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Critical Reviews in Oral Biology & Medicine
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DOI: 10.1177/10454411970080020101 1997 8: 108CROBM
Nellie W. Kremenak and Christopher A. SquierVienna To
America
Pioneers in Oral Biology: The Migrations of Gottlieb, Kronfeld,
Orban, Weinmann, and Sicher From
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PIONEERS IN ORAL BIOLOGY: THE MIGRATIONS OFGOTTLIEB, KRONFELD,
ORBAN, WEINMANN, ANDSICHER FROM VIENNA TO AMERICA
Nellie W. KremenakChristopher A. SquierDows Institute for Dental
Research, (ollege of Dentistry, University of Iowa, Iowa City, Iowa
52242
ABSTRACT: Following the annexation of Austria by Hitler's
Germany in 1938, officials at the eminent University of
ViennaMedical School purged faculty ranks of Jews. Among those
forced out were several distinguished physician dentists, several
ofwhom emigrated to the United States. The assimilation of
foreign-trained dentists raised questions at national meetings of
theAADS and the National Association of Dental Examiners. Already
existing ties between dental schools in Chicago and theUniversity
of Vienna, including the 1928 appointment of Rudolf Kronfeld to the
faculty at Loyola, led to the relocation of BalintOrban, Harry
Sicher, and Joseph Peter Weinmann in that city. Bernhard Gottlieb,
who had been director of the Dental Institutein Vienna,
transplanted less easily, but eventually found a niche at the
Baylor College of Dentistry in Dallas. The careers of theVienna
dentist-scientists strengthened the scientific foundations of
clinical dentistry in the United States, contributed to
thedevelopment of a stronger research establishment, and enlarged
the scope of oral biology.
Key words. History of dentistry, history of medicine, dental
schools, history, Chicago, University of Vienna.
(I) IntroductionIn the spring and summer of 1938, the winds of
AdolfHitler's ambitions fanned long-smoldering embers of
racism and anti-Semitism in Austria. Following
Hitler'sannexation of Austria in March, 1938, the rapid emer-gence
of a harsh and ominous official stance againstpeople of Jewish
descent and their families and friendsled officials at the
University of Vienna to dismiss morethan 75% of their
world-renowned Medical Faculty(Ernst, 1995). Recent documentation
of this event lists,among the senior faculty members forced to
abandontheir homes and careers, eight physicians whose special-ty
training had been in dentistry, several of them inter-nationally
respected leaders in the biological sciencesbasic to dentistry
(Muihlberger, 1990). Five of the eightwho were forced out "on the
basis of racial persecutions"("aufgrund rassistischer
Verfolgungen") emigrated to theUnited States: Bernhard Gottlieb,
Albin Oppenheim,Balint Orban, Harry Sicher, and Georg Stein. Many
in lesssenior positions came also. Of the remaining three,
FritzSchenk died in the concentration camp atTheresienstadt, Bruno
Klein apparently remained andwas later restored to his position in
Vienna, and the fateof a third, Bertold Spitzer, is unknown.
Although a substantial literature exists on the con-tributions
of German and Austrian intellectuals and sci-entists of Jewish
descent forced from their homelands inthe 1930s, the careers of
renowned dental scientists ofthat era have received little
scrutiny. The purpose of thispaper is to discuss the careers of
three members of thisgroup of emigres, Gottlieb, Orban, and Sicher,
as well asthose of their colleagues Rudolf Kronfeld and
JosephWeinmann. We will describe the ways in which these menhelped
to interweave the fabrics of two scientific culturesto strengthen
American dentistry and the scientific foun-dations on which it is
constructed.
This group of scientists from the University ofVienna, already
linked to US dentistry through their par-ticipation in the
Federation Dentaire Internationale(FDI), was welcomed into academia
in this country,despite a Depression-wracked economy and the
resis-tance of the National Association of Dental Examinersand most
state boards. They came in a period whenAmerican dentistry, still
rising to the challenges embod-ied in the Gies report of 1926,
struggled toward thedevelopment of a research enterprise. The
Viennagroup's appreciation of the biological basis of
dentistrycomplemented American technical expertise in restora-
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tive dentistry. They helped to give an emerging dentalresearch
effort a sound foundation, one that was pre-pared to take advantage
of the Federal funding forhealth-related research that followed
World War II.
Three dental schools in Chicago-Northwestern,Loyola, and the
University of Illinois-drawing on theheritage of such leaders as
G.V. Black, William Logan,and Frederick Noyes, were already
building a researchcapability in the 1930s, and were positioned to
both offerand gain the most through associations with BalintOrban,
Harry Sicher, and Joseph Peter Weinmann.Bernhard Gottlieb, who had
led the group in Vienna,transplanted less easily. Although he
finally found aniche as a respected faculty member at Baylor
College ofDentistry in Dallas, this great scientist's intellectual
andgeographic isolation sadly limited his research produc-tivity in
the United States.
(11) Dentistry in the United States in the 1 920sThe first
decades of the twentieth century foundAmerican dentistry still
struggling to define its role in thehealth care hierarchy. In 1890,
leaders in the professionhad been appalled to learn that US Census
Bureau offi-cials, planning their regular survey of industry,
intendedto classify dentists as manufacturers. Only a
last-minutemeeting with Census Bureau Superintendent Robert
B.Porter and impassioned pleading by representatives ofthe
profession warded off the unwanted label (Bentley,1892). In the
same decade, dentistry had managed toresist a late nineteenth
century effort takeover by themedical profession, only to find,
twenty years later on theUS entry into World War 1, that dentists
in the armedforces were to be relegated to a rank subservient to
offi-cer physicians. Again, vigorous negotiations were neces-sary
to preserve hard-won status (Puterbaugh, 1943).
Although for decades American dentistry had beenrenowned
throughout the Western world for its technicalexcellence, serious
questions concerning the quality ofcare had emerged. English
physician William Hunter'scharge that American dentists deployed
their technicallyexcellent prosthetic devices over woefully
diseased teethstill reverberated throughout the health care
environ-ment in the 1920s (Hunter, 1911). Although many recog-nized
Hunter's "mausoleum of gold over a mass of sep-sis" as a colorful
exaggeration, anxious patients andeager physicians were only too
willing to attribute a widevariety of ailments to "focal infection"
and recommendtreatment with extensive tooth extraction
(Rosenow,1926). At the same time, the better-educated members ofthe
profession, especially in academia, acknowledgedthe validity of
Hunter's charge that dentists too oftenwere ignorant of
"fundamental truths connected with theanatomy, physiology, and
pathology of the teeth withwhich they deal". American dentistry,
while technicallyadvanced, was in need of a strengthened biological
foun-
dation. Furthermore, it was clear that such a foundationwas not
to be found in the medical curriculum, whichwas hardly less
deficient than dentistry in Hunter's "fun-damental truths" on the
subject of oral and dental struc-tures.
To shore up dentistry's reputation, the professionincreased
efforts to raise standards for education andpractice. As was true
of medicine, academic dentistry inthe 1920s had already begun to
move toward non-profitprofessional education, subsidized by the
state or privatefoundations. Recommendations made in
AbrahamFlexner's study of academic medicine in 1910 andWilliam
Gies' study of academic dentistry in 1926, bothfunded by the
Carnegie Foundation for the Advancementof Teaching, only formalized
goals of a movement alreadywell under way (Starr, 1982). The Gies
report's call for amore vigorous research enterprise in dentistry
reflected aview already strongly held by some academicians,notably
leaders in dental education in the Chicago den-tal schools (Gies,
1926).
(111) Academic Dentistry in ChicagoAs the city of Chicago grew
to be a great metropolitancenter with economic dominance extending
over a largeregion in the central United States (Cronon, 1991),
lead-ership in academics and in the rise of the health profes-sions
followed (Veysey, 1965; Jarausch, 1983; Dummettand Dummett, 1993).
By the 1920s, three dental schoolswere well-established in the
city: the Chicago College ofDental Surgery at Loyola University,
NorthwesternUniversity Dental School, and the University of
IllinoisCollege of Dentistry (Jackson and Jackson, 1964).
Thecomplex early histories of each of these schools hadinvolved
many of the same players, leaders in Chicago'sdental profession
such as G.V. Black, Truman Brophy,Edmund Noyes, Charles N. Johnson,
and Thomas L.Gilmer. All three institutions had early associations
withproprietary schools, but by the mid-1920s, bothNorthwestern and
the Chicago College of Dental Surgerywere associated with respected
private universities,while the school at the University of Illinois
was a state-supported institution.
The oldest of the three, the Chicago College ofDental Surgery,
had been founded as a proprietaryschool by Truman Brophy in 1883
with a small facultythat for a time included G.V. Black. The
Chicago Collegerepresented the proprietary model at its best, but
its fac-ulty owners recognized that the tide was turning awayfrom
profit-making dental schools and by 1921 hadestablished an
affiliation with Loyola, a small Catholicuniversity. Because of the
standing of the ChicagoCollege of Dental Surgery, William Gies
described themove to associate with Loyola as an "event of
nationalsignificance in the conflict between private and
publicinterests in the conduct of dental schools" (Gies, 1926,
p.
