A History of Dentistry in Canada 9781487596361

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A HISTORY OF DENTISTRY IN CANADA Beginning with the earliest records available describing the dental health of the Indians before the arrival of European settlers, Dr Gullett gives a detailed and carefully documented history of dentistry in Canada. He describes the unscrupulous tramp dentists who roamed the countryside years ago as well as their respectable contemporaries, and he traces the development of practice, education, and professional associations, as dentistry developed from an art to a science. The author spent five years gathering information for this book from public archives, libraries, personal interviews, and the records of the profession. The result is a lively and readable story told with a continuing concern for health services. D.W. GULLETT has had a long and distinguished career in the dentistry profession. He graduated in dentistry from the University of Toronto in 1923 and practised in Picton, Ontario, until 1940. Subsequently he was secretary of the Canadian Dental Association, 1942-64, registrar-secretary of the Royal College of Dental Surgeons of Ontario, 1940-56, and president of the American College of Dentists, 1959-60; since 1966 he has been an archivist of the Canadian Dental Association.

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D. W . GULLETT

A history of dentistry in Canada

PUBLISHED FO R THE CANADIA N DENTA L ASSOCIATIO N B Y UNIVERSITY O F TORONT O PRES S

© Universit y of Toronto Press 1971 Printed in Canada by University of Toronto Press Toronto an d Buffal o ISBN 0-8020-1759-2 Microfiche ISBN 0-8020-0048- 7 LC 79-151370

Our professional ancestors have passed on to us standards of value based on accumulative experience, and these standards have become a part of the spirit of dentistry. Therefore, it is important that we rescue some of the ideals of the past and use them in charting the course for the future . P. G. Anderson Associate Dean Faculty of Dentistry University of Toronto 1955

PICTURES COURTESY OF: Faculty o f Dentistry, University of Toronto, page 7; Gagnon Collection, Montreal Cit y Library, pag e 14 ; Notman Archives, McCord Museum, McGill University, page 22; Faculty o f Dentistry, Dalhousi e University , pages 28, 72, 114 , 264; Quebec Public Archives, page 34 ; Ontario Archives , page 37; Ontario Dental Association , page s 41, 71; Royal College o f Dental Surgeon s of Ontario , pages 59, 94; Glenbow-Alberta Institute, page 68; Alberta Dental Association, page 69; Paul-E. Poitras Collection, pag e 85; Hon. Chief Justice Dalton C . Wells, page 87; Dr. G. Ratté, page 88; New Brunswick Museum, page 119; Faculté de chirurgie dentaire, Université de Montréal, pages 139, 264; Faculty of Dentistry, McGill University, pages 140, 263 ; McGill University, page 15 3 ; Manitoba Dental Associa tion, page 154; Faculty of Dentistry, University of Alberta, pages 180, 261; Royal Canadian Dental Corps, page 203 ; Faculty of Dentistry, Universit y of British Columbia, page 261 ; University of Western Ontario, pag e 262; Faculty of Dentistry, University of Manitoba, page 262; University of Toronto, page 263.

Contents

Preface i 1 Th e first Canadians 3 2 Earl y colonial perio d ( 1800-1839 )1 3 Lat e colonial perio d ( 1840-1859) 2 4 Creatio n of a profession ( 1860-1869 ) 3 5 Forma l educatio n (1870-1879 ) 5 6 Expansio n (1880-1889 ) 6 7 Technica l advancemen t (1890-1899 ) 8 8 Nationa l organization (1900-1904 ) 10 9 Ora l sepsis (1905-1909) 11 10 Professiona l freedom (1910-1914 ) 13 11 Wa r years (i) (1915-1919 ) 15 12 Altere d concepts of training (1920-1924) 16 13 Publi c health (1925-1929 ) 17 14 Depressio n year s (1930-1934) 18 15 Co-ordinatio n (1935-1939 ) 19 16 Wa r years (n) (1940-1944 ) 20 17 Peacetim e adjustment s (1945-1949 ) 21 18 Broadene d social concepts (1950-1954) 23 19 Assessmen t (1955-1965) 25 Notes 26 Appendices 27 Index 30

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Preface

The developmen t o f the ar t an d scienc e o f dentistry i n Canada parallel s the historica l developmen t o f the countr y a s a whol e wit h considerabl e exactitude. At the time of Confederation in 1867, dentistry had develope d as a recognizable profession . A s further province s becam e identifie d one by one with Confederation, s o too were their dental professions ready fo r identification. Fe w like to admit that tim e of war i s one o f progress. Ye t three wars - th e Boer War and the two world wars - i n which Canada as a nation ha s been a participant, mar k significan t period s of advancement in Canadian dentistry. Archaeological record s sho w that ma n ha s suffere d fro m denta l dis eases fro m earl y times . Through th e age s dentistr y i n various forms ha s been practised by many types of practitioners. I t was on the Nort h Ameri can continent, however, and during the first half of the nineteenth century, that dentistr y firs t becam e a separat e profession . Th e formatio n o f th e Society of Surgeon Dentist s o f th e Cit y and Stat e o f New York i n 183 4 and o f the America n Societ y o f Dental Surgeon s i n 1840 , th e establish ment of the American Journal of Dental Science in 1839, and the chartering of the Baltimor e College of Dental Surger y in 184 0 se t a pattern fo r dentistry not to be found elsewher e in the world. The development o f the dental profession in Canada and the United States has been along paralle l lines. It has been wel l said that a country which is not interested i n its past either ha s non e o r i s ashamed o f it . Thi s i s equally tru e o f a professio n within a country. I t i s impossible t o comprehen d th e present , muc h les s guess at the future, without knowledge of the past. The present i s so close

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to us , o f so immediate and pressin g importance, tha t w e are incline d t o forget that our predecessors had problems, s o different fro m an d yet comparable to ours. History, to be worthy of the name, must be not only descriptive of that of which we are proud, but also not guilty of excluding that which we may not regard with pride. The dental profession constitutes but a small section of society and for an understandin g of its attitudes and action s it is necessary to know something of the environs of society as a whole. To one who chose to become a dentist during his seventh year, an d ha s never regretted the choice, the gathering together of the facts related herein has been a labour of love. The selection from voluminous subjec t matter and th e writin g of the tex t ha s been difficul t an d laborious . Ever y state ment of fact has been reasonably documented. For the comments upon the factual informatio n I accep t responsibility. In severa l instance s informa tion hande d dow n ove r th e year s wa s foun d a t varianc e wit h origina l sources. Special care has been exercised respecting such instances . The pla n o f th e boo k wa s establishe d t o cove r th e developmen t o f Canadian dentistry, but wit h room for detailed account s of the histor y of the profession in individual provinces. Organizations within the profession have altered titles from tim e to time : th e policy has been t o us e the title current at th e time of reference. My original ambition was to includ e al l significant achievement s with du e credi t t o th e dentist s responsible . I n order to keep within reasonable bounds, however, it became necessary t o be selective and concise. I hav e had the ful l co-operatio n o f the variou s denta l organizations , dental libraries, and other professional bodies in compiling basic information. A grea t numbe r of individua l dentists have assisted in establishin g facts and it is not possible to list them all here. A few, who have exceede d what migh t be expecte d o f any individual , are: G.M . Dewi s of Halifax , C.C. Bourne and Mervyn A. Rogers of Montreal, Conra d Godi n of Three Rivers, John Clay of Calgary, and J.D . Hawkin s of Edmonton. Th e lat e Paul-E. Poitra s o f Montrea l lef t a larg e privat e collectio n o f historica l items on dentistry, which I have ha d th e pleasure o f studying. J. Stanle y Bagnall of Halifax, during his latter years, compiled voluminous historical notes from the literature which I have utilized. Much informatio n ha s com e fro m archive s an d referenc e libraries , and credit appears in the text for the main items from these sources. How ever, I should like to express my gratitude for the courteous and generous

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assistance given during my visits and for the care exercised i n replying to my numerous letters of inquiry to: British Columbia Provincial Archives , Victoria; Glenbo w Foundation , Calgary ; Saskatchewa n Provincia l Ar chives, Regina; Manitob a Provincia l Archives , Winnipeg; Royal Ontari o Museum, Toronto ; Toronto Referenc e Library ; Ontari o Archives , To ronto; Montreal City Library - Gagno n Collection; Archive s du Québec, Quebec; Ne w Brunswic k Museum , Sain t John ; Th e Publi c Archives , Halifax; Public Archives of Canada, Ottawa . I am greatly indebted to Dr W.G. Mclntosh, who read the manuscript an d made valuable suggestions and t o M r Ia n Montagne s o f Universit y of Toront o Pres s fo r hi s sag e advice and counsel. Without th e patienc e an d assistanc e o f m y wife , Alice , thi s boo k would not have been possible. She has done practically al l the typing and assisted at each stage of preparation. Willowdale, Ontario

D.W.G.

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A HISTOR Y O F DENTISTRY I N CANAD A

Official emble m o f dentistry i n Canada

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1

The first Canadian s

The developmen t o f a profession is inextricably relate d t o th e histor y of the countr y wherei n i t exists . Advance d profession s ar e no t forme d i n underdeveloped countries . (This is not to say, however, that in develope d countries al l professions need be equally advanced . Som e ma y lag.) Th e history of Canad a i s a short one , bu t durin g it the denta l professio n ha s advanced rapidly and progressively along with its homeland. The advanc e has not been even from coast to coast. Canada is the second largest countr y in the world, exceeded i n area onl y by the USSR . Its developmen t ha s oc curred b y regions, whic h gradually wer e united i n a federatio n o f prov inces. In much the same way the segments of society, including the profes sions, have grown regionally and been co-ordinated . Geography ha s alway s playe d a n importan t par t i n th e histor y o f Canada. Th e patter n o f settlemen t wa s alon g th e souther n borde r i n clusters which eventually coalesced int o a ribbon o f population stretchin g 4,000 miles from th e Atlantic to the Pacific. As population increased , th e ribbon widened northward. Because of the size of Canada and the distribution o f it s people , organizatio n i n al l phase s ofte n prove d difficult . I t i s easily understood tha t individual s living on the Atlantic sid e might think quite differentl y fro m thos e o n th e Pacifi c side , particularl y whe n com paratively few Canadians ever travel completely acros s their own country . These fact s ar e basic to an understanding of the nature and progress of a profession from birth to maturity. Toothache an d othe r denta l disorder s arrive d i n Canada , insofa r a s we ca n guess , wit h th e firs t inhabitants . Ou r knowledg e o f condition s among the early Indians and Eskimos is recent and fragmentary, based on

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HISTORY OF DENTISTRY I N CANADA

the researc h o f anthropologists, bu t th e evidenc e suggest s that th e inci dence of dental disease was high indeed before the white man came to this continent. Among some Indian cultures, ossuary burials occurred approximatel y every te n years . A t suc h times a 'Feas t o f the Dead ' wa s held, an d th e village dead were exhumed from thei r individual primary graves and re buried i n a common larg e pit . A considerabl e numbe r of these ossuar y sites are known and two of them near Toronto (th e Robb and Fairty sites) have been carefully excavate d during recent years. Both have been date d to th e 1500s . An analysi s of finds at th e Fairt y site , involving a study of approximately 36,00 0 bones with the expecte d proportio n o f upper an d lower jaws, has been published.1 It states: Premortem los s o f teet h ha s occurre d i n 44 % o f maxilla e an d i n 77 % o f mandibles. The ages represented are : prepuberta l - 28% ; adolescent - 14% ; adults - 58% . Abou t 20 % o f jaws are with periodonta l diseas e an d abscess formation. Molar s hav e th e highes t evidenc e o f premorte m loss , followe d by premolars and canines .

The incidence of caries in remaining teeth was: lower molars, 62% ; upper molars, 53% ; premolars, 1 3 % ; canines, 7% ; incisors, 6%. The incidence of hypercementosi s was : uppe r molars , 47% ; lowe r molars , 35% ; canines, 20% ; incisors, 7% . A t the pre-Iroquois Robb site , carie s were found i n abundance , alon g wit h periodonta l diseas e an d considerabl e cementosis.2 Muc h the sam e incidence of denta l diseas e wa s discovere d at a Huron ossuary site near Midland, Ontario, dated to 1636 : the buria l ceremony i s described b y Father Brébeu f i n th e Jesui t Relations. 3 On e further example , a pre-Iroquoi s buria l in Ontario know n as the Bosom worth Site , containe d the bone s o f at leas t 1 5 adults and nin e children. 4 All adult skull s showed signs of denta l pathology : caries , attrition , pre mortem tooth loss, and alveolar abscesses were common, as well as slight evidence of periodontal disease. On the basis of such evidence, Indians must have suffered sever e pain from dental disease. We can only guess how they treated it: thei r medicine men belonge d t o a secre t societ y an d littl e i s known of thei r practices . However, th e discover y o f jawbones with on e o r mor e teeth , o r indee d all of them, removed befor e deat h suggests that som e manner o f extrac tion had occurred. I n some cases it appears that heroic action wa s taken, resulting in the removal not only of the tooth bu t o f the alveola r process .

The first Canadians 5 In others the tooth appear s t o hav e been removed without destruction of surrounding tissues. Writings on the medicin e man ar e confine d largel y to description s of an Indian, elaborately dressed in skins and feathers, who performed com plicated magica l ceremonies. I t is known, however, that a second typ e of medicine ma n existed , wh o dresse d i n ordinar y fashio n an d treate d th e sick wit h variou s herbs. A compendiu m o f India n medicina l plant s an d their application s has been established. 5 It list s poultice s mad e fro m th e leaves, bar k o r root s o f severa l differen t kind s o f wil d plants , an d i t i s reasonable to assume that these were used to treat abscessed teeth. Specific herbal remedie s ar e give n fo r toothache : 'Iris-roo t inserte d i n a cavit y will kill nerve, tooth will come out'; 'bit of [yarrow] root inserted in hollow tooth for toothache.' In desert regions of North America , turtle back was commonly referre d t o a s 'toothach e plant, ' an d th e drie d leave s wer e chewed on the sid e of the mout h that hurt. There are eve n suggestions of preventive dentistry . In hi s exhaustiv e study, The Bella Coola Indians, T.F. Mcllwrait h noted: 'Whe n a milk tooth i s lost, anyon e who happens to be present, should pick it up, pass it four time s around the child's hea d sunwise and throw it away.' No explanation for this West Coast custom is given, bu t i n thi s respec t India n folklor e was n o mor e mysteriou s (o r unfounded) tha n some followed today. There i s reason t o believe that th e incidence of dental diseas e varie d considerably amon g the Indians. An Englis h surgeon wrote in 188 5 tha t he ha d see n Indian skull s with perfect dentitions at York Factory, where he wa s employe d b y th e Hudson' s Ba y Company. 6 I n som e case s th e teeth were well worn down, which he attribute d t o th e habi t o f chewing pitch. On the other hand, he stated that Indians suffered a great deal fro m toothache, an d tha t aphous and ulcerativ e stomatitis epidemics were an nual occurrences . Considerabl e variatio n i n th e incidenc e o f carie s wa s reported fro m are a t o are a amon g moder n Cree s an d Chipewayan s in a study published in 1930. 7 The Indian s examine d were for th e most par t adults, an d th e number s involve d wer e small . A t Fitzgeral d an d For t Smith, 54% o f the men had sound teeth, bu t at Fond-du-lac the incidenc e of sound teeth skyrocketed to 76% fo r the women and 94% fo r the men . The autho r commented : 'I f t o hav e sound teet h b e th e mar k o f a pur e Indian, an d i f to have carious teeth a n indication that ther e is a strain of white blood i n the stock , the n the Fond-du-la c me n and wome n are th e purest.' Behind this statement seems to be the belief, held for many years, that

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HISTORY O F DENTISTR Y I N CANAD A

the whit e ma n brough t denta l diseas e t o th e nativ e people s o f Nort h America. Anthropologica l evidenc e doe s no t suppor t thi s theory . Som e exceptional find s hav e bee n made , i t i s true . On e o f th e mos t excitin g archaeological discoverie s i n easter n Nort h America , mad e a t Por t a u Choix, Newfoundland, in the summe r of 1968 , reveale d skeleta l remain s that b y radiocarbon tes t ar e 4,30 0 year s old . Virtuall y n o denta l carie s could b e foun d i n them , thoug h man y individuals ha d ver y wor n teet h with th e pul p cavit y ofte n exposed , resultin g i n apica l abscesses. 8 Thi s evidence indicates that dental caries did not in fact exist among Indians a t that early date, at least not in this tribe. On the other hand, a study of an Ohio India n buria l ground , date d t o 90 0 AD , reveale d tha t 70 % o f th e people ha d abscesse d teeth , mor e tha n hal f ha d los t on e o r mor e teet h from periodonta l disease , and onl y three ou t o f 10 3 skulls did no t sho w tooth decay. 9 Th e difference , i f any , befor e an d afte r th e whit e man' s arrival appears to be one of percentage i n the incidence of dental diseas e rather than its absence or presence. Across Canad a ther e were some fifty different India n tribes . Among them the prevalence of dental disease varied considerably. Generally, thi s variation has been attributed t o diet. It i s said that cor n planter s suc h as the Iroquois were prone to tooth decay because of their mush diet, whereas those hunters whose diet was almost exclusivel y of protein an d fa t wer e almost immune to caries. Methods of treatment for dental disorder varie d as well from trib e to tribe. Th e herbs employed were those near a t hand. The Iroquois used blue flag for toothache. Th e Ojibwa y used camas root. The Haida cauterize d the nerve of a decayed tooth wit h a sharp slive r of flint, and chewed spruce gum to kee p their teeth white . The Beothuk s of Newfoundland gav e teething infants inflate d fish bladders t o chew on. T o categorize dental diseases and treatments amon g the India n tribes would be an interesting but most difficult task . The Eskimo is noted for th e use he makes of the few natural resourc e materials availabl e to hi m in the Arctic. Hi s carvings in stone, ivor y and bone in particular have gained for him a high reputation. Th e ingenuity of one Eskimo is shown in the accompanyin g illustration. Durin g his travels on the fringes o f th e white man's civilization this man foun d a vulcanit e denture wit h centra l an d latera l inciso r teeth . I t s o happene d tha t th e same teet h wer e missing in his ow n mouth, togethe r wit h som e others . From ivory he proceeded t o carve teeth to fit the extra spaces in his mouth, bored holes in the vulcanite, and tied the pieces of ivory in proper position . He wor e th e denture , w e are told , wit h a considerabl e degre e o f pride . Now it is in the museum of the Faculty of Dentistry, University of Toronto.

The first Canadians 7 In 1939 , C.H.M . William s of that facult y investigate d denta l healt h among Eskimos o f Canada's Easter n Arctic. 10 Among his findings were: that immunity to caries existed, except among those Eskimo with access to white man's food; that susceptibility to periodontitis was almost universal; that the roots o f Eskimo teeth are surprisingly short an d sharply tapered; and tha t considerabl e mobilit y o f teeth existe d b y ag e 45 , wit h 20 % o f teeth per individual missing. The Eskimos ha d thei r shamans , correspondin g i n many respects t o the medicin e men o f th e Indians . Som e wer e trained b y apprenticeship , while other s receive d thei r power s throug h a sudde n vision. The y use d juggling tricks, but their usual practice was to induce in themselves a kind of temporar y dementi a an d i n that conditio n giv e utterance to mor e or less incoheren t ravings , whic h th e lait y interprete d a s instructio n fro m oracles whic h would drive out th e evi l spirits. Eskimos wer e ignorant of herbal medicines but could bandage a wound and wer e capabl e of using splints for a broken limb.11 The firs t dentis t t o visi t th e Canadia n Arcti c wa s W.P . Milla r o f Edmonton, who went in response to the urging of the Hudson's Bay Com-

The ingenuity of the Eskimo

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HISTORY O F DENTISTRY I N CANAD A

pany post manager s i n the fa r north . Milla r spen t si x months durin g th e summer of 1922 travelling some eight thousand miles, down the Macken zie River, the n west, an d bac k via Bering Strait t o Vancouver . A t every landing along the wa y he was met by dental sufferer s wh o were ready t o fight for a place in his operating chair. According to the published accoun t of the trip, the Eskimos were very receptive to the services offered bu t th e Indians were suspicious. Along the way, Millar employe d a s an assistan t an Eskimo named Mike, who at the en d of the journe y asked i f he coul d buy the equipment. Millar jokingly named a price. To his surprise, 'Mik e pulled out a roll of Canadian currency sufficient t o choke an ox and immediately becam e the possesso r o f the apparatus. ' Mik e loaded th e equip ment on his sleigh, and drove his team of huskies into the unknown eastern Arctic.12 Unt u hi s death i n 1930 , h e wandered acros s th e Arcti c regio n extracting teeth, becoming a small legend as 'Siberian Mike,' the Eskimo's dentist. Presumably , th e tas k wa s no t difficult , owin g t o hi s patients ' susceptibility to periodontitis and the short tapered roots of their teeth. Practically al l account s o f earl y Canadia n histor y relate , wit h con siderable variation, how Jacques Cartier and his men suffered fro m scurvy during the winter of 1535-6, while they were frozen i n near the site of the present cit y o f Quebec . Cartie r himsel f wrot e a narrativ e o f the voyage , which wa s published a s a smal l boo k (Bref récit) i n 1545 . O f th e 11 0 Frenchmen, th e diseas e eventuall y killed 2 5 an d al l but thre e wer e dis abled. In despair, an autopsy was performed on the body of one of the first victims, Philippe Rougemont o f Amboise. This was the firs t postmorte m in Canadian history, but unfortunately, it gave no clue to a remedy. Car tier's book is of particular interes t to dentists, because of its description of the oral manifestations of the disease: 'An d al l the sick had their mouth s so tainted and their gums so decayed that the flesh peeled of f down to th e roots o f thei r teet h whil e the latte r al l fel l ou t i n turn. ' Al l woul d hav e probably perished miserably , had not the captai n notice d tha t a n India n named Do m Agaya , who two weeks earlier ha d bee n sufferin g fro m th e disease, ha d regained hi s strength and health. Throug h careful inquiry, it was discovered that the Indian remed y was to boil the bark an d sap of a tree, 'the n to drink of the same decoction ever y other da y and to put th e dregges of it upon the legge s that i s sick'. 13 The Indian s terme d th e tre e annedda or 'Tree of Life'; various investigators have referred to it as white cedar, spruce, o r othe r evergreen . Withi n eight day s the me n wer e well . The account constitute s th e first recorded description o f a disease o n this continent and , fro m th e standpoin t o f dentistry , th e firs t recor d o f ora l disease.

The first Canadians 9 Folklore has come down through the years that Champlain brought a dentist wit h hi m o n hi s expeditio n t o th e ne w worl d durin g th e earl y seventeenth century. This could no t be true, because dentist s as such did not exist at that time. However, Louis Hébert, an apothecary, di d accom pany Champlain , firs t t o th e ill-fate d Acadian settlemen t o n th e Ba y of Fundy and then, after returning to France, to Quebec. The designation of apothecary ha d a wider meaning then than today. The apothecar y prac tised medicine, and undoubtedl y Hébert would have extracted teet h an d performed emergenc y dental treatment in both ne w colonies. Th e name s of severa l barber-surgeons who also accompanied Champlain on his trips and stayed at Quebec on a more or less temporary basis are recorded, bu t Hébert ha s a specia l plac e i n histor y a s the firs t rea l Canadia n settler , having brought his wife and famil y an d erecte d the first house in Quebec . He serve d a s the firs t practitione r o f healt h service s in Canad a unti l his death in 1627 from a fall on the ice.14 The first physician in New France was Robert Giffard , a French nava l surgeon, wh o cam e ou t o n a tradin g venture i n 1627 . I n 163 4 h e was granted th e seigneur y of Beauport , wher e h e buil t a hom e an d entere d into the first private colonizing enterprise by bringing out settlers and their families. I n 164 0 h e became th e first doctor o f the Hôtel-Dieu , Quebec , the first hospital i n the colony . Giffar d continue d his activities , engagin g in colonizatio n an d fur-trading , a s well as medica l practice . H e die d a t Beauport in 1668. 15 Beginning i n th e thirteent h century , guild s o f barber-surgeon s wer e formed in Europe, probably first in France and then in England, Germany and som e othe r countries . Originally , th e barber s owe d thei r busines s largely to the fact that after the monks were forbidden by the Pope to wear beards, smooth chins and shaving became a general fashion. Physicians of the er a considere d th e lettin g of bloo d wa s necessar y bu t beneat h thei r dignity, and were glad to relegate the task to the barbers. Gradually , th e activities o f th e latte r cam e t o includ e bleeding, cupping , leeching, th e giving of enemas, and the extracting of teeth. The guilds of barber-surgeons became establishe d b y royal decrees , limitin g the service s that coul d b e performed an d establishin g examinations b y appointe d senio r members for admissio n t o th e guild . Eventually, the surgeon s separate d fro m th e barbers an d forme d guild s of thei r own . Thi s separatio n too k plac e i n England in 1745, and at a later date in France.16 Jean Madry, th e first barber-surgeon i n Quebec, arrive d abou t 165 1 and eventually succeeded Giffard i n charge of Hôtel Dieu. In 166 3 he was appointed by Royal Commission of Louis xiv lieutenant in New France of

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HISTORY OF DENTISTRY IN CANAD A

the chie f barber-surgeo n o f th e King , an d authorize d t o establis h 'th e mastership of a school of barber-surgeons in the locality, so that the town of Quebe c an d als o al l places , towns , village s an d settlement s unde r obedience to the King, all those passing through or sojourning there may be well and safely treated ,..'17 As a barber-surgeon, Madr y was qualified to extract teeth . The first directory in Canada was published in 1791 , and listed thos e practising the healing arts.18 At this period, Lower Canada (late r Quebec) had a population of approximately 110,000 (100,000 French- and 10,000 English-speaking) and Upper Canada (late r Ontario) fewe r than 20,000. The practitioner s liste d wer e located onl y in the large r centres , Quebe c and Montreal, where examining boards for licences existed. The manne r of listing suggests that the age of specialization was already in existence a t this early date. Nineteen practitioners appear i n Quebec and 3 3 in Mont real. For Montreal, the names are grouped under the categories for which they were licensed to practise - physicians , surgeons, accouchers, apothe caries, an d soigneurs et aracheurs de dents (blood-letter s an d tooth drawers). Of the last category, there were nine. While these men engaged in littl e dentistr y beyond extraction , the y mus t b e considere d th e fore runners of the dental profession in Canada. The great-grandso n of one of them, Stephen Globensky, became one of the most prominent dentists hi Montreal 75 years later. With the exception of seven or possibly eight, the names liste d ar e French , an d fo r th e mos t par t the y wer e mos t likel y trained i n France. Probabl y i t would be wrong to thin k of these me n a s practising their profession exclusively, because for many years to come it would stil l be necessary to have some additiona l occupation i n orde r t o make a living. This was partly due to the economy of the colony and als o to lack of appreciation of the healt h sciences. I t i s said that the fathe r of surgery, Ambrose Paré, a coupl e of centuries earlier mad e his livin g hi France by cutting hair and shaving in order to work as a surgeon. By the en d of the eighteenth century, the type of practice carrie d ou t by th e barber-surgeon s wa s rapidly dying. As i n othe r branche s o f th e healing arts, a new kind of dentistry was developing, influenced greatly hi Canada by the developments which occurred in the United States.

2

Early colonial period

1800-1839

Pierre Fauchard (1678-1761 ) o f Paris i s justly recogni/ed as the fathe r of moder n dentistry . On e o f the founder s of the denta l professio n i n th e United States , Chapí n A. Harris, ha s said of him, 'He found denta l art a crude branch of mechanics; he left i t a digested and systemati c branch of the curativ e art. ' N o singl e individua l in th e entir e histor y o f dentistr y exerted a stronger influenc e upo n it s development. Hi s book, Le chirurgien dentist, is the most famous of all books in the field and made him the pioneer of modern dental thought. He was the first of a group of renowned dentists o f France wh o followe d rapidly durin g the eighteent h century . Whether or not he coined th e title 'Surgeo n Dentist' is not clear , bu t h e became known for this in any event. The level of dental skill in his lifetime is indicated by discoveries made in 196 6 during the restoration o f the Fortress o f Louisburg, Cap e Breto n Island. Tw o o f the me n burie d in the King's Chapel o f the fortres s ha d metallic fillings in their teeth. The material of the fillings was investigated with an electron probe microanalyzer. 1 One filling was found in one burial: a mesial cavity in the first upper left mola r was partially filled with lead , apparently i n th e for m o f a thi n foil . I n th e othe r burial , filling s wer e present i n both lower first molars, an d i n each case , th e meta l use d wa s tin. Th e latte r skeleto n ha s bee n identifie d a s that o f the Du e d'Anville, who die d i n 174 6 and wa s reburied beneat h th e chape l i n 1749 . These skulls represent one of the earlies t examples, if not th e earliest , o f denta l restoration foun d withi n th e boundarie s o f wha t becam e Canada . Un doubtedly, the fillings were inserted in France. During th e America n Revolutio n rappor t betwee n Franc e an d th e

12 A

HISTORY O F DENTISTR Y IN CANAD A

United States was high, and many French troops crossed th e Atlantic to join the battle against the British. Among them were dentists, disciple s of Fauchard, a number of whom remained in America. Their influenc e was great: establishe d precedents di d no t exis t i n the Ne w World, an d ne w ideas were quickly absorbed. The y wer e not wholl y responsible fo r th e development o f the professio n in the Unite d State s (befor e th e Revolu tion, a few dentists had already come from England and France to practis e in Boston and othe r cities) , but th e influenc e o f these French dentists of the 1770 s was the single most important factor during the period, extend ing beyond their direct work. The Ne w World thus gained th e legac y of dental knowledge of Fauchard, L e Farge, Bourdet and Bunon of France, together wit h tha t o f John Hunter , Thoma s Berdmore , Willia m Green , and John Watts of England. The new arrivals broke through the barriers of secrec y which surrounded denta l practic e i n their countrie s o f origin . Though comparatively few, they acted as preceptors - pioneer s of dental education. I n a comparatively shor t time , the numbe r o f nativ e dentist s increased through the apprenticeship training they offered. Shortly after th e turn of the century, dentists who had som e degree of apprenticeship training began to come to Canada from th e United States . For th e mos t part , thes e me n visite d th e large r centre s o f population , Montreal, Quebec , an d Yor k (late r Toronto ) ; gradually, som e o f them established practic e o n a mor e o r les s permanen t basis . A t tha t time , Canada still consisted of only two provinces, Lower an d Uppe r Canada , the former with 250,000 inhabitants, the latter wit h 70,000. Nova Scotia , New Brunswick, Prince Edward Island, and Newfoundland were separat e colonies t o whic h dentists fro m th e Unite d State s als o came . Th e mai n trade route of the period between Canada and the United States ran fro m Montreal vi a Lake Champlai n to New York an d Boston. I t wa s natural that dentists arrived first by this path. Contemporary information respecting these early practitioners i s to be found, for the most part, in their newspaper advertisements. The first such announcement foun d i n Nova Scotia appeare d i n the Acadian Recorder of 3 December 1814: Mr. Hume , Surgeon , ha s remove d int o Ne w Hous e i n Harringto n Street , 2 doors south of the Baptist Meetin g House, He will also operate as a Dentist in fixing Artificial Teeth etc. etc .

The origins of Hume have not been established , bu t fro m th e advertise ment it can be assumed that he was a surgeo n wh o had picke d u p som e knowledge of dentistry. This was a common circumstance for many years.

Early colonial period ( 1800-1839 )1

3

Probably the assumption may also be made that he came from England . A surve y o f earl y advertisement s establishe s that a fe w of thes e practi tioners came directly to Canada from England , although the general flow was from the south. It i s of interest to kno w somethin g of the degre e of proficiency whic h had been reached in dentistry. The length of training that Canada's early practitioners receive d woul d hav e varie d greatly , a s th e onl y for m o f agreement was indentureship contract betwee n precepto r an d pupil , not always fulfilled . Josia h Flag g wa s on e o f th e outstandin g dentist s o f th e time. In 1796 he published the following advertisement in a Boston newspaper, which in 1875 was reproduced in the Boston Medical Journal. Josiah Flagg , surgeo n dentist - inform s the public that h e practises i n all the branches wit h improvements , i.e . transplant s bot h liv e an d dea d teet h wit h just conveniency, and gives less pain than that heretofore practise d i n Europe or America; extract s teeth an d stumps or roots wit h ease; reinstates teet h and gums that are much depreciated by nature, carelessness, acids , or wasted at the roots; regulates teeth fro m thei r first cutting to prevent fever and pain in children, assists nature in the extension o f the jaws for the beautiful arrangemen t of th e secon d set and preserves the m in their natura l whiteness . Entirel y fre e from al l scorbutis complaints. An d when thus put i n order an d his direction s followed (whic h are simple), he engages that the further care of a dentist will be wholly unnecessary; eases pain i n teeth withou t drawing , stops bleeding i n the gums, jaws or arteries; lines and plumbs teeth with virgin gold, foil or lead . Fixes gold roofs and palates, an d artificia l teet h of an y quality without injur y to, and independent of the natural ones; greatly assisting the pronunciation an d the swallow, when injured by natural or other defects. A room for the practice, with ever y accommodation a t hi s house, wher e ma y be had dentifrices , tinctures, teeth and gum brushes, mastice etc. warranted, approved an d adapted t o the variou s age s an d circumstances ; als o charr-stick s particularl y usefu l i n cleaning the fore teeth and preserving a natural whiteness; which medicine and charr-sticks ar e to b e sold wholesal e and retail tha t they may be more exten sively useful. Dr . Flagg has a method to furnish thos e ladies and gentlemen o r children with artificial teeth, gold, gums, roots or palates, that are at a distanc e and cannot attend him personally. Cash give n for handsom e and health y liv e teet h a t No . 4 7 Newbur g Street , Boston, 1796 . Among the early dentists to come from Vermont was Levi Spear Parmly, who practised a t Montreal for a short tune and then continued at Quebec

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HISTORY OF DENTISTRY IN CANADA

Title page of the first book on dentistry published in Canada

City. While in Quebec, he published in 181 5 the first Canadian book on dentistry, a work of 65 pages entitled Summum Bonum. An original copy of the book is in the Gagnon Collection of the Montreal City Library, and the type of practice can b e determined fro m th e fe e schedule it contains. Any advice given gratis. Prices for the following are as circumstances present themselves . A full set of teeth with gold springs not to exceed one hundred dollars. A single tooth not to exceed ten dollars. Evening the teeth not to exceed one dollar. Separating the teeth not to exceed one dollar. For mending a tooth with foil one dollar, gold etc.

Early colonial period (1800-1839 ) 1

5

Teeth made white and polished, pric e depend s on the state an d number o f the teeth; from one to five dollars — not the least pain under the operation . Tooth paste etc. etc. for keeping the breath, teeth and gums agreeable . Deranged an d ulcer teet h extracte d gratis , wit h a s great car e an d ease a s any operator. My first wish is a continuance o f the public's patronage - m y highest ambitio n to deserve it.

The Quebe c Almanac fo r the yea r 181 6 still listed five soigneurs et aracheurs de dents (barber surgeons), but this type of practitioner was being replaced b y dentists , man y o f the m itinerants . Amon g suc h me n wa s Eleazer Gidney, on e of the most successfu l an d prominent dentist s of his generation. After completing three years of apprenticeship, Gidney gained a licence to practise physic and surgery in New York State. H e practise d for a brief period , but b y the autum n of 181 7 was studying dentistry a t Baltimore an d Ne w York . H e practise d dentistr y fo r a shor t tim e a t Utica, NY, an d then came to York (Toronto) , where he practised during 1825. In February 182 6 he left Yor k and went to Quebec City, bearing a letter of introduction from Christophe r Widmer, president o f the Medical Board of York, to James Forbes, Deput y Inspector o f Hospitals, Quebec . The letter read: I certify that Eleazer Gidney has resided in this village during the year past and pursued th e busines s of a dentist . I tak e grea t pleasur e i n certifyin g tha t h e sustains a fair an d irreproachable character ; an d fro m a knowledge an d som e experience, I feel authorize d to state that he is a man of skill and judgement in his profession.

Gidney stayed in Quebec City for a few months and then left fo r Englan d where he practised a t Manchester . Fro m thi s tim e forward he practise d for th e most part a t Manchester , bu t returned a t interval s t o practis e a t New York City and at the end of 1832 returned to York, where his patients included Lad y Colborne , wif e o f th e Lieutenant-Governor , an d severa l of he r friends . Gidne y wa s on e o f th e mos t astut e me n o f hi s time . Wherever he was, his practice consisted of the 'finest people.' He accumu lated wealt h rapidl y b y wha t wer e fo r hi s da y th e mos t up-to-dat e methods.2 These itineran t dentist s transported wit h them a fitted chest o f han d instruments. For the most part, these chests were elaborately mad e of fine

16

A HISTOR Y O F DENTISTRY I N CANAD A

An itinerant's chest of instruments from the mid-nineteenth century

wood, bound wit h brass, an d lined o n the inside with velvet. The y wer e fitted with a surprising number of hand instruments (12 1 in the exampl e illustrated), the handle s o f which were usually made o f ivory, wood , o r bone. The instruments were generally manufactured by the dentist himself and exhibit a high degree of technical ability. Quite likely the design of the chest and the large number of instruments were to som e measure for th e purpose o f impressing the patient . Usuall y visits were advertise d i n th e local newspaper . Som e o f th e itinerant s staye d i n a plac e a fe w days , others a couple of weeks, but seldom for a longer period. Itinerant dentist s continue d t o visi t th e large r centre s fo r severa l decades. One , Joh n Plimpton , wh o visite d Toront o durin g th e 1830s , made his wa y a s fa r a s Prince Edwar d Island , Newfoundland , and th e other Atlanti c provinces . To gai n some ide a o f what thi s entailed , i t i s necessary t o kno w something of travel conditions of the time . I n winte r the itinerant dentist journeyed by sleigh, in summer, at first by wagon-like conveyance an d late r b y stag e coac h ove r road s hardl y entitle d t o th e name. Transportation b y water was preferable, when available. B y 1840, stagecoaches wer e running from Toront o to Montreal i n the record time of 4Vz t o 5 days. Canada's first railway, the Champlain and St Lawrence,

Early colonial period ( 1800-1839) 1

7

began operating in 1836, but the first train from Montreal to Toronto did not run unti l Octobe r 1856 . Ye t under thes e conditions , th e itinerants , with their heavy chests of instruments, travelled long distances. The ability of these adventurers should not be discounted. I n 1913 , a Nova Scotian dentist named Daman related ho w John Plimpton, as an old man, had made a partial denture for his father.3 Daman was a boy at the time and watched Plimpton hamme r out the bas e plate fro m a n Englis h silver coin and solder on the clasps. The father, he said, wore this dentur e satisfactorily for many years. Men like Plimpton had ability, and the talent of using available materials for the task at hand. Resident dentists , or those wh o set up practice a t least o n a more or less permanen t basis , first appeared i n Montreal , th e larges t populatio n centre. Amon g these was John Roac h Spooner , wh o arrive d durin g the later 1820 s fro m Vermont , an d practise d i n Montrea l unti l 1841 . H e gained fam e throug h hi s discover y o f the us e o f sulphid e of arseni c fo r pulp devitalization . Hi s younger brother , Shearjashub , wh o apprentice d with him in Montreal an d then returned to the United States, publishe d a book on dentistry in 1836 in which he described th e use of arsenic, statin g that hi s brother ha d employe d i t fo r severa l years . Bot h Spooner s wer e scholarly men . John Spoone r neve r claime d originalit y for th e ide a bu t said frankly that he had discovered it from reading Arabian medical manuscripts, wher e he had learne d tha t th e us e o f red sulphid e of arseni c fo r relief o f pain i n teeth was well known by Arabian physician s a thousand years previously. Arsenic was rapidly adopted b y other dentist s t o assis t in the remova l o f th e liv e pulp. U p t o thi s time , tw o othe r method s of devitalization had been used: th e nerve was cauterized b y hot iron, or a sliver of hickory was shaped, carefull y slippe d in th e apertur e besid e th e pulp an d give n a shar p ta p wit h a mallet . I f properl y performed , th e 'hickory peg ' metho d wa s said t o b e painless . Arseni c continue d t o b e used i n practic e unti l displace d b y loca l anaesthetic s mor e tha n three quarters of a century later. At York , th e advertisemen t o f S . Wood, Surgeo n Dentist, appeare d first in the 4 December 183 2 issue of the Colonial Advocate and continued to appear in newspapers and directorie s until 1851 . Many names of other practitioners appeared , fo r period s o f varyin g lengths, i n th e advertise ments o f earl y Toront o newspapers , bu t Wood' s showe d remarkabl e continuity. H e wa s awa y onl y on e year , 1837 , whic h h e spen t i n Ne w York, Philadelphia, an d Boston. On his return his advertisements emphasized that, through his travels, he was in possession o f the latest method s

18 A

HISTORY O F DENTISTRY I N CANADA

of practice , includin g the use of 'Incorruptible Enamel Teeth' and 'Roya l Mineral Cemen t which, in certai n cases , i s preferable t o an y othe r sub stance.'4 This i s the first reference foun d t o the us e by a Canadian dentis t of what came to be known as amalgam. A Parisian dentis t ha d announce d the discover y o f a 'silve r paste ' i n 1826 , whic h led t o experimentatio n with several substance s in combination with mercury as fillin g materials . The Crawcour brother s arrive d i n New York fro m Pari s i n 1834 , intro ducing what they called 'Royal Mineral Succedanum.' They promoted this substance wit h extravagan t claims, much t o th e disgus t of th e gol d foi l operators, and bringing about the amalgam war. The controversy cause d the destructio n o f th e America n Societ y o f Denta l Surgeons , th e firs t national dental society. That societ y passed a resolution declarin g it to be malpractice t o fill a toot h wit h amalga m and later expelle d an y member who refused t o pledge himself no t to use the material. Apparently, Wood found himself in the midst of the excitement and brought the new material back to Canada. Little i s known abou t S.C . Parsons , surgeon-dentis t o f York, excep t that he published a book o f 38 pages in 183 0 entitled, An Essay on the Disorders and Treatment of the Teeth.5 At leas t on e original copy of this book exists , i n th e archive s o f th e Universit y o f Marylan d (Baltimor e College o f Dental Surgery) . I n hi s introduction , Parson s state d tha t h e had thoroughl y investigate d th e practic e o f th e principa l dentist s i n America, France, an d England . Tw o shor t extract s fro m th e boo k giv e some idea of dental practice in 1830 : OF STOPPING TEETH

Should it be found that the tooth is too far decayed t o bear th e degree of forc e which is necessary fo r applyin g the gold, pure tin, well prepared, ma y be used in its stead. ARTIFICIAL TEET H

The chief object of attention i n artificial teeth is , that the substance b e durable and no t liabl e t o chang e colour . Huma n teet h an d thos e o f smal l animal s therefore, answer s th e purpos e best , a s their ename l i s fa r superior , bot h i n colour an d textur e t o an y ar t ca n produce . Teet h forme d fro m thos e o f th e sea-horse ar e next in general use, and lately also, they hav e been forme d wit h great succes s o f fin e bake d clay , covere d wit h a coa t o f enamel , afte r th e manner o f china, whic h gives them th e advantage of not changing colour ; but

Early colonial perio d ( 1800-1839) 1

9

these are better adapted for entire sets than for separate teeth. Great improvements have been made in this art. During thes e pionee r days , lan d settlemen t o f immigrant s wa s stil l th e main occupatio n o f th e colony , mone y wa s scarce , an d th e fe w practitioners o f healt h service s foun d difficult y i n makin g a living . Willia m Dunlop, a British surgeon who first came to Canada with the army during the War of 1812, wrot e at that tune, 'Taller than most European women , slight and sallow, the women of the frontier weathered quickly . Hardl y a woman o f twent y coul d b e found , wh o ha d no t alread y los t hal f he r teeth ...' 6 Dentists wer e very few, though occasionall y on e advertise d i n the pres s o f towns like Kingston and Cobour g an d a t time s travelle d t o lesser settlements for a day or two. Filling of teeth and provision o f plates were no t fo r th e poo r however ; reference i s mad e t o a se t o f artificia l teeth price d at £ 30 , the equivalent i n modern purchasing power of well over $1,000. 7 'Pliers or tooth drawers ' were used to pul l teet h whe n the occasion demanded, and dentists and doctors were not alone in extractin g them. Many a farmer built up a local reputation as a tooth puller.8 The distressin g reality o f toothache wa s the chie f fac t o f dentistry a s far a s the pioneers were concerned. Complaint s recur i n the sparse literature o f the times . I n retrospect , th e earl y availabilit y an d us e o f clove s seems rather surprising. Spice was one of the earliest commodities of international trade , an d spice s were being brought to the settler s o n the New England coast at an early date; yet with the difficultie s o f transportation , one migh t no t hav e expected t o fin d evidenc e o f their us e b y th e earl y settlers in Canada. Th e first call for spices was to relieve the monotony of a limited, bland diet, but in time it was found that a piece of clove, shaped and fitted in the cavity of an aching tooth, would ease pain. Later, the oil pressed from clove s was used on a small fragment o f absorbent material . For abscesse d teeth, the pioneers als o used sliced hot onions , placed i n a sack an d hel d agains t the cheek . A n earl y Canadia n recip e fo r cleaning teeth consiste d o f equa l part s o f orri s root , charcoal , an d whiting , pul verized together and applie d by finger or brush. White of egg was recom mended for canker sores. Gunsmiths were recognized a s expert, and very necessary, craftsme n in th e earl y days , an d man y of them engage d in dentistr y a s a sideline . Percy Ghen t o f Toronto , a moder n write r wit h th e happ y facult y o f making histor y liv e wit h accuracy , recognize d thi s dua l facilit y i n a n article entitled 'A Christmas Eve Sleigh Ride ( 18 3 3 ) ':9

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HISTORY O F DENTISTRY I N CANADA

Have we heard about the Christmas present ol d Jock Stocking , th e hatter, has bought fo r himself ? No, well , for years , until yesterday, Joc k hadn' t a toot h in hi s head . Bu t a mont h o r s o ago , h e wen t t o se e the Frenchman , Isaa c Columbus, th e gunsmit h of Carolin e Street , t o hav e a gu n fixed . 'Ho w ar e you going to eat the venison when you get it, with never a tooth to bite with?' says Isaac. 'Yo u had better mak e me a set,' answere d Jock, i n a joking way. And Isaac did. They're a s natural as life, and they work. Isaac ca n make anything. In several instances, the records show that gunsmith s eventually became dentists. On e o f th e mos t notabl e example s wa s th e Marti n famil y o f Ottawa.

3

Late colonial period

1840-1859

Aldis Bernard crosse d the border a t the Niagara frontier in 1840. He was born o n the shor e o f Lake Memphremagog, Quebec , i n 181 0 but a t a n early age was taken by his family to the southern United States . Evidently he served an apprenticeship with an American dentist an d started practising about 1834 . On his return to Canada, he spent a year trying to find a suitable plac e t o establis h a practic e i n th e Niagar a peninsul a withou t success. Toronto , wit h a populatio n o f 12,000 , wa s considere d wel l supplied b y two resident dentists. H e continue d hi s searc h t o Montreal , where he practised until 1876, being one of the founders of the profession in the provinc e of Quebec. At th e tim e of his arrival i n Montreal, whic h then had 40,000 inhabitants, there were three other dentist s established i n practice, namel y Logan, Scripture , an d Joh n R . Spooner . Bernar d wa s very active in municipal affairs, becomin g mayor of Montreal i n 1873. One of the early dentists to establish practice, othe r than in the large r centres was G.V.N. Relyea. He was born in Albany, NY, and took lectures at th e Alban y Medica l Colleg e i n hi s spar e time , whil e employe d a s a clerk. Later, h e studied dentistry for a year with a practising dentist , an d then practise d o n hi s own at severa l location s i n New Yor k Stat e fo r a short time. After surveyin g the larger towns of Upper Canada , he settle d in 184 3 i n Belleville (populatio n the n 2,500) , where h e practise d unti l 1874. By his own statement, he had command of dental practice between Cobourg an d Kingston . He spen t two day s ever y other wee k at centre s other tha n Belleville . A t thes e town s h e ha d assistant s (qualification s unknown) wh o extracte d teeth , an d he made the plates . Relye a wa s an astute businessman . I n th e fiftie s h e learne d abou t th e inventio n o f

22 A

HISTORY O F DENTISTRY I N CANAD A

Aldis Bernard, Mayor of Montreal, 1873

vulcanizers, journeyed to New York, obtaine d th e agency , an d sol d vul canizers to dentists in Canada for a number of years. Later, he was active in founding the professio n formally i n Ontario. Until 1840 , ther e i s littl e evidenc e tha t Canadia n yout h exhibite d interest i n learnin g t o becom e dentists . Soo n afte r that , however , th e number of dentists began to increase through apprenticeship training. For the most part , the education wa s brief and rudimentary, and men starte d out o n thei r ow n with little knowledge or skill . Som e settle d dow n and , gradually, town s of an y siz e gaine d a residen t dentist . Picton , Ontario , seems to have been one of the earliest of the smaller towns to gain residen t dentists, a s indicate d i n th e 186 0 advertisement s place d i n th e Picto n Gazette by 'Dr' Fanning and Henry T. Wood. The latter was a self-trained dentist who becam e one o f th e founder s of th e profession . Man y o f th e newly-trained men instead became itinerants throughout th e country an d smaller municipalities . Ofte n the y travelle d o n foo t wit h a bac k pac k containing the tools of their trade. Vulcanite cam e int o genera l us e a s a denture base during the late 1850s , one result being a rapi d increas e in the number of travelling dentists who extracted teeth an d mad e dentures only. Perhaps a n accurate case from the late 1860 s will illustrate.

Late colonial period (1840-1859)

23

Dental advertisement in the Belleville (Ontario) Intelligencer, 1868

24

A HISTORY OF DENTISTR Y IN CANAD A

From the Picton (Ontario) Gazette, 1860

Cicem Borland was plodding along a back concession road northeas t of Bellevill e o n a cold winter day callin g from farmhous e to farmhouse . He had a pack on his back which must have been heavy, for it contained a vulcanizer, forceps, a few instruments, and other materials for the making of denture s At on e farmhous e he foun d a gir l o f fifteen years, wh o ha d been stayin g inside for severa l days . She ha d cavitie s betwee n her tw o front teet h which ached whe n she went out o f doors . B y Dorland's ow n admission, he r othe r teet h wer e goo d bu t hi s diagnosi s wa s quick . H e was invited to stay overnight and the following morning he extracted he r upper teeth, without anaesthetic of any kind, took an impression in beeswax, poured a model in plaster o f paris, an d produced a continuous gum

Late colonial period ( 1840-1859) 2

5

denture with which the patient ate her supper. The vulcanizing was done on the kitchen stove. To the dentist of our time this whole procedure was about the worst service dentistry could offer, bu t i n fairness to Dorland, i t must b e sai d tha t th e patien t was wearing this sam e denture i n pristin e condition on her seventy-fifth birthday . The patient was my mother. By th e 1850s , dentistr y was bein g practised b y fou r type s o f indi viduals. 1 Medica l practitioners performed emergency services. Of necessity practically all physicians possessed a few pairs of forceps for extraction s and by various means attempted to relieve pain for patients. 2 A fe w graduate s o f medica l school s too k som e apprenticeshi p training and confine d themselve s to the practic e o f dentistry. 3 Th e flamboyan t typ e o f denta l practitione r arrive d i n urba n centres, precede d b y extravagantl y advertised claims . Thes e me n made generous us e o f handbills , testimonial s an d newspape r advertisements , claiming a perfection which today's dentist would find not only abhorren t but impossible. 4 A n increasin g number of me n ha d serve d a n apprenticeshi p of varying lengt h wit h a dentist . A t first , th e indentureshi p wa s a loos e arrangement, bu t graduall y i t becam e a rathe r sever e lega l contrac t between preceptor an d apprentice . W . George Beers was to become th e most outstanding Canadian dentist for a number of years. His indenture ship, drawn up legally i n 1856, reads as follows: 1 On thi s da y th e nint h o f Decembe r i n th e yea r o f ou r Lor d on e thousan d eight hundre d an d fift y six . Befor e us th e undersigne d Notarie s Publi c dul y commissioned an d swor n i n an d fo r tha t par t o f th e Provinc e o f Canad a heretofore constitutin g the Province o f Lower Canad a residin g i n the Cit y of Montreal in the said Province . Personally cam e an d appeare d Mr . Jame s C . Beer s o f th e sai d Cit y o f Montreal Gentleman who for the good and advantage of his minor son William George Beer s aged fifteen years on the fifteenth day of May last past declared to have bound and engaged an d by these presents h e doth bind and engage his said son now present an d consenting as testified by his becoming a party to and signing thes e presents , t o an d wit h Charle s M . Dickinso n o f th e sai d cit y of Montreal , Esquir e Surgeo n Dentis t part y heret o an d acceptin g o f th e sai d William George Beers as his covenant student and apprentice t o the study and profession o f Dentis t fo r an d durin g the ter m o f fou r years, t o b e compute d and reckone d fro m th e twenty-secon d da y o f th e mont h o f Novembe r las t

26 A

HISTORY OF DENTISTRY IN CANAD A

past 185 6 durin g all of whic h tim e th e sai d Willia m Georg e Beer s shal l an d will willingly serve the said Charles M . Dickinson obe y his lawful command s do no hurt and damage to him in any manner howsoever neither se e or suffe r it to be done b y others withou t giving instant informatio n thereof t o th e sai d Charles M . Dickinson; shal l follo w his directions, atten d regularl y ever y da y during the sai d period o f sai d apprenticeshi p th e surger y o f th e sai d Charle s M. Dickinson an d al l and ever y the particula r an d genera l dutie s which ma y from tim e to time be assigned to hi m by the sai d Charle s M . Dickinson; and finally shall demean himself towards the said Charles M . Dickinson a s a goo d attentive an d faithful studen t ough t an d i s bound to do . And th e said Charles M. Dickinson for divers good and lawfu l considera tions him thereunto moving and for an d in consideration o f the service s s o to be rendere d b y th e sai d Willia m Georg e Beer s dot h hereb y promise , bin d and oblig e himself t o teac h an d instruc t o r caus e o r procur e t o b e wel l an d sufficiently taugh t and instructed the said William George Beer s in an d about all an d ever y matte r an d branche s connecte d wit h an d touchin g an d con cerning the profession of a Dentist i n so far a s the said William Georg e Beer s has the capacit y t o tak e u p an d lear n th e same ; an d furthe r shoul d th e sai d William George Beer s conduct himsel f durin g the term o f his present engage ment to th e entir e satisfactio n o f th e sai d Charle s M . Dickinso n h e th e sai d Charles M . Dickinson will allow him a sum of twelve pounds and ten shilling s for eac h an d every year o f th e sai d apprenticeshi p whic h said su m it i s per fectly understoo d shal l no t b e considere d a s a salary , bu t merel y a s a n in centive to good behaviour on the part of the said William George Beers which can eithe r b e pai d o r retaine d b y the sai d Charle s M . Dickinso n a s he ma y think th e sai d Willia m Georg e Beer s deservin g o r no t thereof ; an d i n th e event o f continue d misbehaviou r o r insubordinatio n o n hi s par t i t shal l b e optional wit h th e sai d Charle s M . Dickinso n immediatel y t o discharg e th e said Willia m Georg e Beer s an d cance l th e presen t indentur e withou t an y notice whatever . And it is hereby further agree d an d understoo d b y and betwee n the sai d parties heret o that shoul d the said Charle s M. Dickinson giv e up the practice of hi s said profession either fro m il l health o r otherwis e a t any tim e prior t o the expir y o f th e ter m o f th e presen t engagement , h e the n shal l hav e th e privilege of either cancelling the present Indentur e o r of transfering them fo r the unexpired period through to his successor i n which case all the Covenant s and engagement s herei n entere d int o wil l b e a s binding an d obligator y a s if no suc h chang e o r transfe r ha d taken place . [A n initialled margina l not e t o this paragraph reads 'With the consen t o f the sai d Jame s C . Beer s being first

Late colonial period (1840-1859 ) 2

7

asked and obtained.'] And fo r th e Executio n o f thes e present s th e sai d partie s heret o hav e respectively electe d domicile s a t thei r ordinar y place s o f abod e abov e men tioned. Done an d Passe d a t th e sai d Cit y o f Montrea l i n th e offic e o f Jame s S. Hunter on e o f sai d Notarie s o n th e day , mont h an d yea r firs t hereintofor e written unde r th e numbe r on e thousan d nin e hundre d an d twent y tw o an d signed by the said partie s hereto with an d in the presenc e o f us said Notarie s these presents having been first read to said parties. James C. Beers William G . Beers C. M. Dickinson

On a wall of the Facult y o f Dentistry, Dalhousi e University, Halifax , hangs a portrait o f Dr Lawrence E. Va n Buskirk , who is identified on a plaque beneat h th e paintin g as , 'Th e first man t o administe r a n anaes thetic fo r a surgica l operatio n i n Canada. ' Va n Buskir k graduate d i n medicine fro m Columbi a Universit y i n 1828 . H e practise d medicin e a t Woodstock, NB , for fiv e year s an d the n afte r som e stud y confine d hi s practice t o dentistr y a t Halifax , becomin g th e firs t permanen t denta l practitioner o f repute in Nova Scotia. Hearing of the discovery of general anaesthesia b y W.T.G . Morton , h e wen t t o Boston , learne d th e tech nique, returne d t o Halifax , an d bega n extractin g teeth wit h the us e of ether. Thes e fact s ar e verified , particularl y b y D.M. Parker , a physician who, hearin g of Va n Buskirk' s success i n administerin g anaesthesia fo r extractions, requeste d his assistance. Parke r wrote: 2 Lawrence VanBuskirk , a dentist practisin g i n Halifax, learned tha t ether wa s being used by inhalation in practical dentistry , visited Boston and familiarized himself with its use. On his return, having a case that required amputatio n o f a femur, wen t to VanBuskirk's office an d asked hi m to administer ethe r t o him , as h e personall y woul d hav e som e knowledg e o f it s action . Th e nex t day , VanBuskirk administere d ether , th e lim b wa s amputated .

It is to this operation that the plaque below Van Buskirk's portrait refers . The Royal Gazette for 1 6 February 184 8 moreover contains the following statement : 'D r L.E . Va n Buskir k ha d mad e a n inhale r an d fo r th e last year ha s used ether fo r ove r 10 0 extractions. No w that Chlorofor m has been used by doctors in Halifax, Dr Van Buskirk is using chloroform.'

28

A HISTORY O F DENTISTR Y IN CANAD A

Lawrence E . Va n Buskirk , first man t o administe r a n anaesthetic for a surgical operation in Canada

This latter statement places the advent of general anaesthesia by ether in Canada to b e early in 1847 . Since Morton made his demonstration i n Boston onl y i n Octobe r 1846 , Va n Buskir k mus t ver y quickl y hav e realized the great importance of the discovery. On e or two other dentist s have claime d b y inferenc e to b e th e firs t t o us e genera l anaesthesi a i n Canada. O f thes e J.H . Webste r o f Montrea l ha s mad e th e stronges t claims i n the literature . However, a t n o plac e ar e date s stated , an d fo r the mos t par t th e claim s consis t o f reminiscence s b y elderl y me n wit h considerable confusio n respecting dates . The fac t tha t dentist s wer e th e first to administer general anaesthetic s i n Canada i s not disputed . The Van Buskir k family wer e Knickerbocker Dutch , wh o came with the Loyalists from Ne w Jersey t o New Brunswick. For a time during the

Late colonial period ( 1840-1859 ) 2

9

thirties, Lawrence and his brother Georg e practised dentistr y together a t Saint John, an d eve n afte r Lawrenc e went to Halifax he returned inter mittently to practise with his brother. In a short histor y of early dentistry in New Brunswick, A.J. McAvenney vividly describes the administratio n of a genera l anaestheti c (presumabl y nitrou s oxide ) t o a youn g lady, 'shortly after D r Horace Wells, the American dentist, discovered surgica l anaesthesia.'3 Thi s even t place s th e administratio n o f th e firs t genera l anaesthesia for a surgical operatio n i n Canada earl y i n 1845 , two years before th e mor e sensationa l amputation . I t i s recorde d tha t Lawrenc e Van Buskirk also was the first Canadian dentis t t o subscrib e to a denta l publication, th e American Journal of Denial Science, in 1839. Search o f the literatur e indicate s tha t W.H . Elliott o f Montrea l wa s the firs t dentis t practising i n Canada t o mak e a contributio n t o denta l journalism. I n all , Elliott publishe d 1 8 paper s betwee n 184 2 an d 1851 . Originally he was an American dentist and is known to have practised i n Plattsburg, NY , durin g 1845 ; afterwards h e came t o Montreal , probabl y in 1846-7 , wher e he carrie d o n a most successfu l practic e until 1856, when George Van Buskirk of Saint John too k i t over. Before leaving the United State s Elliot t ha d publishe d a numbe r of papers , an d i t appear s that his first contribution from Montreal occurred during 1847. An articl e by him and certainly from Montrea l appeared i n the January 184 9 issue of th e New York Dental Recorder. This articl e i s o f interes t becaus e i t concerns hi s inventio n o f a n improve d 'fil e carrier, ' a n instrumen t fo r operative dentistry, long since discarded bu t evidentl y in genera l use for many years. From th e illustrations i n the article, i t appears to be a small edition o f th e fret-sa w use d b y cabine t makers . I t wa s use d chiefl y i n separating teeth. Between 1849 an d the early 1860s , articles appeare d i n American journals by such Canadian dentists as C. Brewster and George Beers of Montreal and G.L. Elliott of Toronto. Some descriptio n o f th e practic e o f dentistr y durin g the 1850 s wil l indicate th e stag e of development . Al l operation s wer e performe d wit h hand instruments: another two decades would pass before the foot engine came int o genera l use. 4 Th e greates t advanc e a t thi s tim e wa s i n th e manufacture o f artificial teeth. James A. Bazi n of Montreal recalled that , 'Previous to thi s period mos t dentists had thei r ow n furnace fo r making "incorruptible" teeth , whic h resembled a spli t bea n mor e tha n anything else.'5 Manufactured artificial teet h no w became availabl e t o dentist s in continuous-gum and single-tooth forms. The introductio n o f vulcanite i n the late fifties re-oriented th e whol e

30 A

HISTORY OF DENTISTRY I N CANAD A

practice o f dentistry. U p t o thi s tim e dentures ha d bee n buil t o n meta l base plates which were prohibitively expensive. Vulcanite mad e denture s available t o most people. I n th e years to com e a great numbe r o f othe r materials wer e introduced fo r us e a s bas e plate s o f dentures , th e trad e names o f whic h ar e lon g sinc e forgotten , bu t vulcanit e hel d swa y fo r nearly a century, until replaced by the acrylics . Gold foi l i n man y form s wa s th e suprem e filling , inserte d h i th e prepared cavit y wit h han d instruments . Case s ar e o n recor d wher e th e root cana l wa s fille d wit h gol d a s wel l a s th e cavit y i n th e tooth . Th e beginnings o f th e us e o f lea f gol d fo r fillin g teet h ar e unknown . Some historians date the use to the eighth century in Baghdad, but the support ing evidence appears inconclusive . Gold lea f i n various forms wa s at any rate used by dentists in Europe durin g the eighteent h century . B y 181 2 one manufacturer in the Unite d States specialized i n beaten gol d leaf fo r dental purposes . Definit e evidenc e exist s tha t Lev i Spea r Parml y use d gold leaf i n his practice at Quebec abou t 1815 , and he was probably th e first dentist in Canada to do so. Amalgam was known and used, but it was poor i n qualit y an d ther e wa s som e fea r o f insertin g mercur y i n th e mouth. Dentist s o f reput e seldo m employe d amalga m befor e th e lat e 1850s, but the so-called quack s used it freely an d often abuse d i t - fo r example, by filling cavities in adjoining teeth without separation . For extractions , th e forcep s wer e graduall y replacin g th e key . Th e latter was a formidable instrument. There were many variations in design, but the one illustrated is typical in general. A mechanism somewhat simi lar to a miniature canthook grasped the tooth; the metal shaft an d wooden handle gav e the dentis t sufficien t leverag e t o wres t th e toot h ou t o f it s socket. In Europe, th e instrument was usually referred to as a 'key,' and there was a similar instrument known as the 'pelican.' In Nort h Americ a it was usually called a 'turnkey.' Forceps ha d been used t o som e exten t before this period, but keys of various types had been preferred. Now they were being replaced b y improved forcep s tha t fitte d th e neck s o f teeth , although th e ke y remaine d i n us e i n outlyin g district s fo r man y mor e years.6 Considerable variatio n existe d i n th e kind s o f instrument s i n th e dental armamentarium . Each dentis t designed an d made his own instru ments o r ha d the m made to hi s specifications . H e ma y hav e copie d a n instrument use d b y another dentis t or invente d a ne w one. Instrument s came to have the name of the inventor attached to them. Two innovation s

Late colonial period ( 1840-1859)

31

A turnkey - once a common dental instrument, no w a museum piec e

in operative dentistry that appeared during the 1850 s were spoon excava tors for removing decay and Jack's chisels for cutting away enamel. The manufacture of supplies to meet the nee d of dentists was still i n its infancy. I n the Unite d States, Samuel S. White began to practise den tistry i n 184 3 bu t retire d i n 184 6 t o devot e hi s whol e tim e t o manu facturing, beginnin g with the productio n o f artificial teet h an d graduall y extending to othe r require d dental supplies . I n thi s period als o th e first Canadian denta l suppl y depo t wa s established . U p t o thi s time , an d probably fo r som e tim e after , Canadia n dentist s wer e i n th e habi t o f making trips at intervals to New York, Bosto n an d Philadelphi a t o see k

32 A

HISTORY O F DENTISTRY IN CANAD A

new technique s an d instruments . On e such traveller wa s S.B. Chandler , who wa s born a t Richville , NY , apprenticed a t Ogdensburg , establishe d practice a t Por t Hope , uc , i n 1848 , an d later move d t o Newcastle . H e frequently mad e suc h trip s an d othe r dentist s asked hi m t o mak e pur chases for them as well. As a result of this experience, h e established th e first dental suppl y house in this country, th e Canadia n Denta l Depot , a t Newcastle in the late 1850s. In 188 3 he decided to devote his whole time to the dental supply business and moved his depot to Toronto. The secon d Canadia n suppl y business , th e Toront o Denta l Depot , was establishe d i n 186 0 b y C.H . Hubbard , wh o wa s bor n i n London , England an d came to Toronto i n 185 6 via New York. Hi s original business was the manufacture of gold leaf, which he continued until his death in 1900 . Gradually , h e branched ou t into other denta l supplies. Thi s was the beginnin g of an inventiv e age in dentistry , and th e establishmen t o f dental depot s mad e ne w kind s o f supplie s readil y an d convenientl y available. A notable event was the formation of the Halifax Visiting Dispensary Society in 1855. 7 The dispensary was supported by philanthropic citizen s who paid a n annual membership fee o f 20 shilling s each, an d b y a gran t from th e provincia l government . Service s wer e rendere d a t specifie d hours eac h da y b y 1 4 physicians , on e dentist , an d on e apothecary . Patients who could afford to pay were charged a small fee, but for the most part treatmen t wa s free. Th e institutio n continue d fo r severa l decades . This dispensar y i s the earlies t recorde d exampl e o f fre e denta l service s for the underprivileged in Canada. On the Pacific coast, th e earliest practitioner s o f dentistry were ships' surgeons, some o f whom stayed i n Canad a fo r varyin g lengths o f time. Despite considerabl e research , i t i s difficult t o establis h th e first man t o confine hi s practice t o dentistry , but i t appear s t o hav e been Josep h B . Haggin, a medica l graduat e who i s said t o hav e specialized i n dentistr y and practise d i n Victoria i n 1858. 8 I n thi s same year the first gold rus h occurred, an d othe r dentist s arrived amon g the horde s o f men crowding into th e colony , chiefl y fro m California . Th e secon d residen t dentis t appears t o have been H.D. Longlaker , 'Surgica l and Mechanical Dentist' in 1859. 9 By 1863, th e city of Victoria ha d three dentists - G.W . Cool , S.M. Harris, and Thomas Walker.10 Some idea of the number of dentists practising by the year 185 8 may be gained from municipal directories, which were freely publishe d durin g these years fo r th e large r centre s (population s give n in brackets) . Fo r

Late colonial period ( 1840-1859) 3

3

Nova Scoti a fiv e dentist s wer e listed , al l i n Halifa x (25,126) . I n Ne w Brunswick seve n appeared , thre e o f the m i n Sain t Joh n (27,300) . Canada East had not more than ten, with three in Quebec (51,000 ) an d five i n Montrea l (75,000) . I n Canad a Wes t thirty-on e dentist s wer e listed, five at Toronto (50,000) , four a t Hamilton (29,000) , an d three a t London (19,000) . But these directories liste d only dentists established i n fixed practice.11 Itinerant dentists in considerable number s were travelling from place to place, making short visits to municipalities large and small . Any attempt to estimat e the total numbe r of dentists a t tha t tim e would be difficult bu t the number was certainly small . One dentist, whose name appears in most historical records of Canada, was W.H. Bown , a nativ e o f Brantford, Ontario , wh o travelle d throug h rugged territor y to th e Red Rive r Settlemen t (late r Manitoba) , arrivin g in 1863 . H e was a son of J.Y. Bown , MP for Bran t from 186 1 to 1873 , and an intense patriot. Bown is referred to as the shado w of J.C. Schultz , a medical practitioner, wh o was prominent in founding the medical pro fession in Manitoba an d was also active politically, becomin g LieutenantGovernor o f the province in 1888 . The Red Rive r Settlemen t wa s made up o f peopl e o f severa l nationalities , Europea n immigrants , British , French, an d th e Métis, al l of whom were highl y independent i n nature . Like othe r earl y practitioners , Schult z an d Bow n engage d i n activitie s beyond th e provisio n o f healt h services , includin g fu r tradin g and gol d mining. Considerable resentment existed among the settlers respecting the introduction of legal measures from outsid e the settlement - eve n though the territory was recognized a s British, nominally ruled throug h a monopoly held by the Hudson's Ba y Company. Louis Riel became leader of the opposition. Th e first newspaper in the area , The Nor'wester, whic h was initiated in 1859, was bought by Schultz, and later sold by him in 186 8 to his friend Bown. 12 Both Schultz and Bown used the newspaper to advance British aim s an d objectives , an d henc e receive d considerabl e credi t i n retaining the trouble d territor y a s Canadian. Durin g the Re d Rive r Re bellion when Riel wa s a t th e hea d o f his self-style d provisional govern ment an d Bow n edito r o f The Nor'wester, Rie l demande d tha t Bow n cease publishin g a British proclamation an d prin t materia l submitte d by him. This Bow n refused t o do . A s a consequenc e h e wa s thrown i n jail by Riel, bu t release d b y the military forces o n thei r arrival . H e wa s th e first dentist i n the area , an d th e first between southern Ontari o an d th e Rocky Mountains. Pierre Baillargeo n was the first Canadian dentis t t o achiev e notabl e

34

A HISTORY OF DENTISTRY IN CANAD A

Senator Pierre Baillargeon

political recognition, being a member of the Senate fro m 187 4 to 1891. 13 He wa s bor n a t Cran e Island , Quebec , graduate d fro m Harvar d Uni versity i n medicine in 184 0 and practise d dentistr y a t Quebe c Cit y unti l his deat h i n 1891 . Hi s nam e i s th e secon d o n th e Quebe c Registe r o f 1869, an d h e wa s a n executiv e o f th e firs t Denta l Associatio n o f th e Province o f Quebec. An interesting story is recorded respecting the Bail largeon family. 14 His mother had been lef t a widow with four smal l boys, and grew discouraged trying to bring them up. Then she had a dream that one would become an archbishop, two priests, an d one a senator. All of it came true. Changes i n th e colonie s ha d thei r effec t o n th e developmen t o f th e

Late colonial perio d (1840-1859) 3

5

profession. Perhap s th e greatest chang e was in the number s o f people t o be served . B y 185 2 th e rapidl y growin g populatio n o f Canad a Wes t (952,004) had become greater than that of Canada Eas t ( 890,261 ). The Act of Union of 1840, which had united Lower an d Upper Canada a s the provinces of Canada East an d Canad a West , had specifie d dutie s for th e separate provincia l administrations , an d thi s led i n time to confusio n in seeking legislatio n fo r th e profession . Unti l Bytown , re-name d Ottawa , was selected as the capital o f Canada b y Queen Victoria i n 1857, Parliament had roamed, meetin g first at Kingston, then a t Montreal, an d the n alternately at Toronto an d Quebec City. Postage stamp s were introduced in 185 1 but until the railway came int o being it still too k five and a half days for a letter mailed i n Montreal t o be delivered in Toronto. Decimal currency wa s adopte d i n 1858 . Unti l the n th e officia l currenc y wa s i n pounds, shillings , an d pence ; bu t i n fac t man y kinds o f mone y wer e i n circulation, varyin g i n valu e fro m plac e t o place . Dentists ' fee s wer e quoted generally in dollars, but often i n sterling. The unsettled condition s contributed t o th e slo w development o f the denta l profession . Aldis Bernar d o f Montrea l mad e wha t prove d t o b e a prematur e attempt t o obtai n denta l legislation durin g the 1840s . A bil l fo r th e in corporation o f the Colleg e o f Physicians and Surgeon s of Lower Canad a had bee n introduce d i n the legislature and Bernard , a man o f influence , attempted t o hav e additional clause s inserte d fo r th e regulatio n o f den tistry. The bill became subject to acrimonious debate with accompanying delays, amidst which a ruinous fire occurred a t the Court House. Papers , including the propose d clause s respecting dentistry, were destroyed . N o further attemp t was made to secure legislation for the control o f dentistry for another twenty years. Then, i n 1860 , Charles Brewster o f Montreal sen t a circular lette r t o all known dentists in Canada. His principal message was a protest agains t horrible denta l exhibition s which were occurring a t the time , bu t a t th e end he placed th e following question : 'Wha t is your opinion a s to incor porating the dentist s by Act o f Parliament an d obligin g all those wh o in future ma y wis h t o practis e i n Canada , t o pas s a prope r examinatio n before a Boar d o f Dentists?' 15 The replie s t o thi s questio n wer e unani mously favourable. Way s an d mean s o f carrying out th e objectiv e wer e investigated, until it was found tha t the Parliamen t o f Canada woul d no t consider th e bill. Such legislation was under the jurisdiction of the provinces. As will be seen later, Brewste r di d not ceas e i n his endeavour bu t for the while had to mark time.

36 A

HISTORY OF DENTISTRY IN CANADA

The stor y of the Martin family illustrate s remarkably well how some men became dentists during this period. Jean Paul Martin grew up on He Sainte-Hélène, th e futur e locatio n o f Exp o '67 , wher e h e becam e a n expert mechani c an d gunsmith . Abou t 184 0 h e move d t o Brockville , where the hunting was exceptionally good and his trade might be expected to prosper . Hi s famil y consiste d o f fou r son s an d fou r daughters . Th e sons - Alexandr e (change d to Alexander), Olivier (change d to Oliver), Charles, an d Joseph - al l became dentists . In the early 1850s , whe n it appeared tha t Bytow n wa s likely to b e chosen a s the capital , th e famil y moved there , wher e the boy s al l engage d i n thei r father' s vocation . B y 1860 Alexander an d Oliver ha d turned t o dentistry. For a time Charle s worked in the railway shops at Belleville, Ontario , but returned an d als o took up dentistry in Ottawa. Joseph, the youngest, learned dentistry fro m his brothers an d went to Hammond, Indiana, wher e he practise d durin g his life . Whil e the name s of othe r dentist s appear fo r brie f periods , th e three Marti n brother s reall y establishe d th e professio n i n th e Ottaw a area. The y were highly skilled craftsmen, an d there is no indication that they serve d a s apprentice s i n making th e chang e to dentistry . Olive r i n particular wa s a rea l student , a s indicate d b y hi s well-use d textbooks , which hav e survived . The brother s wer e highl y independent b y natur e and, apart from collaborating for learning purposes, they conducted sepa rate practice s wit h very differen t characteristics . Th e oldest , Alexander, had as patients governors-general, prime ministers, including Sir John A . Macdonald, an d othe r notables . Olive r wa s recognized a s the leade r i n professional matter s an d had th e largest practice, mad e up o f the 'good ' people of Ottawa. Charles's offic e a t 24 Susse x Street was well-known by the local sporting fraternity. A s a humorous after-dinner speaker , he was greatly i n demand . Accordin g to th e famil y h e wa s muc h bette r a s a n entertainer than as a dentist; but he became an active leader as the number of dentist s increased in the area, an d as a consequence his name appears more ofte n i n denta l literatur e tha n thos e o f hi s brothers . Fo r a lon g period, th e thre e brother s wer e recognize d a s th e foremos t dentist s o f Ottawa. A son of Oliver, by the same Christian name, graduated from th e Royal Colleg e of Dental Surgeon s in 189 0 and practise d i n Ottawa until his death in 1952 . His son, Lawrence Melville, graduated fro m th e sam e school in 1921 and also took up practice in Ottawa. No accoun t o f this period woul d be complet e withou t some descrip tion of the advertisin g by dentists. In comparison to the smal l size of the newspapers, man y o f the advertisement s wer e large. Man y portrayed a

Late colonial period (1840-1859)

An immodes t advertisement in Roswell's City of Toronto Directory, 1850-1

37

38 A

HISTORY O F DENTISTRY I N CANADA

set of artificial teeth, doubtles s to attrac t attention . Particula r abilit y was stated i n superlative terms. Fees , sometimes with discounts, specia l tech niques, an d testimonials , were published. The advertisement s o f Charle s Rahn o f Toronto i n 185 0 see m toda y rathe r fantasti c in th e reference s offered: twenty-on e names ar e given , including most o f th e notable s o f his tim e in the city . Th e inclusio n o f Baldwin an d LaFontaine , govern ment leaders of their day, seems incredible. Judgmen t must be related t o the custom s o f th e tim e an d no t t o th e ethica l concept s o f th e present . Each ag e makes its own definition o f customs, habits, an d ethics . Advancement of dentistry had bee n slow , at times distorted, an d few indications existed of important changes which were about t o take place . The number of dentists in the whole country was small, an d among thes e only a comparatively fe w were able to make a full livin g from dentistry . Many had sideline occupations to supplement incomes, o r practised den tistry a s a sidelin e t o mor e remunerativ e employment . Dentistr y wa s expensive and only people of means could afford it s services. Fortunately , among dentists there were a few, probably not more than half a dozen, who had foresight and vision which were to bear fruit in the near future. Impor tant alterations wer e about to take place i n the political sphere , an d these men were ready to establish a place for dentistry within the concept of the new constitution.

