A History of Dentistry in South Australia

James (Bill) Scollin, previously Dental Superintendent, Royal Adelaide Hospital

This address was delivered at the sixth Foundation Day Ceremony held at Royal Adelaide Hospital on 11 July, 1984.

Before I attempt to recount the history of the Dental Hospital, it is necessary for me to give you some idea of the availability of dental services in the years 1880-90. In those times the persons providing dental attention to the population were varied: some dentists with formal training had migrated from England: a few chemists extracted teeth – one even offered to provide mechanical teeth (as dentures were called in those days), and there were many charlatans. The medical profession was also prepared to extract teeth – in passing, I may add up until the 1960s, medical students attended the Dental Hospital for a course of instruction in the art of extracting teeth.

Persons wishing to become dentists were apprenticed to a dentist for a varying period of time. This state of affairs continued until August, 1889, when the government of the day was asked to introduce legislation to provide for the registration of persons qualified to practice dentistry. A Bill seeking to provide for registration of dentists was introduced in Parliament in November, 1901, but was withdrawn, by consent, because of various shortcomings. The Dentist Act of 1902was introduced and assented to in November of that year and the administration of the Act was vested in a dental board. The board was empowered to make regulations and conduct examinations.

The initial meeting of the board was held in the board room of Royal Adelaide Hospital in December, 1902. What is of great interest to us is, that in 1905, the Dental Board turned its attention to dental education. Regulations were drafted which provided for a course of study at the University of Adelaide, combined with a minimum of four years apprenticeship to a registered dentist. This minimum requirement for registration became law on 15 October, 1905, and the dental board/university course commenced on 13 March, 1906. The first persons to complete the course were registered in January, 1911. The odontological society had been formed in 1907, and it now put forward the suggestion of a degree course to be established at the university.

A subcommittee of the Dental Board consisting of Drs H S Newland (later Sir Henry), P Crank and Mr Gill Williams reported favourably on the suggestion. Years later, this report formed the basis upon which a joint committee of the existing dental societies and the university succeeded in establishing the BDS course. In 1919, under the aegis of the faculty of medicine, the degree course was initiated and the first undergraduates were several persons who had already been registered by the Dental Board. An independent faculty of dentistry was established in 1921 and the great benefactor of dentistry, Sir Joseph Verco, became the first dean. This preamble has led us to the burning question – where were the dental students to obtain their clinical training which hitherto had been achieved under the apprenticeship scheme?

As far back as 1917, an approach had been made by the Odontological Society, to the University of Adelaide and the board of management of Royal Adelaide Hospital to provide a dental school/hospital. Eventually the government accepted a proposal put forward by a select committee and authorised the superintendent of Public Buildings to prepare plans which were finally approved in 1919.

About this time Sir Joseph Verco became aware that the British Red Cross was to make a gift of £150,000 to Australia – the distribution of this money was to be at the discretion of the governor-general – each State was to receive a share. Like all good deans, Sir Joseph got busy – he succeeded in persuading the governor-general to allocate £15,000 to South Australia for the purpose of building a dental hospital. The South Australian government decided to come to the party with £10,000 and so the Dental Hospital was born and the hospital was opened in July, 1923. The origins of the dental school and dental hospital are so closely interwoven that they can be likened to a set of Siamese twins – born together and never capable of separation.

As the degree course had started prior to the completion of the hospital, temporary accommodation was found in an old tin shed, which had been used by the army as a dental clinic during the years 1914-18. One end of this shed was filled with military equipment and field guns. The shed was situated on the east side of Frome Road not far from the present medical school. A photograph of this magnificent accommodation existed but has been lost – much to the distress of Mr Ricketts.

The British Red Cross laid it down as a condition of the gift, that a tablet, suitably inscribed to commemorate the gift, should be mounted in the new building. This was done but in the course of demolition and rebuilding the plaque was lost. Happily, it has been recovered and restored and is now mounted on the wall of the main reception area.

The functions of the dental hospital were to be

  • treatment of the poor
  • treatment of soldiers, sailors and their dependents – no mention was made of airmen
  • People unable to afford the fees of private practitioners – they were to be assessed to pay a small fee
  • To provide students with clinical facilities.

As far as I am aware, prior to the establishment of the Dental Hospital, the only dental treatment afforded by Royal Adelaide Hospital consisted solely in the extraction of teeth – the official records of Royal Adelaide Hospital disclose the appointment of a number of honorary dentists during the period 1878-1920.  I have no knowledge of the existence of any clinical facilities within Royal Adelaide Hospital during those years.

