Journal American College of Dentist

SEPTEMBER 1957 / VOLUME 24 • NUMBER 3
JOURNAL
4I,etitAm6&ye orY)4t4
Published Quarterly for General Circulation

by The American College of Dentists
$5.00 a year • $1.50 a copy

Journal American College of Dentists
Presents the proceedings of the American College of Dentists and such
additional papers and comment from responsible sources as may be useful
for the promotion of oral health service or the advancement of the dental
profession. The JOURNAL disclaims responsibility for opinions expressed
by authors.
Published four times a year—in March, June, September and Decem-
ber—at 1201-05 Bluff Street, Fulton, Missouri. Editor: Alfred E. Seyler,
18557 East Warren Avenue, Detroit 36, Michigan. Business Manager:
0. W. Brandhorst, 4221 Lindell Boulevard, St. Louis 8, Missouri.
Second-class mailing privilege authorized at the post office at Fulton,
Missouri.
Entered in the Index to Dental Literature.
Objects
The American College of Dentists was established to promote the ideals
of the dental profession; to advance the standards of efficiency of den-
tistry; to stimulate graduate study and effort by dentists; to confer Fel-
lowship in recognition of meritorious achievement, especially in dental
science, art, education and literature; and to improve public understand-
ing and appreciation of oral health service.
Teacher Training Fellowship

Recognizing the need for more dental teachers and their proper train-
ing in educational procedures, the Board of Regents in 1951 established
a fellowship program for the training of teachers of dentistry. The fel-
lowship grant covers a period of one year in the amount of $2500.
Grants-in-Aid
Because of its interest in research, the Board of Regents in 1951 estab-
lished the following grant-in-aid funds:
(a) The William J. Gies Travel Fund, through which grants are made to
research workers "to enable them to visit the laboratories of other investigators
to obtain first hand information on associated problems."
(b) Research Fund for Emergencies, available for aid in the event of loss of
equipment, animal colonies, needed repair and the like.
For application or further information apply to the Secretary,
Dr. 0. W. Brandhorst, 4221 Lindell Boulevard, St. Louis 8, Missouri.
Journal American College of Dentists
Published Quarterly for General Circulation by the
American College of Dentists
Volume XXIV September, 1957 Number 3
CONTENTS
American Academy of the History of Dentistry 131
President's Address, William N. Hodgkin 131
The Significance of the Fauchard Manuscript, George B. Denton 136
Thomas William Parsons, Jr., Arthur H. Merritt 146
Our Recorded and Unrecorded History, E. S. Khalifah . . 150
The Research Institute of the History of Dentistry of Berlin—
Curt Proskauer 158
The Fourth Dimension of Dental Education, Willard C. Fleming,
D.D.S. 163
Calendar of Meetings 175
Ethiconomics 176
Convocation Program 178
The American Association for the Advancement of Science, Geo.
C. Paffenbarger, D.D.S. 180
Prepayment Group Dental Care, Harold J. Noyes, D.D.S., M.D. 208
Writing Award Competition 214
Sections, American College of Dentists . . 216
Copyright, 1957, by American College of Dentists
Board of Editors (1956-1957)

ALFRED E. SEYLER, D.D.S., Detroit, Mich., Editor
Officers and Regents of the College, Ex-Officio
Contributing Editors
WILBUR McL. DAVIS, Orlando, Fla. (1957) ELIAS S. KHALEFAH, St. Louis, Mo. (1959)
RALPH L. IRELAND, Lincoln, Neb. (1957) J. C. ALMY HARDING, Calif. (1960)
FREDERICK H.BROPHY, New York City(1958) CHESTER V. TOSSY, Okemos, Mich. (1960)
J. MARTIN FLEMING, Raleigh, N. C. (1958) ROBERT A. COLBY, Navy (1961)
Jouw E. BUHLER, Atlanta, Ga. (1959) Wm. P. SCHOEN, JR., Chicago, Ill. (1961)
OFFICERS, 1956-1957
President Treasurer
GERALD D. TIMMONS WILLIAM N. HODGKIN
Temple University Warrenton, Va.
School of Dentistry
Philadelphia, Pa. Secretary
President-elect OTTO W.BRANDHORST
ALFRED C. YOUNG 4221 Lindell Blvd.
121 University Place St. Louis, Mo.
Pittsburgh, Pa.
Historian
Vice-President JOHN E. GURLEY
THOMAS J. HILL 350 Post St.
Brecksville, Ohio San Francisco, Calif.
Editor
ALFRED E. SEYLER
18557 East Warren Avenue
Detroit, Mich.
REGENTS
HENRY A.SWANSON S. ELLSWORTH DAVENPORT, JR.
1726 Eye St. N.W. 654 Madison Ave.
Washington, D. C. New York, N.Y.
AUSTIN T. WILLIAMS DONALD W.GULL=

70 Washington St. 94 Coldstream Ave.
Salem, Mass. Toronto, Can.
HAROLD J. Nos
JACK S. ROUNDS 611 S.W. Campus Drive
3875 Wilshire Blvd. Sam Jackson Park
Los Angeles, Calif. Portland, Ore.
EDGAR W.SWANSON SAMUEL R.PARKS
25 East Washington St. 1505 Medical Arts Bldg.
Chicago, Ill. Dallas, Tex.
130
THE AMERICAN ACADEMY OF THE
HISTORY OF DENTISTRY
Annual Meeting, San Francisco, October 14, 1955
In the following section of our JOURNAL we present five addresses

which constitute the program of the 1955 meeting of the Academy,
in addition to a paper presented by Dr. John B. Saunders "Califor-
nia's Fantastic Medical Profession," published by the Los Angeles
Corral in The Westerner's Brand Book.
JOHN GURLEY, Historian
President's Address
WILLIAM N. HODGKIN
Warrenton, Va.
More years ago than one cares to remember, a young man en-
countered in the records of present Essex County (old Rappahan-
nock), Virginia, a will probated in 1673. Ill equipped at the time
with a general comprehension of history, harboring only rosy ideas
of the sumptuous environment and grandeur of the luxury loving
FFV's as gained from many a novel and other story, and doubtless
hoping to find stimulating evidences of such luxury in his own
background, he read:
"In the name of God Amen, I, William Hodgkin, of Rappahannock in
Virginia, being bound for England and the danger of the sea to undergoe,
having my perfect sense and memory, doe make this my last will and testament,
etc."
Following this usual introductory passage, and after bequeathing
his soul to Almighty God, the testator's bequests from his temporal
estate were disappointing to say the least to the highly expectant
and poorly oriented young reader. There were, for instance, items
such as one ewe and lamb to the eldest son, one heifer to the
youngest son, a bay mare to a brother-in-law; and the sparse furni-
ture, bedding and household utensils, with the remaining estate
in Virginia, to his loving wife, Phoebe Hodgkin. About the only
sop to vanity was found in the bequest of a bay mare and colt "unto
131
132 JOURNAL AMERICAN COLLEGE OF DENTISTS
my servant, John Booles" and "500 lbs. of tobacco unto a minister

chosen by my executrix to preach a sermon in remembrance of me."
The further scant records of legal transactions of this testator—
such as the 1660 purchase of four oxen from his neighbor, Colonel
Moore Fauntleroy—likewise were of such humble and small nature
as to be unimpressive to a youthful mind thinking in terms of
the lush Eighteenth Century rather than of the hazardous and
austere Seventeenth Century background into which his findings
properly should have been placed. That a later and sensible scan-
ning of contemporary wills naturally brought a reasonable orienta-
tion by acquaintance with the simple and scarce personal property
common to all the settlers is but dim in memory, so clearly is the
initial disillusionment recalled.
The young reader, as you have anticipated, was the present
speaker. Has not his early experience of deflating disappointment,
through ignorance of contemporary background, often been re-
peated by the beginning and casual reader of dental history?
Dental practitioners of the past appear to have been peculiarly
prone to fall into the same faulty interpretation. It was common
experience until lately to encounter practitioners who manifested
concern and discontent as to their status and prestige in the family
of professions. Fortunately, and due largely to recent and helpful
emphasis on our history, the encounters are markedly less frequent.
Yet, if such concerned individuals exist in any appreciable number,
it would appear that we have failed lamentably in one phase of
orientation of those entering the profession. It seems possible that
in concentrating on development of the highest clinical standards
we may have overlooked the tremendous cultural advantage of
dental history in orientation of the individual toward an attitude
of self respect as a suitable foundation on which to build a whole-
some group prestige.
A valid evaluation of any dental historical material, quite beyond
an appropriate placing in its contemporary general setting, falls
of necessity in perspective against the period background of its
older sister of the healing arts. Comprehensive study reveals that
the dental profession has run a course somewhat parallel with that
of medicine; naturally not so broad in its scope of service, and
therefore not of as prompt prestige in community life, but never-
theless a reasonably parallel course in its more restricted field.
Actually, any phase of either profession is but an accurate index
AMERICAN ACADEMY OF THE HISTORY OF DENTISTRY 133
to the national cultural level of the period examined. The con-
trast is that medicine long has studied all phases of its history with
objective and appreciative interest, whereas the concerned indi-
vidual in dentistry has apparently sought a studied evasion of
dental history as if fearful of its story. He fits aptly to the poet's
observation of the inherent inclination of the man of high achieve-
ment to "despise those rungs by which he did ascend."
In view of the frequent reference to dentistry as a young and
fairly recent profession, it may be as well to address ourselves to
first things first and to consider just when the practice of dentistry
actually began. On being asked such question, your speaker be-
lieves himself accurate in responding that the practice of dentistry
began when the first human suffered a toothache. Some nearby
individual, with a temerity prompted by sympathy and a natural
inclination to experiment, surely sought somehow to relieve his
pain—however irrationally or futilely. Moreover, that there likely
was a long period of such ministrations by volunteer laymen before
the existence of recognized practitioners of the healing arts and
the incorporation of dental treatment into medical practice. Then,
to the original question, finally responding that dentistry in its
present development as an autonomous profession is largely, but
distinctly, an American accomplishment—an accomplishment cred-
ited throughout the world, even among those leaders of variant
ideologies who scoff at the social and political advances of the United
States.
As previously noted, much of erroneous interpretation in dental
history may be attributable to the examination of remnants of
artifacts of a period, usually the most unsavory remnants at that,
with no study of the contemporary setting from which they are taken
but contrasted solely with standards of today. A more knowing and
faithful interpretation, however, would suggest that the rolled foil
from Dutch ducats and the improvised instruments of the early
practitioner, for instance, be studied against the background of the
spinning wheel and the walnut-stained home-spun, among other
improvisations of the time, just as the carefully prepared filling
materials, accurately designed armamentarium and well appointed
operating rooms of today appropriately are studied against the
associated finely spun and gaily colored products of the modern
textile plant. Drawings and etchings of crude extractions or descrip-
tive bits of operative procedure are noted with revulsion but often
without the realization that in the Middle Ages a large portion

of the practitioners of the healing arts practiced their art on the
street corner and in the market place.
Again, in our own Colonial period are we prone to read the
precious bits of dental history as preserved in newspaper announce-
ments—frequently the only clues to identity and the movement of
these desultory individuals—and unwittingly regard them as un-
worthy progenitors because of immediate contrast with clinical
and ethical standards of today? For a true perspective some of the
crudities of Colonial life must be borne in mind.
Resorting thus to Virginia conditions—with an admitted provin-
cialism enforced by limited acquaintance—a fair picture scarcely
can be gained by reading alone from the Virginia Gazette that
Dr. John Baker, on his arrival in Williamsburg in 1772, announces
that his Anti-Scorbutic Dentifrice will "eradicate the scurvy, be it
ever so bad." It is well, for more accurate evaluation, to scan
accompanying press announcements, and note in the same issues
that Dr. John Tennant's Rattlesnake Root is advanced as a panacea
for all the fevers and ills of the Tidewater country, or a prominent
attorney advising that he "intends to collect more money or do less
business." Many contemporary news items will yield the realization
that a dental announcement at which many might now be disturbed
was in perfect keeping with the forthright and often crude customs
of the day. In truth, both Drs. Baker and Tennant were highly
esteemed in the Colony and each of such interest as to be the sub-
jects of biographical studies.
Nor is it broad historical perspective to look askance at the
guarded operative procedures and process patents of the early dental
practitioners without some knowledge of the Vaccination Trust
with which medicine was beset over the same period. We have a
ready ear for the cry of the prominent early dentist against the
"gasconading charlatan" without hearing the like plaint of the
contemporary high-minded physician against the "quacks, arcanums
and bedside banditti."
Were it not that dental historical papers must of necessity be
condensed for accommodation to the limited pages of our journals,
one might advocate a fairly frequent tying-in of dental items with
some well-known milestone of contemporary general history. Thus,
to relate the dental services of Dr. Benjamin Fendall to the Lees
of Stratford prior to 1781 is to record merely a cold figure scarcely
registering with the reader, whereas to associate those services to

the year of the surrender of Cornwallis at nearby Yorktown seems
to lend it more warmth and meaning in ready orientation.
The pioneers who later pushed Westward doubtless fared even
worse in attention to physical ills, dental included, than their
settled brethren; armed usually only with a copy of one of the
standard books on household medicine and remedies, occasionally
attended by a venturesome health practitioner who sought more
exciting and promising territory for his recorded therapy of "Bleed,
Blister and Purge."
More basic than any of the problems encountered by the pioneer
was that of health. Unless the settler survived, all other problems
were relegated into insignificance; he simply never got around to
them. Dr. Nathaniel Potter, one of the editors of the Maryland
Medical and Surgical Journal, writing of the Western country, re-
ported the heavy incidence of every affliction then known to man and
susceptible of diagnosis, save that of hypochondria. The ever mov-
ing horse and buggy dentist of the day fitted perfectly into the
picture of restless and precarious living.
If there were lacking here an abiding conviction that medicine is
one of the noblest endeavors in which man may engage, the above
use of the medical background might be held as in questionable
taste. Yet, there is the strong persuasion that dental history is
meaningless save against that coincident medical and general cul-
tural setting.
It would be difficult to measure the results of a succession of
papers devoted to the objective, yet appreciative, study of phases of
dental history—particularly in view of the higher level of scholastic
achievement and obvious advantages of the entering dental student
of today. Not, of course, repeating to him the greatest fallacy in
history—that the dental practitioner until recent years was but a
craftsman—and part blacksmith at that. Rather, acquainting him
truly of that nucleus of great and cultured figures who built the
American dental profession through the generations, and who would
have graced any noble calling, despite a general inaccurate appraisal
resulting from a number of untrained men who pretended and
obtruded for profit.
The Academy has a most promising and useful role as the
medium of stimulation in its objectives to present dental history
in its proper perspective.
The Significance of the
Fauchard Manuscript
GEORGE B. DENTON
Chicago, III.
The significance of the Fauchard manuscript is largely biograph-

ical and bibliographical rather than historical. It in nowise alters
the position of Fauchard's book as the pioneer and most important
work in the professional history of dentistry. It throws some light
on the relation of the author to his work and gives information
on the way in which the book was written and published.
Somehow the manuscript came into the possession of J. R. Duval,
the most learned dentist of his era, who was greatly interested in
the history of the profession. Born in 1759 only a few years before
Fauchard's death, he could not have received it directly from the
author, and it is likely that the manuscript remained with the
printer and was not returned to the author. Dagen,1 the historian,
suggests that it is probable that the manuscript was preserved by
the publisher of the third edition and by him passed on to Duval,
but there is no reason to assume that the publisher of the third
edition should have had the manuscript of the first edition.
A note on a fly leaf of the manuscript indicates that Duval gave
the manuscript to his grandson Rene Marjolin, also a dentist and
physician. In this inscription Duval refers to himself as a member
of the Royal Academy of Surgery since 1813; therefore this is the
earliest date at which the manuscript could have been passed on
to Marjolin. The note is written in an extremely shaky hand—a fact
that suggests that the writer was very old. Duval died in 1854, at the
age of 95, and it would seem likely that the presentation of the
manuscript was near that time.
Later it passed into the possession of the Faculty of Medicine
of Paris. In 1892 it was discovered in the library of that school by
George Viau2 who mentioned his discovery briefly in the pref-
ace of a book published at that time. A full description and dis-
cussion of the document was given by him in 1923 on the occasion
of the bicentenary celebration of the completion of the first manu-
script version of Fauchard's book.
136
The manuscript in the Faculty of Medicine of Paris has been

examined and studied with more or less thoroughness by only three
persons; namely, Viau, B. W. Weinberger3 in 1924, and Georges
Dagen in 1931. Each of these has written brief articles on the manu-
script. In 1935, in a paper read before the Medical Library Asso-
ciation,4 I had occasion to discuss the Fauchard manuscript, basing
my comments on the accounts given by the aforementioned authors
and on the facsimiles of a few pages of the manuscript published
by Weinberger and Dagen. At that time I concluded that, "What
is known of the manuscript proves, whatever else, the need of
photostatic reproduction and a close textual study." Judging from
the comments of the men who had examined the manuscript, and
especially Weinberger, I was convinced that it would be difficult
to persuade the Faculty of Medicine of Paris to allow any sort of
copy of the manuscript to be made, and therefore did not attempt
to secure the reproduction which I felt was needed. When, in 1951,
I learned that Dr. Harold Hillenbrand was to attend the meeting
of the Federation Dentaire Internationale, I suggested to him that
he might use his influence to secure a copy of the manuscript. As
a result, the Federation Dentaire Nationale of France had a micro-
film of the manuscript made, which in 1952 was presented to the
Secretary of the Association, along with the two-volume, first edition
of Le Chirurgien Dentiste, Fauchard's work, published in 1728.
The present paper is a preliminary study of the manuscript as
it appears in this microfilm.
The writers who have commented on the Fauchard manuscript
from a first hand study and from various conjectures about it,
have offered numerous opinions with regard to what the manu-
script is and what it represents. Some of these statements should
be reviewed and re-evaluated in the light of a new study of the
document.
First of all, the physical nature of the manuscript may be de-
scribed. Viau has pointed out that the manuscript is made up of
a number of unbound sewed fascicles numbering about 400 sheets,
approximately 13 inches high and 9 wide, with a margin of about
one third of the page on the left. The leaves are written on both
sides. Writing in 1924, Weinberger described the manuscript as
"a large leatherbound volume of 400 pages," and Dagen declared
that the manuscript was bound shortly after publication. From
these variant statements it must be inferred that the manuscript was

bound between the time Viau first saw it in 1892 and the time
Weinberger examined it in 1924.
THE PRINTER'S COPY

