'Smile Stealers' Recalls A Time When Dentists Routinely Reached For The Pliers

Medical historian Richard Barnett traces the history of dentistry in his new book. He says that prior to the 18th century, the profession was often practiced by charlatans with "big muscles."

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. I don't usually gasp while preparing my interviews, but I gasped several times while looking at the illustrations in the books by my guest Richard Barnett. He's a medical historian who's just completed a trilogy of books on the history of disease, surgery and dentistry. The illustrations are historic drawings, paintings, woodcuts and photos, dating back decades, or in most cases centuries, of tumors, pox, leprosy, incisions, amputations and so on. In most cases, the illustrations were originally intended for medical students and practitioners. The final book in the trilogy is called "The Smile Stealers: The Fine And Foul Art Of Dentistry," and it includes illustrations of rotting teeth, early dental instruments, Etruscan dentures, Dutch paintings and more. Barnett teaches at Cambridge University's Pembroke College.

Richard Barnett, welcome to FRESH AIR. Reading your books, I was just kind of almost at war with myself between wanting to look at all the illustrations and being so kind of repelled by them because some of the images are so gruesome. I want to look because the body is capable of such strange and beautiful and gruesome things. And, you know, because your books deal with surgery and cancers and diseases and pox, there's a lot of hideous stuff in there, a lot of irregularities. And, you know, I want to see it, and at the same time, I'm afraid of scaring myself. I'm afraid that these images will stay with me and that the next time I have a little rash, I'll be thinking about the worst-case scenario (laughter) which - well, I have just witnessed in your book. So what do you think the value is for non-medical professionals of seeing these images?

RICHARD BARNETT: Well, I think these images show us the outside of the inside. They show us a side of the human body that, if we're lucky, we never get to see. And I think there are a number of different kinds of value from seeing these images. Firstly, as an academic historian, I'd have to say they are deeply enlightening about many different kinds of history - the way that we've thought about disease in the body most obviously but also aspects of aesthetic history as well, changing conventions of depicting the body, especially I think depicting differences in gender and race, which is perhaps a subject we can come to think more about.

So historically, I think they're fascinating - aesthetically as well. I thought a lot about what you might call the bodily sublime or the anatomical sublime. These certainly aren't pretty images, but I do think many of them are beautiful the way in which something like a lupus, various kinds of skin disease, the body flaid, the body put on display, the body disfigured, can be a very powerful and a very moving kind of beauty. And I think it can lead to a kind of sympathy as well. Something I'm very interested in is the question of how do we look at these images.

I think there's a certain ethical weight that comes with these images. We're looking at images of people made in a time well before any notion of informed consent. Very often, we don't know their names. We don't know anything about them other than their diagnoses. They exist in history almost as, you know, incompetent or broken body parts. So I think a bigger question here about how any historian relates to the human beings they study, the human beings who lived and breathed and felt and died, how do you treat them with dignity?

GROSS: So in the books that you've done with these historic medical illustrations, is there an image that has most haunted you?

BARNETT: Honestly, no, but I daresay the two images that stay with most readers of these books are the cover images that we chose for the first two in the series, "The Sick Rose" on the history of disease and "Crucial Interventions" on the history of surgery. The image on the front of "The Sick Rose" is of a young woman dying of cholera in Vienna in 1831. And we were far from the first book to reproduce this image. It's widely used in histories of cholera. But the more you look into it, the more unsettling and the more moving it becomes. It's firstly one of a pair of images. The first image is of the young woman in health, looking very healthy, very rosy-cheeked, indeed very beautiful. The second image was made shortly before she died, and she is evidently moribund. She is extremely sick. The skin is drawn over her features, and she's clearly in a very bad way indeed.

And the more I thought about this image, the more I wrote about it, the more intriguing the nature of the relationship between the artist, the doctor and the patient seemed to me. I wanted to know how this image was made. Was it made retrospectively? Was it, as it were, an imagining, a remembrance of what this young woman had looked like in health and in disease? Or was the artist sitting by her bed? That's a very strange kind of encounter. It's a kind of encounter that a novelist might try and imagine. What would have been the commerce, as it were? What would have been the conversation between this dying young woman and the artist trying to record her. And I was also intrigued by the way in which he gives her so much character. There's a lot in this image that doesn't, so to speak, need to be there. There's a lot in this image that isn't communicating medical knowledge. For example, there's great attention paid to her hairstyle and to the little bit of her dress that we can see.

