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Journal of Dental Research
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DISCOVERY!

The Birth of the Most Important 18th Century Dental Text: Pierre Fauchard’s Le Chirurgien Dentist

Andrew I. Spielman

Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010, USA; andrew.spielman{at}nyu.edu

Martin Taubman, Editor

ABSTRACT

Pierre Fauchard (1678–1761) is considered the father of modern dentistry. His seminal book, Le Chirurgien Dentiste, ou Traité des Dents (1728), is the discipline’s first complete work. During the five years preceding its publication (1723–1728), Pierre Fauchard sought the opinions, contributions, and "approbation" (approval) of 19 of his colleagues: six physicians, 12 surgeons, and one dentist. The first and most important contributor to the manuscript was Jean Devaux, surgeon and mentor to Fauchard. The next six reviewers were illustrious physicians and scientists of the time: Philippe Hecquet, Jean-Claude Adrien Helvetius, Jean Baptiste Silva, Antoine DeJussieu, Raymond Jacob Finot, and Antoine Benignus Winslow. The subsequent 12 reviewers were all sworn-surgeons (certified by St. Côme), including a lone dentist, Laudumiey, surgeon-dentist to His Majesty, Philip V, King of Spain. Fauchard knew that for dentistry to be regarded as a learned profession, and perhaps for Fauchard to be recognized as its leader, he needed the support and approval of the establishment before publishing his book. This is an account of how he attained this endorsement.

Key Words: Fauchard • history of dentistry • chirurgien dentist • surgeon dentist

What was it like to write a textbook early in the 18th century in a new field like dentistry? How did the original manuscript get put together? How did Fauchard go about running his ideas past other professionals? Who, exactly, were the people Fauchard consulted between 1723 and 1728, and why? These are some of the questions I asked in looking at Le Chirurgien Dentiste, ou Traité des Dents (1728) (Fig. 1Go), the first complete work in dentistry, and the textbook that made Pierre Fauchard (1678–1761) the "Father and Founder of Dental Surgery" (Viau, 1923a). This paper is not an account of Fauchard’s life or his seminal contributions to the field. Several excellent reviews, including some recent ones, have done that (Viau 1923a,b; Weinberger, 1941; Hoffmann-Axthelm, 1981; Angot, 1983; Lynch et al., 2006). This is an account of the peer review process that his manuscript went through during a five-year period between 1723 and 1728.


Figure 1
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Figure 1. Pierre Fauchard’s (1678–1761), "Le Chirurgien Dentiste", 1st ed., 1728. The copy in this image is found in the Dental Library at the NYU College of Dentistry.

 
Pierre Fauchard worked on his famous manuscript on and off while practicing as a certified "mâitre" (master) chirurgien-dentist. His manuscript was over 600 written pages in 1723, when he first registered it. However, it took him five more years to bring it to its final form of 783 pages, after making corrections in response to feedback from 19 of his peers, highly prominent members of society and the medical profession, pre-eminent scholars in the fields of science and healing. Many of them referred patients to Fauchard; some were his patients. Fauchard sought and obtained their endorsements for his book.

Pierre Fauchard was hailed by his contemporaries as a pioneer and became a pre-eminent "Chirurgien-Dentiste", the term he coined and used for himself. This new term was meant to create a ’pecking order’, to distinguish those with surgical training from those untrained. Dentistry was practiced by a variety of individuals, some formally trained, some not at all. The hierarchy that started with physicians and surgeons was thus extended to trained surgeon dentists and to untrained dentists, some less reputable than others (barbers, blacksmiths, itinerant handymen, or even charlatans).

Fauchard’s education began at age 15, in 1693, while serving as a young naval surgeon apprentice to Alexandre Poteleret, surgeon-in-chief to His Majesty’s ships. As Fauchard witnessed the ravaging effect of scurvy on the dentition of sailors, he became interested in dentistry. Fauchard never completed his training as a surgeon, due to lack of funds. Dentistry, in contrast, did not require a costly apprenticeship. His experience with Poteleret was more than many practicing dentists had at the time. He became a dental surgeon, initially in Angers, Tours, Rennes, and finally, starting in 1718, in Paris (Hoffmann-Axthelm, 1981).

