VINCENT'S ANGINA\p=m-\STOMATITIS. and sensitive to heat and cold. Obscure cases some herpes labialis but not frequent. Impaired By John E. D.D.S., Brockton, Mass., Ganley, sense of taste both to foods and cigars, cigar- Attending Dental Surgeon, Brockton Hospital. ettes or pipe; patient, if a smoker, does not Acute ulcerative inflammation of mucous care to smoke. membrane of mouth and contiguous parts, i.e., Treatment Type I case : Dry off areas with cheek, tongue, palate, tonsils, pharynx, gingiva, cotton pellets. Apply 7% chromic acid and and lips. follow immediately with tincture benzoin com- The direct cause is ascribed to Vincent's fusi- pound. Apply both profusely, using separate form bacillus, associated with Vincent's spiro- dressing pliers for each agent; repeat treat- chetes. The various: modes of infection are pro- ment twice same day if possible. miscuous kissing, drinking from taps on Lyster Second day: General prophylaxis is given, bag by directly applying the mouth to tap, un- removing all calculus, all stains! and deposits. sterile drinking cups and glasses, drinking from Allow gums to bleed profusely. Rinse mouth comrade's canteen or cup, insufficient steriliza- with warm normal saline solution. Treat with tion of mess kits in wash water provided for 7% chromic acid and tincture benzoin com- the same, inability to perform proper mouth pound twice this day. hygiene due to environment, as life in trenches Third day: In the morning massage gums and in the field. with 15% solution argyrol, with vigorous mas- The contributing causes: the soldiers in the sage, inducing hyperemia; afternoon, chromic trenches or in the field are unable to care for acid and tincture benzoin compound. the mouth and teeth properly, food remnants Fourth day and thereon: Spray mouth with being retained in the interproximal spaces of copper sulphate 2% until gums heal and a nega- the teeth. The most active lesions are found tive slide is procured. around defective dental work, namely, defec- Type II : Headache, sore throat, anorexia, tive bridge work, crowns and fillings, mal- lassitude, gingiva, somewhat hyperaemie, bleeds erupted and impacted wisdom teeth. readily, palate and gingiva very sensitive to There are many types simulating syphilis hot and cold drinks and food, gingiva and pal- with herpes labialis. The character of the le- ate present characteristic bluish tinge. sion in Vincent's has irregular shaped margins, Treatment: First day administer a cathar- bleeds readily on pressure, has tendency to tic, preferably castor oil. Perform general ' ' ' ' granulate or scab ' over ; lesions are multi- prophylaxis, removing all calculus, stains and form. In syphilis characteristic single sore, not deposits with pointed orange wood sticks, work painful, has an indurated base and more pro- 5% phenol or 5% AgN03 in pockets and in- nounced. terproximal spaces under free margin of gum. The methods of diagnosis—Smears from gin- In the afternoon of same day apply chromic gival margins, cheeks, tonsils, lips, palate, etc. acid 7%, follow immediately with compound Stain—Carbo-fuchsin strong, three minutes, tincture benzoin. washed off with alcohol, then ready for exam- Second day: Apply chromic acid 7% and ination ; appears under a microscope a cigar- benzoin compound a.m. and p.m. shaped bacillus, sometimes striated, sometimes Third day: Copper sulphate 2%—spray non-striated ; spirochetes are slender organisms mouth. Continue daily until negative slide is consisting of six, eight, or ten spirals, almost obtained. invariably with bacillus. In cases where the Type III : Usually found in a fairly healthy lesions are located in the posterior portion of mouth. Patient as a rule practises some mouth the mouth it is well to "take the blood" for hygiene, gums very hyperemic, bleed easily; one or several Wassermanns as a great many palate very sensitive to heat and cold. Prophy- lesions closely resemble those of syphilis. laxis contraindicated. First day: Apply chromic acid and tinc- TYPES AND TREATMENT OP SAME. 7% ture benzoin compound a.m. and p.m. until sore- Type I. Symptoms—Headache, foul breath, ness is relieved, and then give general prophy- sore throat, anorexia and lassitude. Heavy, laxis. Spray mouth with normal saline solution. scummy deposits or films on gingiva. Saliva is Spray mouth with copper sulphate daily until very ropy, teeth and palate tender to pressure, lesions heal and a negative slide is procured.

