i D E N T A L H I S T O R I A N

NUMBER 65 (2) July 2020

Contents

Lindsay Society Officers & Membership 2020/21...... iii

Editorial...... iv

Lindsay Society News...... v

The dawn of the digital era in dental education:Charting the changes and challenges up to 2020 Part 1 The Dawn of Dental Education Reynolds PA, Eaton KA and Dobozy E...... 55

Eric Cooper. Oral Surgeon and Dentist in Colditz Peter Dyer...... 67

History of the Rubber Dam Shir Lynn Tan...... 73

The Founding of the University of Alberta School of Dentistry, Canada G.H. Sperber ...... 79

Public Dental Services, Queensland, Australia: School Dental Service, 1911-1973 Harry F Akers, John P Brown, Michael A Foley, Valerie Woodford...... 81

ii Dental Historian The Dental Historian (DH) is an international journal that publishes peer reviewed papers, biographies and descriptions of historical artefacts. The DH accepts manuscripts online. It is a condition of acceptance of a manuscript that it has not previously been published or is not under consideration of publication in any other journal. If more information is required then please contact the Editor. Persons wishing to submit a paper for publication should send it to Dr Margaret Wilson, Editor at [email protected] Manuscripts should be sent as Word documents, single spaced, Times New Roman, font size 12 and left justified. Images should be sent as separate jpegs. The publisher and editor cannot be held responsible for errors or any consequences arising from information in this journal. The views and opinions do not necessarily reflect those of the publisher and editor. Authors are reminded that it is their responsibility to obtain permission for publication of images in the Dental Historian.

The Dental Historian is sent free to members of the Lindsay Society.

iii Lindsay Society Officers 2020/21

President Roland Hopwood [email protected]

Immediate past-president David McGowan [email protected]

Hon Secretary Brian Williams [email protected]

Treasurer Noel Stamp [email protected]

Committee members Rachel Bairsto Stuart Geddes Craig Rushforth Andrew Sadler Editor of Dental Historian Margaret Wilson [email protected]

Associate Editor Nairn HF Wilson

Membership Membership applications should be sent to the Honorary Secretary, Dr Brian Williams, 14 Howard Road, Great Bookham, Surrey, KT23 4PW. Email: [email protected] Subscriptions £30.00 Individual UK membership £49.00 UK Joint membership-both at same address £38.00 Individual overseas member, payable in sterling. £58.00 Overseas joint members-both at same address, payable in sterling Free to UK student members of the BDA £30.00 Overseas dental student Single issues can be bought by sending a cheque for £16.00+P&P made out to the “Lindsay Society for the History of Dentistry”. For on-line banking Account No. 10868167 Sort Code 20-51-43. For international payments SWIFTBIC BUKBGB22, IBAN GB69BUKB 4310 8681 67 All requests should be sent to the Distribution Manager, Dr Stuart Geddes, Ysgubor Argoed, Tregagle/Monmouth, NP25 4RY. E Mail [email protected]

iv Editorial As I am writing this editorial, the country is still in lockdown. Who knows what future historians will make of 2020? It will be some time before we know the full impact of coronavirus on dentistry One thing is for sure, things will be different; how different remains to be seen. Perhaps people will come to appreciate that oral health is important to general health and wellbeing and that people with good oral hygiene are less liable to get respiratory infections and pneumonia especially when intubated- a forgotten element in the current crisis. Will there be more emphasis on health and function rather than beauty or will we revert to the pre-crisis obsession driven by whiter than white teeth and unnaturally even teeth? Will owning and running a practice be seen as high risk, will dental corporates expand? -questions questions. The year 2020 began with such anticipation. In February the British Dental Association Library celebrated 100 years and had a wonderful display of some of the rare books held in their collection. Past librarians were able to join in the celebrations and reflect on the enormous changes that have taken place, both in terms of IT and also changes in patterns of library usage.

The Old Library The Library in 2020

Also, in February, Rachel Bairsto, the Head of Museum Services and I visited the Unilever Archives and Records in Port Sunlight. Unilever have a comprehensive archive of all the products they produce. Included are the dental brands: Gibbs (toothpaste and toothbrushes), Signal, Dentabs, Pepsodent, Close-up, SR and Mentadent P. The collection contains examples of the products and also the marketing research, scientific and company records relating to the products. The quantity and quality of their archive and storage facilities are outstanding. Unilever should be congratulated on keeping this valuable collection which is such a huge resource for dental historians. Since the promising start to the year, the Coronavirus Pandemic has now put paid to all our plans. The Lindsay Memorial Lecture was postponed to the Annual Conference in October, then the Annual Conference to be held in Bath in October was postponed until 2021. (see the Hon Secretary’s report) The International College of Dentistry meeting, to be held in Japan in November 2020, to celebrate 100 years of its founding by Drs Tsurukichi and Ottofy has also been postponed until 2021. A celebration which hopefully is going ahead is the installation of a plaque at the University of Maryland Dental School in Baltimore to honour Dr Lucy Hobbs Taylor who was the first woman to be installed in the Pierre Fauchard Academy Hall of Fame, and the first woman dentist to graduate from dental school. She obtained her degree in 1866 from the Ohio College of Dental Surgery. Looking back 100 years we recall the Spanish Flu Epidemic after the World War I, and it is difficult not to compare that particular pandemic with our current crisis. I hope by the time of our next issue the current circumstances will be behind us and we can look forward to travelling, meeting and indulging in dental history research once again.

v Lindsay Society News The (non) Annual Conference of 2020 As with all events and conferences, planning starts many months before the date. This was the case with the 2020 Lindsay Society’s Conference in Bath. Speakers had been primed, the hotel booked and the Conference Dinner venue sorted – or so we thought! Then someone became ill in China and this ‘illness’ started to spread at an alarming rate and the world started to shut down. Package holidays were withdrawn, country borders closed and cruise ships quarantined. We Brits only took notice when The Grand National, The Chelsea Flower Show and Wimbledon were cancelled. This must be serious! It was at this stage, in early April, the Society had to make the decision to cancel or not to cancel. When the only constant ‘theme’ coming from the Government is “stay home and save the NHS”. But by staying home will it be enough to save our Bath Conference? And what about the ‘scare story’ regarding the 5G network. Some people believe the communication masts are spreading the Coronavirus and, if so, will they all be removed from the Bath area pre-conference; or is this just fake news? We have been told ‘lockdown’ could last six months. Is this more fake news, scaremongering or true? If true it will mean only members living in Bath and taking their daily exercise could attend. With no speakers or fellow delegates, it could be a very lonely weekend! And would all the venues we had intended visiting be open? Fortunately, by now, hysteria was replaced by common-sense and the priorities of the Society came to the fore. Could the Lindsay Society Committee guarantee a safe conference for the delegates and speakers; with all the unknown ramifications of Covid -19 possibly still being active? The answer was a resounding NO and with that answer the conference for 2020 was cancelled. But all is not lost. True, there will be no Bath meeting in 2020 but the Lindsay Society will hold a conference next year. Where will it be? Where else but BATH.

Brian Williams – Hon Secretary Lindsay Society

vi Dental Historian 2020 65(2) 55 - 66

The Dawn of the Digital Era in Dental Education: Charting the Changes and Challenges up to 2020 Part 1 The Dawn of Dental Education

Reynolds PA, Eaton KA and Dobozy E.

Abstract: This two part series provides a living and historical account of how education generally, and dental education specifically, has developed and been transformed. Part I “The Dawn of Dental Education” will chart the educational sea changes across thousands of years at the advent of the third Millennium. The influence of philosophers such as Plato, and pioneers of print such as Gutenberg, who changed educational delivery, are highlighted. Part II “The Dawn of Dental Digital Education” will embrace the digital revolution (Reynolds, 2014)1.

Keywords: dental digital education, history Introduction The Four Educational Revolutions Although educational change has been slow Ancient philosophers and innovators predicted across the Millennia, its effects on teachers and the impact of new technologies on the education of learners, as they gained access to new knowledge the population. The advent of the medium of has been profound. Furthermore, education writing, the invention of the printing press, the remained largely static for many centuries, available industrial revolution, and most recently the only to the elite, upper classes and clergy. The ’information highway’ have all had profound dawning of the digital age has made the access to effects on the delivery of education. Figure 1 charts knowledge and educators all pervasive. This is the educational milestones mediated by the further enhanced by new paradigms and affordances development of various technologies from Neolithic of the new media (Laurillard, 2005)2. As the times to the present. It serves as a historical philosopher, Marshall McLuhan, famously said “the perspective of the key developments that underpin medium is the message” (Gibson, 2008)3. our current educational systems and the four educational ‘revolutions’. There have been both positive and negative effects of each technological revolution. Most Oral traditions and the written word recently, the positive applications of sharing social In primitive societies, knowledge was passed on media brings with it issues of bullying, privacy and 4 through oral traditions by elders to their people and security (Berki and Jakala, 2009) . However, those children. Writing emerged five millennia ago in who have resisted change have not been able to hold Ancient Egypt with the early use of papyrus scrolls back the future. (Schönwetter and Reynolds, 20135; 1 and hieroglyphics. At this time, simple arithmetic Reynolds, 2014 ). This is not a new phenomenon, using the sexagesimal (60 base) Sumerian abacus as barriers to change in educational practices are appeared in Mesopotamia. Multiples of 60 are still seen at the beginning of each of the four educational used today in measuring time (Ifrah, 20018). In revolutions: the oral to written revolution (300 BC); China, formal schools were first established during the advent of the printing press (1439 AD); the Xia dynasty (2070 BC-1600 BC). It was also in industrialisation and Fordism (mass production) this era that clay tablet libraries were appearing in (19th th and 20 centuries) and the digital age (circa Assyria. A thousand years later the oldest verified 2000). alphabet was created by the Phoenicians (1050 BC) It is fair to say that the educational wheel has with its origins based on the hieroglyphs from been reinvented several times using the new which Latin, Greek, Hebrew and Arabic languages 9 technologies and media, but what has emerged are have their derivation (Humphrey, 2006 ). new pedagogical practices that surpass all Ancient Greek education was focussed on educational expectations (Eaton et al., 20086 , physical, military and moral matters and was Schönwetter et al., 20107 ). A ‘brave new world’ is exclusively for boys (Cordasco, 197610). Girls dawning. remained in the home to learn domestic skills. The famous library in Alexandria was founded by 55 Dental Historian 2020 65(2) 55 - 66

However, those who could read and write helped create a body of knowledge that became an instrument of power. The written word became crucial to building and sustaining empires (Harris, 199113).

Automation of the written word (the printing press) The first printing press in the West was invented by Johannes Gutenberg (1398-1468), a German goldsmith and publisher (Figure 2). He introduced mechanical ‘moveable type’ printing to Europe and produced the first Latin version of the Bible in 1455 (Davies, 199616). This was a major step forward in the production of written work for the wider literate population. Books had previously been laboriously copied by hand. Interestingly, the printing presses of China predated Gutenberg by several hundred years, but the Chinese characters were complex to Figure 1. Educational timeline from Neolithic times to publish. William Caxton (1422 – 1491), an present and the four ‘educational revolutions’ English merchant, was considered to be the first person to introduce a printing press into England, Ptolemy I (367-282 BC), the Macedonian historian in 1476. He notably introduced the public to 11 of Alexander the Great (MacLeod, 2000 ). Chaucer’s Canterbury Tales and Chancery English 17 Whilst the great ancient Greek philosophers, by publishing the text (Duff, 1905 ). such as Socrates and Plato, mused over drama, The printing press therefore played a key role in history and poetry they also grappled with the the Renaissance and the Reformation that followed. cultural shift from oral to written traditions. Plato “The Gutenberg Galaxy: The Making of (424-348 BC), the Athenian Philosopher, was a Typographic Man” (McLuhan, 196218) was a pupil of Socrates and teacher of Aristotle. He ground-breaking study of oral, print and media appreciated the power of writing, and was prolific; cultures. McLuhan emphasised how the alphabet, over 250 of his manuscripts survive today writing and the printing press yielded/produced 12 (Brumbaugh and Wells, 1989 ) and he realised profound effects on people’s perceptions and social that writing made that knowledge widely visible. interactions. Hence, the development of the printing The Romans notably added oratory as a core press is worthy of being referred to as an curricular topic and were responsible for the Latin educational milestone. Grammar Schools. However, even in Roman times, Industrialisation and Fordism only about 10% of the population was literate, although there were regional variations of 5-20% The industrial revolution created a period of (Harris, 199113 )The Ancient Greeks and the rapid technological developments, predominantly Romans relied heavily on oral communication. in the 19th and 20th centuries. A paper machine was invented in 1799 by Louis-Nicholas Robert. During the Dark Ages (from 476 AD), now However, as this was shortly after the French called the Early Middle Ages, monasteries provided Revolution, Robert came to England and was education in Scolae monasticae from which introduced to the brothers, Sealy and Henry European medieval universities developed in the Fourdrinier, stationers of London, after whom the th th 14 11 and 12 centuries (Riché, 1978 ). During paper machine was named. The ‘Fourdrinier’s’ the Carolingian Renaissance in the time of methods of production form the basis of the paper Charlemagne, King of the Franks (768 to 814 AD), making today (Hills, 201519). literature, architecture, and art flourished once again (Story, 200515). Unfortunately, the industrial revolution also brought hardship and poverty. There was child 56 Dental Historian 2020 65(2) 55 - 66

Between the two World Wars of the 20th Century, the term ‘Fordism’ (mass production and mass consumption) was coined (‘Fordism’ after Henry Ford, the American Industrialist 1863-1947). Whilst the debate between "Fordism" and ‘Post Fordism’ (more contemporary industrialisation) continues to occupy scholars, one of the attributes of a post Fordism society has been the rise of information technologies. The key point here is that it is not just the adoption of the technology that is important, but the ‘cultural shift’ that accompanies it (Boyton & Milazzo, 199622, Dobozy et al, 201223). New paradigms have arisen that have enabled innovation and new approaches to educational methods (Soucek, 199524). An example of this is the growth of open and distance education and the cross-cultural contexts involved (Evans, 199525). The Open University has made a great success out of distance education (also called distance learning), often enabling adult education for those who had previously missed out on higher education (HE). The External Programme of London University had predated Fordism, as it provided the first ‘correspondence courses’ in 1848 to students in Mauritius. This was also one avenue that women Figure 2. Top left: Plato; Top right: Johannes Gutenberg; could obtain a university education from London at Bottom left: Henry Ford in 1919; and Bottom right, Sir Tim that time. Berners-Lee in 2014. (Source of each image: Wikimedia Creative Commons Licence V 4.0) * In dentistry, some of the first graduate distance * Images obtained from Wikimedia: learning courses were pioneered through the Plato: https://commons.wikimedia.org/wiki/File:Plato_Pio- External Programme of the University of London Clementino_Inv305_n2.jpg and then at King’s College London by Professors Gutenburg: https://en.wikipedia.org/wiki/Johannes_Gutenberg#/media/ David Smith and Stanley Gelbier. Innovative File:Gutenberg.jpg practices such as video recording dental procedures, Ford: and the use of blended learning approaches (face to https://commons.wikimedia.org/wiki/Henry_Ford#/media/F face with online courses) enhanced the courses, ile:Henry_ford_1919.jpg which ran as a successful business model, returning Berners-Lee: https://en.wikipedia.org/wiki/Tim_Berners- Lee#/media/File:Sir_Tim_Berners-Lee_(cropped).jpg a modest profit to the host colleges. This was an excellent example of a successful Post-Fordism labour in the factories, environmental pollution and model, with the courses scoring highly in quality workplace hazards. There was also a lack of any assessments. formal education for the majority of the population. However, in 1833, the British Government passed However, changing regimes and leadership in a Factory Act making it compulsory for children, the host institutions, against a backdrop of failing who worked in factories, to receive two hours of governmental initiatives, led to the restructuring education per day (Surrey, 201720). Charitable and and/or loss of pioneering distance learning free schools were also set up including the ‘Ragged programmes. Such government initiatives included Schools’ in 1844 (Lee, 201421). Other educational the ill-fated NHS e-University (2004) and opportunities also emerged as better educated controversial Higher Education and NHS IT workers were required. systems (e.g. NHS National Programme for IT [NPfIT], 2009), (Education and Skills Committee, 2005; Public Accounts Committee,

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2011). Even with evidence of at least comparable efficacy between technology enhanced learning (TEL) and traditional methods, the latter approach still prevails at the dawn of the digital revolution (Allen et al, 200627, Laurillard, 2010 & 201228,29, Nicoll, 201830).

