- Email: [email protected]
Dentistry in the Confederacy
Dentistry in the Confederacy
William N . Hodgkin, D.D.S., Warrenton, Va.
The advanced and wider utilization of the dentist in his professional capacity by the Confederate Army, as contrasted with the practice by the Union Army, in the War Between the States, has been noted by dental historians. Koch1 relates: D u r in g th e C iv il W a r an e ffo rt was m a d e to secure d en tal service in. th e U n io n A rm y , bu t the id e a w as n o t r e ce iv e d w ith fa v o r b y the W a r D e p a rtm e n t. A sim ilar e ffo rt was m ad e in th e C o n fe d e r a te A r m y a n d it su cce e d e d in so fa r that several dentists w e re reg u la rly c o m m issioned as m em bers o f the m e d ica l d e p a rt m en t an d assigned fo r d u ty at the larg er h os pitals. I n th e U n io n A r m y the o n ly dental service was that o f la n cin g “ g u m boils” an d the e x tra ction o f teeth.
Taylor2 has this brief note: I t was r e la te d that d u rin g the w ar betw een the N o r th an d the S o u th several dentists w ere ca rried in the arm y h ospitals o f the S ou th ern C o n fe d e r a c y .
The material in this restricted study is limited almost wholly to Virginia. The four year accumulation of the records of Surgeon-General Samuel P. Moore was destroyed in the burning of Richmond in April 1865. However, resource has been had to the correspondence of Surgeon William A. Carrington, Medical Director of Hospitals in Virginia, as preserved in the National Archives, and to other offi cial records. The findings are sufficient to confirm a fairly wide and importantly helpful service in the Confederate Army. 647
Indeed, the recognition at high levels of dental personnel, and their organiza tional status, would seem to warrant the dubbing of a fairly well defined “Con federate Dental Corps.” Among the factors which brought the Confederacy’s dental service to levels and usage theretofore unknown in military history may be cited the following: 1. The overwhelming demand by soldiers for dental service at intervals be tween action when army forces were stationed near cities having available dentists. 2. The inability of the private soldier to pay for his own dental care, especially in the later days of the Confederacy. The price demanded for gold foil in 1864 and 1865 was $64 an ounce in gold coin, or, in the depreciated currency of the Con federacy, about $3,840 an ounce. Pre vailing dental fees ran on the high scale of $120 for a gold filling, $20 for an ex traction, with other services in propor tion. For a single gold filling the Con federate soldier, drawing $18 a month, would have had to give six months’ pay. Lest dental fees be unwittingly criticized, let it be known that contemporary prices of other goods and services were at the
1. K o c h , C h a r le s R . E. H is t o r y o f d e n t a l s u r g e r y . F o r t W a y n e , I n d . , N a t io n a l A r t s P u b lis h in g C o . , 1910, V o l. I,
p. 138. 2 . T a y lo r , J . A . H is t o r y L e a & F e b ig e r , 1922, p . 208.
of
d e n t is t r y .
P h ila d e lp h ia ,
648 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
same scale; a coat could be had for $1,800, shoes for $300, cavalry boots for $1,000 and an ordinary felt hat for from $300 to $500. 3. The resourcefulness of SurgeonGeneral Samuel P. Moore in meeting the responsibilities for the total health care of the forces under the charge of the Medical Department. Moore’s warm ad vocacy and support of dental service is attested by the tribute of Burton:3 D en tists o f every la n d o w e a d ebt o f g ra titu d e to a m an w h o gav e o fficia l r e co g n itio n to the im p o rta n ce o f th eir p rofession , an d w h o e x ten d ed to those u n d e r h im every e n c o u ra g e m en t in the p ro s e cu tio n o f th eir ard u ou s d u ties; . . . they o w e m o re to S am u el Preston M o o r e , S u rg e o n -G e n e ra l o f the late C o n fe d erate States arm y, than to an y m an o f m o d e rn tim es.
4. The brilliant accomplishments of James Baxter Bean in caring for maxillo facial wounds in the battles about At lanta, which led to a heightened appre ciation of the scope of oral surgery. 5. The possible continuing interest and influence of President Jefferson Davis in the advantages of dental care of the military. As Secretary of War in the Pierce administration (1852-56), he had been approached by Edward Maynard of Washington, advocate of an army dental corps, and had “received the proposition as one of great value,”4 and lent it his support. It may be assumed that the stringencies of Confederate days lent force to his earlier persuasions. Of the slightly more than 100 dentists listed in the 1860 census as residing within the present boundaries of Vir ginia, 61 entered the service of the Con federacy. Most of these had official serv ice records from the early days of conflict, either in the ranks or as contract dentists. Whereas every record witnesses their patriotic response to the call of duty, there is likewise evidence that they were sensitive to all measures touching their professional status. Such controversies began with the rigid, though ambiguous,
conscription laws of the Confederate Congress, under the provisions of which dentists were conscripted. Whereas phy sicians of “seven years practice” were exempt from military service under this act, there was no specific mention of dentists. Naturally there arose the ques tion as to whether the Congress intended to include the latter as special practition ers. Despite the ruling of the War De partment through its representative, Judge Campbell, and the eminent legal opinion of General George W. Randolph as Secretary of War of the Confederate States that such exemption was intended, the conscription of dentists was con tinued by those in effective posts. However, there had been overtures looking to the employment of contract dentists previous to or concurrent with the conscription measures, as indicated by a letter of Medical Director W. A. Carrington to Surgeon James B. McCaw, head of Chimborazo Hospital, Richmond, dated March 20, 1863, inquiring McCaw’s: . . . o p in io n as to the a d visability o f a S u rgeon D en tist m a k in g visits to y ou r H o sp l. at stated tim es say 2 o r 3 w eek ly fo r su ch sim ple o p e ra tion o n the teeth (P r in c ip a lly ex tra ction s) as m ay be r e q u ired . T h e services o f a D en tist very skillful o n e x tra ction m ay be secu red on c o n tra ct.6
But the dental practitioner of the day was more concerned with conscription than with contract. In December 1863 there was presented in the Confederate Congress the following “Petition of Den tal Surgeons of Ten Years Practice for Exemption from Military Service” (Fig. 1 ):
3. B u r to n , W . L e ig h . D e n t a l s u r g e r y as a p p l ie d in th e a r m ie s o f t h e l a t e c o n f e d e r a t e s ta te s . A . J .D .S . I, 3 r d s e r . : 180 A u g . 1867. 4. H o d g k in , W i l l i a m N . E d w a r d M a y n a r d , a p r o g e n i t o r o f th e a r m y a n d n a v y d e n t a l c o r p s . J . A . D . A . 2 8:1 969 D e c . 1 9 4 !. 5. L e tte r s r e c e iv e d a n d s e n t, C h im b o r a z o H o s p it a l, 1861-1865. C h a p t e r V I, v o l. 708, W a r D e p a r t m e n t C o l l e c t io n o f C o n f e d e r a t e R e c o rd s . T h e N a t io n a l A r c h iv e s . ( O r ig in a l le t t e r s . )
H O D G K IN . . . V O L U M E SO, J U N E 1955 • 649
P E T IT IO N
RECO M M END ATIO NS
R ic h m o n d , D e c . 29, 1863 T o the C ongress o f the C o n fe d e r a te States: W e, the u n d ersig n ed , D E N T A L S U R G E O N S residin g in th e C o n fe d e r a te States h u m b ly pray that w e m a y b e e x e m p te d fr o m m ilitary service in the arm ies o f th e C o n fe d e ra te States, fo r the fo llo w in g reason s: 1st. D e n ta l S u rgery b e in g a sp ecia lty o f the m ed ica l scien ce, D e n ta l S urgeons treat dis eases w h ic h are n o t usually in c lu d e d in the p ra ctice o f a gen eral p ra ctitio n e r o f M e d ic in e an d Surgery. D e n ta l S u rg ery em braces a w id e field o f P ath o lo g y . T h e diseases o f the teeth, the gum s, the m o u th a n d su rro u n d in g organs, an d fractu res o f the bo n e s o f the h e a d and fa ce are in c lu d e d in i t ; an d to ensure c o m p eten cy in a p ra ctitio n e r o f D e n ta l Surgery, m any years o f e x p e rie n ce are requ ired . 2n d. T h e p ro p o r tio n o f D e n ta l S urgeons to the p o p u la tio n is alrea d y v e ry sm all. It is estim ated that there are a b o u t five h u n d re d in the C o n fed erate States, an d o f this n u m b er ab ou t tw o h u n d red an d fifty are liable to con scrip tion . 3rd. W h ilst w e c o n sid e r ourselves e x em p t from m ilitary service u n d e r law s o f C ongress ex e m p tin g “ P hysicians,” u n d e r a fa ir con stru c tion o f it, in som e instan ces this righ t has been qu estion ed b y the m ilita ry a u th o ritie s; an d w e beg , th erefore, th at the sam e e x e m p tio n m ay b e ex te n d e d to us as S p e c ia l P ra ctitio n ers o f M e d ic in e a n d Surgery. 4th. W e believ e o u r services to be absolutely essential a n d necessary to the health an d c o m fort o f every c o m m u n ity ; an d w e th erefore pray, that all D e n ta l S u rg eon s, p ro v id e d they are in g o o d sta n d in g a n d h ave been fo r ten y ears in the actu al p ra ctic e o f D e n ta l Surgery, m ay b e ex e m p te d fr o m m ilita ry service.
