The History of Orthodontia.

~2 7

The Mandibular Arch.

The first brachial arch forms the lower b o u n d a r y of the mouth and bv
its development grows into a projecting lower jaw.

The Lips and the Gums.

Very soon after the upper jaw has been formed, and the maxillary pro*
cess unites with ttie nasal process, its surface develops two parallel ridges.
The outer ridge becomes the lip, the inner ridge becomes the gums. An
analogue of this process is seen in the lower jaw. In the sixth to t h e seventh
there is developed a peculiar epithelium of the lips, t h a t appeared in the
strata lucidum and the epitracheum. In the rabbit thirteen d a y s old the
epitracheum is seen running over the region of the future lip. In the pig
embryo measuring 3.5 m.m. the epitracheum is still present, but in places
it is commencing to show an enlargement of the basal cells and cornification
is beginning.

THE HISTORY OF ORTHODONTIA.

(Continued f r o m page 458)

BY BERNHARD WOLF WEINBERGER, D.D.S.

NEW YORK CITY.

Dentistry During the Hebraic Age.

T HareE main sources of our knowledge of medical history of the Hebrews

the Bible and the Talmud. Notwithstanding
lations with the Egyptians and the close proximity to th,
tribes, medical science never reached the degree of development among
them as it did with their neighbors.
The principal interest displayed bv the Hebrews in a definite direction
were the efforts in preventative medicine, yet in hygiene were they most
pre-eminent and distinguished. Moses makes the first reference to phy-
sicians, about 1640 B.C. "Joseph,
1 commanded, his servants and the phy-
sicians to embalm his father. These physicians were no doubt Egyptians.
In the Bible many allusions are made to the t e e t h , y e t no specific ref-
erence in early Hebrew literature to dentistry is :
in the excellent sanitary laws drawn up by Moses
of the people under his care, none are on record ff
mouth. We are thus led to the presumption t h a t the teeth of the ancri~nt
Hebrews were sound and healthy. In the "Songs of Solomon," referenze is
made to the beauty and whiteness of the teeth in the following words. " T h e
teeth are like a flock of well selected sheep, which are come up f r o m the
washing. ''2 This passage, with a slight variation occurs again, 3 showing
I. Genesis 5-2 2. IV-2. 3. VI-6.
Most.of the a b o v e detail, as well as those on dentistry throughout this work is taken f r o m " A History-
of D e n t i s t r y , " By Dr. Vineenzo Guerini.
(Copyright, 1915. by Dr. Bernhard W, Wefnberger.)
528 The International Journal of Orthodontia.

how beautiful teeth were appreciated by him. T h a t the "full compliment of

t e e t h " was appreciated by Moses is shown-by the criminal code in which
he states in the book of Exodus (XXI, 23-27):
23. And if a n y mischief follow, t h e n shalt t h o u give life for life.
24. Eye for Eye, t o o t h for tooth, h a n d for hand, a n d foot for foot.
27. And if he strike o u t his m a n - s e r v a n t ' s tooth, or his maid s e r v a n t ' s t o o t h , he shall
let him go free for the sake of his t o o t h .

Broken and decayed teeth are referred to as symbolic of weakness,

"Like a broken tooth and a foot out of joint, is confidence in a treacherous
man in a time of distress. ''4 Again, "Arise, O I,ord, help me, O my God,
for thou smitest all m y enemies upon the cheek bone; the teeth of the wicked
dost thou break. ''s

Sumerian and Babylonian Dentistry.

