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D E N T A L H I S T O R I A N

NUMBER 63 (1)

January 2018—––––––––––––––––––––––––––––––

Contents

Lindsay Society Officers 2017/18..........................................................................................................3

Membership Details...............................................................................................................................3

Editorial...................................................................................................................................................4

Lindsay Society News.............................................................................................................................5

Fatality of a dental team member caused by a preventable explosion

Tony Landon............................................................................................................................................7

A General Anaesthetic Saga

Stuart Robson..........................................................................................................................................9

Resistance and toothbrushes within the Heinkel kommando

Xavier Riaud..........................................................................................................................................13

The Cautley Dental Dynasty

Tara Renton...........................................................................................................................................15

Sir John Tomes (1815-1895): a Scientific and Academic Legacy

Barry Berkovitz…..................................................................................................................................22

The evolution of the foot pedal powered dental engine - three dentists and an engineer

Margaret Wilson……..………………………………………………………….………………….…33

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Dental Historian

The Dental Historian (DH) is an international journal that publishes peer reviewed papers, biographiesand descriptions of historical artefacts. The DH accepts manuscripts online. It is a condition of acceptanceof a manuscript that it has not previously been published or is not under consideration of publication inany other journal. If more information is required then please contact the Editor. Persons wishing tosubmit a paper for publication should send it to Dr Margaret Wilson, Editor [email protected]

Manuscripts should be single spaced, Times New Roman, font size 12 and left justified. The publisherand editor cannot be held responsible for errors or any consequences arising from information in thisjournal. The views and opinions do not necessarily reflect those of the publisher and editor. Authors arereminded that it is their responsibility to obtain permission for publication of images in the DentalHistorian.

The Dental Historian is sent free to members of the Lindsay Society.

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President David McGowan [email protected]

Immediate past-president [email protected]

Hon Secretary Brian Williams [email protected]

Treasurer Noel Stamp [email protected]

Editor of Dental Historian Margaret Wilson [email protected]

Committee members Rachel Bairsto

Stuart Geddes

Roland Hopwood

Craig Rushforth

Andrew Sadler

Associate Editor Nairn HF Wilson

Membership DetailsMembership applications should be sent to the Honorary Secretary, Dr Brian Williams, 14 Howard Road,Great Bookham, Surrey, KT23 4PWEmail: [email protected]

£28.00 UK member£46.00 UK joint membership-both at same address£35.00 for overseas member, payable in sterling.£55.00 for overseas joint members-both at same address, payable in sterlingFree to UK student members of the BDA£30.00 overseas dental studentSingle issues can be bought by sending a cheque for £16.00 + P&P made out to the “Lindsay Society forthe History of Dentistry” to the Distribution Manager, Stuart Geddes, Ysgubor Argoed, Tregagle/Monmouth,NP25 4RY. Email: [email protected]

Lindsay Society Officers 2017/18

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If we as a profession do not treasure and protectour artefacts and history why on earth should weexpect anybody else to have any interest? If a firstedition book or a valuable item containing preciousmetals is donated to a museum, it is usuallywelcomed with open arms. But what abouteveryday utility items with no intrinsic value exceptthat they mark the development of dentistry at acertain point in time? These items are only ofinterest and collected by a very few specialistmuseums. We are fortunate that there do existmuseums attached to Royal Colleges, universitiesand of course the British Dental Association (BDA)that do collect items donated by the public and theprofession. A major problem encountered by allmuseums is the lack of display space and the costof storage. If you have attended the BDAheadquarters in Wimpole Street you will have seenpart of the collection which is displayed andchanged by the museum volunteers and the headof Museum Services, Rachel Bairsto. The displayof historic dental equipment or portraits celebratesour profession and reminds us of the contributionmade by our predecessors.

We are not alone in celebrating a rich history.For example, it is refreshing to see the use ofapothecary jars displayed next to the outside wallof the new building of the Royal PharmaceuticalSociety. Those of you who attended the Anglo–American meeting of the Lindsay Society last yearin the Royal College of Surgeons of England willremember the famous statue of John Hunter in thefoyer. During the huge changes to the buildingwhich are currently taking place, great care wastaken when moving the statue to the NuffieldBuilding. But not all institutions seem keen tocherish their heritage. How disappointing it is thatthe General Dental Council decided againstdisplaying portraits and busts followingrefurbishment of their building. These were dentistswho have made an enormous contribution to theregulation of our profession. We are thankful thatthe BDA museum has accepted the portraits andbusts on a loan arrangement so that they can bedisplayed and protected. Included is a portrait ofthe first dental Dame, Margaret Seward, whoamongst many other things was a pioneer of womenin the dental profession. Anyone wishing to see theportraits from the GDC should first contact the

Editorial

BDA Museum as not all items are on display dueto constraints of space.

In dentistry and medicine it is not unusual tohave families where several generations have beeninvolved in the profession. In this issue there is apaper describing one such family. If readers knowof any other dental dynasties, please get in touch.

On a totally different topic, I would like to bringto your attention the changes that have been madeto the production of this journal. The publicationof the Dental Historian twice a year is the singlegreatest expenditure for our Society. In order tocontain costs, this will be the first issue producedourselves. By taking these measures now, it ishoped that the Dental Historian will be able to existas a paper journal for many years to come.

Finally I think it is appropriate for me, on behalfof the Lindsay Society, to thank Stanley Gelbierand Stuart Robson for all their contributions to thecommittee over the years. As those who attendedour last AGM in Portsmouth will remember,Stanley and Stuart decided it was time to standdown from the committee. They have both madehuge contributions to our Society and we have beengrateful for all their wise counsel. I hope that theywill continue to write their most interesting papersfor the Historian.

We were all saddened to hear the recent newsthat Robin Basker had died. Robin was a greatsupporter of our Society and former Chairman.Over the years he made a huge contribution to UKdentistry and dental education. An obituary willfollow in the next edition.

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Report of the 55TH ANNUALCONFERENCE OF THE LINDSAY

SOCIETY

The Holiday Inn Portsmouth was this year’svenue for the 55th annual conference of The LindsaySociety. Joined by our French colleagues fromSociété Française d’histoire de l’art Dentaire theweekend of the 6th – 8th October proved to be asparkling event. A welcome on the Friday eveningby Professor Chris Louca, Director of thePortsmouth Dental Academy followed by aninformal buffet supper, was just the start of thisincredible weekend.

The Saturday and Sunday mornings saw 55delegates from France and the UK join together tohear eleven papers on subjects as diverse as‘Ancient World Dentistry’ by Dr Roger Forshaw,‘Nazi Dental Gold’ by Dr Xavier Riaud, and‘Seaside Postcards’ by Dr Brian Westbury to namejust three. Lecturers were split evenly between thetwo nations with all the talks thankfully deliveredin English. Even so, it was a roller coaster ride ofemotions with details of war time deprivationsfollowed by French dental comic strip charactersfollowed by the death of Marat in Rue desCordelier. Never has the annual conferenceprovided such a contrast of subjects and characters.A truly memorable lecture programme.

The memorable only got better with the Saturdayevening conference dinner in the Mary RoseMuseum at the Historic Portsmouth Dockyard.Arriving by 6.00pm for a private viewing of theMary Rose, numerous museum volunteers were onhand to answer all our questions and explain whyHenry VIII’s flag ship sank so rapidly off Spitheadin 1545. And then there was the dinner; seated just

Lindsay Society News

yards from the ship the food, wine and bon viveurwere superb. The perfect climax came at 10.00pmwhen we were ushered onto a balcony overlookingPortsmouth Harbour to view HMS Victory floodlitin all her glory – a fitting end to a perfect evening.

Someone said: it’s not just been a trulymemorable lecture programme but a trulyremarkable weekend – now right they were!

To view the full programme go towww.bda.org/lindsaysociety

Brian Williams Hon Sec

Images courtesy of Pat Reynolds

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Award of L Solas and LJ Cecconi Medal

Following the successful Anglo-French conference Malcolm Bishop was awarded the L Solas andLJ Cecconi Medal by La Société française d’histoire de l’art dentaire. This was to acknowledge hislecture contributions to at least four of their annual conferences. In addition he has helped them todevelop aspects for the virtual museum, the MVAD. The latter can be seen at:

www.buisante.parisdescartes.fr/mvad

The medal was established in 2005 in honour of the two named people. Dr Ludovic-Jean Cecconiwas the founder of the Société, in 1949. Dr Lucien Solas was its first President.

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Dental Historian 2018 63 (1) 7 - 8

Fatality of a dental team member caused by a preventable explosion

Tony Landon

The scene is set

Mr Herbert Roger Watson, forty-one years ofage, of Maryport, Cumbria was employed as adental technician by a dentist in Curzon St,Maryport, Westmorland, now in the county ofCumbria. The dental laboratory was located in acellar below the dental surgery. Mr Watson wasconsistent in being scrupulous in boiling out waxfrom brass denture flasks. He always ensured thatthe outside surfaces of the denture flasks were cleanof all debris prior to packing the separated dentureflask halves with polymethyl methacrylate resindough.

The flasking technique

All denture technicians are mindful that everytrace of wax from trial-insertion dentures must beremoved from the surfaces of the encasing plasterof Paris and dental stone by boiling water. This isdone to avoid contamination of the polymerisationof the acrylic dough. Mr Watson was meticulousin his technique. At all times, he ensured that boththe denture surface imprints and outer surfaces ofthe halves of his denture flasks were clean and freeof any residual waxy film, which is difficult tovisually detect.

Mr Watson’s technique, following the boilingout process, was to leave the open flask halves ina pan of boiling water on a lit gas ring and to pourover the flasks a “washing up” soap solution as awax solvent.

In 1966, Mr Watson would have been aware ofpast practices of using chemical solvents to removewax residues in the production of acrylic dentureswas a health risk to both the immediate operatorand other members of the dental team when visitingthe dental laboratory. Ether, chloroform andcarbon tetrachloride solutions had been, and, at thetime, were still employed to remove traces of waxfrom the artificial acrylic teeth and denture imprintsurfaces in denture flasks, following boiling out

procedures to remove the wax bases of trial-insertion dentures.

The problem with wax solvents

In dental journals during the late 1950s and1960s there were many publications advisingagainst the use of ether, chloroform, or carbontetrachloride solutions to remove wax residuesfollowing boiling out procedures. The reasons givenwere health risks to the operator and damage toplastic denture teeth. In addition, the warm to hotembedding gypsum in the flask halves, holding thedenture teeth in the required position, would absorbthe chemical solutions. The subsequent heatprocess required to polymerise the polymethylmethacrylate denture base would result in thechemical solvent being driven into the dentureresin, adversely affecting its physical properties andleading to crazing and staining of the denture basein clinical service.

Events leading up to the accident

Mr Watson was evidently aware that liquiddetergents, that were becoming widely available fordomestic purposes, removed all traces of residualwax during the boiling out process. Unfortunately,Mr Watson kept his liquid detergent in the sameshaped and sized, one gallon (4½ litre) metal tincan as his denture resin monomer. He hadinadvertently reached for and poured out the wrongliquid from the wrong can. The highly inflammablemonomer was poured directly into the pan ofboiling water, sitting on a lighted gas ring burner.The flash point of the particular monomer productwas 11.11°C, with vapour flammability of 2.1% to12.5%.

Methyl methacrylate monomer vapour is heavierthan air, thus the vapour sinks to and travels acrossthe floor surface. Working in the closedenvironment of a cellar where Mr Watson’slaboratory was located proved to be exceptionallydangerous.

Abstract: On the 28th September 1966, a dreadful explosion occurred in a dental laboratory withina dental surgery premises. This resulted in very sad consequences for an experienced colleaguewho lost his life in the process of manufacturing polymethyl methacrylate dentures, usingtechniques he had always applied. This paper describes the events leading up to this tragic accidentKey words: explosion, dental laboratory, polymethyl methacrylate

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It was as a direct result of Mr Watson’smeticulous technique, but unfortunate mistake, thaton the 28th September 1966, a horrendous explosionoccurred as he poured out methyl methacrylatemonomer instead of detergent into the container ofboiling water sitting on the lit gas ring burner. Theexplosion caused an immediate fire in the laboratory.

