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.AJDIDIR/IESS'
" Dental Specialties,"
BEFORE the
meritanBmtalSssotiation
Chicago, July 2t, 1865,
PROF.  BRAINARD

 
 
DR.  BRAINARD'S  ADDRESS
                       BEFORE
       THE AMERICAN DENTAL ASSOCIATION,
                       —AT—
              Chicago, July 27, 1865.
Gentlemen :
   It gives me great pleasure to meet here the members  of so
honorable and useful a profession as yours.  The profession
of Dentistry is one of very modern origin, and is that branch
of the  medical profession which owes its development and
perfection most essentially to our own country, and is, indeed,
I think I may say, the one branch of the profession  in which
we Americans can claim especially the pre-eminence.  To be
an American dentist is a recommendation in all the  principal
cities of Europe, and although the medical  profession in gen-
eral, and the surgical department especially, has an honorable
position in the literature and among the profession in foreign
countries, it can hardly  be said to have a claim to the title of
any pre-eminence.
  I have said that your profession was of comparatively re-
cent  origin.  It is almost, I think, within the memory of many
persons here present, when it was regarded as a merely me-
chanical operation, little better  than the higher branches of 
2
Dr. Brainard's Address.
mechanical employment.   Step by step it has developed itself
to a degree that, in perfection, in usefulness, it does not, in my
opinion, rank second to any of the single branches of medical
or surgical science, [applause] ; so that at the present day, to
be without a dentist would be to  be without one of the essen-
tials of civilized life.   [Renewed  applause.]
  Now, in speaking of its having a  mechanical  origin, I  do
not intend  anything  disrespectful to  it.  My own especial
branch of tae profession is surgery,  and, I might  say,  a  part
of surgery ; and it is not very long since surgeons, as a class,
occupied a position far less honorable and important than  that
occupied by dentists at the present day.  In  the  middle  ages
in Europe, so called, or rather in the  latter part of the  middle
ages, from the fourteenth to the end of the fifteenth  century,
or  thereabouts, surgical  operations  were  performed by  bar-
bers.   There was no distinction between those that performed
a surgical operation and  those that cut  hair,  and  curled hair,
and powdered hair.  The duty of the surgeon was considered
to be to perform an operation when he was directed, and as he
was directed by a physician, and, when he  had performed the
operation, to retire and leave the case to the  physician.   And
it happened, after  a certain period of time, that  these  opera-
tors acquired a certain amount of knowledge beyond the im-
mediate  needs of operating, and were  called upon to advise
about operations, and about the treatment of cases after opera-
tions.  And this was considered a great innovation  upon the
profession.  It was considered something outrageous and  dis-
graceful  to the profession ; and the man who should have  con-
sented to meet a surgeon in consultation, would have been ex-
pelled  from  the faculty for consulting with a quack.   I  have
in my library a work published by the President  of the Facul-
ty of Medicine, in Paris, entitled "  The Brigandage of  /Sur-
geons" setting forth that they were  asserting claims which, if
allowed,  would be  the  destruction and disgrace of the medical
profession. 
Dr. Brainard's Address.                3
   This comparison I bring forward for the purpose of sustain-
 ing the assertion that I make, that the difficulties under which
 the dental profession labors are nothing  new.  By speaking of
 the difficulties under which you labor, I mean this : the difficulty
 and length of time which it has taken  for the honorable, and
 educated, and competent men of that profession, to assert and
 maintain  full  equality in professional standing with members
 of the medical profession who practice  other branches  of it.
 That difficulty has existed in regard to every particular branch
 of the profession that has at  any time been embraced by any
 particular class of men, and is not peculiar to the dental profes-
 sion.  It  results from that deep seated prejudice, for I can call
 it by no other name,  that  has existed from the earliest  times,
 and is inherent apparently in the nature of every profession,
 and that  is  to resist innovations or  changes  in regard t-j
 the doctrines or the practices of that  profession.   This  pecu
 liar aversion to changes results from the nature of professional
 education, and is one of those things  that is treated  of by
 Lord Bacon  in his Novum Organum, under the name of " Idols
 of a Class," or those things which prevent members of a par-
 ticular class  from seeing the truth in regard to  their o^n pro-
 fession.   It is, and has been, one of the  great obstacles  to the
 progress of the medical profession.  It is an obstacle which at
 the present day is partially, but only partially overcome.  It
 is the thing which has  prevented a large number of men of
 genius and industry in the profession from embracing and  fol-
 lowing out the study  and practice of a particular class of  dis-
 eases, in  such  a way  as to have perfected our knowledge  of the
 nature and treatment of such diseases.