So I was fascinated by the idea that the artist here might have been trying firstly to give a sense of verisimilitude, firstly to give a sense that you're not just looking at an abstract case here. You're looking at a real person dying of a real disease. But I think to any sensitive viewer, one has to think as well about whether he's trying to capture something of her personality, whether there's something here about trying to preserve, record even a little bit of this woman who very soon will be gone.

GROSS: Let's talk about your new book on the history of dentistry. And you write in that pain in the head can seem unbearably close to the core of who we are, to which I can say, yes (laughter). Is that part of why you wanted to write the book?

BARNETT: Well, I think dentistry of all the medical professions has always generated the most fear, certainly continues to generate the most fear. I think very few of us go into a dentist's surgery with a light heart and a spring in our step. So I wanted to think about the place of fear, the place of pain but also the place of attempts to mitigate that in the history of dentistry. And I was very struck as I researched the history of dentistry that it's the story of technique.

It's the story of getting better at solving medical problems, practical problems with the teeth. But it's also the history of making dentistry and crucially dentists acceptable to ordinary middle-class folk, moving away from that medieval idea of the charlatan in the town square holding a bloody tooth in a pair of pliers and moving toward something that is more respectful, more expert, more professional but also crucially that takes more account of the patient's feelings.

GROSS: Well, your book made me think how in the past before dentistry was really an art and a medical science that people lived with a lot of dental pain and with few teeth (laughter) because your teeth would be extracted or they'd fall out or they'd decay. And so if you lived long enough, a lot of people were toothless.

BARNETT: Absolutely. If you look at the earliest surviving human fossils, they bear mute witness to the kind of suffering that human beings and hominids have always experienced from their teeth if they lived more than perhaps 30 or 40 years untreated. And certainly, if you look at the average working person in Europe perhaps in the 15th or 16th century, they probably wouldn't have most of their teeth after the age of 30 or 40. They would sort of gradually fall out or decay, and the amount of pain involved in that must have been absolutely terrible.

This is one area where there's a sort of paradoxical social dimension to dentistry as well. Very often, it's the rich who've suffered most from problems like caries and tooth decay. And this is because the rich were able to afford all of the new exciting commodities that were coming out of the mystic East, as Europeans would have seen it in this period, so things like sugar, for example. If you look at the example of Queen Elizabeth I of England, she, from a very young age, became addicted to sweets and toffees and sweet meats and all sorts of things. And the immediate result of this was that her teeth turned black, and she suffered very, very badly from dental decay and all kinds of problems throughout her life.

So I certainly wouldn't want to make the case that the poor were better off. They certainly, of course, had many problems to face, but if we're looking at the people who suffered the most from that kind of what we think of as the modern problems of dentistry, the problems of, you know, sugary drinks and too many sweets, it was the rich who were really the first to suffer these problems.

GROSS: One of the things that surprised me is that, you know, dating back to ancient history, there are illustrations of kind of makeshift dentures that were made for people who had lost critical teeth.

BARNETT: Early dentistry could be surprisingly sophisticated. We've got evidence from ancient Indian culture and especially from ancient Roman culture of fairly sophisticated, fairly elegant dentures being made. We're talking here about what a modern dentist would call a bridge, so a partial replacement for a couple of - one or two missing teeth, generally clipped or tied to the surviving teeth. A lot of these survive in ancient Rome because that was a habit in Roman culture of removing any prostheses or jewelry before a body was cremated and then putting it back in with the ashes, so quite a few of these survive. And they really are quite magnificent.

They're not quite the sort of thing a modern dentist would be proud of, but they're certainly sophisticated attempts to solve a problem practically but also to solve it aesthetically as well. This is a really important word, I think, in the history of dentistry. So much of it is about aesthetics. So much of it is about appearance, not only restoring a functioning mouth, but restoring something like beauty and respectability.

GROSS: Which leads to what were false teeth made of hundreds of years ago? And you use the example of George Washington's dentist, John Greenwood. What are some of the things he made false teeth out of?

BARNETT: Good heavens, yes. Washington, in his later years, was walking around with almost the history of America in his mouth, one might almost say world history in his mouth. His teeth were made of various materials. One of the most common materials for false teeth in this period is what is called walrus ivory. So these are the long tusks of Arctic walruses. This was a sort of byproduct, one might say, of the Greenland whaling trade. So you've got that kind of trade, that kind of exploitation of world resources going on.

