Bytes of History

Robert Tanner Freeman

freemanRobert Tanner Freeman was born in Washington DC in 1846. He was the son of slaves who had bought their freedom in the 19th century. Historical records are unclear but they probably adopted the surname Freeman in response to their transition.

In those days many dentists learned their profession-really more properly thought of as a trade at that time-as apprentices and laboratorians. This preceptorial system was rightly criticized by those who believed that theory, as well as practice, was vital in the education of a dentist. The first three formal dental schools created in response to this need were the Baltimore College of Dental Surgery founded in 1840, the Ohio College of Dental Surgery founded in 1845, and the Michigan School of Dentistry. These were all stand-alone schools however–the medical schools and universities of the time refused to let dentistry become a part of their curriculum. They viewed dentistry as a trade rather than a profession requiring a university-based education. Yet it eventually became apparent that the public would best be served by making formal dental education part of the university system, on the same level as medical schools. The first university-based dental school in the United States was Harvard Dental School, founded in 1867. (The second was the University of Michigan in 1875 and the third was the University of Pennsylvania in 1878).

Robert Tanner Freeman had a strong interest in the health professions, and he sought work as a dental assistant and clerk from Dr. Henry Bliss Noble, his white dentist who tutored Robert and encouraged him to pursue his own career in dentistry. Dr. Noble hired Robert to work in his office which was in the 1500 block of Pennsylvania Avenue in Washington, DC. At this time it is estimated that there were a total of 120 African-American dentists in the entire U.S. All of those dentists had learned via informal apprenticeship.

Dr. Noble “was a reputable dentist whose humane acts of employment and encouragement of an African-American were indeed remarkable, especially in the nation’s capital where residents were sensitive to Confederate values and traditional interracial dogma,” wrote dental historian Dr. Clifton O. Dummett in Courage and Grace in Dentistry: The Noble, Freeman Connection, from the Journal of the Massachusetts Dental Society (1995).

Dr. Noble “encouraged him to think seriously about pursuing a dental career, pointing out that Freeman would be in a better position to help alleviate human suffering and serve the dental health needs of his fellow African-Americans in this way.”

Thus inspired, Robert applied to two of the independent dental schools. He was rejected on racial grounds.

Then, Dr. Noble set about the process of working his colleagues.

Noble was well acquainted with Dr. Nathan C. Keep, Harvard Dental School’s first Dean, and other members of the Board of Trustees. Dr. Noble strongly lobbied these men to accept his African-American employee and friend into the first class of their new school. At first there was resistance, and they too considered rejecting Robert’s application. As they met, however, the conversation must have taken an unexpected course, as it often does in a new, creative grouping of people. These academics were, after all, taking what was a trade and molding it into an integral part of the medical profession. On Dr. Keep’s recommendation, Harvard decided the school would “know no distinction of nativity or color in admitting students.”They also stated that they wished to establish a tradition of inclusion, not exclusion, as they began their enterprise. Dean Henry M. S. Miner later wrote: “Robert Tanner Freeman, a colored man who has been rejected by two other dental schools because of his race, was another successful candidate. The dental faculty maintained that right and justice should be placed above expediency and insisted that intolerance must not be permitted.” Dr. Freeman thus became the first African-American graduate of a U.S. dental school in history.

After graduating from Harvard in 1869, Dr. Freeman returned to Washington, D.C., and practiced in the same building as his mentor, Dr. Noble. Unfortunately, his death came only four years after dental school. He contracted one of the water-borne diseases so common at that time, most probably cholera. Every indication is that he served his community in an exemplary way and gave vital assistance to an African-American community in a time of tremendous cultural and political change. Recall that the American Civil War had only ended 4 years before his graduation.

His career also began a distinguished legacy for his family. Dr. Freeman’s grandson, Robert C. Weaver, Ph.D., became the country’s first African-American presidential cabinet member, serving as Lyndon B. Johnson’s Secretary of Housing and Urban Development.

None of this success would have happened without a small group of dentists listening to a few influential members who stood up for something that must have been exceedingly unpopular at the time. I also find it interesting and inspiring that the decisions of a relatively small circle of people in the 1860s could reverberate down through time into the 1960s and influence choice at the presidential cabinet level. Dr. Weaver would not have been able to reach his own success without building on that of his grandfather.

