- Email: [email protected]
1859–1880 The early years
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J L . J flL s 26 dentists met in Niagara Falls to establish an American Dental Association, the country was poised on the brink of its greatest national tragedy. The ques tion whether Southern agriculture would prevail over N orthern in dustry was to be settled in a four-year civil war that left more Amer icans dead than in any war before or since. Although slavery was introduced in New England, it soon died out because of the lack of farms and the lack of training for black workers in factories. In the South, however, the number of slaves skyrocketed with the invention of the cotton gin. When the de pleted Southern soil could no longer yield cotton crops, plantation owners moved West and planted more cotton. Northern determi nation to prevent slavery in the West drew the North and South into war. Nothing was left unchanged by the war. Those years trans formed what had been essentially an agricultural society into an in dustrial one, as the engines of war poured out of factories. An entire race had been freed, and the first assassination of an American president took place. During these years, the first transcontinental railroad was completed, linking Omaha to San Francisco, and the telephone and the electric light were invented. The Association during these early years was seeking profes sional status for its members, creating committees to investigate the state of dental science and establishing clinics as part of its an nual meetings. Public relations, public and professional education, and the advancement of dental science were among the respon sibilities embraced by the new dental organization. The elimination of quackery and aiding the less fortunate members of the dental profession also became its goals. The new association would be made up of delegates chosen by state and local dental society members and by dental school facul ties. Although the Association recognized the need for formal den tal education, it was torn between formal training and the preceptor system, the system under which most of its members had received their training.
The early years
he American Dental Association was founded in 1859 but its roots can be traced to the American So ciety of Dental Surgeons (ASDS), a pro fessional organization formed in 1840. This society was established by dentists seeking to protect their interests from the growing number of charlatans who began appearing across the country promising miracle cures for dental diseases. ASDS was formed during the free-for-all atmo sphere of Jacksonian democracy, at a time when the public opposed regulation of ac cess to occupations and the conduct of economic pursuit. Instead, the leadership of dentistry chose to create a voluntary as sociation “ to run a clear line of discrimina tion between the man of competent attain ment and the impudent empiric.” Fifteen leading dentists organized the American Society of D ental Surgeons dur ing a meeting in 1840 in New York City, laying the institutional foundations for or ganized dentistry in the United States. The ASDS constitution outlined duties of a na tional dental association and requirements for the profession similar to the A D A ’s current objectives. The early organization assumed an entire range of professional re sponsibility, including public relations,
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public information, professional educa tion, and advancement of dental science and art. Elimination of fraud and quackery and the welfare of members hit by misfor tune also became goals of the society. The ASDS constitution summed up its goals in its opening paragraphs: “ The ob jects of this society are to promote union and harmony among all respectable and well-informed dental surgeons; to advance the science by free communication and in terchange of sentiments, either written or verbal, between members of the society, both in this and other countries; in fine, to give character and respectability to the pro fession by establishing a line of distinction between the truly meritorious and skillful and such as riot in the ill-gotten fruits of un blushing impudence and empiricism.” But the heyday of the American Society of Dental Surgeons was shortlived. The society never achieved a truly national scope, hampered in part by geographic dis tances and inadequate transportation be tween the various regions of the country. “ It is not so easy a m atter. . . to travel from St. Louis to New York, a distance of 1,500 or 1,800 miles, to attend the annual meet ings of the society—not to mention the sm all m atte r of e x p e n s e ,” an A SD S
Greene Vardiman Black, MD, DDS, ScD, LLD (1836-1915), a d ental pioneer, responsiblefor the standardization o f cavity preparation, am algam m anufacture, dental nom enclature and anatom y. C ourtesy o f Dr. C harles B. M illstein, C am bridge, M ass. F acing page: Walnut wood portable dental kitfrom Civil War period; the photograph a t the top is probably that o f the civilian contract d entist and his com m anding officer. C ourtesy o f Dr. G ordon E. D a m m ann C ollection, L ena, III.
member in the West wrote to friends. The society also was plagued by regional rival ries and the widely differing viewpoints held by dentists in the East and the West. T he internal policies of A SD S also doomed it to failure. By setting profes sional standards too high, ASDS alienated public and professional support that might have elevated the status of dentistry. For example, the society accorded preferential tre a tm e n t to the g ra d u a te s of dental schools, even though at that time there were only two regularly chartered dental schools in the country. The ASDS also lacked the num bers and resources to spread its beliefs because of restrictive membership requirements which limited new members to those dentists personally known to current members. By the late 1840s, ASDS was scorned by the majority of the dental profession, with one dentist noting that it had become a “ mere clique of self-constituted exclusives.” The ASDS was followed by another un 482 ■ JADA, Vol. 108, April 1984
successful attempt to form a national dental organization—the American Dental Con vention. The group espoused goals similar to ASDS but was not able to capture the following large enough to support a na tional dental organization. Prominent den tists’ dissatisfaction with the convention eventually led to a campaign to form the American Dental Association, a national body to represent “ organized dentistry.” The new association would be composed of delegates chosen by membership of local and state societies and dental school facul ties, instead of individually selected mem bers.
Niagara Falls meeting he A D A was formed by 26 men who gathered at the International Hotel in Niagara Falls, N Y , on Aug 3, 1859. They represented eight dental societies and two colleges. A t that initial meeting, delegates urged the form ation of more regional
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societies, stipulated that delegates must be “ practitioners of dental su rg ery ,” and fixed the proportion of delegates to mem bers. They also selected a committee to draft a constitution and assigned five mem bers to prepare scientific papers for the next meeting. The A D A ’s first major task was to strike a balance between high professional stan dards and exclusivity of membership re quirem ents. “ T o give it stability and character and deprive it of any approach to a clique, the proper basis of such an organi zation would be a representative body composed of delegates that have received their appointments from permanently or ganized dental societies and regularly con stituted dental colleges,” one organizer wrote.
Proponents of the representative type of organization cited the American Medical Association as a model. They disputed ar guments that a representative organization would lead to exclusiveness. One propo nent noted that, “ He who objects to the es tablishment of such an organization on the ground that it is anti-democratic and exclu sive, fails to remember that where a large number are interested and it is impossible for the entire body to meet, that a represen tative basis is absolutely demanded and that such representation is eminently dem ocratic and only exclusive so far as the will fully ignorant are concerned.” The organizers of the A D A also hoped to improve the standards and quality of the profession through scientific investigation, a task left unfulfilled by the American Den-
tal Convention. Critics noted that dental knowledge on a scientific level was grossly inadequate, with one commenting that, “ We know but little about the cause of caries and some other diseases of the teeth; and as to their treatm ent, we are nothing but empirics.” Selection of delegates for their abilities and attainments would lead to scientific in vestigations that would elevate the profes sional standard by developing a more accu rate science and more perfect art, one founder argued. “ The combined influence of national and local societies would de velop that desire for mental cultivation, literary research, and scientific investiga tion so much needed on the part of indi vidual members o f the profession,” he said. ANNIVERSARY COMMEMORATION ■ 483
Constitution adopted lthough the 1859 meeting in Niagara Falls is viewed as the first of the modern-day Association, it was at the an nual meeting in Washington City on the last Tuesday of July 1860 that the details of or ganization were completed and a constitu tion and bylaws adopted. A few months la ter, Abraham Lincoln would be elected president of the United States. The 23 participating dentists ratified the profession’s structural framework beneath the crenelated towers of the Smithsonian Institution building, a rom antic setting hard by a rancid canal flowing along what is now Constitution A venue, giving birth under Article 1 to an organization “ known by the name of the American Dental Asso ciation.” Organization was a primary considera tion of delegates to this second annual Dr. Horace Wells (inset) was the fir s t d entist to meeting, the first of six held in the nation’s use anesthesia when, in ¡844, he instructed a p a tie n t to inhale nitrous oxide before a tooth m y is capital. But the proceedings of that Wash extracted. P ictured above are Dr. W ells’ book, ington City session on the eve of civil war An Essay on Teeth, published in 1838; a p age also reported “ a very spirited discussion” fro m his daybook; and A True History o f the about the quality of dental education and a D iscovery o f A nesthesia by G . Q . Cottony, formally expressed desire by a Philadel published in 1896. C ourtesy o f the H istorical phia delegate for dentistry “ which results M useum o f M edicine and D entistry, H artford, in both young and old placing implicit con C onn. fidence in whatever their dentist tells them, feeling that what he says must be so, be cause he says it! ” The constitution, adopted at that meet w ar, professional activities continued. (SDA) also considered uniting with the ing, placed permanent members—former During this period, the educational func A D A . The SDA was founded by Southern delegates who had maintained membership tion of the Association grew as the profes dentists during the Civil War. At a joint in the national organization by signing the sion became increasingly interested in es meeting of the three groups in 1878 in Niag constitution and paying annual dues—on tablishing scientific standards. The oppor ara Falls, a special committee was formed an equal basis with delegates. F or many tu n ity fo r se lf-im p ro v em e n t th ro u g h to “ devise means to secure the concentra years, the members, rather than the dele “ demonstrations by clinics, illustrations tion of the entire strength of the profession gates, governed the Association, supplying by microscope, and exhibitions of instru in one truly national body.” ‘ the majority of its officers and much “ sub ments and appliances” proved a major at A t the A D A ’s annual meeting in 1880 in stance to the scientific discussions.” A traction for dental meetings. As