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The General Plan of the Proposed Work at the Eastman Dispensary
TH E GENERAL PLAN O F TH E PROPOSED W O R K A T THE E A STM A N DISPENSARY. B y H a rv ey J. B urkhart, D . D . S., R ochester, N. Y.
(Head before the National Dental Association at Its Twentieth Annual Session, Louisville, Ky.,
July 25-28, 1916.)
D
EN TAL Clinics and Dental Dispen saries, except those connected with colleges, are o f recent origin. School Clinics have been conducted in several cities, but all m ore or less under varying conditions. It has not been pos sible thus far to bring about a stand ardization of methods or equipment, as is the case with dispensaries connected with m edical1 schools and hospitals. Ev ery dispensary has had to blaze its own trail subject to the various local condi tions. There are a num ber of clinics scattered about the country that have been and are doing good and satisfactory work, but many of them are handicapped by lack of equipment and funds. The Forsyth Dental Dispensary o f Boston and the R ochester Dental Dispen sary are fortunate in having at their dis posal ample means to carry on the work o f educating the public to a proper reali zation of the need fo r dental treatment, and to be able to render such service as may be required. The business o f playing the role of prophet is an uncertain one. It is not m y intention to prom ise definite results along any particular line, but to tell you som ething of our hopes and aspirations and with the perm ission of this associa tion, I shall be glad to appear before you annually and give an account of the progress of the work. You w ill be interested to know that a com plete survey o f the mouths o f the children o f R och ester w ill be made dur 582
ing the com ing autumn, under my direc tion, and with the assistance of the mem bers o f the R ochester Dental Society, w e propose to make as real a survey as possible for the purpose of recording for clinical and other observations the exact conditions present in 1916. A survey w ill be made every year so that com par isons may be made betw een the condi tions now and in subsequent years for the purpose o f ascertaining the value of the services rendered. The magnitude o f the undertaking is appalling, with 35,000 children in the public sch ools and 15,000 in the paro chial schools and institutions, but this work must be done in order that accu rate and reliable data may be at hand with w hich to prove to people of means and m unicipal authorities, the need for this work. This institution was founded and en dow ed by Mr. George Eastman for the sole purpose of devising ways and means to dem onstrate the value o f preventive dentistry. A t no time w ill this be tost sight of, and while various activities w ill be carried on, it is the intention that all will w ork in harmony with that basic and fundamental object in view. I shall not take your time to describe the execu tive department o f the institution, except to tell you that there are thirteen public spirited citizens in Rochester, not includ ing Mr. Eastman, who are the directors o f the Rochester Dental Dispensary and who w ere sufficiently interested to pledge
B U RK H ART.— PROPOSED W O R K AT EA STM AN DISPENSARY. $1000 a year each fo r six years to carry on the work. Y ou w ill also be interested to know that the municipality o f R och es ter agreed to appropriate $20,000 a- year fo r five years fo r the cleaning of the teeth of the children in the public schools.
B U IL D IN G A R R A N G E M E N T . The interior arrangem ent of the build ing, While necessarily follow in g in som e particulars th e Forsyth Dental Infirm ary of Boston and dental college and hospital infirmaries generally, w ill have m any and new and unique features, and so fa r as Mr. Eastman and the man agem ent can make it, w ill em ploy and em body the very latest thought and ap pliances to m ake this the m ost efficient institution of its kind in the world. You may be interested in a brief d e scription o f the arrangem ent of the building. The heating plant w ill be housed in a sm all building at the rear. The basem ent w ill contain the necessary locker, rest room s and showers for the permanent staff o f operators on the east side, and w om en on the w est side, lunch room and kitchen, supply and janitor’s room s. On the main floor will be found the children’s waiting, examination and cloak room , trustees’ directors and exec utive clerk s’ room s and officers’ research laboratory, museum and library and a large lecture room. One side of the mezzanine floor w ill be used fo r X -Ray and photographic work, and the other fo r a hospital for babies or very young children requiring oral sur gical attention. On the top floor in the center w ill be located the general dental operating room, on the w est side the extracting and orthodontia departments, and on the east side the surgical preparation, ope rating and recov ery rooms, and every thing necessary to make this an efficient and com plete children’s hospital fo r the w ork contemplated.
DEN TAL
O P E R A T IN G
583
IN F IR M A R Y .
The fam ily o f the late Frank Ritter, will, as a m em orial to him contribute an equipment for the dental infirmary, which w ill be placed especially for this institution. W ith the assistance of trained expert engineers from the Ritter Dental Company, units w ill be devised which w ill represent the latest type oif dental appliances. Operators w ill have com plete outfits of instruments, and the necessary accesso ries, including an individual sterilizer at each chair. T h ey w ill be held strictly responsible for its proper care. Their w ork w ill be carefully supervised, so that patients and the public m ay be as sured that the operations perform ed in the infirmary w ill be w ell and properly done. The training w hich recen t gradu ates from college may obtain will be of much value to them selves and the public when they enter private practice. The work in the dental infirmary w ill consist o f filling teeth and roots with plastic fillings, the rem oval of tartar and cleaning of the teeth; the making of splints for fractured jaw s and appliances for regulating teeth, and such other work as would be perform ed in any properly equipped dental office. Operations will be done by a carefully trained staff of paid assistants who w ill have the bene fit o f the advice and assistance of a visiting staff and prominent local dental and other specialists, who w ill donate their services fo r this purpose. An im portant part of the w ork to be done in the infirmary, w ill be the atten tion which is proposed to be given to root canal work. A special department w ill be organized fo r this work, and an opportunity given to test the value o f the various m ethods of root canal treatment. The hope is indulged that with the clini cal opportunities and advantages pre sented for study and observation, that many perplexing questions may be solved. In the w ork o f organizing the staff of the D ispensary I am confronted with a
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problem w hich is o f vital im portance to all institutions o f this kind. I refer to the matter o f obtaining operators for the Infirmary who appreciate the value and responsibility o f the position. There appears to be am ong young m en with whom I have conversed an utter lack of the proper professional spirit w hich ■should be a part of the make up o f re cent graduates in order to flt them to carry on their w ork to the best advant age to them selves and their patients. I regret to say that the first question usually asked by a prospective opera tor is “ how much m oney is there in it.” It appears w ith few exceptions, that the money consideration is first and fore m ost in their minds. The great value to them selves o f a post graduate course and the opportunity for study, are lost sight o f in the mad rush to accum ulate a com petence im mediately. It is a w ell known fact that with the lim ited time at the disposal of colleges operating under ¡a three ye^r course there is not the opportunity or tim e for teaching of the practical branches as they should be taught, anti with few ex ception's graduates might profitably spend a year or m ore in post graduate work. I h ave not arrived at the conclu s ion hastily, but after mature considera tion and observation, extending over a considerable period of years, we hear much about considering ourselves on equality w ith m edical men, but until our young men becom e sufficiently inter ested in their w ork to be w illing to car ry on their studies after graduation, the less said about that the better will it be fo r the dental profession. The responsibility for this state of affairs belongs in no small degree to the teachers in our dental schools, and they should lose no opportunity to impress upon the minds of the students the n ec essity fo r m ore practical experience after graduation. Colleges cannot be expected to guarantee that every graduate shall be a finished operator, but they can do much m ore than they have done to awaken
their students and endeavor to im press upon their minds the advantages to themselves, and their patients, o f the sat isfaction to be gained by the rendering o f real and true service, without regard always to financial consideration.
X -R A Y D E P A R T M E N T . An X-ray department with proper photographic equipment in charge of a com petent operator, w ill be one of the useful and attractive features of the institution. It w ill be placed at the disposal o f those in general practice and the cost of m aking photographs greatly reduced. This w ill mean much, not only to operators but patients who w ill be the ch ief beneficiaries, by having a place where the w ork may be done at a m oder ate cost. The research laboratory w ill be an im portant part of the institution. Opportunity will be given to m em bers o f the dental profession and others to carry on their studies in conjunction with the regular staff of the dispensary. The research de partment w ill be conducted along ration al and practical lines. It w ill not be used to exploit theories and fads, but an en deavor made to learn the truth and ap ply the discoveries in a practical man ner. The museum and library w ill be placed at the disposal o f the dental pro fession, and provide a place fo r study and reference work.
LECTURE
ROOM.
The lecture room w ill fill a long felt want fo r the dental profession in R och ester. Lectures w ill be delivered here to children, parents and the public, on mat ters relating to the care o f the teeth, oral hygiene and prophylaxis, by expert dental practitioners and teachers, who are com petent to entertain and instruct. The local dental societies w ill make it their m eeting place, and by that close community of interests w hich it is hoped to establish, much benefit w ill be derived by the public and the profession.
B U R K H A R T.— PROPOSED W O RK A T EA STM A N DISPENSARY.
