Читать книгу A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century - Vincenzo Guerini - Страница 16

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For many centuries the Romans, according to the saying of Pliny, lived entirely “without doctors, although not without medicine;”108 that is, there existed without doubt a popular medicine and also a sacerdotal medicine, but still there were no persons whose exclusive occupation it was to cure disease.

The medical art, properly so called, was introduced into Rome by the Greeks. The first Greek doctor who went to Rome was Archagathus (in the year 535 after the foundation of the city, that is, 218 years before Christ). His arrival was at first welcomed, so much so that he was made a Roman citizen and a shop bought for him in the Acilian square, at the expense of the State. However, his popularity was of brief duration. Being an intrepid operator, the use and abuse he made of steel and fire gained for him the not very honorable qualification of the butcher, and he soon became the horror of all the population.

But it appears that dentistry had begun to be practised in Rome prior to the coming of Archagathus, that is, long before the medical profession existed. We have the clear proof of this in the Law of the Twelve Tables, wherein we find mention made of teeth bound with gold. The Law of the Twelve Tables was written in Rome 450 years before Christ, by a body of ten magistrates (decemviri) expressly named for that purpose, as up to that time no written law had existed.

As gold was at that time somewhat scarce, and fears were entertained that it would become still scarcer (to the great damage of the State) by reason of the custom that prevailed among the wealthy of burning or burying gold articles with the corpses to honor the memory of the deceased, or, rather, to satisfy the pride of the survivors, it was thought necessary to prohibit this abuse by a special disposition of the law referring to funeral pomps. This disposition was thus formulated: “Neve aurum addito, ast quoi auro dentes iuncti escunt (sunt) im cum illo sepelirei vrive sine fraude esto;”109 that is, “Neither shall gold be added thereto (to the corpse); but it shall not be unlawful to bury or to burn it with the gold with which the teeth may perchance be bound together.”

From this it results that at the time when the Law of the Twelve Tables was written, that is, four centuries and a half before the Christian era, there were already individuals in Rome who practised dental operations. And these individuals cannot have been medical men, as at that epoch (corresponding pretty nearly with the date of Hippocrates’ birth) Rome had as yet no doctors.

The inquiry naturally suggests itself whether the gold mentioned in the legal dispositions above cited was used for fixing artificial teeth or simply for strengthening unsteady natural teeth. Some authors, Serre among them,110 have pronounced in favor of the first hypothesis, others, as, for example, Geist-Jacobi,111 are rather disposed to accept the second. In truth, however, we do not possess sufficient historical data to definitely resolve this problem. I myself am rather of opinion that artificial teeth were already in use in Rome, as they were, even before this time, among the Etruscans. Indeed, if we take into consideration the priority of the Etruscan civilization to the Roman and the relations of vicinity existing between Etruria and the Roman State, of which it afterward became a part, it is even possible that dental prosthesis was first practised in Rome by Etruscans.

In a Greek-Roman necropolis near Teano (Province of Caserta, Italy) there was found in February, 1907, a prosthetic piece of a very peculiar construction, and which may be considered as quite unique in its kind. It is an appliance destined to support three inserted human teeth (the two lower central incisors and the lateral incisor on the right). These teeth—lost perhaps by the patient himself, in consequence of alveolar pyorrhea—were fixed by means of a system of rings, made of laminated gold wire, turned around the teeth and then soldered.

By the examination of the piece it is easy to argue that the author of this prosthesis made at first three separate rings by tightly turning the laminated gold wire around each of the three teeth to be applied, and by soldering together the ends of the wire forming each ring, after having taken away the tooth, in order not to spoil it in making the soldering. Then, with another laminated gold wire of sufficient length, he soldered the three rings together in due position, put the appliance in the mouth and turned the two ends of the wire around the sound teeth, serving as a support for the lateral incisor on the left and the two canines. After this, he took the apparatus delicately out of the mouth, made the soldering necessary for finishing the skeleton of the apparatus, forcibly put the three teeth in their respective rings again, and applied the prosthesis.

