THE NEED OF DENTAL SURGEONS IN THE

ARMY AND NAVY.

BY JOHN S. MARSHALL, M. D.,

SYRACUSE, N. Y.

Mr. President and Gentlemen :

The subject chosen is one that from time to time has been brought to the attention of the profession and the public, and after a more or less earnest agitation has disappeared from sight, comet-like to return again.

Various articles, advocating the appointment of dental surgeons in the army and navy, were published in the earlier volumes of the American Journal of Dental Science, and the New York Dental Journal, and later in the Dental Cosmos and New York Times. The matter, however, was not brought formally before the profession until August, 1861, at the session of the American Dental Convention, held in New Haven, Conn., when, after considerable discussion, it was referred to a committee of five, composed of the following gentlemen: Drs. W. H. Atkinson, of Cleveland, Ohio; Geo. H. Perrine, of New York; B. W. Franklin, of New York; J. D. White, of Philadelphia, and I. J. Wetherbee, of Boston, who were instructed to inquire into the advisability of such appointments, and report to the convention. They reported having waited upon the SurgeonGeneral of the Army, Dr. W. A. Hammond, and that the subject of such appointments met with his approbation. No positive action was taken, however, for some years thereafter. The anxieties and changes incident to the civil war, so occupied the sympathies and attention of those interested in the movement, that it was virtually dropped until the year 1868. Senator Hamlin, of Maine, at this time introduced a bill before both Houses of Congress which provided for the appointment of dental surgeons in the army and navy. The bill was referred to the

Committee of Military and Naval Affairs, where, from a lack of a proper appreciation of the need of such appointments, or, perhaps, because the bill would entail a greater outlay of treasure than in their judgment was advisable at just that time, no further action was taken upon it, and the measure died before it was born.

The second attempt to interest Congress in these appointments was made during the sessions of the Forty-second Congress, by the introduction of a bill before the House of Representatives by the Hon. De Witt Townsend, simply advocating the appointment of dental surgeons to the military and naval academies. The experiences of the previous effort, no doubt, caused this modification of plans, upon the principle that a half-loaf is better than no bread. The bill, as before, was referred to the same committee, but they failed to comprehend its importance, and consequently nothing came of it; except, perhaps, indirectly, it brought about, after a time, the appointment of a dental surgeon at the naval academy at Annapolis, with the rank of assistant surgeon. (Right here let me acknowledge my indebtedness to Dr. George H. Perrine, of New York, for many of the facts just narrated.)

It seems very strange that a measure of so much importance to the physical comfort and health of our soldiers and sailors should have received so little attention at the hands of the profession. With this apathy on their part, it is no wonder that Congress is not interested in the matter.

It must be apparent to those who will give the subject a fair investigation, that the appointments to which we refer are very much needed. The government requires of those who would serve in either the military or naval departments that they have sound teeth as well as sound limbs, and the applicant is thrown out by the medical examiner as quickly for loss or unsoundness in one as in the other. Why, then, should this care as to the teeth cease after the man has entered the service, any more than for the other organs of the body? Before the introduction of metallic cartridges, the loss of a soldier's front teeth rendered him almost useless for active service, but of course in these days it is not of so much consequence. To the sailor, however, good teeth are of the utmost importance, for frequently they have to serve him in the place of an extra pair of hands. To illustrate many times when reefing topsails in a gale of wind,

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he is obliged to maintain his position by holding on with his teeth, while his hands are engaged in passing the "gasket." The knife, the end of a rope, and many such like things, have to be held between the teeth while going aloft. Such unnatural use cannot otherwise than predispose to certain dental diseases.

The nature of their food, also, is such (and this applies equally to both soldiers and sailors) that without good, sound teeth thorough mastication is impossible. The food is often dry and hard, and many times insufficiently cooked, and with diseased teeth it is very liable to be swallowed before being thoroughly masticated; and, as a consequence, a train of diseases may be established through derangement of the stomach, and the men, sooner or later, unfitted for duty.

In speaking of the nature of their food, an "old salt," grow ing funny in his description, said, "The hard-tack' furnished by the government was marked B. C. (Before Christ), and the beef was so hard that it made good material from which to carve tobacco-boxes."

