Chapter XII: of the seventh book is, of all the work of Celsus, the (2)

ANDROMACHUS THE ELDER, of Crete, the physician of Nero, who conferred upon him, for the first time, the title of _archiater_, became famous through his _theriac_, an extremely complicated remedy, the virtues of which were sung by him in a Greek poem, dedicated to the Emperor. The theriac was considered an antidote against all poisons and a remedy against the greater part of diseases, in short, as a real panacea. It is not even necessary to remark that this portentous medicine, which has held a post of honor, from ancient times almost up to the present day, was also used against odontalgia; and in those cases in which this was produced by caries, Andromachus advised the filling up of the cavity with the electuary which he rendered so famous. As the chief basis of the theriac was opium, combined with stimulating and aromatic substances, there is no doubt that its use locally or even internally would prove beneficial, temporarily at least, in many cases of odontalgia.[175]

ARCHIGENES, of Apamea, a city of Syria, lived in Rome toward the end of the first century and at the beginning of the second, under the Emperors Domitian, Nerva, Trajan, and Hadrian. He acquired great fame as a physician and as an operator, and distinguished himself particularly by daring amputations and trepannings. He recommends various remedies against odontalgia, among which are mouth washes of strong hot vinegar, in which gall-nuts or halicaccabum[176] have been boiled. He usually introduced into carious teeth a mixture of turpentine and vitriol of iron (_sory ægyptium_), or a mixture of pepper, and oil of spikenard or of almonds, and this was also dropped into the ear, on the side on which the pain was felt.

Archigenes, too, like other great physicians of that time, recommended various remedies taken from the animal kingdom against diseases of the teeth, which now seem very strange to us, but at that period appear to have been in great use. Thus, it would be of great benefit to hold in the mouth for some length of time a mixture of vinegar and water in which a frog has been well cooked. The slough of a serpent, burnt and then reduced, by the addition of oil, to the consistency of solidified honey, would be a valuable remedy, which being introduced into a carious hollow, and plastered all around the tooth and on the surrounding parts, would cause the most violent pain to cease. And, moreover, desiring to cause a diseased tooth to fall out, it would be enough to apply to and press upon it a piece of the unburnt slough of a serpent. Two excellent anti-odontalgic remedies to be introduced into carious hollows would be roasted earth-worms and spikenard ointment mixed with the crushed eggs of spiders. It would be also of use to drop into the ear on the side of the aching tooth some oil of sesamum in which earth-worms have been cooked.

When the pain is situated in broken teeth, Archigenes advises them to be cauterized with a red-hot iron.

Against bleeding of the gums, he recommends rubbing them with very finely pulverized alum and myrtle and the application of astringent and tonic liquids.

When odontalgia appears to depend upon an inflammatory condition, he advises the aching teeth to be plastered up with a mixture composed of red nitre, pounded peach kernels, and resin.

Archigenes repeatedly recommends the cleaning of the teeth and of the carious cavities before applying to the former or introducing into the latter the appropriate remedies.[177]

But Archigenes’ principal merit, so far as concerns the art of dentistry, consists in his having guessed that odontalgia, in certain cases, arises from a disease of the interior part of the tooth (viz., from inflammation of the pulp) and in having discovered an excellent method for curing such cases. When a tooth appeared discolored, without being affected by caries, and was the seat of violent pains, against which every remedy had proved of no avail, Archigenes perforated it with a small trephine, invented by himself for the purpose. He applied the instrument to that part of the crown which was most discolored and drilled right down to the centre of the tooth.[178]

Without doubt this talented surgeon was induced to adopt this method of cure by the idea of the existence of morbid substances in the interior of the tooth and by the consequent indication of giving them a free exit.

The operation devised by Archigenes proves, among other things, two important facts: first, that the anatomical constitution of the teeth had already been explored, seeing that Archigenes did not ignore the existence of the pulp cavity; and secondly, that Archigenes was greatly opposed to the extraction of a tooth unless absolutely necessary. It might be thought that such aversion depended upon an exaggerated idea of the dangers connected with the extraction of a tooth, an idea widely diffused at that period; but regarding such a daring surgeon as Archigenes was, it is more logical to suppose that in similar cases he had recourse to trephining and not to extraction, especially on account of the importance he attached to the preservation of the tooth.

