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A Historical Sketch*
1242
T he Journal of the American D en tal Association
not have to remove the entire enamel even in these cases. O f course, it is al ways necessary to meet mechanical re quirements in the preparation o f teeth for fillings or crowns. Sometimes, exten
sions are made solely to meet these re quirements. T h e principles of anatomy, biology, esthetics and mechanics must be considered in planning dental restora tions.
A H IS T O R IC A L SK E T C H * By A R T H U R D. BLACK, A.M ., M.D., D.D.S., Sc.D., Chicago, 111. H E practice of dentistry, in one form or another, dates back to the time when teeth first began to de cay. W h ile our records cover but a few thousand years, we are constrained to be lieve that if Cain or A bel had a tooth ache, A dam had to do something for it. Professor Olmstead, archeologist, report ing on excavations about the biblical city o f Nineveh, refers to tablets which rec ord that a physician was called to task by the king because he had not cured him of an illness. T h e physician replied that if the king would carry out certain di rections, his fever would leave him, and, after giving other instructions, stated that the pain in the king’s head, in his back and in his limbs, came from his teeth and they must be extracted. T h e idea of focal infections and the relation of mouth conditions to the general health was evidently recognized then, about 600 B. C., or about 2,500 years ago.
T
W e know something of the dentistry of the Egyptians, the Etruscans, the Greeks and the Romans, when it was practiced as a specialty of the healing art, by “ physicians for the teeth.” D u r ing the M id d le Ages, dentistry suffered * A d d re ss on the occa sion o f the dedication o f the n e w b u ild in g o f W a sh in g to n U n i v ersity D en tal School, St. Louis, Feb. 22, 1929.
Jour. A . D. A ., Ju ly, IQ2Ç
a serious setback from which it very slowly emerged with the dawning of more enlightened years. D uring this period, those who performed operations on the teeth were called dentators. T here were barber dentists, as there were bar ber surgeons in those days. T h e first dental book of which we have knowledge was published anonymously in German in 1534, and the last chapter in this book is devoted to methods of treatment to prevent the falling out of the hair. T h ere was a splendid dental revival in France during the early part of the eighteenth century. T h e leader was Pierre Fouchard, who wrote a remark able and wonderfully illustrated com plete treatise on dentistry in 1728. This book describes the diseases o f the gums and their treatment, the correction of irregularities o f the teeth, appliances to be worn by persons having cleft palates, artificial sets o f teeth that were enam eled, the removal of decay and the filling of teeth, the treatment o f abscessed teeth, methods of extracting, etc. T h e w ord “ dentist” originated during this period. T h e dentistry of France became very slow ly established in our colonies. T hose of this audience w ho are not dentists may be surprised to learn that Paul Revere practiced dentistry. M a y I read
Black— A H istorical Sketch
you his advertisement, copied from the Boston G azette for A ug. 29, 1768.1 W h e r e a s m any P ersons are so un fortu nate as to lose their F o re -T e e th by A ccid e n t, and otherw ays, to their g re a t D etrim ent, not only in Looks, but sp eakin g both in P u b lic and P riv a te : T h is is to in fo rm all such, that they m ay h a v e them re p la ce d w ith fa lse Ones, that looks as w e ll as the N atu ral, and an sw er the E nd o f S peaking to all Intents, by P aul R evere, G old sm ith , near the H e a d o f D r. C larke’ s W h a r f, B oston.
T h e advertisement2 of another Boston dentist, appearing in 1796, is of interest as it gives an idea of the dentistry o f the time, this man apparently being one of the leading practitioners. J osia h F la g g , S urgeon Dentist, In form s the P ublic, that he practices in all the branches, w ith im provem en ts. T ra n sp la n ts both liv e and d ead T e e th w ith g re a te r con ven ien cy, and g iv e s less pain than h e re to fo re p ra c tised in E urope o r A m e r ic a ; Sew s up H a re L ip s; Cures U lc e r s ; E xtracts T e e th and stumps, o r roots w ith c a r e ; Fastens those T eeth that are lo o s e ; and w hen thus put in order, and his d irection s fo llo w e d (w h ich are sim p le ), he en g a ges that the fu rth er care o f a dentist w ill be w h o lly u n n ecessa ry ; fixes G o ld R o o fs and P alates, an d artificial teeth o f any quality, w ith ou t in ju ry to and independent o f the natural o n e s ; a room fo r the p ra ctice w ith e v e ry accom m od ation at his house, w h e re m ay be had T e e th and G um Brushes, M astics, e tc.; also C hew -sticks, p a r ticu larly useful in clean sin g the fo r e T e e th and p re s e rv in g a natu ral and beautiful w h ite ness; w h ich M e d icin e an d C hew -sticks are to be sold w h olesale an d retail, that they m ay be m ore exten sively useful. D r. F lag g , has a m ethod to fu rn ish those L a d ies and G entlem en, or C hildren w ith artificial T eeth , G o ld G um s, R o o fs, o r Palates, that are at a distance and cann ot attend him p erson ally . C ash g iv e n fo r handsom e and H ealth y L iv e T eeth , at N o. 47, N e w b u ry Street, B oston (1 7 9 6 ).
T h e real development of dentistry in America began in 1839, with the estab lishment of the first dental college in 1. K o ch , C. R. E., H isto ry o f D en tal Sur gery, V ol. I, p. 96.
2 . Footnote 1, P . 92.
