The French Revolution and the American Invention of Dentistry

Eric K Curtis. Journal of American Culture. Volume 17, Issue 3. Fall 1994.

Antoine Lavoisier stepped up to the guillotine on May 8, 1794. History would remember Lavoisier as the founder of modern chemistry. He named oxygen and described its role in combustion. He demonstrated the law of conservation of matter and wrote the first chemical equation. He originated the modern concept of the chemical element. But the versatile Citizen Lavoisier was about to be consumed by the French Revolution he had served as a member of the governing Paris Commune and administrator of the national treasury. Found guilty of having earlier functioned in the royal government as a tax collector, he was beheaded the same day he was sentenced. Of Lavoisier’s execution the public prosecutor is said to have declared, “The republic has no need of scientists” (Gooding and Dorozynski 1-24).

In 1989 France commemorated the 200-year anniversary of the beginning of its tumultuous revolution. Accompanying the celebrations has been a good deal of reflection on the premiere public upheaval of modern times. The American Revolution introduced the notion of freedom and self governing in a world of monarches. But the framers of the Constitution, colonials removing the burden of administration from the mother country, envisioned stability rather than disruption. They sought to maintain order rather than propel change. The French Revolution, however, was a social cataclysm. In deposing their own ruler, the French cancelled the divine right of kings and their idealistic struggle became one to rearrange an entire society.

The ensuing confusion had profound effects on the shaping of modern dentistry. France’s political convulsion shifted the focus of the emerging dental discipline from that country to the United States, where dentistry was consolidated and reinvented as a full-fledged, autonomous profession.

Through the ages France has maintained a formidable reputation for ideas and inventions. In science and medicine particularly it has been a major contributor to world progress. The first western hospitals evolved in France; the Hotel Dieu in Paris was founded in the A.D. 600s. The 14th-century surgeon Guy de Chauliac molded medical thought throughout Europe with the definitive text: Chirurgia Magna, written in 1363, set the standards for surgery for centuries. Guy identified dentistry as a separate category of health care, coining the Latin-based term “dentista” for one who treats teeth.

Ambroise Pare was the 17th-century surgeon who is considered the founder of modern surgery. Not a physician, he gained his skills through apprenticeship and practical experience. He was successively barber, barber-surgeon and master barber surgeon. His advancement neatly illustrates the classic sociomedical hierarchy of his day. In terms of dental care, treatment of patients might be divided up something like this: physicians, trained in theory and Latin, conducted consultations on oral disease. Medicine was originally mainly talk and very little effective diagnosis and treatment. Extractions, being surgery, were assigned to the hands-on healers, surgeons or barber-surgeons who occupied a social peg below physicians. Prosthetics and mechanical dentistry were developed by artisans and craftsmen. Competing against trained personnel was a variety of street-corner mountebanks and charlatans extracting or breaking teeth to the amusement of onlookers.

Pare became surgeon to several kings of France. His reputation and writings, which included extensive descriptions of dental instruments and procedures, began to advance surgery from lowly craft to medical art.

In 1619, presumably under pressure from surgeons’ guilds seeking to upgrade their official status, an ordinance was passed in France granting equal rank to dentists, bone setters and lithotomists. Upon passage of examinations before a commission of three Masters in Surgery, each specialist would be considered “expert” in his branch of surgery.

Parisian surgeons of the College of Saint Come, asserting their independence from patronizing physicians of the University of Paris, set about to block the performance of minor surgery by street hawkers. In 1699 Louis XIV decreed that training for surgeon dentists should be conducted at the college. After a prescribed two-year course of study, a student could call himself “chirurgien dentiste.” That name, which was borrowed from the English word “dentist,” is still the designated title for dentists in France.

France’s dental leadership in the 18th century is largely due to one man. Pierre Fauchard envisioned a profession out of a craft and in so doing created the modern concept of dentistry. Fauchard did not invent dentistry but he catalogued existing techniques, procedures and ideas and published them to the world in an age when secrecy among practitioners was deemed essential for business. His landmark 1728 work, Le Chirurgien Dentiste, ou Traite des Dents, signaled the beginning of shared information among professionals. Fauchard argued that dentistry was deficient in three key areas. He decried inadequate dental literature, the scarce opportunities for instruction and the sketchy regulation of practice across France. He clamored loudly and eloquently against those “who practice [dentistry] at hazard, possessing neither principles nor system.”