The question has been raised by Weinberger as to the stage in
the writing of the book represented by the extant manuscript. He
wrote:
Upon examining the manuscript, I found that it was but a part of the
original edition, and consisted of only the first volume. This puzzled me a
great deal, until after a study and an analysis of the photographed plates. My
observations lead me to believe that this manuscript was that of his original
writings and the part corrected by his medical friends. After five years, having
been in the hands of twenty of his colleagues, it needed a revision and rear-
rangement of material so that it was necessary to recopy all of it, in order that
a printer could easily set it up in type. The second volume, being Fauchard's
own, and not having someone superior to him at the time in prosthetic knowl-
edge, needed no revision, was used by his publisher as it was originally written.
The revised copy of the first volume, as Fauchard originally wrote it, has not
been found.
Weinberger's speculations are plausible, but untrue. The manu-
script bears conclusive evidence that it was the printer's copy for
the first edition. Throughout the manuscript for both volumes,
the signature marks have been inserted with the number of the
first printed page, in a hand quite different from other hands in the
manuscript.
(For those who are unfamiliar with bookmaking, the term signa-
ture as used by the printer and bookbinder may be explained.
Signature is the collective term for all the pages printed on one
sheet of paper. The signature marks are letters or numbers placed
at the bottom of the first page of the signature and also sometimes
on other pages for the purpose of indicating how the sheet shall be
folded and the sequence of the signatures in the bound book. Signa-
tures are in multiples of four—usually four, eight, twelve, or six-
teen.)
Since the signatures could be determined only after the type had
been set, it is certain that the printer used this copy.
Why the printer should have marked the manuscript copy with
the signature marks is not clear to me, since the type would already
have been set for a signature before its designation could be deter-
mined. Certain liberties that have been taken with the manuscript
by adding irrelevant comments indicate that the printer did not

expect to return the copy to the author. The suggestion offered by
Dagen that this copy might also have served for the preparation of
later editions is likewise untenable, since the first edition contains
everything in the manuscript, whereas later editions include mate-
rial and modifications not found in the manuscript.
As quoted, Weinberger, in 1925, asserted that the manuscript
was for Volume I only, and I called attention in 1935 to the fact
that Dagen published facsimiles of pages of the manuscript which
belonged in Volume II. An examination of the microfilm repro-
duction of the manuscript shows that all the chapters of both
volumes are present. If any part is missing, it is not considerable.
THE VARIOUS HANDWRITINGS
One of the most important problems that has arisen in regard
to Fauchard's book is the question of authorship. From the close
of the eighteenth century, there have been persons who claimed
that Fauchard was only partly responsible for the work that was
published under his name. These persons have given more or less
credit to Jean Devaux as co-author with Fauchard. This ascription
is based on the assertion of Pierre Sue, the younger, who in 1772,
published a comment on the works of Devaux. This assertion has
been since supported by many commentators on Fauchard.
"Aside from Sue's positive assertion, there are circumstances
which give color to Devaux's participation. Among the published
approbations of Le Chirurgien Dentiste, one by Devaux was not
only the earliest—being written shortly after the manuscript was
first prepared for printing—but also the most descriptive of the
organization and content of the work. This familiarity with the
work, some think, is in itself sufficient to mark Devaux as one of
its authors.
"Moreover, Devaux's reputation and talents as a literary man
among physicians make the hypothesis more plausible. He was a
commentator and translator of earlier works, and is reputed to
have aided other medical men to bring forth their books."4
The problem of authorship has never been conclusively solved.
The various handwritings appearing in the manuscript have been
regarded as important in throwing light on the part played by any
possible collaborators of Fauchard. Viau, and both Weinberger
and Dagen following him, have detected three handwritings in
the manuscript. The bulk of the manuscript is in a regular and

formal hand which has been interpreted, undoubtedly with justice,
as the hand of the scribe or copyist who prepared the manuscript
for the printer just as today a typist would transcribe it for this
purpose. A rather bold irregular hand in passages characterized
by occasional misspelling and incorrect syntax have been ascribed
to Fauchard. A fine scholarly hand, appearing in corrections and
annotations, according to Viau, Weinberger, and Dagen, has been
ascribed to Devaux. To these hands others should be added, cer-
tainly at least a fourth, which belonged to the printer or somebody
in his establishment.
As stated above, most of the manuscript is in the hand of a copyist
or perhaps two or three copyists and there are numerous correc-
tions and additions to this text.
A considerable amount of additional matter appears also in the
irregular hand ascribed to Fauchard. To one who is not an expert
in the French language, these passages do not appear to be any
more incorrect than one might expect of the copy submitted by a
professional man today. They are in a running hand (one word
often connecting with the next) that would suggest a person with
confidence and with purpose and competence. In the microfilm
version of the manuscript, this hand is much easier to read than
any other. A study will be made of parts of the book in this hand-
writing, especially as regards the known dates of the material. In
general, it may be said that these passages are of material which
was added after 1723, when Fauchard says he had a first completed
version of his work ready for publication.
The very finely written annotations and corrections, usually in
the margins of the manuscript and presumably ascribed to Devaux,
appear to me to be for the most part the corrections of one of the
copyists in a diminutive version of his regular hand. There are,
however, numerous detailed corrections of spelling and diction
in a somewhat less condensed and more disjointed hand which
may be that of another person.
There are two types of emendations which, judged by the hand-
writing, may have been ascribed to Devaux. One that occurs in
a few instances is a moderately large, beautiful, curved and shaded
penmanship. This seems to me more likely to be that of a scribe—
not, however, the copyist who did most of the manuscript. The
other type, which occurs in long annotations crowded into the
margin of the page is a microscopic hand with a regular slant.

When it is considered that Devaux was born in 1649 and died
in 1729, some doubt may be cast on the likelihood of his being
the writer of either of these types of writing. He was, at the time,
eighty years of age and died the following year. Such manual skill
at that age is at least unusual.
Dagen was puzzled by certain pecularities in the text. He wrote:
On page 183, the text has been modified as regards style, but the original
text has not been stricken out, and, curiously enough, there is to be noticed
in the second version, interpolated among the lines of the revision, the follow-
ing: "Teeth longer than their neighbors. Monsieur, I have the honor," and
further on also, "Monsieur!"
"What a scribe this is who amuses himself in the text!" Dagen

exclaims. However, he was mistaken in supposing that the inter-
lineations were corrections of the text: they are word for word an
exact repetition of the text. The hand is not that of the copyist,
but it bears some resemblance to it. The obvious explanation is
that somebody, probably in the printer's establishment, after the
manuscript had been set up in type and was no longer copy, used
the scribe's formal hand as an example for a lesson in handwriting.
The added words "Monsieur" and so forth help to confirm this
inference. There are several such instances of copying the text and
adding irrelevant remarks on other pages.
So far as I know, nobody competent to pass on the identity of
the various allegedly different hands has examined the manuscript.
The opinion of a chirography expert is needed. The problem of
handwritings may require a more detailed scrutiny than can be
afforded by the microfilm.
WINSLOW'S APPROBATION
The Approbation of the surgeon Winslow appears first among
the Approbations in Volume I of the published work and also first
in the manuscript. In the manuscript it appears also at the very
end of the document. Winslow was the royal censor and read
Fauchard's manuscript as part of his official duty. The handwriting
of the Approbation at the close of the manuscript appears to be
somewhat different from any other in the manuscript and was
probably written and signed by Winslow himself. Dagen has also
noticed this point and inferred that Winslow's approval was so
placed on the manuscript to give the publisher official permission
to issue the work and safeguard him against action for unlicensed
publication. As it is dated December 8, 1727, Winslow could have
read everything in the manuscript as published, except part of
Observation 4 in Chapter XXXII, in which Fauchard refers to an
incident early in February 1728, and six of the Approbations which
were dated 1728.
DATE OF THE MANUSCRIPT
At the beginning of Chapter XXIV of Volume II, Fauchard
declared that he had been ready to publish his book in 1723. Some
commentators have conzluded that the manuscript was completed,
and without further change, was reserved until publication in 1728.
This can hardly be true, since the book contains a great deal of
material regarding circumstances which occurred after 1723 up to
early in 1728. The basic text in the hand of the copyist, however may
have been prepared earlier, and the later material may have been
added in the hand of Fauchard or a collaborator. It is interesting
to attempt to fix approximately the date when the original copyist
finished his work. A check on the dates of cases published (in
Chapters XXIII-XXXVII of Volume I) shows that the latest date
of a case written in the hand of the copyist is April 5, 1724, and
that the earliest date of a case appearing in the hand of Fauchard
or a collaborator or a second scribe is May 15, 1724. It is likely,
therefore, that the basic manuscript was completed by the scribe
shortly after the April 1724 date. It is to be noticed that the date
of Devaux's Approbation (March 29, 1724) is very close to this
latter date. A considerable amount of the manuscript, probably all
that was written after 1724, is not in the hand of the original copyist.
There is some indication that the original scribe worked on the
manuscript more than once. For instance, the number of cases
in a chapter, given in the chapter heading, will often be corrected
as many as three times, all but the final number being stricken out.
In one instance, Chapter XXXII of Volume I, the original number
of cases was two; then a third case was added in the hand of the same
scribe; and finally a fourth case in the hand ascribed to Fauchard.
The third case, it may be inferred, was added by the scribe at a
second writing, possibly between 1723 and 1724.
ORGANIZATION OF THE BOOK

The order of the parts of the manuscript as it is today is not
significant, for as Dagen says:
. . . since many of the pages have been differently numbered afterwards,
the binder, embarrassed, has sometimes bound together fascicles which are
not consecutive. We have often been obliged to seek a following part in the
midst of the manuscript.
The chapters, however, are numbered as to an earlier position

in the manuscript as well as to their place in the published book.
With the exception of very few chapters in either of the volumes
of Fauchard's book, none of the chapters finally appeared in the
published work at the points occupied by them in the original
manuscript. It is difficult to discover in all cases, where a chapter
stood in the original plan, since the numbers have often been
changed three or four times.. Although the old numbers have not
always been stricken out, the final placing of the chapters has been
indicated in practically all cases in the margin near the chapter
heading, in these words: "This chapter should be chapter so and
so, volume so and so." The handwriting of these directions is
small, light, and rather irregular. It might be that of Devaux.
The organization of Fauchard's published book was for the
most part logical and well arranged. The first volume dealt with
the anatomy and pathology of the mouth with illustrative cases.
There was little of the technique of practice. The second volume
dealt with the technique and was intended for the dentist and
dental student. In the original arrangement of the chapters, as
far as their position can be ascertained, there was little logic. In
two respects, subjects that certainly belong in the second volume
were found among chapters intended for the first volume. These
deviations were:
1. the description of an extraction instrument and
2. four obturators for cleft palate cases.
These chapters, certainly, are definitely technical. Within the
manuscript of the first volume, the order of chapters appears to be
without reason, as for instance when two chapters discussing caries
are separated by at least ten others and when the chapters dealing
with various conditions of the soft tissues fail to follow directly
the general discussion of diseases of the gums.
The earlier arrangement of the chapters, however, may not
always be as illogical as it appears. For instance, the introduction
of the four chapters on obturators in Volume I as originally planned
may be explained by the fact that in the preceding chapter on the
harmful effects of caries on the surrounding tissue, Fauchard in-
dicated that loss of palatal substance may be due to carious teeth.
In the published book, at this point he calls attention to his dis-

cussions of obturators in Volume II, as a means of correcting these
defects.
The order in the manuscript for the second volume is in the
main, fairly logical, although it was considerably altered in the
final version.
The arrangement of chapters in the manuscript is worthy of more
consideration than is given here.
MANUSCRIPT COMPARED WITH BOOK

To what extent the manuscript, in minor details, is at variance
with the published book, has not been ascertained, since a suffi-
ciently close comparison has not been made. But there are at least
two such deviations. At the close of Volume I, the last four words
of the manuscript "in the same field," appear in the published
version, "in this matter." The change neither alters the sense nor
improves the style.
Also the dating of Fauchard's correspondence with the surgeon
Juton, in the manuscript, is at variance with that in the book.
In the latter, both Juton's letter and Fauchard's reply are dated
1727; in the manuscript Juton's letter is dated 1725, and the last
digit of the date of Fauchard's letter is blotted and cannot be
deciphered.
Changes of this sort could be made, of course, after the manu-
script was set up in type.
DEVAUX'S CONTRIBUTION
Of the many marginalia, only one appears to be a criticism of the
text. Having occasion to mention the celebrated surgeon Dionis,
the text gives a lengthy recital of the qualifications and distinc-
tions of that notable. The passage has been bracketed by the com-
mentator and in the margin he has remarked: "This should be
put in a note in order not to interrupt the continuity of the narra-
tive" (la suite du cours). This comment is certainly not a direction
to the printer, but a suggestion for the author, since the reason for
the change is stated. If Devaux, the critic, added anything to the
manuscript, this certainly would be his correction. The note is
written in an uneven hand very much like the marginal notes
at the head of each chapter indicating their proper position in
the book. These facts suggest strongly that Devaux was responsible
for the final arrangement of chapters. It also suggests that he did
not write the chapters himself, for if he had, he would have or-
ganized them in the beginning as they were finally arranged.
SUMMARY
This preliminary study has been productive in clearing up the
following:
1. The manuscript has the complete text of Fauchard's first
edition, 1728, consisting of first and second volumes.
2. It was not a preliminary manuscript, but was the one used by
the printer.
3. The marginalia are either revisions of the text or directions
to the printer; in only one instance is there an apparent criticism
of the text.
4. Although the problem of various handwritings in the manu-
script has not been settled,
a. It is unlikely that any extended passages of the document
are in the hand of Devaux.
b. The considerable sections ascribed to Fauchard's hand are
not impeccable but they are creditable as regards correctness
and style.
c. Many of the emendations, sometimes ascribed to Devaux,
are probably in the hand of the scribe who copied most of the
work.
d. There was probably more than one copyist, one that made
additions after 1724.
e. Somebody in the printer's establishment made notes on
the manuscript, notably the signature marks.
f. Winslow's Approbation at the end of the manuscript is
probably a holograph.
5. There are some slight variants from the manuscript in the
published book.
6. The organization of the work as published is very different,
as regards arrangement of chapters within each volume, from what
it was in the manuscript before revision, and it is notably more
logical.
7. The manuscript reveals nothing that points toward substantial
collaboration by Devaux or anybody else, although of course it
does not preclude that possibility.
222 E. Superior St.
BIBLIOGRAPHY
1. Dagen, Georges. "Etude sur le manuscrit de Fauchard." La Semaine
Dentaire 14:1230-1239, 1932.
2. Viau, George. "The Manuscript of Fauchard." Dental Cosmos 65:823-826,
1923. Also in French L'Odontologie 63:389-395, 1925.
3. Weinberger, Bernhard Wolf. "The Works of Pierre Fauchard (1678-1761)."
Section XII of his "Dental Literature; Its Origin and Development." Journal
of Dental Research 6:351-359, 1924-1926.
4. Denton, George B. "The Most Famous Dental Book." Bulletin of the
Medical Library Association 24:113-123, December, 1935.
Thomas William Parsons, Jr.

ARTHUR H. MERRITT
New York City
In the Boston Almanac for 1852 will be found the names of 75

dentists, who at that time were practicing in Boston. Among these
are the names of two who became famous. One of them, known
wherever dentistry is practiced, is that of William T. G. Morton, the
demonstrator of sulfuric ether as an anesthetic at the Massachusetts
General Hospital, October 16, 1846. The other, Thomas William
Parsons, Jr., almost unknown to the dental profession of the present,
was equally distinguished in his day and generation as a scholar,
poet and translator of Dante.
By coincidence both were born in the same year and the same
month: Morton on August 9, 1819, Parsons nine days later, on
August 18. Among others in Boston who were their contemporaries,
was J. Foster Flagg, the last of the three generations of the Flagg
family, and Nathan C. Keep, founder and first dean of the Harvard
Dental School.
Parsons, Jr., was born in Boston, the son of Thomas W. Parsons,
a graduate of the Harvard Medical School in 1818, who is said to
have practiced both medicine and dentistry in Boston.
At the age of nine, young Parsons entered the Boston Latin
School, famous at the time for its devotion to the classics. Here he
became an outstanding student, especially in Latin and Greek,
graduating at the age of fifteen. Two years later, his father took
him to Europe where he spent a year or more in Italy. Having a
remarkable gift for languages, he soon mastered Italian and became
as familiar with it as with his native tongue. It was during his
stay in Italy that he became enamored with the poetry of Dante,
especially the Divine Comedy.
Very early in life he was recognized as one of the foremost Dante
scholars in this country. It is reported of him that he could repeat
from memory all of the Paradise in the Italian language consisting
of more than 4500 lines.
On his return to Boston he entered the Harvard Medical School
where he continued for a year and a half, leaving without a degree,
following which he engaged in the practice of dentistry. Since
there were at that time no dental schools and no laws governing
the practice of dentistry, it would seem probable that he acquired
what knowledge he may have possessed, in the office of some practi-
tioner of that day—possibly his father. (There being no biography
of Parsons, some things must be left to conjecture.) He appears
to have continued in practice up to the latter part of his life, mostly
in Boston, though he is reported as having practiced in London
for a year or more in the early 1870's, at which time he was made
a member of the exclusive Atheneum Club.
He is usually referred to as "Dr. Parsons" though there is no
record of his ever having received a doctor's degree. Nor is there
any evidence of his having made any contribution to his profession.
From what information is available it would appear that he had
little interest in dentistry beyond that of making a living.
For this he is hardly to be blamed. Dentistry as it is known at
present, did not exist when he entered the Harvard Medical School
in 1837. Moreover, his interests were centered in the literary world.
To this he gave the best that was in him—a scholarly mind, talents
such as are given to but few, plus the publication of four volumes of
verse, insuring him a permanent place in American literature.
Nevertheless, he continued in the practice of dentistry throughout
most of his life, numbering among his patients some of the elite
of Boston.
While a student at the Harvard Medical School, there appeared
a poem by Parsons entitled,"On a Bust of Dante," referred to by an
English poet of that day, Mary Russell Mitford, as "by far the finest
poem that ever left America." It is generally referred to as one of
his best and will usually be found in most American anthologies.
In 1843 when Parsons was twenty-four years of age, there was
published anonymously a small volume of 83 pages bearing the
title of "The First Ten Cantos of the Inferno of Dante, Newly

Translated into English Verse." It was most favorably received,
critics according it "high rank for its nobility of style and its verbal
felicity." James Russell Lowell characterized the translation as one
that "ranks with the best for spirit, faithfulness and elegance."
Seven additional cantos were later added by Parsons. The study
of Dante plus the writing of poetry always occupied first place in
his life.
In 1857 Parsons married Anna M. Allen of Boston, who is said to
have shared his literary interests. It was she who was instrumental
in bringing together his poems which over the years were published
in four small volumes, now long out of print and hard to find.
Among them there is an elegic poem on the death of Daniel Webster
on October 24, 1852—one of the finest tributes ever paid to the
great statesman. The last verse is often quoted as "one of the gems
of American Literature":
"We have no high cathedral for his rest,
Dim with proud banners and the dust of years,
All we can give him is New England's breast
To lay his head on, and his country's tears."
Since Webster's home was in Marshfield, only a few miles south of

Scituate where Parsons lived the latter part of his life, it is possible
he may have known Webster personally.
In another poem entitled "To James Russell Lowell" reference
is made to the use of ether with a footnote stating that it was
"Written just after the discovery in Boston by Morton of the surgical
use of ether." This reference will be found in the following lines:
"For us, to whom a wisely—ordering Heaven
Ether for Lethe, wire for wings, has given . .
Life's all a miracle—and every age
To the great wonder-book but adds a page."
The words "wires for wings" doubtless refers to telegraphy which
came into use almost simultaneously with surgical anesthesia.
By nature, Parsons is reported as having been reserved, sensitive
and deeply religious. He was a life long member of the Episcopal
church and a translator of its litany into verse. It was predicted by
a clergyman of Boston "that he would be honored ages after the
mediocrities who first surpassed him in fame, have been forgotten."
Parsons also had a social side and was closely associated with the
literary life of Boston, numbering among his friends such well-
known poets as Lowell, Longfellow, Emerson and Holmes.
He was one of that small group who frequented the Red Horse
Inn at Sudbury where it is said he spent some of the happiest hours
of his life. Longfellow respected Parsons for his literary talents and
immortalized him by making him the Poet in the "Tales of a Way-
side Inn." He did not tell the stories attributed to him but it is said
"he could have told them and made them live."
Parsons was a literary craftsman who took such pride in his work
that he labored over it, rewriting and polishing it, which explains
why his output was relatively small and his great work on Dante
was never finished. He was apparently indifferent as to the fate of
his poems and equally so as to his repute as a poet. Though urged
by his publisher to make a definitive edition of his poems, it was
never done.
Parsons died at his home in Scituate in 1892 by falling into a well,
following what is believed to have been a stroke.
In 1893 the best of his poems were brought together and pub-
lished in a single volume of 250 pages, plus a companion volume
containing his translation of Dante. It is as scholar, poet, student
and translator of Dante that he will always be known.
When Parsons began the practice of dentistry there was no dental
school, no anesthesia, no knowledge of dentistry as a health service,
and practically no professional organizations. Dentistry as an organ-
ized profession did not exist. Nevertheless he continued in the prac-
tice of dentistry throughout the major part of his life—a scholar
ly,
cultured member of the dental profession who deserves an honore
d
place in the history of American dentistry.
Whatever place Thomas William Parsons will occupy in the
literary or professional world, his place as Poet in Longfellow's
"Tales of a Wayside Inn" will always remain as one laurel that
will never fade.
BIBLIOGRAPHY
1. The Characters in the Tales of a Wayside Inn. Universalist
Publishing
House. John Van Sc.haick, Jr. p. 96.
2. The Dictionary of American Biography. (Scribner 1934) Vol.
14, P. 274.
3. National Cyclopedia of American Biography. 1907 Vol. 5,
p. 359.
4. New York University College of Dentistry. Vol. 10, p. 94.
5. Library of the World's Best Literature. Vol. 19, p. 117.
6. Personal letter, Boston Public Library.
Our Recorded and Unrecorded
History
E S. KHALIFAH
S. Louis, Mo.
What history is and what its objectives are have been variously
is
stated, and these range from Henry Ford's dictum that history
bunk, and Voltaire's (or is it Napoleon's?) "a fable agreed upon,"
past
to Henry Sigerist's scholarly statement that "history is the
seen through the medium of the human mind," and though it deals
with a dead past, it is never dead itself, but "one of the most power-
ful driving forces of life."1
In a sense, the study of history is part of the humanities, which
are "distinct from sciences and social sciences in being centered
r
about the meaning of life to man as an individual."2 In anothe
sense, history may be considered a great discipl ine of the social
sciences.
On the writing of history, Sigerist says that it "is a highly respon-
d
sible task. The historian must submit to the iron discipline impose
upon him by the methods of historical researc h. They set sharp
limits to his interpretations and forbid him to ascribe to an indi-
e
vidual either actions or words unless he has documentary evidenc
for them. . . . The picture he gives of the past must be true, for
or
only true history is fertile; faked history, written uncritically,
frivolously for purposes of propaganda is always destructive. . . .
of
The poet, the novelist, and the dramatist also recreate aspects
the world. They too must be true if they want to be persuas ive, but
they enjoy much more freedom than the historian. They may create
people, while the historian can only recreate them."3
Judged by these strict rules of Sigerist, our recorded dental history
ship
has not often been written critically. In fact, laxness of scholar
and of accuracy seems to find favor with some publish ers and
editors. And when critical reviews of such histories are written , they
ly
are not published. In so doing, we fool only ourselves and certain
of the rest of the world about us.
not the scholars and historians
nce
When a profession restrains and tone's down even the sembla
under
of critical analysis of so-called literature, scholarship sails
false colors, if it sails at all.
To be more specific, I have in mind a history book that was
150
AMERICAN ACADEMY OF THE HISTORY OF DENTIS
TRY 151
published some years ago.4 It was badly written, replete with
errors,
to say nothing of its complete lack of documentation. A critica
l
review of it was prepared by one whose life-work has been
history
of dentistry, and who is better qualified than most of us to evalua
te
historical material. His evaluation of this book was reject
ed for
publication. Had it been accepted and published and then heede
d,
the same gross and inexcusable errors would not have reappe
ared
in later editions of the same book.
In the most recent editions and under his picture, Arthu
r D.
Black is referred to as the contributor of an accompanying
article
on the development of operative dentistry,6 yet nowhere in
the
book could that article be located. Here, Wilhelm Konrad Röntg
en,
after the misspelling of his middle and last names,7 is said
to have
made his epochal discovery at the University of Strasbourg, while
in another chapter Wilhelm becomes William, Konrad and Röntg
en
are again misspelled, the scene of the discovery moves from
the
University of Strasbourg to the University of Wurzburg, Germa
ny,
and Wurzburg is incorrectly spelled "Wurtzberg."
Of Sir William Hunter the book says that he gave his
famous
lecture (on the role of oral sepsis) in 1910;9 somewhere else
in the
book the date becomes 1911.10
The dates for S. P. Hullihen, the so-called father of oral
surgery,
are given as 1810-1857; his medical degree is stated to
have been
acquired from the Medical Department of Washington Colleg
e at
Baltimore, whereas his dental degree is said to be honorary.11
Some-
where else in the book Hullihen becomes Hullien at least
twice,
the dates change to 1828-1895, and both degrees become honora
ry.12
The author tells the reader that Edward H. Angle remov
ed to
St. Louis in 1887; three lines farther on in the same paragr
aph the
date changes to 1895; and, as a Missourian, I object to the
spelling
of Missouri to end with "y".13
To spell Greene Vardiman Black's given name as the color
green,
and to do so repeatedly, though no sin in itself, reveals
carelessness
of authorship which is no attribute of any book.14
These are only a few of the errors which were spotted
at random,
and although some of them are not serious errors, they
all detract
from the weight of authorship which the student of dental
history
likes to attribute to his source of knowledge. Furthermor
e, without
documentation a history book becomes one of opinion.
Yet the publishers say, in a personal communication to
me, that
the book has been completely revised and is a great improvement