N E E D FO R D E N T A L H Y G IE N IS T S . It is n ot possible at this tim e to pre dict the fa r reaching effect, im portance and value w hich w ill result from the em ploym ent o f dental hygienists, hut I have no hesitation in giving it as my personal opinion that their proper employm ent w ill.b e so satisfactory and beneficial that there w ill be a universal demand for their services. Dental H ygienists w ill give particular attention to oral hygiene and prophylaxis, and it w ill be the most im portant part o f their work. The need for properly educated dental hygienists is very great. W hile their em ploym ent in dental offices is desired by many, the services w hich they can ren der in public institutions, and particu larly the sch ools, will be o f far m ore im portance to the public. It is difficult to place an estim ate upon their value, and the influence w hich they w ill exert for good in the instruction they w ill give children in the care o f the teeth, the re m oval o f tartar and the proper m echani cal cleaning o f the mouth. The em ploy m ent o f m edical inspectors and trained nurses in public schools is generally ap proved, and has been of great value in the preservation o f the health of the chil dren, and the additional dental hygienist to the staff w ill prove equally beneficiary and satisfacory.
H Y G IE N IS T S
SCHOO L.
On O ctober 1st there w ill be establish ed in connection with the Dispensary a school for the training of dental hygien ists. The length of the course will be eight or nine months, and it is the pur pose o f he managers o f the school to pro vide facilities fo r the proper teaching of the young w om en in oral prophylaxis and hygiene. Full time and paid instructors w ill be em ployed, and the course will consist of lectures in anatomy, physiol ogy, chem istry, bacteriology, history, san itation, hygiene, diatectics, etc., practical dem onstration and instruction in the prop er use o f instruments and to perform the various operations of rem oving calcareous
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deposits, the cleaning o f teeth, and the restoration o f the mouth to a healthy condition. The w ork of the school w ill be supervised by a com petent staff of expert operators and experienced prac titioners olf dentistry. The la\/ w hich will go into effect Sep tem ber 1,_A916, provides very strict reg ulations for the governm ent of the dental h ygienist; and it also makes it obligatory upon a n . operator em ploying a hygienist to see that she does nothing except just what the law provides; namely,, that she do nothing except to rem ove tartar from the free margin of the gum and use or dinary m eans of rem oving tartar from the teeth. Any practitioner of dentistry who em ploys a young woman to do anything m ore than that will have his license re voked. It can be done very easily. That provision w as put in to rem ove the ob jection w hich has been raised by so many practitioners against the employm ent of a dental nurse or “ dental hygienist,” w hich I prefer to call it. By legislation enacted during the year, the Regents w ere permitted to appoint a Conim ission o f seven, eight or nine men to prepare a course o f study that would be com prehended by the children, start ing from the first grade up. Each per son appointed on that Commission is supposed to be an intelligent and educat ed man in his specialty. The mem bers of the Com m ission are to be members o f the various professions, and there is a rep resentative o f the State Board of Health and the State Com missioner of Health. Practically every branch of the healing art w ill be represented on that Com m ission that is to devise this book of instructions and inform ation for the use of children in the com m on schools.
O B JE C T S OF D IS PEN SA R Y . T here appears to be a vague and in definite idea in the minds o f the public with regard to the real objects and pur poses of the founder of the dispensary, and those associated with him. It is Mr. Eastm an’s hope, first and forem ost,
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T H E JOURNAL OF THE N ATION AL D EN TA L ASSOCIATION.
that an opportunity
will be presented
here for the proper care and treatment o f all defects, diseases and deform ities of the mouth, teeth, throat and nose o f all the children in Rochester. No child in this city— from the tim e of the eruption o f its first tooth, or the baby wi'. j a cleft palate or hare lip, to the ch '/J, say of 14 years o f age, need go w ithout dental or surgical treatm ent when required. It is also the intention and hope of Mr. Eastman, the board of trustees and all those conn ected with this project, that an opportunity w in here be afforded to teach the children the value of and how best to care fo r their teeth; the teaching o f oral hygiene and prophylax is ; orthodontia or correctin g of irregular ities of teeth; the placing of children un der proper observation during the differ ent stages o f developm ent, using every means to prevent abnorm alities, espec ially in the developm ent of the jaw s, ar rangem ent o f the teeth, the nose, throat, face and head operations for the rem oval o f tonsils and adenoids, hare lip and cleft palate. It is planned that there shall be a careful exam ination o f the mouths, teeth, nose and throat of all children at tending school, and the results of those exam inations carefully recorded. Dupli cate copies indicating' the w ork that should be done w ill be given to, or trans m itted to the parents of the child, who are able to em ploy regular dentists. A follow-up schem e w ill be devised and an endeavor m ade to im press upon reluctant and careless parents the n ecessity o f cor recting th'e various defects observed.
C O R R E C T D E N T A L H A B ITS. It is not planned to do the ordinary relief or rescue w ork usually done in m edical and dental colleges and infirm aries, but to bring the baby erupting its first tooth in direct relation to the insti tution and that relation continued for tw elve or fourteen years with the hope that by this m ethod much o f trouble and suffering arising from early neglect, may, by prompt m echanical and other means,
be greatly relieved or rem oved. The in culcation in the minds of the children of the n ecessity o f the proper use of the tooth brush, and other means for keeping the mouth healthy, the value of the pres ervation of their teeth as one o f the n ec essary things in the m astication o f the food to prepare it for digestion, will h;> ve much to do in the form ation of habits that w ill rem ain with them, and be of in estim able benefit thru life. Those in charge o f the w ork of the dis pensary w ill have a w onderful opportun ity to note the value o f the means em ployed in the treatm ent and correction of troubles about the mouth, and should be able to dem onstrate the im portance and value of preventive dentistry. It is the opinion o f experienced practitioners in the m edical and dental professions, that in preventive m edicine and dentistry there is held out the hope of the greatest relief and good to humanity. The w ork done in this dispensary will be o f far reaching im portance, the effect of w hich w ill not only be observed lo cally, but thruout the state and nation, by reason o f the interchange o f ideas b e tw een institutions o f a like character. The 700,000 school children in this state will) be benefited. T h e educational auth orities in the contem plated preparation o f a schem e of study fo r use thruout the com m on school course, w ill include its teaching, such know ledge as a child should have with referen ce to the pijpper care o f the body, and what is essential to prom ote good health. In devising this schem e the physicians and dentists of Rochester w ill no doubt be consulted and have much to do with the preparation of the course of study.
C A R E OF T H E T E E T H . The necessity for the care of the teeth must be apparent to you from the result o f the exam ination of the teeth of eight thousand children in a city where there is m edical and dental supervision. It was found that 96 per cent of the chil dren had defective teeth; 58 per cent of
B U RK H ART.— PROPOSED W O R K A T EASTM AN DISPENSARY.
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their perm anent teeth w ere decayed; 62
m agnificent contribution was to give ev
per cent betw een eight and nine years o f age required attention, and 30 per cent had lost the sixth year molar, the most im portant m asticating tooth in the m outh; 75 per cent of the children ex amined did not use a tooth brush. The figures just quoted tell their own sad story of pain and suffering. The surgical work to be done in the dispensary w ill consist of the rem oval o f adenoids and tonsils, hare lip and cleft palate operations. The laity is quite fa miliar with the form er, but has an im per fect know ledge o f the great num ber of cases o f the latter, and the w onderful field that w ill be opened for the doing o f good by providing proper means and a place for doing this work. In cases o f hare lip and cleft palate very satisfactory results are obtained when children can be operated upon within tw o months after birth. No w ork that can be done w ill be m ore humane or add more to the com fort and happiness of the child and par ents than the early operation for cleft palate and hare lip. The econom ic side of the question is recognized in this city by the appropria tion proposed to be made the dispensary by the city authorities for the care of the teeth of the children. Those connect ed with schools and boards of education can tell you of the large extra expense for the education of defectives and re peaters, m uch of which expense could be saved by early and proper attention to the health of the children.
ery child in R ochester a fair chance. No child in R och ester need suffer, because there is no m oney in the fam ily with which to pay fo r the professional ser
T A L K S AND L E C T U R E ? . The talks and lectures to be given to children and parents will be educational in character and designed to teach those things w hich will be useful and helpful in raising the standard o f efficiency. It is not necessary to tell you that a sick child, or one with a diseased nose or throat, or toothache, is far from being in a position to do its work, or take its place by the side o f one in good health. Mr. Eastm an’s main object in making his
vices required. The opportunity w ill be given to a man with a fam ily, earning a small wage, to have his children receive care and attention in the relief of their sufferings, and the doing o f necessary operations, thereby placing them on an equality with other children, and giving them a fair start in life ’s race. The dispensary is designed for the ben efit of the w orthy poor children of R och ester, and all without regard to race, creed o r color, may avail them selves of its benefits. It m ay interest you to know the plan w hich w ill be follow ed in de term ining who are eligible to receive treatment. W hile a definite schem e-has not yet been adopted the board of trus tees w ill probably decide upon a certain per capita o f earnings for a fam ily to permit them to becom e beneficiaries of the institution. For example, if the earn ings of the father and other members of the fam ily amounted to m ore than $3 or $4 per w eek for each mem ber of the fam ily, they, could not receive the ben efits of the institution, but must employ a regular practitioner. The incom e of the fam ilies and w orthiness of those seeking relief w ill be determined by social w ork ers and inspectors, or those connected with institutions, churches, social w el fare workers, etc.
