Rethinking “Teething” Deaths

“All experience teaches that dentition is to be dreaded.” [1] Though it seems laughable to modern parents, this was the prevailing attitude until fairly recently. [2] At least from the time of Hippocrates teething was believed to be a perilous time for children. [3] When my daughter began teething I expected nothing more than some irritability and drooling. My ancestors may have feared for their children's lives. It is easy for us to dismiss this fear because we have the advantage of knowing it is baseless. Our ancestors didn't have that luxury.

I didn't grasp how very great the fear for teething infants was when I began looking into deaths attributed to teething in Michigan. “Isn't it funny,” I thought “that they believed these children died from teething.” Then I came across a book written by Jean Baumes, published in French in 1783 and translated into English in 1841 (by T. Bond). The entire book, about 160 pages, was devoted to the dangers of teething, diseases attributed to teething and remedies for them. I scanned it from cover to cover to obtain a better understanding of the subject. When I finished I felt as though I had been transported back in time to when the four bodily humors were on the cusp of medicine. While there is still much we don't know about how the human body functions, there is no question that teething does not cause diarrhea, constipation, convulsions or death.

Teething was believed to cause numerous ailments, for which the author could only provide vague explanations. The basic belief seemed to be that nerves directly connected the gums with the rest of the body and when the gums were swollen and painful with teeth about to emerge, the inflammation and irritation spread throughout the body, wrecking havoc. [4,5] Two major classes of illnesses were attributed to difficult teething; one involved the digestive tract primarily including diarrhea and constipation, but not excluding “vomiting, cough, colic or hiccough.” [4] The nervous system was the other supposed target. Minor symptoms might include restlessness, twitching, and fitful sleep which were believed to increase the risk of more serious complications. [6] By “the exhaustion and irritation which are thus produced [from teething], the nervous system of the child becomes deranged, and convulsions follow.” [5] Even cases of “dental paralysis” were suspected of arising from teething, usually in response to canine emergence. [7]

Some children successfully cut their teeth without incident. This was believed to occur when the child was born to healthy parents and “the mother has restrained her passions during pregnancy – has preserved a tranquil mind and avoided excesses in ailment.” [8] The more a child's situation deviated from the above ideal the more likely he was to experience consequences from teething. [8] Improper care of the child was believed to be detrimental, or as Baumes put it “Does any one doubt that errors of diet and abuses of regimen occasion difficult dentition?” [9] Baumes described a vicious cycle between the body and teething. “Feebleness of constitution, exuberance of fluids, engorgement of the principal organs of nutrition, and the organic disorders of those systems . . . all act more or less injuriously upon the formation and development of the teeth: and on the other hand dentition encountering obstacles from the gums and walls of the alveoli [tooth sockets], re-acts upon the whole machine and produces consequences of which death is often the result.” [10] In other words, a poor constitution and preexisting conditions “more or less directly impede dentition” while reciprocally, the act of teething can affect the whole body, sometimes fatally. [11] Baumes then proceeded to describe these teething-induced disorders in detail (77 pages in all), providing case studies and remedies. [12] Among Baumes' treatments for teething-induced diseases, were injections, enemas, purgatives, emetics, bleeding and leeching, in addition to more mild ones like drinks, baths and liniments. [13, 14] In treating dentition-induced convulsions, one doctor boasted he had saved lives by performing enemas on children made unconscious, sometimes for hours, with chloroform. [15]

The basis for this belief system was that the new teeth had difficulty piercing the gum tissue. [16, 17] Baumes put it this way, “it is reasonable to suppose that [gum] tissue is very often too dense and hard owing to [its] pathological condition.” [18] The strain of the teeth against the gum tissue was believed to cause disease by propagating that “tension” throughout the body. [16, 17] “The Handbook For Mothers,” published in 1866 declared “it is sufficient to state the fact, that in consequence of the pressure of the teeth against the gums before they penetrate them, there arises a relaxed condition of the bowels,” among other problems. [16] One case Baumes cited was of a child who was sick with fever, could not sleep, had a distended belly and suffered from diarrhea. [19] The child also happened to be teething. [17] The author attributed all of the child's troubles to teething and encouraged the gums to be lanced, but couldn't prevail upon the attending physician. “The teeth did not come through, the gums grew pallid, the fever continued and became chronic; finally the child died in six weeks. . . The gums were examined after death. . . but nature had not been able to terminate her work and the resistance of the gums was not overcome. . . Would [lancing the gums] have prevented the train of consequences which ultimately proved fatal? The post mortem examination leaves no room to doubt it. The symptoms were caused by the unsuccessful effort of nature to bring out the teeth; the irritation and inflammation of the gums caused such a change in them as prevented their division by the natural means, and all the consequent disorder would have disappeared had the operation been performed.” [emphasis added by this author] [20]

