Sectional Proceedings of the Royal Society of Medicine Vol.

50
page 21 747

Section of Odontology
President-J. A. S. WRIGHT, A.F.C., F.D.S. R.C.S.Eng., H.D.D.,
F.D.S. R.C.S.Ed.
[October 22, 1956]
A Hundred Years of Dentistry
PRESIDENT'S ADDRESS
By J. A. S. WRIGHT, A.F.C., F.D.S.R.C.S.Eng., H.D.D., F.D.S.R.C.S.Ed.
DURING the forthcoming session we will be celebrating the centenary of the Odontological
Society, as well as the jubilee of the Royal Society of Medicine of which it was a foundation
society.
This is, perhaps, an occasion upon which I may be forgiven for referring to my own
special and personal interest in the Section. The practice which I joined in 1923 was
started in 1840 by Sir John Tomes, secretary of the Odontological Society of London at its
foundation in 1856. He became President in 1862 and for the second time in 1875.
He was succeeded in the practice by his son, Sir Charles Tomes who was President of
the Society in 1887. He was followed by Mr. E. G. Betts (President 1905) and then by
Sir Harry Baldwin and Mr. Carl Schelling. Baldwin was secretary in 1896 and President
in 1915. Schelling was secretary in 1904-5 in the years during which the negotiations
were taking place which led to the amalgamation with the other societies to form the
Royal Society of Medicine in 1907. He was President of this Section in 1930 and I had the
honour to be one of the Honorary Secretaries during his year of office. On his retirement
he presented the Presidential badge to the Section.
Prior to 1856 there was no organized professional education for dentists. The only
method of obtaining any training was by apprenticeship to a private practitioner. There
was, of course, no Dentists Register and clinical instruction was limited to occasional visits
to the master's surgery. The pupil might, indeed, gain a good knowledge of dental
mechanics, but unless he obtained a medical qualification his chance of having any training
in dental anatomy or surgery was remote.
There were a few books available, notably John Hunter's "Natural History of the Teeth"
(1771); "The Anatomy, Physiology and Diseases of the Teeth", by Thomas Bell (1829);
and in 1847 was published John Tomes's "Dental Physiology and Surgery". Lectures on
Dental Surgery were given at Guy's by Joseph Fox in 1799 and by Thomas Bell, who
succeeded him.
In 1855 and 1856 two separate efforts were being made to organize dentistry upon a
scientific and professional basis. On August 25, 1855, a letter from Samuel Lee Rymer,
a 22-year-old dentist, practising in Croydon, was published in the Lancet, calling attention
to the need for proper dental education and suggesting that the College of Surgeons might
examine candidates who might well be termed Licentiates in Dental Surgery, and further
suggesting the formation of a Dental College. This letter was favourably received by a
large number of the profession, but a small group of perhaps the more eminent dentists,
most of whom were Members or Fellows of the Royal College of Surgeons, or Fellows
of the Royal Society, were quietly making approaches to the Royal College of Surgeons.
In December 1855 they met privately, and eighteen practitioners signed a "memorial"
to the College of Surgeons, suggesting that a course of education should be held, and an
examination in dental surgery instituted. This did not produce any immediate result, and
while the paper was lying at the Royal College of Surgeons the memorialists agreed to
constitute themselves a scientific society. A notice appeared from Rymer in the public
press calling a second meeting of the profession on Tuesday, November 11, 1856, and
the profession was then made aware that on the previous day (November 10) the
Odontological Society of London had been formed, its by-laws framed and invitations
sent to those members of the profession who were known personally to the memorialists
and were deemed anxious to promote the well-being of the Society. The first ordinary
meeting of the Odontological Society was held on Monday, January 5, 1857, under the
presidency of Mr. Samuel Cartwright. It may be noted that he was not a Member of the
Royal College of Surgeons, but was, in fact, a Fellow of the Royal Society. In the following
year the Society acquired No. 32, Soho Square, and there established the first dental
hospital and school, and, indeed, provided most of its staff from among the members of
the Committee.
There was, unfortunately, considerable irritation in the profession generally at the
OCTOBER 40
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748 0;04.

manner in which the Society had been started. A large number of highly respectable
practitioners felt that the promoters had been both selfish and unjust in instituting the
society in a private and clandestine manner.
