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REVIEW
W. E. Gerabek
Abstract The concept of a tooth-worm, which according ence of the humors of the body were the reason for the dis-
to popular belief, caused caries and periodontitis, has ex- astrous, long lasting opinion that worms come into being
isted in diverse cultures and across the ages. During the in any place within your body as soon as there are spoiled
Enlightenment, however, the theory of the tooth-worm was humors. ([10], p. 20). Kobusch states in his dissertation,
assigned by medical doctors almost exclusively to super- published in 1955, that it is uncertain where the belief in
stition. Even so, the idea that toothache was caused by the tooth-worm originated. He doubts that research will be
gnawing worms held on even into this century. There were able to answer this question ([29], p. 8).
many different ideas with regard to the appearance of tooth-
worms. In England, for instance, it was thought that the
tooth-worm looked like an eel. In Northern Germany,
people supposed the tooth-worm to be red, blue, and gray Appearance of the tooth-worm
and in many cases the worm was compared to a maggot.
The gnawing worm was held responsible for many evils Belief in the evil worm has existed in diverse cultures and
and, in particular, was blamed for toothache provoked by across the ages. For example, both very advanced civil-
caries. The question is discussed of how the belief in the izations as well as people living in the Roman Empire and
existence of the tooth-worm in former times can be ex- the Middle Ages believed in the tooth-worm ([21, 23], vol.
plained. In popular medicine, numerous therapies were 1, p. 182; vol. 2, p. 838). In Germany, for instance, the
applied in order to eradicate the tooth-worm. In addition term zanewurm can be found in ninth and tenth century
to the fumigations with henbane seeds, which allowed the literature ([42], vol. 3, p. 503; vol. 4, p. 367, [22], p. 834].
tooth-worm to develop in the form of burst seeds, there In her book Causae et curae, Hildegard von Bingen men-
were also magical formulas and oaths. tions the tooth-worm as a possible cause of dental caries
([29], p. 10). Patients spoke of the monster as well in
Key words Tooth-worm Toothache Caries later times. For example, Nicol Nicoli Falcucci, who
Periodontitis Popular medicine Medical superstition lived in Florence during the Renaissance and who died in
1412, reported on the problem of tooth-worms ([43], p.
138). The belief that a worm developed in a bad tooth,
started to pick immediately and then died as soon as it
The origin came into contact with air can be traced back to Paracel-
sus [3, vol. 9, col. 849]. We meet the parasite again in the
According to Townend (1944), the idea of the tooth-worm seventeenth and eighteenth centuries ([22], p. 834): Al-
developed in the Near East and spread from there through- brecht von Haller talks about the tooth-worm in his
out the world ([44], p. 58). Paul Diepgen, however, be- Onomatologia medica, which was written about 1750
lieves that Ancient Egypt was the source of the tooth-worm ([20], vol. 2, p. 544).
story. He writes, Since parasites have appeared very of- During the Enlightenment, however, doubt arose about
ten in Egypt the worm has become the main symbol of all the existence of the tooth-worm. Pierre Fauchard, who was
diseases. The frequent occurrence of parasites and the sci- born in Bretagne and worked as a dentist in Paris, rejected
the theory of the worm in his epochal two-volume work
Le Chirurgien dentiste ([43], p. 189) which was published
W. E. Gerabek
Institute for the History of Medicine,
in 1728. Fauchard thought that the cause of caries was not
Bayerische Julius-Maximilians-Universitt Wrzburg, the tooth-worm. In his opinion, the reasons for dental car-
Oberer Neubergweg 10 a, D-97074 Wrzburg, Germany ies were different internal and external physical conditions
2
([43], p. 189) which he wanted to study by using precise opportunity to demonstrate the tooth-worms as materia
scientific research methods. From the middle of the eight- peccans in a tricky way. Within the heat and humidity of
eenth century (or more precisely, from the time everything the hot coals the seeds developed into white little threads
was considered from a scientific aspect) Fauchards opin- the tooth-worms! The pain would get better thanks to
ion was widely accepted by those who were skilled in med- these herba dentaria ([43], p. 95).