W e , the u n d ersig n ed , are o f the o p in io n th at the p rofession a l services o f D E N T A L S U R G E O N S are ab solu tely essential and necessary to the h ea lth , c o m fo r t an d w ell b ein g o f ev ery c o m m u n ity , a n d think th ey sh ou ld b e e x em p te d fr o m m ilitary service un der the c o n d ition s p ra y ed fo r b y the w ith in p ra ctition ers. (S ig n e d ) W m . A . C a rrin g to n , M e d . D ir e cto r E. W . Jon es, S u rg eon , M e d . P urveyor C h . B ell G ib son , M .D ., P rof. Surgery, M e d . C o l. V a . Jam es H . C on w a y , P rof. O bstetrics, M e d . C o l. V a . L . S. Joyn es, M .D ., P rof. Inst. M e d . in M e d . C o l. V a . B. R . W e llfo r d , M .D ., P rof. M a t. M e d . in M e d . C o l. V a . J. B. M c C a w , M .D ., P rof. C h em . & P har. M e d . C o l. V a . D a v id H . T u c k e r , M .D ., P rof. T h e o . & P roc. M e d . C o l. V a . Jam es D u n n , S u rg eon , M e m b e r A rm y M e d ica l B oard St. G e o r g e P each y, S u rg eon , M e m b e r A rm y M e d ic a l B oard
(S ig n e d ) W . B. Pleasants W . L e ig h B urton Jos. W o o d w a r d Joh n M a h o n e y R . F in ley H u n t F. D a v ison G . W . Jones G eorg e B. Steel J. S. M ich a r d H . C larke J. H . W a y t J. E d w a rd C hase M . A . B lankm an A p proved : S. P. M o o r e , S u rg eon -G en era l Jas. F. H arrison , S u rgeon C .S .N . In ch a rg e o f office M e d ic in e an d Surgery, N a v y D e p ’ t.
F ig. 1 ' P etitio n o f th e d en ta l surgeon s o f ten years’ p ra c tice fo r e x e m p tio n fr o m m ilitary s er v ic e, D e c e m b e r 18 63
650 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
A.
E . P eticolas, S u rg e o n , M e m b e r A rm y M e d ic a l B o a rd H e n ry F. C a m p b e ll, S u rg e o n , M e m b e r A rm y M e d ic a l B oard T h o s . H . W illia m s, S u rg e o n , C .S .A . C hs. B rew er, S u rg e o n , P .A .C .S . W . B. S in clair, S u rg e o n , C .S . N a v y F. W . H a n c o ck , S u rg e o n , P .A .C .S . Jam es B eale, M .D . C . W . P. B ro ck , A ss’ t. S u rg e o n , P .A .C .S . Jas. B. R e a d , S u rg e o n , P .A .C .S . A lex . Y . P. G a rn e tt, M .D . J. G . C a b e ll, S u rg e on , P .A .C .S . P eter L y o n s, S u rg e o n , P .A .C .S . R o . W . H a x a ll, M .D . A . S n e a d , M .D . O . A . C ren sh a w , M .D . F. H . D e a n e , M .D . M . B u rto n , M .D . M . H o w a r d , S u rg e o n , P .A .C .S . J. P. L ittle , M .D . G e o . W . C a rrin g to n , A ss’ t. S urg., P .A .C .S . R . S. J. P eebles, S u rg e o n , P .A .C .S . R o . G . C a b e ll, M .D .'
All the dental signers of the afore mentioned petition may be placed defi nitely as in Richmond on this date save R. Finley Hunt, who was practicing in Washington at the outbreak of war. Since he served the Confederacy and was known to have worn his Confederate gray for the remainder of his days, it is pre sumed he had come on to Richmond. Blankman, French born practitioner of Fredericksburg, had joined the Rich mond group somewhat earlier. While the majority thus relied on peti tion for a favorable interpretation of the disputed conscript provisions, at least one dentist brought the matter before the courts for legal test and decision. J. W. Hunter of Forsyth County, N. C., insti tuted a test case in his claim for exemp tion as a physician under the act. Fol lowing trial before the Supreme Court of that state, Chief Justice Richmond M. Pearson rendered an opinion in his favor.7 Despite such eminent opinion, supported by rulings in the higher eche lons in Richmond, the Confederate Con gress finally inserted in the clause ex empting physicians the words—“the term physicians not to include dentists,”
and thus the much disputed question was settled. A S S IG N M E N T OF D E N TISTS
The first official assignment of a dentist was apparently that of W. Leigh Burton to the Richmond hospitals in March 1864. He reported the number of opera tions performed “exceeds all belief,” adding: In a d d itio n to treatm ent o f fractu res o f the bon es o f the fa ce , a d a y ’ s w ork con sisted o f fr o m tw en ty to thirty fillings, the p rep a ra tion o f the cavities in c lu d e d , the e x tra ction o f fifteen o r tw en ty teeth , an d the re m o v a l o f tartar ad lib itu m .3
Medical Director Carrington alerted the Richmond hospital heads of the available services in a directive of June 14, 1864, thus: Y o u are d ire cte d to have the p atien ts in the H o sp ita l u n d er y o u r ch a rg e w h o r eq u ire dental op era tion s c o lle cte d on o n e d a y in e a ch w eek an d in som e c o n v en ien t p la ce an d n o tify D r. B u rton corn er 8th an d F ranklin Streets so that he can atten d at th e tim e sp ecified an d p e r fo r m the necessary op era tion s.8
Surgeon-General Moore had moved with dispatch to make available the de tail of dentists for duty in the hospitals and, after a few months of experiment, he caused the following order to be is sued : 3 O ffice o f the M e d ic a l D ir e cto r C .S . H osp itals in V ir g in ia R ic h m o n d , V a ., N o v . 4 , 1864 C ircu la r N o . 15 I. A s fa r as p ra ctica b le in fu tu re, the op e ra tion s o f dentistry req u ired in G en eral H osp itals in V ir g in ia , w ill b e p e rfo rm e d by officers, soldiers o r con scrip ts assigned to those duties, w h o are dentists by p rofession .
6. C .S . A . M is c e lla n e o u s p a m p h le ts n o . I, 1861-66. L ib r a r y o f C o n g r e s s , r a r e b o o k c o lle c t io n . 7 . F le m in g , J . M a r t i n . H is t o r y o f th e N o r t h C a r o li n a d e n t a l s o c ie ty . R a le ig h , N . C . B y n u m P r in t in g C o ., 1939, p . 33. 8. L e tte r s s e n t a n d r e c e iv e d , M e d i c a l D ir e c t o r 's O f fic e , R ic h m o n d , V a ., 1864-65. C h a p t e r V I, v o l . 3 6 4 . W a r D e p a r t m e n t C o l le c t i o n o f C o n f e d e r a t e R e c o r d s . T h e N a t io n a l A r c h iv e s .
