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Medieval Dentistry - Giovanni Of Arcoli

If there is one phase of our present-day medicine and surgery that most

of us are likely to be quite sure is of very recent development it is

dentistry. Probably most people would declare at once that they had

every reason to think that the science and art of dentistry, as we have

it now, developed for the first time in the world's history during the

last generation or two. It is extremely interesting to realize then, in

> the light of this almost universal persuasion, founded to a great extent

on the conviction that man is in process of evolution and that as a

consequence we must surely be doing things now that men never did

before, to find that dentistry, both as an art and science, is old; that

it has developed at a number of times in the world's history, and that

as fortunately for history its work was done mainly in indestructible

materials, the teeth themselves and metal prosthetic apparatus, we have

actual specimens of what was accomplished at a number of periods in the

olden times. Surprising as it will seem to those who hear of it for the

first time, dentistry reached high perfection even in what we know as

ancient history. It is rather easy to trace scientific and craftsmanlike

interest in it during the medieval period and in the magnificent

development of surgery that came just at the end of the Middle Ages,

dentistry shared to such degree that some of the text-books of the

writers on surgery of this time furnish abundant evidence of

anticipations of many of the supposedly most modern developments of


There are a number of historical traditions with regard to dentistry and

the treatment of the teeth in Egypt that can be traced back to good

authorities in Egyptology of a generation or more ago, but it is rather

hard to confirm the accounts we have by actual specimens; either none

were found or for some reason those actually discovered are now not

readily available for study. Among the Phenicians however, though we

have good reasons to think that they learned their arts and crafts from

the Egyptians, there is convincing evidence of a high development of

dentistry. M. Ernest Renan, during an exploring expedition in Phenicia,

found in the old necropolis at Sidon a set of teeth wired together, two

of which were artificial. It was a striking example of bridgework, very

well done, and may now be seen in the Louvre. It would be more than a

little surprising, from what we know of the lack of inventiveness on the

part of the Phenicians and their tendency to acquire their arts by

imitation, if they had reached such a climax of invention by themselves.

Since they adapted and adopted most of their arts and crafts from Egypt,

with which they were in close commercial relations, it has been argued

with some plausibility that the Egyptians may have had many modes of

dental prosthesis, but removed all artificial teeth and dental

appliances from the mouth of corpses before embalming them, in

preparation for the next world, because there was some religious

objection to such human handiwork being left in place for the hereafter,

as they hoped for it.

There is a well-authenticated tradition of intimate intercourse in a

commercial way between the old Etruscans who inhabited the Italian hill

country and the Phenicians, so that it is no surprise to find that the

oldest of Etruscan tombs contain some fine examples of bridgework. An

improvement has come over Phenician work however, and bands of gold

instead of wire are used for holding artificial teeth in place. Guerini,

whose History of Dentistry is the standard work on the subject, on a

commission from the Italian government, carefully studied these

specimens of Etruscan dental work in the museums of Italy, and has made

some interesting observations on them. In one specimen, which is

especially notable, two incisor teeth are replaced by a single tooth

from a calf. This was grooved in such a way as to make it seem like two

separate teeth. Guerini suggests a very interesting and quite unexpected

source for this. While examining the specimen he wondered where the old

Etruscan dentist had obtained a calf's tooth without a trace of wear on

it. He came to the conclusion that he must have cut into the gums of a

young calf before the permanent tooth was erupted in order to get this

structure absolutely unworn for his purpose. A number of examples of

bridgework have been found in the old Etruscan tombs. The dates of their

construction are probably not later than 500 B.C., and some of them are

perhaps earlier than 700 B.C.

The Etruscans affected the old Romans in the matter of dentistry, so

that it is easy to understand the passage in the Laws of the Twelve

Tables, issued about 450 B.C., which, while forbidding the burial of

gold with corpses, made a special exception for such gold as was

fastened to the teeth. Gold was rare at Rome, and care was exercised not

to allow any unnecessary decrease of the visible supply almost in the

same way as governments now protect their gold reserves. It may seem

like comparing little things with great, but the underlying principle is

the same. Hence this special law and its quite natural exception.

