Читать книгу A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century - Vincenzo Guerini - Страница 13

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.

About six hundred years later, Galen wrote three books of commentaries on this treatise of Hippocrates. He says, among other things, that the doctor’s shop ought to be spacious and furnished with wide openings, to let in abundance of light. These medical stations to which the sick and infirm repaired in great numbers to ask advice, to undergo operations, or receive medical dressings, must have been of great importance, as is to be presumed from the cited books of Hippocrates and Galen.

The greatest doctors of antiquity practised the medical art in these places. It is also said that the great philosopher and naturalist, Aristotle, who came of a race of doctors, had inherited a doctor’s shop of great value, but that notwithstanding this he refused to dedicate himself to the medical profession.

The doctors’ shops were at the same time real pharmacies, where doctors prepared medicines, and where all the remedies then in use, either simple or compounded, were kept and sold to the public. Besides, there were to be found instruments of every kind and articles for medicating; and, therefore, bandages, compresses, lint, sponges, cupping glasses, cauteries, knives, bistouries, lancets, sounds, needles, hooks, pincers, files, saws, scrapers, splints, appliances for replacement of luxated bones, speculums, trepans, apparatus for fumigation, trusses, and a thousand things besides.

Naturally, dentistry was also practised in these shops, either by doctors who occupied themselves with dental maladies as with those of any other part of the body, or, later on, by individuals who dedicated themselves exclusively to this specialty.

Medicine and surgery were exercised, however, not only in doctors’ shops, but also at the patients’ houses, and it was Hippocrates who especially inaugurated clinical medicine—that is, the practice of visiting patients in their beds.

But we must not digress from our argument.

Many observations relative to the teeth are to be found in the seven books of Hippocrates on Epidemics. Unfortunately, the observations are not always given in clear and precise terms, which principally depends on the fact that these books consist for the most part of simple and most concise notes, written by Hippocrates on cases observed by him, and not intended for publication under such form, but rather constituting the material for further work.

Here is a passage from the fourth book on Epidemics, which reveals Hippocrates’ extraordinary power of observation, for even teeth that had fallen out were minutely examined by him, to the end of acquiring precise ideas on the anatomical conformation of these organs, held by him to be of the highest importance.

“In the youth suffering from a phagedenic affection in the mouth, the lower teeth fell out, as well as the front upper ones, which left a cavity in the bone. The loss of a bone in the roof of the mouth causes depression in the middle of the nose; the falling out of the upper front teeth sometimes causes a flattening of the point of the nose. The fifth teeth counting from the front ones had four roots (two of which were almost united to the two contiguous teeth), the points of which were all turned inward. Suppurations arising from the third tooth are more frequent than from any of the others; and the dense discharge from the nose and pains in the temples are specially owing to it. This tooth is more apt to decay than the others; but the fifth does so, as well. This tooth had a tubercle in the middle and two in the front; a small tubercle in the internal part, on the side of the other two, had first begun to decay.58 The seventh tooth had only one large, sharp-pointed root. In the Athenian boy, there was pain in a lower tooth on the left, and in an upper one on the right. When the pain ceased, there was suppuration of the right ear.”

This last fact—of the suppuration of the ear—is mentioned by Hippocrates not as a simple coincidence, but as a fact intimately connected with the cessation of the toothache. This may be argued from the general ideas of Hippocrates in regard to the beginning and the resolution of diseases. He considers a malady to be produced by a humor, which becomes localized in a given point of the body. The crisis gives exit to the peccant humor,59 and the mode in which this is evacuated constitutes the critical phenomenon; the same may be represented either by a profuse perspiration, by abundant urine, by diarrhea, by vomiting, by expectoration, by bleeding or discharge of other humors from the nose, by the issuing of pus from the ear, and even by deposits on the teeth.60 If by effect of organic sympathies the morbid humor, instead of being thrown outward, be transported into another region of the body, this constitutes the so-called metastasis.

