This author agrees with Galen in considering the teeth as bones, but he is of opinion that they differ from the other bones in more than one respect; that is, first of all, on account of their sensibility; secondly, because, whilst the other bones are formed in the uterus, the teeth are formed outside the uterus; and lastly, for a reason which cannot but appear very strange to us, that is: “The bones are produced by the sperm and menstrual blood, whilst the teeth are produced by the blood in which there has remained the virtue of the sperm.”[259] This passage gives us an idea of the state of embryological knowledge of those days!
Pietro of Argelata (or of La Cerlata), professor of surgery at Bologna (died in 1433), wrote a treatise on surgery in six books, in which diseases of the teeth are also taken into serious consideration. He speaks of a great number of dental instruments, which, however, are the same as those enumerated by Guy de Chauliac. His methods of cure do not offer anything very new, being for the most part identical with those of Avicenna and Abulcasis. He considers cleanliness of the teeth of the greatest importance; shows what great injury is done by dental tartar—which by him is considered a very important sign of the bad state of the teeth—he counsels the removal of it by means of scrapers, files, or the use of strong dentifrice powders; and to make the teeth white, he even advises the use of aqua fortis.
He says nothing in regard to the filling of decayed teeth; he, however, counsels the cleansing of the carious cavities with aqua fortis, or even, in some cases, the widening of them, in order to render them shallower and therefore less liable to retain alimentary residues.
Pietro of Argelata cured dental fistulas by means of caustics and arsenic. He counselled simple palliative means of cure for hard epulides of a cancerous nature. In regard to soft, benignant epulides, he was little favorable to excision, as this might cause hemorrhage; he preferred ligating the tumor; or he repeatedly cauterized it with boiling oil or other caustics, until he caused it to fall.[260]
Bartolomeo Montagnana, who taught surgery in the University of Padua and died in 1460, recommended, as an excellent anti-odontalgic remedy, a mixture of camphor and opium. In his days, faith in the pretended eradicating virtues of certain substances was being gradually lost; but, on the other hand, a tendency now arose to neglect, in regard to the teeth, the conservative principle, to which the ancients had held so jealously; and little by little the extraction of a tooth began to be considered an operation of small or no importance, that could be performed with the greatest indifference. Montagnana himself considers the extraction of a tooth as the best means of curing odontalgia, whilst the ancients did not have recourse to it, saving as a last resource. Notwithstanding this, if the caries was not deep, he preferred to extraction the use of caustics and a red-hot iron.[261]
Giovanni Plateario, a professor at Pisa in the latter half of the fifteenth century, cauterized carious teeth with a small piece of kindled ash wood, or with a red-hot iron, and held that cauterization was more effectual when, before performing it, the carious hollow had been filled up with theriac.[262]
He, too, made the administration of purgatives or bloodletting precede the extraction of a tooth. Plateario has, however, the merit of having introduced the sitting position for operations on the teeth, whilst preceding surgeons made the patient lie in a horizontal position, or held his head steady between their knees, as may be read in Abulcasis and in other writers. Besides, he recommends taking care, when the extraction of a tooth had to be performed, that the surrounding air should be pure; perhaps because he thought that when operating in a place where the air was tainted, complications might more easily arise, on account of contagious substances reaching the inside of the wound; or perhaps because he judged, not without reason, that certain accidents, such as syncope, could more easily happen, and were more dangerous in a tainted atmosphere than in the midst of pure, vivifying air. After the operation, he prescribed astringent mouth washes. Against dental worms, whose existence no one at that period doubted in the least, Plateario recommended various remedies, chiefly under the form of fumigations; and among these latter, those performed with burnt opium. Against ulcerations of the gums and mouth he commended the use of wine and aromatic substances. An excellent remedy was also, according to him, lime dissolved in very strong hot vinegar, and mixed, after complete evaporation of the liquid, with a fourth part of orpiment.
Giovanni of Arcoli (in Latin, Joannes Arculanus), professor at Bologna and afterward at Padua (who died in 1484), wrote a commentary on a celebrated book of medicine, which Rhazes had dedicated to the glorious King Almansor, great patron of science and art.[263]
In this most valuable work of Arculanus there are several chapters relative to diseases of the teeth; and this subject is treated rather fully and with great accuracy.
The author, first of all, treats of the anatomy and physiology of the teeth; he, however, falls into many errors, for instance, in regard to the number of dental roots. (“The first six teeth of the upper jaw have only one root; the first six of the lower not more than two; the molars of the upper jaw have three; those of the lower generally only two in like manner; the neguezid[264] of the upper jaw have four roots, but the two lower neguezid have only three.”)