Before the National Health Service – not for the squeamish!

This year, on 5th July, we celebrate 70 years of the National Health Service. It’s often thought of as one of Britain’s greatest achievements, and it’s now been with us so long that life without the NHS is almost unimaginable.

It’s the job of archaeologists to help us understand what the past was like, so what happens when we look back? The first medical tools on the Portable Antiquities Scheme’s database are Roman, and these are mostly thought to be surgical implements. There were no anaesthetics in the Roman world, apart from herbal sedatives, so surgery must have been a painful last resort, yet clearly quite often used.

Roman scalpel handle (SF-97C5D2)
Roman scalpel handle (SF-97C5D2).

After the Romans, we have to wait until the post-medieval period to see much artefactual evidence of medical expertise. A useful reference collection is in the surgeon’s chest from the Mary Rose, Henry VIII’s flagship which sank in 1545. This dovetailed walnut chest, about the size of a modern blanket box, contained pottery and metal vessels, wooden ointment containers, syringes, bandages, a feeding bottle, and the handles of surgical implements. None of the iron ‘business ends’ of the tools survived, though, and as most medical tools would have been of iron in this period, we have very few on the PAS database.

As medicine grew more sophisticated in the 18th and 19th centuries, we might expect to record more objects. But, because the PAS doesn’t record objects less than 300 years old, we haven’t recorded many objects associated with recent medicine or health care. The PAS can make a significant contribution in at least one area, though, and that’s the history of tooth decay and its consequences – in a world where sugar was an increasing part of the diet.

There are several documentary histories of false teeth, usually focusing on prominent people who suffered from tooth decay, such as George Washington and William III. We know a lot about these people from surviving correspondence with their dentists and false-teeth suppliers, but they are hardly representative of most of the population, who were also struggling with too much sugar and not enough toothbrushes.

Another problem in the history of dental hygiene has been the ghoulish fascination with the ‘Waterloo teeth’ of the 19th century, re-used human teeth from the battlefields not only of the Napoleonic wars but also wars of later decades, right up to the American Civil War. The idea of using the teeth of a dead person is quite horrible to us today, and can crowd out any other thoughts about how our ancestors coped with the problem of tooth decay.

Hard archaeological evidence of false teeth has until now been scanty. Lost dentures find their way into the archaeological record in a limited number of ways, and I’m indebted to Geoff Burr, dentist and PAS volunteer, for his advice on this.

The most common way in which early dentures were lost stems from the fact that they were not at all comfortable. Many denture-wearers tended to take them out between meals and perhaps put them in a pocket, from which they could fall out and get lost. The second most common way is through sneezing; and the third is vomiting. All of these methods would mean that the teeth would not enter the conventional buried archaeological record. (I’m sorry to have to labour the point, but vomit would normally make its way into nightsoil, which is eventually spread on fields – but it is just possible that it could enter a cesspit, and therefore survive in a buried context).

We now have sixteen dental plates recorded on the PAS, and these form evidence of actual use and loss, to complement the curated collections of the British Dental Association’s museum.

In general the lost dental plates are made from thin gold or silver which would have fitted over the gums. Gold was best, used because it would not react with food or saliva, and because it was soft yet strong so could easily be worked to a thin but sturdy plate. Loops were used to fix most plates to the surviving teeth, although this put extra stress on those teeth and often led to their being lost too.

Gold dental plates with loops to fit around surviving teeth (YORYM-DEF0E2 and DEV-E68EC1)

One or more false teeth survive on some plates, showing that they were normally made from porcelain, again an inert strong substance; but one has teeth made apparently from bone (IOW-A114B2), and we also have a single example with human teeth (WMID-F353B8). The teeth were held to the plate using gold or silver rods.

Porcelain teeth on gold dental plates (LANCUM-3DE363 and IOW-D164D2)
Porcelain teeth on gold dental plates (LANCUM-3DE363 and IOW-D164D2). Note the decoration on the upper surface of LANCUM-3DE363, which is paralleled by small indentations on IOW-E8BFA3. At the time of writing, even the staff of the British Dental Association Museum cannot explain these marks.

It’s interesting to see that, from the PAS’s small sample, human teeth are not as common as porcelain.

The dentures above probably date from the 19th century. By the early 20th century, the rods and plate would have been cast in one piece, and combined with hardened rubber (often called vulcanite). LVPL-ED4792 is an example of an early 20th-century denture. These were eventually replaced by the type of acrylic and plastic dentures in use today.

In the early days of the NHS, teeth were seen as being as important as any other part of health care. This is because poor oral health can affect general health, with bacteria in the mouth being both swallowed and breathed in. The bacteria in the bloodstream can cause blood clots, leading to strokes and heart attacks, and bacteria being breathed in can lead to lung infections.

These days, with modern fluoride toothpastes and inexpensive electric toothbrushes, our teeth are in far better condition. Many dentists no longer offer NHS treatment, and so the link between our teeth and our general health is not so well understood.

False teeth are an intimate thing. They are put in one of our most sensitive places, where normally we are careful to only put things that are delicious and good for us. But are these modern objects worth recording? Yes, in that they provide evidence for life that is rarely easily visible through historical records. Without the real thing, it’s hard to understand the development of prosthetic dentistry in human terms. Many people had tooth trouble in the past, but it’s not something that we often talk about.