THE TEETH OF HEALTHY PRISONERS. By W. J.
BUCHANAN,
b.a., m.b.,
Dipl.
State Med.
CAPTAIN, I.M.S.,
Superintendent,
Central Jail,
Bhagaljmr.
My friend Major Andrew Buchanan lias, in his little volume (reviewed in this issue), raised again the important question of the nature of the spongy and ulcerated gums so frequently seen, especially in unhealthy years, in the Native prisoners in Indian jails. Having long held the belief, in common with I believe the majority of medical officers in Bengal, that these affections of the teeth and gums are not scorbutic, but (neglect and dirt apart) rather due to the debility produced by repeated attacks of malarial fevers, I looked up some notes I had made a year
interesting
ago on the condition of the teeth and gums of several hundred prisoners examined in the Dacca Central Jail, and moreover made a careful examination of the teeth of 500 men in good health and 011 hard labour in the Central Jail, Bhagalpur, The results of the latter examination, which, though more in detail, agrees with the figures recorded at Dacca, are given in the following Tables I, II. I may premise that I have very little knowledge of the special subject of dentistiy, and only here describe as plainly as possible the appearances seen by me and noted down at my inspections. I may add that I do not believe there is at present the slightest scorbutic taint among the prisoners of this Jail. The extremely low death-rate* is enough to *
1895 (9 per ; and 1898
mille)
mille); 1896 (7 (11 per mille).
per
mille); 1897 (21
per
Sept.
TEETH OF HEALTHY PRISONERS.
1899.]
315
and floor of mouth acting as a sort of show this. In a separate column I have shown lip for the acrid foreign accretions the condition of the teeth in 28 patients in retaining bag or secretions. This to my mind is an arguhospital, and 22 in the convalescent and special ment against the view that all spongy gums men :? gangs, many of the latter feeble old are scorbutic. One would naturally suppose Table I. that a dyscrasia acting through the circulating blood would affect both upper and lower jaws Sick and In the two articles on Scurvy, impartially. Healthy Men. Sickly. which I have at hand to refer to, this point Upper is not mentioned, but the plural "gums" is and Condition found. Upper Jaw. Lower Lower always used, referring, I suppose, to both i.pper Per cent. Jaw. Jaws. Percent and lower jaws. To return, however, to Table I. Per 500 men. 500 men cent. The large percentage of retracted gums in the 50 men. lower jaw includes all cases whether one only or many teeth were exposed. In nearly all cases, Retraction of Gums (oue or 75 70 9 p. c. more teeth) only the front teeth are affected, and chiefly the 14 13 7 One or more teeth fallen out lateral incisors and canines. The retraction of ? 8 11 3 One or more loose teeth 4 ? the gums in many cases was slight, but in others 12 14 4 Pas exuded on pressure 2 10 21 11 very advanced. As regards loose or fallen teeth, Irregular rows of teeth 38 35 Blue-black pigment, slight 40 this may be attributed in some cases to the 21 17 7 ? deep abuse of mercury by baids, and such class of Gum thickened but firm, not 10 24 U practitioners, though it is not easy to get a i-pougy Thin bright red line around definite history of such from prisoners. Another 10 base of teeth 3 ? fertile cause of loose teeth and toothless gums 16 10 Copious deposit of tartar 18 10 is the long continued use of lime with the pan. 11 S ight deposit of 66 20 12 Gums swollen or spongy 1 The betel-nut mixture so much used by Indians 13 Bright red, but firm, healthy is, I have no doubt, useful as an aid to the diges1 gums tion of bulky meals of rice, but we have the 14 Blackened teeth-rows 3 15 Genuinely clean and healthy of Norman Chevers that the use of lime authority 2 14 55 gums with the is bad, because especially where pan 16 Ulcerated gums Nil. Nil. Nil. toothcleaning is neglected, the lime forms an incrustation between tooth and gum and ultimateTable II. ly lifts the tooth out of its socket. In the above Both and lower upper table there are no cases of ulcerated gums, which gums 14 p. c. healthy I well remember as common in the autumn of Both gums equally bad 1 189-i. Pus exuded on firm pressure on the 2 Upper worse than lower 5 Tongue, red and raw patches ? in gums only a few cases, and mostly in connec14 ,, Tongue pigmented tion with one or two teeth only. This is the 3 on Aphthous spots gums condition Major A. Buchanan has called special 1 Gum-boils ? 