The digital revolution (Technology Enhanced Learning, TEL) The digital revolution started with the advent of computers. Two important British mathematicians of the 19th Century - Ada Lovelace (1815-1852) and Figure 3. Watercolour of Ada Lovelace by Alfred Edward Charles Babbage (1791 – 1871) - provided the Chalon, and Photograph of Charles Babbage by unknown. (Source of each image: Wikimedia Creative Commons knowledge base for modern computers with their Licence V 4.0) * ‘analytical engine’ (Figures 3 & 4) (Fuego and Francis, 200331). *Images obtained from Wikimedia: Ada Lovelace: By Alfred Edward Chalon - Science Museum Fast forward to World War II, when Colossus I Group, Public Domain, https://commons.wikimedia.org/w/index.php?curid=28131 and II were built by British code breakers to 684 synthesise high-level military intelligence (Figure Charles Babbage: By Unknown - 5). Colossus was designed by research telephone http://images.google.com/hosted/life/l?q=Charles+Babbage engineer (Tommy Flowers) at the Government &prev=/search%3Fq%3DCharles%2BBabbage%26um%3 Code and Cypher School at Bletchley Park D1%26hl%3Den%26sa%3DX%26biw%3D1680%26bih%3 32 D916%26tbs%3Disz:l%26tbm%3Disch&imgurl=19fc9fba4 (Flowers, 1983 ). It was developed to help solve a ea4a1cb, Public Domain, mathematical problem set by Max Newman in 1935 https://commons.wikimedia.org/w/index.php?curid=15392 for which Alan Turing developed a theoretical 737 all-purpose computer solution in 1936 ‘The Turing Machine’ (Newman, 195533). Turing did contribute to the design of the Colossus by the use of probability in cryptanalysis but it would have been necessary to connect 10 Colossi made to simulate a Turing machine (Wells, 200934). By the end of World War II, there were 10 machines, but they were destroyed in the 1960s and kept secret until the 1970s (Barber, 201535). A replica of a Colossus II now exists at Bletchley Park (Sale, 200836). However it was not the computer itself, that made the greatest impact of the digital revolution. Colossus was unwieldy and only useable by a few people. Thomas Watson, the President of IBM, Thomas Watson, infamously said in 1943: "I think there is a world market for maybe five computers”. Computer Scientists grappled with the internet and connectivity for another 40 years before Tim Berners-Lee devised the World Wide Web (WWW) Figure 4 Trial model of a part of the Analytical Engine, built in 1989 (Table 1). by Babbage, as displayed at the Science Museum (London). Photo by Bruno Barral (ByB), CC BY-SA 2.5, The WWW enabled computation through https://commons.wikimedia.org/w/index.php?curid=6839854 networking to reach a global audience, greater than any other communication system in the history of Nevertheless, the explosive expansion of mankind (World Wide Web Foundation, 201937). connectivity was a sea-change in networking, Computers had already been used for education pedagogical practices and social organisation. before the WWW (Cox et al, 1974a & b38,39). However, as with many good things there is often

58 Dental Historian 2020 65(2) 55 - 66

Figure 6. Henry VIII and the Barber Surgeons. Hans Holbein (cartoon) overpainted in oils by another artist Figure 5 A Colossus Mark 2 codebreaking computer being (unknown). Oil on paper mounted on canvas (160 x 280cm). operated by Dorothy Du Boisson (left) and Elsie Booker Royal College of Surgeons of England. Public Domain. (right), 1943. Photograph by: Stephanie Photo by Unknown - This file is from the collections of The National Archives (United Kingdom), catalogued under document record FO850/234. Public Domain, notes go straight to the students’ lecture notes, https://commons.wikimedia.org/w/index.php?curid=501979 without passing through the brains of either”. The digital age offers progress from the medieval concept of education via lectures. but despite an ever increasing body of evidence, the impact of the digital revolution on the learners is still being realised (Reynolds et al, 200840, Laurillard, 201341). Early Learners and The Barber Surgeons

Table 1 Development of components that led to the World In medieval Europe barber-surgeons were both Wide Web by Tim Berners-Lee medical and dental practitioners who often learnt their trade through surgery of the war-wounded. a dark side, and the insurgency of undesirable Most acted as apprentices but many would not have aspects such as viruses, hacking, spam, the dark had any formal learning, and some were even web, pornography and loss of anonymity, have led illiterate. They would often peddle their trade in to new methods of web control and management. distinctive livery in the market-place. The symbolic Anti-virus programmes, parental controls, and red and white pole of today’s barbers signifies the General Data Protection Regulations (GDPR) are blood and cloths as part of bloodletting. In England examples. There was also the resistance to change barbers and surgeons each had a Guild that were in educational approaches and methods in TEL, and merged by Henry VIII in 1540 (Figure 6). this will be discussed in Part II of the mini-series. Barbers were then only allowed to carry out Given the above four influential revolutions in teeth-pulling and bloodletting, and indeed, a few of educational practice, the influence on the actors these were actually women. The Barber-Surgeons involved has been profound. The following sections became responsible for instigating teaching discuss the learners and teachers, significant aspects programs and the licensing of men to practice the of the new technologies, pioneers and barriers to art of surgery. In 1745 George II separated the TEL, and a glimpse into the future, respectively. Barbers and Surgeons Guilds. The latter were then Many of the developments and consequences of the university educated - but only men were admitted revolutions pertain to general and healthcare education, and Part II of the mini-series will focus on the digital era in dental education.

Trainees and Learners across the Millennia From parent to child, master to student, peer to peer, knowledge has been conveyed across the Millennia. Mark Twain reputedly said that “College is a place where a professor’s lecture Figure 7. Photo of indenture for barber’s apprentice 1896

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(Robinson, 1984, Science Museum, 2019). To become a barber in the late 19th Century, apprentices were signed up for 3 years with some interesting stipulations such as keeping their Master’s secrets and not frequenting taverns (Figure 7).

Lilian Lindsay – the first female dentist in the UK (1895) Lilian Lindsay (Figure 8), has been much feted for her pioneering role for women in dentistry. She highlights the male dominated society of the late 18th and the 19th Centuries, where the education of women was frowned upon especially in Higher Education. In 1892, as a student she was refused entry at the National Dental Hospital in Great Portland Street by the Dean, Henry Weiss, who interviewed her on the street, because she would have been a distraction to the male students. Even when she gained entry Edinburgh Dental Hospital and School, Sir Henry Littlejohn announced that she would be “taking the bread out of some poor fellow’s mouth”. However, having won the Wilson Medal for Dental Surgery and Pathology, the Medal for Materia Medica and Therapeutics, she qualified LDS in 1895. (Cohen and Cohen, 199144, Bairsto, 201945). This journal is the publication of the Lindsay Society, founded in 1962, two years after her death at the age of 88. It is only right that she has an important mention as the first female student of dentistry in UK. It has taken 100 years for the Figure 8 Lillian Lindsay. Courtesy of the British Dental number of women in dentistry to register from 1% Association to just under 50% (Brooks, 201946).

The 20th Century - The apprenticeship model to distance learning The apprenticeship model described in Section 3.1 above thrived throughout the 20th Century in dentistry. It was the mainstay of teaching and learning (Marckmann, 200147). The old adage of "see one, do one, teach one" was not far from the truth. Figure 9 shows groups of students in the Prosthetics Lab of the Old Dental School at Guy’s Hospital in 1974 learning denture techniques from the dental technicians. Figure 9. Students in old Prosthetics Lab, Guy's Hospital, 1974 The apprenticeship model continues in dentistry, and has an important role in patient care and student scientific teaching and advice from experts education at the chair-side (Hindmarsh, 201148). (Laurillard, 201341). Furthermore, with the advent However, the blended use of TEL can enhance the of haptics and robotics with the sense of touch, learning process both synchronously and simulation and virtual reality has been shown to asynchronously with access to information, play an important role (Cox, et al, 201549). As Marckmann (200147) says “the apprentice model 60 Dental Historian 2020 65(2) 55 - 66 will not be “either-or” but rather “both – but in which proportion?” The concept of distance learning is not new, though postal services have given way to more instant online systems. Taking advantage of new technologies enabled several successful dental Table 2 The generations defined adapted from Dimock, graduate programmes to be pioneered in the late (2019), Pew Research Centre 20th Century. These included part-time Master’s https://www.pewresearch.org/fact-tank/2019/01/17/where- degrees in Dental Radiography, Community millennials-end-and-generation-z-begins/ Dentistry and Prosthodontics at King’s College through high-bandwidth mobile services. Whereas London. Many adversaries argued that it was Millennials experimented with Learning 2.0, using impossible to teach and learn such a practical Learning Management Systems (LMS) and mesh- subject as dentistry at a distance. However, the up software through the interoperability of innovative use of technologies such as video diaries technology, Generation Z learners embrace and videoconferencing, and the use of global Learning 3.0, which is more informal, global, open intensive face-to-face courses created a unique and flexible. ‘blended’ experience that was highly valued by the students. Many of the participants would not have Digital proficiency and internet addiction been able to access such courses otherwise, but benefitted from living in a connected world. (Miller The extent to which the digital environment may & Reynolds, 200650, Bains et al, 201251). Students need to be considered as a virtual space, where from many countries across the world such as excessively unhealthy and problematic behaviour is exhibited, is increasingly researched and debated Alaska to Fiji and Australia to Zambia benefitted 54 from this innovation. What became evident was that (Romano et al, 2013 ). Whether, how and to what there was a ‘digital divide’ between teachers and degree the digital environment is facilitating the students’ ability to use and understand unhealthy and addictive behaviours, leading to technology (van Dijk & Hacker, 200352). specific internet-use disorders or internet addiction, is currently not well understood and the term is Net generation and millennial ‘snowflakes’ ill-defined. Nevertheless, research on internet A cohort of people born within defined addiction has increased significantly (Brand et al, timeframes provided researchers in our data rich 201655), and following initial research by Young 21st century with invaluable information about (199656) is generally conceptualised as impulse- generalised values, attitudes and behaviours and control disorder. Addictive behavioural symptoms most importantly analysable data of changes in are typically listed as excessive internet usage (more views and habits over time (Table 2). The Pew than seven hours per day), loss of sleep, skipping Research Centre, specialising in generational of meals and/or conflict with family members research, decided to make 1997 the cut off for the resulting in detrimental social, work and education next generation to keep their cohort research outcomes. analytically meaningful. Hence, anyone born Research conducted in Hong Kong with over 700 between 1981 and 1996 (aged 38 to 23 in 2019) is young participants found that the higher the considered to belong to the Millennial generation proficiency level increased the possibility of and anyone born from 1997 onwards will become unhealthy behaviour displays. The researchers note part of the new Generation Z (Dimock, 201953). that “as expected, internet activities, especially SNS Whereas Baby Boomers born between 1946 and and online games, were significantly and positively 1964 (aged 73 to 55 in 2019) grew up with advent linked to Internet addiction as well as to all Internet of colour television and reality TV when Candid addiction symptoms” (Leung & Lee, 201257). As Camera entered the living rooms in the UK and with any advance or invention, there will be positive elsewhere, Generation X, born between 1965 and and negative effects. 1980 (aged 54 to 38 in 2019) grew up as the first home computers became popular. Millennials grew It has been suggested that heavy internet use in up with the WWW and Generation Z grew up with youngsters may overdevelop the left side of the the internet and explosion of the internet brain and leave the right side underdeveloped. It connectivity through mobile devices enabled can also adversely affect the neuroplasticity of the 61 Dental Historian 2020 65(2) 55 - 66 brain. This is akin to ‘digital dementia’ leaving user’s attention and memory span, and impulse control affected (Dossey, 201458, Spitzer, 201559). These traits are difficult to reverse, and would not Figure 10 Plutarch, be helpful for any aspiring dental student. In dental By Odysses education, this needs be understood to minimise and manage risks, and to maximise the student learning experience.

The Teachers/Practitioners Diana Laurillard so aptly said in 2012 that “There is something extraordinary happening in education. Teachers and learners are embracing technologies that will change the way we develop and share human knowledge and skills”. This solving skills are better nurtured by other methods section discusses the role of teachers in the cultural of interaction, including a blended learning change from traditional to digital approaches in approach. education, and the need to become digitally Digital fluency and digital mastery of educators competent. Understanding the development of the underlying pedagogies that map out the educational Given the rapid development of technology and theories is part of this digital mastery. the ease and frequency of their use, especially by prospective and current students, there is a need for Cultural change educators to find successful techniques to integrate From being a ‘Sage on the stage’ (lecturing) to learning technologies, in a meaningful way, into the becoming a ‘Guide on the side’ (moderating), is classroom culture. However, the issues of digital quite a cultural shift, however it can be very re- competence, proficiency, literacy, fluency and mastery of students and educators are a significant 60 warding (Rowntree, 1997 ). There will be no more and ongoing strategic problem, irrespective of the “death by Powerpoint” episodes, crowd control level of education or discipline (The New Media tactics or waking sleepy students. This change is Consortium, 201964). Although it has been very recent, lectures have been around since an- recognised that there is an urgent need for upskilling cient times, and were the mainstay of education of educators, recent reports suggest that current since medieval times. As Tony Bates (199961 said learning environments and infrastructure are not fit “If a student from the thirteenth century suddenly for purpose, leading to a failure of the education found himself in a university lecture today, he system to adequately prepare future knowledge would probably know immediately where he was”. workers for the digitised work environments There are some schools such as MIT (Massachu- (O’Doherty, 201865, Slaughter, 201866). Most setts Institute of Technology) which have stopped importantly, the role of educators as a key conduit lectures entirely (Young, 201662). Others rely on to instil lifelong learning skills and prepare the next lecture capture which is a very poor substitute generation for future work, is key for success. (Edwards & Clinton, 201963). Students attendance Educators need to be adequately supported to be drops even further and because there is very little able to fulfil this demanding task. Despite the quality editing of the capture, and they often fast voluminous research in the area of TEL and the forward the recording. Some lecturers also feel that pockets of innovation reported, system-wide TEL they cannot interact freely with the students. Stu- strategies and the integration of good practice has not yet been achieved (The New Media Consortium, dents often record the lectures themselves and this 64 can cause confidentiality issues especially when 2019 ). patient images are used. It is fitting that the UK Higher Education Policy It was Plutarch (46-120 AD), the ancient Greek Institute warn as follows: “It is essential that any Philosopher who said that, “The mind is not a vessel changes to delivery are driven by educational that needs filling, but wood that needs igniting.” So considerations rather than university balance sheets. bombarding students with information in a lecture Any perception that technology is being used just just overloads them. Creative thought and problem- to cut costs will make it harder for universities and 62 Dental Historian 2020 65(2) 55 - 66 students to benefit from future developments in educational technology”, (Davies et al, 201767). What is abundantly clear, is that the focus of much of the debate about TEL has quite rightly shifted from technology to pedagogy. Therefore, it is imperative to insist on conceptual clarity when discussing issues surrounding effective digital pedagogy and educator TEL competence. Table 3 provides much needed conceptual clarity around the need to move beyond digital literacy to digital Table 3. Digital pedagogy and levels of digital proficiency fluency and digital mastery.