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Figure 1. William H.G. Logan, 1872-1943, Dean, ChicagoCollege of
Dental Surgery at Loyola University. Bur 43(2):50,August, 1 943.
Reprinted with permission.
322). Despite the accolade, however, Gies urged theCollege to
reduce its enrollment, questioning whether aschool with a faculty
of 45 had the necessary resources tohandle an enrollment of over
600.
The Northwestern Dental School, associated withthe University at
Evanston but established in downtownChicago in the 1890s, combined
two earlier proprietaryschools. By the 1 920s, Northwestern was one
of the mostdistinguished dental schools in the nation,
attractingstudents from throughout the United States as well asfrom
Europe, Asia, Canada, and Australia. G.V. Black hadleft the Chicago
College of Dental Surgery to join theNorthwestern faculty and
served as the school's deanfrom 1897 until his death in 1915. His
son, Arthur D.Black, had been appointed to the dean's position
in1918 and still held the position in the 1920s. ArthurBlack, a
different kind of scholar than his celebratedfather, made it part
of his life's work to ensure develop-ment of bibliographic access
to the dental literature.With his own extensive personal index as
the nucleus,Black supervised publication of the Index to
DentalLiterature, encompassing scholarly publications in den-tistry
from 1839 forward.
The College of Dentistry at the University of Illinoiswas the
smallest and youngest of the three schools.Organized in 1913, it
was the first state-supported dentalschool in Illinois. Located
across the street from CookCounty Hospital, the University of
Illinois had thestrongest research component of the three schools
bythe time of the Gies report. Gies noted that the school'sfaculty
had several publications in 1924 and 1925, includ-ing a "notable
volume" titled "Pathology of the mouth"(probably by Frederick Brown
Moorehead and KaetheWeller Dewey lPhiladelphia: W.B. Saunders,
19251). Healso reported several publications by Northwestern
fac-ulty as well as the presence of an excellent library. In
con-trast, he cited no publications for the overworked
Loyolafaculty in 1924 and only one in 1925.
Yet despite these unfavorable beginnings, it wasLoyola's Dean of
Dentistry, William H.G. Logan, who, inthe mid-1920s, sought advice
from Bernhard Gottlieb onhow to bring research to academic
dentistry in Chicago(Fig. 1). Logan's ambition was to create a
research unitmodeled on Gottlieb's Dental Research Institute
inVienna. He had first met Gottlieb in Geneva in 1925 at
aconference set to finalize plans for the upcoming FDICongress that
was to be held in Philadelphia in 1926(lackson and lackson, 1964).
As President of thatCongress, Logan extended his personal
invitation toGottlieb and his associates to attend the meeting
and,while they were in the United States, to visit
Chicago.Gottlieb's visit in 1926 established a link with
Viennathat, within a few years, led to the establishment of
aresearch foundation at the College, funded by a gift fromthe
Chairman of the Board of the Pepsodent Corporationand headed by
Gottlieb's brilliant student, RudolfKronfeld.
(IV) Dentistry at the University ofVienna School of Medicine
In Europe as in the United States, late nineteenth centu-ry
dentistry had struggled to redefine its status and itsstandards.
The paths taken by the profession variedbetween countries, even
among those which shared acommon language such as Germany and
Austria. InAustria, dentistry evolved as a specialty of
medicine,while in Germany, dental education developed in sepa-rate
institutions, as was the case in the United States(Lesky, 1976;
Huff, 1985). In both countries, dentistry anddental education
benefited from the strong research ori-entation of the biological
and medical sciences inWestern Europe.
The achievements of the Vienna medical school inthe nineteenth
century enriched the scientific basis ofevery area of medicine,
including the ill-defined disci-pline of dentistry, and so
established a basis for the sig-nificant progress that would be
made in the first part ofthe twentieth century (Lesky, 1976). Georg
Carabelli
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(1787-1842), a military surgeon who gave his name to thefifth
cusp of the upper molars, presented lectures in den-tistry as early
as 1821, developing a classification forbites and constructing
orthodontic appliances. He wassucceeded in 1842 by Moriz Heider
(1816-1866), who pro-posed a philosophy for dental education that
has echoeddown the ages: "a tooth...must be seen in its
connectionwith the entire organism" and "dentistry must not
beconsidered as an independent theory which is uncon-nected to
medicine" (Lesky, 1976, p. 209). In 1869, Heiderjoined with Carl
Wedl (1815-1891) to publish the "Atlas ofthe Pathology of the
Teeth", which introduced the con-cept of a bacterial etiology for
dental caries. Wedl was ahistopathologist who had introduced
improved methodsfor fixing and staining tissues, and it was this
combina-tion of scholarship and microscopic technique that wasto be
one of the major contributions to oral sciencemade by the
University of Vienna physician-dentists.Victor von Ebner
(1842-1924), who taught histology inthe Medical School, published a
series of works on thesalivary glands that came to bear his name.
He alsodeveloped techniques for the decalcification of teeth andthe
use of polarizing microscopy that he applied indescriptions of the
structure and development of thedental hard tissues. Much of this
work was incorporatedinto Julius Scheff's "Handbook of Dentistry",
publishedbetween 1891 and 1893, a work that made Vienna thefocus of
dental science for the German-speaking coun-tries. Scheff's volume
reflected the philosophy enunciat-ed fifty years earlier by Heider
and provided informationnot only on the macroscopic and microscopic
anatomyof the oral cavity but also on the relationships
betweendentistry and general medicine.
Dental education in Austria at the end of the nine-teenth
century presented a striking contrast to that in theUS. The concept
of a formal professional program offeredin an academy had been
established as early as 1840 inthe school at Baltimore, and by the
early decades of thetwentieth century, many US dental schools
struggled todevelop a more scholarly foundation for what were
pre-dominantly technical programs. In contrast, despite therich
heritage of oral anatomy, histology, and pathologyassociated with
names such as Carabelli, von Ebner, andTandler (1869-1936), the
University of Vienna did notestablish clinical training in
dentistry until 1890, with thefounding of the Imperial Royal Dental
Dispensary underthe leadership of physician Julius Scheff
(1846-1922). In1894, this became the Dental Institute, and in
1898Scheff was appointed as the first professor of dentistry inthe
University. Despite the formalization of dental edu-cation at the
University of Vienna, it was not until 1925that Austria required
practitioners to have completedfour semesters at dental school
before entering practice.
The Viennese dentist physicians who brought theirknowledge and
skills to the US in the nineteen twenties
and thirties would undoubtedly have been aware of theworks of
Heider and Scheff, for the latter was still occu-pying the Chair of
Dentistry at the time that Oppenheim,Gottlieb, and Sicher were
completing their medical train-ing at the Medical School.
Nevertheless, it was JuliusTandler who probably had the greatest
influence on thisgroup. Appointed to the Chair of Anatomy at
theUniversity of Vienna in 1910, Tandler was particularlyinterested
in the relationship between form and func-tion, and the view that
function determines form. Thisconcept is intrinsic to the
approaches to dental anatomyand histology that Sicher, Weinmann,
and co-workersused in collaborations that were to occur many
yearslater in Chicago. A second theme permeating the teach-ing of
the Viennese anatomists was the importance ofthe relationship
between anatomy and clinical practice.Emil Zuckerkandl (1849-1910),
Tandler's predecessor asProfessor of Anatomy in Vienna, had
inscribed above theanatomy lecture theater the Latin text: "Hic
locus est, ubimors gaudet succurrere vita-"Here death is glad to
assistlife." Although known principally for his studies on
theanatomy of the urogenital system, Tandler co-authored avolume on
"Anatomy for dentists" (Anatomie fur zah-narzte) in 1928 with Harry
Sicher, which was the basis foran English-language version
published in 1949.Interestingly, Tandler spent the last two decades
of hislife in public health administration in Vienna, in whichrole
he established sixteen dental clinics for children inthe city
(Goetzl and Reynolds, 1944).
(V) European Dentistry andthe Chicago Schools
Relationships between the Chicago dental schools andresearchers
in Europe had begun at least two decadesearlier than Logan's 1926
encounter with Gottlieb, fueledin part by respect for European, and
particularly German,biologic research, and the growing realization
thatAmerican dental schools needed to strengthen the bio-logical
basis of practice. Nineteenth century German sci-entific
scholarship set the standard for the Western worldin many fields,
drawing ambitious American students tostudy abroad and serving as
the model for the design ofnew universities such as Cornell and the
University ofChicago in the United States (Veysey, 1965). G.V.
Blackstudied German so that he could read the scholarly liter-ature
in that language and traveled to Europe severaltimes to attend
meetings and visit the laboratories ofcolleagues (Black and Black,
1940).