icine and who were carrying out precise empirical research. The tooth-worm was not only regarded as a source of
During the following era the theory of the tooth-worm evil due to its characteristics, it was also used as a medi-
was assigned almost exclusively to superstition. Although cation. Scribonius Largus, for instance, referred to the
medical doctors havent really believed in the existence of tradition of applying gnawing worms on bad teeth. The
actual tooth-worms since the Age of Enlightenment, the Roman medical doctors thought that they could get rid of
idea that toothache was caused by gnawing worms held on bad teeth quicker this way and that this loss of teeth helped
even into the present century ([4], p. 31). the patient get well faster ([29], p. 10]. In the Middle Ages,
There were many different ideas regarding the appear- we encounter this idea again. In Avicennas (9801037)
ance of a tooth-worm. In England, for instance, it was Canon medicinae, one is advised to spread cabbage but-
thought that the tooth-worm looked like an eel. In North- terfly caterpillars on the hollow teeth, which are supposed
ern Germany, people supposed the tooth-worm to be red, to fall out soon. The Persian reported that, in fact, sick teeth
blue, and gray ([3], vol. 9, col. 849) and in many cases the fall out after a few days ([299, p. 10); but certainly, this
worm was compared ([11], vol. 7, p. 496, [9], p. 341, [22], didnt happen because of the caterpillars!
p. 651) to a maggot ([22], p. 651). The gnawing worm was We can learn more about the development of the belief
held responsible for many evils and, in particular, it was in tooth-worms and how, 200 years ago, they were con-
blamed for toothache provoked by caries. It was also con- ceived to be by consulting Grimms Deutsches Wrterbuch
sidered to be the cause of headache ([22], p. 834). The fa- (Grimms dictionary). According to the entry for Zahn-
mous Flemish surgeon Jan Yperman (who died about 1330) wurm, the tooth-worm is viscous lymph which is squeezed
claimed to have observed that the moving worms caused out of the blocked pores of the teeth by the contracting
suppuration in the teeth. strength of fumigation. The fumigation was the result of
the henbane seeds which wwere distributed on coal. This
lymph might actually be the viscous sulcus liquid which is
visible with periodontitis ([12], vol. 31, col. 188). It is, of
Explanation of its existence course, not tenable and no longer accepted to assert that a
viscous liquid can escape out of pores within the tooth.
How can the belief in the existence of the tooth-worm in There is a reference in the Handwrterbuch des deutschen
former times be explained? During the imperial era in Aberglaubens (Concise Dictionary of German Super-
Rome Scribonius Largus, the famous medical doctor and stition) that in Mecklenburg, Swabia, and Franconia, for
physician to the Emperor Claudius, wrote (from 43 to 48 example, the hanging pulpa was considered to be a little,
A.D.) a prescription book which was called De composi- living worm ([3], vol. 9, col. 849). The hanging pulpa was
tione medicamentorum and dedicated to his patron Cal- probably only an encapsulated abscess. The Deutsche
listus. Scribonius Largus suggested methods to relieve the Krankheitsnamen-Buch (book of names of illnesses) of
pain suffered from a toothache. He mentioned palliatives Hfler explains the tooth-worm in a similar way. In former
that included fumigations, rinsings, and fillings. These times, if a hollowed tooth was inflamed the pulpa dentis
palliatives also formed the basis for the production of rem- was killed like a worm by cauterization with a thin
edies that were to be chewed. In particular, Scribonius rec- wire. The idea of gray, blue, white, red, or black tooth-
ommended henbane for relief of toothaches. The Romans worms is attested in numerous German blessings. The
sometimes called this herb herba dentaria ([17], col. worm might also be explained in a different way, with re-
1918) because it was often used for toothaches, while in spect to the tooth germ. The teeth are gnawed by these
Tyrol one spoke of a tooth-herb and in Carinthia (an- germs, which are similar to worms, and can be imagined
other region of Austria) the Apollonia-herb (Apollonia as hanging onto the pulled out, hollowed, resting teeth
is the patron of toothache) ([32], p. 224). Scribonius gave ([22], p. 834). It is strange that, in the last century, the lar-
the following instructions for a fumigation, distribute vae of a fly named Sacophila Wohlfarti that look similar
henbane-seeds onto coal, allow the smoke to come to the to worms were observed in the gums of Russian farmers
teeth, and rinse again with lukewarm water. While spit- ([32], p. 221).