Pedagogical timeline The late Robin Mason from the Open University said in 1991 “Good teachers may be good teachers in any medium”68. However, an appreciation of the educational theories behind best practice will enhance their understanding. Learning theories have Table 4. Summary of main learning theories an identifiable internal orientation, with roots both in educational philosophy and psychology and can be historically positioned in time and space. As such learning theories can be mapped and their underlying theoretical frameworks classified and coded, relevant to dental education or any other context. The main theories of learning are set out in Table 4. The list of influential education thinkers in Table 5 suggest that the pedagogical timeline is confined to theorists who can be termed constructivist in their conceptualisation of education (Dobozy, 201969). Table 5. Timeline of Constructivists Each of these thinkers has, over the years, strategy to employ. Building on the enhanced provided their unique perspectives and ideas, understanding of the value of collaborative contributing to the evolution of the learning theory, knowledge generation and the market capitalisation enabling it to become mainstreamed as the currently of ‘micro’ in other areas of the globalised accepted orthodoxy in education all over the world. marketplace. A key market opportunity for course development is to capitalise on the attractiveness of 21st Century pedagogy and ‘micro’ product ‘stackable credentialing’ to build into registrable innovation awards/credits for both undergraduate and ‘Micro’ was in fashion in the early 21st Century. postgraduate courses (Dobozy69). The surfacing and disruptive power of ‘micro’ in finance was seen through the introduction of micro Attractiveness of micro credentialing loans, micro insurance and micro savings; and in Credentials are issued to warrant that learners housing, through micro homes and micro have demonstrated learning outcomes, at or above consignment, which was a social or community the required standard. The quality of a credential enterprise model. Until 2020 this was also seen in centres on the assessment upon which it is based. education, with the increasing popularity of micro Macro credential is a term describing a credentialing and its disruptive force, driving qualification, such as a degree that is conferred change. In spite of this, up to 2020, there has been following successful completion of a course over little standardisation in terms of approaches, an extended period of time. Micro credentialing is frameworks and platforms. As micro credentials distinguishable from macro credentialing in that it proliferate, the challenge for universities is to find focuses on warranting or certifying the ways to capitalise on this trend and find out what accomplishment of a specific competency of skill. 63 Dental Historian 2020 65(2) 55 - 66

8.Ifrah, G., (2001). The Universal History of Computing: From the Abacus Compared to macro credentialing, a micro to the Quantum Computer. New York, NY: John Wiley & Sons, credential is much more granular in nature (Ifentaler Inc. ISBN 978-0-471-39671-0. 70 9.Humphrey, J.W., (2006). Ancient technology. Greenwood guides to his- et al, 2018 ). Teachers have much to master in this toric events of the ancient world (illustrated ed.). Greenwood Publishing brave new world. Understanding their students’ Group. p. 219. ISBN 9780313327636 10.Cordasco, F., (1976). A Brief History of Education: A Handbook of needs whilst grasping the fundamental pedagogical Information on Greek, Roman, Medieval, Renaissance, and Modern Educa- practices of TEL, are turnkeys to embracing tional Practice, Rowman & Littlefield; p. 5, 6, & 9. ISBN 0-8226-0067-6, ISBN 978-0-8226-0067-1426). Oxford: Elsevier. education in the digital era. 11.MacLeod, R., (2000), Introduction: Alexandria in History and Myth, in MacLeod, Roy (ed.), The Library of Alexandria: Centre of Learning in the Summary Ancient World, New York City, New York and London, England: I.B.Tauris Publishers, pp.1–18, ISBN 978-1-85043-594-5 Part I of this mini-series has described the four 12.Brumbaugh, RS., and Wells, RS. (1989). Completing Yale's Microfilm Project. The Yale University Library Gazette. 64 (1/2): pp.73–75. JSTOR revolutions in education. They have each had a 40858970. profound effect on educational methods. However, https://www.jstor.org/stable/40858970?seq=1#page_scan_tab_contents Ac- contemporaneous teaching still relies on methods cessed 1st May 2019 13.Harris, W.V., (1991). Ancient Literacy. Harvard University Press. ISBN where the teacher is the ‘sage on the stage’ and this 9780674033818 has changed little since medieval times. In dentistry, 14.Riché, P., (1978). Education and Culture in the Barbarian West: From the Sixth through the Eighth Century, Columbia: University of South Caro- innovative solutions to enhance the apprenticeship lina Press, ISBN 0-87249-376-8 , pp.126-7, 282-98 model, and practical training methods are now well 15.Story, J., (2005). Charlemagne: Empire and Society, In Story, J., (Ed). Charlemagne and Anglo-Saxon England, Manchester University Press, documented. The advent of distance learning and 2005, pp.195 a blended learning approach is also well 16.Davies, M., (1996). The Gutenberg Bible. British Library. ISBN 0-7123- 0492-4. 71 documented (Millar, et al., 2011 ), and the 17.Duff, E.G., (1905). William Caxton. In: Oxford Dictionary of National introduction of haptics in practical skills acquisition Biography, Oxford: Oxford University Press, https://archive.org/details/williamcaxton00duff/page/n11Accessed 1st May is gaining momentum (Cox, et al, 2015). 2019. 18.McLuhan, M., (1962). The Gutenberg Galaxy : the making of typograph- ic man. Toronto, Canada: University of Toronto Press. pp. 293. ISBN 978- The students, themselves, have changed and live 0-8020-6041-9 in a digital world, a world that is still alien to some 19.Hills, R., (2015). Papermaking in Britain 1488–1988, Bloomsbury Aca- demic Collections, London. ISBN 147424128X, 9781474241281 of their teachers. Understanding the best https://books.google.co.uk/books?id=Zn5qCgAAQBAJ&lpg=PP1&ots=G2 pedagogical practices in the context of dentistry, is 5mthfgT4&dq=Hills, R., (1988). Papermaking in Britain 1488–1988", Ath- lone Press&lr&pg=PA2 - v=onepage&q&f=false Accessed 1 May 2019 key to enabling the best learning opportunities for 20.Surrey, R. (2017). 1833 Factory Act - The National Archives. [online] The the profession. National Archives. Available at: http://www.nationalarchives.gov.uk/education/resources/1833-factory-act/ Accessed 1 May 2019. 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Author Biography learning and teaching, she led the development and implementation of new education products and managed all Professor Patricia Ann Reynolds BDS MBBS MAODE(Open) aspects of quality assurance including the effective use of PhD FDSRCS(Eng)(Ed) FHEA learning technologies, curriculum review and harmonisation of Transnational Education (TNE) policies and practices. Dr Qualifying in Dentistry in 1977 at Guy’s Hospital, and Dobozy’s leadership has been recognised through the Medicine at UMDS (United Medical and Dental Schools) in Professional Service Award of the Professional Teaching 1984, a career in Oral Surgery beckoned. Following the Council of Western Australia (2015), the Curtin Learning academic route, a PhD in lasers was awarded in 1996 when and Teaching Award (2015), and a nomination by the United she became a Senior Lecturer in Oral and Maxillofacial Nations Global Compact for the Principles of Responsible Surgery at KCSMD (King’s College School of Medicine and Management Education Implementation Progress report Dentistry). (2017). In 2018, Dr Dobozy was awarded the Higher Education Academy’s Principal Fellowship. Dr Dobozy is A Master’s in Open and Distance Education from the Open the President of the Western Australian Institute of University with Distinction was gained in 1999, when it Educational Research, Executive Board member of the became clear that a second career in technology enhanced International Council for Educational Media, and Academic learning was on the horizon. As Director of Flexible Learning Board member of the International Institute of Business and at the newly merged GKT (Guy’s, King’s and St. Thomas’s), Technology. she devised two large government funded projects in robotics and virtual dentistry, respectively, gaining a Chair in Dental Address for correspondence: [email protected] Education in 2007. She has published widely including a BDJ series on e-learning with Kenneth Eaton, an award winning anatomy text book and 3D DVDs. She became Professor Emeritus at King’s College London in 2014 and holds visiting appointments at three overseas Universities in Italy and Australia. She was President of the Dental Alumni Association at King’s, 2014-15.

Address for correspondence: [email protected] Professor Kenneth Anthony Eaton BDS, MSc(Dist), PhD, MGDS RCS(Eng), FFGPD(UK), FFPH, FHEA, DHC. Qualified as a dentist from Guy's Hospital in 1968 and served in the Dental Branch of the Royal Air Force (RAF) for 19 years, during which time he trained as a periodontist at the Eastman Dental Institute and subsequently became Adviser in Periodontics to the RAF and Director of its School of Dental Hygiene. In 1990 he became an Adviser to the Department of Health and in 1997 was seconded to be Director of the National Centre for Continuing Professional Education of Dentists. During this time he commissioned and evaluated a wide range of digital, distance learning material for dentists and members of the dental team, including a number in collaboration with Patricia Reynolds. He has been the Adviser to the Council of European Chief Dental Officers since 1992 and his PhD thesis was on oral health care systems in Europe. He has produced over 350 scientific publications. Among other posts, he is currently the Chair of the British Dental Editors and Writers Forum, a Visiting Professor at University College London and an Honorary Professor at the University of Kent.

Address for correspondence: [email protected] Dr Eva Dobozy BBUS BEd Hons (first class) PhD Murdoch (Aus) PFHEA Initially qualified in Business Education at the Verwaltungs Hochschule in Switzerland, she moved to Australia, and gained a first class honours degree in 1999 and PhD in 2004 in education. She followed a classical academic career in education at various Western Australian universities. In her educational leadership roles, including the inaugural directorship of quality assurance and acting deanship for

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Eric Cooper. Oral Surgeon and Dentist in Colditz Peter Dyer Abstract: In 1995, Eric Cooper was interviewed by Colin Davis in the BDJ about his life and work1. This article adds a personal glimpse about Eric Cooper, consultant oral surgeon (1951-1974) and prisoner of war (POW) in Colditz, from staff and patients in the Lancaster, Barrow and Kendal area who knew him and from letters and cards that he wrote during his internment to family and to colleagues in later years. Keywords: Dentist, oral surgeon, World War II, Colditz

Introduction To mark the 70th birthday of the introduction of the NHS, in the summer of 2018 health organisations were asked to identify local heroes from the past and the present who had made or were making a significant contribution to their patients. Eric Cooper, consultant oral surgeon in Lancaster, Barrow and Kendal (1951-1974) was one of those clinicians identified as someone who had given tremendous service not only to his patients but also to his country before being appointed as a consultant. Having been identified as a local hero a presentation was researched and written which included personal memories and anecdotes about Eric from people who had worked with him or had been treated by him. In addition, Eric had written home to his family from Colditz and in later years to colleagues about his work as a consultant. These documents added information to the interview given Eric Cooper in the Army by Eric to Colin Davis in 1995 about his life and work. procedure in the anterior mandible of the patient. To secure a pack in the sulcus, Eric reached over Subsequently the BDA Museum held an and removed a button from my theatre gown and exhibition about Eric during the summer of 2019, proceeded to suture that in place on the skin in the after his family kindly agreed that his memorabilia labial fold. This was enough to inspire me to apply should be held by the Museum. By coincidence the for a place at dental school. Having been offered a BBC’s Antiques Roadshow had an item in one of place, Eric let it be known that whilst he was their programmes, broadcast from the Isle of Wight, delighted that I was pursuing a career in dentistry in which his daughter Heather showed some of his he was sorry that I was going to do that at the Royal possessions relating to Colditz. Dental Hospital and not Guy’s! I think he would have said that with a twinkle in his eye. This paper also aims to redress the omission of Eric from the historical account of Colditz2. Although the Beaumont Hospital has been demolished to make way for a housing estate, many The author, not unlike a number of boys thinking people in Lancaster recall being treated there. about a career in dentistry, had the opportunity to watch and assist Eric Cooper whilst he operated at Eric’s Story1 Beaumont Hospital in Lancaster. After being taught how to ‘scrub up” by the theatre sister, I recall Brought up in Rotherham, Eric won a watching Eric carry out a sulcus deepening scholarship to Guy’s Hospital to study dentistry

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(1931-1936). He was one of the first students to graduate with a Bachelor of Dental Surgery (BDS) degree from London University and with Honours having gained and Distinctions in Surgery and Pharmacology. After “six magical months” as house surgeon with Sir William Kelsey Fry, he entered general dental practice in Chistlehurst. Eric maintained an interest in oral surgery by working as a locum at Greenwich Hospital performing mainly outpatient extractions under general anaesthesia. With the advent of the war in 1939 Eric enlisted in the Army Dental Corps (as it was at that time) and trained at a dental centre in York before setting sail on the Queen Mary with No.26 General Hospital. This military hospital was based at Kifissia, north of Athens but was evacuated in 1941 as the German Army advanced through the Balkans into Greece to reinforce the Italian Army. Travelling by night on a Royal Navy ship, the medical and nursing staff hoped to reach Egypt but instead stopped in Souda Bay, Crete. Living rough in olive groves and villages, Eric made his way to Student dental box belonging to Eric Cooper at Guy’s No.7 General Hospital, which consisted mainly of which was a Civil Repatriation Unit for returning tents and was situated on the north coast of Crete prisoners of war. They married in August 1946; Joy in a vineyard. Whilst the other members of No.26 being given away by a Colonel. After celebrating were soon transferred to Egypt, Eric’s departure in the Officer’s Mess with sandwiches and Pimms was cancelled because the dental officer of No.7 their honeymoon was a weekend in Dorking, had sprained his ankle and could no longer work. reached by Greenline bus. Living in a caravan in The Battle of Crete in 1941 resulted in the the grounds of Kerry House, Eric worked at German Army occupation of the island and the Knightsbridge Barracks to close down the dental rapid evacuation of No.7 General Hospital. Eric centre before moving with Joy to Somerset as was subsequently transferred as a prisoner by ship School Dental Officer. firstly to Athens and then onto Salonika In July 1948 at the inception of the NHS, the (Thessaloniki) in Greece. This was a transit camp Manchester Regional Hospital Board was formed for all prisoners. After a few days a train took him, and was responsible for the hospitals in and other officers, to Stalag VIIIB at Lamsdorf in Westmorland, Lancashire and much of Cheshire. Upper Silesia (now in Poland). He was transferred There were four main hospitals delivering a in 1942 to a prisoner of war camp near Berlin where consultant dental service – namely Baguley (later he was able to practise dentistry in a reasonably called Wythenshawe), Crumpsall in North equipped dental surgery. After the RAF, in a raid Manchester, Preston and Bolton. Baguley, unlike on Berlin, destroyed this camp he was moved again the hospitals in Crumpsall, Preston and Bolton, had to another camp. One day in 1943 he was informed been the specialist centre for plastic and that he was going “to a holiday camp in the Black maxillofacial surgery during the war and continued Forest”. He never reached the destination because to provide specialist dental and oral surgery services he was diverted to become the dental officer of for the whole of the North West of England region. Oftag IV C or Colditz. Eric stayed in Colditz until The dental surgeon in charge was Mr AW Moule the US Army liberated it on the 16th April 1945. with overall responsibility held by Professor Eric met his wife-to-be, Joy, on New Year’s Eve Wilkinson at Manchester Dental School. 1945 at Kenry House in Kingston-Upon-Thames

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Consultant contract orderly and mechanics, and in the afternoons went Eric joined Baguley on the day that the NHS was to the dunes for a swim and sunbathing. One day formed. Mr AW Moule and Mr FW Monks (at he fell asleep on the beach whilst reading All Bolton) were awarded honorary Fellowships in Passion Spent by Vita Sackville-West and got very Dental Surgery (FDS) soon afterwards and sunburned. The following day he stayed in his tent; confirmed as consultants in their respective areas. this proved to be life saving because a German In 1950, Eric passed the FDS examination and one plane flew low over the beach killing his year later was appointed as consultant to Preston companions. Royal Infirmary, the Royal Albert Edward When the German invasion commenced, No.7 Infirmary in Wigan, Blackpool Victoria, the Royal General Hospital was evacuated and Eric and his Lancaster Infirmary and North Lonsdale Hospital companions were instructed to head south through in Barrow. His area covered 83 hospitals in all the Samaria Gorge to Agia Roumeli on the coast. although the clinical commitments to all those apart They were than told to turn eastwards to Chora from the main five sites were vague. Sfakion where the British Navy would rescue them. He subsequently narrowed down his They never made it to the ship because they were commitments to Lancaster, Kendal and Barrow, found by some German soldiers and sent back to serving as consultant ‘dental’ surgeon (and then where they had started in the north. consultant ‘oral’ surgeon) until 1974 before retiring Many years later Eric and Joy had a walking to the Isle of Wight. holiday on Crete. They returned to the Samaria Eric’s war experiences on Crete Gorge but this time made it to Chora Sfakion where they found a monument, which read: Although there was a detailed discussion between Eric and Colin Davis about the time spent “From this spot on 31-05-1941 were embarked in Crete there are two recollections that have the last batch of Allied soldiers to be evacuated subsequently been discovered which did not appear from Crete.” in the original account. As life settled into a daily routine at No.7 General Hospital, Eric used to spend the morning working in the dental tent with his

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Red Cross food supplies Colditz now Eric in Colditz illustration of the dental clinic and a passage describing conditions for the dentist and doctor. Eric was a modest man and did not talk much about his wartime experiences as a POW. However, “Prior to our arrival, a French Doctor and there are two themes, which have become apparent Dentist did the honours. When the French left, through his letters and the recollections of those excellent British Doctors and Dentists ultimately who with whom he worked. Firstly, he had a respect arrived. Meanwhile the German civilian Dentist for the German administration. When he was filled in with some blacksmithing. Bare necessities captured in Crete all of his belongings were taken in the line of instruments were provided by the from him. These were returned, intact, when he was Germans.” liberated from Colditz. In theatre he would occasionally ask for the drill in his own version of There were many escape attempts and the stories 3,4 German – it was “Der Bonen machine”. The sucker have been written about in other texts . Although was “de sucken worker”. Eric never attempted to escape, he did help others. The story of how a tunnel was discovered under his The second theme that influenced his life during dental chair has been described before and how he and after Colditz was the hunger that he and his fashioned the spars (parts of the wings) for the fellow prisoners endured. During his walk through glider out of wooden floorboards1. Eric also used Crete, after No.7 General Hospital was disbanded, to prepare soldiers for their escape attempts by he went for four days and nights without food and drilling a hole in a molar tooth and inserting a map sleep. He recalled seeing beautiful marble buildings of the surrounding area on a piece of rice paper. on the fourth night but they were an hallucination This was concealed below a temporary filling, due to the hunger and sleep deprivation. During the which could be easily removed once the prisoner next few months until he was moved off the island had escaped. he survived mainly on boiled rice. The journey to Lamsdorf brought little respite from the hunger, His cards home are now part of the BDA eating bread on the train and a baked potato on collection. They were written to his niece whom he arrival. Eric described how his face had become had not met before he left England. Most poignant bloated due to the protein deficiency. Red Cross is the card he wrote on the day he was flown home Parcels were a source of food, cigarettes and coffee to England. In it Eric gave a minute-by-minute in all the camps in which he stayed. These often account of leaving Germany, flying over the came through Canada and in Colditz the tins were Channel and the first sight of England. used to help excavate tunnels, examples of which, Life after Colditz are now with the BDA Museum. Eric once wrote: One of his fellow prisoners in Colditz kept a diary and this was made into a book, which is part “My career was influenced by great events, the of the Eric Cooper collection5. There is an war, the timely introduction of the NHS, the FDS and then the consultant service.”

