A Dentist and a Gentleman: Gender and the Rise of Dentistry in Ontario 9781442670297

Table of contents :
Contents
Preface
1. Dentistry, Gender, and Profession Creation
2. The Rise of the Dental Profession in Ontario
3. Defining Dentistry
4. Enforcing the Dental Ideal
5. Professional Status, Ideology, and Gender: Dentistry, 1900–1918
6. Public Health, Public Education, Public Image
7. Gender and the Division of Dental Labour
8. On Becoming a Dentist: Dental Students, 1903–1917
9. Women in Dentistry
Conclusion
Appendix 1: Historical Sources
Appendix 2: Women as a Percentage of Practitioners in Selected Male- Dominated Professions in Ontario, 1911–1996
Notes
References
Index

Citation preview

A DENTIST AND A GENTLEMAN

This page intentionally left blank

A Dentist and a Gentleman Gender and the Rise of Dentistry in Ontario

TRACEYL. ADAMS

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

www.utppublishing.com c University of Toronto Press Incorporated 2000

Toronto Buffalo London Printed in Canada ISBN 0-8020-4826-9

Printed on acid-free paper

Canadian Cataloguing in Publication Data Adams, Tracey Lynn, 1966A dentist and a gentleman : gender and the rise of dentistry in Ontario Includes bibliographical references and index. ISBN 0-8020-4826-9 1. Dentistry - Ontario - History. 2. Dentistry - Social aspects - Ontario. 3. Sexual division of labor - Ontario - History. 4. Women dentists Ontario — History. I. Title. RK60.A32 2000

617.6'023

COO-931521-7

The University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario arts Council. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial support for its publishing activities of the Government of Canada through the Book Publishing Industry Development Program (BPIDP).

7

Preface

vii

1 Dentistry, Gender, and Profession Creation 3 2 The Rise of the Dental Profession in Ontari 1 3 Defining Dentistry 39 4 Enforcing the Dental Ideal

56

5 Professional Status, Ideology, and Gender: Dentistry 1900-1918 76 6 Public Health, Public Education, Public Image 90 7 Gender and the Division of Dental Labour 110 8 On Becoming a Dentist: Dental Students 1903-1917 126 9 Women in Dentistry 144 Conclusion Appendix 1 Appendix 2

167 Historical Sources 187 Women as a Percentage of Practitioners in Selected MaleDominated Professions in Ontario, 1911-1996 195

Notes 197 References 207 Index 231

This page intentionally left blank

Preface

In May of 1870 my great-great-grandfather, John Gennings Curtis Adams, left small-town Drayton, Ontario, for the big city, Toronto. At the time John was thirty-one years old. He was married and had four children. Although it is not known what he did for a living before that, it is clear that when he relocated, John Adams was looking for a new career. He moved to Toronto to study dentistry under the tutelage of his half-brother, W. Case Adams, who was eighteen years his senior and a well-established Toronto dentist. Dentistry had just received professional legislation in Ontario in 1868, and with his brother a thriving practitioner, it must have seemed like a promising career to John. In undertaking to study dentistry, John was not merely looking for a job, but was searching for his calling. An extremely religious man, and son of a Methodist preacher, John wanted to find work that would not only enable him to support his wife and children in comfort and allow them to live a respectable life, but that would also let him help others and serve God. In dentistry John Adams seems to have found what he was looking for. He devoted his life to helping others through his work as a dentist, providing free dental services to the poor. This charity work enabled him both to serve God and to help or improve others whose daily habits were not deemed respectable. In the dental profession John Adams also found the respectable and prosperous lifestyle he sought. His four sons followed his example: they all held dental degrees, and two held medical degrees as well. John's son J. Franklin Adams (my great-grandfather) did well enough as a dentist to afford a home in the tony Toronto neighbourhood of Rosedale and establish most of his eight children in professional occupations as well. It was through dentistry that John Adams and

viii Preface his children attained a comfortable middle-class life. However, this social mobility was not the result of the practice of dentistry in and of itself, but of how men like Case, John, and Frank Adams actively worked to define and structure the profession so that it provided prosperity and respectability for those who practised it. This book is about the rise of the dental profession in Ontario. In the late nineteenth and early twentieth centuries many men like John Adams entered dentistry. Although few of them shared John's religious goals, most shared his goals of a respectable lifestyle, social status, and economic prosperity. This book looks at how they structured and defined their profession to attain these goals. Moreover, it argues that in establishing dentistry as a profession, these men sought to fulfil not only their desire for a middle-class status, but also to establish their manhood. They wanted to be professional gentlemen: with all the class and gender assumptions that that implied. In nineteenth-century Ontario, however, dentistry was not considered one of the learned professions. Terms such as 'learned professions' and 'professional gentlemen' were reserved for medical doctors, lawyers, and Anglican clergymen. Throughout the late nineteenth and early twentieth centuries dentists fought to have these terms apply to themselves and their work too. They wanted to be dentists and gentlemen. While at the beginning of the period, those two terms appeared largely antithetical, by the First World War, they did not. My interest in studying dentistry stemmed, at first, from this family connection. Many of my ancestors, in the four generations that preceded my own, worked as dentists. Some were prominent enough to be mentioned in professional histories. In reading these histories, however, I was struck by the seemingly significant, but unexamined importance of gender, class, and race to the formation of the dental profession. I therefore settled on doing my doctoral dissertation on the role of gender in the rise of dentistry in Ontario. This book is based on that dissertation. Many people helped me with both the dissertation and the process of turning it into a book. I would especially like to thank Bonnie Fox, my thesis adviser, for her unending support of both me and this project, as well as for her insight, editorial assistance, and guidance. Thanks as well to David Coburn and Julian Tanner for reading many drafts of the dissertation and providing valuable advice on how to improve it. Ruth Pierson both encouraged me to tackle a historical project and provided guidance on how it could be done. She was a valuable examiner, and her critical comments helped to improve both the final version of the

Preface

ix

dissertation and the book in its present form. Peta Tancred and Sandy Welsh also gave me guidance that shaped the direction and content of the book. Julie McMullin read excerpts from the book and provided helpful suggestions and reassurance. The research and the book would not have been possible without generous grants from two institutions. The research was funded by a grant from the Social Sciences and Humanities Research Council of Canada. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. I would like to thank the staff at the dental library at the University of Toronto, who were very helpful in helping me find archival material. Dr Anne Dale provided pictures for the book and some much appreciated enthusiasm. Moreover, thanks are due to the University of Toronto for supporting my doctoral research, and the Department of Sociology at the University of Western Ontario, which provided facilities and a job, enabling me to write this book. Material from chapters 5, 6, and 9 has been previously published in Social Science and Medicine, Gender & Society, and the Canadian Revi&tv of Sociology and Anthropology respectively. Thank you to the editorial staff and readers of those journals whose critical comments helped to improve the final product. Many thanks also to everyone at the University of Toronto Press, especially to Siobhan McMenemy, my editor, and to Virgil Duff for their support and much-needed advice. Kate Baltais provided a very thorough copy-edit and improved the text a great deal. Two manuscript readers also provided valuable advice. Finally, I owe a debt of gratitude to my family. My dad, Dr John R. Adams, provided a great deal of assistance in this project - Thank you, Dad, for your help and your interest. My gratitude goes also to my mother, Cynthia Adams, for her support. To my husband, Steve Desmond, I owe many thanks, for his support, his shoulder to cry on, and especially for all the times he looked after our children, so that I would have time to work on this project. I also want to thank my children, Meg and Rhys, not for their support of this project - for they were a hindrance every step of the way - but for making life more interesting and more fulfilling while I was trying to complete it. Thank you to you all; I could not have done it without you. London, Ontario December 1999

This page intentionally left blank

Dental School Hustle, 1913. (All photos reprinted by permission of The Dental Museum, Faculty of Dentistry, University of Toronto)

John Gennings Curtis Adams and child suffering from a dental abscess, 1890s.

C.L.Josephine Wells, the first woman licensed to practice dentistry in Ontario, 1893. She obtained her doctorate in 1899.

Dr Jack A. Marshall of Belleville Ontario, his young assistant, and a respectable woman patient, 1886. He made the instrument tray himself by hand.

Graduating class from the RCDS school in 1889. The students are standing in front of what was then the dental school at 13 Louisa Street in Toronto.

Dr W.A. Cowan in his Toronto dental office, circa 1890 to 1900. Dental chairs were frequently placed in front of windows to provide better operating light.

A DENTIST AND A GENTLEMAN

This page intentionally left blank

Chapter 1

Dentistry, Gender, and Profession Creation

In 1993 the Royal College of Dental Surgeons of Ontario published a booklet celebrating its 125th anniversary and 125 years of dentistry in Ontario. On the cover was a picture of the graduates from the profession's dental school in Toronto, circa 1888. The graduates were not arrayed in rows looking straight at the camera, but were pictured in various poses, seated and standing, within an elegantly appointed room. In this picture the dental graduates represent a professional ideal that dental leaders were striving to achieve at the time: without exception, the graduates were white men who had the demeanour and appearance of elegant gentlemen. The picture made a convincing case for dental leaders' assertion, voiced consistently in the late nineteenth and early twentieth centuries, that dentistry was a learned and gentlemanly profession that deserved the public's respect and patronage. Dentistry was one of a number of professions trying to assert and increase its status during the late nineteenth and early twentieth centuries in Ontario and, more broadly, in Canada at large, the United States, and Britain. Like these other professions, dentistry was overwhelmingly male-dominated. Although this fact has been well documented in the sociological and historical literature on professions, its significance for profession formation and organization has not been sufficiently explored.1 This book examines the significance of gender, and especially masculinity, to the formation of professions through a case study of the dental profession in Ontario. In this study I argue that not only did gender influence the creation of male-dominated professions, it was central to processes of profession creation. Many male-dominated professions were created by middleclass white men at the end of the nineteenth and the beginning of the

4 A Dentist and a Gentleman twentieth centuries. Gender relations and ideology characteristic of the white middle class during this period were drawn on by professional leaders to both define and legitimate professional roles and claims to professional status. Thus, gender relations and ideas about gender came to infuse the very definition of professions. Male-dominated professions were defined by middle-class white men, for middle-class white men. As a result, the employment of anyone but middle-class white men in maledominated professions has, historically, been discouraged. Although I focus on the case of dentistry, I do not believe that dentistry was unique in this use of gender. In a field where the literature is dominated by studies of the medical and allied professions, and to a lesser extent law, one may well ask, 'Why study dentistry?' Dentistry provides a good subject for a case study for many reasons. First, dentistry is a male-dominated profession and has been since its inception. To date, women have made fewer inroads into dentistry than into many other male-dominated professions such as medicine and law. In 1996 about 21 per cent of dentists were women, compared with 30 per cent of physicians and lawyers (see Appendix 2). Second, while sociologists have examined the nature and history of a number of professions, the profession of dentistry, although not completely ignored, has not been widely studied. Its history may provide new insight into processes of profession creation in general. Third, dentistry's rise to professional status was relatively brief, encompassing a period of less than fifty years. Given this short time span the factors that contributed to dentistry's rise to professional status may be more evident. Fourth, unlike the professions of medicine and law, it seems that women were never formally excluded from the dental profession in Ontario. An examination of the dental profession, thus, may more clearly reveal the factors beyond formal exclusion that defined professional work as men's work. Fifth, dentists' efforts to establish their occupation as a profession are documented in their professional journals and other documents. Professionalizing dentists clearly defined their vision of a dental profession and the ideal professional dentist, and they carefully recorded their efforts to turn this vision into a reality. Dentists publicly discussed their efforts to construct a professional identity that was both masculine and middle class. These five factors make dentistry a good subject for a case study on the significance of gender to the creation of male-dominated professions. Nevertheless, there are obvious limitations to a case study approach. Most notably, by focusing on only one profession of a relatively small size, one risks losing sight of the interdependence and interaction

Dentistry, Gender, and Profession Creation

5

among professions (Abbott 1988; Coburn 1994). Dentistry did not professionalize in a vacuum, and this process was influenced by other professions that were attempting to establish themselves during the same period. In fact, these other professions were grappling with the same issues that consumed dentists. Thus, it is important to acknowledge dentistry's place within a system of professions and to consider dentistry's interaction with other professions. However, to explore the processes through which gender influenced professionalization, it is useful to study one profession in depth to allow closer examination of the detailed and subtle ways in which gender is significant to processes of profession creation. It is likely that gender ideology and relations influenced the organization of other male-dominated professions. I will leave it to future research to determine the extent to which the influence of gender on the dental profession can be generalized to other professions and/or the system of professions as a whole. Professions and Professionalization

Exactly what constitutes a profession has been much debated in the sociological literature. Many definitions emphasize the characteristics of professions. Notably, they have stressed autonomy, a body of knowledge and expertise, restricted access to professional practice, codes of ethics, self-government, and the presence of professional associations. Although these characteristics describe most professions fairly accurately, they may also describe other occupations, and they are unable to account for variations across time and place. Particularly thorny is the issue of professional autonomy, given that most occupations commonly viewed as professions are currently found in bureaucratice structures that appear to limit, at least modestly, professional autonomy. A profession has also been defined as control over an occupation (T. Johnson 1972), and as a group with control over the provision of specialized services (as in Larson 1977). These latter definitions are useful in highlighting aspects of power and control inherent in professions, but they do not really help us in identifying or explaining professions. Perhaps the most useful, and most flexible, definition of profession is that provided by Eliot Freidson (1983), who advocates using the term 'profession' as a folk concept, that is, not as something that can be objectively defined through reference to particular characteristics, but as something that is socially defined. With this definition, the focus of investigation becomes what, in a particular social-historical context, is defined as a profession and how. The above-mentioned characteristics are those

6 A Dentist and a Gentleman that in certain social-historical circumstances have been central to defining an occupation as a profession. However, they need not be the only characteristics, and they may not always be the most significant ones. Extrapolating from this definition, professionalization can be seen as the process through which a group of practitioners strives to define their occupation as a profession - that is, how they go about convincing the public, the state, and other professions that their occupation is deserving of professional status and privileges. This definition emphasizes the social construction of professions but, again, it does not contradict the findings of most mainstream studies of professionalization. These studies have tended to define professionalization as 'a process by which producers of special services sought to constitute and control a market for their expertise,' and further, as a 'collective assertion of upward social mobility' (Larson 1977: xvi). Central to the professionalization process are efforts by practitioners to monopolize the practice of that profession and any ensuing rewards through government legislation, restricting practice to those with specific education and credentials. It is through these mechanisms that practitioners have endeavoured, historically, to define their occupation as a profession. However, these efforts are not in and of themselves enough. As others have noted, they must be accompanied by efforts to gain what some call 'cultural authority' (Starr 1982; Abbott 1988), and what I generally refer to as social legitimacy. A profession cannot establish a monopoly, attain legislation, or create a market for its services, without this legitimacy. Studies of profession creation should take all of these different aspects into account. This approach to professions and professionalization is particularly useful when studying the establishment of the dental profession in Ontario. Dentistry gained professional legislation in 1868. However, like other professionals, dentists did not at first have an easy time enforcing this legislation. The main difficulty, in dentists' eyes, was that the public did not recognize their claim to professional status - they had no social legitimacy. They therefore concentrated their efforts over the next fifty years (1868-1918) on trying to convince the public that they were professionals deserving of public respect and patronage. To do this, dentists drew on a number of social ideologies and institutions, but gender, in combination with class and race, was central to their efforts. Dental leaders believed that the key to raising their status and social influence was to define professional roles and professional relations in a way that would appeal to the public - and especially to their mostly upper- and middle-class female patients. Thus, they argued that everything about a

Dentistry, Gender, and Profession Creation

7

dentist - his appearance, demeanour, conduct in practice, and interactions with others - should convey his status as a middle-class, white gentleman. Dental leaders believed that if all dentists behaved like middle-class professional gentlemen, then the public would come to respect them. Professional gentlemen were seen to embody all the qualities that professional leaders valued: 'A man entering any profession, if he has a well balanced and cultivated mind, an honest and humane heart that incites him to do unto others as he would that they should do unto him, and a good, common sense knowledge of the demands and courtesies of civilized society, is intuitively or by natural bent of mind and force of habit, that man [a professional gentleman]' (Whitney 1870: 226; italics in original). Unfortunately, for dentists there were very few such men in the profession during its early years. Thus, professional leaders struggled to ensure that men who entered the profession in the future were gentlemen and that dentists currently in the profession did their utmost to behave like gentlemen. In so doing, however, they defined professional roles and professional behaviour in terms of prevailing conceptions of middle-class masculinity. They argued that the ideal dentist was a gentleman, and only gentlemen could become good dentists. Gender ideology and relations characteristic of the late nineteenth and early twentieth centuries were used by dental leaders not only to define professional roles and legitimate their claims to professional privileges, but also to define and structure dentists' relations with their patients and the public. Dentists worked to establish their professional authority over their generally female patients by building on the gender authority they held as men. In this manner, prevailing gender relations became embedded in the very structure and organization of professional practice. Gender identity was also important to the organization of the dental profession as well. Middle-class masculinity shaped how dentists defined themselves as professionals and how they constructed professional practice. In attempting to define themselves as professionals, dental leaders were trying to define themselves as middle-class gentlemen. But the reverse was true as well. Dentists sought to define, assert, and maintain their status as middle-class gentlemen through their professional practice. Anne Witz (1992) speaks of profession creation as a 'professional project.' In a similar vein, Connell (1995) writes of the construction and reconstruction of male gender identity as 'projects of masculinity.' In the professionalization of dentistry we see a merging of these two projects. Dentists' professional project was also a project of masculinity.

8 A Dentist and a Gentleman Dentists themselves described the process of their professionalization as a drive to achieve manhood. This was asserted in countless articles that argued that a true professional man was a gentleman. However, it was also clearly illustrated through the imagery dentists used to describe their professional project. For instance, a dentist in 1870 commented that although the profession was still in its infancy it was 'rapidly approaching vigorous manhood' (Lennox 1870: 360). Less than two decades later professionals debated whether dentistry had yet achieved its manhood, concluding that as their professional progress was incomplete, the profession could not fully be called 'manly' (Willmott 1889). In defining their profession, and their manhood, dentists drew on specific notions of masculinity shared by many white, middle-class North American men in the late nineteenth and early twentieth centuries. Concomitantly, they altered this conception somewhat to suit themselves, adding skills and characteristics that were valued by professionals in general, and dentists in particular. The resulting image of masculinity, which changed somewhat over the period discussed, became central to the construction of the dental profession. Notions of middle-class manhood not only shaped the dental profession, as I will argue throughout this book, they also helped to motivate middle-class men, more generally, to create professions - a fact that has not been noted in previous work on profession creation. In the following section, I set the historical scene for the discussion to follow, by illustrating how nineteenth-century social reality and gender relations influenced the desire of middle-class men to create professions and to shape the form that these professions took. Nineteenth-Century Social Change and the Rise of Professions

Before the mid-nineteenth century Upper Canada was, by and large, a pre-industrial, agricultural society. Local markets were virtually nonexistent and transportation was difficult. Typically families produced for their own use, and the labour of all family members was geared towards agricultural production and family maintenance. Encouraging self-sufficiency were difficulties with communication between regions and transportation because of bad roads and inefficient rail travel (Glazebrook 1968). The isolation of many families and small communities ensured that there was little demand for many goods, health care, and other social services, outside of a few small urban centres. However, in the latter half of the century life in Upper Canada, which became

Dentistry, Gender, and Profession Creation

9

Ontario, changed dramatically. The isolation of many Ontario families was diminished by improvements to local roads and railways (ibid.). Improved communications with the introduction of the telegraph and telephone had the same effect. Both of these changes allowed for greater movement of people, goods, services, arid information. Urbanization became a dominant trend: while at mid-century, 85 per cent of Ontario citizens lived in rural areas, by 1900 or so, this percentage had dropped to 60 per cent (Cohen 1988: 123). Accompanying urbanization was the rise of capitalism and the spread of industrialization that further transformed Ontario society (Gaffield 1984, 1990; Gagan 1989). Domestic markets for goods and services became more important, and reliance on a cash economy spread (Pentland 1981; Glazebrook 1968). Rather than meeting their own subsistence needs through their own labour on a farm, families increasingly bought goods and services in these local markets, and some family members sold their labour power in the nascent capitalist labour market. Families became less isolated and less self-sufficient (Gaffield 1984; Glazebrook 1968). With these social trends, the organization of family labour changed. Adult males became the main family income earners, while children were more often sent to school than to work for their families or for wages (Gaffield 1984). Women's work was structured around the needs of their families and the availability of paid work. Women performed a wide range of work tasks both in the home and out of it, for the market, and for their families (Cohen 1988). Because women's work in the home remained an essential part of family survival, married women were less likely than single women to seek outside wage work (ibid.: 119, 128-9). Married women did perform a number of wage-earning activities that allowed them to work within their homes (Cohen 1988). However, it became increasingly common, for women who could afford to do so, to restrict most of their work to the household and the many tasks associated with family maintenance and social reproduction. The lack of good opportunities for wage work for married women encouraged this decision (Gaffield 1984). This latter pattern of family labour became particularly common among the urban middle class. The Middle Class

The rise of professions in general, and the rise of dentistry in particular, was very much associated with the rise of the middle class. Although little has been written about the rise of a middle class in Ontario, histori-

10 A Dentist and a Gentleman ans believe its initial formation began before 1840, after which it expanded more rapidly (Morgan 1996; Gagan 1989; Gidney and Millar 1994). The occupational bases of middle-class families were the merchant, industrial, and professional jobs expanding in urban centres after mid-century. Studies of the rise of the middle class in the United States and Britain argue that middle-class men and women strove to secure a place for themselves in society (Davidoff and Hall 1987; Bledstein 1976; Ryan 1981). Members of the middle class seemed intent on establishing and defining an identity for themselves that set them apart from both those above and below them in the social order (Davidoff and Hall 1987; Reader 1966; Millard 1988). Similar processes seemed to occur in Ontario, where members of the middle class sought to define and secure their own positions and lifestyles, and to extend their social influence over Ontario society in general (Gagan 1989: 80; Valverde 1991). Their efforts to establish this identity and secure their social position were integral to the establishment of professions. Members of the nascent middle class strongly valued family, and they sentimentalized family ties and home life to a greater extent than had been common previously (Tosh 1999; Davidoff and Hall 1987). The family was constructed as a loving and caring entity, removed from the world of work, business, and the stresses of nineteenth-century life. Within the family, there developed a division of labour that was sharply demarcated along the lines of gender. Although the family division of labour had been organized around gender in the past, the division between men's work and women's work became sharper and, at least in the ideal, less flexible. Ideally, in middle-class families, men would spend their days working hard outside the home, and then return home for comfort and calm, love and respite, before going back to work the next day (Tosh 1999; Davidoff and Hall 1987; Ryan 1981). As noted, the ideal for middle-class women was to concentrate on running the household and caring for their husbands and children. These tasks were imbued with new importance at this time.2 While many working-class families during this period relied on the wage labour of a number of its members for survival, middle-class families tended to rely on only a male breadwinner. For these families, economic stability, status, and respectability were viewed as stemming from men's work and men's careers (Ryan 1981; Davidoff and Hall 1987). Therefore, these families typically devoted their efforts to securing the positions of household heads. The education and socialization of sons became a topic of concern and discussion (Tosh 1999). To attain

Dentistry, Gender, and Profession Creation

11

a middle-class career, men had to devote a great deal of time to education and career-building, and securing the positions of sons and husbands could take much longer than previously (Ryan 1981; Tosh 1999). Men began their working life later than they had previously, and typically they delayed marriage until their careers were established (Ryan 1981; Tosh 1999). Adulthood for many men was not seen to begin until around the age of thirty because it was not until this age that most of them became secure in their careers, married, and started families of their own. For many men, the professions provided a vehicle for securing the status and middle-class lifestyle they so desired. The labour of women in the home and behind the scenes was seen as essential to creating the 'independent' middle-class male (Ryan 1981; Davidoff and Hall 1987; Tosh 1999). Women also worked in the labour force, particularly when they were unmarried, to provide families with more money to devote to the education and careers of sons (Ryan 1981). In this patriarchal family structure, more effort was devoted to securing the future of sons in the labour force than of daughters. Daughters were groomed to meet the needs of their present and future families - largely through their work in the home. Girls were socialized into the emerging role of womanhood defined by and for middle-class women (Ryan 1981; Davidoff and Hall 1987). This role placed family first and emphasized the value and necessity of women's role in social reproduction on both a generational and daily basis. Devotion to family and a strict gender division of labour were just two key elements in the distinct class identity that members of the middle class developed during the nineteenth century. In their study of the rise of the middle class in Britain, Leonore Davidoff and Catherine Hall (1987) argue that this identity, in part, was built on Protestant and Dissent religious beliefs and ideals of ascetic living and morality. Gail Bederman (1995) has shown that middle-class identity was also bound up with beliefs about race supremacy and civilization: white middle-class men and women believed that white civilization was more advanced than any other and that white people, and particularly white men, were superior to all others. Central to the middle-class identity were also a number of valued attributes and attainments including education, a respectable and civilized mode of living, and devotion to religion, family, and work (Tosh 1999; Davidoff and Hall 1987; Reader 1966; Bledstein 1976). While middle-class men and women did not reject status and wealth, they believed that these attributes should be earned, not endowed by birth or family connections. Through education, clean

12 A Dentist and a Gentleman living, and hard work one developed 'character,' and character was seen as the measure of the middle-class man or woman (Bledstein 1976; Valverde 1991; Bederman 1995). Members of the middle class were achievement-oriented: ideally, people were to be judged by what they did, and how well they did it. While character and achievement were largely internal, they were expected to be publicly demonstrated. A proper appearance and respectable lifestyle were outward indicators of internal character and morality (Bledstein 1976; Davidoff and Hall 1987; Glazebrook 1968; Valverde 1991). As the nineteenth century advanced, the middle class paid even more attention to health and appearance as indicators of morality and respectability - a factor that likely encouraged their increased patronage of the expanding medical and dental professions. Central to the middle-class identity was a gender ideology in which men and women were seen as inherently different (Davidoff and Hall 1987). This ideology was influential in shaping not only gender relations during the period, but also processes of professionalization. According to the ideology, biological differences between men and women meant they possessed different abilities and characteristics that fit them for different roles in life. This doctrine of separate spheres held that men were ideally suited for the public sphere, encompassing politics, business, and paid work, because by nature they were rational, independent, and authoritative. Women remained in the private sphere of home and family where their caring, emotional, and dependent natures were most valuable (Davidoff and Hall 1987; Ryan 1981; Tosh 1999). Although both middle-class men and women tended to value family life, their family roles were different. Men were the ultimate authorities within the family, and they were responsible for guiding and protecting their wives and children; however, men also expected to receive comfort and love from their families (Tosh 1999). It was women's role to care for and comfort their children and husbands, as well as to raise children and run the household. In return, women could expect financial support, protection, and love. While women's involvement in the public sphere was limited, men could traverse the two spheres easily (ibid.). Beliefs in the inherent differences between men and women not only affected the construction of family and gender roles, but other aspects of social life as well. For instance, not only were women viewed as being biologically different from men, they were seen as biologically inferior (Laqueur 1990). Men's biological make-up was used as the standard by which women's was judged (ibid.; Mitchinson 1991). Men were viewed

Dentistry, Gender, and Profession Creation

13

as healthy and physically strong, while women were portrayed as less healthy, frail, and nervous, and they were seen to be ruled by their reproductive organs (Laqueur 1990; Mitchinson 1991; Wood 1974). The perceived physical frailty of women bolstered the argument that their activity should be restricted to the private sphere. Moreover, these biological and physical differences were used to support the argument that higher education was more appropriate for men than for women. Many nineteenth-century thinkers feared that education for women sapped their strength and impaired their ability to reproduce properly (Wood 1974; Laqueur 1990; Bederman 1995). It is important to recognize that while the inherent natures of men and women were seen to be opposite, they were also viewed as complementary. Men had characteristics that women lacked, and vice versa. Together, men and women were seen to make an ideal unit, each bringing important characteristics and abilities into the family. Although the doctrine of separate spheres presents a neat picture of gender roles and white middle-class family life in the nineteenth century, historians argue that it is a highly simplified and exaggerated version of reality. While men were said to belong to the public sphere, it was clear, at the time, that they were also a very important part of the private sphere (Morgan 1996; Tosh 1999). Within the home they were not only the predominant authority figures, but men were also expected to spend time with their families, be companions to their wives, and play with their children, in addition to providing guidance and socialization (Tosh 1999; Morgan 1996). At the same time, women were not completely absent from the public sphere, as evidenced by their work for associations, charities, and social causes, and their involvement in work and family enterprises outside the home (Morgan 1996). As Cecilia Morgan (1996: 214) argues, there was no strict separation between private and public spheres, and the meaning and boundaries of the two spheres tended to fragment and shift across time and location. Moreover, as Morgan illustrates, these two spheres were actually not separate, but integrally connected. Our vision of separate spheres is further clouded by the fact that the exact definition of these spheres was being continually contested, defined, and redefined throughout the nineteenth century. Although many groups used the discourse of separate spheres, they used it in different ways to support substantially different claims. For instance, women's groups argued that women's different natures and their responsibility for home and family meant that they should be entitled to

14 A Dentist and a Gentleman an expanded public role, including the right to vote (Roberts 1979). At the same time, medical men used the discourse of separate spheres to argue that women had no place in their profession or the public sphere, in general, and that women's activity should be restricted to the home (Mitchinson 1991; Smith-Rosenberg 1985). Thus, the doctrine of separate spheres should be regarded as dynamic rather than monolithic, and as an ideal-type typology, rather than a description of actual relations between men and women.3 I believe it is most useful to think of separate spheres as an ideology that influences and provides a way of conceptualizing reality, without accurately reflecting it. As a gender ideology, the doctrine of separate spheres is most significant in purporting that men and women are inherently different and also significant in highlighting those differences. While the specific traits associated with men and women could vary within the separate spheres ideology, they tended to cluster around a few common characteristics: men were independent, authoritative, and rational, while women were dependent and emotional. These elements of the separate spheres ideology seem to have had a lasting impact on organizing social relations and constructing gender identity, beyond the period in which they arose. Middle-Class Masculinity and Prof essionalization

Research on men and masculinity has grown exponentially in the past decade. Notably, there have been a number of studies that examine middle-class masculinity in the nineteenth century. These studies have highlighted the significance of class, race, and gender ideology to the formation of masculinity and how notions of masculinity prevalent during the period helped to shape social institutions (Kimmel 1996; Bederman 1995; Games 1989; Tosh 1994, 1999; Grossberg 1990). They have illustrated that by the end of the nineteenth century, middle-class men were very concerned with manhood (Bederman 1995; Kimmel 1996). This concern, it is suggested, was partly the result of social changes such as the expanding political and social power of the working class, increased immigration, economic instability, and the women's movement, all of which appeared to challenge middle-class white male dominance. Manhood, at the time, had a specific social and moral meaning. 'Manly' men possessed the characteristics deemed appropriate for men, including independence, strength, and bravery; most importantly, 'manly' meant honourable (Bederman 1995: 18). Manhood was a quality to be achieved and demonstrated. As such it was also somewhat tenu-

Dentistry, Gender, and Profession Creation

15

ous - there was always a risk that a man would fail to acquire or demonstrate the appropriate traits. Such a failure would be seen in moral terms: not only would a man be 'unmanly,' but dishonourable and basically immoral. Because manliness was a character trait that could be acquired, nineteenth-century men and women endeavoured to socialize, educate, and morally guide their sons to ensure they would become manly (Tosh 1999; Rotundo 1987). A great deal of emphasis was placed on attaining the proper education and occupation to signify manly status. Only some men could truly be labelled 'manly,' and in the nineteenth-century middle class, 'manliness' was a term reserved for white middle-class men. Bederman (1995) shows how in nineteenth-century America, AfricanAmerican and Asian men were denied manhood both through legal and political mechanisms and through public discourse (see also Tosh 1991 on similar discourses in England). In a similar vein, middle-class men drew on the language of manhood to argue that they were more manly than other white men (Kimmel 1996). Men who were selfemployed or independent regarded themselves as more manly than those working-class men employed by others (ibid.; Tosh 1991). Nonetheless, conceptions of manhood varied across social class and race, and across time and location. The language of manhood was used by some men to demarcate themselves from other men (Kimmel 1996; Bederman 1995; Morgan 1996). Analyses by Michael Kimmel (1996) on manhood and America and by Morgan (1996) on gendered discourses in Upper Canada show how men used an oppositional conception of gender to define themselves as manly - and thereby upstanding and honourable - while defining their opponents or other men as inherently unmanly. Other men were criticized for their effeminacy and lumped with women as dependent and over-emotional (see also Bederman 1995; Carnes 1989). In this manner, the language of manhood and gender identity was used by men to further their causes - as Morgan (1996) shows with respect to early nineteenth-century political reformers - and to assert their status and superiority as compared with another group of men. To summarize, in the nineteenth century, manhood was by no means a certainty for middle-class men. It was a valued and valuable quality that had to be achieved and demonstrated. For middle-class men, being manly often entailed living up to the characteristics stressed in definitions of manhood and gender ideology at the time, such as independence, authority, and rationality. Manliness was also often (although not

16 A Dentist and a Gentleman always) associated with supporting a family. But how were they to demonstrate and prove their manliness? For many men, proof was sought through paid work (Tosh 1999; Carnes 1989; Kimmel 1996). It was here that professions proved so valuable to middle-class men. Professions provided a vehicle for middle-class men to establish and reaffirm their gender, class, and race identities, as well as their social position. The significance of gender and race to professionalization has not received a great deal of attention in the literature. Rather, studies have tended to emphasize the important role of social change and class on the creation of professions. Sociologists have stressed that professionalization is a historically contingent process, most associated with the experiences of a limited number of occupations in Anglo-North American society in the late nineteenth and early twentieth centuries (Larson 1977; Starr 1982; Torstendahl and Burrage 1990). Moreover, professionalization was a strategy pursued by a particular class at a particular time: it was a middle-class response to nineteenth-century social change (Bledstein 1976; Millard 1988; Reader 1966). A number of studies have illustrated how the rise of professions was spurred by the social trends of urbanization, industrialization, the expansion of markets, improved transportation, the rise of corporate capitalism, and progressive ideology (Howell 1992; Larson 1977; Starr 1982). As we have seen, urbanization and changes within capitalism gave rise to a middle class that was eager to secure a good standard of living in this time of social upheaval. Professions became a vehicle through which members of the newly emerging middle class could improve their status, security, and social influence (Gidney and Millar 1994; Larson 1977; Millard 1988; Reader 1966). Social change and the rise of the middle class also helped to create new markets for certain services (for example, medical, dental, and engineering) that professions aimed to provide. Thus, processes of professionalization were contingent upon social context and the rise of the middle class. In the literature, mentions of gender and race rarely extend beyond the observation that women and minorities have been excluded by professional elites in the latter's efforts to attain occupational closure and raise the status of their professions (Larson 1977; Starr 1982; Witz 1992). Although it is true that professions were a vehicle for the middle class, male-dominated professions were vehicles for middle-class, white men. Professions were not only a means for achieving class-based interests for status and security, they were also a means for achieving the gender- and race-based interests of middle-class men. As we have

Dentistry, Gender, and Profession Creation 17 seen, within the middle class, family status and security were seen to lie with men and were based on their work, status, and income. Through professionalization, middle-class men sought to secure this middle-class lifestyle and status for themselves and their families. In professions, these men sought work that would not only provide them with a family income, but would also enable them to demonstrate valued characteristics of middle-class white manhood, such as education, rationality, authority, independence, and a public presence. That is, in professions, middle-class men sought to meet the prevailing expectations of middleclass white manhood. Through professions they sought to define themselves as manly — and as we have seen manliness carried class, gender, and racial connotations. In this manner, the class, gender, and race interests of middle-class men led them to seek out professions and form professions in the late nineteenth century. Their backgrounds and identities also shaped the way these men went about creating and defining their professions, as we will see in later chapters. For now, it is important to stress that the ideology of separate spheres, and prevailing discourses of masculinity, emphasized difference. Men tried to demarcate themselves from women, and other men, through the language of gender and manhood. Through professions, middle-class men were trying to distinguish themselves from other men around them - to define themselves as skilled experts deserving of public privilege and social status. In this context, the language of gender difference and masculinity would prove useful for professionalizing men. In the following chapters, the significance of class, gender, and race to the formation of the dental profession in Ontario will be examined more closely. I will argue that not only was gender, in combination with class and race, a factor motivating professional projects, it also influenced the way in which professional roles and relations were constructed, defined, and organized. In the establishment of the dental profession, nineteenth-century beliefs about gender influenced the organization of professions and the definition of professional roles. In Chapter 2, I examine the rise of the dental profession in Ontario and the passing of professional legislation in 1868. This chapter illustrates that, from its earliest days, dentistry was an occupation performed by men. Chapter 3 looks at dentists' efforts to define professional roles and relations. Dentists used gender ideology and relations in this process, as they defined dentistry as work for middle-class gentlemen. In Chapter 4,1 examine how dental leaders tried to turn their vision of an

18 A Dentist and a Gentleman ideal dentist into a reality, through their education and matriculation standards, and through professional discipline activities. Chapter 5 examines changes in the dental ideal after the turn of the twentieth century. This chapter also reviews the factors that encouraged dentistry's rise in status at this time, including its relationship with the medical profession. Chapter 6 examines dentistry's public education and public health campaigns. Gender, class, and race figured prominently in these campaigns, which aimed both to increase dentists' professional authority and reform the habits of those outside dentists' class and ethnicity. Chapter 7 continues a look at dentistry in the twentieth century, by examining the establishment of a division of dental labour. Dentists drew on gender and class when defining the division of dental labour and constructed the occupation of dental assistant specifically for middle-class white women. Chapter 8 follows the making of dentists after the turn of the twentieth century at the only dental school in Ontario (at the time), the Royal College of Dental Surgeons. Specifically, this chapter explores the centrality of masculinity to dental education and the student culture at the school. In Chapter 9 I examine the participation of women in dentistry and consider how women fared in this occupation that was defined by men for men. The masculine definition of dentistry acted to discourage women from entering the profession, and it conditioned the experiences of those who did practise dentistry at this time. The Conclusion explores the extent to which my findings can be generalized to other professions, both in the past and the present. Moreover, it examines the implications of this study for research into professions, profession creation, and gender. Throughout the book I explore the significance of gender to the establishment of the dental profession by focusing on both the key events in its professionalizing drive and what dentists themselves had to say about this process through the pages of their dental journals, through dental board meetings, association meetings, and assorted other outlets (see Appendix 1). It is through their own words and imagery that the significance of gender to dentists' actions is most clearly revealed.