The Babylonians, Assyrians, Egyptians, Hebrews, Greek, Romans and
Brahmas, were among the early cultured nations of whom historical records
exist, their priests were the embodiment of the clergy and our professional
man, they were the doctors, surgeons, astronomers, lawgivers, and scientists,
as well as "voices of the gods".
In the libraries of China, Alexandria and Memphis, were records of their
learnings, probably containing valuable medical and dental literature. As
in the case of the pillaging of the Alexandrian Library during the seventh
century, when t h e Saracens invaded and subjugated Egypt, devoting six
months to the destruction of books, records, etc., so other hostile tribes
plundered the great libraries of their times.
"Before the a d v e n t of the Babylonians, it is supposed t h a t an original
non-Semetic or Sumerian race existed, (about 4000-3000 B.C.), which laid
the foundation of modern civilization by the invention of pictorial writing
and the development of astronomy. Others assume t h a t the cursive script
of the Sumerians, which like Chinese writing runs from right to left, was in
the first instance only a sort of a cipher-code used by the d o m i n a n t Semetic
race. In any case, Mesopotamia was the starting point of Oriental ~civi-
lization, of which the B a b y l o n i a n s were undoubtedly the principal found-
ers. ''6 T h e y were the inventors of the cuneiform inscription, reading from
left to right. Among the hieroglyphic records recently excavated in Baby-
lonia and transcribed by Deletzsch, Thompson and others, are found some
interesting accounts concerning the practice of medicine and dentistry.
Like the Egyptians, the Babylonians reached the stage where they
had physicians for every disease, but whether dentistry was practiced as a
separate branch we do not know. T h e y e m p l o y e d the same methods as the
Egyptians in treating the sick, requiring those who were ill to be brought to
the market place, in order t h a t whoever passed and had been so afflicted
might advise as to how they were cured or had escaped similar diseases.
Montaigne quaintly observed, " T h e whole people was the physician." We
learn, however, from the code of K i n g H a m m u r a b i (2250 B.C.,), a c0ntem-
porary of Abraham, t h a t the medical profession in Babylon advanced far
4. Proverbs of Solomon XXV:19.
5. Psalm: III:8.
6. Garrison Fielding, H.: A n introduction to the " H i s t o r y of Medicine."
 The History of Orthodontia. 529

.~nough in public e s t e e m to be r e w a r d e d with a d e q u a t e fees c a r e f u l l y pre-

scribed a n d r e g u l a t e d b y t h e law. " T h u s ten shekels in silver w a s t h e s t a -
t u t o r y fee for t r e a t i n g a w o u n d or o p e n i n g a n abcess, if t h e p a t i e n t h a p p e n e d
to be a ' G e n t l e m a n ' :if he were a p o o r m a n or a s e r v a n t , the fee w a s five to t w o
respectively. If the d o c t o r c a u s e d the p a t i e n t to lose his sight or life, he h a d
his h a n d c u t off in t h e case of a g e n t l e m e n , o r h a d to r e n d e r v a l u e for v a l u e
in the case of a slave. ''7 A m o n g the records f o u n d in r e c e n t e x c a v a t i o n s ,
are a n u m b e r of i n t e r e s t i n g f a c t s c o n c e r n i n g the p r a c t i c e ef d e n t i s t r y u n d e r
Hammurabi. " I f one k n o c k s o u t a t o o t h of one of his o w n c a s t his o w n
t o o t h shall be k n o c k e d out, while if it is a f r e e m a n , he p a y s o n e - t h i r d m i n e
silver. Severe p u n i s h m e n t , h o w e v e r , was in store for the surgeon if he
o p e r a t e d on the critical d a y s of the m o n t h Schall-Elul ( L e a p Year), viz..
7th, 14th, 21st, 27th. ''8
T h e earliest m e t h o d for t r e a t i n g " t o o t h - a c h e , " of which we possess re-
cords, is t h a t p r a c t i c e d b y the a n c i e n t B a b y l o n i a n s , w h o believed t h a t caries
was the result of the g n a w i n g of small w o r m s a t the to6th, a belief t h a t re-
m a i n e d p r e v a l e n t until r e c e n t times. T h e following i n c a n t a t i o n was recited
with the hope t h a t it would p r e v e n t f u r t h e r d e s t r u c t i o n of the t o o t h :
"After Anu (had created the heavens),
The Heavens created (the E a r t h ) ,
The E a r t h created the Rivers,
The Rivers created the Canals,
The Canals created the Marshes,
The Marshes created the Worm.
Came the W o r m and w e p t before Shamask,
Before E a came her tears
W h a t wilt thou give me for m y food
W h a t wilt thou give me to devour?
I will give thee dried bone,
And scented . . . . . . . . . . . . . . . . . . . . (wood)
Le~ me drink a m o n g the teeth,
And set me on the gums,
That I may devour the blood of the teeth
And of their gums destroy their strength,
T h e n shall I hold the bolt of the door."

A f t e r c h a n t i n g this t h r e e times, the p a t i e n t was d i r e c t e d

w i t h a m i x t u r e of beer, a certRin h e r b a n d a p u n g e n t oil, the
c a n n o t a t p r e s e n t be indentified.

