Transcriber’s note: No major corrections have been made in the text, except a few to have consistency in spelling and hyphenations. Captions have been added to the portraits of dentists for clarity.
The book cover image was created by the transcriber and is placed in the public domain.

PUBLISHED UNDER THE AUSPICES OF

THE NATIONAL DENTAL ASSOCIATION OF THE UNITED STATES OF AMERICA

A
History of Dentistry

FROM THE MOST ANCIENT TIMES
UNTIL THE END OF THE
EIGHTEENTH CENTURY

BY
Dr. VINCENZO GUERINI, Cav. Uff.

SURGEON-DENTIST, NAPLES, ITALY; DENTIST BY APPOINTMENT TO THE ROYAL HOUSE; DENTIST OF THE
SURGICAL CLINIC OF THE UNIVERSITY OF NAPLES; EDITOR OF THE ITALIAN REVIEW
L’ODONTO-STOMATOLOGIA; AUTHOR OF MANY ODONTOLOGICAL WORKS;
HONORARY PRESIDENT AD VITAM OF THE ITALIAN ODONTOLOGICAL SOCIETY; MEMBER OF THE ITALIAN SOCIETY
OF SCIENTISTS, LITERARY MEN, AND ARTISTS; OFFICER OF THE ORDER OF THE CROWN OF ITALY; DOCTOR
OF DENTAL SURGERY AD HONOREM OF THE CHICAGO COLLEGE OF DENTAL SURGERY; HONORARY
MEMBER OF THE NATIONAL DENTAL ASSOCIATION, U.S.A.; MEMBER OF THE EXECUTIVE
COUNCIL OF THE FEDERATION DENTAIRE INTERNATIONALE; TITULAR MEMBER
OF THE SOCIETY OF THE PARIS DENTAL SCHOOL AND DISPENSARY;
HONORARY MEMBER OF THE ODONTOLOGICAL
SOCIETY OF MALAGA, ETC.

With 104 Engravings and 20 Plates

LEA & FEBIGER
PHILADELPHIA AND NEW YORK
1909

Copyright, 1909
by the
National Dental Association of the
United States of America

PREFACE.

The idea of writing a History of Dentistry first suggested itself to me ten years ago, when I was charged by the Organizing Committee of the Eleventh International Congress of Medicine with the reproduction and description of all the appliances of ancient dental prosthesis existing in the museums of Italy.

The highly interesting researches in which I then became engaged in order to carry out worthily the important mission intrusted to me, awoke in me the desire to gain still further acquaintance with all that relates to dental art in the time of the ancients. I was thus urged on to ever fresh efforts, not only in the discovery of prosthetic appliances and other objects of ancient dentistry, but in the study, as well, of dental literature and of all the written matter that might throw light on dentistry in past ages.

This subject has already occupied many before me, and each one has brought to it his contribution of greater or less value, some in the form of short pamphlets, others in that of larger works.

The end I proposed to myself was to write a History of Dentistry which should be much more complete, more circumstantial, and more exact than those published hitherto, and which, instead of being, as are many of these works, simply a compilation, should represent, at least in part, the fruits of personal research and scrupulous examination of a vast number of works of various kinds containing elements utilizable for the purpose.

The first part of my work, which I now offer to the public, comprises the remote origin of Dentistry and its development throughout the ages as far as the end of the eighteenth century. In a short time I hope to publish the second part of it, viz., the History of Dentistry during the last hundred years.

I have carefully collected the greatest possible number of historical data, keeping in view the consideration that some facts, although of little value in themselves, may possess a certain importance for the student desirous of procuring historical information relating to some particular point of dental science.

If this book should, as I hope it may, contribute to the diffusion of exact historical knowledge as to the origin and gradual development of dentistry, my labor will not have been lost, for it will have realized the object, a highly practical one, which has guided me in writing it.

Vincenzo Guerini.

CONTENTS.

INTRODUCTION.

Every dentist who has ever given any thought to the development of his profession must have realized the growing necessity for an accessible and authoritative history of the dental art. The early efforts in this direction by Duval, Fitch, Carabelli, Snell, Linderer, Harris, and others, followed in this country by the more recent essays of Perine, Dexter, and Cigrand, are out of print and difficult to obtain. The Geschichte der Zahnheilkunde, by Geist-Jacobi, and Notice sur l’Histoire de l’Art Dentaire, by Lemerle, have given to the practitioners of Germany and France valuable information which the English-speaking dentist has often sadly lacked.

Realizing this situation, at the first meeting of the National Dental Association, the late Dr. R. Finley Hunt offered the resolution: “That a Committee of Three be appointed by the President to report at the next annual meeting a measure looking to the preparation of a full history of the Dental Profession.” After a careful consideration of the subject, this committee reluctantly concluded that, “whereas a complete history of dentistry may some day be the result of the effort now being made, this Association must confine its first attempts to the history of dentistry in America.” In a letter to the committee the late Dr. W. D. Miller said: “Of course, a universal history of dentistry would be very interesting and valuable, but its compilation would naturally cost an immense amount of labor.” Aside from this, it did not seem possible that the data for a proper history of the early development of the dental art in Africa and Europe could be collected by an association working in America.

After several years of what may have seemed a policy of masterly inactivity the unexpected happened, and the committee was able to report at the Buffalo meeting of the Association that Dr. Vincenzo Guerini, of Naples, Italy, had written a history of dentistry from the earliest times to the beginning of the nineteenth century, and that this work, translated into English and fully revised, had been generously placed in the hands of the committee for publication under the auspices of the National Dental Association, in token of the distinguished author’s appreciation of American dental development.

The Association, deeply sensible of this high compliment, and fully realizing this opportunity for accomplishing a purpose which had hitherto seemed impossible, gladly arranged for the publication of the book. After the delay incidental to the production of a work of this character, and the necessary subscribers being obtained, this exhaustive history of early dentistry, by the greatest authority on that subject in the world, is presented for the serious consideration of the thoughtful and studious members of the profession.

Dr. Guerini has spent many years of his professional life and large amounts of money in collecting the material for this work. Our historical records are scattered through a vast literature, and much of it is of great antiquity, and it has never before been gathered together and arranged in such a consecutive, logical order.

The importance and value of dental art and science as a humane service are well recognized, but we are so accustomed to view the question from the modern standpoint that we, generally speaking, overlook the immense work done by our predecessors reaching far back in unbroken line to the mists of antiquity. It was they who laid the foundations upon which modern dentistry has been built, and no man can peruse the record of their efforts as set forth in Dr. Guerini’s book without developing a higher appreciation of their work and a keener realization of the worth and dignity of the calling which they in common with ourselves followed.

It has been deemed wise to make a few amendments and commentaries, and when that has been done the amendment has in each case been inserted as a foot-note and designated by the initials of the commentator.

The supervision of the work while passing through the press and the correction of proofs have been entrusted to Dr. Edward C. Kirk, of the Committee; the index has been prepared by the chairman.

Charles McManus, D.D.S.,
Chairman of Committee on History of Dentistry,
National Dental Association, U. S. A.

A HISTORY OF DENTISTRY.

PART I.
FIRST PERIOD—ANTIQUITY.

INTRODUCTION.

The first beginnings of dental art were undoubtedly the same as those of general medicine, for it is evident that in primitive times, when the healing art was still in its rudimentary stage, no divisions could have existed in it.

Scientific medicine, whose most ancient representative is Hippocrates, was preceded for the course of many centuries by sacerdotal medicine and by popular medicine.

Necessity, instinct, and even mere chance must have taught primitive man some simple curative practices, in the same manner that they taught him gradually to prepare his food and to satisfy the other wants of life. It was in this way that popular medicine, which is found without exception among all races and is perhaps as ancient as man himself, had its earliest beginning.

As regards sacerdotal medicine, it was principally derived from the false ideas prevalent among primitive peoples about the causes of maladies. When, for example, an individual in full health was seized with sudden illness, no one could imagine, in those times of profound ignorance, that this happened in a natural manner; the fact was therefore attributed to a supernatural cause, that is, to his having been stricken by the wrath of some divinity. In this state of things it was believed to be absolutely necessary to propitiate the inimical or vengeful divinity, so that the patient might be restored to health. It was, therefore, very natural that the intervention of sacerdotal aid should be sought, that is, of the supposed intermediaries between human beings and the gods. The priests, on their side, were ready to occupy themselves with such cases, for their services were always well recompensed, and, added to this, if the patient recovered, the respect and veneration of the people for the sacerdotal caste was considerably increased, whilst if he did not, this simply meant that he or his family was not worthy of receiving the desired pardon, or that, anyhow, the Divinity, for good reasons of his own, would not grant it.