N O M IN A L F E E S . Children w ill be charged a small fee— perhaps fv e cents for each operation, but this will not prevent those who are found absolutely destitute from having w ork done and som e plan will be devised for taking care of these. The ob ject o f a small charge is to teach a child that the service is worth having, to preserve his self-respect, and m ost of all to avoid the sem blance of anything that would partake o f the na ture of pauperism. .Under this plan every
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child w ill be on the same level with every other child, and should feel no re luctance about accepting the benefits of the dispensary. Tim e w ill not permit me to refer to many o f the details o f the proposed work, as fully as their im portance warrants. It is not my purpose to make extravagant predictions o f the results which it is hoped to attain, but sim ply to tell you that the dispensary will be conducted along practical and rational lines, with the firm expectation that practical results will be obtained w hich w ill be for the lasting benefit o f those who w ill be its beneficiaries. The building w hich w ill be erected to house the R ochester Dental Dispensary will be erected for practical utility in preaching the gospel of good health and good teeth. It will, so far as possible, be a school house fo r teaching the chil dren thé value and care of their teeth. It’s w ork w ill be educational along many lines, with the hope that parents and chil dren w ill be benefited by the advice and instruction w hich w ill be at their dis posal. The w oeful ignorance of the pub lic with regard to the simple rules for preserving the teeth is appalling, and makes the people an easy prey to quacks and charlatans. Now and again new rem edies are placed upon the m arket and her alded from one end of the land to the other as a sure cure for all diseases of the body. New ailments or old ones un der new names are exploited to put dol lars into the pockets o f m ercenary physi cians and dentists, without any adequate or proper return to the patient. It is a well recognized fa ct that the mouth is a* great breeding place for the various germ s of disease, and that the filling o f various cavities in the teeth, the treatm ent and filling of roots, and curing o f abscesses about the teeth and gums rem oves very prolific sources o f in fection. The constant absorption of pois ons from abscessed or ulcerated teeth af fects the general .health, and it w ill be
our endeavor to prove that a healthy mouth is essential to good health. This institution w ill have done much to ju stify the wisdom o f 'its founder, if thru the educational propaganda which it w ill conduct, the children and pub lic may be taught plain simple rules of health, so that they may be able to avoid by preventive measures som e of the ills o f life, and by increased education dis crim inate between the good and bad in m edicine and dentistry. The desire to do his utmost for the alleviation o f suffering, to make child hood m ore happy and pleasant; to m ore properly fit the child for life’s battles, and, above all, his intensely human feel ing and wish to do good, have been the controlling reasons w hich anim ated the m odest and unassum ing gentleman who is the founder of this beautiful and splen did charity. All w ho have experienced the m isery of a pain from toothache and earache in early childhood and those who have been wakened by their children in the sm all hours o f the night with sobbing and crying from pains m ore intense and excruciating than any others, w ill bless the day when preventive dentistry r e m oves from innocent childhood the suf ferings w hich have com e down thru all the ages.
Discussions.
,
H erb ert L . W heeler D . D . S
., Arew
Y ork City.
Mr. Chairman and Fellow M em bers of the N. D. A. Dr. Burkhart has made such a com plete survey o f the situation that it is not nec essary fo r me to say much, and I shall not detain you long. There are som e things in his paper that I would like, how ever, to enlarge upon slightly. He spoke o f the survey which they propose to carry on in the schools o f Rochester. That is a splendid idea. Som e years ago, when I had m ore time fo r this w ork than I now have, I secured the privilege from the Departm ent o f Ed ucation o f N ew Y ork City to make a sur
B U R K H A R T — PROPOSED W O R K A T E A STM AN D ISPENSARY. vey of som e tw enty schools, having over 40,000 children; and I found it im pos sible to secure dentists that would give the time to this w ork, w hich for that reas on fell thru, much to my chagrin. This, however, did not prevent m y im pressing upon the Departm ent of Health of New Y ork City the necessity for dental ser v ice s ; and at that time we secured the dental services o f twelve dentists in the Health Departm ent of New Y ork City w hich has done such m agnificent work since. I w ish also to call attention to this m agnificent institution w hich Rochester is to be so fortunate as to secure. R och ester, as you probably know, has had free dental service for the p oor and needy in the public schools longer than any other city in A m erica; and I be lieve that the statement is correct that the R och ester free dental service is the oldest in this country, and at least the oldest that has been continuous. I want to im press upon you m y belief, founded upon no little experience, that the ability to secure the-attention, the interest and financial support from men like Mr. Eastman came about thru the self-sacrificing and honest w ork of the dentists in Rochester shown in the very practical w ay of attending to the neces sities, com m on every-day w orking neces sities of lookin g after the mouths of the children o f that city. It did not com e about by much talk and much writing in the public press without a solid founda tion along with it to show that the state m ents w ere based upon a certainty. I be liev e that the same thing can be said of the Forsyth Institute, of which I know som ething of the beginnings that resulted in that magnificent institution. Another thing o f which I wish to refer m om entarily is the question that Dr. Burkhart brought up when he spoke of the difficulty o f finding young men who would appreciate the privileges and pos sibilities that w ere open to them in institutions of this kind for acquiring larg er experience and practice before they
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entered upon actual work as a dentist in private practice. It is m y fortune to hold a position in connection^ with the Bellevue and allied hospitals in New Y ork City w hich enables me to make recom m endations for the ap pointm ent o f seven dental internes an nually. N ow when I say “ dental internes” I mean young men who have received a dental education and who are appointed to the infirmary staff of the Bellevue and allied hospitals. They receive their ap pointm ent on the same plane exactly as the medical! internes. They receive their board and lodging, their hospital cloth ing and their laundry. Their privileges as dental internes are identical with the privileges enjoyed by the m edical in ternes; besides they receive a certificate at the end o f the year that they served fo r that period in the hospital. I am a teacher in a school where I teach some 500 students, 130 to 200 in a class; and you would think that I could get m ore in ternes than I could possibly use; but this, gentlemen, is not the fact. They do not appreciate, notwithstanding all the talking that I do, the value to them selves in the opportunity for increased know ledge that such an appointment as dental interne means, and w hich you can appreciate when I tell you that in Belle vue alone we have over 150 cases o f frac tured jaw yearly w hich are treated by the Dental Department alone, and that our pow er is such in the dental service that they cannot discharge a patient from that im mense hospital, except from the prison ward upon order of court, or from wards where contagion exists, if the Dental Department says that that pa tient must be retained until the necessary service in the mouth is completed. W e have that much power. The dentist is on the sarfie plane and enjoys the same priv ileges as the physician. Y et I find it difficult to get proper, intelligent and conscientious young men to fill these sev en positions. I want to say that if there are any men here connected with teach ing institutions where you have ambitious
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TH E JOURNAL OP TH E NATION AL DENTAL ASSOCIATION.
young men who wish opportunity such as I have spoken to you about, I shall be very glad to have them com m unicate with me, and that I can secure the oppor tunities I have described for the right type o f young men. In order to show you how far I go in this and that under no circum stances have I ever been partial even to students o f our own College, I will state that the present seven internes com prise two stu dents from our own school, three from T u ft’s Dental School and two from the University o f Pennsylvania. The work that w ill be done in an in stitution like this w hich has been de scribed to us by D octor Burkhart, repre sents no greater usefulness to the public than to the dental p ro fession ;for if there is any one thing that is needed at the present time in the rank and file of our profession it is that the dental profes sion must stand on the same plane and share equally in the confidence o f the public as the m edical profession; and it must be willing to accept a n i fulfill the same responsibilities that the m edical profession takes. If it w ill take the re sponsibilities that the m edical profession takes it must also be w illing to sacrifice the time and the energy to learn the sci entific side of the profession as well as m ere ability to use the fingers. There is a grand opportunity now op ening to the dental profession w hich is quite apart from the ability to do mere m echanical work. A splendid opportunity is open to us in hospitals and infirmaries to exem plify the relationship of the mouth to general disease and to general patho logical conditions as such. W e must con stantly keep posted on these lines; we must be fam iliar with all the new discov eries in physiology, pathology, bacteriol og y ; and w ith all the rem edies, meth ods and appliances that m ay contribute to the service of our profession for the benefit of hum anity; and all of which is bound eventually to increase the mental pow er and grasp, and the intelligence and general standing o f the profession in the
estimation o f the public, ju st as a course in the gymnasium increases your physical' welfare. It cannot help it. And for that let us all be thankful; and the things that have brought about these possibili ties, or one of the things, along with the Research Departm ent and other things of that kind are these institutions such as have been described in Rochester, of w hich we now have two. M ay the day com e when w e w ill have one in every city of any size. (Applause.)
,
W m. IV. B e lc h e r D . D . S
., R ochester , Ar.
