InternationalDentalJournal (1 997) 47, 340-348

Therapeutic concepts of endodontic

treatment in the nineteenth century
M. Zimmer
Strasbourg, France

Summary

Interest in dental history does not only help to develop a higher appreciation of those who
founded modern dentistry, but also allows the present generation of practitioners detailed
memories and savoir-faire founded on a thorough knowledge of old medical writings. This
paper reviews the techniques available for use during the last century in cases of alveolar
abscesses and treatment of pulp cavities and canals before filling. Historical backgrounds
prove how much the evolution of our profession is dependent on scientific knowledge and
developing of techniques. In the past the conditions of root infections were not understood
in present days terms. By analysing old medical texts, historians may contribute to the
scientific evolution. Indeed old writings enable us to undertake new research; being
valuable in order to understand and eventually solve some of our medical enigmas. As
with farmers repeatedly sowing and planting forgotten varieties of fruit and vegetables, so
we are bound to come to terms with forgotten drugs in our therapeutics.

What behaviour could a practitioner of the first decades

of thel9th century adopt if his patient had severe tooth-
ache?
In 1808, Ricci’, the dentist of His Royal Highness
Duke of Berri, and Edme Marie Miel used a little hand
drill to penetrate root canals (Figure 1) making holes of
equal diameter along their length. This drill is repro-
duced in C. Fr. Delabarre’s book Odontologie ou observa-
tions sur les dents humainesz, published in 1815. As it
could only be used on incisors and canines, Maury3
developed another drill in 1820 which could reach
molars (Figure 2). As the operation was often too diffi-
cult, practitioners preferred to use excavators.
We must be aware that the discussion of techniques
for capping exposed pulps, or alleviating dental pain is
Figure 1
not new. Hippocrates had certainly borrowed the prac- Hand drill working with the cord of a bented bow, printed in
tice of cauterising the tooth pulps from the Egyptians, C. Fr. Delabarre, Odontologie ou observations sur les dents
and Galen handed down the procedure to the surgeons humaines, Paris, 1815.
of the 18th century4. Cauterisation was performed to Forage manuel avec le fil d’un arc, imprime dans C. Fr.
obtain two results: first, to destroy the dental nerve, and Delabarre, Odontologie ou observations sur les dents humaines,
second to stop, or to limit and to dry the caries5.In 1808, Paris, 1815.
Alter Handbohrer. Aus: C. Fr. Delabarre, Odontologie ou
Audibran-Chambly6 had recognised that the result of
observations sur les dents humaines, Paris, 1815.
cauterisation was often an irritation of the already Taladro manual funcionando con la cuerda de un arc0
inflamed tissues, and that cautery did not always cure doblado, impreso en C. Fr. Delabarre, Odontologie ou
the decayed tooth. He recommended the technique for observations sur les dents humaines, Paris, 1815.

