“Some Reminiscences of the Practice of Dentistry in the Years Between 1845 and 1855” by A. W. French, 1904

SOME REMINISCENCES OF THE PRACTICE OF DENTISTRY IN THE YEARS BETWEEN 1845 AND 1855
BY A. W. FRENCH, D.D.S.

It is with great pleasure and satisfaction, though also with much diffidence, that I respond to the suggestion of the Dean of the Faculty of the Dental Department of Washington University that I should give some reminiscences in addition to those published in the Dental Era two or three years ago, of the state of dental practice at the time that I became a student and learner of the then new art, and here I present such incidents and facts as I can recall to what is now a well advanced and mature profession.

The period traversed may fairly be termed the experimental stage, when everything which suggested itself to the mind as of some value had to be tested, and whatever was good in it discovered by trial.  Of course the patrons of the dentist knew even less than he did, and this fact evened up the relation between them, and as expectation’s were not high the fall was not great.

Model of an 1853 dental office

At the time that I entered upon the study of dentistry in 1845, the usual course for one desiring to become a dentist was to enter the office of a reputable practitioner on an agreement to remain one or two years, pay a stipulated sum for the instruction, and devote his time to the office.  There were placed in his hands a work on anatomy, one on materia medica, on practice, therapeutics, and in short most of the text-books used by medical students.  There was a skull and in some offices a whole skeleton to aid in the study of anatomy, and in my case, but half a block away, there was every winter a course of private lectures on the recent subject with dissections and demonstrations which were open to either amateur or professional students, and I participated in dissections here quite as profitably as when under the drive and pressure of the course in a medical college.  This course was given by one who filled a chair in two medical colleges as much to keep his own knowledge fresh as to instruct students.  In the office of course a busy practitioner gave but little time to the instruction of his students in the studies laid before them, and the learner was left to himself to get what he could out of the book.  How much he absorbed under the conditions, as you know, depended upon himself.  He was permitted to see some of the operations in the mouth, and sometimes was allowed to use the scalers, while all laboratory work was open to him.  He necessarily acquired some knowledge of metallurgy, as much of the skill of the dentist was expended on metal and he had no other basis for his work.  The dread of a visit to the dentist, though not yet wholly absent was much greater than it is now, and not without reason.  The manufacturer of dental instruments had not yet been grafted on to that of surgical instruments, and many of those used would be thought impracticable both in form and finish.  There were but few patterns of forceps, designed for the use of physicians, and those in use were better fitted to crush, than to extract a tooth.

No manufacturer had dreamed of taking a skull to the shop and making a tool that would perfectly fit one tooth, though it could do no more, as was done a little later.  It was sometimes the case that the turnkey was often both a surer and safer tool than any of the forceps, and I may say in passing that this old (I know not how old) and much maligned instrument often performed its function most beautifully.  But alas, like a treacherous friend, any reliance on it was misplaced.  The operator knew only when he had the tooth without its maxillary investment in his hand, how much he had done, and if it was free of several times its weight of alveolus, or other bony matter or a tooth or two not included in his arrangement with the patient, had not accompanied it into the open air, his spinal shiverings began to subside.  I still have my turnkey but it has not been in a mouth in more than fifty years.  The first tooth I extracted, which was in the absence of the dentist, was not the one I intended to remove, as one of the jokes of the canthook (as the key was popularly called), was to slip forward a little when the pressure began and take its grip on the next tooth.  Of course the accident could be adjusted with the patient, by charging him for but one when you had gotten the right one.  The settlement with conscience was more difficult.  Extracting was performed or attempted by the physician, and it was generally beneath his dignity to ask any remuneration for it, and this being the case he very willingly surrendered this part of his practice to the dentist.  Holding the operation in contempt, not much pains did he take to make it respectable.  His patient was seated on the floor, or if patient and physician met on the road or in the field, on the ground.  Locked between the knees of the operator the turnkey was brought out and the fulcrum well wrapped in a corner of the doctor’s handkerchief, and applied to the offending tooth; and if the hook did not slip something had to come.  It was not always what he went for.  From the fulcrum to the point of resistance was about one half inch, but the handle had a length of four inches, thus giving the operator great leverage power.  The people were wholly ignorant of the merits of the pretenses which these members of a new profession made of doing them a great good, and the disinclination to learn by what was regarded as painful methods was naturally not very strong, and the dentist had plenty of time for rest or recreation and study.  A natural result of this was that itinerating became common.  Hanging up a tin sign on the door of the village tavern (the word hotel as meaning a house of entertainment, was not yet known), he spread out on the parlor table a set of fine ivory and pearl handled instruments, or earlier than this a few wire tools made by himself, and he was ready for business.  The curious were attracted to the room and this gave him the opportunity which was essential to success, of enlightening them as to what he could do and to solicit patronage.  If one had long lacked an incisor or cuspid and a root remained, it was but the work of an hour to attach a pivot tooth, and then curiosity was turned to wonder.  It was a restoration possibly never before attempted.  Dentists of very respectable attainments and character did not always disdain to spread this knowledge and extend their acquaintance by a tour of the country.  Off course this opened a large field for a class of montebanks and charlatans, who constituted a much larger proportion of practitioners than now, but all kinds contributed to the calling of the attention of the people to the fact that something could be done to improve their teeth.  I knew one quite ignorant and also thickheaded young man who was admitted to an office where a moderate amount of practice was done, as a student.  The proprietor was interested in the making of some of the plainer forms of surgical and dental instruments, and so did not scrutinize the character of his students very closely.  The novice was given the books to read as usual, but books were not much to his liking, and after napping over them for two or three weeks he announced his conviction that he could “learn faster by practice” and left the office and set up one of his own.  There was a gentleman in the city possessed of respectable qualifications both as to skill and ethical principles, and the upstart offered him a position in his office with plenty to do.  Pushed by his needs he accepted.  When it was nine o’clock the first morning the proprietor said: “Well, it is time to go to work.”  “What shall we do?” said the other.  “Do?  Why, go out in the street and get somebody to come in.  We might set here all day and do nothing.”  The gentleman quickly threw up his position.

