Horace Wells Discovers Pain-free Dentistry

By Emily E. Gifford

In the early 19th century Hartford dentists Horace Wells and William Morton played instrumental roles in the development of anesthesia for dental and other medical applications. Horace Wells, born in Hartford, Vermont, and educated in Boston, began his practice in Hartford, Connecticut, in 1836 and quickly rose to prominence. He married Elizabeth Wales in 1838 and continued to write about dentistry and invent various devices, such as a foot-powered shower.

Wells Sees Potential in Laughing Gas
In 1842, Wells took Morton, first, as his student and then as his partner. Morton, who was born in Massachusetts and trained for dentistry in Baltimore, Maryland, married Elizabeth Whitman, daughter of Lemuel Whitman, on her father’s condition that he quit dentistry and study to practice medicine instead. In 1844, Morton began (but never completed) his studies at Harvard Medical College.

Although Wells tried to form a dentistry practice with Morton in Massachusetts, the new partnership lasted less than two weeks, and Wells returned to Connecticut. In December of 1844, Wells and his wife attended a demonstration at Union Hall in Hartford of “laughing gas” (nitrous oxide) put on by showman Gardner Colton, who had briefly studied medicine. Wells noticed that one of the volunteers, while ingesting the gas to the amusement of the audience, had injured his leg during the demonstration. Wells later talked to the man and found he was unaware he had suffered an injury.

Since Wells had long been concerned about the amount of pain suffered by his patients during dental procedures, he immediately enlisted Colton’s help. The day after the demonstration, Colton came to Wells’s practice and administered nitrous oxide while Wells’s associate, John Riggs, extracted one of Wells’s own troublesome wisdom teeth. Feeling not “so much as the prick of a pin” in the course of this usually painful procedure, Wells believed that he, with the help of Colton and Riggs, had invented painless dentistry.

Experiments with Anesthesia
After Colton taught Wells how to administer the gas, Wells performed a dozen painless procedures over the next few weeks. Always intense, Wells became more excited with each successful procedure. He decided to demonstrate painless dentistry in Boston and did so in January of 1845 at Massachusetts General Hospital for the benefit of Harvard Medical School students and faculty members. The demonstration did not go well. The patient moaned as if in pain, and the audience drove Wells from the lecture hall with cries of “Humbug” and “Swindler,” even though the patient tried to explain that he was not, in fact, in pain.

Despite his setback in Boston, Wells continued to use nitrous oxide in his practice in Hartford and freely shared his discovery area dentists. While dental patients elsewhere continued to suffer, many throughout Hartford were enjoying painless dentistry by the middle of 1845. Wells’s apparent failure in Boston, however, temporarily deterred him from any further attempts to publicize his innovation nationally.

Meanwhile, in Boston, Wells’s former partner Morton was experimenting with the use of ether as an anesthetic. In 1846, Morton demonstrated the use of ether to perform a painless tooth extraction. He did not, however, identify his anesthetic as being ether. Instead, Morton called it “letheon” and applied for a patent for his “substance.” He established a monopoly on painless dentistry in the Boston area and soon got positive publicity for his discovery of ether’s medical applications. Morton also tried to make a profit from his discovery, but his attempts to claim sole discovery of anesthesia in general and ether in particular were denied.

Both Horace Wells and Charles Jackson, who had been Morton’s chemistry professor at Harvard and originally introduced him to ether, stepped forward to challenge Morton’s claim that he had discovered anesthesia. Wells, for his part, sought to strengthen his claims by publishing History of the Discovery of the Application of Nitrous Oxide, Ether, and Other Vapors, to Surgical Operations (1847). Morton and Jackson entered into protracted legal battles in their attempts to prove their claims.

Wells Seeks Fortune in NYC
Wells was also trying to find a way to gain fame and fortune as an anesthetist. By the end of 1847, he had participated in dental and other surgical procedures in Hartford, but decided that he should relocate to New York City to achieve greater recognition and success.

He moved there in January of 1848, intending to establish himself before sending for his wife and their young son, Charles Wells. Loneliness and homesickness overcame him, however, and Wells began using ether and chloroform in an attempt to ease his depression. Wells spent several days intoxicated on the combination of drugs, eventually becoming so confused that he could not distinguish sleep, dreams, and reality.

On the night of his 33rd birthday, Wells went out and threw acid on a pair of women in the street. Fortunately, the acid only burned their clothing and did not permanently injure the women. The police responded to their cries for help and arrested Wells, who they incarcerated in the Tombs Prison. He continued to ingest chloroform and ether while in jail, but in moments of clarity realized the depths to which he had sunk.

Believing that he had disgraced himself and his family beyond repair, Wells took a large dose of chloroform and used a razor to slash a major artery on his thigh. He quickly bled to death, and his body was released to his family for burial at Old North Burying Ground in Hartford. In 1908, Charles Wells re-buried his father and mother (who had died in 1889 and been buried alongside her husband) at Cedar Hill Cemetery. Wells’s tombstone identifies him as the “discoverer of anesthesia.” (In like fashion, Morton’s stone acclaims him as the “Inventor and Revealer of Inhalation Anesthesia.”)

The Nature of Discovery
In 1864, the American Dental Association, followed by the American Medical Association in 1870, recognized Horace Wells as the discoverer of anesthesia. Morton was never able to gain the fortune he sought for his own contributions to the field, including a $100,000 prize which was contested by Jackson and Wells’s survivors.

Although claims to singular discovery reinforce society’s fascination with individual genius, historians of science note that it is not unusual for innovations to occur at a moment when several individuals—sometimes with knowledge of each others’ efforts and sometimes not—are working along similar lines. Discovery, they emphasize, is not typically an event but a process. Wells, then, is rightly recognized for his pioneering role in pain-free dentistry and the field of medical anesthesia.

Emily E. Gifford is an independent historian specializing in the history of religion and social movements in the United States.

Image: Miniature Portrait of Horace Wells

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Management of Jaw Injuries in the American Civil War: The Diuturnity of Bean in the South, Gunning in the North

By Richard A. Pollock, M.D.

ABSTRACT
James Baxter Bean published a series of articles in the Southern Dental Examiner in 1862 describing his work with “plaster and its manipulations.” This early experience included a new way of managing jaw fractures, with customized splints uniquely based on pretraumatic occlusion. Bean's oral splints and their method of construction, using an articulator, became the standard of care in the Atlanta region during the American Civil War and, by 1864, throughout The Confederacy. In short course, Bean's approach also swept The Union, following in large part the efforts of a colleague in the North, T.B. Gunning. Thus, what began in the early 1860s in a dental laboratory in the southeast swept the continental United States and revolutionized management of jaw-fractures during, and immediately after, the American Civil War.

The desideratum, in treating fractured jaws, is to retain the fractured extremities in close and perfect apposition, thus maintaining the exact antagonism of the teeth, until provisional callus is thrown out, and union is effected. (Edward N. Covey, Medical Inspector, Confederate Army, 1866)

A forerunner of intraoral splints was developed by Richard Wiseman during the English Civil War (1642); he reduced a fracture of the maxilla with his hands, and patient and family maintained the reduction with a short-handled, Y-shaped wooden spatula.1 In 1771, Desault and Chopart introduced a cork-and-tin splint for fractures of the mandible that was fully contained within the oral cavity.2 The Desault-Chopart appliance was not significantly modified over the ensuing decades, except perhaps with the introduction of gutta-percha, a resin derived from latex (and resembling rubber), by Hayward and others in 1845.3,4 It was several more decades (1862 to be exact) before James Baxter Bean used plaster dental models that, when sectioned and placed on an articulator, formed the basis for an intraoral splint. The Bean splint restored pretraumatic occlusion of the injured and promoted accelerated healing.