Chapter 2

The Rise of the Dental Profession in Ontario

Although it is possible to trace aspects of dental practice back to ancient Greece and ancient Egypt, the modern foundations of dentistry date back to the activities of medieval European barber-surgeons. Dentistry in the Middle Ages was not very sophisticated, and it is likely that barbersurgeons limited their dental work to pulling teeth. Barber-surgery was a masculine occupation, although there were a few women who practised the craft with their husbands or as widows. Women's involvement in the trade, however, was substantially curtailed by male barber-surgeons in the sixteenth century in the face of hard economic times and increased competition (N. Davis 1986). Dentistry came into its own as a separate occupation in eighteenthcentury France, largely thanks to the founder of modern dentistry, Pierre Fauchard (Bremner 1964). From France dentistry spread to the United States at the time of the American Revolution. Dentistry spread to Canada from the United States in the mid-nineteenth century. Before discussing the rise of dentistry in Ontario, it is valuable to review its rise in the United States briefly, for it was in the United States that dentists first endeavoured to establish their trade as a profession. Although dentistry arrived in the United States in the late eighteenth century, it was not until the nineteenth century that it emerged as an independent occupation (Bremner 1964). By then, urbanization was more advanced, creating a better climate for the rise of an independent occupation specializing in the care of teeth (ibid.). Increases in wealth, 'cultural refinement,' and the rise of a middle class are other factors that dental historians identify as preconditions for the rise of dentistry (ibid.; P. Davis 1980). Most dental services provided in the late eighteenth and nineteenth centuries were for the wealthy and prominent;1

20 A Dentist and a Gentleman the cost of dental services would have been prohibitive for most members of the general public. For those who could afford them, dentures were in high demand as the complete or partial loss of teeth was a common problem. Making dentures at this time required a significant amount of skill and often involved the use of real teeth. Some dentists actually bought healthy teeth from the poor and extracted them so that they could be implanted in, or used to make dentures for, the mouths of the wealthy (Bremner 1964). Dentistry in this era, thus, catered to a very select and limited clientele. Dentists themselves were scarce and variably trained, and they usually combined dentistry with other trades and occupations. The number of dentists practising in the United States rose steadily in the first three or four decades of the nineteenth century, although they continued to vary in the extent and nature of their training. Some had formal education and medical training, while others had virtually no education, formal training, or knowledge of medicine. Educated dentists came to try to disassociate themselves from their less educated counterparts, who were generally portrayed as theatrical and lying tooth-pullers who gave dentistry a bad reputation.2 Educated dentists were vexed by the public perception of dentists as people who lied about the pain involved in dental operations, who sometimes stole the teeth of dead people to construct dentures.3 They tried to distance themselves from these images and endeavoured to establish dentistry as an occupation that would grant them respect and a good living. In the 1830s elite educated dentists established dental journals and a society the American Society of Dental Surgeons. Its stated aim was to provide protection for educated, 'ethical' dentists from 'ignorant, unskilled quacks' (ibid.: 148; Fraundorf 1984). Internal divisions and disagreements over the nature of dental practice and the ability of the society to dictate the nature of this practice to its members destroyed this society around mid-century. After this time many other dental societies were established in the United States. A further step towards professional status was taken in 1840 when the first dental college in the world, the Baltimore College of Dental Surgery, was established. This school was to further reduce the practice of dental 'quacks,' raise the status of the occupation, and increase the presence of educated, medically trained men in dentistry. Elite dentists first sought to establish dental education through medical schools. However, medical men - eager to increase their own profession's status - had little desire to be associated with a low-status occupation like dentistry (Butler

The Rise of the Dental Profession in Ontario 21 1889; Bremner 1964). In the ensuing decades, dentists established a number of their own separate schools in the United States. Between 1870 and 1900 laws regulating the practice of dentistry were enacted in most U.S. states (Fraundorf 1984). These laws established a dental licence that was automatically given to every graduate of a dental school. Non-graduates were forced to take a licensing exam. The prevalence of for-profit proprietary schools, however, meant that many licensed dentists were not of the highest quality. In the United States it was not until the demise of for-profit schools in the 1920s that dentistry became a fully closed profession (ibid.). Throughout its professionalization period, American dentistry remained an overwhelmingly masculine occupation. Although it is possible that some women participated in dental practice earlier, there is no record of them working as dentists before 1850. The first woman known to practise dentistry in the United States was Emeline Roberts Jones, who learned dentistry by assisting her dentist husband in the 1850s. In 1859 she became a partner in her husband's practice, and after his death in 1864 she practised on her own (CHRFAWD 1928: 1735-6). In the 1860s some women finally attained access to dental colleges, overcoming much discrimination and resistance. Dentists were unwilling to accept women as apprentices, and dental colleges were reluctant to accept women to their programs (CHRFAWD 1928; Stern 1963). The first woman to attend and graduate from a dental college, Lucy B. Hobbs, was accepted only after she had practised dentistry for many years successfully and had earned the support and backing of her state dental society, which arranged for her to attend dental college; she graduated in 1866 (ibid.). Despite opposition, resentment, and hostility from male faculty and students, some women graduated from dental school in the United States in the late nineteenth century (Truman 1911). A significant proportion of them lived and worked in Europe; they came to the United States to take advantage of its advanced education in dentistry (CHRFAWD 1928). Through much of the nineteenth century, the dental profession and dental education were more advanced in the United States than in any other nation in the world. American dentistry built on the advances in the dental craft and science in Europe, introducing many innovations in dental practice. Dentistry came to Canada via the United States, and Canadian dentists followed American dentists' lead when it came to pursuing professional status. Canadian dentists were less directly influenced

22 A Dentist and a Gentleman by British dentists, who pursued professional status through association with the medical profession. Under the governance of the Royal College of Surgeons, British dentistry was not as aggressive or as successful in pursuing dental legislation that limited dental practice to those with a licence. In Britain, until the early 1930s, technically anyone could practise dentistry as long as they did not call themselves a 'dentist' - a term reserved for those who had been formally trained and registered (Richards 1971). As a result of this different path to professionalism, British dentists came under the control of the medical profession, and they did not achieve the status, independence, or remuneration that North American dentists achieved. 4 Early Dentistry in Ontario

While by the mid-nineteenth century dentistry in the United States had established journals, societies, and dental schools, dentistry in Ontario was almost non-existent. At this time dentistry was largely a part-time occupation, performed as a sideline from one's real business or trade. For instance, physicians often did dental work such as pulling teeth for their patients, in addition to their regular medical practice, to make extra money (Gullett 1971; Starr 1982). The bulk of dental work was performed by craftsmen such as blacksmiths and gunsmiths (Gullett 1971). A sketch of the extent of dental practice in mid-century Ontario is provided by the account of an American-trained dentist, Dr G.V.N. Relyea, who toured Ontario in 1842 searching for a location for his own dental practice. Relyea found two dentists practising in Toronto, but no local dentists in large towns like Kingston, London, Woodstock, Brantford, Hamilton, Coburg, or Belleville (Relyea 1898: 354). The majority of the population depended on the services of travelling, itinerant dentists who roamed the countryside. These 'tramp' dentists, as they were later called, appeared quite backward and unskilled to this trained dentist (ibid.). Local blacksmiths and gunsmiths pulled teeth, as a sideline to their smithing work. As another dentist described such work: 'On a visit from a patient he would leave the forge, wipe his hands on his apron, get the old turnkey wrench, and his brawny arm would soon draw not only the sufferer's tooth, but often the screaming patient himself, from the old kitchen chair' (Wood 1898: 266). Many blacksmiths and gunsmiths also constructed dentures, although, according to later, trained dentists, the correctness and effectiveness of their efforts were

The Rise of the Dental Profession in Ontario

23

questionable. The nature of dental practice at this time does not seem to have bothered the public, especially in the country, where many had never even heard of dentistry or dentists (Relyea 1898: 354). Before mid-century most rural families would have taken care of any dental needs themselves or relied on the itinerant tooth-pullers. Early Ontario dentists appear to have been exclusively male, and the nature of practice at this time emphasized the skill and strength of the craftsman. Pulling teeth seems to have required, by and large, a strong arm and the right tool. Although by mid-century the use of forceps to remove teeth was becoming more common, the instrument of choice until, and somewhat after, this time was the 'turnkey' - with handles for both hands, a shaft, and hooks that fit over the top of the teeth to be removed. Taking out a tooth required a good deal of strength and leverage, and the inside of the jaw was used as a fulcrum. Having a tooth removed by turnkey appears to have been awkward and painful. Although strength seems to have been the most important factor when extracting teeth, constructing dentures and filling cavities required a great deal of skill and knowledge in the use of fine metals (Gullett 1971; Beers 1895a; Clement 1898). Craftsmen such as gunsmiths and blacksmiths used their skills to construct denture sets for customers and neighbours (Gullett 1971; Relyea 1898). In the midnineteenth century this was a complicated task that involved the use of delicate tools, expensive metals such as gold and platinum, and often bone or human or animal teeth. Dentures generally consisted of frames or plates 'made from bone, ivory, or hippopotamus1 teeth, filed and carved to models made to fit, as well as could be, from impressions of the mouth, and human or teeth attached to these frames by means of pins, screws, or otherwise' (Cogswell 1893: 171). Partial sets of dentures were often carved 'from one piece of bone, with the teeth filed, cut and shaped to suit the case' (ibid.: 172). Later in the century teeth were crafted by hand from porcelain made and shaped by the dentist and attached with screws to a gold metal frame. Skill in working with metals and a mechanical turn of mind were important. Dentures involved working with gold and platinum and required the dentist to band, line, solder, and finish the teeth with only simple tools and instruments (Beers 1895a: 147-8). Many of these were hand-made by the dentists themselves. The heavy reliance on gold, and the degree of time, materials, and skill it took to construct a set of teeth, meant that dentistry was generally quite expensive. In the mid-nineteenth century the average price for a set of dentures was

24 A Dentist and a Gentleman forty dollars in Montreal and thirty dollars in Toronto (Beers 1897: 383). However, in the countryside the work was likely not as expensive, or sophisticated (Relyea 1898; Wood 1898). Around mid-century cavities were most frequently filled with gold, especially by formally trained dentists.0 Dental patients were seated in something like a rocking chair, propped up at the front so that it rested backwards. Filling cavities was done by hand, with chisels, mallets, hand drills and other tools, along with much hand pressure (Wood 1898). The skill of the operator in using such fine tools and working in small places was important. 'Unfortunate mishaps' could occur under this method, as one dentist later remembered: while filling a tooth with gold, his hand tool slipped and 'so great was the force used that it pierced the lip of the patient before [he] could stay [his] hand' (ibid.: 266). At this time there was little use of anesthetics. Early dental practice required the skills of a craftsman (Gullett 1971; Clement 1898; C. Martin 1898). Early Ontario dentists and craftsmen practising dentistry would not have had much training, if any, in dental technique. They generally had their own, self-learned methods and used hand-made tools (Gullett 1971; C. Martin 1898; Beers 1900a, 1894a). Any training a dental practitioner received was by apprenticeship; however, the length of apprenticeship could be as short as a few weeks or as long as a year or two. During this period, there was little emphasis in dental training on medical or scientific knowledge. Dentistry in Ontario grew out of male-dominated craft work, and all known, early dentists were male. The Expansion of Dentistry in Ontario While there were likely only a handful of men specializing in dentistry in Ontario in the 1840s, in the following two decades specialization in dentistry became more common. Dentistry was increasingly practised as a full-time occupation as the demand for dental services and the income to be gained from dental practice rose. As described in Chapter 1, urbanization, the expansion of the middle class, the rise of a cash economy, and other social trends increased the demand for many services, including dentistry. Other social factors further encouraged the demand for dental services. One was the extent to which the Ontario population were either fully or partially edentulous. Dental observers from the mid- and late-nineteenth century held that dental caries and tooth loss were quite widespread. They argued that with advances in civ-

The Rise of the Dental Profession in Ontario

25

ilization, people's diets had changed to include more cavity-causing sugary foods, and, as a result, there was a greater demand for dentistry than there had been previously (Trotter 1869a).6 Later researchers question whether the rise of dentistry could really be attributed to a rise in dental caries (Nettleton 1992: 6). Since there are no statistics on the incidence of dental disease collected before the late nineteenth century, there is no way of knowing whether caries and loss of teeth were indeed on the rise through the nineteenth century. Regardless of whether dental disease was actually on the increase at this time, there is little doubt that it was prevalent. Many people had already lost most of their teeth shortly into adulthood. Those who could afford to do so, primarily members of the new middle class, were eager to avoid the discomfort and pain associated with tooth loss and dental caries, as well as the accompanying possibility of facial disfigurement. As the fortunes of middle-class families improved, so did their ability to afford dental work. Increased demand for dental services was encouraged by technological change after mid-century that made dentistry both more affordable and more attractive. The introduction of vulcanite (vulcanized rubber) in the late 1850s reduced the cost of producing dentures. Vulcanite provided a new, much cheaper base for dentures, thereby eliminating the need for metal bases (Gullett 1971; Beers 1895a). No doubt a rubber base was also more comfortable than a metal one. The use of general anesthesia (nitrous oxide, ether, and chloroform) after mid-century also made dentistry more appealing as the element of pain, long associated with dentistry, was diminished. Around mid-century, dentistry had found in the middle class a clientele who was both interested in obtaining dental services and increasingly able to afford them. With the concentration of the middle class in growing urban centres, dentistry began to flourish. Increased demand for dental services meant that dentists' ability to make a good living from dental practice improved. Accordingly, the number of dentists practising in Ontario gradually increased. However, it was still difficult for even a trained and educated dentist to sustain a full-time practice by remaining in one place. Dentists usually had practices that covered a wide area (Gullett 1971). Typically, they would establish a base office in a town or city, but they would also serve the surrounding towns and countryside. Some dentists had branch offices that they would travel between, while others temporarily set up shop in rented rooms or roamed the countryside in search of patients, often carrying their trunk of tools and equipment on their backs (ibid.; Beers

26 A Dentist and a Gentleman 1890a). The distances covered could be substantial, even before rail travel became more common and established: for instance, one dentist claimed that in the 1850s he supplied services for the entire region between Coburg and Kingston (Gullett 1971: 21). By the 1860s more dentists, especially in large centres like Toronto, were able to sustain a practice by remaining in one place. Dentistry at and after mid-century was overwhelmingly male-dominated, as it had been in the past. The nature of dental practice ensured that it would remain male-dominated for some time. The itinerant and craft nature of the profession discouraged women's participation. They would have had difficulty moving around to attain a living from dental practice, as such independence of movement was much more acceptable for men. Women had numerous family responsibilities, and it would have been difficult to reconcile these and household labour with itinerant dental practice. Women had little access to the craft skills that dentistry still required. Middle-class women had neither the exposure to these skills nor the desire to engage in the low-status manual work dentistry entailed. While some working-class women may have had limited access to the skills through male family members, the itinerant nature of much of dental practice meant that their exposure to the skills would not be extensive. Because of the many other demands placed on the labour of working-class women, both within the home and in the labour force, they did not have much opportunity to acquire craft skills. Societal beliefs that women were mentally and physically unsuited for dental practice likely also discouraged their participation in dentistry at this time. These barriers to women's participation in dentistry ensured that both formally trained and untrained dentists were exclusively male. By the 1860s there were two, fairly distinct types of dentists practising in Ontario. The first group were 'formally trained' dentists. They had served a formal apprenticeship with a trained dentist, usually for a period of two to four years, and generally they had some medical education on top of this training. The medical education varied widely: from the reading of a few medical texts under the supervision of a preceptor, to attending some medical lectures at a Canadian college or a dental school in the United States, to - in a few cases - actually possessing medical degrees. These dentists were guided in their practice and conduct by some notion of ethics. They generally practised in one office, usually located in their own home, and often they served a distinguished clientele. Formally trained dentists sought to attain a middle-class income and lifestyle for themselves.

The Rise of the Dental Profession in Ontario

27

The second group was composed of dentists who have been characterized as, at best, 'flamboyant' (Gullett 1971: 25), and, at worst, 'tramps,' 'quacks,' and 'vagabonds' (Shosenberg 1992; Beers 1897; Bremner 1964). These men sometimes had training in dentistry, but it was not very extensive: often as little as six weeks or even less (Wood 1898). They were typically more itinerant than those with more extensive training and travelled from city to city, town to town, and house to house soliciting patients. Often they made extravagant claims with respect to their talents and the painlessness of their operations, and they advertised these claims extensively in newspapers and handbills. Dentists in this group were not viewed as respectable by formally trained dentists, and they could not claim middle-class status. Although on paper the practice of dentists in these two groups seems very different, in reality, the differences were not very dramatic. The correlation between 'ethics' and 'education' was not as strong as educated dentists asserted; nor, in all likelihood, was the correlation between education and ability to practise. Nevertheless, the typology does capture the fact that there were substantial variations in dental practise at this time, and it illustrates the extent to which trained dentists viewed themselves as being markedly different from, and better than, untrained dentists. The typology appears to demonstrate the existence of class differences within dentistry. Educated dentists certainly aspired to be members of the middle-class. Although little is known about their social backgrounds, selected published biographies suggest that they were probably from lower-middle-class and farming backgrounds, although a few came from smithing families. Their fathers were teachers and preachers and farmers; quite a few were American. These men certainly valued education and training - hallmarks of the middle class at the time. Although the backgrounds of the men from the less-trained group are not known, they are generally depicted as fellows who needed to earn a living, without a lot of time or money to spend on getting extended training or establishing a permanent practice. It seems clear they were of a lower class status than trained dentists, and probably they had little hope of gaining a distinguished clientele or a middle-class income. During the 1860s the numbers of both groups of dentists increased substantially. While estimates suggest that there may have been as few as five or six dentists practising in Ontario in the 1840s (Wood 1871; Relyea 1898; Willmott 1896: 263), by the late 1860s the number is estimated to have grown to 1757 (Willmott 1896; McFarlane 1965). The technolog-

28 A Dentist and a Gentleman ical changes that helped to make dentistry more affordable and profitable also made it easier to practise. The use of vulcanite in dentistry resulted in a decline of craft skills within dentistry, as there was less need for the dentist to possess extensive knowledge and skill in the use of fine metals (Beers 1895a; Shosenberg 1992; Bremner 1964). The growing availability of manufactured artificial teeth further diminished the need for dentists to be craftsmen, as they no longer had to carve and manufacture teeth themselves. The result was that more men pursued dental practice at this time, and many of them were opportunists who were not highly trained or skilled, although the number of trained and educated dentists increased as well. Increases in the number of dentists, particularly in the numbers of those without formal training, were of great concern to educated dentists. Not only did they fear the increased competition for dental services, they feared for their reputations. For educated dentists success in dental practice was heavily based on their reputation, status, and patient trust; the proliferation of less trained, 'flamboyant' dentists posed a direct threat to their ability to earn both this trust and a respectable living from dental practice. By its nature, dental practice requires physical proximity between dental operator and patient. In this context the respectability of the dentist was crucial because the majority of dental patients at the time were middle- and upper-class women. For women during this period such closeness with a strange man was viewed as distasteful and somewhat inappropriate. If women were going to submit to a dental operation, they needed to have confidence and trust in their dentists. The use of general anesthesia made the character of the dentist even more important. Patients who would be rendered unconscious while in a dental chair had to be certain that they and their belongings would be safe. Dentists told anecdotes about female patients who, before receiving a general anesthetic, carefully counted their money and their possessions, to ensure that nothing more than a tooth was removed. Patients tended to be apprehensive about dentists and dental practice, and it was therefore important for dentists to appear respectable and trustworthy. Ethical, trained dentists found the growing numbers of dentists who did not fit their mould offensive and destructive to their livelihood. The presence of dentists who made extravagant claims about their skill and the painlessness of their operations did nothing to combat the bad reputation dentistry had carried with it for some time. Educated dentists were, thus, eager to distance themselves from practitioners they

The Rise of the Dental Profession in Ontario 29 regarded as less ethical and less trained. They were also eager to distance themselves from the kind of dentistry practised by the itinerants dentistry that was based on neither learned craft skills nor a medical education. Indeed, their goal was to eliminate the practice of itinerants altogether (Wood 1898; Shosenberg 1992). This desire led a number of educated dentists to seek professional association and government legislation in the 1860s. Establishing the Dental Profession The history of the Ontario Dental Association dates back to a circular sent by Kingston dentist Barnabus Day, late in 1866, to 'every reputable dentist' known in Ontario, inviting them to meet in Toronto in January 1867 to discuss the formation of an association and dental legislation (Wood 1898: 271; Day 1898; Gullett 1971; Shosenberg 1992). This was not the first attempt at forming a dental association in Ontario. Apparently, some dentists had tried to establish associations earlier in the decade, but had failed in doing so (Wood 1871: 290; Elliot 1870). Day's effort proved to be successful, although it had an inauspicious beginning. Only nine dentists, most of them from small towns east of Toronto, attended the January 1867 meeting (O'Donnell 1898: 351; Gullett 1971; Shosenberg 1992). It seems that the eastern Ontario dentists had already been meeting informally as a group for some time, and they were quite eager for association and legislation (Gullett 1971: 52-3). None of the established Toronto dentists, nor anyone from south and west of Toronto, attended the meeting. There must have been some interest in establishing an association, for one Toronto dentist had earlier attempted to do so (Elliot 1870). However, it seems that neither the Toronto dentists nor those from elsewhere in Ontario took this circular from a small-town dentist seriously (Gullett 1971: 41). Despite their small numbers, the dentists attending the Toronto meeting decided to form an association and pursue dental legislation. Technically, the Ontario Dental Association (ODA) was not established until its second meeting in July 1867 at Coburg. At this meeting an additional twentytwo dentists presented themselves for membership, including one from Toronto and a few from southwestern Ontario (Wood 1898; ODA Minutes 1867). The reasons these 'reputable' dentists were interested in forming an association and drafting legislation were made clear at the second meet-

30 A Dentist and a Gentleman ing of the ODA.8 The dentists stated that they were 'surrounded by quacks' who were 'hurting the public' and, perhaps more to the point, were hurting 'qualified dentists who had to maintain established offices' (ODA Minutes 1867). It was believed that dental legislation would 'show the public who [was] qualified' and thereby help reputable dentists make a living (ibid.). A dental association provided the means through which respectable dentists could work together to distinguish themselves from those deemed unrespectable. Through this association, they could draft legislation to restrict entry into dental practice. Membership in the Ontario Dental Association was made exclusive. It was restricted to those dentists who had been in fixed, established practice for five years. Those in practice for between two and five years were allowed to join the association as 'incipient' members if they were recommended by two association members. Prior to becoming members, all dentists had to present proof of five years of regular practice9 and of their moral character. Evidence of a dentist's good moral character was to be supplied by the names of two physicians, two clergymen, and one association member who would attest to 'his respectability and moral standing' (ibid.). These requirements were aimed at excluding from membership those 'immoral' and 'disreputable' dentists who were in casual or itinerant practice. Significantly, these requirements name professional men as the arbiters of respectable and moral behaviour. Among the initial points of business in the new association was the discussion of standards governing dental practice. These standards represent the first attempt by Ontario dentists to define how, ideally, a dentist should behave in his practice. It was stated that dentists without a medical or other doctorate degree should not use the prefix 'Dr,' as many dentists did (ibid.). Using this title without a degree was seen as a misrepresentation and, therefore, not respectable. Moreover, the association deemed dental advertising and showcases10 'beneath the dignity of any respectable dentist' (ibid.). The use of amalgam in fillings, while not prohibited, was to be cautious and limited; gold was the preferred substance for filling cavities. Furthermore, ODA members emphasized the importance of the dentist's authority in the dentist-patient relationship: they 'denounced dentists becoming subservient to the will and dictation of his patient' (ibid.: 14). In these ODA prescriptions we see an early sketch of the image of the ideal dentist. A dentist should be authoritative in his relations with his patients and should not misrepresent himself or his work. He should be respectable and dignified in his behaviour. These prescriptions, combined with the rules governing

The Rise of the Dental Profession in Ontario

31

membership eligibility, were designed to ensure that dentists in the association were respectable and ethical. After this second meeting membership in the ODA grew substantially. With the association more established, and busy drafting a bill to licence dentists, Toronto dentists and those from southwestern Ontario finally took notice. The third meeting of the ODA took place in Toronto in January 1868, with between sixty and seventy dentists in attendance. They must have represented a sizeable proportion of the established dentists practising in the province, as the 1861 census lists a total of 114 dentists in Ontario, while the 1871 census lists 230. By 1868 most educated, established dentists in Ontario seemed to have been members of the ODA. At the third meeting of the ODA, and in the preceding months, the association worked on drafting a bill concerning licensing. Although the majority of dentists seem to have been behind the bill, it did generate a little controversy. Some dentists opposed the idea of legislation entirely, arguing that the government had no right to meddle in private affairs, or that legislation was unnecessary in a young profession like dentistry (Gullet 1971: 42). Some hesitated to endorse the legislation because they feared it would diminish the income they gained from indentured students - since the legislation made a dental school likely (Shosenberg 1992). Less-established dentists opposed the bill because they would not automatically attain a licence to practise under the bill's grandfather clause (Gullett 1971; Shosenberg 1992). This group resented having to be examined and judged by the more established dentists and feared that they would be unjustly excluded from the profession. Their vocal opposition apparently jeopardized the success of the bill while it was before the provincial parliament (Marshall 1898; Gullett 1971). Others supported the proposed legislation, but felt left out of the power structure of the dental board that was to be established (Shosenberg 1992). The proposed legislation named dentists who would compose a board to examine, license, and 'govern' dentists until an election was held. The names on the original draft of the bill were limited to eight of those dentists from eastern Ontario who were the founding members of the ODA. However, some of those dentists who had, heretofore, had little to do with the nascent association wanted to be included as well. They were very suspicious of the motives and character of the dentists who had appointed themselves to the dental board and ODA executive. After some argument, it was decided that the names of four

32 A Dentist and a Gentleman other dentists be added to those already present in the bill. With this compromise, the bill was deemed acceptable by the majority of the dentists in the ODA. Nevertheless, some dentists did not support it. The day after Ontario dentists approved the dental legislation at the ODA meetings, it was read in the legislature. In order to make a favourable impression, members of the ODA decided to adjourn their meetings and remove to the legislative buildings en masse. In total a group of about one hundred people comprising dentists and their supporters marched to Queen's Park to see the bill introduced (Gullett 1971; Shosenberg 1992). The grand parade of one hundred well-dressed and refined dentists and other worthies must have made quite an impression. Accompanying the bill was a petition in support of legislation mandating the examination and licensing of dentists. This petition was signed by sixty-eight dentists, twenty-five medical men, a druggist, a judge, and the mayor of Toronto. Dentists had worked to get a number of respected men behind their cause. In their drive to attain legislation dentists had a good deal of support and help from medical men. The appearance of so many physicians' signatures on the petition for dental legislation is indicative of doctors' support for the cause. The bill was presented in the legislature by an eastern Ontario medical man. Not only did this doctor introduce the bill and guide it through the legislature, he also helped write it. Other physicians were consulted on the contents of the dental bill (Gullett 1971: 43). Barnabus Day, the founder of the ODA, had a medical degree and was likely able to draw on connections in the medical profession to further dentistry's drive for legislation. Given the extent to which members of the medical profession assisted dentists, it is not surprising that the content of the dental bill was somewhat similar to the medical legislation passed in 1865 and 1869 which established a professional college to examine doctors (Gullett 1971; MacNab 1970). The dental legislation seems to have taken the best elements of the 1865 medical legislation and added measures that members of the medical elite felt lacking from their own legislation, including control over professional education (MacNab 1970). The assistance of members of the medical profession in formulating and presenting the bill to the provincial legislature seems to have been invaluable to Ontario dentists in their drive for professional legislation and professional status. Although there was some dissent from within the profession over the bill, there was little overt opposition, and in March 1868 the bill passed into law with a few last-minute changes, but little controversy (ibid.; Gul-

The Rise of the Dental Profession in Ontario

33

lett 1971). In comparison with the passing of the medical acts of 1865 and 1869 and the Pharmacy Act of 1871, all of which created much debate both within the legislature and without, the passing of the Dental Act was notably uneventful. In this respect, dental legislation was somewhat similar to legislation passed in 1859, 1861, and 1869 which extended to homeopaths and eclectics the rights granted to regular doctors (Connor 1997; MacNab 1970). The similarity may indicate that dentistry was regarded as a medically related health care occupation like regular medicine, homeopathy, and eclecticism; of course, the latter two specialties were opposed by the medical profession, while the dental profession was not. The Ontario 'Act respecting Dentistry' was the first piece of dental legislation in the world, although legislation regulating dentistry in some U.S. states was passed shortly thereafter. The Ontario legislation was unique in the extent of the powers and independence it gave to the dental profession in Ontario.11 This seems peculiar, given that dentistry was such a young occupation in Ontario: the very concept that dentistry was, or could be, a profession was quite new. Legislation in the United States did not grant dentists such extensive powers, despite the fact that professional dental societies, journals, and education had existed there for many years. British dentists did not gain professional control equivalent to that attained by Ontario dentists until the early 1930s (Richards 1971). Exactly why Ontario dentists were so successful in their drive for professional legislation and self-regulation remains an open question. According to the principal historian of dentistry in Canada, D.W. Gullett, dentistry was merely following in the footsteps of the medical profession, which had already attained such legislation (Guilett 1971: 43). While pre-existing medical legislation was undoubtedly important, this explanation seems insufficient for two reasons. First, compared with medicine, dentistry was a much newer full-time specialty in Canada, and it did not have the professional status medicine carried. Second, this explanation says nothing about why doctors got such extensive powers. Another opinion about why dentists were so successful in their drive for professional legislation suggests that the Ontario government did not want to be bothered with having to regulate professional employment themselves; therefore, they decided to let the professions run themselves (Shosenberg 1992). This explanation is also unsatisfying. The most plausible explanation for dentistry's success in gaining professional legislation is offered by R.D. Gidney and W.P.J. Millar (1994),

34 A Dentist and a Gentleman who suggest that the dentists succeeded because leading dentists were 'readily recognized as professional gentlemen,' and they knew 'how to work the levers of power' (ibid.: 221, 217). Moreover, dentists had 'the advantage of selling a highly valued product to the relatively affluent and thus moving in circles where they might command respect from the influential and powerful' (ibid.: 221). While dentistry may have been a relatively new specialty with trade origins, the professional elite appeared to be respectable professional men, some of whom had medical educations and friends in high places. The assistance of medical men and dentists' association with respectable people, as evidenced in their petition and their presence at the legislature, seem to have contributed to the success of the legislation. The timing of dentists' request for such legislation was also important. The Ontario parliament was more open to professional legislation during this period - as evidenced by the number of such acts passed. Occupations seeking professional status later in the nineteenth century, and after the turn of the twentieth century, did so in a climate hostile to such legislation, and they met with little success (Gidney and Millar 1994; MacNab 1970). The Act respecting Dentistry The 'Act respecting Dentistry' established dentistry as a self-regulating profession, ostensibly for the 'protection of the public' (Dental Act 1868: Preamble). There was no description contained in the act of exactly what dentistry was, or what dentists did. Rather, the legislation focused on establishing a dental board comprised of licensed dentists, who would examine, license, and regulate dentists. The Dental Act created the Royal College of Dental Surgeons of Ontario (RCDS) with a board of directors that would be in charge of administering the dental profession. In the act, twelve men are listed by name as composing the first dental board, but starting in June 1868 the positions were to be filled by election. In addition to being granted powers to examine and license dentists, the dental board of the RCDS was granted the authority to determine the length of apprenticeship necessary for a dental licence and, importantly, to establish and conduct a dental college in Toronto (Article 10). The board was to meet twice a year to examine students, grant licences, and conduct professional business. Not only was the board able to grant licences, but it was also given the power to rescind them (and to return them again) if a dentist acted in a way 'detrimental to the interests of