0 1997 FDI/World Dental Press

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Figure 2
Drill of J.C.F.Maury,ManueZ du dentiste, Paris, 1820.
Foret de J.C.F.Maury, Manuel du dentiste, Paris, 1820.
J.C.F.Maurys Bohrer. Aus: Manuel du dentiste, Paris, 1820.
Taladro de J C F Maury, Manuel du dentiste, Paris, 1820.
incisors and canines, but did not advise it in cases where
inflammation was present.
The instruments used for cauterisation of the dental
nerve differed in their shapes, subject to the various
kinds of teeth on which the dentist operated. The first
instruments or probes were made of iron such as a long
pin or extremity of a wire. The temperature of the
instruments was gradually increased so as to be toler-
ated, until they were heated to being white hot when
they were quickly pushed in the hole of the canals with
a simultaneous rotational movement before removal. As
the probes were liable to rust they also had a tendency
to become easily breakable. Therefore, in 1820, Maury7
suggested manufacturing them in platinum.
Another method of cauterisation was the use of
hydrogen gas8. On 21 July 1845, a cautery called
'Denticure' was patented9 by the Parisian dentist Pierre
Honor6 Penot (Figure 3). This invention used a gas that
chemists and alchemists knew as inflammable air or
hydrogene gas, considered in those days as an element
Zimmer: Nineteenth century endodontics 341
Figure 3
The Denticure of Pierre Honor6 Penot, 1845.
Les soins dentaires de Pierre Honor6 Pernot, 1845.
Zeitgenossisches Instrument von Pierre Honor6 Penot, 1845.
El Denticure de Pierre Honor6 Penot, 1845.
of fire. Penot's apparatus is composed of a glass globe, a
tap, a bladder and a blowtorch. Unfortunately Penot
does not enumerate the required materials to produce
inflammable air.
According to Joseph Priestley's doctrine of phlogis-
ton and decomposition of waterlo, and to John Maclean's
lectures on combustion" the matras screwed on the
bladder, might have been filled with charcoal.
"The water, therefore, from the finery cinder (black
oxyd of iron) uniting with the charcoal makes the
inflammable air (hydrogene gas), at the same time that
part of the phlogiston from the charcoal contributes to
revive the iron. Inflammable air (hydrogene gas) of the
very same kind is procured when steam is made to pass
over red-hot charcoal", writes Maclean.
As soon as hydrogene has filled the bladder, the
latter will be removed from the globe, the tap having
been locked. Then the blowtorch will be screwed on it,
inflamed and presented to the canal of the tooth. The
flame has the size of a pin head, but thanks to use of two
silver spatulas the internal part of the jaw and the tongue
were saved from the clumsiness of the dentist or from
the patient's movements.
On 2 September 1847, Julien Louis Descot, a dentist
from Dijon, patentedI2 an apparatus called 'Phlogothera-
peudonte' (Figure 4), in which hydrogene gas was stocked
in an Indian rubber cushion, set inside an oakwood
box. On this model a sheet of lead helps to compress
the gas. On the inferior part, a flexible copper tube,
one meter long, allows the fixing of a kind of hollow
copper cylinder ending at the extremity with a slightly
bent blowtorch. Two taps help regulate the gas rate, and
the cylinder could be dismounted into three parts in
order to clean it. Descot's apparatus was presented at
the traditional meeting of the Academy of Medicine on
11 September 1849, under the Presidency of the well-
known surgeon of the Hospital de la Charit6, Alfred
Velpeau.
342 International Dental Journal (1997) Vol. 47/No.6
Figure 4
The Phlogotherapeudonte of JulienLouis Descot, 1847.
Le Phlogotherapeudonte de JulienLouis Descot, 1847.
Zeitgenossisches hstrument yon JulienLouis Descot, 1847.
El Flogoterapedonte de JulienLouis Descot,.1847.
First steps with chemical treatments
Sheajashub Spooner had recommended arsenic trioxide
for the purpose of destroying the dental pulp since 1836,
but in fact many years elapsed before serious considera-
tion was given to the treatment of the pulp and the
canals.
William Green Morton13, the well-known pioneer of
anaesthesia, lived in the summer of 1844 in Charles T.
Jackson's house where they discussed this method of
destroying a dental nerve, and the nuisance that it caused
irritation when the operator often did not cause a
permanent pain. As a joke, Jackson suggested testing his
toothache drops, that where in fact sulphuric ether drops.
Morton immediately experimented the procedure by
sealing cotton impregnated with ether in a tooth, trying
to diminish the sensitivity of vital pulps by this
application.
Many of the essential oils of clove, cinnamon,
peppermint, spearmint or turpentine, have been
employed in the treatment of pulpitis or used in mouth-
washes. Samuel s. FitchX4had recommended astringents,
alum, borax and Aleppo gall since 1835, and Thos. Bell
had used stimulants, such as alcohol and spirits of
camphor for the treatment of exposed dental pulps since
1837. At that time the common idea was that a patient
had to be able to use his teeth for mastication without
too much discomfort.
In 1845, M. J. DidierI5, a French physician-dentist,
adopted the following schedule:
In the case of an exposed dental pulp, he started by
introducing in the tooth, for five or six days, cotton
impregnated with:
Alcohol 40 degrees: 4g used as a tonic, as an astrin-
gent and for its cooling action.
Ammonia in the liquid form: 60g. If diluted with
water, ammonia has a stimulant and energetic
diaphoretic effect.
Oil of Cinnamon: 2g employed as a stimulant and a
tonic.
Then, after eight days he applied, using small
impregnated cotton-balls, with a brush or simply with
 Zirnmer: Nineteenth century endodontics 343

