JOHN SAYRE MARSHALL,
PIONEER ARMY DENTAL SURGEON
John Sayre Marshall was a man of outstanding achievements in professional and military life. His first military experience was obtained when as a boy eighteen years of age he enlisted in the volunteer Federal Forces1 and participated in several important engagements of the Civil War.2 His second military experience came later in life after he had practiced his profession a number of years and had earned a national reputation as a skillful and painstaking operator, and as an educator, organizer, and author. It was then the opportunity presented that enabled him to render an outstanding service to his profession and his country: the organization of the first military dental service in any military establishment in the world.
When the Congress authorized in 19013 the employment of dental surgeons in the Army, the matters of selecting qualified dentists, providing them with suitable equipment, their distribution throughout the service, and the prescription of methods of procedure that would insure the greatest efficiency for the number of dentists employed, presented new and unusual problems in the military service that required the services of experienced and qualified dentists. Having been eminently qualified, and recommended by the executive committee of the National Dental Association, Dr. Marshal was the first dental surgeon appointed and was made President of a Board of Examining and Supervising Dental Surgeons whose duty was to organize and develop the newly authorized service.4 He served in that capacity from 1901 to 1911 when he was retired from the Army at the age of sixty-five. His service was characterized by gentlemanly qualities, tact, and skill that won for him the admiration of his professional confreres and the respect of his military associates.
1. Co. “G”, 2nd New York Cavalry, (Volunteers).
2. Waynesboro Gap, Sailors’ Creek, Dinwiddie Court House, Five Forks, Appomattox Station and Appomattox Court House.
3. Act of February 2, 1901.
4. The Board’s actions were subjected to approval of The Surgeon General and the Secretary of War.
He never tired of his profession nor neglected what he considered his patriotic duty. Following his retirement from the Army, he engaged in research activities, working, and encouraging others to work, for answers to unsolved professional problems. He continued those efforts until his final illness and death at the age of seventy-seven. In 1916 when it appeared that the United States would become involved in the World War, he wrote The Surgeon General of The Army offering his services in any capacity they were needed. He was then seventy years old and had been retired from the Army for five years.
Born in England,5 June 26, 1846, he came to the United States with his parents in 1858 and received his preliminary education in the local public schools of De Witt, Onandago [Onondaga] County, New York. After his return from the Civil War,6 he entered Fayettesville Academy, Fayettesville, New York, and graduated in 1868. Early in the following year he took up the study of dentistry in the office of Dr. Frank G. Tibbetts; later, he studied with Dr. Charles Forman, of Syracuse, New York, until he passed the Board of Censors of the Fifth District Dental Society, in December 1869. He opened an office in Cato, New York, and later practiced in Waterford and Syracuse.
Realizing the importance of a thorough professional education, he began the study of medicine in the University of Syracuse in 1873 from which institution he graduated three years later as a Doctor of Medicine. He was made an instructor in dental and oral surgery in the faculty of the college. At about that time he became active in medical and dental societies and served as secretary of both medical and dental societies for many years.
In 1882, Dr. Marshall moved to Chicago, Illinois, and associated with Dr. W. W. Allport in dental practice. He also accepted an appointment as instructor in dental and oral surgery in the faculty of medicine of Northwestern University and in 1884, at the solicitation of President Cummings of the University, he organized the present Dental Department and became its first Dean. He was Dean and Professor of Dental Pathology
5. Tunbridge Wells, County of Kent .
6. Mustered out of service June 5, 1865.
and Oral Surgery at Northwestern University until 1890, when he resigned.
Early in 1892, he accepted an invitation to reorganize the American College of Dental Surgery, and upon its successful accomplishment he became Dean and Professor of Oral Surgery. He held those positions until the consolidation of Northwestern Dental College and the American Dental College in 1896.
Dr. Marshall was active on the surgical staffs of Mercy, St. Luke’s, and Baptist Hospitals in Chicago, and enjoyed particularly his work in harelip and cleft palate reconstruction. Even in those days he recognized the importance of malnutrition and faulty metabolism as important etiological factors in dental disease.
Dr. Marshall was burdened with many duties and professional activities but he found time to write two valuable text books: Injuries and Diseases of the Face, Mouth and Jaws, published in 1897 by S. S. White, and Operative Dentistry, published in 1901 by J. B. Lippincott. His third book, Mouth Hygiene and Mouth Sepsis was published in 1912 by J. B. Lippincott.