That our government makes ample provision for the care of its sick and wounded soldiers and sailors no one doubts for a moment, and that every appliance possible to be obtained is placed in the hands of the surgeon for the treatment of all ordinary cases except those of the teeth and jaws.

The teeth of the men in military and naval service are just as liable to disease, especially dental caries, as those in private life. Caries of the teeth is without doubt the most common of all diseases. Few persons of either sex, among civilized nations, reach the age of maturity without suffering from its ravages; consequently a great host of men have been raised up, largely out-numbering any other class of specialists, whose life-work it has become to repair the damage wrought by this enemy of the health and comfort of mankind, and to attempt to stay its progress by a better understanding of the causes that produce it, and to put in practice the most efficient means of prevention and cure.

The soldiers on the frontier and the sailors on a long cruise have no opportunity of receiving dental services, no matter how much they may need them. If caries attack their teeth,-and the chances are strongly in favor of such a supposition,-they are compelled to let the disease run its course, for no means are

provided in either garrison or on shipboard for the treatment of such cases.

The teeth, as a consequence, are utterly neglected until an attack of odontalgia drives the poor victim to seek relief by the extraction of the offending tooth, not at the hands of the surgeon, for they are usually turned over to the bungling of the hospital steward, or some even less competent person. We fail to see the justice in compelling the men to lose their teeth for the want of the proper means of treatment, any more than we would to lose any other member of the body from the same cause.

The treatment of fractures and gun-shot injuries of the lower jaw, in our government hospitals, if I have been correctly informed, is considerably behind the times, for no means are provided for their treatment, except those in common use twenty-five or thirty years ago. A fractured jaw is of as much consequence, and many times as difficult to treat, without leaving a deformity, as some of the worst fractures of long bones, and yet the latter are much more scientifically treated than the former. Splints adapted to the treatment of the worst of these cases cannot be made and kept in stock. Each case demands an apparatus made to suit its own peculiarities.

The interdental splint, as invented by Dr. J. B. Bean, of Georgia, during the civil war, and improved by Dr. Norman Kingsley, of New York, is a very great improvement on the treatment of these cases, and has the endorsement of the best surgeons the world over, securing, as it does, comfortable articulation and deglutition to the patient while under treatment, and this is no small advantage. These splints cannot, of course, be made by the surgeon unless he has received special instruction in the mechanical branch of dental surgery.

Therefore, if these fractures are to be treated in the army and navy hospitals with as much skill as in private practice, it is necessary that a certain number of surgeons be appointed, who have been specially educated in dental and oral science.

The practicability of treating these cases by the interdental splint was first demonstrated by Dr. S. H. Stout, Medical Director of the Hospitals of the Confederate Army of the Tennessee, by sending all such cases to one hospital, which was put under the charge of Professor W. F. Westmoreland, of the Atlanta, Georgia, Medical College, and J. B. Bean, dentist, and their success with this class of fractures was very remarkable. Dr.

Stout also appointed several dentists in his department, with the rank of hospital steward, who cared for the teeth of all men who applied for such services, paying for the material out of the general hospital fund. These were the first, and, so far as I have been able to ascertain, the only dentists ever appointed to military service in this or any other country.

The feeling of the chief medical officers of the army and navy seems at present to be opposed to such appointments, from the fact that, according to the medical reports, the amount of dental diseases are so small as not to require specially educated surgeons to treat them.

Surgeon-General Barnes kindly sent me a tabulated report of all the dental diseases treated in the army for the years 1878-79 and 1879-80, but declined giving an opinion upon the advisability of such appointments until such time as the measure contemplated shall have taken definite shape. The report is as follows, under the head of diseases of the teeth:

The whole number of men in the service for 1878-79 was 23,812. The whole number of dental diseases treated, according to the report, was 70, or 1 case in every 340 men, while the whole number of the men in the service for 1879-80 was 24,460, and the dental cases treated 69, or 1 case in every 354 men.

But is it possible that out of 23,812 men in the first year, and 24,460 in the other, that there should be only 5 cases of dental caries in one, and 7 in the other, requiring treatment?

The report of Surgeon-General Wales, of the navy, for the year 1878, covers about the same ground, with the exception that dental caries has no place whatever in the report. The following is the report, under the head of diseases of the teeth: