “Preparation for strengthening the gums and making the teeth firm” (Chapter XXXVIII); “On tartar and spots on the teeth” (Chapter XXXIX); “Another preparation for whitening and preserving the teeth” (Chapter XL); “Mode of burning hart’s horn, very necessary in preparations for the teeth” (Chapter XLVII); “‘Water of salt,’ which makes the teeth white and is also good for ulcers of the gums” (Chapter XLIX).

Evidently Cintio d’Amato treats of dental matters only within extremely restricted limits. He tells us nothing with regard to the treatment of toothache, nothing about caries, about prosthesis, and, what is still more remarkable, he does not allude even in passing to the extraction of teeth. Now, if in a book treating of all that which appertains to the diligent barber, the most important dental subjects are passed over in silence, this shows that, contrary to the generally diffused opinion of today, the dental art was not at that time (at least not in Italy) exclusively, or even in great part, in the hands of the barber. Even at that time there must have been dental specialists, and the proof of this may be found in d’Amato’s book itself, in the chapter entitled “Necessity and Origin of the Barber’s Art.” The author, after having spoken of the divisions which the practice of the medical art had undergone from the most remote times, and after having alluded to the great number of parts into which Medicine was divided in the time of Galen, adds: “Which may also be seen in our own times, for as many as are the members of the human body, so many are nowadays the various kinds of doctors and of medicines. Some are for the teeth, some are for the ears, some for sexual maladies, others are ordinary doctors, others cure cataracts, others ruptures and stone, some make new ears, lips, noses, and others remedy harelips.”

As, under the generic name of doctors, Cintio d’Amato also comprises surgeons, it results from the above passage that in his time, that is, in the seventeenth century, there were surgeons who dedicated themselves specially to the treatment of the teeth; there were, in fact, dentists; and even admitting that the greater number of these were no better than simple tooth-pullers, this cannot be true of them all indiscriminately. Cintio d’Amato’s book demonstrates in the most vivid manner that even among the barber and phlebotomist class, that is, among the practitioners of minor surgery, there were, at that time, men of considerable culture. This ought to hold good with still greater reason concerning surgeons, whose professional level was certainly superior to that of barbers; and as dentists belonged to the class of surgeons (whence the denomination still in use of “surgeon-dentist”), it is but natural to admit that besides the ignorant tooth-puller there were even then more or less cultured dentists well capable of treating dental diseases and performing dental operations within the limits permitted by the knowledge of the times.

The six chapters in which Cintio d’Amato speaks of matters referring to the teeth do not contain anything whatever of real importance; notwithstanding this, we will here refer to the beginning of Chapter XXXIX, treating “Of tartar and spots on the teeth,” because it is of some historical interest:

From an engraving of the Seventeenth Century.]

“It happens in general that owing to vapors that rise from the stomach, a certain deposit is formed on the teeth, which may be perceived by rubbing them with a rough cloth on waking. One ought, therefore, to rub and clean them every morning, for, if one is not aware of this, or considers it of little account, the teeth become discolored and covered with a thick tartar, which often causes them to decay and to fall out. It is then necessary that the diligent barber should remove the said tartar with the instruments destined for this purpose.”

We have seen that the practice of the dental art was for the most part in other hands than in the barber’s. Nevertheless, the important operation of the removal of tartar was also carried out by him. If, therefore, even the barbers, who were not in the least the true representatives of the dental art of that period, carried out such an important operation, it may logically be argued from this, in support of what we have said before, that the sphere of action of the true dental specialists of those times (especially of the best among them) was not at all so limited as imagined by those who affirm that in past times dentists properly so called did not exist, but only tooth-pullers.

The barbers, however, having become, in a certain manner, members of the medical class, sought to extend their sphere of action, and it is probable that in a later period than that of Tiberio Malfi and Cintio d’Amato they invaded the whole field of dental activity; for which reason, when the barber’s art came down to a very low level, the dental art must have degenerated, too, and have been represented for a certain time only by ignorant barbers and tooth-pullers. Vicissitudes similar to these have occurred in different epochs, not only in various parts of Italy, but also in other countries of Europe.

FLEURIMOND. In 1682 a little book on dental hygiene was published in Paris by a certain Fleurimond, the title of which was: Moyens de conserver les dents belles et bonnes. Portal, in his history of anatomy and surgery, makes mention of this pamphlet, and, briefly alluding to certain parts of it, he says: “The author proves by observation that acids act upon the enamel of the teeth. He makes some very just reflections upon dentition. Fleurimond speaks of a tooth powder invented by him, but does not say how compounded.”

