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138 SECOND PERIOD—THE MIDDLE AGES

the tooth, every needful precaution, however, being taken that it may not
injure the neighboring teeth. Cauterization, when practised to produce
the exfoHation 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/
To cure a dental fistula, Mesue cauterized it to the very bottom with
a cauter}' 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.

' [In connection with the practice of applying medicines to the teeth or upon the gums,
with the object of rendering the operation of tooth extraction less difficult, the use of
arsenical compounds as an ingredient of these topical applications is of peculiar interest.
In an Italian translation of the writings of Johannes Mesue, published at Venice in 1521,
the following interesting reference to the use of arsenic appears:
"The son of Zachariah Arazi compounds a medicine to assist the extraction of the
teeth. I^—Pyrethrum, colquintida root and the bark of the mulberry root, the seed and
leaves of almezeron, huruc, and yellow arsenic, milk of alscebram or pieces of it, ground
very thoroughly with vinegar; then pour some of it over bdellium and halasce, of each,
equal parts, dry and dissolve in strong vinegar and make trochisi of it, and with them
anoint the roots of the tooth from hour to hour; this facilitates the extraction of it.
"There is also another medicine with which one fills the decayed tooth and breaks it:
1^—Seeds of almezereon and milk of alscebram compounded with liquid pitch, and fill
with it the decayed tooth. Another one: I^—Bauras, bark of the willow, of each, one
part; yellow arsenic, two parts; compound with honey and plii.e it upon and around the
tooth and immediately extract it.
"The fat of the green frog which lives upon the trees breaks teeth which are anointed
with it the same as when you anoint them with milk of alscebram or titimallo, and similarly
also the milk of celso with yellow arsenic."
In this connection it is also interesting to note that the ancient Arabian medical writers
referred to the red sulphide of arsenic or realgar as sandarach. The term Sandarach was
clearly used by these writers to designate two different medicaments-^one the gum-vernix,
exudate of the Juniper tree, and which we now know as Sandarach gum. They also apply
the term to red arsenic, as above stated. Avicenna clearly distinguishes between the two
kinds of Sandarach, and says with regard to the gum-vernix or Juniper Sandarach that it
is the best of all known remedies for toothache. While, as shown by Dr. Guerini, many
of the medicaments used as topical applications to facilitate the extraction of teeth were
wholly without any possible effect of that character, it cannot be doubted that the applica-
tion of arsenical preparations, such as those referred to by Mesue, could not fail to set up
an arsenical necrosis about the roots of the tooth, rendering it loose and easy of removal,
bur necessarily with the disadvantage of producing a dangerously extensive necrosis of the
tissues.
Mesue Vulgar.—Impresso in Venitia per Cesaro Arrivabcno Venitiano a di vinti octubrio,
mille cinquecento e vintiuno.
Delle Medicini Particulate, Libro Quarto, Capitolo XLI.— K. C. K.]
- Joannis Mesue opera, Venetiis, 1562.