over preceding editions; and to compound the insult to scholarship,
the publishers, in their letter, spell "preceding" incorrectly!
The student of dental history laments the preponderance of this
uncritically prepared material and deplores the dearth of studies
of men who raised dentistry to its present professional level. In the
latter, he is somewhat comforted by the fact that dentistry is not
alone in this lack. For only recently, and fifty years after his death,
there was published the first full-length study of Rudolf Virchow,
the pioneer cellular pathologist, anthropologist, and German states-
man of the latter half of the last century.
In another ten years G. V. Black will have been dead fifty years,
and will a grateful profession come forth with a worthy full-length
study of the man to whom American dentistry owes more than it
does to any other single man—living or dead? Nineteen fifty-three
marked the one-hundredth anniversary of the birth of W. D. Miller,
yet there was not a ripple to memorialize the scientist whose theory
of dental caries has not been refuted or basically altered or improved
upon sixty-five years after it was first advanced in 1890. In 1957
Miller will have been dead fifty years, yet not even the learned
Encyclopedia Britannica seems to know that he ever lived or to
have contributed anything to science or dental science. J. Leon
Williams, William Taggart and Greene Vardiman Black are, to
the Encyclopedia Britannica, also unknowns. Of the four Blacks
it lists, one was a Scottish publisher, one an American lawyer, one
a Scottish chemist, and one a British novelist, but G. V. Black is
not among them. There is, however, a fleeting reference to Horace
Wells and William Thomas Green Morton, and others of lesser
light in other fields.
This lack of worthy studies is a handicap also to other historians
than those of dentistry. For example, in the Encyclopedia of Amer-
ican History, a one-volume reference work, prepared by specialists
and experts, and edited by a professor of history, there is, under
the heading of Medicine and Public Health, only this reference
to dentistry:15
"1839-41. Dentistry. Amer. J1. of Dental Science (1839), College of Dental
Surgery (Baltimore, 1840), American Soc. of Dental Surgeons (1840), Ala.
introduced licensing of dentists (1841)."
The biographical section of this encyclopedia contains sketches
of 300 notable Americans, one of whom was a dentist. These 300
American men and women were selected by a group of American
historians, after careful and profound study of the American past
and present, because of their lasting contributions to humanity.
It is gratifying to know that dentistry has been recognized for at
least one such everlasting contribution. Now if you were to be
asked, either collectively or individually, to name the dentist who in
your considered judgment contributed the most to our human
society, it would be reasonable to assume that, though the answers
would vary within a limited range, an agreement amongst you
would not be difficult to reach. But I venture to say that, with due
respect to the honesty of your judgment and to your command of
dental history, none of your selections, not even that of the scholarly
George B. Denton, would coincide with that of the experts, the
specialists, and the observers of the American scene.
Naturally, the question arises: Why the difference? Before at-
tempting an answer, and while you are guessing the identity of the
dentist upon whom greatness has been thrust, I will review that
study,16 the value of which is open to conjecture. My conjecture
is that its value parallels that of the sports writers' selection of the
All-American star team, and merely satisfies our mania for collect-
ing facts, which often border on the ridiculous.
The rules for the selections were ground rules and arbitrary,
with room for exceptions. First, an American was defined to mean
that, prior to 1776, any person who had spent the greater part of his
life in the American Colonies; after 1776, a citizen of the United
States. Naturalized citizens were included only when their contri-
butions post-dated their American citizenship. Secondly, the con-
tribution must have been notable for its time and place and must
have had a measurable impact on American life; it also had to have
staying power. Thirdly, accumulation of wealth was not enough.
The businessman also had to have contributed to organization and
development of industry and commerce, and to public service.
Fourthly, the list had to have a well-rounded representation of the
major fields of human activity. Perhaps that is why dentistry was
included.
Now the results of that study. Two hundred and four of the 300,
came from privileged backgrounds which were not necessarily
wealthy.
One hundred ninety-nine of the 300 had advantages of college
education; 157 of the 199 graduated from college, but there was
no close correlation between high scholastic grades and great achieve-

ment. For example, Louis Brandeis and Douglas MacArthur had
high grades, whereas Franklin D. Roosevelt did not. And some
of these American notables were even expelled from college—James
Fenimore Cooper, John C. Fremont, James Whistler and Mark
Hanna.
Of the 300, only 16 were women, explained by their previous
lack of opportunity for professional advancement.
The majority of the 300 came from rural backgrounds. Only 31
were naturalized citizens. Of these only five came from Southern
or Eastern Europe, because previous to the 1880's most of the
immigrants came from Northern and Western Europe.
Only 84 were self-made notables. Of these three had been slaves,
one with the stigma of illegitimacy, two born out of wedlock, one
was virtually blind, one deaf, one had lost the sight of one eye, two
were victims of tuberculosis, one had a series of nervous break-
downs, one was lame, and another was a polio cripple. And, if I
may add a note of my own, it is not known how many wore bi-focals
or artificial dentures, because no such statistics are available!
These statistics remind one of what 0. Henry once wrote: (Mr.
Pratt talking to Mrs. Simpson)
"Let us sit on this log at the roadside," say I, "and forget the inhumanity
and ribaldry of the poets. It is in the glorious columns of ascertained facts and
legalized measures that beauty is to be found. In this very log we sit upon,
Mrs. Simpson," say I, "is statistics more wonderful than a poem. The rings
show it was sixty years old. At a depth of two thousand feet it would become
coal in three thousand years. The deepest coal mine of the world is at Killing-
worth, near Newcastle. A box four feet long, three feet wide, and two feet
eight inches deep will hold one ton of coal. If an artery is cut, compress it above
the wound. A man's leg contains thirty bones. The Tower of London was
burned in 1841."
"Go on, Mr. Pratt," says Mrs. Simpson. "Them ideas is original and soothing.
I think statistics are just as lovely as they can be."17
The Presidents of the United States—all 33 of them—head the

list of 300, because it was agreed that no one elected in his own
right to the highest office of the land is not notable, regardless of
whether he did anything else to distinguish himself or his office.
Jurists and lawyers came next, with twenty names to their credit.
There were 33 statesmen, 18 military and naval figures; 40 in the
group of belles lettres, philosophy and social sciences; 13 artists;
6 architects, and 6 from the theatre and allied arts. Musicians and
composers numbered 4, religious leaders 14, and educators 14,

among whom is Abraham Flexner, to whom medical education
and, indirectly, dental education, owe a great deal. Social reformers
and labor leaders placed 15; journalists, editors and publishers 8;
pioneers and explorers 10; business leaders 18; inventors 16. Finally
came the scientists with 32, one of whom is William Thomas Green
Morton, the dentist.
It is not my intention at this time to revive the century-old
controversy of who should receive full honors for the discovery of
surgical anesthesia. But dentistry has long recognized Horace Wells
in this field, whereas other historians have favored Morton.
While preparing this paper I was attracted by a book review,
captioned in big and bold type, "Dangerous Dentist." So here, one
thought, was another rare dentist who found an author and a pub-
lisher, and whose biography seems to have merited space in the
Saturday Review.1-8 But, unfortunately, this folklore adds nothing
to the annals of dentistry. Briefly, it is about a legendary figure of
the Wild West, one Doc Holliday, a dentist-turned-gambler who,
because of tuberculosis, ended his Georgia practice in 1872 and
moved West. He stopped at Dallas, where he practiced dentistry,
the handling of cards and of the knife and the gun, and where he
committed his first murder before leaving town in a hurry. He was
chased out of other towns, too, for he was too tough even for the
then Wild West, where he committed other murders and teamed
with one Big Nose Kate, a free-lance prostitute of uncertain last
name. The only dear thing about this book is its price; it retails
for $4.75.
I mention all this simply to illustrate the kind of dental biography
the literary world will read or read about if dentistry were to con-
tinue to neglect the stories of its great men. If the world of history
is indifferent to us, we, alone, are to blame.
For dentistry to discount learning and learned people is to ignore
history. The influence of learning and learned people on civilization
has been tremendous. America of the eigtheenth century had that
respect for learning. John Adams, John Quincy Adams, Ben Frank-
lin, Thomas Jefferson, James Madison, Alexander Hamilton and
John Marshall were only a few of the many who molded the founda-
tion of the United States as a great nation. Woodrow Wilson was
also a so-called egghead. Therefore, the influence of learning in
shaping the destiny of America cannot be discounted. And the
influence of learning and learned dentists who laid the foundation

of modern dentistry should no longer be hidden from the eyes of the
practicing dentist and the world. And unless the world knows more,
and fully and correctly, about the great men of dentistry and their
contributions to human society, the world will continue to be
ignorant of what it is entitled to know. To attribute this ignorance
to the lack of glamour on dentistry's part is to resort to oversimpli-
fication.
One hopes that one day scholarly dental histories and biographies
will be written and will be available to dentists and other scholars.
And when they are written, they will not be the product of chance
or of inspiration handed down from above. They will have to be
planned and commissioned before they are prepared. Scholars and
not dentists-turned-makeshift-scholars will have to prepare them.
And those who will have to plan and commission them are the
official bodies that represent dentistry and its history. This will
constitute a worthy contribution to the humanities, a phase that
dentistry has long neglected.
Do dentists read and will they read their history? My observa-
tion is that dentists do read whenever they are given something
worthwhile to read. That not many dentists read their official publi-
cations, considering the numbers who receive them, is a reflection
not on the dentist but on the quantity and quality of the reading
matter he receives. For whether he reads it or not, he will continue
to receive it and to dispose of it. The source, however, will con-
tinue to supply him with more of the same, because our subscrip-
tions, like the hidden taxes, have to be paid if we want to continue
in the good graces of organized dental society.
The reader—more correctly the recipient—of our official dental
publications, because of his patience and generosity, is entitled to
an occasional and perhaps an annual bonus, or a five- or ten-year
dividend in the form of a scholarly historical novel or a well-docu-
mented history that he may read and enjoy. He will then learn
that he is the beneficiary of professional status, not because of the
techniques and gadgets he exchanges for lucre in a lucrative practice,
but because of the idealism, scholarship and scientific contributions
of those who preceded him. Thus our pioneers, though dead, would
be alive in books and in the memory of humankind.
Volumes have been written on Horace Wells and William Mor-
ton, but one is unaware that these volumes have been critically
analyzed and evaluated. It is time that some impartial historians are
assigned the task of evaluating and synthesizing this material for
arbitration of a needless and fruitless controversy which can and
should be resolved. Perhaps one day we will have books such as
The Discovery of Anesthesia; Greene Vardiman Black and the Rise
of American Dentistry; Willoughby D. Miller, Dental Caries and
Mankind; William Taggart, the Man Who Revolutionized the Prac-
tice of Dentistry; Science, Dentistry and J. Leon Williams. We are
not too old to dream, and I do not think the dream is far fetched.
Having lived for a while in the North Arabian Desert, I am well
acquainted with desert life, its barrenness and its patient camels.
I must also add that even that desert has its scholarly literature, and
has a philosophy sometimes too deep to fathom. Part of that
philosophy is that, while the camel driver has a plan, the camel
also has a plan. But I am not yet convinced that dentistry has a plan
for its history.
If I have bored you I am consoled by the knowledge that I am
not the first dentist to do so at a dental gathering. But I do hope
that I shall be the last.
BIBLIOGRAPHY
1. Civilization and Disease, Henry Sigerist. Cornell Univ. Press, New York,
1943, p. 180.
2. The Changing Humanities, David H. Stevens. Harper & Brothers, New
York, 1953.
3. Civilization and Disease, p. 181.
4. The Story of Dentistry, M. D. K. Bremner. Dent. Items of Interest Pub-
Co., 1939.
5. Ibid. Third edition, 1954.
6. Ibid. Third edition, Photographic Section.
8. Ibid. Third edition, p. 298.
10. Ibid. Third edition, p. 296.
12. Ibid. p. 347.
13. Ibid. Photographic Section.
14. Ibid. p. 409, 410.
15. Encyclopedia of American History, edited by Richard B. Morris. Harper
& Brothers, New York, 1953, p. 542.
16. "Where Success Begins," Richard B. Morris. Saturday Review, Nov. 21,
1953.
17. As quoted by J. A. Gengerelli in "Facts, Thoughts, and Dreams." The
Scientific Monthly, Vol. 80, No. 1. January, 1955, p. 47.
18. Saturday Review, January 29, 1955, p. 28.
The Research Institute of the History
Of Dentistry of Berlin
CURT PROSKAUER
New York
The Berlin Research Institute of the History of Dentistry (For-

schungsinstitut far die Geschichte der Zahnheilkunde) was the first
and until the present time the only one of its kind in the world. It
was partly destroyed in 1944 or 1945 and does not longer exist. I
shall give you first a short survey on the development of this in-
stitute, or better, a statement of the idea to establish such an in-
stitute.
It was started in 1907, in a sort of embryonic anlage without the
faintest idea of future possible developments. I was at that time a
second year student of dentistry at the University of Breslau. I saw
in the window of an art dealer a photograph of an oil painting then
in the Royal Art Gallery of Dresden. This was by the 17th century
artist, Gerard Dou, representing a dentist shortly after the act of
drawing a tooth from the mouth of a boy who, wretched and suffer-
ing, bending down his head, touches with his finger the place where
the tooth had been. The dentist, standing behind the sill of the
window on which his opened case of instruments, a barber's basin
and his diploma, are lying, looks through the window with the ex-
pression of pride in his features, showing in his raised hand the ex-
tracted tooth.
This was the first picture representing a dentist which I pur-
chased, and which caused a chain of reactions during the next twenty
years, leading to the establishment of the Berlin Research Institute.
Since this picture made a great impression on me I looked for other
works of art representing the same or similar subjects, not in the
least realizing that there existed many paintings, drawings, copper
plates, lithographs, sculptures and other techniques of art represent-
ing the dentist and his patients. At first I relied, and not without
success, on chance to find them. A few years later, however, in 1911,
an article appeared in the German Monthly Journal for Dentistry
(Deutsche Monatsschrift far Zahnheilkunde) by Rudolf Koch on
Zahniirztliche Motive in der bildenden Kunst (Dental Subjects in
Art) which gave me important information on the existence of such
158
works and therefore the possibility of searching for them more
systematically.
Another publication of greatest influence on my interest in the
development of dentistry and its literature was the History of Den-
tistry by the Italian dentist, Vincenzo Guerini. This comprehensive
and very accurate work of a man with a wide cultural background,
covering many fields of science, was for the first time based on
original source material and not, as usually then and sometimes
now, compiled from other publications. It is still a classic in the field
of the literature on the history of dentistry.
From then on I had the good fortune to secure a large collection
of old dental books, dental pictures and instruments in the original,
and photographs which I exhibited for the first time in 1921 in
Breslau at the Annual Meeting of the Centralverein Deutscher
Zahniirzte (Central German Dental Society), the association which
corresponds in Germany to the A.D.A. in the United States. This ex-
hibition gave me an opportunity to discuss the subject of the founda-
tion of a Museum and of an Institute of the History of Dentistry be-
fore a large audience with the result that Professor Partsch, the
Director of the Dental Institute of the University of Breslau, gave
me permission to place my collection in a large room of the Institute
under the official name of Zahnorztlich-Historische Sammlung am
Zahnarztlichen Institut der Universitat Breslau (Dental-Historical
Collection at the Dental Institute of the University of Breslau)
where a Research Institute and a chair in the History of Dentistry
might be established.
The inflation in Germany after the First World War with its ap-
palling consequences made a speedy end to all these plans. There
was a rush to the dental schools with a relatively short study of
dentistry by a large number of young men who could not find any
employment in commercial fields, especially by officers discharged
from military service. For this large number of students all avail-
able space was needed so that space used by the collection had to be
given up. The complete lack of any funds for new foundations made
the establishment of a Research Institute of the History of Dentistry
impossible.
However, every thing has its two sides! The rush to the dental
schools and the development in German dentistry of the newly
created title Doctor Medicinae Dentariae (D.M.D.), resulted in an
extraordinary large number of doctor theses which were obligatory
for receiving this title. A large part of these theses were required
in the field of the history of dentistry. Most of them were written
under the guidance and supervision of Karl Sudhoff, the world-
famous Head of the Institute of the History of Medicine at the Uni-
versity of Leipsig, and based, without exception, on the original
texts.
Sudhoff himself had just published his excellent History of Den-
tistry in 1921, the still unsurpassed work in this field. It is indeed
regrettable that this brilliant book is not yet available in an English
translation.
Sudhoff's work and that of his students introduced a dental-his-
torical movement, the heroic age of the history of dentistry in Ger-
many, which flourished during the twenties and the beginning of the
thirties until Hitler came to power. The quantity and the quality
of these publications and some exhibitions of my collection in var-
ious cities of Germany, and in 1926 in Philadelphia, on the occasion
of the Seventh International Dental Congress, stimulated interest
of some influential men of the Reichs-verband der Zahniirzte
Deutsch lands (The German Organization of Dentists) in the history
of dentistry. The result was that in 1927 the German dental asso-
ciation took over my collection and established a Museum and a
Research Institute of the History of Dentistry of which I became
Director.
The founding of this Institute was an important step, not only in
the development of the history of dentistry, but also in the history
of dentistry. Up to that time it was a matter of individual interest
of some historically minded dental practitioner who was respon-
sible for the development of dental-historical literature and for
collecting dental-historical material.
The collection, located in the Deutsches Zahnarztehaus (German
Dentists Building), was now installed in the Billowstrasse in Berlin
in especially designed show cases. The office of a dentist of about
1820, consisting of his operating room and his laboratory, equipped,
not with replicas, but with the original old furniture, apparatus
and instruments of that time, was set up.
The Museum depicted the evolution of dentistry, from fetish,
amulet and charm worship, through worship of Apollonia,1 the
saint to whom people pray for relief from toothache, up to em-
piricism, followed later on by rational and experimental procedure.
We tried to represent each stage in development through old instru-

ments, old dental books, documents, paintings, engravings, copper
plates, lithographs and photographs representing dental scenes in
the various centuries. Artificial teeth and dentures, sculptures,
medals, portraits of dentists, clippings from old newspapers with
advertisements of dentists, handbills, various representations of
Saint Apollonia, and many other items in both original and copies,
are displayed.
Highlights in this collection are a richly ornamented pelican
of about 1550; a copy of the 1536 edition of the first dental book,
the Zene Artzney, which exists in six copies only (the first edition
was published six years earlier); the earliest known full denture
about the end of the 15th century; the original document of regu-
lations given in 1716 to the barbers, surgeons and dentists by the
Roman-German Emperor Charles VI, written on parchment and
bound in red velvet; the famous Meissen porcelain group by Kaend-
ler of 1741 representing a dentist, his patient and assistant; and the
largest collection in existence of toothpicks, starting with luxuri-
ously decorated toothpicks of the Renaissance and comprising
toothpicks up to the middle of the nineteenth century. It also
contains many objects donated by dentists to whom appeal had been
made in dental journals and in personal letters to donate whatever
they possessed in obsolete instruments and apparatus, old ledgers, let-
ters, books, photographs, journals and other items out of practices of
older generations of dentists.
The Museum has helped to bring dentistry into broad compre-
hensive relations with medicine and with the general development
of culture, and to improve the understanding of the public of the
value of dentistry.
All this material of the Museum is catalogued, described and
classified on index cards. We made photostatic copies of all dental
historical articles and notes of interest found in available dental
journals, medical journals and journals of other disciplines, as for
instance those of archaeology, palaeography, ethnography, anthro-
pology, general history, history of art, and many others. It is very
convenient to have needed reference articles in photostatic copies
on the table instead of a heap of bulky, bound journals. Besides
this advantage for our own work, these photostats were also of great
I See J. Am. Col. Den. 12, 101; 1945, June.

