Sir, the recent forensic anthropological examination of the skull of Marie-Antoine Carême (1784-1833) brought to light a clear cause of death directly related to poor dental status.

Carême, a nineteenth century French pâtissier, is considered the first internationally renowned celebrity chef, and the creator of the standard chef's hat, the toque.1 He served as a chef de cuisine to Talleyrand, Napoléon, Tsar Alexander I and banker James Mayer Rothschild. He published several books on cookery, above all the encyclopaedic Art of French cookery, translated in London in 1836.2 He died in Paris at the age of 48. The cause of death was considered to be chronic carbon monoxide intoxication and/or anthracosis (due to too many years inhaling the toxic fumes of the charcoal on which he cooked).1

Carême's skull is preserved in the National Museum of Natural History (Paris, France), as a part of the phrenological collection of Dumoutier (MNHN-HA-29888).3 Its state of preservation is perfect (Fig. 1). The rest of the body (including the mandible) has been buried and remain, to date, non-observable.

Figure 1
figure 1

Carême's skull (picture by MNHN, anthropological collections)

Full size image

The external examination of the maxillary shows the persistence of only one tooth (14), and an extensive ante-mortem and post-mortem tooth loss (respectively: 11, 12, 13, 15, 16, 17, 18, 21, 22, 23, 24, 25, 26, 27). 5 mm- and 8 mm-length abscesses existed directly related to teeth 16 and 27, this last communicating with the maxillary sinus through a bone opening of 3 mm. Only a fragment of the 16 was still present at the time of death, inserted in the maxillary bone, maybe as a result of an incomplete tooth extraction during dental surgery.

This poor dental status is directly related to the occupational activities of Carême, ie the professional confection of pastries. Previous studies have shown the implication of personal and professional factors in the development of sugar caries, such as manipulation of sugars, frequent tasting of sweet dishes, sieving of icing sugar, etc.4,5,6,7 Local infectious complications (maxillary sinusitis) may have played a direct role in the cause of death of the first celebrity chef.