  Dr. Richard Wilson

Gabriel d’Erchigny de Clieu

GabrielWe’ll return to dental history in the next installment of Bytes of History; for now let�s appeal to the coffee (and tea!) drinkers in the audience!

For most cultures in most of human history, no adult was ever completely sober.

That’s right. You didn’t think they drank water, did you? Water was always suspect. Without modern sanitation facilities there was always the risk of water-borne diseases: cholera, typhoid, dysentery. Some have called these diseases the biggest killers of all time. So if not water, then what? Depending on the culture, they drank beer or wine. The process of fermentation did away with much risk. Most people in most places, since the dawn of agriculture, did not drink plain water. They went through their lives in a constant state of mild inebriation.

Coffee, tea, and hot chocolate were available in some parts of the world (depending on how strictly the Islamic prohibition against alcohol was enforced). Nowadays, each has a staunch following of devotees. But until the 1600s, coffee, tea and chocolate — the only plant sources of caffeine edible by human beings — were completely unknown in Europe and the Americas. Even after Pope Clement the VIII proclaimed that it would be “a shameful waste” to leave the enjoyment of coffee to the heathen, officially sanctioning it to the vast, influential Catholic Church, one nation — the Dutch — exclusively controlled its production. Prices were very high, and supplies were limited. Simply put, there were no competitors.

This is the story of the man who changed all that.

Gabriel d’Erchigny de Clieu was a French naval officer and resident of Martinique, in the Caribbean. De Clieu had a secret ambition: to steal a coffee plant from the Jardin des Plantes, where Louis XIV had them jealously protected. De Clieu’s plan was to cultivate coffee plants in the West Indies, but getting such a plant was an incredible challenge. The plants were guarded with great zeal.

De Clieu’s solution was a lateral attack. He persuaded a young lady of the Court to prevail upon M. de Chirac, the Royal Physician, to purloin one of the rare plants from the Jardin. And in 1723, de Clieu sailed from Nantes with his single, precious coffee plant installed in a glass-framed box on the deck of the ship — a sort of protective greenhouse.

His crossing was difficult. A Dutch-speaking passenger (perhaps an early example of an industrial spy!) seemed intent on disrupting de Clieu’s plans; on one occasion de Clieu surprised him in the act of opening the greenhouse and snapping off a twig. But that wasn’t all — the ship barely escaped an attack by Tunisian pirates, and heavy storms nearly smashed the greenhouse. The greatest threat, during a prolonged calm, was the rapid depletion of drinking water aboard ship. De Clieu wrote:

“Water was lacking to such an extent that for more than a month I was obliged to share the scanty ration of it assigned to me with my coffee plant, upon which my happiest hopes were founded and which was the source of my delight.”

Despite all, de Clieu did make it home to Martinique, coffee plant intact! He set it out with great care, under guard. Upon reaching maturity it bore coffee beans, and propagated with ease in the friendly climate. Eventually coffee plantations sprang up all over South America, particularly Brazil. Many botanists feel that the entire population of coffee plantations in the New World, until recent mixing, descended from De Clieu’s single enterprising plant.

By 1746, with lower coffee prices and greater cultural acceptance, de Clieu was presented before Louis XV, who (unlike his father) was a serious coffee drinker! De Clieu was appointed Governor of Martinique, an honor bestowed for his cultivation of coffee.

The shift from wine and beer (which dull the senses) to coffee and tea (containing stimulants) was world-changing. Along with railroads and the telegraph, the partial replacement of alcohol with caffeine as the most commonly used drug in the world encouraged modern work methods and industrial progress. Thanks to the vision and perseverance of one man willing to challenge the status quo, the coffee drinker’s barrier to entry was altered dramatically: from wealth and influence to simple taste.

Dr. Rick Wilson and Megan Elizabeth Morris

Anesthesia: Dentistry’s Great Contribution to Medicine

EtherDayAnesthesia. The ability to block painful sensations during surgical procedures of any kind. Of all our advancements in medical knowledge, it can be said that no other has alleviated human suffering more than the discovery of anesthetics.

This great gift to Mankind was made by an American dentist in 1844.