a result, Boston, the committee reported that it de series of standing committees also were the A D A in 1864 decided to include clinics sired “ nothing more than that the whole created to investigate the state of dental as part of the regular program. Some mem profession should be united under one ban science and techniques, including dental bers of the profession challenged the deci ner, but they are unable to see in what physiology and chemistry, dental pathol sion in the early 1870s, contending that the manner this object can be attained, unless , ogy and surgery, and mechanical dentistry. “ Association could not afford to flitter the members of the profession throughout A committee also was formed to review away its time in manipulative exercises, the country come to this Association with plans, improvements, and specimens sub which can be carried on in local societies. ” proper authenticated credentials from their mitted by inventors and to reject those But the Association continued the clinics state or local societies.” Noting that the deem ed unw o rth y o f p re se n ta tio n . A as an integral part of its annual meetings. A D A already possessed the “ requisite committee on prize essays also was estab In the late 1860s, the Association also qualifications of a truly national body,” the lished to award two annual prizes ‘ ‘consist began establishing relations with other den committee recommended that the Associa- ' ing of medals not exceeding in value $50 tal organizations including its predecessor, tion “ take no action which would in any each” to those fostering improvement in the American Dental Convention. The way tend to impair its usefulness or termi dental science and technology. Other per A D C was to continue for nearly 25 years nate its existence.” manent committees were formed to over after the founding of the Association. D ur With organized dentistry still in its in see the progress of dental education and ing the post-war period, the A D C made fancy in the United States, the possibility dental literature. several attempts to establish formal rela of an international dental network seemed The outbreak of the Civil War forced the tions with the A D A despite objections far away. But as the national organization A D A to abandon plans for its annual meet from members of both groups. During this grew stronger, it ventured out to meet the ing in the summer of 1861. But despite the period, the Southern Dental Association world. Like a child taking its first steps, it
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early as 1863, it was urging military officials to appoint dentists to military hospitals. Those appeals were repeated insistently through the end of the century. The profes sion’s frustrations with government bu reaucracy, in this case the War Depart ment, were discussed at the Association’s 1864 meeting. Because the Association lacked a formal structure for representing the profession’s needs in W ashington, dentistry’s inter changes with government were primarily conducted on an ad hoc basis. Individual entrepreneurs conducted their own negoti ations with the governm ent, like D r. Mahlon Loomis, who secured a patent for his wireless system and the approval of Congress and President Ulysses S. G rant for a charter of incorporation for his Aerial Telegraph Co. These individual entreaties during the profession’s formative years would shape its relationship with the na tional government. N ot all the profession’s disputes with government were handled in Washington. When some government tax agents tried to im pose extra duties on d en tists, alert Philadelphia practitioners managed to get a decision from the Internal Revenue Collec tor in that city which held that “ a dentist having paid his license has no further tax to pay. Operations upon the mouth do not place a dentist in the category of manufac turers; neither does the construction of ar tificial dentures for his own patients.” It was an important step in the establishment of professional status for dentists and ap propriate government recognition.
Formal education needed long with military concerns, leaders of the fledgling dental organizations were turning their attentions to the need for formal dental education. When Dr. Chapin A. Harris addressed the formal opening of the world’s first dental college in 1840, he was under no illusions about the state of the art. “ Filled as the ranks of the profession are with individuals who have never learned the first rudim ents,” he said at that historic November convocation of the Baltimore College of Dental Surgery, “ it will doubt less require some time to effect the wished reformation.” That reformation, he added, would be accomplished only by fixing a “ line of distinction between the competent and the incompetent.” Dr. Harris saw very clearly that educa tion was the key to raising dentistry to true professional status. H e could scarcely have guessed how many years and how
A was not always successful—but always de termined to try again. One of the earliest American attempts at an international dental meeting was at the Centennial of Independence, celebrated in Philadelphia in 1876. Despite promotion and planning on the part of the American Dental Association, the event attracted only eight foreign dentists. It was hardly an international congress.
Military concerns he terrible conflict following Lincoln’s election focused the profession’s at tention on what has become the longest standing concern of the Association in its dealings with governments in Washington: the military services and dentistry. D en
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tists served ably on both sides in the Civil War but were soon frustrated with the lack of recognition accorded dentists and the sad state of dental health among recruits. Although recruits needed only six oppos ing anterior teeth “ to bite the cartridge” and thus qualify for military duty, rejec tions reportedly ran as high as 40%. Condi tions of war hardly improved the dental health of soldiers, and the demand for care was so great that “ charlatans followed the armies pretending to practice dentistry.” The issue of professional status was taken all the way to the White House, when Dr. S. S. White “ interviewed President Lin coln concerning the m atter.” President Lincoln referred him to the War D epart ment. The A ssociation’s youthful vigor was expended largely on military matters. As
ANNIVERSARY COMMEMORATION ■ 485
Horace H . Hayden, top, the dean o f the dental profession in his day, and C hapin A . H arris helped to introduce the fo r m a l dental education system ; D r. H arris served as the fir s t dean o f the B altim ore C ollege o f D entistry, m iddle, which opened in 1840. P hotographs o f D rs. H a y d en a n d H arris, courtesy o f the A m erican D e n ta l A ssociation A rchives. P hotograph o f the Baltim ore College, courtesy o f the Journal o f the Baltimore College o f Dental Surgery, 1938.
much effort it would involve. H e and his colleague D r. Horace H. Hayden knew that some dental practitio ners had a little medical education, train ing, or experience, as they themselves did. There also was a group of “ mechanical dentists” whose experience was derived mainly from working with metals and je w elry . B ut m any— probably m ost— o th e rs w ere the d e n tists w hose frag mented, technically oriented training had been gained entirely in an apprenticeship or preceptorship. Preceptorial training did not necessarily 486 ■ JADA, Vol. 108, April 1984
foster incompetence. In fact, both Dr. Harris and Dr. Hayden had acquired some of their skills in that system. Much de pended, however, on the knowledge and ability of the preceptor, the capacity of the apprentice, and the interaction between the two. N o qualifying examination and no legal controls existed to prevent the in c o m p e te n t from going into p ra c tic e . Though great tutors undoubtedly existed, they were far outnumbered by the practi tioners who simply found the system prof Harvard Dental School. T he fir st departm ent o f itable. One observer marveled at the rapid m echanical dentistry was located on the second ity with which new dentists emerged, “ We flo o r o f the C am bridge S tre et Building; live in a busy age,” he said. “ It takes but a illustration, right, show s the schedule o f courses little while to become a grandfather in den f o r dental stu d en ts in the 1870s. C ourtesy o f the tistry, that is, to send out a student who in a M assachusetts D ental Society. short time will have sent out his student.” Given this prolific chain, the preceptor system was difficult to eradicate, even w hen d ental schools w ere no longer a committee on education to report on all rarities. N evertheless, the system was phases of dental education for discussion at marked for extinction. The scientific age the annual session. Among the subjects was at hand and the scientific foundation were the proper qualifications for students, for dentistry was being recognized and ex the length of the school term, and the man plored. It could only follow that academic ner of determining the fitness of candidates » education, supplemented by clinical expe for the dental degree. The relationship be rience, would become an increasingly ef tween preceptorial and collegiate instruc fective means of drawing the line between tion became a perennial discussion point. the competent and the incompetent. As might be expected, members were In introducing the formal dental educa strongly in favor of the older system. Most tion system, Dr. Harris and Dr. Hayden members had learned dentistry that way, provided dental education with its own and many were preceptors. separate identity. They also were at pains By 1867, the committee demanded that to recognize the achievements of contem dental students should have at least suffi poraries who, through force of circum cient literary knowledge to speak and write stances, lacked the formal education the grammatically and to pursue the study of new school offered. In its first decade, 136 the sciences with understanding. The fact honorary degrees of D octor of Dental that more skill and learning were deemed Surgery were awarded by Baltimore. Each necessary is an indication of the slim edu recipient, chosen by the faculty in accor cational background of aspirants in an era dance with the school’s charter, had “ ren when even a high school education was not dered service to the science or distin easy to come by in many parts of the coun guished himself in his profession.” try. A subsequent committee report elabo Within 40 years after Baltimore College rated arguments for broad preparation. opened, 28 additional schools were estab “ O ur p ro fe ssio n ,” it said, “ must be lished across the country. One of them, at brought up to the standard of a ‘learned . Harvard University, was the first dental profession,’ or it will lose much of the education program under university spon power and influence it has already gained. ’’ sorship. Eight of the schools set up during Though the A ssociation continually this springtime of dental education have urged high standards of preliminary educa remained in continuous operation under tion, less than half those entering the pro the same authority and control for a cen fession during the early years of the Asso tury; another 13 have survived through ciation came from the dental colleges. D e mergers, absorptions, and amalgamations. spite the serious drawbacks of the precep torial system, the Association could hardly take extreme measures against the method Association involvement that had trained most of its constituents and in education continued to be a lucrative source of sup plementary income to dentists. Too strin- ; rom the beginning, the Association gent membership requirements might re took a keen interest in dental educa sult in withdrawal of local societies from tion. The A D A ’s first constitution created the national organization and a consequent
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1859-1880 iliw v a fd
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DAILY ORDER OF EXERCISES, 8PBING TEEM, 1874. Hoar. 1 Monday. 0
j Dent. Lab.