The hints just given will serve to render some of the passages which we quote from the works of Hippocrates more intelligible.

In the fourth book on Epidemics we find among other clinical cases the following:

“Egesistratus had a suppuration near the eye. An abscess manifested itself near the last tooth; the eye directly got quite well; there was a dense discharge of pus from the nostrils; and small, rounded pieces of flesh were detached from the gums. It seemed as though a suppuration at the third tooth were going to take place, but it went back; and suddenly the jaw and the eye swelled up.”61

And farther on one reads:

“In Egesistratus the two last teeth were decayed in the parts where they touched one another. The last had two tuberosities above the gum, one on the decayed side, the other on the opposite side. In the part in which the two teeth were in contact with one another there were two roots in each, large and similar, and corresponding to those of the contiguous tooth; on the other side there was only a half root62 and rounded.”

Toward the end of the fourth book on Epidemics, we find repeated an observation which we have already noted:

“The third upper tooth is found to be decayed more frequently than all the others. Sometimes a suppuration is produced all around it.”63

In the following passage mention is made of a mouth wash against toothache, the basis of which is castoreum and pepper:

“In consequence of a violent toothache the wife of Aspasius had her cheeks swollen up; but on making use of a mouth wash of castoreum and pepper she found great relief.”64

A little after we find the practice of bleeding mentioned; and contemporarily an allusion to the use of alum—with regard to a painful swelling of the gums, that is to say, a gingivitis:

“Melisandrus suffered severe pain and swelling of the gums; he was bled in the arm. Egyptian alum, if used in this malady, arrests its development.”65

Toward the commencement of the sixth book the following observation is registered:

“Among those individuals whose heads are long-shaped, some have thick necks, strong members and bones; others have strongly arched palates, their teeth are disposed irregularly, crowding one on the other, and they are molested by headache and otorrhea.”66

While we should be tempted to attribute the knowledge of the relations between malformation of the skull, ogival palate, and bad arrangement of the teeth to quite modern studies, we are obliged to admit, and to our great surprise, that these relations were already noted, twenty-four centuries back, by the great physician of Cos.

In the seventh book on Epidemics, a case of scorbutus is described, where incense and a decoction of lentils proved useful against the lesions of the buccal cavity:

“… Large tubercles, of the size of grapes, had formed on the gums close to the teeth, black and livid, but not painful, except when the patient took food. For the mouth, incense powder mixed with some other ingredients proved useful. The internal use of the decoction of lentils also did good to the ulcers of the mouth.”67

In the same book there is a passage in which Hippocrates warns against the use of origanum, as harmful to the teeth and eyes:

“Origanum in drinks is harmful to affections of the eyes, and also to the teeth.”68

Farther on a case of necrosis of the jaw is mentioned:

“Cardias, the son of Metrodorus, by reason of pains in the teeth was subject to mortification of the jaw. Excrescences of a fleshy kind formed on the gums, that grew most rapidly; the suppuration was moderate; the molars fell out and afterward the jaw itself.”69

Some 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.”

Among the many and many counsels of practical value registered in the works of Hippocrates, the following deserves special mention:

“When a person has an ulcer of long duration on the margin of the tongue, one should examine the teeth on that side, to see if some one of them does not, by chance, present a sharp point.”88

In fact, it not infrequently occurs that a lingual ulcer deriving from irritation produced by a broken or sharp tooth assumes a malignant aspect that causes it to be mistaken for a cancerous ulcer, and medical men may even be so far misled as to advise the extreme remedy of amputation of the tongue. If, however, the consulting surgeon has some experience, he will not neglect in the first place to examine accurately the state of the patient’s teeth; it then mostly happens that after the removal of the offending tooth a complete cure is obtained in a brief space of time. How much anxiety would not such poor sufferers be spared if physicians in general were acquainted with the counsel given by Hippocrates twenty-four centuries ago!