V.
A s the w riter has been so closely iden tified with the w ork of the establishm ent and conduct of the free dental dispensary movement in R ochester, he suffers from a lack o f perspective and with all respect to the Chairman who made the selection, the least suitable person to intelligently discuss such a paper. The essayist has touched on the expect ed activities o f the new Dispensary and in so doing has given a too brief mention of the fact that in R och ester we w ill have a com bining o f the best points in the Forsyth and the w ork o f Dr. Fones at Bridgeport, Conn. The amount of m oney appropriated by the city of Rochester, $20,000.00, is to pay for the service o f a trained corps o f lady hygienists who w ill give prophylactic treatments to all public and parochial school children in the first five grades, combined with lectures on oral hygiene, tooth brush drills, and exam ination and treatment three or fou r times each year. It is expected that much preventive work will be accom plished w hich w ill rem ove the need of service at the central dispensary. The city of R ochester is in the happy position of having a w ell organized body called The United Charities, w hich is a clearing-house for inform ation as to the worthiness of all applicants for free service or aid. Forty different organiza tions, including churches, aid societies, and such bodies as the R och ester Dental
BU RK H AK T.— PROPOSED W O RK A T EA STM AN D ISPENSARY.
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Society, are mem bers, and freely furnish inform ation w hich is tabulated and sup plied to the different organizations. If necessary, special investigation is made and a report forw arded to inquiring mem bers as to the w orthiness or unworthiness
properly should be a burden o f the state. It should not be necessary for a few in dividuals and the m edical profession as a. whole to bear the burden o f these eco nom ic conditions. In the older cities and countries of Europe, it is w ell recognized
of each applicant, and this dispensary abuse is obviated in a degree. In the good old days, the physician in the small place, at least, had a feelin g
that the state must care for those persons who are ill and im provident, and various types o f industrial, health, and unem ploym ent insurance associations have been devised. “ In Am erica, we are rapidly com ing to
that he was a public servant and it was his duty to respond to any call whether he received com pensation for it or not; to refuse a call from a poor patient was a sin w hich could hardly be forgiven. Today, with the grow th of our large cities, the endowed hospitals, and dispen saries, the increase of specialties, the de velopm ent o f the trained nurse and the various social agencies, all this has changed. The old-fashioned kindly feel ing has passed away, and except fo r dis tinctly personal reason practitioners re fuse service to undesirable unremunerative patients. The feeling o f respect and confidence in the physician, aye, and even the dentist, is rapidly disappearing, and he is regarded by an increasing number as one who is likely to take advantage of their necessities. A s a result, only the very poor who go to the public hospital or dispensary, or the very rich, receive the best m edical or dental service. The essayist has stated that with the head o f the fam ily receiving a wage of $3.00 to $4.00 per individual per week, service would be refused at the R ochester Dental Dispensary. In the line of recent investigation, it would seem that this would shut out many deserving fam ilies. The follow ing extract is taken from a recent article by Borden S. Veeder, M. D., St. Louis, appearing in the issue o f July 8th, 1916, Journal of the A m erican M edi cal A ssociation: “ In an attem pt to m eet the results of econom ic conditions, persons are often forced to accept private charity for what in reality is society’s duty as a whole, and
this point of view, and in January, the present year, a bill was introduced into several of the State Legislatures thru the efforts of the Social Insurance Com mittee of the National A ssociation for Labor Legislation specifying com pulsory health insurance for all fam ilies earning less than one hundred dollars a month. W ithin the next few years, it is expected that such a bill w ill undoubtedly pass many of our State Legislatures, and un til1 som e such form of insurance is estab lished, the free clinic is apparently the only solution o f the problem which w ill furnish an efficient type of service at the low est possible cost to those persons who are deserving of free treatment. “ In setting a financial standard, there is a certain minimum figure or incom e below w hich there can be no question as to the financial suitability o f an applicant for treatment. In a broad aspect, this figure should be one w hich allows fo r a decent standard o f living and includes adequate food, clothing, and shelter, for without these three things health will suffer and the race w ill undergo physical degeneration. “ There are tw o methods of obtaining fam ily budgets. One o f these is to figure out theoretically the least a fam ily o f a given size could live on. This method^ tho frequently used, is inaccurate. The second m ethod does away with theory and ascertains the cost of living by tab ulating the actual budgets or amount spent by fam ilies of different sizes. “ In many respects the m ost valuable
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TH E JOURNAL OF TH E NATION AL D EN TA L ASSOCIATION.
study in this line was made by Chapin* nine years ago. Altho his actual figures are in many respects no longer of much value, because o f the subsequent in crease in the cost of living, the m ethod used has served as a model for subse quent investigations. His figures are based on the so-called “ norm al fam ily” of five persons; a w orking man, the woman at home, and three children under fifteen years of age, and were o b tained by com piling the actual figures of a large number of fam ilies in regard to the incom e, and the detailed expendi-. tures fo r food, clothing, lodging, heat and fuel, insurance, health and sundries. His conclusions w ere that from $600.00 to $700.00 a year incom e is wholly inade quate to maintain a proper standard o f living; with an incom e of $700.00 to $800.00, a fam ily can barely support it self. H is final conclusion is that an in com e of $825.00 a year is barely sufficient for the average fam ily of five to main tain a proper standard of living in New Y ork City. “ It is thus show n that a “ norm al fam ily” is just able to eke out a norm al liv ing on $800.00' providing no em ergency such as ill-health arises. These figures are for 1907, and since that time the cost of living has increased som e 16%. “ The New Y ork State Factory Investi gation Com m ission using Chapin’s meth ods, and the New Y ork City Board of Estimates, w hich studied the cos.t of liv ing for unskilled laborers, recently issued reports, the conclusions of which are that $876.43 and $840.18, respectively, are the necessary incom e for the maintenance of the average fam ily of five in the city of New York. A table is here given of the conclusions of these two reports and an itemized account o f the expenditures. It includes $21.00 a year for health, physi cians’ and dentists’ services, and m edi cine for five persons. It makes no pro•NOTE— Chapin : Standards o f Living Among Workingmen’ s Families in New York City, New York, 1907.
visions for savings, as the insurance is only burial insurance. “ Cost of living fo r a norm al fam ily in New Y ork: Items
N. Y. S. Board Factory of Estimate Commission Average
$325.00 Pood ..............................$380.00 Rent .............................. 168.00 200.00 140.00 Clothing ....................... 104.00 Fuel and L ight..........................42.00 20.00 Carfare ........................................30.30 31.20 Insurance .................................. 22.88 35.60 Health ....................... .. 20.00 22.00 Sundries .................................... 73.00 102.63 Totals
...................... $840.18
$876.43
$352.50 184.00 122.00 31.00 30.75 29.24 21.00 87.81 $858.30
“ These figures are the yearly wage and are not based on a m onthly or weekly earning, as it has been shown that in many cases the w eekly wage must be 20% higher to com pensate for periods of unemployment. “ A n investigation made in New York City in 1910 o f 745 patients, 672, or 90%, w ere worthy of free treatment. A recent similar investigation covering 1,881 pa tients applying for admission to the B os ton Dispensary showed that only two per cent, w ere able to pay for the services of a private physician. A recent investi gation at the Presbyterian H ospital in Philadelphia, showed that ‘abuse’ was a very m inor factor (tw o per cen t). “ W ashington U niversity Dispensary, St.-Louis, as a result o f an investigation determined that but two patients in ev ery hundred applying w ere not deserving of free treatment. To make an investiga tion that is really worth while, it costs from thirty cents to fifty cents fo r each patient, and W ashington U niversity clinic spends nearly $100.00 a month in the m atter of investigation to avoid this so-called dispensary abuse, w hich is som ewhat larger than is spent by any other clinic in the United States for the same purpose.” In the foregoin g quotation referen ce was made to the “ abuse” of the dispen sary in St. L ou is; and in connection with that I may say that in St. Louis they had three dispensaries located in the negro section. W hen establishing the new
B U RK H ART.— PROPOSED W O R K A T EASTM AN DISPENSARY. m edical buildings, the university and col leges w ere com bined in one, and they discovered that the class of patients that w ere com ing to this new dispensary were entirely a different class, who w ere ap parently prosperous; further, the service that was being rendered was considerably more than three tim es the amount that had been given in the free dispensary; so that an attempt was made to find out what other cities had been doing as to investigating patients who cam e in for dispensary treatment. Only ten per cent, o f our population is said to have an incom e o f one thousand dollars a year, and it is clearly shown that a fam ily of five with an incom e of less than this amount, cannot pay for m edical or dental service. Only ten per cent, of the people in Am erica are patro
693
nizing the dentist. Perhaps this is all that can really afford to do so under present conditions and circum stances. The higher dental fees are placed (and it would seem necessary to place them higher in order to provide the latest and best dental service) the few er people are to be b en efited.. Certainly, if one is to avail him self of the best service of the dentist and physician he must have an annual incom e o f several thousand dollars. R obert Grant, in an article that ap peared in Scribner’s M agazine, a number o f years ago, described a certain stage of poverty as follow s: “ You know the kind of fam ily I mean, where the den tist’s bill is an unexpected calam ity.” Yes, we know them R obert; the woods are full of them.
