20th-Century Teeth: Dentistry at the Turn of the Century

By Johanna Goldberg, Information Services Librarian

This is part of an intermittent series of blogs featuring advertisements from medical journals. You can find the entire series here.

“How did you learn to be a dentist? Did you go to a college?”

“I went along with a fellow who came to the mine once. My mother sent me. We used to go from one camp to another. I sharpened his excavators for him, and put up his notices in the towns–stuck them up in the post-offices and on the doors of the Odd Fellows’ halls. He had a wagon.”

“But didn’t you never go to a college?”

“Huh? What? College? No, I never went. I learned from the fellow.”

Trina rolled down her sleeves. She was a little paler than usual. She fastened the buttons into the cuffs and said:

“But do you know you can’t practise unless you’re graduated from a college? You haven’t the right to call yourself, ‘doctor.'”1

In Frank Norris’ 1899 novel McTeague: A Story of San Francisco—better known for its depiction of greed than the professionalization of dentistry—the title character loses his 12-year-old dental practice after California requires practitioners to hold a degree in the field. The timing couldn’t be worse for McTeague: he’d only just fulfilled a long-held dream, obtaining and hanging an enormous golden tooth outside his dental parlor.

McTeague’s fictionalized struggle was based in reality: until the mid to late 1800s, dentistry in the United States was not a regulated profession. Alabama became the first state to regulate dentists in 1841, and other states followed suit through the end of the century.2 In 1885, California passed a law requiring practicing dentists to register with a board, which could call up registrants for examination. Diplomas from a licensed dentistry school—the University of California College of Dentistry opened in San Francisco in 1882—also qualified registered dentists to practice. In 1901, a new law made practicing dentistry in California even more restrictive, part of a nationwide move to tighter regulation.3,4 In the novel as it would have been in real life, McTeague’s practice was toast.

Advertisements in dental journals from the era depict the trend toward professionalization, along with other technological advances. In 1840, the Baltimore College of Dental Surgery opened its doors as the first dental school in the world; by 1895, it had some local competition, including the Dental Department of the Baltimore Medical College.4 This school advertised heavily in journals like the American Journal of Dental Science.

Ad for the Dental Department of the Baltimore Medical College in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

Ad for the Dental Department of the Baltimore Medical College in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

Intriguingly, not only dental schools advertised in dentistry journals: The February 1901 volume of Dental Hints includes an ad encouraging dentists to take up a correspondence course in optometry, “on account of the intimate relationship between the eye and the teeth.” Huh?

Advertisement for the Philadelphia Optical College in Dental Hints, vol. 3, no. 2, February 1901.

Advertisement for the Philadelphia Optical College in Dental Hints, vol. 3, no. 2, February 1901.

Dental journal advertisements also reflect anesthetic advances. William Morton, a dentist, performed the first public demonstration of ether as a surgical anesthetic in 1846.2 A similar demonstration of nitrous oxide in 1845 did not go so well: dentist Horace Wells extracted a tooth before administering the proper dosage, and the patient cried out in pain. The drug was tabled for about 20 years; by 1869, it was commonly used either on its own or in conjunction with ether for dental procedures.2,5 Dental surgeries held less risk than other medical procedures, as they were commonly performed either in the patient’s or dentist’s home, locations less teeming with deadly microbes than operating theaters. After advances in antiseptic surgery by people like Joseph Lister, dental surgery became even safer—and Dr. Joseph Lawrence named an antiseptic mouthwash in his honor.5,6

Codman & Shurtleff's Inhaler for Gas or Ether advertisement in Dental and Oral Science Magazine, vol. 1, no. 2, May 1878.

Codman & Shurtleff’s Inhaler for Gas or Ether advertisement in Dental and Oral Science Magazine, vol. 1, no. 2, May 1878.

