Betelnut Chewing and Its Effects, Including Cancer of the Mouth

Medical literature contains many references to cancer of the mouth in betelnut chewers.This sequence of events is cited in illustration of malignant growth developing as a result of chronic irritation (injury) of tissue.Statements regarding this subject are based largely on observations made in India, Africa and some of the islands in the Pacific Ocean.The receipt in the pathological laboratory of Siriraj Hospital of specimens of cancer of the lip from persons using betelnut, suggested an investigation of this question in Siam where the habit is exceedingly prevalent.It was soon found that the scarcity of systematic records in this country makes an extended statistical study of cancer impossible, but, as in other countries, very much that cannot be reduced to exact figures may be learned.The subject was accord- ingly taken up in a somewhat broader way, and this promptly led to the realization that another of its phases is of more practical importance than is its relation to cancer.As a part of this study, I sent a questionnaire to twenty-five physicians, including those at the various Mission stations, and the replies thereto represent all parts of the kingdom.Much of the data contained in this paper was furnished by these colleagues, for whose aid I am very grateful.Except in the larger cities, nearly all adult Siamese chew betelnut.Exceptions in the cities occur among those who have been in foreign countries or who have attended advanced Siamese or foreign-taught schools.In some of the provinces there is said to be a decrease in the habit in the younger generation, but this is not in all instances clearly demonstrable ; in Bangkok it apparently is true.It is said that habitual users in the south chew much greater quantities than do those in northern Siam.Chewing is more nearly universal among women than among men and, in general, women chew more of the substance.Some of the large numbers of Chinese here are addicted but the majority are not ; among them, women chewers are less numerous than are men.Betelnut chewing, as practised here, is a very complex procedure.In making up what tobacco devotees call a "chew," people use many substances.Of these at least four are of recognized medicinal value, thus contributing to the medical feature of the subject.