The Story of the Teeth
I was born with comically bad teeth. I have only one wisdom tooth – welded firmly to my jaw – and had multiple permanent teeth for some of my milk teeth, and none for others. (I still have two milk teeth.) That I don’t look like a caricature of a Blackadder-ish wisewoman is down entirely to my parents’ swift removal of me to a brilliant orthodontist who – with the aid of braces, plates, and two operations – gave me a decent set of teeth.
I spent rather a lot of my childhood and adolescence in pain, as my teeth and jaw were cajoled and wired into place. (I must add, though, that my parents provided me with an endless supply of sympathy, and soft, delicious things to eat, as well as plenty to read.) It was partly for this reason that I never understood the outrage that greeted the news of Martin Amis’s decision to spend around £20,000 in fixing his teeth, ending decades of persistent toothache.
Of course, much of the anger about this amount was linked to his lucrative move, in 1995, from the late Pat Kavanagh, the literary agent who helped him to build his career, to Andrew Wylie, causing an acrimonious rift with Julian Barnes, Kavanagh’s husband. Indeed, AS Byatt later apologised to him for having criticised both his dental work and his acceptance of an extraordinarily high advance negotiated by Wylie, explaining that she had had toothache at the time.
In his memoir, Experience (2000), Amis writes evocatively of the hell of toothache: that it seems to be the only manifestation of dull pain which can’t be blocked out or ignored. It demands attention. (Apparently James Joyce and Vladimir Nabokov were fellow martyrs to tooth pain. There is, clearly, a link between toothache and stylistic experimentation.)
It’s no wonder that modern dentistry is usually cited as one of the best reasons against time travel. The dentist Horace Wells (1815-1848) originated the use of nitrous oxide (laughing gas) as an anaesthetic during dental surgery. Wells died – partly as a result of an addiction of chloroform, ironically – before nitrous oxide became the anaesthetic of choice, rather than ether for example, among dentists. In South Africa, I’ve found evidence to suggest that it was possible to have teeth extracted under anaesthetic from around the 1880s – although it’s likely that this was available to wealthier patients before then.
In fact, the state of one’s teeth has been a potent indicator of class difference since at least the nineteenth century. Access to dentists and technology – powders, pastes – to prevent tooth decay meant that the middle and upper classes had better teeth than those who were poor, whose diets tended to feature substantial amounts of tooth-eroding sugar, and whose visits to dentists – who had usually had little or no training – were done only in case of dire emergency.
In the pub conversation described in TS Eliot’s The Waste Land (1922), the speaker refers to a friend, Lil, who worries that her recently demobbed husband will leave her, partly because she had aged so much during the recent Great War:
Now Albert’s coming back, make yourself a bit smart.
He’ll want to know what you done with that money he gave you
To get yourself some teeth. He did, I was there.
You have them all out, Lil, and get a nice set
As false teeth became cheaper and more widely available, it seemed to make better sense to have all one’s teeth out at once, rather than suffer a lifetime’s worth of dental pain.
We attach a wide range of meanings to teeth: from the elongated incisors of vampires, to the whiter-than-white rictus grins of celebrities. My friend Shahpar in Dhaka points out that in south Asia, some Muslims associate oral hygiene using the bark of the miswak tree with holiness, as they believe that the Prophet used the bark to clean his teeth. More generally, people in the region place an exceptionally high value on having a healthy, full mouth of teeth – reflected in some truly appalling jokes.
I’ve been reading about anxieties about oral hygiene and dentistry recently, hence this interest in shifting cultural and social constructions of teeth. During the early decades of the twentieth century, global anxieties about infant mortality and childhood health, resulted in a heightened concern about the care of children’s teeth. This was part of an infant welfare movement which had emerged all over the world at the end of the nineteenth century, in response to unease about high rates of infant mortality (usually as a result of diarrhoea), the apparently failing health of urban working-class men, and eugenicist anxieties about maintaining white control over political, social, and economic power.
Although child welfare campaigners during the nineteenth century drew parents’ attention to the need to instil in their children good habits of dental hygiene, the discourse around the state of children’s teeth during the early twentieth century differed. To be fair, rotting teeth and gum disease are the cause of a range of health problems, and it makes sense to direct public health policy towards making dental services freely available.