In Pope Julius' Museum in Rome there is a specimen of a gold cap made of

two plates of gold riveted together and also riveted to bands of metal

which were fastened around the neighboring teeth in order to hold the

cap in place. This is from later Republican times at Rome. At the end of

the Republic and the beginning of the Empire there appear to have been

many forms of dental appliances. Martial says that the reason why one

lady's teeth--whose name he does not conceal--are white and

another's--name also given--were dark, was that the first one bought

hers and the second still had her own. In another satiric poem he

describes an elderly woman as so much frightened that when she ran away

her teeth fell out, while her friends lost their false hair. Fillings of

many kinds were used, dentrifices of nearly every kind were invented,

and dentistry evidently reached a high stage of development, though we

have nowhere a special name for dentist, and the work seems to have been

done by physicians, who took this as a specialty.

While in the Middle Ages there was, owing to conditions, a loss of much

of this knowledge of antiquity with regard to dentistry, or an

obscuration of it, it never disappeared completely, and whenever men

have written seriously about medicine, above all about surgery in

relation to the face and the mouth, the teeth have come in for their

share of scientific and practical consideration. Aetius, the first

important Christian writer on medicine and surgery, discusses, as we

have seen in the sketch of him, the nutrition of the teeth, their

nerves, which came from the third pair and entered the teeth by a small

hole existing at the end of the root, and other interesting details of

anatomy and physiology. He knows much about the hygiene of the teeth,

discusses extraction and the cure of fistula and other details. Paul of

AEgina in the next century has much more, and while they both quote

mainly from older authors there seems no doubt that they themselves had

made not a few observations and had practical experience.

It was from these men that the Arabian physicians and surgeons obtained

their traditions of medicine, and so it is not surprising to find that

they discuss dental diseases and their treatment rationally and in

considerable detail. Abulcasis particularly has much that is of

significance and interest. We have pictures of two score of dental

instruments that were used by them. The Arabs not only treated and

filled carious teeth and even replaced those that were lost, but they

also corrected deformities of the mouth and of the dental arches.

Orthodontia is sometimes said to be of much later origin and to begin

many centuries after Abulcasis' time, yet no one who knows of his work

can speak of Orthodontia as an invention after him. In this, however, as

in most of the departments of medicine and surgery, the Arabs were

merely imitators, though probably they expanded somewhat the practical

knowledge that had come to them.

When the great revival in surgery came in the twelfth and thirteenth

centuries it is not surprising that there should also have been an

important renewal of interest in dentistry. A detailed review of this

would take us too far afield, but at least something may be said of two

or three of the great representative surgical writers who touched on

this specialty.

About the middle of the fourteenth century that prince of surgeons, and

model of surgical writers, Guy de Chauliac, wrote his great text-book of

surgery, Le Grande Chirurgie. An extremely interesting feature of this

work is to be found in the chapters that treat of diseases of the teeth.

These are not very comprehensive, and are evidently not so much the

result of his experience, as the fruit of his reading, yet they contain

many practical valuable ideas that are supposed to be ever so much later

than the middle of the fourteenth century. His anatomy and physiology at

least are not without many errors. His rules for the preservation of the

teeth show that the ordinary causes of dental decay were well recognized

even as early as this. Emphasis was laid on not taking foods too hot or

too cold, and above all not to follow either hot or cold food by

something very different from it in temperature. The breaking of hard

things with the teeth was recognized as one of the most frequent causes

of such deterioration of the enamel as gives opportunity for the

development of decay. The eating of sweets, and especially the sticky

sweets--preserves and the like--was recognized as an important source of

caries. The teeth were supposed to be cleaned frequently, and not to be

cleaned too roughly, for this would do more harm than good. We find

these rules repeated by succeeding writers on general surgery, who touch

upon dentistry, or at least the care of the teeth, and they were not

original with Guy de Chauliac, but part of the tradition of surgery.

As noted by Guerini in his History of Dentistry, the translation of

which was published under the auspices of the National Dental

Association of the United States of America,[28] Chauliac recognized the

dentists as specialists. Besides, it should be added, as is evident from

his enumeration of the surgical instruments which he declares necessary

for them, they were not as we might easily think in the modern time mere

tooth pullers, but at least the best among them treated teeth as far as

their limited knowledge and means at command enabled them to do so, and

these means were much more elaborate than we have been led to think, and

much more detailed than we have reason to know that they were at

certain subsequent periods.

