CHAPTER XI.

THE SEVENTEENTH CENTURY.

The first signs of the separation of dental science from general medicine were to be perceived in the sixteenth century, the period in which, as we have seen, the earliest dental monographs appeared. From that time this separation tended to accentuate itself ever more strongly; dental monographs became more numerous and dentistry progressed ever more rapidly, both in its scientific and practical aspects.

In the seventeenth century, about which we are now to speak, we shall have to call attention to many facts of the highest importance for the development of dentistry, and with regard to literature, it is worthy of note that while the publications on dentistry that appeared in the various countries of Europe during the preceding century only amounted to about twenty (taking also into account several pamphlets on the famous golden tooth!), in the seventeenth century the number was considerably higher, that is, about a hundred. We shall speak of the most important of these, as also of the works on general medicine or on surgery of the same period, that present some interest from the point of view of dentistry.

JOHANN STEPHAN STROBELBERGER, physician to the imperial baths of Carlsbad, published in the year 1630 a very curious book, the title of which, being translated, runs somewhat as follows: _Complete Treatise of Gout in the teeth, or, more properly said, of Odontagra or toothache; in which are set forth, theoretically and practically, for the use of physicians and surgeons, the means of mitigating these pains, as well as the various modes of ably extracting teeth with or without instruments_.”[332]

This book merely presents some interest, because it gives us a clear idea of the pitiful state in which the dental art still was in the first half of the seventeenth century, and shows us most clearly what enormous progress our specialty has made in little less than two centuries. Apart from this, Strobelberger’s monograph is of no importance, it being nothing more than a most accurate compilation of all that is to be found on the subject of dental affections in earlier works, especially from the medical point of view; the surgical part of dental therapeutics is treated in a much less complete manner, and prosthesis is entirely excluded from the plan of the work, which, however, is fully in accordance with the title of the book.

Under the generic name of gout,[333] or podagra, are meant, says the author (Chapter I), all the affections produced by diseased humors, falling “by drops” into the articular cavities and the parts surrounding them. Strictly speaking, however, only gout in the feet is named _podagra_, whilst when the disease is seated in other parts of the body it is indicated by other names, gout in the hands being called _chiragra_; in the fingers _dactilagra_; in the knee, _gonagra_; in the elbow, _pechiagra_; in the shoulder, _omagra_; in the spinal column, _rachisagra_, and so on. When the seat of the evil is in the teeth or in their articulations, by analogy it is denominated odontagra, or odontalgia, an affection which Paul of Ægina was the first to consider as being of a gouty nature (Chapter II).

After having spoken of the sensibility of the teeth (Chapter III), of the various kinds of dental pains (Chapter IV), of the different causes, external and internal, which produce them (Chapters V to VII), of the signs which make known their special nature in each case (Chapters VIII to X), and of the prognosis (Chapter XI), the author occupies himself very minutely, throughout the rest of the book, with all that concerns means of cure, dedicating to this subject sixty-seven chapters and a long appendix.

If, after the publication of Strobelberger’s book, all previous works treating of dental affections had been entirely lost, it would be of inestimable value for the history of dentistry, the author having gathered together in an almost complete manner—citing faithfully the respective authors—all that had been written about dental diseases before him. On the other hand, the book contains almost nothing original; therefore, rather than analyze minutely its contents—which would involve a long repetition of things already noted—we limit ourselves merely to a few observations.

Strobelberger, like Heurnius, is of opinion that for the cure of dental pains it is necessary to have recourse to doctors rather than to _dentispices_, or tooth drawers (Chapter XII); however, he does not consider the calling of the latter absolutely useless; indeed, he expressly advises (page 174) that they should be applied to for the instrumental extraction of the teeth, it not being possible for such operations to be carried out well and without danger except by those who, through great practice, have acquired the necessary skill in the use of the relative instruments. He refers to the words of Hollerius, already quoted, as to the falseness of the opinion that fumigations made with the seeds of hyoscyamus cause the worms to fall out of the teeth. Notwithstanding, he does not in the least doubt the existence of the worms themselves; and he, like Heurnius, recommends killing them with oil of vitriol or with a decoction made from a frog cooked in water and vinegar (Chapter XXXIII). From this, one clearly perceives that the doubts expressed by Hollerius about the existence of dental worms had not in the least shaken the popular belief in them. Nor, indeed, could it be otherwise when one considers that Hollerius, as we duly noted in another place, had not the courage either decidedly to deny the existence of dental worms, or to formulate in a clear and explicit manner the doubts which had arisen in his mind on this subject. We are, therefore, unable to recognize the merit which Linderer[334] and Geist-Jacobi[335] have attributed to this author, viz., that of having effectually affirmed the non-existence of dental worms.