  Now, the principle that  I wish particularly to  assert here is
 this, that  the medical profession, in order to be  most useful,
 in order to  acquire  its due influence over the community, in
 order to perfect its knowledge of the nature and  treatment of
 diseases, must adopt a special course of study ;  each individual
member embracing that course which he  judges on the  whole 
4               Dr.  Brainard's Address.

to be best adapted to his faculties, and leaving out to a certain
extent others for which he has no  qualifications.   I advocate
special studies and special  practice; and, although  the  words
have been somewhat discredited, I advocate " specialties "  and
" specialists."
  Now, I undertake to say  that the very  great  opposition
which this doctrine has met in the profession,  is  not  founded
upon reason, or justified by the experience of the profession.
It is an opposition which is working to the disadvantage of the
profession as well as the public, and to the manifest disadvan-
tage of a very great number of the individual members of the
profession;  and  therefore  I  wish to insist  a little upon  the
point.
  What are the natural divisions of  the science and  practice of
medicine ?   Is there no natural division ?  I hardly think that
any one would  be so bold as to assert  that  there are,  and
ought to be, no natural  divisions.  For a long time, when,  the
science of medicine was in a  very  rude  and  imperfect  state,
the members of that profession did  study and  practice all  its
branches; and in the older works on Surgery, Pharmacy  and
Chemistry were  as much treated of as the operations of Sur-
gery.  Still, even at that time, there was the  commencement
of division,  and the first was into Pharmacy, Surgery and Ob-
stetrics.  The next  division  which  came  was into Medicine
and Surgery, Surgery being, as I have stated,  the mechanical
application  in the manner already indicated.  At a later  pe-
riod, there commenced to be apparent the distinction between
the Obstetrical department of the profession,  and  the  sepa-
ration between  Pharmacy and  Medicine  was accomplished
entirely.  By degrees the distinction between obstetricians  and
medical practitioners came to  be  recognized  in particular  lo-
calities, in large cities especially, to a  very considerable  ex-
tent ; so that medicine, towards the middle of the last cen-
tury,  might  be  said to be divided  into Pharmacy,  Medical
Practice properly so called,  Surgery, and Obstetrical  Prac- 
Dr. Brainard's Address.
5
tice, whilst yet it remained true in regard to the greater por-
tion of the civilized world.—the  country in  general, in Ame-
rica as well as* in Europe—that the larger number of practi-
tioners continued to practice  all the branches, to collect and
prepare their own -medicines,  to  practice Pharmacy, Surgery,
and'Obstetrics.   And at the  present day, this is the case with
a very large part of the profession  throughout the civilized
world.
  Now, it is manifest—all experience and reason show—that
men  who practice  medicine  in this way, practice it only in a
rude and imperfect manner;  that they  neither understand
Pharmacy, nor Medicine, nor Obstetrics ;  that, from the na-
ture  of things,  they  are incapable  of acquiring skill in any
one of these branches ;  that  it is absolutely  necessary, in  or-
der that there should be any  progress in regard to the science
or practice of medicine, that  some  of  these  should  be  exclu-
ded, and others  proceeded with  especially, by  each individual
member of the profession.  Let us  examine the question  for
a moment.  The Dentists, as a  body,  have,  according  to my
own  knowledge  and observation,  perfected the mechanical
means of performing operations beyond what  has been done
in any other branch  of  the profession.   They  are bettor me-
chanics than  the Surgeons,  and their instruments for accom-
plishing  the different  objects  which  they  have  in view are
more numerous  and better suited to their purpose than are the
instruments of surgeons.  Xow this is essential to the proper
performance of dental  operations.  And  how  has  this hap-
pened?  It has been simply  that there have been dentists, as a
class, who have devoted their attention to that purpose ; and
we  as surgeons never could have invented or perfected these
instruments, and consequently could never  have  perfected
dentistry.  And that division of labor is a thing which, at the
present day, is manifestly necessary, and which no one now
disputes.