H O D G K IN
I I . E x a m in a tio n s w ill b e m a d e , at su ch tim e as m ay b e fix ed b y th e su rg eon in ch a rg e , o f ea ch o ffice r a n d so ld ie r a d m itte d in to h os p itals, a n d th e necessary o p e ra tio n p e rfo rm e d w ith the c o n c u r r e n c e o f the a tte n d in g M e d ic a l officer. I I I . D en tists are e x p e c te d to b e p ro v id e d w ith th eir o w n instrum ents, bu t the necessary m aterials a n d files w ill b e p u rch a se d w ith the hosp ita l fu n d s, an d requ isition s m a d e fo r o th e r instrum ents th o u g h t necessary. I V . D en tists w ill h a v e the rank, p a y an d perquisites w h ic h th eir p o sitio n in the arm y entitles th e m , a n d in a d d itio n , su ch e x tra d u ty p a y fo r e x tra o rd in a ry skill a n d industry, as the S u rg eo n -G e n e ra l w ill a llo w , in a c c o r d a n c e w ith G en era l O r d e r , N o . 6 6 , A .& I .G ., o ffice , cu rren t series. V . M o n th ly re p o rts o f D e n ta l op era tion s an d a c c o m p a n y in g registers in a c c o r d a n c e w ith form s fu rn ish ed , w ill b e fo r w a r d e d th rou g h the S u rg e o n in c h a rg e an d th ro u g h this office, to th e S u r g e o n -G e n e r a l b y the 5th o f the m on th su cce e d in g . (S ig n e d ) W illia m A . C a rrin g to n M e d ic a l D ir e c t o r o f G en . H osp ita ls in V ir g in ia
The wider assignment of dentists to hospitals in Virginia was unquestionably spurred by events in the deep Southern theater of war during June 1864. Had the motion picture “Gone with the Wind” depicted a handsome and stately young man of about 30 years of age going about the wounded, giving gratuituously of his facile skill to those suffering from wounds of the face and jaws, following the action about Atlanta, the scene would have been authentic. For E. N. Covey, a medical inspector of the Confederate Army, de scribes just such a role in the ministra tions of James Baxter Bean, then in civilian practice in Georgia.9 So im pressed was Covey by Bean’s accomplish ments with the interdental splint, espe cially in the face “of the frequency of this class of fractures in military surgery” and what he described as “the almost total want of success among surgeons, with the treatment usually adopted,”10 that he took the responsibility of direct ing that all the cases at Atlanta should be sent to one hospital for his treatment. Burton relates that over 100 cases were
V O L U M E 50, J U N E 1955 • 651
handled by Bean at Atlanta with invari able success.3 The validity of Covey’s plaint in the “want of success among surgeons in the treatment usually adopted” may be un derscored in Burton’s description of the usual surgical practice in handling jaw fractures; namely, the employment of a material made of pasteboard softened with vinegar and water, which was adapted in its pastelike state as an extra oral splint over the soft tissues of the face and, on hardening, formed a sort of pa pier-mache splint. The uncertain posi tioning of fractured bones, the fouling of the absorbent splint by mouth secretions and wound discharges, together with a lack of access to wounded regions, re sulted in a high percentage of failures. Covey’s reference to “one hospital in Atlanta” to which all jaw fractures were sent, remains indefinite. The identity of the hospital has eluded all effort. With the fall of Atlanta, the cases under treatment were removed to the Blind School Hospital at Macon, Ga., and a ward of that institution was opened to care for all jaw cases in the hospital department of the section. Identity of the Blind School Hospital (an institu tion converted into a hospital) is estab lished by Bean’s case reports, in which admissions to the Blind School Hospital are noted. Thus the Blind School Hos pital, though yielding in priority to the Atlanta institution, becomes the first identifiable hospital in military or dental history known to have had a ward de voted exclusively to maxillofacial sur gery (Fig. 2). Reports of Bean’s notable success, coupled with a high incidence of jaw wounds as troops fought increasingly from breastworks, impelled officials in Richmond to make the advanced mode
9 . C o v e y , E. N . T h e i n t e r d e n t a l s p l i n t . R ic h m o n d M . J . F e b . 1866, p . 8 1 -9 !. 10. S c h w a rtz , L . L a s z lo . D e v e lo p m e n t o f th e t r e a t m e n t o f ja w f r a c t u r e s . J . O r a l S u r g . 2:1 9 3 J u l y 1943.
652 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
F ig. 2 ' B lind S ch o o l H o sp ita l, M a c o n , Ga.
of treatment more widely available. Surgeon-General Moore ordered Bean to Richmond where he presented the tech nics of the interdental splint before the Army Medical Board of the Confederate States at the office of W. Leigh Burton. General adoption of the technic was recommended unanimously, and dentists on nearby duty were called in for in struction. Contemporary orders and correspond ence reflect the stepped-up interest. Wit ness the following: S .G .O . C ircu la r N o . 2 4 — F ebru ary 6, 1865 I. M e d ic a l D ire cto rs o f H osp itals w ill, w ith ou t d elay, select a th o ro u g h ly lig h ted w ard , (g a s-lig h te d , if p ra ctic a b le ) in som e o f the H osp itals u n d e r their ju r isd ic tio n , to w h ich w ill b e sent fo r treatm ent, by B ean’ s ap p a ra tus, all cases o f fra ctu re o f the su perior an d in ferio r m ax illary bon es, n o w in H osp ita l, o r that m ay h erea fter b e ad m itted . I I . In the co n stru ctio n , ad ju stm en t an d use o f this ap p aratu s, the a tte n d in g S u rg eon w ill be a id e d by th e D en tist assigned as su ch to the H o sp ita l selected. I I I . T h e W a r d selected b e in g re p o rte d to this O ffice , the in v e n to r w ill visit the H osp ita l to
c o n fe r w ith the au th orities on the p rep a ra tion , a d ju stm en t an d use o f the ap p aratu s.12 T o im p le m e n t these arrangem ents th e fo l lo w in g o r d e r w en t to B ean : C o n fe d e r a te States o f A m e rica S u rg eon G en era l’ s O ffice R ic h m o n d , V a ., F eb. 18, 1865 S ir: In p u rsu a n ce o f orders, y o u are in stru cted to h o ld y o u rse lf in readiness to be o r d e r e d to any h ospital, w h ere y ou r services m ay b e req u ired in the a p p lic a tio n an d ad ju stm en t o f y ou r a p p aratus fo r trea tin g fractu res o f the inf. and sup. m a x illa ry bones. V e r y resp ectfu lly , Y o u r O b t. Servant, S. P. M o o r e , S u rg .-G en era l, C .S .A .12 D r. Jam es B. B ean R ic h m o n d
Though Medical Director Carrington designated a ward in the Receiving and Wayside Hospital, at the corner of Frank lin and Nineteenth Streets, Richmond,11
11. B la n to n , W y n d h a m B. M e d i c in e in V ir g i n i a in th e n in e t e e n th C e n t u r y . R ic h m o n d , V a ., G a r r e t t & M a s s ie , 1933, p . 305. 12. L e tte r s , o r d e r s a n d c ir c u la r s s e n t, S u r g e o n G e n e r a l's O f f ic e , R ic h m o n d , V a . V o l. 741, c h a p t e r V I , W a r D e p a r t m e n t C o l l e c t i o n o f C o n f e d e r a t e R e c o rd s . T h e N a t io n a l A r c h iv e s .
H O D G K IN . . . V O L U M E 50, J U N E 1955 • 653
to which surgeons in charge at Richmond and Petersburg were directed to send cases “for treatment of fractures of the maxillary bones,”12 and likely some cases were cared for there, Burton recalls that Surgeon-General Moore later “ordered a ward to be prepared at the Robertson Hospital [at the corner of Third and Main Streets, Richmond] for the exclusive treatment of all cases in which it [inter dental splint] could be applied,”3 and it appears that the latter hospital saw greater use in the specialized service (Fig. 3 ).
Various assignments of dentists have been found in the Confederate hospitals of Virginia, and Burton attests that such assignments were made “to the*most im portant points throughout the Con federacy.”3
P A Y OF D E N TA L P E R S O N N E L
The pay of the dental personnel of the Confederacy is indicated in the advices of Medical Director Carrington to Surgeon-General Moore under date of January 30, 1865:12 In answ er to y ou r com m u n ica tion s o f Jan. 28 I re sp e ctfu lly in fo rm y o u that the D en tists o f the H osp itals in R ic h m o n d d o n ot mess or lo d g e at the H osp ita l. T h e y receiv e the p ay an d a llo w a n ce o f d eta iled m en w ith the extra du ty p a y y o u a llo w th em , a m ou n tin g in value to a b o u t $ 1 0 p e r d iem , v iz : E xtra du ty p a y at $ 4 p er d iem for 30 d a y s ........................................................ $ 1 2 0 .0 0 C o m m u ta tio n fo r r o o m ............................................. 4 0 .0 0 C o m p a n y p a y ................................................................. 18.00 M o n th ly rations v a lu e d at ....................... 125.00 C lo th in g 2 suits yearly w orth $ 15 per m o .................................................................. 15.00
Fig. 3 • R o b er ts o n H o sp ita l, R ich m o n d , V a.
$ 3 1 8 .0 0
654 • T H E J O U R N A L O F T H E A M E R IC A N D E N T A L A S S O C IA T IO N
The rank of dental personnel has been found almost without exception to have been that of Hospital Steward, with the insignia similar to that of a first sergeant, save that the chevrons on the coat sleeves and the stripes down the trousers were black— common to the medical personnel —as contrasted with the light blue of the infantry, the scarlet of the artillery and buff of the cavalry.13 Those dentists whose service in a pro fessional capacity has thus far been estab lished, and who may be said to have com prised the “Confederate Dental Corps” are here listed: Angle, Solomon, Danville E nlisted as p riv a te in C o m p a n y E , 2 3 rd R e g i m en t, V ir g in ia In fa n try , M a y 7, 1861. C o m p a n y m uster r o ll fo r Ju ly an d A u g u st 1862 show s h im absent. “ F o rm e rly h o sp ita l S tew ard R e g t. N o w details at H o w a rd G r o v e H osp ita l, R ic h m o n d .” O c c u p a tio n sh ow n as dentist.11
Bean, James Baxter,8 Georgia and Rich mond Bidgood, Richard Maurice,8 Farmville W . A . C a r r in g to n to S e n io r S u rg eon , L y n c h b u rg , S ep t. 6 , 18 64: E n c lo sin g orders u n d e r w h ic h “ H o sp . S tew ard B id g o o d , w ill b e re q u ire d to visit in ro ta tio n , at stated tim es, the H osp itals at L y n ch b u rg , V a . a n d p e r fo r m such op e ra tio n s o n the teeth a n d m o u th as are fo u n d necessary. . . . I n a d d itio n to p lu g g in g , cle a n in g a n d e x tra ctin g teeth the D en tists h a v e b e e n serv icea ble in a d ju stin g fractu res o f the ja w a n d o p e ra tin g o n the m o u th an d fa u ce s.”