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The other influencing factor was, as I have After retirement he and Joy travelled the world, already mentioned, the hunger, which he often on their tandem and he did return once to experienced as a POW. He was acutely aware that Colditz to visit the room that was his dental surgery. a country could run short of food very quickly in a Having been kept prisoner for so long he relished time of crisis. This motivated Eric to own a small his freedom and admired Ulysses the hero in holding in a village called Nether Kellet, within Tennyson’s poem quoting: easy reach of Lancaster and Barrow for on-call purposes. He combined being a surgeon with “…. for my purpose holds running a farm in which he kept chickens, pigs, a To sail beyond the sunset and the baths cow and lots of fruit and vegetables. Of all the western stars, until I die.” His first cow arrived on a wagon pulled by a train into Carnforth Station where “Brief Two further stories have emerged during the Encounter “was filmed. He collected the animal, preparation of the exhibition and this paper. There which was a beautiful brown Jersey, an unusual was a second dentist in Colditz for a short period sight in the early 1950’s in Lancashire. Together of time and would have possibly known Eric. Julius with his brother-in-law, they walked the animal M Green was a Captain in the 152 (Highland) Field back to Nether Kellet a distance of about 4 miles, Ambulance of the 51st (Highland) Division and across fields – there was no M6 motorway. A local wrote about his experiences in a book published in farmer more used to the black and white Friesians 19716. leant, over a wall and asked Eric, “Eh, Mr. Cooper. Hast thou bought a donkey?” Interestingly he does not appear to have practised dentistry in Colditz having been recruited to the Perhaps because of his experiences as POW and British Directorate of Military Intelligence, Section certainly because of his innate inventiveness, Eric 9-M19 in 1941. was at the forefront of developing new techniques in oral surgery. He was known to ask his staff to go The second story resulted from a chance to the local hardware shop to buy screws which, discussion with a Scottish dentist in Thessaloniki having been sterilised were used to fix fractured who has an interest in Archie Cochrane, the doctor jaws. This was decades before screws became a who developed the idea of evidence–based standard fixation procedure. He worked closely medicine. He was taken prisoner on Crete on the with his dental technician Moffat Coates to devises 1st June 1941 and flown to Athens before transfer ingenious ways in which to manage complex cases to Salonika, where he conducted what he later called in the days prior to seat belt legislation. As a new “my first, worst and most successful trial”, which consultant I became used to seeing patients who had was published in the British Medical Journal in been treated by Mr. Cooper as a child. The 19847. Unfortunately, the curator of the Archie grandmother of one of my patients informed me Cochrane archive in Cardiff was not able to find that she had had a jaw procedure by Eric and having any reference to where he was stationed in Crete retrieved her archived radiographs I realised that he but it is tantalizing to speculate that Eric and he may had performed a mandibular osteotomy, stabilised have known each other. successfully using wires. Acknowledgements Epilogue I am very grateful to Eric’s children, Heather Eric often claimed to have “the best job in the Freeman, Madelaine Cooper and Paul Cooper and world”. He wrote about being called out at night to his nephew Johnny Wakeham, not only for their treat an emergency. support in collecting the information about Eric but also for their generous donation of his collection to “Once, near Christmas, I travelled to Barrow the BDA Museum. at 2am and stopped the Land-Rover to gaze at the full moon shining on the snow-capped mountain During the course of the NHS70 celebrations I peaks. I had it all to myself, to be a cherished was asked to present a series of lectures about Eric memory for ever.” to the University Hospitals of Morecambe Bay NHS Trust (UHMB) members and staff. Many people spoke to me at these events with their personal 71 Dental Historian 2020 65 (2) 67 - 72 recollections of Eric. I am also grateful to Brenda Cropley (retired staff nurse in theatres at Beaumont Hospital, Lancaster) and Michael Nelson (retired associate specialist at UHMB) for their recollections of working with him.

References

1. Davis C (1995) Fifty Years on: Colin Davis, interviews Eric Cooper. Br Dent J 179: 157-159.

2. Chancellor H. Colditz. The Definitive History. Hodder and Stoughton, London, 2001.

3. Reid PR. The Colditz Story. Hodder and Stoughton, London, 1952.

4. Reid PR. The Latter Days at Colditz. Hodder and Stoughton, London, 1953.

5. Wood JER. Detour: The Story of Oflag IV C. The Falcon Press, London, 1946

6. Green JM. From Colditz in Code. Robert Hale Ltd, London, 1971.

7. Cochrane AL (1984) Sickness in Salonika: My first, worst, and most successful clinical trial. Brit Med J (Clin Res Ed) 289 (6460): 1726-7. Author Biography:

Peter graduated in dentistry from the Royal Dental Hospital in 1979 and in medicine from University College Hospital, London in 1988. He was appointed consultant in oral and maxillofacial surgery to the University Hospitals of Morecambe Bay NHS Foundation Trust in 1998 with a special interest in trauma and orthognathics. He co-edited the Handbook of Immediate Care and has contributed chapters about dento-facial trauma in a number of textbooks. Peter worked as the medical director for the Trust and is currently the responsible officer overseeing the appraisal and revalidation of the medical staff. He is also a clinical senior lecturer in oral surgery at UCLan. Peter has been an active member of the British Dental Association since student days. He is the chair of the Central Committee for Hospital Dental Services and Past-President of the Association. He is married to Vicky a consultant in restorative dentistry and they have two children. Address for correspondence: [email protected]

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History of the Rubber Dam Shir Lynn Tan Abstract: This paper describes history and evolution of the use of the rubber dam, its discovery, and controversy surrounding its first use. It explores different techniques of application and the introduction of clamps. Latex-free alternatives of the rubber dam are discussed. It also briefly examines professional and public perceptions, and non-dental uses of the dam.

Key words: Rubber dam, kofferdam, isolation, gold foil placement, patient safety, latex allergy

Why do we need the rubber dam? contamination of gold during condensation will inhibit its cohesive property7 Perhaps there is no other dental device that is so . profoundly valuable yet so commonly undervalued Historical techniques of moisture control and underused than the simple rubber dam Prior to the discovery of rubber dam, many other (sometimes termed ‘kofferdam’). Not only does techniques of moisture control had been tried. This retraction of oral tissues using the rubber dam help included the use of bibulous paper, cotton rolls to maintain a dry working area, it also improves access to and visibility of the operating field. It ensures patient safety by preventing aspiration or ingestion of dental materials and fragments, thus protecting the airways 1. In those who are dentally anxious, it can act as a psychological barrier separating the patient from the procedure being performed 2. Tooth isolation with a rubber dam is increasingly thought to be essential good practice when performing endodontic treatment. In addition to preventing the inadvertent swallowing of fine Figure 1. Gold foil being condensed and burnished into a cavity. instruments and noxious irrigants, rubber dam isolation minimizes the risk of contamination of the (absorbents), cottonoid, and small folded napkins8. root canal system by indigenous oral bacteria 3. A paper published in Dental Cosmos in 1898 Time and time again, the use of rubber dam shows describes the use of ordinary muslin, torn or cut into to significantly favour endodontic success 4. squares, one placed on either side of the tooth Gold foil placements between tongue and cheek. And if for any reason it became necessary for the clinician to leave the The need for a dry operating field, free of saliva, patient temporarily, the patient was tasked with the has been recognised by generations of dentists. The great responsibility of holding onto the tooth to keep need for a completely dry cavity became more it dry 9. It is therefore unsurprising that neither of critical following the introduction of cohesive gold these techniques achieved quite the success afforded foil for direct gold restorations in the mid nineteenth by the rubber dam. century 5. In this restorative technique, gold in various forms (foil, crystalline mat, or powdered) The man who introduced the rubber dam is annealed over an alcohol flame to remove Sanford Christie Barnum (Figure 2) is widely impurities, and then compacted directly into regarded as the man behind this innovation 10. prepared cavities6 (Figure 1). Documented Oldest son of George W. Barnum and Caroline G. procedures by the American Academy of Gold Foil Clowes, he was born in 1838 in Sullivan County, Operators states that one of the fundamental New York. He received early education at public requisites for the successful placement of gold foil and private schools, and attended Monticello restorations is the presence of an absolutely dry Academy, a renowned private educational working field, as the slightest moisture institution of that time. His journey as a dental student began in 1858 when at 18 years of age he 73 Dental Historian 2020 65 (2) 73 - 78

dentistry, Dr La Roche was employed by a dry- goods business that operated in the same office as the Goodyear Rubber Glove Company. It was from Figure 2. this company that he reportedly obtained the first Sanford Christie rubber dam to be applied on a patient. When Barnum; inventor of questioned on why it took him so long to voice his the rubber dam. claims, La Roche stated that during the period of time when Barnum first made his claim, he (La Roche) was residing out of New York and was

entered the dental surgery of his uncle, Dr. Joseph Clowes in New York City. He commenced his own dental practice in Monticello four years later, subsequently returning into education at the New York College of Dentistry, graduating on December 2, 1868 with the degree of Doctor of Dental Surgery. It was in 1862, during his residence in Monticello, when he conceived the idea of the rubber dam 11-14. He reportedly first used it in the mouth of a patient, Mr. R. C. Benedict, who was a jeweler at Strong, Stern & Co. on Main Street, Monticello 15. Figure 3. Affidavits from patients and students of William T. La Roche. He demonstrated this to his uncle in 1864, and having swiftly realised the usefulness of it, Dr. J. seldom able to attend dental meetings. This was Clowes convinced his nephew to share this further complicated by problems with his vision, discovery with the local dental society. Barnum’s which prevented him from keeping abreast of generous nature led him to present his innovative published material 19. idea as a gift to the profession, without the motive Even so, many believe it odd that La Roche, of claiming any financial remuneration. Despite the having discovered the usefulness of the rubber dam, initial skepticism on its practicality, the profession did not then introduce it to the profession at large. later came to recognise its value and presented him 16,17 Ergo, the universal sentiment remains that Barnum, with a series of accolades . owing to his ingenuity and benevolence, will Controversy surrounding the first use of continue to be heralded as the inventor of the dam. rubber dam Techniques developed to apply rubber dam The discovery of the simple rubber dam is not There were various recorded methods employed devoid of controversy. A decade after Barnum’s for keeping the dam in place surrounding a tooth. rise to fame, a New York dentist by the name of Dr A small hole was made through the dam and passed William T. La Roche came forward at a dental down to the neck of the tooth, the rubber’s elasticity society meeting to declare that he first knew of and permitting a snug embrace to prevent ingress of used the rubber dam in 1857, prior to Barnum. This fluids 20. SS White simplified the cutting of holes assertion was substantiated by affidavits of patients with the introduction of a rubber dam punch in and students who were either operated on or present 188221. If several teeth were to be isolated, a waxed during such operations when the dam was applied floss silk or ligature was used to push the dam (Figure 3). He claimed to have been the one to share apically between contact points. The edge of the the idea with young Barnum when the latter visited 18 dam abutting each tooth was sometimes turned his office between 1858 and 1862 . under using a burnisher to prevent leakage. Once Unsurprisingly, many dismissed this as petty the dam was in place, small hooks with strings or rivalry. But perhaps there may be some veracity in elastic bands attached were placed in the corners. his claims and some credit is due. Prior to practising These strings were either carried over the ears or

74 Dental Historian 2020 65 (2) 73 - 78 passed around the patient’s head, holding the dam must be willing to bestow, but those who persevere taut and out of the way. Special appliances were seldom find its usefulness less than worthwhile. also developed, particularly when isolating teeth Latex-free rubber dam with less retentive forms. In the string and weight method, small weights were attached to the ends of The primary chemical constituent of the rubber the strings and allowed to hang down the sides of dam, cis-1,4 polyisoprene, is from milky latex of the mouth (Figures 4-5)1,22. the native rubber tree Hevea brasiliensis, mainly grown in tropical countries. The earliest description Subsequently, J. F. P. Hodson, a New York of an allergic reaction to natural rubber appeared in dentist, addressed the local dental society in 1870 the medical literature in 1927, and for still unknown and proposed an alternative to the string and weight reasons, its occurrence increased significantly method (Figure 6). Dr Hodson had much preferred using a piece of annealed iron wire twisted lightly around the neck of the tooth in order to secure the dam. Further ingenuity led to the development of rubber dam clamps- a wide clasp of metal with its flared lateral edges fitted around the tooth to retain the rubber dam23 (Figure 7). Eventually, in 1875, Dr Delous Palmer devised a set of metal clamps specific for each tooth in the dentition, the designs of which closely resembles those which are used to this day (Figure 8) 21. Placement of clamps was and still is facilitated by the use of special forceps (Figure 9-10) 24. Undoubtedly, proper application of the dam requires some amount of patience that operators Figure 6. J.F.P. Hodson’s publication on the rubber dam – 1870.

Figure 4. A. Rubber dam tensors. B and C. Dam holder. Figure 7. The selection of rubber dam clamps developed by Dr Hodson.

between the 1980s and 1990s. Immediate symptoms can range from minor redness, itching, and swelling, to a more severe reaction like anaphylaxis, the first of which to latex surgical gloves was reported in 1984 25,26. The rise in prevalence of IgE-mediated latex allergy and irritant contact dermatitis amongst healthcare workers27 and patients28 culminated in the introduction of latex-free equivalents of these medical devices. Nitrile rubber is a synthetic alternative that is increasingly used. It has comparable tear resistance to natural rubber, but without the troublesome allergenic proteins. Polyethylene and polyvinylchloride dams have also Figure 5. An early image (circa 1887) of rubber dam been proposed. The use of these alternatives allows applied using the string and weight method. the management of latex allergy without

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significantly less likely to cite these as barriers compared to less frequent or non-users support this notion 34. Advocates of the rubber dam suggested that the best way to overcome the technical difficulties and to increase efficiency of placement is by simply using the dam more frequently. Figure 8. Metal clamps specific for each tooth. On the other hand, from the public’s perspective, the dental dam and clamp were not often well tolerated by patients on whom it is used. In the early years following its introduction, newspapers were filled with satirical articles written by the general public pertaining to this ‘dam rubber’, with comparisons to instruments of torture (Figure 11- 12) 35,36. However, with the advancement of dentistry, techniques of clamp application were adapted to minimise iatrogenic damage and local anaesthesia was frequently administered to help reduce patient discomfort. Increased usage amongst members of the profession has also resulted in increased Figure 9. Advertisement by Dixon Tools for rubber dam proficiency. So much so that operators nowadays appliances. are met with little protest towards regular use of the rubber dam for various dental procedures. Non-dental uses Aside from its use in dentistry, in the early 1900s, there arose an intriguing opinion that the rubber dam could act as a ‘flesh reducer’ in those who were eager to keep their weight down. This Figure 10. Application of the rubber dam with forceps and held in placed by clamps. method involved wrapping four to five yards of rubber tightly about a targeted part of the body compromising on operative technique or patient whilst undertaking vigorous sporting activities. The safety 29. author of the newspaper article claimed that this Professional and public perceptions inexpensive method encourages perspiration and subsequent weight loss of up to five to six pounds Although the use of the rubber dam gained a day (Figure 13) 37. widespread popularity in the decades following its introduction, universally, there are a proportion of Another more credible use of the dental dam is dentists who dismiss its routine use. Surveys carried as a barrier during oral sexual practices. Although out in a variety of clinical settings present common there is little evidence for prevention of sexually reasons for this, one of which is concerns over transmitted infections using this method, its use is patient acceptance30-33. Many dentists found that the often promoted at safer sex campaigns as a means to reduce the possibility of exchange of body placement of rubber dam unnecessarily increases 38,39 treatment time, which did not bode well in terms of fluids . cost-effectiveness. Technical difficulties in its Conclusion application, alongside inadequate training were also The historical importance of the invention of often cited. Less commonly, the cost of equipment rubber dam must not be underestimated. The claim and materials served as an obstacle. and counterclaims of who actually was the first However, could the majority of these dentist to apply and use rubber dam to isolate a tooth disincentives be related more to practitioners’ is part of this intriguing story. Rubber dam first attitudes rather than evidence-based reasoning? The introduced to facilitate gold foil restorations, fact that frequent users of the rubber dam are subsequently seen as essential for endodontics,

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Figure 11. Comic strip portraying the use of a rubber dam.

