AMEDD Corps History > U.S. Army Dental Corps> Walter D. Vail and the History of the U.S. Army Dental Corps
DENTAL BULLETIN SUPPLEMENT TO THE ARMY MEDICAL BULLETIN
VOLUME 4, NO. 4 (OCTOBER 1933)
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ORGANIZATION OF THE DENTAL CORPS
(Continued from page 122, July issue).
As stated before the board of supervising and examining dental surgeons was convened in Washington, Feb. 18, 1901. The board remained continuously in session until July 31, 1901. On the latter date orders were issued assigning members of the board to stations as follows:
John S. Marshall, Presidio of San Francisco. (S.G. 70760)
Robt. W. Morgan, Havana, Cuba. (S.G. 78281)
Robt. T. Oliver, Manila, P.I. (S.G. 70729).
Dr. Marshall’s order included instructions for him to proceed, enroute, to Milwaukee, Wis., to represent the Medical Department of the Army at the meeting the National Dental Association, held in that city August 6-9th, 1901, inclusive.
The following is extracted from Transactions of the National Dental Association, 1901 (page 32):
ORGANIZATION OF THE DENTAL ORPS OF THE U.S.
ARMY, WITH SUGGESTIONS UPON THE EDUCAT-
IONAL REQUIREMENTS FOR MILITARY DENTAL
PRACTICE.
Special Report by JOHN S. MARSHALL, Representative of
Army Dental Examining Board.
Pursuant to an order issued by the Secretary of War, the Surgeon General of the U.S. Army convened in Washington, Feb. 18, 1901, the members of the examining and supervising board of dental surgeons. These gentlemen had been previously appointed by the Surgeon General and approved by the Secretary of War, on the authority of the provisions of the army reorg-
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anization bill, which was passed on February 2, to have charge of the examination of the candidates who were seeking appointment as dental surgeons in the U.S. Army. Orders were thereupon issued to the Board to immediately formulate the plans for the examination, and to be prepared to receive the first class of candidates upon Feb. 25.
The Board after due deliberation presented to the Surgeon General the following plan: First, The candidate should be required to pass a satisfactory written and oral examination upon the following theoretical subjects, which form the curricula of the colleges that are members of the National Association of Dental Faculties, namely: Anatomy, Physiology, Histology, Physics, Metallurgy, Chemistry, Dental Anatomy and Physiology, Dental Materia Medica and Therapeutics, Dental Pathology and Bacteriology, Orthodontia, Oral Surgery, Operative and Prosthetic Dentistry. Second. They should prove to the satisfaction of the Board their ability to perform all of the usual dental operations and laboratory work by clinical tests upon patients furnished for that purpose. These tests consisted of—Operative Dentistry: 1. The examination and record of condition of mouth and teeth. 2. Preparation of cavities with hand and engine instruments. 3. Instrumentation and technique. 4. Preparation and manipulation of filling materials. 5. Insertion of fillings. 6. Treatment and filling of root canals and preparation of root for pivot crown. 7. Manipulative technique in removal of calcareous deposits. 8. Application of rubber-dam, metallic separators, matrices, etc. 9. Diagnosis, prognosis, and treatment of oral diseases. 10. Care and sterilization of instruments and hands. Prosthetic Dentistry: 1. Impressions in plaster paris and modeling compound, casts, bite and articulation. 2. Construction of a denture in vulcanite. 3. Construction of die and counter-die from model to completion, carving the endentulous model from a solid block of plaster paris. 4. Construction of swaged plate, with metal and rubber attachments, also two shell crowns (bicuspid and molar) and one Richmond crown. 5. Construction of interdental splints (Dunning and Kingsley).
An average of seventy-five per cent was required in each subject for the theoretical and eighty-five per cent for the practical examination. This was to make it certain that none but
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skillful operators would succeed in obtaining an appointment. In marking the papers, and in grading the operations on the teeth, the methods of treatment, and the prosthetic work, a rigid system was suggested so that every candidate would be graded according to his merit. This plan was approved by the Surgeon General and has been conscientiously carried out by the Board. These examinations covered just two weeks with each class, one week being devoted to the theoretical subjects and the other to the practical work. The patients which were furnished for the clinics came from the General Hospital, Washington Barracks, and Fort Myer; while many of the officers of the army on duty at the war department have been glad to avail themselves of this opportunity to have their teeth treated and put in a serviceable condition. By this system of examinations the Board felt sure that it would be able to weed out the ignorant and incompetent applicants, and believe it has succeeded in so doing.
