Chapter VI: is dedicated to the stopping of decayed teeth. The sole (2)

Berdmore considers as the principal advantage of the application of single artificial teeth the support they afford to the neighboring ones. Although in no way an impassioned partisan of dental grafting, like his contemporary, the celebrated surgeon Hunter, he, nevertheless, sometimes had recourse to replantation, recognizing the advantages to be derived from this operation, provided it be ably and opportunely carried out; but he was decidedly averse to transplantation. Before definitely inserting a gold filling, Berdmore considers it a good practice to try the tolerance of the tooth with a temporary filling of cement or some other like substance. His experiments as to the action of acids on the teeth are most interesting. He found that nitric acid destroys the enamel in a quarter of an hour; muriatic acid acts almost as rapidly, but with the difference that it also alters the color of the interior parts; sulphuric acid renders the teeth very white, and, even if used for three or four days, only destroys a small portion of the dental substance, but by reason of its action the enamel becomes rough and can be easily scraped away with a knife. Remarkable experiments on this subject were also made later by Kemme.[509]

PIERRE AUZEBI, a dentist at Lyons, published a treatise on odontology in 1771, which is only remarkable for certain strange ideas that he therein exposes, the entire book being in complete contradiction with the great progress already realized, at that period, in dental science. Auzebi likens the human body to a hydraulic machine, formed by the union of solid and liquid parts. For him the bones are merely _folded membranes_ and the teeth are _bones composed of small membranes_. The author declares that he is unable to admit the theory of germs in the genesis of the teeth because “these germs, being all in identical conditions as to heat and moisture, ought all to develop at the same time like the grains of corn in a field.” Rather than having their origin from special germs, the teeth, he says, are derived from lymph, this being, according to Auzebi, the fundamental substance from which all the hard parts of the body are generated. A drop of lymph gathered at the bottom of the alveolus hardens and constitutes the first beginning in the formation of the teeth. Beneath this other lymph is gradually collected, which pushes upward and the part of the tooth already formed, surrounds the dental vessels, and thus becomes the root of the tooth. To facilitate dentition he recommends, among other things, rubbing the gums with hard, rough, and angular bodies. He also maintains, as does Brunner, that the milk teeth have no roots, contradicting, in this respect, the opinion of Fauchard, of Bunon, of Bourdet, who decidedly affirm that the deciduous teeth are furnished with roots, precisely the same as the permanent ones. According to him, when it so happens that the milk teeth have roots, they are not shed. To calm toothache, the author recommended a sedative elixir, the aspirating of a few drops of which sufficed to obtain the desired effect.[510]

JOHN AITKIN, in 1771, perfected the English key, so as to render the extraction of the teeth easier and to avoid the danger of fracturing the alveolus or the tooth itself, and of injuring the gums.[511]

FRÈRE CÔME, a celebrated French surgeon, also contributed to the perfecting of this instrument.[512]

In 1771-72, Fr. L. Weyland and Henkel recorded some very important cases of diseases of Highmore’s antrum.[513]

W. BROMFIELD, in a collection of surgical observations and cases published in London in the year 1773, also speaks of affections of the maxillary sinus. He says that he has had opportunity of persuading himself that the purulent gatherings of this cavity not unfrequently discharge spontaneously during the night, finding their exit through the natural orifice of the antrum, when the body is in the horizontal position.[514]

JOHN HUNTER, the celebrated surgeon, must be named among the most illustrious champions of odontology in England. He was born February 13, 1728. His first instructor in medical studies was his brother, William Hunter, a scientist of great merit, whose school of anatomy in London was attended by numerous students from all parts of the British Kingdom. Under so excellent a guide John Hunter made rapid progress, and in less than twenty years became the most famous physiologist and professor of surgery of that day. He was surgeon-general to the English army.

His _Natural History of the Human Teeth_ (London, 1771) and his _Practical Treatise on the Diseases of the Teeth_ (London, 1778) initiated in England a new epoch for the dental art, which, abandoning its blind empiricism, began to take its stand on the basis of rigorous scientific observation.

But although Hunter’s merits were great with respect to the scientific development of odontology, we must remember that he was a general surgeon, and not a dentist, and that precisely for this reason he had not, neither could he have, other than a restricted personal experience relative to the treatment of dental diseases. This explains why the anatomical and physiological part of Hunter’s works on the teeth is so far superior to the part concerning practical treatment.

Indeed, in the field of practice, this author often falls into grave contradictions, and is frequently hesitating and uncertain on important points of dental therapeutics.

Hunter gives a very long and detailed description of all the parts constituting the oral cavity and the masticatory apparatus. He sought to establish a scientific nomenclature for the teeth, and in fact the denominations of _cuspidati_ for the canine teeth and of _bicuspids_ or _bicuspidati_ for the small molars originated with him. Hunter says that the enamel of the teeth is a fibrous structure, and that its fibers depart from the body of the tooth like rays. He believes it to be entirely inorganic, as it is absolutely impossible to convert it into animal mucus. The tooth is constituted for the most part by a long mass (it is thus he calls the dentine), which is, however, much harder and denser than any other bone. This part of the tooth is formed of concentric lamellæ, and is vascular, as is proved by the exostosis of the roots and the adhesions that exist at times between the roots and the alveoli. Hunter gives a good description of the pulp cavity and of the pulp itself. He studied odontogeny with great care, as is demonstrated by his special researches on this point. He admits the existence of distinct germs for the enamel and for the dentine. According to him the incisors are formed from three points of ossification, the canines from one, and the molars from three or four. The tooth after its eruption is an extraneous body “with respect to a circulation through its substance, but they have most certainly a living principle by which means they make part of the body, and are capable of uniting with any part of a living body.” The milk teeth, says Hunter, are not shed by a mechanical action of the second teeth, but by an organizing law of Nature. The physiology of the masticatory apparatus is treated by Hunter with great accuracy and most extensively. This author combats, by many arguments, the opinion that the teeth grow continually; he explains the apparent lengthening of those teeth whose antagonists are wanting, by the tendency of the alveoli to fill up, which, however, is not possible in normal conditions, because of the constant pressure exercised upon the teeth by their antagonists.