4
the extremity of a feather:
Alcohol 40 degrees: 4g
Potash with alcohol: l g used for its caustic effect.
To change damp rotted, rapidly progressing decays
into dried decay, Didier hid in cotton pledgets a very
small quantity of silver nitrate or hell stone. This topi-
cally applied substance is rarely painful, he said, as any
pain would not last longer than some few seconds.
I I‘A

Delabarre had recommended this method in 1815, using

half silver and half lead acetate. It was a less terrifying
process.
According to Didier a milder remedy could be used
to diminish the sensitivity of the pulp:
Balsam of Commandeur: 8g
Laudanum of Sydenham: 50 centigrs. (Laudanum of
Sydenham is composed of opium (2 ounces), saffron
(1 ounce), cinnamon & clove (4g each), and wine of
Malaga (500g)
Extract of jusquiamus, a narcotic poison used for its
sedative and painkilling effect: 50 centigrs.
In the case of spontaneous inflammation of the pulp,
without any known cause of injury, if the pain was
slight and of short duration, reappearing only at irregu-
lar intervals, Didier, with the means of a cotton-bud or a
matchstick, introduced every day in the hole of the tooth
a very small quantity of paste made of:
Soft turpentine of Venezia: 4g (a very energetic stimu-
lant which has a good action on mucous membranes). Figure 5
Zinc ointment or tuthie: 25g used as a tonic and for Walter Blundell’s cooling device, 1854.
its astringent effect. This medicine acts particularly Le systeme de refroidissement de Walter Blundell, 1854.
on the nervous system. Walter Blundells Kiihlgerat, 1854.
Styptic powder or alum: 2g used for its very ener- El dispositivo de refrigeracibn de Walter Blundell, 1854.
getic astringent effect, slightly escharotic.
After 2 or 3 weeks, he suggests substituting this paste
by a more drastic preparation made of:
Nitric ether: 4g which has the same properties and
use as sulphuric ether. Nitric ether was used to avoid the local lesion may be increased by the
pain, and for its anti-spasmodic effect. reaction‘ ...‘Congelation may be gradually induced with salt
Zinc sulfate: 60 centigrs. an astringent and a tonic if and shaved ice”.
used in small quantities, but a violent emetic if used In September 1854, a new system was elaborated and
in high doses. patentedl8 by Walter Blundell, a dental surgeon from
Caustic of Vienna: 50 centigrs. used for its cauteris- London. He placed salt and ice in a gutta-percha drum
ing effect. (Caustic of Vienna is composed of potash (Figure 5 ) . Being liquefied, the frigorific mixture passed
with lime and quicklime in powder. Both parts of through a tube, on which a rabbit bladder was adapted.
each are mixed in alcohol to get a soft paste). When the tap was open, the bladder was filled and the
Sang-Dragon powder, a powerful astringent effect; melting ice or cold water could be applied on the gingivae
this substance is used to get a paste as liquid as adjacent to the tooth. The degree of cold depended on
honey. the velocity with which the liquid was passed through
In April 1849, James RobinsonI6, the well known the bladder, which could be regulated by pressure on
dental surgeon, used collodion, a viscous solution of the tube. A year later, Blundell made an improvement to
pyroxylin, with morphia, and filled cavities with asbes- this apparatus (Figure 6 ) , by inserting a graduator
tos. If pulpitis was too painful, dentists had two containing hot water between the drum and the bladder.
options: the former, says C. P. FitchI7, was to amputate It was necessary to keep a steady temperature through-
nervous force and to suspend the sensibility of the part out and to return to body temperature without any
”by paralysing the periphery of the sentient and the sympa- further pain.
thetic nerves by a local anaesthetic”, and the latter was to Should the clinical picture be more serious, a third
arrest to some extent the functions of the part by option was to induce a valuable local anaesthesia,
congelation. Snow may be “applied to the part in oil silk”, asserted FitchI9. This was to be applied upon a face
but “care must be taken, however, to restore the part gradu- threatened with an abscess, and consisted of a plaster
ally to normal temperature by holding ice upon it; otherwise made of the following formula:
344 International Dental Journal (1997) Vol. 47/No.6
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Figure 6
Details of Walter Blundell’sdrum and graduator, 1855.
Etude detaillee du tambour et du graduateur de Walter
Blundell, 1855.
Zeitgenossische Instrumente von Walter Blundell, 1855.
