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Dental health of elderly confederate veterans Evidence from the Texas State Cemetery.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 124:59 –72 (2004)
Dental Health of Elderly Confederate Veterans:
Evidence From the Texas State Cemetery
Helen Danzeiser Wols* and Joan E. Baker
U.S. Army Central Identification Laboratory, Hawaii, Hickam Air Force Base, Hawaii 96853-5530
KEY WORDS
abscess
paleopathology; Civil War; hypoplasia; caries; antemortem tooth loss; dental
ABSTRACT
Analysis of the skeletal remains of 50
Confederate veterans provided a unique opportunity to
explore the dental health of a geriatric sample. These
men, who died between 1907–1932, had an average age at
death of 76.7 years. Ninety percent were institutionalized
at the Confederate Home for Men (Austin, TX) prior to
their deaths. This elderly sample was assessed in terms of
caries, antemortem tooth loss (AMTL), abscesses, and linear enamel hypoplasias. On a per tooth basis, the AMTL
rate was 57.2%. Of 39 dentate men, 33 (84.6%) had dental
caries, and 24.4% (121 of 496) of teeth were carious. Ten
(25.0%) of the dentate men had hypoplastic teeth. At least
one abscess was seen in 14 (28%) of 50 individuals. Results
from this geriatric institutionalized sample are compared
to contemporaneous historical samples. Disparities in
dental health among these groups may be due to differences in average age at death, and these comparisons
allow a better understanding of dental changes that occur
with age. The sample is also compared to modern elderly
samples: modern groups have higher caries rates, possibly
because they retained more teeth. This finding may be due
in part to diets in the United States becoming increasingly
cariogenic over time. In addition, dental care has moved
from the reactive practices seen in the nineteenth and
early twentieth centuries (such as tooth extractions) to
modern proactive solutions dedicated to preserving and
restoring teeth (such as tooth brushing, fluoride treatments, and dental fillings). Am J Phys Anthropol 124:
59 –72, 2004. © 2004 Wiley-Liss, Inc.
Recent studies show that institutionalized elderly
people have poorer dental health than that of the
independent elderly (Loesche et al., 1995; Vigild,
1989; Weyant et al., 1993). In general, institutionalized elderly have higher rates of edentulism, caries,
and other oral/dental conditions. Poor dental health
has a negative impact on the aged in terms of chewing difficulties that can result in nutritional deficiencies, weight loss, speech difficulties, and low
self-esteem (Banting, 1973; Garcia, 1995; Loesche et
al., 1995). Although the dentition of elderly people,
institutionalized and independent, has been welldocumented in modern medical literature, archaeological samples with a large sample of elderly people
are rare. Because of this, it has not been possible to
assess and compare dental health of past and
present elderly populations, nor to assess dental
health of the elderly from a historical perspective.
The goal of this paper is to describe the dental
health of a historical geriatric population, an opportunity provided by the excavation and analysis of a
sample of 50 Confederate veterans, all of whom were
over age 60 years at time of death. Furthermore,
almost all of the veterans (90%) were institutionalized in the Confederate Home for Men (CHM) for
some period of time prior to death, providing insights into historical institutionalized populations.
In an effort to characterize the dental health of this
population, the veterans are compared to a number
of groups with similar demographic and/or social
characteristics, including modern institutionalized
elderly, historical institutionalized populations, and
eighteenth and nineteenth century soldiers. Due to
improvements in preventive and corrective dentistry over the last 100 years, modern institutionalized populations are expected to have lower rates of
dental pathology than historical ones. In contrast,
contemporaneous historical institutionalized populations are expected to have similar rates of dental
pathology, due to similar life circumstances. However, most of the dental disorders (i.e., antemortem
tooth loss, dental caries, and abscesses) examined in
this study are expected to be age-cumulative, so
samples with greater average ages at death are anticipated to have higher rates of dental disease.
Likewise, groups of soldiers from the same time
©
2004 WILEY-LISS, INC.
Grant sponsor: Prewitt and Associates, Inc.
*Correspondence to: Helen Danzeiser Wols, U.S. Army Central
Identification Laboratory, Hawaii, 310 Worchester Ave., Hickam Air
Force Base, HI 96853-5530. E-mail: wolsh@cilhi.army.mil
Received 16 August 2002; accepted 22 March 2003
DOI 10.1002/ajpa.10334
Published online 11 August 2003 in Wiley InterScience (www.
interscience.wiley.com).
60
H.D. WOLS AND J.E. BAKER
TABLE 1. Summary historical data for Confederate veterans in TSC sample
Range
Low
High
Average
1
Year of
birth
Year of move
to Texas
Age at
death
Age when moved
to Texas
Length of time in
Texas in years
Age at
beginning of
Civil War
Length of time spent
in CHM (in months)
1814
1847
1836
1902
60.0
95.0
76.7
1.01
71.0
25.9
5
88
51
14.0
47.0
26.6
1.0
232.0
57.2
Excluding native Texans.
period might be expected to have comparable rates
of dental pathology due to shared experiences (i.e.,
military service), barring differences in average ages
at death.
MATERIALS AND METHODS
In 1886, the CHM was established in Austin,
Texas, by a group of veterans who were responsible
for maintaining the facility until the State of Texas
took over in 1893 (Barkley, 1963). Initially, 16 acres
of land were purchased to build the CHM; disabled
and dependent veterans of the Confederate States
Army began to use the home in 1891. Eventually, 10
additional acres of land were purchased, and a hospital was constructed (Barkley, 1963; Webb, 1952).
One man who stayed at the CHM described it as
follows: “Now, as for the Confederate Home it is like
h–’s half acre [sic]. It needs enlarging. It is on a
beautiful hill; was made for honorable soldiers to
rest in their declining days, who had no place to
stay. . . It is looked on by the public as a place of
peace. . . far from that. . . it is not the place it ought
to be by any means. . .” (Gautier, 1902, p. 53). In
reference to the burials provided by the CHM for
veterans, however, he wrote, “You are buried neatly
and nicely and in a beautiful place: a nice monument
to each grave, your home and age, residence, everything in first class order” (Gautier, 1902, p. 53). The
place of which he spoke is the Texas State Cemetery
(TSC), located near downtown Austin and still in use
today.
The TSC is a burial ground for the interment of
members/former members (and their spouses) of the
Texas legislature, elected state officials, some appointed state officials, and Confederate veterans
(Dockall et al., 1996). The first interment occurred in
1851, and the cemetery continues to be used. In
summer 1995, the State Cemetery underwent a multimillion-dollar renovation. As part of this renovation, an archaeological consulting firm was hired to
relocate 57 graves to another location within the
cemetery; 50 of these contained the remains of Confederate veterans. The graves were marked with
headstones documenting, minimally, name, regiment, date of death, and age at death. Therefore, age
at death for these Confederate veterans, with one
exception, is known. These Civil War survivors varied in age from 60 –95 years old, with an average age
at death of 76.7 years (Dockall and Baker, 1996;
Table 1). Most of the men (44%) comprising this
Fig. 1.
50).
Age composition of Confederate veterans at TSC (N ⫽
sample were in their seventies when they died (Fig.
1). Prior to their deaths, the majority (90%) had been
residents of the CHM in Austin and, as such, were
wards of the State of Texas for some period during
their last few years of life. Indeed, the average
length of stay at the Confederate Home was 4.76
years, with a range from 1 month to 19 years (Table
1, Fig. 2). Most of the men died in 1907 or 1908, but
a few survived until the 1930s. Despite the fact that
all of the men died in Texas, only three were born
and raised in the state. The rest, with two exceptions, were from other parts of the South. Those who
immigrated from elsewhere lived in Texas for varied
lengths of time, from 5– 88 years, with an average of
51 years (Table 1). In terms of the men’s shared
history of fighting in the Civil War, their average
age at the beginning of the war was 26.6 years, with
a range from 14 – 47 years (Table 1).
Due to time constraints imposed by projected completion dates for cemetery renovations, analysis was
limited to approximately 5 hr per individual. The
remains were assessed using standard metric and
nonmetric techniques (Buikstra and Ubelaker,
1994). Because age and sex were known, demographic information came from headstones and
other archival information. Due to financial, logistical, and temporal constraints, analyses of dental
pathology were limited to macroscopic examination
of teeth and supporting skeletal elements.
Evidence for the dental health and dental care of
Confederate veterans at the turn of the century was
determined through analyses of linear enamel hypoplasias, caries, abscesses, and antemortem tooth
loss. Taken together, these dental pathologies pro-
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
61
For comparative purposes, the dental disorders
described here are presented using a tooth-count
method, as well as on a per individual basis. When
appropriate and comparable data are available, the
results from Confederate veterans at the TSC are
compared with other historical archaeological samples (Table 2), as well as modern samples.
