A Period Fairy Tale (of a dental nature)

[Mission]

I was entering my notes from Matthias Gottfried Purmann's excellent period book Chirurgia curiosa and I came across this lovely fairy tale of a prince, a princess, a team of surgeons and a dental fistula. So I thought I'd share it. It even has a moral, like all good fairy tales do. (Sort of.) [Note, I have preserved the period grammar and spelling for you enjoyment.]

“August the Seventh 1693. a Great Princess with the Prince her Husband, came to Breslaw out of Austria, who had a Fistula in the Lower Part of the Right Side of her Neck, which gave her Intolerable Pain. The bottom of this Fistula was near the furthermost Teeth, and the Orifice about half a Hand’s Breadth toward the Mouth, the Cavity was so crooked, bending upwards towards the Teeth, that a Probe could reach no farther than about a Thumb’s Breadth into the Fistula, which caused the Matter to continue longer there, and the Putrifaction to be greater. Towards the Ear it was sometimes extremely Swelled and Inflamed, and gave the Princess a great deal of Pain, who was otherwise in very good Health, and at that time about Twenty-eight Years of Age. Great Diligence had been already used to cure it, by the Advice of the most Learned Physicians and Chirurgeons sent for from several Places, who agreeing, That the Tooth over the Fistula ought to be drawn

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out; a very expert Tooth-Drawer at Ulm, was the Operator; but it happened so unfortunately, that the Crown, or Head of the Tooth broke off, and the Stump remained behind. Upon this unhappy Accident the Fistula grew every Day worse and worse, so that her Highness resolved to go to Breslaw, where she arrived the Seventeenth of July in the Evening, and brought with her that Famous Chirurgeon and Burgermaster of Prague, Mr. Christian Schutzbredt, and immediately sent for me and Dr. Tralles; but we could do nothing that Evening, but only search the Fistula, and apply Dr. Fabricius’s Plaister, which was sent her Highness from Nurenberg.

July the Twentieth we all met in the Princely Court Oelsse, Dr. Agricola first search’d which way the Fistula went. Afterwards Mr. Schutzbredt and my self search’d it with a Probe, but could not reach so far as the Tooth, tho’ at that time there was no Inflammation or Swelling, and nothing came out of the Outward Orifice but Two or Three Drops of Matter at a time. The Pus was also well digested, nor was there an ill Smell from the broken Tooth, and the Gums thereabouts vvere in good Order. Upon vvhich, others as vvell as Dr. Agricola, were of Opinion, That the Fistula did not reach the broken Tooth, but time taught us better, for tho’ I kept it open above three Weeks with a convenient Tent [folded bandage inserted into the wound], took away the Spongy Flesh, seringed it often, and blew into it the Powder prescribed in the Fistula Lachrymalis, insomuch that every thing seemed to heal, and that on the Twenty fifth of August the Fistula was quite closed up, and remained so till the Eleventh of September following.

Yet on the Twelfth, about Ten a Clock in the Morning, the Princess found great Pain in the Tooth again, and an Extension and Swelling toward the Ear; which Symptoms increased towards the Evening, because the Princess vvent that Day to Great Peterwitz, and had taken no Medicines vvith her to apply to it. In the Night it grew so painful, that she was forced to return back in the Morning. Then I perceived a great Swelling and Inflammation towards the Ear, and in the Inside of the Mouth about the Teeth; to which I immediately applied Internal and External Remedies, and upon the Ear and Cheek a proper Cataplasm. But on the Fourteenth of September it again possessed all the same Places where the Fistula was, which opened in the Afternoon, and let out half a Spoonful of well concocted Quitter, and it continued Running very fast till the Twenty first in the same Month; then the Matter decreased, the Wound was so well closed, that the smallest Tent could no enter it, and the Fistula healed up again the same Week, to our great Admiration. No Arguments could prevail with this Princess to suffer the stump to be drawn, though her Highness was daily told she must never expect a perfect Cure till the Tooth was out. October the Fourteenth all the former Symptoms unexpected broke out again, and gave us opportunity to shew the Princess her Danger and continual Affliction, unless she would consent to have the Stump drawn; but she persisted in her Obstinancy, and said she would not consent to it whatever she suffered.