help to those who worked outside our Institute as we could so

easily send them out.
As you will understand from these remarks, the goal of our Insti-
tute was not only to have a good dental-historical museum and a
good functioning workshop for ourselves, but, still more important,
to have a place where students could get help and reliable informa-
tion founded on source material for their dental-historical work.
Shortly after the establishment of the Institute we published
in the official publication of the Reichsverband der Zahniirzte (Ger-
man Dental Society), the weekly Zahniirztliche Mitteilungen (Dental
Magazine), every month short articles and important notes in the
field of the history of dentistry, called Beitriige aus dem Forschungs-
institut fiir Geschichte der Zahnheilkunde (Contributions from
the Research Institute of the History of Dentistry) which increased
interest in this subject. It was our goal to transform this appendix
into an independent journal devoted exclusively to the history of
dentistry.
Another project planned for the future was the cataloguing of
all dental books published before 1900, listing the names of the
various libraries and, if possible, of the large private collections
where these works could be found, a task similar to the outstanding
American publication, the Union List of Serials.
It is not possible to give more details about everything we had
done or planned to do in a short paper. But it is to be hoped that
the seeds which were laid will bear fruit. Not much has been done
since. In 1944 or 1945 the rich library and the valuable collection
were destroyed or looted. The organization which was a center
of research and an agency for information came to an end.
The Fourth Dimension of
Dental Education*
WILLARD C. FLEMING, D.D.S.**
San Francisco, Calif.
THE GENERAL THEME of this in-

EDITOR'S NOTE: Educator, den-
tal student, practicing dentist— augural ceremony is "New Di-
all should enjoy the accompany- mensions of Learning in a Free
ing paper by Doctor Fleming, who Society." This indicates that we
always seems to put into inter-
are gathered to discuss the fu-
esting reading or listening a peda-
gogical, yet practical, challenge ture. The use of the phrase
to the status quo of dental edu- "New Dimensions" implies that
cation. A. E. S. our discussions are not to be
bound by the traditional dimen-
sions of learning, such as the length of the curriculum, the width of
its subject spread or the depth of the learning experience, but rather
that we are to be concerned primarily with all that is new today and
promised for tomorrow, and how these things may reshape our con-
cepts of learning: we are to be concerned with the past only as it may
help to bring into sharper focus our projection into the future. This
brings us to the title of this paper,"The Fourth Dimension in Den-
tal Education." Here we are face to face with the subject of relativity,
an area completely devoid of angels who fear to intrude.
The introduction of relativity and the time-space continuum con-
cepts in a discussion of education may not be as far fetched as at
first it might appear. Certainly, education is not a static fixture in
our society. It is constantly moving—and we hope it is moving for-
ward—but in order to measure its motion, we must remember that
this motion is relative to our social, economic and political activities,
which in turn are moving at variable speeds. In other words, educa-
tion, and I speak primarily of dental education, is moving in rela-
tion to social change, economic change and political change. We are
much the same as a small aircraft moving at a pace quite satisfactory
to the occupants, in this case the dental profession. However, this
plane, viewed from a faster aircraft, the rest of our economy, may
•Presented during inauguration of Dr. Edward H. Litchfield as twelfth chan-

cellor of the University of Pittsburgh. May 10, 1957.
"Dean, University of California School of Dentistry.
163
not only appear to be moving backwards, but may appear to be off

course and lacking in altitude. There are some who believe that this
is the case in both dentistry and medicine. As passengers in the
small aircraft operating in three-dimensional space, it is difficult for
us to know. However, if it is true, and the people in the faster plane
tell us it is, it would appear that we had better correct our positions
relative to the other parts of the world in which we live.
This is not an easy task to perform: there is no pat answer or easy
formula. We must view the past and the present in their true per-
spective and ferret out the relationship of our profession to the vari-
ables of the society within which we function.
As we view the past in an effort to get our bearings in the present
and to make a projection into the future, we cannot help but be
impressed by the fact that continual change has characterized dental
education and the dental profession. Our history has been a series of
educational changes to meet changing objectives and the increasing
responsibilities of dentistry. In rapid succession we have gone from
no educational program to the apprenticeship type of education,
with its emphasis on mechanics and trade secrets, through a minimal,
formalized, yet mainly technical type of schooling, until shortly after
the turn of the century, when the discovery that oral infection is
related to general health stimulated the development of our educa-
tional program to the point when it eventually emerged as a true
university discipline. Up to this point, dentistry was still more art
than science, and the pre-clinical sciences were included in school
programs somewhat as a window dressing, in an effort to identify
ourselves as a respectable part of the health sciences, but few dentists
were able to apply them to clinical practice. With the advent of
focal infection, there seemed to be a real basis for the knowledge
of these subjccts. Preprofessional education at the college level
soon was accepted as a necessity to our educational system. Other
influences forced their imprint on the profession and dental educa-
tion: World War I, with its mass recording of the high incidence of
dental disease: followed by the Gies Report in the twenties, with its
lift to dental education and dental research: and the depression of
the thirties, which opened up the social implications of health and
welfare. Following the depression came World War II, which em-
phasized the importance of dental disease among the health prob-
lems of the country, and stimulated an increase in public demand
for dental services. The shortage of dental and medical manpower
THE FOURTH DIMENSION OF DENTAL EDUCATION 165
during the war, and the special selective service treatment of den-
tists and physicians, tended to put dentistry and medicine on par-
allel planes in the public mind.
During these years of transition and change, dentists have become
important and respected members of the health professions. As our
stature grew, we had need for more broadly prepared personnel to
meet our new responsibilities, and the preprofessional educational
program was increased to provide a better prepared and socially con-
scious person to study and practice dentistry. The surge of applicants
for admission to dental schools after the last war is testimony to the
prestige and importance of dentistry in our social and economic way
of life. The period following World War II, and the one in which
we find ourselves today, is a period characterized largely by an ac-
celeration of the social, political and economic changes which are
affecting our health programs today more than in any period of our
history. Specifically, what are these factors?
In the early days of our economy, only the "survival" items of
food, clothing and shelter were important, but with the growth of
greater economic security, other items have been added to the basic
list of "necessities." Preservation of health was one of the first to be
added, and the people have demonstrated an increasing willingness
to give health expenses a high priority in the family budget. In 1953,
an unprecedented 5 per cent of the nation's yearly income was
spent for the maintenance of health. Socio-economic developments,
such as the welfare funds of the unions and the spread of medical
and hospital insurance, and the acceptance of post-payment and pre-
payment plans, have all had their impact on the financing of health
service. The union welfare funds, a large part of which are devoted
to health, are now counted in the billions. In measuring the growth
of hospital insurance, we find in 1940 that 9 per cent of the popula-
tion carried some type of hospital insurance. Today, this percentage
is about 66 per cent, with corresponding increases in surgical and
medical insurance. On the west coast we see evidence of the success
of the pre-payment plan, where the International Longshoremen and
Warehousemen's Union—Pacific Maritime Association Welfare
Fund has set up a plan for dental service for children. Already, the
California State Dental Association has formed a service corporation
to deal with contractual relations with other groups.
Recent experiences have shown legislators that recommendations
for group practice and health insurance are no longer instruments of
political suicide, and that support of health programs have increas-

ing political significance in our legislative halls. The politician today
can plead for American motherhood, lower taxes and health for his
constituents with equal facility, and hope for an increased number
of votes.
Most recently the state legislatures have come to recognize that
concurrently with the promotion of health service, there must be
promotion of educational programs for the health sciences. The sov-
erign states have been willing to relinquish enough of their sov-
ereignity to set up regional educational programs in medicine, den-
tistry and veterinary medicine, with nursing and dental hygiene pos-
sibly soon to be added. I refer to the Southern Educational Board,
the Western Interstate Commission for Higher Education and the
newly formed Regional Board in the Northeast. This is, indeed, a
major accomplishment, when one considers that the formation of
these groups required legislative approval, and to some extent call
for an exchange of state funds across state borders. Another social
change which will have an increasing influence on dentistry and on
dental education, is the great population expansion, with an antic-
ipated 200,000,000 people in 1975. Along with the already great
population increase, there has been a relatively small increase in the
number of dentists, and unless the challenge is met fully and changes
are instituted, there can be no greatly expanded output of new den-
tal graduates in the years ahead.
This poses a sort of "Alice Through the Looking Glass" problem.
You will recall in one of the episodes that Alice and the Red Queen
ran as fast as they could and finally, all out of breath, ended up the
same place they started. The Red Queen explained that in that coun-
try one had to run to stay in the same place, and that if one wanted
to go to another place, one had to run twice as fast. Dentistry is in
somewhat the same predicament as Alice, except that despite our
running, we are actually losing ground. We are turning out more
graduates than ever before, but the population growth is such that
we are not holding our own. At the present time, we have a popula-
tion ratio of 1,800 per dentist, with 35 per cent of the population
requesting dental service. In 1975, we face a population ratio of
2,400 per dentist, with close to a 50 per cent demand for service.
Even if we have the additional schools that are in the "talk-talk"
stage, we will be far short of the needed dental manpower.
Another point must also be emphasized, and that is that not only
are we facing a continuously increasing ratio of population to den-
tists, but we are experiencing also an increase in requests for dental
service. On the credit side of the ledger, we have the advent of flu-
oridation and the reduction of dental caries in children. It is too
soon to say positively, but it would appear that we may face the
paradoxical situation when the very retention of these teeth, as a
result of fluoridation, may bring about an increased demand for
dental service to preserve them. The fluoridation program will re-
sult in our carrying more teeth into adulthood, but in turn it will
mean that we will be faced by a greater demand on dental time to
maintain these teeth. Added to this is the aging population, which
will increase the demand for dental services to cope with the de-
generative diseases of the periodontium. Fluoridation promises bet-
ter and healthier mouths, but not necessarily less demand for den-
tal service; in fact, we should plan for more demand.
During this period of approximately fifty years from focal infec-
tion to fluoridation, what changes have occurred in dentistry and
in dental education? There have been many advances in technical
and clinical dentistry and in public health. In this short span we
have changed the status of dental caries from a "treatment only"
disease to one that can be effectively controlled. Prevention seems
to be attainable in this area. Progress, but not as much, has been
made in the matter of periodontal disease: however, our knowledge
of etiology in this area is very meager. The degenerative character-
istics of this disease in its relation to over-all systemic problems in-
dicate that it will be some time before it can be classified properly
as preventable.
The progress in the control of these diseases has been brought
about largely by an increased knowledge of etiology or cause, ac-
companied by considerable progress in the area of health education.
The latter is important because any disease that is subject to control
measures must have an informed and cooperative public, and, thus,
any successful control program is based upon an effective program
of health education. The development of the Dental Hygiene Cur-
riculum, as well as the Councils on Dental Health, is a reflection of
the recognition of the value of health education in our present at-
tempts to control dental caries and periodontal disease.
We have reached a point in our professional competency where
we are able to control partially periodontal disease to about the same
degree that medicine can deal with cancer. We can control dental
caries much more effectively: in fact, to about the same degree that
the medical profession can control diabetes. Obviously, our next
step is toward the prevention of these conditions. This step can be
taken only through the increased knowledge of etiology. This is
synonymous with research. We need a great deal more research be-
fore we can add dental caries to the list of preventable diseases,
and prevention of periodontal disease appears to be still further in
the future.
There has been some measurable change in dental research, but
unfortunately, most of the research has come from relatively few
schools and institutions, one can point with pride to the research
on fluorosis of the teeth and to the increased productivity of the re-
search reports in our journals and at our meetings, but as one ex-
amines the dental curriculum, one cannot help but wonder what
measurable effect this has had on the dental faculties and the dental
courses of instruction.
We have come to realize with awful clarity that we are lacking
not only in research, but particularly in the manpower to perform
it; and even given the manpower to perform the research, we are
lacking the teaching faculty to apply it. Our dental faculties are
largely populated with clinical dentists, the majority of whom pos-
sess unusually fine clinical competence. However, most of these men
have little basic science preparation or a window-front dressing
which is old and fly-specked through disuse. Here and there, of
course, one sees an exception, yet the highlight cast by these excep-
tions only emphasizes their rarity. The realization of this important
shortcoming has resulted in a great and frenzied quest for qualified
research people and teachers. All sorts of schemes have been de-
veloped: the Yale Plan, the Harvard Plan, the Rochester, Zoller,
Guggenheim and other graduate and postgraduate programs, includ-
ing the Army, Navy and Air Force graduate and residency plans.
And recently the U. S. Public Health service has begun to emphasize
teaching programs and training centers.
There is no doubt that during these fifty years dentistry has come
to occupy a shoulder-to-shoulder relationship with the other health
sciences, the calibre of the dentist and the dental student has greatly
improved due to the expansion of educational requirements and to
our increased stature through public acceptance of the dental pro-
fession.
This is all progress of which we can be and are proud, but if we
are to get our bearings in four-dimensional space, as we started out

to do, and if we are to see ourselves in full relationship to the other
activities in a changing and complex world, we must dwell not on
accomplishment alone, but we must investigate most carefully where
accomplishment is lacking. It has been pointed out that in the area
of research there is need for re-evaluation, and that some steps have
been taken in this direction. As we look at the dental curriculum
as an entity, we cannot help but feel that the need for re-evaluation
is great and urgent. During all the period from focal infection to
fluoridation, our dental educational program at the professional
level has been plodding along with only a few changes here and
there usually in the form of additions to meet obvious needs. These
changes were consolidated in the thirties in what is known as the
Blauch Curriculum Survey. There has been little change since that
time in the over-all picture of the average dental curriculum. True,
a few schools have tried an experiment here and there in undergrad-
uate education, but these have been mainly curriculum shufflings,
with no basic change. The one exception was the Harvard School of
Dental Medicine. This genuine attempt to experiment in dental
education received only opposition from the official organizations
dealing with dental education. A number of new schools have started
in recent years, but here again, there has been little attempt to ex-
periment. For the most part these schools have followed the same
old pattern and have failed to take what appeared to be a God-given
opportunity to break away from the old traditions and try a new
approach. Some schools have emphasized graduate and post-graduate
activities; others have emphasized research, and one or two seemed
to have concentrated on expanded and elaborate physical facilities.
There has been little or no change in the basic dental curriculum or
in dental educational philosophy.
As one examines the present undergraduate curriculum, one has
grave doubts that it can be improved by any simple shuffling of
courses and hours—the addition of five o'clock classes, evening
classes, required summer sessions, or even a fifth year of dentistry or
a required internship "tacked on" to the present curriculum. The
present dental curriculum was established in the days when dental
care was "treatment only." It follows pretty much the same pat-
tern in all of the schools. Variations appear, but these are not funda-
mental, and many times are the result of local action, influence by
faculty compromise, log rolling, personal prejudices and expedien-
cies. The student performs almost isolated from the rest of the world
by the pressure of his course requirements. The emphasis is still on
the attainment of skills with the newer knowledge being sandwiched
in here and there.
If dental education is going to assume its part in providing the
necessary manpower requirements, it is going to have to do some
self-analysis and initiate certain fundamental changes. This is going
to be very difficult (one thinks of, but hesitates to use the word "im-
possible"), because these changes will affect all the other segments of
the dental profession, and will necessitate a change in the "follow-
the-leader" attitudes we seem to have adopted in recent years. It
may mean that our greatest need in the future will be to break with
the traditional dictums of today's leaders, and one is tempted to par-
aphrase Winsor's "Space-Child's Mother Goose":
Little Bo-Peep has lost her sheep
And Univac Computer has failed to find them,
But, they will meet face to face
In fourth dimensional space,
Preceding their leaders behind them.
In the beginning of this paper I tried to picture dentistry as the

occupant of a small aircraft faced with the necessity of correcting its
readings to bring it into position in relation to the other speeding
planes labeled "Social, Economic and Political Changes." Actually,
dentistry at present should be portrayed not as one airplane, but as
several: Dental Education, American Dental Association, the Boards
of Dental Examiners, the Specialty Boards, and so on, all moving at
varying rates of speed. If this analogy has any merit, it must be
pretty apparent that it would be helpful, and perhaps essential, if
the dentists moved as a unit, not as a series of parts.
The dental profession exists for a number of reasons, but mainly
to provide dental service to the people. Our other functions are to
expand the frontiers of dental knowledge, develop new procedures,
educate our successors, supervise and discipline members of the pro-
fession and provide guidance and leadership for the people in the
area of our special competence. In order to help us accomplish these
ends, the state has granted us a virtual monopoly to practice den-
tistry. For this monopoly the state expects us not only to set the ob-
jectives, but the means by which these objectives can be reached.
That is why over ten years ago it was suggested that there should
be a total survey of dentistry—a survey of all of its parts. This was
voted down, but its need soon became so obvious that it has finally
been approved. In fact, it was only a few months ago that the
American Dental Association announced that, together with the
Rockefeller Brothers Fund and the Hill Family Foundation, it is
supplementing the Kellogg Foundation Grant of a quarter of a mil-
lion dollars and other grants to make this total survey possible.
If dentistry is to catch up with the rest of the world around us,
our first and most important objective must be to provide the dental
manpower to meet the demand for dental service in the years ahead.
Undoubtedly, that segment of the profession dealing with dental
education will be a most important part of the over-all survey, be-
cause it is the schools that provide the source of dental manpower.
What can we anticipate from such a detailed survey of the dental
curriculum—a survey which it is hoped will correlate the objectives
of dental education and the profession within the always moveable
framework of an ever-changing society? One thing we can hope for
is that it will not be the curriculum survey of the thirties brought
up to date with the publication of a "Revised Red Book," with
neatly prescribed courses, and the implication of a "One and Only"
program. The curriculum survey of the thirties was an admirable
contribution; in fact, on a par with the Gies Report of the twenties.
However,since the thirties, dental education has grown past the state
of "Father Knows Best."
Great latitude should be allowed and educational experimenta-
tion encouraged, not frowned upon and actually opposed as it has
been in the past. Attempts to standardize and force into patterns
should be avoided. Practically all of the schools are integral parts of
universities and can be trusted to embark on legitimate programs.
Prescription of predental subjects should be liberalized. For ex-
ample, physics may be dropped in some schools and the humanities
emphasized. It must be clear that we cannot inject a dental student
with even a fraction of the new knowledge. Therefore, in his prepro-
fessional years, should we not prepare the student to find his way
around in the Land of Knowledge, stimulate his intellectual curios-
ity, and provide him with methods of obtaining information and
with habits of learning that will give him a liberal approach to his
professional education?
Selection of students must be reappraised. We have rather good
measuring devices today to identify the student who has promise of
developing as a competent practitioner, but little or no way of iden-
tifying the applicant who has the potential to develop as a profes-