A fellow dental technician, a Mr Joseph Harris,stated at the subsequent Coroner’s Court that he andMr Watson were employed by a dentist who had alaboratory in a cellar below his dental surgery onCurzon Street, Maryport, Westmorland1. They wereboth working in the cellar laboratory on the day ofthe explosion. Mr Harris was working at alaboratory bench which was separated by a partitionfrom the area in which Mr Watson was boiling outsome denture flasks on a gas ring. Mr Harris wasthrown to the floor by the blast of the explosion,whilst witnessing flames all around him. He heardMr Watson shouting, his clothes on fire, as he ranto the exit door. Mr Harris managed to roll MrWatson up in a mat, putting out the flames that hadengulfed him2.

A policeman, Constable Blackshaw, reached thescene of this terrible accident fifteen minutes afterit occurred. Mr Watson was conscious andmanaged to inform PC Blackshaw that he hadchosen the wrong tin can, despite having beenmanufacturing acrylic dentures for twenty years.

Mr Watson was taken by ambulance to WestCumberland Hospital outside Whitehaven towncentre, a sixteen mile, half an hour drive away fromthe dental practice and laboratory. Mr Watson’sburn injuries were so severe that it was decided totransfer him by ambulance to a specialised burnsunit at Newcastle General Hospital. This involveda further road journey of a hundred miles, involvingat least another hour and a half drive; there were noair ambulances five decades ago.

Poor Mr Watson, having endured at least twohours being conveyed by ambulance from the sceneof the accident in Maryport on the west coast ofCumbria to Newcastle upon Tyne General Hospital,unfortunately passed away, due to the severity ofhis injuries.

The Coroner, a Mr F. A. Walker at the Newcastleinquest, commented that this was a tragic accidentwhich he thought could easily be repeated. Averdict of death by misadventure was returned bythe jury.

Hazards

This, to the best of my knowledge, is the onlydental technician fatality whilst using methylmethacrylate monomer in the production ofdentures, despite the various hazards posed by thismaterial in the dental laboratory. Methylmethacrylate is an organic compound with theformula CH₂=C (CH₃) COOCH₃ a methyl esterof methacrylic acid. The monomer is a transparent,highly flammable liquid, which irritates eyes andmucous membranes. The monomer vapour, whichhas a distinctive smell, is toxic. It is therefore vitalthat the monomer is stored and mixed with polymerto create the required dough in a specialised fumecupboard. Handling such monomers, both heat-and self-cured, can prove problematic to dentallaboratory personnel prone to dermatitis3.

Hopefully, no such loss of life as suffered byMr Watson, will ever occur again in a dentallaboratory.

References

1 Report by Porter HJ, Chief Fire officer CountyFire Service, Cumberland County Councilpublished in the Dental Technician Journal 20 (3);12; 1967

2 Whitehaven Newspaper, 148 Queen Street,Whitehaven, Cumbria England CA28 7AZ;8/12/1966

3 Leggat PA and Kedjarune U, Toxicity of methylmethacrylate in dentistry. International DentalJournal 53 (3); 126 -131; 2003

Author Biography

Tony Landon trained as a dental technician at theUniversity of Cardiff Dental School 1965-1968. Hewas an instructor in Dental Technical Methods atthe University of Birmingham Dental School in theRestorative and Prosthetics Departments 1974-2014. He has provided hands-on courses in: Corkand Dublin, Eire, New York and West Virginia,USA, Wroclaw and Krakow, Poland, Mar delPlata, Argentina and Turku, Finland from 1981-2009.

Address for correspondence: 3, Besbury Close,Dorridge, England. B4 6NN.

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Dental Historian 2018 63(1) 9 - 12

A General Anaesthetic Saga

Stuart Robson

The puzzle in a box

Having had a professional lifetime interest inanaesthetics, I was confronted at the British DentalAssociation (BDA) Museum with a cardboard boxfull of a jumble of rubber pipes and gadgets whichappeared to be valves of some kind, looking as theyhad been acquired from a car boot sale (Fig 1).Somebody thought it might have had something todo with delivering gaseous general anaesthesia sopassed the relics to the Museum. Having unravelledall the bits and pieces it soon became apparent thatthis piece of equipment was the business end of aBoyle’s Anaesthetic Machine, made circa 1958 bythe British Oxygen Co.

The Boyle’s Machine

The cylinder yokes and pressure regulatorsshould be fixed to a frame on the rear of a surgicaltrolley for the delivery of oxygen (O2) and nitrousoxide (N2O), and the whole was usually mountedon wheels for easy mobility of the unit (Fig 2)together with attendant oxygen and nitrous oxide

cylinders. It also had a trichloroethylene (Trilene)interlock unit fitted to measure the flow of theTrilene which was vaporised by the passage of theanaesthetic gases, and an emergency oxygen button.Trilene, manufactured by ICI, was an early adjuvantto supplement the nitrous oxide and oxygen mixturewhich expedited the induction of anaesthesia phase,and also provided some limited muscle relaxationwhich was beneficial for the surgeon and indeed forthe anaesthetist. It superseded earlier frequentlyused anaesthetic chemicals such as chloroform(highly toxic) and ether (which was flammable andhad an unpleasant pungency). Trilene was itselfsubsequently superseded by Halothane which wassafer, had a quicker induction, was a better musclerelaxant, and had a shorter recovery time for thepatient. Halothane was also developed by ICI in thelate 1950s and early 1960s and required a differentvaporiser, which therefore dates this apparatus toapproximately 1958 at the latest (Fig 3).

Abstract: A donation to the BDA Museum resulted in a description of the Boyle’s anaestheticmachine and a short biography of Dr H.E.G. Boyle the inventor.Key words: Boyle’s anaesthetic machine, WWI

Figure 1. Jumble

Figure 2.

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The vertical glass rotometers on the machinemeasure the flow of gases, which were controlledby the anaesthetist from the cylinder screw valvesmounted on the top of the gas cylinders. Themixture was delivered to the patient by a blackcorrugated rubber pipe which was in turn attachedto a face mask with an inflatable cuff surround,ensuring a tight, leak proof seal around the patient’snose or nose and mouth.

The origins

Having solved the problem of the bits and piecespresented to the Museum, this then prompted thequestion of the origins of Boyle’s anaestheticmachines. These were developed in 1917 duringthe First World War by a Dr Boyle. He determinedthat many deaths were caused to soldiers who,having suffered extensive wounds, were not ableto receive early and prompt treatment in a casualtyclearing station due to lack of adequate anaesthesia.Soldiers might have to wait many hours or evendays before being evacuated to hospitals usuallysome distance behind the front lines, or even backto England.

Early problems

In the early days, between 1918 and 1955, therewere problems and some unfortunate and tragicdeaths which occurred during use of theseanaesthetic machines1. The oxygen and nitrousoxide cylinders providing the compressed gaseswere of similar size and not very well colour coded.When empty cylinders were being replaced by fullones, it was possible to connect the wrongcylinders to the oxygen and nitrous oxide outlets,thereby ensuring that the wrong mixture of gaseswould be administered. The original colours for

the tubing and cylinders were nitrous oxide (N2O)black, Carbon dioxide (CO2) green and Oxygen(O2) white (when new!). The tubing and machinewere connected to the gas cylinders merely bypushing the end of the rubber tube onto the gas exitvalve of the cylinder (Fig 4).These ‘connections’frequently failed and leaked.

Safety features introduced

Eventually in 1955, the Ministry of Health, ina laudable change in regulations to preventaccidents, decided that all National Health Service(NHS) hospitals and other areas, such as dentalsurgeries, where general anaesthetics wereadministered, had to use special regulators (AdamsRegulators) on anaesthetic machines. The regulatorhad a special pin index retention coupling whichensured that the cylinders of O2 and N2O could onlybe attached to the correct side of the anaestheticmachine. The cylinders were no longerinterchangeable, which meant that accidentalconnections of wrong gas cylinders could not occur.Another safety feature introduced was the adoptionof a universal cylinder colour code. All oxygencylinders were to be black with a white shoulderand all nitrous oxide cylinders were to be blue tominimise any further confusion. This colour code

Figure 3. Trilene vapourised, thereby dating the machine

Figure 4. Boyles original anaesthetic machine

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remains to this day in the UK, but the Americancolour code is green for O2. The UK wide changetook some time to implement and required veryclose cooperation between gas users and gassuppliers. The emergency oxygen button (colouredred) ensures that a flow of oxygen bi-passes therotometers, and therefore there is no risk of anyother gases, or of Trilene, being mixed with the pureoxygen. Very simple, if not to say elementary,instructions such as ‘reminding the anaesthetist tomake sure the gas cylinders are turned on’, wereissued with the early Boyle’s machines.

So who was Dr Boyle?

Henry Edmund Gaskin Boyle OBE was born inBarbados on 2nd April 1875, the only child of asugar plantation estate manager, Henry E. Boyleand his wife Elizabeth, the daughter of BenjaminGaskin who was an MP in the Barbados Parliament.Following early schooling in Bridgetown he movedto England in 1894, and qualified MRCS, LRCPfrom St Bartholomew’s Hospital, London in 1901.He worked as a houseman in the anaestheticdepartment at Bristol Royal Infirmary before beingappointed to St Bartholomew’s in 1902, and wherehe was promoted to Visiting ConsultantAnaesthetist in 19032.

War service

During World War 1, Dr Boyle wascommissioned with the rank of Captain in the RoyalArmy Medical Corps and administered 3,600anaesthetics, mainly in casualty clearing stations inFrance, anaesthetising the patients with nitrousoxide/oxygen/ether (Fig 5). His outstanding workwas justly recognised with the award of an OBE(Military).

Initially he used imported Gwathmey machinesfrom the USA, but found them unreliable and thatthey leaked gas so he developed his own continuousflow machine, described above. Captain Boyle,RAMC, developed his machine in conjunction withhis friend Lord George Wellesley MC (1888-1967)who was at that time a Wing Commander in theRoyal Flying Corps. Wellesley had connectionswith an engineering manufacturing companyhaving been Managing Director of a firm calledCoxeters and Sons Ltd before the war. Thiscompany did all the engineering work involved inmachining the components for the anaestheticmachines. Eventually a large number of thesemachines were sent to France in WW1, and portableversions installed in casualty clearing stations nearthe front lines5. Prompt treatment was, and is, a keyingredient for the successful treatment of warwounds. Facilitated by general anaesthesiaavailable for the first time, thereby minimisingsurgical shock, minimising blood loss, andminimising pre and post operative infection, itensured that much more rapid treatment wasavailable, which in turn undoubtedly savedcountless lives3. The original machine included aBoyle’s Bottle to vaporize diethyl ether (aprecursor to trilene) as an adjuvant. In order toprevent the valves freezing up a small spirit lampwas hung under the cross bars (labelled in Fig 4).Despite the lamp being in very close proximity toether, only one explosion was recorded, althoughthere were probably more but unrecorded in thegeneral mayhem of the Western Front. Boyle wasleft handed and the machine controls were thereforedesigned for left handed operators. It was only inthe 1950s that the controls were reversed toaccommodate right handed anaesthetists. He alsowrote a popular textbook Practical Anaesthetics in1907, which had two subsequent editions.Additionally, being a very practical person, apartfrom the anaesthetic machine, he invented the

Figure 5. Dr Boyle in Army uniform

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Boyle’s gag which is still used today duringtonsillectomies4.

