The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine

by Thomas Morris

  THE MAN WHO FOUGHT A DUEL IN HIS SLEEP

  If you’ve ever shared a house with a habitual sleepwalker, you may be familiar with the strange experience of having a conversation at 2 A.M. with somebody who is fast asleep. One of my sisters went through a sleepwalking phase in childhood, and we soon became used to guiding her back to her bedroom, while saving the weirdest of her utterances for gleeful quotation at breakfast the next morning.

  But as somnambulists go, it turns out that she was a mere amateur. In 1816, a London medical journal told the story of a Dutch student identified only as Mr. D.:

  In 1801, young Mr. D. went to stay as a paying guest at the home of the Reverend Mr. H., a respectable priest with a young family. On his arrival he warned his hosts that he sometimes walked in his sleep; they were not to be alarmed if he did so. A few nights later the clergyman was woken by an unusual noise, and went downstairs to investigate:

  I found Mr D. in his sleep taking down some of his books, which had been sent him by his parents. I stayed in the room some time, not choosing to wake him on the sudden. On further examination, I perceived he was employed in making a catalogue of them quite in the dark, and with as much precision as I could have done with a light; making no mistakes with regard to the titles of the books, the names of their authors, their respective editions, and where they were printed. On letting one of the books fall, the noise appeared to have startled him, and he hastily retired to bed.

  The next morning, the young man had no memory of the incident. He was capable of surprisingly elaborate tasks while asleep: He played chess and cards, and once wrote a letter to his professors—in Latin.

  At another time, when he was to deliver a Latin oration in public, we heard him in his somnambulant state rehearse it aloud, as though the curators of the school were present; and as he was feeling for the desk to lay his thesis upon, Mr H. stooping a little before him, he laid it upon his neck, supposing it to be the rostrum. When he had finished his oration, he bowed to the audience and to the curators, as if present, and then retired.

  On another occasion after he had gone to bed, the landlord’s daughter began to play the piano. Mr. D. arrived in the room with a score, pointed to a favorite piece and placed it on the music stand for her to play. When she had done so, Mr. D. and the family all applauded. He then left the room hurriedly, having apparently just woken up and realized that he was undressed.* For the most part, his behavior when asleep was calm and rational, although there was one notable occasion when this was not the case:

  He supposed one night that he must fight a duel with one of his former fellow-students at Utrecht, and asked Mr H. to be his second; the hour was fixed, the ground measured, and when the signal was given, down fell Mr D. as mortally wounded, and requested to be put to bed, and a surgeon to be sent for immediately. As a surgeon of our acquaintance desired to see him in his somnambulant state, we sent for him. When he asked Mr D. where he was wounded, he put his hand to his left side, saying “here, here—here is the ball.” “I am come to extract it,” said the surgeon; “but before I begin the operation, you must take some of these drops which I have brought with me.” After that, making some great pressure upon the side where Mr D. said he was wounded, the surgeon said the ball was out. Mr D. felt at his side— “so it is,” he said; “I thank you for your skilful operation. Is my antagonist dead?” he asked; and when they told him he was living, joy beamed in his countenance; and it appeared as if that joy awakened him.

  Quite a yarn. The editor of The London Medical Repository evidently feared it might be thought a bit too good, since he appended to it this wry little footnote:

  This letter was put into our hands by a practitioner of great respectability, with the assurance that he could vouch for the authenticity of the facts it details, being personally acquainted with the writer, who is a clergyman in Holland of high character and undoubted veracity. The facts are of so very singular a description, that, notwithstanding the source from which they proceed, we conceive it proper to give them to our readers accompanied by this testimony: we leave them to the degree of credence to which they may be considered entitled.

  Quite.

  THE MYSTERY OF THE EXPLODING TEETH

  This engaging little mystery first appeared in the pages of Dental Cosmos—the first American scholarly journal for dentists, founded in 1859. I love the title; imagine going into your local store and asking for “a pint of milk and Dental Cosmos, please.” In one of its early issues, W. H. Atkinson, a dentist from Pennsylvania, wrote to the journal to report three strange and similar cases that he had encountered over a period of forty years in practice.

  The first of his subjects was the Reverend D.A., who lived in Springfield in Mercer County, Pennsylvania. In the summer of 1817, he suddenly developed an excruciating toothache.

  At nine o’clock a.m. of August 31st, the right superior canine or first bicuspid commenced aching, increasing in intensity to such a degree as to set him wild. During his agonies he ran about here and there, in the vain endeavor to obtain some respite; at one time boring his head on the ground like an enraged animal, at another poking it under the corner of the fence, and again going to the spring and plunging his head to the bottom in the cold water; which so alarmed his family that they led him to the cabin and did all in their power to compose him.

  This is not terribly dignified behavior for a clergyman. That toothache must have hurt a lot.

  But all proved unavailing till at nine o’clock the next morning, as he was walking the floor in wild delirium, all at once a sharp crack, like a pistol shot, bursting his tooth to fragments, gave him instant relief. At this moment he turned to his wife, and said, “My pain is all gone.”