Listerine advertisement in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

Listerine advertisement in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

Local anesthetics also entered the market around the turn of the century. Some, like Mylocal, contained cocaine—though in the case of Mylocal, that cocaine was to be added by the practitioner prior to use. Perhaps unsurprisingly, the amount of cocaine used in local anesthetics was often poorly controlled, with sometimes dire results.5 Another local anesthetic, Eureka, proudly advertised that it “[avoids] that most dangerous drug that is known to the profession as COCAINE.” A third, Wilson’s Local Anaesthetic, notes that it is “non-secret and positively guaranteed.” Unfortunately, its ads don’t state what these non-secret ingredients are.

Advertisement for Mylocal anaesthetic in the American Journal of Dental Science, vol. 39, no. 1, January 1908.

Advertisement for Mylocal anaesthetic in the American Journal of Dental Science, vol. 39, no. 1, January 1908.

Advertisement for Eureka Local Anaesthetic in Dental Hints, vol. 3, no. 2, February 1901.

Advertisement for Eureka Local Anaesthetic in Dental Hints, vol. 3, no. 2, February 1901.

Advertisement for Wilson's Local Anesthetic in Dental Clippings, vol. 3, no. 6, April 1901.

Advertisement for Wilson’s Local Anesthetic in Dental Clippings, vol. 3, no. 6, April 1901.

Other turn-of-the-century advances include the development of tube toothpaste in the 1880s (previously, toothpaste had only been available in powdered form); awareness of microbial causes of tooth decay, leading to the promotion of flossing and brushing in the 1890s; and the use of gold foil as a cavity filling in the 1850s.2 The ads below reflect these advances and others, and were selected to show the relatively pain-free side of dentistry.

R. S. Williams Toothbrushes advertisement in Dental and Oral Science Magazine, vol. 1, no. 2, May 1878

R. S. Williams Toothbrushes advertisement in Dental and Oral Science Magazine, vol. 1, no. 2, May 1878.

Ney's Gold Plates advertisement in the American Journal of Dental Science, vol. 33, no. 1, May 1899.

Ney’s Gold Plates advertisement in the American Journal of Dental Science, vol. 33, no. 1, May 1899.

Dental Floss Silk advertisement in advertisements in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

Dental Floss Silk advertisement in advertisements in the American Journal of Dental Science, vol. 33, no. 10, February 1900.

McConnell Dental Chair advertisement in Dental Hints, vol. 3, no. 4, April 1901.

McConnell Dental Chair advertisement in Dental Hints, vol. 3, no. 4, April 1901.

Standard Dental Manufacturing Co. advertisement in Dental Hints, vol. 3, no. 5, May 1901.

Standard Dental Manufacturing Co. advertisement in Dental Hints, vol. 3, no. 5, May 1901.

Dentacura toothpaste advertisement in Dental Hints, vol. 3, no. 11, November 1901.

Dentacura toothpaste advertisement in Dental Hints, vol. 3, no. 11, November 1901.

Munson's Standard Teeth advertisement in Dental Hints, vol. 3, no. 12, December 1901.

Munson’s Standard Teeth advertisement in Dental Hints, vol. 3, no. 12, December 1901.

Prophylactic Toothbrush advertisement in Dental Summary, vol. 22, no. 7, July 1902.

Prophylactic Toothbrush advertisement in Dental Summary, vol. 22, no. 7, July 1902.

Antikamnia and Odontoline advertisements in advertisements in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

Antikamnia and Odontoline advertisements in advertisements in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

Baker Coat Co. and Keeton Gold advertisements in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

Baker Coat Co. and Keeton Gold advertisements in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

Bowl Spittoon advertisement in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

Bowl Spittoon advertisement in the American Journal of Dental Science, vol. 39, no. 4, April 1908.

References

1. Norris F. McTeague.; 1899. Available at: http://www.gutenberg.org/files/165/165-h/165-h.htm. Accessed May 9, 2016.

2. History of Dentistry Timeline. Available at: http://www.ada.org/en/about-the-ada/ada-history-and-presidents-of-the-ada/ada-history-of-dentistry-timeline. Accessed May 9, 2016.