Caries, says Hunter, is a disease of altogether obscure origin; it is not owing to external irritation or to chemical processes, and seems to be a morbid form altogether peculiar to the teeth. Only in very rare cases does it attack the roots of the teeth. It rarely appears after fifty years of age. Hunter does not admit that this disease may be communicated by one tooth to another. As to its treatment, the caries, if superficial, may be completely removed by filing the decayed part of the tooth before the disease penetrates to the cavity, and its spreading will thus be arrested for a time at least. In cases where the caries penetrates to some depth, without, however, the destruction of the crown of the tooth being so extensive as to render it useless, Hunter believed the best mode of treatment to be extraction and replanting of the tooth after having subjected it to boiling in order to cleanse it perfectly and to destroy its vitality entirely, this being, according to him, the mode of preventing the further destruction of the tooth, which once dead can no longer be the seat of any disease. If, instead, one wishes to have recourse to cauterization of the nerve, it is necessary to reach as far as the apex of the root; which, however, is not always possible. This is a very important point, for no one before Hunter had yet affirmed the necessity of entirely destroying the diseased pulp as an indispensable condition of the success of the filling to be later carried out in order to conserve the tooth.

Hunter is extremely concise when speaking of the filling of teeth; considering the great importance of this argument, his conciseness can only depend on his having had no personal experience in the matter. He considers lead preferable for fillings.

The frequent occurrence of erosion of the teeth, whether of the cuneiform variety or of other kinds, did not escape the attention of this acute observer, but he was not able to give any explanation of it.

In cases of empyema of Highmore’s antrum, Hunter advises the opening of the cavity through the alveolus of the first or second large molar.

Periodontitis is classified by the author among the diseases of the alveolar process. He occupies himself with this affection at great length, seeking to explain the mode in which it is produced. He distinguishes two forms of the disease, according to whether or not there be exit of pus from the alveolus. The alveolar process is, in his opinion, the principal seat of the disease, to which, as a complication, is added the retraction of the gums. For the diseased alveolus the tooth becomes, in a certain manner, an extraneous body, of which it tends to rid itself. The alveolar margins undergo absorption; the bottom of the alveolus tends to fill up, analogously to what occurs after extraction, and the falling out of the tooth ensues as a natural consequence of this process. An altogether similar process, producing the falling out of the teeth, is the normal consequence of senility.

The author considers that the malady in question has as its point of departure an irritation caused by a tooth; and as almost a proof of this he relates a case in which the extraction of the affected tooth, an upper incisor which became too long, and the transplantation of another tooth caused the cessation of the morbid process and the perfect consolidation of the transplanted tooth. However, Hunter does not draw from this isolated case the conclusion that transplantation may be elevated to a method of cure for this malady. Indeed, he says that, so far as is known to him, there is no means of prevention or of cure for it. His treatment, therefore, is merely directed to the curing, in so far as is possible, the phlogistic symptoms, by scarifications of the gum and by the use of astringent remedies. He does not exclude the possibility of a complete recovery, but the mode in which this obtains seems to him as obscure as is the nature of the disease itself.

In speaking of the correction of dental irregularities, Hunter advises not to extract the milk teeth unless this be an absolute necessity. He says, besides, that it is useless to extract any tooth whatever, unless one endeavors at the same time to force the irregular tooth or teeth into their normal position by exercising the requisite pressure upon them. In young subjects the regulating of crooked teeth is an easy matter, because of the softness of the maxillary bone. However, it should not be undertaken before all the bicuspids have come through. To correct protrusion of the upper jaw, the author recommends the extraction of a bicuspid on each side. To regulate the incisors it is sometimes necessary to make them rotate on their axis with the forceps. In certain cases of protrusion of the lower jaw one may have recourse with advantage to the inclined plane.

As a general rule, it is useless to lay bare a tooth with the lancet before extracting it, although in certain cases this may be advantageous in order to render its extraction easier and less painful.

Hunter was a strenuous partisan of replantation and transplantation of the teeth; he made various experiments on animals, and treated this important argument with particular fulness and much better than had been done up to then by others.

In cases of difficult dentition he considered incision of the gums most useful and, if necessary, to be had recourse to several times.

FOUCOU, the French dentist, in 1774, made known a compressor invented by him for arresting hemorrhage ensuing on the extraction of teeth. This instrument, which could be used for either jaw, exercised its pressure not only in a vertical direction, but also laterally, and did not give much inconvenience to the patient. Carabelli, who wrote seventy years later, speaks with praise of Foucou’s compressor, which he considers the best instrument of its kind.

