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Critical Reviews in Oral Biology & Medicine
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Pioneers in Oral Biology: The Migrations of Gottlieb, Kronfeld, Orban, Weinmann, and Sicher From Vienna To America
Nellie W. Kremenak and Christopher A. Squier CROBM 1997 8: 108 DOI: 10.1177/10454411970080020101 The online version of this article can be found at: http://cro.sagepub.com/content/8/2/108
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PIONEERS IN ORAL BIOLOGY: THE MIGRATIONS OF GOTTLIEB, KRONFELD, ORBAN, WEINMANN, AND SICHER FROM VIENNA TO AMERICA
Nellie W. Kremenak Christopher A. Squier Dows 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 Vienna Medical School purged faculty ranks of Jews. Among those forced out were several distinguished physician dentists, several of whom emigrated to the United States. The assimilation of foreign-trained dentists raised questions at national meetings of the AADS and the National Association of Dental Examiners. Already existing ties between dental schools in Chicago and the University of Vienna, including the 1928 appointment of Rudolf Kronfeld to the faculty at Loyola, led to the relocation of Balint Orban, Harry Sicher, and Joseph Peter Weinmann in that city. Bernhard Gottlieb, who had been director of the Dental Institute in Vienna, transplanted less easily, but eventually found a niche at the Baylor College of Dentistry in Dallas. The careers of the Vienna dentist-scientists strengthened the scientific foundations of clinical dentistry in the United States, contributed to the development 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) Introduction
In the spring and summer of 1938, the winds of Adolf Hitler's ambitions fanned long-smoldering embers of racism and anti-Semitism in Austria. Following Hitler's annexation of Austria in March, 1938, the rapid emergence of a harsh and ominous official stance against people of Jewish descent and their families and friends led officials at the University of Vienna to dismiss more than 75% of their world-renowned Medical Faculty (Ernst, 1995). Recent documentation of this event lists, among the senior faculty members forced to abandon their homes and careers, eight physicians whose specialty training had been in dentistry, several of them internationally respected leaders in the biological sciences basic to dentistry (Muihlberger, 1990). Five of the eight who were forced out "on the basis of racial persecutions" ("aufgrund rassistischer Verfolgungen") emigrated to the United States: Bernhard Gottlieb, Albin Oppenheim, Balint Orban, Harry Sicher, and Georg Stein. Many in less senior positions came also. Of the remaining three, Fritz Schenk died in the concentration camp at Theresienstadt, Bruno Klein apparently remained and was later restored to his position in Vienna, and the fate of a third, Bertold Spitzer, is unknown.
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Although a substantial literature exists on the contributions of German and Austrian intellectuals and scientists of Jewish descent forced from their homelands in the 1930s, the careers of renowned dental scientists of that era have received little scrutiny. The purpose of this paper is to discuss the careers of three members of this group of emigres, Gottlieb, Orban, and Sicher, as well as those of their colleagues Rudolf Kronfeld and Joseph Weinmann. We will describe the ways in which these men helped to interweave the fabrics of two scientific cultures to strengthen American dentistry and the scientific foundations on which it is constructed. This group of scientists from the University of Vienna, already linked to US dentistry through their participation in the Federation Dentaire Internationale (FDI), was welcomed into academia in this country, despite a Depression-wracked economy and the resistance of the National Association of Dental Examiners and most state boards. They came in a period when American dentistry, still rising to the challenges embodied in the Gies report of 1926, struggled toward the development of a research enterprise. The Vienna group's appreciation of the biological basis of dentistry complemented American technical expertise in restora8(2):108-128
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tive dentistry. They helped to give an emerging dental research effort a sound foundation, one that was prepared to take advantage of the Federal funding for health-related research that followed World War II. Three dental schools in Chicago-Northwestern, Loyola, and the University of Illinois-drawing on the heritage of such leaders as G.V. Black, William Logan, and Frederick Noyes, were already building a research capability in the 1930s, and were positioned to both offer and gain the most through associations with Balint Orban, Harry Sicher, and Joseph Peter Weinmann. Bernhard Gottlieb, who had led the group in Vienna, transplanted less easily. Although he finally found a niche as a respected faculty member at Baylor College of Dentistry in Dallas, this great scientist's intellectual and geographic isolation sadly limited his research productivity in the United States.
dation. Furthermore, it was clear that such a foundation was not to be found in the medical curriculum, which was hardly less deficient than dentistry in Hunter's "fundamental truths" on the subject of oral and dental structures.
(11) Dentistry in the United States in the 1 920s

The first decades of the twentieth century found American dentistry still struggling to define its role in the health care hierarchy. In 1890, leaders in the profession had been appalled to learn that US Census Bureau officials, planning their regular survey of industry, intended to classify dentists as manufacturers. Only a last-minute meeting with Census Bureau Superintendent Robert B. Porter and impassioned pleading by representatives of the profession warded off the unwanted label (Bentley, 1892). In the same decade, dentistry had managed to resist a late nineteenth century effort takeover by the medical profession, only to find, twenty years later on the US entry into World War 1, that dentists in the armed forces were to be relegated to a rank subservient to officer physicians. Again, vigorous negotiations were necessary to preserve hard-won status (Puterbaugh, 1943). Although for decades American dentistry had been renowned throughout the Western world for its technical excellence, serious questions concerning the quality of care had emerged. English physician William Hunter's charge that American dentists deployed their technically excellent prosthetic devices over woefully diseased teeth still reverberated throughout the health care environment in the 1920s (Hunter, 1911). Although many recognized Hunter's "mausoleum of gold over a mass of sepsis" as a colorful exaggeration, anxious patients and eager physicians were only too willing to attribute a wide variety of ailments to "focal infection" and recommend treatment with extensive tooth extraction (Rosenow, 1926). At the same time, the better-educated members of the profession, especially in academia, acknowledged the validity of Hunter's charge that dentists too often were ignorant of "fundamental truths connected with the anatomy, physiology, and pathology of the teeth with which they deal". American dentistry, while technically advanced, was in need of a strengthened biological foun8(2) 108-128 (1997) (1997) 8(2):108-128
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To shore up dentistry's reputation, the profession increased efforts to raise standards for education and practice. As was true of medicine, academic dentistry in the 1920s had already begun to move toward non-profit professional education, subsidized by the state or private foundations. Recommendations made in Abraham Flexner's study of academic medicine in 1910 and William Gies' study of academic dentistry in 1926, both funded by the Carnegie Foundation for the Advancement of Teaching, only formalized goals of a movement already well under way (Starr, 1982). The Gies report's call for a more vigorous research enterprise in dentistry reflected a view already strongly held by some academicians, notably leaders in dental education in the Chicago dental schools (Gies, 1926).
(111) Academic Dentistry in Chicago