Burton,. Watkins Leigh,8 Richmond P reviou s se rv ice : B u rton h a d b e e n n o m in a te d “ by th e G o v e r n o r to the A d v iso ry C o u n c il o f the S tate o f V ir g in ia as a C a p ta in o f V o lu n teers o n A p r il 30, 1861. A p p o in tm e n t m ad e a c c o r d in g ly .” 16
Chase, J. Edward,16 Richmond C o m p a n y A , 17th R e g im e n t, V ir g in ia I n fa n try. D e t a c h e d service as D iv isio n D entist.
Daughtrey, Marmaduke E., Portsmouth C o m p a n y A , 16th R e g im e n t V ir g in ia In fa n try, an d H o s p ita l S tew ard , 14th R e g im e n t. S ur ren d ere d a t A p p o m a tto x .1“
Doggett, Cyrus K., Fincastle E n listed as p riv a te M a y 1, 1861, at N orfolk . D e ta ile d b y S ecretary o f W a r as H osp ita l S tew ard , B attery B , 19th B atta lion o f A r til lery.”
Grant, Robert G., Abingdon E n listed A p ril 16 (y ea r n ot sh ow n ) as p rivate in C o m p a n y F , 13th B atta lion V ir g in ia R e serves, at A b in g d o n , V a . T h e c o m p a n y m uster ro ll fo r S ep tem b er an d O c to b e r 1864, last on file, show s h im absent w ith the re m a rk : “ D e tailed as stew ard fo r H osp ita l o f 13th B a ttn .” 11
Harris, J. W., Harrisonburg W . A . C a rrin g to n to S u rg eon D av is, H a rrison b u rg G e n era l H osp ita l, N o v e m b e r 3, 1 8 6 4 : “ P rivate J. W . H arris is d eta iled fo r d u ty at G en . Ho%pl. H a rrison b u rg , V a . an d assigned to d u ty as D en tist to that H o s p l.” 8
Thackston, Wm. W. H., Farmville E n listed A p ril 2 0 , 1864, as p riv a te o f C o m p a n y D , 3 rd R e g im e n t V ir g in ia R eserves. H is n a m e ap p ears o n a R eg ister o f G e n e ra l H o s p ita l, F arm v ille, V a ., w ith rem arks as fo llo w s : “ R ic h m o n d , V a ., M c h . 3, 1865. D e ta ile d fro m the R eserves as D en tist at H osp tl. F arm ville. W ill b e a llo w e d to reside at his resid en ce near B u rkeville, V a . a n d visit the H o sp l. o n c e w eek ly o r as o fte n as necessary. W m . A . C a r r in g to n , M e d . D ir .” 11
Wilkinson, W. S., Amelia County L iste d in rep ort o f J. G ravatt, Surg. in ch arge o f R e c e iv in g an d W ayside H osp ita l, R ic h m o n d , to Surg. W . A . C a rrin g ton , M e d ic a l D ir e cto r , o f m e d ica l officers in c lu d in g physicians em p lo y e d u n d e r c o n tra ct an d h osp ita l stewards f o r the m on th en d in g F eb . 15, 18 65. “ W . S. W ilk in son , H osp ita l S te w a id , date o f c o m m ission N o v e m b e r 4 , 1862. O n d u ty as d en tist.” 8
Williams, S. H., Alexandria
13. R o b e r ts , D e e r in g J . O r g a n iz a t io n a n d p e r s o n n e l o f th e m e d i c a l d e p a r t m e n t o f th e C o n f e d e r a c y . T h e P h o t o g r a p h ic H is t o r y o f th e C i v i l W a r , V o l. X . N e w Y o r k , R e v ie w o f R e v ie w s C o . , 1911, p . 350. 14. D e p a r t m e n t o f t h e A r m y , O f f ic e o f t h e A d j u t a n t G e n e r a l. 15. P r o c e e d in g s o f th e A d v is o r y C o u n c il o f t h e S ta te o f V i r g i n i a . W a r o f th e R e b e llio n , O f f i c i a l R e c o r d s o f th e U n io n a n d C o n f e d e r a t e A r m ie s . W a s h in g t o n , G . P . O . 1897. S e rie s I, V o l. L I, P a r t I I , p . 54-5 5. 16. C o n f e d e r a t e R e c o r d s , V o l. I I , p . I I I . a n d p . 21 5 . 17. S iz e R o lls W a r D e p t . C o n f e d e r a c y . 4 3 -5 .
BL A C K
Enlisted as private at Spottsylvania Court House in company organized as “ M t. Pleasant Riflemen” in 1861. Detailed M arch 11, 1865 — S.O . 5 8.1*
The above listing is limited to those with record of official professional serv ice. Excluded are unofficial dental services performed for compatriots as reported in family correspondence, au thentic notes of services at Camp Look
V O L U M E 50, J U N E 1955 • 655
out, Md., and other Union prisons where dentists cared for their fellow prisoners “to keep their hands in” ; and such in stances as J. Martin Fleming’s vivid de scription of E. Vines Turner—a captain on the staff of General W. H. T. Walker —operating in the field “with a forked branch as a head-rest.” 18.
C o n f e d e r a t e R e c o rd s , V o l. I l l , p. 39 6 .
Facts in refutation of claims by opponents of fluoridation
A. P. Black, Ph.D., Gainesville, Fla.
When the story of fluoridation is ex amined in retrospect, it becomes clear that its development as a recognized public health measure may be divided into three distinct periods. The first and longest was a period of study and obser vation which could be called the Period of Discovery,, for during that period the idea of fluoridation was born. It began in 1906 with the now classical studies of G. V. Black of the enamel lesions which were found on the teeth of most of the native population of Colorado Springs, Colo., and which in 1909 he called “mottled enamel.” It witnessed the pub lication in 1916 of a series of five papers by G. V. Black and Frederick S. McKay1 describing for the first time these lesions and indicating that some constituent of the water supply might be the causative agent. It witnessed the important studies carried out at Britton, S. Dak.;1 Oakley, Idaho,2 and Bauxite, Ark.3 The latter study led directly to the discovery by
Churchill in 19314 that the fluoride ion present in the water supply was the cause of the mottling. In the period 1933 to 1937,. Dean and Elvove5 reported that fluoride in concentration of 1 ppm or less had no public health significance. The period was brought to a close by the well-planned field surveys of Dean,
P re s e n te d b e f o r e S e c t io n o n P u b lic H e a lt h D e n t is tr y , n in e t y - f if t h a n n u a l s e s s io n , A m e r i c a n D e n t a l A s s o c ia t io n , M ia m i , F la . , N o v e m b e r 8 , 1954. H e a d , d e p a r t m e n t o f c h e m is tr y , U n iv e r s ity o f F lo r id a . 1. B la c k , G . V ., a n d M c K a y , F. S. M o t t l e d t e e t h : a n e n d e m ic d e v e lo p m e n t a l im p e r f e c t i o n in t h e e n a m e l o f t e e t h h e r e t o f o r e u n k n o w n in t h e l i t e r a t u r e o f d e n t is t r y . D . C o s m o s 58:1 2 9 F e b . ; 477 M a y ; 627 J u n e ; 781 J u ly ; 894 A u g . 1916. 2 . M c K a y , F . S . M o t t l e d e n a m e l: t h e p r e v e n t io n o f its f u r t h e r p r o d u c t io n t h r o u g h a c h a n g e o f t h e w a t e r s u p p ly a t O a k l e y , I d a . J . A . D . A . 2 0 :1 1 3 7 J u ly 1933. 3 . K e m p f, G . A . , a n d M c K a y , F . S . M o t t l e d e n a m e l in s e g r e g a te d p o p u la t i o n . P u b . H e a lt h R e p . 4 5:2 923 N o v . 28. 1930. 4 . C h u r c h ill, H . V . O c c u r r e n c e o f f lu o r i d e s in s o m e w a te r s o f t h e U n it e d S ta te s . J . In d . & E n g . C h e m . 2 3 :9 9 6 S e p t . 1931. 5 . D e a n , H . T ., a n d E lv o v e , E. S tu d ie s o n th e m in im a l t h r e s h o ld o f t h e d e n t a l s ig n o f c h r o n ic e n d e m ic f l u o r o sis ( m o t t l e d e n a m e l) . P u d . H e a lt h R e p . 5 0 :1 7 1 9 D e c . 6, 1935.