4

Creation o f a profession

1860-1869

The decad e o f th e 1860 s wa s on e o f grea t decision s i n Britis h Nort h America. Th e colonie s ha d till the n bee n widel y separate d an d sparsel y settled, with little communication between them. By 1861, Canad a had a population of 2,500,000. In Nova Scotia there were 325,000 people, New Brunswick ha d 250,000 , Newfoundlan d 150,000 , an d Princ e Edwar d Island som e 80,000. With the increas e in population th e peopl e becam e conscious of a new sense of maturity. After muc h hesitation, debate , an d conferring amon g representative s o f th e colonies , th e Britis h Nort h America Ac t wa s enacte d i n 186 7 b y th e Britis h Parliamen t an d th e Dominion o f Canad a wa s forme d o f Ontario , Quebec , Ne w Brunswick, and Nov a Scotia . A t late r dates , th e othe r province s joine d i n th e con federation. Circumadjacent t o thes e politica l adjustments , socia l change s oc curred. Reference in general literature to 'elegant Canadians' o f the 1860 s indicates that at least some of the people had attaine d success marked by a higher level in society. It would be a serious mistake, however, to interpret this advanced status as applying to more than a very few. Life for the vast majority of people was hard, organization scanty, money scarce, and the outloo k precarious . Hard y pioneer s wer e stil l clearin g th e bus h i n order to plant crops an d establish frontier communities . I t i s a tribute to the faith an d fortitud e o f our forebears that the y tolerated th e condition s which surrounded them. In their midst were high-minded men, albeit few, who endeavoure d t o brin g abou t ne w order . Wit h persistence , the y worked throug h many discouragements t o achiev e improvement s in th e interests o f futur e generations . Amon g them wa s Barnabu s W . Da y o f

40 A

HISTORY OF DENTISTRY IN CANAD A

Kingston, wh o circulated a lette r t o know n dentist s i n th e provinc e o f Ontario in the fall of 1866 , calling them to a meeting in Toronto early in January 1867. 1 Day was born on a farm nea r Kingsto n an d is known to have been practisin g dentistry in Kingston during the late 1850s , having previously articled for six months with PJ. Sutton of Kingsbury, Quebec. While practising , h e attende d medica l schoo l a t Queen' s University , graduating in 1862 and afterward s continuin g to practise dentistry . Day di d no t clai m originalit y fo r hi s idea . Charle s Brewste r o f Montreal, t o whom reference has been made in the previous chapter, ha d been i n correspondenc e wit h hi m o n th e subjec t o f incorporation . 'D r Brewster realize d tha t o n accoun t o f the numerica l strengt h o f the pro fession i n Uppe r Canada , th e firs t step s shoul d b e take n there.' 2 Th e story circulated i n following years was that Brewster' s wif e ha d relative s in Kingston and through this connection knew Day. No on e can be sure just how many dentists there were in Ontario a t that time, for no professional regulatio n existed and man y so-called den tists were scarcely entitled to the name. It is safe to assume, however, that the number was somewhat in excess of 100 . Th e meeting was held a t th e Queen's Hotel , Toront o o n 3 Januar y 1867 . Nin e me n wer e i n atten dance. A s thi s wa s th e firs t meetin g calle d o f Canadia n dentists , i t i s appropriate t o look briefl y a t thes e men . Day has already been referred to. Curtis Strong Chittenden wa s born at Burlington , Vermont , obtaine d hi s trainin g i n Ne w Yor k State , an d came to Hamilton in 1849, where he practised fo r forty years. During the 1850s he became a member of the Michigan State Dental Association an d was elected its president in 1860 ; as a consequence, he was the only man of th e grou p wh o kne w somethin g abou t professiona l organization. 3 Henry T. Woo d came from New York State an d practised i n the town of Picton. He became known as a gentleman dentist who settled disputes . A more necessar y typ e o f ma n i n th e followin g year s woul d b e har d t o imagine. Joseph Stuart Scott was a medical student at the time, who afte r graduation from Victori a Medica l School late r i n the sam e year too k u p the practice o f dentistry. F.G. Callende r practise d a t Cobourg an d while little i s known about hi s origins , it i s believed h e cam e fro m Ne w Yor k State. Joh n O'Donnell , wh o becam e th e firs t secretary , practise d a t Peterborough. Th e other s wer e A.D . LaLond e fro m Brockville , D.A . Bogart fro m Hamilton , an d M.E . Snide r fro m Toronto . Little i s known respecting LaLonde an d Bogart. I t wa s said later tha t Snider wa s newly arrived i n Toronto an d attende d th e meetin g out o f curiosity. Fo r som e

Creation o f a profession (1860-1869)

41

Barnabus W. Day, LDS, MD, father of dentistry in Ontari o

unknown reaso n G.V.N . Relye a o f Belleville , wh o wa s activ e i n th e cause, was not present a t the meeting. Obviously the seven dentist s prac tising i n Toronto pai d little , i f any, attention t o th e lette r sen t ou t b y a Kingston countr y dentist . No minute s of th e meetin g have survived , bu t fro m publishe d ad dresses, together with records following the event, a fairly clear picture of it is possible. Da y wa s elected chairman , an d state d that th e purpos e of the meetin g was to find ways and mean s o f securin g legislation fo r dentistry. Probabl y throug h th e influences o f Chittenden , a decisio n wa s reached tha t i t would be better first to organiz e the dentists an d then t o seek legislation . Fou r decision s wer e reached: first , tha t effor t b e mad e to secure legislation; second , tha t in order t o attain thi s objective, i t was

42 A

HISTORY OF DENTISTRY I N CANADA

first necessary to organize dentists ; third, that a committee b e appointe d to draf t a suitabl e constitution , an d bylaws ; fourth , tha t a meetin g b e called fo r th e followin g July, a t Cobour g t o conside r th e repor t o f th e committee. Some 3 1 dentist s attende d th e Cobour g meeting , indicatin g a n in creased general interest. The main business was the adoption of the report on the constitution an d bylaws, whereby the Ontari o Denta l Associatio n came into being on 2 July 1867 , the first organization o f Canadian den tists.4 The first decision reache d b y the newly created associatio n was to seek legislation . A committe e was appointed t o see k advic e an d draf t a bill fo r consideratio n a t a meetin g to b e hel d th e followin g January a t Toronto. The Januar y meetin g was held i n St Lawrence Hal l o n Kin g Street, the city' s mai n plac e fo r importan t gatherings. 5 Confederatio n ha d be come a realit y an d th e firs t sesió n o f th e Ontari o Legislatur e wa s i n progress a t the Parliament Building s on Front Street. I t is evident tha t a great dea l o f work had bee n don e i n gainin g support fo r legislation . A petition addresse d to th e Legislativ e Assembl y ha d bee n circulate d an d signed by 68 dentists, 2 5 medical men, one judge, the mayor of Toronto, and a druggist. 6 The Medical Council had adopted a strong resolution i n support. Tw o days were taken up with a discussion of the propose d bill . Some dentists opposed i t on grounds that it was 'quixotic and immature ' and, anyway , the y di d no t wan t th e governmen t interferin g wit h thei r private affairs . A s a matter of fact, th e oppositio n fo r th e mos t part wa s made u p o f thos e wh o coul d no t qualif y unde r th e bill' s 'grandfathe r clause,' whic h grante d recognitio n withou t examinatio n onl y t o thos e dentists who ha d bee n constantl y engaged for a perio d o f five years i n established offic e practice . Th e insistenc e on 'establishe d offic e practice ' precluded, amon g other s th e 'tramp ' dentists . Eventuall y th e meetin g adopted th e proposed bill, and o n the third day dentists and other s o f its supporters, numberin g approximately 100 , marche d t o th e Parliamen t Buildings an d th e bil l was introduced. Oppositio n b y dentist s continue d during passage through the legislature, but with some minor amendments, the bill became law on 4 March 1868. 7 During th e six-mont h perio d betwee n th e Cobour g an d Toront o meetings, th e committe e o f th e newl y forme d organizatio n wa s ver y active. The securin g of signatures on the petition required a great deal of time and effort . Th e draftin g o f an acceptabl e bil l wa s a time-consuming matter for which advice was sought from ever y possible source . Probabl y

Creation of a profession ( 1860-1869) 4

3

through th e influenc e o f Relyea, th e interes t an d co-operatio n o f G.W . Boulter, MD , Member o f th e Legislatur e fo r Hasting s County , wa s ob tained. Boulter not only assisted in the drafting, but introduced the bill and persevered i n piloting it through the legislature, finally succeeding on th e last da y o f th e session . N o stor y o f th e legislatio n woul d b e complet e without due credit to Boulter . This wa s the first Dental Ac t t o b e adopte d anywher e in th e world . The onl y legislatio n related t o dentistr y predating the Ontari o Ac t oc curred i n the Stat e of Alabama i n 1841 , when a section o f three o r four clauses was inserted in a medical bill. The Ontari o Denta l Act related to dentistry alone . I n checkin g this poin t wit h the variou s state attorneys general, i t was found tha t the secon d suc h Act wa s adopted b y the Stat e of Ohi o two months after Ontario's. 8 The 186 8 Ac t create d th e Roya l College o f Dental Surgeon s o f On tario, with a Board of Directors elected by the members of the profession. 9 This bod y was granted full power s o f licensing and regulatin g dentistry. The importanc e of the Act lay not only in that i t gav e the professio n th e right to govern itself, but in that it set a pattern for legislation in the othe r provinces. A t variou s time s there ha s bee n speculatio n a s t o ho w thi s type o f denta l legislation , whic h apparently doe s no t exis t i n an y othe r country, came into being. For dentistry , the reason appear s clear . Legis lation for medicine had already been enacted by the Parliament of Canada West i n 1865 , establishin g the Colleg e o f Physician s an d Surgeon s o n a similar basis. Thi s legislation was reaffirme d b y th e Ontari o Legislatur e in 1868 . I n vie w o f th e fac t tha t member s o f th e medica l professio n assisted, probabl y with the sam e legal advice, in formulating the legislation fo r dentistry , i t i s reasonabl e t o believ e tha t th e patter n alread y adopted for one profession wa s followed with minor variations. Indeed, a corporate bod y fo r th e lega l profession , th e La w Societ y o f Uppe r Canada, ha d bee n established a s early a s 1822 , an d has been continue d by eac h successiv e La w Societ y Ac t t o th e present . Th e righ t o f self government by the professions has existed from th e beginning in Canad a and th e principl e ha s withstood th e test of time. This freedo m has, i n a large manner , accounte d fo r th e rapi d developmen t no t onl y o f th e dental professio n but o f all professions in Canada . Dentists i n th e Provinc e o f Quebe c quickl y followe d thei r Ontari o colleagues. A meeting was held, with some 1 5 dentists present, o n 2 September 186 8 in Montreal, where the Ontario Act was reviewed clause by clause. Th e Denta l Association o f the Provinc e o f Quebe c wa s initiate d

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HISTORY OF DENTISTRY I N CANADA

and a committee appointed to draft a constitution an d bylaws. Aldis Ber nard wa s elected presiden t an d W . George Beer s secretary . A serie s of meetings of the association followed at which the main business was con sideration of draft legislatio n for incorporation. It wa s thought expedient to follow the Ontario Act in so far as possible. An Act to incorporat e th e Dental Association of the Province of Quebec was enacted by the Quebe c Legislature o n 4 April 1869. Ther e were several mino r difference s fro m the Ontari o legislation ; a notabl e on e was that i n Quebe c th e foundin g association was incorporated whil e in Ontario a new College was created, leaving the original association 'out in the cold.' In the other tw o provinces, Nova Scotia an d New Brunswick, effort s were made to secure legislation during 1869 without success. On e phase of the difficulties face d wa s described by AJ. McAvenney of Saint John , NB, i n an address several years later: 'I n 186 7 St John wa s honoured by having a dentist from Paris, Louis de Chiverie by name. Louis, for several years, hovere d betwee n S t Joh n an d Halifax , takin g i n town s o f Ne w Brunswick and Nova Scotia. He was noted for his outdoor displa y .. . He impressed himself so much on the members of the Nova Scotia Legislature that whe n Dr Alle n Haley presente d a bil l t o regulat e dentistr y in tha t province in 1869, it was rejected.'10 As an editor, W. George Beers, never one to mince words, also referred to this event: '... Bu t alas! what has poor Nova Scotia done that she should be afflicted wit h that little quintessenc e of quackery and rascality styled de Chevry, who it appears by the Acadia n Recorder, recentl y appeare d i n Halifax in a sleig h drawn by fou r whit e horses, an d s o "lectured" a gaping crowd against the passag e of a law in Nova Scoti a incorporatin g th e denta l profession.' 11 Th e professio n i n these Atlantic provinces was to wait another twent y years for legislation. The enactment of legislation in Ontario and Quebec constituted a great advancement, giving legal recognition to the dental profession. However , it was quickly discovered that existence of a law requiring practitioners t o possess a licence an d the implementatio n of that la w were no t on e an d the same thing. Custom and habit can create a law but they also can render a law ineffective. Th e Boards established under the Acts found themselves with the difficul t tas k initially of separating those who qualified unde r th e legislation from thos e who were not qualified , an d then of controlling th e activities of the unqualifie d a s well as keeping the qualifie d i n order . A t times, th e difficultie s seeme d almos t insurmountable . Unfortunately , o n many occasions a n individual whom the Board refuse d t o recogniz e was granted a licence by decree of the legislature. Suc h action ceased gradu ally, and terminated only over several decades.

Creation o f a profession ( 1860-1869 ) 4

5

Being a member of a Board proved to be an arduous task, demandin g a great deal of time. Some o f the case s received considerabl e newspape r publicity, which did not always aid the Boards' endeavour s - althoug h at other time s i t wa s helpful . I n 1870 , fo r example , a n individua l name d C.H. Stewar t hun g out his shingle in Montreal an d attracted considerabl e attention b y hi s low prices an d marvellou s promises . Document s an d a photograph produce d a t a meetin g o f th e Quebe c Boar d identifie d M r Stewart as a dentist named C. Sill who had run away from Pittsburg h with a woman named Kate Fry, leavin g a wif e an d severa l childre n i n a stat e of destitution , and showe d that Kate Fry wa s living with him as his wife . A Montreal newspaper go t hold of the circumstances and made Stewart' s name still more notorious by publishing th e followin g 'fre e lance ' poem . Ah! Dr. Sill to run away, And leave your 'better fraction,' And olive-branches, was, we think, A very silly action. In fact, we are inclined to say, — Now, please don't shed our blood, Still That, in the language of the South, You are a precious 'Mud-silll' A dentist, too - well hold your jaw; Canadian skies beneath, By gum, there are some folks who dare To cast it in your teeth. Kate Fry! - suc h an appropriate name, But surely meets our eye, Were you sick of domestic broils That you preferred a Fry? Consistent too, until the last, Your nom-de-guerre shows true art, For you've converted Mrs Fry, Into a Mrs Stew-art. Ah! Doctor Sill, ah! Doctor Sill, This is no theme for laughter, Take care lest Fry-ing be your fate In this life and hereafter.

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HISTORY O F DENTISTRY I N CANADA

The poetr y i s ba d bu t th e resul t prove d efficacious . Afte r suc h pub licity th e Boar d rejecte d Stewart' s applicatio n o n th e sol e ground s o f immoral character. S o satisfied wa s Stewart o f the positio n of the Boar d that he at once retired from practice . From the present point of view the examiners appointed by the Board performed thei r work with competence. The tas k was a difficul t one , i n that just about the only available training was by apprenticeship. A number o f graduate s from medica l schools wer e registered, bu t fo r th e firs t two years afte r th e Act s onl y one graduat e fro m a recognizabl e denta l school appear s o n the provincia l register s - H.H . Nelle s o f London , Ontario, who graduated from th e Baltimore College of Dental Surger y in 1860.12 As time went on, the most frustratin g par t o f the legislation was the provisio n tha t (i n Ontario ) person s 'wh o hav e been constantl y en gaged fo r fiv e year s an d upward s i n establishe d offic e practice , nex t preceding the passage of the Act' were entitled to licence upon furnishing satisfactory proof, and without examination. In Quebec, the required time was two years. Rather elaborat e affidavi t form s wer e formulated , t o b e sworn by a minister, a medical practitioner, an d a well-recognized citize n to the effec t tha t th e applican t was known by them t o hav e fulfille d th e stated condition . Initia l decision s wer e easil y reached , base d o n th e affidavits an d knowledge of the individuals, but as applicants continue d t o present themselve s in possession of th e require d affidavit s ove r th e nex t twenty years, the process became rather ridiculous . Beginning i n th e 1860 s an d unti l th e en d o f the century , th e nam e of W . George Beers of Montreal was a dominating one i n the lif e o f th e profession. I t i s well to paus e i n orde r t o summarize , for n o histor y of Canadian dentistry during the followin g fou r decade s could b e compiled without repetitive reference to this man. At the time of his death, in 1900, a Montrea l dail y newspape r describe d hi m a s ' a well-know n dentist , a fearless patriot , a famous athlete , a n efficien t militi a officer, an d a much respected citizen.' Beers was born in Montreal in 1841, served his apprenticeship with a dentist named Dickinson, and practised i n that city all his life. H e was the first secretary o f the Quebec Association, later becomin g president. H e serve d hi s professio n i n innumerabl e ways , a s a n editor , as dean of the first dental school in Quebec, and as a public adviser on all matters related to dentistry. His reputation as a public speaker wa s great, both withi n an d without dentistry. As a sportsma n he gaine d a tremen dous reputation , particularl y a s a n authorit y o n lacrosse . H e carefull y watched the pla y of Indians, to who m the game originally belonged, an d drafted th e first set of rules. On two occasions h e took lacrosse teams o n

Creation of a profession ( 1860-1869)

47

William George Beers, DOS, editor, dean, and a founde r of Canadian dentistry

his own to England, where a series of games wer e played, includin g on e before Royalty . Hi s patriotis m le d hi m int o th e militi a an d h e serve d during th e Fenia n raids , retirin g wit h th e ran k o f captain . H e wrot e widely, not onl y on dentistry but als o o n sport s an d patriotism , an d was published bot h i n Canada an d the United States . Beer s was a great ma n of his era. Perhap s a n author's persona l not e will not be out o f place. In the periodical s an d book s comin g into m y home durin g the yea r 1967 , George Beers was the subject of six articles, tw o in Centennial books, two in newspapers, an d tw o i n institutional publications. I n an y walk of life , not many men will receive such tribute so long after death . Here, our interest i s in his establishment i n 186 8 of the Canada Journal of Dental Science. He starte d i t wit h his ow n resources . Tw o short lived effort s i n dental journalism preceded thi s event. In 1854 , there ha d

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A HISTORY OF DENTISTR Y I N CANAD A

been a few issues of a publication entitled The Family Dentist, edited b y S.S. Blodget t o f Brockville , Ontario ; an d th e Journal of the Times ha d appeared irregularl y at Halifa x betwee n 185 8 an d 1860 , publishe d b y Paine an d Macallister. 13 In reality , Beers' was the first dental journal in Canada. He was a splendid reporter , an d i t is from thi s source that most of th e historica l informatio n i s t o b e obtaine d fo r th e period . Potentia l subscribers were few in number, however, and financia l difficultie s soo n arose. Th e Journal wa s firs t publishe d i n Montreal , beginnin g i n Jun e 1868, the n i n Hamilton wher e C.S. Chittende n acte d a s assistant edito r for a period, an d finally moved back to Montreal. Th e Journal appeare d monthly until October 1871 , but the last issue of Volume 3 did not appear until May 1872 . Onl y four issue s of Volume 4 appeared an d thes e wer e widely separated, the last being in August 1879. But Beers was persistent . He attempte d to obtai n financia l suppor t i n al l possible ways , including assistance from th e existin g associations, wit h no success . Without ques tion, he drained his personal finances in order to publish a journal in the interests o f the profession .

Title page of Canada's first true dental journal

Creation of a profession ( 1860-1869 ) 4

9

In Ontario, almost immediately after the legislation was enacted, pres sure developed for the establishment of a dental school. Th e Board estab lished a committee to investigate the feasibility of such action. I n October 1868 the committee reported tha t 'we consider it impracticable an d inexpedient therefore not judicious to start suc h a n institution a t the presen t time.' Georg e L . Elliott , a membe r of the Board , wa s a membe r o f th e committee and signed the report, makin g it unanimous. Yet even then he must hav e ha d othe r negotiations under way , for almos t immediatel y a rather elaborat e announcemen t appeare d o f th e establishmen t o f th e Canada College of Dentistry with Elliott a s dean. The facult y was named and th e cours e described ; the first session was to ru n fro m 1 Decembe r 1868 to 1 March 1869 , with a tuition fee of $50. Statement s appear later that th e Boar d o f th e Colleg e ha d approve d th e cours e an d agree d t o recognize th e graduates , bu t n o suc h agreemen t i s t o b e foun d i n th e Board minutes . Nor i s much else known today of the school . Seve n stu dents attende d the first course, an d a t least on e dentist claime d i n news paper advertisements to be a graduate of the Canada College of Dentistry. Dr. D.V . Peacoc k o f Brockvill e als o mentione d th e colleg e i n a larg e street sign in front o f his office. Bu t no addres s in Toronto fo r the schoo l was stated in the announcement , and i t has no t bee n possibl e t o find its location. Th e minute s of th e Boar d revea l ver y littl e detai l abou t th e school except that there was heated controversy over it. A year and a half after h e signed the repor t recommending against a dental school , Elliot t

A dental office sig n from 1880 . Beacock graduated from the first Canadian denta l school, a short-lived private institution in Toronto

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published a rather elaborat e an d extended explanation, bu t undoubtedl y presented onl y on e sid e o f th e matte r whil e little wa s recorde d o n th e other. The school was not a financial success. Its importance lies in that it was th e firs t effor t i n Canad a t o establis h a denta l schoo l an d th e onl y effort eve r mad e i n th e countr y t o operat e a privat e denta l schoo l fo r profit. While Elliott claimed in 187 0 that the Canada College of Dentistr y was still being sustained, little is heard of it thereafter. In July 1869 the Ontario Board, reversing its previous decision, agreed to establish a dental school immediately. The action appear s to have been a hasty one, probably influenced by the controversy with Elliott, who was a membe r o f the Boar d unti l 1870 , whe n h e wa s no t re-electe d a t th e annual meeting of licentiates. Th e Board decided not to name a dean, but appointed F.G . Callender , a reputabl e practitione r a t Cobourg , a s pro fessor o f operative dentistry and J. O'Donnel l o f Peterborough a s professor o f mechanica l dentistry, an d arrange d fo r th e basi c science s t o b e taught b y th e medica l schools . Th e cours e wa s si x month s i n lengt h beginning October 1 ; the fee was $100. The Board grante d a sum not t o exceed $300 to support the school. Two student s presente d themselve s an d complete d th e six-mont h course - Benso n Gilbert of Belleville and James Woods of Sarnia. At the close of the session , the Boar d was faced wit h a defici t o f approximatel y $125, an d i n July 187 0 a resolution wa s passed cancellin g th e arrange ment. Toda y th e amoun t appear s smal l t o promp t suc h decision , bu t money at that time was a scarce commodity of which the Board had little, the valu e o f a dolla r wa s muc h greater , an d th e futur e di d no t appea r bright. The effor t mus t have prove d costl y t o Callender , wh o moved t o Toronto fro m Cobour g t o tak e hi s position , an d fo r O'Donnell , wh o travelled back and forth fro m Peterboroug h t o teach when travelling was a comparativel y slo w an d uncomfortabl e process . Afte r thes e rathe r disastrous attempt s to establish a school, n o further effor t wa s made until 1875. The difficultie s o f implementing the legislatio n an d institutin g formal education ar e difficul t t o comprehen d fo r ou r present-da y generation . There were in the seventies some first-class men who worked assiduousl y for advancement , but ther e also existed a class o f men who attempted i n every way to discredit altruistic efforts. Henr y T. Wood described them in a later address, stating that his story was not coloured in any way.14 Men wh o wen t abou t th e countr y ignorantl y an d presumptuousl y talkin g dentistry t o th e curiou s crowd s whic h gathere d t o liste n t o them , an d some -

Creation of a profession (1860-1869 ) 5

1

times before the victim was aware of his intentions the dirty fingers of a dental vagabond woul d ente r a rustic' s mout h an d man y a goo d mola r woul d b e doomed. The n woul d com e th e professiona l advice . 'Severa l teet h mus t b e pulled and others should be filled.' As a rule, this would occur in the country and among the farmers who had large families, and the 'doctor' had a keen eye in business when he learned on e of th e sons o f the house was suffering fro m toothache. 'Well, ' said he , 'It is a lucky thing for you that I've come round here today. We'll soon pull out all the ache, and put the teeth of the whole family in good shape.' 'But,' the farmer would say, 'what about the cost? When there ar e so many teeth to be filled and extracted seem s to me you ought to make some reductio n in your prices. Do you?' 'Of cours e I do,' says the doctor; 'ther e wil l be no trouble o n tha t point . My price is twenty-five cent s for eac h silver filling, and ten cents fo r pullin g a tooth. Why , if you went to town to have this job done i t would cost yo u fro m fifty to seventy-five cent s for silve r fillings, and twenty-fiv e cent s fo r havin g a tooth pulled . Sometimes when I've a lot of work to d o for one family I fill six or eight teeth for one dollar, an d I don't suppose the whole job here wil l cos t more than five or si x dollars. S o now, if yo u sa y the word , we will bring ou r tools in and begin right after dinner. 'Of course you'll feed the horse and give us our dinner in the bargain? Here is my assistant. I generall y have some one to hel p me . You se e I ca n tak e a smart young man an d learn him the trade i n six weeks. Now just look a t this young man. This is his fourth week, and he can fill a tooth, just as well as I can, only not s o quick. Say , farmer, you ought to have one of your boys learn th e trade. I t onl y takes abou t si x weeks and th e cos t i s only $100.0 0 an d h e will come out a first-class dentist.' At the risk of some repetition, it is well to keep in mind the type of practice in the 1860s . As explained earlier, the introduction of vulcanite prompted a great increase in the practice of dentistry. Porcelain teeth were originally manufactured wit h long straight pin s for soldering to the metal base plates. Dentists no w bent these pin s fo r retentio n i n vulcanite ; the 'foote d pin, ' while a small change, was considered a great advance at the time. Dental chairs were changing : th e first ones were simpl y straight-backe d kitche n chairs, to which a primitive hea d rest was added eventually . Later, a dentist woul d sketc h ou t hi s needs an d cal l o n a cabinetmake r t o buil d a n upholstered chai r speciall y fo r him . These chair s wer e comfortabl e fo r the patient, if not for the operator. The first iron chair, with movable back and seat , cam e int o us e durin g thi s period . Gol d foi l wa s th e suprem e

52 A

HISTORY O F DENTISTRY IN CANAD A

filling. It was inserted by hand pressure until 1861 , when the hand malle t was introduced. Fiv e years later the automatic malle t wa s invented. Bot h were welcome aids. The contro l o f saliva was one of the grea t problems : although napkins of various types, duct compressors, tongu e holders, an d other appliance s ha d bee n introduced, the y wer e found t o b e onl y par tially successful . In 186 4 C.S. Barnum , a dentist i n New York, invente d 'rubber dam' and presented it to the dental profession. The need was great and Barnu m was showered wit h recognition i n the for m o f gifts , money , and medals from dental societies and individuals. Amalgam wa s used freel y b y the so-calle d 'tram p dentist' bu t u p t o this poin t ha d mad e slo w progres s amon g th e reputabl e practitioner s owing to it s poo r quality . Durin g this decade , however , improve d type s became availabl e an d it s valu e wa s recognized. A small-size d amalga m war broke out in the late sixties between H.M. Bowker , a Montreal den tist, and Georg e Beers , whic h attracted considerabl e attentio n an d con tinued into the early 1870s . Bowker published his articles in the Canada Medical Journal, wherei n h e resurrecte d argument s agains t th e us e o f amalgam which wer e dust y with negate d age. 15 Beer s refute d th e state ments with adequate proof. The article s continue d unti l the edito r o f the Canada Medical Journal refuse d t o publis h more, whereupo n Beer s ha d the last word in his own Canada Journal of Dental Science.19 Many othe r minor improvement s occurred, bu t th e pai n o f toothache wa s ofte n sur passed by the pain of extraction. The beginnin g of organizatio n b y dentist s ha d occurred . A s alread y observed, th e Ontari o Denta l Associatio n an d th e Denta l Associatio n (Société Odontotechnique ) o f th e Provinc e o f Quebe c wer e organize d before an y denta l legislatio n existed . Th e Ontari o Denta l Associatio n achieved its prime objective in obtaining the legislation, and unfortunately for th e association , th e effort s o f the initia l professiona l leader s becam e almost wholly taken up with the new Royal College o f Dental Surgeons of Ontario. Dissensio n aros e withi n th e OD A an d unde r th e leadershi p o f A.C. Stone , o f London , a secon d organization , th e Ontari o Societ y of Dentists, wa s formed i n 1868 . Through th e tact an d diplomac y of a few, however, the two societies united in the following year. At the union meet ing, held i n Belleville in July 1869 , a definit e decisio n wa s reached tha t only on e provincia l organizatio n shoul d exist , bu t tha t i n suc h a larg e province local dental societies should be formed, and effort s wer e bent i n that direction. According to a statement mad e at that meeting, dentist s i n the Ba y of Quinte area ha d bee n holdin g meetings fo r som e time . Sinc e

Creation of a profession ( 1860-1869 ) 5

3

Day, Relyea, Woo d and Callende r (al l originator s o f the ODA ) practise d in this area, it appears reasonable that they were in fact meetin g previous to th e firs t gatherin g called b y Day i n Januar y 1867 . I n an y event , th e Quinte Dental Society became the first local dental society to be organized formally, i n Augus t 1869 . I n Novembe r o f th e sam e yea r th e Wester n Dental Societ y was organized at Chatham with A.C. Ston e of London as the moving spirit, and during the same year the Hamilton Distric t Denta l Society wa s organized, C.S . Chittende n bein g the leader . A t thi s point , the effor t appeare d t o pete r out . I t ha d bee n anticipate d tha t Toronto , having the largest concentration o f dentists would give leadership an d a n effort wa s made in 1870 , bu t withou t success. Toront o delaye d anothe r twenty year s befor e organizin g a loca l society . Th e Montrea l Denta l Society wa s organized i n 1871 , th e firs t loca l denta l societ y i n Quebec . Jacob Neelands of Lindsay, Ontario , becam e noted fo r hi s earl y us e of nitrou s oxid e fo r genera l anaesthesi a i n extractin g teeth . Neeland s began practic e a t Lindsa y i n 1861 , afte r servin g a n apprenticeshi p o f a year with his brother, T. Neelands, a t Port Hope, and was still practisin g in 192 8 a t th e ag e o f 90 . Fo r man y years h e wa s know n a s Ontario' s Grand Ol d Ma n o f Dentistry. Durin g his time he ha d man y indenture d students, several o f whom gained prominence in the professio n later. All spoke in glowing terms of him as a dentist. Reference i s sometime s made t o Neeland s a s bein g the firs t t o us e nitrous oxide as an anaesthetic in Canada and he probably was in his own area. Th e questio n of priority in it s use i s difficult t o determin e becaus e any decisio n woul d be based o n fragmentar y evidence. Horace Well s of Connecticut ha d conceive d th e ide a o f usin g nitrous oxid e fo r surgica l anaesthesia i n 1844 . I t appear s tha t a rathe r long perio d woul d hav e elapsed between its use by Wells and the 1860 s when Neelands i s reputed to have begun using it. The earliest reference found t o its apparent us e in Canada is in fact, a s noted in Chapter 3 , by the Van Buskir k Brothers in the mid-forties . Som e evidenc e exist s tha t ga s (N 2O) anaesthesi a was used b y Montrea l dentist s prio r t o th e 1860s , bu t name s o f individua l users and exac t dates hav e not bee n established . Mor e definit e evidenc e exists that H.H . Nelle s o f London wa s using nitrous oxid e a t th e sam e time or befor e Neelands, an d others , includin g J.B . Meacha m o f Brant ford, laid claims to early use. Study o f th e situatio n reveals tha t ther e wa s considerabl e difficult y both i n obtainin g satisfactory gas an d i n devisin g a metho d o f adminis tration. Neeland s manufacture d his own ga s and devise d equipmen t for

54 A

HISTORY OF DENTISTRY IN CANAD A

administration whic h overcame the difl&culties . Fo r thi s he receive d an d deserved great credit. Furthermore, h e made his methods known to other dentists at a time when secrecy of techniques playe d a real part in dental practice. Dentists, then as now, rapidly seized new improvements to practice, particularly those for the relief of pain. On the west coast, meanwhile , gold was exercising its eternal attraction. Initia l discoveries along the lower Frase r an d Thompso n river s led prospectors furthe r nort h int o the Cariboo country , an d with the finding of gol d i n quantity there i n 1862 , thousands of men flocked to th e are a from distan t places. Among them were an undetermined numbe r of dentists. They probably came more to gain riches than to engage in practice, but some of them did provide dental service. Of these the main individual was William Allen Jones, a blac k dentist , originall y from England , wh o made hi s wa y vi a th e Wes t Indie s an d Californi a t o Barkerville , th e central minin g town. I n th e British Columbia Directory o f 1877-89 , Jones is listed a s a miner, but i n recognition o f his professional skills he had th e distinctio n of being the firs t perso n registere d unde r th e Britis h Columbia Denta l Act , enacte d in 1886 . Durin g recent years , Barkerville has bee n restore d a s a touris t attraction . Mainl y through th e effort s o f L. King Grady, a Vancouver dentist , on behalf o f the Britis h Columbi a Dental Association , Jones' s denta l offic e ha s bee n refurbishe d with th e dentist and hi s patient present i n manikin. The decade of the 1860 s was a momentous one nationally: a federation consistin g of fou r province s was created. Dentistr y als o mad e sub stantial progress, being recognized by professional acts in two provinces . By the end of 1870, there were 163 qualified dentists registered in Ontari o and 3 7 i n Quebec. Bu t the pictur e wa s not completel y bright. Th e first census take n i n 1871 , reporte d a populatio n o f 1,620,85 1 fo r Ontari o and 1,191,51 6 for Quebec. The ratio of dentists to population wa s by no means favourable. On the other hand, public appreciation o f the services that dentists were prepared t o render was low; in fact, man y dentists had to engage in money-making sidelines in order to ensure a living. Glowing stories o f the professiona l celebrations hel d a t the tim e of the enactmen t of denta l legislation were current for many years after th e event . Dentists of tha t tim e though t thei r trouble s solve d b y law . Soon , however , th e leaders o f th e professio n discovere d that privilege s grante d brough t in creased responsibilities , and i f advancement was to b e attaine d dentist s themselves would have to achieve it.

5

Formal education 1870-1879

By the 1870 s the eastern half of what is now Canada was well beyond its pioneer days . Th e typica l Canadia n o f th e perio d wa s a countryman , living on a farm, in the bush, or in a fishing village along the coast. Some nine cities, wit h population ove r 10,000 , ha d develope d b y th e tim e of the 187 1 census. The thre e largest wer e Montreal, wit h a population of 129,822, Quebec, with 59,699, and Toronto, with 59,000. Saint John was the fourth largest with 41,325; Halifax, Hamilton, and Ottawa were in the twenty thousands , while London an d Kingsto n had 18,00 0 an d 12,40 7 respectively. Winnipe g had 24 1 persons . Already , th e stron g tren d to wards urbanizatio n ha d begu n whic h has continue d t o th e present . I n 1871, 8 0 per cen t of all Canadians were classified a s rural; by 188 1 thi s figure had declined t o 74 per cent . The populatio n o f the whole countr y in 187 1 wa s 3,687,257, whic h increased t o 4,324,810 by 1881 . Brick houses were replacing fram e one s and ever y city had it s man sions elaborately furnished . Al l towns worthy of the nam e possessed ga s lighting, but th e street s were as muddy as ever. Inventive minds were at work producing many improvements in th e styl e o f Canadia n life . On e such innovator was Alexander Graham Bell who invented the world's first telephone of practical use at Brantford, Ontario, in 1874. Lumbering was an importan t economi c industry ; mining wa s developin g rapidly , an d manufacturing, particularly of farm machinery, was well established. After considerabl e negotiation , th e provinc e o f Manitoba joine d th e Canadian federation in 1870 . On 20 July 1871 , one year later to a day, British Columbi a becam e Canada' s sixt h province , an d i n 187 3 Princ e Edward Island came into formal union, thus creating one country 'A Mari

56 A

HISTORY OF DENTISTRY IN CANAD A

Usque ad Mare.' Between the provinces of Manitoba an d British Colum bia lay a vast area referred to as the North-West Territories, recognize d as a part of Canada . A few selected items from dental records for 187 1 may give some idea of matter s of concern a t tha t time . The Quebe c Denta l Societ y passe d a resolution statin g tha t 'al l denta l advertisement s wer e unprofessiona l which drew attention in any way to special methods or modes of practice.'1 Later during the same year the Ontari o Board , a t the behes t o f th e On tario Dental Society, cancelled th e licence o f S.J. Sovereig n o f Hamilton , who had become a notorious advertiser; but upon legal advice it withdrew the action. 2 Thes e ar e th e firs t recorde d action s agains t advertising , a matter of concern for the next half century . At the secon d meetin g of th e Montreal Dental Society, an endeavour was made to establish a measur e of control over non-paying patients. Decision was made to open a 'Black Book' i n whic h woul d be entere d th e nam e an d addres s o f eac h 'dead head' patient, and each member of the Society was to have a copy.3 How practical thi s action proved t o be is not recorded, bu t i n modern term s it appears like an early attempt at credit rating. Exemption from jur y service for dentist s was a subject of much discussion which continued fo r severa l years, until granted. Following som e debate, Beer s state d i n a n editorial that whil e i t wa s prematur e t o establis h denta l hospitals , i t woul d b e 'highly desirable to have a dental department in connection with all general hospitals.'4 The most absorbing activit y i n time and effor t wa s the searc h for mean s of dealing with men practisin g without a licence. Grea t effor t had gon e into the securin g of legislation an d a tendency existed , amon g the rank and file of dentists, to think that the answer to aU problems la y in seeking legislative amendment s grantin g more powers t o th e profession . Very early, however, the leaders in dentistry realized tha t a n Act did not automaticall y make a profession - legislatio n wa s only an initial advance towar d professiona l stature , an d constructiv e progres s depende d upon th e effort s o f dentists themselves. Thi s wa s a n importan t ste p for ward. The first effort tha t followed was an attempt t o find a way of securing adequat e recompens e fo r th e dentis t s o tha t h e coul d rende r hi s patients a servic e o f goo d quality . A t a meetin g o f th e Quebe c Denta l Society i n 1870 , Georg e Beers stated th e matter tersely : 'I f w e conside r dentistry a mere trade, the n let us agree to work for a little ove r cos t as the shoemaker who makes our shoes; but if a profession, let us charge fo r our brains.'5 The difficultie s face d lay, in the main, in two existing condi tions. First, a considerable numbe r o f competent men were in dentistry,

Formal education (1870-1879 ) 5

7

but probabl y th e majorit y o f practitioner s wer e wha t wer e know n a s 'cheap dentists. ' Th e well-qualifie d dentis t foun d i t necessar y t o charg e two dollars fo r a gold-foil filling of good quality, while the chea p dentist inserted a filling of little value for seventy-five cents . The publi c suffered , and denta l practice was downgraded . Second, th e publi c i n genera l ha d very littl e appreciatio n o f denta l services . Bot h conditions , i n variou s forms, wil l have a familiar rin g to the ears of at least the older dentist s of our own period. The point is that they were realized early in the lif e of the profession. Another facto r whic h inhibite d th e developmen t o f dentistr y fo r several decades was professional narrow-mindedness. Dentists vigorously protected the 'secrets ' of their practice. Pupils were indentured with sol emn formality, whereby th e innocen t studen t wa s legally boun d no t t o open a n offic e withi n on e hundre d miles o f his preceptor , no r t o revea l to riva l dentist s th e 'secrets ' h e migh t learn i n hi s preceptor' s offic e o r laboratory. Technique s wer e mor e importan t an d persona l tha n ban k accounts. A s a resul t o f thi s attitude , an y proposal s fo r co-operation , association, o r reform were met wit h repulsion. Thi s attitud e improve d somewhat with the adoption of legislation, but its eventual disappearanc e was discouragingl y slow . Meanwhil e the developmen t o f tru e scientifi c organizations wa s deterred . A s mentione d previously , a fe w denta l so cieties were forme d o n othe r tha n the provincia l level , bu t i t wa s much later before society programs revealed 'secrets' or freely offere d presenta tions of a true scientific nature . Indentureship trainin g wa s subjec t t o man y abuse s an d serve d t o multiply the existing problems in many respects. Th e better practitioner s took grea t care both in selecting a student and in training him, but othe r dentists, greater in number, simply used indentured students to their own advantage. Pressure developed again in Ontario for the establishment of a school. The Ontari o Board was hesitant after th e failure of two schools in Toronto, but the subject came under discussio n at each meeting. Amendment to the Dental Act was secured to strengthen the hands of the Board in respect t o education . A t th e sam e time, a n amendmen t was sought t o permit the granting of doctorates by the Royal College of Dental Surgeons of Ontario . Thi s request wa s refused b y th e Legislatur e o n th e ground s that only a university could confer degrees. Then the Board endeavoured to obtain some form o f affiliation wit h a university and requested the Senate of the University of Toronto to estab lish a curriculu m an d examinatio n i n denta l science , pointin g ou t tha t

58 A

HISTORY OF DENTISTRY I N CANADA

Harvard Universit y had organize d a dental department i n 1867 , leadin g to the degree of Doctor o f Dental Medicine, and that the California State University had taken similar action, and was conferring degrees of Doctor of Denta l Surgery . (Th e firs t denta l schoo l i n the world , th e Baltimor e College of Dental Surgery , had bee n establishe d i n 1840 . B y the 1870s , other schools ha d been organized in the United States, but Harvar d wa s the first to b e under university jurisdiction. ) Th e Universit y o f Toront o refused. I t appears that lengthy discussions then took place with Queen's University, Kingston, but agai n with no favourable end result . The matter of affiliation with a university was not wholly a question of whether or not dentistry should be recognized a s a university discipline. A strong public argumen t that prevaile d fo r man y years agains t subsidiza tion o f the educatio n of doctors an d lawyer s at a provincially-supported institution wa s that, onc e th e student s had qualifie d with publi c ai d a s members of lucrative professions, the public would have to pay over again for their services. At the same time, many dentists were anxious to secur e the prestig e of the title , 'Doctor,' and irritate d tha t ther e wa s no wa y to obtain it legally in Ontario. Under the Act, the Board had power to grant no more than a Licentiate of Dental Surgery (LDS ) , sometimes mistakenly referred t o as a degree. A few medical graduates who practised dentistr y used the doctoral degree , and so did some Canadians who had graduate d in th e Unite d States , fo r a number o f independent denta l school s ther e conferred doctorate s withou t an y universit y affiliation. Bu t i n Canada , only universities could gran t degrees. From th e beginning, many dentists freely use d the doctoral degree to which they had n o inherent right. Thi s situation continue d until 1889, afte r th e Toront o schoo l t o b e described next was affiliated wit h the Universit y of Toronto. In Jul y 1875 , th e Ontari o Denta l Society , meetin g i n Hamilton , adopted a strong resolution requestin g the Ontari o Boar d t o establis h a school o f dentistr y i n Toront o an d 't o ai d i t b y suc h appropriatio n of funds a s in their judgement may b e expedient.' 6 The quote d part o f this resolution wa s all-important , becaus e th e mai n difficult y wa s financial . During the same month the Board too k action . Tw o teachers were con sidered sufficien t an d th e Boar d appointe d J.B . Willmot t an d Luk e Teskey. I n vie w o f th e financia l experienc e i n operatin g th e previou s school, a carefully worded document was drafted, setting forth the conditions under which the schoo l wa s to operate. 7 To summarize it, the first course of four month s was to begin 3 November 1875 ; the tw o lecturer s were t o divid e state d subject s betwee n them ; a n infirmar y wa s t o b e

First announcement of the School of Dentistry, Toronto - eventuall y the University of Toronto Faculty of Dentistry

60 A

HISTORY OF DENTISTRY IN CANAD A

opened fo r th e gratuitou s treatment o f diseases of the teeth , wit h one of seven stated dentists to be present each morning; budgets of $150 for rent and $25 0 fo r furnishing s were voted; th e studen t fe e wa s t o b e $100, which was to be used by Willmott and Teskey in operating the school; and there wer e to b e eigh t applicant s fo r th e cours e befor e th e schoo l wa s started. I n reality, Wilhnott and Teskey wer e granted $400 by the Boar d and asked t o operate a school. The Board exercise d considerabl e car e to avoid responsibilit y for an y deficits whic h might occur. Thes e term s be came subject to serious controversy within the profession at a later date . Money values of the time are not to be judged in modern terms: Timothy Eaton wa s offering bargain s of a spool of thread fo r on e cen t an d men' s neckties at five cents each. The sums involved were in fact substantial . The establishmen t of the schoo l a t Toront o wa s the mos t importan t event to take place in Canadian dentistry during the period fro m 187 0 to 1890. The school became known as the Royal College of Dental Surgeons, ever to be confused with its creator, the Royal College of Dental Surgeons of Ontario. 8 The Board was very careful t o mak e the money granted th e final amount an d t o place th e responsibility fo r financia l succes s o n th e shoulders of Willmott and Teskey. The two men succeeded, academicall y as well as administratively. It is well to briefly observe them. James Bransto n Willmott was born i n June 183 7 in Halton County , Ontario, o f English parents wh o had com e t o Canad a h i pionee r days , doing thei r par t i n convertin g wildernes s int o fruitfu l fields . Durin g 1854-5 he studied at Victori a University, intending to tak e a degre e in Arts, but was forced t o withdraw owing to ill health. I n 185 8 he entere d the offic e o f W. Case Adams of Toronto a s a student of dentistry, and a t the en d of two years he began practising at th e tow n of Milton, nea r hi s birthplace. He took a n active interest in town affairs an d soo n held positions o f trust, being appointed a Justice o f the Peac e an d electe d t o th e town council . I n 1870- 1 h e attende d th e Philadelphi a Denta l College , graduating in 187 1 at the hea d of his class wit h the degre e o f Doctor of Dental Surgery. In this same year he moved his dental offic e t o Toronto. Throughout his life he was an ardent Liberal, thereb y making friends an d foes alike , but n o on e ever doubte d hi s honesty. I n religion , h e wa s a n active, devote d Methodist . In 1868 , the Ontario Dental Association had split into two organiza tions owin g to disagreements . J.B . Willmott's firs t activit y in organize d dentistry wa s actin g as secretar y o f a join t committe e se t u p fo r a fe w months i n 186 9 to heal the breach . A t a n open meetin g of licentiates i n

Formal education (1870-1879 ) 6

1

1870, h e wa s elected t o th e Ontari o Boar d an d a mont h late r h e wa s elected secretar y o f the Board , a position h e held continuousl y unti l th e time of his death i n 1915 . Although h e was a leader in all phases of Ontari o dentistry for fort y years, hi s greates t contributio n wa s in the fiel d o f education . Whe n th e school opened in Toronto, the Board did not appoint a dean and for some strange reason actually did not establish the office, accordin g to the officia l minutes, until 1893 , when Willmott was appointed. Fro m the beginning , however, he was head of the school. As such, he was not content to equal what was being done elsewhere, but strove to be ahead o f others' efforts . Steadfastly h e refuse d t o compromise , and wa s stubbor n i n adherin g t o principle. He occupied the position of dean until the day of his death. His son , Walter E . Willmott , graduate d i n 188 8 an d immediatel y came on the staf f o f the Toronto school, where he served in many capacities. On the death of his father, he succeeded a s secretary of the Ontari o Board. H e serve d th e professio n i n many capacities fo r ove r fifty years and was known as a personal friend t o every Ontario dentist. Both father and son made great contributions to the progress of the profession during difficult times . For mor e than a half century, scarcely a page of the history of Ontario dentistry appears without the name of Willmott. Luke Teskey earned his Licentiate in Dental Surgery by examination of th e Ontari o Boar d i n 1873 . Littl e i s know n respecting hi s persona l history, but apparentl y he was practising dentistry and studying medicine when he was appointed wit h Willmott to establis h the Toronto school in 1875. He graduated two years later from Trinity Medical College with the degree of Doctor of Medicine. Later h e qualified wit h the Roya l College of Surgeons in England and became a surgeon on the staf f o f the Toronto General Hospital. Teskey made a tremendous contribution to early dental education and serve d on the staff o f the school for more than thirty years. From th e beginning , h e taugh t thos e subject s relate d t o medicine . Latterly, hi s name appeared i n the announcement s as professor o f prin ciples an d practic e o f medicine and surgery . He als o serve d as registra r of th e schoo l fo r fiftee n years . Betwee n Willmott an d Teske y th e base lines of dental education were formulated. The school opened in two rooms over a cabinet sho p on 3 November 1875, with eleven students in attendance. The course lasted four months . During the tw o previous winters, Willmott had give n evening lectures t o indentured student s preparing t o tak e th e licensur e examination . A significant statemen t appeare d i n th e firs t announcemen t o f th e school :

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HISTORY O F DENTISTRY I N CANADA

'While the Board have not, as yet, made attendance upon lectures a con dition of examination, they now urge upon the students to attend a t leas t one and if possible two courses. The licensure examinations in the futur e will be of such a character that it will be expedient for the student to avail himself o f al l possible assistance. ' At th e time a student was required t o be properly indenture d with a qualified licentiat e fo r tw o year s befor e h e coul d tak e th e licensur e examination. Nothin g i n th e school' s firs t announcemen t state d tha t students taking the cours e ha d t o b e indentured , nor wa s anything said respecting academic qualifications for admission to the course. During the first session , 12 0 patient s wer e rendere d gratuitou s service s i n th e in firmary; they cam e i n greate r number s tha n coul d b e attende d b y th e students. In thei r repor t t o th e Boar d followin g th e clos e o f the firs t session , Willmott an d Teske y requeste d mor e spac e fo r th e school . The y als o asked that all students thereafter article d should be required to attend two full course s of lectures in 'our own' school, and tha t the term o f pupilage be shortene d t o tw o years, includin g the eigh t month s spen t attendin g lectures. Th e respons e to th e latte r reques t wa s contradictory i n rulin g and practice . Th e Boar d demande d tha t student s b e article d fo r thre e years and atten d two full session s in any reputable denta l college befor e seeking admissio n t o th e licensur e examination . However , th e school' s second announcement called only for a two year indenture, inclusive of the time spent in attendance upon lectures, before a student could si t for th e licentiate. Th e annua l gran t wa s increase d b y $5 0 i n orde r t o provid e more space. Th e numbe r of professors was increased b y the additio n of Francis G . Callendar, C.S. Chittenden , H. Hipkins , an d Thoma s Rowe , but a t the same time a motion was adopted permittin g these men to dis charge their duties by deputy - an d that Messrs Willmott and Teskey b e accepted a s thei r deputie s fo r thi s purpose . Presumabl y i t wa s though t better to have additional names on the next announcemen t of the schoo l even i f the numbe r of teachers wa s not materiall y increased . Durin g th e years that followed, the indentureship period was adjusted; the academi c course was extended; a matriculation standard wa s set and altere d fro m time t o time ; an d a s th e numbe r o f student s increased , th e staf f wa s enlarged an d large r premise s were secure d fo r th e school . I t remaine d the only dental schoo l i n Canada until 1892 . By 1880 , there were 351 registered dentists practising i n Ontario an d 117 in Quebec. The Atlantic provinces had no dental register a s yet. The

Formal education (1870-1879 ) 6

3

census for 188 1 reported 51 0 dentists in the whole of Canada. I n spite of law, ther e wer e me n practisin g dentistry , o r som e phas e o f dentistr y without a licence. Outsid e of Ontario and Quebec, i t was difficult t o deter mine who was truly entitled to be called a dentist, fo r little o r no regula tion existed. A matte r o f concern wa s that, whil e extrem e variatio n existe d a s t o ability an d skil l amon g practitioners, ther e wa s n o wa y o f recognizin g those wit h superio r qualifications . A s presiden t o f th e Ontari o Board , Henry T . Wood propose d applicatio n t o the Legislatur e fo r amendmen t to the Dental Act to permit the creation o f 'Fellows' of the Royal Colleg e of Dental Surgeon s of Ontario.9 The Legislature refuse d tha t change , bu t did amen d the Ac t t o permi t the grantin g of the title , Master o f Denta l Surgery (MDS) . To obtain the title, the candidate was required t o pass an examination o f high calibre an d presen t a thesis . Th e Master' s titl e be came known as a degree , thoug h the Boar d (a s noted ) ha d n o righ t t o confer degrees. The first title of Master of Dental Surgery was conferred in 1878 and the last in 1925 , there being a total o f 39. While few members in fac t qualified , thi s actio n represente d th e firs t effectiv e ste p toward s higher academic standing . In 1877 , Hubbard' s Denta l Depo t wa s advertisin g t o dentist s thei r stock of 'Crystal and corrugated Gol d foil s (Kearsing's , Valleau's, Pack' s and Watt's ) ; S.S. White's , Justi' s an d Johnso n an d Lund' s Teeth , als o cheap teet h fo r thos e wh o wis h them ; vulcanizers , forceps , pluggers , excavators, operatin g chairs , lathes , corrundu m wheels , brushes , files , celluloid plate s an d al l articles used b y the profession.' 10 Th e advertise ment made no mention of amalgam, which was freely i n use. Th e 1870s ' greatest innovation, which radically altered practice , wa s the introductio n of th e Morriso n Denta l Foo t Engine . U p t o thi s tim e hand instruments had been used entirely, an d a good deal o f scepticism arose a t the intro duction o f a machine . J . A . Bazin , an outstandin g dentist i n Montreal , cited th e danger s i n 1878 , th e engine' s wors t featur e i n hi s eye s bein g 'that quantit y remove d a t eac h revolution , a s wel l a s speed , engender s heat.'11 H e criticize d th e professio n severely , o n th e ground s tha t eve r since the introduction of the machine, 'so many minute fillings always in a nice place fo r a drill' were to be foun d i n the mouth s o f patients . Afte r castigating unscrupulou s dentists , h e raise d a questio n tha t ha s bee n raised in years since in many forms : 'the engine is a convenient instrument, only in so far as it will, without doubt, do reliable work , or assist them to do the possible bes t for their patients ; and it is to these I mos t earnestl y

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press the question, has the public been and will it still be, the gainer by this machine?' As previously stated, Charles A. Martin of Ottawa was a very popular after-dinner speake r in eastern Ontari o fo r many years. H e was perfectly bilingual, bu t usuall y apologize d fo r hi s Englis h whe n beginnin g a n address. No meeting of the Eastern Ontario Dental Association (organize d in 1880 ) wa s quite complete withou t an addres s b y him. Having bee n a gunsmith i n earl y life , h e wa s a n excellen t mechanic . I n on e o f hi s ad dresses, h e related on e of hi s experience s wit h a denta l engine . H e an d his brother had laboured fo r several years in putting together pulley s an d belts t o operat e a drill ; then , just whe n the y ha d th e thin g perfected, a Yankee pedla r cam e alon g wit h on e ready t o use . O n anothe r occasio n he tol d i n hi s inimitabl e manner th e stor y o f th e bes t instrumen t i n hi s cabinet. It had been made from a steel stay secured fro m his wife's corset! Unlike it s origina l purpose , th e us e h e ha d create d fo r i t promise d t o endure i n perpetuity . Th e ingenuit y o f dentist s o f tha t tim e kne w n o bounds. The y create d instrument s t o sui t thei r purposes , an d i n th e process made the prototypes of instruments in use today. Generally, i t is observed, dentist s u p to th e tur n o f the centur y were seized wit h th e technica l sid e o f thei r profession . Thi s i s true , fo r i f a health servic e was to be rendered a t all, a great man y technical problem s had to be solved. There were many exceptions, however . At a meeting of the Denta l Associatio n o f the Provinc e o f Quebe c earl y i n 1870 , Pierr e Baillargeon presented a dissertation on the effects o f sugar upon the teeth. The lengthy discussion whic h followed ha d a moder n ring . W.H . Patto n of Montreal presented a forward approach t o the subject of dental hygiene at th e sam e time, and A.C . Ston e o f London stresse d th e importanc e of caring fo r children' s teet h an d th e nee d fo r patien t education . Othe r individual dentists wer e rising abov e the mechanic s o f dentistry; indeed , for year s to come the main emphasis was on the educatio n o f the dentist . From the beginning of the Toronto school , th e course lai d weigh t on th e basic sciences . O f tw o professor s initiall y appointed , on e ha d medica l training. When a third professor was appointed i n 1877 , another medica l doctor, W . Theophilis Stuart, was chosen. Th e need for a basic scientific emphasis is recognized today but the school was strongly criticized o n this point fo r man y years . Th e criticis m wa s base d o n th e ol d adag e tha t philosophy bakes no bread. In th e newl y created provinc e o f Manitoba, th e populatio n wa s stil l small. The earliest dentis t of record t o establish practic e i n Winnipeg was

Formal education (1870-1879 ) 6

5

James L. Benson . A s a young man, he had gon e west with the Wolsle y expedition a t th e tim e o f th e Re d Rive r Rebellio n i n 1870 , bu t ha d returned to his birthplace of Peterborough, Ontario , an d then indenture d with Jacob Neeland s a t Lindsay. In the latter 1870s , he moved west and established practic e a t Winnipeg , where h e remaine d unti l hi s deat h i n 1926. The measur e o f a professio n i s sometime s assesse d b y th e strengt h and development o f its associations, schools , an d journals . By the en d of the seventies, the beginnings of each had occurre d i n Canadian dentistry . Associations o f dentists existed in Quebec an d Ontario , a schoo l wa s in operation a t Toronto, an d the Canada Journal of Dental Science had bee n established. Th e organization s ha d gaine d varyin g strengths , bu t wer e dependent upo n th e effort s o f a fe w dentists . Th e schoo l a t Toront o had mad e rathe r rapi d progres s sinc e it s establishment , an d it s futur e appeared assured . However, the Journal ha d faltered . George Beers was an excellent edito r wh o realized th e importanc e o f a publication, but hi s effort wa s made as an individua l and h e exhauste d his personal financia l resources i n attemptin g t o provid e a mean s o f communication . The as sociations wer e neither ready no r in a position to giv e him the necessary support. Monthl y issues of th e Journal ende d i n Ma y 1872 . Then fou r issues followed durin g 1877 and 1878 . The next decade passed without a journal, which seriously retarded the advancement of dentistry. During this period Beer s told the Quebe c Denta l Society : 'A n infal lible law exists with regard t o al l science and art , which, like tha t o f the mutation o f race s an d tongues , preserve s th e tru e o r remove s th e im perfect, accordin g t o thei r development.' 12 T o th e leader s o f dentistry , this was an exceedingly slow process, requirin g abundant patience , time , and energy on the part of a few. For these years the dental literature contains many addresse s o n th e sam e theme . C.P . Lennox , o f Chatha m pointed ou t t o th e Ontari o Denta l Societ y tha t educatio n wa s the rea l basis of a profession, and not legislation a s many dentists seemed t o suppose. Further, h e stated: 'It is a general conceived notion that the profession adds dignity to the man. This idea is false; it is the man who dignifie s the profession.' 13 Statements made hi many published addresse s indicat e deep concer n respectin g views , the n currentl y expresse d b y dentists , which wer e considere d detrimenta l t o th e futur e o f dentistr y a s a profession.

6

Expansion 1880-1889

The opening of the West was the dominating feature of the 1880s . During the seventies , treatie s ha d bee n signe d wit h th e variou s India n tribes . The Nort h Wes t Mounte d Police , late r t o becom e th e Roya l Canadia n Mounted Police , had been formed to keep order in the vast territory. Th e land was surveyed, and with the completion o f the Canadian Pacifi c Railway i n Novembe r 188 5 th e are a wa s read y fo r settlers . Man y wer e attracted. Canada' s first transcontinental passenge r trai n lef t Montrea l i n June 188 6 with several colonis t car s ful l o f hopeful and probabl y appre hensive homesteaders. I n additio n to this westward activity, easter n link s were strengthene d whe n th e Intercolonia l Railwa y betwee n Haifa x an d Central Canada was completed i n 1888. The achievemen t o f railway transportation fro m coas t to coas t initi ated a perio d o f rapi d developmen t i n Canad a a s a whole . Citie s gre w from villages . Winnipe g becam e th e commercia l centr e o f th e entir e northwest and by 1890 ha d a population o f over 25,000 . Regin a became the administrativ e centre fo r the territor y an d develope d int o a sizeabl e community o f 2,00 0 persons . Calgary , whic h bega n a s a Nort h Wes t Mounted Police for t erecte d a t the junction of the Bo w and Elbow rivers in 1875 , consisted o f only half a dozen log buildings when the Canadia n Pacific Railwa y reache d i t in 1883 , bu t b y 189 0 i t ha d grow n to nearl y 4,000 people . Vancouve r ca n b e describe d a s th e cit y transportatio n built: before the CPR chose it as its western terminus, only a small lumbering villag e existe d there ; b y 1891 , it s populatio n wa s 13,700 . Wit h th e completion o f the Intercolonia l Railway , Halifa x gaine d i n importance , becoming a city of 38,437 by 1891.

Expansion (1880-1889) 6

7

Dentistry followe d the developmen t o f the country . Frederic k Davi s Shaw wa s th e firs t establishe d dentis t i n th e whol e o f th e North-Wes t Territories, th e enormou s are a whic h include d al l o f wha t becam e th e provinces of Alberta and Saskatchewan. Shaw was born at Kentville, Nova Scotia, of pioneer stock, the son of William Henry Shaw, MD, aprominen t figure in tha t province . Afte r attendin g Annapolis College , h e obtaine d his degre e a s a veterinar y surgeon . Later h e graduate d fro m a privat e dental school in the United States. He had difficulty, however, in establish ing practice in his native province, and took a position a s auditor wit h the Intercolonial Railwa y for fou r an d a half years . Bu t the cal l o f the Wes t was strong, an d in 1880 he joined the North Wes t Mounted Police. Shaw served i n the forc e fo r fou r years , during which he wa s promoted t o th e rank of staff sergeant: his discharge certificate, dated 5 March 1884 , states that he left i n consequence of being invalided. At this time his father died, and he returned to Nova Scotia, married Agnes Madeline Moran o f Halifax, an d the n move d her, together wit h his mothe r an d famil y o f thre e brothers, on e sister and a nephew, to the West . They arrive d i n Calgar y on one of the first Canadian Pacific train s in 1885 , an d the n transferre d to a stage coach fo r the final leg of the journey to Fort MacLeod, i n what is no w souther n Alberta . Th e populatio n o f th e are a wa s scant y an d scattered, but Shaw decided i t was possible to open a dental practice . H e applied t o th e North-West Territories Counci l a t Regin a fo r permission , which was granted. At the same time, he was granted permissio n to practise veterinar y science . H e provide d himsel f wit h a buckboar d an d se t up a regular schedul e between Fort MacLeod, Pinche r Creek, an d Leth bridge. Sha w became an importan t citizen in th e whol e district . H e wa s not onl y the first dentist an d first veterinarian i n the North-Wes t Terri tories, but was also in time appointe d Corone r an d Collector of Custom s in the St Mary's area . Whe n the North-Wes t Territories Denta l Registe r was established in 1889 , Shaw's name was the onl y one shown that year . William Wilson , locally know n as 'Tug ' Wilso n fo r obviou s reason s related t o hi s extractiv e services , was unquestionably the firs t dentis t t o practise a t Calgary , thoug h som e confusio n exist s respectin g th e date. 1 In th e city' s firs t directory , publishe d i n 1885 , he wa s th e onl y dentis t listed, togethe r wit h a n advertisemen t that h e extracte d teet h painlessly . Probably Wilso n ( a nativ e of Kingston, Ontario) establishe d practic e a t Calgary ver y soo n afte r Sha w di d s o a t MacLeod , bu t th e questio n of which was first in the area may never be settled satisfactorily. At any rate, Shaw i s firs t o n th e North-Wes t Territorie s Register . Wilson' s nam e

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appears the following year ( 1890), with Edmonton a s his address. I t may be that Wilson was wandering from plac e to place when Shaw establishe d his practice. Bot h men had retire d fro m th e North Wes t Mounte d Polic e at about the same time. In 1966 , John Clay, a prominent Calgary dentist , recalled tha t Wilso n was practising there in a log shack near th e junction of the Bow and Elbow rivers when he settled in Calgary in 1907. 2 At Edmonton , th e firs t denta l practic e wa s establishe d b y A.H . (Sandy) Goodwi n in 1891 , althoug h th e settlemen t had bee n visite d by other dentist s earlier. Goodwi n wa s a native of Baie Verte , Ne w Bruns wick, and a member of the sam e family a s W.S. Goodwin, who was later the firs t registere d dentis t i n Newfoundland . H e graduate d fro m th e Baltimore Colleg e o f Denta l Surger y i n 188 9 an d afte r tw o year s a s a transient dentis t i n New Brunswick, left fo r th e West . H e arrive d a t hi s destination on the second train to run fro m Calgar y to Edmonton, whic h then ha d a populatio n o f 1,500 . Th e fron t parlou r o f Mrs . Kelly' s lo g house on Jasper Avenue became his office a t a rent of $10 a month. Lorenzo D. Keown and his brother William set up practice a t Regin a in 1886. Theirs was said to be at the time the only dental practice betwee n

The first licence to practise dentistry in the North-West Territories

Expansion (1880-1889 )

69

Brandon and Calgary, a distance of nearly 700 miles. Feeling that Regina had no future, Lorenz o move d to Moosomin, where he practise d fo r ove r a hal f century . Hi s brothe r remaine d i n Regina , an d die d i n 1899 . Lorenzo Keow n served on the Saskatchewa n Denta l Counci l fo r twenty five years. Hi s abilit y wa s recognize d i n man y way s an d h e serve d i n several publi c offices . I n politics , h e wa s a life-lon g Conservativ e an d organized th e party i n the North-West Territories . I n orde r t o bring the benefits o f his practice t o th e settlers , h e mad e long trip s b y horse an d buggy. These men , an d other s wh o followe d i n bringin g dentistr y t o th e West, experienced man y physical hardships, and had real problem s earn ing a living from thei r practice alone . Establishin g a dental offic e i n town meant little as far a s gaining a living was concerned. I t was necessary t o take dentistr y to th e scattere d settlers , b y any means availabl e an d ove r long distances . A n eve n greate r hindranc e wa s th e visitation s o f th e travelling 'showman-type ' dentist , wh o down-grade d th e professio n i n the eye s o f th e public . Th e followin g quotatio n describe s Goodwin' s opposition i n Edmonton durin g the 1890s: s

Frederick Davis Shaw (1856-1926)

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His onl y competitio n came from a travellin g charlatan — the amazing , th e incredible 'Dr' True. 'Dr' True used to hit town twice a year, travelling with two ladies , a drum , an d a se t of tongs . 'Dr ' Tru e was late-thirtyish, wit h a Buffalo Bil l haircut , a pal e face , piercin g eye s an d a n eve n mor e piercin g voice. He would ride up and dow n Jasper, beating the drum , unti l he drew a crowd. Then he'd exhibit a basket of bills, and for five dollars you could stick your hand in and take a chance on pulling out a ten-dollar bill or a twenty, or a one. Then he'd sell charms - charm s that would ward off anything, including pain. If yo u bought a charm the amazin g 'Dr' True would yank on e of your teeth - righ t there in the dust of Jasper Avenue - t o prove that the charm warded of f pain . He used the sam e tongs for ever y tooth and between extractions woul d clea n the m of f o n hi s trousers . Peopl e wh o bough t charm s wouldn't car e to admi t they' d been take n in , s o they woul d testif y tha t th e yanking didn't hurt a bit. Dr Goodwi n got some business out of the amazin g 'Dr' True's dentistry - treatin g the infections and fishing out the roots. Following th e achievement s i n Ontari o an d Quebe c durin g the lat e 1860s, dentists in Canada's othe r province s endeavoure d t o obtai n legis lative recognition. A n Act establishing the Manitoba Denta l Associatio n was passed in 1883 , mainly as a result of the effort s o f James L. Benson, referred t o in the last chapter, who became the first president. I n Britis h Columbia, th e chie f protagonis t wa s Thomas J. Jones , wh o was born i n Toronto, bega n studying dentistry in 1860 , and practised i n Bowmanville and St . Catharine s fo r twent y years , durin g whic h perio d h e serve d a s president o f the Ontario Dental Society . I n 1884 , he moved to Victoria , where he practised for another forty years. Coming from Ontari o wher e a dental ac t existed , h e ver y naturall y agitate d fo r legislatio n i n Britis h Columbia, an d succeede d i n 1886 . Durin g th e followin g three years , twenty-one person s wer e licensed t o practis e dentistr y i n th e province , eleven of them in Victoria, four i n Vancouver, fou r i n New Westminster, and on e eac h i n Nanaim o an d Barkerville . On e o f the m possesse d a degree bot h i n medicin e an d dentistry , nin e ha d doctora l degree s i n dentistry, an d thre e ha d obtaine d licentiat e standin g (LDS ) elsewhere.4 Apparently a n informa l provincial denta l societ y existe d earlie r bu t th e British Columbia Dental Association wa s not founde d until 1891 . A t it s first annual meeting in Victoria, i n 1891, Jones (it s principal organizer ) was elected president . I n a special editio n o f the Victori a Daily Colonist in April 1896 , Thomas Jones was credited with being a foremost citizen: in addition to his large modern practice, i t reported, h e had various othe r

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71

Thomas Joseph Iones, LDS, father of dentistry in British Columbi a

interests an d was considered an enterprising , public-spirited citizen . Hi s activities on behalf of the professio n entitle him to recognition as Father of Dentistry in British Columbia. New Brunswick obtained legislation in 1890, and in both Nova Scotia and Prince Edward Island dental acts were enacted by the respective legislatures during 1891. Legislation cam e about i n Newfoundlan d i n 1893 . The North-West Territories Council adopted an Ordinance for the control of dental practice in 1889 - but without consulting dentists and it was only as a resul t o f amendment s secured b y W.D . Cowa n o f Regin a tha t i t became a workable measure. Legislation followed more normal routes on the Atlanti c coast . I n eac h province , som e on e dentis t wa s responsibl e for first gaining the support of his colleagues for the objectives of a dental act, an d then having the patience an d endurance necessar y to secure the

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legislation. History doe s not produc e men ; it i s men who make history . In New Brunswick, after other s had failed , C.A . Murra y of Moncton was successful. Th e Act he fought fo r establishe d th e New Brunswick Denta l Society wit h power s simila r t o thos e grante d it s counterpart s h i othe r provinces. A.J. McAvenney of Saint John wa s the first president. Alfred Chipma n Cogswell , a membe r o f on e o f Nov a Scotia' s mos t prominent families , was the province' s leadin g dentist fro m th e 1860 s t o the tur n o f th e century. 5 Bor n i n Cornwallis , NS , hi 1834 , h e attende d Acadia College for two years, spent a couple of years on his father's far m near Portland , Maine , an d the n indenture d wit h Edwi n Parson s o f tha t city. H e practise d a fe w years i n Ne w Englan d an d i n 185 9 move d t o Halifax. H e attende d Philadelphi a Denta l Colleg e durin g on e winter , graduating in 1869 . That sam e year, followin g th e enactmen t o f legislation i n Ontario , h e mad e hi s first attempt t o secur e legislatio n i n Nov a

Alfred Chipma n Cogswell, DOS, of Halifax (1834-1904)

Expansion (1880-1889 ) 7

3

Scotia. This effor t failed , owin g to th e d e Cheveri e affair relate d earlier . For twenty years he pursued the objective. During this period, practicall y all the informatio n respecting dentistry in Nova Scoti a tha t appeare d i n the dental literature came from hi s pen. It i s said of him that no one man worked more incessantl y for s o many years endeavouring to elevat e his profession. H e wa s instrumental in bringing about the Ac t whic h finally incorporated th e Nova Scotia Dental Associatio n i n 1891 . Cogswell was a great traveller and in 1904, on one of his many trips, he was accidentall y shot in Mexico City. During 1891 , a s i n Nov a Scotia , a denta l Ac t cam e int o forc e i n Prince Edward Island, though it did not name an association o r society as governing body . Doubtless , thi s differenc e fro m legislatio n i n th e othe r provinces occurred because of the small number of dentists - onl y seven then practising on the island could qualify . Th e Act was secured throug h the efforts o f one man, John S. Bagnall, father o f J. Stanle y Bagnall, who became dean at Dalhousie University. It was not until 1901 that an asso ciation wa s formed , wit h th e elde r Bagnal l it s firs t president . Later , through amendment to the Act, the association wa s made the governin g body of the profession. In 1893 , the Colonial Government in Newfoundland enacted a dental Act, thu s completin g legislation for dentistr y across th e whol e country. Since then these original dental acts hav e been amende d o n many occasions, but the principle of self-governing professions has been adhered to . This achievement represented a great deal of arduous, often discouraging , struggle by a few dentists in each province. Today the accomplishmen t i s taken fo r granted , but fo r mor e tha n twent y years recognition b y legis latures was a prime professional objective . Probably on e o f th e mos t notabl e event s i n th e developmen t o f th e dental profession occurred in 1888 when the dental school at Toronto was affiliated wit h th e Universit y o f Toronto . Th e universit y establishe d a Department o f Dentistry (Royal College of Dental Surgeons) an d agreed to confe r th e degre e of Doctor o f Dental Surgery upon student s on compliance with the requirements o f the curriculu m in dentistry as approve d by the University Senate. In essence, under the agreement future matriculation standards , curricula, an d examination s were to have the approval of the university. The first examination for the degree occurred i n Marc h 1889, whe n twenty-five candidate s wer e successful. These wer e the firs t doctorate degree s conferre d o n denta l graduate s outsid e o f th e Unite d States. Next t o th e incorporatio n o f dentistr y i n Ontari o (1868 ) an d th e

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establishment o f a dental schoo l (1875) , this affiliatio n represente d th e greatest move forward by the profession to that date. The academic standing of dentists was elevated. Whil e several men made periodic contribu tions towards the goal, J.B. Willmott worked continuously for it for some twenty years , an d i n realit y deserve s credi t fo r it s attainment . O n th e university side, William (later Sir William) Mulock, vice-chancellor at the time, persuaded his colleagues t o recognize dentistry. By this time, Willmott had become an outstanding citizen, known for his service to dentistry as well a s public affairs. I n th e nex t announcemen t o f th e school , J.B . Willmott was shown as dean for the first time. 6 In tracing the development of the profession, the impression must not be left that gains were achieved in logical sequences or easily. Perhaps th e greatest handicap came from dentists themselves. Criticism of leaders an d their objective s was severe and a t times malicious, illustratin g ignoranc e or lack of understanding. One illustration, a letter received fro m a dentis t and th e reply from Georg e Beers a s editor o f the Journal, wil l suffic e t o exemplify a state of affairs which was altogether too prevalent.7 The letter Beers received read : I am not a subscriber to the Journal, an d I don't mean to be, and I'll giv e you my reasons: You take too high a stand to start with, as the profession i s new in Canada, an d th e dentist s canno t affor d t o starv e fo r th e sak e o f keepin g u p appearances, societie s an d journals. I neve r aske d anybod y fo r ideas , an d I don't give any. I do not trouble anyone. I f you choose t o crack u p education, I wil l not quarrel l wit h you . Onl y I hav e s o far satisfie d a goo d majorit y o f the people for over twenty-eight years or more, an d I think my work will spea k for itself . I woul d no t hav e ninety-nin e ou t o f ever y on e hundre d o f you r 'educated' youn g me n i n m y office . The y thin k the y kno w s o much ; yo u discover the y know very little, though the y can tal k theor y t o you, an d hav e more brag, and gas than real ability. Just let dentistry slip along in the old way, and if you have any practical hints give them to us and w e can pay fo r them . But I say we don't want 'highly-educated' men. We want good mechanics, wh o can wor k i n thei r shir t sleeves , an d wh o aren' t particula r abou t al l th e fine nonsense of antiseptics, bacteria etc . What the mischief does it all mean? Am I a fool, or are you.

Beers replied in an editorial: If the kicker had his way in Canada, instead o f organized mean s o f education,

Expansion (1880-1889 ) 7

5

we shoul d fin d stabl e boy s an d jeweller s jumpin g fro m th e curry-com b an d the bench into the surgery at one bound, afte r perhaps si x weeks training. The kicker, a s a rule, who condemns education because i t is not equa l to the ver y best order and more populou s countrie s supply , is well aware tha t h e himself is unqualified to improve it, and the impracticable suggestion s he ever venture s to make only prove tha t h e is more animate d b y jealousy an d ignoranc e than any idea of self-sacrifice or sincerity. He is as lavish i n unreasonable criticis m as h e i s niggardl y of hi s tim e o r mone y .. . Th e kicke r ha s rarely , i f ever , distinguished himself by self-sacrifice.