RESULTS
Linear enamel hypoplasias
Fig. 2. Length of stay at CHM (N ⫽ 45).
vide data on diet, disease, childhood stress, dental
hygiene, and historic dental practices.
Linear enamel hypoplasias (LEH) are nonspecific
indicators of stress occurring during childhood,
forming from 5 months in utero to age 7 years and
then from approximately 10 –16 years (Goodman et
al., 1984; Skinner and Goodman, 1992). The number
of hypoplastic events per tooth was recorded. Only
enamel hypoplasias of a linear type (characterized
as type 4; Goodman and Rose, 1990) were recorded
for these individuals, and all teeth not obscured by
adhering dental calculus were examined for hypoplasias. In order to be coded as a hypoplastic defect,
the deficiency had to be apparent without the use of
any magnification (Goodman and Rose, 1990).
Carious lesions result from an infectious disease
process that results in localized demineralization of
enamel and/or dentin. Carbohydrate level in the diet
plays a large role in carious lesion frequency, since
high-carbohydrate foods raise bacterial activity,
which in turn increases production of organic acids
(Larsen, 1997, p. 65; Powell, 1985, p. 313; Hillson,
1996). Early stages of caries development are characterized by opaque areas in the enamel, and later
stages appear as rough areas (Hillson, 1996). Because of the difficulty of assessing these opacities in
archaeological samples, only those caries in a later
state of development (i.e., pits) were identified as
carious lesions for this study. The locations, types,
and sizes of carious lesions were recorded on all
observable teeth. Following Lukacs (1989), a probe
was used when recording small caries, to insure that
normal pits were not coded as carious lesions.
Dental abscesses result from dental caries or from
extreme dental wear that allows exposure and subsequent infection of the pulp chamber. Dental abscesses were coded according to type (i.e., cervical or
periapical), location, and size. Because taphonomic
processes can easily damage the thin, fragile structure of alveolar bone, care was taken to ensure that
only lesions with smooth, rounded edges were coded
as abscesses.
Antemortem tooth loss (AMTL) can occur for a
variety of reasons, including extreme dental wear,
severe alveolar resorption, caries, and abscesses
(Lukacs, 1989). Locations of AMTL were recorded
when the alveolus was partially or fully resorbed.
Ten of 39 dentate men (25.6%) had at least one
tooth with a hypoplasia. Seven men (17.9%) had
three or fewer teeth with LEH, while three (7.7%)
had six or more teeth with hypoplasias. Of 450 teeth
that could be coded for LEH, 37 (8.2%) had at least
one hypoplastic line. Of teeth with LEH, the majority had two hypoplastic lines (54.1%), followed by
one line (27.0%). Five teeth (13.5%) had three LEH,
while two teeth (5.4%) had four lines. Incisors and
canines were the only teeth to display three or more
hypoplastic events. In terms of observed LEH per
tooth type at the TSC, prevalence ranged from a low
of 0% of maxillary premolars and molars to a high of
18.2% of maxillary canines (Table 3). As expected,
incisors and canines had the highest prevalence.
Caries
Of 39 men with teeth that could be coded for
carious lesions, 33 (84.6%) showed at least one occurrence. Using a tooth-count method, 24.4% (or 121
of 496) of the Confederate veterans’ teeth had carious lesions. While only 121 carious teeth were recorded, there was a total of 140 carious lesions, since
some teeth had as many as three lesions. Each tooth
type bore evidence of caries, with rates of occurrence
varying from a low of 8.8% of mandibular premolars
to a high of 38.8% of maxillary molars (Table 3). In
general, maxillary teeth were more likely to have
lesions than mandibular teeth. Not surprisingly,
given their more complex morphology, molars were
the most common teeth to have carious lesions (Powell, 1985). The mean number of carious lesions per
mouth was 3.5,1 suggestive of a high-carbohydrate
diet (Rose et al., 1984). The majority of carious lesions were located on the mesial and distal cervical
margins (30.7%), followed by the interproximal margins of the crowns (25.0%). Almost 13% of carious
lesions were occlusal in nature, while 9.3% were
buccal and 4.3% were lingual. Nearly 18% of carious
lesions were too large to make an assessment as to
their point of origin.
Four of the 50 men (8%) had dental fillings. Of the
121 carious teeth observed in these elderly Confederate veterans, only four teeth had dental fillings
(3.3%). Three of the fillings were of a possible dental
amalgam, while one was gold. Of the four teeth with
1
This figure is based on dentate people; when all people are considered, the rate of dental caries per mouth drops to 2.8.
62
H.D. WOLS AND J.E. BAKER
TABLE 2. Comparative historical bioarchaeological samples
Sample
N
Date
Reference
Average age at
death (in years)
TSC
Fort Laurens
Colonial–Civil War
Snake Hill–War of 1812
Indian Wars
Civil War
Glorieta Pass
Little Bighorn
Belleville
Rural Texas
Belleview Plantation
Weir family
Monroe County poorhouse
501
211,2
291
261
141
491
301
91
229
16
31
20
296
891
102
40
1907–1932
1779
1675–1879
1812–1814
1870–1899
1861–1865
1862
1876
1821–1874
1850–1880
⬃1738–1760s
1830s–1907
1826–1863
1826–1863
1860–1895
1880–1900
Dockall et al., 1996
Sciulli and Gramly, 1989; Sledzik and Sandberg, 2002
Angel, 1976
Sledzik and Moore-Jansen, 1991
Sledzik and Moore-Jansen, 1991
Sledzik and Moore-Jansen, 1991
Sledzik and Sandberg, 2002
Sledzik and Sandberg, 2002
Saunders et al., 1997
Winchell et al., 1995
Rathbun and Scurry, 1991
Little et al., 1992
Lanphear, 1988
Sutter, 1995
Phillips, 2001
Phillips, 2001
76.7
23.52
39.6
21.6
33.6
27.1
23.5
27.4
42.5
⬍30.0
30.3
40.0
nd
35.1
nd
nd
Oneida County asylum
Albany almshouse
1
2
Males only.
According to Sledzik and Sandberg (2002), N ⫽ 19 and average age at death ⫽ 23.9 years.
TABLE 3. Frequency of dental pathologies per tooth type in elderly Confederate veterans
LEH
Maxillary
Incisors
Canines
Premolars
Molars
Subtotal
Mandibular
Incisors
Canines
Premolars
Molars
Subtotal
Total
Caries
Abscesses
% affected
N
% affected
N
% affected
16.7
18.2
0.0
0.0
7.4
54
33
52
63
202
24.2
22.5
23.8
38.8
28.6
66
40
58
67
231
1.3
3.7
2.0
1.3
1.8
15.5
13.2
3.9
2.1
8.9
8.2
71
53
76
48
248
450
22.4
25.5
8.8
31.5
20.8
24.4
76
55
80
54
265
496
1.0
1.9
0.5
1.3
1.1
1.4
fillings, three were third molars, and one was a first
molar.
In discussing caries, we focus strictly on the number of observable teeth with lesions. However, calculation of a decayed-and-missing index allows an
evaluation of the total caries rate in a sample determined by including information pertaining to observable carious lesions and to antemortem tooth
loss (Kelley et al., 1991). This index assumes that all
teeth lost prior to death were lost due to caries,
rather than extreme dental wear, local trauma to
the tooth, or severe periodontal disease. When this
index is applied to the TSC data, results show that
as many as 48% of teeth may have had caries, as
opposed to 24.4% based only on observable teeth.
Abscesses
At least one dental abscess was noted in 14 of the
50 males (28.0%), yielding a total of 19 abscesses. Of
1,366 observable dental sockets, only 1.4% (n ⫽ 19)
showed evidence of abscesses (Table 3). Of these, 11
were periapical, and the rest were alveolar (cervical). Compared to rates of other dental disorders,
these rates are low, varying from less than 1% of
mandibular premolars to 3.7% of maxillary canines.
AMTL
N
% affected
N
160
81
150
157
548
50.0
45.5
54.1
54.8
51.8
154
77
135
157
523
204
104
209
301
818
1,366
49.5
37.5
56.2
80.8
61.0
57.2
192
96
194
271
753
1276
This low abscess rate was unexpected, given the
high average age of individuals in this sample and
the high caries rate. The low abscess prevalence,
however, suggests that teeth were extracted prior to
pulp exposure and infection. It is also possible that
some abscessed teeth were lost long before death,
and the surrounding alveolus remodeled to the extent that no visible signs of abscessing remained at
the time of an individual’s death.