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11
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12 1 2
Tuesday. Wednesday Thursday.
Friday.
D ent. Lab.
Chem. R.
D ent. Lab.
D ent. Lab. P hys. K.
Surg. L
Saturday.
Phys. R. Phys. L.
M. G. H. Operations.
M. G. H. Operations.
Surg. R.
Surg. L. Anat. L. till Anat. L or li 1 May. till May. j Infirmary. Infirm ary.
Infirm ary.
A nat. L. till Anat. R. till May. May. Infirm ary. Infirmary.
P ractical Anatomy in th e Dissecting-Room daily till May. Chemistry ta u g h t daily in Chemical Laboratory. The D em onstrator is present in th e D ental Laboratory every forenoon, and in th e Infirm ary every afternoon.
“ May the smiles of the innumerable friends reveal to you the perfection of your handiwork; and your praise be in all the mouths of a grateful community.” —Oliver Wendell Holmes, to the first graduating class of Harvard Dental School, 1872.
loss of hard-won unity. Although it was recognized that some qualification other than dental society membership should identify the responsi ble dental practitioner, and although pos session of a diploma from a dental college appeared to be such a qualification, the As sociation was simply not in a position to demand. F or the time, moral pressure, mainly expressed in resolutions “ recom mending” educational reforms, had to suf fice.
Science and research n th e y ears b e fo re th e A D A was founded, debate waxed and waned over the role of organized dentistry in dental sci ence and research. Dental science and re search were not the primary focus of early dental journals; instead the publications concentrated on listing articles by bona fide dentists.
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In 1881, the ADA met in New York; the American Medical Association inaugurated a section on dental and oral surgery to which dentists holding an MD degree were eligible. The same year American dentists participated in the International Medical Congress in London. Courtesy of S. S. White Dental Products International.
“Where satisfaction is not given, money will be refunded.’* John H. Holliday, Dentist, Dodge City, Kan 1878
John Henry Holliday, born in Griffin, Ga, on Aug 14,1851, graduated from the Pennsylvania College of Dental Surgery in 1872. His first practice was located in Atlanta, and he was appointed preceptor for his cousin, Robert A. Holliday, who also attended dental school in Philadelphia. However, the preceptorship was not completed when it was discovered that Dr. Holliday had tuberculosis; he was advised to go West for his health. Doc Holliday practiced throughout the West, in such towns as Dallas and Dodge City, Kan; however, he augmented his dental income by gambling. Eventually, it was his skill as a gambler in such towns as Deadwood, SD, and a gunslinger, after an incident in Dallas, that won him fame. In 1877, while practicing dentistry in Dallas, Doc Holliday met Kate Elder and Wyatt Earp. Kate, in the euphemism of the day, was a “ soiled dove;” she and Doc maintained a stormy relationship that she claimed culminated in marriage. By 1881, however, Doc and Kate had separated for good. His friendship with Wyatt, however, was to have a lasting effect on Doc’s life. By 1881, Doc had retired from dentistry to pursue gambling as a full-time profession. He moved to Tombstone, Ariz, where Wyatt had settled with his brothers Virgil (town marshall) and Morgan. And it was there,
Courtesy of Mrs. Edward R. Holliday, Atlanta.
in October 1881, that Doc became involved in the gunfight at the OK corral. Accounts vary, but it seems that Doc and the Earp brothers met the Clanton-McLowrey gang in the classic lawmen vs cowboys shoot-out. The cowboys suffered fatalities for which Doc and Wyatt were tried—eventually, they were exonerated. However, within a few months, Virgil Earp was seriously wounded and Morgan Earp was killed by unknown assailants; Doc and Wyatt found themselves on the run after the death of Frank Stillwell, a friend of the Clantons and McLowreys. Eventually Doc surfaced in Colorado. He lived the remaining seven years of his life in Glenwood, drinking, gambling, and assuring people that he had not killed 30 men. Doc Holliday died of tuberculosis on Nov 8,1887; he was 36. In that same year the Southern Dental College opened; and it was Dr. Robert A. Holliday, Doc’s cousin, who was the prime moving force behind the establishment of the first dental school in Georgia. The author thanks Susan Mickey Thomas, Valdosta, Ga, for assistance.
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Deadwood, SD, in the 1870s. C ourtesy o f Dr. R ichard J. Schoessler Pierre, SD , and Sou th D akota S ta te H istorical Society. w
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By 1845, the forerunners of the Ameri can Dental Association recognized ad vancements in dental science by such ac tions as rem itting dues to a m em berinventor for a certain period or by awarding the scientist a medal. Applying for a patent to protect a new invention or to elicit a fee from dentists evoked anger and disap proval from the dental com m unity, so much so that in 1879 a representative of the Vulcanite Company was shot and killed by an irate dentist over the unauthorized use of the vulcanite process. In another incident, Dr. John Allen of Cincinnati was se verely reprimanded in 1847 for his “ highly reprehensible conduct” in obtaining a pat ent for an apparatus to help reconstruct the face. Dentists who sought patents continued to be viewed suspiciously even after the Association was formed in 1859. Despite its distaste for patents, the Association strived to become a leader among profes sional dental organizations in monitoring scientific discoveries. A series of standing committees was created to investigate the existing state of dental science and tech n iq u e s , fro m d e n ta l p h y s io lo g y to pathologic conditions of the hard and soft tissues. Coming into vogue in the mid-1800s was D arw in ’s theory o f the origin o f the species, which spawned intense interest in the biologic sciences. During the Associa tion’s annual session in 1864, theories about the causes of dental caries were dis cussed in relation to current environmen talist thought and medical fads of the day. It was at that annual meeting that the Asso ciation inaugurated scientific clinics as part of the regular program. Early Association members such as Dr. G. V. Black published scientific reports. Results of his studies linking caries to bacterial origins were published in 1880. Because of the advancements in equipment such as the microscope, development of solid-culture media for isolation studies, and aniline dyes for staining specimens, the late 1800s saw an explosion of scientific discoveries and theories. Anesthesia, and its properties, was being studied by den tists for its usefulness. Electricity moved from the curiosity stage to a practical stage for application in dental engines and other uses in the dental office and laboratory. An atmosphere of competition and dis agreement led dentists to debate the use of amalgams as filling com pounds, and to herald the use of the rubber dam in certain procedures, as advanced by Dr. S. C. Barnum. He was honored at the 1870 annual meeting with a medal. And during that ses-
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sion, patents again were denounced as self-serving and inappropriate. The patent issue would continue to plague the profes sion until the 1940s.