Advertising in every possible for m becam e the mos t seriou s impedi ment to those endeavouring to elevate the profession. In th e language of the day, offenders were conducting 'quackish' practices by means of 'claptrap' advertisements and 'cheap John' performances. The public suffere d the consequences . B y 1887 , 8 X 1 2 foo t board s stoo d a t ever y public road entranc e to th e cit y of Toronto, settin g forth i n fourteen-inch-hig h letters th e name s and addresse s o f dentist s wh o emphasize d cheapnes s and nothing more. Evidence of the horrible extremities reached ar e to b e found i n ol d newspapers , handbills , an d cards . Advertisin g b y dentist s seemed t o reac h a crescend o b y th e tur n o f th e century ; afte r tha t i t diminished, slowly and over several decades. Amendments to dental laws and refor m movement s initiate d withi n denta l organization s finall y brought advertisin g under control , bu t al l this too k a distressingl y lon g time. Both in Quebec and Ontario, the dental boards fought the issue with all the tools at their command. The records o f the voluntary societies ar e filled with discussion s a s t o method s to counte r th e advertiser . A t on e point the Ontario Dental Societ y fell under the control o f the advertisers , and fo r a few years little record o f it s activitie s has survived . I n 1889 , however, a group of ethical dentists called a meeting at London, an d with forty-six members in attendance made every effort t o dissociate fro m th e former society . The objective s of the societ y were altered, an d wit h considerable emphasi s that meetin g was numbered One. The mai n busines s was the adoption of a code of ethics which strictly prohibited advertising. To become a member of the new society, each applicant ha d t o sig n this code. Nearl y al l th e dentist s present signed . Although advertisin g continued, eve n increasin g somewhat afte r thi s date , th e Ontari o meetin g represented a turnin g point. I n proo f i t i s tempting to includ e a t considerable length details of a battle which took place within the professio n

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over fa r to o man y years , an d greatl y hindere d it s development . Man y dentists wer e involved , i n increasin g numbers , agains t th e cance r o f advertising, chiefly under the leadership o f Beers in Quebec an d Willmott in Ontario. The foundation of dentistry was greatly strengthened by a journalisti c revival. Th e Dominion Dental Journal wa s established , th e firs t issu e appearing in January 188 9 with W. George Beers as editor. An amicabl e arrangement ha d bee n mad e whereb y th e faltere d Canada Journal of Dental Science was taken over by the ne w publication. Fo r th e first year, this ne w journal was issued quarterly ; i n the secon d yea r i t becam e bi monthly, an d in 189 3 monthly. I t wa s published i n Toronto an d serve d the profession well over fort y years, when it was absorbed b y the Journal of the Canadian Dental Association. From thi s time forward, dentist s in Canada possesse d a mean s o f communicatio n whic h ha d bee n sadl y lacking for seventeen years. The need of a profession for adequate mean s of intercours e ca n hardly be better illustrate d tha n by the vacant interval . In coverin g this period , th e historia n i s lef t wit h onl y scant y records , public archives , ol d newspapers, an d extraneou s publication s a s source s of information . The economic s of the times ar e illustrate d i n an accoun t fo r service s rendered b y G.E . Hanna , wh o late r becam e presiden t o f th e Ontari o Board. Hanna represent s wel l th e practisin g dentis t o f th e period . Th e account for m no t onl y lists the service s rendere d an d fee s charged , bu t also contain s a fee schedule. The service s wer e rendered fo r a famil y of three children . Mis s Lizzi e ha d nin e fillings performed fo r five dollars, Miss Maggie's tooth was extracted for twenty-five cents, while Angus cost his parents a dollar for one filling and an extraction. The total account fo r the thre e amounte d to $13.75 , but tw o gallon s o f maple syru p an d tw o cords o f wood at a dollar a cord are credited. Barter item s were common on many dental accounts . Orthodontist s migh t note tha t th e fe e for cor recting irregularities of teeth varie d al l th e wa y from tw o to te n dollars . Other account s examined for the 1880 s are comparable . Charles Nelson Johnson was born in a farming community in Ontario and graduate d fro m th e Roya l Colleg e o f Dental Surgeon s i n 1881 . H e established practice at Collingwood and while there published a pamphlet entitled, The Teeth, their Importance and How to Preserve Them, whic h had wide circulation. At the end of three years, he went to Chicago wher e he became one of the most outstanding American dentists, occupyin g th e highest positions the profession ha d to offer. Ye t even while living in Chi-

Expansion (1880-1889 )

77

A typical account of the 1880 s

cago, he made a great contribution to Canadian dentistry. Over a period of forty years, his name appeared o n the convention programs o f the Ontario Dental Associatio n mor e often tha n that of any other person. 8 He wa s a prolific writer , an d contribute d generousl y to Canadia n denta l literatur e articles tha t wer e rea d wit h avi d interest . Th e Universit y o f Toront o honoured hi m in 193 2 wit h the degree of Doctor o f Laws. Seldo m ha s a man, spending his life in another country , done so much for his profession in hi s nativ e land . A t hi s deat h i n 1938 , Canadia n dentistr y pai d hi m glowing tribute. Earlier , a t a luncheon give n in his honour a t Toronto in 1924, it was said of him: 'He helped his fellow men, ' and 'H e stooped t o aid a fallen comrad e wheneve r h e sa w one down an d pu t a pro p unde r those who m he found tremblin g in the balance.' 9 Coming-of-age celebrations in the central provinces occurred in 1889,

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when progress t o date was assessed an d predictions mad e for the future . C.F.F. Trestler, president of the Quebec Board, pointed out that in comparison with Ontario his province faced two main difficulties - numerica l weakness in the ranks of the profession and dual language s - tha t mad e progressive activitie s costly . Owing to lack o f support fo r dental services , it wa s no t ye t considere d practicabl e t o establis h a denta l schoo l i n Quebec. Frenc h student s were in the majority and existing dental school s taught in English only ; but public deman d woul d not warrant th e estab lishment o f two teaching bodies . On e o f the grea t difficultie s i n Quebe c was to deal effectively wit h quacks and unlicensed practitioners. However, amendments to the dental law had just been obtaine d which , it was said, would handle this matter with efficiency. Trestle r was one of the founder s of dentistry in Quebec. He was a medical graduate, and one of the earliest dentists in Canada to use chloroform and nitrous oxide in his practice. In Ontario, th e recent affiliation o f the dental school wit h the Univer sity of Toronto wa s the main achievement pu t fort h at anniversary meet ings. A tendenc y existed t o conside r professiona l maturit y attained , bu t J.B. Willmott warned in stern language that dentists had not yet cultivate d in themselves that respect and enthusiasm for their profession that woul d engender respec t fro m th e public . H e note d th e absenc e o f such profes sional etiquette as would indicate full professional maturity: dentist s wer e too muc h dispose d t o misrepresen t an d tak e advantag e o f on e anothe r through advertising. Dentistry had made giant strides forward, but further advancement depende d upo n correctin g situation s whic h existe d withi n the profession. It was also noted with surprise tha t afte r th e long struggl e for affiliation , a secon d Ontari o universit y had , withou t knowledg e o r behest o f the profession , given notice o f the introductio n o f a statut e t o establish a curriculum in dentistry leading to a degree. The twenty-firs t birthda y wa s a tim e o f review , whe n th e founder s and principa l contributor s t o advancemen t wer e honoured . I n Quebec , the name s o f Bernard, Baillargeon , Trestler , Brewster , LeBlanc , Beers , Bazin, an d Webste r were placed i n the hal l o f dental fame . I n Ontario , the name s of men like Day, Wood, Relyea, Chittenden , O'Donnell, an d Willmott were referred to wit h pride . Unfortunately , time ha d take n it s toll amon g the earl y stalwarts , C.S. Chittenden , a n energeti c worke r i n every goo d effort , die d durin g this year . Da y an d Relye a ha d gon e t o United States, and O'Donnell ha d died in 1879. In Quebec, Bernar d die d in 1876. Baillargeon was to die a year later, Webster had died, and Brew-

Expansion (1880-1889 ) 7

9

ster had retired. LeBlanc carried o n as secretary for six years more. Beers and Willmott now were the outstanding men of dentistry in the two provinces. Fortunately, othe r hands, in increasing numbers, had come forward to replace those who had gone, and were carrying on the work. The wide range of activities of W. George Beers an d his lasting influ ence on Canadian lif e ar e remarkable. H e wa s an intens e patrio t an d i n demand as a public speaker. I n 1888 , a t a time of political disturbance s between the United States and Canada, h e addressed th e New York Stat e Dental Societ y a t Syracus e o n th e subject , 'Canad a No t Fo r Sale. ' Hi s words were terse an d undoubtedl y th e audienc e wer e surprise d t o hea r hun say : ' I a m sure tha t yo u could hav e nothin g but contemp t fo r any free peopl e wh o measur e thei r allegianc e purel y b y commercia l stan dards, an d who, fearing t o fac e th e difficultie s whic h meet ever y nation , turn peddler s instea d o f protector s o f thei r nationa l birthright . Jus t a s you ha d an d hav e you r croaker s an d coward s w e hav e ours , bu t M r Chairman, Canada is not for sale.' This even t would mean little if it were not fo r th e aftermath . Canadia n newspaper s printe d th e speec h widely , and fo r man y years after , editorial s referre d t o it . Th e addres s wa s a n influential factor in the federal election i n 1911 , when it was used freely , and as late as 1916, some sixteen years after hi s death, it was reprinted h i full. Fe w member s o f th e denta l professio n hav e attaine d hi s publi c stature. Among the names whic h appeared durin g these years, tha t of Jame s Wellington Ivor y becam e familia r t o ever y practisin g dentist . H e wa s born at Newcastle, Ontario, graduate d fro m th e Royal Colleg e o f Denta l Surgeons in 1887 , and practised in Toronto fo r six years. His hobby wa s inventive mechanics. Leaving Toronto, h e went to Philadelphia, wher e he established th e firm of J.W. Ivory, Inc, specializing in the manufacture of dental instruments. During his lifetime, he held a great number of patent s and his instruments were readily accepted. 10 By 1889 , ther e were 21 dentists registered i n British Columbia, 4 0 hi Nova Scotia , 11 7 i n Quebec , an d 49 4 i n Ontario . Th e othe r province s had only few dentists. By modern standards, these numbers represented a poor servic e fo r a countr y o f five million people . Eve n i n Ontario , th e largest province , th e rati o wa s less tha n on e dentis t fo r fou r thousan d of th e population . Lac k o f public appreciatio n fo r denta l service s was a great proble m whic h woul d b e th e targe t o f a n increasin g effor t o n th e part of all dental organizations .

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Always, chang e comes hard t o some , an d ofte n mos t har d for thos e who hav e achieve d th e mos t unde r th e ol d system . Durin g thi s perio d Oliver Marti n commented : 'W e ha d a trad e wit h principles , an d no w have a profession with none.' Some truth existe d for hi s statement. Den tists were going through a transition period and it took some time to adap t themselves t o a ne w environment . Th e principle s o f a trad e wer e wel l understood; the ethics of a profession had yet to be learned .

7

Technical advancemen t 1890-1899

During the hiatus in the progress o f the Ontari o Dental Societ y referre d to in the preceding chapter, th e Eastern Ontari o Denta l Associatio n be came actively engaged in the affair s o f the profession , mainly under th e inspiration o f Charles A . Marti n o f Ottawa . Insidiou s rumours , initiall y discussed at EOD A meetings, spread amon g Ontario dentist s that the pro fessors a t the Toronto schoo l were becoming rich out of the profit s fro m the school. At the 1890 annual meeting of the rejuvenated Ontari o Dental Society, Presiden t G.C . Davie s emphatically state d 'tha t the Dental Col lege should be managed by the Boar d o f Directors o f the Roya l Colleg e of Denta l Surgeons of Ontario, that al l fees shoul d be paid to the Board , they t o assum e its liabilities. 1 When the schoo l wa s founded i n 1875 , th e Ontari o Boar d ha d ver y carefully place d th e financial responsibility for its operation o n the shoul ders o f the tw o appointe d professors, Willmott an d Teskey . Th e Boar d had mad e certain, as far a s possible, tha t i t would have no responsibilit y for an y deficit, such as had developed with the abortive school of 1869 . I t voted only a small grant of $400 t o cover rent an d furnishings . Willmott and Teskey operated the school out of the student fees, an d i f any money was left a t the end of the year, the staf f wa s paid on a pro-rata basis. Th e Board howeve r retaine d contro l throug h th e appointmen t o f staff , th e setting of matriculation standards, the settin g of the numbe r o f sessions , the amoun t o f th e academi c fee , an d th e curriculu m content . B y th e 1888-9 session, th e numbe r o f students i n attendanc e ha d increase d t o fifty. Finances relate d t o th e schoo l wer e kep t entirel y separat e fro m

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HISTORY OF DENTISTRY IN CANADA

those of the Board, an d at no tune do the records show a financial statement o n the operatio n o f the school . A t meetings , the dissiden t dentist s argued that the Board should take over complete operation of the school , issue ful l financia l statements , an d pa y salarie s t o th e staff . Betwee n meetings, exaggerate d rumours wer e rife and th e whol e matter becam e one of heated controversy for two or three years. The principles involve d were right, but th e detail s discussed were incorrect . Ove r th e years , th e professors, a s they were termed (sometime s with derision durin g heate d arguments), had received ver y little recompense; som e years nothin g a t all was left ove r for division . Undoubtedly they ha d mad e a mistak e i n not issuin g annua l financia l statements , bu t n o suc h reques t ha d bee n made. In fact , recorde d discussion s suggest that al l financial aspects ha d been avoided by the Board, who were content t o let Willmott and Teske y bear the responsibility. Even with the school established , th e Board found the position somewhat awkward. The matriculation standard , no w a university matter, was being raised, and a reduction in the number of students was anticipated . Afte r length y discussions , however , th e Boar d finall y accepted financial control. To modern eyes, perhaps, the magnitude of the whole argument is somewhat diminished with the statement that the salary of the dean was set in 189 3 at $250 per year . A goo d deal of rivalry existed among educational institution s durin g this period. After th e years of effort spen t by the Ontari o Board in secur ing an affiliation agreemen t with the University of Toronto, th e formatio n of a denta l facult y a t th e Universit y o f Trinit y Colleg e (t o giv e tha t institution it s ful l an d prope r name ) wa s a considerabl e surprise . Th e records o f the Royal Colleg e o f Dental Surgeon s o f Ontario d o not indi cate any consultation o r agreement with Trinity. In fact , almost th e onl y mention found of that university in Ontario dental records is its conferring of a n honorary doctorate i n 190 3 on G.E. Hanna , a former president o f the Ontari o Board . Th e first doctorate i n dentistr y conferre d b y Trinit y College wa s upon Albert W. Spaulding in 1890 . The calendar s issue d b y th e Denta l Facult y o f Trinit y Colleg e state that graduate s from an y recognized university or the Royal Colleg e of Dental Surgeons would be recognized for examination. I t is interestin g to note that, at the beginning, the staff liste d consisted o f W.T. Stuart and Luke Teskey, who also served on the staf f o f the Roya l College o f Denta l Surgeons, together with C.A. Snelgrove, F.J. Capon, an d C. Sheard, who were prominen t Toront o dentists . A t a late r dat e J.B . Willmott , A.E . Webster, and RJ. Reade joined the Trinity staff - whic h was larger in the

Technical advancemen t ( 1890-1899 ) 8

3

calendar lists than that of the Royal College of Dental Surgeons . Difficult y is found, however, in finding evidence of actual lecture s o r clinical train ing of any kind being given by Trinity. I t appear s that th e staf f acte d a s examiners fo r th e degre e o f Docto r o f Denta l Surgery . I n total , som e sixty-six degree s wer e conferre d b y Trinit y h i dentistry , fiv e o f the m honorary. The last holder of a Trinity degree, Oliver A. Marshall of Belleville, die d in 1957 . Durin g 1903 , Trinit y an d th e University of Toronto joined in federation, and under the agreement, Trinity gave up al l degreeconferring power s except i n divinity . No furthe r degree s h i dentistr y o r medicine wer e conferred . Th e Universit y o f Toront o recognize d thos e which had been conferred by Trinity.2 Progress in the development of dental services cannot be judged solely by official action s taken, for ofte n i t took man y years to bring the intent of suc h actions t o fruition. I n the majo r centres o f population, i t is true, dental services were by this time receiving increasing recognition, but large rural area s existe d where littl e improvemen t was noticeable. I n spit e of legislative authority, the dental boards found contro l of quacks difficult. I spent my early childhood in one of the poorer areas , an d ca n remembe r that as late as 1904 it was a debatable point among the populace whethe r it wa s bette r t o hav e a loca l farme r extrac t a n achin g toot h wit h hi s turnkey or drive six miles to a dentist with his cruel forceps. The education of the public to professional dental services was a slow process. To obtai n a perspective o n the manne r of change, i t may be wel l to follow th e caree r o f a singl e dentist. Joh n N . Brimacomb e practise d a t Bowmanville, Ontario , fro m th e earl y 1860 s unti l his death i n 1908 . I n 1899 h e wa s elected presiden t o f th e Ontari o Dental Society . When he died, th e loca l newspape r describe d hi m a ver y esteeme d citize n wh o wrote his name in kindness, love, and mercy on the hearts o f those whom he met from da y to day, and said that many a poor an d needy family ha d been mad e riche r o r bette r b y hi s gifts. 3 Hi s lif e stor y illustrate s th e changed position of the dentist over a period o f half a century h i a relatively smal l community. Like many other young men, Brimacombe arrived in the Bowmanville area fro m Englan d during the earl y 1850s . I n a few years h e had save d $400, a considerable sum in those days, from workin g at several occupa tions. H e became interested i n dentistry , an d wa s referred t o a Toronto dentist, W . Case Adams. But two years' indentureshi p with Adams a t a fee o f $20 0 wa s mor e tha n hi s pocketboo k coul d stand , s o h e signe d indenture papers fo r eightee n months a t a fe e of $10 0 wit h an Oshaw a

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HISTORY OF DENTISTRY I N CANADA

dentist named Vars. His preceptor's librar y was small: it consisted of only two books - Goddard' s The Anatomy, Physiology, and Pathology of the Human Teeth and Harris' Principles and Practises oj Dentistry. An incident during his indentureship is best told by Brimacombe himself:4 But th e wors t piec e o f downrigh t chee k wa s whe n m y precepto r sen t m e (armed wit h turnkey ) man y mile s int o th e countr y t o extrac t a lowe r wis dom toot h fo r a lad y stil l i n be d recoverin g afte r confinement . Operatio n performed o n my knees. Strang e t o say it was considered a great success , an d after forty-tw o year s sh e stil l enjoy s goo d health . Bein g of a charitabl e dis position, sh e considers hersel f fortunat e to be numbered amongs t m y patients, as well as her children an d grandchildren. Wishin g t o retai n he r friendship , I took the advice of Punch's Almanac, whic h says some things ough t never to be told.

When Brimacomb e se t u p hi s practic e i n Bowmanville , i t wa s no t possible to make a living in a small community from dentistr y alone; being musical, he became an agent for a piano compan y to supplement his income. Late r h e wa s appointe d telegrap h agent , a positio n h e hel d fo r several years. He was an able dentist for his time, but it was not until th e late 1880 s tha t h e coul d affor d t o confin e his activitie s t o hi s practice . Most dentists had simila r experiences up to the 1890s , an d eve n beyond this period. Due to th e spatia l natur e o f Canada , experience s wer e repeate d a s each are a opene d u p fo r settlemen t ove r a long spa n o f years . Medica l graduates for many years found forcep s an essentia l part o f their equip ment. Th e stor y i s vividly told o f Murrough O'Brien , a n earl y graduat e (in 1897 ) o f the Manitoba Medical College at Winnipeg. 5 He establishe d practice i n souther n Manitob a a t Dominio n City , a villag e wit h a bi g sounding name . Hi s firs t patient s wer e fo r toot h extractions , an d hi s reputation wa s established b y his proficiency in that operation . I n newly settled areas, a mechanic or farmer ofte n establishe d a similar reputation for extractin g teeth, albei t i n a crude r fashion . Toothache wa s not con strained t o awai t the arrival o f a qualified practitioner . In 1896 , S.W . Mclnnis o f Brandon, Manitoba , publishe d a n articl e describing his country practice. 'The patients of the city, whether residen t or visiting, are educated to a great extent as to the value of their teeth an d the possibilities of dentistry. With people living in villages and the outlying country it i s not so , at leas t no t s o much so. The farmers ' cree d i s very

Technical advancemen t ( 1890-1899 ) 8

5

simple - "i f your tooth aches have it pulled." The brushing and cleansing of teeth ar e to the ordinary farmer like wearing a white shirt, a n uncalle d for an d snobbis h extravagance. The farmer' s wife o r daughter looks for ward to th e tim e when she can hav e as pretty a new set of teeth a s he r neighbour, with a longing proportionate to the envy, ambition and vanity of he r nature. Thi s ignorance , thi s lack o f education, i s one o f the fore most difficultie s t o b e encountered in a country practice.' He wen t on to describe hi s practice , whic h involved visit s t o severa l village s withi n a radius of fifty miles of his house ('m y head office'). H e said that patient s presented thei r mouths with teeth in all stages of irregularity, decay , an d disease. They were not rich, did not value their teeth, and were not willing to spend much time or money on them.6 During thi s period , Quebec , unde r th e twi n handicap s o f tw o lan guages and fe w dentists, struggled toward the establishmen t o f a school . After a great dea l o f negotiation, th e Denta l Colleg e o f th e Provinc e of Quebec opened courses at Montreal i n the fal l o f 1892 , with W. Georg e Beers a s dean. Instructio n wa s give n in bot h Frenc h an d English , wit h lectures in medical subjects taken at McGill and Laval Universities. 7 The Dental Boar d lease d a buildin g o n Phillip s Square , Montreal , fo r th e

Home of Quebec's first dental school, the Dental College of the Province of Quebec, at 2 Phillips Square, Montreal

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HISTORY OF DENTISTRY IN CANAD A

school, an d mad e a gran t o f $50 0 towar d equipment . Th e cours e was three year s i n length , on e yea r mor e tha n th e indentureshi p perio d i n Quebec a t the time. After a successful first year of operation, the Dental Board sought university affiliation fo r the school so that graduates would receive the degree of Doctor of Dental Surgery. Letters making the request were sent to both Laval an d McGill . Fo r som e reason , no t ver y clear , Lava l coul d no t accept th e overture for affiliation . McGil l was willing to accep t the proposal conditionall y by granting a degree o f Graduate o f Dental Surger y (CDS) whic h th e Denta l Boar d foun d meaningles s an d unacceptable . There was, however, a third medical school in Montreal, operated by the University of Bishop's College, Lennoxville, from 187 1 to 1905 , when it was merged with the Medica l Faculty o f McGill. The fac t tha t Bishop' s had bee n ignore d b y th e Denta l Boar d resulte d i n som e dispute , bu t eventually a compromise was reached. I n 1896 , a Departmen t o f Den tistry wa s forme d i n Bishop' s Facult y o f Medicin e b y affiliatio n o f th e Quebec Denta l College . Teachin g wa s i n bot h Frenc h an d English . Bishop's thu s became the first university in Quebec t o provid e a denta l course leading to th e degre e of Doctor o f Dental Surgery . An event occurred in the same province during 1896 which influenced the attitud e of th e professio n i n respect t o th e employmen t of auxiliary personnel i n dental office s fo r many years i n future . I n orde r t o under stand its import, it is necessary to summarize the indentureshi p arrange ment at that time. In all provinces, indentureship with a registered dentist was originally the onl y form o f training. When dental education becam e available, attendanc e a t the sessions of a school reall y became a part of the indentureship term. The student still had to sign an indenture contrac t with a registered dentist for a stated term of years, and during those years he was required to attend sessions of the school in order to qualify for the licensure examination . Of course, abuse s o f th e syste m occurred. Som e contracts wer e broke n b y student s who attempte d t o practis e illegally , and some dentists took advantage of the students by using them for thei r own profit rather tha n training them. The important point in this context is that no person except a registered dental student was permitted to work with a licensed dentis t in a dental office . A grou p of Quebec dentists, however , without consultation wit h th e Dental Board , submitte d a petitio n i n 189 6 t o th e Quebe c Legislature , requesting an amendment to the Dental Act to permit the employment of dental assistants. Several members of the staff o f the dental school signed

Technical advancemen t (1890-1899)

87

the petition , an d a s a result Georg e Beer s resigne d a s dean . A genera l uproar ensued . Th e Denta l Boar d circularize d th e profession , pointin g out that the requested amendmen t would make a licence to practis e unnecessary, tha t th e doo r woul d b e opene d t o th e extensio n o f branc h offices conducte d b y suc h assistants , an d tha t a clas s o f practitioner s would b e establishe d wh o woul d seriousl y injur e qualifie d dentist s an d registered students . A secon d petitio n wa s forwarded to th e legislature , signed b y mos t dentist s wh o ha d signe d the firs t one , requesting with drawal of their names. As a result n o action was taken. Beers, however , refused t o withdra w his resignation , whic h wa s finall y accepte d wit h regret an d wit h gratitud e fo r al l h e ha d accomplishe d fo r dentistry . Stephen Globensk y wa s appointe d hi s successor . Globensk y ha d bee n one of the most active dentists in organizing the profession in Quebec. Hi s great-grandfather wa s listed unde r th e soigneurs et aracheurs de dents of the French regime, and he himself had served many years on the Quebe c Board an d ha d been a member of the staf f o f the schoo l from th e begin ning. The first Canadian woman to graduate from a dental school was Mrs. C.L. Josephin e Wells, who completed th e course at the Royal College of

Caroline Louisa Josephine Wells, first woman graduate in dentistry in Canada

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Dental Surgeons in 1893. 8 Later, encouraged by her friends, she took th e examination a t Trinit y Colleg e an d obtaine d he r doctorat e i n 1899 . Her husband , Joh n Wells , ha d graduate d i n dentistr y i n 188 2 a s gol d medallist o f his year, an d whe n his healt h became poor , sh e decide d t o follow hi s profession . She practise d mos t creditabl y fo r som e thirty-si x years, during which sh e became very interested in institutional dentistry . She is credited with initiating dental services in Ontario Mental Hospitals , and confine d hersel f entirel y to practic e in those hospital s fo r te n year s before he r retirement . Sh e die d i n 193 9 i n he r 83r d year . O f he r fiv e children, the youngest, the Honourable Dalto n C . Wells , wa s appointe d Chief Justic e of the High Court of Ontario in 1966.1 acted a s assistant to Dr Wells at the Toronto Mental Hospital during one winter and can vouch for he r intelligent approach to dental treatment for mental patients. Annie Grant Hill was the first woman to be granted a licence to practise i n Quebe c b y examination , in 1893. 9 Sh e practise d fo r a tim e i n Montreal but little is known of her excep t that sh e marrie d an d ha d lef t that province by 1899 . Th e stor y of Madame Emma Casgrain, who was the secon d woma n t o practis e i n Quebec , i s wel l recorded . Sh e wa s granted a licence pro forma i n 1898. Her husband, H. Edmond Casgrain ,

H.E. Casgrai n and Mme Casgrain o f Quebec in the first snowmobile, which he invented

Technical advancemen t ( 1890-1899 ) 8

9

who was also a dentist, served on the Quebec Board for several years and took considerable interest in public affairs. H e was moreover an artist an d inventor of some magnitude and held a sizeable number of patents. He is credited as the first Canadian to own a motor car - on e with three wheels which he bough t in France i n Februar y 1897 . Amon g his invention s i s listed th e first snowmobile (1898), which was described in a n articl e in the Scientific American for tha t year. 10 H e ha s als o been describe d a s a great sportsman. Probably all these activities of her husband were factors in Madame Casgrain's decisio n to practis e dentistry ; she may als o hav e been influence d b y th e exampl e o f he r brother , Stanisla s Gaudreau , a successful dentis t i n Quebe c Cit y fo r many years. ( A nephew , Gustav e Ratte, wa s presiden t o f th e Canadia n Denia l Associatio n i n 1952-3. ) Mrs Wells, Miss Hill an d Madame Casgrain were the pionee r wome n in Canadian dentistry, an d no others appeared fo r some years. The 1890 s were a period of considerable technical advance on many fronts. Ther e wa s grea t interest , fo r example , i n an y ne w dru g whic h became available . Man y wer e introduced int o denta l practice , receive d enthusiastic support for a short period, and later discarded. Endorsemen t was based usuall y upo n clinica l experience rather tha n scientifi c proof . In an address to the Ontario Dental Society on the subject in 1892, W.E . Willmott presente d thre e drug s recentl y introduce d i n denta l practic e which wer e then considere d valuable . Aristo l (dithymol-biniodide ) wa s stated to be non-irritating, non-poisonous , an d while similar to iodofor m in use did not have its disgusting odour or its toxic properties. Hydroge n peroxide, discovere d i n 1818 , wa s just comin g int o surgica l use . Cam phophenique wa s comparatively new , and advocate d fo r us e as an antiseptic. Three techniques for treatment came into vogue during the 1890 s a t least two of which seem to possess great powers of recurrence at intervals. The firs t wa s mesmerism , or hypnosi s as i t becam e named , whic h was introduced i n Europe b y Franz Mesmer , a n Austria n mystic and physi cian, during the middle years of the eighteenth century. He was called a n imposter and a charlatan by physicians of the time. A paper presented by a famous professor from Harvar d University at the 189 6 annual meetin g of th e Ontari o Denta l Societ y initiate d a reviva l o f it s use i n Canadia n dental practice. Sinc e then the subject has reappeared i n dental program s at fairl y regula r interval s o f te n t o fiftee n years , receivin g perhap s it s greatest attentio n i n Canada durin g the mid-1900s. Implantation o f teeth has als o had its vogues ever sinc e John Hunter

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(1728-93) carrie d ou t the first experiments i n England, base d upo n his belief i n a natural tendency of all vital tissues to unit e whe n closely ap proximated. The original preserved experimen t of implanting a tooth in a cock's comb , whe n observe d i n th e Hunteria n Collectio n o f th e Roya l College o f Surgeon s o f England , stil l i s fascinating . Followin g Hunter , various dentists attempted it , but seldom with success; later Hunte r him self state d that , ou t o f a grea t numbe r o f trials , h e ha d succeede d bu t once.11 A revival o f interest in implantation occurre d i n Canada durin g the 1890s , when J.B. Willmott reported apparen t succes s at a meeting of the Ontario Denta l Society. Considerabl e furthe r researc h too k plac e o n this continen t durin g th e mid-1900s , withou t muc h practica l resul t h i general practice. Fro m time to time, the subject has re-appeared i n Cana dian dental literature . Following th e introductio n o f electricit y i n dental practic e cam e th e third prominen t techniqu e introduce d durin g thi s period , cataphoresis . This was a method of introducing medicine into the syste m by means of an electric current . Dentists used it for root cana l treatment. Fo r severa l years, a convention program was hardly complete without a paper on this subject. It s valu e fo r treatmen t wa s greatl y enhance d b y prominen t speakers, an d enthusias m for it s us e continue d fo r severa l year s befor e adequate researc h establishe d tha t i t wa s no t i n fac t beneficial . I n th e meantime, elaborat e equipmen t fo r cataphori c treatmen t appeare d o n the market . A s lat e a s th e 1920 s suc h equipmen t wa s t o b e foun d i n modern denta l offices , althoug h by that tun e its usefulness ha d bee n dis counted.12 Numerous othe r development s occurred durin g this period which did have lastin g value. Electricit y wa s coming int o genera l us e an d wa s t o cause th e secon d grea t alteratio n i n denta l practice , the introductio n o f vulcanite havin g been th e first . Strang e t o say , whil e th e firs t electri c engine with a flexible shaft had been invented in 1883, it was cataphoresis which first caught the imagination o f dentists, a t least judgin g by paper s presented a t their meetings . One of the key figures in the electrical revolution wa s Frank DeMill e Price, a Toronto dentist from 189 2 to 1935 . H e was the type of man who fascinates the studen t of history. On e o f a family o f twelve, h e was bor n on a far m nea r Napanee , Ontario , i n 1866 , graduate d fro m th e Roya l College o f Denta l Surgeon s i n 1892 , an d receive d a doctorat e fro m Trinity i n 1894 . Durin g hi s undergraduat e day s h e becam e intensel y interested i n the development o f uses of electricity, an d even during these

Technical advancement ( 1890-1899 ) 9

1

years h e contributed significantl y to the field of electro-therapeutics. Th e therapeutic value of ionization, the breaking up of a substance into its constituent ions, was under discussion and h e did considerable experimental work of value; he also worked on other electrical aid s for dentistry. Then in 1895 Rôntgen, a German physicist, made the discovery of x-rays for which his name became famous. Within a year Frank Pric e had constructed th e first x-ray machine manufactured in Canada, though it is said that one was earlier importe d to Montreal. Together wit h one of his brothers, who was in the manufacturing business, he devised a process of adding lead salts to rubber t o make protective apron s and gloves for x-ray operators. He had already bee n appointed , upo n graduation , t o th e staf f o f th e Toront o school, a s instructor an d later a s professor of electro-therapeutics, and i n 1900 the school decided to buy its own x-ray machine. Without patterns to guide him, Price manufactured virtually all the electrical appliance s h i use i n denta l office s today , thoug h the y wer e i n som e case s markedl y different i n for m fro m thei r moder n counterparts . Amon g thes e appli ances wer e controlle d heater s fo r air , water , an d wax , an d cautery , sterilizer, an d othe r devices , al l of practical use. All of these he donate d freely t o th e school , withou t though t o f recompense . H e wa s a popula r speaker a t dental meetings, greatly in advance of his times, for electricit y had not yet been installed in dental offices. A note in the record o f a meeting hel d i n 189 3 i s significant : 'Evidently , th e member s di d no t thin k electricity had much connection with the practice o f dentistry. The members did not see m to be very well-up o n the subjec t an d there wa s little discussion.' By any standard of measurement, Frank Pric e was a great contributor to dental progress . Hi s activitie s were not confine d t o electricit y an d h e took a n increasin g interest i n developin g knowledg e of th e relationshi p between nutritio n an d denta l caries . ( A younge r brother , Westo n A . Price, DOS , MBSC , o f Cleveland , a wel l know n pionee r h i thi s field , became president o f the American Dental Association. ) A s the so n of a Methodist lay preacher, Fran k Pric e was a real humanitarian. All during the depression year s he ground, packaged, and delivered a weekly sourc e of fres h vitamin B to over one hundred poor families i n co-operation wit h his friend , Si r Josep h Flavelle . A t th e tim e o f hi s deat h i n 1937 , th e Toronto newspaper s paid glowing tribute to him, stating that his heart was set on the bettermen t o f humanity, not on making money or a n exclusiv e name for himself.13 According t o paper s presente d a t denta l meetings , Pete r Brow n of

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Montreal, o f whom more will be said later, was a leader in the introduc tion of electricity into the denta l office. Brow n laid n o claim to inventiv e genius, but recognized early the advantages and was instrumental hi con vincing dentists of the benefits o f electricity. At ever y opportunity, eithe r at dental meetings or as a teacher on the staf f o f the newly-formed Montreal dental school, h e strongly advocated th e use of electrical devices i n the dental office a s they became available. Of othe r improvements, none had greater influence than the publica tion o f the researc h finding s o f G.V. Blac k of Chicago on cavit y preparation (1891 ) an d balanced alloy s (1895) . He placed cavity preparation on a scientifi c basis , with emphasis o n extensio n fo r prevention . U p t o this time, alloy s use d fo r fillin g purpose s wer e ofte n o f doubtfu l value : they tended to expand upon setting, which cracked th e tooth, o r to con tract, which resulted in a leaking filling. By several years of experimentation, Blac k produced a balance d allo y which would neither expand no r contract, an d whic h with little variatio n ha s stoo d th e tes t o f time. Th e beginnings o f th e us e o f bake d porcelai n fo r toot h restoratio n als o occurred durin g thi s epoch, an d th e cas t gol d filling was i n th e experi mental stage. The solder gold inlay was prepared by burnishing thin sheet

A dental operating room of the 1890s

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gold int o th e cavit y an d the n fillin g th e shape d mol d wit h solder . I n general, local anaesthetics were in experimental use, but th e solution s of cocaine bein g used ofte n gav e untowar d results : a t a meetin g in 1895 , J.B. Willmot t denounced 'the sinful an d unjustifiable practic e of injecting anaesthetics' an d he was probably right in relationship t o what was being done a t tha t time . Considerabl e technologica l advanc e occurre d durin g the 1890s . Many refinements have occurred since, but most of the technical adjuncts used in the modern dental office eithe r came into use or were in the experimental stage by the end of the nineteent h century. Advancement in practice in this period depended almost entirely upon technological improvement s an d i t i s little wonde r tha t dentist s largel y confined their attention to the development of their mechanica l adjuncts . If a service was to be rendered, a n efficient instrumen t was necessary. I t was not until after th e turn of the century that dentists were rather rudely awakened to certain fact s concernin g a health professio n - tha t practic e did no t consis t onl y o f cement s (sometime s calle d bon e amalgam s in early days), instruments, and techniques: a broadening concept in education an d practice was essential, an d the chie f differenc e betwee n a trade and a professio n wa s that a professio n gav e more i n servic e than wa s represented b y the recompense received . These concepts were but faintl y heard in the 1890s , but there were stirrings. In 1892 , the Montreal Genera l Hospital appointed R . Hugh Berwick as staff dentis t - th e first Canadian dentis t t o receive a hospital appoint ment. Berwick had indentured with SJ. Andre s of Montreal and obtained his Licentiate i n Dental Surgery, followin g whic h he began th e stud y of medicine at McGill University , graduatin g in 1891 . He the n decide d t o confine hi s practice t o ora l surgery , and i n s o doing may have been, b y modern interpretation , th e firs t specialis t amon g dentist s i n Canada. 14 Berwick wa s recognized a s on e o f th e earl y brillian t me n i n dentistry . Unfortunately h e die d a t twenty-six years o f ag e from tuberculosis , sai d to have been the result of over-exertion i n study. This appointment marks the beginnin g o f a lastin g relationshi p o f dentistr y wit h th e Montrea l General Hospital. J.S . Ibbottson was appointed t o succeed him. During thi s perio d th e Toront o Schoo l outgre w availabl e rente d quarters. The number of students increased from sixty-si x in 189 2 to on e hundred an d thirty-fiv e i n 189 6 an d passe d th e tw o hundre d mar k i n 1897. In the meantime, the course had been increased fro m tw o to thre e years. Th e situatio n calle d fo r drasti c action , an d i n meeting th e emer gency Ontari o dentist s exhibite d on e o f thei r fines t hours . Wit h stron g

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support fro m th e profession , th e Ontari o Boar d purchase d a lo t o n College street , th e easter n par t o f the lan d wher e the Toront o Genera l Hospital no w stands . Plan s wer e devise d fo r a sizeabl e buildin g (tw o storeys 10 6 X 50 feet with basement) whic h was completed an d opene d with elaborate ceremonie s on 1 October 1896 . I t was a financial venture of som e magnitude for th e tune , amountin g to approximatel y $50,000 . No assistance from governmen t or other sourc e was received o r contemplated: th e professio n accepte d th e ful l responsibility . Th e architect' s description o f the buildin g emphasized modernity. While the professio n is said to have worked as one man in accomplishing the project, the record shows that Dean J.B. Willmot t and Henry T. Wood were the responsibl e leaders. The Fathe r o f Publi c Healt h Dentistr y i n Canad a wa s Joh n C.G . Adams o f Toronto , a ma n wit h a missionar y zeal fo r dentistry . Afte r completing his indentureship with an older brother , W . Case Adams , he opened practic e i n 1874 . H e wa s a ma n o f stron g convictions , grea t tenacity o f purpose , unusua l foresight, and simpl e Christian faith . Soon he becam e convince d tha t th e then-curren t emphasi s o f dentistr y wa s wrongly placed on dentures. The proper emphasi s he felt, was to preclude

The Royal College of Dental Surgeons at 93 College Street, Toronto, built by Ontario dentists and opened in 1896

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the need for artificial dentures by preventing diseases of the teeth among children. With the courage of his convictions, after qualifying , h e founde d a free denta l hospital for poor children, naming it Christ's Dental Educa tional Institute. 15 The nam e indicates his missionary spirit an d portend s the emphasi s on health educatio n which was to com e i n later years , bu t in his day he struggle d alone . He wa s not th e typ e of man wh o pursued his conviction fractionally. Adams operated th e fre e hospita l fo r twentyfive years, during which he invested in it everything and it was said that no poor child in Toronto went without dental care. The picture of the hospital shows a sizeabl e thre e store y building which he ha d purchase d wit h no money other than his own. Its end was tragic. Adams had a verbal understanding with the city authorities that the hospital was to be considered a charitable institution, but suddenl y in 189 9 th e cit y seize d the building and it s content s fo r bac k taxes . Adam s coul d no t rais e th e demande d money. The newspapers took up his cause and the Toronto Dental Society made protest to the City Council, all to no avail. In the meantime, Adams had written a 152-pag e book, School Children's Teeth: Their Universally Unhealthy and Neglected Condition, probably th e firs t t o b e writte n o n thi s subject . H e als o publishe d a

John Gennings Curtis Adams (1839-1922)

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pamphlet of sixteen pages for public distribution. Ironically , 5,00 0 copies of hi s boo k wer e seized b y the cit y i n closin g hi s hospital . Fortunately , the influenc e o f this one man, wh o had sacrifice d s o much, wa s destine d to increase rapidly in adversity. In 1896 , Adam s wrote , wit h documentar y evidenc e respectin g th e condition of children's teeth , t o th e Ontari o Boar d o f Health. The com munication wa s accompanie d b y a stron g resolutio n fro m th e Toront o Dental Society. The Toronto Trades and Labour Council also submitted a resolution to th e government, requesting that action b e taken t o provid e systematic dental health inspection o f children in the public schools . Th e Board of Health se t up a committee to consider the communication fro m Adams, an d thi s committe e produce d a length y report . I n essence , i t recommended tha t municipalitie s appoin t denta l inspector s wh o woul d periodically visi t the schools , examin e pupil' s teeth , an d advis e the chil dren's parents wha t course to pursue. I t was only a short tim e thereafter before th e Cit y o f Toront o wa s spendin g $30,00 0 a yea r t o replac e Adam's hospital, which the city had closed because of $200 in back taxes . Adams had not only won public support but also had altered th e concep t of professiona l service . A s tim e progressed , hi s view s o n preventiv e dentistry were accepted an d adopte d throughou t Canada . The Adams family has long played a notable part i n the developmen t of Canadia n dentistry. An elder brother , W . Case Adams, began practis ing dentistry in Toronto during the early 1850s and is said to have trained more dentists by apprenticeship, includin g his brother an d J.B. Willmott , than any other man. J. Franklin Adams , a son of J.G. Adams, conducte d a most creditable practice in Toronto for forty-eight years and made many worthy contributions , amon g them th e discover y o f the famou s 'Adam s N & I Treatment' for purulen t gum diseases tha t becam e widel y used i n Canada and abroad. Hi s son, G.A. Camero n Adams , graduate d in 1933 , established practice in Toronto, and ha s serve d o n the staf f o f the denta l school. In 1965 , J.R . Adams , son of G.A.C. Adams, extended th e famil y profession to a fourth generation for the first time in Canada. A year later, 1966, th e Bruc e famil y o f Kincardine , Ontario , becam e th e secon d fourth-generation famil y o f Canadian dentists . During th e 1890 s a n economi c depressio n occurre d i n Canada , caused chiefl y b y th e high-protectiv e McKinle y Tarif f whic h cam e int o effect i n the United States. Money became scarce and a cry of overcrowding was heard fro m al l professions in Canada, particularl y fro m medicin e and dentistry . At the sam e time, a s stated above, th e numbe r o f student s

Technical advancement ( 1890-1899 ) 9

7

in dentistry was increasing rapidly. Numerous editorials on the subject of an over-stocke d professio n appeare d i n th e Journal an d th e situatio n dominated discussion at meetings. As editor, Beer s attacked th e proble m in his usual forthright manner. A sampling of his statements in editorial s represents th e thinking of the time. He wrot e initially, 'It i s evident that the business of making dentists is progressing too fast, and that the supply is already far beyon d the demand. ' I n referenc e to th e expansio n o f th e Toronto school, he stated that 'there were 16 0 students and with Ontario fully supplie d wit h dentists , nobod y kne w wher e the y wer e goin g t o practise whe n they graduated. ' Fo r Quebec , h e said , 'ther e wer e mor e students indentured than there were licentiates practising.' He pointed t o a result: 'W e can keep quacks from getin g a licence, but i t is doubtful if we can keep licentiates from becomin g quacks, or using quack methods.' If al l thi s criticis m affecte d th e leader s wh o wer e establishin g the ne w enlarged schoo l buildin g at Toronto , n o suc h indicatio n appear s i n th e records. The need for increased dental services existed. The difficult y wa s economic. Th e othe r contributin g factor was lack o f public appreciation for denta l services . Doubtless, whe n th e Denta l Board s i n Ontari o an d Quebe c wer e formed, the elected dentists thought that with law to enforc e their efforts , qualified dentist s woul d b e quickl y recognize d an d th e quack s woul d disappear. Twent y year s late r the y wer e stil l facin g th e problem , eve n after strenuou s an d continuin g efforts , bu t t o a muc h lesse r degree . Dentists in the other provinces found themselves in a similar position afte r gaining legislation, and a large percentage o f time and effor t wa s devoted to the problem i n each case. However , th e beginning s of scientific meetings also occurred in all provinces, an d at these meetings presentations of high calibr e fo r tha t tim e wer e made . Th e Britis h Columbi a Denta l Association wa s formed in 1891 , wit h T.J. Jone s electe d presiden t an d A.C. West as secretary. In his address, the President referre d to a former informal organization , th e Britis h Columbi a Denta l Society , an d state d that th e tim e ha d com e fo r forma l organization . Th e progra m o f th e second annua l meeting gives an impression of advanced ratiocination fo r the period. The following papers were read and discussed:16 President's Address T.J . Jones , LDS Administration of Ether Lewi s Hall, DOS The Relation of Physician and Dentist J. Holmes, DOS Extraction of Children's Teeth W.J . Quinlan , DOS

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Orthodontia A.E . Verrinder , MD, DOS Oral Surgery H.F . Verrinder , MD, DOS Treatment of Teeth During Pregnancy A.R . Baker, DDS Use of Electric Mallet (clinic ) A.R . Baker, DDS

In the Atlantic provinces, scientific meetings were arranged b y the newly formed organization s on an annual basis. In 1898 , the first joint meeting of these provinces was held at Digby. All of this was a giant stride forward from th e individualistic secrecy which had dominate d the attitud e of th e great majorit y of dentists . L a Sociét é d'Ontologi e d e Montréa l an d th e Montreal Denta l Clu b wer e formed , an d th e Toront o Denta l Societ y became a n active organization. Ottawa an d several other centres formed local societies . A scientifi c meeting was organized b y the Ontari o Denta l Societ y in 1898 in celebration of the thirtieth anniversary of enactment of the Dental Act. Papers were presented summarizin g the past, marking the iniquities of the present, and pointing put the objectives of the future. In his address, RJ. Husband o f Hamilton gav e portent o f future activitie s in two state ments: 'I believe we should extend our limits and I look hopefull y to the time whe n we shal l hav e a Dominio n Associatio n Meetin g in differen t parts o f the Dominion' ; and, 'Individua l member s o f the professio n ar e responsible for the wide-spread ignorance and misinformation abou t th e dental affairs whic h prevail everywhere.' One of the most moving speeches during this decade was delivered by H.C. Wetmor e i n hi s presidentia l addres s befor e th e Ne w Brunswick Dental Society in 1897. 'It would be presumption on my part to recite the events, which to dentists, will appear a s most important, when the doings of this period come to be crystallized into the history of the future . Wit h them, we are all familiar. And wit h that noble band of apostles, th e bes t years of whose lives were spent, and ar e being spent, in then* endeavours to fathom the mysteries of our restricted specialty, o r with those geniuses of mechanis m and art , wh o hav e taugh t u s t o suppl y th e deficiencies nature ha s oftentime s been guilt y of in her handiwork , o r t o reproduc e parts which man in his negligence or inabilit y to preserve , hav e become useless or defunct - we , too, are familiar. Those sturdy veterans are aged and ar e aging. Many, too many , of those old familiar face s hav e already completed thei r las t experiment , writte n thei r las t treatise , an d hav e departed t o that bour n from whic h no traveller returneth.' 17 The en d o f a centur y i s a tim e o f assessmen t an d prognostication .

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Canada consiste d o f seven provinces an d a n immens e territory betwee n Manitoba an d Britis h Columbia, with a total populatio n o f slightly over five million. Seventy-on e pe r cen t o f th e peopl e live d i n Ontari o an d Quebec, twelve per cen t west of Ontario, an d les s than a million in th e Atlantic Provinces . O f th e cities , th e tw o larges t wer e Montrea l wit h 267,730 people , an d Toront o wit h 208,400 . Ther e wer e abou t 1,30 0 qualified dentists for the whole country, of whom 186 were in Quebec and 984 in Ontario.18 A most heartening aspect of the time was the fact that new and strong voices were arising within the profession and leadership appeared assured. Frank Woodbury , o f Halifax , wa s beginnin g t o b e hear d acros s th e country and eventually became known as the Dean of Canadian Dentists. Each provinc e had activ e men o f leadership calibr e wh o were devoting zeal an d energ y toward the advancemen t of th e profession . O f th e ol d guard, Georg e Beers was to die within a year an d J.B . Willmot t wa s to give another fiftee n year s of service .

8 National organization 1900-1904

Two of the principal externa l feature s whic h contribut e t o the advance ment o f a professio n ar e increase d populatio n an d buoyan t economi c conditions. Durin g the earl y years of the ne w century, som e two million immigrants fro m Britain , Germany , Scandinavia , th e Balkans , Russia , and the United States came to Canada a s a result o f federal governmen t advertising, fre e homesteads , an d assiste d passages . Thi s mean t th e coming o f ag e of th e Prairi e provinces . Fro m th e souther n par t o f th e North-West Territories the province s of Saskatchewan and Albert a were created i n 1905. Much to the chagrin of Calgary, Edmonto n becam e th e capital o f th e latter , an d afte r tw o year s o f wrangling , Regina wo n th e parliament buildings of Saskatchewan. This action complete d th e political organization o f Canada int o provinces unti l 1949 , whe n Newfoundland became the tenth province. Across th e country, th e population increase d by fifty per cent to over seven million, in a short period . Bread was five cents a loaf an d milk five cents a quart. Coa l sol d for $4.50 a ton and $15 a month was good rent for a house. You could buy a ticket for twenty-one restaurant meals for $2.75 , although i n at least on e restaurant there was a sign warning customers tha t a napkin would not be provided to anyone ordering a meal for under 1 5 cents. Women's chemises were featured i n newspaper advertisements for 25 cents, and dres s goods for 1 5 cents a yard. Meat was 6 to 1 2 cents a pound , accordin g to cut .

Skilled labourers in the construction trade received wages of $12 and common labourers from $8 to $10 a week. All of this was reflected in dental practice, with extrations at 25 to 50 cents, gold foil fillings at $2, and complete dentures at $10.

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Canadian dentistr y suffere d on e o f it s mos t grievou s losse s o n 2 6 December 1900 , when W . Georg e Beer s o f Montrea l die d a t fifty-nin e years of age. For th e advancemen t of his profession, his effort s kne w n o bounds. Outsid e th e profession , h e wa s widel y know n a s a patriot , a sportsman, and a supporter of every good cause. Th e newspaper s of the time, not only of his own city but across the country, devoted much space to extolling his virtues on a wide horizon. A booklet about him written by W.K. McNaught of Toronto, a n industrialist and a member of the Ontario Legislature, appeare d shortl y afte r hi s death an d wa s widely distributed across Canada . Seldo m has any man received greate r unmitigated praise and, as noted earlier, his name continues to appear in print to the present day. Hi s appearanc e an d personalit y wer e concisel y describe d b y McNaught:1 Dr Beer s was no ordinary man. Of medium size , bu t admirabl y proportione d and wit h a fac e singularl y resemblin g tha t o f th e lamente d Genera l Gordo n of Suda n fame , h e had a personality tha t was at once strikin g an d attractive . One coul d no t b e i n his compan y lon g befor e becomin g impresse d wit h th e fact tha t h e was not onl y a gentlema n i n th e trues t sens e o f th e word , bu t a man o f scholarl y attainments , wh o ha d see n muc h o f th e worl d an d whos e opinions on most subjects were the results of personal convictions , rather than derived from others.

A large square granite stone marks the grave of this outstanding Canadian dentist i n the Moun t Royal Cemeter y i n Montreal . Hi s influenc e stil l is felt. Among his contributions was that o f his dental library to th e Roya l College of Dental Surgeon s of Ontario - undoubtedl y the largest denta l library in Canada a t the time, consistin g of some four hundre d volumes. The library was housed in the Toronto school and forme d th e nucleu s of the larg e library collectio n no w possesse d b y th e Facult y o f Dentistry , University o f Toronto. The death of Beers left the editorship of the Dominion Dental Journal vacant. Fortunately for the future o f the Journal, a young man, Albert E. Webster of Toronto, wa s appointed editor, a position h e was to hold fo r thirty-five years . Beers' positio n a s dean o f the Montrea l schoo l prove d considerably mor e difficul t t o fill . Followin g hi s resignatio n i n 1897 , Stephen Globensk y was appointed bu t occupie d th e positio n fo r onl y a little over a year. He was followed by his brother, J.G. Globensky, for one session. W.J. Kerr was dean for the session 1900-01, and William J. Giles

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was dea n durin g the nex t session . Pete r Brown , a prominen t Montrea l dentist, was appointed i n 190 2 an d remained dea n until 1905 , whe n the school was closed. It i s eviden t tha t a goo d dea l o f dissatisfactio n aros e a t th e schoo l respecting th e relationshi p wit h the Universit y o f Bishop's College . Th e effort t o teac h i n bot h Frenc h an d Englis h als o ha d no t prove n ver y successful. Th e Quebe c Boar d consequentl y hel d ne w discussion s wit h both McGil l an d Lava l Universities , whic h culminate d i n 190 4 wit h agreements whereby both universitie s agreed t o undertake formal denta l education, i n th e cas e o f Laval a t it s Montrea l branc h (whic h becam e l'Université d e Montréa l i n 1920) . Th e progres s o f thi s chang e wa s hastened by the fact tha t Bishop's Medical College in Montreal cease d t o exist an d wa s joined wit h th e Medica l Facult y o f McGil l Universit y i n 1905.2 Both new schools opene d in the fal l o f 1905 , an d th e Quebe c Boar d abolished th e Denta l Colleg e o f the Provinc e o f Quebec . Arrangement s were necessary, however, for the teachin g of practical dentistry . For thi s purpose the Quebec Board rented clinic quarters over Sax's clothin g store at the corner of St Lawrence and St Catherine Streets. Later, in 1906 , th e clinic wa s move d t o spac e i n th e newl y erecte d La Patrie newspape r building. In reality, that is to say, the Quebec Board continued to provide for th e teachin g of practical dentistr y unti l the universitie s wer e abl e t o make proper arrangement s for doing so . In 1906 , th e clini c for McGil l students wa s move d t o th e Montrea l Genera l Hospital , wher e clinica l instruction ha s been give n to the present . Laval student s remaine d unti l 1909, whe n the equipmen t wa s sol d t o l'Universit é Lava l fo r $450 , a s recorded i n the Denta l Board minutes . The detail s o f the transfe r o f th e teaching of practical dentistr y from th e Quebe c Boar d to the universities are difficul t t o delineate . Th e participatio n o f the Denta l Board, beyond providing space an d equipmen t for the clinic , is not clear . I n an y event, McGill had take n ove r complete contro l o f dental student s by 190 6 an d Laval had done so by 1909. The McGill dental clinic made use of the large morgue facilities of the Montreal Genera l Hospital. Up to this time, extensive morgues had been necessary to mee t the tragic result s of large-scale epidemic s of smallpox . The fight for the introductio n of vaccination, which took plac e i n practi cally al l communities , was particularly intens e an d sever e i n Montreal ; and the deat h o f a prominent youn g Montreal dentist , Joh n H . Samuel , while not resulting in the adoption o f compulsory vaccination, di d creat e

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a turnin g point i n th e battle for thi s publi c healt h measure . Gradually , vaccination wo n ou t an d smallpo x subsided ; extensiv e morgu e facilitie s were no longer necessary and could be converted to other uses. At bot h universities, the denta l cours e wa s established a s four year s in duration, the length adopted b y the Royal Colleg e o f Dental Surgeons in 1903 . The incorporatio n o f th e denta l school s withi n th e universit y structure differe d considerably . A t Laval , th e denta l schoo l becam e a division of the university with Eudore Dubeau as dean, a position he held for som e forty years . At McGill, the denta l schoo l became a department of th e Facult y o f Medicine . Th e initia l McGil l announcemen t stated : 'This departmen t is not independent , bu t i t i s a sectio n o f th e Medica l Faculty.'3 The same announcement listed instructors in the dental department but di d not indicat e a head o f the department . The nam e of Peter Brown appeare d firs t o n th e list . Previousl y h e ha d bee n dea n o f th e Bishop's school, and he has been referred to as head of the department at McGill, but thi s is not specifically stated. Dentistry did not become a ful l faculty at McGill until 1920. From the beginning, Laval conferred the degre e of Doctor of Dental Surgery, but McGill refused t o do so. The first calendar issued by McGill stated that upon completion of the course the degre e of Master of Dental Surgery (MDS ) woul d be conferred. It wa s found tha t a master's degre e could not be conferred, however, and the calendar fo r the followin g year offered th e degree of Graduate i n Dental Surgery (CDS) . In 1908 , McGill finally announced the degree of Doctor of Dental Surgery (DOS) . Doubt less this decision was influenced b y a loophole quickly discovered by th e students. The Universit y of Bishop's College, even though it had stopped giving course s i n Montreal , ha d no t relinquishe d th e righ t t o confe r degrees in medicine and dentistry, and McGill dental students found tha t by registering at Bishop's they could qualif y fo r the doctorate, whic h they proceeded to do. Only six CDS degrees were ever conferred by McGill, al l in 1906, and three of these were later converted t o doctorates. On e went to Georg e Lynch Cameron, wh o became a prominent Canadia n dentist . In thi s context , th e case s o f Georg e L . Camero n an d Georg e S . Cameron ar e interesting . Bot h men began their studie s at Bishop's , and had complete d tw o years of the cours e whe n the schoo l wa s closed an d they were transferred to McGill. There they were informed tha t they had to begi n agai n i n th e firs t year . Georg e L . dutifull y di d s o an d afte r graduation practise d a t Swif t Current , Saskatchewan , fo r man y years , becoming a distinguishe d member o f th e profession . Georg e S . refuse d

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McGill's conditio n as insulting, and went to the United States to complet e his education . O n his return t o Montreal , h e wa s granted permissio n t o write hi s licensur e examinatio n an d performe d s o impressivel y tha t h e was invited to teac h a t McGill ; for man y years he wa s on e o f th e mos t prominent dentist s in the city . This period also saw the creation o f a national denta l association . A s early as 188 9 Beers had published a n editorial advocatin g the formatio n of a Dominio n Denta l Society . I n hi s usua l forthrigh t manner , h e ha d pointed ou t th e weaknesse s o f individua l provincia l policie s an d th e advantages o f concerte d actio n o n a nationa l basis . H e continue d hi s advocacy for a national dental organization but unfortunately did not live long enough to se e its consummation. Frank Woodbur y of Halifax, wh o wa s secretar y o f th e Nov a Scoti a dental body , initiate d a movemen t i n 189 3 fo r reciprocit y betwee n th e provincial denta l boards. I n som e detail , h e pointe d ou t th e similaritie s and difference s i n licencin g requirement s o f th e variou s boards . Th e differences whic h did exis t were mino r ones , an d wit h sligh t alteration s reciprocity coul d b e achieved . Th e Nov a Scoti a Denta l Associatio n unanimously supporte d th e proposa l an d resolve d t o wor k towar d it s attainment. Discussion s b y correspondenc e an d persona l conversatio n between provincia l representatives continued , an d grew . Both Beer s an d Webster gave strong editorial support, an d man y of the denta l organizations adopte d favourabl e resolutions . For a period o f ten years, enthusiasm for the organization o f the pro fession o n a national basis increase d i n every province. S.W . Mclnnis of Brandon, F.A. Godso e of Saint John , Fran k Woodbur y o f Halifax, J.S . Bagnall o f Charlottetown, W.D. Cowa n o f Regina, R. Nas h o f Victoria , F.A. Stevenso n of Montreal, an d J.B . Willmot t o f Toronto wer e amon g the stronges t advocates . Credi t fo r takin g th e vita l fina l ste p rightfull y belongs t o th e Quebe c Denta l Association , whos e secretary , Eudor e Dubeau, mailed a letter t o ever y dentist i n Canada containin g thes e significant sentences: 4 Every dentis t wh o ca n ris e abov e mer e loca l o r provincia l affair s i n ou r country, an d has thought abou t th e immens e advantage s to be gaine d b y the nationalization o f the dental profession, shoul d unhesitatingl y giv e the idea hi s support. The lega l representative s o f th e professio n i n th e variou s province s have agree d t o work towar d givin g dentistry a national character . The wa y seems t o b e prepared fo r th e firs t ste p toward s th e goal . Th e

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Quebec Dental Association, together with one representative from eac h of the provinces, hav e undertake n t o organiz e a meetin g i n Montreal , September 16th, 1902... F.A. Stevenso n was president o f the Quebec Associatio n a t the time and an outstanding dentist. He ha d graduate d fro m th e Harvar d Universit y Dental School in 1888 and practised i n Montreal until his death in 1934. During his lifetime, Stevenson held practicall y ever y possible positio n i n his profession, was honoured b y hi s fello w practitioner s i n man y ways, and served on the teaching staff o f the McGill school. With the unanimous support o f the Quebe c Association, h e an d Dubea u organize d the meet ing. Stevenso n preside d a t th e meetin g an d henc e becam e th e firs t president. The attendanc e a t thi s meetin g in 190 2 was remarkable. Som e 34 4 dentists were present, ninetee n pe r cen t o f the dentist s in Canada a t th e time. All provinces and the North-West Territories were represented. The meeting ran fo r thre e day s and enthusias m wa s great. Bot h th e lengthy scientific program and the business sessions indicated great care in preparation. Fro m th e busines s session s resulte d tw o ne w nationa l denta l organizations - th e Canadia n Denta l Associatio n an d the Dominio n Dental Council , both created with great unanimity. It i s evident that a great deal o f work had precede d th e meeting , for each delegat e was presented whe n he registered wit h a cop y o f the proposed constitution and by-laws of a Canadian Denta l Association. Also a code of ethics was presented, which was a slightly amended version of that adopted b y th e Nationa l Denta l Associatio n (late r rename d America n Dental Association) . Prepare d paper s o n variou s phase s o f nationa l organization wer e presente d fro m eac h province , eac h expressin g ap proval o f th e objective . Afte r discussio n an d mino r amendments , th e constitution and by-laws, together wit h the cod e of ethics, were adopted . The first action taken by the newly formed Association was the adop tion o f a strongl y worde d resolutio n requestin g th e severa l corporat e bodies to appoint one member each to a Dominion Dental Council. Thes e appointees wer e t o formulat e a schem e fo r establishin g a nation-wid e qualification fo r th e practic e o f dentistry whic h would b e acceptabl e t o the several licensing boards. Their recommendation s were to be reporte d to the next meeting of the Association. For the first time, there was something les s tha n ful l unanimity , however . Th e Quebe c representative s stated tha t whil e the y wer e no t personall y opposed , th e proposa l fo r

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reciprocity of licence wa s reaching fo r an ideal too quickly. O n the othe r hand, th e presiden t o f th e Britis h Columbi a Boar d o f Examiners , T.J . Jones, wh o was unable to attend, sen t a letter t o the meeting in praise of Dominion registration . Al l th e othe r province s welcome d th e objectiv e enthusiastically. This meeting was the first time Canadian dentist s ha d come together , and many other subject s of mutual interest were discussed. Denta l healt h education fo r th e publi c wa s on e predominan t theme . Bot h Ontari o and Nov a Scoti a ha d mad e some progress towar d publi c education , an d following th e meetin g efforts wer e initiate d i n other province s patterne d on their experience . Th e need for a dental corp s wa s the othe r principa l subject o f discussion . Th e Sout h Africa n Wa r (1899-1902 ) ha d concluded only a few weeks before the meeting. In all, about 7,300 Canadian s had crossed th e ocean to fight in it, and soo n afte r thei r arriva l oversea s letters had been received i n Canada tellin g of their suffering s fro m defec tive teeth . As a result, tw o dentists , Davi d Henr y Bair d o f Ottaw a an d Eugene Lemieux of Montreal, were taken on the army's strength in 1900 and sen t to South Africa, wher e they served unti l May 1902. 5 No record exists respectin g thei r equipmen t bu t i t i s know n tha t the y rendere d extractions an d emergenc y services an d presumabl y they took thei r ow n equipment wit h them . Bair d an d Lemieu x wer e th e firs t Canadian s t o serve a s dental surgeons in a military field of action . Th e firs t recorde d proposal fo r military dentistry was made by the Easter n Ontari o Denta l Association in 190 0 in a strong resolution tha t provisio n be made in th e militia for the appointment of dental surgeons to the forces. Other denta l organizations quickly forwarded simila r resolutions to the authorities. The government's replies wer e favourable but sai d tha t n o provisio n existe d for th e appointmen t of such officers . Ir a Bower , a n Ottaw a dentist , ha d been mos t activ e i n thi s effor t an d h e presente d a pape r a t th e firs t national meeting summarizing the position . A supportin g resolution wa s adopted, setting up a national committee with Bower as chairman, which became one of the mos t active committee s o f the newly-forme d Association. In view of later developments, the wording of the resolution, 'favour the adoptio n b y the Militi a Departmen t o f provisio n fo r a regular arm y dental staf f whic h shall be a distinct branch o f the service, ' is interesting. The enthusias m engendere d a t th e foundin g meeting was grea t an d delegates returne d hom e feelin g that rea l progres s ha d bee n made . Previous to the formation of the Canadian Dental Association, the Dominion Dental Journal ha d been th e profession' s onl y unifying force . In a larg e

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country like Canada, geograph y and finance are the principal enemie s to be overcom e i n nationa l organizations . A thir d facto r face d b y th e CD A was th e strengt h o f it s membershi p - approximatel y 1,31 0 dentist s stretched across a thin ribbon of over 4,000 miles . These conditions were considered realisticall y an d i t wa s decide d tha t onl y biennia l meetings were possible . The second meeting of the Canadian Dental Association took place a t Toronto i n Septembe r 1904 . In hi s presidentia l address , J.B . Willmott summarized th e positio n o f dentistr y i n Canada. 6 The organization o f the Canadian Denta l Association marked , to some extent, the tim e o f completio n o f th e preliminar y stag e i n th e developmen t o f th e dental profession in Canada. Provincia l an d local societies had bee n formed in every province . Fo r th e protectio n o f th e publi c agains t th e injur y t o th e public healt h whic h woul d resul t fro m unskilfu l denta l operations , eac h provincial legislatur e ha d passe d law s requirin g a goo d degre e o f professiona l education an d skill . Th e corporat e bodie s constitute d unde r thes e law s ha d organized th e professio n an d fixe d a hig h standar d fo r admissio n i n th e several provinces. Denta l school s had been established i n Quebec and Ontario, with capacity fo r the education o f the dental student s o f the Dominion . Fro m small beginnings, the Dominio n Denta l Journa l ha d grow n t o b e a large an d influential factor in maintaining and extending the credit of Canadian dentistry . What stil l was lackin g wa s th e bringin g togethe r o f th e result s o f th e goo d work accomplishe d i n th e severa l province s an d makin g i t effectiv e i n th e development o f dentistr y throughou t th e Dominion .

The repor t o f th e committe e o n militar y dentistr y wa s significant . Th e appointment o f denta l surgeon s ha d bee n authorize d o n 2 Jul y 1904 , although the committee had been unsuccessful in securing an independent corps. Th e chairman, Ira Bower , had bee n persisten t i n gaining support for th e objectiv e and wa s to continue his effor t fo r satisfactor y arrangements : initial credit fo r th e establishmen t of dental servic e i n the Cana dian force s rightfull y belong s to him. The process o f organizing the Dominion Dental Counci l proved to be slower than anticipated. Meetings of the representatives o f the provincia l boards were held in both 190 4 and 1905 , wit h all provinces represente d except Britis h Columbia . Th e Quebe c representative s state d tha t the y could no t report a firm decision from thei r Board , bu t othe r representa tives reported affirmation . Thi s mean t tha t seve n o f the nin e province s

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were prepared t o accep t reciproca l agreements , althoug h tw o provinces , Saskatchewan an d Alberta , wer e in th e proces s o f formatio n an d fina l affirmation woul d be necessary by each. The organizing committee, under the chairmanship of Frank Woodbur y of Halifax, had performed a grea t deal o f preparatory work . At th e 190 5 meetin g held i n Toronto , a very complete documen t containin g the objects , rules , an d standards , a s well as the detaile d operation , o f the Counci l was presented. Afte r discussio n in detail, an d with some amendments, this document wa s adopted a s the constitution and by-laws. Harry R. Abbott o f London was elected the first president, and W.D. Cowan of Regina became secretary. Th e first examinations were conducted in 1906 ; C.H. Juve t o f Ottawa is the first in th e register o f recipient s o f th e Dominio n Denta l Counci l Certificate. 7 Th e Council continued to serve the participating provinces for forty-five years , when it was succeeded by the National Dental Examining Board. Quebe c did not join the agreement at any time, but for several years sent representatives to th e meetings. On two occasions, Britis h Columbia participate d for a brief period . Under the reciprocal agreement, the holder o f a Council Certificate wa s entitled to registe r fo r licenc e t o practis e i n an y par ticipating province . Th e arrangemen t wa s a mos t sensibl e on e whic h served initiall y to brin g uniformit y of qualificatio n throughou t Canada , and which continued to work to the advantage o f both dentist s and pro vincial licencing boards. Owing to the smal l number of dentists in the west , it wa s difficult t o hold satisfactor y scientifi c meeting s o n a provincia l basi s durin g thi s period. A t th e annua l meetin g o f th e Manitob a Denta l Associatio n i n January 1900 , a decisio n wa s mad e t o organiz e th e Wester n Canad a Dental Society. The first meeting of the new society was held in Winnipeg the following July. R.R. Dalgleis h of Winnipeg was elected presiden t and G.C. Mathiso n becam e secretary . Thi s meetin g prove d successful , an d while, as with most societies, som e difficulties aros e from time to time, the dentists in the province s o f Manitoba, Saskatchewan , an d Albert a hav e continued to support their regiona l body at biennial meetings. The idea still prevailed that al l pertaining to the practic e o f dentistry must be kept within the confines of the dental office an d performed by the dentist himsel f o r in a minor way by a properl y indenture d student, but cracks were appearing in the wall. Already, as related earlier, the philosophy o f secrec y ha d bee n attacke d b y dentist s wh o wante d t o emplo y assistants i n thei r offices , an d i n spit e o f objection s fro m th e denta l boards, such assistants were gradually making their appearance. A t abou t

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the turn of the century, dental suppl y houses i n both Toront o and Montreal conceive d the ide a of setting up laboratories t o perfor m mechanica l services for their clients . Th e denta l board s reacte d sharply ; letters wen t to the supply houses stating that such laboratories mus t be closed, as they were engage d in the practic e o f dentistry without a licence. Th e laboratories cease d t o operate . I t shoul d b e explaine d tha t i n thos e day s th e laboratory wa s a n integra l par t o f th e denta l offic e an d o f practice , an d considered o f vital importance. Althoug h th e board's attitude may see m reactionary today , t o condon e th e establishmen t o f denta l laboratorie s outside o f denta l office s a t th e tim e wa s comparabl e t o splittin g denta l practice i n half . Th e employmen t o f assistant s and th e laborator y affai r were directly related. Wit h few exceptions, th e assistant s employe d were males an d thei r mai n dutie s were i n the laboratory . I t wa s natural tha t gradually some of these men, trained by a dentist in his own office, would do the sam e work independently for severa l dentists . As a result, an d in spite of the boards , b y 190 5 the commercia l denta l laborator y wa s well established in the cities . A n editoria l i n the Dominion Dental Journal of that year confirmed that ther e was more money to be made in running a laboratory for the profession than in working on salary for a single dentist. Like so many alterations in the way of things, the change had an economic basis. Study o f the Canadia n denta l literatur e ove r man y years reveals in tensive discussions respecting the relationshi p of medicine and dentistry . The subjec t reached a crescendo aroun d th e turn o f the century. Diverse views existe d amon g the leader s o f the profession . J.B. Willmott argue d in his usual forthright manner that dentistry was not a specialty of medicine. Fran k Woodbur y stated tha t 'nothin g should clai m more attentio n than a study of our proper relation to the public at large, and the status of dental surgery among the specialtie s o f medicine.' 8 The argument s dated back t o th e beginning s of dentistry , when in Europea n countrie s i t wa s considered a par t o f surgery. Men like John Hunte r o f England empha sized its biological aspects. When the first dental school was established at Baltimore, afte r a n attempt to teach dentistr y in the medical school there , it was settled that the practice of dentistry could not be taught in a medical school. Hencefort h dentistr y o n th e Nort h America n continen t becam e independent, while in a dwindling number of European countrie s a medical course remains a prerequisite for its study. The adoption of an autono mous position brough t rapid developmen t t o professiona l status . I t als o gave impetus to the invention of innumerable practica l aid s to practice in

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the for m o f instruments, materials, an d techniques , accompanie d b y a n ever-improving reputation . B y the earl y 1900s , however , th e pendulu m had starte d to swing back towar d the biological aspect s o f dentistry, an d this caused men to think again in terms of the medical-dental relationship . The discussion s continued; the situatio n was met ove r th e year s t o th e present by an increasing biologica l conten t i n the denta l curriculum . Advertising was still the bane of the profession. There was an increas ing interes t i n dentistry , indicated positively by th e growin g numbe r of applicants to the schools. On the darker side were the commercial artifice s employed by a certain clas s of men t o whom moral suasio n was a farce . Quacks an d quac k imitator s mad e a poin t o f challengin g the worl d i n general and reputabl e dentist s i n particular. Eac h on e publicly declare d that he was the only genuine and unadulterate d geniu s in the profession ; that he was the author of ideas which were old before he entered th e pro fession; that he was the inventor of appliances whic h everybody else had the good sense not to use. These men utilized tricks of trade and theatrica l superlatives with the objectives of circus advertisers. Their method s took many forms. Thei r activitie s were, i n the main , confined to the larger cities, although the large newspaper advertisements, handbills, and cards affected th e whole profession. Among them were the Good Samaritan Dental Association, which placed large advertisements in Montreal newspapers in 189 9 announcing in large type, that 'Tyranny is Dead' and 'Revolution has again Succeeded,' and promising among other items, perfect-fittin g artificia l teet h fo r $4.8 5 an d gol d fillings , 1000t h fine, from $1.00 . The Boston Dental Parlours als o placed advertisement s in the newspapers. In Toronto, the Toronto Painles s Dental Parlour s and department stor e dentistr y becam e issues . I n Montreal , a bookkeepe r named Paquette established the 'Institute Dentaire Franco-American' and hired dentists, thu s forming a company practice and advertisin g services at ridiculously low rates. Throug h cour t action , th e Quebe c Associatio n finally succeeded i n closin g thi s organization . Ne w amendment s t o th e Dental Acts were sought and obtained to deal with the problem. However, as soon a s one door wa s closed, anothe r wa s opened b y som e ingenious device, and the battl e continue d fo r two more decades . I n retrospect , i t appears regrettable that the profession had to spend so much time, effor t and mone y i n overcomin g a situatio n create d primaril y b y a smal l minority. The last great gold rush on the Pacific slope began with the discovery of gol d o n the Klondike , a tributary o f the Yuko n River. Rapidly , me n

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The first dental office at Dawson City, Yukon

came from all over the world to the area, overcoming tremendous difficul ties in transportation. I n 189 7 the population of Dawson City was 1,500, a year later it had increased to 25,000. Among the newcomers were a few dentists, who arrived initiall y seeking wealth other than by practise. Th e first to actuall y establis h a denta l offic e wa s Antoine Avaricle , wh o exhibited a certificate statin g that he was a member o f La Sociét é Dentaire de Paris. Avaricle set up his office ove r the Come y Bar, which was probably a good location i n the minin g community as far a s traffi c wa s con cerned. By 1900, the main rush was over and decline had set in, but othe r smaller deposits continued to be discovered. Avaricle moved his offic e t o Granville, som e seventy-fiv e miles sout h o f Dawson , an d ther e Franci s George Berton apprenticed wit h him. A short time later, Avaricle lef t fo r parts unknown . Berton carrie d o n th e practic e fo r a perio d i n orde r t o supply the community with a dental service, then turned to other occupa tions. Twent y year s later , th e tota l populatio n o f th e enormou s Yuko n Territory wa s 5,000 souls; by 193 0 fewe r tha n a thousand wer e living at

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Dawson. During thi s interva l ove r a doze n dentist s ar e know n to hav e practised i n th e are a fo r varyin g lengths o f time . Surprisingly , amon g them was one lady, Nanette Finlay Clay, who is listed in 1911 . When the last qualifie d dentist , A.W . Faulkner, lef t Dawso n in 1925 , F.G . Berto n bought hi s equipmen t an d maintaine d th e practic e unti l othe r dentist s appeared. His son, the author and broadcaster, Pierr e Berton, states that: 'My mouth and that of my sister's, al l those years, seemed to be constantly full o f plaste r o f pari s a s m y fathe r practise d takin g impressions to fi t people for dentures. ' The elde r Berto n made n o clai m t o b e a qualifie d dentist. However, he filled a need and his services were greatly appreciated. Of th e othe r dentist s wh o practise d i n th e Yuko n durin g this era , al l except two o r three exhibite d academi c qualifications of some kind, bu t none were Canadian graduates. Canadian dentistry was reaching a stage of maturity with many indications o f increased recognition . Th e futur e appeare d bright . I n hi s presi dential addres s a t th e annua l meetin g of the Ontari o Denta l Societ y in 1904, R.E . Spark s of Kingston expressed th e attitud e prevailin g among dentists:9 As I look over the horizon, I see dawning great possibilities fo r those enterin g our profession at the present time. The x-rays, the microscope, th e fluoroscope, the development of bacteriology, th e introduction o f electricity, th e recognitio n of th e reactio n o f genera l t o loca l diseases , an d th e inventio n o f ne w instru ments and appliances, ar e doing wonders in the prevention, diagnosis and treatment of dental ills. But, I believe our knowledg e of these subject s is but i n its infancy. Th e youn g men wh o enter upo n a scientifi c study o f dentistry , an d who carry thei r stud y and research into their practice s afte r graduation , have opportunities o f becomin g famous , an d o f makin g our s on e o f th e grandest , because one of the most beneficial of professions .

