Back of the Last Frontier

Bureau of D ental H ealth Education T h is w ork can best be done in the rig h t w a y ; T h e n shall I think it not too g re a t nor sm all T o su it m y sp irit and to prove my p o w e rs; T h e n shall I cheerful g re et the lab o u rin g hours, A n d cheerful tu rn w hen the long shadow s fall

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A t eventide, to play and love a n d rest Because I know fo r me my w ork is best.”

T his is Canadian deavoring literature

the spirit of romance that the D ental Hygiene Council is en­ to infuse into the history and of dentistry.

BACK OF T H E LAST FRO N TIER By FRANK I. LIVINGSTONE, D.D.S., L.D.S., Oak Park, III. O the traveler of pavements and highways seldom comes the reali­ zation that these trails have been blazed by pioneers. Less often do we realize that pioneers are still fighting the age old battle for home and prog­ ress on the last frontier of this con­ tinent. Frontiers shift, and w ith them go those in whose blood is the lure of the unknown. T h e W est has been con­ quered, and now the fight is on to claim the N orth. T o these pioneers m ust be brought the medical arts. T h e Red Cross, mission­ ary societies and other organizations have sent nurses and an occasional physician to aid. T o the observer, who can see behind the scenes, there awaits a vision of medicine at its b est: and then only does a small part of the picture come into view. Vivid impressions of places, people and cases; operating rooms in hotels and hospitals, log cabins and nursing stations, homes and lodging houses; meetings and partin g s; assembling and taking down of equipment— scenes that remain as sharp and clear as an etching— such is the life of a traveling dental clinician. T h e first day it is the boarding house in an Icelandic settlement. T h e big room has been cleared and given a wholly unnecessary recleaning and is now the

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operating room. T h e children come to school in horse drawn vans so the oper­ ator has them literally by loads at a time. T h e house swarms w ith them. T h e first p atien t: a swift examination a question or two, a slow injection of anesthetic (this is the first experience of dentistry for many of these children and extra care must be taken not to startle them ), a brief dismissal, and the next one. A cavity is cut and the filling placed, an injection made for the hope­ less tooth. T im e now to extract for the first one. A few words of explanation and encouragement, a few seconds’ swift work and then, “ H u r t” ? “ N o.” “ Fine.” A pat on the back and a satisfied child is away to show the place where an old offender has been and to explain his feel­ ings, in detail, to admiring mates. H um or is not w anting to lighten the day as in the case of the 5-year-old young lady who swallowed a taste of procain. O n being tested w ith a probe and asked if her gums hurt, she answered swiftly and shrilly: “N o! but my belly does.” T h en there was the boy who turned up day after day for the removal of yet another baby tooth (any one of which could have been self-extracted), and w ent away smiling. T he mystery was cleared up when his m other informed the operator that the visits had cost her a

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T he Journal of the Am erican D ental Association

dollar and a half. T h e bold laddie had been promised a quarter to visit the den­ tist, and being a good business man, had figured the more visits, the more quarters. T h e last day comes and one is sur­ prised at the m ounting lists of record charts. Y et the time seems so short when there is so much more th at could be done. A schedule is a stern master, and the next place is waiting, so the last cup of four o’clock coffee is interrupted to extract a last tooth; to give a final examination to the fisherman, who had traveled many miles over the frozen lake, where his nets are set through the ice to provide food for the tables of C hi­ cago and N ew York, and who had given up an impacted lower third m olar w ith the aid of a flickering lantern, an ele­ vator and a lot of good luck, and a start is made. Farew ells are said while the train is held to load the delayed equipment. I t is a friendly train, this, and although it is largely fish-filled box cars and runs only twice a week, it has something the main line express lacks— a human touch, an atmosphere of service and helpfulness. D inner time and the end of steel. O ne is quite a veteran now at picking out the w aiting committee and, in a few m in­ utes, has been installed, in comfort, in the log hotel th at is to be the home and office for the next week. Six months is the age of this town, and yet all arrange­ ments have been made by a public spirited group of citizens and everything is ready. Days of w o rk ; w ork that is made deeper and more interesting by the gen­ erous cooperation of mothers who have left their household duties to be a dental assistant for a day. W h a t wonderful assistants they were and w hat a knowl­ edge of child psychology they displayed! One among them had, for many years, worked side by side w ith her doctor hus­