Dentistry’s image he dentist’s image before the public was a concern as important to the early members of the Association as it is today. The founders sought to establish dentistry as a learned profession and they were anx ious that the public look to them for accu rate, up-to-date information about oral health. To do so, they rallied against the quackery they saw rampant among men who displayed diplomas from schools that existed nowhere but on paper. They also scorned the advertisements for dentifrices and other dental “ nostrum s” that would cure everything from bleeding gums to in fluenza. Early reports on the state of the profes sion, while decrying the disorder that de scended on the country and the profession with the advent of the Civil War, also noted the need for “ popular dental education,” as described by D r. J. Taft in “ A report on the condition and organization of local societies,” Transactions, 1863. (Dr. Taft would later serve as the ninth A DA pres ident, 1868-1869.) “ Another m atter to which all Associa tions should direct their attention is popu Samuel S. W hite(inset), fo u n d e r o f S . S . W hite D en ta l P roducts International; the S . S . W hite build lar dental education. This is a subject of ing was e re cted in 1867. Dr. W hite was a defender o f the dental profession a n d interview ed A braham vastly more importance than is usually at Lincoln during the C ivil War in an unsuccessful effort to gain recognition a n d status fo r dentists then tached to it. We do not propose here to servingin the arm y. P hotograph o fth e S . S . W hite building, courtesy o f S . S . W hite D ental P roducts discuss its advantages, nor to specify par International. P hotograph o f Dr. W hite, courtesy o f the A m erica n D ental A ssociation A rchives. ticulars in carrying out the method; but we will suggest, and indeed urge, that every In his 1866 report, Dr. McManus pro society should immediately set about some announced “ through the columns of the systematic and efficient method of giving d aily jo u r n a ls , flan k e d w ith re c o m posed that dentists take the role of conser information to the people; the work has al mendations from members of the medical, vators of dental health and prepare a state ready been commenced, though not exten ministerial, and editorial professions, and a ment “ as to what should constitute a safe, goodly array of names from the honorables popular dentifrice.” H e noted that this sively,” Dr. Taft wrote. Another early observer, Dr. C .P. Fitch, down to the ordinary run of men and formula was to be recommended for gen who became the seventh A DA president in women who state in praise of their favorite eral use and not for “ that other class of in 1866-1867, noted that the People’s Dental preparation, that it leaves the mouth with a dividuals who desire a Sunday or holiday dentifrice, to be used on special occasions Journal had assumed the ‘‘pleasing duties” pleasant taste after using it.” D r. M cM anus, a delegate from the only.” The recommended ingredients for a of getting the dental message of 1864 to the public. E arlie r effo rts w ere m ade by Hartford Dental Society who served as tooth powder included chalk, pulverized Stockton’s Dental Intelligencer and the A DA second vice-president in 1865, wrote Peruvian bark, orris root, carbonate of his report in response to a resolution that he soda, sugar, and castile soap, with sassa Brooklyn D ental Mirror. Although dental product advertising in had proposed the previous year, stating fras oil for flavor. If a toothpaste was de the 19th century cannot compare with to that the Association considered its duty s ire d , he re co m m e n d e d su b s titu tin g day’s mass media campaigns, dentists then “ to guard the public against the use of the glycerine and honey for the sassafras oil. Dr. M cM anus’ paper generated consid were commiserating over misleading ad various articles so extensively advertised vertising that “ extravagantly lauded” den as beneficial to the teeth, but which we erable discussion at the 1866 annual ses tifrices. The criticism of such dentifrices deem injurious.” The resolution called for sion. A Dr. Colburn of N ew ark, N J, was, in turn, extravagantly phrased by Dr. five dentists to be appointed to a committee wasn’t pleased with Dr. M cM anus’ idea of J. McManus, who in 1866 lamented that the on dentifrices, and Dr. McManus was in a dentifrice— Dr. Colburn apparently had Continued on page 492 questionable virtues of the dentifrices were cluded in the group.
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ANNIVERSARY COMMEMORATION ■ 489
Adjusting the Dental Chair The dental chair is one piece of dental equipment that has stayed basically the same throughout its history. The only changes have been those of adjustability, maneuverability, and better access to the patient’s mouth. Subtle changes in form, headrests, attachments, and looks have been contrib uted to create a comfortable seat for the patient during a den tal procedure. Pierre Fauchard recommended the use of regular wooden chairs so that patients could grip the arms with their hands to keep from moving. He also recommended that chairs with high backs be used so patients’ heads would remain station ary. At this time no suggestions were made to adjust the height or angle of the chair to make dental treatment any easier on the practitioner. In the late 18th and 19th cen turies, the rocking chair was used for backward and forward movement. Dental chairs have advanced from simple wooden seats to the sleek and comfortable couch chairs of today. The chairs on these two pages portray a smattering of the changes in style, maneuverability, and comfort.
( 1850s
Josiah Flagg's dental c h a ir is considered the olde st dental c h a ir in the U nited States and po ssib ly in the world.
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Ludwig Cron is shown dem onstrating the p re fe rre d position for rem oving teeth from the lo w er ja w : the p atien t on the floo r is supported betw een th e dentist’s knees.
The P erkins Chair was sup ported b y a ba ll a n d socket and co u ld be clam ped in to any po sitio n. But, when the chair wasi n o t clamped, i t co u ld move freely in ny direction.
This c h a ir was developed by M. W. Hanchett. It had a central s up portin g screw like a piano sto o l and the seat was hing ed fo r tipp in g back and forth.
TheJ. O. W hitcom b Dental Operating C hair was the firs t that cou ld be raised and low ered w ith the patient in the chair. A fo o t lever locked the cha ir in position.
James Snell, o f London, invented this chair with an adjustable seat and back. The back could be moved forw ard and back, and the seat c o u ld be raised. A m ovable table was attached to the arm o f the chair.
' Mi'ieor
1920s
Ritter dental pump chair.
S. S. White Chair
1930s
The Gould Dental Chair was popular because all of its movements (lateral, oblique, and horizontal) were done with ease.
1950s The contour dental chairs were introduced with the advent of sit-down dentistry. They had powered backs.
[ 1970s
Dentalez
Dr. S. J. Cobb, perhaps the fir s t to theorize a d ental m arketing plan. In 1870 Dr. C obb said, "W h e n ev er we fu rn ish the m asses with . . . inform ation . . . [about h o w ] the preservation o f their teeth is econom y, we will be looked up to as great benefactors o f the hum an fa m ily . . . C ourtesy o f the A m erican D en ta l A ssociation A rch ives.
some interest in a product called Sozodont, allowing his name to be printed on the product’s advertising circulars. Dr. Col burn said he had insisted on an affidavit of the ingredients and used it himself. “ I sup pose there is hardly a member here that is in favor of it, probably because it is so exten sively advertised, and therefore is called a q u ack p r e p a r a tio n .” F o llo w in g th a t speech, Dr. Colburn was ruled out of or der. One critic said an analysis of Sozodont showed it “ so highly alkaline that it made the teeth rough, making places for deposits of foreign m atter.” Another compared it to a product advertised as the “ Balm of a Thousand F low ers.” This product was found to be “ bone potash, mixed with loaf sugar and a little castile soap.” Dr. J. A. Kennicott of Chicago noted his belief “ that any popular nostrum and dentifrice which is expected or calculated to cure all dis eases of the gums is likely to be a most in fernal humbug. . . . Every dentist should have the brains necessary to add such therapeutics as are necessary for every in dividual case. If any man pretends to do more than that, he is humbugging the people, and the profession, to o .” Advertisem ent of amalgams also dis tressed some of the early dental leaders. The Association in 1880 adopted a resolu tion against “ the pernicious practice” of dentists, especially dental educators, who allowed their names to be used in endorse 492 ■ JADA, Vol. 108, April 1984
Emeline Roberts Jones and her traveling dental chair. Dr. Jones, the fir s t wom an dentist, traveled throughout eastern C onnecticut and R h o d e Island. C ourtesy o f the Dr. R ichard A . G lenner Collection.
ment of amalgams or therapeutic agents. The danger of these endorsements, the resolution held, was that “ charlatans lose no opportunity to exhibit and parade the names of such professors before an ignor ant community.”
Dental health education efforts he pitch for educating the public about dental health was made in 1868 and re peated in 1870 by Dr. S. J. Cobb. Dr. C obb, like his contem poraries, relied heavily on superlatives in making a point. “ The manufacturing of this great mind mould [sic] is the business of everybody, but more especially those best calculated for the work, and as we claim to be able to contribute very much to man's comfort and welfare on earth, it is especially our duty to see that our dental impress is made upon this mould.” While today his grandiose manner of writing seems more entertaining than pithy, his message is as contemporary as the A D A ’s current marketing program: “ Whenever we furnish the masses with such information as will demonstrate the
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fact that time and means spent in the pres ervation of their teeth is economy, we will be looked up to as great benefactors of the human family, and our days of harvest will com e.” Dr. Cobb’s plea must have fired some enthusiasm because a report of the special committee to prepare a “ circular upon popular education” was called for in 1871. None of the committee members was pres ent, and the report was postponed to the following year. Things continued in the same vein until 1874 when the committee chairman said the information for the circu lar was gathered, but “ was not deemed suf ficiently m atured.” It apparently con tinued in its unmatured state until the mat ter was resurrected in 1877. Instead of its ow n, however, the committee presented an Illinois Dental Society pamphlet. Action was deferred to the next annual meeting; however, no evidence of any action on the pamphlet is recorded for 1878. Although members of the young Associ ation showed interest in public dental edu cation, little more than talk seems to have been accomplished on a national level be fore the 1880s. □
J L . J flL s 26 dentists met in Niagara Falls to establish an American Dental Association, the country was poised on the brink of its greatest national tragedy. The ques tion whether Southern agriculture would prevail over N orthern in dustry was to be settled in a four-year civil war that left more Amer icans dead than in any war before or since. Although slavery was introduced in New England, it soon died out because of the lack of farms and the lack of training for black workers in factories. In the South, however, the number of slaves skyrocketed with the invention of the cotton gin. When the de pleted Southern soil could no longer yield cotton crops, plantation owners moved West and planted more cotton. Northern determi nation to prevent slavery in the West drew the North and South into war. Nothing was left unchanged by the war. Those years trans formed what had been essentially an agricultural society into an in dustrial one, as the engines of war poured out of factories. An entire race had been freed, and the first assassination of an American president took place. During these years, the first transcontinental railroad was completed, linking Omaha to San Francisco, and the telephone and the electric light were invented. The Association during these early years was seeking profes sional status for its members, creating committees to investigate the state of dental science and establishing clinics as part of its an nual meetings. Public relations, public and professional education, and the advancement of dental science were among the respon sibilities embraced by the new dental organization. The elimination of quackery and aiding the less fortunate members of the dental profession also became its goals. The new association would be made up of delegates chosen by state and local dental society members and by dental school facul ties. Although the Association recognized the need for formal den tal education, it was torn between formal training and the preceptor system, the system under which most of its members had received their training.