The Rise of the Dental Profession in Ontario

35

the profession' (Article 15). The board was also granted the ability to make regulations and bylaws to better govern the profession. Thus, the Dental Act provided dentists with the opportunity to govern themselves and the ability to control entry into the profession. The Dental Act set out the criteria for attaining dental licences. All prospective licencees had to be British citizens, and they had to possess 'integrity and good morals' (Articles 12, 14). Dentists who had been constantly 'engaged for five years and upwards [before 1868] in established office practice ... in the practice of the profession of dentistry' were automatically granted a dental licence upon presenting proof to the board and paying the requisite fees (Article 12). Dentists who had practised for fewer than five years had to pass an exam set by the RCDS board. This was the rule that had raised opposition from dentists who had not been in 'established' office practice for five years, and of course, this clause was of utmost importance to dental leaders who hoped to use the legislation to prevent dentists in irregular and itinerant practice from practising at all. Leading dentists wanted to ensure that only men with a certain level of knowledge, ethics, and respectability could practise. In addition to defining the criteria for the attainment of a dental licence, the Dental Act also specified the punishment for practising without one. After March 1869 anyone who practised dentistry 'for hire, gain, or hope of reward' without a licence, or who pretended to have a licence when he did not, was liable to prosecution and conviction. Practising dentistry without a license was a misdemeanour, and the punishment was a fine of not more than twenty dollars (Article 18). At least in theory, this section provided dentists with some power in trying to drive out those who were unethical, unlicensed, and who misrepresented themselves. Interestingly, the Dental Act ended with a section reaffirming the rights of physicians and surgeons. The final article states that nothing in the Dental Act 'shall interfere with the privileges conferred upon Physicians and Surgeons' in the province (Article 19). This was likely included at the recommendation of the many doctors who assisted dentists in drafting the act. It may have enabled doctors to continue to perform some dental operations, such as pulling teeth, that they typically performed for their patients, especially in the countryside. Doctors made sure that their professional powers remained untouched by the claims of dentists. With the power to set standards, educate, license, and discipline, edu-

36 A Dentist and a Gentleman cated dentists felt that they finally had the ability to undermine and eliminate less trained, 'disreputable' dentists. They believed that their vision of a dental profession, in which all practitioners were respectable, educated, and ethical, would soon come to pass. They were wrong. Professional Development: 1868-1 In 1868, after the passing of the Dental Act, the RCDS board began granting licences and examining candidates. First, the members of the dental board granted themselves the dental licence which conferred the title 'Licensed Dental Surgeon' (LDS). Then, they set about licensing and examining other candidates. This process was referred to as 'the grand grind of making us all great men and LDS's' by one dentist, indicating that, although this dentist thought it questionable, dentists hoped that the LDS. degree would be a sign of distinction (Elliot 1870: 4). However, these exams did not exact a very high standard at first, and a number of men were granted licences even though they were not well trained (Elliot 1870). Dentists were fearful of being too restrictive in their entrance requirements, as they believed that neither the public nor excluded dentists would tolerate and accept such restrictiveness. For their rights to be considered legitimate, they felt they had to give a little in terms of their standards. Although the intention of the Dental Act was clearly to keep those unknowledgeable, untrained, and unethical dentists out of the profession, the exams do not seem to have served this purpose at first. One board member argued that the licensing exams turned out 'rather a questionable batch of dentists, ... with here and there an exception' (ibid.: 4). Moreover, some dentists managed to fraudulently enter the profession under the 'five years'clause, 'notwithstanding the affidavit and the certificates of two medical men as to their knowledge of some of the subjects required, and from two clergymen as to their moral character' (Marshall 1898: 276). Thus, despite the dental legislation, a number of men of questionable skill and training were licensed in the profession. Dental board members seem to have found the examination process frustrating, and they were eager to find other ways of raising the standard of dentists entering the profession in Ontario. One of the board's first actions was to set the criteria for entrance into the profession by those new to dentistry. Candidates for a dental licence had to have apprenticed with a licensed dentist for a period of two years, and had to

The Rise of the Dental Profession in Ontario

37

pass an exam, set by the board, in nine subjects, including anatomy, chemistry, and various aspects of dental practice (Shosenberg 1992). Attendance at certain medical school lectures also seems to have been compulsory (Beers 1894d: 222). However, even these standards did not ensure that all incoming dentists would be well trained and knowledgeable. Hence, there was much talk and debate among the board members over opening a dental school. After much infighting and debate, two schools were established in 1868-9. One was sponsored by the dental board, and one was a proprietary school established by a few members of the dental board on their own. Both schools failed, without generating much income or interest. An additional proprietary school was established in 1871-2 but it also failed. In the hopes of raising the standard of men entering the dental profession, a matriculation exam for incoming dental students was established in 1872. It was not until 1875 that the profession established a permanent dental school. An additional effort towards raising the standard and knowledge of practitioners came with the establishment of a dental journal in 1868. The Canada Journal of Dental Science was edited and published by Montreal dentist G.W. Beers, although the journal's co-editors were based in Ontario. The goal of the journal was to provide 'respectable' dentists in Ontario and Quebec with a forum for the exchange of ideas on dental matters and to provide advice to dentists about what was expected of them in dental practice. The journal provided a primary means through which the role of professional dentist was defined. The advice contained in this and other dental journals published in Ontario was influential in defining and structuring the dental profession, and it forms the basis for much of the analysis to come. Discussion Between 1840 and 1870 dentistry in Ontario changed from a part-time sideline practised by craftsmen and doctors to a so-called profession with privileges ensconced in provincial legislation. At the head of this profession was a group of middle-class male dentists eager to secure respectability and a good standard of living by eliminating the practice of lesser-trained, 'quack' dentists. Although these dentists seemed to have continually bickered with each other over one petty matter or another, they were not fundamentally divided in terms of their practice philosophy or their belief that dentistry was deserving of professional

38 A Dentist and a Gentleman status. In this respect, dentists were more unified than medical doctors during the same period. Unlike doctors, however, dentists had little claim to status. While medical doctors in Ontario had long been considered members of a 'learned' profession, dentists' antecedents were tradesmen and untrustworthy tooth-pullers. The status of dentists as professionals was dubious. Their goal of eliminating the practice of nonmiddle-class, lesser-trained dentists was distant. With the formation of the Ontario Dental Association and the passing of the Dental Act, however, dentists had begun to establish a clear standard and a clear image or role for dentists. They had begun to define dentistry as an occupation that only certain men could perform. From its very beginnings through to the passing of the dental legislation, dentistry had been practised almost exclusively by men. Through their professionalizing drive, educated dentists endeavoured to limit dental practice to only those men who, like themselves, were middle class, established, and respectable.12 In their efforts, dentists followed the lead of the medical profession which was engaged in a similar project at the time and which had pursued legislation to restrict professional access and regulate professional conduct. In the regulations for association membership and in the dental legislation we see the initial attempts by dental leaders to sketch a picture of the ideal dentist. This was a man who had undergone an apprenticeship of at least two years and possessed knowledge on dental and medical subjects. He had one dental office and was characterized by morality, integrity, and authority in his interactions with the public. This image of the ideal dentist was adapted from the popular image of a professional gentleman - an ideal heretofore only applicable to lawyers, clergymen, and physicians (Gidney and Millar 1994). Dentists sought to adopt and adapt this ideal so that they too could claim the status associated with professional gentlemen (ibid.). Through legislation and association formation, dental leaders tried to bring this ideal image closer to reality for the majority of practising professional dentists. The image of the ideal dentist, however, remained a somewhat vague and ill-defined sketch at this time. Dentists would spend the next few decades refining this ideal, and taking steps to ensure that it became a reality.

Chapter 3

Defining Dentistry

The late 1860s and early 1870s were heady times for professions in Ontario. There was a flurry of legislation establishing professional privileges for medical doctors (1865, 1869), pharmacists (1871), and dentists (1868), among others. In the later decades of the nineteenth century, however, the climate for professions changed. The legislature was much less open to granting professional privileges, and, indeed, seemed tempted to limit or withdraw those previously granted. The population was suspicious of professions and their claims to monopoly over the provision of certain services. In the mid-1890s a political party called the Patrons of Industry succeeded in having some of its candidates elected to the provincial parliament on a platform that was opposed to professional privileges and monopolies of any kind (Shortt 1972; Naylor 1986). In 1895 the Patrons introduced a bill that would have reduced the medical profession's powers of self-regulation (Naylor 1986). Although it was defeated, it sent a message to professionals that neither the government nor the public was in any mood to tolerate an extension of professional privileges or any abuses of those privileges. In addition to these political concerns, members of professions had economic and professional concerns during this period. The relative prosperity and enthusiasm for the future that had characterized Ontario around the birth of the nation in the late 1860s gave way to economic depression and uncertainty in the later decades of the nineteenth century, particularly in the 1890s. Hard times negatively affected professions like medicine and dentistry which, at the same time, were having to contend with internal divisions and difficulties. There were too many practitioners to meet the limited demand for professional services (Gidney and Millar 1994; Rushing 1991; Beers 1896a: 224, 1898a).

40 A Dentist and a Gentleman Problems with illegal and 'unethical' practitioners would not go away. Moreover, professionals lamented the lack of public respect and patronage. It was in this context that dentistry began to stake its claim to professional status. Despite the 1868 Dental Act declaring dentistry a self-regulating profession, dentistry's professional status was tenuous. The Ontario public had little respect for dentists or dentistry, and they refused to limit their patronage to 'respectable,' educated dentists. Dentistry's professional leaders were frustrated. Throughout the period they aimed to raise the status of the dental profession to its 'rightfully deserved' level. They believed that if they could improve dentistry's image, the public would accept dentists' claims to professional status. If the quality of men in the profession was raised, the public would come to look upon dentistry as a legitimate, high-status profession, and dentists would prosper. Dental leaders endeavoured to define exactly who, ideally, should be a professional dentist. They fleshed out the sketch of the ideal professional dentist, originally outlined in their association and legislation. In so doing, they detailed what characteristics a person entering dentistry ought to have and how dentists should look and behave, both inside and outside dental practice. Notions of middle-class masculinity and gender relations were central to the way in which professional roles and relations were defined. Professional leaders attempted to define dentists' roles and relations in a way that would garner public respect and grant them an identity and lifestyle that would make them proud. They organized the profession so that through their practice they would be recognized and valued as respectable gentlemen. Gender relations and ideology proved useful when defining the nature of professional roles and when legitimating these roles and claims to professional privilege to the public. Defining Dentists

In the thirty years following the attainment of professional legislation, dental leaders created an image of the ideal dentist and urged dental practitioners to live up to this image. It was spelled out in dental journals, association meetings, and through dental education. Although a great deal of advice was dispensed, the character of the ideal dentist was straightforward: everything about a dentist - his appearance, demeanour, and conduct in dental practice - was to convey his status as a

Defining Dentistry 41 middle-class, white gentleman. Professional leaders argued that there was a correlation between professionalism and middle-class masculinity, such that only those who acted professionally could truly be called men. All others, especially 'quack' dentists were inherently 'unmanly.' Through this imagery of masculinity, dental leaders tried to shame and cajole rank-and-file practitioners into practising dentistry in a way that dental leaders believed acceptable and status-enhancing. If all dentists behaved in a gentlemanly manner, the public - and particularly the middle-class women who composed the majority of their patients would respect them and patronize them.1 Characteristics of the Professional Dentist The characteristics of the ideal dentist were clearly laid out in the first article of the first dental journal published in Canada in 1868. The innumerable pieces on this topic written over the next thirty years offered variations of the same themes. According to that first article, the following characteristics were 'some of the qualifications which it is essentially necessary that a man should possess before he commences his dental studies1 (Chittenden 1868: 2; italics in original): 'He should be a man possessed of a strong and healthy frame and a good constitution ... He should possess a fair amount of intellectual capability, as well as untiring industry and perseverance. He should be the most cleanly of clean men. His person, his clothes, his hands, his mouth, and, in fact, everything about him, should be kept in the neatest and cleanest possible condition ... He should also be the most patient of men ... He should be a strictly honest man ... [and a] man whose mind has been thoroughly trained in the attainment of a literary, scientific and classical education' (ibid.: 2-3). These qualifications were seen as high, and possibly too high for students entering the profession as early as 1868 (ibid.: 4). They represented an ideal towards which the dental profession should strive. These characteristics were associated with middle-class gentlemen in the nineteenth century, but many were seen as particularly necessary for those engaged in dentistry. Professional leaders held that since dentists' patients tended to be women 'of intelligence, taste and refinement,' it was necessary that dentists possess those qualities that 'command respect from such' people (Trotter 1868: 102). Such qualities included those particularly valued for middle-class men at this time, such as industry and health, as noted in Chapter 1. Dental leaders saw health as

42 A Dentist and a Gentleman particularly important, as they viewed their work as quite stressful and physically taxing. Also clear in the passage is the value attached to three factors that together constituted the basis of dental masculinity: education, cleanliness, and honesty. These were the characteristics most emphasized in the dental literature throughout the period. It was argued that they, above all other characteristics, would define dentists as middle-class gentlemen. As far as education was concerned, a 'literary, scientific and classical education' was seen as singularly important in defining the dentist as a gentleman. Culturally, such an education was viewed as a defining characteristic of both gentlemen and learned professionals (Gidney and Millar 1994). As one dentist argued, it was their education that distinguished them from 'mere' tradesmen (Lennox 1870). Education was an indicator of respectability and capability (Beers 1869a; Lennox 1870). Lack of education, and the use of bad grammar illustrated in dental advertising during the period, was said to indicate only ignorance. Like other professionals and, notably, their contemporaries in the medical profession, dentists believed that if they demanded a high level of education from practitioners then they would win public respect (Trotter 1868; Lennox 1870; Howell 1981). Although high educational standards might exclude some good dental practitioners, dental leaders regarded this as unimportant. Dentists argued that only well-educated men would advance the profession: 'Some very good men as practitioners graduated as bell-boys and sweepers of the door-step. I say this to their credit in one sense, yet I do not hesitate to declare that it should not be, and that as a rule it will be found that whatever obstruction and particular annoyance we have had in our progress, can be traced directly to the "beggar on horseback" conceit and crankiness of this class' (LDS 1894a: 3-4). A good education was seen as 'an essential preliminary to a life of refinement and cultivation' (Beers 1894b: 116), and such a life was what dentists sought. Education was believed to be necessary to dental practice. A professional dentist 'who has the writings of great minds to digest and whose judgement, at times, undergoes the most trying ordeals, requires to be highly educated' (Lennox 1870: 358). By 'highly educated,' professionalizing dentists meant that dental students should at least be able to fulfil the matriculation requirements set by the medical profession and that they should have some education in medical and scientific subjects (Lennox 1870). The study of anatomy, physiology, pathology, and chemistry was seen as being as important for dentistry as for medicine (Beers

Defining Dentistry 43 1870b; Lennox 1870; Scott 1871). However, a classical education and a knowledge of Latin were also deemed to be important for the dentist (Beers 1870b; Chittenden 1868; Scott 1871; Lennox 1870). Such a scientific and classical education would place dentists on a par with other learned professional gentlemen (Gidney and Millar 1994). It was argued that with such a background dentists would take their place among other cultivated and highly educated professional men, and they would gain public respect. The education requirements in dentistry encouraged the recruitment of middle-class men, who were more likely to possess this education than middle-class women and either men or women from other class backgrounds (Prentice et al. 1996). As the second basis of dental masculinity, cleanliness could have both a practical and a moral and social significance. In dental practice there is a potential problem of sepsis: disease-causing organisms in the mouth can be transmitted through unclean dental practice. Cleanliness is important to ensure that disease is not spread. However, dentists' concern for cleanliness predated and transcended their concerns for germs and disease. Rather, dentists valued cleanliness for its moral and social implications. Articles in the dental literature stressed that dirtiness was socially unacceptable. Respectable middle-class people would not want to patronize a dentist whose instruments were dirty or whose person was dirty. Through their cleanliness dentists could indicate they were respectable middle-class gentlemen, and not lower-class tradesmen. Dentists firmly believed in the maxim 'cleanliness is next to godliness' (Relyea 1872; Nelles 1870). Through their cleanliness dentists could indicate that they were morally upright, solid in their Christian beliefs, and ethical. A dentist's cleanliness was expected to be evident in his person and in his office. Ideally, a dentist's appearance should reveal clean, neat, and temperate habits: 'Gentlemanly deportment in and out of the office, and tidy and correct personal habits are essential requisites for the dentist. If any man has an excuse for bordering on foppishness it is he. His calling permits him to dress neatly and be always clean, and the comfort and confidence of his patients demands it. The habits of smoking and chewing tobacco, snuffing, drinking strong drinks, ought to be eschewed if not totally, until after office hours ... The dentist ought to consider bad breath as tantamount to a disability to practice, and when it exists ought to use immediate and effectual means to remove it' (Trotter 1869a: 266). It was important for dentists to set a good example for their patients by having clean, well-kept teeth themselves (Relyea 1872). Possession of these characteristics was deemed important if dentists

44 A Dentist and a Gentleman were to gain the public respect they felt they deserved. Dentists would be judged on their appearance by their patients and the public, and if they were found wanting in their cleanliness, neatness, or temperance, the public would not respect them or patronize them (Wells 1871). Through a clean and distinguished appearance, dentists demonstrated their gentlemanly status. Dentists were advised to further illustrate their gentlemanly status through the cleanliness and appearance of their dental offices (Chittenden 1868; Whitney 1870). Because many patients were 'persons of refinement and good taste' they should find everything in the office 'neat, clean, in good taste, and inoffensive' (Trotter 1869a: 266; Relyea 1872; Wells 1871). Dentists were reminded to make sure that their dental instruments were clean (Trotter 1869a). The office should be decorated in a refined and tasteful way, and everything should be as clean as possible. The cleanliness of a dentist's office, as much as his own personal cleanliness, would indicate his gentlemanly status to his patients. The final 'gentlemanly' characteristic emphasized in this age of quackery and grand claims was honesty (Beers 187lc; Relyea 1872). Dentists were advised to be honest in their dealings with their patients and not to lie about the amount of pain involved in dental operations. Dental leaders held that quack dishonesty, especially in advertising, was a main cause of the low status of dentistry (Beers 1871c, 187ld). If only honest men practised dentistry, then, they believed, dentistry's status would be raised. To convince rank-and-file dentists about the importance of honesty, dentists argued that 'cheaters never prosper' (Beers 187lc). Although dishonest dentists might seem to acquire many patients by lying about their abilities or the painlessness of their operations, in the end they would come to grief and disgrace (Beers 187lc: 313). The route to success in dentistry was through honesty and integrity (Relyea 1872). Without these qualities, a dentist could not attract the patronage of the middle- and upper-class women who formed the cornerstone of a successful practice for middle-class dentists. For members of the middle class, honesty was associated with integrity and morality and, thus, was valued. Through their honesty dentists could serve as role models for their patients (ibid.: 363). Dental leaders held that dentists should be the leaders of other men, women, and children, and through their honesty, they could lead the way towards good behaviour. Honesty was seen as especially important when dealing with young children. Dental leaders warned that some mothers may try to calm their children by telling

Defining Dentistry 45 them dental operations were not painful. When faced with this situation, the honest dentist was advised not only to contradict the mother, but to give her and the child a lecture on the importance of honesty (Relyea 1872). In providing such advice, dentists would be behaving in a 'gentlemanly' manner - kindly guiding women and children towards proper behaviour. Dentists believed that their professional status hinged on possession of these three characteristics. Just as middle- and upper-class women during the era began to prefer the service of medical doctors to midwives - the higher-status practitioner being preferred to lower-class women - they also chose to patronize gentlemanly dentists (Rushing 1991). For dentists, then, professional status and success were predicated on their status as middle class gentlemen. Dentists sought to define their professional identity in terms of their class and gender identity. However, while education, cleanliness, and honesty were valued by members of the middle-class during this period, there is little implicit in these characteristics that would define them as inherently, or even culturally, masculine. Nonetheless, dental leaders viewed these characteristics as central to their manhood. These characteristics were defined by dentists as both manly arid professional. That dentists associated professionalism with ideals of manhood and the possession of 'gentlemanly' characteristics is particularly evident in their discussions of quack or unethical dental practice. It is in these writings that professional leaders established a clear dichotomy. Ethical dentists were gentlemen, while unethical dentists were unmanly. Quackery

During the final two decades of the nineteenth century, dentists, like other professionals, had many problems with unethical and unlicensed practitioners. These dentists were called 'quacks' by dental leaders. By definition a quack was a person who boasted, or talked 'noisily and ostentatiously,' and generally one who pretended to have medical or dental skills that he did not possess (Beers 1891a: 161). Quack behaviour and the differences between quacks and 'ethical' dentists were frequent topics of discussion in the dental journals of this period. While ethical dentists were educated, honest, and clean, quacks were uneducated and dishonest, and their cleanliness was questionable. Quacks were particularly disdained for their use of advertising, which made grand claims about their skills and often boldly lied about their

46 A Dentist and a Gentleman qualifications or about their ability to guarantee successful, painless operations (Beers 1869a, 1869c: 58, 1869d; Whitney 1870). These advertisements were also disliked for their use of bad grammar, which, it was feared, conveyed to the public that dentists were ignorant men (Beers 187la, 1869a, 1869d; Chittenden 1871). Thus, in their advertising, quacks behaved in a manner opposite to that expected of gentlemen dentists: they were dishonest and uneducated. Quacks were also disdained for their efforts to attract patients through show cases and by handing out dental cards to every passerby. Such practices were 'debasing to any gentleman, and injurious to the name and fame of the profession' (Beers 1871b: 286). Quacks were further criticized by professional leaders for charging low fees. Hard economic times in the later decades of the nineteenth century, combined with a larger supply of dentists and low demand for dental services, had resulted in falling fees in dentistry. 'Ethical' dentists were particularly bothered by this event, as they increasingly found it difficult to support themselves in the style they expected. They lamented that with the current fees, few dentists would 'ever build terraces and own much bank stock' (Beers 1877a: 51). Low fees prevented dentists from living in a gentlemanly fashion. Moreover, low fees were argued to encourage the public to attach a low appreciation to the dentist and dental services and to suggest that dentistry was a trade, and not a profession (Beers 1869b, 1870a, 1870c, 187ld). Dentists urged practitioners to charge 'honest,' higher fees. While dental leaders continually urged dentists to charge higher fees, and called those who charged low fees 'quacks,' many rank-and-file dentists rebelled. They argued that they would not starve themselves or their families to conform to an ethical code (Perplexity 1897; Correspondent 1897a; 'Kicker' 1890; Beers 1896a, 1898a). For them, low fees and advertising were a means of survival (Bazin 1895; 'Veteran' 1895; Jean 1896). As one dentist explained: 'I am not an advertiser from choice. I have been handicapped by expenses and hard times into doing what to me is obnoxious, and as I am in the 'Hole' (excuse the term) I intend to get out of it. What sensible man can blame me?' (Lake 1894; parentheses in original). Hence, some otherwise ethical and educated dentists advertised, lied, and charged low fees (Beers 1895d). Difficult times and professional overcrowding led dentists into unprofessional and unethical dental practice (Bazin 1895; Beers 1899a). Additional characteristics of 'quack' dentists were their tendency to be 'unclean' in their dental practices and their personal habits (LDS

Defining Dentistry 47 1896b). Other dentists were called quacks for their tendency to compete with and slander fellow practitioners (Beers 1894c, 1895b, 1899b; Mills 1897; Senex 1894). Dentists who did not possess a dental licence and practised dentistry illegally were also labelled quacks.2 In general, any dentist who was not entirely honest, highly educated, very clean, and licensed was labelled a 'quack' by dental leaders. By the late 1890s a sizeable proportion of practising dentists would have fit this description, as even educated men who viewed the professional ideal favourably felt driven to advertise and charge low fees in order to earn a living.3 Professional leaders countered that if dentists behaved like gentlemen, then in the long run they could support their families and earn professional and gentlemanly respect. As part of their campaign against quack dentistry, dental leaders continually questioned the manhood of quack dentists. Only ethical practitioners were said to be 'men,' behaving in a 'manly' way (Lyon 1897; Habec 1914). Quacks were inherently unmanly (Beers 1895b: 175, 1899d, 1869d: 198). Quackery was viewed as the antithesis to both professionalism and manhood. Dentists argued that at the heart of dental professionalism was 'manliness' (Bruce 1895: 216; Ottenglui 1898). The images and language of manhood were used to urge rank-and-file dentists to behave in an ethical manner. They were urged to 'quit themselves like men' and be 'honest, upright, and just' by conducting their practices 'in a legitimate manner' (Senex 1894: 189). They were also asked to 'struggle manfully' against the temptations of unethical, dishonest, and unclean dental practice (Willmott 1890: 89; Senex 1894). Only 'manly' behaviour would raise the status of the profession and bring professional success to practitioners (Beers 1869d; Bowers 1895). Dental leaders appealed to images of manhood to encourage dentists to reject quack behaviour. In so doing, they suggested that only by behaving in an ethical fashion - being honest, clean, educated, and respectable - could a dentist secure his manhood. Manly, professional behaviour was seen as the key to raising professional status and defeating the threat of quackery. Through 'firm and manly aggression on the part of honorable men,' quackery would be defeated and the standard of the profession would be raised (Beers 1896b: 257; Lennox 1870). The profession's status was seen to hinge on the masculinity of its members. Quack behaviour degraded one's manhood and the profession (Lyon 1897: 242); gentlemanly behaviour did the opposite. Dentists made the same association between tradesmen and a lack of masculinity. According to some dentists while (working-

48 A Dentist and a Gentleman class) tradesmen's highest goal was the pursuit of money, (middle-class) professionals had higher - 'more manly' - goals, such as benefitting mankind (Martin 1896: 149-50; Capon 1900; Johnson 1900; Eaton 1895; Ottenglui 1898; McElhinney 1899). Similarly, those dentists who conducted their practices in a 'trade manner' were also deemed unmanly (Eaton 1895). Through their discussions of quackery and quack behaviour, dentists laid bare the connection between manhood and dental professionalism. Ethical practice required manliness and was a means through which a dentist could define his manhood. Dentists joined their middle-class contemporaries in late nineteenth- and early twentieth-century society in asserting that manliness was not something possessed by all men. Only certain men - certain middle-class, white men - were honourable enough to be manly. Dentists used the ideal of manhood to demarcate themselves from less ethical practitioners. In their eyes quack dentists and tradesmen could not truly be called men. Only gentlemen dentists possessed enough manhood to successfully practise dentistry. Professional Practice

The association between professionalism, dentists' roles, and manhood was also evident in prescriptions about the conduct of a dental practice and dentists relations with their patients. Dental practice was organized by dentists to fulfil the image of themselves as middle-class gentlemen. Through dental practice dentists expected to earn enough money to support themselves and their families in gentlemanly style, that is, in 'great comfort and a degree of what we may call quiet elegance' (Wright 1890: 174-5; Beers 1877a). As noted above, dentists were frustrated by low fees common in the nineteenth century, which threatened their social standing as well as 'the happiness and comfort of themselves and their families' (Beers 1877a: 51). In the dental literature, it was generally assumed that the dentist was a male breadwinner with a family to support (Correspondent 1897a; Sparks 1897). Younger dentists were urged to take a wife, 'a silent partner ... who will love you, and encourage you, and help you, and swear by you, even if you go home like a cowardly brute and beat her with a stick' (Beers 1890a: 59). A wife was said to improve a man's dental practice and a man's life. Further, dentists were expected to keep gentlemanly practice hours: working five and a half days a week for about seven hours a day. Dentistry was viewed as a stressful and physically demanding occupation

Defining Dentistry 49 that, when not practised properly, had been known to drive men insane (Beers 1877b: 54; Darby 1877: 61). To keep themselves healthy (and respectable) dentists were advised to make time for eating good food (roast beef and other food that demanded chewing), exercise, and substantial vacations of four to six weeks in the summer (Beers 1877b; Darby 1877). Only a rested dentist could serve his patients well and present the appropriate gentlemanly demeanour. Dentists were expected to spend their off hours in gentlemanly pursuits, including being active in public and professional affairs and keeping abreast of professional developments. In addition, dentists were advised to have gentlemanly leisure activities, including duck-hunting, trips to Europe, and reading (Beers 1877b: 54-5). Apparently, a dentist who took such time away from his work became 'a better man, physically, mentally, and morally' (Darby 1877: 64). The importance of gentlemanly leisure activities was particularly stressed by some who felt dentists spent so much time in the company of women that they were in danger of becoming effeminate (Habec 1912a, 1912b; Thornton 1907). 'The average dental practice is largely composed of women and children, ... [dentists] become influenced by constant contact until [their] natures and actions are affected thereby ... The boisterous acute mannishness possessed by the man whose business brings him in contact with men alone is rarely possessed by the dentist' (Habec 1912a: 69). Studies of middle-class men in the nineteenth century have shown that many men at this time feared that too much contact with women and participation in white-collar or service work might make them effeminate (Kimmel 1996; Carnes 1989). Like their contemporaries, dentists were distressed at the thought that they might be viewed as effeminate, 'meek,' or 'lowly' - characteristics they associated with femininity (Habec 1912a). Thus, dentists were urged to have manly hobbies and socialize with men after work as much as possible to maintain their manly dispositions (ibid.; Thornton 1907). Similarly, other dentists acknowledged that dentistry might narrow a man's point of view — associating narrow-mindedness with femininity — and encouraged dentists to broaden themselves and to cultivate a 'manly independent spirit without apologies' (Anonymous 1912: 163; Mitchell 1904). These writers emphasized that dentists should be manly and live their lives and conduct their practices in a manly fashion. To many dentists manhood was to be gained and proven through their work hours, the nature of their work, as well as their activities and lifestyle outside of work. In constructing dentistry as work for middle-

50 A Dentist and a Gentleman class gentlemen, dentists hoped to establish an occupation that would reaffirm their sense of manhood, bring them a sense of pride and accomplishment, and gain them public respect. They structured the profession in a way that fit the working patterns and identity of middleclass men, but few others. Defining Dentist-Patient Relations

Dental leaders also endeavoured to define dentist-patient relations during the thirty years that followed the passing of the Dental Act. The physical closeness required in a dental operation made interactions between dentists and their patients particularly delicate. Such closeness, dentists argued, was more 'than is agreeable to the sensibilities of cultivated and refined people' and therefore required an approach 'made with a delicate regard to the natural feelings of repugnance to the contact of another person' (Reade 1896: 38). The fact that the majority of dental patients were middle-class women made the close contact all the more unsettling. Dentists' response was to continue to assert their gentlemanly status in their interactions with patients. Patients would be more comfortable with close contact if the dentist were a respectable member of their own class. To convey their status as gentlemen, dentists not only presented a gentlemanly appearance and demeanour, as described above, but also treated their patients with gentlemanly manners and authority. In structuring relations with their patients, dentists built on nineteenth- and early twentieth-century gender relations and ideology. They were to act like gentlemen in their practice while their patients were treated like ladies. Dentists were advised to be polite and friendly towards their patients, but also to treat them as subordinates in need of guidance and assistance. Attaining a position of authority over patients was not always easy, as dentists sometimes had a lower-class position than the patients who patronized them. In this circumstance, it was important for dentists to act like respectable men of an equal class position, and emphasize the authority associated with their gender and their expertise to gain the upper hand in their interactions with patients. In accordance with nineteenth-century views of womanhood, female patients were portrayed in the dental literature as nervous, emotional, and in need of male guidance. Thus, when dealing with their patients, dentists were urged to be polite, respectful, punctual, cheerful, and sympathetic (Relyea 1872: 364). This demeanour was important to convince

Defining Dentistry 51 patients, hesitant to come to a dental office in the first place, to return for more treatment (Trotter 1869a). Moreover, with such a demeanour dentists would be better able to soothe nervous patients in pain (Whitney 1870; Wells 1871). Dentists were advised to have patience and a controlled temper when dealing with their 'high-strung' female patients. For instance, one article cautioned that a dentist should control his temper if his patient became 'nervous and insist[ed] upon holding [his] hand with both of hers' while he worked on a cavity (Relyea 1872: 364). Dentistry was said to require a good deal of patience when dealing with emotional, nervous women who sometimes required hours of calming and coaxing before they would let the dentist work on them (Relyea 1871: 131). The dentist was portrayed as a rational man authoritatively calming the fears of emotional women. While they were calming their female patients, dentists were expected to act with authority and confidence towards them. Dentists were expected to teach their patients to respect dentists' skills and authority (Whitney 1870; Scott 1870). Patients, like children, were said to require 'firmness and authority tempered with condescension as to inspire in them respect and confidence' (Whitney 1870: 231). Here condescension was not seen in a negative way; dentists believed that, as professional gentlemen, they should be patronizing with their female patients. Ideally, a dentist should 'control' his patients (Beach 1907; Eaton 1904). If they behaved like authoritative men, looking after the welfare of their female patients - that is, in a way appropriate to their gender, race, and class - dentists believed they would earn respect. Dentists further asserted their authority vis-d-vis their patients by refusing to let their patients guide their own treatment. In the dental journals, a number of dentists describe incidents in which female patients tried to tell them what dental treatment should be given or how it should be given (Scott 1870, 1871; Relyea 1872). Even if the patients' requests were somewhat reasonable, these dentists refused to treat them. It was professional principle that dentists should not be told what to do by an 'ignorant' patient (Scott 1870: 249-50). Professional leaders advised that gentlemen dentists should refuse to deal with patients who would not submit to their authority (Scott 1870; Scott 1871; Relyea 1872). By asserting their authority in this way, dentists believed they were behaving as ideal, professional gentlemen should. Indeed, medical men, drawing on the same gender ideology and beliefs about professional expertise, also insisted on complete authority over their patients during treatment (Smith-Rosenberg 1985).

52 A Dentist and a Gentleman Dentists tried to extend their authority over patients beyond the specifics of dental treatment. For instance, many dentists argued that they were very influential people and should act as role models for their patients and the larger public: 'The dentist, as a cultured gentleman, owes certain duties and responsibilities to society ... and as it is impossible to isolate himself from the effects of his personal influence, he should strive to make that influence an inspiration to others' (Smith 1904: 163—4). Thus, dentists argued that they should make use of the 'tremendous' influence they had over others and guide their patients and the public towards appropriate living habits (Smith 1904). In addition to modelling appropriate behaviour, dentists were expected to instruct their patients on a variety of subjects. These subjects were not limited to dentistry, but encompassed topics such as food, exercise, honesty, and the importance of living well, both physically and morally (Leblanc 1871; Nelles 1870; Trotter 1868). As men, they believed they had the responsibility to guide others, particularly women and children. Fears about the racial degeneracy of the Anglo-Saxon race, common during this period, gave dentists' 'advice' particular urgency. If, by instructing women, they could improve the eating habits, living habits, and dental habits of Anglo-Saxons, then they could help ensure the future well-being of the race. Ultimately, dentists were expected to interact with their patients 'in a way becoming to a professional man and a gentleman' (Coghlan 1904: 167). In this manner, dentists tried to build on their gender authority to establish their professional authority. Dentists believed that their patients wanted and needed them to act in a paternal manner and that they would only earn patients' respect by doing so. Once again, dentists used the role of middle-class white gentleman to help them gain professional status. However, in this period, when there was so much uncertainty surrounding the attainment of manhood (Tosh 1994, 1999; Kimmel 1996), we might also see dentists' attempts to define their authority over their patients as an attempt to bolster their authority as men more generally. That is, as dentists built on gender to establish their professional status and authority, they were also trying to reaffirm their masculine identity and authority through their professional practice. Internal Professional Differences

The image of the ideal professional dentist was constructed by professional leaders - those actively involved in associations, journals, dental

Defining Dentistry 53 education, and the dental board. Within this group of dentists there is little record of dissension or disagreement. However, there seems to have been some difference of opinion between professional leaders and rank-and-file dentists. Reading the behavioral prescriptions outlined by professional leaders is like listening to a conversation between two people where you can only hear one party speaking. While it is clear in the dental literature that most rank-and-file dentists did not come close to the dental ideal and many did not care to, the rank-andfile vision of dental practice was not clearly articulated. Often we can infer rank-and-file views by the way in which professional leaders responded to them. At rare points, rank-and-file practitioners speak in their own voice. When the opinions of rank-and-file dentists differed from their professional leaders', they did so in one of two ways. First, many dentists seem to have supported their leaders' vision of professional status and gentlemanly demeanour, but felt that practising in a gentlemanly manner was impractical: it would not put bread on the table. These men had families to feed and could not afford to 'starve for the sake of ethics' (Perplexity 1897; Correspondent 1897a; Lake 1894; Bazin 1895; 'Veteran' 1895; Jean Baptiste 1896). Second, other dentists clearly did not share professional leaders' vision of dentistry as a profession and felt that dentistry should be practised as a trade. They emphasized dental technique and felt that as long as they were satisfying their customers (not patients), they were doing a good job. They had little respect for education or medical science and no use for professional associations or dental journals. This position was clearly articulated in a letter written by an unnamed dentist (quoted in its entirety in Chapter 4): 'I say we don't want "highly-educated" men [practising dentistry]. We want good mechanics, who can work in their shirt sleeves, and who aren't particular about all the fine nonsense of antiseptics, bacteria etc. What the mischief does it all mean?' ('Kicker' 1890: 185). As the quote illustrates, education, attention to science, and gentlemanly dress were regarded as ridiculous by some dentists. Such rank-and-file dentists would have had a very different sense of manhood than the one advocated by professional leaders. For these dentists manhood was based on trade skill and hard work, rather than characteristics like education and cleanliness. For all their opposition, however, rank-and-file dentists did not actually challenge the actions or authority of professional leaders. They simply asked to practise quietly, on their own. They did not want to interfere with professional leaders, and they did not want professional leaders to interfere with them.