Fauchard’s precepts flourished. The rod was remapped for the next generation of dentists. French dentistry gained a reputation for superiority.

While a humanistic rebirth of learning developed in Italy, France moved into its age of political absolutism. Kings and their ministers solidified and centralized power. Monarchical authority grew steadily from the 1500s to the 1700s. The palace at Versailles became a showplace of the weakened nobility and Louis XIV was able to crow, ‘L’etat c’est moi.” French philosophers argued that the prevailing autocratic world view weakened innovative thought. Descartes had preached that systematic doubt and logical reasoning were the basis of true knowledge. His teachings presaged the Enlightenment, the 18th-century movement that emphasized reason and human progress.

An enepreneurial spirit took hold in France and class distinctions blurred under leveling influence of money. It was an epoch in which the research chemist Lavoisier could also run a tax agency. The Enlightenment, optimistically emphasizing social improvement, fueled the fires of revolution. At least one revisionist historian views France’s revolution in terms of an infatuation with modernity that began not with the masses but the top of society: nobles, lawyers, priests and professional men (Schama). Tensions mounted as the elite debated over how to best vitalize the country. Violence was rationalized in the name of change. The jubilant dreams of grand possibility melted as rival factions exploited the rage of those victimized by change—housewives unable to afford bread, artisans blocked from guild activities. The Reign of Terror erased all sense of common purpose and the much hoped-for progress ground to a halt.

France eventually picked up the pieces, and its medical thinkers again began to produce. In 1820 Pierre Joseph Pelletier isolated quinine from the tropical chinchona tree. Soon he and other French scientists had isolated morphine, caffeine and digitalis. Nine years later the pharmacist Henri Leroux extracted salicin from the bark of the willow tree, leading to the development of aspirin. Louis Pasteur virtually created microbiology; his Institut Pasteur remains a major center of biomedical research.

Medicine is often actually improved by war. The stark necessities thrust forward by the wounds of battle can compel the improvisation that leads to innovation. The battlefield experience and discipline forced on French surgeons disrupted the normal way of doing, things giving rise to profound changes for later medical practice and education (Vess). The war that began in 1792 provided doctors their training. Formal training had ceased to exist, so the battlefront itself became medical school.

For dentistry the French Revolution was a disaster. Pierre Fauchard’s vision of an autonomous, disciplined, educated body of practitioners was cut off by the revolutionary ideal of egalite. In a wild, utopian attempt to secure equality among the people, the old training standards were obliterated. In 1792 all requirements for professional training were swept away. Only a license, available to any citizen for the asking, was needed to practice medicine, surgery or dentistry. The ensuing chaos enveloped all areas of medicine. Marketplace charlatans surged forward, unchecked and sanctioned by the state.

It became apparent that unrestricted medical practice was leading to dangerous situations. In 1795 the National Convention revived formal medical education. In 1789 representatives of the people were sent to Paris to discuss aspects of French life. The documents left by those convocations show repeated requests to weed out charlatans, to provide more doctors for the rural areas, and set up appropriate laws for physicians and surgeons (Caron 20-26).

In 1803 Napoleon moved to re-establish laws of medical regulation. Strangely, dentists were not Included; no legal standards were instituted for dental surgery until 1892. Itinerant, open-air dentists still existed in Paris into the 20th century. Through the whole of the 19th century, dentistry was the only profession not regulated in France, “where everything is regulated” (Carson). Dentistry fell into disrepute.

The focus of dentistry’s evolution shifted to the United States (Ring 19). There are four reasons. In the first place, the tumult of France’s revolution interrupted scientific advancement and broke up the social stability needed to nurture the frail future profession. Second, the United States, young and hungry for legitimacy, was itself developing an ambitious, inquiring and entrepreneurial spit. The U.S. fostered in ideal climate for business and professional minds and European-trained medical men found the services in great demand.