Figure 13. Newspaper excerpt describing a new method of weight reduction using the rubber dam. mastering. Well-placed rubber dam can be a time saver and quality enhancer in 21st century dentistry. Acknowledgements Thank you to Margaret Wilson, Honorary Curator of the British Dental Association (BDA) Museum, for introducing me to the topic and providing extensive amount of information and guidance during the preparation of this piece; I am grateful for your enthusiasm. Thanks are due also to Paul Blaylock, Deputy Postgraduate Dental Dean and GPT Training Programme Director of Health Figure 12. Newspaper excerpt likening the rubber dam to Education England, for the support and an instrument of torture. encouragement in my collaboration with the BDA should it is suggested, find wider application in Museum. modern clinical dentistry. In addition, moisture Author’s Biography: A graduate of King’s College isolation is highly desirable for successful state of London, Shir Lynn Tan is a young dentist currently the art adhesive dentistry. Rubber dam is considered undertaking the two-year longitudinal General Professional to be an incredibly valued and possibly underused Training (GPT) programme in Newcastle Dental Hospital and device which once mastered can greatly elevate the a dental practice in Stockton-on-Tees. quality of clinical care, while substantially reducing Address for Correspondence: [email protected] the risk of cross infection. The reliance on facemasks, visors, and goggles is greatly reduced References when there is no salivary aerosol and splatter. Some 1.Castellucci A. Tooth isolation: The rubber clinicians may give the excuse that rubber dam is dam.Endodontics. 1990;1:226-227. difficult and time-consuming to apply, however, 2. Sonis ST. Chapter 10 pediatric dentistry and orthodontics. those who have taken time to master the technique In:Dental secrets.Vol 4. Fourth ed. St. Louis, Missouri 63043: Elsevier Inc.; 2015:239. and can place rubber dam quickly and effectively 3. AAE Clinical Practice Committee. Dental dams, AAE are in no doubt that it is a technique well worth position statement.https://www.aae.org/specialty/clinical-

77 Dental Historian 2020 65 (2) 73 - 78 resources/guidelines-position-statements/. Updated 2017. 26. Cullinan P, Brown R, Field A, et al. Latex allergy. A Accessed January, 2020. position paper of the british society of allergy and clinical 4. Carrotte P. Endodontics: Part 6 rubber dam and access immunology.Clinical & Experimental Allergy. cavities.Br Dent J. 2004;197(9):527-534. 2003;33(11):1484-1499. 5. Arthur R. A new method of using gold foil.Bull Hist Dent. 27. Safadi GS, Safadi TJ, Terezhalmy GT, Taylor JS, Battisto 1977;25(1):46-50. JR, MELTON JR AL. Latex hypersensitivity: Its prevalence among dental professionals.J Am Dent Assoc. 1996;127(1):83- 6. Small B, Johnson W. Gold foil and its use in modern 88. dentistry.https://www.dentistrytoday.com/restorative- 134/1838--sp-1547062389.Updated 2006. Accessed March, 28. Fuchs T, Wahl R. Immediate reactions to rubber products. 2020. . 1992;13(2):61. 7. Stibbs G. Direct golds in dental restorative therapy.Oper 29. Kosti E, Lambrianidis T. Endodontic treatment in cases Dent. 1980;5:107-114. of allergic reaction to rubber dam.J Endod. 2002;28(11):787- 789. 8. Progress in dental science; use of rubber dam.Daily Arkansas Gazette (Little Rock, Arkansas). Saturday, May 22, 30. Going RE, Sawinski VJ. Frequency of use of the rubber 1909 1909:4. dam: A survey.J Am Dent Assoc. 1967;75(1):158-166. 9. White JW. New york odontological society.Dental Cosmos; 31. Joynt RB, Davis EL, Schreier PH. Rubber dam usage A Monthly Record of Dental Science. 1898;XL:315. among practicing dentists.Oper Dent. 1989;14(4):176-181. 10. Latimer JS. Little things.The Dental Cosmos; a monthly 32. Marshall K, Page J. The use of rubber dam in the UK. A record of dental science. 1864;6(1):12-13-14. survey.Br Dent J. 1990;169(9):286-291. 11. Thorpe BL. History of dental surgery. . 1909;II:417-418- 33. Marshall K. 'Dam it–it's easy!'–or is it?Br Dent J. 420. 2017;222(11):839. 12. Boardman WE. Biographies of the founders, ex- 34. Whitworth J, Seccombe G, Shoker K, Steele J. Use of presidents, prominent early members and others of the rubber dam and irrigant selection in UK general dental massachusetts dental society. . 1914:198-199. practice.Int Endod J. 2000;33(5):435-441. 13. Winner HJ. Brief history of the rubber dam.United States 35. Pry P. The infamous rubber dam and the agony it Navy Medical Newsletter. 1964;44:11-12-13. inflicts.Evening Star (Washington, District of Columbia). Saturday, Oct 24 1896;In a Dentist Chair:18. 14. Epitome of proceedings of dental societies; original communications.The Canadian Journal of Dental Science. 36. Parable of the rubber dam.The Belding Banner. 1916:8. 1878;4(3):88-89. 37. Rubber as flesh reducer.The Rexford News (Rexford, 15. Child H.Gazetteer and business directory of sullivan Kansas). June 29 1905:2. county, N. Y., for 1872-1873.Sullivan Country, N. Y.: 38. Roberts C, Kippax S, Spongberg M, Crawford J. Going Syracuse; 1872:14. down': Oral sex, imaginary bodies and HIV.Body & Society. 16. Proceedings of dental societies. american dental 1996;2(3):107-124. association.The Dental Cosmos; a monthly record of dental 39. Dental dam use. science. 1870;12(10):531. https://www.cdc.gov/condomeffectiveness/Dental-dam- 17. Cushing GH. The missouri dental journal; monthly record use.html. Updated 2016. Accessed February, 2020. of medical science. . 1870;2:389-390-393. 18. Barnum's rubber dam.The New England Journal of Dentistry. 1884;3:27-28-29, 44. 19. La Roche WT. What is the true history of the use of the rubber dam?The New England Journal of Dentistry. 1884;3:101-102-105. 20. Black GV. The rubber dam. In:A work on operative dentistry.Chicago: Medico-Dental Publishing Company; 1908:69-70-92. 21. Marwash N. Chapter 44; rubber dam. In:Textbook of pediatric dentistry.4th edition ed. India: Jaypee Brothers Medical Publishers; 2019:545. 22. Litch WF.The american system of dentistry (volume 2).Philadelphia Lea Brothers and Co.; 1887:34-35. 23. Hodson JFP. The rubber dam.The Dental Cosmos; a monthly record of dental science. 1870;12(10):505-506-512. 24. McGehee WHO. Instruments and appliances. In:Operative and dental anatomy technics.P. Blakiston's Son & Co; 1914:79-80-84. 25. Ownby DR. A history of latex allergy.J Allergy Clin Immunol. 2002;110(2):S27-S32.

78 Dental Historian 2020 65 (2) 79 - 80

The Founding of the University of Alberta School of Dentistry, Canada Geoffrey H. Sperber

Abstract: This paper describes the formation of a dental school in Edmonton in 1917 and its development over a hundred years.

A Province -Alberta The Province of Alberta was named after Queen Victoria’s daughter, Her Royal Highness the Princess Louise Caroline Alberta, during Queen Victoria’s reign at the time of the founding of the province in 1909.

A University and Dental School Fig 2 The old dental school The founding of a Dental School at the University of Alberta in the Capital City of University of Toronto or McGill University in Edmonton ostensibly occurred in 1917, just nine Montreal, Quebec, under the auspices of the years after the establishment of the University. The University of Alberta. The students were then to Dental School’s origin was the consequence of the return to Alberta to complete the final two years University President, Henry Marshal Tory’s desire with clinical instruction from Dr. Bulyea. It was not to identify the newly established Province as an until 1923 that the University of Alberta offered a outpost of higher education in Western Canada, full four-year DDS dental degree, with seven more than a thousand kilometers from established students graduating. Schools in Eastern Canada. President Tory needed The dental programme continued as a Faculty of to have a dental educator to fulfil his desire to Medicine component until 1944, when the Faculty establish a dental school within the already of Dentistry achieved its independence from established Faculty of Medicine. He invited his Medicine, with the appointment of the first Dean of personal dentist, Dr. Harry Ernest Bulyea, a Dentistry, Dr. Scott Hamilton. The School’s intake Harvard University graduate, to consider of students was raised to fifty candidates, that establishing a dental education programme at the continued until 1990, when the admittance to university (Fig 1). Dr. Bulyea at first demurred, but Dentistry was cut to forty students that continues agreed to take on the task with another local dentist. today. The first dental students School of Dental Hygiene While the first seven students were admitted to The establishment of a School of Dental Hygiene the Dental Programme in 1917, they never in 1961 was another initiative undertaken by the proceeded initially to pursue further dental second dean, Dr. Hector MacLean, under the education because of the World War taking place in Europe at that time. Once Dr. Bulyea agreed to begin the dental course, the first students were to undertake the first two years of the four-year programme by attending basic science courses in anatomy, physiology, biochemistry and bacteriology at either the Fig 1 Dr Harry Ernest Bulyea Fig 3 The new joint Faculty building 79 Dental Historian 2020 65 (2) 79 - 80

curriculum is an ongoing programme over the next three years, with completion in 2022. References 1. Lambert T. Roots: Extracted Tales from a Century of Dentistry at the University of Alberta. University of Alberta 2017.p. 195. 2. Thompson G.W. The First Centennial of the Alberta Dental Fig 4 The dental museum Association and College.1906-2006. Direction of Ms. Margaret Berry. The programme Author Biography: G.H. Sperber, Professor initially offered a two-year diploma in Dental Emeritus, Faculty of Medicine & Dentistry, University of Alberta. Professor Emeritus Geoffrey Sperber is a BDS and Hygiene to at first twenty students. The programme PhD graduate of the University of the Witwatersrand, was later extended to a four-year BSc. Dental Johannesburg, South Africa. He graduated from the University Hygiene Degree in 2020. of Rochester, USA with a MSc before he joined the Faculty of Dentistry, University of Alberta in 1961to initiate the Specialty Training and continuing education Dental Hygiene Programme. He currently continues as a th The establishment of specialty training was Faculty member in the 59 year of his appointment. initiated with a two-year Orthodontics programme Address for correspondence: [email protected] by Dr. Bus Haryett in 1964 that continues today. Further specialty programmes have been established in Pedodontics, Periodontics and Dental Pathology, expanding the post-graduate training opportunities. The requirement for dentists in Alberta to complete continuing education credits to maintain their practicing licenses has led to a large Division of Continuing Dental Education component of the Dental School. It offers courses in all the specialties of dentistry, expanding into cosmetic dentistry with facial rejuvenation with botulin therapy. Medical and Dental Faculties Unite The separate identification of the Faculty of Dentistry from the Faculty of Medicine came to an end in 1999, when the then President of the University, Dr. Paul Davenport advocated the closure of the Faculty of Dentistry as a cost-cutting measure. The proposal met with vigorous opposition by the dental profession, and the issue was resolved by the Dean of Medicine, Dr. Lorne Tyrrell offering to incorporate Dentistry into a newly-formed Faculty of Medicine & Dentistry which now pertains1. A Dental Museum featuring the history of dentistry is a component of the School of Dentistry that plans to move into a new facility in 20222. The old and new buildings and the museum are shown (Figs 2,3,4). In 2017 the School of Dentistry celebrated the centenary of its founding in 1917 with a planned innovation of the dental curriculum to incorporate medical issues in dental practice. The new

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Public Dental Services, Queensland, Australia: School Dental Service, 1911-1973 Harry F Akers, John P Brown, Michael A Foley, Valerie Woodford Abstract: There is a widely held misconception that the School Dental Service (SDS) in Queensland materialised from the Australian School Dental Program in the 1970s. In reality, the SDS had its genesis (1911) in calls from Members of the Odontological Society of Queensland (OSQ); concerns about public health at schools; the demographic profile and attitudes of Queenslanders; a humanitarian need to resolve the effects of the caries epidemic; and the paucity and distorted coastal distribution of registered dentists across the state. The division of federal-state authority within the Australian Constitution and state- specific historical developments guaranteed that the SDS would evolve in a markedly Queensland fashion. The agrarian ideal of closer settlement, affiliated policy canons relating to defence, decentralisation, development and White Australia and Hanlon’s influence and legacies guaranteed that the SDS would endure and expand. It became a pioneering organisation that involved heroic and poorly recorded contributions in the field. However, with several notable exceptions, Members of the OSQ and the Australian Dental Association Queensland Branch contributed little to the post-genesis SDS narrative. Moreover, policy planners, in the 1945-1973 era, failed to transform the SDS into an effective public health programme. Accordingly, the authors use historical method to record and analyse an exceptional chapter in Queensland dental history.

Key words: Hanlon, Haenke, Rail dental clinics, Road dental clinics, School dental service, Queensland difference, Queensland Health, Queensland identity. Introduction years of Indigenous presence on land, now known It is a common refrain that, within the Australian as Australia, and the post-1911 provision of dental context, the economic, political and social treatment to children within many institutions, development of post-colonial Queensland is hospital-based clinics and private practices throughout Queensland. Contemporaneous ‘different.’1 While this line of thinking is amenable nomenclature also warrants explanation. In slowly to challenge, comparative reasoning appears in adopted conventions, the ‘Australian Labour Party’ analyses of the systems of delivery of public dental in 1912 changed its name to the ‘Australian Labor services. For instance, in 1946, 1961 and 1963, Party’ and after 1930, the term ‘Minister’ replaced three high profile commentators described the the term ‘Secretary.’ Lastly, in 1928, the delivery of public dental services throughout Odontological Society of Queensland (OSQ) Queensland as ‘worthy of consideration,’2 ‘more became the Australian Dental Association organised’3 and ‘somewhat unique.’4 While the Queensland Branch (ADAQ). history of government-administered dental service in Queensland has been the subject of significant Two developments in Queensland, scrutiny,5,6,7 one chapter within the narrative, unprecedented within the Australian Parliamentary namely the genesis (1911) and pre-1973 context, exerted a profound influence on the development of the School Dental Service (SDS), direction of the SDS narrative. Firstly, Queensland remains poorly recorded. Indeed, at the outset of Parliamentarians, via the Constitution Amendment this investigation, the authors uncovered a common Act (1921), abolished the Legislative Council misconception: namely, the SDS materialised from (House of Review). This action centralised Australian Labor Party (ALP) Prime Minister administrative, fiscal and legislative authority in the (1972-1975) Gough Whitlam’s promise to Cabinet. It also underpinned ALP Home Secretary implement the Australian School Dental Program.8 (1932-1935), Health and Home Affairs Minister Accordingly, the authors use historical method to (1935-1944) and Premier (1946-1952) ‘Ned’ record and analyse an exceptional chapter in Hanlon’s autocratic and authoritarian tactics and Queensland history. the expansion of government-administered health services across the state.9 Acknowledgements, Nomenclature and Aberrations The second development was two extensive eras For the purposes of this manuscript, the authors of continuous Labor Government (1915-1929 and acknowledge, but choose to ignore, over 65,000 1932-1957) interrupted only by Premier (1929- 81 Dental Historian 2020 65 (2) 81 - 97

1932, Country and Progressive National Party) Arthur Moore’s term through the worst of the Great Depression. This 39-year tenure in office allowed Labor to pursue its traditional policy canons of closer settlement (widespread, intense small scale agriculture), defence, decentralisation, development and “White Australia”. Hanlon appreciated that this vision required yeoman farmers’ access to health services throughout the state. Hence, while the genesis of the SDS occurred during Premier William Kidston’s (1906-1907, 1908-1911, Kidston and Liberal Parties) and Premier Digby Denham’s (1911-1915, Liberal Party) terms in office, it expanded throughout Labor eras. Australia and Queensland: Overview In 1788, the British established a penal colony, Fig 1 The Commonwealth of Australia. Source: H Akers. New South Wales, on the east coast of the mainland of Australia. Compared to European counterparts, presence of vast tracts of crown land suitable for Australia is a vast and geographically isolated pastoral purposes, a Great Artesian Basin with landscape. In 1859, after decades of penal and free accessible groundwater that allowed decentralised settlement and southern administrative neglect, settlement, a fertile coastal strip with ports and Queensland separated from New South Wales to regular rainfall, a fragmented rail network, minerals become the last colony in Australia. Via the and timber. This was the historical backdrop to the Commonwealth of Australia Constitution Act genesis of the SDS. (1901), all six colonies became states and united Rail and Road Infrastructure into a federation, the Commonwealth of Australia, Figure 1, which declared two mainland territories Railways contributed to and followed the social in 1911. The Commonwealth of Australia and economic development of Queensland.12 Constitution Act established a hybrid dispersal model for federal-state division of constitutional responsibilities. From 1901 to 1973, despite elements of an emerging post-WWII welfare state and the introduction of federal funding to provide returned service personnel with dental treatment, Australia did not go down the path of nationalised dentistry. Moreover, the states retained sole responsibility for the funding and the delivery of public dental services to the socially disadvantaged. For most Australians, throughout the era under investigation, dental treatment was a personal expense. Immediately after Federation, administrators in Queensland, Figure 2, faced many problems.10 These involved: a vast area (668,497 square miles); a remote, scattered and sparse population (503,266); age- and gender-inequities (184,485 <15 years, 56% male); a meagre base for taxation; frequent inland droughts; little road infrastructure; and the absence Fig 2 Generic Queensland Map Source: H Akers. Not to of a large navigable river system. Public debt in scale. The National Library of Australia publishes a chronological sequence of detailed maps from the Department June 1901 amounted to £36,898,414 and the Great of Public Lands Queensland Survey Office, for instance: Dividing Range split the state into contrasting east https://nla.gov.au:443/tarkine/nla.obj-233464090 and and west ‘Queenslands.’11 The positives were the https://nla.gov.au:443/tarkine/nla.obj-231871600