ting out afterwards, there may occur sometimes tiny In summary, it is very likely that one concluded that
(tooth-)worms. there must be a concrete reason as soon as the first pain
Karl Sudhoff gave the following explanation: occurred. The assumed cause of the gnawing worm was
In the Orient (for instance in Avicennas Canon apparently substantiated by accidentally made observa-
medicinae) ([43], p. 118) and in the Occident (in medie- tions ([29], p. 9).
val England, e.g. Gilbertus Anglicus) ([43], p. 128) the
blackish seedcorn of this narcotic plant has been spread on
the glowing coal and it was inhaled into the open mouth
as vapor fumigation. This process gave again and again the
3
the analgesic effect of the henbane was based on its capa- rinde weg/vnd schneide darunter einen span heraus/
bility to kill worms. In the case of myrrh or tansy, there is stchere die Zeene damit/das sie bluten/vnd las das blut
an analogy between intestinal worms, on the one hand, and am Span trucken oder treuge werden. Darnach gehe hin
imaginary illnesses of the teeth caused by tooth-worms, on vnd setze den Span fein wider ein/wie du in aus der Weide
the other. Remedies used against intestinal worms were genomen/lege die Rinde wider drber/vnd binde es mit wei-
considered as a remedy against the tooth-worm. The for- chen Lehme zu/so vergeht dich die wehetage. Est vera cura,
get-me-not was also prescribed for various illnesses caused vnd ist keine Zauberey ([29], p. 37).
by worms. The anthelminthic served simultaneously as a Of Tooth-Worms.
remedy against ear worms, intestinal worms, and tooth- It is a strange but a true trick. Cut off a stem of a young
worms ([25], p. 189). willow the upper part of the bark. Then cut a chip of wood
out of the willow. Pick your teeth with it until they start
bleeding. Let the blood become dry on the chip. After you
Spells and formulas have done all that go back and insert the wooden chip into
the bark again. The chip should be at the same place as it
Illnesses of the teeth, whose treatment is based in the po- was before you took it out. Cover the chip again with the
pular medicine on bushes and trees, would be of great cul- bark and connect both by using soft loam. Your days of
tural and historical interest. However, only little evidence pain will pass this way. This is a true remedy and no magic.
has been passed on in regard to the treatment of tooth- There was also the possibility of relieving pain by pick-
worms and, therefore, the few existing references are very ing the teeth. The inflamed socket of a tooth opened by
important. For example, there is a spell addressed to a pear- piercing with the help of a wood chip results in an analge-
tree: sic reduction in pressure ([29], p. 39). In a metaphorical
sense, this was also called the nailing of an illness. One
Pear tree, I complain to you,
referred to the nailing of an illness in the sense of pre-
three worms are gnawing me,
venting the disease from staying or more precisely, from
one is gray and the other one is blue,
being effective. The original instructions have been mod-
the third one is red,
ified, completed, or even lost over the centuries. It is no
I wish, all three were dead
wonder, therefore, that the wood chip actually was replaced
While reciting the verses one touched the tree and turned by a nail either because of the lack of knowledge or be-
three times around it clockwise ([29], p. 35). cause of the reference to the term nailing. Of course, this
misunderstanding was associated with disastrous conse-
quences for the patient troubled by toothache. As a rule the
Oaths and formulas danger of blood poisoning always existed. For example, an
instruction that was given for the relief of toothache or the
It must be assumed that both the tooth-worm and the tree unspoken tooth-worm read as follows: Drill with an iron
have a demonic character if such oaths are used. Tree nail within the bad tooth until it is bloody, then drive it into
demons were widespread in superstition and were even a deciduous tree in the direction of the sunrise, pray three
thought to be able to harm human beings and animals. It times the Lords Prayer and finally go away without look-
was a common idea that various insects living either on or ing backwards ([29], p. 39).
