Civil War Dentistry

No Teeth, No Man: The Union Army and Dentistry during the Civil War.
By Douglas Richmond
During the American Civil War, the Union Army went the duration of the war without any military
dental care. On the opposite side of the spectrum, the Confederate Army was heavily sympathetic to
dental care and even employed dentists at one point during the war. As Dr. William Roberts explains
in his March 1863 article for the New York Dental Journal, "There is no dentist in the army, so all the
tooth has to do is rot away at its earliest convenience, when the soldier goes to the surgeon, the
surgeon draws the tooth as expeditiously and painfully as he knows." Those responsible on the Union
military's high command thought so little of dental care that they even neglected to issue
toothbrushes to every new recruit. Despite protestations and petitions from both the American
Dental Association and sympathetic dental practitioners, the Union military remained without any
sort of commissioned dental care. With the amount of funding the Union had, including the fact that
the Confederacy provided dental care for their soldiers, one must ponder the question, why did the
Union not do the same?
The fact remains; the Union military had no rendered dental corps available and did notstress the
importance of dental hygiene to their men. The only medical personnel made available to Union
soldiers were medical surgeons and stewards, whose dental experience was null. Dr. Roberts would
go on to claim in the same New York Dental Journal article that "the army surgeon is generally not
only utterly incompetent to the proper care of teeth, but he is also entirely averse to it." Roberts also
states that issuing one dentist to every brigade and stressing the importance of proper tooth care
would spare the U.S. War Department a "useless and ill-regulated expense." The Union military had
a clear disadvantage stemming from its lack of military dental care and their soldiers suffered
accordingly for the duration of the war. With the amount of progress that the Confederacy made in
dental care for the military, the Union Army should have provided dental care as it would have been
substantially beneficial for both soldierand medical personnel alike.
In explaining why military dental care was necessary during this period, one mustrecognize the
context for this period. By the mid nineteenth century, dentistry in the United States had acquired a
strong standing. A greater understanding of dentistry in the nation in part isdue to the establishment
of colleges dedicated to the discipline of dentistry. By 1840, the first college of dentistry would be
established in Baltimore, Maryland, and by the 1860's, there would be two additional colleges of
dentistry created in Philadelphia and New York. The establishment of these colleges provided
graduating students with a Doctorate of Dental Surgery, a first of its kind in the United States. The
establishment of these schools would also help spur an increase in the amount of dental
professionals. By 1860, there would be five thousand dentists working in the United States.
Dentistry was recognized as important by some high ranking political figures, such as Jefferson
Davis. Davis, while he was Secretary of War for Franklin Pierce, endorsed an idea to construct a
dental related unit for the military. Davis "received the proposition [for dentists] as one of great
value." The idea was supported by the current Surgeon General, Thomas Lawson;however, it
received no official action from Congress. This would be partly due to another pending bill, a bill
that involved the addition of surgeons into the Army. Davis's early interest in dentistry is perhaps
why the Confederacy was able to construct a dental unit. Similar attempts were enacted during the
Civil War, but all of them were denied and the Union Army's dental care would be practiced by the
"qualified" regimental surgeons.
The remainder of this paper will be structured as follows: the first section will discuss the Union
Army's "dental care," and its impact on soldiers and dentists, as well as the various attempts made
by the latter to provide dental care for the military. The next portion of the paper will deal with the
Confederacy's dental care. I will demonstrate the benefits and achievements obtained from the
Confederacy's dental unit as I believe a juxtaposition of the two will allow me to demonstrate why
dental care is beneficial to the military. The last portion of my paper will focus on why dental care
was necessary for soldiers; I will include a typical soldier's diet and the illnesses that resulted from
poor dental care. With all these portions intact, I believe I will be able to illustrate why the Union
Army made a huge error in omitting dental care.