The first dental superintendent was Dr Arthur Chapman and Dr T D Campbell of anthropological fame was the first dental house surgeon. Dr Chapman was succeeded by Dr Campbell and in April, 1926, John Francis Clark was appointed senior dental house surgeon and demonstrator.

The hospital was of red brick construction, with a portico style entrance facing Frome Road. The ground floor provided accommodation for waiting and reception areas and the administration offices. The floor in this area was a lovely parquet one, which retained its beauty throughout the life of the building. Three rooms were set aside for clinical procedures and the south-western corner of the floor provided accommodation for a theatre and male and female recovery rooms. These rooms were used for pre and post operative patients – the situation did little to allay the fears of the pre operative patients! The eastern end of the building provided workroom accommodation for both dental students and staff dental mechanics (as they were called in those days). The small student locker room and toilets looked out onto the beginnings of the Institute of Medical and Veterinary Science. This was a small area of ground which provided stable accommodation for a succession of draught horses. These were bled at regular intervals by members of the pathology section of Royal Adelaide Hospital. In those early days when student initiations were in vogue these draught horses played a prominent role.

The first floor of the building was devoted almost entirely to clinical accommodation – there was also a lecture theatre, X-ray room, office for the superintendent, library and locker rooms for the sisters and nursing staff – the female students shared accommodation with the nurses.

The clinical areas provided room for forty eight chairs, but for some years there were only twenty one chairs installed: this was the era when students provided their own instruments and dental foot engines. The mastery and operation of these foot engines required the skill of a ballet dancer and the staying power of a professional bike rider. The southern wall of this area from about four feet above floor level, was completely of glass – this expanse of glass was designed to ensure adequate lighting for the operators, but as you can imagine those students working in the back rows away from the window were in difficulties.

Artificial lighting consisted of a few overhead household type bulbs. I suspect that it is about this time that the phrase, ‘flying blind’, was coined. The hospital house dentists were a privileged class and occupied the front row and were supplied with electrically driven engines. As can be imagined, in summertime the temperature in this area was awful.

A sister was responsible for the allocation of patients to the students – if you were in her good books you were given good patients – if not, you found yourself treating the drunks and the unwashed! Students were required to mix their own filling material and sterilise their hand instruments. Occasionally sister or the nurses would help with unruly or distressed patients.

On the ground floor where the extraction of teeth was carried out, more nursing assistance was available and the nursing staff was responsible for the supply and sterilisation of instruments. Sterilisation was done in the old water bath sterilisers, and it says much for the blood supply of the oral activity, that serious post operative complications seldom occurred.

Multiple extractions for children and adults were done in the small theatre on the ground floor. This did have a reasonable operating light. In this same theatre, and I am not sure of the date, was staged the first television filming, in Adelaide of an operation. In the early years children were given a single dose of ethyl chloride or nitrous oxide and oxygen using a Heidbrink machine. The adults were usually anaesthetised using ethyl chloride and open ether and many was the battle that ensued with some of the husky adults.

There were visiting honorary anaesthetists, who came on several sessions per week. I recall to mind Dr Gilbert Brown, who was a highly skilled anaesthetist. He lectured to our students and it was his joy to show them slides demonstrating how he controlled a difficult patient, which always made a great impression on the students. There were times when the visiting anaesthetists were unable to attend. Then we depended on what house surgeon or possibly a registrar could be made available by the medical superintendent. Not surprisingly the dental staff suffered some moments of anxiety as the house surgeons had very limited experience in the giving of anaesthetics – let alone anaesthetising a patient who was half reclining in a dental chair. Happily, this situation changed when the Department of Anaesthesia came into being, and our needs were met by the full time staff of that department. At the present time, patients who are to undergo treatment under general anaesthesia are assessed the day before operation, premedication is given and there is trained staff in the recovery ward. If necessary, the patient can be admitted to Royal Adelaide Hospital. For major procedures our Oral Surgery Unit has the use of beds in the Adelaide and full theatre facilities.

It is important to realise, in the early years of the hospital, how much of the treatment of patients was carried out by senior students. In the period 1923 till 1939 the full time staff of the hospital never rose much above the superintendent, senior dental house surgeon and demonstrator and one and a half house surgeons. In addition to patients presenting for treatment, the hospital was responsible for the care of inmates of the mental institutions, Adelaide Gaol and Yatala, Northfield Wards, reformatories, wards of state and patients suffering from tuberculosis. The teaching staff of the university was inadequate and for years students sought help in their clinical work from the senior house surgeon and demonstrator – John Francis Clark. Truly he was a man of all seasons, and is remembered with great affection by dental students of this period.