His book is a compilation of the knowledge of dentistry at the turn of the 18th century. No doubt many of his observations were from first-hand experience. His manuscript has many original elements, such as the description of tooth dysplasia (dentinogenesis imperfecta), and descriptions of cysts, which Fauchard linked to caries lesions. However, its most important attribute was its systematic, scientific, and comprehensive character—its amazing thoroughness—a first for dentistry. Through the book, Fauchard established a new profession that, until that time, was practiced by an assortment of other professionals. Attempts to publish on aspects of dentistry as part of other medical works were made by great scientists and artists of the time, such as Vesalius (1543), Martinez de Castrillo (1557), Eustachio (1563), Paré (1564), and others, but not as a separate, scientific, self-contained and complete work. Pierre Fauchard’s book was unique. Its publication had such an effect on the profession that, within 5 years, it had been translated into German (Fauchard, 1733).

The final manuscript of the first edition, kept today at the Library of the School of Medicine in Paris, has 783 pages (Fauchard, 1728). Upon inspection, one finds the handwriting of at least three people in the manuscript (Viau, 1923a,b). The main body of the text shows handwriting that most likely belongs to Fauchard himself—not just because it appears throughout the manuscript, but because of specific spelling errors not uncommon in the 18th century. Fauchard did not have a formal education. He had to work from an early age. Furthermore, spelling errors were not considered a major embarrassment in 1723 (Viau, 1923a,b). A second script is visible in the margins of the manuscript. It is more mature and erudite, and is most likely that of Jean Devaux (1649–1729), the first reviewer of Fauchard’s manuscript. The third appears to be more carefully written, most likely rewritten notes by Fauchard following changes that were suggested by reviewers (Viau, 1923b) (Fig. 2Go, TableGo).


Figure 2
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Figure 2. Portraits of (A) Jean DeVaux (1649–1729), (B) Philippe Hecquet (1661–1737), (C) Jean Baptiste Silva (1682–1742 or 1746), and (D) Jacob Benignus Winslow (1669–1760).

 

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Table. List of Reviewers of Fauchard’s Manuscript
 
Devaux was a close friend, mentor, and colleague. His "approbation" of the book is dated March 29, 1724, 16 months prior to any other approval. Devaux, a sworn-surgeon (certified by St. Côme) of Paris and former Provost of its Society, was born in 1649. When he wrote his approbation for Fauchard, he was already 75 years old and a very well-established surgeon. He authored several works, including "Médecin (le) de soy-mesme, ou l’art de conserver sa santé par l’instinct (One’s Own Doctor, or the Art of Conserving One’s Health by Instinct, 1682), and "Les Aphorismes d’Hippocrates" (Hippocrates’ Aphorisms, 1725–27). Devaux also publicized previously published works, such as "L’Anatomie de Dienis" (Dienis’ Anatomy). According to Viau (1923a), this particular work of Devaux was so successful that Emperor Khang-hi of China (1662–1723), of the Tartar-Manchu dynasty of Thsing, asked the document to be translated into Tartar.

By asking Devaux’s opinion, the 45-year-old Fauchard had clearly identified what he was missing: influence and confidence. Devaux also provided Fauchard with a great deal of help, ideas, and corrections, as the notes in the margin of the manuscript attest. Some scholars, at the turn of the 19th century, questioned if the work was indeed entirely written by Fauchard. Based on the extent of the notes, it is clear that the work was written by Fauchard, who took advantage of the tutelage and advice of his older mentor and collaborator. Devaux, who died in 1729, clearly did not know much about the technical/dental part of the two-volume book. Most of the suggested corrections deal with the first volume, the more medical/surgical section of the book. The second volume of Le Chirurgien Dentiste, which concerns technical aspects of dentistry, denture-making, and instruments, has no similar additions to the margins of the manuscript. Fauchard dutifully corrected the manuscript for the next 16 months and incorporated suggested changes before submitting it to other colleagues (see TableGo).

The second person Fauchard asked to review his manuscript was Monsieur Philippe Hecquet (1661–1737) (Encyclopédie méthodique, 1798a), Regent Doctor, Professor of Medicine, and former Dean of the Faculty of Medicine of Paris (1712), personal physician of Henry-Jules de Bourbon (Prince of Conde), of the duchess of Vendôme, and of the young Louis XV. Hecquet graduated as a physician from the Faculty of Medicine of Rheims in 1684 and became doctor-regent in Paris in 1697. A prolific writer, in both French and Latin, Hecquet published at least 13 books, many still available today, among them "La medicine, la chirurgie et la pharmacie des pauvres" (Medicine, Surgery and Pharmacy of the Poor), in four volumes. He wrote books on digestion, the stomach, natural medicine, purgatives, the use of opium, etc. He was an early promoter of vegetarianism. By the time Fauchard sought his approval, Hecquet was 64 and at the height of his career.