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Baltimore. Previous to that time, den tistry was a trade that might be acquired by apprenticeship, and there were many itinerants, w ho made the rounds from village to village as did the umbrella menders and the s c is s o r s g r in d e r s . Horace Hayden, a dentist of fine breed ing and good education, an organizer of ability, petitioned the medical faculty of the University of M aryland to institute a course of lectures on dentistry. T h e medical faculty declined, and Hayden, assisted by Chapin A . Harris, established the Baltimore College of Dental Sur gery. It was this action on the part of the University of M aryland that resulted in the development of dentistry as a sep arate profession. T h e practice of den tistry at that time was so generally con sidered a trade, in connection with which health relationships were not recognized, that one could hardly criticize the action of the medical school. It was the first emergence of dentistry from charlatan ism, quackery and commercialism. H o w ever, in view of the fact that in all European countries dentistry has devel oped under medical control, it is not out o f place to question whether American dentistry has not outstripped all other countries because of its independent de velopment. T his is not a criticism of our medical schools, but relates rather to the highly developed t e c h n ic a l t r a in in g which is a part of modern dental practice. Other dental colleges were established ; in Cincinnati in 1845, in Lexington, Ky., in 1850; in Philadelphia and Syracuse, N .Y ., in 1852; tw o more in Philadelphia in 1856 and 1863, and one in N e w Y ork C ity in 1866. O f these schools, three were discontinued, so that there were but five other dental colleges in existence when the M issouri Dental College, the forerunner of W ashington University Dental School, was established in 1866.
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T h e Journal o f the Am erican D en ta l Association
T h e other five were located, one in Bal timore, one in Cincinnati, tw o in Phila delphia and one in N ew Y ork City. In St. Louis, at that time, there lived what appear to me to have been the most wonderful group o f men that ever prac ticed dentistry in a single city. Hom er Judd, W . H . Eames, H . E. Peebles, W . N . M orrison, H . J. M cK ellops, Isaiah Forbes, A . M . Leslie and Edgar Park were among the leaders w ho organ ized this school. T h ey were o f such high standing that they became a center of influence for the advancement of den tistry in the Central W est. A number of physicians appear to have been equally interested with the dentists in the success of the school. T his group consisted of Charles W . Stevens, A . Litton, J. T . Hodgen, J. S. P. Alleyne, E. H . G reg ory, Frank W . W hite, Charles A . Pope and J. B. Johnson. I am especially pleased to be one of your guests on this occasion, for much of my life has been spent in what might be termed the spiritual atmosphere of this school. As a matter of fact, Northwest ern University Dental School owes its establishment in large measure to the high idealism and outstanding achieve ments of the group who organized this school. T w o of the founders of N orth western, Thom as L . G ilm er and G . V . Black, as well as tw o others who put in many years of service, C . R . E. Koch and J. H . Prothero, all received their D .D .S . degrees from M issouri Dental College. It was the spirit of Judd and his associates that inspired those who or ganized Northwestern, and we are proud to believe that we continue to w ork in that atmosphere. One o f our choice pos sessions is an oil portrait of H om er Judd. It is appropriate that we should, on this occasion, turn to the Commencement
address3 delivered by D r. Judd in 1871, fifty-eight years ago, and quote from it, because he there states the ideals o f the group that organized the school: U n d er a charter o f the State o f M a ry la n d , the B altim ore C olleg e o f D en tal Surgery w as brou gh t into existence, and took its stand am on g the literary and scientific institutions o f the land, as the first reg u larly org a n iz ed dental colle g e the w o r ld had ever know n. Dentists w ill ev e r look back w ith interest upon this even tfu l epoch, in w hich dental art burst its ch ry salid fo r m and stood rev ea led a liv in g science. It w as not born su rroun ded by the m ysticism , the superstition, and the darkness o f the w o r ld ’s early history, but cam e into existence in the fu lness o f the m id d a y ligh t o f the nineteenth century. U n tram m eled by the w eig h t o f h oa ry theories, and un fettered by the p reju d ices engen dered by acrim on ious disputations, it w as fitted to ap p rop riate to its ow n use w h a tev er o f art o r science it fou n d read y d evelop ed to m inister to its necessities, and w ithout stop p in g to m ingle w ith the disputants o f o p p os in g d ogm as, set itself v ig o ro u sly to w ork in the direction o f scientific progress. T h a t there m ay be a still m ore rapid a d van cem ent in scientific attainm ents in the p rofession , arises the necessity f o r a m ore extended cou rse o f dental studies, and a m ore intim ate k n ow led g e o f the fu n d am en tal p rin ciples o f m edicine, that all the sym pathies, and p h y siolog ica l and p a th olog ica l con n ec tions o f the d ifferen t org a n s o f this w on d rou s w o rk o f nature m ay be fu lly appreciated and un derstood. T h e attention can scarcely d w ell fo r a m om ent upon this p rop osition w ithout the g ran d truth fo r c in g itself upon the m ind, that to be able to treat su ccessfully and safely the v a rio u s p a th olog ica l condition s of the teeth and oral cavity, requires the same am ount o f gen eral k n ow led g e o f m edicine that is necessary fo r the success o f the oculist, the aurist, the surgeon, or the p ractitioners o f g en era l m edicine. In v ie w o f these facts, the p ra ctition ers o f the W e st con ceiv ed the idea o f establish ing an institution o f lea rn in g f o r dental students, w h ere the fu n d a m ental p rin cip les o f m ed ica l science should be recog n ized to the fu llest extent, as the only p ro p er
fou n d a tion
fo r
a
k n ow led g e
of
scientific dentistry. 3. 1871.
Ju dd, H o m e r : M issou ri D ent. J., 3:81,
Black— A H istorical Sketch A ll im provem en ts in dental practice, w h ich h ave looked to a m ore exten ded con servatism o f dental org an s, are b e in g m ore and m ore ap p reciated, and the im m ense ad v an ce m ade by the p ro fe ssio n in the last fe w years is destined h erea fter to exert no fe e b le influence in p ro m o tin g and p re s e rv in g the g en eral health o f com m unities, and thereby co n trib u tin g to the gen eral w eal o f man.
