Old teeth!

CUSTOMS RELATING TO THE TEETH AMONG
DIFFERENT PRIMITIVE PEOPLES.

Joseph Murphy, in his book, A Natural History of the Human Teeth,1 says that the natives of Hindostan, especially the Brahmins or priests of Brahma, take extreme care of their teeth. Every morning they rub them for about an hour with a small twig of the fig tree, at the same time that, turned toward the rising sun, they recite their prayers and invoke Heaven's blessing on themselves and their families. As this custom is prescribed in the most ancient codes and religious writings of India, it reverts, without doubt, to the remotest ages, and, therefore, demonstrates the great importance that this people, and particularly the Brahmin caste, has ever attributed to beauty and cleanliness of the teeth. Murphy affirms that the Brahmins, in general, have magnificent teeth; and that this depends, certainly in great part, on the assiduous and scrupulous care that they take of them.

From the writings of their ancient poets one also deduces in what high esteem the people of India held beautiful teeth, considering them one of the principal ornaments of the face. The lover, says Murphy, never neglected, in enumerating the beauties of his lady-love, to praise the whiteness and regularity of her teeth.

Among some of the people of India, when the second dentition is completed, it is customary to separate the teeth one from the other with a file; we do not know, however, whether this is done as an embellishment or with some other object—perhaps, as suggested by Joseph Linderer,2 to prevent caries.

Anyhow, this and other customs in vogue in various parts of India and in many islands of Oceanica demonstrate that these peoples attribute great importance to the teeth.

The substituting of gold teeth for those missing has been in use in Java from exceedingly remote times.3

Dyeing the teeth black is considered a great embellishment among many races of Asia and Oceanica; this operation is sometimes preceded

1 London, 1811.

2 Die Zahnheilkunde, etc., 1851, p. 347.

3 J. Bontii, De medicina Indorum, 1642, lib. iv.

by another, viz., the filling up of the interdental spaces very cleverly with gold leaf.1

In Sumatra and the neighboring islands many women file their teeth down to the gums; others file them into points; or partially remove the enamel so as to render it easier to apply the black dye; this being held to be the height of elegance. Men of high rank and condition dye their upper teeth black and cover the lower ones with fine gold plates, which in a full light produces what they consider a fine contrast. The natives of other islands gild the upper central incisors and dye the others black.2

In Japan, the married women may easily be distinguished from the others by their black and shining teeth. The coloring preparation they use to blacken the teeth is composed of urine, raspings of iron, and a substance called saki. This mixture has a most unpleasant odor, and if applied on the skin acts as a caustic. Its action on the teeth is so powerful that they do not regain their whiteness even after a lapse of years. In applying this substance, and also for some time after, the women take care to preserve their gums and lips from its effects, as it would otherwise cause them to assume a dark blue tint.3 The inhabitants of the Pelew Islands make use of the wild thistle and shell chalk to blacken the teeth. It is also the custom to blackervthe teeth among the inhabitants of Tonkin and Siam, the women of the Maria Islands, and the single ladies of Java.

Some of the peoples of Eastern India plane their teeth down to an even level; and from the habit of masticating areca nuts mixed with chalk and other substances, their lips and teeth are dyed red. At Macassar the natives have their teeth dyed red; they also substitute missing teeth by artificial ones made of gold, silver, or tombac.4

Negroes, especially those of Abyssinia, very often file their incisors into points to resemble the form of the canines; this is in order to give themselves an air of greater ferocity.

Murphy relates that the inhabitants of one of the islands of the Sound make an incision in the upper lip in a parallel line with the mouth, and large enough to allow the tongue to pass. After the margins have healed they have a great resemblance to the lips. This kind of artificial mouth is made to support a shell, carved in such a manner as to produce the effect of a row of teeth.

The natives of the Sandwich Islands sacrifice their front teeth to conciliate the favor of their god Eatoa.5

1 Carabelli, Handbuch der Zahnheilkunde, 1844, i, 8.

2 Linderer, op. cit.

3 [The newer civilization of Japan has caused this custom to largely fall into disuse. —E. C. K.]

'Carabelli, Ioc. cit. 5 Linderer, loc. cit.

Among the natives of New South Wales, it is the custom when a youth reaches virility to knock out his front teeth with a stone; this operation being carried out by the kuradshis or wizards.

The savages of Peru are also in the habit of making the front teeth fall out; the reason of the custom is that the space thus made is regarded by them as an embellishment.1

1 Carabelli, op. cit., p. 17.

CHAPTER V.
THE GREEKS.

An ancient Greek physician—Asldepios, afterward called /Esculapius1—by the ability he displayed in the art of healing, so impressed the minds of the simple and uncultured at that primitive epoch as to be held in repute rather as a god than as a man. Not only was he held to be the author of wonderful cures, but it was also affirmed that he had resuscitated the dead; no doubt from his having in some case or other of apparent death restored the individual to consciousness by the assistance he rendered him. Exaggeration, so natural to ignorant minds, afterward did the rest, and magnified the healing and restoring powers of ^Esculapius to such an extent that it is not to be wondered at that he should have been looked upon as a divine being. With the lapse of time, various traditions formed around his name, among which there was, however, finally such discrepancy that the popular voice spoke no more of one, but of many iSsculapii,2 and to one of these was attributed, among other merits, that of having invented the probe and the art of bandaging wounds, while another was held to be the inventor of purgatives and of the extraction of teeth.