This ingenious appliance was found still adherent to the mandible of a skeleton, in a tomb which, according to the eminent archæologist Dalli Osso, belongs to a period comprised between the third and the fourth century before Christ.

From the nature of the objects found in the tomb near the skeleton (a necklace, perfume vessels, etc.) it was quite evident that the skeleton bearing the above-described prosthesis was that of a woman.

As the said appliance was found in South Italy (the ancient “Magna Græcia”) it is quite probable that it was made by some dentist of the Greek colonies.

The above apparatus belongs to the archæological collection of Signor Luigi Nobile, in Teano, in whose possession it was found.

Fig. 25 Seen from behind.	Fig. 26 Seen from above.
A prosthetic piece of very peculiar construction (see description), found in 1907 near Teano, Italy.

The Romans, as well as the Hebrews, and other peoples of antiquity, attributed great importance to the integrity of the dental system. This may be deduced with certainty from another article in the Law of the Twelve Tables (Table VII, at the rubric De delictis), which says: “Qui dentem ex gingiva excusserit libero homini, trecentis assibus multator, qui servo C L.” (Whoever shall cause the tooth of a free man to fall shall pay a fine of three hundred as, and for that of a slave one hundred and fifty.) The as was worth about ten cents American money, so that the first fine amounted to about thirty dollars and the second to about fifteen dollars. These sums, because of the difference in the monetary value in those times, were considered heavy fines.

After the Romans had conquered Greece (146 B.C.) a very great number of Greek doctors went to Rome. The wealth, luxury, and ever-increasing corruption of the metropolis caused the practice of the medical art (which was almost entirely in the hands of the Greeks) to become a great source of lucre. But an art practised with the sole purpose of making money soon degenerates to the level of a trade; it is, therefore, hardly to be wondered at if very few doctors of that epoch have merited being recorded in history.

Among these few, the name Asclepiades (born at Prusa, in Asia Minor; died in Rome ninety-six years B.C.) shines with particular lustre. He was the founder of the “methodic school,” whose curative precepts, largely based upon hygiene, come nearer to those of modern scientific medicine. Unfortunately, all the writings of this great physician, whose name is almost as glorious as that of Hippocrates, have been lost; we do not know, therefore, whether and in how far he contributed to the development of our specialty.

But one of the first places in the history of dental art is due without doubt to Cornelius Celsus, of whom we will now speak.

Cornelius Celsus. The historical researches in regard to the life of this celebrated author have given but meagre results. It is uncertain whether his birthplace was Rome or Verona. The precise dates of his birth and death are also unknown; but it is very probable that he was born about thirty years before Christ, and that he died during the fifth decade of the first century.

Aulus Cornelius Celsus belonged to the illustrious patrician family of the Cornelii. He was a man of great erudition, and wrote on the most varied subjects, and among others, on agriculture, on rhetoric, on the art of warfare, on medicine, etc. All these writings, however, are lost to us excepting his excellent treatise on medicine.

Some historians consider that Celsus was a true doctor by profession; others, instead, hold that he never undertook the cure of the sick. Neither the one nor the other of these opinions is quite acceptable; and it is much more likely, as Daremberg observes in his valuable Histoire des Sciences Médicales, that Celsus was one of those philiatri mentioned by Galen, who had studied medicine rather from books than at the bedside of the sick, but who, although not doctors by profession, in case of necessity, put their knowledge and skill into practice on behalf of their relations and friends.112

The work of Celsus, gathered in great part from Greek authors, has an especial value, because it sums up, in an admirable manner, the whole of the medical and surgical science of the ancients, from the earliest times up to the days of Augustus.