But particularly during the 1920s and 1930s, preventing poor oral hygiene and tooth decay began to take on moral overtones. Doctors and child welfare activists increasingly understood bad oral health as a signifier of chaotic, ‘unscientific’ upbringings – which, they believed, tended to occur in working-class families. Writing about Major General Sir Frederick Barton Maurice’s influential 1903 study of the large numbers of volunteers who were deemed to be physically unfit to fight in the South African War (1899-1902), Anna Davin explains:
If, as it seemed, these puny young men were typical of their class (‘the class which necessarily supplies the ranks of our army’), the problem was to discover why [they suffered from so many physical ailments], and to change things. Proceeding to speculate on possible explanations, [Maurice] accounted for the prevalence of bad teeth among recruits by unsuitable food in childhood (‘the universal testimony that I have heard is that the parents give the children even in infancy the food from off their own plates’), and decided at once that ‘the great original cause’ (of bad teeth at this point, but subsequently, and with as little evidence, of all the ill-health) was ‘ignorance on the part of the mothers of the necessary conditions for the bringing up of healthy children’.
This was one of several essays and articles which argued that poor nutrition in childhood – most notably feeding babies food meant for adults – caused ‘bad teeth’ and, thus, compromised health in adulthood. The best means of remedying this situation was to encourage mothers (and in the minds of doctors, welfare campaigners, and policy makers, these mothers were inevitably working-class) to adhere to ‘scientific principles’ in raising their children, chief of which was providing babies and young children with a diet calibrated precisely to their needs. These principles and diets were formulated by health professionals – medical men – and they, as well as nurses, health visitors, and others, encouraged mothers to abandon ‘superstitious’ and ‘ignorant’ childrearing practice in favour of properly ‘scientific’ guidelines.
Those doctors and campaigners influenced by eugenics argued, though, that children’s moral character depended on good dental hygiene. (Susanne Klausen explains what we mean by ‘eugenics’: ‘in its broadest definition…eugenics was concerned with improving the qualities of the human race either through controlling reproduction or by changing the environment or both.’) In The Story of the Teeth, and How to Save Them (1935), Dr Truby King, the extraordinarily influential founder of the global mothercraft movement, argued that the health and strength of babies’ and children’s teeth depended, firstly, on the health of the pregnant and lactating mother, and, secondly, on proper nutrition.
Breastfeeding – not on demand, but at regular intervals depending on the age of the baby – was, he believed, the foundation for the development of strong teeth and jaws. The introduction of nutritious food once the baby was six months old should, he wrote, encourage the child to chew, thus stimulating the nerves and blood vessels in the face, causing the milk and permanent teeth to emerge quickly and cleanly.
King had dire warnings to those parents – particularly mothers – who, he suggested, ‘gave in’ to the demands of their babies and children:
Decay of the teeth is not a mere chance unfortunate disability of the day – it is the most urgent and gravest of all diseases of our time – a more serious national scourge than Cancer or Consumption….
Why? Because oral hygiene and healthy teeth ensured that the citizens of the future would be morally good, productive, conscientious individuals:
‘Building the Teeth’ and ‘Forming a Character’ are parts of construction of the same edifice – standing in the relationship of the underground foundations of a building to the superstructure.
Our dentists tell us that nowadays when they insist on the eating of crusts and other hard food [necessary for encouraging the child to chew and, thus, in King’s view, develop its jaw], the mother often says ‘Our children simply won’t!’ Such children merely exemplify the ineptitude of their parents – parents too sentimental, weakly emotional, careless, or indifferent to train their children properly. The ‘can’t-be-so-cruel’ mother who cries half the night and frets all day on account of the mother’s failure to fulfil one of the first of maternal duties, should not blame Providence or Heredity because her progeny has turned out a ‘simply-won’t’ in infancy, and will become a selfish ‘simply-can’t’ in later childhood and adolescence. Power to obey the ‘Ten Commandments,’ or to conform to the temporal laws and usages of Society is not to be expected of ‘SPOILED’ babies when they reach adult life. …
Unselfishness and altruism are not the natural outcome of habitual self-indulgence. Damaged health and the absence of discipline and control in early life are the natural foundations of failure later on – failure through the lack of control which underlies all weakness of character, vice, and criminality.
Good teeth meant good citizens. Bizarre as this thinking may have been, it did – often – have positive outcomes. For instance, similar views held among South African doctors and child welfare campaigners were behind the establishment of a network of dental clinics for poor children – albeit mainly white children – during the 1920s and 1930s. Children whose parents could not afford private dental care, could attend these clinics gratis.
One of the most striking characteristics of eugenicist thinking was its tendency to blame mothers’ ignorance, stupidity, or credulousness for the poor health of their babies and children, ignoring the environmental factors – the contexts – in which they raised their offspring. King’s implication was that mothers were ultimately responsible for the ‘vice and criminality’ of society: if they, he wrote, had simply disciplined their children, feeding them properly and ignoring their demands, then all adults would be productive, self-controlled citizens.
