SPECIAL ARTICLES

Edward H. Angle versus Calvin S. Case: Extraction

I was a graduate student in the Orthodontic De- "Dento-facial Relations" that "caused a great deal of
partment of Boston University at the beginning of the discussion." This publication,2 which emanated from a
1960s. It was an interesting time for orthodontics as symposium entitled "Symposium on Extraction, Sec-
the ideologic extraction / nonextraction battles were ond District Dental Society of New York", featured
mostly over. There were a few, old guard actions to be Calvin Case, the leader of the "rational school" of ortho-
sure, but the main battles had been won. The "no ex- dontics and the apparent chief challenger of the "new
tractions under any circumstances" Angle forces had school," Varney Barnes of Cleveland, Ohio.
been defeated by "extractions when necessary" Case OttolenguP goes on to state: "By this time one might
forces on the strength of argument supported by the almost say that the question of the hour was 'to extract
overwhelming preponderance of countervailing scien- or not to extract?' Many orthodontists were arguing that
tific and clinical evidence. extraction is almost a crime, and even a new word was
The history of this battle, which continues to re- coined for those who ruthlessly [emphasis mine] re-
verberate to this day, is a fascinating chapter in the move sound teeth from so-called crowded arches, and
history of orthodontics. Moreover, it is also an intrigu- we heard much of 'odontocides.' On the other hand
ing window into the minds of intelligent men when men long counted as experts in this branch of work still
ideology replaces rationality, when psychologic make- argued that often, either for reasons of expediency or
up stifles and directs discourse, and when men espouse for actual benefit to the physiognomy, extraction was
positions and concepts that they do not totally follow. permissible and even advisable."
Unfortunately, orthodontics is not the only arena of our The result of this meeting necessitated the arranging
civil life where this type of behavior takes place-as of another for the presentation of both sides and resulted
that is the nature of our being human. The fact that it in the publication of an entire issue of Items of Interest.
did take place in our back yard, so-to-speak, and con- OttolenguP further reports that as a result of this meet-
tinues in other orthodontic subjects, should give us ing "Many men present, after seeing the illustrations
pause, and time for reflection and introspection. on the screen, decided on the moment never to attempt
I will attempt to use an historial mode of devel- the regulation of teeth again, but to refer patients in
opment to show some of the bases of the arguments, future to specialists. Indeed, there is little doubt that
try to correct sorp.e misunderstandings of people and this one meeting did much to establish orthodontia as
events, and present material to corroborate certain po- a separate specialty [emphasis mine]."
sitions that I am placing before you. As you will see, It is interesting to note that even in the early 1900s
some of the questions of the era are not answerable, or there were questions as to how involved general prac-
understandable, up to this time. Perchance this presen- titioners should be in providing orthodontic treatment.
tation will cause others to search archives not seen or For example, Martin Dewey,3 in 1906, wrote an article
made available to me. discussing how much "orthodontia a general practitio-
Let us go over the documentation I have and be ner should do." La plus l1a change, la plus c'est la meme
prepared to take issue with any of the assumptions and chose.