5 teeth ,, Decaying attention to under the name pyorrhoea alveolaris. Buccal membrane pigmented 11 k It was first described by Riggs, and is a chronic inflammation of the edges of the periosteum. It It will be seen from the above table, that is probably mildly infective (Quain), and spreads even healthy men fit for, and working at, hard from tooth to tooth if not effectually treated. labour have very far from sound and healthy It is limited to the front teeth, and, according to That the state of their teeth would be teeth. Quain, is excited by local irritants, food, tartar even worse I believe, but that nearly a year ago and undue pressure of the bite. It is not necesI ordered the use of tooth-sticks and gave a scorbutic affection, nor in any way characorders for the jailers to encourage their use. sarily teristic of scurvy. The table shows a percenThe most remarkable fact, however, is the very tage of irregular lines of teeth ; this is interesting contrast between the lower and great upper from another point of view. Talbot of Chicago jaws. Nearly every bad condition noted is has shown in his book on Degeneracy" that of found much worse and much more commonly in over 1,500 criminals examined at the Elmira and the lower jaws. In only 14 per cent, out of Pontiac Reformatories in America, no less than over 500 men examined, could I record that the 40 per cent, had irregular lines of teeth, and he gums and teeth of both jaws were in a sound looks this as one of the stigmata of deupon and healthy condition ; but 55 per cent of them We come now to the question of the had upper gums which were sound, firm and generacy. from a pathological point of view, of importance, health}^. This, I think, is not difficult to ac- the blue-black pigment noted in a large percenof the count for, and helps us to an explanation of cases. This pigment is found in gums tage condition. Decomposing food or any other local off all stages of health, often associated with cause acting on the teeth would naturally most pigment patches on the tongue, palate and affect the lower on account of the lower ? ?
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,,
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...
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...
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...
...
...
...
...
...
?
...
"
teeth,
THE INDIAN MEDICAL GAZETTE.
316
[Sept.
1899.
seen are in great part due to neglect of buccal mucous membrane. On the gums it is commonly the teeth and the consequent decomposition of often looked upon as a sign of ill-health (a when malarial fevers are blue blackness from congestion would be so), food particles ; whereas, these conditions in feeble and debi prevalent,-}* in to be pathobut it is too common my opinion litated men become worse and go on to spottilogical. I believe it is akin to the pigment on ness and most intractable ulceration. Whilethe tongue and buccal membrane, and to be, as I hold this view, I never for a moment, however, has of more P. shown, Maynard* Captain F. relax my vigilance about a supply of good antianthropological than pathological interest. I have scorbutic vegetables; for, if these are neglected, found it often in all castes who are found in there is not a doubt but that true genuine scurvy this Jail, especially perhaps in lower castes and will certanily prevail, as it has prevailed in Nagtribes, as Sonthalis, Domes, Chamars, Haris, &c. during the recent famine. It is possible, pur of Kabuli dacoits now in jail, In one gang that a casual observer seeing teeth and moreover, this pigment is conspicuously absent, though as described above in Table I in these gums in some cases their teeth and gums are as 500 sleek and healthy prisoners of Bhagalpur bad as any of the others. As regards the might suspect a scorbutic taint, but this aphthous spots 011 the gums and inner surface of IJail, endeavoured to show would be a misunhave lower lips of a few cases, they were very slight of the case3. and were generally associated with very dirty derstanding and neglected teeth. In the 500 cases examined, there was not a single case of the "post molar ulcer" described by R. D. Murray and Crombie. This ulcer I believe to be a bad sign, not of scurvy alone, but of general bad health. During the past year I have noted it only six times, and it is now to be seen in a Pnrnea prisoner here who is dying of advanced malarial cachexia. A word more on Professor