  In regard to surgical  instruments, there are two departments 
6               Dr. Brainard's Address.
in which they have been singularly perfected.  The one is in
regard to those instruments which are used for  crushing  urin-
ary calculi, which are the most admirably adapted to their pur-
pose.  How did that  come about ?   Three men of genius at
the same time happened to devote their whole attention to that
thing—the crushing of stone—and they especially  perfected
those instruments.   And without that perfection of these in-
struments, the crushing of urinary calculi must have remained
forever, as it had up to that time, a mere phantom floating in
the mind, without any practical  application whatever.  There-
fore it was necessary in this  particular that  there  should be
special  studies.  The other branch  in  which I consider the
mechanical means to be wonderfully perfected, is that regard-
ing  instruments for  operations  upon the eye.  These instru-
ments have been brought to such a degree of perfection, of
delicacy and accuracy, that they  are  capable of accomplishing
things almost inconceivable, and  accomplishing them regularly,
constantly, and without difficulty  or  danger.   Now, how has
this happened ?  It has happened in the same way ; there have
been a class  of men who have devoted their attention to that
subject exclusively, have thought of nothing else, have worked
at nothing else but the perfection of means  for the accomplish-
ment of that which  they saw before  them  to  be done.   But
when you come to other things that have not been made spe-
cialties, the condition of our science is  singularly  rude and
imperfect.  There is nothing in our science at the present day
which has the  slightest claim to be respectable, apparatus  for
the  treatment  of  fractures.   Particular individuals, by the
attention which they have paid to it, and by an excess of supe-
rior mechanical talent or ingenuity, have been able to accom-
plish with the  instruments  which they use  a  considerable de-
gree of success, but there is no instrument for any given frac-
ture that can be mentioned, that can be taken by a person of
ordinary good education of the profession,  and put  upon the
member in such a manner as to accomplish any perfect result. 
Dr. Brainard's Address.
7
The greater number of the instruments which are used  in the
profession for fractures of the leg, and called " fracture boxes,"
are no better than  dry goods boxes, [applause],  and simply
serve to accomplish the result of concealing  from the surgeon
the position in which a limb may happen to lie.  [Renewed ap-
plause,]  What is  the reason of that ?   The reason is,  that
there never has  been as yet an instance in which a man devoted
himself to fractures as a specialty,  and nothing  else, and  this
is the one branch in which a speciality is most needed.  They
are the species of accident which are the most  frequent,  and
which disable  a man more than  any  other,  and entail  untold
miseries upon him if unskilfully treated ; but the  instruments
for the  accomplishment of this purpose never will be reduced
to  any great perfection, until  it shall be known that the de-
voting of time and talents to one subject leads  to  honor  and
not  to  being  partially thrown  out of the  profession.  [Ap-
plause.]
   If I should be unfortunate enough to meet with a fracture
of the jaw, the first thing I should  do would be—not to send
for  a  surgeon—but I should  send for a dentist.  [Cheers.]
They have directed their attention to the mechanical means and
apparatus necessary for holding the jaws in their place, to such
an extent, that they are better  qualified to  make  them than
surgeons  are  as a general  thing,  and, perhaps I might  say,
more than any surgeons are.
   I  mio-ht go on and point out to you that with regard to no
one  thing about them  are the instruments used by surgeons,
the best adapted to their purpose,
  We are disputing, at the  present day, all over the  world,
what kind of sutures are the best to  use.  A great many  of
our instruments  for the purpose  of  ligating  arteries and per-
forming similar operations, are singularly rude and imperfect,
and their  imperfection is only remedied by the skillful use  of
the fingers of  the surgeons.