band on hospital work in the deary wastes of Siberia; only to see him die in a dun­ geon ; and after almost unbelievable ad­ ventures. W ith her young sons, she found freedom in Canada from the perils of revolution-swept Russia. G raduate of three universities and a trained nurse, she gave invaluable aid. As the oper­ ator spoke no Russian, G erm an or Flem ­ ish, when English became hopeless a conversation was carried on in L atin that would have caused a college professor to collapse. Here, too, word was carried to the dis­ trict nurse, and after traveling many wearly miles through the woods, she came to help on an ether case. E ther was found, but the mask was missing. A soup strainer pressed into action succeeded in half anesthetizing both nurse and oper­ ator, and leaving the patient almost un­ touched. A fter recovery, a local anes­ thetic had to be resorted to. Evenings of relaxation in hospitable homes where one may be at ease and friendly and happy. A ttending a bril­ liant lecture by the school supervisor, in the little log school house, a teacher whose schools were scattered over hun­ dreds of miles of territory, and whose health and more pressing desire to serve had led him to remove from the city to direct his scattered, efficient staff. So contented an existence th at it is a wrench to leave and one does so only w ith an inward promise to return again. A cold w inter morning, and the same mixed train has deposited dentist and equipment at yet another town. Here, the station is half a mile from the town for the better convenience of the w inter fishers who drive in from the ice covered lake in their sleds. Queer contraptions these, w ith their canvas tent on top, in­ side which the driver sits on his load of boxes in front of the glowing wood-burn­

Bureau of D ental H ealth Education ing stove, whose stovepipe, sticking through the canvas roof, waves a plume of grey smoke. I t gets cold in this country, and these people have learned the fine art of w inter travel. T ransportation is waiting, and the separation of town and station is soon driven over. H ere, an office is set up in the kitchen of a newly built women’s institute and nursing service cottage. N ot many days here, because there has just been an ending to an outbreak of m easles; the schools are not yet open, and it is consequently hard to get news around. By 10 o’clock, the chair is up and the day is started. Children are already waiting, and more are on the w ay who have started before dawn in the family cutters w ith little houses built on them, each w ith its little w arm ing stove, to keep out the b itter cold. In the afternoon, the nurse who rules this district drives back after an all night case and relieves the housewife who has been the dentist’s right hand. Protests are of no avail, even though the nurse has been, for days and nights, traveling and attending cases. O n this last one, she has ju st come from nursing an entire family, and this very morning attended to the burial of the youngest. T h ere is w ork to be done, and even though there is a tired body and a sad mind, she carries on, w ith a smile, until the day is done. Evenings spent in the dispensary where the thin walls mock the huge log burning stove and where it is sometimes 40 below zero in the opposite corner when the fire burns low. O ne must w ear overshoes indoors to keep the body heat in. T a lk of travels and books and cases; of far cities and contrasting experiences in them ; and to the dentist, a deepening of the adm iration and respect for these pioneer alleviators of human suffering, a deepening of the longing to know the

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whole story (so zealously hidden) of w hat these people do and a strengthening of the wish th at the outsider come to see and help. A long ride this tim e ; graduating to a sleeping car that joggles on steel too light for it. An early m orning change to yet another mixed train, and continued slum­ ber on a short backed seat. W akened by a question as to whether I am the dentist, and a hurried rush from a mov­ ing train to find the equipment w ill not be along until later. A missed connection somewhere. H ere we have a hospital and, be it confessed, it is w ith considerable trepida­ tion that we enter. Can we live up to it after our travels? W h a t groundless fears! T his is home. Another service station for humanity, striving desperately to stem the tide of suffering. N ot a soulless mechanism of a city institution, but a live, human, Christian society, the sort of place, one reverently imagines, where H e would have liked to work H is miracles and rest. A place of hope, the center of com­ munity life and a leaven working in the tremendous mass of foreign born sur­ rounding it. T h e lone physician, a P er­ sian who, after many years of untiring missionary work in Persia and a private practice comprising the nobility, has re­ turned to the country of his student days to carry on in this new field. Nurses, graduates of famous hospitals, postgradu­ ates of such places as N ew Y ork’s famous child clinics, yet w illing and able to paint, in their few spare hours, the three story hospital when the missionary society funds are low. A place where children came in hun­ dreds, walking miles through blinding snow, by team, by train, in groups shep­ herded by relatives, teachers and outpost workers, and singly. Some suffering for