However, it being to the interest of the priests to obtain the greatest possible number of cures, they did not limit themselves merely to offering up prayers and sacrifices and to imposing on the patients the purification of themselves and other religious exercises; they also put into practice—always to the accompaniment of ritualistic words and ceremonies—the means of cure which their own experience and that of others suggested to them. The art of healing the sick was transmitted from generation to generation in the sacerdotal caste, acquiring an ever greater development and complexity in proportion to the making of new observations and fresh experiences. It is to be understood that in this manner the priests became more and more skilful in the treatment of disease; they were really the doctors of those times, albeit their curative practices were mixed up with an ample dose of imposture. This, at least in many cases, must have had, besides, the advantage of acting favorably on the patients by means of suggestion.

We learn from Herodotus that the Babylonians used to carry the sick into the public squares; the passers-by were expected to make inquiries as to their illnesses, and if it so happened that they or any of their acquaintances had been similarly afflicted, to come to the aid of the patient by offering their advice and making known the means of treatment that had effected recovery, exhorting him, at the same time, to have recourse to them.

This usage had without doubt its advantages, as it must have led, little by little, to the recognition of such remedies as were most efficacious, among all those recommended, against the various maladies.

Another custom that served to furnish useful elements for the development of the art of medicine was that of the votive tables, hung in the temples by patients after their recovery, in sign of gratitude for having received the invoked blessings. These tables contained a brief description of the malady and of the treatment that had proved useful in dispelling it. If we reflect that dental affections are often of long duration and very tormenting, the thought naturally suggests itself that among the votive tables not a few must have referred to maladies of the teeth.

The numberless cases recorded by votive tables afforded precious clinical material, which without doubt was utilized in a great measure by the priests in compiling the earliest medical writings, and, as we shall see later, Hippocrates himself stored up all the medical records existing in the celebrated temple of Cos.

Introduction of Ebers’ Papyrus, transcribed in Egyptian hieroglyphic characters.

CHAPTER I.
DENTAL ART AMONG THE EGYPTIANS.

Among the people of ancient times, the Egyptian nation was, without doubt, the one in which civilization first took its rise and had its earliest development. From the time of Menes, first King of Egypt (3892 B.C.), the inhabitants of the valley of the Nile were well advanced on the path of civilization, and under the fourth dynasty, dating from 3427 years before the Christian era, they had already attained a high degree of progress.

Medical art and science in every country have always progressed in proportion to the general civilization, for the treatment of disease is one of the first and most important manifestations of civilized life. It is therefore natural that the healing art should have flourished earlier in Egypt than elsewhere, that is, in the midst of the oldest civilized people.

There, as in other countries, medicine was practised for some time only by the sacerdotal caste; but not all the members of this caste were doctors and priests at one and the same time; there was a special class among them, called “pastophori,” whose mission it was to cure the sick.

Our knowledge of medicine as practised among the Egyptians of old is now no longer limited to the scanty notices handed down to us by Greek and Roman writers. The researches made by students of Egyptian lore have placed original medical writings in our hands, now already partly interpreted, that permit us to form a sufficiently exact idea of the science of Medicine in ancient Egypt.

These valuable documents, denominated papyri, from the material on which they are written, now exist in great numbers in the Berlin Museum, in the British Museum, and in those of Leyden, Turin, Paris, and other cities; but the most important of the papyri treating of medical subjects is certainly the papyrus of Ebers, in the library of the Leipzig University.[1] This very valuable papyrus—the most ancient of all known works on Medicine—is the best written of all the Egyptian medical papyri, and is also the best preserved and most voluminous. In size it is 30 centimeters high, 20 meters long, and the whole text is divided into 108 sections or pages, each one of about 20 to 22 lines. The celebrated Egyptian scholar, Prof. George Ebers, procured it, toward the beginning of the year 1873, from an inhabitant of Luxor, in Upper Egypt. He published a beautiful edition of it two years later in Leipzig; and in 1890 Dr. Heinrich Joachim published a German translation of the whole papyrus, with an introduction and explanatory notes.

The Ebers’ papyrus is written in hieratic characters. We here reproduce some passages of it, so as to give our readers an idea of the style of writing.[2]

Lepsius and with him the greater part of Egyptologists are of opinion that the Ebers’ papyrus is not an original work at all, but simply a copy of medical writings of still earlier date, belonging to different epochs, and which were collected and reunited to form a kind of manual on medicine.

Fig. 1

Part of Ebers’ papyrus in Egyptian hieratic characters containing three dental prescriptions..

From some indications existing in the papyrus itself, Ebers has been able to argue, with quasi certainty, that the papyrus was written toward the year 1550 B.C. But some parts of it have their origin in a far more remote epoch; they go back, that is, to thirty-seven centuries or more before the Christian era. In fact, at page ciii of the Ebers’ papyrus[3] one reads:

“Beginning of the book about the treatment of the uxedu in all the members of a person, such as was found in a writing under the feet of the God Anubis, in the city of Letopolis; it was brought to His Majesty Usaphais, King of Upper and Lower Egypt.” Now, as Joachim remarks, the Usaphais herein named was the fifth king of the first Egyptian dynasty, and he reigned toward 3700 before the Christian era. Hence, it may be argued that some, at least, of the writings from which the Ebers’ papyrus was taken were composed in the very remote epoch to which we have just alluded, or perhaps still farther, for it is impossible to know whether the book, deposited by unknown hands at the foot of the statue of the God Anubis, had been written but a short time previous or at a much earlier epoch.

Fig. 2

Part of Ebers’ papyrus in Egyptian hieratic characters containing eleven dental prescriptions.

Dental and gingival maladies are in no way neglected in the Ebers’ papyrus. At page 72, a remedy is prescribed “against the throbbing of the bennut blister in the teeth,” then two other remedies “to cure the bennut blisters in the teeth and to strengthen the flesh (gum).”

It is somewhat difficult to say what is meant by bennut blisters; but perhaps it means small, gingival abscesses of dental origin. The first of the above remedies—probably meant to calm the pricking or throbbing pain that, in such cases, often accompanies the dental malady—consisted of:

The other two remedies, very likely intended for the cure of dental fistulæ, were to be used as masticatories. The first consists of:

The other was still more complicated and thus compounded:

At page 89 of the papyrus[4] we find two other remedies, having the same object, that is, “to cure the bennut blisters in the teeth and to strengthen the flesh.”

The first is compounded in this way:

This is the second receipt:

In this same page 89 many other remedies corresponding to various indications are prescribed.

The following is another remedy for the same purpose:

Next comes a remedy “to cure the growth of uxedu in the teeth,” that is:

The word uxedu recurs more than thirty-five times in the Ebers’ papyrus, in relation to affections of the most different parts of the body. By confronting all the passages of the papyrus in which one finds the word uxedu, Joachim deduces that it does not indicate any special disease, but has the general signification of “a painful swelling.” According to Geist-Jacobi, by “growth of the uxedu in the teeth” may be understood an alveolar abscess and the consequent swelling of the surrounding parts.

Another remedy is intended for “the cure of the tooth that gnaws unto the upper part of the flesh.”

The translator of the papyrus remarks that by the “upper part of the flesh” is to be understood the gum. The remedy would, therefore, correspond to the indication of curing a tooth “that gnaws or gives pain unto the gum.” But as one sees, even putting it in these words, the meaning is anything but clear. Perhaps the destructive action of the carious process, reaching as far as the gum, is what is here meant to be alluded to. Meanwhile here is the receipt:

Besides the remedies already given, the two following are prescribed for strengthening the teeth:

The other is compounded of:

We next find a formula, preceded by this very vague indication: “Chewing remedy for curing the teeth.”

Another masticatory is intended to “strengthen and cure the teeth,” and is compounded thus:

Finally, we have a medicament “for curing the gnawing of the blood in the tooth.” It is complicated enough, being compounded with:

But what meaning is to be attributed to the “gnawing of the blood in the tooth?”