Another very common and really rather macabre source of teeth was the dead. There's a long tradition in Britain of what were called Waterloo teeth after the great Battle of Waterloo in 1815. The idea was that these were teeth that were supposed to have been pulled from the mouths of dead soldiers. Now, in fact, although this was a - this was as it were a kind of marketing routine, this was a way of selling the public the idea of, you know, fresh healthy young teeth from soldiers who were killed on the battlefield.

In fact, most of these teeth most likely came from morgues. Of course, there was no reason to go all the way to a battlefield to get fresh teeth. You could go to any morgue or undertaker and find a fairly good supply of dead bodies. So, in fact, most of the people who were proudly walking around with the teeth of dead heroes in their mouths were most likely walking around with the teeth of the outcast dead in their mouths.

Washington's dentures were also partly made out of silver as well. And, of course, most silver in this period came from South America, a lot of it from the great mine of Potosi. So it's quite possible that George Washington was walking around with a - really a history of his age in his mouth.

GROSS: You have pages of illustrations of early dental instruments that were used for various procedures, including extractions. What do those instruments tell you about what dentistry was like before modern dentistry?

BARNETT: It's very striking that in some ways the instruments haven't changed enormously. Extraction of a tooth is still a violent business, as any modern dentist will tell you. When there's a lot that can be done to make that better, most obviously anesthetics. But the basic business of extracting teeth from jaws, it always has taken a great deal of brute muscle power. We can see this in the evolution of the equipment used for it. Go back to ancient Greece and Rome, and they had special pliers carefully made out of lead.

The great problem when you're trying to extract a tooth is if the tooth shatters, the root can be left in the jaw, and with the root, quite a lot of the decay. And it's much harder to get purchase on that. So the great challenge is extracting the tooth without shattering the enamel crown of it. So Greek and Roman dentists would use lead pliers with the idea that lead is a little bit softer, and it's less likely to shatter the tooth. But it's really in the medieval period that I think we have the most terrifying instruments for extracting teeth.

The most famous of these is called the pelican. The pelican is based on a device used by barrel-makers to get iron hoops down over the staves of a barrel. If you've ever seen a barrel being made, it's basically about using loops of iron to kind of bring the staves of wood together. So the Pelican was essentially a kind of hook combined with a lever. And you'd sort of clip the hook onto the teeth and kind of pull the lever back. And it must have been an agonizing process, especially if the tooth was well lodged in the jaw.

There's a point here about the position in which dentistry used to take place. We're now used to if we go to the dentist, we're used to lying in a fairly comfortable chair in a fairly sort of comfortable prone position. But early dentists would have got their patients into whatever was the most practical position for levering teeth out of their jaws, so lying on the floor or head between the knees was quite a common position as well. So all things considered, this must have been an extremely painful and a most undignified kind of activity.

GROSS: When you say head between the knees, you mean the patient's head between the dentist's knees?

BARNETT: Well, I suppose it depends how well it went but yes, that's what I meant.

GROSS: (Laughter) OK. If you're just joining us, my guest is Richard Barnett. He's a medical historian who's just completed a trilogy of books about the history of disease, the history of surgery and now the history of dentistry. The dentistry book, the new one is called "The Smile Stealers." This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Richard Barnett. His new book, "The Smile Stealers: The Fine And Foul Art Of Dentistry," completes his trilogy of books on the history of disease, surgery and dentistry. Before becoming a medical historian, he went to med school.

How much of a chance as a medical student before you dropped out of med school did you have to observe the kind of, you know, viscera and disease and surgery that your books are about?

BARNETT: In Britain, at the time, medical school still followed the old preclinical clinical model. So in the first two years that I was at medical school, it was largely an academic education. So it was lectures, and very strikingly, it was the dissection room. That made a big impression. I still think dissection is one of the greatest privileges I've ever had. There are no other legal settings in which one can open up a human body and learn about it.

I've always had great admiration for those who donate their bodies to medical schools. It really is a tremendous act of charity and one that is enormously appreciated by medical students. It was a chance to confront death. I don't want to be too pretentious here and call it a kind of Hamlet moment, you know, Hamlet confronting the skull of his dead friend Yorick.

