An Epitome of the History of Medicine

by Roswell Park

Another most valuable American invention was that of taking impressions by the use of plaster. This was introduced about 1844-'45. This method permitted the making of socket-plates, which, of itself, was a long step in advance.

So much for a very brief epitome of some of the most interesting facts in the history of dentistry. Did time permit, the matter would warrant treatment at much greater length. But what now is to be said of the condition of dentistry to-day? First of all, that it is no longer relegated to charlatans and itinerants, but is studied, practiced, and honored by men of the ablest minds and of the highest type. There is to-day scarcely any branch of applied science which calls for greater qualifications or for greater combination of mental endowment and manual dexterity than does dentistry. We, in New York, find ourselves now in position where the State has assumed not only to regulate the practice of dentistry, but even to pass upon the qualifications of those who propose to study it. In the assumption of this task by the State there is paid, perhaps, the greatest possible compliment to its dignity and to its importance.

The great field of medicine is now altogether too vast, and the various branches which pertain to it are too complex, to permit a mastery of all its details by any one mind. The man does not live who to-day can be considered facile princeps in more than a few departments of medicine. Life is too short to permit of it, and the study is altogether too extensive. There is also a growing public demand for specialization of work, and there is probably more excuse for the perpetuation of dentistry as a specialty than for almost any other branch. Nevertheless, it is necessary constantly to repress a tendency toward a failure to comprehend the general principles underlying all medical specialties, and it has been hard, at least until recently, to impress upon the men of the dental profession that they were really only practicing a branch of medicine, and that, in disregarding a general and comprehensive knowledge of the fundamental branches, they were but poorly preparing themselves for the practice of a dignified specialty. Certainly dentistry makes as many demands for mechanical training, digital dexterity, familiarity with the properties of materials, etc., as does. surgery, and in some respects even more. Of course, to a certain extent in these respects it is like a mechanical trade. The great trouble with the dental profession, until very recent times, is that they have regarded their work too much as a trade and not enough as a profession. By taking the latter view of it the work is ennobled and their interest for it cultivated. By taking the trade view of it they have lost those finer features which lift mechanical work out of the mere level of a trade. Moreover, men in time past have been guilty of altogether too much trades-union tactics, which are vehemently opposed to professional ethics, and this has been another feature to degrade rather than elevate dentistry.

This has been indeed a great misfortune, for men have been misled by the need for cultivation of their hands, or their manual powers, and have been persuaded away from a finer study of fundamental principles upon which the whole practice of dentistry should be based. And so it has happened that men have been so ambitious to become perfect operators that they have neglected anatomy, physiology, chemistry, and pathology, have even neglected odontology, sacrificing everything else to their work as mere artificers.

If one scrutinizes the subject properly, there is no reason why there should not grow up a class of men fitted to attend to any lesion of the mouth or of the parts adjoining. In other words, there is no reason why there is not more excuse for true oral surgeons than there is for any other class of specialists, save possibly those who treat the eye. Aural surgery, nasal surgery, pelvic surgery, rectal surgery, etc., are simply voluntary limitations and applications of general surgery to special parts; but he who attends to the teeth has to do so much work of a character which the surgeon is not called upon to perform in any other area, that I have always claimed the oral surgeon deserved a place, as he had a field, by himself. Nevertheless, the knowledge which shall fit a man for such work is not to be obtained in the ordinary dental course, nor in three years of study, even under the best of auspices. The man who would be an ideal oral surgeon must be not only generally familiar with anatomy and physiology, but must thoroughly know the embryology of the face and teeth, the physiology not alone of the organs of the mouth, but of all the secreting glands and the chemistry of all their secretions; not only the anatomy of the cranium, but general anatomy as well, and even comparative anatomy. He must be well informed in the explanations of all the congenital defects met about the face and mouth; he must be familiar not only with the ordinary principles of pathology and bacteriology, but he will find in the fluids about the mouth such a fertile opportunity for bacteriological study that, be he ever so expert or erudite, he has still much left to investigate in this direction. There is no disease-germ with which he can afford to be unfamiliar, and, as any form of tumor may be found in or about the mouth, he should be familiar with the entire subject of tumors and their surgical treatment.