  To be fair, so was his tooth.

  He went to bed, and slept soundly all that day and most of the succeeding night; after which he was rational and well. He is living at this present time, and has vivid recollection of the distressing incident.

  The second case took place thirteen years later; the sufferer this time was a Mrs. Letitia D., from Mercer County in Pennsylvania:

  This case cannot be so clearly or fully traced as case first, but was much like it, terminating by bursting with report, giving immediate relief. The tooth subsequently crumbled to pieces; it was a superior molar.

  A final example occurred in 1855, also in Mercer County (was it something in the water?), the victim a Mrs. Anna P.A.:

  This had a simple antero-posterior split, caused by the intense pain and pressure of the inflamed pulp. A sudden, sharp report, and instant relief, as in the other cases, occurred in the left superior canine. She is living and healthy, the mother of a family of fine girls.

  Though it’s good to know that she’s well and has a family, I doubt many readers would have been expecting a minor dental incident to be life-threatening.

  Dr. Atkinson’s report seems to have presaged a mini epidemic of detonating dentine, as a number of similar cases came to light over the next couple of decades. In a book published in 1874, Pathology and Therapeutics of Dentistry, J. Phelps Hibler described one particularly striking example. His patient was a woman whose tooth was aching so badly that she felt she was losing her wits:

  All of a sudden the raving pains eased up greatly; having been walking the floor for several hours, she sat down a moment or two to take some rest. She averred that she had all her senses unimpaired from the moment aching ceased; all at once without any symptom other than the previous severe aching, the tooth, a right lower first molar, burst with a concussion and report that well-nigh knocked her over.

  The tooth was split through from top to bottom, the impact of the explosion “rendering her quite deaf for a considerable length of time.” It was as if a firecracker had gone off inside her mouth.

  If we are to believe such accounts, these were quite dramatic explosions. So what might have caused them? In his original article, Dr. Atkinson suggested
that a substance that he called “free caloric” was building up inside the tooth and causing a dramatic increase of pressure. This hypothesis can be ruled out straight away, since it relies on an obsolete scientific theory. For many years, heat was believed to consist of a fluid called caloric, which was self-repelling—although this would make a pressure increase plausible, we now know that no such fluid exists. J. Phelps Hibler had a different idea: He believed that caries (tooth decay) inside the dental pulp generated flammable gases that eventually exploded. But this is no more plausible, since we now know that caries is a process that starts on the outside of the tooth, not its interior.

  Several other theories have since been proposed and rejected, ranging from the chemicals used in early fillings to a buildup of electrical charge. The most likely explanation seems to be that the patients were exaggerating symptoms that were far more mundane. Teeth do sometimes split if you bite into something hard, and the noise it makes can seem quite dramatic if it’s inside your own jaw. But even this fails to explain the “audible report” claimed by several witnesses; like the fate of the Mary Celeste, or the identity of Jack the Ripper, all remains shrouded in obscurity. For now, at least, it seems that the mystery of the exploding teeth will remain unsolved.

  THE WOMAN WHO PEED THROUGH HER NOSE

  Dr. Salmon Augustus Arnold, an obscure general practitioner from Providence, Rhode Island, has not left much of a mark on history. He does have one claim to immortality, however: a perplexing report that he provided for The New England Journal of Medicine and Surgery in 1825. It reads like a Rabelaisian version of The Exorcist, complete with horrifying plot twists and inexplicable bodily fluids. Dr. Arnold believed he had identified a rare illness new to science, which he called paruria erratica—a Latin phrase meaning “wandering disorder of urination.” A strange name, but curiously apt:

  Maria Burton, aged 27 years, of sound constitution, generally enjoyed good health until June 1820, when she was afflicted with a suppression of the catamenia accompanied with haemoptysis.

  Translated into English: She had missed her period and was spitting blood.

  The physicians in attendance, irregular practitioners, bled her profusely every other day, and after the system had become greatly debilitated, injudiciously administered emetics, the operation of the last of which was succeeded by a prolapsus uteri, and a total inability to perform the function of urinary secretion. In this state she continued for nearly two years and a half without any alleviation of the disease, though for the most part of the time under the care of respectable physicians.

  A prolapsed uterus occurs when the muscles and ligaments holding it in position in the abdomen weaken and stretch. The organ then slips down into the vagina. A common complication of the condition is a prolapsed bladder, causing inability to urinate, which is clearly what had happened in this case. It was now necessary to insert a catheter into her bladder once a day to draw off the urine. This is where things started to turn very . . . weird.

  In September 1822, soon after I first saw her, the urine not having been drawn off by the catheter for seventy-two hours, found an outlet by the right ear, oozing drop by drop, and continued for several hours after the bladder had been emptied. The next day at five o’clock pm it again commenced and continued about as long as on the day preceding, but a larger quantity was discharged. This was thrown on to a heated shovel, and gave out the odor so peculiar to urine, indicating the presence of urea.