Post war

He was President of the Anaesthetics Section atthe Royal Society of Medicine in 1923, a foundingmember of the Association of Anaesthetists ofGreat Britain and Ireland, and an examiner for theDiploma of Anaesthesia (DA) and he himself wasone of the earlier recipients of the treasured DA.Additionally, he had a reputation as being a popularand excellent teacher, nicknamed ‘Cocky’,although the source of this has become lost in themists of time. He was a rotund figure of a genialnature and always showed a keen interest instudents’ extra-curricular activities, particularlyinter-hospital sporting fixtures, especially Bart’srugby, whilst he himself was a keen cricketer (Fig6). He was elected Staff President of the StudentsUnion. As a tribute to his far sighted inventions, in2000 the department at St. Bartholomew’s Hospitalwas named the Boyle Department of Anaesthesia.

He retired with his wife to Godalming in Surreyin 1939, but sadly died after a long illness on 15th

October 1941. His machines, suitably modified andcontinuously improved and updated, were ingeneral use in many hospitals and dental practices

in the United Kingdom until the 1980s to thebenefit of countless millions of patients. Howeversadly it is also unfortunate to relate that Dr Boyleapparently did not benefit financially to theslightest degree from his invention or from thesubsequent improvements to his machine. Indeedrumour has it that he was tragically in somewhatstraitened circumstances at the time of his death ata relatively early age of 66.

References:

1 O.M.Watt ‘Anaesthesia, Vol 23, no1, Jan 1968.’2 RCS, ‘Parr’s Lives of Fellows.’3.’Wikipedia’.4 ’Update in Anaesthesia’, Dr Q.Milner, PapworthHospital.5 Boyle H.E.G. ‘Use of Nitrous Oxide and Oxygenin Military Service. 1917’Author Biography

J. Stuart Robson BDS, MGDP FRCS. FormerPresident of the British Dental Association and theLindsay Society of Dental History. Member of‘General Anaesthesia, Sedation and Resuscitationin Dentistry’ Expert Working Party, Departmentof Health 1990 (‘Poswillo Enquiry’)

Address for correspondence:[email protected]

Figure 6. Dr Boyle at Bart’s

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Resistance and toothbrushes within the Heinkel kommando

Xavier Riaud

The camp

Oranienburg-Sachsenhausen was a largeconcentration camp near Berlin. The inmates calledthis camp “Sachso”. Close to this concentrationcamp was the Heinkel manufacturing factory,which amongst other things made aircraft for theLuftwaffe. The Heinkel factory made use of theinmates of the Oranienburg-Sachsenhausenconcentration camp where, over a period of severalyears, it is thought that about 100,000 inmates died.

At the Heinkel factory the inmates dideverything they could to subvert Nazi warfare1,2.In particular, there was a production line for theHE-177 bomber plane. In Hall 2 there were themechanical presses and a part of the tool productionsection.

Alex Le Bihan explained: “We make spoons, forks,tin-openers, pipes, cigarette holders, snuffboxes.Felipe Noguerol and Roger Guérin specialised inclandestine manufacturing of toothbrushes at theirown risk.”

Felipe Noguerol remembered that “one morning,I fainted on the roll-call parade ground. I was takento the infirmary. Thankfully, there was a Belgianmale nurse, Jacques Placet, whom I knew. He toldme: ‘Don’t worry, I will take care of you’. He hidme and treated me for eight days. We could not staylong. It was too dangerous. We were likely to besent to the gas chamber if we did not recover aftereight days 3.

During my stay in the infirmary, Placet saw thatI had a toothbrush, which was of good quality,similar to a ‘Gibbs’ toothbrush of the time, with myname engraved on it by a friend who was a jewellerin Marseille.

‘Who gave you this?’ he asked me.

- ‘I made it myself.’

- ‘Can you make me one?’

I said: ‘Yes I can. When I work during night time,I will go to the hall to look for some tools.’ Therewere chainsaws, drills, everything which wasneeded to manufacture planes.

Naturally, I risked being hanged, but life did notmatter. We told each other: ‘If I am sent to the gaschamber today or tomorrow, it will be the same.’Therefore we never took the necessary precautionsthat we would take today.

To make that toothbrush, I went to a hall wherewe stocked the finished planes. I went there with myfriend from Marseille. Once there, I got on theaircraft. With the hammer, I broke the windscreenwhich was made of plexiglas. I collected all thepieces. With a knife I cut hog hairs which were verylong because in these combat aircrafts there was atower with a cannon. Around the tower there wasa row of hog hairs to limit the friction and toprevent the flow of air.

And this is how I made a toothbrush for myfriend Placet. He was very happy.

One day, an SS doctor and commander searchedall the rooms. He opened a cupboard and saw thetoothbrush. He spoke little French: ‘Who gave youthis?’ Placet told him the truth 4.

That same day, whilst I was working, an SSsoldier called me ‘63260’, ‘Come with me!’ What’sgoing on? I was already shaking. I arrived at theSS commander’s office. The soldier opened thedoor. I saw the SS commander who told me: ‘Sitdown.’ He opened the drawer and took Placet’stoothbrush. ‘Did you make this?’ For a long time Istood there without being able to answer. I toldmyself: ‘I am going to be hanged, especially if hefinds out that I broke a plane.’ He repeated: ‘Didyou make this?’

After a while I said ‘yes’. Then he toldme: ‘Listen, I am going to ask you for a service. Thecamp commander has to go on vacation with hisfamily for Christmas. I know that I would please

Abstract: How is it possible to create a resistance with toothbrushes? Why were toothbrushes anissue in Nazis concentration camps? This is the story of two men who were heroes. They resistedthe Nazis while they were making toothbrushes.Key words: World War II, Nazis concentration camps, Toothbrushes.

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him greatly if I offered his wife a toothbrush. Therehaven’t been any toothbrushes available for a year,in the shops in Germany. So, I ask you to make meone.” 5

This was the beginning of December. I couldmake a toothbrush in a day. So I told him: ‘I don’thave the time. I made it over many months.’ He toldme: ‘Listen, make an effort. I will provide a roomof the infirmary where you will be able to work dayand night. Then I will give you a month of rest.’

This is how, with my friend from Marseille, Iwent back to the hall of finished aircraft. Onceagain I broke a windshield. This was on December1944. The Germans knew they had lost the war.One year previously I would have been hanged.During the night I prepared twelve toothbrushhandles and I went back to the infirmary. I startedworking. In my pocket, I had the twelve handles. Itook one and inserted two rows of hairs and then Iput it back in my other pocket. Then I took a secondhandle, etc. The SS came to see me twice or threetimes a day to check how the work advanced. In themorning there were two rows of hairs, in theafternoon, four. But they did not know that it wasfour times twelve. This is how I pleased my friendswho had asked me for toothbrushes and how I gavethe SS officer his toothbrush.

He kept his word. He allowed me to rest for amonth and this is why I am still alive today.

A few days later, another SS officer came to lookfor me, took me to the kitchen and introduced meto some SS lieutenant who was the chef. The lattertold me: ‘I learnt that you are a toothbrush expert.Here, we haven’t got brushes to clean the cookingpots anymore. We have the necessary material(wood and vegetable fibres), but no expert. We willmake two brushes per day.’ This is what I did. I wasgiven an extra bowl of soup and this is how I wasable to cope with my situation as a toothbrushexpert.”

Finally

If the deportees’ life obviously lackedtoothbrushes, the Sachsenhausen camp supposedlyhad its own internal rules, dating back fromNovember 6th 1942. A paragraph was included ondental hygiene: “Before going to sleep eachprisoner has especially to clean his feet. The teethhave to be cleaned. ….. To read in one’s bed isforbidden. Storage in wardrobes: upper shelf

destined for letters and for the toilet kit(toothbrushes, toothpaste, razor), tobacco,” Thesedirectives were nothing but a monument tocynicism and hypocrisy 2,6.

References:

1 Xavier, La pratique dentaire dans les camps duIIIème Reich [Dental practice in the Third Reichcamps], L’Harmattan (ed.), Collection Allemagned’hier et d’aujourd’hui, Paris, p94, 2002.2 Oranienburg-Sachsenhausen Association, Sach-so, Minuit/Plon (ed.), Paris, 1982.3 Balny Huguette, Au nom de la vie [In the name oflife], brochure, personal communication,Montpellier, p29, 2004.4 Balny Huguette, Au nom de la vie [In the name oflife], brochure, personal communication,Montpellier, p30-31, 20045 Riaud Xavier, Etude des pratiques dentaires dansles camps de l’Allemagne nazie, entre dérive ETthérapeutique [A study of dental practices in thecamps of Nazi Germany: between going adrift andgiving treatment], Universitaires EuropéennesEditions, Saarbrücken, 2010.6 Xavier, La pratique dentaire dans les camps duIIIème Reich [Dental practice in the Third Reichcamps], L’Harmattan (ed.), Collection Allemagned’hier et d’aujourd’hui, Paris, p 55, 2002.

Author Biography

Dental Surgeon, Doctor in Epistemology, Historyof Sciences and Techniques, Laureate and Memberof the National Academy of Dental Surgery, FreeMember of the National Academy of Surgery.

Address for correspondence: 145, route deVannes, 44800 Saint Herblain, France,0033240766488, [email protected]

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The Cautley Dental Dynasty

Tara Renton

Introduction

I embarked on this task with relish, having lovedand admired both my grandfather and father, bothdentists, who had seeded several stories of anextended dynasty of dentists and surgeons in thefamily (Fig 1).

When scrutinising my family history, goingback to the 1500s, many were ordained ministersof religion or farmers situated in and aroundYorkshire in the Cautley village and near the‘Spout’ waterfall, near Sedbergh, Yorkshire. Thereare also strong themes of medicine, engineeringand dentistry and Charterhouse School. Many ofmy ancestors also worked in India; my grandfatherwas born in Lucknow, the largest city in UttarPradesh.

The most famous family member

The most famous family member, who wasneither a doctor nor a dentist, was Sir ProbyCautley, who led many engineering projects innorthwest India. He is best known for conceivingand supervising the construction of the GangesCanal during East India Company rule in India. Thecanal stretches some 350 miles between itsheadworks at Haridwar and, after dividing nearAligarh, it confluences with the Ganges rivermainstream in Kanpur and the Yamuna River inEtawah. At the time of completion, it had thegreatest discharge of any irrigation canal in theworld. It provided drinking water and irrigation,transforming the health and wealth of millions ofIndians who had faced famine and cholera during1838. He joined Lord Hugh Falconer’s fossilexpeditions in the Siwalik Hills. He presented alarge collection of fossil mammalia, presenting apaper at the British Museum. In 1837 he advisedDisraeli on the Indian Council; he received theWollaston medal of the Geological Survey of GreatBritain, and the plant genus Cautleya is named inhis honour. His incredible story is brilliantlydescribed in a novel entitled ‘Garden of Fools’1.

The family ‘dynasty’ is summarised in Figure 1but what was of particular interest was how the fourgenerations of dentists in my direct family,punctuated the key political developments of theBritish dental profession, each of us working duringdifferent legislative times, often significantlyimpacting on our chosen sphere of practice.

The Dental Dynasty

John Burton Cautley My Great Grandfather wasborn in 1875 in Burton, Pidsea, Yorkshire and diedin February 1924 in Kent.

School. Schooling unknown

Qualifications He graduated in medicine andforensic medicine from St Bartholomew’s Hospital,qualifying in 1898 and registered with the GeneralMedical Council as Surgeon in 1899, L.S.A.Licentiateship of the Society of Apothecaries,1815-1854, L.M.S.S.A. in Medicine, UK MedicalSociety of Surgeons and Apothecaries. It is unclearwhere he undertook specialist training in dentalsurgery in 1907, but he worked as a dentalpractitioner in Kent, retiring in 1922. I was alwaysinformed that my great grandfather could earn moremoney in the Indian Medical Service by extractingteeth. I was led to believe he did his extractiontraining at Guys and St Thomas’ but there is noconfirmation of this.

Type of practice He had a medical practice"Devane and Cautley” with his partner, ThomasFrancis Devane. This was located at 23, Maple Rd,London. The practice closed in 1900. He wasregistered as working in a dental practice, in theDover and Maidstone area of Kent and retired in1922.