As the city of Chicago grew to be a great metropolitan center with economic dominance extending over a large region in the central United States (Cronon, 1991), leadership in academics and in the rise of the health professions followed (Veysey, 1965; Jarausch, 1983; Dummett and Dummett, 1993). By the 1920s, three dental schools were well-established in the city: the Chicago College of Dental Surgery at Loyola University, Northwestern University Dental School, and the University of Illinois College of Dentistry (Jackson and Jackson, 1964). The complex early histories of each of these schools had involved many of the same players, leaders in Chicago's dental profession such as G.V. Black, Truman Brophy, Edmund Noyes, Charles N. Johnson, and Thomas L. Gilmer. All three institutions had early associations with proprietary schools, but by the mid-1920s, both Northwestern and the Chicago College of Dental Surgery were associated with respected private universities, while the school at the University of Illinois was a statesupported institution. The oldest of the three, the Chicago College of Dental Surgery, had been founded as a proprietary school by Truman Brophy in 1883 with a small faculty that for a time included G.V. Black. The Chicago College represented the proprietary model at its best, but its faculty owners recognized that the tide was turning away from profit-making dental schools and by 1921 had established an affiliation with Loyola, a small Catholic university. Because of the standing of the Chicago College of Dental Surgery, William Gies described the move to associate with Loyola as an "event of national significance in the conflict between private and public interests in the conduct of dental schools" (Gies, 1926, p.
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Figure 1. William H.G. Logan, 1872-1943, Dean, Chicago
College of Dental Surgery at Loyola University. Bur 43(2):50, August, 1 943. Reprinted with permission.
322). Despite the accolade, however, Gies urged the College to reduce its enrollment, questioning whether a school with a faculty of 45 had the necessary resources to handle an enrollment of over 600. The Northwestern Dental School, associated with the University at Evanston but established in downtown Chicago in the 1890s, combined two earlier proprietary schools. By the 1 920s, Northwestern was one of the most distinguished dental schools in the nation, attracting students from throughout the United States as well as from Europe, Asia, Canada, and Australia. G.V. Black had left the Chicago College of Dental Surgery to join the Northwestern faculty and served as the school's dean from 1897 until his death in 1915. His son, Arthur D. Black, had been appointed to the dean's position in 1918 and still held the position in the 1920s. Arthur Black, a different kind of scholar than his celebrated father, made it part of his life's work to ensure development of bibliographic access to the dental literature. With his own extensive personal index as the nucleus, Black supervised publication of the Index to Dental Literature, encompassing scholarly publications in dentistry from 1839 forward. 1110 10
The College of Dentistry at the University of Illinois was the smallest and youngest of the three schools. Organized in 1913, it was the first state-supported dental school in Illinois. Located across the street from Cook County Hospital, the University of Illinois had the strongest research component of the three schools by the time of the Gies report. Gies noted that the school's faculty had several publications in 1924 and 1925, including a "notable volume" titled "Pathology of the mouth" (probably by Frederick Brown Moorehead and Kaethe Weller Dewey lPhiladelphia: W.B. Saunders, 19251). He also reported several publications by Northwestern faculty as well as the presence of an excellent library. In contrast, he cited no publications for the overworked Loyola faculty in 1924 and only one in 1925. Yet despite these unfavorable beginnings, it was Loyola's Dean of Dentistry, William H.G. Logan, who, in the mid-1920s, sought advice from Bernhard Gottlieb on how to bring research to academic dentistry in Chicago (Fig. 1). Logan's ambition was to create a research unit modeled on Gottlieb's Dental Research Institute in Vienna. He had first met Gottlieb in Geneva in 1925 at a conference set to finalize plans for the upcoming FDI Congress that was to be held in Philadelphia in 1926 (lackson and lackson, 1964). As President of that Congress, Logan extended his personal invitation to Gottlieb 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 Vienna that, within a few years, led to the establishment of a research foundation at the College, funded by a gift from the Chairman of the Board of the Pepsodent Corporation and headed by Gottlieb's brilliant student, Rudolf
Kronfeld.
(IV) Dentistry at the University of
Vienna School of Medicine

In Europe as in the United States, late nineteenth century dentistry had struggled to redefine its status and its standards. The paths taken by the profession varied between countries, even among those which shared a common language such as Germany and Austria. In Austria, dentistry evolved as a specialty of medicine, while in Germany, dental education developed in separate institutions, as was the case in the United States (Lesky, 1976; Huff, 1985). In both countries, dentistry and dental education benefited from the strong research orientation of the biological and medical sciences in Western Europe. The achievements of the Vienna medical school in the nineteenth century enriched the scientific basis of every area of medicine, including the ill-defined discipline of dentistry, and so established a basis for the significant progress that would be made in the first part of the twentieth century (Lesky, 1976). Georg Carabelli
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(1787-1842), a military surgeon who gave his name to the fifth cusp of the upper molars, presented lectures in dentistry as early as 1821, developing a classification for bites and constructing orthodontic appliances. He was succeeded in 1842 by Moriz Heider (1816-1866), who proposed a philosophy for dental education that has echoed down the ages: "a tooth...must be seen in its connection with the entire organism" and "dentistry must not be considered as an independent theory which is unconnected to medicine" (Lesky, 1976, p. 209). In 1869, Heider joined with Carl Wedl (1815-1891) to publish the "Atlas of the Pathology of the Teeth", which introduced the concept of a bacterial etiology for dental caries. Wedl was a histopathologist who had introduced improved methods for fixing and staining tissues, and it was this combination of scholarship and microscopic technique that was to be one of the major contributions to oral science made by the University of Vienna physician-dentists. Victor von Ebner (1842-1924), who taught histology in the Medical School, published a series of works on the salivary glands that came to bear his name. He also developed techniques for the decalcification of teeth and the use of polarizing microscopy that he applied in descriptions of the structure and development of the dental hard tissues. Much of this work was incorporated into Julius Scheff's "Handbook of Dentistry", published between 1891 and 1893, a work that made Vienna the focus of dental science for the German-speaking countries. Scheff's volume reflected the philosophy enunciated fifty years earlier by Heider and provided information not only on the macroscopic and microscopic anatomy of the oral cavity but also on the relationships between dentistry and general medicine. Dental education in Austria at the end of the nineteenth century presented a striking contrast to that in the US. The concept of a formal professional program offered in an academy had been established as early as 1840 in the school at Baltimore, and by the early decades of the twentieth century, many US dental schools struggled to develop a more scholarly foundation for what were predominantly technical programs. In contrast, despite the rich heritage of oral anatomy, histology, and pathology associated with names such as Carabelli, von Ebner, and Tandler (1869-1936), the University of Vienna did not establish clinical training in dentistry until 1890, with the founding of the Imperial Royal Dental Dispensary under the leadership of physician Julius Scheff (1846-1922). In 1894, this became the Dental Institute, and in 1898 Scheff was appointed as the first professor of dentistry in the University. Despite the formalization of dental education at the University of Vienna, it was not until 1925 that Austria required practitioners to have completed four semesters at dental school before entering practice. The Viennese dentist physicians who brought their knowledge and skills to the US in the nineteen twenties
and thirties would undoubtedly have been aware of the works of Heider and Scheff, for the latter was still occupying the Chair of Dentistry at the time that Oppenheim, Gottlieb, and Sicher were completing their medical training at the Medical School. Nevertheless, it was Julius Tandler who probably had the greatest influence on this group. Appointed to the Chair of Anatomy at the University of Vienna in 1910, Tandler was particularly interested in the relationship between form and function, and the view that function determines form. This concept is intrinsic to the approaches to dental anatomy and histology that Sicher, Weinmann, and co-workers used in collaborations that were to occur many years later in Chicago. A second theme permeating the teaching of the Viennese anatomists was the importance of the relationship between anatomy and clinical practice. Emil Zuckerkandl (1849-1910), Tandler's predecessor as Professor of Anatomy in Vienna, had inscribed above the anatomy lecture theater the Latin text: "Hic locus est, ubi mors gaudet succurrere vita-"Here death is glad to assist life." Although known principally for his studies on the anatomy of the urogenital system, Tandler co-authored a volume on "Anatomy for dentists" (Anatomie fur zahnarzte) in 1928 with Harry Sicher, which was the basis for an English-language version published in 1949. Interestingly, Tandler spent the last two decades of his life in public health administration in Vienna, in which role he established sixteen dental clinics for children in the city (Goetzl and Reynolds, 1944).
(V) European Dentistry and
the Chicago Schools
Relationships between the Chicago dental schools and researchers in Europe had begun at least two decades earlier than Logan's 1926 encounter with Gottlieb, fueled in part by respect for European, and particularly German, biologic research, and the growing realization that American dental schools needed to strengthen the biological basis of practice. Nineteenth century German scientific scholarship set the standard for the Western world in many fields, drawing ambitious American students to study abroad and serving as the model for the design of new universities such as Cornell and the University of Chicago in the United States (Veysey, 1965). G.V. Black studied German so that he could read the scholarly literature in that language and traveled to Europe several times to attend meetings and visit the laboratories of colleagues (Black and Black, 1940). At the same time, American dentistry continued to be internationally recognized and admired for its technical excellence, and despite the cloud of disapprobation generated by the focal infection controversy, European dentists came to the United States to learn American dentistry. Early in the century, Hans Pichler, later to be Dean of the School of Dentistry at the University of
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Figure 2. Bernhard Gottlieb, 1885-1950. Photo courtesy of William C. Hurt.
Figure 3. Location of Gottlieb's laboratory. 15 Turkenstrasse, Vienna, 1 996. Photo by Stephanie Ettinger.
Vienna and Sigmund Freud's oral surgeon, studied under G V. Black at Northwestern and translated Black's landmark work, "A work on operative dentistry" (1908) into German (Kronfeld, 1930; Davenport, 1992). Black's friend and colleague, Willoughby D. Miller, educated at the University of Michigan and the Pennsylvania College of Dental Surgery, studied bacteriology with the microbiologist Robert Koch at the University of Berlin, and out of those studies developed his understanding of the relationship between bacteria and dental caries. Miller's most important work, published first in German as "Die mikroorganismen der mundhohle" (1889) and a year later in English by S.S. White as "The micro-organisms of the human mouth: The local and general diseases which are caused by them" (1890), established the basis for most caries research into the twentieth century. (Miller's career was cut short by his unexpected death in 1907 at the age of 54, just after he had been named Dean of the College of Dentistry at the University of Michigan IDummett and Dummett,
(VI) Gottlieb and the 1926 International Dental Congress in Philadelphia