Antemortem tooth loss
High rates of AMTL were observed in these Confederate veterans, as expected given the age-cumulative nature of tooth loss and the advanced age of
people in this sample. Eleven men (22.0%) exhibited
AMTL in all observable alveoli; three men were buried with dentures. An additional seven veterans had
lost between 75–99% of all observable teeth prior to
death, while half had lost more than 50% of their
teeth. Only two men (4%) did not display any AMTL
(based on observable alveoli). AMTL calculated on a
tooth-count basis shows a high rate of 57.2%. An
average of 10.9 teeth were retained per mouth (i.e.,
an average of 14.6 teeth were lost per mouth). When
determined by tooth type, AMTL varied from a low
63
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
TABLE 4. Antemortem tooth loss by age categories1
Totals
0%
1–24%
25–49%
50–74%
75–99%
100%
Age in years
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
60–69
70–79
Subtotal (60–79)
80–89
90–99
Subtotal (80–99)
Unknown
Totals
11
22
33
11
5
16
1
50
22
44
66
22
10
32
2
100
0
1
1
0
1
1
0
2
0
2
2
0
2
2
0
4
3
6
9
1
1
2
0
11
6
12
18
2
2
4
0
22
3
6
9
2
1
3
0
12
6
12
18
4
2
6
0
24
2
5
7
0
0
0
0
7
4
10
14
0
0
0
0
14
1
3
4
3
0
3
0
7
2
6
8
3
0
6
0
14
2
1
3
5
2
7
1
11
4
2
6
10
4
14
2
22
Percentages shown were calculated as percent of total sample (N ⫽ 50). Category headings represent proportion of teeth lost (i.e., 100%
category includes edentulous people, while 0% category includes people who retained all of their natural teeth).
of 37.5% of the mandibular canines to a high of
80.8% of the mandibular molars (Table 3). When
maxillary and mandibular dentitions were combined so that AMTL was calculated based on the
number of observable dental sockets per tooth type,
the canines showed the lowest percentage of AMTL
(41.0%), while the molars had the highest rate
(71.3%).
When AMTL is examined by age, several significant patterns emerge (Table 4). Complete edentulism (AMTL of all teeth in observable alveoli) occurs
in all age categories. However, it is most common
among 80 – 89 year olds, at 10% of the total sample.
Because the number of individuals in each 10-year
age category is so small, age-cumulative patterns of
AMTL are more clearly seen when the data are
viewed in terms of two 20-year age groups (60 –79
years and 80 –99 years; Table 4). Edentulism is the
most common state among 80 –99 year olds, with 7 of
16 men (44%) in this age group experiencing 100%
AMTL. Retention of all teeth in observable alveoli
(0% AMTL) occurs in both age categories. When
viewed as a percentage of the total sample, completely edentulous 80 –99 year olds represent 14% of
the total sample (7 of 50 men), while edentulous
60 –79 year olds make up only 6% of the total sample
(3 of 50 men). In this study, men in the older age
category were more than twice as likely to have lost
all their teeth when compared to the younger men.
From the opposite perspective, younger individuals
(60 –79 years old) were four and a half times more
likely (18%, or nine individuals) to have retained
more than 75% of their teeth, as opposed to the older
group (4%, or two individuals). Given the advanced
age of the men in this sample, it is not surprising
that 50% of the Confederate veterans experienced
AMTL of more than half their teeth.
DISCUSSION
Comparison with archaeological samples
The LEH rate of Confederate veterans excavated
from the TSC (25.6% of dentate men) is lower than
that observed in other historical samples. The rate is
significantly lower than the rate of 73% of indigent
people at the Monroe County Institutional Cemetery
(Lanphear, 1988, Table 43), and is also lower than
56% of adults from a mid- to late 1800s rural cemetery in Texas (Winchell et al., 1995). Based on LEH
rates, it would appear that these Confederate veterans were relatively healthy as children. This difference suggests that they did not represent a stressed
or socially marginal subset of the population, as seen
in the study by Lanphear (1988) of the Monroe
County Poorhouse sample in New York. Because the
men shared the commonalities of having fought in
the Civil War and having been institutionalized at
the CHM, it is tempting to assume that all had
similar backgrounds of rural childhoods in Texas.
However, only three men (6%) in this sample were
born and raised in Texas. Most spent their growing
years in other regions, and moved to Texas relatively late in life.
It is possible that the relatively low rate of LEH
observed in this elderly sample is an artifact of the
high AMTL rate, such that teeth displaying LEH
were lost prior to death. Specifically, 49.7% of incisors and 41% of canines of these Confederate veterans were lost prior to death (as determined from
data provided in Table 3; see also Dockall and
Baker, 1996, Table 23). These teeth are the most
likely to display episodes of LEH, but they are also
single-rooted teeth and potentially more prone to
loss; their absence could artificially lower the sample numbers.
Table 5 documents the rate of carious lesions of
the TSC Confederate veterans by tooth type, as compared to three historical U.S. military samples. The
caries rates of the Confederate veterans are generally higher than the comparative samples. However,
when the TSC Confederate veterans are compared
to Civil War soldiers (a sample that includes both
Union and Confederate war dead), the latter have
higher rates of caries in their mandibular canines
and molars, in spite of the fact that their average
age at death (27.1 years) is much lower than that of
the TSC Confederate veterans (Sledzik and MooreJansen, 1991). This disparity is presumably due to
the age-cumulative nature of AMTL, in that many of
the carious teeth of younger individuals would have
been either naturally exfoliated or manually extracted had they lived to the ages achieved by the
Confederate veterans.
64
H.D. WOLS AND J.E. BAKER
TABLE 5. Frequency of dental pathologies per tooth type of elderly Confederate veterans and military samples
TSC1
Civil War2,3
Maxillary
Mandibular
Maxillary
24.2
22.5
23.8
38.8
22.4
25.5
8.8
31.5
10.5
7.4
18.4
27.4
1.3
3.7
2.0
1.3
1.0
1.9
0.5
1.3
3.1
3.2
5.8
6.2
50.0
45.5
54.1
54.8
49.5
37.5
56.2
80.8
3.7
Caries
Incisors
Canines
Premolars
Molars
Abscesses
Incisors
Canines
Premolars
Molars
AMTL
Incisors
Canines
Premolars
Molars
Snake Hill2,4
Mandibular
Mandibular
Maxillary
Mandibular
10.1
5.1
13.2
23.3
2.2
3.3
26.5
5.5
6.7
13.9
30.2
18.4
1.2
1.1
1.8
5.0
4.5
6.8
5.8
11.1
14.8
13.0
2.3
21.4
7.2
2.5
3.7
11.5
4.1
21.2
7.7
3.7
9.3
31.2
3.1
13.6
28.6
43.3
5.3
13.0
Indian Wars2,5
Maxillary
Average age at death ⫽ 76.7 years.
Data from Sledzik and Moore-Jansen (1991, Table 5).
3
Average age at death ⫽ 27.1 years.
4
Average age at death ⫽ 21.6 years.
5
Average age at death ⫽ 33.6 years.
1
2
TABLE 6. Comparison of caries rates among
historical archaeological samples
Sample
TSC
Fort Laurens
Glorieta Pass3
Little Bighorn3
Colonial-Civil War4
Belleville5
Rural Texas6
Monroe County poorhouse7
Monroe County poorhouse8
Belleview Plantation9
Oneida County asylum10
Albany almshouse
Per
mouth
(no.)
3.51
3.91,2
2.41
5.63
1.45
2.7
1
Tooth
count
(%)
24.41
16.62,3
17.91
22.11
27.0
8.9
10.41
36.11
16.91
Average
age
at death
76.71
23.51,2
23.51
27.41
39.61
42.5
⬍30.0
nd
35.11
30.3
nd
nd
1
Males only.
Scuilli and Gramly, 1989.
3
Sledzik and Sandberg, 2002.
4
Angel, 1976.
5
Saunders et al., 1997.
6
Winchell et al., 1995.
7
Lanphear, 1988.
8
Sutter, 1995.
9
Rathbun and Scurry, 1991.
10
Phillips, 2001.
2
Other discrepancies occur when caries are compared on a per-mouth basis to other archaeological
samples (Table 6). The Confederate veterans have a
caries rate that is relatively high compared to other
historical archaeological samples, with the exception of the Belleville sample, which has the highest
per-mouth caries rate of the comparative samples. It
is possible that the Belleville sample has a high
caries rate per mouth because their average age at
death (42.5 years) is such that they may have developed the maximum number of caries possible before
loss of the affected teeth due to related dental diseases (e.g., gingivitis, infection). Thus, as individuals age, caries incidence remains high, but the num-
ber of retained teeth (particularly those affected
with caries) decreases. This is reflected in the data
by a somewhat lower number of carious lesions per
mouth in older individuals.
