SPECIAL ARTICLES
Edward H. Angle versus Calvin S. Case: Extraction
versus nonextraction. Part I. Historical revisionism
Leonard Bernstein, DMD*
Brookline, Mass.
I was a graduate student in the Orthodontic De-
partment of Boston University at the beginning of the
1960s. It was an interesting time for orthodontics as
the ideologic extraction / nonextraction battles were
mostly over. There were a few, old guard actions to be
sure, but the main battles had been won. The "no ex-
tractions under any circumstances" Angle forces had
been defeated by "extractions when necessary" Case
forces on the strength of argument supported by the
overwhelming preponderance of countervailing scien-
tific and clinical evidence.
The history of this battle, which continues to re-
verberate to this day, is a fascinating chapter in the
history of orthodontics. Moreover, it is also an intrigu-
ing window into the minds of intelligent men when
ideology replaces rationality, when psychologic make-
up stifles and directs discourse, and when men espouse
positions and concepts that they do not totally follow.
Unfortunately, orthodontics is not the only arena of our
civil life where this type of behavior takes place-as
that is the nature of our being human. The fact that it
did take place in our back yard, so-to-speak, and con-
tinues in other orthodontic subjects, should give us
pause, and time for reflection and introspection.
I will attempt to use an historial mode of devel-
opment to show some of the bases of the arguments,
try to correct sorp.e misunderstandings of people and
events, and present material to corroborate certain po-
sitions that I am placing before you. As you will see,
some of the questions of the era are not answerable, or
understandable, up to this time. Perchance this presen-
tation will cause others to search archives not seen or
made available to me.
Let us go over the documentation I have and be
prepared to take issue with any of the assumptions and
determinations I make.
In an article published in 1907 in Items of Interest,
which includes volumes for the years up to 1907,
Ottolengui 1 writes about an article contributed on
'Clinical Professor of Orthodontics, Boston University School of Graduate
Dentistry.
8/1/34612
464
"Dento-facial Relations" that "caused a great deal of
discussion." This publication,2 which emanated from a
symposium entitled "Symposium on Extraction, Sec-
ond District Dental Society of New York", featured
Calvin Case, the leader of the "rational school" of ortho-
dontics and the apparent chief challenger of the "new
school," Varney Barnes of Cleveland, Ohio.
OttolenguP goes on to state: "By this time one might
almost say that the question of the hour was 'to extract
or not to extract?' Many orthodontists were arguing that
extraction is almost a crime, and even a new word was
coined for those who ruthlessly [emphasis mine] re-
move sound teeth from so-called crowded arches, and
we heard much of 'odontocides.' On the other hand
men long counted as experts in this branch of work still
argued that often, either for reasons of expediency or
for actual benefit to the physiognomy, extraction was
permissible and even advisable."
The result of this meeting necessitated the arranging
of another for the presentation of both sides and resulted
in the publication of an entire issue of Items of Interest.
OttolenguP further reports that as a result of this meet-
ing "Many men present, after seeing the illustrations
on the screen, decided on the moment never to attempt
the regulation of teeth again, but to refer patients in
future to specialists. Indeed, there is little doubt that
this one meeting did much to establish orthodontia as
a separate specialty [emphasis mine]."
It is interesting to note that even in the early 1900s
there were questions as to how involved general prac-
titioners should be in providing orthodontic treatment.
For example, Martin Dewey,3 in 1906, wrote an article
discussing how much "orthodontia a general practitio-
ner should do." La plus l1a change, la plus c'est la meme
chose.
The opening salvos in the literature regarding this
controversy go back, for Calvin Case at least, to an
article4 he published in 1905. From the content of the
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-
miliarity with Case's thinking and treatment philosophy
would lead one to believe that he addressed extraction
Volume 102
Number 5
needs in an article dealing with the correction of facial
defonnities published in 1896. 4 That there was contro-
versy as early as 1903 is evidenced by an article by
Cases in which he takes issue against the injudicious
[emphasis mine] extraction of pennanent teeth.
