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118 FIRST PERIOD—ANTIQUITY

period, emollients, and then, when the inflammation has subsided, as-
tringents and weak caustics. Lastly, if the epulis resist these remedies,
he takes hold of it with a vulsella and proceeds to remove it with a small
scalpel/
When the incision of a fistula of the gums and the use of appropriate
remedies are not sufficient for curing it, ^tius advises the extraction of
the diseased tooth, from which the fistula has its origin.''
Apart from what has been mentioned, /Etius does not tell us, in regard
to dental diseases, anything worthy of note, and in many places he only
repeats Galen's observations.
Paul of ^gina (seventh century) establishes a very clear distinction
between epulis and parulis. The epulis is a fleshy excrescence of the
gums in the neighborhood of a tooth; the parulis is an abscess of the gums.
To cure the former aff"ection it is necessary, says the author, to sieze
and stretch the tumor with a vulsella or with a hook and to perform its
excision. As to the parulis, although not unfrequently it is sufficient,
for curing it, to give an exit to the pus by means of a slight incision, the
author, however, usually prefers the method of cure recommended by
^tius, viz., excision. After such operations he orders the patient to
rinse his mouth with wine and on the morrow with hydromel.'' From the
third day onward he sprinkles the wound with a cicatrizing powder,
until a complete cure is obtained. But if the wound, instead of healing,
be transformed into a putrid ulcer resisting all the ordinary means of
cure, it is necessary to cauterize the part aff^ected with an oval-shaped
cautery.*
In extracting a tooth, the operation is begun by detaching the gum all
around it as far as the alveolar border ; then the tooth is seized with
the forceps, shaken loose, and drawn out. Paul of i^igina, like Celsus,
recommends that before extracting a tooth deeply attacked by caries,
the cavity be filled up with lint, in order to avoid the crumbling of the
tooth under the pressure of the instrument. On the other hand, he too
is convinced that a diseased tooth can be made to fall out without pam,
by the use of suitable remedies.
When supernumerary teeth cause an irregularity of the dental arches,
this must be corrected, says the author, either by resection of such teeth,
if they are very firm, or by their extraction.
if a tooth projects above the level of the others, the protruding part
must be removed with the file. Ihis instrument must also be emplo\ed
to remove the sharji edges of broken teeth.

1 ctrabil)!., ii, scriiK) iv, cap. xxv.
' " Ibid., cap. xxvi.
' I he author (juotccl directs hydroniel to be made from one part ot honey and eight
[
parts of water boiled until it has ceased frothing.— E. C. K.]
* Pauh .'Kginetae de re inedica, hb. vi, cap. xxvii.