According, therefore, to these traditions, dental surgery had its origin with ^sculapius, the god of Medicine. But what was the precise epoch in which this benefactor of humanity lived?

We learn from Homer that two sons of ^Esculapius, Machaon and Podalirius,3 took special part, as doctors, in the siege of Troy. This celebrated siege, which lasted ten years, took place in the twelfth century before the Christian era (that is, 1193 to 1184 B.c.); admitting, therefore, the account of the parentage to be authentic, one may argue therefrom that ^Esculapius must have lived between the twelfth and thirteenth centuries BC. Many temples were built and dedicated to ^Esculapius; these were called asklepeia, after the Greek form of his name. The priests were called Asklepiadi, and alleged their direct descent from ^Esculapius himself.

1 I he Greek name Asldepios became in the Latin, /F.sculapius; the two names are therefore equivalents.

2 See Cicero, De Natura deorum, lib. iii, chap. xxii.

'[Homer speaks of them as "two excellent physicians," and refers to Machaon as "a blameless physician," and admits that "a medical man is equivalent to many others." Their renown was continued in a poem of Arctinus, wherein one was represented as without a rival in surgery, the other as sagacious in detecting morbid symptoms.—C. M.]

The temples of ^Esculapius became so numerous in time that they were to be found in almost every Greek city. The most celebrated were those of Epidaurus, Cos, Cnydus, and Rhodes, as well as that of the great city of Agrigentum, in Sicily. The Asklepiadi not only performed the temple rites, but were doctors at the same time, for as interpreters of the wisdom of the god, they also occupied themselves in curing the sick. From this it resulted that these temples became in time, through observation and experience, schools of medical science.

But besides this sacerdotal medicine, there was also a lay medicine in Greece. Many great philosophers, especially Pythagoras, Alcmeon of Croton, Empedocles, Anaxagoras, and Democritus, occupied themselves with physiology, with hygiene, and with medicine; also the gymnasiarchs, or directors of gymnasiums, or schools of gymnastics, an art having for its end to increase physical strength and maintain health, cultivated medicine, particularly that part of it which concerns hygiene, dietetics, and surgery as applied to the treatment of violent lesions, such as fractures, luxations, etc.

The Asklepiadi often themselves imparted the principles of medicine to students outside their caste. Lay medicine thus gradually came to supplant sacerdotal medicine, especially after Hippocrates, who through his works, exercised a preponderant influence in the secularization of the science. However, the Asklepiadi, on their side, continued to practise medicine up to the time when the pagan temples fell into complete ruin, through the advance of Christianity.

On the columns of the asklepeia and on the votive tables were written the names of those cured by the god, together with indications regarding their various maladies and the treatment by virtue of which the sick had been restored to health.

Surgical instruments of proved utility were deposited in the temples. Celius Aurelianus makes mention of a leaden instrument used for the extraction of teeth (plumbeum odontagogon), which was exhibited in the temple of Apollo, at Delphi.

As a matter of fact, it would seem more natural that this instrument should have been shown in the temple of ^Esculapius, he being the god of Medicine, and believed, besides, to be the inventor of dental extraction. One is rather inclined by this to think that the odohtagogon may have been deposited in the temple of Apollo before the building of iiEsculapian temples. Indeed, who can tell if y^sculapius himself, not yet deified, may not have deposited there a model of the instrument he had invented!

From the fact of the odontagogon in the temple of Apollo being made of lead, Erasistratus, Celius Aurelianus, and other ancient writers have drawn the deduction that it was only permissible to extract teeth when they were loose enough to be taken out with a leaden instrument. But

Serre1 observes, not without reason, that if a tooth be so unsteady as to be able to be extracted with leaden pincers, this may just as well be done, and perhaps even better, by pinching the tooth between the fingers, no other aid being required than a handkerchief to prevent them from slipping. Avulsive pincers of lead would be, therefore, a nearly useless invention; so it is much more probable, as Serre remarks, that the original pincers were of iron, and that the inventor, reserving these for his own use, made a simple model of the same in lead (this being easier to do) and deposited it in the temple of Apollo, in order to make known the form of the instrument to contemporaries and to posterity, naturally supposing that whoever wished to copy it would understand of himself, or learn from the priests, that it was to be made of iron and not of lead.

Portrayal of a dental operation on a vase of Phoenician origin, found in Crimea (see Cigrand, Rise, Fall, and Revival of Dental Prosthesis, pp. 60-63 and 287).

Hippocrates. The sacerdotal and philosophical schools of medicine, as well as the gymnasiums, were the three great sources whence Hippocrates derived his first knowledge of medicine.