T h a t is a program of the finest tech nical training, founded on a knowledge of the medical sciences, looking forward to the relations o f the mouth to the gen eral health and to the prevention of dental disease. C ould it be better stated today ? T h e Missouri Dental College became a part of W ashington University in 1892. A t that time, but very few of our great universities had recognized the service value of dentistry by accepting the responsibility of establishing dental departments. In 1900, there were fortytwo dental schools in the United States and Canada, of which only fifteen were departments o f universities, the other twenty-seven being privately owned or more or less closely affiliated. In 1929, there are forty-four dental schools, o f which forty are departments o f univer sities and four are privately owned. Pos sibly nothing means more to the future of dentistry than the action o f our uni versities in accepting the burden of dental education as one o f their duties. It means that the education of each student w ill cost considerably more than he pays; also, that there w ill be developments in graduate training and research, all of which call for endowment for dental schools. A ccording to figures collected by the American M edical Association, gifts to medical education and research in the United States for the period from 1911 to 1920 amounted to about $65,000,000; from 1921 to 1925 to about $100,000,-
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000, and for .1926, $109,000,000. Suffi ciently accurate figures are not available for the past tw o years, but the amount for each year is considerably less than for 1926. W e may safely say that more than $325,000,000 has been given to medical education in the past twenty years. D uring the same period, the total for dentistry has been about $8,000,000. Dentistry does not begrudge medicine any of its munificent financial support, but it is quite plain that the universities which have assumed the responsibility for the training of dentists must devote a generous share o f their endowment in come to dental departments until such time as special gifts may be obtained. It is the duty of dentistry to so impress its service on the public mind that gifts will be forthcoming. T h e Code of Hippocrates established the high ideal o f professionalism as d if ferentiated from a trade. A ll that is good and worth while in medicine is built upon this oath, which can be summed up in the single w ord “ service.” T h e C en tury Dictionary defines a trade as a skilled or specialized handicraft, or a business carried on for profit. A profes sion is defined as a vocation that properly involves a liberal education and mental rather than manual labor. A s we review the development o f dental education dur ing the past twenty-five years, we find a succession of additions to courses of study and to the preliminary educational re quirements which have led some to com plain o f the time necessary to prepare one to enter practice. W e may ask why there should be so much training in the sci ences for the practice o f medicine, and since our dental colleges are now in the process of extending their preliminary re quirements, it may not be amiss to touch on this point. I could not do better than
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T h e Journal of the Am erican D en ta l Association
to quote from a splendid address4 deliv ered by Sir Robert Falconer, president of T oron to University, before the annual meeting of the Institute of Dental Teachers held in M ontreal in 1922. In answer to the question, W h y is the med ical man trained in the premedical sci ences, or even in the sciences which are not medical? he says: P artly that he m ay becom e acquainted w ith the organ ism w ith w h ich he has to deal, and p artly that he m ay be trained scientifically. T h e la b o ra to ry is used ev e ry w h e re and his p o w ers o f observation are b e in g m ad e acute. It is not that he rem em bers all these things. H e must, o f course, rem em ber the m ost out stand ing things, bu t it is that he is b e in g g iv e n a scientific attitude o f m ind. We kn ow w h at a v a st d ifferen ce in in terpreta tion is m anifested by d ifferen t m en w hen they are asked to g iv e an account o f an ord in a ry happ enin g— w e get the m ost d iverse accounts o f w h at has taken p lace. T h e in accuracies o f o b serv a tion are n otorious. C e r tainly, success in m edicin e d epen ds on a c cu ra cy o f observation . A n d the tra in in g o f the scientific m ind is, p a rtly at least, the tra in in g to see, to kn ow w h at to look fo r and to be sure that you h ave fo u n d w h at is there. T h a t is really the basis o f diagnosis.
In dealing with an organism so com plicated as the human being, we have not only to consider the physiologic or normal mechanism, and all of its patho logic derangements; we must also mas ter, as far as w e are able, the psychologic and personal sides, if we are to be suc cessful in the highest degree. F or success in practice is quite as often dependent on the proper diagnosis of the peculiarities of the individual as on an exact deter mination of the disease. T o find the gate of entry to both the individuality and the physical derangement is the problem o f the professional man. T h e physician or the dentist with the broadest know l edge, rightly applied, w ill be most suc cessful. 4. p. 24.
A s medicine and dentistry delve deeper into the field of prevention, the study of the psychologic and personal sides be comes more important, because the man agement of the patient must be carried to the point of conviction that it is best to consult the doctor at stated intervals while well, in order to keep well, and to be w illing to pay for the advice received year after year. M a y we suggest that the present trend of medicine and dentistry toward prevention w ill be greatly aug mented in the future by added successes in the management of diseases hitherto uncontrolled. O u r idealistic aim should be to prevent disease so surely that there w ill be none left for us to treat. Prac tically, it is fully realized that we can hope, by the utmost endeavor, to do no more than reduce in small measure the incidence or severity of diseases in gen eral ; yet there are numerous examples of specific diseases which have been vir tually eradicated. Jenner’s discovery of inoculation with the virus o f cowpox to prevent smallpox gave us the first positive means of eradi cating a disease which had taken its toll of many thousands o f lives. T h e experi ments of Reed, Lazear, C arroll and A rgomonte in 1881 proved the mosquito ( stegomyia) to be the intermediate host in yellow fever. Lazear lost his life in the experiment and Reed died soon after wards, that the w orld might be freed of this scourge. It was the w ork of these men that made it possible for General Gorgas to prevent yellow fever in the Panama Canal Zone. Otherwise, General Goethals would probably have failed, as did the French, in the construction of our great interoceanic waterway.