Well, sort of. It’s complicated…

In the last quarter of the eighteenth century, chemists, especially in England, were discovering and isolating gases, such as oxygen and nitrogen. Joseph Priestly discovered nitrous oxide in 1772, as well as oxygen in 1774. Oxygen was isolated by Daniel Rutherford in 1772. The medical establishment at the time had high hopes for using these newly revealed substances to cure various illnesses; a number of “Pneumatic Institutions” were established where gases were administered to patients suffering from a range of diseases.

It wasn’t in a medical institution where the ability of these agents to block painful sensations was first noticed, however. In America there were many itinerant showmen who styled themselves “professors” and traveled about holding popular demonstrations of the effects, among other things, of nitrous oxide. “Professor” Gardner Quincy Colton was one of them. Keep in mind that nitrous oxide’s effects vary according to the situation, and although most people remain quiet and relaxed during dental treatment, when an audience member volunteers to go on stage they tend to get much more excitable, similar to the experience of having a few drinks and then taking the microphone and singing karaoke.

Well, on December 11, 1844, Dr. Horace Wells, a young dentist from Hartford, Connecticut, attended one of the Professor’s exhibitions. An acquaintance of Well’s, a fairly large man named Cooley, volunteered, breathed the requisite nitrous oxide, and was dancing around the stage when he fell off the edge and severely scraped his shin. He returned to his seat and for a few minutes seemed to have absolutely no awareness of any pain. History has not recorded for us his reaction when the nitrous wore off and he felt the full force of his injury, but we do know that Wells immediately saw the implications of this event. In his mind, there was tremendous potential in nitrous oxide to alleviate the suffering that patients experienced during tooth extractions.

Wells happened to need a molar tooth extracted himself. He asked Professor Colton to come by his office the next day with a supply of nitrous oxide. Colton administered the gas to Wells and Well’s colleague, Dr. John Riggs, extracted the tooth. Wells’ exact words upon awakening were: “I didn’t feel it so much as the prick of a pin. A new era in tooth-pulling has arrived!”

(I have to note here that at that time, unlike today, the nitrous oxide was used at 100% concentration, giving almost full anesthesia- but no oxygen! Machines today cannot exceed 70% nitrous oxide/ 30% oxygen; patients are always getting more oxygen than there is in the air around us, which is 21%. The fact is, back in the 1800’s one was either alive and well or- not!- so that techniques like this, risky by today’s standards, tended to have relatively few complications, as the patients were fairly robust to begin with.)

The next step for Wells was to petition the prestigious Massachusetts General Hospital for the chance to demonstrate his discovery. In January 1845 he presented himself at Dr. John Collins Warren’s class and extracted a tooth for one of the students. Wells withdrew the gas a bit early and the student briefly cried out in pain, yet afterward insisted that he had felt nothing. He probably didn’t remember coming out of the anesthesia. Unfortunately, Wells was hissed and booed out of the class. Not one to be put off easily, Wells continued to use nitrous oxide for extractions in his dental practice, and he discussed his work with another colleague and former student, Dr. William Thomas Greene Morton.

Morton talked about nitrous oxide with one of his professors, Charles Jackson. Jackson had the habit of inhaling ether, and often fell unconscious. Morton tried ether himself and then, on September 30, 1846, performed his first extraction where the patient inhaled ether. This was also a success, the patient having no sensation of pain during the extraction.

It was now Morton’s turn to ask Dr. Warren for a chance at a demonstration of anesthesia during surgery. We can only imagine the good surgeon’s reaction at being pestered by so many dentists to try something so radical at the time as anesthesia! However on October 16, 1846, Morton administered ether to a surgical patient and Warren removed a tumor from the neck of his patient, Gilbert Abbott. It is also difficult for us to imagine today the advantages to a 19th century surgeon of not having their patient screaming and moving due to the pain of a procedure, but Dr. Warren must have been thrilled and impressed because he turned to his audience of students and exclaimed, “Gentlemen, this is no humbug!” (Slang evolves, but a humbug was a very very bad thing in the 1800’s.)

The concept of using anesthesia during surgery and dental procedures spread swiftly around the world and met with rapid acceptance once influential surgeons started to operate routinely with its benefits.