9

Oral sepsis 1905-1909

In the Atlantic provinces young men found i t necessary to go to Boston or some othe r centr e i n the Unite d State s i n orde r t o stud y dentistry . Thi s was expensive, and a deterrent t o increasing the number of practitioners in the area. Early in the century, the Nova Scotia Dental Association, under the leadership o f Frank Woodbury , initiate d a movement for th e estab lishment of a dental school. Consultations wer e held wit h the New Brunswick Denta l Societ y an d th e Princ e Edwar d Islan d Denta l Association . Unanimous agreement was reached tha t a school should be founded, an d that it should be located i n Halifax with a relationship t o Dalhousie University. In response to that initiative, the Nova Scotia Legislature at its 1906-7 session passed an Act establishing the Maritime Dental College. Through hearty co-operatio n o f Dalhousi e Universit y an d th e Halifa x Medica l College, an agreement wa s formulated. Under it, Dalhousie supplied th e dental infirmary, laboratories , an d lecture rooms, together wit h adequate staff fo r th e teachin g o f chemistry , physics , an d biology . Th e Halifa x Medical College agree d to teach anatomy , physiology, histology, bacteriology, and materia medica to the dental students, and to supply necessary laboratory facilitie s fo r thos e subjects . Dalhousi e establishe d a Facult y of Denta l Surger y t o examin e candidate s fo r th e degre e o f Docto r o f Dental Surgery. Dental students were accorded necessar y privileges in the Victoria Genera l Hospital . A four-year course bega n 1 September 1908 . Leaders i n the province s o f Quebec an d Ontario , wher e the struggle for prope r dental educatio n had been s o arduous an d lengthy, must have read wit h amazemen t o f suc h achievement s i n s o shor t a time . Ye t th e

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accomplishment was not as easy as it may appear. As always in establishing a school , financia l difficultie s constitute d a majo r stumbling-block . The teachin g o f denta l subject s remained th e obligatio n o f th e dentist s themselves, and, since the school was designed to serve the Atlantic region as a whole, dentists from Ne w Brunswick, Prince Edwar d Island , Nova Scotia, an d Newfoundlan d serve d a s member s o f th e initia l staff . Th e Nova Scoti a Denta l Associatio n mad e a gran t t o th e maximu m of it s ability, an d i n additio n eac h membe r o f th e Denta l Boar d contribute d fifty dollars, a sizeable amount for that period. The ownership of the Maritime Denta l Colleg e remaine d i n th e hand s o f th e Nov a Scoti a Denta l Association, and as much financial support as possible was freely granted in eac h succeedin g year . Thi s arrangemen t prevaile d unti l 1912 , when both the Maritime Dental College and the Halifax Medical College ceased to exist , unde r a n agreemen t whereb y Dalhousie Universit y took ove r complete teaching in both faculties. Thus, Dalhousie was the first university in Canada to establish a fully integrate d faculty of dentistry. Frank Woodbury was appointed the first dean of the college, a position he held until his death in 1922. He had been the first registrar of the Dental

Frank Woodbury, DDS, LLD, Dean of the Faculty of Dentistry, Dalhousie University, 1908-22

Oral sepsis ( 1905-1909)

115

THE WOODBUR Y FAMIL Y I N DENTISTR Y FRANCIS WOODBUR Y (1813-1852 )

a fanner in Annapolis County, NS

HIBBERT WOODBURY (1842-19*3 )

FRANK WOODBURY (1853-1922 )

apprenticed in Massachusetts graduated Philadelphia Dental College, 1877 practised at Halifax, 1878-1913 charter member, NS Dental Association a founder, Maritime Dental College professor of prosthetics (1904-12)

graduated Pennsylvania Dental College, 1878 practised at Halifax, 1878-1922 first registrar, NS Dental Board president, NS Dental Association, 1898 a founder of Dominion Dental Council dean. Maritime Dental College, 1908-12 dean, Faculty of Dentistry, Dalhousie University, 1912-22 president, Canadian Dental Association, 1918 Hon. LLD from Dalhousi e University, 1920 first president, Dental Faculties Association, 192 0

WILLUM w. WOODBUR Y (1882-1967)

RALPH H. WOODBURY (1884-1924)

graduated, Philadelphia Dental College, and opened general practice, Halifax, 1908 orthodontics at Halifax, 192 0 prof essor of orthodontics, 1910-5 2 dean at Dalhousie University, 1935-47 president, Canadian Denta l Association, 1940- 2 Hon. LLD from Dalhousi e University, 1953

graduated, Philadelphia Dental College, 1908 on staff, Maritime Dental College, 1909-2 4

EARL WOODBURY (1893-1946 )

graduated, Dalhousie University, 1915 served in Canadian Army Dental Corps, 1916-19 lecturer at Dalhousie Dental Faculty for several years

116 A

HISTORY OF DENTISTR Y IN CANAD A

Board and later was elected presiden t o f the Nova Scotia Dental Associa tion. The groundwork for the establishment of the Dominion Dental Council was done by him, and later he became president of the Canadian Denta l Association. Comparabl e i n his home provinc e t o Beer s i n Quebe c an d Willmott in Ontario, h e als o contribute d s o greatly o n the nationa l level that h e becam e know n as th e Dea n o f Canadia n Dentists . Indeed , th e Woodbury famil y wer e al l intimatel y connecte d wit h th e developmen t of the profession. Each also was extremely active in lay enterprises, particularly those of religious and related charitabl e organizations . Over the years, New Brunswick had benefited fro m som e of Canada's earliest resident dentist s and ha d experience d one o f the country' s mos t difficult legislatures . A.J. McAvenne y described bot h development s in a short historical summary. 1 In i t he stated tha t M r Rath, surgeo n dentist , had establishe d a n offic e a t Sain t Joh n i n 1823 . Itineran t dentist s ha d visited that city earlier. Other residents, in the main of Loyalist stock fro m the United States, had followed Rath, spreading to Fredericton an d othe r municipalities. Th e numbe r o f dentist s increase d slowly , but whe n they organized i n 189 0 a s the New Brunswick Dental Societ y they proved t o be a progressiv e group , whic h fro m th e beginnin g carrie d o n scientifi c programs a t it s annual meetings . Much o f thei r leaders ' time , however , was consumed i n dealing with the legislature. Bot h th e Quebe c an d On tario associations had tribulations with their respective legislatures, which over-ruled th e Board s an d grante d licence s fo r practic e t o unqualifie d individuals, but this problem appears to have been more severe and lasted longer in New Brunswick than in any other province. During the early period, a considerable numbe r of strong leaders de veloped in New Brunswick on both provincial and national levels. Among them, Frank A. Godsoe, who served as registrar and secretary fro m 189 1 to 1931 , made an outstanding contribution. H e lived a long life, dyin g at the age of one hundred in 1962. Godsoe had a rare professional breadth of vision for his day and left a lasting memory of altruism. The first registered dentist in New Brunswick was J.M. Magee, who graduated from Pennsyl vania College of Dental Surgery in 188 3 and immediatel y became active in the development of his profession. After serving in many capacities i n his own province he broadened his activities, becoming a charter member and late r presiden t o f bot h th e Canadia n Denta l Associatio n an d th e Dominion Dental Council. One of his colleagues, C.A. Murray, is credited with successfull y carrying through th e effor t t o secur e a Denta l Ac t i n 1890 afte r severa l earlier attempts had failed . A.J . McAvenney , the first

Oral sepsis ( 1905-1909 ) 11

7

president o f the New Brunswick Dental Society , an d George O . Hannah, the first president of the Saint John Dental Society, both played importan t parts i n establishing the professio n i n their province . Al l possesse d hig h objectives together wit h the stamina to work consistently toward achieve ment. New Brunswic k als o produce d th e greates t showma n dentis t eve r known on this continent in the person o f Edgar Randolp h Parker , better known by his ow n description a s Painles s Parker . Whil e for ove r hal f a century his name appeared fro m tim e to time in dental literature, fo r th e most part it was in relation to legal actions brought about by the profession against him. He attracted.great publicity, however, in the lay press.2 Parker almost reached perfectio n as a showman, but dentists who knew him also admitted tha t h e was a capabl e practitione r fo r hi s era, whic h stretche d to modern times. A brief outlin e of his career suggests the stor y of other s who operated in perhaps a less expansive style. Painless Parker was born a t Tynemouth Creek, a small village in New Brunswick; in his youth he tried to become a minister, bu t wa s expelle d from bot h Acadi a Universit y and th e Baptis t Seminar y at St . Martin's , NB. Ho w h e becam e intereste d i n dentistry i s not known , but h e gaine d

James M. Magee, DOS, first registered dentist in New Brunswic k

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admission to the New York College of Dentistry for part of a course. The n he was expelled fo r practising outdoor dentistr y while a student. H e was next admitted to the Philadelphia Denta l College , wher e he graduated i n 1891. O n hi s return t o hi s nativ e province , h e obtaine d a licenc e an d established practice in a small community, St Martin's, rentin g the secon d chair in a one-man barber shop. Although he exhibited great respectability by faithfully carryin g a large Bible under his arm to church each Sunday, his practice did not thrive. He turned t o othe r methods . From thi s poin t forward, Parke r relie d upo n circu s adjunct s t o attrac t patients , an d th e stories o f hi s activitie s ar e legion . B y mean s o f handbill s and al l othe r available form s o f advertising , h e dre w the crowd s to fre e street-corne r shows with chorus girls, clowns, brass bands, an d many other attractions . During hi s earl y years , hi s incom e wa s derive d fro m so-calle d painles s extractions. On e of hi s earl y method s wa s to hav e a ma n wit h a bugle stand behind the patient and blow a blast at a given signal: this distracted the patient just when the tooth was coming out. Except for one or two short intervals , Parker spen t little time in New Brunswick. He set up shop in Brooklyn, NY, and engaged a tightwire artist to traverse a wire stretched across the street to his office window. As far as the crowd s below were aware, th e artis t entere d th e windo w and ha d a tooth extracted painlessly every hour. Free of charge, an d for advertisin g purposes only, he inserted diamonds in the anterior teeth of the great prize fighter, Bob Fitzsimmons. In a few years, he had thirty-six dentists on his payroll in the Brooklyn and Manhattan area. In his prosperity he took t o wearing a swallowtail coat an d cultivate d a Vandyke beard. A s mos t of the man y articles publishe d abou t hi m wer e base d upo n hi s ow n state ments, often extremely boastful, it is difficult t o separate truth from fiction. Financially, he was successful, and when he decided to retire in New York, officially i t was because of ill health. Perhaps a better reason was that th e eastern state s had been bus y amending their dental legislation respecting advertising, thu s creatin g difficultie s fo r him . I n an y cas e h e move d t o California, wher e his retirement laste d onl y a fe w months. Withi n a few years, Parke r ha d severa l offices i n Los Angele s an d graduall y extended his offices i n the cities along the west coast to twenty-seven, including one in Vancouver . An y attemp t t o enumerat e hi s activitie s woul d deman d much space. At one stage he bought a circus, and as ringmaster advertised the dentistr y to b e obtained i n his offices. H e als o rente d stor e windows and practise d i n the windows to attract crowds . To defea t th e law that a dentist must practise under hi s own name, he ha d hi s name changed by

Handbill distributed by Edgar Randolph Parke r ('Painles s Parker,' king of the advertising.dentists) in Saint John, NB, in 189 6

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court orde r t o Painles s Parker. H e becam e a n exper t i n defeatin g court actions against him, although he did not win them all. Parker die d i n 195 2 a t eighty years o f age. A t on e time , he boaste d that h e ha d practise d i n ever y provinc e i n Canada , bu t i t ha s no t bee n possible t o obtai n proo f o f thi s statement . H e wa s a Canadia n expor t contributed, without regret, by the dental profession to the United States. First an d foremost he was a showman , who claimed t o hav e done mor e to publiciz e dentistr y tha n an y othe r man . Perhap s thi s i s true, bu t th e difficulty la y i n his methods. H e claime d als o t o hav e brought dentistr y to the poor, but examination of related finances shed doubt o n this state ment a s well . Th e denta l professio n i n Nort h Americ a has ha d a con siderable number of advertisers; Parker was king of them all. Some o f th e othe r individual s who attempte d dentistr y b y mean s of circus-like performances carried o n for a period, whil e others faile d afte r brief efforts , probably due to lack of showmanship. None was able to succeed fo r lon g i n Canada . Tw o example s o f widel y differen t type s ar e 'Professor' Ashley and Madame Enault. The Original Professo r Napoleo n Ashley, Th e King of Dentists (accordin g t o his advertisements), roamed the Atlantic Provinces wit h his group of entertainers fo r a few years. H e claimed to be from Montreal, but no record o f him has been found a t that city an d th e nam e used wa s likely a pseudonym. During one o f his per formances a t Charlottetow n i n May 1880 , h e extracte d teet h fo r a Mrs McDonald an d later tha t nigh t she bled t o death . A n immediat e searc h for Ashley found that he had absconded. He was not heard of afterwards. 3 A mor e peculia r cas e wa s that o f Madame Enault , th e onl y known woman i n this category. I n Jun e 1882 , 'Dr ' an d Madam e Dufot Enaul t arrived in Montreal from Belgium on the transatlantic liner Helvetia. The y posed i n considerable styl e and a few days later Madam e Enault lef t th e Richelieu Hotel i n a beautiful carriage pulle d by three super b horses an d escorted b y twelve Mexican musicians. She paraded through town, putting on a show in Jacques Cartier Squar e before a large crow d of people. I n her sale s pitc h sh e claimed to extract teet h withou t pain. Sh e also ha d a panacea, referre d to in newspaper account s a s 'Chinese Perfume,' which would cure practically any physical disability. In the course of a few weeks she extracte d hundred s o f teet h an d distribute d grea t quantitie s o f he r panacea. Th e physician s an d dentist s o f Montrea l reacte d strongly , t o such an extent that the Enaults lef t fo r Quebec City , where they repeated their performanc e with the sam e success. However , thei r sta y in Quebec was shorter because, as the reports state, the dentists and physicians were

Oral sepsis (1905-1909 ) 12

1

able to gain the assistance o f the clergy an d the Enaults left suddenly . N o further trace of them has been found. 4 In th e west , meanwhile , the politica l formatio n o f Albert a an d Saskatchewan necessitate d th e enactmen t o f denta l legislatio n i n eac h ne w province. The first meeting of the dentists of Alberta was held 3-5 Octobe r 1905 with sixteen in attendance. Th e initial purpose wa s the formation of an organization . R.B . Sullivan (president) , A.E . Aunge r (secretary) , C.F. Strong , R.C. McClure, and E.M. Doyle were elected member s of the first Alberta Board. After reviewin g available dental legislation an d draft ing a tentative bill, they applied t o the legislature for enactment, and th e Dental Law of Alberta was assented to 9 May 1906. The earl y minutes of the Colleg e o f Denta l Surgeon s o f Saskatchewa n ar e lost . Fro m othe r sources i t i s know n tha t th e firs t meetin g of Saskatchewa n dentist s wa s held a t approximatel y th e sam e tim e a s tha t i n Albert a an d tha t W.D. Cowan was elected president. Cowan and Lorenzo D . Keown were activ e members of the council of the college from th e beginning and remained s o for many years. In form , th e Ac t adopte d i n Saskatchewan in 190 6 followed closel y that whic h had existe d in the North-Wes t Territories , wit h appropriat e alterations: i t create d th e Colleg e o f Denta l Surgeon s o f Saskatchewan , retaining the same members of Council until their successors wer e elected. The Albert a Ac t create d th e Albert a Denta l Associatio n wit h provisio n for the election of a board o f directors from it s members. Both Acts stated that ever y person dul y qualifie d an d registere d by the Colleg e o f Denta l Surgeons o f th e North-Wes t Territorie s wa s automaticall y eligibl e fo r membership. Wit h mino r variations , th e legislatio n wa s simila r t o tha t existing in the othe r provinces . I n Britis h Columbia , Saskatchewan , On tario, an d Quebec , th e Act s establishe d a colleg e o f denta l surgeons ; i n Alberta, Manitoba , Ne w Brunswick , Nov a Scotia , an d Princ e Edwar d Island, association s wer e established. In th e first group o f provinces, th e colleges wer e specifically delegate d dutie s under the term s o f the legisla tion, primarily for the protection o f the public; other provincial organiza tions cam e int o being for th e purpos e o f developin g scientifi c an d othe r matters of purely professional interest. In the other provinces, the associa tions created unde r dental legislatio n elected board s o r council s t o carr y out the terms of the Act, while the association proceede d t o hold conven tions to forward scientific and other matters related to the profession. Both systems hav e functione d wel l ove r th e years , wit h th e en d effec t bein g much the same.

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With the enactment of dental legislation in Saskatchewan and Alberta , the North-Wes t Territorial organization cease d t o exist . W.D . Cowa n of Regina had been the moving spirit in all its activities and continued in this capacity i n Saskatchewan. H e wrot e a history o f dentistr y i n the North West Territories which was never printe d i n full , bu t a copy ha s becom e available and is the source of most of the early information respecting dentistry i n the vast midwest. 5 Cowan wa s a man o f stron g convictions an d forcible language , and i t i s said tha t som e of hi s observation s respectin g the holders o f political office o f the time were cautiously deleted. The firs t meeting of dentists in the are a ha d bee n called b y Cowan i n hi s offic e a t Regina in July 1889 . Very little space was required. Eleve n dentist s were named a s practisin g the n i n th e Territory , o f who m thre e attende d th e meeting. Two or three othe r 'partial ' dentists were named, fo r example : 'Dr Callendar of Toronto ha d taken a homestead nea r Regin a an d while his horses rested , h e would occasionall y inser t a gol d filling for a neighbour.' Decision wa s made to form the North-West Territorial Denta l As sociation an d Cowan was elected president , a position h e held durin g the life of the Association an d the early years of its Saskatchewan successor. 6 Quite probabl y on e reaso n fo r organizin g at thi s tim e wa s tha t th e

Walter Davey Cowan, DDS (1865-1934)

Oral sepsis (1905-1909 ) 12

3

number o f settlers wa s increasing at a rapid rate. Anybody could practise dentistry: n o qualification s wer e necessary . Th e firs t objectiv e wa s t o secure legislation fro m th e Territorial Council, an d that body adopted a n ordinance regulatin g th e practic e o f dentistr y i n Novembe r 1889 . Th e lawyer wh o drafte d th e legislatio n an d pilote d i t throug h th e assembl y accepted a s payment in full upper and lower dentures made by Cowan . Implementation of the ordinance proved difficult, however , over a territory o f almost unlimite d space. Continuall y som e individual or anothe r began practising, ofte n hundred s of miles away from a main centre , an d the expense s o f securin g evidenc e an d prosecutio n fel l upo n th e fe w members, who were forced t o pay the cos t o f any action ou t o f their ow n pockets. Th e firs t ordinanc e prove d faulty , an d fo r year s a continuin g battle ensue d t o secur e amendment s respectin g qualifications and othe r pertinent matters. In the meantime an influx of individuals, some qualified and some not, began practising. As president, Cowa n was subject to much abuse, bu t i n spit e of it all hi s popularity wa s sustained . H e wa s electe d mayor o f Regin a i n 191 6 b y a n overwhelmin g majority an d late r wa s elected Membe r o f Parliament . I n 190 3 the ordinanc e wa s amended , changing th e titl e o f th e organizatio n fro m Denta l Associatio n t o th e College o f Dental Surgeon s of th e North-Wes t Territories , an d b y 1905 there were 250 dentists registered i n the Territories. However , there were not tha t man y dentist s actuall y practising . A numbe r o f non-resident s registered simpl y because i t wa s comparativel y eas y t o d o so , a s goo d insurance fo r an y futur e decisio n t o chang e locatio n durin g a perio d o f rapid migration. 7 K.C. McDonal d wa s elected presiden t of the British Columbia Dental Association i n 1905 . Later h e became activ e politicall y an d wa s elected to the British Columbia Legislature in 1916 , becoming Minister o f Agri culture i n 1933 . In the word s of his daughter, 'Dentistr y was my father' s profession, but politics was his life.' He died in office i n 1945. Sepsis and its prevention were the most prevalent subjects of addresse s and discussions at both dental and medical meetings during the early years of th e presen t century . Beginnin g i n th e 1890s , thi s threa t ha d bee n receiving increasing attention. Albert E. Webster of Toronto was a leader in pointin g ou t th e danger s o f sepsi s i n th e practic e o f dentistry. 8 He , together wit h others , presente d method s o f preventin g its occurrenc e i n many published articles . I t remaine d fo r a visitin g lecturer, however , t o present th e situatio n forcibl y an d arous e th e attentio n o f Canadia n dentists.

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HISTORY O F DENTISTRY I N CANAD A

In October 1910 , William Hunter, a prominent British physician, gave an addres s at McGil l University in which he deal t a t lengt h wit h sepsis , laying particula r emphasis on ora l sepsi s an d it s relationship t o disease . His tex t wa s publishe d i n th e Lancet, receive d marke d attention , wa s widely circulated , caused a goo d dea l o f editoria l comment , an d stirre d great controvers y among dentists for several years. 9 Seldom ha s an y on e speech had so much influence over so much time. Many of the statement s in the lengthy address must have seemed radical a t th e time , and indee d some seem so even today. Ten years earlier, Hunter ha d published a paper under th e title , 'Oral Sepsi s a s a Caus e o f Disease,' which ha d receive d editorial commen t i n professiona l publications includin g the Dominion Dental Journal, bu t ha d apparentl y attracte d littl e mor e tha n ordinar y notice. I n hi s McGil l address , late r delivere d a t Toront o an d severa l American cities, he claimed that he had coined the term 'ora l sepsis.' To present hi s impor t full y woul d requir e almos t complet e quotation . I n essence, h e argue d that ora l sepsi s wa s 'mor e importan t a s a potentia l disease facto r than an y othe r sourc e o f sepsi s i n th e body' ; that 'i f ora l sepsis (an d nasopharyngeal ) coul d b e successfull y excluded , th e othe r channels b y which "medical sepsis " gain s entrance int o th e bod y migh t almost be ignored'; and tha t 'th e gums and periosteum of the socket s ar e the sea t o f numerous septic wounds.' I n considerabl e detai l h e discusse d the current practice of dentistry: No on e ha s probabl y ha d mor e reaso n tha n I hav e ha d t o admir e th e shee r ingenuity and mechanical skill constantly displayed b y the dental surgeon . An d no one has had mor e reaso n t o appreciat e th e ghastly tragedie s o f ora l sepsi s which hi s misplaced ingenuit y so often carrie s i n it s train . Gol d fillings , gol d caps, gol d bridges , gol d crowns , fixed dentures, buil t in , on , an d aroun d dis eased teeth, form a veritable mausoleum of gold over a mass of sepsis t o whic h there i s n o paralle l i n th e whol e real m o f medicin e o r surgery . Th e whol e constitutes a perfect gold trap of sepsis of which the patient i s proud an d whic h no persuasio n wil l induc e hi m t o par t with . Fo r ha s i t no t cos t hi m muc h money, an d ha s h e not bee n prou d t o hav e hi s blac k root s elegantl y covere d with beaten gold , although no ingenuity in the world ca n incorporate the gol d edge of the cap or crow n with the underlying surfaces o f th e root beneath th e edges of th e gums ? There i s no ran k o f societ y fre e fro m th e fata l effect s o n health of this surgical malpractice .

And further he stated boldly:

Oral sepsis (1905-1909) 12

5

The medica l ill-effect s o f this septic surger y are t o b e seen ever y da y in those who ar e th e victim s o f thi s gilde d dentistr y i n thei r dirty-grey , sallow , pale , wax-like complections, an d in the chroni c dyspepsias , intestina l disorders , ill health, anaemias, and nervous ('neurotic' ) complaint s fro m whic h they suffer . In no class of patients and in no country ar e these , i n my opinion, mor e com mon tha n amon g Americans an d i n America , th e origina l hom e o f thi s clas s of work.

Needless t o say , these accusations wer e no t accepte d kindl y by many in the dental profession at the time, but in the long run, together wit h othe r findings, they served to bring about a changed concept o f the dentist's role. Up to this period, the preponderance of emphasis in practice had been on the side of mechanical perfection. Dental art had achieve d a level of great pride for both practitioner an d patient. Now the biological side of practice was forcibl y presented . Th e teachin g in dental school s ha d altere d con siderably, well ahead of Hunter, but time was required before th e change would reach th e operating chair. By his attack, Hunter served to hasten a process already well begun. Looking backward, it appears a long, slow trail to the recognitio n of sepsis as a cause of disease. Leeuwenhoe k of Holland, afte r inventin g his microscope, reported to the Royal Society of London in 168 0 that he had seen littl e animal s runnin g around in drop s o f saliva . Pasteur o f Franc e had establishe d in 186 4 the validity of the ger m theory of disease , fro m which Lister o f Great Britain had in 186 5 devised the use of carbolic aci d spray t o exclud e atmospheri c germs and preven t putrefactio n followin g surgical procedures. Koch of Germany isolated and related specifi c germs to specific diseases, thus creating the science of bacteriology, near the end of th e nineteent h century . Other s mad e lesse r contribution s alon g th e way, but i t wa s not unti l th e beginnin g of th e presen t centur y that rea l implementation of the sepsis theory came into practice. As with all new theories, the reception was varied, particularly among older practitioners . Men do no t leav e the pas t lightly . Perhaps th e earl y attitude toward sepsis is expressed better than in many explanatory words by a bi t o f doggere l writte n anonymousl y an d printe d i n a numbe r of professional journal s in 1903 . I t i s thought tha t th e write r was an olde r medical practitioner. I am somethin o f a veteran jest a turnin eighty yearA man that's hale and hearty as a stranger tew all fear;

126 A

HISTORY O F DENTISTRY I N CANAD A

But I've heard some news this morning, that has made my old head spin, An' I'm goin', to ease my conshuns if I never speak again . I have lived my fourscore years of life, an' never till today Wuz I taken for a jackass or an ignorant kind of jay. Tew be stuffed wit h such darned nonsense 'bout them crawlin bugs and worse, That's a killin' human bein's with their microscopic germs. They say there's microbes all about a-lookin for their prey, There's nothin' pure to eat or drink, an' no safe place to stay; There's miasmy in the dewfall, an' malary in the sun, Tain't saf e to be outdoors at noon or when the day is done; There's bactery in the water, an' trikeeny in the meat, Ameeby in the atmosphere, calory in the heat; There's corpussels an' pigments in a human bein's blood , An' every other kind of thing, existing since the flood. Therbacer ful l of nickerteen, whatever they may be An' yer mouth'Il get all puckered by the tannin in the tea. The butter's olymargereen, it never saw a cow; An' things is gittin' wus from what they be just now, Them bugs is all about us jest awaitin' for a chance Ter navigat our vitals and tew naw us off like plants. There's me n that spend a lifetime huntin' just like a goose, An' tacki n Latin names to 'em an' lettin on 'em loose. Now I don't believe such nonsense, an' I'm not agoin' to try If things have come to sech a pass I'm satisfied to die, I'll go hang me in the suller, fer I won't be sech a fool As to wait until I'm pizened by an annymalycool. The mos t distressin g phas e o f denta l practic e fo r bot h patien t an d dentist stil l wa s th e accompanyin g pain . Genera l anaesthesia , firs t dis covered b y dentists, was utilized fo r majo r operation s i n the mouth , bu t was not practica l fo r routin e work . Variou s preparation s with a cocain e base produced local anaesthesia, but cocaine, bein g a potent, dangerous, and habit-formin g drug , produce d man y untowar d result s i n patients. I n addition, this dru g was associated with seriou s social problems. The firs t ste p i n th e developmen t o f a satisfactor y loca l anaesthesi a was th e determinatio n o f the chemica l structur e o f cocaine. Afte r man y

Oral sepsis (1905-1909 ) 12

7

years o f study, Alfred Einhorn , a German chemist , enunciate d th e prin ciple tha t al l ester s o f aromati c acid s produc e som e degre e o f loca l anaesthesia. Chemists have produced man y hundreds of such esters. Procaine hydrochloride, unde r the proprietory name of novocain, was introduced into medical practice by Professor Brau n of Germany in 1905 . The first pape r i n Englis h o n th e us e o f novocai n i n loca l anaesthesi a wa s published in the Lancet i n 1906 . In 1907 , novocain becam e availabl e o n the North American continent. The first article on it to appear in Canadian dental literature was published in the Dominion Dental Journal i n 1908 . The article stated that novocain was first used for the extirpation of a vital pulp (b y pressure anaesthesia) an d was considered t o b e less toxi c tha n cocaine. Due to previous experience with products of a cocaine base type, many dentists hesitated before using the new product. It was first supplied commercially in powder or table t form , an d th e dentist mixed his solution a s he required it . This was a cumbersome, time-consuming , an d inaccurat e method, an d office-prepare d solution s rapidl y deteriorated . Th e ide a of using commercially prepared anaestheti c solutions, as well as other drugs , in cartridge s wa s develope d b y Harve y S . Cook , a n America n surgeo n during the first world war. 10 Ove r the years, researc h ha s continued an d improved solutions have been produce d unde r man y proprietary names . The developmen t o f satisfactor y loca l anaesthetic s brough t on e o f th e greatest assets to dental practice . Somnoform, discovere d b y Rollan d o f Bordeaux , France , i n 1901 , was introduce d i n Canad a i n 1904 . This anaestheti c consiste d o f ethy l chloride 60% ; methy l hydrat e 35% ; an d ethy l bromid e 5% . Adminis tered wit h comparativel y simpl e equipment , i t provide d genera l anaes thesia o f shor t duration . Th e us e o f somnofor m becam e intermittentl y popular fo r a coupl e o f decade s i n denta l practice , an d wa s discarde d mostly because of improved local anaesthetics. A significan t even t i n th e histor y of Canadia n dentistr y occurre d i n 1907 whe n Ashle y W . Lindsa y becam e th e country' s firs t denta l missionary, sponsore d b y the Wes t Chin a Missio n of th e Methodis t Churc h of Canada. A few months after receivin g his dental degree from th e University o f Toronto, h e arrive d a t Chengtu . N o for m o f denta l educatio n existed in China at that time. There were a few English dentists practising , mostly i n Shanghai , wh o employe d Chines e youth s o n a n inadequat e apprenticeship basis, following which the 'students' set out to practise for

128 A

HISTORY O F DENTISTRY I N CANAD A

themselves. By 1911 , Lindsay ha d erecte d a denta l hospita l a t Chengtu . In th e meantim e he wa s joined by John Thompson , wh o ha d graduate d from th e Toront o school . Graduall y a Chines e denta l schoo l wa s de veloped, but staf f remaine d a problem. Thompson died afte r a few years. In 1917 , Lindsay was joined b y Harrison Mullett , anothe r graduate , fol lowed by Gordon Campbell , R.N. Anderson , and Gordo n Agnew. Thes e dentists mad e u p th e staf f unti l 1928 , whe n thre e America n graduate s were added. At first, the Chengtu dental schoo l wa s a department i n the College of Medicine, and later becam e a College o f Dentistry. In 1929 , a College o f Medicin e an d Dentistr y wa s establishe d b y th e Wes t Chin a Union University, with two deans. In 1937 , Lindsay was appointed Vice Chancellor o f the university, a position he held until the change of regime in China in 1950, afte r whic h no foreigner could hold suc h a position an d he was forced to leave the country. Over the years, graduates of the schoo l had bee n sen t t o denta l school s i n Canad a an d th e Unite d State s fo r further training . On their return , these men became members of the staf f and too k position s i n hospitals. A s a result, th e schoo l wa s left i n 195 0 with a capabl e Chines e staff. 11 Th e visio n o f on e Canadia n dentis t ha d been accomplished. Lindsay utilized his furlough tim e to pursue his own graduate educa tion. I n 192 8 h e obtaine d a Bachelo r o f Denta l Scienc e degree , an d i n 1936 hi s Master' s degree . Th e Universit y o f Toront o conferre d th e honorary degre e o f Docto r o f Law s o n hi m i n 1942 . O n hi s retur n t o Canada, h e wa s appointe d edito r o f th e Journal oj the Ontario Dental Association, a position he held for fifteen years. In thi s perio d als o occurre d anothe r even t wit h long-ter m conse quences. Harold Clar k was a well-respected dentis t in Toronto for nearl y fifty years. He had many interests, possessed a large library, an d it would probably b e fair t o sa y that h e was one of the more learned member s of the profession in his day. In an y event, his advice was sought an d take n seriously. In 1906 , h e delivered a paper to the Ontario Denta l Societ y on the proprietary preparations bein g used in dentistry, indicating that many of th e dentifrices on the market were doing more harm than good. U p t o this time, testing, if any was done, of proprietary preparations used within practice o r by the public was haphazard. One dentist in Clark's audience , Andrew J. McDonagh , becam e concerne d wit h th e nee d fo r actio n an d within a year created an organization for the purpose. McDonagh had graduated from the Royal College of Dental Surgeon s in 1887 . He had engaged in general practice in Toronto fo r several years,

Oral sepsis ( 1905-1909) 12

9

but durin g the earl y 1900 s graduall y limite d his practice t o treatmen t o f the tissues surrounding the teeth, being the first Canadian dentis t to do so. For severa l years , h e ha d bee n a lecture r o n pyorrhe a aveolari s an d a member o f the staf f o f the Toronto school; in 1915 , wha t is said t o be th e first chair in the world for teaching periodontology in a dental schoo l was established, wit h McDonagh as a professor. H e was very active, both a s a citizen an d i n th e interest s o f hi s profession , fo r hi s whol e career . McDonagh wa s a convincing clinical teacher with a keen mind devoted t o research an d the advancement of periodontology a t a time when this phas e of practic e wa s at it s beginning. He hel d man y position s withi n the pro fession, an d was a founding member of the American Academ y o f Periodontology. T o him, the impossible was only something which took a little longer t o accomplish . N o tas k for th e advancemen t o f dentistry wa s to o great; yet h e was always ready t o hel p anothe r dentis t wit h the simples t problem. Before the day of Clark's speech, McDonagh had done some investiga tion into the content of dentifrices o n the marke t and th e shape s o f tooth brushes fo r sale . Afte r it , h e organize d th e Canadia n Ora l Prophylacti c Association with the prime purpose of developing an acceptable dentifric e and toot h brus h whic h dentist s coul d recommen d wit h impunity . Th e name give n th e products , Hutax , wa s coine d fro m tw o Gree k word s meaning health and mouth. The motive of the new association was altruistic. Th e dentifrice s the n bein g sold t o the publi c wer e know n t o contai n injurious substance s an d th e toot h brushe s wer e prove n incapabl e o f accomplishing thei r intende d purposes . Onc e th e ne w product s wer e developed, it was initially thought, there would be no difficulty i n inducing a reputabl e produce r t o manufactur e them . However , thi s assumptio n proved incorrect , an d th e associatio n itsel f wa s forced t o undertak e th e responsibility o f manufacture . Th e associatio n ha d a length y life : it s charter o f incorporation wa s not finally surrendered unti l the 1940s . Ye t throughout it s history, continuing difficulties occurre d i n finding a manu facturer wh o woul d adher e t o th e formul a establishe d an d retai n th e franchise. In the fac e of commercial producers ' advertising, th e associatio n de pended entirel y upo n th e recommendation s o f dentists. Fro m th e be ginning, dentists were kep t well-informed respecting its products throug h their ow n publications and a grea t dea l o f spac e i n the denta l literatur e was occupie d durin g tw o decade s wit h report s o n it s activities . O n on e point som e disagreemen t occurre d amon g th e leader s o f th e profession .

130 A

HISTORY O F DENTISTRY I N CANAD A

The association received a small royalty on the products, an d the moneys thus received wer e devoted t o th e suppor t o f dental researc h an d denta l public health education. No other financial support wa s then available for either o f these purposes an d th e need was great. However, som e dentist s objected t o involvement in a commercial pursui t for th e suppor t o f pro fessional activities of this nature. Over the years, some sharp controversie s occurred. Th e timin g o f th e movemen t an d th e circumstance s o f th e period must be taken into consideration in assessing its significance. During its existence, othe r agencie s came int o being with differen t method s but similar objectives, with the result that commercial products improved . But th e associatio n di d it s part , a s wel l a s supportin g Canadia n denta l research an d the publication of dental public health matter. The Canadia n Oral Prophylacti c Associatio n wa s als o largel y responsibl e fo r makin g possible the creation of another organization to be treated later, the Cana dian Dental Hygiene Council, which made a very substantial contribution . The first directory of Canadian dentists was published i n 190 9 by the Dominion Dental Journal. The book in itself i s a fine production i n semihard covers , bu t mor e importan t i t i s a min e o f informatio n abou t th e profession a t this stage of its development. The book not onl y records th e name, any degrees, and address of every Canadian dentist. It also presents the provincia l denta l Act s a s amende d t o tha t date ; th e officer s o f al l existing denta l societies ; the denta l school s wit h description s respectin g admission requirements and relate d matters , includin g th e name s o f th e complete staf f an d thei r position s i n each school ; manufacturers , denta l laboratories, an d denta l suppl y houses ; an d ful l informatio n o n th e DENTISTS PRACTISING I N CANAD A IN

1909

British Columbi a Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Islan d

86 ( 350,000 ) 76 ( 301,000 ) 62 ( 401,000 ) 93 ( 427,000 ) 900 (2,444,000 ) 231 (1,931,000 ) 82 ( 346,000 ) 114 ( 483,000 ) 21 ( 94,000 )

Total 1

,665 (6,777,000 )

Oral sepsis ( 1905-1909 )13

1

Dominion Denta l Council . Al l was sold fo r a price o f one dollar . Man y years wer e t o pas s befor e anothe r director y appeare d an d eve n the n nothing so complete was attempted. For th e first time, an accurate recor d fro m th e registrar s o f the pro vincial denta l board s wa s published , showin g th e numbe r o f dentist s practising i n 190 9 i n Canada. (Th e tabl e appear s o n th e opposit e page . The provincial population figures, in parentheses, ar e from th e Dominion Bureau of Statistics, estimated for intercensal years. ) Some measurement of the academi c qualifications of dentists the n i n practice is gained from th e accompanying table, althoug h the percentage s given d o no t represen t th e whol e picture. Man y who graduate d fro m a dental school did not bother to obtain the degree, whic h required anothe r examination b y th e university. 12 Thi s i s particularl y tru e o f thos e wh o graduated from a Canadian school before its affiliation wit h a university. The ag e of the practising dentist was also a factor affectin g th e likelihoo d of hi s holding a degree. Certai n observations can be safely made . Almos t two-thirds o f Canadia n dentist s possesse d a degree , an d th e percentag e was highe r i n th e olde r province s tha n i n th e ne w ones . Th e academi c stature of the Canadian dentist had risen considerably i n a comparatively short period. The page s o f th e director y offe r furthe r opportunitie s t o asses s developments in the profession as of 1909. In spite of strenuous oppositio n less tha n a decad e earlier , som e thirty-si x establishe d laboratorie s ar e listed.13 These wer e locate d mostl y i n th e large r centres : Montrea l ha d four, Toronto thirteen, Winnipeg four, an d Vancouver two; but they als o were spreading out to smaller centres such as Oshawa and Brandon. Den tal suppl y houses were established in the mai n cities across th e country , with eleven in Toronto alone. Four dental school s were in operation. Th e Maritime Dental Colleg e at Halifa x was affiliate d wit h Dalhousie University ; l'Ecole d e chirurgi e dentaire, d e l'Université Laval wa s functioning a t Montreal ; the McGil l Dental School , also at Montreal, was still a department i n the Faculty of Medicine; the Royal College of Dental Surgeons at Toronto wa s affiliate d with th e Universit y of Toronto. Late r al l these school s wer e t o becom e faculties o f th e respectiv e universities , but anothe r tw o decade s passe d before a fifth dental school was established a t the University of Alberta.14 By thi s period , th e numbe r o f denta l organization s ha d multiplied , particularly on the local level, as indicated in Appendix D. Any attempt to follow throug h the development of these societies would be most tedious.

Registered dentist s holding doctorate degrees (DDS ) practising in the year 190 9 Srhnnl n f

O VI 111 U 1 \J1

graduation CANADA

University of Toront o Bishop's Colleg e Trinity University McGill University Laval University UNITED STATE S

Philadelphia Dental College University o f California Boston Denta l Colleg e North Pacifi c Denta l Colleg e Northwestern University Milwaukee Medical Colleg e University o f Buffal o

Province

B.C.

Alta. Sask . Man

5

17 7 3

8 1 1 1 1 1 1

2

. 4

Ont. Que 538 3

33

1 21

. N.B

6

2 18

11 8

3

2

N.S. P.E.I .

69

7 1

15

.

29 61

Registered dentists holding doctorate degrees (DDS) practising in the year 1909 parentheses (continued) Province

School of graduation

B.C.

Maryland Dental College Detroit Dental College Louisville College of Dental Surgery University of Pennsylvania Chicago College of Dental Surgery Coll. of Physicians & Surgeons—San Francisco Baltimore College of Dental Surgery Western Reserve University University of Michigan Harvard University Denver Dental College Miami Dental College Ohio University New York Dental School Tufts Dental College American College of Dental Surgery Indiana Dental College Source of degree not stated Percentage of total number of practising dentists SOURCE:

Canadian Dental Directory 1909

1 1 1 1 1 1

1 30.2

Alta.

Sask.

Man.

Ont.

Que.

1

N.B.

N.S.

1

8

P.E.I.

1 1 2

1 2

3 2

1

39.5

1 3

1 1

2 43.5

8

3 4

7

17

1

1

4

10

24

6

1 1

1 2

1 2 1

1

3 7

1 4 2

1

83.3

52

1

1 38.7

32 69.5

1 1 3

4 53.2

1 47.5

1

134 A

HISTORY O F DENTISTRY I N CANADA

The name s or title s were altered fro m tim e to time , an d o f course som e were no t sustained . At thi s point i n time it becam e th e fashio n t o for m odontological societies , all of which have disappeared o r bee n renamed . Progress o f dental supply houses and manufacturer s has been impor tant to Canadian dentists, particularly to those pioneers who found them selves as much as two thousand miles from a source of dental supplies. By the early 1900s, advertisements are to be found for eight supply houses in Toronto, two in Montreal, an d on e i n Halifax. Through amalgamation s most of the original names of these firms have disappeared. A s the Wes t opened up, the firms in Toronto began sending agents to its larger municipalities. The first to make a trip was H.P. Templ e o f Toronto, i n 1902 . A.E. Aunger , an Alberta dentist , recalls tha t h e received a car d fro m a Toronto depo t advisin g him that thei r agen t woul d b e a t a certai n hote l in Winnipeg, 800 miles away, on a certain date . I f he wanted to se e th e agent, h e ha d t o mak e th e trip . Th e establishmen t o f wester n branc h depots followed , firs t a t Winnipe g in 1903 , an d b y 191 2 a t othe r large r cities. Thes e developments , togethe r wit h greatl y improve d mean s o f transportation, contribute d greatl y to the abilit y of widely scattered den tists to render services. Some of the early efforts o f the dental firms seem to have been motivate d more b y service than profit . Today, dentist s acros s the countr y fin d themselve s wit h denta l supplie s withi n relatively eas y reach. Alterations i n practic e occurre d a s ne w products becam e available . In 190 7 a new filling material appeared , firs t know n as petroid cement . Originally thi s material , invente d by Emmanue l d e Trey, wa s produce d in Zurich , Switzerland , and imported . I t wa s easy t o use , an d i n theor y could b e matched in colour t o the tooth, although the earl y produc t lef t much to be desired in the matching of shades. By 1911 it was being manufactured o n this continent under the nam e of synthetic porcelain, and th e shades gradually improved. Like other innovations, it caused disturbances . Gold foi l ha d stoo d th e tes t o f time and man y dentists hesitated t o sub stitute a produc t o f unknow n quality. Th e bake d porcelai n restoratio n also had come into general use and proven satisfactory. But public demand for a n unnoticeable restoration a t a lower fe e brought th e ne w material into increasing use. S.W. Mclnnis, a n outstandin g leader o f the professio n i n Manitoba , died in November 1907, at the age of 42. At the time he was president of the Canadia n Denta l Association . Durin g hi s relativel y brie f career , Mclnnis had no t only creditably occupied al l possible position s th e pro -

Oral sepsis ( 1905-1909) 13

5

fession ha d t o offer , bu t ha d als o serve d a s Speake r o f th e Manitob a Legislature, Provincia l Secretary , an d Ministe r o f Education . A larg e number of tributes were forwarded by professional and la y organization s from across the country. The interes t of the professio n in the educatio n o f the publi c i n denta l health is typified in a resolution, adopted a t the 190 6 meeting of the Canadian Dental Association in Montreal. It called for :1S 1 A n act requiring the periodical examinatio n o f the teeth of school children , and providing for the appointment o f dentists fo r the purpose. 2 Revisio n of school books with regard to the hygiene of the mouth and teeth. 3 Distributio n o f suitable booklets in the public and private school s an d larg e military camps. 4 Specia l instruction in this subject in normal schools . 5 Specia l pape r o n subject s o f denta l hygien e i n examinatio n fo r teacher' s licence. 6 Lecture s befor e teachers ' association s an d schoo l childre n i n publi c an d private schools .

By the end of the period dealt with in this chapter, th e beginnings of a turning-point in Canadian dentistry had been reached. The whole question of sepsi s opene d a ne w concept of dental service . Scientifi c program s o f the futur e wer e t o la y emphasi s upo n sterilization , th e relationshi p o f dental disease to genera l health, an d the plac e o f dentistry in health ser vices. A t th e 191 0 meetin g of th e Canadia n Denta l Association , A,E . Webster devoted th e majo r par t o f his presidential addres s t o thes e sub jects. Of course, the trend was gradual, but the inclination to the biologica l concept o f dentistry was definite, an d continuing. It would be accelerate d by other factor s i n the future , amon g them the x-ray , which was not ye t in common use in practice and would not be for several years. Often i t has been said that the only thing more certain i n this life tha n death an d taxe s i s the inevitabilit y of change. Th e degree , direction , an d speed o f change may vary fro m on e perio d t o another ; bu t a significan t feature of Canadian dentistry over th e years has been that a s soon a s the new was proven, the profession implemented it rapidly. At this stage, with a new concept recognized, the dental schools altere d their courses to meet the new environment. Dental art was not lowered, but dental scienc e was elevated.

10

Professional freedo m 1910-1914

Professional legislative freedom in Canada is unique. The first dental Act , adopted i n 1868 , provide d tha t registere d dentist s practisin g i n th e Province of Ontario elect a board of directors t o carry out the provision s of th e Act i n the interest s of the public . This principle o f freedom within the profession was copied b y the other province s with minor variatio n a s their legislation wa s enacted. Som e dela y occurre d i n British Columbia , where the first Act (1886 ) provide d for appointmen t o f a Boar d b y th e Lieutenant-Governor i n Council; in 1895 , thi s was amende d t o provid e for th e appointmen t b y th e governmen t o f member s selecte d fro m a lis t of te n names submitted by the British Columbia Denta l Association ; an d in 190 8 a new Act was passed, providin g for the election of a Council b y the qualifie d dentist s withi n th e province . Bot h th e lega l an d medica l professions had obtained this legislative freedom before dentistry. Study o f legislation i n othe r countrie s indicate s tha t th e establishe d methods of governing the professions and their services fall int o two main categories. I n th e first , appointment s ar e mad e t o a governin g board o r council by the government of the day, either wholly or in part, sometime s from a list of names submitted by the representative professional organiza tion an d sometime s not . Wher e th e governmen t doe s no t mak e al l th e appointments, i t usuall y controls th e majorit y of appointment s an d th e profession, generall y by election , a minority . I n th e secon d categor y of legislation, th e governin g o f professiona l service s i s entirel y unde r th e control of a department or division of the government. On onl y tw o occasion s ha s th e syste m bee n seriousl y questione d i n Canada. A s a resul t o f charge s tha t th e profession s wer e abusin g thei r

Professional freedom (1910-1914) 13

7

privileges, th e Ontari o Governmen t se t u p a commissio n o f enquir y which reporte d i n 1918 . I t absolve d th e professions , wit h a fe w recom mendations for improving the system. In 1947, the Saskatchewan Govern ment threatened to take ove r th e administration o f the professions : considerable public controversy resulted, and in the end the government withdrew. Accusations against the right of self-government by the profession s appear fro m tim e to time, generally on isolated points , often bizarre , an d far fro m th e fac t whe n investigated. Ofte n th e publi c doe s no t recogniz e that th e professions , throug h th e legislation , ar e accountabl e fo r thei r actions to the legislatures. They have not thirsted fo r the ichor o f power , but rathe r hav e sought to provid e services o f quality in the bes t possibl e manner. In carrying out this aim, criticism from withi n the profession has often bee n mor e sever e tha n tha t fro m the laity . Muc h of the progres s made by the healt h profession s in Canad a i s credited t o th e fac t o f self government.1 Reference wa s made earlier t o the outcr y tha t aros e from som e dentists that too many graduates would be produced followin g the construc tion o f a large r schoo l a t Toront o i n 1896 . By 1902 , i t wa s alread y necessary t o increas e the siz e of that building by approximatel y fift y pe r cent. Thi s nee d cam e abou t for thre e mai n reasons . First , it had bee n announced tha t th e cours e woul d b e increase d fro m thre e year s t o fou r years i n 1903 , which automatically increased th e numbe r of application s before th e extensio n too k place . Second , a publi c deman d existe d i n Ontario fo r mor e graduates . Third , n o schoo l existe d i n Canad a wes t of Toronto, an d a n increasing number of students were applying for admis sion from th e West. This situation was to exis t for th e next twenty years, and a t times a high percentage of students at Toronto cam e from outsid e Ontario. As the years passed, a similar situation developed at McGill, and to a lesser extent at Dalhousie. In 1907, the Hospital Trus t notified the Ontario Denta l Board tha t they desired to purchase the property occupied by the dental school i n order t o expand the Toronto Genera l Hospital. Thi s created a situation somewhat similar t o tha t o f 1896 , whe n th e schoo l no w threatene d wa s built . I n order t o obtain the secure backing of the profession, the Board circulate d a questionaire to al l Ontario dentists , outlining the situatio n an d specifi cally calling for a vote on seeking establishment of the schoo l a s a faculty of th e Universit y of Toronto. Ninety-five pe r cen t o f the ballot s returne d were favourable . Several meeting s were hel d betwee n representative s of the Board an d the university. The university did not raise an y substantia l

138 A

HISTORY O F DENTISTRY I N CANAD A

objections to establishment of a dental faculty, but stated it was impossibl e to d o s o i n th e forseeabl e futur e fo r financia l reasons . Onc e mor e th e profession ros e to an emergency , and proceeded t o purchas e propert y a t the corne r o f Colleg e an d Huro n Streets : a muc h large r schoo l wa s erected, an d equippe d i n th e mos t moder n style , withou t an y financia l assistance fro m outsid e the profession. I n the course o f only a few years, even thi s building, which was considere d a t th e tim e fully adequate , ha d to be enlarged. To a considerabl e extent , th e buildin g experienc e o f th e Toront o school reflect s the rapid expansio n of dental service during the earl y part of the twentieth century in Canada. Th e other three schools mad e adjust ments durin g the sam e period. Th e Lava l schoo l move d i n 191 3 to th e new Lava l denta l hospita l i n Montreal' s Lati n Quarter , an d i n th e nex t year a new dental clinic was established by McGill at the Montrea l Gen eral Hospital. A dental faculty ha d already been established at Dalhousie University in 1912 . With th e expansio n of the school s cam e th e nee d fo r full-tim e staff . No longer could a school be administered by a man who at the same time was conducting a bus y practice. A.W . Thornton , a staf f membe r o f th e Toronto school , wa s appointe d full-tim e hea d o f th e McGil l schoo l i n 1913. Eudore Dubea u was a full-time dean o f the Laval school , and th e Royal Colleg e o f Denta l Surgeon s a t Toront o increase d it s numbe r o f full-time men , including A.E. Webster . Dalhousie, with a smaller numbe r of students , was able to carry o n wit h a part-tim e staf f unti l much later. For th e leaders i n dental education during this period, notabl e contribu tions often involve d a real sacrifice in time away from lucrativ e practices . While servic e o n a teachin g staf f migh t hol d considerabl e honour , th e recompense, if any, was insignificant. The acceptanc e o f a full-time position on a teaching staff mean t diminishe d income. Eudore Dubeau was born at Quebec City in 1875. After attendanc e at Saint Mary' s Jesui t College , h e obtaine d hi s Art s degre e a t l'Universit é Laval i n 189 2 an d hi s denta l degre e fro m Bishop' s Colleg e i n 1895 . Almost immediatel y after graduation , h e wa s recognize d fo r hi s abilit y and appointe d secretar y o f the Quebe c Dental Board , a position h e hel d from 190 0 t o 1923 . H e wa s a founding member o f the Canadia n Denta l Association an d serve d a s it s presiden t fro m 190 4 t o 1906 . Wit h th e founding of the Laval dental school i n 1905, he became its first dean, an d continued i n that positio n when in 192 0 th e schoo l becam e th e Facult é de chirurgi e dentaire , Universit é d e Montréal . H e retire d i n 1945 . D r

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Dubeau wa s the first Canadian dentis t to tak e a n activ e interest i n th e International Denta l Federation , attendin g th e firs t sessio n i n 190 0 i n Paris, France, and receiving at that time a medal as a founding member . Outside his profession he was also active; he was Consul in Montreal fo r Portugal, an d a member of Montreal City Council. During his career, the French Republi c bestowed several decorations on him, including those of Officer d'Académi e (1909) , Office r d'Instructio n Publiqu e (1916), and Chevalier d'Instruction d'honneur (1923) . He also received the award of Honneur et Mérite (Haiti) in 1935 and was made Chevalier of the Order of Christ (Portugal) i n 1936. He died in 1953 . A.W. Thornton wa s a dentist of exceptiona l ability. He wa s born a t Perth, Ontario , an d taugh t school fo r twelv e years before studying den tistry. After receivin g his degree from th e University of Toronto i n 1890 , he practised in western Ontario for twelve years, during which he inspired the organizatio n o f th e Wester n Ontari o Denta l Society . I n 1903 , h e moved to Toront o t o tak e a position o n the staf f o f the Toront o school . Ten years later he was appointed head of the McGil l school. In large part he i s credite d wit h th e establishmen t o f dentistr y as a ful l Facult y a t McGill, which occurred in 1920. Thornton continued as dean until 1927 ,

Eudore Dubeau, BSC, DOS, Doyen, Faculté de chirurgie dentaire, Université de Montréal, 1905-^44

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when failin g healt h force d hi m t o retire . H e serve d a s presiden t o f th e American Associatio n o f Denta l School s i n 1926-7 . H e wa s a literary man, a poet of no mean calibre, an d a very popular after-dinne r speaker. His abilit y i n this direction did muc h to initiat e the publi c of Quebe c i n dental education. He died in 1931, aged 73 . The nam e o f Willmot t an d Ontari o dentistr y wer e synonymou s fo r half a century. J.B. Willmot t died in June 191 5 at seventy-eigh t years of age, stil l i n offic e a s dea n o f th e Roya l Colleg e o f Denta l Surgeon s an d secretary of the Ontario Dental Board. At his death, glowing tributes were paid t o hi m i n th e la y pres s an d i n resolution s sprea d o n th e minute s of denta l organizations, larg e an d small , acros s th e country . H e wa s a recognized builde r o f th e profession , particularl y i n th e are a o f denta l education, whic h h e recognize d a s it s cornerstone . T o a larg e exten t through hi s energ y an d far-sighte d views , dentistr y ha d bee n elevate d from a motley crowd o f expert technicians to a professio n of recognized academic standing . Often h e was misjudged, but an y man wh o succeed s in satisfying everybod y can be sure that his work will not endure. He had to fac e man y difficultie s an d som e o f th e prejudice s whic h mee t ever y pioneer, bu t s o many first s occurre d a t hi s instigatio n tha t i t woul d b e

A.W. Thornton, DDS, Dean of th e Faculty of Dentistry, McGill University, 1913-2 7

Professional freedom (1910-1914) 14

1

almost impossibl e t o compos e a complet e list . H e wa s honoured b y th e profession on many occasions. In 1910 , when the new Toronto school was built, the profession , by individual contribution, installed a large staine d glass commemorative windo w in hi s honour , whic h was carefull y transferred when the presen t home of the Faculty o f Dentistry was built during the 1950s . I n 1914 , th e Universit y of Toront o conferre d th e honorar y degree o f Doctor o f Laws upo n him, the firs t Canadia n dentis t s o honoured.2 I n late r lif e h e ha d difficultie s i n dealin g wit h the risin g denta l generation, but ther e i s nothing unusual in this situation. Devoted t o hi s profession, h e was pertinacious, resourceful, and ingeniou s in advancin g it throughout his long life. His son , Walter E . Willmott , succeede d hi m a s secretar y o f th e Ontario Dental Board, an d held the position for twenty-five years. Walter Willmott graduated fro m th e Roya l Colleg e o f Dental Surgeon s i n 1888. The followin g year h e graduate d fro m th e Philadelphi a Denta l College , and immediatel y wa s appointe d th e firs t full-tim e staf f membe r o f th e Toronto school. Over a period o f forty years on the staff , h e taught nearly every subjec t o n th e curriculum , an d a t th e sam e tim e serve d i n som e administrative capacit y o r othe r i n th e school . Earl y i n th e 1930s , h e

James Branston Willmott , DDS, MDS, LLD, Dean o f th e Royal College of Dental Surgeons, 1875-1915

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HISTORY O F DENTISTRY I N CANADA

severed hi s direc t connectio n wit h th e schoo l an d becam e full-tim e secretary o f the Denta l Board . U p t o hi s deat h i n 195 1 h e wa s greatl y respected by the profession at large and received many honours . In the previous chapter, th e other giant of Canadian denta l educatio n during thi s period, Fran k Woodbur y o f Dalhousie , wa s introduced . O f course, th e accomplishment s o f thes e me n wer e attaine d onl y throug h the assistance and co-operation of a host of colleagues in the schools. From the length of faithful an d effectiv e servic e a s a staff membe r Frederick G . Henry stands fort h prominentl y in the lists . He wa s born i n Montreal i n 1870. Befor e studyin g dentistry, h e spen t te n year s i n commercia l life , which undoubtedly contributed to his ability to understand his fellow man. Immediately followin g graduation i n dentistr y fro m Bishop' s College i n 1899, h e bega n his teachin g career o n th e staf f o f that school . Whe n i t was taken over by McGill (a move in which he played an important part), Henry continued as a member of the staff, an d assisted in the change fro m departmental to faculty status in 1920. During the earlier year s he taught materia medica and pathology , also servin g in numerou s capacities. H e reached retiremen t ag e in 1935 , bu t ther e wa s no on e to tak e hi s plac e and he served on for a time. In 1935 , he was appointed professor emeritus . In 1914 , McGill University conferred on him the DOS degree (ad eundem) . He was 94 when h e died i n 1964 . Thes e bar e fact s do no t represen t hi s greatest contribution. He was greatly respected an d loved by students who sought hi s counsel o n al l occasions, an d durin g his latter year s thi s wa s his main service. Unassuming in character, quie t in manner, highly prin cipled, he was a maker of professional men. None o f thes e leader s i n denta l educatio n foun d th e tas k easy . A constant flow of obstacles arose , difficul t t o overcome. On e typically frus trating inciden t occurred a t McGill . By custom on this continent, gradu ates in dentistry have received the degree of Doctor o f Dental Surgery . N o question aros e a t an y other Canadia n university in thi s respect. McGill , however, firs t grante d onl y a degre e o f Graduate i n Denta l Surgery . I n 1908 i t decided to grant the degre e of Doctor of Dental Surgery , an d s o stated i n the calendar for that year; but when the certificate was issued i t read, Doctoris in Arts Dentalis Scientia. This cause d furthe r controversy . It wa s not until 1918 that Thornto n wa s able t o obtai n th e desire d cer tificate for the degree . As in the othe r professions , the ide a o f indentureship trainin g had a slow demise . During the earl y days, whe n formal courses wer e o f shor t

Professional freedo m (1910-1914) 14

3

duration, ampl e reaso n existe d fo r apprenticeshi p training ; bu t a s th e academic course s increase d i n length , th e nee d fo r i t diminished . However, indentureshi p ha d bee n a n establishe d custo m fro m th e beginnin g and practising dentists strongly protested agains t any change. B y the end of th e 1890s , leader s o f th e professio n wer e advocatin g shortenin g th e period an d in some cases doing away with it entirely. Perhaps th e syste m should b e explained. I n those days a student intendin g to stud y dentistry could not simply apply to a school. Firs t he had to find a dentist who was willing t o sig n a n indentureshi p contrac t wit h him , and wh o wa s als o acceptable t o the dental board o f the province. Durin g his indentureship, the student was required to attend the established courses of instruction at an acceptable dental school. From time to time, the periods of indentureship and academic courses altered. By 1900 the term of indentureship was four complet e calenda r years , during which the apprentic e wa s require d to atten d a recognized denta l schoo l fo r three session s o f approximatel y five months each . I n 1903 , th e academi c cours e wa s increased t o fou r sessions an d indentureshi p remained th e same . Th e trainin g perio d wa s measured i n calendar years , no t th e academi c years o f today . The pros and con s of indentureship occupy much space in Canadia n dental literature during the early years of the present century. Many dentists took a pragmatic position - tha t the schools taugh t theory bu t a real dentist was produced through practical experience in the office. Educator s and members of the dental boards, through experience, possesse d th e op posite view. To them, indentureship was filled with abuse an d uncontrol lable; the student in the dental office learne d questionabl e methods, ofte n contradicting teaching in the school, and on many occasions was left with out proper supervision. In 1908, action was taken in Ontario to end dental education by preceptor. However, th e feeling was so strong that a student could no t be trained i n a dental schoo l t o operate a practice, that inden tureship with a practitioner remaine d compulsory during the summer preceding final year. I n 1911 , students in Ontario wer e granted a choice, of attending a summe r sessio n a t th e denta l schoo l o r indenturin g wit h a practitioner, an d i n 191 2 compulsor y indentureshi p wa s abolishe d en tirely. In the other provinces, indentureshi p gradually disappeared durin g the following decade, except on a voluntary basis. Directly relate d to the disappearance of indentureship, there occurred several alterations in the methods of practice. On e did not cause the other , but each was reinforced by the other. Unti l well after th e turn of the cen-

144 A

HISTORY OF DENTISTRY IN CANAD A

tury, i t wa s believe d tha t everythin g even remotel y connecte d wit h th e practice o f dentistry must b e performe d by a licensed dentis t himsel f o r by a registere d denta l studen t unde r hi s direc t supervision . Th e denta l boards attempte d t o enforc e this concept, an d man y dentists were disciplined fo r employin g other personne l i n an y capacity . A s note d earlie r attempts to establish laboratories were harshly dealt with . The laborator y was a most important component of the dental office, an d it was there tha t indentured student s spent most of their time . The birt h pain s tha t intro duced auxiliary personnel into dentistry were lon g and severe. Yet in spite of prohibitions , the number of outside dental laboratorie s increased , an d dentists employe d technicians othe r tha n registere d denta l students . Ini tially, and wit h extremel y few exceptions, th e person s s o employed wer e male. A s denta l laboratories becam e established , however , th e nee d fo r such personnel in the office lessened. Women began to be hired in increas ing numbers for duties other tha n purely mechanical. B y 1910 , althoug h many dentists still performed the whole service for the patient in their own offices, laboratories were established across the country. A dental editoria l in 191 4 stated that , 'I t i s in the interes t of the publi c fro m a n economi c standpoint tha t ever y person shal l perform the highes t servic e that h e is capable of. It is waste of money to educate a dental surgeo n and have him spend hi s time performing operations tha t migh t be done b y a nurse, a n assistant or dental mechanic.' 3 The greates t overal l factor contributing t o this proces s wa s th e changin g concep t o f denta l service . A s emphasi s shifted fro m mechanical to biological, the fabrication of appliances becam e incidental. And so did the reliance on cheap, indenture d labour t o do that work. In 1910 , th e las t grea t lan d rus h go t underway . Th e Peac e Rive r country, approximately 120,000 square miles with over a million acres of fine arable land , straddle s th e norther n borde r o f Britis h Columbia an d Alberta. Th e are a ha d bee n well-known by fur traders (For t Dunvegan , a fu r trading post, was built i n 1815 ) an d b y gol d seekers , bu t it s grea t agriculture potential was not recognized until the end of the first decade of the present century. Transportation wa s the difficul t problem . Edmonto n was th e jumping-of f place , bu t owin g to a n enormou s muske g area be tween i t and the Peace Rive r country , summe r travel ha d t o be by river and lake . Th e fait h o f th e earl y settler s ha s bee n ampl y rewarded . Th e visitor toda y finds prosperous town s supported b y th e physica l riches of good black soil, gas, oil, coal, water power, timber, an d pul p wood. The first dentist arrive d in the Peac e Rive r countr y i n March 1911 .

Professional freedom (1910-1914 ) 14

5

Albert Sproul e was born near Parrsboro, Nov a Scotia , i n 1869. His olde r son, J.C. Sproule , a noted geologis t o f Calgary, has provided detail s of his adventures.4 The stor y pertains no t onl y to th e history of Canadian den tistry, but also to the lives of settlers moving from on e o f the oldest settle d areas o f Canad a t o it s newes t frontier . Albert Sproul e wa s a n onl y so n with ten sisters. He remained on the famil y farm , helpin g his fathe r edu cate th e sisters , until he wa s twenty-six years old. Then , wit h practicall y no educatio n himself , h e wen t t o Boston , wher e b y intensiv e stud y h e covered th e preliminar y academic requirement s i n on e yea r an d gaine d admission t o th e Bosto n Denta l College . H e graduated i n 1898 . Afte r a short interva l he returned t o Parrsboro , wher e he practise d som e twelv e years. Durin g this time he helped hi s father pay of f the debt s incurre d i n educating his sisters - i n accordance wit h the tradition o f Nova Scotia , where education has always held a top priority. People wh o kne w Sproul e personall y hav e describe d ho w h e wa s seized wit h the ide a o f servin g where th e nee d wa s greatest . A s new s of the Peac e Rive r countr y spread rapidl y acros s Canad a i n th e winte r of 1910-11, h e decided t o g o there. B y this time he wa s married an d ha d two sons, the youngest only one year old. With his family, Sproul e travel led b y train t o Edmonto n an d the n t o Edson , a statio n som e 15 0 mile s further west. From here nothing more than a trail existed to his destination of Grande Prairie, approximately 200 miles to the northwest. I n a caboos e which h e buil t himself , carrie d o n sleigh s an d draw n b y tw o team s o f horses, th e family reache d Grand e Prairi e in early 1911 . An inventory of his equipmen t an d supplies , i f it were available , woul d mak e interestin g reading. Sproule had n o illusions abou t wher e he was going and realize d that he would probably find it necessary to farm, at least par t o f the time, in the new territory. He did actually take up land. However, peopl e cam e from suc h grea t distance s an d i n suc h grea t number s fo r denta l servic e that afte r a fe w years h e foun d himsel f subsidizin g the operatio n o f th e farm from his professional fees. He therefore gave up agriculture. To mee t the requests from distan t points all over th e Peac e Rive r country , h e de signed a portabl e denta l office , probabl y th e first in Canada, an d durin g the summer months visited outlying settlements. On e of his student assist ants o n these norther n trek s was a youn g man named Hecto r MacLean , later dean of Dentistry at the University of Alberta . Sproule was a perfectionist, no t only in dentistry, but i n all else he attempted t o do. He was an inventor an d spent hi s latter year s workin g on patents for ga s furnaces an d ga s appliances, no w widely used. Anothe r o f

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HISTORY OF DENTISTRY I N CANADA

his patents had to do with house-trailers, a by-product of his portable dental office an d the caboose he had built in 1911. He died i n April 1941 . A pioneer neighbou r o f Dr Sproul e i n Grand e Prairi e wrot e t o me : 'Th e doctor wa s quit e a colourfu l figur e i n the earl y day s o f Grand e Prairie , holding many public positions of authority and his wife was a lovely singer and playe d the pian o beautifully.' H e als o recalled tha t 'o n th e trail, the doctor wa s known as a n aristocrat , b y reason o f th e fac t tha t h e drov e horses instead of oxen, which were the predominant mod e of power.' 5 In spit e o f it s importance , professiona l journalis m has alway s bee n beset with difficulties. Fro m it s introduction in 1889, the monthly Dominion Dental Journal wa s the onl y denta l journa l i n Canada. I t depende d entirely upo n individua l subscriptions fo r support , an d considerabl e dis parity existed between the number of subscribers an d the total number of dentists in the country. While dental organizations recognized th e journa l as an officia l organ- , non e contributed t o it s support. Durin g thi s period, Wallace Seccombe conceived the idea of publishing a new dental journal , supported b y advertising, and mailed free t o every Canadian dentis t eac h month. Seccombe was a most energetic dentist who possessed a s well considerable business ability. His endeavour, Oral Health, was born i n 1911 . He continued as both publishe r and editor until his death i n 1936 . Whil e the format ha s been altered from tim e to time, this journal has continue d to be published to the present. Activities in the field of dental public education continued durin g the 1910s. Initially , great fait h wa s place d i n actio n b y government . Yea r after year , dental organizations submitted resolutions o r briefs to govern ments, pointing out the existing oral health o f Canadian childre n an d emphasizing the need for action. No department of health then existed in any Canadian government . Provincia l board s o f healt h di d exist , bu t thei r budgets were minimal. A historic cairn o n the ground s of the Parliamen t Buildings at Fredericton record s th e fact tha t the first Ministry of Health in the British Empire was established by the New Brunswick Government in 1918. The plaque reads in part, 'the resulting benefits were so noticeable that the example was followed in other parts of Canada an d th e Empire.' However, i t was another decade befor e all Canadian government s established suc h departments . A s a consequence, sinc e th e emphasi s wa s o n children, submissions in this period wer e directed t o the Department s o f Education. As noted previously , permissive legislation ha d been obtaine d for denta l inspectio n of school children in two provinces, bu t th e respon-

Professional freedom (1910-1914) 14

7

sibility for this rested wit h local school boards, wh o did not always accep t the need. By 1910 , a definite chang e o f attitud e ha d occurre d withi n the profession. Fait h i n governmen t actio n ha d diminishe d an d i t wa s realize d that th e professio n woul d hav e to provide th e leadership. Me n like J.G. Adams of Ontario an d Georg e Ker r Thompson o f Nova Scoti a ha d bee n aware of this for years, but it took tim e for the rank and file of the dentist s to realize it. When they did, active educationa l committees , as they were named a t thi s period , wer e se t u p b y mos t denta l organization s acros s Canada. Through th e energeti c leadershi p o f Wallac e Seccombe , wit h R.J . Reade a s secretary , th e educationa l committe e o f th e Ontari o Denta l Society rapidly developed a n amazing list of accomplishments. It produced booklets and, through the Department o f Agriculture, arrange d fo r publi cation an d distributio n o f copie s i n enormou s quantitie s a t governmen t expense. Lectures o n dental health were organized for nurses in hospital s and teachers ' trainin g schools . Th e appointmen t o f a denta l inspector , W.D. Doherty, for the Toronto school s was secured. (I t is notable that the stated purpos e o f his appointment was to preven t deca y o f teeth , rathe r than to inspect teeth whe n decayed.) Chart s an d exhibit s were prepare d for us e i n th e schools . Denta l clinic s wer e establishe d a t th e Toront o General Hospital an d the Hospital for Sick Children in 1911. A free denta l clinic for the poor children of Toronto wa s launched in 1913, in the charge of J.A . Bothwel l unde r th e Medica l Healt h Officer ; thi s wa s th e firs t recognition by a Canadian municipality of it s responsibility i n the treat ment of dental diseases.0 While such activities became commonplace later , they wer e new a t th e time . Th e result s wer e rapidl y apparen t an d th e endeavours copied i n the othe r provinces . Whil e the wor k o f these committees on education was directed toward the public, within the profession they serve d t o re-orien t thinkin g an d establis h a stron g attitud e towar d the prevention of dental diseases. Wallace Seccombe wa s a leader o f great energ y and ability. Up to the time of his activity in the area o f education of the public, efforts ha d bee n largely confined t o the repair o f damage in the mouths of children. I n th e main, he deserves the credit fo r the alteratio n o f emphasi s to preventing the damag e befor e i t occurred . H e wa s responsibl e fo r initiatin g th e movement toward prevention, which has since continued, wit h increase d emphasis, i n Canadian dentistry. In 1915 , h e establishe d what is said t o

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be the first chair o f preventive dentistry i n an y denta l school . Lik e othe r strong leaders , hi s activities di d no t alway s endea r hi m t o hi s confreres , largely becaus e h e was not content t o wai t for everyon e t o be converte d to the obviously right procedure. Man y 'cut and thrust' arguments arose, but Seccomb e wo n in th e end . On e humorou s inciden t occurre d a t th e annual meeting of the Ontari o Denta l Society. Seccomb e wa s opposed t o the activitie s of the Canadia n Ora l Prophylacti c Associatio n i n th e field of denta l healt h education , an d Andre w J . McDonag h wa s presiden t o f that organization . Seccomb e ha d pointe d ou t a t lengt h th e iniquitie s of selling th e publi c a produc t i n orde r t o educat e them . Wit h Iris h wit , McDonagh aros e an d said : 'Well , boys , yo u kno w Wallac e an d I hav e these little arguments at meetings and afte r th e meeting is over, we go out and get gloriously drunk together,' and sat down. Everyone in the audienc e knew that Seccomb e wa s a teetotaler - an d that McDonag h dran k spar ingly if at all. Owing to th e smal l numbe r o f dentist s in Nov a Scotia , Ne w Bruns wick, an d Princ e Edward Island , effort s wer e mad e t o hol d combine d meetings. The first was held at Digby in 1898 , and was successful. Owing to the guarding of provincial rights, however, any permanent organization was steadfastly avoided , and officer s wer e elected for the curren t meeting only. Such interprovincial meetings were held at irregular intervals at first, but graduall y develope d int o th e Atlanti c Province s Denta l Associatio n with regular conventions. The Britis h Columbia Dental Societ y meanwhile became inactive . I n the 1890 s it had held annual meetings with programs that are surprisingl y modern. By 1908, however, the society wavered, probably i n part becaus e of th e alteration s i n legislatio n relate d a t th e beginnin g o f thi s chapter . The Act o f 1908 created the College of Dental Surgeons of British Columbia an d provide d fo r th e electio n o f a counci l b y th e member s o f th e College. Th e dat e o f this ne w legislation an d th e diminishe d activity b y the Societ y coincide . Th e ne w counci l largel y too k ove r th e contro l o f activities related t o the profession. However, a skeleton societ y remaine d in existence . At a reorganization meetin g in 1916 , WJ. Lea wa s electe d president, wit h J.E . Blac k a s retirin g president ; an d sinc e the n annua l meetings have been held regularly. I n 1920 , th e name was changed fro m Society to Association. The first mention of the term 'state medicine' to be found i n Canadia n dental literature occurred i n 1911 , when a joint meeting was called o f the Toronto Academ y of Medicine and the Ontario Denta l Societ y to discuss

Professional freedo m ( 1910-1914) 14

9

the subject.7 The news media of that time were carrying many items abou t the introductio n o f a nationa l insuranc e pla n b y th e Britis h Parliamen t over the objections of the healt h professions. 8 Th e subjec t was to absor b the attention of the health professions in Canada a t a much later date. By 1914 , th e professio n wa s wel l organize d throughou t th e whol e country. Eac h province , thoug h th e natur e wa s varied, ha d satisfactor y dental organizations which hav e remained much the sam e to th e presen t day. Local societies, first in the larger centres and then in other areas, had come int o being. Coincidentally came a strengthenin g of the voic e o f th e profession an d increased publi c education i n dental health .