It is almost certain that this figurative expression referred to the pain deriving from caries and pulpitis. It may have had its origin in the observation of two phenomena, that is, first of all, the pulsating character which the pain alluded to often assumes, and the eventual issuing of blood from the cavity of a tooth affected by caries and pulpitis, when the pulp is exposed. At any rate, the Egyptian doctors of remotest antiquity undoubtedly did not ignore the presence of blood in the interior of the tooth.

From what we have related, it clearly appears that at that remote epoch many remedies were already in use for combating dental affections. These must consequently have been frequent enough, which demonstrates the erroneousness of the opinion held by some, who affirm, as does Mummery,[6] that in ancient times diseases of the teeth were extremely rare.

Besides this, it is fully evident, from the Ebers’ papyrus, that at the time in which this was written, dental pathology and therapy were still in a very primitive condition, and formed a part of general medicine, from which they showed as yet no tendency to separate; so true is this, that the remedies intended for the treatment of the teeth do not constitute a special section of the work, but are to be found among medicaments of an altogether different nature. Thus, at page lxxii of the papyrus[7] we find, first, three remedies against the itch; then five remedies for the cure of pustules in various parts of the body; next an ointment and a potion for the bennut blisters in whatever part of the body they may occur; after this, three medicaments against the bennut blisters of the teeth; and lastly, a plaster for curing crusts and itching in whatsoever part of the body.

One finds no mention of dental surgery in the Ebers’ papyrus. No conclusions could be drawn from this fact if the work only spoke of medical treatment, for then it might reasonably be supposed that the compiler had purposely occupied himself with this subject only; but, on the contrary, the Ebers’ papyrus frequently makes mention of operative interventions, and among these, of the use of the knife and of the red-hot iron for the treatment of abscesses and of certain tumors. Therefore, there being no mention made in the papyrus of any dental operation, not even of extraction, gives us reason to suspect that at that remote epoch no surgical operation was carried out on the teeth, and that, as yet, no instruments existed for practising extraction.

In the time of the celebrated historian Herodotus, of Halicarnassus, who lived in the fifth century previous to the Christian era (about from 500 to 424 B.C.), that is, more than a thousand years after the time in which the Ebers’ papyrus was written, the dental art in Egypt had made remarkable progress, and was exercised by specialists. In fact, in the second book of Herodotus we find the following passage: “The exercise of medicine is regulated and divided amongst the Egyptians in such a manner that special doctors are deputed to the curing of every kind of infirmity; and no doctor would ever lend himself to the treatment of different maladies. Thus, Egypt is quite full of doctors: those for the eyes; those for the head; some for the teeth; others for the belly; or for occult maladies.”[8]

Having here had occasion to refer to the History of Herodotus, we will quote two passages of this famous work, which have a certain interest for our subject;

“Whilst the tyrant Hippias, after having been driven out of Athens (510 B.C.), was marching against Greece at the head of the Persian army and had already arrived at Marathon, he happened one day to sneeze and to cough in a more vehement manner than usual; and he being already an old man, and his teeth all shaking, a violent fit of coughing suddenly drove one of them out of his mouth, and it having fallen into the dust, Hippias set to work, with great diligence, to search for it; but the tooth not coming to light, he drew a long sigh, and then said, turning to those who were standing by: ‘This land is not ours, neither shall we ever be able to have it in our power; what clings to my tooth is all of it that will ever belong to me.’”[9]

In another part of the History, that is, in the ninth book, Herodotus recounts as follows:

“When the corpses buried after the battle of Platea were already despoiled of their flesh, a curious fact was seen; for the people of Platea having collected the bones of those who had perished, there was found amongst them a skull altogether devoid of commissures, and composed of one single bone. A jaw was also found, the teeth of which, comprising the molars, appeared to be made all of one piece, as though composed of a single bone.”

Relative to this last passage of Herodotus, we may remark, as does Stark, that the total synostosis of the skull bones is certainly very rare, but that, nevertheless, one has authentic examples of the same, not only in ancient but also in relatively modern times, witness the famous skull of Albrecht von Brandenburg, surnamed the German Achilles, who died in 1486, and was buried in the monastery of Heilbronn. As to teeth united together and forming a single piece, no example exists save in very ancient authors, for instance, in Valerius Maximus, who recounts a similar marvellous fact of Prusia, King of Bithynia, and in Plutarch, who attests to a similar fact in the person of Pyrrhus, King of Epirus.

It is very difficult to establish within what limits the activity of the dentists alluded to by Herodotus was displayed. It has been affirmed by some that dental art in ancient Egypt was very far advanced, and that not only the application of artificial teeth, and even of pivot teeth, but also stoppings, were practised by the Egyptian dentists of those days. Here are some data on this subject:

Joseph Linderer[10] tells us that, according to Belzoni[11] and others, artificial teeth made of wood and very roughly fashioned have been found in Egyptian sarcophagi.

George H. Perine, a dentist of New York, in an article on the history of dentistry,[12] says: “Both filled and artificial teeth have been found in the mouths of mummies, the cavities in the former stopped with gold and in some cases with gilded wood. Whether these fillings were inserted during life for the purpose of preserving the teeth, or after death for ornamentation, it is, of course, impossible to say. That the Egyptians were exceedingly fond of embellishing their persons with gold ornaments and bright colored materials is a fact which has been clearly established, and the discovery of mummies—of exalted personages no doubt—some organs of which were gilded and embellished with showy colors proves that their fondness for display accompanied them even to the grave.” To this may be added, that after an embalmment of the highest class[13] it was usual to gild the eyebrows, the point of the nose, the lips, and the teeth of the corpse, and place a gold coin between the teeth, or cover over the tongue with a thin gold plate.

Dr. J. G. Van Marter, a dentist in Rome, in an article on prehistoric dentistry,[14] writes, among other things, that the renowned archæologist, Mr. Forbes, had seen mummies’ teeth stopped with gold.

The great defect of all the assertions referred to is that of not being accompanied by any element of proof, wherewith to demonstrate their truth. When, for example, we are told that Mr. Purland possesses, in his collection of antiquities, a tooth pivoted on to the root of a mummy’s tooth, the question suggests itself naturally: If this tooth is, as it appears, separated from the jaw of the mummy to which it is said to have belonged, how can we be certain that the tooth itself is really that of a mummy? Until sufficient proof of this be furnished, we cannot but consider the above assertion as absolutely without value.[15]

The same may be said as to the assertions of Wilkinson and Forbes with regard to mummies’ teeth stopped with gold. Where and by whom were these mummies found? And where are they preserved? Was the stopping, too, verified at the time of the finding of the mummy, in such a manner as to exclude all possibility of fraud, or was it discovered afterward, in circumstances such as to suggest the possibility of a mistification? It has, in fact, been reported[16] that the pretended Egyptian stopping in a mummy existing in an English museum was nothing else than a practical joke, carried out, besides, in a very awkward manner.

In opposition to the above assertions, we have the most absolute contradictory statements on the part of the most competent authorities.

The celebrated Egyptologist, Prof. George Ebers, has only been able, in spite of the most accurate research, to arrive at completely negative results in all that has reference to the dental art of the ancient Egyptians.[17]

The distinguished craniologist Prof. Emil Schmidt, of Leipzig, who owns a collection of several hundred mummies’ skulls, writes thus on the question now before us: “In no jaw have I ever found anything that could be attributed to the work of dentists: no fillings, no filing or trepanning of teeth, no prosthesis.”[18] Virchow, who also examined a great many Egyptian skulls, among which were several belonging to royal mummies, did not find any indications of dentists’ work;[19] and Mummery, as well, although he made the most conscientious researches on this subject, could not arrive at any positive results whatever.[20]

Between the affirmations of some and the negations of others, it is very difficult to say on which side the truth lies. For my own part, I fail to find that there is the least proof of the ancient Egyptians having known how to insert gold fillings and still less to apply pivot teeth. But at the same time I think it cannot be doubted that the Egyptian dentists knew how to apply artificial teeth. And even though it may not be possible to demonstrate this by direct proof, one is equally prone to admit it when one considers, on the one hand, the remarkable ability of the ancient Egyptians in all plastic arts, and, on the other hand, the great importance they attributed to the beautifying of the human body; so much so, that even in so ancient a document as the Ebers papyrus, one finds formulæ for medicaments against baldness, for lotions for the hair, and other kinds of cosmetics. Is it likely, therefore, that so refined and ingenious a people should not have found the means of remedying the deformity resulting from the loss of one or more front teeth?