Wright's views on scurvy. Last year, at Dacca, I made a gang of the worst cases I could find of bad teeth and gums, and very carefully administered to them for many weeks alternate doses of calcium chloride and soda tartai'ata as advised by Wright. I could not honestly say that I noticed any improvement in the condition of their gums till I commenced active local treatment. I will not go so far as to say that this is an argument to show that the gum affection was not scurvy. What then about the scurvy and malarial views ? I believe that the vast majority of the bad gum cases in jail are due to local causes, i.e., neglect of the teeth. In healthy, non-malarious years, if the teeth are neglected, little or no bad etfect will be produced upon the general health; but if malarial fevers or diarrhoea or f Confirmation of this view is given by the following quotadyspepsia prevail, a very large number of the tion from an article entitled Malarial Scurvy," by Col. Netley (Journal of Tropical Medicine, Sept. prisoners who thus suffer will show very un- K. McLeod of p. 32.) :?" Among invalids in Netley from India, there is healthy, swollen and even ulcerated gums. This 1898, always a large proportion of soldiers who have suffered from may be due to want of assimilation of the food, malarious disease. In many of these, swollen, spongy and ulcerated gums, with occasional bleeding, are observable. In especially when the fever has been" of the form these, the dietetic element may be eliminated." A typical case common in jails and known as night fever," in a British soldier is then given?and clinically," writes which is often neglected by careless prisoners Col. Mcleod, "the state of the gums in this case was precisely in No doubt, if the same as genuine scurvy of dietetic causation." Yet 01* ignorant medical subordinates. he was a well- fed British soldier. are neglected in a jail, true scurvy vegetables That bad teeth are not incompatible with good health is will, and does arise, and in famine years many shown (I.M.G., July 18i)0, p. 262) by the following remark : ?'? astonishing how many fine muscular men there prisoners suffering from scurvy do come to jail; are Itofis really the recruits' age with poor and defective teeth." that Professor Wright but we must remember Seventy-five per 1,000 of recruits are rejected yearly on tells us that the symptoms so commonly looked account of bad teeth only. In his medico-topographical of scurvy are by no means Account of Jeypore, Col. T. H. Hendley, i.M.s,, c.i.e., writes upon as distinctive of the is I believe that as follows :?"A scorbutic state as for gums very common, pathognomonic of that disease, andand example, Bunniahs and vegetarians, amongst particularly in healthy jails the bad teeth gums so and Jains, whose mouths are frequently filled with tartar, breath extremely offensive, teeth carious, and gums much "
?'
*
ulcerated."
I. il/. G., Oct. 1897.
BUCHANAN,
b.a., m.b.,
Dipl.
State Med.
CAPTAIN, I.M.S.,
Superintendent,
Central Jail,
Bhagaljmr.
My friend Major Andrew Buchanan lias, in his little volume (reviewed in this issue), raised again the important question of the nature of the spongy and ulcerated gums so frequently seen, especially in unhealthy years, in the Native prisoners in Indian jails. Having long held the belief, in common with I believe the majority of medical officers in Bengal, that these affections of the teeth and gums are not scorbutic, but (neglect and dirt apart) rather due to the debility produced by repeated attacks of malarial fevers, I looked up some notes I had made a year
interesting
ago on the condition of the teeth and gums of several hundred prisoners examined in the Dacca Central Jail, and moreover made a careful examination of the teeth of 500 men in good health and 011 hard labour in the Central Jail, Bhagalpur, The results of the latter examination, which, though more in detail, agrees with the figures recorded at Dacca, are given in the following Tables I, II. I may premise that I have very little knowledge of the special subject of dentistiy, and only here describe as plainly as possible the appearances seen by me and noted down at my inspections. I may add that I do not believe there is at present the slightest scorbutic taint among the prisoners of this Jail. The extremely low death-rate* is enough to *
1895 (9 per ; and 1898
mille)
mille); 1896 (7 (11 per mille).
per
mille); 1897 (21
per
Sept.
TEETH OF HEALTHY PRISONERS.
1899.]