A cothinker and supporter of Case, Matthew Cryer,
who did battle along side him at the 1911 great debate,
also published an article in 1905. 6 In this article Cryer
defends the use of extractions, and the content of the
article refers to one published the previous year.
The battle was evidently of the nature of a world
war as is shown in an article also published in 1911.
This article 7 featured an exchange between A. E. Ket-
cham and T. E. Constant. Ketcham represented the
nonextraction or "new school" side, whereas our En-
glish colleague did battle for the extraction side, which
at least shows that not everything in orthodontics was
happening only on this side of the Atlantic.
In a 1902 article, Angle 8 sets forth his line of rea-
soning toward the development of his treatment phi-
losophy. In this article he recounts his conversations
with his friend, the artist Edmund Wuerpel, whose help
led to his concepts of facial beauty and harmony.
Earlier, in 1887, Angle9 wrote on his new system
to regulate and retain the teeth. In that same year, the
first edition of his book JO on the same subject was pub-
lished. Other editions supposedly followed up to 1897
when the fifth edition, II expanded in scope, came out.
This was followed by the enigmatic sixth edition, 12
which was supposedly withdrawn by Angle from pub-
lication. This edition,12 which has never been referred
to previously in the literature as far as I can tell, and
seems never to have been referred to in lectures by
Angle and! or his supporters nor by his opponents, is
enigmatic because of the large number of extraction
cases presented in it. This sixth edition is the central
basis and reason for my article and will be referred to
again. However, what is even more fascinating is that
the subsequent seventh edition l3 was completely
stripped of all the extraction case material present in
the sixth edition.
Getting back to the extraction!nonextraction ques-
tion, the battle was really joined in what has become
to be known as "The Extraction Debate of 1911." At
the 1911 meeting of the National Dental Association,
Calvin Case l4 presented an article entitled "The Ques-
tion of Extraction in Orthodontia," which was followed
by discussions by Matthew H. Cryer, Martin Dewey,
H. Clay Ferris, J. P. Buckley, G. F. Bowman, and
Thomas P. Hinman. The transactions were printed from
the Transactions, National Dental Association for 1911,
and from the Dental Cosmos for February, March, and
September 1912, and January 1913. The articles were
Special article 465
reprinted in 1964 in the AMERICAN JOURNAL OF ORTHO-
DONTICS. 15
In his article, Case sets the stage by entering into
a discussion of "causes," as he believes it is "intimately
bound up" in a discussion of extractions. He claims
that the writings of the "new school" (Angle) say that
the causes of malocclusion are "local," whereas Case
claims that they "partly at least, arise from the law of
heredity and from other laws that govern the develop-
ment of plants and animals, and especially to laws that
govern the mixture of dissimilar types." From here, he
enters into a dicussion of "Bible theory of creation,"
or creationism, versus-but let us look at his words.
"Upon no other basis but the Bible theory of special
creation can I reconcile the teaching that nature never
puts teeth into an individual's mouth that do not belong
to his or her physiognomy, etc. While I should dislike
to destroy or even weaken the theological belief of any-
one who finds comfort in his religion, I feel that a
question of such importance demands the whole truth
from the advanced standpoint [emphasis mine] of evo-
lution."
This is not the first time that Case queried this line
of thinking. In 1905 he wrote, "But why enter such a
field of doubt, of danger, and of possible failure, merely
to satisfy a sentiment that God does not make the mis-
take of placing in the mouth of the human individual
more teeth than is necessary for perfect harmony in all
physical and aesthetic relations? Why ignore the pos-
sibility and the frequent undoubted fact that inherited
inharmonies in contiguous structures over which we
have no control make it impossible for us to place all
of the teeth in the arch without fulfilling the designs of
an inherited defonnity? In my humble estimation it
should be the highest aim of the orthodontist to remove
without hesitation such portions of those naturally pro-
duced anatomical disharmonies as are within his reach,
and which characterize the principal defonnity, instead
of attempting to carry out in so limited a degree the
original designs of the Maker when he fashioned an
Apollo. "16 (The Apollo reference here is a very so-
phisticated thrust at Angle whose concept of beauty
was based on this statue.)