Analysis based on percent of carious lesions using
a tooth-count method shows a high caries rate for
the Confederate veteran sample, as well as for the
nineteenth-century Canadian sample (Belleville;
Table 6). The per-tooth caries rate for Confederate
veterans, however, is lower than that of another
long-term care facility, the Oneida County asylum,
but higher than the Albany almshouse sample. This
discrepancy is probably due to differences in length
of residency at the various facilities. While the Confederate veterans lived in a government-run institution, most of them arrived when they were elderly
and therefore were not long-term (i.e., lifetime) residents of the home. In contrast, residents of the
Oneida County asylum usually arrived as young
adults and stayed until their deaths, while residents
of the Albany almshouse typically stayed for only a
few days or weeks after having fallen on hard times
(Phillips, 2001). The differences in caries rates in
these samples may also be related to economic factors and the availability of dental care, since the
TSC veterans probably had access to regular dental
care prior to their admittance into the home, while
individuals in the asylum did not (Phillips, 2001).
Although the per-mouth rates of carious lesions
are similar in the TSC and Fort Laurens samples,
the per-tooth caries rate for the two samples differs.
The per-tooth rate in the TSC sample (24.4% of
teeth) is higher than that cited for the Fort Laurens
sample (16.6%; Sledzik and Sandberg, 2002). Again,
this difference is probably related to the age-cumulative nature of both caries and AMTL (cf. Saunders
et al., 2002), i.e., the Confederate veterans had fewer
teeth per mouth, and were more likely to have caries
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
in their remaining teeth than the younger Fort Laurens individuals.
Dental fillings in the TSC sample were rare,
present in only 3.3% of carious teeth, and in only 8%
of the men. All four fillings were in the molars, and
only one was gold. During the Civil War, gold was
the most commonly used dental filling material, but
tin fillings were used when the lesion was especially
large (Dammann, 1984). Amalgams were a more
practical choice for Confederate soldiers, because
they were inexpensive and easy to insert. The material composing the three nongold fillings is unknown, but they may have been an amalgam, tin, or
even thorium, all materials known to have been
used to fill cavities during the Civil War era (Bollet,
2002; Glenner et al., 1996).
Sledzik and Moore-Jansen (1991) noted that of the
U.S. military samples they examined (i.e., samples
from the War of 1812, the Civil War, and the Indian
Wars), the only examples of dental fillings were observed in Civil War dentitions. They observed four
individuals out of 49 Civil War cases (8.2%) with
fillings, accounting for 1.5% of carious teeth (Sledzik
and Moore-Jansen, 1991, p. 218). The Weir family
cemetery, a wealthy Anglo-American family cemetery in Virginia dating between the 1830s and 1907,
had a high rate of dental fillings (9.6% of teeth,
38.9% of individuals; Little et al., 1992). Over 50% of
the carious lesions observed in that sample were
filled with gold or gold and an amalgam (Little et al.,
1992, p. 407). In the Belleville sample, dating from
1821–1874, 18 of 229 adults (7.9%) had dental restorations (Saunders et al., 1997, p. 80), but it is
unclear what percentage of carious teeth was filled.
At the Oneida asylum, 5 of 285 carious teeth (1.8%)
had drilled holes; four of these were gold-filled, while
the material used to fill the fifth could not be determined (Phillips, 2001, p. 91). These five fillings came
from three individuals, for a sample rate of 2.9% (3
of 102 people; Phillips, 2001, p. 105). Phillips (2001)
suggested that the presence of gold fillings in the
Oneida sample was due to dental care received prior
to institutionalization, and that they may have reflected the socioeconomic status of some of the residents and their families. The Albany almshouse
sample had no evidence of dental care (Phillips,
2001, p. 91). Regardless of time period, when comparisons are made among the historical samples,
they are consistent in terms of dental fillings, with
the exception of the wealthy Weir family. In general,
it appears that relatively few people during the
nineteenth century were able to afford fillings, or
perhaps any dental care at all.
Compared to a military sample from Colonial-period Fort Laurens, the rate of abscesses at the TSC
is lower. For example, elderly Confederate veterans
had 0.38 abscesses per mouth vs. 1.7 abscesses per
mouth among a sample of young soldiers from Fort
Laurens (Sciulli and Gramly, 1989). However, this
pattern does not hold true when the Confederate
veterans are compared to other military samples,
65
based on percent of tooth type affected (Table 5). In
general, the rate of abscesses in the maxillary dentition is lower in the older Confederate veterans,
especially when compared to soldiers killed during
the Indian Wars. Rates of mandibular abscesses observed in the Confederate veterans are very similar
to rates observed in samples of much younger males
killed in the Civil War, the War of 1812, and the
Indian Wars (Sledzik and Moore-Jansen, 1991). In
addition, the rate of abscesses per mouth seen in the
Confederate veterans is lower than that observed in
the skeletal sample of white males from the Colonial
to Civil War period (1.9 abscesses per mouth; Angel,
1976). The seemingly lower rate of alveolar abscessing observed in the elderly Confederate sample may
be the result of healing to the bone after an abscessed tooth had been extracted. Conversely, it may
be the result of dental treatment in the form of
extractions that occurred prior to infection of the
pulp chamber and resultant bone loss.
Table 5 displays AMTL rates by tooth type for
Confederate veterans at the TSC and young nineteenth-century U.S. military men who were killed
during the Battle of Snake Hill, the Indian Wars, or
the Civil War. As expected, the AMTL rate is significantly higher in the Confederate veterans than in
the soldiers killed in battle (Sledzik and MooreJansen, 1991). Similarly, compared to rates of tooth
loss recorded in other archaeological samples, the
overall AMTL rate of Confederate veterans at the
TSC is much higher (AMTL of 14.6 teeth per mouth,
or 57.2% of teeth; Table 7). Notably, the next highest
AMTL rate (23.6% by tooth count) was documented
in Belleville population, the sample with the next
oldest age at death (42.5 years; Saunders et al.,
1997).
Much of the difference between the AMTL seen in
the TSC sample vs. the others is probably explained
by the markedly disparate age at death (see Table
2). Average age at death for these comparative samples ranged from 23.5 years (Fort Laurens and Glorieta Pass; Sciulli and Gramly, 1989; Sledzik and
Sandberg, 2002) to 42.5 years for Belleville (Saunders et al., 1997), as compared to 76.7 years for the
TSC sample.
Comparison with modern samples
The rate of dental caries in modern elderly samples is higher than that seen in the Confederate
veterans from the TSC. Although 84.6% of dentate
Confederate veterans had caries, a modern, living
sample from Department of Veteran Affairs nursing
home care units showed a higher caries rate of 93%
(Weyant et al., 1993). Another study of institutionalized elderly documented a caries rate of 90% (Vigild, 1989, p. 104). In addition, 95% of a sample of
noninstitutionalized seniors from Florida had at
least one carious lesion (Heft and Gilbert, 1991).
This difference may be related to the fact that modern elderly people have a higher number of teeth per
mouth than the Confederate veterans (described
66
H.D. WOLS AND J.E. BAKER
TABLE 7. Comparison of AMTL rates among historical archaeological samples
Sample
TSC
Fort Laurens
Belleville4
Belleview Plantation5
Colonial to Civil War6
Little Bighorn3
Glorieta Pass3
Snake Hill3
Average number of
teeth lost per mouth
Percent of teeth lost
(tooth count method)
Average age
at death
14.61
0.91,2
6.65
8.01
6.91
57.21
4.11,3
23.6
76.71
23.51,2
42.5
30.3
39.61
27.41
23.51
21.61
7.31
2.21
8.81
1
Males only.
Scuilli and Gramly, 1989.
3
Sledzik and Sandberg, 2002.
4
Saunders et al., 1997.
5
Rathbun and Scurry, 1991.
6
Angel, 1976.
2
later in text), as well as modern populations’ increasing intake of sugar and highly processed foods
(cf. Saunders et al., 2002). However, some of the
factors resulting in high dental caries in modern
samples were probably also issues for Confederate
veterans. For example, high caries rates and poor
dental health in general may be due to physical and
mental disabilities, financial limitations, and lack of
access to prior dental care (Kambhu et al., 1996;
Vigild, 1989).