3. Newkirk G. California. In: Koch CRE, ed. History of dental surgery: Dental laws and legislation, dental societies and dental jurisprudence, Vol. III. Fort Wayne, Ind.: National art publishing Company; 1910:755–756. Available at: https://books.google.com/books?id=9iE-AQAAMAAJ&pgis=1. Accessed May 9, 2016.

4. Schulein TM. A chronology of dental education in the United States. J Hist Dent. 2004;52(3):97–108.

5. Enever G. History of dental anaesthesia. In: Shaw I, Kumar C, Dodds C, eds. Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery. Oxford: Oxford University Press. doi:10.1093/med/9780199564217.001.0001.

6. From Surgery Antiseptic to Modern Mouthwash | LISTERINE®. Available at: http://www.listerine.com/about. Accessed May 10, 2016.

Fascinating Mad Men-Era Advertisements

By Anne Garner, Curator, Center for the History of Medicine and Public Health

This is part of an intermittent series of blogs featuring advertisements found in our collection. You can find the entire series here.

In American Journal of Obstetrics and Gynecology 83, no. 3 (1962).

In American Journal of Obstetrics and Gynecology 83, no. 3 (1962).

Nobody conjures the ’60s better than Matthew Weiner and the writers, designers, and stylists of AMC’s Mad Men. We’ll miss the quotidian details: the trash left behind at the Draper family picnic, that unbelievable maternity dress of Trudy’s, the choking smoke of Mohawk’s planes, Metro-North’s trains, and Don’s automobiles. When Sally Draper puts a plastic dry-cleaning bag over her head and her mother scolds her—not out of fear for her safety and only for dumping her dry-cleaning on the floor—we’re gob-smacked. These moments crystallize the seismic shifts that have occurred in cultural expectations over the last fifty years.

The Academy Library has strong holdings in the major journals of the 19th and 20th centuries. Journals were then, as they are now, the primary place of publication for innovations and discoveries. In addition, the advertisements aimed at the professional readers of these journals offer insights into changing cultural beliefs. Most libraries excised the advertisements, especially if they were gathered in a separate section of the journal. The Academy tradition was to keep the advertising, and these ads are now heavily used by historians.

The images and texts in these advertisements provide artists, writers, and historians with richly-textured cultural context. There is much to be learned, for example, from looking at the way antidepressants were marketed to women in the twentieth century, at the early advertisements for the birth control pill, and at tobacco advertising aimed directly at physicians as consumers.  Here, a look at a Flavorwire piece we wrote using ads entirely from our collections and relating them to Mad Men.

More Doctors Smoke Camels

By Johanna Goldberg, Information Services Librarian, with Andrew Gordon, Systems Librarian

This is part of an intermittent series of blogs featuring advertisements from medical journals. You can find the entire series here.

From the 1930s into the 1950s, medical journals—including the Journal of the American Medical Association and the New England Journal of Medicine—ran advertisements for cigarettes.1,2 The New York State Journal of Medicine alone published 600 pages of cigarette advertisements spanning more than two decades, starting in 1933.3 Around the same time, advertising agencies created campaigns featuring physicians; these continued until 1954, as concerns about the negative health effects of smoking grew.2

"How mild can a cigarette be?" Published in the New England Journal of Medicine, volume 240, number 17, April 28, 1949. Click to enlarge.

“How mild can a cigarette be?” Published in the New England Journal of Medicine, volume 240, number 17, April 28, 1949. Click to enlarge.

Presented chronologically below are some of the cigarette advertisements—and one cigarette paraphernalia‎ ad—that appeared in medical journals during the 20-year period. Note especially the 1945 series of ads that ran in several medical journals, including the Medical Woman’s Journal, celebrating the work of war doctors and suggesting that a Camel cigarette could be a welcome break.

Notable, too, is that the earliest ad shown here—printed in Preventive Medicine in 1937—comes from a New York Academy of Medicine publication.

For more information on the history of cigarette advertising, including the use of medical professionals in ads, visit SRITA, Stanford Research into the Impact of Tobacco Advertising.