T h e development o f our knowledge of typhoid fever and of means of preventing Institute D en tal T e a c h e r s T ra n s., 1922, this disease is an interesting example of the years o f study often required to mas
Black— A H istorical Sketch
ter a disease. In 1837, Gerhard differ entiated typhoid and typhus fever clini cally; in 1880, Eberth isolated the ty phoid bacillus; in 1896, W id a l and Sicard introduced the agglutination test for typhoid, and, in 1902, Firth and H orrocks showed that flies and other insects could carry typhoid bacilli. T h e prin cipal fight against typhoid for many years was, an effort to prevent contami nation of water and food by proper sani tation. M ore recently, the development of typhoid inoculation has given very nearly complete control o f the disease. In referring to the progress which might be made in the application o f pre ventive measures, Charles H . M ayo called attention to the fact that the ad vance of the profession may often be delayed until the public is educated first to understand and then to demand pre ventive service. O ne o f the advantages to humanity resulting from the W o rld W a r has been the advancement o f pre ventive medicine. Hundreds of thou sands of soldiers had their first experience with preventive measures while in serv ice, and these men have, consciously or unconsciously, spread the gospel o f pre vention as applied to typhoid and other diseases, and to certain phases o f hygiene and sanitation, in such a way as to make the public more receptive to the ideas of prevention. In this connection, attention is called to the fact that dentistry has made w on derful progress toward prevention in recent years from the very fact that large numbers of persons are coming every six months for examinations even though they know of nothing that requires at tention. O u r people are gradually com ing to appreciate the fact that preventive dentistry is best, both as a safeguard o f a healthy mouth and as a matter of economy. It is realized that definitely
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arranged p e r i o d i c e x a m in a t io n s and treatments tend to prevent chronic ab scesses and pyorrhea, and thus protect the general health. Patients are coming to the dentist regularly, instead of, as formerly, delaying until an aching tooth, with an exposed pulp, has brought them in. It should be the foremost duty of every physician and dentist to teach the people the value of regular and thorough physical examinations— to prefer to pay the doctor to keep them well. M a y we compare medical and dental education in one other respect, as we look a little into the future. In the early days, dentistry was practiced largely as a trade, and there was little realization of the need of medical education for a dentist. T oday, no one should question the statement made by D r. Judd in 1871 that the dentist needs the same basic edu cation as the man practicing any other specialty of medicine. W h ile great prog ress has been made, dentistry is still lack ing in the most thorough training in the fundamentals o f medicine, which should constitute its foundation. O n the other hand, our dental colleges represent the highest development in schools designed to train men for the practice of one of the specialties o f medicine. O u r medical schools have held closely to the task of training men for general practice and have only recently assumed responsibility in the training o f their graduates for the practice of the several specialties. M e d i cine must develop specialty schools com parable to dental colleges; while dentistry elaborates the medical fundamentals. Progress along both lines w ill eventually make the requirements for all specialties closely parallel. W e have gathered here today for the formal dedication of this building to the service of humanity. In its construction, equipment and appointments, it repre-
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T h e Journal o f the Am erican D en ta l Association
sents the finest that can be provided for the purpose, and w ill long stand as a monument to the members o f the faculty who are responsible for its design. It gives to the faculty increased opportunity for thorough teaching and research, and to the students those facilities and accom modations which w ill make their studies and their training in fingerskill more en gaging. It stands as a pledge on the part of the trustees of W ashington University that it has accepted the responsibility to all communities which the alumni o f this school serve that the preparation for that service w ill continue to be o f the high character for which this university has always stood. W e rejoice in the continued existence in this school of a faculty which has the same high ideals as had its founders, and which is now, in this splendidly equipped building, girding itself for the achieve ments which will meet the needs of the future. Permit me to congratulate the officers and members of the board of trustees,
also the members of the faculties, the alumni, students and friends of W a sh ington University on the dedication of this building. I especially felicitate Dean Bartlett and the members o f the faculty, the alumni and students o f the dental school. T h e location o f this building on the campus as one of the medical group insures an atmosphere which promises much for the future. M ore intimate re lations w ill result in better understand ing, finer cooperation and greater prog ress toward the ideals of H om er Judd and his associates w ho organized this school. W o u ld that Judd, Eames, Peebles, M orrison, M cK ellops, Forbes, Leslie and the others o f that group might be here today. W h a t joy it would be to them. W h a t realization of fruitfulness of the w ork which they began. T heir spirit is here; it must be in the men o f this faculty and those who have gone out from this School. T o be true to them, we and those who follow must ever carry on.
A S U R V E Y O F P R E S E N T -D A Y D E N T IS T R Y * By C. N. JOHNSON, D. D. S., Chicago, III.
S H O U L b like first to express my keen appreciation o f the honor paid me by an invitation to appear before this society on the present occasion. Ever since I began to read dental literature the profession o f N ew Y ork has held in its ranks many men of outstanding abil ity. I recall in particular the names o f
I
* R e a d at the D e ce m b e r M e e tin g fo r B etter D en tistry o f the F irst D istrict D en tal S oci ety o f N e w Y o rk , D ec. 3, 1928.