While AMTL is higher at the TSC compared to
archaeological samples, this trend is not maintained
when the Confederate Home sample is compared to
modern samples in terms of rates of edentulism. For
example, the rate of edentulism at the TSC (22% of
individuals) is lower than that documented at longterm care facilities of modern veterans (51.1%; Weyant et al., 1993). This sample, composed primarily of
white males whose average age at death is 71.8
years, is demographically more similar to the TSC
sample than any of the others. Another study of
long-term care veterans documented an edentulism
rate of 37% of individuals (Niessen and Weyant,
1989). Even noninstitutionalized modern samples
have higher rates of edentulism than observed at
the TSC. A survey of tooth loss in the elderly showed
that 41% of modern patients are edentulous (Marcus
et al., 1994). Edentulism rates in a rural Iowan
sample (38.1%, males only; Hunt et al., 1985) and a
Florida sample (28%, males only; Heft and Gilbert,
1991) are also higher than observed at the TSC.
However, when the mean number of teeth per
mouth is compared, rather than edentulism rates,
modern samples of seniors exhibit a higher number
of teeth per mouth, regardless of whether the people
are institutionalized or not. One of the institutionalized comparative samples averaged 16.9 teeth per
mouth (Niessen and Weyant, 1989), higher than the
TSC’s rate of 10.9. The survey of seniors by Marcus
et al. (1994) documented an average of 17.2 remaining teeth per mouth, while the study by Heft and
Gilbert (1991) of Floridians showed an average of
17.0 teeth remaining.
These disparities are almost certainly due to advances in and the relative affordability and availability of dental care in modern populations. Modern
veterans generally have access to free or nearly free
dental care. This may be one reason for the higher
rate of edentulism in modern veterans; since they
would have a higher degree of access to dentures as
a form of dental treatment (although notably, several sets of dentures were recovered from the TSC),
professional extractions may have contributed to the
discrepancy between modern and Confederate veterans. In modern cases, dental extraction is sometimes suggested for problem teeth over “tooth-saving” options, especially when dealing with the
institutionalized elderly (Kambhu et al., 1996, p.
23). At the same time, increased access to preventive
dental care may account for the higher number of
teeth per mouth for the modern elderly samples.
That is, modern elderly people who do not undergo
extractions for the purpose of fitting dentures are
more likely to retain more teeth than their early
twentieth century counterparts, simply because of
contemporary dental practices (e.g., toothbrushes,
fluoridated water).
Diet, hygiene, and dental care in the Civil War
through Postreconstruction eras
The TSC Confederate veterans’ lives encompassed
a relatively long period: the earliest date of birth
was 1814, and the latest date of death was 1932
(Dockall et al., 1996, p. 53–56). These were turbulent years in the United States, with numerous political, economic, social, and scientific changes. It is
difficult to say how much influence any of these
factors had on the health of these men, or which
period of an individual’s life was the most important
to his dental welfare. Below, particular emphasis is
placed on Civil War-era and turn-of-the century lifestyles. Although the Civil War lasted only a few
years (a relatively short period in the lives of these
elderly veterans), service during the war was an
experience common to all of them; therefore, it is
important to discuss the quality of life during this
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
period and its potential impact on dental health.
Another common life experience among all but five
of the veterans was residency at the CHM. According to Confederate Home, burial, and pension
records, the men in this study served in Army units
from many states, including Alabama, Tennessee,
Arkansas, Georgia, South Carolina, Mississippi,
Missouri, Louisiana, and Virginia (Dockall et al.,
1996). They lived in different economic and geographic settings for some periods of time; the majority of them lived in the Confederate Home for various lengths of time (mostly at the turn of the
century).
Diet. During the first half of the nineteenth century, the Southern diet in general relied heavily on
pork and corn; these were supplemented by wild
game (Larkin, 1988; Silverthorne, 1986). Garden
plots of vegetables were common among Texas residents and added variety to their diet (Lowe and
Campbell, 1987). The early and mid-nineteenth century saw the addition of new key food crops to Texas
agriculture, including sweet potatoes, peas, beans,
potatoes, and rice (Campbell and Lowe, 1979; Larkin, 1988). Sugar and molasses were available to
some rural families in Texas during the first half of
the nineteenth century, as sugar cane was planted
in greater and greater quantities, peaking in the
early 1850s (Silverthorne, 1986). Importantly, Larkin (1988) noted that sugar consumption skyrocketed during the nineteenth century. While they had
been luxuries in the eighteenth century, refined
sugar and molasses became ubiquitous in the diet
(Silverthorne, 1986). White breads and other foods
made of white flour also became popular (Larkin,
1988).
During the Civil War, the soldiers’ diet varied
little. Confederate soldiers relied on salted meats
(pork, beef), in addition to cornmeal, rice, beans,
potatoes, and flour (Bollet, 2002; Chisolm, 1862;
Cunningham, 1958). Fresh vegetables were occasionally foraged, purchased, or taken as spoils of
war, and canned or tinned vegetables and fruits
sometimes made their way to field hospitals (Adams,
1952; Bollet, 2002; Cunningham, 1958). Generally
speaking, the wartime diet relied heavily on carbohydrate-laden foods.
Due to the poor diet consumed by most soldiers,
scurvy was an ailment commonly seen by field surgeons (Bollet, 2002; Cunningham, 1958). Civil War
physicians were aware that scurvy caused tenderness and bleeding of the gums (with the latter contributing to tooth loss), night blindness, lethargy,
and muscle and joint pain, and that it contributed to
infections and mortality rates (Bollet, 2002). Signs
of the condition usually arose after 2–3 months without vitamin C-rich foods (Bollet, 2002). Desiccated
vegetables were provided to the soldiers expressly
for their antiscorbutic properties; however, soldiers
typically prepared them by boiling them extensively,
probably destroying most of the vitamin C in the
67
process (Bollet, 2002). Although Confederate surgeons called for the addition of lime and lemon juice,
fresh fruits, onions, sorghum, wine, and other vitamin C-rich foods to the soldiers’ rations, scurvy became more common toward the end of the war
(Bollet, 2002; Chisolm, 1862; Cunningham, 1958).
Interestingly, a geographic shift in diet occurred
during the nineteenth century. In the early 1800s,
rural populations were more well-nourished, due to
their greater access to fresh foods. As the century
wore on, industry and transportation made commercial products more widely available and increased
urban access to fresh fruits and vegetables (Ross,
1993; cf. Saunders et al., 2002). Urban dwellers
gained access to a wider variety of foods (Ross,
1993). This may have been a particularly important
shift to the residents of the CHM, since 25 (50%) of
these men listed their occupation as farmer,
rancher, cattleman, or stockman (Dockall et al.,
1996). This information implies a geographic move
from rural areas during their younger days to an
urban center (Austin, TX) in their later years, when
they resided at the CHM. Presumably, a dietary
change would have accompanied this geographical
relocation. However, given the shift toward urban
dwellers having a wider availability of food products, the impact of the move from rural to urban
settings may have been mitigated. In turn-of-thecentury Austin, a wide variety of foods would have
been available to residents of the city. An examination of the 1905 city directory reveals no fewer than
139 grocers, 30 meat markets, 25 dairies, 15 confectioners and fruit dealers, and 2 fish and oyster suppliers.
While it might seem logical to assume that the
variety of foods available to the veterans living at
the CHM was limited due to state budgetary restrictions, there is some evidence to the contrary. In a
letter written by Barton (1971) concerning his visits
to the home between 1898 –1912, he noted that a
variety of foods were served to the residents. He
found the fruit served during meals particularly remarkable, since he wrote, “At home we had those
fruits only at Xmas [sic].” For those residents with
spending money, a concession stand at the Confederate Home offered soda water, confections, and tobacco products (Yearbook for Texas, 1901). Archival
evidence for special events at the home also suggests
a high-quality diet for the residents. For example, a
notice in the Austin Evening News in April of 1894
made special note of a beef and mutton barbecue to
be held for “the special benefit of the inmates of the
home.”
Impact of diet on dental health. The ever-increasing reliance on refined flours and sugars undoubtedly had an effect on dental calculus and the
caries rate among the veterans from the TSC. These
dental ailments would have contributed greatly to
AMTL, either through loss of teeth due to damaged
68
H.D. WOLS AND J.E. BAKER
tissues or through dental extraction as a form of
health intervention.
However, calculus and caries are not the only
causes of AMTL; other factors, such as trauma, infection, and vitamin insufficiencies, may have
played a role. For example, one of the consequences
of scurvy is tooth loss (Ortner and Putschar, 1985).
Scurvy contributes to AMTL through the weakening
of connective tissues, due to bleeding and inflammation. Single-rooted (i.e., anterior) teeth are particularly likely to be lost (Ortner and Putschar, 1985).