The early years
he American Dental Association was founded in 1859 but its roots can be traced to the American So ciety of Dental Surgeons (ASDS), a pro fessional organization formed in 1840. This society was established by dentists seeking to protect their interests from the growing number of charlatans who began appearing across the country promising miracle cures for dental diseases. ASDS was formed during the free-for-all atmo sphere of Jacksonian democracy, at a time when the public opposed regulation of ac cess to occupations and the conduct of economic pursuit. Instead, the leadership of dentistry chose to create a voluntary as sociation “ to run a clear line of discrimina tion between the man of competent attain ment and the impudent empiric.” Fifteen leading dentists organized the American Society of D ental Surgeons dur ing a meeting in 1840 in New York City, laying the institutional foundations for or ganized dentistry in the United States. The ASDS constitution outlined duties of a na tional dental association and requirements for the profession similar to the A D A ’s current objectives. The early organization assumed an entire range of professional re sponsibility, including public relations,
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public information, professional educa tion, and advancement of dental science and art. Elimination of fraud and quackery and the welfare of members hit by misfor tune also became goals of the society. The ASDS constitution summed up its goals in its opening paragraphs: “ The ob jects of this society are to promote union and harmony among all respectable and well-informed dental surgeons; to advance the science by free communication and in terchange of sentiments, either written or verbal, between members of the society, both in this and other countries; in fine, to give character and respectability to the pro fession by establishing a line of distinction between the truly meritorious and skillful and such as riot in the ill-gotten fruits of un blushing impudence and empiricism.” But the heyday of the American Society of Dental Surgeons was shortlived. The society never achieved a truly national scope, hampered in part by geographic dis tances and inadequate transportation be tween the various regions of the country. “ It is not so easy a m atter. . . to travel from St. Louis to New York, a distance of 1,500 or 1,800 miles, to attend the annual meet ings of the society—not to mention the sm all m atte r of e x p e n s e ,” an A SD S
Greene Vardiman Black, MD, DDS, ScD, LLD (1836-1915), a d ental pioneer, responsiblefor the standardization o f cavity preparation, am algam m anufacture, dental nom enclature and anatom y. C ourtesy o f Dr. C harles B. M illstein, C am bridge, M ass. F acing page: Walnut wood portable dental kitfrom Civil War period; the photograph a t the top is probably that o f the civilian contract d entist and his com m anding officer. C ourtesy o f Dr. G ordon E. D a m m ann C ollection, L ena, III.
member in the West wrote to friends. The society also was plagued by regional rival ries and the widely differing viewpoints held by dentists in the East and the West. T he internal policies of A SD S also doomed it to failure. By setting profes sional standards too high, ASDS alienated public and professional support that might have elevated the status of dentistry. For example, the society accorded preferential tre a tm e n t to the g ra d u a te s of dental schools, even though at that time there were only two regularly chartered dental schools in the country. The ASDS also lacked the num bers and resources to spread its beliefs because of restrictive membership requirements which limited new members to those dentists personally known to current members. By the late 1840s, ASDS was scorned by the majority of the dental profession, with one dentist noting that it had become a “ mere clique of self-constituted exclusives.” The ASDS was followed by another un 482 ■ JADA, Vol. 108, April 1984
successful attempt to form a national dental organization—the American Dental Con vention. The group espoused goals similar to ASDS but was not able to capture the following large enough to support a na tional dental organization. Prominent den tists’ dissatisfaction with the convention eventually led to a campaign to form the American Dental Association, a national body to represent “ organized dentistry.” The new association would be composed of delegates chosen by membership of local and state societies and dental school facul ties, instead of individually selected mem bers.
Niagara Falls meeting he A D A was formed by 26 men who gathered at the International Hotel in Niagara Falls, N Y , on Aug 3, 1859. They represented eight dental societies and two colleges. A t that initial meeting, delegates urged the form ation of more regional
T The demand fo r dental care by soldiers fro m both sides o f the M ason-D ixon line was- so great that charlatans grew w ealthy b y "trea tin g ” the troops. C ourtesy o f the Library o f Congress.
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societies, stipulated that delegates must be “ practitioners of dental su rg ery ,” and fixed the proportion of delegates to mem bers. They also selected a committee to draft a constitution and assigned five mem bers to prepare scientific papers for the next meeting. The A D A ’s first major task was to strike a balance between high professional stan dards and exclusivity of membership re quirem ents. “ T o give it stability and character and deprive it of any approach to a clique, the proper basis of such an organi zation would be a representative body composed of delegates that have received their appointments from permanently or ganized dental societies and regularly con stituted dental colleges,” one organizer wrote.
Proponents of the representative type of organization cited the American Medical Association as a model. They disputed ar guments that a representative organization would lead to exclusiveness. One propo nent noted that, “ He who objects to the es tablishment of such an organization on the ground that it is anti-democratic and exclu sive, fails to remember that where a large number are interested and it is impossible for the entire body to meet, that a represen tative basis is absolutely demanded and that such representation is eminently dem ocratic and only exclusive so far as the will fully ignorant are concerned.” The organizers of the A D A also hoped to improve the standards and quality of the profession through scientific investigation, a task left unfulfilled by the American Den-
tal Convention. Critics noted that dental knowledge on a scientific level was grossly inadequate, with one commenting that, “ We know but little about the cause of caries and some other diseases of the teeth; and as to their treatm ent, we are nothing but empirics.” Selection of delegates for their abilities and attainments would lead to scientific in vestigations that would elevate the profes sional standard by developing a more accu rate science and more perfect art, one founder argued. “ The combined influence of national and local societies would de velop that desire for mental cultivation, literary research, and scientific investiga tion so much needed on the part of indi vidual members o f the profession,” he said. ANNIVERSARY COMMEMORATION ■ 483
Constitution adopted lthough the 1859 meeting in Niagara Falls is viewed as the first of the modern-day Association, it was at the an nual meeting in Washington City on the last Tuesday of July 1860 that the details of or ganization were completed and a constitu tion and bylaws adopted. A few months la ter, Abraham Lincoln would be elected president of the United States. The 23 participating dentists ratified the profession’s structural framework beneath the crenelated towers of the Smithsonian Institution building, a rom antic setting hard by a rancid canal flowing along what is now Constitution A venue, giving birth under Article 1 to an organization “ known by the name of the American Dental Asso ciation.” Organization was a primary considera tion of delegates to this second annual Dr. Horace Wells (inset) was the fir s t d entist to meeting, the first of six held in the nation’s use anesthesia when, in ¡844, he instructed a p a tie n t to inhale nitrous oxide before a tooth m y is capital. But the proceedings of that Wash extracted. P ictured above are Dr. W ells’ book, ington City session on the eve of civil war An Essay on Teeth, published in 1838; a p age also reported “ a very spirited discussion” fro m his daybook; and A True History o f the about the quality of dental education and a D iscovery o f A nesthesia by G . Q . Cottony, formally expressed desire by a Philadel published in 1896. C ourtesy o f the H istorical phia delegate for dentistry “ which results M useum o f M edicine and D entistry, H artford, in both young and old placing implicit con C onn. fidence in whatever their dentist tells them, feeling that what he says must be so, be cause he says it! ” The constitution, adopted at that meet w ar, professional activities continued. (SDA) also considered uniting with the ing, placed permanent members—former During this period, the educational func A D A . The SDA was founded by Southern delegates who had maintained membership tion of the Association grew as the profes dentists during the Civil War. At a joint in the national organization by signing the sion became increasingly interested in es meeting of the three groups in 1878 in Niag constitution and paying annual dues—on tablishing scientific standards. The oppor ara Falls, a special committee was formed an equal basis with delegates. F or many tu n ity fo r se lf-im p ro v em e n t th ro u g h to “ devise means to secure the concentra years, the members, rather than the dele “ demonstrations by clinics, illustrations tion of the entire strength of the profession gates, governed the Association, supplying by microscope, and exhibitions of instru in one truly national body.” ‘ the majority of its officers and much “ sub ments and appliances” proved a major at A t the A D A ’s annual meeting in 1880 in stance to the scientific discussions.” A traction for dental meetings. As a result, Boston, the committee reported that it de series of standing committees also were the A D A in 1864 decided to include clinics sired “ nothing more than that the whole created to investigate the state of dental as part of the regular program. Some mem profession should be united under one ban science and techniques, including dental bers of the profession challenged the deci ner, but they are unable to see in what physiology and chemistry, dental pathol sion in the early 1870s, contending that the manner this object can be attained, unless , ogy and surgery, and mechanical dentistry. “ Association could not afford to flitter the members of the profession throughout A committee also was formed to review away its time in manipulative exercises, the country come to this Association with plans, improvements, and specimens sub which can be carried on in local societies. ” proper authenticated credentials from their mitted by inventors and to reject those But the Association continued the clinics state or local societies.” Noting that the deem ed unw o rth y o f p re se n ta tio n . A as an integral part of its annual meetings. A D A already possessed the “ requisite committee on prize essays also was estab In the late 1860s, the Association also qualifications of a truly national body,” the lished to award two annual prizes ‘ ‘consist began establishing relations with other den committee recommended that the Associa- ' ing of medals not exceeding in value $50 tal organizations including its predecessor, tion “ take no action which would in any each” to those fostering improvement in the American Dental Convention. The way tend to impair its usefulness or termi dental science and technology. Other per A D C was to continue for nearly 25 years nate its existence.” manent committees were formed to over after the founding of the Association. D ur With organized dentistry still in its in see the progress of dental education and ing the post-war period, the A D C made fancy in the United States, the possibility dental literature. several attempts to establish formal rela of an international dental network seemed The outbreak of the Civil War forced the tions with the A D A despite objections far away. But as the national organization A D A to abandon plans for its annual meet from members of both groups. During this grew stronger, it ventured out to meet the ing in the summer of 1861. But despite the period, the Southern Dental Association world. Like a child taking its first steps, it