When the faculty of dentistry was established there were eighteen students. This level was maintained for many years eventually rising to thirty one in the year 1937.

In 1946 the university participated in the Commonwealth Reconstruction Scheme.

Eighteen trainees were admitted to the course, bringing the total number to sixty.

Numbers continued to rise: 104 in 1954 and by 1971 the number of students enrolled in the course had risen to 250.

The clinical facilities available to students remained much the same up until 1939, although new chairs and electrically driven engines were installed. During the war years, portion of the facilities were made available to the RAAF and a verandah on the north side of the hospital was converted to provide laboratory accommodation for their use.

Temporary laboratories, offices and classrooms were erected to try and cope with the numbers, but it was obvious that a larger hospital was required to serve the needs of the hospital and school.

In 1948 a building committee drew up plans for the reconstruction of the existing building. These plans were submitted for examination by the Standing Committee on Public Works in 1949. Around this period Professor Campbell retired and his successor was Professor A M Horsnell. The arrival of Professor Horsnell threw the plans into the melting pot. I am glad to acknowledge here the great benefit of the planning committee derived from the vision of Professor Horsnell – even though at times we all felt like sending him back to England! The revised plans were again submitted to the Standing Committee and approval for the extensions was given. Unhappily, due to a variety of causes, work was not commenced until 1958. The building operations caused great inconvenience to patients and staff. The noise of jackhammers under one’s feet, the dust and numerous shifts to temporary accommodation had to be endured.

The new north wing was completed in 1962 and two years later, the south wing was occupied. Even these additions were not adequate for our needs and plans for further development were finally approved by the government in 1964. The old centre building was demolished and the north and south wings were linked by a building of six floors. The building was opened in August, 1969.

I think I should acknowledge the great debt of gratitude the planning committee owed to the late Murray Barrett, who was so unsparing of himself. Hours of hard work over and above his teaching commitments, meant nothing to him.

The facilities in the new complex for the treatment of patients and the training of students were of world standard and we were very proud of our new dental hospital and school. A description of these facilities is not warranted but mention must be made of the Central Sterile Supply Department and the creation of postgraduate training programmes in oral surgery and orthodontia.

The decision taken by the planning committee, with approval of the Board of Management, Royal Adelaide Hospital, to implement a central sterile supply department was a bold one. It entailed a tremendous amount of detailed planning and this was one of the areas in which Murray Barrett proved his worth. He was ably assisted by Dr O F Makinson. The hospital was also fortunate in obtaining the services of Mrs B Ujhazy as supervisor. Mrs Ujhazy had worked for many years in the Pharmacy Department, Royal Adelaide Hospital, and I doubt if we could ever have achieved success without her knowledge and drive. The installation and functioning of the department attracted great attention overseas and throughout Australia and we had visits from a number of interested parties.

By reason of the improved accommodation and better facilities, the postgraduate training courses in oral surgery and orthodontia were able to be implemented once the board of management agreed to the establishment of these posts.

I think it can be said, because of our close association with Royal Adelaide Hospital and the help received from the surgical and medical staff, that the training programme now offered in oral surgery is of world standard.  This programme owed much to the efforts of Dr J A Cran who was the reader in oral surgery and pathology.

A training course for dental hygienists was established in May, 1975, and proved successful. It has now been transferred to the school of paradental studies.

In all those years from 1948 onwards, the dental hospital was often subjected to adverse criticism. I did not keep a record of the number of times I was instructed to supply information regarding the number of patients on our waiting lists for dentures. I have often gone to sleep counting patients and not sheep.

These criticisms eventually led to an investigation of the functioning of the dental hospital by a firm of business management consultants. A great deal of time, effort and money was expended by all concerned. In my opinion this investigation achieved little.

In 1975 upon the retirement of the dental superintendent, the board of management appointed an administrator to replace him. The first appointee resigned after a very short period of time and Mr R J Barter then became administrator.

My history of the Dental Hospital closes on, for me, a sad note. The Health Commission decided to amalgamate the School Dental Service and the Dental Hospital. In June, 1982, the new organisation, South Australian Dental Service came into being and Mr Barter returned to Royal Adelaide Hospital.