determinations I make. The opening salvos in the literature regarding this
In an article published in 1907 in Items of Interest, controversy go back, for Calvin Case at least, to an
which includes volumes for the years up to 1907, article4 he published in 1905. From the content of the
Ottolengui 1 writes about an article contributed on article, it is evident that the subject of extraction versus
nonextraction had been the subject of other previous
meetings and discussions as noted above. 2 Some fa-
'Clinical Professor of Orthodontics, Boston University School of Graduate
Dentistry. miliarity with Case's thinking and treatment philosophy
8/1/34612 would lead one to believe that he addressed extraction
464
Volume 102 Special article 465
Number 5

needs in an article dealing with the correction of facial reprinted in 1964 in the AMERICAN JOURNAL OF ORTHO-
defonnities published in 1896. 4 That there was contro- DONTICS. 15
versy as early as 1903 is evidenced by an article by In his article, Case sets the stage by entering into
Cases in which he takes issue against the injudicious a discussion of "causes," as he believes it is "intimately
[emphasis mine] extraction of pennanent teeth. bound up" in a discussion of extractions. He claims
A cothinker and supporter of Case, Matthew Cryer, that the writings of the "new school" (Angle) say that
who did battle along side him at the 1911 great debate, the causes of malocclusion are "local," whereas Case
also published an article in 1905. 6 In this article Cryer claims that they "partly at least, arise from the law of
defends the use of extractions, and the content of the heredity and from other laws that govern the develop-
article refers to one published the previous year. ment of plants and animals, and especially to laws that
The battle was evidently of the nature of a world govern the mixture of dissimilar types." From here, he
war as is shown in an article also published in 1911. enters into a dicussion of "Bible theory of creation,"
This article 7 featured an exchange between A. E. Ket- or creationism, versus-but let us look at his words.
cham and T. E. Constant. Ketcham represented the "Upon no other basis but the Bible theory of special
nonextraction or "new school" side, whereas our En- creation can I reconcile the teaching that nature never
glish colleague did battle for the extraction side, which puts teeth into an individual's mouth that do not belong
at least shows that not everything in orthodontics was to his or her physiognomy, etc. While I should dislike
happening only on this side of the Atlantic. to destroy or even weaken the theological belief of any-
In a 1902 article, Angle 8 sets forth his line of rea- one who finds comfort in his religion, I feel that a
soning toward the development of his treatment phi- question of such importance demands the whole truth
losophy. In this article he recounts his conversations from the advanced standpoint [emphasis mine] of evo-
with his friend, the artist Edmund Wuerpel, whose help lution."
led to his concepts of facial beauty and harmony. This is not the first time that Case queried this line
Earlier, in 1887, Angle9 wrote on his new system of thinking. In 1905 he wrote, "But why enter such a
to regulate and retain the teeth. In that same year, the field of doubt, of danger, and of possible failure, merely
first edition of his book JO on the same subject was pub- to satisfy a sentiment that God does not make the mis-
lished. Other editions supposedly followed up to 1897 take of placing in the mouth of the human individual
when the fifth edition, II expanded in scope, came out. more teeth than is necessary for perfect harmony in all
This was followed by the enigmatic sixth edition, 12 physical and aesthetic relations? Why ignore the pos-
which was supposedly withdrawn by Angle from pub- sibility and the frequent undoubted fact that inherited
lication. This edition,12 which has never been referred inharmonies in contiguous structures over which we
to previously in the literature as far as I can tell, and have no control make it impossible for us to place all
seems never to have been referred to in lectures by of the teeth in the arch without fulfilling the designs of
Angle and! or his supporters nor by his opponents, is an inherited defonnity? In my humble estimation it
enigmatic because of the large number of extraction should be the highest aim of the orthodontist to remove
cases presented in it. This sixth edition is the central without hesitation such portions of those naturally pro-
basis and reason for my article and will be referred to duced anatomical disharmonies as are within his reach,
again. However, what is even more fascinating is that and which characterize the principal defonnity, instead
the subsequent seventh edition l3 was completely of attempting to carry out in so limited a degree the
stripped of all the extraction case material present in original designs of the Maker when he fashioned an
the sixth edition. Apollo. "16 (The Apollo reference here is a very so-
Getting back to the extraction!nonextraction ques- phisticated thrust at Angle whose concept of beauty
tion, the battle was really joined in what has become was based on this statue.)
to be known as "The Extraction Debate of 1911." At Later, Case l4 talks about a case that would have
the 1911 meeting of the National Dental Association, produced a marked protrusion with severe facial dis-
Calvin Case l4 presented an article entitled "The Ques- tortion. He rhetorically asks if he should have treated
tion of Extraction in Orthodontia," which was followed without extracting and says, "All for what? To satisfy
by discussions by Matthew H. Cryer, Martin Dewey, an absurd sentiment, that God does not make the same
H. Clay Ferris, J. P. Buckley, G. F. Bowman, and mistake (if one wishes to express it that way!) in the
Thomas P. Hinman. The transactions were printed from number and natural positions of human teeth, as He
the Transactions, National Dental Association for 1911, does repeatedly in other osseous portions of the facial
and from the Dental Cosmos for February, March, and framework; and therefore, as the theory runs, by shift-
September 1912, and January 1913. The articles were ing the crowns of the teeth to nonnal occlusion, it will
 Am. J. Orthod. Dentofac. Orthop.