11

War year s (i) 1915-1919

As a nation , Canad a ha s bee n involve d i n thre e majo r war s whic h oc curred with intervals of roughly twenty years - th e South African war, the first world war , an d th e secon d worl d war . Full-scal e wa r ha s alway s instigated rapi d chang e withi n the countrie s involved , includin g the de velopment o f thei r professions . Canadia n dentistr y i s n o exception : it s history might be written in parts divided by war. The beginning s of Canadia n militar y dentistr y i n the Sout h Africa n war have already been described. From the first two dentists sent oversea s in 190 0 i t was a long way, however, t o th e establishmen t o f an effectiv e dental corps . Muc h of the initia l credit mus t g o to th e persisten t effort s of Ira Bower and to the interest of the Canadian Dental Association, which took up th e question o f dental care for military personnel a t it s founding meeting in 1902. The proceedings of the Association recor d a progressiv e effort a t every meeting over the next four decade s t o establish a n efficien t corps, which would be independent but with ranks and pay commensurat e with that of the medical corps. On many subjects, th e Associatio n foun d difficulty i n securing harmonious internal agreement, but on this objective there wa s complet e unanimity , wit h arden t suppor t b y al l th e denta l organizations across Canada . After severa l interviews with authorities, a General Orde r wa s passed in Jul y 190 4 whic h reorganize d th e Arm y Medica l Service s int o tw o separate branches , th e Arm y Medica l Departmen t an d th e Regimenta l Medical Service . The former consisted of the Medical Staff an d the Army Medical Corps . Th e latte r consiste d o f th e Permanen t Activ e Medica l Corps an d the Militia Army Medical Corps, comprisin g medical officers ,

War years (i ) (1915-1919 ) 15

1

dental surgeons , an d nursin g sisters . O n appointment , denta l surgeon s were given the relative rank of lieutenant, an d after five years' service that of captain, but it was provided that in no case was the officia l designation to be othe r tha n Dental Surgeon . O n organization, the numbe r of denta l surgeons wa s t o b e eighteen . Th e firs t dentis t whos e appointmen t wa s gazetted, on 1 0 September 1904 , was W.T. Hackett of Oakville, Ontario. This initial General Order containe d an anomaly. Although the dental surgeons wer e to be par t o f the Militi a Army Medical Corps , th e orde r specifically referred to the establishment of a 'Dental Corps.' This wording may have come through the intensive efforts o f the committee representing th e profession ; th e actualit y wa s fa r fro m thei r tru e objectiv e o f a n independent body . Th e order' s importanc e lie s i n th e fac t that , fo r th e first time, dental surgeons were recognized as an essential part of the mili tary establishment. This earl y progress resulted from th e experience of the South Africa n war. But Canada is not a military nation. Her history between wars is one of dispersion and reduction of military units. Nevertheless, th e committe e representing th e professio n continue d thei r effort s an d graduall y mad e gains. Qualifications for military appointment were established. The initial equipment provide d b y the Arm y was rudimentary, and som e improve ments were obtained. Th e typ e of servic e rendered wa s elementary , an d some betterment was gained. The length of service before promotion fro m lieutenant to captain was reduced from five years to three. I n 1908, during the annua l meeting of the Canadia n Denta l Associatio n a t Ottawa , th e first meetin g o f th e Arm y Denta l Servic e wa s held . Tw o year s late r the establishmen t wa s increased t o twenty-si x denta l surgeon s - th e service was proving itself. Yet there was still much left t o achieve. Certai n matters rankled - amon g them, the fact that the promoted dental surgeon was designate d 'honorary ' captai n an d n o provisio n wa s mad e fo r an y higher rank . I n negotiation s wit h th e government , th e appointe d repre sentatives o f th e professio n wer e i n th e mai n Bower s o f Ottawa , J.M . Magee o f Saint John, and Georg e Ker r Thompson o f Halifax. During an interview i n 1912 , the Ministe r o f Militi a state d tha t 'Canad a wa s no w doing mor e i n respec t t o denta l service s tha n an y othe r countr y i n th e world.' At th e same intervie w th e Minister requeste d tha t th e Canadia n Dental Association presen t a n outline of a scheme for the establishment of a dental corps directly to him, rather than through the usual channels. This was done i n keeping with the Association's adopte d policy . This the n was the situation when, in August 1914 , war was declared

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which would involve over 600,000 Canadians during the next four years . Initially, th e denta l requiremen t fo r recruit s wa s 'tha t th e candidates ' teeth are to be in good order and the loss or decay of 10 teeth will be considered a disqualification' ; artificia l teet h wer e 'no t recognized. ' Ver y rapidly, recruits came forth. When the first Canadian contingent of 33,000 men sailed overseas, ten sets of dental equipment accompanied them. Ye t in spit e o f al l tha t ha d bee n attempted , th e examinatio n an d car e o f soldiers' teet h wa s still chaotic . Th e dentist s wh o ha d bee n attache d t o the militia for a good number of years had never been more than a kind of fifth wheel. Recruit s wer e examine d fo r ora l healt h b y physician s an d even drill sergeants. Me n were rejected whose teeth wer e actually i n very good condition, and man y were accepted whos e mouths were a constant source o f danger . Man y receive d n o physica l examinatio n o f an y kind . Soon request s arrive d from Englan d fo r dental unit s to b e establishe d a t base hospitals. Th e few dentists in the militia were in no position to cope with th e number s involved , an d ther e wa s little inducemen t fo r privat e practitioners t o join as dental surgeons under the service conditions. On a voluntary basis, civilia n dentist s organize d themselve s t o examin e appli cants a t recruitmen t centre s an d thei r service s wer e gladl y accepte d b y commanding officers. 1 The call for dental services at base hospitals brought an early response from McGill , whic h thus becam e th e firs t universit y t o offe r a medica l unit for oversea s service . Th e uni t was entitled N o 3 Canadia n Genera l Hospital (McGill), and was organized entirely within the university. Thi s unit consisted o f 35 officers, 7 5 nurses, an d 22 4 othe r ranks . Among the officers wer e tw o dentists , Captai n G.H.A . Stevenson , wh o appear s i n the listing as Officer i n charge of Dentistry, an d Captain L.H . Thornton , the son of the dean. 2 The othe r ranks were made up o f students, man y of them registere d i n Medicin e an d Dentistry . Amon g the m wa s Ear l M . Laurin, the n i n his second year , and later a prominent Montrea l dentist . The me n arrived i n England i n May 1915 , refused t o b e split , an d wer e established as a unit in France on 14 June 1915. A dental clinic was immediately established, th e first, as far as Canadian dentistr y is concerned, t o operate in a field of military action. The most famous member of this unit undoubtedly was Lieutenant-Colonel Joh n McCrae, wh o was in charge of medicine an d secon d i n command . H e die d o f pneumoni a i n Franc e shortly afte r writin g 'I n Flander s Fields, ' a poe m whic h ha s obtaine d a lastin g plac e i n modern anthologies. 3 Queen' s Universit y organize d a

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medical unit soon after McGill, taking on its strength Captain E.B. Sparks, who practised dentistr y at Kingston for many years. The first military dental clinic in Canada wa s opened i n March 191 5 at the Canadian National Exhibition grounds at Toronto. Permissio n had been grante d b y th e Ministe r of Militia , Genera l Si r Sa m Hughes , wh o showed great interest in the clinic and made an official inspection . Shortl y after, he announced unofficially tha t he had authorized the formation of a separate Denta l Corp s an d appointe d J . Ale x Armstrong , a n Ottaw a dentist, a s Directo r o f Denta l Services , wit h th e ran k o f colonel . Un doubtedly, thi s action took plac e a s a result o f pressure from bot h commanding officer s o f th e militi a an d th e activitie s o f dental organization s across th e country . Actually , Armstron g wa s gazette d a s a lieutenant colonel, on 2 April 1915 , and began his duties immediately in organizing The Canadian Army Dental Corps. Up t o thi s date , eighty-tw o dentist s had joine d th e force s a s denta l surgeons with the honorary rank o f lieutenant, an d they became th e nu cleus o f the newl y formed Corps . Othe r dentist s wh o had bee n activ e in

Military dentistry in France during the first world war. The dentists are G.H.A. Stevenson (left) an d L.H. Thornton. The site is a Jesuit college at Boulogne

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the militia were in service but no t a s dentists i n their respective militar y units, generall y wit h higher rank s tha n thos e serving i n th e Corps , an d for th e most part they continued to serve with these units throughout th e war. Once the Corps was established, the enlistment of dentists increased rapidly. Details from the military viewpoint have been related elsewhere. 4 The intention here is to portray more particularly developments as they affected the denta l profession as a whole. O n 24 Jun e 1915 , th e firs t contingen t of th e Corp s lef t Montreal . It consiste d o f 15 1 men, of whom fifty-thre e were graduate dentists an d th e other s wer e either undergraduates o r ex perienced laboratory men with the rank of sergeant. On arrival in England, clinic an d laborator y headquarter s wer e establishe d a t Shorncliffe , an d the dental service went into operation. The demand was even greater tha n anticipated an d ver y quickly a call for more me n arose. Before the wa r

First contingent of the Canadian Army Dental Corps overseas, 191 5

War years (I ) (1915-1919 ) 15

5

was over, nearly one-quarter o f all Canadian graduate dentists were members o f the Corps , an d a n undetermine d number o f othe r dentist s wer e serving with other units. Many problems arose in supplying the necessary personnel. The dental schools accelerate d classes , an d entir e graduatin g classes wen t directl y into th e Corps . Th e deman d fo r denta l sergeant s (assistants ) becam e urgent, and the Toronto schoo l generousl y placed equipmen t an d staf f a t the disposa l o f th e militar y for training . Civilian dental servic e wa s de nuded in many rural areas and greatly reduced in urban areas. The publi c accepted thi s a s a conditio n o f war, an attitud e whic h wa s somewha t different durin g the secon d worl d war . One o r tw o incident s occurre d during this period, however , that were occasions fo r professiona l alarm . In th e dyin g hours of the Saskatchewa n Legislature i n 1916 , a n amend ment to the Dental Act was passed under which a dentist who had a licence to practise coul d emplo y a man who was not a dentist to practise unde r the dentist's name, though he travelled fro m tow n to town throughout th e province. Th e Saskatchewa n College o f Dental Surgeon s had n o knowl edge of the amendmen t until after th e clos e o f the session . A fe w weeks later a patient die d in the chair of one of these unqualified practitioners , causing a publi c uproar . Th e amendmen t was short-lived. A somewha t similar action that occurred in Nova Scotia is described in the next chapter. The kin d of dental servic e best suite d fo r me n i n the force s becam e a subjec t o f considerabl e discussion . Initiall y th e polic y o f th e militar y authorities was to perform necessary services to last tw o years, but as the war lengthened their attitude changed. The number of applicants rejecte d for denta l reason s soo n brough t abou t th e additio n t o th e service s o f vulcanite dentures, which had not been permitte d a t the beginning. Mili tary denta l servic e graduall y settle d dow n principall y t o extractions , vulcanite dentures, amalgam, and oxy-phosphat e fillings. While i t wa s a primitive kind of dentistry, it had the merit of clearing the mouth of infection and restoring efficiency o f mastication. And some significant advances were made. From almost the beginning of the war, a disease which became known as 'trench mouth' was one of the mai n problems facing the Dental Corps. This acut e stomatiti s incapacitated larg e numbers o f soldiers. It s clinica l history wa s fairly wel l recorded, bu t th e patholog y wa s unknown . Th e Corps organized a special study and devised a method of treatment which controlled the disease. Another notable area of treatment was in maxillo-

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facial cases, that brought together surgeons and dentists in unprecedente d achievements. Th e us e o f th e x-ray , th e introductio n o f ne w denta l techniques, and the development of numerous instruments and appliances , were all accelerated i n meeting wartime emergencies. Several subsidiar y effort s contribute d greatl y t o th e succes s o f th e Corps. Whil e the governmen t supplied instrument s and materials , ther e was n o provisio n fo r numerou s other essentials . To mee t thi s need , a n Army Dental Fun d wa s established an d member s o f the professio n an d the public contributed. Wives of dentists formed auxiliarie s which kept u p a generou s flo w o f parcel s containin g hand-knitted sock s an d sweaters , food, an d cigarette s to dentists overseas . By 1917 , the dental service regulations calle d fo r a Director-General of Denta l Service s wit h th e ran k o f ful l colonel , si x lieutenant-colonels , and othe r officers . Th e establishmen t calle d fo r on e denta l surgeo n t o every five hundred men in the services. The Canadian Gazette, in London, England, testifie d t o the success in a report tha t 'th e Canadian Army was the only army in the world, that attempted to send its soldiers to the fron t dentally fit. To Canada , belong s th e honou r o f being the firs t countr y i n the worl d t o organize an d pu t a separat e denta l corp s i n th e field; and New Zealand's Arm y is the onl y othe r on e that has anothe r suc h corps , though it is understood tha t the Americans are organizin g a dental corps . In all the other armies, the dental corps is part of the medical corps.' 5 Two mai n points wer e causin g the representative s o f th e professio n concern, however . Th e firs t wa s tha t th e Corp s wa s establishe d o n a wartime basi s only ; it s futur e becam e a n issu e o n whic h a numbe r o f presentations wer e made . On e o f th e earl y action s take n b y th e Unio n Government afte r i t took offic e i n Ottaw a late i n 191 7 was to mak e th e Corps a permanent part o f the army. The Canadian professio n rea d this announcement wit h pride . Th e othe r matte r o f concer n wa s th e inde pendence o f the Corps , a statu s th e professio n ha d presse d fo r fro m th e beginning i n 1902 . Th e permanen t establishmen t applie d t o servic e i n Canada only . The Minister of Militia had state d repeatedly fro m th e first that the Dental Corp s wa s independent, but there appeare d t o be stron g opposition amon g the militar y authorities . I n Canada , wher e th e com munications wer e direct fro m th e Corp s t o th e Adjutant-General , ther e was no, or little, difficult y respectin g this matter, but the situation altere d overseas. I n England , th e poin t wa s controversia l throughou t th e wa r and Canadia n dentist s servin g soldier s i n Franc e wer e drafte d int o th e Army Medical Corps .

War years (i ) (1915-1919 ) 15

7

On both these matters, the battle had to be fought agai n a t the begin ning of the second world war. Between 191 8 and 1939 , economy-minde d governments al l bu t wipe d ou t man y o f th e establishment s o f th e firs t world war, including the Dental Corps. As will be seen later, however, such action di d no t dete r th e professio n i n it s endeavour s t o establis h th e Corps on a satisfactory basis in readiness for any future catastrophe. Following the war, demobilization brought a new set of problems. O n discharge, every man was supposed to be given medical and dental exami nations. I f furthe r dental treatment wa s foun d necessary , whic h wa s th e case with the vast majority, the discharged soldie r wa s given a certificate entitling him to the treatment prescribed a t public expense. Theoretically , this arrangement seeme d good . But a t som e demobilizatio n centres, despite valian t effort s b y th e member s o f th e Corps , ther e wer e jus t no t sufficient personne l t o provid e adequate examinations i n the rus h ou t of the forces. In addition , dentists in the Corps were themselves anxiou s for discharge i n orde r t o re-establis h civilia n practice. Othe r trouble s aros e when th e federa l Departmen t o f Soldiers' Civi l Re-establishmen t issue d regulations in respect t o denta l services for returne d soldiers , wit h a fe e schedule attached . Immediat e protes t occurre d withi n th e profession , mainly o n tw o points. First , th e fe e schedule wa s criticized, bot h fo r it s limitation of services and for the fee s allowed. Second, the administratio n of the plan was attacked because it was to be entirely by medical person nel. A journal editorial stated, 'I t i s difficult t o understan d ho w the self respecting dentist in civil practice, coul d submi t to having an office r wh o knows nothing about dentistry dictate to him what dental operations ar e to be done and what is to be paid for them.' 6 As a result of the protest , th e department appointed a director of dental services. With adjustments from time t o time , thi s arrangemen t wa s t o remai n i n forc e unti l afte r th e second world war. Among those dentists who served durin g the wa r in units other tha n the Dental Corps , Joh n S . Stewart o f Lethbridge, bor n i n 187 7 an d stil l enjoying an active life a s this was written, is one of the more notable. Hi s life encompasse s practicall y th e entir e developmen t perio d o f wester n Canada. His family moved from Ontari o to the North-West Territories, in the are a tha t becam e Alberta , whe n h e wa s a youngster . Fo r a shor t period, h e taught school. I n 1899 , h e joine d th e Strathcon a Hors e a s a private an d serve d i n the Sout h Africa n war wher e he wo n the Queen' s medal wit h bars fo r bravery . O n hi s retur n h e gaine d admissio n t o th e Royal Colleg e o f Dental Surgeon s a t Toronto , graduatin g an d obtainin g

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his dental degree from Trinity in 1903. In the same year he began practice at Lethbridge, Alberta, where he remained i n practice until his retirement in 1960 , wit h the exception of time spent in military service. T o improv e his army qualifications, h e attended th e Royal Militar y College at Kings ton during 1907-8, graduating with the rank o f major. I n 1911 , he was elected t o the Legislative Assembl y of Alberta, wher e he served for fourteen years. On the outbreak of hostilities in 1914, he joined the Canadia n Expeditionary Forces , was promoted to lieutenant-colonel, an d went overseas in command o f the Sevent h Artillery Brigade . In 191 7 h e was pro moted t o brigadier general i n command of the Thir d Division , Canadia n Artillery an d le d hi s division throug h al l th e engagement s i n whic h th e Canadian Corp s participated , bein g wounded twice . H e receive d many awards, includin g the Distinguishe d Servic e Order , Companio n o f th e Order o f St. Michael and St . George, an d Croi x d e Guerre. I n 193 0 h e was elected t o the House of Commons and served there for four years. I n the mids t o f al l hi s activities, h e continue d t o conduc t a highl y ethica l practice in his city and took a prominent , bu t unassuming , part i n com munity affairs. The city of Lethbridge recognized him on many occasions , including the naming in 195 6 of General Stewar t School. Th e Universit y of Albert a conferre d th e honorar y degre e o f Docto r o f Laws o n hi m i n 1957. Th e arden t spiri t o f thi s remarkable Canadian a t ninet y years of age is represented i n a privat e communication to th e author , writte n i n fine legible longhand which begins: 'Your s of the 28th came this A.M. and as I have finished the chores, swep t the garage, shovelle d th e snow , even on the boulevard, therefore with a clear conscience I apply myself to reply to you r questions . Gladl y undertake this smal l item for th e goo d o f th e cause.' The wa r brough t abou t a heightene d publi c appreciatio n o f denta l services tha t continue d i n peacetime . Ther e wer e thre e mai n reasons . First, th e larg e numbe r o f me n rejecte d fo r militar y servic e because o f dental disease had received publicity; the general public now took its oral health more seriously. Second, the services of the Dental Corps during the war had a n indirect result in that unprecedented number s of demobilize d men from al l branches applied for admission to the dental schools. Third , the professional organizations had managed to continue their programs of dental education o f the public despite the war. Newspapers of the postwar period carrie d considerabl e informatio n respectin g dental health . Ernes t Hemingway, wh o was then a reporte r wit h the Toront o Star, wrot e a t

War years (i ) (1915-1919 ) 15

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least tw o effective article s on the subjec t befor e goin g to Pari s an d fam e as a novelist.7 The dental schools quickly found themselves in an emergency. Studen t applicants wer e i n larg e par t me n wh o ha d alread y los t severa l year s through military service, and from patrioti c motives alone grea t effort wa s expended t o accommodate them. Yet even before the war had ende d th e schools wer e filled to capacity, largely with men already discharged fro m the forces . Wit h demobilization , th e floo d o f applicant s overtaxe d al l available teaching facilities. Some effor t t o establis h a n additiona l schoo l i n Quebe c occurre d during thi s period . A n ite m i n th e minute s o f th e Quebe c Colleg e o f Dental Surgeons (1916) reads : 'the Bill for the incorporation o f the Royal Dental School ha d bee n refuse d b y the Legislature.' It has not, however, been possible to secure details related to this project. During the war, the Universit y of Alberta ha d considere d organizin g a course in dentistry, and in the fall of 1918 three students were accepted. The denta l cours e wa s established unde r th e Facult y o f Medicine o n a four-year basis, with the first two years at Alberta and, by agreement, th e final two years at the Royal College of Dental Surgeons or McGill Univer sity. The followin g year , th e numbe r o f applicant s increase d fa r beyon d the capacit y o f th e course , bu t i t wa s not unti l 192 3 that dentistr y wa s recognized a s a separat e departmen t a t Alberta , wit h H.E . Bulye a a s director. In the fall o f 1919 , the Roya l College o f Dental Surgeon s a t Toronto had 37 5 qualifie d applicant s fo r th e firs t denta l year . Th e schoo l wa s equipped for maximum classes of eighty students. Over eight y per cent of the applicants were men who had serve d oversea s in the forces, many for the full four years of war. The members of the Ontario Board ha d tried t o prepare for this crisis, but with limited success. The previous year they had estimated, on the basis of annual increases i n the numbe r of applications , that th e Colleg e woul d hav e to provid e fo r 50 0 student s i n th e sessio n beginning i n th e fal l o f 191 9 (actuall y ther e wer e 804) . T o mee t thi s expected demand they had applied to the Ontario Governmen t for a grant of $100,00 0 to build an addition to the school: th e estimated cos t o f the addition was $150,000, and in its application the Ontario Board promise d to raise the balance. I n the spring of 1919 the government had refused to consider any such grant, on the grounds that grants had never been made to independent educationa l institution s and t o acced e t o thi s applicatio n

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would se t a dangerou s precedent . Th e situatio n becam e critica l a s hun dreds of applicants milled around the campus in the fall. Hurried meeting s were held with government authorities. The cause of the returned soldie r was dominant at the time, and the newspapers gave more suppor t t o th e issue tha n dentistr y ha d eve r bee n abl e t o enjo y before . A chang e o f government facilitated action, an d eventuall y the provinc e di d make th e grant - no t actually until February 1920 , but in the meantime all returned soldiers wer e accepted. 8 Certai n condition s wer e attache d t o th e grant , the main one being that the school coul d no t be sold without governmen t permission. Later, the Ontario Governmen t created th e Ex-Service Men' s Loan Fund , unde r the terms of which loans (repayabl e afte r graduation ) were made to studen t veterans wh o were in need o f financia l assistance . This provision mad e completion o f the course possible for a considerabl e number of future dentists. A minorit y of Ontario dentist s argued tha t i n seekin g this gran t th e profession wa s 'selling out' t o th e government . In today' s society , whe n government suppor t i s sough t s o liberally , suc h protes t ma y appea r strange, bu t the n a pride o f ownership existed. Th e Toront o schoo l ha d been operated for nearly fifty years by the profession and this was the first time tha t outsid e financial assistance had bee n sought , eve n thoug h for several year s leaders ha d been statin g that the profession coul d no t con tinue to support dental education alone. More general criticism o n educa tional grounds was levelled a t the schoo l fo r acceptin g so many student s beyond th e capacit y o f its existing teaching facilities. Suc h criticis m wa s just an d man y expediencie s ha d t o b e utilized , bu t ther e wer e savin g factors. Perhap s th e chie f wa s the student age level. Thes e returne d me n were muc h olde r tha n norma l undergraduates , considere d thei r oppor tunity a privilege , an d wer e keen to establis h themselve s i n civilia n life . However, expansio n o f thi s natur e wa s avoide d followin g th e secon d world war. The us e o f denta l assistant s (sergeants ) durin g th e wa r prompte d renewed discussio n respecting the us e an d trainin g of denta l auxiliaries . The first recorded actio n was a resolution adopted a t the annua l meeting of Quebe c licentiate s earl y i n 1917 , requestin g the establishmen t o f a training course fo r denta l nurses, bu t n o actio n followed . The followin g year, Dean Webster recommended to the Ontario Board that a course fo r dental assistant s b e established . Thi s resulte d i n a one-yea r cours e fo r dental nurses at the Toronto school , whic h began in the fal l o f 191 9 an d continued until I960.9

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Special concession s wer e mad e fo r denta l sergeant s wh o wishe d t o register in dental schools , but onl y a small percentage applied . However , the special wartime courses i n which the sergeant s ha d bee n traine d di d arouse interest . Representative s o f a n organizatio n calle d th e Ontari o Prosthetic Denta l Associatio n made presentations t o th e Ontari o Boar d in tw o successiv e years , requestin g th e establishmen t o f a cours e fo r laboratory assistants. A committee of three representatives of this association and three Board members was set up to study the proposal, but there is no record of their report. This incident nevertheless represents th e first effort t o establis h trainin g o f technician s fo r civilia n purposes , an d th e beginning of a continuing problem. As a n outcom e o f proposal s made by the researc h committe e of th e Canadian Denta l Associatio n a t tw o successiv e meetings , th e Canadia n Dental Researc h Foundatio n wa s formed under federa l charter i n 1920. Financial suppor t fo r denta l researc h wa s negligibl e a t th e time . Th e foundation establishe d a fun d i n honou r an d recognitio n o f th e servic e and sacrific e o f Canadian dentist s durin g th e war . Under th e energeti c leadership of Wallace Seccombe, an d of a board made up of dental representatives from all provinces, a financial campaign was organized: moneys collected were to be placed i n a trust fund, wit h the net annual income to be paid to the foundation for use in the support of research activities . Th e profession responde d well . Man y dentist s mad e sizeabl e contributions . In addition , denta l student s gav e money ; grant s wer e mad e b y denta l organizations across the country ; and surpluse s fro m socia l an d athleti c activities were turned in. Contributions from outsid e the professio n were disappointing, however. The general public were not a s research-minded as today, and faile d t o appreciat e th e practical valu e to be obtained, no t only for dentistry but for research in general. Consequently only a fraction of th e proposed capita l fun d wa s attained, but thi s remains intac t t o th e present time and is still in active use. Perhaps th e greates t value of the campaign di d no t lie in the amoun t of mone y collected, bu t i n the awakenin g to the nee d for denta l researc h which it stimulated. A number of highly qualified, research-minde d grad uates had developed . The school s possesse d littl e financial means, if any, to assis t thes e me n i n researc h activities , an d practicall y n o mean s o f publishing their results existed. The foundation endeavoure d to find solutions. It assiste d the men i n other way s as well, but it s main activity was for som e twenty years the publicatio n and distributio n of acceptabl e re search bulletins , varying in size from pamphlet s t o a book o f 12 5 pages.

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The bulletins were quickly in demand from man y parts o f the world, an d did much to establish dental research i n Canada o n a firm basis. I n 1951 , the foundation came under the administration of the Research Counci l of the Canadia n Denta l Association , fro m whic h i t ha d originated , an d continues to assist research actively. The fathe r o f dental research i n Canada wa s Harold Keit h Box . H e was a brilliant student, who graduated fro m th e Royal Colleg e o f Denta l Surgeons i n 191 4 an d immediatel y became a part-tim e membe r o f th e staff. He wa s appointed professor of dental pathology and periodontolog y in 1920 , an d a fe w years late r becam e researc h professo r o f periodon tology. Whil e conducting a practice an d servin g on the staff , h e engage d in intensiv e denta l researc h requirin g lon g hour s o f concentration . I n 1920, h e receive d fro m th e Universit y o f Toront o th e firs t degre e o f Doctor o f Philosophy earned by a Canadian dentist. O f the bulletins published by the Canadian Dental Research Foundation, h e was the author of twelve. His research spanne d many areas, but he was principally acknowl edged a s an international leader i n periodontology. Durin g his career, he received man y honours. B y the tim e of his death i n 1956 , Toront o ha d

Harold Keith Box, DOS, PHD, father of dental research in Canada

War years (i ) (1915-1919 ) 16

3

become well known as a centre of research i n periodontics, and he left his work in the hands of a number of capable disciples. Public denta l health received som e postwa r assistanc e a s on e happ y result o f a grea t tragedy . O n the mornin g o f 6 December 1917 , a shi p loaded wit h explosive s wa s ramme d i n th e harbou r o f Halifax . Th e detonation dwarfed an y previous disaster i n Canada. Som e 2,000 peopl e were killed and 8,00 0 wounded. A large part o f the cit y was devastated . All denta l office s wer e mor e o r les s wrecked . Non e di d mor e devote d relief work in hospitals, homes, or shelters than the dentists of the city. For a month , ever y dental offic e wa s practically close d an d th e entir e tim e given t o publi c needs . Immediat e relie f fund s an d supplie s wer e mad e available from government and voluntary agencies. The Andrew Carnegie Commission offere d t o mak e good al l damage t o Dalhousi e University . The neighbourin g state o f Massachusett s wa s ver y generou s i n makin g contributions. With moneys left over after relief needs had been taken care of, th e Massachusetts-Halifa x Healt h Commissio n wa s formed , fo r th e purpose o f conducting a publi c health campaig n o f educatio n an d prevention. Among its activities was the establishmen t o f pre-school denta l clinics, designe d t o rende r educationa l rathe r tha n reparativ e services . Arabelle Mackenzie, the first woman graduate in dentistry from Dalhousi e University (1919) , was placed i n charg e o f the denta l servic e wit h th e title o f pedodontist . Appointe d i n 1920 , she wa s wel l qualified , having taken postgraduate training in the Forsythe Clinic at Boston. Th e projec t as a whole is notable in that the services concentrated upo n the early ages, from prenata l to si x years, with emphasis on nutrition. This was the first instance in Canada of what in later years came to be known as well-baby clinics.10 The 191 8 annua l meetin g of the Canadia n Denta l Associatio n wa s held i n Chicag o i n co-operatio n wit h th e Nationa l Denta l Associatio n (which became th e American Dental Associatio n i n 1922) . Thi s i s th e only occasion whe n the Association has held its meeting outside Canada . The emphasi s of the meeting was placed largel y upon experience s of th e profession during the war. The year s immediatel y preceding 192 0 were dominated by war an d postwar pressures and advances . The statur e o f the dental professio n increased greatly . With more demand for denta l services , ne w assessment s were required. The populatio n o f Canada i n 191 9 was 8.75 million, and there were 2,590 dentists. The distribution of practitioners was not good .

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In Ontari o (wit h approximatel y one-thir d o f th e tota l populatio n bu t almost hal f th e dentists ) ther e wa s on e dentis t fo r ever y 2,29 2 people . Quebec had onl y one dentist to 6,44 5 people, whil e in British Columbia the ratio was one to 3,438. Beyond this evident imbalance, there was the challenge of new techniques that had developed rapidly wit h the urgency of war . Development s i n th e surgical-prosthesi s fiel d wer e notable. Th e diagnostic potentia l o f th e x-ra y becam e full y recognized , bu t th e eco nomics o f th e averag e denta l offic e hardl y permitted its us e a s yet . Im proved means of anaesthesia became available. The need for reorientatio n of dental education was recognized, and this was to become the predomi nating issue during the following years.

12 Altered concept s o f trainin g 1920-1924

Ideas discusse d an d debate d durin g the previou s decad e reache d a cul mination in the early 1920s . Emphasis in education was placed upo n th e fundamentals underlyin g th e professio n o f dentistr y rathe r tha n th e practical aspect s o f practice . Mor e complicate d technique s demande d better understanding of fundamental principles ; a public awakened to the serious natur e o f denta l diseas e place d greate r responsibilit y upo n th e dentist; and the positio n of the dentist as a professional man in society a s a whol e calle d fo r a n appropriat e academi c background . Thes e wer e matters o f primar y concer n t o th e denta l schools , an d fortunatel y th e leaders in dental education acted with dispatch and in harmony. They were strongly influenced b y a survey of dental education i n th e United States and Canada conducted by the Carnegie Foundation. 1 While the report wa s not published until 1926, th e survey was in progress over a five-year perio d an d man y of th e recommendation s were wel l know n in advance an d implemente d befor e the y wer e formall y announced . Th e report wa s prepared b y William J. Gies , a former professo r o f biological chemistry at Columbia University who had a n interest in dental research , and i t had a continuing influence o n the directio n o f dental educatio n i n North America over a long period. From the beginning, dental educatio n in Canada an d th e Unite d State s ha s followe d parallel lines . Th e denta l schools of both countrie s had co-operated throug h various representativ e organizations: th e Denta l Facultie s Associatio n o f Canada, organize d i n 1920, thre e years later became amalgamate d wit h the National Associa tion of Dental Faculties and the American Institute of Dental Teachers i n the new American Association o f Dental Schools. (Reversin g this trend,

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the Association of Canadian Faculties o f Dentistry was formed in 1967 , a mov e reflectin g th e establishmen t o f severa l ne w school s acros s th e country an d th e enlargemen t o f the olde r ones . However , th e Canadia n schools retaine d associat e membership with the American Association of Dental Schools. ) Th e clos e co-operatio n o f th e professio n i n th e tw o countries fro m th e beginnin g in th e developmen t o f dentistr y ha s bee n most beneficial to Canada, particularl y in the area o f dental education . During the eighteent h an d nineteent h centuries , whe n this continen t was settled , i t wa s natura l tha t th e immigrant s brough t wit h the m th e customs o f thei r nativ e lands . I n general , thes e usage s wer e modifie d gradually, bu t i n the cas e o f dentistry a definit e breakthroug h occurred . In Europe, wit h variations from countr y to country , dentistr y develope d under the aegis of the medical profession, an d academic requirements fo r the practic e o f dentistr y were se t withi n the jurisdictio n of th e medica l schools. I n mos t of these lands a separation o f the tw o professions even tually occurred , bu t thi s was an extremel y slow process an d toda y ther e are still a small number o f countries in Europe wher e graduation fro m a medical school is a requirement for the practice o f dentistry. In North America , despite some long-lived misconceptions abou t th e beginnings of dental education, there was no quarrel between the medica l and denta l professions . Thoug h tale s o f disagreement recu r disturbingly often, seldom will the statement be found that lectures on odontology were given as early as the 1820 s by dentists who were members of the staf f a t the Medical and Chirurgical Faculty o f Maryland. Horace B. Hayden was one o f these and mus t be regarde d a s the pionee r o f institutiona l dental teaching. A t Marylan d an d simila r medica l schools , educatio n i n th e necessary biologica l science s wa s satisfactor y bu t difficult y wa s ex perienced i n providing for adequat e technical training . Highl y respecte d men, bot h medical an d dental, endeavoured t o secur e adequat e facilitie s for instructin g the denta l studen t i n both th e scienc e o f dentistr y an d it s art of practice. The result was the founding of the first independent dental school i n the worl d i n 1840 , the Baltimor e Colleg e o f Denta l Surgery. 2 From thi s beginning , emerged th e independent denta l schoo l whic h ha s prevailed o n the North America n continen t an d man y other part s of the world. Only on two occasions have serious differences arise n between Canada and th e Unite d State s i n denta l education . Shortly afte r th e tur n o f th e century, a n agreement was reached t o increase the norma l denta l cours e from thre e t o fou r years . Th e existin g Canadia n school s (Toront o an d

Altered concepts of training ( 1920-1924 ) 16

7

Montreal) too k thi s action. The American school s evidentl y ha d secon d thoughts and delayed for several years. The second matter had to do with the conferring of the doctorate degree . Under Canadian law, only universities wer e permitte d t o confe r academi c degrees ; i n th e Unite d State s all chartered denta l schools conferred the degree with or without university affiliation . Th e firs t o f these differences mean t tha t fo r som e tim e a Canadian coul d save a year of study by taking the shorte r cours e i n th e United States . Th e secon d differenc e prompte d a scepticis m an d eve n hostility toward s graduates o f th e America n proprietary schools , which had n o counterpar t i n Canada. An y effec t thes e difference s ha d o n th e development of dental education in the two countries was temporary. But , in those Canadian provinces wherein a dental school existed, drastic actio n was taken by licensing boards t o prohibit practice by graduates of American schools, and this regrettable attitude, with its repercussions, proved to be a lasting one . Th e wester n provinces, having no denta l schools , wel comed American graduates. In 1918 , over eighty per cen t o f the dentist s in Britis h Columbi a ha d graduate d fro m denta l school s i n th e Unite d States. By the 1920s , th e futur e o f dental educatio n ha d becom e th e prim e subject o f professional importance. All through the previou s decade , th e serious leaders o f the professio n had pointe d ou t th e nee d fo r improve ment. Among them was Frank Woodbury , dean a t Dalhousie University and recognize d a s th e dea n o f Canadia n dentist s durin g this period. I n 1920 he state d in an address , 'A s th e year s pass an d th e importanc e of dentistry in the preservation of the health of the world is being recognized, and th e large r responsibilit y i s bein g place d upo n th e profession , th e necessity of better preparation becomes more apparent. Better preliminary education must be required if we are to kee p step an d continu e t o meri t the confidence of the public.'3 The alterations taking place in the curricul a of the dental schools made the financing of dental education more difficult , but a n increasin g number of leader s i n th e professio n spok e frankl y i n support. In essence, these men said that if the dentist of the day and in the future wa s to hold his high place i n the community and in public esteem , he must develop that menta l attitud e an d breadt h o f vision whic h com e from a trainin g that i s based o n a soli d foundation . Dea n Webster , a s editor of the Dominion Dental Journal, wrote many editorials on the need for change in dental education. The ground had been well tilled. The profession was ready in support . An amazin g number of major alteration s i n denta l educatio n too k plac e

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in a short period. Most o f them depended upo n educatio n preliminar y to the denta l course , an d o n a prope r relationshi p wit h a university . Th e ingredients necessar y fo r th e professiona l educatio n thes e leader s en visioned were to be found onl y within the disciplines of a university. Canada ha d a t th e tim e four develope d school s an d on e i n embryo . By 1921 , thre e wer e ful l facultie s withi n their respectiv e universitie s Dalhousie, McGill , an d Montreal . A t Toronto , th e discussion s tha t ha d been held o n numerous occasions ove r the year s with the official s o f th e university respectin g establishmen t o f a denta l facult y finall y bor e fruit . To understan d tha t situation , i t mus t b e remembere d tha t th e Toront o school was owned by Ontario dentists and operated b y them through th e direction of the Boar d of Directors of the Roya l College of Dental Sur geons of Ontario a s trustees. Ther e existe d considerable prid e o f owner ship. When a tentative agreement had been negotiated, the Ontario Boar d prepared an d mailed ou t detailed explanatory circulars to the profession. In turn , wha t prove d t o b e a smal l grou p o f reactionar y dentist s als o circularized thei r colleagues. 4 Th e whol e matte r wa s complicate d b y internal schoo l matters , bu t whe n th e Boar d submitte d th e propose d agreement t o th e membership , 85 8 ou t o f 87 0 votin g wer e i n favour . Under the agreement, the building, fittings, and equipment valued at jus t under hal f a millio n dollar s becam e th e propert y o f the university . Thi s action by Ontario dentists portrays the profession at one of its finest hours . The Facult y o f Dentistry of the Universit y of Toronto wa s establishe d i n 1925, th e fourth in Canada. The fifth, in Alberta, initiall y was formed as a division of the Faculty of Medicine in 1918. In 1923 , i t was operated a s a department and eventuall y was recognized a s a separate facult y of th e University of Alberta in 1942. One o f th e importan t alteration s i n th e patter n o f trainin g wa s th e instituting of a pre-professional course. The secondary school level was no longer adequat e fo r admission to the study of dentistry; instead, student s were required to take a set of subjects referred t o a s basic, cultural , an d scientific. Th e Carnegi e report late r recommende d tha t two years be re quired fo r thi s stud y and afte r considerabl e debat e o n variou s arrange ments, the Canadian schools adopted what came to be known as the twofour pla n - tw o years pre-dental an d four year s professional education . The chang e wa s gradual. I n th e fal l o f 1919 , whe n th e Toront o schoo l was faced wit h a n excessiv e numbe r o f applicants, i t offere d a one-yea r voluntary pre-professional cours e to thos e wh o could no t b e accepte d i n the professiona l course . Eightee n me n accepte d th e opportunity . Tw o years later, the two-four plan was made compulsory at Toronto. At Dal -

Altered concepts o f training (1920-1924) 16

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housie, the plan was adopted i n 1922, and at McGill in 1925. The Frenchspeaking school i n Montrea l face d a somewha t differen t situation . Mos t of it s applicant s cam e fro m th e classica l college s o f th e provinc e o f Quebec. N o questio n arose respectin g the cultura l content o f the course s they had taken , bu t ther e existe d considerabl e variatio n i n th e scientifi c content. Eventuall y the problem wa s overcome b y requiring those appli cants wantin g in scienc e to fulfil l th e requirement s i n a pre-professiona l course. No longer could the mere mastery of technical skills be considered th e only necessary qualification of the dentist . This change was of the utmos t importance to the future o f the profession. Great activit y occurred withi n the denta l facultie s a s they arrange d thei r curricul a t o th e ne w formula, with considerabl e variatio n i n detai l fro m schoo l t o school . A decad e later, a curriculu m surve y committe e wa s organize d b y th e America n Association o f Denta l School s consistin g o f representative s o f denta l schools in the United States an d Canada unde r the chairmanship of Dean Seccombe of Toronto. The report of this committee in 193 5 se t minimum requirements fo r conten t i n th e curriculu m bu t i n n o wa y curbe d th e excellence o f teaching in any particular branc h of dentistry in any school . That repor t reall y completed, fo r the time being, the alteratio n o f denta l education begun in the early twenties.5 Among the many matters contained in the Carnegie Report, one other should b e mentioned . From tim e to tim e som e influentia l dentist s hav e questioned the autonomou s position o f their profession in relationship t o medicine. Whil e there wa s neve r an y questio n bu t tha t th e majorit y of dentists stoo d fo r independence , ther e wer e stron g argument s o n bot h sides o f th e question . Th e repor t discusse d thi s matte r a t considerabl e length and summarized its findings in the statement, 'Tha t dentistry is an independent divisio n of health servic e which is attaining the ful l equiva lence o f an ora l specialt y o f medicine, and commend s these view s of th e Foundation t o th e attentio n o f the publi c an d o f the medica l an d denta l professions.' Thi s conclusion , heartil y commende d b y denta l bodies , brought t o a n en d th e recurrin g discussion s o n th e subjec t unti l recen t years, when it arose again in a different form. 6 The effectivenes s o f changes made at this time in the pattern o f denta l education ha s been prove n over the years . While many improvements in detail have since been made, th e genera l outlin e ha s remained th e same . The trend has been steadily to ever more education. A considerable num ber o f student s now ente r th e professiona l course wit h highe r academi c standing than the two year pre-professional course . Mor e remarkable stil l

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has been the grea t increas e in graduate education , whic h can be largel y attributed to the foundation of dental education established i n this period. The transitio n was not , however , a s eas y a s i t ma y appear . Objection s were stron g from thos e dentists who called themselve s practical . I t wa s said that dental schools would produce graduates who would know everything except how to practise. Strong leadership was fortunately at hand in the person s of the dean s of th e denta l schools . Woodbur y o f Dalhousie , Thornton o f McGill , Dubea u o f Montreal , Webste r an d (afte r 1923 ) Seccombe of Toronto had ample reason to know that a profession is born Stoic and dies Epicurean. In spit e o f the progres s whic h had bee n mad e i n th e recognitio n of dentistry as a professional health service, threatenin g incidents still arose . One wa s relate d t o taxation . I n 192 0 th e federa l governmen t issue d an order that dentists , as manufacturers, would have to pay the recently introduced sale s ta x o f two pe r cent . Protest s wer e made b y al l denta l organizations. To make matters worse, a subsequent order require d den tists to obtain trading licences and cancelling machines for use in collecting the tax. While the amount of the tax was small, the principle involved was great: was dentistry a trade or truly a profession serving the public health ? After considerabl e effort , th e Canadia n Denta l Association succeede d i n having th e orde r abrogated . Th e decisio n reache d a t thi s time , afte r a strenuous battle by the profession, created a precedent, laying the foundation for future decisions in many areas, even in matters related to taxation. The matte r o f legal ai d fo r dentist s facin g actua l o r threatene d mal practice action s becam e a subjec t o f concer n a t thi s time . A s earl y a s 1917, th e Ontari o Denta l Societ y had se t u p a committe e t o stud y th e subject unde r th e chairmanshi p of R.J . McLaughli n o f Toronto . A s a result o f the committee' s report, th e Dentists' Lega l Protectiv e Associa tion o f Ontario wa s organized i n 192 3 an d ha s acte d i n th e interest s of Ontario dentists ever since. On several occasions, effort s hav e been made to establis h a simila r organization o n a nationa l basis , bu t thes e endea vours have failed. Simila r organizations have , however , been establishe d in Britis h Columbia an d Alberta . Focal infection - infectio n spreading throughout th e circulation fro m circumscribed collections of bacteria - becam e a dominant theory for the cause of disease in the earl y 1920s . While several possibl e foc i existe d i n the huma n body , th e mout h cam e unde r mos t suspicion . Th e theor y gained suc h suppor t tha t th e discover y o f a devitalize d toot h o r a large restoration, particularl y a gol d crown , i n a patient' s mout h prompte d

Altered concepts o f training ( 1920-1924 )17

1

many a medica l practitione r t o prescrib e immediat e extraction . Th e position o f the dentis t wa s very awkward. For a decade , foca l infectio n appeared t o be the most frequent diagnosis for almost any ailment. Man y quips develope d durin g this period. On e wa s a ne w definition of a spe cialist, a s a man who wants all your teeth pulle d befor e he tries anothe r guess. The effect o n dental practice was both good and bad. Larg e number s of soun d teeth were extracted needlessl y and this was regrettable. O n th e other hand , the dentist was forced to improve his diagnostic ability . Th e x-ray becam e a n essentia l aid . Improve d root-cana l therap y an d ne w techniques fo r larg e restoration s als o resulted . Dentist s wer e quic k t o respond t o th e foca l infectio n challeng e an d it s ne w requirements , but recognition tha t dentists were capable o f making a proper scientifi c diag nosis o f th e mout h cam e abou t rathe r mor e slowly. 7 Th e relationshi p between tooth infection an d general health had in fact been recognized fo r many years. The implementatio n i n practice of the theor y of focal infec tion a s a caus e o f diseas e durin g this perio d ofte n wa s base d mor e o n enthusiasm than reasoning. The pendulum swung altogether to o ofte n t o the exclusio n o f othe r causes . Increase d knowledge , bette r diagnosti c methods, an d improve d technique s brough t abou t a mor e scientifi c approach by the 1930s . Measurement o f the statur e o f a profession ca n be best estimate d b y the thre e recognize d fundamentals ; education , association , an d jour nalism. Dental education in Canada wa s now on a solid foundation. Pro fessional organization s had in many cases gon e through adjustments, but by this time were well established, represented wel l their member s a t th e local, provincial, and national levels, and were creditable scientific bodies. Journalistically, th e professio n wa s serve d b y the English-languag e Dominion Dental Journal an d Oral Health. The first issue of a journal in the French language had appeared in December 191 5 under the editorship of Honoré Thibault. Thi s publication first appeared a s La Société d'Odontologie but the name was changed in the following May to La Revue Dentaire Canadienne. It continue d t o be published monthl y until 1934 , an d eventually merged with the ne w Journal of the Canadian Dental Association. In 1926 , th e Ontario Denta l Associatio n bega n a monthly publication calle d The Booster. Th e nam e wa s altere d t o The Journal of the Ontario Dental Association in 193 1 an d i t ha s bee n publishe d continuously since. An even t o f importance fo r the futur e wa s the appointmen t i n 192 4

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of a director o f dental services by the Ontario Government , th e first government i n Canada to do so . Ontario ha d alread y establishe d a Department o f Health i n 192 3 to replace th e Provincial Boar d o f Health - a n action which had extende d provincia l activit y in health matter s an d ha d prompted the Ontario Dental Association to intensify it s long-term effort s to secure the appointment o f a dental director. Th e first to hold th e title was FJ. Conboy, an active, public-spirited ma n who held a great numbe r of positions of trust within and without the professio n during his lifetime. He served as president of both the Ontario and Canadian Dental Associa tions an d wa s secretar y o f th e provincia l bod y fo r fiftee n years . Fo r twenty-nine years, he wa s a lecturer o n the staf f o f the Toront o school . In publi c lif e h e serve d i n man y capacities, includin g th e mayoralt y o f Toronto for two terms. He died in 1949. As director of dental services, h e ardently advance d th e caus e o f denta l healt h withi n hi s province . Hi s appointment wa s th e beginnin g of th e establishmen t o f denta l division s within department s o f health , thoug h i t wa s t o tak e twenty-fiv e year s before al l Canadian governments had take n simila r action . The first report i n the literature o f what cam e to b e called industria l dentistry appeare d i n 1924. 8 Th e Laurentide Healt h Servic e ha d bee n established a t Grand'Mère , Quebec , i n 1922 , an d wa s notabl e fo r em phasis on dental health. Its dental clinic was in charge of a dental hygienist trained a t th e Forsythe Denta l Infirmar y a t Boston , th e first member of this auxiliar y vocation know n to hav e bee n employe d i n Canada . Th e services performed a t th e clini c were described i n the Dominion Dental Journal a s 'an examination of the mouth to see the conditio n of the teet h and a thorough cleansing of the mouth and teeth and where pyorrhea ha s set in , treatmen t fo r pyorrhe a i s given . Th e conditio n o f th e mout h i s charted and where there is work for the dental surgeon indicated, the man is urged to g o at once to some dentist...' Accurate record s wer e kept and for th e first two years a tremendous improvement in dental health among employees wa s recorded . A grea t dea l o f discussio n occurre d i n futur e years as to the services properly rendered by industrial dental clinics. The Harry R . Abbott Memoria l Library was established i n 1925, one of th e first philanthropic action s taken b y a dentist i n the interest s o f his profession. Harr y Abbot t graduate d fro m th e Toront o schoo l i n 1901 , received hi s dental degree from Trinity , an d engage d in practice i n Lon don, Ontario . Fo r 2 5 year s he wa s a member o f the Ontari o Board , a s well as occupying many other noteworth y professional positions . O n his death h i 1921 , i t was found tha t hi s will provided fo r th e establishmen t

Altered concept s o f training (1920-1924) 17

3

and maintenance of a dental library, the trust fund t o be administered by the Board o f the Royal College o f Dental Surgeons of Ontario. B y agree ment, this library is housed at the Faculty of Dentistry of the University of Toronto an d remain s a continuin g memoria l t o a ma n wh o serve d hi s profession well. Marked professiona l progress ha d bee n mad e i n the stabilizatio n of dental educatio n under university control, but som e less salutar y profes sional matter s stil l require d regulation . Amon g thes e wa s advertising . From th e beginning , flagran t an d objectionabl e advertisin g ha d bee n a thorn in the flesh of ethical practitioners . I n al l provinces, blatant news paper advertisements, large signs, showcases at entrances to dental offices , distribution of advertising cards, an d other mean s had bee n utilized by a small minority to the detriment of the profession as a whole. Amendments to th e provincia l denta l act s wer e sough t an d obtained , bu t n o soone r was on e loophol e plugge d than offence s appeare d i n anothe r form . Th e matter becam e political i n some provinces. I n Nov a Scoti a i n 1919 , on e of these advertisers obtained an amendment permitting him (an d others) to employ unregistered assistants in his dental parlour. The Quebec Board spent a considerable sum in legal fees to bring the objectionable activitie s of th e Institu t Dentair e Franco-America n a t Montrea l unde r control . During the twenties the showcases at the entrances to dental offices alon g Yonge Street in Toronto came down through action by the Ontario Board . The battle was long and arduous. Through good legal advice it was eventually won, but spasmodic cases continued to arise for several years. Th e creation ove r a long period of controlling regulations fo r ethica l conduc t of practice contributed , second onl y to dental education , to the advance ment of the profession. By 1925 , Canad a ha d approximatel y 3,60 0 dentist s t o serv e 9. 5 million people . Ontari o ha d 5 1 pe r cen t o f the dentist s t o serv e 4 0 pe r cent of the population, while British Columbia had 5.5 per cent to serv e 5 per cen t o f th e population . Th e numbe r o f dentist s ha d increase d con siderably as a result of the larg e classes accepte d i n the school s following the first world war. The overall ratio of dentists to population wa s higher than it would be for many years to come. Durin g the depressio n th e student leve l i n th e school s wa s t o reac h a lo w eb b whil e th e populatio n continued to increase ; and n o new training facilities fo r dentist s wer e t o be established in Canada until another war had passed . Thomas Cowlin g wa s a write r fa r abov e averag e i n ability . Afte r graduating in dentistry, he gained his master's degre e in Arts and later his

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doctorate i n paedagogy, which was certainly unusual for a dentist o f the time. He was a member of the staf f o f the Toronto school for thirty-seve n years, servin g as assistant dea n fo r eigh t years previou s t o hi s deat h h i 1950. For fourteen years, he was editor of Oral Health. In 1924 , Cowlin g published a detailed review of the existin g status of dentistry . His report was optimistic: 'We recall tha t only a few years ago, we were clamoring for recognition ; toda y more attention is being given to dentistr y tha n t o any other branc h of the healing art. Quit e truthfully, it may be sai d tha t the pas t few years have been year s of great achievemen t an d note d als o for th e hopefulness of outlook.'9 This statemen t represents th e spiri t and attitude of the time.

13

Public health 1925-1929

The Canadian Dental Hygiene Council was incorporated by federal charter in 1924. Its sixteen stated objectives were all-embracing, but in reality the first indicated the purpose: 'T o undertake such measures a s may be necessary to prevent, reduce or assist in the control of dental disease, thus establishing a highe r standar d o f publi c health. ' Th e origina l sponsor s envisioned an organization broad in scope with public participation, thu s widening the base of an activity which up to this time had been sponsore d by the profession with very little outside assistance, governmen t or other wise. The interest and participation of outstanding lay citizens contributed greatly to the success of the council. For ove r twenty years, it functioned successfully an d mus t be give n credi t for establishin g public healt h den tistry on a firm basis in Canada.1 In a countr y a s larg e as Canada , ther e i s much room fo r variatio n from provinc e t o province . Th e firs t recorde d effort s t o rende r denta l services t o the publi c a t large, othe r than throug h private practice , ha d occurred befor e the turn of the century in Nova Scotia (th e Halifax Visiting Dispensary ) an d Ontari o (Christ' s Missio n Denta l Hospital) . A s related earlier, the charitable work of J.G. Adams in Toronto ende d in a tax dispute, but the Halifax Visiting Dispensary operated unti l the 1920s , when i t was replaced b y schoo l denta l clinics . Thes e endeavour s ha d a lasting influenc e fa r beyon d th e actua l treatmen t the y rendered . The y aroused th e interes t bot h o f th e publi c an d o f th e profession . Dentist s began to realize that treatment alone was not the complete answer to the problems o f denta l health : a n intensiv e progra m directe d toward s th e education o f the public was also essential . A s a consequence, th e denta l

176 A

HISTORY O F DENTISTRY I N CANAD A

organizations i n these tw o provinces establishe d committee s durin g th e early 1900 s t o educate the public. Thi s actio n was followed graduall y in other provinces . Throug h th e years , th e titl e give n thes e committee s is indicative of progressive thinking. Initially known as 'education' committees, they became 'oral hygiene' committees during the second decade and then 'denta l publi c health ' committee s durin g the latte r twenties . The y were activ e in utilizin g al l possibl e media towards th e educatio n o f th e public, and at the same time in arousing the profession to the need. To a considerable degre e the increasin g stature o f dentistr y is attributabl e t o their enthusiastic efforts. A notabl e even t occurred i n Quebec durin g the mid-twentie s when, under th e leadershi p of Joseph Nolin , a commissio n on denta l hygien e was set up with financial support fro m th e provincia l government. Noli n was a well-respecte d dentist , vice-dea n o f dentistr y a t l'Universit é d e Montréal, a past president of the Canadian Dental Association, and above all a most capable man. The commission made a thorough study of activities by the profession in public education, and visited the main centres i n the United States and Canada to gain information. Its report, when read today, has a modern ring, setting forth the mistakes of the past and pointing out directions for future activities. 2 Nolin pointed out that the informative literature the n bein g distribute d wa s intelligible t o dentist s bu t no t adapted t o the publi c for whom it was intended; that muc h of the information distribute d was contradictory; tha t i n al l the visit s mad e b y th e commission little proof was found for the statements being made; that the base o f operation ha d t o b e broadened b y gainin g the interes t o f publi c health officials , th e medica l profession, an d leadin g public-minde d citi zens; an d tha t th e responsibilit y fo r th e movemen t towar d preventiv e dentistry wa s the denta l profession's . H e pointe d ou t in a frank manne r that th e averag e dentis t too k littl e persona l interes t i n publi c educatio n and was willing to relegate the responsibility to a few individuals while he remained a critical spectator . A turning point in the movement for public health dentistr y had been reached. Assessment s were also taking place i n the other provinces , par ticularly i n Ontario . Th e trut h o f th e statement s mad e b y Noli n wer e attested b y futur e program s o f public education . I t wa s durin g this re assessment perio d tha t th e Canadian Denta l Hygien e Council came into being. It wa s i n on e sens e a n offshoo t o f the Canadia n Ora l Prophylacti c Association whic h sinc e 190 6 ha d raise d money , throug h th e sal e o f recommended dentifrice s and tooth brushes , t o finance public educatio n

Public health (1925-1929 ) 17

7

and dental research. I n 1920 , Harr y S. Thomson o f New Brunswick ha d been appointe d directo r o f that association . Thomso n wa s a graduat e of Tufts Denta l Colleg e i n 1906 , an d a former president of the New Bruns wick Dental Society . H e was a most capabl e organize r and inspirational speaker. Bu t i n the associatio n h e quickl y foun d himsel f facin g th e ol d dilemma o f an organization engaged i n commercial activities an d profes sional pursuits at the same time. In solution of the problem, and to enlarge dental publi c health activity, Thomson conceive d th e ide a o f a separat e Canadian Denta l Hygien e Council, an d secure d th e interes t o f the pro fession an d a number of prominent laymen . He wa s appointed fiel d sec retary o f the newly-formed council . Fo r twe'nty-fou r years , he directed a campaign o f education in dental public health which bore abundant frui t both for the public and the profession. When the main objectives had been accomplished, he retired. For severa l years , th e Canadia n Ora l Prophylacti c Associatio n len t their directo r t o th e council , payin g his salary . Initia l financia l suppor t was difficult, but came from many sources including governments, the Red Cross, denta l organizations , an d th e Canadia n Lif e Insuranc e Officer s Association. Improve d educationa l informatio n was produce d an d dis tributed throug h all possible media. The most importan t activit y was the

Harry Scott Thomson, DMD , Field Secretary, Canadian Dental Hygiene Counci l

178 A

HISTORY O F DENTISTRY I N CANAD A

Mouth Health Campaigns in the provinces. Th e first of these too k plac e in Saskatchewan in 1928 . The province was divided into sections, wit h a committee in eac h sectio n mad e u p o f lay representative s togethe r wit h one or two local dentists . Th e field secretary visite d eac h sectio n befor e the campaign to help with plans. Through it s Departments of Health an d Education, th e Saskatchewa n Government participated , an d s o di d th e Canadian Re d Cros s an d othe r la y organizations . A travellin g denta l clinic was used to reach outlyin g areas. I n th e cours e o f each campaign , the mouths of the area' s school childre n were examined by dentists, an d lay organizations of all kinds were addressed. It wa s said that th e entir e province thus took a course in preventive dentistry. This overall approac h was new, received co-operative support , an d prove d t o be the mos t suc cessful effor t i n dental publi c health u p t o that time . I n followin g years , similar campaigns , wit h som e variations , wer e conducte d i n th e othe r provinces. In the beginning there were no means to build a continuing program once a campaign was over. Recognizing this weakness, the council se t as one of its earliest objectives the establishment of a division of dental health in each government health department, with a properly qualified director in charge, as already existed in Ontario. When the council surrendered its charter i n 1948 , i t coul d announc e wit h understandable prid e tha t thi s main objective had bee n achieved . Her e wa s a n organizatio n formed t o meet a definite public need, which accomplished it s objective and then of its ow n accord cease d t o exist. Government s had assume d th e responsi bility, and professiona l organizations had strengthene d thei r activitie s i n dental public health to a point where the cause could b e carried forward without it. Within th e profession , th e counci l als o gav e fine leadership. Practi cally all dental organizations forme d active committees o n denta l publi c health. Indeed , outsid e o f th e scientifi c programs , denta l publi c healt h became th e dominan t activit y of man y professiona l organizations. Tw o provinces forme d specia l organization s t o carr y o n th e work . I n Mani toba, th e Canadia n Foundatio n fo r Preventive Dentistr y wa s formed in 1929 wit h th e ful l suppor t o f th e Manitob a Denta l Association , an d carried o n a n activ e progra m fo r severa l years . Fo r som e reason , thi s foundation was organized under a federal charter, bu t confined it s activities to Manitoba. I n Quebec, after severa l arrangements, the Ligue d'Hy giène Dentair e d e l a Provinc e d e Québec , Inc , wa s incorporate d an d continues to carry out an extensive program. When John G. Adams wrote his letter to the Ontario Board of Health

Public health (1925-1929) 17

9

in 1896 , he was initiating a policy o f dental care for childre n whic h ha s been adhered to , with variations, ever since. Before that he had operate d his dental hospital for twenty-three years, done considerable travellin g to other municipalities , an d investigate d denta l healt h condition s i n othe r countries. Th e nee d fo r actio n wa s compelling. Th e record , fortunately extant, suggest s tha t whil e Adams was staunchly supporte d b y th e To ronto Dental Society, it was the ardent demand for action by the Toronto Trades an d Labou r Counci l tha t influence d th e Provincia l Boar d o f Health t o carry out a detailed study and recommend the periodic inspec tion of school children's teeth. O f course, actio n on the recommendatio n was slow, but by the en d of the 1920s , most larger urba n municipalitie s across Canad a ha d som e for m o f denta l inspectio n fo r children , wit h arrangements for dental care for those whose parents could not pay. This whol e movement was par t o f a slowl y growin g recognition of government responsibility for public health. Today's great interes t i n the field, includin g th e jurisdictiona l argument s betwee n Ottaw a an d th e provinces, i s a comparativel y recen t development . Th e Britis h Nort h America Act o f 1867 , often referre d t o a s Canada's constitution , mad e extremely little reference to health, except to state that the federal government would maintai n marine hospitals an d tha t provincia l government s were responsible fo r the establishment, maintenance, and management of hospitals, asylums , charities , an d eleemosynar y institutions , othe r tha n marine. The first department of health in Canada was established by New Brunswick i n 1918 , a n exampl e followe d gradually by th e federa l government an d othe r provinces. 3 Previously , provincia l board s o f healt h had existed , mor e o r les s indirectl y relate d t o th e legislatures . Thes e boards were rather circumscribe d in thei r dutie s an d limite d respectin g any financial assistance. It is perhaps fair t o state that up to the establish ment o f department s o f health , advance s mad e i n healt h car e wer e attained by the professions with only meagre assistance from government. Indeed representative s o f th e denta l professio n ha d difficult y eve n i n approaching government . I n on e province , th e Departmen t o f Agricul ture, strang e t o say, proved t o b e th e mos t helpfu l governmen t agency for severa l years. Becaus e schoo l childre n wer e th e chie f targe t o f th e programs o f preventive dentistry, th e Departmen t o f Educatio n wa s th e one most often approached , and generally proved co-operative. Wit h the establishment o f department s o f health , th e lin e o f approac h becam e clearer. But even so, government activities were not enough : th e profes sion has remained active in the field, creating and distributing information about the importance of prevention and dental public health.

180 A

HISTORY O F DENTISTRY IN CANAD A

Since th e earl y 1900s , th e watchwor d o f Canadia n dentistr y ha s been prevention . I t i s true tha t man y preventive theorie s fo r denta l dis eases hav e arisen an d waned. The profession has always endeavoured t o secure adequat e proo f befor e advocacy. Wit h the advancemen t o f denta l research, the position in this respect has become more secure than was the case in earlier days . In 1927 , seve n student s graduate d i n dentistr y afte r takin g th e firs t complete course offered a t the University of Alberta. The course had been started in 191 8 as part o f the Facult y o f Medicine. Th e initia l instructo r was H.E. Bulyea , who had been born in New Brunswick, graduated fro m Harvard Denta l Schoo l i n 1897 , an d afte r practisin g a few years i n his home province , move d t o wester n Canada wher e h e becam e greatl y respected, bot h a s a man an d a dentist. As thi s was written h e was still living - despit e the fact tha t as early as 1903 he was already presiden t of the New Brunswick Dental Society , and even before that had been chose n to presen t clinic s t o meeting s o f tha t society. 4 H e pilote d th e Albert a school fro m birt h unti l its establishmen t a s a facult y i n 1942 , whe n h e retired. Man y honour s hav e bee n bestowe d upo n him , includin g th e degree o f Doctor o f Laws b y th e Universit y o f Manitoba. A mor e tha n

H.E. Bulyea , DDS, LLD, Director o f th e Dental Department, Universit y of Alberta, 1918^*2

Public health (1925-1929 ) 18

1

ordinary point i s the grea t respec t i n which his former students hold this grand old man o f Canadian dentistry . The establishmen t an d sustainin g o f a nationa l organizatio n i n a federated countr y like Canada i s difficult, eve n without the geographica l separation an d divers e interest s o f a peopl e spannin g fou r thousan d miles fro m coas t t o coast. I n it s development , th e Canadia n Denta l As sociation by this time had tried several arrangements to ensure satisfactory representation an d financing , non e of which had prove d ver y successful. The progres s o f the Associatio n depende d largel y upo n th e faithfu l fe w who gave generously of both time and money. Under such conditions, th e many importan t accomplishment s o f th e Associatio n appea r amazing . Few questioned the need for a strong national organization, but the means to provid e th e necessar y financia l suppor t wer e a subjec t o f endles s debate. I n 1926 , John Cla y o f Calgary , a highl y respected dentist , wa s elected presiden t and undertook a reorganization of the Association o n a more equitabl e basis. I t woul d be difficul t t o fin d a mor e activ e perio d in the history of the presidency than his two years. Several of the provin cial bodies in this period felt self-sufficient , an d Cla y had difficult y secur ing the participatio n of a representative body i n ever y province. H e di d achieve this , however. Financial support o n a pe r capit a basi s als o was attained, thoug h at thi s stage it wa s minimal, and indee d insufficient . A new constitutio n was drafted, and adopted i n 192 8 - anothe r ste p forward. However , th e Associatio n waite d anothe r decad e befor e a ne w effort buil t upon Clay's work established a truly sound basis of operation . The da y of commercial ai r trave l had no t arrived , an d th e tim e and ex pense involved in transportation was still a great handicap . Way s had t o be b e foun d t o tak e th e Associatio n t o th e membership , rathe r tha n expecting the member s to com e to it . By th e 1920s , th e olde r settle d part s o f Canada were well served by health personnel . Bu t there wer e other enormous , sparsel y settle d area s with little or no medical or dental services at all. Co-operative endeavour s by th e professio n with the department s of health an d la y organizations , chiefly th e Canadian Red Cross , sought to overcome this want. Railroad coaches t o serv e small municipalities along the righ t of way, and moto r coaches for other areas, were equipped as travelling dental offices . I n th e most remot e areas , dentist s and equipmen t were carrie d b y an y mean s available. Arrangements varie d fro m provinc e t o provinc e t o mee t existin g conditions. The first rural treatment program apparently was organized in

182 A

HISTORY OF DENTISTRY IN CANAD A

Nova Scotia . Re d Cross caravan s - consistin g o f equipped ambulance s staffed b y a dentist, a nasopharyngeal specialist, a public health physician, and a public health nurs e - toure d remot e areas of the province durin g the summer month s for several years, beginning i n 1919 . Tw o years later Saskatchewan, throug h the Junio r Re d Cross , organize d denta l coache s for th e sam e end . Othe r province s followed . I n Alberta , Governmen t Travelling Clinic s wer e organize d i n 192 4 an d operate d unti l th e wa r years, when the shortage of personnel forced the m to stop. One who took part in this servic e wrote: 5 The Travellin g Clini c was organized i n the lat e twentie s to giv e medical an d dental treatmen t t o th e childre n o f th e rura l area s o f th e province . A t tha t time practically al l the outlying areas wer e without medica l an d denta l treat ment and the need was great. The staf f o f th e clinic consisted o f on e surgeo n an d on e anaesthetist , tw o dentists, five nurses and a truck driver. Transportation wa s by automobile an d truck, and in some instances when neither automobile nor truck wer e availabl e the staf f wa s forced to us e animal s t o transpor t thei r equipment . Difficultie s of travellin g wer e legen d wit h th e clinic , however , regardles s o f travellin g inhibitions the clini c manage d t o b e considerably promp t i n carryin g ou t it s schedule. In some instances the staff wa s forced to play the part of the woodsman and road builder. This held true especially in wet weather when travelling over the infamous dir t road s of the rural provincial areas . To compensat e fo r the bad surface s the members laid willow and smal l poplar tree s o n the roa d to get through. In most instances there was an itinerary o f the area s the clini c was to visit. A district nurse was assigned to each are a an d she would arrang e a schedule of patients for her particular area . This same nurse made the neces sary arrangements for working accommodations, whic h were usually a schoo l or church. Tents were on the average the living quarters fo r the staff . The most frequent patients were farmers' children, however, in the sparsely populated North , th e clinic ofte n came i n contact wit h trapper s an d Indians . The tentativ e schedule for th e grou p wa s to examin e Thursday, operat e Friday an d move Saturday. Th e restorative denta l progra m laste d fou r days , since ther e wa s no laborator y work . The denta l equipmen t consiste d o f tw o portable chairs, portable dental cabinets, instruments and two foot engines. The restorativ e progress consiste d o f amalgams and silicates . Mos t of th e extractions wer e done under a general anaesthesi a an d usually in associatio n with a tonsillectomy.

Public health ( 1925-1929 )18

3

Often, ther e woul d b e a s man y a s fift y genera l anaesthetic s i n a singl e operating day , using ethyl chlorid e an d ether. As you can well imagine , treat ment wa s under th e mos t primitiv e conditions , bu t ther e wa s never th e firs t casualty.

During th e 1920s , considerabl e enthusias m develope d fo r denta l research, bu t i t wa s soon realize d tha t enthusias m alon e woul d accom plish little. The real need was twofold - mor e financial support an d more qualified personnel . I n 1926 , th e Canadian Denta l Researc h Foundatio n reported tha t i t ha d grante d smal l sum s t o th e Toront o an d Halifa x schools; the other schools had intimated they were not yet ready to undertake research. The work at Dalhousie was of a minor nature but, through much effor t an d sacrifice , mor e satisfactor y progress wa s taking place a t Toronto unde r the leadershi p o f Harol d K . Box . Hi s PH D in patholog y demonstrated the need for graduate study and higher degrees in dentistry. In 192 7 the University of Toronto establishe d th e degree s of Bachelor o f Science i n Dentistry , BS C (DENT), an d Maste r o f Scienc e i n Dentistry , MSC(DENT). While these graduate programs did not solv e all difficulties , they di d establis h a soun d academi c foundatio n fo r th e trainin g o f re searchers an d th e carryin g out o f thei r endeavours. 6 One othe r ma n amon g th e earl y researcher s a t Toront o deserve s mention. W.E . Cumme r di d monumenta l wor k i n denta l prosthetics , introducing engineering principles to establis h orde r ou t o f chaos. Cum mer wa s bor n i n Hamilton , Ontario , an d registere d i n dentistr y a t To ronto. He was an excellent student and almost immediately after gradua tion i n 190 2 becam e a member of the staff . H e was appointe d professo r of prosthetics in 1907 , a position he held for twenty-four years. I n 1931 , he wa s appointe d dea n o f th e Schoo l o f Dentistr y at th e Universit y of Detroit. Tw o years later, while at the very height of his dental career , h e resigned the deanship and was admitted to the Basilian novitiate, and was ordained as a priest in 1938. He had a life-long interest i n music. In den tistry, music , o r religion , h e wa s a perfectionist . Professionall y he wa s greatly in demand as a clinician and had an international reputation . Fe w dentists have exceeded his contribution to dental literature . In 1928 , Dentiste s de Langue Français e d e l'Amérique du Nor d was organized, wit h S . Gaudrea u a s president , t o brin g togethe r French speaking dentists in Canada and the United States. It began with great enthusiasm, but owing to development of parallel organizations durin g these

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HISTORY O F DENTISTRY IN CANAD A

years, much of its support was dissipated and it disappeared afte r holdin g seven congresses, the last of them at Quebec City in 1941. 7 The first recorded surve y of Canadian dentists was made by the Royal College o f Denta l Surgeon s o f Ontari o durin g 1929. 8 Presumabl y th e results ma y b e take n t o reflec t mor e o r les s th e situatio n i n th e othe r provinces a s well . Approximatel y one-quarte r o f Ontari o dentist s re turned complete d questionnaire s consisting of ove r fift y questions . Th e answers to a few of these questions indicate the nature of dental practic e at that time. Less than half the dentists reporting employed a lady assistant or nurse. The average gross income reported wa s $5,864.75, the averag e net income being $3,576.51. It is interesting to note that only 25 per cent of patient s paid regular fees , an d 3. 5 per cen t pai d n o fee a t all . Two thirds of the dentist s inserted gold foil fillings. Practically al l encourage d parents to bring their children to the dental office. Jus t under 4 0 per cen t made use of commercial dental laboratories. Approximatel y one-thir d of practice tim e was occupied wit h prostheti c dentistry , and th e averag e fee for ful l vulcanit e dentures was $53.08 . Some 60 pe r cen t o f the dentist s made us e o f a recal l syste m fo r patients . Ver y fe w dentist s use d a n operating stool. No mention of x-ray i s contained i n this detailed survey, and other sources confirm that comparatively few dental offices ha d x-ra y equipment at the time . A persisten t subjec t i n denta l record s ove r man y year s wa s reci procity of licence. Pro-British sentimen t was strong in Canada, and effort s were mad e t o obtai n som e for m o f mutua l recognitio n o f graduate s o f both countries . Thi s movemen t wa s initiate d b y th e Roya l Colleg e o f Dental Surgeon s of Ontario i n th e 1880 s an d continue d t o b e discusse d by correspondence. Othe r province s became interested , an d i n 191 2 the Canadian Denta l Association appointed a committee t o pursue th e mat ter. I n May 1930, Matthe w A. Garvin, a past president o f the Canadia n Dental Association , represente d th e professio n a t a conferenc e i n Lon don, England, calle d b y the Britis h Denta l Associatio n an d attende d b y several representative s fro m th e Dominion s an d Colonies. 9 N o tangibl e result for Canadian dentistry resulted, and indeed the difficultie s involve d respecting reciprocity appear to have been great. The form and content of dental training , a s develope d i n Nort h America , differe d considerabl y from tha t i n Great Britain . I n addition , the Britis h seeme d t o hav e diffi culty understanding licensing powers by provinces in a federated country . In Canada , a for m o f reciprocity ha d bee n achieve d betwee n province s through th e Dominio n Denta l Council , bu t unfortunatel y two province s

Public health (1925-1929 ) 18

5

did no t recogniz e th e certificat e o f th e Counci l an d thi s fac t prove d another stumblin g block. From time to time discussions have continued , but u p t o th e tim e thi s wa s written no for m o f reciprocit y wit h Britis h dental authoritie s ha d bee n achieved . Histor y provide s n o alternatives , but th e questio n arise s a s to th e effec t o n th e developmen t o f Canadia n dentistry had reciprocity been won during these long negotiations. The latte r 1920 s wer e prosperous years . The industria l boom o f the mid-twenties gave rise to a psychosis of speculation and an over-extensio n of credi t whic h led t o inflate d prices . Enthusiast s though t th e econom y had transcended the process of boom and slump. Dentistry had progresse d along wit h th e genera l economy , reachin g a pinnacl e o f servic e t o th e population b y the en d o f the decade . Th e economi c disaste r ahea d wa s not suspected . But dentist s would learn i n the thirtie s that , unlike som e other needs, dental care can be neglected when money is short. The profession wa s about to fac e a most difficul t period .