In fact, it seems that this pamphlet was compiled from a commercial point of view, viz., that of making known the special tooth powder invented by the author. The era of advertisement had already begun!

ANTON NUCK (1650 to 1692), a Dutch surgeon and anatomist, who taught most ably in the University of Leyden, devoted great attention to dental surgery and prosthesis. Relative to the extraction of teeth, he says that, in order to be able to carry out this most important operation, an exact anatomical knowledge of the alveoli and of the teeth themselves is required. He insists on a principle of capital importance that has only had its full application in the nineteenth century, viz., that the instruments to be used for the extraction of teeth ought to vary according to the tooth to be extracted. For the removal of the incisors, he says, the “goat’s foot” should have the preference; the canines ought to be extracted with the common dental forceps, but sometimes, when they are decayed, they may be extracted with greater security with the pelican; for the small molars the straight-branched pelican is to be preferred, for the large molars the curved pelican; as to the extraction of roots or of splinters of bone, this ought to be carried out with the rostrum corvinum.

The author counsels never to extract teeth during pregnancy, except under circumstances of the greatest urgency, and especially to avoid the extracting of the upper canines (or eye teeth), this being capable of producing pernicious effect on the visual organs of the fetus!

The best way of obtaining the cessation of a violent toothache without having recourse to extraction is, according to the author, cauterization of the antitragus, an operation which he carried out with a special cauterizing instrument, made to pass through a small tube, the better to localize and to limit the action of the red-hot iron. With regard to this means of cure already recommended by other authors, we may remark that, although it seems ridiculous at first sight, and although no one could be so senseless as to make use of it in our days, nevertheless, for the times of which we are writing, when the curing of toothache was in a great measure effected by indirect means, this remedy might well stand on a level with many others, and was not perhaps altogether inefficacious. It is a sufficiently well-known physiological fact that the application of a strong stimulus in one part of the body may diminish or suppress a painful sensation in another part of the organism. It is an equally well-known fact that it is in no way a matter of indifference, in producing this phenomenon, to what part the stimulus be applied, especially because of the great difference existing in the relations of the several parts of the body with the brain—the centre of sensation. It is, therefore, very possible that the cauterization of the antitragus may really have the effect of causing strong toothache to cease, at least temporarily.

Nuck used a variety of remedies to arrest dental hemorrhage, such as tinder, burnt linen, vitriol, sulphuric acid and the cauterizing iron.

As to the use of the file, far from rejecting it entirely, as does Martin, he holds it necessary in many cases for planing down points and sharp edges of broken teeth, as well as for removing, at least in a measure, the inconvenience and deformed appearance caused by irregular teeth. He says the file may be used without causing the slightest harm, if one takes care not to approach the inner cavity of the tooth too nearly, and above all not to penetrate right to it, which would give rise to intolerable pain. Such an accident, he adds, may happen much more easily when, instead of using the file, whole pieces of teeth are removed with the excising forceps.

This author acquaints us with a tooth powder, much used in his time, especially by Parisian ladies. The ingredients were powdered cuttle fish, coral powder, cream of tartar, Armenian bole, and powder of red roses.

At that time artificial teeth were generally made of ivory; Nuck, however, observes that it soon becomes yellow by the action of food and drink, and of the saliva itself. He therefore recommends, instead, the use of hippopotamus’ tusks, giving the preference to the whitest. According to Nuck, artificial teeth made of hippopotamus’ tusks would be capable of preserving their color even for seventy years. In the case of all the teeth of the lower jaw being wanting, the entire dental arch ought to be framed in with a single piece of ivory or tusk of hippopotamus.

CARLO MUSITANO, a celebrated Neapolitan doctor (1635 to 1714). According to Carlo Musitano, the real cause of toothache consists in the irritant action of saline or acid particles on the extremely thin membrane that lines the alveoli or on the exquisitely sensitive nerves of the teeth. As he believes, these particles have an angular form, sometimes pointed or even hooked, and they reach the sensitive parts either directly from the outside, through the air, the food or drink (especially when the teeth are already decayed), or else through the blood and other humors, which often, by reason of their deteriorated quality, contain great quantities of such irritant particles.

Among the various influences which may be conducive to toothache, atmospheric conditions ought also to be included; thus, says the author, the inhabitants of the Baltic littorals, and other northern peoples, are very subject to toothache, for the reason that in those regions the air contains, in abundance, saline particles of various kinds which penetrate into the organism by the act of respiration. It is said, on the contrary, that in Egypt, where the air is remarkably mild, the teeth are not subject either to pain or to decay.

Musitano, too, believes in worms in the teeth, but does not admit, as preceding authors had done, that they generate spontaneously. He holds instead that they result from the eggs of flies and other insects, which, together with food, are introduced into the carious cavities and there develop by the heat of the mouth.