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The Journal of the American D ental Association

months w ith conditions that only a den­ tist could relieve; came so thick and fast that extra time on the return was asked for and granted. Literally hundreds of them seeking relief and hurrying away to find a little sister or brother so they, too, might share in the relief from pain. T h a t first day: W orking w ith the forceps which had fortunately been packed in the traveling bag, using a morphin syringe; emptying the carpules into it and leaving the needle behind after every injection w ithdraw al (fortunately, a new supply of anesthetic had been ex­ pressed a h e a d ); using one’s lap as a head rest. W h a t a relief when the equipment turned up. Cases? Six year olds w ith abscesses draining through the neck. T hanks be for the resident physician and his ether bottle. Chewing on nerves that had suf­ fered so long they had grown out of the tooth and covered themselves w ith a tis­ sue coat to w ithstand the shock of m asti­ cation. T eeth twisted and tu rn ed ; double sets decayed; teeth causing stu t­ tering and appearing in almost all places in the mouth— all stages of decay— teeth at their worst. H alls and rooms so full of children, they overflow into the yard. And w ith it all, a staff who, busy w ith their medical service, assisted, helped and encouraged so that twice the daily quota was gone through. T ru ly , it was a revelation of w hat a missionary hospital can be and do. A t the next stop, the clinician found the public health nurse, who was the advance guard and whose untiring ef­ forts had resulted in flawless arrange­ ments and the saving of much valuable time. M idnight, and the Pas train halts, briefly, at the little town, once the center of the lumber camps, and one is deposited, boxes and all, in front of the station that

bears a startling resemblance to a box car. H ere, our committee of the nurse and the school teacher and his wife awaits. An extra size toboggan is ready and the kit piled on it. M any were the laughs we had later (the teacher and I ) of that pull through the snow in the pitch dark. H e claims that one of us was going north, the other south, inside the 2 inch rope. W e did spend much of the time off the trail in snow almost waist deep, so he may go uncontradicted, even if he is an old army mate. T h e fact remains, though, we did get there too breathless to argue. T his time a log cabin to work in, w ith a bedroom for a w aiting room— and then they came. W hole schools at a time, w ith the teachers as escorts. Schools from 50 miles away, even to the Indians from O ld F ort. H ow the days did go until, at 8, the chair was relegated to a corner to make room for a bridge table. N ot always to stay there, however, for this is a country of distances, and it takes time to travel even if one does start early in the morning. M ore pitiful cases, two of which were taken to the hospital, on the way down, for better facility in operating. M ore cooperation and once more the evidence of cultured, intelligent people giving themselves and their lives to a commun­ ity. A London graduate in music teach­ ing where the only instrum ent is the battered church organ. A short stop at the hospital again. M ore cases, with a morning of ether w ork that well filled one side of a bed w ard. T hen away to the end of steel on another line. T h e final post. T his time a Red Cross station. A r­ riving after 8, we find the escort w ait­ ing, and, in a short time, are comfortably settled. T ra in night is an event at the

Bureau of D ental H ealth Education end of the steel, and so, many people are in from the surrounding country. Incidentally, that means more patients at the station and, for the first few hours, the nurse is busy compounding, advising and generally carrying on all the essen­ tials of a medical practice. W hen things have quieted down, the proverbial tea­ pot appears, and we have a chance to be­ come acquainted. T h a t night the chair is set up and everything arranged for an early start, because the train has been picking up children all along the line on the way in, and the dentist has already met several of his young paitents. Ready to start in the morning, it is discovered the nurse has been away all night on a case and has arranged for ev­ erything. So we start in, and when she arrives at noon, we have something to show for a m orning’s efforts. A nd so it goes. Days when we handle thirty and more and average well over forty teeth a day in extraction (un fo r­ tunately, most of them first permanent m olars), besides the other work, so that it is often after 8 before the housekeeper can (after repeated hints) get us to the table. H ere, too, came some minor surgery, and the rubber gloves and the sterile field made their appearance. Doubly glad were we for the able assistance of a trained, experienced postgraduate surgi­ cal nurse. A nd Saturday n ig h t: T w o ether cases on the dining room table and the gener­ ous assistance of the mother next door. N othing strange to this ta b le : the travel­ ing Red Cross physician has performed m ajor operations on it. Later, when the little patients are chattering again and away to bed, a game of cards on the same table. Such are the contrasts of life.