"Let Your Own Experience Guide You." Published in Preventive Medicine, volume 7, number 1, April 1937. Click to enlarge.

“Let Your Own Experience Guide You.” Published in Preventive Medicine, volume 7, number 1, April 1937. Click to enlarge.

"Look this way for more pleasure." Published in the New England Journal of Medicine, volume 218, number 14, April 7, 1938. Click to enlarge.

“Look this way for more pleasure.” Published in the New England Journal of Medicine, volume 218, number 14, April 7, 1938. Click to enlarge.

"How much do you smoke?" Published in JAMA, volume 12, number 11, March 11, 1944. Click to enlarge.

“How much do you smoke?” Published in JAMA, volume 12, number 11, March 11, 1944. Click to enlarge.

"The Army Doctor's Call to Action!" Published in Medical Woman's Journal, volume 52, number 4, April 1945. Click to enlarge.

“The Army Doctor’s Call to Action!” Published in the Medical Woman’s Journal, volume 52, number 4, April 1945. Click to enlarge.

Combat Team in White! Published in Medical Woman's Journal, volume 52, number 5, May 1945. Click to enlarge.

Combat Team in White! Published in the Medical Woman’s Journal, volume 52, number 5, May 1945. Click to enlarge.

"The Flying Capsules." Published in Medical Woman's Journal, volume 52, number 6, June 1945. Click to enlarge.

“The Flying Capsules.” Published in the Medical Woman’s Journal, volume 52, number 6, June 1945. Click to enlarge.

"Welcome Home, Doctor!" Published in Medical Woman's Journal, volume 52, number 12, December 1945.

“Welcome Home, Doctor!” Published in the Medical Woman’s Journal, volume 52, number 12, December 1945. Click to enlarge.

"Recommended by Physicians to Patients who are 'Problem Smokers.'" Published in JAMA, volume 133, number 11, March 15, 1947.

“Recommended by Physicians to Patients who are ‘Problem Smokers.'” Published in JAMA, volume 133, number 11, March 15, 1947. Click to enlarge.

"Some questions about filter cigarettes that may have occurred to you, Doctor." Published in the New York State Journal of Medicine, volume 53, number 12, June 15, 1953.

“Some questions about filter cigarettes that may have occurred to you, Doctor.” Published in the New York State Journal of Medicine, volume 53, number 12, June 15, 1953. Click to enlarge.

"When your patients ask . . . 'Which Cigarette Shall I Choose?'" Published in the New York State Journal of Medicine, volume 54, number 12, June 15, 1954. Click to enlarge.

“When your patients ask . . . ‘Which Cigarette Shall I Choose?'” Published in the New York State Journal of Medicine, volume 54, number 12, June 15, 1954. Click to enlarge.

References

1. Healy, M. (2011, August 4). Cigarette packages in medical journals: New look for a new age. Los Angeles Times. Retrieved from http://www.latimes.com/health/boostershots/la-heb-cigarette-packages-medical-20110804,0,7658494.story#axzz2rL60QSQm.

2. Gardner, M. N., & Brandt, A. M. (2006). The Doctors’ Choice Is America’s Choice. American Journal of Public Health, 96(2), 222–232. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470496.

3. Blum, A. (2010). When “More doctors smoked Camels”:  Cigarette advertising in the journal. Social Medicine, 5(2), 114–122. Retrieved from http://www.socialmedicine.info/index.php/socialmedicine/article/view/461/0.

Shadow Journals: The Story of Medical Advertising (Part 3 of 3)

Today we have the third and final part of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part one here and part two here.

We don’t have a definitive history of medical advertising (dissertators, take note!). In fact, the world of medicine barely appears in the standard histories of advertising beyond 19th-century patent medicines. We know all about the key campaigns that transformed the wider advertising industry: Uneeda Biscuit and Oleo margarine in the Progressive Era, Wonder Bread and Dwight Eisenhower in the 1950s, the Volkswagon Beetle in the 1960s, and so forth. The annals of medical advertising begin promisingly with a chapter on patent medicines but then basically peter out.

