Today’s guest post is by Geraldine Gnych. Geraldine is a first year PhD student at Swansea University studying medieval oral health, dentistry and speech impediments, with a view to also researching Cleft Lip and Palate. Her research is currently focused on medical sources, although later may include other literary and art sources.
The way our teeth look affects how our face appears: the gleaming white teeth are a sign of the beautiful, whereas the black and decaying teeth are unsightly. This unsightly appearance of decaying teeth has, throughout history, often been attributed to the infamous tooth worm.
Figure 1. Cross section of an extracted molar with caries, Wellcome Images.
Tooth worms were supposed to reside within the tooth eating holes in it, and thus creating what we would term dental caries, or cavities. The belief in worms is plausible because they were recognised in other parts of the body including the ears, feet, hands and stomach; so it follows that if there are worms infecting all these parts of the body, there is no logical reason for there not to be a similar explanation for toothache and dental caries. We know now that dental caries are a type to tooth decay that is caused by acids from bacterial action upon sugar, and leads to destruction of the enamel and possibly also the dentine and pulp of the tooth (Oxford Dictionary of Biology, 2004). Figure 1 is a modern example of a tooth with dental caries.
E Gerabek identifies a number of sources across the centuries, though not a comprehensive list, which shows the prevalence of the theory of tooth worms (Gerabek, 1999). The use of tooth worms to explain toothache and dental decay is documented in Roman times and likely dates back far earlier. One Roman author that discusses tooth worms is Scribonious Largus, physician to Emperor Claudius; there are more authors in the Middle Ages, including Hildegard of Bingen, and some even as recently as the eighteenth century with the work of Albrecht von Haller (Gerabek, 1999). These few choice examples serve to demonstrate the enduring nature of the tooth worm, however it is in the medieval that this devil of toothache will be further explored.
Replica of an 18th-century French sculpture portraying the toothworm inhabiting the pulp of a tooth. On the right, the toothworm devours a man. On the left, the torment of a toothache is equated with the fires of hell. German Museum for the History of Medicine, Ingolstadt. Photo Michael Kowalski.
Toothache is intensely painful; this was not overlooked by medieval medical writers. One text, the Regimen Sanitatis Salernitanum, a hygiene manual written in short verses, offers one possible solution: henbane (Hyoscyamus niger) and leek seeds to be burnt and the smoke funneled into the affected tooth (Regimen Sanitatis Salernitanum, 1505):
Sic de(n)tes serva porror(um) collige grana./
Ne careas iure cu(m) iusq(ui)amo simul ure./
Sicq(ue) p(er) e(m)botu(m) fumu(m) cape de(n)te remotu(m)
(Regimen Sanitatis Salernitanum, 1505)
This may not sound like a terribly effective solution to toothache but it may have been more efficacious than at first thought. The henbane in the recipe, a relation of belladonna, although being an extremely poisonous plant can be used in small quantities as an anaesthetic and sedative so the patient feels no pain, however in large quantities it can prove fatal (Akeroyd, 2000). Gerabek also adds that the effect of the active ingredient, hyoscyamine is developed through fumigation, by which it acts as a ‘surface narcotic’ (Gerabek, 1999). It is possible that the use of henbane, a poison, may have been thought to poison the worms, and thereby prevent them from destroying any more of the tooth.
Henbane is also used in a different recipe of an earlier period in the Leechbook of Bald, an Anglo-Saxon medical work. It is listed in the third recipe for tooth worms, which also contains acorn meal and wax, out of which a candle is made and the ‘reek’ of the candle is let into the mouth (Cockayne, 1865). This recipe, although containing different ingredients to the later one in the Regimen, does show similarities in the use of henbane and the idea of allowing the fumes of the burning ingredients to pervade the aching tooth. Although both of these recipes provide solutions to the worms, neither mentions what happens afterwards. Clearly the patient is left with a hole in the tooth which is at risk of further infection and abrasion, yet there is no remedy for this listed.
Guy de Chauliac, a fourteenth century French surgeon, offers a solution to this. In his Chirurgia Magna, Chauliac first prescribes a mouth wash and that the tooth is stuffed with ‘pills made of small seeds of leek or onion, hyoscyamus, mashed with cow fat’ (The Major Surgery of Guy de Chauliac, trans.2007). The hyoscyamus mentioned is referring to henbane, and as such this bears striking resemblance to the ingredients in the Regimen recipe, although uses a different method of application. Failing that Chauliac recommends using scissors to make a hole in the side of the cavity; cauterizing it, and then removing the tooth, before packing the gap with cloth.
These three recipes, taken from three different centuries, show certain similarities in the medical and surgical responses to tooth worms. They all include henbane, a poison but in small quantities a sedative and two of them use smoke to allow the medicine to make contact with the affected tooth. Although this is not by any means a comprehensive set of remedies for tooth worms it does show the enduring nature of the medical understanding of the cause of dental caries as well as the similarities in the remedies that were used.
Oxford Dictionary of Biology, fifth edn. (Oxford: Oxford University Press, 2004), p. 179.
E. Gerabek, ‘The Tooth-worm: historical aspects of a popular medical belief’, Clinical Oral Investigations, 3.1 (1999), pp. 1-6.
Regimen Sanitatis Salernitanum, Imprint: Venezia: Bernardino Vitali, 1505, Early European Books Online, (Chadwyck).
John Akeroyd, The Encyclopedia of Wild Flowers, (Bath: Parragon, 2000), p. 247.
Rev. Oswald Cockayne, Leechdoms, Wortcunning, and Starcraft of Early England, Vol II (London: Longman, Green, Longman, Roberts, and Green, 1865), Book I Chapter VI, p. 51.
The Major Surgery of Guy de Chauliac, ed. by E Nicoise and trans. By Leonard D Rosenman (n.p. : Xlibris, 2007), p. 533.