sional man, with all of the intangible attributes and qualities of
personality which we like to see in such people. Such identification
will not be easy. A great many programs to accomplish this objective
will have to be tried. The time to start them is now.
An analysis should be made of every branch of the curriculum
with the idea of eliminating the unimportant and delegating to the
ancillary groups and to postgraduate studies that which, in the opin-
ion of the profession, can be delegated. There should be a critical
eye cast at the specialty groups other than orthodontics and oral sur-
gery. Is there enough fundamental knowledge in these fields to
justify formal academic work and a degree beyond the D.D.S.? Can-
not a great deal of this be attained by a coordinated series of re-
fresher courses extending over a number of years? Why is it neces-
sary for a graduate of a four year dental curriculum, who has prac-
ticed a few years, to return to school for two additional years of
postgraduate instruction to qualify for his specialty? Why not a
curriculum of "Majors" and "Minors" which will prepare for spe-
cialty practice in certain fields? One school prepares undergraduates
for the specialty practice of orthodontics. This program has been in
successful operation for over twenty years. (Let us pause for a mo-
ment and listen to the cries of anguish coming from the various
specialty academies and the Council on Dental Education, which has
granted formal recognition to seven specialties in dentistry!) It is
hoped that such an analysis will point up the need for experimenta-
tion at the local level of the individual school.
It is to be hoped also that the survey will recognize differences in
regions, where local interests and practice are different. Eventually,
internships will be required in some localities. One of the states al-
ready requires an internship for eligibility for State licensure. Cer-
tainly, the technical courses should be altered to meet local require-
ments, and where needed, there should be an expansion of training
facilities for the auxiliary dental groups.
It is anticipated that, with the proper latitude and with educa-
tional experimentation being given an aura of respectability, each
school individually will have to consider seriously what its own ob-
jectives are to be: what knowledge it should attempt to impart to its
undergraduates; what skills the student should have when he grad-
uates. For example, how much knowledge and what skills should
the recent graduate have in the area of denture prosthesis? Should
he have the theoretical knowledge of immediate dentures, cleft pal-

ate and temporomandibular joint complications, reserving the skills
in these subjects for study after graduation? Should he have a
comprehensive knowledge of the field of oral surgery, but only the
skills and clinical experience in the extraction of teeth with exposed
crowns?
All of these questions and problems will go into the mill of the
survey, but the major question still remains, "How are we going to
meet the dental manpower needs in the years ahead and at the same
time maintain and improve the quality of our professional service?"
There seem to be three ways to accomplish this, but to the speaker
each by itself appears unrealistic, and yet with modifications and in
combination they might be made to work. They are:
1. The expansion and delegation of broader duties to the auxiliary dental
services. The ultimate in this direction is the dentist-technician.
2. A sharp increase in the number of dental schools to a number far beyond
what is even being discussed at the present time.
3. An increase in enrollment of the present schools.
It is reiterated that in the opinion of the speaker, these ideas, as
they stand, are unrealistic, and in fact, I am flatly opposed to the sec-
ond part of number one, the dentist-technician. However, I am of
the belief that the dental manpower needs can be met by combin-
ing the expansion of the numbers of auxiliary dental personnel, de-
veloping some new dental schools and the more efficient use of the
present dental educational facilities. This last idea needs some ex-
planation.
At the present time the usual dental curriculum covers 32 weeks
per year for four academic years, or a total of 128 weeks. If this
curriculum were changed to three calendar years of 46 weeks, with
a week of vacation at Christmas and in the spring and four weeks
in the summer, we would have 138 weeks of instruction and our stu-
dents would graduate in three years in place of the usual four. This
is not the "Accelerated Program" as we remember it from the war
years, because we would admit and graduate only once a year. At
first glance it does not appear that we would increase the number
of graduates. However, let us take an example of a school with phys-
ical facilities to maintain four classes of 100 students each—a total
student body of 400, with 100 graduates per academic year. If this
school were to operate under this three year plan, and continue to
admit 100 students, the total student body would never be more
than 300 students. Theoretically, this school would have the space
and facilities for a student body of 400 and would be able to admit
graduate classes of 133, or an increase in its output by one-third.
Obviously, there are practical problems such as staffing, size of class-
rooms, the special facilities of the clinical years, loss of student
summer employment, to say nothing of the uprooting of old habits
and traditions.
This is not offered as anything like a final solution, but is present-
ed as an example of the type of thinking which will be essential to
the ultimate solution of the manpower problem: a willingness
to break with tradition if necessary and to experiment in the
field of administration as freely as we know we must in the science
laboratories.
In conclusion, let us again think of those airplanes rushing
through four dimensional space, and let us admit that there are fast-
er planes from which dentistry's plane seems slightly off course, but
let it be pointed out that the occupants of that small aircraft started
the correction of their readings when they decided on the over-all
survey of dentistry. It is my belief that we, as dentists, have faced up
to solving the problem of relating dentistry and dental education
to the world around us. We have come to the realization that if
we do not, non-dentists will do it for us, and history has shown
that when problems are solved by legislatures it is only the quanti-
tative aspects that are solved. We are strongly aware that the people
granted us, through licensure, a monopoly to practice dentistry
and for this expect us to produce competent dentists and to render
good dental service. This we have done and are doing. Further than
this, the people expect us to provide leadership and guidance in
the field of our competency. This we recognize, even though it
leads us out of the present dimensions of practice. We know that
the members of a profession must be concerned with the total wel-
fare of the people, not a segment—particularly our own segment.
When we think of ourselves only as a profession with isolated
problems to be solved, it is three dimensional thinking. When we
think of ourselves in relation to the world around us, we are ap-
proaching fourth dimensional thinking, even if this means "preced-
ing our leaders behind us."
CALENDAR OF
MEETINGS
CONVOCATIONS
November 3, 1957, Miami, Fla.
November 9, 1958, Dallas, Texas
September 20, 1959, New York, N. Y.
October 16, 1960, Los Angeles, Calif.
BOARD OF REGENTS
November 1, 2 and 4, 1957, Miami, Fla.
175
Ethiconomics
EDITORIAL
Is there a place for the hard-headed policies of business in the

high-minded ethical codes of the healing-art professions? Is there
a common meeting ground toward which the alien worlds of com-
merce and the healing arts should stride? Can ethics and economics
be fused into one new science?
Historically, business is much older than the professions. The
Bible is filled with accounts of transactions, some of which were
corrupt, some honest, and some rather questionable. In all trans-
actions the prime motive of both parties is gain. The desire to
acquire money, property, goods, services, food, shelter, brings both
buyer and seller to the market place. If the deal they strike is a
sound one, both parties depart feeling they have done a smart piece
of business, for each will have that which he desired more than that
which he had. If they meet again they will meet as friends and
further transactions will be expedited.
Not so when the satisfaction is one-sided. By means of persuasion
and misrepresentation many a transaction is forced through and
the deceived person leaves with the seeds of dissatisfaction and
distrust germinating within him. Unless he is a fool, further business
between these two is forever blocked. Blinded by avarice, the sharp
dealer has taken the one golden egg but driven away the goose.
Business began to be ethical when its leaders discovered that
ethics had a high dollar value, that a reputation for fair dealing was
a priceless asset. The rapidly rising standards of business ethics are
the result of the clear thinking of executives who are planning for
the future. These business leaders are approaching professional
status—they are the "doctors of commerce."
From tribal witch doctor to the highly trained medicine man of
today is a long jump. Yet the commodity each has had to offer has
been the same: Relief. Relief from pain, fear and the imminence
of death. In rendering this relief, mystery and secrecy has shrouded
our every step. No one should deny that much of this mysterious-
ness was necessary to the development of the art and to the ultimate
welfare of the patients, particularly in the days of empirical treat-
ment. Nor can it be denied that the unscrupulous practitioner
176
ETHICONOMICS 177
took advantage of the desperation of his patients and the very
convenient mantle of professional secrecy.
Recognizing the need for a code of professional behavior by
which physicians could judge themselves and be judged by others,
Hippocrates formulated his famous Oath, which still serves as the
classical code of medical ethics. That physicians have given heed
to his teachings is attested by the high esteem in which they are
held in every civilized country, by rich and by poor.
The physician and dentist have been trained to diagnose condi-
tions by taking a detailed history, making a full examination and
then verifying doubtful points by special methods including con-
sultation. They can then prescribe according to their diagnosis and
they maintain contact with the case until all is well.
But this is not the whole of their ethical responsibility. They
should be equally able to determine a fair fee and arrange for its
payment, keeping contact with that phase of the case until the
obligation is discharged.
Dentists have good reason to look askance at much of the advice
they have been given under the name of practice management.
For many years non-dentists did most of the lecturing on dental
economics. This was natural as they wanted to develop and enrich
their market and our need was so great. Their approach to the
problem was unfortunately often below the standards of the pro-
fession but they did awaken us to our ignorance, so that a few
dentists and lay-economists began teaching management technics
that attempted to combine the time-tested procedures of commerce
with the ethical requirements of the healing arts. Eventually a
sound system of ethical economics must emerge that will meet the
two fundamentals previously discussed: that the welfare of the
patient must come first; and that both parties to a transaction must
be satisfied.
J. C. ALMY HARDING
Convocation
Miami Beach, Florida
Sunday, November 3, 1957
PROGRAM
MORNING MEETING, 9:00 A.M.
Pompeian Room, Eden Roc Hotel
INVOCATION
EXECUTIVE SESSION
Minutes
Report of the Secretary
Otto W. Brandhorst, St. Louis, Mo.
Report of the Treasurer
William N. Hodgkin, Warrenton, Va.
President's Address
Gerald D. Timmons, Philadelphia, Pa.
Report of the Necrology Committee
Coleman T. Brown, Tampa, Fla.
Report of the Nominating Committee
Willard C. Fleming, San Francisco, Calif.
Indoctrination
Jay H. Eshleman, Philadelphia, Pa.
THE PROGRAM
PANEL DISCUSSION
TOPIC: "CONTINUING EDUCATIONAL EFFORTS AND OPPORTUNITIES FOR
PROFESSIONAL ADVANCEMENT"
PARTICIPANTS:
"THE PHILOSOPHY OF THE PROFESSION IN THE SHARING OF KNOWLEDGE AND
THE BASIC PRINCIPLES TO BE CONSIDERED IN A CONTINUING EDUCATIONAL
PROGRAM"
Cyril F. Strife, D.D.S., New York, N. Y.
Chairman, Committee on Continuing Educational Effort
"THE NEED FOR CONTINUING EDUCATIONAL EFFORT BY THE PROFESSIONAL
MAN AND OPPORTUNITIES AVAILABLE"
Philip E. Blackerby, Jr., D.D.S., Battle Creek, Mich.
Chairman, Committee on Education
"CONTINUING EDUCATIONAL OPPORTUNITIES AT THE UNIVERSITY OR DENTAL
SCHOOL LEVEL"
Francis J. Conley, D.D.S., Los Angeles, Calif.
Vice Chairman, Committee on Education
178
CONVOCATION PROGRAM 179
"OPPORTUNITIES THROUGH STUDY CLUBS, SEMINARS, ETC."
George W. Redpath, D.D.S., Portland, Ore.
Vice Chairman, Committee on Continuing Educational Effort
"SCIENTIFIC LECTURE PROGRAMS: THEIR CONTRIBUTION TO CONTINUING
EDUCATIONAL EFFORT"
Charles S. Kurz, D.D.S., Carlyle, Ill.
Chairman, Council on Scientific Session, American Dental
Association
"THE PREDOMINANT ROLE OF LITERATURE"
Thomas F. McBride, D.D.S., Columbus, Ohio
Chairman, Committee on Journalism
GENERAL DISCUSSION
(Doctors Strife and Blackerby will also act as moderators of this discussion)
LUNCHEON, 12:30 P.M.

La Ronde Room,Fontainebleau Hotel
Under the auspices of the Florida Section of the American College of Dentists,
Rupert H. Gillespie, Chairman
ADDRESS: "A FLYING TRIP TO INDIA. OBJECT: TIGER HUNT"
Kenneth C. Pruden, D.D.S.
Past President, American College of Dentists, Paterson, N. J.
AFTERNOON MEETING, 3:00 P.M.

Pompeian Room,Eden Roc Hotel
INVOCATION
ADDRESS: "THE PROFESSIONAL MAN AND HIS EDUCATION"
Millard E. Gladfelter, A.B., M.A., Ph.D., D.Sc. in Ed., LL.D., LittD.,
L.H.D.
Provost and Vice President of Temple University, Philadelphia, Pa.
CONFERRING OF FELLOWSHIPS
EVENING MEETING, 7:00 P.M.

Pompeian Room, Eden Roc Hotel
DINNER
INTRODUCTION OF GUESTS
INSTALLATION OF OFFICERS
PRESENTATION OF SERVICE KEY TO GERALD D. TIMMONS
J. Ben Robinson, Morgantown, W. Va.
INAUGURAL ADDRESS
Alfred C. Young, Pittsburgh, Pa.
ENTERTAINMENT: SONGS AND BALLADS
Jim Symington, St. Louis, Mo.
The American Association for the
Advancement of Science
Proceedings of Section Nd—Dentistry at the One
Hundred Twenty-Third Annual Meeting*
Edited by
GEO. C. PAFFENBARGER, D.D.S.**
EDITOR'S NOTE: The four sessions of Section Nd—Dentistry consisted of a

Friday morning session on the "Contribution of Science to Everyday Practice";
a Saturday morning and a concurrent afternoon symposium on "The Human
Dentition in Forensic Medicine"; and a concurrent symposium on "Anti-
enzymes." George C. Paffenbarger was the program chairman and Earl 0.
Butcher, College of Dentistry, New York University, was the local chairman.
The present membership of Section Nd—Dentistry is 1,137; a gain of 330
during 1956.
Isaac Schour, Dean, College of Dentistry, University of Illinois, was elected
vice president of the AAAS and chairman of Section Nd, and Joseph C.
Muhler, College of Dentistry, Indiana University, was elected a committeeman-
at-large. Maynard K. Hine, Dean, School of Dentistry, Indiana University, is
the program chairman for the 1957 meeting which is to be held in Indianapolis,
Indiana, December 26-31, 1957. Suggestions for this program should be sent
to him.
I. Contributions of Science to Everyday Practice

H. Trendley Dean, presiding
I. The Influence of William J. Gies in the Recognition

Of Dentistry by the American Association for
The Advancement of Science
Geo. C. Paffenbarger
Senior Research Associate
American Dental Association Research Division
National Bureau of Standards
Washington 25, D. C.
William John Gies, the noted biochemist, spent the best part
of an unusually active life in promoting and advancing dental
• Held in New York City, December 26-30, 1956.

** Member of the AAAS Council representing the American College of Dentists.
180
ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE
181
health service. Since his activities are too numerous to mention in

this brief time, your speaker will confine his remarks to one small
aspect of Dr. Gies' service to dentistry; that aspect dealt with his
persistent efforts regarding the recognition of dentistry by the
American Association for the Advancement of Science.1,2
The Section on Medical Sciences was created in 1905 as a result
of Dr. Gies' efforts. He served from 1905 to 1909 as its secretary and
active promoter. It was in 1909, that Dr. Gies' active interest in
dental affairs began.3 His success in creating a medical section in
the AAAS encouraged him to atempt to create a dental section
.
At the outset of that effort and through several years of it he was
not successful. It can best be told in his own words as extracted
from his letter of January 18, 1956, to your speaker. "... informally,
members of the medical section objected to the proposed dental
recognition; they said that dentistry is 'inactive in science.' By
a
compromise agreement, my proposed dental section was later made
an acceptable subordinate part of the medical section. I believed
this would be only a temporary condition, dependent upon recog-
nized growth in research in dentistry."
The compromise agreement of which he speaks was the admit-
tance of the American College of Dentists in 1931 as an associa
ted
society. In 1932 the American Association of Dental School
s and
the American Dental Association successively became associa
ted
with the AAAS.
In 1932 the American College of Dentists conducted an all-day
associated dental session under the auspices of Section N.
Dr.
Gies served as the program chairman. Similar meetings were
held
in 1933 and 1934 under the auspices of the three associated societi
es.
In April 1935 the AAAS admitted the American Division
of the
International Association for Dental Research as an affiliated
society
with a representative on the AAAS Council and created in
Section
N (Medical Sciences) a subsection N15 on Dentistry. Dr.
Theo. B.
Beust was the first chairman and Dr. Wm. J. Gies, the first
secre-
tary. Dr. Gies declined reelection because he wanted to
increase
the recognized activity of selected dental leaders. So the
1936 pro-
gram of the Subsection on Dentistry was arranged by Drs.
Thomas
J. Hill, J. L. T. Appleton and M. L. Ward, who continued
in such
capacity until the 1939 meeting. Since then Drs. Paul C.
Kitchin,
Isaac Schour, and Russell Bunting have served as secreta
ries of
the Subsection on Dentistry.
Further recognition for dentistry came in 1954 when the AAAS

organized a Section Nd (Dentistry) with the consent of Section N
(Medical Sciences). The first chairman of the new section was Dr.
Willard C. Fleming. Dr. H. Trendley Dean served as chairman
in 1956 and 1957. Dr. Russell Bunting serves as secretary.
The dental programs in the AAAS have been excellent. In fact,
four of them have been published by the AAAS as symposium
volumes.
Thus, it is seen that through Dr. Gies' persistent efforts and his
faith in the development of dentistry as a scientific discipline, the
recognition came. It is indeed small homage that we pay Dr. Gies
when we dedicate this meeting to him.
BIBLIOGRAPHY
1. Hill, Thomas J. (o) American Association for the Advancement of Science:
Subsection on Dentistry. J. Amer. Col. Dent., 4:213, Dec., 1937.
2. Kitchin, Paul C. International Association for Dental Research. J. Amer.
Col. Dent., 4:214, Dec., 1937.
S. Friesell, H. Edmund. Wm. J. Gies, a biographical sketch. J. Amer. Col.
Dent., 4:164, Dec., 1937.
4. Gies, William J. American College of Dentists. Scientific Proceedings of
the First Meeting of a Dental Organization with the American Association for
the Advancement of Science. Atlantic City, New Jersey. December 30, 1932.
J. Dent. Res., 13:135, April, 1933.
5. Gies, William J. American Association for the Advancement of Science.
Proceedings of the Subsection on Dentistry. First Meeting: St. Louis, Mo., Jan.
4, 1936. J. Amer. Col. Dent., 3:79, March-June, 1936.
ABSTRACT
2. Vertigo Attributable to Mandibular
Joint-Dental Bite Abnormalities
Herbert T. Kelly
Graduate School of Medicine
University of Pennsylvania
And David J. Goodfriend
Philadelphia, Pa.
Anatomical, histological, x-ray and clinical data show the patho-
genic effect of mandibular joint abnormalities upon the ear and
the role they play in the etiology of vertigo. The differential diag-
nosis of mandibular joint-dental bite abnormalities, methods for
their correction, and the criteria of these corrective procedures
in the treatment of vertigo are discussed.
ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE 183
This work follows a previous study by one of the authors (DJG)
which was reported in the Archives of Otolaryngology of July,
1947. This previous study showed a high statistical correlation
between mandibular joint abnormalities and certain symptoms of
which vertigo and neuralgia occurred most frequently; and were
the most responsive to the correction of mandibular joint-dental
bite abnormalities.
The problem of vertigo is broad and complex. Medical literature
shows that vertigo may be caused by innumerable diseases including
those of the ears and eyes, brain tumors, and abscesses, meningeal
involvements, infections, arteriosclerosis, cardiovascular diseases, and
many others; as well as by abnormalities of the mandibular joint.
The purposes of this present work included determination of the
statistical incidence of the mandibular joint cause of vertigo in
medical practice, and of the effectiveness of dental procedures in
the treatment of vertigo. All patients of the Medical Department
of the Urologic Clinic of Philadelphia were studied during a period
of three years. Of about 600 patients observed, 65, or about 10 per
cent had case histories of a group of symptoms which we classified
as vertigo. These symptoms included light-headedness, lateral walk-
ing, disturbances of equilibrium with change of posture, slight
to severe dizziness, nausea, vomiting, and clouding and complete
loss of consciousness. Of the sixty-five patients with these symptoms,
sixty-three had mandibular joint abnormalities and dental bite
defects which were suspected to be factors in the etiology of their
vertigo. Fifty-four patients cooperated in accepting treatment of
their mandibular joint-dental bite abnormalities. Fifty-two or 96.8
per cent of the 54 patients were relieved of their vertigo symptoms
to the extent that indicated that mandibular joint abnormality
was the primary cause of their vertigo.
These included many who had been treated medically for many
years without permanent relief of their vertigo symptoms. One
had suffered with these symptoms for over 20 years and had sub-
mitted to two cranial operations. Another had retired from an
important executive position because his condition was aggravated
by a seeming fusion of voices which came from different directions
of the conference table. The third had been diagnosed as one who
suffered from altiphobia and claustrophobia. Her vertigo symptoms
made her fearful of steps. As a result, she was reluctant to travel.
The most serious cases were those where vertigo resulted in a
complete blackout of the victims. These blackouts occurred with-