466 Bernstein
November 1992

be found 'That the full complement of the teeth is nec- porters who would need the anchor of immutable laws.
essary to establish the most pleasing harmony of facial This flavor was also picked up by Bates lS who, as
lines. '" late as 1980, commented on the "debate" papers. Bates
Here we are with Case willing to deal with variation notes that "To begin with, there is a discussion of the
and with the concept that there are not necessarily any theory of evolution versus the theory of special creation.
absolutes as opposed to Angle whose insecurities It is well to remember that both are theories only, and
(which I will try to show by quoted example) demanded neither can be proven even today by scientific method."
that he seek absolutes and to hang on them as dogma, While his observation of the nature of the controversy
much as the proverbial dog hangs onto a bone. is insightful, I would take great issue with Dr. Bates
But what of Angle's thoughts in this area? It is first as to the putative theoretical basis of evolution. The
of all evident from the statements of Angle and his scientific evidence is so overwhelming as to be con-
supporters that their philosophic basis was creationist tested only by the most die-hard creationists. Bates
dogma rather than concordance with Darwinian think- concludes this section of his article by stating that "we
ing. Wuerpel 17 makes reference to Angle's belief system know today that both (Angle and Case) were partially
when he says "The trouble was that his profession was right and that the answer lies in a compromise between
more than a religion to him: it was his religion and his the two opposites of extreme." I, for one, would take
god. It was so sacred there wasn't a thing that was too issue with that statement as there is no doubt that Case's
noble and fine for it. He would sacrifice everything for position has prevailed.
its sake. He always exalted everything that was con- Continuing on to the extraction question, it seems
nected with his profession. He could only see his life that Case's rationale can be stated by the following:
and his work and his devotion in terms of orthodontia. "My objection to this classification (Angle's classifi-
Anything that in the slightest degree lessened one's cation of malocclusions) has arisen from the fact that
attitude of respect toward his profession was wrong." the occlusion or malocclusion of the buccal teeth gives
No doubt commitment is fine, but this smacks of an no indication of the real position of the dentures in
obsessive ideologue, and the history books are full of relation to facial outlines, which, after all, is the only
the harm people like this can do if they get into positions true basis of diagnosis; therefore after determining the
of great power. malocclusion and classifying it under the occlusal head,
In his 1902 article, AngleS states "that my belief is I would still have to find out "what's the matter," in
that if we would confer the greatest benefits upon our order to apply the proper treatment. "14
patients from an aesthetic standpoint we must work Case calls attention to a case he treated, which re-
hand in hand with nature and assist her to establish the sulted in a bimaxillary protrusion, that he was extremely
relations of the teeth as the Creator intended they should unhappy with. He waited a year to see if "developing
be, and not resort to mutilation." growth would harmonize the relations." They did not
Case 14 makes reference to this core of "new school" and he was happy that the parents of the young woman
thinking when he says "These writers do not admit, concurred in his decision to then extract all four first
and they even go so far as to ridicule by absurd and premolars. The results "do not do full justice to the
false examples, the possibility that heredity has had present beauty of the face or the occlusion of the teeth
anything to do in the inharmonies which arises in the of the patient."
