A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century. Vincenzo Guerini
on the just relation one to another of these principles, as to composition, force, and quantity, and on their perfect mixture; instead, when one of the four principles is wanting or in excess, or separates itself from the other components of the organism, one has a diseased condition. In fact, he adds, if some one humor flow from the body in a measure superior to its superabundance, such a loss will occasion illness. If, then, the humor separated from the others collect in the interior of the body, not only the part that remains deprived of its presence will suffer, but also that into which the flow takes place and where the engorgement is produced.
We have here briefly stated these generalities in order to make ourselves clearly understood in speaking hereafter on different subjects, whether with regard to Hippocrates or to other authors of the time.
In the works of Hippocrates there is not one chapter that treats separately of the affections of the teeth, just as there is no book in which he speaks separately of diseases of the vascular or nervous systems, and so on. There are, nevertheless, a great number of passages scattered throughout the Hippocratic collection from which we can deduce very clearly the great importance that the Father of Medicine ascribed to the teeth and to their maladies.
In the book De carnibus, the formation of the teeth is spoken of among other things. It might have been supposed that Hippocrates would have been ignorant of the fact that the formation of the teeth commences in the intra-uterine life. This, however, is not the case; in fact, he says: “The first teeth are formed by the nourishment of the fetus in the womb, and after birth by the mother’s milk. Those that come forth after these are shed are formed by food and drink. The shedding of the first teeth generally takes place at about seven years of age, those that come forth after this grow old with the man, unless some illness destroys them.”47 And a little farther on one reads: “From seven to fourteen the larger teeth come forth and all the others that substitute those derived from the nourishment of the fetus in the womb. In the fourth septennial period of life there appear in most people two teeth that are called wisdom teeth.”48
There is a passage in this same book De carnibus, in which the great importance of the teeth for clear pronunciation of words is alluded to: “The body,” says Hippocrates,49 “attracts the air into itself; the air expelled through the void produces a sound, because the head resounds. The tongue articulates, and by its movements, coming into contact with the palate and the teeth, renders the sounds distinct.”
The book De dentitione is written in the form of brief sentences or aphorisms, and speaks of the accidents that often accompany the eruption of the deciduous teeth. The most important passages in this short treatise are the following:
“Children who during dentition have their bowels frequently moved are less subject to convulsions than those who are constipated.”
“Those who during dentition have a severe attack of fever rarely have convulsions.”
“Those who during dentition do not get thinner and who are very drowsy run the risk of becoming subject to convulsions.”
“On conditions of equality, those children who cut their teeth in the winter get over the teething period the best.”
“Not all the children seized with convulsions during dentition succumb to these; many are saved.”
“In the case of children who suffer with cough the period of dentition is prolonged, and they get thinner than the others when the teeth come forth.”
In the third book of Aphorisms, where Hippocrates speaks of the illnesses that prevail in the various seasons of the year and in the various ages of life, mention is also made of the accidents of dentition. The twenty-fifth aphorism says: “At the time of dentition, children are subject to irritation of the gums, fevers, convulsions, diarrhea; this occurs principally at the time when the canines begin to come forth, and in children who are very fat or constipated.”
The works of Hippocrates are nearly silent on the hygiene of the teeth; but in the second book, on the diseases of women,50 some prescriptions are to be found against bad-smelling breath. We translate the passage integrally:
“When a woman’s mouth smells and her gums are black and unhealthy, one burns, separately, the head of a hare, and three mice, after having taken out the intestines of two of them (not, however, the liver or the kidneys); one pounds in a stone mortar some marble or whitestone,51 and passes it through a sieve; one then mixes equal parts of these ingredients and with this mixture one rubs the teeth and the interior of the mouth; afterward one rubs them again with greasy wool52 and one washes the mouth with water. One soaks the dirty wool in honey and with it one rubs the teeth and the gums, inside and outside. One pounds dill and anise-seeds, two oboles of myrrh;53 one immerses these substances in half a cotyle54 of pure white wine; one then rinses the mouth with it, holding it in the mouth for some time; this is to be done frequently, and the mouth to be rinsed with the said preparation fasting and after each meal. It is an excellent thing to take small quantities of food of a very sustaining nature. The medicament described above cleans the teeth and gives them a sweet smell. It is known under the name of Indian medicament.”
In the book De affectionibus there is a passage where it is said that inflammation of the gums is produced by accumulations of pituita, and that, in like cases, masticatories are of use, as these remedies favor the secretion of saliva, and thus tend to dissipate the engorgement caused by pituita.
Still more important, however, is the following passage of the same book:55
“In cases of toothache, if the tooth is decayed and loose it must be extracted. If it is neither decayed nor loose, but still painful, it is necessary to desiccate it by cauterizing. Masticatories also do good, as the pain derives from pituita insinuating itself under the roots of the teeth. Teeth are eroded and become decayed partly by pituita, and partly by food, when they are by nature weak and badly fixed in the gums.”
Hippocrates, therefore, considers affections of the teeth to depend in part on natural dispositions, that is, on congenital weakness of the dental system, in part on accumulations of pituita, and the corroding action of the same. If a painful tooth were not loose, it was not to be extracted; but one was to have recourse to cauterization and to masticatories, intended the one and the other to dissipate the accumulation of pituita, believed by him to be the cause of toothache.
It is easily to be understood that as only loose teeth were to be extracted, Hippocrates considered the extraction of teeth a very easy operation, notwithstanding that the instruments then in use cannot have been other than very imperfect; and this is clearly to be seen from a passage in the book entitled De medico, where, after having spoken of the articles and instruments that ought to be kept in a doctor’s office (officina medici), he adds:
“These are the instruments necessary to the doctor’s operating room and in the handling of which the disciple should be exercised; as to the pincers for pulling out teeth, anyone can handle them, because evidently the manner in which they are to be used is simple.”56
Fig. 8
Very ancient dental forceps and two other dental (?) instruments existing in the Archæological Museum of Athens.
Having made mention of the officina medici, we think it opportune to explain here with some precision what is to be understood by this term.57 Medicine and surgery were practised in ancient times in open shops; this was so in Greece, and later also in Rome. When the practice of medicine became secularized through its abandoning the Æsculapian temples, doctors’ shops began to arise in the most important centres of population, to which those in need of assistance resorted or were carried. In time these stations for the practice of medicine, and particularly of surgery, became more and more numerous.
The Hippocratic collection contains a special treatise (De officina medici), which speaks of the conditions these places were expected to fulfil, the articles therein to be contained, the instruments, the general rules relative to operations, the bandages, etc.
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