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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

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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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