T h e D e n t a l Art of t h e G r e e k s .
I t is G r e e c e which f u r n i s h e s the m o s t i n t e r e s t i n g r e c o r d s of t h e h i s t o r y
of m e d i c i n e d u r i n g a n t i q u i t y . F o r o v e r se~
underwent a transformation, being practiced
sacred a n d finally w r a p p e d in m y s t e r y . W e
p h i l o s o p h e r s to find a n y k n o w l e d g e concernirtg t h e t e e t h .
N o t h i n g ot c o n s e q u e n c e is to be f o u n d in t h e e a r l y h i s t o r y of Greece,
time having destroyed everything. I t is k n o w n t h a t ab,
i s t r a t u s deposited, in the T e m p l e of Apollo, a forceps,
lead. for the p u r p o s e of e x t r a c t i o n of t h e t e e t h .
7. Ibid.
8. Prinz, H e r m a n n : D e n t i s t r y in Early Folklore, " O l d P e n n . " Jan. 16. 1915.
530 The International Journal of Orthodontia.

We find no reference to dentistry or other sciences, during the first cen-

tury of Greek civilization. To the time of the siege of Troy (1193 B.C.)
the writings of the early Grecians consisted almost entirely of hymns to the
gods. Homer has failed to mention the subject in his works, although he
relates that the teeth of warriors were broken; yet he does not tell what was
done to replace the same. According to Cicero, extraction was first advised
by the third A~sculapius, son of Arsinoe and Arsippi (1300 B.C.,) who also
recommended cleansing the mouth and teeth. According to t h i s , dental
surgery had its origin with tEsculapius, the "God of Medicine" and most
ancient authority on medical science.
It is not known whether the above traditiou, related by Cicero,is authen-
tic, b u t as there were numerous temples of healing dedicated to 3Esculapius
in almost every large Greek city and to them came the sick seeking relief,
so we m a y presume that dentistry must also have been practiced at this early
period.
Celius Aurelianus records that instruments of lead was used for extrac-
tion of the teeth, one having b e e n deposited at Delphi in the Temple of
Apollo. It is not known, whether this was simply a model placed there for
anyone who wished to copy it in other metal, or kept there in order that
physicians might become acquainted with the same. Herodotus and Aris-
totle give us some information concerning the t r e a t m e n t of the teeth, mention
ing such instruments as "scrapers" and "extractors", thus dentalsurgery
must have been known to the Greeks at this time.
Solon (640-558 B . C , ) n o t e d that the deciduous teeth were replaced
by permanent ones a b o u t the age of seven years, and Democrates alluded to
the falling out of the teeth and its causes.
As the Hippocratic period is approached a gradual advance in medical
knowledge m a y be noticed, and that the care of the mouth was considered
of importance.
Hippocrates, founder of Greek Medicine, came of an A~sculapius family
at Cos (460-355 B.C.). Never before, or since, have so many great men of
genius lived within the short period of time. His first medical instruction
was received from his father, studying at Athens, and acquiring extensive
experience in travel and practice among the cities of Trace, Thessaly and
Macedonea. "The eminence of Hippocrates is three-fold; he dissociated
medicine from theology and philosophy, crystallized the loose knowledge of
the Coan and Cindian Schools into systematic science, and gave physicians
the highest moral inspiration they have. ''9 To him medicine owes the art
of clinical inspiration and observation.
Hippocrates instituted for the first time, a careful systematic and thor-
ough examination of the patient's pulse, temperature, respiration, excreta,
sputum, localized pains, and movements of the body.
In his writings are found the earliest known literature pertaining to the
teeth, a crude description dwelling mostly upon the phenomenon of nutri-
tion and upon the disorders of which they are the cause. He describes the
function and the period of eruption o f the teeth, and probably w a s t h e , first
to recommend the use of a dentifrice. Living in an age of superstition, he
9. Garrison, Fielding H.: History of Medicine, p. 65.
 The History of Orthodontia. 53]

had the ability to discover natural causes and the courage to proclaim them
in spite of long rooted prejudices.
" T h e r e is", he says, "a glutinous i ncr em ent from the bones of t he head and
jaws, of which the f a t t y par t is dried by heat and b u r n t up, and the teeth arc
made harder than other bones, because there is nothing cold in t h e m . "
In his works there is no one chapter devoted to the teeth, but a great
n u mb er of passages scattered t h r o u g h o u t the collection. In the book De
Carnibus the formation of the teeth is spoken cf among other things: " T h e
shedding of the first teeth generally takes place at about seven years of z~ge,
those t h a t come forth after this grow old with the man. unless some illness
destroys them. ''1

Fig. l . - - H i p p o c r a t e s (460-355 B.C.). P r o b a b l y the first to notice irregularity of the teeth.