Surgery in ancient times was eminently conservative; later on—partly by effect of its own progress—it became too readily inclined to the removal of diseased parts; in modern times it has again become what it was originally, and what it must ever be, viz., conservative in the highest possible degree.

CLAUDIUS GALEN, after Hippocrates the greatest physician of ancient times, was born at Pergamus, a city in Asia Minor, in the year 131 of our era. His father Nicon, a man of great abilities, who was at the same time a man of letters, a philosopher, a mathematician, and an architect, had put him, at a very early age, to the study of science and of the liberal arts. Galen began to study medicine at the age of seventeen, under the guidance of skilful doctors of his native country; he made several journeys in order to have the benefit of the instruction of celebrated masters, and finally frequented the renowned medical school at Alexandria. On going to Rome, in the thirty-fourth year of his life, he soon acquired in that city a very high renown. He died in the first decade of the third century, but we do not know exactly in what year.

Galen was a most prolific writer, and his works, considering the period in which they were written, form a real medical encyclopedia. Anatomy through his researches made considerable progress, for he studied with the utmost care and attention (especially in apes) the bones, muscles, heart, bloodvessels, brain, nerves, and every other part of the organism. His anatomical researches enabled him to correct many errors, but as he had dissected almost exclusively animals and not human corpses, he himself fell into several errors, especially in attributing to man parts which he does not possess, for example, the intermaxillary bone.

Galen justly observed that the inferior maxilla (resulting, according to him, from the union of two bones, which, indeed, is embryologically true) has in man, proportionally to the other bones of the skeleton, a lesser length than in animals.

He holds that the teeth must be enumerated among the bones, and does not admit any doubt to be raised on this point, as these parts can be looked upon neither as cartilages, nor as arteries, nor as veins, nor as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat, nor as hair—a method of reasoning by elimination which is very specious but far too weak!

Galen indicates exactly the number of incisor, canine, and molar teeth (without, however, making any distinction between small and large molars), and speaks of the different functions of these three kinds of teeth. Not always, he says, are the molars of each jaw five in number on each side; in some individuals there appear only four; in others six. The incisors and canines have but one root; the upper molars have generally three, but sometimes, though not often, four; the lowers have for the most part two, rarely three.

Galen is the first author who speaks of the nerves of the teeth. He says that these organs are furnished with soft, that is sensitive, nerves[179] belonging to the third pair.[180] The teeth, according to him, are furnished with nerves, both because, as naked bones, they have need of sensibility, so that the animal may avoid being injured or destroyed by mechanical or physical agencies, and because the teeth, together with the tongue and the other parts of the mouth, are designed for the perception of the various flavors.[181]

In regard to odontalgia, Galen made some very important observations on his own person:

“Once when I was troubled with toothache, I directed my attention to the seat of the pain, and thus I perceived very clearly, that not only was the tooth painful but also pulsating, which is analogous to what happens in inflammations of the soft parts. To my astonishment, I had to persuade myself that inflammation may arise even in a tooth, in spite of the dental substance being hard and lapideous. But another time, when I again was attacked by odontalgia, I perceived very distinctly that the pain was not localized in the tooth, but rather in the inflamed gums. Having, therefore, suffered these two kinds of pain, I have acquired the absolute certainty that, in certain cases, the pain is situated in the gums, in others, on the contrary, in the very substance of the tooth.”

When a tooth becomes livid, Galen deduces from this that the tooth is the seat of a morbid process equivalent to inflammation. Besides, he says, we cannot be surprised that the teeth may be subject to a phlogistic process, when we consider that these, like the soft parts, assimilate nourishment. The teeth, by effect of mastication, are continually worn down, but nutrition repairs the losses, and they, therefore, preserve the same size. But when a tooth from want of its antagonist is consumed but little or not at all by mastication, we see that it grows gradually longer, for the very reason that under such conditions the increase due to nutrition is not counteracted by a corresponding waste.