In fact, though Guy de Chauliac frankly confesses that he touches on the

subject of dentistry only in order to complete his presentation of the

subject of surgery and not because he has anything of his own to say

with regard to the subject, there is much that is of present-day

interest in his brief paragraphs. He observes that operations on the

teeth are special and belong to the dentatores, or dentists, to whom

doctors had given them over. He considers, however, that the operations

in the mouth should be performed under the direction of a physician. It

is in order to give physicians the general principles with which they

may be able to judge of the advisability or necessity for dental

operations that his short chapters are written. If their advice is to be

of value, physicians should know the various methods of treatment

suitable for dental diseases, including mouth washes, gargles,

masticatories, anointments, rubbings, fumigations, cauterizations,

fillings, filings, and the various manual operations. He says that the

dentator must be provided with the appropriate instruments, among

which he names scrapers, rasps, straight and curved spatumina,

elevators, simple and with two branches, toothed tenacula, and many

different forms of probes and canulas. He should also have small

scalpels, tooth trephines, and files.

Chauliac is particularly emphatic in his insistence on not permitting

alimentary materials to remain in cavities, and suggests that if

cavities between the teeth tend to retain food material they should even

be filed in such a way as to prevent these accumulations. His

directions for cleansing the teeth were rather detailed. His favorite

treatment for wounds was wine, and he knew that he succeeded by means of

it in securing union by first intention. It is not surprising, then, to

find that he recommends rinsing of the mouth with wine as a precaution

against dental decay. A vinous decoction of wild mint and of pepper he

considered particularly beneficial, though he thought that dentifrices,

either powder or liquid, should also be used. He seems to recommend the

powder dentifrices as more efficacious. His favorite prescription for a

tooth powder, while more elaborate, resembles to such an extent, at

least some, if not indeed most of those, that are used at the present

time, that it seems worth while giving his directions for it. He took

equal parts of cuttle bone, small white sea-shells, pumice stone, burnt

stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia,

and reeds. All of these substances should be carefully reduced to powder

and then mixed. His favorite liquid dentifrice contained the following

ingredients,--half a pound each of sal ammoniac and rock salt, and a

quarter of a pound of sacharin alum. All these were to be reduced to

powder and placed in a glass alembic and dissolved. The teeth should be

rubbed with it, using a little scarlet cloth for the purpose. Just why

this particular color of cleansing cloth was recommended is not quite


He recognized, however, that cleansing of the teeth properly often

became impossible by any scrubbing method, no matter what the dentifrice

used, because of the presence of what we call tartar and what he called

hardened limosity or limyness (limosite endurcie). When that condition

is present he suggests the use of rasps and spatumina and other

instrumental means of removing the tartar.

Evidently he did not believe in the removal of the teeth unless this was

absolutely necessary and no other method of treatment would avail to

save the patient from continuous distress. He summarizes the authorities

with regard to the extraction of teeth and the removal of dental

fragments and roots. He evidently knew of the many methods suggested

before his time of removing teeth without recourse to instrumental

extraction. There were a number of applications to the gums that were

claimed by older authors to remove the teeth without the need of metal

instruments. We might expect that Chauliac would detect the fallacy with

regard to these and expose it. He says that while much is claimed for

these methods he has never seen them work in practice and he distrusts

them entirely.

The most interesting phase of what Guy de Chauliac has to say with

regard to dentistry is of course to be found in his paragraphs on the

artificial replacement of lost teeth and the subject of dental

prosthesis generally. When teeth become loose he advises that they be

fastened to the healthy ones with a gold chain. Guerini suggests that he

evidently means a gold wire. If the teeth fall out they may be replaced

by the teeth of another person or with artificial teeth made from

oxbone, which may be fixed in place by a fine metal ligature. He says

that such teeth may be serviceable for a long while. This is a rather

curt way of treating so large a subject as dental prosthesis, but it

contains a lot of suggestive material. He was quoting mainly the Arabian

authors, and especially Abulcasis and Ali Abbas and Rhazes, and these of

course, as we have said, mentioned many methods of artificially

replacing teeth as also of transplantation and of treatment of the

deformities of the dental arches.