(Head before the National Dental Association at Its Twentieth Annual Session, Louisville, Ky.,
July 25-28, 1916.)
D
EN TAL Clinics and Dental Dispen saries, except those connected with colleges, are o f recent origin. School Clinics have been conducted in several cities, but all m ore or less under varying conditions. It has not been pos sible thus far to bring about a stand ardization of methods or equipment, as is the case with dispensaries connected with m edical1 schools and hospitals. Ev ery dispensary has had to blaze its own trail subject to the various local condi tions. There are a num ber of clinics scattered about the country that have been and are doing good and satisfactory work, but many of them are handicapped by lack of equipment and funds. The Forsyth Dental Dispensary o f Boston and the R ochester Dental Dispen sary are fortunate in having at their dis posal ample means to carry on the work o f educating the public to a proper reali zation of the need fo r dental treatment, and to be able to render such service as may be required. The business o f playing the role of prophet is an uncertain one. It is not m y intention to prom ise definite results along any particular line, but to tell you som ething of our hopes and aspirations and with the perm ission of this associa tion, I shall be glad to appear before you annually and give an account of the progress of the work. You w ill be interested to know that a com plete survey o f the mouths o f the children o f R och ester w ill be made dur 582
ing the com ing autumn, under my direc tion, and with the assistance of the mem bers o f the R ochester Dental Society, w e propose to make as real a survey as possible for the purpose of recording for clinical and other observations the exact conditions present in 1916. A survey w ill be made every year so that com par isons may be made betw een the condi tions now and in subsequent years for the purpose o f ascertaining the value of the services rendered. The magnitude o f the undertaking is appalling, with 35,000 children in the public sch ools and 15,000 in the paro chial schools and institutions, but this work must be done in order that accu rate and reliable data may be at hand with w hich to prove to people of means and m unicipal authorities, the need for this work. This institution was founded and en dow ed by Mr. George Eastman for the sole purpose of devising ways and means to dem onstrate the value o f preventive dentistry. A t no time w ill this be tost sight of, and while various activities w ill be carried on, it is the intention that all will w ork in harmony with that basic and fundamental object in view. I shall not take your time to describe the execu tive department o f the institution, except to tell you that there are thirteen public spirited citizens in Rochester, not includ ing Mr. Eastman, who are the directors o f the Rochester Dental Dispensary and who w ere sufficiently interested to pledge
B U RK H ART.— PROPOSED W O R K AT EA STM AN DISPENSARY. $1000 a year each fo r six years to carry on the work. Y ou w ill also be interested to know that the municipality o f R och es ter agreed to appropriate $20,000 a- year fo r five years fo r the cleaning of the teeth of the children in the public schools.
B U IL D IN G A R R A N G E M E N T . The interior arrangem ent of the build ing, While necessarily follow in g in som e particulars th e Forsyth Dental Infirm ary of Boston and dental college and hospital infirmaries generally, w ill have m any and new and unique features, and so fa r as Mr. Eastman and the man agem ent can make it, w ill em ploy and em body the very latest thought and ap pliances to m ake this the m ost efficient institution of its kind in the world. You may be interested in a brief d e scription o f the arrangem ent of the building. The heating plant w ill be housed in a sm all building at the rear. The basem ent w ill contain the necessary locker, rest room s and showers for the permanent staff o f operators on the east side, and w om en on the w est side, lunch room and kitchen, supply and janitor’s room s. On the main floor will be found the children’s waiting, examination and cloak room , trustees’ directors and exec utive clerk s’ room s and officers’ research laboratory, museum and library and a large lecture room. One side of the mezzanine floor w ill be used fo r X -Ray and photographic work, and the other fo r a hospital for babies or very young children requiring oral sur gical attention. On the top floor in the center w ill be located the general dental operating room, on the w est side the extracting and orthodontia departments, and on the east side the surgical preparation, ope rating and recov ery rooms, and every thing necessary to make this an efficient and com plete children’s hospital fo r the w ork contemplated.
DEN TAL
O P E R A T IN G
583
IN F IR M A R Y .
The fam ily o f the late Frank Ritter, will, as a m em orial to him contribute an equipment for the dental infirmary, which w ill be placed especially for this institution. W ith the assistance of trained expert engineers from the Ritter Dental Company, units w ill be devised which w ill represent the latest type oif dental appliances. Operators w ill have com plete outfits of instruments, and the necessary accesso ries, including an individual sterilizer at each chair. T h ey w ill be held strictly responsible for its proper care. Their w ork w ill be carefully supervised, so that patients and the public m ay be as sured that the operations perform ed in the infirmary w ill be w ell and properly done. The training w hich recen t gradu ates from college may obtain will be of much value to them selves and the public when they enter private practice. The work in the dental infirmary w ill consist o f filling teeth and roots with plastic fillings, the rem oval of tartar and cleaning of the teeth; the making of splints for fractured jaw s and appliances for regulating teeth, and such other work as would be perform ed in any properly equipped dental office. Operations will be done by a carefully trained staff of paid assistants who w ill have the bene fit o f the advice and assistance of a visiting staff and prominent local dental and other specialists, who w ill donate their services fo r this purpose. An im portant part of the w ork to be done in the infirmary, w ill be the atten tion which is proposed to be given to root canal work. A special department w ill be organized fo r this work, and an opportunity given to test the value o f the various m ethods of root canal treatment. The hope is indulged that with the clini cal opportunities and advantages pre sented for study and observation, that many perplexing questions may be solved. In the w ork o f organizing the staff of the D ispensary I am confronted with a
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TH E JOURNAL OP TH E NATION AL D EN TA L ASSOCIATION.
problem w hich is o f vital im portance to all institutions o f this kind. I refer to the matter o f obtaining operators for the Infirmary who appreciate the value and responsibility o f the position. There appears to be am ong young m en with whom I have conversed an utter lack of the proper professional spirit w hich ■should be a part of the make up o f re cent graduates in order to flt them to carry on their w ork to the best advant age to them selves and their patients. I regret to say that the first question usually asked by a prospective opera tor is “ how much m oney is there in it.” It appears w ith few exceptions, that the money consideration is first and fore m ost in their minds. The great value to them selves o f a post graduate course and the opportunity for study, are lost sight o f in the mad rush to accum ulate a com petence im mediately. It is a w ell known fact that with the lim ited time at the disposal of colleges operating under ¡a three ye^r course there is not the opportunity or tim e for teaching of the practical branches as they should be taught, anti with few ex ception's graduates might profitably spend a year or m ore in post graduate work. I h ave not arrived at the conclu s ion hastily, but after mature considera tion and observation, extending over a considerable period of years, we hear much about considering ourselves on equality w ith m edical men, but until our young men becom e sufficiently inter ested in their w ork to be w illing to car ry on their studies after graduation, the less said about that the better will it be fo r the dental profession. The responsibility for this state of affairs belongs in no small degree to the teachers in our dental schools, and they should lose no opportunity to impress upon the minds of the students the n ec essity fo r m ore practical experience after graduation. Colleges cannot be expected to guarantee that every graduate shall be a finished operator, but they can do much m ore than they have done to awaken
their students and endeavor to im press upon their minds the advantages to themselves, and their patients, o f the sat isfaction to be gained by the rendering o f real and true service, without regard always to financial consideration.
X -R A Y D E P A R T M E N T . An X-ray department with proper photographic equipment in charge of a com petent operator, w ill be one of the useful and attractive features of the institution. It w ill be placed at the disposal o f those in general practice and the cost of m aking photographs greatly reduced. This w ill mean much, not only to operators but patients who w ill be the ch ief beneficiaries, by having a place where the w ork may be done at a m oder ate cost. The research laboratory w ill be an im portant part of the institution. Opportunity will be given to m em bers o f the dental profession and others to carry on their studies in conjunction with the regular staff of the dispensary. The research de partment w ill be conducted along ration al and practical lines. It w ill not be used to exploit theories and fads, but an en deavor made to learn the truth and ap ply the discoveries in a practical man ner. The museum and library w ill be placed at the disposal o f the dental pro fession, and provide a place fo r study and reference work.
LECTURE
ROOM.
The lecture room w ill fill a long felt want fo r the dental profession in R och ester. Lectures w ill be delivered here to children, parents and the public, on mat ters relating to the care o f the teeth, oral hygiene and prophylaxis, by expert dental practitioners and teachers, who are com petent to entertain and instruct. The local dental societies w ill make it their m eeting place, and by that close community of interests w hich it is hoped to establish, much benefit w ill be derived by the public and the profession.
B U R K H A R T.— PROPOSED W O RK A T EA STM A N DISPENSARY.