At the time of the Seventh International Dental Congress held in Philadelphia in 1926, the Faculty of Medicine at the University of Vienna was arguably the most eminent in Europe. By the mid-1920s, the work of its Dental Research Institute, led by Bernhard Gottlieb, had gained wide recognition among dentists and oral scientists in the German-speaking world. Gottlieb, born in Poland in 1886, had received his medical degree from the University of Vienna in 1912 (Fig. 2). After valorous service in the Austro-Hungarian army during World War 1, he returned to the University to organize his laboratory (Fig. 3), and to establish a dental practice next door at 13 Turkenstrasse with his protege, Balint Orban (Hurt, personal communication, 1995). Gottlieb's histological studies, published in the 1920s and 1930s, characterized many previously undescribed microscopic features of oral tissues, including the attachment of the gingival epithelium to 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 and union" between dentists of all nations (Federation Dentaire Internationale, 1923, p. 3), it provided a forum in which dental leaders and researchers from around the world could meet their colleagues and share research findings, restorative techniques, and educational strategies. In the five-year intervals between congresses, representatives of the world's dental organizations met annually as an executive board to conduct FDI business and plan the international meetings. It was at such a meeting in 1925 that William Logan, who was to chair the conference in Philadelphia, met Bernhard Gottlieb. The Philadelphia Congress attracted hundreds of dental leaders from across the US and throughout the world. Representatives came from nearly every state in the United States, the US Armed Forces, and the Public Health Service. More than 280 papers were read by representatives of dental associations in thirty-six countries. Not surprisingly, the papers varied widely in quality and subject matter. Many presentations in the research sections contained little more than personal reflections on a particular research problem. Others described more systematic approaches to problem-solving. Among all the reports, those of the Vienna school stood out-papers by Gottlieb, Stein, Orban, and Pichler, ranging from histologic research through animal studies to case reports. All reported carefully documented and systematic examinations of the material, and all included extensive visual as well as textual information. The most well-received of the Vienna papers appears to have been Gottlieb's "Tissue changes in pyorrhea" (Gottlieb, 1926a). This richly illustrated paper documented the investigator's studies of structural changes accompanying severe periodontal disease. Gottlieb's series of enlarged histopathologic microphotographs caused a sensation and according to one observer "shook the dental schools of America" (Obituary, 1950; Stein, 1950). The Vienna laboratory's ready access to autopsy material, together with its highly developed capabilities in tissue preparation and microscopy, gave them a decided advantage over most other investigators and earned worldwide respect. Moreover, the Vienna investigators' adroitness in analyzing, synthesizing, and explaining their observations seemed to place their work on a higher level than that of most of the rest of their colleagues. Gottlieb's presentation reflected his methodological approach. Setting out his holistic orientation plainly in the first paragraph, Gottlieb argued that to understand "the nature of the processes" it is necessary to view biology as a whole, rather than in terms of "artificial divisions". "lAllthough it is our task to speak here of the loss of teeth," he continued, "we must start with their devel8(2) 108 128 (1997) 8(2): 108-128
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opment." Reviewing the growth and development of the normal dentition throughout life, Gottlieb touched on many of his own contributions to the subject. Balint Orban's two papers also received attention. The first, "Nutrition and teeth," reported Orban's own animal studies on the effect of nutrition on the growth and development of teeth (Orban, 1926a). The second, "Histology of the enamel lamellae and tufts," built on Gottlieb's work to continue the investigation of the structural development of tooth enamel (Orban, 1926b). Georg Stein's "Studies in transplantation" discussed histologic sections from his bone transplant work in an animal model (Stein, 1926). Hans Pichler, an oral surgeon, presented detailed case reports illustrating his method of using attached bone grafts to repair mandibular deficiencies resulting from accidents or imperfect development (Pichler, 1926). A profile of American dentistry emerges from titles of papers presented by representatives from the US at this great Congress whose subject matter spanned research, education, and professional issues. The number of papers on restorative dentistry clearly illustrated this country's strong emphasis on technique issues. Representative examples are papers by three nationally recognized clinicians, all from Iowa: two papers by Roscoe H. Volland on cast gold restorations, Arthur 0. Klaffenbach's "Fixed bridge restorations: Their indications, 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 technical, however. A report presented by Northwestern researchers W.G. Skillen and Emil Mueller, "Epithelium and the physiologic pocket," building on Gottlieb's work, illustrated the growing biological orientation of Chicago researchers (Skillen and Mueller, 1926). The critical intersection of the biological and the technical that was beginning to reshape American dentistry in this period was exemplified in reports on histologic findings associated with root canal therapy by Chicago researchers Edward H. Hatton and Edgar Coolidge (Hatton et al., 1926; Coolidge, 1926). A lengthy presentation by Mayo Clinic physician Edward Rosenow, citing extensive documentation from his own practice of a wide variety of disease states attributed to dental infection, suggests the dilemma dentistry faced as well as the limitations of some research in medicine (Rosenow, 1926). When the Congress closed, Gottlieb traveled to the Midwest to visit Dean William Logan and the dental school at Loyola. An oral surgeon with training in medicine as well as dentistry and the son-in-law of Chicago College founder Truman Brophy, William H.G. Logan's own interests spanned a broad spectrum. His early animal studies addressed the etiology and treatment of periodontal disease. As the focal infection issue intensiBiol Med
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(VIl) The Research Institute at Loyola

(A) BALINT ORBAN
Although Balint Orban returned to Vienna in 1929 after only two years at Loyola, to be replaced by another Gottlieb assistant, Rudolf Kronfeld, his first brief stay in Chicago was productive. Dean Logan equipped the laboratory according to Orban's requests, calling for "the best of everything", which included "a microtome, photomicrograph, grinding machine, research microscope, and other appliances" (Coolidge, 1943). With the assistance of a faculty member and researcher, E B. Fink, Orban's first project was to organize a research methodology course for Loyola faculty. Twenty members of the faculty, including Dean Logan, attended the lecture and laboratory sessions, which covered dental histology and pathology, taught by Orban, and general pathology and bacteriology, taught by Fink Orban's fine training and his passion for research, combined with his excellent command of the English language, made him an extraordinarily effective teacher. By the conclusion of the course, several faculty members had begun their own projects, and several senior dental students had requested permission to assist in the laboratory Faculty from other schools came to Chicago to work with Orban, and invitations poured in for him to present his work at other institutions. By the end of two years, Orban had given thirty lectures in various parts of the country and published several papers and abstracts in the English-language literature as well as a textbook, "Dental histology and embryology" (Orban, 1928). A total of twenty-two research papers had been published from the department In his closing report to the Chicago College of Dental Surgery alumni, Orban said that it was the contents of the papers rather than their number of which he was most proud:
Each has a different touch; each sees things with a different eye and from a different angle They are never dry descriptions, they all try to explain biologic processes, they try to explain life, and so live themselves (Orban, 1929)
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 to investigate the extent to which pulpless teeth, root fragments, or impacted teeth harbored bacteria or caused systemic disease (Coolidge, 1943) Later, with the assistance of Gottlieb's associate, Rudolf Kronfeld, Logan was to turn his attention to improving the design of surgery for repair of the cleft palate (Logan and Kronfeld, 1933). At the conclusion of Gottlieb's visit to Chicago, Logan asked the eminent researcher to recommend an individual who could establish a research program at Loyola. Gottlieb recommended his brilliant young assistant, Balint Orban (Fig. 4). Logan immediately issued an invitation, and in 1927 Orban came to Chicago to join the faculty at the Chicago College of Dental Surgery at Loyola (Coolidge, 1943). Born in Temesvar, Hungary, in 1899, Orban had completed his medical training at the University of Budapest in 1922 and then moved to Vienna, where he joined Gottlieb's staff. By the time he came to the United States in 1927, Orban had already published 19 papers, primarily in the German literature (Everett, 1970).
A dynamic and charismatic individual, Balint Orban was to have a significant impact on both clinical dentistry and dental research in this country following his return to the United States almost a decade later.
(B) RUDOLF KRONFELD

