In Jane Austens day as now, people obviously had to care for their teeth, and the Austen family was no exception. In two letters to Cassandra, on Wednesday 15 & Thursday 16 September 1813, Jane describes in some detail accompanying her young nieces Lizzy, Marianne and Fanny, on a visit to the London dentist Mr Spence. It was, she relates, a sad business, and cost us many tears. They attended Mr Spence twice on the Wednesday, and to their consternation had to return on the following day for yet another disagreeable hour . Mr Spence remonstrates strongly over Lizzys teeth, cleaning and filing them and filling the very sad hole between two of the front ones. But it is Marianne who suffers most: she is obliged to have two teeth extracted to make room for others to grow. When her doom was fixed says Jane Austen, Fanny Lizzy and I walked into the next room, where we heard each of the two sharp hasty Screams. Fanny came off lightest, but even her pretty teeth Mr Spence found fault with, putting in gold and talking gravely, moving Jane Austen to grave doubts about his motives. He must be a Lover of Teeth & Money & Mischief to parade about Fannys, she declares.
My first question upon reading these letters, was to wonder about the status of dentists and dentistry in Jane Austens time. There is an implication here of a respected professional person Mr Spence carrying out an accepted branch of science, namely dentistry. Let us then try to put into context this particular visit to the dentist, on an autumn day in early 19th century London.
Accounts of toothache and other oral complaints, along with suggested forms of treatment, have been found in some of the earliest texts of ancient civilisations, including China, Egypt, India and Mesopotamia. Clay tablets from Sumeria, dated sometime between 5000 and 3000 BC, record the belief that dental decay and toothache were caused by the gnawing away of the tooth by a minute worm. Its interesting to note that this belief persisted for several millennia for although it appears to have disappeared by Jane Austens time, Liza Picard, in Restoration London (1997: 105), notes that only a century before, When caries [occurred] it was thought to be due to a worm in the tooth, and an "operator for the teeth" in the local market would remove the worm and hold it up for inspection by his admiring audience.
Early civilisations had a surprisingly advanced dental knowledge, practising a great variety of dental procedures: filling or extracting decayed teeth, for example, and the splinting of loose teeth. Egyptian mummies have been found with teeth made of ivory, or of transplanted human teeth. And the ancient Greeks actually made the deduction that sweet foods caused teeth to decay something that was only scientifically confirmed in the 20th century, in the 1940s.
Over the centuries, various kinds of dental instruments and forms of treatment developed but dentistry seems to have remained essentially a craft included in the activities of surgeons or practised by itinerant healers. In early 16th century Europe in fact, dentistry was practised by barbers. It was Henry VIII who granted a charter to the Barber-Surgeons Company (later the Royal College of Surgeons). By the 17th century however, surgery and dentistry began to pass out of the hands of barbers, and dentistry gradually became a specialty with its own literature. It was France, particularly under Louis XIV, that led the way here.The title surgeon-dentist is first recorded in 1622, with prescribed examinations to be passed before anyone could practise this newly recognised field of surgery.
England was not far behind. Although, as we have seen above, there were still operators for the teeth in the local markets in Restoration London, the first English text on dentistry was published in 1685, and by the middle of the 18th century, the term dentist had replaced that of operator for the teeth. George III (whose long reign coincided with Janes lifetime) had his own dentist, William Green. In England and in France, women practised dentistry, and some combined this with other skills, such as a Madame Silvie who made and fitted artificial teeth but also made snuff-boxes and tweezer cases.
But to come back to Jane Austens time. In 1771, four years before her birth, John Hunter, an anatomist and surgeon published A Natural History of the Human Teeth. In 1799, one Joseph Fox was appointed dental surgeon at Guys Hospital, and at the same time, lectures on dentistry were set up in Guys, and also in hospitals in a number of other areas. Dentistry as a science was, then, developing quite rapidly in Jane Austens own lifetime. We are not told the age of Mr Spence, the dentist, but I like to think that he trained at Guys Hospital and heard Mr Foxs lectures, so that on that day in September 1813 he was practising this still newish and exciting branch of medical science on Lizzy, Fanny and Marianne. What did this entail? If the girls had their teeth cleaned, filed, extracted, and a sad hole filled, what would this have meant, in terms of dental procedures, in 1813?
Extraction always seems the most brutal of dental procedures. Liza Picard (2000 : 154-155), in her account of Dr Johnsons London, has a lovely passage about this:
The fearsome instruments designed to extract teeth usually wrenched them out sideways, once they had been loosened by careful hammering. Pulling perpendicularly without damaging the surrounding teeth and gums seems to have been beyond an eighteenth-century dentist, even when he flexed his muscles, put the patient on the floor, and took his the patients head between his the dentists knees.