The Union Army's "Dental Care"
The Union Army provided minimal dental care to their troops. The only help for soldiers, if they
could not afford the services of a civilian dentist, was the care from a regimental
surgeon.Regimental surgeon's inexperience with dentistry led to inferior dental services. These
surgeons were inept when it came to dental matters. Dr. John McQuillen, co-editor of the dental
journalDental Cosmos, spoke of the surgeons' education in his December 1861 article. In it, he
states, "The education of the surgeon, however, in this direction, it must be admitted, has not
heretofore been sufficiently attended to, and it is extremely doubtful whether one out of ten can
diagnosebetween an aching and sound tooth, an exposed pulp and acute periostitis."
Being able to properly infer a diagnosis is imperative in performing dentistry, as teeth in many
instances can be saved if the dental surgeon has the correct diagnosis. In most cases, these
surgeons made matters worse for their patients, through careless tooth extractions, as illustrated in
the reminiscences of Dr. Williams W. Keen, a surgeon during the Civil War. Keens recalls aparticular
operation performed by a colleague that went less than satisfactorily:
"The [bullet] passed through the left temporomaxillary articulation and ankylosis of the jaw followed;
a surgeon who attempted to remedy this ankylosis broke a number of his good teeth, and also by a
later operation caused a salivary fistula, requiring another operation for its cure; repair of his teeth
was impossible on account of the ankylosis, and he was compelled to live all his life after his wound
on soft diet, being able only to separate his teeth to a very slight extent and not being able to
masticate other food."
Adding to the Union's dental surgery issue was the fact that these medical surgeons were ill-
equipped for dental surgeries. In the New York Dental Journal, Dr. William Roberts explains that,
"attached to the encumbrances of the surgeon are: one turnkey, two pairs of straight forceps, one
pair of lower molar forceps, one gum lancet, and the occasional stump screw." These tools might
seem adequate for the layman, but Roberts, a trained dentist, felt otherwise. Roberts claimed that
the proposed tools were inadequate and even "the best trained dentist in the world could not
perform with these instruments...to any degree of satisfaction." One could blame the Union Army for
failing to properly supply these surgeons for dental duties. Another notableproblem of the Union was
its failure to equip all their soldiers with the most rudimentary of tools for ensuring dental hygiene,
toothbrushes.
The Union Army and Toothbrushes
Soldiers typically neglected to care for their teeth, and soldiers' diet complicated theircondition.
Coupled with this was the fact that toothbrushes were hard to come by while serving for the Union,
as the U.S. government failed to issue toothbrushes to all their men. They fendedfor themselves by
either "[purchasing] from sutlers or [getting them] sent from home." An unfortunate issue when
dealing with civilian sutlers is that these individuals often did not offer toothbrushes for purchase at
Union encampments. Dr. Jonathan Taft, co-editor of the Dental Register of the West, while
frequenting various encampments, had this to say of civilian sutlers,"Toothbrushes, dentifrices,
toothpicks...These things should be placed within the reach of every soldier; but strange as it might
seem, we have not been able to find any of the kind, in a single sutler's establishment, in a large
encampment."
A scarcity of toothbrushes, like the dental care provided by military surgeons, was an issue for the
Union Army throughout the war. Without dental professionals available to stress the importance of
dental hygiene and toothbrushes, many soldiers who did not have toothbrushescausing issues as
explained here such as dental caries and tooth decay. Those who could not afford the services of a
dentist had to endure the "tortures" of the regimental surgeon.
Impact on Union soldiers
There were many soldiers who had to fare the inhumane procedures of these surgeons just to
remedy a toothache or any other dental ailment. Sergeant Alexander G. Downing grieved about this
process in his January 1865 diary log, "I arrived at the doctor's tent...I pointed out the exact tooth;
he hooked on, at the same time telling me to hold on to the chair, and pulled. He succeeded in
bringing the tooth, but it was not the aching one." First Lieutenant Ziba Graham harped about his
reluctant visit to the regimental surgeon in his diary:
Our surgeon, Doctor Everett, who had been hard at work all night at the amputation table, made but
short work and little ado about one tooth. He laid me on the ground, straddled me, and with a
formidable pair of nippers pulled and yanked me around until either the tooth came out, or my head
off. I was glad when my head conquered. I then made up my mind never to go to a surgeon for a
tooth pulling matinee the day after.