On July 17, 1725, in Paris, Hecquet wrote his approval:

"This book is no work that has originated in the imagination,...but it is a sure and certain way, which Monsieur Fauchard has discovered by his labors, and experience. This he now gives,...to the world, for which he is entitled to the high esteem and assured confidence by right." (Weinberger, 1941)

This was a very important endorsement. Being the first after that by Devaux and coming from such an illustrious person was a major boost. It was all the more important because Hecquet, as a pre-eminent physician, was also the author of the book, Le brigandage de la chirurgie, ou la médicine opprimé par le brigandage de la chirurgie (The Brigandism of Surgery, or Medicine Oppressed by the Brigandism of Surgery, 1738), describing the hostility that existed between physicians and surgeons at the time. Due to opposition in Paris, the book on brigandism was published in Utrecht, the Netherlands, albeit several years later.

The same week, Fauchard sought approval from Monsieur Jean-Claude Adrien Helvetius (1685–1755), a famous physician. His father, Jean Adrien Helvetius (Adrianus Engelardus Helvetius, a.k.a. Jean-Adrien Schweitzer, 1662–1727), originally from Amsterdam and a famous physician in his own right, introduced the ipecacuanha root to the French court. When the Grand Dauphin, the son of Louis XIV, the Sun King, was apparently dying of amebic dysentery, Helvetius, the father, was summoned. Upon witnessing his son cured, Louis XIV gave 1000 Louis-d’Or to Jean Adrien Helvetius and showered him with honors, appointing him, in 1708, as Conseiller du Roi, specifically, as inspector-general of French hospitals.

The son, Jean-Claude Adrien Helvetius (Encyclopédie méthodique, 1798b), to whom Fauchard turned, was born in Paris and graduated with a degree in medicine in 1706. At the age of 30, Jean-Claude Adrien became a member of the Royal Academy of Science in Paris. In 1719, Louis XV was again dangerously ill, and this time, the younger Helvetius saved his life. He became the first physician to the King and the Queen of France, and in 1726 was named the King’s deputy head of the University in Paris. Jean-Claude Adrien was the author of at least one book on smallpox ("Idée Generale de l’oeconomie animale et observations sur la petite vérole"). When Fauchard asked for his letter of approval, in July, 1725, Jean-Claude Adrien Helvetius was 40. The year before, Helvetius had referred a patient to Fauchard (Angot, 1983). The "approbation" of such an illustrious person was clearly helpful to Fauchard, even though it is unlikely Helvetius spent any substantial time with the manuscript, assuming that there was only one handwritten version. Receiving the manuscript on a Tuesday (July 17, 1725) and approving it on a Thursday (July 19, 1725) would have required considerable speed-reading of all 783 pages for a busy Helvetius, if there was only a single manuscript.

Five days later, on July 24, 1725, Fauchard obtained another approval, from Monsieur Jean Baptiste Silva, Regent-Doctor at the Faculty of Medicine, Paris, Physician to the Duke and Consulting Court Physician to the King, Louis XV, physician to Karl the Elector of Bavaria, and physician to Tsarina Anna of Russia and to Voltaire (Gélizé, 2000). Jean-Baptiste Silva (1682–1746) was born in Bordeaux. He was the son of a physician who practiced in Bordeaux for 64 years. He graduated with a medical degree in 1711. In Paris, under the protection of his former professor, Chirac, he became a well-thought-of physician. He was the author of at least two works, one entitled Traité de l’usage des différentes sortes de saignées, principalement celle du pied (Study on the Use of Different Types of Venisections, Primarily of the Foot, 1727), with an introduction by Hecquet, a book later refuted by François Quesnay, first surgeon to the King. In 1724, Silva became consulting physician to Louis XV (Encyclopédie méthodique, 1798b).