But there was a sense of being able to have laid before you on a table - on a mortuary table - everything that it was to be human or everything it is to be human, you know, 6 feet and a couple hundred pounds of flesh. And it does - what I really appreciated was that it was a space in which you could kind of return.

To the idea of dissection is - in English medical schools, anyway - that you do it over a couple of years. You gradually over the course of a term dissect certain parts of the body, and then you return next term to another part of the body. So it's a very gentle, very low-key way of I suppose living with the dead, coming to terms with the dead and also getting over that and then learning.

I think learning to see, learning that peculiar kind of clinical or even pathological gaze that one needs when looking at the chaos of a dead body to reduce it to some sort of order, to reduce it to something you can understand and say, well, this is the structure I'm looking at, and this is how it functions, and this is how it goes wrong and so on.

So I really appreciated that kind of encounter. It's - looking back, I don't think I had these thoughts at the time, but looking back, it was very interesting to reflect on the anonymity of the dead. That in some ways this was a very important relationship that went on over two years with somebody whose name I didn't know but with whose body I and my colleagues were more intimate than anybody had been during that person's life.

You know, we saw more of him. We explored more of him. We took him apart to try and work out, you know, what made him tick and what had stopped him ticking, as it were. So it's a fascinating and I think unsettling in the best possible way kind of relationship. And it's one that I've returned to in my mind and in my thoughts many times over the last couple of decades.

GROSS: Were you mentally prepared - were you prepared by your teachers in any way for your first encounter with a corpse that you're going to dissect?

BARNETT: Yes. Medical schools, as you can imagine, are very careful to make sure that their students are prepared for this. One of the most important aspects of this concerns the face. What - certainly, again, in English medical schools, the order in which dissection proceeds one begins with the abdomen and the chest. And the head of the body that you are dissecting is covered. And this goes on for, I think - my memory's a little fuzzy, but it was certainly a couple of terms, if not an entire year.

So again, you have the chance to sort of get used to, come to terms with - and there are - I remember that it was sort of widely advertised that if one needed to talk to a member of staff about this experience and how it was affecting you, you could do so. So, no, there was a great effort on the part of the medical school authorities to make this a constructive rather than a destructive and challenging experience.

GROSS: So the impression I get from your books is that the surgeon used to be considered lower than the physician - that the surgeon was seen more as like the mechanic who would, like, you know, step in or the craftsman who'd step in. But it was the surgeon who was, like, directing it and who was the more educated person. Why was it seen that way?

BARNETT: There's a very long division in the history of Western medicine between surgeons who are seen as fundamentally craftsmen or tradesmen and physicians who are seen as educated professional gentlemen. Partly, this comes down to education. The way for a long time in the European tradition that you get to be a physician is by going to university. So you become an heir to this long-learned classical tradition. You study in Latin, and you get a degree at the end of it. So you acquire all of the trappings of a learned gentleman, whereas, if you wanted to be a surgeon, you learn surgery through an apprenticeship. So you become a surgeon in the way that you become a butcher or a baker or a candlestick maker. It's through experience. It's through what you might call tacit knowledge rather than any kind of higher-status education.

But I think there's more to it than that. I think we can see an emotional and a social aspect to this, as well. Of course, surgeons are associated with blood, pain, death, suffering of all kinds. So I think surgery rather like butchery, rather like professional executioners - there are people who it seem to be useful to have around, but they're not people you want to have dinner. They're not people you want living next to you. So there are people who carry a certain kind of stigma because of the work that they do.

In fact, if you take the word surgeon back to its Greek root, it comes from the Greek word kheiros (ph) or cheiros (ph), which means hand. So you can very directly think of surgeons as the hand embodying a certain amount of expertise, an amount of skill but very much under the control of the head. And it's the physicians, the educated learned gentleman, who wanted to see themselves as the head of medicine.

GROSS: Richard Barnett, thank you so much for talking with us.

BARNETT: Absolutely my pleasure. Thank you for having me.

GROSS: Richard Barnett's new book is called, "The Smile Stealers: The Fine And Foul Art Of Dentistry." After we take a short break, we'll hear from Pamela Paul, the editor of The New York Times Book Review, who has a new book of her own about her life as a reader. And Ken Tucker will review new solo albums by Harry Styles of One Direction and Dan Auerbach of The Black Keys. I'm Terry Gross, and this is FRESH AIR.

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