Orban's replacement at Loyola, selected by Gottlieb, was 28-year-old Rudolf Kronfeld. Kronfeld had worked under Gottlieb since completing his medical training at the University of Vienna in 1926. His brief career in the United States blazed across dental research with mete8( 2 ):108- 128 ( 1 997)
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Figure 6. The Harrison street entrance to the Chicago College of Dental Surgery in the 1 930s. Bur 37:114, 1 937. Reprinted with
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Figure 5. Rudolf Kronfeld, 1901-1940. This photo was probably taken in the mid-i 930s. Bur 40:16, March, 1940. Reprinted with permission.
oric brilliance, only to end abruptly with his tragic death in 1940 (Fig. 5). Kronfeld was energetic and ambitious, and his command of the English language was excellent. His lucid lecture style, his affability, and his willingness to share his expertise with others soon made him a popular figure. He quickly established himself as a participating member of the major dental organizations, including the Chicago Dental Society and the International Association for Dental Research (IADR), with its active Chicago Section. In 1933, he published "Histopathology of the teeth and their surrounding structures" (Kronfeld, 1933). The book, notable for its abundant histological illustrations and extensive bibliographies, quickly became a standard text in the dental curriculum. New editions continued to be published until 1955 (Kronfeld, 1937a; Kronfeld and Boyle, 1949, 1955). Also in 1933, with William Logan, Kronfeld published a landmark 48-page paper on "Development of the human jaws and surrounding structures from birth to the age of 15 years" (Logan and Kronfeld, 1933). Drawing on
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autopsy material and originally intended primarily for cleft palate surgeons, the project had been planned as a study of the infant jaw and all adjacent bone structures and attached soft tissue. The significance of the work had increased as Logan and Kronfeld expanded the project to include material from 25 individuals ranging in age from newborn to 15 years, allowing for collection of groundbreaking chronological data on the location of permanent tooth buds and the timing of calcification in unerupted permanent teeth ("A new light on tooth development", 1933). Using the "celloidin technique, as devised and used by Professor Gottlieb and his associates..." (p. 395), the work was a technical tour de force and included some 35 micrometer sections, combining hard and soft tissues, that were as large as 6 by 8 cm. "To our knowledge," the authors said, "microscopic sections of this size through the head and neck have never before been prepared or reported" (p. 401). Unlike Orban, Kronfeld seemed certain that he had come to stay. Soon after his arrival, he married an American woman, Margaret North, whom he had met in Vienna. Along with his responsibilities as an assistant professor of histology and pathology, he enrolled in the dental school at Loyola and in two years had completed the requirements, receiving his DDS in 1933. He opened a practice in Chicago's "Loop", seeing patients four afterOrcul
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Figure 7. A view of part of Kronfeld's new lab aher the Foundation was established in the mid1 930s at the Loyola School of Dentistry. Bur 36:24, 1 936. Reprinted wi ath permission.
testabmishsion.
Chicago research had become an increasingly strong presence at the annual meetings of the IADR. Four of the fifteen men who had served as president since the organization's founding in 1921 had been from the Chicago schools Frederick Noyes, Arthur Black, Edward Hatton, and WCG Skillen (Orland, 1973). By 1939, almost a third of the 61 papers read at the annual scientific session, held in Cleveland, came from the Chicago schools. Northwestern's representation was strongest, with ten papers, followed by four from Loyola, three from the Zoller Clinic at the University of Chicago, and two from the University of Illinois. In IADR mem1937, the bership elected Kronfeld vice-
noons a week. As a practicing dentist who was also a practical researcher, he forged a strong link between the lab bench and the clinician, a relationship he regarded as critically important to the profession. The strength of Kronfeld's and Orban's work at Loyola and the growing recognition of the school's role in dental research gave Kronfeld's faculty colleague, Edgar D. Coolidge, the evidence he needed to persuade a wealthy patient with a philanthropic bent to subsidize research at Loyola (Fig. 6). Beginning in 1935, Kenneth G. Smith, President and Chairman of the Board of the Pepsodent 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 Foundation for Dental Research, to be directed by Kronfeld under the oversight of an eight-member committee headed by Dean Logan. Three advisors, recognized researchers at other institutions, helped evaluate planned projects. The funds made possible a move to larger, roomier quarters and the employment of additional laboratory staff (Fig. 7). A collaboration with bacteriologist Ruth Tunnicliff at the nearby lohn McCormick Institute for Infectious Diseases was facilitated (Kronfeld, 1936). In 1936, ten years after Logan's meeting with Gottlieb at the Philadelphia Congress, Kronfeld, Logan, and other Chicago College faculty presented their work at the FDI's Ninth International Congress, held in Vienna and organized by Balint Orban (Kronfeld, 1937b). The work of the Foundation was also represented in Vienna by an exhibit of two hundred photomicrographs, described by Kronfeld as the largest exhibit contributed by any US institution.
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president, and he began moving up the ladder toward the presidency. During these same years, Kronfeld had been named a Fellow by the Academy of Periodontology and was elected President of that organization in 1939. In the winter of 1939-40, life took a bitter turn for Kronfeld. On February 13, 1940, at the age of thirty-nine and only a month before he was to assume the presidency of the IADR, Rudolf Kronfeld was found dead in his research laboratory. The New York Times reported coronary thrombosis as the cause of death (New York Times, 1940), but Kronfeld's friends soon learned that he had taken his own life (Chicago Tribune, 1940a,b). Late in 1939, Kronfeld had been diagnosed with a serious neurological disease, possibly multiple sclerosis (lackson and lackson, 1964). He apparently found the prospect of progression into helpless invalidism unacceptable, and with his illness a closely guarded secret from all except his wife, Kronfeld had planned for the close of his life. He died, as his friend Edgar Coolidge described it, "surrounded by his library, his histologic material and his work in progress for the coming season" (Coolidge, 1940). At his request, his body was cremated and his ashes buried in the Indiana sand dunes on the southern shore of Lake Michigan, where he and his wife had a summer home It is interesting to speculate on how Rudolf Kronfeld's career might have evolved had he lived out a normal life span. An energetic and skilled researcher with a strong interest in clinical dentistry and a gift for communication, Kronfeld clearly had the potential to play a significant role in dentistry and dental research. At the time of his death, the Journal of the American Dental
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Association described his career as one of "distinguished achievement" and his two textbooks as "distinctive and authoritative" (Kronfeld, 1940). Perhaps more importantly, Kronfeld recognized and clearly articulated to his fellow clinicians the critical relevance of good research to the standing of dental practice in the community. He chided fellow researchers for their propensity to present their work in "another language", not intelligible to their clinical colleagues. He deplored studies designed to support advertising campaigns and "research for the sake of decoration" (Kronfeld, 1937a). His message to clinical dentistry was set out most explicitly in a widely published article entitled "Research and the future of dentistry", in which he delineated the crucial connection between the techniques of restorative dentistry and the biological foundation on which those techniques must rest (Kronfeld, 1939). Drawing on such examples as G.V. Black's fundamental research on cavity preparation and the materials studies of the National Bureau of Standards, he reminded practicing dentists that the familiar, reliable procedures and materials they took for granted in their work had been developed through years of research and testing. In the same way, Kronfeld said, "Biologic research has laid the foundation for correct diagnosis and the proper treatment of dental and oral disease." No matter how enthusiastically a treatment method might be endorsed by clinicians or manufacturers, Kronfeld assured his readers, unless that treatment was based on the fundamentals of biological science, "it will fail and soon be forgotten." Many reliable treatments are not yet fully understood, he conceded, and much remained to be explained. Calling for closer ties between researchers and practitioners, Kronfeld challenged his fellow dentists to recognize that "...an honest admission of lack of knowledge is far preferable to a pseudoscientific, unsound explanation."
a complex struggle between those who saw facilitating the emigration of "foreign-trained dentists" across the Atlantic as an opportunity for the profession as well as a moral responsibility and those who saw it quite simply as an economic threat.
(A) THE ANNEXATION OF AUSTRIA Although the great Austro-Hungarian Empire had broken
apart at the end of the First World War in 1918, the city of Vienna remained the cultural heart of Central Europe. The standing of the University of Vienna drew students from all sectors of the former Empire: Hungary, Czechoslovakia, Poland, and the Balkans. Love of learning and the attractions of Vienna's high culture as well as the political instability and the crude anti-Semitism of many of the newly independent Central European nations drew many Jews to the city. One historian has estimated that, by the early 1930s, at least a third of the University's Faculty of Medicine and about half of the physicians 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 service), but medicine was one that remained open. Even in medicine, problems were sometimes raised in relation to promotion. Adopting Christianity presented a possible circumvention of such limits. This course offered a reasonable option, especially for those individuals whose families had not followed traditional Jewish religious practice for generations and who thought of themselves as Germans or Austrians, not Jews (Berkley, 1988; Beller, 1989). Austria's long tradition of officially condoned demonstrations of hostility toward Jews combined with the intractable economic difficulties of the Great Depression heightened anti-Semitism in the 1930s. Even in the University, where an increasingly conservative student majority clashed with the more liberal faculty, intimidation, harassment, and even physical violence against Jewish students and faculty became increasingly common. Many in Austria watched Hitler's rise to power in Germany with intense interest, and a growing faction sympathetic to the Nazis began to emerge. Austria's chancellor, Kurt Schuschnigg, struggled to chart a course that would maintain the nation's independence, but when Hitler led troops into Austria on March 11, 1938, he was welcomed by most Austrians, and a Nazi government was quickly installed. The impact on the Medical Faculty was immediate. Within the month, faculty had received letters from a newly installed dean, an outspoken Nazi, requiring them to provide documentation of their own and their spouses' Aryan descent. Before the end of March, the "cleansing" of the faculty had begun, with those who were Jews
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(VIII) The Crisis in Europe

