Authors: Richard Hollingham
Rotten teeth were the price the wealthy of Georgian England
paid for their lifestyle. These days everything seemed to have sugar
in it – from tea at breakfast to the sweets many sucked before
bedtime. All this sugar was ruining the nation's smiles. If this lady
ever hoped to find a husband, something would have to be done.
She could have had some false teeth made – carved for her from
ivory – but these rarely fitted well. No, thought Spence, in coming
to him she had made the best decision.
Across Europe tooth transplants had been carried out for many
years. The surgical textbooks gave detailed accounts of how to carry
out transplantation operations, with some suggesting the use of
animal teeth. Ambroise Paré (see Chapter 1) was one of the many
eminent surgeons who wrote about the procedure, describing the
case of a noblewoman who received a tooth transplant from one of
her ladies-in-waiting. By 1780, transplanting teeth from poor donors
to wealthy recipients had become commonplace. There were a few
voices claiming that it was morally dubious, and others who came to
realize that the transplants were rarely successful, but Spence
backed neither of these views.
Spence went to examine the women queuing by the back door.
Some of them he dismissed straight away, including one whose face
was covered in sores and another who looked like she was in need
of a tooth transplant herself (not that she would ever be able to
afford it). The remaining three he ushered inside so that he could
take a closer look. They all appeared to be in reasonable health – no
telltale signs of venereal disease or TB. Spence remained unconvinced
that disease could be passed on from the donors to
recipients. Still, best to be on the safe side. He explained to the
three women what was going to happen and how much they would
be paid for their contribution. His servant went to fetch the pliers.
Spence seated his first donor down on a couch in a back room
and asked her again if she was willing to go through with the extraction.
She nervously agreed. Spence took the pliers and gripped an
upper left canine. With his knee placed against the couch for leverage,
he pulled sharply on the tooth, twisting it until it came away.
The woman screamed as blood poured from her mouth and dribbled
down her chin. The servant passed her a handkerchief to plug
the wound and Spence headed next door to perform the transplant.
He instructed his patient to open her mouth and try not to
make a sound. She grasped her friend's hand as Spence held her jaw
steady. With the pliers he extracted one of her rotten teeth and with
his lancet made a slit in her gums. He gave the new tooth a quick
wipe with a cloth to remove the blood and jammed it into the cavity.
The patient was sobbing with the pain but did her best to keep her
mouth open. Her friend reassured her that she was being brave.
Spence finished off by looping a thread around the new tooth and
tying it to the adjacent teeth. The first transplantation completed,
Spence went back to his donors for more teeth.
After an hour or so, the donors left with a few shillings and
fewer teeth, and the patient nursed a swollen jaw. Nevertheless, she
was very pleased with the outcome – a glance in the mirror was all
she needed to be convinced that all the pain had been worthwhile.
Spence assured his patient that the swelling would soon subside and
congratulated himself on another successful operation.
Within a few days the swelling had indeed subsided, although
the new teeth felt a little loose. After a fortnight she started to experience
sores around her mouth and a rash developed across her
body. A physician was sent for, but when a large abscess began to eat
away at her nose it was obvious to everyone that she was suffering
from syphilis. It could only have come from the teeth; the disease
must have been passed on from the donor's blood. Within a few
months the whole side of her once beautiful face was horribly disfigured.
It wasn't long before the poor young woman was dead. All
because she had wanted some nice white teeth.
Spence is said to have infected at least seven of his wealthy
patients with syphilis. But it wasn't incidents like this that finally put
a stop to tooth transplantation, or the fact that almost all tooth
transplants failed through rejection. What brought the practice to
an end was the invention of an alternative: ceramic false teeth.
However, the idea that living matter could be taken from one
person to be transplanted in another was an idea that was far too
good to dismiss for long.