The nutritive process of the teeth may, according to Galen, be altered either by excess or by defect; from which arise morbid conditions, quite different the one from the other. An excess of nutrition produces a phlogistic process analogous to that of the soft parts; a defect of nutrition makes the teeth thin, arid, and weak. The first of these pathological states is met with especially in young men and must be fought against with the ordinary antiphlogistic means, designed to eliminate the excess of humors (evacuant, resolvent, revulsive, and astringent remedies). As to defect of nutrition, this is met with most frequently in old people. It has the effect not only of making the teeth thin, but also of enlarging the alveoli, from which there results a looseness of the teeth more or less noticeable. Against this morbid condition we do not possess, says Galen, any direct remedy; however, it can be combated, up to a certain point, by strengthening the gums with astringent medicaments, so that they may close tightly around the teeth and thus make them firm.

Dental caries is produced, according to Galen, by the internal action of acrid and corroding humors, that is, it is produced in the same manner as those cutaneous ulcers which appear without any influence of external causes. The cure must consist in acting upon such vicious humors by means of local or general medicaments according to circumstances and also in strengthening the substance itself of the teeth by the use of astringents and tonic remedies.[182]

After these preliminary remarks, Galen gives a minute description of the numerous remedies which, from his own experience and from that of other great doctors, were to be considered useful for the cure of the various affections of the teeth and gums.

Against gingivitis and the pains deriving from it, the best remedy, according to Galen, consists in keeping in the mouth the oil of the lentisk moderately warm; noting, however, that such a remedy is the more efficacious the more recently it has been prepared.

A decoction of the root of the hyoscyamus in vinegar, used as a mouth wash, is another remedy recommended by Galen against the pains in the gums. It would also be of benefit to apply on the inflamed gums a powder composed of one part of salt to four of alum, afterward washing the mouth with wine or with a decoction of olive leaves. If the gums are ulcerated, Galen recommends them to be cauterized with boiling oil, using for the purpose a little wool wrapped around a probe or toothpick. This medicament, says Galen, greatly modifies the diseased part, exciting a reparative process in it, to aid which, however, suitable remedies must be used, and especially frictions with a mixture of gall-nuts and myrrh reduced to a fine powder.

For the cure of epulides the application of green vitrol, together with an equal quantity of powdered myrtle and a little alum, is especially recommended.

In dentition, if the gums are painful, it is advisable to rub them with the milk of a bitch. The teeth, moreover, appear very readily, says Galen, if the gums be rubbed with hare’s brain.

Against odontalgia, properly so called, independent, that is, of diseases of the gums, Galen particularly recommends warm applications, either on the cheek or directly on the tooth. Externally, on the side of the pain, may be applied dirty (!) pieces of linen, well warmed, or else small bags full of roasted salt, or cataplasms of linseed or barley flour. But if it is desired to act directly upon the sick tooth, this may be rubbed with a branch of origanum (wild marjoram) dipped in hot oil, or else, after applying a bit of wax on the tooth, the heated end of a probe may be laid upon it; or lastly, fumigations may be made by burning the seeds of the hyoscyamus. In case the above remedies, or others like them, be found of no use, Galen recommends them to be adopted anew after having perforated the sick tooth by means of a small drill. But if even from this no benefit be derived, and it is considered well to remove the tooth, this can be done without pain by the application of special medicaments. Among these the root of pyrethrum kept in very strong vinegar for forty days and then pounded takes the first place. The remedy is applied after having well cleaned the sick tooth, and after having covered the others with wax. At the end of an hour the tooth will have already become so loose that it can be drawn out with the fingers or with the mere help of a style. The same effect may be obtained, says Galen, by the application of blue vitriol mixed with very strong vinegar.

To prevent a carious tooth from producing pain or fetor, he advises the carious hollow to be filled up with black veratrum mixed to a paste with honey.

To restore to blackened teeth their whiteness, Galen advises them to be rubbed with special medicaments, one of which is made up of dried figs, burnt and pounded, with spikenard and honey. He gives, besides the receipts of many dentifrice powders and tinctures designed both to strengthen the teeth and gums and as preservatives against the diseases of these parts. Such powders and tinctures do not offer any interest to us, since they do not much differ from those recommended by other authors whom we have previously quoted.