Military History Late in 1900, he was onprobation to join the Royal Army Medical Corp(RAMC). He was appointed to the rank of aLieutenant in November 1900, in the British ArmyOfficer School in Aldershot. He joined the RAMCand was immediately assigned to India. Two tours

Abstract: The Cautley family history record stretches back to the 16th century. In more recenttimes many family members were trained as doctors or dentists. The dentists have been in practiceover the period when there have been significant changes to the regulation and training of dentists.Keywords: Cautley dental family history

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in India followed, the first starting in1901 at LT. inRoorkee (where Sir Proby Cautley set up anengineering college 60 years before, Cawnpore(Kunpar) and Simla. He was promoted to Captainin November 1903, returning to England in 1906.Then in his second tour to India in 1908 he joinedthe 8th (Lucknow) Division, where my grandfatherand his brother were born. It is unknown when hereturned to the UK but he retired from full timeservice in the Army on 2nd March 1910. However,he remained active as a reservist with the RAMCthrough to at least 1917.

Details of registration Between 1st August 1815and 31st December 1858 the Society ofApothecaries examined and licensed medicalstudents to practise as apothecaries (in effect ageneral practitioner) anywhere in England and

Wales; hence anyone wishing to practise as suchhad to hold the Licence of the Society ofApothecaries (the LSA). The Society holds recordsof those who gained this qualification. The Societyalso licensed surgeons who wished to engage ingeneral practice but it did not license surgeons topractise as surgeons. Apothecaries were not trainedin surgery unless they had been apprenticed to asurgeon, to a surgeon-apothecary or to a surgeon,apothecary and man-midwife. A small number ofpeople with medical or surgical diplomas from aRoyal College of Surgeons or the WorshipfulSociety of Apothecaries practised dentistry as anappendage to their main professions (as my greatgrandfather practised).

After the passage of the Medical Act of 1858,which set up the General Medical Council, the LSA

Figure 1. The Cautley Medical and Dental dynasty

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continued to be set and was recognised as a fullyregistrable medical qualification. However, afterthe Medical Act 1886 was entered onto the statutebook; anyone qualifying to practise medicine alsohad to be examined in surgery. The post-nominalsLSA were therefore altered to LMSSA (Licence inMedicine and Surgery of the Society ofApothecaries) by the Apothecaries Act 1907, todenote the all-round competence of the Society’sLicentiates. The Society holds records of thoseindividuals who took the examinations. Themajority of those who took the examination to gainthe Licence in Medicine did not become membersor Liverymen of the Society itself. However, it wasaccepted during this period that medically qualifiedpractitioners were also able to work as dentists.

Ronald Lockwood Cautley My Grandfather,born in Lucknow India 1909. Died 6th November1981. Spouse Ena Lily Medwin. In the 1911 censushe was aged 6 years old living in Yorkshire.

School : St Lawrence School, Herne Bay, NorthKent.

Qualifications LDS 1927, Guys Dental School,Honorary FDS RCS Eng. 1948

Details of Registration First registered in March23 1927. GDC no 21695. His address was 9, NorthEnd Rd, Golders Green London NW1. He came offthe Dental Register in 1981. From1970-1981 hepaid a reduced fee to the GDC to keep his name onthe list and retired from practice in 1970.

Type of practice Private dental practice

Military History He had a naval career fromApril 1941-1948 based in Iceland

Details of practice Grandpa was brought backfrom India to England after my great grandfather,apparently a renowned philanderer, embarked onyet another affair, resulting in my greatgrandmother returning to England with two youngsons. She eventually remarried and both Grandpaand his brother, a future Royal Veterinary Surgeon,rarely talked of their childhood. Grandpa enjoyedboarding school and embarked on a dental careeras an apprentice with a family friend. It is unclearas to whether the second cousins influenced hisdecision, but definitely not his father, as by thistime he had been disenfranchised from the family.Grandpa took his finals in 1926 on the day of thegeneral strike. My cousin Sarah told me he tookgreat pride in telling the story that as there were nobuses he had to walk from Ealing all the way toGuys in order to sit his examinations. He practisedinitially in Wimpole Street and for over 40 years at9, North End Road, Golders Green, which is still adental practice. His surgery was located in the frontroom and the waiting room doubled as a familydining room at weekends. My childhood memoriesinclude the smell of oil of cloves pervadingthroughout the house, and meeting variouscelebrities (the ‘Carry On’ casts to mention a few),who often frequented Grandpa’s practice as it wasonly a few doors away from the Golders GreenHippodrome, then a centre for entertainment. Hewas married to a formidable, second generationIrish immigrant, whose father sold Spanish sherryto the West Country. Ena Medwin inherited herconsiderable business skills from her father and sheran the practice for my grandfather. His militaryservice during World War II was in the Navy, basedin Iceland. Again this was a subject he rarelydiscussed, like many of his generation. He washonoured with a Fellowship in Dental Surgery at

Figure 2. Guys Dental House Officers 1927 RonaldCautley right hand side Front row

Figure 3. 1926-7 Guys Hospital Hockey teams RonaldCautley 4th from left back row

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the first ever dinner of the Faculty of DentalSurgery, Royal College of Surgeons, England, andI recently discovered his signature in the Facultyregistration book (Figs 4,5).

Grandpa’s passion remained his family, flyfishing and his spaniels. Grandpa received hisKnighthood of St Gregory KSG (an honourablepapal award) for his lifetime inspirational work forthe Parish of St Edward the Confessor, GoldersGreen, his adopted faith. He established a localparish youth club, notorious for losing all theirboxing matches. He was still refereeing hockeygames the year he died of a hospital relatedinfection, picked up during assessment for his atrialfibrillation.

The establishment of formal dental education

Prior to the mid-1850s there was no recognisedand regulated profession and little formal dentalteaching. The Odontological Society of Londonwas formed in 1856 and the Dental Hospital ofLondon in 1858 and its London School of DentalSurgery in the following year. In 1880 most dentaltreatment was provided in general practice. Somedentists were trained at a dental school; others bymeans of apprenticeships (my grandfather later atGuys Hospital). The name of Tomes is probablybest known to practitioners because of the dentinalfibres named after him, but he was an all-rounder:general practitioner, hospital dental surgeon,scientist and dental politician. Before the periodunder consideration Tomes had been a prime moverin the establishment by the Royal College ofSurgeons of England of the Licentiate in DentalSurgery examinations and diploma. In 1878 theDentists Act for the registration of practitioners wasinitiated and the establishment in 1879 of a DentistsRegister, which was held by the General Councilof Medical Education and Registration (the GMC),and was aimed to restrict the type of people able topractise dentistry. In 1880 the British DentalAssociation was established. The Dentists Act was"to amend the Law relating to Dental Practitioners".It stated: "A person shall not be entitled to take thename or title of 'dentist' (alone or in connection withany other word) or of 'dental practitioner' or anyname, title, additional description implying he isregistered under the Act, or that he is a personspecially qualified to practise dentistry, unless heis registered under this Act." The only exceptionswere registered medical practitioners (for examplemy great grandfather). Once the 1878 Dentists Act

was passed, the registered men tried to preventunregistered people from practising dentistry. Theywere unsuccessful until the 1921 Act created a'closed-shop'. Some dentists treated poor people intheir own surgeries, the care being financed byincome derived from richer patients. A fewdispensaries also treated poor people. In 1874 theDental Hospital of London and its associated schoolmoved from Soho to Leicester Square. Its remit wasspecifically "for the purpose of affording to the poorgenerally the means of obtaining gratuitous reliefand advice"2.

My grandfather predominantly conductedprivate dentistry and later National Insurancedentistry. He started his training as an associate and

Figure 4. FDS RCS first Faculty registration book

Figure 5. Ronald Cautley signature FDS signature book1948

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later trained at Guys Dental Hospital (1924-1927)where he played hockey and later became a houseofficer (Figs 2,3).

From 1911 approved societies were authorised topay for some dental treatment and spectacles whenthey had 'surplus funds'. The BDA was keen forthese additional benefits to be provided and consid-ered possible schemes in 1913. There were discus-sions between some societies and individualdentists. In 1920, the 8th National Conference ofIndustrial Approved Societies was told that mostsocieties had substantial surpluses. They decided toprovide additional services rather than simply in-creasing the value of the already available benefits.

Care provided under insurance or state schemesinvolves an interaction between patients, providersof services, purse-string holders and regulatorybodies. The introduction of dental benefits in 1922produced a need for a monitoring system. RegionalDental Officers were appointed in 1923 to advisesocieties on the treatment provided. Never againwould dentists have complete clinical freedom tocarry out every treatment they wished and be paidfor it. However, for the first time they saw thepossibility of an assured and regular income. Thesedevelopments occurred after my great grandfatherbut influenced the training and practice of mygrandfather.

During World War II the Government of NationalUnity wanted to give the troops something to lookforward to, so they suggested the possibility ofcheap or even free health and welfare benefits. A1942 report to the government by William Bev-eridge included his thoughts on dentistry, indicated

"a general demand that dental services shouldbecome statutory benefits available to all underhealth insurance". He suggested that, as dentalhealth was part of general health, preservativedental treatment was of major importance. Bev-eridge wrote: "This measure involves, first, achange of popular habit from aversion to visitingthe dentist till pain compels, into a readiness tovisit and be inspected periodically." He recognisedthat a much larger dental service would be neededto cope with any increased demand. On 5th July1948 the National Health Service came into beingand the General Dental Services were founded. Itwas to be available to everyone, free at the time oftreatment and financed out of taxation. From thebeginning, dentists were paid on an items-of-serv-ice basis3. This development significantly impact-ed on my father at 17 years of age. He wasimmensely inspired by this act and he would neverundertake private care on any of his patients.John Medwin Cautley My father was born in1931 in Highgate and died in 1994 in TauntonSomerset. Spouse Gloria Olive Moore.

School Douwe School. My father was evacuatedduring the Second World War from North Londonto this monastic boarding school, which was thesource of many stories my father told us. Despitethe very strict regulation, it didn’t dampen myfather’s enthusiasm for reading and making modelrailways (with a torch under the dorm blankets!).

Qualifications LDS,RCS Eng1954.

Details of Registration GDC no 32133. Firstregistered in 1954, address 9, North End Rd,London NW1. 1954

Graduated from Guys Dental School 1950-54 (Fig6) Photo Guys Hospital Hockey, Team winnersinter hospital cup 1954, (Fig 7) Guys HospitalDental preliminary year 1950.

Type of practice 1962-1994 General dentalpractice Yarde House, Taunton, Somerset, 1Staplegrove Rd, Taunton Somerset. Partner TonyStern.

Military History He was a Flying Officer in theRAF from 1955-59 based in Cyprus and RAFChivenor, Barnstaple, Devon.

My father was an inspiring man. He had manyinterests including hockey, skiing, cycling, sailing,model railways, vintage cars and he adored my

Figure 6. Photo 1954 Guys Hospital Hockey Team winnersinter hospital cup John Medwin Cautley 2nd from left frontrow

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mother. She was one of his patients, in Cypress, herfather being in the Army based there during theSuez crisis when my father was stationed inEpiscope for his RAF national service. He charmedher with his ‘James Masonesque’ Hollywood goodlooks completed with neckerchief and deep tan.They married in 1958 and returned to England in1960 where my father demobbed from RAFChivenor, Devon. I was born soon afterwards andmy father joined one of his best friends, TonyStearn (who still lives in Taunton), at Yard HouseDental Practice, 1, Staplegrove Road, Tauntonwhere he practised NHS general dentistry for over30 years. He was Chairman of Somerset BDAbefore his retirement.

I was born in 1961, followed by two brothers. Wehad an idyllic childhood growing up in a Somersetcounty town. Unfortunately, one of my father’sgreat passions was smoking; this sadly resulted inhis premature death at 62 of an MI at the local gym,a sudden and horrible shock for all of us.

Tara Frances Renton (nee Cautley) Born 1961,Barnstaple Devon. Spouse Tony Renton

School Bishop Fox’s Girls Grammar School 1972-79

Qualifications LDS 1983, BDS 1984,FRACDS 1988, MDSc 1991, FRACDS (OMS)1991, FDS RCS 1996, PhD 2003, FHEA 2003

Details of Registration First registered in1984, GDC no 58499.