  How  is this  to be remedied?  It is to be remedied, gentle- 
8               Dr. Brainard's Address.
 men, by special study;  by the  profession changing  its views
 upon that subject, and saying to  the  young  men, when they
 are entering the profession,  and when they are about to leave
 the schools, that it is better for them  to devote themselves to
 some particular branch of the profession and try to understand
 it.   I am often called upon by young  men from various parts
 of this country, who are visiting the West for the purpose of
 locating themselves in their practice.   They  very frequently
 come to Chicago, and we  are always glad to see  them.  We
 are very proud of our city, and if you want  to get  into the
 good graces of any Chicago man or woman, you have nothing
 else to do but  to tell them it is a nice  place.  [Laughter.] And
 these young men  come here and they  say :  " What kind of a
 place is Chicago for a professional man ?"  Now this is a very
 hard  question  to answer, because  politeness  does not permit
 me to ask another question.  I could  say to  the  young man,
 that if you know  any one thing better than the generality of
 the profession, it  is a good place for  you; but if you do not,
 it will be a bad place for you.  And for those young  men who
 are incapable of applying their knowledge in such a way as to
 earn their daily bread, incapable of using their knowledge for
 the benefit of any particular class of men, so as to make it de-
 sirable for them to call upon them, Chicago is not the  place.
 That is the difficulty under  which  members of the profession
labor when they would enter into practice.
  How is this  to be remedied ?   It is  to  be remedied, in the
first  place, by acting  upon public opinion.   The profession
 which listens with leaden ears to the propositions which come
from  members of it  to change the  time honored usages to
which it is subjected, is sensitively  alive to intimations  which
 come from the people  who employ them.  Public opinion in
this country is law, and  in order that the laws be  made  good,
public opinion must be enlightened.   Individuals are power-
less, but ideas  are irresistible ; and the way to remedy it is to
take the idea or fact that in order to make the profession use- 
                  Dr. Brainard's Address.                9

ful and powerful, it must be developed and  perfected in all its
branches,  constituting each one of these branches  one body,
each part of which co-operates in its proper sphere and most
useful manner in advancing the interests of the whole  profes-
sion.   [Cheers.]
   Now,  in saying that I am  in  favor  of special studies and
practice, in that way,  I  do not commit myself to  anything ;
and the profession won't regard this as  anything  but a " glit-
tering generality."  Therefore, I state that I think there ought
to be Dentists to attend  to the teeth, Oculists to attend to the
eye, Aurists to attend to the ear, and special Physicians to at-
tend to diseases of the heart and lungs, and make  the physical
examinations which are so difficult, and a special class who will
be able to  use the microscope for  special  examinations,  that
there should be not only practitioners of obstetrics, but those
especially  devoted to different  branches, I  mean  that  the  in-
capable obstetrical practitioners never should be allowed to use
instruments;  that there should be men qualified for  that.
And then in regard to surgery, that it should in addition have
a  number  of branches.   That in these  there  should  be one
branch devoted especially to the treatment of fractures.   That
there  should  be another branch  devoted to the  treatment of
tumors, without absolutely circumscribing  these  departments
by definite lines at the present time.  When that  is  done, then
the profession will cease to occupy  the  principal  part of the
time  in  its  meetings or  associations  with quarreling  with
quacks.  The man who is thoroughly accomplished in any par-
ticular department of his profession, is very little  troubled  by
quacks.  [Applause.]   Then the public will come  to know the
usefulness  of the profession.
  The dental profession, at the present time, is  not consulted
in one case in a hundred, or one in a thousand of  those  which
require the care of a  dentist.   That  is  because  the  medical
profession  is  not educated to the proper standard, and does
not tell  these people,  as  they ought to, that  in cases of 
10
Dr. Brainard's Address.
difficulties  about the teeth, they should apply to a good den-
tist.
   The same is true in regard to Surgery.   There are opera-
tions  enough that  ought to  be  performed,  in every populous
county in the State of Illinois, and which  are not performed,
to give employment to all the surgeons  in  those counties.