The impact of scurvy on AMTL in the Civil War
veterans described here is difficult to determine, in
part because medical records specific to the Confederate military are practically nonexistent. While
scurvy was reportedly common during the war
(Bollet, 2002; Chisolm, 1862; Cunningham, 1958),
few subperiosteal hematomas were found in the TSC
sample, and cribra orbitalia (now thought in some
cases to be the result of scurvy; Ortner et al., 1999)
was limited to two men. However, the potential role
of scurvy in AMTL cannot be ignored, particularly in
edentulous individuals.
It seems likely that dental calculus and caries had
a greater influence on AMTL among these men than
scurvy. Diets high in sugars, carbohydrates, and
milk proteins provide optimal nutrition for plaque
bacteria, so high-carbohydrate diets such as those
described above can contribute to dense deposits of
plaque, which can further mineralize into calculus
(Hillson, 1996). If these deposits are not removed
through brushing or other mechanical methods as
described below, they can lead to other dental diseases. The Confederate veterans of the TSC displayed numerous examples of calculus; of 39 men for
whom this could be assessed, only eight (20.5%)
showed no or minor calculus deposits. The rest of the
men had teeth with either coalescent or three-dimensional calculus deposits (Dockall, 1996a).
Interestingly, Leigh (1925; cited in Hillson, 1996,
p. 267) found that populations relying on diets high
in corn (such as the Southern diet described above)
had the most significant rates of alveolar bone loss.
While periodontal disease and bone loss are in part
related to carbohydrate consumption, sugar seems
to the primary factor in the development of caries
(Hillson, 1996, p. 282). The increasing availability
and consumption of refined sugar seen during the
nineteenth century may have contributed to the
high number of carious lesions seen in this sample.
Hygiene. While toothbrushes and tooth powders
were sold in country stores as early as 1820, few
people apparently used them. While some people
brushed their teeth regularly, many more did not,
leading to a picture of “[h]undreds of thousands of
Americans [with] at least some of their teeth badly
rotted, a source of chronic pain and foul breath to
many” (Larkin, 1988, p. 92). In the first half of the
nineteenth century, almanacs and etiquette manuals issued careful instructions about proper tooth-
brushing while proclaiming the importance of the
practice, with the implicit assumption that most
readers were not in the habit of doing so (Larkin,
1988). Furthermore, modern fluoride treatments, as
administered in a dentist’s office and as delivered in
city water supplies, did not exist until the latter half
of the twentieth century (Ring, 1985; Shafer et al.,
1983).
Hygiene, as well as diet, suffered in camps during
the Civil War. Chisolm (1862) stated that all soldiers
should carry a toothbrush; however, given that soldiers were often not required to wash their faces
(even in stricter training camps; Adams, 1952), it
would be surprising to learn that dental hygiene was
superlative. For example, Cunningham (1958) described the poor dental health of the soldiers, and
noted that toothbrushes were not commonly owned
by the rank and file.
Impact of hygiene on dental health. The idea
that inadequate dental hygiene results in poor dental health is widely accepted among many modern
industrialized populations. However, during the
nineteenth century, this idea was new to many people. Dental hygiene, in the form of daily tooth brushing, may have been viewed by many as an eccentricity or an indulgence (Larkin, 1988, p. 93). Poor oral
hygiene may cause a number of dental disorders.
For example, subgingival plaque deposits may arise
in individuals with poor dental hygiene, inflaming
the gingiva and subsequently leading to periodontal
disease (Hillson, 1996). Bone loss may result from
repeated episodes of periodontitis, and loss of the
tooth may eventually occur (Hillson, 1996). The aftermath of poor dental hygiene was seen among the
veterans in the TSC sample to varying degrees, in
the form of dental calculus, caries, abscesses, and
AMTL. At least theoretically, modern additions to
the dentists’ arsenal (such as fluoride and regular
toothbrushing) may have contributed to some of the
discrepancies between this study and studies of
modern veterans.
Dental care. Preventive dentistry, aside from the
toothbrush and tooth powder, consisted of the use of
scalers or dental picks to remove dental calculus
from the tooth surfaces (Dammann, 1988). Most
dentistry at the time focused on reactive solutions to
troublesome teeth (e.g., extractions, fillings, or dentures). Prior to the Civil War, dental extraction was,
in practice, the only solution for decaying teeth (Larkin, 1988). Extractions were accomplished using extraction keys during the early stages of the war, and
forceps in the later part. In contrast to the pulling
motion used with forceps, extraction elevators were
sometimes used to pry teeth out of the alveolus. A
special tool known as a screw elevator was employed
after attempts at extraction failed to remove the
roots along with the crown; this typically occurred
when the extraction key was used. These tools were
literally screwed into the roots of the tooth and used
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
to lift the broken roots out of the alveolus (Dammann, 1988). Roots left by incomplete tooth extractions, reportedly a common occurrence, could cause
infections and other dental problems, such as abscesses (Bollet, 2002).
Restorations or dental fillings were made using tin
or gold foil. Using excavators and finger drills, the
soft carious part of the tooth was scraped out, and
the margins were excavated to prepare the tooth for
the filling. Small pieces of foil were then firmly
pressed into the tooth with a plugger, layer by layer,
until the cavity was filled. Once this was accomplished, small files and other burnishing tools were
used to smooth the restoration (Dammann, 1988).
During the mid-nineteenth century, full or partial
dentures were available to those requiring them.
From 1855 to the 1930s, vulcanized rubber was the
best denture material produced, and was the primary material used in their manufacture (Bollet,
2002; Peyton, 1975). It was relatively inexpensive
and easy to mold, and so became the standard in
denture manufacture (Hagman, 1979; Peyton,
1975). While this material was the best available,
there were some disadvantages to it, such as an
inadequate aesthetic quality and varying color,
taste, and odor (Peyton, 1975).
Some 500 dentists were living in the Confederate
States at the time of the war. A regular dental corps
was never created in the Confederate Army, although dentists were conscripted and served in Confederate hospitals (Bollet, 2002; Cunningham,
1958). Their primary duties included fillings, extractions, the removal of calculus, and treatment of facial injuries. Gold fillings and even dentures were
available for an often-astronomical price. Vulcanized rubber or gold-based upper dentures, for example, sold for $1,800 –$4,000 during the war (Cunningham, 1958). Dental extractions, while still
costly, were more economically feasible than dental
fillings: “the cost of dental operations was more than
the average soldier could pay. The charge for a gold
filling, as currency inflation sets in, was $120 —more
than 6 months’ pay of a private. At the same time
dentists charged $20 to extract a tooth” (Cunningham, 1958, p. 243). These prohibitive costs almost
certainly contributed to poor dental health, particularly among soldiers from families of modest means.
Impact of dentistry on dental health. Glenner
et al. (1996, p. 1676) noted that, “During the war,
Confederate soldiers were in dire need of dental care
because most had been in the service for several
years without having had a dental examination.
This neglect, coupled with improper diet and lack of
toothbrushes, accelerated tooth loss.” The AMTL
rate observed in the Confederate veteran sample can
be partially explained by the statement of Glenner
et al. (1996), but is compounded by loss associated
with aging and increases in caries and alveolar resorption. Many problematic teeth may have been
extracted rather than resorting to other, more costly
69
dental options. One modern study demonstrated
that people of limited financial needs were more
likely to have teeth extracted, and that “many teeth
may have been candidates for extraction . . . due to a
belief in the inevitability of disease progression, especially in elderly or medically compromised populations who exhibited low utilization of dental services” (Niessen and Weyant, 1989, p. 21). It is
possible that this practice was in effect at the CHM
in early twentieth-century Austin, as well as before
the men even entered the home.
Generally speaking, dentistry as it was practiced
in the nineteenth and early twentieth centuries was
limited to a number of procedures that were regularly performed. Given the relative lack of preventative care at home, most of these procedures were
reactive rather than proactive, and dealt with existing problems such as caries. While there was some
direct evidence of dental care (e.g., dentures, fillings)
among the Confederate veterans in this sample,
there was also indirect evidence for one of the most
common procedures: extractions. In one individual,
the crown of the fourth premolar was broken off,
leaving the roots in situ (Dockall and Baker, 1996).
The appearance of this tooth resembled the description by Dammann (1984) of root breakage occurring
with the use of an extraction key, and brings to mind
the assertion by Bollet (2002) that the roots were
often left behind following extraction attempts.