COURTOIS, in his book published in 1775,[515] says that the enamel of the teeth only reaches its perfection of development at twenty to twenty-two years of age, and begins thenceforward to wear away gradually. In speaking of the enamel, he advises avoiding the use of the file as much as possible. This author’s book is interesting for the many important clinical cases it contains.

WILLICH, in 1778, related a most curious case relating to a woman, aged forty years, who had never had her menstrual function, but had, nevertheless, given birth to two children; the extraction of a tooth was followed by an alveolar hemorrhage that lasted an hour; thenceforward, this hemorrhage recurred regularly each month, for the space of eight years.

BÜCKING, in 1782, published a _Complete Guide to the Extraction of the Teeth_,[516] wherein he minutely describes all the instruments, their use, the position of the operator and of the patient, indicating at the same time the instruments best adapted for the extraction of each tooth. He declares himself averse to the practice of subluxation as a means of cure for toothache, a method which, first recommended by the Arab physician Avicenna, and later, in the sixteenth century, by Peter Foreest, had fallen into oblivion for a long time, and was again brought into credit by two celebrated French dentists, Mouton and Bourdet, the latter of whom relates having had recourse to it successfully in not less than six hundred cases.

Notwithstanding the high authority of this illustrious dentist, Bücking does not consider this method of cure advisable, adducing, however, in support of his opinion, arguments of no great value, viz., that teeth after subluxation continue painful for a certain time, and that they always remain in an oblique position. The method in question, which has the effect of breaking the dental nerve, is, in our opinion, practically equivalent to a replantation, or is, in point of fact, a replantation, when the luxation of the tooth is complete. The arguments that Bücking brings forward against it are futile; the first objection, for the most part, does not subsist, and, in any case, the persistence of pain for a short time would be of small importance compared with the great advantage of preserving the tooth; as to the second, it is to be understood of itself that subluxation performed by means of the pelican (the instrument then used for the operation) would cause the tooth to assume an oblique position; but even supposing it did not straighten up of itself, there could not have been any difficulty for the good dentists of that period in forcing the tooth again into normal position and in maintaining it there. The weak side of the operation consisted rather in the fact of its being probably carried out without due consideration of the dangers resulting from the possible alterations of the dental pulp.

At the time of which we are writing many believed that the enamel of the teeth could be regenerated altogether or in part, and that, therefore, it was of no great consequence that it should be worn away by the use of the file or of abrasive dentifrice powders. Thus, for example, the renowned surgeon Theden expressly recommended such powders, as the best adapted for cleaning the teeth and for freeing them from tartar.[517]

VAN WY,[518] the Dutch surgeon, in 1784, related two cases of regeneration of the maxillary bones; other cases of the same kind were related some years later by Percy and Boulet.[519]

CHOPART and DESAULT recommended, in cases of difficult dentition, the excision of the gum in correspondence with the teeth that are to come out, rather than simple incisions.[520]

Pelican for extracting incisor, canine, and molar teeth (Campani, 1786).]

ANTONIO CAMPANI, of Florence, published in 1786 a treatise on dentistry,[521] very elegantly printed, and illustrated with thirty-six plates very neatly carried out. This book, however, contains nothing of real importance for the development of dentistry.

BENJAMIN BELL, the English surgeon, a contemporary of Hunter, also devoted much attention to diseases of the teeth, and, if it may be argued from the clear and precise manner in which he expresses his opinions on various questions relating to dental pathology and therapy, it would seem that he had much greater experience in this field than the celebrated Hunter.

Pelicans for extracting wisdom teeth (Campani).]

With regard to incision of the gums, in cases of difficult dentition, this author contradicts certain assertions of the German surgeon Isenflamm (1782), who argued that when the tooth is already to be perceived through the gum, the incisions are altogether useless, while if the tooth be still at some depth, the gingival incision will soon close again, so that the cicatrix will render the eruption of the tooth still more difficult. Bell admits, too, that lancing the gum is altogether superfluous when the tooth has pierced the tissue, all the more so that the accidents provoked by the eruption are then generally already passed and gone, but the operation ought, in his opinion, to take place much earlier; and should the wound close again before the tooth has erupted, the gum must be lanced a second time.

Campani’s forceps: The first for molar teeth when loose or after having been shaken with the pelican; the second for deciduous teeth.]

Bell contradicts the opinion of Jourdain and Hunter that the morbid gatherings of Highmore’s antrum are generally consequent upon the closing of the normal opening of the cavity in the middle meatus. In many cases of disease of the maxillary sinus this orifice remains open, the liquid therein collected discharging itself not unfrequently through it, in certain positions of the body. Instead of penetrating into the antrum through the nasal orifice, as Jourdain would have it, Bell advises opening the cavity by Lamorier’s, or, better still, by Drake’s method. Except in special cases, the first or second molar ought to be extracted, but preferably the second. After trepanning the alveolus and emptying the cavity, the opening should be closed with a conically shaped peg to prevent its slipping into the cavity. From time to time the liquid that tends to reaccumulate should be allowed exit, and detersive injections should be made, preferably of lime water.

Two key instruments with changeable hooks (Campani).]

Looseness of the teeth, which in old age may be considered a normal condition, is always a disease when it occurs in youth. In certain cases its cause is unknown, in others it depends on an affection of the gums, either of a scorbutic nature or consequent on an accumulation of tartar.