  The “heated shovel test” is inexplicably no longer a part of conventional diagnostic practice. The discharge of urine from the ears continued, becoming more frequent each day. It was, reports Dr. Arnold,

  increasing gradually in quantity, and being discharged in less time, until a pint was discharged in fifteen minutes in a stream about the size of a crow quill; then becoming more irregular, being discharged every few hours, and increasing in quantity, until eighty ounces were discharged in twenty-four hours.

  That’s four pints, more than the average person urinates in a day. New symptoms then appeared: She started to suffer from spasms and “swooning.” At times she would laugh, sing and talk incoherently, though “frequently with an unusual degree of wit and humor”; at others she remained catatonic for up to twelve hours. And worse was to come.

  The sight of the right eye was soon destroyed, and frequently that of the left was so impaired that she could not distinguish any object across the room, but the latter is now entirely restored. The hearing of the right ear is so much impaired that she cannot distinguish sounds, and there is a constant confused noise heard by her like the roaring of a distant waterfall.

  Strangely, this imaginary waterfall soon turned into the real thing:

  The next outlet the urine found was by the left ear, a few moments previous to which discharge, a similar noise is heard to that noticed in the right ear: she cannot hear distinctly for ten or fifteen minutes previously, and after the urine passes off. Soon after the discharge from the left ear, the urine found another outlet by the left eye, which commenced weeping in the morning and continued for several hours, producing considerable inflammation.

  Look, this is getting ridiculous. But wait, there’s more.

  On the 10th of March, 1823, urine began to be discharged in great quantities from the stomach, unmixed with its contents. On the 21st of April, the right breast became tense and swollen, with considerable pain, and evidently contained a fluid, a few drops of which oozed from the nipple. Urine has been discharged occasionally from the left breast.

  So far, we have urine coming from both ears, both eyes, the stomach and both breasts. There can’t be any more orifices left, surely? There can:

  May 10th, 1823: the abdomen about the hypogastric and umbilical region became violently and spasmodically contracted into hard bunches, and a sharp pain was felt shooting up from the bladder to the umbilicus, around which there was a severe twisting pain; in a few days subsequently a loud noise was heard, similar to that produced by drawing a cork from a bottle, and immediately afterwards urine spirted out from the navel, as from a fountain.

  The poor woman’s experience sounds pretty ghastly, but you have to admit that a fountain of urine gushing from her navel must have been quite a sight. Incredibly, the pièce de résistance was yet to come:

  Nature wearied in her irregularities, made her last effort, which completed the phenomena of this case, and established a discharge of urine from the nose. This discharge commenced on the 30th of July, 1823, oozing in the morning guttatim* and increasing in quantity every day until it ran off in a considerable stream.

  Was the liquid really urine? Dr. Arnold sent several samples to a professor of chemistry, who analyzed them and confirmed that they contained a high proportion of urea, an organic waste product found in normal urine. The next obvious question: Was this phenomenon genuine, or was the woman faking it somehow?

  To remove every doubt, I and my friend Dr. Webb, who at my request had occasionally attended her, remained with her four hours alternately, during twenty-four hours, and the quantity discharged during this time was as large as it had been for several days previous to, and after this period. There has never been any doubt that these fluids, which have been proved to be urine, were actually discharged from the ear and the other outlets, since the fact has been proved, day after day, by ocular demonstration.

  The doctor could have written “I saw it myself” but decided that the gratuitously highfalutin “by ocular demonstration” sounded better. So what happened to her? The story has a happy ending—of a sort:

  This great disturbance in the system continued to increase for nearly six months, and it was the opinion of all who saw the patient that she could not survive from day to day; after which period it gradually abated, and she is now, when the urine is freely discharged, so much relieved that she is able to walk about her room, and during the summer of 1824 frequently rode out. The discharges from the right ear, the
right breast and navel continue daily, but they are not so great nor so frequent as they were a year since; from the bladder the quantity is as usual; from the stomach, nose, eye, there has for some months been no discharge.

  Not ideal: A tendency to urinate spontaneously from the ear does not make one the perfect dinner-party guest. The report concludes with what Dr. Arnold calls a “diary of the discharges”: a heroic, seventeen-page document recording how much urine the patient produced each day over a nine-month period, as well as the orifice(s) from which it emerged.

  If you’re thinking the whole thing sounds too far-fetched to be true, you’re probably right. But there is just the faintest chance that Maria Burton was suffering from an exotic combination of conditions with bizarre symptoms. We know that her illness began with a prolapsed uterus, which caused an obstruction to the urinary tract. If the body can’t get rid of its waste products in the urine, the blood can become saturated with urea, a condition known as uremia. Typical symptoms include fatigue, abnormal mental state and tremors, all of which were present in this case. But the most striking feature of uremia, seen only in patients with kidney failure, is uremic frost, in which urea passes through the skin and crystallizes. When dissolved in sweat, it produces a liquid that smells and looks like urine. And if she was suffering also from edema—a buildup of fluid in the tissues—this smelly perspiration might have been quite copious.