Detalles del tambor y graduador de Walter Blundell, 1855.
Goulard’s cerate, which derives from a liquid lead
acetate. This medicine is employed as an astringent,
often used as a resolutive, soothing the pain of the
inflammation or used so as to get an indirect effect.
Extract of aconite, which is a narcotic poison, acting
on the nervous system if prepared in small quanti-
ties.
This application diminished the calibre of the capil-
lary blood vessels by contraction; the accumulated
blood would then be forced into the general venous
circulation, and thus the part would be relieved of its
congestion and pain would be suspended.
In the case of any further turgescence, the practi-
tioner could apply a leech or scarify the part thoroughly
and promote depletion by getting the patient to hold
warm water in the mouth. If there was a great pain, a
gentle cathartic could be recommended for the night. If
the symptoms were more aggravating, if pus was formed,
or if fluctation had been perceived, the best solution
was to incise at once and to open the apex of the tooth
through the alveolus. After syringing with tepid water,
a saturated solution of resublimed iodine in creosote
was used to dress the pus. A small splinter of wood,
covered with cotton whittled to a point, was dipped “in
the above solution and carried to the depth of the wound”.
Every day this dressing had to be renewed. “Then a
milder remedy, such as iodine in glycerine, vinum opii,
sulphate of aluminum’’ could be employed until the
fistula was healed. “The.. cavity of decay should be filled as
soon as all periosteal inflammation has disappeared”zQ.
In July 1859, H. N. Wadsworthzl wrote in the Ameri-
can Journal of Dental Science that chronic alveolar
abscesses were incurable. At that time, the application
of any remedy was only palliative not curative. Topical
applications of creosote, which was discovered by Range
in 1834, lancing the gingivae, opening of canals, or the
application of 10 or 12 leeches at the angle of the maxil-
lary were current treatments. It should not be forgotten
that artificial crowns with gold pivots inserted in roots
were most of the time surrounded with wood. It is easy
to imagine that this material swelled with the infiltra-
tion of saliva. Often pus travelled above the mucous
membrane and the suppuration passed through the skin,
thereby producing ugly scars. Among the different local
remedies, the most common were external fomentations
and poulticeszz. Wadsworth recommended arnica as
applicable to periostitis.
Another remedy was to drill a hole directly through
to the apex of the root, following which a gold probe
was carefully introduced through the channel formed
by the fistulous opening. After this exploration, a gold
tube was inserted in the hole, and a small piece of cotton
wool, rolled in finely pulverised nitrate of silver twisted
upon a barbed gold wire, was passed through the tube.
This gold wire was in fact the same instrument as that
used in cauterising the male urethra in gonorrhoea and
gleet. The procedure was repeated three times, at inter-
vals of three days, but invariably the abscess continued.
The tooth could be tolerably useful, but the secretion of
pus never ceased totally.
Wadsworth was not satisfied with the mechanical
killing of the pulp. He suggested giving superiority to
chemical treatments by the application of arsenic. Three
months later, in October 1859, James White23reported in
the Editorial Department of the American Journal of
Dental Sciences in which manner arsenious acid was
prepared for convenience: l g of arsenious acid was mixed
with the same quantity of sulphate of morphia. These
ingredients, thoroughly incorporated were then divided
into thirty parts. “Each of these part of powders were put
into a paper by itself and put by for use. In applying it to a
tooth, a small quantity of raw cotton is moistened in
creosote, and then placed on the arsenical powder, which it
readily absorbs. This done, the cotton is placed carefully over
the exposed pulp, and the cavity sealed”, with softened
wax. “It is permitted to remain in the tooth from 7 to 10
hours”; after this time, the practitioner removed the dress-
ing and the pulp could be extirpated
Four years later, in June 1863, C. P. FitchZ4read a
paper in front of the Brooklyn Dental Association in
which he condemned for the first time ”the practice of
destroying the nerve and subsequently filling the cavity of
decay, leaving it in the fangs to disintegrate and rot“. As a
result, devitalised products, hydrogen sulphide, and
serous fluids of pus and blood would soon form. FitchZ5