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Sunday and ready to go out to dinner. Ruthenian parents w ith a little tot of 5 to see the nurse. H istory of vomiting blood and “feel no good.” A thorough examination reveals a constant drip, drip from swollen gums around infected teeth, and a pitiful case of adenitis w ith the glands broken down and suppurating. Scarred for life. Again the ether bottle appears, and after much patient allaying of superstitious fears, the parents hover fearfully around while the case is cleared up. Soon the little one is explaining, in a foreign tongue, all her sensations to her relieved parents. N ot the least interesting part of the stay here was the occasional ride out w ith the nurse on her night calls. Long w ill such a call be remembered and the coming back through the cold night. T h en the usual happened, and we came home on the rim w ith the dentist part time balanced on the running board to keep the old Ford on the high crowned road (? ) and out of the ditch. W h a t a welcome the roaring stove at that 5 a. m. journey’s end. And this little red-headed Scotch girl has worked alone, many miles from any d octor: traveling for months w ith a dog team, stamping out an epidemic among the In dians; taking surgical cases down the line on a hand car to the nearest hos­ pital ; working on m aternity cases; using the left hand for the ether cone and striving desperately to keep the right ster­ ile ; and never, no m atter the complica­ tion, losing a case. A fitting climax to the trip was the last ride through a fair imitation of a b lizzard : crashing through the rotten ice of swamps; often lost, but finding the trail again through the wood’s skill of the driver. Forty odd miles of it, with a hos­ pital emergency case of the nurses, to catch the M ain Line T rain to W inni­

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T he Journal of the American D ental Association

peg. A fter 2, and just there w ith two minutes to spare. F o r sheer helpfulness, recommend a train crew. H ow they helped: moving the train to just the right spot for a quick transfer of the sweet wee one; carrying hot w ater bottles and assisting so thor­ oughly and well that not a precious sec­ ond was lost. So the trip has ended, and, to the oper­ ator at least, it has brought a widening of vision and a newer incentive to w ork and study, and left a treasure house of delightful memories. T h e spirit of these pioneers may best be exemplified by the case of the grand­ father, skilled woodsman for many years, who is returning from the hospital to the homestead to see for the first time his

children and grandchildren. And who is wondering, too, if he can swing the axe as skilfully, w ith the sight of the one good eye the operation has given him, as when he was blind. T h e story of those who, w ith untiring zeal and self sacrifice, conscientiously and quietly, day and night, year in and year out, give themselves and their training to the great battle to relieve and prevent human suffering in the far places— that story will never be told, because they are a modest band who work in the name of the G reat H ealer and their work is their justification and their life. It were impertinence for the w riter of this fragm entary article to try and do them justice, for truly they are of those whose “ deeds shall be sung by silver trum pets.”

A PROPOSED M O V IE FILM LIBRARY By GEORGE H. WANDEL,* D.D.S., Chicago, 111. O the individual who has attended various district, state and national dental meetings in recent months, there is apparent an ever increasing pro­ duction of films showing various phases of dental technic. T h e Sixty-Sixth M eet­ ing and Clinic of the Chicago D en­ tal Society threw an interesting light on the grow ing extent to which the motion picture has been adopted by some of the most advanced workers in all branches of the dental profession. O nly a year ago, the technical dental movie was cham­ pioned by just a tiny handful of pioneers. T his year, at the Chicago meeting, no

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*S upervisor of the B u reau of D en tal H e a lth E ducation. J o u r. A . D . A ., M a rc h , 1930

less than ten reports were illustrated with 16 mm. motion pictures. Almost every scientific section was represented on the clinical movie roster. Besides, several dentists who were not listed as clinicians or essayists brought along films of their own making and arranged impromptu showings. Among the films which were shown were, “ Physiology of M astication,” by H ugh W . M acM illan, and “ Pontic and Fixed Bridgework,” by Donald E. Smith. A painstaking piece of w ork was dem­ onstrated by W . H . Wasson. T h e films of John A. M arshall, W . A. Grouws, C. J . Stansbery, F. E. Roach and J. A. H eidbrink all made indispensable contri-