The act providing for the employment of dental surgeons in the Army authorized the appointment of a number not to exceed thirty and, “That three of the number of dental surgeons to be employed shall be appointed by the Surgeon General, with approval of the Secretary of War, with reference to their fitness for assignment, under direction of the Surgeon General, to the special service of conducting the examination and supervising the operations of others * * *,” etc.
The three dental surgeons appointed7 by The Surgeon General constituted the Board of Examining and Supervising Dental Surgeons. The Board convened in Washington, D. C., February 15, 1901, and remained in session continuously until July 31, 1901, when the several members were ordered to stations to begin their operating duties.8 Dr. Marshall’s orders assigned him to Presidio of San Francisco, Calif., and directed him to proceed, en route, to Milwaukee, Wis., to represent the Medical Depart-
7. John S. Marshall, Pres., R. W. Morgan, Member, and R. T. Oliver, Recorder.
8. The order appointing the Board was dissolved March 5, 1905. Thereafter each member of the Board functioned as a separate examining board, insofar as the professional qualifications of candidates was concerned.
ment of the Army at the meeting of the National Dental Association held in that city August 6-9, 1901.
As a representative of the Army Board of Examining and Supervising Dental Surgeons, Dr. Marshall made a special report to the National Dental Association entitled Organization of the Dental Corps of the United States Army, with Suggestions upon the Educational Requirements of Military Dental Practice. The report was published in the Transactions of the National Dental Association, 1901, and is unquestionably the most important document in the early history of military dentistry.
The report consisted of two parts. The first part went into details of the organization of the Board, the preparation of examinations which all applicants for appointment were required to undergo; the selection of equipment and supplies; the number of applicants examined; the results of the examination and the assignment of those who qualified; the devising of records and reports for the purpose of securing valuable statistics; and finally, a discussion of securing permanent commissions for members of the Corps, their status at that time being contract dental surgeons subjected to reappointment every three years. His satisfaction with the work of the Board and his faith in the future was expressed in the following sentence: “But I believe that the young men who form the Dental Corps of the United States Army will prove themselves equal to the occasion and bring honor upon the profession to which they belong.”
The second part of the report covered suggestions upon the educational requirements for military dental practice. He said:
“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 present to him for treatment.” He believed a dental surgeon’s general education should be upon broad lines and his professional knowledge as complete as possible in every department of dental practice, including a good knowledge of general materia medica and therapeutics, physical diagnosis, urinary analysis, and general principles of general surgery.
Dr. Marshall had been engaged in teaching and educational work among students for a number of years. The experiences
of the Board in examining dentists for appointment in the Army offered an opportunity to study in detail the results of dental educational programs as exhibited by graduates who had been practicing for varying periods of years in various parts of the country. Dr. Marshall felt there were weaknesses in those programs, and while he stated in his report that he did not wish to be critical, his love of his profession no doubt tempted him to suggest remedies that, in his judgment, were necessary for the correction of deficiencies. He said: “The result of these examinations, it seems to me, prove very conclusively that there is great need for raising the standard of entrance requirements of our dental colleges, and for lengthening the course of instruction to four years, so as to be able to devote more time to theoretical teaching.”
These observations were far ahead of their time. It was not until 1917-18 that the dental curriculum itself was extended from three to four years. In the meantime, preliminary educational requirements for admission to dental colleges had been gradually advanced from the completion of two years’ high school study (1902) to graduation from four years’ high school course in 1917.
While stationed at Presidio of San Francisco, California (1901-07), he continued to serve as President of the Board of Examining and Supervising Dental Surgeons and acted as chief of the dental service. In addition to his operating duties, he corresponded with The Surgeon General on matters relating to the Dental Corps, received professional reports from dental surgeons in the field, compiled statistical data and prepared annual reports to The Surgeon General on the activities of the dental service. Those reports were included in and made a part of The Surgeon General’s Annual Report to the Secretary of War, practically without change.
In his annual reports to The Surgeon General, Dr. Marshall discussed the prevalence of dental diseases in the Army, their effect on the health and efficiency of military personnel, the measure for improvement of dental health and other matters that seemed appropriate at the time. Apparently his reports were
9. See Bulletin No. XIX, Carnegie Foundation, (1926), pp 127.
very satisfactory to The Surgeon General’s Report to the Secretary of War for the fiscal year ending June 30, 1903.