sizes and malrelations of the teeth and jaws, or any of It is more than likely that Charles Tweed was fa-
the other bones in the skull. In fact, they deny that such miliar with this article, and this report could have had
inharmonies exist in the natural or normal state-in a great influence on him as this is exactly what Tweed
other words that the union of dissimilar types produces did. Tweed was extremely unhappy with the faces he
in the offspring inharmonies in the sizes, etc., of bones was producing. The idea of treating cases again with
which are so closely related as the teeth and jaws and extractions formed the basis of his further work. His
associate bones." long and arduous journey is described in his 1952 arti-
In reading these articles, one can thus easily come cle. 19 It behooves every orthodontist and student to read
to a belief that there are personal forces operating in this article to understand the enormous commitment in
the positions that these men take, some of which relate time, effort, and energy that Tweed went through to
to creationist versus evolutionary concepts. Again, one arrive at the formulation of what became known as the
has to look at the zeitgeist of the times to realize that Tweed philosophy. I doubt that such a prodigious un-
it was not that far removed from the introduction of dertaking has ever been repeated or is likely to be.
Darwin's and Huxley's concepts. One can theorize that It is enlightening to see what Case had to say about
Case, the scientist, and his supporters would more another area of controversy between his "rational
readily embrace and understand these revolutionary school" and Angle's "new school." Angle's group be-
concepts than the more empirical Angle and his sup- lieved that bone could be induced by mechanical means
Volume 102 Special article 467
Number 5

to grow beyond its inherent size, especially the man- African continent with the arrival of the white man can
dible. Case's group believed otherwise. Let us look at hardly be lauded as the actions of "a higher race."
Case's words and see if some current proponents of The comments by the other speakers on Case's pre-
this concept with their supposed scientific evidence will sentation are of historical interest and add little of im-
undergo some revisionism in this area. Case wrote that portance except that they give the flavor of the times.
"The correctness of the statement that the mandible will The comments by Deweyl4 are the most interesting as
grow to a harmonizing size will depend entirely upon Dewey was renowned as an expert debater, and he
whether it has been stunted in normal growth devel- certainly went for the jugular in going after Case. In
opment, which is quitely improbable, unless we aSSume my opinion, Dewey, after all his sound and fury, was
the absurdity that the same cause at the same time not able to make any points on Case. Case's response
produced the over-development of the upper jaw. Mal- to Dewey is as elegant a piece as his opening lecture.
relations of this character point directly to heredity. The At the end of his rebuttal, he makes reference to what
claim and recently repeated inference that the mandible seems to be a recurring theme with all of the nonex-
can be made to grow by artificial stimuli beyond its traction adherents; and that is that they all admit to
inherent size is not in accord with any law of organic doing it, albeit with a lot of caveats. Case sums up by
development."14 Baring future chemical or genetic ma- saying "It is certainly not a far-fetched belief, as stated
nipulation, this still appears to be a valid principle, in my paper (if the truth be known), that nearly all
although there are others who march to a different drum- experienced orthodontists of whatever school extract
mer, as we are all aware. teeth in the correction of all the marked protrusions for
Bates l8 in discussing this aspect of the debate, says which I claim extraction is demanded. Then why not
that "However, there is at hand prominent research in come out frankly, and openly acknowledge, in their
this subject indicating very slight (Y8 inch) growth of papers and on the floors of conventions, that which they
bone upon induction." Not only is the evidence ex- feel they must do in private practice for their patients
tremely tenuous, but many question it, and others, like and for their own reputations."14
myself and Graber, think that the therapy based on it The tide really started running in the other direction
was oversold. Even Gianelly, who, along with his co- after the presentation of the concepts of Charles
workers at Boston University, has done a major portion Tweed. 19.20·22 He wrote an article in 1941 on the edge-
of the research on this subject says more in frustration wise arch,20 but it was the case he re-treated with ex-
than conviction, "alright, maybe I will give you at most tractions that did it. In 1945 he presented his philosophy
1 millimeter," and he will readily admit to the difficulty of treatmene 2 and reinforced his commitment to the
in measuring that millimeter. Later in the article, on necessity of extractions in his 1952 article on why he
this same subject, Case writes that "While the rapidity extracts teeth in certain types of cases. 19 In this article,
of their early growth may be hastened, while inhibited which should be read by every student or practitioner
developments may be stimulated to normal growth, and interested in the history of orthodontics, Tweed docu-
while the forms of the bones may be varied slightly by ments the intellectual and practical journey he under-
bending [emphasis mine], I doubt if it has ever been took from his first questioning in 1934 to the publication
authentically proved that natural or artificial forces have of this article.