The rival parties continued to work independently, and in 1857 the College of Dentists
was formed, largely as a result of Rymer's campaign. Lecturers were appointed and
commenced on February 18. This College opened the Metropolitan School of Dental
Science in 1859, and two years later the National Dental Hospital of London. Students
were examined and the successful candidates were entitled to use the letters M.C.D.E.,
Member of the College of Dentists of England.
The promoters of the College of Dentists were endeavouring to build up a dental
profession which would be independent of medicine or surgery, while the memorialists
were working to the same end through the College of Surgeons. The antagonism between
the two was bitter and undisguised.
The year 1856 also saw the appearance of a monthly professional journal-the British
Journal of Dental Science. In its opening number (July) the Editor assured his readers
that its columns were open for free discussion, and at the disposal of any and every member
of the profession requiring a medium for the extension of accumulated knowledge. The
number for September 1856 warmly supported Rymer's plan, and there was already
discussion on the title to be used by dentists, the editor feeling that it was an error, even
for those who were members of the Royal College of Surgeons to call themselves Surgeon
Dentists. By the end of 1856 the ownership of the Journal changed hands. It was offered
to the committee under Mr. Rymer, which offer was refused, and then became the property
of some gentlemen in the profession who supported the Odontological Society. From
being the friend of the College of Dentists it became its foe and was apparently unwilling
to publish its proceedings. Undaunted, the College decided to publish its own proceedings
and in April 1857 appeared the first number of the Quarterly Journal of Dental Science.
In 1857 efforts were being made to bring about a fusion of the College of Dentists and
the Odontological Society. These were unsuccessful, mainly as a result of unwillingness
on the part of members of the College to follow the lead of its more far-sighted President
and officers. Most of the latter resigned, and from then on the College appears to have
diminished in numbers and importance, while the Odontological Society increased. The
Royal College of Surgeons obtained its Dental Charter in 1859 authorizing examinations
in Dental Surgery and the issue of certificates of fitness to practise. The first examination
for the Licence in Dental Surgery was held by the College of Surgeons on March 13, 14,
and 20, 1860, when 43 gentlemen, most of whom were distinguished members of the pro-
fession, were candidates. Among them were Samuel Cartwright, John Tomes, Thomas
Bell, and Arnold Rogers, the last three being the dental members of the first Board of
Examiners in Dental Surgery. They are reported in The Times of March 15, 1860, as
"having undergone the necessary examinations", although by whom they were examined
I have been unable to ascertain. In 1871 the status of the profession was further improved
when the council of the College agreed to give its certificate the form of a diploma bearing
the College arms and signed by the President.
In 1862 Rymer appreciated the fact that the Dental College was not going to succeed
in getting a charter and so establish on a firm basis, either itself or its examination and
diploma, especially as the Royal College of Surgeons had by then been empowered to
admit dentists to examination and licence. He therefore approached the Odontological
Society with a view to making another attempt at amalgamation.
When the first approach was made in 1857, the proposals came mainly from the
Odontological Society, and, although agreed by the officers of the College, were rejected
by its members. It was therefore considered desirable that the College of Dentists should,
this time, formulate the proposals. On December 22, 1862, representatives of the College
met Arnold Rogers, Samuel Cartwright and John Tomes for the Odontological Society,
and agreed upon terms for the embodiment of the members of the College of Dentists with
the members of the Odontological Society of London, under the new name of the
Odontological Society of Great Britain. The amalgamation of the two bodies took place
at a meeting of the Odontological Society held on May 4, 1863.
Even at this period dentists were concerned about status. The College of Surgeons had
instituted in 1843, a Fellowship which carried with it a share of the responsibility for the
control of its affairs. It was feared that the Licentiates in Dental Surgery might also
expect a voice in the affairs of the College, but the memorialists denied any such intention.
Tomes considered that education for the diploma should be equal in degree to, but different
in kind from that for the Membership of the Royal College of Surgeons and may even
have visualized a Fellowship in Dental Surgery.
The examination and licence in Dental Surgery were permissive and there was still no
register, or limitation of the right to practise. The Medical Register was started in 1858,
23 Section of Odontology 749
but the General Medical Council refused to register the L.D.S. and this refusal was an
important factor in the starting of a campaign in 1870 by Charles Fox for compulsory
education and registration. This led to the election of the Dental Reform Committee in
1875 and to the passing of the Dentists Act of 1878. John Tomes was the first to inscribe
his name on the Dental Register and in 1879 the Dental Reform Committee resolved itself
into the Representative Board of the British Dental Association.
