It is not much to be wondered at that these things should have been blindly believed in, if we reflect that only a short time previous to this the story of the golden tooth had been taken seriously by men of great erudition, and that in the very epoch of which we are speaking the illustrious anatomist Thomas Bartholin (1616 to 1680), of Copenhagen, relates having seen a man, at Padua, who had an iron tooth! Besides, the possibility of such a phenomenon was explained in a most curious manner by Thomas Minadous, who explained that in the same way as iron is generated in the macrocosm, that is, in the world, so it is equally admissible that it may be generated in the microcosm, that is, in man![349]
Nathaniel Highmore. In the year 1651 the English physician and anatomist Nathaniel Highmore (1613 to 1684), of Hampton, published a treatise on anatomy (Corporis humani disquisitio anatomica, etc.), by which he acquired a celebrity superior, perhaps, to his merits. This work, however, served without doubt to diffuse the knowledge of an anatomical fact of the highest importance, especially from the point of view of dentistry and surgery.
There is no doubt that the existence of the maxillary sinus was already known before Highmore, the celebrated anatomists Vesalius, Ingrassias, Eustachius, and Fallopius having spoken of it very clearly; only through ignorance of the history of anatomy has it been affirmed by many that this cavity was discovered by Highmore, to whom is only due the merit of having described the maxillary sinus, by him called antrum, most accurately, and of having made known the possibility of a communication between it and the mouth. Highmore calls attention to the fact that the inferior wall of the antrum often presents small projections, which correspond with the tops of the alveoli, and that the osseous lamina which interposes between these latter and the maxillary sinus is often extremely thin; for which reason, it may easily happen that, in extracting one of the teeth below the cavity, one may bring away together with the tooth the small osseous plate that forms the bottom of the alveolus, thus leaving the maxillary sinus open at its inferior part. With regard to this, he refers to a most interesting case which afterward acquired a high degree of notoriety. It relates to a lady who had suffered from toothache for some years, and who from time to time had had several decayed teeth extracted, without, however, finding relief. The pain only ceased after the patient had had the left upper canine removed. But after this operation an incessant flow of humors from the alveolus of the extracted tooth took place. The patient, in great anxiety at this circumstance and desirous of seeing clearly into the causes of it, herself explored the affected part with a silver probe, the entire length of which penetrated into the cavity, producing in the patient the effect of its having reached the eye. Still more amazed, and urged on by the desire of becoming still better acquainted with the extent of the evil, she now made use of a long feather, which she had previously stripped, and discovered to her painful surprise that this new instrument of exploration entered to so great a distance that it, according to her idea, penetrated into the skull. From this she derived argument for the belief that the morbid phenomenon had its origin in her brain. Believing herself affected with a serious malady, she consulted Highmore, who had the satisfaction of being able to tranquillize her completely by making her understand that the jaw bone is hollow in the inside, and that its cavity had remained open underneath in consequence of the extraction of the canine tooth; and also, that the feather had not penetrated to such a distance as she supposed, but had curved inside the bone. As to the discharge which had given so much trouble and alarm, Highmore considered it quite a natural circumstance, derived simply from the opening of the antrum, as he held that in many cases the maxillary sinus contains mucus, and that this condition was, therefore, altogether normal. So he did not propose any treatment, and the lady thenceforth supported her infirmity with resignation.
This most interesting case soon became generally known, and contributed, without doubt, not a little to attract the attention of medical men to the anatomical peculiarities which Highmore had pointed out in the upper maxillary bone, thus causing his name to become inseparably associated with the maxillary sinus.
It is evident, however, that Highmore never even suspected to what very important practical applications his description would give rise. He knew nothing about the diseases of the antrum, and believed that, even in perfectly normal conditions, this cavity is often filled with liquid; the idea, therefore, of its being advisable, in certain cases, to extract a tooth and perforate the alveolus in order to give exit to the liquid contained in the maxillary sinus never occurred to him.
About fifty years went by before a rational treatment for affections of the antrum was initiated, the merit of which, as we shall see at its time and place, was due to William Cowper. During that half century maladies of the maxillary sinus continued to be badly diagnosticated and badly treated.
Bernardo Valentini. In the year 1686, that is, thirty-five years after the publication of Highmore’s book, Bernardo Valentini, professor at the University of Giessen, described a case of tumefaction and abscess in the cheek, treated by him with emollient remedies, and in which, although according to him caries of the underlying bone did not exist, the separation of a sufficiently large osseous fragment took place. Without doubt the affection of the cheek was derived in this case from some disease of the antrum; however, it would appear that Valentini did not in the least perceive any such casual relation, as he makes no allusion whatever to it.[350]
Antonio Molinetti, professor at the University of Padua, had, however, ten years previously, diagnosticated and cured an affection of the antrum by means of an operation. In his book Dissertationes anatomico-pathologicæ, published at Venice in 1675, Molinetti relates that in a case of abscess of the maxillary sinus, which caused the patient great suffering, he performed the operation of trepanning the upper maxillary bone anteriorly, after incision of the soft parts overlying it. In a certain way we may, therefore, consider Molinetti as a precursor of William Cowper.
Having spoken of the very important anatomical fact illustrated by Highmore, we will now also speak briefly of those authors who, in the seventeenth century, occupied themselves with the anatomy of the teeth. Their number is sufficiently large; we will, however, only make mention of such as contributed to the development of this branch of science, or who, at least, expressed some opinion worthy of note.
The celebrated anatomist Adrian Spiegel (1578 to 1625), better known by the Latinized name of Spigelius, wrote nothing noteworthy about the teeth, but he appears to have been the first to affirm that the teeth are more firmly fixed in the alveolus, when their roots are curved after the manner of hooks.[351]