stated that practitioners had first “to remove the cause of
irritation or suspend the action of the irritant. In the second
place”, they had to “recognize the stage of the
inflammation and treat it“, and ” thirdly“ to ”medicate the
systemic lesion”.
To remove the cause of irritation, it was necessary to
open the tooth and to evacuate its contents. This could
be done with a syringe of warm or cold water and by
applying a dressing of creosote to the root canal, carry-
ing it to the apex of the tooth. “The root must be mopped
out every day, or every two days. This can be done by fasten-
ing a small portion of damp cotton on the end of a nerve
probe, passing it u p and down the root as if you were swab-
bing out a gun-barrel, continuing the operation until the
cotton ceases to be discolored ”, wrote J. D. Whitez6.
In 1864, only one year later, the treatment of pulp
cavities and root canals before filling was carefully stud-
ied by Henry Chasez7 and John Nutting Farrar2* (1839-
1913) .
Farrar recognised three cases and proposed three situ-
ations:
when the pulp is exposed and alive,
when there is an alveolar abscess,
when the pulp is dried and not followed by an ab-
scess.
According to Farrar, if the pulp is exposed and alive,
two principal formulas are placed at the dentist’s
disposal.
James White’s: Arsenious Acid: 30g
Sulphate of morphia: 20g
Creosote: q.s. To form a thick paste.
or Pierce’s: Arsenious Acid: log
Sulphate of morphia: 20g
Creosote: q.s. To form a thick paste.
The 3 components were mixed together in a mortar
for about 30 minutes. Farrar had a preference for Pierce’s
formula; he found it much better and safer.
Arsenious acid acts as a destroyer of the vitality of
the pulp, sulphate of morphia diminishes the pain by its
narcotic properties, and creosote acts as a styptic, astrin-
gent, antiseptic and escharotic. “Sometimes a preparatory
treatment is necessary, if the pulp is highly inflamed”; in
this case, a most salutary effect is produced by the
”application of morphia and creosote, or morphia and tannic
acid, and followed by the paste after the lapse of a f e w hours,
or a day or two”.
After the application of the arsenical paste, cotton
saturated with sandarac varnish, was packed into the
cavity (the sandarac preparation hardening the tempo-
rary filling). With White’s formula, good results were
obtained in 8 or 12 hours for children and 20 or 36 hours
for adults; with Pierce’s formula 10 or14 hours for chil-
dren and 24 or 48 hours for adults were reported as
required. At the expiration of the time necessary to cause
the death of the pulp, the cotton was removed, the
remaining portion of the paste washed away, and a
barbed nerve broach passed down in the canal.
If the pulp was not completely dead and the manipu-
lation accompanied with considerable pain, a small piece
of cotton impregnated with creosote was applied over
Zimmer: Nineteenth century endodontics 345
the exposed dead pulp, followed by a cotton and a
sandarac tent. The styptic, astringent and antiseptic prop-
erties of the creosote had the effect of hardening the
dead pulp, reducing any inflammation, but care had to
be taken of the lips and tongue, for creosote acts as an
escharotic on the mucous membrane. After a week or
two, the instrument could be carried to the apex of the
root and the pulp canal filled with gold. If periodontitis
or inflammation of the dental membrane was produced,
due to excessive retention of the arsenical paste, a floss-
silk saturated with creosote was claimed to rapidly
reduce the pain. If some people were particularly
susceptible to the action of creosote, this product was
superseded with nitrate, scarifying of the gums, and
application of one or two Spanish leeches.
Method of filling root canals
After dressing out the canal with cotton, floss-silk or