Graduated From Guys Dental School LondonUniversity 1979-84, MDSc, Melbourne University,PhD, Kings College London.

Type of practice OMFS, Senior House Officer(SHO) and Registrar at Guys and Torbay Hospitals,GDP Bournemouth 1987 and GDP Melbourne1987-8, OMFS Training Melbourne 1987-1991,Senior Registrar OMFS Guys 1992, AssociateSpecialist OMFS Guys 1993-2003, Senior LecturerOMFS Bart’s London. 2003-2006, Professor ofOral Surgery, Kings College London, 2006-present.

Military History None

Since my father’s generation, the changinglegislation has meant that dentistry wasconsolidated by the 1957 Dentists Act. A Dentists(Amendment) Act 1973 and the 1957 Act wererevoked by the Dentists Act 1984 which modifiedthe constitution and powers of the GDC. The DentalQualifications (EEC) Recognition Order 1980 tookon board the implications for undergraduate andpostgraduate education plus specialisation withinEEC/EU legislation.

I was fortunate to have a completely structuredundergraduate training at Guys 1979-1984 which Iloved. Inspiring characters including Professor TomPitt Ford my personal tutor for some time. GeoffreyHowe and Frank Ashley kept me enthused with mychosen profession, which incidentally my father hadbarred me from! I first knew I was in the right placeat my first biochemistry lecture in the HodgkinMedical Building on Guys Campus and I nevercease to get goose bumps even now, visiting theGordon Museum. Later on, after graduating, Ibecame Don Gibb’s House Officer at Guys andsubsequently Hugh Walter’s SHO in Torbay bothof whom remain the inspiration for my chosenspecialty of oral surgery. As this speciality did notthen exist when I graduated, I remained loyal to mydental ‘roots’ and continued specialising andstudying in the hope that one day, common sensewould prevail. It did, and in 2000 the GDC openedup the Oral Surgery Register, to comply withEuropean Legislation that recognised onlyOrthodontic and Oral Surgery Dental Specialties,onto which I was grandfathered with four years ofOral and maxillofacial training in Melbourne(inspiring mentor and lead David Wiesenfeld) andgraduated with both Masters and OMFS exitexaminations.

My chosen career as a clinical academic continuesto enthral me and it has provided me with an oftenchallenging but wonderful family balance,particularly with my ‘silent weapon’ husband Tony.

Figure 7. Guys Hospital Dental year 1952 John MedwinCautley second in right front row

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Sadly none of my three children have chosenhealthcare for a career. But Maths, MechanicalEngineering and Computer Sciences are the futureand I’m immensely proud of them. India remains atheme with us now; even my name, Tara, refers toan Indian goddess, now referred to as Dulma. Thisname was given to me by my grandfather. Myhusband is also involved in tiger conservationcollaborating with Born Free, requiring regularvisits to Nagpur.

I hope this paper may be of some interest to thereaders of the Dental Historian. It has certainlygiven me some wonderful moments searchingthrough old family documents.

References

1 ‘Garden of Fools’, Robert Hutchison, PalimpsestPublishing House; 1st edition (30 Jun. 2012)ASIN: B00DYVFFT8).2 S Gelbier. 125 years of developments in dentistry,1880–2005 Part 6: General and specialist practice.British Dental Journal 199, 746 – 750, 2006.3 S Gelbier 125 years of developments in dentistry,1880–2005 Part 7: War and the dental profession.British Dental Journal 199, 794 – 798, 2005.Acknowledgments

I would like to thank Margaret Wilson, HonCurator of the BDA Museum, who invited me towrite up my family’s ‘Dental Dynasty’. I must alsothank my Uncle Paul (Dad’s brother) who puttogether the Cautley chronicle, Sarah Jane mycousin and Paul my brother in the USA for theirsupport and contributions.

Author BiographyTara Renton (Nee Cautley) BDS MDSc PhDProfessor Oral Surgery, Kings College LondonAddress for correspondence:[email protected]

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Dental Historian 2018; 63 (1) 22 - 32

Sir John Tomes (1815-1895): a Scientific and Academic Legacy

Barry Berkovitz

The Hunter legacy

The history of dentistry in England is dominatedby two men: John Hunter and Sir John Tomes(Fig.1). To most people, John Hunter is revered asthe father of scientific surgery, based on his pre-eminence as an anatomist and scientist. Among hisdiscoveries was to show that the blood circulationsof the fetus and the mother were separate. He alsocarried out all the dissections for one of the mostimportant books in medical history, namely hisbrother William Hunter’s book, “The Anatomy ofthe Human Gravid Uterus” published in 1774.Unfortunately, as he felt he did not receivesufficient recognition for his contribution, Johnnever spoke to his brother after its publication. Hisbelief in careful and repeated observation and inthe stringent testing of hypotheses is still retainedin the term the ‘Hunterian tradition’.

Less well known are Hunter’s contributions todentistry. On returning to England after a spell asan army surgeon, and in need of a supplementalincome, Hunter formed a working relationship witha dentist named John Spence. Spence was wellrespected as a dentist. The great diarist JamesBoswell writes “Toothache easier. Went to Spence.Two stumps dran and teeth cleaned: agreeable tosee things well done." Realising the poor scientificbasis of dentistry, Hunter published his first twobooks, entitled “The natural history of the humanteeth” (1771) and “A practical treatise on thediseases of the teeth” (1778). That someone aseminent as John Hunter would publish a book onthe subject of teeth immediately raised the profileof dentistry.

It must be remembered that, at the time ofHunter, dentistry was an unregulated trade: anyonecould practise it. A common source would havebeen the local barber or blacksmith. Dental

treatment mainly involved tooth extraction, andthis was well before the discovery of generalanaesthesia. Despite Hunter’s major contribution,dentistry as a profession made no further advancefor the next 70 years, until the arrival on the sceneof John Tomes.

Tomes’ scientific career

The career of John Tomes can be convenientlydivided into two phases: an early, scientific phaseand a later, political phase. The latter politicalphase has been described in a number of

Abstract: 2015 represented the bicentenary of the birth of Sir John Tomes (Fig. 1). In my capacityas the Honorary Curator of the Odontological Collection at the Hunterian Museum of the RoyalCollege of Surgeons of England, I was invited by the Faculty of Dental Surgery to commemoratethe occasion by giving a lecture about this man, who had close connections to the College. As adental histologist, I knew something about Tomes as a scientist, as his name is still associated withcertain dental histological structures that I taught. As I had recently retired, I now had the timeto look more into the life of Tomes, particularly his scientific contribution. The preparation of thelecture had one unexpected outcome.Key words: Sir JohnTomes

Figure 1. Sir John Tomes. Courtesy British DentalAssociation

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publications (e.g. Cope, 1961; Gelbier, 2007;Bishop and Parker, 2010) as well as in his obituary(1895).The present paper describing his scientificphase covers the period 1836-1856.

Born in 1815, John Tomes was all set for a lifein medicine. His pathway was typical for the time.As a youth, he was first apprenticed to theapothecary Thomas Furley Smith in Evesham,where he would learn about the preparation anduse of medicines. In 1836, at the age of 21, Tomescame to London to study medicine at King’sCollege Hospital and the Middlesex Hospital.

Considerable histological research was beingundertaken by researchers at King's College and,during his second year of medical study, Tomesbecame involved in preparing ground sections ofteeth for microscopical examination. This newtechnique was being undertaken in a number ofEuropean centres and had provided the earliestdescriptions of the structure of enamel and dentine.The technique was difficult but Tomesimmediately showed an aptitude for the procedure.

Tomes’ expertise in hard tissue microscopy wassuch that he was encouraged by Thomas Bell,

Professor of Zoology at King’s College London(and later dental surgeon to Guy’s Hospital), topresent his findings to the Royal Society in 1838,the most important scientific society in England.He was then only 23 years old. As his sponsor,Professor Bell communicated the paper, its titlebeing “On the structure of the teeth, the vascularityof the organs and their relation to bone”. At thistime, Richard Owen, (later to become the founderand Director of the British Museum of NaturalHistory), was the Hunterian Professor andconservator at the Royal College of Surgeons: hewas also preparing ground sections. Tomes wasintroduced to Owen who must have been impressedenough for him to encourage Tomes’ study andeven to ask Tomes to prepare ground sections ofsome of his fossil teeth.

A paper is rejected

In my early researches of Tomes’ publishedscientific papers, although I was aware of theexistence of an abstract of his 1838 presentation, Iwas surprised to find no record of the full paper. Idecided to visit the Library of the Royal Society inLondon and asked the library staff if they had anyinformation on the paper. The librarian bade mewait a few minutes while she went to investigate.On returning, her first question stunned me.“Would you like to see the original paper?” shesaid. I couldn’t believe my luck! Within a fewminutes I had before me John Tomes’ originalhandwritten 1838 presentation. It consisted of 38pages of text (Fig 2) with a number of diagramsprepared by his friend Mr. Bowman. Tomesconcluded the paper stating: “I am entirely indebtedto the great kindness of Professor Bell and Mr.Owen for the opportunities afforded me to examinethe teeth of less common animals” (Fig 3)

Having read Tomes’ original paper, I asked thelibrarian if she had any idea why the full paper hadnot appeared in the Proceedings of the RoyalSociety. Her answer was that all papers have to bereviewed and accepted before they can be publishedand this must indicate that the paper had not beenaccepted. She said she would investigate furtherand left me alone for another 15 minutes. On herreturn, she confirmed that the paper had indeedbeen rejected, but then astounded me even more byasking whether I would like to see the originalreferees’ report (The Royal Society has kept alloriginal submissions and referees’ reports goingback to its origins).

Figure 2. Title page of John Tomes' 1838 paper readbefore being rejected by the Royal Society. Courtesyof the Royal Society. Catalogue no. 37, 1838

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A case of intrigue or academic jealousy

With the three-page referees’ report (Ref 247,1838) in front of me, my eyes quickly scrolleddown to the end to see the names of Richard Owenand Thomas Bell. The two people who had offeredTomes such encouragement had rejected the paper.Although commenting favourably on the quality ofthe work (the word “excellent” was even writtenon the first line but subsequently crossed out), themain reason given for the rejection was that anumber of the findings already existed in foreignpublications, although at the time we assume thatthese would have been in a different language andwould not have been available to Tomes or mostother workers in the field in England, apart fromOwen. If either Owen or Bell knew of thesefindings then one would have thought they wouldhave informed Tomes before encouraging him topresent his paper to the Royal Society.

A question that needs to be raised concerns theattitude of either one or both of the referees. It is to

Figure 3. Final page of John Tomes' 1838 paper. Catalogueno. 37, 1838. Note the acknowledgements to Thomas Belland Mr. Owen. Courtesy of the Royal Society

be assumed that Tomes, a mere medical student,would not himself have made the decision toundertake the considerable work necessary toprepare the paper for communication to so augusta body as the Royal Society. It must be concludedthat he was encouraged to do this either byProfessor Bell and or Richard Owen, probably theformer. Furthermore, it is likely that the contents ofthe paper would have been discussed beforehandby Bell, who communicated the paper on behalf ofTomes. To allow Tomes to go ahead and presentthe paper in the knowledge that it would be rejectedseems extremely unjust, particularly withoutalerting him to any related foreign literature. Owen,though one of the greatest and most influentialscientists of the age, has a history of being a difficultperson to deal with and was in conflict with anumber of other fellow scientists throughout hislifetime. He was ambitious, perhaps to the point ofnot wanting anyone else competing in his field ofresearch, even if it was only a young medicalstudent. One way to avoid this would have been toreject Tomes’ paper. The referees’ report was a jointreport and one wonders if Owen, who could haveclaimed to be more conversant with the literature,persuaded Bell to accept this recommendation.