The first book of the work De Medicina113 does not contain anything of great importance in regard to dentistry. The following hygienic precept is, however, worthy of note: “After rising, if it be not winter, the mouth should be rinsed with a quantity of fresh water.” In regard to the hygiene of the mouth, nothing more is found in the work of Celsus; and it is also necessary to note that the aforesaid precept forms part of a chapter, in which he speaks of the rules of life, which must be observed by weak people, to which class—the author remarks—belong a greater part of the inhabitants of cities and almost all literary men. According to Celsus, therefore, perfectly healthy and strong people would not even need to wash their mouths with fresh water, and perhaps the keen-witted Roman doctor was not wrong; for it is very probable that the saliva and mucous secretion of the mouth, in perfectly healthy individuals with normal constitutions, have the power of combating the pathogenic germs that produce caries and other diseases of the teeth and mouth. In this way the fact can be explained of many peasants and the greater part of the individuals of the negro race having such good teeth, without possessing even the remotest idea of what hygiene of the mouth may be. And here I venture to refer to a passage in which Celsus alludes to the relation between diseases and civilization with its vices: “It is probable that in ancient times, although there was but little knowledge of medicine, health was for the most part well preserved; this being due to good habits, not yet spoiled by intemperance and idleness. These two vices, first in Greece and then among us, have brought upon us a very host of evils; whence it is that in our days, in spite of the intricate art of medicine—once not necessary to us, as it is not necessary to other peoples—few among us attain the beginning of old age.”114

In the second book, speaking of the various kinds of disease to which the different periods of life are subject, he writes: “Children are especially subject to serpiginous ulcers of the mouth, called by the Greeks aphthæ. … There are also infirmities due to dentition, such as ulceration of the gums, convulsions, fever, looseness of the bowels; and it is especially the eruption of the canine teeth which produces these disturbances. To these, however, very fat children are more particularly liable, and those, also, who have costive bowels.”

In Chapter XXV of the fifth book we find the receipt for a narcotic drug, recommended by the author for producing sleep in persons tormented with odontalgic and other pains. This receipt is very complicated, being composed of ten ingredients, among which are acorns, castoreum, cinnamon, poppy, mandrake, and pepper.

Most important for our subject is Chapter IX, of the sixth book, where the author treats of odontalgia. “In toothache, which may be numbered among the worst of tortures, the patient,” says Celsus, “must abstain entirely from wine, and at first, even from food; afterward, he may partake of soft food, but very sparingly, so as not to irritate the teeth by mastication. Meanwhile by means of a sponge he must let the steam of hot water reach the affected part, and apply externally, on the side corresponding with the pain, a cerate of cypress or of iris, upon which he must then place some wool and keep the head well covered up. But when the pain is violent, the use of purgatives is very beneficial, the application of hot cataplasms on the cheek, and the keeping in the mouth of some hot liquid, prepared with fitting medicine, changing this liquid, however, very frequently. For this purpose the root of cinquefoil may be boiled in wine, or that of hyoscyamus (henbane), or a poppy-head, seedless and not too dry, or the root of the mandrake. But in regard to the last three remedies, one must be careful not to swallow the decoction whilst it is kept in the mouth. For the same purpose one may boil the bark of the root of the white poplar in wine, or the scrapings off a stag’s horn in vinegar or figs in mulse115 or in vinegar and honey. It is useful also to pass repeatedly around the tooth the end of a probe which has first been wrapped around with wool and then dipped in hot oil. It is customary also to apply around the tooth certain remedies, after the manner of plasters. For this purpose the inside of the peel of dried, bitter pomegranates may be pounded with equal quantities of gall-nut and pine bark; to these must be added a little minium116 and the whole mixed together with the addition of rain water to form a paste; or else a similar paste may be formed with equal parts of panax,117 poppy, peucedanum,118 and taminia grape119 without stones; or with three parts of galbanum to one of poppy. On the cheek, however, must be applied at the same time the cerate spoken of above, covered over with wool.”

Celsus then speaks of a revulsive adopted, in his times, against odontalgia. It was composed of myrrh and cardamom, ana one part; saffron, pyrethrum, figs, pepper, ana four parts; mustard seed, eight parts. The plaster, spread on linen, was to be applied on the shoulder corresponding to the side of the pain, and, according as this was situated in a tooth of the upper or lower jaw, the revulsive was applied on the back of the shoulder, or in front.