Hippocrates was born in the island of Cos, toward the year 460 BC. He belonged to the sacerdotal caste of the Asklepiadi, and was, according to some of his earliest biographers, the nineteenth descendant of ^Esculapius on his father's side, and the twentieth descendant of Hercules on his mother's side. The time of his death is even still more uncertain

1 Praktische Darstellung aller Operationen der Zahnarznei-kunst, von Johann Jakob Joseph Serre, Berlin, pp. 7 to 13.

than that of his birth, for, according to some, he died at eighty-three, according to others, at eighty-five, at ninety, at one hundred and four, and even at one hundred and nine years of age.

Hippocrates was initiated in the study of medicine by his own father, Heraclides; but in the medical art he also had as a teacher the gymnasiarch Herodicus of Selymbria; besides, he studied eloquence under the sophist Gorgia and philosophy under the celebrated Democritus. He treasured up all the records of medical practice that were preserved in the temple of Cos; but according to some ancient authors he is said to have set fire afterward to this temple, and to have left his native country in order to flee from the resentment he had aroused. Probably it was the priests themselves who attributed the burning of the temple (which certainly took place at that time) to Hippocrates, out of jealousy for his growing fame; though it may also be possible that this great man, having first collected together all that was useful among the medical records that were to be found there, afterward courageously destroyed this centre of superstition, so that medicine, ceasing to be confused with imposture and being despoiled of the supernatural character attributed to it, which paralyzed its progress, should become a liberal and human art, based purely on the observation of clinical facts and the study of natural laws.

For a long time, Hippocrates travelled in various parts of Europe, Asia, and Africa, everywhere making valuable observations. He finally returned to his native country, where through the practice of medicine and by his immortal writings he acquired such esteem and veneration that his compatriots almost tributed him with divine honors after death.

Not all, however, of the works that make up the so-called collection of Hippocrates were really written by the father of medicine. Two of his sons—Thessalus and Draco—and his son-in-law Polvbius also distinguished themselves by the practice of medicine and by their admirable writings, which together with those of other doctors of that period were erroneously included in the collection of Hippocrates' works. At any rate, the collection of Hippocrates faithfully represents the state of medicine and surgery at the epoch in which he and his disciples flourished, that is, toward the end of the fifth and during the fourth century before the Christian era.1

Neither Hippocrates nor others before him had ever dissected corpses; it is, therefore, not to be wondered at that the anatomical notions contained in the Hippocratic works should be scarce and very often inexact. The physiological notions also are highly deficient and imperfect, which is, indeed, very natural, for an exact knowledge of the functions of the human body presupposes an exact knowledge of the relative organs.

1 Guardia, Histoire de la Medecine, p. 250.

The philosophical ideas of the time had considerable influence on the medical theories of Hippocrates and his successors. The universe was considered as constituted by four elements: earth, air, fire, water. To each of these elements a special quality was attributed, and, thus, one recognized four fundamental qualities, viz., cold, dryness, heat, and moisture. Man—the most perfect being—was regarded as a "microcosmos," or small world in himself, that is, a sort of compendium of the whole universe, and his organism, in correlation to the four primordial elements of the universe, was believed to be constituted of four fundamental humors—the blood, the pituita or mucus, the yellow bile, and the black bile or atrabile.

Health, says Hippocrates,1 depends 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."2 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."1

1 Hippocratis opera, Genevae, 1657 to 1662, De natura hominis, p. 225.

2 Page 251.

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,2 "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,3 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

1 Page 252. 2 Page 253. 3 De morbis mulierum, lib. ii, p. 666

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,1 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 wool2 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;3 one immerses these substances in half a cotyle4 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:5

"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:

'The use of carbonate of lime or chalk as a dentifrice evidently goes back to antiquity.

2 Unwashed wool—that is, wool not cleansed of the fat secreted by the skins of the animals from whom it is taken—was much in use by the doctors of antiquity. One now obtains lanolin from it.

3 The obole was about three-quarters of a gram.

1 The cotyle was a little more than a quarter of a liter. s Page 507.

"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."'

Having made mention of the offiana media, we think it opportune to explain here with some precision what is to be understood by this term.2 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

Fig. 8

Very ancient dental forceps and two other dental (?) instruments existing in the
Archaeological Museum of Athens.

medicine became secularized through its abandoning the ^Esculapian 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 oficina 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,

1 Page 21.

2 See Daremberg, Dictionnaire des Antiquites Greques et Romaines, article "Chirurgie."

IN Japan Dentists Pull Teeth With Fingers.—lt has been discovered
that the dentists in Japan pull teeth with their fingers, without the aid
of a single instrument. This remarkable prowess m extracting teeth is
attributed to the training the dentist undergoes in early youth. To
strengthen the fingers for their later work they commence by practicing
on nails which are driven into a plank placed on the ground. he has to
pull out the nails without moving the board. At the beginning soft
wood is used and then harder wood up to oak. An apprentice is not
considered proficient in his art until he can do this perfectly.