315
and floor of mouth acting as a sort of show this. In a separate column I have shown lip for the acrid foreign accretions the condition of the teeth in 28 patients in retaining bag or secretions. This to my mind is an arguhospital, and 22 in the convalescent and special ment against the view that all spongy gums men :? gangs, many of the latter feeble old are scorbutic. One would naturally suppose Table I. that a dyscrasia acting through the circulating blood would affect both upper and lower jaws Sick and In the two articles on Scurvy, impartially. Healthy Men. Sickly. which I have at hand to refer to, this point Upper is not mentioned, but the plural "gums" is and Condition found. Upper Jaw. Lower Lower always used, referring, I suppose, to both i.pper Per cent. Jaw. Jaws. Percent and lower jaws. To return, however, to Table I. Per 500 men. 500 men cent. The large percentage of retracted gums in the 50 men. lower jaw includes all cases whether one only or many teeth were exposed. In nearly all cases, Retraction of Gums (oue or 75 70 9 p. c. more teeth) only the front teeth are affected, and chiefly the 14 13 7 One or more teeth fallen out lateral incisors and canines. The retraction of ? 8 11 3 One or more loose teeth 4 ? the gums in many cases was slight, but in others 12 14 4 Pas exuded on pressure 2 10 21 11 very advanced. As regards loose or fallen teeth, Irregular rows of teeth 38 35 Blue-black pigment, slight 40 this may be attributed in some cases to the 21 17 7 ? deep abuse of mercury by baids, and such class of Gum thickened but firm, not 10 24 U practitioners, though it is not easy to get a i-pougy Thin bright red line around definite history of such from prisoners. Another 10 base of teeth 3 ? fertile cause of loose teeth and toothless gums 16 10 Copious deposit of tartar 18 10 is the long continued use of lime with the pan. 11 S ight deposit of 66 20 12 Gums swollen or spongy 1 The betel-nut mixture so much used by Indians 13 Bright red, but firm, healthy is, I have no doubt, useful as an aid to the diges1 gums tion of bulky meals of rice, but we have the 14 Blackened teeth-rows 3 15 Genuinely clean and healthy of Norman Chevers that the use of lime authority 2 14 55 gums with the is bad, because especially where pan 16 Ulcerated gums Nil. Nil. Nil. toothcleaning is neglected, the lime forms an incrustation between tooth and gum and ultimateTable II. ly lifts the tooth out of its socket. In the above Both and lower upper table there are no cases of ulcerated gums, which gums 14 p. c. healthy I well remember as common in the autumn of Both gums equally bad 1 189-i. Pus exuded on firm pressure on the 2 Upper worse than lower 5 Tongue, red and raw patches ? in gums only a few cases, and mostly in connec14 ,, Tongue pigmented tion with one or two teeth only. This is the 3 on Aphthous spots gums condition Major A. Buchanan has called special 1 Gum-boils ? 5 teeth ,, Decaying attention to under the name pyorrhoea alveolaris. Buccal membrane pigmented 11 k It was first described by Riggs, and is a chronic inflammation of the edges of the periosteum. It It will be seen from the above table, that is probably mildly infective (Quain), and spreads even healthy men fit for, and working at, hard from tooth to tooth if not effectually treated. labour have very far from sound and healthy It is limited to the front teeth, and, according to That the state of their teeth would be teeth. Quain, is excited by local irritants, food, tartar even worse I believe, but that nearly a year ago and undue pressure of the bite. It is not necesI ordered the use of tooth-sticks and gave a scorbutic affection, nor in any way characorders for the jailers to encourage their use. sarily teristic of scurvy. The table shows a percenThe most remarkable fact, however, is the very tage of irregular lines of teeth ; this is interesting contrast between the lower and great upper from another point of view. Talbot of Chicago jaws. Nearly every bad condition noted is has shown in his book on Degeneracy" that of found much worse and much more commonly in over 1,500 criminals examined at the Elmira and the lower jaws. In only 14 per cent, out of Pontiac Reformatories in America, no less than over 500 men examined, could I record that the 40 per cent, had irregular lines of teeth, and he gums and teeth of both jaws were in a sound looks this as one of the stigmata of deupon and healthy condition ; but 55 per cent of them We come now to the question of the had upper gums which were sound, firm and generacy. from a pathological point of view, of importance, health}^. This, I think, is not difficult to ac- the blue-black pigment noted in a large percenof the count for, and helps us to an explanation of cases. This pigment is found in gums tage condition. Decomposing food or any other local off all stages of health, often associated with cause acting on the teeth would naturally most pigment patches on the tongue, palate and affect the lower on account of the lower ? ?
..
,.
?
...
?
?
...
?
,,
?
...
?
...
...
...
?
...
...
?
...
...
...
...
...
...
...
...
...
?
...
"
teeth,
THE INDIAN MEDICAL GAZETTE.
316
[Sept.