out warning and involved the danger of accidents and possible
erroneous medical diagnosis that included strokes and heart attacks.
Of the 54 patients who submitted to dental treatment, 52 patients
received relief. The two patients whose symptoms were not relieved
included an 82-year-old woman with a cardio-vascular disease. The
other was a 76-year-old woman whose vertigo was at first completely
relieved; but who found later that she preferred the former atten-
tion of her family; and by removing her bite-correcting appliances,
could bring on an attack of vertigo. The 52 patients whose symptoms
of vertigo were eliminated by the dental bite treatment included the
woman who had previously undergone a cranial operation, and the
business executive who found that he could again successfully
conduct conferences without the return of his vertigo disturbances.
The ages of the treated patients ranged from 8 to 89 years. In
elder patients, it was found important to cure the vertigo in order
to prevent them from falling and causing body injuries. The 8-year-
old boy who had vertigo suffered from vomiting spells every time
he ate solid food. His parents and pediatrician considered this a
behavior problem and resorted to psychological correction and
discipline. Before being treated, he was under-nourished, fearsome,
and shy. His dental bite was so badly out of line that hardly any
contacts between his upper and lower teeth existed. The lower jaw
was retruded and the lower front teeth bit into his palate. On the
basis of the dental studies, and x-ray findings made, his bite was
corrected and in short order it resulted in a spectacular cure of his
vomiting. He was immediately able to eat solid foods and retain
them. During the 18 months since wearing these appliances, he
has not vomited once. He has fully recovered from his under-
nourishment and resumed a normal life with his friends in play
and school.
The mandibular joint abnormalities and bite defects that were
found to cause vertigo were those in which the bite was overclosed,
and traumagenic, the condyle was displaced upward and backward
in the mandibular fossa resulting in injury, deformity, and de-
generation of bone, cartilage, blood vessels and nerves of the joint-
ear area.
Diagnosis was based on history of mandibular joint and/or ear
disorders, irregularity of jaw movements; loss of bite-supporting
teeth; inadequate dental restorations and replacements; interlock-
ing deep overbites; and abnormal intermaxillary relationships as
shown by landmark studies of the face and mouth.
The final diagnosis of mandibular joint abnormalities was made
by x-ray studies of the joint-ear areas. These were made from the
lateral and vertex aspects and showed the relationships of the con-
dyle to the fossa, the external auditory meatus, the middle ear and
eustachian tube. It was found that these studies were indispensable
in the diagnosis of joint conditions which were pathogenic to the
ear and contributed to the vertigo symptoms. These x-ray studies
were essential to check the establishment of normal joint-ear rela-
tionships by correcting the dental bite defect.
The treatment of vertigo attributable to mandibular joint-dental
bite abnormalities consists of repositioning the mandible to estab-
lish normal intermaxilliary and intra-mandibular joint relation-
ships; and reconstructing the dental bite so that it articulates in
harmony with the normalized joints. These procedures include
posturing the mandible by means of bite blocks as guided by land-
mark relations and muscle reflexes until the x-ray studies show that
the intra-articular relationships, and the relationship of the joint
to the ear are normal. The occlusal surfaces are then plotted to
reproduce, or to parallel Kirk's basic dental curve from the mesio-
incisal point to the mandibular joints. These plotted occlusal sur-
faces are constructed, either as fixed splints, or as dentures or
bridges, as the masticating surfaces of both the upper and lower
bicuspids and molar teeth. These curved occlusal surfaces usually
guide the mandible to the planned position. In extreme reposi-
tioning, it may be necessary to arrange counter-sunk pyramids
on the biting surfaces of the bite planes, or inclined guides on the
posterior upper and the anterior lower portions of the bite-planes.
It is usually necessary to spot-grind and adjust the occlusion of the
bite planes or replacements during a period of a month or two,
because the bite relationships change with the regeneration of the
normalized joints. Within two to six months, the bite relationships
become static and, if the mandibular joint was the cause of the
vertigo, it is either markedly improved or eliminated.
The second phase of bite-joint treatment is to establish the cor-
rected bite and occlusal relationships with dental restorations and
replacements. Mandibular joints that have been pathogenic are
particularly senstive to subsequent occlusal trauma. In replacing
the treatment bite planes, the height and form of the occlusal
surfaces should be accurately reproduced in the biting surfaces

of the dental restorations. While tooth carvings are advisable, inter-
cuspal interference should be avoided. The balanced articulation
of the occlusal surfaces and its harmony with the normalized man-
dibular joints must be preserved.
Psycho-neurotic factors are important in the etiology of vertigo
attributable to mandibular joint-dental bite abnormalities. Pa-
tients with unresolved psycho-neurotic conflicts are more susceptible
to vertigo. The persistence of unexplained, unrelieved vertigo
symptoms contributes to the vicious cycle of psycho-neurotic factors.
The experience of this study shows that a combination of psycho-
therapy with correction of the mandibular joint-dental bite abnor-
mality is far more effective in the treatment of vertigo than is
either form of treatment alone.
The relief of vertigo in about 97 per cent of patients treated
in this study by correcting mandibular joint-dental bite abnormal-
ities indicates that the physician should consider this cause early
in diagnosis, and suggest a dental study early in the treatment of
vertigo.
3. A Clinical Study of the Mortality of Teeth

Harold W. Krogh
Washington, D. C.
In 1929 Brekhus published his findings after the extraction of

13,909 teeth from 2,723 patients at the University of Minnesota
Dental School Clinic. Caries and periodontal disease were respon-
sible for 96.62 per cent of the extractions and the remaining 3.38
per cent were due to impactions, cystic conditions, supernumerary
teeth and accidents. Caries loss was highest during the growth and
development periods whereas periodontal disease began to take its
toll after maturity and increased with age, with a corresponding
decrease in loss due to caries.
Allen in 1944 at the University of Michigan Dental School Clinic
analyzed the causes of extraction of 1,424 teeth from 353 patients.
Caries accounted for the loss of 48.8 per cent of the teeth, perio-
dontal disease for 40.7 per cent and only 2.8 per cent were lost
because of prosthetic reasons.
This study was undertaken at the suggestion of Dr. George

Paffenbarger and planned under the guidance of Dr. A. L. Russell.
Its primary purpose was to help answer the question "is periodontal
disease responsible for the loss of more teeth than caries or vice
versa?" However, the data to be presented are concerned with all
the causes of tooth loss in a private oral surgery practice among
a middle income group in the city of Washington over a period of
one calendar year.
A total of 8,420 teeth were removed from 3,037 patients during
the year. The same person x-rayed every tooth preoperatively, deter-
mined the specific reason for each extraction, performed the surgery
and transferred the data to the punch cards. A punch card was made
for each tooth extracted. Taking all these teeth into consideration,
dental caries caused the loss of more than twice as many teeth as
periodontal disease, 42 per cent for caries as compared to 18 per
cent for periodontal disease. Equalling periodontal disease as a
major cause of tooth loss were those teeth lost for prosthetic reasons,
a surprising 18 per cent. Many teeth in the latter category were
justifiably lost to facilitate prosthetic restorations but a substantial
number were lost needlessly.
The detailed analyses to follow are based upon 744 males with
2,331 extracted teeth and 1,593 females with 4,478 extracted teeth;
all of whom were judged to be of middle status economically. The
data therefrom have been analyzed by Dr. A. L. Russell at the
NIDR.
The significant findings of this study were:
1. Caries is about twice as destructive to the human dentition as periodontal
disease.
2. Males lost substantially more teeth from periodontal disease than females.
3. In females more teeth were lost from caries than from periodontal disease
in all decades except that from 50-59, where the proportions were about equal.
4. In males periodontal disease led caries as a cause of tooth loss in the
three decades between 40 and 69 years of age.
5. At ages 70 and over, more teeth are lost from caries than from periodontal
disease in both sexes.
6. Females tended to lose appreciably more teeth than males for prosthetic
reasons. They lost more teeth for that reason than for periodontal disease.
7. In both sexes caries took its greatest toll in the 20-29 decade and continued
predominantly in the 30-39 decade with periodontal disease building up to
parity between the ages of 40 to 70.
8. On the whole, males retained their teeth about two years longer than
did females.
These findings do not bear out the commonly heard statement

that "after the age of 45" or some other age "more teeth are lost
from periodontal disease than from any other cause."
4. Recent Advances in Orthodontic

Diagnosis and Treatment Planning
Robert E. Moyers
School of Dentistry
University of Michigan
Ann Arbor, Mich.
An understanding of recent advances in orthodontic diagnosis
and treatment planning may be understood best by studying the
current trends in orthodontic research. These may be grouped under
four headings as follows: (1) Cephalometrics, (2) Development of
Occlusion, (3) Electromyography and Other Muscle Research,
(4) Socio-economic and Public Health Aspects of Orthodontic
Treatment.
The field of cephalometrics, while being the most productive
single area in diagnosis and treatment planning, has been widely
misused. However, there are significant signs that it is being better
understood and more sensibly and rationally applied. Recently
orthodontic research in the field of occlusal development has con-
centrated on the patterns of transition during the mixed-dentition
stage, and the relationship between tooth widths and alveolar arch
perimeter. Increasing emphasis on early orthodontic treatment sug-
gests that study of the transition stage is apt to be very active
for several years to come. Particularly controversial at this time is
the question of whether or not extraction of permanent teeth should
be a part of orthodontic treatment. In consideration of the perma-
nent dentition perhaps the most difficult problem at the moment
is that of determining where teeth should be with regard to the
supporting bone. Studies in great number have computed mean
values for angulation of various teeth, but no opinion is yet uni-
versally adopted and much work will likely be done in the future.
Electromyog-raphic papers have studied the action of the muscles
moving the mandible, the muscle patterns in Angle Class II mal-
occlusions, cleft palate, response to myotherapeutic exercises, lip
and facial musculature, age changes in facial muscle action and
centric and other mandibular relationships. Electromyography de-
mands a different philosophic approach than do cephalometric and
other more orthodox research aids in orthodontics. It does not
breed dogma quite so readily because of its infinite complications in
recording and interpretation. Research in the oro-facial musculature
is now on a relatively sound basis and the findings will undoubtedly
have a strong influence on diagnostic and treatment planning
procedures for some time to come.
One of the biggest problems in diagnosis and treatment planning
lies in the field of diagnosis and treatment for the community's
total need. We know well how to serve the individual patient,
but we have not yet begun to learn how to extend our service in
orthodontics to all the people needing it.
5. An Appraisal of the Use of Rustless

Metals in Everyday Practice
Saul M. Bien
New York, N. Y.
The dentist and the manufacturer of jet airplanes use some of
the same rustless metals and frequently have similar problems in
using the metals which are available. The wrought metal used for
making appliances which straighten teeth is also used to make tank
cars which move milk. Rustless metal alloys developed for casting
partial dentures and surgical implants are now being used in in-
dustry because they are among the hardest, toughest metal alloys
known. Research by dental scientists in their field of application
has industrial applications and research by scientists in industry
benefits dentistry.
Various alloys chiefly constituted of nickel-chromium-iron, nickel-
chromium-cobalt and chromium-cobalt-molybdenum used in the
everyday practice of dentistry today are light, strong and resistant
to corrosion. They are capable of being in contact with or of being
imbedded in body tissues without eliciting an inflammatory re-
sponse.
Rustless metals are used to make orthodontic appliances for
moving the teeth and jaws into good function; to make surgical
appliances for preserving the teeth and jaws in good function after
attack by disease or accident; and to make prosthetic appliances
and obturators for replacing the teeth and jaws whenever they have
been lost.
6. The Present Status of Knowledge in the Treatment

And Prognosis of Peridontal Disease
Samuel Charles Miller
College of Dentistry, New York University
New York, N. Y.
One of the most common health problems of today is the reduc-
tion of bodily health and the loss of teeth due to periodontal dis-
ease. At least one-half of all teeth that are lost succumb to this affec-
tion of the supporting structures. In addition, the absorption of
pus, bacteria and noxious products of tissue inflammation and
destruction is harmful to the entire body creating a greater suscepti-
bility to disease and premature aging. The reduction of chewing
efficiency by the loosening and loss of teeth from this cause is an
important factor in the induction of nutritional deficiencies.
Periodontal disease is definitely curable with the methods known
today. Teeth can be tightened and pus pockets can be eliminated.
The cause is now known. It is not due to infection but is caused by
a combination of factors from three categories: dysfunctional, ir-
ritational and systemic.
By the application of correct principles of prevention and treat-
ment as they are known today, it should be possible for most people
to avoid wearing full artificial dentures.
Symposium: Part I
II. A.M. Session. The Human Dentition in Forensic
Medicine
Geo. C. Paffenbarger, presiding
7. The Determination of Personal Identity

By Means of the Teeth
Robert D. Wyckoff (DC), U.S.N.
Dental Division
Bureau of Medicine and Surgery, Navy Department
Washington 25, D. C.
Although fingerprints are considered the best means of deter-
mining personal identity, the teeth possess enough of the require-
ments in a system of identification to provide information which

will lead to the identity of some individuals when fingerprints or
other recognizable characteristics are not available.
In the Navy and Marine Corps where hazards of the air and sea
take a toll in time of war and in peace, there is a continuous need
for dental records to identify individuals who have met violent death
by means of fire, force or submersion. Without the record, the teeth
give only clues which may assist in identification by giving evidence
of age or race.
Factors which make the teeth unique as a means of identification
are their indestructibility and the fact that there is little chance of
there ever being two individuals with identical sets of teeth, due to
the combination of caries, restorations, missing teeth and abnormal-
ities which are present in most dentitions.
Establishment of personal identity is not only a passive sort of
comfort to the next of kin but is oftentimes a requirement in
settling legal entanglements. It is within the capability of all persons
in the dental profession to assist in the identification of the dead
when teeth are involved. The determination of personal identity
by means of the teeth, therefore, is a service to the other forensic
sciences which may be rendered by the dental profession.
8. Criteria for Age Determinations by Means of

Teeth and Identification of Fragmentary Teeth
David B. Scott
National Institute of Dental Research
National Institutes of Health
Bethesda 14, Md.
In the handling of unknown post-mortem material it is customary
to estimate age of the individual. Information relative to age can
be gained from gross and microscopic examination of teeth. Age
determinations by means of teeth are of special importance in the
case of mutilated or fragmentary specimens. The various laboratory
methods for estimating age from isolated teeth will be described
and evaluated. Other laboratory techniques, useful in the examina-
tion of fragmented solid matter, thought possibly to be tooth or
bone, will be discussed.
9. Calcification Pattern of Human Teeth

Maury Massler
College of Dentistry
University of Illinois
Chicago, Ill.
The enamel and dentin forming cells are extremely sensitive to
minor aberrations in calcium metabolism which may occur during
the period of enamel and dentin formation and calcification. This
is especially true of the enamel forming cells (ameloblasts). Major
and minor events in the life history of the child are recorded
permanently and clearly within the structure of the enamel and
dentin in the form of growth rings and as variations in the degree
of calcification of these tissues. Every primary tooth contains a
neonatal ring in the enamel and dentin as a result of the metabolic
changes incident to birth and neonatal adjustment. This line clearly
demarcates the almost perfect degree of prenatal calcification from
the imperfect calcification of the tissues formed during infancy.
Another ring is found constantly in the enamel of permanent
teeth at the level forming at 10 to 12 postnatal months (the infancy
ring). The origin of this ring is unknown. It demarcates the im-
perfectly calcified tissue formed between birth and 10 months of
life, from the much better calcified tissue formed after the first
year. Other rings are found consistently at 2/ 2 years (early child-
1
hood ring) and at 5 years (later childhood ring). In the third
molars, a ring of arrested growth and zone of imperfect calcification
are found at the level forming at the time of puberty.
These rings or lines of arrested growth and zones of good and
poor calcification have been carefully analysed and dated in each
one of the primary and permanent teeth. This resulting calcifica-
tion pattern permits the precise indexing of unknown teeth by the
characteristic location or level of the neonatal ring in the primary
teeth and the infancy ring in the permanent teeth. Prematurity
is easily determined by this technique as are the character and
extent of the infancy and childhood periods.
Severe disturbances in systemic metabolism are recorded as enamel
hypoplasias (defects in enamel formation). These can be analysed
grossly without recourse to histologic sectioning. Dating is easily
accomplished by reference to a standard chart on tooth develop-
ment. The pattern of enamel hypoplasias follows the pattern of
calcification very closely. The majority of enamel hypoplasias occur
during the period of infancy (birth to one year).
ASSOCIATION FOR THE ADVANCEMENT OF SCIEN
CE 193
Histologic analysis of the calcification pattern offers a simpl
e and
accurate method of cross-indexing unknown tooth samples.
Further-
more, it permits analysis of the stresses and strains which
occurred
during the early life of the individual. Since the teeth are often
the
only remnants available for identification, analysis of the
calcifica-
tion pattern may offer valuable clues and means of identificati
on.
10. Time and Sequence of Tooth Eruption

V.0. Hurme
Forsyth Dental Infirmary for Children
Boston, Mass.
Use of teeth as a criteron of age is hampered by
remarkable
variability of the process of teething. Tables of erupt
ion available
in textbooks can be misleading to the medicolegal
expert. Author
recommends use of the 95 per cent range derived from
his analyses
of eruption data on almost 100,000 white children. Sex
differences
in timing and sequence of eruption exist, the lower
canine being
the most distinctly sex-linked member of the dentition.
Deviations
from general averages are frequent, and many children
today reveal
an order of eruption that was once supposed to be
a primitive
human trait. Wisdom teeth are of relatively little value in
estimating
age or sex of human skeletal remains. Racial differ
ences do not
appear striking, excepting perhaps somewhat early
teething in
African Blacks. As for the primary, or milk teeth,
no universal
standards of eruption have been developed yet. Intens
ive studies
of the monkey indicate that serial records on teeth
can be used
in the future to assign a birthdate to a war orphan or
a foundling
with no birth certificate. The timing of the baby's first teeth
may also
be of value in settling disputes of contested paternity.
II. P.M. Session. The Human Dentition in Forensic

Medicine
David B. Scott, presiding
I 1. Criteria of Individuality in the Teeth

Albert A. Dahlberg
Zoller Memorial Dental Clinic and Department of Anthropology
University of Chicago
Chicago, Ill.
The form and markings on teeth reflect the sum
total of a variety
of possible conditions in the experience and
history of the tooth
or dentition. Dependability of these recordings as individualistic

and useful in identification stems from the biological laws and con-
cepts involved in tooth development. Seven general categories of
evidence found in teeth are:
1. Anatomical components (specific units of form and structure)
2. Genetic factors (inherited variations and units)
3. Recorded developmental incidents
4. Physiological processes (timing and sequence of loss and emergence of
the teeth)
5. Artifically produced markings or alterations
a. Fillings and restorations
b. Injuries
c. Deliberate decoration or mutilation of the teeth
6. Evidences of aging
7. Effects of environment and of use.
These various evidences are sometimes common to many indi-
viduals. The frequency with which they are apt to occur in differing
groups allows for statistical weighing of the separate points of evi-
dence. In combination the individuality factor spirals to astronomi-
cal figures of probability or improbability as the case may be.
12. Racial Traits in the Human Dentition

Gabriel W.Lasker and Marjorie M.C. Lee
Wayne State University
Detroit, Mich.
If the scattered investigations of tooth morphology made by differ-
ent observers throughout the world are classified according to the
main racial groups, some differences in the dentition are seen to be
racial. Although there are also differences in dental traits between
subgroups and local populations, their analysis would require more
systematic sampling of populations. Furthermore, when sex is un-
known, the differences between male and female teeth complicate
racial diagnosis.
In respect to the teeth, Mongoloids may be defined to include
not only Chinese, Japanese, Malays and Javanese, but also Eskimos,
Aleuts and American Indians. Asiatic Indians are like Europeans
and American Whites in dental characteristics and therefore can be
grouped with Caucasoids. Little satisfactory data is available for
Negroes except for South African Bantus. Other groups studied
include Bushmen, Australian Aboriginals, Melanesians and Lapps.
In Mongoloids there is very high incidence of shovel-shaped
incisors (especially the upper lateral incisors, but also the central
incisors) and the related development of lingual marginal ridges
in canines and lower incisors. In marked cases the shovel-shaped
trait is indicated by longitudinal grooves on the labial aspect of
the teeth. Premolars are comparatively smaller and usually show one
short undivided root. They occasionally show an enamel pearl on
the occlusal surface which occurs more frequent in the lower second
premolars than the other premolars. The crown of the upper molars
tends to be bulbous, usually with 4, 4 and 3 cusps respectively
on the first, second and third. This occlusal surface appears to be
more or less wrinkled especially in the third molar. The roots of
the upper molars are short and straight and have a high tendency
to fuse. This is associated with large pulp cavities (taurodontism).
In the lower molars the cusp pattern is usually Y5 in the first, and
+5 in the second and third. There is higher incidence of the proto-
stylid tubercle in the lower first molar and it occurs also in the
second. An extra third root situated disto-lingually is quite common
in the first lower molar, less in the third, rarely if ever in the second.
Both upper and lower molars tend to show enamel prolongations
between the roots. Sometimes there are enamel pearls in this
location. Congenital absence of the third molars is most frequent in
Mongoloids.
In Caucasoids, the incisors are usually chisel-shaped, the upper
lateral incisors are frequently much smaller than the central. Roots
of the incisors and canines tend to be long and pointed. Compressed
bucco-lingual dimension of the lower second premolars, although
rare, has been reported only in this race. The incidence of divided
roots in the premolars is relatively high. Molars tend to have few
cusps and simple fissures. There is a high incidence of Carabelli's
tubercle in the upper first and sometimes also second molars. Roots
of molars are long and divergent.
Among South Africans, teeth tend to be large in the Bantu though
small in Bushmen, and there is a tendency for two or even three
roots in premolars in the Bantu. As in Mongoloids there is little
reduction of molar cusp number. There is a high tendency of fusion
of roots and taurodontism in the second and third molars in some
groups (Bushmen) but not in other groups (Bantu).
On the average Australians have the largest teeth and long roots.
The second lower molar tends to be larger than the first, and fourth
molars occur more frequently than in other races. Melanesians also
have large teeth.
Very few criteria for racial differentiation have been described
in the primary teeth. Shovel-shaped incisors and primary lower
second molars with a protostylid may be seen in primary as well

as in permanent teeth; so may Carabelli's tubercle on the upper
second primary molar.
From the standpoint of forensic medicine and dentistry, only
rather general and somewhat guarded racial diagnoses are usually
possible on the basis of teeth. In this respect teeth are little, if any,
better or worse than hair, skin, blood or bony remains. Small in-
bred groups of men may show unusual frequencies of congenitally
absent lower incisors or of fourth molars, etc. The major racial
groups, however, are largely abstractions; they show considerable
intragroup and inter-individual variability overlying and partly
obscuring the differences between them.
13. The Genetics of the Human Dentition