made them grow interstitially longer than their inherent Orthodontics was now free to progress into new
normal size.''l4 areas of scientific research and technologic advance,
Case himself would hopefully undergo some revi- aided by breakthroughs in biologic, physical, and chem-
sionism in light of today's understanding with a state- ical discoveries. And yet, there was still a dynamic
ment he makes that can only be labeled as racial ego- question not so much on the role of extractions but
tism. Case makes an observation that the white race is more to the "proper" role of this procedure. In the past
so mixed now that there are few representatives left of we heard such expressions as "when in doubt, whip
the original Caucasions. He goes on to say, "Yet be- them out" to "four on the floor." Currently, these state-
cause of the fact that our tastes and appreciation of ments are no longer bandied about. The assumption is
these qualities are being varied under the same adaptive that trained orthodontists will do a careful analysis of
guiding forces of evolution which have characterized each problem presented and make decisions on the basis
the physical, we not uncommonly meet with types of their scientific and clinical training, their clinical
which fully accord with our understanding of manly experience, their familiarity with the literature, and, if
beauty and perfection, which I presume was also true necessary, consultation with their peers. Even so, there
of the Hottentots, before their land was visited by a are practitioners who change their criteria in both di-
higher race. "14 I assume here that Case, in writing of rections as different forces work on their decision-
a "higher race," is referring to the white Europeans. making processes. Some do statistical analysis on the
However, what transpired on the negroid part of the percentage of cases treated by extractions, and the
 Am. J. Orthod. Dentafae. Orthop.
468 Bernstein
November 1992

stated results show, as one would expect, variation of Unfortunately, some more recent bone-grower pro-
proportions. We have, according to Graber in a letter ponents did not listen to Case. Had they done so, it
dated April 1991, Wick Alexander who claims that he may have spared our specialty a lot of controversy and
now has about 10% extraction cases and Norman Cetlin the public a lot of treasure.
who went from 95% extraction to zero-only, as Gra- Dewel goes on to make a defense of Angle when
ber points out, when Cetlin is questioned about this, he states that:
he says he will not accept extraction cases. So the
pendulum continues to swing, as it should in any dis- "His (Angle's) was the good fight to offset extremism in
cipline purporting to base itself on scientific knowledge. extraction, and what he said needed to be said. Extraction
had not only been rampant prior to his time: it also had
The advances could be maintained by reading the
been practiced on an empirical basis with little thought
articles published in the AMERICAN JOURNAL OF to the functional problems that follow irrational ex-
ORTHODONTICS (as it was known then), other publi- traction."
cations, and by attending presentations at meetings like
the Annual Session of the American Association of It is unfortunate that there are no references as to
Orthodontists. The battles of old now became the stuff the extent of the use of extractions by early, empirically
of folklore, with stories passed along about the old trained workers or to what constituted rampant use.
battles and their participants. These were the battles The argument could be made that these early practitio-
that literally tore the specialty apart. Very soon, first- ners were simply doing problem solving to the best of
hand accounts, as they passed and were told second-, their abilities on the basis of their knowledge at the
third- and beyond-hand, became the stuff of myths. time, thinking out for themselves the best way to
The problem with myths is that they often do not fit achieve a reasonable goal. There is most likely no doubt
the facts of what actually happened. Much of what gets that since their decisions were empiric and that there
written down has been ideologically cleansed and be- were probably many unscrupulous practitioners, many
comes accepted dogma. Such is what seems to have results were terrible. Dewel also states that "Angle was
occurred in some of the mythology surrounding Edward not a man to compromise with his ideals."23 Yet, what
H. Angle (1855-1930) and especially that relating to is it other than compromising of ideals when you look
Angle's position on the use of extractions in the treat- at the printed record of the sixth edition compared with
ment of malocclusions. As we have and shall see, it Angle's much reported position. Folklore told me that
appears that Angle himself did some ideologic revi- Angle's position was the result of an ego conflict with
sionism, but the stated dogma became the accepted Calvin Case?