They  do not know that there is any man who applies himself
to that particular kind of disease, and when they look around
for information, they look to that  particular kind of advertise-
ment  in the newspapers ; and you know what kind of informa-
tion they get there.  [Laughter.]  I repeat, then, that the way
of progress in the medical profession is  in  the way of special
studies.
   How is this to be brought about ?  I would not have you to
suppose, by any means, that there should be a  special school
for every department of medicine and surgery.   On the con-
trary,  I would  very much prefer that there  should be no
divisions whatever.  And if I might be  permitted to express
an  opinion upon a subject  which  may  be  delicate, it  would
be an opinion with regard to the dental profession, that they
had better not  be separated from the medical  profession.   I
think  it would be better  for them to receive their education in
the same schools  and to the same extent as other members of
the profession.   And I think that in order to effect their edu-
cation, there ought to be, and will be, perhaps not in my day,
but there will be  professorships  of diseases of the teeth in
every respectable medical  school in Christendom.   [Cheers.]
What is taught at the present time in most  medical  schools in
regard to teeth, is  the order and time of dentition ; and then,
in case the  child is sick during that period,  that the gums are
to be  lanced.   [Laughter.]   In some schools, there is a little
advance  upon that.
  But there is no medical school, so far  as I have any knowl-
edge,  where the diseases of the teeth and the  causes  which
produce them, the  means of obviating them, the irregularities 
Dr. Brainard's Address.
11
of the teeth, and the means of correcting them ;  the best thing
to do in  case of any particular appearances of the teeth ; 1
am not aware that in any institution, even to that  extent,  it is
properly taught.
   Of course there must be colleges of  dental surgery,  so long
as dental surgery cannot be learned  elsewhere. This is a want,
and until we can supply it, the practice of surgery must be
necessarily more or less  imperfect.  It is  necessary,  in my
opinion, that the dentist should  he an  educated physician.
[Cheers.]   It is necessary  that  he should  understand  the
structure  of the  body beyond  the  teeth.  [Cheers.]   And I
will mention this curious thing about anatomy and quackery.
Anatomy in itself would not seem to teach a man much of a
practical nature ; but I have never yet seen  an  accomplished
anatomist who was a quack, or a quack who was  an anatomist.
There is an  incompatibility  between the pursuit  of that sub-
lime science, which makes  the two  incompatible ; and  if  you
will fetch before me any man, whether  he be a dentist or  oth-
erwise,  anu he will tell me all that is known  in  reference to
anatomy,  I  will accept  that man as a scientific man, without
asking him another question.  [Laughter and  applause.] That
is the foundation of all medical  science, and therefore  you
must  have that; and you must have, in  addition to that, the
knoAvledge of physiology.   You must have an especial  knowl-
edge of the  action of medicines, as  they operate upon  the hu-
man system, not to speak of those other branches of  science
and accomplishments, outside the profession strictly so-called,
which are so necessary to give influence to  science, to. render
man happy,  to adorn his life, and make him a gentleman.  I
would have,  in the first place, all the different classes  of the
medical profession educated  in the same schools', to  the  extent
of acquiring this general knowledge  of  which I have just spo-
ken ;  and then I would have in each college not only a profes-
sor of diseases of the teeth, but I would have a special  profes-
sor with regard to a certain  number  of  other branches,  at pre- 
12               Dr. Brainard's Address.
sent of the diseases of the eye and ear, and of the nature and
treatment of deformities of every kind.  These branches have
all acquired a degree of development which requires  them to
be treated from  separate chairs ;  and when the student had
got sufficiently accomplished  in  general principles,  I  would
have him adopt that branch which he proposes to  follow, and
devote his special attention to it;  and I would have these new
chairs instituted from time to time as the wants of the commu-
nity seem to require.