Fortunately, however, we are not bound to content ourselves with simple suppositions, for a well-authenticated archæological discovery made in the month of May, 1862, has put us in possession of an irrefutable proof.

The discovery to which we allude is registered in Renan’s Mission de Phénicie, and was the result of researches made in the necropolis of Saida (the ancient Sidon) by Dr. Gaillardot, Renan’s colleague in his important scientific mission. In a grave in one of the most ancient parts of the necropolis, Dr. Gaillardot found, in the midst of the sand that filled the grave, a quantity of small objects, among which were two copper coins, an iron ring, a vase of most graceful outline, a scarab, twelve very small statuettes of majolica representing Egyptian divinities, which probably formed a necklace, to judge by the holes bored in them. But among the objects found (which, together with that we are about to mention, are now in the Louvre at Paris), the most important of all is “a part of the upper jaw of a woman, with the two canines and the four incisors united together with gold wire;[21] two of the incisors would appear to have belonged to another individual, and to have been applied as substitutes for lost teeth. This piece, discovered in one of the most ancient tombs of the necropolis, proves that dental art in Sidon was sufficiently advanced.”[22]

Fig. 3

Phœnician appliance found at Sidon, as represented in a cut of Renan’s Mission de Phénicie.

To these words, literally translated from Renan’s work, we will only add the following considerations:

Egypt was, in its time, a great centre of civilization, whose influence was strongly predominant in all the neighboring region, and especially in ancient Phœnicia and in its large and industrious cities Tyre and Sidon. The remains discovered in many of the Phœnician tombs would of themselves alone be sufficient to demonstrate luminously the enormous influence exercised by the Egyptian civilization on the life and customs of that people. Now, if there were dentists in Sidon capable of applying false teeth, it may reasonably be admitted that the dentists of the great Egyptian metropoli Thebes and Memphis were able to do as much and more, the level of civilization being without doubt higher there than in Tyre or in Sidon, or in other non-Egyptian cities.

CHAPTER II.
THE HEBREWS.

In the Hebrew literature, as principally represented by the Bible and by the Talmud, there does not exist any book on medicine. Notwithstanding the vicinity and the close relations of the Hebrews with Egypt, medical science never reached the degree of development among this people that it did in the land of the Pharaohs.

In the Bible we do not find the least trace of dental medicine or dental surgery. Indeed, although the books of Moses contain a great number of exceedingly wise hygienic precepts, there are not any that refer directly to the teeth or to the mouth. We may therefore conclude, with a certain degree of probability, that the Hebrews had in general good teeth and that dental affections were very rare among them.

The word tooth or teeth occurs in the Bible more than fifty times,[23] but very few of the passages in which it is to be met with present any interest so far as our subject is concerned.

That the Hebrews attached great importance to the integrity of the dental apparatus is plainly seen from the following verses of the book of Exodus (xxi: 23 to 27):

23. ... thou shalt give life for life,

24. Eye for eye, tooth for tooth, hand for hand, foot for foot,

25. Burning for burning, wound for wound, stripe for stripe.

26. And if a man smite the eye of his servant, or the eye of his maid, that it perish; he shall let him go free for his eye’s sake.

27. And if he smite out his manservant’s tooth or his maidservant’s tooth; he shall let him go free for his tooth’s sake.

These legislative measures show clearly enough that among the Hebrews the loss of a tooth was considered a lesion of great gravity, as they thought it of sufficient importance to be named in the same category as the loss of an eye, of a hand, or of a foot. If anyone caused the loss of an eye or of a tooth to his servant, the punishment was the same in both cases; that is, he was obliged to give him his liberty, thus undergoing the loss of his purchase money.

Beauty and whiteness of the teeth were also in great repute. Thus we read in the Song of Solomon (iv: 2):

“Thy teeth are like a flock of sheep that are even shorn, which came up from the washing; whereof every one bear twins, and none is barren among them.”

In another part of the Song (vi: 6) he repeats these same words, thus giving it to be understood how great was his admiration for the beautiful teeth of his beloved.

From various passages of the Bible, one perceives that integrity and soundness of the teeth was considered a prime element of force and vigor. In Psalm iii: 7 David says: “Arise, O Lord; save me, O my God: for thou hast smitten all mine enemies upon the cheek bone; thou hast broken the teeth of the ungodly.” (That is, reduced them to impotence.) And in Psalm viii: 6 we read: “Break their teeth, O God, in their mouth.”

On the other hand, in one of the Proverbs of Solomon (xxv: 19), broken or decayed teeth are taken to symbolize weakness: “Confidence in an unfaithful man in time of trouble is like a broken tooth, and a foot out of joint.” (In the Latin translation, instead of “broken tooth” stands “dens putridus.” Perhaps the corresponding expression in the Hebrew language, signifies in a general sense a decayed or injured tooth.)

The uncomfortable sensation produced on the teeth by acid substances (teeth on edge) is to be found several times alluded to in the Bible. In the Book of Proverbs (x: 26), one reads: “As vinegar to the teeth, and as smoke to the eyes, so is the sluggard to them that send him.” And Jeremiah says (xxxi: 29, 30): “In those days they shall say no more, The fathers have eaten a sour grape, and the children’s teeth are set on edge. But every one shall die for his own iniquity; every man that eateth the sour grape, his teeth shall be set on edge.”

As is apparent, there is nothing in the passages quoted that can be in any way connected with the treatment of dental affections; neither is it to be wondered at, when one reflects that even in the Talmud—which is much less ancient—medicine in general is hardly at all spoken of. This famous code as to practical life is almost silent with regard to therapeutic medicine, and only recommends hygienic practices. An axiom of the Rabbi Banaah is worthy of note, and may be quoted here as bearing on the subject, and also because many Christians might be found to conform willingly thereto:

“Wine is the best of all remedies; and it is in places where wine is wanting that one is in need of pharmaceutic remedies.”[24]

CHAPTER III.
DENTISTRY AMONG THE CHINESE.

For above 4000 years science and religion among the Chinese, as well as their customs, have remained quite unchanged. The inhabitants of the Celestial Empire can vaunt a most ancient civilization; which is, however, altogether stationary; neither has their medicine made any progress, and its actual state represents with sufficient exactness what it was in primitive ages.

In Europe, various works have been written about the medicine of the Chinese, one of the best being that of Dabry,[25] taken from the most celebrated medical books of China,[26] and which may be considered as a compendium of the medical science of this people.

In this work we find two chapters relating to our specialty: the first of these (p. 286) speaks of toothache, the second (p. 292) treats of all the other dental and gingival diseases.

The Chinese call the toothache ya-tong, and distinguish a great many varieties of the malady, that is:

1. Fong-je-tong. This kind of toothache is caused by sudden cold, and has the following characteristic symptoms: Red and swollen gums, which after a little time discharge purulent and fetid mucus; abundant salivation; acute pain; swelling of the cheek. It is to be cured with draughts, mouth washes, and various kinds of frictions.

We consider it useless to give the particulars of the various receipts, because Dabry hardly ever translates the names of the drugs of which they are compounded. These formulæ are therefore incomprehensible by most people.

2. Fong-lan-tong. This kind of toothache is also caused by cold. The pain is very great, but the gums are neither red nor swollen.

3. Ye-tong. Is also produced by chill. The gums are red and swollen; there is no discharge of mucus; great pain, which is aggravated by cold liquids. If the malady lasts for some time, the gums end by becoming black, and the teeth are loosened; the pain becomes more intense in spitting. In this stage of the malady the sufferer no longer fears cold drinks, but rather desires them, to soothe the pain. The cure varies according to whether the malady be of recent or of old date; it consists in the use of internal remedies (pills, potions), or of frictions on the part where the pain is situated.

4. Han-tong. This is also owing to the action of the cold. Pains in the cheek and forehead proceeding from the teeth; no diseased condition either of the gums or of the alveoli.

5. Tou-tan-tong. Violent cough and toothache at the same time; difficulty in masticating.

6. Yn-hiue-tong. The gums are pale, or violet-red, hard and lumpy, sometimes bleeding; the toothache is continuous. Among the numerous remedies recommended against this malady (mouth washes, frictions, draughts, pills), one particularly deserves mention: it is the urine of a child used as a mouth wash.