gospel by the faithful. More recently, Asbell,24 in an article entitled "A
Since the disciples of a perceived prophet are often Brief History of Orthodontics" makes specific reference
more religious than the master, it is not hard to under- to Angle's putative position and quotes references to
stand how the battle lines came to be drawn and, in support this thesis. In fact, it was this article by Asbell
retrospect, to see how the battle would eventually that led me to the belief that the book that I had in my
evolve. library, the sixth edition of the text that Angle entitled
The putative position of Angle on extractions has "Treatment of Malocclusion of the Teeth and Fractures
been well documented in the historic record. Dewel,23 of the Maxillae. Angle's System," was not as well
past editor of the AMERICAN JOURNAL OF ORTHODON- known as I had supposed. Not only might it not have
TICS, was kind enough to send me a reprint of his article, been well known, but I began to question whether any-
"The Case-Dewey-Cryer Extraction Debate: A Com- one beside myself even had a copy of this book. The
mentary," which appeared in the JOURNAL in 1964. For flyleaf of the the book states that it is the "Sixth edition,
those interested in the history of orthodontics, the article greatly enlarged and entirely rewritten, with two hun-
is well worth reading. In this article, Dewel states, dred and ninety-nine illustrations." Although it further
writing about Angle and Case, that: states that it was published in 1900, in Philadelphia,
by The S.S. White Manufacturing Company, the copy-
"Their chief difference was in the indications and need rights are 1898 and 1900. The book is also signed and
for premolar extraction in the treatment of malocclusion, stamped by the original owner, Dr. Robert H. Nones,
and the controversy was extensive, bitter, and irrecon-
1708 Chestnut St., Philadelphia, Penn., and dated Nov.
cilable. Angle's contention was that there is no place for
5, 1900.
extractions in orthodontics, and this was the basic precept
of his 'new school' in the specialty. Case countered with
Graber 5 states that the 1887 first edition of Angle's
what he called the 'rational school', the basis for which book lO was a paperbound one, and he makes reference
was that 'new bone cannot be induced to grow beyond to the fifth edition ll published in 1897. Graber 5 makes
its inherent size and that, therefore, there are indications reference also to the seventh edition 13 which was fully
for extractions in certain forms of malocclusion." revised and published in 1907. I have not as yet come
Volume 102 Special article 469
Number 5

across any article that makes reference to the sixth of the lower incisor having to be upright over basal
edition. 12 bone.
What is unique about the sixth edition is that it Margolis used to tell us that he got the idea for his
contains an enormous amount of material and case re- research on this concept as he was driving in an au-
ports in which the extraction of teeth was involved to tomobile with Tweed (I will expand on this further on
solve orthodontic treatment problems. in the text). Thus was born the seed of Margolis's
The reason why only this edition contains this ma- research and the scientific validity of Tweeds concept.
terial, what happened to it, and why the subsequent I still think that Margolis's further conceptualization,
seventh edition not only had none of this material in it based on Tweed's upright idea, of the variation of the
but inveighed against the use of extractions, forms the incisor-mandibular plane angle for different mandibular
raison d'etre of this article. growth patterns (from high angle to low angle) with
It is interesting to note how I happened to acquire the relation of the cingulum of the lower central incisor
a copy of this sixth edition. In the early years at Boston to the nasion-pogonion plane is still the most singularly
University (the first programs started in 1959), there useful diagnostic aid for clinical treatment decisions.