Another passage in this same book alludes to the clear pronunciation o~

words and the imp or t ance of the teeth. " T h e body a t t r a c t s the air into its-
self; t he air expelled through the voice produces a sound, because the head
resounds. T h e tongue articulates and by its m o v e m e n t coming in contact
with the palate and the teeth, renders t he sound distinct. ''11
Perhaps to us the most interesting passage recorded in his works is fou nd
tO. ]]il[~Oe_xates: De Carnibus, p. 251.
11. Ibid., p. 253.
532 The International Journal of Orthodontia.

in the sixth book of Epidemics:* " A m o n g those individuals whose heads are
long-shaped, some have thick necks, strong members and bones; ethers
have strongly arched palates, their teeth are disposed irregularly, crowding
one on the other, and t hey are molested by headaches and otorrhea. ''12
I t is surprising to learn t h a t these relations were noticed, and t h a t so
close a t t e n t i o n was paid to the palate during the time of Hippocrates. It is
more t h a n interesting to know t h a t the relation between irregularity of the
teeth and malformation of the skull and palate is not new, and t h a t there
was knowledge on this subject t w e n t y - f o u r centuries ago.
Hippocrates also refers a num ber of times to fractures of the jaw, which
was evidently not infrequent in his time. In speaking of fractures of the jaw,
he recommends "binding the teeth together on the right and left of the
lesion. ''13 " A f t e r having carried out the coaptation, the teeth ought to be
bound one to the other, this greatly contributes to obtaining the immobility
of the fragments, particularly if properly carried out. 14
" I n the case of tooth-ache if the tooth be decayed and loose it must be
extracted. If it be neither decayed nor loose, but still painful , it is neces-
sary to desiccate it by cauterizing. Masticatories also do good, as the pain

F i g . 2 . - - A n c i e n t G r e e k f o r c e p s , a n d t w o o t h e r d e t i t a I (?) i n s t r u m e n t s . (From the Archaeological

M u s e u m of A t h e n s . )

derives from pituita insinuating itself under the roots of the teeth. T e e t h
are eroded a n d ' b e c o m e decayed partly by pituita and part l y by food, when
they are b y nature weak and badly fixed in the gums. ''Is
T h e use of carbonate of lime or chalk dates back prior to the time of
Hippocrates, being used as a basis for a dentifrice mixed with the head of
a hare and the intestines of mice. I6 Vinegar as a m out h wash was recom-
mended by Hippocrates, 17 as well as one composed of castorium and pepper,
which was found efficacious in cases of toothache.
He refers to the use of instruments, in his work entitled "De medico",
mentioning the in s t r um ent s and articles necessary for a physician's office.
* T h e w o r k s of H i p p o c r a t e s a r e u s u a l l y divided into four groups, the genuine, the spurious, the
w o r k s of his predecessore, and t h o s e of his c o n t e m p o r a r i e s a n d followers. T h e g e n u i n e w r i t i n g are the
aphorisms, ( B o o k I - I I I ) t r e a t i s e o n p r o g n o s i s . O n e p i d e m i c d i s e a s e s , ( B o o k I & I I t ) , w o u n d s , d i s l o c a t i o n s ,
f r a c t u r e s a n d ulcers, and t h a t o n " A i r , W a t e r , a n d PlacEs." T h e opkos, p h y s i c i a n s o a t h , is" not r e g U d e d
a s hi~,|but t h g u g h t to be an ancient temple oftth of t h e A s c t e p i d a s . F o r t h i s r e a s o n w e canno.t s a y p o s i t i v e l y
it~ ~ 1 ~ w h o . f i r s t .iloted i r r e g u l a r i t y of the teeth and th~ relation btgtween thio at~d the thai.
f o r m a t i o n o l t l ~ s k u l l artu palate. . ~ . - '
12. H i p p o c r a t e s : D e m o r b i s v u l g a r i b u s lib., vi, s e c t i o n i, p. 1t64. ' "~
13. D e a r t i c u l i s , p. 800.
14. I b i d . , p. 799.
15. D e M~ectionibus, p. 507.
16. D e m o r b i s m u l i e r u m l i t . , ii, 13. 666.
17. D e l i q u i d o r u m usu, p. 426.
 The History of Orthodontia. 5.33