When one or more teeth, in consequence of a trauma, or from other cause, become loose and project above the level of the others, Galen removes the whole exuberant part by means of a small iron file. In performing this operation, after having covered the gums with a soft piece of cloth, he holds the tooth to be filed steady with the fingers of the left hand, using the file in such a way as not to give the tooth any shock. Besides, he does not complete the operation at one sitting, but rather interrupts it as soon as the patient feels any pain, and continues it after one or two days. In the meanwhile, he makes use of remedies suited to strengthen the loosened teeth, and bids the patient remain silent and nourish himself with liquid or soft food.

When the teeth, without the action of external causes, become loosened, Galen holds that this is due to a relaxation of the dental nerve in consequence of an excessive abundance of humors. In such cases he counsels the use of desiccative remedies.

Galen, like ancient authors in general, is not very favorable to the extraction of teeth with the forceps. Even he seems convinced that a tooth may be made to fall out, without pain, by means of the application of certain remedies, to which we have already alluded. However, in one of the Galenic books[183] we find the precept already given by Celsus, that before extracting a tooth the gums must be detached all around; from which one may argue that, at least in certain cases, instrumental extraction was considered inevitable. Galen even alludes to the pain which sometimes remains after the extraction of a tooth, and is of the opinion that this depends upon an inflammatory condition of the stump of the dental nerve.

In Galen are found recorded many means of cure, recommended by celebrated doctors of ancient times. Elsewhere we have already spoken of some remedies counselled by Damocrates, by Andromachus the elder, and by Archigenes. Apollonius, as a medicament against odontalgia, advised that the juice of the beet root be dropped into the nostrils, or else a liquid prepared from cumin seed, myrrh, cucumber, and woman’s milk. Heraclides of Tarentum recommended against the pains and looseness of teeth that a vinous decoction of black veratrum, mandrake, and hyoscyamus root should be kept in the mouth. Criton prescribed, for strengthening loose teeth, that the mouth should be frequently washed with a vinous decoction of lentisk, myrtle, and gall-nuts.

CELIUS AURELIANUS. In the book _De morbis acutis et chronicis_, written by Celius Aurelianus (who lived, according to some, in the third century, according to others, in the fourth or at the beginning of the fifth), a very interesting chapter on odontalgia is found. He shows himself to be, for the most part, a follower of Celsus. During the violence of the pain he advises abstinence from food and rest in bed with the head somewhat raised. As remedies he recommends several mouth washes (infusions or decoctions made with wine or vinegar and with various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil, poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides, the application of wool soaked in hot oil on the cheek of the affected side, or the application of little warm bags, and also that some hot oil, or the juice of fenugreek,[184] should be kept in the mouth, or milk with honey. When the pain is excessively violent, he has recourse to bloodletting, and after two days’ fasting, he begins to feed the patient with liquid and warm food. If the bowels are closed he prescribes the use of clysters, and when, in spite of all, the pain persists, he has recourse to scarified cuppings on the cheek, in correspondence with the pain. In certain cases he also proceeds to scarification of the gums, or else he detaches them all around from the tooth, by means of a special instrument called a _pericharacter_. It would often turn out useful to apply to an aching tooth a grain of incense warmed by the fire and wrapped in a thin piece of cloth, or to press between the teeth, where the pain is situated, several pieces of cloth, in succession, in which some powder of incense has been wrapped, and which are dipped into hot oil before being used. The author, moreover, commends external fomentations made by means of sponges soaked with emollient decoctions and afterward squeezed; and also the application of moderately hot cataplasms.

Roman dental forceps found (1894) at Hamburg, Germany, in the ancient Roman castle Saalburg. (Geist-Jacobi.)]