However, we sent again for Mr. Schutzbredt, and prevailed with her Highness to send for Two more Chirurgeons from Vienna, in hopes that

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the concurring Opinions of so many in the same thing, might induce her Highness to comply with her own Advantage. This being done, in Twelve days came Mr. Bernard Norbert of Zeidler, Chief Chirurgeon to the Emperor, and with him Mr. Bouchard, Chirurgeon of Vienna, Mr. Schutzbredt came the Day before; who with Dr. Tralles and Agricola all unanimously agreed, That the Stump of the Tooth ought to be pulled out, the Place Cauterized where the Bone was Rotten, and then we should proceed to the Cure of the Fistula. This Agreement was the same Evening related and proposed to her Highness, who after discovering some faint Unwillingness, courageously resolved it should be done, and accordingly was performed by Mr Adam Plahue a Tooth-Drawer in Breslaw, who, after two violent Onsets, not without giving the Princess great Pain, brought it out. We suffered it to bleed a while, to give the Lady time to recover her self. After her Highness was a little composed, I searched the matter very diligently, and twice Cauterized the Jaw-bone with a Hot Iron made for the purpose. Three Days after the Chirurgeons all returned to their respective Homes, and in Three Weeks time I so perfectly cured the Fistula, that her Highness has never been troubled with the least sign of it since. Hence you may see how absolutely necessary it is, that the Teeth should be drawn in these kind of Fistula’s, which I would have done at first if I had been left to my own Liberty; but in such great Persons one dares not act alone what he thinks he ought to do; which gave these Great Chirurgeons, all my Intimate Friends and Acquaintance, the Trouble of coming from Vienna and Prague to Breslaw.” (Purrman, p. 104-6)

[William Brand]

That is an awesome, very detailed account, and having known a great infection in my jaw from a tooth that cracked at the roots, I empathize with her Majesty.

[Mission]

It is one of the more interesting ones about dentistry. (Dentistry is often treated like the step-child of surgery although you can imagine how important it must have been on long voyages.) I thought it was funny because it was about a Princess. Disney should definitely consider making this one.

[Littleneckhalfshell]

Mission, are you so in awe of this account that you are stuttering whole paragraphs? Or was it the concept of Disney doing a Princess movie involving Dentistry?

(you posted the same three sentences twice)

[Mission]

Hmm. The web was hiccuping and not posting my entry. I even checked it in a separate tab with no joy before hitting the post key again.

[Littleneckhalfshell]

ahh, it looks ok now, how odd, there is no note that you edited it, as usually happens when I go back and correct me spelling ;-)

[Mission]

The one benefit of being an admin is that the edit line doesn't appear for some reason.

Here is another one, not quite as fairy tail-ish, but along similar lines, I think. I am adding some paragraph breaks to make it a bit more digestible.

“The Son of a Great Nobleman De la Genevrage, was push’d into the Breast with a Sword on the right Side, between the Fourth and Fifth Rib counting downward. When I cam to the Patient I soon perceived by the shortness of his Breath and clear Blood running out of the Wound, that it had penetrated his Breast; for whensoever the Lungs are wounded, difficulty of Breathing and Tratling in the Throat do always accompany it, the Blood comes foaming out of the Mouth, and that which issues out of the Wound is of a Fine Crimson Colour. In the first three days there came out two Pounds of Blood, and two days after at every Dressing about two Ounces of a very viscous Red and thick Moisture, which congealed as soon as received into the Porringer [dish for collecting blood.]

However, this plentiful evacuation could not prevent a Fever [letting blood was thought to relieve fevers], which seized Him on the Sixth day, and continued with great violence till the Fourteenth, attended with a Cough which increased every day, and was a dangerous symptom. The Tent [folded bandage] came out of the Wound very Black, and yet there was no sign at all of any corruption in the Cavity of the Breast. The Fifteenth day the Cough abated. The Seventeenth a Substance partly Fleshy partly Membranous but very rotten came out of the Wound, with above three Ounces of bloody coagulated Matter, after which the Tent never look’d black again as before. The Eighteenth, Nature cast out another piece of a Fleshy substance, and as much matter as the day before, to the great Ease of the Patient, but this Evacuation not succeeding on the Nineteenth day, the Patient was taken with a very great cold and shivering, and after that with a Hot fit of a Fever, which abated the next day towards the Evening, but presently after such another fit seized him worse than the first, tho’ the Fit was not so violent and intermixed with some gentle breathing Sweats.

These Paroxisms tho; they are commonly the Signs of a returning Fever, yet all the Physicians thought they proceeded from some latent Sanies in the Cavity of the Thorax, so that at their desire, tho’ contrary to my own Intentions, I was forced to make a Paracentesis, or opening into the Chest, upon which followed some drops of Blood with a kind of blowing and a steam; Now after they had seen this, and found the Operation was to no purpose, they desired it might be healed up again. Two days after this Operation, there came out of the old Wound a small piece of

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a putrified Membrane, and more than half a pound of stinking Matter, which continued flowing more or less every day, sometimes white and other times blackish; but this brought the Patient into a Consumption.

Afterward the Wound turn’d to a Fistula, and the Patient was forced to wear a Pipe cover’d with Emplaistr. Andreæ á Cruce two year together. However, all this time the Patient kept a good Dyet, lived very temperately, and by the constant use of Womens Milk, the Wounds were healed, and the Patient so perfectly recovered, that afterwards he used all the Exercises of a Fencing School, which requires good Strength and Activity of Body; he Married, begot several Children, and lives in good Health, tho every one Thought him in a Consumption before he was wounded. This Observation I thought fit to insert in this Place, to let you understand how such Patients may sometimes be cured, contrary to all Opinions and Expectations; to the end that the Chirurgion may not despair, but use all possible endeavours for the Recovery of his Patient.” (Purrman, p. 129-30)

[William Brand]

"This Observation I thought fit to insert in this Place, to let you understand how such Patients may sometimes be cured, contrary to all Opinions and Expectations; to the end that the Chirurgion may not despair, but use all possible endeavours for the Recovery of his Patient.”