In 1938, two years before Kronfeld's death, political changes in Austria sharply altered the history of the University of Vienna School of Medicine and the careers of Bernhard Gottlieb and his colleagues. in the face of clearly expressed Austrian support for Hitler's policies of "racial hygiene", members of the faculty who were Jews or simply had a Jew in their family tree or were married to a lew were forced to flee for their lives. As these men looked to their colleagues in other nations for assistance in relocating their lives and careers, the great national and international networks of relationships embodied in the concept "the dental profession" faced real and human challenges. The profession in Austria clearly failed the test, splitting quickly along ethnic lines, relinquishing international standing for the more immediate rewards of political expediency and a less competitive playing field. In the United States, the response reflected
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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 loyalty to Hitler dismissed from their posts. More than 75% of the Medical Faculty lost their positions. Vacancies were filled with individuals from the lower academic ranks whose credentials as Aryans and supporters of the new regime were acceptable (MOhlberger, 1990; Ernst, 1995). Recognizing that not only their careers but also their very lives and the lives of their families were threatened, the eight Jewish physician-dentists and their colleagues on the Medical Faculty must have begun a desperate review of their options. For Gottlieb, Orban, Sicher, and Weinmann, their already-established ties with the dental profession in the United States represented a lifeline.
assimilated into Austrian life and the culture of its capital city, and many may have believed themselves to be safe from the kind of persecutions occurring in Germany (Beller, 1989). A few, however, Balint Orban among them, perhaps recognizing that their scholarly environment would soon deteriorate, had begun efforts to move their work elsewhere. Although Orban may have been a member of the Catholic Church, in 1938 his position on the Medical Faculty was de-activated ("stillgelegt") on the basis of racial persecutions ("aufgrund rassistischer Verfolgungen") (Muhlberger, 1990, pp. 7, 28). But Orban was no longer in Vienna. In 1937, he had begun negotiations with Northwestern dean Arthur Black. Black secured immigration visas for Orban, his wife, and son, and arranged for his enrollment as a student at the Northwestern dental school and for a faculty appointment. He and his family sailed for the United States in January, carrying his histological material with him (Jackson and Jackson, 1964). When the great purge of the University of Vienna began in March, 1938, although still listed as a member of the Medical Faculty, Orban was already in Chicago. He completed his clinical requirements in time to graduate in September of the same year and assumed a position as assistant professor of pathology at Northwestern (Jackson and Jackson, 1964). Two years later, after Kronfeld's death, Dean William Logan offered Orban the Research Foundation directorship at Loyola, and he accepted.
(2) Orban's later career Orban had the most public career of the emigrating Vienna dentists in the United States (Fig. 8). He published widely-books, research reports, and other articles. He had an active career on the lecture circuit, particularly in the emerging specialty of periodontics, and he marketed his own line of instruments for periodontal treatment. In 1946, his career-long interest in promoting the preservation of non-vital teeth and in countering the impact of the focal infection scare led him to serve as editor of a new scholarly publication, the Journal of Endodontia. Although the journal survived through only three issues, its brief life heralded the appearance of the new specialty of endodontics and its association, founded in 1943. (The Journal of Endodontics, Vol. 1, made its second and more permanent appearance in 1975.) Orban's scholarly productivity was astonishing. His 1928 text "Dental histology and embryology" (Orban, 1928), published before his return to Vienna, was the precursor of his later influential text, "Oral histology and embryology" (Orban, 1944). It is remarkable to see in the 70-year-old "Dental histology" many of the photomicrographs of periodontal tissues that illustrate the most recent edition of "Oral histology and embryology"
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(1) An early departure: Balint Orban Although many in the professions who had reason to fear Nazi anti-Semitism had begun to leave Germany and Austria soon after Hitler's rise to power in the early 1930s, most senior Medical Faculty at the University of Vienna remained in their places. For several generations, people of Jewish descent had seemed to be almost fully
(Bhaskar, 1990), a testament to the outstanding quality of the histologic preparations that came out of the Vienna laboratory. Now in its eleventh edition, the book remains as one of the standard teaching texts in the area, and is appropriately edited by a student of the Chicago group, Surindar N. Bhaskar. Before leaving Vienna in 1937, Orban had completed seventy publications, including several major texts in German, co-authored with Weinmann and Gottlieb, addressing such subjects as occlusal trauma and the gingival attachment. His productivity continued after his second emigration to the United States, where he collaborated frequently with Sicher and Weinmann, whose tenure at Loyola coincided with his own (Fig. 9). Orban continued his research on the histopathology and surgical treatment of periodontal disease and developed his views on the structure, function, and classification of oral mucosa, which were set out in the first volume of "Oral histology and embryology" and remain the basis for nomenclature of the tissues to the present. Rather than limit his publication to his own views alone, Orban brought together a group of experts to write individual chapters, a technique he also used for his "Periodontics: A concept-theory and practice" (Orban, 1958) with Frank M. Wentz, Frank G. Everett, and Daniel A. Grant, and an approach which is today common in most texts. Orban established a research foundation in Colorado in 1952 but maintained his affiliation with Loyola until his death from a heart attack in 1960 (Sicher, 1960a; Everett, 1970).
(3) "The stranger dentist within our gates": The US dental profession considers its options
Figure 9. (I-r) Sicher, Orban, and Weinmann. J Periodontol 31:271, 1960. Reprinted with permission.
and state boards), any statement of policy by the national organization would inevitably have a powerful impact on the direction taken by individual units. Although AADS member deans reflected a range of opinions, the schools, most still suffering from a Depression-influenced decline in enrollments, took a more welcoming stance toward the refugee dentists than did the examiners. (a) The AADS. When the AADS met in Cleveland in March, 1939, many members, especially deans, came prepared to discuss the issue (American Association of Dental Schools, 1939). R.W. Bunting, dean at Michigan, opened a meeting of the Administrative Section with a discussion of the issue and his survey of how individual schools were responding to recent foreign applicants. Bunting's survey showed that of 39 responding schools (from a total of 41), only fifteen had so far admitted refugee dentists as students. Those fifteen all reported difficulties in assessing the level of preparation of applicants and in gaining curriculum information about the dental schools they had previously attended (Bunting, 1939). Bunting argued that, in view of the fact that the profession was "not overcrowded", and that enrollments had dropped in recent years, it seemed reasonable to think that "a moderate number of the better qualified practitioners" could be admitted to the dental schools and subsequently to the profession. He admitted difficulty in determining whether foreign applicants had had appropriate pre-professional education and concluded that if
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The schools of this Association are faced with a decision as to what they will do to orient the stranger dentists within our gates to become useful citizens and respected
practitioners.
R.W. Bunting, Dean University of Michigan (Bunting, 1939)