1899.
seen are in great part due to neglect of buccal mucous membrane. On the gums it is commonly the teeth and the consequent decomposition of often looked upon as a sign of ill-health (a when malarial fevers are blue blackness from congestion would be so), food particles ; whereas, these conditions in feeble and debi prevalent,-}* in to be pathobut it is too common my opinion litated men become worse and go on to spottilogical. I believe it is akin to the pigment on ness and most intractable ulceration. Whilethe tongue and buccal membrane, and to be, as I hold this view, I never for a moment, however, has of more P. shown, Maynard* Captain F. relax my vigilance about a supply of good antianthropological than pathological interest. I have scorbutic vegetables; for, if these are neglected, found it often in all castes who are found in there is not a doubt but that true genuine scurvy this Jail, especially perhaps in lower castes and will certanily prevail, as it has prevailed in Nagtribes, as Sonthalis, Domes, Chamars, Haris, &c. during the recent famine. It is possible, pur of Kabuli dacoits now in jail, In one gang that a casual observer seeing teeth and moreover, this pigment is conspicuously absent, though as described above in Table I in these gums in some cases their teeth and gums are as 500 sleek and healthy prisoners of Bhagalpur bad as any of the others. As regards the might suspect a scorbutic taint, but this aphthous spots 011 the gums and inner surface of IJail, endeavoured to show would be a misunhave lower lips of a few cases, they were very slight of the case3. and were generally associated with very dirty derstanding and neglected teeth. In the 500 cases examined, there was not a single case of the "post molar ulcer" described by R. D. Murray and Crombie. This ulcer I believe to be a bad sign, not of scurvy alone, but of general bad health. During the past year I have noted it only six times, and it is now to be seen in a Pnrnea prisoner here who is dying of advanced malarial cachexia. A word more on Professor Wright's views on scurvy. Last year, at Dacca, I made a gang of the worst cases I could find of bad teeth and gums, and very carefully administered to them for many weeks alternate doses of calcium chloride and soda tartai'ata as advised by Wright. I could not honestly say that I noticed any improvement in the condition of their gums till I commenced active local treatment. I will not go so far as to say that this is an argument to show that the gum affection was not scurvy. What then about the scurvy and malarial views ? I believe that the vast majority of the bad gum cases in jail are due to local causes, i.e., neglect of the teeth. In healthy, non-malarious years, if the teeth are neglected, little or no bad etfect will be produced upon the general health; but if malarial fevers or diarrhoea or f Confirmation of this view is given by the following quotadyspepsia prevail, a very large number of the tion from an article entitled Malarial Scurvy," by Col. Netley (Journal of Tropical Medicine, Sept. prisoners who thus suffer will show very un- K. McLeod of p. 32.) :?" Among invalids in Netley from India, there is healthy, swollen and even ulcerated gums. This 1898, always a large proportion of soldiers who have suffered from may be due to want of assimilation of the food, malarious disease. In many of these, swollen, spongy and ulcerated gums, with occasional bleeding, are observable. In especially when the fever has been" of the form these, the dietetic element may be eliminated." A typical case common in jails and known as night fever," in a British soldier is then given?and clinically," writes which is often neglected by careless prisoners Col. Mcleod, "the state of the gums in this case was precisely in No doubt, if the same as genuine scurvy of dietetic causation." Yet 01* ignorant medical subordinates. he was a well- fed British soldier. are neglected in a jail, true scurvy vegetables That bad teeth are not incompatible with good health is will, and does arise, and in famine years many shown (I.M.G., July 18i)0, p. 262) by the following remark : ?'? astonishing how many fine muscular men there prisoners suffering from scurvy do come to jail; are Itofis really the recruits' age with poor and defective teeth." that Professor Wright but we must remember Seventy-five per 1,000 of recruits are rejected yearly on tells us that the symptoms so commonly looked account of bad teeth only. In his medico-topographical of scurvy are by no means Account of Jeypore, Col. T. H. Hendley, i.M.s,, c.i.e., writes upon as distinctive of the is I believe that as follows :?"A scorbutic state as for gums very common, pathognomonic of that disease, andand example, Bunniahs and vegetarians, amongst particularly in healthy jails the bad teeth gums so and Jains, whose mouths are frequently filled with tartar, breath extremely offensive, teeth carious, and gums much "
?'
*
ulcerated."
I. il/. G., Oct. 1897.