Although Spence's forays into transplantation often ended in
disaster, his reputation as a dentist attracted the attention of a
young surgeon, John Hunter, a man obsessed with understanding
what made something alive – the 'living principal'. It is difficult to
know how best to describe Hunter. Pioneering surgeon, teacher,
naturalist, philosopher – he was to become all these things. His
observations and 'scientific' experiments shed new light on biological
processes. He advanced the understanding of the human body,
both its anatomy and physiology, and devised daring new medical
and surgical techniques. His collaboration with Spence not only
yielded the first accurate scientific study into teeth, it also gave
Hunter far more ambitious ideas.
After witnessing tooth transplants, Hunter started dabbling with
other transplantation experiments. He cut the spur from the foot of
a cockerel and grafted it on to its head; he took a human tooth and
transplanted it on to a cockerel's comb; he even transplanted the
testes from a cockerel and attached them to a hen. In a few cases his
transplantation operations appeared to be completely successful,
but most of them failed. It is thought that the transplants between
animals succeeded only because, through inbreeding, the chickens
were genetically very similar.
Hunter showed that transplantation was possible – albeit a little
hit or miss – and made the first tentative steps towards understanding
it. Future generations of dentists, surgeons and scientists,
including Charles Darwin and Joseph Lister, would owe Hunter an
immense debt of gratitude. People would visit the museum he
founded and marvel at his scientific discoveries. But while Hunter
would be commemorated as a great pioneer, other surgeons who
pushed the limits of science would not be so lucky.
Lyon, 25 June 1894
French president Sadi Carnot had rarely received such a rapturous
welcome – not only from the mayor and city officials of Lyon (which
was only to be expected), but from the exuberant crowds that filled
the streets everywhere he went. During the last few days, horses
draped with the flag of the republic had led his carriage to banquets
held in his honour, and from a balcony he had watched a torchlight
procession and a display of fireworks and illuminations. He had
marvelled at the wonderful exhibits on view at the Exhibition of
Arts, Sciences and Industries. Finally, after all the excitement, he
was looking forward to an evening at the theatre, where a gala
performance had been arranged.
The president left the Lyon Chamber of Commerce, where he
was guest of honour at yet another banquet, a few minutes after nine
o'clock. Thousands of spectators cheered as he crossed the short
distance to his open carriage waiting outside. Everyone was trying to
get close, pressing to catch a glimpse of the French leader. The president
didn't mind – it was wonderful to be greeted in such a way.
As he settled into his seat and the carriage started to move off,
a young man in a light brown suit and peaked cap was pressing his
way through the crowd. He was clutching a newspaper in his hand,
but no one took much notice of him; he was just another person
jostling for the best view. Suddenly, the man jumped on to the
carriage step and flung aside the newspaper to reveal a dagger. The
president barely had time to react before the knife was plunged into
the left side of his chest and he slumped back against the seat.
President Sadi Carnot was still alive, but unconscious. The
assassin had hardly withdrawn the dagger before he was seized
by the crowd, their cheers having turned within seconds to screams
of horror. The man was punched to the ground amid cries that
he should be killed there and then. As the police did their best to
protect him from the fury of what had now become an angry
mob, the carriage containing the dying president was rushing
towards the hospital.
As the assassin was bundled off to the police station, protected
by police and mounted guards, the president was laid on a bed. His
condition was worsening. A crimson stain on his shirt was spreading
as blood seeped from the wound and dripped on to the sheets.
Lyon's finest surgeon was summoned. At the police station the assassin
gave his name as Cesare Giovanni Santo, a twenty-two-year-old
Italian anarchist with a poor grasp of French and, as one reporter
put it, 'a very small moustache'.
The doctors who had now gathered around the president
concluded that the dagger had missed his heart, but one of his
major blood vessels 'in the region of the liver' had been punctured.
The blood pouring from his wound told only part of the story: most
of the blood was being lost inside the president's body.