7. Tchong-che-tong. Pain in the teeth after mastication; there is also sometimes excoriation of the gums; flow of purulent mucus mixed with blood; bad-smelling breath; the tooth falls; it is decayed, and one can perfectly well distinguish a small hole; the root is unsound; in extracting the tooth one sometimes brings away together with it a little white worm, with a black spot on the head, which can be distinguished by the aid of a magnifying glass. A remedy must immediately be administered to destroy these worms, otherwise the patient runs the risk of having his other teeth attacked in the same manner, and of their falling out. The remedies against this affection are most numerous, and belong for the most part to the oftentimes cited categories. One of them presents a certain interest, its basis being arsenic.

In Dabry’s book it is described in the following manner: “Arsenic (gr. 1.80), houang-tan (gr. 3.60); pulverize, mix with water, and with a part of the mass form a small pill, which put close to the aching tooth or into the ear, if afraid of the arsenic; then sleep. Cure certain.”

8. Toothache, the effect of general weakness, following principally on abuse of coition. It is to be cured by the use of internal medicine, or by local remedies to be rubbed on the painful spot. Some of the medicaments registered in this paragraph have reference to the special case, in which the teeth are loosened through excess of coition. Among others there is a prescription for a dentifrice powder for strengthening the teeth, to be used every morning.

9. Toothache following on a blow. It is to be cured by using a certain dentifrice powder, composed of six ingredients. Another medicament consists in heating about an ounce and one-half of silver in some recipient, and then pouring wine upon it, and rinsing the mouth with it.

Besides these nine kinds of toothache, the Chinese doctors recognized a peculiar morbid condition of the teeth and their surrounding parts, which is thus described in Dabry’s book:

“It sometimes occurs, after recovery from illness, that convalescents, in order to acquire strength, drink too great a quantity of wine; and that this after a certain time produces a beginning of inflammation of the stomach. In such cases the teeth often fall out, the breath becomes fetid, and if the patient eats hot food, the empty alveoli as well as the cheeks are painful.”

Various internal medicaments and dentifrice powders are prescribed for combating this morbid condition. One of these latter includes a great number of ingredients in its composition; among others, the bones of mice.

Mention is also made of certain remedies, to which recourse may be had at times, for allaying violent dental pains, of whatsoever kind, or whatever be the cause that occasions them.

One of these remedies is composed of different substances (among them, garlic and saltpetre), to be pulverized and made into pills. If the pain be on the left side, one introduces one of the pills into the right ear, and vice versa.

The formula is also given for a very complicated medicated powder, to be snuffed up in the left nostril if the person suffering from toothache be a man; in the right if a woman.

Another powder is to be smelt with the right nostril or with the left, corresponding to the side on which the pain is located.

Abscesses and fistulæ of the gums are spoken of as follows:

“It sometimes occurs that an abscess forms in some one point of the gum; this communicates great pain to the tooth near it; the abscess is white, with discharge of purulent matter.” The treatment consists in the use of different medicated powders, to be rubbed on the affected part. Two of the powders contain musk, besides several other ingredients. A lotion is also prescribed.

In the next chapter the following affections are described:

1. Ya-heou. Gums are red, soft, and swollen, and a fetid and purulent matter exudes from them; the teeth are not painful; if the gums are lanced, blood of a pale red color flows from them in abundance. This malady is to be treated with various internal medicines and sometimes with scarification.

2. Ja-suen. Gums swollen; little by little they are corroded and destroyed by ulceration, which leaves the roots of the teeth bared; the patient has an aversion for hot food; continued pain in the teeth; discharge of purulent and fetid mucus; by the slightest exposure to cold the pain becomes very violent. This affection is to be combated with internal remedies and local treatment (frictions with medicated powders; application of an ointment of very complicated preparation).

3. Tchuen-ya-kan. The gums are painful for a few days; apparition of the root of the tooth; absence of ulceration. Children of five or six years of age are frequently exposed to this malady. The best means of cure consists in the extraction of the tooth. There are, besides, various internal and external remedies prescribed. One of these latter contains verdigris and three other ingredients. Among those to be used internally there is a decoction prepared with twelve different drugs, two of which are mint and rhubarb. The quantity of rhubarb is about seven and one-half grams; therefore, this prescription is certainly intended to act as a purgative.

4. Ya-ting. The right or left gum suddenly swells; a tumor forms of about the size of a grain of sorgo; in the beginning it is red, afterward black; severe pain in the cheek and neck; itching in the cheek; the tumor afterward bursts, giving exit to blood, and becomes black; it ought to be pricked directly (before it opens of itself) with a silver needle; blood of a violet color will flow from it, which should be left free course until it regains its ordinary color. The sufferer has at the same time pains in the stomach, great thirst, abdominal pains, and sometimes even delirium.

5. Ya-jong. Gums swollen and painful, abscess, fever, swollen cheeks; great thirst, and vomiting of a liquid kind; dejections dry. The treatment consists in the methodical use of certain medicines to be used internally, among which is rhubarb. If one neglects to make use of this treatment, an ulceration sets in with discharge of a purulent and sanguine mucus; it is then necessary to rub the part with a medicinal substance called by the Chinese, ping-pang-san. Should the tooth be somewhat loose, it ought to be extracted and the gum rubbed again with the substance just now named.

6. Tso-ma-ya-kan. An illness common to children after the smallpox; ulceration of the gums, which turn black; fetid breath. In certain cases the gums are hard and the mucous membrane of the cheek is also attacked; all the teeth shake; there is flow of blood from the gums, upon which certain spots begin to form that are clearly distinguishable as small holes. These holes must be filled with a particular medicinal substance (named lay-ma-ting-kouei-sse), and, besides, one ought to make use of various other internal and external remedies.

This is a very serious illness. In the case of recovery, the patient ought to abstain from taking any heating aliment for one hundred days.

7. Tsee-kin-tong or tsee-ly-tong. Gums swollen; slight but continuous pain, aggravated by the effort of the wind; the gums become ulcerated little by little, with discharge of purulent and sanguine mucus; and the root of the tooth is afterward seen to be uncovered. This malady is to be treated by means of draughts, pills, mouth washes, and frictions of various kinds.

After the treatise on the maladies referred to above, we find in Dabry’s book a long series of “general remedies for every kind of toothache.” There are about forty of these, and decoctions and powders predominate among them, the latter to be rubbed on the painful spot. Decoctions are the form of medicament most in use among the Chinese. In this list of about forty anti-odontalgic remedies we find as many as eighteen decoctions, seven for internal use, and the others to be employed as mouth washes. Some of the latter are compounded with vinegar instead of with water.

Four remedies of the above list are to be made into a paste and formed into pills, to be applied upon the aching tooth.

Another medicament is also to be formed into pills and applied inside the ear.

The following remedy is particularly worthy of note:

“One roasts a bit of garlic, crushes it between the teeth, and afterward mixes it with chopped horseradish seeds, reducing the whole to a paste with human milk; one then forms it into pills; these are to be introduced into the nose on the side opposed to that where the pain is situated.”

Two other remedies, in powder, are to be snuffed up through the nose.

A powder to prevent the progress of caries is prescribed, with which the tooth should be rubbed every day, or it may be applied on the decayed spot.

Finally, two powders are also prescribed for whitening the teeth. One of these is compounded of seven ingredients, among which is musk; the other has only three substances in its composition: salt (gram 25), musk (gram 1.8), tsang-eul-tsee (gram 36).

A therapeutic method much in vogue among the Chinese is acupuncture, which is used in the treatment of the greatest variety of affections, including those of the dental system. The doctors of the Celestial Empire have the greatest faith in this operation, which they hold capable of removing obstacles to the free circulation of humors and vital spirits, thus reëstablishing that equilibrium of the organic forces which constitutes health, and the absence of which causes disease.

The Chinese doctors prefer to use gold or silver needles for puncturing; but they also frequently use needles of the best steel. These instruments vary very much in length, in thickness, and in form, and there are not less than nine distinct kinds of puncturing needles.

Every doctor who intends dedicating himself to the practice of this operation has to begin by the most accurate study of the elective points for puncturing according to the various affections; he should also know to what depth precisely to drive the needles in each case, in order to reach the site of the morbific principle and procure convenient exit for it; he ought to know equally well how long to leave the needle in the affected part, so as to obtain the best possible therapeutic results in each case.