The treatment of toothache ought to differ according to its causes. If the pain be owing to acidity, one uses medicines adapted for tempering the acids; if it be owing to the action of saline substances, one has recourse to remedies which dissolve them; if to worms, to such remedies as destroy them, and so on. Purgatives and bleeding ought, however, never to be used as remedies against toothache; for, far from doing good, they often do harm. As to the other torments usually inflicted on poor sufferers, they are the punishment of their sins, for God often gives the unrighteous into the hands of doctors! (This language will perhaps appear less strange when the reader comes to know that Carlo Musitano was at one and the same time priest and physician!)

After a lengthy enumeration of medicaments to be used against toothache, which we pass over in silence because already known, the author speaks of two remedies which carry us back absolutely to the days of Pliny! He relates us a fact experienced by himself, that, by touching an aching tooth with the leg of a frog completely cleaned of the flesh, the pain ceases altogether. Also, if the aching tooth be touched with the root of a tooth extracted from the jaw of a corpse, the pain ceases, the tooth becomes as cold as ice, and often, after a certain time, it falls to pieces.

As to worms, the best mode of destroying them is by using bitter substances, such as myrrh, aloes, colocynth, centaurea minor, etc., but sometimes the use of sweet substances, such as honey, is a good means of drawing them out of the carious cavities!

Musitano also cites a great number of remedies against the setting on edge of the teeth. Among the best of these he mentions urine applied to the teeth whilst still warm! Alkali in general, and particularly lye, such as is used for washing purposes, are good remedies against the setting on edge of the teeth.

The treatment of loose teeth ought to vary according to whether this pathological condition depends on old age, or on scurvy, on syphilis, on superabundance of humors, etc. Sometimes, especially in old persons, it may be useful to bind the teeth with gold wire, in order to prevent their falling out, but this operation must be very ably performed, otherwise it may give rise to inflammation.

Relative to artificial teeth, Musitano says that they are made of ivory or hippopotamus tusks; of these last he does not speak as of a novelty; we may, therefore, deem it probable that hippopotamus tusks were used in Naples for making artificial teeth even before the Dutchman Anton Nuck (contemporary of Musitano) made mention of them in his writings.

In cases of difficult dentition, the best remedy, according to Musitano, for facilitating the eruption of the teeth consists in friction of the gums, once, or at most twice, with blood drawn fresh from the comb of a cock! If, however, even this remedy fails to produce the desired effect, it will then be necessary to lance the gum at the point where the tooth is to erupt, or to press it hard with the thumb, that the tooth may the easier come through.

The sole merit of this author (as to what concerns our specialty) consists in his having declared bleeding useless, or even harmful in the treatment of toothache, and, besides, in his having recommended, with great warmth and in most impressive terms, cleanliness of the teeth. What is more beautiful, says he, than a mouth furnished with white teeth, similar to so many pearls? And what is more abominable than black or livid teeth, covered with a fetid deposit or with tartar? Unclean teeth spoil the appearance of the person, and nauseate those who behold them.

WILLIAM COWPER (1666 to 1709). Toward the end of the seventeenth century the celebrated English doctor and anatomist, William Cowper, opened up a new field of action to oral surgery by inaugurating the rational treatment of the diseases of the maxillary sinus. In order to empty Highmore’s antrum of deposits and to be able to carry out the necessary irrigations, he extracted in most cases the first permanent molar, and then penetrated through its alveolus into the sinus with a pointed instrument.

JAMES DRAKE, also an Englishman and a contemporary of Cowper, operated in the same manner; and it was this author who made known in a book of his the operative method of Cowper; for which reason the above-mentioned proceeding is sometimes called “the Cowper-Drake operation.” A certain time elapsed, however, before it became generally known. Thus, in a book published by JOHANN HOFFMANN in 1713 there is no mention made of this operation, albeit the author refers therein to the case of a young girl, one of whose canine teeth having been extracted by him, there ensued a considerable flow of whitish pus from the maxillary sinus. In speaking of this case, Hoffmann stigmatizes many of the surgeons of his time who were not acquainted with the existence of Highmore’s antrum, and therefore, in cases of patients whose teeth had fallen out as an effect of syphilis, if they happened to penetrate with the sound into the maxillary sinus, believed this to be an accidental excavation of the bone, produced by caries.