When the odontalgia has already become inveterate and recurs in paroxysms, separated by intervals of calm, Celius Aurelianus counsels, among other things, that the general health be strengthened by temperate living, exercise, rubbing of the whole body (an ancient practice, now revived under the name of massage). He recommends, besides, special rubbing of the cheeks (to be carried out with a rough cloth), and also of the gums and teeth, and indicates a great number of medicaments, some of which are to be used during the paroxysms and others during the periods of calm. In regard to the use of narcotics, he very shrewdly observes that such remedies take away sensibility but not pain. Some doctors of those days, for the cure of odontalgia, had recourse to sternutatories, or to the dropping of special medicaments into the nose or into the ear, but Celius Aurelianus seems to have put but little faith in such means of cure. He, moreover, solemnly reproaches those who, to cure odontalgia, are too hasty in having recourse to the extraction of the aching tooth. To remove a part, says he, is not to cure it; and if every tooth that aches has to be extracted, it would be necessary to draw them all out when they all ache. Therefore, before having recourse to extraction, every other means of cure should first be tried. If the removal of the tooth becomes indispensable, he advises that it should never be performed during the violence of the pain, for from this serious consequences might arise (a prejudice which has not yet entirely vanished, and which is met with, sometimes, not only among common people, but even among physicians); and a still greater danger would be the extraction of teeth neither carious nor loose, seeing that, by consensus, the muscles, the eyes, and the brain might suffer. The author, on this point, quotes Herophilus and Heraclides of Tarentum, who related some cases in which the extraction of a tooth was followed by death. He alludes, moreover, to a passage of Erasistratus, regarding the “odontagogon of lead” (_plumbeum odontagogum_) which was exposed in the temple of Apollo at Delphi; as much as to show that it was not lawful to extract teeth other than those which were so loose that an instrument of lead was sufficiently strong to extract them.

When the looseness of the teeth seems to depend upon the flaccidity of the gums, Celius Aurelianus recommends astringent mouth washes: decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince, of myrtle berries, etc.; and besides these, lentiscine oil and asses’ milk, which latter was also believed to possess astringent virtues. Against hemorrhages of the gums, he advises the use of very fine coral powder, or of alum with honey.

GNAEUS MARCELLUS EMPIRICUS, of Burdigala (Bordeaux), who lived at the end of the fourth century and at the beginning of the fifth, wrote a book, _De medicamenti_, which shows, more than anything else, the decadence of the medical science in those days. Regarding the diseases of the teeth and their cure, Marcellus does not tell us anything new. He freely copies Scribonius Largus and other authors, not adding anything save a few methods of cure, which are exceedingly strange and superstitious. To get rid of toothache, it is sufficient that the patient, when the moon is waning, and in the days of Mars (Tuesday) or of Jupiter (Thursday), repeat seven times the words _argidam_, _margidam_, _sturgidam_. It is a great pity that a curative method so simple and easy be efficacious in two days of the week alone, and even then on condition that the moon be waning.

The following method is also a very good one: Whilst in the open country, one must take a frog by the head, open its mouth and spit into it, then having begged the animal to take the toothache with it, must replace it on the ground and let it free. To remove loose teeth easily, it is necessary to keep in reserve some juice of black ivy mixed with a little green oil; in case of necessity, the nose of the patient must be anointed with it, and after having drawn a deep inspiration, he must put a little stone between his teeth, and stay with his mouth open, inclined a little forward, so as to let all the morbid humor flow out, which sometimes flows very abundantly and even may reach to three herminæ.[185] Having afterward rubbed the nose with pure oil, and washed the mouth with wine, the teeth will be free from every pain and may be very easily pulled out. If the root[186] of a tooth be rubbed with dried African sponge, the tooth will fall out within three days; naturally, says the author, care must be taken not to touch, whilst doing this, any healthy tooth. He who desires never to be subject to pain in the teeth, may obtain this end by the following method: When at the beginning of spring he sees the first swallow, he must go in silence to some running water, take some of it in his mouth, rub his teeth with the middle fingers of both his hands, and say: “_Hirundo,_ _tibi dico, quomodo hoc in rostro iterum non erit, sic mihi dentes non doleant toto anno._”[187]

The same must be done each following year, so as to continue to enjoy the effects of such a cure!