We were assured at the outset by the Surgeon General that no political pressure from any source would be brought to bear upon our Board in favor of any candidate; but if there should be, our duty was to pass upon the professional fitness and aptitude of the candidate for the service, as required by the law which called our Board into existence, and our report would be final. There has been some fault-finding by the friends of some few candidates who failed to pass these examinations, and the cry has been raised that the examinations were “too rigid,” “too high,” and “too medical,” but this is really the highest compliment that could have been paid to the work of the Board.
The examinations of the Board have proved that those gentlemen who had been out of college for any considerable number of years generally failed in the theoretical examination, while those that had recently graduated failed in the practical examinations. The majority of those candidates who successfully passed the examination had been in practice from two to four years. These men as a rule took high standing in their practical work, and this is also an evidence that they had kept up with the studies of the theoretical department.
The results of these examinations are as follows: Number of candidates invited to take the examinations, 86. Declined to appear, 10. Total number examined, 70. Found qualified and
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approved, 19, or 27 1/7 per cent of the number examined. Physically disqualified, 8, or 11 3/7 per cent of the number examined. Fully examined and rejected, 3, or 4 2/7 per cent of the number examined. Failed in theoretical examination, 7, or 10 per cent of the number examined. Withdrew before completing theoretical examination, 33, or 47 1/7 per cent of the number examined. Average age of approved candidates, 27 2/12 years. Candidates examined who were graduates in both dentistry and medicine, 1. Number of persons appointed by the Surgeon General without examination by the Board, as provided for in the law, 5. Total number of dental surgeons now in the Army, including the three members of the Board, 27. Vacancies yet to be filled, probably in the Autumn, 3.
It will perhaps be interesting to know the states and territories from which these gentlemen came: Alabama, 1. California, 1. District of Columbia, 2. Iowa, 1. Maryland, 1. Massachusetts, 1. Missouri, 2. Montana, 1. Nebraska, 1. New Jersey, 1. New York, 1. Ohio, 1. Pennsylvania, 2. Washington, 1. West Virginia, 1. Wisconsin, 1.
The following is a complete list of the members of the Corps and their present stations. Members of the Board - John S. Marshall, President, Presidio, San Francisco, Cal., Robert T. Oliver, Recorder, Manila, Philippine Islands. Robert W. Morgan, Member, Havana, Cuba. Robert P. Updike, Fort Leavenworth, Kans. Edwin P. Tignor, Fort Riley, Kans. William H. Ware, Philippine Islands. Hugo C. Rietz, Philippine Islands. Ord M. Sorber, Fort Sam Houston, Tex. William C. Fisher, Fort Sheridan, Ill. John H. Hess, Military Academy, West Point. Ralph W. Waddell, Philippine Islands. Seibert D. Boak, Philippine Islands. Franklin F. Wing, Philippine Islands. George M. Decker, Island of Cuba. Frank P. Stone, Philippine Islands. Frank H. Wolven, Philippine Islands. William H Chambers, Fort Monroe, Va. George L. Mason, Philippine Islands. Clarence E. Lauderdale, Philippine Islands. Jean C. Whinery , Philippine Islands. Charles J. Long, Philippine Islands. Hugh G. Voorhies, San Juan, Porto Rico. Appointed from the Army - Emmet J. Craig, Philippine Islands. Samuel W. Hussey, Philippine Islands. Charles A. Petre, Philippine
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Islands. Douglas E. Foster, Philippine Islands. Alden Carpenter, Philippine Islands.
The Board, after being in continuous session for five and one-half months, from six to eight hours each day, and often being obliged to devote the greater parts of its evenings to marking papers, and other work pertaining to its official duties, finally adjourned sine die on July 31, 1901.
The examination of the candidates, however, was only a small part of the work that the Board found to do. It was early recognized in our deliberations that successful practical examinations could not be conducted except by the aid of a complete operating and laboratory outfit. We therefore recommended to the Surgeon General that two complete outfits be purchased at once and set up in suitable quarters for the use of the Board. This was immediately approved by the Surgeon General, and orders were issued by the Secretary of War, instructing the Board to proceed at once to Philadelphia and purchase such outfits. These were shipped and set up ready for use by the time that the first class had passed its theoretical examinations.