Soldiers loathed every moment of having to get a tooth extracted. Captain William Thompson Lusk
and Second Lieutenant John W. Puterbaugh stressed the same concerns aboutthe dental care from
medical surgeons. Lusk stated that as he went to his regimental surgeon to correct his teeth, the
surgeon accidently "breaks one of [the teeth] off," Lusk was unwilling to participate a second time
and had to pay a proper dentist for the job. Puterbaugh explained, of his foray with a surgeon, that
"the damned old fool broke it off and it was ten times worse off than before."
Soldiers who refused the services, of the medical surgeon, often sought out the services of civilian
dentists. Here, these soldiers could receive the attention that they required; however, the cost was
paid from their own pocket. Those who could not afford to hire a dentist were left with the option of
either: dealing with the pain or seeking the unit's regimental surgeon. This improper practice of
dentistry from regimental surgeons infuriated many separate dentists and dental groups, such as the
American Dental Association, and caused them to voice their solutions for the Union Army's dental
problem.
Response from Northern Dentists and Dental Groups
The dental situation in the Union Army was deplorable and disturbed much of the dental community
in the North. After hearing of the treatment received from regimental surgeons, coupled with the
fact that the Union did not include toothbrushes in regulations for soldiers, the dental community
was outraged and petitioned for changes. These changes included simple solutions such as re-
educating the regimental surgeons and/or conscripting professional dentists or dental surgeons for
the Union military.
Dr. John McQuillen had a particular suggestion that involved not replacing these medical surgeons
with dentists but actually properly supplying and re-educating them. McQuillen voiced his concerns
over the improper amount of tools given to the medical surgeon for dental surgery.In his article,
"Instruments Furnished for the Extraction of Teeth to Army and Navy Surgeons," McQuillen argued
that the tools, these "two forceps," which are provided by the medical department "are inadequate to
meet the most ordinary contingencies of [tooth extraction]."McQuillen suggested that the military
issue these surgeons' larger tool sets of forceps numbering"six pair...at least twelve pair." These
larger pairs would allow the surgeons and stewards to beequipped for "every contingency that might
arise." Upon that suggestion, McQuillen advised that these surgeons and stewards be provided "text
books on [dental] surgery" to properly instruct the surgeons how to perform dental surgery
correctly.
Proper education and equipment would be necessary for the regimental surgeon, as theonly known
procedure for a soldier suffering from tooth pain would be tooth extraction. When performing such a
procedure, a hint of professionalism was required, or as Dr. C.N. Peirce describes in his January
1864 issue of the Dental Times, "There is probably no operation performed by the dentist that...[has]
greater liability to accident...than that of extracting teeth."Peirce claims that "the operator should be
familiar" as it would "do much to prevent accident, and render the accident less painful." With this
rhetoric in mind, there were many from the dental community that felt that an appropriation of
competent dental surgeons to the Union militarywould be best.
In that same issue of Dental Times the article, "Dentists in the Army," was featured with the main
purpose of proposing to the Union military the employing of dental surgeons:
"I have been told by a military officer that dentists are greatly needed in the army. That he had
repeated occasions to give men furloughs to go to Washington to have teeth filled and otherwise
treated; for very many in our army are sufficiently intelligent to know that troublesome or decayed
teeth may be saved, and are therefore unwilling to have them sacrificed by extraction, which is all
the army surgeon can do; therefore, the want of an intelligent dentist is apparent, who, I have no
question, could make it mutually advantageous,(as he would charge for his operations,) by remaining
with the army, ... Such a procedure would furnish an unanswerable argument in favor of what the
profession has been long contending for, Governmental employment of dentists in the army."