Among innumerable vegetable remedies recommended by Strobelberger against odontalgia, we will only cite two American plants, the guaiacum and the tobacco-plant (Nicotiana tabacum). Of the decoction of guaiacum (Chapter XXXVI) the author says that, used as a mouth wash, it has the triple virtue of strengthening the gums, of preventing putrefactive processes, and of calming toothache.

The anti-odontalgic virtue of tobacco is mentioned (Chapter XXXVIII) for the first time in this work, but, as we learn from Strobelberger himself, Heurnius has already obtained, experimenting in his own case, the cessation of an attack of toothache by holding in his mouth spoonfuls of tepid decoction of nicotiana for the space of two hours.

The same soothing effects may be obtained, says the author, from the smoke of tobacco; but he attributes this not to the narcotic action of the remedy, but to the fact that it causes the flow of much saliva from the mouth and mucus from the nostrils, through which the morbid humors which provoke the pain are eliminated.

To those suffering from odontalgia, says Strobelberger (Chapter XL), the internal use of certain mineral waters is also of value, and especially that of the waters of Carlsbad (Thermæ Carolinæ). Like many other remedies, they are useful in rendering the secretions more active, favoring thus the elimination of morbid substances from the blood. For the same object of purifying the organism and dispersing the accumulated humors causing the pain, many other means of cure were in usage, such as aperients (Chapter XXV), phlebotomy, and arteriotomy (Chapter XXVIII), leeching (Chapter XXIX), scarification and cupping (Chapter XXX), blistering and cauterizing (Chapter XXXI), masticatories, viz., substances intended to be chewed for the purpose of exciting salivary secretion (Chapter XXVI), sternutatories, viz., substances which provoke sneezing (Chapter XXVII), and so forth.

Like Arculanus, Strobelberger makes a distinction between the _real_ and the _false_ cure of odontalgia (_cura vera et cura mendosa_). This latter he also subdivides in _palliative_ cure and _vain_ cure (Chapter LV). The palliative cure is constituted by the use of narcotics and stupefying remedies (Chapter LVI), whilst the vain cure is represented by certain remedies which he calls “fanatical” or rather “fantastical.” The _vain_ cure, in its turn, undergoes a new distinction, since it comprises three species of remedies, that is, the wearing of amulets, the superstitious remedies, and the ridiculous remedies. Indeed, this last apellation might also fittingly be applied to the preceding ones!

One would be inclined to believe that the author who qualifies these remedies as vain, fantastic, superstitious, and ridiculous was a thoroughly unprejudiced man; however, this is not so. Strobelberger, too, had to pay his tribute to the dominating prejudices of his century; this manifestly appears from various passages in his book, and especially from the Chapters XVI and XLIV. The first of these bears the following title: “How to procure immunity from toothache,” and Strobelberger therein asserts in all seriousness, basing his assertion on the authority of Rhazes, that “if the canine tooth of a lion be suspended to a child’s neck before the milk teeth fall out and during the eruption of the second teeth, it will secure the child immunity from dental pains.” In Chapter XLIV the author speaks of those animals whose teeth are useful to man as remedies against toothache, and reiterates—lending, as it seems, perfect faith thereto—various prejudices that are found in Pliny and other writers of antiquity.