tissue paper, the method consisted of pressing down a
pellet of ’stopping’; this stopping consisted of gold,
cotton, or asbestos, first saturated with creosote. A
cotton plug, and in some cases gold, was properly
applied on the foramen. Canals were filled with gold,
taking care to fill every portion tight and solid with a
mallet and serrated instruments. If the metal could not
be placed in some abnormal posterior canals, very small
balls of creosoted cotton were placed into the cavity and
the main canal filled with gold.
When there was an alveolar abscess our predecessors
applied the so called ’absolute cleanliness plan‘. Accord-
ing to Farrar, the escape of the pus could be eased either
by the lancet or by the application of a roasted fig or
raisin to the gum over the point where it was most likely
to open. Sometimes the tincture of capsicum applied to
the gum was of great benefit. Opium and anodynes were
used with the view of quieting the pain. Chasezq
proposed to thoroughly “syringe out“ the roots “with
tepid water, succeeded by alcohol, and, before plugging, to
wipe with creosote and tannin. In the case of the under
teeth as the force of gravity would be likely to bring portions
of the decomposed vessels through the roots and there set up
periostitis”, he proceeded differently. As soon as the pulp
was removed, if the root canals could not be really evacu-
ated, he saturated the contents with creosote and tannin;
at the end of a week he syringed them thoroughly with
alcohol and saturated them again with tincture of
iodine. At the expiration of another week, he syringed
again with alcohol, wiped with creosote and tannin and
immediately plugged with metal. Chase suggested
sucking out the decomposed vessels with “a small, but
powerful suction pump or syringe made of different shaped
nozzles or points, to which soft rubber should be adapted in
such manner as to make the cavity to which it might be
applied nearly air-tight”. Farrar30 recommended syring-
ing the canal with creosote or aromatic acid, an
alcoholic solution also called elixir of vitriol, to cauter-
ise the inside of the sac. Care had to be taken to avoid
getting any of this solution on the mucous membrane of
346 International Dental Journal (1997) Vol. 47/No.6
Figure 7
John Nutting Farrar’s syringe.
La seringue de John Nutting Farrar.
John Nutting Farrars Spritze.
La jeringa de John Nutting Farrar.
the mouth. The syringe, invented by Farrar (Figure 7), is
a nickel plated hypodermic syringe. Its nozzle can be
bent and each revolution of the thumb-screw, turned by
an assistant, injects one drop of liquid through the
nozzle.
If the abscess had no fistula, the dentist had to pass
through the gingival and periodontal tissues with a small
drill opposite the apex of the tooth; creosote could be
forced into the abscess through the hole by means of a
small piston or by a broach covered with floss-silk satu-
rated with this agent. If the practitioner makes some
rotations, until blood shows, with a small instrument
passed into the abscess through the fistula or the canal,
he may break or lacerate the s a P . Some practitioners
mixed creosote and tincture of iodine in equal parts.
Sometimes the abscess was cauterised by passing a
silver wire, dipped first into nitric acid. This method,
forming nitrate of silver, was elaborated by Bucking-
ham. According to Farrar, Atkinson mentioned that the
abscess cavity would slowly harden into a fibro-
cartilaginous substance gradually becoming ossified.
The advice for when the pulp had died but had not
been followed by formation of an abscess, was that,
after cleaning the canal thoroughly, the dentist had to
pack it with floss-silk and creosote and to put over that
a sandarac and cotton plug. After several hours, or even
days, the antiseptic pellet as described could be placed