The next most important question in the organization of the corps was the selection of the general or field outfit. This was no insignificant undertaking, because it was exceedingly important in the selection of the furniture, instruments, and supplies, that they be as light as possible, for the reason that transportation in an army is always a serious consideration. Consequently, the lighter the weight of the outfit the better from this standpoint. After the furniture, instruments and supplies had been selected, it was necessary to have special chests to hold them, so that they would not be displaced or broken in transportation.
Each dental surgeon is furnished with one of these outfits, which contains all necessary instruments for operations on the teeth and sufficient supplies for a three months' service. It is so light that it can be carried upon the backs of two mules, together with an army field desk, two folding tables and two folding chairs. Another important question was that of preparing a nosological table for the use of the corps. The object in preparing this table was to secure uniformity and the same nomenclature in the register of dental operations and in the monthly
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returns. For the same reason a system of designating the teeth by numbers, of describing the location and the character of cavities of decay, the kind of filling material used, the nature and character of other operations, and the treatment of diseased teeth was designed by the use of letters and a combination of letters, which is so simple that any hospital corps private could master it in an hour or two of study.
These records if carefully kept will prove of great value after a few years in the study of the etiology of dental and oral diseases, and will also be of considerable value to the Pension Office in detecting fraudulent claims for pensions by reason of physical disability claimed to have been induced from the loss of teeth while serving in the army. These records will show every form of dental operation that is performed upon each officer and enlisted man, and every form of disease treated.
According to the provisions of the army reorganization bill, which incorporated the bill prepared by your committee on National Dental Legislation, the number of dental surgeons to be employed in the army was reduced to thirty. As a consequence of this the dental corps will be for a time at least the hardest worked branch of the medical service. Private letters received from those of the corps who have already reached their stations prove this statement to be true. One says: “There is more immediate dental service needed at this post than three men can perform in six months. I am working over hours to relieve the necessity.” Another says: “I find plenty to do, more in fact, than I can do.” The bill provides, however, that free dental service can be rendered only to the officers and enlisted men of the regular and volunteer armies. The army regulations fix the hours of service at 9 A.M. to 4 P.M. During these hours the dental surgeon is expected to devote his entire time and attention to the care of those persons who are entitled by law to his services, except in cases of emergency, but after these hours he may attend civilian attaches and others who may request treatment, and for this he is permitted to charge a regular fee. He is however, required by a special rule of the Surgeon General to state upon the monthly returns how many civilian attaches he has treated during each month. This was thought to be necessary as a check upon the temptation to neglect regular duty for that
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which would pay better in dollars and cents. There will be many opportunities of this kind presented, and to one who is not afraid of work a considerable sum may be earned during the year, enough to increase the income to a figure commensurate with the dignity of a professional calling. The hours for regular service are so fixed that the dental surgeon will have at least two hours each day that he can devote to the treatment of the families of the officers and enlisted men. I believe, however, that if the corps becomes a permanent organization the courtesy of free dental service will be extended to them, just as is now the case with medical and surgical treatment, and I am inclined to think that this would be better from the standpoint of the highest efficiency of the corps, and only a just concession to those who are every ready to defend our country against a foreign foe, even at the cost of their lives; while their pay is so small in many instances that there is no possibility, with a family to feed, clothe and educate, of laying by anything for old age.
In closing this part of my communication I desire to say, that I have been assured by scores of officers of the regular army whom I have met in Washington that our corps will be most cordially welcomed wherever it may be sent, for there is dire need of its services, and this is especially true in Cuba, Porto Rico and the Philippines. We are also encouraged by these gentlemen to believe that it is only a question of time when the corps will be made permanent by giving its members commissions. It will be necessary, however, in my judgment, before commissions can be obtained to first prove two things, namely—Is the corps necessary to the health and efficiency of the army? And does it pay in dollars and cents? These will be the questions that must be answered to the satisfaction of Congress before any more legislation along this line can be expected. After the Philippine Islands have been pacified and the war is really ended retrenchment in the expense of maintaining the army and navy will come prominently before Congress. Sentiment for the soldier will by this time have disappeared, because of the fact that the volunteers who have friends in every community are now all at home, and there will no longer be any strong political influence brought to bear upon our senators and congressmen on behalf of the regulars. Cold facts will then be the only power
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that will move Congress to increase the expenses of maintaining any department of the army. We must convince Congress that our corps is not only necessary to the good health, and consequently to the efficiency of the army, but it must be shown that it pays; that from a financial standpoint it is a matter of economy; that by having dental surgeons in the army much loss of service from incapacity for duty, resulting from dental and oral diseases, and by reason of necessary leave, often of weeks, in order to have troublesome teeth treated and filled, will be prevented. When the balance-sheet is presented to Congress it must be shown to be in favor of the government, if the corps is to be made a permanent feature of our military establishment. This I trust we shall be able to do. We have been given a chance to prove ourselves a beneficient profession in an entirely new and untried field, with no precedents to guide or experience to warn us of the dangers in our pathway or of the obstacles to be overcome. But I believe that the young men who form the dental corps of the U.S. Army will prove themselves equal to the occasion and bring honor upon the profession to which they belong.