In speaking of fracture of the lower jaw, Hippocrates recommends binding the teeth next to the lesion together. He distinguishes between the complete and the incomplete fracture; he then speaks separately of the fracture of the symphysis. Treating of the incomplete fracture, he says:

“If the teeth in proximity of the lesion be shaken, one ought, after having reduced the fracture, to bind them one to the other, until the consolidation of the bone, using preferably gold wire for the purpose; but if this be wanting, linen thread can be used instead, and not only ought the two teeth next to the site of the fracture to be bound, but several of the others besides.”89

Fig. 9

Two Greek appliances existing in the Archæological Museum of Athens.

Farther on, when speaking of complete fractures, he renews this advice in these words:

“After having carried out the coaptation, the teeth ought, as we have said already, to be bound one to the other; this greatly contributes to obtaining the immobility of the fragments, particularly if properly carried out.”90

Also, in cases of fracture of the symphysis, Hippocrates recommends “binding the teeth together on the right and left of the lesion.” And after having spoken of the best adapted means of constraint in such kinds of fractures, he adds: “If the reduction has been well performed, and the part kept in proper repose, the consolidation takes place in a short time and the teeth do not undergo any damage; in the contrary case, the cure is retarded, the fragments reunite in a bad position, and the teeth are injured and become useless.”91

From what we have referred, it is easy to perceive how much importance Hippocrates attached to the dental system, what knowledge he possessed as to the pathological conditions of the teeth, the gums, and the jaws, and what means of treatment he used. But in what relates to therapy it will perhaps not be useless to make some further observations.

One of Hippocrates’ aphorisms says:

“Cold is the enemy of the bones, the teeth, the nerves, the brain, and the spinal marrow.”92

From this it is easy to conclude that Hippocrates was no friend to hydrotherapic treatment, and that he considered the use of cold drinks bad for the teeth, and cold applications harmful in dental diseases.

The idea expressed in the aphorism just quoted is to be found repeated in the book entitled On the Use of Liquids;93 and in this same treatise we find vinegar recommended shortly after in cases of burning of the teeth (an expression probably meant to indicate those pathological conditions of the teeth and gums which are accompanied by a sense of burning).

Some of the Hippocratic maxims, full of wisdom and good sense, will forever conserve their importance, whatever be the degree of perfection to which medical science may come.

“Diseases, says he, should be combated in their origin;”94 which is as much as to say, that it is not enough to apply symptomatic or palliative means of cure, but that it is necessary, rather to seek and to combat the true causes of disease. And in another place we find written:

“One should take care of two things in illnesses—to do good and not to do harm. The art of curing includes three terms: the malady, the patient, and the doctor. The latter is the minister of the art; the patient has to combat the malady together with him.”95

It is only too true, that not all the representatives of the healing art keep sufficiently in view the precept to do good and not to do harm; nor do all patients comport themselves in such a manner as to contribute, in accordance with Hippocrates’ wise counsel, to the work of their own cure.

Aristotle, the greatest philosopher of antiquity, was born at Stagira, in Macedonia, and lived from 384 to 322 B.C. He wrote most excellent works on all branches of human knowledge, and was the founder of Natural History and Comparative Anatomy. His acquaintance with anatomy as illustrated principally in his treatise On the Different Parts of Animals, is absolutely extraordinary for the time in which he lived. One chapter of this work96 is altogether dedicated to the study of the teeth; but he also speaks of these organs in many other of his works, particularly in his History of Animals, which is a real and proper treatise on zoölogy, wherein the author records a great number of notes about the peculiarities presented by the dental system, in the different classes of animals.

In spite of the great errors into which he has fallen, his ideas about the teeth are, taken as a whole, quite worthy of attention, especially when one considers the remote epoch in which this great philosopher wrote. We will here give a brief notice of the most important of his observations relating to the dental organs.