On the whole, however, it must be confessed that we have here in the

middle of the fourteenth century a rather surprising anticipation of the

knowledge of a special department of medicine which is usually

considered to be distinctly modern, and indeed as having only attracted

attention seriously in comparatively recent times.

After Guy de Chauliac the next important contributor to dentistry is

Giovanni of Arcoli, often better known by his Latin name, Johannes

Arculanus, who was a professor of medicine and surgery at Bologna and

afterwards at Padua, just before and after the middle of the fifteenth

century, and who died in 1484. He is famous principally for being the

first we know who mentions the filling of teeth with gold.

It might possibly be suggested that coming at this time Arculanus should

rather be reckoned as a Maker of Medicine in the Renaissance than as

belonging to the Middle Ages and its influences. His education, however,

was entirely completed before the earliest date at which the Renaissance

movement is usually said to begin, that is with the fall of

Constantinople in 1452, and he was dead before the other date, that of

the discovery of America in 1492, which the Germans have in recent years

come to set down as the end of the Middle Ages. Besides, what he has to

say about dentistry occurs in typical medieval form. It is found in a

commentary on Rhazes, written just about the middle of the fifteenth

century. In the later true Renaissance such a commentary would have been

on a Greek author. In his commentary Arculanus touches on most of the

features of medicine and surgery from the standpoint of his own

experience as well as from what he knows of the writings of his

predecessors and contemporaries. With the rest he has a series of

chapters on diseases of the teeth. Guerini in his History of Dentistry

says that this subject [dentistry] is treated rather fully, and with

great accuracy. Even some short references to it will, I think,

demonstrate this rather readily.[29]

Arculanus is particularly full in his directions for the preservation of

the teeth. We are rather prone to think that prophylaxis is

comparatively a modern idea, and that most of the principles of

conservation of human tissues and the prevention of deterioration and

disease are distinctly modern. It needs only a little consideration of

Arculanus' instruction in the matter of the teeth, however, to undo any

such false impression. For obvious reasons I prefer to quote Guerini's

summation of this medieval student of dentistry's rules for dental


For the preservation of teeth--considered by him, quite

rightly, a matter of great importance--Giovanni of Arcoli

repeats the various counsels given on the subject by preceding

writers, but he gives them as ten distinct canons or rules,

creating in this way a kind of decalogue of dental hygiene.

These rules are: (1) It is necessary to guard against the

corruption of food and drink within the stomach; therefore,

easily corruptible food--milk, salt fish, etc.--must not be

partaken of, and after meals all excessive movement, running

exercises, bathing, coitus, and other causes that impair the

digestion, must also be avoided. (2) Everything must be

avoided that may provoke vomiting. (3) Sweet and viscous

food--such as dried figs, preserves made with honey,

etc.--must not be partaken of. (4) Hard things must not be

broken with the teeth. (5) All food, drink, and other

substances that set the teeth on edge must be avoided. (6)

Food that is too hot or too cold must be avoided, and

especially the rapid succession of hot and cold, and vice

versa. (7) Leeks must not be eaten, as such a food, by its own

nature, is injurious to the teeth. (8) The teeth must be

cleaned at once, after every meal, from the particles of food

left in them; and for this purpose thin pieces of wood should

be used, somewhat broad at the ends, but not sharp-pointed or

edged; and preference should be given to small cypress twigs,

to the wood of aloes, or pine, rosemary, or juniper and

similar sorts of wood which are rather bitter and styptic;

care must, however, be taken not to search too long in the

dental interstices and not to injure the gums or shake the

teeth. (9) After this it is necessary to rinse the mouth by

using by preference a vinous decoction of sage, or one of

cinnamon, mastich, gallia, moschata, cubeb, juniper seeds,

root of cyperus, and rosemary leaves. (10) The teeth must be

rubbed with suitable dentrifices before going to bed, or else

in the morning before breakfast. Although Avicenna recommended

various oils for this purpose, Giovanni of Arcoli appears

very hostile to oleaginous frictions, because he considers

them very injurious to the stomach. He observes, besides, that

whilst moderate frictions of brief duration are helpful to the

teeth, strengthen the gums, prevent the formation of tartar,

and sweeten the breath, too rough or too prolonged rubbing is,

on the contrary, harmful to the teeth, and makes them liable

to many diseases.