Jour. A . D. A ., Ju ly , 1929
some of the members o f the O dontological Society of N ew Y ork , which organ ization, I am told, was merged into the First District Society when the A m er ican Dental Association was reorganized. I recall vividly such names as Atkinson, Kingsley, D w in d le, Northrup, Jarvie, Perry o f blessed memory, and many others. (Speaking o f the last tw o calls to my mind the fact that there have been three men whose names have ever repre-
T he Journal of the American D en tal Association
not have to remove the entire enamel even in these cases. O f course, it is al ways necessary to meet mechanical re quirements in the preparation o f teeth for fillings or crowns. Sometimes, exten
sions are made solely to meet these re quirements. T h e principles of anatomy, biology, esthetics and mechanics must be considered in planning dental restora tions.
A H IS T O R IC A L SK E T C H * By A R T H U R D. BLACK, A.M ., M.D., D.D.S., Sc.D., Chicago, 111. H E practice of dentistry, in one form or another, dates back to the time when teeth first began to de cay. W h ile our records cover but a few thousand years, we are constrained to be lieve that if Cain or A bel had a tooth ache, A dam had to do something for it. Professor Olmstead, archeologist, report ing on excavations about the biblical city o f Nineveh, refers to tablets which rec ord that a physician was called to task by the king because he had not cured him of an illness. T h e physician replied that if the king would carry out certain di rections, his fever would leave him, and, after giving other instructions, stated that the pain in the king’s head, in his back and in his limbs, came from his teeth and they must be extracted. T h e idea of focal infections and the relation of mouth conditions to the general health was evidently recognized then, about 600 B. C., or about 2,500 years ago.
T
W e know something of the dentistry of the Egyptians, the Etruscans, the Greeks and the Romans, when it was practiced as a specialty of the healing art, by “ physicians for the teeth.” D u r ing the M id d le Ages, dentistry suffered * A d d re ss on the occa sion o f the dedication o f the n e w b u ild in g o f W a sh in g to n U n i v ersity D en tal School, St. Louis, Feb. 22, 1929.
Jour. A . D. A ., Ju ly, IQ2Ç
a serious setback from which it very slowly emerged with the dawning of more enlightened years. D uring this period, those who performed operations on the teeth were called dentators. T here were barber dentists, as there were bar ber surgeons in those days. T h e first dental book of which we have knowledge was published anonymously in German in 1534, and the last chapter in this book is devoted to methods of treatment to prevent the falling out of the hair. T h ere was a splendid dental revival in France during the early part of the eighteenth century. T h e leader was Pierre Fouchard, who wrote a remark able and wonderfully illustrated com plete treatise on dentistry in 1728. This book describes the diseases o f the gums and their treatment, the correction of irregularities o f the teeth, appliances to be worn by persons having cleft palates, artificial sets o f teeth that were enam eled, the removal of decay and the filling of teeth, the treatment o f abscessed teeth, methods of extracting, etc. T h e w ord “ dentist” originated during this period. T h e dentistry of France became very slow ly established in our colonies. T hose of this audience w ho are not dentists may be surprised to learn that Paul Revere practiced dentistry. M a y I read
Black— A H istorical Sketch
you his advertisement, copied from the Boston G azette for A ug. 29, 1768.1 W h e r e a s m any P ersons are so un fortu nate as to lose their F o re -T e e th by A ccid e n t, and otherw ays, to their g re a t D etrim ent, not only in Looks, but sp eakin g both in P u b lic and P riv a te : T h is is to in fo rm all such, that they m ay h a v e them re p la ce d w ith fa lse Ones, that looks as w e ll as the N atu ral, and an sw er the E nd o f S peaking to all Intents, by P aul R evere, G old sm ith , near the H e a d o f D r. C larke’ s W h a r f, B oston.
T h e advertisement2 of another Boston dentist, appearing in 1796, is of interest as it gives an idea of the dentistry o f the time, this man apparently being one of the leading practitioners. J osia h F la g g , S urgeon Dentist, In form s the P ublic, that he practices in all the branches, w ith im provem en ts. T ra n sp la n ts both liv e and d ead T e e th w ith g re a te r con ven ien cy, and g iv e s less pain than h e re to fo re p ra c tised in E urope o r A m e r ic a ; Sew s up H a re L ip s; Cures U lc e r s ; E xtracts T e e th and stumps, o r roots w ith c a r e ; Fastens those T eeth that are lo o s e ; and w hen thus put in order, and his d irection s fo llo w e d (w h ich are sim p le ), he en g a ges that the fu rth er care o f a dentist w ill be w h o lly u n n ecessa ry ; fixes G o ld R o o fs and P alates, an d artificial teeth o f any quality, w ith ou t in ju ry to and independent o f the natural o n e s ; a room fo r the p ra ctice w ith e v e ry accom m od ation at his house, w h e re m ay be had T e e th and G um Brushes, M astics, e tc.; also C hew -sticks, p a r ticu larly useful in clean sin g the fo r e T e e th and p re s e rv in g a natu ral and beautiful w h ite ness; w h ich M e d icin e an d C hew -sticks are to be sold w h olesale an d retail, that they m ay be m ore exten sively useful. D r. F lag g , has a m ethod to fu rn ish those L a d ies and G entlem en, or C hildren w ith artificial T eeth , G o ld G um s, R o o fs, o r Palates, that are at a distance and cann ot attend him p erson ally . C ash g iv e n fo r handsom e and H ealth y L iv e T eeth , at N o. 47, N e w b u ry Street, B oston (1 7 9 6 ).
T h e real development of dentistry in America began in 1839, with the estab lishment of the first dental college in 1. K o ch , C. R. E., H isto ry o f D en tal Sur gery, V ol. I, p. 96.
2 . Footnote 1, P . 92.