THE DISCOVERY
Bean (Fig. 1) was born July 19, 1834, in eastern Tennessee, attended Washington College in Limestone (in the tri-cities area of the State), and in 1860 graduated from the Baltimore College of Dental Surgery.5 He briefly practiced in Micanopy, Florida (south of Gainesville), and it was from there that he authored articles on “Plaster and its [Dental] Manipulations.” While awaiting publication of his four-part series in the Southern Dental Examiner in 1862,6 Bean moved to Atlanta, Georgia, to be closer to the South's only dental supply house, Brown & Hape, and to enjoy the stability of transactions in Georgia currency or in gold-and-silver coin.7,8

By the summer of 1864, the South's leadership had vacillated on a Confederate Army proposal to invade and split the North,9 and Sherman, taking the initiative, was poised to thrust through the heart of Georgia, to divide the Confederacy by marching to the sea. In vogue at the time, management of fractures of the jaws called for manual reduction and stabilization by means of a gutta-percha splint,4,10,11,12 depicted well, by example, in an 1864 report of Watkins Burton,13 a dentist assigned to Jackson Hospital, Richmond, Virginia. A Confederate soldier of the 53rd Georgia Regiment, James Hutchinson, had suffered a fracture of the left maxilla between the first and second premolars. Burton wrote: “After forcing the fracture into position, gutta-percha softened in warm water was pressed on the teeth [including] the fractured portion, and the jaws closed in occlusion. The impression was then carefully removed and placed in cold water” to harden. “The material [after reinsertion],” Burton added, “afforded a pleasant rest to the jaw [during healing], and left an opening through which food might be received, and at the same time not be affected by the secretions of the mouth, or by discharges from the wound.” In vogue also, because of the need for practicality, were splints made of pasteboard softened with vinegar.14 Circumferential dressings, such as the Barton or the Hamilton bandage, added a modicum of stability.15,16

It was in this setting in June of 1864, during visits to hospitals in Atlanta, Georgia, that Edward N. Covey, the Medical Inspector of the Confederate Army, learned of James Baxter Bean and his novel approach, initiated first in 1863, for management of fractures of the jaws. Covey described Bean's approach in 1866, some 10 months after cessation of the war, in the inaugural issue of the Richmond Medical Journal:

Bean first took “wax impressions of the uninjured jaw and separately each fragment of the broken jaw, as soon after the injury as the condition of the parts permitted.”

From these impressions, Bean “then produced casts of plaster of Paris, giving as perfect representations of the teeth as possible.”

“The plaster models were next antagonized in their normal [occlusal] position, in an articulator”.

The “fragments of the model representing the broken jaw were trimmed, placed in their proper antagonism, and held in position with wax”.

“The articulator model was then imbedded in plaster and packed with rubber gum.”
“The gum was finally separated and by heat, thoroughly vulcanized,” creating the Bean splint.

After “some adjustments” and after insertion of the splint, the jaws “came together in their most natural and easy position,” Covey wrote, and an “occipital-frontal linen bandage [probably the Hamilton] was applied in most cases,” to maintain anatomic position of the broken fragments.17,18

Upon receiving Covey's and other reports describing Bean's prowess and successful outcomes,17,19,20,21,22 the Surgeon General of the Confederate War Department directed Bean to report to Army Headquarters, in Richmond, Virginia. There, before the Medical Board, Bean described his unique, occlusion-based methodology. A month later, a circular by J. Carrington, the Medical Director of Virginia, mandated that all soldiers in the Confederate theater with jaw injuries be directly or indirectly transferred to the care of Dr. Bean, centered at Robertson Receiving-and-Wayside and other Richmond and Petersburg, Virginia hospitals.8,17,18

After the fall of Atlanta to Union forces, the management of jaw injuries was relocated to a dedicated ward at the Blind School Hospital in Macon, some 90 miles south of Atlanta. Personnel and the resident dentist there were already versed in the ways of Bean.17,19,23

A COLLEAGUE IN THE NORTH
Bean's articulator-based splint was the first of its kind by some 6 to 7 years and is well documented in the meticulous dental records of the Confederacy. The published report in the Richmond Medical Journal (by Covey17) in February of 1866, immediately following the war shared the methodology with the dental profession at large.

The originality of Bean's work and that of purported competitors, such as Thomas Brian Gunning of New York City (Fig. 5), can now be confirmed because of the availability of digital copy of rare collections. A review of this recently available literature indicates the following:

The means by which Gunning became aware of Bean's technique is unclear. The possibility of a Union spy at Bean's open presentation to the Medical Board, at Confederate Army Headquarters in Richmond, Virginia can be speculated. More probably, however, Union forces retained a copy of the circular issued by the Medical Director of Virginia, J. Carington, describing and mandating the use of an articulator in the construction of vulcanite splints, and then referred it on, through proper channels.

The publications in the Southern Dental Examiner (by Bean, in 18626) and the Richmond Medical Examiner (by Covey, in 186617), preceded by 6 and by 2 years, respectively, the series published (by Gunning) in the American Journal of Dental Science in 1868.24

The original Gunning splint of a single jaw did not involve an articulator and was secured in place by screws driven through the gingiva and into the boney stock of the mandible; Gunning used this method on April 27, 1865 (originally thought to be in 1864), to manage a fracture of the mandible of Secretary of State, William H. Seward.25,26

Gunning's successful management of a 36-year-old male with bilateral fractures of the mandible in August of 1866 was 6 months after Covey's review in the Richmond Medical Journal.24

THE REST OF THE STORY
After his service to the Confederate Army, Bean returned to Baltimore, the center of his dental training. There, he developed a method of casting aluminum denture bases and invented an apparatus for simplified manufacture and administration of nitrous oxide.8

In 1866, Bean became one of the founders of the Maryland State Dental Society, and, recognized for his seminal management of jaw fractures, served as its president, beginning in 1868.8 Bean's contributions were prescient, and his method of articulator-based splint construction persists today

Unlike Richard Wiseman after the English Civil War (1641 to 1648),1 Gunning after the Civil War (1861 to 1865),24 and Harold Gillies after World War I (1914 to 1918),27 Bean did not publish the breadth of his prewar, wartime and postwar experience. More like Stephen Crane (Red Badge of Courage) and John Keats (To Autumn),28,29 Bean died at an early age (36) and lost the chance to further publish, when a Smithsonian expedition to Mount Blanc encountered a weeklong snowstorm in 1870. The death of Bean and nine colleagues at the highest summit of the Alps (Mont Blanc) near the French border30 is legendary in the annals of mountaineering history.* The Bean articulator splint, often mistakenly identified as the Gunning splint, is less recognized in the annals of craniomaxillofacial history.

ACKNOWLEDGMENTS
The photographs of Doctors Bean and Gunning are courtesy of the National Library of Medicine, Washington, DC. Linda Combs rendered assistance in manuscript form and submission. A poster presentation of this topic was exhibited by the author at the Fifty-second Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, San Juan, Puerto Rico, June 6 to 10, 2009.

FOOTNOTES
*Bean is buried in the Protestant Cemetery in the Chamonix Valley, in the Haute-Savoie region of France.5 Chamonix is bordered by Switzerland and Italy and dominated by the incredible Aiguilles de Chamonix chain of mountains that peaks at the summit of Mont Blanc.