54 A Dentist arid a Gentleman They rarely challenged the vision of professional leaders openly, generally preferring to ignore it. While professional dentists felt that they could 'reform' the first group of rank-and-file dentists who were sympathetic to their views (and there is evidence that they had some success in doing so), they held little hope of changing the habits of the second. However, they did work to ensure that future dentists shared their own vision of the profession by raising matriculation standards and tightly controlling dental education. In the next chapter we will look at dental leaders' use of education and professional discipline to ensure that their vision of dentistry became the only vision of dentistry. Discussion

In looking at how dental leaders defined the ideal dentist, it is interesting to note not only the characteristics that were stressed, but also those that were not. Most importantly, dental leaders said surprisingly little about the dentist's skills and the actual practice of dentistry. They valued abstract and scientific education more than the manual skills that had long been at the heart of dental practice. While dentists at the time still valued these skills, they chose not to emphasize them. Already they had begun to distance themselves from the craft elements of their occupation, choosing rather to embrace the scientific aspects. This trend was one that continued into the next century. Dentists asserted that they provided a service based on their knowledge and expertise, not a product as craftsmen or tradesmen would. Downplaying the manual aspects of dental practice was perfectly in keeping with professional leaders' goals to define dentistry as a profession and as proper work for gentlemen. While some rank-and-file dentists disagreed with their professional leaders, they were not influential within the profession, and their presence was decreasing over time. The men entering dentistry in the late nineteenth and early twentieth centuries wanted to be professionals and gentlemen. In emphasizing education, cleanliness, honesty, and authority as essential characteristics for a professional man to possess, dental leaders were by no means unusual. Virtually all professions, particularly, maledominated ones, placed a great deal of emphasis on education as an indicator of professional status (Gidney and Millar 1994; Larson 1977). Similarly, honesty and cleanliness were emphasized by other professionals. It is possible that dentists stressed these characteristics more strongly

Defining Dentistry 55 than others because of their clientele and their history. Since virtually all dental practitioners were men, while the majority of dental patients were women, dentists had to be extraordinarily diligent in playing the part of gendemen and being respectable, honest, and clean. Their ability to attract middle-class female patients depended on it. Moreover, in terms of their social mobility, dentists had further to go. Although medicine did not enjoy an extremely high status in the late nineteenth century, it did have a long-standing reputation as a learned profession (Gidney and Millar 1994). Dentistry did not, and thus had to work harder to earn a good reputation, especially given dentists' historical reputation as lying tooth-pullers. As a result, dentists may have demonstrated a greater concern for gentlemanly demeanour and behaviour than other professionals. However, it seems unlikely that dentists were unique in drawing on class and gender characteristics to define roles and raise their status. In using the language of gender to differentiate themselves from quack dentists, Ontario dentists were pursuing a strategy that was fairly common for their place, time, class, and gender, as studies of manhood in North America have recently shown (Kimmel 1996; Morgan 1996). Middle-class white men in the nineteenth century frequently tried to assert their sense of manhood by portraying their opponents, and particularly men from other races and classes, as unmanly and effeminate (Kimmel 1996; Bederman 1995; Morgan 1996). In pursuing this strategy, dentists defined professionalism in terms of middle-class manhood (and similarly defined manhood in terms of professionalism). Professional roles and relations were structured with reference to prevailing middle-class gender relations and gender ideology. In this manner, dentists embedded expectations about white middle-class manhood, and gender more broadly, into the very structure of their profession.

Chapter 4

Enforcing the Dental Ideal

It is one thing to outline an ideal image of dentists and dentistry, but it is quite a different, more difficult, task to enforce that definition. At the same time that dental leaders defined dentists' ideal characteristics, roles, and relations, they also organized professional education and discipline to turn this ideal into a reality. Dental leaders set matriculation standards so that the 'quality of men' entering the profession would be raised. They also structured education to ensure that practitioners, no matter what their background, would behave like professional gentlemen once they graduated and attained a dental licence. Additionally, dental leaders monitored the behaviour of practising dentists to ensure that it was both ethical and gentlemanly. In these activities, dentists joined medical doctors, lawyers, and other professional men during the period who tried to raise the status of their profession through selective recruitment and tougher professional discipline (Howell 1984, 1992; Gidney and Millar 1994). In so doing they continued to define professional work as work for middle-class gentlemen. Dental Education Professional leaders attached a great deal of importance to the establishment of a dental school. The believed such a school would grant them more control over both who entered the profession and how nascent dentists would be educated and socialized into the profession. Here, Ontario dental leaders had an advantage over their confreres in the United States. Dental legislation in Ontario had granted the profession the right to establish and run its own school. While it was not clear that this right was an exclusive one, it was treated as such by the dental

Enforcing the Dental Ideal 57 board. Thus, whereas the United States was characterized by a proliferation of privately owned, for-profit dental schools, the dental profession in Ontario, in establishing its own school, sought to establish the only port of entry into dental practice in that province. Through their own dental school, dental leaders hoped to ensure that all future dentists would better approximate the gentlemanly ideal. After a few false starts, the board of the Royal College of Dental Surgeons (RCDS), at the urging of the Ontario Dental Association (ODA), established a dental school in Toronto in the fall of 1875. It was generally referred to as 'the dental school,' but also came to be known as 'the Royal College of Dental Surgeons,' bearing the name of the professional body.1 By establishing the school, it was hoped that dental education in the province would become more systematic and uniform. Dental leaders had been unhappy with dental education as it stood before 1875. Apparently, the licensing exam set by the RCDS board and the system of indentureship then in place were not doing enough to raise the standard of men in the profession (Sparks 1897; Gullett 1971). Some dentists selected dental students of only the highest calibre and trained them thoroughly to be gentlemen as well as dentists. Many others were not so discriminating: they tended to take on more students than they could properly train in order to receive the extra income and labour that students brought (Gullett 1971; Trotter 1868). This, the profession believed, led to a proliferation of unethical dentists, who were improperly trained in both dental technique and gentlemanly behaviour. With the establishment of a dental school, matriculation standards could become more uniform and, dental leaders believed, more easily raised so that a better class of students entered the profession. Moreover, through a dental school, students would be guaranteed to learn about both dental science and appropriate practice behaviour. While students would still be expected to indenture with an established dentist, the school could provide an extra control over who could become a dentist and how dentistry would be practised. Dental leaders also believed that establishing post-secondary education for incoming dentists would increase the profession's status in the eyes of the public. Overall, professional leaders believed that a school was the most important element in establishing dentistry as a learned profession (Gullett 1971; Shosenberg 1992; Beers 1868b). Although the RCDS board was eager for the status and improved standards that a dental school might bring, it was hesitant to bear the costs

58 A Dentist and a Gentleman of a school, especially after the previous failed attempts. Members distanced themselves from the project at first, giving two dentists, J.B. Willmott and Luke Teskey, four hundred dollars to establish and run a school and bear full responsibility for it (Gullett 1971; Shosenberg 1992). Thus, although the school was formally under the control of the RCDS board, it had little involvement in day-to-day operations. During its first year the school was considered quite a success. It had eleven students and did not create a large debt. In the following years attendance grew. Eventually there were enough students that the school began to be a money-making enterprise. At this time the profession became very suspicious of Willmott and Teskey. It was one thing for them to run the school when it was barely getting by, but now that it was successful, people feared the pair would grow greedy and rich. In 1893 operation of the school was taken over by the board of directors, although Willmott remained dean. In the hands of the board, the school continued to succeed both financially and academically. The board ran the school until 1925, when it finally convinced the University of Toronto to take it over.2 Education at the dental school had a scientific emphasis and included courses in chemistry, physiology, anatomy, and 'materia medica' (Shosenberg 1992; Gullett 1971). Science was seen as important not only to the practical side of practising dentistry, but also to improving dentists' status. It was believed that if dentistry were scientific, it could not help but be respectable (Beers 1870b: 41). Students also took courses in more dentistry-oriented subjects, learning both the operative and the more mechanical side of nineteenth-century dental practice. Before being accepted at the school, students had to sign an 'indentureship' agreement with an established dentist. Dental education at this time combined a two- to three-year period spent in an indentureship with completion of courses at a dental school. Time spent in both indentureship and school was lengthened over the period, such that by the end of the nineteenth century, dental education took four years, during which three years were spent in dental college, and the time in between college sessions was spent in indentures. As of 1902 students had to attend the school for four years of seven-month terms, with the interim spent with a preceptor. Thus, by the turn of the century dental education was a lengthy process. Dental leaders wanted to set high education standards to ensure that only the best, most-educated, and welltrained men entered the Ontario dental profession. Initially the dental board required incoming dentists to have completed a program at any dental college: the RCDS was then the only one

Enforcing the Dental Ideal 59 in Canada, but there were many in the United States. However, by the late nineteenth century, the board had instituted a rule whereby all Ontario dentists had to attend the Toronto school before being licensed. Thus, American-trained dentists could gain a licence to practise in the province only after matriculating in and attending the Ontario dental college for at least one term, and writing the RCDS board's licensing exams. This rule was intended to keep 'unfit' men from getting into the profession by attending schools in the United States, whose standards of matriculation and education tended to be lower (Webster 1903c). Because the board set the matriculation standards of the school and influenced the school's curriculum, it had substantial control over the education and qualifications of those entering the profession. Matriculation standards were raised frequently in the years following the establishment of the dental school. Between 1872 and 1878 the RCDS board gave a matriculation exam to weed out unacceptable students (Willmott 1896). After 1878 provincial education department certificates were required. Prospective students were required to have taken a variety of science courses and Latin. Making Latin a compulsory subject for entrance into dentistry had the desired effect of reducing the number of students. Dental leaders believed that students who had Latin in addition to science courses were of a higher calibre and were more gentlemanly than those who did not (Shosenberg 1992). Students who graduated from the dental school and passed their final exams - set by the dental board - were granted their dental licence or LDS: they became licensed dental surgeons. Through the licensing exams, dentists further tried to ensure that only the most capable, gentlemanly men entered the profession. While in the first few years of the RCDS board's existence the licensing exams seem to have been easy, they got progressively more difficult as the years went on (Willmott 1879; Chittenden 1871). Later on, many who tried the exams failed them. For instance, of the forty-nine men taking the exams in 1876-8, thirty-one passed and eighteen failed. Those who failed were allowed to repeat the exams at a later date, and some passed the second time around ('Canadian' 1879). Dentists felt that through these difficult exams they could ensure that only the best students entered the profession. The dental board was eager to improve the status of the profession by conferring the degree of Doctor of Dental Surgery (DDS) on dental graduates. However, while in the United States privately owned schools could grant doctorates, in Canada only universities had that right. The

60 A Dentist and a Gentleman board, therefore, attempted to follow the lead of the Ontario medical profession and form an affiliation between its school and various Ontario universities (Gullett 1971; Shosenberg 1992). At this time universities were not interested in establishing a dentistry department. It was not until 1888 that the RODS succeeded in gaining affiliation with the University of Toronto and, thereby, the doctorate degree for dentists in Ontario. Students wishing to attain the DDS degree had to take an additional examination, for an additional fee. Many dentists did not take this extra step. At the turn of the twentieth century, the exams were merged, and all graduating dentists attained both the LDS and the DDS degree at the same time. The establishment of the dental school was an important moment in the professionalization of dentistry in Ontario. The school not only helped ensure that future dentists were gentlemen, but it also provided a uniform education for all Ontario dentists with an emphasis on science and appropriate practice behaviour. It provided a medium through which all incoming dentists could be indoctrinated with the dental leaders' prescriptions concerning the ideal behaviour of dentists. A professionally owned and run dental school provided Ontario dentists with the ability to standardize the production of professional dentists and thereby improve dentistry's bid for professional status (see Larson 1977). In the final decade of the nineteenth century dentists became even more concerned with education issues. Overcrowding in the profession, the prevalence of quack practice, and low fees convinced many that dental education needed to be reformed. 'Ethical' dentists reasoned that, since quackery was so widespread, clearly current education and matriculation standards were not entirely successful in restricting entrance into the profession and ensuring all dentists were gentlemen. Something needed to be done. For a number of dentists the solution was a complete moratorium on the acceptance of new dental students or at least more restricted entry into the dental school (Rowlitt 1896; 'Ontario' 1896; Beers 1895d). Some felt that professional overcrowding could only be reduced if absolutely no new dentists were produced for five to ten years (Beers 1895c). Others argued that if only a few gentlemanly students of the highest quality were allowed in the school, then overcrowding and the problems that accompanied it would diminish (Beers 1895d, 1896b; Bazin 1895: 251; Correspondent 1896). However, dental leaders knew that they could not afford to be too restrictive in their admission of students. The

Enforcing the Dental Ideal 61 public was already suspicious of professional privileges at this time and would not tolerate severe restrictions. Dentists feared that they might end up losing all the privileges they had heretofore gained ('No More LDS' 1895). Although dentists had tried to set relatively high matriculation standards for incoming students, they had not made a concerted effort to restrict their entrance. The dental college seems to have accepted all students who presented themselves, paid their fees, and met the matriculation requirements. The number attending the college rose steadily, except for temporary declines when matriculation standards were raised. In the mid-1890s students at the dental college numbered about 150 (RCDS 1896). This number was considered to be too high by dentists worried about overcrowding and quackery in the profession. With such high numbers, it was believed, ethical dentists would be driven to advertise and lower their fees in order to survive. For many dental practitioners, large dental classes also indicated that matriculation standards were not high enough. The extent of dental quackery was taken as evidence that the profession was still not selective enough in its recruitment of young men. The only solution, many argued, was to raise matriculation requirements and improve the quality of dental education (Senex 1894). Rather than severely restricting the number of student dentists, professional leaders sought to discourage interest in dentistry by increasing matriculation standards. At the same time it was believed that these higher standards would help to ensure that future dentists acted like gentlemen. If standards were sufficiently high, then surely quack practice, overcrowding, excessive competition, and unethical behaviour in the profession would be eliminated (Lyon 1897; LDS 1894a). High matriculation standards were not intended to limit access into the profession to only the most intelligent men, but rather to recruit only men from the best social backgrounds (Beers 1894b: 114). It was acknowledged that such discrimination might exclude some good practitioners. However, it was said that educators were not philanthropists, and therefore they should not be concerned if some able but less fortunate men were excluded (Beers 1894b). Professional progress depended more on the status and gentlemanly behaviour of practitioners than on their intelligence or ability (LDS 1894a). Medical men had reached the same conclusion (Howell 1981; Starr 1982; Moldow 1987). If a man managed to -transcend his class background through the attainment of a good education, then, and only then, would he be welcome in the profession

62 A Dentist and a Gentleman (LDS 1894a). As studies of the history of medicine indicate, race and gender backgrounds could not be transcended, and thus, they tended to be more substantial barriers (Moldow 1987; Starr 1982; Larson 1977). Education was seen as the mechanism through which professionalizing dentists could exclude men from a lower-class background - those who were not gentlemen - from their profession. Given the extent of dentists' concern over the status of men in their profession, it would seem that many dental practitioners during the first decades of the profession were not from middle-class backgrounds. Indeed, there is little information on the backgrounds of rank-and-file practitioners. Information on dentists' backgrounds during this period is sporadic at best, and the few records that do exist tend to focus on those men who were more active in the profession - men whom I refer to as professional leaders or professionalizing dentists. The records indicate that, like the earliest dentists mentioned in Chapter 2, these men were primarily from rural and/or lower-middle-class backgrounds. When obituaries mention dentists' fathers, these are frequently teachers, preachers, or farmers.3 Later, more and more dentists came from dental or medical families. Many had children who went on to be medical doctors, and some sons of medical doctors went on to become dentists. Thus, more dentists in this period than in the earlier period came from professional backgrounds. Whatever the background of rank-andfile practitioners (whether similar to or below that of professionalizing dentists), professional leaders felt that they were not educated enough. More educated men were needed in dentistry, so that respectable men, who shared leaders' values and goals, predominated in the profession. In 1896 the matriculation standards of the dental school were raised to a level that members of the profession considered respectably high. Applicants to the dental school had to have passed the matriculation exams of the University of Toronto or the provincial educational department exams with a Latin option (University of Toronto Calendar 1934); knowledge of sciences and mathematics was required, as well as knowledge of the English language and literature. It was felt that with the implementation of this high standard the number of men entering dentistry would be reduced, as would the incidence of quackery. It was also hoped that these standards would ensure that dentists in the future would be respected. These requirements were similar to those required by the medical profession at the time (MacNab 1970). After the turn of the twentieth century these standards were raised even higher. Students at the RCDS school had to pass the arts matricula-

Enforcing the Dental Ideal

63

tion examination of a Canadian university, or they had to hold a junior or senior high school leaving certificate (Pearson 1903b). The lowest standard, the junior high school leaving certificate, required courses in English grammar, composition, literature, and rhetoric, as well as arithmetic, algebra, physics, Latin, and other languages or sciences (Pearson 1903b: 305; Webster 1903c). The dental school kept its matriculation requirements in line with those of the University of Toronto, with which it was loosely affiliated, and with medical education in the province.4 High standards in the examinations given at the dental school were another, less discussed, way to ensure that dentists were respectable, educated men. The exams were a final mechanism through which dentists could prevent 'unfit' men from entering the profession. Students were examined on their knowledge of dental subjects, as well as on their ability to practise. It was common for some students at the school to fail their exams. They were allowed to retake the exams, and many passed the second time around, but a few failed outright. It was argued by some professionalizing dentists, however, that the dental school was not strict enough in its requirements and that not enough students failed (McElhinney 1894). The school's standards allowed some men who had behaved in ways deemed unethical while at the dental college to graduate and enter the profession nevertheless (ibid.: 214-15). Some dentists believed that more should be done at the school to keep such men out of the profession. Even higher standards of education were required. While a great many Ontario dentists were eager to raise the education standards of the profession, there were also many who were opposed. These dentists did not see respectability and high status as a goal, nor did they believe that education made better dentists. The thoughts of one such dentist were revealed in a letter to the dental journal (quoted in part in Chapter 3): I am not a subscriber to the Journal, and I don't mean to be, and I'll give you my reasons: You take too high a stand to start with, as the profession is new in Canada, and the dentists cannot afford to starve for the sake of keeping up appearances, societies and journals. I never asked anybody for ideas, and I don't give any. I do not trouble anyone. If you choose to crack up education, I will not quarrel with you. Only I have so far satisfied a good majority of the people of [sic] for more than twenty-eight years or more, and I think my work will speak for itself. I would not have ninetynine out of every one hundred of your 'educated' young men in my office. They think they know so much; you discover they know very little, though

64 A Dentist and a Gentleman they can talk theory to you, and have more brag and gas than real ability ... But I say we don't want 'highly-educated' men. We want good mechanics, who can work in their shirt sleeves, and who aren't particular about all the fine nonsense of antiseptics, bacteria etc. What the mischief does it all mean? Am I a fool, or are you? ('Kicker' 1890: 185)

The writer of this letter calls into question the connection between education and ability. Education may create better gentlemen, but it does not necessarily create better dentists. It was acknowledged by some leading dentists that indeed education may not produce dentists with greater skill (Johnson 1891; Beers 1900b). Dental school graduates may have had more theoretical knowledge than practical knowledge; however, dental leaders did not see this as a problem (Johnson 1891; Beers 1893). Men who could 'work in their shirt sleeves' belonged with tradesmen, not with professional dentists (Johnson 1891). Education would help ensure a better class of gentlemen in dentistry, and this was dental leaders' primary goal. To professionalizing dentists this letter merely served to confirm that they were right proclaiming the importance of a high standard of education. The 'ignorance' and 'bad grammar' displayed by this dentist were exactly what they were trying to banish from the profession through their high standards. Because there were such men in the profession trying to 'drag dentistry into the dust,' dentists had to work that much harder to raise its status to a respectable level (Johnson 1891: 9; Beers 1890b). There were many dentists who did not meet the ideal established by professionalizing dentists. Nevertheless, their presence, far from deterring these dentists from their mission, served to encourage them to try harder to distance themselves, socially and professionally, from those men who regarded dentistry as a trade and not a highstatus, learned profession. Through education, dental leaders hoped to ensure that future dentists would share their vision of dentistry as a profession. At the same time that they endeavoured to increase matriculation standards, dental leaders worked to reform another aspect of dental education: the indenture requirement. During the 1890s dental leaders became concerned that indentures were not doing enough to ensure that all incoming dentists were gentlemen. To start with, there was too much variability in individual dentists' standards for accepting students. Some dentists were very selective and only took one or two students at a time so that they could train them carefully. Others accepted almost any

Enforcing the Dental Ideal 65 student and took on as many as five or six at a time as a source of income and cheap labour (G.S. Martin 1898; Sparks 1897; McElhinney 1899). In 1896 the RCDS board tried to curtail this latter practice by limiting the number of students a dentist could accept to two (RCDS 1897). However, this limit did nothing to determine the quality of students accepted by dentists or the quality of education that students received under their preceptors. To improve the practical training aspect of dental education, dentists began to outline exactly what was expected in the preceptor-student relationship. Professional leaders advised that if the status of dentistry was to be raised, dentists must accept only the best men as students, and they should give these students the best education possible (Sparks 1897; McElhinney 1899; Husband 1898). Preceptors were advised to inspect the students who presented themselves to ascertain whether they possessed the qualities that were demanded of a dentist (Sparks 1897; McElhinney 1899). If they did not, dentists were to turn them away. Not surprisingly, among the characteristics emphasized was 'gentlemanliness.' The ideal student was expected to be a gentleman who was eager to learn, was moral, and possessed some mechanical ability (Sparks 1897: 91; Husband 1898). Dental leaders further asserted that once he accepted a student, a dentist was responsible for ensuring that this young man became a wellrounded, educated, cultivated gentleman, as well as a proficient dentist (Sparks 1897). In addition to teaching a student how to practise ethically, the dental preceptor was expected to make sure that he attended to his studies and was a well-rounded gentleman both physically and socially (ibid.; Lyon 1897). A student was to have plenty of time for lawn tennis and other exercise (Sparks 1897: 92). Moreover, the preceptor was supposed to have 'fatherly oversight of his [the student's] social life' and ensure that he was 'introduced into respectable society, such as would be elevating socially and religiously' (ibid.). Professionalizing dentists argued that if preceptors behaved in this manner towards their students, future dentists would assuredly be well-respected gentlemen. In reality preceptors and dental students behaved in a manner far from ideal. While students were expected to be deferential, eager to learn, and willing to do anything for their preceptor, they often were not ('Antiquity' 1891). Dentists complained of students wrecking their tools and equipment and being lazy in their duties (which were frequently mundane) (ibid.; 'Antiquary' 1891; LDS 1894a; Beers 1893c). Students were often unwilling to do many of the odd jobs that their pre-

66 A Dentist and a Gentleman ceptors asked of them ('Antiquity' 1891). Moreover, dentists complained that their students did not treat them with sufficient respect and deference. They tended to regard themselves as educated college gentlemen who knew more than and/or were superior to, their preceptors - many of whom would not have attended college (ibid.; 'Kicker' 1890; Beers 1895a). Among educated students and rank-and-file dental practitioners there seem to have been conflicting definitions of manhood. Dental students prized education and youth, and therefore, they felt superior to those rank-and-file, older dentists who had less education. Older dentists, acting as preceptors, tended to emphasize the mechanical skills in dentistry as being more important than education and as central to their notions of manhood (Antiquity 1890). Problems with students, combined with heavy professional commitments, prompted many of the 'most ethical' and most prominent dentists not to take students at all (G.S. Martin 1898). Hence, those dentists who most approximated the 'ideal' tended not to become preceptors, although they often were heavily involved in the dental school. Professionalizing dentists were disturbed that students were sometimes indentured to preceptors who engaged in bad practices like advertising and whose offices were not entirely clean (ibid.; Sparks 1897). It was feared that despite the influence of the dental school, students would learn unethical practice methods from their preceptors and would likely become unethical dentists themselves. Problems with the preceptor-student relationship led to calls for abandonment of, or change to, the indenture requirement (G.S. Martin 1898). At this time, however, dentists still believed that indentures were a key ingredient in the making of an ideal dentist. In summary, education was a principal means through which dental leaders, like other professional leaders, sought to ensure that all practitioners were gentlemen. The establishment of a dental school, high matriculation standards, and more clearly defined relations between students and preceptors were seen as essential both to ensuring that recruits to dentistry increasingly behaved like gentlemen dentists and to raising the status of the profession in the eyes of the public. Matriculation standards and educational requirements5 were the principal way through which Ontario dentists attempted to ensure that members of the profession conformed to their image of the ideal dentist. Nevertheless, education standards in themselves were not enough to enforce that ideal. They were intended to encourage the entrance of gentlemen into

Enforcing the Dental Ideal 67 the profession, but they did nothing to affect the behaviour of practising dentists. Disciplining Professional Dentists

To further ensure that all professional dentists conducted themselves as gentlemen, the RCDS board attempted to enforce those sections of the Dental Act that forbid practice by unlicensed dentists, as well as behaviour harmful to the profession. With mixed success, the board tried to rid the province of illegal dental practitioners by prosecuting them in court. At the same time the board also endeavoured to pressure licensed practitioners to practise dentistry in a manner deemed ethical, also with mixed results. As noted, in the final decades of the nineteenth century the public was not sympathetic to professions' claims to monopoly and privilege. As a result, dentists did not gain a lot of support from the public or from magistrates when attempting to discipline errant dentists. After the turn of the twentieth century, however, dentists began to have greater success in enforcing the Dental Act.6 Illegal Practitioners

Following the passage of the Dental Act, the RCDS board attempted to prosecute those dentists practising without a licence. To locate illegal practitioners it frequently relied on licensed dentists' reports about the illegal dentists in their regions. Often it required these licensed dentists to prosecute the unlicensed themselves. The RCDS board sometimes covered the costs if they were not too high. Not surprisingly, this method did little to stop unlicensed practice, as few dentists were willing to undertake the cost and aggravation of prosecution. In 1876 the board hired a detective to prosecute offenders on its behalf (Willmott 1879). In addition to prosecuting dentists without licences, this detective visited dentists who were in practice for less than five years in 1868 and who had not yet attained a licence, to convince them to do so. Apparently, some of these latter men chose to leave the country (to the pleasure of the dental board), while some others actually came forward to be examined (ibid.). Attempts to prosecute illegal practitioners in all professions, in the late nineteenth century, were rarely successful (Gidney and Millar 1994). Although the RCDS board took a number of violators to court, it rarely succeeded in getting a conviction. Patients who patronized an

68 A Dentist and a Gentleman unlicensed dentist often proved unwilling to give testimony against him, especially in smaller towns (RGBS 1914). Moreover, some judges seem to have been reluctant to convict an illegal dental practitioner. The Dental Act defined illegal practice as that conducted for 'hire, gain or hope of reward.' If it could not be proven that dentists accepted money for their work, they were acquitted. For instance, one unlicensed dentist swore in court that he practised 'for love, not money' and therefore was acquitted (RCDS 1896: 13). Another illegal practitioner was a woman who despite many complaints could not be convicted because it was argued that she worked for her father, a licensed dentist, and therefore took no money for the dental work she did (RCDS 1894, 1900). There were also cases where the board believed it had proven its case only to have the magistrate find in favour of the defendant. Public and judicial opinion was not often on the dentists' side. Even if it was successful in gaining a conviction against an illegal practitioner, the board had difficulty collecting the twenty-dollar fine. Frequently, the illegal dentist either skipped town or suddenly declared bankruptcy before he could pay. Collected fines rarely covered the cost of prosecution. Despite these problems the board managed to prosecute and halt the illegal practice of some illegal practitioners. Nevertheless, these problems continued into the late nineteenth century and beyond. Clearly, some dentists managed to practise dentistry without a licence, regardless of the Dental Act. By the end of the nineteenth century, the board had only been moderately successful in ensuring that all dentists were licensed and gentlemanly. Because prosecuting illegal practitioners proved to be an expensive venture for the board, it began to prosecute fewer offenders. Instead, board members began to write letters asking offenders to cease and desist. They hoped that if unlicensed practitioners were asked to stop practising they would, and perhaps some did. A number of cases were settled out of court, saving both parties the cost of a trial. Many blatant cases, however, where there seemed to be a good chance for conviction, were still prosecuted. After the turn of the century the board also faced problems from a new type of unlicensed practitioner: dentists who had been trained and, in many cases, formally educated in dentistry, but could not attain a dental licence because they could not meet the board's high matriculation standards or other requirements of the dental school. These dentists caused many problems for the RCDS, as they attempted to circumvent the profession's requirements and practise dentistry regard-

Enforcing the Dental Ideal 69 less of the regulations. The board became particularly concerned with illegal practice by dental students practising dentistry before graduation, American-trained dentists who practised in Ontario without meeting the board's conditions, and dental assistants who performed dental operations. The board expended great effort to thwart these violators of the Dental Act. Dental students who attempted to practise dentistry before they graduated were variously dealt with. Typically, they were merely warned not to do it again, and in some cases were penalized by having to get a new preceptor or by having their licence withheld for a period of time after graduation (RCDS 1895, 1897). Oddly, in a profession that claimed to prize honesty and ethical behaviour, the students were rarely expelled from the school. Having met the education requirements established by the dental board, dental students were more easily forgiven than were other illegal practitioners. Medical men had a similar problem in the 1890s with medical students practising illegally before graduation, and they tended, like dentists, to treat them somewhat lightly (MacNab 1970). Viewing these students as future respectable professional colleagues, professional leaders wanted to make them stop their illegal practice, without going as far as to prosecute them. The board tended to be quite strict in its policy that practitioners had to meet its education requirements. This strictness is evident in the board's response to American-trained dentists and illegal dental assistants. As noted, professionalizing dentists were quite willing to exclude some very able practitioners from their midst, in their quest to ensure that all dentists were highly educated and, by extension, gentlemanly. Therefore, the board consistently refused to grant dental licences to some Ontario residents who had attained DDS degrees in the United States and who, in many cases, had practised in the United States for a number of years. Although a man might hold a doctorate degree, if he did not have a high school education and knowledge of Latin - thereby meeting the RCDS matriculation requirements - he was not eligible for a dental licence in the province of Ontario. Further, even if a dentist did meet the matriculation requirements, he could not practise in the province unless he attended the final year at the dental school and/or passed the final exams at the dental college. This policy led to many conflicts between the RCDS board and a number of American-trained dentists who desired to practise in Ontario.7 Some of them actually tried to write the final exams at the dental school and failed. These dentists, along with others who lacked the requisite

70 A Dentist and a Gentleman matriculation, searched for other ways to make a living through dentistry. Typically, they either set up practice on their own or were employed by another dentist as a dental assistant who performed dental operations. Both strategies violated the Dental Act. It was also common for these illegal practitioners to try to gain access into the profession through a petition to the Ontario legislature. Dentists who had trained in the United States were not the only men practising dentistry illegally as dental assistants. A number of dental assistants were taught to perform dental operations by the licensed dentists who employed them. With these trained assistants, dentists could serve twice as many patients, and they could stay away from the office, visiting the countryside or doing other work, while their assistants maintained their office practice. The RCDS board was very much opposed to this type of practice and both warned and prosecuted dentists who allowed their assistants to become illegal practitioners. Sometimes these assistants decided to become independent dentists themselves. Lacking the prerequisite education, they petitioned the legislature for a private bill. Dentists were especially warned against having men as dental assistants because it was believed that men were more likely to overstep their bounds and try to practise dentistry illegally (Webster 1908a). In the late nineteenth and early twentieth centuries, private bills were largely pursued by illegal practitioners who desired a dental licence but did not meet the requirements established by the profession. Americantrained dentists and former dental assistants who had learned to perform dental operations were the two most likely groups of illegal practitioners to petition the provincial parliament for a private bill that would grant them a dental licence, despite their failure to live up to the dental board's standards. Although the RCDS board fought these petitions vehemently, the legislature granted some illegal practitioners dental licences. Successful applicants managed to convince the private bills committee that, despite the board's objections, they were competent practitioners who deserved a licence to practise dentistry (Webster 1907c). The legislature's willingness to override the dental profession and legislate dentists on more than one occasion is indicative of how tenuous dentistry's claim to professional status and privilege was at the turn of the century. While the dental board claimed the right to determine who could be a dentist, the Ontario government sometimes overruled them, thereby usurping their professional authority. As the century wore on, however, the RCDS board became more successful in fighting private bills. At first, it merely succeeded in placing

Enforcing the Dental Ideal 71 conditions on the bills: limiting a dentist's licence to a given county, a specified time period, and/or requiring that the dentist take an exam before a permanent licence was granted. Increasingly, the board succeeded in stopping the bills altogether. In the second decade of the twentieth century, the board had achieved such success in opposing the petitions that they became rarer and then stopped. Dentists' experiences in limiting and then preventing private bills mirror those of other professions (MacNab 1970). The dental profession, and especially the RODS board, disdained private bills for a number of reasons. First, the board believed that its education standards were necessary to the proper practice of dentistry and to the elevation of the profession. In its eyes, no one lacking such education could enter the profession without hurting the profession, and potentially, the public (Webster 1903b). Second, men who lacked such education and who had practised dentistry illegally did not conform to the ideal of the educated, honest gentleman dentist stressed by professional leaders. Finally, in overriding the RCDS board and granting these men a dental licence, the legislature undermined the board's authority. Dentists believed that the legislature's actions revealed a lack of respect for dentistry and the RCDS board's efforts to govern the profession and protect the public (Webster 1905a, 1907a). The board felt perfectly justified in refusing licences to dentists who did not meet its standards, even if the applicants seemed competent. Illegal practice and private bills were not the only alternate route into dentistry for those who lacked the requisite education. A few men fraudulently obtained a matriculation certificate: some had others write their matriculation exams for them, while others claimed to have what they did not. These students created a dilemma for board members. Lies about their matriculation were not discovered until they were well advanced in their studies and, often, on the verge of graduating. Thus, the board was faced with men who did not have the educational background deemed 'necessary' for dental education and an ethical dental career, yet these men had proceeded through school successfully and were almost fully trained dentists. Students who lied about their matriculation were variously dealt with by the board; however, typically they were dealt with harshly. The students had lied and cheated and, therefore, were not the honest educated young gentlemen that dental leaders desired in the profession. As punishment a student might be forbidden to graduate or be licensed. In one case, even after repeated apologies, and efforts to improve his circumstances, the board decided not to

72 A Dentist and a Gentleman grant a dental graduate a licence (RGBS 1900). The board was adamant that those who did not meet its education requirements (or its honesty ideals) were not eligible to join the profession, regardless of skill or training. By the end of the First World War dentists had very few problems with illegal practitioners. They had managed to curtail unlicensed practice and the passage of private bills. Increasingly the legislature, the judicial system, and to some extent, public support were on their side. Perhaps more importantly, by the First World War there was little attempt to enter the profession illegally, and less illegal practice. The board had further ameliorated its own problems by making some concessions to American-trained dentists: allowing them to practise in Ontario if they had practised in the United States for a number of years and passed an exam; matriculation was no longer a necessity for these dentists. Thus, by about 1918 the RGBS board had virtually complete control over entrance into the profession, and over the content and nature of the education that dental students received, and was better able to ensure that dentists came closer to the gentlemanly ideal. Monitoring Behaviour

The dental board further tried to encourage gentlemanly behaviour by dentists through the clause in the Dental Act granting the board the right to rescind the licences of people who 'acted in a manner detrimental to the profession' (Bental Act 1868). At first the board was very reluctant to use its power in this area or at least reluctant to test its power. In 1871 the board cancelled the licence of a Hamilton dentist who was a 'notorious advertiser' and, thereby, degrading to the profession; however, on legal advice they decided to return the licence (Gullett 1971). Even though the board felt it technically had the authority to rescind licences, it was believed that such an action would not be accepted in a court of law or by the public at large (RGBS 1907). Bentists felt they lacked the social legitimacy to exercise the power technically granted them by law. Nevertheless, after the turn of the century, the RGBS board decided to attempt to discipline its members. The board decided that if it did not have the legislative power and authority to do so, it should change the Bental Act to ensure that it did (Webster 1907c). Thus, between 1900 and 1917, the RGBS became more assiduous in policing the behaviour of its members and in trying to coerce them to behave in a manner befitting respectable gentlemen dentists.