The debate over how to respond to the challenges presented by dentists from Germany and Austria, seeking refuge and new careers in the United States, appeared quickly on the agendas of at least two major dental organizations. By Spring, 1939, both the American Association of Dental Schools (AADS) and the National Association of Dental Examiners had begun to address the question. The long-standing struggle between the two groups for control of the gatekeeper's role led each to keep a weather eye on the other's discussions. Despite the fact that neither organization exercised administrative control over its members (individual dental schools
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foreign dentists were to be admitted, the pre-professional admission requirements of the "leading foreign universities" would have to be accepted as sufficient. Only Dr. R.L. Sprau, a dentist from Kentucky and a visitor from the National Association of Dental Examiners, contested Bunting's view that European dentists were well-prepared in the basic sciences and in some instances better prepared than students in the US. On the other hand, Bunting agreed, their limited knowledge of American technical procedures necessitated that they begin with the "first principles" of the freshman technique laboratory. In some instances, however, rapid progress would be made and the student might move quickly to junior class level. At the same time, Bunting acknowledged, the language problems and the variety of backgrounds presented by these special students placed extra burdens on faculty. The prospective student's ability to read and speak the English language was essential to his ability to complete the necessary work, Bunting noted. A second report, by University of Pennsylvania dean Charles R. Turner, described a survey of state boards designed to gather information on "conditions of licensure" boards had set for immigrant dentists (Turner, 1939). Of 41 boards responding, 22 required or had legislation pending that would require examinees to be US citizens. 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 the 41 boards refused to accept graduation from a German or Austrian gymnasium as meeting pre-professional educational requirements. Almost 90% required graduation from an American dental school, and four of these required that examinees complete the full four years' attendance. Although Bunting and some others at the session deplored as inhumane state board rules that seemed to set up nearly unachievable conditions, not everyone attending felt responsibility toward the immigrant dentists. Baltimore College dean J. Ben Robinson characterized Bunting's views as "more emotional than rational" and pronounced himself as "orthodox in jealously guarding high educational standards" (American Association of Dental Schools, 1939, p. 61). Dr. Hamilton B.G. Robinson expressed concern that "refugee professors" would absorb all available open faculty positions, leaving none for students currently enrolled in teacher training programs (American Association of Dental Schools, 1939, p. 63).
(b) The Examiners At the annual meeting of the National Association of Dental Examiners later that summer in Milwaukee, discussion of the refugee issue took a more strident tone (National Association of Dental Examiners, 1939). The examiners located the weakest link in their fortifications
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squarely among the dental schools, who, according to one examiner, might be expected to hand out diplomas indiscriminately, even after the immigrant dentists had simply "loafed in the halls" during meaningless refresher courses. Their professed concern to safeguard the public from the poor technical skills of European-trained dentists seemed disingenuous, since an individual with poor technical skills would presumably be unable to pass the board. The examiners looked for the most effective strategy to protect the interests of the dentists already in practice and of American-born dental students. Ira Williams, an examiner from Illinois, perhaps referring to Arthur Black's vigorous advocacy of Balint Orban, reported that difficulties had already arisen in Chicago, where "one of our schools" had been "taking them and giving them a diploma in one year." Williams added, "They are not doing it any more because we refused to take them on that basis...." He urged members of the organization to pass a strong advisory resolution that would send a warning to the schools against bending requirements for the refugees (National Association of Dental Examiners, 1939, p. 109). Dr. R.L. Sprau, the examiner from Kentucky who had attended the AADS session on immigrant dentists, suggested that the schools might be waiting for the examiners to take a stand. He reported "no agreement, no unity, and very little understanding among the School people... I would consider them rather disorganized on it," he added, suggesting that they seemed to have an inclination to " 'pass the buck' to somebody else" (National Association of Dental Examiners, 1939, p. 88). Because clearly the most nativist and conservative members participated in this discussion, with many others keeping silent, it would be unfair to judge the whole membership by the views of these few. At least one more moderate view was expressed. Dr. William N. Hodgkin, representing Virginia's board, called for what seemed a reasonable stance: "...if a man can meet our standards we should 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 committee charged with drafting a resolution on the subject for the Association's consideration. The hastily drawn-up resolution called for states to require graduation from an accredited dental school with satisfactory completion of at least the junior and senior years, before a Europeantrained individual would be eligible to take the board. The body as a whole found this standard less stringent than the danger warranted and after some wrangling, amended the resolution to require satisfactory completion of four years instead of only two. The resolution passed. Evaluating the response of the profession and its leaders to the plight of their European colleagues on the basis of only these two meetings would be unfair. Even in
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the case of the Examiners, it is difficult to separate genuine concern for standards of clinical practice and the well-being of patients from the ever-present impulse of state board members to control competition. Responses clearly varied widely among individual schools and boards and must have reflected the particular needs and biases of the individual states and their constituent communities. Perhaps we can conclude that the combination of the diversity of communities and the decentralization of licensing authority in the US (to the states rather than the Federal Government) created an environment where, despite noisily voiced insularity, no single point of view could prevail, and some hospitable niches remained available. In retrospect, we know that at least some immigrant dentists received dental degrees from US schools and subsequently went on to pass state boards and practice dentistry. Others voluntarily or involuntarily left careers in patient care behind and concentrated their work in academic positions with responsibilities in basic science teaching and research. Assessing the extent to which individuals were blocked from the pathway they would otherwise have chosen would be difficult.
(4) Sicher and Weinmann Following their exile from Europe in 1939, Harry D. Sicher and his younger colleague, Joseph P Weinmann, also brought the skills and training of the Vienna School to Chicago. Sicher became a master teacher, first at the Chicago Medical College and then at Loyola, where his presentations to students and to practitioners alike were legendary (Anatomy lecture lives up to advance notices, 1947). The more reserved Weinmann settled at the University of Illinois, where he built a research program in oral pathology that gained significant NIH grant support and served as the training ground for new generations of researchers. Frequent collaborators, Weinmann and Sicher wrote the classic "Bone and bones: Fundamentals of bone biology" (Weinmann and Sicher, 1947, 1955), which incorporated descriptions of their own research with a comprehensive treatment of the work of others in the field. Born in 1889 in Vienna, Sicher was the most senior of the group that came to Chicago, and also lived the longest. After three years as Associate Professor of Neuroanatomy at the Chicago Medical School, he joined the faculty at the College of Dental Surgery at Loyola University as Associate Professor of Anatomy and Histology in 1942 (Fig. 10), where he remained until his retirement. It was here, in 1949, that he published the first edition of "Oral anatomy", based on the German text he had authored in collaboration with Julius Tandler. The influence of Tandler and the Viennese school was clear in the volume that reviewers hailed as bridging the gap between theory and practice and demonstrating that anatomic understanding facilitates clinical work (Oral 8(2):108-1 28 ( 1997)