Additionally, the presence of dentures suggests
deliberate extraction of teeth; even today, older people with few teeth or with diseased dental tissues
(e.g., carious or badly fractured teeth, or severe periodontal disease) may have their remaining teeth
pulled in order to facilitate the fitting of dentures. In
fact, this deliberate extraction of teeth to allow for
the fitting of dentures and other modern dental appliances may contribute to discrepancies in edentulism between modern veterans (e.g., Niessen and
Weyant, 1989; Weyant et al., 1993) and the Civil
War veterans in this sample. Although rates of
AMTL and edentulism were high among the Confederate veterans excavated from the TSC, only
three men had dentures, manufactured from vulcanized rubber and porcelain. Modern veterans may
have greater access to professional dentistry and
intervention (in the form of extraction and replacement of teeth with various appliances) than did
their predecessors.
Finally, the high rate of AMTL in the TSC sample
may suggest dental intervention in the form of extraction; given the apparent availability of professional dental extractions (performed by dentists,
country doctors, barbers, and others), the assumption that at least some of these teeth were extracted
(rather than lost due to progression of dental disease) is reasonable.
While several sets of dentures were recovered in
this sample, these may not be representative of the
number of individuals who actually wore dentures
in life. Since dentures were recovered with three
70
H.D. WOLS AND J.E. BAKER
Confederate veterans, the practice of burying people
with their dental appliances was obviously not unheard of. Iserson (1994) noted that modern embalmers replace dentures in the mouth during the restoration process in order to retain a natural-looking
mouth. However, it is not clear if this was a standard mortuary practice at the turn of the century,
when most of these men were buried. If this was not
the standard, the number of dentures recovered at
the TSC may not be representative of the number of
individuals who wore them in life.
Wealth may have played a larger role in the use
and subsequent recovery of dentures; one of the men
with dentures was an attorney, one was a judge, and
one was a salesman. Furthermore, two of these men
did not die while in the CHM, and they were interred in a separate section of the cemetery. The
style of their headstones, the casket hardware, and
personal effects recovered during excavation indicate relatively greater wealth. The other set of dentures belonged to a man who had been buried by the
CHM using state funds (Dockall, 1996b). This pattern of wealthy denture-wearers fits the picture of
financially based access to dental care painted by
Cunningham (1958) and others.
CONCLUSIONS
This study provided a unique opportunity to assess dental health in the elderly from a historical
perspective, and demonstrated that the issues affecting dental health are complex, involving aspects
of age, diet, hygiene, access to dental care, environment, and socioeconomic status. This analysis illustrated the age-cumulative nature of many dental
diseases and the confounding effects of AMTL. In
general, as people age, their dental health worsens,
requiring more care. In particular, this study verified that AMTL is a sequela of old age. Further, this
study confirmed the significance of the complex interaction between dental disease and AMTL when
examining samples composed of older individuals,
especially because AMTL can play a role in the
apparent frequencies of dental diseases.
In general, the TSC sample was dissimilar from
archaeological samples of institutionalized and noninstitutionalized populations. Much of this dissimilarity may be due to the significantly older age at
death of the Confederate veterans from the TSC
when compared to archaeological samples drawn
from military and institutionalized populations. Any
similarities that existed between these historical
samples in terms of dental health may well be
masked by the elderly age of the men described here.
Discrepancies in dental health were also apparent
when the TSC population was compared to modern
elderly populations (both institutionalized and noninstitutionalized), presumably because of historical
differences in diet, the availability and accessibility
of dental care, and advances in dentistry.
From a historical perspective, socioeconomic and
historic factors appear to have influenced the dental
health of the individuals comprising the TSC sample. Improvements in transportation and the introduction of certain crops into new areas made refined
sugars, white flour, and other carbohydrate-laden
foods more widely available. Some modern methods
of maintaining dental hygiene were available during
the nineteenth and early twentieth centuries, but
were not widely used. We found little evidence that
these Confederate veterans from the TSC were receiving adequate dental care, although, as mentioned earlier, the rate of dental extraction is unknown. Dental fillings and dentures demonstrate
that some degree of professional dentistry was available to these men, though on a limited basis. Individuals with dental appliances and fillings were
clearly in the minority in the TSC sample, and may
have represented people of higher socioeconomic status.
Hopefully, future studies will focus on similar issues in archaeological noninstitutionalized elderly
people or on geriatric samples derived from late 19th
or early 20th century anatomical collections. For
example, analyses of modern samples documented a
trend such that the dental health of the institutionalized elderly tends to be worse than that of the
independent elderly, especially in terms of higher
rates of tooth loss and caries. So far, an archaeological sample with a similar demographic composition
to the Confederate veterans described here, but composed of people who were not wards of the state, is
unavailable for comparison to see if this holds true of
past populations as well. Such studies may provide
further insights into the causes and effects of dental
disease in elderly people.
ACKNOWLEDGMENTS
We are grateful to have had the opportunity to
participate in this research, which resulted from a
cemetery restoration project jointly managed by
Emily Little Architects, the Texas General Services
Commission, and the Texas Parks and Wildlife Department. Prewitt and Associates, Inc. (PAI), was
responsible for the bioarchaeological and archaeological efforts undertaken as part of the renovations.
We extend our sincere gratitude to PAI for their
intellectual and financial support. Douglas K. Boyd
of PAI was especially generous with his time and
energy; his enthusiasm for this project was endless.
Brenda Baker, Gregory Berg, and James Pokines
read and made valuable suggestions on several earlier drafts of this paper. We are most grateful to four
anonymous reviewers and to Clark Spencer Larsen,
whose helpful comments significantly improved the
flow of this paper.
LITERATURE CITED
Adams GW. 1952. Doctors in blue: the medical history of the
Union Army in the Civil War. New York: Henry Schuman.
Angel JL. 1976. Colonial to modern skeletal change in the U.S.A.
Am J Phys Anthropol 45:723–736.
Banting DW. 1973. Dental care in long-term hospitals. Can Hosp
50:49 –51.
DENTAL HEALTH OF ELDERLY CONFEDERATE VETERANS
Barkley MS. 1963. History of Travis County and Austin, 1839 –
1899. Austin: Austin Printing Co.
Barton RC. 1971. Transcript of letter on file (C6400), dated January 18, written in Buda, Texas. Austin, TX: Austin History
Center.
Bollet JB. 2002. Civil War medicine: challenges and triumphs.
Tucson: Galen Press, Ltd.
Buikstra JE, Ubelaker DH, editors. 1994. Standards for data
collection from human skeletal remains. Research series no. 44.
Fayetteville: Arkansas Archeological Survey.
Campbell RB, Lowe RG. 1979. Some economic aspects of antebellum Texas agriculture. Southwest Hist Q 82:351–378.
Chisolm JJ. 1862. A manual of military surgery, for the use of
surgeons in the Confederate States Army, with an appendix of
the rules and regulations of the Medical Department of the
Confederate States Army, 2nd ed. Richmond, VA: West and
Johnson.
Cunningham HH. 1958. Doctors in gray: the Confederate medical
service. Baton Rouge: Louisiana State University Press.
Dammann GE. 1984. Dental care during the Civil War. Ill Dent J
53:12–17.
Dammann GE. 1988. A pictorial encyclopedia of Civil War medical instruments and equipment, volume II. Missoula, MT:
Pictorial Histories Publishing Co.
Dockall HD. 1996a. Appendix G. In: Dockall HD, Boyd DK, Freeman MD, Garza RL, Stork KE, Kibler KW, Baker JE, editors.
Confederate veterans at rest: archeological and bioarcheological investigations at the Texas State Cemetery, Travis County,
Texas. Reports of investigations, number 107. Austin: Prewitt
and Associates, Inc. p 309 –327.
Dockall HD. 1996b. Analysis of material culture. In: Dockall HD,
Boyd DK, Freeman MD, Garza RL, Stork KE, Kibler KW,
Baker JE. Confederate veterans at rest: archeological and bioarcheological investigations at the Texas State Cemetery, Travis County, Texas. Reports of investigations, number 107. Austin: Prewitt and Associates, Inc. p 123–172.
Dockall HD, Baker JE. 1996. Analysis of osteological remains. In:
Dockall HD, Boyd DK, Freeman MD, Garza RL, Stork KE,
Kibler KW, Baker JE. Confederate veterans at rest: archeological and bioarcheological investigations at the Texas State
Cemetery, Travis County, Texas. Reports of investigations,
number 107. Austin: Prewitt and Associates, Inc. p 23–31.
Dockall HD, Boyd DK, Freeman MD, Garza RL, Stork KE, Kibler
KW, Baker JE. 1996. Confederate veterans at rest: archeological and bioarcheological investigations at the Texas State
Cemetery, Travis County, Texas. Reports of investigations,
number 107. Austin: Prewitt and Associates, Inc.
Garcia RI. 1995. Geriatric dentistry. In: Reichel W, editor. Care of
the elderly: clinical aspects of aging, 4th ed. Baltimore: William
and Wilkins.
Gautier GR. 1902. Harder than death—the life of Geo. R. Gautier,
an old Texan, living at the Confederate Home, Austin. Privately published.
Glenner RA, Willey P, Sledzik PS, Junger EP. 1996. Dental
fillings in Civil War skulls: what do they tell us? J Am Dent
Assoc 127:1671–1677.
Goodman AH, Rose JC. 1990. Assessment of systemic physiological perturbations from dental enamel hypoplasias and associated histological structures. Yrbk Phys Anthropol 33:59 –110.
Goodman AH, Martin DL, Armelagos GJ, Clark G. 1984. Indications of stress from bone and teeth. In: Cohen MN, Armelagos
GJ, editors. Paleopathology and the origins of agriculture. New
York: Academic Press. p 13– 49.
Hagman HC. 1979. The history of dentures, part II. Dent Lab Rev
54:22–26.
Heft MW, Gilbert GH. 1991. Tooth loss and caries prevalence in
older Floridians attending senior activity centers. Community
Dent Oral Epidemiol 19:228 –232.
Hillson S. 1996. Dental anthropology. Cambridge: Cambridge
University Press.
Hunt RJ, Beck JD, Lemke JH, Kohout FJ, Wallace RB. 1985.
Edentulism and oral health problems among elderly rural Iowans: the Iowa 65⫹ Rural Health Study. Am J Public Health
75:1177–1181.
71
Iserson KV. 1994. Death to dust: what happens to dead bodies?
Tucson: Galen Press, Ltd.
Kambhu PP, Warren JJ, Hand JS, Levy SM, Cowen HJ. 1996.
Medical and functional status changes among nursing facility
residents: implications for dentistry. Spec Care Dent 16:22–25.
Kelley MA, Levesque DR, Weidl E. 1991. Contrasting patterns of
dental disease in five early northern Chilean groups. In: Kelley
MA, Larsen CS, editors. Advances in dental anthropology. New
York: Wiley-Liss, Inc. p 203–213.
Lanphear KM. 1988. Health and mortality in a nineteenth century poorhouse skeletal sample. Ph.D. dissertation, University
at Albany, State University of New York. UMI order #8813594,
Ann Arbor, Michigan. Ann Arbor: University of Michigan.
Larkin J. 1988. The reshaping of everyday life, 1790 –1840. New
York: Harper and Row.
Larsen CS. 1997. Bioarchaeology: interpreting behavior from the
human skeleton. Cambridge: Cambridge University Press.
Leigh RW. 1925. Dental pathology of Indian tribes of varied
environmental and food conditions. Am J Phys Anthropol
8:179 –199.
Little BJ, Lanphear KM, Owsley DW. 1992. Mortuary display
and status in a nineteenth century Anglo-American cemetery
in Manassas, Virginia. Am Antiq 57:397– 418.
Loesche WJ, Abrams J, Terpenning MS, Bretz WA, Dominguez
BL, Grossman NS, Hildebrandt GH, Langmore SE, Lopatin
DE. 1995. Dental findings in geriatric populations with diverse
medical backgrounds. Oral Surg Oral Med Oral Path Oral
Radiol Endod 80:43–54.
Lowe RG, Campbell RB. 1987. Planters and plain folk: agriculture in antebellum Texas. Dallas: Southern Methodist University Press.
Lukacs JR. 1989. Dental paleopathology: Methods for reconstructing dietary patterns. In: Iscan MY, Kennedy KAR, editors. Reconstruction of life from the skeleton. New York: Alan
R. Liss. p 261–286.
Marcus SE, Kaste LM, Brown LJ. 1994. Prevalence and demographic correlates of tooth loss among the elderly in the United
States. Spec Care Dent 14:123–127.
Niessen LC, Weyant RJ. 1989. Causes of tooth loss in a veteran
population. J Public Health Dent 49:19 –23.
Ortner DJ, Putschar WGJ. 1985. Identification of pathological
conditions in human skeletal remains. Smithsonian contributions to anthropology 28. Washington, DC: Smithsonian Institution.
Ortner DJ, Kimmerlee EH, Diez M. 1999. Probable evidence of
scurvy in subadults from archaeological sites in Peru. Amer J
Phys Anthropol 108:321–331.
Peyton FA. 1975. History of resins in dentistry. Dent Clin North
Am 19:211–222.
Phillips SM. 2001. Inmate life in the Oneida County asylum,
1860 –1895: a biocultural study of the skeletal and documentary records. Ph.D. dissertation, University at Albany, State
University of New York. UMI order #3012357, Ann Arbor,
Michigan. Ann Arbor: University of Michigan.
Powell ML. 1985. The analysis of dental wear and caries for
dietary reconstruction. In: Gilbert RI, Mielke JH, editors. The
analysis of prehistoric diets. New York: Academic Press. p
307–338.
Rathbun TA, Scurry JD. 1991. Status and health in Colonial
South Carolina: Belleview Plantation, 1738 –1756. In: Powell
ML, Bridges PS, Mires AMW, editors. What mean these bones?
Studies in southeastern bioarchaeology. Tuscaloosa: University
of Alabama Press. p 148 –164.
Ring ME. 1985. Dentistry: an illustrated history. New York:
Abradale Press.
Rose JC, Burnett BA, Nassaney MS, Blauer MW. 1984. Paleopathology and the origins of maize agriculture in the Lower Mississippi Valley and Caddoan culture areas. In: Cohen MN,
Armelagos GJ, editors. Paleopathology and the origins of agriculture. New York: Academic Press. p 393– 424.
Ross A. 1993. Health and diet in 19th-century America: a food
historian’s point of view. Hist Archaeol 27:42–56.
72
H.D. WOLS AND J.E. BAKER
Saunders SR, DeVito C, Katzenberg MA. 1997. Dental caries in
nineteenth century Upper Canada. Am J Phys Anthropol 104:
71– 87.
Saunders SR, Herring A, Sawchuk L, Boyce G, Hoppa R, Klepp S.
2002. The health of the middle class: the St. Thomas’ Anglican
Church cemetery project. In: Steckel RH, Rose JC, editors. The
backbone of history: health and nutrition in the Western Hemisphere. Cambridge: Cambridge University Press. p 130 –161.
Sciulli PW, Gramly RM. 1989. Analysis of the Ft. Laurens, Ohio,
skeletal sample. Am J Phys Anthropol 80:11–24.
Shafer WG, Hine MK, Levy BM. 1983. A textbook of oral pathology. Philadelphia: W.B. Saunders Co.
Silverthorne E. 1986. Plantation life in Texas. College Station:
Texas A&M University Press.
Skinner M, Goodman AH. 1992. Anthropological uses of developmental defects of enamel. In: Saunders SR, Katzenberg MA,
editors. Skeletal biology of past peoples: research methods.
New York: Wiley-Liss. p 153–174.
Sledzik PS, Moore-Jansen PH. 1991. Dental disease in nineteenth century military skeletal samples. In: Kelley MA,
Larsen CS, editors. Advances in dental anthropology. New
York: Wiley-Liss, Inc. p 215–224.
Sledzik PS, Sandberg LG. The effects of nineteenth century military service on health. In: Steckel RH, Rose JC, editors. The
backbone of history: health and nutrition in the western hemisphere. Cambridge: Cambridge University Press. p 185–207.
Sutter RC. 1995. Dental pathologies among inmates of the Monroe County poorhouse. In: Grauer AL, editor. Bodies of evidence: reconstructing history through skeletal analysis. New
York: Wiley-Liss. p 185–196.
Vigild M. 1989. Dental caries and the need for treatment among
the institutionalized elderly. Community Dent Oral Epidemiol
17:102–105.
Webb WP. 1952. The handbook of Texas, volume I. Austin: Texas
State Historical Association.
Weyant RJ, Jones JA, Hobbins M, Niessen LC, Adelson R, Rhyne
RR. 1993. Oral health status of a long-term care, veteran facility. Community Dent Oral Epidemiol 21:227–233.
Winchell F, Rose JC, Moir RW. 1995. Health and hard times: a
case study from the middle to late nineteenth century in eastern Texas. In: Grauer AL, editor. Bodies of evidence: reconstructing history through skeletal analysis. New York: WileyLiss. p 161–172.
Yearbook for Texas. 1901. The cactus. Volume VIII. Austin: Athletic Association, University of Texas.
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