were only residency programs at the postgraduate level, Margolis was one of the early workers in cepha-
and these were in orthodontics, endodontics, periodon- lometrics and one of the first to produce a cephalostat.
tics, oral pathology, oral surgery, and a one-year pro- The story around all this is worth relating because of
gram for the then oral surgery didactic training prereq- the importance of the incisor mandibular plane angle
uisite. Henry M. Goldman, a periodontist and founder to the substantiation of Tweed's concepts.
of the school, had not yet received a charter from the After Margolis finished his orthodontic training at
Trustees of Boston University to found a postdoctoral the Dewey School in New York, he came back to Boston
or predoctoral school. The whole program was, for the to practice. He also wanted to teach in the orthodontic
first few years, under the aegis of the medical school department at Harvard Dental School. (According to
as the Department of Stomatology of the Boston Uni- stories I heard as a student, this was putatively a never
versity Medical School. consummated life ambition of this complex man.) As
During this period, the periodontal students spent there was no opening in the dental school, he accepted
their first year at the University of Pennsylvania and an appointment in the anthropology department, and
their second year at Boston University. The department thus became friends with Professor Earnest A. Hooten,
was very small in those days, everyone got to know head of the Anthropology Department. Hooten had a
everyone else, and I became friends with one of the large collection of human skulls from all age groups.
periodontal residents. One day he showed me this text Thus Margolis had access to these many skulls that he
of Angle's that he had obtained for a small sum from used in his cephalometry research. To expand more
a group of books that the library of the University of fully on the tale that Margolis used to tell, the story
Pennsylvania no longer wanted and were selling. He goes that Margolis was riding in a car driven by Tweed,
said he had no use for it and thus gave it to me without and Tweed was saying that the "lower incisors had to
either of us realizing its significance. be upright over basal bone" while indicating with a
I did read through it and came to realize that Angle hand gesture what he meant. Tweed had no specific
was not the extreme opponent of extractions as everyone answer for Margolis as to what that meant. Tweed 19
assumed and further assumed that everyone knew this. states that he learned visually to relate the lower incisors
It did puzzle me when I came across references or to the body of the mandible by doing "sagittal sections
stories about the bitter extraction/nonextraction battles. (of the plaster casts) of all his cases for a period of 5
I felt that many other people must have copies of this or 6 years." As a result, Margolis did his work, which
book and could not understand why references were culminated in the publishing of his article on the sub-
not made to it. It thus remained in my library, mostly ject. 27 Tweed 19 credits Margolis by stating: "It remained
forgotten and only occasionally thought of when Angle for Margolis, at a later date, to scientifically relate them
references were made or anecdotes related. to the lower border of the mandible."
While I was a student at Boston University, and After all the formal lectures, seminars, and clinical
while Herbert I. Margolis was chairman, the program sessions, there was always time and incidents of in-
included as part of its faculty people such as Robert formal get-togethers, such as plain old "bull-sessions"
Strang and Arthur Greenstein, as well as visiting cli- to lunches and dinners and even a little elbow-bending
nicians such as Charles Tweed. Greenstein 26 even pub- at a pub.
lished a paper on the "The Tweed Philosophy" in 1943, From, and as a result of, all these people being at
which was only two years later than Tweed's own pa- Boston University, along with my older brother, Murray
per. 20 Tweed was a good friend of Margolis, and it was Bernstein, who did his orthodontic training under Mar-
Margolis27 who gave scientific validity to the concept golis at Tufts Dental School in the early fifties, I was
470 Bernstein Am. 1. Orthod. Dentofae. Orthop.
November 1992

told some of the stories, now called "oral history," of in it. Be that as it may, the elastic issue was finally put
some of the early greats in orthodontics, including An- to rest at the end of Case's article when he makes
gle. Staying with the extraction/nonextraction contro- reference to an article by Angle 30 in which Angle notes
versy, I will relate, in a digested and third-hand form, that the use of elastics was introduced to him by Baker
the stories that were told to me. but that Case had published on their use in 1893. Angle
The story about extractions that came to me was concludes the paragraph by saying "Which of these
that Angle was not always opposed to the need and use gentlemen was the first to use it, I know not; but be
of extractions in treatment. He dramatically changed that as it may, I am certain that it is one of the most
his position when he became involved in a controversy valuable additions to modem orthodontia." While it is
with Calvin Case (supposedly the Case/Baker first use possible, it does not seem conceivable that this event
of intermaxillary elastics brouhaha) who did advocate could have been the cause of all the controversy that
the use of extractions. Case's position can be read in became the hallmark of these two men.