Two days later, on July 26, 1725, Fauchard secured another "approbation", this time from Antoine DeJussieu (1686–1758), physician, botanist, and professor at the famous Jardin du Roi in Paris. Born in Lyon in 1686, DeJussieu was 8 years younger than Fauchard. DeJussieu studied medicine at Montpellier, and, as early as 1708, at the age of 22, he was appointed as professor and demonstrator at the famous garden that was originally established in 1635 as a medicinal herb garden for King Louis XIII. During the XVIIth century, it rose to prominence. Lectures and demonstrations in anatomy, botany, and chemistry, given at Jardin du Roi in French, as opposed to Latin (the language used by the rival Sorbonne), had greatly influenced science throughout France and Europe. Famous physicians, botanists, and chemists were brought in from Montpellier. Antoine DeJussieu was one of them. In 1711, barely 25, he became a member of the French Academy of Science. DeJussieu’s contributions were primarily in the area of botany. He traveled all over France, and in 1716 he mapped the flora of the Pyrenean peninsula. Starting with 1718, he used quassia bark (Cortex simarubæ) in his medical practice. A description of the bark, originally sent to him from Cayenne, was included, along with subjects on anatomy, zoology, paleontology, and mineralogy, in his work entitled "Mémoires", published in 1729.

Apparently, Antoine DeJussieu called on Fauchard to operate on a patient in 1719 (Weinberger, 1941). Six years later, when Fauchard approached Antoine DeJussieu, the latter was 39 and very well-established as a respected Regent-Doctor at the Faculty of Medicine in Paris and Member of the Royal Societies of London and Berlin. Just how important DeJussieu was in the 18th century is evidenced from Vol. 7 of the Encyclopédie méthodique, médecine, par une société de médecins (1798c) (Methodical Encyclopedia, Medicine, by a Society of Medicine), published in 1798, in which Antoine DeJussieu’s biography takes 4 pages. The same encyclopedia allocates to Helvetius three pages, to Hecquet 13, and to Fauchard one page. Similar to Helvetius, DeJussieu spent very little time on Fauchard’s manuscript, probably skimming through it. Nevertheless, obtaining the support of an illustrious person like DeJussieu was paramount for Fauchard.

Fauchard must have been working on his manuscript for the next several months before he turned, on January 15, 1726, to Raymond-Jacob Finot, distinguished physician and the son of Raymond-Jacob Finot, a similarly famous physician. Finot obtained his doctorate in 1700 and became regent-physician at the Faculty of Medicine in Paris and the personal physician of the Prince and Princess of Conti. Similar to DeJussieu, Finot knew Fauchard and had referred a patient suffering with a tumor to him in 1723 (Angot, 1983). Finot’s approval reads:

"I have read M. Fauchard’s book with much pleasure, from this book the public will derive very solid advantage. It contains many facts exactly recounted, judicious reflections on disease of the teeth and the means of curing them....There is therefore nothing but praise for a work...he has produced with so much clarity and precision from the obscurity which has enveloped it and the superficiality with which it has been treated hitherto." (Fauchard, 1946b)

There was a hiatus of 23 months before further approvals were sought. One can only surmise that Fauchard was probably recording additional observations and working on his manuscript. In December, 1727, he sought the approbation of Monsieur Jacob Benignus Winslow, Regent-Doctor at the Faculty of Medicine, Paris, Member of the Royal Academy of Science, and later Professor of Anatomy and Surgery at the Jardin Royal in Paris. Born in Odense, Denmark, in 1669, Winslow attended the University of Copenhagen, where he studied philosophy and theology and, subsequently, medicine, obtaining his degree in 1694. Winslow arrived in Paris in 1698 and obtained a license to practice medicine in 1704. In 1708, he became a member of the Royal Academy of Science at Paris and, subsequently, a member of the Academy in Berlin in 1721, where, at the age of 52, he became professor of Surgery. Because of his language skills, he also became German interpreter to the Royal Library in 1723 and Regent Doctor in 1728. Between 1743, when he was 74, and until the august age of 87, he was Professor of Anatomy and Surgery at the Jardin du Roi, where DeJesseus was Professor of Botany. Winslow also had a thriving practice that included patients like King Louis XIV, the Sun King. Winslow published books in both French and German, including "Exposition anatomique de la structure du corps humain" (Anatomical Exposition of the Structure of the Human Body, Paris, 1732), translated throughout Europe. In 1727, when Fauchard showed him Le Chirurgien Dentiste, Winslow was 58. Winslow at age 76 was the only person asked to approve his second edition (March 2, 1746) (Fauchard, 1746a). This was not surprising in light of their continuous professional relationship. Winslow referred several patients with parulis to Fauchard (Fauchard, 1946c).

For 6 months after December, 1727, Fauchard worked on his manuscript. In May and June, in rapid succession, he sought the approval of six additional colleagues, all sworn-surgeons of Paris. On May 26, 1728, he secured the approval of Monsieur Duplessis, a sworn-surgeon of Paris.

