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1910–1917 Two to four years of high school and three professional years of

32 weeks each-total, five to seven years. 1917–1924 Four years of high school and four professional years of 32 weeks

each-total, eight years. 1924 Four years of high school, one year of college, and four profes

sional years of 32 weeks each-total, nine years. Comparing 1869 and 1925 we see that the minimum number of years between the grammar school and the dental degree is now nine times what it was in 1869. Comparing 1891 and 1925, we find that the number of sessions in the professional school in 1925 is twice that in 1891. We have already seen that the present length of session is a minimum of 32 weeks, against 16 in 1884. The number of weeks' instruction in the entire professional school course in 1884 was 32, but this was repeated instruction in a nongraded curriculum; so the actual number of weeks of new instruction received by each student was but 16. Now it is 128 weeks, or eight times as many weeks of new instruction as in 1884. When in connection with this, it is considered that the average dental student now has five years more of education before entering the professional school than he had in 1884, we may assume that his profit by instruction by reason of education and maturity is from 50 to 100 per cent increased over that of the students of 1884, which indicates a dental professional course to-day from 12 to 16 times the value of that of 1884, irrespective of any improvements in equipment and in the quality of teaching. To-day's course is 24 to 32 times as effective as that of 1869. Truly the quantitative increase has been wonderful.

One may conjecture as to the length of the dental course of the future, but the prevalent opinion of dental educators is that the dental course will finally become stabilized at four years of professional study after two years of preparation in a college of arts and science, making a total of six years from high-school graduation to dental degree, and that this will be reached within a decade.

Meanwhile, it is conceded that we shall have a period during which five years from high school to dental degree will prevail. There are two plans as to the division of these five years. One is that the present one year of college entrance and four years of professional school will continue until such a time as two years of college work can be generally required for entrance. The other plan is that the schools should immediately require two years of college work for entrance, reduce the professional curriculum leading to the initial dental degree to three years, saving time by more effective teaching and by excluding the dental specialties, and then offer the specialties and some advanced work in one additional optional year leading to a second dental degree. This plan assumes that enough more effective teaching can be at once secured to do in three years what is now

taking nearly four years to accomplish. It is conceded in this plan that perhaps ultimately this optional year will be incorporated into the required course, the initial degree abandoned, and thus lead to the stabilized program of six years from high school to dental degree.

The progress in the qualitative aspects of dental education are less definite but may be referred to under six headings: The graded curriculum, the breadth of curriculum, the equipment, the quality of instruction, the standards of scholarship, and university control.

4. THE GRADED CURRICULUM

In 1884 the usual professional curriculum in dentistry, following the prevalent custom in medicine for more than a century, consisted of a single course of lectures in each of several subjects, repeated year after year. To these courses came first-year students, secondyear students who had heard the lectures once, and later third-year students. If such a course were scaled for comprehension by the first-year students, it would be very elementary and lack any stimulus for the second and third year men. If it were planned for the older classes, it would be almost unintelligible for the freshmen. If it tried to compromise, it would fit none of them.

The unsoundness of this plan became fully apparent when laboratory subjects were introduced. A student might consent to attend the same lectures twice, but to repeat the same laboratory course twice would hardly be tolerated, and yet in human dissection, which is the oldest type of laboratory course in medical education, it is less than a decade since some medical schools ceased to require that a student dissect the body twice.

The repetitive curriculum was an inexpensive course to carry on, because it required only a fraction of the teachers required by the graded course. It was prevalent until the early nineties, then gradually was replaced by the graded curriculum, but it took more than two decades fully to eradicate it, and even to-day there are a few vestiges in the “circular courses."

Into this matter of graded curriculum enters another aspect, and that is the matter of sequence of courses. The justification of a graded curriculum is that progressively throughout all the years of the course the earlier subjects shall prepare for the subjects that follow, and that the later subjects shall make use of the information and training gained in the earlier courses. This fundamental pedagogical principle has not been uniformly enforced in dental education. In the university dental schools that are part of a systematic educational force the logical sequence of courses has been reasonably well regulated, but in the independent schools this has been largely ignored, and some subjects occupy unfit positions in the curriculum. This educational problem needs careful and thorough study in order that both proper sequence and correlation of courses and subjects may be obtained. Its very complete neglect is one of the outstanding failures of the dental education.

5. THE BREADTH OF THE CURRICULUM

The subjects of the curriculum of the first dental school were those of the medical curriculum of that day, exclusive of any considerable attention to clinical medicine and surgery, and plus mechanical and operative dentistry. Specialties in dentistry were not yet in vogue.

As time went on, less and less attention was given in dental schools to medical subjects and more and more to the dental subjects, especially to mechanical dentistry. The average curriculum of 1870 was not as broad as that of 1850.