At the same time, American dentistry continued tobe
internationally recognized and admired for its techni-cal
excellence, and despite the cloud of disapprobationgenerated by the
focal infection controversy, Europeandentists came to the United
States to learn Americandentistry. Early in the century, Hans
Pichler, later to beDean of the School of Dentistry at the
University of
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I I
It I'F
Figure 2. Bernhard Gottlieb, 1885-1950. Photo courtesy ofWilliam
C. Hurt.
Vienna and Sigmund Freud's oral surgeon, studied underG V. Black
at Northwestern and translated Black's land-mark work, "A work on
operative dentistry" (1908) intoGerman (Kronfeld, 1930; Davenport,
1992).
Black's friend and colleague, Willoughby D. Miller,educated at
the University of Michigan and thePennsylvania College of Dental
Surgery, studied bacteri-ology with the microbiologist Robert Koch
at theUniversity of Berlin, and out of those studies developedhis
understanding of the relationship between bacteriaand dental
caries. Miller's most important work, pub-lished first in German as
"Die mikroorganismen dermundhohle" (1889) and a year later in
English by S.S.White as "The micro-organisms of the human mouth:
Thelocal and general diseases which are caused by them"(1890),
established the basis for most caries researchinto the twentieth
century. (Miller's career was cut shortby his unexpected death in
1907 at the age of 54, justafter he had been named Dean of the
College of Dentistryat the University of Michigan IDummett and
Dummett,19931)
Figure 3. Location of Gottlieb's laboratory. 15
Turkenstrasse,Vienna, 1 996. Photo by Stephanie Ettinger.
(VI) Gottlieb and the 1926 InternationalDental Congress in
Philadelphia
At the time of the Seventh International Dental Congressheld in
Philadelphia in 1926, the Faculty of Medicine atthe University of
Vienna was arguably the most eminentin Europe. By the mid-1920s,
the work of its DentalResearch Institute, led by Bernhard Gottlieb,
had gainedwide recognition among dentists and oral scientists inthe
German-speaking world. Gottlieb, born in Poland in1886, had
received his medical degree from theUniversity of Vienna in 1912
(Fig. 2). After valorous ser-vice in the Austro-Hungarian army
during World War 1, hereturned to the University to organize his
laboratory (Fig.3), and to establish a dental practice next door at
13Turkenstrasse with his protege, Balint Orban (Hurt, per-sonal
communication, 1995). Gottlieb's histological stud-ies, published
in the 1920s and 1930s, characterized manypreviously undescribed
microscopic features of oral tis-sues, including the attachment of
the gingival epitheliumto the tooth, the continuous eruption of the
dentition(with the related topic of traumatic occlusion), and a
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detailed description of the structure of the cementum.The FDI,
the organization sponsoring the
Philadelphia Congress, was only 26 years old in 1926.Founded in
Paris as a "permanent link of relation andunion" between dentists
of all nations (FederationDentaire Internationale, 1923, p. 3), it
provided a forumin which dental leaders and researchers from around
theworld could meet their colleagues and share researchfindings,
restorative techniques, and educational strate-gies. In the
five-year intervals between congresses, rep-resentatives of the
world's dental organizations metannually as an executive board to
conduct FDI businessand plan the international meetings. It was at
such ameeting in 1925 that William Logan, who was to chair
theconference in Philadelphia, met Bernhard Gottlieb.
The Philadelphia Congress attracted hundreds ofdental leaders
from across the US and throughout theworld. Representatives came
from nearly every state inthe United States, the US Armed Forces,
and the PublicHealth Service. More than 280 papers were read by
rep-resentatives of dental associations in thirty-six coun-tries.
Not surprisingly, the papers varied widely in quali-ty and subject
matter. Many presentations in theresearch sections contained little
more than personalreflections on a particular research problem.
Othersdescribed more systematic approaches to problem-solv-ing.
Among all the reports, those of the Vienna schoolstood out-papers
by Gottlieb, Stein, Orban, and Pichler,ranging from histologic
research through animal studiesto case reports. All reported
carefully documented andsystematic examinations of the material,
and all includ-ed extensive visual as well as textual information.
Themost well-received of the Vienna papers appears to havebeen
Gottlieb's "Tissue changes in pyorrhea" (Gottlieb,1926a). This
richly illustrated paper documented theinvestigator's studies of
structural changes accompany-ing severe periodontal disease.
Gottlieb's series ofenlarged histopathologic microphotographs
caused asensation and according to one observer "shook the den-tal
schools of America" (Obituary, 1950; Stein, 1950). TheVienna
laboratory's ready access to autopsy material,together with its
highly developed capabilities in tissuepreparation and microscopy,
gave them a decided advan-tage over most other investigators and
earned worldwiderespect. Moreover, the Vienna investigators'
adroitnessin analyzing, synthesizing, and explaining their
observa-tions seemed to place their work on a higher level thanthat
of most of the rest of their colleagues.
Gottlieb's presentation reflected his methodologicalapproach.
Setting out his holistic orientation plainly inthe first paragraph,
Gottlieb argued that to understand"the nature of the processes" it
is necessary to view biol-ogy as a whole, rather than in terms of
"artificial divi-sions". "lAllthough it is our task to speak here
of the lossof teeth," he continued, "we must start with their
devel-
opment." Reviewing the growth and development of thenormal
dentition throughout life, Gottlieb touched onmany of his own
contributions to the subject.
Balint Orban's two papers also received attention.The first,
"Nutrition and teeth," reported Orban's ownanimal studies on the
effect of nutrition on the growthand development of teeth (Orban,
1926a). The second,"Histology of the enamel lamellae and tufts,"
built onGottlieb's work to continue the investigation of the
struc-tural development of tooth enamel (Orban, 1926b).Georg
Stein's "Studies in transplantation" discussed his-tologic sections
from his bone transplant work in an ani-mal model (Stein, 1926).
Hans Pichler, an oral surgeon,presented detailed case reports
illustrating his methodof using attached bone grafts to repair
mandibular defi-ciencies resulting from accidents or imperfect
develop-ment (Pichler, 1926).
A profile of American dentistry emerges from titles ofpapers
presented by representatives from the US at thisgreat Congress
whose subject matter spanned research,education, and professional
issues. The number ofpapers on restorative dentistry clearly
illustrated thiscountry's strong emphasis on technique
issues.Representative examples are papers by three
nationallyrecognized clinicians, all from Iowa: two papers byRoscoe
H. Volland on cast gold restorations, Arthur 0.Klaffenbach's "Fixed
bridge restorations: Their indica-tions, limitations and
construction," and, inevitably,Charles E. Woodbury on gold foil
technique(Klaffenbach, 1926; Volland, 1926a,b; Woodbury, 1926).Not
all presentations from the United States were tech-nical, however.
A report presented by Northwesternresearchers W.G. Skillen and Emil
Mueller, "Epitheliumand the physiologic pocket," building on
Gottlieb's work,illustrated the growing biological orientation of
Chicagoresearchers (Skillen and Mueller, 1926). The critical
inter-section of the biological and the technical that wasbeginning
to reshape American dentistry in this periodwas exemplified in
reports on histologic findings associ-ated with root canal therapy
by Chicago researchersEdward H. Hatton and Edgar Coolidge (Hatton
et al.,1926; Coolidge, 1926). A lengthy presentation by MayoClinic
physician Edward Rosenow, citing extensive docu-mentation from his
own practice of a wide variety of dis-ease states attributed to
dental infection, suggests thedilemma dentistry faced as well as
the limitations ofsome research in medicine (Rosenow, 1926).
When the Congress closed, Gottlieb traveled to theMidwest to
visit Dean William Logan and the dentalschool at Loyola. An oral
surgeon with training in medi-cine as well as dentistry and the
son-in-law of ChicagoCollege founder Truman Brophy, William H.G.
Logan'sown interests spanned a broad spectrum. His early ani-mal
studies addressed the etiology and treatment ofperiodontal disease.
As the focal infection issue intensi-
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(VIl) The Research Institute at Loyola
Figure 4. Balint Orban in the 1 920s. Bur 1 9:84, 1
929.Reprinted with permission.
fied, he had used autopsy material in his own research
toinvestigate the extent to which pulpless teeth, root frag-ments,
or impacted teeth harbored bacteria or causedsystemic disease
(Coolidge, 1943) Later, with the assis-tance of Gottlieb's
associate, Rudolf Kronfeld, Logan wasto turn his attention to
improving the design of surgeryfor repair of the cleft palate
(Logan and Kronfeld, 1933).At the conclusion of Gottlieb's visit to
Chicago, Loganasked the eminent researcher to recommend an
individ-ual who could establish a research program at
Loyola.Gottlieb recommended his brilliant young assistant,Balint
Orban (Fig. 4). Logan immediately issued an invi-tation, and in
1927 Orban came to Chicago to join thefaculty at the Chicago
College of Dental Surgery atLoyola (Coolidge, 1943).
Born in Temesvar, Hungary, in 1899, Orban had com-pleted his
medical training at the University of Budapestin 1922 and then
moved to Vienna, where he joinedGottlieb's staff. By the time he
came to the United Statesin 1927, Orban had already published 19
papers, primar-ily in the German literature (Everett, 1970).