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Baltimore. Previous to that time, den tistry was a trade that might be acquired by apprenticeship, and there were many itinerants, w ho made the rounds from village to village as did the umbrella menders and the s c is s o r s g r in d e r s . Horace Hayden, a dentist of fine breed ing and good education, an organizer of ability, petitioned the medical faculty of the University of M aryland to institute a course of lectures on dentistry. T h e medical faculty declined, and Hayden, assisted by Chapin A . Harris, established the Baltimore College of Dental Sur gery. It was this action on the part of the University of M aryland that resulted in the development of dentistry as a sep arate profession. T h e practice of den tistry at that time was so generally con sidered a trade, in connection with which health relationships were not recognized, that one could hardly criticize the action of the medical school. It was the first emergence of dentistry from charlatan ism, quackery and commercialism. H o w ever, in view of the fact that in all European countries dentistry has devel oped under medical control, it is not out o f place to question whether American dentistry has not outstripped all other countries because of its independent de velopment. T his is not a criticism of our medical schools, but relates rather to the highly developed t e c h n ic a l t r a in in g which is a part of modern dental practice. Other dental colleges were established ; in Cincinnati in 1845, in Lexington, Ky., in 1850; in Philadelphia and Syracuse, N .Y ., in 1852; tw o more in Philadelphia in 1856 and 1863, and one in N e w Y ork C ity in 1866. O f these schools, three were discontinued, so that there were but five other dental colleges in existence when the M issouri Dental College, the forerunner of W ashington University Dental School, was established in 1866.
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T h e Journal o f the Am erican D en ta l Association
T h e other five were located, one in Bal timore, one in Cincinnati, tw o in Phila delphia and one in N ew Y ork City. In St. Louis, at that time, there lived what appear to me to have been the most wonderful group o f men that ever prac ticed dentistry in a single city. Hom er Judd, W . H . Eames, H . E. Peebles, W . N . M orrison, H . J. M cK ellops, Isaiah Forbes, A . M . Leslie and Edgar Park were among the leaders w ho organ ized this school. T h ey were o f such high standing that they became a center of influence for the advancement of den tistry in the Central W est. A number of physicians appear to have been equally interested with the dentists in the success of the school. T his group consisted of Charles W . Stevens, A . Litton, J. T . Hodgen, J. S. P. Alleyne, E. H . G reg ory, Frank W . W hite, Charles A . Pope and J. B. Johnson. I am especially pleased to be one of your guests on this occasion, for much of my life has been spent in what might be termed the spiritual atmosphere of this school. As a matter of fact, Northwest ern University Dental School owes its establishment in large measure to the high idealism and outstanding achieve ments of the group who organized this school. T w o of the founders of N orth western, Thom as L . G ilm er and G . V . Black, as well as tw o others who put in many years of service, C . R . E. Koch and J. H . Prothero, all received their D .D .S . degrees from M issouri Dental College. It was the spirit of Judd and his associates that inspired those who or ganized Northwestern, and we are proud to believe that we continue to w ork in that atmosphere. One o f our choice pos sessions is an oil portrait of H om er Judd. It is appropriate that we should, on this occasion, turn to the Commencement
address3 delivered by D r. Judd in 1871, fifty-eight years ago, and quote from it, because he there states the ideals o f the group that organized the school: U n d er a charter o f the State o f M a ry la n d , the B altim ore C olleg e o f D en tal Surgery w as brou gh t into existence, and took its stand am on g the literary and scientific institutions o f the land, as the first reg u larly org a n iz ed dental colle g e the w o r ld had ever know n. Dentists w ill ev e r look back w ith interest upon this even tfu l epoch, in w hich dental art burst its ch ry salid fo r m and stood rev ea led a liv in g science. It w as not born su rroun ded by the m ysticism , the superstition, and the darkness o f the w o r ld ’s early history, but cam e into existence in the fu lness o f the m id d a y ligh t o f the nineteenth century. U n tram m eled by the w eig h t o f h oa ry theories, and un fettered by the p reju d ices engen dered by acrim on ious disputations, it w as fitted to ap p rop riate to its ow n use w h a tev er o f art o r science it fou n d read y d evelop ed to m inister to its necessities, and w ithout stop p in g to m ingle w ith the disputants o f o p p os in g d ogm as, set itself v ig o ro u sly to w ork in the direction o f scientific progress. T h a t there m ay be a still m ore rapid a d van cem ent in scientific attainm ents in the p rofession , arises the necessity f o r a m ore extended cou rse o f dental studies, and a m ore intim ate k n ow led g e o f the fu n d am en tal p rin ciples o f m edicine, that all the sym pathies, and p h y siolog ica l and p a th olog ica l con n ec tions o f the d ifferen t org a n s o f this w on d rou s w o rk o f nature m ay be fu lly appreciated and un derstood. T h e attention can scarcely d w ell fo r a m om ent upon this p rop osition w ithout the g ran d truth fo r c in g itself upon the m ind, that to be able to treat su ccessfully and safely the v a rio u s p a th olog ica l condition s of the teeth and oral cavity, requires the same am ount o f gen eral k n ow led g e o f m edicine that is necessary fo r the success o f the oculist, the aurist, the surgeon, or the p ractitioners o f g en era l m edicine. In v ie w o f these facts, the p ra ctition ers o f the W e st con ceiv ed the idea o f establish ing an institution o f lea rn in g f o r dental students, w h ere the fu n d a m ental p rin cip les o f m ed ica l science should be recog n ized to the fu llest extent, as the only p ro p er
fou n d a tion
fo r
a
k n ow led g e
of
scientific dentistry. 3. 1871.
Ju dd, H o m e r : M issou ri D ent. J., 3:81,
Black— A H istorical Sketch A ll im provem en ts in dental practice, w h ich h ave looked to a m ore exten ded con servatism o f dental org an s, are b e in g m ore and m ore ap p reciated, and the im m ense ad v an ce m ade by the p ro fe ssio n in the last fe w years is destined h erea fter to exert no fe e b le influence in p ro m o tin g and p re s e rv in g the g en eral health o f com m unities, and thereby co n trib u tin g to the gen eral w eal o f man.