Bertram S. Kraus
University of Arizona
Tucson, Ariz.
Data will be organized as follows: 1) comprehensive descriptions
of the dental features of a skeletal series; 2) twin studies of such
subjects as pathological entities, occlusal types, incidence and
topologies of caries, anomalies, etc.; 3) intensive studies of single
entities, such as shovel-shaped incisors, or Bolk's paramolar tubercle
as they are manifested morphologically and incidence-wise over
various populations. On a sample of 200 Whites, 30 Negroes, 50
Papagoes, 30 White Mt. Apache, 130 Yaqui, and 30 Chinese, dental
casts were secured and details of tooth-crown morphology were
studied (premolars and molars, especially lower Pm 1). Ethnic
differences in 16 morphological traits were tested for significance.
I3a. (The following paper was given in the form of an extended
discussion.)
13a. Hereditary Pathological Traits in

The Human Dentition
Carl J. Witkop, Jr.
National Institute of Dental Research
Bethesda, Md.
Certain hereditary pathological traits in the human dentition can
be used for medical-legal identification if they happen to be present.
These traits have been identified during a survey of 94,671 school
children in the State of Michigan.
Amelogenesis Imperfecta
1. Hypoplasia of enamel—inherited as a sex-linked dominant
trait.
2. Hypocalcification of enamel—inherited as an autosomal
dominant trait.
3. Hypomaturation of enamel—inherited as a sex-linked reces-
sive trait.
4. Pigmented hypomaturation of enamel—inheritance un-
known.
5. Local hypoplasia—inherited as an autosomal dominant trait.
Dentinogenesis Imperfecta
Inherited as an autosomal dominant trait linked with phenyl-
thiocarbamide taste trait.
Dentin Dysplasia
Inherited as an autosomal dominant trait.
Other inherited defects affecting the formation of the teeth, jaws
and skull may also be used.
Three cases have been presented wherein these factors were util-
ized for identification purposes. They include a skull from an In-
dian reservation, a father in a disputed paternity case and an heir
in the settlement of an estate.
14. Roentgenographic and Physiographic Appraisal

OF Cephalo-Facial-dental Individuality
Viken Sassouni
Philadelphia Center For Research in Child Growth
Phiadelphia, Pa.
The face of a person has always been considered as the character-
istic of his individuality.
For purposes of identification the face was studied in two ways:
externally by means of a special photographic technique, the phys-
iograph; internally by means of oriented roentgenographic ceph-
alometry. The Sassouni-Krogman physiograph is a setting by means
of which a calibrated millimetric grid is projected on the face while
the picture is taken by a camera placed at right angle. The physio-
print represents the face in profile. The lines of the grid permit the
evaluation of the face in the three dimensions of space. The physio-
print, comparable to the fingerprint, is characteristic of the individ-
ual and is of potential use for identification purposes.
Roentgenographic cephalometry, on the other hand, provides the

means to study the bony architecture of the face. A set of propor-
tions and positions devised from the lateral and frontal X-ray films
enable us to reconstruct a face from the remains of it.
On the lateral X-ray film four horizontal planes are traced: su-
praorbital, palatal, occlusal, mandibular. These four planes (more
often, any three of them) meet at a focal area "0" situated posterior-
ly.
From "0" as center, two arcs are drawn: one anterior passing
through the root of the nose, the anterior nasal spine, the upper in-
cisor, the most forward chin point; one posterior, passing through
dorsum Sella and the jaw angle. The palatal plane divides the face
vertically in two parts equal in size and position.
On the frontal X-ray film, the bigonial diameter equals the bi-
orbital diameter.
From the combination of the lateral and frontal X-ray films, we
find that the corpus of the mandible and the anterior cranial base,
as seen from above, form equilateral triangles. The length of the
corpus of the mandible = the length of the cranial base (Sella-Nasion)
posterior facial height (Sella-Gonion).
The deviations from the optimum pattern give the characteristic
of the individuality.
This is a preliminary report subject to later and more intensive
investigation.
III. Antienzymes
Ed F. Degering, presiding
I 5. Insulinase-Inhibitors
Arthur Mirsky
Department of Clinical Science
School of Medicine, University of Pittsburgh
Pittsburgh, Pa.
The destruction of insulin in vitro and in vivo is dependent
upon the action of an enzyme system, insulinase, which is relatively
specific in catalyzing the hydrolysis of insulin. This system is in-
hibited irreversibly in vitro by Cu, Zn, Hg, iodoacetate, p-chlo-
romercuribenzoate and a large number of other sulfhydryl poisons.
In contrast, with the irreversible non-specific inhibitors of insulinase
is the competitive type of inhibition produced by an hepatic factor.
The hepatic factor appears to be a small peptide and is effective in
enhancing the hypoglycemic action of insulin in the rat. Similar
insulinase-inhibitory activity is exerted by three hour acid hy-
drolysates of a variety of proteins. Studies of such hydrolysates led to
the observation that L-tryptophan inhibits the destruction of insulin
by the intact mouse. The oral administration of L-tryptophan pro-
duces a significant hypoglycemia in the normal but not in the severe-
ly diabetic rat. Studies of various metabolic derivatives of L-tryp-
tophan revealed that a similar insulinase-inhibitory and hypoglycem-
ic action is produced by anthranilic acid, niacin, nicotinuric acid,
indole-3-acetic acid, 5-hydroxytryptophan and 5-hydroxytryptamine.
Since indole-3-acetic acid is a natural plant growth regulator and
since the other effective compounds fulfill some of the known struc-
tural requirements for plant growth regulatory activity, the in-
sulinase-inhibitory and hypoglycemic action of other plant growth
regulators were studied. Nearly all known synthetic plant growth
regulators were found to act as did indole-3-acetic acid. Studies with
man revealed that indole-3-acetic acid produces a small but signif-
icant hypoglycemia in normal subjects and a more marked hypo-
glycemic response in patients who developed diabetes mellitus after
40 years of age. These studies support the hypothesis that in the
majority of instances, diabetes mellitus in man is due to an increase
in the destruction of endogenous insulin consequent to a decrease
in the synthesis of an insulinase-inhibitor.
16. Antimetabolites and Semienzymes

D. W. Woolley
The Rockefeller Institute for Medical Research
New York, N. Y.
Since the purpose of this symposium is to discuss antienzymes, the
description of both antimetabolites and semienzymes is most ap-
propriate. The antimetabolites are highly specific antagonists to the
action of a wide variety of enzymes and semienzymes. A basic under-
standing of the mechanism of these effects, and of the natures of the
substances involved, can lead to advances in knowledge and to useful
practical results.
The basis of action of the antimetabolites will be discussed. This
action is to compete with the structurally related substrate for the
active site of a specific enzyme.
Semienzymes are specific proteins which combine with certain
essential molecules, but which, unlike the enzymes, do not then alter
these molecules. The semienzymes occur widely in nature, and are
represented by such proteins as hemoglobin, avidin, various apoen-
zymes, antibodies, and perhaps by receptors for some of the hor-

mones. The actions of these semienzymes can be specifically blocked
by a suitable antimetabolite of their substrate.
The case for the semienzymes will be illustrated by showing how
a typical enzyme can be converted into a semienzyme. Thus chymo-
trypsin has been made to function as a semienzyme rather than as
an enzyme by construction of the proper kind of "substrate" for it.
This substrate behaves toward the protein as a hapten does to its
antibody. The enzyme which is now functioning solely as an anti-
body can then be made to act as the enzyme again by suitable altera-
tion of the substrate. When the enzyme is made to act as a semien-
zyme or antibody, by the use of this special substrate, it is power-
fully inhibited from acting as the enzyme. The net result is the
realization of potent and specific inhibitors of chymotryptic activity.
The semienzymes which act as receptor sites for hormones will be
discussed. The serotonin receptors may be used as an illustration.
By knowing the chemical configuration of the natural substrate for
this receptor (viz. serotonin) it has been possible to construct anti-
metabolites which block the activity of these receptors. One of these
antimetabolites was so constructed as to exert a selective effect on the
receptors in the periphery of mammals. However, it was excluded
from those in the brain. This was an essential point, because it was
shown that those antiserotonins which penetrate into the brain cause
mental disorders. With this selective one however it was possible to
block only peripheral receptors. By so doing it has been possible to
control the high blood pressure of human beings suffering from es-
sential hypertension. Presumably this disease arises from an excess
of the hormone serotonin in the periphery. The successful conclu-
sion of this work has shown that it is entirely feasible to develop
new series of drugs by use of the antimetabolite approach, provided
only that sufficient attention is paid to the understanding of some of
the basic principles.
I 7. Chemical Aspects of Enzyme Inhibition

Irwin W.Sizer
Department of Biology
Massachusetts Institute of Technology
Cambridge, Mass.
The use of chemical reagents as enzyme inhibitors has yielded
information concerning the mechanism of inhibition and the role in
catalysis played by active groups on the protein apoenzyme, the

coenzyme or the metal component. Inhibition analysis has also fur-
nished valuable clues concerning the architecture, chemical prop-
erties and catalytic mechanism of the active site of the enzyme. In
many cases in vivo effects of inhibitors can be closely correlated with
in vitro inhibition of purified enzyme systems. The effects of anti-
microbial and anticancer agents, insecticides, and drugs can often be
explained in terms of enzyme inhibition. The design and synthesis
of new inhibitors offers great promise when applied to the control
of undesirable organisms, and to the prevention and cure of disease
in the immediate future.
I 8. Organic Structure Capable of Inhibiting

Bacterial Glycolysis
Richard S. Manly
School of Dental Medicine
Tufts University
Boston, Mass.
Many dental investigators have had the goal of discovering ther-
apeutic means of preventing dental caries, by search for substances
which would arrest the formation of acid by bacteria which accumu-
late in films on the teeth. These accumulations of bacteria have the
ability to form acid from sugar in foodstuffs, and this acid is be-
lieved by many investigators to be capable of etching enamel suf-
ficiently to permit dental caries to begin. Our general efforts have
been to find new types of organic structures which might show
promise as inhibitors of this type of glycolysis. Such inhibitors would
deserve further study as possible additives to dentifrice, chewing
gum, or foodstuff. The equipment for testing glycolysis was arranged
to make two additional requirements of inhibitory chemicals—that
they be able to diffuse through a thin layer of bacterial sediment
resembling "dental plaques" on teeth, and that they be able to
resist rinsing for at least one hour.
Of the 3,000 substances tested, over 250 had a persistent glycolysis-
inhibiting action. Occasional inhibitor actions were found among
a wide variety of common organic structures such as alcohol, phenols,
amines, aldehydes, ketones, acids, amides and urethane derivatives.
Phenol and substituted phenols showed inhibitory action. Several
derivatives of methyl alcohol sometimes involving ring structures
were also inhibitory. Some of the alcohol derivatives possessed struc-
tural formulas resembling the pyranose forms of glucose. Eight of

such compounds were tested at different concentrations with the glu-
cose substrate, but no evidence of competitive inhibition was ob-
served.
Generally, the inhibitory structures were highly specific, and
closely related compounds were inactive. Of 70 tests on aldehydes,
there were 6 compounds which produced inhibition of glycolysis by
60 per cent or more, but three possessed other structures which
could cause inhibition. The three remaining aldehydes were simple
compounds; aldehydes with very similar structures were non-in-
hibitory. There were tests on 112 ketones with 6 showing activity;
in each instance inhibitory action could be explained on the pres-
ence of some other group or on the possibility of enolization to form
a cyclic secondary alcohol. There were over 250 structures possessing
carboxyl groups and only 2 showed appreciable inhibitory action;
these were cyclohexenyl—or cyclopentenyl derivatives of 5 or 6 car-
bon fatty acids. There was evidence of a high degree of specificity
since closely related structures were inactive. Among amides, in-
hibitory action was less specific. Of the 222 amides studied there
were 13 having an inhibitory action of 40 per cent or greater. Ex-
cept for a piperazine derivative and a sarcosinate, the active sub-
stances were either monosubstituted alkyl amides or lactamides con-
taining 11 to 21 carbon atoms. Specificity was extremely great among
the carbamates studied; of the 162 substances tried, only two of the
total appeared promising. These two were the N-carboisopropoxy
derivative of pyrollidine and piperidine. This group appeared to be
highly specific since five other pyrollidine compounds were negative
and 11 compounds with carbamate in a five-membered heterocyle
were without effect.
There were two other reports presented at the AAAS meeting
that had special import to dentistry. The first, given in Section Q
(Education), follows:
The Fluoridation Controversy—A Study in the

Acceptance of Scientific Authority
Bernard Mausner
Graduate School of Public Health
University of Pittsburgh
Pittsburgh, Pa.
One of the most pressing needs in our time is for public decisions
on issues involving the sciences. For example, it will be necessary
soon for our society to decide on the amount of radiation it will

permit through industrial and military applications of atomic en-
ergy. New public health procedures, such as the Salk vaccine, cannot
be adopted without a decision as to permissible risk.
The bases for this kind of decision are complex. Decision makers
in our society must themselves understand the issues involved. Un-
fortunately, in many cases, the issues are too complex for those in-
dividuals in whose hands policy decisions lie, to arrive at such an
understanding. Here, there is little that can be done beyond accept-
ing the advice of scientific authorities.
When we move from the realm of decision makers to that of
the population as a whole, there are even greater difficulties. For
such a decision as that to continue with or suspend the testing of the
H-bomb, it would be optimal that the bulk of the population under-
stand the crux of the issue. Only in that way will widespread fears
and panic be averted. Thus, one of the primary problems of the
scientist becomes that of communicating either the bases for his de-
cisions or the basis of his authority in making these decisions.
The controversy over fluoridation represents a test case in which
the problems of scientific authority raised above have been encoun-
tered in a very severe form. The fluoridation of public water sup-
plies has been urged for some years as a measure for the prevention
of dental caries. This procedure has been accepted as one which is
relatively free of risk and which has good social consequences by
virtually all of the appropriate scientific authorities in the field.
Nevertheless, there has been considerable public opposition to the
adoption of fluoridation. In at least half of the communities in
which a referendum was held over the issue, the adoption of flu-
oridation was defeated.
Why the controversy? Firstly, the very nature of the procedure
rouses fears of being poisoned in some, and of an invasion of in-
dividual rights in others. The evidence for it is based on an epide-
miological analysis which is not easily communicated. Secondly, flu-
oridation was usually introduced from the top through conferences
between scientific authorities and public health officials. Thus, the
population was often given the feeling that there was a conspiracy
involved; that is, that the public health officials were "putting some-
thing over." There has been enough public disagreement among
people who seem to be reputable authorities in the field, so that it
is not clear to the general public that consensus has been reached
among the experts. Lastly, once the controversy arises and the is-
sue has been polarized, the methods used to educate the public have
been inadequate. The major approach has been to dismiss the op-
position to fluoridation as "crackpot," and to rely on the prestige of
scientific authorities.
That this approach is inadequate was demonstrated in the city
of Northampton, Mass., in which a referendum on fluoridation was
held, and in which the issue was defeated by a two to one vote. The
writer carried out two public opinion polls; one before the refer-
endum, the other a year after it. The first of these polls, in which the
results of the referendum were predicted accurately, found that by
and large, those people who voted for fluoridation had accepted the
authority of the scientists who were for it. Those people who voted
against fluoridation were unwilling to accept this authority. It was
found also that the bulk of the opposition was concentrated among
older, less well educated individuals in working class and middle
class circles, especially among people without children. Those for
fluoridation were primarily younger, better educated, middle-class
and professional people with young children.
The second survey attempted a more comprehensive study of the
psychological processes back of opposition to or acceptance of flu-
oridation. In this poll, the respondents in the sample were asked to
indicate why they had voted for or against the measure. Those in-
dividuals who were for fluoridation mentioned most often that it
was "good for people," and that "authorities are for it." Only ten
per cent had any clear idea of the reasons for its adoption. In-
dividuals who were against the measure most frequently gave as
their reasons, their opinion that the measure was ineffective or un-
necessary, that it was harmful, that authorities were against it, and
that it violated individual rights or tampered with nature.
Among the voters for fluoridation, those who had higher educa-
tional levels more frequently mentioned the fact that "authorities
were for it." Those with less education more frequently had a clearer
idea of the benefits to be derived from the procedure. Apparently,
the few less well educated people who were for fluoridation were
those who had really been convinced of its merits.
The conclusions to be drawn from these findings can be applied
both to an understanding of the specific problem of the acceptance
of fluoridation and to the broader question of education in the sci-
ences. For the former, certain conclusions are possible. Firstly, the
proponents of the measure should have stressed a clearer under-
standing of the issues. In the main, neither those who accepted flu-
oridation in Northampton, nor those who rejected it really under-
stood what it was about. Secondly, it seemed to be an inadequate
device to dismiss the opposition to fluoridation as "crackpot" or ir-
rational. Only a minority was willing to accept this point of view.
There are some general implications in this study for education
in the sciences. The reactions of better educated people in North-
ampton indicated that on the whole, they were either unwilling or
unable to make the effort to follow the sense of the issue. Their
reaction was primarily based on their acceptance or rejection of the
bona fides of the authorities involved. Certainly, there were failures
in the education of these people. What conclusions can we make on
the basis of these failures? Firstly, that the present attempt to teach
the substance of the sciences to all well educated citizens so that the
actual bases for such decisions can more clearly understood is cer-
tainly laudable. However, something more is needed. Apparently,
many individuals must at some point in their lives resign from the
necessity for following the content of issues. Therefore, it is neces-
sary that we, as educators, develop clear-cut criteria as to the accept-
ance or rejection of expertness.
The second report, given in a joint session of AAAS Section Q
(Education) and the American Educational Research Association,
follows:
Testing for the Profession of Dentistry