After almost 5 years in preparing his manuscript, on June 9, 1728, Fauchard, for the first time, sought the approval of a Parisian dentist colleague, Monsieur Laudumiey, Surgeon-dentist to His Majesty, Philip V, King of Spain. Laudumiey said:

"...My experience in the author’s profession leads me to extol with much pleasure the excellence of his treatise, which he gives with disinterestedness as praiseworthy as it is rare." (Weinberger, 1941)

According to the 1759 Almanac Royal, there were two Mâitre en Chirurgie (Master of Surgery) and 29 Expert Dentists listed in Paris. One of the expert dentists was Fauchard, and the other was Laudumiay (Laudumiey).

Less than two weeks later, on June 11, 1728, he sought approval of yet two more surgeons: Monsieur Saveur-François Morand (1697–1773), sworn-surgeon of Paris, Member of the Royal Academy of Science, Royal Demonstrator of Surgery, and chief surgeon of the "des Invalides"; and Monsieur Cesar Verdier (1685–1759), sworn-surgeon of Paris, and Royal Instructor of Anatomy (Le Chirurgiens).

Cesar Verdier obtained his "maître" in Surgery at St. Côme in 1724 and a year later, he was made demonstrator of Anatomy. When the Royal Academy of Surgery was established in 1731, he was one of the first members. His book, "Abrégé de l’anatomie du corps humain" (Abridged Anatomy of the Human Body, 1746, Paris), is a concise and clear description of surgical and anatomical knowledge of the time. When Fauchard approached Morand, he was 33, while Verdier was 43, considerably younger than Fauchard (Le Chirurgiens).

The last approval Fauchard sought, dated July 7, 1728, was from a group of sworn-surgeons of Paris, lieutenants to the Chief Surgeon of the King. These were Monsieurs Bourgeois, Mouton, Chavet, Rothonnet, Motherau, and Bertrand. It is possible that Mouton was the famous dentist Claude Mouton, who published the first specialized text on Prosthodontics, entitled "Essai d’odontechnie, ou dissertation sur les dents artificielles", Paris, 1746 (Mouton, 1760).

Pierre Fauchard dedicated his first edition (Fauchard, 1728) to Dodart, Councilor of State, and the first Physician of the King (Louis XV). The second edition (Fauchard, 1746a) Fauchard dedicated to Jean-Frédéric Phélypeaux, comte de Maurepas (1701–1781), Minister and Secretary of State, Commander of the Royal Order and later Minister of State and chief advisor for Louis XVI. Originally registered on February 28, 1723. and for the second edition on October 7, 1746, Fauchard secured a "Privilege du roi" (Privilege of the King), permission to publish and produce the first and second editions. Fauchard, through his professional knowledge and political deftness, knew how to open doors. This was the period of Louis the XV (1715–1774), a time of stability and prosperity in France.

We do not have knowledge of all 19 individuals who gave their seal of approval to Fauchard. It is clear that, first, he looked for approval from his mentor, Devaux, and then from the establishment—famous physicians like Hecquet, Helvetius, Silva, DeJussieu, Finot, and Winslow. The second set of individuals included surgeons exclusively, with the exception of Laudumiey and possibly Mouton, the only dentists in the group. It is not surprising to see Fauchard ask for approbation from the more respected physicians first, and from surgeons later. Clearly, Fauchard was astute enough to know that he needed buy-in from those who counted more. It is also notable that Claude Mouton’s book on Prosthodontics that appeared in the middle of the 18th century had only one approval, compared with 19 for Fauchard. This may illustrate the importance Fauchard placed on his work being widely accepted.

The publication of Le Chirurgien Dentiste was more daring than one can imagine today. Fauchard was seeking to gain access to a professional elite, a society that was separated by financial and professional castes. Furthermore, he was seeking approval from the very same physicians who were at the top of the societal hierarchy, looking down on surgeons and dentists, respectively. Fauchard was trying to move dentistry into a "privileged" environment. In achieving the recommendation of 19 established professionals, 18 of whom were not in the dental field, he obtained entry to history.

ACKNOWLEDGMENTS

Thanks to Jeremy Duhme for his help in editing this manuscript, and to Van Afes, Director of the Library at NYU College of Dentistry, for giving me unlimited access to the original Fauchard editions. An abbreviated version of this manuscript appeared in Nexus, the NYU College of Dentistry magazine.

Received for publication April 3, 2007. Revision received May 24, 2007. Accepted for publication May 30, 2007.

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Journal of Dental Research, Vol. 86, No. 10, 922-926 (2007)
DOI: 10.1177/154405910708601004


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