T h a t is a program of the finest tech nical training, founded on a knowledge of the medical sciences, looking forward to the relations o f the mouth to the gen eral health and to the prevention of dental disease. C ould it be better stated today ? T h e Missouri Dental College became a part of W ashington University in 1892. A t that time, but very few of our great universities had recognized the service value of dentistry by accepting the responsibility of establishing dental departments. In 1900, there were fortytwo dental schools in the United States and Canada, of which only fifteen were departments o f universities, the other twenty-seven being privately owned or more or less closely affiliated. In 1929, there are forty-four dental schools, o f which forty are departments o f univer sities and four are privately owned. Pos sibly nothing means more to the future of dentistry than the action o f our uni versities in accepting the burden of dental education as one o f their duties. It means that the education of each student w ill cost considerably more than he pays; also, that there w ill be developments in graduate training and research, all of which call for endowment for dental schools. A ccording to figures collected by the American M edical Association, gifts to medical education and research in the United States for the period from 1911 to 1920 amounted to about $65,000,000; from 1921 to 1925 to about $100,000,-
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000, and for .1926, $109,000,000. Suffi ciently accurate figures are not available for the past tw o years, but the amount for each year is considerably less than for 1926. W e may safely say that more than $325,000,000 has been given to medical education in the past twenty years. D uring the same period, the total for dentistry has been about $8,000,000. Dentistry does not begrudge medicine any of its munificent financial support, but it is quite plain that the universities which have assumed the responsibility for the training of dentists must devote a generous share o f their endowment in come to dental departments until such time as special gifts may be obtained. It is the duty of dentistry to so impress its service on the public mind that gifts will be forthcoming. T h e Code of Hippocrates established the high ideal o f professionalism as d if ferentiated from a trade. A ll that is good and worth while in medicine is built upon this oath, which can be summed up in the single w ord “ service.” T h e C en tury Dictionary defines a trade as a skilled or specialized handicraft, or a business carried on for profit. A profes sion is defined as a vocation that properly involves a liberal education and mental rather than manual labor. A s we review the development o f dental education dur ing the past twenty-five years, we find a succession of additions to courses of study and to the preliminary educational re quirements which have led some to com plain o f the time necessary to prepare one to enter practice. W e may ask why there should be so much training in the sci ences for the practice o f medicine, and since our dental colleges are now in the process of extending their preliminary re quirements, it may not be amiss to touch on this point. I could not do better than
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to quote from a splendid address4 deliv ered by Sir Robert Falconer, president of T oron to University, before the annual meeting of the Institute of Dental Teachers held in M ontreal in 1922. In answer to the question, W h y is the med ical man trained in the premedical sci ences, or even in the sciences which are not medical? he says: P artly that he m ay becom e acquainted w ith the organ ism w ith w h ich he has to deal, and p artly that he m ay be trained scientifically. T h e la b o ra to ry is used ev e ry w h e re and his p o w ers o f observation are b e in g m ad e acute. It is not that he rem em bers all these things. H e must, o f course, rem em ber the m ost out stand ing things, bu t it is that he is b e in g g iv e n a scientific attitude o f m ind. We kn ow w h at a v a st d ifferen ce in in terpreta tion is m anifested by d ifferen t m en w hen they are asked to g iv e an account o f an ord in a ry happ enin g— w e get the m ost d iverse accounts o f w h at has taken p lace. T h e in accuracies o f o b serv a tion are n otorious. C e r tainly, success in m edicin e d epen ds on a c cu ra cy o f observation . A n d the tra in in g o f the scientific m ind is, p a rtly at least, the tra in in g to see, to kn ow w h at to look fo r and to be sure that you h ave fo u n d w h at is there. T h a t is really the basis o f diagnosis.
In dealing with an organism so com plicated as the human being, we have not only to consider the physiologic or normal mechanism, and all of its patho logic derangements; we must also mas ter, as far as w e are able, the psychologic and personal sides, if we are to be suc cessful in the highest degree. F or success in practice is quite as often dependent on the proper diagnosis of the peculiarities of the individual as on an exact deter mination of the disease. T o find the gate of entry to both the individuality and the physical derangement is the problem o f the professional man. T h e physician or the dentist with the broadest know l edge, rightly applied, w ill be most suc cessful. 4. p. 24.
A s medicine and dentistry delve deeper into the field of prevention, the study of the psychologic and personal sides be comes more important, because the man agement of the patient must be carried to the point of conviction that it is best to consult the doctor at stated intervals while well, in order to keep well, and to be w illing to pay for the advice received year after year. M a y we suggest that the present trend of medicine and dentistry toward prevention w ill be greatly aug mented in the future by added successes in the management of diseases hitherto uncontrolled. O u r idealistic aim should be to prevent disease so surely that there w ill be none left for us to treat. Prac tically, it is fully realized that we can hope, by the utmost endeavor, to do no more than reduce in small measure the incidence or severity of diseases in gen eral ; yet there are numerous examples of specific diseases which have been vir tually eradicated. Jenner’s discovery of inoculation with the virus o f cowpox to prevent smallpox gave us the first positive means of eradi cating a disease which had taken its toll of many thousands o f lives. T h e experi ments of Reed, Lazear, C arroll and A rgomonte in 1881 proved the mosquito ( stegomyia) to be the intermediate host in yellow fever. Lazear lost his life in the experiment and Reed died soon after wards, that the w orld might be freed of this scourge. It was the w ork of these men that made it possible for General Gorgas to prevent yellow fever in the Panama Canal Zone. Otherwise, General Goethals would probably have failed, as did the French, in the construction of our great interoceanic waterway.