N E E D FO R D E N T A L H Y G IE N IS T S . It is n ot possible at this tim e to pre dict the fa r reaching effect, im portance and value w hich w ill result from the em ploym ent o f dental hygienists, hut I have no hesitation in giving it as my personal opinion that their proper employm ent w ill.b e so satisfactory and beneficial that there w ill be a universal demand for their services. Dental H ygienists w ill give particular attention to oral hygiene and prophylaxis, and it w ill be the most im portant part o f their work. The need for properly educated dental hygienists is very great. W hile their em ploym ent in dental offices is desired by many, the services w hich they can ren der in public institutions, and particu larly the sch ools, will be o f far m ore im portance to the public. It is difficult to place an estim ate upon their value, and the influence w hich they w ill exert for good in the instruction they w ill give children in the care o f the teeth, the re m oval o f tartar and the proper m echani cal cleaning o f the mouth. The em ploy m ent o f m edical inspectors and trained nurses in public schools is generally ap proved, and has been of great value in the preservation o f the health of the chil dren, and the additional dental hygienist to the staff w ill prove equally beneficiary and satisfacory.
H Y G IE N IS T S
SCHOO L.
On O ctober 1st there w ill be establish ed in connection with the Dispensary a school for the training of dental hygien ists. The length of the course will be eight or nine months, and it is the pur pose o f he managers o f the school to pro vide facilities fo r the proper teaching of the young w om en in oral prophylaxis and hygiene. Full time and paid instructors w ill be em ployed, and the course will consist of lectures in anatomy, physiol ogy, chem istry, bacteriology, history, san itation, hygiene, diatectics, etc., practical dem onstration and instruction in the prop er use o f instruments and to perform the various operations of rem oving calcareous
585
deposits, the cleaning o f teeth, and the restoration o f the mouth to a healthy condition. The w ork of the school w ill be supervised by a com petent staff of expert operators and experienced prac titioners olf dentistry. The la\/ w hich will go into effect Sep tem ber 1,_A916, provides very strict reg ulations for the governm ent of the dental h ygienist; and it also makes it obligatory upon a n . operator em ploying a hygienist to see that she does nothing except just what the law provides; namely,, that she do nothing except to rem ove tartar from the free margin of the gum and use or dinary m eans of rem oving tartar from the teeth. Any practitioner of dentistry who em ploys a young woman to do anything m ore than that will have his license re voked. It can be done very easily. That provision w as put in to rem ove the ob jection w hich has been raised by so many practitioners against the employm ent of a dental nurse or “ dental hygienist,” w hich I prefer to call it. By legislation enacted during the year, the Regents w ere permitted to appoint a Conim ission o f seven, eight or nine men to prepare a course o f study that would be com prehended by the children, start ing from the first grade up. Each per son appointed on that Commission is supposed to be an intelligent and educat ed man in his specialty. The mem bers of the Com m ission are to be members o f the various professions, and there is a rep resentative o f the State Board of Health and the State Com missioner of Health. Practically every branch of the healing art w ill be represented on that Com m ission that is to devise this book of instructions and inform ation for the use of children in the com m on schools.
O B JE C T S OF D IS PEN SA R Y . T here appears to be a vague and in definite idea in the minds o f the public with regard to the real objects and pur poses of the founder of the dispensary, and those associated with him. It is Mr. Eastm an’s hope, first and forem ost,
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that an opportunity
will be presented
here for the proper care and treatment o f all defects, diseases and deform ities of the mouth, teeth, throat and nose o f all the children in Rochester. No child in this city— from the tim e of the eruption o f its first tooth, or the baby wi'. j a cleft palate or hare lip, to the ch '/J, say of 14 years o f age, need go w ithout dental or surgical treatm ent when required. It is also the intention and hope of Mr. Eastman, the board of trustees and all those conn ected with this project, that an opportunity w in here be afforded to teach the children the value of and how best to care fo r their teeth; the teaching o f oral hygiene and prophylax is ; orthodontia or correctin g of irregular ities of teeth; the placing of children un der proper observation during the differ ent stages o f developm ent, using every means to prevent abnorm alities, espec ially in the developm ent of the jaw s, ar rangem ent o f the teeth, the nose, throat, face and head operations for the rem oval o f tonsils and adenoids, hare lip and cleft palate. It is planned that there shall be a careful exam ination o f the mouths, teeth, nose and throat of all children at tending school, and the results of those exam inations carefully recorded. Dupli cate copies indicating' the w ork that should be done w ill be given to, or trans m itted to the parents of the child, who are able to em ploy regular dentists. A follow-up schem e w ill be devised and an endeavor m ade to im press upon reluctant and careless parents the n ecessity o f cor recting th'e various defects observed.
C O R R E C T D E N T A L H A B ITS. It is not planned to do the ordinary relief or rescue w ork usually done in m edical and dental colleges and infirm aries, but to bring the baby erupting its first tooth in direct relation to the insti tution and that relation continued for tw elve or fourteen years with the hope that by this m ethod much o f trouble and suffering arising from early neglect, may, by prompt m echanical and other means,
be greatly relieved or rem oved. The in culcation in the minds of the children of the n ecessity o f the proper use of the tooth brush, and other means for keeping the mouth healthy, the value of the pres ervation of their teeth as one o f the n ec essary things in the m astication o f the food to prepare it for digestion, will h;> ve much to do in the form ation of habits that w ill rem ain with them, and be of in estim able benefit thru life. Those in charge o f the w ork of the dis pensary w ill have a w onderful opportun ity to note the value o f the means em ployed in the treatm ent and correction of troubles about the mouth, and should be able to dem onstrate the im portance and value of preventive dentistry. It is the opinion o f experienced practitioners in the m edical and dental professions, that in preventive m edicine and dentistry there is held out the hope of the greatest relief and good to humanity. The w ork done in this dispensary will be o f far reaching im portance, the effect of w hich w ill not only be observed lo cally, but thruout the state and nation, by reason o f the interchange o f ideas b e tw een institutions o f a like character. The 700,000 school children in this state will) be benefited. T h e educational auth orities in the contem plated preparation o f a schem e of study fo r use thruout the com m on school course, w ill include its teaching, such know ledge as a child should have with referen ce to the pijpper care o f the body, and what is essential to prom ote good health. In devising this schem e the physicians and dentists of Rochester w ill no doubt be consulted and have much to do with the preparation of the course of study.
C A R E OF T H E T E E T H . The necessity for the care of the teeth must be apparent to you from the result o f the exam ination of the teeth of eight thousand children in a city where there is m edical and dental supervision. It was found that 96 per cent of the chil dren had defective teeth; 58 per cent of
B U RK H ART.— PROPOSED W O R K A T EASTM AN DISPENSARY.
587
their perm anent teeth w ere decayed; 62
m agnificent contribution was to give ev
per cent betw een eight and nine years o f age required attention, and 30 per cent had lost the sixth year molar, the most im portant m asticating tooth in the m outh; 75 per cent of the children ex amined did not use a tooth brush. The figures just quoted tell their own sad story of pain and suffering. The surgical work to be done in the dispensary w ill consist of the rem oval o f adenoids and tonsils, hare lip and cleft palate operations. The laity is quite fa miliar with the form er, but has an im per fect know ledge o f the great num ber of cases o f the latter, and the w onderful field that w ill be opened for the doing o f good by providing proper means and a place for doing this work. In cases o f hare lip and cleft palate very satisfactory results are obtained when children can be operated upon within tw o months after birth. No w ork that can be done w ill be m ore humane or add more to the com fort and happiness of the child and par ents than the early operation for cleft palate and hare lip. The econom ic side of the question is recognized in this city by the appropria tion proposed to be made the dispensary by the city authorities for the care of the teeth of the children. Those connect ed with schools and boards of education can tell you of the large extra expense for the education of defectives and re peaters, m uch of which expense could be saved by early and proper attention to the health of the children.
ery child in R ochester a fair chance. No child in R och ester need suffer, because there is no m oney in the fam ily with which to pay fo r the professional ser
T A L K S AND L E C T U R E ? . The talks and lectures to be given to children and parents will be educational in character and designed to teach those things w hich will be useful and helpful in raising the standard o f efficiency. It is not necessary to tell you that a sick child, or one with a diseased nose or throat, or toothache, is far from being in a position to do its work, or take its place by the side o f one in good health. Mr. Eastm an’s main object in making his
vices required. The opportunity w ill be given to a man with a fam ily, earning a small wage, to have his children receive care and attention in the relief of their sufferings, and the doing o f necessary operations, thereby placing them on an equality with other children, and giving them a fair start in life ’s race. The dispensary is designed for the ben efit of the w orthy poor children of R och ester, and all without regard to race, creed o r color, may avail them selves of its benefits. It m ay interest you to know the plan w hich w ill be follow ed in de term ining who are eligible to receive treatment. W hile a definite schem e-has not yet been adopted the board of trus tees w ill probably decide upon a certain per capita o f earnings for a fam ily to permit them to becom e beneficiaries of the institution. For example, if the earn ings of the father and other members of the fam ily amounted to m ore than $3 or $4 per w eek for each mem ber of the fam ily, they, could not receive the ben efits of the institution, but must employ a regular practitioner. The incom e of the fam ilies and w orthiness of those seeking relief w ill be determined by social w ork ers and inspectors, or those connected with institutions, churches, social w el fare workers, etc.