Irrespective of the reason for the rejection, itsurely would have come as a crushing blow for mostpeople and perhaps even have provided a goodreason for giving up further research. However,John Tomes was not to be deterred. The rejectioncould even have had the opposite effect. His strongwill and self-belief may have enabled him to riseabove this setback and to continue his research, butensuring that any further publications would be sothorough and original that they would proveimpossible to reject.

Dental lectures and publishing

Tomes’ continued interest in dental research ledhim to abandon medicine for dentistry in 1840, andin 1843 he became the first dentist to be appointedto the Middlesex Hospital. Amongst his earliestduties, Tomes was required to give the first seriesof lectures in dental surgery in England. The 16lectures took place during 1845 and 1846 and wereserialized in the Medical Gazette. In 1848 theselectures were published together in a book underthe title, “A course of lectures on dental physiologyand surgery”. This book represents the first text ofits kind on the topic.

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Dental surgery took a giant leap forwardfollowing the discovery of anaesthesia (nitrousoxide in 1845 and ether in 1846). Each anaestheticwas discovered by an American dentist and reportedalmost immediately: nitrous oxide by Horace Wellsand ether by Henry Morton. That Morton wasapprenticed to Horace Wells makes the discoveriesamazingly coincidental. News of the use of etherarrived in England from North America inDecember 1846. Tomes was one of the very firstpeople who used ether anaesthesia in England,when he extracted teeth painlessly in January 1847.He also helped to administer it for other medicalcolleagues during operations in different regions ofthe body. His far-sightedness allowed him to be thefirst person to include a chapter on generalanaesthesia in his 1848 textbook of collectedlectures (see his Lecture XV, pp 342-360).

Academic plagiarism and rivalry

Between 1840-1845 Richard Owen produced anencyclopedic text entitled "Odontography". Thispublication described the teeth of all majorvertebrate groups. Although Owen would haveexpected only praise for his efforts, one anonymousreviewer in the July 10th edition of the LondonMedical Gazette was unimpressed, saying thatanother book already described similar informationand also chided Owen that there was no mention ofthe recent work on the structure of teeth by A.Nasmyth (of Nasmyth's membrane fame). Thename of the reviewer remains unknown but theresult led to an acrimonious and vitriolic publicexchange of letters between Owen, the anonymousreviewer and Nasmyth, in the Medical Gazette, thatalso spilled over into The Lancet, with no holdsbarred.

In July 1840, Tomes himself was drawn into theexchange and published a letter in the 31st Julyedition of the London Medical Gazette. He drewattention to the fact that, even though he hadreceived much encouragement by Owen, he had hispaper rejected by the Royal Society. This in itselfdid not worry him. However, he subsequentlybecame aware that a number of his own findingshad been used by Owen without anyacknowledgement. Similarly, slides he himself hadprepared at the request of Owen had subsequentlybeen claimed by Owen to be of his own making. Inclearly stated terms, Tomes branded Owen aplagiarist.

For a young, unknown dentist to publicallyaccuse someone of the stature of Owen to be aplagiarist reveals Tomes’ strong and determinedpersonality. In the dispute, editorials in The Lancet(1840) and the Dublin Medical Press (1840) cameout strongly in support of Nasmyth's and Tomes'claims.

Further publications

Continuing his researches, Tomes submittedfour major papers to the Royal Society between1849-1856: all were accepted. Having alreadylearned that the Library at the Royal Society hadretained Tomes’ original rejected 1838 paper, Iagain visited the library and was delighted to begiven access to all his original hand written papers,together with the original hand-written referees’reports. There were two referees’ reports for threeof the papers and three for the remaining one (butsee later). Thomas Bell and William B Carpenterwere referees for three papers each, WilliamSharpey refereed two of the papers and WilliamBowman one paper (Table 1). All were Fellows ofthe Royal Society, with expertise in histology.

1849 paper (Catalogue no. PT/36/5): On theStructure of the Dental Tissues of MarsupialAnimals, and More Especially of the Enamel.Vol. 139, pp. 403-412.

Tomes' hand written manuscript for this paperconsisted of 32 pages plus three pages ofillustrations. This paper was the first paper to detailthe distribution of a special type of enamel (tubularenamel) in a wide range of marsupials, togetherwith its absence in the koala bear (Phascolomys).The referees for this paper were Thomas Bell andWilliam Benjamin Carpenter, who produced acommon report (PT/35/5 RR/1/250)

1850 paper (Catalogue no. PT38/14, PT/39/1):On the Structure of the Dental Tissues of theOrder Rodentia. Vol. 140, pp. 529-567 (PT/46/3).

This very large and comprehensive paperconsisted of 176 hand written pages and 12 pagesof diagrams and was the first to demonstrate thatrodents could be identified by the complex patternsin the enamel of their incisors. With typicalthoroughness, Tomes selected 60 typical species forexamination and prepared 450 sections. The paperwas refereed separately by William BenjaminCarpenter (RR/1/249) and William Bowman(RR/1/248).

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1853 paper (Catalogue no. PT/46/3):Observations on the Structure and Developmentof Bone (With Campbell. De Morgan).Vol. 143,pp 109-139.

This joint paper contained 157 hand writtenpages and 9 pages of diagrams. This wide-rangingpaper on bone was one of the first to suggest thatbone was subjected to turnover and remodeling. Thepaper was refereed by William Sharpey (RR/2/241)and William Benjamin Carpenter (RR/2/242). Thecomments by Sharpey (the same person who gavehis name to Sharpey’s fibres) extended over ninepages and almost represented a paper in itself. Itended with the favourable words:

“In conclusion I beg leave to express a mostdecidedly favourable opinion of the memoir as awhole; I look on it, indeed, as a valuablecontribution to our knowledge of the osseoustissues, and I can have no hesitation in stronglyrecommending its publication in the PhilosophicalTransactions with its admirably executed andhighly illustrated figures; only waging once morethe expediency of such compression as may becompatible with a full exposition of the peculiarmatter which it is the object of the paper tocommunicate.”

1856 paper (Catalogue no. PT/53/6). On thePresence of Fibrils of Soft Tissue in the DentinalTubes. Vol. 146, pp. 515-522.

This was the first paper in settling a long-runningdispute as to whether dentine was a living tissue. Itcomprised 40 small pages of text and six pages ofdiagrams. With very careful histological techniquesand careful reasoning, Tomes clearly showed thepresence within the dentinal tubules of cytoplasmicprocesses derived from the odontoblast cells liningthe surface of the pulp. Reference to this study byTomes is mentioned in the first edition of Gray’s

Anatomy in 1858. The paper was refereed byWilliam Benjamin Carpenter (RR/3/263) andWilliam Sharpey (RR/3/264). It is worthreproducing Carpenter's full report below as it alsoindicates that he had looked at Tomes’ materialhimself (Fig. 4).

Report 263 1856 Tomes by Carpenter May30th 1856

On the presence of fibrils of soft tissue inthe dentine tubules by John Tomes FRS

In this communication, Mr. Tomes adduces(satisfactory-deleted) evidence, derived frommicroscopic examination of newly-extracted teeth,that the cavities of the tubuli excavated in the soliddentine, are occupied in the living state by softfibrils of organized substance. He does not feeljustified in affirming, however, whether thesefibres are hollow or solid. Having myself examinedthe preparations which are delineated in theillustrations to Mr. Tomes’ paper, I am fullysatisfied of the accuracy of the statements whichhe has made as to their microscopic appearance.

1838 Paper (Rejected): Richard Owen, Thomas Bell1849 Paper on marsupial enamel: T Bell, WilliamBenjamin Carpenter1850: Paper on rodent enamel*: William BenjaminCarpenter, William Bowman,1853: Paper on bone (With C. De Morgan): WilliamSharpey and William Benjamin Carpenter1856: Paper on dentine tubule content: WilliamBenjaminCarpenter and WilliamSharpe*See text for additional referees report by T Bell

Table 1. Referees list for Tomes’ Royal Society papers

Figure 4. Last page of Carpenter's handwritten report onTomes' 1856 paper. Report no. 263, 1856. Courtesy of theRoyal Society.

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Regarding the nature and function of these fibrils,Mr. Tomes does not consider himself warranted inexpressing a positive opinion; but he adduces muchimportance to evidence, derived from facts wellknown to dentists as to the sensibility of dentine, infavour of the idea that these fibres have the powerof conveying sensory impressions, and must,therefore, be of the nature of nerve fibres. He doesnot, however, by any means deny the usuallyreceived doctrine that the dentinal tubuli serve forthe conveyance of fluids – of which dentine, indeed,he adduces additional proof.

Considering the subject of Mr. Tomes’scommunication to be one of much scientific andpractical importance and having a full confidencein the accuracy of his statements, I recommend thepaper for publication in the PhilosophicalTransactions.

William B. Carpenter

A misfiled report is discovered

I spent a most productive afternoon at theLibrary of the Royal Society reading the originalreferees’ report of Tomes’ four papers. All weresupportive of the papers being published. Excitedby the presence of such important historicaldocuments in my hand, and having some sparetime, I thought I would just spend a few extraminutes browsing randomly at some other referee’sreports on other subjects submitted to the RoyalSociety. I could not believe my luck, for the firstreport I encountered was for Tomes’ 1850 paper onrodents (RR/2/240). It was completely out ofcontext and should have appeared with the otherreferees’ reports of the same paper in anothervolume. It would never have been found undernormal circumstances. Whereas the two originalreferees were in favour of publication, this thirdreport was firmly against publication. This refereewas Thomas Bell, the same person who firstencouraged Tomes to study teeth and who hadfavourably refereed other papers of John Tomes. Inaddition to asking for the paper to be rejected, heclearly wanted his comments to remain anonymousand marked his report with the instructions that theyshould “not to be forwarded”.

Tomes (1847) also wrote an article on bone forRichard Bentley-Todds third volume of theprestigious Cyclopedia of Anatomy andPhysiology, in which he describes experiments

feeding madder to pigeons and young pigs. Heobserved that sections of bone viewed under themicroscope showed the presence of red dye lining,not only the outer (periosteal) and inner (endosteal)bone surfaces, but also the inner surface of everyHaversian system, indicating that this must beaccounted for when considering bone growth.

In addition to his hospital post in dental surgery,Tomes also established a private practice at 41Mortimer Street, Cavendish Square. He would soonacquire the reputation of being one of the bestdental practitioners in London and no doubtsuccessfully treated and obtained the patronage ofmany influential people. This, together with hisgrowing scientific reputation, would have markedhim out as a leading advocate of the fledglingdental profession.

Tomes as a Fellow of the Royal Society

Tomes’ scientific eminence was cemented byhis being elected a Fellow of the Royal Society in1850 at the young age of 35, even before his fourmajor papers had been published. Although twoother people with dental connections had receivedthe FRS by then, namely Thomas Bell (1828) andSamuel Cartwright (1841), Tomes was the firstscientist awarded an FRS for scientificinvestigations relating to dental science. The fourreasons for the award stated on his FRS certificateare:

1. His 1838 paper presented to the Royal Society(which the Society rejected!)

2. His series of lectures at the Middlesex Hospitalin 1845-6

3. His article on bone in Todd’s Cyclopedia ofAnatomy and Physiology

4. His invention of a machine for carving dentures,for which the Arts Council awarded him its goldmedal.

Bishop and Parker (2010) have analysed indetail the names of those Fellows of the RoyalSociety who supported Tomes’ application for hisFRS. These were important people of influence andpower and further attest to his scientific stature.This power base would be of crucial help in hislater efforts to establish dentistry as a professionequivalent to medicine.

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In 1859, Tomes published the first majortextbook in England on dental surgery entitled “Asystem of dental surgery”. It included on pages78-79 illustrations showing root resorption clearlybeing carried out by large multinucleated cells(which we would today term odontoclasts) lyingin recesses (Howship’s lacunae) (Fig. 5). He notedthe similarity between root resorption and boneresorption. When attributing the discovery of cellsresponsible for eroding hard tissues (osteoclasts),this image puts Tomes at the forefront.