However, the honor of having initiated the rational treatment of diseases of the maxillary sinus is not exclusively due to William Cowper and to James Drake; a large share is also due to the celebrated German physician and anatomist, Heinrich Meibom. The mucous membrane of the maxillary sinus was considered by him as the real point of departure of the diseases which occur in this cavity, it being liable to become inflamed and to suppurate, thus giving rise to much pain and to various accidents. Meibom rejects the operation of Molinetti, that is, the trepanning of the cavity from the front, the lesion produced in the soft parts of the face being likely to give rise to unpleasant consequences. “Some, he adds, try the introduction of medicated vapors into the antrum, but the best way is to open the maxillary sinus by extracting a tooth, as the pus generally makes its way as far as the roots of the teeth.” The author says that his father, who was also a physician, had already used the above method with success. He does not speak at all of the artificial opening of the antrum by perforation; but, as is well known, this is not necessary in many cases, so that, even now, the operation is sometimes reduced to procuring the opening of the sinus by the simple extraction of a tooth, as was, in fact, practised by Heinrich Meibom and his father.

Seeing that Heinrich Meibom was born twenty-eight years before William Cowper, and was already known to the scientific world when Cowper was still a child, it is very probable that his operative method, having come to the knowledge of the latter, was only followed up and perfected by him.

CHARLES ST. YVES (1667 to 1733), oculist in Paris, records an interesting case of a secondary affection of the maxillary sinus. The point of departure of the evil was an abscess in the orbit. The suppurative process, after having produced an erosion and the perforation of the orbital plane, had reached by propagation the antrum of Highmore, whence the pus took its way, issuing through the nose. St. Yves had a molar tooth extracted on the affected side (we do not know which side it was), after which, day by day, he made injections of detersive liquids through the orbital fistula, which returned constantly through the alveolus of the extracted tooth. By this means the cure of the patient was obtained.

CHRISTOPHER SCHELHAMMER (1649 to 1716), who was professor in various German universities, and distinguished himself specially as an anatomist and as an ear doctor, strongly recommends stopping decayed teeth as the best means of causing pain to cease. If, however, the stopping does not hold, by reason of the cavity being too extended, it is then necessary, says Schelhammer, to extract the tooth; this, however, may very well be stopped after extraction, and then replanted, for it will take root again, but no longer be the cause of any pain.

PIERRE DIONIS, a celebrated surgeon and anatomist of Paris (died 1718), in his Anatomie de l’homme, admits the possibility of a double dental series, holding the case, however, to be of very rare occurrence.

Another work of his, entitled Cours d’operations de Chirurgie, wherein he treats very extensively of diseases of the teeth and mouth, and their surgical cure, is of much more importance in relation to dentistry. He recognizes the high importance of this part of surgery, but expresses the opinion that one of the dental operations, that is the extraction of teeth, ought to be left entirely to the tooth-pullers, not only because they are, by reason of great practice, better qualified to perform it than general surgeons, but also because the output of force required for this tooth-pulling operation renders the hand heavy and tremulous, and, lastly, because, according to him, it always has something of charlatanism about it. (This is a luminous example of how preconceived ideas can influence the minds even of men of the greatest talent.)

Pierre Dionis, like many of the preceding authors, had frequently occasion to observe cases of epulis. He speaks at great length of the treatment of this affection, as well as of parulis, but says nothing on the subject of sufficient importance to be worth recording.

Dental operations, according to Dionis, are of seven kinds:

1. The opening of the dental arches in the case of spasmodic constriction of the jaws. This operation, of the greatest importance for nourishing and keeping patients alive, is carried out by means of a lever and of a screw dilator.

2. The cleaning of the teeth. For this, as for the other operations, says Dionis, a certain amount of skill is required. The author advises the use of gold instruments if one be called upon to clean the teeth of persons of rank. This appears rather strange in the present levelling times, but Pierre Dionis lived in the days of Louis XIV, whose doctor he was, that is, in a period of unbridled luxury, when the nobles and those in power would have nothing in common with the lower classes.

3. Operations for the preservation of the teeth. These, says Dionis, are of the greatest importance, it being necessary to oppose a barrier to the destructive processes of the teeth. Caries, when so situated as to permit of it, ought to be scraped away; for approximal caries one ought to have recourse to the file; in the case of caries of the triturating surfaces, cauterization should be used, by applying a drop of oil of vitriol with a miniature paint brush. Should the caries, however, be in a very advanced stage, it is better to make use of the cauterizing iron. But in cases of intense and persistent pain there is no other remedy than extraction.