(A) BALINT ORBANAlthough Balint Orban returned to Vienna in 1929
afteronly two years at Loyola, to be replaced by anotherGottlieb
assistant, Rudolf Kronfeld, his first brief stay inChicago was
productive. Dean Logan equipped the labo-ratory according to
Orban's requests, calling for "the bestof everything", which
included "a microtome, photo-micrograph, grinding machine, research
microscope, andother appliances" (Coolidge, 1943). With the
assistanceof a faculty member and researcher, E B. Fink,
Orban'sfirst project was to organize a research methodologycourse
for Loyola faculty. Twenty members of the faculty,including Dean
Logan, attended the lecture and labora-tory sessions, which covered
dental histology andpathology, taught by Orban, and general
pathology andbacteriology, taught by Fink Orban's fine training and
hispassion for research, combined with his excellent com-mand of
the English language, made him an extraordi-narily effective
teacher. By the conclusion of the course,several faculty members
had begun their own projects,and several senior dental students had
requested per-mission to assist in the laboratory
Faculty from other schools came to Chicago to workwith Orban,
and invitations poured in for him to presenthis work at other
institutions. By the end of two years,Orban had given thirty
lectures in various parts of thecountry and published several
papers and abstracts inthe English-language literature as well as a
textbook,"Dental histology and embryology" (Orban, 1928). A totalof
twenty-two research papers had been published fromthe department In
his closing report to the ChicagoCollege of Dental Surgery alumni,
Orban said that it wasthe contents of the papers rather than their
number ofwhich he was most proud:
Each has a different touch; each sees things witha different eye
and from a different angle They arenever dry descriptions, they all
try to explain bio-logic processes, they try to explain life, and
so livethemselves (Orban, 1929)
A dynamic and charismatic individual, Balint Orbanwas to have a
significant impact on both clinical den-tistry and dental research
in this country following hisreturn to the United States almost a
decade later.(B) RUDOLF KRONFELD
Orban's replacement at Loyola, selected by Gottlieb,
was28-year-old Rudolf Kronfeld. Kronfeld had worked underGottlieb
since completing his medical training at theUniversity of Vienna in
1926. His brief career in theUnited States blazed across dental
research with mete-
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Figure 5. Rudolf Kronfeld, 1901-1940. This photo was proba-bly
taken in the mid-i 930s. Bur 40:16, March, 1940. Reprintedwith
permission.
oric brilliance, only to end abruptly with his tragic deathin
1940 (Fig. 5).
Kronfeld was energetic and ambitious, and his com-mand of the
English language was excellent. His lucidlecture style, his
affability, and his willingness to sharehis expertise with others
soon made him a popular fig-ure. He quickly established himself as
a participatingmember of the major dental organizations, including
theChicago Dental Society and the InternationalAssociation for
Dental Research (IADR), with its activeChicago Section. In 1933, he
published "Histopathologyof the teeth and their surrounding
structures" (Kronfeld,1933). The book, notable for its abundant
histologicalillustrations and extensive bibliographies,
quicklybecame a standard text in the dental curriculum. Neweditions
continued to be published until 1955 (Kronfeld,1937a; Kronfeld and
Boyle, 1949, 1955).
Also in 1933, with William Logan, Kronfeld pub-lished a landmark
48-page paper on "Development of thehuman jaws and surrounding
structures from birth to theage of 15 years" (Logan and Kronfeld,
1933). Drawing on
Figure 6. The Harrison street entrance to the Chicago College
ofDental Surgery in the 1 930s. Bur 37:114, 1 937. Reprinted
withpermission.
autopsy material and originally intended primarily forcleft
palate surgeons, the project had been planned as astudy of the
infant jaw and all adjacent bone structuresand attached soft
tissue. The significance of the work hadincreased as Logan and
Kronfeld expanded the project toinclude material from 25
individuals ranging in age fromnewborn to 15 years, allowing for
collection of ground-breaking chronological data on the location of
perma-nent tooth buds and the timing of calcification inunerupted
permanent teeth ("A new light on tooth devel-opment", 1933). Using
the "celloidin technique, asdevised and used by Professor Gottlieb
and his associ-ates..." (p. 395), the work was a technical tour de
force andincluded some 35 micrometer sections, combining hardand
soft tissues, that were as large as 6 by 8 cm. "To ourknowledge,"
the authors said, "microscopic sections ofthis size through the
head and neck have never beforebeen prepared or reported" (p.
401).
Unlike Orban, Kronfeld seemed certain that he hadcome to stay.
Soon after his arrival, he married anAmerican woman, Margaret
North, whom he had met inVienna. Along with his responsibilities as
an assistantprofessor of histology and pathology, he enrolled in
thedental school at Loyola and in two years had completedthe
requirements, receiving his DDS in 1933. He openeda practice in
Chicago's "Loop", seeing patients four after-
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Figure 7. A view of part of Kronfeld's new lab aher the
Foundation was1 930s at the Loyola School of Dentistry. Bur 36:24,
1 936. Reprinted wi
noons a week. As a practicing dentist who was also apractical
researcher, he forged a strong link between thelab bench and the
clinician, a relationship he regarded ascritically important to the
profession.
The strength of Kronfeld's and Orban's work atLoyola and the
growing recognition of the school's rolein dental research gave
Kronfeld's faculty colleague,Edgar D. Coolidge, the evidence he
needed to persuadea wealthy patient with a philanthropic bent to
subsidizeresearch at Loyola (Fig. 6). Beginning in 1935, Kenneth
G.Smith, President and Chairman of the Board of thePepsodent
Corporation, made a ten-year annual gift of$25,000 to Loyola for
research (lackson and lackson,1964). The funds were used to
establish the Foundationfor Dental Research, to be directed by
Kronfeld under theoversight of an eight-member committee headed
byDean Logan. Three advisors, recognized researchers atother
institutions, helped evaluate planned projects. Thefunds made
possible a move to larger, roomier quartersand the employment of
additional laboratory staff (Fig.7). A collaboration with
bacteriologist Ruth Tunnicliff atthe nearby lohn McCormick
Institute for InfectiousDiseases was facilitated (Kronfeld, 1936).
In 1936, tenyears after Logan's meeting with Gottlieb at
thePhiladelphia Congress, Kronfeld, Logan, and otherChicago College
faculty presented their work at the FDI'sNinth International
Congress, held in Vienna and orga-nized by Balint Orban (Kronfeld,
1937b). The work of theFoundation was also represented in Vienna by
an exhibitof two hundred photomicrographs, described by Kronfeldas
the largest exhibit contributed by any US institution.
Chicago research hadbecome an increasingly strongpresence at the
annual meet-ings of the IADR. Four of the fif-teen men who had
served aspresident since the organiza-tion's founding in 1921
hadbeen from the Chicago schoolsFrederick Noyes, Arthur
Black,Edward Hatton, and WCGSkillen (Orland, 1973). By 1939,almost
a third of the 61 papersread at the annual scientific ses-sion,
held in Cleveland, camefrom the Chicago schools.Northwestern's
representationwas strongest, with ten papers,followed by four from
Loyola,three from the Zoller Clinic atthe University of Chicago,
and
established in the mid- two from the University
oftestabmishsion. - Illinois. In 1937, the IADR mem-ath permission.
bership elected Kronfeld vice-president, and he began mov-
ing up the ladder toward the presidency. During thesesame years,
Kronfeld had been named a Fellow by theAcademy of Periodontology
and was elected President ofthat organization in 1939.
In the winter of 1939-40, life took a bitter turn forKronfeld.
On February 13, 1940, at the age of thirty-nineand only a month
before he was to assume the presi-dency of the IADR, Rudolf
Kronfeld was found dead in hisresearch laboratory. The New York
Times reported coronarythrombosis as the cause of death (New York
Times, 1940),but Kronfeld's friends soon learned that he had taken
hisown life (Chicago Tribune, 1940a,b). Late in 1939, Kronfeldhad
been diagnosed with a serious neurological disease,possibly
multiple sclerosis (lackson and lackson, 1964).He apparently found
the prospect of progression intohelpless invalidism unacceptable,
and with his illness aclosely guarded secret from all except his
wife, Kronfeldhad planned for the close of his life. He died, as
hisfriend Edgar Coolidge described it, "surrounded by hislibrary,
his histologic material and his work in progressfor the coming
season" (Coolidge, 1940). At his request,his body was cremated and
his ashes buried in theIndiana sand dunes on the southern shore of
LakeMichigan, where he and his wife had a summer home
It is interesting to speculate on how RudolfKronfeld's career
might have evolved had he lived out anormal life span. An energetic
and skilled researcher witha strong interest in clinical dentistry
and a gift for com-munication, Kronfeld clearly had the potential
to play asignificant role in dentistry and dental research. At
thetime of his death, the Journal of the American Dental
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Association described his career as one of
"distinguishedachievement" and his two textbooks as "distinctive
andauthoritative" (Kronfeld, 1940). Perhaps more important-ly,
Kronfeld recognized and clearly articulated to his fel-low
clinicians the critical relevance of good research tothe standing
of dental practice in the community. Hechided fellow researchers
for their propensity to presenttheir work in "another language",
not intelligible to theirclinical colleagues. He deplored studies
designed to sup-port advertising campaigns and "research for the
sake ofdecoration" (Kronfeld, 1937a).