"The obvious anxieties that preoccupy many middle-aged minds often obscure a coexisting depression." From JAMA, volume 209, number 1 (September 22, 1969). Click to enlarge

“The obvious anxieties that preoccupy many middle-aged minds often obscure a coexisting depression.” From JAMA, volume 209, number 1 (September 22, 1969). Click to enlarge.

Obviously any such history would need to be based, in part, on the records of a medical advertising company or the in-house marketing arm of a pharmaceutical company. But they also require access to the advertisements themselves, in the context in which they appeared—i.e., among other places, in medical journals.

It’s not just historians of medical marketing who need the advertisements. Anyone interested in the history of medicine, or of medicine’s relationship to society at large, should care about them. The ads and the articles talked to each other, either through their joint acceptance of larger cultural beliefs or through vigorous debate when professional and profit-seeking agendas clashed. Advertisements also provide a bridge to connect such medical histories to broader developments, via the same links that contemporaries deplored. “They sell medicine like soap!” raged witnesses before Congress in the 1950s, believing that this was argument enough to win the day. This same observation, less polemically framed, might tell us as much about soap and the consumer culture as it does about medicine.

"In many cases the result of 'empty-nest snydrome.' From JAMA, volume 232, number 2 (April 14, 1975). Click to enlarge.

“In many cases the result of ’empty-nest syndrome.'” From JAMA, volume 232, number 2 (April 14, 1975). Click to enlarge.

This is why it was a historic mistake to cut out the ads. And it’s a mistake that we may still be making: today’s online databases offer a la carte articles without the surrounding advertisements, nearby articles, particular layouts, cartoons, etc. (Medical journals used to have cartoon pages; editorial policy apparently insisted that these mostly be nasty pokes at women patients. These pages, too, were often sliced out by well-meaning librarians.)

As I noted before, the New York Academy of Medicine was the only library I have found that did not cut out the advertisements. And even there policy changed for a while in the 1970s. I still don’t know why they had the prescience to spare the advertisements, but we are lucky that they did. It makes for a precious collection that is unlikely to be made obsolete in the digital era.

Shadow Journals: The Story of Medical Advertising (Part 2 of 3)

Today we have part two of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part one here and part three here.

This story of medical journal advertising is typically cast as what historians call a “declension narrative,” a tale whose main arc tracks a decline from the honorable virtues of past generations to the immoral venality of today. In this telling, commerce and marketing slowly colonized the therapeutic endeavor, transforming from the noble pursuit of health into an untrustworthy, buyer-beware precinct of the larger consumer culture.

But this story can also be told very differently.

After all, there had always been advertisements in the medical journals, and subscribers had always been able to see them—they had no librarians to slice-and-dice for them. Subscribers read the articles in the context of having also seen the ads.

From JAMA, volume 207, number 11 (March 17, 1969)

“For the ‘Cheater Eater.'” From JAMA, volume 207, number 11 (March 17, 1969). Click to enlarge.

What might they have drawn from the experience of flipping through the unexpurgated journals? Well, historians have had a field day analyzing the messages of particular ads or particular articles. But the overall structure of the journals also sent its own message. When subscribers flipped past the bundle of advertisements before the table of contents to the ad-free material within, they saw to their satisfaction that commerce had been carefully contained where its self-interested values would not contaminate the real work of medicine—the empirical pursuit of truth, the professional sharing of new ways to alleviate illness and suffering, etc.

And yet, as historians have repeatedly demonstrated, commerce, especially the pharmaceutical kind, had long been a powerful force in medicine. From Parke-Davis’ hyping of cocaine in the 1880s, to Smith Kline French’s careful orchestration of research on amphetamine in the 1930s and 1940s, to Carter Product’s “launching” of minor tranquilizer Miltown with a public relations campaign worthy of a Hollywood starlet, drug companies and their marketing departments are ubiquitous in the history of medicine if you look for them. Their influence was only heightened, ironically, by their loud protestations that their marketing campaigns had no influence on physicians’ therapeutic decisions—doctors, they said, were obviously far too smart and well educated to be swayed by Madison Avenue gimmickry. Few physicians were inclined to argue with such logic, and so the marketing hoopla remained paradoxically below the radar, relatively free of scrutiny or regulatory oversight.