That's a great line and a good addendum to the narrative. I would love to have a modern doctor interpret these very visual explanations and symptoms.

[Mission]

I actually understand almost all of it, but then I've been reading these things for year and I tend to forget not everyone will immediately understand the words.

Here's a couple that may give you trouble:

Fistula - an abnormal connection between two places

Emplaistr. - Plaster (medicine)

Consumption - wasting away of the body

What else doesn't make sense? (I will not translate medicines unless you REALLY want me to. They're all in misspelled Latin and are a right pain in the arse to figure out. Plus no sane person would want to recreate them as they didn't work for the most part.)

[William Brand]

No, I mean the internal and more specific activities of the body that are happening in addition to the narrative. I would love to have a modern surgeon agree or disagree with the flow of symptoms and the procedures. See what a pathologist would make of the information as it was described.

[Mission]

Oh. I dunno. You'd have to find a doctor who wanted to read through all that.

Medicine was sort of on the cusp between doggedly following ancient medical treatments (those recommended by Hippocrates and his followers) and actual treatment by the scientific principle of treating and recording what worked and what didn't. Purrman actually holds forth for a page or more on how the idea of suppuration in a wound was not really a good thing. [suppuration is the formation of pus.] Ancient medicine believed suppuration was a sign that the bad humors were being released and so recommended encouraging the formation of pus in wounds by keeping them open. Of course we now know that pus was a sign of infection. Over the next hundred years, medicine made progress unlike what had been seen in two thousand years previous to it.

[Mission]

Ah, this is sort of fun. An account about a "Person of great Quality." The fun part is about midway through, IMO. Note that it was typical to have several surgeons consult on such people - as the previous examples also indicate.

“In July 1692, I had a Person of great Quality in Cure, who was afflicted with such Oedematous [fluid filled] Legs, mightily swelled, and besides the Patient was sixty two years of Age, when Dr. Tielisch, Dr. Peruse, and my self, were sent for. I first applied the following Plaister, and rolled the Legs very well with a Linen Bandage.

Rx. Empl. de Ran, cum Mercur. Diaphoret Myns ana {uncia}x. Diasulphur. Ruland. (uncial}vj Succin. tartar albiss. ana {uncial}ij. Malax. Cum s. q. Ol. Laterin. ad Emplastrum. [uncias were the ancient measurement for an ounce, so I am guessing this is an old recipe.]

Now, tho this Plaister made the Legs sweat very well, and something abated the Swelling, yet , seeing it would be a tedious piece of Work, we applyed Goats Piss and Sheeps Dung to the Legs, eight Days together, which succeeded very well, but since it made the Room nasty, and the Patient was obliged to receive many Visitants, we left it off and applyed the following Formentation round the Legs, with double Linen Cloaths moistened in it.

Rx. Herb Cochlear. Theæ, Trasol. Aquat. Sabin Cicut ana Miss Rad. Bryon Ebul. ana {ounce}jss. Summit. Absinth. Rutæ rec. ana mj Sal. Tartar. Ammo nana {dram}iij. Nitri {dram}ijss cum. s. q Spirit Vini & Urin. Oven coquantur s. a postea Cola. VVhich succeeded so well, that in a Month’s time the Patient was perfectly cured.” (Purrman, p. 194)

I'll bet it made the room nasty at that! Those People of Quality are so picky about their remedies...

[Littleneckhalfshell]

"in a month's time the Patient was perfectly cured" was it due to the ministrations of those attending him? or would it have been cured if he had just been left alone? Maybe the body said to itself, 'If we are to be delivered from this stench, we must bring things back on an even keel'

on a more serious note: anything in that concoction that remotely sounds like it might help with leg swelling? more and more I am convinced that even modern medicine is more art than science, and that is just why they 'practice' medicine, because hopefully 'practice makes perfect' ???

[Mission]

Considering that the plaster has Mercury in it (apparently being used as a diuretic), I suspect you want to steer clear of this remedy.

Every medical writer from period that i have read seems to have a different script for the same disease, so I seriously doubt their medicines were (for the most part) anything notable. (They frequently disparage each other's recommendations in their books. Purmann holds forth for almost a page on how rotten various other surgeon's suggestions and 'receipts' were for curing Syphilis were. The joke was on him; none of their medicines worked. Syphilis naturally goes into remission between the second and third stages.) Modern medicine may be more of an art than a science, but we do use the scientific method to test it, where these surgeons were basically just guessing and repeating things other surgeons and physicians said would work.