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484 ■ JADA, Vol. 108, April 1984
early as 1863, it was urging military officials to appoint dentists to military hospitals. Those appeals were repeated insistently through the end of the century. The profes sion’s frustrations with government bu reaucracy, in this case the War Depart ment, were discussed at the Association’s 1864 meeting. Because the Association lacked a formal structure for representing the profession’s needs in W ashington, dentistry’s inter changes with government were primarily conducted on an ad hoc basis. Individual entrepreneurs conducted their own negoti ations with the governm ent, like D r. Mahlon Loomis, who secured a patent for his wireless system and the approval of Congress and President Ulysses S. G rant for a charter of incorporation for his Aerial Telegraph Co. These individual entreaties during the profession’s formative years would shape its relationship with the na tional government. N ot all the profession’s disputes with government were handled in Washington. When some government tax agents tried to im pose extra duties on d en tists, alert Philadelphia practitioners managed to get a decision from the Internal Revenue Collec tor in that city which held that “ a dentist having paid his license has no further tax to pay. Operations upon the mouth do not place a dentist in the category of manufac turers; neither does the construction of ar tificial dentures for his own patients.” It was an important step in the establishment of professional status for dentists and ap propriate government recognition.
Formal education needed long with military concerns, leaders of the fledgling dental organizations were turning their attentions to the need for formal dental education. When Dr. Chapin A. Harris addressed the formal opening of the world’s first dental college in 1840, he was under no illusions about the state of the art. “ Filled as the ranks of the profession are with individuals who have never learned the first rudim ents,” he said at that historic November convocation of the Baltimore College of Dental Surgery, “ it will doubt less require some time to effect the wished reformation.” That reformation, he added, would be accomplished only by fixing a “ line of distinction between the competent and the incompetent.” Dr. Harris saw very clearly that educa tion was the key to raising dentistry to true professional status. H e could scarcely have guessed how many years and how
A was not always successful—but always de termined to try again. One of the earliest American attempts at an international dental meeting was at the Centennial of Independence, celebrated in Philadelphia in 1876. Despite promotion and planning on the part of the American Dental Association, the event attracted only eight foreign dentists. It was hardly an international congress.
Military concerns he terrible conflict following Lincoln’s election focused the profession’s at tention on what has become the longest standing concern of the Association in its dealings with governments in Washington: the military services and dentistry. D en
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tists served ably on both sides in the Civil War but were soon frustrated with the lack of recognition accorded dentists and the sad state of dental health among recruits. Although recruits needed only six oppos ing anterior teeth “ to bite the cartridge” and thus qualify for military duty, rejec tions reportedly ran as high as 40%. Condi tions of war hardly improved the dental health of soldiers, and the demand for care was so great that “ charlatans followed the armies pretending to practice dentistry.” The issue of professional status was taken all the way to the White House, when Dr. S. S. White “ interviewed President Lin coln concerning the m atter.” President Lincoln referred him to the War D epart ment. The A ssociation’s youthful vigor was expended largely on military matters. As
ANNIVERSARY COMMEMORATION ■ 485
Horace H . Hayden, top, the dean o f the dental profession in his day, and C hapin A . H arris helped to introduce the fo r m a l dental education system ; D r. H arris served as the fir s t dean o f the B altim ore C ollege o f D entistry, m iddle, which opened in 1840. P hotographs o f D rs. H a y d en a n d H arris, courtesy o f the A m erican D e n ta l A ssociation A rchives. P hotograph o f the Baltim ore College, courtesy o f the Journal o f the Baltimore College o f Dental Surgery, 1938.
much effort it would involve. H e and his colleague D r. Horace H. Hayden knew that some dental practitio ners had a little medical education, train ing, or experience, as they themselves did. There also was a group of “ mechanical dentists” whose experience was derived mainly from working with metals and je w elry . B ut m any— probably m ost— o th e rs w ere the d e n tists w hose frag mented, technically oriented training had been gained entirely in an apprenticeship or preceptorship. Preceptorial training did not necessarily 486 ■ JADA, Vol. 108, April 1984
foster incompetence. In fact, both Dr. Harris and Dr. Hayden had acquired some of their skills in that system. Much de pended, however, on the knowledge and ability of the preceptor, the capacity of the apprentice, and the interaction between the two. N o qualifying examination and no legal controls existed to prevent the in c o m p e te n t from going into p ra c tic e . Though great tutors undoubtedly existed, they were far outnumbered by the practi tioners who simply found the system prof Harvard Dental School. T he fir st departm ent o f itable. One observer marveled at the rapid m echanical dentistry was located on the second ity with which new dentists emerged, “ We flo o r o f the C am bridge S tre et Building; live in a busy age,” he said. “ It takes but a illustration, right, show s the schedule o f courses little while to become a grandfather in den f o r dental stu d en ts in the 1870s. C ourtesy o f the tistry, that is, to send out a student who in a M assachusetts D ental Society. short time will have sent out his student.” Given this prolific chain, the preceptor system was difficult to eradicate, even w hen d ental schools w ere no longer a committee on education to report on all rarities. N evertheless, the system was phases of dental education for discussion at marked for extinction. The scientific age the annual session. Among the subjects was at hand and the scientific foundation were the proper qualifications for students, for dentistry was being recognized and ex the length of the school term, and the man plored. It could only follow that academic ner of determining the fitness of candidates » education, supplemented by clinical expe for the dental degree. The relationship be rience, would become an increasingly ef tween preceptorial and collegiate instruc fective means of drawing the line between tion became a perennial discussion point. the competent and the incompetent. As might be expected, members were In introducing the formal dental educa strongly in favor of the older system. Most tion system, Dr. Harris and Dr. Hayden members had learned dentistry that way, provided dental education with its own and many were preceptors. separate identity. They also were at pains By 1867, the committee demanded that to recognize the achievements of contem dental students should have at least suffi poraries who, through force of circum cient literary knowledge to speak and write stances, lacked the formal education the grammatically and to pursue the study of new school offered. In its first decade, 136 the sciences with understanding. The fact honorary degrees of D octor of Dental that more skill and learning were deemed Surgery were awarded by Baltimore. Each necessary is an indication of the slim edu recipient, chosen by the faculty in accor cational background of aspirants in an era dance with the school’s charter, had “ ren when even a high school education was not dered service to the science or distin easy to come by in many parts of the coun guished himself in his profession.” try. A subsequent committee report elabo Within 40 years after Baltimore College rated arguments for broad preparation. opened, 28 additional schools were estab “ O ur p ro fe ssio n ,” it said, “ must be lished across the country. One of them, at brought up to the standard of a ‘learned . Harvard University, was the first dental profession,’ or it will lose much of the education program under university spon power and influence it has already gained. ’’ sorship. Eight of the schools set up during Though the A ssociation continually this springtime of dental education have urged high standards of preliminary educa remained in continuous operation under tion, less than half those entering the pro the same authority and control for a cen fession during the early years of the Asso tury; another 13 have survived through ciation came from the dental colleges. D e mergers, absorptions, and amalgamations. spite the serious drawbacks of the precep torial system, the Association could hardly take extreme measures against the method Association involvement that had trained most of its constituents and in education continued to be a lucrative source of sup plementary income to dentists. Too strin- ; rom the beginning, the Association gent membership requirements might re took a keen interest in dental educa sult in withdrawal of local societies from tion. The A D A ’s first constitution created the national organization and a consequent
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I I’hys. !..