His message to clinical dentistry was set out mostexplicitly in
a widely published article entitled "Researchand the future of
dentistry", in which he delineated thecrucial connection between
the techniques of restorativedentistry and the biological
foundation on which thosetechniques must rest (Kronfeld, 1939).
Drawing on suchexamples as G.V. Black's fundamental research on
cavitypreparation and the materials studies of the NationalBureau
of Standards, he reminded practicing dentiststhat the familiar,
reliable procedures and materials theytook for granted in their
work had been developedthrough years of research and testing. In
the same way,Kronfeld said, "Biologic research has laid the
foundationfor correct diagnosis and the proper treatment of
dentaland oral disease." No matter how enthusiastically atreatment
method might be endorsed by clinicians ormanufacturers, Kronfeld
assured his readers, unless thattreatment was based on the
fundamentals of biologicalscience, "it will fail and soon be
forgotten." Many reliabletreatments are not yet fully understood,
he conceded,and much remained to be explained. Calling for
closerties between researchers and practitioners,
Kronfeldchallenged his fellow dentists to recognize that
"...anhonest admission of lack of knowledge is far preferableto a
pseudoscientific, unsound explanation."
(VIII) The Crisis in EuropeIn 1938, two years before Kronfeld's
death, politicalchanges in Austria sharply altered the history of
theUniversity of Vienna School of Medicine and the careersof
Bernhard Gottlieb and his colleagues. in the face ofclearly
expressed Austrian support for Hitler's policies of"racial
hygiene", members of the faculty who were Jews orsimply had a Jew
in their family tree or were married to alew were forced to flee
for their lives. As these menlooked to their colleagues in other
nations for assistancein relocating their lives and careers, the
great nationaland international networks of relationships embodied
inthe concept "the dental profession" faced real andhuman
challenges. The profession in Austria clearlyfailed the test,
splitting quickly along ethnic lines, relin-quishing international
standing for the more immediaterewards of political expediency and
a less competitiveplaying field. In the United States, the response
reflected
a complex struggle between those who saw facilitatingthe
emigration of "foreign-trained dentists" across theAtlantic as an
opportunity for the profession as well as amoral responsibility and
those who saw it quite simplyas an economic threat.
(A) THE ANNEXATION OF AUSTRIAAlthough the great Austro-Hungarian
Empire had brokenapart at the end of the First World War in 1918,
the city ofVienna remained the cultural heart of Central Europe.The
standing of the University of Vienna drew studentsfrom all sectors
of the former Empire: Hungary,Czechoslovakia, Poland, and the
Balkans. Love of learn-ing and the attractions of Vienna's high
culture as well asthe political instability and the crude
anti-Semitism ofmany of the newly independent Central
Europeannations drew many Jews to the city. One historian
hasestimated that, by the early 1930s, at least a third of
theUniversity's Faculty of Medicine and about half of thephysicians
in the city of Vienna were Jews (Beller, 1989, p.36).
Anti-Semitic rules, both official and unofficial,closed off many
career paths for Jews (e.g., law, civil ser-vice), but medicine was
one that remained open. Even inmedicine, problems were sometimes
raised in relation topromotion. Adopting Christianity presented a
possiblecircumvention of such limits. This course offered a
rea-sonable option, especially for those individuals whosefamilies
had not followed traditional Jewish religiouspractice for
generations and who thought of themselvesas Germans or Austrians,
not Jews (Berkley, 1988; Beller,1989).
Austria's long tradition of officially condoneddemonstrations of
hostility toward Jews combined withthe intractable economic
difficulties of the GreatDepression heightened anti-Semitism in the
1930s. Evenin the University, where an increasingly conservative
stu-dent majority clashed with the more liberal
faculty,intimidation, harassment, and even physical violenceagainst
Jewish students and faculty became increasinglycommon. Many in
Austria watched Hitler's rise to powerin Germany with intense
interest, and a growing factionsympathetic to the Nazis began to
emerge. Austria'schancellor, Kurt Schuschnigg, struggled to chart a
coursethat would maintain the nation's independence, butwhen Hitler
led troops into Austria on March 11, 1938, hewas welcomed by most
Austrians, and a Nazi govern-ment was quickly installed.
The impact on the Medical Faculty was immediate.Within the
month, faculty had received letters from anewly installed dean, an
outspoken Nazi, requiring themto provide documentation of their own
and their spous-es' Aryan descent. Before the end of March, the
"cleans-ing" of the faculty had begun, with those who were Jews
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Figure 8. Balint Orban, 1899-1960. J Periodontol 31:266,1960.
Reprinted with permission.
or married to Jews or who refused to take an oath of loy-alty to
Hitler dismissed from their posts. More than 75%of the Medical
Faculty lost their positions. Vacancieswere filled with individuals
from the lower academicranks whose credentials as Aryans and
supporters of thenew regime were acceptable (MOhlberger, 1990;
Ernst,1995). Recognizing that not only their careers but alsotheir
very lives and the lives of their families were threat-ened, the
eight Jewish physician-dentists and their col-leagues on the
Medical Faculty must have begun a des-perate review of their
options. For Gottlieb, Orban,Sicher, and Weinmann, their
already-established tieswith the dental profession in the United
States repre-sented a lifeline.
(B) FORCED MIGRATION AND RESETTLEMENT
(1) An early departure: Balint OrbanAlthough many in the
professions who had reason to fearNazi anti-Semitism had begun to
leave Germany andAustria soon after Hitler's rise to power in the
early1930s, most senior Medical Faculty at the University ofVienna
remained in their places. For several generations,people of Jewish
descent had seemed to be almost fully
assimilated into Austrian life and the culture of its capi-tal
city, and many may have believed themselves to besafe from the kind
of persecutions occurring in Germany(Beller, 1989). A few, however,
Balint Orban among them,perhaps recognizing that their scholarly
environmentwould soon deteriorate, had begun efforts to move
theirwork elsewhere.
Although Orban may have been a member of theCatholic Church, in
1938 his position on the MedicalFaculty was de-activated
("stillgelegt") on the basisof racial persecutions ("aufgrund
rassistischerVerfolgungen") (Muhlberger, 1990, pp. 7, 28). But
Orbanwas no longer in Vienna. In 1937, he had begun negotia-tions
with Northwestern dean Arthur Black. Blacksecured immigration visas
for Orban, his wife, and son,and arranged for his enrollment as a
student at theNorthwestern dental school and for a faculty
appoint-ment. He and his family sailed for the United States
inJanuary, carrying his histological material with him(Jackson and
Jackson, 1964). When the great purge of theUniversity of Vienna
began in March, 1938, although stilllisted as a member of the
Medical Faculty, Orban wasalready in Chicago. He completed his
clinical require-ments in time to graduate in September of the same
yearand assumed a position as assistant professor of pathol-ogy at
Northwestern (Jackson and Jackson, 1964). Twoyears later, after
Kronfeld's death, Dean William Loganoffered Orban the Research
Foundation directorship atLoyola, and he accepted.
(2) Orban's later careerOrban had the most public career of the
emigratingVienna dentists in the United States (Fig. 8). He
pub-lished widely-books, research reports, and other arti-cles. He
had an active career on the lecture circuit, par-ticularly in the
emerging specialty of periodontics, andhe marketed his own line of
instruments for periodontaltreatment. In 1946, his career-long
interest in promotingthe preservation of non-vital teeth and in
countering theimpact of the focal infection scare led him to serve
aseditor of a new scholarly publication, the Journal ofEndodontia.
Although the journal survived through onlythree issues, its brief
life heralded the appearance of thenew specialty of endodontics and
its association, found-ed in 1943. (The Journal of Endodontics,
Vol. 1, made its sec-ond and more permanent appearance in
1975.)
Orban's scholarly productivity was astonishing. His1928 text
"Dental histology and embryology" (Orban,1928), published before
his return to Vienna, was theprecursor of his later influential
text, "Oral histology andembryology" (Orban, 1944). It is
remarkable to see in the70-year-old "Dental histology" many of the
photomicro-graphs of periodontal tissues that illustrate the
mostrecent edition of "Oral histology and embryology"
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(Bhaskar, 1990), a testament to the outstanding qualityof the
histologic preparations that came out of theVienna laboratory. Now
in its eleventh edition, the bookremains as one of the standard
teaching texts in the area,and is appropriately edited by a student
of the Chicagogroup, Surindar N. Bhaskar.
Before leaving Vienna in 1937, Orban had completedseventy
publications, including several major texts inGerman, co-authored
with Weinmann and Gottlieb,addressing such subjects as occlusal
trauma and the gin-gival attachment. His productivity continued
after hissecond emigration to the United States, where he
col-laborated frequently with Sicher and Weinmann, whosetenure at
Loyola coincided with his own (Fig. 9). Orbancontinued his research
on the histopathology and surgi-cal treatment of periodontal
disease and developed hisviews on the structure, function, and
classification of oralmucosa, which were set out in the first
volume of "Oralhistology and embryology" and remain the basis
fornomenclature of the tissues to the present. Rather thanlimit his
publication to his own views alone, Orbanbrought together a group
of experts to write individualchapters, a technique he also used
for his "Periodontics:A concept-theory and practice" (Orban, 1958)
withFrank M. Wentz, Frank G. Everett, and Daniel A. Grant,and an
approach which is today common in most texts.