Dentists such as Dr. William Roberts and George H. Perine had similar suggestions for the dental
issue that the Union Army had acquired. Roberts suggested that the War Department assign dental
practitioners that would practice on troops in the field at their own expense and be paid at
reasonable costs. Perine in Dental Cosmos felt that, "few, if any, of our army and navy surgeons
possess knowledge of dentistry, and that the appointment of physicians practicing our specialty
would necessitate a new order of things." These suggestions did little to inspire any sort of change
within the Union Army. In response to the Union's apathy toward dental care, there were attempts
made by dentists and dental groups to provide dental care for Union soldiers.These attempts
accomplished very little in terms of acquiring dentists for a military dental unit; the U.S. military
would be without a dental unit until 1911, when the U.S. military created a Dental Corps.
Actions made by Northern Dentists and Dental Groups
Upon realizing that their solutions and suggestions for dental care were going nowhere,those in the
dental community decided to approach this dilemma in a different fashion. Thisapproach included
professional dentists offering their services, unofficially and officially, to the U.S. military to
legislative attempts made by dental groups to create a military dental unit.
There were hundreds if not thousands of dentists in the North who took up arms for the Union, many
of whom gave up their profession to fight. However, there were a few dentists who continued to
practice dentistry unbeknownst to the Union military. One particular dentist whowould fare the
horrors of war for the Union was Dr. Charles Koch. Koch entered the military and would acquire a
variety of roles ranging from enlisted soldier, to infantry officer, to commander of one of the Union's
colored regiments, the 49th colored regiment. Koch would still revert to his dentist sensibilities,
whenever he had the free time to, and provide dental assistance to ailing soldiers. As an infantry
officer, Koch commanded his subordinates and carried a "small satchel" that "kept dental
instruments and medicines to relieve the tortures of the mouth". Like Koch, there were dentists that
wanted to be commissioned officially as military dental surgeons; however, these individuals were
denied by the Union military.
Dr. James Garretson tried to offer his services to the U.S. military. Garretson, who has been called
"the father of oral surgery," hoped that his services would be recognized and deemed useful. In April
1862, Garretson even pleaded to the Surgeon General, William Hammond, in the hopes that
Hammond would place him as the surgeon in charge at a local military hospital in Red Bank, New
Jersey. Hammond responded the same month stating, "Your request cannot be granted, as the Red
Bank hospital is to be placed in charge of a surgeon of regular service."
Garretson was renowned in the dental community for his prowess in plastic and oralsurgery;
unfortunately, the Union military did not take advantage of his services. Coincidently, Garretson's
book, A System of Oral Surgery, would be added in 1872 as the official reference tool for regimental
surgeons when performing oral surgery. While individual dentists tried to perform dentistry for
soldiers, many attempts were made by dental groups to create a dental unit for the Union military.
Much was done by dental groups, such as the American Dental Association, to establish a dental unit
for the U.S. military or at least military hospitals. A committee of professional dentists was collected
by the American Dental Association to pledge legislative action for a military dental remedy; efforts
were made by this committee through 1863-1864. Such proceedings even involved efforts to
encourage Surgeon General Hammond, in the hopes that his assistance would help solve the issue.
Hammond, who appeared to be sympathetic at first, ultimately reneged on his decision to implement
a dental unit. From 1861-1865, four years passed and the Union Army remained again without any
military dental unit. In contrast, military dental care was well received by those involved with the
Confederate Army's high command, so much so, that the Confederacy appointed dentists into their
army as early as 1861.
The Confederate Army and Dental Care
The inclusion of military dental care into the Confederate military's infrastructure wasgradual: a
process that began with the incorporation of dental methods and tools into the Confederacy's
Medical Corps and ended with the full conscription of dentists into the Confederate military. By
early 1864, the Confederacy would have professional dentists circulating amid the military hospitals
and providing care to soldiers out in the field. High ranking Confederates' such as President
Jefferson Davis and Surgeon General Samuel Moore compassion and interest in dentistry allowed for
the inclusion of dentistry within the Army. Theestablishment of dental care, as the Confederacy
would soon learn, would allow for the swift return of soldiers with dental related ailments or wounds
back to their respective units. Furthermore, the employment of dentists allowed for the conservation
of medical units in the Confederacy.