They did their best to stem the flow with towels and bandages,
and at 11.30 the surgeons issued an optimistic statement in which
they stated that the condition of the president was 'alarming but not
hopeless'. The bulletin went on to suggest that the haemorrhage
had ceased. The surgeons were wrong. The president was bleeding
to death and there was nothing anyone could do. At 12.45 the
president of France was declared dead.
French justice was swift. A little over a month after the assassination
the president's murderer was tried, convicted and executed.
The Lyon surgeons concluded that Carnot had died from blood loss
caused by a wound to the portal vein – the major blood vessel from
the intestines to the liver. Even if they had attempted to operate on
him, they would have had little chance of success. No one had
managed to mend a broken blood vessel before; the only option
open to surgeons was to tie off blood vessels completely. This was
fine in a limb, although cutting off the blood supply inevitably
ended in amputation. When it came to a major internal vein or
artery, the procedure was out of the question.
The whole affair was deeply shocking, particularly for a young
doctor at the hospital, Alexis Carrel. In his autobiography Carrel
wrote how the president's life 'left him with his blood, in the midst
of the holiday crowd. I can still hear it flowing drop by drop fifty
years later.'
*
Carrel was appalled that the surgeons had been unable
to save the president. The death set him on a path that would lay the
foundations for modern transplant surgery. It would lead Carrel to
a Nobel prize, a partnership with the world's most famous aviator,
and into collaboration with the Nazis.
*
It is very unlikely that Carrel was at the bedside of the dying president, but in later years he
seems to have convinced himself – and everyone else – that he was. There is also some debate
over exactly where the president died. Some historians claim it was at the hospital, whereas
reports in newspapers of the time say it was in the city
préfecture
.
Alexis Carrel was an odd-looking young man. He had the countenance
of someone who thought about things a lot, whether it was the
death of a president, the latest surgical advances or the future of
humanity. Carrel was intense, self-absorbed and somewhat distant. It
was as if he were observing the world from a higher intellectual plain.
Physically, he was also quite unusual. Anyone meeting him for the first
time found it difficult to identify what it was about his appearance that
was so unsettling, until they peered into his tiny eyes. Behind his
pince-nez, which he wore for his chronic short-sightedness, you could
see that one of his eyes was brown and the other one blue.
Throughout his life Carrel collected enemies, usually power
ful ones. And where better to start his collection than with his
superiors at the hospital in Lyon – those surgical butchers who
considered themselves such experts, but who had so impotently
failed to save the life of the president. They said saving him had
been impossible; Carrel thought they were wrong, said as much and
set out to prove it.
First he needed to develop his sewing skills, but not the brutal,
clumsy sewing he was used to seeing during operations in the hospital
(he sometimes wondered if surgeons took pride in the grotesque
size of the scars they left behind). If Carrel wanted to sew together
delicate blood vessels, he needed to learn how to do minute, delicate,
precise stitching. So he headed to Lyon's silk district and acquired the
services of the city's finest embroiderer, Madame Leroudier.
Carrel was a driven and conscientious pupil and, with the smallest
of needles and finest silk thread, he worked tirelessly to perfect
his technique. Just trying to thread the microscopic eye of an
embroidery needle takes considerable patience and determination
but Carrel worked night after night, much to the derision of his
macho medical colleagues. Within months, he had not only
mastered the stitches, but was almost as good as Madame Leroudier
herself. It was said that Carrel was so proficient that he could place
five hundred tiny stitches in a single piece of cigarette paper. Now
all he had to do was apply his beautiful embroidery technique to
some veins.
Blood vessels are circular, slippery and easily damaged. Cut one
and it resembles a damp, floppy drinking straw. Clamp a vein or
artery with forceps and it is left crushed and bruised; sew a vein back
together again and it will almost certainly leak or clot – either way,
it will be all but useless. Carrel had to overcome all these problems
if he was to sew blood vessels together successfully, so he headed
back to the laboratory with his tiny curved embroidery needles and
fine silk thread and set to work.