REFERENCES
Wiseman R. Several Chirugical Treatises. London: Flesher & Maycock; 1676.
Beeson B B. Pierre-Joseph Desault. Ann Med Hist. 1933;5:342–346.
Koch C RE. History of Dental Surgery. Fort Wayne, IN: National Art Publishing; 1910.
Kingsley N W. A Treatise of Oral Deformities. New York: Appleton & Company; 1880.
Baxter C F. Dr. James Baxter Bean, Civil War dentist: an East Tennessean's Victorian tragedy. J East Tennessee Hist. 1995;67:34–37.
Bean J B. Plaster and its manipulations. Southern Dent Examiner. 1862;11:53–57. 69–76, 89–96.
Brown J PH, Hape S. Brown & Hape Business Notice. Southern Dental Examiner. 1861;1:152.
Borden Institute Available at: Dentistry in the Confederacy, 1861–1865. In: A History of Dentistry, pp: 55–81. http://www.bordeninstitute.army.il/other_pub/dental.html. Accessed June 1 2009. http://www.bordeninstitute.army.il/other_pub/dental.html
Alexander B. How the South Could Have Won the Civil War: The Fatal Errors that Led to the Confederate Defeat. New York: Crown; 2007.
Burton W L. Dental surgery as applied in the armies of the late Confederate states. Am J Dent Sci. 1867;3:181–188.
Macaulay J G. Dentistry in the Confederate armies. S C Dent J. 1950;8:13.
Georgia Dental Association History of Dentistry in Georgia. Macon, GA: Southern Press; 1962.
Burton W L. Dental notes on the late Civil War. Am J Dent Sci. 1868;3:443–445.
Bolton J. A simple interdental splint. Richmond Med J. 1866;1:318–320.
Barton J R. A systemic bandage for fracture of the lower jaw. Am Med Recorder Phila. 1819;2:153.
Hamilton F H. A Practical Treatise on Fractures and Dislocations. Philadelphia: Lea Publishing; 1860.
Covey E N. The interdental splint. Richmond Med Digest. 1866;1:81–91.
Obituary of James Baxter Bean, D.D.S., M.D. Am J Dent Sci. 1870;4:287–288.
Stout S H. Correspondence. [WH Morgan] Dent Reg. 1869;23:162–164.
Stout S H. Dental surgeons in the armies and navies. Tex Med J. 1899;15:132–134.
Schwartz L L. American dentist: James Baxter Dean (1834–1870) Ann Dent. 1946;4:167.
Cunningham H H. Doctors in Gray: The Confederate Medical Service. Baton Rouge, LA: Louisiana State University Press; 1958.
Hodgkin W N. Dentistry in the Confederacy. J Am Dent Assoc. 1955;50:647–655. [PubMed]
Gunning T B. Treatment of fracture of the lower jaw by interdental splints: I–III. Am J Dent Sci. 1868;2:214–220.
Seward F W. Seward at Washington as Senator and Secretary of State: A Memoir of His Life, with Selections from his Letters (1861–1872). New York: Derby & Miller; 1891. p. 281.
Romm S. Thomas Brian Gunning and his splint. Plast Reconstr Surg. 1986;78:252–258. [PubMed]
Gillies H D. Plastic Surgery of the Face, Based on Selected Cases of War Injuries to the Face Including Burns. Oxford: Oxford University Press; 1920.
Crane S. The Red Badge of Courage. New York: D. Appleton & Company; 1895.
Colvin S. John Keats. London: Macmillan; 1920.
Christen A G, Christen J A. The triumph and tragedy of James Baxter Bean, MD, DDS (1834–1870) J Hist Dent. 2003;51:19–25. [PubMed]

Image 1: James Baxter Bean pictured after the American Civil War, before his death in 1870. (Photo courtesy of the National Library of Medicine, Washington, DC.)

Image 2: Thomas Brian Gunning pictured after successful delayed management of a fracture of the mandible of William H. Seward, Secretary of State, using an occlusive splint of the lower jaw secured with screws.

From: ncbi.nlm.nih.gov

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Civil War Era Recipe for a “Wash for Teeth”

From: civilianwartime.wordpress.com

"Dissolve two ounces of borax in three pints of boiling water and, before it is cold, add one teaspoonful of spirit of camphor and bottle for use. A teaspoonful of this mixture mixed with an equal quantity of tepid water and applied daily with a soft brush preserves and beautifies the teeth, arrests decay, induces a healthy action of the gums, and makes them look pearly white. The best time to wash teeth is at night before sleeping."

Source: John Hammond Moore, ed., The Confederate Housewife (Columbia, SC: Summerhouse Press, 1997).

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Dental Tools

From: civilwarvirtualmuseum.org

The tooth key was first mentioned in literature in 1742; the first examples were made of iron with a handle shaped like a turnkey. As improvements were made over the years the handle was made of horn, ivory and different types of wood. They were also made in different sizes, with the smaller sizes and shapes being made for children. In the second half of the Eighteenth century the tooth key became the most popular instrument for tooth extractions.

Leading up to the Civil War, tooth care was generally poor, dentists few and dental care expensive. Despite poor dental care, a soldier’s teeth were important on the battlefield. Many recruits were turned down if they lacked opposing upper and lower teeth, considered necessary to bite the end off paper cartridges used with muzzle-loading muskets.

The Confederate army had a dental program and conscripted dentists into the army, usually at the rank of hospital steward, although some held the rank of surgeon. The Union army rejected the idea of a dental corps.

Image Courtesy Wilson’s Creek National Battlefield; WICR 30592

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Lost and Found at the Battle of Shiloh: One Half of a Very Fancy Denture

By Judy M. Chelnick, June 9, 2014.

Here in the [Smithsonian] museum's Division of Medicine and Science, we're undertaking an inventory of the museum's dental collection, and we discovered one half of an interesting denture. The upper palate appears to be made of silver and it has eight porcelain or mineral tube teeth. Each tooth has a "central canal" which is secured to the palate with pins. Two teeth are missing.

The museum's dental collection has dozens of dentures made from these exact materials. What makes this denture interesting are the two inscriptions: In pencil or ink on the top of the palate it reads, "FOUND AT SHILOH BATTLEFIELD"; and etched into the bottom of the palate "FOUND AT BATTLE OF SHILOH".

When curators like myself find a cool object like this, with little identifying information to place it in context, we immediately have a lot of questions. What information can we glean from this artifact? Was it really lost at the Battle of Shiloh? Who lost the denture? What do we know for certain about the denture?

The denture was given to the museum in 1969 by dentist D.L. Crowson of Petal, Mississippi. In a letter to Curator Audrey Davis, Dr. Crowson wrote, "I have no history on this denture except I was told by the person who gave it to me that it had been picked up on the Shiloh battlefield site".

When the Civil War began in 1861, there were few university-trained dentists on either side of the conflict. However, just as now, people suffered from tooth decay diseases that made dentistry as essential on the battlefield as on the home front. The surgical sets supplied to Union surgeons included dental tools for the extraction of teeth. Many of the soldiers who participated in the Battle of Shiloh had probably lost a tooth at some point in their lives, but false teeth would have been relatively rare, especially a denture of this quality.

Porcelain teeth were developed in 18th century Europe and brought to the United States in the early 19th century. The so-called "tube teeth," artificial teeth with a vertical hole in the center cemented to a metal post attached to the base of the denture, were developed in London around 1840 by Claudius Ash. Gold, silver, tin, lead, and eventually gutta-percha, a plastic cultivated from the sap of trees found in Malaysia, were also common materials used to form the palate in the 19th century. That being said, it is possible that this denture was worn during the war, but how can we know for sure?

Technology has given us some new tools to test our objects without harming them in order to do some material forensics. Here at the National Museum of American History's Object Conservation Lab, Conservator Beth Richwine uses an X-Ray Fluorescence (XRF) Spectrometer to determine the elemental composition of different materials. We took the denture to the lab to have Richwine analyze the metal content of the palate.

The XRF found the palate was composed of silver, copper, lead zinc, and bismuth. The analysis showed that the palate was probably an alloy known as German silver, predominantly coin-grade silver, but mixed with small amounts of lead, tin, zinc and bismuth. Richwine explained the trace materials would contribute to the malleability of the metal during processing. "This makes sense because they very well could have been added to the mix to help with the forming process of the palate," she reported. German silver was developed by a German industrial chemist named E. A. Geitner in the early 19th century and was often used in dental applications throughout the 1800s.

Therefore, it is very possible, given the materials and its construction, that the denture is from the time of the Civil War.

But questions remain: Who might have worn this, and how did they lose it? In this period, only the well-off could afford dentures, especially those with a high silver content. So we have to assume the owner was probably an officer, someone with the means to purchase dentures. When the average person lost a tooth, they went without; the unfortunate person walked around with a gaping hole.

Despite all of our evidence, we still do not know for sure if the denture was lost at the Battle of Shiloh and are still left with some unanswered questions. We would love to find a diary entry or letter from the time in which someone mentions dropping their denture on the battlefield to solve our mystery, but so far none has turned up. There is also the grisly possibility that this denture was removed from a corpse, but the high casualties (around 3,400 Americans died at Shiloh) make even this theory a difficult avenue for research.

What do you think? Have we missed an angle? Is there any information you can add to help us solve the mystery of the Shiloh denture?

Judy M. Chelnick is the curator of medical and dental instrumentation in the Division of Medicine and Science at the National Museum of American History. 

Image: The mystery denture in our collection

Learn more about Civil War dentistry at www.CivilWarRx.com.

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No Teeth, No Man: Dentistry during the Civil War

By Douglas Richmond

During the American Civil War, the Union Army went the duration of the war without any military dental care. On the opposite side of the spectrum, the Confederate Army was heavily sympathetic to dental care and even employed dentists at one point during the war. As Dr. William Roberts explains in his March 1863 article for the New York Dental Journal, “There is no dentist in the army, so all the tooth has to do is rot away at its earliest convenience, when the soldier goes to the surgeon, the surgeon draws the tooth as expeditiously and painfully as he knows.” Those responsible on the Union military’s high command thought so little of dental care that they even neglected to issue toothbrushes to every new recruit. Despite protestations and petitions from both the American Dental Association and sympathetic dental practitioners, the Union military remained without any sort of commissioned dental care. With the amount of funding the Union had, including the fact that the Confederacy provided dental care for their soldiers, one must ponder the question, why did the Union not do the same?