4. Stopping of the carious cavity. Dionis does not enumerate this operation among those intended for the preservation of the teeth. At that period, this operation was performed solely with a view to preventing the penetration into and the retention within the carious cavity of alimentary substances, and the disadvantages caused thereby. The carious process, says the author, often ceases altogether, and the pain then generally ceases also. However, as the residual cavity often becomes troublesome in various ways, among others by making the breath offensive, it is better to stop it. For this purpose, gold or silver leaf is generally made use of; but this mode of stopping is not durable, because gold or silver in leaf is apt to become loosened and fall out. It is therefore preferable, says Dionis, to make a stopping with a piece of gold or silver corresponding in size and shape to the cavity. Many, he adds, prefer lead as a stopping, on account of its softness, whilst others simply use wax.

5. The use of the file. The indications given by Pierre Dionis for using the file do not differ from those we find in other authors. Dionis warns, however, against using the file to level down a tooth which has become lengthened through the loss of its antagonist, for after a certain time it would again project above the level of the others.

6. Extraction. This operation, says Dionis, ought not to be performed too lightly, but only in those cases in which it is really necessary; that is, when a tooth is the cause of insupportable pain and its crown is almost entirely worn away; when nothing remains of a tooth but its root; when a tooth is so loosened in its socket as to leave no hope of its again becoming firm; when supernumerary teeth or irregularly planted teeth give rise to inconvenience or deformity; and lastly, to remove deciduous teeth that have become loosened. The opinion that if the loosened milk teeth be not promptly extracted they cause the permanent teeth to grow irregularly, is, however, considered by Dionis to be a prejudice.

Dionis strongly doubts whether a tooth that has been extracted and replanted can really take root again, as had been affirmed by Dupont, Pomaret, and other authors. This shows that Dionis had had no experience on this point.

7. The application of artificial teeth. These teeth, says Dionis, are generally made of ivory, but may also be made of ox bone, which is less liable to turn yellow than ivory. He does not mention the use of hippopotamus tusks, but we learn from him that one Guillemeau made artificial teeth with a composition of his own invention, which was obtained by fusing together white wax and a small quantity of gum elemi, and then adding ground mastic, powder of white coral and of pearls. This fact is, as everyone can see, most important, for it constitutes the first step toward the manufacture and use of mineral teeth. Dionis tells us that the teeth made of Guillemeau’s composition never became yellow, and that it was also very good for stopping decayed teeth. It would seem, therefore, that it could be used as cement is now used.

The Guillemeau of whom Dionis speaks is probably Jacques Guillemeau, the author of a book now no longer to be found, which was translated from the French, first into Dutch, and afterward into German. Crowley, in his Dental Bibliography, only quotes the German edition, published at Dresden in 1710, the title of which runs thus: Der aufrichtige Augen und Zahnarzt.

JEAN VERDUC, also a Frenchman, relates a case of the surgeon Carmeline, analogous to that of Denis Pomaret, in which a sound tooth which had been extracted by mistake was immediately replanted and took root again, becoming quite firm. However, Verduc does not speak of replantation as a special method of cure, but merely refers to the above case incidentally in speaking of the extraction of teeth. He considers this operation a most dangerous one, and advises not having recourse to it except in cases of utmost necessity. Notwithstanding this, Verduc gives us to understand that teeth were drawn with sufficient ability by most of the operators of the time, and precisely because of this he omits describing the manner of performing the operation. According to Verduc, the drawing of teeth is often of little or no advantage against toothache. In proof of this assertion he relates the case of a hypochondriac, who little by little had as many as eighteen teeth extracted, without, however, getting the better or the wiser; but as this case does not prove anything at all, one is disposed to think that Verduc, in relating it, had the intention of being humorous.

MONSIEUR DE LAVAUGUYON. To another French surgeon, Monsieur de Lavauguyon, also a contemporary of Dionis, belongs the merit of having declared useless, in the greater number of cases, the practice, at that time general, of separating the gums from the tooth before proceeding to the extraction of the latter. He says that this is only necessary when a tooth, either because broken or because its crown emerges too little above the gum, offers an insufficient hold for the pelican.

Our historical survey has now reached the end of the seventeenth century. Embracing at a glance the whole of this last period of time, we remark, among many facts of minor importance, some events which, in the history of the development of dental art, stand out in strong relief. Such are the replantation of teeth used as a special curative method by Dupont and others; the method of plugging in cases of alveolar hemorrhage, the credit of which is due to Rivière and to Tulpius; the description of the maxillary sinus given by Highmore; the rational treatment of affections of the antrum, inaugurated by Meibom, Cowper, and Drake; the researches into the microscopic structure of the teeth, brilliantly initiated by Leeuwenhoek, who discovered the dentinal tubuli; the use of models introduced by Purmann into the workmanship of prosthetic pieces; the employment of hippopotamus’ tusks in making artificial teeth, first recommended by Nuck; and the invention of Guillemeau, which was the first step toward the use of mineral teeth.