As to the remedies which Strobelberger recognizes as _vain_—that is, as devoid of real curative virtue—he remarks that they may nevertheless be useful by acting powerfully on the imagination of the sufferer, thus causing, in fact, the cessation of pain (Chapter LVII). This clear and explicit affirmation of the efficacy of suggestion in a book published 270 years ago is certainly not without interest.

If, says Strobelberger, a place is to be accorded, in dental therapeutics, to the _vain_ remedies, among these, amulets deserve the preference; and the best accredited amulet is the root of the lepidium, already recommended by Dioscorides, who affirms that if it be hung around the neck of the sufferer it will cause the pain to cease.

One of the _superstitious_ remedies to be used against this affection (Chapter LVIII), consists in touching the aching tooth with the tooth of a dead person, and afterward greasing it with horse’s marrow.

Among the _ridiculous_ remedies (Chapter LIX), the author describes one that was especially in use among soldiers. With a piece of chalk or of rubble one writes on a table:

Chiacia Chiacia Chiacia X O X X O X X O X

One then pricks the tooth with a knife or an iron toothpick until it bleeds slightly; then thrusting the point of the instrument, to which the blood adheres, into the first cross, then into the second, then into the third, and so on, one asks the patient each time if the tooth still pains him. Before one gets to the last cross the pain ceases! This stolid cure, says the author, has no other value than that of the scarification of the part affected.

Strobelberger held, as did many of the preceding authors, that the extraction of a tooth ought to be the _last_ remedy, that is, to be had recourse to when all others, including cauterization, which he considers as the _last but one_, have proved ineffectual. There are cases, however, in which the extraction of a tooth is absolutely indicated, and here, by the way, the author acquaints us with the following poetic aphorism, which expressed the unanimous opinion of doctors:

Si dens pertusus, vel putridus esse notatur, Corrumpens alios, tunc protinus ejiciatur.

That is, if one finds that a tooth is hollow or decayed, and corrupts the others, it must at once be extracted.

Strobelberger, like the greater number of his predecessors, is fully persuaded that diseased teeth may be made to fall out by the use of special remedies; indeed, this clearly appears from the title of the work itself, as, without doubt, the reader will already have observed. Such remedies are called by him “odontagoga,” and he describes them at great length in five different chapters (X to XIV) of the second section of his book, dedicated to the surgical care of the teeth.

In regard to _violent extraction_ of teeth, Strobelberger shows still greater cautiousness and timidity than Celsus or Abulcasis. He requires that, after the gum has been detached, one should endeavor to extract the tooth with the fingers or by means of a thread; if, however, this does not succeed, one may have recourse to the trifid lever; only at last, that is, when even the lever has failed, does he allow the use of an appropriate dental forceps.

[Illustration: Wilhelm Fabry.]

ARNAULD GILLES, a Frenchman, in the year 1622, published in Paris a work whose curious title we will here note: _The flower of the remedies against toothache_.[336] We know nothing else about this publication, which, however, to judge from its title, cannot be other than a mere compilation.

DUPONT, another Frenchman, in 1633, published an important pamphlet, which I have, unfortunately, not been able to see. I can, therefore, only quote what Sprengel says of it.[337] Dupont recommends, in cases of obstinate toothache, the extraction and immediate replantation of the tooth; which, he says, becomes quite firm again, but will no more cause any pain. In confirmation of this, Denis Pomaret related, a little later, a case in which a healthy tooth having been pulled out by mistake, and immediately put back into the socket and treated with astringent remedies, became perfectly firm again.[338]

Although Abulcasis and Ambroise Paré had already recommended the replantation of teeth, the loss of which had been caused by trauma, and although Peter Foreest had already made known as a result of his own personal experience that the luxation (not, however, complete extraction) of a tooth and its successive replantation is capable of causing toothache to cease, nevertheless, we must recognize that the merit of having elevated replantation in non-traumatic cases to a special method of cure must be attributed to Dupont.

WILHELM FABRY (1560 to 1634), a German, and native of the small town of Hilden near Cologne, better known by his Latin name of Fabricius Hildanus, was chief doctor to the city of Berne, and acquired great fame as well by his extraordinary professional ability as by his works, consisting principally in reports of many hundreds of important and instructive clinical cases. He is rightly considered one of the most illustrious German surgeons. His writings have largely contributed not only to the progress of surgery in general, but also to that of dental surgery in particular.