Later, Case l4 talks about a case that would have
produced a marked protrusion with severe facial dis-
tortion. He rhetorically asks if he should have treated
without extracting and says, "All for what? To satisfy
an absurd sentiment, that God does not make the same
mistake (if one wishes to express it that way!) in the
number and natural positions of human teeth, as He
does repeatedly in other osseous portions of the facial
framework; and therefore, as the theory runs, by shift-
ing the crowns of the teeth to nonnal occlusion, it will

466 Bernstein
be found 'That the full complement of the teeth is nec-
essary to establish the most pleasing harmony of facial
lines. '"
Here we are with Case willing to deal with variation
and with the concept that there are not necessarily any
absolutes as opposed to Angle whose insecurities
(which I will try to show by quoted example) demanded
that he seek absolutes and to hang on them as dogma,
much as the proverbial dog hangs onto a bone.
But what of Angle's thoughts in this area? It is first
of all evident from the statements of Angle and his
supporters that their philosophic basis was creationist
dogma rather than concordance with Darwinian think-
ing. Wuerpel 17 makes reference to Angle's belief system
when he says "The trouble was that his profession was
more than a religion to him: it was his religion and his
god. It was so sacred there wasn't a thing that was too
noble and fine for it. He would sacrifice everything for
its sake. He always exalted everything that was con-
nected with his profession. He could only see his life
and his work and his devotion in terms of orthodontia.
Anything that in the slightest degree lessened one's
attitude of respect toward his profession was wrong."
No doubt commitment is fine, but this smacks of an
obsessive ideologue, and the history books are full of
the harm people like this can do if they get into positions
of great power.
In his 1902 article, AngleS states "that my belief is
that if we would confer the greatest benefits upon our
patients from an aesthetic standpoint we must work
hand in hand with nature and assist her to establish the
relations of the teeth as the Creator intended they should
be, and not resort to mutilation."
Case 14 makes reference to this core of "new school"
thinking when he says "These writers do not admit,
and they even go so far as to ridicule by absurd and
false examples, the possibility that heredity has had
anything to do in the inharmonies which arises in the
sizes and malrelations of the teeth and jaws, or any of
the other bones in the skull. In fact, they deny that such
inharmonies exist in the natural or normal state-in
other words that the union of dissimilar types produces
in the offspring inharmonies in the sizes, etc., of bones
which are so closely related as the teeth and jaws and
associate bones."
In reading these articles, one can thus easily come
to a belief that there are personal forces operating in
the positions that these men take, some of which relate
to creationist versus evolutionary concepts. Again, one
has to look at the zeitgeist of the times to realize that
it was not that far removed from the introduction of
Darwin's and Huxley's concepts. One can theorize that
Case, the scientist, and his supporters would more
readily embrace and understand these revolutionary
concepts than the more empirical Angle and his sup-
Am. J. Orthod. Dentofac. Orthop.
November 1992
porters who would need the anchor of immutable laws.
This flavor was also picked up by Bates lS who, as
late as 1980, commented on the "debate" papers. Bates
notes that "To begin with, there is a discussion of the
theory of evolution versus the theory of special creation.
It is well to remember that both are theories only, and
neither can be proven even today by scientific method."
While his observation of the nature of the controversy
is insightful, I would take great issue with Dr. Bates
as to the putative theoretical basis of evolution. The
scientific evidence is so overwhelming as to be con-
tested only by the most die-hard creationists. Bates
concludes this section of his article by stating that "we
know today that both (Angle and Case) were partially
right and that the answer lies in a compromise between
the two opposites of extreme." I, for one, would take
issue with that statement as there is no doubt that Case's
position has prevailed.