A detriment to the Confederacy following secession was their lack of supplies and funds. Seceding
from the Union meant that the Confederacy would be isolated from its main supply line. This was
true regarding matters of dentistry, too; the Confederacy had only one dental supplier, Brown and
Hape in Atlanta, and only a small percentage of the dentist population in the United States. The
Confederacy would have to overcome these issues to provide dental care in their military.
Despite obvious resource and supply deficiencies, the Confederacy began to lay the foundations for
what would become their dental care. As early as 1861, the Confederacy began procuring dental
supplies. In Regulations for the Medical Department of the Confederate States Army, states that all
medical supply tables were to be equipped with the proper amount of tooth extracting kits. Like the
Union's regimental surgeons, the Confederate surgeons were inept to dentistry. Confederate
soldiers realized this and were more than willing to pay for the fees of a qualified dentist.
The issue of Confederate soldiers seeking out dentists would be the cost of their services. Dr.
Watkins Leigh Burton would assess this issue in his 1867 article to the American Journal of Dental
Sciences. Burton states, "The charges of dentists were proportionally high. The charge for a gold
filling was $120.00, for extracting a tooth $20.00, and for an upper set of teeth on gold or vulcanite
base, from $1800.00 to $4000.00." These charges were way beyond the pay grade of soldier, as their
pay would be between 12 and 18 dollars a month, depending on rank. Unlike the Union military, the
Confederacy acknowledged this problem and effortlessly sought to correct it.
The Beginning of Confederate Dental Care
Dentistry brought the Confederacy to a stark realization. For one, they realized thatdentistry was
necessary for the continued well-being of soldiers; secondly, the Confederacy also acknowledged
that soldiers could not afford dental treatment. In response, the Confederacyslowly contracted the
services of civilian dentists and began to reassign soldiers with dentist backgrounds to dental units.
The first dentist to be appointed would be in 1861, when the Confederacy utilized the services of Dr.
J.B. Deadman. Deadman was a dentist from North Carolina who joined the Confederacy as a private
in May 1861; upon hearing of his dental background, Deadman would later be reassigned as a post
dentist.
Another dentist who would join the war and provide dental assistance would be Dr. Theodore
Cheupein. Cheupein fought for the Confederacy as a Sergeant in an artillery unit;however, his
military obligations did not prevent him from performing dentistry as he wouldpractice whenever he
found the time. Cheupein's efficiency in dentistry led him to be reassigned to Charleston to perform
dentistry for ailing soldiers. The Confederacy would not make true progress in their creation of a
dental unit, until it implemented the Conscription Act of February 1864, which included dentists into
the conscription by-laws.
The Conscription of Dentists into the Confederacy
The Conscription Act of 1864 drew a mixed reaction from the Southern dental community. Unlike
the North, there were dentists who opposed the draft heavily, as they felt that they should be
exempted like their doctor and medical surgeon counterparts. Some dentists were able to get
exempted on the basis of "special practitioners." The abovementioned Dr. Watkins Burton
vehemently opposed the draft when he was conscripted in 1863; Burtons even began making legal
provisions for his exemption. Ultimately, when the Confederacy adopted its 1864 Conscription Act,
Burton would be drafted as a hospital steward.
Despite the slight opposition, the 1864 Conscription Act provided the Confederacy with a significant
influx of dentists. Surgeon General Moore began organizing these dentists into military hospitals
working as regimental surgeons, since there was no official rank of dental surgeon. These personnel
worked diligently, and began extracting, cleaning, placing fillings, and treating victims with
maxillofacial injuries. Dr. Watkins Burton commented on how a typical day for a dentist would
constitute "twenty to thirty fillings...the extraction of fifteen or twenty teeth, and the removal of
tartar." This passionate dedication would lead to a significant improvement in not only the lives of
soldiers, but how the military viewed dentistry in general.
The Impact of Confederate Dental Care
Dental Care in the Confederacy had a resounding impact on its military. With the introduction of
dentists into the military, the Confederacy was able to conserve medical personnel and properly
treat and utilize men who had been previously deemed unfit for servicedue to dental problems. New
surgery techniques were being performed by dentists that allowed for explained here the
preservation of teeth rather than extraction; one particular technique that was being used by
dentists was endodontic treatment, commonly known as a root canal. Such procedures saved many
teeth that would have been commonly extracted.