Orban established a research foundation inColorado in 1952 but
maintained his affiliation withLoyola until his death from a heart
attack in 1960 (Sicher,1960a; Everett, 1970).
(3) "The stranger dentist within our gates": The USdental
profession considers its options
The schools of this Association are faced with a decisionas to
what they will do to orient the stranger dentistswithin our gates
to become useful citizens and respectedpractitioners.
R.W. Bunting, DeanUniversity of Michigan
(Bunting, 1939)
The debate over how to respond to the challenges pre-sented by
dentists from Germany and Austria, seekingrefuge and new careers in
the United States, appearedquickly on the agendas of at least two
major dentalorganizations. By Spring, 1939, both the
AmericanAssociation of Dental Schools (AADS) and the
NationalAssociation of Dental Examiners had begun to addressthe
question. The long-standing struggle between thetwo groups for
control of the gatekeeper's role led eachto keep a weather eye on
the other's discussions. Despitethe fact that neither organization
exercised administra-tive control over its members (individual
dental schools
Figure 9. (I-r) Sicher, Orban, and Weinmann. J
Periodontol31:271, 1960. Reprinted with permission.
and state boards), any statement of policy by the nation-al
organization would inevitably have a powerful impacton the
direction taken by individual units. AlthoughAADS member deans
reflected a range of opinions, theschools, most still suffering
from a Depression-influenceddecline in enrollments, took a more
welcoming stancetoward the refugee dentists than did the
examiners.
(a) The AADS.When the AADS met in Cleveland in March, 1939,
manymembers, especially deans, came prepared to discussthe issue
(American Association of Dental Schools,1939). R.W. Bunting, dean
at Michigan, opened a meetingof the Administrative Section with a
discussion of theissue and his survey of how individual schools
wereresponding to recent foreign applicants. Bunting's surveyshowed
that of 39 responding schools (from a total of41), only fifteen had
so far admitted refugee dentists asstudents. Those fifteen all
reported difficulties in assess-ing the level of preparation of
applicants and in gainingcurriculum information about the dental
schools theyhad previously attended (Bunting, 1939).
Bunting argued that, in view of the fact that the pro-fession
was "not overcrowded", and that enrollments haddropped in recent
years, it seemed reasonable to thinkthat "a moderate number of the
better qualified practi-tioners" could be admitted to the dental
schools andsubsequently to the profession. He admitted difficulty
indetermining whether foreign applicants had had appro-priate
pre-professional education and concluded that if
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foreign dentists were to be admitted, the pre-profession-al
admission requirements of the "leading foreign uni-versities" would
have to be accepted as sufficient.
Only Dr. R.L. Sprau, a dentist from Kentucky and avisitor from
the National Association of DentalExaminers, contested Bunting's
view that European den-tists were well-prepared in the basic
sciences and insome instances better prepared than students in the
US.On the other hand, Bunting agreed, their limited knowl-edge of
American technical procedures necessitated thatthey begin with the
"first principles" of the freshmantechnique laboratory. In some
instances, however, rapidprogress would be made and the student
might movequickly to junior class level. At the same time,
Buntingacknowledged, the language problems and the variety
ofbackgrounds presented by these special students placedextra
burdens on faculty. The prospective student's abili-ty to read and
speak the English language was essentialto his ability to complete
the necessary work, Buntingnoted.
A second report, by University of Pennsylvania deanCharles R.
Turner, described a survey of state boardsdesigned to gather
information on "conditions of licen-sure" boards had set for
immigrant dentists (Turner,1939). Of 41 boards responding, 22
required or had leg-islation pending that would require examinees
to be UScitizens. Nine schools had less stringent
requirements:Examinees needed only to have taken out "first
papers"before being allowed to take the board. Twenty-five of the41
boards refused to accept graduation from a German orAustrian
gymnasium as meeting pre-professional educa-tional requirements.
Almost 90% required graduationfrom an American dental school, and
four of theserequired that examinees complete the full four
years'attendance. Although Bunting and some others at thesession
deplored as inhumane state board rules thatseemed to set up nearly
unachievable conditions, noteveryone attending felt responsibility
toward the immi-grant dentists. Baltimore College dean J. Ben
Robinsoncharacterized Bunting's views as "more emotional
thanrational" and pronounced himself as "orthodox in jeal-ously
guarding high educational standards" (AmericanAssociation of Dental
Schools, 1939, p. 61). Dr. HamiltonB.G. Robinson expressed concern
that "refugee profes-sors" would absorb all available open faculty
positions,leaving none for students currently enrolled in
teachertraining programs (American Association of DentalSchools,
1939, p. 63).
(b) The ExaminersAt the annual meeting of the National
Association ofDental Examiners later that summer in Milwaukee,
dis-cussion of the refugee issue took a more strident tone(National
Association of Dental Examiners, 1939). Theexaminers located the
weakest link in their fortifications
squarely among the dental schools, who, according toone
examiner, might be expected to hand out diplomasindiscriminately,
even after the immigrant dentists hadsimply "loafed in the halls"
during meaningless refreshercourses. Their professed concern to
safeguard the publicfrom the poor technical skills of
European-trained den-tists seemed disingenuous, since an individual
with poortechnical skills would presumably be unable to pass
theboard.
The examiners looked for the most effective strategyto protect
the interests of the dentists already in practiceand of
American-born dental students. Ira Williams, anexaminer from
Illinois, perhaps referring to Arthur Black'svigorous advocacy of
Balint Orban, reported that difficul-ties had already arisen in
Chicago, where "one of ourschools" had been "taking them and giving
them a diplo-ma in one year." Williams added, "They are not doing
itany more because we refused to take them on thatbasis...." He
urged members of the organization to pass astrong advisory
resolution that would send a warning tothe schools against bending
requirements for therefugees (National Association of Dental
Examiners,1939, p. 109). Dr. R.L. Sprau, the examiner from
Kentuckywho had attended the AADS session on immigrant den-tists,
suggested that the schools might be waiting for theexaminers to
take a stand. He reported "no agreement,no unity, and very little
understanding among the Schoolpeople... I would consider them
rather disorganized onit," he added, suggesting that they seemed to
have aninclination to " 'pass the buck' to somebody else"(National
Association of Dental Examiners, 1939, p. 88).
Because clearly the most nativist and conservativemembers
participated in this discussion, with many oth-ers keeping silent,
it would be unfair to judge the wholemembership by the views of
these few. At least one moremoderate view was expressed. Dr.
William N. Hodgkin,representing Virginia's board, called for what
seemed areasonable stance: "...if a man can meet our standards
weshould accept him as an applicant before our Boards"(National
Association of Dental Examiners, 1939, p. 89).The chair appointed
Hodgkin and two others to a com-mittee charged with drafting a
resolution on the subjectfor the Association's consideration. The
hastily drawn-upresolution called for states to require graduation
from anaccredited dental school with satisfactory completion ofat
least the junior and senior years, before a European-trained
individual would be eligible to take the board.The body as a whole
found this standard less stringentthan the danger warranted and
after some wrangling,amended the resolution to require satisfactory
comple-tion of four years instead of only two. The
resolutionpassed.
Evaluating the response of the profession and itsleaders to the
plight of their European colleagues on thebasis of only these two
meetings would be unfair. Even in
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the case of the Examiners, it is difficult to separate gen-uine
concern for standards of clinical practice and thewell-being of
patients from the ever-present impulse ofstate board members to
control competition. Responsesclearly varied widely among
individual schools andboards and must have reflected the particular
needs andbiases of the individual states and their constituent
com-munities. Perhaps we can conclude that the combinationof the
diversity of communities and the decentralizationof licensing
authority in the US (to the states rather thanthe Federal
Government) created an environment where,despite noisily voiced
insularity, no single point of viewcould prevail, and some
hospitable niches remainedavailable. In retrospect, we know that at
least someimmigrant dentists received dental degrees from USschools
and subsequently went on to pass state boardsand practice
dentistry. Others voluntarily or involuntarilyleft careers in
patient care behind and concentrated theirwork in academic
positions with responsibilities in basicscience teaching and
research. Assessing the extent towhich individuals were blocked
from the pathway theywould otherwise have chosen would be
difficult.
(4) Sicher and WeinmannFollowing their exile from Europe in
1939, Harry D. Sicherand his younger colleague, Joseph P Weinmann,
alsobrought the skills and training of the Vienna School toChicago.