“The foregoing interesting tabulations, with professional comments, have been ably prepared for this report by Dr. John S. Marshall, contract examining and supervising dental surgeon, U. S. Army. The work of the contract dental surgeons has been of high order and deserves commendation. Reports from experienced officers of the Army indicate appreciation of efficient and faithful services of the Army dentists is steadily growing among officers and men.”
Discussing the prevalence of dental diseases, Dr. Marshall said: “The prevalence of dental caries and other dental and oral diseases among troops, as shown by the following tabulated statistics, is very marked, and when the fact is taken into account that officers and enlisted men have been chosen for service after a rigid examination to determine their physical perfection, and that all but those in perfect health and of good physical development are rejected, it seems evident that excessive physical and mental strain predisposes the individual to dental diseases and that great care should be exercised in the examination of the teeth, a full complement of those organs in a sound condition being such important factors in maintaining the general health of the individual.
“* * * Good, or at least serviceable, teeth are very necessary as a means of maintaining the general health, and consequently the highest efficiency of the Army, particularly when campaigning in the tropics where conditions of the climate and necessary changes in the habits of life are so enervating and debilitating to the general system. Resistance to disease under these conditions is greatly lessened and the individual is consequently predisposed to a certain class of diseases, among which are dental caries, pulpitis, pericementitis, dento-alveolar abscess, pyorrhea alveolaris, necrosis of the jaws, and inflammatory and ulcerative conditions of the gums, of the oral mucous membrane, the throat and tongue.”
Commenting on the services of the Dental Corps, he said:
“The services of the Dental Corps have been highly appreciated by officers and enlisted men of the Regular and Volunteer Armies and have proved very satisfactory to the Medical Department,
because they have been able to relieve a great amount of acute suffering and to conserve a large number of teeth and restore them to a healthy condition, thus almost immediately returning to duty many cases that were previously carried for several days on the company sick report. This has resulted in greatly reducing the loss of valuable time to the service, incident to diseases of the mouth, teeth and jaws, and relieving and hastening the cure of such gastric and intestinal disorders as were due to defective mastication and infective and suppurative conditions of the teeth and oral cavity.”
The above quotations were taken from Dr. Marshall’s reports for the fiscal years 1902 and 1903: They demonstrate his keen insight and professional attainments. Modern laboratory methods and training were not available then, and it was not until 1917-18 that military dentistry was based on the principle that dentistry is truly a health service. It is to the credit of military dentistry that its service during the World War furnished an impetus to the practice of dentistry as a health service, and it is also to the credit of military dentistry that the man who acted as its first chief of service was one who recognized its value as a health service and recommended its acceptance as such at the very beginning of military dentistry.
Reference has been made to Dr. Marshall’s report to the National Dental Association in 1901 as one of the most important documents in the early history of military dentistry. Another document of equal importance is his letter to The Surgeon General recommending the establishment of an Army Dental School.
The occasion for writing that letter was a conversation he held with Major [William Cline] Borden, Medical Corps, who was with The Surgeon General in San Francisco on an extended inspection tour. Major Borden had discussed The Surgeon General’s plans for the establishment of a large U. S. General Hospital and Medical School in Washington, “for the purpose of treating such cases as need the attention of specialists; and for clinical teaching of student medical officers who would be in attendance at the Army Medical School.”
“These plans are of great interest to me,” Dr. Marshall wrote, “not only from the side of military medicine and surgery, but I see great possibilities in them for the dental surgeons of
the Army, and through them, the Army at large and the public in general, if you could so enlarge your plans so as to incorporate them in your scheme.”
“By the establishment of such a postgraduate school for dental surgeons with hospital advantage along the line of oral surgery, and laboratories for special investigations in applied physics, dental histology, pathology and bacteriology, organic chemistry and mechanics, the Medical Department of the United States Army might add greatly to its enviable reputation for scientific research and investigation.”
Other pertinent paragraphs in Dr. Marshall’s letter read as follows:
“There are also many important propositions in dental embryology, histology and pathology, which have not been solved; while the study of the bacteriology of the mouth opens up a vast field of original research as applied to diseases of the oral cavity, and, particularly to certain diseases of the throat and lungs, and gastric and intestinal disorders. The fact that the unclean mouth is the habitat of myriads of pathogenic bacteria, lends more than color to the supposition that may obscure infections will, upon further investigation, be found to have their origin in the mouth.”
