Monday, August 18, 2014

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.

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?



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