It is interesting to see that, in 1876, during this period of agitation for the formation
of a Dentists Register the Association of Legally Qualified Dental Surgeons was formed
under the chairmanship of Samuel Cartwright, Junior, with his nephew, Samuel Hamilton
Cartwright, as Secretary. It appears to have been limited to Members of the Royal College
of Surgeons. Both John and Charles Tomes refused to join, and it petered out after a few
years. In 1900 its funds were handed over to the Royal College of Surgeons to be
administered for the Cartwright Prize, and, to quote Dr. Lilian Lindsay, "as a Parthian
shot from its founders, this can only be competed for by a member of one of the Colleges
of Surgeons".
We must not overlook the developments which were taking place on the scientific side,
as distinct from what might be called the administrative or even the political side of the
profession.
It was not long before this period-in fact in 1844-that Horace Wells, an American
dentist, showed that teeth could be extracted painlessly after the inhalation of nitrous
oxide. A committee was appointed by the Society in conjunction with the Dental Hospital
to investigate its merits and a careful report was issued based on 1,380 cases.
In 1846 Dr. Morton, a dentist of Boston, U.S.A., gave ether as an anmesthetic. Tomes
took this up at once and used ether in the out-patients' room for dental operations.
During the early years there were frequent papers, letters and discussions on the relative
merits of chloroform, ether and nitrous oxide for dental anaesthetic purposes. It was a
long time before the safety and the easy administration of gas ousted the others from
general use in dental practice. I remember being told by a doctor patient of mine that
when he needed an extraction he usually gave himself chloroform. He sat upright in the
dental chair, administered the chloroform to himself on an open mask, and told the dentist
that, when his hand dropped and he was no longer able to hold up the mask he was ready
for the operation to start. Happily for me he did not then require any extractions.
At a meeting of the Odontological Society held in March 1859 a paper was read by
Dr. Blandy of New York advocating the use of cast base metal denture bases as better than
swaged metal, ivory, or the relatively new vulcanite, and at the following meeting in April,
Mr. Putnam, also of New York, spoke of the use of vulcanite.
This had been introduced in the United States by Mr. Goodyear in 1855, although Mr.
Evans of Paris claims to have made some experiments for Goodyear in 1851 or 1852, and
to be the first to make a practical "piece" as dentures were called.
Tomes was busy designing, not only the extracting forceps for which he was so well
known, and which have, in many cases, remained unchanged to the present day, but also
instruments for the insertion of fillings.
W. D. Miller of Berlin propounded in 1884 his chemico-parasitic theory of dental caries.
Although it has been hotly disputed ever since, and certainly is not the whole story, it has
not yet been generally discarded.
Non-cohesive gold had come into general use as a filling material early in the nineteenth
century, and about 1855 Dr. Robert Arthur of Baltimore invented the method of cold
welding pure gold in the cavity. Incidentally, he became a corresponding member of the
Society in 1859.
In 1857 John Tomes read a paper describing a method of keeping teeth dry during filling,
with a membrane of gutta-percha coated on one side with either gelatine or gum-arabic
to make it adhere to the mucous membrane. Rubber dam was introduced by S. C. Barnum
of New York in 1864.
The passing of the Dentists Act in 1878 and the starting of the Dentists Register, initiated
a new era in dentistry. Before that time there was nothing to prevent anybody, with no
surgical training whatever, holding himself out as qualified to practise, and advertising in
the most blatant and outrageous manner. The new Act was designed to prevent un-
registered and, ultimately, unqualified practice by prohibiting any unregistered practitioner
from calling himself dentist or dental practitioner or by any name, title or description
implying that he was registered or specially qualified to practise dentistry. The General
Medical Council was entrusted with the duty of keeping the Register and maintaining, in
the interests of the community a high standard of professional conduct. It is amusing to
note that, in the discussions which took place prior to the passing of the Act there was
considerable opposition to the imposition of duties of control by the General Medical
Council. The British Medical Journal protested that "Medicine is a profession, Dentistry
750 Proceedings of the Royal Society of Medicine 24
is largely a business. To adjudicate upon charges likely to be brought against dentists
involves some knowledge of trade matters as well as of professional matters". In spite
of this, these duties were imposed upon the General Medical Council and carried out by
them with the greatest care. There were at first no dental representatives on the General
Medical Council and in May 1899 the British Dental Association requested the appoint-
ment of one or more. The Council replied that they had no power to do this, but the
Privy Council nominated Charles Tomes as Crown nominee, in succession to Sir Richard
Quain.