When a tooth is decayed, Celsus advises that there should be no haste in drawing it; but that the pain be combated, if the above medicines are not sufficient, with others more energetic. A mixture may, for example be applied to the tooth, composed of one part of poppy, two of pepper, and ten of sory,120 pounded and mixed to a paste with galbanum; or else, especially in the case of a molar tooth, the remedy of Menemacus, resulting from saffron, one part; cardamom, soot from incense, figs, pepper, pyrethrum, ana four parts; mustard seed, eight parts; or even a more complicated remedy made with pyrethrum, pepper, and elaterium,121 ana one part; scissile alum,122 poppy, taminia grape, crude sulphur, bitumen, laurel berries, mustard seed, ana two parts.

“If, says Celsus, the pain renders necessary the removal of the tooth, this may be made to fall to pieces, by introducing into the cavity a pepper berry without its skin, or a berry of ivy, pared in the same way. The same result may be obtained in the following manner: The sharp bone (aculeus) of that flat fish called by the Greeks trygon and by us pastinaca, must first be roasted and then reduced to powder and mixed with resin, so as to form a paste; which applied around the tooth will make it fall out. Likewise, scissile alum induces the fall of the tooth, when introduced into its hollow. This substance, however, is best introduced into the small cavity, after being wrapped around with a tuft of wool, for thus the pain is soothed and the tooth preserved.”

Somewhat curious is the following passage, in which Celsus speaks of the superiority of a method of cure used by peasants, compared to the remedies advised by the doctors. From his words we clearly see that he, as we have already remarked, did not belong to the class of doctors properly so called.

“These are the remedies accepted and held in account among the doctors. But it is known through the experience of peasants, that when a tooth aches one must pluck up wild mint by the roots, put it into a large vessel, pour water on it, and make the patient sit near it, covered all around with a blanket; and red hot stones should then be thrown into the water, so that they be entirely immersed; and then the patient, wrapped all around, as we have said before, and keeping his mouth open, receives into it the steam evaporated from the water. Thus profuse perspiration is induced, and a great quantity of pituita flows from the mouth, and with this a cure is obtained for a very long period, often for more than a year.”

In the six following chapters of the sixth book, Celsus treats of the diseases which affect the soft parts of the mouth. Against tonsillitis, he recommends, among other things, the application of a remedy principally made of the juice of the sweet pomegranate, cooked, by a slow fire, to the consistency of honey. The same remedy is also of great value, according to the author, for the cure of ulcers of the mouth, when they are accompanied by inflammation, and are somewhat foul and of a reddish color. But under such circumstances it will also be necessary to keep frequently in the mouth an astringent decoction, to which a little honey has been added. The exercise of walking is also profitable, as well as the taking of food that is not acid. When, however, the ulcers begin to be clean, the mouth should be frequently filled with a softening liquid or even with simple pure water. It is also helpful to drink genuine wine and to eat rather freely, avoiding, however, acid food. The ulcers must be sprinkled with a powder composed of two parts of scissile alum to three of unripe gall-nuts. If, however, the ulcers are already covered with a scab similar to those produced on burns, some of those compositions should be used which are called by the Greeks antheræ; for example, a remedy may be formed of equal parts of cyperus,123 myrrh, sandarac, and alum; or another which contains saffron, myrrh, ana two parts; iris, scissile alum, sandarac, ana four parts; cyperus, eight parts.

“Much more dangerous, says Celsus, are those ulcers of the mouth which the Greeks call aphthæ; they oftentimes lead to death in children; in adult men and women, however, there is not the same danger. These ulcers begin in the gums; then they attack the palate and the whole of the mouth, and finally extend to the uvula and to the fauces; when these parts are attacked, it is not very likely that a child will recover.”

As to the ulcers of the tongue, Celsus says that those which are situated at the borders of this organ last a very long time, and he adds: “It should be seen whether there may not be some sharp tooth opposite, which hinders the ulcer from healing; in case such a tooth exists, it should have its edge taken off with a file.”