Suggestions Upon the Educational Requirements for Military Dental Practice. The army dental surgeon, by reason of his military surroundings and associations, and the isolated position in which he will often find himself professionally, will need to be broadly educated, and so expert in his calling that he will be capable of managing any case that may be presented to him for treatment. Many times we will be so placed, as for instance, at a remote post upon our western or southwestern frontier, in Cuba or the Philippines, that he can by no possibility obtain the aid of a suitable consultant or advisor ; so he must rely entirely upon his own judgment and experience in conducting his cases. It therefore becomes necessary that his general education shall be upon broad lines and his professional knowledge as complete as possible upon every department of dental practice. This should also include a good knowledge of general Materia Medica and Therapeutics, Physical Diagnosis, Urinary Analysis, and the general Principles of Surgery. This is necessary if the mem-
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bers of the dental corps are to fill their positions with credit to themselves and honor to the profession.
In considering the character and the scope of the examination of candidates for appointment as contract dental surgeons in the U.S. Army, the Examining Board took into account the special and peculiar conditions likely to obtain in military dental practice, and the adverse criticism which would be likely to come from our confreres, the army surgeons, if we passed incompetent men. The examinations in both the theoretical and the practical subjects were so outlined as to cover so far as possible every feature of dental practice, and those general medical and surgical subjects which are necessary to be known by one who must, when occasion requires, be able not only to prescribe constitutional remedies for the relief of those general conditions which are often present as existing causes or complications of dental and oral affections, or are associated with certain surgical diseases of the mouth and jaws; but must also be able, by conducting a physical diagnosis, to determine the condition of the heart and of the lungs, and by urinary analysis ascertain the condition of the kidneys, and thus determine if an anesthetic can with safety be administered; which anesthetics are indicated or contraindicated; whether or not a surgical operation can be made with any degree of safety to the life of the patient, and the best method to be pursued in the operation under consideration.
In fairness to the Board it should be said that the questions which have been submitted to the candidates have all been of an eminently practical nature, and so selected and presented as to test their general knowledge of each subject and their ability to apply this knowledge in a practical manner.
To prove this, let me say that the examination questions in general anatomy were confined to the bones, muscles, blood-vessels and nerves of the head, face and neck. In general physiology they were confined to the functions of digestion, of the circulation, of the nervous system, especially those of the cranial nerves and the vasomotor system, of the liver and of the kidney. These physiological functions have all a more or less important bearing upon the normal and abnormal conditions of the teeth and of the oral cavity. The questions in histology were confined to the origin and minute structure of the teeth, bones, oral mucous
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membrane, salivary glands, mucous glands, gums and the tongue.
In physics the questions were simply elementary and composed of the tables of the metric system, the principles of the lever, the screw and the inclined plane; the divisions of matter, the methods of obtaining the specific gravity of various bodies, the differences between atomic and molecular weight, etc. The questions in metallurgy covered similar ground, namely, the classification of metals; the origin, preparation and physical characteristics of the metals employed in dental surgery; their specific gravity, atomic weight and fusing point. The making of dental alloys, solders and gold plate of various carats. The value of platinum, silver and copper as alloys in making gold plate for dental purposes. The principles governing the use of fluxes in melting metals and in soldering, etc. In chemistry the questions were also largely of an elementary character, dealing with those substances chiefly employed in dental surgery, with usually one or two questions on organic chemistry and analysis either of the saliva or of the urine.
In dental anatomy and physiology, dental materia medica and therapeutics, dental pathology and bacteriology, orthodontia, oral surgery, operative and prosthetic dentistry, the questions were comprehensive and searching and intended to thoroughly test their theoretical knowledge of these subjects. The practical examinations in operative dentistry were conducted in an operating room with all the convenience in furniture, apparatus and instruments that are to be found in a first-class dental office, while the practical examinations in prosthetic dentistry were conducted under equally favorable circumstances.
