A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century. Vincenzo Guerini
passages in the Epidemics,70 and in other books of Hippocrates, even when not referring directly to pathological conditions of the teeth, are of value as demonstrating what importance the author attaches to the dental organs, and to the phenomena of which they may possibly become the site.
In establishing the diagnosis of a malady, he recommends searching for its point of departure; for example, if it has begun with a headache, an earache, a pain in the side, and adds, that in some cases the nature of the malady is revealed by the teeth, in some others by swelling of the glands.71 The truth and importance of this observation are not to be doubted.
In fevers, Hippocrates considers it an unfavorable sign if there be a deposit of viscous matter on the teeth, especially when the patient keeps his mouth half open, that is, when he lies in a state of stupor.72
Other prognostics drawn from the teeth or the gums are the following:
“Grinding of the teeth in those who have not this habit when in full health, gives reason to fear a furious delirium and death; but if the patient, already delirious, presents this sign, it is an absolutely fatal one.73 It is also a most unfavorable sign when the teeth get very dry.”
“Necrosis of a tooth heals the abscess formed at the gum.74 This is very easily explained by the fall of the tooth. But Hippocrates knew very well that the affection does not always take such a favorable course; he therefore adds, immediately after:
“In the case of necrosis of a tooth the supervening of a strong fever with delirium gives reason to fear a fatal exit. If, notwithstanding this, the patient be saved, there will be suppuration and exfoliation of the bone.”75
According to Hippocrates, “violent pains in the lower jaw give reason to fear a necrosis of the bone.”76
“Gingival hemorrhage in cases of persistent diarrhea is an unfavorable symptom.”77 In fact, the easy and frequent occurring of hemorrhage of the gums may, in many cases, be an indication of profound alteration of the blood, a condition serious in itself, but still more so when associated with obstinate diarrhea.
In different parts of the books of Hippocrates, the influence of atmospheric conditions on the production of dental and gingival maladies is alluded to.
“Much inconvenience was caused to various persons at that period of time by swelling of the fauces, by inflammation of the tongue, by abscesses of the gums.”78
“After the snow, there were west winds and light rains; colds in the head, with or without fever, were very frequent; in one of the patients, pains were produced in the teeth on the right side, and in the eye and eyebrow.”79
In more than one of his books Hippocrates speaks of special dental or gingival symptoms, having their origin in different maladies, especially those of the spleen:
“In many who have enlargement of the spleen the gums become affected and the mouth has a bad smell.”80
In another place we read:
“Among those persons who have an enlargement of the spleen, the bilious ones have a bad color, are subject to ulcerations of a bad nature, their breath is fetid, and they themselves are thin.”81 Finally, in the Book on Internal Diseases, Hippocrates describes different species of splenic maladies, to one of which he assigns the following symptoms:
“The belly becomes swollen, the spleen enlarged and hard, the patient suffers acute pain in it. The complexion of the individual is altered. A bad smell emanates from the ears. The gums are detached from the teeth and smell bad; the limbs wither, etc.”82
The cases of splenic swellings spoken of by Hippocrates in the above passages must have been owing, without doubt, to grave cachectic conditions (among which, probably, scurvy); and we know that gingivitis, with all its possible consequences (among which expulsive periodontitis), is not only a constant symptom in scurvy, but is also frequent in all diseases attended by profound disorders of nutrition.83
Setting on edge of the teeth is counted by Hippocrates among the many symptoms to which a protracted leucorrhea may give rise:
“One should ask women who have been troubled for some time with a white flux whether they suffer from headache, pains in the kidneys and in the lower part of the belly, as well as setting on edge of the teeth, dimming of the sight, singing in the ears.”84
Hippocrates had also observed that the phenomenon of setting the teeth on edge (stupor dentium) may be produced as well by acids in general, also by acid vomiting;85 and that it may also be produced in many individuals by a strident sound.86
In the second book of Epidemics we find a proposition of the following tenor:
“Long-lived individuals have a greater number of teeth;”87 which is as much as to say that “the having a greater number of teeth is a sign of longevity.” This prejudice is to be found repeated by many authors subsequent to the epoch of Hippocrates, and among these by Aristotle and Pliny. Not even the greatest men are infallible; there is, therefore, no reason to be scandalized if Hippocrates should really have fallen into such an error. Anyhow, it should be observed that only the first and the third book on Epidemics are held to be really authentic, while the other five were probably compiled by other doctors of the school of Hippocrates who did not limit themselves merely to gathering together the many isolated notes and observations left in writing or derived from the oral teachings of their master, but took it upon themselves to introduce into the compilation something of their own besides. It is, therefore, anything but certain that the above-mentioned error is really to be attributed to Hippocrates.
The probable origin of this prejudice, which certainly originated among the people and was afterward accepted by the doctors, is easily to be guessed at. Individuals blessed with dental arches of remarkable beauty and perfection may sometimes convey the impression of having a greater number of teeth than others, for those two rows of regular white teeth, close to one another, strike the optic sense much more vividly than teeth of the ordinary kind. This impression is somewhat analogous, at least as regards color—to the optical illusion which causes a white circle to appear larger than a black one of equal diameter. Now, without doubt, individuals with a perfect denture are mostly healthy and well constituted, and, therefore, live longer, in general, than others. It is also to be noted that these people usually keep all their teeth to a more or less advanced age; and there is no doubt that among adults of the same age, those who have a less number of teeth, by reason of having lost several of them, are, in general, individuals whose organic constitutions are less good, whose health is less satisfactory, and who are, therefore, destined in all probability to live a shorter time than the others. It is, therefore, perfectly true, but only in a certain and very limited sense that “long-lived individuals have a greater number of teeth.”
Geist-Jacobi, perhaps in order to dissipate the erroneous signification of the Hippocratic proposition cited above and to place in evidence that part of it which may be true, has thought well to translate it thus:
“He who lives long keeps many teeth.” But this translation does not render faithfully the idea expressed in the original Greek, ὁι μαχρόβιοι πλείους ὁδόντας ἔχουσιν (literally, the long-lived have more teeth); a proposition that the most celebrated commentators of Hippocrates interpret in the sense given by us, and which Litré translates excellently well in these words: “Avoir des dents en plus grand nombre est un signe de longévité.”
Notwithstanding this prejudice, which survived vigorously for many centuries, the regular number of teeth was not unknown at the time of Hippocrates. This is to be perceived from a brief treatise of the Hippocratic collection, entitled De hominis structura, wherein is written:
“The teeth, together with the molars, are thirty-two.”
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