Modes of practice were, of course, not developed, and most of the dentist’s attempts were experimental.  Amalgam and also tin were largely used for fillings, but neither was tolerated in the front teeth, as its presence was perceptible, and that even in the case of gold was not to be tolerated.

The amalgam was usually made by filing from a coin the required amount.  Tin foil of a fair quality was made, not for the dentist alone, but could be obtained.  It was applied in the same way as was gold with heavy handled pluggers with blunt points and forced in with the full strength of the dentist from one side of the cavity to the other, and then further condensed by wedge-shaped points pressed into the center.  Very serviceable fillings were made in this way where the tooth was strong and not predisposed to decay in other places.  In filling a tooth with whatever material, the object, I may say, the sole object was its preservation and not its embellishment.  As Dr. Forbes used often to reiterate as the chief end of the existence of a dentist was to “save that tooth,” and this meant to save all that caries had spared.  No waste of tooth substance was good practice, and the impossible was often undertaken under this restriction.  Like an attempt to fill with foil the posterior surface of a wisdom tooth without removing any of the enamel, however thin, which concealed the cavity, or an approximal cavity in a bicuspid with the same precaution.  I think that Dr. McKellops was one of the first to practice cutting more freely and saving one-half or three-fourths of the tooth rather than to lose the whole, and his success was enviable.  The charge for a gold filling rarely exceeded one dollar, and sometimes was even less, but it must be remembered that large gold fillings were not often attempted, amalgam or tin being then used.  Gold used in the way above described, without any regard to or knowledge of cohesion, when released was but crumbs of the metal, but under favorable conditions preserved the teeth to an extent which would astonish a modern dentist.  The cohesive quality of gold had not yet been discovered.  The blunt points did not always answer expectations, as with them nothing could be added to the surface if sufficient gold had not been used in course, and the attempt to prick it in by some fine points was made, and the reader may be surprised to learn that the first serrated plugger was formed by taking a hard tempered excavator and breaking the point off in a vice.  This served the required purpose, as the steel would break in such a way as to retain several sharp points.  The idea was quickly caught and serrations, not casual or accidental, were made.

But as concealment of our work was essential, no building on was permitted.  Our failures could have been reduced in number by a freer use of the file or chisel, and those dentists who were deemed the most unscrupulous in this respect were most successful.  I have stated that the student acquired some knowledge of metallurgy.  All artificial teeth were based on either gold or silver.  If, as was often the case, after extracting a number of teeth, the patient declined to wait five or six months for absorption, an impression was soon taken and a plate of silver was fitted to the rough jaw and on it was mounted a set of plain teeth.  These were backed and soldered on the same as was done with gold, but both labor and materials were worth less than with gold plate and gum teeth.  Silver was sometimes used for permanent sets, when economy was important, the charge for them being 40 or 50 per cent less than that for gold.  Springs were indispensable on every full plate.  When only an upper set was required a bicuspid or a molar in the lower jaw was capped much as is done now, but for quite a different purpose.  To this cap was attached one end of the spring, and it acted very much as when a whole set was to be kept in place.  The cap was removable so as to permit taking the plate from the mouth.  The narrow plates first used had little adhesion to the palate, as none was expected, but in some cases when they came away or were broken the plate could still be kept up, and this favorable accident suggested the attempt to dispense with these supports.  It would seem now to be a pretty hard fate to have to wear the two plates chained together as they were, but these sets performed all the functions required of teeth and were cheerfully paid for and joyfully worn.  Indeed, some of the first sets which I inserted without springs were reluctantly accepted, and went out with the pledge that these supports should be added at the option of the wearer, and sometimes when I suggested a trial of the new plan I was assured that they would not be accepted without the springs.  One reason for the tenacity of the requirement was the fear that the wearer might be exposed to great shame by having her teeth come loose in the presence of others, and the springs seemed to offer some security against that frightful accident.  The spring wire was drawn by the jeweler of 14-carat gold and the coiling was usually done by the dentist.  Though a cup was usually used in taking an impression, I have seen for small plates the wax placed on the fingers and then into the mouth.  As in these cases the dentist had his clasps to secure the retention of his plate; it could hardly get away, however ill the adaption might be, and the wearer must do the rest.  This careless work had quickly to be discarded when it was required that the air must be absolutely excluded from the palatal surface of the plate.  A great deal more pains in both impression and in forming the plate were necessary, and then sometimes, when with much labor the set was completed, there was no adhesion.  The error was not easily discernible; but the patient could not breathe and retain the teeth in place.  Here was a problem coupled with a great perplexity.  If you let it go out with the assurance that time only was necessary to complete success, you perhaps found it on your table the next morning where it had been left by a discouraged and disgusted patient.  But with the next set you might succeed, though in the progress of the work you could not see why one as well as the other was not successful.  These difficulties were gradually overcome, and it became easy to secure adhesion or, what was next to that in importance, see why it did not adhere.  As an experiment I have attached a wire to a three-pound cast of lead and suspended it from a gold plate which I was fitting without detaching it from the mouth.  But the early practitioner of the dental art, as do all pioneers, worked in the dark, and his experiments and theories sometimes clashed and, though satisfactory results were obtained, his experiments would not prove his theories, though the latter were well studied out.