ADAMANTIUS, an Alexandrine philosopher and physician, who probably lived in the fourth century, paid much attention to the diseases of the teeth, as may be argued from two chapters of the _Tetrabiblos_ of Ætius. One of these chapters is entitled, according to the Latin translation of Giano Cornario: “Cura dentium a calido morbo doloroso affectorum, ex Adamantio, sophista.”[188] This writer clearly belonged to the pneumatic school, founded as early as 69 A.D. by Athenæus of Cilicia. According to the pneumatics (so called, because they admitted the existence in the animal organism of an aëriform principle, _pneuma_, to which they attributed great importance), heat and dryness gave rise to acute maladies; the phlegmatic affections generally arose from humidity, and melancholy was brought on by cold and dryness, as every object dries up and becomes cold on the approach of death. The author says that the cure must vary according as the disease affects in a greater degree the gums or the teeth themselves with or without participation of the dental nerves and neighboring parts. He makes, in regard to this, many subtle distinctions; but the remedies which he counsels do not offer to us any special interest, being almost identical with those that had been recommended by Galen and by other doctors prior to Adamantius. The latter also gives much importance to dietetic therapy; he prescribes that such patients should nourish themselves with pottages of barley, or of spelt, with eggs, lettuce, pumpkins, and other cooling food, abstaining, however, from wine.[189]

The author enumerates among the causes of such dental affections the dryness of the air, the autumnal season, the dry constitution of the individual, a troubled life, and scanty nourishment. The use of sour and piquant substances is not favorable to these patients, so much so that the mulberry preserve produces, not unfrequently, violent dental pains in them. Adamantius, therefore, advises, in such cases, not to use strongly astringent mouth washes, but rather lenitive, moistening, and emollient substances; simple lukewarm water, decoction of bran, licorice juice, starch with boiled must of wine diluted with warm water, milk, especially asses’ milk, decoction of mallows and the like.[190]

The work of Adamantius from which Ætius has taken the above-mentioned chapters is lost to us. Of his writings there only remain to us the treatise _on the winds_ and the one _on physiognomics_. In this latter book the author attributes great importance to the canine teeth as physiognomonic elements, and from their shape and size he makes deductions in regard to the character of the individual.

ORIBASIUS (316 to 403), the most celebrated of all the compilers who appeared during that long period of decadence, wrote, by order of the Emperor Julian the Apostate, whose physician and friend he was, a whole medical encyclopedia and later on a summary (synopsis) of this same work of his. In the books of Oribasius are found many things about dentition and diseases of the teeth, but they are all taken, substantially, from preceding authors, and therefore it is not worth while repeating them.

ÆTIUS OF AMIDA, a celebrated Greek writer on medicine, lived at the end of the fifth century, and at the beginning of the sixth, and has also left us a kind of medical encyclopedia, which, being divided into four sections, each composed of four books, was called _Tetrabiblos_. He teaches that the mucous membrane of the gums, tongue, and mouth is provided with nerves from a portion of the third pair of cerebral nerves, and that the teeth, too, by a small hole existing at the end of every root, receive tiny ramifications of sensitive nerves, having the same origin. The nutrition of the teeth is understood by Ætius in the following way: The nourishment which reaches the dental nerves is not entirely assimilated by them; these only appropriate the liquid or soft part and reject the drier part. This accumulates in the alveoli, becomes by degrees more tenacious and denser, finally being transformed into osseous substance and forming the nutriment of the teeth; these, therefore, tend to grow continually, although the waste arising from the mechanical action of mastication prevents them from undergoing any real or visible growth. On the other hand, in the old, from the weakening of the nutritive functions, the teeth become thin and loose, and finally fall out.[191]

Ætius advises that during dentition hard objects to chew should not be given to children, seeing that the gums being hardened by these and becoming almost callous would render the cutting of the teeth very difficult.[192]

For curing parulides, he recommends emollients at the beginning of the disease, and later on astringents. But if the inflammation of the gums does not resolve and passes into suppuration, he prefers to perform the excision of the parulis, instead of making a simple incision, which might very easily cause the abscess to change into a fistula.[193]

The epulis, according to Ætius, is a fleshy excrescence of the gums, brought on by inflammation. To cure it, he uses, during the inflammatory period, emollients, and then, when the inflammation has subsided, astringents and weak caustics. Lastly, if the epulis resist these remedies, he takes hold of it with a vulsella and proceeds to remove it with a small scalpel.[194]

When the incision of a fistula of the gums and the use of appropriate remedies are not sufficient for curing it, Ætius advises the extraction of the diseased tooth, from which the fistula has its origin.[195]

Apart from what has been mentioned, Ætius does not tell us, in regard to dental diseases, anything worthy of note, and in many places he only repeats Galen’s observations.