under the barkor on the trunk or roots of trees were to be In former times, the nailing of an illness was a very
blamed for such mischief. common habit in some areas. It is reported, for instance,
Though from our present point of view quite primitive, that there were many nailed, isolated oaks in the area called
people believed analogously that worms had to be identi- Vogtland (Germany) and in the region called Lausitz (Ger-
fied with evil demons. They felt that vicious demons had many). In the trunks of these oak trees a lot of different
settled down as parasites in the body of human beings or nails were drilled in to relieve pain when suffering from
animals as caterpillars, butterflies, ring worms, toads etc., toothache ([29], p. 40).
and were responsible for numerous diseases. Evil ghosts Another way to fight the tooth-worm demon was with
supposedly also came out of the woods and attacked hu- oaths and formulas. Only from German speaking regions
man beings and animals. People believed that the trees, in have many different prayers, oaths, and tooth or tooth-
whose bark the brood of evil ghosts was evidently living, worm blessings been passed on to us [14]. In addition, we
sent them off. According to this superstition the tree itself are familiar with a large number of other customs for fight-
or the demons of the tree were sending the vermin causing ing toothache or tooth-worms. Unfortunately, not all of
illnesses but at the same time they were able to take them these examples can be discussed here and only a small se-
back ([29], p. 37). There were apparently many procedures lection can be named. It is said that in former times splin-
by which one could send the tooth-worm demons causing ters belonging to a dug out coffin helped against toothache
toothache back to the trees. In a text published in 1604 we if one used them for picking in the hollow tooth. Accord-
read the following lines: ing to the saying, the splinters had to swim away in flow-
Vor die Wrme in Zeenen. ing water after the procedure was finished ([29], p. 40).
Ein wunderlich/vnd doch wahrhafftig/Kunststcklein. Even at the beginning of our century it was common to
Schneide von einem jungen Weidenen stamme/die bere chew on a piece of bread or crust when troubled by tooth-
5
ache. Finally, the patient had to spit it onto an anthill. Be- 4. Baldinger M (1936) Aberglaube und Volksmedizin in der Zahn-
lieving in the effectiveness of an amulet was another prac- heilkunde. Schweiz Arch Volkskunde 35: 1
5. Bang AC (1901) Norske Hexeformularer og magiske Opskrift-
tice. er. Kristiana
At the turn of the century, it was a custom in the Land- 6. Brodmann C (1921) Deutsche Zahntexte in Handschriften des
shut area (Germany) to hang little worms around the neck Mittelalters. Thesis, University of Leipzig
when bothered by toothache. The troubled patient waited 7. Buchheim L (1964) Der lteste Zahnwurmtext in babyloni-
scher Keilschrift. Zahnarztl Mitt 54: 10141018
until the little worms had died, then he/she threw the worms 8. Diefenbach L (1857) Glossarium Latino-germanicum mediae
into an oven and prayed the Lords Prayer ([29], p. 49). et infimae aetatis e codicibus manuscriptis et libris impressis
Considering the previously mentioned method of dealing concinnavit Laurentius Diefenbach. Frankfurt; reprinted
with toothaches, the idea of worms causing the pain comes (1968): Supplementum Lexici mediae et infimae Latinitatis,
to mind. Finally, reference should be made to another tra- Darmstadt
9. Diefenbach L (1867) Novum glossarium Latino-germanicum
ditional procedure which was also very common in the re- mediae et infimae aetatis. Beitrge zur wissenschaftlichen
gion of Graz (Austria) 100 years ago. It was usual that Kunde der neulateinischen und der germanischen Sprachen.
people wore a tooth which had been extracted from a hu- Frankfurt; reprinted (1964): Aalen
man being to prevent toothache or if toothache had al- 10. Diepgen P (1923) Geschichte der Medizin, vol I, 2nd edn.