Continuing on to the extraction question, it seems
that Case's rationale can be stated by the following:
"My objection to this classification (Angle's classifi-
cation of malocclusions) has arisen from the fact that
the occlusion or malocclusion of the buccal teeth gives
no indication of the real position of the dentures in
relation to facial outlines, which, after all, is the only
true basis of diagnosis; therefore after determining the
malocclusion and classifying it under the occlusal head,
I would still have to find out "what's the matter," in
order to apply the proper treatment. "14
Case calls attention to a case he treated, which re-
sulted in a bimaxillary protrusion, that he was extremely
unhappy with. He waited a year to see if "developing
growth would harmonize the relations." They did not
and he was happy that the parents of the young woman
concurred in his decision to then extract all four first
premolars. The results "do not do full justice to the
present beauty of the face or the occlusion of the teeth
of the patient."
It is more than likely that Charles Tweed was fa-
miliar with this article, and this report could have had
a great influence on him as this is exactly what Tweed
did. Tweed was extremely unhappy with the faces he
was producing. The idea of treating cases again with
extractions formed the basis of his further work. His
long and arduous journey is described in his 1952 arti-
cle. 19 It behooves every orthodontist and student to read
this article to understand the enormous commitment in
time, effort, and energy that Tweed went through to
arrive at the formulation of what became known as the
Tweed philosophy. I doubt that such a prodigious un-
dertaking has ever been repeated or is likely to be.
It is enlightening to see what Case had to say about
another area of controversy between his "rational
school" and Angle's "new school." Angle's group be-
lieved that bone could be induced by mechanical means
Volume 102
Number 5
to grow beyond its inherent size, especially the man-
dible. Case's group believed otherwise. Let us look at
Case's words and see if some current proponents of
this concept with their supposed scientific evidence will
undergo some revisionism in this area. Case wrote that
"The correctness of the statement that the mandible will
grow to a harmonizing size will depend entirely upon
whether it has been stunted in normal growth devel-
opment, which is quitely improbable, unless we aSSume
the absurdity that the same cause at the same time
produced the over-development of the upper jaw. Mal-
relations of this character point directly to heredity. The
claim and recently repeated inference that the mandible
can be made to grow by artificial stimuli beyond its
inherent size is not in accord with any law of organic
development."14 Baring future chemical or genetic ma-
nipulation, this still appears to be a valid principle,
although there are others who march to a different drum-
mer, as we are all aware.
Bates l8 in discussing this aspect of the debate, says
that "However, there is at hand prominent research in
this subject indicating very slight (Y8 inch) growth of
bone upon induction." Not only is the evidence ex-
tremely tenuous, but many question it, and others, like
myself and Graber, think that the therapy based on it
was oversold. Even Gianelly, who, along with his co-
workers at Boston University, has done a major portion
of the research on this subject says more in frustration
than conviction, "alright, maybe I will give you at most
1 millimeter," and he will readily admit to the difficulty
in measuring that millimeter. Later in the article, on
this same subject, Case writes that "While the rapidity
of their early growth may be hastened, while inhibited
developments may be stimulated to normal growth, and
while the forms of the bones may be varied slightly by
bending [emphasis mine], I doubt if it has ever been
authentically proved that natural or artificial forces have
made them grow interstitially longer than their inherent
normal size.''l4
Case himself would hopefully undergo some revi-
sionism in light of today's understanding with a state-
ment he makes that can only be labeled as racial ego-
tism. Case makes an observation that the white race is
so mixed now that there are few representatives left of
the original Caucasions. He goes on to say, "Yet be-
cause of the fact that our tastes and appreciation of
these qualities are being varied under the same adaptive
guiding forces of evolution which have characterized
the physical, we not uncommonly meet with types
which fully accord with our understanding of manly
beauty and perfection, which I presume was also true
of the Hottentots, before their land was visited by a
higher race. "14 I assume here that Case, in writing of
a "higher race," is referring to the white Europeans.
However, what transpired on the negroid part of the
Special article 467
African continent with the arrival of the white man can
hardly be lauded as the actions of "a higher race."
The comments by the other speakers on Case's pre-
sentation are of historical interest and add little of im-
portance except that they give the flavor of the times.
The comments by Deweyl4 are the most interesting as
Dewey was renowned as an expert debater, and he
certainly went for the jugular in going after Case. In
my opinion, Dewey, after all his sound and fury, was
not able to make any points on Case. Case's response
to Dewey is as elegant a piece as his opening lecture.