The Act of 1878 appears to have succeeded at first in controlling dental practice, and
no legal decision on it is reported until eight years later. Subsequently there were many
prosecutions. Most of them were under the section which prohibits the use of titles
implying registration or the possession of special qualifications. Convictions were followed
by appeals, some of which were dismissed, and some allowed. Advertising by unregistered
practitioners became general and blatant. The most important legal case under this Act
was that of Bellerby v. Heyworth, which was taken to the House of Lords.
Their decision on April 15, 1910, that there was nothing in the Act which prevents any
man from doing dentists' work and informing the public that he does such work, without
being registered under the Act, was a statement of Law by the Supreme Court of Appeal
of the United Kingdom and was unalterable except by Act of Parliament. From this
time until the Act of 1921 it was quite clear that an unregistered man could not call himself
a dentist or imply that he was on the Register; but that he might expatiate upon his skill in
dentistry, employ any number of unqualified assistants, and advertise in the most blatant
manner without hindrance.
The first Dentists Register, authorised by the 1878 Act, contained the names of 5,289
practitioners, of whom only 483 were licentiates, and it is a little surprising to find that,
prior to the 1921 Act the numbers on the Register were almost the same-about 5,500.
By this time, however, at least 75% were graduates or licentiates, and practically all the
rest were those who had been admitted as being in practice in 1878. There were then
added some 8,000 practitioners who, again, claimed to have been in practice at that time.
Since then the number has increased a little, but of the 15,000 now on the Register only
about 12,000 are actually practising. Very few of those registered as in practice in 1921 will
remain on the active list after the next ten years, and it is probable that more than one-
third of those now on the Register will have ceased to practise-a loss of about 5,000-
while new registrations may number only 3,000.
It follows then, that, as our dental schools have scarcely been able to maintain the number
of active practitioners, and as the Welfare State is irrevocably committed to the provision
of a comprehensive dental service, there is an urgent need for steps to be taken to make good
the rapidly increasing rate of loss to be anticipated in the next few years.
This is hardly the place to discuss the pros and cons of the use of ancillary workers and
the provisions of schools and teachers to train them, but I cannot help comparing thethen era
which is now beginning with the state of the profession a century ago. There was was
a totally inadequate number of qualified dentists, and a large amount of the work
carried out by untrained or partly trained practitioners, and now, with the number of
qualified dentists still inadequate, it is proposed to experiment with the use of partly trained
operators, under the control of the General Dental Council which took over the Dental
functions of the General Medical Council in 1956.
The training of the dental student in the early days of the Odontological Society was,
as I have said, by apprenticeship to a dental practitioner. When the first regulations
for the curriculum were laid down and training was started at the Dental Hospital of of
London, and the National Dental Hospital, great stress was laid upon the importance be
acquiring manual dexterity. Before admission to a dental school the studenta had towas
apprenticed for three years to a dental surgeon to learn dental mechanics. Ifwas pupil and
fortunate enough to be articled to a practitioner whose standard of work high
who took pains to see that he was well instructed, the system was very satisfactory.
A most interesting description of the professional training of the time is to be found in
the autobiographical notes of the late J. H. Badcock, published in the British Dental Journal
in January 1954. He started in 1880, and was President of this Section in 1917.
Later the time spent at dental mechanics was reduced to two years, which could be spent
either privately or in the pupils' laboratory at one of the dental schools. Before private
apprenticeship was finally abolished, the regulations required either three years articles or
two years at a dental school.