Saliva was thought to soften the “fibres” in the gums, allowing the teeth to sever them. [18] This was, they believed, the reason teething infants produced excess saliva. [18] Occasionally, this natural means seemed insufficient to accomplish the task, spurring people to “help” nature along. To soften the gums they rubbed them “frequently and lightly. . . with fat, mucous or emollient substances. Some recommend the grease of the capon or pullet, very fresh hog's lard” or even the brains of hares. [18] Baumes scoffed at the use of fats, “ridiculous nostrums in vulgar use,” [17, 21] and was also opposed to permitting children to teethe on hard substances like coral or ivory. [21] This he believed “must harden the gums, render them callous, and cause them to resist more firmly the progress of the teeth.” [21] He saw nothing wrong, however, with permitting children to chew on a piece of licorice or mallow root because they were “instruments of soft pressure.” [22]

If the remedies to treat teething-related diseases failed, or if it was clear they would be ineffective, lancing the gums was the method of choice, if conducted “properly.” [2, 6, 7, 17, 23] This measure was designed to allow the teeth through to alleviate the nervous tension and thus cure the teething-induced disorders. [20] Dr. Parker described seeing many children suffering from diarrhea brought to a clinic. He observed that of the ones that were teething most were too weak from diarrhea to be helped, but that in the rest, there was rapid improvement after their gums were lanced. [6] Baumes wrote of a child experiencing convulsions that reportedly ceased after the gums were dissected from the emerging teeth. [24] “This case proves that the convulsions depended solely upon the resistance offered to the egress of the teeth by the dense and solid gums, and demonstrates the necessity of dividing the parts for the relief of such affections.” [24] “A simple incision is not always sufficient to remove the difficulty. Frequently, if the operation be not carried further than this, the unpleasant symptoms will recur from the swelling and inflammation of the wounded parts. All observers agree upon this point.” [24] He then mentioned a case in which the gums were lanced, but the flaps of skin were not excised. The gums allegedly formed scar tissue and the child's spasms returned. Baumes felt this should “warn young practitioners of the necessity of fully liberating the teeth.” [25] In cases when these measures did not promote recovery Baumes recommended breaking the tooth socket or even extracting the tooth as a last resort. [26]

I think it is safe to say that no children perished because of a systemic reaction to teething. So, the question becomes, what did the children whose deaths were attributed to teething actually die from? That is difficult to say. Gibbons and Hebdon published a brief study on “teething” deaths between 1847 and 1881 in Utah. [27] They attempted to determine if these deaths were possibly caused by SIDS or cholera infantum, by comparing the average age of death and the months in which the children died. [27] No clear trends emerged from their analysis, however, indicating that no single cause of death could explain the “teething” fatalities in their study.

After reading Baumes' book, I don't find this at all surprising. If children with symptoms as diverse as diarrhea, convulsions and ricketts were all believed to have died from teething then I think to look for a single diagnosis to fit all “teething” deaths is unrealistic. I suspect that these poor children died from any number of causes from contaminated food or water to communicable diseases. Many children under the age of two died during this time and their deaths just happened to coincide with teething.

Just for the record, the number of reported deaths in Michigan attributed to teething ranged from 21 to 106, with an average of 68 deaths/year between 1868 and 1895 (with data for 23 of those years). [28-38] After 1895 I was unable to find any “teething” deaths in the annual Michigan reports. 

