THE DOCTOR'S BAG

PULL THAT TOOTH, DOC!

Keith Souter aka Clay More

If you had a look at the post DIG IT OUT, DOC! in which we looked at arrow wounds, you may have been expecting Part 2 this month, about bullet wounds. But I thought we'd save that for later and this time cross boundaries and look at dentistry, because your average frontier doctor would very likely have to deal with his fair share of oral and dental problems. In the absence of a qualified dentist  the doctor may have been a preferable option than the blacksmith, or anyone else who could wield a pair of pliers or tongs.

I am actually working on a series of short stories at the moment for High Noon Press, about Doctor Marcus Quigley, a qualified dentist, gambler and occasional bounty hunter, so dentistry is very much on my mind at the present. Each story is from Doc Quigley's casebook, but they are all linked, like the matinee serials of yesteryear  to tell a larger complete story. The first is called DEAD IN THE SADDLE and the second, GUILTY AS SINNED is due out today!

Dentistry in ancient days
Teeth have always been of prime concern to people. The pain of toothache, the agony of gumboils, the smell of halitosis, and the unpleasant appearance of black, yellow or dirty teeth have caused people to seek the ministrations of all manner of practitioner over the centuries.

The ancients believed that dental caries was the result of a toothworm that got inside the tooth and ate it away. The Babylonians attempted to smoke these irritating creatures out by a quite ingenious method. As long ago as 2250 BC they mixed henbane with beeswax and then heated it in order to produce smoke. This smoke was directed into the carious hole, after which the hole was filled with a sort of gum mastic and more henbane.

The Egyptians had specialist physicians who would deal with teeth and gum problems. They seemed to do little in the way of removal, their treatments mainly consisting of magic rituals, charms and sacrifices to appease the gods, then the use of various purgative, enemas and masticatory agents which when chewed would encourage the production of saliva.

The Etruscans in the first millennium BC seem to have been the first people to use false teeth. They even made bridges so that false teeth could be anchored to normal teeth by rings of gold. Archaeologists are unsure, however, whether these were designed for the use of the living, or whether they were made to enhance the look of the body after death.

The Greeks actually recognised that sometimes teeth need to be pulled in order to allow an abscess to be released. The great Hippocrates even invented some crude forceps for the purpose.

The Romans built on the work of the Greeks and developed a series of instruments specifically for work on the teeth. They also worked gold into crowns for the teeth and different types of forceps for tooth pulling. Mostly dental care was restricted to the nobility and caries, gum disease and ultimately toothlessness were the norms for the bulk of the population.

As for mouthwashes, one of the most widely advocated in Roman times was urine, especially the freshly passed urine of young boys.

The middle ages

Although universities were starting to spring up across Europe, at Padua, Salerno, Bologna, Montpellier and Paris, and in Britain at Oxford and Cambridge, yet knowledge about teeth and their care did not really advance from the days of the Romans. Medical texts were reprinted, but the treatments and recommendations were still a mix of magic and multi-ingredient medication, coupled with purgation and emesis.

St Apollonia of Alexandria was the patron saint of toothaches. She had been a deaconess who was martyred by the Romans in 249 AD, after riots inspired by her teachings. When she refused to renounce her religion she had her teeth pulled one by one and her jaw broken. She then threw herself into a fire after saying in her prayer that she hoped no-one would experience her pain and suffering or the agony of toothache. Such was the power of the Church and the belief in the saint that many would probably receive relief from toothache by praying to her. Whether that relief was the result of saintly intervention or the power of the placebo effect is another question.

For the common people recourse was often made to remedies from the old leech books (from the Anglo-Saxon leche, meaning ‘leach’, the sign of a doctor). These would advise that caries could be cleared of our old friend the toothworm by the smoke of henbane, or after being packed with mixtures containing substances like ground beetles and lizards or raven dung.

And of course tooth-pulling would be the most effective way of dealing with agonising toothache. Putting up with the pain of the extraction would for many be preferable to the agony of the underlying abscess or nerve pain. Physicians did not generally like to get their hands dirty, so tooth-pulling was done by barber-surgeons or itinerant tooth-pullers. 

These itinerant tooth-pullers or mountebanks could make a decent living by going from town to town and market to market, setting up their stall with a flag or poster of St Apollonia, a string of wooden teeth or a carved crocodile with sharp teeth. They would climb on their crude box or stage and bring in crowds with their claims of being able to pull teeth without pain, or with such speed that there would be minimal pain. Any teeth that proved difficult to extract would be left alone with the advice that they must not be removed, since the pain they had experienced was because they were ‘eye-teeth.’ This was of course another of the myths that was promulgated, that they were in some way connected to the eyes and that blindness could result if they were pulled.

The favoured instrument was called the Pelican, a large instrument like pliers, which would inspire fear in the mind of the sufferer as a tooth-puller advanced with it poised.

The tooth-pullers also offered their quack remedies or mouth washes that were guaranteed to whiten black teeth and turn them into ivory. Doubtless they had many tricks and ploys up their sleeves or in the mouths of the paid confederates in the audience. By all accounts these mountebanks were great crowd drawers with their teeth-pulling, for such is the darker side of human nature that people often revel in watching the misfortune of others.