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Nonetheless, area, decentralisation, distance, diverse population densities, isolation and the dearth of land-based transport infrastructure across Queensland were major impediments to coordinated statewide development. Unlike other states with centralised ‘spider-web-like’ configurations to and from their respective capital cities, railways stretched inland in autonomous finger-like projections to and from coastal ports. This ‘proliferation of separate systems’ permeated a ‘vast empty state’ and opened ‘up vast tracts of land for closer settlement.’ Moreover, excluding the Normanton to Croydon rail link on the Gulf of Carpentaria and disparate north-south lines along Fig 3 under a railway bridge outback Queensland the coastline, all track planning and implementation had to ‘conquer the main range.’ Railways linked Brisbane to Cairns only in 1924. Hence, Queenslanders initially developed a parochial, almost tribal, regional affinity to their respective local government. State and national allegiances came later. This evidence and these developments underpin, in part, commentators’ assertions of ‘a Queensland difference’ within the Australian context. Primitive road infrastructure contributed further to regional parochialism and the ‘Queensland difference’ concept. Construction and maintenance, apart from main roads and highways, were the Fig 4 Digging out a bogged wheel Source: John Oxley Library, State Library of Queensland, ID: 159386. responsibility of local authorities, which varied vastly in area, population and resources. Rural road The Dentists design and surfaces accommodated animal-drawn Before 1902, anyone in Queensland could claim vehicles but were unprepared for the advent of the to be a dentist and could practise dentistry. While automobile. Administrators focused on exit and the Dental Act 1901 sanctioned the need for a dental entry portals to and from railheads and ports. board and dentist register, problems remained. The Improvements came with the inauguration of a act stipulated an ambiguous definition of dentistry, Main Roads Board (1920) and Chair John Kemp’s provided a liberal ‘grandfather clause’ and accepted (later Sir) focus on the construction of main road ‘tooth extractors only.’14 Further legislative change mileage rather than main road width. However, for would not evolve until the Dental Act Amendment Dental Inspectors of Schools, adversities remained, Act 1916. Moreover, the paucity and skewed coastal Figures 3 and 4. Despite construction of distribution of registered dentists meant that many infrastructure for unemployment relief throughout sought remedial treatment for toothache from the the Great Depression, in 1935, there were nearest provider. Hence, across Queensland respectively 45, 1,220, 4,324 and 27,667 miles of between 1901 and 1916, a collective of registered concrete, bitumen, macadam and ‘other’ roads dental and medical practitioners, chemists, 13 throughout Queensland. Thousands of miles of druggists, tooth extractors and others provided corrugated and unsealed roads persisted into the dental treatment for either the natural or the 1970s. Hence, for Dental Inspectors of Schools who artificial dentition. regularly used secondary (minor) roads, motor vehicle travel was slow, bone-shattering, exhausting The Genesis of a SDS and time-consuming. The genesis of the SDS evolved from a diverse, linked and prolonged sequence of events involving the dental, medical and teaching professions. At Federation, the Queensland government provided, 83 Dental Historian 2020 65 (2) 81 - 97 where schools were available, free, secular and Eden, also President (1908-1909) of the Committee compulsory education.15 Like road and rail, the of the Brisbane Dental Hospital, cited the infrastructure for state-wide primary and secondary ‘deplorable condition of children’s teeth’ at the education was inadequate.16 Nonetheless, the state Committee’s first annual meeting.27 However, government attempted to enforce broader and more despite this advocacy and a favourable response regular attendance at schools. While distance, from Home Secretary (1909-1915) John Appel exemptions within the frequently amended (Ministerial Party),26 there was no immediate education act, labour shortages and parental apathy practical outcome. contributed to pupil absenteeism, fears of Calls for a Dental Inspector of Schools soon contracting either a potentially fatal or a gathered momentum throughout a wider social transmissible disease further interfered with student spectrum. In 1910, a nascent National Dental attendances. By the early 1900s, communal hygiene Association emerged across Australia.28 and public health at schools were emerging as issues Commentary in Queensland, Figure 5, regarding an that affected standards of education. ineffective attempt to amend the Dental Act focused More mundane afflictions also generated major attention on the limited access to registered dentists problems within the education system. The Great and the cost of dental treatment. A collective of Drought (1900-1903) and summer fly plagues school associations,29 Labour Party Convention created an epidemic of ‘blight’ (ophthalmia). delegates, 30 at least one Parliamentarian31 and, Students wore green fly veils to school. Their eyes again, Members of the OSQ32 called for either a were often ‘blood shot, scalded… students ‘systematic inspection of teeth of children’ or a squinted... [they] bent double and stood within a ‘Dental Inspector of Schools.’ Finally, a newspaper, foot of the blackboard to see.’ A formal report Truth, campaigned strongly for a school medical confirmed that more than 50% of school children and dental service.33,34 This evidence confirms the suffered from ‘eye disease.’17 Furthermore, the presence of need, demand and growing political ubiquity of caries, teachers’ inability to educate pressure. students suffering either pain or infection and the presence of c125,526 (1910) enrolled schoolchildren13 and c27818 (1912) registered dentists throughout Queensland, contributed to student absenteeism. In 1907, the Commissioner for Health (1901-1910), Nathaniel ‘Bertie’ Ham perceived a range of public health issues at schools.19 Ham emphasised the importance of Fig 5 Newspaper Commentary Source: National Library of children to the future of the state and recommended Australia, Trove, available at: medical inspections at schools. https://trove.nla.gov.au/newspaper/?q= As a philanthropic measure, OSQ Members opened the Brisbane Dental Hospital to provide The appointment of John Elkington, Figure 6, as 20 Commissioner for Public Health (1910-1914) was gratis treatment to the ‘necessitous poor.’ The 35 incessant demand for treatment at that institution another pivotal development. Elkington was was another contributing factor to the genesis of the highly qualified, acknowledged the ‘good work’ at 21 the Brisbane Dental Hospital, expressed an interest SDS. At the May 1909 OSQ meeting, Vice- 36 President,14 Christopher Hurworth, moved that in dental hygiene and had witnessed the 22 introduction of a school dental service in Members examine school children’s teeth. OSQ 37,38,39 President (1905, 1910-1911), David Eden, endorsed Tasmania. Moreover, like Ham, Elkington the proposal. A subsequent investigation at the appreciated the bigger issue of communal safety at Normal School demonstrated the widespread schools and emphasised the importance of ‘ear, prevalence of dental caries.23 OSQ visits to the eyes, hands, mouth, school lighting and not Commissioner for Health and the Minister ensued.24 spitting.’ He prepared a medical and dental scheme Within months, at the Second Dental Congress in for Queensland. Appel now expressed support for Melbourne, delegates called for widespread making school hygiene a ‘burning issue’ and the government amended the Education Act to allow publicity relating to care of children’s teeth and the 15 appointment of Dental Inspectors of Schools.25,26 the ‘Use of Schools’ for a new purpose. Thereafter, personnel from an imminent School 84 Dental Historian 2020 65 (2) 81 - 97

Medical Service could access the Department of the introduction of the SDS. Public Instruction’s facilities. The Appointment of Edward ‘Ted’ William The appointment in early 1911 of a Medical Haenke Fig 6 Dr John Simeon To facilitate an understanding of the emerging Colebrook Elkington narrative, a brief portrayal of Haenke’s curriculum vitae and the backdrop to his career is worthwhile. Source: John Oxley A former Ipswich Boys’ Grammar School student Library, State Library of and apprenticed to KL Barnett of Ipswich, Haenke Queensland, ID: was a Dental Board of Queensland licentiate 21218125660002061 (c1908) with a creditable academic record.46 He practised in two states, Victoria and New South Wales, before returning to Queensland in 1911.47 The Department of Public Instruction, after appointing Haenke, Figures 7 and 8, on an interim basis as the Dental Inspector of Schools in early 1911,48 advertised the position in major daily and Inspector of Schools, Eleanor Bourne, set the provincial newspapers across three states. precedent for a dental counterpart.40 That same year, OSQ Members gave lectures regarding oral hygiene Archival evidence is ambiguous but suggests that to teachers.41 The National Dental Association the OSQ envisaged that it could influence the maintained that ‘solving problems of treatment’ [of prescribed duties of the Dental Inspector of Schools school children’s teeth] was ‘a necessity.’42 and patient eligibility to the emerging SDS. The Moreover, on several occasions, Eden OSQ Executive canvassed applications and acknowledged Elkington’s advocacy of, and counselled: ‘that it be definitely understood that the contribution to, children’s dental health.43 Hence, Dental Surgeon appointed has no right to Private by 1911, an internal partisan and ministerial resolve Practice but in districts where children are without were present. The underpinning rationale was the the opportunity of obtaining professional services, ubiquity and effects of caries, need, in such cases he may give the necessary relief.’ In humanitarianism, the requirement for communal its advertisements, the Department of Public student health and the paucity of dentists. Finally, Instruction stipulated that the successful applicant should forfeit any right to private practice.49 Haenke from newspaper commentary, it was apparent to 50 Parliamentarians that the move would be popular was the anointed OSQ and Bourne’s nominee. His with the electorate and members of the teaching appointment was to the School Medical Service profession. within the Department of Public Instruction. However, the subsequent prescription of duties, Another motive for the SDS surfaced several namely ‘examination, advice, extractions and any years later. The “White Australia” policy, a other attentions’51 appears to exceed the OSQ’s recurring theme in historians’ interpretations of parameters. Moreover, it soon became apparent that Australians’ social, economic and political the Minister intended to expand the system.17 development, was one major reason for Federation. Secretary for Education (1912-14), James Blair Haenke soon appeared at the forefront of calls for community oral health throughout Queensland. (Ministerial Party, later Sir) posited that medical 52 53 and dental inspections in schools assisted to In an acclaimed and widely circulated paper at ‘establish Queensland as not only a white man’s the Third Australian Dental Congress (1912), land, but as a white woman’s and a white child’s Haenke detailed the poor condition of dental health 44 in school children and reinvigorated a recurring land.’ The desire to settle the tropical north and 54 the pastoral west with European-based labour was hypothesis in Australia: an association between an integral component of closer settlement. Hence, the consumption of groundwater and reduced levels while the OSQ with some justification claimed of dental decay. In an era that preceded not only credit for the appointment of the first Dental methods to assay fluoride concentration in fluids Inspector of Schools,45 the reality is far more but also knowledge relating to the therapeutic complicated: a diverse range of educational, benefits of adjusted fluoridation, Haenke attributed medical and socio-political contexts underpinned this association to the higher mineral concentration in groundwater.55 Moreover, in the first annual 85 Dental Historian 2020 65 (2) 81 - 97 report of the School Medical Service, Haenke advised of examinations of 5,706 school children: 3,027 ‘Metropolitan’ (Brisbane-domiciled) and 2,679 ‘Country.’56 Tables classified Haenke’s observations according to school, gender, use of toothbrush, cleanliness of mouth and number of cavities in permanent and deciduous dentitions. Commentary compared caries prevalence in children who imbibed either ground or surface water. Hence, Haenke conducted the first broad- scale ‘epidemiological’ survey of dental caries and oral health in Queensland.

The reality was that the state government, not Fig 8 Senior Dental Officer E. W. Haenke demonstrating the OSQ, dictated Haenke’s and subsequent Dental the use of toothbrushes c1913 Source: John Oxley Library, Inspectors of Schools’ conditions of employment. State Library of Queensland, ID 188090. Nonetheless, Haenke tactfully reported in his first Overt OSQ-Government Tensions annual report: ‘As far as possible, all truly needy cases were attended to. So as not to interfere in any A series of developments between 1912 and way with the practising dentists great care was 1932 strained relationships between the dental exercised in determining the needy cases, no work profession and the state government. In 1913 and being undertaken without the head teacher’s in 1914, several dentists complained to the Dental recommendation.’56 This was the pre-welfare state Board of Queensland about the activities of the SDS and pre-Hanlon era: one where religious and affecting their livelihood.14 In 1920, the Department charitable institutions administered many hospitals; of Public Instruction reduced, from £500 to £250, professions were autonomous bodies; the OSQ its subsidy to the OSQ-Trust-administered Brisbane controlled the Brisbane Dental Hospital; and Dental Hospital, which treated 7,456 (1918-1919) credible calls for nationalisation of the health and 7,817 (1919-1920) children.63 Haenke provided professions were yet to emerge. However, demands OSQ Members with ‘The Case for School Dental from the public for more SDS staff and for Inspection.’ The consequence was ‘animated widespread treatment of students, including those discussion’ but archives provide no further details.64 attending high schools,57 soon In 1926, the Brisbane and South Coast Hospitals materialised.58,59,60,61,62 These calls exceeded the Board took over the Brisbane Dental Hospital. The OSQ’s intentions for an SDS and intermittently state government, not the OSQ, now controlled placed Haenke, an OSQ and later ADAQ Member, admissions to that institution. The ALP move to in a difficult position. government-administered dental practices in Queensland had begun. The expansion of government-subsidised public dental services contributed further to tensions between registered dentists and the government. In 1926 and with a fanfare of publicity, the Department of Public Instruction launched a ‘Mobile Dental Van Truck’65 for service in remote areas of Queensland, Figure 9. The ‘Travelling Dentist’ treated children gratis and adults for a fee.66 Government-subsidised delivery of services increased. For instance, in 1928, the Department of Public Instruction employed twelve Dental Inspectors of Schools who, at unspecified locations, provided 44,061 examinations and 87,881 operations.67 Moreover, in 1929, in another broadly Fig 7 Senior Dental Officer E.W. Haenke examining patient publicised event, the Premier (1925-1929) William c1913 Source: John Oxley Library, State Library of Queensland, ID 188089. McCormack (ALP) unveiled, the ‘Dental Rail

