In cases of fracture of the lower jaw[222] it is not only necessary to cure the fracture itself according to the rules which the author prescribes for the various cases, but it is also necessary to pay attention to the teeth and with a gold or silver wire, or a silk thread, to tie, in the manner already described, those teeth which in consequence of the wound have become loose, but the consolidation of which may be hoped for.
A dental file (Abulcasis).
Mesue the Younger, a disciple of Avicenna, is of opinion that when a tooth is the seat of violent pain, this may easily propagate itself to the other teeth; and therefore advises, if the pain does not soon cease, to extract the tooth affected, without delay. This operation, however, must not be performed, says the author, whilst the pain is at its height, but rather when it is somewhat lessened, otherwise, the extraction of the tooth may result in a syncope sometimes ending in death, or else be the cause of intense inflammation and of suppuration, which, also, may, in certain cases, place the patient’s life in danger. He recommends an infinite number of remedies against odontalgia; in these, however, there is nothing new to us. As to the removal of a tooth, this may be obtained in three different ways, that is, with the forceps, with eradicating remedies, or by cauterization. In order to cause a tooth to fall out by the use of acrid, eradicating substances, the author advises to proceed in the following manner: The tooth is first freed, by means of a scalpel, from the surrounding gum; the eradicating remedy is next applied to the root of the tooth, every needful precaution, however, being taken that it may not injure the neighboring teeth. Cauterization, when practised to produce the exfoliation of a diseased tooth, may be performed, according to Mesue, either with a small red-hot iron, passed through a little metal tube in order to protect the neighboring parts, or with the heated kernel of a nut, or with a grain of burning incense.[223]
To cure a dental fistula, Mesue cauterized it to the very bottom with a cautery in the form of a probe, or extracted the tooth, which by reason of its diseased root was the cause of the fistula; and when the bone was likewise affected, he laid bare the carious part, which he then scraped.[224]
Avenzoar. The last of the great Arabian physicians was Avenzoar. He was born at Peñaflor, near Seville, in 1070 and died in 1162. He became famous by his very valuable work on medicine, entitled the Teisir. It is strange, however, that in this book there is hardly anything about the treatment of dental diseases. Against caries and looseness of the teeth the author limits himself to recommending bloodletting either from the ranine or the basilic vein. Apart from this, he speaks neither of operations nor of remedies for diseases of the teeth.[225] Probably at the time in which Avenzoar wrote, that is, in the first half of the twelfth century, doctors in general did not occupy themselves with the curing of teeth at all, this being abandoned entirely to barbers and other persons. This would sufficiently explain why this author is so silent in regard to dental diseases.
But what can have been the reason for doctors refusing thus contemptuously to occupy themselves with so important a branch of therapeutics? In every age there have been a great number of ignorant persons, who either in good faith, or else for imposture, have practised, within a more or less limited circle, the art of healing, usually dedicating themselves to some particular class of diseases. Even in our days, notwithstanding the superabundance of duly qualified doctors, there is, especially in certain countries, no small number of quacks, secretists, bone-setters, chiropodists, and the like. It is, therefore, not to be wondered at that in times when dentistry was still in its infancy there should have been persons more or less ignorant who undertook tooth drawing and the concoction and sale of specifics against odontalgia. The doctors, on their part, under the pretext of being unwilling to have anything to do with these individuals, found it very convenient to dispense with the cure of dental diseases and with the extraction of teeth, this operation being sometimes too difficult for them, on account of their want of practice, besides being almost always very painful, and considered, even from the most ancient times, capable of eventually producing evil consequences, among which, in some cases, even the death of the patient.
But perhaps this was not the only reason for the fact above mentioned. In the middle ages the extraction of one or more teeth was sometimes inflicted as a punishment; for example, for having eaten flesh during Lent,[226] or on those found guilty of felony, for having refused to contribute sums of money demanded from them by their liege lord. Now, as this punishment was carried out on the guilty ones by the executors of public justice, it is only natural that doctors should have refused to practise an operation which would have degraded their profession by bringing it down nearly to the class of the hangman.