Shailer Peterson
Council on Dental Education
American Dental Association
Chicago, Ill.
Unlike most fields of education, business, and industry, "evalua-
tion" and "testing" have legal status in the fields of the health pro-
fessions. From the time of the early state boards for licensing den-
tists, groups have been empowered with the authority for and given
the responsibility of evaluating the competence of individuals who
wished to practice their profession on the public.
In the field of dentistry, the examiners (i.e., members of the state
boards of dental licensure) have recognized the need for attacking
the problem of testing on a scientific basis. The examiners have con-
ducted series of seminars for improving their testing techniques at
the state level and the national professional association—the Amer-

ican Dental Association—has promoted the development of testing
programs at the national level. From this has come the testing pro-
gram of the National Board of Dental Examiners which is conduct-
ed by the American Dental Association.
Dentistry, through its accrediting agency—the Council on Dental
Education—which is an agency of the American Dental Association,
has developed and conducted other testing programs designed to im-
prove the selection of students both in dental schools and now in
dental hygiene schools. The Council has also promoted additional
programs of testing through the schools for evaluating the achieve-
ment of students and for encouraging educational research projects.
Dentistry has found all of its agencies concerned either with
licensure or with education sincerely interested in developing new
and better methods of evaluation. There are few groups that have
shown their interest in utilizing the sound educational principles of
teaching and sound methods of psychometrics as has the dental pro-
fession through its consistent 100 per cent cooperation.
From the outset of the five-year experimental program in the field
of aptitude testing, all of the dental schools have entered into the
program, with the result that student selection has been improved
and student mortality or loss through the professional program has
been reduced tremendously. Ten years ago, some schools found it
necessary to fail or drop as many as 50 per cent of their first-year
class whereas today, about one-fourth of the schools have no losses
during the first year and nation wide, only about 7 per cent are lost
from the original number entering all schools. This is the lowest
mortality figures for any of the health professions.
The dental profession also works with the other associations rep-
resenting its dental auxiliaries. At the present time, a program of
aptitude testing is being conducted through the joint efforts of the
American Dental Association's Council on Dental Education and
the American Dental Hygienists' Association. A testing program is
being developed by these same two agencies for an achievement
evaluation of students; and it is anticipated that this will evolve into
a national board program for the licensing of dental hygienists. An-
other phase of testing which is being planned is that for the certifica-
tion or recognition, through examination, of dental assistants and
dental laboratory technicians.
These testing programs have many values, as evidenced by the
fact that during the last ten years all of the dental schools have de-
veloped committees for the study of their admissions problems,
others for the restudy of their curriculum and still others for study-
ing their methods and standards of promotion. Dental education can
well point to the last decade as the period during which the most
progress was made due to dentistry's recognition of the importance
of sound evaluation practices, and through the close cooperation of
all of the agencies concerned.
NOTICE
The National Opinion Research Center of the Uni-
versity of Chicago, at the request of the American Col-
lege of Dentists, and in cooperation with the Walter
G. Zoller Memorial Dental Clinic, is currently engaged
in a study of procedures and problems of dental prac-
tice. Personal interviews with a nationwide sample of
active, practising dentists are now being conducted.
Results of the study, which will be useful to the entire
dental profession will be made generally available in
summary terms toward the end of the year. The main
interest of the study is in the procedures and problems
of dental practice, including their preventive aspects.
Prepayment Group Dental
Care Programs*
HAROLD J. NOYES, D.D.S., M.D.
Portland, Oregon
WHILE PREPAYMENT dental care plans are by no means new, with

the exception of government operated programs they have until re-
cently found little favor. This mechanism for group care may be
characterized generally in five types:
Insurance or indemnity plans in which a properly constituted
commercial agency provides dental care in return for the payment
of a premium for the insured. The services are usually restricted to
a greater or less extent depending upon the premium and in many
instances the accumulated dental need of the insured must be elimi-
nated before he is eligible for participation. Plans of this type have
been slow to develop but we are experiencing a greater interest in
them and more are being initiated currently.
Employers dental programs are in the main of limited extent and
many are restricted to dental examination and emergency care.
Employees, usually union organized, occasionally have operated
their own programs.
Combined Employee-Employer plans of the fringe benefit type
created through negotiation between management and labor,
financed largely by employers and conducted by Welfare Funds or
joint committees are in operation today. This is the type of which
I will speak later.
Services provided by tax-collected funds. The largest and probably
the most successful is the Veterans Administration dental care pro-
gram. There are many public school plans which vary greatly in
administration and extent of service provided. In general these are
very restricted. It is likely we will see the development of a mechan-
ism for the dental care of dependents of armed services personnel.
MANNER OF RENDERING SERVICE

If we can generalize without too much oversimplification, the
* Presented before the Texas Section of The American College of Dentists, Mineral
Wells, Texas, December 8, 1956.
208
PREPAYMENT GROUP DENTAL CARE PROGRAMS 209
manner of rendering dental care may be classified into three cate-
gories.
Open Panel in which there is complete freedom of choice of
dentist.
Partial or Limited Open Panel. Here the choice of dentist may be
limited to practitioners having certain qualifications, such as being
members of the A.D.A., state and local societies or those having
agreed to accept patients under the plan.
Closed Panel. In this circumstance there is no choice of dentists or
at most it is extremely limited.
PAYMENT FOR DENTAL SERVICES

Under the open panel or partial open panel obviously the pay-
ment is made to the private practitioner. This may be upon a previ-
ously published fee schedule to which the dentist subscribes either
before or at the time he accepts the patient. Less often the plan
permits the dentist to bill for his services in the same way he would
in the case of a patient not included in the prepayment plan. Pay-
ment is usually guaranteed by the agency providing the patient
though there have been and perhaps are today programs that assure
payment only and insofar as funds are available.
The closed panel may and usually does operate on a salary based
upon the time given to the clinic, the skill of the dentist and his
bargaining ability. A percentage basis is, of course, an alternate
method of profit sharing over and above a minimum salary.
THE ILWU-PMA WELFARE FUND CHILD DENTAL CARE PROGRAM

It is my purpose to speak to you about a particular prepayment
program, that of the International Longshoremen's and Warehous-
ingmen's Union and the Pacific Maritime Association administered
through their Welfare Fund. The plan was started as a pilot program
in the winter of 1954-55, extended to June 30, 1955 and again for
the year July 1, 1956 to June 30, 1957. This gives a certain degree
of permanence to this fringe benefit but it could be discontinued at
the end of any bargaining period.
The plan was designed to give comprehensive dental care to
dependent children of union members from birth to age fifteen. The
age range was selected by union and management negotiators with-
out consultation with organized dental groups or, for all I know,
individual dentists familiar with the problems of child dental care.

It was not intended to include orthodontic treatment or restorations
of essentially aesthetic nature such as anterior porcelain jacket
crowns. Certain other dental operations were eliminated in geo-
graphic areas where the type of contract program budget would not
permit their inclusion.
Because of the experimental nature of the plan, the time schedule
for starting the service and certain differences of opinion between
the dental associations upon the west coast there resulted consider-
able variety in the type of prepayment plans now in operation. In
California a union member has a choice between a closed panel
operating under contract with the trustees of the Welfare Fund and
an open or semi-open panel conducted by the Continental Casualty
Company. Under the former the child is entitled to comprehensive
dental care exclusive of orthodontics and aesthetic dentistry and the
latter $75.00 limit determined by a fee schedule meeting the ap-
proval of both California state dental associations.1
Washington and Oregon have programs which differ from one
another only in details. Both have established corporate bodies which
are separate and distinct from the state dental associations though
the majority of the board of directors of each are chosen directly or
indirectly by the state association. Both Dental Service Corporations
can negotiate contracts with other agencies for dental care of either
children or adults and Washington has done so. In Oregon the
agreement between the dentist and the service corporation becomes
effective when the dentist signs a statement agreeing to the fee
schedule which is on the form he completes as an estimate of services
needed. In Washington the dentist is required to contract with the
service corporation in advance of taking a patient. In the latter state
there is a formula for post checking of selected samples of completed
cases while in Oregon this procedure is not formalized.
In both states samples of union children were examined in surveys
in which the dental schools participated for the purpose of esti-
mating the extent of dental care needed and in consequence the
cost per average child according to the fee schedule agreed upon.
As a result of data thus accumulated the Welfare Fund agreed to
pay the service corporation $100.00 per child and make specified
expectations to comprehensive care in addition to orthodontics and
I. Group Dental Health Care Programs, Council on Dental Health, A.D.A. 1955.
aesthetic dental restorations. The amount was to include overhead
and nonprofessional expense not to exceed 8%. In both Oregon
and Washington the union member originally had a choice between
the state dental service and indemnity plan conducted by the same
company as that operating in California except that the total limit
of service was $95.00 and the fee schedule was that accepted for
dentists on the open panel program. There were certain other insur-
ance benefits identical with the California plan.'
OREGON DENTAL SERVICE AND THE ILWU-PMA WELFARE FUND
In the pilot program, representing the first year of operation, there
were 1666 children enrolled and of this number 1260 or 76% visited
a dentist. About 85 children reached their 15th birthday in the pilot
period and a little less than half of them did not see a dentist regis-
tered with the Oregon Dental Service. A total of 243 dentists received
$75,897.00.
There have been certain changes in the program for the current
year, July 1, 1956 to June 30, 1957, as might be expected due to the
relative increase in participating children who have benefited by
complete dental care and are now on a maintenance basis. For new
children in the program the Welfare Fund pays $80.00. This also
applies to children who have not been seen by a dentist for 12
months. However, for children who are on a maintenance or follow-
up basis, an annual amount of $45.00 is paid and this applies to
children transferred from areas where another service agency, indem-
nity program or closed panel has been responsible for their care.
A distinct difference in the current program is that because of lack
of interest in the indemnity plan it was discontinued. This is true
in Washington as well. In these two states only the dental service
program is in operation.
STATISTICS
In the state of Oregon a survey of union children indicated that
the average cost of services excluding the items that the Welfare
Fund felt they could not afford was $92.00. Actually, the estimates
of dentists fell short of this amount $58.68, yet the actual billing was
very close to estimate $59.82. One reason for this discrepancy be-
tween the survey figure and cost realized was the overestimate of the
1. Group Dental Health Care Programs, Council on Dental Health, A.D.A. 1955.
number of dentists that would include topical application of sodium

fluoride and the next most influential factor was that only 48.2%
of children 14 years of age came to a dentist. Neither of these cir-
cumstances was anticipated.
The program was received almost without dissent from either the
the parents or the dentists. I think I could make this observation
about the patient as well though there were some who protested on
entering the operating room!
The American College of Dentists is making a study of the Wel-
fare Fund Program conducted in Oregon and California and I hope
it will be extended to Washington. In California it is being con-
ducted by the School of Public Health with cooperation of the
College of Dentistry, University of California, in Oregon by the De-
partment of Political Science of the University of Oregon and the
Dental School. Both studies are closely correlated. I shall give you
some of the early findings which we may have to modify as later
returns are tabulated.
Of the dentists interviewed, 115 are in general practice and 5
restrict their patients to children. There is one area where most den-
tists avoid children and one practitioner in that region has 200 chil-
dren on the program. The average number of children per dentist
is 11. An appreciable number of dentists would like to add space
maintainers to the services now rendered. The average compensation
from union patients is $14.95 and the average for non-union children
is $15.70 per chair hour. Of 118 replies to the question asking recom-
mendation for fee schedule changes, 84 had no suggestions. There
were 105 replies that had no suggestions for changes in records or
paper work. Only five dentists said they refused to accept children
on the program and of these four indicated they had a full practice
and one did not take children. One hundred would like to see other
unions adopt a similar program.
SUMMARY AND CONCLUSIONS
As we appraise the program at this point we must conclude that
in the state of Oregon the plan has been successful. Many children
have received comprehensive dental care who would have had little
or none. This is important in a state that is retarded in its concept
and approach to comprehensive dental care particularly for children.
Sampling of over half of the participating dentists indicates the
program is well received. Similarly, the union families are happy
with it. There has been no complaint in giving up the indemnity
plan.
No small factor in the professional acceptance of the program has
the full publicity given all relations with the Welfare Fund both in
literature sent to dental society members and in open meetings.
Great credit should be given Dr. Harold Kramer for this approach.
We have proceeded on the basis that the Welfare Fund was honest
and forthright in its approach to the profession and after two years
we have no reason to revise our opinion.
The dental profession has been saying for years that it genuinely
wished to provide dental care for the entire population—this ap-
proach is one mechanism for doing just that.
Second Annual
Writing Award Competition

Sponsored by
The American College of Dentists
The American College of Dentists again is promoting a compe-

tition in the writing of papers and essays, and the preparation of
manuscripts, for graduating students in the dental schools of the
United States and Canada.
The purpose of the competition is to create reader interest, to
stimulate the more wide-spread use of libraries and to develop com-
petent dental writers.
A prize of $500.00 and a plaque will be awarded the national win-
ner. In addition, an appropriate plaque will be given the winner of
each school entry.
RULES AND PROCEDURES
1) The competition is open to all senior students in the dental
schools of the United States and Canada.
2) Students will be notified of the competition in the spring of
their junior year, and manuscripts must be received by the Sec-
retary of the American College of Dentists by February 1 of their
senior year. This will allow ten months for preparation. An-
nouncement of the winner will be made not later than April 1.
The time and occasion of awarding the prize and the plaques
shall be determined by the schools, but it is suggested that this
take place prior to the graduation of the recipients.
3) Deans will be asked to designate a faculty member to promote the
competition, to decide how the competition will be conducted,
and to determine the manner in which the winner is selected,
in each school. Only one essay may be submitted from each
school in the National competition.
4) Manuscripts submitted shall be accompanied by a letter from
either the faculty member designated to conduct the competi-
tion, or from the dean of the school from which they originate,
assuring the authenticity of the manuscript submitted.
5) For each annual competition, the American College of Dentists
will select and announce a topic.
214
WRITING AWARD COMPETITION 215
6) The topic will be in a non-technical aspect of dentistry. The
ethical, social, historical, or cultural relationships of dental
practice, education, research, organization and journalism will
be the areas from which the topic will be selected.
7) No hard and fast rule concerning length of the manuscript will
be established. However, it is suggested that the manuscript not
exceed ten double-spaced typewritten pages, exclusive of bib-
liography, tables and charts and illustrations. White bond paper,
81
/ 2 x 11 inches must be used.
8) The original and five (5) copies must be submitted; this is for
judging purposes. Manuscripts must be sent either flat, or
folded once in the center. Pages must be held together by clips
or fasteners. Footnotes must be designated by placing them at
the bottom of the appropriate manuscript page, separated from
the text by a line. References and bibliography must be on sep-
arate pages and must conform to the style adopted by the Ameri-
can Association of Dental Editors and the American Dental As-
sociation. Tables, charts and illustrations also must be on sep-
arate pages. Good compositional form must be followed.
9) Manuscripts will become the property of the American College
of Dentists. None will be returned. The winning manuscript
will be published in the JOURNAL OF THE AMERICAN COLLEGE OF
DENTISTS.
10) The Committee on Journalism of the American College of
Dentists will assume the responsibility of determining the win-
ner. Its decision will be final.
11) Manuscripts will be judged as they reflect these general qualities:
purpose, scholarships, accuracy, impartiality, neatness, objectiv-
ity, and as a contribution to the periodical literature of the pro-
fession.
12) The topic selected for the 1958 competition is: "Ethics in Den-
tal Practice."
For details concerning this competition consult your dean, your
faculty advisor or write to:
DR. 0. W. BRANDHORST, Secretary
4221 Lindell Blvd.
St. Louis 8, Missouri
Sections, American College of Dentists
CAROLINAS: Frank 0. Alford, Sec- NEW JERSEY: Walter M. Dunlap,
retary, 1109 Liberty Life Bldg., Char- Secretary, 144 Harrison St, East
lotte, N. C. Orange, N. J.
COLORADO: Ralph R. Gibson, Sec- NEW YORK: David Tanchester, Sec-
retary, 1132 Republic Bldg., Den- retary, 120 Central Park South, New
ver, Colo. York, N. Y.
FLORIDA: Robert Thoburn, Secre-
NORTHERN CALIFORNIA: Ches-
tary, 227 Orange Ave., Daytona ter W. Cusick, Secretary, 2300 Dur-
Beach, Fla. ant Ave., Berkeley, Calif.
GEORGIA: Everett K. Patton, Sec-
retary, P. 0. Box 136, Ben Hill, Ga. OHIO: Earl D. Lowry, Secretary, 79
East State St., Columbus, Ohio.
INDIANA: Frank C. Hughes, Sec-
retary, 1121 W. Michigan St., Indi- OREGON: Frank Mihnos, Secretary,
anapolis, Ind. 920 Selling Bldg., Portland, Ore.
ILLINOIS: Elmer Ebert, Secretary, PHILADELPHI A: J. Wallace Forbes,
10058 Ewing Ave., Chicago, Ill. Secretary, 1420 Medical Arts Bldg.,
IOWA: Leslie M. FitzGerald, Secre- Philadelphia, Pa.
tary, 718 Roshek Bldg., Dubuque, Ia. PITTSBURGH: Clarence W. Hagan,
KANSAS CITY-MID-WEST: Phillip Secretary, 7528 Graymore Road,
M. Jones, Secretary, 1108 E. 10th Pittsburgh, Pa.
St., Kansas City, Mo. ST. LOUIS: John T. Bird, Jr., Secre-
KENTUCKY: Russell F. Grider, Sec- tary, 4559 Scott Ave., St. Louis, Mo.
retary, 129 E. Broadway, Louisville, SOUTHERN CALIFORNIA: Ru-
Ky. lon W. Openshaw, Secretary, 6703
LOUISIANA: Robert Eastman, Sec- Melrose Ave., Los Angeles, Calif.
retary, 735 Navarre Ave., New Or-
TEXAS: Crawford A. McMurray,
leans, La.
Secretary, Alexander Bldg., Ennis,
MARYLAND: D. Robert Swinehart, Tex.
Secretary, 717 Medical Arts Bldg.,
Baltimore, Md. TRI-STATE: James T. Ginn, Secre-
tary, 847 Monroe St., Memphis,
MICHIGAN: Glenn R. Brooks, Sec-
Tenn.
retary, Rochester, Mich.
MINNESOTA: Dorothea F. Radusch, WASHINGTON, D. C.: C. V. RauIt,
Secretary, 3900 Reservoir Rd., N. W.,
Secretary, 832 Marquette Bank
Bldg., Minneapolis, Minn. Washington, D. C.
MONTANA: Elmer A. Cogley, Secre- WEST VIRGINIA: John Boatman
tary, 417 Medical Arts Bldg., Great Davis, Secretary, 510 Goff Bldg.,
Falls, Mont. Clarksburg, W. Va.
NEBRASKA: Walter W. Key, Secre- WISCONSIN: Leonard C. Alexander,
tary, 1314 Medical Arts Bldg., Oma- Secretary, 604 N. 16th St., Mil-
ha, Neb. waukee, Wis.
NEW ENGLAND: Richard J. Larkin, WASHINGTON-BRITISH COLUM-
Secretary, 1245 Hancock St., Quincy, BIA: Bruce B. Smith, Secretary, 812
Mass. Cobb Bldg., Seattle, Wash.
216

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SEPTEMBER 1957 / VOLUME 24 • NUMBER 3

Published Quarterly for General Circulation

$5.00 a year • $1.50 a copy

Teacher Training Fellowship

Volume XXIV September, 1957 Number 3

Board of Editors (1956-1957)

AUSTIN T. WILLIAMS DONALD W.GULL=

In the following section of our JOURNAL we present five addresses

my servant, John Booles" and "500 lbs. of tobacco unto a minister

without the realization that in the Middle Ages a large portion

registering with the reader, whereas to associate those services to

The significance of the Fauchard manuscript is largely biograph-

The manuscript in the Faculty of Medicine of Paris has been

these variant statements it must be inferred that the manuscript was

THE PRINTER'S COPY

by adding irrelevant comments indicate that the printer did not

the manuscript. The bulk of the manuscript is in a regular and

margin of the page is a microscopic hand with a regular slant.

"What a scribe this is who amuses himself in the text!" Dagen

ORGANIZATION OF THE BOOK

The chapters, however, are numbered as to an earlier position

In the published book, at this point he calls attention to his dis-

MANUSCRIPT COMPARED WITH BOOK

Thomas William Parsons, Jr.

In the Boston Almanac for 1852 will be found the names of 75

title of "The First Ten Cantos of the Inferno of Dante, Newly

Since Webster's home was in Marshfield, only a few miles south of

the book has been completely revised and is a great improvement

no close correlation between high scholastic grades and great achieve-

The Presidents of the United States—all 33 of them—head the

composers numbered 4, religious leaders 14, and educators 14,

influence of learning and learned dentists who laid the foundation

The Berlin Research Institute of the History of Dentistry (For-

We tried to represent each stage in development through old instru-

I See J. Am. Col. Den. 12, 101; 1945, June.

help to those who worked outside our Institute as we could so

THE GENERAL THEME of this in-

•Presented during inauguration of Dr. Edward H. Litchfield as twelfth chan-

not only appear to be moving backwards, but may appear to be off

political suicide, and that support of health programs have increas-

are to get our bearings in four-dimensional space, as we started out

In the beginning of this paper I tried to picture dentistry as the

tifying the applicant who has the potential to develop as a profes-

he have the theoretical knowledge of immediate dentures, cleft pal-

November 3, 1957, Miami, Fla.

November 9, 1958, Dallas, Texas

September 20, 1959, New York, N. Y.

October 16, 1960, Los Angeles, Calif.

November 1, 2 and 4, 1957, Miami, Fla.

Is there a place for the hard-headed policies of business in the

LUNCHEON, 12:30 P.M.

AFTERNOON MEETING, 3:00 P.M.

EVENING MEETING, 7:00 P.M.

EDITOR'S NOTE: The four sessions of Section Nd—Dentistry consisted of a

I. Contributions of Science to Everyday Practice

I. The Influence of William J. Gies in the Recognition

• Held in New York City, December 26-30, 1956.

health service. Since his activities are too numerous to mention in

Further recognition for dentistry came in 1954 when the AAAS

complete blackout of the victims. These blackouts occurred with-