“Furthermore, from the standpoint of oral surgery, the establishment of such a hospital would furnish a magnificent clinic for the teaching of this department of surgery, and the mechanical methods of restoring portions of the jaw, the nose, or the face, by artificial substitutes, in those cases beyond the help of surgery; and the treatment of fractures of the jaws by the various forms of interdental splints, etc.”
“If the appointment to the Dental Corps is placed upon the same basis as appointment in the Medical Corps has recently been placed, the examination conducted on the same plan, and successful candidates given a contract for one year and assigned to duty at a school of the kind outlined, with a course of instruction adapted to their official and professional needs, it would be a great advantage to the service, and also give an opportunity to ascertain their adaptability or inadaptability for the service, and thus exclude undesirable men. On the other hand, dental surgeons returning from a three year tour in the Philippine Islands, where they have been cut off from contact with members
of their own specialty, would greatly enjoy a few months= detail at such a school of instruction, where they could have the advantage of studying the latest improvements in technique and operations, or where they might be sent to prepare for examinations for promotion.”
“Of course, in making these latter suggestions, I am looking into the future, for I know, at the present time, such a plan could not be carried out; but I see no reason why, in the near future, this or some similar scheme may not be adopted to the great advantage of the Corps, in scientific attainment and general efficiency in service, and, of course, to the good of the whole Army.”
“In this connection I will speak of another matter that has been on my mind for a long time, viz., the need for competent dental assistants in the Hospital Corps. All of the dental surgeons have found great difficulty in securing as assistants enlisted men who know anything of dental surgery, * *. I would therefore suggest that in the scheme for the dental school you consider the advisability of planning a course of instruction for enlisted men of the Hospital Corps which would fit them for the duties of dental surgeon’s assistants, as indicated in Par. 1581 A. R., and also to do mechanical laboratory work. A bright student with a mechanical turn of mind could learn the practical side of laboratory work in a course of instruction, covering six or eight months. On passing a satisfactory examination he could be given the grade and pay of a sergeant in the Hospital Corps. Men of good habits having this knowledge would be invaluable to the dental surgeons and make it possible for them to perform a much greater amount of work and at very little additional expense to the government, while at t same time, the men would be contented and probably remain in the service indefinitely.”
That letter written February 6, 1904, demonstrated again his vision and the breadth of his professional knowledge. His outline of the purposes of the school and the fields to be covered in research and instruction for officers and enlisted assistants, essentially parallels those inaugurated when the Army Dental School was established, eighteen years later, at the Army Medical Center, Washington, D. C.
Dr. Marshall’s prime interest throughout his professional career was the progressive development of dental practice, and
he realized that the development of military dentistry was dependent, not only on a high type of professional service, but also on a broad and effective administrative policy. He was always alert and ready with suitable recommendations on administrative procedures when the occasion arose. He felt that dental service should be available to the Army wherever it might be, and in the selection of initial equipment for dental surgeons, he was instrumental in obtaining equipment designed and packed in such a manner as to facilitate its transportation in any type of campaign.
In 1903, when it appeared there was a possibility of hostilities between United States troops and those of Colombia, he recommended to The Surgeon General that dental surgeons be sent with our troops to the seat of war.
Believing as he did that dental diseases had a direct bearing on the health and efficiency of military personnel, Dr. Marshall recommended increased dental standards for applicants for enlistment. It appears that men were accepted with little or no regard for their dental conditions, and his advice that “applicants who show signs of extensive dental caries should not be accepted for service” is as sound today as when made in his annual report in 1902.
Mention has been made of his desire to secure trained enlisted dental assistants. He felt their value to the service would be greatly increased if they were promoted or given a rating that in the end would offer a reward for long and faithful service. In November 1902, he wrote The Surgeon General recommending “that privates of the Hospital Corps who have served as dentist’s assistants or clerks for a period of six months may, upon recommendation of the dental surgeon with whom they are serving, be promoted, after an examination, to the grade of acting Hospital Steward with the pay, allowances, etc., of that grade.”