One of his observations clearly shows the etiological relation frequently existing between a prosopalgia or a supposed hemicrania and a dental affection. The case referred to is that of a lady who had been subject for six months to violent pain in the upper teeth of one side of the jaw. The toothache little by little disappeared, giving place to an obstinate cephalalgia in the same side of the head, which gradually became so intense as to be perfectly insupportable, the patient being particularly subject to it when the weather was cold and damp. After four years of atrocious suffering, and after innumerable remedies had been tried without avail, Fabricius Hildamus—having had the luminous idea of seeking the cause of the evil in the teeth—obtained a complete cure, without further trouble, by extracting four of the patient’s teeth, which were decayed.

Nowadays, it is an all-important canon of medical practice, that in every case of neuralgia occurring within the region influenced by the trifacial nerve one should give particular attention to the state of the teeth and carefully treat every affection of the same. Notwithstanding—we say it with regret—there are still medical men who ignore or neglect this precept, and prescribe internal remedies or have recourse to injections of morphine when they ought, in the first place, to call in the aid of a dentist. How many patients would have been delivered from slow martyrdom if the example of the clear-seeing physician of Berne had been followed from his days up to the present time!

Fabricius Hildanus relates, besides, many cases of dental fistula, cured by him through the extraction of roots or of decayed teeth. In one such case the fistula dated from fourteen years back. Fabricius Hildanus, contrary to the opinion of many other doctors, extracted a decayed tooth, and by this operation obtained, in a brief period of time, the complete recovery of the patient.

Among the many very important clinical cases cited by Fabricius Hildanus, the following deserves to be recorded: In the year 1590 a woman presented herself to him who had a hard tumor in the space behind the last molar on the right side. The author, after having prepared the patient for the operation by the methods then in use (that is, by aperient medicine, by bleeding, and appropriate diet), destroyed the tumor by the application of escharotic substances. The remaining wound, however, defying all the cicatrizing remedies which the author had recourse to, one after the other, by reason of its being continually disturbed by the movements of the jaws, he then thought of maintaining the dental arches in a determined position, and this he obtained by means of two pieces of wood somewhat hollowed out above and below, which he placed on the right and on the left between the upper and the lower teeth, fixing them to the teeth themselves by brass wires passing through two openings made expressly in each of the two pieces of wood. In this way he succeeded in obtaining the absolute immobility of the jaws and the complete cure of the wound in a few days, during which time the patient was nourished with liquid food.[339]

A very interesting case, inasmuch as it demonstrated the damage and peril which may result from certain absurd means of cure, was reported to this author by Claudio Deodato, physician to the Prince-Bishop of Basle. The case was that of a patient who, after having tried in vain a great number of remedies for a stubborn toothache, finally had recourse to the use of aqua fortis; but this substance, which in those days was in frequent use for dental caries and for toothache, produced most deleterious effects in the patient, that is to say, the loss of almost all his teeth, necrosis of the inferior jaw, with fistulous sinuses and ulceration of the neck, abundant sanious discharge, fever, a cachectic condition, incipient necrosis of the upper jaw, etc.[340] Fabricius Hildanus, consulted by Claudio Deodato about this most serious case, proposed both a local and a general treatment, the result of which is, however, not mentioned in his book.

In the fifth “_centuria_ of medical and surgical observations and cures”[341] we find a case of oral surgery, to which it is worth while briefly to refer here. It relates to an epulis situated next to the upper canine of the left side. The tumor, already of ancient date, had at this time reached the size of a walnut, was very hard, livid in color, irregular in form, and adhered somewhat to the upper lip; according to the author, it was of a cancerous nature. After the usual preparative measures, Fabricius Hildanus proceeded to the ablation of the tumor, and to this end he first pierced it with a curved needle and strong thread, in order to get a good hold on it, and he then removed it entirely down to the bone, by means of a curved bistoury.[342]