I did my own mechanical training with a practitioner who had a good middle-class
practice at which he worked in the daytime, and in the evenings he had a dental dispensary
in the Waterloo Road. Here, although the fees were low, the standard of work was good,
and it had the great advantage, as far as I was concerned, that I was able, under supervision,
25 Section of Odontology 751
to take impressions, and make quite a number of dentures for patients. I was also per-
mitted to do free extractions, without any anzsthetic, and often removed 70 or 80 teeth
in one evening. We used only three pairs of forceps, as far as I remember-straights and
bayonets for uppers and a pair of lower root forceps. We used to feel a sense of
superiority when, as happened from time to time, patients came in who had had roots
left in after attempts at extraction at Guy's. This was countered later, when I was a student-
at Guy's, by the appearance there of some of the failures of the Dental Dispensary.
Clinical teaching was done entirely by part-time honorary teachers, who spent the rest
of their time in private practice. The first dental professor in this country was Samuel
Cartwright (junior) who was appointed to the Chair of Dental Surgery at King's College,
London, in 1860, but there was at that time no dental school there. The first professor
to hold a Chair in a Dental School was Gilmour, who was appointed in 1920 at Liverpool.
Since that time dental education has come more and more into the hands of full-time
teachers.
The appointment of these teachers was a tremendous advance, as it provided opportunities
for men of the highest ability in the profession to initiate projects of research, and to co-
ordinate to a much greater extent the academic and clinical teaching. I would not like it
to be thought that I underestimate the value of these full-time teachers. They are essential
to the teaching of dental surgery as we know it to-day, but there has been, in recent years, a
real danger of the clinical training becoming too academic. Of course it would be much
easier administratively to organize the necessary sessions with full-time teachers, and
there is still much room for improvement in the teaching, but it must never be forgotten
that for a good many years to come graduates will have to spend most of their time putting
in fillings, doing straightforward extractions, and replacing lost teeth with prosthetic
appliances, and treating periodontal conditions. All these will be done the better for
a wider knowledge of anatomy, pathology and surgery, but extension of education in this
direction must never be at the expense of time spent acquiring operative skill in dentistry.
The part-time clinical teacher does, I think, still serve a useful purpose in relating the
operative work of the student to the needs of private practice, an aspect difficult for him
to appreciate while he is treating only hospital patients and with which the purely academic
teacher is in danger of losing touch.
From the passing of the 1878 Act onwards, there was a period of scientific advance.
This came mainly from the isolated efforts of individual workers, as there was little or
no organized research until a much later date.
Sir John Bland-Sutton made many of his contributions to the study of dental pathology
at the Odontological Society, his first paper in April 1883 being on the development of the
mandible. From that time until 1905 his interests included problems of calcification of
the jaws, the pathology of odontomes, of pyorrhoea alveolaris or Riggs' disease as it was
then called, structure and development of ovarian teeth, treatment of caries, and after-
treatment of extractions. The Transactions of the Odontological Society contain some
22 papers or discussions in which he took part between 1883 and 1905.
Cocaine was first introduced as a local anvsthetic about 1885, and in spite of its danger,
soon came to be used extensively. Up to 1907 cocaine and the chemically related eucaine
and Stovaine were the only local anesthetics in general use. The British Medical Journal
of March 1907 published a letter advocating the use of 20 minims of a 10% solution of
cocaine, equivalent to 2 grains. On March 25, 1907, Dr. J. W. Pare gave a casual com-
munication to the Society on Novocain, which he said had been introduced to this country
in the previous June.
In February 1899 Dr. William Hunter read his paper on the Relations of Dental Diseases
to General Diseases, which initiated what might be termed the era of focal sepsis. It was
accepted with rather uncritical enthusiasm by the progressive members of both the medical
and dental professions and for many years its validity was scarcely disputed. It was not
at all unusual for the doctor who was at a loss to understand his patients' symptoms to
send him to the dentist with instructions to have all his teeth out.
While dental sepsis is no longer regarded as the specific cause of the vast number of
general diseases which used to be attributed to it, I think the pendulum may have swung
too far in the opposite direction, and that there is some danger of the effect of oral infection
being underestimated.
Dental radiographs were taken in America about 1896, and as far as I can ascertain were
first shown here to the Odontological Society on January 28, 1901, when Carl Schelling
read a short paper on "An obscure case of dental trouble diagnosed by X-rays". He had
seen the patient 18 times, gradually dilating a sinus in the upper canine area, with bibulous
paper. The patient had assured him that 321 had been extracted without fracture of the
roots. The area was radiographed by Dr. Mackenzie Davidson with a piece of tintoil
in the sinus, and a root was shown to be present.