Then, again, he must be familiar not only with the physical properties of metals and the various materials used in plastic dentistry, nor expert alone in the operations about the teeth, but, inasmuch as he has to cope with various wounds, injuries, and operations about the soft parts, he must be thoroughly familiar with the principles of wound-healing; with the causes of sepsis and the agents which produce it, and the means of avoiding it; in other words, he must have a general training in operative surgery, and, according to my ideal, which may be high, he should be a man able to do almost any operation in surgery before he limits himself to surgery of the mouth. Unless he have this ability, he will not do such operation as well as a general surgeon can, because the underlying principles are the same, and the latter will have the greater command over them.

When, then, this perhaps ideal man has become thoroughly familiar with the principles of surgical anatomy, operative surgery, surgical pathology, and bacteriology, in addition to the things already mentioned, then, and not until then, may he and should he assume to operate for harelip, cleft palate, cancer of the tongue, and various other lesions in the parts about the mouth.

I wish I could say and demonstrate more to impress upon you the important bearing of modern surgical pathology to dentistry. Perhaps I can give you no better illustrations than you can see in the studies and writings of Prof. W. D. Miller, of Berlin, of whom I am proud to say that he is an American, and that he is the only American occupying a professorship in a German university. In his studies on the causes of dental caries and upon the bacteria of the mouth he has identified and named nearly a hundred species of the bacteria, many of which he has shown to be the active causes of dental decay. He has done, then, for dental pathology in this direction what other eminent observers have done for the processes of suppuration and ulceration in other textures and tissues, and has helped to show that they are all evidences of pernicious germ activity. By his researches, also, upon inflammation in elephant-tusks, and the results of injury, mainly by bullet wounds, he has shown us that the phenomena attending these changes in dental tissues are practically identical with those in bone. His researches have done very much to explain the pathology of that common disease, pyorrhoea alveolaris, which is known to be but one expression of local infection, while the possibility of migration of infectious organisms and of metastatic lesions in other parts of the body, having their origin in infectious disease in or near the teeth, has been brilliantly demonstrated by his interpretation of well-known clinical facts.

That American dentists are most highly regarded abroad is more than a matter of every-day knowledge. It has got to be so now that a foreigner will purchase instruments of American make, and then advertise himself as an American dentist for the purpose of getting business,—a purpose in which, as a rule, he is quite successful. But let me stop here to do honor to another American dentist who is more highly honored abroad than one ever can be at home, and of whom it might be said, perhaps, that he has had more friends among the royalty and nobility of Europe than any other man of his time. This is Dr. Evans, who has lived for years in Paris, who was the personal friend of Napoleon III and the trusted guide and companion of the Empress Eugenie when she fled from Paris. While it may be said of him that the qualities that made him so universally popular were personal qualities, rather than professional knowledge, it must be said in reply that it was his eminent professional attainment which first brought him such influential friends.

But time presses, and I want, before closing, to say a little about dentistry in America. It was about 1835 that Dr. Harris, then residing in Baltimore, though born near Syracuse, conceived the modern idea of the scope and practice of dentistry. He was ambitious to put the dentists of his time upon a higher professional level, and to make of dentistry a specialty in medicine. He applied to various medical schools to found dental chairs, and to teach oral pathology along with dental mechanics, as one of the branches of medicine, the graduating degree to be M.D., as with other medical specialties. But the men of his time were so short-sighted and of such constricted mental calibre, and the dentists were so uneducated, that the Baltimore schools declined. He therefore established a separate school, being forced to take this step. This school was the Baltimore College of Dental Surgery, established in 1839,—the first in any country. The dentistry of that day was crude, and its teaching was comparatively inefficient. It was not until six years later that the next, the Cincinnati College of Dental Surgery was organized,—in 1845. Then, in time, followed Philadelphia. But all these colleges were separate institutions, teaching only those branches which it was held necessary that a dentist should know and having very little of medicine in their curriculum. They conferred the degree of D.D.S.