All this is so modern in many ways that we might expect a detailed exact

knowledge of the anatomy of the teeth and even something of their

embryology from Arculanus. It must not be forgotten, however, that

coming as he does before the Renaissance, the medical sciences in the

true sense of the word are as yet unborn. Men are accumulating

information for practical purposes but not for the classification and

co-ordination that was to make possible the scientific development of

their knowledge.

Giovanni of Arcoli's acquaintance with the anatomy of the teeth was

rather sadly lacking. He does not know even with certainty the number of

roots that the teeth have. This has been attributed to the fact that he

obtained most of his information from books, and had not the time to

verify descriptions that he had found. It has been argued from this that

he was himself probably not a practical dentist, and turned to that

specialty only as a portion of his work as a general surgeon, and that

consequently he was not sufficiently interested to verify his

statements. His chapters on dentistry would seem to bear out this

conclusion to some extent, though the very fact that one who was himself

not specially interested in dental surgery should have succeeded in

gathering together so much that anticipates modern ideas in dentistry,

is of itself a proof of how much knowledge of the subject there was

available for a serious student of that time. The anatomy of the teeth

continued to be rather vague until about the middle of the next century

when Eustachius, whose investigations of the anatomy of the head have

deservedly brought him fame and the attachment of his name to the

Eustachian canal, wrote his Libellus de Dentibus--Manual of the Teeth,

which is quite full, accurate, and detailed. Very little has been added

to the microscopic anatomy of the teeth since Eustachius' time. He had

the advantage, of course, of being intimately in contact with the great

group of Renaissance anatomists,--Vesalius, Columbus, Varolius,

Fallopius, and the others, the great fathers of anatomy. Besides, his

position as Papal Physician and Professor of Anatomy at the Papal

Medical School at Rome gave him opportunities for original

investigation, such as were not easily obtained elsewhere.

Arculanus can scarcely be blamed, therefore, for not having anticipated

the Renaissance, and we must take him as merely the culmination of

medieval knowledge with regard to anatomy and surgery. Medieval medical

men did not have the time nor apparently the incentive to make formal

medical science, though it must not be forgotten, as has been said, that

they did use the knowledge they obtained by their own and others'

observation to excellent advantage for the practical benefit of ailing

humanity. The sciences related to medicine are conscious developments

that follow the evolution of practical medicine, nor must it be

forgotten that far from always serving as an auxiliary to applied

medical science, often indeed in the history of medicine scientific

pursuits have led men away into side issues from which they had to be

brought back by some genius medical observer. As might be expected,

then, it is with regard to the practical treatment and general

consideration of ailments of the teeth that Giovanni of Arcoli is most

interesting. In this some of his chapters contain a marvellous series of


Arculanus was probably born towards the end of the fourteenth century.

The date of his death is variously placed as either 1460 or 1484, with

the probability in favor of the former. From 1412 to 1427 he was

professor at Bologna, where in accordance with the non-specializing

tendencies of the time he did not occupy a single chair but several in

succession. He seems first to have taught Logic, then Moral Philosophy,

and finally Medicine. His reputation in medicine drew many students to

the university, and his fame spread all over Italy. The rival University

of Padua then secured him, and he seems to have been for some twenty

years there. Later apparently he accepted a professor's chair at

Ferrara, where the D'Estes were trying to bring their university into

prominence. It was at Ferrara that he died. He was a man of wide

reading, of extensive experience, both of men and medicine, and one of

the scholars of his time. His works are, as we have said, mainly

excerpts from earlier writers and particularly the Arabians, but they

contain enough of hints drawn from his own observation and experience

to make his work of great value.

While, as Gurlt remarks in his History of Surgery, Arculanus' name is

one of those scarcely known--he is usually considered just one of many

obscure writers of the end of the Middle Ages--his writings deserve a

better fate. They contain much that is interesting and a great deal that

must have been of the highest practical value to his contemporaries.