The fact remains; the Union military had no rendered dental corps available and did not stress the importance of dental hygiene to their men. The only medical personnel made available to Union soldiers were medical surgeons and stewards, whose dental experience was null. Dr. Roberts would go on to claim in the same New York Dental Journal article that “the army surgeon is generally not only utterly incompetent to the proper care of teeth, but he is also entirely averse to it.” Roberts also states that issuing one dentist to every brigade and stressing the importance of proper tooth care would spare the U.S. War Department a “useless and ill-regulated expense.” The Union military had a clear disadvantage stemming from its lack of military dental care and their soldiers suffered accordingly for the duration of the war. With the amount of progress that the Confederacy made in dental care for the military, the Union Army should have provided dental care as it would have been substantially beneficial for both soldier and medical personnel alike.

In explaining why military dental care was necessary during this period, one must recognize the context for this period. By the mid nineteenth century, dentistry in the United States had acquired a strong standing. A greater understanding of dentistry in the nation in part is due to the establishment of colleges dedicated to the discipline of dentistry. By 1840, the first college of dentistry would be established in Baltimore, Maryland, and by the 1860’s, there would be two additional colleges of dentistry created in Philadelphia and New York. The establishment of these colleges provided graduating students with a Doctorate of Dental Surgery, a first of its kind in the United States. The establishment of these schools would also help spur an increase in the amount of dental professionals. By 1860, there would be five thousand dentists working in the United States.

Dentistry was recognized as important by some high ranking political figures, such as Jefferson Davis. Davis, while he was Secretary of War for Franklin Pierce, endorsed an idea to construct a dental related unit for the military. Davis “received the proposition [for dentists] as one of great value.” The idea was supported by the current Surgeon General, Thomas Lawson;however, it received no official action from Congress. This would be partly due to another pending bill, a bill that involved the addition of surgeons into the Army. Davis’s early interest in dentistry is perhaps why the Confederacy was able to construct a dental unit. Similar attempts were enacted during the Civil War, but all of them were denied and the Union Army’s dental care would be practiced by the “qualified” regimental surgeons.

The remainder of this paper will be structured as follows: the first section will discuss the Union Army’s “dental care,” and its impact on soldiers and dentists, as well as the various attempts made by the latter to provide dental care for the military. The next portion of the paper will deal with the Confederacy’s dental care. I will demonstrate the benefits and achievements obtained from the Confederacy’s dental unit as I believe a juxtaposition of the two will allow me to demonstrate why dental care is beneficial to the military. The last portion of my paper will focus on why dental care was necessary for soldiers; I will include a typical soldier’s diet and the illnesses that resulted from poor dental care. With all these portions intact, I believe I will be able to illustrate why the Union Army made a huge error in omitting dental care.

The Union Army’s “Dental Care”
​The Union Army provided minimal dental care to their troops. The only help for soldiers, if they could not afford the services of a civilian dentist, was the care from a regimental surgeon. Regimental surgeon’s inexperience with dentistry led to inferior dental services. These surgeons were inept when it came to dental matters. Dr. John McQuillen, co-editor of the dental journal "Dental Cosmos", spoke of the surgeons’ education in his December 1861 article. In it, he states, “The education of the surgeon, however, in this direction, it must be admitted, has not heretofore been sufficiently attended to, and it is extremely doubtful whether one out of ten can diagnose between an aching and sound tooth, an exposed pulp and acute periostitis.”

​Being able to properly infer a diagnosis is imperative in performing dentistry, as teeth in many instances can be saved if the dental surgeon has the correct diagnosis. In most cases, these surgeons made matters worse for their patients, through careless tooth extractions, as illustrated in the reminiscences of Dr. Williams W. Keen, a surgeon during the Civil War. Keens recalls a particular operation performed by a colleague that went less than satisfactorily:

"The [bullet] passed through the left temporomaxillary articulation and ankylosis of the jaw followed; a surgeon who attempted to remedy this ankylosis broke a number of his good teeth, and also by a later operation caused a salivary fistula, requiring another operation for its cure; repair of his teeth was impossible on account of the ankylosis, and he was compelled to live all his life after his wound on soft diet, being able only to separate his teeth to a very slight extent and not being able to masticate other food."

Adding to the Union’s dental surgery issue was the fact that these medical surgeons were ill-equipped for dental surgeries. In the New York Dental Journal, Dr. William Roberts explains that, “attached to the encumbrances of the surgeon are: one turnkey, two pairs of straight forceps, one pair of lower molar forceps, one gum lancet, and the occasional stump screw.” These tools might seem adequate for the layman, but Roberts, a trained dentist, felt otherwise. Roberts claimed that the proposed tools were inadequate and even “the best trained dentist in the world could not perform with these instruments…to any degree of satisfaction.” One could blame the Union Army for failing to properly supply these surgeons for dental duties. Another notable problem of the Union was its failure to equip all their soldiers with the most rudimentary of tools for ensuring dental hygiene, toothbrushes.

The Union Army and Toothbrushes
​Soldiers typically neglected to care for their teeth, and soldiers’ diet complicated their condition. Coupled with this was the fact that toothbrushes were hard to come by while serving for the Union, as the U.S. government failed to issue toothbrushes to all their men. They fended for themselves by either “[purchasing] from sutlers or [getting them] sent from home.” An unfortunate issue when dealing with civilian sutlers is that these individuals often did not offer toothbrushes for purchase at Union encampments. Dr. Jonathan Taft, co-editor of the Dental Register of the West, while frequenting various encampments, had this to say of civilian sutlers,“Toothbrushes, dentifrices, toothpicks…These things should be placed within the reach of every soldier; but strange as it might seem, we have not been able to find any of the kind, in a single sutler’s establishment, in a large encampment.”

A scarcity of toothbrushes, like the dental care provided by military surgeons, was an issue for the Union Army throughout the war. Without dental professionals available to stress the importance of dental hygiene and toothbrushes, many soldiers who did not have toothbrushes causing issues such as dental caries and tooth decay. Those who could not afford the services of a dentist had to endure the “tortures” of the regimental surgeon.

Impact on Union Soldiers
There were many soldiers who had to fare the inhumane procedures of these surgeons just to remedy a toothache or any other dental ailment. Sergeant Alexander G. Downing grieved about this process in his January 1865 diary log, “I arrived at the doctor's tent…I pointed out the exact tooth; he hooked on, at the same time telling me to hold on to the chair, and pulled. He succeeded in bringing the tooth, but it was not the aching one.” First Lieutenant Ziba Graham harped about his reluctant visit to the regimental surgeon in his diary:

Our surgeon, Doctor Everett, who had been hard at work all night at the amputation table, made but short work and little ado about one tooth. He laid me on the ground, straddled me, and with a formidable pair of nippers pulled and yanked me around until either the tooth came out, or my head off. I was glad when my head conquered. I then made up my mind never to go to a surgeon for a tooth pulling matinee the day after.

Soldiers loathed every moment of having to get a tooth extracted. Captain William Thompson Lusk and Second Lieutenant John W. Puterbaugh stressed the same concerns about the dental care from medical surgeons. Lusk stated that as he went to his regimental surgeon to correct his teeth, the surgeon accidentally “breaks one of [the teeth] off,” Lusk was unwilling to participate a second time and had to pay a proper dentist for the job. Puterbaugh explained, of his foray with a surgeon, that “the damned old fool broke it off and it was ten times worse off than before.”

Soldiers who refused the services, of the medical surgeon, often sought out the services of civilian dentists. Here, these soldiers could receive the attention that they required; however, the cost was paid from their own pocket. Those who could not afford to hire a dentist were left with the option of either: dealing with the pain or seeking the unit’s regimental surgeon. This improper practice of dentistry from regimental surgeons infuriated many separate dentists and dental groups, such as the American Dental Association, and caused them to voice their solutions for the Union Army’s dental problem.