The form, the disposition, the number of the teeth, varies in animals, according to the quality of their food and according to whether the teeth serve merely to divide and to chew the alimentary substances, or as instruments of offence and defence as well. In man, the teeth serve principally for mastication, but the front ones have, besides, another most important office, namely, that of assisting in the articulation of words, in the pronunciation of certain letters.

In those animals in which the teeth also serve as weapons, it is to be observed either that some of them protrude like those of the boar, or that they are sharp and saw-like in their disposition, as in the lion, the panther, the dog, etc. No animal possesses at the same time protruding and saw-like teeth.

The teeth are not always equal in number in both jaws; the animals provided with horns have no teeth in the front of the upper jaw; this, however, is also to be observed in animals without horns, as for example, in the camel. Among the animals provided with horns there are none which have protruding or saw-like teeth.

In general, the front teeth are pointed and the back ones broad. Nevertheless, all the teeth of the seal are pointed, with a saw-like disposition, perhaps because this animal marks the transition from the quadruped to the fish, all of which, with few exceptions, have their teeth formed in that way. Animals with saw-like teeth have generally very large mouths.

No animal has ever more than one row of teeth in each jaw; however, says Aristotle, if Ctesias97 is to be believed, there is an animal in India, named marticora, which has a triple row of teeth.

The molar teeth are never changed either in man or in any known animal; the pig never changes its teeth.

One can judge the age of many animals by their teeth. As the animal grows older, the teeth become darker in color, except in the case of the horse, whose teeth grow whiter with age.

The last molars are cut by men and women about the twentieth year; but in some cases, and especially with women, they have been known to come forth—not without pain—very much later, even so late as at eighty years of age.

The man has more teeth than the woman; this peculiarity is also to be found in the female of some animals (such as sheep, goats, and pigs).

Individuals provided with many teeth generally live the longest, those instead who have fewer teeth (or simply far apart) are generally shorter lived.

The teeth are generated by the nourishment distributed in the jawbone; they are, in consequence, of the same nature as bones. Their surface, however, is very much harder than that of the bones. The teeth, contrarily to all other bones, grow throughout life, so as to provide for their wearing away through mastication; and for this reason they lengthen when the antagonizing teeth are wanting.98

The teeth differ from all the other bones, therein that they are generated after the body has been already constituted; they are, therefore, secondary formations; and precisely for this reason are able to be shed and to be renewed.

Some of the veins of the head, says Aristotle, terminate with very slender branches inside the teeth.99

The dental system of the monkey is altogether similar to that of man.

The molar teeth exist in viviparous quadrupeds as well as in man; in the oviparous quadrupeds and in fish they are wanting. They serve to grind food, a function in which the lateral movements of the inferior jaw have, in many animals, a large share. For this reason, in animals who have no molars, these lateral movements do not exist.

In birds, the beak takes the place of the lips and teeth; the substance of which it is formed is similar to that of the horn or the nails.

In those animals which, instead of having all the teeth sharp, are furnished with incisors, canines, and molars, these three species of teeth are disposed in the same order as in man.

The setting on edge of the teeth may be produced not only by eating acid things, but also simply by seeing them eaten. This sensation may be made to cease by the use of purslane and salt.

In the book entitled Problems, many of which have reference to medical matters, one is to be found to the following effect:

“Why do figs, when they are soft and sweet, produce damage to the teeth?” Perhaps, answers Aristotle, because the viscous softness of the fig causes small particles of its pulp to adhere to the gums and insinuate themselves into the dental interstices, where they very easily become the cause of putrefactive processes. But, he adds, it may also be that harm is produced to the teeth by masticating the small hard grains of this fruit.