An instrument especially destined to extract loose bicuspid teeth. The screw in the interior of the instrument allowed the hook to be brought to just the right point in each case (Campani).]

According to Bell, dental caries is generally owing to a bad condition of the humors of the entire body and to a peculiar morbid disposition, rather than to external causes acting locally, although these latter may contribute, together with the general causes, to the producing of the disease.

Campani’s dental cauteries: The large ones for cases of post-extractive hemorrhage; the small ones for the cauterization of carious cavities.]

This author was decidedly averse to the use of the file. For stopping carious cavities he advises the use of mastic, gum lac, or wax, if the cavity is large and funnel-shaped; this stopping, however, requires to be renewed frequently. But when the cavity, wider at the bottom, narrows toward the surface, one ought to use gold or, still better, tin-foil. The pulp ought always to be destroyed previously by cauterization.

Bell advises great caution in carrying out transplantation, it having been proved by many examples that contagious maladies of a serious nature may easily be communicated in this way from one individual to another.[522]

In the case of a young woman who had an upper incisor transplanted, WATSON observed undoubted symptoms of syphilitic infection with supervening accidents of exceptional gravity, which in spite of careful treatment ended in death.[523]

Hunter also relates having observed, in seven cases of transplantation, very serious accidents which, however, he did not believe to be owing to syphilis, although bearing a certain symptomatic resemblance to it. Contrariwise, the well-known German surgeon Richter not only admitted the possibility of transmitting syphilis through a transplanted tooth, but even that the transplantation of an altogether healthy tooth from the mouth of a person undoubtedly free from syphilis might be followed by serious accidents of a syphilitic nature, and this because the possible existence of a latent syphilis in the person to whose mouth the tooth was transplanted cannot be excluded; in which case the abnormal stimulus exercised by the transplanted tooth might very well give rise to syphilitic manifestations. Therefore, the fact that the person who furnished the tooth was and continued to be in a state of perfect health (as precisely in the case cited by Watson) would not be sufficient proof that the accidents ensuing on the transplantation might not be of a syphilitic nature.

LETTSON also observed, in certain cases of transplantation, accidents of more or less gravity which he held to be due to syphilis, calling, however, to mind a case cited by Kuhn, of Philadelphia, where the possibility of syphilis was not to be thought of, as the morbid symptoms disappeared entirely, without any treatment, as soon as the transplanted tooth was removed.[524]

AUGUST G. RICHTER, the above-named German surgeon, in those portions of his work dedicated to dental affections and diseases of Highmore’s antrum, treated these subjects with admirable clearness and order, without contributing, however, anything original to the development of dental surgery.[525]

NICHOLAS DUBOIS DE CHEMANT, in 1788, of whom we shall later have occasion to speak again, published in Paris his first pamphlet on mineral teeth, entitled _Sur les avantages des nouvelles dents, et rateliers artificiels, incorruptibles, sans odeur_.

JEAN JACQUES JOSEPH SERRE (1759 to 1830). Among the dentists of the end of the eighteenth century and the beginning of the nineteenth, a special mention is due to Jean Jacques Joseph Serre. He was born at Mons, in Belgium, but his remarkable practical and scientific activity was chiefly called into exercise in Vienna and in Berlin. He published several works, the most important of which is a practical treatise on dental operations.[526]

Among his minor works, one edited in Vienna, in 1788, treats of toothache during pregnancy; another, printed in Leipsic in 1791, treats most extensively of diseases of the gums; a third speaks of the mode of maintaining the teeth and gums in good condition. This little book of dental hygiene, like the rest of Serre’s books, met with great favor, and went through two editions in a brief space of time (Berlin, 1809 to 1812).

The works of this author show great study, very wide practice, and an admirable spirit of observation and research. They had the merit of greatly contributing to raise the level of dental culture in Germany, and one finds in them a pretty nearly complete account of the dentistry of that period. Apart from this, they possess a special interest because of the vast number of dates and important historical facts therein contained.

As it would be useless here to enter into a minute analysis of the contents of these books, we will limit ourselves to mentioning a few ideas of which Serre was a strenuous supporter.

He combats an old prejudice that had recently been reinforced by the authority of Jourdain, that is, that it does harm to extract a tooth when the soft parts around it are inflamed and swollen. He likewise combats the prejudice, also of very ancient date, that teeth ought not to be extracted during pregnancy. Only, he considers it as well to avoid the cauterization of the dental pulp in cases of gestation. In extracting teeth, the forceps ought only to be used after the tooth has been luxated by means of the pelican. Serre highly approves of this instrument, although he recognizes it to be a dangerous one in the hands of those who do not know how to make a proper use of it. This author invented or perfected various extracting instruments, among which a conical screw for extraction of roots hollowed out by caries deserves particular mention, and which, under a somewhat modified form, is still in use.

One of the most interesting chapters of Serre’s great work is the one in which he treats of affections of Highmore’s cavity.[527] He speaks at length of the anatomy of the maxillary sinus, of its relation to the teeth situated below it, of the various modes in which the diseases of the antrum are produced, of their symptoms and treatment. He passes in review the various operative methods, and finds that in general the Cowper-Drake is the one to be preferred to all the others. He says that to open the sinus the simple extraction of a molar suffices in the greater number of cases, the trepanning of the alveolus not being generally necessary.