Dr. Marshall was always concerned with the character and qualifications of dentists who were seeking employment in the Army. He reported on several occasions that many of the candidates were poorly qualified, and after the passage of the Act of March 3, 1911, authorizing commissions for dental surgeons—after initial employment as Acting Dental Surgeons for a period
of three years—he wrote The Surgeon General suggesting that an article be sent to all dental journals setting forth the requirements and advantages of the Army Dental Service.
The Surgeon General approved his suggestions and asked him to prepare such a notice and forward it to The Surgeon General’s Office at the earliest practicable date. Dr. Marshall’s article cited the improved status of the Dental Corps, explained the provisions of the Act of March 3, 1911, and spoke of the opportunity of qualified dentists to render a high type of service. He also solicited the aid of deans of dental colleges and the profession generally in helping to build up and increase the efficiency of the Dental Corps by recommending and advising young practitioners of high attainments to apply for those positions. The article was published in all the leading dental journals of the day.
On July 22, 1905, he was relieved from duty at the Post of Presidio of San Francisco and assigned to duty at the general hospital, now known as Letterman General Hospital. While on duty there he designed and had built a dental cabinet which was far superior to any cabinet then on the market.
Later while on duty in Manila, he made an extensive research on inlay investments. He did not succeed to his own satisfaction and returned to gold foil operations until a satisfactory inlay investment was received from the States. During his tour in the Philippines, he also designed a dental electric switchboard which proved to be of considerable value to him while stationed there.
Dr. Marshall had the appearance of a man of unusual attainments; he was dignified, proud in spirit, and a gentleman in every respect. He was proud of his profession and felt that dentistry was not accorded the proper recognition in the military service. For a man of his age, experience, and attainments, a quasi-military status was hardly in keeping with his professional dignity. He, with others, accepted the position of Contract Dental Surgeon with the belief that dentistry would soon demonstrate its value in the military service and that commissioned rank would be granted shortly after military dentistry began to function.
He was doomed to disappointment in this respect for a number of years, but his high professional qualifications, his tenacity and tact, contributed very greatly to the limited recognition which was granted in 1911, and furnished the groundwork for full recognition which came a few years later. Dentistry, like other branches of the service, had to grow up. Dr. Marshall’s role was that of the pioneer.
Early in his military career, he began making recommendations for commissioned rank for dental surgeons and continued making such recommendations when an opportunity presented. His correspondence with The Surgeon General on that subject, which began in the latter part of 1903, is a classic in military dental history with respect to the skill, tenacity, and tact with which he presented his arguments. The Surgeon General acknowledged his letter of November 3, and in reply submitted some questions that seemed to present objections to the granting of commissions to dental surgeons. Dr. Marshall’s reply to his letter contained detailed and specific answers to the questions submitted, together with further statements of argument. In reply The Surgeon General wrote, “* * On first reading I am impressed with the lucid and positive manner in which the points touched on by you are presented. While complimenting you on this, I feel bound to say that the statement does not quite make clear what compensating advantage from a commission the Army dentist will gain to make up for the two hundred dollars a year he will sacrifice in pay, or how the efficiency of the service will be promoted. But I am open to conviction.”
Dr. Marshall was commissioned First Lieutenant, Dental Corps, with rank from April 13, 1911, and was retired from the service June 17, 1911, with the rank of Captain. The rank of Captain was granted him by reason of his service in the Civil War.
During the time he was on duty in San Francisco, he was appointed special lecturer in the dental department of the University of California. After his retirement he returned to California, renewed informally his University affiliations and enjoyed the opportunity of studying research problems until his final illness. Among the reports and papers published by him during this period were: Septic teeth; A Contribution to the study of
human enamel, with special reference to its nutrition; Some problems in dental histology, physiology and patho-histology that need to be solved; A Study of the rate of interstitial growth of the persistent teeth of the albino rat, as shown by vital dyes. He was assisted in this work by his son, John A. Marshall, who is now widely known in dental research fields and is a member of the teaching staff of the dental department of the University of California.
In 1910 the University of Syracuse conferred upon Dr. Marshall the degree of Doctor of Science. In 1914 he was elected a Fellow of the American College of Surgeons.
Dr. Marshall died November 20, 1922, at Berkeley, California. He left a record of achievement marked by painstaking effort and signal ability. It stands today as a proud heritage of members of the dental profession, more especially to those who practice military dentistry.
W. D. Vail,
Lt. Col., Dental Corps, U. S. Army.