at the foramen and the canal packed with gold until it is
filled.
Two varieties of creosote were considered:
the pure wood creosote, a non-escharotic form, was
used for exposed pulps and sometimes for the later
stages of alveolar abscesses, where tissues were not
to be destroyed.
the second variety, the escharotic form, was used for
general treatment of alveolar abscesses. A few
people did not allow the use of creosote because of
the pain and sometimes swelling which resulted from
it. For them, salicylic acid, sulphuric acid or
Labarraque’s solution could be employed.
During the same period, (1864-70), Homer Judd
spoke in clear terms on the histology and pathology of
chronic abscesses, and in 1873, Louis from
Philadelphia, C.E. Francis33 from New-York, and Thos.
C. S t e l l ~ a g e nread
~ ~ papers on the treatment of exposed
dental pulps.
In November 1877, Farrar35 made an accurate
analysis of the necroses of bones. He enumerated three
varieties of dead bones and experimented with the chemi-
cal action of different commercial sulphuric acids, to
ascertain the difference of the action of the acid upon
bones at different periods. His conclusions were:
a simple abscess unaccompanied with necrosis should
be treated with an antiseptic treatment such as
creosote,
necrosis without the involvement of teeth indicates
an aqueous solution of sulphuric acid,
necrosis with the involvement of teeth, indicates an
aromatic sulphuric acid; it will stimulate the sur-
rounding living tissues to a healthier condition and
hasten the natural process of decomposition.
In 1893, Emil SchreieP of Vienna suggested using
sodium and potassium in metallic form (2 part of
sodium, 1 part of potassium) prepared in such a manner
that it would stick sufficiently to a barbed nerve broach.
After placing rubber for protection, the nerve broach
was inserted into the canal; the matter and the decom-
position products of albumen which existed in the
putrescent mass coming in contact with the sodium and
potassium, forming potassium and sodium hydroxides
which in combination with the fat substances of the
pulp resulted in the formation of soap. Destruction of
the organic contents of these canals occurred by saponi-
fication, changing “the characteristic gangrenous odor into
a well-marked soapy After that, Schreier washed
the canals with water or with a weak solution of
carbolic acid and water; the final cleansing of the root-
canal was completed on a second appointment three
days later, the cavity being meanwhile closed with wax.
A year later, in 1894, Cassidy3*from Covington, called
attention to a preparation made by Schering from
Berlin, known as formalin. Formalin being an aqueous
solution of formaldehyde, the aldehyde of methyl
alcohol. Cassidy experimented with this agent as Miller
from Berlin had challenged him to find something to
sterilise the inaccessible portions of root-canals.
In 1906, J. P. Buckley introduced f o r m o ~ r e s o l ~ ~ .
Chloro-percha ,gutta-percha, gold or tin foils ( S.S.White
N”4) were used to fill the canals, and after 1906, M. I.
Schamberg40 from Philadelphia, suggested using X-rays
to make an accurate diagnosis of alveolar abscesses.
Conclusion
Better local anaesthetic agents, the introduction of anti-
biotics, and more recently digital imaging systems, give
the practising endodontists of the 20th century valuable
tools. Root fillings can now be carefully scrutinised and
the percentage of infections greatly reduced. Despite
these advances, the identification of the source of
persistent infection, canal irrigation, and the failure of
root canal fillings due to micro-organism contamination
and irritation still remain as much the concern of
today‘s practitioners as they did for their 19th century
predecessors.
 Zirnmer: Nineteenth century endodontics 347