At the end of his rebuttal, he makes reference to what
seems to be a recurring theme with all of the nonex-
traction adherents; and that is that they all admit to
doing it, albeit with a lot of caveats. Case sums up by
saying "It is certainly not a far-fetched belief, as stated
in my paper (if the truth be known), that nearly all
experienced orthodontists of whatever school extract
teeth in the correction of all the marked protrusions for
which I claim extraction is demanded. Then why not
come out frankly, and openly acknowledge, in their
papers and on the floors of conventions, that which they
feel they must do in private practice for their patients
and for their own reputations."14
The tide really started running in the other direction
after the presentation of the concepts of Charles
Tweed. 19.20·22 He wrote an article in 1941 on the edge-
wise arch,20 but it was the case he re-treated with ex-
tractions that did it. In 1945 he presented his philosophy
of treatmene 2 and reinforced his commitment to the
necessity of extractions in his 1952 article on why he
extracts teeth in certain types of cases. 19 In this article,
which should be read by every student or practitioner
interested in the history of orthodontics, Tweed docu-
ments the intellectual and practical journey he under-
took from his first questioning in 1934 to the publication
of this article.
Orthodontics was now free to progress into new
areas of scientific research and technologic advance,
aided by breakthroughs in biologic, physical, and chem-
ical discoveries. And yet, there was still a dynamic
question not so much on the role of extractions but
more to the "proper" role of this procedure. In the past
we heard such expressions as "when in doubt, whip
them out" to "four on the floor." Currently, these state-
ments are no longer bandied about. The assumption is
that trained orthodontists will do a careful analysis of
each problem presented and make decisions on the basis
of their scientific and clinical training, their clinical
experience, their familiarity with the literature, and, if
necessary, consultation with their peers. Even so, there
are practitioners who change their criteria in both di-
rections as different forces work on their decision-
making processes. Some do statistical analysis on the
percentage of cases treated by extractions, and the

468 Bernstein
stated results show, as one would expect, variation of
proportions. We have, according to Graber in a letter
dated April 1991, Wick Alexander who claims that he
now has about 10% extraction cases and Norman Cetlin
who went from 95% extraction to zero-only, as Gra-
ber points out, when Cetlin is questioned about this,
he says he will not accept extraction cases. So the
pendulum continues to swing, as it should in any dis-
cipline purporting to base itself on scientific knowledge.
The advances could be maintained by reading the
articles published in the AMERICAN JOURNAL OF
ORTHODONTICS (as it was known then), other publi-
cations, and by attending presentations at meetings like
the Annual Session of the American Association of
Orthodontists. The battles of old now became the stuff
of folklore, with stories passed along about the old
battles and their participants. These were the battles
that literally tore the specialty apart. Very soon, first-
hand accounts, as they passed and were told second-,
third- and beyond-hand, became the stuff of myths.
The problem with myths is that they often do not fit
the facts of what actually happened. Much of what gets
written down has been ideologically cleansed and be-
comes accepted dogma. Such is what seems to have
occurred in some of the mythology surrounding Edward
H. Angle (1855-1930) and especially that relating to
Angle's position on the use of extractions in the treat-
ment of malocclusions. As we have and shall see, it
appears that Angle himself did some ideologic revi-
sionism, but the stated dogma became the accepted
gospel by the faithful.
Since the disciples of a perceived prophet are often
more religious than the master, it is not hard to under-
stand how the battle lines came to be drawn and, in
retrospect, to see how the battle would eventually
evolve.
The putative position of Angle on extractions has
been well documented in the historic record. Dewel,23
past editor of the AMERICAN JOURNAL OF ORTHODON-
TICS, was kind enough to send me a reprint of his article,
"The Case-Dewey-Cryer Extraction Debate: A Com-
mentary," which appeared in the JOURNAL in 1964. For
those interested in the history of orthodontics, the article
is well worth reading. In this article, Dewel states,
writing about Angle and Case, that:
"Their chief difference was in the indications and need
for premolar extraction in the treatment of malocclusion,
and the controversy was extensive, bitter, and irrecon-
cilable. Angle's contention was that there is no place for
extractions in orthodontics, and this was the basic precept
of his 'new school' in the specialty. Case countered with
what he called the 'rational school', the basis for which
was that 'new bone cannot be induced to grow beyond
its inherent size and that, therefore, there are indications
for extractions in certain forms of malocclusion."