They attracted wide attention in his own and immediately succeeding

generations. The proof of this is that they exist in a large number of

manuscript copies. Just as soon as printing was introduced his books

appeared in edition after edition. His Practica was printed in no less

than seven editions in Venice. Three of them appeared before the end of

the fifteenth century, which places them among the incunabula of


Probably nothing in the history of human intellectual interest is more

striking than the excellent judgment displayed by the editors who

selected the works to be printed at this time. Very few of them were

trivial or insignificant. Fewer still were idle speculations, and most

of them were almost of classical import for literature and science. Four

editions of this work were printed in Venice in the sixteenth century,

one of them as late as 1560, when the work done by such men as Vesalius,

Columbus, Eustachius, and Fallopius would seem to have made Arculanus

out of date. The dates of the various editions are Venice, 1483, 1493,

1497, 1504, 1542, 1557, and 1560. Besides there was an edition printed

at Basel in 1540.

Arculanus is said to have re-introduced the use of the seton, that is

the method of producing intense counter-irritation by the introduction

of some foreign body into an incision in the skin. We owe to him, too,

according to Pagel in the chapters on medieval medicine in Puschmann's

Handbook of the History of Medicine, an excellent description of

alcoholic insanity.

His directions for the treatment of conditions in the mouth and nose

apart from the teeth are quite as explicit and practical, and in many

ways quite as great an anticipation of some of our modern notions as

what he has to say with regard to the teeth. For instance, in the

treatment of polyps he says that they should be incised and cauterized.

Soft polyps should be drawn out with a toothed tenaculum as far as can

be without risk of breaking them off. The incision should be made at the

root so that nothing or just as little as possible of the pathological

structure be allowed to remain. It should be cut off with a fine

scissors, or with a narrow file just small enough to permit its ingress

into the nostrils, or with a scalpel without cutting edges on the sides,

but only at its extremity, and this cutting edge should be broad and

well sharpened. If there is danger of hemorrhage, or if there is fear of

it, the instruments with which dissection is made should be fired

(igniantur), that is, heated at least to a dull redness. Afterwards

the stump, if any remains, should be touched with a hot iron or else

with cauterizing agents so that as far as possible it should be


After the operation a pledget of cotton dipped in the green ointment

described by Rhazes should be placed in the nose. This pledget should

have a string fastened to it, hanging from the nose in order that it may

be easily removed. At times it may be necessary to touch the root of the

polyp with a stylet on which cotton has been placed that has been dipped

in aqua fortis (nitric acid). It is important that this cauterizing

fluid should be rather strong so that after a certain number of touches

a rather firm eschar is produced. In all these manipulations in the nose

Arculanus recommends that the nose should be held well open by means of

a nasal speculum. Pictures of all these instruments occur in his extant

works, and indeed this constitutes one of their most interesting and

valuable features. They are to be seen in Gurlt's History of Surgery.

In some cases he had seen the polyp was so difficult to get at or was

situated so far back in the nose that it could not be reached by means

of a tenaculum or scissors, or even the special knife devised for that

purpose. For these patients Arculanus describes an operation that is to

be found in the older writers on surgery, Paul of AEgina (AEginetus),

Avicenna, and some of the other Arabian surgeons. For this three

horse-tail hairs are twisted together and knotted in three or four

places, and one end is passed through the nostrils and out through the

mouth. The ends of this are then pulled on backward and forward after

the fashion of a saw. Arculanus remarks evidently with the air of a man

who has tried it and not been satisfied that this operation is quite

uncertain, and seems to depend a great deal on chance, and much reliance

must not be placed on it. Arculanus suggests a substitute method by

which latent polyps or occult polyps as he calls them may be removed.

There is scarcely an important disease for which Arculanus has not some

interesting suggestions, and the more one reads of him the more is one

surprised to find how many things that we might think of as coming into

the purview of medicine long after his time or at least as having been

neglected from the time of the Greeks almost down to our own time are

here treated explicitly, definitely, and with excellent practical

suggestions. He has a good deal to say with regard to the treatment of

angina, which he calls synanche, or synanchia, or cynanche, or angina.