America’s revolutionary war not only set the stage for France’s revolution but also set In motion the transfer French talent to the United States. Scholars have argued that few dentists fled the revolution. But most educated men practicing dental surgery were probably general surgeons, of which some 300 left France (Vess).

Among top dentists emigrating to the former English colonies was Jacques Gardette (1756-1831), a French naval surgeon who had been attached to Lafayette’s forces. Gardette authored the first scientific article on dentistry in American literature and is thought to have trained the first eminent American-born dentist, Josiah Flagg.

Another prominent French-born dentist in America was Jean Pierre LeMayeur (died 1806). LeMayeur arrived in British-occupied New York during the American Revolution. An anti-French statement made in his presence sent him storming from the city. He was invited to the headquarters of General George Washington who placed himself in LeMayeur’s professional care.

The third factor contributing to America’s gathering pre-eminence in dentistry involved the growth of technology. The burgeoning population and the coming of the Industrial Revolution augured a rise in expectations of better living. The resulting upswing in consumption encouraged the experiments of inventors and designers. Many of them applied their ingenuity to dentistry. Charles Goodyear’s development in the 1850s of vulcanite rubber, for example, meant that denture bases could be made cheaply and easily; suddenly, false teeth were available to the masses.

Fourth, the spread of free public school education produced an expanded audience of readers resulting in the proliferation of reading material. For dentistry it meant increased printing and circulation of both patient education tracts and professional publications. In the fledgling United States both European-educated and home-grown practitioners made great strides. Lacking a restrictive dental tradition like Europe’s barber-surgeon guilds and aided by a growing populace developing in sophistication, America’s dentists were free to reconstruct their calling into a profession. By 1826 a German-born dentist named Leonard Koecker, who had practiced in both London and Philadelphia, proclaimed of America, “In m, part of the world has the [dental] art attained a more elevated station” (Ring 19).

As Pierre Fauchard had intimated dentistry as a professional depends on a solid footing of three ingredients: education, organization and literature. During the years 1839 and 1840, this tripartite base was established for the first time in e world in the U.S. To a great degree the impetus came from two men, Horace Hayden and Chapin Harris.

Between the two, Hayden and Harris organized the original dental society (The American Society of Dental Surgeons) and the world’s preere dental periodical, the American Journal of Dental Science. Hayden and Harris were responsible for the founding of the Baltimore College of Dental Surgery, the first school dedicated to educating dentists. They constituted two of the initial four instructors who gave lectures on anatomy, physiology, pharmacology and therapeutics and “Practical Dentistry.” The curriculum covered a two-year span, equivalent to the of existing medical schools.(1) Drs. Hayden and Harris Meated the the school’s degree, Chinugia Dentium Doctods, the initials of whose translation became the familiar D.D.S.(2) With the granting of the first diploma, the dentist was reinvented as doctor.

Thus the framework was evolved and the institutions fashioned for the rise of dentistry in the United States as a health profession distinct from medicine. France, heir to many of Europe’s greatest medical advances, forfeited its 18th-century dental preeminence during the storm of its revolution. What was good for medicine in France was bad for dentistry. By disrupting the social and scientific milieu conducive to the progress of the embryonic profession, France effectively passed on its gifted dentists, its collective dental reputation and the ideas of its medico-dental thinkers to America.

Thomas Evans, the Philadelphia dentist who practiced in Paris in the mid-1800s, became court dentist to Emperor Napoleon III. He had been told as a youth that, as an American, he might never be an excellent dental surgeon since “it is [the French] who make the dentists.” Looking back on his career he mused “how strangely this has been reversed, for it is America that has made the profession—lifted it up from the trade or art I found it in France when I lived there” (Carson).

In the 19th century dentistry flowered in the new country: oral surgery and orthodontics were molded into specialties, the dental engine was devised and anesthetics came into being. Americans like Thomas Evans even took their energies back to Europe after 1840, reversing the usual direction of cultural influence between the continents.

Current dentistry owes its form to the scientific thought and political conditions in two countries. The Histories of France and the United States influenced each other during the profound changes of their respective late-18th-century revolutions. France’s tradition of medical excellence and Enlightenment thinking enabled it to engender the principles for the modern practice of dentistry. America’s open society and unstructured enthusiasm allowed it to carry those ideas to fruition.