William N . Hodgkin, D.D.S., Warrenton, Va.
The advanced and wider utilization of the dentist in his professional capacity by the Confederate Army, as contrasted with the practice by the Union Army, in the War Between the States, has been noted by dental historians. Koch1 relates: D u r in g th e C iv il W a r an e ffo rt was m a d e to secure d en tal service in. th e U n io n A rm y , bu t the id e a w as n o t r e ce iv e d w ith fa v o r b y the W a r D e p a rtm e n t. A sim ilar e ffo rt was m ad e in th e C o n fe d e r a te A r m y a n d it su cce e d e d in so fa r that several dentists w e re reg u la rly c o m m issioned as m em bers o f the m e d ica l d e p a rt m en t an d assigned fo r d u ty at the larg er h os pitals. I n th e U n io n A r m y the o n ly dental service was that o f la n cin g “ g u m boils” an d the e x tra ction o f teeth.
Taylor2 has this brief note: I t was r e la te d that d u rin g the w ar betw een the N o r th an d the S o u th several dentists w ere ca rried in the arm y h ospitals o f the S ou th ern C o n fe d e r a c y .
The material in this restricted study is limited almost wholly to Virginia. The four year accumulation of the records of Surgeon-General Samuel P. Moore was destroyed in the burning of Richmond in April 1865. However, resource has been had to the correspondence of Surgeon William A. Carrington, Medical Director of Hospitals in Virginia, as preserved in the National Archives, and to other offi cial records. The findings are sufficient to confirm a fairly wide and importantly helpful service in the Confederate Army. 647
Indeed, the recognition at high levels of dental personnel, and their organiza tional status, would seem to warrant the dubbing of a fairly well defined “Con federate Dental Corps.” Among the factors which brought the Confederacy’s dental service to levels and usage theretofore unknown in military history may be cited the following: 1. The overwhelming demand by soldiers for dental service at intervals be tween action when army forces were stationed near cities having available dentists. 2. The inability of the private soldier to pay for his own dental care, especially in the later days of the Confederacy. The price demanded for gold foil in 1864 and 1865 was $64 an ounce in gold coin, or, in the depreciated currency of the Con federacy, about $3,840 an ounce. Pre vailing dental fees ran on the high scale of $120 for a gold filling, $20 for an ex traction, with other services in propor tion. For a single gold filling the Con federate soldier, drawing $18 a month, would have had to give six months’ pay. Lest dental fees be unwittingly criticized, let it be known that contemporary prices of other goods and services were at the
1. K o c h , C h a r le s R . E. H is t o r y o f d e n t a l s u r g e r y . F o r t W a y n e , I n d . , N a t io n a l A r t s P u b lis h in g C o . , 1910, V o l. I,
p. 138. 2 . T a y lo r , J . A . H is t o r y L e a & F e b ig e r , 1922, p . 208.
of
d e n t is t r y .
P h ila d e lp h ia ,
648 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
same scale; a coat could be had for $1,800, shoes for $300, cavalry boots for $1,000 and an ordinary felt hat for from $300 to $500. 3. The resourcefulness of SurgeonGeneral Samuel P. Moore in meeting the responsibilities for the total health care of the forces under the charge of the Medical Department. Moore’s warm ad vocacy and support of dental service is attested by the tribute of Burton:3 D en tists o f every la n d o w e a d ebt o f g ra titu d e to a m an w h o gav e o fficia l r e co g n itio n to the im p o rta n ce o f th eir p rofession , an d w h o e x ten d ed to those u n d e r h im every e n c o u ra g e m en t in the p ro s e cu tio n o f th eir ard u ou s d u ties; . . . they o w e m o re to S am u el Preston M o o r e , S u rg e o n -G e n e ra l o f the late C o n fe d erate States arm y, than to an y m an o f m o d e rn tim es.
4. The brilliant accomplishments of James Baxter Bean in caring for maxillo facial wounds in the battles about At lanta, which led to a heightened appre ciation of the scope of oral surgery. 5. The possible continuing interest and influence of President Jefferson Davis in the advantages of dental care of the military. As Secretary of War in the Pierce administration (1852-56), he had been approached by Edward Maynard of Washington, advocate of an army dental corps, and had “received the proposition as one of great value,”4 and lent it his support. It may be assumed that the stringencies of Confederate days lent force to his earlier persuasions. Of the slightly more than 100 dentists listed in the 1860 census as residing within the present boundaries of Vir ginia, 61 entered the service of the Con federacy. Most of these had official serv ice records from the early days of conflict, either in the ranks or as contract dentists. Whereas every record witnesses their patriotic response to the call of duty, there is likewise evidence that they were sensitive to all measures touching their professional status. Such controversies began with the rigid, though ambiguous,
conscription laws of the Confederate Congress, under the provisions of which dentists were conscripted. Whereas phy sicians of “seven years practice” were exempt from military service under this act, there was no specific mention of dentists. Naturally there arose the ques tion as to whether the Congress intended to include the latter as special practition ers. Despite the ruling of the War De partment through its representative, Judge Campbell, and the eminent legal opinion of General George W. Randolph as Secretary of War of the Confederate States that such exemption was intended, the conscription of dentists was con tinued by those in effective posts. However, there had been overtures looking to the employment of contract dentists previous to or concurrent with the conscription measures, as indicated by a letter of Medical Director W. A. Carrington to Surgeon James B. McCaw, head of Chimborazo Hospital, Richmond, dated March 20, 1863, inquiring McCaw’s: . . . o p in io n as to the a d visability o f a S u rgeon D en tist m a k in g visits to y ou r H o sp l. at stated tim es say 2 o r 3 w eek ly fo r su ch sim ple o p e ra tion o n the teeth (P r in c ip a lly ex tra ction s) as m ay be r e q u ired . T h e services o f a D en tist very skillful o n e x tra ction m ay be secu red on c o n tra ct.6
But the dental practitioner of the day was more concerned with conscription than with contract. In December 1863 there was presented in the Confederate Congress the following “Petition of Den tal Surgeons of Ten Years Practice for Exemption from Military Service” (Fig. 1 ):
3. B u r to n , W . L e ig h . D e n t a l s u r g e r y as a p p l ie d in th e a r m ie s o f t h e l a t e c o n f e d e r a t e s ta te s . A . J .D .S . I, 3 r d s e r . : 180 A u g . 1867. 4. H o d g k in , W i l l i a m N . E d w a r d M a y n a r d , a p r o g e n i t o r o f th e a r m y a n d n a v y d e n t a l c o r p s . J . A . D . A . 2 8:1 969 D e c . 1 9 4 !. 5. L e tte r s r e c e iv e d a n d s e n t, C h im b o r a z o H o s p it a l, 1861-1865. C h a p t e r V I, v o l. 708, W a r D e p a r t m e n t C o l l e c t io n o f C o n f e d e r a t e R e c o rd s . T h e N a t io n a l A r c h iv e s . ( O r ig in a l le t t e r s . )
H O D G K IN . . . V O L U M E SO, J U N E 1955 • 649
P E T IT IO N
RECO M M END ATIO NS
R ic h m o n d , D e c . 29, 1863 T o the C ongress o f the C o n fe d e r a te States: W e, the u n d ersig n ed , D E N T A L S U R G E O N S residin g in th e C o n fe d e r a te States h u m b ly pray that w e m a y b e e x e m p te d fr o m m ilitary service in the arm ies o f th e C o n fe d e ra te States, fo r the fo llo w in g reason s: 1st. D e n ta l S u rgery b e in g a sp ecia lty o f the m ed ica l scien ce, D e n ta l S urgeons treat dis eases w h ic h are n o t usually in c lu d e d in the p ra ctice o f a gen eral p ra ctitio n e r o f M e d ic in e an d Surgery. D e n ta l S u rg ery em braces a w id e field o f P ath o lo g y . T h e diseases o f the teeth, the gum s, the m o u th a n d su rro u n d in g organs, an d fractu res o f the bo n e s o f the h e a d and fa ce are in c lu d e d in i t ; an d to ensure c o m p eten cy in a p ra ctitio n e r o f D e n ta l Surgery, m any years o f e x p e rie n ce are requ ired . 2n d. T h e p ro p o r tio n o f D e n ta l S urgeons to the p o p u la tio n is alrea d y v e ry sm all. It is estim ated that there are a b o u t five h u n d re d in the C o n fed erate States, an d o f this n u m b er ab ou t tw o h u n d red an d fifty are liable to con scrip tion . 3rd. W h ilst w e c o n sid e r ourselves e x em p t from m ilitary service u n d e r law s o f C ongress ex e m p tin g “ P hysicians,” u n d e r a fa ir con stru c tion o f it, in som e instan ces this righ t has been qu estion ed b y the m ilita ry a u th o ritie s; an d w e beg , th erefore, th at the sam e e x e m p tio n m ay b e ex te n d e d to us as S p e c ia l P ra ctitio n ers o f M e d ic in e a n d Surgery. 4th. W e believ e o u r services to be absolutely essential a n d necessary to the health an d c o m fort o f every c o m m u n ity ; an d w e th erefore pray, that all D e n ta l S u rg eon s, p ro v id e d they are in g o o d sta n d in g a n d h ave been fo r ten y ears in the actu al p ra ctic e o f D e n ta l Surgery, m ay b e ex e m p te d fr o m m ilita ry service.