Am. J. Orthod. Dentafae. Orthop.
November 1992
Unfortunately, some more recent bone-grower pro-
ponents did not listen to Case. Had they done so, it
may have spared our specialty a lot of controversy and
the public a lot of treasure.
Dewel goes on to make a defense of Angle when
he states that:
"His (Angle's) was the good fight to offset extremism in
extraction, and what he said needed to be said. Extraction
had not only been rampant prior to his time: it also had
been practiced on an empirical basis with little thought
to the functional problems that follow irrational ex-
traction."
It is unfortunate that there are no references as to
the extent of the use of extractions by early, empirically
trained workers or to what constituted rampant use.
The argument could be made that these early practitio-
ners were simply doing problem solving to the best of
their abilities on the basis of their knowledge at the
time, thinking out for themselves the best way to
achieve a reasonable goal. There is most likely no doubt
that since their decisions were empiric and that there
were probably many unscrupulous practitioners, many
results were terrible. Dewel also states that "Angle was
not a man to compromise with his ideals."23 Yet, what
is it other than compromising of ideals when you look
at the printed record of the sixth edition compared with
Angle's much reported position. Folklore told me that
Angle's position was the result of an ego conflict with
Calvin Case?
More recently, Asbell,24 in an article entitled "A
Brief History of Orthodontics" makes specific reference
to Angle's putative position and quotes references to
support this thesis. In fact, it was this article by Asbell
that led me to the belief that the book that I had in my
library, the sixth edition of the text that Angle entitled
"Treatment of Malocclusion of the Teeth and Fractures
of the Maxillae. Angle's System," was not as well
known as I had supposed. Not only might it not have
been well known, but I began to question whether any-
one beside myself even had a copy of this book. The
flyleaf of the the book states that it is the "Sixth edition,
greatly enlarged and entirely rewritten, with two hun-
dred and ninety-nine illustrations." Although it further
states that it was published in 1900, in Philadelphia,
by The S.S. White Manufacturing Company, the copy-
rights are 1898 and 1900. The book is also signed and
stamped by the original owner, Dr. Robert H. Nones,
1708 Chestnut St., Philadelphia, Penn., and dated Nov.
5, 1900.
Graber 5 states that the 1887 first edition of Angle's
book lO was a paperbound one, and he makes reference
to the fifth edition ll published in 1897. Graber 5 makes
reference also to the seventh edition 13 which was fully
revised and published in 1907. I have not as yet come
Volume 102
Number 5
across any article that makes reference to the sixth
edition. 12
What is unique about the sixth edition is that it
contains an enormous amount of material and case re-
ports in which the extraction of teeth was involved to
solve orthodontic treatment problems.
The reason why only this edition contains this ma-
terial, what happened to it, and why the subsequent
seventh edition not only had none of this material in it
but inveighed against the use of extractions, forms the
raison d'etre of this article.
It is interesting to note how I happened to acquire
a copy of this sixth edition. In the early years at Boston
University (the first programs started in 1959), there
were only residency programs at the postgraduate level,
and these were in orthodontics, endodontics, periodon-
tics, oral pathology, oral surgery, and a one-year pro-
gram for the then oral surgery didactic training prereq-
uisite. Henry M. Goldman, a periodontist and founder
of the school, had not yet received a charter from the
Trustees of Boston University to found a postdoctoral
or predoctoral school. The whole program was, for the
first few years, under the aegis of the medical school
as the Department of Stomatology of the Boston Uni-
versity Medical School.
During this period, the periodontal students spent
their first year at the University of Pennsylvania and
their second year at Boston University. The department
was very small in those days, everyone got to know
everyone else, and I became friends with one of the
periodontal residents. One day he showed me this text
of Angle's that he had obtained for a small sum from
a group of books that the library of the University of
Pennsylvania no longer wanted and were selling. He
said he had no use for it and thus gave it to me without
either of us realizing its significance.