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at THE CHINESE UNIVERSITY OF HONG KONG on July 3, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. Type IV: Lesions in definite localized area. Prof Edward 0. Otis was the first speaker. Patient complains of soreness in region or area. Dr. Otis, in his talk on tuberculosis, briefly Usually quite a healthy mouth. reviewed the history of the disease. He men- First day: Apply chromic acid 7%. Follow tioned the finding of the tubercular infection with compound tincture benzoin to gingiva and in the spine of a very old Egyptian skele- palate complete. ton. In the second century Galen described Second day: General prophylaxis. Swab findings which are now recognized as having mouth complete chromic acid 7% and follow a relation to tuberculosis. Nothing further of with compound tincture benzoin. note is recorded until the time of the so-called Third day: Remove stains of chromic acid anatomic period, when dissection became estab- and tincture benzoin compound and administer lished as a part of medical science. The tuber- daily vigorous massage with finger cot 15% cle was then noted as an abnormality in the argyrol until negative slide is procured. form of an inflammatory lesion. Linnet pro- claimed that all forms of tuberculosis were CONCLUSION. from a single type of infection. In 1865 Vel- Many patients present hypertrophied tonsils mar proved the disease to be communicable. with large crypts. After mouth has cleaned up Case of eye infection in a French tonsils should be if not, there is lia- hospital removed; proved to be tubercular. About this time bac- of recurrence, as it is almost impossible bility was on a scientific basis to in in teriology being placed destroy organisms remaining crypts and this form of research the bacillus tonsils. through was shown to be existent. In 1882 reports on Vincent's angina : Ludwig's angina : Differ- the subject were handed to the medical socie- ential diagnosis in floor of mouth. Cellulitis in ties. Koch made important contributions to neck in Vincent's and not in floor of mouth; the work of combating this disease, produced a also smears for Vincent's and Tem- streptococci. glycerin extract from cidtures of the; tubercle more marked in 103°-104°. perature Ludwig's bacillus,—Koch's lymph. Smith, investigator In the management of hundreds of cases, of the bovine type of the bacillus showed that both in the Army at Hospital No. 26, Camp this type was never transformed into the hu- St. France, and in civilian Aignau, practice, man type. The bovine bacillus affects chil- if the cases are classed according to types and dren, but not adults. In a series of experi- treated as such, i.e., to type, a nega- according ments it was found that 10 per cent, of the tive slide can be and a clean, procured healthy child subjects had been infected with the bovine mouth presented in four to seven One days. bacillus. Children seldom have infection of must have the hearty cooperation of patient in the ; it is confined mostly to the bones. In- abstinence from alcohol and tobacco lungs during fants die from lack of glandular treatment. I believe this treatment to be far resistance, infection involvement. Various attempts have more efficacious than méthylène blue, diarsenol, been made to produce a preventative of infec- arsphenamine, Fowler's solution; not poison- tion with but little results as long as the efforts ous in any degree, with mercuric I find cyanide, were directed against the infection itself. The the only other medicament of merit being a warnings issued from various sources were re- solution of diarsenol in ampules put up by sponsible for a special kind of phobia and Health Laboratory in Philadelphia, and the use served no useful purpose. Autopsies showed of same Dr. M. T. Barrett of Uni- suggested by 90 per cent, infectious evidence in children versity of Pennsylvania. and adults; not evidence of an active in- fectious process but proof of the individual's having received the infection at some time. Immunity in adults is early MASSACHUSETTS gained through THERAPEUTIC MAS- association successfully combated. The tuber- SAGE ASSOCIATION.* cular individual is dangerous only to children TUBERCULOSIS AND WEAK BACK. who have not had their infection. An English doctor forth a Meeting held at Hotel Brunswick April 15, put suggestion that it would be 1920. Dr. Douglas Graham presided. Twenty- well to feed all children with a sufficient amount of the bacteria to four were present. guard against hap- hazard infection to an *Reported by Mr. Thomas Burns of Caines Institute. and produce early im-

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at THE CHINESE UNIVERSITY OF HONG KONG on July 3, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.