W e , the u n d ersig n ed , are o f the o p in io n th at the p rofession a l services o f D E N T A L S U R G E O N S are ab solu tely essential and necessary to the h ea lth , c o m fo r t an d w ell b ein g o f ev ery c o m m u n ity , a n d think th ey sh ou ld b e e x em p te d fr o m m ilitary service un der the c o n d ition s p ra y ed fo r b y the w ith in p ra ctition ers. (S ig n e d ) W m . A . C a rrin g to n , M e d . D ir e cto r E. W . Jon es, S u rg eon , M e d . P urveyor C h . B ell G ib son , M .D ., P rof. Surgery, M e d . C o l. V a . Jam es H . C on w a y , P rof. O bstetrics, M e d . C o l. V a . L . S. Joyn es, M .D ., P rof. Inst. M e d . in M e d . C o l. V a . B. R . W e llfo r d , M .D ., P rof. M a t. M e d . in M e d . C o l. V a . J. B. M c C a w , M .D ., P rof. C h em . & P har. M e d . C o l. V a . D a v id H . T u c k e r , M .D ., P rof. T h e o . & P roc. M e d . C o l. V a . Jam es D u n n , S u rg eon , M e m b e r A rm y M e d ica l B oard St. G e o r g e P each y, S u rg eon , M e m b e r A rm y M e d ic a l B oard
(S ig n e d ) W . B. Pleasants W . L e ig h B urton Jos. W o o d w a r d Joh n M a h o n e y R . F in ley H u n t F. D a v ison G . W . Jones G eorg e B. Steel J. S. M ich a r d H . C larke J. H . W a y t J. E d w a rd C hase M . A . B lankm an A p proved : S. P. M o o r e , S u rg eon -G en era l Jas. F. H arrison , S u rgeon C .S .N . In ch a rg e o f office M e d ic in e an d Surgery, N a v y D e p ’ t.
F ig. 1 ' P etitio n o f th e d en ta l surgeon s o f ten years’ p ra c tice fo r e x e m p tio n fr o m m ilitary s er v ic e, D e c e m b e r 18 63
650 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
A.
E . P eticolas, S u rg e o n , M e m b e r A rm y M e d ic a l B o a rd H e n ry F. C a m p b e ll, S u rg e o n , M e m b e r A rm y M e d ic a l B oard T h o s . H . W illia m s, S u rg e o n , C .S .A . C hs. B rew er, S u rg e o n , P .A .C .S . W . B. S in clair, S u rg e o n , C .S . N a v y F. W . H a n c o ck , S u rg e o n , P .A .C .S . Jam es B eale, M .D . C . W . P. B ro ck , A ss’ t. S u rg e o n , P .A .C .S . Jas. B. R e a d , S u rg e o n , P .A .C .S . A lex . Y . P. G a rn e tt, M .D . J. G . C a b e ll, S u rg e on , P .A .C .S . P eter L y o n s, S u rg e o n , P .A .C .S . R o . W . H a x a ll, M .D . A . S n e a d , M .D . O . A . C ren sh a w , M .D . F. H . D e a n e , M .D . M . B u rto n , M .D . M . H o w a r d , S u rg e o n , P .A .C .S . J. P. L ittle , M .D . G e o . W . C a rrin g to n , A ss’ t. S urg., P .A .C .S . R . S. J. P eebles, S u rg e o n , P .A .C .S . R o . G . C a b e ll, M .D .'
All the dental signers of the afore mentioned petition may be placed defi nitely as in Richmond on this date save R. Finley Hunt, who was practicing in Washington at the outbreak of war. Since he served the Confederacy and was known to have worn his Confederate gray for the remainder of his days, it is pre sumed he had come on to Richmond. Blankman, French born practitioner of Fredericksburg, had joined the Rich mond group somewhat earlier. While the majority thus relied on peti tion for a favorable interpretation of the disputed conscript provisions, at least one dentist brought the matter before the courts for legal test and decision. J. W. Hunter of Forsyth County, N. C., insti tuted a test case in his claim for exemp tion as a physician under the act. Fol lowing trial before the Supreme Court of that state, Chief Justice Richmond M. Pearson rendered an opinion in his favor.7 Despite such eminent opinion, supported by rulings in the higher eche lons in Richmond, the Confederate Con gress finally inserted in the clause ex empting physicians the words—“the term physicians not to include dentists,”
and thus the much disputed question was settled. A S S IG N M E N T OF D E N TISTS
The first official assignment of a dentist was apparently that of W. Leigh Burton to the Richmond hospitals in March 1864. He reported the number of opera tions performed “exceeds all belief,” adding: In a d d itio n to treatm ent o f fractu res o f the bon es o f the fa ce , a d a y ’ s w ork con sisted o f fr o m tw en ty to thirty fillings, the p rep a ra tion o f the cavities in c lu d e d , the e x tra ction o f fifteen o r tw en ty teeth , an d the re m o v a l o f tartar ad lib itu m .3
Medical Director Carrington alerted the Richmond hospital heads of the available services in a directive of June 14, 1864, thus: Y o u are d ire cte d to have the p atien ts in the H o sp ita l u n d er y o u r ch a rg e w h o r eq u ire dental op era tion s c o lle cte d on o n e d a y in e a ch w eek an d in som e c o n v en ien t p la ce an d n o tify D r. B u rton corn er 8th an d F ranklin Streets so that he can atten d at th e tim e sp ecified an d p e r fo r m the necessary op era tion s.8
Surgeon-General Moore had moved with dispatch to make available the de tail of dentists for duty in the hospitals and, after a few months of experiment, he caused the following order to be is sued : 3 O ffice o f the M e d ic a l D ir e cto r C .S . H osp itals in V ir g in ia R ic h m o n d , V a ., N o v . 4 , 1864 C ircu la r N o . 15 I. A s fa r as p ra ctica b le in fu tu re, the op e ra tion s o f dentistry req u ired in G en eral H osp itals in V ir g in ia , w ill b e p e rfo rm e d by officers, soldiers o r con scrip ts assigned to those duties, w h o are dentists by p rofession .
6. C .S . A . M is c e lla n e o u s p a m p h le ts n o . I, 1861-66. L ib r a r y o f C o n g r e s s , r a r e b o o k c o lle c t io n . 7 . F le m in g , J . M a r t i n . H is t o r y o f th e N o r t h C a r o li n a d e n t a l s o c ie ty . R a le ig h , N . C . B y n u m P r in t in g C o ., 1939, p . 33. 8. L e tte r s s e n t a n d r e c e iv e d , M e d i c a l D ir e c t o r 's O f fic e , R ic h m o n d , V a ., 1864-65. C h a p t e r V I, v o l . 3 6 4 . W a r D e p a r t m e n t C o l le c t i o n o f C o n f e d e r a t e R e c o r d s . T h e N a t io n a l A r c h iv e s .