N O M IN A L F E E S . Children w ill be charged a small fee— perhaps fv e cents for each operation, but this will not prevent those who are found absolutely destitute from having w ork done and som e plan will be devised for taking care of these. The ob ject o f a small charge is to teach a child that the service is worth having, to preserve his self-respect, and m ost of all to avoid the sem blance of anything that would partake o f the na ture of pauperism. .Under this plan every
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child w ill be on the same level with every other child, and should feel no re luctance about accepting the benefits of the dispensary. Tim e w ill not permit me to refer to many o f the details o f the proposed work, as fully as their im portance warrants. It is not my purpose to make extravagant predictions o f the results which it is hoped to attain, but sim ply to tell you that the dispensary will be conducted along practical and rational lines, with the firm expectation that practical results will be obtained w hich w ill be for the lasting benefit o f those who w ill be its beneficiaries. The building w hich w ill be erected to house the R ochester Dental Dispensary will be erected for practical utility in preaching the gospel of good health and good teeth. It will, so far as possible, be a school house fo r teaching the chil dren thé value and care of their teeth. It’s w ork w ill be educational along many lines, with the hope that parents and chil dren w ill be benefited by the advice and instruction w hich w ill be at their dis posal. The w oeful ignorance of the pub lic with regard to the simple rules for preserving the teeth is appalling, and makes the people an easy prey to quacks and charlatans. Now and again new rem edies are placed upon the m arket and her alded from one end of the land to the other as a sure cure for all diseases of the body. New ailments or old ones un der new names are exploited to put dol lars into the pockets o f m ercenary physi cians and dentists, without any adequate or proper return to the patient. It is a well recognized fa ct that the mouth is a* great breeding place for the various germ s of disease, and that the filling o f various cavities in the teeth, the treatm ent and filling of roots, and curing o f abscesses about the teeth and gums rem oves very prolific sources o f in fection. The constant absorption of pois ons from abscessed or ulcerated teeth af fects the general .health, and it w ill be
our endeavor to prove that a healthy mouth is essential to good health. This institution w ill have done much to ju stify the wisdom o f 'its founder, if thru the educational propaganda which it w ill conduct, the children and pub lic may be taught plain simple rules of health, so that they may be able to avoid by preventive measures som e of the ills o f life, and by increased education dis crim inate between the good and bad in m edicine and dentistry. The desire to do his utmost for the alleviation o f suffering, to make child hood m ore happy and pleasant; to m ore properly fit the child for life’s battles, and, above all, his intensely human feel ing and wish to do good, have been the controlling reasons w hich anim ated the m odest and unassum ing gentleman who is the founder of this beautiful and splen did charity. All w ho have experienced the m isery of a pain from toothache and earache in early childhood and those who have been wakened by their children in the sm all hours o f the night with sobbing and crying from pains m ore intense and excruciating than any others, w ill bless the day when preventive dentistry r e m oves from innocent childhood the suf ferings w hich have com e down thru all the ages.
Discussions.
,
H erb ert L . W heeler D . D . S
., Arew
Y ork City.
Mr. Chairman and Fellow M em bers of the N. D. A. Dr. Burkhart has made such a com plete survey o f the situation that it is not nec essary fo r me to say much, and I shall not detain you long. There are som e things in his paper that I would like, how ever, to enlarge upon slightly. He spoke o f the survey which they propose to carry on in the schools o f Rochester. That is a splendid idea. Som e years ago, when I had m ore time fo r this w ork than I now have, I secured the privilege from the Departm ent o f Ed ucation o f N ew Y ork City to make a sur
B U R K H A R T — PROPOSED W O R K A T E A STM AN D ISPENSARY. vey of som e tw enty schools, having over 40,000 children; and I found it im pos sible to secure dentists that would give the time to this w ork, w hich for that reas on fell thru, much to my chagrin. This, however, did not prevent m y im pressing upon the Departm ent of Health of New Y ork City the necessity for dental ser v ice s ; and at that time we secured the dental services o f twelve dentists in the Health Departm ent of New Y ork City w hich has done such m agnificent work since. I w ish also to call attention to this m agnificent institution w hich Rochester is to be so fortunate as to secure. R och ester, as you probably know, has had free dental service for the p oor and needy in the public schools longer than any other city in A m erica; and I be lieve that the statement is correct that the R och ester free dental service is the oldest in this country, and at least the oldest that has been continuous. I want to im press upon you m y belief, founded upon no little experience, that the ability to secure the-attention, the interest and financial support from men like Mr. Eastman came about thru the self-sacrificing and honest w ork of the dentists in Rochester shown in the very practical w ay of attending to the neces sities, com m on every-day w orking neces sities of lookin g after the mouths of the children o f that city. It did not com e about by much talk and much writing in the public press without a solid founda tion along with it to show that the state m ents w ere based upon a certainty. I be liev e that the same thing can be said of the Forsyth Institute, of which I know som ething of the beginnings that resulted in that magnificent institution. Another thing o f which I wish to refer m om entarily is the question that Dr. Burkhart brought up when he spoke of the difficulty o f finding young men who would appreciate the privileges and pos sibilities that w ere open to them in institutions of this kind for acquiring larg er experience and practice before they
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entered upon actual work as a dentist in private practice. It is m y fortune to hold a position in connection^ with the Bellevue and allied hospitals in New Y ork City w hich enables me to make recom m endations for the ap pointm ent o f seven dental internes an nually. N ow when I say “ dental internes” I mean young men who have received a dental education and who are appointed to the infirmary staff of the Bellevue and allied hospitals. They receive their ap pointm ent on the same plane exactly as the medical! internes. They receive their board and lodging, their hospital cloth ing and their laundry. Their privileges as dental internes are identical with the privileges enjoyed by the m edical in ternes; besides they receive a certificate at the end o f the year that they served fo r that period in the hospital. I am a teacher in a school where I teach some 500 students, 130 to 200 in a class; and you would think that I could get m ore in ternes than I could possibly use; but this, gentlemen, is not the fact. They do not appreciate, notwithstanding all the talking that I do, the value to them selves in the opportunity for increased know ledge that such an appointment as dental interne means, and w hich you can appreciate when I tell you that in Belle vue alone we have over 150 cases o f frac tured jaw yearly w hich are treated by the Dental Department alone, and that our pow er is such in the dental service that they cannot discharge a patient from that im mense hospital, except from the prison ward upon order of court, or from wards where contagion exists, if the Dental Department says that that pa tient must be retained until the necessary service in the mouth is completed. W e have that much power. The dentist is on the sarfie plane and enjoys the same priv ileges as the physician. Y et I find it difficult to get proper, intelligent and conscientious young men to fill these sev en positions. I want to say that if there are any men here connected with teach ing institutions where you have ambitious
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young men who wish opportunity such as I have spoken to you about, I shall be very glad to have them com m unicate with me, and that I can secure the oppor tunities I have described for the right type o f young men. In order to show you how far I go in this and that under no circum stances have I ever been partial even to students o f our own College, I will state that the present seven internes com prise two stu dents from our own school, three from T u ft’s Dental School and two from the University o f Pennsylvania. The work that w ill be done in an in stitution like this w hich has been de scribed to us by D octor Burkhart, repre sents no greater usefulness to the public than to the dental p ro fession ;for if there is any one thing that is needed at the present time in the rank and file of our profession it is that the dental profes sion must stand on the same plane and share equally in the confidence o f the public as the m edical profession; and it must be willing to accept a n i fulfill the same responsibilities that the m edical profession takes. If it w ill take the re sponsibilities that the m edical profession takes it must also be w illing to sacrifice the time and the energy to learn the sci entific side of the profession as well as m ere ability to use the fingers. There is a grand opportunity now op ening to the dental profession w hich is quite apart from the ability to do mere m echanical work. A splendid opportunity is open to us in hospitals and infirmaries to exem plify the relationship of the mouth to general disease and to general patho logical conditions as such. W e must con stantly keep posted on these lines; we must be fam iliar with all the new discov eries in physiology, pathology, bacteriol og y ; and w ith all the rem edies, meth ods and appliances that m ay contribute to the service of our profession for the benefit of hum anity; and all of which is bound eventually to increase the mental pow er and grasp, and the intelligence and general standing o f the profession in the
estimation o f the public, ju st as a course in the gymnasium increases your physical' welfare. It cannot help it. And for that let us all be thankful; and the things that have brought about these possibili ties, or one of the things, along with the Research Departm ent and other things of that kind are these institutions such as have been described in Rochester, of w hich we now have two. M ay the day com e when w e w ill have one in every city of any size. (Applause.)
,
W m. IV. B e lc h e r D . D . S
., R ochester , Ar.
V.