Now, one doesnt imagine this happened to Marianne. She is attending the dentists some time later than the period Picard is writing of, and perhaps Mr Spence had learnt more refined methods at Guys Hospital. In fact it sounds like quite a short time elapsed between the time her doom was fixed and the sound of her two sharp hasty Screams distressed the other ladies. Although we cant be entirely certain about this, it would appear that Marianne would have had those teeth extracted without painkillers hence the screams. Anaesthesia was not established as a major tool of dentistry at this time. General anaesthesia was introduced to medical practice in the 1840s, and it was from there extended to dental practice. I suppose a man of this time might have resorted to strong drink if he knew he was to have an extraction, but a lady could never do this.
If it is true that dentistry at this time was carried out without any means to dull the pain, this doesnt mean that there would not have been remedies for toothache, or palliatives to ease the pain of toothache. There would undoubtedly have been many natural remedies oil of cloves for example has a long tradition. I came across on the Internet a remedy described as recipe for toothache using ether, from a manuscript book of recipes and prescriptions, c.1800. Its taken from a London magazine, and the date written on the recipe is actually 1827, but it is obviously from around Janes time, and so possibly used by her family or relatives suffering from toothache.
A remedy for this most painful affection which has succeeded in 95 of 100 cases is alum reduced to an impalpable powder 2 drams, nitrous spirit of ether 7 drams, mixed and applied to the tooth. At a recent meeting of the London medical society, Dr Blake stated that the extraction of the tooth was no longer necessary as he was enabled to cure the most desperate cases of toothache (unless this disease was connected with Rheumatism) by the application of this remedy.
Mr Spence cleaned the girls teeth on their first visit. Presumably he would have scraped away visible tartar, just as today. In the normal course of events, though, did people of this era habitually clean their teeth? One reads about the infrequency of washing the body, compared to our practices today, and wonders if that infrequency of attention was also extended to the care of the teeth. Perhaps not: an interesting light is thrown on the subject by one of Lord Chesterfields letters to his son, in which he urges him to wash his teeth first thing every morning with a soft sponge and warm water for 4 or 5 minutes. He does not recommend the use of any hard substance such as sticks or even a dentifrice since they damage the gums and destroy the varnish of the teeth (Picard 2000: 154).
Chesterfield was referring to the fact that there were in this period dentifrices on the market, which just as today made extravagant claims as to brilliance and whiteness. They also however (unlike today) contained substances which destroyed the enamel. Dentifrices of this era also, indeed, claimed to fasten in loose teeth, an improbable but seductive claim in an era of rampant scurvy and pyorrhoea. Fouchard, the contemporary French dentist renowned for his skill in fashioning false teeth, recommended ones own urine for cleaning the teeth. Others recommended a touch of gunpowder every now and then, and Horace Walpole put his faith in a lump of alum dissolved in the mouth as a sure expedient to keep teeth strong as indeed his were. For a toothbrush, it was common practice to bash the end of a wooden stick and scour the teeth with this, although it had the disadvantage of leaving behind splinters. The wealthy had delicate little gold-handled toothbrushes, sometimes with replaceable heads. The nearest thing to dental floss in the 18th century was toothpicks made of quills.
Lizzy, we read, had a sad hole between two of her front teeth. When teeth decayed, the decayed part was scraped away with scalpels and files, and any exposed nerve cauterised with a red-hot wire before the filling was inserted. Mr Spence puts gold into Fannys teeth, which was the most expensive filling and so we can perhaps assume that this was the preferred filling material for teeth where the client could afford it. It was certainly superior to other filling materials used then, such as lead, pitch and beeswax. Beeswax presumably would be useless in the long run, and both pitch and particularly lead, while not only tasting quite horrible, must have been quite dangerous to the system although this may not have been known at the time. There was also a type of porcelain filling used, which appeared quite effective but which had an unfortunate side-effect. It was so acidic that it killed the nerve of the tooth on impact, so that the wearer eventually ended up with a lovely white filling embedded in a black tooth. Teeth were filed then, as now, presumably to improve the bite or perhaps to effect a regularity of appearance.
Two other interesting aspects of dentistry at this time are not mentioned in Jane Austens account. I am referring here to the practices employed for remedying the loss of teeth. In this era, this was achieved either by fitting false teeth or by the transplantation of others teeth into ones own mouth Janes nieces, fortunately, were too young for such measures to be necessary. They are quite fascinating as an example of the lengths that people have always been prepared to go to in order to present to the world a full set of teeth.