H O D G K IN
I I . E x a m in a tio n s w ill b e m a d e , at su ch tim e as m ay b e fix ed b y th e su rg eon in ch a rg e , o f ea ch o ffice r a n d so ld ie r a d m itte d in to h os p itals, a n d th e necessary o p e ra tio n p e rfo rm e d w ith the c o n c u r r e n c e o f the a tte n d in g M e d ic a l officer. I I I . D en tists are e x p e c te d to b e p ro v id e d w ith th eir o w n instrum ents, bu t the necessary m aterials a n d files w ill b e p u rch a se d w ith the hosp ita l fu n d s, an d requ isition s m a d e fo r o th e r instrum ents th o u g h t necessary. I V . D en tists w ill h a v e the rank, p a y an d perquisites w h ic h th eir p o sitio n in the arm y entitles th e m , a n d in a d d itio n , su ch e x tra d u ty p a y fo r e x tra o rd in a ry skill a n d industry, as the S u rg eo n -G e n e ra l w ill a llo w , in a c c o r d a n c e w ith G en era l O r d e r , N o . 6 6 , A .& I .G ., o ffice , cu rren t series. V . M o n th ly re p o rts o f D e n ta l op era tion s an d a c c o m p a n y in g registers in a c c o r d a n c e w ith form s fu rn ish ed , w ill b e fo r w a r d e d th rou g h the S u rg e o n in c h a rg e an d th ro u g h this office, to th e S u r g e o n -G e n e r a l b y the 5th o f the m on th su cce e d in g . (S ig n e d ) W illia m A . C a rrin g to n M e d ic a l D ir e c t o r o f G en . H osp ita ls in V ir g in ia
The wider assignment of dentists to hospitals in Virginia was unquestionably spurred by events in the deep Southern theater of war during June 1864. Had the motion picture “Gone with the Wind” depicted a handsome and stately young man of about 30 years of age going about the wounded, giving gratuituously of his facile skill to those suffering from wounds of the face and jaws, following the action about Atlanta, the scene would have been authentic. For E. N. Covey, a medical inspector of the Confederate Army, de scribes just such a role in the ministra tions of James Baxter Bean, then in civilian practice in Georgia.9 So im pressed was Covey by Bean’s accomplish ments with the interdental splint, espe cially in the face “of the frequency of this class of fractures in military surgery” and what he described as “the almost total want of success among surgeons, with the treatment usually adopted,”10 that he took the responsibility of direct ing that all the cases at Atlanta should be sent to one hospital for his treatment. Burton relates that over 100 cases were
V O L U M E 50, J U N E 1955 • 651
handled by Bean at Atlanta with invari able success.3 The validity of Covey’s plaint in the “want of success among surgeons in the treatment usually adopted” may be un derscored in Burton’s description of the usual surgical practice in handling jaw fractures; namely, the employment of a material made of pasteboard softened with vinegar and water, which was adapted in its pastelike state as an extra oral splint over the soft tissues of the face and, on hardening, formed a sort of pa pier-mache splint. The uncertain posi tioning of fractured bones, the fouling of the absorbent splint by mouth secretions and wound discharges, together with a lack of access to wounded regions, re sulted in a high percentage of failures. Covey’s reference to “one hospital in Atlanta” to which all jaw fractures were sent, remains indefinite. The identity of the hospital has eluded all effort. With the fall of Atlanta, the cases under treatment were removed to the Blind School Hospital at Macon, Ga., and a ward of that institution was opened to care for all jaw cases in the hospital department of the section. Identity of the Blind School Hospital (an institu tion converted into a hospital) is estab lished by Bean’s case reports, in which admissions to the Blind School Hospital are noted. Thus the Blind School Hos pital, though yielding in priority to the Atlanta institution, becomes the first identifiable hospital in military or dental history known to have had a ward de voted exclusively to maxillofacial sur gery (Fig. 2). Reports of Bean’s notable success, coupled with a high incidence of jaw wounds as troops fought increasingly from breastworks, impelled officials in Richmond to make the advanced mode
9 . C o v e y , E. N . T h e i n t e r d e n t a l s p l i n t . R ic h m o n d M . J . F e b . 1866, p . 8 1 -9 !. 10. S c h w a rtz , L . L a s z lo . D e v e lo p m e n t o f th e t r e a t m e n t o f ja w f r a c t u r e s . J . O r a l S u r g . 2:1 9 3 J u l y 1943.
652 • T H E JO U R N A L O F T H E A M E R IC A N DEN TA L A S S O C IA T IO N
F ig. 2 ' B lind S ch o o l H o sp ita l, M a c o n , Ga.
of treatment more widely available. Surgeon-General Moore ordered Bean to Richmond where he presented the tech nics of the interdental splint before the Army Medical Board of the Confederate States at the office of W. Leigh Burton. General adoption of the technic was recommended unanimously, and dentists on nearby duty were called in for in struction. Contemporary orders and correspond ence reflect the stepped-up interest. Wit ness the following: S .G .O . C ircu la r N o . 2 4 — F ebru ary 6, 1865 I. M e d ic a l D ire cto rs o f H osp itals w ill, w ith ou t d elay, select a th o ro u g h ly lig h ted w ard , (g a s-lig h te d , if p ra ctic a b le ) in som e o f the H osp itals u n d e r their ju r isd ic tio n , to w h ich w ill b e sent fo r treatm ent, by B ean’ s ap p a ra tus, all cases o f fra ctu re o f the su perior an d in ferio r m ax illary bon es, n o w in H osp ita l, o r that m ay h erea fter b e ad m itted . I I . In the co n stru ctio n , ad ju stm en t an d use o f this ap p aratu s, the a tte n d in g S u rg eon w ill be a id e d by th e D en tist assigned as su ch to the H o sp ita l selected. I I I . T h e W a r d selected b e in g re p o rte d to this O ffice , the in v e n to r w ill visit the H osp ita l to
c o n fe r w ith the au th orities on the p rep a ra tion , a d ju stm en t an d use o f the ap p aratu s.12 T o im p le m e n t these arrangem ents th e fo l lo w in g o r d e r w en t to B ean : C o n fe d e r a te States o f A m e rica S u rg eon G en era l’ s O ffice R ic h m o n d , V a ., F eb. 18, 1865 S ir: In p u rsu a n ce o f orders, y o u are in stru cted to h o ld y o u rse lf in readiness to be o r d e r e d to any h ospital, w h ere y ou r services m ay b e req u ired in the a p p lic a tio n an d ad ju stm en t o f y ou r a p p aratus fo r trea tin g fractu res o f the inf. and sup. m a x illa ry bones. V e r y resp ectfu lly , Y o u r O b t. Servant, S. P. M o o r e , S u rg .-G en era l, C .S .A .12 D r. Jam es B. B ean R ic h m o n d
Though Medical Director Carrington designated a ward in the Receiving and Wayside Hospital, at the corner of Frank lin and Nineteenth Streets, Richmond,11
11. B la n to n , W y n d h a m B. M e d i c in e in V ir g i n i a in th e n in e t e e n th C e n t u r y . R ic h m o n d , V a ., G a r r e t t & M a s s ie , 1933, p . 305. 12. L e tte r s , o r d e r s a n d c ir c u la r s s e n t, S u r g e o n G e n e r a l's O f f ic e , R ic h m o n d , V a . V o l. 741, c h a p t e r V I , W a r D e p a r t m e n t C o l l e c t i o n o f C o n f e d e r a t e R e c o rd s . T h e N a t io n a l A r c h iv e s .
H O D G K IN . . . V O L U M E 50, J U N E 1955 • 653
to which surgeons in charge at Richmond and Petersburg were directed to send cases “for treatment of fractures of the maxillary bones,”12 and likely some cases were cared for there, Burton recalls that Surgeon-General Moore later “ordered a ward to be prepared at the Robertson Hospital [at the corner of Third and Main Streets, Richmond] for the exclusive treatment of all cases in which it [inter dental splint] could be applied,”3 and it appears that the latter hospital saw greater use in the specialized service (Fig. 3 ).
Various assignments of dentists have been found in the Confederate hospitals of Virginia, and Burton attests that such assignments were made “to the*most im portant points throughout the Con federacy.”3
P A Y OF D E N TA L P E R S O N N E L
The pay of the dental personnel of the Confederacy is indicated in the advices of Medical Director Carrington to Surgeon-General Moore under date of January 30, 1865:12 In answ er to y ou r com m u n ica tion s o f Jan. 28 I re sp e ctfu lly in fo rm y o u that the D en tists o f the H osp itals in R ic h m o n d d o n ot mess or lo d g e at the H osp ita l. T h e y receiv e the p ay an d a llo w a n ce o f d eta iled m en w ith the extra du ty p a y y o u a llo w th em , a m ou n tin g in value to a b o u t $ 1 0 p e r d iem , v iz : E xtra du ty p a y at $ 4 p er d iem for 30 d a y s ........................................................ $ 1 2 0 .0 0 C o m m u ta tio n fo r r o o m ............................................. 4 0 .0 0 C o m p a n y p a y ................................................................. 18.00 M o n th ly rations v a lu e d at ....................... 125.00 C lo th in g 2 suits yearly w orth $ 15 per m o .................................................................. 15.00
Fig. 3 • R o b er ts o n H o sp ita l, R ich m o n d , V a.
$ 3 1 8 .0 0
654 • T H E J O U R N A L O F T H E A M E R IC A N D E N T A L A S S O C IA T IO N
The rank of dental personnel has been found almost without exception to have been that of Hospital Steward, with the insignia similar to that of a first sergeant, save that the chevrons on the coat sleeves and the stripes down the trousers were black— common to the medical personnel —as contrasted with the light blue of the infantry, the scarlet of the artillery and buff of the cavalry.13 Those dentists whose service in a pro fessional capacity has thus far been estab lished, and who may be said to have com prised the “Confederate Dental Corps” are here listed: Angle, Solomon, Danville E nlisted as p riv a te in C o m p a n y E , 2 3 rd R e g i m en t, V ir g in ia In fa n try , M a y 7, 1861. C o m p a n y m uster r o ll fo r Ju ly an d A u g u st 1862 show s h im absent. “ F o rm e rly h o sp ita l S tew ard R e g t. N o w details at H o w a rd G r o v e H osp ita l, R ic h m o n d .” O c c u p a tio n sh ow n as dentist.11
Bean, James Baxter,8 Georgia and Rich mond Bidgood, Richard Maurice,8 Farmville W . A . C a r r in g to n to S e n io r S u rg eon , L y n c h b u rg , S ep t. 6 , 18 64: E n c lo sin g orders u n d e r w h ic h “ H o sp . S tew ard B id g o o d , w ill b e re q u ire d to visit in ro ta tio n , at stated tim es, the H osp itals at L y n ch b u rg , V a . a n d p e r fo r m such op e ra tio n s o n the teeth a n d m o u th as are fo u n d necessary. . . . I n a d d itio n to p lu g g in g , cle a n in g a n d e x tra ctin g teeth the D en tists h a v e b e e n serv icea ble in a d ju stin g fractu res o f the ja w a n d o p e ra tin g o n the m o u th an d fa u ce s.”