Fabricius Hildanus, having dissected several abortive fetuses of under four months, was able to verify the exactitude of the assertion made by Hippocrates, afterward luminously confirmed by different Italian anatomists, that the teeth begin to be formed during intra-uterine life. And with reference to this he also relates the following fact:

The wife of a Protestant minister gave birth to a female child which already had a fully developed tooth, a lower middle incisor, equal in size to that of a child of two years old, and which interfered with the sucking by injuring the nipple of the mother’s breast and the tongue of the child itself. So it was necessary that it should be removed. But it was found to be so firm that the surgeon sought in vain to extract it with a thread, and was obliged to have recourse to the forceps.[343]

Observation XXXI of the third _centuria_ relates a case of rhinoplasty. In the year 1590, when the Duke of Savoy made war on the inhabitants of Geneva, a girl named Susanna N. fell into the hands of the soldiers, who tried to deflower her; enraged at not succeeding in their intent, they cut off her nose. Two years later the girl went to Lausanne, the residence of J. Griffon, an eminent surgeon of that time, who performed the rhinoplastic operation on her in so splendid a manner that one would have taken the new nose for a natural one, not only from its normal appearance, but also because the scar was hardly visible. Fabricius Hildanus, having had occasion to see and examine the patient several times, even up to twenty-one years after the operation, was able to testify to the perfect condition of the nose; in the extreme cold of the winter, however, it was apt to become livid at the point. He does not describe the operative process followed by Griffon, but merely says that the first inventor of this operation was Gaspare Tagliacozzi, of the University of Bologna, and that Griffon had undertaken the reproduction of the same from his own conception of it, based on the information imparted to him in conversation, by an Italian who had been operated upon by Tagliacozzi.

JOHANN SCHULTES (1595 to 1645), a physician in Ulm, was the author of a very important work entitled _Armamentarium chirurgicum_, in which are given plates and descriptions of almost all the surgical instruments that had been in use up to that date. As to the part relating to dental and oral surgery, we find the following instruments named in this work:

1. Several kinds of pelicans; an instrument which was so called from its resemblance to the beak of the bird of the same name, and used for extracting the molar teeth.

2. The common dental forceps, then named _cagnolo_ by the Italians, because of the supposed likeness to a dog’s muzzle.

3. The crow’s beak forceps (_rostrum corvinum_), designed for the extraction of dental roots, and, therefore, corresponding to the rhizagra of Celsus.

4. Two special dental forceps, or _dentiduces_, for the removal of teeth which could not be extracted either with the pelican or with the common dental forceps.

5. Bifid and trifid elevators (_vectes bifidi et trifidi_), to be used for the extracting of incisors and canine teeth, as well as roots.

6. _Dentiscalpia_ for detaching the gum from the tooth before proceeding to extract it, in order that this may be the more easily accomplished and with less danger.

7. A silver funnel or cannula (_infundibulum seu fistula argentea_), for nourishing patients affected with trismus, by conveying liquid food into the fauces, through the free space behind the last molars.

8. Forceps more or less like in form to the beak of the parrot or the vulture (_rostrum psittacinum et vulturinum_), for the removal or resection of teeth that have grown in abnormal positions.

9. A screw dilator (_dilatatorium cum cochlea_), for gradually opening the dental arches in cases of spasmodic constriction of the jaws.[344]

[Illustration: _A plate of Schulte’s “Armamentarium Chirurgicum,” showing some dental and other operations._]

[Illustration: FIG. 77

A plate from Schultes’ “Armamentarium chirurgicum,” showing several dental instruments.]

MARCO AURELIO SEVERINO (1580 to 1656), of Tarsia, a celebrated professor of surgery in the Neapolitan University, had a great predilection for the use of the cauterizing iron, which he also used very frequently in curing caries and other dental diseases. At times, to effect a cessation of violent toothache, he would have recourse to the cauterization of the antihelix! Against flaccidity of the gums and loosening of the teeth he also used cauterization, disapproving the use of astringent substances, as these cannot get so far as the roots of the affected teeth. Severino boasts of having cured by cauterization at least two hundred cases of dental diseases.