Although King’s reasoning is demonstrably bonkers, this tendency to blame (single) mothers for children’s anti-social behaviour persists, particularly within right-wing political and media circles. This is a strategy which absolves the state and other institutions of any responsibility for ensuring that children are adequately care for.
The study of attitudes towards teeth and dentistry reveals a range of beliefs about parenting, childhood, and, nutrition. It seems, then, that we are not only what we eat, but we are also how we eat.
Sources cited here:
Anna Davin, ‘Imperialism and Motherhood,’ History Workshop, no. 5 (Spring 1978), pp. 9-65.
Susanne Klausen, ‘“For the Sake of the Race”: Eugenic Discourses of Feeblemindedness and Motherhood in the South African Medical Record, 1903-1926,’ Journal of Southern African Studies, vol. 23, no. 1 (March 1997), pp. 27-50.
Antora Mahmud Khan and Syed Masud Ahmed, ‘“Why do I have to Clean Teeth Regularly?” Perceptions and State of Oral and Dental Health in a Low-income Rural Community in Bangladesh’ (Dhaka: BRAC, 2011).
Truby King, The Story of the Teeth and How to Save Them (Auckland: Whitcombe & Tombes, 1935).
Naomi Murakawa, ‘Toothless: The Methamphetamine “Epidemic,” “Meth Mouth,” and the Racial Construction of Drug Scares,’ Du Bois Review, vol. 8, no. 1 (2011), pp. 219-228.
Alyssa Picard, Making the American Mouth: Dentists and Public Health in the Twentieth Century. (New Brunswick: Rutgers University Press. 2009).
David Sonstrom, ‘Teeth in Victorian Art,’ Victorian Literature and Culture, vol. 29, no. 2 (2001), pp. 351-382.
* This photograph is from Retronaut.
Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.
Sweetness and Light
This weekend some friends and I cooked a Lusophone world-themed dinner. I contributed pudding: an updated version of bebinca – a Goan dessert consisting of layers of coconut pancakes – and brigadeiros, a Brazilian interpretation of chocolate truffles made of condensed milk and cocoa. The recipe for the latter is incredibly easy:
This is an unbelievably sticky procedure: oil everything (utensils, crockery, yourself) before attempting to roll the mixture because otherwise there may be, frankly, quite a lot of swearing. Also, clean up thoroughly. The ants which attempt periodically to invade my kitchen had a short-lived fiesta on my counter tops before being swiftly washed away.
As I was looking for recipes, I was struck by how frequently particular ingredients and dishes recurred within Brazilian, Mozambican, Goan, and Macauan cuisines: limes, chillies, coconut, spicy chicken (sometimes called piri piri, or similar), and custards. These continuities are not particularly surprising. In the circulation of people and things around the Lusophone world – from Portugal to Brazil, to Angola and Mozambique, to Goa, and parts of southeast Asia – recipes, plants, and animals were exchanged and traded.
Another, more unexpected, similarity between these cuisines is sweetened condensed milk. It appears in beverages, cakes, and other puddings, be they Brazilian or Goan. For cultures unused to cooking with dairy products – in India, for instance, or parts of southeast Asia – condensed milk is more easily incorporated into dishes as a sweetener. Also, tins of milk keep far more easily than bottles of fresh milk in warm climates.
The person who patented the recipe for condensed milk was the American inventor, adventurer, and politician Gail Borden. Having initially devoted himself to coming up with a recipe for ‘meat biscuits’ (high protein bars to be supplied to soldiers), he turned his attention to preserving milk. He was not the only person interested in extending the shelf-life of milk: evaporated and dried milk products were being experimented with at the same time. The process that Borden used – adding sugar and then condensing milk via a vacuum process – created a product which tasted delicious and had a long shelf life. In 1858, he and Jeremiah Milbank founded the New York Condensed Milk Company. Their fortunes were assured when, from 1861, the Company supplied the Union Army with condensed milk throughout the Civil War.
The first overseas condensed milk factory opened in Switzerland in 1866. Owned by two Americans – George and Charles Page, the latter being the US Consul at Zurich – the Anglo-Swiss Condensed Milk Company eventually merged with Nestle, another manufacturer of condensed milk, in 1904. Sweetened condensed milk spread around the world after the First World War. It arrived in Brazil in 1921, and was almost immediately incorporated into the cuisine.
Borden’s interest in milk and meat stemmed partly from anxieties about the cleanliness and purity of processed food. His Eagle Brand of condensed milk was advertised on the grounds that it was produced in hygienic conditions and could safely be fed to the very young and the very old. Indeed, sweetened condensed milk was regarded as having potentially healthy properties. The earliest incarnation of bircher muesli – fed to patients at Maximilian Bircher-Benner’s sanatorium in Switzerland – consisted of condensed milk, fruit, and oats. And it was seen as a decent substitute for breastmilk.