14

Depression years 1930-1934

The Great Depressio n cam e with unprecedented abruptnes s an d speedil y worsened. Th e unsophisticate d citize n could no t understan d wh y transactions o n distant stock exchange s should brin g calamity to him , an d h e had a deep suspicion that the experts didn't know either. The causes of the economic crisi s are stil l being debated. Th e 1920 s had bee n a decade of great expansion, accompanie d b y increased productio n an d rising prices . Stocks ros e b y 2 5 pe r cen t i n 192 8 an d 3 5 pe r cen t durin g th e earl y months o f 1929 . Grea t number s o f peopl e bough t stock s o n ver y lo w margin, seeing no reason why they should not participate i n the enormou s profits they visualized. Investments became dangerously speculative, wit h shares in industry being priced fa r beyon d their value. Commodities sol d easily a t inflate d prices . Th e crisi s cam e o n 2 4 Octobe r 1929 , 'Blac k Thursday,' when the pendulum swung far in the opposite direction , bring ing financial ruin to a great man y persons, drasti c cut-backs i n industry , accompanying unemployment, and a fall i n commodity prices belo w th e cost of production. The situation worsened during the earl y thirties, wit h ever more people desperately attempting to find a means of livelihood. A full decad e wa s t o pas s befor e Canad a recovere d fro m thi s economi c catastrophe, world-wid e i n it s scop e an d unequalle d i n histor y i n it s impact. Government s undertoo k solutions , radica l an d o n a scal e un dreamed of previously. All kinds of ideas wer e advanced, bot h wis e an d unwise, an d solution s wer e recommended b y man y a newly-forme d or ganization. Th e proposal s varie d fro m complet e socialis m t o stringen t free enterprise . Like everyone else , members of the healt h profession s wer e severel y

Depression years (1930-1934 ) 18

7

affected. Many , deeply i n debt an d servin g patients wh o themselves ha d no money, were ruined financially. The paymen t o f an account i n actual money became a significant event. Barter wa s the system of the day, and patients brough t whatever they could spar e in exchange for services. Ye t few patient s aske d fo r o r accepte d charity . Th e grea t majorit y eithe r found som e metho d o f recompens e fo r service s rendered , o r pai d thei r debt a t a later date , sometime s years afterward . I n denta l practice , th e most regrettable result was neglect - patient s put off treatment rather than build up a debt which could not be paid. As in other countries , Canadia n governments , bot h federa l an d provincial, wer e face d wit h th e proble m o f providin g fo r th e unemployed . Health service s constitute d a sizeabl e par t o f thi s responsibility , an d brought governmen t int o a n are a i t ha d no t previousl y entered . Healt h service scheme s varie d somewha t fro m provinc e t o province , bu t i n general al l experienced difficultie s i n establishing a satisfactory means of administration bot h fo r patient s an d fo r practitioners . I n th e mids t of these difficulties , an d wit h cost s o f administratio n rapidl y rising , th e medical profession in Ontario approache d th e governmen t and offere d t o take over the administration of medical services at a stated per capita rat e of payment. This proposal wa s accepted an d proved more satisfactory to all concerned. Thi s was the initiation of a system which spread t o severa l other province s a s a basi s fo r managin g futur e healt h servic e plans . During the early stage the dental profession co-operated i n this arrange ment, but late r it withdrew, deciding that the two health service s did not mix wel l administratively . Dental service s durin g th e depressio n wer e administered in Ontario by a government advisory committee made up of dentists. Variou s othe r system s operated i n th e othe r provinces . I n th e larger urban centres, dental societie s were instrumental in setting up fre e clinics, i n which large numbers of their member s gave voluntary service . By 1931 , there wer e dentist s o n relief . Practic e i n rura l area s wa s carried o n largely by barter o f commodities for services : man y a dentis t had th e backyar d o f his home piled hig h with wood fo r us e i n his coalburning furnac e an d hi s cella r fille d wit h edibles accepte d a s payment . The worst conditions existe d in industrial areas, wher e the large number of unemploye d ha d nothin g to offer . Th e dept h o f th e depressio n wa s reached i n 1933 . After tha t condition s improved , bu t ver y gradually . These trying conditions were met with a sense of humour, as in the cas e of the farmer patient who assured his dentist that he would be able to pay in cash when he sold his pigs: whe n the dentis t observed how nice it was

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to have pigs ready for market, the farmer replie d tha t the old sow wasn't pregnant yet. The are a mos t afflicte d wa s in the Prairi e provinces , centre d i n Sas katchewan, where the depression coincided wit h the great drought . Dur ing five or six years of little rain, hot dry winds, and no crops, the people lived o n hope . 'Prosperit y i s jus t aroun d th e corner ' wa s th e famou s saying. Dentists, like everyone else, suffere d grea t hardships. On e in Saskatchewan has left a summary of his experiences. H e was the only dentist within a radius of forty miles and, he said, he did no more than an y othe r dentist woul d have done. Prou d mother s wer e compelle d t o brin g thei r crying children fo r hel p and , wit h tears i n thei r eyes , explai n tha t the y had no money; they always asked for a bill, for they did not want charity . This is what he received i n barter: ' a thoroughbred Angu s bull, 20 0 liv e hens an d man y dead ones , 5 0 turkeys , 2 0 duck s an d geese , 10 0 Ib s of butter, fres h por k an d sausage , sauerkraut, a cella r alway s full o f vege tables, a cook stove , a heater stove , a blacksmithing outfit , a lot o f gro ceries, a mower, a wagon, an Essex coupe with rumble seat, a garage, 5 sets of team harness, 3 horse collars, 4 bridles, a saddle, 30 head of cattle, 13 horses, 6 live pigs and one dead one, 8 tons of hay, etc.' As he explains , the dentis t himself ha d to becom e a barte r man , tradin g th e variegate d goods h e received t o meet his necessities. 1 It i s little wonder that i n thi s area th e era i s still referred to as the Dirty Thirties. To a greate r o r lesse r degree , th e whol e countr y wa s affected . Th e Langstroth famil y a t Sain t John, Ne w Brunswick, had bee n lon g estab lished i n dental practic e - S.F . Langstrot h fro m 189 6 t o 190 6 an d his son, L.A. Langstroth , fro m 190 0 t o 1930 . Bot h wer e graduate s o f th e Philadelphia Dental College. One of the third generation, R.S. Langstroth , having graduated from Toronto, joined his father in 1929. There was little dentistry t o b e practised . Hi s fathe r wa s wel l know n fo r hi s hobb y o f collecting suc h thing s a s coins , stamps , an d documents , an d th e denta l office quickl y became a n exchang e place. Peopl e ofte n wer e lined u p o n the sidewal k with value d possession s brough t fo r sale . Practic e o f den tistry occurred chiefl y i n the evenings , because patient s wit h job s woul d not even think of requesting time off for a daytime appointment.2 These example s may have been mor e extrem e tha n th e averag e bu t all dentist s wer e drasticall y affected . Th e degre e o f hardshi p depende d upon location and type of practice. In general, the income of the specialis t was more seriously reduced than that of the general practitioner. Governments were hard pressed i n all directions. Proposal s fo r chang -

Depression year s (1930-1934 ) 18

9

ing th e administratio n o f healt h services , an d fo r adoptin g stat e healt h services or health insurance, were made by many lay organizations. Under the desperate economic conditions, the health professions agreed to greatly reduce fee schedules unde r government-sponsore d schemes . Advertisers , attempting to tak e advantag e of the public , becam e activ e agai n wit h a new wrinkle - mail-orde r dentistry. Some legislative changes occurred, the most important of them from the standpoint of dentistry in Alberta. There, in 1933 , the Publi c Health Act wa s amended, without consultation wit h the dental profession, to enabl e a registered dentis t t o be associated wit h a denta l mechani c b y mean s o f a contrac t approve d b y th e Provincia l Board of Health. The contract had to include a description o f the separate duties t o b e performe d b y eac h o f the associates . Th e arrangemen t len t itself t o abuse s and wa s contrary t o th e accepte d principl e o f control o f the service by qualified practitioners . This actio n alarmed the dental profession i n all provinces and constituted th e beginning of a real problem of finding a proper relationshi p betwee n dentist and dental technician . Organizations representing the profession made various arrangement s with government to provide dental services, in which the majority of dentists co-operated. Bu t thes e agreements wer e not alway s to th e likin g of all the dentists concerned. Rugged individuals reacted vigorously to some measures. A t on e stage, the Alberta Denta l Associatio n agree d wit h th e provincial government to supply dentures at a very low set fee in order to meet public needs, an d sent out a circular letter t o this effect t o it s members. One of them, William J. Green e of Peace River , too k exceptio n t o being tol d wha t fe e h e woul d charge , an d too k a quarte r pag e i n th e Northern Gazette to state his position in no uncertain terms. The association attempted to bring him in line but not very successfully. Greene ha d a n exceptiona l career . Th e mai n sourc e o f information about hi m is an abundanc e of newspaper clippings . He wa s born i n Sa n Francisco in 1872 , apparentl y int o a famil y o f considerabl e means . H e had a n inventiv e turn of mind, and earl y in life turned his efforts toward s inventing a machine which would fly. At th e sam e time he attende d th e University of California, graduating in 190 7 in both dentistr y and medi cine. For a time he practised dentistr y in New York City, but spen t mos t of hi s time inventing and experimentin g with flying machines. H e estab lished himself as one of the three great rivals in the aviation industry, along with the Wright Brothers and Glenn Curtis, and was one of the first eight men to fly. He established several 'firsts.' Without having seen anyone fly, he built a plane an d flew it for five hundred feet, a record at the time. I n

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1908 he became the first pilot to carry two passengers i n a heavier-than air machine, and received an outstanding award for this accomplishment. He established the first factory for the commercial production of airplanes at Rochester , NY , but the n in a lawsui t lost hi s ow n money and tha t of friends wh o had backed him. Discouraged, he decided to ge t away as far as possible. In 191 2 he arrived in the Peace River area and took up practice. After th e declaration of war in 1914, he offered hi s services for training flyers and served briefly at Deseronto and Camp Borden airfields , but at thi s point i n th e fighting the Canadia n Governmen t wa s no t greatl y interested i n air activities or else did not recognize the valu e of the man . In any event, he was discharged on account of age. Immediately, he offere d his services t o Washington and was made receiving an d testing office r a t the famou s Kell y Field. Followin g th e war , Green e returne d t o Peac e River, turned his inventive mind to motor boats, an d became a leader i n conservation efforts . H e continued to practise dentistry until his death in 1952. His widow erected a monument high above the town near the monument of the local folk hero , 'Twelve Foot Davis.' As th e depression continued, there was increased publi c criticis m of the financial and economic institutions of the country. In 1933 , the Canadian Dental Association submitted a resolution which had been approve d by the provincial dental bodies to the prime minister. After stating that the current crisis afforded a special occasion for examining existing economic structures; that th e laws regulating the promotio n an d administratio n of companies were in need of correction; and that the Canadian Dental Association wa s desirous of helping and supportin g the country' s statesmen , the resolution stated: 3 because we do not wish to see a regime, sound in its source and principles, tend to eventuall y vanish awa y i n almos t genera l disapprobation , th e Canadia n Dental Associatio n doe s herewith sugges t to th e Governmen t o f Canad a th e desirability o f creatin g a NATIONA L COMMISSIO N compose d o f economists , jurists and professional men, not connected with politics or any financial group, for th e purpose o f investigating our presen t economi c structure , wit h th e en d in view of recommending to Parliament the necessary changes fo r the remova l of whatever is vitiated.

It will be observed that this resolution makes no mention of health services. Throughout th e depression period, the emphasi s was on economic s an d every organizatio n in th e countr y was under pressur e t o d o something .

Depression year s ( 1930-1934 )19

1

Specifically wha t was to be done was seldom definitel y stated. Othe r or ganizations sent resolution s advisin g government action, bu t th e fac t re mains that a commission such as was recommended i n this resolution wa s set up and will be dealt with later. Needless to say, there was little material progres s during the early depression years , bu t professiona l advancement continued . Attendanc e a t conventions was surprisingly good, and activities in the local societies in creased considerabl y a s dentists attempted t o mee t th e nee d fo r service . Public health dentistry was not curtailed. Whe n the Ontario Government , for economi c reasons , dismisse d it s directo r o f denta l services , W.G. Thompson o f Hamilton, a prominent dentist an d former president o f the Ontario Dental Association, took up the position on a voluntary basis and served fou r years until the government found i t possible to make anothe r appointment. Man y dentist s acros s th e countr y assume d responsibilitie s without recompense , an d ofte n outsid e th e scop e o f their profession , to meet needs of their communities. Considerable stud y was give n to ways and means of providing services at fees patients could pay without reducing the quality of the service. Yet scientific advancement was not impaired, as program s at convention s illustrate. The numbe r of students attendin g dental school s was, however, greatly reduced. Within the profession it was a time of reassessment. Many dentists had time on their hands. In financial desperation, a few resorted t o question able methods of practice. In his 193 0 presidential addres s to the Ontari o Dental Association, A.W. Ellis said: There is an element of commercial ism which creeps int o ou r professio n her e an d there , lik e a thie f i n th e night. I t rob s th e profession o f tha t hig h idea l fo r whic h we exis t an d creates in the public mind a wrong and unpleasant attitude toward us , as members.' The first duty of a dentist, he continued, was to render servic e to the public to the best of his ability, and the great majority of the denta l profession did place service first and fees second. 4 Ample evidence existed in suppor t o f his latter statement . Undoubtedly , dentist s rendere d mor e services, without consideration of payment, during this period than in any other. Wit h time and goo d leadership available, mor e dentist s als o gav e freely o f their abilities in the field of dental public health, which became an asset in future years. In the midst of these strained economic conditions, there occurred th e most successful dental gathering in Canada up to the time. In 1932, a joint convention o f the Britis h Dental Association, Canadia n Denta l Associa tion, an d Ontari o Denta l Associatio n wa s held a t Toronto. Preparation s

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had been made long in advance. Indications were few that the depression reduced attendance , fo r th e registratio n wa s beyond anticipation . Som e 145 notabl e representative s o f th e professio n from Britain , th e Unite d States, an d Canada presented paper s an d clinics - th e greatest effor t by dentistry to date at a convention in this country. During the meeting, the University of Toronto conferre d the honorar y degree of Doctor o f Laws upon three prominent participants: George Northcroft o f London, Eng land, C.N. Johnson of Chicago, and Alber t E . Webste r of Toronto. A n enlarged issu e of the British Dental Journal wa s entirely devoted to re porting the meeting , and th e editoria l comment set fort h wit h accuracy the attainments of Canadian dentistry at that time.5 The scientifi c basis of denta l surger y an d it s practical applicatio n necessaril y occupied an important place in the five days' deliberations an d demonstrations , but i t will be generally agreed tha t methods of prevention, an d thei r predomi nating importance , wer e the outstandin g featur e o f th e meeting . Probabl y i n no part o f the world ... has dental hygiene been given a more prominent plac e by public authorities than in Canada, an d it was not surprising to find that th e officers o f stat e wh o had honoure d th e gatherin g b y participating i n the pro gramme, wer e insisten t upo n th e desirabilit y o f includin g i t i n al l officia l measures for public health.

In the lay press, the terms state medicine (o r stat e dentistry ) an d healt h insurance appeare d interchangeabl y during these years, wit h littl e inter pretation o f what was meant by either term, except that the government would pay . Understandabl y unde r suc h straine d circumstances , som e dentists were ready to support social change in the hope of improved conditions. Papers and editorials on the subject appeared in the dental journals. The following extracts from editorials in two such journals represent the diversity of opinion which existed.6 There are some dentists who feel that changes which i n their opinion, mus t be made in the socia l orde r will lead t o the introductio n o f a for m o f stat e den tistry. They apparentl y se e the da y when all dentists will be in the emplo y of the Government an d all patients will attend clinics . No such thing will happen. There is no need fo r it. It could no t be maintained excep t by direct provincia l taxation and no government would think of introducing suc h a system.

And from another journal:

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3

Believe it or not, like it or not, there is going t o be some form o f health insur ance or healt h servic e unde r stat e contro l i n every country o f the world . Mos t countries eve n now have [som e for m of ] stat e contro l of health. Dentistr y ha s made out such a good case for the value of its services tha t the public, whethe r they pay for it or not, are going to demand it .

The first issue of the Journal of the Canadian Dental Association ap peared fo r Januar y 1935 , with M.H. Garvin o f Winnipe g a s editor-in chief an d Philipp e Hamel of Quebec a s editor of the French section . S.A. Moore of London wa s business manager. Th e establishment o f a nationa l dental journa l had bee n a subjec t of long negotiations . A committe e fo r the purpos e wa s set up durin g the 1920 s bu t fo r severa l year s reporte d only faltering progress. At the time there existed enoug h journals to serv e the professio n - Th e Dominion Dental Journal, Oral Health, La Revue Dentaire Canadienne and the Journal of the Ontario Dental Association although only the last was actually published b y and unde r th e control of the profession. Much discussion took place, aimed at amalgamating all the journals into one national publication. This objectiv e failed, and probabl y it was in the best interests of the profession that it did so for the expressio n of mor e tha n on e viewpoin t wa s a necessity . La Revue Dentaire Canadienne acquiesce d i n the proposal fo r a national journal , provide d spac e was allotted i n the publicatio n fo r article s i n French. Alber t E . Webste r had been editor of the Dominion Dental Journal for thirty-four years an d took a good deal of pride i n the publication, but afte r som e hesitation h e too decided it was best for the profession to possess it s own journal. As a result of these decisions, the Journal of the Canadian Dental Association was inaugurate d wit h the financia l backin g o f th e Association . Webste r was appointed editor emeritus and after a brief period, Alcide Thibaudeau replaced Philipp e Hame l a s edito r o f the Frenc h section . Wit h the ne w publication, th e professio n brough t denta l journalis m under it s control. 7 Three me n made a fine contribution t o the advancemen t o f the profession b y their persistent effort s ove r several years to establish a nationa l journal. M.H. Garvi n accepted the editorship reluctantly , but he served in an exemplary manner for nearly two decades. Philipp e Hamel, while only briefly edito r o f the French section , had bee n instrumenta l i n making th e journal trul y national . Highl y cultured , ethical , an d publi c spirite d fa r above average, he was a force in dentistry for many years, serving the profession i n numerou s capacities . S.A . Moore, throug h strenuou s efforts , stabilized th e finances of the publicatio n a t a time when the financing of

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any project wa s exceedingly difficult. H e was to pilot dentistr y through a critical period in the near future . When Albert E . Webste r die d a fe w months later, hi s obituar y was entitled, 'A Prince in Canadian Dentistry has Fallen.' Born a t the village of Creemore, Ontario , he graduated fro m th e Chicag o College o f Denta l Surgery in 189 3 and the Royal College of Dental Surgeons (Toronto ) i n 1894. He the n attended the Rus h Medical College, Chicago , graduating with his medical degree in 1897. For a short time he practised a t Collingwood, Ontario, before moving to Toronto. He had been a brilliant studen t and his ability as a teacher wa s recognized immediately, and h e was appointed t o th e staf f o f th e Toront o school . I n numerou s capacities , h e served as a teacher o f great merit throughout his whole professional life, being dean of the school from 191 5 to 1923. Students recognized him as a man wh o not only taught dentistry but professiona l life a s well. Webster was also a writer of no mean calibre, an d hi s editorials reflec t hi s perio d well with remarkable portents for the future. H e took a particular interes t in the development of auxiliary dental personnel. Many honours came t o him during his career, including an honorary Doctor of Laws conferred by the University of Toronto. He was the third Canadian dentist so honoured.

Albert Edward Webster, DDS, MD, LLD, Dean of the Royal College of Dental Surgeons, 1915-23, and Editor of the Dominion Dental Journal, 1901-34

Depression years ( 1930-1934) 19

5

In many respects, thi s was a time of the parting of the ways. Many of the old stalwarts of the profession had eithe r gone to their reward or were easing their activities; new men were looking fervently to the future. Th e chief factor in the overall transformation was the change which had take n place i n dental education. Recen t graduate s had received a very differen t training from tha t of the older men, and this was reflected in the conduct of dental practice. O f course, there were those dentists who felt tha t thei r yesterdays were bein g torn u p an d sai d so , sometime s with more forc e than logic. But the great majority of older practitioners accepte d th e new teachings with alacrity, and attendance at scientific meetings increased. The transition was marked by the recognition given to the builders of the profession by their younger confreres. J.M. Magee and F.A. Godsoe , to take two examples , wer e honoured b y a dinne r an d presentation s a t Saint John in 1933. Both men had been active provincially and nationally in the interests of the profession. Magee was the first registered dentist in New Brunswick, and hi s many contributions to denta l literatur e giv e us most of the informatio n available about tha t provinc e during his period . In character he was tolerant, but se t a high standard of conduct fo r him self; mild mannered yet forceful i n declaiming principles; genia l and kind; a public-spirite d man of integrity. F.A. Godso e was registrar-secretary o f the Ne w Brunswic k Dental Societ y fo r mor e tha n fort y years . H e ha d graduated fro m Bosto n Denta l Colleg e i n 188 3 an d practise d a t Sain t John throughout his active professional life. Godso e was a sane, forward looking man who served his profession extremely well through a difficul t period. He celebrated his on e hundredth birthday in 1962 , at which time he was said to be the only surviving member of the organizational meeting in 1902 of the Canadian Dental Association. Walter E. Willmott, son of J.B. Willmott , retired from th e staf f o f th e Toronto school in 1932 after mor e than four decade s of teaching. He ha d held some fifteen positions on the staff a t different times during his teaching career, while at the same time acting as an officia l o f many organizations. On his retirement, a dinner was held in his honour and a scroll presented . One sentence from i t read: 'Followin g in the footsteps of your illustriou s father, who was the founder of dentistry in this province, you have given yourself unstintingly to the task of developing a profession whose members would b e learned an d efficient, ethica l and altruistic, and thus competen t to safeguard the health of the public.' 8 After leavin g the school, he acted as registrar-secretary o f the Royal College of Dental Surgeons of Ontari o for eight years and lived until 1951, dying in his eighty-fifth year .

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Many other builders were honoured i n a similar manner, but the grim reaper had been busy. A.W. Thornton had been forced t o resign his position as dean o f the McGill school owing to ill health in 1927 , an d die d in 1931. During his deanship the school had made remarkable progress . He was very active within the profession and in many public activities , an d a frequent speaker . H e was succeeded as dean by A.L. Wals h of Montreal . Walter D . Cowan , founde r o f the denta l profession in the West , died i n 1934. Cowa n had graduated in 1888 from th e Baltimor e College o f Dental Surgery and took up practice at Regina, then little more than a village in tha t vas t are a know n as the Nort h Wes t Territories . Immediatel y h e organized th e fe w dentists i n th e are a an d sough t legislation , whic h h e obtained afte r a har d struggle . After th e organizatio n o f the provinc e of Saskatchewan in 1905, he continued as the recognized leader o f its denta l profession. H e serve d a s presiden t o f th e Canadia n Denta l Associatio n from 191 0 t o 1912 , an d wa s secretary o f the Dominio n Denta l Counci l from it s formation t o 1932 . Cowa n was a most energeti c ma n servin g in many public offices , includin g the mayoralt y o f Regina i n 191 6 an d tw o terms in the House of Commons. By 1934 , th e depression cloud s were lifting, althoug h exasperatingly slowly. The stresses and strains of the early thirties had brought dentistry new problems . A differen t conceptio n o f th e meanin g of healt h servic e was born . Previously , satisfactory denta l servic e ha d bee n provide d fo r some 20 per cent of the population, but now that was no longer considere d adequate. Eve n in the depression economy , those who could no t pay had been provided with meagre dental services, and no one doubted that suc h provision woul d improve in the future . Th e professio n laid renewe d em phasis upon prevention, advocating treatment services for children a s the only tru e approac h t o improvin g denta l health . Nationwid e economi c hardship inaugurated discussions, political and otherwise , of new systems to serve the public.

15

Co-ordination 1935-1939

During the latter thirties , tw o studies were carried ou t which represente d a beginnin g of a new outlook wit h lasting effect s upo n health service s i n Canada. I n 1937 , th e federa l governmen t appointe d th e Rowell-Siroi s Commission to inquire generally into economic matters, wit h special em phasis upon federal-provincial relations . I n it s terms o f reference, healt h services were specifically mentioned. At approximatel y th e sam e time, a group of philanthropic citizen s underwrote th e costs o f a national survey of th e distributio n o f healt h services , carrie d ou t unde r th e directio n of the Nationa l Committe e fo r Menta l Hygien e (Canada) . Bot h investiga tions drew upon dental organizations at the national and provincial levels . The surve y report wa s published i n 193 9 an d represente d th e firs t national examination of health services and public health to be conducte d in Canada. 1 The main activit y of the professio n had bee n th e furnishin g of statistics, and dentists were rather surprised to find so much considera tion give n t o thei r services . Th e factua l dat a wer e base d upo n th e las t census, taken in 1931. In its conclusions and recommendations, the report stated tha t t o insur e adequat e denta l services , th e numbe r o f dentist s would have to increase from 4,039 to 10,362 . It also noted that the distribution o f health personnel , includin g dentists, wa s determine d mor e b y opportunities t o gai n livelihoo d tha n b y actua l medica l needs . Anothe r significant recommendatio n fo r tha t tim e wa s tha t 'i t woul d b e highl y desirable t o foste r development s i n th e directio n o f co-operatio n plan s for medica l nursing , dental an d hospita l services. ' I n th e contex t o f th e depression, the report wa s concerned abou t those who could no t pa y for health services and recommended state responsibility for the care of those dependent upon the state.

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Shortly afte r th e appointmen t o f the Rowell-Siroi s Commission , th e Canadian Dental Association was asked to present a brief for the profes sion as a whole: the commissioners preferred not to receive separate pro vincial briefs. A committee on state dentistry had been active since 1928 , and th e responsibility fo r preparin g th e presentatio n fel l upo n it , unde r the chairmanship of John S. Lapp of Toronto. The request for a brief an d the date set by the commission for presenting it, May 1938 , bot h fel l be tween meeting s of the Association , s o that th e committe e ha d t o wor k under th e handica p o f considerabl e correspondence . However , concur rence wit h th e conten t wa s secured fro m th e provincia l bodie s i n time . This brief was the firs t o f a succession of presentations o n th e subjec t of health insurance made over the next decade. After settin g forth th e objects of the dental profession, the positio n of dentistry in general health service, and the responsibility of the profession for health , the brief stated , in some detail, the services being rendered fo r those able to pay; for those able to pay in part; for those unable to provide any dental services for themselves; and for wards of federal and provincial governments.2 I t wa s frankly state d tha t the provisio n of dental service s for th e whol e population wa s impossibl e an d tha t 'th e solutio n woul d seem to be to provide adequate preventiv e and restorativ e treatmen t fo r the young people of Canada.' The need for intensified dental public health education and fo r financial support fo r dental researc h wa s emphasized . On the subject o f health insurance, the profession said it was 'neither ad vocating no r opposin g an y syste m o f compulsor y contributor y denta l health insurance, because of lack of definite information regarding amount of services necesary or the cost of the same.' Of th e recommendation s made i n th e brief , severa l were eventuall y implemented, although it took several year s and much effor t b y the profession. Among these were the establishment o f divisions on dental healt h within departments of health, with qualified dentists in charge; support fo r dental research b y government; and government activit y in dental healt h education. It must be kept in mind that this presentation wa s made at the end of the depression an d it was mandatory that some statement b e mad e directly respectin g th e provisio n o f treatment . Th e brie f recommende d that the governmen t assume 'responsibility for the provision o f necessar y dental treatment for all young people of Canada from ag e of two to fifteen years inclusive , whose parent s canno t provid e thes e service s fo r them. ' As later investigation indicated, the profession was by no means aware of the number involved, the amoun t of services required , o r th e cost of im-

Co-ordination (1935-1939) 19

9

plementing thi s recommendation. However , the statement was in keepin g with the thinking of the profession at that time. The repor t o f th e Roya l Commissio n wa s publishe d b y th e federa l government i n May 1940. 3 It included a general summar y of matters re lated t o health i n Canada a t that time, wit h emphasi s o n the jurisdictio n of th e federa l and provincial governments . Certain statement s ha d direc t or indirec t effects o n th e futur e o f th e denta l profession . Th e followin g appeared significant : It ma y be confidently predicte d that the health activities of governments are indeed only beginning. The municipality has always been and still is , the basic unit in public health administration. Certain provinces, and notabl y Quebec , hav e take n step s to establis h public health units distinct from municipal areas, especially in rural districts. We cannot see that it would be practicable to assign publi c health exclusivel y to the Dominion or to the Provinces. It must not, of course, be assumed that the Commission i s in any way recommending the adoption of health insurance by the provinces. The last statement was interpreted as being something less than enthusias tic respecting th e introductio n o f health insurance . However , withi n two years a n intensiv e movemen t develope d fo r th e introductio n o f som e health insurance measures . The two reports discussed above served to awaken dentists to the need for bette r co-ordinatio n withi n the professio n i n orde r t o mee t pressin g problems. The leaders of dentistry came to recognize that they must know themselves an d thei r service s better , i f concerte d opinion , base d upo n reasonable prove n fact, was to be presented t o the authorities . Whil e decisions ha d bee n reache d throug h discussio n on variou s matters a s they arose, policy-making had never been a strong point within the professional organizations. An d whil e the organization s ha d fro m tim e t o tim e been concerned with establishing reasonable and adequate fees for services, they had give n little consideratio n t o a basi s o f paymen t fo r larg e masse s of people. The economics of dental services was becoming a most important feature, requiring specialized assistance from outsid e the membership. By the early forties, with added pressures, th e leaders full y realize d th e nee d for strengthenin g the organizations representing dentistry. Convincing the rank and file proved arduou s and time-consuming.

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Towards the end of the thirties, a quiet movement began which was to have grea t consequences . I t starte d wit h a smal l grou p of dentist s wh o held meeting s not directl y connected wit h any organization. All had ha d experience in various dental associations and societies and sought no personal aggrandizemen t fo r themselve s o r an y specifi c body. The y wer e concerned rathe r wit h the lack of cohesion within the profession. Rivalr y between societies withi n a province made the adoptio n of policy eve n on the provincia l leve l difficult , an d th e existin g relationship betwee n pro vincial bodies made national policies almost impossible. Corrective effort s in th e pas t ha d bee n base d entirel y upo n consideration s o f financ e an d membership. Thes e fe w dentist s decide d tha t th e essentia l ingredien t necessary wa s a proper co-operativ e spiri t withi n dentistry: i f this spiri t could b e created , financial and othe r problem s woul d dissolve. Fro m a practical standpoint , so nebulous a progra m could hardl y b e considere d dynamic. Yet without glamour, without regularly organized meetings (n o minutes o f earl y meeting s wer e kept) , an d withou t advertisement , th e spirit o f thi s smal l grou p o f well-intentione d me n rapidl y sprea d unti l leading dentists from coas t t o coas t were pressing in the sam e direction . From this inconspicuous beginning arose a spiritual reorganization o f the profession i n Canada . An d jus t a s surmise d i n th e beginning , practica l obstacles fel l before it. It would be contrary to the character an d attitud e of the group that any names be mentioned. Seldom has a movement been so timely. War and other major demands lay immediately ahead an d th e profession, as a whole, was now in a position to act. Other long-sought goals were also attained i n this period. B y the en d of th e twenties the advertising dentist, who had bee n a real hindranc e t o professional progress , wa s brough t unde r contro l b y amendment s t o provincial dental acts across Canada. However, som e trouble stil l arose , for th e most part of a minor nature, from advertisin g in Canada b y den tists in bordering area s o f the Unite d States, wher e such contro l did no t exist. One such incident, the 'Cowen case,' became notorious on the west coast. Cowen, a dentist in Spokane, Washington, advertised throughou t a large area i n British Columbia b y radio. T o counte r him , the Colleg e of Dental Surgeon s o f Britis h Columbi a gaine d th e co-operatio n o f th e Canadian Broadcasting Corporation, the n the governing body for broad casting. When this medium was closed to him, Cowen began an advertising campaign i n the local newspapers. Lega l actio n followed . The cas e was to remain in the various courts for five years. At one stage, a decision was handed down that the provincial dental act applied only to those dentist s practising i n British Columbia . Thi s decisio n wa s appealed. Finally , th e

Co-ordination (1935-1939) 20

1

case reached th e Supreme Court o f Canada in 1941 . Judgment sustaine d the amendment to th e Britis h Columbia Denta l Ac t which read i n part, 'No person not registered under this Act shall within the Province directl y or indirectly offe r t o practise or hold himself out as being qualified o r entitled t o practis e th e professio n of dentistr y ...' Th e denta l board s i n all provinces watched anxiously the progres s of this case. It s importanc e lay in the fac t tha t muc h o f th e labou r ove r man y year s i n controllin g th e advertisers could hav e been lost. Th e result ran g the deat h knel l for th e advertising dentist, who had misled the public with his ridiculous claims. At intervals over the years, a few enthusiasts had discussed formation of a n Empire denta l organizatio n an d i n July 193 6 a meeting, with this purpose i n mind, was held in London, England, arrange d by the Britis h Dental Association . Th e meetin g was conveniently timed, precedin g the congress o f the Internationa l Denta l Federatio n a t Vienna . Some thirty Canadian dentists attended unde r the leadership of George L. Cameron , president of the Canadian Dental Association at the time. Representatives from Sout h Africa, Ne w Zealand, Australia, and India were present, an d scientific presentation s wer e made by selecte d delegates . Th e Canadia n delegates onc e again raised informall y th e ol d questio n o f reciprocity of licences, but no progress occurred. The main business part of the meeting was discussion of a basis for the formation of an Empke organization. N o definite conclusio n wa s reached . Thi s wa s th e firs t forma l effort , an d proved t o be the last meetin g of the propose d organization . From it s formatio n in 1902 , the committe e on military service s ha d been one of the most active committees of the Canadian Denta l Associa tion. Despit e change s in its personnel ove r the years , its records show a remarkable continuity of effort throug h success and disappointment. Th e achievements during the first world war were a matter of pride and satisfaction to the profession, which worked actively for a peacetime establish ment on the same basis. This did in fact prevail on paper for a short period. But by 1920, economic retrenchment wa s the orde r o f the day with government, an d militar y dentistr y reverte d t o almos t prewa r conditions . Efforts t o alte r th e situatio n prove d unavailing . Th e situatio n brough t some causti c observation s i n th e denta l periodical s respectin g broke n promises b y government and, in the mid-thirties , a decision t o develop , as the only recourse, a sound and detailed plan for military dental services . P.M. Lott, then secretary of the committee, undertook an exhaustive study of all available plans for operation i n other countries as well a s the Canadian experience . Fro m hi s analysis , a propose d denta l servic e fo r th e defence forces of Canada was developed in four parts: a dental service for

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the Activ e Militia ; a simila r servic e fo r th e Permanen t Activ e Militia , Permanent Active Air Force; a service for general mobilization ; an d th e supply and transport o f equipment for both peace an d war services. Thi s thorough and detailed report was presented and adopted at the Vancouver meeting of the Canadia n Denta l Associatio n i n 1938 . B y that time , th e threat o f impendin g war wa s gainin g strength , an d a reorganizatio n o f Canadian defenc e force s wa s unde r way . I n adoptin g th e report , th e Association recommende d tha t i t shoul d b e brough t 'a t onc e throug h proper officer s .. . to the notice of the Ministe r of National Defence' ; tha t 'defence denta l services should be directly unde r th e Adjutan t General's Department, no t unde r th e Directo r o f Medica l Services' ; an d tha t th e 'Association, as officially representin g Canadian Dentistry , b e allowed t o name the Director o f Dental Services. ' The committe e at thi s tim e con sisted of Ira Hamilton, Ottawa, chairman; J.F. Blair , London; W.G. Trelford, Toronto ; E.T. Bourke , Montreal , an d P.M. Lott, Toronto. All became members of the Corps with the outbreak of war. Stephen A. Moore of London had been elected president o f the Association an d a t that tim e officials serve d for a two-year period. Hi s was a most active term in carrying out the directives of the Association respect ing the creation of a new dental corps. Close contact wa s maintained with the departmental authorities by the chairman of the committee, Ira Hamil ton, and in order to be prepared, Moore himself wrot e to each delegate of the Associatio n requestin g thei r recommendation s fo r th e positio n o f Director o f Dental Services . Hi s actio n prove d mos t appropriate : whil e attending a meeting in Halifax, Moore received a telegram requesting his presence i n Ottawa the followin g day . E n route , h e hear d b y radio th e declaration o f war by King George VI . O n his arriva l a t militar y head quarters i n Ottawa , h e foun d tha t orders-in-counci l ha d alread y bee n prepared to disband the old Corps and create a new one. He was asked, on behalf of the Association, to name its director. Moor e named Frank M . Lott, who had been the overwhelming choice of the delegates. He was also given t o understand that th e pla n submitte d b y the Associatio n wa s acceptable in principle to the government. A few days later Lott's appointment was announced as lieutenant-colonel an d Director o f Dental Services in th e ne w Corps. Thus , accordin g t o th e records , wa s establishe d th e Canadian Denta l Corps, successo r t o the Canadian Arm y Dental Corps . Apparently th e initial steps ha d proceede d i n a satisfactor y manner. The individua l who had drafte d th e pla n of operation fo r the ne w Corp s had bee n appointed director , an d o n his shoulders fel l th e responsibilit y

Co-ordination (1935-1939) 20

3

for implementation. P.M. Lott had had military experience, a s a lieutenant in the First Divisional Signal Company during the first world war. Following demobilization, h e became a brilliant studen t at the Toront o school , graduating in 1923 . After a few years of practice he returned to the Uni versity of Toronto, becoming professor of prosthetic dentistry in 1931. He pursued researc h i n dentistry intensively and als o continued hi s studies , obtaining his MSC (DENT ) i n 193 4 and hi s PH D in 1941 . Th e latte r wa s conferred fo r a thesis on military dentistry. These attribute s augure d well for the future of the Corps. Many difficulties wer e to arise, demanding the ingenuity of the best qualified dentis t for the position. No real purpose would be serve d i n attempting to enumerat e al l the many problem s i n reorganizin g wha t ha d becom e practicall y a non existent par t o f th e militia . The necessit y o f immediat e actio n wa s no t questioned. Th e expensiv e lesso n o f dela y whic h ha d occurre d a t th e beginning of the first world war wa s evident enough. The existenc e o f a completely detaile d plan of operation a t a time of emergency was a rea l asset. A s always , some conflic t o f opinio n existe d betwee n civilia n an d military authorities, but this was to be expected. The greatest singl e early problem lay in the area of administration. The directive on this point from

Brigadier Frank Melville Lott, CBE, ED, Director-General Dental Services, Canadian Dental Corps, 1939-46

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the professio n wa s explicit. Lik e al l leaders, afte r hi s appointmen t Lot t found himsel f i n a positio n o f lonel y responsibility . H e fough t throug h many administrative battles for an autonomous Corps, directly responsibl e to the Adjutant General, an d to his great credit he finally won out. Onc e that objectiv e ha d bee n accomplished , recruitmen t t o th e Corp s wa s greatly facilitated . By the time the war ended i n 1945 , som e 3 8 per cen t of th e total number of Canadian dentists were members. A separat e boo k ha s been devote d t o th e formation and activitie s of the Denta l Corp s durin g the war. 4 Th e launchin g of a ne w Corps i s a formidable tas k at an y time but t o undertake it at the openin g of a total war was a frightening undertaking . Equipment and supplie s were all but non-existent; organization had to be formed, nationwide, practically fro m the beginning. All this was accomplished by a newly-created headquarter s staff workin g long hours, seven days a week, in very inadequate quarters , as accommodation was at a great premium. The result o f their effort s wa s that th e Corp s wa s ready whe n needed t o accep t it s commitments wit h other unit s of the forces . O f many points respectin g th e organizatio n o f the Corps, on e i s significant i n the ligh t of later developments . Fro m th e beginning, th e Dental Corp s wa s tri-service - servin g army , navy , and air forc e fro m a unifie d bas e rathe r tha n separately . When , afte r muc h heated controversy, unification of all Canadian armed forces took place i n the 1960s , dentist s proudl y recalle d tha t the y wer e firs t i n establishin g such a service. Throughout the latter thirties, dental science and technology advanced unabated. Denta l organization s gaine d i n strengt h i n dealin g wit h problems primarily caused by the depression. As a matter of fact, many dentists during these years had mor e time than in periods of greater prosperit y t o devote to increasing their knowledge, and, as noted earlier, attendanc e a t scientific meetings increased. Improved equipment gave a new appearance to th e operatin g room. Denta l unit s ha d replace d th e ol d bracket tabl e attached to the wall. X-ray equipment was considered essentia l to prope r practice. Some dentists were even using a stool instea d o f standing when operating, though this was considered by many as a sign of weakness. The whole range of instruments had undergone refinement, with improvement of th e ol d an d developmen t o f man y other s t o mee t th e need s o f ne w techniques. Elastic impression material s were beginning to become avail able which were to replace the old reliable, plaster of paris. Of all the new materials, perhap s the one most remembered by dentists of the period was the new , lifelik e dentur e base . Ove r previou s years , al l kind s o f bas e

Co-ordination (1935-1939 ) 20

5

material ha d bee n invente d an d advocated , fro m celluloi d t o glass , bu t nothing had taken the place of dependable vulcanite. Now the early stag e of plastic s wa s a t hand . Durin g the thirties , a whol e series o f product s under variou s trad e name s became availabl e fo r us e a s denture bases . Their natura l appearanc e cause d considerabl e publi c demand , bu t performance was not always up to promise. For several years the dentist was subjected to experimentation: each product wa s recommended in glowing terms, but some warped, others blistered, other s disintegrated, and eac h time the dentist returned to vulcanite with firm decision. By the end of the thirties, however, the acrylic resins finally met the necessary requirements, and gradually took over. Dean Wallace Seccomb e died i n January 1936 . Practically fro m th e day o f his graduation in 1900 , he ha d bee n a force for progres s i n dentistry, filling numerou s positions with zest and action . B y 1908 he was a member of the Ontario Board, and in 191 2 he was appointed superinten dent of the Toronto schoo l in recognition of his administrative ability. I n 1923, he was appointed by the Ontario Board to replace Albert E. Webster as dean of the school. This action was not accepted graciousl y at th e time b y a large number of Ontario dentists . Webster was a teacher pa r

Wallace Seccombe, DOS, Dean of th e Faculty of Dentistry, University of Toronto, 1923-36

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excellence and Seccombe was an administrator of outstanding ability . Th e appointment occurre d a t the time when negotiations wer e under way for the transference of the school fro m th e Board's control to the Universit y of Toronto . Seccomb e possesse d th e typ e o f abilit y necessar y fo r thi s change an d wa s largely responsible for th e satisfactor y establishmen t o f the school as a faculty of the university. His main interests wer e in denta l education, dental research , an d denta l publi c health , t o al l o f which h e made great contributions. I n 191 6 he inaugurated the chair o f preventive dentistry, sai d t o b e th e firs t i n an y denta l school , an d serve d a s hea d of thi s departmen t until his death . H e encourage d th e developmen t o f dental research i n many ways within and without his school. Through his efforts, graduat e degrees in dentistry were established a t the University of Toronto in 1927. Becaus e of his widely acknowledged reputation, h e was appointed chairma n of the important curriculum survey of dental school s in the United States an d Canada - th e report o f which wa s published , after severa l year s o f intensiv e work , jus t previous t o hi s death . A t al l times he held a remarkable number of positions within the professio n on national, provincial, and local levels. I n addition, he established a denta l journal, Oral Health, in 1911 , and served as both editor an d publisher a s long as he lived. Outside his profession, he was very active in church an d community affairs . H e was a remarkable leader, a forward-looking edu cator fo r hi s time with an intens e prid e i n his profession . Arnol d D.A . Mason was appointed his successor as dean at Toronto. The latter thirties were remarkable for change in circumstances. Th e declaration o f war in 193 9 abruptl y altered th e environmen t o f the pro fession. Successfu l denta l service s depen d greatl y upo n continuit y o f service. For economic reasons, patient s in great numbers had been forced to be negligent. With improved economic conditions, they endeavoured t o make up for this neglect. At the same time, the ranks of practitioners were depleted owing to enlistments for military service; thus the average dentist found himsel f overwhelme d with demands for hi s services. Thi s situatio n was at first considered temporary, but it was to persist for many years, for fundamental economi c reasons only in part related to the war. The depression and war years should have been a period whe n training facilities for dentists increased . Th e inevitabl e delay cause d man y problem s fo r th e profession in future years.

16 War years (ii ) 1940-1944

For five long years, the war dominated the mind s of all Canadians. A s it progressed, manpowe r shortage s becam e critica l fo r bot h militar y an d civilian purposes . Wit h ove r one-thir d o f Canadia n dentist s i n militar y service, man y area s throughou t th e countr y became denude d o f denta l service. In addition, the health profession s becam e involved i n a number of othe r problems . A t a tim e whe n bot h militar y an d civilia n dentist s were overwhelmed with demands for service, the problems o f the profes sion multiplied . Health insurance had first become a political issue during the federa l election o f 1919 . Afterward s th e issu e ha d arise n befor e eac h election , then had disappeared after the voting like many other campaign proposals. Dentists had as a body become rather blas é abou t th e topic. Bu t the depression year s ha d brough t forwar d a grea t man y recommendations b y lay organizations for the introduction of some health insuranc e measure . Pressure develope d i n severa l provinces , bu t Britis h Columbi a wa s th e only one which actually endeavoured to introduce such legislation. Amids t much political turmoil , a government had been elected ther e hi 193 3 with the promis e t o implemen t a progra m t o includ e medica l an d hospita l services. Th e medica l professio n strongl y opposed th e medica l service s legislation an d i t wa s ultimately dropped ; a hospita l insuranc e ac t was placed o n the statute books but wa s not implemente d becaus e o f lack of funds. (Thi s act in amended form became operative in 1948.) In respons e to the genera l mood, plans for prepaid medica l service s came int o bein g during the forties, for the most part controlled and operated by the medical profession. Dental services were not part of these voluntary plans: patient s

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who were members were entitled to receive services from a medical prac titioner bu t no t fro m a dentist . Particularl y i n th e fiel d o f ora l surgery , disputes arose respecting who was entitled t o perform the services. It was natural fo r th e patien t t o obtai n al l possibl e service s fro m a medica l practitioner in order to benefit to the utmost from his premiums. The representativ e denta l organizations , nationa l an d i n most prov inces, ha d se t u p stud y groups o n healt h insuranc e by 1940 . Th e mos t active group at this time was a committee organized by the Royal College of Denta l Surgeon s of Ontario . A competen t economis t wa s engage d a s consultant and a series o f booklets wer e published dealin g with the sub ject, whic h were distribute d t o th e member s o f th e profession. 1 A t th e time thes e studie s appeare d t o som e dentist s a s premature . Durin g the previous decad e th e politician s ha d bee n concerne d wit h medica l an d hospital services . Comparativel y little mentio n had bee n mad e o f denta l services. Politically , th e matte r o f healt h insuranc e appeare d quiescen t because of the pressures of war. Yet without warning, and with consider able surprise, the Canadian Dental Association received a communication from th e federal government in April 1942 , announcing the government' s intention t o introduc e a healt h insuranc e bill tha t woul d includ e denta l services. An advisory committee of the government wa s prepared to hea r a presentation by the officers o f the Association o n a set date in June. Th e notice caused considerabl e consternatio n because th e professio n was not prepared to deal satisfactorily with it within the allotted time. Fortunately, th e annua l meeting of th e Associatio n ha d bee n calle d for Ma y that year. Much of the prepare d agend a wa s discarded, an d th e time extended in order to deal with the emergency. The studies which had been prepare d b y th e Ontari o committe e became mos t important . Th e outcome was that a set of principles for dental health service s (ther e was steadfast refusa l t o us e th e title , principle s fo r healt h insurance) an d a draft presentatio n wer e prepare d an d adopte d afte r muc h travail. 2 Th e meeting represented th e greatest concentrate d effor t mad e by the profes sion up to that time. While many amendments and alteration s hav e sinc e been made to this initial statement a s a n outcom e o f further knowledge , the basic ideas remain much the same. As requested , th e officer s appeare d befor e th e governmen t advisor y committee in Ottawa the following month and made the presentation. 3 A revealing point of increasing future significanc e became recognizable dur ing this hearing. The government committee was made up o f eleven men, the chairma n bein g the onl y one professionall y relate d t o healt h affairs .

War years (u ) (1940-1944 ) 20

9

The others were chiefly economists. They not only requested statistic s but demanded the m in the specifi c form to whic h they were accustomed . I t seemed as if the health economis t ha d been born overnight , and the position o f th e denta l professio n wa s awkward . Th e presiden t (Arthu r L . Walsh o f Montreal ) an d th e secretar y lef t tha t meetin g with a distinc t feeling that a turning point in health affair s ha d been reached. Up to this time requeste d informatio n respectin g dentistr y ha d bee n furnishe d t o various government authorities and generally accepted a t face value. Now it became evident that any information submitted would be considered of value onl y when accompanied b y proo f i n a for m acceptabl e t o econo mists. I t becam e obvious that, i f the professio n wa s going to b e abl e t o fulfil thi s requirement, ther e was nee d fo r knowledg e which few, if any, dentists possessed . The sequenc e of action durin g the nex t two years wa s rapid. I n th e fall o f 1942 , the Beveridg e Report o n socia l insuranc e in Grea t Britai n was published and had its influence not only in Canada, but i n many other countries. I n Februar y 1943 , the Marc h Repor t o n socia l securit y fo r Canada was tabled in the House of Commons.4 A month later, the federal advisory committee published a voluminous report o n health insurance. 5 These reports , a s wel l a s som e mino r ones , al l include d proposal s fo r dental benefits. In the meantime, the professio n learned tha t a n enabling bill fo r nationa l healt h insuranc e was bein g drafted . Al l thi s mad e fo r feverish activit y by professional bodies and numerous appearances befor e authorities. On e o f th e chie f presentation s was befor e th e larg e specia l committee of the House of Commons on social security, at which time the profession was represented by President A.L. Walsh, Harry S . Thomson , Armand Portier, and the secretary of the Association.8 While th e draf t bil l b y n o mean s containe d everythin g desired , through strenuou s effort s b y th e representative s o f th e professio n th e content wa s in line with th e presentation s that ha d bee n made . Wherea s the dental benefit wa s originally to be open t o all the population , th e bill confined the services to children. In several instances phrases contained in the bill were lifted directl y from th e principles adopte d b y the profession . Influenced b y the dentists ' own emphasis on prevention and control , th e economists initiall y inserte d a claus e requiring children's attendanc e fo r dental care, but this compulsory feature was later deleted. The dangerous area, and the one where most argument centered, was in th e permissiv e regulations under th e propose d legislation . I n ligh t of increased knowledge, some of the proposals appear rathe r ludicrous today.

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Perhaps th e poin t i s bes t illustrate d b y th e estimate d expenditures . N o acceptable statistical information on costs of providing a dental service for children en masse was available. The initial proposal made by the govern ment committee was fifteen cents pe r chil d pe r year . I t wa s said tha t by some undisclosed method the expenditures for dental services for children across Canada durin g th e previou s yea r ha d bee n estimated , an d thi s estimate was divided by th e numbe r of Canadian childre n unde r sixtee n years o f age . Throug h hurrie d activity , th e professio n endeavoure d t o accumulate cos t dat a an d afte r vigorou s effor t succeede d i n gettin g th e cost per child raised to $3.60 a year, but no further. Minimal cost estimates established at the time through surveys carried ou t by the profession wer e nearly fou r time s thi s figure . Th e experienc e illustrate s tha t th e denta l profession wa s ill-prepared fo r activity of this nature and that the govern ment possessed littl e basic knowledge respecting dental services . Dentists bega n t o realiz e tha t ther e wa s somethin g mor e t o denta l service than practising in an individual office. The y als o began t o under stand that covering 20 or 25 per cent of the population adequatel y wa s no longer goo d enough . Lay organization s wer e demanding that denta l ser vice be made available to all the population o n an equitable basis . In th e past, th e profession s ha d determine d when , where , an d ho w service s would be performed; now the public was demanding a say in these matters . All this led to considerable confusion, an d a fear among many members of the profession that untried ways would prove dangerous and costly. In spite of efforts t o fully infor m dentists respecting the objectives an d critical nature of decisions at hand, the leaders of the profession were often surprised by statements emanating from the rank and file, which illustrated lack of understanding. The positio n o f dentistry was critical a t this time . The fact that dentists had recently passed through a severe depression an d that the crisi s of war was at han d tempered th e view s of members o f th e profession. Perhap s th e situatio n wa s best summarize d i n a repor t pre sented at the 194 3 annual meeting of the Canadian Denta l Association: 7 Repeatedly i t ha s bee n indicate d tha t man y dentist s believ e th e institutio n o f health insuranc e fo r dentistr y t o merely mea n th e settin g u p o f system s o f ar rangements for the extracting, filling, etc. of greatly increased number s of teeth . If this interpretation i s allowed to remain, i f the philosophy o f dentistry shoul d be thus determined ; then th e same positio n wil l be ultimately reache d b y th e dental professio n in Canad a a s in som e othe r countries unde r simila r cogen t health legislation. Le t it be stated emphaticall y tha t organized dentistry i s not supporting legislatio n t o merel y set up large scale systems o f treatmen t but is

War years (n ) (1940-1944 ) 21

1

proposing a definite plan of approach toward the controlling of dental disease in Canada. The former is retrograde for dentistry, the latter is advance. The first means dorman t dentistry , th e second militan t dentistry ; militant agains t dental disease. The one means making dentists excavators an d fillers of teeth; the other places dentist s in the scientific and professional healt h category. A corner is to be turned i f healt h insuranc e i s introduce d an d th e directio n taken depend s upon whethe r a program of control or prevention can be carried through or one of treatment or curative is instituted. Thi s i s th e al l importan t matter . Control i s possible wit h a n increasingl y brigh t futur e ahea d whil e a curativ e program i s disastrous an d wil l bo g down th e denta l profession o f Canada . In time of war emergency a dental program for treatment is essential and most appropriate but for an all time peace proposal it would prove disastrous for the profession and the public as well. The dentists of Canada must b e educated t o see the proposal in its proper interpretation.

In hi s presidentia l addres s t o th e Montrea l Denta l Clu b i n 1943 , J.C . Flanagan said : 'B y an d large , w e as dentist s have no t bee n particularl y interested i n that phas e of work that ha d t o do with public responsibilit y of dental health or hygiene. It was a question of laissez-faire and we hoped it would not be a serious problem i n our time. Well, it has arrived o n our doorstep an d ignoring its reality will not help us to evade or solve it. We, as dentists, mus t of necessity have a n interna l an d externa l policy.' 8 H e went on to say that the profession had looked afte r it s internal policy, but the external relationship was weak and neglected. These years were critical ones, not only for dentistry but fo r all health services, and it only remains to relate the end result of the proposed legis lation. Health association officials became aware that the proposed bill was printed wit h al l it s faulty part s an d read y fo r introductio n i n th e Hous e on 2 2 Jun e 1944 . Representative s o f healt h bodie s gathere d i n Ottaw a with concer n tha t day . To thei r surpris e an d relief , th e prime ministe r brought i n anothe r socia l securit y bill , providin g for famil y allowances , the 'baby bonus.' Rumour had it at the time that the prime minister made his choice of social legislation overnight. Whether or not this is true is not known, but in his personal diary for the date, Mackenzie King referred t o the struggl e withi n th e cabine t respecting the sequenc e o f socia l refor m legislation.9 This may refer t o the two bills known to have been ready for introduction at that time. This experience had a lasting effect o n the activities of the dental profession. One direct result was recognition of the needs of the profession the nee d fo r strengthenin g the organization s representin g dentistry ; th e

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need for improved external relations; the need for expert adviser s in area s other tha n dentistr y itself ; an d th e nee d fo r th e developmen t o f soun d data, particularly in the realm of economics. No longer could the problem s of dentistry be dealt with in an adequate manner by the few dentists elected to office: i t was necessary to widen the bases of activity. The rank and file of th e professio n als o recognized thes e needs , wit h the result that denta l organizations gaine d i n strengt h an d statur e rapidly . Association s an d societies whic h had confine d thei r activitie s mainly to scientifi c matter s broadened their scope. For varyin g periods of time, there had existed in most provinces what might b e terme d a n oligarcha l for m o f managemen t fo r professiona l affairs. Thi s situatio n existe d i n Britis h Columbi a longe r tha n i n an y other province . Fo r ove r twenty-fiv e years , fou r men , W.J . Lea , W.J . Bruce, R.L. Pallen , an d B.C. Jones, made the crucial decisions respecting legislative amendments , rules , regulations , an d othe r matter s relate d t o dentistry. Lea was the leader, ver y capable, determined in effort, incline d to see problems i n black an d whit e with no gre y areas between . Fortunately, al l fou r wer e highl y ethica l an d excellen t professionally . Thei r accomplishments wer e most creditable , bu t th e method s employed ofte n left somethin g to b e desired. I t becam e common procedure fo r the m t o report t o meeting s after actio n ha d bee n taken . Fro m th e standpoin t of the historian, such administration lef t little in the form of records. I n fair ness, it should be said that the profession appeared to accept their leadership willingly; but b y 194 0 the siz e and scop e o f th e politica l an d othe r problems facin g dentistr y had greatl y increased . Th e resul t wa s that th e membership as a whole became involved. One explanation why 'oligarchy' persisted so long in British Columbia is that the dentists there were intensively interested i n scientific advance ment to the exclusion of other matters. Study clubs, which became popula r elsewhere as a form of graduate study, developed in profusion o n the west coast. Initially , these study clubs concentrated on perfection in the use of gold foil . A s time progressed, thei r subject s of attentio n becam e diversi fied. In a province without a dental school, the development of these clubs made a particularl y grea t contributio n t o professiona l advancement . Interest in them continues to the present, but fro m 194 0 onwards a better balance between the scientific and organizational aspects of dentistry came to exist. By mid-1942, considerable disparit y was apparent i n the distributio n of Canadia n healt h personnel . Enlistmen t fo r militar y servic e ha d lef t large area s almos t destitut e o f civilian healt h service s - an d still mor e

War years (ii) (1940-1944 ) 21

3

military personnel were needed. Furthermore, it was the younger and more active practitioners wh o had gone into military service. Older practitioner s redoubled thei r efforts i n an attempt to cope with the situation, often with disastrous consequence s t o thei r ow n health. For plannin g purposes, a n estimate o f the lengt h o f the war , which was altere d fro m tim e t o time , became a vital factor. Where possible, the dental course was accelerated in order t o produce graduates at an earlier date . For the primary purpose of determining the number of physicians, dentists, and other necessary health personnel availabl e fo r appointmen t t o th e arme d forces , an d t o allo t them, the Canadian Medical Procurement an d Assignment Board wa s set up by the federal government. The members of this board were representa tives of the health group s concerned. Thei r first major activity was a de tailed survey of all remaining civilian health personnel. Fro m this survey, certain conclusion s were drawn. In the case of dentistry, it was determined that 'for the safety of the public, a 30 per cent reduction [in civilian person nel] i s al l that coul d b e contemplated.' 10 Befor e th e wa r wa s over , th e percentage wa s much higher, 3 8 per cen t o f the country' s graduat e dentists. Procuremen t an d Assignmen t Board s wer e establishe d i n eac h province, and studies were made of every area to determine the availability of personne l fo r militar y purposes togethe r wit h th e essentia l need s o f civilians. A grea t deal was accomplished but th e wor k wa s handicappe d by a lac k o f stringen t compulsion ; politically , conscriptio n ha s alway s been a difficul t matte r i n Canada . I n som e cases , dentist s disregarde d their assignmen t to militar y or civilia n service , but i n genera l ther e wa s acceptance. The matte r o f rank in the Corp s becam e a subjec t of concern t o th e profession. Ran k structur e withi n the Corp s depende d upon th e ran k of the Director-General o f Dental Services. At the beginning of the war, the Director wa s give n the ran k o f lieutenant-colonel; a fe w weeks later h e was promoted t o ful l colonel . I n Septembe r 1942 , forma l representatio n was made b y th e profession , pointin g out th e numerica l strengt h o f th e Corps i n compariso n wit h othe r division s o f th e militar y forces , an d requesting the rank of brigadier for its Director. In several interviews with authorities, representative s o f the professio n supported th e presentation . Occasions occu r wher e a privat e conversatio n lend s mor e weigh t tha n formal efforts, an d in the end that was the case in this instance: Arthur L . Walsh, the n presiden t o f th e Canadia n Denta l Association , an d J.N . Blacklock o f Montreal finally won the poin t talking to a senio r govern ment official i n a private club . Onc e th e rank of the Director wa s raised, so too could be the ranks of other officers in the Corps .

214 A

HISTORY O F DENTISTRY I N CANADA

The first Canadian dentis t to lose his life i n military service was T.E . Hayhurst of Windsor. He was killed at Dieppe in 1942, while serving as a major with the Essex Scottish Regiment. Before the war was over, fourteen members of the Denta l Corp s die d while in military service . At th e beginnin g of the war , i t was thought that th e Corps ' nee d fo r dental technician s coul d b e supplie d b y recruiting traine d employee s o f the commercia l laboratories . However , thi s sourc e o f personne l prove d inadequate. A t th e reques t o f the government , th e Facult y o f Dentistry , University of Toronto, instituted a course of training for Corps technician s in Ma y 1941 . Member s o f th e teachin g staf f quickl y volunteere d then services fo r the purpose . Th e Toront o schoo l wa s selected becaus e o f its central locatio n an d its laboratories, th e largest an d best equippe d avail able. Classe s o f sixt y me n possessin g universit y entranc e requirement s were given a six-month course in comprehensive general prosthetic labora tory procedures. A considerable numbe r of these men entered the dental course following the war. Under wa r conditions , man y situation s develope d whic h affecte d civilian dental service. General regulation s seldo m allowed for th e need s of individua l practitioners . Gasolin e an d automobil e tir e rationing , fo r example, restricte d th e dentis t wh o was attempting to rende r service s in municipalities, mile s apart , wher e th e residen t dentist s wer e i n militar y service. A critica l perio d occurre d whe n certain import s wer e curtailed , and among them were dental supplies. Muc h time and effort was expended in alleviating such difficulties. Throughou t th e wartime emergency, price s and wage s were under rigi d governmen t control. Professiona l fee s wer e excepted, but o n several occasions, thei r control als o wa s discussed. Th e professions howeve r undertook t o contro l thei r ow n fees o n a voluntary basis, whic h with a patriotic motiv e worked well , an d i t wa s the excep tional dentis t who advanced his fees withou t adequate reason durin g th e period of stabilization. A most humane activity occurred whe n the bombing of Great Britai n was a t it s worst . Canadia n dentists , throug h their societie s an d associa tions, volunteered to care for the children of British dentists fo r the dura tion. A number of youngsters crossed the Atlantic and remained until the end of the war. From th e beginnin g of hostilities , th e arriva l i n Canad a o f refuge e dentists fro m Europ e create d a new problem. Previously , extremel y few dentists fro m Europ e ha d emigrate d t o Canada . No w i n a shor t perio d there wer e several hundred. Owin g to the shortage o f civilian denta l per -

War years (ii ) (1940-1944 ) 21

5

sonnel an d fo r patrioti c reasons , ther e wa s considerabl e pressur e fo r recognition o f these refugees. Yet on what basi s was this t o be done ? I n making their escape , fe w were able to bring credentials o f any kin d with them, an d unde r war conditions i t was impossible to secur e informatio n from th e Europea n institution s fro m whic h they claime d t o hav e grad uated. Moreover , eve n i f all were bona fide graduates , denta l educatio n in many European countries bore little comparative relationship t o recognized standard s o n thi s continent . Languag e difficultie s als o ha d t o b e overcome. All were sympathetic to these applicants, but recognition coul d not be granted on a basis of sympathy. A fair and equitable solution to the problem prove d difficult . Th e denta l school s se t up preliminary examina tions to test the academic knowledge of the refugees, an d upon the result s the applicant s wer e tol d wha t furthe r trainin g the y require d t o mee t Canadian standards . Through this screening process, a few were found t o possess onl y a little technica l training and usuall y admitted thei r lac k of qualification. Th e vas t majorit y realize d thei r nee d fo r furthe r trainin g and wer e admitte d a t som e stag e o f th e regula r cours e o r t o a specia l course fo r foreig n students . Initially , man y of thes e dentist s fel t th e re quirements hars h an d to o difficul t t o mee t unde r thei r desperat e condi tions, bu t i n the en d th e sam e individual s proclaimed th e necessit y an d fairness of their treatment. Man y who entered the Canadian profession by this method becam e most creditable members , and a few have made fine contributions to the advancemen t o f the professio n through teaching an d research. A poin t worth notin g is that a relatively high percentage o f the refugee dentist s were women. Comparatively fe w Canadian wome n have entered th e stud y o f dentistry . Largely owin g t o th e refuge e (an d later immigrant) dentists , th e numbe r o f women dentists increase d fro m on e per cent of the tota l in 1939 to 2.3 per cen t in 1965. Problems withi n th e professio n aros e durin g th e earl y forties , no t directly related t o the war, but undoubtedly brought int o focus by it. One of thes e wa s th e us e o f auxiliarie s i n denta l services , an d thei r prope r relationship to the dentist. During the economic depression of the thirties, minimum us e wa s mad e o f denta l auxiliarie s i n denta l offices . Th e wa r brought a rapi d alteratio n a s th e numbe r o f civilia n dentist s droppe d rapidly an d the demand for their service s rose. Whe n the depressio n wa s at it s worst, probabl y no t mor e tha n one-thir d o f Canadian dentist s employed a n assistan t in the office . No w practically ever y dentist wanted an assistant, a t a tim e when personne l o f any qualificatio n were al l but un available.

216 A

HISTORY OF DENTISTRY IN CANAD A

Pressures grew both withou t an d withi n th e professio n for extended use of auxiliary personnel in dental services. The position at the time was summarized i n a statemen t b y th e secretar y i n hi s 194 4 repor t t o th e Ontario Board: 'An y of the contemplated proposal s fo r change in health services will create new problems in dentistry and alte r ol d ones in abun dance. The matte r of auxiliar y personnel is a mos t difficul t proble m fo r solution. Th e present inquirie s directed toward the rinding of economical adjustments of dental practice in order to render services to greater numbers of the population i s fertile ground for the splitting up of dental practice. Up to the present in Ontario (likewis e in other provinces), a definite line of demarkation has been drawn whereby the dentist renders all necessary services within the oral cavity and th e auxiliar y personnel performs ancillary service s require d outsid e th e orific e o f the mouth . Th e specifi c dividing lin e ha s bee n considere d valuabl e fro m th e lega l standpoint . Once th e barrie r i s broken down , it i s difficul t t o kno w where the nex t division ca n be established.' 11 The perio d wa s one o f advocated change . All kind s o f suggestion s an d recommendation s wer e prevalent , comin g from bot h authoritativ e an d unauthoritativ e source s an d varyin g fro m compulsory comprehensiv e healt h insuranc e t o intensifie d method s of private enterprise . Fro m th e economi c standpoint , emphasi s wa s lai d upon the increased use of auxiliary personnel in the rendering of all health services. What happened respecting the relationship between dentists and technicians in the succeeding years may be stated briefly . The denta l technicia n gaine d importanc e i n par t fro m hi s essentia l role in military dentistry. He reasoned, wit h some degree of justification, that if a university course of training in his skill was necessary during war, it was als o appropriat e i n peacetime . Thi s poin t wa s quickl y countere d when Canadian universities declared they would have nothing to do with trade school functions , but th e need fo r a training course remained. Th e second objective of the technicians, wh o were by this time well organized, was to obtain legislation recognizin g their group, and thi s movement was to g o through a most difficul t scal e o f nuances over the followin g years. Such legislatio n come s unde r provincia l jurisdictio n and , a s wa s t o b e anticipated, variation s occurre d fro m provinc e to provinc e in both pro posals an d en d results . Th e professio n di d no t oppos e legislatio n fo r technicians s o lon g a s th e conten t di d no t infring e upo n th e right s of dentists. I n som e provinces, joint committee s of dentist s and technician s were formed for th e purpose o f arriving at mutually agreeable objective s for legislation . Suc h procedures i n the centra l an d easter n province s re -

War years (n) (1940-1944 ) 21

7

suited in the adoption of bills acceptable to both dentist s and technicians . In the western provinces certai n group s of aggressive technicians di d no t choose t o wor k wit h th e profession , an d th e issu e becam e extremel y political. Fo r ove r a decade , th e denta l professio n oppose d legislatio n proposed b y technician s i n thes e province s a s bein g not i n th e bes t in terests o f th e public . B y th e en d o f th e fifties , however , legislatio n wa s adopted, particularl y i n Albert a an d Britis h Columbia , whic h infringed upon th e recognize d right s of the dentis t i n th e are a o f prostheti c treat ment. T o representative s o f th e professio n wh o participate d i n man y heated controversie s befor e legislativ e bodies , th e issu e appeare d t o b e decided o n questionable claim s rathe r tha n soun d reasoning . During th e year s o f war, a grea t numbe r o f dentist s mad e sacrifice s of time and money in order t o serve their profession at a time when their ranks wer e deplete d b y militar y requirements , whe n thos e i n civilia n practice wer e mor e tha n occupie d i n attemptin g t o mee t demand s fo r service, an d when recompense o f any kind was simply not available . Th e need was great and the sacrifice was personal. Across the country, dentists accepted ke y positions and carried out allotted duties, some of which were distasteful t o those of independent mind. Under wartime emergency regulations, decision s were made by the central authority , and th e mos t vital activities were initiated on the nationa l level . Repeatedly , meeting s were called i n Ottawa with notice in hours, no t days , with no consideration of office appointment s a dentist migh t have, or any thought given to possibl e means o f transportation , i n itsel f a difficul t matter . Thos e wh o serve d without fai l unde r suc h circumstance s aske d n o credit , advance d th e stature o f the professio n tremendously, and create d a n unprecedentedl y higher level of unity among Canadian dentists . At th e ris k o f omission , a fe w o f thes e me n mus t be name d i n an y record o f the period. W.W. Woodbury of Halifax, dean at Dalhousie, gave intelligent leadershi p an d hi s addresse s stil l rea d wel l twenty-fiv e years later. Arthur L. Walsh of Montreal, dean of the McGil l school, a man of high intellect , sa w early th e nee d to strengthe n the organization s repre senting dentistr y an d worke d diligentl y towar d th e objectiv e wit h a marked degree of success. Probably no Canadian dentist gave so much of his tim e for s o man y years an d s o freel y t o th e caus e o f th e professio n amidst a practice of high calibre a s did Harvey W . Reid o f Toronto - a man of ideas, an d idea s do have consequences. R.A. Rooney o f Edmon ton was a focus of strength, no sacrifice being too great when the advance ment o f dentistr y wa s involved . G.V . Fisk o f Toront o chaire d severa l

218

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important committee s which , i n retrospect , elevate d th e statur e o f th e profession immeasurably . Armand Portier o f Montreal gav e strong consistent leadershi p whic h contribute d greatl y t o th e unificatio n o f th e profession. Thes e me n i n particula r bor e heav y load s o f responsibilit y during the war years, at a time when many decisions had to be made without waitin g fo r norma l democrati c procedures . O f cours e ther e wer e a host o f others , withou t whos e effort s progres s woul d hav e bee n impos sible. The period was one of stress which brought forth an increased spiri t of co-operation among Canadian dentists .

Arthur L . Walsh, DOS, Dean of the Facult y of Dentistry, McGill University, 1927-48

17 Peacetime adjustments 1945-1949

The en d o f th e wa r i n 194 5 quickl y altere d th e directio n o f activity . Canada as a nation was much better prepare d fo r peace than it had been for war in 1939. Gradually , wartime controls were released, an d rehabili tation legislatio n enacted whic h had considerabl e influenc e o n dentistry . The most rapid increas e o f population in Canada's histor y occurred an d was to continu e in future years . Man y people wh o had experience d th e years following the first world war anticipated a depressed economy , bu t this di d no t occur . Demobilizatio n o f militar y force s too k plac e wit h comparative ease . Members of the Canadian Dental Corp s wer e anxiou s to return to peacetime practice an d retired fro m militar y service rapidly . Newfoundland becam e a province joining Canada i n 1949. I t was a time of general reorganization during which dentistry grew, and health services received increasing government attention. Within the federal government, among other adjustments, the Department o f Pension s an d Nationa l Healt h wa s divide d i n 194 4 int o th e Department o f Veterans Affairs an d th e Departmen t o f National Healt h and Welfare . Followin g th e firs t worl d war , a Departmen t o f Soldiers ' Civil Re-establishment had been formed whic h for the first time seriously involved th e governmen t i n th e provisio n o f denta l service s fo r a larg e group of retired soldiers . Afte r som e delay, a dentist, R.B. Sullivan, QBE, had bee n appointe d it s directo r o f denta l services . Clinic s wer e rapidly established in the larger centres of population and arrangements made for the rendering of services by private practitioners in centres not sufficientl y large to warrant government clinics. In 1926 , D.D . Wilson , a dentist who

220 A

HISTORY OF DENTISTRY IN CANADA

had practise d a t Trenton , Ontario , succeede d Sullivan . Th e numbe r o f clinics gradually diminished to ten by 1930, but a great number of persons were entitle d t o service s whic h were largel y performe d by privat e prac titioners. To these numbers were added in 1939 all personnel of the Roya l Canadian Mounte d Police . An organizatio n therefore existe d whe n hos tilities cease d i n 1945 . Bu t wit h ever y membe r o f th e militar y force s entitled t o hav e hi s mout h rehabilitate d unde r existin g legislation , th e newly forme d Departmen t o f Veteran s Affair s face d a n astronomica l problem. Th e personnel o f the military forces amounted to approximately one million ; ye t b y 194 9 abou t two-third s o f the m ha d bee n dentall y rehabilitated, a t enormou s cos t t o th e country . Th e numbe r o f denta l clinics increase d rapidly , bu t a larg e proportio n o f th e service s wer e rendered b y private practitioners. Th e service by this time was under th e direction o f L.A. Kilburn , who succeeded Wilso n in 1948 , an d was himself succeede d b y Dougla s M . Tanner , MBE , i n 1963 . Bot h me n ha d served in the Canadian Dental Corp s throughou t th e war. When th e firs t departmen t o f healt h wa s establishe d b y th e federa l government i n 1919 , th e professio n had endeavoure d t o have a divisio n on dental health established. 1 During the following years, severa l presen tations were made requesting such action, but no progress occurred. Wit h the establishmen t o f th e Departmen t o f Nationa l Healt h an d Welfare , efforts wer e renewed an d a dental healt h division was finall y establishe d in 1945. The stated purpose of the division was 'to improve dental healt h in Canad a throug h co-operatio n wit h th e Provincia l Department s o f Health, th e Canadia n Denta l Associatio n an d it s relate d professiona l groups, th e denta l schools , denta l researc h bodies , an d al l other relate d organizations.' Th e firs t chie f o f th e divisio n was L.V. Janes , OBE , wh o had serve d as head of the Corps oversea s for most of the wa r period . He resigned afte r tw o year s an d wa s replace d b y Harr y K . Brown , wh o occupied th e positio n fo r sixtee n years . Brow n wa s exceptionall y wel l qualified. I n earl y lif e h e ha d taugh t schoo l fo r a fe w years , gaine d hi s degree in Arts a t the University of Saskatchewan, and the n entere d den tistry, graduating from th e University of Alberta i n 1930 . H e practised i n Alberta until the beginning of the war, when he enliste d i n the Canadia n Dental Corps , retiring at th e en d o f the wa r wit h th e ran k o f lieutenantcolonel. Then h e entered the cours e i n public health a t the Universit y of Toronto, obtaining the diploma (DDPH ) i n 1946 . Unde r his direction th e division becam e effectivel y organized . O n hi s retiremen t i n 1963 , h e was succeede d b y R.A. Connor .

Peacetime adjustments ( 1945-1949 ) 22

1

No question s aros e a t th e en d o f th e wa r respectin g th e nee d fo r retaining the Dental Corps, as had occurred afte r th e first world war. The Corps ha d ampl y prove n it s value. Brigadie r Lot t retire d a t th e en d of January 1946 , an d wa s succeede d briefl y b y D.S. Coons. In Septembe r E.M. Wansbroug h wa s appointe d Director-Genera l o f Denta l Services , remaining i n th e positio n unti l 1958 . O n thi s retirement , K.M . Bair d became Director o f the Corps, to be succeeded by B.P. Kearney in 1966 . The ran k o f brigadie r fo r th e Directo r ha s bee n retained . Effectiv e 1 5 January 1947, His Majesty The King approved the use of the title 'Royal', and the Corps became the Royal Canadian Dental Corps. Alterations at the federal level were quickly reflected i n the provinces . Whereas befor e the wa r th e denta l professio n had on e administrato r i n the federal government and at times his authority appeared questionable , now i t ha d directorate s i n thre e department s wit h satisfactor y term s of reference. Th e magnitud e of the influenc e attendan t upon these appoint ments was realized at the time by few dentists. The Rehabilitation Act, adopted i n mid-war, contained provisions for retired militar y personnel that were considered generou s at the tim e and probably prove d t o b e mor e magnanimou s than originall y anticipated . From the standpoint of the dental profession two of these provisions were of grea t importance. First, all veterans who desired to obtain educational training were granted substantia l financial assistance. A s a consequence , the limited facilities fo r training dentists i n Canada wer e strained to thei r utmost for severa l years , preference being give n to applicant s wit h military service . Second, all military personnel were entitled to ora l rehabili tation upon retiremen t fro m th e forces . Th e deman d for denta l service s was such that dentists retiring from th e Corp s foun d themselve s wit h an immediate practice made up in the main of other veterans. But difficultie s did arise, particularly in the negotiation of adequate fee schedules. An incident which occurred during the drafting of this legislation illustrates som e of the problems encountered. During a private interview, the main officia l in charge of preparing the Act stated that the provision of dental service s for retire d militar y personne l woul d probabl y cos t on e o r tw o millio n dollars. Effort s t o persuad e hi m tha t h e shoul d multipl y his estimat e by at least twenty-five were ineffective until the service had been in operation a ful l year . Then the profession was requested to justif y th e cost. A wide disparity of view on the detail s of dental services often occurre d between the governmen t an d th e profession . The professio n wa s als o concerne d abou t th e rehabilitatio n o f it s

222 A

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members, many of whom had graduate d an d gon e immediatel y int o th e Corps. Preparation bega n two years before the cessation o f hostilities. I n every province committees were established whic h made survey s of locations for practice and stood ready to give advice. A booklet was publishe d and distribute d t o member s o f th e Corps , containin g information abou t the return to civilian life. Thi s publicatio n containe d provisions made by the government as well as the advisory arrangements of the profession. A remarkably generou s spirit o f co-operation existe d during the year s fol lowing demobilization . I n man y cases , civilia n dentists ha d undertake n to care for patients of a colleague upo n his enlistment, and these patient s were advised to return to their original practitioner once he was re-established. Thos e wh o were establishing peacetime practic e fo r th e first time found othe r me n in the area assisting by referring patients . Loca l denta l societies playe d the most vital role throughout thi s period o f adjustment. Conditions ha d altere d considerabl y i n municipalitie s durin g fiv e year s of war . Besides arranging socia l function s t o welcom e the retur n o f thei r confreres, th e local bodie s tried to assist the m with their many problems , of which the greates t perhaps wa s finding an office . Accommodatio n wa s practically non-existen t in many municipalities. One outstanding example was th e actio n o f th e Toront o Academ y o f Dentistry , which , wit h th e co-operation o f denta l trad e officials , lease d a larg e buildin g an d con verted i t into denta l offices . Thi s buildin g became a 'halfwa y house ' be tween a dentist's retirement fro m the Corps and his securing of permanent office space . Th e problem s an d thei r solution s varie d fro m municipalit y to municipality, and the local societie s assiste d in every possible way. In memor y o f dentists wh o los t thei r live s durin g the war , th e Wa r Memorial Scholarship Trust Fun d wa s established in 1947. The fund wa s created throug h subscriptions by Canadian dentists . The incom e fro m i t is awarded annually through a n essa y competition , open t o undergradu ates of the final year attending Canadian dental schools. One o f the grea t handicap s unde r whic h the professio n was servin g at this time was the lack of training facilities for dentists. During the war, the capacit y o f dental school s ha d bee n straine d i n effor t t o mee t emer gency needs. Following the war, only a fraction o f the qualified applicant s could b e accepted becaus e of lack of facilities. No expansion of the capacity of dental schools ha d occurre d sinc e 1927 , whe n the Alberta schoo l graduated it s first class o f seven. During the late thirties, a proposal had been initiated by Dean Mason, an d a site selected, fo r the building of an enlarged schoo l a t Toronto , bu t thi s effor t wa s negate d b y wartime re -

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3

strictions o n building. During the early forties, a s the ratio of the numbe r of dentists to the population steadil y worsened, the profession had studied the position carefully and made representations t o authorities at all levels. Before th e en d of the war , reconstruction bodie s wer e set up an d estab lished priorities . In spit e of the fact s presente d b y the profession , denta l needs appeared t o be low on the list of national priorities. In looking back at th e effort s durin g the year s immediately following th e war , i t i s interesting to note that neither the authorities nor the profession even dreamed apparently tha t th e populatio n woul d nearl y doubl e i n th e followin g twenty years. It was a time of frustrating effort: studie s were made; plans were drawn; but no construction occurred . I n the end, as shall be related later, th e publi c outcry fo r dentists prove d mor e effectiv e tha n an y pro fessional pleadin g in securing expanded teachin g facilities. Another importan t developmen t whic h began i n the nineteent h cen tury reache d fruitio n i n thi s period . Thi s wa s th e ris e o f th e denta l specialist. Fo r a few years before his death in 1900 , W . George Beer s of Montreal ha d confine d his practic e t o exodontia , an d a s a consequenc e is generally recognized as the first specialist in Canada, although, as stated earlier, R . Hug h Berwic k o f Montrea l ha d limite d hi s practic e t o ora l surgery at or near the same time. 2 Encouraged b y his success, othe r den tists in the larger cities followed Beers' example and a new trend in dental practice was established. At the turn of the century, the following dentist s had confine d thei r practice t o one branch o f dentistry: Thoma s Hender son, Toronto, t o exodontia; Andrew J. McDonagh, Toronto, to periodon tia; J.B. Morison, Montreal, and Arthur Roberts, Toronto, t o orthodontia. Thus th e foundatio n wa s lai d fo r thre e denta l specialtie s whic h hav e developed vigorously over the years. These earl y men made a great point of confinin g thei r practic e wholl y to th e designate d specialty. Fro m thi s small beginning , th e numbe r o f dentist s confinin g thei r practice s ha d gradually increased, influence d greatl y by th e developmen t of specialties in the United States. The Canadians advanced their knowledge by joining American societies devoted to their respective specialties, and by forming clubs o r societie s i n Canada . Graduat e course s als o developed , usuall y conducted b y an outstanding member of the specialty concerned. Almost without exception, these dentists were highly respecte d and specializatio n developed wit h little difficulty . I t wa s considere d logical, an d regulatio n was in general established voluntarily by custom, although in Alberta th e Dental Ac t wa s amended , at th e reques t o f th e profession , to th e effec t that no person could hol d himself out to the public as a specialist without

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acquiring state d academi c standing . I n th e thirties , unde r difficul t eco nomic conditions , i t wa s natura l tha t specialt y practice s wer e affecte d even mor e tha n genera l practices ; an d i n a few cases, dentist s wh o ha d been practisin g a s specialist s returne d t o genera l practice . Som e diffi culties developed respecting referred patient s who had had dental service s performed b y specialists in addition to those for which they were referred. Such instance s le d t o consideratio n tha t th e tim e ha d arrive d whe n th e specialties should be regulated . The forties brought a surge of interest amon g young graduates, ofte n before graduation, in entering one of the specialties. In addition a demand for recognitio n develope d amon g group s othe r tha n th e thre e origina l specialties o f orthodontics, denta l oral surgery , an d periodontics . Afte r holding a serie s o f discussions wit h th e respectiv e specialt y groups , th e Ontario Board in 1944 adopted a by-law for the recognition and certification o f specialties. Doubtles s wit h the experienc e o f the thirtie s i n mind, the group s insiste d on a strict limitatio n o f practice to the specialt y con cerned. Th e thre e existin g specialtie s wer e recognize d an d academi c qualifications established . Th e requiremen t tha t a graduat e cours e o f designated length and content be completed at a recognized dental schoo l or institutio n gav e some initia l difficulty , bu t thi s was overcom e b y th e Faculty o f Dentistr y o f th e Universit y o f Toronto , whic h establishe d qualification course s i n th e respectiv e areas . Thu s Ontari o becam e th e second province to regulate specialization. The others followe d gradually with similar action . By the end of the 1940s , the number of specialists had increase d con siderably. Active provincial societies and local organizations of specialists existed, an d agitatio n developed for representation on the nationa l level . The Canadia n Denta l Associatio n ha d establishe d a committe e o n spe cialization i n 194 5 wit h representatio n o f th e specialt y groups , an d i n 1950 a group of members applied for recognition as an Orthodontic Sec tion, whic h wa s approved . Th e denta l ora l surgeon s an d periodontist s applied subsequentl y an d wer e accepted , thu s givin g al l thre e majo r groups of specialists representation o n the national level. The whol e subjec t o f specializatio n ha s bee n on e o f considerabl e controversy over recent years, and probably will continue to be in future. What i s best i n th e publi c interes t ha s bee n th e concer n o f paramoun t importance. The subject is closely related t o the objective of encouraging graduate education . A numbe r o f additiona l specialis t group s hav e ap -

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plied fo r recognitio n an d som e have been approved , includin g prosthodontics, endodontics, and paedodontics. A n Act to incorporate th e Royal College o f Dentists of Canada wa s enacted by the federa l government in 1964, th e objec t bein g to promot e hig h standard s o f specialization ; to set up qualifications; to encourag e establishment of training programs in Canadian denta l schools; and to provide for recognition and designation of dentist s wh o possess specia l qualification s in area s no t recognize d a s specialties. Thi s legislation was supported by all provincial dental licensing boards. The name s o f those member s who establishe d practice s i n th e specialties i n th e earl y year s stan d ou t prominentl y i n th e histor y o f th e profession, as do many of the specialists of later years. The name of Beers will always stand as one of the founders of dentistry in Canada. Edgar W. Paul succeeded Thoma s Henderso n earl y in the ne w century as the out-

First convocation o f th e Royal College o f Dentists of Canada , Toronto, 1966 . The first president, Frank A. Smith of Vancouver, is speaking.

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standing dental oral surgeon at Toronto and took a most active part i n all phases o f the developmen t o f th e profession , servin g on th e staf f o f th e Toronto school fo r fort y years . Jame s Beatti e Moriso n wa s a leade r of merit and a plaque on the wall of the McGill school testifies to his ability . Andrew J. McDonagh was one of the most energetic men in the interest s of hi s profession , th e firs t dentis t i n Canad a t o limi t hi s practic e t o periodontics, and , it is said, the first in the world to hold a teaching chair in periodontology in a dental school (1915). George W. Grieve succeede d Arthur Roberts, becomin g an orthodontis t wit h an internationa l reputa tion; a t th e tim e o f hi s death , Canadia n orthodontist s establishe d th e Grieve Memorial Lecture i n his honor. These men, and many others who became specialists, retained thei r interest in the profession as a whole and worked with zeal toward the advancement o f Canadian dentistry . W.W. Woodbury of Halifax was the first to establish a specialty prac tice (orthodontics ) i n the Atlanti c provinces , in 1919 . Th e first to limit their practices i n the western provinces also were orthodontists; although several dentist s were well qualifie d i n ora l surgery , they di d no t choos e to limi t thei r practic e unti l later . I n Januar y 190 9 Willia m J . Lea , o f Vancouver, announce d tha t i n th e ligh t o f 'th e heart y encouragemen t accorded hi m by the profession, ' h e ha d decide d t o devot e himsel f 'en tirely to the prevention an d correction o f irregularities of the teeth an d to consultation therein.'3 By 1912, Manley Bowles and Basil Brownlee were established as orthodontists a t Winnipeg . These men formed the nucleu s of specialization outside Ontario an d Quebec . B y 1968 , slightl y over five per cent of Canadian dentists were practising specialties. Following th e experienc e o f 1944 , th e healt h insuranc e questio n re mained i n semi-quiescenc e unti l 1948 , whe n th e prim e ministe r an nounced i n the Hous e o f Commons a n introductor y ste p towards healt h insurance.4 A series of large grants were to be made for specifi c purposes, stated to be preparatory for a complete health insurance program. The first of thes e grant s was fo r a surve y o f al l healt h resource s availabl e i n th e country: committees , i n which th e healt h profession s participated , were established in eac h province , an d a detailed repor t wa s produced i n ap proximately three years. Several other grants were employed by dentistry, including on e fo r publi c healt h trainin g an d anothe r fo r suppor t o f re search. A t th e time , in a semi-privat e manner , the leader s o f the healt h professions wer e informe d tha t th e governmen t planne d t o introduc e health insuranc e step by step, with these original grants to be followed in sequence, approximately five years apart, by additional grants, mainl y for

Peacetime adjustments (1945-1949) 22

7

diagnostic services, hospital services, medical services, and dental services . This schedul e ha s bee n followe d wit h considerable exactitude . Hospita l insurance legislation was enacted in 1957, and afte r som e delay a measure for medica l services was adopted b y the federa l governmen t in 1966 . Two points need t o b e understood i n respect t o healt h legislatio n i n Canada, whic h appl y mor e o r les s t o othe r federate d countries . First , under the British North America Act, health matters are interpreted as a provincial responsibility . Second , healt h i s als o a federa l interest , bu t Ottawa's enactment s are usually in the for m o f enablin g legislation o n a cost-sharing basi s wit h th e provinces . Th e provincia l legislature s eac h decide whether or not t o accep t th e enablin g legislation. Thi s i s a grea t oversimplification, an d much overlapping of health activity has occurred . The cru x of the matte r lies in financing, for th e federa l government ha s unlimited power s o f taxation , wherea s th e provincia l legislature s ar e limited. In the case of the step-by-ste p federal proposals for health insurance, the provinces readily accepted the arrangements for a detailed survey of healt h resources an d fo r expansio n o f healt h facilities . Hospita l insur ance was adopted b y all provinces with little delay, but th e legislation for medical service s wa s a subjec t o f acrimoniou s politica l debate , mainl y centred aroun d th e compulsor y an d cos t feature s o f th e legislation . By 1969, however, nearly all the provinces had accepted th e proposal. Of the progressive steps outlined i n 1948 , only the provisio n of denta l services remained. In th e meantime , the professio n intensifie d effort s towar d preventio n and contro l o f denta l disease . Course s o n dentistr y fo r childre n wer e conducted acros s Canada , unde r th e leadershi p o f a well-recognize d authority, S.A. MacGregor of Toronto. The numbe r of dentists confining their practice t o children increased rapidly . The number and distribution of informativ e booklet s an d leaflet s fo r publi c educatio n wer e greatl y increased. Amon g thes e wa s a bookle t entitle d A Charter for Dental Health, stating in simple terms the policy of the profession toward prevention an d control , whic h wa s widel y distributed, especiall y t o al l healt h authorities. Thes e an d othe r effort s ha d desirabl e results , fo r les s an d less was heard about dental services for all and more was heard about the need to concentrate effort s o n the younger sectors of the population . To th e profession , th e ke y to a successfu l progra m i n denta l healt h lay i n it s educationa l aspects . Detaile d stud y o f insuranc e program s adopted i n othe r countrie s convince d th e professio n tha t onc e overal l dental treatment service s were introduced, preventive measures 'flew ou t

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the window, ' owin g t o th e magnitud e o f th e immediat e deman d fo r remedial treatment . The need was for a preventive program, carried ou t by dentists wit h graduate training in public health. A graduat e course in dental public health was established a t the University of Toronto i n 1945 , and later another was founded at l'Université de Montréal.5 Federal public health training grants became available, position s opened, an d were filled by dentist s wit h publi c healt h training . B y 1950 , eigh t ou t o f te n pro vincial government s ha d establishe d division s on denta l healt h an d ap pointed qualifie d directors . Thes e appointment s augure d wel l fo r th e future: th e profession felt tha t the long struggle for officia l recognitio n o f the importanc e o f dental healt h ha d bee n achieved. Until th e establish ment of dental health divisions within the departments of health, progres s had depende d almos t entirel y upo n th e voluntar y effort s o f denta l organizations. Provincial public health legislation had divided the various province s into areas o r units. Now came an opportunity to tes t the effectivenes s of the policy of prevention and control. The Canadian Red Cross was willing to support financially a pilot test program. A public health area was carefully selecte d that was both urban an d rura l and o f mixe d population , in the Niagara district. S.L. Honey, who possessed a diploma in dental public health, wa s appointed denta l healt h officer . I n essence , unde r th e plan , the dental health officer confine d hi s activities i n the area t o educatio n of parents an d childre n togethe r wit h regular inspectio n o f th e children' s mouths. Treatment wa s to b e performed in the privat e offices o f dentists practising in the area. The objective of the pilot plan was, in the main, to prove what could be accomplished by a properly constructed progra m of public educatio n by a qualifie d individual. The result s were remarkable. Within two years, the dental health of the childre n in the are a improved by fifty per cent . The projec t attracte d th e interes t of health authorities , expanded to other areas , and influence d alteration s i n existing programs. It was a turning point in the emphasis of dental public health. The annual reports o f othe r municipa l denta l service s emphasize d th e numbe r o f extractions an d filling s performe d fo r children , i n increasin g number s each year . Her e wa s a progra m whic h eac h yea r reporte d definit e im provement i n the children' s denta l health . The ke y to succes s had bee n shown t o li e i n directio n b y a properl y traine d denta l officer . T o thei r credit, a numbe r of dentist s returne d t o universit y for graduat e training and took up positions i n the public health field. In 1938, less than one-quarter of one per cent of all Canadian dentists

Peacetime adjustment s ( 1945-1949 ) 22

9

had bee n employe d o n a full-time salarie d basis . B y 1949 , ove r five per cent wer e o n full-tim e salary . Th e increas e wa s moderatel y rapid , an d represented a n openin g u p o f opportunitie s fo r th e graduat e dentist . Private practice was no longer his only possible destination. Public health was only one o f the area s o f expansion. Th e denta l schools wer e adding to thei r number s o f full-time teachers ; th e permanen t Dental Corp s re quired recruits ; th e rehabilitatio n progra m o f denta l service s required full-time dentists ; th e hospital s engage d th e service s o f mor e dentists ; positions i n denta l researc h wer e developin g - al l indication s o f the widening scope of dentistry following the war. In addition to the full-tim e salaried dentists , anothe r tw o pe r cen t hel d half-tim e positions . Th e change represented progres s for the dental profession, but i t also reduced the potentia l numbe r o f th e privat e practitioner s wh o wer e s o muc h i n demand. During th e 1940s , also , ther e develope d a stron g deman d fo r pro vision o f denta l service s t o welfar e recipients . I t stemme d fro m th e depression years, when health services were provided for the unemployed, and from subsequen t welfare legislation that had been enacted t o provide medical an d othe r car e fo r thos e group s of citizens who wer e unable t o provide fo r themselves . Th e extensio n o f denta l service s t o the m wa s gradual, and is still not complete afte r twent y years. It took various forms in th e provinces . Saskatchewa n adopte d a pla n wit h th e administratio n directly through a government department. Th e Alberta Dental Association presented a plan to the Alberta governmen t whereby the associatio n administered th e pla n wit h th e governmen t payin g th e associatio n a n agreed amoun t per capit a fo r those o n the relie f rolls ; the proposa l was adopted i n 194 7 and ha s operated t o the mutua l satisfaction of both th e government and the profession since. In the other provinces arrangements have varie d betwee n these tw o systems . On e benefi t arisin g fro m thes e plans has been the development of statistical data relating to the provision of denta l services for specifi c an d sizeabl e groups of people. On th e evenin g of 1 1 Decembe r 1944 , a larg e delegation of dentists gathered a t th e Unio n Statio n i n Toront o unde r the leadershi p of R.G . Ellis (late r dean of the Toronto school), who was chairman o f the Canadian Dental Association research committee . Their purpose was to keep a long-sought appointment wit h the Nationa l Research Counci l i n Ottaw a the following morning. However, thi s was the nigh t of a record snowfal l in Toronto, whic h disrupted transportation services . The train that was to leave tha t evenin g actually lef t a t 5 a.m . th e nex t day afte r th e waitin g

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delegation ha d stoo d al l night i n the crowde d station . Th e appointmen t was kept in Ottawa at 3 o'clock in the afternoon. The purpose was to seek establishment o f a n Associat e Committe e i n Dentistr y o f th e Nationa l Research Council . Th e doggednes s of the delegatio n i n keepin g the ap pointment despite the difficult condition s did no harm to thei r presenta tion, and the request was granted a short tim e later. This incident had been preceded b y a series of interviews and discussions ove r severa l years . Fo r a lon g time , money had bee n sough t re peatedly fo r denta l researc h fro m al l possible sources , bu t th e amount s received ha d bee n trivial . Oppositio n wa s encountere d fro m thos e wh o undoubtedly though t that an y suppor t grante d t o dentistr y woul d mea n financial los s for thei r ow n efforts. Now , financial support becam e avail able, but only if two conditions coul d be met. First, adequat e new facili ties ha d t o b e built , an d existin g facilitie s ha d t o b e expanded . Th e universities with dental schools met this problem, particularly the Toronto school which was best equipped for graduate education. Th e second need was for trained personnel to do research, an d this one was more difficul t to meet. Capabl e graduate s o f fine academic calibre , wh o were anxious to possess advance training, were available, but no means to support thei r graduate work financially existed. After du e consideration, th e Canadia n Dental Associatio n establishe d a fund , b y mean s o f annua l grants , i n support o f studentships . Th e arrangemen t worke d well , an d wit h it s assistance a considerable number of individuals attended graduat e courses in th e basi c science s a t variou s universities . A numbe r o f the m gaine d high academi c standing , formin g a nucleu s o f full y qualifie d researc h workers who for the most part joined the staff s o f the dental schools . While thes e activities did no t b y an y mean s solv e al l th e problem s related to research, a surge forward in this activity occurred. Owin g to its size, location, and existing facilities, Toronto initially became the national centre for dental research, but all dental schools participate d wit h gradually increasing momentum. Interest accelerated no t only in the professio n but als o among the public, a s a project initiate d by C.H.M. Williams of the Toronto facult y illustrates. Hi s plan was organized t o meet a crisis in the mid-fifties whe n several dentists, who had qualifie d with the assistance of th e studentshi p plan, returne d an d ther e wa s n o immediat e employ ment for them. The situation, together with other problems, was discussed with a few prominent businessmen . With resolution the y agreed t o giv e assistance, provide d Ontari o dentist s woul d sho w comparabl e concern . A campaig n wa s institute d whic h raised , i n a relativel y shor t time , $100,000 fro m businessme n and $132,00 0 fro m th e denta l profession .

Peacetime adjustments ( 1945-1949 ) 23

1

This fund stabilized the research effort a t the University of Toronto during a difficult period . Efforts t o establish dental research o n a satisfactory basis had encompassed a period of fifty years. Many dentists had worked ardently to secure facilities an d financial support. I n th e beginning , men lik e Wallac e Sec combe and Andrew McDonagh mad e valian t attempts an d succeede d t o a limite d extent , bu t ultimat e credi t belong s t o Harol d K . Bo x wh o a t great sacrific e an d wit h very littl e financia l suppor t ove r a lon g period laid th e foundatio n upo n whic h denta l researc h i n Canad a wa s built . Today th e necessit y for researc h i n dentistry i s well recognized, but thi s was no t alway s the case . Th e ris e o f a professio n t o a n establishe d an d honourable statu s is a gradual process based o n the activities of a succes sion of men. By 1950 , th e dentist s o f th e ne w provinc e o f Newfoundlan d ha d become integrate d wit h th e Canadia n denta l profession . Confederatio n had introduced som e new and differen t problem s t o th e Canadian scene. Newfoundland i s a very large island, some 156,00 0 square miles in area, with a population i n 195 1 o f 360,000 person s serve d by onl y seventeen dentists.6 Outside of the few urban centres, th e populatio n wa s scattered in small villages around the long coastline. Man y of these outport s could be reached onl y by boat. Governmen t official s wer e anxious to secur e an immediate increase in the numbe r of dentists. After stud y the profession pointed out that th e primar y need was for publi c education; that car e of children should be the first objective; and that time would be required for improvement o f dental services . During the nex t few years, several pro grams were instituted. Unde r federa l grants , a directo r o f denta l healt h was appointed; with the assistance of the Canadian Red Cross, a boat was equipped to bring dental treatmen t t o the outports; qualified Newfound land students were assisted in finding places i n Canadian denta l schools , with financial help fro m thei r own provincial government; a progra m of services fo r childre n was established , togethe r with several othe r efforts . Within ten years, th e number of dentists mor e than doubled . Som e diffi culty arose when the supply of services ran to o far ahead of public education i n dental health, particularl y i n areas wher e dental service s had no t previously bee n available . Th e Newfoundlan d experienc e gav e ampl e proof o f the nee d for public health activity in the improvemen t of denta l health. Records of the earl y history of dentistry in Newfoundland are practi cally non-existent . Whe n John Plimpto n cam e to Charlottetown , PEI , i n 1850, he claimed i n his advertisement that h e had practise d i n St John's

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for te n years . Th e name s o f a considerabl e numbe r o f othe r dentist s appear i n ol d Newfoundlan d newspaper advertisements ; mos t o f the m appear t o have been transients. Macalliste r of Halifax made more or less regular visit s to S t John's during the late 1850s . Th e first legislation for dentistry was enacted by the Colonial Government in 1893, but the denta l board thu s created appear s t o have been inactive until 190 0 whe n W.S . Goodwin became the first registered dentis t and was issued a licence. Th e basic difficult y fo r a long time was weak legislation. Onl y in recent years has th e professio n i n Newfoundlan d bee n abl e t o secur e strengthenin g amendments. These wer e years whe n the horizo n o f al l matter s relate d t o healt h was greatly widened, not only nationally, but internationall y as well. Th e World Healt h Organizatio n wa s forme d i n 1948 , an d Canad a too k a n active part ; i n te n years , eighty-eigh t countries wer e members an d WHO was the largest of the postwar international bodies. Much earlier, dentistry had bee n the first health grou p (afte r th e Re d Cross) t o organiz e inter nationally. Th e Internationa l Denta l Federatio n wa s established i n 190 0 in Paris by a small group of dentists representing Spain, England, Sweden, the United States, France, Holland, Germany , and Austria. These dentist s

Whitman Smith Goodwin, DOS, first officially registered dentist in Newfoundland

Peacetime adjustments ( 1945-1949) 23

3

had a vision , an d i t i s wort h notin g th e condition s unde r whic h the y determined t o serve . The y agree d tha t the y would represent th e denta l profession without distinction of nationality, and tha t expenses should be divided equall y amon g individual members. Wit h suc h idealism , i t wa s natural that dentists in other countries should come forward. C.E. Pearso n of Toront o attende d th e Federation' s first formal meetin g at Cambridge , England, i n 1901 . A t severa l succeedin g meetings, Eudor e Dubea u o f Montreal appeared . Excep t durin g the two world wars, the Internationa l Dental Federatio n ha s met regularl y since . Following the secon d worl d war reorganizatio n becam e essential , fo r man y o f th e altruisti c dentists from severa l countries who had supporte d th e organizatio n financially in the past were impoverished and no longer able to assist. During the war, A.E. Rowlett , a pas t presiden t o f the Britis h Denta l Association , mad e several trip s t o thi s continen t despit e th e difficult y o f transportatio n t o speak befor e dental societie s i n the interest s o f the federation . He wa s a dentist wh o devote d hi s latte r year s entirel y to th e advancemen t o f his profession, preachin g th e importanc e o f risin g abov e loca l an d eve n national interest s t o elevat e dentistry. I n part, i t was his influenc e which brought abou t th e decision o f the Canadia n profession to take u p activ e membership i n th e reorganize d internationa l body . A mor e definit e influence was the fact tha t dentists were learning in no uncertain manner from experienc e tha t idea s relate d t o thei r professio n were not circum scribed b y politica l boundaries , eithe r provincia l o r national . Th e de cision has advanced Canadia n dentistr y on a worldwide basis, an d com pleted it s organizatio n o n fou r level s — local, provincial , national , an d international. An event of more than passing interest occurred during the late 1940s, notable because such philanthropic actio n has been rare in the histor y of Canadian dentistry . Th e MacKa y family , o f Scottis h origin , were earl y settlers i n Nova Scotia . A descendant , Gurdon Rober t MacKay , left hi s native area of Shelbourne County to study dentistry at Philadelphia. After graduation, he established a successful practic e at Boston, but throughout his life he spent most summer vacations at his native home. On his deat h in 1945 , h e lef t th e bul k of hi s estat e t o hi s wife, wit h instruction s tha t she carry out a plan he had formulated for the establishment of a modest hospital, of which their Shelbourne home was to become the nucleus. Mrs MacKay faithfull y carrie d ou t th e instruction , an d o n he r deat h thre e years late r lef t mone y o f he r ow n t o supplemen t th e suppor t fo r th e project. Th e en d result was that the MacKay home was converted into a

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dental clinic , wher e th e childre n o f Shelbourn e Count y receiv e denta l services. Under the terms of the will, the clinic is administered by a board of trustees. I t would be difficult t o imagine a more appropriate memoria l for a membe r o f th e denta l profession . In the early hours of 17 September 1949 , a disastrous fire broke out in the Great Lake s cruis e ship s s Noronic, while it was docked i n Toronto harbour. I n the holocaust 11 8 persons wer e trapped and lost thei r lives . The identificatio n o f the victim s was difficult, becaus e the intensit y of th e fire was so great that th e bodies were extensively disfigured an d partiall y destroyed. A tea m o f dentists , pathologists , an d radiologists , quickl y recruited, assiste d by the Canadia n Re d Cros s an d othe r organizations , eventually succeeded in identifying al l but three . The denta l member s of the tea m recorde d i n detai l particular s o f natura l an d artificia l teet h which, when compared with charts, x-rays, and other data supplied by the victim's dentist s an d relatives , mad e i t possibl e t o identif y positivel y approximately hal f th e bodies. Som e nineteen had n o dental structures . The victim s had com e to thei r deaths i n Toronto fro m widel y separate d areas o f the mid-continent. Seldom has a disaster occurred , involvin g so many victims, when dental records assumed such great value. Considerable chang e occurred durin g the fortie s i n the leadershi p o f the profession. This was particularly tru e in dental education: ne w deans were appointed i n all five dental schools . H.E. Bulyea , who had pilote d the Alberta school from it s beginning, retired in 1942 and was succeeded by W. Scott Hamilton. After servin g forty year s as dean of the schoo l a t l'Université d e Montréal , Eudor e Dubea u retire d i n 194 4 an d wa s succeeded by Ernest Charron, ïn 1947 , W.W. Woodbury retired at Dalhousie and was replaced b y J.S. Bagnal l (wh o had serve d for many years on the staff of that school and for twenty years as part-time secretary of the Cana dian Dental Association). The same year, A.D.A. Mason retired as dean of the Toronto school afte r servin g eleven year s and was succeeded by R.G. Ellis. A yea r late r A.L . Wals h relinquished th e deanshi p o f th e McGil l school an d was succeeded b y O.P. Mowry. The dean s ha d serve d well : their successors coul d build upon the foundations they had laid. The year s immediatel y following th e wa r wer e one s o f progressiv e advancement. Th e denta l professio n gaine d i n recognitio n a s a healt h service. S o many people wanted to join that existin g dental school s wer e crowded with students and unable to accept man y qualified applicants . A notable improvemen t occurred i n public appreciation of dental health , in large part due to the wartime work of the Dental Corp s an d the progra m

Peacetime adjustments (1945-1949) 23

5

of denta l rehabilitatio n fo r veterans . Th e populatio n o f the countr y wa s increasing rapidly , an d question s relate d t o denta l personne l an d th e distribution o f denta l service s wer e concernin g government s an d th e professions. I t wa s a tim e of comparatively rapid change ; a tim e when views of old problems were altered; a time when new ideas were prevalent in abundance. The health services in Canada received more public attention durin g this period tha n eve r before , an d thi s interes t wa s to prov e continuing. Aesculpius had two daughters, Hygeia and Panacea. The first was worshipped a s a goddes s o f health , an d th e latte r ha s bee n sough t after by all classes of people. Canadians were intensifying th e search.

18

Broadened social concept s 1950-1954

Canada b y 195 0 ha d emerge d fro m th e immediat e postwa r perio d an d had entered a n era when old issues were revived and new proposals mad e on th e politica l front . Th e rapi d ris e o f industrialism, th e definit e trend toward urbanization , th e fas t increas e i n population , an d th e growt h of the welfare state were underlying influences o n the positio n of the healt h professions. Healt h legislation - rumoure d and actually introduced - was considered b y dentists the most seriou s consequence of these trends, an d particularly the y were fearful o f political contro l o f health services . Th e adage over the years had been that public health was primarily a government responsibility, bu t treatmen t service s wer e a professiona l responsibility. Canadian dentistry had been built by the devotion and sacrific e of a great man y members o f th e professio n an d politica l intrusio n wa s con sidered destructive . Th e ardou r whic h destroys i s seldom mated wit h the patience that builds. The individualism of the dentist made acceptance of new social concept s difficult . A whole new field of social science had develope d which dentists had great difficult y i n understanding . Th e educativ e process i n dentistr y i s based upo n exac t science s wherein two and tw o make four a t al l tunes , with facts establishe d upo n adequat e proof . In th e dentist' s view , socia l science dat a neve r appeare d neutra l an d proof , i f present, ofte n seeme d based o n flims y foundations . Th e objectiv e o f th e profession , t o offe r improved qualit y of service to more and mor e people, wa s countered b y the proposa l o f the socia l scientis t that th e qualit y of denta l service s b e lowered an d sprea d t o mor e people . Th e goa l o f reaching an increasin g number o f peopl e wa s commo n t o bot h groups ; th e metho d an d th e

Broadened social concepts (1950-195 4 ) 23

7

timing were greatly a t variance . Whe n reading the writing s of the socia l scientists, th e dentis t wa s apt t o ge t the impressio n that Eucli d wa s not being taught i n the school s as well as he used t o be, fo r thei r angle s did not seem to join. And yet a change of attitude was gradually occurring. A n increasing social consciousness wa s noticeable among many dentists, who said that the human story was not reckoned o n a mathematical table; that in life irregularities d o occur, no t abidin g by exact formula ; and tha t th e element o f the unexpecte d an d unforseeabl e i s what save s humans fro m falling int o th e mechanical thraldo m o f the logicians . Th e 1950 s were a time of intensive arguments at dental meetings. Men do not brea k lightl y with the past. But out o f the controvers y cam e ne w thinking on the pro fession's rol e in society . At no time did the dental profession oppose th e adoption o f measures to increas e denta l service s t o th e public , bu t i t adhere d strongl y t o th e primacy o f method s o f preventio n an d control . Th e state d objectiv e o f the professio n wa s th e improvemen t o f th e denta l healt h o f th e natio n and no t th e adoptio n o f a syste m whereby treatment service s woul d b e promised bu t coul d no t b e supplied . I n furtheranc e o f thi s objective , intensified effort s wer e mad e t o presen t i n ever y possibl e manne r th e prime needs fo r it s achievement. I f an y progra m fo r the improvemen t of dental healt h wa s t o succeed , mor e qualifie d dentist s traine d i n publi c health were necessary t o carry out the essential educatio n o f parents an d children. Expansio n o f bot h personne l an d facilitie s i n denta l researc h was necessary. Above all, mor e trainin g facilities wer e needed . For thirt y years, no significant increas e in teaching facilities for train ing dentists had occurred , wit h the exceptio n o f a new school t o replace the old one at l'Université d e Montréal. Th e potentia l numbe r o f annual graduates acros s th e countr y remaine d essentiall y th e sam e whil e th e population doubled . Eve n before the war, the position was recognized a s becoming critical. Followin g th e war , the professio n pressed fo r relie f a t all levels , t o bot h governmenta l an d educationa l authorities , o n ever y possible occasion . I n Ontario , i t se t up a committe e a t considerabl e ex pense to investigate the situation, but its exhaustive report seemed to have little effect a t the time. With the generou s financial assistance o f the Kel logg Foundation, a conference o f representatives o f governments, universities, and dentistr y in the fou r wester n provinces wa s held i n Saskatoo n in 1953 , bu t onc e agai n whil e al l expresse d concer n an d recommenda tions were made, n o immediate tangible results occurred . Whil e the most extensive university building program up to that time in Canadian history

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was under way , provision fo r denta l training remained low on the lis t of priorities. The record s o f the professio n i n the fou r wester n province s sho w a long histor y o f continuin g effor t t o secur e denta l schools . Beginnin g i n 1915, practicall y every year some proposal was made for the establishment of a school at Winnipeg. Saskatchewan ha d grea t nee d fo r mor e dentist s and repeatedly requeste d th e government to establish a school at the provincial university. The profession in Alberta pressed for expansion o f th e one and only school i n western Canada an d gaine d some increased spac e in 1948. In British Columbia, most students had for many years been able to attend denta l school s i n the northwestern Unite d States; but under th e postwar pressure fo r accommodation, thes e schools quit e properly foun d it necessary to limit acceptance of Canadian applicants. Despite the expan sion at Alberta, al l Canadian school s were crowded and the accommoda tion of British Columbia applicants was a particular problem . In the 1950s , the public became concerned at the lack of dentists. Ill informed critic s laid the blame o n the profession, restating the ol d clich é that dentists were operating a 'closed shop' for their own benefit. After al l the efforts tha t had been made by the profession, such criticism was hard to accept, but it did a great deal to stimulate interest among authorities a s to the need for greatly increased numbers of graduates. Finally, an expan sion o f denta l teachin g facilitie s di d occur , whic h wil l be relate d i n th e following chapter . Distribution of dental services also gaine d new pertinence. Like othe r professional men, dentists had tended over man y years to establish prac tice in the more populous areas. When older practitioners in smaller municipalities retired or died, they were not replaced. A s a consequence, many people in rural areas which had had one or two dentists found themselve s with none. Initially, this situation was considered t o be one of supply and demand. Study and some experimentation disclosed , however, that socia l changes in rural life, together with new ease of transportation and a general drift t o urbanization , wer e complicating factor s whic h mad e i t difficul t for any dentist to maintain himself in many of these areas . Under new pressures, on e old battle wa s finally won. The Dominion Dental Council (latterly named the Dental Council of Canada) ha d func tioned for nearly half a century, holding annual examinations and issuing certificates tha t wer e recognized b y licencing boards i n seve n provinces . On many occasions, the Council had made efforts t o gain the co-operatio n of the remainin g provincial licencing boards, bu t withou t success. Britis h

Broadened social concepts (1950-1954) 23

9

Columbia di d on three occasions agree to accep t th e certificate, but eac h time withdrew after a short period; Quebec never did accept the certificate. Walter D . Cowan , secretar y o f the Counci l for it s firs t thirt y years, an d Augustus J. Brett , hi s successor, bot h o f Regina , worke d assiduousl y i n the interests of the Council throughout this half century. On severa l occasions , proposal s wer e mad e t o hav e the counci l in corporated b y federal charter, bu t thi s ste p wa s alway s postponed unti l all the province s wer e in ful l co-operation . Thu s i t wa s neve r achieved . Beginning in the mid-forties, work began on a formula for a national board to which all provincial licencin g boards would agree. By a process o f re vision over six years, the objective was attained. An application, supported by statement s o f agreemen t fro m al l provincia l licencing boards, wa s presented t o the federa l government for th e establishmen t of a Nationa l Dental Examinin g Board. Th e legislatio n wa s passe d i n 1952 , and th e newly formed board appointe d H.N.B . Beach of Ottawa a s it s secretary . The director s o f th e Council , i n a mos t amiabl e statement praisin g the accomplishment entaile d i n establishin g th e ne w Board , transferre d al l records and assets to the new organization. The recognition of credentials possesse d b y dentists had been a matter of controversy throughout the history of the Canadia n profession. During early times , ther e ha d i n trut h existe d adequat e reasons fo r a licensin g board t o circumscrib e it s are a o f jurisdiction, owing t o th e tremendou s variation i n academi c qualification s which the n prevailed . However , a s the educativ e proces s ha d becom e mor e uniform , ther e develope d a counter-tendency to build fences higher and highe r so that i t became al most prohibitive for a dentist to transfer from one are a to another , eve n within Canada. The Dominion Denta l Counci l had mad e an honourabl e endeavour to rectify th e situation , and the prim e purpose o f creating th e National Dental Examining Board was to complete the task. From the beginning , Canadian dentist s have enjoyed an d benefitte d from a clos e relationshi p wit h the professio n i n the Unite d States . Th e development o f dentistry in both countrie s has bee n alon g similar lines : the problems hav e been generall y th e same , althoug h the solution s have varied a t time s du e t o basi c difference s i n law, or wha t might be calle d differing philosophica l views. Canadian dentists have freely attende d professional meetings in the United States and gained greatly therefrom. Many Canadian dentist s are graduates of American universities and a considerable number of students fro m th e Unite d State s hav e attended Canadia n dental schools. Joint discussion s have resulte d i n the adoptio n of similar

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policies, despite difference s i n implementation . The consequenc e i s tha t the training and the practice o f dentistry are closely parallel on both sides of the 49th parallel. One exampl e ma y illustrat e th e man y benefit s arisin g fro m thi s co operation. Discussion s wer e initiate d durin g the latte r 1940 s t o attai n common bases for recognition o f dental schools in the two countries. Th e American Denta l Association, throug h its Council on Dental Education , had for many years conducted a survey of dental schools in an accredita tion program, which had been successful in raising standards o f educatio n and in improving the facilities available. The Canadian Dental Association agreed t o institut e a simila r program , adopte d minimu m standards fo r school accreditatio n i n 1948 , an d throug h it s ow n Counci l o n Denta l Education gaine d the co-operatio n o f the universities with dental schools and al l others concerned . Th e firs t surve y of the school s wa s conducte d during 1950-1 by a team consisting of A.C. Lewis, an outstanding educationist who was dean of the Ontario College of Education, Toronto; A.L. Walsh of Montreal, retired dean of the McGill school; and Harvey W. Reid of Toronto , representing genera l practice . Afte r extende d visit s to eac h school, th e team issued confidentia l reports o f their findings to the presi dent o f each universit y concerned, wit h a copy to th e dea n o f dentistry . After two years, a second survey was made. Invariably, the recommenda tions o f the tea m had eithe r been carried ou t o r wer e under way by th e time o f it s secon d visit . Afte r i t wa s adopte d b y th e Canadia n Denta l Association, the American Dental Association accepted th e final report of the survey team, and thus dental schools i n both countries achieved equivalence in accreditation . Canadian dentistry was assisted financially by the Kellogg Foundation in initiatin g the surve y of dental schools . Thi s foundatio n ha s provide d large amounts of money in support of Canadian projects in dentistry, par ticularly in the field of dental education , and continues to do so. The sur vey of dental schools has been a continuing activity under the direction of the Council o n Dental Educatio n an d ha s bee n instrumenta l in bringing real benefits to dental education. A by-produc t o f the surve y program wa s th e growt h in eac h o f th e dental school s o f teacher-training conference s conducted b y outstandin g educationists. Thes e course s wer e wel l attended b y th e facult y and , b y explaining the methodolog y o f teaching , helped improv e th e instructio n offered. The movemen t towar d th e introductio n o f the denta l hygienis t int o

Broadened social concepts (1950-1954) 24

1

practice bega n i n the Unite d State s i n 1913 . Th e hygienist' s proscribe d duties were preventive i n nature, wit h emphasi s upo n prophylaxi s o f th e teeth. Rather rapidly, training courses were established an d law s enacte d regulating this new field. Before long, ardent advocate s were proposing a parallel developmen t fo r Canada . Opponent s argue d jus t a s strongl y that onl y a full y qualifie d dentis t shoul d b e permitte d t o operat e i n th e mouth. After much discussion, the Toronto school established a course in dental nursin g in 191 9 bu t limite d th e activitie s o f th e denta l nurs e t o duties outside the mouth, thus delaying for a couple of decades acceptanc e of th e denta l hygienis t i n Ontario. 1 Discussions respectin g th e introduc tion of such personnel di d occur i n several other provinces . In Manitoba, sincere advocates endeavoured at every opportunity over a long period t o persuade thei r confreres, an d a t least on e prominen t dentist employe d a graduate hygienist in her full capacity until forced to stop by the provincial Board. Th e ide a di d no t die , however, an d wit h th e acut e shortag e of dental personne l i n th e fortie s i t wa s forcibl y revived . Th e denta l hy gienist's dutie s complemente d th e effor t fo r a preventiv e progra m i n dentistry. Th e Ontari o denta l la w wa s amende d i n 194 7 to provid e for hygienists, an d th e firs t Canadia n cours e o f trainin g i n thi s are a wa s announced b y the Toront o school in 1951 . Similar legislativ e action followed i n th e othe r provinces . B y th e mid-sixties , al l Canadia n denta l schools eithe r had establishe d course s i n dental hygiene or had plan s for doing so. By 1967, the ratio of hygienists to dentists had reached approxi mately one to fifteen. The hygienist, employed in private dental offices an d dental publi c healt h programs , ha s becom e recognize d a s a valuabl e auxiliary, rendering services enhance d b y capable patien t education.In 1950 , the 75t h anniversar y o f denta l educatio n i n Canad a wa s celebrated a t a combine d meetin g i n Toront o o f th e Canadia n Denta l Association an d th e Ontari o Denta l Association . I n speakin g o f th e contribution mad e by the deans of dental schools, G.V. Fisk said , 'Their vision an d foresigh t have bee n largel y responsibl e fo r raisin g the statu s of dentistry to its present high professional level. With singula r devotion, they have shifted the emphasis of dental teaching from replacemen t o f lost dental organs to the prevention and control of dental diseases.' The searc h fo r preventiv e mean s t o reduce denta l carie s ha d bee n constant ove r the years. Various method s had bee n advocated , an d late r discarded whe n proven ineffective throug h scientific investigation . It ha d long been establishe d tha t a larg e percentag e o f denta l carie s coul d b e prevented through dietary control an d regular brushing of the teeth. As a

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result, dentist s strongly advocate d reductio n of carbohydrate intak e an d strict adherence t o effective an d frequent brushing. While the slogan that 'a clea n toot h neve r decays ' migh t b e questione d scientifically , i t wa s heard in the land for many years. Dentists observe d als o tha t childre n bor n an d raised i n certain area s developed markedly less dental caries tha n the average. Beginnin g in the late 1920s , investigatio n gradually establishe d tha t th e wate r suppl y i n these area s containe d quantitie s o f fluorid e sal t an d tha t thi s wa s th e determining factor. By the forties, several large-scale survey s were under way in the Unite d States an d Canada. Du e t o th e progressiv e attitud e of the loca l medica l office r o f healt h a t Brantford , Ontario , Willia m L . Hutton, a n investigatio n wa s initiate d i n 194 5 b y th e Departmen t o f National Healt h in co-operation with the Ontario government. The study began wit h th e additio n o f sodiu m fluorid e ( 1 ppm ) t o th e Brantfor d water supply. It was then widened to Stratford, which had fluoride content already i n its water supply, and Sarnia , whic h ha d none . The childre n in these thre e municipalitie s were examine d regularly over a perio d o f te n years. The study firmly established tha t the addition of sodium fluoride to the wate r suppl y i n Brantfor d reduce d th e occurrenc e o f denta l carie s among childre n b y ove r 6 0 pe r cent . Thi s resul t wa s corroborate d b y concurrent studies in the United States. This ne w preventive measure wa s greete d wit h considerabl e excite ment by the dental profession . A t first many dentists thought the result s of th e investigation s appeared almos t to o goo d t o b e true. Pressure s de veloped fo r th e approva l o f fluoridatio n o f municipa l wate r supplies . Canadian dentist s hesitated , however , until th e fact s wer e firml y estab lished and sufficien t researc h conducte d to prove that the additio n o f the fluoride salt would be harmless to the community . With incontrovertibl e evidence a t hand , th e professio n recommende d fluoridatio n o f wate r supplies in 1952 . I t was followed by other recognize d Canadian scientific health organizations . A fac t o f fundamental importanc e in public healt h had been established. But as with all other suc h measures, fro m vaccina tion for smallpox onwards, opponents t o the proposal spran g up. Strange pseudo-scientific organizations, never heard of previously, lay groups, and self-proclaimed experts , made spurious charges against fluoridation which were often ridiculous and sometimes based upon fear. The procedur e fo r introduction of fluoridatio n ha s bee n by plebiscit e in eac h municipality , a metho d questione d b y man y authoritie s o n th e grounds tha t the uninformed voter i s sometimes swayed by the activitie s of those who brush aside scientific evidence. As a result of votes, the public

Broadened socia l concepts (1950-1954 ) 24

3

health benefi t ha s bee n los t t o a considerabl e numbe r o f municipalities . However, there has been in general steady progress. B y the en d of 1969, fluoridation ha d reache d 4 6 per cen t o f possible coverag e o f the popula tion served by municipal water supplies (33. 4 per cent of the total population). Fro m th e clinica l standpoin t th e chang e ha s bee n dramatic , a s reported b y dentists practising in fluoridated areas. N o longer d o dentists have to face children with untreatable cariou s teeth. Fluoridation doe s not lessen th e nee d fo r dietar y contro l an d prope r brushing , bu t al l thre e methods of control together mak e the preventio n o f dental carie s a t las t largely possible . During the 1950s , clinica l practic e wa s revolutionized by th e intro duction of high-speed equipment. Th e time required fo r an operation was greatly reduce d an d th e comfor t o f th e patien t enhanced . Man y othe r refinements i n instrumentation an d equipmen t also occurred , du e t o th e ingenuity o f both dentist s and manufacturers . Root cana l treatmen t was by this time a science in itself, and as a result of extensive research perio dontics ha d assume d a n increasin g par t i n denta l practice. Bot h th e ar t and scienc e of dentistry progressed considerably , t o the benefit of practitioner and patient. The pattern of dental practice had altered considerably. Very fe w dentist s i n th e fiftie s performe d an y technica l wor k i n thei r offices; the y ha d suc h service s execute d i n denta l laboratories . O n th e other hand, employment of other auxiliar y personnel in the denta l offic e increased. Th e wor k o f th e denta l assistan t wa s improved , initiall y b y training courses conducted in co-operation wit h local denta l societies and later b y formal courses. Th e denta l hygienis t als o playe d a n increasin g role. Greate r efficienc y enable d th e dentis t t o provid e services t o mor e people. The 195 2 meetin g of th e Canadia n Denta l Associatio n wa s hel d a t Vancouver and took the form of a Golden Jubilee celebration. Its emphasis was on the rapidly changing society and the place of the dentist in this new environment. The feeling of the profession at that time is indicated by a few sentences in the report of the meeting: 'The trend of the last decade has been rapidly toward action in the mass. Individualism in many spheres appears to be a disappearing condition of life an d wit h a lack o f sense of importance o f persona l action . Th e spiri t o f frustratio n within the individual i s exemplified in casual conversatio n whereve r groups gather to gether. The tendency is to become dependent upon someone else, to allow leadership to rest on shoulders other than those educated to assume it and to side-step responsibilities even in the organization s which vitall y represent us. It i s a movement so gradual that i t is scarcely recognized and in

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which th e man y are becomin g shepherded b y fewe r an d fewer . Al l bu t forgotten is the fact that the great things of life have originated fro m idea s and idea s originate with individuals. As representatives o f individualism, dentists should alert themselves to this situation.'3 In 195 0 th e Universit y of Alberta honoure d on e o f th e stalwart s of Canadian dentistry by conferring the honorary degree of Doctor of Laws upon John W . Clay of Calgary. Clay had com e to Canada fro m Englan d as a child, and had received his early education a t Toronto schools. Afte r earning doctorates in dental surgery from bot h the University of Pennsylvania and the University of Toronto, he had established himself at Calgary in 1906. There he continued to practise for sixty years, while the city grew from little more than a good-sized village to a thriving metropolis. He was elected t o practically a u the office s th e professio n had t o offer , includin g presidency o f the Canadia n Dental Associatio n durin g a critica l perio d (1926-8). Matthew H. Garví n also saw the West develop from earl y days. Like Clay, he graduated from th e dental school s at Toronto an d Philadelphia . In 190 3 he began practising at Winnipeg and remained in active practic e for sixty-two years. He was an energetic leader who held many positions in the profession, both in Manitoba and nationally. When the Journal of the

John William Clay, DOS, LLD, President of the Canadian Dental Association, 1926-8

Broadened socia l concepts (1950-1954 )

245

Canadian Dental Association wa s formed , h e becam e th e firs t editor , occupying th e positio n fo r eightee n year s unti l 1953 . I n thi s bilingua l venture h e wa s associate d wit h thre e French-speakin g editors , briefl y with Philippe Hamel, then fo r twelve years with Alcide Thibaudeau, an d after 194 6 wit h Gerar d d e Montigny . H e wa s considere d on e o f th e founders o f th e America n Academ y o f Periodontology , an d fo r a ter m served a s its president. Th e Western Canada Dental Society established a scholarship i n his name at the University of Alberta i n 1957 ; the Univer sity of Manitoba conferred the honorary degree of Doctor o f Laws on him. It i s worthy of note tha t twenty-on e papers b y Garví n wer e published i n dental journals outside Canada. Throug h his own editorial page, he made a great contributio n to Canadian dental literature. Other men gave abundantly t o the development o f dentistry in the West , bu t Garvi n and Cla y stand out for their energy over the longest period. In 1944 , Ernest Charro n wa s appointed dean , Facult é d e Chirurgi e Dentaire, Universit é d e Montréal , afte r havin g serve d o n it s staf f fo r a long period. Practitioner, teacher , writer , and schola r of note, he took a n active par t i n th e progres s o f denta l educatio n an d th e evolutio n o f organized dentistry. It was not his nature to seek positions of prominenc e and only accepted the m at the earnest behest o f his confreres. During his

Matthew H . Garvin , DOS , LL D, Editor of the Journal of the Canadian Dental Association, 1935-52

246

A HISTORY O F DENTISTR Y I N CANADA

fourteen years as dean, he not only advanced his own school to a position of eminenc e but hi s vigorou s leadershi p brough t abou t many improve ments in Canadian dental educatio n a s a whole. Unfortunately, but a s he would desir e it , hi s grea t contributio n t o hi s professio n i s largel y un known, except to the few leaders in dentistry of his day. His quiet advic e was eagerl y sought , alway s reliable , an d i n th e bes t interest s o f hi s profession. Illnes s force d hi s retiremen t a s dea n i n 1958 ; h e die d i n January 1969 . Arnold D.A . Mason , fourt h dea n o f th e Toront o school , retire d i n 1947 and died in 1962. He had served full-time o n the staf f o f the school, since 1927 , whe n he gav e up privat e practice . Becaus e h e wa s himself artistic i n temperament, h e endeavoure d t o introduc e this characteristic into dental education, which he considered to o pragmatic. Like so many Canadian dentist s of his time who became prominent , he had graduate d from both an American dental school (Chicag o School of Dental Surgery ) and the Universit y of Toronto. Throughou t his career a s a leadin g educator i n denta l science , h e displaye d man y fine qualitie s whic h supple mented an d gav e poise, dignity , and statur e t o al l his undertakings. N o one doubted his sincerity of purpose. H e lived by the philosophy tha t th e

Ernest Charron, DOS , LLD, Doyen, Faculté de chirurgie dentaire, Université de Montréal, 1944-5 8

Arnold D.A . Mason , DDS , LLD , Dea n of the Faculty of Dentistry, University of Toronto, 1936-47

Broadened socia l concepts ( 1950-1954) 24

7

only wa y t o hav e friend s wa s to b e one . Hi s universit y conferre d th e honorary degree of Doctor of Laws on him in 1959. In 1951 , the Canadia n Society of Dentistry for Children wa s formed, and gradually chapters wer e established in the provinces. This action was in accordanc e wit h th e long-standin g polic y o f Canadia n dentistr y i n emphasizing service s fo r children . Muc h o f th e professiona l an d publi c interest i n thi s are a o f preventiv e dentistr y ha d bee n fostere d b y th e Canadian Dental Hygiene Council. The change in attitude was significant. Once, speaking at a dental meeting in Canada i n 1927 , C.N . Johnso n of Chicago ha d sai d tha t succes s i n denta l practic e largel y depende d upo n treating children as adults and adults a s children. This attitud e had bee n discarded. Ne w leadershi p demonstrate d tha t th e successfu l practic e o f dentistry fo r childre n wa s differen t fro m tha t fo r adult s an d require d specialized knowledge . B y th e tim e thi s ne w societ y wa s formed , th e number of dentists confining practice to children had increase d consider ably; th e denta l school s ha d establishe d department s o f children' s den tistry; an d parents wer e requestin g specia l service s fo r thei r children . Wisely, th e societ y di d no t restric t membershi p t o thos e dentist s wh o practised for children only. Dentistry in Canada had reached a period of transition. The profession had laboured consistently for many years towards objectives of prevention and control, and now there was general recognition of this sane approach to dental health. Many handicaps existed, however, in the achievemen t of the final goal. In his address to the annual meeting of the Ontario Denta l Association in 1952, Dean R.G. Ellis enumerated the limitations besetting the development and assimilation of preventive procedures. He referred t o the existin g accumulation of treatmen t require d b y th e population ; th e increased demands arising from th e socia l equalizin g process, which was creating a much larger grou p of persons potentiall y able to bear th e cost of needed treatment; the worsening ratio of dentists to overall population; the slo w acceptance b y the denta l professio n o f auxiliar y personnel; th e tendency toward the establishmen t of an all-embracing welfare state ; the lag in communication of research findings throughout the professio n and in the dental health education o f the public; and the low proportion o f the dentists' tim e devote d t o th e chil d patient . Thes e questions , state d i n a variety of ways in the context of many situations, dominated the thinkin g of the time. Canadian dental literature records a considerable number of thoughtful addresse s durin g the fifties respecting th e positio n o f th e profession .

248 A

HISTORY OF DENTISTRY IN CANAD A

Among these was the presidential address of C.R. Sella r to the Montreal Dental Club hi 1951 , portions of which concisely summarize the attitud e of many dental leaders hi this period.4 In the light of our experiences an d in view of the many unsolved problems with which dentistr y i s confronted i n th e present , ou r firs t dut y i s clearly tha t of research. It offers one of the greatest opportunities ever given to any profession. Notwithstanding th e progres s i n dentistry, th e denta l ill s of mankind ar e stil l almost universal. Their cost in discomfort, deformity, and ill health, is beyond compilation. N o one can measure the far-reachin g effects o f a condition suc h as this. The proble m i s one tha t cannot b e solved b y present-day method s of practice. Som e wa y will have t o b e foun d t o chec k denta l disorder s a t then source. This ca n be done onl y by a long-range program o f research , it i s the public who must support it. Prevention represent s anothe r opportunity . Dental ills, unlike most other s to which the human body is heir, create conditions which are not remedied b y the usual processes o f nature. They bring about conditions tha t ar e to a large extent irreparabl e excep t b y outside interference . It i s this situatio n tha t ha s given birth to the art of dentistry, which has now almost reached th e acm e of perfection. While further progress will doubtless be made in this respect, thi s is not th e road alon g which dentistry must travel in th e future . Th e ar t o f den tistry must , i n increasin g measure , giv e wa y t o preventiv e dentistry . T o a considerable extent this waits on research. Much , however, can be done while waiting for research t o catch up with present-day needs. Dentistry must provide for a wider distribution of dental care among those of ou r population who are unable to provide for their own needs. I n this , th e profession shoul d tak e the initiative . I t mus t not b e drive n to thi s cours e b y outside agencies . Fo r it s ow n soul' s sak e it shoul d assum e leadership i n an y program t o expan d the boundarie s o f ora l healt h service . This responsibility , fortunately, i s being recognized b y our governin g bodies, an d step s are bein g taken t o meet it. I t i s the dut y of ever y member o f th e professio n t o whole heartedly support these bodies in this effort . And lastly , i f thes e thing s w e hav e bee n discussin g are t o b e pu t int o operation i n the year s ahead, the y wil l provide vastly increased opportunitie s for service . Th e doo r o f opportunit y stand s wid e open , bu t a s always , only those will be permitted t o enter wh o are willing to pay the pric e o f admissio n with toil, sacrifice, and service. In the words of Virgil The nobles t motive is the public good.'

Broadened socia l concepts ( 1950-1954) 24

9

Dentists, wit h a very few exceptions, are not politicians. Difficulty was experienced i n bridgin g the wide gap between the utterance s o f those in public life respectin g denta l service s an d th e thinkin g of th e profession . The genera l interes t wa s illustrate d whe n the professio n was invite d t o present a brief on dental health problems to the House o f Commons an d Senate Committee on Health i n 1955. Th e attendanc e at the meeting was so great tha t i t appeared a s if all the member s of th e Hous e and Senat e were present, no t just the committee. After pointin g out the lack of training facilities for dental personnel, the representative of dentistry explained that the prope r sequence i n solving the dental health proble m was , first, education, next , research , an d then , treatment . Ignoranc e an d lac k o f understanding was said to be the mai n cause of dental neglect. Researc h had already pointed the way to preventive methods, and intensification of effort woul d undoubtedly diminish the need for reparative services. To be effective, treatmen t service s had t o b e directed towar d contro l an d pre vention, henc e concentrate d o n th e earl y age s o f th e population . Thi s presentation served to clarify the position and created a better understanding in future discussions . Othe r effort s simila r in nature were made at all levels of government across the country.

19 Assessment 1955-1965

Widespread recognitio n o f th e country' s enormou s untappe d natura l resources attracte d increasin g amount s o f developmenta l capita l fro m outside Canada durin g this decade. Tremendou s expansio n o f Canadia n industry wa s accompanie d b y a correspondin g growt h i n populatio n through increas e in the birth rat e (23. 5 pe r thousand in 194 5 t o 28. 0 i n 1955) an d by immigration. Labour an d material costs increased rapidly , with inflationary tendencies . As the expenses of practice rose in step with the economy, the dentist found himsel f with an ever-smaller ga p between gross and net income. Dental organizations opened serious and continuing studies of fee schedules. The relationship of dental services within hospitals had been a matte r of concern since the forties. Up to this point, most large hospitals had ha d a dental service in some form, an d i n smaller hospitals on e or more den tists were recognized as being attached. Generall y speaking, the relation ship had bee n casua l i n nature an d considerabl e variatio n existed . T o a large extent, the hospitals concerned wer e autonomous, operated b y local boards: most governmen t mental hospitals an d sanatoria ha d establishe d a dental service as early as the 1920s . When accreditation of hospitals wa s introduced, questions aros e respectin g standardizatio n of denta l service . By 1950 , whe n a large proportion o f the populatio n wa s covered b y th e Blue Cros s Plan s fo r hospita l care , th e cost s relate d t o denta l service s became a critica l matter . Furthe r confusio n aros e aroun d th e variou s prepayment plan s fo r medica l services , whic h als o increase d rapidl y i n number and membership, but provided payment for services performed in hospitals by medical practitioners only.

Assessment (1955-1965) 25

1

As a result of the federal hospital construction grants of 1948, hospital facilities were greatly expanded all across Canada. During this period the dental professio n was called upo n t o devis e plans for denta l service s i n hospitals of varying sizes. Blue Cross official s pointe d out the great varia tion in dental services performed in hospitals from are a to area. Through joint meetings , th e professio n reache d agreement s respectin g type s o f dental service s whic h require d hospita l care . I n 1957 , Ottawa passe d enabling legislatio n fo r hospita l insuranc e tha t wa s adopte d b y al l th e provinces, and intensifie d the need for further clarificatio n o f the positio n of dental services. Hospital legislation is of provincial jurisdiction, and th e relevant Act s varie d fro m provinc e t o province . Amendment s wer e sought b y the profession an d gradually obtained , although no t without a great dea l o f tim e an d effort . I n th e meantim e th e denta l professio n adopted its own standards for hospital dental services, and many hospitals have been issue d certificates of approval. Condition s of interneship have been delineate d an d approve d i n accordanc e wit h facilitie s an d training requirements. In thi s period, the long continuing effort o f the professio n to secur e increased teachin g facilitie s finally bore results . The firs t definit e action occurred i n 1954 , when th e Ontari o governmen t announce d financia l support for construction o f a new school at the Universit y of Toronto. I n comparatively rapi d sequence , othe r ne w school s wer e announced . B y 1968, the number of Canadian dental schools in various stages of development had doubled. Dalhousie University opened a new school in 1958, which doubled its old capacity . I n th e sam e yea r th e firs t clas s o f denta l student s wa s accepted b y the Universit y of Manitoba, an d a new dental buildin g was opened officiall y ther e th e followin g year . Th e ne w school a t Toronto , occupied in 1959 , could accommodate an increas e of more than fifty per cent in undergraduate registration, and had ampl e provision for graduate education an d research . Th e Universit y of Britis h Columbia announced the establishmen t o f a denta l faculty in 1962 , and accepte d it s first class of dental students three years later. The Ontario government announced in 1964 th e establishmen t of a dental facult y a t th e Universit y of Western Ontario, which accepted its first class of dental students in the fall of 1966. In 1965 , the Saskatchewan Government announced the establishmen t of a denta l facult y a t the Universit y of Saskatchewan, and th e firs t clas s of students wa s accepte d a yea r later . L'Universit é Lava l bega n activit y toward establishin g a dental faculty in 1968 . For th e mos t part, the an -

252 A

HISTORY OF DENTISTRY IN CANAD A

nouncements o f these ne w school s mad e reference to, an d th e buildin g plans containe d provisio n for , th e educatio n of denia l hygienist s t o b e initiated afte r th e undergraduat e denta l cours e becam e stabilized . I n the meantime, the McGill, Alberta, and Montreal schools were expanded to accommodate more students.1 This unprecedente d activit y in providin g facilities for denta l educa tion, while most gratifying, als o brought problems. Th e planned increas e in th e potentia l numbe r of graduate s pe r yea r wa s ove r 15 0 pe r cent , effective b y the mid-1970s . Th e distributio n of facilities had change d fo r the better : instea d o f dental school s i n onl y four provinces , ther e wer e now school s i n seven , a t logica l centre s withi n reasonabl e distanc e o f students' homes. But there was a great nee d fo r qualifie d teaching per sonnel - a need accentuate d b y the increasing employmen t of full-time staff. Thi s proble m wa s recognized earl y i n th e plannin g stage o f eac h school, an d financial assistance was arranged to provide graduate education fo r selecte d potentia l teacher s amon g local dentists . A considerabl e number of well-qualified teacher s from othe r countries also have become staff members of Canadian dental schools. The Canadia n Fun d fo r Denta l Educatio n wa s founded i n 196 2 b y the profession . I n essence , it s purpose s ar e t o receiv e mone y i n ai d of dental education , an d t o gran t money for suc h purposes . This fun d ha s been successful in securing generous support from bot h the profession and the public . The grant s from th e fun d hav e contributed extensively to th e advancement of dental education. The expansio n o f graduat e educatio n ha s reinforce d a n anomaly . Upon completio n o f th e undergraduat e cours e i n dentistry , a studen t receives a doctorat e degree . Thi s ha s ofte n bee n discusse d withi n aca demic confines , for i n othe r disciplines , apar t fro m medicine , the firs t degree is generally a bachelor's. Long-standin g custom has established th e doctorate in dentistry and it appears unlikely that any alteration will occur. But for those who go on to graduate studies, a peculiar situation is created. The candidate , wh o alread y possesse s a doctorate , proceed s t o obtai n bachelor's, master's , an d finall y doctora l degree s i n hi s fiel d o r are a o f study. (All dental courses in Canada led to the degree of Doctor o f Dental Surgery until recently; but the newer courses at the Universities of Manitoba, Britis h Columbia, an d Saskatchewa n chose to awar d the degre e of Doctor of Dental Medicine. )2 A profession may be likened to an individual. When it is young, it has a stron g tendenc y t o emphasiz e th e tangibl e thing s o f life , bu t a s lif e

Assessment (1955-1965 ) 25

3

lengthens, faith becomes more established i n the intangible elements. Thi s attitude i s reflecte d i n the variou s code s o f ethic s an d th e amendment s thereto adopte d b y th e denta l profession . Th e numbe r o f alteration s i n codes increased considerabl y durin g the latter years as the social environment changed. By the mid-fifties, th e great industrial expansion in Canada was beginning t o affec t th e calibr e o f applicant s fo r th e professions . Prospectiv e dental student s wer e attracte d t o th e field s o f commerc e an d industry , where the fruits appeare d s o bountiful. The proble m di d not lie so much in the decline in number of applicants a s in the lowering of their academi c standing. On both the national an d provincial levels, the dental professio n instituted a continuin g recruitment program , t o increas e th e numbe r of suitable applicant s fo r trainin g i n dentistr y an d auxiliar y fields, and t o stimulate dentist s to act positivel y and aggressivel y in encouraging young people to seek careers i n dentistry. The program took many forms. Attractive dental career booklets were published and the advantages of dentistry as a vocatio n wer e presse d throug h al l possibl e media . Th e progra m proved effectiv e i n raising the academic level of applicants and i n addition augmented public interest in dentistry as a profession. Voluntary prepaymen t plan s fo r hospita l an d medica l car e aros e initially as a n outcom e o f the depressio n perio d of the thirties , and grew rapidly. Kindre d plan s fo r denta l service s wer e subjec t t o continuin g discussion a t denta l meeting s but th e majorit y o f dentists exhibite d hesitancy i n developin g suc h arrangements . Earl y book s upo n th e healt h insurance movemen t pointed ou t tha t voluntar y health servic e plan s became a stepping stone to compulsory measures and som e dentists objected on this basis. Others objected to the introduction of a third-party arrangement interferin g with the traditiona l relationshi p o f patien t and dentist . On the othe r hand , there wer e thos e dentist s who strongly believed tha t the forces at work in society as a whole made change inevitable, and that the professio n needed experienc e in the operatio n of such plans i n order to establish acceptable data, if for n o other reason . Until th e 1940s , th e onl y dental servic e plans in operatio n wer e fo r school children , operated b y municipalities with financial assistance fro m provincial governments. When legislation was adopted dividing the prov inces int o health regions , areas , o r units , a tendency developed to widen dental plan s to includ e all children within th e boundarie s of these larger areas. Th e firs t o f thes e enlarge d plan s appeare d i n 194 3 in Quebec , where the governmen t appointed dentist s in thirty healt h units . In 1946,

254 A

HISTORY O F DENTISTRY I N CANAD A

Saskatchewan establishe d a dental car e pla n in the Swif t Curren t Healt h Region, geographical y a very large area , wherei n dentists were employed on a salary basis to care for all children unde r sixteen years (subsequently lowered t o twelve). The pla n i n Ontario ha s been relate d earlier . Othe r provinces adopte d plans , based o n health units, which varied all the way from simpl y providing treatment service s t o program s of preventio n an d control. The firs t significan t pla n fo r prepai d denta l service s wa s tha t nego tiated i n 194 7 betwee n th e Alberta Denta l Associatio n an d th e Albert a government fo r th e provisio n o f denta l car e fo r welfar e recipients . A postpayment pla n wa s initiate d b y th e professio n i n Saskatchewa n i n 1955. Severa l othe r province s introduce d postpaymen t plan s bu t non e proved t o be very successful. More recentl y a number of insurance com panies hav e issue d grou p policie s wit h denta l insuranc e coverage . Th e profession i n mos t province s forme d administrativ e facilitie s fo r th e operation o f prepai d denta l servic e plans ; negotiation s an d discussion s were held with a great number of groups, bu t with little success u p to the time this was written. The one exception wa s in British Columbia, wher e several groups were participating in a plan sponsored by the profession in 1969. Like most othe r countries , Canad a share d i n the stron g social move ment whic h gaine d increasin g strengt h followin g th e secon d worl d war . Perhaps th e greates t singl e objection withi n th e professio n t o thi s tren d was a fea r o f interferenc e wit h th e dentist' s independence . True , som e dentists considere d al l thei r ow n gees e a s swans , an d other s wer e lik e watermen looking astern while they rowed ahead, but increasing numbers saw tha t healt h service s were graduall y becomin g a subjec t i n which all parties expected to help set policy. For twent y years, the dental profession had taken par t i n continuing negotiation wit h government authorities. At any one time several matter s of concern wer e under discussion, an d diffi culty was often experienced i n reaching mutually satisfactory conclusions. Basically, th e problem s o f th e professio n aros e fro m rapidl y changin g social conditions. In an address while serving as president of the Canadian Dental Associatio n i n 1958 , A.G . Racey , said : 'Ho w wel l the publi c is being serve d canno t b e measure d alon e b y advancement s i n technica l skills but rathe r b y our proficienc y in socia l scienc e an d it s related sub jects.' Recognition o f the trut h o f this statemen t an d other s o f a similar nature gradually altered the attitude of the profession . The whol e concep t o f dentistr y ha d widene d tremendously , both i n

Assessment (1955-1965) 25

5

the publi c min d an d i n tha t o f th e dentis t himself . I n earlie r times , th e dentist ha d confine d hi s effor t t o improvin g his servic e t o his patient . Gradually h e came t o understan d tha t th e professio n had responsibilit y for service s to the population as a whole. The poin t was one o f attitude: the profession had state d on innumerable occasions tha t it s objective was dental healt h fo r th e nation , bu t thi s ha d lon g been considere d b y an d large an altruistic goal, admirable but of questionable practicability. During the years of social change, new means of supporting health services had developed, apparentl y makin g possibl e wha t wa s formerl y considere d practically unattainable . Th e questio n the n becam e on e o f method . O n this new horizon leve l a public demand develope d fo r immediat e action, alongside ful l realizatio n b y th e denta l professio n that improve d denta l health depended upon long-term plans of prevention and control . In 1961 , the federa l government appointed a Roya l Commission on Health Services . Durin g th e followin g two years , thi s commissio n held hearings at strategic centres acros s Canada. Brief s were presented in great numbers by both professional and lay groups. Some twenty organizations representing th e denta l professio n mad e presentation s whic h deal t i n detail wit h dental healt h service s an d lai d dow n a definit e pla n of procedure directe d towar d improve d nationa l denta l health . Man y o f th e presentations b y lay groups were extreme i n their demands - s o much so that at one hearing a member o f the commission was moved to state that no matter what was recommended, governmen t legislation could no t provide fo r th e establishmen t o f healt h service s i n th e fron t yar d o f ever y farmhouse. In a n extensiv e an d well-documente d brief , th e Canadia n Denta l Association pointe d ou t tha t th e denta l healt h proble m woul d neve r b e solved unles s th e prevalenc e an d incidenc e o f denta l disease s wer e de creased; tha t th e economi c facto r wa s no t th e onl y o r eve n th e mos t important caus e o f poo r denta l health ; tha t th e Associatio n coul d not recommend a nationa l denta l healt h insuranc e pla n unde r existin g circumstances; that i f the commissio n shoul d nevertheles s recommend th e establishment o f a denta l insuranc e plan , i t shoul d be precede d b y an d accompanied b y intensiv e denta l healt h educatio n an d confine d t o th e youngest age groups o f the population, wit h annua l extension t o children one year older. The specifi c recommendations made in the brief ar e summarized i n Appendix K . The goa l o f the denta l professio n was state d a s the improvemen t o f th e leve l of denta l healt h unti l ultimately all Cana dians enjoyed good denta l health.

256 A

HISTORY OF DENTISTRY I N CANADA

The presentation wa s well received b y both th e commissio n an d th e press. Thi s submission , togethe r wit h th e brief s fro m al l othe r denta l organizations, represente d th e greates t effor t eve r mad e to tha t dat e by the denta l professio n t o presen t th e factor s relate d t o denta l healt h i n Canada. Thei r effectivenes s wa s found i n the repor t o f th e commission . The Roya l Commissio n issue d a voluminous report whic h contained an unprecedente d numbe r o f recommendation s respectin g dentistry. 3 After pointin g to th e 'parado x o f ou r age ' a s bein g 'the enormou s ga p between scientifi c knowledg e and skill s on on e hand , an d ou r organiza tions and financial arrangements to appl y them to th e need s o f men, on the other, ' th e commissio n recommende d ' a comprehensiv e universa l health service s progra m fo r th e Canadia n people. ' Th e majorit y of th e recommendations respectin g denta l service s wer e fo r th e mos t par t i n accordance wit h the proposal s mad e b y th e profession . These include d support fo r fluoridatio n o f community water supplies, dental health educational programs , increase d fund s fo r dental research , denta l treatment benefits fo r all beneficiaries under public assistance programs, immediate action i n increasin g teachin g facilities , hospital arrangement s fo r denta l services, an d severa l othe r points . I n agreemen t wit h the denta l profes sion, th e commissio n state d tha t th e approac h t o denta l healt h shoul d begin wit h th e younges t ag e group s o f th e population . Contrar y t o th e proposals of the profession , it also recommended, i n considerable detail , the establishmen t o f denta l clinic s a s th e metho d o f implementin g th e children's program , an d further , tha t denta l auxiliarie s b e traine d 't o prepare cavitie s and place fillings in the teeth of children an d undertake dental health education and giv e instruction to patient s in self care. ' The report stated tha t 'Thi s progra m mus t have one o f the highes t priorities among our proposals.' The dental profession reacted strongl y against this method o f dealin g wit h denta l car e fo r th e ag e group s tha t ar e mos t important from the standpoint of control and prevention. If a professio n i s t o develo p int o a scientifi c body , ther e mus t b e leaders wh o adhere strongl y t o th e principle s underlyin g this objective. The pric e mus t b e paid . Canadia n dentistr y has bee n fortunat e i n it s leadership an d th e name s o f man y o f thes e me n hav e appeare d i n thi s book. For ove r fort y years , Sydney W. Bradley of Ottawa laboured con sistently towar d stabilizin g th e scientifi c foundatio n o f dentistry . Al l through hi s life, h e quietl y an d withou t publicity gave suppor t t o a re markable number of projects designed to this end. One o f the condition s attached t o hi s contribution s wa s stric t privacy . He wa s a n astut e man in the financia l world . While he was elected to man y professiona l office s

Assessment (1955-1965 ) 25

7

and honoured i n several ways, his main contribution consisted o f financial assistance: no other Canadian dentis t gave so much of his worldly possessions to his profession. Durin g his later years , h e evolved the ide a tha t a national librar y wa s an essentia l part o f an y scientific profession . Such a library wa s establishe d i n 195 1 a t th e headquarter s o f th e nationa l as sociation, an d he consistently gave support in large amounts on an annual basis t o it s development , withou t the knowledg e of hi s confreres . When he died i n 1967 , his wil l left mone y t o assis t i n th e maintenanc e of th e library, whic h wa s the n name d th e Sydne y Woo d Bradle y Memoria l Library. From th e earlies t times , Canadia n dentist s have been ver y active in public life , particularl y o n th e municipa l level, an d hav e occupie d posi tions of trust i n many capacities. J.B . Willmott was Justice o f the Peac e in the town of Milton before coming to Toronto. On e of the earl y dentists of Montreal , Aldi s Bernard, becam e mayo r of tha t city in 187 3 afte r a n active career i n city affairs. Throughou t th e years, dentists in great number hav e serve d municipal , educational , an d charitabl e institution s wit h distinction. A considerabl e numbe r hav e been electe d t o thei r provincia l legislatures, an d a few have served as members of the federal Parliament , beginning with W.D. Cowan of Regina in 1917. 4 Comparatively few dentists hav e lef t th e rank s o f thei r professio n t o ente r othe r vocations . A notable exception however was Gaspard Fauteux, who while serving as a member o f th e Hous e of Common s becam e Speake r o f th e House , an d was create d a membe r o f th e Priv y Counci l i n 1949 . He the n becam e Lieutenant-Governor o f his native province of Quebec, serving from 195 0 to 1958. The percentag e o f women dentists i n Canada i s low when compare d to several othe r countries . Probabl y th e prim e reason wh y more women do no t ente r th e stud y of dentistry i s established custom . Onl y i n recen t years have many Canadian women after marriag e engaged in vocations as a life pursuit. Another deterren t ma y be the cost of dental education, on e of th e highes t amon g the professions . Th e numbe r o f wome n graduate s in most profession s in Canad a i s no t high , althoug h highe r i n medicine than in dentistry.5 With the strong emphasis on children's dentistry, there has develope d a rea l opportunit y fo r mor e wome n dentists ; an d thos e who are in practice invariably have excellent clienteles and report income s comparable to the men. The profession has endeavoured to attract women to dentistry, believing that service s to th e publi c would benefit, bu t with little apparent resul t to date . In earl y times , th e dentis t wa s forced t o inven t his own instruments

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A HISTORY O F DENTISTRY IN CANAD A

and equipment , i f he was to hav e any. Many of the operativ e tool s use d today are improved models of those originally designed by early dentists . As time passed an d ne w techniques developed, th e instrument s and ma terials becam e furthe r improve d throug h researc h b y manufacturer s of dental supplies . However, dentist s als o continue d t o desig n instruments and equipmen t t o mee t thei r needs . Som e dentist s did no t confin e then inventive efforts t o devices related to dentistry. Even a casual examination of patent listing s reveals th e name s of a great number of members of th e dental profession . Th e basi c paten t o n th e rotar y snowplo w for railwa y locomotives was taken out by J. W. Elliott, a Toronto dentist , in 1869 . He appears t o have been on e of the first dentists to invent a practical devic e to meet a real need: his design is still employed i n the snowblowers many

E.R.K. Hart established his practice a t Sackville, NB, in 1898. At the age of 95 in 1969, he was still practising in the original office , statin g that he had no intention of retiring or of cutting down on his work week.

Assessment (1955-1965 ) 25

9

householders us e today. Throughou t th e years , othe r inventiv e dentists have been activ e in the areas of gas-burning, magnetic, and electrica l de vices. Like inventors in general, many have gained no financial advantage but some have done well economically through royalties.8 The literary production o f Canadian dentists ha s not bee n abundant, although man y paper s publishe d i n professiona l journal s exhibi t marked ability. It may seem surprising, but dentist s have published more poetry tha n prose . A fe w poem s writte n b y Dea n Thornto n o f McGil l have survived and sho w talent; Mark McElhinne y of Ottawa published a book o f poem s i n 1927 ; W.A. Blac k o f Toront o wrot e considerabl e poetry, some of which appeared in dental journals; I.B. Ezra o f Windsor published a book of poetry in 1951 ;several poems o f literary merit were published b y Joseph Nolin of Montreal; an d other s hav e published lesser amounts of poetry. I n prose, George Frederick Clark e of Woodstock, NB, is by far th e mos t outstanding of Canadian dentists. 7 During his lifetime , he has published som e fifteen books an d sixt y stories and articles , one of the book s i n 196 8 when he was eighty-five year s old. His writing s have enjoyed a worldwide distribution. Also from Ne w Brunswick, at an earlier date, F.K. Crosby published a considerable amount , chiefly i n prominent magazines o f th e Unite d States . H e wa s a highl y culture d ma n an d hi s publications are probably second in quantity only to Clarke's. A few other dentists have written literature of merit but in general production has been meagre. No statemen t appear s mor e continuousl y o r frequentl y i n denta l literature tha n th e one that dentistr y i s both a n art an d a science. Basi c dictionary meaning s o f 'art ' a s 'skill ' an d 'science ' a s 'o f knowledge, ' meaning knowledge of the basic sciences, in one sense furnish a measuring stick fo r th e advancemen t o f th e profession . Dentistr y bega n a s a skill, and scienc e graduall y becam e a n integra l part , developin g very rapidly after the turn of the century. The scientifi c educatio n of the dentist today has little i n common wit h that o f the graduat e of a fe w decades ago. At some stag e o f developmen t a balanc e wa s reached , betwee n ar t an d science, makin g a true healt h profession . The speculativ e student of the history of dentistry finds great difficulty i n establishing an exact date when this occurred. H e may even be inclined t o conclude tha t th e relationship is an ever-changing one. Historically, Canadia n dentistr y advanced very rapidly from skil l t o scientific profession. Th e earl y difficulties i n gaining recognition of dental care as an essential healt h need have long since been overcome. The long

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struggle fo r adequat e teachin g facilitie s an d qualifie d educationa l per sonnel is largely over. The long-standing policies of the dental professio n respecting prevention an d control o f dental diseases hav e become recog nized by authorities. Dental research receives increasing financial support. These and many other factors augur well for th e future . After year s of stringent labour, a solid foundation for th e profession has been established. Objectives , which were initially considered altruisti c by many, have become recognized a s reality through the ardent advocacy of a host of humane dentists. To these men, the dental profession owes all that Canadian dentistr y stands for today. Th e progres s of the pas t i s the encouragement for the future. N o viable profession can affor d t o clip the coupons o f the histor y of its pas t an d tak e it all for granted . The tas k of the historian is to relate the past, with explanation, and not to predict the future.

Within the last 1 5 years, the facilities for training new dentists in Canada have more than doubled to meet growing national demands for oral health services. Ne w facultie s hav e bee n opene d i n fiv e provinces; established schools have been enlarged and modernized. On th e nex t fou r page s is a sampling o f scene s o f moder n denta l education , spannin g th e countr y from Pacific to Atlantic.