Sicher became a master teacher, first at theChicago Medical College
and then at Loyola, where hispresentations to students and to
practitioners alike werelegendary (Anatomy lecture lives up to
advance notices,1947). The more reserved Weinmann settled at
theUniversity of Illinois, where he built a research programin oral
pathology that gained significant NIH grant sup-port and served as
the training ground for new genera-tions of researchers. Frequent
collaborators, Weinmannand Sicher wrote the classic "Bone and
bones:Fundamentals of bone biology" (Weinmann and Sicher,1947,
1955), which incorporated descriptions of theirown research with a
comprehensive treatment of thework of others in the field.
Born in 1889 in Vienna, Sicher was the most seniorof the group
that came to Chicago, and also lived thelongest. After three years
as Associate Professor ofNeuroanatomy at the Chicago Medical
School, he joinedthe faculty at the College of Dental Surgery at
LoyolaUniversity as Associate Professor of Anatomy andHistology in
1942 (Fig. 10), where he remained until hisretirement. It was here,
in 1949, that he published thefirst edition of "Oral anatomy",
based on the German texthe had authored in collaboration with
Julius Tandler. Theinfluence of Tandler and the Viennese school was
clear inthe volume that reviewers hailed as bridging the gapbetween
theory and practice and demonstrating thatanatomic understanding
facilitates clinical work (Oral
Figure 10. Harry Sicher, 1889-1974. Sicher at the time hejoined
the faculty at Loyola in 1942. Bur 42(3):136, November,1 942.
Reprinted with permission.
anatomy, 1949). That the work is now in an eighth edi-tion,
edited by Lloyd DuBrul, a colleague from theUniversity of Illinois
College of Dentistry, is evidence ofits significance and durability
(DuBrul and Sicher, 1988).
In addition to textbooks, Sicher published someeighty papers in
oral anatomy and histology, many in col-laboration with Weinmann.
Sicher's work formed the cor-nerstone for the teaching of oral
anatomy in the dentalcurriculum for decades. A broad spectrum of
the dentalprofession drew on his work, ranging from general
prac-titioners who came to hear his advice on the best loca-tions
for administering local anesthesia, to craniofacialbiologists and
orthodontists who studied his explicationof the growth of the head
and face. In 1967, toward theclose of his career, the American
Association ofOrthodontists recognized his contribution to their
disci-pline with the Albert H. Ketcham Memorial Award(Presentation,
1968). Accepting the award, Sicherreminded the orthodontists of
their debt and his own toJulius Tandler, whom he described as one
of the greatestteachers that he had ever met, and to his dental
col-league at the University of Vienna, Albin Oppenheim,whose
animal studies helped make early orthodonticsthe most biologically
grounded of specialties.
Sicher himself was regarded by his students as a bril-liant
teacher, and an anatomist with a respect for biolo-gy who always
kept the whole living system in mind. Noone who had heard him
lecture could ever forget his abil-ity to stand in front of a
chalkboard and draw, with bothhands simultaneously, the
complementary halves of an
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1+&14.1.Figure 11. Joseph Peter Weinmann, 1896-1960. IL Dent
J29:772, November, 1960. Reprinted with permission.
anatomical structure! Sicher maintained his contactswith the
College of Dental Surgery at Loyola and theUniversity of Illinois
until his death in 1974 at the age of85 (Gowgiel, 1975).
Joseph Peter Weinmann, born in Bohemia in 1896,joined Gottlieb
as a research associate in his laboratoryin Vienna in 1923
immediately after gaining his medicaldegree. On coming to the US in
1938, he spent one yearat the College of Dentistry at the
University of Illinois anda year at Columbia University before
joining the DentalSchool at Loyola University as an Assistant
Professor ofOral Pathology. In 1946, he joined the University
ofIllinois Department of Histology as an associate profes-sor and
in 1949 became Professor and Head of theDivision of Oral Pathology,
a position he held until hisdeath in 1960 (Fig. I).
Weinmann was a prolific researcher, publishing morethan 160
articles on bone physiology and pathology,amelogenesis, normal and
pathologic oral epithelium,and periodontal disease. His greatest
achievement, how-ever, was the creation of a department at the
Universityof Illinois that for twenty years trained many of
thosewho would lead academic dentistry in this country
andelsewhere. Almost alone among the Viennese group,
Weinmann benefited from the increasing grant fundingthat a
well-supported National Institutes of Healthoffered to academic
researchers in the health sciences.For example, in an era in which
the average NIH grantwas about $13,000, Weinmann in 1957 held six
grantsfrom NIH for a total funding of just over $90,000(National
Institute of Dental Research, Grants andawards funded between
fiscal years 1947-1960, unpub-lished computer printout,
2/14/96).
A catalyst in the research enterprise in Weinmann'slaboratory
was lulia Meyer, herself a refugee from NaziEurope, who joined the
Division of Oral Pathology at theUniversity of Illinois in 1953
following completion of herPhD at the University of Chicago.
Working on the biologyof oral epithelium, Weinmann and Meyer
developed asignificant research and graduate training program
thatcontinued until Meyer's retirement in the mid-1980's.
Animportant focus of this research was the structure of thetissue
in terms of function, the classic Vienneseapproach, and for several
editions, Julia Meyer preparedthe chapter on oral mucosa for
Orban's "Oral Histologyand Embryology". Peter Weinmann's death in
1960occurred within a few weeks of that of his colleague,Balint
Orban (Sicher, 1960b).
Many of those who passed through the University ofIllinois oral
pathology program in the department duringthis period have gone on
into significant professionaland academic positions in the US,
including OlavAlvares, Erwin Barrington, Surindar Bhaskar,
Sow-YehChen, Stanley Gerson, loseph Henry, Klaus Nuki,
lamesSciubba, and Leo Sreebny. Many also came from abroadto work in
the department, such as Martin Ferguson(Scotland), Mark yollY
(Australia), Harald L6e (Denmark),Gordon MacDonald (Scotland), lens
Pindborg(Denmark), Frank Schroff (New Zealand), Mervyn Shear(South
Africa), and Christopher Squier (England).
(5) Bernhard GottliebAlthough Orban, Sicher, and Weinmann were
drawn tothe research community that had grown up over the pasttwo
decades in Chicago, Gottlieb clung to Europe.Putting his wife and
son on a flight to London, and withthe assistance of non-lewish
friends, he escaped eastoverland and then vici the Black Sea to
Palestine, carryingcrates of his histological specimens with him
(Harold B.Younger and Frank Wentz, unpublished interview;Strauss
and Roder, 1983). In the pioneering lewish com-munity in Palestine
and the university at Tel Aviv,Gottlieb hoped to find a locale
where he could re-createthe Dental Institute in an environment
which wouldembody a kind of Talmudic ethic of inquiry
(Gottlieb,1943; Stein, 1950; In mernoriam, 1950; Obituary:
ProfessorBernard Isic) Gottlieb, 1950). As that part of the
worldbecame drawn into the war, however, Gottlieb realizedthat the
pioneering spirit was not enough. Research
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required space, equipment, libraries, and time to reflect,all in
very short supply in the Palestine of this era. SoGottlieb looked
for another place to restart his career. Heapparently tried,
unsuccessfully, to find a position inEngland, where he had often
lectured to admiring fellowresearchers. In 1940, he turned to the
United States, firsttaking a visiting professorship at the
University ofMichigan and then finally, in 1941, settling at
BaylorCollege of Dentistry in Dallas (Fig. 12).
The oldest dental school in Texas, the former StateDental
College had been organized in 1905 as a propri-etary establishment.
In 1918, as the move away from pro-prietary dental schools began,
the owners of State nego-tiated an affiliation with Baylor
University, and theschool became Baylor Dental College (Gies, 1926;
Stout,1969). By the early 1940s, small in enrollment and facul-ty
size, the school's administrators struggled to maintaina basic
science dental curriculum without the assistanceof the medical
school, which completed a move toHouston in 1943. His learned
background and the oppor-tunity to develop a research program
encouraged Bayloralumni in the Dallas County Dental Society to
proposeGottlieb's name to the dean, offering to raise funds
tosupplement what the College could afford to offer insalary
(William C. Hurt, personal communications, 1995,1996). Gottlieb
accepted and remained at Baylor until hisdeath in 1950 at age
65.
Gottlieb struggled to establish a research programduring his
years at Baylor, with limited financialresources and with
colleagues who were willing, but withlittle or no research
background. Cut off from the main-stream of dental research by
distance, language barriers,and his own sense of alienation from
his more fortu-nately placed former students and colleagues in
Chicago,he never again achieved the recognition he had enjoyedas
director of the Dental Institute in Vienna. Even beforehis arrival
in the United States, his "Biology and pathol-ogy of the tooth and
its supporting mechanism"(Gottlieb and Orban, 1938), co-authored
with Orban, hadreceived mixed reviews. The work was an
English-lan-guage translation, drawn from material published
inAustria as "Zahnfleischentzundung und Zahnlockerung"(Gottlieb and
Orban, 1933). A reviewer in the lournal of theAmerican Dental
Association, illustrating the unwillingnessof some elements of the
profession to examine the biol-ogy of tooth structure, labeled
Gottlieb's description ofthe epithelial attachment a "so-called
fact" and theVienna researchers' caution against allowing
restorativeprocedures to disrupt the attachment as "dogmatic" anda
mere "philosophic" interpretation (Biology and pathol-ogy, 1939).