Dentists in the Confederacy were also stressing the importance of dental hygiene, for example, the
aforementioned Dr. Cheupein would stress the importance of dental hygiene soheavily that every
man in his unit would carry around a toothbrush in their uniforms.Confederate dentists created new
and innovative dental devices such as the Interdental Splint, created by Dr. James Baxter Bean.
The Interdental Splint or "Bean Splint" was a device that has been credited with the successful
treatment of over a hundred cases of gunshot wounds to the mouth and jaw. The splint itself was
made of vulcanized rubber, and braced teeth together with the corresponding indentations of the
splint. The splint would keep the jaw in place and allow it to heal, thus preventing the facial
disfigurement and deformity that was common with such wounds. This splint would allow the patient
to continue to consume food without the fear of infection. The Interdental Splint was so successful
that it was even used in the treatment of Confederate military leaders, such as James Patton
Anderson and John Brown Gordon. Following the end of the Civil War, Bean tried to get his splint
adopted in the North, however, a fellow northern dental surgeon, Dr. Thomas Gunning, had already
created a similar device.
Near the end of the war, almost all Confederate military hospitals would have at least one dentist
assigned to medical staff. Had the war lasted longer, the Confederacy would have established a
Bureau of Dental Surgery; this Bureau would have been associated with the medical staff of the
army. This success in dentistry could not have been accomplished had it not been for the
Confederacy's enthusiasm in military dental care. The Confederacy understood the necessity of
dental hygiene and their military forces benefitted from it significantly. The Union could have
benefitted from a similar program if it had understood the importance and reasons for military
dentistry.
Additional reasons for Military Dental Care during the Civil War
Besides the reasons stated before, there were additional reasons for the incorporation of dental care
into the Union military. First, many northern Americans were exempted from military service due to
the status of their teeth. This was to the increase of meals consisting of refined sugar and a larger
consumption of fresh meat rather than salted. This diet, coupled with the fact that most Americans
did not practice tooth brushing, could be attributed to the increase of dental problems. With an
increased need for men in the subsequent Union drafts during the war, many men were exempted
due to their "lack of certain teeth." Such teeth were required to properly chew food, such as hard
bread, salted pork and beef, and to effectively tear paper cartridges, which held bullets with
gunpowder in place. If there were trained dentists on hand, these dentists, like the Confederate
ones, could have treated most of the exempted and allowed for their military service.
Secondly, if there were Union dental care, these trained dentists could have stressed the importance
of dental hygiene. Even Surgeon General William Hammond states in his book,Treatise on Hygiene,
the importance of dental hygiene; yet he did nothing to help create a unit. In Treatise, he states, "No
one can be here healthy whose teeth are deficient or in bad condition; and soldiers, of all other
classes of men, require that these organs should be sound." Consistent dental hygiene is imperative
when deterring many dental problems such as gingivitis and neuralgia. If these problems go
unnoticed they could also lead to more serious problems, thus incapacitating the soldier indefinitely.
Conclusion
In conclusion, Dentistry in the military lacked the recognition it deserved during the American Civil
War. The Union Army chose to ignore it, and as a result the Union soldiers had to suffer for their
superior's actions. The Confederacy chose to embrace dentistry and benefittedfrom it tremendously.
The Confederate military is also a nice example of how a military can benefit from dental care.
This project shows that both militaries during the Civil War had differing opinionsconcerning
military dental care and both armies and soldiers were significantly affected by their superiors'
actions. Secondly, the significance of my project shows that even in a time as early as the Civil War,
dentistry was important as it impacted the soldier's well being. The advancesmade by dentists in the
mid-nineteenth century allowed for better dental treatment. I believe that my research provides the
historical community with a topic that is both original in the field of the American Civil War. One
question that my research might suggest is why did the U.S. military wait until 1911 to implement a
Dental Corps?