The points of election for carrying out puncturing in various maladies are spread over the whole superficies of the body, and amount in number to 388. Each of these is known by a special name. Each site of election stands in determinate relations, as to distance, to the known anatomical points, and may, therefore, be easily and precisely found by appropriate measurement. The unity of length for these measurements is called tsun, and is divided into ten fen; its value varies, however, according to whether the said measurements be taken on the head, the trunk, or the extremities. For the head, the length of the tsun is calculated as equal to the distance existing between the inner and the outer angle of the eye; for the trunk, it is equivalent to the eighth part of the horizontal line between the two breast nipples; and for the extremities, it is equal to the length of the second phalanx of the middle finger, measured with the joints bent.

There are twenty-six points of election upon which to carry out puncturing used as a remedy against toothache. There are also six other points of election for pains in the gums.

One would naturally be disposed to believe that these points of election would be situated in proximity to the teeth. Instead, many of them are situated in distant parts of the body—for example, in the elbow, in the hands, the feet, the vertebral region, the coccyx, and so on. However, about half of them are to be found in the labial, maxillary, and periauricular regions.

The puncturing of every point of election is almost always indicated for the cure of not only one but several, and, indeed, very often many, maladies; for example, the puncture carried out on the point of election, kin-tche, situated at the outer extremity of the bend of the elbow, may be utilized in more than twenty-five morbid conditions; among which are pains in the arm, paralysis of the arm, edema of the whole body, excessive perspiring, vomiting, hematemesis, toothache, boils, gastralgia, hemiplegia, and even cholera!

This mode of cure depends on the special relation of each point of election to the so-called canals of transmission and communication (named in Chinese king) through which the blood and the vital spirits circulate, and which serve at the same time to transmit the “innate heat” and “the radical moisture” to all parts of the body.

And here we must be allowed a brief digression in explanation of what we have just said.

The anatomical notions of the Chinese are very erroneous;[27] their ideas on the functions of the human body and of human life in general, differ considerably from ours. They recognize two natural principles of vitality, one they call yang (vital, primordial, or “innate heat”), the other yn (radical moisture). The spirits (that is the air) and the blood serve as vehicles to these two essential principles of life; that is, vital heat and radical moisture. The constant equilibrium, the accord, the perfect union of these two essential principles of life constitute a state of health. From their alteration, corruption, or disunion originate all diseases.

There are twelve principal sources of vitality in the human organism; that is, twelve organs from which the two aforesaid vital principles are distributed throughout the body: The heart, the liver, the two kidneys, the lungs, and the spleen are the seat and origin of radical moisture; the large and the small intestine, the two ureters, the gall-bladder, and the stomach are the seat and origin of vital heat. These twelve sources of life are in intimate relation with one another by means of the canals of communication, through which the blood and the vital spirits (air) circulate, carrying with them into every part of the body vital heat and radical moisture.[28]

The points of election upon which to carry out puncturing are situated along the course of the large lines of communication and transmission; and that explains, according to the Chinese medical theories, why a puncture carried out on a given point of the body can prove useful in relieving a variety of maladies even in distant parts of the organism.

Puncturing is almost always associated with cauterization, for after having drawn out the needle, it is usual to cauterize the site of the puncture with the so-called “moxa,” that is, with a kind of vegetable wool obtained from the leaves and dried tips of the artemisia. One compresses this substance very tightly between the fingers into the shape of a small cone. One next applies a small coin with a hole in the centre upon the site of election; the cone of moxa is placed on the hole in the coin and lighted at its top. As the cone is very compact, it burns slowly enough, without developing excessive heat, so that, according to Ten Rhyne,[29] who was an enthusiast for this mode of cure, “the epidermis is drawn without violence and rises gently into a small blister. The moxa, whilst burning, draws out the peccant humors visibly, absorbing them in such a manner that they are totally consumed without destroying the skin itself.”

The application of the moxa is not as painful as might be thought, and even children support it without much crying. The number of times for repeating the operation varies according to the malady and the site of application, etc. Thus, in the point kin-tche, which we have mentioned once before, the cauterization is generally repeated seven times, but in certain cases the number may be brought up to 200.

There are certain points of election for which puncturing alone is prescribed without subsequent cauterization; in other instances, the puncturing is held to be unnecessary or even dangerous; one, therefore, only applies the moxa in these cases.[30]

In Japan, the moxa was still more in use than in China. According to Ten Rhyne, from the remotest times the moxa has been the best and almost the sole mode of treatment for illness in Japan, and was regarded not only as an excellent remedy, but also as an excellent preservative; so much so that even convicts condemned to perpetual imprisonment had permission to go out every six months to undergo this cure.

Dental affections also were especially treated with the moxa, and, judging by what Ten Rhyne says on the subject, it would seem that this caustic, when used against toothache, was usually applied in the region of the mental foramen.[31]

CHAPTER IV.
CUSTOMS RELATING TO THE TEETH AMONG DIFFERENT PRIMITIVE PEOPLES.

Joseph Murphy, in his book, A Natural History of the Human Teeth,[32] says that the natives of Hindostan, especially the Brahmins or priests of Brahma, take extreme care of their teeth. Every morning they rub them for about an hour with a small twig of the fig tree, at the same time that, turned toward the rising sun, they recite their prayers and invoke Heaven’s blessing on themselves and their families. As this custom is prescribed in the most ancient codes and religious writings of India, it reverts, without doubt, to the remotest ages, and, therefore, demonstrates the great importance that this people, and particularly the Brahmin caste, has ever attributed to beauty and cleanliness of the teeth. Murphy affirms that the Brahmins, in general, have magnificent teeth; and that this depends, certainly in great part, on the assiduous and scrupulous care that they take of them.

From the writings of their ancient poets one also deduces in what high esteem the people of India held beautiful teeth, considering them one of the principal ornaments of the face. The lover, says Murphy, never neglected, in enumerating the beauties of his lady-love, to praise the whiteness and regularity of her teeth.

Among some of the people of India, when the second dentition is completed, it is customary to separate the teeth one from the other with a file; we do not know, however, whether this is done as an embellishment or with some other object—perhaps, as suggested by Joseph Linderer,[33] to prevent caries.

Anyhow, this and other customs in vogue in various parts of India and in many islands of Oceanica demonstrate that these peoples attribute great importance to the teeth.

The substituting of gold teeth for those missing has been in use in Java from exceedingly remote times.[34]

Dyeing the teeth black is considered a great embellishment among many races of Asia and Oceanica; this operation is sometimes preceded by another, viz., the filling up of the interdental spaces very cleverly with gold leaf.[35]

In Sumatra and the neighboring islands many women file their teeth down to the gums; others file them into points; or partially remove the enamel so as to render it easier to apply the black dye; this being held to be the height of elegance. Men of high rank and condition dye their upper teeth black and cover the lower ones with fine gold plates, which in a full light produces what they consider a fine contrast. The natives of other islands gild the upper central incisors and dye the others black.[36]

In Japan, the married women may easily be distinguished from the others by their black and shining teeth. The coloring preparation they use to blacken the teeth is composed of urine, raspings of iron, and a substance called saki. This mixture has a most unpleasant odor, and if applied on the skin acts as a caustic. Its action on the teeth is so powerful that they do not regain their whiteness even after a lapse of years. In applying this substance, and also for some time after, the women take care to preserve their gums and lips from its effects, as it would otherwise cause them to assume a dark blue tint.[37] The inhabitants of the Pelew Islands make use of the wild thistle and shell chalk to blacken the teeth. It is also the custom to blacken the teeth among the inhabitants of Tonkin and Siam, the women of the Maria Islands, and the single ladies of Java.

Some of the peoples of Eastern India plane their teeth down to an even level; and from the habit of masticating areca nuts mixed with chalk and other substances, their lips and teeth are dyed red. At Macassar the natives have their teeth dyed red; they also substitute missing teeth by artificial ones made of gold, silver, or tombac.[38]

Negroes, especially those of Abyssinia, very often file their incisors into points to resemble the form of the canines; this is in order to give themselves an air of greater ferocity.

Murphy relates that the inhabitants of one of the islands of the Sound make an incision in the upper lip in a parallel line with the mouth, and large enough to allow the tongue to pass. After the margins have healed they have a great resemblance to the lips. This kind of artificial mouth is made to support a shell, carved in such a manner as to produce the effect of a row of teeth.

The natives of the Sandwich Islands sacrifice their front teeth to conciliate the favor of their god Eatoa.[39]

Among the natives of New South Wales, it is the custom when a youth reaches virility to knock out his front teeth with a stone; this operation being carried out by the kuradshis or wizards.