Parasynanche is a synonymous term, but refers to a milder synanche. He

distinguished four forms of it. In one called canine angina, because the

patient's tongue hangs out of his mouth, somewhat the same as from an

overheated dog in the summer time, while at the same time the mouth is

held open and he draws his breath pantingly, Arculanus suggests an

unfavorable prognosis, and would seem to refer to those cases of

Ludwig's angina in which there is involvement of the tongue and in which

our prognosis continues to be of the very worst even to our own day. At

times the angina causes such swelling in the throat that the breathing

is interfered with completely. For this Arculanus' master, Rhazes,

advised tracheotomy. Arculanus himself, however, apparently hesitated

about that.

It is not surprising, then, to find that Arculanus is very explicit in

his treatment of affections of the uvula. He divides its affections into

apostema, ulcus, putredo sive corrosio, et casus. Apostema was

abscess, ulcus any rather deep erosion, putredo a gangrenous

condition, and casus the fall of the uvula. This is the notorious

falling of the soft palate which has always been in popular medical

literature at least. Arculanus describes it as a preternatural

elongation of the uvula which sometimes goes to such an extent as to

make it resemble the tail of a mouse. For shorter elongations he

suggests the cautery; for longer, excision followed by the cautery so

that the greater portion of the extending part may be cut off. If people

fear the knife he suggests following Rhazes, the application of an

astringent powder directly to the part by blowing through a tube. His

directions for the removal of the uvula are very definite. Seat the

patient upon a stool in a bright light while an assistant holds the

head; after the tongue has been firmly depressed by means of a speculum

let the assistant hold this speculum in place. With the left hand then

insert an instrument, a stilus, by which the uvula is pulled forward,

and then remove the end of it by means of a heated knife or some other

process of cauterization. The mouth should afterwards be washed out with

fresh milk.

The application of a cauterizing solution by means of a cotton swab

wrapped round the end of a sound may be of service in patients who

refuse the actual cautery. To be successful the application must be

firmly made and must be frequently repeated.

After this it is not surprising to find that Arculanus has very

practical chapters on all the other ordinary surgical affections.

Empyema is treated very thoroughly, liver abscess, ascites, which he

warns must be emptied slowly, ileus especially when it reaches

stercoraceous vomiting, and the various difficulties of urination, he

divides them into dysuria, ischuria, and stranguria, are all discussed

in quite modern fashion. He gives seven causes for difficulty of

urination. One, some injury of the bladder; two, some lesion of the

urethra; three, some pathological condition in the power to make the

bladder contract; four, some injury of the muscle of the neck of the

bladder; five, some pathological condition of the urine; six, some

kidney trouble, and seven, some pathological condition of the general

system. He takes up each one of these and discusses the various phases,

causes, disposition, and predispositions that bring them about. One

thing these men of the Middle Ages could do, they reasoned logically,

they ordered what they had to say well, and they wrote it out


That Arculanus' work with regard to dentistry was no mere chance and not

solely theoretic can be understood very well from his predecessors, and

that it formed a link in a continuous tradition which was well preserved

we may judge from what is to be found in the writings of his great

successor, Giovanni or John de Vigo, who is considered one of the great

surgeons of the early Renaissance, and to whom we owe what is probably

the earliest treatise on Gun-shot Wounds. John of Vigo was a Papal

physician and surgeon, generally considered one of the most

distinguished members of the medical profession of his time. Two

features of his writing on dental diseases deserve mention. He insists

that abscesses of the gums shall be treated as other abscesses by being

encouraged to come to maturity and then being opened. If they do not

close promptly, an irritant Egyptian ointment containing verdigris and

alum among other things should be applied to them. In the cure of old

fistulous tracts near the teeth he employs not only this Egyptian

ointment but also arsenic and corrosive sublimate. What he has to say

with regard to the filling of the teeth is, however, most important. He

says it with extreme brevity, but with the manner of a man thoroughly

accustomed to doing it. By means of a drill or file the putrefied or

corroded part of the tooth should be completely removed. The cavity left

should then be filled with gold leaf. It is evident that the members of

the Papal court, the Cardinals and the Pope himself, had the advantage

of rather good dentistry at John de Vigo's hands even as early as the

beginning of the sixteenth century.

John de Vigo, however, is not medieval. He lived on into the sixteenth

century and was influenced deeply by the Renaissance. He counts among

the makers of modern medicine and surgery, as his authorship of the

treatise on gun-shot wounds makes clear. He comes in a period that will

be treated of in a later volume of this series on Our Forefathers in