12 1 2
Tuesday. Wednesday Thursday.
Friday.
D ent. Lab.
Chem. R.
D ent. Lab.
D ent. Lab. P hys. K.
Surg. L
Saturday.
Phys. R. Phys. L.
M. G. H. Operations.
M. G. H. Operations.
Surg. R.
Surg. L. Anat. L. till Anat. L or li 1 May. till May. j Infirmary. Infirm ary.
Infirm ary.
A nat. L. till Anat. R. till May. May. Infirm ary. Infirmary.
P ractical Anatomy in th e Dissecting-Room daily till May. Chemistry ta u g h t daily in Chemical Laboratory. The D em onstrator is present in th e D ental Laboratory every forenoon, and in th e Infirm ary every afternoon.
“ May the smiles of the innumerable friends reveal to you the perfection of your handiwork; and your praise be in all the mouths of a grateful community.” —Oliver Wendell Holmes, to the first graduating class of Harvard Dental School, 1872.
loss of hard-won unity. Although it was recognized that some qualification other than dental society membership should identify the responsi ble dental practitioner, and although pos session of a diploma from a dental college appeared to be such a qualification, the As sociation was simply not in a position to demand. F or the time, moral pressure, mainly expressed in resolutions “ recom mending” educational reforms, had to suf fice.
Science and research n th e y ears b e fo re th e A D A was founded, debate waxed and waned over the role of organized dentistry in dental sci ence and research. Dental science and re search were not the primary focus of early dental journals; instead the publications concentrated on listing articles by bona fide dentists.
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In 1881, the ADA met in New York; the American Medical Association inaugurated a section on dental and oral surgery to which dentists holding an MD degree were eligible. The same year American dentists participated in the International Medical Congress in London. Courtesy of S. S. White Dental Products International.
“Where satisfaction is not given, money will be refunded.’* John H. Holliday, Dentist, Dodge City, Kan 1878
John Henry Holliday, born in Griffin, Ga, on Aug 14,1851, graduated from the Pennsylvania College of Dental Surgery in 1872. His first practice was located in Atlanta, and he was appointed preceptor for his cousin, Robert A. Holliday, who also attended dental school in Philadelphia. However, the preceptorship was not completed when it was discovered that Dr. Holliday had tuberculosis; he was advised to go West for his health. Doc Holliday practiced throughout the West, in such towns as Dallas and Dodge City, Kan; however, he augmented his dental income by gambling. Eventually, it was his skill as a gambler in such towns as Deadwood, SD, and a gunslinger, after an incident in Dallas, that won him fame. In 1877, while practicing dentistry in Dallas, Doc Holliday met Kate Elder and Wyatt Earp. Kate, in the euphemism of the day, was a “ soiled dove;” she and Doc maintained a stormy relationship that she claimed culminated in marriage. By 1881, however, Doc and Kate had separated for good. His friendship with Wyatt, however, was to have a lasting effect on Doc’s life. By 1881, Doc had retired from dentistry to pursue gambling as a full-time profession. He moved to Tombstone, Ariz, where Wyatt had settled with his brothers Virgil (town marshall) and Morgan. And it was there,
Courtesy of Mrs. Edward R. Holliday, Atlanta.
in October 1881, that Doc became involved in the gunfight at the OK corral. Accounts vary, but it seems that Doc and the Earp brothers met the Clanton-McLowrey gang in the classic lawmen vs cowboys shoot-out. The cowboys suffered fatalities for which Doc and Wyatt were tried—eventually, they were exonerated. However, within a few months, Virgil Earp was seriously wounded and Morgan Earp was killed by unknown assailants; Doc and Wyatt found themselves on the run after the death of Frank Stillwell, a friend of the Clantons and McLowreys. Eventually Doc surfaced in Colorado. He lived the remaining seven years of his life in Glenwood, drinking, gambling, and assuring people that he had not killed 30 men. Doc Holliday died of tuberculosis on Nov 8,1887; he was 36. In that same year the Southern Dental College opened; and it was Dr. Robert A. Holliday, Doc’s cousin, who was the prime moving force behind the establishment of the first dental school in Georgia. The author thanks Susan Mickey Thomas, Valdosta, Ga, for assistance.
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Deadwood, SD, in the 1870s. C ourtesy o f Dr. R ichard J. Schoessler Pierre, SD , and Sou th D akota S ta te H istorical Society. w
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By 1845, the forerunners of the Ameri can Dental Association recognized ad vancements in dental science by such ac tions as rem itting dues to a m em berinventor for a certain period or by awarding the scientist a medal. Applying for a patent to protect a new invention or to elicit a fee from dentists evoked anger and disap proval from the dental com m unity, so much so that in 1879 a representative of the Vulcanite Company was shot and killed by an irate dentist over the unauthorized use of the vulcanite process. In another incident, Dr. John Allen of Cincinnati was se verely reprimanded in 1847 for his “ highly reprehensible conduct” in obtaining a pat ent for an apparatus to help reconstruct the face. Dentists who sought patents continued to be viewed suspiciously even after the Association was formed in 1859. Despite its distaste for patents, the Association strived to become a leader among profes sional dental organizations in monitoring scientific discoveries. A series of standing committees was created to investigate the existing state of dental science and tech n iq u e s , fro m d e n ta l p h y s io lo g y to pathologic conditions of the hard and soft tissues. Coming into vogue in the mid-1800s was D arw in ’s theory o f the origin o f the species, which spawned intense interest in the biologic sciences. During the Associa tion’s annual session in 1864, theories about the causes of dental caries were dis cussed in relation to current environmen talist thought and medical fads of the day. It was at that annual meeting that the Asso ciation inaugurated scientific clinics as part of the regular program. Early Association members such as Dr. G. V. Black published scientific reports. Results of his studies linking caries to bacterial origins were published in 1880. Because of the advancements in equipment such as the microscope, development of solid-culture media for isolation studies, and aniline dyes for staining specimens, the late 1800s saw an explosion of scientific discoveries and theories. Anesthesia, and its properties, was being studied by den tists for its usefulness. Electricity moved from the curiosity stage to a practical stage for application in dental engines and other uses in the dental office and laboratory. An atmosphere of competition and dis agreement led dentists to debate the use of amalgams as filling com pounds, and to herald the use of the rubber dam in certain procedures, as advanced by Dr. S. C. Barnum. He was honored at the 1870 annual meeting with a medal. And during that ses-
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sion, patents again were denounced as self-serving and inappropriate. The patent issue would continue to plague the profes sion until the 1940s.