Acknowledgements author expresses his gratitude to Prof. Danielle

Gourevitch, Ecole Pratique des Hautes Etudes, IV““‘ sec-
This article was presented at the meeting of the FDI’s tion, Sorbonne, Paris. Her teaching methods are highly
Section of the History of Dentistry, 84th Annual World appreciated. Special thanks to Prof. Ertugrul Sabah, Ege
Dental Congress on September 29, 1996 in Orlando. The University, Izmir, for encouragement in this study.

Les concepts thkrapeutiques en endodontie au dix neuvikme sikcle

RCsumC
S’intkresser a l’histoire de la dentisterie n’a pour seul but de mieux connaitre ceux qui fonderent la
dentisterie moderne mais egalement de fournir 2 la generation actuelle de praticiens des informations
detaillees et d u savoir faire bases sur une connaissance approfondie des anciens ecrits dentaires. Cet
article passe en revue les techniques utilisees au cours du siecle dernier, dans des cas d’abces de
l’alvkole et les traitements effectues sur les cavites pulpaires et les canaux avant obturation. Les
sources historiques prouvent combien l’evolution de notre profession depend de la connaissance
scientifique et du developpement des techniques. Dans le passe, on ne comprenait pas la genese des
infections radiculaires comme on la comprend de nos jours. En etudiant les vieux textes de medecine,
les historiens peuvent contribuer l’kvolution scientifique. En effet, les ecrits anciens nous permettent
d’entreprendre de nouvelles recherches ; ils servent a mieux comprendre et a resoudre a la longue
certaines de nos Cnigmes medicales. Tout comme les agriculteurs semant et plantant sans cesse des
varietes oubliees de fruits et de legumes, nous sommes nous aussi amen& a nous pencher dans notre
therapie sur des medicaments oublies.

Therapeutische Konzepte in der endodontischen Behandlung des 19. Jahrhunderts

Zusammenfassung
Das Interesse fur die Geschichte der Zahnheilkunde hat nicht nur dazu beigetragen, das Verdienst der
Begriinder der modernen Zahnheilkunde und deren Errungenschaften schatzen zu lernen. Vor allem
bedeutet es, daiJ sich der heute praktizierende Zahnarzt - basierend auf Fakten aus alten medizini-
schen Schriften - fundierte praktisch-theoretische Kenntnisse aneignen kann. Der vorliegende Beitrag
beschreibt die im letzten Jahrhundert ubliche Behandlung von Alveolarabszessen, Pulpakavitaten und
Wurzelkanalen vor der Kavitatenversorgung. Historische Fakten zeigen, wie sehr die Entwicklung des
Zahnarztberufs vom wissenschaftlich-methodologischenFortschritt abhangt. So war im vorigen Jahr-
hundert eine andere Auffassung hinsichtlich der Ursachen von Wurzelinfektionen vorherrschend als
heute. Mit der Analyse alter medizinischer Schriften leisten Historiker einen Beitrag zu der
Wissenschaftsentwicklung. Alte Schriften regen neue Forschungstatigkeit an. Ein weiterer Nutzen
ergibt sich aus dem Verstandnis bzw. der Auflosung heutiger medizinischer Ratsel. So wie der Bauer
immer wieder auf alte Frucht- und Gemusesorten anbaut, so konnen wir nicht umhin zu erkennen,
daB in Vergessenheit geratene Arzneimittel ihren Platz in der modernen zahnarztlichen Therapie
haben.

Conceptos terapCuticos del tratamiento de endodoncia en el siglo diecinueve

Resumen
El inter& en la historia de la odontologia no solo ayuda a desarrollar un mayor aprecio por 10s
fundadores de la odontologia moderna, sin0 que ademas permite que la generacidn actual de
odontologos cuente con recuerdos detallados y un savoire-faire fundados en un conocimiento acabado
de 10s escritos medicos antiguos. Este articulo examina las tecnicas disponibles durante el siglo pasado
en caso de un absceso alveolar y el tratamiento de la cavidad pulpar y de 10s conductos radiculares
antes de la obturaci6n. Los antecedentes historicos demuestran que la evolucion de nuestra profesion
depende en gran parte del conocimiento cientifico y del avance en las tecnicas. En el pasado las
348 International Dental Journal (1 997) Vol. 47/No.6

condiciones de infecci6n radicular no se entendian en 10s terminos actuales. Con el an6lisis de 10s
textos medicos antiguos 10s historiadores pueden contribuir a la evoluci6n cientifica. En efecto, 10s
escritos antiguos nos permiten emprender nuevas investigaciones y constituyen una ayuda invaluable
para comprender y finalmente resolver algunos de 10s enigmas medicos. A1 igual que 10s agricultores,
que siembran y plantan variedades olvidadas de frutas y vegetales, tenemos la obligacibn de conside-
rar el us0 de fkrmacos olvidados en nuestras terapias.

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Correspondence to: Dr. Marguerite Zimmer, 55, Rue de SClestat, 67100 Strasbourg, France.