Dental Building, University of British Columbia, opened in 196 8

Oral pathology laboratory, Universit y of Alberta

Health Sciences Building, University of Western Ontario. The Faculty of Dentistry is one occupant of this major new complex, completed in 1968

Dental material s research laboratory, University of Manitoba

Laboratory class , McGill University Closed circuit T V has become a major teachin g tool in dentistry. Students at their lectures can see the same close-up of the patient's mout h as appears on the monitor in this University of Toronto studio

Dental library, Université de Montréal

Dentists-to-be practise their science in the clinic at Dalhousie University, opened in 1958

Notes

CHAPTER 1

Pages 3-10

1 I.E . Anderson, The Peopl e of Fairty,' Contributions to Anthropology 1961-2, Part 1, National Museum of Canad a Bulletin No 19 3 2 I.E . Anderson, 'A Pre-Iroquois Burial Site,' Ontario Archaeology, Publication No 7, the Ontario Archaeological Society , 196 2 3 Kennet h E. Kidd, The Excavatio n an d Historical Identification of a Huron Ossuary,' American Antiquity, Vol 18 4 Anderson , ' A Pre-Iroquois Burial Site' 5 Edit h VanAllen Murphy, Indian Uses of the Native Plants (Desert Printers, Palm Desert, California , 1959 ) 6 Perc y W. Mathews, 'Notes on Diseases amon g the Indians Frequenting York Factory, Hudson Bay,' Canada Medical and Surgical Journal, Vol 13 , 1885 7 J.C . Boilea u Grant, Anthropology of the Chipewayan and Cree Indians, National Museum of Canada Bulleti n No 64, Anthropological Series No 14, 1930 8 Persona l communication from James Tuck, Department of Sociology and Anthropology, Memoria l University, St. John's, Newfoundlan d 9 'Discover y o f prehistori c cemeter y reveals Ohio Indians with arthriti s and ba d teeth,' Journal of the American Dental Association, 1968 10 C.H.M . Williams, 'An Investigation concerning the Dentition of Eskimos of Canada's Eastern Arctic,' Journal of American Academy of Periodontology, 1942 11 D . Jenness, Indians of Canada (Ottawa , 1932 ) 12 Se e the article by A. de H. Smith, Dominion Dental Journal, Vol 34 , December 1922. 13 H.P . Biggar, Voyages of Jacques Cartier, Public Archives of Canada Bulletin N o 11,1924 14 N.B . Dionne, Champlain (Toronto, 1905 ) 15 Nora h Storey, The Oxford Companion to Canadian History and Literature (Toronto, 1967) 16 Fieldin g H. Garrison, An Introduction to the History of Medicine (Toronto, 1929)

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17 Maud e E. Abbott, History of Medicine in the Province of Quebec (Montreal, 1931 ). See also Dictionary of Canadian Biography, Vol I (Toronto, 1966) 18 Almanack de Québec pour tanné 1791 (Quebec Publi c Archives ) CHAPTER 2 Pages 11-20 1 Communicatio n to author from Department of Northern Affair s 2 Menzie s Campbell, From a Trade to a Profession (publishe d for privat e circulation, 1958) 3 Dominion Dental Journal, Vol 26, No 6, June 1914 4 The Examiner, Toronto, 1 January 1840 5 Printe d by R. Stanton, who was publisher o f the Upper Canada Gazette, Printer to the King's Most Excellent Majesty, general printer, stationer, and bookbinder at 164 King Street West, Toronto, ove r a considerable number of years . 6 W.H . Graham, The Tiger of Canada West (Toronto , 1962 ) 7 B.C . Guillet, The Pioneer Farmer and Backwoodsman (Toronto, 1963 ) 8 Ibid. 9 The Telegram, Toronto, 24 December 193 3 CHAPTER 3 Pages 21-38 1 Montrea l Judicial Archive s 2 Nov a Scotia Public Archives, Halifax 3 A.J . McAvenney, 'Early History of Dentistry in New Brunswick,' Dominion Dental Journal, Vol 17, December 190 5 4 Th e first foot engine was invented by Morrison i n 1872. 5 J.A . Bazin, 'Yesterday,' Dominion Dental Journal, Vol 4, May 189 2 6 Description s of the key are to be found in numerous books on the history of dentistry. One of the best concise accounts of the development and use of this instrument is in the Catalogue o f the Menzies Campbell Collection, prepare d b y J. Menzies Campbell (Royal College of Surgeons of Edinburgh, 1966). 7 Annua l reports of this dispensary in the Nova Scotia Public Archives show considerable dental services rendered each year. The report for 189 1 points to 'benefits derived from substitutin g for indiscriminating extraction that of preser vative treatment,' The dispensary continued to operate until the 1920 s when it was replaced by school dental clinics. 8 Northwest Digest, 19 June 1858 9 Victoria Gazette, 23 June 1859 10 Trad e licenses assessment lists, Victoria, 186 3 11 Se e Appendix A, Dentists of 1858 . 12 A complete file of The Nor'-wester is in the Manitoba Public Archives, Winnipeg. 13 Bulletin des recherches historiques, Vol 41 and 49 14 Québe c Public Archives 15 Dominion Dental Journal, January 1890 CHAPTER 4 Pages 39-54 1 N o copy of this circular letter has been found but a description of its contents by Day appears in the Dominion Dental Journal, Vol 10, p 354. Its content is also stated b y several others in the literature.

Notes 26

7

2 W . George Beers , 'Sketch of Dentistry in Canada,' Dominion Dental Journal Vol 12 , July 1900 3 Rober t M. Warner, Profile of a Profession: A History of the Michigan State Dental Association (Detroit , 1964 ) 4 Th e copy of this first constitution an d bylaws was lost for a long period, and was found among the papers of J. Neelands. It was then published in the Dominion Dental Journal, Vol 39, p 171 . 5 Th e Globe reported the meeting at some length, featuring the fact that the organizers wer e from 'east of Port Hope.' 6 Se e Appendix B , Petitio n t o the Ontario Legislature, 1868 . 7 Se e Appendix c, The World's First Dental Act . 8 Privat e communication wit h the author 9 Th e use of the term 'Royal' in the legislation establishing the Royal College of Dental Surgeon s of Ontari o i n 186 8 has been somewhat of a mystery, subject of speculation ove r the years. O f the provincial professiona l acts, this is the only one in which the term appears in the title of the body established. Such use of 'Royal' requires permission of the Queen, a matter requiring considerable time: it must first have the sanction o f the Secretary of State, wh o passes the request, if approved, on to the Governor-General, Wh o if in agreement in turn forwards the request to Buckingham Palace for permission. Eve n with modern means of communication, thi s procedure i s likely to require a minimum of si x months and probably longer. In 1868, the Ontario dental bill was introduced on January 30 and passed o n March 3 . Preceding introductio n som e actio n ma y have occurred respectin g th e title, but this could no t have happened befor e late 1867 , because the preliminary draf t was not prepared until near the end of that year. Diligent searc h for a n answer to this mystery has been made without result. Authorities stat e that the word 'Royal' would not appear in such legislation without permission. Th e papers of John Sandfield Macdonald, first premier of Ontario, are largely lost, but the remaining ones are deposited a t the Public Archives of Canada, Ottawa . Search of these papers has revealed no reference to the matter. These archives possess an accurate list of permissions granted for the use of the term 'Royal' but this list dates only from 1889 . 10 A.J . McAvenney, 'Early History of Dentistry in New Brunswick,' Dominion Dental Journal, Vol 17 , November 190 5 11 W . George Beers , 'Poor Nova Scotia,' Canadian Journal of Dental Science, Vol 3, March 187 1 12 I n a private letter to the author, John J. Salley, Dean of the School of Dentistry, University of Maryland, states: 'Professo r Fole y further advise s that the first and only Canadian dentist to receive an honorary degree (fro m the Baltimore College of Dental Surgery ) was a Dr J. Fayne in 1847 . Another Canadian dentist, Dr E.P. Burroughs, was graduated in 1846 . This would make Dr Burroughs the first Canadian graduat e instead of Dr Nelles. Our records show that Dr Burroughs was the first graduate from a country outside the United States.' Diligent search has not resulted in finding either of these names among Canadian dentists. Presumably they may not have returned to Canada to practice. 13 N o copies of The Family Dentist have been found. The Journal of the Times was a letterhead-size, four-pag e quarterly, of which seven issues were published in total. Perusal of the issues shows that only the first page was devoted to dental subjects. The other pages contained a miscellany of short items and verses of a general nature, extracted from various publications and dealing with subjects from philosophy to odd news events, interspersed with statements respecting the dental practice o f Macallister an d Paine of an advertising nature. A few adver-

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tisements by merchants appeared. Evidently a thief ha d stolen the street sign of the publishers' office, for the following notice appeared in the second issue: THE SIG N O F TH E GOLDE N TOOT H If the person or persons who a few weeks ago stole the large golden tooth from over our door, (we suppose they must have thought it was solid gold) finding it worthless, at least to themselves, will return it, we will not only suitably reward them for their trouble, but will extract all their teeth without charge. This was the largest tooth ever extracted and was originally removed from the mouth of the Kennebeck River; and its loss has caused our cheeks to fal l i n very much. If the tooth i s not returned to us soon, we shall have to supply its loss by an artificial tooth of our ow n manufacture. There is no indication in the next following issues that the tooth was returned. 14 Henr y T. Wood, 'Dentistry and Dentists in Ontario before 1868,' Dominion Dental Journal, Vol 10 , July 1898 15 Canada Medical Journal, Vol 7, 1870-1 16 W . George Beers, 'Amalgam for Fillin g Teeth,' Canada Journal of Dental Science, Vol 3, April 187 1 CHAPTER 5 Pages 55-65 1 Canada Journal of Dental Science, Vol 3, May 187 1 2 Minute s of the Royal College of Dental Surgeons of Ontario, July 1871 3 Canada Journal of Dental Science, Vol 3 , June 1871 4 Ibid. 5 Canada Journal of Dental Science, Vol 3, December 1870 6 Minute s of the Royal College of Dental Surgeons of Ontario, July 1875 7 Ibid. 8 Th e name of the school used in the text is 'Royal College of Dental Surgeons' or 'Toronto school.' The annual announcements of the school from the first (see page 59) up to 1904 bore the title, 'The School of Dentistry, Toronto.' No reference to a change of name has been found in the official records , bu t from 1905 to 192 4 the name used in announcements was 'Royal College of Denta l Surgeons of Ontario in affiliation wit h the University of Toronto.' From 192 5 onwards, the name used has been, 'Faculty of Dentistry, University of Toronto.' But when the school was built at College and Huron Streets in 1909, 'Royal College of Dental Surgeons' was cut in large letters in the stone above the front door, and references to the school contained in records relating to the transfer of the school to the University of Toronto used the name, 'Royal College of Dental Surgeons. " 9 Minute s of the Royal College of Dental Surgeons of Ontario, January 187 7 10 Canada Journal of Dental Science, Vol 4, November 187 7 11 Canada Journal of Dental Science, Vol 4, March 187 8 12 Canada Journal of Dental Science, Vol 3 , December 187 0 13 Canada Journal of Dental Science, Vol 2, August 1870 CHAPTER 6 Pages 66-80 1 Informatio n respecting F.D. Sha w and William Wilson is courtesy of the Glenbow-Alberta Institute, Calgary . 2 Persona l communication to the author 3 Ton y Cashman, 'Edmonton Story,' The Edmontonian 4 British Columbia Gazette, 16 January 1890

Notes 26

9

5 Nov a Scotia Public Archives 6 I n vie w of the statement on this point made in the preceding chapter, som e explanation is necessary. The actual motion adopted by the Board of the Royal College of Dental Surgeons of Ontario on 31 March 189 3 reads: 'Tha t J.B. Willmott be, and is hereby appointed dea n of the schoo l of dentistry at a salar y of $250.00 per annum.' This is the first official action recorded in the minutes respecting the position of dean. The announcement referred to was issued for the year 1888-9. Willmott had been regularly referred to in the dental literature as dean. Two minor references are contained in the Board minutes (188 9 and 1892) to the dean of the faculty but this is all. Explanation fo r this situation may lie in the fact that considerable controversy arose respecting the administration of the school during this period, as explained i n Chapter 7. 7 Dominion Dental Journal, October 189 0 8 Throughou t the text of this book, the name used for a dental organization i s the one current at the time referred to. Several organizations altered their names from tim e to time, often for shor t periods. Ontario Dental Associatio n wa s the name originally adopted in 1867, but the proceedings of the meeting held in July 1868 are entitled those of the Dental Association o f Ontario. B y 1869 the titl e Ontario Dental Society was in use, and this name prevailed, with one or two short interruptions, until 1920 , whe n the organization was incorporated unde r the original name, Ontario Dental Association . 9 Tex t of an address by FJ. Conboy, Dominion Dental Journal, Vol 37, March 1925 10 Privat e correspondence with his grandson, now president of the compan y CHAPTER 7 Pages 81-99 1 Dominion Dental Journal, Vol 2, No 3, July 1890 2 Universit y of Trinity College Archives. The Archivist of Trinity states that ther e is no evidence that actual teaching of dentistry occurred there. 3 Bowmanvill e Statesman, July 1908 4 'J.M . Brimacombe - His Life,' Dominion Dental Journal, Vol 20, September 1908 5 Rober t Tyre, Saddlebag Surgeon: The Story of Dr Murrough O'Brien (Toront o 1954) 6 Dominion Dental Journal, Vol 8, No 1 , January 189 6 7 Lava l University at Montreal wa s a branch of Laval University at Quebec until 1920, when it became the University of Montreal. 8 Th e name of Josephine Wells appears on the Register of the Royal College of Dental Surgeons of Ontario, numbered 616. 9 Anni e Grant Hill appears on the Register of the College of Dental Surgeons of the Province of Quebec, numbered 135. 10 I n describing this machine at some length in its 1 8 June 1898 issue, Scientific American reported: 'It was rebuilt for winter use by Dr H.E. Casgrain of Quebec, Canada. I t is an interesting development of the automobile vehicle and opens another field for those who are working on the important problem of automobile propulsion.' 11 Denta l literature contains many references to the implantation of teeth by John Hunter. In a copy of his book, A practical treatise on the diseases of the teeth (Ixmdon, 1778) appear s a footnote: ' I may here just remark that the experiment is not generally attended with success. I succeeded but once out of a great

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number of trials.' The author is indebted to Menzies Campbell of Glasgow for accuracy on this point. 12 Cataphoresi s must not be confused with electrolytic medication (ionization ) which came into use two decades later . 13 I n part the statements respecting Frank Price ar e based upon privat e correspondence with his son, Dr Harold W. Price of Calgary. 14 O n this point see Chapter 17. 15 I n a letter to the secretary of the Provincial Boar d of Health, 1 0 February 1896 , Adams stated that he had operated his dental hospital for 25 years. 16 Dominion Dental Journal, Vol 5, April 189 3 17 Dominion Dental Journal, Vol 9, October 1897 18 Base d on 190 1 census figures CHAPTER 8 Pages 100-112 1 Fro m a 16-pag e bookle t prepare d an d distributed b y W.K. McNaught, propos ing erection of a suitable memorial to Beers in the city of Montreal. Copie s exist in several archives and libraries. McNaugh t was one of Toronto's leading businessmen of the period. 2 Fro m 189 6 to 190 6 inclusive, Bishop's conferred 86 dental degrees, of which 26 were granted in 1896 to dentists who had already qualified wit h the Quebec Board. See D.C. Masters, Bishop's University: The First Hundred Years (Toronto, 1950) 3 Origina l documents in the library of McGill University 4 Dominion Dental Journal, Vol 14, No 3, March 1902 5 D.H . Baird' s son, Kenneth Martin Baird, was Director-General Denta l Service s of the Royal Canadian Dental Corps, 1958-66 . 6 Dominion Dental Journal, Vol 16 , No 10 , October 1904 7 Thi s is one of the peculiarities found in the records. Juvet's name does not appear among the successful candidates at the first examination of the Dominion Dental Council. Seven candidates took the first examination, of whom four were successful: J.W . Coram, J.W. Clay, W.R. Glover, and E.C. Jones. 8 Dominion Dental Journal, Vol 12, No 1, January 190 0 9 Dominion Dental Journal, Vol 16, No 3, March 1904 CHAPTER 9 Pages 113-135 1 Dominion Denial Journal, Vol 17 , No 6, June 1905 2 Amon g recent articles about Parker are The Grea t Tycoon' (True, June 1956) and 'Painless Parker' (Maclean's, 1 5 December 1949) . All through his career he gained a great deal of newspaper publicity in addition to his advertisements, which were often full-page in size. 3 Dominion Dental Journal, Vol 26, No 6, June 191 4 4 Le Bulletin des Recherches Historiques, Vol 36, No 9, September 1930 5 Archive s of Canadian Dental Association 6 Th e spelling in official documents during this era is 'North-West' and in other records it tends to be 'Northwest'. 7 Cop y of the register is in the CD A archives. 8 Addres s delivered previous to the visit of William Hunter. Dominion Dental Journal, Vol 22, No 6, June 191 0 9 The Lancet, 14 January 191 1

Notes 27

1

10 Arthu r W. Lufkin, History of Dentistry (Philadelphia, 1948 ) 11 Fo r the most part this information was secured by personal interview with Dr Lindsay, just previous to his death in 1968. 12 Th e number of practising dentists in Canada wh o did not possess a university degree continued to diminish very rapidly. By the 1940 s it became difficult t o find, even among older practitioners, a dentist who did not hold a university degree. 13 Th e establishment of dental laboratories continued to be strongly opposed b y some dentists, as the following item from the minute s of the 191 0 annua l meeting of the Quebec licentiates indicates: Th e matte r of the King Dental Laboratory being brought up, Dr Masson complained of the harm that such laboratories were doing to young graduates. Drs Nolin, Mallet and Dubeau took part in the discussion and finally the matter wa s left with the Board.' 14 A n editorial in the Dominion Dental Journal, Vol 17, No 9, September 1905, stated: 'It is a fact, and has been for years, that there are more Canadians obtaining their dental education in the United States than there are in Canada.' 15 Dominion Dental Journal, Vol 18 , No 10 , October 190 6 CHAPTER 10 Pages 136-149 1 I n 1968 , a Royal Commissio n int o Civil Rights, which had been appointed b y the Ontari o Government, reporte d at considerable lengt h on the whol e matter of self-governmen t by the professions. Man y matters respecting legal procedures in the conduct of proceedings by self-governing boards and councils were discussed with recommendations fo r improvement. Perhaps the most important recommended change was that lay members be appointed 'to each of the selfgoverning bodies o f the self-governin g professions and occupations,' in order t o give protection t o the public. However, the report emphasized that 'the educational training of members of the professions extends over many years and puts members of a profession i n the best position to judge.' 2 Fo r others so honoured, see Appendix H. 3 Dominion Dental Journal, Vol 26, No 5, May 1914 4 Persona l communication with the author 5 M r Gerald V. Carveth of Grande Prairie, in a personal communication 6 Thi s was recognition by a public authority. Voluntary efforts by the Halifax Visiting Dispensary and J.G. Adams have been described in earlier chapters. 7 Dominion Dental Journal, Vol 23, No 10 , October 191 1 8 A good description is to be found in The Britannica Year Book 1913. CHAPTER 11 Pages 150-164 1 Eventually , small payment was offered t o these volunteer dentists, calculated at a rate of $3 per visit. A copy of a letter has survived, signed by twenty-five dentists who had served in this capacity, recording their appreciation for the money and returning the cheque in support of the military dental clinic. 2 Thornto n was in his senior year at time of enlistment and his name appears in the 1917 class of McGill dental graduates. Ranks were allotted without complete regard to regulations in these first overseas units. 3 Se e No 3 Canadian General Hospital in France (published b y McGill University in 1916) an d R.C. Fetherstonaugh, No 3 Canadian General Hospital (McGill) 1914-1919 (Montreal , 1928 )

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HISTORY OF DENTISTRY IN CANADA

4 H.M . Jackson , The Story of the Royal Canadian Dental Corps. Severa l persona l accounts of war experiences have appeared i n dental literature. One of the best, 'Personal Reminiscences of a Field Ambulanc e Dental Officer, ' b y RJ. Godfrey, was published i n the Journal of the Ontario Dental Association, Vol 42, No 8, August 1965 . 5 'Canad a Leads the Way,' reprinted fro m the Canadian Gazette (Londo n ), Dominion Dental Journal, Vol 30, No 4, April 1918 6 Dominion Dental Journal, Vol 32, No 9, September 192 0 7 Considerin g tha t the x-ray was just beginning to come into general use in the dental office, th e following extract from one of Hemingway's articles (Toronto Star Weekly, 1 0 April 1920 ) i s notable: Th e x-ra y is not infallible, according t o dentists. Too many dentists accept the x-ray picture as final and order the tooth pulled. The x-ray should only be one step in the diagnosis. I t may show almost anything, depending upon the angle from which it is taken and the skill of the dentist who is reading it.' 8 Th e government indicate d that it would make the grant before the students were accepted, bu t an anxious period o f delay occurred before the grant received formal government approval . 9 Th e basic reason fo r discontinuing the course then was that the University of Toronto raised the admission requirements in accord wit h those of all its other courses, and this action drastically reduced the number of applicants. 10 Dominion Dental Journal, Vol 35, No 1 , January 1923 CHAPTER 12 Pages 165-174 1 Dental Education in the United States and Canada, Carnegie Foundatio n for th e Advancement of Teaching, Bulleti n No 19 , 1926 2 Proceedings of the Dental Centenary Celebrations (1840-1940) (Baltimore, 1940) 3 Dominion Dental Journal, Vol 32, No 11 , November 1920 4 Origina l copies of these circulars exist in the archives of the Canadian Dental Association. 5 A Course of Study in Dentistry: Report of the Curriculum Survey Committee (American Association of Dental Schools, 1935 ) 6 Today' s debate centres on the position o f the dentist in hospitals, health service plans, group practice, and similar matters. 7 Dentist s in this era were faced with patients for whom the diagnosis was already made. Great tact and diplomacy were required in dealing with the situation, especially when the dentist knew that the diagnosis was incorrect. 8 Dominion Dental Journal, Vol 37, No 1 , January 192 5 9 Dominion Dental Journal, Vol 36, Nos 1 0 and 11 , October and November 1924 CHAPTER 13 Pages 175-185 1 Th e records of the Canadian Dental Hygien e Council are deposited in the Archives of the Canadian Dental Association . 2 Dominion Dental Journal, Vol. 3 9, No 7, July 1927 3 Se e Appendix E, Establishment o f Departments o f Health in Canada . 4 Th e program of a combined meetin g of the Dental Association of the Province of Nova Scotia an d the New Brunswick Dental Societ y held at Amherst, NS, in

Notes 27 August 1900 contains th e following item: 'Combination Gold an d Amalgam Contour Fillings Using a Matrix by H.E. Bulyea.' 5 R.A . McEwen, at present a member of the teaching staff o f the School of Dentistry, Emor y University, Atlanta, Georgia , i n a private communication 6 Dominion Dental Journal, Vol 39, No 5 , May 1927 . See Appendix I for PH D degrees earned in dentistry at Canadian universities . 7 'Résum é de l'évolution d e la chirurgie-dentaire au Canada,' Journal de l'Association Dentaire Canadienne, October 194 3 8 Proceedings of the Royal College of Dental Surgeons of Ontario, 1929-30 9 A transcript of this meeting is in the Archives of the Canadian Denta l Association. CHAPTER 14 Pages 186-196 1 Sylviste r Moyer, 'The Practice of Dentistry i n the Drought Area of the West,' Journal of the Canadian Dental Association, Vol 1 , No 3 , March 1935 . The widow of a blacksmith requested tha t he accept the whole blacksmithing outfit in payment for a complete se t of dentures. On this exchange the dentist did very well, but at a much later date . 2 Privat e interview with R.S. Langstroth o f Fredericton . 3 Journal of the Canadian Dental Association, Vol 1 , No 3 , March 1935 4 Dominion Denial Journal, Vol 42, No 7, July 193 0 5 British Dental Journal, Vol 53, No 7, 1 October 193 2 6 Th e first is from the Journal of the Ontario Dental Association, Vol 7, No 8, August 1932; the second from the Dominion Dental Journal, Vol 46, No 1, January 1934 7 Se e Appendix G, Dental Journalism i n Canada . 8 Journal of the Ontario Dental Association, Vol 7, No 9 , September 193 2 CHAPTER 15 Pages 197-206 1 Study of the Distribution of Medical Care and Public Health in Canada (1939), published by the National Committe e fo r Mental Hygiene (Canada ) 2 Canadia n Dental Association, ' A Submission to the Royal Commission on Dominion-Provincial Relations, ' 1938 3 Report of the Royal Commission on Dominion-Provincial Relations (the Rowell-Sirois Report) (Ottawa , 1940 ) 4 H.M . Jackson, The Story of the Royal Canadian Dental Corps CHAPTER 16 Pages 207-218 1 Hug h H. Wolfenden, A Memorandum for the Dental Profession on the Subject of National Health and Health Insurance (December 1949 ) ; Principles of a Dental Health Plan (Royal College o f Dental Surgeons of Ontario, February 1942) ; Don W. Gullett, An Outline of Health Insurance Referring to Dentistry in Particular (May 1942 ) 2 Thi s presentation, togethe r with others, wa s published by the Canadian Dental Association i n The Dental Profession in Canada and Health Insurance (1944) and distributed to Canadian dentists .

3

274 A

HISTORY OF DENTISTRY IN CANAD A

3 Th e chairman of the government advisory committee had specifically stated tha t only two representatives o f the profession shoul d appear before the committee . 4 L.C . March, Report on Social Security for Canada ( 1943 ) 5 Health Insurance, Report of the Advisory Committee on Health Insurance to the House of Commons Special Committee on Social Security (Ottawa , 1943) 6 Proceeding s of the Special Committe e on Social Security of the House of Commons, May 194 3 7 Proceedings of the Canadian Dental Association, 1943. This statement gave the representatives mor e concern than any other at the meeting. 8 Journal of the Canadian Dental Association, Vol 10 , No 1 , January 1944 9 J.W . Pickersgill and D. F. Forster, The Mackenzie King Record, Vol n (Toronto , 1968) 10 Canadia n Medical Procurement an d Assignment Board , Report of the National Health Survey 11 Proceedings of the Royal College of Dental Surgeons of Ontario, 1944 CHAPTER 17 Pages 219-235 1 Th e 1917 minutes of the Eastern Ontario Dental Association recor d th e following motion: That in the establishment of the Federal Departmen t of Health this Association feel s that the importance of the profession of dentistry demands that it shall be fully recognized b y and adequately represented i n this department.' Subsequently other dental organizations too k similar action, but this is the first recorded statemen t b y the profession that dentistry should be a part of the proposed department . 2 Se e Chapter 7. 3 Dominion Dental Journal, Vol 21, No 1 , January 1909 4 Hous e of Commons Debates, May 194 8 5 I n 1946 , Diplomas in Dental Publi c Health (DDP H ) were awarded by the University of Toronto t o H.K. Brown , S.L. Honey, F.A. Kohli , and H.R. McLaren. These were the first Canadian dentist s to qualify . 6 Thes e 1 7 dentists were graduates of the following dental schools: Dalhousi e University, 6; Royal College of Dental Surgeons, 2; St Louis University, 2; McGill University, University of Toronto, Pennsylvania College of Dental Surgery, Georgetown University , Universit y o f Heidelberg, Universit y of Dublin, Temple University, 1 each. CHAPTER 1 8 Pages 236-249 1 A t the 191 7 General Assembly of the Licentiates of the Province of Quebec, a motion was presented instructing the Dental Boar d to establish a school for dental nurses. No action followed. The discussion which occurred at the time indicates that behind the motion was the valuable service of dental sergeant s (assistants) i n the Dental Corps during the first world war. 2 Mar y A. Brett of Regina became the first registered dental hygienist in Canada in May 1950 . She graduated from the School of Dental Hygiene of th e University of Minnesota i n 1948. Her father, A.J. Brett, was secretary of the Dominion Dental Council fo r many years. 3 Transactions of the Canadian Dental Association, 1952 4 Journal of the Canadian Dental Association, Vol 18 , No 1 , January 1952

Notes 27

5

CHAPTER 1 9 Pages 250-264 1 Se e Appendix J, Canadia n Dental Schools. 2 Harvar d University established th e first dental school under university discipline in the United States in 1867, and awarded the degree of Doctor of Dental Medicine to graduates. As of 1969 , out of 52 dental schools in the United States, the graduates of 1 0 schools receive the DMD degree. Graduates of the other u.s. schools receive the Doctor of Dental Surgery (DOS) degree . 3 Report of the Royal Commission on Health Services (Ottawa, 1964) 4 Se e Appendix F, Dentists in the Parliament o f Canada . 5 Th e number of women students in Canadian medical schools has risen notably in recent years. In 1968 , more than 1 2 per cent of medical students were women; in 1964, it was reported tha t 7.6 per cent of active physicians in Canada were women. In comparison, th e percentage o f dental students who were women was 4.7 in 1968. The highest percentage of active women dentists was 2.3, in 1967. 6 Amon g many others, John Downer of Toronto during the 1920 s invented the electrical device for heating hot water in general use in homes today, and A.H. Goodwin of Edmonton invente d several devices for the use of natural gas early in this century. The inventions of H.E. Casgrain and William Green have been referred to in the text. 7 H e is the only Canadian dentist appearing as an author in the Orford Companion to Canadian History and Literature.

Appendices

A Dentist s of 185 8 B Petitio n to the Ontario Legislature, 1868 c Th e World's First Dental Act: Ontario, 186 8 D Canadia n Dental Organizations, 1905 E Establishmen t of Departments of Health in Canada F Dentist s in the Parliament of Canada G Denta l Journalism in Canada H Honorar y Degrees Conferred on Canadian Dentists I Degree s of Doctor of Philosophy Earned by Graduates of Canadian Dental Schools j Canadia n Dental Schools K Recommendation s by the Canadian Dental Association to the Royal Commission on Health Services, 1962

277

Appendices A Dentist s listed in directories for the year 1858 (Population figures given in parentheses) NOVA SCOTIA Halifax (25,126 )

M.F. Agnew S. Foss N.A. Glover McAllister & Paine L.E. VanBuskirk

NEW BRUNSWICK

Saint John (27,300 ) Fredericton Woodstock

C.K. Fiske T.A.D. Foreste r J.C. Hathaway Mr Archer Hiram Dow W.A. Balloch

CANADA BAST

Quebec (51,000 ) Montreal (75,000 )

Sherbrooke (3,000 ) Three Rivers (7,000) Waterloo (1,500 )

Pierre Baillargeon John McKee H.D. Ross C.M. Dickinson Charles Brewster George VanBuskirk H.M. Bowker Aldis Bernard None listed None listed None listed

CANADA WEST

Belleville (7,000 ) Brantford (8,000 ) Brockville (5,000 ) Cobourg (7,000) Gait (3,000) Guelph (4,500 )

G.V.N. Relyea J.N. Acret John P. Sutton T.W. Smythe F.G. Callande r R. Reid Henry S.M. Swift

278

Hamilton (29,000 )

Kingston (13,000 ) London (16,000 ) Ottawa (10,000) Newmarket (1,000) Perth (2,500 ) Picton (2,000 ) Port Hope (5,000 ) Prescott (4,000 ) St Catharines (6,500 ) St Mary's (2,500 ) Toronto (50,000 )

Whitby (3,500 ) Zimmerman (60 )

A HISTORY O F DENTISTRY I N CANAD A

C.S. Chittenden George S. Smith Myles B. Stennett John Rei d B.W. Day D.G. French A.C. Ston e Darius Perrin F.D. Laughli n R. Moore G.W. Ebertson W.H. Gilber t S.B. Chandler Edwin Church J. Harrison Francis Smit h John McLean W.C. Adams George L. Elliott John W.Elliott Mortimer Frenc h J.B. Jones Justice S. Jones Johnson Zimmerman

The source of the above information is the Canada Directory (Canad a East and Canada West), published in 1858, and directories for Nova Scotia and New Brunswick published in the same year. These directories list by muncipalities each resident with his occupation. The directories are restricted however to more or less permanent residents: they would not take into account itinerant dentists nor the tendency of other practitioners to move often fro m place to place in search of a better location. Names other than those above are to be found in the dental literature. For example, L. Clements stated, some thirty years later, that he had established practice at Kingston in September 1857, but probably he was not considered a resident when the directory was compiled. The above information gives some relative idea only of 'established' practice at that time.

Appendices 27 B Petitio n to the Ontario Legislature An exact copy of the petition presented to the Ontario Legislature by the Ontario Dental Association, 23 January 1868. The original reposes in the Ontario Archives, Toronto.

9

280

A HISTORY O F DENTISTR Y I N CANAD A

Appendices

281

282

A HISTOR Y O F DENTISTR Y I N CANAD A

Appendices 28 C Th e world's first dental Act, Ontario, 1868 A copy of the Act, reproduced b y courtesy of the Ontario Archives, Toronto

3

288

A HISTORY OF DENTISTR Y IN CANAD A

D Canadia n dental organizations, 1905 A page from the Dominion Dental Journal, April 1905 Directory o f Officia l an d Voluntar y Denta l Associations an d Societie s o f Canad a OFFICIAL NOVA SCOTI A DENTA L BOARD . President—Hibbert Woodbury, D.D.S., Halifax . N.S . Secretary—Geo. K . Thomson , D.D.S., Hálito, N.S . PRINCE EDWAR D ISLAND . President—Dr. J. E . McDonald . Summerside, P.E.I. Secretary—Dr. J . H . Ayers , Charlottetown , P.E.I .

BOAKD o r TH E ROYA L COLLEG E O P DENTA L SURGEONS o r ONTAEIO . President—H. R. Abbott, D.D.S., London, Ont. Secretary—;. B . Willmott, D.D.S., 96 College Street , Toronto, Ont. MANITOBA DENTA L ASSOCIATION . President-G. J. Clint , D.D.S., Winnipeg , Man. Secretary— G. F . Bush , D.D.S., Winnipeg, Man.

NEW BRUNSWIC K DENTA L SOCIETY .

NORTH-WKST TERRITORIES DENTA L ASSOCIATION .

President—J. W. Moore, D.D.S., St. John, N.B . Secretary-Frank A . Godsoe, D.D.S., SL John, N.B .

President—R. C. McLure. D.D.S. , Lethbridge, AIM . Secretary—P. F . Sue, D.D.S. , Moosejaw , Asta .

QUEBEC DENTA L BOAR D O F EXAMINERS . President—C. E. Hyndman , D.D.S., Sherbrooke Que.

BRITISH COLUMBI A DFNTA L ASSOCIATION . President—T. J. Jones , D.D.S., Victoria , B.C . Secretary— Richard Nash , D.D.S. , Victoria, B.C . YUKON I ENTA L BOARD .

Secretary—Eudore Dubeau , D.D.S. , 39 6 St . Deni s Street, Montreal , Que.

President—A. J. Gillis , M.D., D.D.S. , Dawson, Y.T . Secretary-C. H. Wells, L.D.S., Dawson , Y.T .

VOLUNTARY CANADIAN DENTA L ASSOCIATION . President—Eudore Dubeau , Montreal. Secretary—Dr. C . F . Morison , 1 4 Philli p Square , Montreal. MARITIME DENTA L ASSOCIATION . President .

M e Arthur, D.D.S., Truro, N.S .

Secretary—G. K . Thompson, D.D.S., Halifax . N.S . DENTAL SOCIET Y O F WESTER N CANADA . President—S. W . Mclnnis . D.D.S. , Brandon , Man. Secretary—C. P . Banning , D.D.S. , Mclntyr e Build ing, Winnipeg Man . ONTARIO DENTA L SOCIETY . President—A. W . Thornton , D.D.S., Chatham, Ont. Secretary—Guy G. Hume , D.D.S., 338 CarltonStreet, Toronto, Ont . LA SOCIETE D'ODONTOLOGI C CANADIENN E FRANÇAIS E President—Joseph Nolin , Montreal . Secretary—Eudore Dubeau , 39 6 St . Deni s Street , Montreal.

WESTERN ONTARI O DENTA L SOCIETY . President—J. Mills , D.D.S., Brantford , Ont . Secretary-C. E . Snell , D.D.S.. ESM X Centre , Ont. BRANT COUNT V DENTA L SOCIETY . President—John Mills . Secretary—F. Brittqn . LONDON DENTA L SOCIETY . President—A. E . Santo , D.D.S., London , Ont. Secretary—S. Campbell , D.D.S. , London , Ont. ELGIN COUNT Y DENTA L SOCIETY . President—G. T. Kennedy , St. Thomas , Ont . Secretary—C. B . Taylor , D,O.S., St. Thomas, Ont . TORONTO DENTA L SOCIETY . President—Chas. E. Pearson , Toronto . Secretary—C. Angu s Kennedy , 73 8 Quee n St. East , Toronto, On L MONTREAL DENTA L CLUB .

EASTERN ONTARI O DENTA L SOCIETY . President—W. J . Gunn , D.D.S., Cornwall, Ont.

President—G. W . Oliver , 268 1 St . Catherin e Street, Montreal.

Secretary—W. B . Cavanagh , D.D.S. , Cornwall, Ont.

Secretary—W. Watson, D. D.S., 48 Park Ave-, Montreal.

Appendices 28

9

E Establishmen t of Departments of Health and Divisions of Dental Health

Federal Government 191 British Columbia 194 Alberta 191 Saskatchewan 192 Manitoba 192 Ontario 192 Quebec 192 New Brunswick 191 Nova Scotia 193 Prince Edward Island 193 Newfoundland 195

Dental Department Divisio n 9 194 5 6 194 9 9 195 9 3 194 8 8 194 6 3 192 5 6 194 3 8 194 8 0 194 8 1 195 0 0 195 2

Departments o f Health in provincial governments were preceded by Provincial Boards of Health. New Brunswick was the first province to establish a department of health and Ontario was first to establish a dental division. The Rowell-Sirois Commission Report contains the following statement: 'Ne w Brunswick alone of the provinces had established a permanent board of health in 1866.'

290

A HISTOR Y O F DENTISTR Y I N CANAD A

F Dentist s in the Parliament of Canada SENATE Baillargeon, Pierre Phillips, Orville Howard Smith, Donald HOUSE OF COMMONS

Armstrong, Ernest Frederic k Buchanan, William Murdock Cowan, Walter Davy Duguay, Joseph Leonard Fauteux, Gaspar d (Speaker of House, 1945-9; Member of the Privy Council, 1949 ; Lieutenant-Governor of Quebec 1950-8) Haley, Allen Hall, William Samuel Larue, Perrault Leduc, Rodolphe Mang, Henry Philip McDougall, John Lome McKay, Matthew Phillips, Orvill e Howard Pommer, William Albert Price, Otto Baird Richard, Charles Slogan, Joseph Smith, Donald Stewart, John Smith

1874-91 19631955Year(s) Elected 1925 1953 1917-30 1930 1942-45-49

1896 1935 1958 1936-40-54-58-62-63 1953 1949-53 1921-35 1957-58-62 1953 1925-26-30 1958 1958-62 1949 1930

Appendices 29

1

G Denta l journalism in Canada THE FAMILY DENTIST published by S.S. Blodgett, Brockville, Ontario, 1854-7 . A few issues only, number unknown THE JOURNAL OF THE TIMES published quarterly b y MacAllister& Paine a t Halifax, Nova Scotia. First issue dated September 1858 ; last issue May and June 1860 ; seven issues in all (The above two publications were individual efforts and more in the nature of promotion fo r the respective practices than true journalism.) CANADA JOURNAL OF DENTAL SCIENCE published monthly at Montreal, excep t for one year at Hamilton. EDITOR W. George Beers. Really the pioneer dental journal in Canada. First issue June 1868. Volumes 1,2 and 3 complete. Fou r widely separated issues in volume 4 appeared, the last being August 1879 DOMINION DENTAL JOURNAL published at Toronto, quarterly 1889-90, bimonthly 1891-2, monthly 1893-1934 (Vol 1-^6). EDITORS

W. George Beer s 1889-190 0 Albert E. Webster 1901-193 4 The Dominion Dental Journal absorbed the Canada Journal of Dental Science (1889), and in turn was taken over by the Journal of the Canadian Dental Association (1935 ) ASH'S CANADIAN MONTHLY CIRCULAR published at Toronto 1910-1 9 (Vol 1-9). Began as a monthly and ended as a quarterly (Ash's Canadian Quarterly) DENTAL PRACTICE published monthly at Toronto 1906-13 (Vol 1-14, two volumes a year). EDITOR Robert J. Reade Became merged with a medical journal ORAL HEALTH published monthly at Toronto 191 1 to the present . EDITORS

Wallace Seccombe 1911-3 5 Thomas Cowling 1936-5 0 Wesley J.Dunn 1951-5 3 J.H. Johnson 1953-6 6 D.B. McAdam 1966-6 8 J.M. Kerr 1969 -

292 A

HISTORY O F DENTISTRY I N CANADA

REVUE DENTAIRE CANADIENNE published monthly at Montreal 1918-3 4 (Vol 1-17). EDITOR Honoré Thibaul t Absorbed by Journal of Canadian Dental Association ( 1935) JOURNAL OF THE ONTARIO DENTAL ASSOCIATIO N published monthly at Toronto. Vol 1-6, No 5,1926, under title of The Booster. Vol 6, No 6,1931 to date under title of The Journal of the Ontario Dental Association. EDITORS FJ. Conboy 1926-4 2 E. A. Grant 1942-4 5 G.T. Mitto n 194 5 (November and December only) S.L. Honey 1946-5 1 A.W. Lindsay 1952-6 7 J.H. Johnson 1967-6 9 C.F. Capp a 1970 JOURNAL OF THE CANADIAN DENTAL ASSOCIATION published monthly at Toront o 1935 to the present. Absorbed Dominion Dental Journal and Revue Dentaire Canadienne (1935) EDITORS

M.H. Garvín 1935-5 3 (includin g June issue) W.J. Dunn 1953-5 8 E.R. Bilkey 1959-6 0 F.H. Compton 1960 FRENCH EDITORS

Philippe Hamel 1935-3 6 Alcide Thibaudeau 1937-4 6 Gerard deMontign y 1946-6 4 Georges Pelletier 1965-6 8 M. Tenenbaum 1969 ADDITIONAL PUBLICATIONS

The following are currently published: Royal Canadian Dental Corps Quarterly (Vo l 1,1960), Ottawa. B.C. Dental Bulletin (formerly B.C.D.A. News), College of Dental Surgeons of British Columbia, Vancouver. A.D.A. News-Information, Albert a Dental Association, Edmonton . College of Dental Surgeons of Saskatchewan Newsletter, Saskatoon.

Appendices 29

3

The Bulletin, Manitoba Dental Association, Winnipeg. Information, Colleg e of Dental Surgeons of the Province of Quebec, Montreal. Le Journal dentaire du Quebec (Vol 1,1963 ), L'Association dentaire de la Province d e Québec, Montréal . N.S.D.A. News, Nova Scotia Dental Association, Halifax. Bulletin mensuel de la Société dentaire de Montréal, Montréal. Mount Royal Dental Society News Letter, Montreal. McGill Dental Review, McGill University Undergraduate Dental Society, annual from 1934 , now biannual, Montreal. University of Toronto Undergraduate Dental Journal (Vo l 1,1964), three issues per volume, Toronto. This journal replaced Hya Yaka (Vo l 1, No 1 , October 1903 ) issued monthly (ten issues per year) until 1929, when it became an annual. University of Western Ontario Dental Students Society Journal (Vol 1,19667). Annual. London, Ontario . Dalhousie Dental Journal (Vo l 1, 1960). Annual. Halifax.

294 A

HISTORY O F DENTISTRY IN CANAD A

H Honorar y degrees conferred on Canadian dentists 1914 J.B . Willmott LLD , University of Toronto 1919 Fran k Woodbury L L D, Dalhousie University 1932 A.E.Webste r LLD , University of Toronto 1943 Fran k M.Lott DOS , Université de Montréal 1945 A.W.Lindsa y LLD , University of Toronto 1950 Joh n Clay LLD , University of Alberta 1953 W.W . Woodbury LLD , Dalhousie University 1954 A.J . Coughlan B sc, St Joseph's University 1957 J.S.Stewar t LLD , University of Alberta M.H. Garvin LLD , University of Manitoba 1958 D.W . Gullett DOS , Université de Montréal A.J. Coughlan LLD , Dalhousie University Ernest Charron LLD , Dalhousie University D.W. Gullett LLD , Dalhousie University 1959 A.D.A . Mason LLD , University o f Toronto 1960 H.J . Merkeley LLD , University of Manitoba J.S. Bagnall LLD , Dalhousie University H.E. Bulyea LLD , University of Manitoba 1961 H.K . Brown LLD , University of Alberta 1962 J.B . Macdonald LLD , University of Manitoba 1963 D.W . Gullett DSC , Temple University 1967 J.B . Macdonald DSC , University of British Columbia 1968 R.G . Ellis LLD , University of Western Ontario 1969 Georg e F. Clarke LLD , University of New Brunswick

Appendices 29 I Degree s of Doctor o f Philosophy earned by graduates of Canadian dental schools up to 1969 1920 Harol d K. Box Universit y of Toronto ( Pathology ) 1940 P.M . Lott Universit y of Toronto (Militar y Dentistry) 1941 R.G . Agne w Universit y of Toronto (Oral Pathology) 1950 S.W.Leun g Universit y of Rochester (Physiology ) 1953 J.B . Macdonald Columbi a University (Microbiology) 1953 KJ . Paynter Columbi a Universit y (Anatomy) 1958 JohnFindla y Glasgo w Universit y (Endocrinology ) 1958 I . Kleinberg Universit y of Durham (Biochemistry) 1959 Gran t T. Phipps Pennsylvani a Stat e University (Psychology ) 1959 W . Stuart Hunter Universit y of Michigan (Anthropology) 1959 J.P . Lussie r Universit y of California (Endocrinology) 1959 Osca r P . Sykora Universit y of Montreal (Slavic Languages) 1963 R.V . Blackmore Universit y of Rochester ( Microbiology ) 1964 M.C.Johnso n Universit y of Rochester (Embryology) 1964 A.T . Store y Universit y of Michigan (Physiology) 1965 Trevo r Harrop Universit y of Iowa (Anatomy) 1967 H.W . Kaufma n Universit y of Manitoba (Oral Biology) 1967 N.S . Taichman Universit y of Toronto (Immunopathology) 1967 Jame s Sanaham Universit y of Manitoba (Oral Biology) 1968 A . Ian Hamilton Universit y of London (Anatomy) 1969 J.E . Staki w Universit y of Manitoba (Ora l Biology)

5

296 A

HISTORY OF DENTISTRY IN CANAD A

J Canadia n dental schools Royal College of Dental Surgeons (Establishe d 1875 ) * DEANS

J.B.Willmott 1875-191 5 A.E. Webster 1915-2 3 Wallace Seccombe 1923- 5 Became Faculty of University of Toronto in 1925 Faculty of Dentistry, Universit y of Toronto DEANS Wallace Seccombe 1925-3 6 A.D.A. Mason 1936-4 7 R.G. Ellis 1947-6 9 Gordon Nikiforuk 1970 The Dental College of the Province of Quebec (Established 1892 ) DEAN W. Georg e Beer s 1892- 6 Became a part of University of Bishop's College in 1896 Faculty of Dentistry, University of Bishop's College DEANS W.George Beers 189 6 J.H. Bourdo n (acting ) 189 7 Stephen Globensky 1897- 9 J.G. Globensk y 1899-190 0 W.J. Kerr 1900- 1 W.J. Giles 1901- 2 Peter Brown 1902- 4 Became two schools in 1905 : Department of Dentistry of the Faculty of Medicine, McGill University; and École de chirurgie dentaire, Université Laval École de chirurgie dentaire, Université Laval DOYEN Eudore Dubeau 1905-2 1 Became Faculty, Universit é de Montréal in 1921 *'Established' signifies th e year when th e first class of student s was accepted by the school

Appendices 29 Faculté de chirurgie dentaire, Université de Montréal DOYENS Eudore Dubeau 1921-4 4 Ernest Charron 1944-5 8 Paul Geoffrion 1959-6 4 Jean-Paul Lussier 1964 Department of Dentistry, Faculty of Medicine, McGill University HEADS Peter Brown 1905- 9 DJ. Berwick 1910-13 A. W.Thornton 1913-2 0 Became Faculty of McGill University in 1920 Faculty of Dentistry, McGill University DEANS A.W.Thornton 1920- 7 A.L. Walsh 1927-4 8 O.P. Mowry 1948-5 5 James McCutcheon 1955-7 0 E.R. Ambrose 1970 Maritime Dental College (Establishe d 1908) DEAN

Frank Woodbury 1908-1 2 Became Faculty of Dalhousie University in 1912 Faculty of Dentistry, Dalhousie University DEANS

Frank Woodbury 1912-2 2 Frank W.Ryan 1922- 4 George K. Thompson 1924- 3 5 W.W. Woodbury 1935-4 7 J. Stanley Bagnall 1947-5 4 J.D. McLea n 1954 Department of Dentistry, Faculty of Medicine, University of Alberta (Established 1918)

DIRECTOR

H.E.Bulyea 1918-4 2 Became Faculty of University of Alberta in 1942

7

298 A

HISTORY O F DENTISTRY I N CANADA

Faculty of Dentistry, University of Albert a DEANS W. Scott Hamilton 1942-5 8 H.R. MacLean 1958-7 0 James McCutcheon 1970 Faculty of Dentistry, University of Manitoba (Established 1958 ) DEAN

J.W. Neilson 1957

-

Faculty of Dentistry, University of British Columbia (Established 1964 ) DEAN S.Wah Leung 1962 Faculty of Dentistry, University of Western Ontario (Established 1966 ) DEAN

W.J. Dunn 1965

-

College of Dentistry, University of Saskatchewan (Established 1968 ) DEAN KJ.Paynter 1967 Section de chirurgie dentaire, Centre des Sciences de la Santé, Université Laval DIRECTEUR

Gustave Ratté 1968 -

NOTES: 1 Th e Roya l College o f Dental Surgeon s of Ontario operated a school fo r a few month s durin g the winte r o f 1869-70 , a t Toronto , an d graduate d tw o students. 2 Th e Canad a College of Dentistr y (1869-71 ) wa s operated at Toronto b y George L. Elliott, LDS . Record s exist of seve n graduate s from thi s school an d there may have been more. This was the only attempt in Canad a to operate a private school. 3 Facult y of Dentistry, University of Trinity College , Toronto (1893-1904 ) granted th e denta l degre e b y examinatio n to successfu l candidate s wh o ha d graduated from recognize d dental schools. No actual teaching occurred.

Appendices 29 KA

9

summary of recommendations contained in a brief to the Royal Commission on Health Services submitted by the Canadian Dental Association, March 196 2

1 Tha t the Provincia l legislature s mak e mandator y the fluoridation of com munal waters 2 Tha t dental publi c healt h educationa l program s b e organized an d actively promoted i n all health regions or units 3 Tha t th e amoun t o f mone y availabl e fo r denta l researc h b e increase d commensurate wit h the increased demand s of research projects 4 Tha t the province s institut e denta l treatmen t benefit s fo r al l beneficiaries of presently operating public assistance programs 5 Tha t the Roya l Commissio n o n Healt h Services , i n co-operation wit h the dental profession , undertak e a definitiv e stud y of denta l healt h need s an d factors influencing demand for dental car e 6 Tha t th e federa l governmen t establis h machiner y t o maintain , throug h annual compilation o f dental health data , the denta l health index initiated by the Canadian Dental Associatio n 7 Tha t immediat e plannin g b e undertake n t o provid e additiona l denta l schools a t the University of British Columbia, a t the Universit y of Saskat chewan, at Laval University, and one additional school i n Ontario; that the Faculty o f Dentistry a t Dalhousie University be expanded; and that facili ties fo r trainin g denta l hygienist s b e mad e availabl e a t th e Universit y of Montreal, McGil l University , th e University o f Manitoba, and a t the fou r additional dental schools recommende d 8 Tha t federa l grant s t o universitie s b e increased i n order t o permi t denta l faculties to improve the ratio of full-time staff t o part-time staf f 9 Tha t healt h agencie s employin g dentist s adop t denta l salar y schedule s comparable t o incomes available in private practice 10 Tha t mor e governmen t fund s b e mad e availabl e to universitie s to enabl e dental school s to expand graduat e program s for training specialists and to add these programs wher e they do not now exist 11 Thafthi s royal commission undertak e a detailed thorough study of recruitment to the health profession s 12 Tha t the federal government increas e it s annual per capita grants to universities sufficientl y t o permi t gradua l reductio n o f fees , beginnin g with th e more expensive courses such as dentistry, until , at the earliest opportunity, they may be removed entirel y

300 A

HISTORY OF DENTISTRY IN CANAD A

13 Tha t a revolvin g loa n fun d b e establishe d fo r undergraduat e an d post graduate denta l students , wit h initial capital t o b e provide d b y matchin g contributions of $50,00 0 each fro m th e Canadia n Dental Associatio n an d the federal governmen t 14 Tha t federal an d provincia l income tax regulation s be amended t o permi t tax relief fo r dentists who attend training courses under auspices of universities or recognized denta l associations 15 Tha t dental schools give preference to applicants from rura l areas, all other factors bein g equal , a s lon g a s th e uneve n rural-urba n distributio n o f dentists continue s 16 Tha t financial and other inducement s be provided to encourage mor e den tists to settle in municipalities without resident dentists 17 Tha t provincia l government s engage full-tim e travellin g dentists t o serv e areas with populations too scattered to warrant resident dentists 18 Tha t dental schools be provided with the financial support required to carry out pilot studies an d operational researc h t o determine the best methods of employing auxiliary personnel 19 Tha t the trainin g of futur e denta l assistant s and denta l technician s be carried out using clinical facilities of university dental schools 20 Tha t dental departments be established in all public hospitals where dental personnel ar e availabl e to provide bot h in-patient and out-patien t service s 21 Tha t provincial publi c hospita l acts o r regulation s b e amende d t o permi t dentists appointed t o hospital staffs to admit patients to hospitals 22 Tha t out-patien t denta l clinic s b e establishe d i n publi c general hospitals , especially to assist in meeting the needs of marginal income groups 23 Tha t centres fo r treatment of cleft palat e cases b e established i n children's hospitals, and in general hospitals where adequate paediatric and associate d services ar e available.

Index

Abbott, Harry R., 108,172 Academic qualifications (1909), 132 Academy of Dentistry, Toronto, 222 Acrylic resins, 204 Adams, J.F., 96 Adams, J.C.G.: his work, 94-6; leader, 147; Ontario Board of Health, 17 8 Adams N & I treatment, 96 Adams, W. Case, 60, 83, 94, 96 Advertising: newspaper, 36; action against, 56; cheap John, 75; professional etiquette, 78; commercial artifice, 110; mail-order dentistry, 189; amendments to Acts, 173; Cowen case, 200 Agnew, Gordon, 128 Alberta Dental Association: creation , 121; mechanics, 189; specialists, 223; technicians, 217; welfare services, 229 Alberta Travelling Clinics, 18 2 Alberta, University of: school established, 159; first graduates, 180 ; expansion of school, 252 Amalgam: Crawcour brothers, 18 ; poor quality, 30; dispute, 52; balanced alloy, 92 Amalgam War, 18 American Association of Dental Schools, 165,240 American Revolution, 1 1 Anaesthesia, general: first use, 27; nitrous oxide, 53; somnoform, 127 Anaesthesia, local: cocaine, 93; Novocain, 127

Anderson, R.N., 128 Andres, S.J., 93 Apprenticeship, 22 Aristol, 89 Armstrong, J. Alex, 15 3 Army Dental Fund, 156 Arsenic, 17 Artificial teeth, 29 Art vs Science, 259 Ashley, Napoleon, 120 Assistants, dental, 144, 160 Association of Canadian Denta l Faculties, 16 5 Atlantic Provinces Dental Association , 148 Aunger, A.E., 121 Auxiliary personnel, Quebec dispute, 86; increased use, 144; relationship to dentist, 215 Avaricle, Antoine, 111 Bagnall, John A., 73, 104 Bagnall, J. Stanley, 73, 234 Baillargeon, Pierre, 33, 64, 78 Baird, David Henry, 106 Baird, K.M., 221 Baker porcelain, 92, 134 Baltimore College of Dental Surgery, 166 Barber Surgeons, 9-1 0 Barnum, C.S., 52 Basic science, 64 Bazin, James A.: artificial teeth, 29; foot engine, 63; honoured, 78

302 Beach, H.N.B., 239 Seacock, D.V., 47 Beers, W. George: indentureship, 25; author, 29; secretary, 44; biographical, 46-48; amalgam controversy, 52; trade or profession, 56; infallible law, 65; criticism, 74; editor of Dominion Dental Journal, 76; honoured, 78; patriot, 79; dean, 85-7; death , 101 ; library, 101; specialist, 223 Belleville, 21, 24 Benson, James L., 65, 70 Berdmore, Thomas, 12 Bernard, Aldis: arrival, 21; portrait, 22; legislative effort, 35 ; first president of Quebec Association, 44; honoured, 78; mayor of Montreal, 257 Berton, F.G., 1 12 Berton, Pierre, 1 12 Beveridge Report, 209 Berwick, R. Hugh, 93, 223 Biological aspects, 109 Bishop's College, University of, 86, 102 Black, G.V., 92 Black, J.E., 148 Black, W.A., 259 Blacklock, J.N., 213 Blair, J.F., 202 Blue Cross Plans, 250 Bogart, D.A., 4 0 Boston Dental Parlours, 11 0 Bothwell, J.A., 14 7 Boulter, G.W., 43 Bourdet, Bernard, 12 Bourke, E.T., 20 2 Bower, Ira, 106 , 150 Bowker, H.M., 52 Bowles, Manley, 226 Box, Harol d K., 162, 183,231 Bradley, S.W., 256 Brébeuf , Father Jean de, 2 Bref Récit, 8 Brett, Augustus J., 239 Brewster, Charles: earl y journal contributor, 29; effort towar d legislation , 35; friend of Day; honoured, 78 Brimacombe, John N., 83 British Columbia, College of Dental Surgeons: creation , 148 ; Cowen case, 200; administration, 212; technicians, 217 British Columbia Dental Association:

A HISTOR Y O F DENTISTR Y I N CANAD A

founding, 70; second annual meeting, 97; reorganization, 179 British Columbia, University of , 251 British Dental Association, 191- 2 British North America Act, 179 Brockville, 49 Brown, H.K., 220 Brown, Peter, 91, 102-3 Brownlee, Basil, 226 Bruce, W.J., 212 Bulyea.H.E., 159, 180, 234 Bunon, Robert, 12 Calgary, 67 Callender, F.G., 40 , 50, 62 Cameron, George L., 103 , 201 Cameron, George S., 103 Campbell, Gordon, 128 Campho-phenique, 89 Canada College of Dentistry, 49 Canada Journal of Dental Science, 47,65 Canadian Army Dental Corps, 153, 202 Canadian Dental Association: formation, 105; second meeting, 106; military dentistry, 150, 202; Chicago meeting, 163 ¡reorganization, 181; economic resolution, 190; joint meeting, 191; journal established, 193 ; Rowell-Sirois Commission, 198 ; health insurance, 208; specialists, 224 ; studentships, 230; survey of dental schools, 240; Royal Commission on Health Services, 255 Canadian Dental Corps: formation, 202-^i; rank, 213; directors, 221; recognition for dental health, 234 Canadian Dental Depot, 32 Canadian Dental Hygiene Council, 130, 175 Canadian Dental Research Foundation , 161,183 Canadian Foundation for Preventive Dentistry, 178 Canadian Fund for Dental Education, 252 Canadian Life Insurance Officer s Association, 177 Canadian Oral Prophylactic Association, 129, 17 6 Canadian Red Cross, 177 , 182, 228, 231, 234

Index Canadian Society of Dentistry fo r Children, 247 Capon, F.J., 82 Carnegie Foundation, 165 Cartier, Jacques, 8 Casgrain, Emma, 88 Casgrain, H-Edmond, 88 Cataphoresis, 9 0 Chairs, dental, 51 Champlain, Samuel de, 9 Chandler, S.B. , 32 Charron, Ernest, 234, 245 Charter for Dental Health, 227 Cheverie, Louis de, 44 Chittenden, Curtis S.: Ontario founder, 40; editor, 48 ; organizer, 53; death, 78 Chloroform, 27 Christ's Dental Educational Institute, 95, 175 Clark, Harold, 12 8 Clarke, G.F., 25 9 Clay, John W., 68, 181,244 Clay, Nanette P., 112 Cobourg, 42, 50 Cogswell, Alfred C, 72 Commercial laboratories , 10 9 Conboy, F.J., 17 2 Connor, R.A. , 220 Cook, Harvey S., 127 Coons, D.S., 221 Cowan, Walter D. : NWT legislation, 7 1 ; national organization, 104; secretary of Dominion Dental Council, 108 ; president of NWT Association an d Saskatchewan College, 12 2 ¡death, 196 Cowling, Thomas, 173 Crosby, F.K., 259 Cummer, W.E., 183 Curriculum survey, 169 Dalgleish, R.R., 108 Dalhousie University: Maritime Denta l College, 1 13; first faculty, 1 14; new school, 251 Davies, G.C. , 8 1 Dawson City, 111 Day, W . Barnabus, 40, 78 Dental College of the Province of Quebec: establishment, 85; affiliation, 86; abolished, 102 Dental schools (1909) , 131

303 Dentistes de Langue Française d e l'Amérique du Nord, 183 Dentistry for children, 227 Dentistry vs medicine, 109 Dickinson, Charles M., 26 Directory of dentists, first, 130 Distribution of services, 197 , 212, 238 Doctor o f Dental Medicine, 252 Doctorate degree: United States, 58; affiliation a t Toronto, 73 ; Bishop's University College, 86; delay at McGill, 10 3 ¡surgery and medicine, 252 Doherty, W.D., 147 Dominion Dental Council: created, 105; organization, 107 ¡replaced by National Dental Examining Board, 238 Dominion Denta l Journal, 76, 193 Dorland, Cicem, 24 Doyle, E.M., 121 Dubeau, Eudore, 103 , 138, 233 Dunlop, William, 19 Early dentists, 12-2 0 Eastern Ontario Dental Association: proposed military dentistry, 106; re Toronto school, 8 1 Edmonton, 68 Einhorn, Alfred, 12 7 Electricity, 90 Elliott, G.L., 29, 49 Elliott, J.W., 258 Elliott, W.H., 29 Ellis, A.W., 191 Ellis, R.G., 229, 234, 247 Empire dental organization, 201 Enault, Madame, 120 Eskimos, 6-8 Ether, 27 Ethics, codes of, 253 Expansion of schools, 238, 251 Ezra, I.B., 259 Family Dentist, 48 Fauchard, Pierre , 1 1 Faulkner, A.W., 112 Fauteux, Gaspard, 257 File carrier, 29 First meeting of dentists, 40 Fisk, G.V.,217,241 Flagg, Josiah, 13

304

A HISTOR Y O F DENTISTR Y I N CANAD A

Flanagan, J.C., 21 1 Flavelle, Sir Joseph, 91 Fluoridation, 242 Focal infection, 170 Foot engine, 63 Forceps, 30 Portier, Armand, 209, 218 Garvín, Matthew H. : British reciprocity, 184; editor, 193; biographical, 244 Gaudreau, Stanislas, 89 , 183 Gidney, Eleazer, 15 Giffard, Robert , 9 Gilbert, Benson, 50 Gies, William J., 165 Giles, William J., 101 Globensky, Stephen, 10, 87 Godsoe,F.A., 104, 116, 195 Gold foil, 30, 51, 63, 134 Gold inlay, 92 Golden Jubilee celebration, 243 Good Samaritan Dental Association, 1 10 Goodwin, A.H., 68 Goodwin, W.S., 68, 232 Graduate degrees, 183 Graduate education, 223 Grady, L. King, 5 Green, William, 12 Greene, William J., 189 Grieve, George, 226 Grieve Memorial Lecture, 226 Gunsmiths, 19, 36 Hackett, W.T., 15 1 Halifax, 12

H a f a i l x e x p o l s o i n 1 , 6 3 Halifax Medical College, 113

Halifax Visiting Dispensary: formation, 32; closure, 175

Hamel, Philippe, 193 Hamilton Dental Society, 53 Hamilton, Ira, 202 Hamilton. W. Scott, 234 Hand instruments, 29 Haggin, Joseph B., 32 Hanna, G.E., 76, 82 Hannah, George O., 117 Harris, Chapin A., 11 Harris, S.M., 32 Hart, E.R.K., 258 Harvard University, 105 Hayden, Horace B., 166

Hayhurst, T.E., 214 Health insurance, 207-11, 226 Health and Welfare, 220 Hébert, Louis, 9 Hemingway, Ernest, 159 Henderson, Thomas, 223 Henry, Frederick G. , 142 High speed equipment, 243 Hill, Annie Grant, 88 Hipkins, H., 62 Honey, S.L., 228 Hospitals;: dental, 56; mental, 88; payment plans, 250 Hubbard, C.H., 32 Hughes, Sir Sam, 153 Hume, Mr, 12 Hunter, John, 12, 109 Hunter, William, 124 Husband, R.J., 98 Hutton, William L., 242 Hydrogen peroxide, 89 Hygienist, dental: first, 172; legislation, 241; training facilities, 252 Hypnosis, 89 Ibbottson, J.S., 93 Implantation of teeth, 89 Incorruptible Enamel Teeth, 18, 29 Indentureship: Beers contract, 25; abuses, 57, 86; control, 108 ; demise, 142 Indians, 1-6 Industrial dentistry, 172 Institute Dentaire Franco-American, 11 0 Instruments, hand , 29 Instruments, manufactured, 30 International Dental Federation, 232 Inventions, 260 Itinerant dentists, 15, 24 Ivory, J.W., 79 Janes, L.V., 220 Johnson, C.N., 76 , 192 Jones, B.C., 212 Jones, Thomas J.: career , 70; organizer, 97 Jones, William Allen, 54 Journal of Canadian Dental Association, 193 Journal of the Times, 48 Jury service, 56 Juvet, C.H., 108

Index Kearney, B.P. , 221 Keown, Lorenzo D., 68, 121 Kellogg Foundation, 237, 240 Key, 30 Kilburn, L.A., 220 Kingston, 40 La Farge, Trocar, 12 La Londe, A.D., 40 Langstroth Family, 18 8 Lapp, John S., 198 La Revue Dentaire Canadienne, 171, 193 La Société d'Odontologie d e Montréal , 98 Laurentide Health Service , 172 Laurin, E.M., 152 Laval Dental Hospital , 13 8 Laval, Université, 86 , 102, 251 Lea, W.J., 148,212,22 6 Le Chirurgien Dentiste, 1 1 Legacy of knowledge, 12 Legal aid, 170 Legislative freedom, 13 6 Lemieux, Eugene, 10 6 Lennox, C.P. , 6 5 Lewis, A.C., 240 Ligue d'Hygiène Dentaire, 178 Lindsay, Ashley W., 65, 127 London, 52 Longlaker, H.D., 3 2 Lott, P.M., 201, 202, 203, 204, 221 Louisburg, Fortress of, 1 1 Lower Canada, 10 , 12 MacGregor, S.A., 227 MacKay, Gurdon R. , 233 Mackenzie, Arabelle, 16 3 MacLean, Hecto r R., 145 Madry, Jean, 9 Magee, J.M., 116 , 117 , 151 , 195 Mail-order dentistry, 189 Manitoba Denta l Association: creation , 70; re Western Canada, 108 Manitoba, University of, 251 Maritime Dental College , 11 3 Marshall, Oliver A., 83 Martin, Alexander, 36 Martin, Charles A.: biography, 36; inventions, 64; EODA, 81 Martin, Joseph, 36

305 Martin, Oliver, 36, 80 Mason, A.D.A.: dean, 206; retirement, 234; career, 246 Master of Dental Surgery, 63 Mathison, G.C., 108 McAvenney, A.J., 29, 72, 116 McClure, R.C. , 121 McCrae, John , 15 2 McDonagh, A.J., 128,23 1 McDonald, K.C. , 123 McElhinney, Mark, 259 McGill University: department of dentistry, 102 ; den tal degree, 142 ; base hospital, 152 ; expansion of school, 252 Mclnnis, S.W., 84 , 134 Mcllwraith, T.F., 5 McLaughlin, R.G., 170 McNaught, W.K., 101 Meacham, J.B., 53 Medical practitioners, 25 Military dentistry: initiation, 106 ; establishing army corps, 150 ; new corps, 201 Millar, W.P., 7 Montreal, early years : barbe r surgeons , 10; intinerants, 12; early dentists, 21 ; journal contributors, 29 ; illegal practice, 45 Montreal Dental Club , 98, 211 Montreal Dental Society, 53 , 56 Montreal General Hospital: appointe d staff dentist , 93; McGill dental clinic, 102; new dental clinic, 138 Montréal, Université de, 228, 237, 252 Moore, S.A., 193 , 202 Morrison, J.B. , 223, 226 Morton, W.T., 2 7 Mouth health campaigns, 178 Mowry, O.P., 234 Mullett, Harrison, 12 8 Mulock, William, 74 Murray, C.A., 72, 116 Nash, R., 104 National Committe e for Mental Hygiene (Canada), 19 7 National Dental Examining Board, 239 National Research Council, 229 Nationalization, 104 Neelands, Jacob, 53, 65 Nelles, H.H., 46 , 53

306 New Brunswick Dental Society: founded, 72; historical summary , 116 Newfoundland: Indian ossuary, 6; dental act, 71; dental health, 231 Nitrous oxide, 29, 53 Nolin, Joseph, 176 , 259 Noronic disaster, 234 Northcroft, George, 192 North-West Territories: dental ordinance, 71; association formed, 122 Nor'wester, 33 Nova Scotia Dental Association : incorporation, 73 ; dental school, 113-16 Novocain, 127 Number of dentists: in 1880, 62; in 1889, 79; in 1909, 130; in 1925, 173 O'Brien, Murrough, 84 O'Donnell, John, 40, 50, 78 Ontario Board of Health, 96 Ontario Board: see Royal College of Dental Surgeons of Ontario Ontario Dental Association (Society ) : formation, 42; dissension, 52; advertising, 56; resolution re school, 58; reorganized, 75; management of school, 81; Dominion associatio n advocated, 98; horizon of dentistry, 1 12; education of public, 147; journal established, 171; duty of dentist, 191 Ontario Prosthetic Dental Association, 161 Ontario Society of Dentists, 52 Oral Health, 146 Ottawa: early dentists, 36 Overcrowding, 96 Paré, Ambroise, 10 Pallen, R.L., 212 Parker, D.M., 27 Parker, Edgar R., 117 Parmly, Levi Spear, 13, 30 Parsons, S.C., 18 Patton, W.H., 64 Paul, Edgar W., 225 Peace River area, 19 0 Pearson, C.E., 233 Pelican, 30 Periodontics, 129 Petroid cement, 134

A HISTOR Y O F DENTISTR Y IN CANAD A

Picton: earl y resident dentists, 22 Pioneer treatment, 19 Plimpton, John, 16, 231 Porcelain teeth, 51 Port au Choix, Nfld., 6 Prepayment plans, 253 Pre-professional course, 168 Prevention and control: watchword, 180; policy , 211; approach to , 227; program established, 228; means of, 242; Commission agreement, 255 Price, Frank D., 90 Price, Weston A., 91 Prince Edward Island: dental act, 71 Prince Edward Island Dental Associa tion: formed, 73; Maritime College, 113 Procurement and Assignment, 213 Public Health Dentistry: father of, 94; Canadian Oral Prophylactic Association, 130; education policy, 135; Ontario effort, 146 ; Canadian Dental Hygiene Council, 175; practice for children, 227; Commission support, 256 Quebec Almanack, 15 Quebec City, 10, 12, 14 Quebec, Dental Association of the Province of: formed, 43; incorporated, 44; fought advertising, 56; established dental school, 85; called national meeting, 104 Racey, A.G., 254 Rahn, Charles, 37 Ratté, Gustave, 89 Reade, R.J., 82 Reciprocity: provincial, 104 , 106; British, 184 Recruitment, 253 Red River Settlement, 33 Refugee dentists, 214 Regina: first dentists, 68 Rehabilitation, 221 Reid, Harvey W., 217, 240 Relyea,G.V.N.,21,75 Research: meagre support, 130; Box and Cummer, 183; National Research Council, 229; studentships, 230 Resident dentists, 17

Index Roberts, Arthur, 223 Rooney, R.A., 217 Rowe, Thomas, 62 Rowell-Sirois Commission, 197- 9 Rowlett, A.E., 233 Royal Canadian Dental Corps, 221 Royal College of Dental Surgeons (School of Dentistry, Toronto) : established, 60-2; affiliated with University of Toronto, 74; became faculty of university, 168 Royal College of Dental Surgeons of Ontario: creation , 43; first school, 48; second school established, 55; dispute re school, 81; built school, 93; built larger school, 137; government grant, 159; survey of dentists, 184; health insurance, 208; specialists, 224 Royal College of Dentists of Canada , 225 Royal Commission on Health Services, 255 Royal Mineral Cement, 1 8 Rubber dam, 52 Rural treatment programs, 18 1 Salaried dentists, 228 Sales tax, 170 Samuel, John H., 102 Saskatchewan, College of Dental Surgeons of: creation, 121 ; first mouth health campaign, 178; depression years, 188; welfare services, 229 Saskatchewan, University of, 251 Schultz, J.C., 33 Scott, Joseph S., 40 Seccombe, Wallace: public health dentistry, 147; Canadian Dental Research Foundation, 16 1 ¡curriculum survey, 169; career, 205 Secrecy, 12, 57 Sellar, C.R., 248 Sepsis, 123- 6 Service plans: depression, 187; prepayment, 254 Shaw, Frederick D., 67, 69 Sheard, C., 82 'Siberian Mike', 8 Snelgrove, C.A., 82 Snider, M.E., 40 Somnoform, 127

307

South African War, 106 Sovereign, S.J., 56 Sparks, E.B., 153 Sparks, R.E., 112 Spaulding, Albert W., 82 Specialists, 223 Spooner, John Roach, 17 Spooner, Shearjashub, 17 Sproule, Albert, 145 State medicine, 148 Stevenson, F.A., 104 Stevenson, G.H.A., 152 Stewart, C.H., 45 Stewart, John S., 157 Stone, A.C., 52, 64 Strong, C.F., 12 1 Stuart, W. Theophilis, 64, 82 Study clubs, 212 Sullivan, R.B., 121,219 Summum Bonum, 14 Supply depots: first established, 32; re dental laboratories, 109 ; western, 134 Survey of dentists (first), 184 Sutton, 40 Sydney Wood Bradley Memorial Library, 15 9 Synthetic porcelain, 134 Tanner, D.M., 220 Taxation, 170 Teacher training, 240 Technicians, dental: dental supply houses, 109 ; dentist associated with, 189; training for Corps, 214; legislation for, 216 Temple, H.P., 13 4 Teskey, Luke: appointment, 58; career, 61 ; administration of school, 8 1 Thibaudeau, Alcide, 193 Thibault, Honoré, 171 Thompson, G. Kerr, 147, 151 Thompson, John, 128 Thompson, W.G., 191 Thomson, Harry S., 177, 209 Thornton, A.W.: appointed dean, 138 ; retired, 196 ; author, 259 Thornton, L.H., 152 Toronto: supply depots, 32; first meeting of dentists, 40 Toronto Dental Depot, 32 Toronto Denta l Society, 95- 6

308

Toronto General Hospital, 94, 137 Toronto Painless Dental Parlours, 1 10 Toronto Trades and Labour Council , 96 Toronto, University of: Royal Colleg e of Dental Surgeons affiliated, 74 ; Beers' library, 101, refused to establish faculty, 137; faculty established, 168; graduate degrees, 183 ; training of technicians, 214; specialist training , 224; dental public health course, 228; research, 230; new enlarged building, 251 Training facilities, 222 Trelford, W.G., 202 Trench mouth, 155 Trestler, C.F.F., 78 Trinity College, University of, 82 Turnkey, 30 United States: dentists from, 12 Upper Canada, 10 , 12 Van Buskirk, George, 29 Van Buskirk, Lawrence E., 27-9 Vars (of Oshawa), 84 Veterans Affairs, Department of, 219 Walker, Thomas, 32 Walsh, Arthur L.: appointed dean, 196; health insurance, 209; portrait, 218; retired as dean, 234; school survey, 240 Wansbrough, E.M., 221 War Memorial Fund, 222 War Regulations, 214 Watts, John, 12 Webster, Albert E.: editor, 101; sepsis, 123; biological concept, 135; dental nurse, 160; alteration in dental training, 167; honorary degree, 192 ; career summary, 194 Webster, J.H., 28, 78 Welfare services, 229 Wells, Horace, 29, 53 Wells, John, 88

A HISTOR Y O F DENTISTR Y I N CANAD A

Wells, S. C. Josephine, 87 West China Mission, 127 Western Canada Dental Society, 108 Western Dental Society, 53 Western Ontario, University of, 251 Wetmore, H.C., 98 White, SamuelS., 31 Williams, C.H.M., 7, 230 Willmott, J.B.: biographical, 58-61; university affiliation, 74; on professional maturity, 78; appointed in charge of school, 81; implantation, 90; comment on local anaesthesia, 93; planning of school building, 94; need for national organization, 107; not a specialty of medicine, 109 ; death, 140 Willmott, W.E.: early activity, 61; drugs in use, 89; career summary, 141; honoured, 19 5 Wilson, D.D., 219 Wilson, William, 67 Winnipeg, 64 Women dentists: first graduate, 87; refugees, 215 ; small percentage, 257 Wood, Henry T.: early dentist, 22; founder, 40; itinerants, 50; recognition for superior ability, 63 ; building of school, 94 Wood, Samuel, 17 Woodbury, Frank: recognized leader, 99 ¡reciprocity of licence, 104; Dominion Dental Council, 108; comment on relationship of dentistry, 109; dean, 113-16; enlarged responsibility for profession, 167 Woodbury, W.W.: family, 11 3 ¡leadership, 217; orthodontics, 226 ; retirement as dean, 234 Woods, James, 50 World Health Organization, 232 X-ray, 91, 204 York (Toronto) : itinerants, 12; first resident dentist, 17 Yukon, 110