T h e development o f our knowledge of typhoid fever and of means of preventing Institute D en tal T e a c h e r s T ra n s., 1922, this disease is an interesting example of the years o f study often required to mas
Black— A H istorical Sketch
ter a disease. In 1837, Gerhard differ entiated typhoid and typhus fever clini cally; in 1880, Eberth isolated the ty phoid bacillus; in 1896, W id a l and Sicard introduced the agglutination test for typhoid, and, in 1902, Firth and H orrocks showed that flies and other insects could carry typhoid bacilli. T h e prin cipal fight against typhoid for many years was, an effort to prevent contami nation of water and food by proper sani tation. M ore recently, the development of typhoid inoculation has given very nearly complete control o f the disease. In referring to the progress which might be made in the application o f pre ventive measures, Charles H . M ayo called attention to the fact that the ad vance of the profession may often be delayed until the public is educated first to understand and then to demand pre ventive service. O ne o f the advantages to humanity resulting from the W o rld W a r has been the advancement o f pre ventive medicine. Hundreds of thou sands of soldiers had their first experience with preventive measures while in serv ice, and these men have, consciously or unconsciously, spread the gospel o f pre vention as applied to typhoid and other diseases, and to certain phases o f hygiene and sanitation, in such a way as to make the public more receptive to the ideas of prevention. In this connection, attention is called to the fact that dentistry has made w on derful progress toward prevention in recent years from the very fact that large numbers of persons are coming every six months for examinations even though they know of nothing that requires at tention. O u r people are gradually com ing to appreciate the fact that preventive dentistry is best, both as a safeguard o f a healthy mouth and as a matter of economy. It is realized that definitely
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arranged p e r i o d i c e x a m in a t io n s and treatments tend to prevent chronic ab scesses and pyorrhea, and thus protect the general health. Patients are coming to the dentist regularly, instead of, as formerly, delaying until an aching tooth, with an exposed pulp, has brought them in. It should be the foremost duty of every physician and dentist to teach the people the value of regular and thorough physical examinations— to prefer to pay the doctor to keep them well. M a y we compare medical and dental education in one other respect, as we look a little into the future. In the early days, dentistry was practiced largely as a trade, and there was little realization of the need of medical education for a dentist. T oday, no one should question the statement made by D r. Judd in 1871 that the dentist needs the same basic edu cation as the man practicing any other specialty of medicine. W h ile great prog ress has been made, dentistry is still lack ing in the most thorough training in the fundamentals o f medicine, which should constitute its foundation. O n the other hand, our dental colleges represent the highest development in schools designed to train men for the practice of one of the specialties o f medicine. O u r medical schools have held closely to the task of training men for general practice and have only recently assumed responsibility in the training o f their graduates for the practice of the several specialties. M e d i cine must develop specialty schools com parable to dental colleges; while dentistry elaborates the medical fundamentals. Progress along both lines w ill eventually make the requirements for all specialties closely parallel. W e have gathered here today for the formal dedication of this building to the service of humanity. In its construction, equipment and appointments, it repre-
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T h e Journal o f the Am erican D en ta l Association
sents the finest that can be provided for the purpose, and w ill long stand as a monument to the members o f the faculty who are responsible for its design. It gives to the faculty increased opportunity for thorough teaching and research, and to the students those facilities and accom modations which w ill make their studies and their training in fingerskill more en gaging. It stands as a pledge on the part of the trustees of W ashington University that it has accepted the responsibility to all communities which the alumni o f this school serve that the preparation for that service w ill continue to be o f the high character for which this university has always stood. W e rejoice in the continued existence in this school of a faculty which has the same high ideals as had its founders, and which is now, in this splendidly equipped building, girding itself for the achieve ments which will meet the needs of the future. Permit me to congratulate the officers and members of the board of trustees,
also the members of the faculties, the alumni, students and friends of W a sh ington University on the dedication of this building. I especially felicitate Dean Bartlett and the members o f the faculty, the alumni and students o f the dental school. T h e location o f this building on the campus as one of the medical group insures an atmosphere which promises much for the future. M ore intimate re lations w ill result in better understand ing, finer cooperation and greater prog ress toward the ideals of H om er Judd and his associates w ho organized this school. W o u ld that Judd, Eames, Peebles, M orrison, M cK ellops, Forbes, Leslie and the others o f that group might be here today. W h a t joy it would be to them. W h a t realization of fruitfulness of the w ork which they began. T heir spirit is here; it must be in the men o f this faculty and those who have gone out from this School. T o be true to them, we and those who follow must ever carry on.
A S U R V E Y O F P R E S E N T -D A Y D E N T IS T R Y * By C. N. JOHNSON, D. D. S., Chicago, III.
S H O U L b like first to express my keen appreciation o f the honor paid me by an invitation to appear before this society on the present occasion. Ever since I began to read dental literature the profession o f N ew Y ork has held in its ranks many men of outstanding abil ity. I recall in particular the names o f
I
* R e a d at the D e ce m b e r M e e tin g fo r B etter D en tistry o f the F irst D istrict D en tal S oci ety o f N e w Y o rk , D ec. 3, 1928.
Jour. A . D. A ., Ju ly , 1929
some of the members o f the O dontological Society of N ew Y ork , which organ ization, I am told, was merged into the First District Society when the A m er ican Dental Association was reorganized. I recall vividly such names as Atkinson, Kingsley, D w in d le, Northrup, Jarvie, Perry o f blessed memory, and many others. (Speaking o f the last tw o calls to my mind the fact that there have been three men whose names have ever repre-