752 Proceedings of the Royal Society of Medicine 26
In 1895 occurred an event of major importance and interest to the dental profession,
when the name of Lilian Murray appeared in the Register, the first woman to be registered.
As Dr. Lindsay she is known to all of us and it would be difficult to exaggerate the debt
owed to her by this Society, the British Dental Association and the profession as a whole.
She was President of this Section in 1945 and of the Section of the History of Medicine
in 1950.
At the end of the nineteenth century amalgam was coming into general use. It was
first regarded as an inferior substitute for gold, to be used only by incompetent workers,
but was not, as far as I can find out, ever held in such disrepute in this country as it was
in the United States. There, at one time, the American Society of Dental Surgeons, the
American Dental Association of its day, had a rule that "any member of this society who
shall hereafter refuse to sign a certificate pledging himself not to use any amalgam, and
moreover, protesting against its use under any circumstances in dental practice, shall be
expelled from this society". Before very long, however, most members were using it
surreptitiously and it seems to have become respectable there in the early 1870s. In both
countries many materials were used. The alloys used were mostly proprietary, although
a number of practitioners made their own. In 1895 Dr. E. V. Black published some work
on amalgams, but from then until 1933, when Dr. Marie Gayler published the results of
her investigations at the National Physical Laboratory, little scientific work seems to have
been done on the subject. Thanks to the Dental Board, a very full study was then made,
and most useful data obtained as to the factors controlling the setting of amalgams.
In 1903 Dr. Black described the fundamental principles of cavity preparation, which
hold good to-day.
The special study of Orthodontics developed in the latter part of the nineteenth century,
much of the interest in the subject being stimulated by the enthusiasm of Edward Angle
and his followers. In this country it culminated in the foundation in 1908 of the British
Society for the Study of Orthodontics, largely due to the work of the late George Northcroft,
who was President of this Section in 1928.
Progress has been made in the treatment of periodontal disease, to which Sir Wilfred Fish
has made important contributions.
The advances in ancsthesia which have come in the last twenty-five years, together
with the general and discriminate use of antibiotics since the war, have improved enormously
the results of oral surgery. When one thinks of the large numbers of impacted third molars
and odontomes which we remove at the present time, one wonders what happened to them
in the past. It may be that the odontomes were treated by the general surgeon and the
impactions relieved by the extraction of the more easily accessible neighbouring teeth.
In the field of prosthetics, the use of acrylic resins has completely replaced vulcanite,
and cast gold has taken the place of the swaged dental plate. Now the chrome cobalt
alloys are to some extent replacing gold.
Advances in conservative dental surgery have been assisted by the increased use of local
anmsthetics and of cold water jets for the prevention of pain. The development of painless
dentistry which is at the same time safe has helped us to take advantage of the improvement
which has taken place not only in plastic filling materials, but in the accurate casting of
gold for inlays and bridges.
While great advances have been made during the hundred years of the life of the Odonto-
logical Society and of this Section, in the conservative, surgical and prosthetic treatment
of dental disease, comparatively little has been learned about its prevention. The large-
scale experiments with fluoridation of water would appear to offer some prospect of a
reduction in the caries rate, but much more evidence is needed over many more years before
this can be finally accepted or rejected.
A country-wide campaign of instruction in oral hygiene would bring about a great
improvement, especially if, before starting it, the profession could agree upon its essentials.
Nearly all of us are fully occupied in repairing damage already done, and it is only recently-
since 1920-that our schools have had full-time teachers, and professors, one of whose
main duties is the promotion of research, without which so little can be done in the field
of prevention.
I venture to think that the next phase of dentistry, which may be only just over the brow
of the hill, will be the era of preventive dentistry, The time may well come when the
dentist willl examine his patient, advise, and prescribe treatment, both preventive and
restorative, which will be carried out by others under his control, whose work would be
analogous to that of the radiographer, the optician or the physiotherapist. The vastness
of the task of controlling such widespread diseases forces us to envisage such a possibility.
It only remains for me to express my thanks to those who have helped me in the
preparation of this Address, especially to Dr. Lilian Lindsay and Mr. Alan Shefford and
to the Librarians of the Royal Society of Medicine, and of the British Dental Association.