A less rigid and searching examination than this the Board felt ought not to be expected ; in fact, the dignity and honor of our specialty, and the future high standing and efficiency of the army dental corps, demanded that the examinations be as rigid and as thorough as the courses of instruction in our best dental colleges would make practicable. The members of the dental corps will naturally be compared in general education and professional attainments with their brethern of the medical corps, and it is to be hoped that in this comparison those of the same age and experience will make a favorable showing.
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In order to stimulate the members of the corps to be studious and progressive, a system of examinations and promotions should be established, and doubtless will be, so soon as the value of the corps as a promoter of the health and efficiency of the soldier as a fighting machine is proved. In order to accomplish this the corps must be commissioned and a sufficient number of higher grades established to make the prize worth fighting for.
The results of the examinations of our Board have shown very conclusively that we need to spend more time upon the theoretical subjects of the curriculum than we are now doing, if we would thoroughly prepare our graduates for army dental practice. This was shown by the fact that nearly all the candidates who failed in their examination were deficient in those subjects which are classed as the fundamentals, and of these the majority failed in anatomy, physiology, histology, physics, metallurgy, chemistry, dental materia medica, therapeutics, dental pathology and bacteriology, and the principles of surgery.
Please do not misunderstand me upon this point, for I make no criticism upon our system of technical teaching, nor would I suggest that one hour less time be spent upon the practical subjects of the curriculum, but I would urge that more time be devoted to laying the foundations of a broad and comprehensive scientific education. This is just as necessary to a successful practice as it is to be an expert finger craftsman. The dental surgeon who knows little or nothing of the sciences upon which his profession is founded can not by any just claim ask to be classed as a professional man. If he has only finger-craft ability he is nothing more than an artisan.
This is a practical age and we are a practical people. Our young men and women as a rule chafe under any system of education which does not fit them to earn a livlihood by the time they reach their majority, and this is particularly true in medicine and dentistry. The evil which underlies all this is the ambition to obtain wealth and position by the shortest possible route, regardless of all other considerations. As a result young men in great numbers, with little or no suitable qualifications for a professional life, constantly clamor for admission to our medical and dental colleges, much to the detriment of the high standing of our profession and of our colleges, for the temptation is
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very strong when there is a deficit in the college treasury to wink at the meager qualifications possessed by the applicants for admission, and trust to the future to correct this deficiency. Occasionally our confidence in these individuals is rewarded, but more often we are woefully disappointed in them.
Candidates have presented themselves before our Board who were unable to write a sentence of twenty words without misspelling at least one-fourth of them. This is no exaggeration, but a plain statement of facts. Many could neither speak or write without transgressing many of the rules of English grammar. We, however, are not alone in this, for the Army Medical Boards now in session are having the same class of candidates come before them. I need not say that such men did not succeed in passing the examinations of the Army Dental Board, for they generally gave up the attempt after trying two or three subjects.
The result of these examinations, it would seem to me, prove very conclusively that there is great need of raising the standard of the entrance requirements of our dental colleges, and of lengthening the course of instruction to four years, so as to be able to devote more time to the theoretical teaching. Our motto in dental education should therefore be “Excelsior.”
(End of extract).
The three vacancies referred to in the above report were subsequently filled by the appointment of the following: Alexander P. Bacon (Nov. 25, 1901), John A. McAlister (Jan. 3, 1902), and Geo. H. Casaday (Feb. 3, 1902).
On Aug. 9, 1901, the National Dental Association passed a resolution commending the board on the manner in which examinations were conducted and expressing its confidence in the board. A copy of the resolution was forwarded to the Surgeon General (S.G.O. 79325-68).
The board of Supervising and Examining Dental Surgeons as such was never reconvened. Dr. Marshall, on duty at the Presidio of San Francisco, examined seven candidates during the months of February - July, inclusive, 1902, after which no examinations for appointment were held until 1904.
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Dr. Morgan became ill and left Cuba on Nov. 3, 1901, on one month’s sick leave, which was subsequently extended to two months, and on Feb. 3, 1902, his contract was annulled on account of physical disability (S.G. 78281). Dr. John H. Hess, contract dental surgeon, was selected to be the third member of the Examining and Supervising Dental Board. Dr. Marshall, President of the board, was directed by the Surgeon General to give Dr. Hess “such instructions as you may think necessary regarding these examinations, the preparation of reports thereof, and other matters your experience may dictate. . .” in order that examinations held by Dr. Hess would be uniform with others held. (S.G. 70760).
(To be continued).