As dental schools associated with medical schools began to arise, there was a return to more emphasis on anatomy and physiology, though usually only in lecture courses. With the rise of cellular pathology, following the work of Virchow and his pupils, nearly coincident with the beginning of bacteriology by Pasteur and the work of Koch on infectious diseases, there came in the last decades of the nineteenth century a great stimulus to the study of bacteriology and pathology. This first appeared in the medical schools, was soon seen in those dental schools connected with universities, and slowly crept into the independent dental schools. The first laboratory course in bacteriology in a dental school was one in a university dental school in a mid-Western State about 1895. Pathology and bacteriology continued to be taught solely by lectures in most dental schools until 1917. Only in some university dental schools were laboratory courses given. The subject of dental pathology as taught in dental schools was not at all a laboratory subject, nor was it really pathology, but a conglomeration of etiology, pathology, diagnosis, and treatment, both medical and mechanical. Even at the present day many dental schools give no laboratory course on the pathology of the oral cavity. Clinical dental pathology is still similarly neglected.

Chemistry entered the dental curriculum relatively early, and with anatomy and histology has had reasonable attention for the past 30 years. Physiology has usually been only a didactic course but now is coming to have a practical laboratory phase added.

In 1917, with the inauguration of the four-year curriculum, came the greatest broadening of the dental curriculum at any one time by the introduction into the first year of the standard four-year curriculum, recommended by the Dental Educational Council, of biology, physics, English, and mechanical drawing. The most im

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portant of these innovations was the introduction of a required course in biology. This was later to be transferred to the predental year, but, beginning with 1917, every dental student has received systematic instruction in biology as an introduction to his professional course. The far-reaching import of this was appreciated by only a few educators at that time, but it laid the foundation upon which a great change in the conception of dentistry is to arise. This change is that dentistry is coming to be considered in its biological relations to the various functions of the human body, instead of primarily as a mechanical art in the restoration of defective or lost structures. The introduction of these academic subjects was not done without resistance. The dentists and dental educators were not at all enthusiastic about them; in fact, some of them contended that all the additional time should go to mechanical and operative dentistry.

Perhaps the attitude of a considerable part of the dentists toward a broadening of the curriculum can best be illustrated by the opinion of the nestor of American dentistry, known internationally as one of the leaders of dentistry and dental education, a graduate in medicine as well as in dentistry and a dental teacher for 40 years. In a stenographic report on page 65 of the proceedings of the National Association of Dental Faculties for 1911, in a discussion concerning giving advanced standing to medical students, he is quoted as saying: “ The medical man in the first two years is devoting his time to biology and other subjects that have no bearing at all on dentistry.” With such opinions from the most revered and honored leaders, it is small wonder that the policy of broadening the dental curriculum was long delayed, and when these academic subjects were introduced into the curriculum they were very shabbily cared for, either in provision of equipment or of competent and stimulating teachers.

However, it took a very short time to prove their value, and they furnished a stimulus for extension of the medical subjects and strongly influenced the appreciation of the value of predental collegiate work. With the introduction of the predental college year these academic subjects have been transferred to the preprofessional school work, permitting yet more attention to the medical subjects. As a result, the curriculum of 10 years ago has been greatly improved in the way of a greater emphasis upon the fundamental sciences and a relative, although not absolute, diminution in the mechanical phase of the course of study. The results are already seen in the products of the newer dental education, who not only are better trained, but are also better able to keep abreast of the great advance in dentistry and medicine that will occur during their professional lives.

6. EQUIPMENT IN DENTAL TEACHING

There is no adequate record of just what equipment was considered a minimum at any time in the history of dental education. A survey of the equipment of dental schools was made in 1896 by the National Association of Dental Faculties, but no organized report was printed. It seems impossible to ascertain, with any approach to accuracy, what was the usual equipment of the dental schools in early days. The catalogues tell of the “complete and modern ” equipment, but to one familiar with the fanciful imaginations of some writers of fiction whose efforts appear in the professional school catalogues, this is not evidence.

When the Dental Educational Council was formed, it was hoped that a standard for equipment would be devised, but it was never done, although some rather broad and liberal suggestions were made. In the proprietary schools, even of recent years, the major part of the equipment was in the infirmary. Here the modern improvements in chairs and accessories were usually the first to be provided. The technical laboratories had little, and even to-day the dental student provides for himself most of the appliances and instruments with which he works in his dental subjects. Only the larger pieces of apparatus, like lathes and vulcanizers, are provided by the school, and in some schools not even these. The typical laboratory equipment in dental technology is a room, more or less well lighted, with drawers and lockers and tables bare of any equipment except gas jets. In better schools there are, in addition, some teaching models and charts.

When one reaches the equipment of the laboratories in fundamental subjects and medical sciences, the independent schools usually felt these hardly worthy of serious consideration, and their equipment has been very meager. In the university schools these subjects are cared for in the college of arts and science, and in university medical schools they usually have reasonably adequate equipment and facilities. As to libraries, with a few praiseworthy exceptions, these have been noticeable until recent years chiefly by their absence. To-day only about half of the dental schools have a library containing as many as 1,000 volumes.

There is even to-day no accepted standard of what equipment a dental school should have anywhere outside the infirmary. All else is simply opinion of different men whose opinions are much influenced by their major interests. If one may rely upon the recollection of older dentists, there has been great improvement, but when one tries to find any really comparative details, it is futile; and about the only conclusion that can be reached is that, in general, there has been gradual improvement in all dental schools in equip

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