Before the war, Gottlieb had collaborated fre-quently with Sicher
and Orban on research reports andbooks, but from the time that he
left Vienna to begin hisodyssey until his death, Gottlieb never
again publishedwith these colleagues.
Figure 12. Bernhard Gottlieb at Baylor, 1945. Photo by
A.K.Fisher.
At Baylor, building on work he had begun in Tel Aviv,Gottlieb
turned his attention to dental caries, clearly thecentral issue in
dental research as the large Federallyfunded fluoride studies began
to be mounted in the1940s (Gottlieb, 1939). Gottlieb fully
understood, per-haps earlier than most, that tooth structure was
dynam-ic living tissue, that the metabolism of
micro-organismsfunctioned in some way to weaken enamel, and that
con-stituents of human saliva might protect against caries.He began
trying to modify and strengthen tooth enamelwith various
combinations of chemicals, including silvernitrate, zinc chloride,
and potassium ferrocyanate, whichhe believed would unite with
enamel to form an insolu-ble compound, thus blocking bacterial
entry by providinga "defense mechanism along the organic roads of
inva-sion" (Gottlieb, 1944, 1947a). Working without
externalfunding, Gottlieb and colleagues in Texas and
elsewheretested this methodology in small groups of children
andreported positive results (Gibson, 1950; New York Times,1950).
For example, Gottlieb reported that, at the end ofone year, caries
incidence in a group of 25 children whohad been treated with a
silver nitrate compound aver-aged 0.44 cavities per child compared
with an average of4.2 cavities per child in a control group of five
(Younger,1944, Gottlieb, 1947b, p. 229).
Subsequent research in the 1950s and 1960s, withmore powerful
microscopy technologies than were avail-
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able to Gottlieb, would demonstrate the flaws in hishypotheses
on the initial causes of dental caries(Mandel, 1955; Silverstone et
al., 1981; Newbrun, 1983). Inthe late 1940's, however, dental
caries researchersfocused most of their attention on prevention.
Whateverits potential value may have been, Gottlieb's caries
pre-vention methodology was eclipsed by the great fluoridestudies
of the 1940s, funded and widely publicized by theUnited States
Public Health Service and, after 1948, bythe National Institute of
Dental Research. By 1947, theyear Gottlieb published his book,
"Dental Caries",describing the theoretical basis for his caries
prophylax-is, most of the rest of the dental research community,
ledby Public Health Service researchers, believed it had onlyto
decide between water fluoridation or topical fluorideapplication as
the most efficacious method of preventingcaries (Harris, 1989).
Gottlieb's reports, drawing on smallsamples and illustrated with
his signature histologicalsections, and emanating from an obscure
dental schoolin Texas, drew little attention. Only three years
later, in1950, with the Grand Rapids water fluoridation study
stillmore than a decade from completion, Bruce Forsyth,chief dental
officer in the PHS, endorsed mass waterfluoridation as a public
health initiative. Gottlieb diedthe same year.
Baylor College of Dentistry cherished its eminentprofessor while
he served on its faculty and after hisdeath. In 1981, he was the
first individual recognized inthe newly established Baylor College
of Dentistry Hall ofFame, with a plaque honoring his memory. At
least someof his histopathological work has been preserved and
isstill drawn on occasionally for study (Dr. BernhardGottlieb,
1947; Davis and Jones, 1985; Krayer and Rees,1993). In the decades
since 1960, the College's researchestablishment has evolved into a
nationally respectedentity.
Although Gottlieb's contributions to our under-standing of the
structure and function of the teeth andoral soft tissues were
significant, his greatest legacy todentistry may have been the
tradition of careful system-atic inquiry his leadership instilled.
His career, and thecareers of the students and colleagues who had
workedwith him in Vienna, enriched the scientific foundations
ofdentistry and, perhaps even more significantly, helpedlay the
foundation for a vigorous research enterprise inthe United
States.
(IX) Conclusion: The Contributions of theUniversity of Vienna
Oral Biologists
The fortuitous juncture of the Vienna school's
biologicalorientation and American technical expertise
enricheddental research, education, and clinical practice.
Gottliebprobably made his most significant contributions beforehe
left Vienna. Most important was his description of theepithelial
attachment, along with his description of nor-
mal and pathological conditions in oral soft tissues,especially
periodontal disease (Gottlieb, 1921, 1926a,b,1927). With Orban, he
reported new information on theeffects of traumatic occlusion
(Gottlieb and Orban,1931). Orban extended Gottlieb's work on the
epithelialattachment and its role in periodontal disease,
frequent-ly emphasizing the importance of taking the structureinto
account in the design of dental restorations (Orban,1941; Orban and
Wentz, 1954; Orban et al., 1956). Orban'stext on the treatment of
periodontal disease (and itssubsequent editions) remained a
standard for many gen-erations of dental students (Orban,
1958).
Although he wrote about soft tissue with Orban(Orban and Sicher,
1945), Harry Sicher's work focused pri-marily on bone. Continuing
in the tradition of his mentorJulius Tandler, Sicher always viewed
tissues as compo-nents of a dynamic, changing organism. His
descriptionsof the movement of teeth in eruption and the
relation-ship of bone growth to tooth movement had
particularrelevance for the clinical practice of orthodontics
(Sicher,1942; Sicher and Weinmann, 1944). His understanding ofthe
structure and function of the jaws had practical valuefor the
delivery of local anesthetic and for the under-standing of
temporomandibular joint disorders (Sicher,1948, 1952, 1954).
Although Peter Weinmann was about the same ageas his Vienna
colleagues (younger than Gottlieb andSicher, older than Orban), his
career represented a bridgeto the next generation of oral
biologists. Beginning hisresearch with studies of bone (Weinmann,
1941; Sicherand Weinmann, 1944) and enamel (Weinmann et al.,1942;
Weinmann, 1943), Weinmann later concentratedon oral epithelium. In
his collaboration with Julia Meyer,he moved oral soft tissue
research to a new level, draw-ing on histochemical techniques
(Weinmann et al., 1959),describing keratinization in more detail
(Weinmann et al.,1960), and examining mitotic activity and rates of
growthfor better understanding of cell function and renewal(Meyer
et al., 1960). He drew his students from the basicsciences as well
as from dentistry, further broadening thescientific foundations of
clinical practice and expandingthe scope of oral biology.
The careers of Gottlieb, Orban, Kronfeld, Sicher, andWeinmann
represent only a small fraction of the storiesthat could be
recounted concerning the successful andunsuccessful transplantation
of scholarly careers result-ing from the tragedies of World War II
(Ash and Sollner,1996). Recognition, by leaders in the US dental
profes-sion, of the need for strengthening the biological
foun-dation of clinical practice and for an active
researchenterprise helped create opportunities for the
refugeescientists. International scientific and professional
net-works established in the 1920s facilitated the moves.
Astrengthened synthesis of the technical and biologicalfoundations
of dentistry resulted and continues to be
124 Crit Rev Oral Bid Med 8(2):108-128124 Crit Rev Oral Biol Med
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developed in our own time. In addition to their knowl-edge and
research skills, the Vienna-trained dentist-sci-entists brought an
approach to learning and a scientificculture of investigation which
continues to play a signif-icant role in the development of
research programs hereand abroad. Forced migration afforded
opportunities toall participants. Recognition of the intellectual
floweringgrowing out of this conjunction of two cultures
seemsworthy of our attention, if only to remind us again of
thevalue of our differences.
AcknowledgmentsThe authors would like to thank the many
individuals who contributedto preparation of this paper. At the
beginning of our research, ProfessorMitchell G. Ash, History
Department, University of Iowa, pointed outseveral important
resources and suggested valuable conceptualapproaches based on his
own research on the forced migration of Jewishscholars and
scientists during World War II. Professor Guenter
Zoeller,Philosophy Department, University of Iowa, assisted with
readingGerman documents. Eric Corbin and the staff of our
EducationalMedia Service prepared the photographs. Ms. Mary Ann
Williamson,NIDR. supplied information about early Federal grant
funding in den-tistry, Drs. B.F. Dewel and Bernard G. Sarnat shared
informationabout their personal experiences with some of the
Viennese scientists. Adiscussion with Dr. Richard Ten Cate helped
clarify some scientificissues. Several colleagues read preliminary
drafts of the manuscript andoffered useful comments and
suggestions. These were: Drs. Richard E.Bradley, Ronald L.
Ettinger, Stanley I. Gerson, William C. Hurt,Richard M. Jacobs,
Charles R. Kremenak, Irwin D. Mandel, andErnest Newbrun. The
contributions of William Hurt to this project havebeen invaluable.
In addition to generously sharing his own researchfiles,
photographs, and knowledge, his enthusiasm and
continuedencouragement throughout the project have been very much
appreciat-ed. Finally, we are grateful for the interest, advice,
and patience of oureditor, Dr. Olav Alvares, who is himself a part
of the story.
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