“A system of dental surgery” remained thestandard work for decades, being updated in furthereditions by Tomes’ son, Charles Sissmore Tomes,whose own contributions to dentistry were almostas illustrious as his father. Like his father, Charlesalso obtained an FRS and a knighthood.

Following the publication of his textbook,despite being active for another 40 years, JohnTomes made no further scientific contributions todentistry. However, his son, Charles, ensured hislegacy as one of the founding fathers of dentalhistology was not forgotten by creating eponymsfor his father’s discoveries in Charles' ownscientific papers and textbook, “A manual of dentaland comparative anatomy”,. Even today we referto the:

• Tomes process (the pyramidal projection at thedistal end of the enamel-forming cells, theameloblasts)

• Tomes fibril (the odontoblast process occupyingthe dentinal tubules)

• Tomes granular layer (the outermost layer of rootdentine)

• Tomes resorbent organ (the vascular connectivetissue with osteoclast-like cells responsible for theresorption of the roots of deciduous teeth)

Tomes devoted the last 40 years of his life tousing his list of contacts and his great powers ofpersuasion in almost single-handedly transformingdentistry from an unregulated trade to the respectedand regulated profession we know today. Heparticipated in the founding of:

1. The Odontological Section of the Royal Societyof Medicine.

2. The L.D.S. R.C.S. certification. Tomes was anexaminer in the first batch of candidates in 1861

3. The first dental hospital in England, the DentalHospital of London and the London School ofDental Surgery in 1858. This later became theRoyal Dental Hospital of London.

4. The Dental Register, whose first member wasJohn Tomes.

5. The British Dental Association, whose firstPresident was John Tomes.

For his contributions to dentistry he was knightedin 1886.

The scientific legacy of Sir John Tomes is stillvery much alive today, especially at the RoyalCollege of Surgeons of England. The far-sightedness of John Tomes has left us today withthree collections of the highest importance relatedto the history of dental science.

Dental Collections

1. Odontological Collection

When founding the first dental hospital inLondon in 1858, Tomes realized the importance ofhaving a Museum to provide material for bothteaching and examinations. He helped establish theMuseum of the Odontological Society of Londonand was its first curator (Table 2). Originally themuseum was housed in the newly-establisheddental hospital and by 1874 it contained over 1,000specimens. By 1907, it had grown to nearly 3,000specimens and became so large that, in 1907, it was

Figure 5. Image of odontoclasts from Tomes' first edition(1859) of A system of dental surgery. Courtesy of the RoyalCollege of Surgeons of England.

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Sir John Tomes 1859Edwin Sercombe 1860-1862W.F. Forsythe 1862-1864Nathaniel Stevenson 1864R.T. Hulme 1865-1869Sir Charles S Tomes 1870-1880S.J. Hutchinson 1880-1885Storer Bennett 1885-1900Sir Frank Colyer 1900-1955A.E.W. Miles 1955-1989B.K.B. Berkovitz 1989-present

Table 2. List of honorary curators of the OdontologicalCollection

housed in the Royal College of Surgeons ofEngland, where it has remained ever since. Bygood fortune, it was housed in the basement of thebuilding and emerged unharmed following thegrievous bomb damage of the College in 1941,during which two-thirds of the contents of theHunterian Museum were destroyed.

To help the Royal College of Surgeons in itsrecovery, the Odontological Collection was giftedto it. It has now grown to contain over 11,000specimens and is one of the most important dentalmuseums in the world, particularly for itscollection of animal skulls, both normal andpathological. As an example of its importance, itpossesses well over a hundred great ape skulls.Tomes donated much of his own valuable materialto the Museum, among which is a series ofdissected skulls showing the stages of developmentand eruption of the dentition (Fig. 6).

1. Tomes Slide CollectionTomes kept all the slides he prepared during his

scientific phase and these, together with those ofhis son, Sir Charles Sissmore Tomes, were donatedto the Royal College of Surgeons by Charles.Thisis notated in the Quarterly Report of the Collegeof 1920 by A. Keith, conservator as follows:

“…..a letter was received from Sir CharlesTomes offering to present to the college all thesections of teeth made and used by the donor andhis father in their researches on the comparativeanatomy of teeth. The series thus offered is of theutmost value to all who are investigating themicroscopic structure and morphology of teeth”

The Tomes Slide Collection contains about1,880 histology slides, mainly ground sections. I

Figure 6. Skull of a five and a half year old child. Courtesyof the Royal College of Surgeons of England.

Figure 7. A Tomes histology slide tray

Figure 8. John Tomes histology slides

have had the great privilege of looking throughthem all. It contains sections of teeth from all themain groups of vertebrates. Until recently, theywere contained in their original glass-frontedVictorian slide cabinet, with a brass plate engravedwith the words "Tomes slide collection". However,

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Figure 9. Tomes histology slides

Figure 10. Contents of box file

a recent visit from Health and Safety Executivesdeemed the cabinet unsafe and it was quietlyremoved and sold at auction. Its presentwhereabouts are unknown.

Any histologist would immediately appreciatethe immaculate quality and careful presentation ofthe slides. They are presently contained in trays of

about 40-50 slides per tray, with a total of 47 trays(Fig. 7).

It is possible in many instances to attribute slidesspecifically to John (rather than Charles) Tomesaccording to the date, species and the labelling onthe slide scratched out with a diamond marker pen,which can be compared with their actualhandwriting (Fig 8). The range and quality of theslides comprising the Tomes slide collection isindicated in Fig 9.Tomes Collection of Offcuts.

Rather than just throw away material associatedwith their research, there is a large collection ofjaws, sectioned teeth and other animal material,carefully labeled and packaged by the Tomeses andpresently held in two box-files (Figs 10 and 11).Inexamining this material, I came across a letter in anenvelope that presumably has never been seenbefore (Fig. 12). It reads, line for line,

Tibia of DinornisNew ZealandFrom Dr Mantell

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Mr Hunter will be pleased ifMr Tomes can see him tomorrow(Thursday) morning at20 minutes after 9 o’clockWhen Mr Hunter will call unlessHe hears from Mr TomesHincham Villa Finchley Road, St John’s Wood, Wednes-day

Dinornis is the extinct giant moa and the DrMantell referred to must be the famous palaeontol-ogist, Gideon Algenon Mantell. By his discoveryof the teeth of Iguanodon, Mantell began the sci-entific study of dinosaurs. As he died in 1852, themeeting referred to in the letter probably tookplace over 150 years ago.

PostscriptMy anticipation in preparing a lecture for John

Tomes proved correct and I was invited to presentthis at the Royal College of Surgeons at theinvitation of the Faculty of Dental Surgery. Afurther bicentenary celebration has beendocumented previously in this Journal (Berkovitz,2016).

At the beginning of this project, I was finallyabout to retire completely from academic work anddevote myself to reading for pleasure all thenon-dental book titles I had accumulated over theyears and to travel much more.

The preparation of my bicentenary lecture,however, had one totally unforeseen consequence.I had gradually noticed some connections with thegreat man. I had obtained the LDS (1961) that hehad inaugurated. I had received my BDS at theRoyal Dental Hospital (1957-62) that he helpedestablish. I was Honorary Curator of theOdontological Collection that he had started. I hadwritten a textbook on dental histology, a subjecthis research established. He (and his son Charles)had a considerable interest in comparative dentalanatomy, a subject on which Charles had written amajor textbook. My own published research had asignificant comparative aspect.

Although as a student I was examined oncomparative dental anatomy and even taught it

Figure 11. Offcuts

Figure 12. Tibia ofDinornis letter fromDr Mantell

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earlier in my academic career at Bristol University,this subject unfortunately is no longer taught in thedental curriculum. This, despite the fact that therehas been a surge of interest in this topic, where theteeth of various vertebrate animals have been usedas experimental systems to understand themolecular biology of evolution. Subconsciously, anidea began to form in the back of my mind overwhich I had no control. Perhaps the spirits of theTomeses put it there.

I ended up approaching my publishers, Elsevier,with a proposal to write, with my colleague Dr PeterShellis, a 450 page book with 500 illustrationsentitled "The teeth of vertebrates". I had the comfortof knowing that it was unlikely to be accepted andtherefore would not alter my retirement plans. Notonly was the proposal accepted, but it soon becameapparent that we would need two books, each of450 pages and 500 illustrations: one dealing with"The teeth of non-mammalian vertebrates", theother with "The teeth of mammalian vertebrates".Over three years of full time work have just led tothe publication of “The teeth of non-mammalianvertebrates" and we are underway with the secondbook, which should take a similar time. I havepromised my wife that nothing more will interferewith my plans for retirement after this (I hope).

References

Berkovitz, BKB. 2016. The bicentenary of the birthof Sir John Tomes. Dental Historian. 61: 15-20.Bishop, M., Parker, M.2010. Sir John Tomes FRS,fellows of the Royal Society, and dental reform inthe nineteenth centuary. Notes Rec. R. Soc. 64:401-416.Gelbier, S. 2007. Pillars of Society. Dent. Hist.2007. 46: 1-76.Cope, Z. 1961. Sir John Tomes, a pioneer of BritishDentistry Dawsons of Pall Mall, London.Dublin Medical Press. (1840). Reviews and noticesof books. 85: 120-122.Lancet (1840). Minute structure of the teeth. Vol.2. July 25: 643-646,Obituary notice: 1895. J. Brit. Dent. Assoc. 16:462-492.Owen, R. Odontography. (1840-1845).Tomes, J. 1847. Osseous tissue. In: Encyclopaediaof anatomy and physiology. Edited by R. Bentley-Todd. Volume 3, pp847-858.

Tomes, J. 1849. On the structure of the dentaltissues of marsupial animals, and more especiallyof the enamel. Phil Trans Roy SocLond. Vol 139:403-412.Tomes, J. 1850. On the structure of the dentaltissues of the order Rodentia. Phil Trans Roy Soc,Lond. Vol; 140: 529-569.Tomes J. 1853. Observations on the structure anddevelopment of bone. Phil Trans Roy Soc Lond.1852. Vol 143: 109-139. (with C. De Morgan).Tomes, J. 1856. On the presence of fibrils of softtissue in the dentinal tubules. Phil Trans Roy SocLond. 146: 515-522.Author Biography:

Dr Barry K. B. Berkovitz (BDS, MSc, PhD,FDSRCS, LDSRCS) qualified at the Royal DentalHospital of London in 1962. He spent 3 years as aJunior Medical Research Fellow at Royal HollowayCollege before moving to the Anatomy Departmentat Bristol University where he taught Anatomy andDental Histology from 1966-1987. He moved tothe Anatomy Department at King’s College Londonfrom 1987 until his retirement in 2005. He is aVisiting Professor to the Oman Dental College,Oman. He has been the Honorary Curator of theOdontological Collection at the Royal College ofSurgeons of England since 1988, through which hehas gained an appreciation of dental history. Thisis reflected in his book “Nothing but the tooth”Elsevier, 2013. His most recent books are “Theteeth on non-mammalian vertebrates” 2017, withRP Shellis, and “”Oral Anatomy, histology andEmbryology”, 5th Ed, 2017, with RG Holland andBMJ. Moxham.



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Introduction

The ability to reach all parts of the teeth in allparts of the mouth is an essential prerequisite fordentists when seeking to remove caries, modifycavities and restore teeth. Prior to the 19th century,dental caries was removed from teeth using handinstruments, such as excavators. Any shaping ofenamel or attempts to modify the shape of the toothto accept a restoration were limited by the abilityto access the tooth with hand instruments such aschisels, hatchets and hoes. As a result, operativedentistry on the teeth was slow and probablyrestricted to the removal of very soft cariousdentine in large cavities where cavitation orcollapse of the occlusal portion of the tooth hadalready occurred. There was clearly a need to speedup treatment and find a way to reach moreinaccessible parts of the mouth. The invention ofthe foot treadle drill is attributed to JamesMorrison, however, as with many inventions, therewere several other contributors, who have largelybeen forgotten but who played a vital role in theevolution of the drill. This paper aims to recognisethe role of several dentists and an engineer in thedevelopment of the foot treadle drill.