  Medical science, which two hundred  years ago  was imper-
fect, has at the  present time acquired a degree of development
which  renders  it impossible that any one should  master it in
all its details.  No  intelligent man  devoting his time  to it can
read all the  works connected with it, that appear in the English,
German and French language, from one end of the year to the
other.  It is a physical impossibility.   It is a  physical  labor
that he could not  endure.  How then is he to become  acquain-
ted with  the details of  all the different  branches, able to
perform every kind of operation,  able  to  prescribe for every
kind of disease ?   In proportion as the  science  advances, it
will become  still more extended and difficult.  As each science
is perfected, this is the rule.  There will be future advances,
which at the present day it will be unwise, if not impracticable,
to define.
  I have said that the profession,  organized in the manner in
which I propose, should be formed in parts not in conflict with
each other, but  should constitute one harmonious whole.   The
dentists are  capable of exercising  a great influence upon socie-
ty.   They are a numerous, enlightened, and I am happy to say,
wealthy and influential body  of  men,  and we, with all our
prejudices, cannot afford to leave them  separate  and  standing
off.  [Laughter.]   The physicians and surgeons are capable
of exercising a great influence in  favor of the dentists, and
they would, if better  informed  and  more enlightened,  ex-
ercise a greater  influence than  they do. by directing their 
Dr. Brainards Address.
13
patiints always to apply to them for alvice with reference to
every  question  which  might  arise  as  to  the  teeth.   This
would  be an  advantage to  the  dental  profession,  and  they
would get it to a much  greater extent if they were  a recog-
nized part of  the  medical  profession, as they deserve to be.
So  with  all the  other  different  specialties ;  and whenever  I
see a man taking up one  of these specialties, and  for years
together  undertaking  the labor connected with it, I say,  " Go
ahead, do what you can in  that branch of the profession."   I
do not regard him as in any degree  conflicting  with my  own
or any other branch of the  profession ; I am happy to see it,
and I carry my approval to the extent of recognizing the prin-
ciple in branches of the profession of which I might have, my-
self, some little doubt.—Such branches as the application of
electricity to diseases,  about which  our information  is  so  im-
perfect and indefinite.   I consider that the application of  elec-
tricity, by an  intelligent man, would probably be of  great use,
and therefore when a  man undertakes that specialty, I think
he enters upon a useful work, and one that it is  necessary to
make a  specialty  of  before it  can  be  relied  upon  by the
profession generally.  It is the same  with regard to  another
class of practitioners—the movement-cure men.   That term—
" Swedish movement cure"—is  an  unfortunate name.  The
method of treatment to which it is applied, did not originate in
Sweden,  but  is founded upon the principles of physiology,
justified by experience, incapable of being applied by  practi-
tioners who have not the necessary  knowledge, and promis-
ing, in  the future,  as it  shall be developed, the  relief of a
large class  of  diseases  which  have been,  heretofore,   and
which are, at  the  present  time,  to a  great extent, beyond the
reach of  surgical treatment.
  These,  gentlemen,  are  the  essential  outlines of the ideas
which  I'wished to  present  to you.  « A word to the  wise is
sufficient," and therefore I need not dwell upon them.  It has
given me  great pleasure to know  that this association is a -
sue- 
14              Dr. Brainard's Address.
cessful association, and that it is attended by a large  number
of men from various and distant parts of the  country.   You
have  already  received a welcome  from your  own  profession
here: that welcome was only the expression of the feelings of
the general community with  regard to yourselves  and  every
other  body which conies here for purposes so useful and hon-
orable as yours, and therefore, from the harmony of your ses-
sion, I have only to hope that it may be useful, interesting and
improving, and if you ever need a place to meet in on another
occasion, I would take the opportunity of asking you, on be-
half of the medical profession and our citizens, to come  back
to Chicago.  [Loud cheers.]

  Dr. Chesebrough, of Toledo, moved  :
  That the thanks  of the  association be unanimously voted
to Professor Brainard, of the Rush Medical College, for his
assistance to us in our course of  life, and that the  sense of the
convention be expressed by rising.
  Professor McQuillen, of Philadelphia, moved as  an  amend-
mend  :
  " And that the learned Professor be  requested to  furnish a
copy of his Address for publication in pamphlet form."
  Dr. Chesebrough  accepted the amendment, and  the motion,
as amended, was adopted.—Chicago Medical Journal. 
 
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