In Aristotle’s Mechanics, the following question relative to the extraction of the teeth is discussed:

“Why do doctors extract teeth more easily by adding the weight of the odontagra (dental forceps) than by using the hand only? Can it be said that this occurs because the tooth escapes from the hand more easily than from the forceps? Ought not the irons to slip off the tooth more easily than the fingers, whose tips being soft can be applied around about the tooth much better? The dental forceps,” adds Aristotle, “is formed by two levers, acting in contrary sense and having a single fulcrum represented by the commissure of the instrument. By means of this double lever it is much easier to move the tooth, but after having moved it, it is easier to extract it with the hand than with the instrument.”

From this passage of Aristotle one may draw various conclusions. First of all, it appears that, at that time, the extraction of teeth was a common enough operation carried out by doctors in general, or, at least, by specialists not indicated by any particular denomination but called doctors (in Greek, ιατροι) just the same as those who dealt with the maladies of every other part of the body. If, therefore (which, however, is very doubtful), there existed in Greece, as there certainly did in Egypt, individuals who occupied themselves exclusively with the treatment of the teeth, they cannot have formed a distinct class of professionals, but merely a section of the medical class. Herodotus, too, as we have already seen, does not say, speaking of Egypt, that there was a proper class of dentists, but gives us to understand that the Egyptian doctors did not occupy themselves indiscriminately with the treatment of all maladies, for some dedicated themselves to curing the eyes, others to the treatment of maladies of the head, others to those of the teeth, and so on.

From the Aristotelian passage on the extraction of teeth, just quoted, it may be concluded that in those times the Hippocratic precept, that only loose teeth were to be extracted, was not observed, for otherwise, Aristotle could not have said that dental forceps are useful to loosen the teeth, but that after this has been done the extraction of the tooth may be more easily effected by means of the fingers than with the instrument.

This last assertion appears very strange. It demonstrates that either the instruments then in use were very imperfect, or that Aristotle, although the son of a doctor and himself possessed of vast medical knowledge, had absolutely no experience as to the extraction of teeth; and, therefore, speaking theoretically, and without any practical basis, he ran into error, as even the greatest men are apt to do when drawing conclusions from purely theoretical reasonings.

From Aristotle to Galen, that is, for the space of five centuries, the anatomy of the dental system, so far as may be deduced from the writings preserved to us, made no sensible progress. But in respect to this, one must take into consideration some historical facts of capital importance. The school of medicine of Alexandria, which arose about three centuries before Christ, numbered among its most brilliant luminaries the celebrated doctors Herophilus and Erasistratus, who were the initiators of the dissection of human corpses,100 thus giving a great impulse to anatomical research. It is, therefore, hardly admissible that these two great anatomists, who studied with profound attention even the most complicated internal organs, should have neglected the anatomy of the teeth. Unfortunately, however, not all the results of their researches have come down to us; nor is this to be wondered at, especially if we reflect on the large number of precious works entirely lost by the destruction of the celebrated library of Alexandria, A.D. 642.

When we come to speak of Archigenes, we shall see how he, in certain cases, advised trepanning the teeth. This would lead to the belief that in his times, viz., toward the end of the first century after Christ, the existence of the central cavity of the tooth was not ignored, and that, therefore, the structure of these organs had already been the object of study.

As to diseases of the teeth and their treatment, there is no doubt that Herophilus and Erasistratus must have occupied themselves with these subjects; and the same may be asserted of Heraclides of Tarentum, a celebrated doctor who lived in the third century before the Christian era. Indeed, we read in Cœlius Aurelianus,101 that the record had come down through the works of Herophilus and Heraclides of Tarentum, of persons having died by the extraction of a tooth.102 The same writer also alludes to a passage of Erasistratus, relating to the odontagogon already mentioned, which was exhibited in the temple of Apollo, and to the practical signification to be attributed to the fact of this instrument being of lead and not of hard metal. Now, if Herophilus, Heraclides of Tarentum, and Erasistratus all spoke of the serious peril to which the extraction of a tooth may give rise, and therefore recommended not having recourse to it too lightly, it is evident that they had given serious attention to this operation and consequently also to the morbid conditions that may render it necessary.