Response from Northern Dentists and Dental Groups
The dental situation in the Union Army was deplorable and disturbed much of the dental community in the North. After hearing of the treatment received from regimental surgeons, coupled with the fact that the Union did not include toothbrushes in regulations for soldiers, the dental community was outraged and petitioned for changes. These changes included simple solutions such as re-educating the regimental surgeons and/or conscripting professional dentists or dental surgeons for the Union military.

Dr. John McQuillen had a particular suggestion that involved not replacing these medical surgeons with dentists but actually properly supplying and re-educating them. McQuillen voiced his concerns over the improper amount of tools given to the medical surgeon for dental surgery.In his article, “Instruments Furnished for the Extraction of Teeth to Army and Navy Surgeons,” McQuillen argued that the tools, these “two forceps,” which are provided by the medical department “are inadequate to meet the most ordinary contingencies of [tooth extraction].”McQuillen suggested that the military issue these surgeons’ larger tool sets of forceps numbering“six pair…at least twelve pair.” These larger pairs would allow the surgeons and stewards to be equipped for “every contingency that might arise.” Upon that suggestion, McQuillen advised that these surgeons and stewards be provided “text books on [dental] surgery” to properly instruct the surgeons how to perform dental surgery correctly.

Proper education and equipment would be necessary for the regimental surgeon, as the only known procedure for a soldier suffering from tooth pain would be tooth extraction. When performing such a procedure, a hint of professionalism was required, or as Dr. C.N. Peirce describes in his January 1864 issue of the Dental Times, “There is probably no operation performed by the dentist that…[has] greater liability to accident…than that of extracting teeth.”Peirce claims that “the operator should be familiar” as it would “do much to prevent accident, and render the accident less painful.” With this rhetoric in mind, there were many from the dental community that felt that an appropriation of competent dental surgeons to the Union military would be best.

In that same issue of Dental Times the article, “Dentists in the Army,” was featured with the main purpose of proposing to the Union military the employing of dental surgeons:

"I have been told by a military officer that dentists are greatly needed in the army. That he had repeated occasions to give men furloughs to go to Washington to have teeth filled and otherwise treated; for very many in our army are sufficiently intelligent to know that troublesome or decayed teeth may be saved, and are therefore unwilling to have them sacrificed by extraction, which is all the army surgeon can do; therefore, the want of an intelligent dentist is apparent, who, I have no question, could make it mutually advantageous,(as he would charge for his operations,) by remaining with the army, … Such a procedure would furnish an unanswerable argument in favor of what the profession has been long contending for, Governmental employment of dentists in the army."

Dentists such as Dr. William Roberts and George H. Perine had similar suggestions for the dental issue that the Union Army had acquired. Roberts suggested that the War Department assign dental practitioners that would practice on troops in the field at their own expense and be paid at reasonable costs. Perine in Dental Cosmos felt that, “few, if any, of our army and navy surgeons possess knowledge of dentistry, and that the appointment of physicians practicing our specialty would necessitate a new order of things.” These suggestions did little to inspire any sort of change within the Union Army. In response to the Union’s apathy toward dental care, there were attempts made by dentists and dental groups to provide dental care for Union soldiers.These attempts accomplished very little in terms of acquiring dentists for a military dental unit; the U.S. military would be without a dental unit until 1911, when the U.S. military created a Dental Corps.

Actions made by Northern Dentists and Dental Groups
​Upon realizing that their solutions and suggestions for dental care were going nowhere,those in the dental community decided to approach this dilemma in a different fashion. This approach included professional dentists offering their services, unofficially and officially, to the U.S. military to legislative attempts made by dental groups to create a military dental unit.

There were hundreds if not thousands of dentists in the North who took up arms for the Union, many of whom gave up their profession to fight. However, there were a few dentists who continued to practice dentistry unbeknownst to the Union military. One particular dentist who would fare the horrors of war for the Union was Dr. Charles Koch. Koch entered the military and would acquire a variety of roles ranging from enlisted soldier, to infantry officer, to commander of one of the Union’s colored regiments, the 49th colored regiment. Koch would still revert to his dentist sensibilities, whenever he had the free time to, and provide dental assistance to ailing soldiers. As an infantry officer, Koch commanded his subordinates and carried a “small satchel” that “kept dental instruments and medicines to relieve the tortures of the mouth”. Like Koch, there were dentists that wanted to be commissioned officially as military dental surgeons; however, these individuals were denied by the Union military.

Dr. James Garretson tried to offer his services to the U.S. military. Garretson, who has been called “the father of oral surgery,” hoped that his services would be recognized and deemed useful. In April 1862, Garretson even pleaded to the Surgeon General, William Hammond, in the hopes that Hammond would place him as the surgeon in charge at a local military hospital in Red Bank, New Jersey. Hammond responded the same month stating, “Your request cannot be granted, as the Red Bank hospital is to be placed in charge of a surgeon of regular service.”

Garretson was renowned in the dental community for his prowess in plastic and oral surgery; unfortunately, the Union military did not take advantage of his services. Coincidentally, Garretson’s book, A System of Oral Surgery, would be added in 1872 as the official reference tool for regimental surgeons when performing oral surgery. While individual dentists tried to perform dentistry for soldiers, many attempts were made by dental groups to create a dental unit for the Union military.

Much was done by dental groups, such as the American Dental Association, to establish a dental unit for the U.S. military or at least military hospitals. A committee of professional dentists was collected by the American Dental Association to pledge legislative action for a military dental remedy; efforts were made by this committee through 1863-1864. Such proceedings even involved efforts to encourage Surgeon General Hammond, in the hopes that his assistance would help solve the issue. Hammond, who appeared to be sympathetic at first, ultimately reneged on his decision to implement a dental unit. From 1861-1865, four years passed and the Union Army remained again without any military dental unit. In contrast, military dental care was well received by those involved with the Confederate Army’s high command, so much so, that the Confederacy appointed dentists into their army as early as 1861.

The Confederate Army and Dental Care
The inclusion of military dental care into the Confederate military’s infrastructure was gradual: a process that began with the incorporation of dental methods and tools into the Confederacy’s Medical Corps and ended with the full conscription of dentists into the Confederate military. By early 1864, the Confederacy would have professional dentists circulating amid the military hospitals and providing care to soldiers out in the field. High ranking Confederates’ such as President Jefferson Davis and Surgeon General Samuel Moore compassion and interest in dentistry allowed for the inclusion of dentistry within the Army. The establishment of dental care, as the Confederacy would soon learn, would allow for the swift return of soldiers with dental related ailments or wounds back to their respective units. Furthermore, the employment of dentists allowed for the conservation of medical units in the Confederacy.

A detriment to the Confederacy following secession was their lack of supplies and funds. Seceding from the Union meant that the Confederacy would be isolated from its main supply line. This was true regarding matters of dentistry, too; the Confederacy had only one dental supplier, Brown and Hape in Atlanta, and only a small percentage of the dentist population in the United States. The Confederacy would have to overcome these issues to provide dental care in their military.

Despite obvious resource and supply deficiencies, the Confederacy began to lay the foundations for what would become their dental care. As early as 1861, the Confederacy began procuring dental supplies. In Regulations for the Medical Department of the Confederate States Army, states that all medical supply tables were to be equipped with the proper amount of tooth extracting kits. Like the Union’s regimental surgeons, the Confederate surgeons were inept to dentistry. Confederate soldiers realized this and were more than willing to pay for the fees of a qualified dentist.

The issue of Confederate soldiers seeking out dentists would be the cost of their services. Dr. Watkins Leigh Burton would assess this issue in his 1867 article to the American Journal of Dental Sciences. Burton states, “The charges of dentists were proportionally high. The charge for a gold filling was $120.00, for extracting a tooth $20.00, and for an upper set of teeth on gold or vulcanite base, from $1800.00 to $4000.00.” These charges were way beyond the pay grade of soldier, as their pay would be between 12 and 18 dollars a month, depending on rank. Unlike the Union military, the Confederacy acknowledged this problem and effortlessly sought to correct it.

The Beginning of Confederate Dental Care
Dentistry brought the Confederacy to a stark realization. For one, they realized that dentistry was necessary for the continued well-being of soldiers; secondly, the Confederacy also acknowledged that soldiers could not afford dental treatment. In response, the Confederacy slowly contracted the services of civilian dentists and began to reassign soldiers with dentist backgrounds to dental units. The first dentist to be appointed would be in 1861, when the Confederacy utilized the services of Dr. J.B. Deadman. Deadman was a dentist from North Carolina who joined the Confederacy as a private in May 1861; upon hearing of his dental background, Deadman would later be reassigned as a post dentist.