The age of enlightenment

A more scientific basis for Medicine and Surgery started to develop in the eighteenth century, but still there were some colorful quacks.  One such person was  the mountebank Martin van Butchall, who rode about London in the 1770s on a large white horse painted with purple spots. He carried a bone before him and declared that he could draw teeth painlessly and also manufacture a set of false teeth and fit them absolutely painlessly.

A natural showman he went beyond the bounds of taste and introduced a macabre reason why clients should go to see him, which they did in droves. When his first wife died he had her embalmed; had glass eyes fitted to the corpse, which he  kept in a glass case in his hall. There he introduced her to all of his guests.

His second wife was not so enamoured by the presence of his first wife in the family home, so reluctantly, van Butchell donated the body to the Royal College of Surgeons, where it was kept until it was destroyed along with many other exhibits when the building was bombed during the Second World War.

Pierre Fauchard (1678-1761) is regarded as the father of modern dentistry. His landmark book Le Chirurgien Dentiste (the Surgeon Dentist) was first published in 1728 and set the standard for the emerging discipline as a specific specialty of surgery. Drawing on his early experience as a ship’s surgeon he wrote about surgical procedures to treat diseased gums and teeth and all manner of injuries to the mouth and jaws. He used silk, linen and metal suture material and taught how to make dentures, bridges and crowns.

He also advocated the use of the toothbrush. It was only at the end of the seventeenth century that people began to use them with any regularity.

Fauchard’s work found its way across the channel and in the 1750s the word ‘dentist’ was adopted into English. An apprenticeship type of profession arose, it taking four or five years to become experienced enough to set up a sign or a brass plate and establish a practice of one’s own.

Waterloo teeth
The craft of dentistry began to develop. Interestingly, as trade increased so too did the importation of sugar from abroad. Many people developed a sweet tooth, which ultimately was followed by rotting teeth. Cause and effect was not apparent and although surgical dentistry was improving, yet many dentists still believed in the mythical toothworm. Their main function was to pull teeth and prepare false ones.

The best false teeth that could be obtained, however, were human ones. Although dentists had experimented with porcelain, ivory and bone, none of these materials was ever as good as the enamel-covered human tooth. This created a huge problem, of course, since they were hard to come by and the law of supply and demand forced the price of dentures ever upward. Some dentists advertised to buy teeth from people willing to sell theirs for a guinea or two a tooth, the highest price going for the incisors.

George Washington, the first President of the USA was reputed to have a wooden set of dentures. In fact this is a myth, since he had a very fine set of dentures consisting of a smoothed plate of hippopotamus ivory into which human, horse and pig teeth were inserted.

 

                                       George Washington's teeth

Pull that tooth, Doc

The Pelican was the first purpose-made instrument for pulling teeth. early examples date from the 14th Century.

This was succeeded by the tooth key, which saw use throughout the 17th and 18th century, right up to the mid-18th, when it was still being used. Doc Marcus Quigley still occasionally uses one when the situation is right.

Fill that cavity Many dental practitioners did attempt to fill cavities. Indeed Fauchard advocated using tin or gold foil, although he found that tin was more effective. It was not until the 1830s that dentists started to prepare the cavity by removing the caries first. Accordingly they started using a bur and thimble to remove as much carious tissue as possible.

One of the greatest aids was the dental mirror, which allowed dentists to see behind teeth. The image is reversed, of course, so you ave to learn how to use them.

A drill based on the Archimedean screw; essentially a hand-drill was introduced from the 1840s, but it had to be used with both hands and it was limited in accessibility. It was not until 1871 that an American dentist, James Beall Morrison (1829-1919) invented the foot treadle drill that this problem was overcome. It was one of the most important dental inventions ever.

The dental chair had been another advance that almost became a dental icon. Custom-made wooden ones were introduced in 1850 with special curves to allow the patient to get into the best position for the operator. Once again, Dr Morrison was at the forefront of this development and the Morrison chair became popular throughout the USA.

In the early part of the nineteenth century dentists started experimenting with amalgams as filling agents. Generally, however, gold was preferred and although silver-mercury amalgams called succedaneum, meaning ‘artificial substitute’ were introduced, it did not become used generally until towards the close of the century. Indeed, in America its use was banned and a dentist could be struck off their register for using it.

Pain was always a problem and early dentists made their name, as did surgeons, by virtue of their speed. Complex procedures were not feasible, unless the patient was drunk.Then in 1846 in America Dr William T G Morton (1819-1868) introduced ether to permit painless extractions and the field of anaesthesia was born.

Doc Holliday
John Henry Holliday (1851-1887) must be the most famous dentist of the old west. He graduated DDS from the Philadelphia College of Dental Surgery in 1872, after a single year of study. It was not long after he started practice that he developed tuberculosis and moved west for his health. At that time the pathology of the condition was unknown, although its severity was understood. 

Although he practised as a dentist when on his travels, he primarily made his living as a professional gambler. And of course, he soon acquired a reputation as a gunman of prowess. His name is forever linked in history with that of Wyatt Earp and the town of Tombstone, Arizona.


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This month the lucky writer of a comment will win a copy of MEDICAL MEDDLERS, MEDIUMS AND MAGICIANS - the Victorian Age of Credulity by Dr Keith Souter. The names will be randomised and the winner 's name will be drawn. Keith will then just need a postal address to send a hardback copy of the book (and it will take a few days, since it will be coming from England)