Gschen, Berlin Leipzig
ready attacked them to wear one of a hung person ([29], 11. Du Cange (1954) Glossarium mediae et infimae Latinitatis, VII.
p. 49). These customs were based on the opinion that ill- Graz
nesses were healed according to the Latin saying, similia 12. DWB (1860/1956) Deutsches Wrterbuch, II, XXXI. Leipzig;
similibus curentur. The extracted (dead) tooth as well as reprinted (1984): Munich
13. Hoffmann von Fallersleben AH (18301837) Fundgruben fr
the (dead) tooth of a hung man were supposed to kill or at Geschichte deutscher Sprache und Literatur, III. Breslau
least to relieve the pain of the patients tooth. 14. Fehrle E (1926) Zauber und Segen. Jena
15. Fonahn A (1905) Orm og Ormmidler. Christiana
16. Frederiksen J (1980) Ddesche Arstedie. In: Ruh K, Keil G,
Schrder W, Wachinger B, Worstbrock FJ (eds) Die deutsche
Conclusions Literatur des Mittelalters. Verfasserlexikon, vol II, 2nd edn,
Gruyter, Berlin, col. 283239
17. Georges KE (1879) Ausfhrliches lateinisch-deutsches und
In conclusion the belief that worms caused toothache was deutsch-lateinisches Handwrterbuch, aus den Quellen zusam-
not unanimous. On the one hand, some people believed in mengetragen. Lateinisch-deutscher Theil, vol I, 7th edn, Leip-
the existence of real worms, parasites which caused peri- zig
odontitis and dental caries by gnawing and drilling. This 18. Gener O (1974) Gift- und Arzneipflanzen von Mitteleuropa,
3rd edn. Heidelberg
led to the use of the orthodox medical treatments which 19. Gorelich L, Gwinnett AJ (1978) Life and death of the tooth worm
aimed to destroy these apparent parasites using appropri- or when I believe it, I will see it. New York State Dent J: 2125
ate remedies and therapies. On the other hand, the tooth- 20. Haller A von (17541756) Onomatologia medica, III.
worm could also be viewed as a demon which could be re- 21. Hoffmann-Axthelm W (1985) Die Geschichte der Zahnheil-
kunde, 2nd edn. Quintessenz, Berlin
moved by specific practices, formulas, oaths, worm bless- 22. Hfler M (1899) Deutsches Krankheitsnamen-Buch. Munich;
ings, and the nailing of the illness. Within the context of reprinted (1970): Hildesheim
popular medicine the two approaches have coexisted for a 23. Hovorka O von, Kronfeld A (19081909) Vergleichende Volks-
long time. Orthodox medicine abandoned the idea of the medizin. Eine Darstellung volksmedizinischer Sitten und Ge-
bruche, Anschauungen und Heilfaktoren, des Aberglaubens
existence of real tooth-worms once and for all at the end und der Zaubermedizin, III. Stuttgart
of the eighteenth century but popular traditions held on to 24. Hbotter F (1913) Beitrge zur Kenntnis der chinesischen sowie
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remind us of the earlier belief in tooth-worms. The former 26. Keil G (1961) Die Cirurgia Peters von Ulm. Untersuchungen
idea of the illness has remained in our speech when de- zu einem Denkmal altdeutscher Fachprosa mit kritischer Aus-
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