86 Dental Historian 2020 65 (2) 81 - 97 Clinic Car,’ Figures 10 and 11.68,69 Finally, the annual budget provided £24,132, a net increase of £1,516, for the ‘School Medical Service.’70 Hence, the SDS was growing in terms of budget, employee numbers and service delivery output. The Great Depression was imminent. By June 1930, Queensland’s unemployment rate was 11.6%: in 1931, over 30%. From 1928 to 1933, ADAQ and OSQ Members expressed concerns, Figure 12, regarding alleged abuses of patient access to the public dental sector, particularly at the Brisbane Dental Hospital.22,71 One ADAQ Member also complained that a School Medical Nurse examined a child’s teeth. A dentist asserted in a newspaper Fig 9 First mobile dental clinic c1928 Source: John Oxley that services at the Brisbane Dental Hospital Library, State Library of Queensland, ID: 256265. threatened the viability of private practice.72 Charles Vidgen’s (Brisbane Dental Hospital Superintendent, c1917-1945) discordant interactions with the Joint Board of Dental Studies (student curriculum and examination board) and his promotion of the Brisbane Dental Hospital in newspaper reports further alienated Members of the ADAQ.73 Hence, it is reasonable to suggest an intermittently tense relationship between Haenke and some private practitioners, including some Members of the ADAQ and the OSQ. Haenke’s Diverse and Difficult Roles Fig 10 Rail Dental Clinic No 5 c1928 Source: John Oxley Library, State Library of Queensland, ID: 256341. The OSQ’s and ADAQ’s codes of ethics did not provide for Haenke’s emerging career profile. The preamble to the ADAQ’s Code of Ethics stated: ‘The public has no right to tax the time and talents of the profession in examinations, prescriptions, or in any way without proper remuneration.’74 Moreover, against the backdrop of the Great Depression, Members of the ADAQ introduced a schedule of minimum fees.75 Haenke presented his view on SDS employment: ‘The dividend, which is large and generous, beginning the day that the patient submits himself for attention, and payable, not in actual monetary benefits, but the greatest of all mundane reward - health.’76 This was a significant philosophical divergence between Fig 11 Interior view No 5 Rail Dental Clinic c1928 Source: private and government-employed practitioners. John Oxley Library, State Library of Queensland, ID: 256281. There is a fine line between promotion and and the Brisbane Dental Hospital and Queensland education. Haenke, via newspaper commentary College of Dentistry Building (1941). Haenke also relating to the annual reports of the School Medical provided input into the design of rail dental clinics Service and to communal oral health advice,77 and the ‘travelling dental clinic truck’,80,81 which became a public identity who intermittently advised became integral components of ALP the Home Affairs Secretary.78 He promoted the SDS propaganda.82,83,84,85 Despite Haenke’s name being to visiting interstate observers79 and was an official absent from the formal list of ADAQ Inaugural delegate at many functions, for instance the opening Members,74 his name appears in the Blue Book of and promotion of the first rail dental clinic (1929) ADAQ Membership. Archives confirm his 87 Dental Historian 2020 65 (2) 81 - 97 intermittent attendance at ADAQ meetings. Haenke relationships, during amelogenesis, between was definitely an OSQ and ADAQ Member. patterns of water consumption, the concentration of bioavailable fluoride in groundwater and animal Tensions between the ADAQ Membership and and human dental fluorosis.90 the state government increased markedly after the In 1937, Fred 1932 state election. Under the Moore Government, Clements, working on behalf of the Federal funding ‘for Medical and Dental Inspection’ had Advisory Council on Nutrition, reported ‘fluorine reduced from £24,132 (1929) to £15,441 (1932).86,87 mottling’ in ‘Community A’ and ‘Community B’ (later named as Julia Creek and the Quilpie- Forgan Smith appointed the abrasive Hanlon as Thargomindah region) in Queensland.91 Within a Minister for Home Affairs.9 Dental problems within cohort of 113 children at both communities, the community throughout the Depression had consumption by children (<3 years-of-age) of deeply moved Hanlon. He immediately promised groundwater (1.6, 1.8 and 3ppmF at bores) appeared and gradually delivered a statewide network of to be associated with the condition. Clements’ government-administered, hospital-based dental report, published in the Sydney-based Dental clinics in tandem with an unprecedented expansion Journal of Australia, which had negligible of access to dental treatment. This provision of circulation across Queensland, attracted little public dental services throughout Queensland would attention. become a recurring feature in ALP election campaigns. An inter-departmental report reveals discreetly managed developments between 1937 and 1947.92 Hanlon urgently needed dentists and, to achieve this goal, expected government employees to do his Firstly, veterinary authorities confirmed dental and bidding. In 1936, Hanlon, ostensibly to ‘fulfil the skeletal fluorosis in livestock. Secondly, the Government Chemical Laboratory analysed Minister’s objective,’88 appointed Haenke as an groundwater carrying 2.75ppm bioavailable Examiner for the Dental Board of Queensland. fluoride. Thirdly, two medical officers stationed at Within six months, Haenke was involved in the Julia Creek and the United Graziers’ Association controversial Section 8 assessment of the Minister’s expressed fluoride-related fears. Finally, selected ‘grandfathered’ candidates, including evaporation of water along open bore drains up to dental technicians and others of dubious 100 miles long, with subsequent concentration of qualifications, for registration. Furthermore, to fluoride, was a real issue, Figure 13.93 ‘coordinate’ health services across the state, Hanlon Sheep readily transferred the School Medical Service from the imbibed water with pathological concentrations of Department of Public Instruction to the Department fluoride. The report concluded, inter alia, that ‘fluorosis’ was ‘a problem of considerable moment’ of Health and Home Affairs.89 This allowed the and recommended: ‘A dental survey of all schools, potential integration of hospital-based dental clinics with particular reference to the incidence of and school dental services. Finally, Haenke was a fluorosis, to be made as early as possible by government-appointee to the Dental Board of appropriate authorities.’ Haenke was the right Queensland (at least from 1937 to 1946). Hence, if person, in the right place, at the right time. Haenke had participated actively in ADAQ affairs, he would have faced serious conflicts of interest at The Queensland medical and agrarian a time when there was very public disagreement bureaucracies perceived dental and skeletal between the dental profession and the government. fluorosis as a serious threat to both human health This, together with travelling commitments, further and to the pastoral industry, the latter being the explains why Haenke’s name appears only mainstay of the state economy.92 The Fluoride in intermittently in ADAQ archives. Water Survey Samplers commenced a massive task: Haenke, Groundwater and Fluorosis A series of international discoveries implicated the SDS in the discreet management of a distinctively Queensland problem with groundwater, namely: the presence in some western Fig 13 Effect of Evaporation on Fluoride Ion Concentration regions of bioavailable fluoride in pathological in an Open Bore Drain Source: Parkinson CE, M White, SB concentrations. In the US, Frank McClure recorded Watkins, WJ Monteith, and J Legg, Interim Report of the the multidisciplinary and prolonged web of post- Fluoride in Water Survey Committee, Department of 1931 research that underpinned findings relating to Agriculture and Stock, Brisbane, 1947. Appendix 3. 88 Dental Historian 2020 65 (2) 81 - 97 an investigation of water from thousands of bore Haenke’s departmental loyalties and responsibilities heads and bore drains across the state. Hence, were either subservient to or compatible with the Haenke played a pivotal role in a poorly recorded ADAQ’s Rules and Codes of Ethics. chapter of Queensland dental, medical and The Hosking Brothers veterinary history. He collected and used data regarding the prevalence of dental fluorosis in Another significant chapter within the history of school children, enabling the Chemical Analyst to the SDS involves the Hosking brothers: Richard target resources on regions where pathological and George, both originally from Charters Towers. concentrations of fluoride existed in potable In contrast to a report that the latter brother was a groundwater.94 In this sense, once again, Haenke’s dental assistant and van driver,16 both were service to the community and to the state far registered dentists: Richard (c1902-c1950), George outweighed his service to the ADAQ. Moreover, (1918-1957).102 The former was an early Member the authors could not find any reference to these of the OSQ103 and private practitioner in Charters activities in ADAQ archives. Indeed, in 1949, when Towers (c1900-c1918),104 whereupon he travelled the ADAQ sought advice on dental fluorosis in to New South Wales and thereafter to Canada.105,106 Queensland, it turned to the Department of In March 1921, he returned to Cairns and practised Agriculture’s animal nutritionist, Montgomery briefly in association with CW Knudson.107 George White, not Haenke.95 joined the SDS in 1920.108 In 1923, Richard and George resided in Brisbane.109,110 Both then served Accolades for a Pioneer on the ‘travelling road motor vehicle’111 and were A cursory scrutiny of the National Library of listed as Foundation Members of the ADAQ.74 Australia’s digital newspaper database, Trove, The authors question Richard’s ADAQ reveals that Haenke is the most widely published membership. His name is not listed as a Foundation pre-1950 advocate for dental health throughout Member in either the 1928 Foundation Member Queensland. Newspapers regularly circulated Blue Book or Jones et al.22 Signatures are difficult Haenke’s advice relating to oral health,96 97 98,99 to read, but Richard does not appear to have prevention and nutrition. In 1929, Eustace attended any ADAQ meeting. Nonetheless, he Russell, Chair of the Medical Advisory Board of served the SDS until retirement age (c1950) and the Brisbane General Hospital, stated: Mr. Haenke made a significant contribution to the dental needs is ‘carrying out ideals of which the State should be of patients in remote areas of Queensland.112 very proud.’68 President of the Dental Board of ,113,114,115 Richard was also an amateur photographer Queensland William Parker concurred. In 1937, who recorded images, now archived in the John Lord Gowrie (Governor General of Australia, Oxley Library (Brisbane), of early SDS life. On the 1936-1945) awarded Haenke the Coronation Medal other hand, George frequently attended ADAQ (an official medal to mark the coronation of King 100 meetings and, on retirement in 1957, was the Chief George VI and Queen Elizabeth). In many ways, Dental Inspector of Schools, Figure 14. The ADAQ Haenke pioneered elements of public health awarded George Honorary Membership.116 Finally, dentistry before that discipline emerged. Chief Dental Inspector of Schools, Thomas Pugh ADAQ and, to a lesser extent, OSQ archives served the SDS for 40 years and the ADAQ also understate Haenke’s contribution to the history of acknowledged his service with Honorary dentistry throughout Queensland. Nonetheless, Membership.22 ADAQ President Jeff Jordan (1955), in awarding Life on the Road Haenke the ADAQ’s highest honour, ‘Life Membership, acknowledged Haenke’s diplomatic Environmental conditions generated lifestyle navigation of a thorny passage between OSQ, problems for Dental Inspectors of Schools. The ADAQ, Dental Board and government policy.101 Travelling Dentist, Figure 15, depicts an early However, one of the accolades must be questioned. school dentist.117 It cautions ‘Mind the Flies’ and Jordon asserted: ‘At no stage in his career had Mr Haenke shown the slightest evidence of becoming what might be described as a typical government servant… he was primarily a member of the dental profession and of the Australian Dental Association.’ Jordan, in this statement, assumes that Fig 14 Chief Dental Inspectors of Schools 89 Dental Historian 2020 65 (2) 81 - 97 advises of the ‘School Verandah Surgery.’ cabin and an enclosed van with two rear doors. The Historian, Hector Holthouse, details problems:16 van housed a dental chair, drill, cabinet, spittoon, ants, bogs, dust, a carbonised engine, cockroaches, steriliser, pressure gas and lighter. Wheel chains either deflated or punctured tyres, flood, hat- and a winch, to extricate the vehicle from bogs, mounted fly and insect veils during treatment, heat, were also included, as was a trailer to carry, inter humidity, moisture, mosquitoes, an overheated alia, fuel, supplies and a tent. A Gloria plant radiator and using a horse’s belly, Figure 15, to provided electrical current to the steriliser, lighting gauge depth of water and stability of a river bed. and ventilation. Richard and George Hosking Diet was frequently biscuit, corned beef, billy tea, initially served on the van throughout the southwest damper and treacle. The 1926 road van had no sector of the state.118 sleeping accommodation. Speed, on good road, was The van also serviced the northern gulf region 12-15 miles per hour. A detachable trailer carried and remained in use until 1935 where, after food, fuel, water and the tent. The last served as a travelling 60,000 miles, the Department replaced it surgery and for accommodation, Figure 16. with Charleville-based and Longreach-based motor The Department of Public Instruction’s ‘Mobile clinics.119,120 The newer truck design had ‘rigidity Dental Van Truck’ required robust design.65 A of construction’ and many features that staff Graham one-ton motor chassis carried a custom- appreciated. The clinic was now 12’ long and 6’3” made Austral Motors body of two parts: the driver’s wide with headroom of 6’3”. The rear axle carried dual-drive wheels to minimise bogging. The driver’s cabin housed two foldup bunks. Finally, the truck often coupled with a caravan, Figure 17.

Fig 16 Mobile dental clinic and caravan c1939 Source: John Oxley Library, State Library of Queensland, ID: 246356.

The School Rail Dental Clinics Apart from conventional goods and passenger Fig 15 Travelling Dentist Poster Source: John Oxley transport, the Department of Railways Library, Queensland Department of Education. ‘The intermittently provided many specialised forms of Travelling Dentist,’ ID: HPT EDU 042. rolling stock: ambulance, child welfare, domestic science, hospital and manual training. Moreover, the Departments of Railways’, Public Instruction’s and Health and Home Affairs’ carriage nomenclatures varied. McCormack launched the Department of Public Instruction’s Dental Rail Clinic Car No 5 with Wagon No 6 (vehicle and stores), Figure 10, in January 1929.80 At the ceremony at Roma Street Station, the Secretary for Education (1925-1929), Thomas Wilson (ALP), revisited Queensland ‘difference’ reasoning and emphasised not only the ‘unique design of the car… the first in the Empire’ but also the need for dental attention in remote areas. An election was looming Fig 16 Dental camp at Camooweal c1928 Source: John and the occasion carried political overtones. Oxley Library, State Library of Queensland, ID: 159402. Compared to other states and territories, the

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Department of Railways had implemented Man.’ The latter transported children to and from distinctive features within its infrastructure: a the school: liaised with the station master; narrow 3’6” gauge, tight track curves, the use of purchased oils, gasoline and gas; and serviced the cylindrical (not coned) wheels on rolling stock and generator, chemical toilet and the station wagon. the rails laid directly onto the sleepers.12 Car No 5 There was no Dental Assistant. The ‘Handy Man’ was the self-contained clinic-sleeper, 8’6” wide and job description excluded these duties. By early buffer to buffer 21’ long. No 6, the motor trailer 1963, SDS operated four ‘mobile units in the form 14’x 6’6”, coupled to No 5.121 To facilitate stability of dental trains’ [sic, actually Rail Dental Clinic and smoother travel on the Queensland-specific Cars] and fourteen other ‘portable dental units infrastructure, No 5 was a six-wheel rail carriage [station wagons with moveable equipment].’4 with a dual-wheelset bogie located at one end and SDS in the 1960s: Personal Commentary a single wheelset at the other. Due to its availability and extreme heat in Queensland, the external One author (JPB), as a new graduate, worked for superstructure and cladding on the chasses were the SDS across the central western and southern timber. However, the roof was curved sheet metal. divisions throughout 1963-65. He offers the following commentary. The implementation of the The internal of the self-contained car was 20’ SDS via educational administration meant that long x 7’ wide. The 7’x 7’ living area, ‘a lesson in SDOs were accorded the legal status equivalent to the economy of space,’122 accommodated a shower, a School Inspector. This standing gave SDOs access lavatory, bunk, collapsible writing table, ice chest to examine all children and enabled statewide dental and an electric griller. The surgery of 8’ x 7’ health surveillance. However, the perennial contained a pump-chair equipped with a special problem of parental understanding of and child’s seat, Webber electric unit, spotlight, electric permission for treatment remained. The underlying engine, porcelain bracket table and wash basin fitted causes were many. Communal consciousness of with a high pressure water system. The Gloria ‘barber surgeons’ and extractions without power system provided electrical current for the anaesthesia lingered. Some parents shielded chairside dental engine, lighting, steriliser and children from mutually feared dental treatment, ventilation. A special tank provided filtered water. Figure 20. Others were apathetic. Many were The waiting room was 4’6” long. Car No 6 carried a ‘Ford Car’ with the rear of the vehicle fitted out as a dental surgery covered by a tarpaulin.123 With the aforementioned transfer of the SDS from the Department of Public Instruction to the Department of Health and Home Affairs, in 1938 the latter department replaced Car No 6 with a new carriage, Fig 18 School Dental Service in Queensland Growth 1945 now named ‘Department of Health and Home Specs Carriages U Source: Foley TA, School Dental Service Affairs Dental Rail Trailer No 6’.124 To further in Queensland, Department of Health and Home Affairs, confuse terminology, Dental Inspectors of Schools, Brisbane, 1945: insert, John Oxley Library, State Library of c1950 retitled School Dental Officers (SDO), Queensland, ID: 371.71 QUE c1. collectively labelled Car Nos 5 and 6, Rail Dental Clinic Car 1. It operated in the Cairns hinterland, Figure 2, until c1970, whereupon the department decommissioned it. By 1950, the Department of Railways had constructed for the Department of Health and Home Affairs three larger Dental Rail Clinic Cars: 1944- 1945 (known to SDOs as Nos 2 and 3) and 1949- 1950 (No 4), Figures 18 and 19. One each operated on the northwestern (from Townsville), central (from Rockhampton) and southwestern (from Brisbane) lines, Figure 2. The clinic cars were 53’ Fig 19 Rail Dental Clinics c1950 Source: Agriculture and 125 x 9’, the trailer cars were 32’ x 9’. Each Dental Stock Department. Queensland State Archives Item ID: Rail Clinic Car carried two SDOs and a ‘Handy 1143233.