From JAMA, volume 207, number 10 (March 10, 1969). Click to enlarge.

“A sleeping pill for night squawks.” From JAMA, volume 207, number 10 (March 10, 1969). Click to enlarge.

From this perspective, we might all have breathed a sigh of relief when the 1950s rolled around and medical journals finally came clean, giving advertisements the pride of place they had long ago earned and beginning the process by which Americans would come to recognize, and grapple with, the centrality of commerce in their medical system. It is no accident that formal regulatory control of medical advertisements was finally given to the FDA less than a decade later.

Shadow Journals: The Story of Medical Advertising (Part 1 of 3)

Today we have part one of a guest post written by David Herzberg, Ph.D., who will present “The Other Drug War: Prescription Drug Abuse and Race in 20th-Century America” on Tuesday, October 22. Read part two here and and part three here.

It’s a historian’s nightmare: librarians spent the better part of a century diligently cutting out and throwing away some of the most important parts of the journals they received each week before binding and shelving them. Precious historic material—capstone work by some of the nation’s brightest and most creative minds—was destroyed by the very people devoted to preserving it, and destroyed only more thoroughly because of those peoples’ good intentions and zealous work ethic. Why would they have done such a terrible thing?

This is no hilariously nerdy horror movie. It really did happen all across America for most of the 20th century. As far as I can tell, the New York Academy of Medicine stood almost alone in deciding—who knows why—not to rip out the advertisements in their medical journals. We owe them sincere thanks for this.

From JAMA, volume 204, number 4 (April 22, 1968)

“‘Deprol helps brighten the depressed patient’s world.” From JAMA, volume 204, number 4 (April 22, 1968). Click to enlarge.

It’s pretty clear why most librarians cut out the ads, and it wasn’t just to preserve space on their shelves. Back in the day, the medical profession prided itself on being insulated from crass commercialism, and major journals like the Journal of the American Medical Association not only insisted on approving each advertisement, it also lumped together all the ads in an easily removable bunch before and after the main body of the journal. Ads were thus clearly identifiable as separate and unrelated to the pristine knowledge housed in the journal’s interior. Why would a good medical librarian save them?

We all know what happened next. Sometime during the consumer culture revolution of the 1950s, when commerce stopped being crass and instead became a beacon of liberty in the fight against communism and a practical organizing principle of most American institutions, consultants advised the American Medical Association to embrace journal advertising. Ads began to proliferate, and they became bigger, more colorful, and ever more dependent on emotionally charged images to convey the kinds of before-and-after miracles of Madison Avenue. Then, one day, they broke out of their quarantine and began to appear in between articles throughout the journal. Advertising became so ubiquitous, and so important, that a separate “Index of Advertisers” was provided in the back of JAMA to help readers locate the ads just like the table of context helped them locate the articles. In a sense, the ads became a shadow journal alongside the articles, providing more digestible (and typically more optimistic) reports from the cutting edge of medicine.

JAMA_11-22-65_Vol194No8

Triavil: Tranquilizer-antidepressant for the anxiety/depression complex.” From JAMA volume 194, number 8 (November 22, 1965). Click to enlarge.

It was only a matter of time until ads became so thoroughly enmeshed that it was no longer possible to cut them out without also removing parts of articles. Librarians continued to try, however: as late as the 1970s and 1980s, they diligently sized up each page and sliced out whatever advertising they could. Those decades are especially frustrating for historians, if you ask me. We can see the appetite-whetting first and last page of, say, an eight-page mega-advertisement on Valium and “the modern man,” but the meat of the sandwich was long ago pilfered.