Dentistry’s image he dentist’s image before the public was a concern as important to the early members of the Association as it is today. The founders sought to establish dentistry as a learned profession and they were anx ious that the public look to them for accu rate, up-to-date information about oral health. To do so, they rallied against the quackery they saw rampant among men who displayed diplomas from schools that existed nowhere but on paper. They also scorned the advertisements for dentifrices and other dental “ nostrum s” that would cure everything from bleeding gums to in fluenza. Early reports on the state of the profes sion, while decrying the disorder that de scended on the country and the profession with the advent of the Civil War, also noted the need for “ popular dental education,” as described by D r. J. Taft in “ A report on the condition and organization of local societies,” Transactions, 1863. (Dr. Taft would later serve as the ninth A DA pres ident, 1868-1869.) “ Another m atter to which all Associa tions should direct their attention is popu Samuel S. W hite(inset), fo u n d e r o f S . S . W hite D en ta l P roducts International; the S . S . W hite build lar dental education. This is a subject of ing was e re cted in 1867. Dr. W hite was a defender o f the dental profession a n d interview ed A braham vastly more importance than is usually at Lincoln during the C ivil War in an unsuccessful effort to gain recognition a n d status fo r dentists then tached to it. We do not propose here to servingin the arm y. P hotograph o fth e S . S . W hite building, courtesy o f S . S . W hite D ental P roducts discuss its advantages, nor to specify par International. P hotograph o f Dr. W hite, courtesy o f the A m erica n D ental A ssociation A rchives. ticulars in carrying out the method; but we will suggest, and indeed urge, that every In his 1866 report, Dr. McManus pro society should immediately set about some announced “ through the columns of the systematic and efficient method of giving d aily jo u r n a ls , flan k e d w ith re c o m posed that dentists take the role of conser information to the people; the work has al mendations from members of the medical, vators of dental health and prepare a state ready been commenced, though not exten ministerial, and editorial professions, and a ment “ as to what should constitute a safe, goodly array of names from the honorables popular dentifrice.” H e noted that this sively,” Dr. Taft wrote. Another early observer, Dr. C .P. Fitch, down to the ordinary run of men and formula was to be recommended for gen who became the seventh A DA president in women who state in praise of their favorite eral use and not for “ that other class of in 1866-1867, noted that the People’s Dental preparation, that it leaves the mouth with a dividuals who desire a Sunday or holiday dentifrice, to be used on special occasions Journal had assumed the ‘‘pleasing duties” pleasant taste after using it.” D r. M cM anus, a delegate from the only.” The recommended ingredients for a of getting the dental message of 1864 to the public. E arlie r effo rts w ere m ade by Hartford Dental Society who served as tooth powder included chalk, pulverized Stockton’s Dental Intelligencer and the A DA second vice-president in 1865, wrote Peruvian bark, orris root, carbonate of his report in response to a resolution that he soda, sugar, and castile soap, with sassa Brooklyn D ental Mirror. Although dental product advertising in had proposed the previous year, stating fras oil for flavor. If a toothpaste was de the 19th century cannot compare with to that the Association considered its duty s ire d , he re co m m e n d e d su b s titu tin g day’s mass media campaigns, dentists then “ to guard the public against the use of the glycerine and honey for the sassafras oil. Dr. M cM anus’ paper generated consid were commiserating over misleading ad various articles so extensively advertised vertising that “ extravagantly lauded” den as beneficial to the teeth, but which we erable discussion at the 1866 annual ses tifrices. The criticism of such dentifrices deem injurious.” The resolution called for sion. A Dr. Colburn of N ew ark, N J, was, in turn, extravagantly phrased by Dr. five dentists to be appointed to a committee wasn’t pleased with Dr. M cM anus’ idea of J. McManus, who in 1866 lamented that the on dentifrices, and Dr. McManus was in a dentifrice— Dr. Colburn apparently had Continued on page 492 questionable virtues of the dentifrices were cluded in the group.
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ANNIVERSARY COMMEMORATION ■ 489
Adjusting the Dental Chair The dental chair is one piece of dental equipment that has stayed basically the same throughout its history. The only changes have been those of adjustability, maneuverability, and better access to the patient’s mouth. Subtle changes in form, headrests, attachments, and looks have been contrib uted to create a comfortable seat for the patient during a den tal procedure. Pierre Fauchard recommended the use of regular wooden chairs so that patients could grip the arms with their hands to keep from moving. He also recommended that chairs with high backs be used so patients’ heads would remain station ary. At this time no suggestions were made to adjust the height or angle of the chair to make dental treatment any easier on the practitioner. In the late 18th and 19th cen turies, the rocking chair was used for backward and forward movement. Dental chairs have advanced from simple wooden seats to the sleek and comfortable couch chairs of today. The chairs on these two pages portray a smattering of the changes in style, maneuverability, and comfort.
( 1850s
Josiah Flagg's dental c h a ir is considered the olde st dental c h a ir in the U nited States and po ssib ly in the world.
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Ludwig Cron is shown dem onstrating the p re fe rre d position for rem oving teeth from the lo w er ja w : the p atien t on the floo r is supported betw een th e dentist’s knees.
The P erkins Chair was sup ported b y a ba ll a n d socket and co u ld be clam ped in to any po sitio n. But, when the chair wasi n o t clamped, i t co u ld move freely in ny direction.
This c h a ir was developed by M. W. Hanchett. It had a central s up portin g screw like a piano sto o l and the seat was hing ed fo r tipp in g back and forth.
TheJ. O. W hitcom b Dental Operating C hair was the firs t that cou ld be raised and low ered w ith the patient in the chair. A fo o t lever locked the cha ir in position.
James Snell, o f London, invented this chair with an adjustable seat and back. The back could be moved forw ard and back, and the seat c o u ld be raised. A m ovable table was attached to the arm o f the chair.
' Mi'ieor
1920s
Ritter dental pump chair.
S. S. White Chair
1930s
The Gould Dental Chair was popular because all of its movements (lateral, oblique, and horizontal) were done with ease.
1950s The contour dental chairs were introduced with the advent of sit-down dentistry. They had powered backs.
[ 1970s
Dentalez
Dr. S. J. Cobb, perhaps the fir s t to theorize a d ental m arketing plan. In 1870 Dr. C obb said, "W h e n ev er we fu rn ish the m asses with . . . inform ation . . . [about h o w ] the preservation o f their teeth is econom y, we will be looked up to as great benefactors o f the hum an fa m ily . . . C ourtesy o f the A m erican D en ta l A ssociation A rch ives.
some interest in a product called Sozodont, allowing his name to be printed on the product’s advertising circulars. Dr. Col burn said he had insisted on an affidavit of the ingredients and used it himself. “ I sup pose there is hardly a member here that is in favor of it, probably because it is so exten sively advertised, and therefore is called a q u ack p r e p a r a tio n .” F o llo w in g th a t speech, Dr. Colburn was ruled out of or der. One critic said an analysis of Sozodont showed it “ so highly alkaline that it made the teeth rough, making places for deposits of foreign m atter.” Another compared it to a product advertised as the “ Balm of a Thousand F low ers.” This product was found to be “ bone potash, mixed with loaf sugar and a little castile soap.” Dr. J. A. Kennicott of Chicago noted his belief “ that any popular nostrum and dentifrice which is expected or calculated to cure all dis eases of the gums is likely to be a most in fernal humbug. . . . Every dentist should have the brains necessary to add such therapeutics as are necessary for every in dividual case. If any man pretends to do more than that, he is humbugging the people, and the profession, to o .” Advertisem ent of amalgams also dis tressed some of the early dental leaders. The Association in 1880 adopted a resolu tion against “ the pernicious practice” of dentists, especially dental educators, who allowed their names to be used in endorse 492 ■ JADA, Vol. 108, April 1984
Emeline Roberts Jones and her traveling dental chair. Dr. Jones, the fir s t wom an dentist, traveled throughout eastern C onnecticut and R h o d e Island. C ourtesy o f the Dr. R ichard A . G lenner Collection.
ment of amalgams or therapeutic agents. The danger of these endorsements, the resolution held, was that “ charlatans lose no opportunity to exhibit and parade the names of such professors before an ignor ant community.”
Dental health education efforts he pitch for educating the public about dental health was made in 1868 and re peated in 1870 by Dr. S. J. Cobb. Dr. C obb, like his contem poraries, relied heavily on superlatives in making a point. “ The manufacturing of this great mind mould [sic] is the business of everybody, but more especially those best calculated for the work, and as we claim to be able to contribute very much to man's comfort and welfare on earth, it is especially our duty to see that our dental impress is made upon this mould.” While today his grandiose manner of writing seems more entertaining than pithy, his message is as contemporary as the A D A ’s current marketing program: “ Whenever we furnish the masses with such information as will demonstrate the
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fact that time and means spent in the pres ervation of their teeth is economy, we will be looked up to as great benefactors of the human family, and our days of harvest will com e.” Dr. Cobb’s plea must have fired some enthusiasm because a report of the special committee to prepare a “ circular upon popular education” was called for in 1871. None of the committee members was pres ent, and the report was postponed to the following year. Things continued in the same vein until 1874 when the committee chairman said the information for the circu lar was gathered, but “ was not deemed suf ficiently m atured.” It apparently con tinued in its unmatured state until the mat ter was resurrected in 1877. Instead of its ow n, however, the committee presented an Illinois Dental Society pamphlet. Action was deferred to the next annual meeting; however, no evidence of any action on the pamphlet is recorded for 1878. Although members of the young Associ ation showed interest in public dental edu cation, little more than talk seems to have been accomplished on a national level be fore the 1880s. □