J. ARNEMAN, in 1766, published at Göttingen a synopsis of surgical instruments[528] that deserves mention in so far that the dental instruments of that time as well as those of earlier periods are therein taken into account with sufficient exactness.

A. F. HECKER attributed the accidents of difficult dentition to a special alteration of the saliva caused by the irritation deriving from the erupting teeth. In these cases the saliva is supposed by him to acquire a high degree of acridness and to become almost similar to the poison of rabies. Departing from this theory, the author declares it to be necessary to mitigate the irritation produced on the gums and other parts of the mouth by the altered condition of the saliva, as well as to modify the quality of the saliva itself and to promote the elimination of the same from the body by emetics and aperients. According to him, liquid carbonate of potash administered in drops, together with syrup of poppy heads, manna, etc., is a most useful remedy, having specially for its effect to diminish the acridness of the saliva.

Besides this remedy, the author extols the use of blisters behind the ears, as also of tepid baths, which calm pain and spasms, favor the excretions, and procure repose and sleep. He rejects the incision of the gums as altogether useless, and is most opposed to the use of opium, which he states renders children liable to apoplexy.

And here we will mention, rather by way of curiosity than for any real historical interest which they possess, two pamphlets on _odontitis_, published respectively in 1791 and 1794 by Ploucquet and Kappis, who maintained that not only the dental pulp, but all the parts that form the tooth are susceptible of inflammation.[529] In Kappis’ pamphlet we find the following ideas developed, upon which we do not think necessary to comment. The inflammatory process consists essentially in the increased flow of humors to a given part and in a more or less intense reaction of the vital force. Both of these things may take place in the teeth. These are liable to swell, that is, to undergo an increase of all their dimensions, in proof of which assertion the author relates the case of an individual, who when attacked by a violent toothache had found the spaces between his teeth so narrowed that it was no longer possible to make use of his usual toothpick, even if he had tried to do so regardless of pain. But when the toothache was over, the same toothpick again became serviceable as before. He says that there is no cause for wonder that in odontitis no redness of the teeth is to be perceived, for in other inflammations as well, redness is wanting, and, moreover, it exists in the interior membrane of the tooth. As in other inflammations, so also in odontitis, the usual issue is resolution. Dental fistulæ may derive from internal suppuration. The impurities deposited on the teeth are by him supposed to be owing to an increase of their secretion! According to the author, caries, the breaking down of teeth apparently healthy, as well as their falling out, is generally caused by an inflammation of these organs, that is, by odontitis, an affection that, he says, may be of very varied kind, the principal forms being the rheumatic, arthritic, sympathetic, and gastric.

RANIERI GERBI.[530] In a book by this author we find recommended a very singular cure for toothache, even of the most violent nature. It is in no way scientific, and is besides not particularly pleasant, notwithstanding that the author, professor at the University of Pisa, was a scientist of merit, enjoying special esteem as a mathematician and cultivator of natural sciences.

Under the name of _curculio anti-odontalgicus_ he describes an insect living habitually inside the flowers of the _carduus spinosissimus_, that could be used with great advantage against toothache, in the following manner: One crushes fourteen or fifteen larvæ of the insect between the thumb and forefinger, and then rubs the two fingers together until the matter remaining upon them is entirely absorbed. Instead of the larvæ (which, as is known, represent the first stage of insect life) one may also use the fully developed insects. One then applies the two fingers that have crushed the insects or their larvæ upon the decayed and aching tooth. If the pain is of a nature to be cured by this means, it diminishes almost instantaneously, and ceases altogether in a few minutes. It is said that the fingers preserve their healing power for a great length of time, even a whole year, and in proof of these assertions Ranieri Gerbi speaks of no less than six hundred cures performed! Other insects besides the _curculio anti-odontalgicus_, used in the same manner, are said to possess the same curative properties, among them the _curculio jaceæ_, _carabus chrysocephalus_, and the _curculio Bacchus_, which last, says Gerbi, has long been used for this purpose by the peasants of Tuscany. The author also says that some German doctors and naturalists experimented with success with several insects indigenous to Germany as remedies against toothache. These insects, also mentioned in a work published in Bayreuth in 1796, author unknown, are:[531] the _coccinella septempunctata_, the _coccinella bipunctata_, the _carabus ferrugineus_, the _chrysomela sanguinolenta_, the _chrysomela populi_, the cantharis or Spanish fly, and others. Later on, Hirsch also extolled the healing power of another insect, the _cynips rosarum_. With regard to the mode of application, Gerbi says that instead of crushing and rubbing these insects or their larvæ between the fingers, one can use a piece of wash leather in a similar manner.