The marketing of condensed milk coincided with heightened concerns about high rates of infant mortality in industrialising cities all over the world. Having noticed that exclusively breastfed babies tended to be healthier than those who were not, by the end of the nineteenth century, scientists had established that the leading cause of death in early infancy – diarrhoea – was caused by ingesting dirty and rotting food, mainly milk products. For instance, in 1895 and 1896, Dr EB Fuller, Cape Town’s Medical Officer for Health, conducted a survey into the causes of infant diarrhoea in the city and discovered, as Peter Buirski explains:
Public health officials and infant welfare campaigners not only doubled their attempts to persuade mothers to breastfeed for as long as possible, but also established depots where they could receive clean, pasteurised fresh milk and, importantly, healthy preserved milk products too – mainly dried or evaporated milk.
But some paediatrians had been pointing out since at least the 1890s that even if sweetened condensed milk was a useful dietary supplement for particularly malnourished children, it was hardly health food. The doctor and public health campaigner Cicely Williams – who identified the disease kwashiorkor – had noticed as early as 1933 that adults in parts of West Africa were adding sweetened condensed milk to their diets. Soon she connected widespread malnutrition in babies and young children with the use of sweetened condensed milk in the place of more nutritious products – including, worryingly, breast milk. Writing about Singapore in the early 1940s, she explained:
Although recognizing that doctors and clinics could do more to inform mothers about breastfeeding, Williams argued for the better control of milk companies:
In 1939 she published the pamphlet ‘Milk and Murder’ in which she blamed the advertising strategies of companies like Nestle for causing mothers to give up breastfeeding – contributing, thus, to high rates of infant mortality in regions such as West Africa and South Asia. That pamphlet formed the basis for War on Want’s 1974 report The Baby Killer – the manifesto for the Nestle boycott which resulted, eventually, in the adoption of the 1981 International Code of Marketing of Breast-Milk Substitutes by the World Health Organisation.
Even if its advertising of artificial baby food had been largely constrained, Nestle still seeks out ways of selling its products – including sweetened condensed milk – to new, unsuspecting markets. Four years ago it was particularly sharply criticised for sending ‘floating supermarkets’ down tributaries of the Amazon, aimed specifically at potential shoppers unaccustomed to processed food.
My point is not that we should all abandon sweetened condensed milk. Far from it. What an understanding of the fraught history of sweetened condensed milk demonstrates is a continuity in the ways in which ingredients and foodstuffs are circulated around the world. As chillies and limes and coconuts were carried around the Portuguese empire, shaping and remaking local cuisines, so Nestle has added sweetened condensed milk to an increasing number of Brazilian and Indian kitchens during the twentieth and twenty-first centuries. The difference, obviously, is that Nestle could advertise its products as the healthy, responsible choice for nursing mothers – piggy-backing, effectively, on to public health concerns about infant mortality. The question then, is should we control or limit the sale of sweetened condensed milk and other, less-than-healthy processed foods, in poor areas unaccustomed to the wiles of Big Food?
Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding, 1890-1950 (Madison, WI: University of Wisconsin Press, 1987).
PJ Atkins, ‘White Poison? The Social Consequences of Milk Consumption, 1850-1930,’ Social History of Medicine, vol. 5 (1992), pp. 207-227.
Peter Buirski, ‘Mortality Rates in Cape Town 1895-1980: A Broad Outline,’ Studies in the History of Cape Town, vol. 5, ed. Christopher Saunders, Howard Phillips, Elizabeth van Heyningen, and Vivian Bickford-Smith (History Department and the Centre for African Studies, University of Cape Town, 1983).
M. Hickey, ‘Current Legislation on Concentrated and Dried Milk Products,’ in Dairy Powders and Concentrated Products, ed. AY Tamime (Wiley-Blackwell, 2009).
Harvey Levenstein, ‘“Best for Babies” or “Preventable Infanticide”? The Controversy over Artificial Feeding of Infants in America, 1880-1920,’ The Journal of American History, vol. 70, no 1 (June 1983), pp. 75-94.
Cicely D. Williams, ‘A Nutritional Disease of Childhood Associated with a Maize Diet,’ Archives of Diseases in Childhood, vol. 8, no. 48 (1933), pp. 423-433.
—. ‘Rickets in Singapore,’ Archives of Diseases in Childhood, vol. 21, no. 37 (1946), pp. 37-51.
Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.