1. Thomas E. Bond, Jr., translator, A Treatise on First Dentition And The Frequently Serious Disorders Which Depend Upon It (New York: Fraetas & Kelley, 1841) (translated from the French version written by Jean Baptiste Timothee Baumes and published in 1783) 17.
2. Rebecca Tannenbaum, Health and Wellness in Colonial America (Health and wellness in daily life) (Santa Barbara, California: Greenwood, 2012) 74.
3. Bond, A Treatise on First Dentition, 122.
4. Bond, A Treatise on First Dentition, 84.
5. Edward H. Parker, The Handbook For Mothers; A Guide In The Care Of Young Children, 2d edition (Toronto and Chicago: Belfords, Clarke & Co., 1880) 83-84.
6. Parker, The Handbook For Mothers, 88.
7. Robert Bell, Our Children, How To Keep Them Well And Treat Them When They Are Ill: A Guide To Mothers, 3d edition (New York: Frederick A. Stokes Co.: 1890) 46. (accessed at HEARTH (Home Economics Archive: Research, Tradition, History) at Cornell University Library (http://hearth.library.cornell.edu/h/hearth/) 21 Mar 2013)
8. Bond, A Treatise on First Dentition, 19.
9. Bond, A Treatise on First Dentition, 32.
10. Bond, A Treatise on First Dentition, 79.
11. Bond, A Treatise on First Dentition, 54.
12. Bond, A Treatise on First Dentition, 82-159.
13. Bond, A Treatise on First Dentition, 109.
14. Bond, A Treatise on First Dentition, 149.
15. Bell, Our Children, 47.
16. Parker, The Handbook For Mothers, 86.
17. Bond, A Treatise on First Dentition, 80.
18. Bond, A Treatise on First Dentition, 51.
19. Bond, A Treatise on First Dentition, 79.
20. Bond, A Treatise on First Dentition, 80-81.
21. Bond, A Treatise on First Dentition, 53.
22. Bond, A Treatise on First Dentition, 52.
23. Bond, A Treatise on First Dentition, 150.
24. Bond, A Treatise on First Dentition, 154.
25. Bond, A Treatise on First Dentition, 155.
26. Bond, A Treatise on First Dentition, 157.
27. Harry Gibbons and C. Kent Hebdon, “Teething as a Cause of Death, A Historical Review,” Western Journal of Medicine 155 (December 1991): 658-659.
28. Secretary of State of Michigan, First Annual Report Of The Secretary Of State Of The State Of Michigan, Relating To The Registry And Return Of Births, Marriages, and Deaths, For the Year Ending April 5^th, 1868 (Lansing, Michigan; John A. Kerr & Co., 1868) 59.
29. Secretary of State of Michigan, Third Annual Report Of The Secretary Of State Of The State Of Michigan, Relating To The Registry And Return Of Births, Marriages, and Deaths, For The Year 1869 (Lansing, Michigan; W.S. George & Co., 1870) 126.
30. Secretary of State of Michigan, Fourth Annual Report Of The Secretary Of State Of The State Of Michigan, Relating To The Registry And Return Of Births, Marriages, and Deaths, For The Year 1870 (Lansing, Michigan; W.S. George & Co., 1872) 229.
31. Secretary of State of Michigan, Seventeenth Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1883 (Lansing, Michigan; W.S. George & Co., 1885) 228.
32. Secretary of State of Michigan, Nineteeth Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1885 (Lansing, Michigan; Thorp & Godfrey, 1887) 144.
33. Secretary of State of Michigan, Twenty-Second Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1888 (Lansing, Michigan; Robert Smith & Co., 1890) 211.
34. Secretary of State of Michigan, Twenty-Fourth Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1890 (Lansing, Michigan; Robert Smith & Co., 1892) 201.
35. Secretary of State of Michigan, Twenty-Fifth Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1891 With A Review Of The Results Of State Registration For Twenty-Five Years, 1867-1891 (Lansing, Michigan; Robert Smith & Co., 1893) 207.
36. Secretary of State of Michigan, Twenty-Sixth Annual Report Relating To The Registry And Return Of Births, Marriages, and Deaths In Michigan For The Year 1892 (Lansing, Michigan; Robert Smith & Co., 1894) 206.
37. Secretary of State of Michigan, Twenty-Eighth Annual Report Relating To The Registry And Return Of Births, Marriages And Deaths in Michigan For The Year 1894 (Lansing, Michigan: Robert Smith Printing Co, 1897) 302.
    
38. Secretary of State of Michigan, Twenty-Ninth Annual Report Relating To The Registry And Return Of Births, Marriages And Deaths in Michigan For The Year 1895 (Lansing, Michigan: Robert Smith Printing Co, 1897) 181.