Instructions for inserting false teeth on springs. An error could render the springs ineffective and prevent the false teeth from staying even roughly in place. Woodforde, The History of Vanity, Alan Sutton Publishing, 1995
False teeth have been around since long before the Christian era. The Greeks and Phoenicians used gold wire for tying artificial teeth made of bone to adjacent natural teeth, and tomb finds show that as early as 700 BC partial dentures of bridgework type were being worn. One of Queen Elizabeths suitors, apparently a very vain man, is recorded as having had several front teeth made of bone, again attached to the existing teeth by fine wire. (Elizabeth herself, however, simply padded out her cheeks to fill in the hollows made by lost teeth.) Advertisements for artificial teeth could be found in magazines of the early 18th century, like that in the Ladies Diary of 1711 which advertised teeth which did not even have to be taken out at night but which may be worn for years together (Woodforde 1992: 62). Artificial teeth could be obtained by post, in exchange for a home-made wax impression which doesnt suggest a very good fit. William Wordsworth when sitting for a portrait was asked by the painter to remove his dentures, which he considered to be distorting the look of the poets face.
George Washingtons looks, also, were apparently ruined by a series of crude false teeth that distorted his mouth irrevocably, as the pictures below show, so that in later portraits he wore cotton rolls in his mouth to soften the protrusion of the lower jaw. My own dentist told me that in the George Washington Museum in the US there is a whole section devoted to the first Presidents teeth. Having lost his natural teeth, Washington then had a sad history of failure with regard to false teeth, and never succeeded in finding ones that were a good fit.
Interestingly, there appears to have been no prejudice against false teeth in the 18th century: they were considered to be infinitely preferable to bare gums, whatever their appearance even if, as one contemporary observed, they looked like the keyboard of a spinet (Woodforde 1992: 65).
This suggests that the false teeth of this time were really more ornamental than functional, stylized in the way that 18th century wigs were. If you think of the 18th appearance of both men and women, it is obvious that there was a high tolerance for or even delight in the artificial and the obviously unnatural: it was almost an art form. Why should teeth be the exception? Certainly, false teeth of this era do not seem to have been expected to be a functional tool for eating. If you chewed on them they tended to slip sideways. So it was standard practice to remove them on coming to the table, with the men putting theirs back so that they could contribute to the conversation over the port (although port had a very bad staining effect on ivory teeth). It is not recorded what people did with their teeth when they took them out to eat did they simply place them on the table next to their plate?
Marianne had her two teeth out to make room for others in her mouth. But if as she grew older she had been unfortunate enough to need a denture, she could have resorted to yet another French invention which came out in the 1790s. This was the celebrated mineral paste dentures made by Nicholas Dubois de Chemant of Paris: false teeth with base and teeth made in one solid piece of shiny, rot-proof porcelain. These teeth conjure up a startling image: shiny, fresh pink gums and a beautifully painted line of teeth, not actually separated from each other (this gave extra strength) but nicely shaded in. Chemants teeth were a sensation for a while, even inspiring a verse from an 80 year old French general, General Comte de Martagne:
The juxtaposition of these two portraits of the younger and older George Washington shows the dramatic re-shaping of his face by poorly fitted false teeth in his later years. From John Woodforde, The History of Vanity, Alan Sutton Publishing, 1992.
If false teeth did not appeal, you could, instead, choose to have teeth transplanted into your jaw. This only worked for single-rooted teeth, not for double rooted teeth like molars. The decayed tooth was drawn, and immediately, a sound tooth from another mouth was pushed into the socket. There is mention of this practice in records of both the 16th and 17th centuries, but it was in the 18th century that transplanting became almost a craze. The famous Emma (Lady) Hamilton, Nelsons lover, as a destitute young girl without a situation once resolved to sell some of her front teeth to support herself. On her way to the dentist however, she met an old fellow servant who persuaded her to resort to a rather less creditable method of making money, albeit one which did not ruin her appearance. Had she gone ahead with her original plan, we might never have had the celebrated love story!
The sound teeth for transplanting of course came from the poor, and there was apparently no lack of volunteers, particularly from the young and healthy, who were the preferred source of teeth. The procedure Hunter advised was that there should be several of these unfortunates on hand. If the first persons tooth did not suit, then one from the next person should be instantly extracted and tried. Once a reasonable fit had been achieved, the transplanted tooth had to be immobilised by tying it to the adjacent tooth with silver wire or silk thread, and with luck, the tooth would eventually take root. Picard (2000 : 55) says that sometimes even cadavers were used, adding not surprisingly, they didnt take.
The fact that there was a flourishing market for sound teeth perhaps accounts for Jane Austens comment about Mr Spence, that He must be a Lover of Teeth and Money and Mischief to parade about Fannys. As a lover of money, he could simply be attempting to increase his clients visits, and hence his fees, by fomenting anxiety about the state of her teeth, and, as Jane writes, he does indeed try to persuade them all to visit again within two months. But his hidden agenda could also have been that he was hoping to persuade Fanny to part with some of her teeth which he could then sell on for even more money. It is perhaps not surprising that Jane Austens concluding remarks about the hapless Mr Spence are that I would not have had him look at mine for a shilling a tooth and double it!
01 August 2004