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Report on BSHM Poynter Lecture 2010
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Promiscuous & Inattentive Proceedings Lecture held at the Wellcome Collection Conference Centre, Euston Road , London on 24th March 2010 |
French Dentist, by Rowlandson - Wellcome Collection |
Transplanting of Teeth, by Rowlandson - Wellcome Collection |
John Hunter, by Reynolds - Wellcome Collection |
Richard Aspin and William Schupbach of the Wellcome put together an exhibition of relevant artwork and books from the Wellcome Collection; the lecturer Ruth Richardson was also involved in the choice of material.
It included the images above which are supplied from the Wellcome Library London
under licence Creative Commons by-nc 2.0. Image details are:
A French dentist showing a specimen of his artificial teeth and false palates.
Coloured engraving 1811 By Thomas Rowlandson (L0000328.)
A fashionable dentist's practice: healthy teeth are being extracted from poor children to create dentures
for the wealthy. Coloured etching by T. Rowlandson, 1787. (L0013320)
John Hunter (1728-1793), surgeon and anatomist. Oil painting after Sir Joshua Reynolds. (L0005712)
There were other cartoons by Rowlandson, books by Hunter, and a life of Hunter. There was also a fine painting showing Oliver Goldsmith's medical advice being rejected in favour of advice from an apothecary. Some of the books are available (from other libraries) in Google Books and there are quotations and links in the lecture report below.
Report by David and Barbara Hawgood.
The announcement of the lecture was "The modern discipline of ethics in Medicine and Surgery is regarded as postdating the Nuremberg Trials, and has become largely the preserve of philosophers. In the Georgian era, by contrast, doctors (some of them eminent) - and others - were ready to comment in public upon questionable medical behaviours. In this lecture Ruth Richardson will examine a range of British humanitarian commentary in the context of the Medicine and Surgery of the period."
By introducing the subject through the example of dentistry, tooth transplantation, venereal disease, and the life of John Hunter, with fascinating illustrations from the Wellcome Collection, Ruth Richardson gave a lecture of interest to all. The "etiquette" side was illustrated by letters between doctors about difficult cases. The ethical questions are both whether teeth should be taken from the poor and supplied to the rich, and also whether the recipients should be warned of the risk of infections like venereal disease.
John Hunter was introduced through his famous quotation "Why think? Why not try the experiment?" which encapsulates his approach to medicine and surgery, through which he became the father of scientific surgery. Tooth transplantation was introduced through an exchange of letters involving Walter Farquar, asking whether the patient had venereal disease after receiving transplanted teeth.
Hunter developed a practice transplanting teeth, in partnership with James Spence. The fee paid by the recipient was the substantial sum of ten guineas per tooth. The tooth usually came from a child paid one shilling.
In 1778 Hunter wrote his "Natural History of Human Teeth". The full text of this book can be found on Google books; the section on transplanting teeth starts at page 230.
We next saw a letter concerning "Watson's case" where a young woman died from an infection following a tooth transplant.
In 1786 Hunter wrote "A treatise on the venereal disease" including an appendix "Of diseases supposed to be venereal
produced by transplanted teeth". A revised edition from 1853 is available on
Google books and in writing this report we found the relevant quotation, at page 504 of this edition.
He gives an account of all the cases he has seen and concludes:
"Let us sum up all the arguments in favor of the disease not being venereal. First, two patients, whose cases were similar
to the others in their origin, recovered without medicine. Secondly, they who seemed to be cured by mercury had not a
treatment exactly similar to those who were indisputably poxed. Thirdly, I consider it as impossible for parts to have
the power of contaminating which are not themselves diseased. Fourthly, the parts contaminating were never known
to have been contaminated themselves. But it must be nearly the same thing to those who want to have teeth transplanted,
whether my reasoning is just or not; for a disease in consequence of the operation most certainly has taken place;
and in some cases this has been worse, or cured with more difficulty, than the lues venerea in common; and whatever
the disease may be, I yet know of no mode of prevention, except the drawing of the tooth early, and that has been tried
in one case only, and in that case was successful."
The lecture next introduced J C (John Coakley) Lettsom who asked "If a live tooth might successfully be transplanted why not also a disease?" At this time 1 in 20 transplant patients suffered after-effects, and of these a quarter died. The title of the lecture is from writings of Lettsom in 1786 saying the disease was the result of such "Promiscuous & Inattentive Proceedings" and writing that Hunter bore some responsibility in Watson's Case.
The lecturer was also able to quote a patient's anguish at having submitted to having a tooth transplant
and suffering greatly as a result. Vicesimus Knox in an account of his life
"Winter Evenings" (facsimile and text available in Google Books). In a section (page 121)
"On injuring the health in attempts to improve beauty" he recounts the experience:
"The remedy was 'transplantation.' I submitted to extraction with a stoical heroism. A chimney sweeper,
who attended at my side,
parted with his best tooth for a shilling, and it was planted reeking with blood and warm with life,
in the socket whence my odious tooth with the black speck had been just drawn. I was now in a state of exultation.
I thought my gums might defy old age and decay, and gloried in the idea of having almost found out the art of
rejuvenescence. My triumph was but transient. A tumour and inflammation ensued. The pain I suffered
is not to be described; but I was still a heroine, animated with the idea that the pain was but for a short time,
and that the happiness would be for life."
"The disease still continued, and I lost several of my teeth and a great part of my gums and palate. My lips were
distorted, or corroded, in a frightful manner. The physician at last insisted on the necessity of my undergoing what
he called a salivation. He said my life depended upon it. I submitted, and preserved my existence; but how shall
I describe what I felt on looking into the glass! Every appearance of old age and deformity.
I will leave to your imagination the ideas of horror and grief which tormented my heart;
I gave up all pretensions to beauty, as indeed I well might; for my countenance was the picture
of every thing disgustful. Think of paleness tinged with a livid yellow, a shrivelled skin, distorted lips,
and toothless gums." . . ."It will contribute something to atone for my folly, if, by communicating the
consequences of it, I warn others from its imitation."
Ruth Richardson concluded by describing the advances in general ethics in this period, citing the abolition of slavery. She also drew parallels with modern ethical problems such as retention of organs of children at Alder Hey.
In the discussion following there were mentions of "Waterloo teeth", of the dentures found in St Brides' skeletons, and a question whether it was the symptoms of rejection of the transplant that looked like those of venereal disease.
There was an informal Buffet Dinner in the nearby Mirrors Restaurant, Novotel, at King's Cross after the Lecture.
Copyright 2010 David Hawgood and the British Society for the History of Medicine.
This page by David Hawgood
was amended 30 Mar 2010