Enforcing the Dental Ideal 73 These efforts were intended both to protect the public and to 'elevate Dentistry to a higher ethical plane' (Burt and Willmott 1907: 471). There were several types of 'unethical' behaviour that particularly disturbed dental leaders. Before and after the turn of the century sensational advertising was considered quackery and 'the bane of the professio^.' Dentists who allowed their assistants to perform dental operations raised the ire of dental leaders, as did the employment of licensed dentists by laymen in dental companies. It was deemed intolerable that licensed dentists would work for laymen. In the eyes of board members, men could not run a dental company without in some way interfering with diagnosing dental disease or other aspects of dental practice. Men who employed dentists were considered to be guilty of illegal dental practice (Webster 1907c). Dental companies were disdained for their inability to allow dentists to practise like gentlemen: these dentists were not in a position of authority, but were subordinate to their employers, and they would have to put their employers' profit needs above the needs of the patient (ibid.: 468; Reade 1909a). The dental board tried to stop dental companies and the employment of dentists by non-dentists. Students of the medical profession will recognize that the latter profession fought very similar issues during this period (Starr 1982; Gidney and Millar 1994). To test and delimit their disciplining powers, the RODS board took a Toronto dental company to court (RODS 1907; Reade 1909c). The case enabled the board to create new bylaws and strengthen its powers and ultimately to change the Dental Act to increase the board's power to discipline its members (Reade 1909c; Webster 1909a: 34; Seccombe 191 Ic). Between 1903 and 1907 it was clarified that the board had the power to suspend or cancel a dentist's licence for employing unlicensed assistants, lying about a student's indenture, and advertising unprofessionally (Willmott 1904b: 643; Webster 1907c; Reade 1909c). In 1907 the dental board formed a discipline committee for the purposes of disciplining professional members and to oversee prosecutions of those who violated the Dental Act. Through the actions of this committee the RCDS board was able to stop dental company practice in Toronto and to discipline erring professional members more effectively (Reade 1909c). The committee also worked to discipline dentists who advertised profusely and who employed unlicensed assistants illegally. These 'unethical' dentists were warned by the board to stop their unethical behaviour. Implicit or explicit in this warning was the threat that if a given practitioner did not alter his behaviour he could be prosecuted or have his

74 A Dentist and a Gentleman licence suspended. This threat seems to have been an idle one. The board does not seem to have ever removed a dentist's licence during this period. There was one instance of a dentist who was convicted of manslaughter for helping to procure an abortion. This dentist did have his license rescinded (RGBS 1898). After serving two years in prison, he returned to his home town and began practising dentistry again, without a licence. The board warned him that he was practising illegally and asked him to stop. This dentist did not cease his practice and, instead, petitioned the board to have his licence returned to him. The board acceded. Board members reasoned that since the sentence of this dentist was commuted from three years to two, and respectable people requested he get his licence back, that he perhaps was not that guilty after all (RGBS Proceedings 1900). In effect, it seems that this dentist was going to practise with or without a licence, and the board decided it was easier to make him a legal dentist again. The support of respectable people for the dentist in question, combined with the board's lack of confidence in its ability to successfully rescind a licence, resulted in its granting a licence to someone whose gentlemanly status was in doubt. The board's main disciplinary measures involved writing letters to practitioners who advertised profusely or employed illegal assistants, asking them to mend their ways.8 After receiving such a letter, most practitioners promised to stop their behaviour, and it seems that many did, as there is no further complaint of their behaviour recorded by the RGBS board (Willmott 1904b; RGBS 1904, 1909). Those practitioners who did not desist in their unethical behaviour were called before the discipline committee. The purpose of this meeting, according to the board, was to confront the wrongdoer and get him to promise to cease his unethical activity (RGBS 1909; Reade 1909d). The board was always successful in extracting this promise. However, many dentists persisted in their unethical behaviour. Some dentists who used illegal assistants were warned incessantly and were even taken to court. Yet, the behaviour of these unethical dentists did not change, no matter how many 'promises' of good behaviour the board elicited. Members of the discipline committee never seem to have taken the matter further. Their only action was to continue requesting that these dentists mend their ways. Although it was suggested at a board meeting that one repeat offender finally have his licence removed, the board decided to defer action in this matter (indefinitely) (RGBS Proceedings 1914).9 Peer

Enforcing the Dental Ideal 75 pressure was the principal method by which the RCDS board tried to shape and regulate the behaviour of Ontario dentists. Although the board was not terribly strict in its disciplinary actions, it seems to have had some success in altering the behaviour of licensed dentists (McLaughlin 1912a). Many erring dentists responded well to peer pressure. When asked not to advertise, or to refrain from using illegal assistants, they did. Moreover, the discipline committee was successful in stopping those outside the profession from hiring dentists to work for them. Thus, in the period between 1900 and 1920 the RCDS board had greater success in regulating the behaviour of licensed dentists and ensuring that unacceptable behaviour was quashed. However, the board's reluctance to rescind the licences of unethical practitioners could be taken as evidence that they still believed they lacked the authority, or public acceptance, to enforce their bylaws completely. Discussion Dentists defined dentistry as work for middle-class white gentlemen, and organized professional education and disciplined professional members to enforce that definition. They hoped to recruit gentlemen selectively into the profession and to encourage all dentists to behave like gentlemen. This process was long and tiresome. At first, dental leaders' attempts to raise matriculation, improve education at the dental college, and discipline professional members seemed to have little effect. Professionalizing dentists had to continually strive to improve their standards, in the hopes that eventually the desired end would be reached. Professional dentists were by no means unique in their efforts. Their actions closely mirrored those of medical and other professionals during the same period. Raising matriculation standards, establishing specialized schools, and disciplining professional members have become defining characteristics of the professionalization process that virtually every profession, or occupation desiring to be a profession, has followed (Larson 1977; Abbott 1988). Significantly, these processes are not only central to creating a profession, they are also key to defining who professionals are and how they behave. They are designed to ensure that professionals are - by background, training, and conduct - middle-class gentlemen.

Chapter 5

Professional Status, Ideology, and Gender: Dentistry, 1900-1918

After the turn of the twentieth century the climate for professions changed substan dally. Public distrust of professional privilege was on the wane. The number of professions and occupations struggling to attain professional status increased dramatically, and many Ontario professions solidified their status and authority. For instance, it was at this time that the medical profession achieved dominance within the health care system (Coburn et al. 1983).] Dentistry's professional boundaries and jurisdiction became more clearly defined. Dentists acquired more public respect and their social influence grew. This chapter provides an overview of these changes and explores the concomitant rise in the social status of dentistry. Dentists' attainment of social legitimacy was the result of a number of factors that encouraged the public to be more responsive to dentistry's claims to status and privilege. In this chapter I place particular emphasis upon dentists' use of social ideologies to legitimate their claims.2 After the turn of the twentieth century dentists continued to draw on middle-class gender ideology and relations to define and portray themselves to the public. At this time, they altered their definition of the ideal dentist and notions of dental masculinity to accommodate and combine with other prevailing social ideologies, notably, popular conceptions of science and notions of professional service. Dentists' efforts to affiliate and associate themselves with the medical profession also seem to have contributed to their rise in status after the turn of the century. While other health care occupations failed to achieve professional status during the period, the professions of dentistry and medicine solidified their status. Dentistry's success in drawing on the ideologies of gender, science, and professional service, combined with its members' gender, class, and race back-

Dentistry, 1900-1918 77 ground, ultimately ensured that by the end of the First World War the profession had largely succeeded in its mission to define itself as a gentleman's profession that was independent, lucrative, and prestigious. Redefining the Ideal in Dentistry In many respects descriptions of the ideal dentist after the turn of the century reiterate the qualities highlighted before then. Articles detailing the characteristics and behaviour that dentists should possess continue to emphasize the importance of education, honesty, and cleanliness, as well as authority and masculinity. Ideal dentists were still middle-class gentlemen. In the dental journals, however, there was a change in tone. Articles published after the turn of the century lost some of the urgency that typified those published in the 1890s. This partly reflects an editorial change in the principal dental journal in 1900, but also the fact that professional leaders believed that their vision of the ideal in dentistry was closer to becoming a reality than ever before. For instance, writers in the dental journal argued that finally a better class of men was being recruited into the profession through the dental school in Toronto. Previously, students had 'beer tastes' and 'could only be entertained in beer company,' but current students enjoyed 'the more refined tastes of wine and brotherhood' (Webster 1903a: 337-8). With a more gentlemanly class of students, dental leaders were confident that their vision of a gentlemanly and prestigious profession would be shortly achieved - as long as the students were given the proper advice and guidance. Many dentists believed that with the rise in the status of dental students, dentistry's social status was becoming more secure. Already the public was coming to respect and trust dentists (Webster 190la: 317; Moyer 1903). Increasingly, dentists were viewed as educated, 'publicminded citizens' whose services were important to the comfort and health of families (Webster 1901a: 317). Moreover, the public had started listening to dentists and occasionally even sought out their knowledge and advice (Moyer 1903). Dental leaders believed that dentistry was finally approaching 'the full stature of [its] professional manhood' (ibid: 204). However, dentists had not yet achieved the measure of respect and authority dental leaders desired. Encouraged by their perceived progress, early twentieth-century dentists continued to define and redefine the ideal dentist and ideal dental practice. Through redefining and reiterating their ideal, they hoped to

78 A Dentist and a Gentleman complete the process of raising their status in the public's eye. Like its earlier incarnations, the twentieth-century conception of the ideal dentist was intended to secure dentists' identity as professionals and middleclass men, while legitimating their legislative privileges and claims to social authority. Dentistry's ideal image had to change somewhat to reflect the changing times. Two new characteristics were added to the dental ideal. Not only were dentists expected to be educated, clean, and honest men, they were also increasingly asserted to be scientific men whose activities were guided by their commitment to professional service. As Canadians joined others in the Western world in respecting science and all things scientific, Ontario dentists more frequently asserted that they were knowledgeable in science and that dentistry itself was a science. Moreover, as notions of professional service gained social currency, particularly as used by members of the medical profession, dentists too incorporated these notions into their professional ideal. Discussions of the professional service ideal in articles and speeches about dentistry are particularly striking because they appear so suddenly. Before the turn of the century dentists rarely mentioned 'service.' Where there was any mention of professional service, it concerned the use of appropriate professional language. Dentists were advised to state that they provided a 'service' to their 'patients' as opposed to providing 'goods' to their 'customers' (Kenneth 1871; Gowan 1903a). However, it was in no way asserted that public service was the primary goal of dentists'. Therefore, it is notable that after the turn of the century many dentists made precisely this argument. They asserted that, through their dental practice and their public education initiatives, they worked selflessly for the benefit of mankind (Clarkson 1905; Simpson 1915). Some argued that serving the public was dentistry's highest and primary aim (Snell 1902; Seccombe 1916b: 110). Dentists held that the service they provided to the public was indispensable. They held in their hands 'the happiness or misery of a large part of the race' (Snell 1902: 408). Dentists likely borrowed the idea of 'professional service' from the medical profession, which they desired to emulate. They claimed that while the medical profession had influence over the domain of life and death, dentistry's sphere was that of beauty and comfort, as well as health (Willmo tt 1901; Seccombe 1916b; Davy 1910). Through their public service dentists could make the public more attractive, healthy, and happy.3 As was typical of prevailing notions of professional service, there was nothing 'servile' about dentists' service provision. The nature of the service dentists' provided to the public was determined by dentists and fol-

Dentistry, 1900-1918 79 lowed their judgments about what the public needed, not what the public requested. Dentists believed that they knew the public's dental health needs better than the public did (Toronto Dental Society 1915). It was their duty to serve the public by telling people what they needed that is, by educating them in dental health and living habits, as well as by treating them. Moreover, while the primary aim of dentists' was said to be serving and helping others, they did not expect to do this for free they expected their services to be remunerated handsomely (Seccombe 1907; Murray 1912). Notions of professional service were important to dentists' professional project. Dental leaders advanced claims to increased social authority upon their assertion that they used this authority to serve and protect the public. Notions of professional service contrast sharply with other prevailing notions of service - those typical of working-class servants and women's traditional caring roles. Dentists' notion of professional service seems distinctly middle class and male. They provided a service by authoritatively guiding others and were paid well for it; they did not exactly 'serve' others. Dentists also drew on science to claim authority over the public. Science became a key part of the image of the ideal dentist in this era: the ideal dentist was scientific in his knowledge and in his outlook (Webster 1904b: 184; Gowan 1910: 198; Murray 1912). While dentists had made some claim to being scientific in the nineteenth century ('B' 1898; Bruce 1895; Kilmer 1894), they placed greater emphasis on science as public respect for science increased. Here, they followed the lead of the medical profession which similarly sought and gained prestige by associating itself with science (Shortt 1983). Dental leaders claimed that dentistry too was a science, closely allied with medical science. Like the medical profession, dentists claimed they were scientific, even at a time when dentistry had made little 'scientific' progress of its own. It was lamented that advances in dentistry were typically mechanical, not scientific (Author unknown 1894; Gullett 1971). Although there was some attempt to create a dental science, dentists tended to claim that medical science formed the basis of their profession, as it did the medical profession (Seccombe 1916b: 109; New York Medical Journal 1908: 213; Webster 1905b). In a sense, dental leaders seemed to have been trying to ride medicine's coat-tails towards public respect and status. As the medical profession and medical science began to increase in status, dentists claimed a close relationship with both. Quite a number of dentists practising in Canada at this time argued that, by rights, they were members of the medical profession (McElhinney 1905, 1909;

80 A Dentist and a Gentleman Reade 1908). They argued that dentists were medical specialists, on the same level as 'oculists and aurists,' and that in the future they would take their rightful place as full-fledged members of that profession (McElhinney 1905; Woodbury 1905b; Reade 1908; Thomson 1901; Webster 1905b). Other dentists, however, argued that dentists were not medical specialists and never would be (Willmott 1901). Even these latter dentists, however, argued that dentistry was closely allied with medicine: dentistry was an 'adjunct' of medicine (Willmott 1901: 163). It was an important part of the healing arts as it covered a territory medicine did not (Willmott 1901; Seccombe 1916b). Although dentists were divided as to how to characterize the ideal relationship between medicine and dentistry, they generally agreed that the two professions were closely related. Through its efforts to associate itself with medical science and the medical profession, dentistry strove to transfer some of the growing public respect for medicine and medical science to itself. In these efforts dentists met with a great deal of success, as in the opening decades of the twentieth century dentistry followed medicine in achieving greater status and prestige. Dentists' new attention to science also entailed a greater concern for running the dental office in a scientific and businesslike fashion. 'Ethical' dentists believed they had the responsibility to themselves and the public to charge fees that were high enough to adequately compensate them for their work (Seccombe 1907; Murray 1912). While dentists had complained about low fees for decades, they now argued that their remuneration levels should be scientifically calculated according to business principals. At this time the popularity of scientific management and trends towards greater rationalization affected professional practice just as they did the business world. Dentists were advised to run their practices efficiently and scientifically (Murray 1912; Webster 1907d; 190; Seccombe 1916b; Johnson 1903; W.C. Trotter 1903). In calculating fees, dentists should consider the time and knowledge that went into doing a given service, as well as the cost of dentists' education and equipment (McElhinney 1911). They were reminded that time was money, and they should both use their time effectively and charge for time set aside for patients (Reade 1909b). Ideal ethical dentists should be prosperous in their practice and financially prudent (O'Neill 1915). The new emphasis dental leaders placed on science and professional service did not supersede dentists' earlier emphasis on 'gentlemanliness' as the defining characteristic of the dentist. Rather science and

Dentistry, 1900-1918 81 service were incorporated into the ideal and the new characteristics blended quite well with the old. Medical science had raised concerns about germs and the spread of disease that provided a new justification and urgency for dentists' insistence on the importance of cleanliness. Moreover, dentists increasingly emphasized to the public that not only were they educated gentlemen, but that they were gentlemen who were educated in science. Dentists' new emphasis on professional service both enhanced their emphasis on honesty and their claims to authority. They claimed to be honest men who were not out for private gain, but had the public's best interests at heart. Dentists also asserted that because of their scientific background and devotion to public service, they deserved authority over their patients (Webster 1904b). Thus, while dentists drew on a number of social ideologies to legitimate their status to the public, and define their professional roles, these ideologies could blend together, and together, they continued to define the ideal dentist as a middle-class gentleman. As in the nineteenth century, twentieth-century dentists made the link between dental professionalism and middle-class masculinity quite explicit. Dental professionalism or ethics continued to be defined in terms of masculinity. In the words of one dentist, 'Ethics is nothing more nor less than manhood, manhood in its most genuine noble and true sense' (Hermiston 1907a: 241). As we have seen, during the late nineteenth and early twentieth centuries, manhood was defined as a set of valued characteristics that only some men (primarily middle-class, white men) possessed, and only the most 'manly' men could achieve (Bederman 1995). Only certain men were manly enough to practise dentistry in the appropriate manner. Manliness was required of dentists to achieve success in dental practice and earn the public's respect (Johnson 1903; Hermiston 1903a; Snell 1902: 218; Habec 1914: 540; Corrigan 1905). When dentists expanded on what manly characteristics and behaviour were required in the practice of dentistry, their statements were very similar to those made before the turn of the century. Dentists were urged to be honest, industrious, and modest, and they were expected to demonstrate respect for their confreres (Hanna 1902: 345-8). Dental professionalism and manly behaviour also entailed certain duties towards patients, including a demonstrated commitment to public service, attention to cleanliness, and the assertion of dentists' authority over their patients (Author Unknown 1913; Price 1902). Commitment to new concerns such as asepsis, service, and science were also defined as 'manly' by dental leaders (Price 1902).

82 A Dentist and a Gentleman Dentistry and the Medical Profession Dentistry's relationship and connection with the medical profession influenced both its success in attaining professional status and the nature of its professionalization drive. The relationship between dentistry and medicine seems somewhat unique among health care professions, and it will be briefly reviewed here. While the medical profession has had a history of undermining its competitors, or at least fundamentally limiting the scope of their activities (Willis 1983; Co burn 1994; Biggs 1983; Coburn and Biggs 1986), it reacted differently to dentistry. At worst, it ignored the dental profession and occasionally criticized it, and at best, it provided actual, concrete assistance and encouragement in dentistry's professionalizing drive. A brief review of the factors influencing the relationship between medicine and dentistry is useful because it sheds light on some factors that have historically been important to the success of professional projects in general, and dentistry's professionalization in particular; furthermore, such an exploration highlights the significance of gender and class to professionalization. There were four key factors that shaped the relationship between medicine and dentistry, and the combination of these factors enabled dentistry to largely escape outright dominance by the medical profession (Adams 1999).4 The first significant factor is the history and timing of professionalization for both medicine and dentistry. While medicine is a much older profession than dentistry, the professionalization drives of the two professions were virtually simultaneous. Both professions achieved their professional legislation in the late 1860s. In the years following this legislation, medicine was beset by internal divisions and direct challenges to its professional powers and claims to monopoly. In this context, dentistry's organization was in no way seen as a threat to medicine. In fact, as we have observed, members of the medical profession actively assisted dentists in the drafting of professional legislation. If dentistry had organized in a later period, after medicine was well established, it may have faced more resistance from the medical profession, as occupations such as chiropractic did. A second, related factor influencing dental-medical relations was that dentistry's claim to jurisdiction over the area of dental health does not directly conflict with medicine's authority over general heatlh. Although historically there have been some jurisdictional disputes between the two professions over the care of the mouth, they have tended to be minor. Dentistry and medicine have managed to coexist because den-

Dentistry, 1900-1918 83 tistry does not offer a direct challenge to medicine's monopoly over treating the human body. The other health care occupations that medicine has actively worked to undermine all trespassed on the area that medicine considered to be its own jurisdiction. Midwifery treated the body during childbirth, chiropractic purported to cure the body through manipulation of the spine, and pharmacists treated human illness through compounding and dispensing medicine. Medicine's efforts to eliminate midwifery and chiropractic and limit the duties of pharmacists were aimed at eliminating their competition. Dentistry did not evoke such hostility because it did not directly compete with medicine. The third factor was dentistry's use of science, particularly medical science, to legitimate its own claims to professional status. This did not challenge medicine's body of knowledge and legitimating strategies. Other health practitioners such as chiropractic, homeopathy, and even to an extent midwifery, offered an alternative vision of healing and caring to that advocated by medicine. Dentists, however, reiterated medicine's focus on disease, germs, and the need for professional intervention to bring about health.5 At the same time, dentists did not try to usurp medical science, rather they tried to incorporate it into their own work and their own 'dental science.' In this manner, dentistry did not challenge medicine's basis, but actually reinforced it. As each profession drew on science to legitimate its own practice and claims to professional authority, it also, by extension, bolstered the other's claims. In this sense, the rise of dentistry may have actually aided the rise of medicine, and it is certainly the case that dentistry benefited from medicine's rise. Perhaps the factor most salient here is the class, gender, and race similarities between practitioners in the two professions. Professional leaders in both medicine and dentistry were middle-class men who were predominantly Anglo-Saxon and white. This similarity is notable, considering that practitioners in the occupations that were eliminated to or subordinated by the medical profession did not share these characteristics. Midwives and nurses were female, and many of them were working class or from rural backgrounds (McPherson 1996; Coburn 1994). Chiropractors were predominantly male, but they were also predominantly working class (Coburn 1994). Pharmacists were generally men whose claim to middle-class status was tenuous; they were small shop owners. The class and gender background of dental and medical leaders was significant for at least two reasons. First, as middle-class men, dentists and

84 A Dentist and a Gentleman medical doctors had more social influence and greater access to power (often through their high-status clientele) than did members of other health care occupations to ensure that their professionalizing drives were a success. Second, similarities in class and gender background led to common interests, outlooks, and goals between members of the two professions. As argued in Chapter 1, through male-dominated professions, middle-class men sought to achieve both class- and gender-based goals. In this manner, occupations like chiropractic and midwifery not only challenged medicine's claim to a monopoly over health care, they also challenged the ability to meet class- and gender-based goals for an occupation that conferred authority, a good family income, and high status. The professionalization of dentistry, like the professionalization of medicine, reinforced existing social relations of class and gender in Ontario society. Thus, members of each profession would have something to gain from supporting the professionalization drives of the other. An additional and related factor that encouraged close relations between medicine and dentistry was the existence of overlapping family ties between the two professions. It is not uncommon to read in the obituaries of dentists that they were outlived by one or more family members involved in medical practice. Moreover, records of some notable dentist families during the period often mention relatives in the medical profession. This is true among my own ancestors. My great-greatgrandfather had four sons, all of whom earned dental and/or medical degrees. Also notable is the case of the Stowe family. Emily Howard Stowe, one of the first female doctors in Canada, was married to a dentist, and her son Frank Stowe went on to become a dentist, while her daughter Augusta Stowe-Gullen followed her mother into medicine. Although the Stowes were not an average Ontario family, the existence of medical doctors and dentists within the same family does not seem to have been that unusual. These family ties likely encouraged positive relations between the two professions and meant that relations were more often characterized by assistance than competition or hostility. A review of factors influencing the relationship between medicine and dentistry is important because it highlights the significance of timing, jurisdiction, ideology, class, and gender to success or failure in professionalization. The professionalization of medicine and dentistry seem to have been mutually reinforcing. The success and claims of one profession bolstered those of the other. Most significant, perhaps, to this study, is the role of class and gender in shaping interprofessional rela-

Dentistry, 1900-1918 85 tions and influencing the success of a professionalizing drive. The class and gender backgrounds of professional leaders not only provided a legitimating strategy for dentists' claims and a basis for defining the profession's roles and relations, but it also enabled dentists to ally themselves with the medical profession, and draw on that profession's claims and social influence, to further their own professional status. The combination of these factors meant that, by the First World War, dentistry was in a prime position to be recognized by the public as a learned and valued profession. The First World War and the Rise in Dentistry's Status

In the first two decades of the twentieth century the public began to recognize dentistry's claim to professional status and its claim to expertise in the area of dental health. At this time, the public began to attach some importance to dental health and the prevention of dental caries. In this chapter I have argued that there were many factors that encouraged dentistry's rise in status. Although all of them were influential, the First World War seems to have been the catalyst for much of the improvement in dentistry's fortunes. The war spotlighted dentistry and the importance of dental health, thereby bringing to the public's attention the accomplishments dentistry had made during the prewar years. Although dentistry's status at the turn of the century was considered higher than in the past, it was still not at a level considered acceptable by dental leaders. Dentists believed that the public held their profession in the same esteem that they did the 'lower grade of lawyers and physicians' (Trotter 1905; ODA Minutes 1905). While this level was a marked improvement, it was still insufficient; dentists wanted to receive the same amount of recognition and esteem as 'other average men in other professions' (Thornton 1905). In their eyes, dentists were too often regarded as mere mechanics rather than professional men of science (Webster 1907b, 1916a). Indicative was the way in which dental offices were categorized by the telephone company. Bell Telephone charged dentistry 'business' rates, while physicians got cheaper, 'professional' rates; dentists were indignant at being classified as a business and getting charged more (Webster 1908b). It was argued that if dentists lived up to the ideal image of the dentist they had constructed, and educated the public about their work, training, and dental health in general, their status would rise even further. This strategy seems to have worked. By the First World War the public

86 A Dentist and a Gentleman had started to look upon dentistry more favourably. There were articles published in the public press that portrayed dentistry in a positive light. Newspaper editorials proclaimed the dentist a 'friend to humanity' and 'the race.' (Toronto World 1910: 47). Other articles portrayed dentistry as a science that demanded a great deal of skill, scientific knowledge, and education ('Lay Woman' 1916; Ottawa Citizen 1908). Dentists boasted that the public was now 'more ready to acknowledge the value of the service rendered by a dentist than at any previous time' (Webster 1910a; Seccombe 1913a). Women's groups attended lectures on the importance of dental health, and they and other groups sought out knowledge about it. There was evidence that members of the medical profession were beginning to regard dentistry with increasing respect. This was further evidenced by government initiatives to provide for dental services to the poor in 1911. Dentistry seemed well on its way to being accorded the status and social influence its leaders were striving for. The First World War provided dentistry, and other health professions, with a further opportunity to convince the public that it was an important and valued scientific profession (see also Fahmy-Eid 1997). The war put a spotlight on dentistry and dental health that dentists were able to turn to their advantage. Dentists had been preaching to the public about their importance and gentlemanly status for decades; with the war, people finally listened. There were many aspects of the war that garnered attention for dentistry, but one of the most important was the inspection of potential recruits for the army. Before they were enlisted in the army, men were given a physical exam that included an inspection of their teeth. This was not done by a dentist. On the basis of these examinations a substantial percentage of men, whose overall health was satisfactory, were rejected for military service because of their dental health (Webster 1914b: 443; Gullett 1971). Suddenly, there was public concern that because of poor dental health Canada's men were not physically healthy enough to fight their enemies (Webster 1914b: 443). This concern was increased by the incidence of dental caries among men who were in the army. Many were prevented from fighting or doing their best, it was said, because of the lack of dental care, and diseases such as trench mouth. Although these concerns also arose during the Boer War, they achieved greater prominence during the First World War (Webster 1903d; Gullett 1971). Dentists responded to these concerns by actively working to improve the dental health of army men. Between the Boer War and the First

Dentistry, 1900-1918 87 World War dentists campaigned for the establishment of an Army Dental Corps which would look after the teeth of army men in war zones and at home. Such a corps was established in 1915 (Gullett 1971). Within it, dentists checked and improved the teeth of recruits before they went off to war. They were stationed in Europe to look after the teeth of the fighting men. Furthermore, they inspected the teeth of all the men returning to Canada. Their work received a great deal of publicity, and there was a frequent cry that there were not enough dentists or dental assistants in the army. Dental students and others were urged to train for such important posts and help their fellow fighting men (Webster 1917a: 23; 'Clippings' 1917). Popular discourse began to portray dentistry as an important profession that was integral to the physical health and comfort of Canadian people. The public demand for dentistry increased during the war. Dentists argued that 'for the first time in the history of dentistry an opportunity has been given the profession to show its value. It is recognized now, if never before, that dentistry is a necessity and not a luxury' (Webster 1917b: 227). The war gave the dental profession publicity and a chance to convince the public that the work dentists did was important. The public seems to have responded with greater patronage of dentists and with a greater acceptance of dentists' advice (Gullett 1971: 158). Moreover, dentistry came to be viewed as a more attractive career option (Webster 1923; Gullett 1971). In the years after the war, the number of people seeking entrance into the dental profession increased substantially. This rise in the number of dental students suited the profession well. The increase in the demand for dental service, combined with a new definition of dentistry's mission - to improve the health of the nation led members of the profession to believe that there was a shortage of dentists in Ontario (Webster 1923; Seccombe 1913b, 1913c, 1914). While only twenty years previously there were incessant complaints of overcrowding, now the profession began to fear that there was such a shortage of dentists that unlicensed men might be allowed to practise. Dentistry, therefore, strove to recruit people, particularly young men, into the profession. Returning soldiers and graduating high school students were considered ideal candidates for dental school (Webster 1917c). The advantages of dentistry were advertised to young men on the verge of seeking a profession (Webster 1916b; Seccombe 1913d, 1915a). While dentists were not opposed to accepting women students in the dental school, they did not make any effort to recruit them into

88 A Dentist and a Gentleman the profession; the perceived shortage of "dentists after the First World War did not lead dentists to alter their image of the ideal dentist as a man. Discussion

This chapter has examined the rise in dentistry's status after the turn of the century and the factors that seem to have encouraged this rise during a period when other health occupations met with less success. Dentists' ability to tap into dominant social ideologies of gender and class, and integrate them with the popularity of science and notions of professional service, did much to legitimate their status with the public. Dentistry succeeded, in part, by associating the desirable social traits of 'manhood' with dental professionalism. In so doing, dentists continued to define dentistry as work for middle-class gentlemen. Dentists' class and gender backgrounds also appear significant.6 Dentistry, like medicine, seems to have been able to use the class and gender status of its practitioners to attain public respect and state assistance. They not only shared a gender and race background (and often class as well) with the majority of legislators, but they also possessed a high-status clientele who supported their actions. Health care occupations that tried and failed to achieve professional legislation at this time, including optometry (which finally found success in 1919), chiropractic, osteopathy, and those occupations subordinated or eliminated by the medical profession such as pharmacy, midwifery, and nursing, did not share both of these characteristics. As Gidney and Millar (1994) describe in their historical study of professions in Ontario, classic professions such as medicine, law, and the Church, had long been dominated by middleand upper-class gentlemen. While dentists' efforts to label themselves as professionals required stretching and expanding the original picture of what defined a profession (formerly based on the classic three professions) , dentists could achieve this without undermining the strength of the picture, largely because they resembled classic professional men in terms of their race, class, and gender. Other occupations striving for professional status were not so fortunat Although dentists had been careful to construct a professional image that would bring them public respect, they needed the public to pay attention to that image. The First World War provided an ideal forum for dentists to show the Ontario public that they were respectable gentlemen who provided a much-needed service. Dentists did not wait until

Dentistry, 1900-1918 89 the First World War to seek this attention, however. They were quite active in trying to educate the public about the importance of dentistry in the years before the outbreak of the war. Chapter 6 explores the nature of these public education and public health campaigns, and the gender, class, and race assumptions that underlay them.