The savages of Peru are also in the habit of making the front teeth fall out; the reason of the custom is that the space thus made is regarded by them as an embellishment.[40]

CHAPTER V.
THE GREEKS.

An ancient Greek physician—Asklepios, afterward called Æsculapius[41]—by the ability he displayed in the art of healing, so impressed the minds of the simple and uncultured at that primitive epoch as to be held in repute rather as a god than as a man. Not only was he held to be the author of wonderful cures, but it was also affirmed that he had resuscitated the dead; no doubt from his having in some case or other of apparent death restored the individual to consciousness by the assistance he rendered him. Exaggeration, so natural to ignorant minds, afterward did the rest, and magnified the healing and restoring powers of Æsculapius to such an extent that it is not to be wondered at that he should have been looked upon as a divine being. With the lapse of time, various traditions formed around his name, among which there was, however, finally such discrepancy that the popular voice spoke no more of one, but of many Æsculapii,[42] and to one of these was attributed, among other merits, that of having invented the probe and the art of bandaging wounds, while another was held to be the inventor of purgatives and of the extraction of teeth.

According, therefore, to these traditions, dental surgery had its origin with Æsculapius, the god of Medicine. But what was the precise epoch in which this benefactor of humanity lived?

We learn from Homer that two sons of Æsculapius, Machaon and Podalirius,[43] took special part, as doctors, in the siege of Troy. This celebrated siege, which lasted ten years, took place in the twelfth century before the Christian era (that is, 1193 to 1184 B.C.); admitting, therefore, the account of the parentage to be authentic, one may argue therefrom that Æsculapius must have lived between the twelfth and thirteenth centuries B.C. Many temples were built and dedicated to Æsculapius; these were called asklepeia, after the Greek form of his name. The priests were called Asklepiadi, and alleged their direct descent from Æsculapius himself.

The temples of Æsculapius became so numerous in time that they were to be found in almost every Greek city. The most celebrated were those of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great city of Agrigentum, in Sicily. The Asklepiadi not only performed the temple rites, but were doctors at the same time, for as interpreters of the wisdom of the god, they also occupied themselves in curing the sick. From this it resulted that these temples became in time, through observation and experience, schools of medical science.

But besides this sacerdotal medicine, there was also a lay medicine in Greece. Many great philosophers, especially Pythagoras, Alcmeon of Croton, Empedocles, Anaxagoras, and Democritus, occupied themselves with physiology, with hygiene, and with medicine; also the gymnasiarchs, or directors of gymnasiums, or schools of gymnastics, an art having for its end to increase physical strength and maintain health, cultivated medicine, particularly that part of it which concerns hygiene, dietetics, and surgery as applied to the treatment of violent lesions, such as fractures, luxations, etc.

The Asklepiadi often themselves imparted the principles of medicine to students outside their caste. Lay medicine thus gradually came to supplant sacerdotal medicine, especially after Hippocrates, who through his works, exercised a preponderant influence in the secularization of the science. However, the Asklepiadi, on their side, continued to practise medicine up to the time when the pagan temples fell into complete ruin, through the advance of Christianity.

On the columns of the asklepeia and on the votive tables were written the names of those cured by the god, together with indications regarding their various maladies and the treatment by virtue of which the sick had been restored to health.

Surgical instruments of proved utility were deposited in the temples. Celius Aurelianus makes mention of a leaden instrument used for the extraction of teeth (plumbeum odontagogon), which was exhibited in the temple of Apollo, at Delphi.

As a matter of fact, it would seem more natural that this instrument should have been shown in the temple of Æsculapius, he being the god of Medicine, and believed, besides, to be the inventor of dental extraction. One is rather inclined by this to think that the odontagogon may have been deposited in the temple of Apollo before the building of Æsculapian temples. Indeed, who can tell if Æsculapius himself, not yet deified, may not have deposited there a model of the instrument he had invented!

From the fact of the odontagogon in the temple of Apollo being made of lead, Erasistratus, Celius Aurelianus, and other ancient writers have drawn the deduction that it was only permissible to extract teeth when they were loose enough to be taken out with a leaden instrument. But Serre[44] observes, not without reason, that if a tooth be so unsteady as to be able to be extracted with leaden pincers, this may just as well be done, and perhaps even better, by pinching the tooth between the fingers, no other aid being required than a handkerchief to prevent them from slipping. Avulsive pincers of lead would be, therefore, a nearly useless invention; so it is much more probable, as Serre remarks, that the original pincers were of iron, and that the inventor, reserving these for his own use, made a simple model of the same in lead (this being easier to do) and deposited it in the temple of Apollo, in order to make known the form of the instrument to contemporaries and to posterity, naturally supposing that whoever wished to copy it would understand of himself, or learn from the priests, that it was to be made of iron and not of lead.

Fig. 7

Portrayal of a dental operation on a vase of Phœnician origin, found in Crimea (see Cigrand, Rise, Fall, and Revival of Dental Prosthesis, pp. 60-63 and 287).

Hippocrates. The sacerdotal and philosophical schools of medicine, as well as the gymnasiums, were the three great sources whence Hippocrates derived his first knowledge of medicine.

Hippocrates was born in the island of Cos, toward the year 460 B.C. He belonged to the sacerdotal caste of the Asklepiadi, and was, according to some of his earliest biographers, the nineteenth descendant of Æsculapius on his father’s side, and the twentieth descendant of Hercules on his mother’s side. The time of his death is even still more uncertain than that of his birth, for, according to some, he died at eighty-three, according to others, at eighty-five, at ninety, at one hundred and four, and even at one hundred and nine years of age.

Hippocrates was initiated in the study of medicine by his own father, Heraclides; but in the medical art he also had as a teacher the gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under the sophist Gorgia and philosophy under the celebrated Democritus. He treasured up all the records of medical practice that were preserved in the temple of Cos; but according to some ancient authors he is said to have set fire afterward to this temple, and to have left his native country in order to flee from the resentment he had aroused. Probably it was the priests themselves who attributed the burning of the temple (which certainly took place at that time) to Hippocrates, out of jealousy for his growing fame; though it may also be possible that this great man, having first collected together all that was useful among the medical records that were to be found there, afterward courageously destroyed this centre of superstition, so that medicine, ceasing to be confused with imposture and being despoiled of the supernatural character attributed to it, which paralyzed its progress, should become a liberal and human art, based purely on the observation of clinical facts and the study of natural laws.

For a long time, Hippocrates travelled in various parts of Europe, Asia, and Africa, everywhere making valuable observations. He finally returned to his native country, where through the practice of medicine and by his immortal writings he acquired such esteem and veneration that his compatriots almost tributed him with divine honors after death.

Not all, however, of the works that make up the so-called collection of Hippocrates were really written by the father of medicine. Two of his sons—Thessalus and Draco—and his son-in-law Polybius also distinguished themselves by the practice of medicine and by their admirable writings, which together with those of other doctors of that period were erroneously included in the collection of Hippocrates’ works. At any rate, the collection of Hippocrates faithfully represents the state of medicine and surgery at the epoch in which he and his disciples flourished, that is, toward the end of the fifth and during the fourth century before the Christian era.[45]

Neither Hippocrates nor others before him had ever dissected corpses; it is, therefore, not to be wondered at that the anatomical notions contained in the Hippocratic works should be scarce and very often inexact. The physiological notions also are highly deficient and imperfect, which is, indeed, very natural, for an exact knowledge of the functions of the human body presupposes an exact knowledge of the relative organs.

The philosophical ideas of the time had considerable influence on the medical theories of Hippocrates and his successors. The universe was considered as constituted by four elements: earth, air, fire, water. To each of these elements a special quality was attributed, and, thus, one recognized four fundamental qualities, viz., cold, dryness, heat, and moisture. Man—the most perfect being—was regarded as a “microcosmos,” or small world in himself, that is, a sort of compendium of the whole universe, and his organism, in correlation to the four primordial elements of the universe, was believed to be constituted of four fundamental humors—the blood, the pituita or mucus, the yellow bile, and the black bile or atrabile.

Health, says Hippocrates,[46] depends on the just relation one to another of these principles, as to composition, force, and quantity, and on their perfect mixture; instead, when one of the four principles is wanting or in excess, or separates itself from the other components of the organism, one has a diseased condition. In fact, he adds, if some one humor flow from the body in a measure superior to its superabundance, such a loss will occasion illness. If, then, the humor separated from the others collect in the interior of the body, not only the part that remains deprived of its presence will suffer, but also that into which the flow takes place and where the engorgement is produced.