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Sometimes a publican’s attitude was grudging and the accommodation matched: poor bedding, Fig 20 Children waiting outhouses and inadequate water supply. in the Rail Dental Clinic, 1946 Source: Department Accommodation was more isolated on the Rail of Agriculture and Stock, Dental Car. In the township of Alpha, where staff Queensland State shortages had curtailed public dental services at the Archives, Image ID 3015. local hospital, Railway Union Representatives virtually held the clinic hostage. They demanded that, unless the SDO treat adult emergencies on the weekend, they would not move the rail car to the next destination on the itinerary. These were the lifestyle realities in the 1960s for the SDO. SDOs needed a strong sense of purpose and appreciative. Great distance and cost precluded identity to deflect common clichés. The community dental care for most. Police Officers, acting as generally afforded higher priority to the services of truancy officers, sometimes rounded up groups of medical and veterinary practitioners, who were not school children who decided to forego the SDO’s itinerant and more highly regarded. Off the line, visit. Neglected children, whose parents, despite SDOs could often access Country Women’s counselling, repeatedly refused either urgent or Association health rooms. However, an SDO was extensive treatment, were not reported. No social asked to vacate these facilities in favour of a Bank service agency existed to receive such a notification. Manager who ‘came each month and paid rent.’ In the early 1970s, many one-teacher primary Some larger schools had designated health rooms. schools, with multi-grade classes, existed across Principals often used these for other purposes and Queensland. These characteristically had one portrayed the SDO’s access as an inconvenient, classrooom. This was an era when families were far inter-departmental (Education versus Health) less mobile. Bus transport to and from isolated demarcation dispute. On arrival, SDOs sometimes schools was scant. As well as rail dental clinics, had to persuade Principals to remove equipment, SDOs, using portable equipment loaded into a fleet personnel and supplies and reinstate the room to its of station wagons, visited schools in defined coastal designated purpose. Parliamentarians, in response and hinterland districts without hospital-based to constituents’ complaints, pressed for maximum dental clinics. The school verandah continued as local services via interfering with itineraries and the dental clinic. A portable wooden dental chair priorities for access to treatment. Hence, local (made at ‘Boggo Road Gaol’) and the foot-treadle allegiances and opinions further affected operations. dental engine remained staple requirements where Additional work-related problems stemmed from an absence of electricity precluded the use of an SDOs’ junior rank based on age and low employee electric-powered dental engine. The SDS seniority and SDOs’ reluctance to organise introduced the high-speed dental turbine handpiece industrially. The public often perceived SDOs as in the early 1960s. On the verandah, dust, heat and either apprenticed or inferior clinicians. Required flies were inescapable. At the Comet State School, Miscellaneous Workers Union membership was clouds of sand flies (midges) appeared after misplaced and ineffective. The union saw SDOs as floodwaters receded. Children had walked to school a very small group and of a pay status warranting carrying pots of burning cow manure mixed with neither better remuneration nor other advocacy. green grass. The ensuing smoke generated Because of anomalies in the Queensland Hospital protection from insects. To enable the SDO and the Act 1936-1964, the early 1960s was an era of patient to be stationary for treatment, a ring of these widespread disenchantment of ‘dentists employed pots surrounded the treatment area on the verandah. in State Government Clinics.’126,127 The ADAQ Itinerancy, isolation and limited cultural outlets conceded its ineffectiveness and its response to affected morale and contributed to staff turnover. government-employed dentists, ‘It is up to you,’ did While there were welcoming communities and a little to instil either confidence or professional few outstanding hotels with excellent food service, backing in SDOs. Hence, state government- SDOs stayed mostly at mediocre pubs. Licensees employed dentists felt even less obliged to join the 128 had to legally provide public accommodation. ADAQ. Between 1911 and 1973, no health 92 Dental Historian 2020 65 (2) 81 - 97 department-employed dentist was either an OSQ or administrators, Parliamentarians, parents and SDOs an ADAQ President. continued with an outdated model for the SDS. In Hierarchical ministerial and departmental the field, seven rail-based SDOs, four handymen control in the face of the enormity and challenge of and a larger body of fourteen SDOs operating with the caries epidemic generated most discontent portable equipment from station wagons, sustained among SDOs. Examples include: departmental a heroic and noble tradition. However, their reliance on restoration and extraction counts to contribution was unable to impact the caries measure performance; failure to address the low epidemic with its effects on education, not to community value relating to dental health and mention occasional mortality due to systemic prevention; inadequate staffing; irregular and infection. SDOs faced a massive task within an incomplete courses of care; and little rationale admirable system but a different approach was long within treatment planning. A survey by JPB of the overdue. stark difference in caries prevalence between 1972-1973 children from a naturally, optimally fluoridated In 1973, 145 government-administered ‘dental community (Barcaldine) and its sub-optimally establishments’ existed across Queensland, Figure fluoridated counterpart (Blackall) drew interest 21.129 Government itinerant- and hospital-based from the Chief Medical and Dental Officers, but no dentists and SDOs were the major providers of ministerial attention. Civic leaders and treatment for vast areas of the state, unshaded Parliamentarians universally endorsed a statewide, section Figure 21. However, this unshaded segment one-on-one, school-based, corrective program but understates the SDOs’ service to adults at were, at best, apathetic to a statewide public health understaffed hospital-based clinics and their strategy and the introduction of adjusted water contributions, by road vehicles, within the shaded fluoridation: the former being a state government areas. Indeed, JPB served in the Brisbane River responsibility, the latter, local authority. By the Valley and at the Queensland Subnormal Children’s 1950s, SDOs worked in a public-sponsored Association Headquarters (Brisbane). Moreover, in program with outmoded goals. 1973, twenty-one SDOs examined 31,239 children Departmental heads and post-1960 Chief Dental at 387 schools and treated 9,139 children with 494 Inspectors of Schools (then called Chief Dental permanent teeth extractions, 3,139 deciduous Officers) did little, if anything, to rationalise public extractions, 29,504 restorations and 63,142 oral health policy. This inertia reflected medical operations in 23,043 teeth. Yet, within ADAQ dominance, together with an implicit focus on archives and the dental literature, the contribution, individual treatment, within Australian public role and significance of the SDS and its SDOs have health models. One brief attempt at an age-based attracted little attention. prioritisation of SDOs’ restorative treatment was The Whitlam Government provided a major promptly abandoned in the face of public opposition paradigm shift in dental care with a specific purpose at perceived reduction of services. Despite clinical grant of $A7.9m in the 1973 budget to fund the trials demonstrating the therapeutic value of the introduction of the Australian School Dental annual application of topical fluorides, SDOs did Program.130 Under the scheme, the Commonwealth not apply this treatment. The department argued that provided the majority of funding, leadership and the frequency of application would be inadequate. coordination. The states and territories became Fluoridated toothpastes did not become readily responsible for the implementation, delivery and available until the late 1960s. There was little administration of dental services. A new era for the official semblance at either targeted, individual SDS dawned in 1975 when the Queensland prevention or complementary community-based Government employed South Australian- and New approaches involving oral health education, Zealand-trained dental therapists to open a school- programme planning and meaningful service based clinic at Inala West Primary School.131 evaluation. Despite sustained ADAQ and pre-1964 advocacy within the Department of Health and Post-script Home Affairs, the consequences of repeated In September 2019, the whereabouts and rejection at referenda of adjusted water fluoridation condition of Dental Road Vans and, what SDOs failed to register with either the public or their termed, Rail Van Nos 1 to 4 were investigated. The representatives. Hence, throughout the 1960s, fate of the Dental Road Vans and Dental Rail Van

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Fig 22 Dental Rail Vans Nos 2 and 4 Sept 2019

Fig 21 Qld Dental Clinics 1973 Source: Annual Report of the Division of Dental Services for Year Ended 30 June 1973, Queensland State Department of Health, Brisbane, 1973. Courtesy Queensland Health. No 1 are unknown. The timber superstructure of rail cars was often demolished and the chassis redeveloped. Nos 2 and 4, Figures 22-24, are in a state of decline at the Australian Rail Historical Society Queensland Museum at Kunkala (near Rosewood). No 2 provides accommodation for a caretaker and the affiliated Rail Trailer Van holds Fig 23 Dental Rail Vans 2 Internal Sept 2019A a power generator for the Museum workshop. Queensland Pioneer Steam Railway (Swanbank) use remodelled No 3 as an administrative office. With limited resources and volunteer support, these organisations are preserving a unique contribution to public dental services, namely the Queensland Rail Dental Clinics. Conclusion The poor connection in Queensland between dental and historical scholarship, together with the sweeping social changes across Australia within the Whitlam era, have generated widely held misconceptions of the origins and development of the SDS. Between 1911 and 1945, the programme Fig 24 Dental Rail Vans 2 Internal Sept 2019B Source: JPB. was groundbreaking in terms of access to dentists, OSQ and the ADAQ contributed little. However, treatment delivered and the method and area of the division of powers within the Australian coverage. Much must be attributed to Hanlon’s Constitution, an idiosyncratic Queensland reforms and poorly acknowledged pioneers, for parliamentary system, socio-political attitudes, instance Haenke and the Hosking brothers. The policy dichotomies between the state (health) and 94 Dental Historian 2020 65 (2) 81 - 97

10. J Hughes, Queensland Official Year Book 1901, GA Vaughan, Brisbane, local government (water supply and adjusted water 1901, pp. 65, 71,72,389,336. fluoridation) and a narrow bureaucratic aptitude for 11. J Holmes, 'Coast Versus Inland: Two Different Queenslands?', Australian policy innovation meant that, in the post-WWII to Geographical Studies, vol. 32, no. 2, 1994, pp. 167-182. 12. J Kerr, The Triumph of the Narrow Gauge, Boolarong Press, Bowen Whitlam era, the SDS clung to out-dated methods Hills, 1990, pp. 1-232,v,vii,8. and values. 13. Government Statistician, Queensland Year Book 1937, AH Tucker, Brisbane, 1937, pp. 162, 79. The pre-1973 era in Queensland was one where 14. MI Thomis, A Century of Regulation the Dental Board of Queensland, community oral health programs were not based on Boolarong Press, Moorooka, 2002, pp. 16-32,20,40. 15. Queensland Government, The State Education Acts 1875 to 1957, sound public health science. Queenslanders Brisbane, 1957, pp. 713-724. Available at: demanded and received massive contributions to https://media.sclqld.org.au/documents/digitisation/v04_pp713- dental treatment and pain relief. Consequently, the 722_Education_State%20Education%20Acts,%201875%20to%201957.pdf 16. H Holthouse, Looking Back the First 150 Years of Queensland Schools, SDS lacked a defined, defendable and written plan. Department of Education, Brisbane, 1975, pp. 22-28,108-112,189,123,123- It failed to bridge the gap from a school-based 126. restorative to community-based preventive 17. 'School Children', Telegraph, 22 August 1912, p. 8. 18. Pugh's Official Almanac, Edwards Dunlop, Brisbane, 1912, pp. 490- programme. Paradoxically, this failure to 492. incorporate biological and behavioural principles 19. 'The Public Health', Brisbane Courier, 28 October 1907, p. 3. may have had its origin in defining legacies of 20. 'Brisbane Dental Hospital a New Institution Its Aims and Objects History of the Project', Brisbane Courier, 9 May 1908, p. 5. Hanlon’s stewardship. While he extensively and 21. 'Brisbane Dental Hospital Rapid Growth of Work Appeal for Government successfully expanded government-administered Subsidy', Brisbane Courier, 17 June 1910, p. 5. 22. HG Jones, JA Sagar, A Marsden, et al., A History of the Australian public dental services across Queensland Dental Association (Qld Branch) 1906-1992, ADAQ, Brisbane, 1997, pp. throughout the 1932 to 1957 Labor era, Hanlon’s 17,31,68,174,158. authoritarian and pragmatic emphasis persisted and 23. 'Brisbane Dental Hospital Annual Meeting Inspection of Children's Teeth', Brisbane Courier, 1 June 1912, p. 5. ultimately crushed innovation. Rationalisation had 24. 'Medical Inspection', Telegraph, 31 August 1910, p. 2. to wait for the Whitlam era. All SDSs across 25. 'Dental Congress', Geelong Advertiser, 16 October 1909, p. 3. Australia faced generic and state-specific 26. 'The Dental Congress', Daily Telegraph, 29 October 1909, p. 8. challenges. Given the universality of ‘difference,’ 27. 'Brisbane Dental Hospital First Annual Meeting', Brisbane Courier, 15 May 1909, p. 7. any allegation of Queensland disparity raises 28. 'National Dental Association', Age, 28 November 1910, p. 10. legitimate questions about the origins and 29. 'State School Committees’ Association', Brisbane Courier, 24 May 1910, significance of a perceived variance. Nonetheless, p. 6. 30. 'Labour in Politics', Evening Telegraph, 22 April 1910, p. 6. within the Australian context, elements within the 31. T Nevitt, Queensland Parliamentary Debates, Legislative Assembly, 28 SDS narrative harmonise with mainstream July 1910: Address in Reply, Queensland Parliament, Brisbane, 1910, p. 251. historians’ recurring theme of Queensland 32. 'Teeth Troubles', Truth, 15 May 1910, p. 10. 33. 'Public Schools Disease, Defects and Dental Troubles', Truth, 9 January exception. Finally, the SDS experience, led author 1910, p. 7. JPB to a career of teaching and research in 34. 'Public Schools', Truth, 9 January 1910, p. 7. paediatric and subsequently preventive and public 35. R Doherty, 'Elkington and After: Public Health, Queensland Style', Australian Journal of Public Health, vol. 19, no. 1, 1995, pp. 7-12. health dentistry. 36. State School Hygiene', Gympie Times and Mary River Mining Gazette, 24 November 1910, p. 1. References 37. 'Toothless Tasmania', Clipper, 11 March 1905, p. 4. 38. 'Schools and Health', Telegraph, 22 November 1910, p. 5. 1. HF Akers, MA Foley and PJ Ford, '‘Remember Who We Are’: An Analysis 39. 'Valued Servant', Brisbane Courier, 4 July 1928, p. 14. of Brand Queensland', Queensland History Journal, vol. 22, no. 6, 2014, pp. 495-506. 40. 'Medical Inspection of Schools', Morning Bulletin, 4 February 1911, p. 6. 2. WJ Tuckfield, Dental Health Service for Children', Australian Journal of Dentistry, vol. 50, no. 1, 1946, p. 24. 41. OSQ, Minutes, 21 March 1911. 3. ND Martin, 'Dental Public Health in Australia and New Zealand', Journal 42. 'National Dental Association Inaugural Meeting', Register, 30 May of Public Health Dentistry, vol. 21, no. 3, 1961, p. 96. 1911, p. 7. 4. AJ Hoole, 'Dental Services in Institutions and Government Departments', 43. DR Eden, 'Chairman’s Address the Care of Children’s Teeth in Australian Dental Journal, vol. 8, no. 1, 1963, pp. 36,39. Queensland', in Report of the Proceedings Third Australian Dental Congress, ed., AR Walker, National Dental Association of Australia, 5. P Forster, Queensland Health Systems Review, Consultancy Bureau, Brisbane, 1912, p. 15. Brisbane, 2005, pp. 154-155. 44. 'Teachers Conference', Week, 16 January 1914, p. 16. 6. ADAQ, Dental Services in Queensland: Future Directions Position Paper, ADAQ, Brisbane, 2012, pp. 1-12. 45. OSQ, Minutes, 19 March 1912. 7. HF Akers, MA Foley and JP Brown, 'The Brisbane Dental Hospital 46. 'Dental Examination', Telegraph, 8 January 1908, p. 7. Building: ‘The Palace’ an Era Ends', Journal of the History of Dentistry, vol. 47. 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52. EW Haenke, 'The Government Dental Inspector’s Report on School 92. CE Parkinson, M White, SB Watkins, et al., Interim Report of the Children’s Teeth', in Report of the Proceedings Third Australian Dental Fluoride in Water Survey Committee, Department of Agriculture and Congress, ed., AR Walker, National Dental Association of Australia, Stock, Brisbane, 1947, pp. 1-6 and Appendices. Brisbane, 1912, pp. 18-21. 93. 'Irreparable Damage to Teeth', Queensland Country Life, 14 February 53. 'Dental Congress', Telegraph, 9 July 1912, p. 4. 1946, p. 13. 54. W Cleary, 'Australians as a Toothless Race', Commonwealth Dental 94. HF Akers and SAT Porter, 'The 1945 - 1955 Queensland Artesian Fluoride Review, 10 May 1904, pp. 165-168. Experience: A Unique Phenomenon within the Australian Wool Industry', 55. 'Inspection of Children’s Teeth', Warwick Examiner and Times, 25 Historical Records of Australian Science, vol. 18, no. 2, 2007, pp. 177-189. November 1911, p. 4. 95. 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Authors’ Biographies: Harry F Akers, BDSc, FRACDS, BA, GCertDent, GDipClinDent, PhD, GCertHE, Harry Akers is a retired dentist. After conducting a private practice at Bundaberg for thirty-seven years, he worked as a Senior Dentist for Queensland Health and as a Clinical Supervisor, Senior Lecturer and Course Coordinator for the University of Queensland School of Dentistry. John P Brown BDSc, MS, PhD, Professor Emeritus, Dental School, University of Texas Health Science Center at San Antonio. A former School Dental Officer and University of Queensland Dental Faculty Member. Michael A Foley, BDSc, MPH, MEpi, Metro North Oral Health Services and University of Queensland Oral Health Centre, Herston, Brisbane. A former Director of the Brisbane Dental Hospital, is Director of Research and Advocacy for Metro North Oral Health Services, Queensland Health and University of Queensland Oral Health Centre, Herston. Valerie Woodford, BDSc, MDSc, Metro North Oral Health Services and University of Queensland Oral Health Centre, Herston, Brisbane. A former Acting Director of the Brisbane Dental Hospital, is a Senior Dental Specialist (Periodontics), Queensland Health and University of Queensland Oral Health Centre, Herston. Address for Correspondence: Harry Francis Akers, Unit 9, 104 Station Rd, Indooroopilly, Brisbane, Australia, 4068. Email: [email protected]

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