LAZARE RIVIÈRE (1589 to 1655), a professor at the University of Montpelier, also known by his latinized name of Lazarus Riverius, treats of dental affections and their cure, in various parts of his works, considering them, however, almost exclusively from a medical point of view.

He speaks first of all of the different causes of odontalgia, and, among these, does not omit to mention worms. These, he says, may be generated in the carious cavities, owing to the putrefaction of substances retained in their interior. Whenever odontalgia is caused by worms, the pain, says Rivière, is not continuous, but ceases and returns at brief intervals; besides, the sufferer perceives at times the movement of the worm inside the tooth!

What one reads in the works of this author as to remedies to be used for odontalgia clearly demonstrates how irrationally dental diseases were treated in the seventeenth century and what tortures were inflicted on the patients. In many cases, and especially when the pain was held to be occasioned by “hot humors,” the treatment was begun by bleeding in the arm. The following day an aperient was administered. Afterward, if the pain still persisted, the sufferer was cupped in the region of the scapulæ or of the spine, blisters were applied to the nape of the neck or behind the ears, resinous plasters to the temples; all this without taking into account the remedies which were introduced into the ears, or the various medications or operations performed on the aching part itself, and many other things besides. In fact, in order to cure a toothache, the whole body of the sufferer was seized upon and put to torture, and in the majority of cases they assuredly finished by extracting the diseased tooth! When we reflect on the extraordinary frequency of dental disorders we cannot do less than recognize that the dentists, by the radical change effected in the methods of treatment, have diminished in no small degree the sufferings of humanity!

According to Rivière, the small veins (sic) that nourish the teeth pass through the ear (!); and this would explain how the cessation of a toothache may be obtained by the introduction of certain remedies into the meatus auditorius externus. Relief may be obtained, for instance, by dropping oil of bitter almonds into the ear on the side affected by the pain, or by allowing the vapor of hot vinegar, in which pennyroyal or origanum has been boiled, to penetrate into it. Others, adds the author, pour a little pure vinegar into the ear, which is especially efficacious against “hot fluxions.” When, however, the toothache depends on a “cold fluxion,” it calms the pain wonderfully to drop into the ear a tepid mixture of garlic juice and theriac. The same advantage, says the author, may be obtained by introducing a piece of garlic, peeled and cut into the form of a suppository, into the ear.

The author also makes a lengthy enumeration of anodyne and narcotic remedies (among which opium), observing, however, that those remedies, unless the vehemence of the pain obliges the use of them, ought not to have the preference, it being much more rational and much more advantageous to institute a cure which aims directly at the cause itself of the pain (fluxions, worms, etc.).

He informs us that Amatus Lusitanus, a celebrated physician of the sixteenth century, extolled, as a remedy for toothache, a decoction of gum sandarach in wine and vinegar; the said decoction was to be made with an ounce of sandarach in six ounces of wine and the same quantity of vinegar, and ought to be kept in the mouth some length of time, whilst hot.

Rivière further speaks of various masticatories, which were composed of mastich, staphisagria, pyrethrum, henbane, etc.

He also mentions oil of cloves, which even then was used against toothache, by introducing into carious cavities a small piece of cotton-wool soaked in it. Oil of camphor was used in the same manner, but the most efficacious of all, according to the author, was oil of boxwood.

As to worms in the teeth, they may be destroyed by the use of bitter substances!

In the case of a caries penetrating into the inner cavity of the tooth, to effect the cessation of pain, it is necessary to burn the nerve with the actual cautery, or with aqua fortis, or with oil of vitriol. If this be repeated several times, the tooth gradually falls to pieces.

After having enumerated all these remedies, the author speaks of the extraction of the teeth, and of all the precautions with which this must be carried out in order to avoid the various accidents which may result from the operations and may even, sometimes, become a cause of death.

When abundant hemorrhage follows the extraction of a tooth, this may often be made to cease by applying a small, very compact ball of linen into the alveolus and maintaining it there by pressure during one or two hours. Should this not suffice, one can combine with compression the use of astringent substances. F