Chapter 6

Public Health, Public Education, Public Image

By the turn of the century the social purity and public health movements in Ontario were well under way (Valverde 1991; Sutherland 1981; MacDougall 1990). Middle-class, Anglo-Saxon Ontarians were concerned with the moral and physical state of the Ontario public. Fearing that the Anglo-Saxon 'race' was degenerating both morally and physically, they worked to 'reform' the way people - especially immigrant and workingclass people - lived their lives. Both the social purity and the public health movements, although somewhat distinct, centred around the belief that there was a direct connection between physical health, cleanliness, and morality. Men and women in the health professions were very active in these movements and they worked to improve the health, cleanliness, and morality of the public. Dentists were no exception. The involvement of dentists in the public health movement dates from shortly after the turn of the century. At this time dentists sought to educate the public about dental health and to ensure that those who needed dental treatment received it. They believed that the public's health depended to a large extent on their efforts, and that, side by side with medical men, they could improve the health and well-being of the entire Ontario public. However, dentists' public health activities served another agenda as well. Through their involvement in public health, dentists sought to improve their public image and status and to secure a market for their services. The public health movement provided dentists with an opportunity to convince the public that they and their work were important. Ideas about gender, class, and race figured prominently in Ontario dentists' public health campaigns. They provided the motivation for these campaigns, and they influenced their nature. Dentists drew on

Public Health, Public Education, Public Image

91

gender, class, and race ideology and relations to convince the public that they were social authorities in the area of dental health whose advice should be heeded. They attempted to transfer the social influence connected with their gender, class, race, and ethnicity — their status as white, middle-class, Anglo-Saxon men - to their profession. In this manner, dentists hoped to solidify their claims to professional status and professional authority as well as their claims to middle-class status, all of which were still tenuous at the turn of the century. Furthermore, in their public health campaigns, dentists continued to use gender, class, and race ideology to define both their own roles and those of their patients and the public. This reinforced their identity as middle-class white men and their authority within dentist-patient relations. Degeneracy and Decay In the late nineteenth and early twentieth centuries it was widely believed that the Anglo-Saxon 'race' was degenerating: that is, that the physical, mental, and moral health of members of the Anglo-Saxon race had declined as civilization advanced. Anglo-Saxon men and women feared that if something were not done, then the race would deteriorate even further and eventually die out. Dentists showed little interest in theories of degeneracy until after the turn of the century. At this time, however, dentists had a keen interest in theories of degeneration and especially in the relationship of dental disease to race degeneracy. Dentists argued that degeneracy in the overall physical, mental, and moral health of the race was at least partly explained by a decline in the dental health of the general public. Therefore, they continued, they could stop degeneracy and improve the Anglo-Saxon race by promoting dental health. At the turn of the century dentists were convinced that the public's teeth were in a more unhealthy condition than they had been at any other time in the history of civilization: 'Our forefathers had better teeth than we and yet they used no tooth brushes. Why this change? Decayed teeth and unclean mouths is the price we pay for modern civilization' (Webster 1907d: 373). Dental disease was so rampant that it was the most prevalent disease in the world (Seccombe 1916c; Davy 1911). Dentists believed that the diets and lifestyles of more primitive, 'savage' cultures were better for the teeth and overall health than those of 'civilized' societies. The lifestyles of civilized societies, especially elements of 'rush' and 'luxury,' had caused oral health and overall health to degenerate (Sec-

92 A Dentist and a Gentleman combe 191 la; Webster 1907d). The tendency of modern people to eat softer foods that required less chewing and more sugary foods was also seen to be a major cause of this degeneration (Seccombe 191 la; Webster 1907d). According to dentists, improper care of the teeth had led to a crisis that threatened the health and well-being of an entire generation. Thus, dentists asserted, their timely intervention was needed if degeneracy were to be halted (Beacock 1904; Webster 1907d). Like their contemporaries, when dentists sought the causes for this degeneracy, they tended to find that, one way or another, women were involved. If the children of today had worse oral and general health than children of the past, then modern women - who were responsible for bearing and raising children — must be at fault. According to some, women's education and emotional natures were the prime cause of degeneracy: First, mothers are more emotional in civilized than in savage life, and the so-called higher education seems to increase this emotionality and excitability. The transmission of these is an increasing evil. Inheriting nervousness, the child is born into a hot-bed of emotion and its education is highly emotional; society then excites and social pleasures exhaust the young girl, till the modern woman becomes the bundle of nerves that she is, and often totally unfit to become the mother of children in turn, and which [sic] are usually born with large brains and small, weak bodies, and scarcely any digestion at all... The brain is supplied in part at the expense of the rest of the body. This hyper-nutrition of the brain means deficient nutrition of the body of the child, which in turn means deficient formation of the teeth. (Beacock 1904: 299-300)

In this manner, the education and emotional natures of early twentiethcentury women were seen as the cause of the rise in tooth decay, and, by extension, the degeneracy of the race. Nonetheless, dentists also stressed women's lack of education - about dental health matters - as an important cause of race degeneration (J. Adams 1896; Hermiston 1903b; Seccombe 191 Ib: 23; Doherty 1912a). Mothers, as well as fathers (who were mentioned far less often), were 'criminally ignorant' about the necessity of good dental health (Hermiston 1903b; Falloon 1909; Thornton 1902). Mothers were seen as completely responsible for the health of their children from the moment of conception. A lack of good nutrition and good living while pregnant were seen to be the doom of many a child's dental health (Beacock 1904; Wells 1908). Mothers were also blamed for caus-

Public Health, Public Education, Public Image

93

ing tooth decay through their neglect after birth (Hanna 1911: 94; Author Unknown 1905: 158; Cowan 1913b). This was particularly true of working-class and immigrant families, in which 'mothers ... either through indolence or the necessity to engage in work outside the home, fail to supply proper meals for their children' (Seccombe 1915b: 500; Pamphlet 1912: 479). Nevertheless, mothers of all class backgrounds were blamed for causing dental disease in their children by feeding them food that did not require mastication, such a porridge, pies, and sugary foods like candy (Seccombe 1914b; Davy 1911; J. Adams 1912). The threat of degeneracy was taken so seriously that mothers who did feed their children such forbidden foods were accused of acting 'immorally' and 'crippling their helpless children for life' (Beacock 1904: 301). Dentists asserted that 'dentally speaking easily ninety per cent of the children [between ages two and six] have no mother at all' (Cowan 1914: 251). Thus, maternal neglect was said to be responsible for the degeneracy of the public's dental health and, by extension, their overall health. Dental health and overall physical health were closely linked by dentists. Dentists cited medical authorities who stated that most disease either entered the body through, or originated in, the mouth (Day 1917: 317; Davy 1911; Webster 1907d; McElhinney 1914; Willmott 1904a). Because their work focused on the mouth and its surrounding tissues, dentists believed that they were uniquely placed to prevent diseases from entering the body. As 'sentinels at the portal of the alimentary tract,' dentists could improve the overall health of the Anglo-Saxon race (Reade 1907: 119; Taylor 1917; Thompson 1908; McElhinney 1909). However, dentists still had to convince the public and the medical profession of the importance of dentistry. To illustrate the importance of their sphere, dentists constructed elaborate and revolting 'scientific' descriptions of the average person's mouth and continually put these before the public. In this age that emphasized social purity and cleanliness, such a picture of filth and germs must have had an especially strong impact. Dentists attempted to define exactly how many bacteria and germs there were in the mouth at any given moment (Day 1917; Willmott 1904a). It was stated that there were at least fifteen different varieties of germs and between thirty and a hundred varieties of bacteria in an unhealthy mouth (Day 1917; Bennett 1908). These multiplied so quickly under certain conditions that a few bacteria could become millions in a few short hours (Day 1917; Willmott 1904a). Some diseased mouths might contain as many as 'one billion one hundred and forty million bacteria' (Day 1917: 318). These were portrayed as swimming around in the mouth, polluting

94 A Dentist and a Gentleman the air people breathed, and infecting the body at every swallow (Day 1917; Bennett 1908). Descriptions were especially colourful when they focused on pus from decayed teeth in the mouth (as they often did). This pus was mixed with food at every chew and then swallowed, spreading disease to the stomach and throughout the body. Vivid descriptions of the widespread presence of germs, disease, and pus in the mouths of adults and children alike were intended to shock members of the public into regarding dentists and dental health as being important to overall health. Once again, dentists drew on powerful social imagery to justify their claims. In dentists' eyes, poor dental health led to poor physical health, and ultimately, poor mental and moral health as well, because once 'physical degeneracy is established [it is] soon followed by mental and moral degeneracy' (Clark 1914: 503; Johnson 1912a; Webster 1907d). Dental journals and public lectures were full of anecdotes intended to illustrate that dental health strongly influenced health in other areas (Davy 1911; Webster 1910a: 359; Willmott 1904a; Taylor 1917). Dentists tell of people who were in a chronic state of bad health until they visited a dentist, started eating properly, and brushed their teeth regularly; suddenly their health improved (Davy 1911; Webster 1907d; J. Adams 1912). The connection between dental health and mental health was illustrated through anecdotes about insane people who became sane upon improving their dental health (Day 1917). There were anecdotes of poor students who were transformed into good students through attention to their teeth (Davy 1911;Johnson 1912a). Itwas also reported that more than one errant boy had been led into a life of crime and moral degeneracy through neglect of his dental health (Fletcher 1904; Day 1917; Rogers 1912).l Thus, although dentists only lay claim to a small area of the body - the mouth - they argued that this area was huge in importance. This connection between oral and overall health gave dentists' mission to halt degeneration new importance. Although the bulk of the blame for dental disease and dental degeneration was placed on women, dentists felt they too could be seen as somewhat responsible (Bean 1916: 224). It was their duty to protect the Anglo-Saxon race from degeneracy by combatting its 'ignorance' and educating it (Hermiston 1903b; Seccombe 1911b: 23; Webster 1904a; J. Adams 1912). Dentists believed they had to show the public the error of its ways. Dental leaders proposed a number of methods through which this could be done. If dentists charged more for their preventative dental work such as clean-

Public Health, Public Education, Public Image 95 ing teeth, then the public would come to learn its value (Bean 1916; Seccombe 1914b: 70). It was also suggested that dentists should lead by example. However, dental leaders most stressed the importance of educating patients and the public about dental disease and maintaining dental health. Dentists' involvement in public dental education was very much influenced by their race, class, and gender identities and relationships. Concern for their own racial-ethnic superiority, and the influx of immigrants from other ethnic backgrounds into Ontario, motivated the campaign. Improving the health and well-being of Anglo-Saxons would keep their race superior. Improving the health of immigrants was also a goal; they were often seen as dirty, unhealthy, and in need of improvement. As middle-class white men, dentists believed they had the right and responsibility to guide women, immigrants, and members of the working class to take better care of themselves and their children (Falloon 1909). Moreover, they believed it was their responsibility to help those less fortunate than they, especially poor children. Of course, their interest in the poor was not completely altruistic: dentists also stated their concern that if degeneracy were not halted among the poor, they would have difficulty finding good servants, labourers, and soldiers in the future (Dental Record 1903; McElhinney 1914). Dentists' public education and public health campaigns, discussed below, built on the belief that as middle-class white men, dentists had the duty and the authority to guide and reform women, children, and the poor in general. Public Education Beginning in the late nineteenth century dentists argued the importance of educating the public about dentistry and the proper way to care for teeth. At this time dentists sought to use education to increase the number of people who visited dentists regularly and to increase the value placed on dentists and on dental services (Beers 1899d). These two goals remained important to dentists' education drives after the turn of the century. However, preventing race degeneracy and protecting children from the effects of dental disease were dentists' most-cited goals at this later date.2 Increasingly, dentists portrayed public dental education not as something that they gained from - although they did but as part of dentistry's duty to the public. Dentists argued that they were providing the public with information and an essential service (Seccombe 191 Ic). Nevertheless, information about dental health was

96 A Dentist and a Gentleman not the only thing disseminated by dentists through their public health campaigns. Middle-class Anglo-Saxon gender ideology was also disseminated as dentists used education to establish their authority and influence over the area of health and over their patients and the public. Because they believed that dental health was so important to the overall well-being of their race and nation, dentists saw dental education as a necessity (Seccombe 1911b; Reade 1911b). Canada would be better off through their efforts. Education was seen as especially important given increased levels of immigration: 'With such an influx of people - who know not oral hygiene - there is not a country where a campaign of dental instruction is more necessary, or more opportune than in Canada today. One cannot conceive of any other effort that would give such an impetus to good citizenship, raise the health standard, and increase self-respect as would a campaign for clean mouths' (Seccombe 191 Ic: 181). Dental education was seen as a means to civilize immigrants entering Canada. However, immigrants were not the main focus of dental education campaigns. Rather, dentists believed that their efforts were best directed at children of all backgrounds (Seccombe 191 Ic; Doherty 1912a). Because children were the future parents of this world, degeneracy could be halted if their health were improved (Croll 1902: 181; McElhinney 1914; Kennedy 1912). It was reasoned that if children acquired good dental habits when young, they would become good, clean adults, able to pass on their good health to their own children. Dentists sought to reach, protect, and educate children indirectly, through women. They aimed their education initiatives at mothers, nurses, and public elementary school teachers (who were predominantly female at this time), believing that women could best carry out their instructions for combating dental disease (Webster 1907d, 1906; Bothwell 1917: 498). In their education initiatives, dentists gave speeches to teachers and student teachers, as well as to practising and student nurses. Dentists' main efforts, however, were devoted to educating mothers. They spoke at meetings of women's groups, talked to their patients, and published pamphlets directed at mothers to educate women about how they should look after their children.3 Dentists believed that if children were to be protected, mothers had to be educated (Kennedy 1912;J. Adams 1912). In addressing mothers, dentists utilized middle-class gender norms to 'guilt' mothers into following their advice about dental hygiene. Mothers were blamed for any dental imperfection their children possessed. In accordance with middle-class gender ideology, it was emphasized that

Public Health, Public Education, Public Image 97 children's dental health was completely a mother's responsibility (Beacock 1904; J. Adams 1912). If women followed dentists' advice, their children could grow up to be healthy, intelligent, and moral people. If they did not, their children would be handicapped for life through their physical, mental, and moral deficiency (Toronto Board of Education 1912; J.Adams 1912). Dentists drew on the increasingly high standards of cleanliness and housekeeping expected of middle-class women to convince women about the importance of their children's dental health. As one dentist told his female audience: 'No woman would think of having her home beautifully decorated, polished floors, dainty rugs, everything absolutely clean, and allow the front entrance to contain several inches of mud and filth. A clean house would be an impossibility under those conditions. A clean body cannot be maintained and allow the vestibule, the mouth, to be filled with noxious, fermenting germ laden filth to be mixed with food and carried to the stomach, there to interfere with functional nutrition and poison the entire system' (Davy 1911: 485). This quote draws on accepted middle-class standards of cleanliness and generalizes them to the new area of oral health in an effort to convince women about the importance of the latter. As the quote illustrates, oral health was women's responsibility: just as they were responsible for keeping their houses neat and clean, they were responsible for keeping their families' mouths clean. The strong words used to refer to an unclean mouth - 'noxious, fermenting germ laden filth' - are effective and sufficiently revolting. A woman who had internalized societal norms concerning the importance of cleanliness could not help but be affected by this description of the state of her children's mouths.4 The above quote is not singular in stressing the connection between women's responsibility for the cleanliness of their homes and dental health. A number of articles asked mothers to generalize their standards of cleanliness for their food, clothing, and household to their children's mouths (Cowan 1914; Webster 1907d: 373). For instance, one article pointed out that it was inconsistent for women to insist that their food was clean, and served on a clean plate, with clean utensils, if they were then going to let their family members insert that food into a filthy mouth (Corrigan 1906: 257). Dentists argued, 'No refined person would tolerate a dirty mouth any more than he would dirty dishes' (Webster 1907d: 380). Dentists portrayed oral health as something every respectable, responsible woman should provide for her family. In their pamphlets and speeches dentists argued that it was impera-

98 A Dentist and a Gentleman tive for women to follow their advice about dental hygiene and the proper care of teeth. Interestingly though, dentists were not completely sure at this time about what advice to give. There was by no means a consensus within the profession concerning how tooth decay was best prevented (Gowan 1909b; Webster 1905c, 1909b). For instance, it was fairly common for dentists to recommend the regular brushing of teeth to prevent decay, but dentists disagreed over whether a toothbrush was really effective. Dentists who did advocate the use of toothbrushes often disagreed over what kind was best, what dentifrice should be used, and when the teeth should be brushed. Research and discussion led to more consensus by the First World War. However, dentists gave advice and asserted their authority over dental matters even before they agreed on what, exactly, their advice should be. Despite differences of opinion about dental health, the nature of the advice given was fairly consistent. Dental pamphlets and speeches followed roughly the same pattern. They began with an illustration of the prevalence of dental disease. Dental disease was said to be the most prevalent disease affecting mankind; almost everybody suffered from it at one time or another. The presence of bacteria in the mouth and the role that germs played in a variety of dental diseases was explained. Often, vivid descriptions of germs, filth, and pus were provided. Scientific explanations and illustrations of dental disease gave the arguments of dentists' greater legitimacy. Pamphlets and speeches also emphasized the pain, suffering, and disfigurement children experienced when mothers neglected their dental health (J. Adams 1912; Pamphlet 1912; Toronto Board of Education 1912). To illustrate the effects of dental disease, pamphlets often contained pictures of unattractive people with decayed and crooked teeth. Such pictures aimed at illustrating how unattractive and unhealthy people could become if their teeth were neglected as children. Dentists believed that women could be particularly swayed by arguments stressing the negative effect dental disease had on appearance (Falloon 1909). Dentists further cautioned that one could judge a person's intelligence, education, taste, and social position just from the appearance of his or her teeth (Gowan 1904: 298). Thus, dentists implied that attention to oral health indicated one's intelligence and social respectability. After presenting the nature and consequences of dental disease, dentists' pamphlets and speeches explained what people (women) could do to prevent dental disease and to promote oral health. The importance of cleaning the teeth was especially stressed. One way in which the teeth

Public Health, Public Education, Public Image 99 could be kept clean was through proper eating habits. It was said to be important that food be chewed carefully if the teeth were to be kept clean and digestion improved (Pamphlet 1912; Gowan 1909a). Dentists were often precise in their instructions about chewing food: 'Mastication should be continued until the morsel is but a pabulous mass, and the bolus glides into the gullet as though it were greased' (Reade 1907: 120). Good mastication would clean the teeth and give them 'exercise,' thereby contributing to good dental health (Pamphlet 1912; Gowan 1909a; Webster 1907d: 374). It was said that 'if children could be sent to chewing school as they are sent to a kindergarten, there would be a marked improvement in the race' (Pamphlet 1912: 343; Grieve 1909: 507). Parents were, therefore, advised to watch their children closely to ensure that they chewed their food. In addition to good mastication, women were told that brushing teeth was essential to keep the teeth clean and to prevent dental disease (Gowan 1909b; Grieve 1909; Pamphlet 1912). It was the duty of the mother to ensure that her children brushed their teeth (Pamphlet 1912: 346; Grieve 1909; Corrigan 1906; Gowan 1909a). Cleaning of the teeth was not only a matter of health and appearance, it was also a matter of self-respect and refinement, women were told (Toronto Board of Education 1912: 480; Pamphlet 1912; Fones 1914). Women were further advised to carefully monitor their children's diet, choosing foods that required a good deal of chewing and were nutritious (Pamphlet 1912; Reade 1907). Candy was disdained by dentists as a lazy or bad mother's substitute for love and nourishing food (J. Adams 1912; Seccombe 1915b). It was implied that if mothers truly cared for their children they would give them food that was less sugary and required more chewing. At various times mothers were also told that artificial light, lack of exercise, and spending too much time indoors could also lead to tooth decay (Wells 1908). Hence, mothers were advised to guard their children's exposure to these potentially harmful influences as well. Most stressed in dentists' advice to mothers and other women was the importance of regular visits to the dentist. Not only were they to consult a dentist regularly, but they were also told that they should cooperate completely with the dentist's advice and instructions (Gowan 1904; Pamphlet 1912; Cowan 1913a; Grieve 1909). Acceptance of the dentist's authority was said to be essential to maintaining good dental health. While public health campaigns were partly aimed at 'protecting' the public from dental disease, they were also, clearly, designed to increase the demand for dental services and solidify dentists' authority over their

100 A Dentist and a Gentleman patients (McElhinney 1901). Public education provided dentists with the opportunity to secure their livelihoods and their professional status. In their dental advice dentists questioned women's daily habits and their capability as mothers. Women were told that, to be good mothers, they had to follow dentists' instructions and visit dentists regularly. The instructions dentists gave them involved changing some fundamental aspects of their lives: what food they ate (nutritious, tough food), how they should eat it (chewing vigorously), and what they should do after they ate (brush their teeth). Dentists argued that their advice was not only central to maintaining dental health, but also to raising good children. Once again, dentists stressed the association between oral health and physical health, appearance, and mental and moral health, thereby indicating that failure to follow their advice could lead to dire consequences for children. Through their advice and education, dentists aimed to intervene and alter the way that people lived their lives. In the words of one dentist, through dental education they could 'teach the ignorant how to act' (Pearson 1897: 161). They believed that not only did they have the right to do this, but that they had the responsibility to do so (Falloon 1909). Dentists held that Ontario citizens would be better off if they changed their lifestyle and lived the way that dentists felt they should. Dentists' advice generally went beyond that which might be seen as strictly relevant to the teeth. They recommended temperance, cleanliness, fresh air, and exercise. The middle class was still in the process of defining itself during the late nineteenth and early twentieth centuries (Davidoff and Hall 1987; Ryan 1981; Valverde 1991). At this time middle-class men and women were both trying to establish their identity and secure their position in Ontario society. As part of this process middle-class women constructed ideas about motherhood. It was in this context that dentists were so aggressive in their 'advice.' They drew on the values and ideas inherent in this middle-class conception of motherhood to convince middle-class women to heed their advice. Through their public education campaigns, dentists structured their relationship to the public in a way that mirrored middle-class white family gender relationships. They were men with authority protecting and guiding their women and children. Women were seen as their junior partners, caring for children and the home capably, but requiring male advice and guidance at times. Children were the main concern of both men and women who worked together to raise them to be healthy, moral adults. Dentists' public education initiatives were aimed primarily at middle-

Public Health, Public Education, Public Image

101

class women: most pamphlets were sent out to 'people of the educated class' (McDonagh 1911: 34). The pamphlets assumed women were intelligent and capable, although ignorant about dental disease, and they gave scientific and detailed explanations about the nature of dental disease and how it could be prevented. It was these women with whom dentists were most willing to work to save children's teeth. Women outside of the middle class were generally treated as less intelligent and in need of far more guidance and more active intervention. While middle-class women may have been treated as 'wives,' working-class women were treated more like social inferiors who needed controlling. Inspection of schoolchildren's teeth and free dental clinics were the main methods by which dentists tried to alter the behaviour of people from poorer families. Public Health - Suffer the Poor Schoolchildren Spurred by their fears of degeneracy, professionalizing dentists became very concerned with the health of Ontario's children after the turn of the century. The focus of their dental work shifted somewhat from dental disease and tooth loss in adults to trying to prevent the occurrence of disease in children (Seccombe 191 le; Webster 1914c). As mentioned above, dentists believed that people who acquired good teeth and good habits while young would be better adults and, therefore, would be better situated to propagate the race. Hence, in addition to their public education campaigns, dentists sought to protect and guide children through dental inspection of schoolchildren's teeth and through the establishment of dental clinics for the poor. Dentists believed that through these public health campaigns they could improve children's health and their ability to learn. However, dentists' public health campaigns were not as altruistic as they claimed. Through their public health activities, dentists strengthened their position of authority over their patients and the public and their claim to authority in the area of dental health. Public health campaigns provided dentists, as middleclass Anglo-Saxon men, with the opportunity to influence and 'purify' working-class people and immigrants whom they regarded as unclean and, at times, immoral. Dentists' public health campaigns centred around their concern for the state of schoolchildren's teeth. Dentists' investigations conducted around the turn of the century suggested that over 90 per cent of schoolchildren suffered from dental disease (J. Adams 1896, 1912).

102 A Dentist and a Gentleman Because of the link dentists made between dental disease and physical and mental disorders, as well as pain and suffering, dentists' regarded such high incidence of disease with alarm. Some dentists asserted that thousands of children failed school every year simply because of bad teeth (Johnson 1912a: 190; Bothwell 1917). These children might be handicapped for life because of dental disease. Even if they managed to succeed through school, children with dental disease or other 'defects,' like malocclusion, might be so physically unattractive that they would be unable to attain good jobs (Johnson 1912a: 192-3; Corrigan 1906). Moreover, it was believed that children who had been improperly nourished because of bad teeth might turn to stimulants like coffee or worse (Johnson 1912a). Bad teeth could lead to bad habits. As noted above, dentists tied moral depravity to dental disease, arguing that children might turn to a life of crime because of neglected teeth (Kennedy 1912; Fletcher 1904; Day 1917; Rogers 1912). Dental disease was further linked by dentists to tuberculosis and other physical illnesses (Corrigan 1906; Johnson 1912a; Graham 1911). It was argued that 'no single ailment of children is responsible directly or indirectly, for more feeble constitutions, disease, physical maldevelopment [sic], and mental dullness than dental caries' (Toronto Board of Education 1912: 481). Dentists knew they could not rely on the parents of these suffering children to look after their teeth. Poor and immigrant parents were especially ignorant about dental health, it was said, and they had many habits that led to disease (Corrigan 1906; Taylor 1917). Dentists accused immigrant mothers of feeding their children soft foods, cookies, cakes, and candies, and thereby hastening dental disease (Toronto Board of Education 1912: 479). According to dentists, ignorance and poverty were not acceptable excuses for this 'shameful' and 'criminal' treatment of children: 'Because the parents are financially embarrassed shall they show such a lack of civilization ... or because they plead ignorance to the laws of sanitation and disinfection, are they to be excused? Emphatically no. People who have no knowledge of the care of children must either be made wise on this subject or else they should not attempt rearing a family. The laws of civilization, or of common decency, give no license for such rash carelessness' (Hermiston 1903b: 443). Immigrants and poor people were seen as living outside the laws of common decency or at least what middle-class Anglo-Saxon dentists viewed as acceptable. Dentists felt that they had to intervene. Given their racism and feelings of superiority, dentists' intervention was not solely the result of concern for the pain and suffering children might endure. Intervention also

Public Health, Public Education, Public Image 103 provided them with the opportunity to influence people outside their race and class, and to assimilate them to the values that they as middleclass, Anglo-Saxon men held dear.5 Moreover, dentists' intervention would enhance their professional authority, status, and income, as more of the public would be brought to 'recognize' the importance of dentists and dentistry (Seccombe 191 Id, 1913e; Webster 1914c). Dentists petitioned government authorities for the inspection of schoolchildren's teeth a number of times after the turn of the century, but nothing was done until after medical inspection in Toronto schools was implemented in 1910 (Webster 1902: 76-7; ODS 1905; Sutherland 1981). Apparently, medical inspectors found that the most prevalent form of disease affecting schoolchildren was dental, not medical (MacDougall 1990). In 1910 dentists carried out their own inspections in a few schools to ascertain the extent of dental disease in Toronto schools (McDonagh 1911). According to their findings, approximately 90 to 95 per cent of all children required dental treatment (Reade 191 la; Seccombe 1917). Armed with these statistics, the Toronto Dental Society approached the Toronto Board of Education to convince them of the need for a dental inspector in their schools. Since dental inspection was seen as an extension of teaching boys and girls the 'underlying principles of correct living,' it was seen as an educational issue (Seccombe 1915b: 499, 1915c: 508-9; Webster 1913a). Members of the school board were presented with the profession's statistics on the incidence of dental caries and abscesses in children. For effect, dentists also described how many children had pus from infected teeth oozing into their mouths, and from there, their entire bodies (Webster 1910b: 592). The presentation seems to have had quite an impact on the Board of Education. The members who were present expressed their immediate support for dental inspection — as long as the appointed inspector was not female (Levee 1910: 593).6 While a decade earlier neither the board nor the general public had been moved by previous efforts to begin inspection of schoolchildren's teeth, by 1910 there was a great deal of support (Sutherland 1981). The Toronto Board of Education appointed a dentist to its medical inspection staff in 1911. This dentist worked with school nurses to inspect teeth and to notify parents when 'defects' were discovered (Seccombe 191 le: 256; Rogers 1913). Parents were advised to take their children to a dentist to have their teeth taken care of. The dental inspector's other duties involved addressing teachers, directing nurses, and instructing children about dental health and disease (Webster

104 A Dentist and a Gentleman 191 Ib: 87). He also prepared pamphlets to distribute to parents and supplied the city press with short articles about oral health for publication and publicity (Seccombe 191 le). In the following years other cities and towns in Ontario appointed dentists to inspect and care for the teeth of schoolchildren. Nurses and teachers were expected to play an important role in promoting children's dental health. They were liaisons between the dentist and the children and their families. They were expected to inspect the children's teeth and inform the dental inspector if something did not look right (Rogers 1913; Seccombe 191 Id). They were not to diagnose dental disease (Rogers 1912). Nurses and teachers were also expected to play a role in monitoring the course of a child's dental treatment and in ensuring that children got necessary treatment. Nurses were to meet with and convince students' parents about the importance of getting treatment and to educate them about dental health (Rogers 1913; Seccombe 1915c). In dental inspection nurses and teachers were subordinate to the authority of the dentist. They were expected to carry out his instructions about how best to protect and treat the children. To educate the children about dental disease, dentists engaged in a number of strategies. There was a regular 'tooth brush drill' where everyone in class brushed their teeth. Children were taught about the importance of brushing their teeth and keeping their mouths clean. The dental inspector also created posters about dental health to be placed in the public schools. These posters taught that cleanliness would stop tooth decay and warned about the connection between bad teeth and bad health. The posters tended to be sensational. They announced in large block letters that decayed teeth could cause tuberculosis and showed pictures of unattractive children to illustrate what could happen if children breathed with their mouths open. They also warned that bad teeth could lead to 'retarded mental development.' The posters left no uncertainty about the relationship between dental health and overall physical and mental well-being. Another strategy for educating children used by the dental inspector was to rewrite familiar nursery rhymes to emphasize the importance of dental health (Doherty 1912b: 88-9). For instance, Georgie Porgie, Pudding and Pie; Kissed the girls and made them cry; They cried and cried - they were very mad; 'Cause his teeth weren't clean and his breath was bad.

Public Health, Public Education, Public Image 105 Little Boy Blue, run brush your teeth; Brush them on top and underneath; If you don't clean them three times a day It won't be long before they decay; The dentist will soon have them to fill, And your papa will have to pay a big bill. So, whether at work or whether at play, Don't fail to brush them three times a day.

These rhymes were apparently used in Toronto public schools to interest students in dental health. The rhymes seem to have been well regarded by members of the profession. How widely they were used, or their effect on the students, has not been recorded. Dentists and educators regarded dental inspection of schoolchildren as successful. The incidence of dental disease dropped substantially after a few years of dental inspection. While the average incidence of dental disease among schoolchildren was 95 per cent in 1911, by 1915 that percentage had dropped to 65, and by 1916, it was down to 51 (Seccombe 1917: 90; McLaughlin 1914). It was said that inspection had a positive effect on the students. They were healthier and happier because of dental inspection and dental treatment (Armstrong in Seccombe 1913: 454). Children were also reported to be increasingly interested in dental health. Moreover, it was asserted, dental inspection and education made the children better students: they concentrated better when they were healthier. Dental inspection was seen to have had an especially important impact on immigrant and poor children - the children dentists were most concerned with reaching through school inspection. It was asserted that these children, lacking dental care because of the poverty and 'ignorance' of their parents, really benefited from school inspection (Bruce in Seccombe 1913: 454). Dentists were pleased that dental inspection seemed to have reached poor and immigrant children and brought them more in line with the standards set by middle-class, Canadian-born professionals.8 To further reach immigrant and poor children, dentists advocated free dental clinics for poor children. The incidence of dental disease, revealed by school dental inspections, helped to convince the Toronto Board of Education that dental clinics would be valuable (Toronto Board of Education 1912; Seccombe 1915c; Reade 191 Ic). Dentists argued that ideally these clinics should be located within schools. Especially emphasized was the dentist's control over the children and their

106 A Dentist and a Gentleman treatment (Toronto Board of Education 1912). It was easier to control the behaviour of poor children and influence their parents through a school dental clinic (Seccombe 1916a). If it was left to a parent, some dental work might never get done. School clinics offered a way to ensure that children with dental disease were treated, and during the course of treatment children could be monitored by teachers and school nurses (Seccombe 1915c: 512, 1917; Rogers 1912). School clinics were preferred because they gave dentists more influence over children's dental health. Dental clinics for poor schoolchildren were first operated in Toronto in 1912-13 (McLaughlin 1912c). The first permanent clinic for poor children was a municipal one that opened in 1913. Around the same time dental clinics were established in schools. By 1916 there were fifteen school clinics around Toronto — one in each school district. These clinics provided free dental services to poor children. Dental clinics for Toronto's poor adult population were opened by dentists under the supervision of the Medical Officer of Health in 1913 (MacDougall 1990). Wealthier children and adults were expected to see a dentist privately and to pay fully for his services. Dentists employed in these clinics were paid by the city for their services. Significantly, although dentists argued that their public health work was a service they provided to the public, they fully believed that the government should pay them for this service (Seccombe 1914a: 69; Reade 191 Ic: 211-12; Seccombe 1915b; Falloon 1909). Through dental inspection they stood to gain more patients, both immediately and in the future. This fact was not lost on the public who sometimes accused dentists of being motivated by selfinterest and greed in their public health work (Seccombe 1916c; Thornton 1910). Dentists defended themselves by reiterating that they were providing an important and necessary service to the public and by claiming that working on children was not very profitable for them (Thornton 1910: 594-5). Coincidentally, at this time dentists began to advocate raising the fees they charged for preventative dental work, as it was becoming an increasingly important part of their practice. Dentists' public health initiatives, and especially the inspection of schoolchildren's teeth, were occasionally criticized by other dentists for being 'paternalistic' and, therefore, unjustified (Clarkson 1905; Habec 1912c). Moreover, it was argued that dental education had no place in the schools: the educational curriculum was already overcrowded without adding oral hygiene (Clarkson 1905). These criticisms were not given much heed by the majority of dental leaders. If they regarded

Public Health, Public Education, Public Image 107 their actions as paternalistic, they did not see this as a problem. In fact, dentists seemed to embrace the paternalism of school inspection. They believed that they had the right and the responsibility to be paternalistic. In their eyes, the children's parents — especially poor and immigrant children's parents - were criminally negligent when it came to dental health. Therefore, it was necessary that dentists intervene and act the part of surrogate father by instructing, guiding, and treating these children. As we have seen, acting 'manfully' was an important aspect of being a good dentist. Through their public health campaigns, dentists merely extended those middle-class gender norms that governed behaviour for men in the family and community to the public at large. Thus, in their public health campaigns, dentists saw themselves as fulfilling their duties and roles as middle-class gentlemen. They were guiding women - school nurses, teachers, and mothers - in their efforts to look after and protect vulnerable children. Women had a large role to play in school inspection and dental clinics. In dental inspection and treatment nurses and teachers dealt with the children more than dentists did. Dentists were the men in charge. They monitored the children and guided the activities of nurses, teachers, and, indirectly, children's mothers. The role that dentists assigned to women in their public health campaigns was a subordinate one that, in keeping with the dictates of gender ideology, involved caring for and supervising children. Coinciding with the family emphasis of domestic ideology at the time, children were the primary focus of both men and women in the public health enterprise. Ontario dentists' public health initiatives were not only influenced by their gender, but by the combination of gender with race and class. Dentists wanted to 'reform' the habits of those immigrants and poor families to conform to the standards of middle-class, Canadianborn (and generally Anglo-Saxon) men and women. Public health work also provided dentists with the opportunity to extend their influence over the public and their authority over their patients. Inspection of schoolchildren's teeth drew attention to the widespread presence of dental disease. Dentists used this spotlight to illustrate the negative effects of dental disease and to emphasize dentists' role in maintaining dental health. Public health campaigns provided dentists with positive publicity. Moreover, these campaigns put a large number of children, and by extension their parents, into contact with dentists. Dentists' patient load increased, and more people were convinced that dental treatment might benefit their health and wellbeing. Hence, public health and public education campaigns increased

108 A Dentist and a Gentleman the market for dentistry. These campaigns also helped to solidify dentists' authority over their patients. Dental inspection gave dentists the opportunity to dictate to their patients exactly what needed to be done and to ensure that their instructions were followed. While adults might sometimes challenge a dentist's treatment, children were not in a position to do so. Dentists' education campaigns further strengthened dentists' authority over their patients by stressing that dentists were professional men with important knowledge that would help children, as long as people complied with their instructions.9 Discussion

While their authority and influence were never absolute, dentists had a great deal of success in altering the habits and behaviour of the public. During the first two decades of the twentieth century, dental health became more of a priority with municipal and provincial governments. Further, more people patronized dentists and followed their advice, particularly about brushing teeth. People had higher regard and greater respect for dentists. Through their public education and public health campaigns, Ontario dentists gained a larger market for their services and more societal influence than they had previously enjoyed. Dentists' public health campaigns were a strong contributor to their increased influence and status (Seccombe 1913e). In these campaigns dentists were able to utilize the popular concern over social purity, public health, and immigration to their own benefit by convincing the public that dentists' professional services would help to make Ontario a healthier, purer place. Dentists found a natural match between the images they used and those of the social purity and public health movements. Both these movements emphasized cleanliness - a quality dentists had valued for decades. Moreover; the social purity movement used images of whiteness to signify purity, morality, and cleanliness (Valverde 1991). Dentists too found this imagery useful and appealing, particularly as it was easily applied to teeth. White teeth were clean teeth, and, as we have seen, clean teeth were seen as indicators of morality and respectability. Yellow teeth and diseased teeth were unclean and indicated an unhealthy body and a questionable morality. To dental leaders, replacement gold teeth were a sign of sexual promiscuity and a complete collapse of morality (J. Adams 1912; Webster 1901c; Beers 1897; Pottles 1910). Dentists' use of the social purity imagery not only strengthened their own arguments about the significance

Public Health, Public Education, Public Image 109 of dental health, but also reinforced that movement's emphasis on cleanliness, morality, and health. As we have seen, dentists also drew on gender, class, and race relations and ideology to legitimate their claims to social authority and to structure their professional relations with various segments of the public. Furthermore, the identity that dentists had been defining over the previous fifty years was solidified through their public health campaigns. In these initiatives, dentists saw themselves as living up to the identity they had been establishing for years: they were acting like respectable, middle-class, Anglo-Saxon, professional gentlemen. In this manner, dentists' gender-class-race identity was constructed and reaffirmed. Moreover, in these public health campaigns, masculinity was further associated with dentistry as aspects of the role of middle-class father were embedded in the role of dentist.