Among m a n y , was the pincers for e x t r a c t i n g teeth, " A n y one can handh:
Lhem, because e v i d e n t l y the m a n n e r in which t h e y are used is simple. ''~8
T h e r e is no d o u b t some form of artificial appliances were k n o w n for re-
placing lost teeth. In the Archmological M u s e u m a t A t h e n s are several
specimens of early G r e e k w o r k m a n s h i p t h a t had been used for such pur-
poses (Fig. 3). T h e u p p e r figure illustrates a form of bridge composed of
metal in which a t o o t h is inserted; the lower figure i~lustrates a bridge t)f
Eour teeth, b o u n d t o g e t h e r b y wire, and as H i p p o c r a t e s m e n t i o n s the use of
g01d wires, no d o u b t it was this material t h a t was used in the lower jaw.
We thus learn b y the n u m b e r of references to dental diseases, instru-
ments and bridge work t h a t has been u n e a r t h e d , t h a t H i p p o c r a t e s and the
Greeks a t t a c h e d a g r e a t deal of i m p o r t a n c e to the dental arch a n d teeth,
Aristotle, pupil 6f P l a t o and t u t o r to A l e x a n d e r the G r e a t , the g r e a t e s t
philosopher of his age, and f o u n d e r of the science of a n a t o m y , lived a b o u t
s e v e n t y years a f t e r H i p p o c r a t e s (384-322 B. C.). H e gave to medicine the
aeginning of zoology, c o m p a r a t i v e a n a t o m y and e m b r y o l o g y . In embrv~

Fig. 3. A n c i e n t G r e e k Artificial T e e t h . ( F r o m t h e A r c h a e o l o e i c a l M u s e u m of A t h e n s . )

ology he n o t e d the fact of the m o v e m e n t of the fetal heart, in c o m p a r a ! i v e

a n a t o m y he was the first to use the t e r m " a n t h r o p o l i g i s t " , b u t not as it is
used t o d a y .
H e was the first to d e v o t e a c h a p t e r of a n y length to the teeth, examiirdng
t h e m in relation to their c o m p a r a t i v e a n a t o m y , noticing there was n o t only
a difference b e t w e e n the h u m a n t e e t h and those of inferior animals, b u t
b e t w e e n species of the latter. T h e n u m b e r and forms o f t h e t e e t h v a r i e d in
animals according to their food and service t h e y are p u t to, In m a n t h e y
serve m a i n l y for mastication, and are also of use in assisting a r t i c u l a t i o n of
words and in the p r o n u n c i a t i o n of certain letters.
Aristotle has given us m u c h i n f o r m a t i o n , of which some is the basis of
our principles t o d a y ; b u t he falls into some curious errors, such a s , t h a t a
m a n has more t e e t h t h a n w o m a n , and t h a t the same difference exists in the
sexes of some animals, such as the m o n k e y ; t h a t h u m a n t e e t h increase i n
length d u r i n g life, and t h u s t h e y differ f r o m o t h e r bones. T h e followil, g
t r a n s l a t e d e x t r a c t will give a fair notion of the e x t e n t of dental kaaowlec}ge
a t t a i n e d in those days.
18. De medico. 19. 21.
534 The International Journal of Orthodontia.

In another book, devoted to mechanics, he refers to extraction in the fol-

lowing words: " W h y do doctors extract teeth more easily by adding the weight
of the odontagra (dental forceps) than by using the hand only? Can it be
said that this occurs because the tooth escapes from the hand more easily
than from the forceps? Ought not the irons to slip from the tooth more
easily than the fingers, whose tips being soft can be applied around the tooth
much better? The dental forceps is formed by two levers, acting in contrary
sense and having a single fulcrum represented by the commissure of the in-
strument. By means of this double lever it is much easier to move the tooth,
b u t after having moved it, it is easier to extract it with the hand than with the
instrument."19
There were other authors, Diocles, Herophilus, Heroclides and Erasis-
tratus who spoke of the serious trouble that might arise b y careless extrac-
tion of a tooth, and recommended great care in this respect.
Diocles, a famous Greek physician during this same century, did not
favor extraction, and strongly recommended treating the tooth with a mix2
ture composed of saffron and cedar gum.
19. Guerini, V: History of Dentistry, p. 64.