I did read through it and came to realize that Angle
was not the extreme opponent of extractions as everyone
assumed and further assumed that everyone knew this.
It did puzzle me when I came across references or
stories about the bitter extraction/nonextraction battles.
I felt that many other people must have copies of this
book and could not understand why references were
not made to it. It thus remained in my library, mostly
forgotten and only occasionally thought of when Angle
references were made or anecdotes related.
While I was a student at Boston University, and
while Herbert I. Margolis was chairman, the program
included as part of its faculty people such as Robert
Strang and Arthur Greenstein, as well as visiting cli-
nicians such as Charles Tweed. Greenstein 26 even pub-
lished a paper on the "The Tweed Philosophy" in 1943,
which was only two years later than Tweed's own pa-
per. 20 Tweed was a good friend of Margolis, and it was
Margolis27 who gave scientific validity to the concept
Special article 469
of the lower incisor having to be upright over basal
bone.
Margolis used to tell us that he got the idea for his
research on this concept as he was driving in an au-
tomobile with Tweed (I will expand on this further on
in the text). Thus was born the seed of Margolis's
research and the scientific validity of Tweeds concept.
I still think that Margolis's further conceptualization,
based on Tweed's upright idea, of the variation of the
incisor-mandibular plane angle for different mandibular
growth patterns (from high angle to low angle) with
the relation of the cingulum of the lower central incisor
to the nasion-pogonion plane is still the most singularly
useful diagnostic aid for clinical treatment decisions.
Margolis was one of the early workers in cepha-
lometrics and one of the first to produce a cephalostat.
The story around all this is worth relating because of
the importance of the incisor mandibular plane angle
to the substantiation of Tweed's concepts.
After Margolis finished his orthodontic training at
the Dewey School in New York, he came back to Boston
to practice. He also wanted to teach in the orthodontic
department at Harvard Dental School. (According to
stories I heard as a student, this was putatively a never
consummated life ambition of this complex man.) As
there was no opening in the dental school, he accepted
an appointment in the anthropology department, and
thus became friends with Professor Earnest A. Hooten,
head of the Anthropology Department. Hooten had a
large collection of human skulls from all age groups.
Thus Margolis had access to these many skulls that he
used in his cephalometry research. To expand more
fully on the tale that Margolis used to tell, the story
goes that Margolis was riding in a car driven by Tweed,
and Tweed was saying that the "lower incisors had to
be upright over basal bone" while indicating with a
hand gesture what he meant. Tweed had no specific
answer for Margolis as to what that meant. Tweed 19
states that he learned visually to relate the lower incisors
to the body of the mandible by doing "sagittal sections
(of the plaster casts) of all his cases for a period of 5
or 6 years." As a result, Margolis did his work, which
culminated in the publishing of his article on the sub-
ject. 27 Tweed 19 credits Margolis by stating: "It remained
for Margolis, at a later date, to scientifically relate them
to the lower border of the mandible."
After all the formal lectures, seminars, and clinical
sessions, there was always time and incidents of in-
formal get-togethers, such as plain old "bull-sessions"
to lunches and dinners and even a little elbow-bending
at a pub.
From, and as a result of, all these people being at
Boston University, along with my older brother, Murray
Bernstein, who did his orthodontic training under Mar-
golis at Tufts Dental School in the early fifties, I was
470 Bernstein
told some of the stories, now called "oral history," of
some of the early greats in orthodontics, including An-
gle. Staying with the extraction/nonextraction contro-
versy, I will relate, in a digested and third-hand form,
the stories that were told to me.