Figure 10. Harry Sicher, 1889-1974. Sicher at the time he joined 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 edition, edited by Lloyd DuBrul, a colleague from the University of Illinois College of Dentistry, is evidence of its significance and durability (DuBrul and Sicher, 1988). In addition to textbooks, Sicher published some eighty papers in oral anatomy and histology, many in collaboration with Weinmann. Sicher's work formed the cornerstone for the teaching of oral anatomy in the dental curriculum for decades. A broad spectrum of the dental profession drew on his work, ranging from general practitioners who came to hear his advice on the best locations for administering local anesthesia, to craniofacial biologists and orthodontists who studied his explication of the growth of the head and face. In 1967, toward the close of his career, the American Association of Orthodontists recognized his contribution to their discipline with the Albert H. Ketcham Memorial Award (Presentation, 1968). Accepting the award, Sicher reminded the orthodontists of their debt and his own to Julius Tandler, whom he described as one of the greatest teachers that he had ever met, and to his dental colleague at the University of Vienna, Albin Oppenheim, whose animal studies helped make early orthodontics the most biologically grounded of specialties. Sicher himself was regarded by his students as a brilliant teacher, and an anatomist with a respect for biology who always kept the whole living system in mind. No one who had heard him lecture could ever forget his ability to stand in front of a chalkboard and draw, with both hands simultaneously, the complementary halves of an
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Figure 11. Joseph Peter Weinmann, 1896-1960. IL Dent J 29:772, November, 1960. Reprinted with permission.
anatomical structure! Sicher maintained his contacts with the College of Dental Surgery at Loyola and the University of Illinois until his death in 1974 at the age of 85 (Gowgiel, 1975). Joseph Peter Weinmann, born in Bohemia in 1896, joined Gottlieb as a research associate in his laboratory in Vienna in 1923 immediately after gaining his medical degree. On coming to the US in 1938, he spent one year at the College of Dentistry at the University of Illinois and a year at Columbia University before joining the Dental School at Loyola University as an Assistant Professor of Oral Pathology. In 1946, he joined the University of Illinois Department of Histology as an associate professor and in 1949 became Professor and Head of the Division of Oral Pathology, a position he held until his death in 1960 (Fig. I). Weinmann was a prolific researcher, publishing more than 160 articles on bone physiology and pathology, amelogenesis, normal and pathologic oral epithelium, and periodontal disease. His greatest achievement, however, was the creation of a department at the University of Illinois that for twenty years trained many of those who would lead academic dentistry in this country and elsewhere. Almost alone among the Viennese group,
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Weinmann benefited from the increasing grant funding that a well-supported National Institutes of Health offered to academic researchers in the health sciences. For example, in an era in which the average NIH grant was about $13,000, Weinmann in 1957 held six grants from NIH for a total funding of just over $90,000 (National Institute of Dental Research, Grants and awards funded between fiscal years 1947-1960, unpublished computer printout, 2/14/96). A catalyst in the research enterprise in Weinmann's laboratory was lulia Meyer, herself a refugee from Nazi Europe, who joined the Division of Oral Pathology at the University of Illinois in 1953 following completion of her PhD at the University of Chicago. Working on the biology of oral epithelium, Weinmann and Meyer developed a significant research and graduate training program that continued until Meyer's retirement in the mid-1980's. An important focus of this research was the structure of the tissue in terms of function, the classic Viennese approach, and for several editions, Julia Meyer prepared the chapter on oral mucosa for Orban's "Oral Histology and Embryology". Peter Weinmann's death in 1960 occurred within a few weeks of that of his colleague, Balint Orban (Sicher, 1960b). Many of those who passed through the University of Illinois oral pathology program in the department during this period have gone on into significant professional and academic positions in the US, including Olav Alvares, Erwin Barrington, Surindar Bhaskar, Sow-Yeh Chen, Stanley Gerson, loseph Henry, Klaus Nuki, lames Sciubba, and Leo Sreebny. Many also came from abroad to 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 Gottlieb
Although Orban, Sicher, and Weinmann were drawn to the research community that had grown up over the past two decades in Chicago, Gottlieb clung to Europe. Putting his wife and son on a flight to London, and with the assistance of non-lewish friends, he escaped east overland and then vici the Black Sea to Palestine, carrying crates of his histological specimens with him (Harold B. Younger and Frank Wentz, unpublished interview; Strauss and Roder, 1983). In the pioneering lewish community in Palestine and the university at Tel Aviv, Gottlieb hoped to find a locale where he could re-create the Dental Institute in an environment which would embody a kind of Talmudic ethic of inquiry (Gottlieb, 1943; Stein, 1950; In mernoriam, 1950; Obituary: Professor Bernard Isic) Gottlieb, 1950). As that part of the world became drawn into the war, however, Gottlieb realized that 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. So Gottlieb looked for another place to restart his career. He apparently tried, unsuccessfully, to find a position in England, where he had often lectured to admiring fellow researchers. In 1940, he turned to the United States, first taking a visiting professorship at the University of Michigan and then finally, in 1941, settling at Baylor College of Dentistry in Dallas (Fig. 12). The oldest dental school in Texas, the former State Dental College had been organized in 1905 as a proprietary establishment. In 1918, as the move away from proprietary dental schools began, the owners of State negotiated an affiliation with Baylor University, and the school became Baylor Dental College (Gies, 1926; Stout, 1969). By the early 1940s, small in enrollment and faculty size, the school's administrators struggled to maintain a basic science dental curriculum without the assistance of the medical school, which completed a move to Houston in 1943. His learned background and the opportunity to develop a research program encouraged Baylor alumni in the Dallas County Dental Society to propose Gottlieb's name to the dean, offering to raise funds to supplement what the College could afford to offer in salary (William C. Hurt, personal communications, 1995, 1996). Gottlieb accepted and remained at Baylor until his death in 1950 at age 65. Gottlieb struggled to establish a research program during his years at Baylor, with limited financial resources and with colleagues who were willing, but with little or no research background. Cut off from the mainstream of dental research by distance, language barriers, and his own sense of alienation from his more fortunately placed former students and colleagues in Chicago, he never again achieved the recognition he had enjoyed as director of the Dental Institute in Vienna. Even before his arrival in the United States, his "Biology and pathology of the tooth and its supporting mechanism" (Gottlieb and Orban, 1938), co-authored with Orban, had received mixed reviews. The work was an English-language translation, drawn from material published in Austria as "Zahnfleischentzundung und Zahnlockerung" (Gottlieb and Orban, 1933). A reviewer in the lournal of the American Dental Association, illustrating the unwillingness of some elements of the profession to examine the biology of tooth structure, labeled Gottlieb's description of the epithelial attachment a "so-called fact" and the Vienna researchers' caution against allowing restorative procedures to disrupt the attachment as "dogmatic" and a mere "philosophic" interpretation (Biology and pathology, 1939). Before the war, Gottlieb had collaborated frequently with Sicher and Orban on research reports and books, but from the time that he left Vienna to begin his odyssey until his death, Gottlieb never again published with these colleagues.
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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 the central issue in dental research as the large Federally funded fluoride studies began to be mounted in the 1940s (Gottlieb, 1939). Gottlieb fully understood, perhaps earlier than most, that tooth structure was dynamic living tissue, that the metabolism of micro-organisms functioned in some way to weaken enamel, and that constituents of human saliva might protect against caries. He began trying to modify and strengthen tooth enamel with various combinations of chemicals, including silver nitrate, zinc chloride, and potassium ferrocyanate, which he believed would unite with enamel to form an insoluble compound, thus blocking bacterial entry by providing a "defense mechanism along the organic roads of invasion" (Gottlieb, 1944, 1947a). Working without external funding, Gottlieb and colleagues in Texas and elsewhere tested this methodology in small groups of children and reported positive results (Gibson, 1950; New York Times, 1950). For example, Gottlieb reported that, at the end of one year, caries incidence in a group of 25 children who had been treated with a silver nitrate compound averaged 0.44 cavities per child compared with an average of 4.2 cavities per child in a control group of five (Younger, 1944, Gottlieb, 1947b, p. 229). Subsequent research in the 1950s and 1960s, with more powerful microscopy technologies than were avail-