As usual in the course of human affairs, once an enormous sum of money enters the picture, things start to get complicated. The U.S. Congress voted to award an honorarium of $10,000 to the discoverer of anesthesia. Wells, Morton, and Jackson all applied, as did Georgia physician Dr. Crawford Long. Long claimed to have used ether anesthesia since 1842 and produced affidavits to this effect from some of his patients, but his position was weakened somewhat by the fact that he had never spoken, lectured or written on the subject before any medical group. Then there is this excerpt from a letter that Long wrote to his friend Robert Goodman:

“I am under the necessity of troubling you a little. I am entirely out of ether and wish some by tomorrow night� We have some girls in Jefferson who are anxious to see it taken, and you know nothing would afford more pleasure than to take it in their presence and to get a few sweet kisses…”

Not exactly following modern ethical principles in medicine, was he?

The controversy surrounding the discoverer of anesthesia ran on for so long that Congress finally withdrew its offer. The lives of these four men who contributed so much to humanity did not end so well:

-Wells became obsessed with obtaining the recognition due him and became addicted to chloroform. He committed suicide in jail at the age of 34.

-Morton became very poor due to his legal fees, incurred in fighting for a share of the profits from what he considered his invention. He died a pauper at age 49.

-Jackson was committed to a mental institution.

-Long went back to his small-town medical practice.

Who most deserves the credit for discovering anesthesia, and giving the world relief from the pain of all kinds of surgical procedures? In terms of both awareness of the significance of what they saw, and of communicating their discovery to others in the medical field, Dr. Horace Wells would seem to be the best candidate for this honor. Both the American Dental Association, in 1864, and the American Medical Association, in 1870, resolved that “The honor of the discovery of practical anesthesia is due to the late Dr. Horace Wells of Connecticut.”

  Dr. Richard Wilson

Dr. Lucy Hobbs Taylor

Lucy_hobbs_taylorIt is extremely difficult for young women today to envision how difficult it was for a woman in the 19th century to advance along a fulfilling career path. Even in the first half of the 20th century countless women were told by their parents that “there’s no need for girls to go to college”. And yet just as with all other forms of prejudice or elitism, there were always outliers, defined by Malcolm Gladwell as “people who do not fit into our normal understanding of achievement”. Here, then, is the story of a very persistent and brilliant outlier, Dr. Lucy Hobbs Taylor, the first female dentist in the United States.

Born in Constable, N.Y. in 1833, Lucy had a strong interest in health care from a very young age. She started out teaching school in Michigan. In 1859 she moved to Cincinnati and applied to the interestingly-named Eclectic College of Medicine. In spite of the name hinting at diversity in the student body, Lucy’s application was rejected because of her sex.

A determined young woman, Lucy found a lateral solution to this challenge and studied privately with one of the school’s professors, who steered her towards dentistry. She next applied for admission to the Ohio College of Dental Surgery and was again rejected because of being female. She again thought not only outside the box, but outside the room which contains the box, and was able to persuade the college dean to tutor her privately.

Finally, in 1861, the now 28-year-old Lucy opened a dental practice in Cincinnati and later moved her practice to Iowa. There, a few years later, the Iowa State Dental Society accepted her as a member. Now, here’s the thing about outliers- they don’t just get a foothold in the realms denied to them and then rest on their laurels. No, outliers can most often be counted on to keep achieving way beyond what’s nominally expected of them. So, our Lucy was sent by the Iowa State Dental Society as a delegate to the ADA’s 1865 convention in Chicago.

In those days apprenticeships vied with formal dental school training as a way into the profession, but a degree always conferred higher status and was becoming more of a prerequisite for success all the time. So, with her Iowa accomplishments set to impress, Lucy was finally accepted into that same Ohio College of Dental Surgery as a member of its senior class in 1865. Receiving credit for her years as a practicing dentist, Lucy earned her DDS degree in February 1866. She thus became the first woman in the world to hold a formal degree in dentistry. (Note the close proximity to Dr. Freeman’s graduation from Harvard- 1869.)

Perhaps the most charming part of the story is what came next. In 1867 Lucy married Civil War veteran James M. Taylor, who became a dentist under his wife’s guidance!

The couple moved to Lawrence, Kansas, where they managed a large and successful dental practice. “Dr. Lucy”, as she was known to her patients, died in Lawrence on Oct. 3, 1910 at the age of 77.

There’s more here:

Dr. Lucy remains one of this author’s favorite outliers- ever.

  Dr. Richard Wilson