It is to be observed, however, that the insects that are found generally in the ripe wild teasle—or more precisely their larvæ—had already been used for a long time as a remedy against toothache; indeed, we even find these means of cure recommended in the natural history of Pliny. In a book entitled _Histoire d’un voyage aux îles Malouines fait en 1763 et 1764_, by a certain Dom Pernetty, this author speaks of some remedies made known to him by the Superior of the Franciscan friars of Montevideo; and among others one finds the following: “One draws out the worm that is generally found in the head of the fuller’s teasle when this is ripe. One rolls this worm between the index finger and the thumb, lightly pressing it until it dies of languor. The one or the other of the two fingers applied on the aching tooth will have the virtue, for a year at least, of making the toothache cease.”[532]

HEINRICH CALLISEN, in an excellent treatise on surgery[533] published at Copenhagen in 1788, writes at sufficient length and with great accuracy on dental and maxillary diseases. According to this writer, it rarely suffices to trepan one alveolus for the treatment of the morbid collections of Highmore’s antrum, as the maxillary sinus is very often divided by partitions into various cells, so that in order to give exit to the pus contained in each of them, it is necessary to extract several teeth and trepan their alveoli.[534] One ought not, therefore, to give the preference to this method, unless in the case of the teeth in question being decayed. But should they all be in a good state, or should a large opening be necessary because of the nature of the disease in the cavity, it will be better to follow Lamorier’s method, that is, to incise the gum crosswise under the malar process and then, after scraping away the periosteum, trepan the bone. Further, in the case of the disease in the maxillary sinus having given rise to tumefaction, softening of the bone, and fluctuation in the palatine region, it is precisely there that the perforation ought to be carried out. To prevent the reclosing of the opening before the cure is completed, the author advises the use of pledgets, small bougies, a piece of prepared sponge, or even a small tube. According to Callisen, the injections through the nasal orifice of the maxillary sinus are partly impracticable, and partly of no utility.

It always does more harm than good to file or to scrape the decayed part of a tooth, without stopping it afterward, as by thus doing, says the author, one only renders it still more liable to the access and the action of harmful external influences. In preparing the cavity for stopping, the bottom of it should be more ample than its external aperture, that the filling may remain firm.

For extracting molars, he makes use either of the pelican or of the key; for the incisors and the canines, of the forceps; and for roots, of the goat’s foot.

Callisen treats incipient _idiopathic_ epulis by destroying it through cauterization, after having covered the teeth with wax; if the epulis be large and more or less hard, he removes it with the bistoury; as to _symptomatic_ epulis, he holds the removal of the original cause to be the best mode of treatment.

This author declares himself decidedly in favor of replantation and transplantation, expressing the idea that these methods are always to be preferred to the application of artificial teeth. He maintains that after a tooth has been replanted, and its consolidation has taken place, there is no possibility of any further pain, the nerve being broken. The author relates a brilliant cure which he carried out upon a lieutenant, who, during the siege of Copenhagen, had received a blow that had sent all his front teeth into his mouth. Callisen immediately put them all back in their places with such ability that they became perfectly firm again. With reference to transplantation, he only believes in its being possible for teeth with a single root.

In works published toward 1790, Lentin and Conradi, devoted their particular attention to the morbid conditions that produce looseness and spontaneous falling of the teeth. For the treatment of these conditions Conradi recommended general and local remedies. The general remedies were directed to the suppressing of acridness in the blood, which he considered to be an etiological element of primary importance. As to the local remedies, they ought specially to consist in keeping the teeth clean by the use of a toothbrush, in painting the gums with tincture of catechu and myrrh, and in rinsing the mouth frequently with a decoction of cinchona or of willow bark. Against toothache caused by caries, he particularly advises essence of cloves, introduced into the carious cavity on a piece of cotton-wool.[535]

FRIEDRICH HIRSCH was much less disposed than were many of the preceding writers to incision of the gums in cases of difficult dentition. Against the accidents connected with this morbid condition, he prefers, in general, the use of gentle aperients or of emetics, and regards the scarification of the gums as opportune only in cases where symptoms indicating a high degree of nervous tension manifest themselves.

Against incipient caries, Hirsch used simple cauterization, which he held to be capable of arresting the morbid process, at least in many cases. He says, however, that when a real carious cavity exists, it is absolutely necessary to stop it; and for this purpose, rather than metallic or resinous fillings, he prefers a cement of turpentine and quicklime, made into a paste with varnish of oil of linseed. Nevertheless, when it is a case of the lower teeth, tin-foil is also, according to him, an excellent filling material.

Like some of the preceding authors, Hirsch admitted the existence of _interior caries_ in apparently healthy teeth, and was the first to indicate a good mode of diagnosticating these occult dental affections. It consists in tapping the suspected teeth with a sound until one finds the one in which the percussion provokes pain, and this will be the diseased tooth. One detaches the gum from the neck of this tooth, and at the point, on the neck itself or on the beginning of the root, where a small protrusion is found, one perforates the tooth with a chisel, or some other fit instrument, so as to penetrate to the interior of it. Through this passage one introduces into the tooth a fine, curved, red-hot sound, repeating the operation several times. Lastly, one fills the cavity with lead; and in this manner the tooth will be cured and no longer painful.

In speaking of the correction of dental anomalies, Hirsch relates a case in which the deformity consisted in the union of two central incisors, which formed one single piece, resembling a paddle, and spoiled the appearance of the face. He divided them with a saw, cauterized the surfaces of the section, scarified the gum, and, to gain a little space, introduced a small wedge, until the gum had grown up within the new dental interstice, thus giving an altogether normal appearance to the part.

It is noteworthy that Hirsch made use almost exclusively of the goat’s foot for the extraction of teeth, of whatever kind they might be, the instrument being rather longer, however, than that ordinarily known by this name, and making his left hand serve as a lever rest.

To arrest strong hemorrhage ensuing from the extraction of teeth, Hirsch used scraped parchment, which he introduced into the alveolus and pressed with force into it by means of a sound; then he superposed compresses and kept the jaws tight together with a bandage passed around the head.