A s the w riter has been so closely iden tified with the w ork of the establishm ent and conduct of the free dental dispensary movement in R ochester, he suffers from a lack o f perspective and with all respect to the Chairman who made the selection, the least suitable person to intelligently discuss such a paper. The essayist has touched on the expect ed activities o f the new Dispensary and in so doing has given a too brief mention of the fact that in R och ester we w ill have a com bining o f the best points in the Forsyth and the w ork o f Dr. Fones at Bridgeport, Conn. The amount of m oney appropriated by the city of Rochester, $20,000.00, is to pay for the service o f a trained corps o f lady hygienists who w ill give prophylactic treatments to all public and parochial school children in the first five grades, combined with lectures on oral hygiene, tooth brush drills, and exam ination and treatment three or fou r times each year. It is expected that much preventive work will be accom plished w hich w ill rem ove the need of service at the central dispensary. The city of R ochester is in the happy position of having a w ell organized body called The United Charities, w hich is a clearing-house for inform ation as to the worthiness of all applicants for free service or aid. Forty different organiza tions, including churches, aid societies, and such bodies as the R och ester Dental
BU RK H AK T.— PROPOSED W O RK A T EA STM AN D ISPENSARY.
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Society, are mem bers, and freely furnish inform ation w hich is tabulated and sup plied to the different organizations. If necessary, special investigation is made and a report forw arded to inquiring mem bers as to the w orthiness or unworthiness
properly should be a burden o f the state. It should not be necessary for a few in dividuals and the m edical profession as a. whole to bear the burden o f these eco nom ic conditions. In the older cities and countries of Europe, it is w ell recognized
of each applicant, and this dispensary abuse is obviated in a degree. In the good old days, the physician in the small place, at least, had a feelin g
that the state must care for those persons who are ill and im provident, and various types o f industrial, health, and unem ploym ent insurance associations have been devised. “ In Am erica, we are rapidly com ing to
that he was a public servant and it was his duty to respond to any call whether he received com pensation for it or not; to refuse a call from a poor patient was a sin w hich could hardly be forgiven. Today, with the grow th of our large cities, the endowed hospitals, and dispen saries, the increase of specialties, the de velopm ent o f the trained nurse and the various social agencies, all this has changed. The old-fashioned kindly feel ing has passed away, and except fo r dis tinctly personal reason practitioners re fuse service to undesirable unremunerative patients. The feeling o f respect and confidence in the physician, aye, and even the dentist, is rapidly disappearing, and he is regarded by an increasing number as one who is likely to take advantage of their necessities. A s a result, only the very poor who go to the public hospital or dispensary, or the very rich, receive the best m edical or dental service. The essayist has stated that with the head o f the fam ily receiving a wage of $3.00 to $4.00 per individual per week, service would be refused at the R ochester Dental Dispensary. In the line of recent investigation, it would seem that this would shut out many deserving fam ilies. The follow ing extract is taken from a recent article by Borden S. Veeder, M. D., St. Louis, appearing in the issue o f July 8th, 1916, Journal of the A m erican M edi cal A ssociation: “ In an attem pt to m eet the results of econom ic conditions, persons are often forced to accept private charity for what in reality is society’s duty as a whole, and
this point of view, and in January, the present year, a bill was introduced into several of the State Legislatures thru the efforts of the Social Insurance Com mittee of the National A ssociation for Labor Legislation specifying com pulsory health insurance for all fam ilies earning less than one hundred dollars a month. W ithin the next few years, it is expected that such a bill w ill undoubtedly pass many of our State Legislatures, and un til1 som e such form of insurance is estab lished, the free clinic is apparently the only solution o f the problem which w ill furnish an efficient type of service at the low est possible cost to those persons who are deserving of free treatment. “ In setting a financial standard, there is a certain minimum figure or incom e below w hich there can be no question as to the financial suitability o f an applicant for treatment. In a broad aspect, this figure should be one w hich allows fo r a decent standard o f living and includes adequate food, clothing, and shelter, for without these three things health will suffer and the race w ill undergo physical degeneration. “ There are tw o methods of obtaining fam ily budgets. One o f these is to figure out theoretically the least a fam ily o f a given size could live on. This method^ tho frequently used, is inaccurate. The second m ethod does away with theory and ascertains the cost of living by tab ulating the actual budgets or amount spent by fam ilies of different sizes. “ In many respects the m ost valuable
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study in this line was made by Chapin* nine years ago. Altho his actual figures are in many respects no longer of much value, because o f the subsequent in crease in the cost of living, the m ethod used has served as a model for subse quent investigations. His figures are based on the so-called “ norm al fam ily” of five persons; a w orking man, the woman at home, and three children under fifteen years of age, and were o b tained by com piling the actual figures of a large number of fam ilies in regard to the incom e, and the detailed expendi-. tures fo r food, clothing, lodging, heat and fuel, insurance, health and sundries. His conclusions w ere that from $600.00 to $700.00 a year incom e is wholly inade quate to maintain a proper standard o f living; with an incom e of $700.00 to $800.00, a fam ily can barely support it self. H is final conclusion is that an in com e of $825.00 a year is barely sufficient for the average fam ily of five to main tain a proper standard of living in New Y ork City. “ It is thus show n that a “ norm al fam ily” is just able to eke out a norm al liv ing on $800.00' providing no em ergency such as ill-health arises. These figures are for 1907, and since that time the cost of living has increased som e 16%. “ The New Y ork State Factory Investi gation Com m ission using Chapin’s meth ods, and the New Y ork City Board of Estimates, w hich studied the cos.t of liv ing for unskilled laborers, recently issued reports, the conclusions of which are that $876.43 and $840.18, respectively, are the necessary incom e for the maintenance of the average fam ily of five in the city of New York. A table is here given of the conclusions of these two reports and an itemized account o f the expenditures. It includes $21.00 a year for health, physi cians’ and dentists’ services, and m edi cine for five persons. It makes no pro•NOTE— Chapin : Standards o f Living Among Workingmen’ s Families in New York City, New York, 1907.
visions for savings, as the insurance is only burial insurance. “ Cost of living fo r a norm al fam ily in New Y ork: Items
N. Y. S. Board Factory of Estimate Commission Average
$325.00 Pood ..............................$380.00 Rent .............................. 168.00 200.00 140.00 Clothing ....................... 104.00 Fuel and L ight..........................42.00 20.00 Carfare ........................................30.30 31.20 Insurance .................................. 22.88 35.60 Health ....................... .. 20.00 22.00 Sundries .................................... 73.00 102.63 Totals
...................... $840.18
$876.43
$352.50 184.00 122.00 31.00 30.75 29.24 21.00 87.81 $858.30
“ These figures are the yearly wage and are not based on a m onthly or weekly earning, as it has been shown that in many cases the w eekly wage must be 20% higher to com pensate for periods of unemployment. “ A n investigation made in New York City in 1910 o f 745 patients, 672, or 90%, w ere worthy of free treatment. A recent similar investigation covering 1,881 pa tients applying for admission to the B os ton Dispensary showed that only two per cent, w ere able to pay for the services of a private physician. A recent investi gation at the Presbyterian H ospital in Philadelphia, showed that ‘abuse’ was a very m inor factor (tw o per cen t). “ W ashington U niversity Dispensary, St.-Louis, as a result o f an investigation determined that but two patients in ev ery hundred applying w ere not deserving of free treatment. To make an investiga tion that is really worth while, it costs from thirty cents to fifty cents fo r each patient, and W ashington U niversity clinic spends nearly $100.00 a month in the m atter of investigation to avoid this so-called dispensary abuse, w hich is som ewhat larger than is spent by any other clinic in the United States for the same purpose.” In the foregoin g quotation referen ce was made to the “ abuse” of the dispen sary in St. L ou is; and in connection with that I may say that in St. Louis they had three dispensaries located in the negro section. W hen establishing the new
B U RK H ART.— PROPOSED W O R K A T EASTM AN DISPENSARY. m edical buildings, the university and col leges w ere com bined in one, and they discovered that the class of patients that w ere com ing to this new dispensary were entirely a different class, who w ere ap parently prosperous; further, the service that was being rendered was considerably more than three tim es the amount that had been given in the free dispensary; so that an attempt was made to find out what other cities had been doing as to investigating patients who cam e in for dispensary treatment. Only ten per cent, o f our population is said to have an incom e o f one thousand dollars a year, and it is clearly shown that a fam ily of five with an incom e of less than this amount, cannot pay for m edical or dental service. Only ten per cent, of the people in Am erica are patro
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nizing the dentist. Perhaps this is all that can really afford to do so under present conditions and circum stances. The higher dental fees are placed (and it would seem necessary to place them higher in order to provide the latest and best dental service) the few er people are to be b en efited.. Certainly, if one is to avail him self of the best service of the dentist and physician he must have an annual incom e o f several thousand dollars. R obert Grant, in an article that ap peared in Scribner’s M agazine, a number o f years ago, described a certain stage of poverty as follow s: “ You know the kind of fam ily I mean, where the den tist’s bill is an unexpected calam ity.” Yes, we know them R obert; the woods are full of them.