We have here briefly stated these generalities in order to make ourselves clearly understood in speaking hereafter on different subjects, whether with regard to Hippocrates or to other authors of the time.

In the works of Hippocrates there is not one chapter that treats separately of the affections of the teeth, just as there is no book in which he speaks separately of diseases of the vascular or nervous systems, and so on. There are, nevertheless, a great number of passages scattered throughout the Hippocratic collection from which we can deduce very clearly the great importance that the Father of Medicine ascribed to the teeth and to their maladies.

In the book De carnibus, the formation of the teeth is spoken of among other things. It might have been supposed that Hippocrates would have been ignorant of the fact that the formation of the teeth commences in the intra-uterine life. This, however, is not the case; in fact, he says: “The first teeth are formed by the nourishment of the fetus in the womb, and after birth by the mother’s milk. Those that come forth after these are shed are formed by food and drink. The shedding of the first teeth generally takes place at about seven years of age, those that come forth after this grow old with the man, unless some illness destroys them.”[47] And a little farther on one reads: “From seven to fourteen the larger teeth come forth and all the others that substitute those derived from the nourishment of the fetus in the womb. In the fourth septennial period of life there appear in most people two teeth that are called wisdom teeth.”[48]

There is a passage in this same book De carnibus, in which the great importance of the teeth for clear pronunciation of words is alluded to: “The body,” says Hippocrates,[49] “attracts the air into itself; the air expelled through the void produces a sound, because the head resounds. The tongue articulates, and by its movements, coming into contact with the palate and the teeth, renders the sounds distinct.”

The book De dentitione is written in the form of brief sentences or aphorisms, and speaks of the accidents that often accompany the eruption of the deciduous teeth. The most important passages in this short treatise are the following:

“Children who during dentition have their bowels frequently moved are less subject to convulsions than those who are constipated.”

“Those who during dentition have a severe attack of fever rarely have convulsions.”

“Those who during dentition do not get thinner and who are very drowsy run the risk of becoming subject to convulsions.”

“On conditions of equality, those children who cut their teeth in the winter get over the teething period the best.”

“Not all the children seized with convulsions during dentition succumb to these; many are saved.”

“In the case of children who suffer with cough the period of dentition is prolonged, and they get thinner than the others when the teeth come forth.”

In the third book of Aphorisms, where Hippocrates speaks of the illnesses that prevail in the various seasons of the year and in the various ages of life, mention is also made of the accidents of dentition. The twenty-fifth aphorism says: “At the time of dentition, children are subject to irritation of the gums, fevers, convulsions, diarrhea; this occurs principally at the time when the canines begin to come forth, and in children who are very fat or constipated.”

The works of Hippocrates are nearly silent on the hygiene of the teeth; but in the second book, on the diseases of women,[50] some prescriptions are to be found against bad-smelling breath. We translate the passage integrally:

“When a woman’s mouth smells and her gums are black and unhealthy, one burns, separately, the head of a hare, and three mice, after having taken out the intestines of two of them (not, however, the liver or the kidneys); one pounds in a stone mortar some marble or whitestone,[51] and passes it through a sieve; one then mixes equal parts of these ingredients and with this mixture one rubs the teeth and the interior of the mouth; afterward one rubs them again with greasy wool[52] and one washes the mouth with water. One soaks the dirty wool in honey and with it one rubs the teeth and the gums, inside and outside. One pounds dill and anise-seeds, two oboles of myrrh;[53] one immerses these substances in half a cotyle[54] of pure white wine; one then rinses the mouth with it, holding it in the mouth for some time; this is to be done frequently, and the mouth to be rinsed with the said preparation fasting and after each meal. It is an excellent thing to take small quantities of food of a very sustaining nature. The medicament described above cleans the teeth and gives them a sweet smell. It is known under the name of Indian medicament.”

In the book De affectionibus there is a passage where it is said that inflammation of the gums is produced by accumulations of pituita, and that, in like cases, masticatories are of use, as these remedies favor the secretion of saliva, and thus tend to dissipate the engorgement caused by pituita.

Still more important, however, is the following passage of the same book:[55]

“In cases of toothache, if the tooth is decayed and loose it must be extracted. If it is neither decayed nor loose, but still painful, it is necessary to desiccate it by cauterizing. Masticatories also do good, as the pain derives from pituita insinuating itself under the roots of the teeth. Teeth are eroded and become decayed partly by pituita, and partly by food, when they are by nature weak and badly fixed in the gums.”

Hippocrates, therefore, considers affections of the teeth to depend in part on natural dispositions, that is, on congenital weakness of the dental system, in part on accumulations of pituita, and the corroding action of the same. If a painful tooth were not loose, it was not to be extracted; but one was to have recourse to cauterization and to masticatories, intended the one and the other to dissipate the accumulation of pituita, believed by him to be the cause of toothache.

It is easily to be understood that as only loose teeth were to be extracted, Hippocrates considered the extraction of teeth a very easy operation, notwithstanding that the instruments then in use cannot have been other than very imperfect; and this is clearly to be seen from a passage in the book entitled De medico, where, after having spoken of the articles and instruments that ought to be kept in a doctor’s office (officina medici), he adds:

“These are the instruments necessary to the doctor’s operating room and in the handling of which the disciple should be exercised; as to the pincers for pulling out teeth, anyone can handle them, because evidently the manner in which they are to be used is simple.”[56]

Fig. 8

Very ancient dental forceps and two other dental (?) instruments existing in the Archæological Museum of Athens.

Having made mention of the officina medici, we think it opportune to explain here with some precision what is to be understood by this term.[57] Medicine and surgery were practised in ancient times in open shops; this was so in Greece, and later also in Rome. When the practice of medicine became secularized through its abandoning the Æsculapian temples, doctors’ shops began to arise in the most important centres of population, to which those in need of assistance resorted or were carried. In time these stations for the practice of medicine, and particularly of surgery, became more and more numerous.

The Hippocratic collection contains a special treatise (De officina medici), which speaks of the conditions these places were expected to fulfil, the articles therein to be contained, the instruments, the general rules relative to operations, the bandages, etc.

About six hundred years later, Galen wrote three books of commentaries on this treatise of Hippocrates. He says, among other things, that the doctor’s shop ought to be spacious and furnished with wide openings, to let in abundance of light. These medical stations to which the sick and infirm repaired in great numbers to ask advice, to undergo operations, or receive medical dressings, must have been of great importance, as is to be presumed from the cited books of Hippocrates and Galen.

The greatest doctors of antiquity practised the medical art in these places. It is also said that the great philosopher and naturalist, Aristotle, who came of a race of doctors, had inherited a doctor’s shop of great value, but that notwithstanding this he refused to dedicate himself to the medical profession.

The doctors’ shops were at the same time real pharmacies, where doctors prepared medicines, and where all the remedies then in use, either simple or compounded, were kept and sold to the public. Besides, there were to be found instruments of every kind and articles for medicating; and, therefore, bandages, compresses, lint, sponges, cupping glasses, cauteries, knives, bistouries, lancets, sounds, needles, hooks, pincers, files, saws, scrapers, splints, appliances for replacement of luxated bones, speculums, trepans, apparatus for fumigation, trusses, and a thousand things besides.

Naturally, dentistry was also practised in these shops, either by doctors who occupied themselves with dental maladies as with those of any other part of the body, or, later on, by individuals who dedicated themselves exclusively to this specialty.

Medicine and surgery were exercised, however, not only in doctors’ shops, but also at the patients’ houses, and it was Hippocrates who especially inaugurated clinical medicine—that is, the practice of visiting patients in their beds.

But we must not digress from our argument.

Many observations relative to the teeth are to be found in the seven books of Hippocrates on Epidemics. Unfortunately, the observations are not always given in clear and precise terms, which principally depends on the fact that these books consist for the most part of simple and most concise notes, written by Hippocrates on cases observed by him, and not intended for publication under such form, but rather constituting the material for further work.

Here is a passage from the fourth book on Epidemics, which reveals Hippocrates’ extraordinary power of observation, for even teeth that had fallen out were minutely examined by him, to the end of acquiring precise ideas on the anatomical conformation of these organs, held by him to be of the highest importance.