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teeth and dental appliances from the mouth of corpses before embalming them, in preparation for the next world, because there was some religious objection to such human handiwork being left in place for the hereafter, as they hoped for it.
There is a well-authenticated tradition of intimate intercourse in a commercial way between the old Etruscans who inhabited the Italian hill country and the Phenicians, so that it is no surprise to find that the oldest of Etruscan tombs contain some fine examples of bridgework. An improvement has come over Phenician work however, and bands of gold instead of wire are used for holding artificial teeth in place. Guerini, whose “ History of Dentistry” is the standard work on the subject, on a commission from the Italian government, carefully studied these specimens of Etruscan dental work in the museums of Italy, and has made some interesting observations on them. In one specimen, which is especially notable, two incisor teeth are replaced by a single tooth from a calf. This was grooved in such a way as to make it seem like two separate teeth. Guerini suggests a very interesting and quite unex pected source for this. While examining the specimen he wondered where the old Etruscan dentist had obtained a calf's tooth without a trace of wear on it. He came to the conclusion that he must have cut into the gums of a young calf before the permanent tooth was erupted in order to get this structure absolutely unworn for his purpose. A number of examples of bridgework have been found in the old Etruscan tombs. The dates of their construction are probably not later than 500 B.C., and some of them are perhaps earlier than 700 B.C.
The Etruscans affected the old Romans in the matter of dentistry, so that it is easy to understand the passage in the “ Laws of the Twelve Tables," issued about 450 B.C., which, while forbidding the burial of gold with corpses, made a special exception for such gold as was fastened to the teeth. Gold was rare at Rome, and care was exercised not to allow any unnecessary decrease of the visible supply almost in the same way as governments now protect their gold reserves. It may seem like comparing little things with great, but the underlying principle is the same. Hence this special law and its quite natural exception.
In Pope Julius' Museum in Rome there is a specimen of a gold cap made of two plates of gold riveted together and also riveted to bands of metal which were fastened around the neighboring teeth in order to hold the cap in place. This is from later Republican times at Rome. At the end of the Republic and the beginning of the Empire there appear to have been many forms of dental appliances. Martial says that the reason why one lady's teeth—whose name he does not conceal—are white and another's -name also given—were dark, was that the first one bought hers and the second still had her own. In another satiric poem he describes an elderly woman as so much frightened that when she ran away her teeth fell out, while her friends lost their false hair. Fillings of many kinds were used, dentrifices of nearly every kind were invented, and dentistry evidently reached a high stage of development, though we have nowhere a special name for dentist, and the work seems to have been done by physicians, who took this as a specialty.
While in the Middle Ages there was, owing to conditions, a loss of much of this knowledge of antiquity with regard to dentistry, or an obscuration of it, it never disappeared completely, and whenever men have written seriously about medicine, above all about surgery in relation to the face and the mouth, the teeth have come in for their share of scientific and practical consideration. Aëtius, the first important Christian writer on medicine and surgery, discusses, as we have seen in the sketch of him, the nutrition of the teeth, their nerves, “ which came from the third pair and entered the teeth by a small hole existing at the end of the root,” and other interesting details of anatomy and physiology. He knows much about the hygiene of the teeth, discusses extraction and the cure of fistula and other details. Paul of Ægina in the next century has much more, and while they both quote mainly from older authors there seems no doubt that they themselves had made not a few observations and had practical experience.
It was from these men that the Arabian physicians and surgeons obtained their traditions of medicine, and so it is not surprising to find that they discuss dental diseases and their treatment rationally and in considerable detail. Abulcasis particularly has much that is of significance and interest. We have pictures of two score of dental instruments that were used by them. The Arabs not only treated and filled carious teeth and even replaced those that were lost, but they also corrected deformities of the mouth
and of the dental arches. Orthodontia is sometimes said to be of much later origin and to begin many centuries after Abulcasis' time, yet no one who knows of his work can speak of Orthodontia as an invention after him. In this, however, as in most of the departments of medicine and surgery, the Arabs were merely imitators, though probably they expanded somewhat the practical knowledge that had come to them.
When the great revival in surgery came in the twelfth and thirteenth centuries it is not surprising that there should also have been an important renewal of interest in dentistry. A detailed review of this would take us too far afield, but at least something may be said of two or three of the great representative surgical writers who touched on this specialty.
About the middle of the fourteenth century that prince of surgeons, and model of surgical writers, Guy de Chauliac, wrote his great text-book of surgery, “ Le Grande Chirurgie.” An extremely interesting feature of this work is to be found in the chapters that treat of diseases of the teeth. These are not very comprehensive, and are evidently not so much the result of his experience, as the fruit of his reading, yet they contain many practical valuable ideas that are supposed to be ever so much later than the middle of the fourteenth century. His anatomy and physiology at least are not without many errors. His rules for the preservation of the teeth show that the ordinary causes of dental decay were well recognized even as early as this. Emphasis was laid on not taking foods too hot or too cold, and above all not to follow either hot or cold food by something very different from it in temperature. The breaking of hard things with the teeth was recognized as one of the most frequent causes of such deterioration of the enamel as gives opportunity for the development of decay. The eating of sweets, and especially the sticky sweets-preserves and the like—was recognized as an important source of caries. The teeth were supposed to be cleaned frequently, and not to be cleaned too roughly, for this would do more harm than good. We find these rules repeated by succeeding writers on general surgery, who touch upon dentistry, or at least the care of the teeth, and they were not original with Guy de Chauliac, but part of the tradition of surgery.
As noted by Guerini in his “ History of Dentistry,” the translation of which was published under the auspices of the National Dental Association of the United States of America, Chauliac recognized the dentists as specialists. Besides, it should be added, as is evident from his enumeration of the surgical instruments which he declares necessary for them, they were not as we might easily think in the modern time mere tooth pullers, but at least the best among them treated teeth as far as their limited knowledge and means at command enabled them to do so, and these means were much more elaborate than we have been led to think, and much more de
1" A History of Dentistry from the Most Ancient Times Until the End of the Eighteenth Century,” by Dr. Vincenzo Guerini, editor of the Italian Review L'Odonto-Stomatologia, Philadelphia and New York, Lea and Febriger, 1909.