This author, too, was very favorable to replantation. As to transplantation, he says that even when the gum and the alveolus are quite healthy, the individual entirely free from scurvy and syphilis, and not above fifty years of age, the transplanted teeth do not take root perfectly except in an average of one case in three. For carrying out this operation he never made use of teeth extracted from the mouth of a living person, but, on the contrary, he used the teeth of young and healthy subjects who had died a violent death; these were, besides, carefully cleaned before transplanting them, and in this way the author believed the transmission of disease to be nearly impossible.[536]

Full lower set in hippopotamus ivory, with human front teeth; seventeenth century. (From Guerini’s collection.)]

Upper denture in ivory, at the end of the eighteenth century, for a case in which the last molars and the front teeth were present. (From Guerini’s collection.)]

J. E. WICHMANN combated energetically the practice, then pretty general, of endeavoring to facilitate the eruption of the teeth by incision of the gums. He considered this practice as one to be absolutely rejected, supporting his opinion on the consideration that dentition, being an altogether physiological process, which, moreover, takes place in parts relatively of but little importance, never can give rise of itself alone to serious accidents. Besides this, he says, it is very difficult to say which tooth precisely is about to erupt and at what point. The incisions would, therefore, have to be made by chance, which would often render the morbid condition still more serious.

K. A. BLUMENTHAL endeavored to confute Wichmann’s opinions, with but little success; for, indeed, the same opinions, expressed later by J. H. Sternberg in a more detailed manner and with ampler views of the subject, met with ever-increasing approval. Thenceforth, the practice of gingival incisions in cases of difficult dentition fell more and more into discredit.[537]

ROBERT BUNON,[538] the French dentist, is one of the most illustrious personalities to be met with in the history of our profession. He was born at the beginning of the eighteenth century, and devoted himself betimes to the dental art, gathering instruction therein partly from different dentists and partly from the few odontological books he was able to find. In this manner he learned pretty much all that was known at that time by dentists in general. He then decided to travel, in order to acquire further knowledge and experience. He practised especially in the north of France and in what is now the state of Belgium; at Antwerp, Brussels, Givet, Maubeuge, Cambrai. In his ardent thirst for knowledge, when he happened to pass through a town where some dentist of note resided, he never neglected to call on him, thus acquiring fresh information and perfecting himself as well in the practical exercise of his profession. At the same time, his desire to learn all that was new concerning dental art and science was so intense that he had translations made of the medical and surgical works of Latin, Italian, German, and English authors. However, all this reading, although it enlarged his general knowledge, taught him nothing, or almost nothing, about those subjects that interested him above all the others. His practical experiences, meanwhile, brought a great number of patients to his notice, and, being by nature a very acute observer, he was able to establish the existence of many facts up to then unknown. At this time he commenced his studies on dental erosion, on the development of the teeth, and on the prophylaxis of dental maladies, his favorite subject. “I felt,” he writes, “that the necessity of having recourse day by day to the extraction of teeth resulted from deficient knowledge on our part, and I considered this extreme remedy as one of the greatest evils to humanity.”[539] He therefore endeavored to extend his own knowledge in every possible way, and as one means of doing this he visited hospitals and schools; and, ardent champion as he was of conservative dentistry and of prophylaxis, he succeeded in interesting medical men and surgeons, midwives and schoolmasters, and parish priests as well, in the question of the preservation of the teeth. The teeth he extracted he kept for the purpose of studying the conformation, the lesions, the dental anomalies; sometimes he split them up to examine the dental pulp. And he never neglected an opportunity of procuring anatomical pieces that appeared interesting to him.

In 1728 Fauchard’s book, _Le Chirurgien Dentiste_, appeared. The fame of this work reached Belgium, where Bunon then was, and he immediately set about trying to get a copy of it. After searching in various towns, he finally found one in Givet. He read it with the greatest interest, and later, in one of his works, spoke of it in terms of highest praise. It would seem, however, that he did not learn much that was new to him by reading this book, which proves that he already possessed a vast odontological culture and was also profoundly versed in technical dentistry, which forms the most important part of Fauchard’s book. He was somewhat astonished at finding in this celebrated author’s work hardly anything on the subjects that principally interested him, that is, the erosion, the development of the teeth, and the prophylaxis of caries. This circumstance very clearly reveals the different mental tendencies in these two great men, the one, drawn toward the practical side of the profession which principally interests him and forms the basis of his work, the other, an impassioned searcher into causes, and student of prophylaxis.

After the perusal of Fauchard’s book, Bunon, who had already conceived the idea of publishing the results of his observations and of his own particular studies, felt more than ever the propriety and necessity of doing so; and to realize his idea, he established himself toward the year 1735 at Paris. Two years later, just when the manuscript of his work was almost finished, Gerauldy’s book appeared. Bunon relates that he opened this book in fear and trembling; its title, _The art of preserving the teeth_, gave him reason to fear that Gerauldy might have profited by some of the ideas and observations he had communicated to various persons, to write a book similar to the one that he himself had it in his mind to publish.[540] He was able, fortunately, to convince himself immediately that his fears of being forestalled and plagiarized were unfounded.