Chapter 7

Gender and the Division of Dental Labour

During the opening decades of the twentieth century dentists became concerned with office efficiency. Borrowing ideas about scientific management and rationalization from the business world, they began to rationalize dental practice. Prosperity and success in dental practice were now seen as a function of the efficient use of dentists' time and money. One of the principal means through which dentists sought to maximize their efficiency was the use of auxiliary dental workers. Two types were used increasingly after the turn of the century: dental assistants and dental mechanics. At this time dentists endeavoured to carefully define and delimit the work performed by these auxiliary workers, so that they could increase their own efficiency while maintaining their authority in the area of dental health. In creating these auxiliary occupations, dentists were also following the lead of the medical profession whose use of auxiliary personnel like nurses and an increasing number of technicians expanded during this era. Hiring dental auxiliary workers served another purpose: it enabled dentists to disassociate themselves from the lower-status aspects of their work. The manual laboratory work, venerated by early dentists, was now seen as more suitable for an unscientific manual trade than to the learned, scientific, gentlemanly profession of dentistry. Dentists, therefore, began to perform less of this work themselves and, instead, hired 'mechanical men' to do the work for them. Similarly, dentists argued that it was not efficient or worthwhile for them, as learned professional men, to bother with the many tasks involved in maintaining a dental practice. Rather, they should hire a female assistant to do these 'mundane' but important tasks for them. In hiring dental auxiliaries, dentists could concentrate on more high-status dental work. In addition, by con-

Gender and the Division of Dental Labour

111

centrating their efforts on dental operations, dentists could treat more patients and earn a higher income. In their auxiliary personnel, dentists sought workers who would assist them with their work, without challenging their professional authority. To meet this end, dentists drew on contemporary class and gender relations and ideology. Dentists hired working-class tradesmen to perform mechanical dental work: men who could be distinguished from dentists by their lack of formal education and their lack of 'gentlemanliness.' Dentists hired middle-class women to work as dental assistants. Dental leaders argued that middle-class women brought special feminine abilities to their work as dental assistants and yet posed no threat to the dentist's authority. In creating these subordinate occupations, dentists reinforced the definition of their own work as work for middle-class men and solidified their professional authority. Establishing the Division of Dental Labour

The use of dental auxiliaries was associated with many benefits for the dentist: office efficiency, improved income, higher status, and overall well-being (Murray 1912; Contributor 1916: 365; Eaton 1903). With dental auxiliaries, dentists could make more efficient use of their time, while at the same time raising their status. That is, dentists could focus on the higher-paying, more prestigious dental work, while lower-status, less remunerative tasks could be performed by someone else (Contributor 1916; Woodbury 1903). Although the hiring of dental mechanics was highly recommended, dental leaders discussed their work very little. Much more emphasis was placed on the benefits of hiring dental assistants. A dental assistant could save the dentist time and, therefore, money (Eaton 1903: 722; Webster 1922). It was argued that it was 'in the interest of the public from an economic standpoint that every person ... perform the highest service that he is capable of (Webster 1914d: 254). Dentists, thus, could limit themselves to the highly skilled dental operations, while assistants and mechanics took on those tasks dentists viewed as requiring less skill. Dentists further argued that employing dental assistants would improve their health and well-being by relieving them of those 'labourious' (sic) and 'annoying' tasks inherent in running a dental practice (Eaton 1903; Woodbury 1903). Not only did dentists outline the benefits that resulted from the employment of dental auxiliary workers, they also carefully delineated exactly who should be employed in these occupations. While in a previ-

112 A Dentist and a Gentleman ous era the use of a male assistant would not have been uncommon, dental leaders now argued that the job of dental assistant should be filled by women. Dental assistants were alternatively referred to as 'lady' assistants. Women were said to bring certain qualities and abilities to a dental practice that a man could not (Burns 1907; A.E. Webster 1908a; Woodbury 1905a). In accordance with prevailing middle/10(7): 258-61. - 1898b. 'Editorial Notes.' DDJl0(5): 181. - 1899a. 'Shall We Endure or Cure?' DD/11(2): 50-1. - 1899b. The Vexed Question.' DDJll(9): 321-3 - 1899c. 'Editorial Notes.' DDJ'11(9): 326-9. - 1899d. The Overcrowded Question.' £>D/11(9): 323-31. - 1900a. 'Sketch of Dentistry in Canada.' DD/12(7): 225-30. - 1900b. 'Editorial.' DD/12(7): 241-2. Bennett, Bessie Burns. 1908. The Mouth of a Child.' DDJ 20(7): 269-70. Bothwell,J.A. 1917. The Oral Hygiene Convention of the Ontario Dental Society, Held at Toronto, November, 1917.' OH 7(12): 494-8. Bowers, G.H. 1895. The Ideal Dentist.' DDJ 7 (5): 135-9. Box, Harold Keith. 1913a. 'Editorials.' HY 12(1): 13-14. - 1913b. 'Good Citizenship.' HY 12(2): 12-14. - 1913c. 'Sophomores Severely Reprimanded.' HY12(2): 15. - 1913d. 'Editorials.' HY12(2): 26-8. Bradley, Sydney W. 1905a. 'Study.' HY 3(3): 67-8. British DentalJournal 1929. 'Women and Dentistry.' BDJ 50 (April): 420-2. British Journal of Dental Science. 1914. 'Dentistry as a Career for Women. BJDS 57(1112): 369-70. - 1915. Untitled article. BJDS 58: 489-90. Bruce, Inspector. 1913. Comments quoted in Seccombe, 1913. 'Effect of Oral Hygiene on Toronto School Children.' OH3(12): 454.

210

References

Bruce, William. 1895. 'Elements of Success in Dental Practice.' DDJ 7 (8): 215-20. Burns, A.A.S. 1907. 'Assistants in the Dental Office.' DDJ19(8): 281-5 Burt, R.B., andJ.B. Willmott. 1907. Untitled letter to licentiates. Z>D/19(12): 470-1. Butler, Charles S. 1889. The Dental Profession.' DDJ 2(1): 18-26. 'By Request.' 1909. 'Our Ladies.' flY7(3): 68. C.A.D. 1911a. 'Infirmary Patients.' H - 1911b. 'The Hustle.' HY10(l): 17. Canada College of Dentistry. 1869. 'Second Annual Announcement.' Toronto: Daily Telegraph Printing House. 'Canadian.' 1879. 'American Diplomas in Canada.' C/DS4(4): 100-2. Canadian Dental Association. 1949. The Advantages of Careers in Dentistry. Ottawa: CDA. - 1961. The Advantages of Careers in Dentistry. Ottawa: CDA. Canadian Practitioner. 1889. 'Dentistry in Ontario.' (Republished article). DDJ 1(1): 22-3. Capon, FrederickJ. 1900. 'Dental Ethics.' DDJ12(1): 1-6. Chittenden, C.S. 1868. 'Qualifications Required of a Dental Student.' CJDSl 2-4. - 1871. 'Matriculation Examination.' CJDS3(ll): 343-4. Clark, Harold. 1914. 'Diet and Dentistry.' DDJ26(12): 497-504. Clarkson, C.H. 1905. 'Correspondence.' DDJ17(12): 462-4. Clement, Dr. 1898. Excerpted from 'Letters from Old Practitioners on the 30th Anniversary of the Incorporation of the Dental Profession in Ontario.' DDJ 10(10): 350-1. 'Clippings from the Daily Press.' 1917. O//7(10): 436-7. Coghlan, Fred T. 1904. 'Discussion.' Paper read at the ODA meetings, Guelph, ON, Feb. 1904. Published in the DDJ 16(4): 166-7. Cogswell, A.C. 1893. 'Dentistry: Past, Present and Future.' DDJ5(8): 169-76. Committee on Historical Research of the Federation of American Women Dentists (CHRFAWD). 1928. 'Women in Dentistry- 1855-1880.' Journal of the American Dental Association, Sept.: 1735-55. Common Sense. 1903. 'Unprofessional Conduct Traceable to the Apprentice System.' DDJ15(6): 406-10. 'Contributor.' 1916. 'Health, Dental Science and Efficiency.' OH 6(9): 363-5. Coon, W.H. 1908a. 'Editorial: On Hazing.' HY7(l): 18-19. - 1908b. 'Indentures.' HY7(2): 44-5. - 1909. 'Editorials.' HY7(4): 9 Correspondent. 1896a. 'Correspondence: Too Many Dentists?' DDJ8(6): 161

References 211 - 1897a. 'What Are Reputable Men to Do?' DZ>/9(2): 52. - 1897b. 'Why Not Make Prosthetic Dentistry a Trade?' DDJ 9(2): 53. Corrigan, M.P. 1905. 'Literary Culture in the Life of a Dental Surgeon.' DDJ 15 (7): 247-50. - 1906. 'Care of Children's Teeth.' DDJ18(7): 257 Cowan, W.D. 1913a. 'Care of Children's Teeth, DDJ25(10): 441-7. - 1913b. 'Dental Caries in School Children and Dental Inspection.' Public Health Journal 4(11): 602-5. - 1914. 'The Relationship of Dentistry to Good Health.' OH 4(6): 251-61. Cowling, Thomas. 1916. 'The Compendium: The Dental Nurse.' OH 6(8): 348-51. Coyne, N.S. 1911. 'Dental Economics.' OH 1(11): 270-3. - 1912. 'Dental Economics.' OH 2(1): 15-17. Croll, H.A. 1902. 'Discussion.' DDJ 14(5): 180-2. Darby, Edwin T. 1877. 'Rest.' C/D54(2): 61-4. Davy, W.C. 1904. 'Reply to a Toast to the Profession at the RCDS graduation dinner.' HY 1(7): 13-16. - 1910. 'President's Address, EODA' DP 9(5): 231-4. - 1911. 'Necessity for Dental Education of the Public.' DD/13(10): 482-7. Day, Arthur. 1912. Comments Made during ODA Meeting Discussion. DDJ 24(8): 331. - 1917. 'Diseased Mouths a Cause of Ill-Health.' OH 7(8): 317-25. Day, Barnabus W. 1898. Excerpt from 'Letters from Old Practitioners ..." DDJ 10(10): 354-5. DOS, LDS. 1897. 'Overcrowded.' DDJ9(12): 437. Dental Nurses Alumni Association of Canada (DNAAC). 1921. 'Consititution of the Dental Nurses Alumni Association of Canada.' DDJ 33(8): 314-15. Dental Record. 1903. 'Relation of the Dental Profession to Public Health.' DDJ 15(9): 578-80. - 1924. Untitled article. DR44(3): 152-3. Dodds, Lee R. 1920. 'The Origin of the Hya Yaka.' HY 20(2): 63-4. Doherty, W.H. 1912a. 'Relation of Mouth Health to Child Development.' OH 2(7): 262-7. - 1912b. 'Nursery Rhymes in the Clean Teeth Campaign.' DP 12(2): 87-9. DoyleJ.R. 1911. 'Character.' #F10(3): 21-2. Eaton, H.E. 1895. 'Some Elements of Success in a Dental Practice.' DDJ 7(11): 287-91. - 1903. 'Dentist's Assistant and Management of Patients.' DDJ 15(12): 722-6. - 1904. 'The Dentist in the Patient's Eye.' DD/16(4): 168-72. Editor. 1906. 'The Battlefield of Great Forces.' HY 4(1): 7.

212

References

- 1906b. 'Advertising.' HY 6(1): 14-17. - 1907. 'Class History of '07.' HY 4(6): 6-7. - 1908a. 'On Hazing.' HY7(1): 18-19. - 1908b. To the Freshmen.' HY 7(1): 19. - 1912. 'Getting Along.' H711(l): 16. - 1914. 'Editorials.' HY13(1): 18. E.H.C. 1912. 'Coon Day at RGBS.' HFll(l): 24-5. Elliot, George Lewis. 1870. 'An Account of My Stewardship.' Toronto: Bell, Barker and Co., City Stream Press. Ewart, Dr. 1909. 'Culture.' HY. 7(4): 84-5. Reprinted from an address given at Ottawa University. Falloon, W.H. 1909. The Care of Children's Teeth.' DDJ 21(10): 450-6 Fletcher, M.H. 1904. 'Pathological Irregularities.' DDJ 16(10): 500-7. Fones, Dr. 1914. 'A Plan that Solves the Fundamental Problem in School Hygiene.' OH4(2): 62-6. Garvin, Dr. 1912. Comments made during ODA meeting discussion.-DDJ24(8): 329-30. Gies, William J. 1926. Dental Education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching. Gowan, W.C. 1903a. 'Words Improperly Used by Dentists Considered from an Ethical Point of View.' DD/15(4): 206-13. - 1903b. 'Dental Students in Bondage.' DDJ15(9): 595-7. - 1904. 'Care of the Teeth.' DDJ16(6): 296-8. - 1909a. 'Oral Hygiene.' DDJ21 (9): 406-11. - 1909b. Teach Only What is Known.' DDJ 16(12): 538-40. - 1910. 'Mechanics.' DDJ22(4): 198-9. Graham, Joseph S. 1911. 'Asepsis in Dentistry.' OH 1(1): 8-11. Grieve, George W. 1909. 'Care of the Teeth.' DD/21(11): 499-510. Habec. 1912a. 'Are We Doctors or Doctoresses?' DP 12(2): 69-70. - 1912b. 'More about Lady-like Dentists.' DP 12(4): 162-3. - 1912c. 'Inspection of School Children.' DP 13(1): 25-6. - 1914.'Should Not's-Because.' OH4(12): 538-43. Hanna, G.E. 1902. 'Doctorate Address.' DDJ14(9): 345-8. Hanna, Mildred. 1909. Untitled comments. HY 7(6): 150. - 1911. Treatment of Children.' DD/23(2): 75-80. Hermiston, G.M. 1903a. Comments made in ODA meeting discussion. DDJ 15(4): 213-14. - 1903b. 'Neglect of Children's Temporary Teeth.' DDJ15(7): 442-5. - 1907a. 'Ethics in Dentistry.' DD/19(7): 241-8. - 1907b. 'Reverence.' HY6(6): 7-8.

References 213 Holmes, G.H. 1905. The Elimination of Pain in Dental Operations.' HY 2(7): 206-11. Hover, Iva Mae. 1920. 'Effienciency for Dental Assistants.' DDJ 32(9): 305-20. 'H.P.M.' 1920. Treshette's Musings.' //Y19(3): 114-15. Husband, RJ. 1898. 'Our Responsibility for the Future of Dentistry in Ontario.' DDJ 10(8): 281-6. Jean. 1896. 'Correspondence: Too Many Dentists?.' DDJ 8(6): 161-2. Jean Baptiste. 1896. 'Correspondence: What Jean Baptiste Thinks.' DDJ 8(8): 219. Johnson, C.N. 1891. 'Education vs — ?' DDJ3(1): 8-10. - 1900. 'Doctorate Address.' DDJ12(11): 3 - 1903. 'Success in Dental Practice.' DD/15(6): 387-96. - 1912a. Teeth and Health.' DDJ 14(5): 197-4. - 1912b. 'Ethics.' HYl 1(2): 6-12. Kennedy, C.A. 1912. 'Oral Hygiene.' OH 2(2): 62-3. Kenneth, H.G. 1871. 'Something in a Name.' C/DS3(10): 297. 'Kicker' 1890. 'Correspondence.' DDJ 2(4): 185-6. Kilmer, Dr F. 1894. 'Address of... Retiring President of Ontario Dental Society.' 6(8): 177-82. Lake, H.G. 1894. Correspondence to the Secretary of the Toronto Dental Society, dated January 6th, 1894. 'Lay Woman.' 1916. 'Dentistry Much Improved in Ontario in Recent Years.' DDJ 28(8): 297-300. LDS. 1894. 'Preliminary Education for Dentistry.' DDJ6(1): 3-4. - 1896. The "Barber-Dentists.1" DDJ8( Leblanc, L.J.B. 1871. 'Dental Hygiene.' CJDS3(7): 201-7 Lennox, C.P. 1870. 'Dental Education.' CJDS2(12): 358-6 Levee, L.S. 1910. 'Dental Inspection as Important as Medical Inspection.' DDJ22(12): 592-3. Leggo, William A. 1908. 'Legislation of Board of Directors of Royal College of Dental Surgeons.' DP 5(5): 211-12. Lyon, V.H. 1987. 'Elements in Dentistry.' DDJ9(7): 240Magee, James M. 1912. Comments made during ODA meeting discussion. DDJ 14(8): 329. Martin, Charles. 1898. Excerpt from 'Letters from Old Practitioners ..." DDJ 10(10): 352-3. Martin, G.S. 1896. 'Anomalies in Dentistry.1 DDJ8(6): 149-54 - 1898. 'Editorial Notes.' DDJ 10(9): 3 Martin, Dr. 1907. Comments made at ODA meeting. DD/19(8): 287.

214 References Marshall, J.A. 1898. 'Development of Dentistry from 1868 to 1898.' DD/10(8): 273-80. McDonagh, AJ. 1911. 'President's Address, COPA.' DD/23(1): 33-6. McElhinney, Mark G. 1894. '"CheapJack" and Quackery.' DD/6(9): 212-15. - 1899. The Higher Mission of Dentistry.' DD/10(5): 160-4. - 1901. 'Popular Dental Education.' DD/13(9): 329-32. - 1903. 'Correspondence.' #715(12): 754-5. - 1905. 'Historical Advance and Ethics.' DD/17(6): 196-9. - 1907a. 'Manual Training - The Mechanical Hobby.' DP 2(3): 95-8. - 1907b. Comments made during ODA discussion. DD/19(8): 287-8. - 1909. 'Our Profession.'DP 6(5): 185-8. - 1911. 'What the Patient Pays For.' DP 11 (3): 97-100. - 1914. 'Relation of Dentistry to the Evolution of Public Health.' OH 4(2): 76-9. McGee, Dr. 1905. Comments made to students at the RCDS. Quoted in HY 13(2): 26. Mclnnis, S.W. 1896. 'Country Practice.' DDJS(l): 9-10. - 1905. Comments made to students at the RCDS. Quoted in HYHY 3(2): 26. McLaughlin, R.G. 1912a. 'Professional House Cleaning.' DP 12(6): 281-2. - 1912b. Comments made during ODA/CDA meetings. DD/24(8): 326-8. - 1912c. 'Free Dental Clinic Assured for Toronto.' DP 13(1): 44-5. - 1914. 'Chairman's Address, Oral Hygiene Convention, ODS.' OH 4(12): 545-8. McLean, Gordon. 1907. Comments made during ODA meeting. DD/19(8): 285-7. McLennan, William. 1937. 'A Survey of Dental Practice. 'Journal of the Canadian Dental Association 3(7): 363-6. Meadows, Marjorie H. 1922. 'Correspondence: The Dental Nurse.' DD/34(1): 37-8. Mills, G. Alden. 1897. 'Correspondence.' DD/10(1): 27-9. Mitchell, Dr. 1904. Comments made during ODS meeting discussion. DD/16(4): 174-5. Moyer, S. 1903. 'Retiring Presidents Address [ODA].' DD/15(4): 203-5. Murray, C.A. 1912. 'Business Possibilities for a Dentist.' DD/24(8): 333-9. National Council of Women (NCW). 1900. Women of Canada: Their Life and Work Ottawa: National Council of Women of Canada. (Reprinted 1975). Nelles, H.H. 1868. 'Royal College of Dental Surgeons of Ontario.' CJDS 1(2): 41-2. - 1870. 'Dental Hygiene.' CJDS3(1): 6-9. New York Medical Journal (NYMJ). 1908. 'The Common Ground of Medicine and Dentistry.'DP 4(5): 213.

References 215 Newkirk, Garrett. 1913. 'Personal Hygiene Relating to the Dentist.' DDJ25(12): 507-20. 'No More LDS.' 1895. 'Correspondence: One Man Out of It.' DDJ 7(11): 296. 'Notniner.' 1907. 'Pupilage.' HY4(4/5): 20-2. O'Donnell, J. 1898. Excerpt from 'Letters from Old Practitioners ...' DDJW(IO): 351-2. 'Old Dentist.' 1870. 'Success in Business.' CJDS3(l): 13-15. - 1878. 'Dentists as Men of Business - No. 1.' CJDS4( 'One Who Is Proud of His Profession.' 1908. 'Indentures.' HY 7(2): 47-9. O'Neill, James G. 1915. 'Sunbeams and Shadows in Dentistry.' DDJ 27(8): 300-5. 'Ontario.' 1896. 'Correspondence: Too Many Dentists?' DDJ8(8): 218. Ontario Dental Association (ODA) 1867. Proceedings of the 1st session of the Ontario Dental Society, Coburg, Ontario, July 1867. ODA. 1895. 'Proceedings of the Annual Meeting of the Ontario Dental Association.' DDJ 7(8): 219-22. - 1905a. 'Annual Meeting of the Ontario Dental Society, March 13, 14, and 15, 1905.'Z)Z>/17(4): 138-42. - 1905b. 'Petition to the Honorable the Legislature of Ontario.' DDJ17(5): 171. ODA. 1907. 'Discussion at the 1907 Meeting of the Ontario Dental Association.' DDJ 19(5): 216-19. Ontario Dental College, Toronto. 1871. 'Announcement... Session of 18711872.' Toronto: 'Pure Gold' Printing Establishment, 40 Church Street. (Dental Library, University of Toronto). Ottawa Citizen. 1908. 'Editorial.' DDJ 20(5): 186-7. Ottenglui, Dr. 1898. 'Four Classes of Dentists.' DDJ10(2): 51-7. Owre, Alfred O. 1905. 'Ethics.' HY3(7): 182-4. Reprinted from the Dental Review. Pamphlet. 1912. 'Decay of the Teeth: Its Causes and Prevention.' Ontario Department of Agriculture, Women's Institute Branch, and OH 2(9): 337-42. Pearson, C.E. 1903a. 'Professional Etiquette.' DD/15(4): 238-41. - 1903b. 'Report of Dental Education in Ontario, Canada.' DDJ15(5): 304-9. - 1903c. The Beginning of Success in Dental Practice.' DDJ15(12): 715-17. Pearson, N. 1897. 'About Popular Education and the Reasons for It.' DDJ9(5): 161-3. Perplexity. 1897. 'What Are Reputable Men to Do?' DZ>/9(2): 52. Pivnick, M. 1913. 'The Status of the Dental Profession.' HY 11(4): 5-8. Pottles, Alexander. 1910. The Gold Tooth.' Z)Z)/22(2): 78-9. Price, F.D. 1902. 'Retiring President's Address, Toronto Dental Society.' DDJ 14(11): 455-8. - 1912. Comments made during ODA meeting discussion. DDJ 24(8): 328.

216

References

Reade, RobertJ. 1896. 'Dental Ethics.' DDJ 8(2): 33-9. - 1907. 'Mastication of Food.' DP 3(3): 119-21. - 1908a. 'How to Make Dentistry a Department of Medicine.' DP 4(5): 209-11. - 1908b. 'Are the Board of Directors a Responsible Body?' DP 4(6): 221-4. - 1908c. 'A Plan to Avoid Future Hasty Action by Any Board of the Royal College of Dental Surgeons.' DP 5(3): 113-14. - 1908d. 'Indentures.' DP 5(4): 163-5. - 1909a. The Discipline Committee.' DP 6(1): 29-30. - 1909b. 'Appointments Broken.' DP 6(5): 219-21 - 1909c. 'Effect of the New By-Laws.' DP 7(1): 31-2. - 1909d. 'The Discipline Committee.' DP 7(2): 84-6. - 1909e. 'RCDS Graduating Class.' DP 6(6): 271-2. - 1910. 'Editorial.' DP 8(4): 179. - 1911a. 'Free Dental Infirmary.' DP 11(5): 208-10. - 1911b. 'Public Dental Education.' DP 11(4): 167-8. - 1911c. 'Free Dental Clinics for the Poor.' DP 10(5): 211-12. - 1912. The Dental Nurse.' DP 12(4): 177-8. - 1916. 'Dental Hygienists.' OH 6(7): 275-7. Relyea, G.V.N. 1871. 'Extracting Teeth.' C/D53(5): 130-2. - 1872. 'Extracts from the President's Address Before the Ontario Dental Society.' C/DS3(12): 362-5. - 1898. Excerpt from 'Letters from Old Practitioners ...' DD/10(10): 353-4. R.M.T. 1897. 'Overcrowded.' DD/9(12): 436-7. Rogers, Lina. 1912. The Field of the School Nurse.' Otf2(2): 43-7. - 1913. The Nursing Aspect of Medical Inspection of Schools.' OH 3(8): 234-8. Root, J.P. 1901. 'Abuses in Dentistry.' DD/13(9): 358-60. Rowlitt, I.L. 1896a. 'Correspondence: Is the Profession Over-Crowded?' DDJ 8(6): 164-5. - 1896b. 'Our Position as a Profession.' DDJ 8(7): 193-4. Royal College of Dental Surgeons of Ontario (RCDS) Toronto. 1894. Proceedings. - 1895. Proceedings. - 1896. Proceedings. - 1897. Proceedings. - 1898. Proceedings. - 1899. Proceedings. - 1900. Proceedings. - 1901. Proceedings. - 1902. Proceedings. - 1903a. Proceedings.

References 217 - 1903b. Dental School Announcement. - 1904. Proceedings. - 1907. Proceedings. - 1909a. Proceedings. - 1909b. Dental School Announcement. - 1911. Proceedings. - 1913. Proceedings. - 1914. Proceedings. Royal College of Dental Surgeons (RCDS). 1919. 'Establishment of a Course of Instruction for Dental Nurses in the School of Dentistry, Toronto.' DDJ31(6): 206-8. - 1993. Royal College of Dental Surgeons of Ontario, 1868-1993. Dispatch Anniversary Issue. Scharlieb, Mary A. Dacomb, MD. 1915. 'Training Women as Dentists.' British Journal of Dental Science 58: 887-95. Schumacher, Mrs Christine H. 1920. 'Efficiency in Dental Nursing.' DD/32(10): 357-65. Scott, H. 1870. 'Miscellanies.' CJDS2(8): 247-5 - 1871. 'Dental Education.' C/DS3(8): 241-5. Seccombe, Wallace. 1907. 'Dental Ethics.' DD/19(7): 251-5. - 1909. 'Indentureship and the College.' DP 7(4): 139-41. - 1911a. 'Foreword.' OH 1(1): 5-11. - 191 Ib. 'A Matter of Ethics.' OH1(2): 23. - 1911c. 'Dental Education of the Public.' OH1(8): 18 - 1911d. 'Dental Inspector's Outline of School Work.' OHl(W): 256. - 1911e. 'Prevention the Keynote.' OH 1(1): 22-3. - 1911f. 'A Message to the Students of the RCDS.' HY10(1): 6. - 1912. 'Editorial.' OH 2(1): 36. - 1913a. 'The Dental Profession, 1913.' OH 3(1): 37-8. - 1913b. 'Shortage of Dentists and Dominion Registration.' OH 3(1): 38. - 1913c. 'Future Need for Dentists in Canada.' OH 3(1): 15-18. - 1913d. 'A Call to the Dentists of Ontario.' OH 3(5): 189-90. - 1913e. 'Fourth International Congress on School Hygiene.' OH 3(10): 379-80. - 1914a. Untitled. OH4(3): 141-2. - 1914b. 'Address.' DD/26(2): 64-73. - 1915a. 'Dental College Enrollment.' OH 5(9): 406-7. - 1915b. The School Lunch.' OH 5(11): 499-500. - 1915c. 'Localized Dental Clinics for Children.' OH 5(12): 507-13. - 1916a. 'Dental Clinics for Children.' Z)D/28(2): 65.

218 References -

1916b. The Successful Practice of Dentistry.' OH 6(3): 109-19. 1916c. The Little Red Schoolhouse.' DDJ 28(6): 221-5. 1916d. The Dental Hygienist and Preventative Dentistry.' OH 6(8): 358-9. 1917. 'Annual Report, 1916, of Chief Dental Officer, Wallace Seccombe, DOS.' OH 7(3): 90-3. Seccombe, Wallace, and RJ. Reade. 1911. 'Report of the Education Committee of the Ontario Dental Society.' OH1(7): 168-70. 'Senex.' 1894. 'An Ethical Resume.' DDJ 6(8): 187-9. 'Senior.' 1903. 'Correspondence: Student vs Preceptor.' HYl(2): 13-14. 'Sensational Advertiser.' 1898. 'Give the Devil His Due.' DDJ 10(1): 29-30. Simpson, C.N. 1915. 'Services Rendered.' DDJ27(10): 377-83. Smith, A.A. 1904. The Dentist in the Public Eye; Or What Should the Dentist Do to Bring Himself before the Public as an Educated, Cultured Citizen, and a Gentleman.' DDJ16(4): 163-7. - 1908. 'Concerning the Recent Legislation of the Directors of the RCDS.' DP 5(3): 117-18. Smith, P. St C. 1906. 'Dental Fees.' DDJ18(7): 253-6. Snell, F.A. 1902. The Ideal and the Real in Dentistry.' DDJU(10): 407-10. Sophmore [sic]. 1913. Untitled Correspondence. HY12(2): 16. Sparks, R.E. 1897. The Dental Preceptor.' DDJ9(3): 87-92. - 1902. 'Little Courtesies Which Help to Build Up and Retain a Successful Dental Practice.' DDJ 14(12): 463-7. Spiers, F.S. 1914. 'Status of the Professional Man.' HY 12(6): 8-11. Stewart, A.A. 1911. The Ideal in Dentistry.' HY 10(3): 7-8. Stone, A.C. 1868. 'Address Before the Ontario Society of Dentists.' CJDS1(5): 168-71. Taylor, J.A. 1917. 'Oral Hygiene in the Rural School.' OH 7(2): 45-7. Thomson, George K. 1901. The Remedy.' Z>Z>/13(3): 82-5. - 1908. The Dental Education of the Public and School Children.' DDJ 20(10): 365-8. Thornton, A.W. 1902. The Necessity for the Proper Care of Children's Teeth.' DDJ14(5): 177-80. - 1905. Comments made during ODA meeting discussion. DDJ 17(4): 1 - 1907. 'If Not -Why Not?' HY 4(7): 3-7. - 1910. 'No Selfish Motive.' DDJ22(12): 594-5. Toronto Board of Education (TBE), Department of Medical Inspection. 1912. 'First Annual Report.' OH 2(12): 459-81. Toronto Dental Society. 1915. 'Principles of Dental Ethics.' DDJ 27(4): 142-4. Toronto World (editorial from the newspaper). 1910? 'We Salute the Dentist." Republished in the DDJ22(1): 47.

References 219 Totten, E.A. 1899. 'Correspondence.' DDJll(U): 413-15. Trotter, Rich. 1868. 'The Dental Profession.' CJDS 1(3): 98-103. - 1869a. 'Office Management, and the Deportment and Habits of the Dentist.' CJDS 1(9): 266-7. - 1869b. 'Premature Decay of Teeth.' CJDS 1(10): 292-3. - 1869c. 'Premature Decay of Teeth, continued.' CJDS1(12): 354-6. Trotter, W.C. 1903. 'Success in Dental Practice.' DDJ 15(12) 717-21. - 1905. Comments made during of 1905 ODA meeting. DDJ17(4): 138. Truman, James. 1911. 'Henriette Hirschfeld (Henriette Tiburtius), DDS, and the Women Dentists of 1866-73.' Dental Cosmos 53: 1380-6. Unknown Author. 1894. 'Science in Dentistry.' DDJ 6(10): 234-9 Veitch, Ernest C. 1936. 'Ethics and Discipline in Ontario.'Journal of the Canadian Dental Association 2(5): 228-9. 'Veteran.' 1895. 'Correspondence: Proof of Overcrowding.' DDJ 7 (11): 298-9. 'Village Dentist.' 1896. 'Medical Men as Quack Dentists.' DDJ8(7): 194. Webster, A.E. 1901a. 'Recognition of the Dental Profession.' DD/13(8): 317-19. - 1901b. 'President's Address, Toronto Dental Society.' DDJ13(11): 419-25. - 1901c. That Gold Crown.' DDJ13(9): 36 - 1901d. 'Preceptors.' DDJ13(11): 445-9. - 1902. 'Editorial.' DDJ14(2): 76-8. - 1903a. 'How Times Do Change!' DDJ15(5): 337-8. - 1903b. 'Another Private Bill Defeated.' DDJ15(6): 339-402. - 1903c. 'What College Shall the Canadian Dental Student Attend?" DDJ 15(10): 603-5. - 1903d. 'Dentists in the Army.' DDJ15(3): 145-6. - 1903e. 'The Preceptor Question.' DDJ15(7): 477-9 - 1904a. 'Are Dentists Up and Doing?' DDJ16(2): 10 - 1904b. Things about Beginning a Dental Practice.' DDJ16(4): 184-90. - 1905a. The Ontario Legislature and Dentistry.' DZ)/17(6): 225-8. - 1905b. The Relationship of the Dentist to the General Practitioner of Medicine.' Z)Z)/17(12): 460-1. - 1905c. Two Important Subjects.' DDJ17'(8): 304-5. - 1905d. 'Mechanical Dental Laboratories.' £>D/17(3): 114-15. - 1906. 'Women's Institutes.' DDJ18(12): 472-3. - 1907a. 'Permitted to Practice Dentistry.' DDJ19(3): 115-18. - 1907b. The Public and Dentistry.' DDJ19(4): 15 - 1907c. The New By-Laws.' DD/19(12): 467-74. - 1907d. 'Proper Care of the Mouth and Teeth Essential to Go Health.' DDJ 19 (10): 372-80. - 1907e. 'Conduct of Students.' HY 4(6): 1-5.