PAUL OF ÆGINA (seventh century) establishes a very clear distinction between epulis and parulis. The epulis is a fleshy excrescence of the gums in the neighborhood of a tooth; the parulis is an abscess of the gums. To cure the former affection it is necessary, says the author, to seize and stretch the tumor with a vulsella or with a hook and to perform its excision. As to the parulis, although not unfrequently it is sufficient, for curing it, to give an exit to the pus by means of a slight incision, the author, however, usually prefers the method of cure recommended by Ætius, viz., excision. After such operations he orders the patient to rinse his mouth with wine and on the morrow with hydromel.[196] From the third day onward he sprinkles the wound with a cicatrizing powder, until a complete cure is obtained. But if the wound, instead of healing, be transformed into a putrid ulcer resisting all the ordinary means of cure, it is necessary to cauterize the part affected with an oval-shaped cautery.[197]

In extracting a tooth, the operation is begun by detaching the gum all around it as far as the alveolar border; then the tooth is seized with the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus, recommends that before extracting a tooth deeply attacked by caries, the cavity be filled up with lint, in order to avoid the crumbling of the tooth under the pressure of the instrument. On the other hand, he too is convinced that a diseased tooth can be made to fall out without pain, by the use of suitable remedies.

When supernumerary teeth cause an irregularity of the dental arches, this must be corrected, says the author, either by resection of such teeth, if they are very firm, or by their extraction.

If a tooth projects above the level of the others, the protruding part must be removed with the file. This instrument must also be employed to remove the sharp edges of broken teeth.

Tartar incrustations must be removed either with scrapers or by means of a small file.[198]

During the period of dentition one must not give children any food which requires mastication, and to soften the gums they must be anointed with hen’s fat or with hare’s brain.[199]

To preserve the teeth and to keep them healthy, Paul of Ægina recommends all tainted food to be avoided, and also all possibility of indigestion and frequent vomitings; the use of very hard or glutinous food or of such as may easily leave a residuum between the teeth, for example, dried figs, and likewise very cold food and such as set the teeth on edge. He also advises that hard things should never be broken with the teeth and that the latter be carefully cleaned, especially after the last meal of the day.[200]

Paul of Ægina also belongs to the class of compilers; but in utilizing the writings of the great physicians who had preceded him, he gives evidence of exquisite good sense, and not infrequently subjects the assertions of his predecessors to an intelligent and enlightened criticism. Besides, he inserts here and there observations and experiences of his own that are not without interest. He has always been, and rightly so, considered one of the greatest physicians of ancient times, the great reputation which he justly held among the Arabs contributing not a little to his renown.

This author is the last of the Byzantine period, and with him, therefore, we must close the earlier part of the history of dentistry. If, before passing to the middle period, we cast a glance over the ground already traversed, it is easy to perceive that dental art, in ancient times, reached its highest degree of development at the time when the Roman civilization was in its greatest splendor, when, in the capital of the world, wealth, luxury, and the refinements of social life marvellously increased its needs, and by this also gave an impulse to the evolution of all human activity. But ancient civilization, after having reached its culminating point, soon fell into decadence, and this necessarily would result in a hindrance to the development of dental art. From the days of Archigenes right up to those of Paul of Ægina, dentistry did not make the least progress; indeed, as far as prosthetic dentistry is concerned, there was probably a retrograde movement, it being very likely that when Italy was subject to the dominion of the barbarians and when Christianity—which but recently had asserted itself—was strongly imposing on the human mind a deep contempt for all that regarded the welfare and beauty of the human body, no one could, any longer, think of artificially repairing the losses sustained by the dental system through disease or injury.