Surgery in ancient times was eminently conservative; later on—partly by effect of its own progress—it became too readily inclined to the removal of diseased parts; in modern times it has again become what it was originally, and what it must ever be, viz., conservative in the highest possible degree.
Claudius Galen, after Hippocrates the greatest physician of ancient times, was born at Pergamus, a city in Asia Minor, in the year 131 of our era. His father Nicon, a man of great abilities, who was at the same time a man of letters, a philosopher, a mathematician, and an architect, had put him, at a very early age, to the study of science and of the liberal arts. Galen began to study medicine at the age of seventeen, under the guidance of skilful doctors of his native country; he made several journeys in order to have the benefit of the instruction of celebrated masters, and finally frequented the renowned medical school at Alexandria. On going to Rome, in the thirty-fourth year of his life, he soon acquired in that city a very high renown. He died in the first decade of the third century, but we do not know exactly in what year.
Galen was a most prolific writer, and his works, considering the period in which they were written, form a real medical encyclopedia. Anatomy through his researches made considerable progress, for he studied with the utmost care and attention (especially in apes) the bones, muscles, heart, bloodvessels, brain, nerves, and every other part of the organism. His anatomical researches enabled him to correct many errors, but as he had dissected almost exclusively animals and not human corpses, he himself fell into several errors, especially in attributing to man parts which he does not possess, for example, the intermaxillary bone.
Galen justly observed that the inferior maxilla (resulting, according to him, from the union of two bones, which, indeed, is embryologically true) has in man, proportionally to the other bones of the skeleton, a lesser length than in animals.
He holds that the teeth must be enumerated among the bones, and does not admit any doubt to be raised on this point, as these parts can be looked upon neither as cartilages, nor as arteries, nor as veins, nor as nerves, nor as muscles, nor as glands, nor as viscera, nor as fat, nor as hair—a method of reasoning by elimination which is very specious but far too weak!
Galen indicates exactly the number of incisor, canine, and molar teeth (without, however, making any distinction between small and large molars), and speaks of the different functions of these three kinds of teeth. Not always, he says, are the molars of each jaw five in number on each side; in some individuals there appear only four; in others six. The incisors and canines have but one root; the upper molars have generally three, but sometimes, though not often, four; the lowers have for the most part two, rarely three.
Galen is the first author who speaks of the nerves of the teeth. He says that these organs are furnished with soft, that is sensitive, nerves[179] belonging to the third pair.[180] The teeth, according to him, are furnished with nerves, both because, as naked bones, they have need of sensibility, so that the animal may avoid being injured or destroyed by mechanical or physical agencies, and because the teeth, together with the tongue and the other parts of the mouth, are designed for the perception of the various flavors.[181]
In regard to odontalgia, Galen made some very important observations on his own person:
“Once when I was troubled with toothache, I directed my attention to the seat of the pain, and thus I perceived very clearly, that not only was the tooth painful but also pulsating, which is analogous to what happens in inflammations of the soft parts. To my astonishment, I had to persuade myself that inflammation may arise even in a tooth, in spite of the dental substance being hard and lapideous. But another time, when I again was attacked by odontalgia, I perceived very distinctly that the pain was not localized in the tooth, but rather in the inflamed gums. Having, therefore, suffered these two kinds of pain, I have acquired the absolute certainty that, in certain cases, the pain is situated in the gums, in others, on the contrary, in the very substance of the tooth.”
When a tooth becomes livid, Galen deduces from this that the tooth is the seat of a morbid process equivalent to inflammation. Besides, he says, we cannot be surprised that the teeth may be subject to a phlogistic process, when we consider that these, like the soft parts, assimilate nourishment. The teeth, by effect of mastication, are continually worn down, but nutrition repairs the losses, and they, therefore, preserve the same size. But when a tooth from want of its antagonist is consumed but little or not at all by mastication, we see that it grows gradually longer, for the very reason that under such conditions the increase due to nutrition is not counteracted by a corresponding waste.