The story about extractions that came to me was
that Angle was not always opposed to the need and use
of extractions in treatment. He dramatically changed
his position when he became involved in a controversy
with Calvin Case (supposedly the Case/Baker first use
of intermaxillary elastics brouhaha) who did advocate
the use of extractions. Case's position can be read in
the reprinted edition of his book28 that I have, entitled,
A Practical Treatise on the Technics and Principles of
Dental Orthopedia and Prosthetic Correction of Cleft
Palate, which was originally published in 1921. The re-
printed edition I have of Case's book, the second edi-
tion, was reproduced by an old scientific book dealer,
Leo L. Bruder of New York City, New York. It was
reprinted in 1963, and I purchased it that same year.
The first edition of Case's book was published in 1908,
the year after Angle's seventh edition, and was titled,
Dental Orthopedia. Dewe1 presents a quote from Case
that he says shows Case to great advantage for he (Case)
defends Angle and himself and gives Angle credit; "for
it was his hand which unloosened the pendulum from
the disgraceful grasp of extracting malpractice. "23 The
rest of the quote says that Angle sent the pendulum on
the right way, but he sent it too far, although the extra
push was probably necessary. This does not mean that
there were not bitter feelings between them for in the
"Preface to Second Edition," (pg. ix), Case writes that
"Dr. Angle has truly observed: 'To fair minds, recorded
dates are usually sufficient evidence of priority'. Un-
fortunately, this rule has not always been strictly ob-
served. "27 This refers to Case's contention that Angle
was claiming credit for the results of work done by
Case. The point at issue here is that Case 29 takes issue
with the claim in Angle's book that he (Angle) learned
about the use of intermaxillary elastics from H. A.
Baker of Boston who claimed he was the originator of
their use. Case writes that his "paper detailing this
whole principal, with illustrations, was published in the
proceedings of the Columbian Dental Congress of 1893,
and earlier in the Dental Record, 7 or 8 years before
the publication of his book. " From 1893, with the men-
tioned 7 or 8 years, would bring the date up to 1900,
the year of Angle's sixth edition. It still is inconceivable
that this is the edition that Case is referring to, as if he
had been familiar with it, he most certainly would have
made use of the extraction case material that Angle had
Am. 1. Orthod. Dentofae. Orthop.
November 1992
in it. Be that as it may, the elastic issue was finally put
to rest at the end of Case's article when he makes
reference to an article by Angle 30 in which Angle notes
that the use of elastics was introduced to him by Baker
but that Case had published on their use in 1893. Angle
concludes the paragraph by saying "Which of these
gentlemen was the first to use it, I know not; but be
that as it may, I am certain that it is one of the most
valuable additions to modem orthodontia." While it is
possible, it does not seem conceivable that this event
could have been the cause of all the controversy that
became the hallmark of these two men.
While Case was certainly an advocate of extrac-
tions, DeweF3 points out that in today's parlance, he
would be considered quite conservative. In his book,
Case, on page 83, makes reference to the paper he
presented to the National Dental Association in 1911
in which he stated that in his own practice, "there was
only about 1 case in 12 to 15 in which the question of
extraction should ever arise. "28
All assumptions would indicate that the controversy
with Angle must have started about the time of the
publication of Angle's sixth edition, as I was told that
in his earlier editions, there was no mention of the role
of extractions in therapy. Perhaps Case was making too
big a name for himself in putting forth the extraction
philosophy and Angle was doing a slow bum. Perhaps
he then decided to stress the nonextraction route coin-
cidently at about the time his sixth edition was hitting
the street and took it off the market. However, not at
least before Dr. Nones, who lived in Philadelphia where
it was published, was able to get hold of a copy. I
always assumed that there must be other copies of the
sixth edition available, and so I always found it puzzling
that the folklore and presentations about Angle being
absolutely opposed to extractions was not refuted by
citing references to the sixth edition. When the copy
of the sixth edition was given to me, the evidence was
there to see in print.
The stories related to me were that Angle, whose
egotistical and explosive personality has been well doc-
umented, became so incensed in this controversy with
Case that he had the sixth edition withdrawn from pub-
lication, to be substituted by the seventh and later, as
the folklore told to me had it, an eighth edition.
I have been informed in a letter from T. M. Graber
that the later editions of Angle's work were not true
editions and that he was not aware that there was an
eighth edition; indeed there may not be, such is the
nature of folklore.