the reprinted edition of his book28 that I have, entitled, While Case was certainly an advocate of extrac-
A Practical Treatise on the Technics and Principles of tions, DeweF3 points out that in today's parlance, he
Dental Orthopedia and Prosthetic Correction of Cleft would be considered quite conservative. In his book,
Palate, which was originally published in 1921. The re- Case, on page 83, makes reference to the paper he
printed edition I have of Case's book, the second edi- presented to the National Dental Association in 1911
tion, was reproduced by an old scientific book dealer, in which he stated that in his own practice, "there was
Leo L. Bruder of New York City, New York. It was only about 1 case in 12 to 15 in which the question of
reprinted in 1963, and I purchased it that same year. extraction should ever arise. "28
The first edition of Case's book was published in 1908, All assumptions would indicate that the controversy
the year after Angle's seventh edition, and was titled, with Angle must have started about the time of the
Dental Orthopedia. Dewe1 presents a quote from Case publication of Angle's sixth edition, as I was told that
that he says shows Case to great advantage for he (Case) in his earlier editions, there was no mention of the role
defends Angle and himself and gives Angle credit; "for of extractions in therapy. Perhaps Case was making too
it was his hand which unloosened the pendulum from big a name for himself in putting forth the extraction
the disgraceful grasp of extracting malpractice. "23 The philosophy and Angle was doing a slow bum. Perhaps
rest of the quote says that Angle sent the pendulum on he then decided to stress the nonextraction route coin-
the right way, but he sent it too far, although the extra cidently at about the time his sixth edition was hitting
push was probably necessary. This does not mean that the street and took it off the market. However, not at
there were not bitter feelings between them for in the least before Dr. Nones, who lived in Philadelphia where
"Preface to Second Edition," (pg. ix), Case writes that it was published, was able to get hold of a copy. I
"Dr. Angle has truly observed: 'To fair minds, recorded always assumed that there must be other copies of the
dates are usually sufficient evidence of priority'. Un- sixth edition available, and so I always found it puzzling
fortunately, this rule has not always been strictly ob- that the folklore and presentations about Angle being
served. "27 This refers to Case's contention that Angle absolutely opposed to extractions was not refuted by
was claiming credit for the results of work done by citing references to the sixth edition. When the copy
Case. The point at issue here is that Case 29 takes issue of the sixth edition was given to me, the evidence was
with the claim in Angle's book that he (Angle) learned there to see in print.
about the use of intermaxillary elastics from H. A. The stories related to me were that Angle, whose
Baker of Boston who claimed he was the originator of egotistical and explosive personality has been well doc-
their use. Case writes that his "paper detailing this umented, became so incensed in this controversy with
whole principal, with illustrations, was published in the Case that he had the sixth edition withdrawn from pub-
proceedings of the Columbian Dental Congress of 1893, lication, to be substituted by the seventh and later, as
and earlier in the Dental Record, 7 or 8 years before the folklore told to me had it, an eighth edition.
the publication of his book. " From 1893, with the men- I have been informed in a letter from T. M. Graber
tioned 7 or 8 years, would bring the date up to 1900, that the later editions of Angle's work were not true
the year of Angle's sixth edition. It still is inconceivable editions and that he was not aware that there was an
that this is the edition that Case is referring to, as if he eighth edition; indeed there may not be, such is the
had been familiar with it, he most certainly would have nature of folklore.
made use of the extraction case material that Angle had