The introduction of treadle power

The application of treadle powered machines hadalready started in the spinning and weavingindustry. The foot treadle powered spinning wheelor “Saxon Wheel” had been introduced into Europeat the beginning of the sixteenth century1 (Fig 1).

Foot treadling made spinning faster and gave theoperator the opportunity to use both hands to controlthe thread. Treadle powered drills were also beingused by wood turners, jewellers, watch makers andivory turners and had been adopted for theconstruction of ivory dentures, for drilling holes forpivots and posts, turning ivory etc.

It was found that the turning speed for a treadlelathe was increased considerably by using a flywheel and belt2. (Fig 2).

At that time, when there was no formaleducation in dentistry, many dentists started theircareers as jewellers, watchmakers or ivory turners,transferring their skills of working with metals andivory to dentistry. It was therefore not surprisingthat techniques and equipment used in these tradeswould be transferred to dentistry.

The evolution of the foot pedal powered dental engine - three dentists and an engineer

Margaret Wilson

Abstract: In many dental museums there will be foot treadle engine on display. The invention isattributed to the American dentist James Morrison. This paper aims to also acknowledge the part playedby other dentists and an engineer in the eventual evolution of this equipment that helped to revolutioniseoperative dentistry.

Keywords: foot pedal dental engine, evolution of a design

Figure 1. Saxon Wheel Figure 2. Wood and ivory turner with pedal power


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John Greenwood (1760-1819) was the son ofthe ivory turner, Isaac Greenwood. He was born inBoston, Massachusetts and served as a fifer in theRevolutionary War at Bunker Hill (Fig 3). Hebecame a dentist working in New York3 andeventually was George Washington’s personaldentist. In 1790 he is attributed with adapting apedal powered spinning wheel to rotate a drill foruse in the laboratory. The pedal powered laboratorydrill was used for drilling holes for pivots and postsand turning ivory for dentures. Although JohnGreenwood was using the foot treadle to turn ivory,

he did not have the technique to use this system inthe mouth for removal of caries and shapingteeth1,4. A method was required to transmit thepower generated by the foot treadle, via a flexiblemechanism, into the mouth.

The engineer- James Nasmyth (1808-18905)

James Nasmyth was born in Edinburgh,Scotland and came from Scottish Covenantingancestry, (Fig 4). He was the son of a well knowScottish landscape artist and attended EdinburghHigh School from 1817-1820. It was in 1817 thathe met the great engineer James Watt, who wasthen 82 years old. This was the inspiration for hisgreat interest in mechanical pursuits. He startedmaking and selling spinning tops to his fellowschoolboys using his father’s foot-lathe. Hisinterest and talent in designing, mechanicaldraughtsmanship and construction of models ofsteam engines fuelled his ambition to be taken onas an apprentice at Henry Maudslay’s works inLondon. Accompanied by his father he sailed toLondon on 18th May 1829. After an interview withMr Maudsley and inspection of his drawings andworking models he was taken on as assistantworkman as it was observed he was so talented hedid not need to be an apprentice.

Figure 3. John Greenwood

Figure 4. James Nasmyth and his autobiography


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James Nasmyth produced numerous mechanicalinventions from 1825 (n>50), whilst working forMr Maudslay. Subsequently, in 1836 he opened hisown engineering works, the Bridgewater Foundryin Patricroft, Lancashire (Fig 5).

Possibly his most well-known invention was theSteam Hammer and the foundry became a majorsupplier of steam locomotives. Nasmyth listed allhis inventions in his autobiography. Included in hislist of inventions is an entry for a date in 1829, “Amode of transmitting Rotary Motion by means ofa Flexible Shaft, formed of a Coiled Spiral Wire orRod of Steel” (Fig 6). This invention wasdeveloped whilst working in Mr Maudslay’sfactory in London. There was a need to have holesdrilled in rather inaccessible places, where use ofan ordinary drill was not possible. He used aflexible shaft formed of a closely coiled spiral ofsteel wire that would allow the transmission ofrotary motion to a drill at the end of the spiral.James Nasmyth records in his autobiographypublished in 1891 that,

“Four years ago I saw the same arrangementin action at a dentist’s operating room, when adrill was worked in the mouth of a patient toenable a decayed tooth to be stopped. It was saidto be the last thing in “Yankee notions”. It wasmerely a replica of my flexible drill of 1829”

This single invention enabling the transmissionof rotary motion by means of a flexible shaft, wasdestined to dramatically change operative dentistryin the nineteenth century.

A hand drill with a flexible shaft- Charles Merry

In 1858, nearly thirty years after JamesNasmyth’s invention of transmission of rotarymovement via a flexible shaft, Charles Merry ayoung dentist in St. Louis, introduced a drill usingthis idea of a flexible shaft (Fig 7). Dr Merryintended this drill for use in cavities in difficultsituations. He described how he prepared a cavityto the St Louis Dental Society in 18596. The drillutilized the flexible shaft to transmit power but itwas still hand powered. Unfortunately this drill wasdifficult to use as it took two hands to operate,

Figure 6. Nasmyth’sinvention

Figure 5. Bridgewater Foundry, Patricroft, Lancashire


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meaning that it was not possible to have a fingerrest on the tooth to be prepared.

In addition the head of the drill which held thebur only allowed the hand piece to be in direct linewith the engine and would clearly be difficult touse intra-orally, only being able to be used on thelabial or buccal surfaces of teeth or possibly on theocclusal surfaces of some anterior teeth, but wouldnot allow access to all parts of the mouth.

Charles Merry further developed his inventionby describing the Revolving Gum Lancet, thedesign was based on the Merry drill but its purposewas to remove gum covering a wisdom tooth priorto extraction7.

Dr Merry had a tragically short life, ending it all“due to a disappointment” by cutting his jugularvein and throwing himself before a train8,9. It canonly be hoped that this tragedy was not brought onby the lack of universal acceptance of his inventions.

However, the concept of the use of a flexibleshaft had been introduced, but there was clearly a

Figure 9. The foot treadle and wheel

need to replace the hand powered mechanism for afaster method of removal of caries and shapingteeth, a method of freeing up hands to steady thebur placement and a mechanism for giving greaterflexibility when preparing cavities in all parts of themouth.

The foot treadle drill-James Beall Morrison(1829-1917)

James Morrison was born in December 5th 1829in East Springfield, Ohio, USA. He died onDecember 22nd 1917 in Kansas City Missouri, USA(Fig 8).

He was the son of a carriage builder and thenephew of a watch maker10. He originally wasapprenticed to a watchmaker but soon change to bea dental apprentice. He began his dentalapprenticeship in Steubenville, Ohio in 1848 aged19years. He was a talented student winning firstprize in a competition held by the Ohio State Boardof Agriculture, for a gold denture he had made. In1857 he moved to St Louis and practiced dentistrywith his brother William until 1861/2. He thenmoved to Paris, France where he stayed for one yearbefore moving to London where he worked for sixyears. In London he was associated with JohnTomes and Edwin Sercombe. He returned to hispractice in Missouri in 1870 where he invented thefoot treadle drill, patenting the design in 1871 inUSA11 (Figs 9, 10). The first Morrison pedalpowered drill was sold at a dental meeting inBinghampton, New York in April 17th, 1872.

Improvement in dental engines. Specificationforming part of Letters Patent No. 111667, datedFebruary 7, 1871.."To all. whom it may concern: Be it known thatI, JAMES B. MORRISON, of St. Louis, in thecounty of St. Louis and State of Missouri, have

Figure 7. Merry Drill

Figure 8. James Morrison


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invented a certain new and useful Dental En-gine, of which the following is a specification:The first part of my invention consists in anarrangement by which the power from a treadle,may be conveyed to a tool which has universalmotion, the arms being swiveled and kept ex-tended lengthwise by springs, so as to hold thebelts at an equal tension as the swivels areturned. The second part of my invention con-vpitman and the treadle, to allow the treadle to bereadily operated in any position. The fifth partof my invention consists in the construction ofthe bur` whose head is made separate and dis-tinct from the spindle or shank, so as to admit ofreversal thereon, and of replacement when wornout. The engine is intended chiefly for operatingon teeth, and other dental uses. “

The Morrison’s foot pedal drill enabled dentiststo obtain 2,000 rpm which was a huge improvementon the use of hand instruments or hand drills. In hispatent application he claims the invention oftransfer of power using a flexible coiled wire whichclearly had first been described by Nasmyth fortytwo years earlier.

Dr Parsons Shaw’s (1825-1897) Modifications

In terms of operating speed, the Morrisontreadle drill proved to be a huge improvement onany previous “hand powered” method of cavitypreparation, and was quickly embraced by dentists.There were still some improvements needed,especially in terms of making a more flexibleconnection between the hand piece and the treadledrill. The modifications to the Morrison drill toincorporate the flexible wrist were designed by DrParsons Shaw and resulted in the production ofShaw’s Dental Engine patented ten years afterMorrison’s patent.

Dr Parsons Shaw commenced studyingdentistry under Dr Messenger in 1844. ParsonsShaw DDS was an American dentist who came towork in Manchester, UK. (Fig 11). He already hadpublished several text books and had numerouspublications in journals. He was included on thefirst Dentist’s Register of 1879, where his addresswas given as 262, Oxford Road Manchester. In1884 he was appointed as a consulting dentalsurgeon at the Victoria Dental Hospital Manchesterand in 1885 he became the first Warden/ Dean ofManchester Dental School, a post which he helduntil 1886. In 1891 he returned to the USA12. Hewas the inventor of the Shaw’s Dental Enginewhich included in the design, the flexible joint.This innovation finally gave dentists the speedrequired to be more efficient in operative dentistrybut also the ability to treat more inaccessiblecavities and prepare teeth in all parts of the mouth(Fig 12).

Figure 10. Patent for J. B. Morrison Dental Engine No.111.667, February 7th 1871 United States Patent Office.James B. Morrison, of St. Louis, Missouri.

Figure. 11. Parsons Shaw DDS


38

Conclusion

Although the name Morrison is alwaysassociated with the foot treadle drill, it is alsoimportant to be aware of and remember the partplayed by largely unsung heroes who also had anenormous input into the development of foottreadle powered drills. One can only speculatewhether Morrison was aware of Nasmyth’sinvention and that Merry’s drill was in allprobability based on Nasmyth’s invention thirtyyears earlier. Did Morrison knowingly claimanother person’s work or was he merelyopportunistic in adapting existing technology?Clearly Nasmyth recognised his own invention andmaybe it would be more accurate to describe thedevelopment of the foot pedal drill as the “last thingin Scottish notions” Fig 13.

References

1 Encyclopaedia Britannica.com2 Coker T H et al, The complete dictionary of artsand sciences 1764-6 vol III3 Behind the dentist’s drill, Malvin E Ring, 1995vol II issue 2

4 John Greenwood Journal, Clark Greenwood,William L Clements Library, University of Mich-igan5 John Greenwood Journal, Clark Greenwood,William L Clements Library, University of Mich-igan6 James Nasmyth Engineer An autobiography ed-ited by Samuel Smiles London John Murray,Albemarle St 18917 American Dental Review. II 1859, 2-38 American Dental Review 1859 vol 2, p 41-419 Sacramento daily Union vol 18, No. 2744, 12January 186010 The North-Carolinian, vol (Fayetteville N.C.),07 Jan, 186011 History of Dentistry, Walter HoffmannAnt-hem, Quintessence 1981, p30312 British Journal of Dental Science 1891 page1054-1056Acknowledgement

I would like to thanks the staff of the BDAMuseum and Library for their assistance in thepreparation of this paper.

Author Biography: Margaret Wilson is a retiredconsultant in restorative dentistry. She is the Kel-sey-Fry Advisor to the FDS RCS Eng. and is theHon Curator of the BDA Museum.


Figure 12. Shaw’s Dental Engine

Figure 13. The completeengine

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