220 References -

1908a. 'Unqualified Assistants.' Z>£/20(3): 118. 1908b. Two Things.' DDJ20(12): 457. 1909a. 'Dentists in Ontario Must Comply with the By-Laws.' DDJ 21 (8): 34-6. 1909b. 'Educating the Public.' DDJ 21(6): 293-5. 1910a. 'Public Interested in Dentistry.' Diy 22(7): 357-9. 1910b. Comments made during a meeting of the Toronto Dental Society. DDJ 22(12): 592. - 191 la. Till Children's Teeth.' DZ>/13(1): 88-9. - 1911b. 'A Dentist Appointment.' Itf)/23(2): 87. - 1912. 'Dental Office Assistants.' DD/24(8): 323-6. - 1913a. 'Medical and Dental Inspection in Public Schools.' DD/25(12): 549-51. - 1913b. 'The Business of Dentistry.' //Fll(7): 17-23. - 1914a. 'What Are Dentists Going to Do about It?' DDJ 26(3): 145-7. - 1914b. 'Teeth of Soldiers.' DDJ 26(10): 443. - 1914c. The Family Dentist.' Z)D/26(7): 337-9. - 1914d. The Dental Nurse, The Dental Assistant and the Dental Mechanic.' DDJ 26(5): 253-4. - 1915. 'Matriculation in Dentistry in Ontario.' DDJ 27(12): 493. - 1916a. The Dentist Is More than a Mechanic.' Z>D/28(1): 35-6. - 1916b. 'What Has Dentistry to Offer as a Professional Career?' DDJ 28(8): 303-4. - 19l7a. 'Editorial.' DDJ29(l): 23-4. - 19l7b. 'Standards in Dentistry During War Time.' DDJ 29(7): 227-8. - 19l7c. 'Give the Returned Soldier a Chance to Become a Mechanical Dentist or a Graduate Dentist.' DDJ29(12): 395-7. - 19l7d. 'A Blind Alley Profession.' DDJ 29(1): 28. - 1922. 'Dental Nursing.' DDJ34(1): 33-6. - 1923. The Study of Dentistry.' DDJ 35(10): 370-1. - 1926. The Dental Nurses' Course.' DD/28(3): 92-3. Webster, Alfred F. 1908. 'Correspondence.' DP 5(4): 168-9. Wells, F.M. 1908. The Effect of Artificial Light on the Hard Tissues of the Body, Including the Teeth, during the Development of the Child.' DDJ 20(9): 326-9. Whitney, B.T. 1870. 'Valedictory Address.' CJDS2(8): 226Willmott, J.B. 1879. Report of the Directors of the RCDS Board of Directors for the Two-Year Period Ending July 1878. CJDS4(4): 104-5. - 1889. 'Dentistry in Ontario of Age.' DDJ1(4): 157-61. - 1890. 'Address to the Graduating Class of 1890.' DDJ 2(2): 88-92. - 1896. 'Review of Dentistry in Ontario.' DDJ 8(10): 263-9. - 1901. 'Commencement Address.' DD/13(5): 161-6.

References 221 - 1904a. 'President's Address, Canadian Dental Association.' DDJ16( 10): 488-90. - 1904b. 'Royal College of Dental Surgeons of Ontario.' £>D/16(12): 643-4. - 1912. To the Members of the Senior Class.' HYIO(7): 6-7. Willmott, W.E. 1920. 'Some Reflections on the Des Moines Convention.' HY 19(3): 164-5. Wells, R.S. 1871. 'Dentistry vs Money.' C/DS3(11): 332-8. Wood, H.T. 1871. 'On the Advancement of Dental Science.' C/DS3(10): 289-92. - 1898. 'Dentistry and Dentists in Ontario before 1868.' DD/10(8): 266-73. Woodbury, Frank. 1905. 'Dental Assistants.' DD/15(10): 616-17. Woodbury, H. 1903. 'Dental Assistants.' DD/15(10): 616-18. Wright, C.M. 1890. The Dentist's Assets.' DDJl(4): 174-5. Secondary Sources Abbott, Andrew. 1988. The System of Professions: An Essay on the Division of Expert Labor. Chicago: University of Chicago Press. Acker, Joan. 1992. 'Hierarchies, Jobs, Bodies: A Theory of Gendered Organizations.' Gender & Society 4: 139-58. - 1990. 'Gendered Institutions: From Sex Roles to Gendered Institutions.' Contemporary Sociology 21(5): 565-8. Adams, Tracey. 1999. 'Dentistry and Medical Dominance.' Social Science and Medicine 48: 407-20. Barker, Kristin. 1998. 'Women Physicians and the Gendered System of Professions: An Analysis of the Sheppard-Towner Act of 1921.' Work and Occupations 25(2): 229-55. Beaujot, Roderic, and Kevin McQuillan. 1982. Growth and Dualism: The Demographic Development of Canadian Society. Toronto: Gage. Bederman, Gail. 1995. Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880-1917. Chicago: University of Chicago Press. Bielby, William T, and James N. Baron. 1984. 'A Woman's Place Is With Other Women: Sex Segregation within Organizations.' In Sex Segregation in the Workplace: Trends, Explanations, Remedies. Barbara F. Reskin, ed. Washington, DC: National Academy Press, 255-75. Biggs, C. Lesley. 1983. The Case of the Missing Midwives: A History of Midwifery in Ontario from 1795-1900.' Ontario History 75(1): 21-35. Bledstein, Burton J. 1976. The Culture of Professionalism: The Middle Class and the Development of Higher Education in America. New York: Norton. Bourne, Patricia Gerald, and Norma Juliet Wikler. 1982. 'Commitment and the Cultural Mandate: Women in Medicine.' In Women and Work. R. Kahn-Hut, A.K. Daniels, and R. Coluard, eds. Oxford: Oxford University Press, 111-22.

222

References

Bremner, M.D.K. 1964. The Story of Dentistry. 3rd ed. Brooklyn, NY: Dental It of Interest Publishing (Isted. 1939). Buckley, Suzann. 1979. 'Ladies or Midwives? Efforts to Reduce Infant and Maternal Mortality.' In A Not Unreasonable Claim. Linda Kealey, ed. Toronto: Women's Press, 131-49. Games, Mark. C. 1989. Secret Ritual and Manhood in Victorian America. New Haven, CT: Yale University Press. Chebib, F.S. 1973. 'Dentists in Canada: A Study of Movement and Distribution 1957-70.' Faculty of Dentistry, University of Manitoba. Clifford, Geraldinejoncich. 1991. '"Daughters into Teachers": Educational and Demographic Influences on the Transformation of Teaching into "Women's Work" in America.' In Women Who Taught: Perspectives on the History of Women in Teaching. Alison Prentice and Marjorie Theobald, eds. Toronto: University of Toronto Press, 115-35. Coburn, David. 1994. 'Professionalization and Proletarianization: Medicine, Nursing and Chiropractic in Historical Perspective.' Labour /Le Travail^ (Fall): 139-62. - 1997. 'State Authority, Medical Dominance and Trends in the Regulation of the Health Professions: The Ontario Case.' In Alternative Health Care in Canada. J.K. Crellin, R.R. Anderson, andJ.T.H. Connor, eds. Toronto: Canadian Scholars Press, 92-109. Coburn, David, and C.L. Biggs. 1986. 'Limits to Medical Dominance: The Case of Chiropractic.' Social Science and Medicine22: 1035—46. Coburn, David, G.M. Torrance, andJ.M. Kaufert. 1983. 'Medical Dominance in Canada in Historical Perspective: The Rise and Fall of Medicine? International Journal of Health Services. 13: 407-32. Coburn, Judy. 1974. '"I See and Am Silent": A Short History of Nursing in Ontario.' In Women and Work. Janice Acton, P. Goldsmith, and B. Shepard, eds. Toronto: Canadian Women's Press, 127-63. Cockburn, Cynthia. 1983. Brothers: Male Dominance and Technological Change. London: Pluto Press. Cohen, Marjorie Griffen. 1988. Women's Work, Markets, and Economic Development in Nineteenth Century Ontario. Toronto: University of Toronto Press. Cohn, Samuel. 1985. The Process of Occupational Sex-Typing: The Feminization of Clerical Labor in Great Britain. Philadelphia: Temple University Press. Collin, Johanne. 1992. 'Les femmes dans la profession pharmaceutique au Quebec: rupture ou continuite?' Recherchesfeministes5(2): 31-56. — 1995. Changement d'ordannance. Mutationsprofessionelles, identite sociale etfeminisation de la profession pharamceutique, 1940-1980. Montreal: Fides.

References 223 Connell, R.W. 1987. Gender and Power: Society, Person and Sexual Politics. Cambridge: Polity Press. - 1994. Masculinities. Berkeley and Los Angeles: University of California Press. Connor, J.T.H. 1997. 'A Sort of Felo-de-se: Eclecticism, Related Medical Sects and Their Decline in Victorian Ontario.' In Alternative Health Care in Canada. J.K. Crellin, R.R. Anderson, and J.T.H. Connor, eds. Toronto: Canadian Scholars Press. Crompton, Rosemary. 1987. 'Gender, Status, and Professionalism.' Sociology 21: 413-28. Crompton, Rosemary, and Kay Sanderson. 1990. Gendered Jobs and Social Change. London: Unwin Hyman. Davidoff, Leonore, and Catherine Hall. 1987. Family Fortunes: Men and Women of the English Middle Class. London: Hutchinson. Davies, Celia. 1996. 'The Sociology of Professions and the Profession of Gender.' Sociology 20: 661-78. Davies, Celia, and Jane Rosser. 1986. 'Gendered Jobs in the Health Service: A Problem for Labour Process Analysis.' In Gender and the Labour Process. D. Knights and H. Willmott, eds. Brookfield, VT: Gower, 94-176. Davis, Peter. 1980. The Social Context of Dentistry. London: Groom Helm. Davis, Natalie Zemon. 1986. 'Women in the Crafts in Sixteenth-Century Lyon,' in Women and Work in Preindustrial Europe. Barbara Hanawalt, ed. Bloomington: Indiana University Press, 167-93. De La Cour, Lykke, and Rose Sheinin. 1991. 'The Ontario Medical College for Women, 1883 to 1906: Lessons from Gender Separatism in Medical Education.' In Rethinking Canada. V. Strong-Boag and A.C. Fellman, eds. Toronto: Copp Clark Pitman, 207-12. Department of National Health and Welfare. 1947. Survey of Dentists in Canada. Ottawa. Devine, Fiona. 1992. 'Gender Segregation in the Engineering and Science Professions: A Case of Continuity and Change.' Work, Employment and Society 6(4): 557-75. Etzioni, Amitai, ed. 1969. The Semi-Professions and Their Organization: Teachers, Nurses, Social Workers. New York: Free Press. Fahmy-Eid, N., 1997. Femmes, sante etprofessions. Histoire des dietistes et des physiotherapeutes au Quebec et en Ontario, 1930-1980. Montreal: Boreal. Fox, Bonnie J., and John Fox. 1987. 'Occupational Gender Segregation of the Canadian Labour Force, 1931-1981,' Canadian Review of Sociology andAnthropology 24(3): 374-97.

224

References

Fraundorf, Kenneth C. 1984. 'Organized Dentistry and the Pursuit of Entry Control. 'Journal of Health Politics, Policy and Law 8(4): 759-76. Freidson, Eliot. 1970. Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Harper and Row. - 1983. The Theory of Professions: State of the Art.' In The Sociology of Professions. Robert Dingwall and Philip Lewis, eds London. Macmillan. Gaffield, Chad. 1984. 'Wage Labour, Industrialization, and the Origins of the Modern Family.' In The Family. Maureen Baker, ed. Toronto: McGraw-Hill Ryerson. - 1990. 'The Social and Economic Changes of Contemporary Families.' In Families: Changing Trends in Canada, (2nd ed. Maureen Baker, ed. Toronto: McGraw-Hill Ryerson. Gagan, David P. 1989. 'Class and Society in Victorian English Canada: An Historiographical Reassessment.' British Journal of Canadian Studies 4: 74-87. Game, Ann, and Rosemary Pringle. 1983. Gender at Work. Sydney: Allen and Unwin. Gidney, R.D., and W.PJ. Millar. 1994. Professional Gentlmen: The Professions in Nineteenth-Century Ontario. Toronto: University of Toronto Press. Glazer, N.Y. 1991. 'Between a Rock and a Hard Place: Women's Professional Organizations in Nursing and Class, Racial and Ethnic Inequality. Gender & Society 5: 340-70. Glazer, Pienina Migdal, and Mariam Slater. 1986. Unequal Colleagues: The Entrance of Women into the Professions, 1890-1940. New Brunswick, NJ: Rutgers University Press. Glazebrook, G.P. de T. 1968. Life in Ontario: A Social History. Toronto: University of Toronto Press. Glenn, Evelyn Nakano. 1992. 'From Servitude to Service Work: Historical Continuities in the Racial Division of Paid Reproductive Labor. Signs: Journal of Women in Culture and Society 18: 1—43. Godfrey, M. Charles. 1979. Medicine for Ontario: A History. Belleville, ON: Mika Publishing. Goffman, Erving. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, NY: Anchor Books. Graham, Elizabeth. 1974, 'Schoolmarms and Early Teaching in Ontario.' In Women at Work: Ontario, 1850-1930.]. Acton, P. Goldsmith, and B. Shepard, eds. Toronto: Women's Press, 165-209. Greenberg, Saul N., and Joan R. Greenberg. 1963. So You Want to Be a Dentist. New York: Harper and Row.

References 225 Griffen, Larry J. 1995. 'Review Essay: How Do We Disentangle Race and Class? Or Should We even Try?' Work and Occupations 22(1): 85-93. Grossberg, Michael. 1990. 'Institutionalizing Masculinity: Law as a Masculine Profession.' In Meanings for Manhood: Constructions of Masculinity in Victorian America. M. Games and C. Griffen, eds., Chicago: University of Chicago Press, 133-51. Guinier, Lani, Michelle Fine, and Jane Balin. 1997. Becoming Gentlemen: Women, Law School, and Institutional Change. Boston: Beacon Press. Gullett, D.W. 1971. A History of Dentistry in Canada. Toronto: University of Toronto Press. Hacker, Carlotta. 1974. The Indomitable Lady Doctors. Toronto: Clarke, Irwin. Hagan, John, and Fiona Kay. 1995. Gender in Practice: A Study of Lawyers'Lives. New York: Oxford University Press. Hall, Richard. 1975. The Professions.' In Occupations and the Social Structure. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall. Hartmann, Heidi. 1976. 'Capitalism, Patriarchy, and Job Segregation by Sex.' Signs 1(3, pt2): 137-69. Heron, Craig, and Robert Storey, eds. 1986. On theJob: Confronting the Labour Process in Canada. Kingston and Montreal: McGill-Queen's University Press. Howell, Colin D. 1992. 'Medical Professionalization and the Social Transformation of the Maritimes, 1850-1950. 'Journal of Canadian Studies 27 (Spring): 5-20. - 1981. 'Reform and the Monopolistic Impulse: The Professionalization of Medicine in the Maritimes.' Acadiensis 11(1): 3-22. Johnson, Leo. 1974. 'The Political Economy of Ontario Women in the Nineteenth Century.' In Women at Work: Ontario 1850-1893.]. Acton, P. Goldsmith and B. Shepard, eds. Toronto: Women's Press, 13—31. Johnson, Terence. 1972. Professions and Power. London: Macmillan. Kanter, Rosabeth Moss. 1977. Men and Women of the Corporation. New York: Basic Books. Kazanjian, Arminee. 1993. 'Health-Manpower Planning or Gender Relations?' In Gender, Work and Medicine. E. Riska and K. Wegar, eds. Berkeley: Sage Publications, 147-71. Kealey, Linda. 1979. 'Introduction.' In A Not Unreasonable Claim. Linda Kealey, ed. Toronto: Women's Press, 1-14. Kimmel, Michael 1996. Manhood in America: A Cultural History. New York: Free Press. Kinnear, Mary. 1995. In Subordination: Professional Women, 1870-1970. Mc Queen's University Press. Kwolek-Folland, Angel. 1991. 'Gender, Self, and Work in the Life Insurance

226 References Industry, 1880-1921.' In Work Engendered. Ava Baron, ed. Ithaca: Cornell University Press, 168-90. Laqueur, Thomas. 1990. Making Sex: Body and Gender from the Greeks to Freud. Cambridge: Harvard University Press. Larson, Magali Sarfatti. 1977. The Rise of Professionalism: A Sociological Analysis. Berkeley: University of California Press. Levine, Philip T. 1970. 'Distaff Dentists.'Journal of Dental Education 34(4): 3527. Linn, Erwin L. 1971. 'Women Dental Students: Women in a Man's World.' In Toward a Sociology of Dentistry. R.M. O'Shea and Lois K. Cohen, eds. Milbank Memorial Fund Quarterly 49(3): 63-75. MacDermot, H.E. 1935. History of the Canadian Medical Association, 1867-1921. Toronto: Murray Printing. MacDougall, Heather. 1990. Activists and Advocates: Toronto's Health Department, 1883-1983. Toronto:Dundurn Press. MacNab, Elizabeth. 1970. A Legal History of Health Professions in Ontario. Toronto: Queen's Printer. Marsh, Margaret. 1990. 'Suburban Men and Masculine Domesticity, 1870-1915.' In Meanings of Manhood. M. Carnes and C. Griffen, eds. Chicago: University of Chicago Press, 111-27. Marshall, Katherine. 1990. 'Women in Professional Occupations: Progress in the 1980s,' in Canadian Social Trends. Toronto: Thompson Educational, 109-12. McFarlane, Bruce A. 1965. Dental Manpower in Canada. Ottawa: Royal Commission on Health Services. McPherson, Kathryn M. 1996. Bedside Matters: The Transformation of Canadian Nursing, 1900-1990. Toronto: Oxford University Press. - 1999. "The Case of the Kissing Nurse": Femininity, Sexuality, and Canadian Nursing, 1900-1970.' In Gendered Pasts. K. McPherson, C. Morgan, and N. Forestall, eds. Toronto: Oxford University Press. Melosh, Barbara. 1982. 'ThePhysician's Hand': Work Culture and Conflict in American Nursing. Philadelphia: Temple University Press. Millard,J. Rodney. 1988. The Master Spirit of the Age: Canadian Engineers and the Politics of Professionalism, 1887-1922. Toronto: University of Toronto Press. Mitchinson, Wendy. 1991. The Nature of Their Bodies: Women and Their Doctors in Victorian Canada. Toronto: University of Toronto Press. Moldow, Gloria. 1987. Women Doctors in Gilded-Age Washington: Race, Gender and Professionalization. University of Illinois Press. Morgan, Cecilia. 1996. Public Men and Virtuous Women: The Gendered Language of Religion and Politics in Upper Canada, 1791-1850. Toronto: University of Toronto Press.

References 227 Muzzin, L.J., G.P. Brown, and R.W. Hornosty: 1994. 'Consequences of Feminization of a Profession: The Case of Canadian Pharmacy.' Women and Health 21: 39-56. - 1995. 'Gender, Educational Credentials, Contributions and Career Advancement: Results of a Follow-up Study in Hospital Pharmacy.' Canadian Revietu of Sociology and Anthropology. 32(2): 151-68. National Council of Women in Canada (NCW). [1900] 1975. Women of Canada: Their Life and Work. Ottawa: NC Women. Naylor, C. David. 1986. 'Rural Protest and Medical Professionalism in Turnof-the-Century Ontario.' Journal of Canadian Studies 21 (1): 5-20. Nettleton, Sarah. 1992. Power, Pain and Dentistry. Buckingham: Open Univers Press. Parr, Joy. 1990. The Gender of Breadwinners: Women, Men, and Change in Two Industrial Towns, 1880-1950. Toronto: University of Toronto Press. Pentland, H. Clare. 1981. Labour and Capital in Canada, 1650-1860. Toronto: Lormer. Phipps, Polly A. 1990. 'Industrial and Occupational Change in Pharmacy: Prescription for Feminization.' In Job Queues, Gender Queues: Explaining Women's Inroads into Male Occupations. Barbara Reskin and Patricia A. Roos, eds. Philadelphia: Temple University Press, 111-26. Pierce, Jennifer L. 1995. Gender Trials: Emotional Lives in Contemporary Law Firms. Berkeley: University of California Press. Podmore, David, and Anne Spencer. 1986. 'Gender in the Labour Process - the Case of Women and Men Lawyers.' In Gender and the Labour Process. D. Knights and H. Willmott, eds. Aldershot: Gower, 36-52. Prentice, Alison, Paula Bourne, Gail Cuthbert Brandt, Beth Light, Wendy Mitchinson, and Naomi Black. 1996. Canadian Women: A History. 2nd ed. Harcourt Brace. Ramkhalawansingh, Ceta. 1974. 'Women during the Great War.' In Women at Work: Ontario, 1850-1930.]. Acton, P. Goldsmith, and B. Shepard, eds. Toronto: Canadian Women's Press, 261-307. Reader, William James. 1966. Professional Men: The Rise of the Professional Classes in Nineteenth-Century England. London: Weidenfeld and Nicolson. Reskin, Barbara, and Irene Padavic. 1994. Women and Men at Work. Thousand Oaks, CA: Pine Forge Press. Reskin, Barbara, and Patricia A. Roos. 1990. Job Queues, Gender Queues: Explaining Women's Inroads into Male Occupations. Philadelphia: Temple University Press. Reverby, Susan. 1987. Ordered to Care: The Dilemma of American Nursing. New York: Cambridge University Press.

228 References Richards, N. David. 1971. 'Dentistry in Great Britain: Some Sociologic Perspectives.' In Toward a Sociology of Dentistry. O'Shea and L. Cohen, eds. Milbank MemorialFund Quarterly 49(3): 133-65. Roberts, Wayne. 1979. 'The New Woman and Maternal Feminism, Toronto, 1877-1914.' In A Not Unreasonable Claim. Linda Kealey, ed. Toronto: Women's Press, 15-45. Roos, Patricia A., and Katherine W.Jones. 1993. 'Shifting Gender Boundaries: Women's Inroads into Academic Sociology.' Work and Occupations 20: 395-428. Rose, Sonya O. 1986. '"Gender at Work": Sex, Class and Industrial Capitalism.' History Workshop Journal 21:113-28. - 1987. 'Gender Segregation in the Transition to the Factory: The English Hosiery Industry: 1850-1910.' Feminist Studies 13(1): 163-84. Rotundo, E. Anthony. 1987. 'Learning about Manhood: Gender Ideals and the Middle-Class Family in Nineteenth-Century America.' In Manliness and Morality.].^. Morgan and J. Walvin, eds. Manchester: Manchester University Press, 35-51. Rushing, Beth. 1991. 'Market Explanations for Occupational Power: The Decline of Midwifery in Canada.' American Review of Canadian Studies, 21: 7-27. Ryan, Mary. 1981. Cradle of the Middle Class. New York: Cambridge University Press. Schirmer, Gretchen C., and Peta Tancred. 1996. 'Women's Participation within Male Parameters: The Official Presence of Women in Engineering Associations.' Paper presented at the Canadian Sociologists and Anthropologists Association Annual Meetings, Brock University, St Catharines, ON, June. Shortt, S.E.D. 1972. 'Social Change and Political Crisis in Rural Ontario: The Patrons of Industry, 1889-1896.' In Oliver Mowat's Ontario. Donald Swainson, ed. Toronto: Macmillan, 211-35. - 1983. 'Physicians, Science, and Status: Issues in the Professionalization of Anglo-American Medicine in the Nineteenth Century.' Medical History 27(1): 51-68. Shosenberg, James W. 1992. The Rise of the Ontario Dental Association: 125 Years of Organized Dentistry. Toronto: Ontario Dental Association. Silius, Harriet. 1994. 'Gendering the Theories of Professions.' Paper presented at the International Sociology Association, conference on Regulating Expertise: Professionalism in Comparative Perspective, Paris, April. Smith-Rosenberg, Carroll. 1985. Disorderly Conduct: Visions of Gender in Victorian America. New York: Oxford University Press. Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.

References 229 Stern, Madeleine B. 1963. 'The First American Woman Doctor of Dental Surgery: Lucy Hobbs Taylor.' In We the Women. New York: Schulte, 95-117. Strange, Evelyn M., and K.H. Lu. 1965. 'Attitudes of Senior High School Students toward Dentistry as a Career for Women.' Journal of Dental Education 29(2): 175-8. Strong-Boag, Veronica. 1979. 'Canada's Women Doctors: Feminism Constrained.' In A Not Unreasonable Claim. Linda Kealey, ed. Toronto: Women's Press, 109-29. Sutherland, Neil. 1981. "To Create a Strong and Healthy Race": Schoolchildren in the Public Health Movement, 1880-1914.' In Medicine in Canadian Society: Historical Perspectives. S.E.D. Shortt, ed. Montreal: McGill-Queen's University Press, 361-93. Talbot, Nell Snow. 1960. 'Appendix C: Women in Dentistry' in B.S. Hollingshead, Survey of Dentistry. Washington: American Council of Education, 528-61. Tanner, Julian, and Rhonda Cockerill. 1996. 'Gender, Social Change and the Professions: The Case of Pharmacy.' Sociological Forum 11(4): 643-60. Tanner, Julian, Rhonda Cockerill, Jan Barnsley, and A. Paul Williams. 1998. 'Gender and Clinical Pharmacy: The Career of an Occupational Ideology.' Canadian Review of Sociology and Anthropology 35: 535-54. Taylor, Barbara. 1979. "The Men Are as Bad as their Masters ..." Socialism, Feminism and Sexual Antagonism in the London Tailoring Trade in the Early 1830s.' Feminist Studies 5(1): 7-35. Torrance, George M. 1987. 'Socio-Historical Overview: The Development of the Canadian Health Care System.' In Health and Canadian Society: Sociological Perspectives. 2nd ed. D. Coburn, C. D'Arcy, and G. Torrrance eds. Markham, ON: Fitzhenry and Whiteside, 6-32. Torstendahl, Rolf, and Michael Burrage, eds. 1990. The Formation of Professions: Knowledge, State and Strategy. London: Sage. Tosh, John. 1994. 'What Should Historians Do with Masculinity? Reflections on Nineteenth-Century Britain.' History Workshop Journal 38: 179-202. — 1999. A Man's Place: Masculinity and the Middle-Class Home in Victorian England. New Haven, CT: Yale University Press. Valverde, Mariana. 1988. 'Giving the Female a Domestic Turn: The Social, Legal and Moral Regulation of Women's Work in British Cotton Mills, 1820-1850.' Journal of Social History 21(4): 619-34. - 1991. The Age of Light, Soap, and Water: Moral Reform in English Canada, 18851925. Toronto: McClelland and Stewart. Vershel, Allen. 1970. Your Future in Dentistry. New York: Richards Rosen. Walby, Sylvia. 1986. Patriarchy at Work. Cambridge: Polity Press.

230 References Walkowitz, Daniel J. 1990. The Making of a Feminine Professional Identity: Social Workers in the 1920s.' American Historical Review 95(4): 1051-75. Westwood, Sallie. 1984. All Day, Every Day: Factory and Family in the Making of Women's Lives. Urbana and Chicago: University of Illinois Press. Wilensky, H.L. 1964. The Professionalization of Everyone?' American Journal of Sociology 70: 137-58. Willis, Evan. 1983. Medical Dominance: The Division of Labour in Australian Health Care. Sydney: George Allen and Unwin. Witz, Anne. 1992. Professions and Patriarchy. London: Routledge. Wood, Ann Douglas. 1974. The Fashionable Diseases: Women's Complaints and Their Treatment in Nineteenth-Century America.' In Clio's Consciousness Raised. M. Hartmann and L. Banner, eds. New York: Harper and Row. Woodeforde,John. 1968. The Strange Story of False Teeth. New York: Universe Books. Wright, Rosemary. 1996. The Occupational Masculinity of Computing.' In Masculinities in Organizations. 77-96. Cliff Cheng, ed. London: Sage. Wypkema, C., and A.M. Hunt. 1975. Women and Dentistry as a Profession. Prepared for the Dental Health Care Services and Epidemiology Research Unit, Faculty of Dentistry, University of Toronto.

Index

abortion, by dentist, 74 Abbott, Andrew, 5, 180 Adams, John Gennings Curtis, vii, 84, 145-6 advertising, 45-6, 73 anesthesia, 25, 28 appearance, 43-4, 50; students', 141 apprenticeship, 34. See also indentureship. Army Dental Corps, 86-7 authority, dental, 50-2, 72-9; and dental assistants, 113-14, 121, 125; and patients 50-2; over public, 98-9, 103, 107-9. See also patients auxiliary workers, 110-25. See also dental assistants, mechanical men barber surgery, 19 Beers, George W., 188, 191-2 Canada Journal of Dental Science, 37,

187-91 caries, cavities, 24-5, 30 civilization, 11,91, 102 characteristics, 40-5, 142 children, 95-6, 99-108, 112-13

class, race, and gender, 14, 16, 51, 83, 90, 109, 169, 180, 182 clean, cleanliness, 41-4, 97, 120 cost of dental services, 20, 23. See also fees craft skills, 28 craftsmen/tradesmen, 22-3, 54 DBS (doctor of dental surgery), 59-60 demand for dental services, 24—5, 39, 87,95 demeanour, 50—1 Dental Act, 40, 67-8. See also legislation dental assistants: as women, 111-13, 116-19, 123-5; duties of, 119-23; education, training, 123-5; ideal characteristics, 115-19; illegal practice, 70, 73; male 112-13; relations with dentists, 113-14, 117-18, 121-2 dental clinics (for the poor), 105-6 dental college, 34, 37, 56-7. See also RCDS school dental companies, 73 dental disease, 94, 98, 107

232 Index dental hygienists, 122-3 dental nurse, see dental assistants dental patients, 28, 34, 41, 50-2. See also patients, dentists relations with dental practice, 25-8, 48; efficiency, 110-11; hours, 48-9; locations, women, 155, 164; and science, 80; standards, 30 dental technicians, see mechanical men dentistry: early dentistry in Ontario, 19, 22-4; early history, 4, 19-20; expansion in Ontario 24—9; United States 19-21 dentists: backgrounds, 62; numbers of, 25, 27-8, 31; relations with assistants, (seedental assistants, relations with dentists); as role models, 44, 52; roles, 30; types of (divisions), 26-8 dentures, 20, 22-3, 25, 114 discipline, professional, 56, 72-3; discipline committee 73-5 division of labour: family, 10-11, 121; gender, 10-11; dental, 110-23; professional, 175 doctrine of separate spheres, 12-14, 161, 197n3. See also gender ideology Dominion Dental Journal, 187-91

edentulous, 24 education: expense (cost), 128, 162; length (period), 58; standards, 60, 71; subjects of study, 31, 42, 58, 60, 62; of patients/public, 95-101, 103-6, 113. See also students; indentures; dental assistants, education; RCDS school effeminate dentists, 49

entry, control, entry into profession, 35-7, 57 ethics, 26, 56 Fauchard, Pierre, 19 fees, 46, 48, 80 femininity, 155-6, 166, 168-9, 184 feminization of professions, 177-80, 181 First World War, 85-8 food, 99 gender, 6, 62, 181-4; conceptualization 181-3; in combination with class and race 6, 107, 182. See also class, race and gender gender and professions, 3-5, 7, 168-76, 175, 180, 197nl, 205nlO gender identity, 7, 45 gender ideology, 6-7, 12, 14, 50 (see also doctrine of separate spheres); and dental assistants, 112; and public education, 96, 107; and women in professions, 169-71 gender relations, 4, 7, 8, 40, 50, 119 gentleman/gentlemen, 7, 41, 44, 50, 75,80 hazing, 131, 136-9 health, 41, 49, 92, 163; health care, 200-lnl; professional intervention and health, 83; relationship of dental to broader health, 93-4, 96, 100 hobbies, see leisure activities Holmes, Sadie, 151, 156-7 honesty, 41-2, 44 hustles, see hazing Hya Yaka, 126, 193

Index 233 ideal, dental, 38, 40-5, 52-3, 56, 71, 76; refining ideal, 77-81. ideology, social, 6, 81. See also gender ideology illegal practice, 35, 67-72; by dental assistants, 69, 70, 73-5; by dental students, 69; by U.S. dentists 69; by mechanical men, 114; by women 68, 146, 205nl; campaigns against 68 illegal practitioners, 40, 47, 67, 69, 72 immigrants, 90, 93, 102, 105 income, 24. See also fees indentures, 64-6, 128, 132-6 indentureship, 34, 57-8, 132 inspection, school, 103-6 inter-professional relations, 84, 175, 180-1. See also medical-den relations itinerant practice, 22, 29 journals, dental, 187-93 jurisdiction, 82 Law, profession, 161, 171, 173-5 LDS (Licensed Dental Surgeon), 36, 59. See also licences legislation, dental, 6, 30-4, 39-40, 67-70, 73; debate and support surrounding 31-2. See also Dental Act leisure activities, 49 licences, dental: criteria for, 35; cancelling 72, 74. See also LDS male-dominated professions, gender and, 3, 25 manhood, 8, 11, 14-15, 66, 81, 138, 159 (see also masculinity); definition of, 14-16; discourses of, 50-66; and education, 131, 134, 142; lan-

guage of, 15, 17, 55; and professionalism, 8, 11, 16-17, 41, 48, 81, 173-5; of quacks, 45, 47-8 masculinity, 7-8, 14, 40-1, 183. See also manhood matriculation, 56-7, 59, 61-2, 69, 71 mechanical men, 114-15, 204nl medical profession, 20, 32-3, 35, 51, 61, 75-8, 110, 173, 178; women in the, 158-9, 161, 163, 170-1 medical-dental relations, 35, 79-80, 82-5 medicine, 35, 82, 200-lnl middle-class, rise of, 9-14 midwifery, 83 morality, 12, 94, 100, 202nl nineteenth-century social change, 8-14 nursery rhymes, dental health, 104—5 nursing, nurses, 168-70; and dental inspection of schoolchildren, 103-4, 106-7 offices, 44 Ontario Dental Association, 29-31, 57, 140, 155 overcrowding, 60, 87 pain, 20, 51 paternalism, 52, 106-7 Patrons of Industry, 39 patients, dentists relations with, 48, 50-2. See also, dental patients; authority pharmacy, 83, 161, 177-8, 179 preventative dentistry, prevention, 101 private bills, 70, 134, 151

234 Index profession: definition of, 5-6; rise of, 8 professions and middle-class manhood, 11, 16-17, 41,173-5. See also, manhood, and professionalism professional discipline, see discipline professional ideal, 3, 40, 54. See also ideal, dental professional identity, 45 professional leaders, 52-3, 62, 75, 188,190 professional roles, 7, 40 professional service, 76, 78-9 professionalism, 48, 56; and manhood, 41, 77, 126,143 professionalization: definition of, 6; processes of, 14-17, 60, 75 public health movement, 90, 99, 101-8, 203n9 public respect, 44, 57, 77, 80, 85-8

schools, see dental college school inspection, see inspection, school science, 58, 76-7, 79-80; medical science 80, 82 socialization, 126-7, 133, 139-43. See also, students social legitimacy, 6, 78, 72, 98 social mobility, viii, 55, 160 social purity (movement), 90, 108-9 status, 6,11, 38, 40, 44, 57,59, 70, 77, 85, 88, 90, 100, 123 students, dental, 77, 65-6; age, 127-9; ideal, 130, 139-143; illegal practice, 69; numbers of, 61, 87; student culture, 126, 132, 138 tooth-brushing, 99, 104, 108 Toronto Board of Education, 103 transformation, of students at school, 126, 131-2, 139, 142 turnkey, 22-3

quacks, 30, 44-8, 73 race, 11, 52, 62, 96, 170, 203n8 racism, 102, 129-30 race degeneracy, 52, 90-2, 94-5, 101, 163-4 rank-and-file dentists, 53-4, 66 rational, rationality, 51 recruitment, 43-56, 61, 87-88 religion, 11,129 respectability, 12, 28, 30, 50 Royal College of Dental Surgeons of Ontario (RGBS), 3, 34, 36, 57, 67, 71, 114, 135; board powers, 34-5, 73-4; RGBS school, 126, 129. See also dental college Royal Bental Society, 142

United States, 19-20, 69, 158 University of Toronto, 58, 60, 62-3 unethical behaviour, 27, 73. See also quacks vulcanite, 25, 28 Wells, C.L. Josephine, 149, 152 Willmott, J.B., 58 Witz, Anne, 7,172 women: as assistants, 111-13; education, 13, 92; as patients, 41, 50-1; and public dental education, 96-101; and public health, 107 (see also nursing, nurses); and race degeneracy, 92-3; in US dentistry,

Index 235 21; as wives, 48, 124, 145-6; work 9, 11 women dentists, 144-66; barriers to practice, 160-4; in dental school, 130-1, 137-8, 154-5, 162, 164; early practice, 145; entrance into

dentistry, 144, 147-8, 157-160; illegal practice, 68, 146, 205nl; practice locations 155 work (men), 10-11, 16 working-class people, 90-3