XII

MEDIEVAL DENTISTRY-GIOVANNI OF

ARCOLI

If there is one phase of our present-day medicine and surgery that most of us are likely to be quite sure is of very recent development it is dentistry. Probably most people would declare at once that they had every reason to think that the science and art of dentistry, as we have it now, developed for the first time in the world's history during the last generation or two. It is extremely interesting to realize then, in the light of this almost universal persuasion, founded to a great extent on the conviction that man is in process of evolution and that as a consequence we must surely be doing things now that men never did before, to find that dentistry, both as an art and science, is old; that it has developed at a number of times in the world's history, and that as fortunately for history its work was done mainly in indestructible materials, the teeth themselves and metal prosthetic apparatus, we have actual specimens of what was accomplished at a number of periods in the olden times. Surprising as it will seem to those who hear of it for the first time, dentistry reached high perfection even in what we know as ancient history. It is rather easy to trace scientific and craftsmanlike interest in it during the

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medieval period and in the magnificent development of surgery that came just at the end of the Middle Ages, dentistry shared to such degree that some of the text-books of the writers on surgery of this time furnish abundant evidence of anticipations of many of the supposedly most modern developments of dentistry.

There are a number of historical traditions with regard to dentistry and the treatment of the teeth in Egypt that can be traced back to good authorities in Egyptology of a generation or more ago, but it is rather hard to confirm the accounts we have by actual specimens; either none were found or for some reason those actually discovered are now not readily available for study. Among the Phenicians however, though we have good reasons to think that they learned their arts and crafts from the Egyptians, there is convincing evidence of a high development of dentistry. M. Ernest Renan, during an exploring expedition in Phenicia, found in the old necropolis at Sidon a set of teeth wired together, two of which were artificial. It was a striking example of bridgework, very well done, and may now be seen in the Louvre. It would be more than a little surprising, from what we know of the lack of inventiveness on the part of the Phenicians and their tendency to acquire their arts by imitation, if they had reached such a climax of invention by themselves. Since they adapted and adopted most of their arts and crafts from Egypt, with which they were in close commercial relations, it has been argued with some plausibility that the Egyptians may have had many modes of dental prosthesis, but removed all artificial

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 unexpected 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 construc

tion 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