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able to Gottlieb, would demonstrate the flaws in his hypotheses on the initial causes of dental caries (Mandel, 1955; Silverstone et al., 1981; Newbrun, 1983). In the late 1940's, however, dental caries researchers focused most of their attention on prevention. Whatever its potential value may have been, Gottlieb's caries prevention methodology was eclipsed by the great fluoride studies of the 1940s, funded and widely publicized by the United States Public Health Service and, after 1948, by the National Institute of Dental Research. By 1947, the year Gottlieb published his book, "Dental Caries", describing the theoretical basis for his caries prophylaxis, most of the rest of the dental research community, led by Public Health Service researchers, believed it had only to decide between water fluoridation or topical fluoride application as the most efficacious method of preventing caries (Harris, 1989). Gottlieb's reports, drawing on small samples and illustrated with his signature histological sections, and emanating from an obscure dental school in Texas, drew little attention. Only three years later, in 1950, with the Grand Rapids water fluoridation study still more than a decade from completion, Bruce Forsyth, chief dental officer in the PHS, endorsed mass water fluoridation as a public health initiative. Gottlieb died the same year. Baylor College of Dentistry cherished its eminent professor while he served on its faculty and after his death. In 1981, he was the first individual recognized in the newly established Baylor College of Dentistry Hall of Fame, with a plaque honoring his memory. At least some of his histopathological work has been preserved and is still drawn on occasionally for study (Dr. Bernhard Gottlieb, 1947; Davis and Jones, 1985; Krayer and Rees, 1993). In the decades since 1960, the College's research establishment has evolved into a nationally respected entity. Although Gottlieb's contributions to our understanding of the structure and function of the teeth and oral soft tissues were significant, his greatest legacy to dentistry may have been the tradition of careful systematic inquiry his leadership instilled. His career, and the careers of the students and colleagues who had worked with him in Vienna, enriched the scientific foundations of dentistry and, perhaps even more significantly, helped lay the foundation for a vigorous research enterprise in the United States.
mal and pathological conditions in oral soft tissues, especially periodontal disease (Gottlieb, 1921, 1926a,b, 1927). With Orban, he reported new information on the effects of traumatic occlusion (Gottlieb and Orban, 1931). Orban extended Gottlieb's work on the epithelial attachment and its role in periodontal disease, frequently emphasizing the importance of taking the structure into account in the design of dental restorations (Orban, 1941; Orban and Wentz, 1954; Orban et al., 1956). Orban's text on the treatment of periodontal disease (and its subsequent editions) remained a standard for many generations of dental students (Orban, 1958). Although he wrote about soft tissue with Orban (Orban and Sicher, 1945), Harry Sicher's work focused primarily on bone. Continuing in the tradition of his mentor Julius Tandler, Sicher always viewed tissues as components of a dynamic, changing organism. His descriptions of the movement of teeth in eruption and the relationship of bone growth to tooth movement had particular relevance for the clinical practice of orthodontics (Sicher, 1942; Sicher and Weinmann, 1944). His understanding of the structure and function of the jaws had practical value for the delivery of local anesthetic and for the understanding of temporomandibular joint disorders (Sicher, 1948, 1952, 1954). Although Peter Weinmann was about the same age as his Vienna colleagues (younger than Gottlieb and Sicher, older than Orban), his career represented a bridge to the next generation of oral biologists. Beginning his research with studies of bone (Weinmann, 1941; Sicher and Weinmann, 1944) and enamel (Weinmann et al., 1942; Weinmann, 1943), Weinmann later concentrated on oral epithelium. In his collaboration with Julia Meyer, he moved oral soft tissue research to a new level, drawing on histochemical techniques (Weinmann et al., 1959), describing keratinization in more detail (Weinmann et al., 1960), and examining mitotic activity and rates of growth for better understanding of cell function and renewal (Meyer et al., 1960). He drew his students from the basic sciences as well as from dentistry, further broadening the scientific foundations of clinical practice and expanding the scope of oral biology. The careers of Gottlieb, Orban, Kronfeld, Sicher, and Weinmann represent only a small fraction of the stories that could be recounted concerning the successful and unsuccessful transplantation of scholarly careers resulting from the tragedies of World War II (Ash and Sollner, 1996). Recognition, by leaders in the US dental profession, of the need for strengthening the biological foundation of clinical practice and for an active research enterprise helped create opportunities for the refugee scientists. International scientific and professional networks established in the 1920s facilitated the moves. A strengthened synthesis of the technical and biological foundations of dentistry resulted and continues to be
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(IX) Conclusion: The Contributions of the
University of Vienna Oral Biologists
The fortuitous juncture of the Vienna school's biological orientation and American technical expertise enriched dental research, education, and clinical practice. Gottlieb probably made his most significant contributions before he left Vienna. Most important was his description of the epithelial attachment, along with his description of nor124
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developed in our own time. In addition to their knowledge and research skills, the Vienna-trained dentist-scientists brought an approach to learning and a scientific culture of investigation which continues to play a significant role in the development of research programs here and abroad. Forced migration afforded opportunities to all participants. Recognition of the intellectual flowering growing out of this conjunction of two cultures seems worthy of our attention, if only to remind us again of the value of our differences.
education and colleges. Paper read before Chicago Dental Club. Dental Cosmos 34:95-98. Berkley GE (1988). Vienna and its Jews: The tragedy of success, 1880s-1980s. Cambridge, MA: Abt Books. Bhaskar SN, editor (1990). Orban's oral histology and embryology. 11 th ed. St. Louis: Mosby. Biology and pathology of the tooth and its supporting mechanism (book review) (1939). J Am Dent Assoc
26:847. Black CE, Black BM (1940). From pioneer to scientist: The life story of Greene Vardiman Black "father of modern dentistry" and his son Arthur Davenport Black, late Dean of Northwestern University Dental School. St. Paul, MN: Bruce Publishing Co. Black GV (1908). A work on operative dentistry. Vol. 2. Chicago: Medico-Dental Publishing Company. Bunting RW (1939). The educational problem presented by the refugee dentist from Europe. American Association of Dental Schools. Sixteenth annual meeting, March 20-22. Proceedings, pp. 41-46. Chicago Tribune (1940a). Dr. R. Kronfeld is found dead in Loyola lab. Feb. 14, p. 26. Chicago Tribune (1940b). Death of Loyola Professor held suicide by jury. Feb. 15, p. 16. Coolidge ED (1926). Dental pulp case histories and root canal filling records. Federation Dentaire Internationale. Seventh international dental congress, Philadelphia, August 23-27. Transactions, pp.
323-326.
Acknowledgments
The authors would like to thank the many individuals who contributed to preparation of this paper. At the beginning of our research, Professor Mitchell G. Ash, History Department, University of Iowa, pointed out several important resources and suggested valuable conceptual approaches based on his own research on the forced migration of Jewish scholars and scientists during World War II. Professor Guenter Zoeller, Philosophy Department, University of Iowa, assisted with reading German documents. Eric Corbin and the staff of our Educational Media Service prepared the photographs. Ms. Mary Ann Williamson, NIDR. supplied information about early Federal grant funding in dentistry, Drs. B.F. Dewel and Bernard G. Sarnat shared information about their personal experiences with some of the Viennese scientists. A discussion with Dr. Richard Ten Cate helped clarify some scientific issues. Several colleagues read preliminary drafts of the manuscript and offered 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, and Ernest Newbrun. The contributions of William Hurt to this project have been invaluable. In addition to generously sharing his own research files, photographs, and knowledge, his enthusiasm and continued encouragement throughout the project have been very much appreciated. Finally, we are grateful for the interest, advice, and patience of our editor, Dr. Olav Alvares, who is himself a part of the story.
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Critical Reviews in Oral Biology & Medicine

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(11) Dentistry in the United States in the 1 920s

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Figure 1. William H.G. Logan, 1872-1943, Dean, Chicago

(IV) Dentistry at the University of

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(V) European Dentistry and

the Chicago Schools

Figure 2. Bernhard Gottlieb, 1885-1950. Photo courtesy of William C. Hurt.

(VI) Gottlieb and the 1926 International Dental Congress in Philadelphia

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(VIl) The Research Institute at Loyola

(B) RUDOLF KRONFELD

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R.W. Bunting, Dean University of Michigan (Bunting, 1939)

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Figure 12. Bernhard Gottlieb at Baylor, 1945. Photo by A.K.

(IX) Conclusion: The Contributions of the

University of Vienna Oral Biologists

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