Another dentist who would join the war and provide dental assistance would be Dr. Theodore Cheupein. Cheupein fought for the Confederacy as a Sergeant in an artillery unit;however, his military obligations did not prevent him from performing dentistry as he would practice whenever he found the time. Cheupein’s efficiency in dentistry led him to be reassigned to Charleston to perform dentistry for ailing soldiers. The Confederacy would not make true progress in their creation of a dental unit, until it implemented the Conscription Act of February 1864, which included dentists into the conscription by-laws.

The Conscription of Dentists into the Confederacy
The Conscription Act of 1864 drew a mixed reaction from the Southern dental community. Unlike the North, there were dentists who opposed the draft heavily, as they felt that they should be exempted like their doctor and medical surgeon counterparts. Some dentists were able to get exempted on the basis of “special practitioners.” The abovementioned Dr. Watkins Burton vehemently opposed the draft when he was conscripted in 1863; Burtons even began making legal provisions for his exemption. Ultimately, when the Confederacy adopted its 1864 Conscription Act, Burton would be drafted as a hospital steward.

Despite the slight opposition, the 1864 Conscription Act provided the Confederacy with a significant influx of dentists. Surgeon General Moore began organizing these dentists into military hospitals working as regimental surgeons, since there was no official rank of dental surgeon. These personnel worked diligently, and began extracting, cleaning, placing fillings, and treating victims with maxillofacial injuries. Dr. Watkins Burton commented on how a typical day for a dentist would constitute “twenty to thirty fillings…the extraction of fifteen or twenty teeth, and the removal of tartar.” This passionate dedication would lead to a significant improvement in not only the lives of soldiers, but how the military viewed dentistry in general.

The Impact of Confederate Dental Care
Dental Care in the Confederacy had a resounding impact on its military. With the introduction of dentists into the military, the Confederacy was able to conserve medical personnel and properly treat and utilize men who had been previously deemed unfit for service due to dental problems. New surgery techniques were being performed by dentists that allowed for the preservation of teeth rather than extraction; one particular technique that was being used by dentists was endodontic treatment, commonly known as a root canal. Such procedures saved many teeth that would have been commonly extracted.

Dentists in the Confederacy were also stressing the importance of dental hygiene, for example, the aforementioned Dr. Cheupein would stress the importance of dental hygiene so heavily that every man in his unit would carry around a toothbrush in their uniforms.Confederate dentists created new and innovative dental devices such as the Interdental Splint, created by Dr. James Baxter Bean.

The Interdental Splint or “Bean Splint” was a device that has been credited with the successful treatment of over a hundred cases of gunshot wounds to the mouth and jaw. The splint itself was made of vulcanized rubber, and braced teeth together with the corresponding indentations of the splint. The splint would keep the jaw in place and allow it to heal, thus preventing the facial disfigurement and deformity that was common with such wounds. This splint would allow the patient to continue to consume food without the fear of infection. The Interdental Splint was so successful that it was even used in the treatment of Confederate military leaders, such as James Patton Anderson and John Brown Gordon. Following the end of the Civil War, Bean tried to get his splint adopted in the North, however, a fellow northern dental surgeon, Dr. Thomas Gunning, had already created a similar device.

Near the end of the war, almost all Confederate military hospitals would have at least one dentist assigned to medical staff. Had the war lasted longer, the Confederacy would have established a Bureau of Dental Surgery; this Bureau would have been associated with the medical staff of the army. This success in dentistry could not have been accomplished had it not been for the Confederacy’s enthusiasm in military dental care. The Confederacy understood the necessity of dental hygiene and their military forces benefited from it significantly. The Union could have benefited from a similar program if it had understood the importance and reasons for military dentistry.

Additional Reasons for Military Dental Care During the Civil War
Besides the reasons stated before, there were additional reasons for the incorporation of dental care into the Union military. First, many northern Americans were exempted from military service due to the status of their teeth. This was to the increase of meals consisting of refined sugar and a larger consumption of fresh meat rather than salted. This diet, coupled with the fact that most Americans did not practice tooth brushing, could be attributed to the increase of dental problems. With an increased need for men in the subsequent Union drafts during the war, many men were exempted due to their “lack of certain teeth.” Such teeth were required to properly chew food, such as hard bread, salted pork and beef, and to effectively tear paper cartridges, which held bullets with gunpowder in place. If there were trained dentists on hand, these dentists, like the Confederate ones, could have treated most of the exempted and allowed for their military service.

Secondly, if there were Union dental care, these trained dentists could have stressed the importance of dental hygiene. Even Surgeon General William Hammond states in his book,Treatise on Hygiene, the importance of dental hygiene; yet he did nothing to help create a unit. In Treatise, he states, “No one can be healthy whose teeth are deficient or in bad condition; and soldiers, of all other classes of men, require that these organs should be sound.” Consistent dental hygiene is imperative when deterring many dental problems such as gingivitis and neuralgia. If these problems go unnoticed they could also lead to more serious problems, thus incapacitating the soldier indefinitely.

Conclusion
In conclusion, Dentistry in the military lacked the recognition it deserved during the American Civil War. The Union Army chose to ignore it, and as a result the Union soldiers had to suffer for their superior’s actions. The Confederacy chose to embrace dentistry and benefited from it tremendously. The Confederate military is also a nice example of how a military can benefit from dental care.

This project shows that both militaries during the Civil War had differing opinions concerning military dental care and both armies and soldiers were significantly affected by their superiors’ actions. Secondly, the significance of my project shows that even in a time as early as the Civil War, dentistry was important as it impacted the soldier’s well being. The advances made by dentists in the mid-nineteenth century allowed for better dental treatment. I believe that my research provides the historical community with a topic that is both original in the field of the American Civil War. One question that my research might suggest is why did the U.S. military wait until 1911 to implement a Dental Corps?

From: dar0007.hubpages.com

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Dentistry during the Civil War

From: civilwartalk.com

About two decades before the Civil War, the dental profession had gained some standing. In the Confederate states there were about 500 Dentist. Jefferson Davis had always been an advocate for a dentistry corps. As Secretary of State under President Pierce, he had called for such a Corps but never was one in U.S. Army.

After outbreak of War, the Confederate Army established a Dental program. The Union Army rejected one. Confederate Surgeon General Moore as well as Jefferson Davis was supportive of the idea of Army dentists. The dentists stated they owed more to Moore "than to any man of modern times".

Soldiers tended to neglect basic care of their teeth. Toothbrushes were scare and they had inadequate diets. Dental operations were very expensive for the common soldier. A soldier's teeth were important on the battlefield. Many recruits were turned down if they lacked six opposing upper and lower front teeth. These were considered necessary to bite off the end of the powder cartridges used with the muzzle loading rifles of the time.

Many Dentists were accorded the rank of hospital stewart. Though some could be full surgeons. Medical Director, William a. Carrington, CSA, commented that dentists "plugged, cleaned, and extracted teeth", in addition to "adjusting fractures of the jaw and operating on the mouth". A Richmond Dentist, Dr. W. Leigh Burton, commented that his days were filled of "twenty to thirty filings, the preparation of cavaties included, the extraction of 15 or 20 teeth, and the removal of tartar ad libitum".

Dentist, Dr. James B. Bean who was from Atlanta, Georgia made significant contributions to the treatment of fractured maxillary bones. Bean invented an interdental splint made of vulcanized rubber that had cup shaped indentations for teeth. His splint was a great success and he was sent to Richmond where his sprint was used for treatment at the Recieving and Way Hospital.

The Confederacy should be praised for it's Dental Corps. In Jan., 1864 the Confederacy began conscripting dentist. This gave the Confederate soldier a small advantage over the Union soldier, as all attempts at the Union Dentistry Corps was turned down.

Dr. W. Leigh Burton (1830-1892) was a Captain in Confederate Army, dentist and inventor. He was first with Quartermaster Dept. at Fredericksburg. In 1864, he worked at Richmond Hospitals as dentist. After the war, he continued working as a dentist and invented the Burton Electric Heater. He is buried in Hollywood Cemetery, Richmond, Virginia.