He then passes on to speak of the diseases of the gums: “Often small painful tumors, called by the Greeks parulides, are produced on the gums. It is necessary at the very first to rub them softly with powdered salt, or with a mixture of burnt mineral salt, cyperus, and catmint, meanwhile keeping the mouth open until there flows from it a good quantity of pituita; after which the mouth must be rinsed with a decoction of lentils. But if the inflammation is great, the same remedies must be used as are adopted for the ulcers in the mouth, and between the tooth and the gum must be inserted a small tent of soft lint, on which has been smeared some one of those compositions which we have said are called antheræ. If this, owing to the hardness of the tumor, is not possible, then by means of a sponge the steam of hot water should be made to act upon the diseased part, and, besides, an emollient cerate must be applied upon it.

“Should suppuration show itself, it will be necessary to use the above-mentioned steam for a longer period; to keep in the mouth hot mulse, in which some figs have been cooked, and to lance the tumor before it is perfectly ripe, so that the pus may not, by remaining too long in the diseased part, injure the bone. But if the tumor be of great size, it will be more advisable to remove it entirely, so that the tooth remain free on both sides. After the pus has been extracted, if the wound be a small one, it is sufficient to keep hot water in the mouth, and to use externally fomentations of steam, as mentioned above; if it be large, it will be fitting to use the decoction of lentils and the same remedies with which all other ulcers of the mouth are cured.

“It also happens, sometimes, that from an ulcer of the gums—whether it follow a parulis or not—one may have for a long period a discharge of pus, on account of a broken or rotten tooth, or else on account of a disease of the bone; in this case there very often exists a fistula. Then the latter must be opened, the tooth extracted, and if any bony fragment exist, this should be removed; and if there be anything else diseased, this should be scraped away. Afterward, the same remedies which have been indicated for the other ulcers of the mouth must be used.

“If the gums separate from the teeth, it will be useful, in this case also, to employ those remedies called antheræ. But it is also beneficial to chew unripe pears and apples and to keep their juices in the mouth. Equal advantage can be derived from keeping vinegar in the mouth, provided it be not too strong.

“Whenever ulcers of the mouth are attacked by gangrene, it is necessary first to consider whether the whole body be unhealthy, and in that case, to do what is necessary to strengthen it. When the gangrenous ulcer is superficial, the use of antheræ is sufficient; when it is somewhat deeper, a mixture must be applied on it, of two parts of burnt paper124 to one of orpiment;125 when it is very deep, three parts of burnt paper to a fourth part of orpiment must be used; or else, equal parts of roasted salt and roasted iris; or lastly, equal parts of chalcites, lime, and orpiment. It is, however, necessary to dip a small pledget of lint in oil of roses, and put it on the caustic medicinals, so that these may not injure the neighboring healthy parts. If the disease is in the gums, and some of the teeth are loose, it is necessary to pull them out, for they greatly hinder the cure. When this latter, however, cannot be obtained by drugs, the ulcer must be cauterized with a red-hot iron.”

Chapter XII of the seventh book is, of all the work of Celsus, the one which presents to us the greatest interest, since there the author treats of the surgical operations required by the diseases of the dental apparatus.

He first speaks of the looseness of the teeth, caused by the weakness of their roots, or by the flaccidity of the gums, and says that in these cases it is necessary to touch the gums lightly with a red-hot iron, then to smear them with honey and wash them with mulse, and later on to strengthen them by means of astringent substances.

“When a tooth aches, and it is thought well to extract it, because medicaments are of no use, the gum must be detached all around, and then the tooth must be shaken until it is well loosened, it being very dangerous to draw a firm tooth, as this may sometimes give rise to a dislocation of the lower jaw. And greater still is the danger in regard to the upper teeth, as this might cause a shock to the temples and eyes. After having well loosened the tooth, it must be pulled out by the fingers, if this is possible; or if not, with the forceps.”

Fig. 27