Burton,. Watkins Leigh,8 Richmond P reviou s se rv ice : B u rton h a d b e e n n o m in a te d “ by th e G o v e r n o r to the A d v iso ry C o u n c il o f the S tate o f V ir g in ia as a C a p ta in o f V o lu n teers o n A p r il 30, 1861. A p p o in tm e n t m ad e a c c o r d in g ly .” 16
Chase, J. Edward,16 Richmond C o m p a n y A , 17th R e g im e n t, V ir g in ia I n fa n try. D e t a c h e d service as D iv isio n D entist.
Daughtrey, Marmaduke E., Portsmouth C o m p a n y A , 16th R e g im e n t V ir g in ia In fa n try, an d H o s p ita l S tew ard , 14th R e g im e n t. S ur ren d ere d a t A p p o m a tto x .1“
Doggett, Cyrus K., Fincastle E n listed as p riv a te M a y 1, 1861, at N orfolk . D e ta ile d b y S ecretary o f W a r as H osp ita l S tew ard , B attery B , 19th B atta lion o f A r til lery.”
Grant, Robert G., Abingdon E n listed A p ril 16 (y ea r n ot sh ow n ) as p rivate in C o m p a n y F , 13th B atta lion V ir g in ia R e serves, at A b in g d o n , V a . T h e c o m p a n y m uster ro ll fo r S ep tem b er an d O c to b e r 1864, last on file, show s h im absent w ith the re m a rk : “ D e tailed as stew ard fo r H osp ita l o f 13th B a ttn .” 11
Harris, J. W., Harrisonburg W . A . C a rrin g to n to S u rg eon D av is, H a rrison b u rg G e n era l H osp ita l, N o v e m b e r 3, 1 8 6 4 : “ P rivate J. W . H arris is d eta iled fo r d u ty at G en . Ho%pl. H a rrison b u rg , V a . an d assigned to d u ty as D en tist to that H o s p l.” 8
Thackston, Wm. W. H., Farmville E n listed A p ril 2 0 , 1864, as p riv a te o f C o m p a n y D , 3 rd R e g im e n t V ir g in ia R eserves. H is n a m e ap p ears o n a R eg ister o f G e n e ra l H o s p ita l, F arm v ille, V a ., w ith rem arks as fo llo w s : “ R ic h m o n d , V a ., M c h . 3, 1865. D e ta ile d fro m the R eserves as D en tist at H osp tl. F arm ville. W ill b e a llo w e d to reside at his resid en ce near B u rkeville, V a . a n d visit the H o sp l. o n c e w eek ly o r as o fte n as necessary. W m . A . C a r r in g to n , M e d . D ir .” 11
Wilkinson, W. S., Amelia County L iste d in rep ort o f J. G ravatt, Surg. in ch arge o f R e c e iv in g an d W ayside H osp ita l, R ic h m o n d , to Surg. W . A . C a rrin g ton , M e d ic a l D ir e cto r , o f m e d ica l officers in c lu d in g physicians em p lo y e d u n d e r c o n tra ct an d h osp ita l stewards f o r the m on th en d in g F eb . 15, 18 65. “ W . S. W ilk in son , H osp ita l S te w a id , date o f c o m m ission N o v e m b e r 4 , 1862. O n d u ty as d en tist.” 8
Williams, S. H., Alexandria
13. R o b e r ts , D e e r in g J . O r g a n iz a t io n a n d p e r s o n n e l o f th e m e d i c a l d e p a r t m e n t o f th e C o n f e d e r a c y . T h e P h o t o g r a p h ic H is t o r y o f th e C i v i l W a r , V o l. X . N e w Y o r k , R e v ie w o f R e v ie w s C o . , 1911, p . 350. 14. D e p a r t m e n t o f t h e A r m y , O f f ic e o f t h e A d j u t a n t G e n e r a l. 15. P r o c e e d in g s o f th e A d v is o r y C o u n c il o f t h e S ta te o f V i r g i n i a . W a r o f th e R e b e llio n , O f f i c i a l R e c o r d s o f th e U n io n a n d C o n f e d e r a t e A r m ie s . W a s h in g t o n , G . P . O . 1897. S e rie s I, V o l. L I, P a r t I I , p . 54-5 5. 16. C o n f e d e r a t e R e c o r d s , V o l. I I , p . I I I . a n d p . 21 5 . 17. S iz e R o lls W a r D e p t . C o n f e d e r a c y . 4 3 -5 .
BL A C K
Enlisted as private at Spottsylvania Court House in company organized as “ M t. Pleasant Riflemen” in 1861. Detailed M arch 11, 1865 — S.O . 5 8.1*
The above listing is limited to those with record of official professional serv ice. Excluded are unofficial dental services performed for compatriots as reported in family correspondence, au thentic notes of services at Camp Look
V O L U M E 50, J U N E 1955 • 655
out, Md., and other Union prisons where dentists cared for their fellow prisoners “to keep their hands in” ; and such in stances as J. Martin Fleming’s vivid de scription of E. Vines Turner—a captain on the staff of General W. H. T. Walker —operating in the field “with a forked branch as a head-rest.” 18.
C o n f e d e r a t e R e c o rd s , V o l. I l l , p. 39 6 .
Facts in refutation of claims by opponents of fluoridation
A. P. Black, Ph.D., Gainesville, Fla.
When the story of fluoridation is ex amined in retrospect, it becomes clear that its development as a recognized public health measure may be divided into three distinct periods. The first and longest was a period of study and obser vation which could be called the Period of Discovery,, for during that period the idea of fluoridation was born. It began in 1906 with the now classical studies of G. V. Black of the enamel lesions which were found on the teeth of most of the native population of Colorado Springs, Colo., and which in 1909 he called “mottled enamel.” It witnessed the pub lication in 1916 of a series of five papers by G. V. Black and Frederick S. McKay1 describing for the first time these lesions and indicating that some constituent of the water supply might be the causative agent. It witnessed the important studies carried out at Britton, S. Dak.;1 Oakley, Idaho,2 and Bauxite, Ark.3 The latter study led directly to the discovery by
Churchill in 19314 that the fluoride ion present in the water supply was the cause of the mottling. In the period 1933 to 1937,. Dean and Elvove5 reported that fluoride in concentration of 1 ppm or less had no public health significance. The period was brought to a close by the well-planned field surveys of Dean,
P re s e n te d b e f o r e S e c t io n o n P u b lic H e a lt h D e n t is tr y , n in e t y - f if t h a n n u a l s e s s io n , A m e r i c a n D e n t a l A s s o c ia t io n , M ia m i , F la . , N o v e m b e r 8 , 1954. H e a d , d e p a r t m e n t o f c h e m is tr y , U n iv e r s ity o f F lo r id a . 1. B la c k , G . V ., a n d M c K a y , F. S. M o t t l e d t e e t h : a n e n d e m ic d e v e lo p m e n t a l im p e r f e c t i o n in t h e e n a m e l o f t e e t h h e r e t o f o r e u n k n o w n in t h e l i t e r a t u r e o f d e n t is t r y . D . C o s m o s 58:1 2 9 F e b . ; 477 M a y ; 627 J u n e ; 781 J u ly ; 894 A u g . 1916. 2 . M c K a y , F . S . M o t t l e d e n a m e l: t h e p r e v e n t io n o f its f u r t h e r p r o d u c t io n t h r o u g h a c h a n g e o f t h e w a t e r s u p p ly a t O a k l e y , I d a . J . A . D . A . 2 0 :1 1 3 7 J u ly 1933. 3 . K e m p f, G . A . , a n d M c K a y , F . S . M o t t l e d e n a m e l in s e g r e g a te d p o p u la t i o n . P u b . H e a lt h R e p . 4 5:2 923 N o v . 28. 1930. 4 . C h u r c h ill, H . V . O c c u r r e n c e o f f lu o r i d e s in s o m e w a te r s o f t h e U n it e d S ta te s . J . In d . & E n g . C h e m . 2 3 :9 9 6 S e p t . 1931. 5 . D e a n , H . T ., a n d E lv o v e , E. S tu d ie s o n th e m in im a l t h r e s h o ld o f t h e d e n t a l s ig n o f c h r o n ic e n d e m ic f l u o r o sis ( m o t t l e d e n a m e l) . P u d . H e a lt h R e p . 5 0 :1 7 1 9 D e c . 6, 1935.