Dr James Baxter Bean (1834-1870) was the most important dental surgeon of the Civil War. After the outbreak of the war, Bean moved to Atlanta where he offered his services to the Confederate medical authorities. His dental device, the "Bean Splint" allowed him to treat successfully over one hundred cases of gunshot wounds to the jaw and face while preventing the facial disfigurement and deformity that frequently resulted from such wounds. In Jan, 1865 the Confederate Medical Board in Richmond, unanimously recommended adoption of the Bean splint. Dr. Bean then supervised Richmond surgeons in the use of his device.

After the war he went to Baltimore. He pioneered in the use of aluminum for dental plates. He took out a patent in 1867. His experiments weren't successful, but his casting was an important step in the development of the casting process in dentistry.

Bean died in 1870 when he and 10 others were caught in blizzard on the summit of Mont Blanc. His notebooks were later recovered from the summit. Mark Twain included extracts from the notebook in his book, "A Tramp Abroad".

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Dental Surgery in the 1840s

From: historyengine.richmond.edu

A dental surgeon by the name of Peter J. Cairnes placed an ad in The Republican convincing the readers of the merits of dental surgery. Dr. Cairnes urges the public to start taking care of their children's teeth starting anywhere between the ages of seven and nine. Dr. Cairnes also offered a reduced rate for any slave owner or tobacco factory owner whose slave was in need of a tooth extraction.

Dr. Cairnes acknowledges public skepticism in dentistry and the fact that dental surgery was thought of as nothing compared to general surgery, but attempted to make a claim for the advancement of dentistry and the need for people to take care of their teeth. At the time there was very little knowledge of dental care, and homeopathic remedies and extractions were often common cures for oral discomforts. Medicine as a whole was in its infancy in the nineteenth century; furthermore, even less was known about dentistry and dental surgery in particular. Many regarded dental care as a luxury and not as a necessity, unless they had a toothache too unbearable to suffer through without dental intervention.

Surprisingly, dentistry was not recognized as a healthcare profession until the outbreak of the Civil War. During the Civil War soldiers who were dentist were given a special salary. Dentists later became exempt from conscription.

Image:  Civil War Dentist examines a soldier's teeth. Courtesy Association of Army Dentistry, San Antonio, TX.

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Civil War Dentistry

From: eHistory.osu.edu

The dental profession had gained some standing during the two decades that preceded the Civil War. In the Confederate states, there were about 500 dentists. Jefferson Davis, while serving as Secretary of War under Pierce, was an advocate for a dentistry corps. Perhaps this is why the Confederate Army had a dental program, while a similar idea in the Union Army was rejected by the War department. Confederate Surgeon General Moore was also quite supportive of the idea of Army dentists, leading to the comment that the dentists owed more to Moore "than to any man of modern times".

Soldiers tended to neglect basic care of their teeth. Toothbrushes were scarce and their diet was inadequate. Also, Dental operations usually cost more than the common private soldier could afford... particularly in the Confederacy when inflation set in. Despite poor dental care, a soldier's teeth were important on the battlefield. Many recruits were turned down if they lacked six opposing upper and lower front teeth, considered necessary to bite off the end of the powder cartridges used with the muzzle loading rifles of the times.

Dentists were usually accorded the rank of hospital steward, though according to one source, they also could be full surgeons with all the pay and benefits of a surgeon. Medical director William A. Carrington, CSA, commented that dentists "plugged, cleaned, and extracted teeth", in addition to "adjusting fractures of the jaw and operating on the mouth". Another, Richmond dentist Dr. W. Leigh Burton, commented that his days were filled of "twenty to thirty fillings, the preparation of cavaties included, the extraction of 15 or 20 teeth, and the removal of tartar ad libitum!"

Dentist Dr. James B. Bean of Atlanta made significant contributions to the treatment of fractured maxillary bones. Bean used an interdental splint made of vulcanized india rubber that had cup shaped indentations for the teeth. Bean's splint was a great success and he was sent to Richmond where his splint was used for treatment at a ward of the Recieving and Way Hospital.

The Confederacy in particular should be praised for its Dental Corps. The act of conscripting dentists in January 1864, gave the Confederate soldier at least that small advantage over his Union counterpart. As before stated, all attempts at the Union Dentistry corps were turned down.

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Civil War Dental Tools

From: Civilwarvirtualmuseum.org

The tooth key was first mentioned in literature in 1742; the first examples were made of iron with a handle shaped like a turnkey. As improvements were made over the years the handle was made of horn, ivory and different types of wood. They were also made in different sizes, with the smaller sizes and shapes being made for children. In the second half of the Eighteenth century the tooth key became the most popular instrument for tooth extractions.

Leading up to the Civil War, tooth care was generally poor, dentists few and dental care expensive. Despite poor dental care, a soldier’s teeth were important on the battlefield. Many recruits were turned down if they lacked opposing upper and lower teeth, considered necessary to bite the end off paper cartridges used with muzzle-loading muskets.

The Confederate army had a dental program and conscripted dentists into the army, usually at the rank of hospital steward, although some held the rank of surgeon. The Union army rejected the idea of a dental corps.

Image: from Wilson’s Creek National Battlefield

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A Dentist Who Served in the Civil War

By Hubert B. Herring

When, as a child, I heard grandiose tales of my great-grandfather the dentist, I could have been forgiven for thinking that before he came along, dentistry was like something out of a sepia-toned comic skit, with mallet as sedative and crude pliers for extraction. And his arrival, in my imagination, instantly brought the modern dental office.

But in this case, I was to learn, hyperbole and fact were surprisingly close cousins. For when I mention that fabled ancestor, G. V. Black, to dentists, roles are reversed and their jaws drop (though this has yet to translate into a free root canal). His statue stands in Lincoln Park in Chicago. And the reproduced office of the man considered “the father of modern dentistry” is a central feature of the National Museum of Dentistry in Baltimore.

The museum, a Smithsonian affiliate, has been open for a decade, but having seen Black’s office years ago when it was at the Smithsonian in Washington, I had not ventured to Baltimore. But a recent, sizable gift from the family of a cousin (a fellow descendant, of course) went to spiff up the Black exhibit, prompting me to make that long-overdue visit. (Naturally, in deference to the occasion — and yes, at my wife’s insistence — I first brushed my teeth thoroughly at our hotel.)

After making our way through a gaggle of preschool children who had yet to know the dentist’s drill, and walking past an intriguing variety of exhibits — George Washington’s dentures, film stars’ smiles, a poster for the 1938 Our Gang short “The Awful Tooth,” fearsome 17th-century instruments, 7th-century Mayan shell implants — we spied a life-size Greene Vardiman Black, in all his bearded, buttoned-up glory, surrounded by his leather dental chair and desk, cabinets of tools (most of which he invented) and elaborate pedal-operated drill (also his creation). An interactive display offered facts and photographs. (Wait! I have that picture, passed down from my mother, but didn’t know who it was. It’s G. V.’s father!)

In that display were the bare bones of a remarkable life: Born in 1836 on an Illinois farm. A mere 20 months of formal schooling. (“The boy with his dog and gun learned more in a day than a teacher taught in a month,” as one biographer put it.) Apprenticed to his brother, a doctor, at 17. Learned all he needed to know — probably just about all there was to know — of dentistry in a few months. Served briefly in the Civil War. Set up shop in Jacksonville, Ill., doing tireless research into all things tooth. (A daughter born there, vintage 1876, became the fearsome grandmother of my youth.) Invention after invention: 102 “cutting instruments,” by one count; silver amalgam for fillings with just the right chemical balance. Joined the faculty of the Northwestern University Dental School in 1891, and in 1897 became its dean.

In one striking photograph, Black is shown in a classroom, with tooth models, three feet tall, arrayed in front of him as teaching tools.

In the mid-19th century, dentistry was all about mending inevitable damage from an eating lifestyle, and it was practiced by pretty much anyone who hung up a shingle. A great part of Black’s legacy was helping to elevate dentistry to a profession and, as he put it in 1896, to shift to “preventive rather than reparative dentistry.” In 1908, two volumes of his “Operative Dentistry” appeared, followed by a third in 1915, the year he died. “For their clarity, illustrations and exhaustive investigation,” a dental journal declared in 1974, “they contain the backbone of dentistry.”