Notwithstanding, Bunon was determined not to publish his book until the opportune moment and with all possible probability of success. With this object in view, he made up his mind first to obtain the diploma of surgeon-dentist. To reach this aim, he was obliged to conform to the regulations of the _Edict of May_, 1699, which then regulated the practising of dentistry, and this was as much as to say that he was obliged to enter the College of Surgery, to undertake two years’ practice with a regularly licensed surgeon, to undergo theoretical and practical examinations, and to take oath before the Chief Surgeon of the Realm. Once in possession of the diploma of surgeon-dentist, he was separated thenceforward from the vulgar crowd of charlatans and invested with all the prestige which a degree, so rarely acquired at that time, conferred upon its possessor; but before facing public opinion he desired to make himself known, and, so to say, first to try his ground, by making known some of his newer ideas, and see what reception they might meet with from his colleagues and the public in general. He, therefore, published, in January, 1741, in the newspaper _Mercure de France_, a letter on the so-called _eye tooth_,[541] combating the then widely diffused prejudice that the extraction of an upper canine constituted a grave peril to the eye. He demonstrated the absurdity of this idea by putting in evidence the anatomical fact that the upper canines are innervated by the infra-orbital nerve, which has no relation whatever with the visual organ.

Still better to further his object of making himself a name, he published in the same year and in the aforementioned paper his dissertation on the teeth of pregnant women.[542] There he demonstrated the falseness of the idea that one ought never to extract teeth during the state of gestation, and brought into relief the necessity of treating the dental diseases of pregnant women with still more accuracy than those of other persons.

These publications, bearing as they did the marks of good sense, favorably interested the public opinion. The way was therefore prepared, and Bunon judging the moment to have come for publishing his work, placed it in the hands of a literary man for the necessary corrections of style. He also showed his manuscript to several persons of consideration, but was grieved to perceive that the new ideas put forward in it were skeptically received. He now thought it might be as well to appeal to the judgment of a highly competent authority, and fixed on M. de la Peyronie, Head Surgeon of the Realm. This gentleman, after reading the work, highly praised the author, and Bunon gained permission to publish the book under his patronage, on consideration that he should give his word to furnish the proof of the many assertions made therein on all kinds of subjects.

The goal was now reached, and Bunon, on the strength of such illustrious patronage, published his book in March of 1743, under the title, _Essay on the maladies of the teeth, wherein are suggested the means of obtaining their good conformation from the earliest age, and of assuring their preservation during the whole course of life_.[543]

All the principal journals of the time (_Journal des Savants_, _Journal de Trévoux_, _Journal de Verdun_, _Mercure de France_, etc.) published extracts from the book and eulogized the author, who had even the high satisfaction of receiving an honorable mention from the Royal Academy of Surgery, in the public sitting held in 1743.

Bunon, therefore, was now famous, and had, besides, gained wealthy clients, as we see from the perusal of his observations, where the best names in France are to be met with, put in evidence by him without the least thought of professional secrecy. He could now enjoy his well-merited successes, in accordance with the thought expressed by him in one of his books: “All those who labor for the progress of an art have legitimate right to the honor and to all the recompenses to which success is entitled.”[544]

The study of Bunon’s work proves, in fact, that he had good right to be proud of having written it. The mere perusal of it, however, does not suffice to enable the reader to judge of its merits, for to do this properly, it is necessary to study at the same time his other book, published in 1746, entitled _Experiences and demonstrations made at the Hospital of Salpêtrière and at St. Côme, before the Royal Academy of Surgery, serving as continuation and proof to the Essay on the maladies of the teeth_.[545] The essay is, in fact, a small 12mo book of 212 pages, written in a concise style, and, strange to say, most concise in the most important points.

Many facts of great moment are given under the form of rapid indications, or of assertions without proof; thus their importance is apt to pass completely unobserved by those who do not take the trouble of studying this work thoroughly and with the help of the explanations, illustrations, and comments contained in the second book we have referred to.

M. A. Barden, of the École Odontotechnique of Paris, was the first to undertake a serious and conscientious study of Bunon’s works. By so doing he has thrown full light on the author’s great merits, and brought forward the high scientific importance of his works.

One of the important questions studied by Bunon concerns the hygiene to be observed in order to obtain the development of a good dentition. On this question he rightly establishes the principle that hygiene and dental prophylaxis should begin from the period of the formation of the milk teeth. He works out this principle with rigorous logic, and finishes by tracing the hygiene of the mother during pregnancy, of the woman (be she mother or nurse) during the nursing period, and of the nursling as well.

As to the accidents of first dentition, Bunon sets forth a highly scientific opinion, fully coinciding with the ideas of modern writers, that is, that dentition is not the sole cause, nor even the principal cause, of such accidents, but simply a coöperating cause. He made the observation that in healthy infants, children of healthy parents and nursed by healthy women, the time of teething is gotten over without difficulty, while serious accidents occur frequently in weak and sickly children not brought up and nourished according to hygienic principles, or born, as not often happens, with special hereditary predispositions.

One of Bunon’s merits is that of having attributed to the first teeth all the importance they really have, and of having insisted on the necessity of attentively curing their maladies. He also drew attention to the dangers that may result from the eventual persistence of the first teeth at the epoch of the second dentition, or from the persistence of their roots after the destruction of the crown by caries. These roots, he says, by their contact with the neighboring permanent teeth may infect them, and cause them to decay.

Bunon’s researches into the development of the teeth enabled him to describe precisely the position that the various teeth of the second dentition occupy in the jaw with regard to the milk teeth, before these are shed.