So, yes, he wrenched dentistry into the modern age, but he was far from a modern man in, say, equality of the sexes. Among my artifacts is a pair of elaborate silver candlesticks given to the venerable G. V. at a 1910 banquet at the Congress Hotel in Chicago. A photograph shows a grand ballroom packed with perhaps 400 tuxedo-clad men and not one woman. And in an 1899 letter to my grandmother, then a young bride, he wrote: “A woman’s chief glory is the glory of her husband. Any action of hers that sets him ahead in the world advances her.”

But that’s a quibble. He is an imposing, white-bearded figure in my circa 1913 family photograph, with my 6-year-old mother at his feet. At one point, I’ve read, his beard reached his waist (now that would be an imposing sight from a dental chair). And he was far from one-dimensional — he was said to be an accomplished violinist, cellist and singer, he once built his own boat, he learned French and German to study medical texts, and he taught himself to be ambidextrous by writing two letters simultaneously.

So with all those inventions so widely used for decades, we descendants must be fabulously wealthy, right? Well, no. Black was, by all accounts, mostly indifferent to money and had little interest in patents. Instead of commercializing his alloy for fillings, for instance, he gathered manufacturers, charged a nominal fee to teach them to make the alloy, and left the business details to them. How un-American! Yet it deepens my respect for this tirelessly inventive man.

Hubert B. Herring is an editor at The New York Times. The National Museum of Dentistry is at 31 South Greene Street, Baltimore. Information: (410) 706-0600 or www.dentalmuseum.org.

IMAGE: Liza M. Pohle/National Museum of Dentistry
FATHER OF MODERN DENTISTRY G. V. Black at a marble grinding machine he used to make very thin tooth sections.

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James Baxter Bean, Confederate Dentist

By Colin F. Baxter, East Tennessee State University   James B. Bean was perhaps the single most important dental surgeon of the Civil War. Born in Washington County, June 19, 1834, James Bean could trace his heritage to the first white settlers of the state. He was the great-grandson of William and Lydia Bean, grandson of Russell Bean, and son of Robert and Mary Hunter Bean. Since Dr. Bean practiced dentistry in other states, left no direct heirs, died on Mont Blanc and was buried in Chamonix, France, his brilliant dental accomplishments during the Civil War have largely escaped the attention of his own state.   Bean attended Washington College Academy, studied medicine, and later practiced in Micanopy, Florida, where he also collected many wildlife and ornithological specimens for the Smithsonian Institution. He received his dental degree from Baltimore College of Dental Surgery in 1860 and married Hester M. Bovell, daughter of Dr. William W. Bovell, in Jonesborough, on October 30 of that year. After the outbreak of the Civil War, Bean moved to Atlanta, where he offered his services to the Confederate medical authorities. His dental device, the "Bean splint," allowed him to treat successfully over one hundred cases of gunshot wounds to the jaw and face while preventing the facial disfigurement and deformity that frequently resulted from such wounds. In January 1865 the Confederate Medical Board in Richmond, Virginia, unanimously recommended adoption of the Bean splint. Bean supervised Richmond dental surgeons in the use of his device.   After the war, Bean established a dental practice in Baltimore. He pioneered in the use of aluminum for dental plates and in 1867 took out a patent for an aluminum denture base. Although his painstaking experiments were not successful, Bean's method of casting aluminum plates was an important step in the development of the casting process in dentistry.   Bean died in 1870 at the age of thirty-six, when he and ten others were caught in a blizzard on the summit of Mont Blanc. Bean's notebook, recovered on his body, recorded his last hours as he froze to death. Mark Twain included extracts from the notebook in A Tramp Abroad (1879).

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Management of Jaw Injuries in the American Civil War

By Richard A. Pollock, M.D., University of Kentucky College of Medicine, Lexington, Kentucky

 

James Baxter Bean published a series of articles in the Southern Dental Examiner in 1862 describing his work with “plaster and its manipulations.” This early experience included a new way of managing jaw fractures, with customized splints uniquely based on pretraumatic occlusion. Bean's oral splints and their method of construction, using an articulator, became the standard of care in the Atlanta region during the American Civil War and, by 1864, throughout The Confederacy. In short course, Bean's approach also swept The Union, following in large part the efforts of a colleague in the North, T.B. Gunning. Thus, what began in the early 1860s in a dental laboratory in the southeast swept the continental United States and revolutionized management of jaw-fractures during, and immediately after, the American Civil War.

 

Bean was born July 19, 1834, in eastern Tennessee, attended Washington College in Limestone (in the tri-cities area of the State), and in 1860 graduated from the Baltimore College of Dental Surgery. He briefly practiced in Micanopy, Florida (south of Gainesville), and it was from there that he authored articles on “Plaster and its [Dental] Manipulations.” While awaiting publication of his four-part series in the Southern Dental Examiner in 1862, Bean moved to Atlanta, Georgia, to be closer to the South's only dental supply house, Brown & Hape, and to enjoy the stability of transactions in Georgia currency or in gold-and-silver coin.

 

After the fall of Atlanta to Union forces, the management of jaw injuries was relocated to a dedicated ward at the Blind School Hospital in Macon, some 90 miles south of Atlanta. Personnel and the resident dentist there were already versed in the ways of Bean.

 

IMAGE: The Bean splint

 

Email: dpollock@mcpollock.com

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Remarks on Dentistry in the Army

By Wm. B. Roberts, M.D. Of New York

June 29, 1861
It is well known to the dental profession that all the diseases common to teeth can not only be cured, but may be prevented by proper and timely treatment. After having thus enumerated the evils appertaining to a defective condition of the teeth, a condition which experience has found to exist among the army to an extraordinary extent, and having shown the importance of such diseased condition being avoided and changed to aid in establishing a proper sanitary condition among these men who risk their lives for their country's service, and have neither time, means, nor opportunity for themselves discharging their duty in this respect; we desire to urge upon the proper authorities, that a corps of dentists, or dental staff, should be attached to the United States army, similarly organized with the surgical department, who would act in connexion with, and as an efficient aid to, that department, besides performing their own duties in a proper manner

Holding this to be a great sanitary measure, as well as an economical and humane movement in behalf of those affected by it, we would especially offer these suggestions to our "Sanitary Commission," believing that in the scope of their noble field of labor there could not be performed a more important act, than the procuring of the passage of a bill through Congress at the approaching session, which should incorporate into the army an efficient DENTAL staff, strengthened with all the powers necessary to enable it to become most serviceable to the cause of health.

Excerpted from an article in the June 29, 1861 issue of the American Medical Times.

Learn more about Civil War Dentists at www.CivilWarRx.com.

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Civil War Dentists

The treatment of dental problems raised separate health issues. By 1860, there were about 5,500 dental practitioners in the United States. Most dentists trained by apprenticeship, but about 400 dentists had graduated from three American dental schools.

The Confederacy required that every soldier have a dental exam. The shortage of men in the South meant that no one could be exempted from service because of problems with his teeth. Dentists were routinely assigned to the larger Confederate military hospitals.

The Federal government provided no official dental surgeons for its troops during the Civil War. Toothbrushes were not provided for troops.

Many dentists served in the Union Army, but any dental treatment they performed wasn’t in an official capacity. Most dentists simply enlisted in their state regiments as privates.

IMAGE: Civil War Dental Drill and Forceps

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Civil War Dentists

The treatment of dental problems raised separate health issues. By 1860, there were about 5,500 dental practitioners in the United States. Most dentists trained by apprenticeship, but about 400 dentists had graduated from three American dental schools.

The Confederacy required that every soldier have a dental exam. The shortage of men in the South meant that no one could be exempted from service because of problems with his teeth. Dentists were routinely assigned to the larger Confederate military hospitals.

The Federal government provided no official dental surgeons for its troops during the Civil War. Toothbrushes were not provided for troops.
Many dentists served in the Union Army, but any dental treatment they performed wasn’t in an official capacity. Most dentists simply enlisted in their state regiments as privates.

Confederate dentist James Baxter Bean and Union dentist Dr. Thomas Gunning developed almost identical and revolutionary methods of treating jaw fractures caused by gunshot. Imperfect healing of these wounds could be life-threatening and earlier treatments had proven uncomfortable and ineffective. Bean and Gunning used intraoral splints to preserve the alignment of the teeth and minimize any deformity. These new techniques were major advancements in the treatment of jaw fractures.

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